Case Study 16

The Scenario: Caught by Surprise

The Setting

You’re on a high ridge forming the east border of Yellowstone National Park, hours into a long walk to the trailhead and the end of this 12-day backpack. Behind you are seven teenagers, your clients, and your lead instructor. Sweat drips from your forehead as you hike the steep wooded trail on a hot summer afternoon. No one is talking. Lost in thoughts of sore feet, thirst, their first burger, and how many emails might be waiting, they pound the dust and pay little attention to the beautiful surroundings. 

Sensing something ahead, you look up and see large black-colored bear right in the middle of the trail and too close for comfort.  Inhaling loudly, you stop, then tumble onto the trail as the fellow following you stumbles and hits your pack. Someone belatedly yells, "Bear!” Branches snap and crack as the bear bashes the underbrush in haste, heading downhill at an impressive speed. Woven into this confusion is another scream and crash. One of your participants has stepped off the trail and is rolling downhill. 

You unclip your pack, throw caution to the wind, and move with surprising grace and speed down the hill. There is John, his roll stopped by a tree. You stabilize him with you hands and try to find those breaths you forgot to take. Your lead instructor, still on the trail, yells that the bear is gone. Scene safety! Yes, of course! Lost for a moment, you find presence and begin the scene-size up and the initial assessment drill. You order another student to carefully descend to the side of the patient and instruct him to maintain spine control. The slope is steep but the patient is stable in the hollow in front of the tree. 

SOAP Report


The patient is a 17-year-old male who rolled with a 40lb backpack down a 40’ hill. He stopped by striking a tree with his backpack. The event was witnessed and we arrived on scene immediately. The patient states that he is “OK, I think.”


The patient was found on his right side. He was awake and alert with no obvious serious injuries and no respiratory distress or active bleeding. Patient exam revealed numerous small scrapes and abrasions on his knees and forearms; the worst is a large abrasion on the back of his right thigh. He has a 2” diameter swelling on the back of his head. He denied loss of responsiveness, headache, shortness of breath, numbness, tingling, or any abnormal sensations in his extremities. He denies spine pain and his spine is not tender to touch.  

Vital Signs







90, strong, regular

72 strong, regular


18, regular, easy

18, regular, easy


Pale, warm, moist

Pink, warm, dry


Strong radial pulse

Strong radial pulse




Not taken

Not taken







occasional ibuprofen for musculoskeletal pain, none taken today

Pertinent Hx:

none pertinent

Last in/out:

patient ate breakfast and lunch, reports 3 liters of water today and clear urine


patient was hiking and fell off the trail

Stop ...

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