Term
| Initial Assessment: Size-Up |
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Definition
1. BSI/Scene Safety
2. # of pts
3. MOI/NOI
4. C-Spine?
5. General Impression
6. AVPU
7. Chief Complaint
8. Backup/Additional Resources |
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Term
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Definition
Airway: Assess and maintain open airway: head-tilt/jaw thrust, OPA/NPA
Breathing: assess rate and quality, bilateral expansion, lung sounds, plug any holes immediately, Oxygen
Circulation: assess SKIN, Pulse, and sweep for major bleeding
Decision: Transport decision/Priority (Verbalize packaging and loading patient before completing the rest of the assessment)
(E, for trauma, expose) |
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Term
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Definition
Focused or rapid medical assessment (Trouble Breathing, listen in many places, etc.)
OPQRSTI
SAMPLE
Baseline Vitals (rate and quality)
CHECK ALLERGIES BEFORE GIVING MEDS! |
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Term
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Definition
Rapid/Focused Physical Exam
Baseline Vitals
SAMPLE
Detailed physical exam: don't forget to verbalize checking back and neck before backboarding/collaring!
Make sure to check pupils and auscultate different parts of chest (Look, Listen, Feel)
CHECK CMS in all extremities. |
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Term
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Definition
I. Assess perfusion. If hypoperfusion is present, refer immediately to the Hypoperfusion Protocol!
II. Place the patient in a position of comfort, usually in a face-up position with the hips elevated and knees flexed.
III. Do not administer any solids or fluids by mouth.
IV. Transport, keeping the patient warm.
V. Detailed physical exam.
VI. Obtain and record the patient’s current and past medical history after transport has been initiated.
VII. Ongoing assessment. Obtain and record the patient’s vital signs; repeat enroute as often as indicated.
VIII. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR). |
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Term
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Definition
I. Assess the situation for potential or actual danger. If the scene/situation is not safe, retreat to a safe location, create a safe zone and obtain additional assistance from a police agency.
II. Perform initial assessment. Assure that the patient’s airway is open and that breathing and circulation are adequate. Suction as necessary
III. Administer high concentration oxygen. In children, humidified oxygen is preferred.
IV. Obtain and record patient’s vital signs, including determining the patient’s level of consciousness. Assess and monitor the Glasgow Coma Scale.
A. If the patient is unresponsive (U) or responds only to painful stimuli (P), transport immediately, keeping the patient warm.
B. Ifthepatienthasaknownhistoryofdiabetescontrolledbymedication,is conscious and is able drink without assistance, provide an oral glucose solution, fruit juice or non-diet soda by mouth, then transport, keeping the patient warm.
V. If underlying medical or traumatic condition causing an altered mental status is not apparent; the patient is fully conscious, alert (A) and able to communicate; and an emotional disturbance is suspected, proceed to the Behavioral Emergencies protocol.
VI. Transport immediately, keeping the patient warm.
VII. Ongoing assessment. Repeat and record the patient’s vital signs, including the level of consciousness and Glasgow Coma Scale enroute as often as the situation indicates.
VIII. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR). |
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Term
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Definition
1. Request ALS
2. For Pts whose status is VP or U.
3. Take suicidal/violent threats seriously: call in PD if in danger.
4. Hx of Diabetes? Oral glucose/fruit juice given PO, EXCEPT in unresponsive or head trauma pts. |
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Term
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Definition
I. Assure that the patient’s airway is open and that breathing and circulation are adequate. Suction as necessary.
II. Administer high concentration oxygen.
III. Determine that the patient has a diagnosed history of anaphylaxis, severe allergic reactions, and/or a recent exposure to an allergen or inciting agent.
IV. If cardiac and respiratory status is normal, transport the patient while performing frequent ongoing assessments.
V. If either cardiac or respiratory status are abnormal, proceed as follows:
A. If the patient is having severe respiratory distress or hypoperfusion and has been prescribed an epinephrine auto injector, assist the patient in administering the epinephrine. If the patient’s auto injector is not available or is expired, and the EMS agency carries an epinephrine auto injector, administer the epinephrine as authorized by the agency’s medical director.
B. If the patient has not been prescribed an epinephrine auto injector, begin transport and contact Medical Control for authorization to administer epinephrine if available.
VI. Contact Medical Control for authorization for a second administration of the epinephrine auto injector, if needed.
VII. Refer immediately to any other appropriate protocol.
VIII. If cardiac arrest occurs, perform CPR according to AHA/ARC/NSC standards and refer to the Cardiac Arrest Protocol.
IX. Transport immediately.
X. Ongoing assessment. Obtain and record the patient’s initial vital signs, repeat enroute as often as the situation indicates. Be alert for changes in the patient’s level of consciousness.
XI. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR).
XII. If epinephrine has already been administered, continue to reassess respiratory effort and vital signs, transport immediately. |
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Term
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Definition
1. Keep pediatric patients comfortable and reassured and with parents.
2. Request ALS |
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Term
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Definition
I. Determine whether the scene/situation is safe. If not, retreat to a safe location, create a safe zone, and obtain additional assistance from a police agency.
II. Perform initial assessment. III. Assure that the patient’s airway is open and that breathing and circulation are adequate.
IV. Consider other causes of abnormal behavior (hypoxia, hypoperfusion, hypoglycemia, etc.) V. Place the patient in a position of comfort if possible.
VI. Attempt to establish a rapport with the patient. VII. Restrain, only if necessary, using soft restraints to protect the patient and others from harm.
Restraints should only be used if the patient presents a danger to themselves or others!
*Police Officer or Peace Officer MUST authorize use of restraints!
VIII. After application of restraints, keep the patient in the most appropriate position, while assuring the restraints do not restrict the patient’s breathing or circulation.
IX. Transport, keeping patient warm.
X. Ongoing assessment. Obtain and record the patient’s initial vital signs, repeat enroute as often as the situation indicates.
XI. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR).
XII. Document the reason for applying restraints to the patient as well as identifying the individual authorizing restraint of the patient. |
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Term
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Definition
I. Assure that the patient’s airway is open and that breathing and circulation are adequate.
II. Administer high concentration oxygen.
III. Place the patient in a position of comfort, while reassuring the patient and loosening tight or restrictive clothing.
IV. Transport, keeping the patient warm.
V. Ongoing assessment. Obtain and record the patient’s vital signs, repeat enroute as often as the situation indicates.
VI. If patient has not taken aspirin and has no history of aspirin allergy and no evidence of recent gastrointestinal bleeding, administer 325mg of nonenteric chewable aspirin.
VII. If chest pain is present and if the patient possesses nitroglycerin prescribed by his/her physician, has a systolic blood pressure of 120mm Hg or greater and the patient has not taken any erectile dysfunction medication in the last 72 hours, the EMT-B may assist the patient in self-administration of the patient’s prescribed sublingual nitroglycerin as indicated on the medicine container.
A. Confirm the systolic blood pressure is above 120mm Hg.
B. Question patient on last dosea dministration of nitroglycerin, effects, and assure understanding of route and administration.
C. Administer one(1) metered dose of nitroglycerin spray or one(1) nitroglycerin tablet under the patient’s tongue without swallowing and record the time of the administration and the current vital signs.
D. Recheck blood pressure within two (3) minutes of administration and record any changes in the patient’s condition.
E. If the patient continues to have chest pain with a systolic BP above 120mm Hg, the EMT-B may assist in administering up to two additional doses following the above steps in VII-A through VII-D for each single dose administered. Each dose shall be no less than 5 minutes from the last dose given.
VII. treatment provided, on a Prehospital Care Report (PCR).
Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR). |
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Term
| Cold Emergencies: Local Injury |
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Definition
A. Remove the patient from the cold environment.
B. Protect the injured areas from pressure, trauma, and friction.
C. Performinitialassessment. D. Administer high concentration oxygen. E. Remove the clothing from the injured areas.
Caution:
Do not rub the injured areas! Do not break blisters!
Do not allow the injured areas to thaw if they may refreeze before
evacuation is completed!
1.
2.
If patient a. b. c. If patient a. b. c.
has an early or superficial local cold injury: Remove jewelry. Splint and cover the extremity. Do not rub, massage, or expose to the cold.
has a late or deep local cold injury: Remove jewelry. Cover the exposed area with dry dressings.
Do not break blisters, rub or massage area, apply heat, rewarm, or allow the patient to walk on the affected extremity.
F. Transport, keeping the patient warm.
G. When an extremely long or delayed transport is inevitable (transport time in excess of 30 minutes) then active rapid rewarming should be done.
1. Immerse the affected part in warm water bath (not to exceed 105° F)
2. Continuously stir the water and ensure that the water does not cool from the affected part.
3. Continue until the part is soft and color and sensation return.
4. Dress the area with dry sterile dressings. If hand or foot, place dry sterile dressings between the fingers or toes.
5. Protect against refreezing the warmed part.
H. Ongoing assessment. Obtain and record the patient’s vital signs, repeat enroute as often as the situation indicates.
I. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR). |
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Term
| Cold Emergency: Generalized Hypothermia |
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Definition
A. General Treatment Guidelines:
1. Handle the hypothermic patient carefully to prevent cardiac arrest from ventricular fibrillation.
2. Remove the patient from the cold environment and protect the patient from further heat loss.
3. Do not allow the patient to walk or exert themselves.
4. Perform initial assessment.
5. Assure that the patient’s airway is open and that breathing and circulation are adequate.
6. Administer high concentration oxygen. Oxygen should be warmed and humidified, if possible.
7. Assess pulses for 30 – 45 seconds. If no pulse begin CPR and refer to appropriate Cardiac Arrest protocol.
8. Place the patient in a warm, draft free environment. 9. Gently remove wet clothing.
10. Wrap the patient in dry blankets.
B. Assesslevelofconsciousnessandrefertotheappropriatesub-sectionbelow:
1.
If the patient is alert and responding appropriately: a. Actively rewarm the patient slowly:
i. Place heat packs (if available) in the patient’s groin area, lateral chest and neck.
ii. Increase heat in the patient compartment.
b. Continue rewarming the patient.
c. Ongoing assessment. Obtain and record the patient’s vital signs, repeat enroute as often as the situation indicates.
d. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR).
2. If the patient is unconscious or not responding appropriately:
a. Passively rewarm the patient slowly.
b. If respirations and pulse are absent, start CPR. It is possible that the patient may still be revived.
c. If defibrillation is required, defibrillate a maximum of three shocks. d. Do not allow the patient to eat or drink. e. Transport immediately.
f. Ongoing assessment. Obtain and record the patient’s vital signs, repeat enroute as often as the situation indicates.
g. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR). |
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Term
| PEDIATRICS: Respiratory Distress/Failure |
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Definition
Signs/Symptoms: use Pediatric assessment triangle (work of breathing, appearance, color)
I. Establish airway control and ventilations using BLS techniques according to AHA/ARC/NSC guidelines.
A. Open the airway using the head-tilt/chin-lift or jaw-thrust maneuver.
B. Remove any visible airway obstruction by hand and clear the airway of any accumulated secretions or fluids by suctioning.
Immediately determine if the child is breathing adequately.
A. If the ventilatory status is inadequate (the child is cyanotic, visible retractions, grunting, head bobbing, severe use of accessory muscles, altered mental status, the respiratory rate is low for the child’s age, capillary refill is greater than 2 seconds, muscle tone is limp, a slow or fast heart rate, or other signs of inadequate perfusion):
1. Insert a properly sized oropharyngeal airway if the gag reflex is absent. If a gag reflex is present insert a nasopharyngeal airway.
2. Determine if the patient needs positive pressure ventilations. If no, use supplemental oxygen and maintain airway. If yes, maintain airway, give positive pressure ventilations and supplemental oxygen.
3. Ventilate (with high concentration oxygen) at a rate appropriate for the child’s age using a pocket mask or bag-valve-mask. Assure there is adequate chest rise with each ventilation.
III. Identify and correct any other life-threatening conditions found during the initial assessment.
IV. Transport, keeping the child warm. V. Ongoing assessment including effectiveness of ventilations.
VI. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR). |
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Term
| PEDIATRICS: Croup or Epiglotitis |
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Definition
If the child presents with respiratory distress with inspiratory
stridor and has a history of upper respiratory infection, suspect:
CROUP, if one or more of the following are present:
Low grade fever, barking cough, and/or
sternal retractions.
EPIGLOTITIS, if one or more of the following are present:
High grade fever, muffled voice, and/or drooling.
Caution:
Do not attempt to visualize the child’s oropharynx or insert
anything into the mouth or perform stressful procedures, which
could cause sudden and complete airway obstruction in these
children! |
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Term
| Heat Emergencies: Moist, Pale, Normal to Cool Skin |
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Definition
A. Perform initial assessment.
B. Assurethatthepatient’sairwayisopenandthatbreathingandcirculationare adequate.
C. Removethepatientfromtheheatsourceandplaceinacoolenvironment. D. Administer high concentration oxygen. E. Loosen or remove outer clothing. F. Place patient in the supine position with legs elevated.
G. Transport the patient immediately. H. Cool the patient by removing excess clothing and fanning the patient.
Do not delay transport to cool the patient! 1. If the patient is conscious, is not nauseated, and is able to drink without
assistance, have the patient drink water (if available). 2. If the patient is unconscious or is vomiting, transport to the hospital with the
patient positioned on their left side.
I. Ongoing assessment. Obtain and record the patient’s vital signs, repeat enroute as often as the situation indicates.
J. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR). |
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Term
| Heat Emergencies: Hot, Dry or Moist Skin |
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Definition
A. Perform initial assessment.
B. Remove the patient from the heat source and place in a cool environment.
C. Remove outer clothing.
D. Apply cool packs to neck, groin, and armpits.
E. Keep patient’s skin wet by applying wet sponges or towels.
F. Fan the patient aggressively.
G. Transport immediately.
H. Ongoing assessment. Obtain and record the patient’s vital signs, repeat enroute as often as the situation indicates.
I. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR). |
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Term
| ADULT: FBAO, able to Cough and/or Speak |
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Definition
I. If the patient is conscious and can breathe, cough or speak, do not interfere! Encourage the patient to cough. If the foreign body cannot be dislodged by the patient coughing:
A. Administer high concentration oxygen.
B. Transportinasittingposition,keepingthepatientwarm.
C. Ongoing assessment. Obtain and record the patient’s vital signs, repeat enroute as often as the situation indicates.
D. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR). |
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Term
| ADULT: FBAO, unable to Cough and/or Speak |
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Definition
II. If the patient is conscious with signs of severe airway obstruction (i.e. signs of poor air exchange and increased breathing difficulty, such as a silent cough, cyanosis, or inability to speak or breathe), perform obstructed airway maneuvers according to AHA/ARC/NSC guidelines.
III. If the airway obstruction persists after two sequences of obstructed airway maneuvers and/or the patient becomes unconscious:
A. Begin CPR .
B. Transport,keepingthepatientwarm..
C. Ongoing assessment. Obtain and record the patient’s vital signs, repeat enroute as often as the situation indicates.
D. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR).
IV. If the airway obstruction is cleared and the patient resumes breathing: A. Administer high concentration oxygen.
B. Transport,keepingthepatientwarm.
C. Obtain and record the patient’s vital signs, repeat enroute as often as the situation indicates.
D. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR). |
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Term
| PEDIATRICS: FBAO, able to Cough and/or Speak |
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Definition
Request ALS
I. Partial Airway Obstruction – If the child is alert and can breathe, cough, cry or speak:
A. Do not interfere, and do not perform BLS airway maneuvers! Allow the child to assume and maintain a position of comfort or to be held by the parent, preferably in an upright position. Do not lay the child down.
B. Administer high concentration oxygen (preferably humidified) by a face mask,if tolerated without agitating the child! Administration of oxygen may best be accomplished by allowing the parent to hold the face mask about 6 – 8 inches from the patient’s face.
C. Transport immediately, keeping the child warm.
D. Ongoing assessment. Obtain and record the patient’s initial vital signs, including capillary refill, if tolerated, repeat enroute as often as the situation indicates, without agitating the child. Limit your exam and do not assess blood pressure.
E. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR). |
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Term
| PEDIATRICS: FBAO, unable to Cough and/or Speak |
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Definition
If the child is conscious but cannot breath, cough, speak, or cry, perform obstructed airway maneuvers according to AHA/ARC/NSC guidelines.
II.
Caution:
Agitating a child with a partial airway obstruction could cause complete obstruction! As long as the child can breathe, cough, cry, or speak, do not upset the child with unnecessary procedures (e.g., blood pressure determination)! Use a calm, reassuring approach, transporting the parent and child securely as a unit.
III.
IV.
If the child is unconscious, becomes unconscious and is not breathing:
A. Attempt to establish airway control using BLS techniques. Open the child’s mouth, and remove any visible foreign body.
B. BeginCPRaccordingtoAHA/ARC/NSCguidelinesandtransportimmediately.
Immediately upon removal of the foreign body and/or establishment of chest rise in a child of any age (including infants), assess the child’s ventilatory status!
1.
2.
If the ventilatory status is inadequate (the child is cyanotic, the respiratory rate is low for the child’s age or capillary refill is greater than 2 seconds):
a. Ventilate at the rate appropriate for the child’s age using a pocket mask or bag-valve-mask. Assure there is adequate chest rise with each ventilation given over one second.
b. Supplemental ventilations with high concentration oxygen.
c. Transport, keeping the child warm.
d. Ongoing assessment. Obtain and record the patient’s vital signs, repeat enroute as often as the situation indicates.
e. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report.
If the ventilatory status is adequate (i.e., the child is breathing spontaneously, the respiratory rate is appropriate for the child’s age, cyanosis is absent, and capillary refill is less or equal to 2 seconds):
a. Administer high concentration oxygen (preferably humidified) by a face mask, if tolerated, without agitating the child! Administration of oxygen may best be accomplished by allowing the parent to hold the face mask about 6 – 8 inches from the patient’s face.
b. Transport, keeping the child warm.
c. Ongoing assessment. Obtain and record the patient’s vital signs, including capillary refill, if tolerated, repeat enroute as often as the situation indicates, without agitating the child.
d. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR). |
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Term
| Poisoning: General Approach |
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Definition
I.
General Approach
A. If possible, identify the product or substance that the patient has ingested, inhaled or come in contact with.
B. Estimatetheamountofproductorsubstanceingested,ifapplicable.
C. Estimatethedurationofexposuretotheproductorsubstance.
D. Attempt to obtain information about the product from the container’s label. If possible, bring the product or substance and it’s container with the patient to the hospital. |
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Term
| Poisoning: Patient Alert and Conscious |
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Definition
II. Patientwhoisconsciousandalert,performaninitialassessmentand:
A. Swallowed Poisons: 1. Administer oxygen.
2. Contact Medical Control for instructions on treatment, which may include the administration of Activated Charcoal, milk, water, and/or Syrup of Ipecac for the induction of vomiting, etc.
3. Transport, keeping the patient warm.
4. Ongoing assessment. Obtain and record the patient’s vital signs, repeat enroute as often as indicated.
5. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR).
B. InhaledPoisons:
1. Assure that the scene is safe for entry. If danger of poisonous gases, vapor, or sprays or an oxygen-deficient environment is present, it may be necessary to obtain assistance from trained rescue personnel.
2. Remove the patient to fresh air.
3. Perform initial assessment.
4. Assure that the patient’s airway is open and breathing and circulation are adequate.
5. Place the patient in a position of comfort.
6. Administer high concentration oxygen.
7. Ongoing assessment. Obtain and record the patient’s vital signs, repeat enroute as often as the situation indicates.
8. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR).
C. Skin or Eye(s) Contamination:
1. Refer to the Burns/Contaminations (Chemical) Protocol). |
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Term
| Poisoning: Patient Unconscious/AMS |
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Definition
III. Patient who is unconscious or has altered mental status: A. Perform initial assessment.
B. Assurethatthepatient’sairwayisopenandthatbreathingandcirculationare adequate; suction as necessary.
C. Administerhighconcentrationoxygen.
D. Ongoing assessment. Obtain and record the vital signs, repeat enroute as often as the situation indicates.
E. Transport, keeping the patient warm.
F. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR). |
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Term
| ADULT: Respiratory Arrest/Failure |
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Definition
**Remember to determine if valid DNR/MOLST present! Do not delay treatment to make determination!!
I. Perform initial assessment.
II. If ventilatory status is inadequate, (patient is cyanotic, visible retractions, severe use of accessory muscles, altered mental status, respiratory rate less than 10 breaths per minute, signs of poor perfusion) proceed with positive pressure ventilations as follows.
III. Insert an oropharyngeal airway if tolerated (i.e., no gag reflex). Provide BLS care according to AHA/ARC/NSC standards. If ventilations are unsuccessful, refer immediately to the Obstructed Airway Protocol. If the patient is in cardiac arrest refer immediately to the appropriate Cardiac Arrest Protocol.
IV. V entilate with supplemental oxygen. V. Transport immediately, keeping the patient warm.
VI. Ongoing assessment including the effectiveness of the ventilations/compressions.
VII. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR).
**Pts w/poor lung compliance may require higher pressure: disable pop-off valve on BVM. |
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Term
| PEDIATRICS: Respiratory arrest/failure |
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Definition
I. Establish airway control and ventilations using BLS techniques according to AHA/ARC/NSC guidelines.
A. Open the airway using the head-tilt/chin-lift or jaw-thrust maneuver.
(Remember to check for signs of impending cardiac arrest, and be ready to initiate Cardiac Arrest Protocol)
B. Remove any visible airway obstruction by hand and clear the airway of any accumulated secretions or fluids by suctioning.
II. Immediately determine if the child is breathing adequately.
A. If the ventilatory status is inadequate (the child is cyanotic, visible retractions, grunting, head bobbing, severe use of accessory muscles, altered mental status, the respiratory rate is low for the child’s age, capillary refill is greater than 2 seconds, muscle tone is limp, a slow or fast heart rate, or other signs of inadequate perfusion):
1. Insert a properly sized oropharyngeal airway if the gag reflex is absent. If a gag reflex is present insert a nasopharyngeal airway.
2. Determine if the patient needs positive pressure ventilations. If no, use supplemental oxygen and maintain airway. If yes, maintain airway, give positive pressure ventilations and supplemental oxygen.
3. Ventilate (with high concentration oxygen) at a rate appropriate for the child’s age using a pocket mask or bag-valve-mask. Assure there is adequate chest rise with each ventilation.
III. Identify and correct any other life-threatening conditions found during the initial assessment.
IV. Transport, keeping the child warm. V. Ongoing assessment including effectiveness of ventilations.
VI. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR).
**Rates of ventilation with advanced airway are at one breath every 6-8 seconds, unlike without which is one breath every 3-5. |
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Term
| ADULT/PEDIATRIC: Cardiac Arrest |
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Definition
**Check for DNR/MOLST, don't delay treatment to find it!
I. If patient is unresponsive and pulseless, begin Cardiopulmonary Resuscitation as per current AHA/ARC/NSC guidelines.
DO NOT DELAY BEGINNING COMPRESSIONS TO BEGIN VENTILATIONS – COMPRESSIONS MUST BEGIN AS SOON AS IT IS DETERMINED THE PATIENT DOES NOT HAVE A PULSE
Note:
Determine if the patient has a Do Not Resuscitate (DNR) order.
Treatment must not be delayed while making this determination.
Request Advanced Life Support if available. Do not delay transport to the hospital.
A.
Artificial ventilation and/or compressions must not be delayed to attach supplemental oxygen. Initial ventilations without supplemental oxygen should be used until supplemental oxygen can be attached.
i. Deliver each breath over 1 second. ii. Give sufficient tidal volume to produce visible chest rise.
iii. Avoid rapid or forceful ventilations.
iv. When an advance airway is in-place with 2 person adult CPR, ventilations are to be given at a rate of one breath every 6-8 seconds without attempting synchronization between compressions. Do not pause compressions for delivery of ventilations.
II. During application of the AED:
A.
B. C.
The AED should be applied to the patient as soon as it is available and without interrupting compressions.
Assure proper application and adhesion of the pads to the patient’s chest. If present, remove Nitroglycerin medication patch from the patient’s chest.
i. ii. iii.
When in doubt of the type of medication patch the patient has on their chest, remove the patch
Assure that patient’s medication patch does not come in contact with your skin (wear appropriate PPE).
Assure proper disposal of the medication patch at the Emergency Department through use of properly identified biohazard bags.
III. Once the AED has analyzed the patient’s rhythm, follow the voice prompts to either “check patient” or administer a “shock”.
A. Pediatric patients under the age of 8 should be defibrillated using an AED equipped for and approved by the FDA for use on children.
i. In an emergency situation where an AED equipped for use on children is unavailable, an adult AED unit can be used.
IV. After the first and all subsequent defibrillations immediately begin CPR (approximately 2 minutes), without checking for a pulse, before the next rhythm check and/or defibrillation. Do not check for a pulse or rhythm after defibrillation until CPR has been completed (approximately every 2 minutes) or the patient appears to no longer be in cardiac arrest.
V. All actions and procedures occurring during a cardiac arrest should be accomplished in a way that minimizes interruptions of chest compressions.
VI. Transport to the Emergency Department:
A.
B. C.
A maximum of 3 defibrillations may be delivered at the scene prior to initiating transport. If transportation is unavailable, continue your AED/CPR sequence until transportation is available.
If the AED advises that no shock is indicated, initiate transport with rhythm checks by the AED occurring approximately every 2 minutes.
During transport, the AED should perform rhythm checks approximately every 2 minutes with as few interruptions of chest compressions as possible.
VII. If patient is no longer in cardiac arrest, complete an initial assessment, support airway and breathing, place patient in the recovery position, obtain vital signs, and treat according to appropriate protocol while continuing transport.
A. If pt remains unresponsive with vital signs they may benefit from therapeutic hypothermia and medical control should be contacted to determine appropriate transportation destination.
Record all patient care information, including the patient’s medical history and all treatment provided (including the total number of defibrillations administered), on a Prehospital Care Report (PCR). |
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Term
| Asthma-Related Respiratory Distress |
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Definition
IV. If the patient’s respiratory distress is caused by an exacerbation of their previously diagnosed asthma, do one of the following:
A. If you have received the appropriate training along with REMAC approval to administer nebulized Albuterol, refer to the Nebulized Albuterol Treatment Protocol.
B. IfyouarenotauthorizedtoadministernebulizedAlbuterol,thepatienthasa prescribed metered dose bronchodilator medication inhaler, and you have REMAC approval, you may assist the patient in administering the medication.
C. Contraindications to the assisted administration of a multidose inhaler (MDI) are if the patient is not alert and/or the MDI is not prescribed to the patient and/or the MDI is a steroid based medication.
D. To administer the patient’s MDI remove the oxygen and administer the MDI. After administration replace the oxygen. |
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Term
| Seizures - Actively Seizing |
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Definition
REQUEST ALS
I.
Management of the patient who is seizing: A. Protect the patient from harm, and remove hazards from the patient’s immediate
area, and avoid unnecessary physical restraint.
B. Performinitialassessment.
C. Assurethatthepatient’sairwayisopen,andthatbreathingandcirculationare adequate.
D. Suction the airway as needed. Avoid stimulation of the posterior pharynx during suctioning because this may cause vomiting.
**If Respiratory Distress/Failure present, treat for it with BVM
E. Position the patient on their side if no possibility of cervical spine trauma.
F. Administer high concentration oxygen.
G. Transport immediately, keeping the patient warm.
H. Ongoing assessment. Obtain and record the patient’s vital signs, repeat enroute as often as the situation indicates.
I. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR). |
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Term
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Definition
II.
Management of the post-seizure patient:
A. Perform initial assessment.
B. Assurethatthepatient’sairwayisopenandthatbreathingandcirculationare adequate.
C. Suction the airway as needed. Avoid stimulation of the posterior pharynx during suctioning because this may cause vomiting.
D. Position patient on their side if no possibility of cervical spine trauma. E. Administer high concentration oxygen. F. Treat injuries sustained during the seizure. G. Be prepared for additional seizures.
H. Transport keeping the patient warm.
I. Ongoing assessment. Obtain and record the patient’s vital signs, repeat enroute as often as the situation indicates.
J. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR). |
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Term
| Stroke (Non-Traumatic Acute Neurologic Deficit) |
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Definition
I. Perform initial assessment.
II. Assure that the patient’s airway is open and that breathing and circulation are adequate.
III. Administer high concentration oxygen, suction as necessary, and be prepared to assist ventilations.
IV. Position patient with head and chest elevated or position of comfort, unless doing so compromises the airway.
V. Perform Cincinnati Pre-Hospital Stroke Scale:
A. Assess for facial droop: have the patient show teeth or smile,
B. Assess for arm drift: have the patient close eyes and hold both arms straight out for 10 seconds,
C. Assess for abnormal speech: have the patient say, “you can’t teach an old dog new tricks”.
VI. If the findings of the Cincinnati prehospital stroke scale are positive, establish onset of signs and symptoms by asking the following:
A. To patient – “When was the last time you remember before you became weak, paralyzed, or unable to speak clearly?”
B. Tofamilyorbystander–“Whenwasthelasttimeyourememberbefore the patient became weak, paralyzed, or unable to speak clearly?”
VII. Transport of patient’s with signs and symptoms of stroke to the appropriate hospital:
A. Transport the patient to the closest New York State Department of Health designated Stroke Center if the total prehospital time (time from when the patient’s symptoms and/or signs first began to when the patient is expected to arrive at the Stroke Center) is less than two (2) hours.
B. Transport the patient to the closest appropriate hospital emergency department (ED) if:
1. The patient is in cardiac arrest, or
2. The patient has an unmanageable airway, or
3. The patient has (an) other medical condition(s) that warrant(s) transport to the closest appropriate hospital emergency department (ED) as per protocol, or
4. The total prehospital time (time from when the patient’s symptoms and/or signs first began to when the patient is expected to arrive at the Stroke Center) is greater than two (2) hours, or
5. An on-line medical control physician so directs. VIII. Maintain normal body temperature; do not overly warm the patient.
IX. Protect any paralyzed or partially paralyzed extremities.
X. Ongoing assessment. Obtain and record the patient’s initial vital signs, repeat enroute as often as the situation indicates.
XI. Notify the receiving hospital as soon as possible of your impending arrival with an acute stroke patient, Cincinnati Stroke Scale findings, and time signs and symptoms began.
XII. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR). |
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