Kelly’s Story:  Young Mother Survives Rare Crossbow Injury

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Pam Cluxton felt helpless. Her son Ian’s girlfriend, Kelly Boucher, was in shock. “She just kept saying, ‘I don't think I can breathe, I don't think I can breathe.’ When I heard the click and I turned around, Ian was sitting with the bow and he was just dumbstruck, like he was in a fugue state. He couldn't even move. He couldn't even speak. He was just sitting there staring.”

Ian had accidentally shot Kelly in the chest with an arrow from a crossbow.

Akpofure Peter Ekeh, MD, FACS, trauma surgeon at Miami Valley Hospital, says he received a notification that they were going to be receiving a patient that had a penetrating injury to the chest.

Pam is a nurse, and she knew at that point there was nothing she could do. “I couldn't remove the arrow, it had to stay where it was. Kelly wasn't bleeding. So I didn't ... you know, there wasn't any bleeding to stop. I wanted her to get down. I wanted her to sit down, but she absolutely refused, she just stood there. She wouldn't sit down.”

Paint Creek Joint EMS and Fire took Kelly to Highland Community Hospital.

Pam recalls that at that point, CareFlight Air and Mobile Services was on the way. “I don't think it takes over 10, 11 minutes maybe for them to get there. So they had to probably just soon after she arrived, within five minutes, I would say they probably landed.”

Jennifer Schueler, RN, MSN, APRN, NRP, CareFlight, says that Kelly needed care at a Level I trauma center. “Highland District is not the Level I trauma center to get her the care that she needed.”

‘Quite an Interesting Sight’

“She came to the emergency room and it was quite an interesting sight,” says Dr. Ekeh. “Something that, even after many years of doing this, I don't see often. She basically had an arrow. This is from a cross bow entering her chest on the right side. You could actually palpate the tip of it on the left side of the chest. So it had gone across the entire chest.”

Unfortunately for Kelly, Dr. Ekeh says, the arrow had not only gone through her chest, it had gone through her heart, and the tip of it was on the other side of the chest, in the abdomen. “We knew right there what we're dealing with, and she needed to go to surgery, so we took her upstairs, because this was involving the heart,” says Dr. Ekeh. “There was a possibility that we would need to have gone on bypass. We right away called our cardiac surgeon here, Dr. Zaman.”

Syed Zaman, MD, thoracic and cardiovascular surgeon, was concerned about how to proceed with Kelly’s treatment. “I think before I kind of opened the chest and looked at what I had to deal with, my biggest concern was how to repair the injury, because on the CT scan there was a suggestion that the arrow actually could have gone through the muscle and created a little tunnel in the muscle itself. And my concern was that when we pull it out, the heart would just completely fall apart.”

Dr. Zaman says that if that would have happened, there's no way it could have been fixed.

“But once we got in, and we controlled the situation with the heart–lung machine, we were actually able to pull the arrow out, and there was two holes, one kind of on the right side of the heart, one in the back. And then we had the ability to kind of you know, close.”

Dr. Zaman was very concerned about whether the repair would hold. Once the heart starts to beat, it fills up with blood and sometimes the holes can start bleeding again. He and the team did everything they could to make sure that the repair was as secure as possible, he says.

Immediately after Dr. Zaman completed the repairs to Kelly’s heart, Dr. Ekeh repaired her stomach.

Rapid Transport For High-Level Emergency Care

The availability of CareFlight, with strategically located bases, allows rapid and quick transport from certain rural areas to a Level I trauma center, says Schueler. “CareFlight gives the patients in the rural areas the advantage of being treated at a level one trauma center and the services that we can provide,” she says.

“We look at our role as a level one trauma center, not just in isolation, but as part of a larger system that starts right on the field with the EMS who would appropriately take certain patients to the closest hospital,” says Dr. Ekeh. “And those physicians at that hospital, once they recognize that it is something beyond their regular capabilities, would make that call to us, and we do everything to facilitate that speedy transfer, whether it’s by CareFlight or by other means necessary to get the patient to us as quickly as possible.”

Pam says that Kelly would not have made it had she not been taken to Miami Valley Hospital. “I believe that wholeheartedly. Because when you get here, you know, you have the staff ready to do what they need to do to take care of something like that. They're ready. They're willing, and even if it's something new to them, like Kelly's case, they go right at it. As soon as you hit the doors here, boom. They're on top of it.”

Kelly says that the team at Miami Valley Hospital was surprised at how well she recovered. “I didn't really know where I got hit in all my organs until after I did the visit, when he took my staples out of my stomach.”

Dr. Zaman is amazed at how rewarding it is to be a cardiac surgeon. “I'm sure that most doctors feel this way, but… It's a very rewarding profession for me to help these patients who have basically like been very close to not surviving, and seeing them happy, healthy and how grateful they are to us, that's why we do what we do.”

A Team Approach From Field To Trauma Center

Dr. Ekeh says that for him, “this case highlights how we're able to take care of complex and unusual trauma at our Level I one trauma center.” He says that the collaboration starts from the field with EMS and referring hospitals, and continues inside Miami Valley Hospital with the emergency department, the medical teams, and the specialties – in this case, thoracic. 

“Working seamlessly together to get great results for patients,” Dr. Ekeh says. “So I think that is a great highlight. It’s what this case exemplifies.”

Pam credits the surgeons and the medical team at Miami Valley Hospital with Kelly’s recovery. “The surgeons here, the people here, they brought her through it, and you would never know today that she had been through that trauma or through all those surgeries or anything. She's back to the good old Kelly we all knew. And Dalton still has his mother.”

“I'm grateful that I had a team that worked on me, and removed the arrow and sewed me up. If it weren't for all these people, I wouldn't ... my son would have no mother right now. I don't even know where he would be,” Kelly says.

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