You are working in a BLS ambulance in a small city with a huge rural area. There is ALS backup available if you need it. Today is a cold fall day and the outside temperature is around 0ºC and windy. You are dispatched to a farming accident; a farmer is caught in a power take-off shaft. Your ALS unit is also dispatched but will be delayed in responding as they are just finishing a call. Your response time is 20 minutes and the ALS response time is 30 minutes. Transport time is another 50 to 60 minutes. You notify dispatch to see if the air ambulance is available and also if they can bring a doctor and blood, if required.
On scene the fire department has arrived and is attempting to assess the patient. Your patient is a 23-year-old female, found lying with her right leg wrapped around a power take-off shaft, which is powered by a 2090 Case IH tractor and hooked onto a grain auger. The fire department members are holding her up as well as holding C-spine. They are also trying to stop the visible bleeding, but with some difficulty.
The patient appears to be awake but seems to have lost considerable amounts of blood. She is obviously experiencing hypovolemic shock. She is very cool, pale and diaphoretic. There are no other signs of trauma or injury. The patient looks to have been stepping off the tractor to start the grain auger when her pants or leg were caught up. The leg is wrapped around the shaft to about the mid femur. Apparently the tractor stalled or the PTO was stopped, but it is a devastating injury. You are worried already. You notify the air ambulance and ALS unit that you need help–a trauma surgeon and a blood bank would be helpful as well.
You complete a set of vitals and find:
HR: 146 strong, regular
RR: 34 shallow
SPO2: N/A initially
Cardiac monitor: sinus tachycardia
12-lead: sinus tachycardia
History: As above.
Past Medical Hx: Appendix removed in 93, Tonsils and adenoids out as a child