Fall from Scaffold with Neck Pain and Deformed Thigh
A 41-year-old scaffolder falls about 3 metres onto a concrete slab. He is lying supine, alert, and complaining of neck pain and tingling in both hands. His left thigh is swollen, shortened, and externally rotated; there is no active bleeding. His hard hat is still on, but the chin strap is loose. One coworker is trying to sit him up, and another wants to remove the helmet to 'help him breathe'. The ground is uneven, the access route is 1 metre wide, and the ambulance is 25 minutes away. You have a cervical collar, scoop stretcher, traction splint, triangular bandages, and one other first aider. The patient's radial pulse is 110, respirations 22, and he repeatedly asks to stand.
1. How would you manage the scene, the patient's position, and the helmet during the first 5 minutes?
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Scene and position. Stop the coworkers from sitting him up; tell him not to move and keep him supine. Take manual in-line stabilization of the head and neck, and assess airway, breathing, and circulation without twisting the neck. Helmet. Leave the hard hat on if it fits well and does not obstruct the airway, because removing it can move the neck. If the helmet must come off because of vomiting, airway compromise, or poor fit, use two trained first aiders: one holds manual stabilization, the other loosens the strap and removes the helmet while maintaining alignment. Reasoning. Neck pain plus tingling suggests spinal injury, and the deformed thigh indicates significant force; movement now can worsen cord injury. The helmet is not the priority unless it interferes with ABC.
2. Describe how you would immobilize the suspected femur fracture and the spine with the equipment available, including the order of splinting.
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Femur first. Check distal pulses, sensation, and movement before and after splinting. Apply a traction splint according to training: steady in-line traction, pad the ankle and groin, and tighten until the thigh is supported and pain is reduced; do not use a traction splint if there is an open fracture with severe contamination, suspected pelvic fracture, or partial amputation. Spine. Apply a cervical collar with manual stabilization still in place, log-roll the patient onto a scoop stretcher with enough helpers, and secure the head, chest, pelvis, and legs. Order. Treat life threats and splint the femur before moving, then immobilize the spine for transfer. Reasoning. A femur fracture can cause major blood loss and pain; splinting reduces both, but spinal protection governs how you move him.
3. What transfer and monitoring decisions would you make, and what would you tell the receiving facility?
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Transfer. Do not let him stand or walk. Monitor pulse, breathing, skin color, and distal neurovascular status every 5 minutes. Transfer on the scoop stretcher to the ambulance, and tell the receiving facility about the fall height, neck pain, hand tingling, thigh deformity, splint time, and any change. Documentation. Record the mechanism, initial and repeat vitals, immobilization times, and refusal/consent. Reasoning. The combination of spinal symptoms and a femur fracture makes him a high-risk transfer; a 25-minute ambulance wait is acceptable only with continuous monitoring and immobilization, not with walking.