Baja Medical Emergency, Hooked in to Help

[DisabledExplorers]

If you ever have been in a serious backcountry medical situation then you know the feeling of intense pressure of having every ones eyes on you. Well now imagine taking it up a notch and being in another country, having young men with machine guns watching closely and a screaming nine year old girl just inches from your ears.

This was my recent experience in Baja Mexico when we were stopped at a Federal checkpoint outside of Gonzaga Bay. A fisherman I had met the day before was there and knew I was some sort of medical person, the young men with big guns in uniforms ask if we would help and out of a Toyota comes a young father and his nine year old daughter holding her wrist.
Being an Intensive Care Nurse I am often involved in life and death situations, chest compressions, shocking people, drugs, and more. Yet this all happens in the safety and security of a huge urban hospital with plenty of doctors, nurses, respiratory therapist and a ample stock of the modern whiz bang machines we all know and love. But since I often find myself in remote areas, I am also a Wilderness EMT and carry a large, well stocked Adventure Medical Kit.
On this particular Disabled Explorers Adventure our double amputee participant has First Responder Training and one of our volunteers is a Paramedic. So with the knowledge that I had solid backup, my Spot Satellite Messenger, and a couple of big First Aid kits in our group I jumped down from the Sportsmobile W.A.V.E. (wheelchair accessible van for expeditions).
My first impression as the screaming young girl came out of the truck was that she had broken or severely sprained her wrist. She was holding it with her other hand wrapped around the wrist, out in front of her with the wrist bent. I was momentarily relieved by the thought that we would only need to splint, wrap and ice it before sending them on the 3 hour journey to San Felipe’s Clinica.
Oh for all the money I would have if I got paid for every wrong first impression in the world. As she turned I saw the neon green glow of a fishing lead line tied to a large rusty hook that was deeply embedded in the meaty outside of her palm. I would have even more money if I was paid for all the times in life we wished we could just disappear from a scene and forget it ever happened.

[DisabledExplorers]

“Stop and brew a cup of tea first” is a saying often heard in the overlanding world and it translates into getting into a calm frame of mind and assessing a situation before taking action.
Well I can tell you that the same holds true in a urban hospital setting, of course it might be that you only have time for one deep breath before making a choice. But even with the best of intentions a screaming girl and young men with machine guns creates an impulse to at least look like you are doing something.

In order to get a better idea of what we were dealing with there was a need to get our young patient into a place where we could see, assess and plan. Luckily the Disabled Explorers Sportsmobile has back doors with a drop table and the Aluminess bumper gave her a place to sit. This also let me use the door & sofa as a way to prevent her from moving away which could make any treatment difficult if not impossible.

One thing I have learned about kids and adult is that everyone wants to know you have a plan, that you project confidence and that you stay calm. Part of this means explaining what you are going to do long before you do anything. And another thing people like is lots of equipment and supplies, not to mention it helps to know what resources you have to work with.

[DisabledExplorers]

Once we had looked things over, talked a bit amongst ourselves and I took a deep breath it was time to explain the plan to both the father and his daughter the patient. She wasn’t too happy to say the least but he understood the plan and agreed to let us treat her. This is a critical part when dealing with minors, regardless of what country you are in, parents can get very angry and a screaming kid adds to any ones stress level.

I really should take a moment to explain what we were up against and our thought processes at the time. This was a large hook in a small hand and it was not only embedded over half way in but it had moved around quick a bit due to the girls pain and fear pulling away from everyone. Now there are 2 common methods for removing a hook, tying a string low on the curve near the skin and pulling backwards or cut the end and push the barb through.


Not knowing the original entry orientation, looking at how close it was to going all the way through and all of our past experiences at hook removal as a group it was decided that we would cut the shank and push through. These moments are purely a matter of being there and making a call. Hindsight might be 20/20 but it is useless after the fact. I believe we made the right choice but I plan to research and learn more in case the situation comes up again.
Looking at how rusty the hook was I figured it would be an easy cut. I was very wrong. After I ask if our patient ate shellfish (quick way to check for iodine allergy), I soaked the area in betadine and since we didn’t have anything to numb the area we tried to cool the hand with first cold cans of soda then with an ice pack. This was a tough call because I was caught between wanting it to bleed and flush the wound and wanting to numb the area if possible.

[DisabledExplorers]

Time for another deep breath and then my first attempt to cut the shank, even using a pair of dikes required me to give it a couple of goes before the I could get through the shank. Of course our young patient screamed bloody murder which I was actually ok with. The father trying to calm her down was making things worse so I told him it was cool to let her scream and I encouraged her to let it all out.
Once we had the shank cut it was time to put my Leatherman WAVE to work pushing the hook through and grabbing it with another multi-tool. My thought in cutting the shank first was that the hook would push through quickly and I wouldn’t have to stop and cut it later.

I could not have been more wrong about the ease with which the hook would get through the skin. After the first two attempts using the Leatherman and not being able to get enough force on the hook I used a needle nose Vice Grip. This was no fault of the Leatherman, just the dullness of the hook. Actually before the Vice Grip I seriously considered using a scalpel to make an small cut to allow the hook barb to pass. However cutting is outside my scope of practice and I wanted to try the Vice Grip first. If that had not worked then I might have made the cut.
Once the hook tip did poke through I grabbed the tip and had it out quickly. I is amazing how loud a nine year old girl can scream and how you only realize that when she stops. Another inspection of the wound, another flush of betadine and squeezing out blood to help flush the wound and it was time to bandage and teach.

[DisabledExplorers]

As I was teaching the father about tetanus shots, signs and symptoms of infection, it was interesting to watch the girl check out her bandages. She was calm and quiet and curious about the first aid kit, which was a much better result than running away from the mean gringo.I also spoke at length about how the wound was a pocket in the flesh, the importance to her life and limb when it came to getting to a doctor for followup very quickly and about wound care and hydration. As a fluent spanish speaker I was able to have the necessary dialogue to be sure the father understood the gravity of the wound.

The last thing I did was go through my pack and give the father the rest of my betadine, an ample supply of gauze and tape for dressing changes and ask the Federal police if they needed any information from us. With lots of handshakes we were on our way, and of course I have spent alot of time since thinking over the scenario and what we could have done better.
I will say that I am grateful to a member of our group for snapping the pictures, I wish I had thought of it earlier to document the original wound and hook position, video might have even been nice to record getting permission and my explanations in spanish.
I have said it before and I will say it time and again, get all the training you can if you plan to travel in remote areas. But with that training make sure you feel comfortable about your actions, check your resources and make sure no one else has a better idea.

[surfgeek33]

Great job Lance!!!

[billwilson]

Good on ya mate

Well done

Foot note:
Another good reason for us to have a WELL STOCKED first aid kit
and KNOW how to use it....

[Aldercrest]

Great story. Thanks. WFR certification is sounding better and better.

[cellularSTEVE]

Hey Lance,
Thanks for sharing. I read and re-read your writeup and pictured myself in the situation.

Very glad you were there.

1. Can you please elaborate on what the next steps would be and how soon would you recommend getting to a hospital?

2. If the hook wasn't rusty and it was the same type of wound, would the hospital follow up be required (I am just thinking that sometimes I go to remote areas and could see getting hooked. Do you cancel your plans and drive to a hospital)?

I apologize for these basic questions. But this is a real life scenario that can and will happen if you fish enough.

Thanks again!
steve

[Bender]

Good job on the help!

I also found that pushing a fishhook barb on through the skin is much harder than you'd expect, given how easy they seem to go in. Twas a friend's thumb in the Boundary Waters of Minnesota. He was trying to catch a Northern and caught himself.