Clinical scenario: Near-amputation in a boating accident

You arrive to find a 23-year-old male whose right leg has been nearly amputated above the knee. What are your treatment priorities?

Editor’s Note:

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While volunteering as an EMT with the local sheriff’s department marine patrol, you are dispatched to a report of a boat accident. The deputy you are assigned to patrol with helps you load your gear into the launch and you begin the five-minute ride to the reported location. 

You are currently patrolling a large inland lake over a holiday weekend. The lake is a popular destination for water sports, and this weekend has been particularly busy. 

As you approach, the driver of the boat waves to you. You see that there are three people in the back of the boat crowded around a fourth person who has obviously been injured. Once the two boats are tied together, you step aboard and survey the scene. 

Patient assessment

Your patient is a 23-year-old male who is conscious and oriented but in obvious distress. The driver of the boat reports that the patient was water skiing when he fell. The driver circled back to where he thought the patient was but overshot the location and struck the patient.

As you visually assess the patient you see that his right leg has suffered significant trauma and has been nearly amputated above the knee. The patient currently has uncontrolled bleeding from his leg despite direct pressure being applied by bystanders. 

Your ALS ambulance is en route with a 15 minute ETA. There is a community hospital 25 minutes from the scene and a trauma center approximately 90 minutes from the scene. 

Think about the following questions:

  • What are your treatment priorities?
  • What additional equipment do you need to package the patient? 
  • Which hospital should the patient be transported to?

Post your answers below in the comments.

About the author

An EMS practitioner for nearly 15 years, Patrick Lickiss is currently located in Grand Rapids, MI. He is interested in education and research and hopes to further the expansion of evidence-based practice in EMS. He is also an avid homebrewer and runner.

  1. Tags
  2. Amputation
  3. Education
  4. Medical / Clinical
  5. Medical Treatment

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