Acute lower back strain following heavy lifting at equipment setup

Patient Information

Dispatch: You are called to a 55-year-old male (Brian Connell) who is a volunteer at the festival site and is lying on his side on the ground near the equipment staging area, reporting severe back pain after lifting a heavy equipment case.
Patient: Brian Connell — 55yr (92kg)
Incident History: Patient was helping lift a heavy audio equipment case (approximately 40–50kg) with a colleague when he felt a sudden 'pop' and immediate onset of severe lower back pain at the moment of peak lift. He was unable to stand upright and lowered himself to the ground with his colleague's help. No loss of consciousness. Both legs moving normally. No bowel or bladder symptoms.
Emergency Contact: Maureen Connell (Wife) — 0412 882 014

Initial Rapid Assessment

Response: Alert
Airway: Patent. Speaking in full sentences.
Breathing: Comfortable. RR 14. No respiratory distress. SpO2 99% on room air.
Circulation: Radial pulse strong and regular. Skin warm and dry. CRT <2s.
Disability: GCS 15 (E4V5M6). Alert and orientated. In moderate to severe pain. Lower limbs moving voluntarily.
Exposure: Lower back — visible muscle guarding and spasm of the lumbar paraspinal muscles bilaterally. No visible deformity or step. No midline bony tenderness on palpation. Bilateral lower limb strength and sensation intact. No bruising.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	99% (RA)	Nil	14	90	144/88	<2s	15	4 4 ++	36.8	–	8
10 mins	99% (RA)	Nil	14	84	136/84	<2s	15	4 4 ++	36.8	–	5

History Taking

Treatment Response

Diagnosis

Acute lumbar paraspinal muscle strain from heavy lifting. No neurological deficit identified. No red flag features for serious spinal pathology — no leg radiation or weakness, no bowel/bladder dysfunction, no fever, no unexplained weight loss, mechanism clearly mechanical. Mildly elevated BP is consistent with pain response and known hypertension, not a primary vascular emergency. This is a painful but not life-threatening musculoskeletal injury within EHS supportive management scope.

Facilitator Triggers — if trainees miss a critical step

! (If trainees do not assess lower limb neurological function before attempting to move the patient — prompt: 'Before repositioning him, what neurovascular checks should you perform?')
! (If trainees do not ask about bowel and bladder symptoms — prompt: 'In a back injury patient, are there specific symptoms that would suggest urgent spinal cord involvement?')
! (If trainees attempt to stand the patient upright immediately — patient cries out and is unable to stand. Prompt: 'The patient is in severe pain — how can you best manage his comfort while completing your assessment?')
! (If trainees are concerned about the BP reading — prompt: 'His BP is elevated — what are the likely contributing factors here? Does this change your immediate management?')

Treatment Objectives

1 Ensure scene safety — assess equipment staging area for hazards.
2 Don appropriate PPE.
3 Perform Primary Survey — confirm no life-threatening injuries.
4 Obtain history — confirm mechanism (heavy lifting, sudden onset), pain character (localised lower back, no leg radiation), prior back history, red flag screen (no neurological symptoms, no bowel/bladder change, no constitutional symptoms).
5 Assess lower limb neurological function — confirm sensation (light touch bilateral feet and legs), voluntary movement (ask patient to wiggle toes and move ankles), and ask about any numbness or tingling; confirm nil deficit.
6 Ask specifically about bowel and bladder function — nil dysfunction in this scenario (important red flag screen for cauda equina).
7 Palpate the lumbar spine — assess for midline bony tenderness (nil in this scenario); note bilateral paraspinal muscle spasm and guarding.
8 Confirm absence of red flags for serious spinal pathology — nil bilateral leg weakness or paraesthesia, nil bowel/bladder dysfunction, nil fever, nil unexplained weight loss, mechanism clearly mechanical.
9 Document pain score — 8/10.
10 Position patient in position of comfort — lateral position on the ground is typically most tolerable for acute back strain; do not force upright positioning.
11 Consider Methoxyflurane (Penthrox) for pain management — appropriate if patient is cooperative, pain is limiting assessment, and patient can self-administer.
12 Monitor vital signs — note mildly elevated BP consistent with pain and known hypertension; repeat after analgesia.
13 Once pain is more manageable — assist patient to a supported sitting or lying position at the FAP; arrange wheelchair transport if needed.
14 Reassure patient — neurological function is intact, no red flags are present, this is consistent with an acute muscle strain.
15 Advise patient — he should see a GP or physiotherapist for ongoing management; he should avoid heavy lifting while symptomatic.
16 Contact CSP if neurological deficit develops, red flags emerge, or pain is unmanageable.
17 Scenario ends when patient is in a position of comfort, analgesia has been provided, and neurovascular status is confirmed intact.
18 Attention to hand hygiene will be given throughout the scenario.

Clinical references: Soft Tissue Injuries · Primary Survey · Secondary & CNS Survey · Penthrox Inhaler Administration · Blood Pressure

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