images-1By Philip Neuwirth, BS, MICP, CCEMTP, FP-C

Air Med One received a flight for an unknown trauma patient five nautical miles from their base. Lift-off and landing were without incidence. Upon landing, Flight Team (FT) was told by Fire Department (FD), the patient was involved in a zip lining accident, and EMS was in the process of extricating him from the mountain. Patient ETA >30 minutes. Flight Team offered their assistance at the scene but told not currently needed. The pilot was signaled to shut-down and awaited patient’s arrival.

Approximately 30 minutes after landing the FT received a cell phone call from ground ALS. It happened to be a guy the Flight Paramedic went to school with 25 years ago. ALS told the FT, the patient sustained traumatic back and leg injuries from a zip lining accident; caused by a break failure, and crashed into a tree. He told the FT, their ETA to the LZ was greater than 30 minutes because they have to carry him off the mountain. To make things worse, he reported, “It was one of their own.” The patient was one of the hospitals senior ground medics, who everyone knew well, and enjoyed working alongside.

30 minutes after the call, the patient arrived in the back of a local volunteer ambulance in the care of ground ALS. The Flight Paramedic entered the side door, and his partner the rear door. What they saw surprised them; after all, you rarely receive a patient from Paramedics prone, secured to a long board. They knew ground ALS must have had a real good reason the patient was positioned prone; the team were veteran Paramedics, who had a history of critical thinking and advanced skills.

The patient received arms over his head, tightly grasping the sides of the longboard and head turned to the right, resting flat on the board. ALS reported patient sustained a possible compression type injury to his back, based on the mechanism of injury and stated, the patient was unable to lie supine. They reported patient had paresthesia of his extremities and unable to move his legs. The patient was C/O severe mid-back, leg and heel pain. The patient was noted to have abrasions across his mid-back, and hypersensitivity to his heels. The patient had no complaint of neck pain and on palpation, no step-offs noted. Vitals: HR=110, BP= 118/68, RR=24, O2 Sat=98% on room air, with a shock index of 1.07. The patient was administered 100 mcg of Fentanyl and 10 mg of Valium before FT’s arrival, but patient remained in severe 10/10 pain.

The patient was, fortunately, conscious and alert, breathing without effort, answering questions appropriately and following simple commands. He recognized the FT right away, and said, “Please do not move me.” They said, you know we can’t leave you prone; how are we going to control your airway?” He said, “I know, but you have to believe me, I can’t move onto my back.” They said, “we will give you additional analgesia and sedation and then carefully roll you over. For no other reason, we can’t bring you to our trauma center like this”. The patient said, “I know, I know, but believe me, I can not move.” “Please, please, make an exception for me, I can not move.

Before we post the FT’s treatment (to roll, or not to roll) and patient outcome, please post any questions. What additional information do you need? How would you handle this patient? Would you roll the patient over? Would you intubate the patient to help control pain?

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