It's mid-June, around 1030. You and your partner are running a first aid standby station at Mile Marker 17 of a mountain marathon. The morning was a bit chilly, but it is quickly climbing to the day's high of 80 degrees F. It's clear and sunny now, but there are clouds on the horizon. Your station is situated at about 8,000 ft above sea level.
As runners begin passing your station, you see two people approaching your station. One is a mid-30s male who appears to be in pain- he is limping slightly. He tells you that his plantar fasciitis is acting up, and he would like to sit down while he waits for his brother to pick him up in a car. He also asks for some water and ibuprofen, which you instruct him to take from your stand-by box (protocols do not allow you to dispense medication, but patients can take what they want.)
The other runner is a mid-30s female complaining of fatigue. She had oral surgery 1 week before, and says she hasn't completely recovered. She appears to be in good spirits, and wants to help hand out water and Gatorade until her husband can pick her up.
You and your partner busy yourselves helping the nearby water station and keeping an eye on the 2 runners waiting for pickup. After ~20 minutes, a late 53 y/o female approaches your station. She complains of dizziness, and shows slight SOB, which resolves itself after a few minutes of rest. The dizziness persists though, even following a couple cups of Gatorade and electrolyte candies (at her request.) She also begins to complain of cold, so you fetch her a blanket and continue to talk to and monitor her (on orders from OLMC) while your partner tends to other runners.
While talking to the patient, you're able to gather a history. She ran another marathon 2 weeks earlier, at sea level in her hometown. A couple days after the first marathon, she came down with a bad case of strep, which she took a week's course of unknown antibiotics for. She flew out to your city for the marathon just the day before, and hadn't yet adjusted to the altitude. At the last marathon, she said she had "issues with dehydration," citing "overhydration" as the cause.
She reported no allergies to medications, and was only taking Celexa for a chronic anxiety disorder.
After you finish your history, you are sitting with your patient when you and your partner receive a report of a collapsed runner about 50 meters up the course from your station. You ensure that your current patients are stable before running to assist your partner. The collapsed patient is a mid-20s F, who suffered serious leg cramps and "just decided to lay there for a bit" to recover. She is A/Ox3 and reports no injury secondary to the fall. You and your partner assist her back to the station, where she drinks some Gatorade, eats some candies, and denies further treatment before continuing the run. You radio ahead to Mile Marker 18 and give them her bib number, just to keep an eye on her.
Upon returning to your station, you and your partner switch off duties. He sits with the SOB patient, who reports still being "chilly," despite being wrapped in a blanket. She also is experiencing depressed thoughts, feeling that she "failed the marathon."
You continue to monitor the other patients and assist other runners with minor issues. Shortly, the other 2 patients are picked up by their family members.
After a further 15-20 minutes, your partner calls you over. The SOB patient has started to shiver violently and is developing cyanosis around her mouth and fingertips. You quickly take a set of vitals and radio OLMC. OLMC decides that 911 is not necessary at this point, and suggests that we transport her to his station at the end of the marathon in a personal vehicle, which is against protocols AND state law. You decide not to risk your licenses, and continue to monitor the patient. Her vitals are as follows:
HR 70, RR 16/adequate, BP 110/80.
10 minutes later, her vital signs have not changed significantly, but she is showing AMS- namely, having trouble remember exactly where she is.
What do you do?
As runners begin passing your station, you see two people approaching your station. One is a mid-30s male who appears to be in pain- he is limping slightly. He tells you that his plantar fasciitis is acting up, and he would like to sit down while he waits for his brother to pick him up in a car. He also asks for some water and ibuprofen, which you instruct him to take from your stand-by box (protocols do not allow you to dispense medication, but patients can take what they want.)
The other runner is a mid-30s female complaining of fatigue. She had oral surgery 1 week before, and says she hasn't completely recovered. She appears to be in good spirits, and wants to help hand out water and Gatorade until her husband can pick her up.
You and your partner busy yourselves helping the nearby water station and keeping an eye on the 2 runners waiting for pickup. After ~20 minutes, a late 53 y/o female approaches your station. She complains of dizziness, and shows slight SOB, which resolves itself after a few minutes of rest. The dizziness persists though, even following a couple cups of Gatorade and electrolyte candies (at her request.) She also begins to complain of cold, so you fetch her a blanket and continue to talk to and monitor her (on orders from OLMC) while your partner tends to other runners.
While talking to the patient, you're able to gather a history. She ran another marathon 2 weeks earlier, at sea level in her hometown. A couple days after the first marathon, she came down with a bad case of strep, which she took a week's course of unknown antibiotics for. She flew out to your city for the marathon just the day before, and hadn't yet adjusted to the altitude. At the last marathon, she said she had "issues with dehydration," citing "overhydration" as the cause.
She reported no allergies to medications, and was only taking Celexa for a chronic anxiety disorder.
After you finish your history, you are sitting with your patient when you and your partner receive a report of a collapsed runner about 50 meters up the course from your station. You ensure that your current patients are stable before running to assist your partner. The collapsed patient is a mid-20s F, who suffered serious leg cramps and "just decided to lay there for a bit" to recover. She is A/Ox3 and reports no injury secondary to the fall. You and your partner assist her back to the station, where she drinks some Gatorade, eats some candies, and denies further treatment before continuing the run. You radio ahead to Mile Marker 18 and give them her bib number, just to keep an eye on her.
Upon returning to your station, you and your partner switch off duties. He sits with the SOB patient, who reports still being "chilly," despite being wrapped in a blanket. She also is experiencing depressed thoughts, feeling that she "failed the marathon."
You continue to monitor the other patients and assist other runners with minor issues. Shortly, the other 2 patients are picked up by their family members.
After a further 15-20 minutes, your partner calls you over. The SOB patient has started to shiver violently and is developing cyanosis around her mouth and fingertips. You quickly take a set of vitals and radio OLMC. OLMC decides that 911 is not necessary at this point, and suggests that we transport her to his station at the end of the marathon in a personal vehicle, which is against protocols AND state law. You decide not to risk your licenses, and continue to monitor the patient. Her vitals are as follows:
HR 70, RR 16/adequate, BP 110/80.
10 minutes later, her vital signs have not changed significantly, but she is showing AMS- namely, having trouble remember exactly where she is.
What do you do?