This document provides 4 pre-hospital scenarios to calculate COAST scores and determine if the patient should be enrolled in PATCH (Pre-hospital Analgesia Trial for Children in Helicopter Emergency Medical Services). Case 1 involves a 23-year old female driver trapped in her vehicle after an MVA with a head injury, chest pain, and decreased breath sounds. Case 2 is a 41-year old male farmhand who fell 10 meters and has a possible hip fracture and chest pain. Case 3 is a 70-year old restrained driver in an MVA complaining of abdominal pain. Case 4 is an unknown male teenager thrown from his motorcycle with a head injury, chest wall abrasions, and a clinical flail

1. Pre-hospital scenarios

2. Instructions
◼A COAST Score template is on the next slide. Consider
printing or copying down to help with the following scenarios.
◼For the following scenarios,
◼Calculate a COAST score
◼Consider if you would enrol them in PATCH
◼If you elect to enrol them which colour pack would you
use?

3. COAST Score

4. Case examples
CASE 1
A 23-year-old female is the unrestrained driver in a single-vehicle, high-
speed MVA in which her vehicle struck a telephone pole. You arrive at the
scene to find the patient trapped on the driver’s side. Her head is slumped
back against the headrest and she is moaning. She responds to
questioning but her answers are slurred. She complains of her chest
hurting. She has decreased breath sounds. Her SBP is 86 mmHg, heart
rate is 140 beats per min, respiratory rate is 30 breaths per min and she
has a GCS 14.

5. 1
86
2
1
?
?
?
?
CASE 1

6. Case examples
CASE 2
A 41 year old male is a farm hand that has fallen 10m onto hard ground from a barn in the
Riverland. On arrival at the scene, the patient is able to talk and tells you he had fallen a
couple of hours ago, and has severe right hip and groin pain limiting movement of his leg, as
well as mild right chest pain. Once you are able to assess the patient you find that his SBP is
95 mmHg, heart rate 100 beats per min, respiratory rate is 18 breaths per min, SpO2 95% on
room air. His temperature is 36.0°C.

7. 0
95
1
0
0
1
2
36 0
CASE 2

8. Case examples
CASE 2 continued
A 41 year old male is a farm hand that has fallen 10m onto hard ground from a barn in the Riverland. On
arrival at the scene, the patient is able to talk and tells you he had fallen a couple of hours ago, and has
severe right hip and groin pain limiting movement of his leg, as well as mild right chest pain. Once you are
able to assess the patient you find that his SBP is 95 mmHg, heart rate 100 beats per min, respiratory rate
is 18 breaths per min, SpO2 95% on room air. His temperature is 36.0°C.
While readying the patient for transport he complains of difficulty breathing due to pain in the chest, and the
SpO2 drops to 92%. The decision is made to intubate the patient prior to helicopter transport to the
receiving trauma hospital. Following uncomplicated intubation a finger thoracostomy is performed in the
right 4th intercostal space, with equivocal air leak; however SpO2 improves to 100%. SBP remains 95
mmHg.
For the purpose of this exercise, consider that you are still within 3 hours since the estimated time of
injury…….

9. 0
95
1
1
0
1
3
36 0
CASE 2 continued
+ 1
+ 1

10. Case examples
CASE 3
A 70-year-old previously well woman was the restrained driver in a car
versus tree MVA at 70km/hr. She self-extricated and is GCS 14 (E4V4M6)
on your arrival, and is complaining of severe upper abdominal pain. Her
other obs are HR 110, BP 90, RR20, SpO2 96%.

11. 0
90
1
0
?
1
?
?
CASE 3

12. Case examples
CASE 4
An unknown male who appears to be in his late teens crashed his
motorcycle into a roadside barrier at approximately 60 km/h, and was
thrown approximately 10m onto grass. On arrival of SAAS MedSTAR team
he is GCS 7 (E1V2M4), moving all limbs, HR 140, SBP 85 mmHg, RR 18,
SpO2 90%, temp 35.5°C. He has bruising and abrasions around his left
hip, left chest wall abrasions and a clinical flail segment.

13. 0
85
2
1
0
1
4
35
CASE 4
5