It's a beautiful summer Saturday at the state park, and a group of teens has been canoeing down a small river. They stopped at a popular small waterfall to take a break. When one teen dares another to jump across the top of the waterfall, another teen immediately accepts the challenge. A mighty leap later, he almost makes it to the other side, but he comes up short on the landing. His feet go out from under him, and he crashes down the bank and falls about 10 feet. He slides into a rock, and rolls off into the remains of a downed tree.

The broken end of a branch leaves a 1" hole under his right scapula. The wound is still bubbling with each breath when you arrive. The patient is alert and articulate and appears pale. He tells you that the reason he stayed motionless by the creek edge was because it "hurt too bad" to move. He has numerous contusions and abrasions, primarily to his right side. He also has a large avulsion to his right calf that is bleeding freely. Vital signs include a pulse of 126 beats/min, shallow respirations of 40 breaths/min, and a blood pressure of 134/70 mm Hg.