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Crush injury by an elephant: life-saving prehospital care resulting in a good recovery

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We present the first case of severe injuries caused by an elephant in an Australian zoo. Although the patient sustained potentially life-threatening injuries, excellent prehospital care allowed her to make a full recovery without any long-term complications.

Clinical record

A 41-year-old female zookeeper was urgently transferred to the Royal North Shore Hospital Emergency Department (ED) by ambulance after a severe crush injury to the chest caused by a 2-year-old male elephant.

The 1200 kg male Asian elephant was born in captivity and was well known to the keeper. On the day of the incident, they were involved in a training session when the elephant challenged an instruction. The keeper recognised this change in his behaviour and tried to leave the training area, but the elephant used his trunk to pin her by the chest against a bollard in the barn, resulting in immediate dyspnoea and brief loss of consciousness for 20–30 seconds. Her colleagues arrived and moved her to safety.

When the ambulance arrived, the woman was alert and oriented, and complaining of dyspnoea and severe right-sided chest pain. Initial observations were pulse rate of 110 beats/min, systolic blood pressure (SBP) of 100 mmHg, and a respiratory rate of 36 breaths per minute. She rapidly developed increasing respiratory distress and was found to have absent breath sounds on the right side of her chest and reduced air entry on…