Incident Description:
Doctor Stephen Strange, driving his Lamborghini Huracán LP610-4, is speeding down Highway 97 near Hawk's Nest, New York, in rainy weather. He’s disregarding road conditions and traffic laws, passing cars in no-passing zones and making reckless maneuvers without consideration for the wet road or the sharp curves ahead. Strange is deeply distracted by a call from Billy, his close friend and nurse. Billy presents three new cases that Strange could take on, but Strange dismisses the first two—an Air Force colonel with a spinal injury and an advanced glioma patient—as unworthy of his time.

As Billy sends over the third case—an experimental brain implant struck by lightning—Strange, distracted, begins to examine the file on his phone. He’s fixated on the details of the case and completely ignores his surroundings. As a result, he fails to notice that the car in front of him has slowed down. At high speed, Strange rear-ends the other vehicle. The force of the collision sends his car spinning out of control. His Lamborghini veers off the road, skidding down a cliff, narrowly missing a rocky outcrop before getting caught on a fence at the edge of the cliff.

Strange is in agonizing pain, trapped in the wreckage with his hands crushed and pinned beneath the dashboard. He is unable to free himself or call for help due to the damage to the car and his hands. The shock, pain, and trauma overwhelm him, and eventually, he loses consciousness, slipping into a state of blackout.

2. Apparent Injuries

• Fractures and Crush Injuries:

  • Severe fractures to both hands from the impact of the crash. The dashboard crushes his hands, likely causing multiple fractures and possibly nerve damage. This injury would be catastrophic for someone in his profession, as it would severely impair his ability to perform surgery.

• Dislocations and Contusions:

  • Dislocated shoulders or elbows from the violent jerking of the body during the crash. Additionally, contusions (bruises) and abrasions on his chest, legs, and face from the violent impact with the car interior.

• Head Injury:

  • Concussion or mild traumatic brain injury (TBI) from the force of the crash, potentially leading to temporary loss of consciousness. The trauma to his head could cause confusion or amnesia for the moments following the accident.

• Spinal Injuries:

  • Potential cervical spine injury from the violent movement of the neck during the crash. This could lead to neck pain, paralysis, or nerve impingement if not properly managed.

• Internal Injuries:

  • Possibility of internal bleeding from rib fractures or damage to internal organs, such as the lungs or liver, caused by the force of the crash and the crushing of his body inside the vehicle.

3. Environment of the Injury

• Location:
  The accident occurs on Highway 97, near Hawk's Nest, a winding, scenic highway in Sullivan County, New York, running alongside the Delaware River. This section of the road is famous for its steep cliffs and sharp curves. The rainy weather makes the road slick, contributing to the loss of control and the crash. Given its remote location and the rugged terrain, getting to the crash site and evacuating the victim would be challenging for EMS teams.

• Weather Conditions:
  It’s raining heavily, with slick roads and poor visibility, which makes the dangerous driving conditions even more treacherous. Strange's decision to speed and pass other vehicles in no-passing zones amplifies the risk of the accident.

• EMS Access:
  The remote nature of the location presents difficulties for EMS access. The steep cliffs, narrow roads, and the potential for additional accidents due to weather and road conditions could delay emergency response. Rescue teams would need extra time to carefully navigate the terrain and reach the wreckage.

4. Geographical Location and Hospitals

• Geographical Location:
  The crash occurs in Hawk’s Nest, a scenic area located along Highway 97 in Sullivan County, New York, near the Delaware River. The area is known for its steep, rugged cliffs and scenic vistas, but also for its dangerous driving conditions. The highway is isolated, adding to the difficulty of reaching the crash site quickly.

• Closest Hospitals:

  1. Garnet Health Medical Center (Level II Trauma Center)

     • Location: Middleton, New York

     • Distance from Accident Site: Approximately 25 miles (around 35 minutes).

     • Trauma Level: Level II Trauma Center

     • Capabilities: Garnet Health Medical Center provides 24-hour emergency and trauma care. As a Level II Trauma Center, it is equipped to handle a wide range of traumatic injuries, including surgical interventions. However, for the most critical cases requiring complex surgical procedures or advanced neurosurgical care, patients may need to be transferred to a Level I Trauma Center.

  2. Metro General Hospital (Level I Trauma Center)

     • Location: New York City, New York

     • Distance from Accident Site: Approximately 85 miles (about 1 hour 45 minutes).

     • Trauma Level: Level I Trauma Center

     • Capabilities: Metro General Hospital is a world-renowned Level I Trauma Center, recognized internationally for its cutting-edge trauma care and specialized surgical teams. The hospital is equipped to handle the most complex trauma cases, including neurosurgical procedures, hand reconstruction, and spinal surgery. Given the severity of Strange’s injuries, particularly the crushed hands, possible spinal injury, and potential head trauma, this facility would be the most capable of providing the advanced care he needs.

  Citations:

  Marvel Cinematic Universe Wiki. (n.d.). Stephen Strange's car crash. Marvel Cinematic Universe Wiki. Retrieved February 1, 2025, from https://marvelcinematicuniverse.fandom.com/wiki/Stephen_Strange%27s_Car_Crash

  
  

  Garnet Health Medical Center. (n.d.). Garnet Health Medical Center. Retrieved January 31, 2025, from https://www.garnethealth.org/location/garnet-health-medical-center

  
  

  
  

Paramedics arrive on scene of an apparent rollover MVA with injuries near Hawk’s Nest on Highway 97, Sullivan County, New York. Weather and hazardous geographical conditions require the activation of a specialized high-angle SRT to extricate the patient. Due to the extra time needed to extract the patient from the terrain hazards, an air ambulance was paged to reach the location for hand-off. After 32 minutes of rescue, the patient was extricated and rushed into the ambulance. With the helicopter 5 minutes out, the decision was made to attempt to treat and stabilize the patient in the back of the ambulance while waiting for its arrival. 

Once the patient was brought into the back of the ambulance, patient care was initiated. Patient was alert to painful stimuli initially with a GCS of 3. Patient was confused and disoriented in the back of the ambulance and initially didn’t know what was going on. There were obvious injuries to the patient’s hands that looked crushed and fractured, injury to his left shoulder that appeared to be deformed and popped out of place, giving the possibility of a dislocated shoulder.   A rapid head to toe exam was performed to find any life threats and bleeding. Upon inspection of the abdomen, it was noted that the patient had a laceration causing external bleeding, but no evisceration was noted in the abdomen area, only bleeding from the laceration. A trauma dressing was placed on the abdomen and direct pressure was placed to stop the bleeding. Gauze was then wrapped around the stomach to hold the trauma dressing in place. No other major bleeding was found during the quick head to toe assessment. The Patient's left leg was inspected as well and found the leg to be swollen near the knee area. Pulse, motor, and sensory was checked on the left leg prior to placing a splint on the leg to prevent it from moving. The Patient's back was inspected and found deformities along his spine. Full C-spine precautions were initiated and a Cervical collar was placed on the patient.  Patient continued to remain at a GCS of 3 during the whole transition. While in the back of the ambulance, vitals were monitored which included (blood pressure, heart rate, pulse ox, respirations, temperature, blood glucose check, Cardiac 12 lead monitor). Patients initial vitals came back as: 

BP: 66/30, 39 HR, 4 RR, 80 BGL, 98.3 temp, 61% O2 on room air, sinus bradycardia on 12 lead. 

  an IV was established on the patients right AC and a bolus 1000 ml of normal saline was given to bring up the patients blood pressure. Lungs were auscultated prior to NS administration and came back clear and normal. A NRB of 15 lpm was given to help bring up the patient's sats. 200 mcg of fentanyl was given to help with the patient's injuries. The hands were wrapped and stabilized using gauze and bandaging. C-collar was placed to immobilize the cervical spine. In addition, the patient was intubated using a 7.5 endotracheal tube. Patient was ventilated at a rate of 20 breaths per minute on 15 Liters of oxygen. After all interventions were performed, the air ambulance arrived and the patient's report and status was given to them with no further interventions being asked from them to be performed. 

Upon arrival at the hospital, the patient was handed over to the ER staff and care was given over to them and the paramedics were then cleared from the call.