Your local community has been having a week long heritage festival. Your service has extra staff on call during the event. Tonight is the finale with a beer fest musical event being held outside on the football grounds. The weather has been incredibly hot all week and tonight is very humid. The sky is threatening and a severe electrical storm has been predicted. The first up crew is out on a motor vehicle call and you are making your way to the station as stand-by second crew. Just as you reach the hall, the thunder starts and is accompanied by a driving rainstorm.

You just make it inside the doors when you are dispatched to the beer fest grounds. You are informed there is an unknown problem near the stage. St. John Ambulance is on scene but information is sketchy as there seems to be a transmission problem with the radio system. As you near the site you become stuck in traffic as patrons rush to get out of the weather. Dispatch informs you they will try to get police officers to clear traffic for you.

After quite some time battling crowds and traffic you arrive at the stage. You find a performer is lying supine on stage and St. John Ambulance personnel are performing CPR. It continues to storm heavily. As you are trying to assess the scene, dispatch tells you they have just received another call that there is an incident occurring somewhere near the goal post on the far end of the field. Once again information is minimal but it appears the people who phoned it in were quite excited and distraught. Dispatch also informs you there are no other crews available and the first unit is likely to be tied up with the motor vehicle accident for at least another hour, as several injuries have been reported, all of a serious nature.

You and your partner split up to do initial assessments. Your patient is a 33-year-old-male. He is the lead guitarist in the band. Bystanders and other band members report he was playing when the electrical storm started. They believe he was struck by lightening as members saw him shake uncontrollably and fall suddenly to the floor. The electric guitar appeared to be smoldering and the power went out immediately. Members rushed to his side and report he was not breathing. The St. John Ambulance volunteer confirms their accounts and reports he was on scene within seconds as he had been watching the concert from the front row. He states the patient was breathless and pulse less on his initial assessment and he has been performing CPR for approximately 5 minutes. All vital signs are absent. The patient’s skin is moist, warm and pale. There is a small red burn mark on his chest to the right of his sternum. There appears to be a larger red area on the patient’s lower right leg and foot that looks like a first degree burn. The shoe on his right foot is burnt and torn. No other trauma is noted. The E.C.G. monitor reveals: (see Patient 1 below)

The band members report the patient does not do any recreational drugs and he has not been drinking alcohol. They report no pertinent past medical history and state that he appeared healthy and normal prior to his sudden collapse.

Your partner reports over the radio that he is on scene with a 25-year-old unconscious male. He suspects the problem to be drug related. He is requesting the intubation and monitoring equipment. This patient is breathing at four breaths per minute and his respirations are shallow. He can detect radial pulses but they are weak and irregular. Chemstrip is 120 mmol/L. He reports the patient is believed to be have taken ‘China White.’ He is also requesting some help with crowd control as he reports the situation appears likely to turn violent with several intoxicated persons engaging in loud verbal arguments.

E.C.G.

Pulse	radial pulses, weak and irregular
Respiration	4 breaths per minute and shallow
Chemstrip	120 mmol/L
Level of Consciousness	unconscious
E.C.G.

The answers to these questions are to industry standards and may not necessarily be correct according to local protocol. If there is any discrepancy between these answers and local protocol, please follow the protocol for your area as set out by your Medical Director.
 

Heather MacKenzie-Carey is the Vice President of Turning Point Group Inc - an Emergency Management consulting firm—and manages its Calgary office. Heather has nineteen years experience in the Health Care Industry as an emergency practitioner, educator, and consultant. Heather has worked in public, private, rural, urban, Mountain Park and multidisciplinary clinical settings. Heather has been an educator/facilitator for the Aberdeen Hospital, Jasper School District, and the Southern Alberta Institute of Technology.

Heather has graduated from Dalhousie University with a Degree in Health Education. She has a diploma in Paramedicine from the Northern Alberta Institute of Technology, and a Certificate of Social Work from the University of Waterloo. Heather is completing a Masters of Science in the Study of Risk, Crisis and Disaster Management from the University of Leichester.

Heather has been widely published in the areas of prehospital medicine, crisis communication, and emergency first aid. She publishes regular columns for Canadian Emergency News, has developed various guide­books for Quick Rooks Publishing Ltd., and produced distance delivery curriculum for the Southern Alberta Institute of Technology.

Canadian Emergency News and the author of this quiz grant permission for readers to copy it for person­al and departmental educational purposes. All other reproduction and re­publication without written consent is prohibited. She can be reached at geomac@cadvision.com or www.turningpointgroup.com.

This Article is reprinted by permission from the author (Heather MacKenzie-Carey) and the Canadian Emergency News. It originally appeared in the August - September 1999 issue (volume 22, number 4).