Tracheal transection from blunt trauma is an uncommon occurrence and presents a difficult challenge even to physicians with experience in managing difficult airway problems. This is a case report of a child who sustained a complete cervical tracheal transection from blunt trauma and presented to an outer metropolitan hospital where definitive care for his injuries was unavailable.

A 10 year old boy presented to the emergency department (ED) of an outer metropolitan hospital with a severe neck injury. He had driven a farm bike into a wire fence, which had resulted in a neck high wire lacerating his neck: a process known as being “clothes lined”.

He had walked 500 m back to his house and his father had driven him by car to the nearest ED, which was 20 minutes away. As this incident occurred out of hours, the ED to which he was brought to had an on-site emergency physician who was immediately available, with an on-call service for anaesthesia, and the average response time being 30 minutes.

On initial assessment, there was an obvious large wound in the anterior neck with some haemorrhage …