CASE 9
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Incident
An aircraft rigging wire has struck the pilot across the anterior neck and he now complains of difficulty breathing. In addition, he remains trapped by the lower limbs within the damaged aircraft. The patient’s right leg has sustained a compound fracture.
He is alert but anxious and tachypnoeic with a RR of 28. All other vitals signs are currently within normal limits.
Relevant information
▪ Aircraft: Rotary wing
▪ Ground resources: Two land ambulances. Fire & Rescue Service
▪ Retrieval options: General hospital 20 minutes by road. Major trauma hospital 30 minutes by air
▪ Other: The scene has been declared safe by the Fire & Rescue Service
Questions
9.1 What is your initial pre-hospital plan prior to arrival?
On arrival, you find the patient anxious but lucid. He has just been freed from the wreckage. He complains of severe anterior neck pain and is spitting out bloody saliva. His voice is hoarse. He remains tachypnoeic with a rate of 30 breaths per minute. Examination reveals an acutely tender anterior neck. There is slight crepitus over the laryngeal structures. There is a compound fracture of the right tibia and fibula with good distal perfusion. No other injuries are detected.
9.2. What is your initial management and which hospital will you transfer to?
9.3. Describe how you will notify the receiving hospital of your planned arrival.
Discussion
9.1. Scene
Safety of the scene should be reconfirmed with the on scene Fire & Rescue Service personnel upon arrival.
Patient
The airway is of great concern due to the mechanism and clinical information. Advanced airway management, if required, is likely to be problematic.
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