Sunday, January 17, 2010

Case Study: Structure Fire with Two Patients

Dispatch time: 0435

Dispatched as a structure fire with possible entrapment.

A rescue crew responded at 0435 from the main station. While en route central advised that the house was fully involved; patient status unknown. The fire department on scene advised EMS that both occupants were out of the structure and to continue response with 10-18 traffic, reference severe burns to a female patient. Rescue arrived on scene to find a 62 year old female patient lying in the front yard. Rescue immediately loaded the patient onto their stretcher and placed the patient in the ambulance. Rescue began assessing the patient and noted that she had first, second, and third degree burns to over 50% of her body. Patient had a large full thickness burn on her back right shoulder; necrosis had set in. The burns included: full rotation from the bottom of both feet to the top of both knees, full rotation of both arms from fingertips to the upper shoulder, back right shoulder, top of head, as well as a burned airway. Rescue began dressing the wounds and immediately called for a life flight helicopter. The patient was placed on high flow oxygen by non re-breather at 15 lpm. Rescue dressed the patients wounds with sterile water and cling. Rescue maintained control of the patient until the arrival of ALS. With the arrival of ALS, Rescue transferred control to the paramedic units and assisted with IV setup and medication administration. When paramedics arrived central advised the life flight helicopter had an eta of eight minutes. Paramedics attempted to start an IV in the patients left arm. The paramedics were unsuccessful due to the degree of the burns. Rescue and paramedics were unable to locate another site to start an IV because of the burns. Veins in the feet, legs, arms, and neck were unable to be located. Life flight arrived and began care. In the back of the ambulance the life flight crew used an intraosseous gun to gain direct access to the bone marrow for the administration of medication. Patient was conscious during the use of the IO gun. After use, the patient was immediately sedated and her airway was taken by county paramedics by the use of an ET tube. Patient was then transported to the helicopter by Rescue and paramedics with the direction of the flight crew. Patient was then loaded into the helicopter and secured. The flight crew made their final checks and Rescue and paramedics cleared the landing zone. Life flight departed; time on ground 12 minutes.

Thursday, January 7, 2010

Case Study: Fall Victim 12 Feet or Higher

EMS and fire agencies dispatched to a local residence for a fall which was reported to be greater than ten feet. When EMS units arrived on scene they discovered the patient in the care of a local fire department. When EMS units approach the patient they met resistance from the fire department. The firefighters were noticeably excited, becoming unprofessional, and would not relinquish control of the patients to the EMS units on scene. Fire fighters loaded the patient onto the ambulance stretcher and placed her into the ambulance. Fire fighters attempted to board the ambulance against EMS personnel's orders. Fire fighters were resistant to relinquishing patient care but were kept off the ambulance by EMS. Paramedics arrived on scene to further asses the patient. Paramedics advised a helicopter was not needed and the helicopter was canceled. Paramedics began to question EMS about the condition of the patients spine and the back of her head. EMS units told paramedics that they were unable to advise on the condition of the patients spine and head due to the actions of the fire department. The local fire department placed the patient on the backboard without palpating the patients head and spine, checking for deformities or abnormalities. Patient was transported in a basic truck with a paramedic and ALS equipment on board to a local trauma center.


1.) The operation of medical scenes with regard to fire and EMS varies from district to district, but ideally fire fighters should relinquish patient care immediately when EMS units arrive on scene with an ambulance. The fire fighters on scene became too excited by the overall scenario and began to act in a way that was unsafe for the patient. EMS units are there to transport the patient in a manner they deem necessary. Fire personnel must relinquish care and allow EMS to asses the patient. Unless the fire department has an ambulance that is going to transport EMS needs to examine the patient and determine the severity of the patients injuries so they can best determine the means of transport for the patient.

Tuesday, January 5, 2010

Case Study: MVC Trauma Victim

This first Case Study involves a female, approximately 40 years old, involved in a motor vehicle collision. The initial dispatch advised the collision took place between a truck and a vehicle, and that the patient was pinned inside the vehicle. Upon arrival rescue workers noted that the patient was trapped in the driver side compartment due to a severe impact on the driver side door. The local fire department on scene began patient care and extrication. The fire department held in line stabilization of the patients C-spine and focused the majority of their attention on removing the driver side door from the vehicle. When Paramedics and EMTs arrived on scene it was observed that the van had a sliding rear door on the passenger side of the vehicle. Paramedics determined that the patient could be quickly extricated by placing the patients seat in a recumbent position and sliding her out onto a backboard. When told of the new extrication plan the local fire department was not willing to follow this new plan and proceeded with attempting to remove the patient's door. By this time approximately 15 minutes had taken place and the patient's was only half way removed. EMS workers on scene proceeded to remove the patient from the rear sliding door with little assistance from the fire department. EMS workers were able to remove the patient by this method in under five minutes. By the time the patient was removed the driver side door was still attached to the vehicle.

Upon extrication the patient was moved by EMS workers to a county paramedic ambulance. Paramedics on scene advised that the patients injuries were minimal. No IVs were started on scene; no medications were administered. Paramedics left the scene and transported the patient to the local hospital.

Approximately three hours later EMS was dispatched to an unresponsive patient. Central advised that the patient was a female in her forties who was involved in a motor vehicle collision earlier in the day. Upon arrival it was discovered that the patient was the same involved in the MVC discussed above. The patient advised she was feeling week and dizzy, and she was very pale. The family members advised that the patient had become unresponsive and had a glazed look in her eyes as she essentially stared off into space. They were unable to advise on whether or not the patient lost total consciousness. Paramedics on scene did not take a blood pressure or perform any basic physical assessment of the patient. The paramedics advised the patient that it was the pain medication given to her by the hospital that caused her to "lose touch with reality." Paramedics transported patient to the same hospital they took her to earlier that day. It was later learned that did not do a CAT-scan on the patient after the MVC.


1.) The local fire department on scene responded inappropriately to the extrication of the patient from the vehicle. There is nothing wrong with the fact that they chose to remove the door from the driver side of the vehicle. However, when shown a second option for extrication that would allow EMS to quickly remove the patient from the vehicle, the fire department chose to ignore this and proceed with the removal of the door. The Chief of the fire department advised that this was a good learning experience for his fire fighters to become acquainted with the tools. The Chief was noticeably disturbed when EMS workers removed the patient from the back side of the vehicle.

2.) Across the country every EMS agency differs in protocol when it comes to the use of a helicopter. In this particular event the use of a helicopter to transport the patient to a hospital that specialized in trauma would not have been out of the question. In the prehospital setting it is impossible to know the full extent of internal injuries. Although the patient may appear to be visibly fine, they could have suffered internal injuries that could be fatal.

3.) During the second encounter with the patient later that night paramedics responded inappropriately during their treatment of the patient. The paramedics should have at least taken a set of basic vitals and not assumed that the patients symptoms were caused by her medication. Worst case scenario, the patient could have suffered a minor skull fracture from the accident and had some internal hemorrhaging.

EMS Scenarios and Case Studies: An Introduction

A note to the reader:

EMS Scenarios and Case Studies is here to offer real world scenarios to assist Emergency Medical Technicians in their daily jobs. We provide scenarios and case studies based on actual events encountered in the field by real medical professionals. Personal patient information has been omitted in order to maintain the patient's privacy. Be advised, the responses listed to the medical cases may vary according to your standing medical orders in your local department.