It's not what you look at that matters, it's what you see.

An elderly man was brought to our emergency department with an occipital head injury sustained after a syncopal episode. The ambulance crew packaged him onto an orthopaedic scoop stretcher, with a semi-rigid cervical collar, head blocks and tape. He was alert and orientated. After transferring him onto an emergency department trolley, the sheet on the ambulance trolley was noted to be blood stained (figure 1). The source of bleeding was the patient’s left aural canal. A presumptive diagnosis of cerebrospinal fluid otorrhea secondary to a basal skull fracture was made. This was confirmed on CT. The patient made an unremarkable recovery with conservative treatment.