08/31/2026
SCENARIO: WHAT WOULD YOU DO?
You are operating as the sole TEMS medic when you encounter three patients, each with multiple gunshot wounds to the abdomen.
There is no active threat, and no other injuries or medical conditions are present.
PATIENT 1
Adult male
• Conscious and alert
• Respirations: 24, non-labored
• Pulse: 120, strong
• Diaphoretic
• Capillary refill: 3 seconds
PATIENT 2
Adult male
• Unresponsive
• Respirations: 8, shallow
• Pulse: 140, palpable only at the carotid
• Diaphoretic
• Capillary refill: greater than 5 seconds
PATIENT 3
Adult female
• Semi-responsive: GCS 9 (E2/V3/M4)
• Respirations: 30
• Pulse: 130, palpable only at the carotid
• Capillary refill: 4 seconds
YOUR RESOURCES
• Tourniquets, hemostatic gauze and bandaging supplies
• Cricothyrotomy kit, size 4 i-gel and BVM
• Four chest seals, two chest-needle decompression devices and one finger-thoracostomy kit
• Four IV start kits
• Two 500 mL bags of normal saline
• One unit of O-positive whole blood
TRANSPORT
• Traditional EMS is 10 minutes away
• The trauma center is 20 minutes away by ground
• Aeromedical resources are unavailable
• One vehicle is available to CASEVAC a single patient directly to the trauma center
What do you do?
• How do you triage these patients?
• Who receives immediate treatment?
• Do you initiate an immediate CASEVAC or wait for EMS?
• If you CASEVAC, which patient goes—and do you accompany that patient?
• How do you prioritize airway and ventilatory support?
• Who receives vascular access?
• Who, if anyone, receives saline?
• Who gets the only unit of whole blood?
• What treatments do you deliberately defer?
Resources are limited. Time is critical. Every decision affects the other two patients.
Drop your plan in the comments—and explain your reasoning.