Facial trauma s/p plane crash


• Scene – C-collar; patient refused long backboard (LBB). Performed evaluation, entered into trauma system, called receiving facility.
• En Route – 16g IV, vitals, EKG
• Hospital – unknown


• Response to treatment – patient states no changes, slight increase in BP en route.
• Disposition: Unknown
• Notes:
• Patient took up flying at age 65. Awesome!
• A second medic came and took 70 yo passenger to same hospital.
• Both patient’s entered into trauma system due to age and mechanism.
• If patients were seriously injured, transport to level 1 would have been initiated. Lifeflight helicopter base also 3 minutes away by ground code 3.


• Mark Shelton Paramedic Woodburn Ambulance
• David Jones, MD Associate Professor Oregon Health and Science University


• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center
• Mohamud Daya, MD Professor Oregon Health & Science University

• Traumatic injury
• Head laceration
• Facial trauma

Differential Diagnosis

• Intracranial injury
• Cervical spinal injury
• Superficial trauma
• Occult trauma
Patient Workup


• Patient was piloting a small airplane that lost altitude and crashed in some trees, fell ~40′ down through trees
• States plane was traveling at ~72mph at time of crash.
• Denies LOC, neck or back pain.
• Was wearing a lap seatbelt only. Upon impact with first tree, flew forward and hit face on instrument panel.

Physical Exam

• GCS – 15
• EKG – SR
• Injury to face and top of head
• Grossly atraumatic, all things considered

Editor’s Notes

Scene safety is a critical take-away from this call. The airplane cut through a lot of trees and left some still hanging above the crash site. I took all of the still pictures before anyone else entered the crash sight. As one of the sheriff’s deputies walked in, I had to caution her to stay clear of the widow makers. Working on patients in this plane or working to extricate the passengers would have been extremely high risk to the rescuers. -Elliott Williams

Standard Approach

• Ensure scene safety before approaching the patient. Stage away from the scene if needed while the scene is secured.
• Approach every trauma patient the same way. The primary survey consists of the following steps:
• Assess airway. Intervene with jaw thrust, oral airway or an advanced airway (supraglottic or endotracheal tube) as needed.
• Assess breathing. Provide oxygen; consider needle decompression of the chest if there is clinical concern or suspicion for tension pneumothorax.
• Assess circulation. Establish IV access; consider fluids if there is evidence of perfusion failure.
• Assess deficits. If concern for spinal injury, immobilize.
• It is very important to note if patients with potential head injuries are on aspirin, clopidogrel (Plavix), warfarin (Coumadin), or any of the newer anticoagulants. These medications decrease the ability to stop bleeding in traumatic situations.
• Monitor trauma patients closely. Any change in vital signs or clinical symptoms could indicate that they are bleeding somewhere you can’t see, and that could be deadly.
• With sudden deceleration injuries, patients are at risk of traumatic aortic dissection. Important clues to this in the EMS setting are the presence of pulse deficits or blood pressure differences between the upper extremities. (A difference of greater than 10 mmHg between arms is considered abnormal until proven otherwise.)

Suggested References

Prehospital risk factors of mortality and impaired consciousness after severe traumatic brain injury: an epidemiological study


• Gender: Male
• Age: 80 years
• Height: Not Available
• Weight: Not Available


• Temperature: Not Available
• Blood Pressure: 143/92
• Heart Rate: 97
• Respiratory Rate: 16
• Pulse Oximetry: 97% RA
Signs and Symptoms
Facial trauma; head laceration


• PMH: Bypass, hypertension
• Allergies: Codeine
• Dispatch info:
• Small airplane crash
• Occupants are out of the plane and walking
• No fire
• Airplane in trees


• Lives with wife


• ASA, lisinopril, atenolol

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