Advanced Trauma Life Support ATLS Student Course Manual 2018

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APPENDIX F n Triage Scenarios
Triage Scenario V
Bus Crash
SCENARIO
You are the only doctor available in a 100-bed community emergency department. One nurse and a nurse
assistant are available to assist you. Ten minutes ago you were notified by radio that ambulances would be
arriving with patients from a single- passenger bus crash. The bus apparently lost control, exited the highway,
and rolled over several times. The bus was reportedly traveling at 65 mph (104 kph) before it crashed. No
further report is received other than that two of the bus passengers were dead at the scene. Two ambulances
arrive at your facility carrying five patients who were occupants in the bus. The surviving injured patients are
as follows.
PATIENT A
A 57-year-old male was the driver of the bus. He apparently experienced chest pain just before the crash and
slumped over against the steering wheel. Upon impact, he was thrown against the windshield. On admission,
he is notably in severe respiratory distress. Injuries include apparent brain matter in his hair overlying a
palpable skull fracture, an angulated deformity of the left forearm, and multiple abrasions over the anterior
chest wall. Vital signs are: BP 88/60 mm Hg, HR 150 beats per minute, RR 40 breaths per minute, and Glasgow
Coma Scale (GCS) score 4.
PATIENT B
A 45-year-old woman was a passenger on the bus. She was not wearing a seat belt. Upon impact, she was
ejected from the bus. On admission, she is notably in severe respiratory distress. Prehospital personnel
supply the following information to you after preliminary assessment: Injuries include (1) severe maxillofacial
trauma with bleeding from the nose and mouth, (2) an angulated deformity of the left upper arm, and (3)
multiple abrasions over the anterior chest wall. Vital signs are: BP 150/80 mm Hg, HR 120 beats per minute, RR
40 breaths per minute, and GCS score 8.
PATIENT C
A 48-year-old male passenger was found under the bus. At admission he is confused and responds slowly to
verbal stimuli. Injuries include multiple abrasions to his face, chest, and abdomen. Breath sounds are absent
on the left, and his abdomen is tender to palpation. Vital signs are: BP 90/50 mm Hg, HR 140 beats per minute,
RR 35 breaths per minute, and GCS score 12.
PATIENT D
A 25-year-old female was extricated from the rear of the bus. She is 8 months pregnant, behaving hysterically,
and reporting abdominal pain. Injuries include multiple abrasions to her face and anterior abdominal wall.
Her abdomen is tender to palpation. She is in active labor. Vital signs are: BP 120/80 mm Hg, HR 100 beats per
minute, and RR 25 breaths per minute.
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