Emergency Scenario 700_f1

Location Information

Full Location:

Miðgarður 2, 700 Egilsstaðir. Single-story private residence, built in 1998, concrete foundation with wooden frame, standard residential door with key lock, no security system. Current conditions: 7°C, overcast, moderate wind, dry roads. GPS coordinates: 65.2658° N, 14.3948° W. Nearest landmark: Egilsstaðir Airport.

Municipality: Egilsstaðir

Postal Code: 700

Emergency Details

Type: Major Trauma

Priority Level: F1

Response Time Goal: Immediate (0-15 minutes)

Description:

35-year-old male, involved in a severe ATV accident. Primary symptoms: Unresponsive, agonal breathing, visible head trauma with bleeding, possible open fracture of the left femur. Secondary symptoms: Cyanosis, rapid and weak pulse. Patient found lying on his side in a ditch approximately 50 meters from the main road. Patient was not wearing a helmet.

History of Events

Timeline:
1400 hours: Patient was riding his ATV on a gravel path behind his house.
1405 hours: Witness (caller) heard a loud crash and went to investigate.
1406 hours: Caller found patient unresponsive and immediately called emergency services.
1407 hours: Current time, patient remains unresponsive with agonal breathing.

Prior Events: Patient has no significant medical history, no known allergies, no regular medications. Last meal was a sandwich at 1200 hours. No prior head injuries or major accidents. Patient was alone at the time of the accident. Patient does not regularly drink alcohol or use any illicit substances.

Diagnostics

Initial Assessment

Initial Impression: Severe Traumatic Brain Injury (TBI) with probable hemorrhagic shock and open femur fracture.
Justification for F1 Classification:
- Unresponsive patient with agonal breathing indicating immediate life threat
- Visible head trauma with bleeding suggests severe TBI
- Possible open femur fracture indicates major trauma with high risk of blood loss
- Cyanosis indicates severe hypoxia and potential respiratory failure

Differential Diagnoses:
1. Traumatic Brain Injury (high probability)
2. Hemorrhagic Shock (high probability)
3. Open Femur Fracture (high probability)
4. Pneumothorax (possible given mechanism of injury)
5. Spinal Cord Injury (cannot be ruled out)

Required Actions:
- Immediate dispatch of ground EMS with ALS capabilities
- Air ambulance dispatch is recommended due to severity of trauma
- Notification of trauma center for potential transfer
- Initiate advanced airway management and ventilation protocols
- Rapid fluid resuscitation and hemorrhage control
- Spinal immobilization procedures

Final Diagnosis

Final Diagnosis: Severe Traumatic Brain Injury with diffuse axonal injury, hemorrhagic shock secondary to open femur fracture, and tension pneumothorax on the right side.
Key Findings:
- CT scan of head showed diffuse axonal injury and subdural hematoma
- Initial blood loss from open femur fracture caused significant hemorrhagic shock
- Tension pneumothorax developed during transport requiring needle decompression
- Patient required intubation and mechanical ventilation upon arrival at the trauma center

Outcome validated F1 priority assignment. Rapid dispatch, early advanced interventions, and rapid transport to a trauma center were critical for patient survival.

Learning Points:
1. F1 classification was appropriate given the life-threatening presentation
2. Initial assessment accurately identified the high likelihood of severe TBI and hemorrhagic shock
3. Early recognition and treatment of tension pneumothorax is crucial in trauma patients
4. Importance of air ambulance dispatch for severe trauma cases in remote areas

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller I need an ambulance! My neighbor had an accident on his ATV, he's not moving!

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

Caller It's Miðgarður 2 in Egilsstaðir. He's in the ditch behind his house.

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

Caller I heard a crash, and I ran over. He's lying there, he's not moving. There's blood on his head, I think his leg is broken.

Dispatcher Is he breathing?

Caller He is breathing, but it's like... gasping. He's not responding to me at all.

Dispatcher Okay, stay with him. Don't try to move him. Is there anyone else there?

Caller No, I'm alone here with him. Please hurry!

Dispatcher Help is on its way. We will be there as quickly as possible.