KS Chew Emergency Medicine Department

School of Medical Sciences Universiti Sains Malaysia

  Transport Mode

  Scene Size up

  Pre-hospital Patient Assessment

To bring the right patient, via the right mode of transportation,

to the right center within the right time

  Land ambulances

◦  Examples: Type A1, A, B, FWD

◦  Private ambulances – for paying cases, often non-emergencies

◦  Patients Transport Van

  Water ambulances

  Air Ambulances

  Motorcycle Squads

TYPE B TYPE A

  Immobilization package

  Trauma Kit

  Triage Card

  Stretcher

  All Grade B Equipments

  Transport Ventilator

  Defibrillator

  Monitor

◦  Note: Type A1: additional specialized equipments – incubator, mini intensive care facilities

  To reach persons in need as quickly as possible with trained personnel

  To stabilize the patient’s condition to prevent further deterioration

  To move the patient to a facility capable of providing more extensive care or additional services that will enhance patient outcome

  To offer the level of care equal to the receiving institution recognizing the limits inherent in traveling.

  Intra-hospital--transport of a patient from one location to another within the hospital

  Inter-hospital--transport of a patient between hospitals

  Scene run--transport of a patient from a non-medical site to the nearest available or designated hospital

•  Advantages –  Door‐to‐door service/no addi4onal transport vehicle 

–  No landing zone required –  Ease of personnel training –  Few weather restric4ons –  Affordable and generally reimbursable 

–  Family member rides too 

•  Disadvantages –  Mo4on sickness –  Limited pa4ent access, light and electrical power 

–  Traffic delays –  Transport 4me 

–  Vibra4on/noise (69‐75 dB) –  Need to carry addi4onal baReries/AC converters

  Transport‐related problem:  any event (expected @ unexpected), that impacted adversely on the pa4ent stability 

  Pa2ent‐related complica2ons:   any difficulty or complica4on, related directly to the pa4ent’s patho‐physiology. 

  Equipment‐related problems:    equipment/technical mishaps & transport environmental factors that could result in pa4ent instability 

Hub 

Ambulance Centre 

Admission Centre 

Relevant Dept. 

Mortuary 

OT 

Ambulance Base Sta4on 

Hospital 

Clinic 

NGO 

Private Hospital 

Police/Fire 

Social Worker 

INTRA 

HOSPITAL 

INTER

FACILITY

Response Time  Percent % 

< 10 min   8.8 

10 ‐20 min  38.3 

20 – 30 min  30.9 

> 30 min  22.1 

Aim to: Determining any threats to your own safety or to the safety of your pa4ents or bystanders, to determine the nature of the call, and to decide if you will need addi4onal help 

  Body substance isolation review

  Scene safety

  Total number of patients

  Essential equipment and resources needed on-scene

  Mechanism of injury

Toxic Substances or Hazmat

Mechanism of Injury Motor Vehicle Collision–Head On

Mechanism of Injury: Motor Vehicle Collision–Rear Impact

Mechanism of Injury:  Motor Vehicle Collision–Side Impact 

Mechanism of Injury:  Motor Vehicle Collision–Rollover 

One Nation, One Number 999

Information to relay to when making an emergency call   E = Exact Location - The precise location of the incident

  T = Type - The nature of the incident (trauma, non-trauma, heart atack, motor-vehicle accident), including how many vehicles, buildings etc. are involved

  H = Hazards - Both present and potential (e.g., explosion, spillage of combustible materials, highly volatile hydrocarbons, chemicals, etc)

  A = Access - Best route for emergency services to access the site, or obstructions and bottlenecks to avoid

  N = Numbers - Numbers of Casualties, Dead and Uninjured on scene

  E = Existing Emergency Services - Which services are already on scene, and which others are required - s0 as not to duplicate services, and for better utilization of services in other concurrently emergency happenings.

  Sorting of patients according to: ◦  ABCDEs

◦  Available resources

  Multiple casualties

  Mass casualties

  Stay and play versus Scoop and Run

Good Early Trauma Management

Impacts

100%

50%

0%

Immediate Deaths

Early Deaths

Late Deaths

% of Deaths

  Time is a critical factor for the patient with a significant MOI

  Barring the need for extrication, the rule of the “Golden hour” and the “Platinum 10 minutes” will apply

  The environment (ie: bottom of stairs, out in the cold, tripod position, pool of blood)

  Patient’s MOI/NOI

  Patient’s age and sex

  Patient’s degree of distress

  Listen for the chief complaint

  Keep the priority of care in focus

Mechanism of Injury:  Motor Vehicle Collision–Vehicle Interior 

  Are they conscious or unconscious? (if unconscious do CPR quick-check)

  Introduce yourself   What’s your name? (oriented to person)   Do you know where you are? (oriented to

place)   What day of the week is it? (oriented to day)   How can I help you today? (chief complaint)

 Alert – oriented to person, place, and day (“big three”)

 Verbal – cannot answer the “big three” correctly

 Painful – either appropriate, inappropriate, or posturing (decorticate/decerebrate)

 Unresponsive

  S – signs and symptoms

  A – allergies   M – medications   P – pertinent past medical history

  L – last oral intake   E – events leading up to

  D – deformity   C – contusions   A – abrasions   P – punctures/penetrations   B – burns   T – tenderness   L – lacerations   S – swelling

  D = Deformity

  O = Open Wound

  T = Tenderness

  S = Swelling

  Time is a critical factor for the patient with a significant MOI

  Barring the need for extrication, the rule of the “Golden hour” and the “Platinum 10 minutes” will apply

  The maximum time EMS providers stay on the scene for a critical trauma patient