Paramedical Science

Retrieval. Case Studies: PST 4106 1 Paramedical Science The following are Case based learning projects. They are worth 50% of your unit mark and therefore are important in terms of the learning process associated with the unit. The questions following the cases are designed to stimulate Clinical and Situational awareness in the aeromedical retrieval environments and are based on an expectation of a high-level clinical knowledge foundation. Stimulating and enhancing your clinical understanding and developing your clinical thinking and application are an underlying goal. The Case Studies will comprise: • Pre-Hospital Retrieval: 3 Cases • Co-ordination: 1 Case • Inter-Facility: 1 Case • Total: 5 Cases The assignment should be presented as per ECU guidelines and use an acceptable academic referencing system where necessary. Use of bullets is acceptable to summarize pertinent points and information to save on word count. The total word count for all submissions should not exceed 3500 words plus or minus 20% Line spacing should be 1.5 Font may be Arial or Times New Roman You can find a copy of the marking key and criteria in this part of the blackboard website Case Studies: PST 4106 2 Paramedical Science Pre-Hospital Cases: Case 1: 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 one potential fatality at the scene. Relevant information: Retrieval means: Rotary Aircraft Ground resources: 3 ambulances, police and fire and rescue Retrieval options: Major trauma center 20 minutes by air, general hospital 30 minutes via road. Environmental: Approaching rain. Questions: 1.1 Describe your Pre hospital plan and immediate actions on arrival at scene On arrival you note 4 patients from 2 vehicles and all have been extricated: a. Patient 1 is pulseless and apneic with a large opened skull fracture with extra-cranial brain tissue visible b. Patient 2 is a middle aged female with a rigid abdomen and bruising over the pelvis. She has decreased air entry over the left lung field according to on scene paramedic. Her BP is 90 systolic and GCS 6 Case Studies: PST 4106 3 Paramedical Science c. Patient 3 is a male 11 years old with a closed bilateral femoral fracture that is crying inconsolably. His pulse is 120 beats per minutes d. Patient 4 is from a 3rd vehicle and is C/O ankle pain. 1.2: Outline your treatment for these patients and provide rationale for which you would select for the air retrieval. What could potentially go wrong with this scenario and how can you prepare? Case 2: A 50-year-old female motorcyclist has collided with a car and is said to be ‘not responding’ Relevant Information: Aircraft option: Rotary Wing landing site less than 200m away. Ground resources: One Ambulance and local Police Service Retrieval options: Major Trauma Centre 30 min by road or 10 min by air Environmental factors: Tuesday Morning 08:00, clear conditions Questions: 2.1: Using the information so far available, outline your pre-hospital plan prior to arrival on scene. Clinical Information: • P: 120/min • BP: 150/90 mmHg Case Studies: PST 4106 4 Paramedical Science • GCS 6 (E1 V2 M3) 2.2: Briefly describe Patient selection criteria for RSI, paying particular attention to the airway examination component and predictors of a difficult intubation. 2.3: Describe the key steps required in the performance of a Pre- Hospital RSI. 2.4 What are the risks and benefits associated with RSI in the trauma patient? Provide a critical assessment of your decision to RSI or not? Case 3: An 18-year-old male has been riding his dirt bike along a dirt track and he is struck across the anterior neck by an unseen guide wire. He is complaining of dyspnea and has also sustained a compound fracture to his Right Tibia and Fibula. He is also anxious and tachypnoeic with a RR of 30. All other vital signs remain within normal parameters. Relevant Information Aircraft option: Rotary wing Ground resources: 2 Ambulances, Fire & Rescue Services Retrieval Options: General Hospital 20 min by road, Major Trauma center 30 min by air Other: Fire & Rescue declare scene safe Case Studies: PST 4106 5 Paramedical Science Questions: 3.1: What is your initial pre-hospital plan prior to arrival on scene On arrival you find the patient anxious but lucid He complains of severe anterior neck pain and is spitting out bloody saliva. His voice is hoarse and remains tachypnoeic at a rate of 30 breaths/min Examination reveals an acutely tender anterior neck. There is slight crepitus over the laryngeal structures and a compound fracture of the Right tibia and fibula with good distal perfusion. No other injuries detected. 3.2: What is your initial management and which hospital will you transfer to? Why might you choose to transport this patient or to leave this patient with the paramedics who would transport to the local general hospital with surgical capacity? 3.3: Describe how you will notify the receiving hospital of your planned arrival and how they might prepare for your arrival. Co-ordination Case: Case 4: The following assessment is related to the tasking and coordination of physician led retrieval. Case Studies: PST 4106 6 Paramedical Science Tasking and clinical coordination are vital aspects of retrieval medicine. Triage resource allocation and high level clinical oversight are key elements to this process. The following incidents need to be considered as being independent of each other. In each case the decision to mobilize, coordinate and support of the retrieval team rests solely with you. You have the maps and communication equipment available to you to make each decision. Incident 1: The ambulance service has alerted you to an ongoing incident in an urban area of or your jurisdiction. Five minutes earlier multiple calls had been received regarding a motorcycle rider who had been struck at an intersection. Information you have received is that the Motorcyclist is unconscious. Incident 2 You receive a call about a shooting in remote area some 50 minutes by rotary winged aircraft. It is 2am and raining. A female made a single call and reported a gunshot as well as figure laying face down in her front yard. A local ambulance crew has been dispatched but will not be on scene for 20 minutes. Incident 3 Case Studies: PST 4106 7 Paramedical Science You are asked by a ground team to activate a helicopter to a semi rural property 25 minutes by air away. A 75-year-old man has collapsed in his living room and cardio pulmonary is in progress. Incident 4 An ongoing incident has been phoned through. A car has been struck by a van on a freeway 25 minutes by rotary winged aircraft. Information is one person dead at scene and another trapped with severe abdominal pain and SBP of 90mmHg. Questions: For all 4 incidents discuss key points in the allocation of a physician based retrieval team resource allocation to these incidents. Include in your answer: 1. Justification for activation or non activation based on the little information you have 2. Problems that may be encountered 3. Your actions to gain a clearer picture of the incidents 4. Critically analyze what your team mix may be and why. Inter-Facility Case: Case 5: Following a fall from farm machinery, a 40-year-old male farmer in the Wheat-belt region of Western Australia, has sustained an intracranial hemorrhage and spinal injuries. He is currently located at a small general hospital. Case Studies: PST 4106 8 Paramedical Science He is intubated and ventilated with the following ventilator settings: • Tidal Volume: 450ml • RR: 12 breaths/min • PEEP (Positive End Expiratory Pressure): 5 cmH20 • FiO2: 28% Clinical Information: • P: 85/min • BP: 140/80 mmHg • SaO2: 98% Relevant Information Aircraft option: Fixed wing and Rotary Wing available Local Resources: One Ambulance Retrieval Options: State Major Trauma Centre (Specialist Neurological and Spinal Units included) 400 km away. Environmental Conditions: Heavy Rain and 15°C Questions: 5.1: Focusing on the principals of flight physiology, analyze how this patient could be affected and the measures you would take to mitigate or eliminate any adverse occurrences. 5.2: Taking all the factors into consideration, critically justify your choice of transport platform.