Aerial Emergency

Setting: Pasochoa inner caldera - Ecuador

At 06h40 a small ultralight plane with two passengers on board departed a small nearby airstrip filled with fuel. Merely 6 minutes later, while attempting to gain elevation, the plane's engine stalled and started spinning down towards the ground and crashed in the middle of a thick forest inside Pasochoa´s inner caldera. Another plane that had taken off from the same airstrip was in the air and was able to see the plane going down and the steam coming from the engine. This other plane stayed in the air while planning a route to get to the patients and called by radio to help prepare the rescue. The airstrip was merely 4 kms away from the accident. The plane that spotted the accident returned to the airstrip it left from where the rescue team was already waiting. From there, they drove a car with a team of 4 rescuers to the entrance of the forest and hiked in thick vegetation to reach the accidented plane, rescue team arrived at 09h45. The first thing that the rescuers did was a size up of the scene, in order to ensure they were not exposing themselves due to the crashed plane´s fuel. Having determined that it was safe, they approached the patients. They found the pilot is awake and oriented and the passenger is laying in the ground with the chief complaint being severe stomach pain.

Subjective:

The first patient is a 50-year-old-female who had the command stick crush against her lower abdomen. She did not lose consciousness, was alert and oriented and complained of severe pain to the lower right and left quadrants of her abdomen. 

The second patient is a 50-year-old-male who was awake and oriented, standing up and trying to help the other passenger.

Objective:

Female patient exam: after doing a head-to-toe exam, there was a large bruise found in her lower left and right quadrants of the abdomen as well as tenderness, pain and stiffness when doing a detailed exam of the abdomen. Blood was coming out of her nose. 

Vital Signs:*

Pt: 50 year-old-female

Time 7h30 

LOR A+Ox4

HR 95 Strong, Regular 

RR 20 Regular, shallow

Skin Pale, cool and clammy 

Second Set

Time 7h40 

LOR A+Ox4

HR 100 Strong, Regular 

RR 20 Regular, shallow (pain on deep breaths)

Skin Pale, cool and clammy 

Symptoms: Pain and tenderness lower left and right quadrants in abdomen. Core temperature is dropping. 

Allergies: None

Medications: None

Pertinent Hx: None

Last in/out: drank 3 liters of water, urinated 2x with a normal BM

Events: The fall of the plane was not caused by a fainting event

WHAT IS YOUR ASSESSMENT AND PLAN?

DO NOT peek at the next section without answering this first.

Assessment:

Possible internal bleeding, leading into a hypovolemic shock; we have a mechanism of injury as well as pain and tenderness.

Plan:

• Control bleeding in nose

• Treat for hypovolemic shock and monitor

• Urgent Evac

Anticipated Problems:

• Worsening hypovolemic shock due to internal bleeding, can lead into decompensatory and eventually irreversible shock.

• Dehydration

• Worsening shortness of breath

The tale continues:

The rescuers had with them a litter and resources to carry the female patient out. Due to the thickness of the vegetation of the terrain and the urgency of the emergency, it was decided that one of the rescuers will carry the patient out on his back. It took them 2 hours minutes to reach a car that was at the entrance of the forest and immediately out to the hospital. Once the patient arrived at the hospital, it was confirmed that she had a ruptured portal vein and superior mesenteric artery, a superficial wound in her nose accompanied with a fractured nose, laceration in her hand, three fractured ribs. 

Take away points:

• The rescuers started their scene size up from the air, taking advantage of the visibility and understanding where the plane had fallen and how to access it. They also took advantage of the radio communications and got everything ready to perform a rescue.

• The pilot of the fallen plane wanted to walk out to get help, luckily the terrain didn’t allow it. It would have caused him to get lost and worsen the situation. 

• Understanding the signs and symptoms of shock saved the patients life, taking longer to evacuate the patient would have resulted in a fatality. 

• The pilot began with the patient assessment on the more critical patient, controlling the blood and making the patient feel comfortable. This made for a more efficient response from the rescue team coming to get them.