1. A Patients Survival Story Dr Laura Attwood EM Consultant, RVI Pre Hospital Care Consultant, GNAAS

2. Aim Case Review Services/Personnel Involved A Patients Perspective

3. Background Difficult patient to manage in pre-hospital setting Multiple traumatic injuries Prolonged hospital stay Required transfer from RVI to JCUH as closer to patients home

4. Pre Hospital Setting Sunday 18 th August 2013 Helimed 063 already out on task Another call for more seriously injured casualty Left previous task at 11:31 Arrived on scene 11:46 A696 – Kirkwhelpington

5. On arrival Police on scene St John’s Ambulance with patient (2 tech crew) Rapid Response Paramedic Road closures in both directions

7. Initial Assessment Multiple injuries apparent – Confused patient, multiple facial fractures and significant bleeding from mouth – Occipital Head Injury – GCS 11/15 (E2, V4, M5) – Right Pneumothorax – Sats 86% on high flow oxygen – Haemodynamically unstable – Probable Pelvic fracture – Bilateral Colles fractures

8. Decision Making Process Protect Airway with RSI Right chest Thoracostomy Pelvic Binder Bilateral Wrist Splints Large IV access TXA 1500mls fluid

9. On the move Left scene 12:31 Landed at RVI 12:41 MHP requested Chest drain requested

10. In ED Primary Survey Bilateral Chest drains inserted Remained Haemodynamically unstable MHP: 7RBC, 4 FFP, 1 Platelets, 1 Cryo CT scan

11. CT – Summary of Injuries L Temporal Contusion Extensive Facial Fractures Biggest concern – Non functioning R lung – ?bronchus/?pulm artery injury L flail chest – ribs 1-5 L2 unstable fracture Pelvic fracture – Comminuted L hemi pelvis/acetabulum and pubic rami Bilateral Wrist fractures

12. ICU – 19 day stay Bronchosocopy – R main bronchus obstruction Theatre – twice – Both wrists – Rib fixation Hospital Acquired Pneumonia TLSO brace C Diff positive diarrhoea Osteomyelitis L wrist ex fix site Multifactorial Delirium

13. Orthopaedic Ward – 7 days R talar fracture/lat mall fracture identified Difficulty mobilising requiring hoist Discussed with JCUH Transfer arranged – Ongoing mamnagement of orthopaedic problems and spinal fracture – Closer to Darlington for patient and family

14. A Patients Perspective