Massive hemorrhage from a ruptured fistula between the trachea and a major cervical vessel is a rare but devastating complication of a tracheostomy. If not recognized and treated immediately, it can result in death. We report on a case of active bleeding from a ruptured tracheo-carotid fistula occurring in on 87-year-old female patient who had a tracheostomy. In order to stop the bleeding, a Foley balloon was temporarily inserted into the ruptured vascular lumen, which successfully stopped the bleeding. Subsequent definitive surgical repair was undertaken, and the patient recovered uneventfully.