Batman 2

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Story for team:
Dispatch centre received emergency call:
Fire brigade officer reports second hand call - some children move on dangerous and instable roof of the manufactory building. After arrival found rupture of the roof surface and 10 years old child on the ground after fall from aproximately 5-6 m high (15-18 feets). Child is lying down, do not move and silently cry.

Your task is:
• establish working diagnose
• care, treatment and preparedness to transport
• decide mode of transport and correct routing

Local situation:
Nearest hospital is 20 km by ground transport with surgery, internal medicine, anaesthesia and general intensive care dept., neurology, gynecology and obstetric, CT scan and

A  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 available at 15 mins.

Situation:
Aprox. 10 years old child after fall from the roof lying on the ground in the store full of mess and stuffs, insufficient light condition and limited movement possibility. Coooperation with firefighters necessary. After EMS crew arrival fire officer announce safe environment and convey the crew to the patient.

Child:
GCS 14, RR 16, breathing sounds normal, SpO2 90 %, HR 140, BP 70/50, pale, small excoriations on the skin, complains abdominal pain, without stiffness, pain at pelvic circle during   examination and abnormal movement. After pelvic immobilisation, oxygen and infusion therapy GCS 15, BP 90/50, HR 110/min., SpO2 95 % - transport possible.