BLS scenerio time

certguy

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It's a beautiful sunday afternoon and you're on duty at your mostly vollie FD . Your dept. covers 12 square miles , rough population of 2800 to 3000 , with 2 additional auto - aid areas . You have a single station with 2 engines , a brush rig that doubles as a rescue , and a utility rig . Your dept. self dispatches for all but multiple alarms . It's just you and the duty LT. watching the chargers kick butt when suddenly you hear a burst of automatic fire , a couple of stray shots , then another long burst . About a minute later , all 3 of your emergency phone lines light up with reports of a shooting in the south end of town . SDSO calls and confirms the reports , states they and CHP are responding , but ETA is at least 15 min. Number of victims is unknown . The LT sends out the dispatch while you're still handling phone traffic , then as a dispatcher arrives , he says to load up , we're heading for staging . In your mind , you remember the responding LE units have to pass your station to get to the scene and there are automatic weapons out there . As you're about to roll out of station , a pickup skids to a stop , blocking you in , and the driver runs up to you screaming he's got a victim in his truck . It's a female in her early 20's and amazingly , she's walking behind the driver despite taking 5 hits . You assess the victim and find 2 shoulder wounds , 1 on each side , both with exit wounds , 1 wound right upper thigh no exit , 1 wound right lower jaw ( graze ) with an amputation of the earlobe , and amazingly , a wound left side of the neck , no exit , and the slug is easily palpated near the c - spine . Somehow , this slug has apparently missed the carotid and jugular , but there is signifigent blood loss in all areas , no airway comprimise , but pts LOC is rapidly decreasing . Vitals are ; b/p 90/p , pulse 130 , resp . 40 shallow , skins pale , cool , very diaphoretic . Nearest hospital 10 min. , medivac 25 min. , the county is just starting it's trauma system and ETA to trauma center is 30 min. READY , SET , GO .
 

Paramajik

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here we go...

Throw her in the most pt friendly vehicle. Administer oxygen NRB - dont gotta bag quite yet, but its comin. control all areas of hemorrhage, fer cuz she needs every little RBC that she has. Oh yeah, and haul ***.
 

Topher38

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Remove the bullet from her neck with tweezers. j/k

IS THE SCENE SAFE!? Are any of them carrying a gun? Who are they and what happened?! Who was shooting? Where are the shooters? WHAT HAPPENED?

After all this is answered then:


Altered mental status?


Airway - O2 via non-rebreather
-Prepare for suction
-Have BVM ready
-Any blood in airway?
-What color is the blood coming from her neck?

Control the bleeding

-SKIN COLOR, TEMP, and CONDITION?
-Direct pressure, elevate
-Treat for shock

S ?
A ?
M ?
P ?
L ?
E ?

Is ALS available? How many more people are injured/shot?
 
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certguy

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Nobody has addressed how they're going to transport to the trauma center . A little hint ; She's obviously very unstable and you can get her to the closest ER even before a medivac can get to you . ALS eta is longer than transport also . This pt. amazes you , there's no airway comprimise and amazingly , no neuro deficit despite the proximity of the slug to the c - spine . There's an important concern with her that has yet to be addressed . Niether of the individuals in the pickup were armed , the hysterical driver is hard to get info from but you do find out there were 3 people in the mercedes that got shot at by a wild - eyed biker looking psycho with an M - 16 . No word on the other 2 pts. or any bystanders . Vollies are pouring into the station , nearly your whole dept. is there . As one of them is arriving , a van comes tearing by the station at a high rate of speed and nearly head - on 's him . It's coming from the area of the incident and the driver matches the description . An alert vollie got the license no. You've seen no LE units pass the station yet . You realize you have a potential MCI .


Welcome to my first shooting .
 

rescuepoppy

Forum Lieutenant
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Puha

First thing notify dispatch an d incoming units that victims are at your base. If they can find you then so can the shooter. Dont do anything fancy load into the nearest rig and apply diesel treatment towaard nearest hospital. Stabilize c spine assess airway and work on bleeding control enroute. Notify hospital LEO an ALS unit of where you are going. The most important thing you need to do is to get yourself out of a possible deadly situation. I want LEO at the hospital for security and information and ALS will probably have to transport to a trauma center,
 

Topher38

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First let me say, nice scenario ^_^ makes me think
 

Code 3

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1. C-Spine precautions

2. Assess LOC

3. C/C and apparent life threats are diminishing LOC, major bleeding and shock. I'm going to get this PT supine, legs elevated 8-12", and toss a blanket on her.

A - Airway is patent for now and there's no airway compromise. I'm going to get an OPA and NPA on standby if she goes unresponsive.

B - Breathing rate is 40 pm with shallow chest rise. Due to the fact that this PT presents with both an inadequate rate and volume, I'm going to initiate PPV with a BVM @ 15 lpm. Suction unit on stanby.

C - Control any major bleeds that are found, assess pulse for rhythm and quality, and lastly check skins.

4. Conduct a rapid trauma assessment; looking for DCAP-BTLS and all that good stuff. I'm also going to take this time to get a C-Collar on the PT so we can log roll her on a board. During the log roll, I'm going to palpate the vertebrae and auscultate lung sounds on the back. In addition, I would check for S/S of a pneumothorax from the GSW's to the shoulders. I would also check for tracheal deviation as well before applying the collar.

5. Grab a set of vitals (PRBELLS)

6. Get a SAMPLE from the person that brought her in

7. Transport whether it be meeting with ALS or flight crew.
 
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certguy

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Rescuepoppy - puha ????? what's that ? You get the prize . You picked up on the c - spine issue the others before you missed . Code 3 did a good workup too . Topher , this was my first shooting pt. What a concept ! they come to you . It scares the ____ out of you though because you don't know what's coming next .


The pt. we had was quickly loaded into the rig , assessed , stripped - n - flipped , c - spined , NPA inserted , ventilations assisted , bleeding control , and treatment for shock . Lifeflight was requested before we even left the station to meet us at the hosp. ER staff was notified and worked to stabilize her prior to the flight . I'm glad to report she made it . Heck of a save for all involved .


When the scene was finally secured , we were notified by SO of 2 additional victims at the scene . Mutual aid ALS was requested , and our 2 engines and chief responded . We found 1 DOA ( the driver ) , and 1 shook up backseat passenger , shocky but otherwise unhurt . ( he must've become one with the floorboards ) No bystanders hit miraculously , though a couple houses took rounds from ricochets . Our pt. was the front seat passenger . It's amazing the backseat guy didn't get hit considering the stories you hear of M 16 rounds passing completely through cars .


According to witnesses , this was a drug deal gone bad . The folks in the car pulled up looking for drugs . The perp calmly goes in the house , comes out with the weapon , and opens up from the porch first , then the hood of the car . He then loads a small arsenal into the van along with his drugs and takes off . 2 hours later , he's involved in an MVA in a town about 100 miles away , but due to a glich in communications CHP has no idea he's wanted , so they let him go . He's apprehended 6 months later .
 
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certguy

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This was the LAST thing I'd ever have expected to respond to in our normally quiet rural area .


Craig
 

Topher38

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You are dispatched to a home on the southern part of town for a "dyspnea". You and your partner hop in the rig, and within 7 min arrive on scene to find lights on in the home and door unlocked. You knock on the door and there is no answer, You radio dispatch to assure you have the right address, "address is correct. You look in the window and see a older man, not exactly elderly but older (45-50) sitting in a chair with his back to you, he appears to be watching TV.....go.....
 

lcbjr3000

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That could be a scary situation. I would speak or yell from the door outside and see for a response. If i get none i go back to rig and get pd there stat. He could easily have a weapon in his hand and just waiting to kill someone. Until i know scene safe im not going near him
 
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certguy

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Gee , thanks topher . I'm 48 and I don't consider myself THAT old ! My first thought would be to find out from dispatch who the RP was - the pt. or someone else . If it was a second party and they're nowhere to be found , pull out and stage till LE clears the scene , this may be a crime scene . I would request LE code 3 JIC ( just in case ) . I would get a REAL good look at what I could see of the scene looking for anything that could indicate danger . If the scene looks safe , the RP was the pt. and we have additional eyes on scene ( engine or LE ) , we would cautiously enter keeping in mind the type of call and pt. may have passed out or coded . If anything at all looks hinky , we back out till LE clears . For all we know , pt. may be deaf and doesn't realize we're here . Once pt. contact made , check ABC's and go from there .
 

Topher38

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That could be a scary situation. I would speak or yell from the door outside and see for a response. If i get none i go back to rig and get pd there stat. He could easily have a weapon in his hand and just waiting to kill someone. Until i know scene safe im not going near him


Good job you both didnt die. Originally if you didnt check with PD or check for scene safety which most people on these scenarios ignore, you would have been dead.

You go back to your rig and soon PD arrives, they sweep in and find the man with a loaded shotgun, the man fires at the officers shot dead center in the chest and grazing another officer in the arm, the "older" man in the wheel chair is killed by the 3rd officer entering. More PD arrives on scene. And declares the scene safe but now it is being turned into a crime scene, You hurry in to help to injured/dieing officers and "older" fella. Another ambulance has been dispatched to your location.

You walk in. And.............Ill tell you what you see shortly I gotta go to school, The scenario is far from over. be back soon.
 
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certguy

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Topher , hate to say it , but you've been watching too many movies . When did the "older " guy ( about my age ) go from sitting in a chair to a wheelchair ? Good imagination though . Don't get into the trap of thinking every call the pt. can't get to the door and is quiet on could be an ambush . There are a lot of " older " and elderly folks out there living alone and the type of scenerio you laid out could also be a very routine call , up until the shootout that is . It's always good to get PD cover if in doubt . Saves time if you wind up having a DOA .
 

Topher38

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I never said he was in a wheel chair. I said he was in a chair.

I made this scenario to be a fun one, not an "everyday call".

Now I have lost my traine of thought :huh:
 

Topher38

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Wow wait I did say wheel chair. I have no idea I did, I musta been zoning out. My bad ^_^
 

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