Case Studies

The following are Case based learning projects.

They are worth 50% of your unit mark and therefore are important in terms of the learning process associated with the unit.

The questions following the cases are designed to stimulate Clinical and Situational awareness in the aeromedical retrieval environments and are based on an

expectation of a high-level clinical knowledge foundation.

Stimulating and enhancing your clinical understanding and developing your clinical thinking and application are an underlying goal.

It is assumed that you are a clinical member of the Aeromedical Team. The Case Studies will comprise:
€¢   Primary Retrieval: 2 Cases
€¢   Co-ordination: 1 Case
€¢   Secondary Retrieval: 1 Case
€¢   Total: 4 Cases

The assignment should be presented as per UNI guidelines and use an acceptable academic referencing system where necessary.

Use of bullets is acceptable to summarize pertinent points and information to save on word count.

The total word count for all submissions should not exceed 3500 words plus or minus 20%

Line spacing should be 1.5

Font may be Arial or Times New Roman

Submissions will be via TURNITIN.

Assignment 3

Pre-Hospital Cases: Case 1:
An 18-year-old male is the sole occupant, driver, of a utility vehicle and has rolled his vehicle several times while texting.

The rollover has happened on a sealed (Bitumen) country road in the

Wheat- belt of Western Australia.

A truck driver has reported that the vehicle suddenly lost control, and rolled over about three times before coming to rest on its wheels with the roof on the driver’s

side crushed but not trapping the driver.

Estimated speed was approximately 110 km/h.

The caller states the driver is still in the vehicle, not responding, but is breathing, with a large laceration on the forehead and bruising around the right eye.

No hazards observed on scene.

Relevant Information:

Aircraft option: Rotary Wing: landing site less than 30m away.

Ground resources: One Volunteer Services Ambulance and local Police

Service.

Retrieval options: Royal Perth Hospital (Trauma Centre) 120 minutes by road or 35 minutes by air

Environmental factors: Tuesday Morning 09:00, clear conditions

Questions:

1.1: Using the information so far available, outline your clinical plan prior to arrival on scene.

Clinical Information:

€¢   P: 120/min

€¢   BP: 150/90 mmHg

€¢   GCS 6 (E1 V2 M3)

€¢   No Allergies

€¢   No Previous medical history

€¢   No current medications.

1.2: Briefly describe Patient selection criteria for RSI (Rapid Sequence Intubation), paying particular attention to the airway examination component and predictors of

a difficult intubation.

1.3: Describe the key steps required in the performance of a Pre- Hospital RSI.

1.4 What are the risks and benefits associated with RSI in the trauma patient? Provide a critical assessment of your decision to RSI or not?

Case 2:

A 22-year-old female working at a dairy farm in a country town has been kicked in the chest and abdomen by a large bull.

She is complaining of dyspnea and abdominal pain, but remains alert.

The paramedic crew arrives about 15 minutes prior to your arrival, and reports the following:

€¢   GCS 15

€¢   No Loss of Consciousness

€¢   Cold & Clammy

€¢   Flail segment on right lateral chest wall with dyspnea.

€¢   Rigid abdomen in all quadrants with visible hoof mark over umbilicus.
€¢   NIBP: 90/60 (Usually 120/75)

€¢   Pulse: 120 beats/min

€¢   Spo2: 93 %, High Concentration Oxygen Mask

Relevant Information

Aircraft option: Rotary wing with a flight time of 30 min.

Ground resources: 1 Paramedic Ambulance (Not critical care/MICA/ICP).

Retrieval Options: Trauma center 30 min by air.

Other: No reported hazards on scene with a wide, flat paddock 30m away; time of incident to your arrival is less than one hour.

Questions:

2.1: Describe the clinical picture you could possibly derive from the given information and what instructions would you give the attending paramedic crew prior to your

arrival, if any?

2.2: What is your clinical plan and initial management? also briefly highlight any potential clinical deterioration that may be encountered ?

2.3: Describe how you will notify the receiving hospital of your planned arrival and how they might prepare for your arrival.

Co-ordination Case:

Case 3:

The four incidents in this case are focused on appropriate and effective resource allocation by a Doctor led aeromedical retrieval team.

Aeromedical retrieval is only effective if a high level of clinical coordination and guidance is maintained, especially when coupled with evidence based tasking

guidelines.

The following incidents need to be considered independently.

In each case the decision to mobilize, coordinate and support of the retrieval team rests solely with you.

All necessary media, information and technology are available to you to make your decision.

Incident 1:

The Metropolitan Ambulance Service communications center has briefed you on a developing incident in an urban area within your area.
Multiple calls have been received regarding a cyclist that has collided with a motor vehicle at a busy intersection.
The cyclist is reported to be unconscious.

Incident 2

You receive a call about a shooting in remote area some 60 minutes by rotary winged aircraft. It is 2am and raining.
A female made a single call and reported a gunshot as well as figure laying face down in her front yard.
A local ambulance crew has been dispatched but will not be on scene for

20 minutes.

Incident 3

A paramedic ambulance crew has requested activation of the medical helicopter to a rural property 30 minutes away by air.
The crew reports CPR in progress for a 65 year old female residing at the residence.

Incident 4

An ongoing incident has been phoned through. A car has been struck by a van on a freeway 25 minutes by rotary winged aircraft. Information is one person dead at scene

and another trapped with severe abdominal pain and
SBP of 90mmHg.

Questions:

For all 4 incidents discuss key points in the allocation of a Doctor based retrieval team resource allocation to these incidents. Include in your answer:
1.  Justification for activation or non activation based on the little information you have
2.  Problems that may be encountered

3.  Your actions to gain a clearer picture of the incidents

4.  Critically analyze what your team mix may be and why.

Comment [I1]: Need to get them all to this level of critical thinking.

Inter-Facility Case:

Case 4:

Following a fall from farm machinery, a 40-year-old male farmer in the Wheat-belt region of Western Australia, has sustained an intracranial hemorrhage and possible

spinal injuries.

He is currently located at a small medical center.

He is intubated and ventilated with the following ventilator settings:

€¢   Tidal Volume: 450ml

€¢   RR: 12 breaths/min

€¢   PEEP (Positive End Expiratory Pressure): 5 cmH20

€¢   FiO2: 28% Clinical Information:
€¢   P: 85/min

€¢   BP: 140/80 mmHg

€¢   SaO2: 98%

Relevant Information

Aircraft option: Fixed wing and Rotary Wing available

Local Resources: One Ambulance

Retrieval Options: State Major Trauma Centre (Specialist Neurological and Spinal Units included) 400 km away.

Environmental Conditions: Heavy Rain and 15°C

Questions:

4.1: Focusing on the principals of flight physiology, analyze how this patient could be affected and the measures you would take to
mitigate or eliminate any adverse occurrences.

4.2: Taking all the factors into consideration, critically justify your

choice of transport platform.    Comment [I2]: Introduce questions that ask for critical appraisal/analysis
rather than describe.