Emergency Scenario 900_f1

Location Information

Full Location:

Miðgarður 10, 900 Vestmannaeyjar. Two-story concrete building, built in 1985. Main entrance has a coded lock, code is 1234. Secondary entrance on the south side, no lock. Street parking available. No elevator, only a central stairwell. Current conditions: 8°C, overcast, moderate wind. GPS coordinates: 63.4418° N, 20.2685° W. Nearest landmark: Vestmannaeyjar Hospital.

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 severe industrial accident. Primary symptoms: Unresponsive, severe head trauma with visible skull fracture, active bleeding from the head and left leg. Secondary symptoms: Gasping respirations, pale skin, rapid and weak pulse. Patient was found by a coworker in the factory area. No medical history provided by caller. No known allergies reported. Last meal unknown.

History of Events

Timeline:
10:00 hours: Patient operating heavy machinery when a large piece of equipment fell, striking the patient on the head and leg.
10:01 hours: Coworker found patient unresponsive and immediately called emergency services.
10:02 hours: Caller is providing information to dispatch. Patient remains unresponsive, bleeding heavily from head and leg. 

Prior Events: No prior medical history known to caller. No previous accidents reported at this location.

Diagnostics

Initial Assessment

Initial Impression: Severe Traumatic Brain Injury with probable skull fracture and significant hemorrhage, possible hypovolemic shock. 
Justification for F1 Classification:
- Unresponsive patient with obvious head trauma and active bleeding.
- High risk of rapid deterioration and death without immediate intervention.
- Requires immediate dispatch of ALS ambulance and potential air transport.

Differential Diagnoses:
1. Traumatic Brain Injury (high probability)
2. Skull Fracture (confirmed by caller)
3. Hypovolemic Shock (due to blood loss)
4. Spinal Cord Injury (cannot be ruled out)
5. Open Fracture of the leg (confirmed by caller)

Required Actions:
- Immediate dispatch of ground EMS with ALS capabilities.
- Notification of air ambulance service due to severity and location.
- Prepare for rapid transport to the nearest trauma center.
- Early notification of hospital to prepare for a trauma patient.

Final Diagnosis

Final Diagnosis: Severe Traumatic Brain Injury with Depressed Skull Fracture, Left Tibial/Fibula Open Fracture, Hypovolemic Shock
Key Findings:
- CT scan revealed a large depressed skull fracture with underlying cerebral contusion and subdural hematoma.
- X-ray confirmed an open fracture of the left tibia and fibula with significant soft tissue damage.
- Patient required immediate intubation and mechanical ventilation upon arrival at the hospital. 
- Patient's blood pressure remained critically low despite fluid resuscitation, requiring vasopressor support.

Outcome validated F1 priority assignment. Immediate response and rapid transport were critical for survival. Patient underwent emergency neurosurgery and orthopedic surgery.

Learning Points:
1. F1 classification was absolutely necessary given the severity of the injuries and the patient's unresponsive state.
2. Initial assessment accurately identified the critical nature of the patient's condition.
3. Rapid response and transport significantly improved the patient's chances of survival.

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

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

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

Caller It's Miðgarður 10, in Vestmannaeyjar. The factory.

Dispatcher Help is on its way. Tell me exactly what happened?

Caller A machine fell on him! He's not moving. There's blood everywhere, especially on his head and leg.

Dispatcher Is he awake? Is he talking to you?

Caller No! He's not responding. He's breathing, but it sounds like he's gasping. His skin is pale, and I can't find a strong pulse.

Dispatcher Okay, this is very serious. Stay with him. Do not move him. Help is on its way. Can you tell me his name?

Caller His name is Einar Jónsson. I don't know his medical history. Please hurry!

Dispatcher Ambulance is on its way. Stay on the line, and I will guide you.

Caller Okay, I'm here with him. I can see a bone sticking out of his leg, and there's a lot of blood coming from his head. He is not responding to me at all.