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3 results

  • Case 14 - Tornado in the Farmland

  • from Section 3 - Meteorological Natural Disasters
  • Edited by Andrew Milsten, University of Massachusetts Medical Center, John Broach, University of Massachusetts Medical Center
  • Book:
    Cases in Simulated Disaster Medicine
    Published online:
    06 February 2026
    Print publication:
    05 March 2026, pp 103-109

  • Summary

    This scenario outlines the management of a 61-year-old female patient who suffered multiple traumatic injuries after being caught in an EF4 tornado outside Birmingham, Alabama. The patient, who has a history of diabetes, hypertension, and obesity, was helmeted and riding her bike when the tornado struck, causing her to be thrown into a field. Her injuries include a closed fracture of the right femur, multiple contaminated lacerations and impalements to her hands, and a suspected globe rupture of the left eye. The scenario emphasizes the importance of a structured approach to trauma care, including a thorough primary and secondary survey, pain management, and the need for rapid stabilization and consultation with specialists. The patient requires immediate initiation of broad-spectrum antibiotics and antifungal therapy due to the high risk of infection from soil-contaminated wounds. Essential actions include immobilization of the femur fracture, detailed ocular examination, and prompt ophthalmologic and orthopedic consultations. This case highlights the complexities of managing multiple trauma in the aftermath of a natural disaster, emphasizing the need for coordinated care, communication, and reassessment to prevent complications and optimize patient outcomes.

  • A Descriptive Analysis of Traction Splint Utilization and IV Analgesia by Emergency Medical Services

  • Joshua Nackenson, Amado A. Baez, Jonathan P. Meizoso
  • Journal:
    Prehospital and Disaster Medicine / Volume 32 / Issue 6 / December 2017
    Published online by Cambridge University Press:
    15 August 2017, pp. 631-635
    • Article
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  • Study Objectives

    Traction splinting has been the prehospital treatment of midshaft femur fracture as early as the battlefield of the First World War (1914-1918). This study is the assessment of these injuries and the utilization of a traction splint (TS) in blunt and penetrating trauma, as well as intravenous (IV) analgesia utilization by Emergency Medical Services (EMS) in Miami, Florida (USA).

    Methods

    This is a retrospective study of patients who sustained a midshaft femur fracture in the absence of multiple other severe injuries or severe physiologic derangement, as defined by an injury severity score (ISS) <20 and a triage revised trauma score (T-RTS)≥10, who presented to an urban, Level 1 trauma center between September 2008 and September 2013. The EMS patient care reports were assessed for physical exam findings and treatment modality. Data were analyzed descriptively and statistical differences were assessed using odds ratios and Z-score with significance set at P≤.05.

    Results

    There were 170 patients studied in the cohort. The most common physical exam finding was a deformity +/- shortening and rotation in 136 patients (80.0%), followed by gunshot wound (GSW) in 22 patients (13.0%), pain or tenderness in four patients (2.4%), and no findings consistent with femur fracture in three patients (1.7%). The population was dichotomized between trauma type: blunt versus penetrating. Of 134 blunt trauma patients, 50 (37.0%) were immobilized in traction, and of the 36 penetrating trauma victims, one (2.7%) was immobilized in traction. Statistically significant differences were found in the application of a TS in blunt trauma when compared to penetrating trauma (OR=20.83; 95% CI, 2.77-156.8; P <.001). Intravenous analgesia was administered to treat pain in only 35 (22.0%) of the patients who had obtainable IV access. Of these patients, victims of blunt trauma were more likely to receive IV analgesia (OR=6.23; 95% CI, 1.42-27.41; P=.0067).

    Conclusion

    Although signs of femur fracture are recognized in the majority of cases of midshaft femur fracture, only 30% of patients were immobilized using a TS. Statistically significant differences were found in the utilization of a TS and IV analgesia administration in the setting of blunt trauma when compared to penetrating trauma.

    NackensonJ , BaezAA , MeizosoJP . A Descriptive Analysis of Traction Splint Utilization and IV Analgesia by Emergency Medical Services.Prehosp Disaster Med. 2017;32(6):631–635.