“A Rural Emergency: The Case of Marty’s Combine Accident”

Case Study
Chapter 27 –Rural, Migrant, and Urban
Communities
Marty, a 75-year-old male, with a history of myocardial
infarction called home complaining of heartburn and
running out of antacids. When his daughter-in-law
reminded him to maintain his rest and diet times, Marty
grew angry. “Knock it off. I am doing fine despite what
the doctor said. I will care for the diabetes after the
harvest and I will come home as soon as I can.”
Driving his combine formation with other workers for a
night harvest, Marty paused at 9:45 PM for a break
while the rest of the combine formation continued
moving forward. Marty’s 6-year-old grandson rode in the
combine with him to experience his first night harvest.
No further communication was received from Marty’s
combine.
The boy’s mother called again at 10:00 PM with no
answer. Used to “farm time” and dead space for the cell
phones, she was not overly worried but was concerned
about her son being out so late at night. The mother
called her spouse who drove another combine in a
different field to find out why the boy was not yet home.
The father dispatched a truck to find Marty while the
combines continued harvesting and gleaning.
The truck driver found the missing combine on its side
in a gully with the lights shining upward. A satellite
phone was used to notify the Northern Air Ambulance
NUR4636
and the local 911 of GPS coordinates. The volunteer
flight and paramedic teams were dispatched. The
Italian-made Agusta Power-109 helicopter used
instruments to fly over two counties of hilly terrain. The
single pilot employed night vision goggles to study the
instrument panel and the radio to keep the pilot
informed of ground rescue operations and hospital
preparations. The flight nurses double checked the
laryngoscopes, blood supplies, and jump kits while
maintaining contact with the first scene arrivals.
When the paramedic vehicle arrived, an employee truck
was seen driving away from the combine. Marty was
unconscious with a weak, irregular pulse of 100,
BP of 65/48, and respirations of 26. A bruise over the
right mastoid is noticed. The grandson is conscious and
crying, splinted for a broken leg. His pulse is 120, BP
138/118, and respirations of 24. Purple circles are seen
around his eyes. The 6-year-old complains of a
headache and calls for his mother.
1. How will the nurse gather needed information to
effect a successful rescue?
2. What travel and emergency transport resources
are available?
3. What rural barriers to diagnosis, treatment, and
follow-up resources exist?
4. What roles do rural nursing theory principles play
in Marty’s health behaviors?
5. The nearest critical access hospital does not
have a trauma level due to the lack of a 24-hour
staff with trauma training. What types of trauma
support do patient needs indicate?