CASE 36
Relevant information
▪ Aircraft: Fixed wing, maximum two stretcher cases
▪ Local resources: Single-doctor clinic. One land ambulance
▪ Retrieval options: General hospital 1.5 hours by air
▪ Other: Equipment available includes portable ultrasound and point of care blood testing facilities
Questions
En route, the tasking agency asks if you can bring a second patient back from the same location.
Clinical information:
• 12-year-old boy.
• Resolving epigastric pain following a fall from a bicycle.
• Currently stable.
The tasking agency also informs you that the elderly patient’s pain has worsened, although no further details are available.
36.1 What are your options with the second patient and illustrate your retrieval plan?
On arrival at the clinic, the elderly man’s observations are:
• P 125.
• BP 95/50 mmHg.
• Severe abdominal pain.
The 12-year-old boy has normal observations but marked abdominal and left chest wall tenderness.
36.2 Discuss your assessment of each patient using the equipment available.
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| Figure 1 |
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| Figure 2 |
36.3 Discuss your management plan. Highlight any concerns about taking both patients simultaneously.
36.4 The clinic has two units of O-negative blood. Discuss.
Discussion
36.1 Optimisation of resources will often lead to the tasking agency trying to ‘fill’ an empty space on the aircraft, especially in remote areas. The PHR team heading to scene needs to consider the practicalities of managing two patients on the return journey and make arrangements accordingly. The PHR team leader should reserve the right to make a final decision on the transfer after assessing both patients but, at this stage, should agree in principle to do so. The entire team should be made aware of the new plan in order to prepare the second stretcher and think about any extra equipment required. The pilot may need to alter the flight plan to cater for extra weight and fuel issues. The tasking agency should be asked whether the child’s mother is hoping to accompany the child.
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