“Engine 2522, Medic 2591, respond Code 2 to the northeast corner of Central Park, access via State St. This is for a report of a 22-year-old female with a leg injury. Happened during a soccer game.”
After the engine pulls into the parking lot, you grab your trauma kit and walk towards the crowd gathered at the soccer field. You hear dispatch advise over the radio that your ALS transport unit is five minutes away.
The patient is awake, anxious from pain and introduces herself as Sarah. She states that she was playing soccer when another participant slide tackled her. She felt a “pop” when she fell and has significant pain in her right lower leg.
Sarah is wearing long pants and blood is soaking through the fabric. You ask Sarah if you can cut up her pant leg to the knee to inspect her injury and she agrees.
When you expose the area, you see an obvious deformity above the ankle with what appears to be a puncture wound on the medial aspect of the lower leg. Slow steady bleeding is noted. The remainder of Sarah’s physical exam is unremarkable and you are able to rule out the need for cervical spine precautions.
Your engineer removes a splint from the trauma bag, but when he attempts to apply direct pressure to her leg before placing the splint, Sarah cries out in pain. She asks if you can give her anything for the discomfort before touching her leg.
Sarah’s vital signs are:
- BP: 152/68
- HR: 112
- RR: 20
- SpO2: 99% on room air
The ALS crew walks up and you give them a brief history of Sarah’s injury and your findings. The paramedic on scene asks if you planned to splint the leg and you explain Sarah’s request for pain management.
The paramedic says, “No, we’ll wait until we’re on the way to the hospital; no sense in wasting time here.” You start to say that you don’t agree but stop.
The county protocol states that a medical scene is controlled by the provider with the highest license level, and this paramedic outranks you within your department.
Think about these questions as you consider what to do next:
- What is the severity of Sarah’s injury?
- How does your answer affect your treatment priorities?
- Do you agree with the paramedic’s current plan? Why or why not?
- If you disagree, how can you handle the situation?
Post your answers below in the comments and view the clinical solution for this patient.
