Major limb haemorrhage following motocross crash

Patient Information

Dispatch: A 28YO male (Jake Morrow) who has come off his motocross bike at high speed during a community moto event at the Perth Motorplex. Bystanders report significant bleeding from the right thigh.
Patient: Jake Morrow — 28yr (80kg)
Incident History: Pt came off his bike at approximately 60km/h on a corner, impacting a barrier. Bystanders applied direct hand pressure to right thigh wound. Significant blood loss estimated at scene.
Emergency Contact: Sarah Morrow (Wife) — 0412 875 341

Initial Rapid Assessment

Response: Voice
Airway: Patent. No obstructions. No stridor.
Breathing: RR 24/min. Shallow but adequate chest rise bilaterally. No paradoxical movement. No open wounds to chest. SpO2 92% on room air.
Circulation: Radial pulse rapid and weak. Skin pale, cool, diaphoretic. Significant active bleeding from large laceration to right mid-thigh with blood-soaked clothing. CRT 4 seconds. No evidence of chest, abdominal, pelvic or long bone injury on rapid survey.
Disability: GCS 13/15 (E3V4M6). Oriented to person and place, confused to time. Pupils equal and reactive 4mm bilaterally.
Exposure: Large stellate laceration to right mid-thigh with arterial-pattern bleeding soaking through makeshift bystander dressing. Motocross gear partially removed by bystanders. No other obvious injuries identified on rapid exposure.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	92% (RA)	Mild	24	128	84/50	4s	13	4 4 ++	36.4	6.2 mmol/L	8
10 mins	97% (O2 NRB 15L)	Nil	18	108	96/62	3s	14	4 4 ++	36.4	6.2 mmol/L	5

History Taking

Treatment Response

Diagnosis

This patient is suffering from major limb haemorrhage with early hypovolaemic shock secondary to arterial laceration of the right thigh sustained in a high-speed motocross crash.

Facilitator Triggers — if trainees miss a critical step

! (If tourniquet is not applied within the first 3 minutes and direct pressure is not escalated, increase pulse to 140 and drop BP to 74 systolic — patient begins to lose consciousness, GCS drops to 10.)
! (If oxygen is not administered within 3 minutes, SpO2 drops to 88% and respiratory distress escalates to moderate.)
! (If trainees attempt to splint or perform secondary survey BEFORE arresting haemorrhage, bleed visibly worsens — direct trainees back to haemorrhage control as the immediate priority.)
! (If tourniquet is applied but not tightened adequately — bleeding continues and trainees must be prompted: 'The wound is still bleeding actively. The tourniquet does not appear to be controlling the haemorrhage.')
! (If trainees do not record time of tourniquet application, prompt: 'At what time was the tourniquet applied? You will need to document this and inform the receiving facility.')

Treatment Objectives

1 Ensure scene safety — confirm event safety officer has cleared the track and the patient is accessible safely.
2 Don appropriate PPE including gloves and eye protection given significant blood and body fluid exposure risk.
3 Perform Primary Survey — identify catastrophic haemorrhage as the immediate priority.
4 Apply firm direct pressure to right thigh wound immediately while preparing Combat Application Tourniquet (CAT).
5 Apply CAT Tourniquet to right thigh — position at least 5cm above the wound directly on skin, tighten windlass until bleeding is controlled, lock and secure windlass strap.
6 Record and document time of tourniquet application on the tourniquet device itself.
7 Apply CAT Tourniquet sticker to a visible region on the patient (e.g. shoulder).
8 Administer Oxygen via non-rebreather mask at 15 L/min — titrate to target SpO2 94–98%. Confirm 6 medication rights: right patient, right drug, right dose, right route, right time, right documentation.
9 Conduct Vital Sign Survey — assess GCS, SpO2, BP, HR, RR, BGL, temperature.
10 Perform secondary survey — assess for concurrent injuries to head, chest, abdomen, pelvis and long bones.
11 Assess distal neurovascular observations to right lower limb post tourniquet application: pulse, CRT, colour, warmth, movement, sensation.
12 Do NOT remove tourniquet once applied.
13 Minimise on-scene time — prepare patient for rapid transport to hospital.
14 Notify receiving facility early — urgent ambulance via CSP — advise CSP of major limb haemorrhage and tourniquet application time.
15 At 60 minutes from tourniquet application time, plan to contact CSP for clinical advice.
16 Monitor and document full observations every 5 minutes given time-critical status.
17 Scenario ends on arrival of ambulance and IMISTAMBO handover.
18 Attention to hand hygiene will be given throughout the scenario.

Clinical references: Haemorrhage · Hypovolemic Shock · Combat Application Tourniquet (CAT) · Primary Survey · Oxygen Delivery

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