Page 75 - Journal of Special Operations Medicine - Fall 2016

An Ongoing Series

Walking the Plank

Joshua Banting; Tony Meriano, MD

CONCEPTS AND OBJECTIVES
The series objective is to review various clinical con- Your planning and forethought come to fruition when,
ditions/presentations, including the latest evidence on late on your second day, you receive word that one of
management, and to dispel common myths. In the pro- the teams was in a vehicle rollover. You are informed
cess, core knowledge and management principles are en- that a two-vehicle packet was traveling over difficult ter-
hanced. A clinical case will be presented. Cases will be rain when the lead SUV got stuck. All passengers got
drawn from real life but phrased in a context that is ap- out to assist except the driver; they managed to get the
plicable to the Special Operations Forces (SOF) or tac- vehicle moving again but, as the driver accelerated to
tical emergency medical support (TEMS) environment. keep momentum, the wheels caught a rut and the vehicle
Details will be presented in such a way that the reader tipped over. The team provided first aid and managed to
can follow along and identify how they would manage extract the driver onto a backboard. They tell you that
the case clinically depending on their experience and the patient is alert and conscious, he has a small lacera-
environment situation. Commentary will be provided tion on his forehead, and is complaining of pain to his
by currently serving military medical technicians. The right thumb where the steering wheel struck him when
medics and author will draw on their SOF experience the vehicle caught the rut. The team is en route to meet
to communicate relevant clinical concepts pertinent to you at a designated location but, because of the terrain,
different operational environments including SOF and it will take some time to get there.
TEMS. Commentary and input from active special op-
erations medical technicians will be part of the feature.
What Are Your Next Steps?
Keywords: cervical spinal injury; Canadian C-spine rule, NEXUS You arrive at the meeting location just before the SUV
criteria; cervical collar carrying the patient comes into view. It has been ap-
proximately 75 minutes since the accident. A 32-year-
old, male logistics officer is offloaded and brought into
The Case
a small housing structure. The patient has a bandage ap-
You are deployed as part of a 20-person forward ele- plied to his forehead, a cervical collar around his neck,
ment delegated with assessing suitability of a remote and is strapped securely to a full-length backboard you
area in which to establish a forward operating base and had previously placed inside the SUV. He remembers the
receive a larger follow-on force. Access to the area is accident fully and denies losing consciousness. When
via a rural airstrip, and travel to a major city center by asked about the laceration, he believes it was from a
road is limited due to distance and the difficult nature of piece of the windshield when it broke during the roll-
overland routes. The country and environment are per- over. His major complaint still remains his right hand;
missive, but local resources and medical facilities con- however, further inquiry now reveals that he is experi-
sist of small outreach clinics with limited capability. The encing neck pain as well.
team plans to use sport utility vehicles (SUVs), already
in place, to reconnoiter the local area and gather infor- The damaged SUV has a smashed windshield and the
mation about the surroundings. Thinking forward, you passenger side is dented, but the vehicle is otherwise
have brought medical supplies and equipment for each functional and made the trip back without any issue.
vehicle in case of accident or injury, because groups will As for your patient, he remains alert with a Glasgow
not always be co-located. Coma Scale score of 15; he is otherwise healthy and

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