# Long Distance Fall



## LAS46 (Nov 25, 2010)

Dispatch: 36 year old male who fell from a tree stand.

You are on a BLS only ambulance today.

Arrive to find: Scene is safe. Man fell to ground and landed on wood. He is responsive to verbal stimuli. Arrival at the scene will be facilitated by the use of ATVs and additional help. Was hunting with Cheney.

Assessment reveals:

• Airway -Patent Airway
• Breathing-rapid and shallow @ 20 breaths per minutes
• Pulse - 64 and regular
• Blood pressure-160/90
• Pupils -dilated and equal
• Lung sounds –present and clear bilaterally
• Skin pale-pale, cool, clammy
• History
• S-head hurts, disoriented
• A-medic alert indicates penicillin
• M-na
• P-na
• L-na
• E-tree stand broke
• O-time of call-to unknown
• P-na
• Q-na
• R-na
• S-na
• T-na

HEENT: wound on head, pale skin, mister to provide moist skin
Further exam does reveal a possible spinal injury due to no sensation in lower extremities. Pulses in lower extremities are normal. No other injuries are found.

*Note* Ground ALS transport is available. Nearest Level 1 Hospital is 50 miles away. FAA has grounded all choppers due to weather conditions.

*What treatment do you need to provide and why? And would you opt for a ALS intercept?*


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## CAOX3 (Nov 25, 2010)

Package, c-spine, O2, monitor his airway be prepared to assist with vent support.  Temp outside? How long has he been on the ground, how far did he fall? C-spine injury, he may be bleeding in his belly or his head, he is compensating right now but that probably isn't going to last long, have ALS meet us on the pavement,  transfer care, offer to drive for them, transport destination may be a level one but that's up to the medics, how far is the closest hospital? Clear for a turkey sandwich and watch the rest of the football game


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## EMT11KDL (Nov 25, 2010)

Package, C-Spine, O2 and maintain airway.  Request ALS.  Meet them and turn over the patient.. they will decide what facility to go to..

Also, you might try requesting a Military Medivac.  Some areas have them available for civilian side.  and I know some pilots are crazy enough to fly at zero zero (zero foot ceiling with zero visibility).  It never hurts to ask.


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## TransportJockey (Nov 25, 2010)

EMT11KDL said:


> Package, C-Spine, O2 and maintain airway.  Request ALS.  Meet them and turn over the patient.. they will decide what facility to go to..
> 
> Also, you might try requesting a Military Medivac.  Some areas have them available for civilian side.  and I know some pilots are crazy enough to fly at zero zero (zero foot ceiling with zero visibility).  It never hurts to ask.


This. In the mountains in NM, the NM Army NG will fly their 'Hawks in pretty much anything, and if civi birds can't get off the ground the are willing to fly for non-.mil requests. 
For packaging I'd go with a scoop and stokes combo instead of the regular LSB. Would make things more comfortable for the patient and make it easier to get the patient to your rig.


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## LAS46 (Nov 25, 2010)

Temp outside is 12 deg F. Dispatched at 0900 Arrived at 0945. Caller says PT has been on ground for about 15 to 20 min. Aprox Height of Tree stand was 18 feet. The Trauma Center and only hospital is 50 miles from your Ambulance. PT is located another 8 miles off road.



CAOX3 said:


> Package, c-spine, O2, monitor his airway be prepared to assist with vent support.  Temp outside? How long has he been on the ground, how far did he fall? C-spine injury, he may be bleeding in his belly or his head, he is compensating right now but that probably isn't going to last long, have ALS meet us on the pavement,  transfer care, offer to drive for them, transport destination may be a level one but that's up to the medics, how far is the closest hospital? Clear for a turkey sandwich and watch the rest of the football game


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## Veneficus (Nov 25, 2010)

So the pt is going to herniate and die before you get him to the hospital?

Not sure how ALS is going to really help that. But since the guy is 8 miles off the road, maybe they could find their way over to the scene. 

I am not really the well versed expert in wilderness rescue, but it seems like it is going to take a few minutes to get this guy 8 miles to the road in a stokes basket. (which would be my device of choice) 

The best thing you could probably do, is get somebody who can cut a hole in his head moving towards you. 

The spinal injury at this point is not going to reverse itself, and he sounds theraputically hypothermic already.

At least he wasn't out in the woods with Cheney, otherwise he might have a GSW to the face to contend with too.


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## gfblanco (Dec 3, 2010)

Hmm.  This would be a Trauma Alert pt because of the height he fell from and lower extremity paralysis. I would put him on a long spine board with c-spine consideration. Also, I would be sure to mark up to where he is paralyzed and make sure to remember to document that it was like that before we back boarded him and transported. This is a Load and Go pt so I would consider ALS intercept to a trauma center. Since he has been out so long I would passively re-warm him. I would check his LOC and ABC's when we got to the back of the truck and re-check his vitals every 5 minutes. In the back of the truck I would also do a detailed head to toe exam and patch up his laceration.
Please leave any feedback! I have my skills EMT-B final on Wednesday!


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## MrBrown (Dec 3, 2010)

Come on Oz its time we went for a drive in the car ....


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## Sandog (Dec 3, 2010)

Cheney lol...


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## Akulahawk (Dec 4, 2010)

As a BLS provider: package in a stokes basket. Mark where sensation disappears. Document as well as possible. Call for an ALS intercept. Get the patient out ASAP. Determine if a mil bird is available. If not, diesel bolus. Keep close tabs on the patient until turned over to ALS or I get to the ED. Provide updates to the ED PRN. Provide further care as needed...


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## boingo (Dec 4, 2010)

Any good sign around his stand, i.e, scrapes, rubs, etc?  Other hunters in area?  How hard would it be for me to get in there and put up another stand?  Ideal for bowhunting, or is this more a gun stand?


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