OUTDOOR EMERGENCY CARE 5TH EDITION
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario #21-01 Degree of Difficulty = 6
|INJURY |ENVIRONMENT |PERSONNEL |
|Head injury (3) |Racecourse (0) |Trained rescuers (0) |
|Probable internal/pelvic injuries (3) | | |
GENERAL SCENARIO DESCRIPTION: Giant slalom racer catches a gate at a high rate of speed. S/He spins and swirls in cloud of snow, hitting his/her head twice on the hard pack, and collides with a horizontal/rigid pipe.
INFORMATION GIVEN TO TRAINEE: You have been assigned to the racecourse for the day. You are located halfway down the course. There is another rescuer located at the start of the course with a fully equipped toboggan.
PATIENT SUMMARY: Skier is responsive only to painful stimuli. Assessment reveals pupils are unequal and sluggishly responsive. S/He is groaning with pain. S/He is not moving as s/he lies over the pipe. S/He will need full attention and extrication before the race can resume.
VITAL SIGNS
|Time in minutes |Pulse and respirations |
|Initial |P = 108; R = 29 |
|5 minutes |P = 116; R = 30 |
|10 minutes |P = 124; R = 30 |
SCENARIO OBJECTIVES
Decision Making
Secure scene safety including stopping the race; patient assessment; correctly identify all injuries; recognize as “load and go” situation due to existence of life-threatening multiple trauma; prioritize rapid extrication, transport, and transfer to ALS (Advanced Life Support); request toboggan with trauma pack and additional personnel; activate ALS with request for air evacuation; notify management.
Problem Management
Standard Precautions; OEC skills; spinal immobilization; fracture management of the pelvic area with possible internal injuries; administration of O2 as soon as available; lift techniques; transportation and transfer plan.
Leadership
Direct others; coordinate rapid extrication and transfer to EMS; notify management and request their assistance; address race officials who are interested in restarting the race; direct additional rescuers to get statements of witnesses.
Scenario #21-01
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
This is a life-threatening injury with a focus on rapid extrication and transfer to ALS, based on the MOI which indicates the possibility of multiple, significant trauma to head and lower abdomen/pelvic area. Scene safety, crowd management, and race officials need to be addressed. However, the primary focus will remain rapid extrication, ALS, and oxygen ASAP.
Location/terrain: GS racecourse
Moulage: Bruising and crepitus over pelvis; unequal pupils (described); clear fluid from the left ear
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: Patient is lying over a horizontal metal pipe and is not able to move.
Answers to SAMPLE
Signs and symptoms: responsive only to pain, unequal pupils, clear fluid from left ear, crepitus over pelvic area
Allergies: none
Medications: none
Past history: none
Last meal: breakfast
Events leading: this is the second run on this course
Behaviors: Patient has clear fluid draining from his left ear, and pupils are unequal. Patient responds only to deep pain.
SPECIFIC COMMENTS FOR EVALUATORS
The trainee needs to recognize that this is a “load and go” situation. The trainee should request additional rescuers and toboggan with full trauma pack. Trainee should request ALS based on MOI. It is a difficult extrication and probably should move the patient directly on the backboard. Trainee also needs to address the crowds and the race official. The trainee also recognizes that management needs to be notified per local protocol.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario #21-02 Degree of Difficulty = 6
|INJURY |ENVIRONMENT |PERSONNEL |
|Possible neck or spine injury (3) |Deep powder on steep terrain under the lift (1)|Single patient (0) |
|Knee sprain (2) | |Trained rescuer (0) |
GENERAL SCENARIO DESCRIPTION
A 15-year-old skier falls 20 feet out of the chair into deep powder. Friends reported this to the lift operator at the top.
INFORMATION GIVEN TO TRAINEE
You are called to respond to an accident of a teenager falling out of the chair at Tower 2. Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
Patient is semi-lying down in a large depression in the snow. Patient complains of pain in the right knee. Patient is alert and responsive to your questions when you arrive. S/He does not complain of any neck or back pain, and wants to return to skiing.
VITAL SIGNS
|Time in minutes |Pulse and respirations |
|Throughout |As found plus 12 pulse, and plus 4 |
| |respirations |
SCENARIO OBJECTIVES
Decision Making
Secure scene; stop lift until assessment is performed to verify severity of injury. Patient assessment: correctly identify all injuries found and reported, but also consider possible injuries due to MOI. Assessment should include how s/he landed and rule out the presence of any neurological deficits from the fall. Inform patient of dangers of this large of a fall and possible injuries to the spine and back. Determine where parents are; inform him/her of the impact of being a minor and the ability to give informed consent and implied consent. Call for spinal immobilization. Notify management. Have base attempt to find parents.
Problem Management
Standard Precautions; OEC skills: Fracture management: knee; spinal immobilization per local protocol especially since the patient is a minor and needs treatment for knee injury anyway; release of liability by parents for a minor. Notify management due to chair involvement. Call for ALS. If appropriate and available arrange for helicopter transportation to a trauma center.
Leadership
Develop and execute a plan of action. Demonstrate thorough understanding of legal issues related to minor giving consent and how this impacts his/her decisions; direct others with clear instructions and with confidence; communicate with clarity and firmness with patient; direct additional rescuers to obtain statements from any witnesses; thorough documentation. Assist with any documentation necessary for accident involving a lift.
Scenario 21-02
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
This scenario addresses the need for a thorough assessment based on the MOI to determine the need for spinal immobilization. The trainee should demonstrate understanding that a fall more than 2½ to 3 times one’s height presents the danger of spinal trauma. (This is mitigated in this scenario by the soft landing in the snow, and assessment demonstrates no signs of head or spinal trauma.) Trainee should be able to communicate a rationale for the decision to use spinal immobilization based on assessment and legal issues of patient being a minor. Trainee should also demonstrate how s/he would address the fact that the patient is a minor.
Location/terrain: Difficult to moderate terrain with deep powder under a lift. This terrain is in a closed area and a short distance from the loading ramp.
Moulage: None
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: Patient is partially lying down under the lift.
Answers to SAMPLE
Signs and symptoms: knee pain
Allergies: none
Medications: none
Past history: has had previous knee surgery
Last meal: has not eaten all day
Events leading: has been skiing very hard for two hours
Behaviors: Patient is oriented and alert. Patient complains of pain in the right knee. Patient reports no tenderness upon palpation of spine. Patient reports no neurological impairment in his lower extremities. S/He feels that he can return to skiing.
SPECIFIC COMMENTS FOR EVALUATORS
The trainee should be evaluated on the knowledge of MOI issues, reasons for concern about possible hidden spinal problems, and legal issues related to a 15-year-old falling from a chair. Trainee should demonstrate knowledge of management issues and local protocols. Trainee should develop a plan for extrication and transport to aid room for further assessment and consultation with parents.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario #21-03 Degree of Difficulty = 7
| INJURY | ENVIRONMENT | PERSONNEL |
|Bilateral broken ankles (4) |Outside maintenance building/garage |Single patient (0) |
|Back injury (3) | |Trained rescuers (0) |
GENERAL SCENARIO DESCRIPTION
A maintenance man is finishing up some painting while perched on a garage roof. He is on the peak of the garage roof, working on the adjoining building. You hear a ladder fall to the ground and notice the maintenance man is rolling around on the driveway in severe pain.
INFORMATION GIVEN TO TRAINEE
You are at your ski area helping prepare your aid room for the upcoming season. You noticed a maintenance employee on the garage roof completing a painting job. You heard the employee scream, and heard the ladder fall. You call out to see if all is ok; when you don't get a response you rush over to assess the situation.
PATIENT SUMMARY
The patient slipped while standing at the peak of the garage roof, rolled down the roof, hit the ladder, and fell onto the driveway. He landed on both feet, causing great pain in his feet and back. Patient did not strike his head. Patient is rolling around on the driveway in a great deal of pain (occasional groans, grunts, or gasps). He is able to verbalize clearly when asked questions.
VITAL SIGNS
| Time in minutes |Pulse and respirations |
|Initial |P + 20 R = 24 |
|5 min |P + 20 R = 24 |
|10 min |Decrease to actual if appropriate splinting or |
| |other care/comfort measures are administered |
| |(i.e., high-flow O2 |
|15 min |Actual (as above) |
SCENARIO OBJECTIVES
Decision making
Scene safety. Patient Assessment, correctly identify patient’s injuries, prioritize back injury over ankle injuries. Request spinal immobilization equipment, oxygen, two quick/hill splints, blankets, EMS transport. Notify management of employee injury
Problem management
Standard Precautions, OEC skills: spinal immobilization, general management of a fracture at a joint, oxygen administration. Obtain permission to assist. Appropriate assessment. Fracture management: Applies splints and backboards appropriately. Checks CMS before and after splinting/backboarding. Implements risk management/employee protocols as per area protocols. Transportation decision
Leadership
Directs others appropriately and with confidence, continued communications with patient, and team members, ensure correct OEC skills of helpers where appropriate. Risk management/employee injury protocols as per local protocol. Verbalizes appropriate transportation decision
Scenario #21-03
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: Outside maintenance building/garage on concrete or blacktop driveway
Equipment: Backboard, cervical collar, quick splints, blankets, oxygen per area protocol, gurney or wheeled stretcher
Moulage: Bruising about the ankles
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: Lying mostly on back, writhing in pain
Answers to SAMPLE
Signs and symptoms: lower back pain, pain in both ankles
Allergies: none
Medication: none
Past history: none
Last meal: report actual
Events leading: painting roof peak, slipped and fell off roof
Behaviors: You are in a great deal of pain in your lower back and both ankles. You are writhing about in pain, but comply if asked to lay still. You calm down when reassured, and treatment is initiated and carried out.
SPECIFIC COMMENTS FOR EVALUATORS
Trainee should prioritize back injury over ankle injuries. Additional backboard help should be available upon request.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario # 21-04 Degree of Difficulty = 3
|INJURY |ENVIRONMENT |PERSONNEL |
| |More difficult slope in proximity to a snow gun|Single patient (0) |
|Contusion of head (1) |(0) |Trained patrollers (0) |
|Lower arm fracture (2) | | |
|Medical condition (0) | | |
GENERAL SCENARIO DESCRIPTION
A mid-40s-aged skier was skiing fast on a moderate pitch, caught an edge and fell forward into the base of an unpadded snow gun.
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to an injured skier on a more difficult slope.
Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
The patient has a contusion at the hairline due to collision with a snow gun, and an angulated lower arm fracture with good distal neurovascular response; patient reveals that s/he has chronic hepatitis.
VITAL SIGNS
|Time in minutes |Pulse and respirations |
|Initial |p = 16, r + 6 |
|5 minutes |p = 20, r + 6 |
|10 minutes |p = 24, r + 8 |
|15 minutes |p + 24, r + 8 |
| |to as found by trainee |
SCENARIO OBJECTIVES
Assessment
Verify scene safety
Obtain permission to assist
Primary assessment reveals contusion on head, lower arm fracture, and history of Hepatitis B
Request needed equipment and personnel
Secondary assessment, no other injuries found
Rote Skills
Standard Precautions
Management of head/spine – spinal immobilization
Fracture management – lower arm. Correctly splint arm
CMS before and after splinting
Oxygen administration per area protocol
Lifting Techniques; loading/position in toboggan
Problem Management
Patient stabilization
Treat for shock as appropriate
Verbalize appropriate transportation plan - EMS notification (based on local protocol)
Notify management for collision incident
Scenario #21-04
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: On or at the bottom of a moderate-pitch slope by an unpadded snow gun, or other similar man-made object that would be the source of the head contusion.
Equipment: Toboggan with standard area equipment
(Spine-boarding equipment if not included in the standard toboggan, following local protocols)
Moulage: Contusion at the hairline. Slightly angulated mid-shaft lower arm fracture. Medical Alert tag for Hepatitis B.
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: You are sitting, leaning against the snow gun, alternately cradling your injured forearm and holding your forehead.
Answers to SAMPLE
Signs and symptoms: lower arm pain and deformity, contusion at the hairline
Allergies: none
Medications: none
Past history: you had hepatitis B three years ago after a blood transfusion, and now you have chronic hepatitis
Last meal: report actual
Events leading: you were headed downhill very fast, caught an edge and fell. In attempting to break your fall you put your arm out and fell on it, and then you ran into the snow gun, hitting your head.
Behaviors: You are alternately placing your hand on your head, and cradling your broken arm. You are in some pain from both injuries. You admit that you were stunned on the impact with the snow gun, but know you did not lose consciousness, is responsive,and remains fully oriented. You have a headache from the impact, but deny having any neck pain or back pain.
SPECIFIC COMMENTS FOR EVALUATORS
If local protocols would not require a spine board for this scenario, all evaluators would need to be made aware of this. Oxygen to be called for per area protocol.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario # 21-05 Degree of Difficulty = 5
| INJURY | ENVIRONMENT | PERSONNEL |
|Spine injury (3) |More difficult slope next to lift tower (0) |Single patient (0) |
|Clavicle fracture (2) | |Trained rescuers (0) |
GENERAL SCENARIO DESCRIPTION
The maintenance worker took a hard twisting fall while descending down a lift tower after inspecting sheaves. S/He is laying on her/his side and the injured shoulder.
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to a lift tower for an injured maintenance worker on the more difficult slope. Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
The spinal injury is in the high thoracic area, with no loss of movement or sensation at the outset. The clavicle injury is painful. The patient is calm and cooperative unless mishandled. The patient slipped on ice on the metal ladder about 7 feet above the snow surface. There is 12 inches of fresh snow under the tower.
VITAL SIGNS
| Time in minutes | Pulse and respirations |
|Throughout |p = 110; r = 22 |
SCENARIO OBJECTIVES
Assessment
Verify scene safety; obtain permission to assist. Request needed equipment and personnel
Patient assessment; correctly identify patient's condition; recognize need for EMS/ALS
Rote Skills
Spinal Immobilization
General Management of a Fracture at or Near a Joint
Universal precautions; shock care
Lifting Techniques; loading/position in toboggan
Problem Management
Call management for incident investigation for an employee.
Stabilizing the patient and stabilizing for transport.
Scenario #21-05
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: On a difficult slope with a chair lift tower
Equipment: Toboggan with standard area equipment. (Spine-boarding equipment if not included in the standard toboggan, following local protocols)
Moulage: Hard hat for the worker. Safety harness but not attached to the tower ladder
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: You are lying on your side across the hill with the arm on your injured side under you.
Answers to SAMPLE
Signs and symptoms: pain between the scapulae, and shoulder pain
Allergies: none
Medications: none
Past history: none
Last meal: report actual
Events leading: you are not really sure exactly why you fell, but it was a hard twisting fall, with you landing on your shoulder and twisting your back as you landed on the fresh snow.
Behaviors: You have a specific area of pain and tenderness of the spine between the shoulder blades, and your clavicle is extremely painful as well. You are generally calm and cooperative, unless not handled gently, especially for the shoulder injury. If the cervical collar is not very carefully placed you complain about it causing the clavicle injury to be even more painful. You have not lost sensation anywhere, but you are hesitant to try moving, since it hurts when you do.
SPECIFIC COMMENTS FOR EVALUATORS
Clavicle immobilization can be included in the securing to the backboard, rather than being done as a separate procedure, providing that appropriate manual stabilization is done prior to, and during the log roll, or lift. The clavicle must be immobilized upon completion of the problem. If the trainee determines that the clavicle injury contraindicates use of a cervical collar the alternative method chosen must immobilize the head to the same extent as the cervical collar would.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario # 21-06 Degree of Difficulty = 4
| INJURY | ENVIRONMENT | PERSONNEL |
|Back injury (3) |In the trees - most difficult slope (1) |Single patient (0) |
|Over-the-counter medications (0) | |Trained rescuers (0) |
GENERAL SCENARIO DESCRIPTION
This skier was skiing through some trees when, because of his speed, he was unable to avoid one. He lunged to the left to miss it, but he turned himself around in the process and his back hit the tree he is lying against. Both skis are on.
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to an injured skier in the trees on (by) the most difficult slope. Equipment and available personnel are to be sent upon request.
PATIENT SUMMARY
Though his back hurts, the patient can wiggle his toes; his feet feel a little tingly. He is unable to appreciably move his legs due to the pain in his back. He says he also hit his right shoulder, but this is very minor soreness.
VITAL SIGNS
| Time in minutes | Pulse and respirations |
|Throughout |p = 100; r = 20 |
SCENARIO OBJECTIVES
Assessment
Verify scene safety; obtain permission to assist
Primary assessment reveals pain in back with leg weakness and tingling, and shoulder pain
Request needed equipment and personnel
Secondary assessment, no other injuries found
Rote Skills
Standard Precautions
Ski removal
Management of head/spine – jams and pretzels techniques, spinal immobilization
CMS before and after splinting
Oxygen administration per area protocol
Lifting Techniques; loading/position in toboggan
Problem Management
Patient stabilization – neurological deficit
Treat for shock as appropriate
Verbalize appropriate transportation plan - EMS notification (based on local protocol)
Notify management for collision incident
Scenario #21-06
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: Scenario could also be done around any post or tower on the more difficult hill. If done in the trees, there should not be such density of trees that the extrication becomes a major rescue operation; however, the patient must be in contact with the tree/post, etc.
Equipment: Toboggan with standard area equipment. (Spine-boarding equipment if not included in the standard toboggan, following local protocols)
Moulage: None
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: You are lying more or less on your side with your back up against the tree. Both skis are still on.
Answers to SAMPLE
Signs and symptoms: back pain at site of contact, minor shoulder pain
Allergies: none
Medications: OTC cold medication
Past history: none
Last meal: report actual
Events leading: you were skiing through the trees (maybe a little out of control), and in trying to avoid one you pivoted, fell, and landed up against it.
Behaviors: You have significant pain in your back at the location where it is in contact with the tree. You have very minor pain in the shoulder that is on the snow (do nothing to indicate fracture or dislocation). You have feeling in all extremities, and can wiggle your toes, but your feet are tingly, and movement of your legs is generally weak and increases the pain in your back. You did not hit your head or lose consciousness at all.
SPECIFIC COMMENTS FOR EVALUATORS
Local protocols will determine if the cervical collar would be required.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario # 21-07 Degree of Difficulty = 5
|INJURY |ENVIRONMENT |PERSONNEL |
|Neck/back pain (3) |More difficult slope below a |Single patient (0) |
|Minor nosebleed (1) |jump (0) |Trained rescuers (0) |
|Cold (0) | |Obstructive friends (1) |
GENERAL SCENARIO DESCRIPTION
A snowboarder has done a “head plant” off a jump. S/He is sitting in the snow upon the trainee’s arrival, with his/her friends encouraging him/her to “just get up and come on.” The friends give both the boarder and patrollers quite a hard time about accepting any treatment, despite the boarder’s report of neck and mid-back pain.
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to a snowboarder who has been sitting on the snow below a jump for a short while. Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
The patient has neck and back pain with no initial signs of neurological deficit, and a minor nose bleed. S/He is quite wet, cold, and shivering. Some tingling in the feet is noted about 8 to 10 minutes into the problem. The patient is reluctant to allow the trainee to treat him/her, partly due to the pressure from his/her boarding friends.
VITAL SIGNS
|Time in minutes |Pulse and respirations |
|Throughout |As found |
SCENARIO OBJECTIVES
Assessment
Verify scene safety; obtain permission to assist. Request needed equipment and personnel
Patient assessment: correctly identify patient's condition
Rote Skills
Spinal Immobilization
Bleeding control
Use of universal precautions
Verbalize hypothermia issue and care to be provided in aid room
Lifting Techniques to spine board; loading/positioning on toboggan
Problem Management
Appropriate use of equipment and patrollers
Appropriate treatment and transport plan to aid room
Deal with patient's reluctance to be treated
Neurological deficit
Scenario #21-07
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: More difficult slope below a jump
Moulage: A small amount of blood for under the nose
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: Sitting on the snow with snowboard still on
Answers to SAMPLE
Signs and symptoms: head and neck pain, minor nosebleed
Allergies: none
Medications: none
Past history: none
Last meal: report actual
Events leading: you attempted an inverted aerial, missed the landing, and landed right on your head. You’ve been boarding for a while, and your clothes have gotten damp from previous falls.
Behaviors: Patient—you are sitting on the snow, still kind of collecting yourself after your fall. You’ve wiped under your nose and found a little blood, though your nose is not actively bleeding. You complain of pain in your neck and in the mid-thoracic area, though neither area is really tender to the touch. You are quite cold and shiver throughout the scenario. When the trainee arrives you tell him/her that you think you are OK, and your friends want you to continue to board with them. You know you don’t feel quite right, but you don’t want your friends to think you are a wimp, so unless the trainee can give you a good reason to be treated, you are going to refuse treatment. You do admit to feeling tingling in your feet after about 8–10 minutes, but it takes this and an effective argument by the trainee to convince you to accept treatment.
Friends—you are shredder types who don’t really like patrollers, and you do your best to convince your buddy to come back boarding. You should be somewhat obnoxious in the initial stages of the problem, but do respond to appropriate actions by the trainee/rescuers. Once your buddy has agreed to treatment you can choose to go along with him/her to the aid room, or to just say “so long” and head back up the hill. (You should discuss with your evaluation team which attitude they would like you to take.)
SPECIFIC COMMENTS FOR EVALUATORS
Both patient and friends should be well prepared for their roles. The patient should be aware of the types of reasoning the trainee may use that would convince him/her to ignore his/her friends and allow treatment. A management representative, host, or courtesy person should be available to be sent to the scene upon request of the trainee to help deal with the friends.
P. S. This scenario came just this way from an actual incident. The patient had compression fractures of two upper thoracic vertebrae.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario #21-08 Degree of Difficulty = 4
|INJURY |ENVIRONMENT |PERSONNEL |
|Spinal injury, thoracic and coccyx areas (3) |Stairway (1) |Single patient (0) |
| | |Trained rescuers (0) |
GENERAL SCENARIO DESCRIPTION
A skier fell while walking down the stairs in his/her ski boots. S/He is about halfway down the stairs.
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to an injured skier on the designated stairway.
Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
The patient landed very hard simultaneously hitting his/her tailbone on one step and mid-back on the next step up. Sensation is good at the start of the problem, but some tingling in the legs begins by the end.
VITAL SIGNS
|Time in minutes |Pulse and respirations |
|Throughout |p + 14, r + 4 |
| |to as found by trainee |
SCENARIO OBJECTIVES
Assessment
Verify scene safety; obtain permission to assist
Primary assessment reveals pain in mid-back and tailbone
Request needed equipment and personnel
Secondary assessment, no other injuries found
Rote Skills
Standard Precautions
Management of head/spine – jams and pretzels (stairs) techniques, spinal immobilization
CMS before and after splinting
Oxygen administration per area protocol
Lifting Techniques; loading/position in toboggan
Problem Management
Patient stabilization – circulation deficit as scenario progresses
Treat for shock as appropriate
Verbalize appropriate transportation plan - EMS notification (based on local protocol)
Notify management for fall incident on stairs
Scenario #21-08
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: A staircase, indoors or out, where skiers would normally walk in boots. It should be narrow enough to create a challenge in the evacuation of the patient
Equipment: Toboggan with standard area equipment if outside. (Spine-boarding equipment if not included in the standard toboggan, following local protocols) Spine board and toboggan equipment if indoors. The use of a short board or “KED” type device should be determined by local protocol and the availability of such equipment.
Moulage: None
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: You are semi-sitting, leaning back on the stairs, using your feet to keep you from sliding.
Answers to SAMPLE
Signs and symptoms: pain to coccyx and thoracic areas
Allergies: none
Medications: none
Past history: none
Last meal: report actual
Events leading: you were coming down the stairs and your feet went out from under you
Behaviors: You report that you dropped straight down and hit the stairs hard. The landing was very painful and knocked the wind out of you. You’ve tried moving everything, and although it is not comfortable, you can do so. You have specific areas of pain in your lower thoracic spine and in the sacrum. As the problem progresses you report that you can feel your neck and back stiffening up. You can still move your extremities, but notice some tingling in your legs. This is beginning to concern you. You are okay with the backboard, but complain loudly if they try to straighten out your legs. It is most comfortable if your legs are flexed a moderate amount.
SPECIFIC COMMENTS FOR EVALUATORS
Care and support of the entire torso should be a priority in treatment. Location of the stairway used will help determine if a toboggan or individual equipment will be called for.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario #21-09 Degree of Difficulty = 6
|INJURY |ENVIRONMENT |PERSONNEL |
|Back injury (3) |Below chair lift, not accessible by skiing (1) |Single patient (0) |
|Lower leg fracture (2) | |Trained rescuers (0) |
GENERAL SCENARIO DESCRIPTION
While riding up the lift, the skier fell about 20 feet out of the chair when the chair made an emergency stop. The area under the lift is not accessible by skiing. The patient complains of lower back and lower leg pain.
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to an injured skier under the named chair lift.
Equipment and available personnel to be sent upon request.
If the chair is not about 20 feet up, the trainee should be told that the patient fell about 20 feet.
PATIENT SUMMARY
This patient has mid-thoracic back pain with numbness and tingling in both legs. There is deformity at the location of the lower leg fracture, with some specific pain upon palpation. Circulation checks are made difficult due to the numbness and tingling.
VITAL SIGNS
|Time in minutes |Pulse and respirations |
|Initial |p + 32, r + 2 |
|5 min |p + 36, r + 2 |
|10 min |p + 40, r + 4 |
|15 min |p + 40, r + 4 |
| |to as found |
SCENARIO OBJECTIVES
Decision Making
Verify scene safety; Patient Assessment - correctly identify patient's condition; call EMS; notify management for risk management concerns; determine if there is reason to shut the lift down during the treatment; plan for extrication and evacuation
Problem Management
Appropriate use of rescuers and equipment; appropriate treatment, extrication, and transport plan; OEC skills according to skill performance guidelines - Spinal Immobilization; Injury/Fracture Management - lower leg; Lifting Techniques; use of Standard Precautions; determine chair number for documentation; communicate with lift ops/management to locate witnesses for statements. Prepare Tram report based on your state’s laws.
Leadership
Direct others appropriately and with confidence; continued communications with patient and team members; ensure correct OEC skills of helpers where appropriate
Scenario #21-09
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: Under a chair lift that is not accessible by skiing. If possible the chair should be about 20 feet overhead.
Moulage: Deformity of the lower leg
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: You are lying mostly on your back with your legs curled somewhat under you.
Answers to SAMPLE
Signs and symptoms: back pain with lower extremity numbness, lower leg pain
Allergies: none
Medications: none
Past history: none
Last meal: report actual
Events leading: you were sitting on the chair, and had slid a little forward to adjust your jacket when the chair stopped, you lost your balance and fell out
Behaviors: You are in quite a bit of discomfort, and are rather worried about the numbness and tingling in your lower extremities. When you feel the pain at the fracture site, you express great concern about your condition. Proper reassurance will help reduce your apparent anxiety.
SPECIFIC COMMENTS FOR EVALUATORS
It would be fairly important for the trainee to concern her/himself about working with area management to get the witness statements from others on the chair.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario #21-10 Degree of Difficulty = 6
|INJURY |ENVIRONMENT |PERSONNEL |
|Cervical spine injury (3) |Disentanglement (1) |Single patient (0) |
|Head contusion (1) |Off slope (1) |Trained rescuers (0) |
GENERAL SCENARIO DESCRIPTION
A skier went into deep ungroomed snow in the trees and hit a tree with his/her forehead. The skier is standing, straddling the tree with skis on and poles in hand. His/Her head and neck hurt, and his/her fingers and toes are tingling, but there is no muscular weakness.
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to an injured skier off the slope in the trees.
Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
The patient has a head/neck injury from hitting the tree, and is sort of hugging the tree for support.
VITAL SIGNS
|Time in minutes |Pulse and respirations |
|Throughout |p + 12 to as found |
| |r = as found |
SCENARIO OBJECTIVES
Decision Making
Verify scene safety; Patient Assessment - correctly identify patient's condition; call EMS; notify management for risk management concerns; plan for extrication and evacuation
Problem Management
Appropriate use of rescuers and equipment; appropriate treatment and transport plan; OEC skills according to skill performance guidelines - Spinal Immobilization; Lifting Techniques; use of Standard Precautions; manage ski removal; manage standing spine board; attempt to determine if incident was witnessed and direct witnesses to management for statements
Leadership
Direct others appropriately and with confidence; continued communications with patient and team members; ensure correct OEC skills of helpers where appropriate
Scenario #21-10
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: Off the side of a slope, in deep snow (if possible), straddling a tree
Moulage: Bump/bruising discoloration for the forehead
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: You are standing, straddling, and sort of hugging a tree with all equipment on
Answers to SAMPLE
Signs and symptoms: head and neck pain, contusion
Allergies: none
Medications: uses Proventil inhaler as necessary (has not used today)
Past history: asthma
Last meal: report actual
Events leading: you were skiing near the edge of the trail, and in trying to avoid another skier went off the trail and hit the tree.
Behaviors: You tried to move away from the tree, but your head really hurts and you didn’t know if you could stand up away from the tree. You are nervous, and have some tingling in your fingers. You have no muscular weakness, but if moved away from the tree without support you are too shaken to stand on your own.
SPECIFIC COMMENTS FOR EVALUATORS
This should be located in an area where there is room to do a standing backboard, though the extrication should be somewhat challenging since two of the degree of difficulty points relate to this aspect of the problem.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario # 21-11 Degree of Difficulty = 7
|INJURY |ENVIRONMENT |PERSONNEL |
|Head injury (epidural hematoma—life |Off the trail in an area with trees (1) |Single patient (0) |
|threatening) (4) | |Trained rescuers (0) |
|Clavicle fracture (2) | | |
GENERAL SCENARIO DESCRIPTION
A 10-year-old was skiing with his/her parent in a closed glade area. The child lost control and struck a tree face/shoulder first and was rendered unconscious for one to two minutes. The child regains consciousness, but is woozy and unable to stand. The rescuer does not arrive until approximately 15 minutes after the occurrence of the accident.
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to an injured skier in a closed glade area. The call includes the information that the patient is a child, with his/her parent, and that the accident occurred approximately 15 minutes prior to rescuer notification.
Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
The patient has a closed clavicle fracture, and a serious head injury, with a developing hematoma in the temple area. S/He is responsive though not completely oriented, with good pupil reaction upon arrival of the rescuer, but his/her condition deteriorates throughout the problem, until finally s/he is unresponsive with a fixed pupil on the same side as the head injury. As the problem progresses the trainee must be told that the hematoma is getting progressively worse, and if the trainee checks the eyes, the pupil is fixed and dilated on the injured side.
VITAL SIGNS
|Time in minutes |Pulse and respirations |
|Initial |p = 92, r = 18/regular |
|5 min |p = 75, r = 20/shallow |
|10 min |p = 60, r = 24/shallow |
|15 min |p = 56, r = 24/shallow |
SCENARIO OBJECTIVES
Decision Making
Verify scene safety; Patient Assessment - correctly identify patient's condition; call EMS for ALS transport (helicopter if available); notify management for risk management concerns - document closed slope markings; recognize “load and go” situation (delayed symptoms of head injury); stabilize clavicle fracture only with backboard straps; call for oxygen and suction; plan for extrication and evacuation
Problem Management
Appropriate use of rescuers and equipment; appropriate treatment and transport plan; OEC skills according to skill performance guidelines - Spinal Immobilization; Use of Oxygen and Airway Adjuncts; Fracture Management - clavicle; Lifting Techniques; use of Standard Precautions; interview parent for patient/situation history prior to the arrival of the rescuers; monitor ABCs/vitals throughout
Leadership
Direct others appropriately and with confidence; continued communications with patient and team members; ensure correct OEC skills of helpers where appropriate
Scenario #21-11
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: Any slope with trees or other obstacle that could provide the mechanism of injury. A “trail closed” sign should be visible.
Moulage: A significant area of swelling and discoloration at the temple on the injured side, and a deformity on the clavicle
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: You are lying on your back with the arm on your injured side held across your chest.
Answers to SAMPLE: discovered in interview with parent
Signs and symptoms: altered mental status, positive LOR, discoloration to temple
Allergies: none
Medications: none
Past history: none
Last meal: report actual
Events leading: you and your child were skiing in this glade, and s/he lost control and fell forward into a tree.
Further information from parent: You report that this accident happened about 15 minutes ago. Your child hit the tree pretty hard, and was not responsive for 1 or 2 minutes. When s/he regained consciousness s/he was woozy, could not stand up, and cried out in pain when the shoulder was touched or moved. You tried for at least 5 minutes to get someone’s attention to get help. You are marginally aware that the area you are in is closed. You were mostly watching your child, not the slope signs.
Behaviors: Patient - you are pretty out of it. You know what year it is, but not the day, and you don’t know where you are. Any pressure or movement of your clavicle is very painful. After a while you will become less responsive, until finally you will be completely unresponsive for the rest of the problem. If the rescuer asks you questions to try and keep you talking, you should act a little confused at first, and have trouble answering them. After a while you will be very confused by the questions, and finally you won’t respond at all.
SPECIFIC COMMENTS FOR EVALUATORS
The child patient should be very well prepared for his/her role. S/He should be cued for reductions in responsiveness. The trainee should recognize that the patient is showing delayed symptoms, and switch to “load and go” mode as soon as that becomes apparent. Local protocols would determine if oxygen and suction would be brought to the scene, or if an OP airway would be used. Transport should take into account the need to deal with possible aspiration issue - the spine board could be tipped to the side if the patient is properly secured. The level of rescuer involvement in the documentation of the closed slope would be determined by local policy.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario #21-12 Degree of Difficulty = 6
|INJURY |ENVIRONMENT |PERSONNEL |
|Bilateral calcaneus (heel) fractures (3) |At base lodge (0) |Single patient (0) |
|Back injury (3) | |Trained rescuers (0) |
GENERAL SCENARIO DESCRIPTION
An area employee was repairing a leak on the roof of the lodge when s/he slipped off the ladder and fell approximately 10 feet to the concrete sidewalk below. S/He is found lying on the sidewalk in a lot of pain.
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to an injured employee on the sidewalk at the base lodge. Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
The patient landed on both feet incurring bilateral calcaneal (heel) fractures. The force of the injury was transmitted up the legs to the lumbar spine.
VITAL SIGNS
|Time in minutes |Patient |
| |Pulse and respirations |
|Initial |p + 24, r + 4 |
|5 min |p + 28, r + 4 |
|10 min |p + 32, r + 6 |
|15 min |p + 32, r + 6 |
| |to as found |
SCENARIO OBJECTIVES
Decision Making
Secure scene; patient assessment: correctly identify the patient's condition; prioritize back injury over feet; request needed equipment for spinal immobilization, additional rescuers, and EMS response; notify management for risk management concerns
Problem Management
Standard Precautions; OEC skills; spinal immobilization; fracture management: bilateral heels, ice heels of feet; seek witnesses and get statements; notify management
Leadership
Develop an emergency response plan; provide clear and direct instructions to others; direct others calmly and with confidence throughout all communications during the rescue; ensure correct OEC skills of helpers where appropriate.
Scenario #21-12
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: At the side of the lodge, next to a ladder. The area should be a hard surface (concrete or frozen ground)
Moulage: Swelling and ecchymosis around both ankles and feet
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: Patient is lying on the sidewalk on his/her side.
Answers to SAMPLE:
Signs and symptoms: pain in both feet and point tenderness in lumbar area of spine
Allergies: none
Medications: none
Past history: none
Last meal: report actual
Events leading: standing at the top of a ladder working on the roof trying to fix a water leak. The patient lost his/her balance, and as s/he started to fall, s/he jumped and landed on his feet.
Behaviors: You have extreme pain in both feet. Your anxiety causes you to talk constantly about various worries such as your ability to do your job and that you have no health insurance. When asked, you have pain in the lumbar area of your spine and point tenderness on palpation.
SPECIFIC COMMENTS FOR EVALUATORS
Area management should be contacted for risk management concerns. EMS should be contacted early in scenario.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario #21-13 Degree of Difficulty = 4
|INJURY |ENVIRONMENT |PERSONNEL |
|Head injury with altered level of |Outside in front of the base area ski racks |Single patient (0) |
|consciousness (3) |(0) |Trained rescuers (0) |
|Shoulder contusion (1) | | |
|Chipped tooth (0) | | |
GENERAL SCENARIO DESCRIPTION
A 40-year-old female is visiting the resort with her 10-year-old son and 9-year-old niece. They have been skiing all day and it is now 2:00 in the afternoon. After they exited the chair, they were getting ready to ski down an intermediate slope. A snowboarder shoots off the bank and blindly strikes the 40-year-old in the shoulder and head. The snowboarder takes off. The 10-year-old saw it all happen. He then spends the next hour helping his mom get down the hill. She can ski but is having trouble and cannot move very quickly. They finally make it.
INFORMATION GIVEN TO TRAINEE
You ski into the base area where the lodge and the aid room are located. You are removing your skis when the 9-year-old niece asks if you could help her aunt. The 10-year-old son is standing above his mom trying to help her with her gear. She is sitting in the snow. The son tells you of the collision and also that his mom isn’t acting like herself at all.
PATIENT SUMMARY
The patient is confused and doesn’t remember how she got there. Her front tooth is chipped but not bleeding. Her shoulder is sore, but she has movement and use of it.
VITAL SIGNS
| Time in minutes |Pulse and respirations |
|Throughout |As found |
SCENARIO OBJECTIVES
Assessment
Verify scene safety; obtain permission to assist
Primary assessment reveals a possible closed head injury, shoulder strain, and fractured tooth
Prioritize head injury over shoulder; assess the needs of the children
Request needed equipment, additional personnel
Secondary assessment, no other injuries found
Rote skills
Standard Precautions
Spinal immobilization
CMS before and after securing to backboard
Oxygen administration per area protocol
Problem Management
Patient stabilization - management of traumatic brain injury
Treat for shock as appropriate
Notify management due to collision; try to identify boarder who collided with patient
Address needs of the children who are concerned about their mother and aunt
Verbalize appropriate transportation plan - EMS notification (based on local protocol)
Scenario #21-13
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: In the base area at the bottom of the hill, where the ski racks are located; aid room is close by
Equipment: Toboggan with standard area equipment; oxygen per area protocol
(Spine-boarding equipment if not included in the standard toboggan, following local protocols)
Moulage: Chipped front tooth
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: Sitting in snow near the base with the 10-year-old and 9-year-old around her trying to help. The 10-year-old is very concerned about mom. She keeps asking him what happened and how she got here. She is rubbing her shoulder trying to figure out what happened. The 10-year-old answers his mom, but she keeps asking him the same questions over and over. Her questions make him feel very uncomfortable about the situation. The 9-year-old is looking around when she spots you and asks for help. The 10-year-old can answer questions to what happened if asked.
Answers to SAMPLE;
Signs and symptoms: mental confusion, pain in shoulder, chipped tooth
Allergies: not sure
Medication: not sure
Past history: not sure
Last meal: lunch time
Events leading: she isn’t sure but 10-year-old can tell the whole story, including the collision, his helping her get down, and that she is not acting normal
Behaviors: You keep asking what happened and how you got here. Ask why shoulder hurts some, and why one of your teeth feels so sharp on your tongue. Keep asking the 10-year-old what happened over and over. He keeps answering you and is now asking why she keeps doing that. You also complain that your head and neck are sore.
SPECIAL COMMENTS TO EVALUATORS
This scenario provides opportunity for the rescuer to demonstrate their assessment skills through questioning others, especially children. Because of the traumatic experiences to a parent, they also need to demonstrate sensitivity and care with the children to calm and reassure them.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario #21-14 Degree of Difficulty = 6
|INJURY |ENVIRONMENT |PERSONNEL |
|Head injury, unresponsive (4) |Extreme slope (1) |Untrained personnel (1) |
| | |Trained rescuers (0) |
GENERAL SCENARIO DESCRIPTION
A 14-year-old male is skiing with friends following the chair line on a steep chute. He catches an edge and falls striking a snow gun tower. The skier is wearing a helmet which now has scrapes and a dent in the front and goggles smashed into his face. The kids skiing with him are upset and concerned about their friend. They can help if asked but must be directed.
INFORMATION GIVEN TO TRAINEE
You are near the top of the mountain when someone on the chair lift yells to you that someone is hurt below the chair at a snow gun. You report this to dispatch and that you are responding. They tell you equipment and personnel will be sent upon request.
PATIENT SUMMARY
The patient is unresponsive. There is bruising around his eyes where the goggles had been. There is a large dent in the helmet just above the eyes. There is a pink/clear fluid oozing from his nose. The patient is lying on his side. One ski is still on and dug into the snow keeping him from sliding down. There is no apparent airway problem.
VITAL SIGNS
|Time in minutes |Pulse and respirations |
|Throughout |p = 70, r = 8 shallow |
| |p = 60, r = 12 deep |
| |p = 50, r = 10 shallow continues throughout|
SCENARIO OBJECTIVES
Decision Making
Secure scene; patient assessment of unresponsive patient: correctly identify patient’s condition; address ABCs; recognize that this is life threatening; extrication is difficult because of slope and his being held by ski; call for a rapid extrication with full trauma pack and additional personnel; request ALS response; notify management for risk management concerns due to collision with tower.
Problem Management
Standard Precautions including untrained helpers; OEC skills: spinal immobilization, oxygen administration, airway management: airway adjuncts, suctioning of the oral cavity; and helmet removal; develop an emergency treatment, extrication, and transport plan, which includes the fact that the ski removal is part of the extrication or the patient will slide down the hill; rescuers and equipment; appropriate treatment; check for EMS ETA
Leadership
Direct others with clear instructions and with confidence; ensure correct OEC skills of helpers, including Standard Precautions; direct Standard Precautions cleanup; discus event with bystanders and rescuers; consider CISD if needed
Scenario #21-14
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: Just below a chair tower on an extreme steep slope. Patient is held from sliding further down the slope by one ski in the snow.
Equipment: Toboggan with standard area equipment
(Spine-boarding equipment if not included in the standard toboggan, following local protocols)
Moulage: Raccoon eyes, pink/clear fluid from nose, soft tissue damage in the face, smashed goggles, and dented helmet.
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: Patient is found lying perpendicular to the fall line with head up hill.
Answers to SAMPLE
Signs and symptoms: patient is unresponsive
Allergies: unknown
Medications: unknown
Past history: unknown
Last meal: 1 hour ago—reported by friends, if asked
Events leading: friends report they were racing down the slope
Behaviors: The patient is unresponsive the whole time. If the airway is not protected, the patient will start having airway problems. If oxygen isn’t administered, the patient deteriorates and breathing will change during scenario (Cheyne-Stokes respirations). If airway isn’t protected, airway will not remain clear. Friends (bystanders) can help only if directed properly until other trained help arrives. Friends are very worried about their hurt pal, but they can be kept in control if talked to.
SPECIFIC COMMENTS FOR EVALUATORS
If care is quickly and correctly provided, the patient stabilizes. If not, he deteriorates quickly over time.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario #21-15 Degree of Difficulty = 7
| | | |
|Injury |Environment |Personnel |
| | | |
|Back injury (3) |On a cat track, mid-slope, under a flipped |Single patient (0) |
|Probable abdominal injuries (2) |snowmobile, with area management concerns (2) |Trained rescuers (0) |
GENERAL SCENARIO DESCRIPTION
While conducting daily opening activities, the lift supervisor is descending a blue graded slope on a snowmobile. The fresh snow from the night before is sticky and wet. As he navigates around a mogul, the front right ski binds up in the snow and rolls the snowmobile. The lift supervisor stays with the machine as it rolls over top of him for several rotations and until it lands on its side and on top of the lift supervisor on a cat track.
INFORMATION GIVEN TO TRAINEE
Dispatch: you receive a radio call that the lift supervisor has crashed his snowmobile at mid-mountain and is pinned under the machine. Equipment and available personnel will be sent upon request.
PATIENT SUMMARY
The patient is a conscious, but dazed, lift supervisor (35 years old, no medical conditions or problems) lying prone on the snow, with the tail end (the track and seat portion) of the snowmobile lying on his hips and legs. The snowmobile is in an upright position, damaged, but movable. Scene survey denotes the smell of gasoline.
VITAL SIGNS
| | |
|Time in minutes |Pulse and respirations |
| | |
|Initial |p = 108/strong, r = 18/deep |
|1 minute |p = 112/strong, r = 20/shallow |
|5 minutes |p = 120/weakening, r = 15/shallow |
|10 minutes |p = 130/thready, r = 10/shallow |
|15 minutes |p = 136/thready, r = 10/shallow |
SCENARIO OBJECTIVES
Decision Making
Secure scene and turn off the snowmobile; make sure other rescuers know that gas is involved immediately upon arrival; patient assessment: correctly identify patient’s condition, recognize need for rapid extrication; request needed equipment, additional personnel, and ALS response; notify area management for staff injury issues and removal of the snowmobile.
Problem Management
Standard Precautions; OEC skills: spinal immobilization; oxygen administration; shock management due to possible internal injuries; ongoing vitals and ABC management; protection from cold injuries; develop emergency care plan for rapid extrication and transfer to ALS.
Leadership
Direct others with appropriate commands and ideas with confidence. Communicate with patient throughout rescue operation; give clear directions while executing plan of action. Complete documentation per local protocol.
Scenario #21-15
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location: flat area between two slopes of a hill
Moulage: None
Weather: Must be the same as day of scenario
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position is lying on your belly, legs extended, and a weight pressing on the hips, buttocks, and upper thigh area of your body.
Answers to SAMPLE
Signs and symptoms: chief complaint is hips and legs hurt. No signs of external hemorrhage or blood loss
Allergies: none
Medications: Valtrex, (antiviral, noncontributory)
Past History: none
Last Meal: breakfast 7:00 a.m.
Events leading: coming down the hill after checking the upper section of the lift. Skis of the snowmobile got caught up in thicker snow, causing him to lose control and roll the snowmobile. He decided to stay with the machine as it rolled rather than bailing off.
Behaviors: You are experiencing severe pain in your lower back and moderate pain in your abdomen. You are panicked that the snowmobile is lying on top of you. You are having difficulty feeling your legs (only due to the machine being on top of you). You are constantly afraid because you smell leaking gasoline and can’t do anything about it.
SPECIFIC COMMENTS FOR EVALUATORS
Trainee should recognize a load-and-go situation, the immediate need for EMS transport, additional personnel, area management involvement, and scene safety from leaking and vaporizing gasoline.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario # 21-16 Degree of Difficulty = 5
|INJURY |ENVIRONMENT |PERSONNEL |
|Unresponsive (4) |More difficult slope (0) |Single patient (0) |
|Laceration - minor bleeding (1) |(narrow area if available) |Trained rescuers (0) |
|Medical condition (0) | | |
GENERAL SCENARIO DESCRIPTION
A skier was on a narrow slope, and became airborne off a mogul. On landing s/he hits a tree (or other object) with his/her head and falls forward onto a jagged rock (or other object) causing a laceration to the thigh. The accident was witnessed by the skier’s friend, who stays on the scene.
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to an injured skier on the designated slope.
Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
The patient is unresponsive throughout, but stable. The bleeding from the laceration on the thigh is only minor, but the friend reveals that the patient is HIV positive.
VITAL SIGNS
|Time in minutes |Pulse and respirations |
|Throughout |p + 30, r + 10 |
| |to as found |
SCENARIO OBJECTIVES
Decision Making
Verify scene safety; Patient Assessment - correctly identify patient's condition; call EMS for ALS transport; recognize need for rapid transport, notify management for risk management concerns; call for oxygen
Problem Management
Appropriate use of rescuers and equipment; appropriate treatment and transport plan; OEC skills according to skill performance guidelines - Spinal Immobilization, Use of Oxygen and Airway Adjuncts, Bleeding Control, properly bandage wound; use of Standard Precautions; monitor ABCs/vitals throughout; logroll directly onto the backboard; plan to deal with bloody rock and snow; direct friend to management for witness statement. Locate Medic Alert tag for HIV.
Leadership
Direct others appropriately and with confidence; continued communications with patient and team members; ensure correct OEC skills of helpers where appropriate; monitor entire situation and all participants in regards to adhering to Standard Precautions and local infection control plan
Scenario #21-16
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: A steep narrow trail is preferred. If not available, a more difficult slope near the edge with a tree, post, etc., and something that could cause the laceration would be needed.
Moulage: Torn pants with a laceration with minor bleeding. Some blood should be on the jagged object and the snow (use small piece of angle iron or pipe sticking out of the snow), but should not be visible until the patient is rolled.
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: You are lying prone, with your leg over the object that has cut your thigh.
Answers to SAMPLE: discovered in interview with friend
Signs and symptoms: unresponsive, laceration with minor bleeding
Allergies: none
Medications: takes “cocktail” of drugs for HIV, but does not know the names
Past history: HIV positive
Last meal: report actual
Events leading: friend reports that the patient hit the bump unexpectedly, and was thrown off balance causing him/her to fall. S/He hit the tree during the fall, and slid a little ways down the hill.
Behaviors: Patient is unresponsive throughout.
Friend - You are concerned about your friend. You saw him/her strike the tree, but didn’t realize that s/he had a bleeding wound. You become a little nervous after you see the blood, but don’t volunteer the information about the HIV unless asked. If not asked, you could wait until the very end when they seem ready to transport your friend and then nervously say that there’s something the rescuers might want to know, and then tell about the HIV.
SPECIFIC COMMENTS FOR EVALUATORS
Local protocol would determine if oxygen would be brought to the hill or readied in the aid room. Trainee should be asked to verbalize the local blood-borne pathogen cleanup plan.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario #21-17 Degree of Difficulty = 5
|INJURY |ENVIRONMENT |PERSONNEL |
|Concussion (2) |Easiest slope (0) |Multiple patients (1) |
|Humerus fracture (2) | |Trained rescuers (0) |
GENERAL SCENARIO DESCRIPTION
A young beginning skier is slowly doing traverses on the easiest hill and is overtaken by another skier who loses control just above him. The out-of-control skier knocks the youngster down before falling forward and hitting his own head.
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to injured skiers on the easiest hill.
Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
Patient #1 is the child patient and s/he has pain and swelling to the upper arm (mid-humerus).
Patient #2 has a tender spot on his temple, seems stunned, and when questioned can’t remember what happened. He repeatedly asks the trainee what happened.
VITAL SIGNS
|Time in minutes |Patient #1 |Patient #2 |
| |Pulse and respirations |Pulse and respirations |
|Initial | |p + 16, r + 4 |
|5 min |p + 32, r + 8 |p + 16, r + 2 |
|10 min |throughout |p + 12, r + 2 |
|15 min | |p + 12, r + 2 |
| | |to as found |
SCENARIO OBJECTIVES
Decision Making
Verify scene safety; Patient Assessment - correctly identify patient's condition; call EMS; notify management for risk management concerns; recognize need for spine board due to neurological deficits; prioritize head injury over humerus
Problem Management
Appropriate use of rescuers and equipment; appropriate treatment and transport plan; OEC skills according to skill performance guidelines – Injury/Fracture Management - mid humerus, Spinal Immobilization - head injury; oxygen administration; Lifting Techniques; use of Standard Precautions; attempt to determine if incident was witnessed and direct witnesses to management for statements; plan for locating parents or responsible adult
Leadership
Direct others appropriately and with confidence; continued communications with patient and team members; ensure correct OEC skills of helpers where appropriate
Scenario #21-17
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: An easiest slope area with no obstacles
Moulage: None
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENTS
Position: Patient #1 - you are lying on your uninjured side with your skis on, holding your injured arm.
Patient #2 - you are lying on your side, rolled toward your back. Your equipment is scattered.
Answers to SAMPLE: (both patients)
Signs and symptoms: Pt. 1 - humerus pain; Pt. 2 - altered mental status, memory problems
Allergies: none
Medications: none
Past history: none
Last meal: report actual
Events leading: Pt. 1 says s/he was just going slowly across the slope when this other skier came up from behind and just bashed into him/her really hard and knocked him/her down. Pt. 2 cannot remember what happened.
Behaviors: Patient #1 - you complain about your arm hurting, but once it’s splinted you are comfortable and able to walk if asked. If asked, you report that your parents dropped you off here and went shopping. You don’t really know how to get a hold of them, and they are not due back to pick you up for another hour and a half.
Patient #2 - you don’t know what happened, and when told, you act surprised. Every couple of minutes you ask what happened again (short-term memory deficit) and act surprised again. You know who you are, but are not oriented to place or time. You act just slightly confused, and indicate that you are OK, with just a little bump on the head, and don’t really want the trainee to do anything for you. You do eventually concede to being put on the spine board.
SPECIFIC COMMENTS FOR EVALUATORS
Patient #2 must be well coached to appear to be just fine, though slightly confused, with the short-term memory problem and lack of orientation to place and time being the only clues that the trainee has to the need for the spine board.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario # 21-18 Degree of Difficulty = 5
| INJURY | ENVIRONMENT | PERSONNEL |
|Unresponsive (4) |Off a more difficult slope by a lift tower (1)|Single patient (0) |
|Broken binder from area rental ski (0) | |Trained rescuers (0) |
GENERAL SCENARIO DESCRIPTION
The skier is lying on his/her side with skis on, and is close to, but not in contact with, a lift tower or similar obstacle. The skier is unresponsive.
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to a skier lying by a lift tower. Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
The patient is unresponsive throughout with rapidly progressive neurological shock. When trainee checks the patient's eyes during the secondary survey, they should be told that they are unequal in size and response to light.
VITAL SIGNS
| Time in minutes | Pulse and respirations |
|initial |p = 92; r = 16 |
|5 min |p = 80; r = 14 |
|10 min |p = 60; r = 12 |
|15 min |p = 54; r = 12 |
SCENARIO OBJECTIVES
Decision Making
Verify scene safety; request needed equipment and personnel; Patient Assessment; correctly identify patient's condition; recognize load and go situation; recognize need for oxygen and EMS (request ALS)
Problem Management
Appropriate use of rescuers and equipment, appropriate treatment and transport plan, OEC skills according to skill performance guidelines – Trauma - head injury and spine injuries management - Spinal immobilization, including use of AVPU scale; use of Standard Precautions; shock care; Use of Oxygen and airway management, ski removal, Lifting Techniques. Call management for incident investigation due to unknown tower contact and broken area rental equipment.
Leadership
Direct others appropriately and with confidence; continued communications with patient and team members; ensure correct OEC skills of helpers where appropriate
Scenario #21-18
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: Off a more difficult slope by a lift tower (or similar obstacle). This is not meant to be a jams and pretzels problem. The patient should be placed in such a way that it is clear that s/he hit the "tower," but is not in direct contact with it.
Moulage: Swelling and ecchymosis on the head from the temporal to the occipital areas on one side (Battle’s sign). Ski with a broken or removed binding. If not available, label binding with masking tape with BROKEN on it.
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: You are lying on your side, across the hill, with skis on. You are near, but not in contact with, a lift tower (or similar obstacle).
Answers to SAMPLE
NONE, due to unresponsive patient
Behaviors: You are unresponsive throughout, however your responses to stimuli as outlined in AVPU deteriorate, so early on you may make some slight response to a shout, and a groan to a painful stimuli. As the problem progresses, your responses to painful stimuli decrease, until finally you respond to nothing at all.
SPECIFIC COMMENTS FOR EVALUATORS
The decision to bring oxygen to the hill would be based on local protocols.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario #21-19 Degree of Difficulty = 6
|INJURY |ENVIRONMENT |PERSONNEL |
|Unresponsive (4) |More difficult slope (0) |Single patient (0) |
|Skull fracture (1) | |Trained rescuers (0) |
|Laceration (1) | | |
|Hepatitis C positive (0) | | |
GENERAL SCENARIO DESCRIPTION
The ski area has been closed about 45 minutes. Two college students take cafeteria trays, climb to the top of a hill, and attempt to ride the trays to the bottom. One of them hits a lift tower.
INFORMATION GIVEN TO TRAINEE
Dispatch: Witness came in to inform the rescuer that there is an injured person on the more difficult hill, and that s/he is not moving. Witness also informs the trainee that friend is Hepatitis C positive.
Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
The patient is deeply unresponsive, and breathing is irregular. There is a laceration on the scalp, a depressed skull fracture, and CSF is draining from the nose and ears. When the trainee looks for drainage from the ears, if moulage is not used, they should be informed that s/he sees drainage from the ears. If pupils are checked, one is dilated and not responsive to light.
VITAL SIGNS
|Time in minutes |Patient #1 |
| |Pulse and respirations |
| | Appropriate care |Inappropriate care |
|Initial |pulse is irregular, (p = 92) and weak (p = |patient quits breathing and goes |
|5 min |76), and |into cardiac arrest |
|10 min |dropping (p = 56) | |
| |resp. are Cheyne stokes type | |
SCENARIO OBJECTIVES
Decision Making
Verify scene safety; Patient Assessment - correctly identify patient's condition; call EMS for ALS transport; notify management for risk management concerns; recognize rapid transport situation and need for oxygen; prioritize airway/breathing over spinal precautions
Problem Management
Appropriate use of rescuers and equipment; appropriate treatment and transport plan; OEC skills according to skill performance guidelines; Trauma, head injury and Spine injuries management - Spinal Immobilization, Use of Oxygen and Airway Adjuncts, Lifting Techniques; use of Standard Precautions; monitor ABCs/vitals throughout
Leadership
Direct others appropriately and with confidence; continued communications with patient and team members; ensure correct OEC skills of helpers where appropriate; monitor entire situation and all participants in regards to adhering to Standard Precautions and local infection control plan
Scenario 21-19
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: Close to a lift tower or similar obstacle. The patient should not be jammed into it.
Moulage: Blood at the mouth, nose, and ears. Depressed skull fracture area on the back of the head in the occipital region. Medic Alert tag for Hepatitis.
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: You are lying on your side, head uphill
Answers to SAMPLE: answers from witness
Signs and symptoms: unresponsive
Allergies: none
Medications: unknown name but pills for Hepatitis C
Past history: Hepatitis C
Last meal: report actual
Events leading: the witness reports that he and the patient decided to go “traying” after the area closed and his friend went out of control and slid into the tower
Behaviors: You are deeply unconscious, and remain unresponsive to any stimuli throughout.
SPECIFIC COMMENTS FOR EVALUATORS
The trainee should be quizzed with regard to the local infection control plan. Evacuation must be completed within 15 minutes. The trainee should recognize that the deteriorating vitals indicate increasing intracranial pressure.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario # 21-20 Degree of Difficulty = 6
|INJURY |ENVIRONMENT |PERSONNEL |
|Head injury (2) |Snow fence along the side of a trail by a post |Single patient (0) |
|Knee sprain (2) |(1) |Trained rescuers (0) |
|Laceration with minor bleeding (1) | | |
GENERAL SCENARIO DESCRIPTION
It is late in the afternoon and a skier has decided to give the bowl one last try before going home. The slope is hard packed and icy, so s/he does not get very far down the slope before losing control. S/He goes over a mogul and is thrown backwards, hitting his/her head sharply on the ice. His/Her skis release, and one hits him/her in the head. S/He then slides into a snow fence at the side of the trail. S/He hooks a leg on one of the snow fence posts, which brings him/her to an abrupt stop.
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to an injured skier at the edge of the bowl by the snow fence.
Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
The patient has a sprained knee, head injury with no loss of consciousness or altered level of responsiveness, and a laceration in the scalp from the ski, with only minor bleeding.
VITAL SIGNS
|Time in minutes |Pulse and respirations |
|Initial |p + 16, r + 6 |
|5 min |p + 16, r + 4 |
|10 min |p + 12, r + 4 |
|15 min |p + 12, r + 2 |
| |to as found |
SCENARIO OBJECTIVES
Decision Making
Verify scene safety; Patient Assessment - correctly identify patient's condition; call EMS; notify management for risk management concerns; prioritize head injury over knee; plan for extrication and evacuation
Problem Management
Appropriate use of rescuers and equipment; appropriate treatment and transport plan; OEC skills according to skill performance guidelines – Head Injury Management - Spinal Immobilization; Injury/Fracture Management - knee; Bleeding control and bandaging - direct pressure; Lifting Techniques; use of Standard Precautions
Leadership
Direct others appropriately and with confidence; continued communications with patient and team members; ensure correct OEC skills of helpers where appropriate
Scenario #21-20
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: Edge of a hard-packed mogul slope with fence post available
Moulage: Small laceration on the forehead near the hairline, minor bleeding
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: You are lying on your side with your skis off and your injured leg still somewhat hung up in the fence.
Answers to SAMPLE
Signs and symptoms: head injury “saw stars; knee pain; laceration with minor bleeding,”
Allergies: none
Medications: none
Past history: none
Last meal: report actual
Events leading: you were doing one last run, and didn’t realize that conditions had gotten so icy. You were going too fast, hit a mogul, fell backwards, and started sliding.
Behaviors: Complain of your head hurting, and feeling a little nauseated. You are upset when you touch your forehead and find it bloody. You report “seeing stars” when you fell, but are sure you did not lose consciousness. You are distracted, but fully responsive. You know you hurt your knee when your motion was stopped by getting tangled in the fence post. You heard and felt it pop. It really hurts, is tender on the medial side, and you will not extend it fully because of the pain.
SPECIFIC COMMENTS FOR EVALUATORS
If the patient’s knee is bent at such an angle that appropriate use of padding under the knees coupled with proper securing to the board would accomplish both objectives, then a separate knee splint would not be necessary.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario #21-21 Degree of Difficulty = 7
|INJURY |ENVIRONMENT |PERSONNEL |
|Unresponsive patient (4) |More difficult slope (0) |Multiple patients (1) |
|Lower leg soreness (0) |(converging trails if available) |Delayed help/bystander (1) |
| | |Obnoxious patient (1) |
GENERAL SCENARIO DESCRIPTION
Two skiers collide at a high rate of speed. A younger skier is knocked unconscious. The middle-aged skier starts to yell that his leg hurts, and it was all the kid’s fault, and he is going to sue.
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to injured skiers on the more difficult hill.
No equipment or personnel will be available for about 10 minutes.
Witness report: both skiers were skiing fast and it seemed like they both just turned into each other. They seemed to be pretty much across the hill from each other when first seen by the witness; neither could be identified as the uphill skier.
(If the scenario is placed at converging trails, alter the story to indicate that both skiers just arrived at the same time.)
PATIENT SUMMARY
Patient #1 - This patient is unresponsive through the early stages of the problem, and only begins to “come around” when the help arrives with the toboggan. S/He is stable throughout, and has no other injuries.
Patient #2 - This patient has a sore lower leg, but can walk if encouraged. He provides distraction to the trainee by threatening to sue the younger skier, and being a general pain, but he will calm down if reasoned with or directed to a “calming” influence such as a management person.
VITAL SIGNS
|Time in minutes |Patient #1 |Patient #2 |
| |Pulse and respirations |Pulse and respirations |
|Initial |p + 20, r + 4 | |
|5 min |p + 12, r + 2 |as found |
|10 min |as found | |
|15 min | | |
SCENARIO OBJECTIVES
Decision Making
Verify scene safety; Patient Assessment - correctly identify patient's condition; call EMS; notify management for risk management concerns; choose method to contain obstructive patient; determine method to monitor unresponsive patient while waiting for help and dealing with obstructive patient
Problem Management
Appropriate use of bystanders and equipment; appropriate treatment and transport plan; OEC skills according to skill performance guidelines - Head Injury Management - spinal immobilization; Use of oxygen; Lifting Techniques; use of Standard Precautions; attempt to determine if incident was witnessed and direct witnesses to management for statements
Leadership
Direct others appropriately and with confidence; continued communications with patient and team members; ensure correct OEC skills of helpers where appropriate
Scenario #21-21
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: This can be positioned anywhere on a more difficult hill. If it can be put where two trails converge, add that element to the “events leading” explanation.
Moulage: None
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: Patient #1 - you are lying in approximately the “coma”/recovery position, both skis off
Patient #2 - you are sitting on the snow a short distance away from Patient #1 rubbing your leg.
Answers to SAMPLE: (both patients)
Signs and symptoms: Pt. #1 – unresponsive; Pt. #2 - lower leg soreness
Allergies: none
Medications: patient #2 - Hytrin, taken on schedule (if patient #2 is male)
Past history: patient #2 - benign prostatic hypertrophy (if patient #2 is male)
Last meal: report actual
Events leading: patient #2 reports that patient #1 ran into him. Patient #1, if asked later in the problem, reports that he was skiing fast and all of a sudden patient #2 was “just there” and they collided
Behaviors: Patient #1 - you are unresponsive through the early part of the problem, and when you do “come around” you remain quiet and report hurting all over. If asked at that time what happened you report remembering only that you were skiing pretty fast, and then it seemed that the other guy was “just there” and you ran into each other.
Patient #2 - you are sitting rubbing your lower leg when the rescuer arrives, and immediately begin blaming the whole thing on the younger skier, saying your leg is really sore, it was all his fault, and you intend to sue. When the trainee leaves you to talk to witnesses or to check on patient #1, you get up and walk over to try and grab his/her attention further with your complaints. If presented with an assertive, reasonable request to curb your complaining for a later time, you do comply. If turned over to a management-type person, you then focus your attention there and are out of the loop with the trainee.
SPECIFIC COMMENTS FOR EVALUATORS
Rescuer help is delayed for about 10 minutes. However, if an area staff person (i.e., management, “courtesy,” or “host”) would normally be available to assist with this type of incident, they should be made available shortly after being called. The witness should come forward and identify him/herself early in the problem, and then be available to the trainee as a bystander, and should respond appropriately to any request to fill out a report or accompany him/her to the aid room, office, etc.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario #21-22 Degree of Difficulty = 7
|INJURY |ENVIRONMENT |PERSONNEL |
|Unresponsive patient (4) |More difficult to most difficult slope (0) |Multiple patients (1) |
|Laceration (2) | |Trained rescuers (0) |
GENERAL SCENARIO DESCRIPTION
It is the day for Nastar races at your area. One of the racers coming down the hill goes out of control, does a tumbling fall, and goes into the crowd at a high rate of speed, hitting a spectator in the arm with a ski.
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to an injured skier who has gone off the Nastar race course.
Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
Patient #1 remains unresponsive throughout. If pupils are checked, they are equally responsive.
Patient #2 has a deep laceration on the arm with continuous (arterial) bleeding.
VITAL SIGNS
|Time in minutes |Patient #1 |Patient #2 |
| |Pulse and respirations |Pulse and respirations |
| | |Appropriate care |Bleeding not controlled |
|Initial | |p + 20 |p + 20 |
|5 min |As found |p + 16 |p + 20 |
|10 min | |p + 12 |p + 24, r + 6 |
|15 min | |p + 12 |p + 28, r + 6 |
| | |to as found |to as found |
SCENARIO OBJECTIVES
Decision Making
Verify scene safety; Patient Assessment - correctly identify patient's condition; call EMS for ALS transport; notify management for risk management concerns; prioritize unconscious patient over laceration
Problem Management
Appropriate use of rescuers and equipment; appropriate treatment and transport plan; OEC skills according to skill performance guidelines – Head Injury Management - Spinal Immobilization, Bleeding Control and bandaging - severe; Lifting Techniques; use of Standard Precautions; request suspension of racing activities until the area is clear; effective crowd control plan; monitor ABCs/vitals of unresponsive patient
Leadership
Direct others appropriately and with confidence; continued communications with patient and team members; ensure correct OEC skills of helpers where appropriate; monitor entire situation and all participants in regards to adhering to Standard Precautions and local infection control plan
Scenario #21-22
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: On a slope that would be used for Nastar-type races, but not on the course itself. It would be especially effective if a number of people could be recruited as spectators.
Moulage: Patient #1, none. Patient #2 - a jacket with a cut sleeve exposing a laceration with a method for providing continuous bleeding until dealt with properly.
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: Patient #1 is lying across the slope, semi-curled up with skis off.
Patient #2 is sitting, holding the injured arm.
Answers to SAMPLE: Patient #2 (patient #1 will have nothing to indicate any positive responses to any SAMPLE categories)
Signs and symptoms: Pt. #1 unresponsive; Pt. #2 laceration and bleeding
Allergies: none
Medications: none
Past history: none
Last meal: report actual
Events leading: you were standing watching the race when suddenly this racer took a tumbling fall straight at you and knocked you down. His flying ski hit you right in the arm.
Behaviors: Patient #1 - you remain unresponsive throughout, though you would groan if roughly handled. If checked, you have reflexive response to painful stimuli.
Patient #2 - you are cooperative and are willing to hold a dressing on your laceration. If nothing is done for your bleeding for a while after the rescuer gets there, you can express some concern about the bleeding. If direct pressure is not used effectively, keep the bleeding going until a tourniquet is used.
SPECIFIC COMMENTS FOR EVALUATORS
Local protocol would determine if oxygen would be brought to the hill or readied in the aid room. Be sure that Patient #2 is well prepared for the role of the “bleeder” so that the trainee has an accurate representation of the bleeding.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario #21-23 Degree of Difficulty = 7
|INJURY |ENVIRONMENT |PERSONNEL |
|Unresponsive patient (4) |Side of a racecourse (0) |Single patient (0) |
|Facial abrasions/lacerations (1) | |Trained rescuers (0) |
|Lower arm fracture (2) | | |
GENERAL SCENARIO DESCRIPTION
A racer hooks an edge and goes off the racecourse, out of control, head and hand first into a stationary object. He then slides to a low area at the side of the course. His coach witnessed the fall.
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to an injured racer on the side of the racecourse.
Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
The patient is unresponsive, has numerous facial abrasions/lacerations, as well as deformity of the lower arm near the wrist. Patient is wearing an open-face helmet. If pupils are checked, they are equally responsive to light.
VITAL SIGNS
|Time in minutes |Pulse and respirations |
|Initial |p + 12, r + 4 |
|5 min |p + 12, r + 6 |
|10 min |p + 20, r + 6 |
|15 min |p + 20, r + 8 |
| |to as found |
SCENARIO OBJECTIVES
Decision Making
Verify scene safety; Patient Assessment - correctly identify patient's condition; call EMS for ALS transport; notify management for risk management concerns; prioritize unresponsiveness over lacerations and lower arm fracture; call for oxygen
Problem Management
Appropriate use of rescuers and equipment; appropriate treatment and transport plan; OEC skills according to skill performance guidelines – Head Injury management - Spinal Immobilization; Use of Oxygen and Airway Adjuncts; fracture management - lower arm; Lifting Techniques; use of Standard Precautions; monitor ABCs/vitals throughout; suspend race activities until the area is secure
Leadership
Direct others appropriately and with confidence; continued communications with patient and team members; ensure correct OEC skills of helpers where appropriate
Scenario #21-23
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: Side of a racecourse, close enough to a stationary object that it could have been hit, but not so close that it causes an obstruction, in a low or flat area if possible
Moulage: Three to five total facial abrasions and minor lacerations, none of which is bleeding significantly, and a deformity of the lower arm near the wrist. Patient is wearing an open-face helmet.
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: Approximately the coma position, with head uphill
Answers to SAMPLE: If the coach is asked these questions, he knows of nothing related to the first four, and he reports what he saw for the “events leading.”
Signs and symptoms: unresponsive, facial abrasion, lower arm deformity
Allergies: unknown
Medications: unknown
Past history: unknown
Last meal: unknown
Events leading: crashed on the racecourse
Behaviors: You are unresponsive to painful stimuli throughout
SPECIFIC COMMENTS FOR EVALUATORS
Local protocol would determine if oxygen would be brought to the scene or readied in the aid room. This is not a “load and go” situation, since the patient is stable.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario #21-24 Degree of Difficulty = 9
|INJURY |ENVIRONMENT |PERSONNEL |
|Unresponsive patient (4) |Easier to more difficult slope (0) |Multiple patients (1) |
|Femur fracture (3) |“Yard sale” of equipment (0) |Trained rescuers (0) |
|Diabetic (0) | |Obnoxious patient (1) |
GENERAL SCENARIO DESCRIPTION
The incident takes place on a very crowded more difficult slope. Three skiers collide.
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to injured skiers on the more difficult hill.
Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
Patient #1 is unresponsive early in the problem, becomes responsive only to strong stimuli partway through. If pupils are checked, they are equally responsive.
Patient #2 smells strongly of alcohol, and complains of mid-thigh pain. He is shocky. His Medic Alert tag is for diabetes, though he says he took his insulin and ate on schedule.
Patient #3 is not injured, but is very angry and creating quite a scene.
VITAL SIGNS
|Time in minutes |Patient #1 |Patient #2 |Patient #3 |
| |Pulse and respirations |Pulse and respirations |Pulse and respirations |
|Initial |pulse as found, |p + 36, r + 4 | |
|5 min |r + 10 to as found |p + 36, r + 2 |as found |
|10 min |throughout |p + 24, r + 2 | |
|15 min | |p + 24, r + 2 | |
| | |to as found | |
SCENARIO OBJECTIVES
Decision Making
Verify scene safety; Patient Assessment - correctly identify patient's condition; call EMS for ALS transport; notify management for risk management concerns; prioritize treatment of femur over unresponsive; choose method to contain obstructive patient
Problem Management
Appropriate use of rescuers and equipment; appropriate treatment and transport plan; OEC skills according to skill performance guidelines - Traction Splinting, Spinal Immobilization, Managing Medical Emergencies; Lifting Techniques; use of Standard Precautions; attempt to determine if incident was witnessed and direct witnesses to management for statements; monitor ABCs/vitals of unresponsive patient; roll patient directly onto the backboard
Leadership
Direct others appropriately and with confidence; continued communications with patient and team members; ensure correct OEC skills of helpers where appropriate
Scenario #21-24
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: On a more difficult hill with no obstructions. Extra bystanders should be around to act as an “audience” for patient #3. Equipment is strewn all over the general area, except that patient #2 still has the ski on his injured leg
Moulage: Patient #1 - a discolored or swollen area in the temple area on one side
Patient #2 - Medic Alert tag for diabetes; pale and “clammy” for shock
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: Patient #1 - you are lying face down
Patient #2 - you are semi-reclining on your injured side holding your leg, with that ski still on
Patient #3 - you are standing, yelling at the other two, and anyone else who will listen
Answers to SAMPLE
Signs and symptoms: Pt. #1 unresponsive; Pt. #2 altered mental status (alcohol), femur pain; Pt. #3 not hurt
Allergies: none
Medications: patient #2 - insulin, taken according to schedule
Past history: patient #2 is diabetic
Last meal: report actual
Events leading: patients #1 and #2 hit approximately head on at high speed, and then slid into patient #3.
Behaviors: Patient #1 - you remain basically unresponsive throughout, though late in the problem some response to questions or movement might be added.
Patient #2 - you are in great pain, and indicate that maybe you should not have “cranked down” your bindings so tight. You admit to having had a few drinks at lunch, but don’t think you’re drunk, nor do you think the accident was your fault as patient #3 is shouting.
Patient #3 - you are yelling at the other two skiers and anyone else who will listen about suing them, the ski area, and anyone else who shows up. You are being extremely obnoxious, to the point where you are obstructive. You demand attention, and will not be easily put aside. You are not hurt.
SPECIFIC COMMENTS FOR EVALUATORS
Patient #3 must be well coached to keep up his behavior to force the trainee to deal with him/her. If the area has a management representative (“courtesy” or “host” type staff person, perhaps) who could be called, that “person” should be available for the trainee to call to deal with patient #3. Local protocols would determine if the head/neck patient #2 would be fully immobilized.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario #21-25 Degree of Difficulty = 5
|INJURY |ENVIRONMENT |PERSONNEL |
|Unresponsive (4) |Mountain bike trail (0) |Single patient (0) |
|Facial laceration (1) | |Trained rescuers (0) |
GENERAL SCENARIO DESCRIPTION: The patient was biking on one of the resort’s mountain bike trails and hits a soft spot of sand on the trail. S/He is lying about 15 feet from the bike. A friend, who went to report the accident, returns as the trainee is completing the rapid survey.
INFORMATION GIVEN TO TRAINEE: You are asked to respond to a biker that has fallen. Equipment and personnel to be sent upon request.
PATIENT SUMMARY: Patient is unresponsive and only moans when shaken.
VITAL SIGNS
|Time in minutes |Pulse and respirations |
|Initial |P + 12; R + 4 |
|5 minutes |P + 20; R + 8 |
|10 minutes |P + 32; R + 12 |
SCENARIO OBJECTIVES
Decision Making
Verify scene safety; permission to assist is implied; patient assessment: correctly identify the problem; call EMS; call for additional help, backboard, C-collar, and oxygen
Problem Management
Appropriate use of help and equipment; appropriate treatment and transportation plan; OEC Skills: spinal immobilization, use of oxygen and airway management. Monitor ABCs and vitals throughout
Leadership
Direct others appropriately and with confidence; continued communications with patient and team members; ensure correct OEC skills of rescuers. Extrication and transfer to EMS
Scenario #21-25
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: Mountain bike trail with medium-grade slope
Moulage: Facial laceration; vomitus
Weather: Same as day of event
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: Patient is lying prone with face into the dirt.
Answers to SAMPLE
Signs and symptoms: unresponsive
Allergies: unknown
Medication: unknown
Past history: unknown
Last meal: ate breakfast about two hours ago
Events leading: were halfway through a 4-hour bike ride
Behaviors: Patient will only moan when shaken.
SPECIFIC COMMENTS FOR EVALUATORS
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario #21-26 Degree of Difficulty = 4
|INJURY |ENVIRONMENT |PERSONNEL |
|Head injury (3) |Outdoor dining patio (0) |Single patient (0) |
|Facial laceration (1) | |Trained rescuers (0) |
GENERAL SCENARIO DESCRIPTION
A middle-aged father is joining his family for lunch on the patio. As he removes his skis to prop them against the fence, he slips, falls backwards, and hits his head on the fence. While going down, he knocks over a row of skis, one of which cuts his face.
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to an injured person adjacent to the outdoor dining patio. Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
The patient, who was unconscious for several minutes initially, has tenderness on the back of the head and a laceration with bleeding on his face. His neck is "sore." He is grumbling about all the skis falling over.
VITAL SIGNS
|Time in minutes |Pulse and respirations |
|Throughout |As found |
SCENARIO OBJECTIVES
Assessment
Verify scene safety; obtain permission to assist
Request needed equipment and personnel
Primary assessment reveals facial laceration and “sore” neck
Recognize that this is a “load and go” situation. Request EMS
Secondary assessment, no other injuries found
Rote Skills
Standard Precautions
Bleeding control: direct pressure and bandaging
Spinal immobilization and traumatic brain injury management; correctly secure patient to backboard
CMS before and after backboarding
Oxygen administration
Extrication, transport, and transfer to EMS
Problem Management
Direct others with confidence; crowd management
Notify management and show awareness of risk management issues
Scene cleanup under local protocol for Standard Precautions
Develop appropriate transport plan
Scenario #21-26
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: in high pedestrian traffic area of resort such as outdoor dining patio
Moulage: Laceration on the patient’s face with blood
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT(S)
Position: You’re sitting among a pile of skis, one of which has fallen over and cut your face. You have tenderness on the back of your head and a laceration with bleeding on your face. Your neck is sore and you feel woozy. You are oriented to the situation, but initially not to time or place. You’re grumbling about all the skis falling over.
Answers to SAMPLE
Signs and symptoms: tenderness on back of head, laceration on face, feeling woozy
Allergies: none
Medications: none
Past history: none
Last meal: report actual
Events leading: you were joining your family for lunch on the patio. You went to move your skis and prop them against the fence when you slipped, fell backwards, and hit your head on the fence. While going down, you knocked a row of skis over, one of which cut your face.
Behaviors: You’re feeling woozy and sheepish along with having a cut face, sore neck, and tenderness on the back of your head.
SPECIFIC COMMENTS FOR EVALUATORS
The facial bleeding is minimal. The greater concern is the head/possible neck injury
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario #21-27 Degree of Difficulty = 4
|INJURY |ENVIRONMENT |PERSONNEL |
|Unresponsive patient (traumatic brain injury) |Moderate trail (0) |Single patient (0) |
|(4) | |Trained rescuers (0) |
GENERAL SCENARIO DESCRIPTION
The skier is in the trees on the side of a moderate trail.
INFORMATION GIVEN TO TRAINEE
You have received a call from dispatch regarding a skier in the trees; skier’s left, halfway down the run. Dispatch indicates the patient is unresponsive. Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
Skiing along and crashed into a tree. Patient is unresponsive.
VITAL SIGNS
|Time in minutes |Pulse and respirations |
|Initial |P = 90 R = 20 |
|5 minutes |P = 96 R = 20 |
|10 minutes |P = 96 R = 20 |
|15 minutes |P = 84 R = 20 |
|20 minutes |P = 72 R = 20 |
SCENARIO OBJECTIVES
Assessment
Verify scene safety, permission to assist is implied
Primary assessment reveals an unresponsive patient, traumatic brain injury
Request ALS; request needed equipment and personnel
Secondary assessment, no other injuries found
Rote Skills
Standard Precautions
Oxygen and airway management: administer oxygen, monitor and maintain airway
Spinal immobilization
CMS before and after securing to backboard
Transport plan
Monitor vital signs
Problem Management
Direct others with confidence
Develop rapid extrication and transportation plan
Notify management
Scenario #21-27
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: On slope, off to the side halfway down the run in the trees
Equipment: Oxygen, toboggan with standard area equipment
(Spine-boarding equipment if not included in the standard toboggan, following local protocols)
Moulage: none is needed
Weather: Must be the same as the day of scenario use; outdoors
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: Laying on your back, off to the side of the run in the trees
Answers to SAMPLE
Signs and symptoms: unresponsive
Allergies: none
Medication: none
Past history: none
Last meal: unknown
Events leading: unknown
Behaviors: Patient is unresponsive to voice, but does elicit a response to pain stimuli.
SPECIFIC COMMENTS FOR EVALUATORS
Trainee must realize that the scenario is an emergency and calls for rapid extrication and transport with immediate transfer to ALS. Airway and cervical spine stabilization must be maintained during the scenario.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario #21-28 Degree of Difficulty = 6
|INJURY |ENVIRONMENT |PERSONNEL |
|Head injury (3) |Mountain bike race course |Trained rescuers (0) |
|Respiratory distress (3) | | |
GENERAL SCENARIO DESCRIPTION
You are stationed near a 6-foot drop as a downhill bike racer comes out of the trees. The racer allows the front wheel to hit nose first into the soft dirt and, as this happens, s/he goes flying off the bike, hitting the ground with his/her chest and head first. S/He does not move. You find the patient unresponsive, with clenched teeth, gasping for air. S/He begins to turn blue. Within minutes, additional help arrives. You have full trauma care equipment with a 4-wheeler stationed with you at the scene.
INFORMATION GIVEN TO TRAINEE
You are the first rescuer to reach the patient. You assume the position at the head. Your partner informs you that the person is turning blue. Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
Patient is gasping for air with clenched teeth and is posturing throughout his/her body. Patient begins to breathe spontaneously within several minutes, after being rolled to the supine position and spinal immobilization is completed. At this time, s/he becomes argumentative and combative, demanding to be removed from the backboard because s/he has to report to the top of the hill for his/her race time.
VITAL SIGNS
|Time in minutes |Pulse and respirations |
|Initial |P = 108; R = gasping |
|5 minutes |P = 104; R = 30 |
|10 minutes |P = 112; R = 24 |
SCENARIO OBJECTIVES
Decision Making
Secure the scene including stopping the race; patient assessment/rapid trauma survey; activate EMS due to existence of life-threatening multiple traumas, execute rapid transport. Provide oxygen immediately. Notify management.
Problem Management
Prioritize rapid extrication, transport, and transfer to ALS (Advanced Life Support). OEC skills: spinal immobilization; oxygen and airway management of severe respiratory distress; administration of oxygen immediately.
Leadership
Direct others; communication with patient and help; coordinate rapid extrication and transfer to EMS; address race officials who are interested in restarting the race; coordinate transfer to ALS personnel
Scenario #21-28
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: Trail with a few feet drop coming out of some trees, where a downhill bike race could be staged
Moulage: none
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: Patient is lying face down.
Answers to SAMPLE
Signs and symptoms: gasping for air, posturing, and initially unresponsive
Allergies: none
Medications: none
Past history: nothing significant
Last meal: breakfast
Events leading: this is the second official run
Behaviors: Patient is unresponsive, gasping for air, and posturing. About 5 minutes into the scenario, as rapid immobilization is being completed, patient begins to breathe spontaneously. S/He then begins to thrash and become argumentative, wanting to be released because s/he needs to go to the start of the race for the next run.
SPECIFIC COMMENTS FOR EVALUATORS: This is a life-threatening injury with a focus on rapid spinal immobilization, extrication and transfer to ALS based on the MOI which indicates respiratory distress and significant trauma to head. Scene safety, crowd management, and race officials need to be addressed. The primary focus will remain on rapid extrication, ALS, and oxygen ASAP.
This is an actual scene that occurred during a bike race. This area was staffed with six medical staff, both OEC and EMTs, with a paramedic arriving within three minutes. You have full radio communication with EMS and a complete trauma pack with an all-terrain 4-wheeler. Patient responded as described. Upon arrival of the helicopter, his level of response was continuing to improve. EMS decided to transport patient by ground transportation due to improved vitals and LOR. Patient was released from the emergency room later in the day.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario #21-29 Degree of Difficulty = 6
|INJURY |ENVIRONMENT |PERSONNEL |
|Neck/back pain (3) |More difficult slope below a jump (0) |Single patient (0) |
|Hypothermia (2) | |Trained rescuers (0) |
| | |Obstructive friends (1) |
GENERAL SCENARIO DESCRIPTION
A rider has done a “head plant” after going off a jump in the terrain park. S/He is lying in the snow upon the trainee’s arrival. His/her friends are attempting to encourage him/her to get up and rip some more jumps. The friends are giving the patient and the rescuers a hard time about accepting any treatment as they want to go ride some more despite their friend’s report of neck and upper-back pain.
INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to a snowboarder who has been lying on the snow below a jump for about 15 minutes. Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
The patient has neck and upper-back pain with no initial signs of any neurological deficit. S/He is quite wet, cold, and shivering. The patient is reluctant to allow the trainee to treat him/her, partly due to the pressure from his/her friends.
VITAL SIGNS
|Time in minutes |Pulse and respirations |
|Throughout |P + 16, r + 6/shallow |
| |to as found |
SCENARIO OBJECTIVES
Decision Making
Secure scene including crowd management; patient assessment: correctly identify patient's injuries; request EMS transport; call area management since the incident involves the terrain park and for scene safety issues. Request needed equipment and additional personnel.
Problem Management
Standard Precautions: OEC skills: spinal immobilization; administer oxygen; hypothermia care; lifting techniques and transportation; develop and execute a treatment and transportation plan that addresses needs according to protocol. Deal with the patient’s reluctance to be treated and his/her obnoxious friends.
Leadership
Direct others appropriately and with confidence; continued communications with patient and team members, while keeping the friends in control; proper treatment for hypothermia both at the scene and in patrol room, loading/positioning on toboggan. Consider using friends to provide scene safety by asking them to stand far enough above scene to stop others from coming.
Scenario #21-29
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: More difficult slope below a jump
Moulage: Damp clothing, which is apparently inadequate for the weather conditions (this should be simulated over waterproof clothing to protect patient and make the scenario realistic)
Weather: Should be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: Lying on the snow. The binding on one foot was broken in the fall.
Answers to SAMPLE
Signs and symptoms: pain in neck and mid-thoracic area; some mental confusion, slurred speech
Allergies: none
Medications: none
Past history: none
Last meal: report actual
Events leading: you attempted an inverted aerial and missed the landing, landed on your head. You’ve been riding for a while, and your clothes have gotten wet from previous falls.
Behaviors
Patient: You are lying on the snow, have slow reactions, some mental confusion, and slightly slurred speech. You complain of pain in your neck and in the mid-thoracic area, though neither area is really tender to the touch. You are quite cold and shiver throughout the scenario. When the trainee arrives you tell him that you think you are okay, and your friends want you to continue to ride with them. You know you don’t feel quite right, but you don’t want your friends to think you are a wimp, so unless the trainee can give you a good reason to be treated, you are going to refuse treatment.
Friends: You really don’t like the rescuers because they always seem to inhibit your fun, and you do your best to convince your friend to get up and go riding, as the day is still young. You should be somewhat obnoxious in the initial stages of the problem but do respond to appropriate actions by the rescuers. Once your friend has agreed to treatment you can choose to go along with him/her to the patrol room, or to just say “so long” and head back up the hill (you should respond to the rescuer’s request for witness statements or help with your friend’s gear).
SPECIFIC COMMENTS FOR EVALUATORS
Both patient and “friends” should be well prepared for their roles. The patient should be aware of the types of reasoning the trainee may use that would convince him to ignore his friends and allow treatment. Rescuers need to address options for hypothermia and need to remove wet clothing, either on hill because you now have multiple dry blankets, or in the aid room. This is complicated by placing the person on the board. Protect privacy of patient at all times.
OUTDOOR EMERGENCY CARE 5TH EDITION
Chapter 21
Scenario # 21-30 Degree of Difficulty = 4
| INJURY | ENVIRONMENT | PERSONNEL |
|Possible neck fracture (3) |Aid room (0) |Single patient (0) |
|Concussion, mildly altered LOR (1) | |Trained rescuers (0) |
GENERAL SCENARIO DESCRIPTION
The patient walks into the aid room escorted by a friend. The friend states the patient fell earlier in the day and hit his/her head. S/He seemed okay at the time, but now, 3 hours later, the patient is acting weirder than normal and can’t remember things. All parties remain standing while this information is given.
INFORMATION GIVEN TO TRAINEE
You are covering the aid room when two people walk in asking for assistance. Equipment and available personnel to be sent upon request.
PATIENT SUMMARY
The patient hit his/her head hard on the snow earlier in the day, approximately 3 hours ago. S/He snapped his/her head back, saw stars, and felt a little dizzy but it went away in a few minutes. S/He just feels tired and sleepy now.
The friend has no injuries and is just there to verify the account of the incident.
VITAL SIGNS
| Time in minutes |Pulse and respirations |
|Initial |P = 70 R = 15 |
|5 minutes |P = 70 R = 15 |
|10 minutes |P = 80 R = 15 w/O2 |
|15 minutes |P = 80 R = 15 w/O2 |
|20 minutes |P = 80 R = 15 w/O2 |
SCENARIO OBJECTIVES
Assessment
Secure scene (in patrol room), obtain permission to assist
Primary assessment reveals neck tenderness, and mildly altered level of responsiveness
Request needed equipment and personnel
Secondary assessment, no other injuries found
Rote Skills
Standard Precautions
Spinal immobilization: neck pain; standing backboard
CMS before and after backboarding
Oxygen administration per area protocol
Problem Management
Direct others with confidence
Treat for shock as appropriate
Verbalize appropriate transportation plan - EMS notification (based on local protocol)
Scenario #21-30
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: Aid room
Equipment: Backboard, c-collar, oxygen, blankets
Moulage: none
Weather: N/A
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: Walked into aid room; now standing in aid room far enough away from walls etc., so that there is adequate room to perform a standing backboard maneuver.
Answers to SAMPLE
Signs and symptoms: neck pain; saw stars on initial fall and felt slightly dizzy
Allergies: none
Medication: none
Past history: none
Last meal: patient states breakfast but friend corrects to say they were just upstairs having a burger & a soda – “see what I mean about acting weird”
Events leading: friend states patient was riding/skiing very fast, went over a roller, caught air, crashed and burned—did kind of a “one-point landing” then tumbled—it was “pretty spectacular”!
Behaviors: Patient responds accurately to questions with slight hesitation before providing inaccurate information regarding last meal. Periodically repeats statement “You know what’s really funny? I had a dream about this!”
SPECIFIC COMMENTS FOR EVALUATORS
This is a standard closed-head injury with a possible neck fracture in a standing patient situation. Trained assistance should be sought immediately and a standing backboard applied. Vitals should be monitored closely for deterioration and O2 should be applied promptly via non-rebreather at a rate of 15 L/min.
OUTDOOR EMERGENCY CARE
Chapter 21
Scenario #21-31 Degree of Difficulty = 2
| INJURY | ENVIRONMENT | PERSONNEL |
|Concussion (2) |Rental shop (0) |Single Patient (0) |
| | |Friend/witness (0) |
| | |Trained rescuers (0) |
GENERAL SCENARIO DESCRIPTION
A snowboarder comes into the rental shop with a broken helmet. S/He crashed while doing a 720 on a large jump. On landing s/he fell on his/her upper left side and head. The helmet was cracked in the process.
INFORMATION GIVEN TO TRAINEE
You are called to your area rental shop where it's reported that a snowboarder has a broken helmet. The patient is unable to explain what happened; however, their girl/boyfriend saw it all happen. The patient did not suffer any loss of consciousness.
PATIENT SUMMARY
The patient is sitting on a bench in the area’s rental shop. S/He is able to walk and talk; however, is disoriented and unable to remember anything short term. Upon examining the helmet you notice it has a crack in it. The patient has a headache; pupils are equal and reactive to light.
Girl/boyfriend witnessed and reports all that occurred.
VITAL SIGNS
|Time in minutes |Pulse and respirations |
|Initial |As found |
|5 min |throughout |
|10 min | |
|15 min | |
SCENARIO OBJECTIVES
Assessment
Verify scene safety, obtain permission to assist
Primary assessment reveals a headache and confusion
Request needed equipment and personnel
Secondary assessment, no other injuries found
Rote Skills
Standard Precautions
Injury management – concussion; spinal immobilization
CMS before and after backboarding
Oxygen administration per area protocol
Lifting Techniques; loading on backboard - standing backboard procedure
Problem Management
Treat for shock as appropriate
Verbalize appropriate transportation plan - EMS notification (based on local protocol)
Scenario #21-31
INFORMATION FOR SCENARIO PLANNING AND OEC INSTRUCTORS
Location/terrain: Rental Shop (accident occurred in the terrain park)
Equipment: Backboard, cervical collar, oxygen
Moulage: cracked helmet if available, or mark helmet with tape
Weather: Must be the same as the day of scenario use
SPECIFIC INSTRUCTIONS FOR INJURED PATIENT
Position: Sitting on a bench in the rental area
Answers to SAMPLE
Signs and symptoms: disoriented, headache
Allergies: morphine
Medication: none
Past history: none
Last meal: cheeseburger, 30 minutes ago
Events leading: (per witness) went off a large jump in terrain park, landed on upper left side and head
Behaviors: You are confused and disoriented. You continuously repeat questions, and comments. Friend will report what happened.
SPECIFIC COMMENTS FOR EVALUATORS
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