RESPOND TO SCENE IN A SAFE MANNER

• Review dispatch information. 
• Use Incident Command System (ICS) for all responses and scene management.

• Standard precautions, scene safety, environmental hazards assessment, number of patients, need for additional resources, and bystander safety. 
• Initiate Mass Casualty Incident (MCI) procedures as necessary. 
• Call for AEMT/Paramedic intercept, if needed, for patients with unstable vital signs, respiratory distress or other life-threatening conditions.

• Determine mechanism of injury / nature of illness.
• If patient is in cardiac arrest, refer to the Cardiac Arrest Protocol - Adult (1 Cardiac) & Pediatric (4 Cardiac).
• Place the Patient in Supine Position or Position of comfort.
• Determine if pediatric protocols apply. 

• Establish responsiveness. 
• General impression.

Determine if DNR protocol applies.

Primary Assessment

• Assess the patient for a patent Airway. If the airway is not patent, take immediate action to correct it (Open & Re Open).

• Assess Breathing: 

  Breathing
  Present	Yes		No
  Speed	Normal	Slow	Fast
  Regularity	Regular		Irregular

1. If breathing is inadequate (slow, shallow), ventilate with 100% oxygen using bag-valve-mask (BVM).
2. Administer oxygen as appropriate with a target of achieving 94 % saturation (88 – 92% in COPD). CO- oximetry.
3. Assess lung sounds and chest.
4. Consider Advance Airway.

• Assess patient’s  pulse: -

  pulse
  Present	Yes		No
  Speed	Normal	Slow	Fast
  Regularity	Regular		Irregular

• Check pulse (feel for a pulse for at least 5 seconds but no more than 10 seconds), if no pulse or less than (60 beats/min for pediatric) Start CPR for 2 min, start 
• Chest compressions (C-A-B Sequence) (30 compressions: 2 breaths) at a rate at least 100 compressions per minute.

• Assess patient’s Skin: -

Skin
Tem	Warm	Hot	Cold
Color	Pink	Yellow	Red
Condition	Dry	Moist

• Assess patient’s Capillary Refill Time for pediatric: - (2 –seconds). 
• Control bleedingusing direct pressure, pressure bandages, tourniquets. 
• Establish IV access and fluid resuscitation as appropriate for the patient’s condition. 
  1. For adult patients, administer fluids to maintain systolic blood pressure refer to Shock Protocol – Adult (56 Medical).
     1. For pediatric patients, administer fluids based on physiological signs and therapeutic end-points refer to Shock Protocol – Pediatric (60 Medical). 

• Assess level of consciousness appropriate for age; use (AVPU) Scale.
• If altered level of consciousness, check blood glucose.
• Utilize spinal motion restriction if indicated by assessment, see Advanced Spinal Assessment Procedure and Policy for Ault & Pediatric refer to Spinal Immobilization protocol (55 skills).

• All patients should be transported to the closest appropriate Health Institutions (Hospital, Polyclinic, and Health Center).  
• Regionalized systems of care for specialized trauma patients may necessitate transport to specialized center (Trauma, Burn Center).
• Notify receiving facility.
• Consider aeromedical transportation when indicated. 

Secondary Assessment

• Reassess chief complaint, history of present illness.
• Complete a physical assessment as appropriate for the patient’s presentation.

• Consider field diagnostic tests including: attach cardiac monitoring, obtain 3/12-lead ECG, blood glucose, body temperature, stroke assessment, pulse oximetry, etc.
• Check Pupil for light reaction.

Take full set of vital signs. (it is the base set of vital signs).

• Check disability by using Glasgow Come Scale.

• Adult Glasgow Coma Scale

  

• Pediatric Glasgow

  
• Refer to appropriate protocol(s) for further treatment options. 
• Dress and bandage lacerations and abrasions.
• Cover evisceration with a sterile dressing to prevent heat loss.
• Maintain normal body temperature.
• Stabilize impaled objects. Do not remove an impaled object unless it interferes with CPR or your ability to maintain the patient’s airway.
• Recheck vital signs at least every 15 minutes (for stable patient) and at least every 5 minutes (for unstable patient).