Case based learning projects

The following are Case based learning projects.
They are worth 50% of your unit mark and therefore are important in
terms of the learning process associated with the unit.
The questions following the cases are designed to stimulate Clinical and
Situational awareness in the aeromedical retrieval environments and are
based on an expectation of a high-level clinical knowledge foundation.
Stimulating and enhancing your clinical understanding and developing
your clinical thinking and application are an underlying goal.
The Case Studies will comprise:
• Pre-Hospital Retrieval: 3 Cases
• Co-ordination: 1 Case
• Inter-Facility: 1 Case
• Total: 5 Cases
Case Studies: PST 4106
1
Paramedical Science
The following are Case based learning projects.
They are worth 50% of your unit mark and therefore are important in
terms of the learning process associated with the unit.
The questions following the cases are designed to stimulate Clinical and
Situational awareness in the aeromedical retrieval environments and are
based on an expectation of a high-level clinical knowledge foundation.
Stimulating and enhancing your clinical understanding and developing
your clinical thinking and application are an underlying goal.
The Case Studies will comprise:
• Pre-Hospital Retrieval: 3 Cases
• Co-ordination: 1 Case
• Inter-Facility: 1 Case
• Total: 5 Cases
The assignment should be presented as per ECU guidelines and use an
acceptable academic referencing system where necessary.
Use of bullets is acceptable to summarize pertinent points and
information to save on word count.
The total word count for all submissions should not exceed 3500 words
plus or minus 20%
Line spacing should be 1.5
Font may be Arial or Times New Roman
You can find a copy of the marking key and criteria in this part of the
blackboard website
Case Studies: PST 4106
2
Paramedical Science
Pre-Hospital Cases:
Case 1:
A van has collided at high speed with a car. The tasking agency reports
that there are three severely injured patients including children. All are
still in the vehicle and could be trapped.
In addition there is one potential fatality at the scene.
Relevant information:
Retrieval means: Rotary Aircraft
Ground resources: 3 ambulances, police and fire and rescue
Retrieval options: Major trauma center 20 minutes by air, general
hospital 30 minutes via road.
Environmental: Approaching rain.
Questions:
1.1 Describe your Pre hospital plan and immediate actions on
arrival at scene
On arrival you note 4 patients from 2 vehicles and all have been
extricated:
a. Patient 1 is pulseless and apneic with a large opened
skull fracture with extra-cranial brain tissue visible
b. Patient 2 is a middle aged female with a rigid abdomen
and bruising over the pelvis. She has decreased air entry
over the left lung field according to on scene paramedic.
Her BP is 90 systolic and GCS 6
Case Studies: PST 4106
3
Paramedical Science
c. Patient 3 is a male 11 years old with a closed bilateral
femoral fracture that is crying inconsolably. His pulse is
120 beats per minutes
d. Patient 4 is from a 3rd vehicle and is C/O ankle pain.
1.2: Outline your treatment for these patients and provide rationale
for which you would select for the air retrieval. What could
potentially go wrong with this scenario and how can you prepare?
Case 2:
A 50-year-old female motorcyclist has collided with a car and is said to
be ‘not responding’
Relevant Information:
Aircraft option: Rotary Wing landing site less than 200m away.
Ground resources: One Ambulance and local Police Service
Retrieval options: Major Trauma Centre 30 min by road or 10 min by air
Environmental factors: Tuesday Morning 08:00, clear conditions
Questions:
2.1: Using the information so far available, outline your pre-hospital
plan prior to arrival on scene.
Clinical Information:
• P: 120/min
• BP: 150/90 mmHg
Case Studies: PST 4106
4
Paramedical Science
• GCS 6 (E1 V2 M3)
2.2: Briefly describe Patient selection criteria for RSI, paying
particular attention to the airway examination component and
predictors of a difficult intubation.
2.3: Describe the key steps required in the performance of a Pre-
Hospital RSI.
2.4 What are the risks and benefits associated with RSI in the trauma
patient? Provide a critical assessment of your decision to RSI or not?
Case 3:
An 18-year-old male has been riding his dirt bike along a dirt track and
he is struck across the anterior neck by an unseen guide wire.
He is complaining of dyspnea and has also sustained a compound fracture
to his Right Tibia and Fibula.
He is also anxious and tachypnoeic with a RR of 30.
All other vital signs remain within normal parameters.
Relevant Information
Aircraft option: Rotary wing
Ground resources: 2 Ambulances, Fire & Rescue Services
Retrieval Options: General Hospital 20 min by road, Major Trauma
center 30 min by air
Other: Fire & Rescue declare scene safe
Case Studies: PST 4106
5
Paramedical Science
Questions:
3.1: What is your initial pre-hospital plan prior to arrival on scene
On arrival you find the patient anxious but lucid
He complains of severe anterior neck pain and is spitting out bloody
saliva.
His voice is hoarse and remains tachypnoeic at a rate of 30 breaths/min
Examination reveals an acutely tender anterior neck.
There is slight crepitus over the laryngeal structures and a compound
fracture of the Right tibia and fibula with good distal perfusion.
No other injuries detected.
3.2: What is your initial management and which hospital will you
transfer to? Why might you choose to transport this patient or to
leave this patient with the paramedics who would transport to the
local general hospital with surgical capacity?
3.3: Describe how you will notify the receiving hospital of your
planned arrival and how they might prepare for your arrival.
Co-ordination Case:
Case 4:
The following assessment is related to the tasking and coordination of
physician led retrieval.
Case Studies: PST 4106
6
Paramedical Science
Tasking and clinical coordination are vital aspects of retrieval medicine.
Triage resource allocation and high level clinical oversight are key
elements to this process.
The following incidents need to be considered as being independent of
each other.
In each case the decision to mobilize, coordinate and support of the
retrieval team rests solely with you.
You have the maps and communication equipment available to you to
make each decision.
Incident 1:
The ambulance service has alerted you to an ongoing incident in an urban
area of or your jurisdiction. Five minutes earlier multiple calls had been
received regarding a motorcycle rider who had been struck at an
intersection.
Information you have received is that the Motorcyclist is unconscious.
Incident 2
You receive a call about a shooting in remote area some 50 minutes by
rotary winged aircraft. It is 2am and raining.
A female made a single call and reported a gunshot as well as figure
laying face down in her front yard.
A local ambulance crew has been dispatched but will not be on scene for
20 minutes.
Incident 3
Case Studies: PST 4106
7
Paramedical Science
You are asked by a ground team to activate a helicopter to a semi rural
property 25 minutes by air away. A 75-year-old man has collapsed in his
living room and cardio pulmonary is in progress.
Incident 4
An ongoing incident has been phoned through. A car has been struck by a
van on a freeway 25 minutes by rotary winged aircraft. Information is one
person dead at scene and another trapped with severe abdominal pain and
SBP of 90mmHg.
Questions:
For all 4 incidents discuss key points in the allocation of a physician
based retrieval team resource allocation to these incidents.
Include in your answer:
1. Justification for activation or non activation based on the little
information you have
2. Problems that may be encountered
3. Your actions to gain a clearer picture of the incidents
4. Critically analyze what your team mix may be and why.
Inter-Facility Case:
Case 5:
Following a fall from farm machinery, a 40-year-old male farmer in the
Wheat-belt region of Western Australia, has sustained an intracranial
hemorrhage and spinal injuries.
He is currently located at a small general hospital.
Case Studies: PST 4106
8
Paramedical Science
He is intubated and ventilated with the following ventilator settings:
• Tidal Volume: 450ml
• RR: 12 breaths/min
• PEEP (Positive End Expiratory Pressure): 5 cmH20
• FiO2: 28%
Clinical Information:
• P: 85/min
• BP: 140/80 mmHg
• SaO2: 98%
Relevant Information
Aircraft option: Fixed wing and Rotary Wing available
Local Resources: One Ambulance
Retrieval Options: State Major Trauma Centre (Specialist Neurological
and Spinal Units included) 400 km away.
Environmental Conditions: Heavy Rain and 15°C
Questions:
5.1: Focusing on the principals of flight physiology, analyze how this
patient could be affected and the measures you would take to
mitigate or eliminate any adverse occurrences.
5.2: Taking all the factors into consideration, critically justify your
choice of transport platform.

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They are worth 50% of your unit mark and therefore are important in terms of the learning process associated with the unit.

The questions following the cases are designed to stimulate Clinical and Situational awareness in the aeromedical retrieval environments and are based on an expectation of a high-level clinical knowledge foundation.

Stimulating and enhancing your clinical understanding and developing your clinical thinking and application are an underlying goal.

It is assumed that you are a clinical member of the Aeromedical Team. The Case Studies will comprise:
•   Primary Retrieval: 2 Cases
•   Co-ordination: 1 Case
•   Secondary Retrieval: 1 Case
•   Total: 4 Cases

The assignment should be presented as per UNI guidelines and use an acceptable academic referencing system where necessary.

Use of bullets is acceptable to summarize pertinent points and information to save on word count.

The total word count for all submissions should not exceed 3500 words plus or minus 20%

Line spacing should be 1.5

Font may be Arial or Times New Roman

Submissions will be via TURNITIN.

Pre-Hospital Cases: Case 1:
An 18-year-old male is the sole occupant, driver, of a utility vehicle and has rolled his vehicle several times while texting.

The rollover has happened on a sealed (Bitumen) country road in the

Wheat- belt of Western Australia.

A truck driver has reported that the vehicle suddenly lost control, and rolled over about three times before coming to rest on its wheels with the roof on the driver’s side crushed but not trapping the driver.

Estimated speed was approximately 110 km/h.

The caller states the driver is still in the vehicle, not responding, but is breathing, with a large laceration on the forehead and bruising around the right eye.

No hazards observed on scene.

Relevant Information:

Aircraft option: Rotary Wing: landing site less than 30m away.

Ground resources: One Volunteer Services Ambulance and local Police

Service.

Retrieval options: Royal Perth Hospital (Trauma Centre) 120 minutes by road or 35 minutes by air

Environmental factors: Tuesday Morning 09:00, clear conditions

Questions:

1.1: Using the information so far available, outline your clinical plan prior to arrival on scene.

Clinical Information:

•   P: 120/min

•   BP: 150/90 mmHg

•   GCS 6 (E1 V2 M3)

•   No Allergies

•   No Previous medical history

•   No current medications.

1.2: Briefly describe Patient selection criteria for RSI (Rapid Sequence Intubation), paying particular attention to the airway examination component and predictors of a difficult intubation.

1.3: Describe the key steps required in the performance of a Pre- Hospital RSI.

1.4 What are the risks and benefits associated with RSI in the trauma patient? Provide a critical assessment of your decision to RSI or not?

Case 2:

A 22-year-old female working at a dairy farm in a country town has been kicked in the chest and abdomen by a large bull.

She is complaining of dyspnea and abdominal pain, but remains alert.

The paramedic crew arrives about 15 minutes prior to your arrival, and reports the following:

•   GCS 15

•   No Loss of Consciousness

•   Cold & Clammy

•   Flail segment on right lateral chest wall with dyspnea.

•   Rigid abdomen in all quadrants with visible hoof mark over umbilicus.
•   NIBP: 90/60 (Usually 120/75)

•   Pulse: 120 beats/min

•   Spo2: 93 %, High Concentration Oxygen Mask

Relevant Information

Aircraft option: Rotary wing with a flight time of 30 min.

Ground resources: 1 Paramedic Ambulance (Not critical care/MICA/ICP).

Retrieval Options: Trauma center 30 min by air.

Other: No reported hazards on scene with a wide, flat paddock 30m away; time of incident to your arrival is less than one hour.

Questions:

2.1: Describe the clinical picture you could possibly derive from the given information and what instructions would you give the attending paramedic crew prior to your arrival, if any?

2.2: What is your clinical plan and initial management? also briefly highlight any potential clinical deterioration that may be encountered ?

2.3: Describe how you will notify the receiving hospital of your planned arrival and how they might prepare for your arrival.

Co-ordination Case:

Case 3:

The four incidents in this case are focused on appropriate and effective resource allocation by a Doctor led aeromedical retrieval team.

Aeromedical retrieval is only effective if a high level of clinical coordination and guidance is maintained, especially when coupled with evidence based tasking guidelines.

The following incidents need to be considered independently.

In each case the decision to mobilize, coordinate and support of the retrieval team rests solely with you.

All necessary media, information and technology are available to you to make your decision.

Incident 1:

The Metropolitan Ambulance Service communications center has briefed you on a developing incident in an urban area within your area.
Multiple calls have been received regarding a cyclist that has collided with a motor vehicle at a busy intersection.
The cyclist is reported to be unconscious.

Incident 2

You receive a call about a shooting in remote area some 60 minutes by rotary winged aircraft. It is 2am and raining.
A female made a single call and reported a gunshot as well as figure laying face down in her front yard.
A local ambulance crew has been dispatched but will not be on scene for

20 minutes.

Incident 3

A paramedic ambulance crew has requested activation of the medical helicopter to a rural property 30 minutes away by air.
The crew reports CPR in progress for a 65 year old female residing at the residence.

Incident 4

An ongoing incident has been phoned through. A car has been struck by a van on a freeway 25 minutes by rotary winged aircraft. Information is one person dead at scene and another trapped with severe abdominal pain and
SBP of 90mmHg.

Questions:

For all 4 incidents discuss key points in the allocation of a Doctor based retrieval team resource allocation to these incidents. Include in your answer:
1.  Justification for activation or non activation based on the little information you have
2.  Problems that may be encountered

3.  Your actions to gain a clearer picture of the incidents

4.  Critically analyze what your team mix may be and why.

Comment [I1]: Need to get them all to this level of critical thinking.

Inter-Facility Case:

Case 4:

Following a fall from farm machinery, a 40-year-old male farmer in the Wheat-belt region of Western Australia, has sustained an intracranial hemorrhage and possible spinal injuries.

He is currently located at a small medical center.

He is intubated and ventilated with the following ventilator settings:

•   Tidal Volume: 450ml

•   RR: 12 breaths/min

•   PEEP (Positive End Expiratory Pressure): 5 cmH20

•   FiO2: 28% Clinical Information:
•   P: 85/min

•   BP: 140/80 mmHg

•   SaO2: 98%

Relevant Information

Aircraft option: Fixed wing and Rotary Wing available

Local Resources: One Ambulance

Retrieval Options: State Major Trauma Centre (Specialist Neurological and Spinal Units included) 400 km away.

Environmental Conditions: Heavy Rain and 15°C

Questions:

4.1: Focusing on the principals of flight physiology, analyze how this patient could be affected and the measures you would take to
mitigate or eliminate any adverse occurrences.

4.2: Taking all the factors into consideration, critically justify your

choice of transport platform.    Comment [I2]: Introduce questions that ask for critical appraisal/analysis
rather than describe.

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