It is a cold winter day in what has otherwise been a great winter so far, at least compared to last year. You are working in a small city today of about 25,000 people. Your ALS ambulance is staffed with one PCP and one ACP. You have two ALS units on night shift and both units are doing their fair share of the emergency calls.
You are dispatched to a snowmobile accident approximately 17 km north of your city. Your dispatcher states a 12 y/o old male child has hit a barbed wire fence while driving a snowmobile in a farmer’s field. You start responding and it will take you approximately 15 to 20 minutes to reach the scene. You also have police, and the local fire department responding with their rescue unit to assist with patient care. Once you arrive you find the local police already on scene. The fire rescue crew is right behind you. You see a patient up against a barbed wire fence with bystanders attempting to keep him still. The patient is in obvious emotional distress and trying to remove himself from the barbed wire.
His initial vital signs are:
- HR: 124 bpm
- RR: 32
- BP: 128/78
- SPO2 is not available now due to the cold initially
- BGL: 5.3 mmol/l
- Cardiac Monitor: sinus tachycardia
- Temp: 34.5° Celsius
On your initial exam, you find that the patient has the wire caught in his clothes and find that barbed wire is buried in a deep laceration in the anterior portion of his neck and left shoulder. You hear a slight stridor as you assess the airway for breathing which causes you to recognize the potential for serious airway compromise with this patient.
You notify your dispatcher that you need assistance from the provincial air ambulance, who are dispatched immediately and will meet you at the scene. If available, they are attempting to include an ER physician and an anesthesiologist with their crew. You have started extrication and then package the patient for immediate transport as the air ambulance will arrive within 15 to 20 minutes. The police will arrange a landing zone.