Case Study 31

The Scenario: Cowboy Takes a Tumble

The Setting

You and a companion, both proud and confident WFRs, are hiking a wilderness trail behind a horse pack string led by a young cowboy. You exchange pleasantries and learn that he is heading to the same trailhead. Suddenly one horse nips at another, a horse kicks, and horses seem to be going everywhere. The rider’s horse rears and bucks, causing him to fall off the back and land on his head and shoulder.

You find yourself in a ritual chant. “The scene appears safe. The weather is warm and sunny. The horses are milling about, no longer in a rodeo. There is one patient. He is on his back. He doesn’t look badly hurt, although he appears to be unresponsive.”  You think about gloves, realizing you don’t have a pair handy. You begin your assessment.

Your patient doesn’t respond to, "Hi, I’m a Wilderness First Responder, can I help?" You assume consent and your companion gently controls the patient’s head. The patient’s airway appears clear and he is breathing without distress. There is no obvious bleeding and he has a strong radial pulse. You control the spine because of the mechanism of injury (MOI). There are no obvious injuries to expose and investigate. 

SOAP Report


The patient is a 25-year-old male who fell off the back of a horse and landed on his head and shoulders. He did not appear to be trampled by the horse. Initially unresponsive, he is now awake and alert. His chief complaint is the pain of the embarrassment of falling from his horse. He requests that we allow him to stand, wrangle his horses, and continue on his way. It’s hard to keep him from moving and looking for his horses.


Patient Exam: The patient was found lying on his back. The patient was initially unresponsive. Within two to three minutes he became A+OX4. 

The patient has a golf ball-sized bruise/swelling on the back of his head and a 3” red spot on his left shoulder that looks like an early bruise. The patient is moving his arms and legs; denies pain on palpation of the spine; and has good circulation, sensation, and motion (CSM) in all four extremities. No other injuries found.

Vital Signs


10:15 a.m.

10:45 a.m.







84, strong, regular

72, strong, regular



12, regular, easy

12, regular, easy



pale, warm, dry

pink, warm, dry



strong radial pulse

strong radial pulse







not taken

not taken




Patient states he has a headache and is slightly nauseous.



Patient is allergic to peanuts with no recent exposure.



Patient denies medications.


Pertinent Hx:

Pt has a history of several fractures, none recent, all healed.


Last in/out:

Patient reports he drank several cups of water this morning, ate breakfast, and had a normal bowel movement.




Stop ...

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