During a four-patient motor vehicle collision, ambulance transport to the nearest hospital takes 40 minutes. Which patient is the top priority for air medical transport to the hospital?

During a four-patient motor vehicle collision, ambulance transport to the nearest hospital takes 40 minutes. Which patient is the top priority for air medical transport to the hospital?

• A. 29-year-old female with bilateral wrist fractures and neck pain
• B. 27-year-old male with abdominal pain and a fractured collarbone
• C. 35-year-old female with a fractured radius and ulna with all vitals stable
• D. 32-year-old male with a pelvic fracture and a SBP of 70 mmHg

Answer: (D)

In trauma transport, urgent decisions hinge on physiologic instability and signs of ongoing hemorrhage. The patient with a pelvic fracture and a systolic blood pressure of 70 mmHg is the top priority for air transport because this combination signals hemorrhagic shock from major pelvic bleeding. Such instability demands rapid access to definitive care ( hemorrhage control, transfusion, and definitive fracture management), and moving this patient by air can shorten the time to that care, which is crucial for survival. The other patients show injuries that, while significant, are currently hemodynamically stable. A patient with bilateral wrist fractures and neck pain has no instability or signs of shock. A patient with abdominal pain and a fractured collarbone may warrant assessment for intra-abdominal injury, but stable vitals mean they are not in immediate threat of sudden decompensation. A patient with a fractured radius and ulna and stable vitals also does not require the same urgent diversion to a trauma center as the unstable patient. So the most urgent scenario is the person in hemorrhagic shock from a pelvic fracture—unstable vitals plus a high risk of rapid deterioration—making air transport the best choice to reach definitive care quickly.

In trauma transport, urgent decisions hinge on physiologic instability and signs of ongoing hemorrhage. The patient with a pelvic fracture and a systolic blood pressure of 70 mmHg is the top priority for air transport because this combination signals hemorrhagic shock from major pelvic bleeding. Such instability demands rapid access to definitive care ( hemorrhage control, transfusion, and definitive fracture management), and moving this patient by air can shorten the time to that care, which is crucial for survival.

The other patients show injuries that, while significant, are currently hemodynamically stable. A patient with bilateral wrist fractures and neck pain has no instability or signs of shock. A patient with abdominal pain and a fractured collarbone may warrant assessment for intra-abdominal injury, but stable vitals mean they are not in immediate threat of sudden decompensation. A patient with a fractured radius and ulna and stable vitals also does not require the same urgent diversion to a trauma center as the unstable patient.

So the most urgent scenario is the person in hemorrhagic shock from a pelvic fracture—unstable vitals plus a high risk of rapid deterioration—making air transport the best choice to reach definitive care quickly.