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Scenario — Major limb haemorrhage following motocross crash
Patient Information
Dispatch
A 35YO 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.
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
Signs/Symptoms
Active bleeding from right thigh laceration. Dizziness and light-headedness. Generalised weakness. Pale, cool, diaphoretic. Confusion.
Onset
Acute — approximately 10 minutes prior to EHS arrival following high-speed impact with barrier.
Pain
Right thigh — sharp, severe, constant pain at wound site.
Quality
Sharp, tearing pain at laceration site.
Radiates
Nil radiation.
Severity
8/10
Allergies
No known drug allergies.
Medications
Nil regular medications.
Pertinent History
Fit and well. No significant past medical or surgical history. Non-smoker, social drinker.
Last Oral Intake
Water approximately 1 hour ago. Light meal 3 hours prior.
Treatment
Bystanders applied firm direct hand pressure to wound using a race marshal's jacket approximately 5 minutes prior to EHS arrival. No tourniquet applied.
Events Leading
Competing in a community amateur motocross event at the Perth Motorplex. Lost control on a corner at approximately 60km/h and impacted a concrete barrier with right leg.
Scenario Progression and Treatment Objectives

((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.'))

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.

  • Ensure scene safety — confirm event safety officer has cleared the track and the patient is accessible safely.
  • Don appropriate PPE including gloves and eye protection given significant blood and body fluid exposure risk.
  • Perform Primary Survey — identify catastrophic haemorrhage as the immediate priority.
  • Apply firm direct pressure to right thigh wound immediately while preparing Combat Application Tourniquet (CAT).
  • 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.
  • Record and document time of tourniquet application on the tourniquet device itself.
  • Apply CAT Tourniquet sticker to a visible region on the patient (e.g. shoulder).
  • Administer Oxygen via non-rebreather mask at 15 L/min — titrate to target SpO2 94–98%.
  • Conduct Vital Sign Survey — assess GCS, SpO2, BP, HR, RR, BGL, temperature.
  • Perform secondary survey — assess for concurrent injuries to head, chest, abdomen, pelvis and long bones.
  • Assess distal neurovascular observations to right lower limb post tourniquet application: pulse, CRT, colour, warmth, movement, sensation.
  • Do NOT remove tourniquet once applied.
  • Minimise on-scene time — prepare patient for rapid transport to hospital.
  • Notify receiving facility early — Priority 1 transport with pre-notification of receiving Emergency Department regarding major limb haemorrhage and tourniquet application time.
  • At 60 minutes from tourniquet application time, plan to contact CSP in SOC to arrange consultation with the State Trauma Unit.
  • Monitor and document full observations every 5 minutes given time-critical status.
  • Scenario ends on arrival of ambulance and IMISTAMBO handover.
  • Attention to hand hygiene will be given throughout the scenario.

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