Wilderness Scenario #4

[RomeViking09]

It is that fun time of the year for those of use who work with scouting to start planning camp. I am writing a new training scenario and though I would post it on here to get feedback and work out the flaws in advance.

Scenario setting: Resident Overnight Scout Camp in the Blue Ridge Mountains in North GA

Time: 1322 Local Time

Call Info: A staff member calls into over the radio reporting a "problem" at the ropes course and telling to you to come quick. at 1325 you, your partners, and the camp ranger (with ability to transport 2 on backboards at a time to the camp health lodge) are on scene with a BLS Jump bag, ALS Airway Bag and 2 long spine boards (with Head blocks, and C-Collars of all sizes), the Ropes course has 1 additional Backboard with blocks and collars on scene already and there are 2 more additional backboard w/ blocks and collars on camp property (1 at the pool 3 mins from the scene and 1 at the lake 6 mins from scene). When you get on scene you find that a high ropes element failed with 3 campers on it, in addition 1 staff member and 1 adult leader have been injured by falling parts of the element. The camp ranger has called for local EMS and Fire and 911 gave him a estimated response time of 20 min for BLS Fire Engine Company, and 1hr for 1 ALS Ambulance, they request you advise if your going to need a 2nd EMS unit.

Here are you patients after a quick triage:

PT 1 (Johnny) - 15 y/o Male, c/c of fall from aprox 40 feet while in a harness and on belay, fall was broken at about 10 feet form the ground by belay device. Back shoulder, and neck pain, minor trauma to the right arm and bruising at harness site. You note damage to the harness from stopping the fall and damage to the climbing helmet.

Vitals:

HR 128

RR 28

BP 140/93

Pupils PERRL

A&O x4

PT 2 (Billy) - 17 y/o Male, c/c of fall from aprox 40 feet while in a harness and on belay, fall was broken at about 15 feet form the ground by belay device. Back shoulder, and neck pain, minor trauma and brusing at harness site. You note damage to the harness from stopping the fall and damage to the climbing helmet. PT is altered and appear to have been hit in the head by a falling steel cable.

Vitals:

HR 96

RR 26

BP 128/60

Pupils Slow to react but equal

Altered LOC but answer questions

PT 3 (Bobby) - 14 y/o Male, c/c of fall from aprox 40 feet while in a harness and on belay, fall was broken at about 5 feet form the ground by belay device with strong impact, pt is unresponsive, airway is clear, no bleeding noted, PT's helmet is broken in 2.

Vitals

HR 52

RR 12/ not regular & Swallow

BP 160/95

PT is unresponsive to Verbal or Pain

PT 4 (Zack) - 24 y/o Male, c/c of back pain due to belay device and headache form falling objects. Pt was belaying Bobby when fall took place. PT was only wearing a half harness (think wist climbing harness). No trauma or bruising.

Vitals

HR 115

RR 26

BP 122/78

Pupils PERRL

PT 5 (Andrew) - 39 y/o Male, c/c of back pain due to belay device and small lac above right eye from falling objects. Pt was belaying Johnny. PT was only wearing a half harness (think wist climbing harness). PT has a 3" long 1/8" wide cut above his right eye.

Vitals

HR 120

RR 28

BP 133/92

Pupils PERRL

In addition to your listed patients you have 3 more adults and 8 more boys on the scene, none are injured. One of the boy was belaying billy but has no complaint of pain or injury.

Tell how you would manage this scene and each patient.

ALS can be on scene in 1 hour by ground, Air Evac Possible after fire arrives (total of 45min response time)

The camp heath lodge is stocked with almost everything that would be on a BLS ambulance with access the the following Drugs:

Acetaminophen

Ibuprofen

Naproxen

Diphenhydramine HCL

Pseudoephedrine HCL

Epinephrine 1:1000 (5x 0.3ml EpiPen, 5x 0.15ml EpiPen)

IV Normal Saline (4x 1 Liter Bags, 2x 250mL Bags)

IV Lactated Ringers (4x 1 Liter Bags)

D50 (2x 25g pre-packaged)

You team is yourself (Paramedic), a 2 additional Medics (1 EMT-Intermediate/85, 1 EMT-Basic who is an Intermediate Student and authorized to do IVs under supervision), 4 First Responders (2 lifeguard w/ FR training, 2 Wilderness First Responders working in other part of the camp) are on camp and can come to assist (3 to 9 min out) with the addition equipment listed at the lake and pool and the Camp Ranger (who is a retired FF/Paramedic). You are operating under BLS Protocols (no Drugs unless listed above) with Limited ALS Authorized for Advanced Airway (Intubation, CombiTube, & Needle Cric are authorized) and IV Therapy (Saline & Lingers) Post how you would treat and when you would transport each patient (you have the ability to transport non-emergent in a camp van that can transport 1 patent on a backboard safely or up to 3 patients and 1 medic in addition to the drive in seats to a level 2 Trauma Center within 45 mins or Call for ALS Transport to the same Trauma Center, No Air Evac)

This is going to be a training scenario that happens without the staff (minus the paramedic, ranger, ropes director, staffers playing patients and camp director) knowing in advance

[CBEMT]

So the way I see it, a borderline yellow/green, two reds, and two greens.

Put the bird in the air. Package Bobby and Billy. Air is taking Bobby, and Billy if they have the capability. If they can't take both, put Billy in the van with the medic and the equipment you have and start driving towards the ALS unit once Bobby's care is transferred to the flight crew (ie don't sit around watching them take off. Once Bobby is being carried to the bird, you're out of there).

If nobody has a car that can be used to transport Johnny, Zack, and Andrew, they'll have to wait until the van can come back for them.

Edited September 9, 2009 by CBEMT

[RomeViking09]

So the way I see it, a borderline yellow/green, two reds, and two greens.

Put the bird in the air. Package Bobby and Billy. Air is taking Bobby, and Billy if they have the capability. If they can't take both, put Billy in the van with the medic and the equipment you have and start driving towards the ALS unit once Bobby's care is transferred to the flight crew (ie don't sit around watching them take off. Once Bobby is being carried to the bird, you're out of there).

If nobody has a car that can be used to transport Johnny, Zack, and Andrew, they'll have to wait until the van can come back for them.

All the Flight Service around here can only take 1, what treatment do you give the patients while waiting on als support?

[Chief1C]

I read to bird. Unless it was like storming, I'd say, get me one. Police. Forestry. National Guard.. Pt. 3 would be prime candidate, maybe pt. 2 if they could fit a second victim.

Wilderness Protocols, only apply to the wilderness, where no ground transport except maybe an ATV/RTV is possible. I wouldn't use the van as an ambulance, to Tx to a hospital, unless it was a licensed ambulance. Certainly use it to get them to a staging area, but not on a 45mi. trip. I'd advise incoming units of a low level MCI. I want 2 ALS ambulances, and a helicopter from somewhere. They have connections, they can get one. One chopper if they can take two ALS patients; two if they can only take one. Fire Engine can drop off 1 EMT and oxygen/trauma kit; and then establish a landing zone at a designated area.

Pt 1 - Yellow - Ground ALS Unit 2

Pt 2 - Red - Ground ALS Unit 1 (But would rather fly)

Pt 3 - Red - Ground ALS Unit 1 (But would rather fly)

Pt. 4 - Green - Board and Van Tx to nearest

Pt. 5 - Yellow - Ground ALS Unit 2

Pt. 6 - Tx with patient 4, just b/c he was involved directly, no care given, other than a once over.

No comment on care. Assess, Secure Airways, Bleeding/Fractures, Make Mobile; basic pricipals of off the beaten path care. Most of the time, our only meds are ammoxicilin, epinephrine, ASA, oxygen and naproxen anyway, not really ALS or BLS; just W-EMS Protocol.