Emergency Scenario 400_f1

Location Information

Full Location:

Hafnarstræti 17, 400 Ísafjörður. Two-story wooden building, built in 1950, main entrance faces the street. Secondary access from back alley. No elevator. Building has standard fire alarm system. Current conditions: 2°C, light snow, moderate visibility, icy road conditions. GPS coordinates: 66.0737° N, 23.1236° W. Nearest landmark: Ísafjörður harbor.

Municipality: Ísafjörður

Postal Code: 400

Emergency Details

Type: Major Trauma

Priority Level: F1

Response Time Goal: Immediate (0-15 minutes)

Description:

35-year-old male, involved in a severe industrial accident at a fish processing plant. Primary symptoms: Unresponsive, significant head trauma with visible skull fracture, profuse bleeding from head wound, agonal respirations. Secondary symptoms: Possible internal injuries, multiple lacerations on arms and torso. Patient found lying on the concrete floor of the processing area. Environment: Loud machinery, slippery floor, potential for secondary injury from equipment.

History of Events

Timeline:
10:00 hours: Patient was operating a filleting machine. A malfunction caused the machine to violently recoil, striking the patient in the head.
10:01 hours: Coworkers witnessed the incident, immediately shut down the machine, and called emergency services. Patient was unresponsive immediately after the impact.
10:02 hours: Coworkers attempted to control bleeding with available cloths. No other interventions were attempted.
10:03 hours: Current time, patient remains unresponsive with agonal respirations.

Diagnostics

Initial Assessment

Initial Impression: Severe Traumatic Brain Injury with Skull Fracture
Justification for F1 Classification:
- Unresponsive patient with significant head trauma and profuse bleeding.
- Agonal respirations indicate imminent respiratory failure.
- High probability of life-threatening injuries requiring immediate intervention.
- Time-critical situation requiring rapid transport to a trauma center.

Differential Diagnoses:
1. Severe Traumatic Brain Injury (high probability)
2. Subdural Hematoma (high probability)
3. Epidural Hematoma (possible)
4. Cervical Spine Injury (possible, needs stabilization)
5. Multiple Internal Injuries (likely given the mechanism of injury)

Required Actions:
- Immediate dispatch of ground EMS with ALS capabilities.
- Air ambulance activation due to severity of the case and remote location.
- Rapid sequence intubation if possible.
- Spinal immobilization.
- Hemorrhage control.
- Immediate transport to the nearest trauma center with neurosurgical capabilities.

Final Diagnosis

Final Diagnosis: Severe Traumatic Brain Injury with Depressed Skull Fracture, Subdural Hematoma, and Multiple Rib Fractures.
Key Findings:
- CT scan revealed a large depressed skull fracture with underlying subdural hematoma.
- Multiple rib fractures were identified on chest x-ray.
- Patient required immediate neurosurgical intervention and mechanical ventilation.
- Patient’s GCS on arrival at hospital was 3. 

Outcome validated F1 priority assignment. Rapid dispatch, airway management, and transport were crucial. Patient underwent emergency craniotomy and is in critical condition. 

Learning Points:
1. F1 classification was appropriate due to the severity and life-threatening nature of the injuries.
2. Rapid recognition of the severity of the situation by dispatch was crucial.
3. Immediate activation of air ambulance was essential given the remote location and need for specialized care.

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller We need an ambulance right away! A man has been seriously injured at the fish plant!

Dispatcher Okay, I'm sending help. What is the address?

Caller It's Hafnarstræti 17, Ísafjörður. It's at the fish processing plant.

Dispatcher Help is on its way. Can you tell me what happened?

Caller He was hit in the head by the machine! It was a terrible accident! He's not moving and there's so much blood!

Dispatcher Is he awake and talking?

Caller No, he's completely out! He's barely breathing, like gasping for air! There's blood everywhere!

Dispatcher Okay, I'm sending an ambulance immediately. Try to stop the bleeding if you can. Do not move him.

Caller Okay, we are trying, but there is so much blood! Please hurry!

Dispatcher Help is on its way. Stay with him and keep him still. I will stay on the line with you.

Caller Okay, thank you. I'm so scared.