Emergency Scenario 600_f1

Location Information

Full Location:

Hafnarstræti 22, 600 Akureyri, third floor, office 301. A modern, five-story commercial building constructed in 2015. Main entrance has automatic doors and a reception desk. Two elevators and a central staircase. Street parking available and a parking garage across the street. Building has security cameras. Current conditions: 7°C, overcast, moderate wind. GPS coordinates: 65.6821° N, 18.0914° W. Nearest landmark: Akureyri Art Museum.

Municipality: Akureyri

Postal Code: 600

Emergency Details

Type: Major Trauma

Priority Level: F1

Response Time Goal: Immediate (0-15 minutes)

Description:

45-year-old male, fell from a ladder at work. Primary symptoms: Unresponsive, significant head trauma with visible bleeding, irregular breathing, possible chest injury. Secondary symptoms: None reported by caller. Patient found on the floor by a coworker. Scene is a construction site with exposed concrete and metal debris. Medical history unknown to the caller. No known allergies. Last meal unknown. Caller is a coworker, panicked and unsure of medical details.

History of Events

Timeline:
10:30 hours: Patient was on a ladder approximately 3 meters high
10:32 hours: Coworker heard a loud crash and found patient on the ground
10:33 hours: Coworker called emergency services
10:35 hours: Current time, patient unresponsive, bleeding from head, breathing irregularly

Prior Events: Patient was working on a construction site, installing new lighting fixtures. No prior injuries reported today. Patient was seen wearing a hard hat, but it is now dislodged and damaged. No witnesses to the fall.

Diagnostics

Initial Assessment

Initial Impression: Severe Traumatic Brain Injury, Possible Chest Trauma
Justification for F1 Classification:
- Unresponsive patient with significant head trauma and irregular breathing indicates a life-threatening condition
- High risk of rapid deterioration requiring immediate intervention
- Potential for airway compromise and hemodynamic instability

Differential Diagnoses:
1. Traumatic Brain Injury (TBI) - High probability
2. Cervical Spine Injury - High probability
3. Tension Pneumothorax - Possible
4. Hemothorax - Possible
5. Rib Fractures - Possible
6. Internal Bleeding - Possible

Required Actions:
- Immediate dispatch of ground EMS with ALS capabilities
- Pre-hospital notification of trauma center
- Rapid extrication of patient from scene
- Advanced airway management and ventilation support
- Rapid fluid resuscitation and hemorrhage control
- Spinal immobilization

Final Diagnosis

Final Diagnosis: Severe Traumatic Brain Injury with Subdural Hematoma, Multiple Rib Fractures, and Pneumothorax
Key Findings:
- CT scan revealed a large subdural hematoma and cerebral edema
- Chest X-ray confirmed multiple rib fractures and a pneumothorax on the right side
- Patient required immediate intubation and mechanical ventilation
- Patient underwent emergency craniotomy to evacuate the hematoma and chest tube insertion to manage pneumothorax

Outcome validated F1 priority assignment. Rapid transport and surgical intervention were crucial for survival. Patient remained in critical condition for several days.

Learning Points:
1. F1 classification was essential for timely intervention
2. Initial assessment accurately identified the severity of the injuries
3. Early airway management and hemorrhage control were critical for patient survival

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller Help! My coworker fell off a ladder! He's not moving!

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

Caller It's Hafnarstræti 22, third floor, office 301, in Akureyri. It's a construction site.

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

Caller He was on a ladder, and I heard a loud bang. He's on the ground, not moving! There's blood on his head!

Dispatcher Is he awake and talking to you?

Caller No! He's not responding! He's breathing funny, like gasping!

Dispatcher Okay, the ambulance is on its way. Do not move him. Is there anyone else there to help?

Caller Yes, there are a few of us here, but we don't know what to do! Please hurry!

Dispatcher Help is on the way. Stay calm and wait for the paramedics.

Caller Okay, we will wait. Please hurry!