EMT Basic Scenario – Vehicle versus Pedestrian Accident - Musculoskeletal Trauma

Dispatch: You are dispatched to the intersection of Main and Vine streets for a pedestrian hit and run.
You arrive to find a 22-year-old man lying supine on the ground and not moving. Witnesses state that
the victim was trying to cross the intersection and walked in front of a car that ran a red light and kept
going. Law enforcement and an engine company are also on scene to assist with scene safety and crowd
control.

Takes, or verbalizes, body substance isolation

Scene is Safe
precautions
Determines the mechanism of injury/nature of
Vehicle vs. pedestrian
illness
Determines the number of patients 1
Requests additional help if necessary Yes
Considers stabilization of spine Yes
Verbalizes general impression of the patient Man on the ground after vehicle collision
Determines responsiveness/level of
Responsive and answers questions appropriately
consciousness
Determines chief complaint/apparent life
Severe left leg, hip, and back pain
threats
Assesses airway and breathing
Opens and assesses airway Airway is Open and Patent
Inserts adjunct if indicated
Indicates appropriate oxygen therapy 18 breaths/min
Assures adequate ventilation
Manages any injury which may compromise (Oxygen via NRB mask at 15 L/min)
breathing/ventilation
Assesses circulation
No major bleeding seen
Assesses/controls major bleeding
Assesses pulse
Radial pulse rapid and thread
Assesses skin (color, temperature, and
condition)
Cool, pale, and dry
If indicated, begins shock management
Identifies priority patients/makes transport
High Priority
decisions based on calculated GCS
S—No other signs seen
A—NKA
M—None
P—No pertinent PMH
SAMPLE history
L—Lunch approximately 15 minutes ago
E—Walked in front of vehicle while attempting to
cross the road

Head assessment – DCAP-BTLS

Inspects mouth, nose, and assesses facial area
No injuries noted
Inspects and palpates scalp and ears
Assesses eyes for PERRL
Neck Assessment – DCAP-BTLS
Checks position of trachea
No JVD or tracheal shift; no obvious injury
Checks jugular veins
Palpates cervical spine
Chest Assessment – DCAP-BTLS
Inspects chest
No injury noted; breath sounds are clear and equal
Palpates chest
Auscultates chest
Abdomen Assessment – DCAP-BTLS
Inspects and palpates abdomen
Unstable left hip; abdomen soft and non-tender in all
Assesses pelvis
four quadrants; no genital injury
Verbalizes assessment of genitalia/perineum
as needed
Lower Extremities Assessment – DCAP-BTLS
Left femur swelling, and deformity to the left
Inspects, palpates, and assesses motor,
tibia/fibul; PMS present in extremities
sensory, and distal circulatory functions
Upper Extremities Assessment – DCAP-BTLS
Inspects, palpates, and assesses motor, PMS present in extremities
sensory, and distal circulatory functions
Posterior Thorax, Lumbar, and Buttocks
Assessment – DCAP-BTLS
Inspects and palpates posterior thorax No injuries noted
Inspects and palpates lumbar and buttocks
area

Blood pressure—106/76 mm Hg
Pulse—112 beats/min
Vitals (obtains/directs baseline vital signs) Respirations—18 breaths/min
SaO2—94% on room air
PEARRL

Abrasions to left leg and hip

Maintain manual c-spine; apply cervical collar; place

Manages secondary injuries and wounds patient on a long backboard; apply cervical
appropriately immobilization device; splint left leg in position of
comfort
High-flow oxygen via NRB mask at 15 L/min; monitor
vital signs for signs of shock
Reassesses Patient Every 5 minutes during transport
EMT Basic Scenario – Penetrating Abdominal Injury - Abdominal Injuries

Dispatch: You are dispatched to a private residence for a patient with an abdominal injury. Upon arrival,
you are met by a frantic wife who leads you to the backyard. Lying next to a tree and a fallen ladder is a
middle-aged man with a tree branch sticking out of his right side. His wife tells you that he was trimming
the trees when she heard a crash and ran outside to find her husband lying on the ground.

Takes, or verbalizes, body substance isolation

Scene is Safe
precautions
Determines the mechanism of injury/nature of
Penetrating abdominal trauma
illness
Determines the number of patients 1
Requests additional help if necessary Yes
Considers stabilization of spine Yes
Middle-aged man lying supine on the ground with
Verbalizes general impression of the patient a large tree limb protruding from the upper right
quadrant of the abdomen
Determines responsiveness/level of Responsive to verbal stimuli only; answers questions
consciousness slowly but appropriately
Determines chief complaint/apparent life Penetrating trauma to upper right quadrant of the
threats abdomen
Assesses airway and breathing
Opens and assesses airway Airway is Open and Patent
Inserts adjunct if indicated
Indicates appropriate oxygen therapy 20 breaths/min
Assures adequate ventilation
Manages any injury which may compromise (Oxygen via NRB mask at 15 L/min)
breathing/ventilation
Moderate bleeding seen coming from the branch
Wound
Assesses circulation
Assesses/controls major bleeding
Radial pulse rapid and thread
Assesses pulse
Assesses skin (color, temperature, and
Cool, pale, and diaphoretic
condition)
If indicated, begins shock management
(prevent shock)

Identifies priority patients/makes transport

High Priority
decisions based on calculated GCS

S—Penetrating trauma to upper right abdomen

A—NKA
M—Lopressor, Vytorin, aspirin
SAMPLE history
P—Hypertension and high cholesterol
L—Breakfast of toast and coffee about 1 hour ago
E—Trimming tree branches

Head assessment – DCAP-BTLS

Inspects mouth, nose, and assesses facial area
No injury noted
Inspects and palpates scalp and ears
Assesses eyes for PERRL
Neck Assessment – DCAP-BTLS
Checks position of trachea
No JVD or tracheal shift; no obvious injury
Checks jugular veins
Palpates cervical spine
Chest Assessment – DCAP-BTLS
Inspects chest
No injury noted; breath sounds are clear and equal
Palpates chest
Auscultates chest
Abdomen Assessment – DCAP-BTLS
Inspects and palpates abdomen
Tree limb protruding from upper right abdomen, with
Assesses pelvis
moderate bleeding; otherwise, normal findings
Verbalizes assessment of genitalia/perineum
as needed
Lower Extremities Assessment – DCAP-BTLS
Inspects, palpates, and assesses motor, No injuries noted; PMS present in extremities
sensory, and distal circulatory functions
Upper Extremities Assessment – DCAP-BTLS
Inspects, palpates, and assesses motor, No injuries noted; PMS present in extremities
sensory, and distal circulatory functions
Posterior Thorax, Lumbar, and Buttocks
Assessment – DCAP-BTLS
Inspects and palpates posterior thorax No injuries noted
Inspects and palpates lumbar and buttocks
area

Blood pressure—100/56 mm Hg
Pulse—130 beats/min
Vitals (obtains/directs baseline vital signs) Respirations—20 breaths/min
SaO2—96% on room air
PEARRL

Abrasions to right abdomen

Maintain manual c-spine; apply cervical collar; place

Manages secondary injuries and wounds patient on a long backboard; apply cervical
appropriately immobilization device; place bulky dressing around the
branch for stabilization
High-flow oxygen via NRB mask at 15 L/min; monitor
vital signs for signs of shock

Reassesses Patient Every 5 minutes during transport

EMT Basic Scenario – Motor Vehicle Accident - Head and Spine Injuries

Dispatch: You are dispatched at 2am to a single-car crash with possible injuries. Law enforcement and
the fire department are also enroute. Upon arrival, you observe a mid-size sedan that had crashed head-
on into an oak tree on the shoulder of a poorly lit rural road. Law enforcement is on scene and has
cleared the scene. They inform you that there is only one patient and that he appears to be under the
influence. You approach the driver’s side of the car to find a middle-aged man, unrestrained,
complaining of a headache and not being able to find his beer. He does not recall the accident or how he
got there. The last thing that the patient can remember is being at the bar with his friends. There is
moderate front-end damage, the air bags have deployed, and the windshield is intact.

Takes, or verbalizes, body substance isolation

Scene is Safe
precautions
Determines the mechanism of injury/nature of
Vehicle vs. tree
illness
Determines the number of patients 1
Requests additional help if necessary Yes
Considers stabilization of spine Yes
Middle-aged man unrestrained in the driver’s seat of
Verbalizes general impression of the patient
his vehicle
Responsive and answers some questions
Determines responsiveness/level of
appropriately; alcohol-like odor is noticeable on his
consciousness
breath
Determines chief complaint/apparent life
Headache
threats
Assesses airway and breathing
Opens and assesses airway Airway is Open and Patent
Inserts adjunct if indicated
Indicates appropriate oxygen therapy 20 breaths/min
Assures adequate ventilation
Manages any injury which may compromise (Oxygen via NRB mask at 15 L/min)
breathing/ventilation
Assesses circulation
No major bleeding seen
Assesses/controls major bleeding
Assesses pulse
Radial pulses strong and equal
Assesses skin (color, temperature, and
condition)
Warm, pink, and dry
If indicated, begins shock management
Identifies priority patients/makes transport
High Priority
decisions based on calculated GCS
S—Headache; minor abrasions to the face from air
bag deployment
A—NKA
M—Lopressor
SAMPLE history
P—Hypertension
L—Unknown
E—Drinking at the bar with his buddies
Head assessment – DCAP-BTLS
Inspects mouth, nose, and assesses facial area
No injuries noted
Inspects and palpates scalp and ears
Assesses eyes for PERRL
Neck Assessment – DCAP-BTLS
Checks position of trachea
No JVD or tracheal shift; no obvious injury
Checks jugular veins
Palpates cervical spine
Chest Assessment – DCAP-BTLS
Inspects chest
No injury noted; breath sounds are clear and equal
Palpates chest
Auscultates chest
Abdomen Assessment – DCAP-BTLS
Inspects and palpates abdomen
Assesses pelvis No injuries noted
Verbalizes assessment of genitalia/perineum
as needed
Lower Extremities Assessment – DCAP-BTLS
Inspects, palpates, and assesses motor, PMS present in extremities
sensory, and distal circulatory functions
Upper Extremities Assessment – DCAP-BTLS
Inspects, palpates, and assesses motor, PMS present in extremities
sensory, and distal circulatory functions
Posterior Thorax, Lumbar, and Buttocks
Assessment – DCAP-BTLS
Inspects and palpates posterior thorax No injuries noted
Inspects and palpates lumbar and buttocks
area
Blood pressure—146/92 mm Hg
Pulse—78 beats/min
Vitals (obtains/directs baseline vital signs) Respirations—20 breaths/min
SaO2—97% on room air
PEARRL
Abrasions to the face from air bag deployment

Maintain manual c-spine; apply cervical collar;

immobilize the patient in the vehicle using a short
Manages secondary injuries and wounds
backboard; place patient on a long backboard; apply
appropriately
cervical immobilization device

High-flow oxygen via NRB mask at 15 L/min; monitor

vital signs for signs of shock
Reassesses Patient Every 5 minutes during transport
EMT Basic Scenario – Head Injury - Musculoskeletal Trauma

Dispatch: You respond to a parking garage for a possible assault victim. Police are on the scene when
you arrive and are waving you over toward them. They are standing over your patient, who is lying
prone on the ground with a small puddle of blood around his head. You do not notice any spontaneous
movement from the patient as you approach. An officer has secured a tire iron approximately 10 feet
away from the patient.

Takes, or verbalizes, body substance isolation

Scene is Safe
precautions
Determines the mechanism of injury/nature of
Blunt trauma to the head
illness
Determines the number of patients 1
Requests additional help if necessary Yes
Considers stabilization of spine Yes
Well-dressed man, approximately 35 years old, on
Verbalizes general impression of the patient the ground after being beaten in the head with a tire
iron
Determines responsiveness/level of
Responds to painful stimuli only
consciousness
Determines chief complaint/apparent life
No complaint verbalized
threats
Assesses airway and breathing
Airway is Open and Patent; three front teeth have
Opens and assesses airway
been knocked out
Inserts adjunct if indicated
Indicates appropriate oxygen therapy
26 breaths/min with an irregular pattern
Assures adequate ventilation
Manages any injury which may compromise
(Oxygen via NRB mask at 15 L/min)
breathing/ventilation
Assesses circulation
Bleeding from laceration on the back of the head
Assesses/controls major bleeding
Assesses pulse
Radial pulse is rapid and weak bilaterally
Assesses skin (color, temperature, and
condition)
Cool, pale, and clammy
If indicated, begins shock management
Identifies priority patients/makes transport
High Priority
decisions based on calculated GCS
S—Possible depressed skull fracture
A—Unknown
M—Unknown
SAMPLE history
P—Unknown
L—Unknown
E—Walking to his car?
Head assessment – DCAP-BTLS
Possible skull fracture on left side; blood and/or CSF
Inspects mouth, nose, and assesses facial area
draining from left ear; no Battle’s sign or raccoon
Inspects and palpates scalp and ears
eyes
Assesses eyes for PERRL
Neck Assessment – DCAP-BTLS
Checks position of trachea
No JVD or tracheal shift; no obvious injury
Checks jugular veins
Palpates cervical spine
Chest Assessment – DCAP-BTLS
Inspects chest
No injury noted
Palpates chest
Auscultates chest
Abdomen Assessment – DCAP-BTLS
Inspects and palpates abdomen
Stable pelvis; abdomen soft and nontender in all four
Assesses pelvis
quadrants; no genital injury
Verbalizes assessment of genitalia/perineum
as needed
Lower Extremities Assessment – DCAP-BTLS
Inspects, palpates, and assesses motor, PMS present in extremities
sensory, and distal circulatory functions
Upper Extremities Assessment – DCAP-BTLS
Inspects, palpates, and assesses motor, PMS present in extremities
sensory, and distal circulatory functions
Posterior Thorax, Lumbar, and Buttocks
Assessment – DCAP-BTLS
Inspects and palpates posterior thorax No injuries noted
Inspects and palpates lumbar and buttocks
area
Blood pressure—186/118 mm Hg
Pulse—58 beats/min
Vitals (obtains/directs baseline vital signs) Respirations—26 breaths/min, irregular
SaO2—94% on room air
PEARRL
No secondary injuries

Maintain manual c-spine; maintain patent airway

Manages secondary injuries and wounds with oropharyngeal airway; suction airway as
appropriately needed; apply cervical collar; oxygen via NRB mask at
10–15 L/min; secure patient to a long backboard;
elevate head of long backboard 30 degrees; reassess
mental status and vital signs every 5 minutes
Reassesses Patient Every 5 minutes during transport
EMT Basic Scenario – Chest Injuries - Blunt Chest Trauma

Dispatch: You are dispatched to the university baseball field for an injured player. Upon arrival you are
escorted to the dugout, where a player is sitting up, complaining of chest pain and shortness of breath.
He was in the batter’s box when he was struck in the left side of the chest with a 90-mile-an-hour
fastball.

Takes, or verbalizes, body substance isolation

Scene is Safe
precautions
Determines the mechanism of injury/nature of
Blunt chest trauma
illness
Determines the number of patients 1
Requests additional help if necessary Yes
Considers stabilization of spine None
Young man sitting in the dugout in moderate to
Verbalizes general impression of the patient
severe respiratory distress
Determines responsiveness/level of
Responsive and answers questions appropriately
consciousness
Determines chief complaint/apparent life
Left-side chest pain and shortness of breath
threats
Assesses airway and breathing
Airway is Open and patent
Opens and assesses airway
Inserts adjunct if indicated
24 breaths/min; shallow & diminished lung sounds on
Indicates appropriate oxygen therapy
the left
Assures adequate ventilation
Manages any injury which may compromise
(Oxygen via NRB mask at 15 L/min)
breathing/ventilation
Assesses circulation
No major bleeding seen
Assesses/controls major bleeding
Assesses pulse
Radial pulse rapid, strong, and equal
Assesses skin (color, temperature, and
condition)
Warm, pink, and diaphoretic
If indicated, begins shock management
Identifies priority patients/makes transport
High Priority
decisions based on calculated GCS
S—Acute onset of left-sided chest pain and shortness
of breath
A—Penicillin
SAMPLE history M—None
P—No pertinent previous medical history (PMH)
L—Dinner 2 hours ago
E—Struck in the left chest with baseball
Head assessment – DCAP-BTLS
Inspects mouth, nose, and assesses facial area
No injuries noted
Inspects and palpates scalp and ears
Assesses eyes for PERRL
Neck Assessment – DCAP-BTLS No JVD or tracheal shift; no obvious injury
Checks position of trachea
Checks jugular veins
Palpates cervical spine
Chest Assessment – DCAP-BTLS
Inspects chest Bruising and tenderness over the left ribs; breath
Palpates chest sounds are diminished on the left side
Auscultates chest
Abdomen Assessment – DCAP-BTLS
Inspects and palpates abdomen
Assesses pelvis No injuries noted
Verbalizes assessment of genitalia/perineum
as needed
Lower Extremities Assessment – DCAP-BTLS
Inspects, palpates, and assesses motor, PMS present in extremities
sensory, and distal circulatory functions
Upper Extremities Assessment – DCAP-BTLS
Inspects, palpates, and assesses motor, PMS present in extremities
sensory, and distal circulatory functions
Posterior Thorax, Lumbar, and Buttocks
Assessment – DCAP-BTLS
Inspects and palpates posterior thorax No injuries noted
Inspects and palpates lumbar and buttocks
area
Blood pressure—95/60 mm Hg
Pulse—122 beats/min
Vitals (obtains/directs baseline vital signs) Respirations—24 breaths/min; shallow
SaO2—95% on room air
PEARRL
Manages secondary injuries and wounds High-flow oxygen via NRB mask at 15 L/min
appropriately Reassess vital signs
Reassesses Patient Every 5 minutes during transport