Scenario 2 Is it ever safe enough?

IRECA BLS Competition 2011 Scenario 2 Is it ever safe enough? Team Name Captain Name Judge 1 Judge 2

The Event: You are dispatched to a shooting for two injured at a local bar. Witnesses have told police that two men entered the patio/pool area of a bar and started arguing with a young people sitting at table. One of the men began hitting the man sitting down and pushed the other when the witnesses tried to intervene. Shots were fired by the other man and he fled the scene. Police arrived on scene and were finally able to subdue pt #2, the shooter, and have just secured the scene as you arrive. Many bystanders are still present. Victim #1: Lying supine Pt. is approx 30 y/o Pt. is semi conscious and moaning Pt. has a gunshot wound to the abdomen Pt. has a bloody nose and red marks on his face Victim #2: Sitting upright in cuffs Pt. is approx. 40 y/o Pt. is out of breath and exhausted Pt. has a small cut above one eye Pt. has a GSW to the right shoulder Victim #3: Floating in pool Pt. is approx. 25 y/o Pt. is unresponsive Pt. has a large lump forming above the right eye

*Judges Sheet* Overview: This scenario is designed to cover multiple injuries, patients and complications. The two victims were sitting at the poolside when they were approached by two men, an argument started and one man began to hit the man sitting down. The other tried to intervene and was pushed backwards. A gunshot was heard and the two males fell to the ground. The third male ran and has not been found. The bullet entered one man (Victim #2) at the shoulder and he is detained in hand restraints and is conscious and alert. The second male (Victim #1) has an entrance wound but no exit wound and is semi conscious. Initially the other patient was not noticed until a bystander yells that there is someone in the water. (NOTE #1) Patient two will be restrained the entire scenario. Treatments and care must be done with patient in that position. Patient three is unresponsive, has a pulse, and not breathing. Once rescue breathing has been initiated, time for 5 minutes and at that time, pt. 3 begins to cough and spit up water and begins breathing on his/her own. (NOTE #2) Skills / Criteria Judged: Pt. 1 Backboarding - C-spine protection Severe Bleed - Bleeding controlled Rapid transport life threats: abd bleeding, head injury and c-spine Pt. 2 Bleeding control Calm and treat Pt. 3 Moving Patient - Removal to safe area out of water Backboarding - C-spine protection Airway management / Rescue breathing - Recognition of non-breathing patient and rescue breathing initiated promptly

Immediate Action Scene Size Up 1 Yes No All kits closed when problem starts 2 Yes No All team members wearing gloves 3 Yes No Police called / recognize they are here 4 Yes No ALS Ambulance called 5 Yes No Fire called 6 Yes No Requests bystanders to be questioned 7 Yes No Scene safety assessed ( No other weapons found ) 8 Yes No Attempt to find other victims ( None other than these two ) Victim #1 (Lying Supine, hand-cuffed Semi-conscious, GSW to abdomen, bloody nose) 9 Yes No Rescuers identify themselves 10 Yes No Attempt to gain consent from patient ( Unable to give ) 11 Yes No Attempt to identify patient ( Unable to answer ) 12 Yes No Determine level of consciousness is Alert & Orientated x 0 or V on AVPU (Semi-conscious/moaning; doesn t answer any questions; responds to pain) 13 Yes No Determines Head/Neck stabilization IS indicated due to blow to bruising and LOC 14 Yes No Assesses airway ( Gurgling airway ) 15 Yes No Suction applied to clear airway (roll/fingersweep is not effective if tried) 16 Yes No Reassess airway ( Cleared ) 17 Yes No Assesses ventilation ( Rapid/Non-Labored 22) 18 Yes No Oxygen applied via partial or non-rebreather mask ( Tolerates mask ) 19 Yes No Oxygen set to at least 15 liters per minute 20 Yes No Assesses pulse ( Rapid 138) 38 Yes No Checks for exit wound ( None Found ) 21 Yes No Check for severe bleeding ( Bleeding heavily from GSW in abdomen ) ( Moderate bleeding from the nose ) 22 Yes No Applies direct pressure to abdomen ( Soaks through bandaging ) 23 Yes No Applies direct pressure to abdomen ( Controlled ) 24 Yes No Applies direct pressure to nose while it is held ( Controlled ) If released in 5 minutes, it will be bleeding again If they have someone hold it (like imaginary police) it is controlled 25 Yes No Held for at least 5 minutes ( Controlled ) If released in 5 minutes, it will be bleeding again 26 Yes No Removes clothing to inspect as necessary 27 Yes No Determines transport priority (urgent or high priority or load & go ) Victim #2 (Sitting upright, hand-cuffed alert & defiant, GSW to shoulder, asthma) 28 Yes No Rescuers identify themselves 29 Yes No Attempt to gain consent from patient ( Go ahead ) 30 Yes No Attempt to identify patient ( Screw you! ) Yes No Determine level of consciousness is Alert & Orientated x 3 (is answering questions and showing that he is aware of his situation) 31 32 Yes No Determines Head/Neck stabilization NOT indicated 33 Yes No Assesses airway ( Patent he is talking to you ) 34 Yes No Assesses ventilation ( Rapid/Shallow/Labored 26) 35 Yes No Oxygen applied via partial or non-rebreather mask ( Tolerates mask ) 36 Yes No Oxygen set to at least 15 liters per minute 37 Yes No Assesses pulse ( Rapid 118) 38 Yes No Checks for exit wound ( Wound found in posterior of shoulder ) 39 Yes No Check for severe bleeding ( Bleeding from both front and back of R shoulder ) 40 Yes No Applies direct pressure to anterior of shoulder ( Controlled ) 41 Yes No Applies direct pressure to posterior of shoulder ( Controlled ) 42 Yes No Removes clothing to inspect as necessary 43 Yes No Determines transport priority (urgent or high priority or load & go ) * AFTER IMMEDIATE ACTION FLIP THE PAGE AND DO NOT RETURN.*

Victim #1 Lying Supine IRECA BLS Competition 2011 Patient Vitals- CHECK PULSE AND RES FOR 15 Sec q q q Pulse... 138 (regular, strong) q q q Respirations... 22 q q q Skin color/temp. Cool, pale, moist q q q BP... 108/70 q q q Pupils... Slow to React, constricted q q q Time Patient Maintenance and Ongoing Assessment Y q N q Head/Neck injury suspected Y q N q Check for Med. Alert Tags Y q N q Tx. for shock applies oxygen Y q N q Tx. for shock Maintain temperature Talks with patient or checks LOC Y q N q... Y q N q... Continues to moan and Y q N q... not respond Y q N q... Patient Interview- DONE IN ANY ORDER Y q N q Signs & Symptoms... cut above eye, shoulder GSW, heavy breathing Y q N q Allergies... ( Unknown ) Y q N q Medications... ( Unknown ) Y q N q Past pertinent Hx... ( Unknown ) Y q N q Last oral intake... ( Unknown ) Y q N q Events preceding... ( Unknown ) GSW to Abdomen 44 Yes No Expose wounds 45 Yes No Applies direct pressure / rechecks previous bandaging ( Bleeding through ) 46 Yes No Applies more pressure and bandages ( Controlled ) 47 Yes No Secure bandages in place 48 Yes No Applies ice 49 Yes No Assures ice does not come into direct contact with skin 50 Yes No Rechecks bandage for bleed through or effectiveness ( No bleed through ) Spinal Immobilization due to possible head injury 51 Yes No Check motor, sensory and pulse before placing cervical collar 52 Yes No Applies properly sized cervical collar 53 Yes No Moves patient keeping in-line spinal stabilization 54 Yes No Evaluates for padding 55 Yes No Secures patient to spinal immobilization device 56 Yes No Re-checks motor, sensory and pulse Nosebleed and Bruising to the Face 57 Yes No Monitors Bleeding into airway ( gurgling ) 58 Yes No Suction applied to clear airway (roll/fingersweep is not effective if tried) 59 Yes No Suction for no longer than 20 seconds 60 Yes No Reassess airway ( Cleared ) 61 Yes No Applies ice 62 Yes No Assures ice does not come into direct contact with skin

PT. 2 Sitting upright, hand-cuffed IRECA BLS Competition 2011 Patient Vitals- CHECK PULSE AND RES FOR 15 Sec q q q Pulse... 118 q q q Respirations... 18 q q q Skin color/temp. Warm/Flush/Moist q q q BP... 130/88 q q q Pupils... Equal/Reactive q q q Time Patient Maintenance and Ongoing Assessment Y q N q Head/Neck injury suspected Y q N q Check for Med. Alert Tags Y q N q Tx. for shock applies oxygen Y q N q Tx. for shock Maintain temperature Talks with patient or checks LOC Y q N q... A&O x 3 Y q N q... A&O x 3 Y q N q... A&O x 3 Y q N q... A&O x 3 Patient Interview- DONE IN ANY ORDER Y q N q Signs & Symptoms... Xxxx Y q N q Allergies... Refused Y q N q Medications... Refused Y q N q Past pertinent Hx... Refused Y q N q Last oral intake... Refused Y q N q Events preceding... What does it look like?!? The cops just ran me down. GSW to Right Shoulder 63 Yes No Expose wound 64 Yes No Checks for exit wound ( Wound found in posterior of shoulder ) 65 Yes No Applies direct pressure / rechecks previous bandaging ( Bleeding through ) 66 Yes No Applies more pressure and bandages ( Controlled ) 67 Yes No Secure bandages in place 68 Yes No Check motor, sensory and pulse of R arm (can move, feel, and pulse is present) 69 Yes No Splints the shoulder with a sling 70 Yes No Splints the shoulder with a swathe 71 Yes No Rechecks motor, sensory and pulse (can move, feel, and pulse is present) 72 Yes No Applies ice 73 Yes No Assures ice does not come into direct contact with skin 74 Yes No Rechecks bandage for bleed through or effectiveness ( No bleed through )

Respiratory Emergency Asthma 75 Yes No Questions patient further on history of respiratory problems ( asthma severe) 76 Yes No Requests removal of hand-cuffs or cuts them off ( They cannot be removed ) 77 Yes No Asks patient about an inhaler ( pt has one in pocket ) 78 Yes No Ensures that it is the patients inhaler ( Pt s name is on the inhaler ) 79 Yes No Ensures that is in not expired ( it expires 9/31/2011 ) 80 Yes No Checks prescription ( 2 puffs as needed ) Yes No States they can assist per their protocols or calling medical control 81 ( Noted or Medical Control says you may go ahead and assist ) 82 Yes No Assists patient with use of inhaler 83 Yes No Reassesses Ventilations/Respiratory Effort ( breathing still difficult ) Yes No Questions patient about past use episodes and inhaler use 84 ( It usually takes a couple times ) 85 Yes No Assists patient with 2 nd use of inhaler ( improvement noted ) 86 Yes No Reassesses Ventilations/Respiratory Effort ( better but still rapid, wheezing ) 87 Yes No Reassesses Ventilations/Respiratory Effort after several minutes ( improving ) 88 Yes No Considers implications of possible drug use 89 Yes No Attempts to calm patient

Pt. 3 IRECA BLS Competition 2011 Floating in pool - found at Note 1 after immediate action Patient Vitals- CHECK PULSE AND RES FOR 15 Sec q q q Pulse... As Found q q q Respirations... None After Note 2... As Found q q q Skin color/temp. As Found q q q BP... As Found q q q Pupils... As Found q q q Time Patient Maintenance and Ongoing Assessment Y q N q Head/Neck injury suspected Y q N q Check for Med. Alert Tags Y q N q Tx. for shock applies oxygen Y q N q Tx. for shock Maintain temperature Talks with patient or checks LOC Y q N q... U on AVPU prior to Note 2 Y q N q... Y q N q... V on AVPU after Note 2 Y q N q... Patient Interview- DONE IN ANY ORDER Y q N q Signs & Symptoms... Unresponsive and not breathing Y q N q Allergies... Unknown Y q N q Medications... Unknown Y q N q Past pertinent Hx... Unknown Y q N q Last oral intake... Unknown Y q N q Events preceding... From bystander: Tried to stop the fight, was pushed and fell. Victim #3 (Floating in pool unconscious, no respiration, pulse, bruise on head) 90 Yes No Rescuers identify themselves 91 Yes No Attempt to gain consent from patient ( Unable to give ) 92 Yes No Attempt to identify patient ( Unable to answer ) 93 Yes No Rescuers immediately get to the pt. within 30 seconds of getting the note 94 Yes No Rescuers immediately get to the pt. within a minute of getting the note 95 Yes No Rescuers immediately get to the pt. within 3 minutes of getting the note 96 Yes No Rescuers attempt to use a tool to reach the pt ( None available ) 97 Yes No Rescuers look for personal floatation device ( None available ) 98 Yes No Rescuers reconsider calling for additional resources (or ask about ALS status) 99 Yes No Determine level of consciousness is U on AVPU ( Unresponsive ) 100 Yes No Determines Head/Neck stabilization IS indicated due to head blow and LOC 101 Yes No Assesses airway ( Gurgling airway ) 102 Yes No Roll and finger sweep or suction ( water comes out ) 103 Yes No Suctions no more than 20 seconds 104 Yes No Reassess airway ( Upper airway seems clear ) 105 Yes No Assesses ventilation ( Absent ) 106 Yes No Assists ventilations at 1 every 3-6 seconds ( Resistance felt when ventilating ) 107 Yes No Oxygen set to at least 15 liters per minute 108 Yes No Assesses pulse ( As Found ) 109 Yes No Check for severe bleeding ( None found ) 110 Yes No Removes clothing to inspect as necessary 111 Yes No Determines transport priority (urgent or high priority or load & go ) Unconscious 112 Yes No Attempt to ID or get history from wallet or ID bracelet 113 Yes No Attempt to get info from bystanders (bystanders available- can give events)

Airway Management 114 Yes No Maintains modified jaw thrust until oral/naso can be placed 115 Yes No Measures airway (Naso or Oro) 116 Yes No Inserts airway (Naso or Oro) (Accepted) 117 Yes No Lung sounds assessed (prior to Note 2 gurgling on ventilations bilaterally ) 118 Yes No Lung sounds assessed (After Note 2 Wet but better bilaterally ) Head injury 119 Yes No Check head ( Large Lump forming above R eye rest of skull intact ) 120 Yes No Applies ice to wound 121 Yes No Ensures ice is not directly in contact with skin Spinal Immobilization 122 Yes No Moves pt through water in a way that will keep in-line spinal stabilization 123 Yes No Removes pt from water in a way that maintains in-line spinal stabilization (Either water backboard or lift out of pool carefully) 124 Yes No Check motor, sensory and pulse before placing cervical collar 125 Yes No Measures or selects appropriately sized collar 126 Yes No Applies cervical collar 127 Yes No Maintains head/neck stabilization until the head is strapped to the board 128 Yes No Moves patient keeping in-line spinal stabilization 129 Yes No Evaluates for padding 130 Yes No Secures patient to spinal immobilization device 131 Yes No Re-checks motor, sensory and pulse Transfer of Care Report Patient #1 (Lying Supine - semiconscious) 132 Yes No Gives patient s age, sex and level of consciousness 133 Yes No Reports vital signs/history 134 Yes No Reports injuries 135 Yes No Reports interventions Transfer of Care Report Patient #2 (Sitting upright - alert) 136 Yes No Gives patient s age, sex and level of consciousness 137 Yes No Reports vital signs/history 138 Yes No Reports injuries 139 Yes No Reports interventions Transfer of Care Report Patient #3 (From the pool) 140 Yes No Gives patient s age, sex and level of consciousness 141 Yes No Reports vital signs/history 142 Yes No Reports injuries 143 Yes No Reports interventions Overall Patient Care 144 Yes No Team changed gloves when switching between patients 145 Yes No Patients were given nothing by mouth unless medically indicated 146 Yes No Team did nothing to jeopardize patient condition If No explain here:

Note #1 (Given at the end of immediate) A bystander begins yelling that there is someone floating in the pool. Victim #3: Floating in pool Pt. is approx. 25 y/o Pt. is unresponsive Pt. has a large lump forming above the right eye Note #2 (Given 5 minutes after Rescuers begin to ventilate) Pt. #3 now has a good pulse and is breathing on his own.

The Event: You are dispatched to a shooting for two injured at a local bar. Witnesses have told police that two men entered the patio/pool area of a bar and started arguing with a young people sitting at table. One of the men began hitting the man sitting down and pushed the other when the witnesses tried to intervene. Shots were fired by the other man and he fled the scene. Police arrived on scene and were finally able to subdue pt #2, the shooter, and have just secured the scene as you arrive. Many bystanders are still present. Victim #1: Lying supine Pt. is approx 30 y/o Pt. is semi conscious and moaning Pt. has a gunshot wound to the abdomen Pt. has a bloody nose and red marks on his face Victim #2: Sitting upright in cuffs Pt. is approx. 40 y/o Pt. is out of breath and exhausted Pt. has a small cut above one eye Pt. has a GSW to the right shoulder