The traumatic incident I chose was Cam Zink’s mountain bike crash at the 2024 Redbull Rampage competition. After successfully executing a 360-degree spin high on the course, he attempted a backflip off a large drop. A crosswind occurred, disrupting his trajectory and causing him to lose control, tumbling down the steep slope.

Cam Zink broke six ribs, which resulted in a pneumothorax.

This injury occurred in Virgin, Utah. Virgin is a remote desert area known for its rugged desert terrain. There are many steep cliffs with challenging rock formations.

Virgin, UT is located in the southwestern part of Utah. It is very remote. Cam Zink was airlifted to St. George Regional Hospital in St. George, Utah. 21 miles south of Virgin. This hospital is a designated Level II Trauma Center. This hospital provides a 24-hour in-house coverage of general surgeons, and quick availability of specialists in orthopedics, neurosurgery, anesthesiology, radiology, and critical care. Another hospital that is located nearby is Cedar City Hospital in Cedar City, Utah. This is located about 50 miles north of Virgin. This is a designated Level IV Trauma Center. This hospital is a rural hospital that offers ATLS then typically will transfer patients to a higher level trauma center for advanced care.

For breathing support, a 14-gauge angiocatheter should be prepared for potential needle decompression, and full chest tube insertion supplies should be staged at the patient’s right side to allow for immediate finger thoracostomy if indicated.

Regarding circulatory access, large-bore IV supplies should be readily available (ideally carried by all team members), and intraosseous (IO) access equipment should be positioned at bedside in case of difficult or failed IV access. The Belmont rapid infuser should be present but not prepped with blood unless the patient’s shock index exceeds 0.9. This patient currently has a shock index of 0.86. A team member will be assigned to obtain a manual blood pressure immediately upon arrival to assess for any significant deviation from the EMS-reported values.

An ultrasound machine should be positioned at bedside for immediate EFAST evaluation. The resuscitation room must be pre-warmed to reduce the risk of hypothermia, and warm blankets should be available to cover the patient post-exposure.

A cervical collar should be accessible at the head of the bed for immediate application if the patient arrives without one. Trauma shears should be at hand for rapid exposure. Monitors should be pre-set and ready for immediate use, with the blood pressure cuff programmed to cycle every 3–5 minutes.

The trauma activation team should include:

Two emergency nurses

OR and ICU charge nurses

Trauma surgeon and trauma APP

Respiratory therapist

Two ER techs

Radiology

House supervisor

ER pharmacist

Social work

A CT suite should remain available and on standby for immediate imaging needs.

I would like to clarify a discrepancy in the EMS report. It was stated that IV access was not established, yet 100 mcg of fentanyl was administered intravenously, along with 4 mg of oral Zofran. Could you please confirm the route of administration for the fentanyl (e.g., intranasal or other) and specify the time of administration? Additionally, could you clarify whether the Zofran was orally disintegrating (ODT) or standard oral formulation, and whether it was administered in response to active nausea or as a prophylactic measure?

The mechanism of energy in this incident involves both high kinetic and gravitational potential energy. The patient was descending at high velocity, and the drop introduced significant gravitational force due to its height. Upon impact with the ground, this accumulated energy was rapidly transferred into the rider’s body and the surrounding terrain. The sudden deceleration resulted in force transmission through the helmet and spine, contributing to compressive injuries. Additionally, shearing forces likely occurred during impact, posing a risk for internal organ damage and other blunt trauma complications.

Thank you for your thorough communication and the care provided in the field. We will be fully prepared for the patient’s arrival.