CASE 19
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Incident
A van has collided at high speed with a car. The tasking agency reports that there are three severely injured patients including children. All are still in the vehicle and could be trapped. In addition, there is potentially one fatality on the scene.
Relevant information
▪ Aircraft: Rotary wing. Maximum of one stretcher case
▪ Ground resources: Three land ambulances. Police and Fire & Rescue Services
▪ Retrieval options: Major trauma hospital 20 minutes by air. General hospital 30 minutes by road
▪ Other: Rain approaching
Questions
19.1 What is your initial pre-hospital plan?
19.2 Describe your immediate actions on arrival at the scene?
On assessment, there are three patients from the two cars involved in the head-on collision. All have now been extricated from the vehicles.
• Patient 1 is pulseless and apnoeic with a large open skull fracture and extra-cranial brain tissue.
• Patient 3 is 11 years old with closed bilateral femoral fractures who is crying inconsolably. His pulse is said to be 120 beats per minute.
• Patient 4 was in a third vehicle that swerved to miss the accident and mounted the kerb. She is complaining of ankle pain.
19.3 Briefly outline your management of these patients. Who do you take with you?
19.4 What is the priority after the job has finished?
Discussion
19.1 This can be an enormously stressful time, even for the most experienced PHR teams. Multiple casualties, a lethal mechanism and a sick child of unknown age are enough to make anyone sweat. The pre-hospital plan is your opportunity to rationalise and prepare for the scene.
Scene safety
With four patients this will be a chaotic scene. Standard safety protocols may have been overlooked so you should reassess everything.
Patients
Four patients may require a temporary team split for initial assessment. Prepare mentally for an injured child, locate your paediatric resuscitation reference material and/or Broselow tape. Be aware of the reported ‘death’ on scene. This patient will also need to be assessed.
Destination
You only have room for one in the helicopter. Inclement weather is approaching rapidly and the air crew will be keen to depart soon. Slower road transport is another consideration. A general hospital is available. Significant triaging and decision making will need to occur.
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