Scenario 3: You are getting towards the end of a south to north trip on the Overland Track

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Scenario 3 You are getting towards the end of a
south to north trip on the Overland Track
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with Mick, a good friend of yours who is not a
doctor but has done some first aid. Its been a
long day and the predicted cold front has arrived
a few hours earlier than forecast. The
temperature has dropped to about 12C and it has
started to rain. You still have about an hour to
go before you reach the car park at Dove Lake. It
is 4.30 pm.Up ahead in the cloud you see a group
of people huddled together rather oddly in the
middle of the path.
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As you get closer you see that it is a group of
children, probably 12 or 13 years old. They are
grouped around an older man, probably in his late
fifties who is lying on his back. One of the
children is trying to do mouth to mouth. Several
of the children are just sitting down in the mud
and crying.
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What are your immediate actions?
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Accident and illness protocol you take
charge,there is no immediate danger to either you
or the children, and you do the following almost
simultaneously- get a very brief bit of
history from the girl who is trying to do mouth
to mouth- do a primary survey on the man on the
ground- tell Mick to check on the condition of
all the children and do a head count
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Martina tells you that they are on a school camp
and that this was their first proper bush walk
with one of their teachers, Mr Mathers.She said
that Erin and Ngaire had started complaining that
they were cold and tired when Mr Mathers suddenly
sat down on the ground. She said he looked like
he was in a lot of pain and was clutching at his
chest. Suddenly he passed out and she thought he
wasnt breathing so she tried to do mouth to
mouth. This probably happened about 15 minutes
ago.
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You do a primary surveyD there is no
immediate danger R there is no response from
Mr MathersA you open his airwayB he is not
breathingC he has no carotid pulseD he is
not bleedingE he is lying exposed in the rain
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Mick reports back there are a total of 8
children, all are now and cold, wet and most of
them look frightened. Erin and Ngaire are looking
particularly cold and tired. It is now raining
more heavily and the wind has picked up.What do
you do next?
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You have a quick chat with Mick and Martina. You
tell them that Mr Mathers has almost certainly
had a bad heart attack and that the chances of
resuscitating him successfully are almost
non-existent. You express your concern for the
other children particularly Erin and
Ngaire.Colquhoun MC. Defibrillation by GPs.
Resuscitation 2002 52 (2)143-148.
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Martina looks shocked, Mick queries but cant we
do CPR? Most of the other children are now
gathered around in a tight huddle looking at
you.You need to put a definitive plan into
place quickly.What is it?
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(This section of the scenario will be run on the
field trip as a role play.)Your priority is to
get all the children down safely. Your map (and
Micks previous knowledge of the track) tell you
that there is an emergency shelter about 10 15
minutes walk away.You ask Martina and Mick to
make sure all the children have got their wet
weather gear on (several havent - theyve been
too dumbstruck by the whole event) while you
assess Erin and Ngaire more fully.
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Erin and Ngaire are both shivering and neither
have wet weather gear on. Erin is irritable
whilst Ngaire just appears tired. Neither have
any injuries and both deny any medical history
particularly of diabetes or asthma.You rummage
around in their packs to find their jackets and
help them get them on. You note that they havent
any food left.You move over to Mr Mathers body
and with Micks help get his rucsac off and cover
his face. Using a marker pen you note on the
covering his name, the date and the time you
pronounced death, adding your own name, mobile
phone number and that you were proceeding to the
emergency shelter.
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Meanwhile Mick rummages around in the sac and
find a flask half full of tea, several bars of
chocolate, spare dry clothing, a jacket, a
sleeping bag and a bivvy bag. You give some tea
and chocolate to Erin and Ngaire, put your own
lightweight pack into Mr Mathers large one and
put it on.You explain again to the children
that Mr Mathers has died and that they all need
to get to some shelter. You tell them that there
is an emergency shelter about 10 minute walk away
and that you are all going to walk there
together.You put Martina up front to lead the
way, then the other children. You and Mick bring
up the rear very closely shadowing Erin and
Ngaire.
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15 minutes later, just after 5pm, you arrive at
the shelter. It is still windy and raining. You
all pile inside.What do you do next?
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You reassess Ngaire and Erin, whilst Mick does
his best to get dry clothes on the other
children. Martina offers to help and you realise
that you will need to keep an eye on her too so
far she has proven capable, but has been exposed
to the same conditions as all the other
children.Ngaire looks much the same, still
shivering, Erin is now less irritable, but rather
more confused and acting irrationally. She seems
unable to answer your questions properly.
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Mick has got some water from outside and has got
his stove going and at his request Martina is
gathering together the groups remaining food
into one pile. You and Martina get Erin and
Ngaires wet clothes off and wrestle them each
into a sleeping bag, whilst ensuring that the
other children are all huddled together. You give
all the children food and drink.
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After an hour or so in the shelter, all the
children look much better, Erin has stopped
shivering and is chatting with Martina. Ngaire
looks no worse, but not much better either.It
is 6.30 and, being mid-summer it wont be dark
until after 9pm. Martina tells you that they have
a minibus at the car park and are staying with
the rest of the school group at a field station
30 minutes drive away. It is still at least a 45
minute walk downhill probably longer given the
circumstances.What are your dilemmas? What is
your next move?
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One dilemma is a common one self-rescue where it
is safe and appropriate is always preferable to
an assisted rescue. If you could walk the
children down they would be back at the car park
in about an hour and safe and warm in one of the
lodges a few minutes after that. An assisted
rescue would require that one of you went to get
help first, and then there would still be a
significant delay in getting a helicopter on the
scene.Ngaire presents a problem in that,
clinically, she has moderate hypothermia. You do
not feel that she is capable of getting down
under her own steam however, the rest of the
children are quite capable.
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You talk through the situation with Mick. He
agrees to walk down with all the children except
Ngaire.You decide to stay put with Ngaire.You
continue slow rewarming with drinks, hot water
bottles (made from sports drink containers
wrapped in a single layer of clothing) and
confinement to the sleeping bag.You await the
rescue helicopter
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And so the scenario ends or does it?What
preparations do you need to make (casualty and
surrounding area) for the helicopter transfer?It
will be dark before it arrives.What about the
aftermath?Mick still wonders why you didnt
start CPR, what legal responsibilities do you
have (police, coroner)How far does your duty of
care extend the children, Mick, Mrs
Mathers?What about self-care?