2019 EMT Refresher Instructor Manual

C.4.A – Scenario 1

Read the following: “You are at a motor vehicle collision on the highway. Six patients are hurt. You have 4 BLS ambulances and 2 ALS intercept units on-scene and one helicopter available. Community hospital is 20 minutes out, trauma center is 40 minutes out. Please decide who is going to get transported and by what means:”

Patient 1: 4 year old, cardiac arrest

Patient 2: 2 3 year old, fx forearm, pregnant, no other complaint

HR 0, RR 0, BP 0/0

HR 96, RR 22, BP 104/72

Patient 3: 58 year old, alert, crepitus of hip

Patient 4: 48 year old, alert but confused, tourniquet on L Leg

HR 118, RR 18, BP 92/62

HR 128, RR 22, BP 96/60

Patient 5: 18 years old, femur fracture

Patient 6: 39 year old, unconscious, flail chest

HR 92, RR 22, BP 118/70

HR 124, RR 42 and shallow, BP 96/58

Patient 1 has a very poor prognosis even with ALS/Medivac and represents a poor triage decision for resources (BLS) also codes generally don’t fly in NJ Patient 2 is stable with minor injury (she can share a BLS unit with another patient) Patient 3 is shocky (BLS + ALS) - ALS might be able to buy him time with fluid Patient 4 is a critical hypovolemic shock patient with controlled bleeding (BLS + ALS) – ALS might be able to buy him time with fluid Patient 5 is a stable femur fracture (BLS shared with another patient) – although ALS would be ideal, they would mainly do pain relief and traction may help with that – under the limited circumstances, he could share a BLS unit with the pregnant patient Patient 6 is a critical injury with airway and breathing compromise (Medivac) – he needs to be intubated and ventilated

C.4.A – Scenario 2

Read the following: “You are at a bus roll-over on the highway. Six patients are hurt. You have 4 BLS ambulances and 2 ALS intercept units on-scene and one helicopter available. Community hospital is 20 minutes out, trauma center is 40 minutes out. Please decide who is going to get transported and by what means:”

Patient 1: 44-years-old, open femur fx

Patient 2: 22 years old, head injury, intubated by ALS on-scene

HR 90, RR 14, BP 148/90

HR 96, RR 12 (assisted), BP 162/70

Patient 3: 38 year old, alert, resolved LOC, feels OK Patient 4: 50 year old, alert, complains of neck and back pain, on a board HR 98, RR 18, BP 108/62 HR 108, RR 20, BP 98/60

Patient 5: 18 years old, unconscious

Patient 6: 39 year old, responsive to pain only, pale and sweaty

HR 62, RR 0, BP 88/58

HR 124, RR 32, BP 88/62

Patient 1 is a relatively stable femur fracture. While ALS would be nice for pain control, he can go BLS if more pressing patients exist. Patient 2 is unstable and has required intubation. He represents the most acute patient and should be flown to a trauma center. Patient 3 is likely concussed. He would benefit from an ER visit to scan his head, but can go BLS. Patient 4 This is a stable BLS patient. He can go with Patient Number 3. Patient 5 is in respiratory arrest and has a very poor prognosis – he is likely going to be in cardiac arrest soon and is poor use of resources. Patient 6 is a critical injury with likely hypovolemic shock. He should go ALS.