Editor鈥檚 Note: In 鈥�,鈥� career Paramedic/Firefighter Chris Kroboth uses shift style case-based learning to enhance learning through more relatable content and help gain deeper insights into critical decision-making, patient assessments, and treatment strategies.
Each case is broken down with detailed findings and explanations. The cases are designed for EMS providers, paramedics and prehospital professionals looking to sharpen their skills and stay at the top of their field. Scan the QR code on the back for 1.5 hours of CEU credits, completely free. Readers also get free simulation files of the cases compatible with the iSimulate REALITi 360 system, enabling realistic practice scenarios. Use the simulations to engage your team and improve collaborative decision-making.
Shift 8 Tanks at 20
Nothing is better than a warm spring Friday night overtime shift with your partner of 15 years. You both have not had the opportunity to work together in quite some time, so take a moment to post up with a smoothie and catch up on old times.
As you dig into the new house you recently bought and the up-coming vacation you have planned, you hear the CAD chirp.
You鈥檙e dispatched to West Street and Halifax Ave. for a motor vehicle collision; you tap en route and enjoy one last sip of the refreshing strawberry smoothie. You start your way to the grocery store parking lot, and after a three-minute response, you pull into a commercial parking lot and find a large 80s-style sedan with a couple of people standing around it. It is head-on into the concrete base of a parking lot light pole. You notice the front grill is compressed, the hood is crumpled, and an elderly gentleman is standing outside talking to two other individuals, and he appears upset.
You make your way over to the patient and glance in the car, noting that the seatbelt seems loose in the vehicle, as if it was worn before impact. Because the vehicle is so old, there are no airbags, and there is a crack on the base of the driver鈥檚 side windshield. Th e light pole is stable, but there is damage to the paint and some chipping of the concrete.
You introduce yourself to George Hoelzen, an 88-year-old male trying to get home with the groceries when he 鈥渂umped鈥� the light pole. He seems jittery, anxious, and embarrassed and is very dismissive of being injured. He wants to get the groceries home to his wife. He鈥檚 moving all his extremities and standing upright but appears pale. He is also rubbing his left shoulder.
You ask the bystanders if they saw him before the accident and if he was acting OK. They did see him, and he appeared to be okay in the store but was in a hurry. You asked George if it would be OK if you get him in the back of the ambulance and do a quick set of vitals before you let him go, and let him know that if everything checks out okay, you have a form for him to sign.
He reluctantly agrees and makes his way to the unit, slowly climbing up the well steps into the back of the ambulance. Your partner hooks him up to the monitor. As you continue your assessment, you recheck and confirm that he has no neck or back pain or knee, leg, abdominal pain, or head pain while palpating the areas for abnormalities. He denies everything, and you find the following vital signs after acknowledging his very reluctant 鈥淚鈥檓 fine鈥� statement. He intermittently holds his left shoulder but quickly stops when you look at him.
Is there anything that jumps out at you or you would want to elaborate on? You ask him if he can refresh your memory on what medications he takes and what medical conditions he has. He states his only medical history is high blood pressure, and he takes a medicine that starts with an M, but he cannot remember the name of it.
You do your best to assess his cognitive capacity with questions around today鈥檚 date, what time it is, where he is currently, what he was doing before you two met, who the president is, etc. He can rattle them all off but is slowly appearing to be fatigued.
You advise him of your findings on the monitor, that you鈥檙e noticing his fatigue, and that with the tank of a vehicle he was driving. Your concern is that he may have underlying injuries that are not manifesting yet because some of his vital signs appear to be culprit of this. Get Friday Night Lights to finish Shift 8 and 9 other shifts.
Excerpted with permission from, 鈥�: A Compilation of Calls for Real Life Pre-Hospital Case-Based Learning Volume 1,鈥� by Chris Kroboth (2024). Available on .
ABOUT THE AUTHOR
Chris Kroboth has been a career paramedic/firefighter for over 19 years and in EMS for over 25. He has been in prehospital and hospital education for the past 18 years. His last assignment before returning to operations was as the EMS training captain in charge of continuing education programs and certification. He is the owner of