Emergency Scenario 900_f1

Location Information

Full Location:

Miðgarður 2, 900 Vestmannaeyjar. Two-story wooden residential building, built in 1965. Main entrance has a small step. Street parking available. No security features. Current conditions: 8°C, overcast, moderate wind. GPS coordinates: 63.4405° N, 20.2696° W. Nearest landmark: Herjólfsdalur valley.

Municipality: Vestmannaeyjar

Postal Code: 900

Emergency Details

Type: Major Trauma

Priority Level: F1

Response Time Goal: Immediate (0-15 minutes)

Description:

35-year-old male, involved in a serious industrial accident. Primary symptoms: Unresponsive, significant head trauma, visible skull fracture, heavy bleeding from head wound, agonal breathing. Secondary symptoms: Possible chest trauma, multiple abrasions and lacerations. Patient found by coworker, lying on the factory floor. Medical history: No known allergies, no known medications, generally healthy. Last meal was a sandwich at 11:00.

History of Events

Timeline:
1215 hours: Patient was operating a heavy machine when a large metal beam fell, striking him on the head and chest. Patient immediately collapsed.
1216 hours: Coworker discovered the patient, unresponsive and bleeding heavily. Coworker immediately called emergency services.
1217 hours: Current time, patient remains unresponsive, agonal breathing, heavy bleeding from head wound. Scene is a busy factory floor with ongoing operations nearby. No prior incidents reported in this area.

Diagnostics

Initial Assessment

Initial Impression: Severe Traumatic Brain Injury with probable skull fracture and associated chest trauma. 
Justification for F1 Classification:
- Unresponsive patient with agonal breathing indicates life-threatening condition
- Significant head trauma with visible skull fracture and heavy bleeding
- High risk of rapid deterioration and imminent death without immediate intervention
- Time-critical condition requiring immediate advanced life support

Differential Diagnoses:
1. Severe Traumatic Brain Injury (high probability)
2. Subdural/Epidural Hematoma (high probability)
3. Pneumothorax/Hemothorax (possible due to chest trauma)
4. Cervical Spine Injury (possible given mechanism of injury)
5. Cardiac Arrest (possible if breathing ceases)

Required Actions:
- Dispatch of ground EMS with ALS capabilities, and air ambulance if ground transport time is excessive
- Early notification of trauma center
- Immediate intubation and ventilation if possible
- Hemorrhage control and fluid resuscitation
- C-spine immobilization
- Rapid transport to nearest trauma center

Final Diagnosis

Final Diagnosis: Severe Traumatic Brain Injury with depressed skull fracture, epidural hematoma, and multiple rib fractures with associated pulmonary contusion. 
Key Findings:
- CT scan revealed a large depressed skull fracture with an underlying epidural hematoma.
- Chest X-ray showed multiple rib fractures and a significant pulmonary contusion. 
- Patient required immediate neurosurgical intervention and mechanical ventilation.
- Initial assessment accurately identified the severity and need for rapid intervention.

Outcome validated F1 priority assignment. Immediate dispatch and rapid transport were crucial. Patient required multiple surgical interventions and had a prolonged ICU stay.

Learning Points:
1. F1 classification was essential due to the severity and time-critical nature of the injuries.
2. Initial dispatch assessment correctly identified the need for immediate ALS intervention.
3. Rapid transport and early notification of trauma center were crucial for patient survival.

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller There's been a terrible accident! A man is badly hurt in the factory!

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

Caller It's Miðgarður 2, in Vestmannaeyjar. It's the main factory building.

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

Caller A beam fell on him, he's not moving. There's a lot of blood, he's not breathing right!

Dispatcher Is he awake? Can you talk to him?

Caller No, he's not responding at all! He's making a strange sound, like he's gasping for air.

Dispatcher Okay, stay calm. Is there anything else you can tell me about his injuries?

Caller His head is badly hurt, I think there's a fracture. There's so much blood! Please hurry!

Dispatcher Ambulance and additional support is on its way. Do not move him. I will stay on the line with you until they arrive.

Caller Okay, thank you, I'm so scared, I don't know what to do.