Pocket Paramedic 2013

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Pocket Paramedic

2013

By Jason Houghton

A collaboration of useful guidelines

In a quick reference pocket book;

Pocket Paramedic

2013

“An elegant solution to a simple problem”

A collaboration of useful guidelines in a quick

reference pocket book tailored for pre-hospital

care.

This handy pocket book resulted from my quest to

consolidate the most relevant and useful

guidance into a single source; something that can

be carried in your pocket at all times - whenever

you may need it.

Pocket Paramedic is 100% non-profit. Sold at cost.

Hopefully, this will mean more people can benefit

from it.

Download the FREE electronic edition from:

PocketParamedic.org

I hope you find it useful.

Jason Houghton - Paramedic

Contents

Adults

Algorithms and Charts 4

Paediatrics

Algorithms and Charts 19

Obstetrics

Useful Information and Charts 32

Equipment

Instructions and Guidance 37

Assessment & History Taking

Aid memoirs, Acronyms and Diagnosis 45

Trauma & Medical Emergencies

Useful Information and Charts 53

Anatomy

Diagrams and Terminology 62

ECG & ETCO2 Interpretation

Examples and Explanations 68

Major Incidents

Acronyms and Plan of Action 77

Infection Prevention & Control

Useful Information 91 Key Contacts Phone Numbers 96 Notes Extra Space 97 References

Adults

Algorithms and Charts

Adult Basic Life Support 5

Adult Advanced Life Support 6

Adult Cardiac Arrest 7

Adult Bradycardia 8

Adult Tachycardia (With Pulse) 9

Adult Chocking Treatment 10

In Hospital Resuscitation 11

AED Algorithm 12

Adult Glasgow Coma Scale 13

Adult Normal Ranges & Drug Dosages 14

Normal Peak Flow Readings 15

Normal Peak Flow Readings Chart - Men 16

Normal Peak Flow Readings Chart - Women 17

Adult Basic Life Support

10

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Adult Advanced Life Support

10

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Adult Cardiac Arrest

10

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Adult Bradycardia

10

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Adult Choking Treatment

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In Hospital Resuscitation

10

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AED Algorithm

10

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Adult Glasgow Coma Scale

Eyes

Verbal

Motor

4 Opens Eyes Spontaneously

3 Opens Eyes in Response to Voice

2 Opens Eyes in Response to Painful Stimuli

1 Does Not Open Eyes

5 Oriented, Converses Normally 4 Confused, Disoriented 3 Utters Inappropriate Words

2 Incomprehensible Sounds

1 Makes No Sounds

6 Obeys Commands

5 Localizes Painful Stimuli

4 Flexion / Withdrawal to Painful Stimuli

3 Abnormal Flexion to Painful Stimuli (Decorticate) 2 Extension to Painful Stimuli (Decerebrate)

1 Makes No Movements

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Adult Normal Ranges & Dosages

Parameter

Unit

Value

Heart Rate BPM 60 - 100

Respiratory Rate BPM 12 - 19

SpO2 % ≥ 95

BP Systolic mmHg 100 - 170

BP Diastolic mmHg 60 - 80

Blood Glucose (BM) mmol/L 5 - 10.9

Energy 1st Shock Joules 200

Energy 2nd Shock Joules 300

Energy 3rd Shock Joules 360

Adrenaline 1:10000 mg (ml) 1 (10) Amiodarone mg (ml) 300 (10) Amiodarone (Refractory VF/VT) mg (ml) 150 (5)

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Normal Peak Flow Readings

8

EU/EN13826 PEF Meters Only

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Adult Analgesic Ladder

(12 Years and Older)

Pain Score Medical Pain

Trauma, Orthopaedic, Musculoskeletal &

Soft tissue Pain 0 – 3 Mild Pain Consider Entonox +/- Ibuprofen 400MG Consider Entonox +/- Ibuprofen 400MG 4 – 6 Moderate Pain Consider Entonox +/- Morphine 2.5 to 5mg (Max 20mg) Consider Entonox +/- Ibuprofen 400MG 7 – 10 Severe Pain Consider Entonox +/- Morphine 2.5 to 5mg (Max 20mg) Consider Entonox +/- Ibuprofen 400MG +/- Morphine 2.5 to 5mg (Max 20mg) For Cardiac Related Chest Pain

Morphine Should be Considered in the First Instance

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Paediatrics

Paediatric Basic Life Support 20

Paediatric Advanced Life Support 21

Paediatric Cardiac Arrest 22

Newborn Advanced Life Support 23

Paediatric Chocking Treatment 24

Paediatric Glasgow Coma Scale 25

Paediatric Arrest Calculations 26

Paediatric Normal Ranges & Arrest Dosages 27

Normal Peak Flow Readings Chart - Paediatric 28

Pain Assessment Faces 29

FLACC Scale Pain Assessment 30

Paediatric Basic Life Support

10

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Paediatric Advanced Life Support

10

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Paediatric Cardiac Arrest

10

Paedi

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Newborn Life Support

10

Paedi

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Paediatric Choking Treatment

10

Paedi

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Paediatric Glasgow Coma Scale

Eyes

Verbal

Motor

4 Opens Eyes Spontaneously

3 Opens Eyes in Response to Speech 2 Opens Eyes in Response to Painful Stimuli

1 Does Not Open Eyes

5 Smiles, Orients to Sounds, Objects, Interacts 4 Cries but Consolable, Inappropriate Interactions 3 Inconsistently Inconsolable, Moaning

2 Inconsolable, Agitated

1 No Verbal Response

6 Infant Moves Spontaneously or Purposefully 5 Infant Withdraws from Touch

4 Infant Withdraws from Pain

3 Abnormal Flexion to Pain for Infant (Decorticate) 2 Extension to Pain (Decerebrate)

1 No motor response

Paedi

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Paediatric Arrest Calculations

10

WEIGHT

ENERGY

TUBE SIZE

FLUID

ADRENALINE

AMIODARONE

GLUCOSE

Age Formula

0 – 12 Months Weight (kg) = (Age in Months x 0.5) + 4 1 – 5 Years Weight (kg) = (Age in Years x 2) + 8 6 – 12 Years Weight (kg) = (Age in Years x 3) + 7

Age Formula

0 – 12 Years Joules = Weight (kg) x 4j

Age Formula

Pre Term 2.5mm

Neonates 3 – 3.5mm

1 – 10 Years Internal diameter (mm) = (Age/4) + 4 Length (cm) = (Age/2) + 12

Type Formula (0 – 12 Years)

Medical Bolus (ml) = Weight (kg) x 20ml Trauma Bolus (ml) = Weight (kg) x 10ml Concealed Haem Bolus (ml) = Weight (kg) x 5ml

Formula (1:10,000) (0 – 12 Years) Formula (300mg in 10ml) (0 – 12 Years)

Dose (mcg) =

Weight (kg) x 10mcg (0.1ml)

Dose (mg) = Weight (kg) x 5mg

…Then ml’s = Dose (mg) / 30)

Age Formula

0 – 12 Years Dose (ml) 10% Glucose = Weight (kg) x 2ml

Resuscitation Council UK 2010

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A ge HR (BPM ) RR (PM ) BP (S ysto lic ) We ig h t (kg ) En e rg y (Jou le s) Tu b e (mm) Flu id s (ml ) A d re n al in e (ml ) ( m cg ) A mi o d ar o n e (ml ) ( m g) Gl u co se (ml ) Bi rth 110 -160 30 -40 70 -90 4 20 3 80 0.40 (40 ) 0.67 (20) 8 1 M 110 -160 30 -40 70 -90 4.5 20 3 90 0.45 (45 ) 0.75 (22.5) 9 3 M 110 -160 30 -40 70 -90 5.5 25 3.5 110 0.55 (55 ) 0.92 (27.5) 11 6 M 110 -160 30 -40 70 -90 7 40 4 140 0.70 (70 ) 1.17 (35) 14 9 M 110 -160 30 -40 70 -90 8.5 40 4 170 0.85 (85 ) 1.42 (42.5) 17 12 M 110 -150 25 -35 80 -95 10 40 4.5 200 1.0 (100) 1.67 (50) 20 18 M 100 -150 25 -35 80 -95 11 50 4.5 220 1.1 (110) 1.83 (55) 22 2 Yr 95 -140 25 -30 80 -100 12 50 5 240 1.2 (120) 2.00 (60) 24 3 Yr 95 -140 25 -30 80 -100 14 60 5 280 1.4 (140) 2.30 (70) 28 4 Yr 95 -140 25 -30 80 -100 16 70 5 320 1.6 (160) 2.66 (80) 32 5 Yr 80 -120 20 -25 90 -100 18 80 5.5 360 1.8 (180) 3.00 (90) 36 6 Y r 80 -120 20 -25 80 -110 25 80 6 500 2.5 (250) 4.20 (125) 50 7 Yr 80 -120 20 -25 90 -110 28 100 6 560 2.8 (280) 4.67 (140) 56 8 Yr 80 -120 20 -25 90 -110 31 100 6.5 620 3.1 (310) 5.12 (155) 62 9 Yr 80 -120 20 -25 90 -110 34 120 6.5 680 3.4 (340) 5.67 (170) 68 10 Yr 80 -120 20 -25 90 -110 37 130 7 740 3.7 (370) 6.17 (185) 74 11 Yr 80 -120 20 -25 90 -110 40 140 7 800 4.0 (400) 6.67 (200) 80

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Paediatric Analgesic Ladder

(Under 12 Years)

Pain Score Medical Pain

Trauma, Orthopaedic, Musculoskeletal &

Soft tissue Pain 0 – 3 Mild Pain Consider Entonox +/- Ibuprofen &/or Paracetamol Consider Entonox +/- Ibuprofen &/or Paracetamol 4 – 6 Moderate Pain Consider Entonox +/- Morphine Consider Entonox +/- Ibuprofen &/or Paracetamol 7 – 10 Severe Pain Consider Entonox +/- Morphine Consider Entonox +/- Ibuprofen &/or Paracetamol +/- Morphine For Cardiac Related Chest Pain

Morphine Should be Considered in the First Instance

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Obstetrics

Algorithms and Charts

APGAR Score for Newborns 33

Mechanics of Normal Birth 34

Shoulder Dystocia 35

APGAR Score for Newborns

Appearance

Pulse

Grimace

Activity

Respiration

1 Blue or Pale All Over

2 Blue at Extremities, Body Pink

3 No Cyanosis, Body and Extremities Pink

1 Absent

2 <100

3 ≥100

1 No Response to Stimulation

2 Grimace/Feeble Cry when Stimulated 3 Cry or Pull Away when Stimulated

1 None

2 Some Flexion

3 Flexed Arms and Legs that Resist Extension

1 Absent

2 Weak, Irregular, Gasping 3 Strong, Lusty Cry

Ob

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Mechanics of Normal Birth

5

Ob

stet

Shoulder Dystocia

4

The McRoberts' manoeuvre is a procedure performed to release a baby's impacted shoulder during shoulder dystocia. The mother's legs are held back in a flexed position and pulled to her chest to further open the pelvis and allow the baby's shoulder to be released. At the same time suprapubic pressure is applied to the mother's lower abdomen over the pubic bone.

Ob

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Breech Birth Delivery

5 1 4 2 5 3 6

Ob

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Equipment

Instructions and Guidance

Laerdal Suction Unit 38

ParaPAC Operation 39

Fitting a Collar 40

Fitting a Donway 41

Fitting a Donway Continued 42

Fitting a KED 43

Laerdal Suction Unit

6

Procedure for Daily Test.

1 Ensure that tubing is unwound and un-occluded

2 Ensure the suction catheter adapter is removed from the

holder (if applicable)

3 Ensure the canister lid, T-bar, angled connector and tubing

are securely fastened.

4

To run the test, press and hold the test button while setting the operating switch to 500+mmHg. Do not release the test button until a minimum of 2 seconds after the operating switch has been set to 500mmHg. The test will start immediately.

5

As soon as LED 2 from the bottom of the battery status indicator comes on (takes approximately 1 second) fully occlude the patient suction tubing until all 4 LED’s have illuminated and LED 1 lights up again.

6 Keep the tubing blocked while LED 2, 3 and 4 lights up.

7 Release the tubing when LED 1 comes on again.

8 Evaluate the test results.

9 After evaluating the test results, turn the operating switch to

“0” to exit the device test.

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Assessment & History Taking

Aid memoirs, Acronyms and Diagnosis

Patient Assessment Triangle 46

Body Assessment - DCAPBTLS 47

Neurological Assessment - 5Ps 47

Chest Assessment - TWELVEFLAPS 48

Chest Assessment – ATOMFC 49

Chest Trauma 49

Chest Pain - History Taking 50

Abdominal Pain - History Taking 51

Patient Assessment Triangle

Airway & Appearance Circulation/Skin Breathing Effort

General Impression (First View of Patient)

Normal Abnormal

A

Normal cry or speech. Responds to parents or to environmental stimuli such as lights, keys, or toys. Good muscle tone. Moves extremities well.

Abnormal or absent cry or speech. Decreased response to parents or environmental stimuli. Floppy or rigid muscle tone or not moving.

B

Breathing appears regular without excessive respiratory muscle effort or audible respiratory sounds.

Increased/excessive (nasal flaring, retractions or abdominal muscle use) or decreased/absent respiratory effort or noisy breathing.

C

Colour appears normal for racial group of child. No significant bleeding.

Cyanosis, mottling, paleness/pallor or obvious significant bleeding.

Initial Assessment (Primary Survey)

Normal Abnormal

A Clear and maintainable. Alert on _{AVPU scale.}

Obstruction to airflow. Gurgling, stridor or noisy breathing. Verbal, Pain or Unresponsive on AVPU scale.

B

Easy, quiet respirations. Respiratory rate within normal range. No central cyanosis.

Presence of retractions, nasal flaring, stridor, wheezes, grunting, gasping or gurgling. Respiratory rate outside normal range. Central cyanosis.

C

Colour normal. Capillary refill at palms, soles, forehead or central body ≤2 sec. Strong peripheral and central pulses with regular rhythm.

Cyanosis, mottling, or pallor. Absent or weak peripheral or central pulses; Pulse or systolic BP outside normal range; Capillary refill > 2 sec with other abnormal findings.

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Body Assessment

Body Assessment

DCAPBTLS D Deformity C Contusions A Abrasions P Penetrations B Burns T Tenderness L Lacerations S Swelling 5Ps P Pain P Paralysis (Movement) P Paraesthesia (Sensation) P Pulses and Capillary Refill

P Pallor (Skin Colour and Temperature) S Swelling

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Chest Assessment

TWELVEFLAPS

T Tracheal deviation (Is it central?)

W Wounds / Bleeding (Check the neck, must be sealed to prevent air embolus / haemorrhage) E Emphysema (Surgical, may indicate tension

pneumothorax)

L Laryngeal Injury (Is there crepitus, indicating injury?)

V Veins (Distended?, if so may indicate a tension pneumothorax or cardiac tamponade) E Expose & Examine the thorax

F Feel (Flail segments, wounds, symmetrical expansion, crepitus, fractures)

L Look (Equal rise and fall, paradoxical breathing, bruising, wounds)

A Auscultation (Equal sounds, absent, diminished, added sounds?)

P Percussion (Dullness, hyper-resonance, symmetry)

S Search sides and back

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Chest Assessment

ATOMFC

A Airway obstruction (Tongue, trauma, foreign object, vomit etc)

T Tension Pneumothorax

O Open sucking wound (Open Pneumothroax)

M Massive Haemorrhage (Haemothroax)

F Flail Chest

C Cardiac Tamponade

Chest Trauma

Differential Diagnosis Condition Chest

Expansion Trachea Percussion

Breath Sounds Pneumothorax Decreased Unchanged Resonant Reduced Tension Pneumothorax Hyper expanded Deviated away from tension Hyper Resonant Absent of affected side Haemothorax Possibly _reduced Undeviated Dullness Reduced or

absent Collapse / consolidation Reduced May deviate towards collapse May be dull Reduced or bronchial breathing Pleural effusion Possibly _reduced Undeviated Dullness Reduced or

absent

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Chest Pain - History Taking

SOCRATES

S Site - Where is the pain or discomfort? Can you point to the _{area with one finger?}

O Onset - What were you doing when the pain first started? _{What do you think may have caused this pain or discomfort?}

C

Character - Can you describe the type of pain? Is it: dull ache, sharp, stabbing, cramping, tearing, tightness, crushing, burning? Is it there all the time or does it in waves?

R Radiating - Does the pain stay in one place or does it radiate? _{Does it follow a certain pattern?}

A

Associated Symptoms - Pale, clammy, dyspnoea, tachypnoea, SOB, dizzy, syncope, lethargy, confusion,

vomiting, haemoptysis, productive cough, fever,

haematemesis, pulse abnormalities, impending doom. Have you had a recent cough or been vomiting? When did you last eat? Have you had any difficulty swallowing?

T

Time - How long have you had the pain? Has it been there ever since? Have you ever had a similar episode like this before?

E

Exacerbate / Relieve - Does anything ease the pain? (Analgesia, patient positioning, resting. Does anything make the pain worse? (Walking, leaning forward, lying down, coughing, movement, inhalation or expiration.

S

Severity - If you were to score the pain out of 10, 1 being no pain and 10 being the worst imaginable, what would you score it?

Previous History - Recent trauma, chest infection or coughing, asthma, angina, COPD, heart failure, dyspepsia, dysphagia,

Risk Factors - Family history, smoker, overweight, heavy

drinker, sedentary life style, hypertension,

hypercholesterolemia, long travel / pregnancy, diabetes.

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Abdominal Pain - History Taking

SOCRATES

S Site - Where is the pain or discomfort? Can you point to the area _{with one finger?} O Onset - What were you doing when the pain first started? What _{do you think may have caused this pain or discomfort?}

C

Character - Can you describe the type of pain? Is it: dull ache, sharp, stabbing, cramping, tearing, tightness, crushing, burning? Is it there all the time or does it in waves?

R Radiating - Does the pain stay in one place or does it radiate? _{Does it follow a certain pattern?}

A

Associated Symptoms - Pale, clammy, dyspnoea, tachypnoea, SOB, dizzy, syncope, lethargy, confusion, nausea, vomiting, diarrhoea? Have you noticed anything abnormal when passing water? For example: Increased or reduced frequency, dark or off colour urine. Does it have a strong odour, burning sensation? Have you noticed anything abnormal when passing a bowel motion? Increased or reduced frequency, pain, loose or hard stools, dark coloured or bright red.

T Time - How long have you had the pain? Has it been there ever _{since? Have you ever had a similar episode like this before?}

E

Exacerbate / Relieve - Does anything ease the pain? (Analgesia, patient positioning, resting, applying pressure, passing wind or bowel motion?) Does anything make the pain worse? (Lying down, coughing, movement, inhalation, expiration, palpation, passing water or bowel motion?)

S Severity - If you were to score the pain out of 10, 1 being no pain _{and 10 being the worst imaginable, what would you score it?} Birth Bearing Age - Any chance you could be pregnant? Are there any changes to your menstruation cycle: early, late, abnormal colour, odours, increased pain? Have you had any vaginal discharge?

Previous History - Recent trauma, chest infection or coughing, asthma, angina, COPD, heart failure, dyspepsia, dysphagia, Risk Factors - Family history, overweight, heavy drinker, sedentary life style, hypertension, hypercholesterolemia, long travel / pregnancy, diabetes.

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Abdominal Pain Locations

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Trauma & Medical Emergencies

Useful Information and Charts

Rule of Nines 54

Submersion/Immersion Drowning 55

Key Points - Submersion/Immersion 55

Shock Comparison 56

Stages of Shock 57

Catastrophic Haemorrhage Tourniquet 58

Removing a Helmet 59

Fitting a Triangular Bandage 60

Rule of Nines

Paediatric & Adult

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Submersion/Immersion Drowning

The pulse may be extremely slow if hypothermia is present, and external cardiac compression may be required. Bradycardia often responds to improved ventilation and oxygenation. Drugs such as adrenaline and atropine are less effective in HYPOTHERMIA, and must not be repeatedly used. These drugs may pool in the static circulation of the drowned casualty, and then, after re-warming and circulation has been restored, act as a dangerous bolus of drug as they are circulated. In hypothermic cardiac arrest, defibrillation will be unsuccessful where the core temperature remains low. At 28C the ventricle may spontaneously fibrillate. Defibrillation may not succeed until the core temperature rises above 30-32C.

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Key Points – Submersion/Immersion

Ensure own personal safety

Successful resuscitations have occurred after prolonged submersion/immersion.

Near drowning is often associated with hypothermia. Special considerations in cardiac arrest treatment in the

presence of hypothermia.

Severe complications may develop several hours after submersion/immersion.

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Routes of Drug Administration

Code

Route

Description

BUC Buccal Administration directed toward the

cheek, from within the mouth.

ET Endotracheal Administration down the ET tube.

IM Intramuscular Administration within a muscle.

INH Inhaled Administration by breathing.

IO Intraosseous Administration within the bone

marrow.

IV Intravenus Administration within or into a vein

or veins.

NASAL Nasal Administration to the nose;

administered by way of the nose.

NEB Nebulised Administration in the form of mist.

PO Oral Administration to or by way of the

mouth.

PR Rectal Administration to the rectum.

SC Subcutaneous Administration beneath the skin;

hypodermic.

SL Sublingual Administration beneath the

tongue.

TOPIC topical Administration to a particular spot

on the outer surface of the body.

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Anatomy

Diagrams and Terminology

Palpable Pulse Locations 63

Bones - General 64

Bones – Spinal Colum 65

Anatomical Terms of Location 66

Palpable Pulse Locations

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Bones - General

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Bones – Spinal Colum

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Anatomical Terms of Location

Term

Definition

Anterior Posterior

From front (Anterior) to back (Posterior).

Dorsal Ventral

From top (Dorsal) to bottom opposite end of body (Ventral). Lateral (Left)

Lateral (Right) From left to right side of the body.

Medial (Left/ Right)

From centre of organism to one or other side

Proximal Distal

from tip of an appendage (distal) to where it joins the body (proximal)

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Patient Positioning

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ECG & ETCO2 Interpretation

Examples and Explanations

ECG Lead Placement 69

Normal ECG 70

ECG Assessment Guide 71

ECG Arrhythmias 1 72

ECG Arrhythmias 2 73

ECG Arrhythmias 3 74

ECG Arrhythmias 4 75

ECG Lead Placements

9

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TCO

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Normal ECG

3

I Lateral aVR V1 Septal V4 Anterior

II Inferior aVL Lateral V2 Septal V5 Lateral

III Inferior aVF Inferior V3 Anterior V6 Lateral

Interval Time in Seconds

PR Interval 0.12 to 0.22 QRS Complex 0.08 to 0.12 QT Interval 0.35 to 0.42

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TCO

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ECG Assessment Guide

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Point Description

What is the rhythm? Regular, Irregular What is the Rate? Fast, Normal, Slow Are there P Waves

Present?

YES - Atrial Foci

NO - Junctional or Ventricle Foci Are all the P Waves

the Same?

YES - Then Same Foci No - Then Different Foci Is there a P Wave

before each QRS?

YES - Atrial Foci

NO - Junctional or Ventricle Foci Is there a QRS after

every P Wave? NO - Ventricular Standstill or Possible Heart Block Is the P-R Interval

Normal?

YES - 0.12 to 0.20 Seconds (3-5 small squares) NO - If >0.0 seconds its First Degree Heart Block Is the QRS Normal? YES - 0.04 to 0.12 secconds (1-3 small squares)

NO – Bundle Branch Block Is the ST Segment

Isoelectric?

If Elevated its Myocardial Infarction If Depressed its Ischemia or Angina Is the T Wave

Normal?

YES – 3 Times the Height of the P Wave NO – Inverted?

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TCO

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ECG Arrhythmias 1

3 Normal Sinus 1st Degree Heart Block Missing QRS Complex 2nd Degree Heart Block Type 1

Multiple Missing QRS Complexes

2nd Degree Heart Block Type 2 3rd Degree Heart Block

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TCO

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ECG Arrhythmias 2

3

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TCO

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Atrial Fibrillation Atrial Flutter Asystole Bundle Branch (Determine Left/Right from 12 Lead) Sinus Bradycardia

ECG Arrhythmias 3

3

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TCO

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Idioventricular Rhythm Junctional Rhythm Multifocal Premature Ventricular Contraction Compensatory Pause Premature Atrial Contraction Paced Rhythm

ECG Arrhythmias 4

3 Compensatory Pause Premature Junctional Contraction Super Ventricular Tachycardia Unifocal Premature Ventricular Contraction Ventricular Fibrillation Ventricular Tachycardia

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TCO

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Interpretation of ETCO2 Waveform

Sudden loss of waveform, ETCO₂ near zero.  ET Tube, disconnected, dislodged, kinked or obstructed.  Loss of circulatory function. Decreasing ETCO₂ with loss of plateau.

 ET tube cuff leak or  deflated cuff  ET tube in hypopharynx  Partial obstruction CPR Assessment.  Attempt to maintain minimum of 10mmHg Sudden Increase in ETCO2.  Return of spontaneous circulation

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Major Incidents

Acronyms and Plan of Action

Approach - Think STEP 123 78

Approach - Scene Assessment - CSCATTT 78

Dynamic Operational Risk Assessment 79

Plan of Action - SitRep - METHANE 80

Plan of Action - Briefing Structure - IIMARC 80

Primary Triage 81

Triage Categories 82

Pre-Alert - ASHICE 83

Handover - Trauma MIST 84

Handover –Medical MIST 84

EH20 Escape Hood 85

NAAK Presentation 86

NAAK Indications 87

NAAK Directions for Use 88

Electronic Personal Dosimeter (EPD) 89

Approach

Think STEP 123 S Safety T Triggers for E Emergency P Personnel

1 Casualty, approach using normal procedures 2 Casualties, approach with caution, consider all

options

3 Casualties or more, without obvious cause, do not approach scene

Scene Assessment - CSCATTT

C Command and Control

S Safety C Communication A Assessment T Triage T Treatment T Transport

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Dynamic Operational Risk Assessment

A dynamic risk assessment is undertaken and applied to tasks or situations that are in the main unforeseeable or

unpredictable or during which the circumstances, environment or behaviour of the patient or those at

scene may be subject to rapid change.

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Plan of Action

_{Situation Report to Control - METHANE}

M Major Incident – Standby or Declared

E Extraction Location T Type of Incident

H Hazards (Present and Potential) A Access (Egress)

N Number of Casualties

E Emergency Services (On Scene or Required)

Briefing Structure - IIMARC

I Information – Overview of incident, location, what is involved and when it happened I Intention – What are we going to do M Method – How are we going to achieve it

A Administration – What records are required R Risks – DORA, hazards, Minimising them and

contingency plans

C Talk groups, mobile phones, de-brief arrangements

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Primary Triage

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Triage Categories

Tag Colour Definition

EXPECTANT / DEAD

Victim unlikely to survive given severity of injuries, level of available care, or both.

Palliative care and pain relief should be provided

Priority 1

Victim can be helped by immediate intervention and transport Required medical attention within

minutes for survival (up to 60) Includes compromises to patients

Airway, Breathing, Circulation

Priority 2

Victim’s transport can be delayed Includes serious and potentially life

threatening injuries, but status not expected to deteriorate significantly over several hours

Priority 3

Victim with relatively minor injuries Unlikely to deteriorate over days May be able to assist in own care Walking wounded

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Pre-Alert

ASHICE

A Age

S Sex

H History

I Illness / Injuries / Intervention

C Condition – HR, RR, SpO2 Air / O2, BP, BM, Temp, GCS, ECG.

E Estimated Time of Arrival

RED

Cardiac Arrest. Peri-Arrest.

Any patient eliciting MTC outcome using Major Trauma Pathfinder. Currently fitting.

GCS 12 or less. PPCI.

AMBER

Cardiac chest pain

New Stroke (regardless of symptom time).

Any other clinical concern.

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Handover

Trauma - MIST M Mechanism of Injury I Injuries S Signs (Vitals) T Treatment Medical - MIST

M Medical History (PMH/Allergies) I Illnesses (PC/HPC) S Signs (Vitals) T Treatment

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EH20 Escape Hood

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For use when the crew believe that they have been potentially exposed to a form of hazardous contamination. One size fits all. It will provide 20 minutes of respiratory protection to escape the scene.

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NAAK Presentation

Services carry a supply of 10 packs of Nerve Agent Antidote Kits on every Emergency ambulance for self-administration by the crew in the event of accidental exposure to nerve agents.

They consist of 2 prefilled automatic intramuscular injection devices linked by a plastic clip and housed in a foam pouch. Atropen containing 2.0mg of Atropine and a Combopen containing 600mg Pralidoxime Chloride.

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NAAK Indications

The Nerve Agent Antidote Kit (NAAK) should be self-administered or assisted by their crew mate if they are incapacitated on occasions where they suspect that they have been accidentally exposed to nerve agents such as Organo Phosphates (deliberate or accidental release), and are suffering the effects listed below.

Clinical Diagnosis: History of exposure Miosis

Respiratory distress Bronchorrhoea

Depressed level of consciousness Bronchospasm

Muscle Twitching Convulsion

Including one or more of the following: Bronchorrhoea

Bronchospasm

Severe Bradycardia (<40 bpm)

User may experience the following side effects:

Impairment of psychomotor function Disorientation

Loss visual accommodation Photophobia

Transient bradycardia then tachycardia

Palpitations Arrhythmias CNS depression Circulatory/respiratory failure

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NAAK Directions for Use

1

Remove Pen No 1 marked ATROPINE from

the plastic holder this removes the safety cap and extreme care must be taken.

2

Place the GREEN cap of the auto injector against the upper quadrant of the thigh making sure that that it is clear of anything in the trouser pocket. Press hard until the injector functions, count to ten slowly and then withdraw. Bend the needle on any hard surface until it breaks off. Record time of administration.

3

Remove Pen No 2 marked PRALIDOXIME

from the plastic holder this removes the safety cap and extreme care must be taken.

4

Place the BLACK cap of the auto injector against the upper quadrant of the thigh making sure that that it is clear of anything in the trouser pocket. Press hard until the injector functions, count to ten slowly and then withdraw. Bend the needle on a hard surface until it snaps off. Record time of administration. Hold both injectors in your hand until help arrives.

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Electronic Personal Dosimeter (EPD)

An Electronic Personal Dosimeter (EPD) is a small pager sized device that will monitor for the presence of ionising radiation. It is designed to allow for normal every day background levels of radiation, but should it detect a rise in levels of radiation in the vicinity of the wearer it will activate an internal audible alarm to alert the wearer to look at the display and take action according to the reading and the perceived local circumstances.

Default Screen

This example shows the Dose Rate on the display screen in micro-Sieverts/hour (µSv/h).

Test Display Screen

At the beginning of every shift the

wearer should perform a

confidence test. From the default display screen press and hold the operating button until “TEST” is displayed.

Confidence Test Display

Double press the operating button to initiate the confidence test, which confirms operation of visual display and the visual and audible alarms. The display screen will show all icons at once, the audible alarm will sound and the visual indicator will flash.

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EPD Alarm Descriptions

Alert Description

Low Battery Warning

There is a low battery warning, which is an intermittent slow tone. This indicated there is about ten hours battery life left. This will be the most common warning heard (the data in the EPD will be stored for about a month without a battery).

Alarm 1

Primary Alert Signal

The first tone or Primary Alert Signal is an intermittent double “fast” chirp and the LED will illuminate RED and indicates the presence of a level of radiation just above background. This tone will also sound whenever the battery is replaced and is a function of the auto test process. It also acts as a reminder of the alerts for the wearer. The user should be aware of this facility and is NOT to change batteries at incident sites. The Primary Alert Signal should be the only activation alarm the wearer will ever hear whilst performing their duties, the most common will be the low battery warning.

Alarm 2

Secondary Alert Signal

The second tone, the Secondary Alert Signal is a slow two-tone alarm and indicated a level of radiation approximately equivalent to that received annually by normal means. Under normal circumstances where this level of radiation is present, Ambulance staff will not be deployed forward to assist casualties. Alarm 3

Tertiary Alert Signal

The third alert tone, the Tertiary Alert Signal

is a continuous single high tone. This tone indicated that the wearer has been exposed to a potentially significant or high dose.

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Infection Prevention & Control

Useful Information

Mops and Buckets 92

Hand Washing Technique 93

Hand Hygiene 94

Protective Clothing 94

Mops and Buckets

Mops and their corresponding colour coded buckets must not be interchanged. If any mop becomes contaminated with blood or body fluids, then the head should be discarded as clinical waste and a replacement fitted immediately. All mop heads should be routinely replaced every month.

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Hand Washing Technique

12

Good and efficient hand hygiene is the single most important factor in the prevention and control of the spread of infection.

Second to hand washing, consistent use of barrier methods, especially wearing gloves, is the most important step in

preventing cross-contamination of staff and patients.

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Hand Hygiene

12

Use the hand washing technique:

Protective Clothing

Circumstance/Activity Appropriate PPE Circumstance/Activity

Appropriate PPE

Circumstance/Activity Appropriate PPE Exposure to blood/body

fluids anticipated, but low risk of splashing.

Wear gloves, plastic apron and sleeve protectors. Wear gloves, plastic apron

and sleeve protectors.

Wear gloves, plastic apron and sleeve protectors.

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Sharp/Splash Injury Procedure

Inoculation/blood splash injuries include any sharp object that pierces the skin, bites or any other exposure

to blood or body fluids.

Bleed it – Apply pressure, but “DO NOT” suck the wound. Wash it – Wash with soap under warm running water for 2 minutes.

Dry it – Do not scrub the injury or pat it dry. Dress it – Cover the injury with a dressing.

For splashes to the eyes – Irrigate with saline or water. For splashes to the mouth – Rinse with copious amounts of water and wash your face.

Donor – Identify and document the source of the inoculation injury include: Name, DOB and home address if possible.

Inform – Contact EOC and inform them of the situation. Attend – Go to the nearest Emergency Department without delay.

Report it – Report the incident to occupational health as soon as possible. Telephone your local Occupational health service. Write Numbers Below:

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Key Contacts

Phone Numbers and Addresses

Notes

Notes

1. Ansari, P (2012) Acute Abdominal Pain [Online] URL: http:// www.merckmanuals.com/professional/gastrointestinal_disorders/ acute_abdomen_and_surgical_gastroenterology/

acute_abdominal_pain.html

2. Avon Protection Systems (2011) EH20 Data Sheet, Melksham/England: Avon Protection Systems.

3. Evans, S (2004) A Guide Through the Maze of ECGs, 3rd Edition, Somerset/ England: Association of Professional Ambulance Personnel.

4. Fikac, L (2000) Shoulder Dystocia [Online] URL: http://

www.capefearvalley.com/outreach/outreach/peapods/obemergencies/ shoulderdystocia.htm

5. Kochenour, N (1997) The Mechanism of Normal Labor [Online] URL: http:// library.med.utah.edu/kw/human_reprod/lectures/physiology_labor/#2 6. Laerdal (2013) Laerdal Suction Unit: Instruction Manual, Kent/England:

Laerdal Medical Limited

7. Medtrng (2012) Postures and Direction of Movement [Online] URL: http:// www.medtrng.com/posturesdirection.htm

8. Peak Flow (2004) Mini-Wright Peak Flow Meter: Predictive Normal Values (Nomogram, EU scale), Essex/England: Clement Clarke International. 9. Queensland Ambulance Service (2011) Clinical Practice Manual [Online] URL:

http://www.ambulance.qld.gov.au/medical/CPM.asp

10. Resuscitation Council UK (2010) Resuscitation Guidelines 2010, London/ England: RCUK.

11. Smiths Medical (2008) Emergency Transport and Ventilation [Online] URL: http://www.smiths-medical.com/Upload/products/product_relateddocs/ EmergencyTransport.pdf

12. World Health Organisation (2009) Clean Care is Safer Care: Clean Your Hands, Geneva/Switzerland: WHO.

Handover

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