Suspected femur fracture following fall from ride

Patient Information

Dispatch: You are called to the ride area at the Perth Royal Show. An 8-year-old male has fallen from a ride platform and is on the ground holding his right thigh and crying.
Patient: Liam Carter — 8yr (26kg)
Incident History: Pt lost his footing stepping off a carnival ride platform approximately 1.2 metres above the ground and landed heavily on his right leg. Bystanders witnessed the fall. Pt has not attempted to stand.
Emergency Contact: Sarah Carter (Mother) — 0412 338 774

Initial Rapid Assessment

Response: Alert
Airway: Patent. Nil airway obstruction. Nil swelling or stridor. Pt crying, which confirms airway is open.
Breathing: Adequate. Crying and speaking in full sentences. Nil increased work of breathing. RR elevated secondary to pain and distress.
Circulation: Radial pulse present, rapid and regular. Skin pale and cool peripherally. No external haemorrhage visible. Right thigh notably swollen and tender on palpation.
Disability: GCS 15 (E4V5M6). Alert, orientated to time, place and person. Distressed and crying due to pain.
Exposure: Obvious deformity and swelling to mid-shaft right thigh. Skin intact — no open wound or exposed bone. Nil other injuries identified on brief inspection. Pt is wearing shorts and t-shirt.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	98% (RA)	Nil	24	118	100/65	2s	15	4 4 ++	–	–	8
10 mins	99% (RA)	Nil	20	108	102/66	<2s	15	4 4 ++	–	–	5

History Taking

Treatment Response

Diagnosis

This patient is suffering from a suspected mid-shaft femur fracture of the right lower limb following a fall from height at a public event.

Facilitator Triggers — if trainees miss a critical step

! (If distal neurovascular observations — CRT, pulse, colour, warmth, movement, sensation — are not assessed before splinting, facilitator advises: Liam says his right foot feels tingly. Prompt trainee: what distal checks should you perform before and after any splinting?)
! (If the limb is not splinted, Liam begins to move and cry out more intensely. Pain score increases to 9/10. Prompt trainee: what can you do to reduce movement and pain for this patient?)
! (If jewellery is not removed from the affected limb, facilitator prompts: Liam is wearing a sports ankle bracelet on his right ankle — what do you need to consider before oedema develops?)
! (If the trainee attempts to straighten the deformity rather than splint in position found, facilitator intervenes: what does the guideline say about managing dislocated joints and obvious deformities pre-hospital?)

Treatment Objectives

1 Ensure scene safety — approach cautiously, confirm ride has been stopped and area is secured by event staff.
2 Don appropriate PPE (gloves minimum).
3 Perform Primary Survey — confirm ABCDE, manage any immediate life threats.
4 Position patient supine on the ground — do not allow Liam to attempt to stand or weight-bear.
5 Perform SAMPLE history — confirm mechanism, allergies (Nil), medications (Nil), pertinent history.
6 Assess and document pain score using age-appropriate pain scale (numeric or Faces Pain Scale-Revised) — initial score 8/10.
7 Perform distal neurovascular assessment of right lower limb BEFORE splinting: pulse (dorsalis pedis/posterior tibial), capillary refill time, skin colour and warmth, movement (wiggle toes), sensation (can you feel me touching your toes?).
8 Apply soft splinting or formable splint to right thigh in position of comfort — immobilise joint above (hip) and joint below (knee) the injury site.
9 Secure splint with broad bandages above and below the injury site.
10 Remove or have parent remove jewellery and footwear from the right foot before oedema develops.
11 Apply cold pack wrapped in cloth or gauze to right thigh to reduce swelling and pain — do not place ice directly on skin.
12 Re-assess distal neurovascular observations AFTER splinting — document any change in pulse, CRT, colour, warmth, movement, sensation.
13 Document re-assessed pain score — target reduction following splint and cold application (expect improvement to approximately 5/10).
14 Keep Liam calm and reassure both patient and parent continuously throughout care.
15 Monitor full observations every 10 minutes — observe for signs of haemodynamic compromise (femur fractures can cause significant internal blood loss even in paediatrics).
16 Request ambulance (urgent ambulance) via CSP — paediatric long bone fracture requires further imaging and definitive care.
17 Advise parent (Sarah Carter) of Liam's condition and plan for transport.
18 Scenario ends on arrival of ambulance and IMISTAMBO handover.
19 Attention to hand hygiene will be given throughout the scenario.

Clinical references: Limb Trauma · Haemorrhage · Primary Survey · Secondary & CNS Survey · Pain Assessment · Fractures & Dislocations — Splinting

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