3.10 Burn Injury - Frontline First Aid · Page 2 09/09/2008 EMA Licensing [email protected] Ministry of Health Services Scenario Information Dispatch Information You are dispatched

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EMA Licensing [email protected] Ministry of Health Services

FIRST RESPONDER INITIAL CERTIFICATION/LICENSURE OR RE-LICENSING PRACTICAL EVALUATION

3.10 Burn Injury

Key Performance Outcomes

• Ensure a safe scene • Burn injury management

Patient Instructions

C/C: "My whole arm is extremely sore" HxC/C: You gripped a live (hot) electrical wire thinking that the power had been shut off Pain Assessment (PQRST) You have severe (9/10) shooting pain in your right hand and arm. The pain does

seem to radiate from the hand up to the elbow. It happened about 10 minutes ago. Relevant symptoms: Relevant past Med Hx: Heart attack 3 years ago and high blood pressure Medications: High blood pressure pills but you don't know the name of them Allergies: Bees and wasps Other: You are portraying a 60 year old patient.

You did not fall, bang your head, lose consciousness, and have no spinal pain.

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Scenario Information Dispatch Information You are dispatched to the local shopping mall for a possible electrocution. Scene Information You are met by the mall manager who tells you a contract electrician has come in contact with a live (hot) electrical wire. He directs you to the mall's electrical utility room. As you enter the utility room you see a man who appears to be in his early 60's sitting against a wall holding his right hand. You notice numerous electrical wires laying around the floor and the patient. Witnessed or Secondary Information (as required) The electrician (patient) can direct you to the main electrical panel where you can safely shut off the main power supply

Criteria Relevant findings Required actions RSE Potential live (hot) electical wires Shut off power supply LOC Alert

D None Determine mechanism of injury, rule out spinal injury

A Clear and open B Present and adequate C Radial pulse present and regular

RBS Electrical burn (entry wound on palm of right hand, exit wound near right elbow)

Find injury

Critical Interventions

Electrical burn Move patient to a safe area. Cool burn for 10 minutes, cover both wounds with dry sterile dressing

C/C "My whole arm is extremely sore" HX C/C Patient gripped a live (hot) electrical wire

thinking that the power had been shut off Med Hx Heart attack 3 years ago and high blood

pressure Medication High blood pressure pills but patient does

not know the name of them Allergies Bees and wasps

Vital Signs Initial Set Second Set (if applicable) LOC Alert LOC Alert

PULSE 100 regular PULSE 100 regular RESP 24 regular RESP 20 regular

SKIN Normal SKIN Normal Other/Misc. Oxygen therapy as soon as practical.

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3.11 Abdominal Injury


• Manage an open abdominal injury with bowel protrusion


C/C: "My stomach hurts" HxC/C: You were passing pieces of "re-bar" (2cm diameter X 3 metres long steel rod) up

to a co-worker who was standing above you on some scaffolding. A piece slipped back hitting you in the abdomen.

Pain Assessment (PQRST) Just above the navel, dull ache, does not radiate, does not hurt too bad (2/10 for severity, and it happened approximately 15 minutes ago.

Relevant symptoms: You are scared and anxious Relevant past Med Hx: Glaucoma Medications: You take eye drops for your glaucoma but you don't know what the medication is

called Allergies: Shellfish Other: You are portraying someone in their 50's

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Scenario Information Dispatch Information You are dispatched to a construction site for an industrial accident. Scene Information You are met by a foreman of the construction site. He tells you the area where the patient is located is safe. He informs you that one of his workers got hit with a piece of "re-bar" (2cm diameter X 3 metres long steel rod) in the stomach Witnessed or Secondary Information (as required) The First Aid Attendant called in sick today.

Criteria Relevant findings Required actions RSE Construction site. Patient is sitting at the

base of some scaffolding. Ensure area is safe to approach and treat patient

LOC Alert but anxious Calm and reassure patient D None Determine mechanism of injury, rule out spinal

injury A Open and clear B Present and adequate C Radial pulse present and regular

RBS Penetrating abdominal wound just above the naval, with approximately 20 cms of protruding bowel

Find injury


Treat an open abdominal injury Position patient supine with head and shoulders raised and knees flexed, cover wound/bowel with sterile gauze, moisten dressings with sterile water, cover with plastic wrap, cover with abdominal pads, apply bulky dressings, and secure dressings in place

C/C "My stomach hurts" HX C/C You were passing pieces of "re-bar" (2cm

diameter X 3 metres long steel rod) up to a co-worker who was standing above you on some scaffolding. A piece slipped back hitting you in the abdomen.

Med Hx Glaucoma Medication Eye drops for glaucoma but patient doesn't

know what the medication is called Allergies Shellfish



SKIN Normal SKIN Normal Other/Misc. Oxygen therapy as soon as practical.

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3.12 Abdominal Injury


• Manage an open abdominal injury with an embedded object


C/C: "I'm having trouble breathing" HxC/C: You were assaulted and stabbed in the upper abdomen by a knife. You got into an

agrument with someone in the night club and after some pushing and shoving he pulled out a knife and stabbed you.

Pain Assessment (PQRST) Pain just under your rib cage in a line directly below your right nipple, dull ache, does not radiate, 6/10 for severity, happened approximately 10 minutes ago

Relevant symptoms: You are having trouble breathing and the pain increases on inspiration Relevant past Med Hx: None Medications: None Allergies: Demerol Other: The knife is still embedded in your abdomen

If asked, you have no idea how long the knife blade is You have no other injuries If asked, you have consumed 6 beer over the last two hours

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Scenario Information Dispatch Information Dispatched to the alley behind a local night club for an assault Scene Information The police are on scene and have the area secure. They direct you to the patient. You see a male patient sitting and leaning up against the side of the building. He is wearing a "hoody" which you notice is soaked with blood. You also notice the handle of a knife prodruding from the patient's abdomen. The area is well lit. Witnessed or Secondary Information (as required) Know one knows how long the knife blade is

Criteria Relevant findings Required actions RSE Safe Ensure police have the area secured LOC Alert but anxious Calm and reassure patient


A Open and clear B Mild shortness of breath but adequate C Radial pulse present but rapid and weak

RBS Knife embedded in upper abdomen just below rib cage. Moderate bleeding coming from around knife

Find injury and embedded object


Open abdominal injury with a embedded knife

Do not remove knife. Apply gentle pressure to wound (around the base of the knife) using sterile dressings and bulky dressings. Secure as best as possible. Position the patient supine with the head and shoulders raised and the knees flexed

C/C "I'm having trouble breathing" HX C/C Stabbed in the upper abdomen by a knife

after being in an argument with another night clup patron

Med Hx None Medication None

Allergies Demerol

Vital Signs Initial Set Second Set (if applicable) LOC Alert but anxious LOC Alert

PULSE 110 weak and regular PULSE 110 weak and regular RESP 24 shallow RESP 24 shallow

SKIN Pale, cool, and clammy SKIN Pale, cool, and clammy Other/Misc. Oxygen therapy as soon as practical

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3.13 Smoke Inhalation Injury


• Manage a patient with smoke inhalation


C/C: "I can't stop coughing and I'm having chest pain" HxC/C: You were trapped on the third floor of an apartment building fire, which was

occurring on a floor below yours. You were not burned but you inhaled thick smoke prior to being rescued.

Pain Assessment (PQRST) You have "burning" pain in your throat and chest, 6/10 for severity, and the pain is not getting any better now that you are out of the smoke

Relevant symptoms: Difficulty swallowing, smoky breath odour, carbon in your sputum, carbon around your nose and mouth

Relevant past Med Hx: Breast cancer in 1999 Medications: Numerous vitamins and nutritional supplements Allergies: None Other: You were able to walk, with assistance, out of the burned structure.

You're portraying a patient in their 70's

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Scenario Information Dispatch Information You are attending a structural fire (apartment fire in a second floor apartment). Scene Information You see a colleague assisting an elderly woman from the burning building. You assist your colleague and help the elderly woman sit on a bench well away from the structure. The patient appears to be in her 70's. She is coughing harshly, appears short of breath, and she states that she is having chest pain. Witnessed or Secondary Information (as required) If asked, your colleague will state that they found the woman sitting beside a kitchen window in a third floor apartment.

Criteria Relevant findings Required actions RSE Patient was removed from a burning

building

LOC Alert Calm and reassure patient D None A Open, patient complains of having difficulty

swallowing, smoky odour on breath

B Present and adequate but has a constant cough

C Radial pulse present and regular RBS Carbon around nose and mouth, no external

injuries found


Smoke inhalation Oxygen via a non-rebreather mask

C/C "I can't stop coughing and I'm having chest pain"

HX C/C Patient was trapped on the third floor of an apartment building fire, which was occurring on a floor below. The patient was not burned but did inhale thick smoke prior to being rescued.

Med Hx Breast cancer in 1999 Medication Numerous vitamins and nutritional

supplements Allergies None


PULSE 100 regular PULSE 96 regular RESP 24 with mild shortness of

breath and a cough RESP 20 with mild shortness of breath and a

cough

SKIN Normal with carbon deposits SKIN Normal with carbon deposits Other/Misc.

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3.14 Smoke Inhalation Injury


• Manage a patient with smoke inhalation


C/C: "I'm having trouble catching my breath" HxC/C: For the last 45 minutes you and two co-workers have been trying to extinguish a

fire that started in a plastics re-cycling depot. It finally got out of control and you have called the Fire Department. You started having difficulty breathing about 15 minutes before the arrival of the Fire Department.

Pain Assessment (PQRST) You don't complain of any pain but you do have an "irritation" in your throat and chest.

Relevant symptoms: Shortness of breath and irritation in throat and chest Relevant past Med Hx: None, but you currently have a urinary tract infection Medications: Cipro Allergies: Almonds Other: You were able to walk away from the fire and meet the Fire Department. If asked,

you did inhale smoke and fumes coming off the burning plastics. You are portraying a 40 year old male patient. You are found standing but leaning forward with your hands on your thighs, SOB.

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Scenario Information Dispatch Information You are sent to a structural fire. Dispatch informs you that it is a plastics re-cycling depot. Scene Information Shortly after your arrival your Chief calls you away from fighting the fire to deal with a patient. You are directed to a man who appears to be in his 40's standing well back from the fire. The patient is leaning forward with his hands on his thighs. The patient appears to be having difficulty breathing. Witnessed or Secondary Information (as required)

Criteria Relevant findings Required actions RSE Safe LOC Alert but anxious Calm and reassure patient

D None A Open and clear B Rapid and laboured but adequate C Radial pulse present and regular

RBS No injuries found Critical

Interventions Smoke (chemical) inhalation Oxygen via a non-rebreather mask

C/C "I'm having trouble catching my breath" HX C/C For the last 45 minutes you and two co-

workers have been trying to extinguish a fire that started in a plastics re-cycling depot. It finally got out of control and you have called the Fire Department. You started having difficulty breathing about 15 minutes before the arrival of the Fire Department.

Med Hx None, but you currently have a urinary tract infection

Medication Cipro Allergies Almonds


PULSE 96 regular PULSE 92 regular RESP 28 laboured RESP 24 laboured

SKIN Normal SKIN Normal Other/Misc.

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3.15 Carbon Monoxide Poisoning


• Manage a patient with carbon monoxide poisoning


C/C: "I have a bad headache and I feel nauseous" HxC/C: Your next door neighbour came over to see why you were running your generator

in your attached garage. He found you in your house confused and complaining of a headache and nausea.

Pain Assessment (PQRST) Headache, dull throbbing, does not radiate, 3/10 for severity, you can't remember when it started

Relevant symptoms: You feel nauseated and fatigued Relevant past Med Hx: None Medications: You think you have taken some Tylenol for your headache Allergies: Shellfish Other: You are portraying someone in their 40's

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Scenario Information Dispatch Information Dispatched to a residence for a sick person Scene Information You are met at the front door by the neighbor who tells you he came over to see why his neighbor (the patient) was running his generator in his attached garage. He states he found his neighbor very confused and not himself so he called for help. You can still hear the generator running in the garage. You are told the patient is sitting in the kitchen. Witnessed or Secondary Information (as required) As you approach the patient, you see a man who appears to be in his 40's sitting at the kitchen table.

Criteria Relevant findings Required actions RSE Generator running in an attached garage Shut off generator, ventilate house, and remove

patient LOC Confused

D None A Open and clear B Present and adequate C Radial pulse present and regular


Interventions Possible CO poisoning Oxygen via a non-rebreather mask

C/C "I have a bad headache and I feel nauseous" HX C/C The next door neighbour came over to see

why you were running your generator in your attached garage. He found you in your house confused and complaining of a headache and nausea.

Med Hx None Medication You think you have taken some Tylenol for

your headache Allergies Shellfish

Vital Signs Initial Set Second Set (if applicable) LOC Confused LOC Alert



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3.16 Carbon Monoxide Poisoning


• Manage a patient with carbon monoxide poisoning


C/C: "I'm very weak…not sure what's going on" HxC/C: Provided by your wife - you were working on your private vehicle in a garage. Pain Assessment (PQRST) N/A Relevant symptoms: Blurred vision Relevant past Med Hx: Provided by your wife - a heart condition called atrial fibrillation. Medications: Provided by your wife - Cardizem for your heart condition. Allergies: Provided by your wife - Penicillin. Other: You are portraying a 30 year old patient. You are found supine. You are confused

to the point where you cannot answer the questions. Your level of consciousness does improve if oxygen is applied.

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Scenario Information Dispatch Information Dispatched to a residence for an unconscious collapse. Scene Information You are met by a woman who directs you to the residence's garage. She tells you her husband was trying to fix their private vehicle. As you approach you see a single vehicle garage, the door is open and the car is shut off. The hood of the car is up and the patient is lying supine beside the hood of the car. The patient appears unconscious. Witnessed or Secondary Information (as required) If asked, the wife will state that when she found her husband the garage door was closed and the car was running. She shut the car off and opened the garage door.

Criteria Relevant findings Required actions RSE Garage still smells of exhaust fumes Determine mechanism of injury, remove patient to

fresh air LOC Mumbles to verbal stimuli. Moans and

withdraws from painful stimuli.

D None A Clear and open Patient will not accept an OPA if attempted B Present and adequate C Radial pulse present and regular


Interventions Possible CO poisoning Oxygen via a non-rebreather mask

C/C "I'm very weak…not sure what's going on" HX C/C Provided by the wife - husband was trying

to fix their private vehicle. She came to check on him and found him unconscious. The garage door was closed and the car was running. She shut the car off and opened the garage door.

Med Hx Provided by the wife - a heart condition called atrial fibrillation.

Medication Provided by the wife - Cardizem for your heart condition.

Allergies Provided by the wife - Penicillin.

Vital Signs Initial Set Second Set (if applicable) LOC Very confused. LOC Less confused (improvement)



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3.17 Hypothermia


• Manage hypothermia


C/C: "I'm extremely cold" HxC/C: You were inadvertently locked in walk-in meat locker/freezer for approximately 2

hours. Pain Assessment (PQRST) N/A Relevant symptoms: Shivering, slurred speech, and confusion Relevant past Med Hx: Gall Bladder surgery two weeks ago Medications: Antibiotic but you are not sure of the name Allergies: Any form of nuts Other: You are portraying a 50 year old patient. You are lying supine outside the meat

locker.

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Scenario Information Dispatch Information You are sent to the local meat processing facility for a possible hypothermic patient. Scene Information You are met at the scene by the Facility Manager. She tells you that the employee (patient) was last seen at coffee break - approximately 2 hours ago. The manager states the employee was found in the walk-in meat locker/freezer "damm near frozen to death". As you approach you see a man who appears to be in his 50's lying supine outside the meat locker/freezer. You notice he is shivering violently. Witnessed or Secondary Information (as required) Other employees removed the patient from the meat locker/freezer.

Criteria Relevant findings Required actions RSE Safe LOC Mild confusion, slurred speech Reassure patient


RBS No injuries found but skin is very cold to the touch and the patient is violently shivering

Notice skin temperature and shivering


Manage hypothermia Cover with blankets

C/C "I'm extremely cold" HX C/C You were inadvertently locked in walk-in

meat locker/freezer for approximately 2 hours.

Med Hx Gall Bladder surgery two weeks ago Medication Antibiotic but you are not sure of the name

Allergies Any form of nuts

Vital Signs Initial Set Second Set (if applicable) LOC Mild confusion, slurred

speech LOC Mild confusion, slurred speech


SKIN Pale and cold SKIN Pale and cold Other/Misc. Oxygen therapy as soon as practical

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3.18 Frostbite


• Manage frostbite


C/C: "My feet are frozen" HxC/C: Hiking/snowshoeing for 4 hours in - 20 C temperatures Pain Assessment (PQRST) Both feet feel numb, pain does not radiate, 4/10 for severity, and the pain has been

getting less severe the last hour of the hike Relevant symptoms: The skin appears white and waxy Relevant past Med Hx: Diabetic for 10 years Medications: Insulin Allergies: Demerol Other: You are portraying a 60 year old patient.

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Scenario Information Dispatch Information You are dispatched to the trailhead of a popular cross-country skiing and snowshoeing area for an injured hiker. Dispatch informs you that the call came in on a cell phone and that the hiker is walking out and will meet you at the trailhead. Scene Information It is a -20C winter day. After waiting 10 minutes you see two hikers enter the parking lot area. One hiker is assisting the other hiker. As you approach you notice that the patient is a woman who appears to be in her 60's. She states "I think my feet are frozen". Witnessed or Secondary Information (as required) The couple has been hiking for 4 hours

Criteria Relevant findings Required actions RSE -20C temperature Remove patient to a warm location LOC Alert


RBS Deep frostbite in both feet (white, waxy, skin feels hard to touch, and extremely cold)

Find injuries


Manage frostbite Remove footwear and socks, cover with dressings, protect feet, handle gently, keep patient and feet warm

C/C "My feet are frozen" HX C/C Hiking/snowshoeing for 4 hours in - 20 C

temperatures Med Hx Diabetic for 10 years

Medication Insulin Allergies Demerol



SKIN Normal (sweaty from hiking) SKIN Normal Other/Misc. Oxygen therapy as soon as practical

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3.19 Hyperthermia


• Manage heat stroke


C/C: "I'm hot and feel sick" HxC/C: You passed out in a hotel sauna Pain Assessment (PQRST) N/A Relevant symptoms: Vomiting, muscle twitching, and very hot skin Relevant past Med Hx: Asthma Medications: Ventolin inhaler Allergies: Pollen and cat dander Other: You were drinking heavily and then you and some friends snuck into the hotel

sauna about 3 am. The security guard found you at 6 am. You are portraying a 23 year old male patient.

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Scenario Information Dispatch Information Dispatched to a local hotel for an unconscious collapse. Scene Information It is 6:15 am. You are met by the hotel security guard who tells you he just found a young man passed out in the hotel sauna. As you head towards the sauna the security guard tells you the patient is "hotter than hell and still appears drunk". Witnessed or Secondary Information (as required) If asked, the patient can state that he thinks he went into the sauna around 3 am.

Criteria Relevant findings Required actions RSE Patient still in the sauna Remove the patient from the sauna LOC Confused, will respond to a painful stimuli

D None A Open and clear Patient will reject an OPA if attempted B Deep irregular breathing but adequate C Radial pulse present and regular

RBS No injuries found but patient is extremely hot and dry to the touch and you notice muscle twitching You also notice the smell of alcohol on the patient's breath

Notice skin temperature and muscle twitching


Manage heat stroke Place patient in 3/4 position, cool the patient with ice or ice packs (focus on armpits, groin, and neck)

C/C "I'm hot and feel sick" HX C/C You passed out in a hotel sauna Med Hx Asthma

Medication Ventolin inhaler Allergies Pollen and cat dander

Vital Signs Initial Set Second Set (if applicable) LOC Very confused. Responds to

painful stimuli LOC Very confused. Responds to painful

stimuli PULSE 110 strong and regular PULSE 100 strong and regular RESP 24 deep and irregular RESP 20 regular

SKIN Red, hot, dry SKIN Red, hot, dry Other/Misc. Oxygen therapy as soon as practical

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3.2 Bleeding Shock


• Control arterial bleeding


C/C: "I stepped on a piece of glass and cut my foot" HxC/C: "I was skateboarding and stepped on a broken bottle" Pain Assessment (PQRST) Sharp pain in the sole of the foot, 8/10 for severity, does not radiate Relevant symptoms: Feels nauseous and may vomit Relevant past Med Hx: "Broken arm 2 months ago, just got my cast off last week" Medications: "Stuff for my acme but I don't know what it is" Allergies: Hay fever Other: You did not fall, bang your head or lose consciousness (no C-spine)

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Scenario Information Dispatch Information You are sent to the local skateboard park for a fall Scene Information As you approach the skateboard park you see numerous teenagers standing around another teenage boy who is sitting on the ground. As you get closer you can see a small pool of blood by the patient's feet. You also notice that the boy is barefoot. It is a warm sunny evening. Witnessed or Secondary Information (as required) If asked there is no danger to you posed by the other teenagers; they are cooperative.

Criteria Relevant findings Required actions RSE Skateboard park with numerous teenagers

present Confirm that it is safe to approach the patient

LOC Alert D None Determine mechanism of injury, rule out spinal

injury A Clear and open B Normal C Radial pulse present and easily felt

RBS Large laceration (10 cm) found on sole of left foot, bleeding heavily

Find injury


Control arterial bleeding Lay patient down, direct pressure, apply dressing and bandage

C/C "I stepped on a piece of glass and cut my foot"

HX C/C I was skateboarding and I stepped on some broken glass"

Med Hx Broken arm Medication "Stuff for my acme but I don't know what it

is Allergies Hay fever



SKIN Normal SKIN Normal Other/Misc. Feels nauseated

Shock

Oxygen should be applied as soon as practical after controlling the bleeding

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3.20 Hyperthermia


• Manage heat exhaustion


C/C: "I feel dizzy and weak" HxC/C: You decided to go for a jog (something that you normally don't do). After running

for about 30 minutes you started to feel dizzy and weak Pain Assessment (PQRST) N/A Relevant symptoms: You have been sweating profusely for 30 minutes Relevant past Med Hx: Minor arthritis Medications: Vitamin D, Diclofenac for joint pain Allergies: Sulpha Drugs Other: You have not had anything to drink for a least two hours

You are found sitting in the sun up against a tree You are portraying a 40 year old patient

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Scenario Information Dispatch Information You are dispatched to a local park for a "sick" person Scene Information It is early spring but the temperature is 30 degrees celsius. Someone meets you at the parking lot and informs you that a jogger almost collapsed while running around the park. The witness says that he and another person helped sit the patient down but that the patient is a little shaky on his feet. As you approach you see a man in his 40's sitting in the sun leaning up against a tree. Witnessed or Secondary Information (as required)

Criteria Relevant findings Required actions RSE Unusally hot spring day Move the patient to a cool location (shade) LOC Alert

D None A Open and clear B Rapid and shallow but adequate C Radial pulse rapid and weak

RBS No injuries found but patient is sweating profusely. The patient looks pale

Notice sweating and skin


Manage heat exhaustion Keep the patient at rest, elevate legs, remove as many clothes as possible, fan the patient

C/C "I feel dizzy and weak" HX C/C You decided to go for a jog (something that

you normally don't do). After running for about 30 minutes you started to feel dizzy and weak

Med Hx Minor arthritis Medication Vitamin D, Diclofenac for joint pain

Allergies Sulpha Drugs


PULSE 130 weak PULSE 100 weak RESP 24 shallow RESP 20 shallow

SKIN Pale but extremely sweaty SKIN Pale Other/Misc. Oxygen therapy as soon as practical

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3.21 Near Drowning


• Airway management • Breathing management


C/C: Unconscious HxC/C: Child found at the bottom of a swimming pool and was removed by bystanders.

There is no clear history of how long the child was immersed - an older sister states she last saw her sister approximately 10 minutes ago.

Pain Assessment (PQRST) N/A Relevant symptoms: Water in the mouth Relevant past Med Hx: Healthy Medications: None Allergies: Sister states the patient is allergic to penicillin Other: A child CPR mannequin should be used for this evaluation

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Scenario Information Dispatch Information Dispatched to a residence for a drowning. Scene Information You are met by a distraught adult who informs you that he and his wife were having a neighbourhood pool party and one of the neighbour’s kids has drowned. He leads you around to the rear of the house. As you approach you see numerous adults and children standing on the pool deck. One adult is performing mouth-to-mouth on a child. The child appears to be 6-7 years of age. Witnessed or Secondary Information (as required) If asked, the parents are not available but the patient's older sister is in attendance. There is no clear indication how long the child was submerged but the sister is able to state that she saw her sister about 10 minutes before she was pulled out of the pool.

Criteria Relevant findings Required actions RSE Safe but numerous adults and other children

standing around Have an adult remove the crowd into the house

LOC Unconscious AV PU D None A Open and clear Insert OPA B Absent Ventilate with Child BVM (or Pocket Mask) C Carotid pulse present and regular


Interventions Airway and Breathing management Insert OPA and ventilate with Child BVM

C/C Near drowning HX C/C Child found at the bottom of a swimming

pool and was removed by bystanders. There is no clear history of how long the child was immersed - an older sister states she last saw her sister approximately 10 minutes before she was pulled out of the pool.

Med Hx Provided by sister - healthy Medication Provided by sister - none

Allergies Provided by sister - penicillin

Vital Signs Initial Set Second Set (if applicable) LOC Unconscious LOC Unconscious

PULSE 90 regular PULSE 90 regular RESP Absent (assisted with BVM) RESP Absent (assisted with BVM)

SKIN Pale, wet, cyanotic SKIN Pale, wet Other/Misc. Oxygen therapy (attached to BVM) as soon as

practical

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3.22 Near Drowning


• Airway management • Breathing management


C/C: Unconscious HxC/C: Patient was found in a lake floating face down beside a private dock. Friends

dragged her to shore and called for help. The witnesses think it was less than 5 minutes between when the patient was last seen on the dock and when she was noticed floating face down.

Pain Assessment (PQRST) N/A Relevant symptoms: Water in the mouth Relevant past Med Hx: Friends state that patient is epileptic Medications: Dilantin Allergies: Not known Other: An adult CPR mannequin should be used for this evaluation

If the patient is treated appropriately they will regain spontaneous respirations within the first 3-4 minutes

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Scenario Information Dispatch Information Dispatched to a local lake for a drowning. Scene Information It is a warm summer day. You are directed to a private beach area. You see numerous teenagers kneeling beside the patient. The patient is a teenage girl who is positioned supine. One of the friends states "she was found in a lake floating face down beside the dock. We dragged her to shore and called for help". Witnessed or Secondary Information (as required) If asked, the witnesses think it was less than 5 minutes between when the patient was last seen on the dock and when she was noticed floating face down.

Criteria Relevant findings Required actions RSE Safe LOC Unconscious AV PU

D None A Water in mouth Roll lateral and/or suction oral cavity, roll back,

insert OPA B Absent Ventilate with Adult BVM (or Pocket Mask) C Carotid pulse present and regular


Interventions Airway and Breathing management Roll lateral and/or suction oral cavity, roll back,

insert OPA, and ventilate with BVM

C/C Near drowning HX C/C Patient was found in a lake floating face

down beside a private dock. Friends dragged her to shore and called for help. The witnesses think it was less than 5 minutes between when the patient was last seen on the dock and when she was noticed floating face down.

Med Hx Provided by friend - epileptic Medication Provided by friend - dilantin

Allergies Not known


PULSE 76 regular PULSE 80 regular RESP Absent RESP 12 regular and effective

SKIN Pale, cool, wet SKIN Pale, warm, dry Other/Misc. Note: If patient is treated appropriately they

will regain spontaneous respirations within 3-4 minutes

Oxygen therapy (attached to BVM) as soon as practical

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3.23 Unconscious Medical


• Manage an unconscious medical patient


C/C: Unconscious HxC/C: While "standing at attention" for an extended period of time, you fainted and

slumped to the grass. Pain Assessment (PQRST) N/A Relevant symptoms: Sweaty Relevant past Med Hx: High blood pressure Medications: Vasotec Allergies: Shellfish Other: You are an RCMP member who is in an honour guard for a foreign dignitary visit.

Once the attendant rolls you 3/4 prone you can start to "come around" - you can answer the history questions. If the attendant does not roll you 3/4 prone then approximately 2 minutes into the simulation you can start to "come around" You are portraying a 50 year old patient.

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Scenario Information Dispatch Information Dispatched to a local park for an unconscious collapse. Dispatch informs you that are to meet the RCMP at the park entrance - apparently there is VIP in town and they are in charge of the event that is taking place. Scene Information It is a warm summer day. As you approach the park you are flagged down by a RCMP member. She informs you that one of the RCMP members who is part of the honor guard fainted. As you approach the patient you notice the RCMP have condoned off the patient from the audience. You see a RMCP member in his red dress surge lying supine on the grass. Two other members are trying to provide shade for him. Witnessed or Secondary Information (as required)


D None Determine mechanism of injury and rule out spinal injury

A Clear and open Patient will reject an OPA if attempted B Present and adequate C Radial pulse rapid and weak


Interventions Manage an unconscious patient Roll 3/4 prone, oxygen therapy,

C/C Unconscious - moans to painful stimuli HX C/C While "standing at attention" for an extended

period of time, the patient apparently fainted and slumped to the grass.

Med Hx High blood pressure Medication Vasotec

Allergies Shellfish

Vital Signs Initial Set Second Set (if applicable) LOC Unconscious LOC Confused

PULSE 110 weak and regular PULSE 80 regular RESP 20 regular RESP 16 regular

SKIN Pale, clammy SKIN Normal Other/Misc. Note: Once the attendant rolls the patient 3/4

prone the patient can start to "come around” and can answer the history questions. If the attendant does not roll the patient 3/4 prone then approximately 2 minutes into the simulation the patient should start to "come around"

Modify which set of vital signs you give, depending on how quickly the attendant gets to assessing vital signs

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3.24 Unconscious Medical


• Manage an unconscious medical patient


C/C: Unconscious HxC/C: Provided by the husband - You are suffering from encephalitis (inflammation of

the brain from a viral infection). The physician said he is suspecting West Nile virus as the cause. Because you were feeling better today the husband decided to take you for a short stroll in the wheelchair in the park adjacent the hospital

Pain Assessment (PQRST) N/A Relevant symptoms: Prior to going unconscious the husband can state that you experienced a headache,

disorientation, a short seizure (10 seconds), and then went unconscious Relevant past Med Hx: Provided by husband - Healthy Medications: Intravenous solution running in your right arm Allergies: Provided by husband - Demerol Other: You are portraying a woman in her mid 40's who is in hospital being treated for

encephalitis

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Scenario Information Dispatch Information You are dispatched to a local park that is adjacent to the hospital. Dispatch informs you a hospital patient has collapsed in the park. Scene Information It is a warm sunny day. You are directed to a couple who appear to be in their mid 40's. The husband is kneeling over his wife holding an Intravenous bag. The patient appears unconscious on the grass. She is positioned supine. Beside the couple is a wheelchair. The husband tells you "We just came out to get some fresh air, she mentioned that she had a headache and then all of a sudden she became disoriented, started shaking, and went unconscious. Witnessed or Secondary Information (as required) If asked, the seizure lasted only 10 seconds and involved the whole body.


D None A Clear and open Patient will reject an OPA if attempted B Present and adequate C Radial pulse present and regular


Interventions Manage an unconscious patient Roll 3/4 prone, oxygen therapy

C/C Unconscious - moans and tries to withdraw from painful stimuli

HX C/C Provided by the husband - You are suffering from encephalitis (inflammation of the brain from a viral infection). The physician said he

is suspecting West Nile virus as the cause.

Because you were feeling better today the husband decided to take you for a short stroll in the wheelchair

Med Hx Provided by husband - Healthy Medication Intravenous solution running in your arm

Allergies Provided by husband - Demerol




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3.25 Heart Attack


• Manage a chest pain patient


C/C: "Chest pain and I just can't seem to catch my breath" HxC/C: Started suddenly while playing squash. You have been inactive for close to a year

and you thought you would get back in shape by playing squash Pain Assessment (PQRST) A squeezing pain in the centre of your chest, pain radiates up into jaw and arms,

8/10 for severity, and the pain started about 25 minutes ago Relevant symptoms: You are very anxious Relevant past Med Hx: High blood pressure Medications: Captopril for your high blood pressure Allergies: Peanuts Other: You are portraying an obese 55 year old patient.

You have been lying (your head and shoulders propped up on a gym bag) outside the squash court for approximately 25 minutes hoping the pain would go away. Finally your squash partner insisted he call for assistance.

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Scenario Information Dispatch Information Dispatched to the local squash club for chest pain. Scene Information You are directed to a man lying (head and shoulders propped up on a gym bag) outside the squash court. He appears to be in his mid 50's, anxious, pale, obese, and sweating profusely. The scene is safe. Witnessed or Secondary Information (as required) If asked, you have been lying outside the squash court for approximately 25 minutes hoping the pain would go away. Finally your squash partner insisted he call for assistance.


D None A Open and clear B Rapid and shallow but adequate C Radial pulse present but irregular

RBS Skin is pale, very sweaty, and patient is complaining of chest pain, no injuries found

Notice skin, profuse sweating, and chest pain


Manage chest pain Position patient sitting or semi-sitting, oxygen therapy, and loosen any constrictive clothing

C/C "Chest pain and I just can't seem to catch my breath"

HX C/C Started suddenly while playing squash. You have been inactive for close to a year and you thought you would get back in shape by playing squash

Med Hx High blood pressure Medication Captopril

Allergies Peanuts


PULSE 110 irregular PULSE 100 irregular RESP 24 shallow RESP 20 regular

SKIN Pale, profuse sweating SKIN Pale, profuse sweating Other/Misc. Note: Once the attendant sits the patient up

the patient's breathing becomes easier. If the attendant does not sit the patient up the vital signs should remain the same.

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3.26 Heart Attack


• Manage a chest pain patient


C/C: "My chest pain is acting up again" HxC/C: You were out mowing the lawn when the pain started. You came inside, sat down

and took 3 doses of your nitro spray medication but the pain remained so you decided you better call for assistance

Pain Assessment (PQRST) Dull ache in the centre of your chest, does not radiate, 5/10 for severity, and the pain started about 20 minutes ago

Relevant symptoms: You feel "weak" and normally this does not happen when you have an angina attack

Relevant past Med Hx: Angina for the last 2 years and you had by-pass surgery 9 years ago Medications: Nitro Spray Allergies: Almonds Other: You are portraying a 60 year old patient.

You are found fully reclined (supine) in a LazyBoy recliner If asked your last angina attack was 2 months ago and at that time the pain was relieved with nitro spray

Page 2 09/09/2008


Scenario Information Dispatch Information Dispatched to a residence for chest pain. Scene Information Upon arrival you are met by a person who tells you their spouse is having chest pain. You are directed to the living room. The patient appears to be in his/her 60's. The patient is supine in a LazyBoy recliner (fully reclined). Witnessed or Secondary Information (as required) If asked, the spouse (or the patient) will tell attendant that the pain started while mowing the lawn; that the patient walked in from the back yard to the recliner; and that the patient has taken 3 doses of his/her nitro spray but it has not helped with the pain. The patient feels "weak" and normally this does not happen when he/she has an angina attack.

Criteria Relevant findings Required actions RSE Safe LOC Alert Calm and reassure patient

D None A Open and clear B Present and adequate C Radial pulse rapid, weak, and regular


Interventions Manage chest pain Position patient sitting or semi-sitting, oxygen

therapy, and loosen any constrictive clothing

C/C "My chest pain is acting up again" HX C/C You were out mowing the lawn when the

pain started. You came inside, sat down and took 3 doses of your nitro spray medication but the pain remained so you decided you better call for assistance

Med Hx Angina for the last 2 years and you had by-pass surgery 9 years ago

Medication Nitro Spray Allergies Almonds


PULSE 120 weak and regular PULSE 110 weak and regular RESP 16 regular RESP 16 regular

SKIN Pale, cool, clammy SKIN Pale, cool Other/Misc.

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3.27 Respiratory


• Manage a short of breath patient


C/C: "Short of breath" HxC/C: You were playing hockey and you are having an exercise induced asthma attack.

Your asthma medication (inhaler) is in your vehicle and you have sent a team-mate to get the medication for you. You have had similar attacks when exercising and the medication normally helps

Pain Assessment (PQRST) N/A Relevant symptoms: You have wheezing lung sounds upon each expiration and you have cyanosis in

your lips Relevant past Med Hx: Asthma for 10 years Medications: Maxair and Advair - both used to control your asthma Allergies: Pollen, dust, and pet dander Other: You are portraying a 30 year old patient.

You can only talk in 2-3 word sentences because of your SOB. Position yourself sitting, leaning forward with your hands on your knees. If the attendant tries to position you differently, insist on staying in this position. Have the team-mate arrive with the patient's asthma inhaler 2 minutes into the simulation

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Scenario Information Dispatch Information You are dispatched to a local hockey rink for a patient short of breath. Scene Information You are directed into one of the players dressing rooms. You see a patient who appears to be in his 30's. The patient is obviously short of breath. Witnessed or Secondary Information (as required) If asked, the patient was playing hockey and quite suddenly became short of breath. The patient is able to tell you that he is experiencing an exercise induced asthma attack. The patient has sent a teammate to his vehicle to get his asthma inhaler. The patient is able to tell you he has had similar attacks when exercising and the medication normally helps

Criteria Relevant findings Required actions RSE Safe LOC Alert Calm and reassure patient

D None A Open and clear B Rapid and laboured. You can hear wheezing

upon each expiration. Adequate

C Radial pulse present, rapid and regular RBS Patient extremely short of breath, cyanosis

on lips, no injuries found Notice shortness of breath and cyanosis


Manage shortness of breath Position patient in the position for easiest breathing, oxygen therapy, and when available, assist patient with his asthma inhaler medication

C/C "Short of breath" HX C/C You were playing hockey and you are

having an exercise induced asthma attack. You have had similar attacks when exercising and the medication normally helps

Med Hx Asthma for 10 years Medication Maxair and Advair - both used to control

your asthma Allergies Pollen, dust, and pet dander


PULSE 120 regular PULSE 100 regular RESP 28 laboured with wheezes RESP 24 regular

SKIN Flushed, sweaty, cyanosis SKIN Normal Other/Misc. The team-mate will arrive with the patient's

medication approximately 2 minutes into the simulation

Give the second set of vital signs only if the attendant assists the patient with his medication.

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3.28 Respiratory


• Manage a short of breath patient


C/C: "I'm short of breath and it is worth this morning" HxC/C: You went to bed last night feeling mildly short of breath but it has progressed

overnight to the point where you are weak and very short of breath Pain Assessment (PQRST) N/A Relevant symptoms: Audible bubbling noises in lungs Relevant past Med Hx: Heart attack 5 years ago, high blood pressure for 10 years Medications: Lasix, Altace, and Isodril Allergies: Morphine Other: You are portraying an anxious patient in their 70's.

You are found supine in a bed. If the attendant sits you up and applies oxygen this helps your breathing considerably over about 5 minutes

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Scenario Information Dispatch Information At 5:00 am you are dispatched to a residence for shortness of breath Scene Information You are directed into a bedroom where you see an elderly patient lying in their bed. The spouse tells you that he/she went to bed feeling a "little short of breath" but it has gotten worse through the night, and now it's at the point where he/she dosen't have the strength to get out of bed. Witnessed or Secondary Information (as required)


D None A Open and clear B Laboured, bubbly, but adequate C Radial pulse rapid and regular

RBS Bubbly sounds coming from lungs, swollen lower legs and feet

Notice abnormal breath sounds and swelling in lower legs and feet


Manage shortness of breath Position patient sitting and oxygen therapy

C/C "I'm short of breath and it is worth this morning"

HX C/C You went to bed last night feeling mildly short of breath but it has progressed overnight to the point where you are weak and very short of breath

Med Hx Heart attack 5 years ago, high blood pressure for 10 years

Medication Lasix, Altace, and Isodril Allergies Morphine

Vital Signs Initial Set Second Set (if applicable) LOC Alert and anxious LOC Alert

PULSE 104 regular PULSE 96 regular RESP 28 laboured and bubbly RESP 20 laboured

SKIN Flushed and sweaty SKIN Flushed Other/Misc. Note: If the attendant does not sit the patient

up stay with the first set of vital signs If the patient is sat up and given oxygen then, after 5 minutes, you can give the second set

Page 1 09/09/2008



3.29 Stroke


• Manage a stroke patient


C/C: Provided by the spouse - "Severe headache - possible stroke" HxC/C: Provided by spouse - sudden onset (about 20 minutes ago) of a severe headache

and now he can't talk and he can't move his right arm Pain Assessment (PQRST) N/A Relevant symptoms: Facial droop, incontinent of urine Relevant past Med Hx: High blood pressure and glaucoma Medications: Aldactone, Lopressor, and Vasotec for your high blood pressure and OptiPranolol

for your glaucoma Allergies: Demerol Other: You are portraying a patient in their 70's. You are confused and unable to talk.

If attempted, you have decreased grip strength on right side You are found lying supine on the couch.

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Scenario Information Dispatch Information You are dispatched to a residence for a possible stroke Scene Information You are met by the wife who tells you that she thinks her husband has had a stroke. You are directed into the living room where you see a male patient lying supine on the couch. Upon approach you notice that he is awake and looking at you but not talking. Witnessed or Secondary Information (as required) If asked, the spouse can provide the following information - sudden onset (about 20 minutes ago) of a severe headache and now he can't talk and he can't move his right arm

Criteria Relevant findings Required actions RSE Safe LOC Awake, appears very confused, and is unable

to talk Calm and reassure patient

D None A Open and clear B Present and adequate C Radial pulse strong and bounding

RBS Facial droop, right side of body not moving, and incontinent of urine

Notice facial droop, paralysis of right side, and incontinence


Manage a stroke patient Leave patient supine but elevate head and shoulders and oxygen therapy

C/C Provided by the spouse - "Severe headache - possible stroke"

HX C/C Provided by spouse - sudden onset (about 20 minutes ago) of a severe headache and now he can't talk and he can't move his right arm

Med Hx High blood pressure and glaucoma Medication Aldactone, Lopressor, and Vasotec for your

high blood pressure and OptiPranolol for your glaucoma

Allergies Demerol

Vital Signs Initial Set Second Set (if applicable) LOC Awake and confused LOC Awake and confused

PULSE 60 strong, bounding, and regular

PULSE 60 strong, bounding, and regular

RESP 16 regular RESP 16 regular

SKIN Flushed and dry SKIN Flushed and dry Other/Misc. If done, the patient has decreased grip

strength on right side

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3.3 Head Injury


• C-Spine control • Control arterial bleeding from a head injury


C/C: "My head hurts" HxC/C: You can't answer this question - simply moan and act very confused. You are not

aware how you got hurt. If they ask a witness they will explain that you were assaulted

Pain Assessment (PQRST) N/A Relevant symptoms: Keep moaning about your head hurting and trying to rub the area with your hand Relevant past Med Hx: "Can't remember". Again, if asked witnesses can state you have HIV and Hepatitis

C Medications: . Don’t remember". Again, if asked witnesses can state you take Methadone Allergies: "I don't think so…maybe" Other: If asked, you think you may have been knocked out for awhile but you are not sure

Page 2 09/09/2008


Scenario Information Dispatch Information Possible assault in the 200 block Main Street. Police are enroute. Scene Information Police are on the scene talking to bystanders. Patient is lying supine with a small pool of blood by his head. Witnessed or Secondary Information (as required) Patient assaulted by two people while walking home. Apparently he was pushed to the ground and he hit his head on the edge of the sidwalk curb.

Criteria Relevant findings Required actions RSE Police on scene Determine the scene is safe LOC Very confused, groaning

D Possible spinal injury C-spine control A Open and clear B Normal C Radial pulse present

RBS Wound on right side of head with profuse heavy bleeding

Find injury


Control arterial bleeding Direct pressure, dressing and bandage applied with minimal head/neck movement

C/C "My head hurts" HX C/C Witnesses state he was assaulted and hit his

head on the curb Med Hx Witnesses state HIV and Hepatitis C

Medication Witnesses state Methadone Allergies None known

Vital Signs Initial Set Second Set (if applicable) LOC Confused, groaning LOC Confused, groaning


SKIN Pale, cool SKIN Pale, cool Other/Misc. Contusion on head with bleeding and

swelling Blood loss

Cold pack Apply oxygen as soon as practical after getting bleeding controlled

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3.30 Stroke


• Manage a stroke patient


C/C: Unconscious HxC/C: As provided by the daughter - you were last seen yesterday evening and at that

time you appeared fine. The daughter came to take you out for lunch and found you unconscious in bed

Pain Assessment (PQRST) N/A Relevant symptoms: You open your eyes to verbal stimuli but you cannot talk, you have facial droop,

and, if checked, you have unequal pupils. You can move the right side of your body but not the left side

Relevant past Med Hx: As provided by the daughter - two previous strokes - last year and the year before that. High blood pressure and arthritis

Medications: As provided by the daughter - Lasix and Blockadren for your high blood pressure and Naproxen and Leflunomide for your arthritis

Allergies: As provided by the daughter - Sulfa drugs Other: You are portraying an 85 year old woman. You are found supine in bed.

Upon the attendant's arrival you should portray snoring like breathing. If the attendant opens your airway (manually or with an OPA) you can then stop the snoring breathing.

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Scenario Information Dispatch Information Dispatched to an assisted living faculty for an unconscious patient. Scene Information You are met at the front door by a woman who informs you she is the daughter of the patient. She states that she thinks her mom has had another stroke. She tells you that she talked to her mom last night and she was fine and when she came today to take her to lunch she was unconscious. You are directed into a bedroom where you see an elderly woman lying supine on a bed. As you approach the patient you notice snoring like respirations. Witnessed or Secondary Information (as required)

Criteria Relevant findings Required actions RSE Safe LOC Opens her eyes to painful stimuli but is

unable to talk Calm and reassure patient

D None A Noisy - snoring in character Open airway (head-tilt/chin-lift or OPA) B Present and adequate C Radial pulse strong and bounding

RBS Facial droop, unequal pupils, no movement of limbs on left side

Notice facial droop and lack of body movement on the left side


Manage a stroke patient Roll 3/4 prone and oxygen therapy

C/C Possible stroke HX C/C As provided by the daughter - patient was

last seen yesterday evening and at that time appeared fine. The daughter came to take patient out for lunch and found patient unconscious in bed

Med Hx As provided by the daughter - two previous strokes - last year and the year before that. High blood pressure and arthritis

Medication As provided by the daughter - Lasix and Blockadren for your high blood pressure and Naproxen and Leflunomide for your arthritis

Allergies As provided by the daughter - Sulfa drugs

Vital Signs Initial Set Second Set (if applicable) LOC Opens eyes to painful stimuli LOC Opens eyes to painful stimuli

PULSE 64 strong, bounding and regular

PULSE 64 strong, bounding and regular

RESP 12 regular RESP 12 regular

SKIN Flushed and dry SKIN Flushed and dry Other/Misc.

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3.31 Diabetic


• Manage a diabetic patient


C/C: "I'm dizzy, confused, and I feel light-headed" HxC/C: You worked a night shift (as a security guard) last night but you never had

anything to eat Pain Assessment (PQRST) N/A Relevant symptoms: Pale sweaty skin and abnormal behaviour Relevant past Med Hx: Diabetic for the last 15 years Medications: Glucophage and Insulin Allergies: Morphine Other: You are portraying a confused 67 year old male patient (retiree working as a

security guard). If asked, you have taken your diabetic medications as prescribed. You are wearing a Medical Alert stating that you are diabetic. You are found standing. If the attendant give you oxygen and sugar/Glucogel you become less confused over 5 minutes

Page 2 09/09/2008


Scenario Information Dispatch Information You are dispatched to the local mall for a patient who is acting abnormally. Scene Information You are met by a mall security guard. He informs you that he came in this morning to relieve the night shift and found the night shift security guard wandering around the mall, confused, and disorientated. You are directed to a man who appears to be in his late 60's. He is standing in the mall security office. He appears confused. Witnessed or Secondary Information (as required) If asked, the relieving security guard does know that his colleague is a diabetic.

Criteria Relevant findings Required actions RSE Safe LOC Awake but confused


RBS No injuries found, skin pale and sweaty, Medical Alert bracelet

Notice pale sweaty skin and find Medical Alert bracelet


Manage a diabetic patient Sit patient down, give the patient sugar (candy, juice, or Glucogel) and oxygen therapy

C/C "I'm dizzy, confused, and I feel light-headed"

HX C/C You worked a night shift (as a security guard) last night but you never had anything to eat

Med Hx Diabetic for the last 15 years Medication Glucophage and Insulin

Allergies Morphine

Vital Signs Initial Set Second Set (if applicable) LOC Awake but confused LOC Alert


SKIN Pale and sweaty SKIN Normal Other/Misc. If the attendant administers sugar/Glucogel

then after 5 minutes go to the second set of vital signs, if not, stay with initial vital signs

Note: The administration of sugar/Glucogel may have to come after the attendant obtains a complete history

Page 1 09/09/2008



3.32 Diabetic


• Manage a diabetic patient


C/C: Unconscious HxC/C: As provided by the husband - his wife has had the flu the last 3 days; she has been

vomiting up everything she tries to eat. She went to bed tired and exhausted and now this morning I cannot wake her up

Pain Assessment (PQRST) N/A Relevant symptoms: Pale sweaty skin Relevant past Med Hx: As provided by the husband - diabetic for 20 years and some thyroid condition Medications: As provided by the husband - insulin and Armour® Thyroid Allergies: Shellfish Other: You are portraying an unconscious 75 year old female patient.

You are found supine in a bed. You are wearing a Medical Alert bracelet stating you are diabetic. Your husband has been giving you your insulin as required.

Page 2 09/09/2008


Scenario Information Dispatch Information Dispatched to a private residence for an unconscious patient. Scene Information You are met at the door by a man who informs you his wife is very sick. As he directs you to the bedroom he tells you his wife has had the flu for the last 3 days, she has been vomiting and unable to keep any food down. He states that she went to bed early last night tired and exhausted and then this morning he was unable to wake her up. As you approach the patient you notice a woman who appears to be in her mid 70's. She is lying supine and you notice her breathing is snoring in character. Witnessed or Secondary Information (as required) If asked about any medical condidtions, the husband will state his wife is a diabetic and has some thyroid problems. He will also state, if asked, that he has been giving his wife her insulin injections as required.

Criteria Relevant findings Required actions RSE Safe LOC Unconscious

D None A Noisy - snoring in character Open airway (head-tilt/chin-lift or OPA) B Present and adequate C Radial pulse rapid and weak

RBS No injuries found, skin pale and sweaty, Medical Alert bracelet

Notice pale sweaty skin and find Medical Alert bracelet


Manage a diabetic patient Position 3/4 prone, oxygen therapy, administer Glucogel

C/C Unconscious HX C/C As provided by the husband - his wife has

had the flu the last 3 days; she has been vomiting up everything she tries to eat. She went to bed tired and exhausted and now this morning I cannot wake her up

Med Hx As provided by the husband - diabetic for 20 years and some thyroid condition

Medication As provided by the husband - insulin and Armour® Thyroid

Allergies Shellfish


PULSE 120 weak PULSE 120 weak RESP 24 shallow RESP 24 shallow

SKIN Pale and sweaty SKIN Pale and sweaty Other/Misc. Note: There is no improvement in the

patient's condition.

Page 1 09/09/2008



3.33 Overdose


• Manage an overdosed patient


C/C: Unconscious HxC/C: Provided by husband - he came home to find you unresponsive lying on the couch.

He thinks you may have purposely overdosed on booze and pills. He last saw you 4 hours ago.

Pain Assessment (PQRST) N/A Relevant symptoms: Smell of alcohol on breath, an empty bottle of Tylenol # 3, and a 1/2 empty bottle

of vodka Relevant past Med Hx: Bi-polar with depression Medications: Elavil Allergies: Bees and wasps Other: You are portraying a 35 year old woman. You remain unconscious. You are found

supine on the couch. The husband does not know how many Tylenol #3 may have been in the bottle.

Page 2 09/09/2008


Scenario Information Dispatch Information Dispatched to a residence for a possible drug overdose. Scene Information You are met by the husband who tells you he came home to find his wife unresponsive lying on the couch. He thinks his wife may have purposely overdosed on booze and pills. He last saw her 4 hours ago. The husband directs you into the living room. You see a woman who appears to be in her mid 30's lying supine on the couch. As you approach you notice a 1/2 empty bottle of vodka and an empty bottle of Tylenol # 3. The patient appears unconscious. Witnessed or Secondary Information (as required) If asked, the husband will state his wife does suffer from bi-polar disorder and is being treated for depression.

Criteria Relevant findings Required actions RSE Safe. Empty pill bottle and 1/2 empty bottle

of vodka Notice empty pill bottle and 1/2 empty vodka bottle

LOC Unconscious D None A Open and clear OPA B Slow but adequate C Radial pulse present and regular

RBS Alcohol on breath Notice alcohol on breath Critical

Interventions Manage a drug overdose Maintain Airway and roll 3/4 prone

C/C Unconscious - possible drug overdose HX C/C Provided by husband - he came home to find

you unresponsive lying on the couch. He thinks you may have purposely overdosed on booze and pills. He last saw you 4 hours ago.

Med Hx Bi-polar with depression Medication Elavil

Allergies Bees and wasps



SKIN Normal SKIN Normal Other/Misc. Oxygen therapy as soon as practical

Page 1 09/09/2008



3.34 Overdose


• Manage an overdosed patient


C/C: Unconscious HxC/C: Provided by brother - you shot up some heroin 20 minutes ago and now he can not

wake you up. The brother panicked and called for an ambulance. Pain Assessment (PQRST) N/A Relevant symptoms: Track marks on both arms Relevant past Med Hx: Provided by brother - you have some form of heart defect but he doesn't know

exactly what it is Medications: Provided by brother - you are suppose to take something for your heart but he

doesn't know what the name of the medication is Allergies: Provided by brother - Shellfish Other: You are portraying a 21 year old male patient. You are found supine and

unconscious.

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Scenario Information Dispatch Information You are dispatched to a know "crack-house" for a possible drug overdose. Dispatch informs you the police are already on scene. Scene Information You are met by the police who tell you the scene is secure. They inform you that one of the residents has overdosed on heroin. As you enter the house you see various drug paraphernalia and you notice one police officer is talking to a young male who is apparently the patient's brother. The patient is lying supine on the living room floor. As you approach you notice a syringe laying beside the patient. Witnessed or Secondary Information (as required) If asked, the brother will state the patient shot up some heroin 20 minutes ago and then he couldn't wake him up. The brother panicked and called for an ambulance.

Criteria Relevant findings Required actions RSE Police have secured the scene. Used syringe

lying beside patient Confirm with police that the scene is safe. Safely remove syringe away from patient

LOC Unconscious D None A Noisy - snoring in character Open airway (head-tilt/chin-lift) or OPA B Slow but adequate C Radial pulse present and regular

RBS Track marks on both arms. No other injuries found

Find track marks


Manage a drug overdose Maintain Airway and roll 3/4 prone

C/C Unconscious - drug overdose HX C/C As provided by brother - shot up heroin

approximately 20 minutes ago Med Hx Provided by brother - patient has some form

of heart defect but he doesn't know exactly what it is

Medication Provided by brother - patient is suppose to take something for his heart but he doesn't know what the name of the medication is

Allergies Provided by brother - Shellfish



SKIN Normal SKIN Normal Other/Misc. Oxygen therapy as soon as practical

Page 1 09/09/2008

EMA Licensing emalb [email protected] Ministry of Health Services


3.35 Seizure


• Manage a seizure patient


C/C: You are not complaining of anything. All you want is to go back to school and be

left alone. State: "I know I had a seizure, I've had them before, just leave me alone and I will be okay".

HxC/C: Friends witnessed you have generalized body seizure on the grassy field behind the high school. The witnesses state the seizure lasted about 30 seconds and that you did not fall.

Pain Assessment (PQRST) N/A Relevant symptoms: Mild confusion ("spaced out") Relevant past Med Hx: Epileptic Medications: Dilantin Allergies: Hay fever Other: You are portraying a high school student.

You are to act confused. You remember the seizure coming on so you sat down on the grass - you have no injuries. You are wearing a Medical Alert that states you have epilepsy.

Page 2 09/09/2008


Scenario Information Dispatch Information Dispatched to the playing field behind the local high school for a seizure. Scene Information You are met by two teenagers who tell you their friend had a seizure. As you walk towards the patient the witnesses tell you their friend is epileptic. The patient is a young girl who appears to be in her late teens. The patient is sitting on the grass. Witnessed or Secondary Information (as required) If asked, the friends will state the seizure was a generalized body seizure that lasted approximately 30 seconds and that the patient never fell.

Criteria Relevant findings Required actions RSE Safe LOC Confused Calm and reassure patient

D None Determine mechanism of injury - rule out spinal injury

A Open and clear B Present and adequate C Radial pulse present and regular

RBS Medical Alert bracelet that states the patient is epileptic

Find Medical Alert


Manage a seizure patient Keep patient sitting on the grass and oxygen therapy

C/C You are not complaining of anything. All you want is to go back to school and be left alone.

HX C/C Friends witnessed patient have generalized body seizure. The witnesses state the seizure lasted about 30 seconds and that the patient did not fall.

Med Hx Epileptic Medication Dilantin

Allergies Hay fever

Vital Signs Initial Set Second Set (if applicable) LOC Confused LOC Alert


SKIN Normal SKIN Normal Other/Misc. Continue to reassure patient and convince to be

seen by a physician

Page 1 09/09/2008



3.36 Seizure


• Manage a seizure patient


C/C: N/A - the patient is actively seizuring and cannot talk HxC/C: Provided by girlfriend - The seizure started about 10 minutes ago. Normally the

seizure stops within a minute or two but this time it has kept going. She states they were getting dressed to go out for supper when the seizure started. The patient slumped against the bed mattress and slid to the floor.

Pain Assessment (PQRST) N/A Relevant symptoms: Generalized body seizures are still occurring. Patient incontinent of urine Relevant past Med Hx: Provided by girlfriend - diagnosed with a small brain tumour 6 months ago Medications: Provided by girlfriend - Temodar (to help reduce the size of the brain tumour) and

Dilantin (to stop the seizures) Allergies: Provided by girlfriend - Morphine Other: You are portraying a 40 year old male patient who is actively having a generalized

body seizure (try and have both arms and legs twitching as best you can). Stop seizuring approximately 2 minutes into the simulation.

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Scenario Information Dispatch Information Dispatched to an apartment for a seizure. Scene Information You are met by a woman who tells you her boyfriend is having a seizure. She directs you to the bedroom where you see a man in his 30's having a generalized body seizure. Witnessed or Secondary Information (as required) If asked, the girlfriend will say that the seizure started about 10 minutes ago; that normally the seizures only last 1-2 minutes and then stop; that the patient was getting dressed and slumped against the bed mattress and then slid to the floor; and she will be able to provide the rest of the medical history.

Criteria Relevant findings Required actions RSE Safe LOC Unconscious (active generalized seizures) Calm and reassure patient

D None Determine mechanism of injury - rule out spinal injury

A Open and clear B Present and adequate C Unable to detect pulse because of seizure

activity

RBS No injuries found, active generalized seizures are ongoing

Notice generalized seizures


Manage a seizure patient Attempt to insert an OPA, oxygen therapy, loosen tight clothing, do not hold patient down, protect the patient from injury, roll patient 3/4 prone

C/C Seizure HX C/C Provided by girlfriend - The seizure stated

about 10 minutes ago. Normally the seizure stops within a minute or two but this time it has kept going.

Med Hx Provided by girlfriend - diagnosed with a small brain tumour 6 months ago

Medication Provided by girlfriend - Temodar (to help reduce the size of the brain tumour) and Dilantin (to stop the seizures)

Allergies Provided by girlfriend - Morphine


PULSE N/A (due to seizures) PULSE 110 regular RESP 24 shallow RESP 24 shallow

SKIN Flushed SKIN Flushed Other/Misc. Patient stops seizuring approximately 2

minutes after your arrival Give second set of vitals after the patient stops seizuring

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3.4 Head Injury


• C-spine control • Airway management


C/C: Unresponsive HxC/C: Witnesses will be able to state that you were knocked off your bicycle by a car Pain Assessment (PQRST) N/A Relevant symptoms: N/A Relevant past Med Hx: Unknown Medications: Unkonwn Allergies: Unknown Other: Lying supine on street, unresponsive with a closed head injury

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Scenario Information Dispatch Information You are dispatched to 500 Waterstreet for a cyclist struck. Scene Information You are met by witnesses who explain that the patient was riding his bicycle and was it by a car. They state the patient was thrown through the air landing on his helmet. They state that the patient has not moved or talked since the accident. They state that they took the patient's helmet off. Witnessed or Secondary Information (as required) If asked, witnesses state that the car turned in front of the cyclist, the patient hit the windshield and then was thrown about 3 metres through the air.

Criteria Relevant findings Required actions RSE Patient found on a residential street Ensure scene is safe before approaching patient LOC Unresponsive

D Possible spinal injury C-spine control A Snoring respirations (normal if airway is

opened) Jaw Thrust, OPA

B Normal C Radial pulse present

RBS Numerous scrapes and bruises. Large contusion on forehead

Find injuries


C/C Unresponsive HX C/C Hit by a car while riding a bicycle. Thrown

through the air landing on the ground head first

Med Hx Unknown Medication Unknown

Allergies Unknown

Vital Signs Initial Set Second Set (if applicable) LOC Unresponsive LOC Unresponsive

PULSE 60 regular PULSE 76 regular RESP 20 adequate RESP 20 adequate

SKIN Dry and warm SKIN Dry and warm Other/Misc. Bystanders took off the patient's helmet Document

Oxygen therapy as soon as practical

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3.5 Chest Injury


• C-spine consideration • Chest wall stabilization for a flail chest


C/C: "My ribs hurts, it hurts to breath" - and point to your left side of your chest HxC/C: "Another player ran into me with his helmet Pain Assessment (PQRST) Sharp pain on my left side that radiates into by breastbone (sternum), 8/10, hurts

more when I breath Relevant symptoms: Guarding, complain if the area is touch Relevant past Med Hx: None - healthy Medications: None Allergies: None Other: If asked, you had your helmet on , did not bang your head, did not lose

consciousness, and have no neck pain

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Scenario Information Dispatch Information You are sent to the local high school for a sports injury. Scene Information You are directed to the fooball playing field and are met by te football coach who leads you to the injured player. You see a teenage boy laying on the grass in obvious pain. He is holding his left chest. Witnessed or Secondary Information (as required) If asked, witnesses will tell you that the patient was practicing without his shoulder pads and chest protector. Another player ran into him at full speed, head down, hitting the patient with their helmet in the left side ot the chest

Criteria Relevant findings Required actions RSE None LOC Alert but in obvious pain Calm and reassure patient


A Open clear B Laboured, shallow, but adequate C Radial pulse present and regular

RBS Chest injury - flail segment on left side of chest

Find injury


Flail chest Position patient semi-sitting. Stabilize

C/C "My ribs hurt - it hurts to breath" HX C/C "Another player ran into me with his helmet" Med Hx None

Medication None Allergies None

Vital Signs Initial Set Second Set (if applicable) LOC Alert and anxious LOC Alert

PULSE 112 regular PULSE 100 regular RESP 28 shallow and guarded RESP 24 shallow and guarded

SKIN Pale, cool, clammy SKIN Pale, cool Other/Misc. The pain will decrease somewhat when the

chest wall is stabilized Oxygen therapy as soon as practical once it is determined the patient has a chest injury

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3.6 Chest Injury


• Treat an open chest injury


C/C: "My chest hurts - I can't breath". HxC/C: "Slipped while climbing over a fence". Pain Assessment (PQRST) Right side of chest, sharp stabbing pain, does not radiate, 8/10 for severity Relevant symptoms: Short of breath, guarding the injury area, chest pain Relevant past Med Hx: Healthy Medications: Over the counter medication for hay fever Allergies: Hay fever and penicillin Other: If asked, did not bang your head, did not lose consciousness, and have no neck

pain

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Scenario Information Dispatch Information Dispatched to a residence for a fall. Scene Information You are met by a witness who leads you to a man who apprears in his late 20's sitting on the grass below a wrought iron fence. Witnessed or Secondary Information (as required) The witiness states that the patient has been "drinking" all afternoon and he tried to climb the fence to retrieve a frisbee and slipped impaling himself on one of the iron pickets.

Criteria Relevant findings Required actions RSE Back yard party, no dangers LOC Alert and agitated


A Open and clear B Laboured, shallow, but adequate C Radial pulse present and regular

RBS Chest injury - open sucking chest injury on the right side of the chest

Find injury


Open chest injury Expose, cover wound with gloved hand and then cover the wound with an occlusive dressing, taped on 3 sides

C/C "My chest hurts - I can't breath". HX C/C Slipped while climbing over a wrought iron

fence and impaled himself on a picket. Med Hx Healthy

Medication Over the counter medication for hay fever Allergies Hay fever and penicillin

Vital Signs Initial Set Second Set (if applicable) LOC Alert and agitated LOC Alert

PULSE 112 rapid PULSE 96 regular RESP 28 shallow RESP 20 shallow

SKIN Pale and cool SKIN Pale and cool Other/Misc. Breathing improves slightly once sucking

chest wound is sealed Oxygen therapy as soon as practical once it is determined the patient has a chest injury

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3.7 Fracture Injury


• Treat a fractured arm


C/C: "Pain in my lower left arm" HxC/C: "Landed on my arm after falling off my mountain bike" Pain Assessment (PQRST) Sharp throbbing pain just above the wrist. Pain does not radiate. 7/10 for severity Relevant symptoms: Swelling at injury site. It is a closed fracture. Relevant past Med Hx: Diabetic Medications: Insulin Allergies: Demerol Other: Position yourself sitting holding your left arm. It hurts to move your arm. If asked,

you had your helmet on, you did not bang your head, you did not lose consciousness, and you have no neck pain.

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Scenario Information Dispatch Information You are sent to a community park for a mountain bike accident. Scene Information You arrive on scene to find 2 mountain bikers kneeling beside a woman who appears to be in her late twenties. She is in obvious pain and you notice that she is supporting her left arm. She is still wearing her mountain bike helmet. It is a warm summer day. Witnessed or Secondary Information (as required) If asked, you had your helmet on, you did not bang your head, you did not lose consciousness, and you have no neck pain.

Criteria Relevant findings Required actions RSE Safe LOC Alert and in obvious pain


A Open and clear B Present, adequate C Radial pulse present and regular

RBS Possible closed fracture lower left arm, redness, swelling, and point tenderness

Find injury


Manage fracture Support and stabilize injury

C/C "Pain in my lower left arm" HX C/C "Landed on my arm after falling off my

mountain bike" Med Hx Diabetic

Medication Insulin Allergies Demerol



SKIN Warm, pink, sweaty SKIN Warm, pink, sweaty Other/Misc. Swelling Apply ice. Oxygen therapy as soon as practical after

stabilizing injury.

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3.8 Dislocation Injury


• Treat a dislocated shoulder


C/C: "Severe pain in my right shoulder, I think I have dislocated it again" HxC/C: You collided with another soccer player running in the opposite direction Pain Assessment (PQRST) Constant throbbing pain in right shoulder, the pain does not radiate, 9/10 for

severity Relevant symptoms: Numbness and tingling in the fingers of your right hand. Unable to move shoulder

joint. Relevant past Med Hx: Healthy but you have dislocated this same shoulder twice before while skiing Medications: Birth control pills Allergies: Morphine Other: Position yourself sitting holding your right arm. It hurts to move your arm. If

asked, you did not bang your head, you did not lose consciousness, you have no neck pain, and you walked off the field after the collision.

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Scenario Information Dispatch Information You are dispatched to a playing field for a sports injury. Scene Information It's a warm sunny day. You find a woman in her mid twenties sitting on the sidelines of a soccer pitch supporting her right arm. She is in obvious discomfort. Witnessed or Secondary Information (as required) If asked, the patient did not bang her head, lose consciousness, has no neck pain, and walked off the field after the collision.

Criteria Relevant findings Required actions RSE Safe LOC Alert but in obvious pain


A Open and clear B Present and adequate C Radial pulse present and regular

RBS Obvious dislocation of right shoulder (deformity

Find injury


Manage dislocation Support and stabilize injury

C/C "Severe pain in my right shoulder, I think I have dislocated it again"

HX C/C I collided with another soccer player running in the opposite direction

Med Hx Healthy but have dislocated this same shoulder twice before while skiing

Medication Birth control pills Allergies Morphine



SKIN Warm, pink, sweaty SKIN Warm, pink, sweaty Other/Misc. Numbness and tingling in fingers of right

hand. Unable to move shoulder joint Apply ice. Oxygen therapy as soon as practical after stabilizing injury.

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3.9 Burn Injury


• Burn injury management


C/C: "I've burned my left arm" HxC/C: You accidentally knocked a saucepan full of boiling water off the range, splashing

water down your left arm. Pain Assessment (PQRST) Burning pain down my left arm and into my hand, does not radiate, 9/10 for

severity, and it happened approximately 15minutes ago. Relevant symptoms: Blistering to the back of the lower arm and hand Relevant past Med Hx: Juvenile arthritis Medications: Extra strength Tylenol Allergies: Peanuts Other: You are portraying a 13 year old child

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Scenario Information Dispatch Information Dispatched to a residence for a burn injury. Scene Information You are met at the door by a distraught mother who takes you to the kitchen. She tells you her 13 year old daughter accidently spilled boiling water on herself while making pasta. You find the girl standing at the sink with her left arm under running water. You notice obvious blisters beginning to form along the back of the lower arm and hand Witnessed or Secondary Information (as required)

Criteria Relevant findings Required actions RSE Safe Ensure range is shut off and the saucepan won't

cause further problems LOC Alert but in obvious pain

D None A Clear and open B Present and adequate C Radial pulse present and regular

RBS Burns to lower left arm and back of the hand Find injuries Critical

Interventions Second degree burn Cool for 10 minutes, cover with dry sterile dressing

C/C "I've burned my left arm" HX C/C "I accidentally spilled water while cooking

pasta" Med Hx Juvenile arthritis

Medication Extra strength Tylenol Allergies Peanuts



SKIN Pale SKIN Pale Other/Misc. Oxygen therapy as soon as practical.

Documents

3.10 Burn Injury - Frontline First Aid · Page 2 09/09/2008 EMA Licensing [email protected] Ministry of Health Services Scenario Information Dispatch Information You are dispatched