Suspected femur fracture following fall from spectator barrier

Patient Information

Dispatch: You are called to a 22YO male who has fallen from a spectator barrier at the south end of the oval. (Marcus Webb)
Patient: Marcus Webb — 22yr (80kg)
Incident History: Pt was leaning against a temporary crowd barrier which gave way. He fell approximately 1.2 metres, landing heavily on his right leg. Bystanders called for EHS immediately.
Emergency Contact: Claire Webb (Partner) — 0412 847 193

Initial Rapid Assessment

Response: Alert
Airway: Patent. Nil airway obstruction. Nil stridor. Patient speaking in full sentences.
Breathing: Adequate. RR 18. No accessory muscle use. Nil abnormal sounds.
Circulation: Radial pulse present, rate elevated, regular. Skin pale and diaphoretic. Right mid-thigh visibly swollen and deformed. No active external haemorrhage.
Disability: GCS 15 (E4V5M6). Alert and orientated to time, place, and person. Reporting significant right thigh pain.
Exposure: Right mid-thigh: marked swelling, tenderness on palpation, obvious deformity with shortening. No open wound. No other injuries identified on brief inspection.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	97% (RA)	Nil	18	108	104/72	3s	15	4 4 ++	–	–	9
10 mins	98% (RA)	Nil	16	98	110/74	2s	15	4 4 ++	–	–	7

History Taking

Treatment Response

Diagnosis

This patient is suffering from a suspected closed femur fracture of the right mid-shaft with signs of early haemodynamic compromise secondary to internal haemorrhage.

Facilitator Triggers — if trainees miss a critical step

! (If trainees do not assess distal neurovascular status — colour, warmth, movement, sensation, and capillary refill time — of the right foot within the first 3 minutes, the patient reports increasing numbness in the right foot.)
! (If trainees do not immobilise the limb, the patient attempts to shift position causing an increase in pain to 10/10 and visible increase in deformity — prompt: 'He tries to sit up and moves his leg.')
! (If trainees do not monitor for signs of haemodynamic compromise — tachycardia, pallor, delayed CRT — after 5 minutes the patient reports feeling light-headed and becomes more anxious.)
! (If trainees remove jewellery is not mentioned, the patient has a ring on his right hand — prompt: 'Is there anything on the injured limb you should address before swelling worsens?')

Treatment Objectives

1 Ensure scene safety — confirm crowd barrier is stable and bystanders are clear of the immediate area.
2 Don appropriate PPE including gloves.
3 Perform Primary Survey — confirm airway patent, breathing adequate, circulation intact with early signs of haemodynamic compromise noted.
4 Position patient supine on the ground — do not allow weight-bearing or movement of the right leg.
5 Expose right thigh — cut or remove clothing if necessary to assess injury site.
6 Assess neurovascular status distal to injury BEFORE splinting: right foot — capillary refill time, skin colour and warmth, sensation (can patient feel you touching the foot?), and ability to move toes.
7 Remove ring from right hand before swelling progresses.
8 Do NOT attempt to straighten the deformity — immobilise in position found.
9 Pad natural hollows and bony prominences to maintain alignment.
10 Apply soft splint (e.g. pillow or blanket rolled around the thigh and secured with broad bandages above and below the injury site) — immobilise joint above (hip) and joint below (knee).
11 Reassess neurovascular status distal to injury AFTER splinting — compare findings to pre-splint assessment and document any change.
12 Administer Methoxyflurane (Penthrox) 3 mL via inhaler for analgesia — patient self-administers. Onset of pain relief after 6–10 inhalations. Confirm 6 medication rights: right patient, right drug, right dose, right route, right time, right documentation.
13 Apply oxygen via nasal cannula at 1–4 L/min or simple face mask at 5–8 L/min if SpO2 drops below 94% — titrate to SpO2 94–98%.
14 Monitor vital signs every 10 minutes — pay close attention to HR, BP, and CRT as indicators of ongoing internal haemorrhage from femur fracture (estimated blood loss from closed femur fracture can be 1–2 litres).
15 Reassess pain score after Methoxyflurane administration.
16 Request ambulance via CSP — this patient requires Advanced Care for pain management and monitoring. Transport urgent.
17 Keep patient warm — cover with blanket to prevent hypothermia while awaiting ambulance.
18 Continuously reassure patient — explain all interventions before performing them.
19 Scenario ends on arrival of ambulance and IMISTAMBO handover.
20 Attention to hand hygiene will be given throughout the scenario.

Clinical references: Limb Trauma · Haemorrhage · Methoxyflurane (Penthrox) · Oxygen · Primary Survey · Secondary & CNS Survey · Fractures & Dislocations — Splinting · Pain Assessment

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