Trauma

Acute lower back strain following heavy lifting at equipment setup

Foundation

Adult · 55yr · male

Patient Information

Dispatch	You are called to a 55-year-old male (Brian Connell) who is a volunteer at the festival site and is lying on his side on the ground near the equipment staging area, reporting severe back pain after lifting a heavy equipment case.
Patient	Brian Connell — 55yr (92kg)
Incident History	Patient was helping lift a heavy audio equipment case (approximately 40–50kg) with a colleague when he felt a sudden 'pop' and immediate onset of severe lower back pain at the moment of peak lift. He was unable to stand upright and lowered himself to the ground with his colleague's help. No loss of consciousness. Both legs moving normally. No bowel or bladder symptoms.
Emergency Contact	Maureen Connell (Wife) — 0412 882 014

Initial Rapid Assessment

Response	Alert
Airway	Patent. Speaking in full sentences.
Breathing	Comfortable. RR 14. No respiratory distress. SpO2 99% on room air.
Circulation	Radial pulse strong and regular. Skin warm and dry. CRT <2s.
Disability	GCS 15 (E4V5M6). Alert and orientated. In moderate to severe pain. Lower limbs moving voluntarily.
Exposure	Lower back — visible muscle guarding and spasm of the lumbar paraspinal muscles bilaterally. No visible deformity or step. No midline bony tenderness on palpation. Bilateral lower limb strength and sensation intact. No bruising.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	99% (RA)	Nil	14	90	144/88	<2s	15	4 4 ++	36.8	–	8
10 mins	99% (RA)	Nil	14	84	136/84	<2s	15	4 4 ++	36.8	–	5

History Taking

Treatment Response

Diagnosis

Acute lumbar paraspinal muscle strain from heavy lifting. No neurological deficit identified. No red flag features for serious spinal pathology — no leg radiation or weakness, no bowel/bladder dysfunction, no fever, no unexplained weight loss, mechanism clearly mechanical. Mildly elevated BP is consistent with pain response and known hypertension, not a primary vascular emergency. This is a painful but not life-threatening musculoskeletal injury within EHS supportive management scope.

Facilitator Triggers — if trainees miss a critical step

! (If trainees do not assess lower limb neurological function before attempting to move the patient — prompt: 'Before repositioning him, what neurovascular checks should you perform?')
! (If trainees do not ask about bowel and bladder symptoms — prompt: 'In a back injury patient, are there specific symptoms that would suggest urgent spinal cord involvement?')
! (If trainees attempt to stand the patient upright immediately — patient cries out and is unable to stand. Prompt: 'The patient is in severe pain — how can you best manage his comfort while completing your assessment?')
! (If trainees are concerned about the BP reading — prompt: 'His BP is elevated — what are the likely contributing factors here? Does this change your immediate management?')

Treatment Objectives

1. Ensure scene safety — assess equipment staging area for hazards.
2. Don appropriate PPE.
3. Perform Primary Survey — confirm no life-threatening injuries.
4. Obtain history — confirm mechanism (heavy lifting, sudden onset), pain character (localised lower back, no leg radiation), prior back history, red flag screen (no neurological symptoms, no bowel/bladder change, no constitutional symptoms).
5. Assess lower limb neurological function — confirm sensation (light touch bilateral feet and legs), voluntary movement (ask patient to wiggle toes and move ankles), and ask about any numbness or tingling; confirm nil deficit.
6. Ask specifically about bowel and bladder function — nil dysfunction in this scenario (important red flag screen for cauda equina).
7. Palpate the lumbar spine — assess for midline bony tenderness (nil in this scenario); note bilateral paraspinal muscle spasm and guarding.
8. Confirm absence of red flags for serious spinal pathology — nil bilateral leg weakness or paraesthesia, nil bowel/bladder dysfunction, nil fever, nil unexplained weight loss, mechanism clearly mechanical.
9. Document pain score — 8/10.
10. Position patient in position of comfort — lateral position on the ground is typically most tolerable for acute back strain; do not force upright positioning.
11. Consider Methoxyflurane (Penthrox) for pain management — appropriate if patient is cooperative, pain is limiting assessment, and patient can self-administer.
12. Monitor vital signs — note mildly elevated BP consistent with pain and known hypertension; repeat after analgesia.
13. Once pain is more manageable — assist patient to a supported sitting or lying position at the FAP; arrange wheelchair transport if needed.
14. Reassure patient — neurological function is intact, no red flags are present, this is consistent with an acute muscle strain.
15. Advise patient — he should see a GP or physiotherapist for ongoing management; he should avoid heavy lifting while symptomatic.
16. Contact CSP if neurological deficit develops, red flags emerge, or pain is unmanageable.
17. Scenario ends when patient is in a position of comfort, analgesia has been provided, and neurovascular status is confirmed intact.
18. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Soft Tissue Injuries · Primary Survey · Secondary & CNS Survey · Penthrox Inhaler Administration · Blood Pressure

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Signs/Symptoms	Sudden onset severe lower back pain following heavy lifting. Bilateral paraspinal muscle spasm and guarding. Unable to stand upright. No leg pain, no neurological symptoms, no bowel or bladder dysfunction.
Allergies	NKDA.
Medications	Ramipril 5mg daily (mild hypertension). No NSAIDs or anticoagulants.
Pertinent History	Known mild hypertension — well controlled on low-dose Ramipril. Episode of lower back pain approximately 5 years ago following a similar lifting incident — resolved with physiotherapy. No osteoporosis diagnosed. No prior back surgery. No recent unexplained weight loss, night sweats, or fever. No malignancy history. No prior aortic disease.
Last Oral Intake	Lunch approximately 2 hours ago.
Events Leading	Patient was volunteering at the festival helping set up audio equipment. He and a colleague attempted to lift a heavy case without adequate technique or planning. He felt the pain onset immediately at the moment of peak lift strain.
Treatment Prior	Colleague helped him lower to the ground carefully. Nil analgesia taken.

Onset	Sudden — felt immediately when lifting heavy equipment case approximately 20 minutes ago.
Pain	Severe lower back pain, central and bilateral lumbar region.
Quality	Sharp and aching with significant muscle spasm. Worse with any movement. Eases very slightly in lateral position.
Radiates	Nil radiation to legs, buttocks, or groin.
Severity	8/10 at rest, worse with any movement.