Project: Las Venturas

Scene Safety

Scene safety is the first priority during any emergency response. EMS personnel must ensure the environment is safe for themselves, the patient, and any bystanders before beginning patient care.

Personnel should evaluate the scene for potential hazards such as:

• Traffic or roadway dangers
• Fire or smoke conditions
• Hazardous materials or chemical exposure
• Violent individuals or unsafe crowds
• Environmental hazards such as unstable structures

If hazards are present, take appropriate actions to secure the scene. This may include requesting law enforcement, fire suppression support, or specialized response units before initiating patient care.

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Primary Survey (ABCDE)

The Primary Survey is a rapid assessment used to identify and treat immediate life-threatening conditions. EMS personnel must follow the ABCDE approach in order of priority.

A – Airway
Assess whether the airway is open and unobstructed. If the airway is compromised, open it using appropriate techniques and remove any obstructions.

**B – Breathing**
Assess breathing rate, depth, and effort. Determine whether the patient is breathing adequately. If breathing is inadequate or absent, initiate assisted ventilation immediately.

**C – Circulation**
Assess pulse, skin color, temperature, and signs of bleeding. Control major hemorrhage and begin circulatory support if necessary.

**D – Disability (Neurological Status)**
Evaluate the patient’s level of consciousness using tools such as:

* AVPU (Alert, Verbal, Pain, Unresponsive)
* Glasgow Coma Scale (if applicable)

Check pupil response and identify any obvious neurological deficits.

**E – Exposure / Environment**
Expose the patient as necessary to identify injuries or medical conditions that may not be visible. Protect the patient from environmental hazards such as hypothermia during this process.

Life-threatening issues identified during the Primary Survey must be treated immediately before continuing further assessments.

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Secondary Survey

Once life threats have been managed, conduct a **Secondary Survey**, which consists of a systematic head-to-toe examination.

The purpose of the secondary assessment is to identify injuries or medical conditions that were not immediately apparent during the primary survey.

Assess the following areas:

* Skin condition
* Head and scalp
* Eyes, ears, nose, and throat
* Neck
* Chest and respiratory movement
* Abdomen
* Pelvis
* Extremities
* Back and spine

During the secondary survey, EMS personnel should obtain a patient history using **SAMPLE** and **OPQRST** assessment tools.

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Patient History Assessment

SAMPLE

**S – Signs and Symptoms**
What symptoms is the patient experiencing?

**A – Allergies**
Does the patient have any known allergies to medications, foods, or environmental factors?

**M – Medications**
What medications is the patient currently taking?

**P – Past Medical History**
Does the patient have any known medical conditions or prior illnesses?

**L – Last Oral Intake**
When did the patient last eat or drink, and what was consumed?

**E – Events Preceding the Illness/Injury**
What was the patient doing when the symptoms began?

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OPQRST (Pain Assessment)

**O – Onset**
Did the pain begin suddenly or gradually?

**P – Provocation / Palliation**
What makes the pain better or worse?

**Q – Quality**
How does the patient describe the pain (sharp, dull, burning, etc.)?

**R – Region / Radiation**
Where is the pain located? Does it radiate to other areas?

**S – Severity**
Rate the pain on a scale of 1–10.

**T – Time**
How long has the pain been present?

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Vital Sign Monitoring

Vital signs provide critical information about the patient’s overall condition.

EMS personnel must routinely monitor and document:

* Heart Rate (Pulse)
* Blood Pressure
* Respiratory Rate
* Oxygen Saturation (SpO₂)
* Temperature
* Level of Consciousness

Vital signs should be reassessed regularly and whenever the patient's condition changes.

Airway Management

Maintaining a **patent airway** is essential for oxygenation and ventilation.

Common airway management techniques include:

* Head-Tilt / Chin-Lift (non-trauma patients)
* Jaw Thrust Maneuver (suspected spinal injury)

EMS personnel must also remove any airway obstructions such as vomit, blood, or foreign objects.

Basic airway adjuncts include:

* Oropharyngeal Airway (OPA)
* Nasopharyngeal Airway (NPA)

Advanced airway procedures may include endotracheal intubation when performed by authorized personnel.

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Breathing Interventions

Assess breathing for:

* Rate
* Depth
* Effort
* Symmetry

If respiratory distress or failure is present, interventions may include:

* Oxygen therapy via nasal cannula or non-rebreather mask
* Bag-Valve-Mask (BVM) ventilation
* Positive pressure ventilation
* Needle decompression for suspected tension pneumothorax (ALS protocols)

Continuous monitoring of respiratory status is required throughout treatment and transport.

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Circulation Support

Circulatory support may include:

* Establishing IV access
* Administration of IV fluids
* Hemorrhage control
* Medication administration under approved protocols

EMS personnel must monitor for signs of shock and intervene accordingly.

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Cardiopulmonary Resuscitation (CPR)

High-quality CPR must be performed according to current guidelines established by the **American Heart Association (AHA)**.

Key principles include:

* Immediate recognition of cardiac arrest
* High-quality chest compressions
* Early defibrillation using an AED
* Minimal interruptions in compressions
* Proper ventilation

CPR must continue until:

* Return of spontaneous circulation (ROSC)
* Care is transferred to advanced providers
* Medical control directs termination of efforts

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Use of Medical Equipment

All EMS personnel must be trained and proficient in the use of department-issued medical equipment.

Key expectations include:

* Ensuring equipment is clean and operational
* Checking equipment at the start of each shift
* Reporting damaged or malfunctioning equipment
* Practicing equipment use regularly during training

Medical equipment must **never be used outside official duty or emergency response situations.**

Bleeding Control

External bleeding must be controlled immediately to prevent shock and death.

Control methods include:

* Direct pressure using sterile dressings
* Pressure bandages
* Tourniquet application for severe extremity bleeding
* Hemostatic dressings when appropriate

Early hemorrhage control is a critical life-saving intervention.

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Fracture Management

Fractures and dislocations must be stabilized prior to patient transport.

Proper management includes:

* Immobilizing the affected limb using splints
* Supporting joints above and below the injury
* Assessing **CMS (Circulation, Motor function, Sensation)** before and after splinting

Pain management should be provided when authorized.

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Spinal Immobilization

Spinal precautions should be considered in patients involved in:

* Motor vehicle collisions
* Falls from height
* Significant blunt trauma
* Patients reporting neck or back pain

Spinal stabilization methods include:

* Cervical collars
* Long backboards
* Kendrick Extrication Device (KED) for seated extrications

Minimize spinal movement during patient removal and transport.

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Shock Management

Shock occurs when the body is unable to deliver adequate oxygen to tissues.

Types of shock include:

* Hypovolemic
* Cardiogenic
* Obstructive
* Distributive
* Septic

Management may include:

* Oxygen therapy
* IV fluid resuscitation
* Patient positioning
* Medication administration per protocol

Continuous monitoring is required to evaluate patient response to treatment.

Patient Care Reports (PCR)

Accurate documentation is essential for both patient care and legal accountability.

Each call requires completion of a Patient Care Report (PCR) including:

Patient demographics

• Assessment findings
• Vital signs
• Treatments performed
• Medications administered
• Patient response to treatment

PCRs must be completed thoroughly and promptly after each call.

Spoiler

Code: Select all

[hr]
[center][size=150][b]BLAINE COUNTY FIRE DEPARTMENT[/b][/size]
[size=120][b]EMS PATIENT CARE REPORT (PCR)[/b][/size][/center]

[b]Incident Information[/b]
[list]
[*][b]Incident Number:[/b]
[*][b]Date:[/b]
[*][b]Time Dispatched:[/b]
[*][b]Time On Scene:[/b]
[*][b]Time Transporting:[/b]
[*][b]Time At Hospital:[/b]
[*][b]Unit / Call Sign:[/b]
[*][b]Crew Members:[/b]
[*][b]Location of Incident:[/b]
[/list]

[b]Patient Information[/b]
[list]
[*][b]Patient Name:[/b]
[*][b]Date of Birth / Age:[/b]
[*][b]Gender:[/b]
[*][b]Contact Information:[/b]
[*][b]Next of Kin / Emergency Contact:[/b]
[/list]

[b]Chief Complaint[/b]

[quote]
Describe the primary reason EMS was requested.
[/quote]

[b]Primary Assessment (ABCDE)[/b]
[list][*][b]Airway:[/b]
[*][b]Breathing:[/b]
[*][b]Circulation:[/b]
[*][b]Disability (Neurological):[/b]
[*][b]Exposure / Environment:[/b][/list]

[b]Secondary Assessment[/b]

[b]Head & Neck:[/b]  
[b]Chest:[/b]  
[b]Abdomen:[/b]  
[b]Pelvis:[/b]  
[b]Extremities:[/b]  
[b]Back / Spine:[/b]  
[b]Skin Condition:[/b]

[b]SAMPLE History[/b]
[list][*][b]Signs & Symptoms:[/b]
[*][b]Allergies:[/b]
[*][b]Medications:[/b]
[*][b]Past Medical History:[/b]
[*][b]Last Oral Intake:[/b]
[*][b]Events Prior to Incident:[/b][/list]

[hr]

[b]OPQRST (If Pain Present)[/b]
[list][*][b]Onset:[/b]
[*][b]Provocation / Palliation:[/b]
[*][b]Quality:[/b]
[*][b]Region / Radiation:[/b]
[*][b]Severity (1-10):[/b]
[*][b]Time:[/b][/list]

[b]Treatment Provided[/b]

[quote]
List all treatments performed (oxygen, splinting, IV access, CPR, etc.)
[/quote]

[b]Transport Information[/b]
[list]
[*][b]Transport Decision:[/b] Transported / Refused / Treated on Scene
[*][b]Destination Hospital:[/b]
[*][b]Transport Priority:[/b] Emergency / Non-Emergency
[*][b]Patient Condition During Transport:[/b]
[/list]

[b]Narrative Report[/b]

[quote]
Provide a full narrative of the call including dispatch information, patient assessment, treatments performed, and outcome.
[/quote]

[b]Receiving Facility Handover (SBAR)[/b]
[list]
[*][b]Situation:[/b]
[*][b]Background:[/b]
[*][b]Assessment:[/b]
[*][b]Recommendation:[/b]
[/list]

[b]Reporting EMT / Paramedic[/b]
[list]
[*][b]Name:[/b]
[*][b]Rank / Certification:[/b]
[*][b]Signature:[/b]
[/list]

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Incident Reporting

Critical incidents or protocol deviations must be reported through the department's incident reporting system.

Examples include:

• Medication errors
• Equipment failures
• Injuries to personnel
• Unusual or high-risk incidents

Incident reporting promotes safety and continuous improvement.

Drug Dosages and Routes

EMS personnel must understand proper medication administration, including:

• Indications
• Contraindications
• Dosage calculations
• Routes of administration

Common administration routes include:

• Oral (PO)
• Intravenous (IV)
• Intramuscular (IM)
• Subcutaneous (SQ)
• Inhalation

Weight-based dosing should be used when appropriate.

Medication Administration Guidelines

All medications must be administered according to department protocols.

Personnel must:

• Verify medication name and dosage
• Check expiration dates
• Confirm patient identity
• Document medication administration and patient response

All medication administration must be recorded in the patient care report.

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Common EMS Medications

Acetaminophen (Tylenol)
Indications: Mild to moderate pain, fever
Contraindications: Known allergy, severe liver disease
Dosage: 650–1000 mg
Route: Oral (PO)

Oxygen (O₂)
Indications: Hypoxia, respiratory distress, cardiac conditions, shock
Contraindications: None in emergency situations (use caution in certain COPD patients)
Dosage:
Nasal Cannula: 2–6 L/min
Non-Rebreather Mask: 10–15 L/min
Route: Inhalation

Nitroglycerin (Nitro)
Indications: Chest pain suspected to be cardiac in origin (angina), acute coronary syndrome
Contraindications:
Systolic blood pressure below protocol threshold (commonly <90–100 mmHg)
Recent use of erectile dysfunction medications (e.g., sildenafil)
Head injury or suspected intracranial pressure
Dosage: 0.4 mg
Route: Sublingual (SL) tablet or spray
Repeat: Every 5 minutes per protocol, usually up to 3 doses

Morphine
Indications: Moderate to severe pain, chest pain associated with myocardial infarction
Contraindications: Respiratory depression, hypotension, altered mental status, allergy
Dosage: 2–4 mg initially
Route: Intravenous (IV) slow push
Repeat: May repeat in small increments per protocol

Transport Decision Making

EMS personnel must determine the most appropriate destination for patient transport.

Factors to consider include:

• Severity of the patient's condition
• Required level of care
• Distance to appropriate medical facilities
• Specialty centers such as trauma or cardiac centers

Medical control should be consulted when necessary.


Preparing Patients for Transport

Before transport, ensure the patient is properly secured and stabilized.

This includes:

• Securing the patient to the stretcher
• Monitoring vital signs
• Maintaining airway management
• Continuing necessary treatments during transport

Patient Handover at the Hospital

A clear and concise patient report must be given to the receiving hospital staff.

Use structured communication such as "SBAR" process:

• Situation – Patient condition and chief complaint
• Background – Relevant medical history and events
• Assessment – Findings and vital signs
• Recommendation – Treatments provided and next steps

Effective communication ensures continuity of care.

Vehicle Safety

Operating emergency vehicles requires a high level of responsibility and attention.

Personnel must:

• Follow all traffic laws when responding to emergencies
• Use emergency lights and sirens appropriately
• Ensure patients and crew are secured before moving the vehicle

Routine vehicle inspections must be conducted at the start of each shift.

Defensive Driving

EMS drivers must practice defensive driving techniques at all times.

Key practices include:

• Maintaining safe following distances
• Adjusting speed based on weather and road conditions
• Anticipating actions of other drivers/locals
• Frequently checking mirrors and blind spots

Safe vehicle operation protects EMS personnel, patients, and the public.