By James J. Augustine, MD
Belly Full of Trouble
A driver’s condition following an accident may be worse than it appears
It’s a warm, sunny afternoon when Attack One responds to a mutual
aid call for assistance in a neighboring jurisdiction. The crew rolls Initial Assessment
up on a severe head-on collision between a sports car and a small
pickup truck. Crews from the neighboring EMS agency are working A 24-year-old male, restrained driver in a head-on
on the driver of the sports car, whose head is protruding through his collision. No air bag. Profuse bleeding from large
windshield. Attack One is directed by Command to care for the single laceration on forehead.
victim in the pickup truck. Airway: Intact and uncompromised.
The driver is alone, still belted in. He’s a healthy man in his 20s. A Breathing: No distress.
single member of the other EMS agency has placed a cervical collar Circulation: Normal capillary refill, pink skin, neck
and is attempting to control the bleeding from a large laceration on veins flat.
the man’s forehead. The patient is helping himself by placing direct Disability: No neurologic deficits. Awake and alert,
pressure. He is awake, alert, oriented and expressing concern about complaining only of forehead pain.
the other car’s driver. He remembers rounding the curve, ﬁnding the Exposure of Other Major Problems: Significant blood
other driver in his lane and being unable to turn away. He saw the other loss from forehead laceration; bleeding is difficult to
driver come through his windshield, and fears for the man’s life. control even with direct pressure.
The Attack One paramedic does a rapid trauma assessment and
ﬁnds the doors on the truck won’t open. They will require a quick extri- Vital Signs
cation, but nothing as time-consuming as will be required to remove Time HR BP RR Pulse Ox.
the other driver. He places a pulse oximeter on the man’s ﬁnger and 1410 96 110/palp. 20 98%
ﬁnds oxygen saturation in the high 90% range, the pulse rate regular.
There’s a lot of blood down the man’s face, chest and in his lap, but he
has no obvious chest, abdominal or extremity trauma. The laceration
on his forehead is the site of all the bleeding, and it continues, rapidly.
may be Only ﬁrm pressure directly on the wound edges slows it.