Scenario — Suspected femur fracture following fall from spectator barrier

foundation Trauma · Adult · 35yr · male

Patient Information

Dispatch	You are called to a 35YO male who has fallen from a spectator barrier at the south end of the oval. (Marcus Webb)
Patient	Marcus Webb — 35yr (80kg)
Incident History	Pt was leaning against a temporary crowd barrier which gave way. He fell approximately 1.2 metres, landing heavily on his right leg. Bystanders called for EHS immediately.
Emergency Contact	Claire Webb (Partner) — 0412 847 193

Initial Rapid Assessment

Response	Alert
Airway	Patent. Nil airway obstruction. Nil stridor. Patient speaking in full sentences.
Breathing	Adequate. RR 18. No accessory muscle use. Nil abnormal sounds.
Circulation	Radial pulse present, rate elevated, regular. Skin pale and diaphoretic. Right mid-thigh visibly swollen and deformed. No active external haemorrhage.
Disability	GCS 15 (E4V5M6). Alert and orientated to time, place, and person. Reporting significant right thigh pain.
Exposure	Right mid-thigh: marked swelling, tenderness on palpation, obvious deformity with shortening. No open wound. No other injuries identified on brief inspection.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	97% (RA)	Nil	18	108	104/72	3s	15	4 4 ++	–	–	9
10 mins	98% (RA)	Nil	16	98	110/74	2s	15	4 4 ++	–	–	7

History Taking

Scenario Progression and Treatment Objectives

Diagnosis

This patient is suffering from a suspected closed femur fracture of the right mid-shaft with signs of early haemodynamic compromise secondary to internal haemorrhage.

Facilitator Triggers — if trainees miss a critical step

! (If trainees do not assess distal neurovascular status — colour, warmth, movement, sensation, and capillary refill time — of the right foot within the first 3 minutes, the patient reports increasing numbness in the right foot.)
! (If trainees do not immobilise the limb, the patient attempts to shift position causing an increase in pain to 10/10 and visible increase in deformity — prompt: 'He tries to sit up and moves his leg.')
! (If trainees do not monitor for signs of haemodynamic compromise — tachycardia, pallor, delayed CRT — after 5 minutes the patient reports feeling light-headed and becomes more anxious.)
! (If trainees remove jewellery is not mentioned, the patient has a ring on his right hand — prompt: 'Is there anything on the injured limb you should address before swelling worsens?')

Treatment Objectives

1. Ensure scene safety — confirm crowd barrier is stable and bystanders are clear of the immediate area.
2. Don appropriate PPE including gloves.
3. Perform Primary Survey — confirm airway patent, breathing adequate, circulation intact with early signs of haemodynamic compromise noted.
4. Position patient supine on the ground — do not allow weight-bearing or movement of the right leg.
5. Expose right thigh — cut or remove clothing if necessary to assess injury site.
6. Assess neurovascular status distal to injury BEFORE splinting: right foot — capillary refill time, skin colour and warmth, sensation (can patient feel you touching the foot?), and ability to move toes.
7. Remove ring from right hand before swelling progresses.
8. Do NOT attempt to straighten the deformity — immobilise in position found.
9. Pad natural hollows and bony prominences to maintain alignment.
10. Apply soft splint (e.g. pillow or blanket rolled around the thigh and secured with broad bandages above and below the injury site) — immobilise joint above (hip) and joint below (knee).
11. Reassess neurovascular status distal to injury AFTER splinting — compare findings to pre-splint assessment and document any change.
12. Administer Methoxyflurane (Penthrox) 3 mL via inhaler for analgesia — patient self-administers. Onset of pain relief after 6–10 inhalations.
13. Apply oxygen via nasal cannula at 1–4 L/min or simple face mask at 5–8 L/min if SpO2 drops below 94% — titrate to SpO2 94–98%.
14. Monitor vital signs every 10 minutes — pay close attention to HR, BP, and CRT as indicators of ongoing internal haemorrhage from femur fracture (estimated blood loss from closed femur fracture can be 1–2 litres).
15. Reassess pain score after Methoxyflurane administration.
16. Request ambulance via State Operations Centre — this patient requires Advanced Care for pain management and monitoring. Transport Priority 1.
17. Keep patient warm — cover with blanket to prevent hypothermia while awaiting ambulance.
18. Continuously reassure patient — explain all interventions before performing them.
19. Scenario ends on arrival of ambulance and IMISTAMBO handover.
20. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Limb Trauma · Haemorrhage · Methoxyflurane (Penthrox) · Oxygen · Primary Survey · Secondary & CNS Survey · Fractures & Dislocations — Splinting · Pain Assessment

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Signs/Symptoms	Severe pain in the right thigh. Inability to weight-bear or move right leg. Visible swelling and deformity.
Allergies	Nil known drug allergies.
Medications	Nil regular medications.
Pertinent History	Nil significant past medical history. Non-smoker. Social alcohol only.
Last Oral Intake	Ate a pie and had a beer approximately 90 minutes ago.
Events Leading	Patient was leaning against a temporary spectator barrier at an AFL game. The barrier collapsed and he fell approximately 1.2 metres, landing awkwardly with all his weight on his right leg. Heard a loud crack on impact.
Treatment Prior	Bystanders held leg still and kept patient calm. No medications administered.

Onset	Immediate on impact after fall approximately 10 minutes ago.
Pain	Right mid-thigh — severe, constant, throbbing.
Quality	Constant aching with sharp pain on any movement.
Radiates	Nil radiation.
Severity	9/10