Emergency Scenario 000_f1

Location Information

Full Location:

Miðbær, Vestmannaeyjar, 900, near the harbor. Two-story wooden building, built in 1950. Main entrance faces the street, no security features. Current conditions: 8°C, overcast, light winds. GPS coordinates: 63.4416° N, 20.2731° W. Nearest landmark: Vestmannaeyjar Harbour.

Municipality: N/A

Postal Code: N/A

Emergency Details

Type: Major Trauma

Priority Level: F1

Response Time Goal: Immediate (0-15 minutes)

Description:

35-year-old male, sustained severe injuries in a workplace accident. Primary symptoms: Unresponsive, significant head trauma, open fracture of the left femur, active bleeding. Secondary symptoms: Agonal breathing, pale skin, rapid and weak pulse. Patient is located at the loading dock of the fish processing plant. Scene is chaotic with several bystanders.

History of Events

Timeline:
10:00 hours: Patient was operating a forklift when it overturned, pinning him underneath.
10:01 hours: Bystanders were able to lift the forklift and free the patient.
10:02 hours: Patient is found unresponsive with significant injuries. Call to emergency services made immediately.
10:04 hours: Current time, patient remains unresponsive, active bleeding from head and leg injuries.

Prior Events: Patient has no known significant medical history. No known allergies. Last meal was a light breakfast at 07:00. No recent illnesses or injuries. Patient is generally healthy and active. No prior hospitalizations or surgical procedures.

Diagnostics

Initial Assessment

Initial Impression: Severe Traumatic Injury, Critical Condition
Justification for F1 Classification:
- Unresponsive patient with significant head trauma, open fracture, and active bleeding indicates a life-threatening emergency.
- Agonal breathing and rapid, weak pulse suggest imminent cardiopulmonary failure.
- Time-critical interventions are required to stabilize the patient and prevent death.

Differential Diagnoses:
1. Traumatic Brain Injury (high probability)
2. Hypovolemic Shock (high probability due to bleeding)
3. Open Femur Fracture (confirmed)
4. Internal Injuries (potential, cannot be ruled out)
5. Spinal Injury (potential, mechanism of injury suggests)

Required Actions:
- Immediate dispatch of ground EMS with ALS capabilities.
- Air ambulance activation requested due to severity of injuries and location.
- Early hospital notification for trauma team activation.
- Scene safety assessment and control.
- Rapid extrication and transport of the patient to nearest trauma center.

Final Diagnosis

Final Diagnosis: Severe Traumatic Brain Injury with Subdural Hematoma, Open Left Femur Fracture, Hypovolemic Shock.
Key Findings:
- CT scan revealed a large subdural hematoma and diffuse axonal injury.
- X-ray confirmed an open, comminuted fracture of the left femur.
- Patient presented with severe hypotension and tachycardia consistent with hypovolemic shock.
- Patient required immediate intubation and ventilation.

Outcome validated F1 priority assignment. Rapid dispatch, early air transport and aggressive resuscitation were crucial. Patient underwent emergent neurosurgery and orthopedic stabilization.

Learning Points:
1. F1 classification was essential due to the critical nature of injuries and the need for immediate intervention.
2. Initial assessment accurately identified the life-threatening conditions.
3. Rapid transport to a trauma center is paramount in such cases. The presence of multiple injuries and altered mental status should always trigger an F1 response.

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller Help! A man has been crushed by a forklift! He's badly hurt, I think he's dead!

Dispatcher Okay, I'm sending help. Where is this happening?

Caller It's at the fish processing plant in Vestmannaeyjar, at the loading dock!

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

Caller The forklift overturned and he was trapped under it! We managed to get him out, but he's not moving. There's a lot of blood!

Dispatcher Is he awake and talking to you?

Caller No, he's not! He's not responding at all. He's breathing, but it's very shallow. Please hurry!

Dispatcher Okay, the ambulance is on its way. Is there anyone there who can help?

Caller Yes, there are a few of us here, but we don't know what to do. His leg is twisted and there is blood everywhere.

Dispatcher Okay, stay there and keep the scene safe. Do not move him. Help is on its way

Caller Okay, we'll wait. Please hurry!