Paramedics and Urostomies

On January 8th, 2023, I was involved in an accident. Shielded by the car to my right as we turned left at an intersection after receiving the green arrow, I did not see the car that was ignoring the red light barreling toward us.

The car to my right stopped, but I did not. The oncoming car hit my right passenger side wheel. Within a matter of seconds, I peripherally noticed the car, it hit me and all was silent. All airbags deployed, my seat belt cinched me to the driver seat and the terrible smell of the deployed bags along with the pain from the seat belt was suddenly apparent.

The aftermath of an accident

I was dazed, my chest hurt, and I released the seatbelt as fast as I could. I certainly was in shock as all I could think about was retrieving the car seats for my grandbabies who I was watching for the weekend while the parents went away to a wedding. I, fortunately, had left home alone with my niece watching the babies as I went to retrieve take-out. After making all the appropriate calls to 911, my niece, and my insurance company. I sat back to wonder if I was hurt.

I could move, the airbags struck only my right shin with all the other bags hitting my down jacket. My sternum was on fire, and my ostomy did not feel full. It's funny how I was worried about whether I needed to empty the bag but not whether I was injured at my stoma site.

Declining care...

When the paramedics arrived, I told them that if they found me ok I would decline treatment at the ER as I had babies at home and I didn't want to spend 4+ hours at the ER for them to tell me I was fine. I repeatedly told them that I had a urostomy. I kept feeling it to see if it was full but never felt any pain. They never asked to inspect my stoma.

I waived my right to care, the tow truck claimed my car, and I received a ride from a friend back home to the babies. It was only once I was home and decided to empty my bag did I see that the bag was full of blood...

What the paramedics missed

So, to the ER I went. Fortunately they took me back promptly and asked for a urine sample. I laughed and said - I don't think you will have much problem diagnosing the issue. Awestruck at the amount of blood, I underwent a complete CAT scan of my torso, pelvic and neck with contrast. No active bleeding was seen on the scan, no rib fractures, but the blood continued to fill the bag. They called in a trauma surgeon, who was in surgery and by the time he arrived the bleeding had stopped. My body had coagulated enough to stop the bleed.

The issue was, where was it coming from? A few days after the accident I changed my appliance and could readily see the problem. The skin at the base of my stoma was torn away from the trauma of the seat belt. The appliance was keeping it together but once removed the separation was easily noticed. A month and a half later I am still trying to heal the injured area which is constantly being attacked by urine. I use stoma powder to create a barrier with the barrier spray, on top I place New Skin, and added an additional skin barrier strip. The area is still not fully healed as it is an angry red and not a healthy pink so I will continue placing barriers to protect from the caustic breakdown of the urine.

What went wrong?

A month later I can see where the errors occurred:

1. The paramedics, upon learning that I had a stoma should have looked at the area. The conduit used for the diversion does not feel pain so of course if there was a tear I would not feel it. Even though the skin had torn away, I had so much pain in my sternum and ribs that I didn't notice this pain.
2. I should have never declined care. Even though the thought of spending 4+ hours in the ER is terrible, having to go on my own after the accident and filling out paperwork to connect my ER visit with the insurance/police report was a further waste of time.
3. The ER doctor should have removed my appliance to see how everything looked. It was assumed that the bleed was somewhere in or around the stoma but never completely diagnosed.

I hope that no one reading will have to experience this, but wanted to share my story to help others avoid pitfall of the medical profession and stomas. I can only think of two reasons why they didn't look at my stoma:

1. They didn't want to infringe on my dignity by asking me to see my urostomy, or...
2. They were ignorant as to what to look for in accidents victims who have stomas.

Stay safe!

Anita

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