Emergency Scenario 780_f4

Location Information

Full Location:

Heilsugæslustöðin Höfn, Víkurbraut 2, 780 Höfn í Hornafirði. Single-story modern clinic building, constructed in 2010. Main entrance is accessible via ramp. Parking available in front of the building. Building has fire alarm system. Current conditions: 8°C, overcast, good visibility. GPS coordinates: 64.2512° N, 15.2068° W. Nearest landmark: Höfn swimming pool.

Municipality: Höfn

Postal Code: 780

Emergency Details

Type: Post-Operative Transfer

Priority Level: F4

Response Time Goal: Routine (1-4 hours)

Description:

72-year-old male, post-operative day 3 following total knee arthroplasty (TKA) at the local health clinic. Patient stable, afebrile, with well-healing surgical site. Request for transfer to Landspítali University Hospital in Reykjavík for further rehabilitation. Patient ambulatory with walker, pain well controlled with oral analgesics. No signs of infection or complications. Patient has history of hypertension and type 2 diabetes, both well managed.

History of Events

Timeline:
Day 0: Patient underwent elective total knee arthroplasty (TKA) at Heilsugæslustöðin Höfn.
Day 1-2: Post-operative care at the clinic, patient stable, ambulating with walker.
Day 3: Request for transfer to Landspítali for rehabilitation.

Prior Events: Patient has a history of osteoarthritis in the right knee, managed with conservative measures for several years. Recent pre-operative assessment showed no contraindications for surgery. Patient has been compliant with pre- and post-operative instructions. Last medical check-up was on admission for surgery.

Diagnostics

Initial Assessment

Initial Impression: Post-operative TKA, stable for transfer
Justification for F4 Classification:
- Patient is stable with no acute medical issues
- Transfer is for routine rehabilitation, not an emergency
- Patient is ambulatory, pain is controlled, no signs of complications

Differential Diagnoses:
1. Post-operative TKA, routine transfer (highest probability)
2. Post-operative infection (low probability, no signs of infection)
3. Post-operative thromboembolism (low probability, no signs of DVT/PE)
4. Post-operative pain not controlled (ruled out by current pain management)

Required Actions:
- Coordinate transfer to Landspítali via non-emergency transport
- Ensure patient has adequate supply of medications
- Transfer patient with medical documentation, including surgical notes and medication list

Final Diagnosis

Final Diagnosis: Post-operative TKA, stable for transfer
Key Findings:
- Clinical examination confirmed patient's stable condition
- Surgical site clean, no signs of infection
- Patient ambulating with walker, pain controlled
- No other medical issues identified

Outcome validated F4 priority assignment. Routine transfer to rehabilitation was appropriate and timely. Patient was transferred to Landspítali without incident.

Learning Points:
1. F4 classification was appropriate for stable post-operative transfer
2. Initial assessment accurately identified the non-emergency nature of the transfer
3. Coordination of routine transfers is essential for resource management

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller This is Hildur Jónsdóttir from Heilsugæslustöðin Höfn. We need to arrange a routine transfer for a post-op patient.

Dispatcher Okay, can you provide me with the patient's details and the reason for the transfer?

Caller The patient is a 72-year-old male, post-operative day 3 following a total knee replacement. He needs to be transferred to Landspítali for rehabilitation.

Dispatcher Is the patient stable?

Caller Yes, he is stable. He is ambulatory with a walker, pain is well-controlled, and there are no signs of infection or complications.

Dispatcher Does he have any medical history?

Caller Yes, he has a history of hypertension and type 2 diabetes, both well managed. He is on regular medications.

Dispatcher Okay, I will arrange a non-emergency transport for the transfer. When would you like the transfer to take place?

Caller Sometime within the next 1-4 hours would be ideal. We will prepare all the necessary documentation.

Dispatcher Understood. Please ensure the patient has all necessary medications for the journey. We will be in contact to confirm the transport details.

Caller Thank you, we appreciate it.