References
Essex and Herts Air Ambulance: a focused case series for pre-hospital practice Case 3: a femoral shaft fracture
Abstract
The femur is the longest bone in the human body and is surrounded by a dense and vascular cylindrical sheath of soft tissue. Femoral fractures are often the result of high-energy traumatic injuries and result in pain, blood loss and immobility of the affected leg. General principles of acute management include analgesia, assessment of the patient for associated injuries and restoration of anatomical alignment of the leg. Assessment and documentation of the neurovascular function in the foot distal to the fracture is essential. Haemorrhage from a femoral fracture can be extensive, even more so if the fracture is open. Control of further blood loss and attention to the patient's cardiovascular status is mandatory.
We report the case of a 23-year-old woman who was involved in a pedestrian-versus-car incident and sustained an isolated right femoral fracture. Scene and patient assessment are discussed along with early management principles including analgesia and traction. We also discuss where an extended care service such as a Helicopter Emergency Medical Service (HEMS) may be of assistance
Essex and Herts Air Ambulance Trust (EHAAT) is a publically-funded charity that operates two doctor-paramedic pre-hospital care teams to provide support to land ambulance crews in two counties in the South East of England. The service is predominantly helicopter-based but operates a rapid response car outside daylight hours or in poor weather. The total population covered numbers approximately 1.8 million. The team responds to major trauma and medical emergencies, with the latter accounting for approximately 20% of all missions. The paramedics who work for the service are all employed by the East of England Ambulance Service NHS Trust, and are seconded to EHAAT for a period of 24 months. A comprehensive selection process is undertaken and an extensive training programme covering aviation practice and extended clinical management is in place for successful candidates. In addition, EHAAT paramedics have been among the first to enrol and undergo enhanced skill training in anaesthetics and intensive care medicine as part of a postgraduate certificate in advanced paramedic practice in critical care. We believe that one of the strengths of the service provided by EHAAT lies in our paramedics acting as role models and ambassadors for both our service and the ambulance service in general.
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