At 3:30 p.m., on a Saturday afternoon

At 3:30 p.m., on a Saturday afternoon in September, a commercial bus collided with a freight train on a US Highway, five miles west of town. The Highway Patrol (1 trooper) and the first ambulance arrived at the scene 20 minutes after the accident. The ambulance crew consisted of two EMT’s. The following injured patients were found: A. pregnant female (first pregnancy, 8 ½ months along), sitting on the ground, a small cut on nose, broken teeth, swollen right angle, having abdominal contractions (pain) every 10 minutes. B. bus driver, slumped over the steering wheel, unconscious, pupils dilated and fixed, no carotid pulse detectable. Respirations irregular and slow, chest wall soft and deformed. C. male adult, lying in the aisle, pain in the right thigh, right foot turned outward, no external bleeding of the thigh, alert, pale, thirsty. D. male adult, lying under the seat, pupils dilated and fixed, carotid pulse not detectable, slight dry blood from nose and ears, swollen side of the head, respirations 4 per minute. E. child, age three, deep laceration of the right leg, oozing blood, deformity of the same leg, crying in mother’s lap. F. mother of “E”, nervous, no complaints, sitting on the ground. G. male adult in US Navy uniform, medical insignia on the sleeve, cut tongue, alert and ambulatory. H. female adult lying on the ground, a large piece of glass in the chest, pupils dilated and fixed, no carotid pulse, no respirations. I. male adult, husband of “H”, hysterical, walking around the area, no obvious injuries. J. female adult, scratches on hands and knees, alert, ambulatory, calm, severe bleeding from scalp laceration. K. baby in diapers, crying in mother’s arms, mother says a child is not hurt. L. female adult, mother of “K”, no injuries obvious or reported, sitting in the bus. M. male adult, lying on the side with knees bent towards the abdomen, hands holding abdomen, moaning, strong alcohol odor, won’t answer questions, pupils constricted, good carotid pulse and vomited once. N. female teenager, painful, deformed and swollen right humerus and elbow and hand cold and bluish, can’t move fingers of the right hand. O. elderly male approximately 60, sitting in the bus, says he has a heart condition, complains of chest pain, pale, sweaty skin, pupils normal, left radial pulse absent, alert, left chest hurts when he moves, lifts an arm or takes a deep breath. P. two elderly sisters, complaining of poor bus service, fast driving and demanding that the trooper arrest the bus driver at once. Q. female adult, pain in right shoulder and neck, hurts to move the right arm, head tilted to the right, alert, ambulatory, right hand warm and fingers move well. R. male adult, deformed jaw, can’t talk, pupils react to light, good pulse, very swollen neck, subcutaneous emphysema of front and sides of the neck, some difficulty breathing. S. female adult, tangled in seats, complaining of severe pain in the back, cannot move legs. T. female teenager, standing outside experiencing difficult and labored breathing, a crowing sound heard on expiration, hands grasping throat, no obvious injuries. Each ambulance trip can include two stretchers and one sitting patient. The scene is as follows: two more officers have arrived, a deputy sheriff and another state trooper. There are approximately 25 bystanders, including an off-duty EMT from your agency. You are in ambulance “A”. Assume you are with another paramedic. Ambulances “B” and “C” have been called to assist but have not yet arrived. There is one helicopter available, en-route. For this scenario, you do not need to worry about overloading hospitals – assume their capacity is whatever you need it to be. Answer the following Questions 1. Upon arrival at the scene in the ambulance, what is the very first thing you would do? 2. How many, and which patients would you place in Ambulance “A” for its first trip and why? Stretcher 1 Stretcher 2 Sitting 3. How do you assign work to the other first responders, useful bystanders or patients? 4. Which patient should go via helicopter? 5. How many, and which patients would you place in Ambulance “B” for its first trip and why? Stretcher 1 Stretcher 2 Sitting 6. How many, and which patients would you place in Ambulance “B” for its first trip and why? Stretcher 1 Stretcher 2 Sitting 7. The first ambulance to return to the scene, second trip. Stretcher 1 Stretcher 2 Sitting 8. The next ambulance to return to the scene, second trip. Stretcher 1 Stretcher 2 Sitting 9. What additional trips are necessary? 10. Which victims would not need to be seen at the hospital? Triage SCIENCE HEALTH SCIENCE NURSING URPN 450

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