Paramedical Science

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.
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
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
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 Center 30 min by road or 10 min by air
Environmental factors: Tuesday Morning 08:00, clear conditions
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
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
Paramedical Science
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
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
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
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
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.
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
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 Center (Specialist Neurological
and Spinal Units included) 400 km away.
Environmental Conditions: Heavy Rain and 15°C
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.

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