Buoy

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Story for team:
Dispatch centre received emergency call:
In the middle of the lake fishermen holds on to a overthrown boat. Calls for help and is not able to get to the shore. Water Rescue on the lake available. Air temperature 15°C (59 F), water 10°C (50 F). Call by witnesses from the shore.
Firefighters arrival in 20 min. Helicopter rescue not available.

Your task is:
• examine the patient
• treat the patient
• mode of transport and decide the correct target medical facility

Local situation:
A Nearest hospital is 20 kms by ground transport with surgery, internal medicine, anaesthesia and general intensive care dept., neurology, gynecology and obstetric, CT scan and  biochemistry.
B Higher level hospital 42 km by ground transport, dept. as A + ED, ENT, oncologic dept., psychiatry, infectious diseases and pediatric dept.
C Specialized centre 55 km by ground. Depts. as B + traumacentre, burn unit, cardiocentre, stroke unit, NMR.
D Helicopter rescue not available.

Situation:
Overthrown boat on a river, dressed man holds on to it - fisherman. Communicates with latency, his head hurts and has a haematoma. He can not swim, that is why he can ́t get to  the shore. Victims on shore have a boat but they also say that there is Water Rescue functioning, it can be avalaible in a minute. If he won ́t be dragged out 5 minutes after start, he  will drown and the task ends. After he is dragged out: wet clothing, CNS dysfunction, GCS 3-4-6, haematom on brow, slowly falls asleep, communicates less and less. HR 40/min,  extrasystoles , BP 70/40, SpO2 unmeasurable, other physical findings normal. Common temperaturemeters do not show, rectal or tympanal shows 30 degree C (86 F) In 8th minute  unconsciousness, cardiac standstill, ventricular fibrillation. In tent avalaible CPR model and Autopulse. On question of crew: 20 min. car drive is hospital, Air Rescue unavailable -  weather. It is required to get patient to the shore, undress, examinate, administer hot i.v. fluids, diagnose immediately asystole, secure airways and consider use of automatic  massage. During continous chest commpressions transport to hospital - ED, General intensive care (ECMO centre, eventually cardiosurgery).

In 10 C water temperature is expected time to exhaustion or unconsciousness 1-2 hours.

Key words:
Hypothermia, water rescue, Autopulse