Complications from pre-hospital immobilisation

Emergency Medical Service (EMS) providers were dispatched to the scene of a rollover injury accident involving a single vehicle on a rural highway. An Advanced Life Support (ALS) ambulance staffed with a paramedic and Emergency Medical Technician-Basic (EMT-B), responded under emergency conditions. Upon arrival at the scene, the EMS crew saw a car lying on its side with minimal external damage on the side of the roadway. Bystanders reported that the car was driving on the highway and suddenly veered off the road. Further questioning of bystanders and closer inspection of the vehicle revealed that the car had merely tipped onto its side and did not actually rollover. Responders initially believed the patient may have experienced either a syncopal episode or may have fallen asleep while driving.

Approaching the vehicle, pre-hospital providers found the lone occupant, an adult female, sitting in the driver's seat of the vehicle that was tipped on its side. The patient was a 67-year-old-female who was awake, alert and answering questions appropriately and did not appear to be in any distress. She stated that she was the restrained driver of the vehicle and prior to arrival of EMS responders had removed her seat belt restraint in an attempt to extricate herself from the vehicle. Her only complaint to providers was minor hip pain. She denied headache, neck or back pain, loss of consciousness, difficulty breathing, chest or abdominal pain and furthermore had no obvious outward injury on their initial evaluation while she was still in the vehicle. Her initial vital signs on scene were as follows: systolic blood pressure of 220mm Hg by palpation, heart rate of 116/min, respiratory rate of 16/min, and a blood sugar of 6.67 mmol/l. It took approximately twenty minutes for fire crews to extricate her from the vehicle. The extrication was prolonged by the fact that she had undone her seatbelt and was unable to climb out of the car on her own. Pre-hospital personnel then placed the patient in a rigid cervical collar and secured her to a long spine board for transportation to the hospital. After the patient was immobilised, they transported the patient to the hospital which was approximately 30minutes away.