Run Amok – It is early October and you are on a trail run up above Golden (CO), about 3 miles from the trailhead when it starts to rain. It is 2 pm with temps in the high 40s (F), with a moderate (10-15 mph) wind. The trail takes a steep drop and at the bottom you wobble, slip in the mud, and do a face plant.
Scene and Primary Assessment: Nasty weather, otherwise, nothing.
Secondary Physical: A pair of runners, also dumb enough to be out in this now nasty weather, come along to find you now sitting up on the wet ground, AO4 but complaining of a sore right ankle, which is rapidly swelling. If asked, you can very gingerly walk on it. You are starting to shiver. What really hurts is your left shoulder. You are cradling it with your right arm and guarding it. When asked you can’t move your arm. Fingers on both hands are cold and fingers on your left hand feel a little “weird.” Your fingers are white on both hands and cap refill is impossible to see. No other findings.
SAMPLE: Symptoms as described in Physical. You are allergic to nuts. You are on cholesterol medicine and daily acid reflux meds, both of which you take daily and you’ve been taking regularly (you don’t remember the names of either). No relevant past history. You had a big and late breakfast and you didn’t want to eat before your run, so no lunch. Bathroom routine normal. You remember the fall and “super-manning” headfirst to land prone on the ground.
Vitals: Round 1 – HR 92; RR 26, AVPU AOx4. Round 2 – HR 84, RR 22, AOx4, but shivering now much more severe and almost uncontrollable.
Setting: Foot trail 3 miles from trailhead at about 7000 feet. Weather as described and it is this time of year. You have on running shoes, shorts and a wool zip t-neck long john top. You took this first aid class a while ago and the brilliant instructor recommend you bring at least the 10 essentials with you out on the trail. So in your fanny pack you brought a very small first aid kit (size of deck of cards), a thin water resistant anorak, a ski cap, a Milky Way candy bar, and half of the liter of water your started off with. Your new best friends have just the clothes on their back, but they do have a cell phone and you are ecstatic to hear they have coverage.
What is your assessment? 21 year old male wet and cold, complaining of unstable ankle injury making rapid extraction to trailhead and definitive medical care a challenge. Left shoulder injury (dislocated?) with possible compromised neuro-vascular issues.
What are anticipated problems? Hypothermia. Nerve and/or tissue damage due to compromised neuro-vascular issues. Other two runners (what do they have to stay dry and warm?) Evacuation. It will be getting dark within several hours. Assuming you are a local but if not, if you are at more than 8000 feet, that might be an issue
What is your plan? Get off the ground and put on all your clothes. Eat the candy bar and drink the water. See if you can walk with assistance from the new friends (assuming they are willing to help) and if so have the friends call anyone who lives nearby to come to the trailhead with dry clothes and food and meet you on the trail. If you can’t walk, have them call local 911 or, better yet, local SAR, and notify them of your location, situation, and request assistance. If you can move at all and there is any kind of shelter near by (thick woods, overhang, etc.) possibly move to that location. Probably best if one of the two friends heads to trailhead and gets warm stuff from their car and/or meets assistance at trailhead and brings them back to you (at least then there aren’t 3 of you getting colder). Call loved ones and let them know you will be home late!