CSM EMCIS PROGRAM

EMR Scenarios
CSM Mine Rescue Team
Chris Enright, NREMT
6/16/2015

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Setup
Single patient, lying supine with minor bleeding from nose. Can be next to desk or chair or other
starting location.

Scenario
Dispatch Information: 27 year old female fall victim, 1600 Jackson St, Suite 160A
Update to information: Reported that patient was in class, and suddenly fell over onto the ground
and wouldnt respond. Pt now conscious and breathing. PD now on scene, reporting patient
conscious and breathing, no significant injuries.

Assessment Steps
Scene Safety
Required BSI?
Nature of illness
# of patients
Additional
resources?
C-Spine
Indicated?
General
Impression
Level of
Consciousness
Chief complaint
Airway
Breathing
Circulation
Skin
Immediate life
threats?
Priority
Initial
interventions
Vitals (set 1)

SAMPLE History

Scene is safe.
Gloves
Medical with trauma possible
1
ALS
No
Syncopal episode
Alert and oriented, to person, place and time- does not remember exact
circumstances leading to fall
Fall post syncope
Open
16/min, quiet, unlabored
Radial pulse of 110
Pink, warm, sweating
None
Green
1. O2 via cannula if wanted (2 Lpm) [Optional]
2. Assess and treat injuries
BP
140/100
SpO2
95%
Eyes
Signs & Symptoms
Allergies
Medication

HR
Skin

112
Pink, warm,
sweaty
ERRL
BGL 105
Some minor pain at the back of the head where it
struck the ground. Small hematoma at back of head
Seasonal allergies
Oral birth control

Prior Hx
Last in/out
Events

Physical
Assessment

Vitals (set 1)

Required
Treatment
Differential
diagnoses

BP
SpO2

Never fainted before

Ate breakfast at 07:45, a couple burritos from
Santiagos. Snacking and water over course of
morning
Was sitting in annual refresher class, remembered
her nose started bleeding suddenly and then she
blacked out, Woke up with others standing around
asking if she was OK
Head: small
hematoma at back of
skull. Mild pain on
palpation. Bleeding
from nose nearly
controlled, mostly
clotted and dried.
No tracheal deviation
or JVD. Chest
unremarkable, with
lungs clear, equal and
bilateral. Abdomen
soft, nontender; pelvis
unremarkable, legs
and feet both
unremarkable. Arms
unremarkable.
132/90
98%

HR
Skin

85
Pink, warm,
dry

Eyes
ERRL
Monitor until ALS care arrives. Treat epistaxis consistent with local protocol.
Patient would be a good candidate to refuse additional care and ALS
treatment/transport to a hospital, which is safe and acceptable.
Syncopal episode (psychogenic?-potentially caused by sight of blood)
Stroke (unlikely. Age group wrong, symptoms wrong)
Drugs/Alcohol (denied by patient, but cant rule out influence).

Setup
Single patient at base of outdoor stairs. Moulage for ankle injury if possible. Scatter large boxes, etc
around the area.

Scenario
Dispatch: Respond to a 20s male, report of a fall, on the stairs entering 1600 Jackson St.
Conscious and breathing.
Other information PTA: Reported that the patient fell while carrying some things up the stairs.
Believes his head is injured and he cant feel his toes.

Assessment and Treatment

Scene Safety
Required BSI?
Nature of illness
# of patients
Additional
resources?
C-Spine
Indicated?
General
Impression
Level of
Consciousness
Chief complaint
Airway
Breathing
Circulation
Skin
Immediate life
threats?
Priority
Initial
interventions
Vitals (set 1)

SAMPLE History

Scene is safe.
Gloves
Trauma
1
ALS
YES
Fall from height/down stairs
Alert and oriented, to person, place and time and event, describing how he fell
while carrying these boxes up the stairs
Pain in head
Open
18/min, quiet, unlabored
Radial pulse of 124
Pink, warm, sweating
None
Yellow
1. Spinal immobilization
2. Assess and treat injuries
BP
132/88
SpO2
98%
Eyes
Signs & Symptoms
Allergies
Medication

HR
Skin

130
Pink, warm,
sweaty
ERRL
BGL 88
Significant pain at back of head and neck, esp on
palpation. Reports feet and lower legs are numb.
Shellfish (anaphylaxis), ondansetron (minor hives)
went to coors lab before work

Prior Hx
Last in/out

Physical
Assessment

Vitals (set 1)

Required
Treatment
Differential
diagnoses

Fell off bike when 12- broke nose.

Bobs Atomic Burgers for lunch, then went to coors lab
(3 beers).
Events
Was carrying large boxes into office to move books and
such into space. Reports he fell backward onto the
stairs, and was struck by the boxes as he hit the ground
Head: large
hematoma at back of
skull. Pain on
palpation. No tracheal
deviation or JVD.
Chest unremarkable,
with lungs clear, equal
and bilateral. RUQ of
abdomen with pain on
palpation, minor
bruising. Pelvis
unremarkable, no
priapism. No
sensation or motor
function below waist,
patient reports a
tingling like they went
to sleep. Arms
unremarkable.
BP
148/112
HR
150
SpO2
94%
Skin
Pink, warm,
sweaty
Eyes
ERRL
Complete spinal immobilization- using either long board or vacuum splint.
Oxygen therapy for shock treatment and mild analgesia. Preserve body heat
and ensure patient comfort. Initiate transport if possible, else wait for ALS
arrival and transport.
Traumatic injury to the basilar skull and cervical spine, with minor
injury to abdomen.
Decrease in SpO2 and increase in BP/HR suggests patient entering
compensatory shock. Shock treatment and transport to hospital are
indicated.

Setup
Single patient with expendable clothing, simulated bicycle or motorcycle prop. Best case done on
dirt road or other roadside with gravel possible.

Scenario
Dispatch: Please respond to reports of an injury motor vehicle accident on Highway 74, mile
marker 17; motorcyclist down. Witnesses report injuries to rider.
Other information PTA: Deputies on scene reporting single patient, male in his 30s, significant
injuries, unconscious and breathing. Update on location: mile 16.5

Assessment and Treatment

Scene Safety
Required BSI?
Nature of illness
# of patients
Additional
resources?
C-Spine
Indicated?
General
Impression
Level of
Consciousness
Chief complaint
Airway
Breathing
Circulation
Skin
Immediate life
threats?
Priority
Initial
interventions
Vitals (set 1)

SAMPLE History

Scene is mildly safe- ensure traffic is controlled and personnel are wearing highvisibility clothing.
Gloves, eye protection, traffic safety attire
Trauma
1
ALS, potentially aeromedical evacuation
YES
Traumatic injury from motorcycle accident
Responsive to pain only- responds incoherently.
Traumatic injury
Requires adjunct to open and stabilize
22/min, shallow, patient grimaces with each breath
Carotid pulse only, approx 40
Pale, cool, diaphoretic
Exsanguinating hemorrhage on left arm- uncontrollable with pressure
Red
1.
2.
3.
4.
BP
SpO2

Open airway
Stop hemorrhage with tourniquet
Spinal immobilization
Assess and treat injuries
84/palp
88%

Eyes
Signs & Symptoms

Sluggish
Patient is unresponsive

HR
Skin
BGL

42
Pale, cool,
diaphoretic
79

Allergies
Medication
Prior Hx
Last in/out
Events

Pt unresponsive
Pt unresponsive
Pt unresponsive
Pt unresponsive
Pt unresponsive

Physical
Assessment

Vitals (set 1)

Required
Treatment

Differential
diagnoses

BP
SpO2

78/palp
84%

Head: large
hematoma at back of
skull. Unstable basal
skull. Tracheal
deviation to right side.
Instability to left ribs
with puncture wound
present through
pleural space, with
diminished lung
sounds on left side.
Abdomen soft,
nontender, no
bruising. Pelvis
unstable, minor
grating and patient
movement with
stimulus. Legs
unremarkable, pulses
not present in feet.
Deep laceration on
underside of left armbleeding controlled
only with TQ. Right
arm unremarkable.
HR
38
Skin
Pale, cool,
diaphoretic

Eyes
Sluggish, equal, responsive
Complete spinal immobilization- using either long board or vacuum splint.
Oxygen therapy for shock treatment and mild analgesia. Preserve body heat
and ensure patient comfort. Treat pelvis fracture and place occlusive dressing
on rib fracture.
Initiate transport if ASAP, do not delay transport for ALS care. Aeromedevac if
possible or believed transport time longer than 20 minutes.
Serious injury to brain, left lung and exsanguinating hemorrhage from
serious motorcycle accident.
Drastically depressed vital signs and diminished LOC indicative of
decompensating shock- this patient is actively dying. May not survive if
not treated and transported in less than 10 minutes.

Setup
Single patient, some blood on ground, seated up against wall of office.

Scenario
Dispatch: Please respond to a 26 yo male with back pain, in the offices of Dewey Cheetam and
Howe Law firm, 1801 Illinois St. Pt conscious, breathing, reporting pain was a sudden onset.

Assessment and Treatment

Scene Safety
Required BSI?
Nature of illness
# of patients
Additional
resources?
C-Spine
Indicated?
General
Impression
Level of
Consciousness
Chief complaint
Airway
Breathing
Circulation
Skin
Immediate life
threats?
Priority
Initial
interventions
Vitals (set 1)

SAMPLE History

Scene appears safe

Gloves
Trauma/Medical
1
ALS
Not likely
Back pain, unknown etiology
Alert and oriented X4
Pain to the right center of the lumbar back
Patent, clear
18/ clear / effortless
110, strong, regular
Warm, slightly diaphoretic
None apparent
Green
1. Assess and treat injuries
BP
SpO2
Eyes
Signs & Symptoms
Allergies
Medication
Prior Hx
Last in/out
Events

140/110
HR
116
98%
Skin Warm diaphoretic
ERRL
BGL 121
Patient reports both a burning and stabbing pain about
two inches to the right of center, three inches up from
waistline
None
Ibuprofen, 400mg- No effect
None
Breakfast at 09:45, huevos rancheros
Just remembered a sudden burning sort of sharp
stabbing pain at that spot. Felt like it penetrated a little
way

Physical
Assessment
GSW

Vitals (set 2)

Required
Treatment
Differential
diagnoses

BP
SpO2

180/120
99%

Physical assessment
unremarkable with the
exception of a single
puncture wound,
approx. 9 mm .
Moderate bleeding,
slow and dark colored.
No other injuries.

HR
Skin

122
Warm
diaphoretic

Eyes
ERRL
Secure scene, attempting to ensure source of shot is secured and hazard is
mitigated
Pack GSW with gauze, transport
Gunshot wound to the back- low severity.