Wilderness Scenario

[RomeViking09]

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

Time: 2000 Local Time

Call Info: Scoutmaster reports one of his scout was running in camp and fell, the scout master is on his way to the health lodge with the scout.

at 2015 the Scoutmaster pulls up in a 15 Passenger Van with a 12 y/o male in a prone position across the middle bench seat of the van with pain in the T10 Region and no feeling or movement in the Right Leg. ALS has been called and will be on scene in 1 hour and 45 min the camp heath lodge is stocked with 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)

You team is yourself, The Camp Director (retired EMT-I/85), the Camp ranger (retired Fire Fighter/ EMT-P), and the Scoutmaster (no real medical training beyond CPR).

Post how you would treat the PT while waiting for the ALS truck?

[Eydawn]

Lol... speaking as a BSA camp medic, first off I'd ensure that this patient got a full trauma exam... airway and breathing as our number one priority, of course.

Medical hx on the kiddo from either their class 1 form or the scoutmaster's files or knowledge? Previous injuries?

Patient is AAOX? Baseline vitals (pulse, respiration, BP, O2 sats) please. I want a better description of how he fell and what he landed on, and how the scoutmaster moved him.

What do you see in your exam? As soon as you've checked his back, including exposing the guy, backboard and extricate the kiddo, don't forget to pad the voids... have the ranger help you with extrication if he will since he has experience. Send the camp director to call the kiddo's folks as listed on the class 1 form to advise them of what's going on and the actions you're taking.

Finding any other deficits? How about visual bruising? Treat the kid with as much TLC as possible... if he's a tenderfoot or first class, just out of webs range, he's going to be really scared. Ensure airway, adequate oxygenation and try to learn as much as you can so you can hand him off to ALS with more than "kid done fell down..." in your report.

None of the above meds would be appropriate as far as I'm concerned... if he's in severe pain, ALS can establish a line and use far more effective painkillers.

You guys have authorization to hand out benadryl, ibuprofen, tylenol etc. to adults on your ranch? We had it written in under our doc's orders this summer where I worked in CO.

How'd it really go? What was the patient's condition?

Wendy

CO EMT-B

Venture Crew 911, DAC BSA

[RomeViking09]

Here is the info you asked for from my field notes from this summer:

Review of PTs Class 1 and Class 2 showed no past Hx and review of camp med log showed no past injuries while at camp

PTs Vitals upon getting to the health lodge where:

A+O x4 (destressed)

BP 120/80

HR 95/Strong/Regular

RR 32/Regular/Unlabored

(We do not have a pulse ox at camp) no O2 Stats Taken

Pupils PERRL @7mm

The Ranger, Medic (me/ you in the Scenario), and Camp Director Log Rolled the PT to a long board and moved him into the Health Lodge Trauma Bay (Note; C-Spine was applied while PT was still Prone before moving him)

Upon getting the PT into the health lodge all clothing was removed to allow for a full Exam. The Ranger set up radio contact to ALS and the ER for On-line direction per local camp protocal.

PT was give 02 by Nasal Cannula (camp did not have Non-Rebreather, only BVM, and NC) @ 4LPM per Online Direction

Exam showed injury (visual bruising and swelling) to the spine between T-10 and T-11 (Scoutmaster says he thinks the PT fell on a rock) Good CSM x3, no feeling in Right Leg slow refill in Right big toe.

PT was covered and Vitals taken every 5 min until ALS was on scene

(Note: All Meds are covered under Off-line direction before camp starts based on the level of training of all medics on camp. Camp was staffed by myself (Wilderness First Responder at the Time now and EMT-I Student), an LPN with no Emergency Training, 1 EMT-I, and the Camp Director and Camp Ranger all Staff are trained in BLS/CPR/AED in staff week, all medical staff must take 5 hours in wilderness protocols related to the region the camp is in, the night of this event the EMT-I was working for the local Fire Dept and the LPN was on her night off)

PT was transported to a Level 2 Trauma Center, ER doc was able to breakup a hemotoma in the T10 T11 Region and the PT returned to camp the next day

On Scene ALS did gain IV Access and give Morphine per Online Direction

Camp staff did not give any meds per online director due to a possible unstable condition.

(I have two more Codes from this Summer I will Post)

[spenac]

(I have two more Codes from this Summer I will Post)

Where's the first "code"? This is a call or patient contact not a code, neither is your wilderness 2. Sorry to nit pic.

[RomeViking09]

local term for on camp medical emergency that requires ALS transport is Code

[spenac]

local term for on camp medical emergency that requires ALS transport is Code

Bad choice, how confusing. :?

[Chief1C]

Why wait? Got flares (or flashlights under road cones)? A field? Call direct to a medevac service nearby, there has to be one somewhere.