Assessment Model Scene Survey H Hazards is there anything in the area that could cause more problems or injuries E Environment is the area hot cold poisonous etc M Mechanism of Injury what happened P Number of Patients how many people need assistance or transport A Additional Resources Ambulance HazMat Tech Rescue Poison Control etc Primary Survey LOC AVPU Alert Verbal stimulus Pain stimulus Unresponsive Critical Interventions D Delicate Spine Presumed or Ruled Out A Airway with Cheater Carotid Check and OPA if unresponsive Manage Life B Breathing Oxygen or Assisted Ventilations if needed Threatening C Circulation Radial, Skin and Rapid Body Survey - Blanket conditions as you Stay & Play or Load & Go Transport decision if applicable find them Secondary Survey Interview S Signs and Symptoms what is hurting or causing discomfort O Onset did this happen suddenly or gradually over time P Provokes what makes the pain better or worse Q Quality is the pain stabbing throbbing crushing sharp dull etc R Radiating does the pain stay in one spot or does it move to other areas S Severity how bad is the pain on a scale of 1-10 T Timing does the pain come and go or stay constant; when did the pain begin A Allergies are you allergic to anything and have you been exposed recently M Medications do you take medication have you taken it did you take too much or not enough P Previous Medical History any relevant medical incidents or ongoing conditions L Last Meal when did you eat last and what was it E Events Leading Up To what were you doing when this happened LOC Respirations SpO2 Skin Blood Pressure Pupils Body Core Temp? Palpation Distal Circulation Vital Signs AVPU compare to previous results Rate Rhythm Character Rate Rhythm Character Oximeter Blood Oxygen Level How does the skin look and feel Palpation or Auscultation record Systolic over Diastolic; Systolic over P if using palpation Pupils Equal and Reactive to Light compare initial size and reaction of each pupil Measure body core temperature if relevant Head to Toe Feel for injuries Assess bilateral pulses and check motor and sensory function in extremities Page 1 of 5
APGAR Score 0 1 2 Activity Limp Some extremity flexion Active Movement Absent Below 100 bpm 100 bpm or higher Grimace No response Grimace Cough, sneeze, cry Appearance Body/Extremities Blue/Pale Body Pink Extremities Blue Completely pink Respiration Absent Slow and Irregular Strong, crying 7-10 is Normal 4-6 is Fairly Low 0-3 is Critically Low CPR Compression: Ventilation Ratios Adult over 9 Child 1-8 Infant under 1 One Rescuer 30:2 30:2 30:2 Two Rescuer 30:2 15:2 15:2 Infant with pulse less than 60 bpm = Start CPR Check pulse for full 60 seconds if patient is Hypothermic 6 Rights of Medication 1 Person Is this your own medication 2 Medication Will this medication help right now 3 Time How often do you take it 4 Dose How much is a dose; and how many doses 5 Route How is this medication delivered 6 Documentation Record the time and amount of each dose Load and Go Criteria Life threatening conditions found Serious injuries with multiple traumas Absent or unstable ABCs or Neurological status Decreased Level of Consciousness Ongoing Seizures Chest Pain if disorder or heart attack suspected Burns with suspected inhalation injuries Extensive burns Abdominal distension/tenderness Unstable pelvis injury Fractured femurs Amputations / Limb Threatening Injuries Pregnancy related conditions Environmental mishaps Page 2 of 5
Critical Findings Finding Implication Action GCS less than 13 Decreased LOC OPA / NPA Breathing over 30 times/minute Tachypnea Assist Ventilations Breathing less than 10 times/minute Dyspnea Assist Ventilations Blood Pressure less than 80 mmhg Systolic Hypo-tension Position Supine Blood Glucose less than 4 mmol/l Hypoglycemia Glucose Oxygen Saturation (SpO2) less than 95% Hypoxia / Hypoxemia Increase O2 intake Infant pulse less than 60 bpm Equivalent to Absent Begin CPR Body core temperature below 35-36 C Mild Hypothermia Rewarm slowly Body core temperature below 30-34 C Moderate Hypothermia Rewarm slowly Body core temperature below <30 C Severe Hypothermia Rewarm slowly Body core temperature above 37 C Hyperthermia Cool rapidly APGAR below 4 Unresponsive Load and Go less, angulated limb Limb Threatening Load and Go Attempt to realign Adult Rate over 160 bpm Urgent Tachycardia Load and Go Oxygen Cylinder Calculations Duration of Flow = (gauge pressure -200 psi) x C Flow Rate (lpm) C = Cylinder Constant D Cylinder = 0.16 L/psi E Cylinder = 0.28 L/psi M Cylinder = 1.56 L/psi Oxygen Flow Rates Device BCAS / BC EMALB Paramedic Association of Canada Simple / Standard Mask 6 15 lpm N/A Non-Rebreather Mask 8 15 lpm 10 + lpm Bag Valve Mask 15 lpm 10 + lpm Nasal Canula 2 4 lpm 1 4 lpm Cushing s Triad 3 concurrent conditions commonly associated with Congestive Heart Failure or Head Injury Increased Systolic Blood Pressure Slow Heart Rate Irregular Breathing Diastolic Blood Pressure remains Normal KED Strapping Sequence My Middle Baby Bottom Looks Legs Hot Head Tonight Top Page 3 of 5
Simple Triage and Rapid Treatment (S.T.A.R.T.) Dead / Non-Salvageable (BLACK) Immediate (RED) Not Breathing Breathing > 30 per minute Breathing with absent radial pulse Decreased LOC Delayed (YELLOW) Unable to walk Minor (GREEN) Able to walk Breathing Normal Radial Present Normal LOC Sager Traction Splint Assess injured leg Look/Feel Motor-Sensory Apply Traction Secure Splint Assess Injured Leg Look Feel Motor-Sensory Suspected Fracture of Femur or Tib-Fib Place splint beside injured leg and have helper stabilize Apply thigh strap and have helper secure splint at thigh Apply ankle harness above malleoli Apply traction of 10% body weight 15 lbs maximum per limb 5 lbs maximum for open fractures, upper or lower third fractures or Pediatric patients 30 lbs maximum for Bi-Lateral fractures (15 lbs per leg) Ensure adequate padding 3 straps around splint; above and below injury Secure thigh strap Secure Figure 8 Strap Reassess all splint straps and Traction Gauge Leg in line with body; same length as other leg Pedal pulse present? No movement / aggravation of injured limb Page 4 of 5
Relevant S-A-M-P-L-E Information (History) MVA Patient Location of patient Which vehicle patient was in How many vehicles involved Impact speed Exterior damage Interior damage Type of restraints Initial position of patient Condition of patient Loss of consciousness Condition of other patients Fall Where from Height Free fall or hit other objects Landing surface Position of patient at impact What hit first Condition of patient Loss of consciousness Cause of fall Pedestrian Struck What hit them Size and weight of object Velocity of vehicle Vehicle part that hit patient Damage to vehicle Distance patient thrown Initial position of patient Condition of patient Loss of consciousness Condition of vehicle occupants Shooting Type of firearm Range Angle of shot Type of bullet Entrance and exit wounds Initial position and condition of patient Loss of consciousness Stabbing Type of weapon Weapon length and width Type of wound Number of wounds Other injuries Initial position and condition Loss of consciousness CPR with Airway Obstruction CPR with Obstruction CPR 30 Compressions 2 Ventilations AED as soon as possible Repeat until Signs of Life 1 Ventilation does not go in Attempt 2 nd Breath 30 Compressions Remove OPA AED as soon as Possible Look in Mouth Finger Sweep if object visible Attempt Ventilation 2 Ventilations go in Repeat until 2 Ventilations go in Re-insert OPA Or Signs of Life Page 5 of 5