"Emergency department delayed response almost resulted in arm loss"

My partner was involved in a wakeboarding accident on Lake Argyle, Kununurra, WA recently. I was with them on the boat and was trying to call 000 for over 30 minutes. The reception was so horrible we activated the EPIRB after the second failed call. The team on the phone kept asking for specific landmarks and a specific location however, Lake Argyle is 19x the size of Sydney Harbour, all the islands are uninhabited rock formations and look the same. I informed them we were next to Lagoon Island; however, they wanted a more specific location. Due to lack of reception the call kept dropping out, so I never got any more information across to the team.

I kept trying to call 000 on the 30km trip back to shore which partially worked, and the police met us at the boat ramp to bring us back towards Kununurra. The ambulance met us halfway as it is an 80km journey from the lake to hospital. The ambulance gave my partner 2 green whistles and 2 vials of fentanyl, however, did not hand this over to the emergency department.

The nurse in ED went to give my partner more medications until I told them what my partner had already been given, the nurse had no record of any medications prior. I raised concerns with staff (as I am an OT specialised in hands and have seen it before) regarding compartment syndrome. Two doctors, a nurse and a clinical nurse manager dismissed my concerns. I continued to report my increasing concerns and my partner's changes in symptoms to which I was reassured that if it was compartment syndrome, they would be in a lot more pain. My partner was reporting 7/10 pain and on a lot of medications.

For 5 hours I continued to raise concern regarding compartment syndrome, however the staff only reassured me it was not despite my partner's hand going increasingly numb and pale, their pain increasing despite the pain medications and their swelling increasing. The staff did not provide them with a pillow or blanket, I had to find these for my partner.

They did not reattach my partner's IV fluids from the ambulance for 4 hours. This is increases risk of kidney failure associated with compartment syndrome! They did not elevate my partner's arm, I had to. The staff also stated that if it was compartment syndrome you do not want to elevate it anyway which is incorrect. The nurses only took circumferential measures of my partner's arm to monitor oedema changes 4 hours post arriving. The nurses recorded the time of injury incorrectly. The doctors stated that the CT scan at the hospital was down so they could not assess. They also stated that they did not have the right equipment to measure the pressure in my partner's arm they needed to diagnose compartment syndrome.

Only after a phone call to RFDS and Royal Perth Hospital Orthopaedics did they put my partner in a stop sign sling to elevate more. RFDS responded quickly to my partner's symptoms as it could be compartment syndrome. They were flown immediately to a different hospital where they had emergency surgery for compartment syndrome. They stated that the incorrect time recorded on the file meant their calculations were incorrect and increased the risk of my partner losing their arm as they thought it was 12 hours post injury, but it was 14+ hours post.

The surgeons reported that my partner was minutes and millimetres away from losing their arm and having it amputated. They had also torn through the muscle bellies of 3 muscles and had to have vascular surgery for the build-up of multiple blood clots in their arm which could be life threatening.

The lack of urgency and treatment my partner received at Kununurra Emergency Department meant they almost lost their arm and if I was not there to advocate so hard for them, I fear they would have. The lack of hand over from the paramedics meant they also could have overdosed on medications.

Thankfully, RFDS responded so promptly, and the treatment received at the other hospital has been phenomenal. I feel let down and disappointed by the lack of understanding by the 000-call centre, the lack of hand over from the paramedics regarding medications and absolutely appalled by the lack of response, investigation or action from the Kununurra emergency department doctors and nurses.

I also feel disgusted to hear that the notes the doctors wrote upon my partner's discharge stated that they had investigated compartment syndrome. It is sickening to think that their lack of investigation almost cost my partner their arm.