Learning Objectives

1. Plan a safe and coordinated evacuation.
2. Learn to manage a complex scene with multiple patients by prioritizing effectively.
3. Assess patients based on their severity of injury.
4. Work effectively in a team to allocate tasks.

Remote Setting: Snowmobile Accident with Pelvic Fracture and Hypovolemic Shock

Title: Face to the Tree

A group of three snowmobilers is enjoying a sunny day exploring isolated trails. During a sharp turn, one of the members loses control and crashes into a tree at high speed. They are 50 km from the nearest road and 30 km from a cabin, with no reliable means of communication.

Initial Information:

• The patient is on the ground, conscious but with intense pelvic pain.
• Moderate external bleeding is visible.
• Vital signs show progressive deterioration.

Available Resources:

• First aid kit (bandages, tourniquet, thermal blanket).
• Three snowmobiles for possible transport.
• Portable GPS.

Reflection Questions:

1. How can you stabilize a pelvic fracture with the resources available?
2. What measures can you take to minimize the risk of hypovolemic shock?
3. What is the optimal evacuation plan?

Prehospital Setting: Pile-Up on a Snowy Road

Title: Collision on Ice

On a high-speed road (90 km/h), a head-on collision between two vehicles triggers a pile-up. The scene is complex: there are 6 patients, including 2 unstable (head trauma, massive hemorrhage) and 4 stable (moderate injuries). A snowstorm complicates access.

Initial Information:

• Two severely damaged vehicles are blocking the road.
• The unstable patients show signs of severity: altered consciousness, tachycardia, and hypotension.
• The first ambulance is expected in 15 minutes, with others arriving between 30 to 90 minutes.

Available Resources:

• First responder intervention kit (immobilization equipment, AED, hemorrhage control, etc.).
• Signaling equipment (triangles, flares, etc.).
• A team of 4 prehospital responders.

Reflection Questions:

1. Which patients should be prioritized and why?
2. What safety measures should be implemented to protect the team and patients?
3. How can you organize triage on a scene with limited resources?

Sporting Context: Spectator Crushed in Bleachers During Outdoor Hockey Game

Title: Crowd on Ice

During a highly anticipated outdoor hockey game, a partial collapse of the bleachers triggers a panic. Several minor injuries occur, but once people extricate themselves from their unfortunate positions, a child is found accidentally crushed under multiple spectators. The parents are present and panicking, complicating the intervention.

Initial Information:

• The child is unconscious with labored breathing.
• Outdoor temperature is -10°C.
• The parents are hysterical and interfere with the assessment. Several minor injuries are present, including musculoskeletal injuries, abrasions, and a few head knocks.

Available Resources:

• Complete intervention kit for a sports therapist, but no pediatric-specific equipment.
• Automated External Defibrillator (AED).
• Two responders (1 per team), and 911 has been called.

Reflection Questions:

1. What severity signs should you monitor in a child in this context? What strategies can you implement to prevent hypothermia and stabilize the child?
2. How can you manage the parents while maintaining an effective intervention?
3. How can you manage and prioritize the numerous patients in this context, despite their minor injuries?

Conclusion and Critical Points

1. The importance of the initial assessment to determine priorities.
2. Strategies for coordination and communication within the team.
3. Resources are rarely sufficient to handle the worst-case scenario.
4. The impact of environmental and emotional conditions on clinical decision-making.