Case 1: Wilderness Setting – Climber Falls on Icy Trail

General Context: An experienced climber slips on an icy trail and falls several meters, sustaining an open tibia fracture on the right leg.

Learning Objectives:

• Primary and secondary assessment in a remote environment.
• Stabilizing an open fracture in a hostile setting.
• Managing environmental risks: cold, ice, and isolation.

Detailed Scenario: A group of climbers is descending a winding and icy trail, taking safety precautions. The injured climber is conscious but very anxious. The weather is adverse, with sub-zero temperatures and snowfall. Besides the leg injury, no other apparent injuries are detected.

Available Information:

• Vital Signs:
  • Heart rate 110 bpm
  • Blood pressure Radial pulse present
  • Respiration 24 rpm
  • Temperature 35.5 °C
• Accessible Resources:
  • Basic first aid kit: tourniquet, dressings, bandages, but no immobilization equipment.
  • Thermal blankets, all climbing equipment (ice axes, ropes, harnesses, etc.), and camping gear (tarp, sleeping mats, sleeping bags).

Reflection and Validation Questions:

1. What are the priorities for this patient? Would you adapt your primary/secondary assessment?
2. How can the fracture be effectively stabilized in this environment?
3. What precautions should be taken to protect the patient and the team from the cold?
4. How would you approach spinal protection in this scenario?

Critical Points and Challenges:

• Pain management and adequate immobilization.
• Transporting the patient in difficult terrain.
• Preventing hypothermia.
• Establishing a prolonged field care plan.

Case 2: Prehospital Setting – Worker Falls from Scaffolding

General Context: A construction worker falls 6 meters from scaffolding at an urban construction site. He reports back pain and pain in the right leg.

Learning Objectives:

• Rapid assessment of a polytraumatized patient.
• Applying immobilization techniques in a prehospital setting.
• Managing intervention risks in a construction site.

Detailed Scenario: The worker is found on a solid surface, conscious but unable to move his legs. The site has residual risks (tools on the ground, unsecured scaffolding).

Available Information:

• Vital Signs:
  • Heart rate 90 bpm
  • Blood pressure 140/80
  • Saturation 98 %
  • Respiration 18 rpm
• Accessible Resources:
  • Full immobilization equipment (backboard, cervical collar, straps, splints).
  • Complete intervention kit.
  • Monitor.

Reflection and Validation Questions:

1. What is the priority in assessing this patient?
2. What environmental risks must be considered during this intervention? How can they be managed?
3. How can a safe transfer to the ambulance be ensured?
4. In evaluating the fall, what criteria should be considered (there are 4!)?

Critical Points and Challenges:

• Suspected spinal cord injury.
• Team coordination for immobilization.
• Maintaining safety at the construction site.

Case 3: Sports Setting – Gymnast Falls from Uneven Bars

General Context: A gymnast falls during a competition. They report intense pain in the right wrist and cannot move it.

Learning Objectives:

• Assessing acute musculoskeletal injuries.
• Temporary stabilization before transport.
• Managing stress in a sporting event.

Detailed Scenario: The gymnast is assisted by a coach before the arrival of emergency responders. The competition is paused, and the crowd is watching.

Available Information:

• Vital Signs:
  • Heart rate 80 bpm
  • Blood pressure 110/70
  • Saturation 99 %
  • Respiration 26 rpm
  • Cap refill slow in the right hand
• Accessible Resources:
  • First aid kit: splints, bandages, ice packs.
  • Medical personnel on-site: 1 therapist (you) and a parent identifying as a first responder.

Reflection and Validation Questions:

1. What clinical signs would confirm a wrist fracture?
2. How can you reassure the patient and the team in this context?
3. What tools should be used to stabilize the wrist before transport?

Critical Points and Challenges:

• Reassuring an anxious patient.
• Immobilizing a suspected fracture without increasing pain.
• Communicating effectively with on-site responders.

Cross-Cutting Competency:

• Rapid primary and secondary assessment in diverse contexts (wilderness, urban, sports).
• Managing specific environmental risks (ice, heights, hard surfaces).

Conclusion and Key Takeaways:

The essential role of communication and coordination in complex scenarios.

The importance of rapid assessment to identify intervention priorities.

Adapting to environmental and contextual constraints.