Critical transfer after attack by a pack of hounds

In September 2022, MD FLY received a request for an air ambulance referral from the City of Bolivar, Province of Buenos Aires, up to national hospital Juan P. Garrahan, in the Autonomous City of Buenos Aires. It was for a 10-year-old patient who entered the hospital with multiple injuries spread all through her body, with bites and scratches, after having been attacked by a pack of street dogs, three kilometers from the urban area.

The patient suffered cranial trauma caused by dragging, with a right parietaltemporal-occipital scalp with loss of substance, avulsion, puncture and cutting wounds and scratches in the face, chest, abdomen, pelvis, and upper and lower limbs.

She was admitted to hospital with sensory alteration, SCG 7/15, for which reason orotracheal intubation with drugs was required, plus arterial hypotension that was revived with hot crystalloids and the need of vasoactive drugs.

The seriousness, extent and urgent need of specialised treatment of her injuries required immediate attention at a higher complexity institution.

Activation

The first few hours after a trauma are critical for medical intervention and a patient’s recovery. 

Specialised immediate care may determine the difference between life and death, as well as the long-term outcome of injuries.

In a matter of a few hours, the MD FLY team, formed by the Medical Director, physicians, nurses specialising in emergency medicine, coordinators and ambulance drivers, meticulously planned the routes and obtained the necessary flight permits, thus being able to take off in record time.

Stabilisation

On arrival at the local hospital, respiratory, circulatory and neurological stability were thoroughly evaluated before the transfer. The patient was intubated, sedated and with analgesics, in RASS -5, with the requirement of vasoactive drugs. She was immobilised with a rigid spinal board, a cervical collar, and she had an occlusive dressing on her scalp. There was good bilateral air entry, symmetrical thorax without anomalies, oxygen saturation at 97% with FIO2 of 0.4. Ventilation parameters: tidal volume: 220 ml, PEEP: 5 cm H2O and breathing frequency: 26 breaths/minute. Stable vital signs, No. 18 permeable venous accesses, soft abdomen without active bleeding, and normal results in entry and control laboratory analysis.

The first few hours after
a trauma are critical for
medical intervention and
a patient’s recovery

Transportation

Once breathing, haemodynamic and neurological stability were verified, and without evidence of external active bleeding, the third phase of secondary transfer began. It started with ground transportation to the airport of the city of Olavarria, one hour away, with the patient immobilised with a vacuum cushion, advanced vital support, including a portable microprocessor-controlled ventilator, a multi-parametric monitor, a cardiac defibrillator, and syringe infusion pumps.

For MD FLY, it is
fundamental to guarantee
bed-to-bed transfers, with
each stage managed by
our specialised team

At the Olavarria airport, MD FLY’s plane was ready to take off awaiting the authorisation of the medical team. Throughout the flight, periodical controls of her vital signs were performed, where sustained hypotension was detected, thus requiring adjustment of vasoactive drugs, stabilising her hemodynamic condition.

In Buenos Aires, MD FLY’s ambulance was ready to transport her to the Juan P. Garrahn hospital.

Transfer

The patient was transferred to the critical care pediatric service receiving medical team, where they were provided with details of all clinical information, intercurrent events, their resolution, laboratory results and follow-up report. For MD FLY, it is fundamental to guarantee bed-to-bed transfers, with each stage managed by our specialised team.

The patient was admitted to critical care seven hours after the occurrence of the traumatic event, hemodynamically stable, and without active bleeding from any of her visible injuries.

An attack by a pack of hounds is a devastating event that may have serious consequences, both physical as well as emotional for the affected victims and their families. The case described emphasises the importance of timely access to specialised medical attention in emergency situations, such as the ones described, and the prompt action of all providers involved in a referral.