Case Study 39

The Scenario: Missing Snowmobiler

The Setting

You are searching, as part of your local SAR team, for an overdue snowmobiler. You know that the overdue person is 62 years old with a history of risk factors for heart disease, but no actual heart attacks. He is described as an experienced snowmobiler and knowledgeable of the local trails.  He planned a short ride this morning, due home by noon. His wife says he is never late or will use his cell phone to inform her if his plans changed. She has heard nothing today. The weather service has posted a winter storm warning, which influences your team’s decision to search early for this person. One of you is pulling a small utility sled with a tarp, sleeping bag, first-aid and survival kit. 

The weather is awful. Visibility is less than 60’ (20 meters) in blowing snow. Travel is slow as you struggle to stay on the trails.  After a couple of hours of searching your teammate notices a snow machine off the side of the trail. 

Scene-size up:

There is one patient. The machine and his snowsuit match the description for your overdue person. The front of the machine has some damage that suggests he struck a tree. It’s 10°F (-12°C) with blowing snow. You are able to protect yourself in this weather.

Initial Assessment:

Your initial assessment (you briefly lift his fogged facemask) finds the patient responsive to a loud shout (responsive to verbal stimulus). His eyes open and he seems to look around by does not say anything.  You assume implied consent to treat. You find a carotid pulse and the skin on his chest seems cool to the touch. He is breathing. You do a quick “chunk check” squeezing all four extremities, the pelvis and the chest. There is no bleeding, you don’t find any obvious injuries, the helmet is intact.

You decide that the scene is unsafe. You cannot fully assess and care for the patient under these conditions. Being as gentle as possible, you wrap the patient in the tarp, then slide him into the sleeping bag and cover it with a second tarp and slide the package onto your utility sled. One of you sits at the patient’s head to maintain contact and protect the spine. The other drives the machine to the trailhead. You are able to inform dispatch of your plan and request EMS to the trailhead.

SOAP Report


The patient is a 62-year-old male who struck a tree (unwitnessed) in a snow machine. There was moderate damage to the front of the machine. The patient was found lying supine in the snow; it is unknown when the accident occurred. On scene weather precluded a full patient assessment.  The patient was packaged in a hypo wrap with manual spine protection and transported for 45 minutes by snowmachine to the trailhead and transferred to EMS.


Patient Exam: Assessment by the EMS unit finds no signs of injury to the patient; the helmet is intact. Hands and feet were initially cold to the touch but soft and pliable and are now pink and warm and without sign of local cold injury and good CSM. Patient is actively shivering.  Patient denies chest pain.

Vital Signs




Reported on scene as “V”.  Currently A + O x 3.  Has no memory of striking the tree or being on the snowmachine earlier in the day, is aware of present surroundings.


90, strong, regular


14, easy, regular


pale, cold, dry





97°F (36.1°C) tympanic




Complains of cold


Patient denies


Unclear; patient reports meds for BP and cholesterol.  Does not know details.

Pertinent Hx:

History of risk factors for heart disease, patient denies heart attacks

Last in/out:

Unclear answer from patient.


Patient was snowmobiling, probably struck a tree, was found in the snow, and transported by SAR to EMS.

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