Emergency Scenario 400_f1

Location Information

Full Location:

Hafnarstræti 17, 400 Ísafjörður. A two-story wooden building, built in 1950, with a small porch at the front. Main entrance is a single door with a basic lock. Street parking is available. No elevator. Current conditions: 2°C, overcast, light snow. GPS coordinates: 66.0756° N, 23.1252° 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. Primary symptoms: Unresponsive, significant head trauma with visible skull fracture, profuse bleeding from the head and chest. Secondary symptoms: Agonal breathing, possible internal injuries. Patient found lying on the factory floor next to a fallen heavy machine. Medical history: No known allergies, no significant past medical history. Medications: None. Last oral intake: Lunch at 12:00. Incident occurred at 13:30.

History of Events

Timeline:
13:30 hours: Patient was working on a heavy machine when it malfunctioned and fell, striking him directly.
13:31 hours: Co-worker discovered the patient unresponsive with severe injuries.
13:32 hours: Co-worker initiated emergency call.
13:33 hours: Current time, patient unresponsive with agonal breathing and severe bleeding. No bystander medical intervention performed. Scene is unsafe due to the fallen machine and potential further collapse.

Diagnostics

Initial Assessment

Initial Impression: Severe Traumatic Brain Injury and Hemorrhagic Shock
Justification for F1 Classification:
- Unresponsive patient with signs of major head trauma, skull fracture, and profuse bleeding.
- Agonal breathing indicates impending respiratory failure.
- High risk of rapid deterioration and death without immediate intervention.
- Time-critical situation requiring immediate dispatch of ALS unit and air ambulance.

Differential Diagnoses:
1. Traumatic Brain Injury (TBI) with skull fracture and intracranial hemorrhage (high probability)
2. Hemorrhagic shock due to severe blood loss (high probability)
3. Chest trauma with pneumothorax or hemothorax (likely)
4. Spinal cord injury (possible, given mechanism of injury)

Required Actions:
- Immediate dispatch of ground EMS with ALS capabilities.
- Immediate dispatch of air ambulance due to severity of injuries and remote location.
- Pre-hospital notification of receiving trauma center.
- Scene safety assessment and securing of the area.

Final Diagnosis

Final Diagnosis: Severe Traumatic Brain Injury with Subdural Hematoma, Hemopneumothorax, and Hypovolemic Shock
Key Findings:
- CT scan revealed a large subdural hematoma and a depressed skull fracture.
- Chest x-ray showed a significant hemopneumothorax.
- Patient required immediate intubation and mechanical ventilation.
- Patient's blood pressure remained critically low despite fluid resuscitation, indicating severe hypovolemic shock.

Outcome validated F1 priority assignment. Rapid dispatch and air transport were crucial for patient survival. Patient underwent emergency craniotomy and chest tube insertion upon arrival at the hospital.

Learning Points:
1. F1 classification was appropriate due to the high risk of mortality.
2. Initial assessment accurately identified the severity of the injuries.
3. Rapid transport to a trauma center was essential for definitive care.
4. Scene safety was a significant concern and required careful management by the responders.

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller Help! There's been a terrible accident at the factory! A machine fell on Jónas!

Dispatcher Okay, I'm sending help. What is your location?

Caller Hafnarstræti 17, in Ísafjörður. It's the factory, by the harbor.

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

Caller A big machine fell on him! He's not moving! There's blood everywhere! He's not breathing right, it sounds like he's gasping!

Dispatcher Is he awake and talking to you?

Caller No! He's completely out! I think he's dead! There's blood coming from his head and chest! Oh my god!

Dispatcher Okay, stay calm. Is there anyone else there who can help?

Caller Yes, there are a few of us, but we don't know what to do. The machine is still on him, we can't move it!

Dispatcher Do not try to move the machine. Help is on its way. Stay with him and keep the area clear. Do not touch him unless you need to move him from immediate danger.

Caller Okay, we will wait here. Please hurry!