1

PocketParamedic.org
contact@PocketParamedic.org
Pocket Paramedic
2013
By Jason Houghton
A collaboraton of useful guidelines
In a quick reference pocket book;
tailored for pre-hospital care.

2



Pocket Paramedic
2013

An elegant soluton to a simple problem

A collaboraton of useful guidelines in a quick
reference pocket book tailored for pre-hospital
care.

This handy pocket book resulted from my quest to
consolidate the most relevant and useful
guidance into a single source; something that can
be carried in your pocket at all tmes - whenever
you may need it.

Pocket Paramedic is 100% non-proft. Sold at cost.
Hopefully, this will mean more people can beneft
from it.

Download the FREE electronic editon from:
PocketParamedic.org

I hope you fnd it useful.

Jason Houghton - Paramedic
contact@pocketparamedic.org
3




Contents
Adults
Algorithms and Charts
4
Paediatrics
Algorithms and Charts
19
Obstetrics
Useful Informaton and Charts
32
Equipment
Instructons and Guidance
37
Assessment & History Taking
Aid memoirs, Acronyms and Diagnosis
45
Trauma & Medical Emergencies
Useful Informaton and Charts
53
Anatomy
Diagrams and Terminology
62
ECG & ETCO2 Interpretaton
Examples and Explanatons
68
Major Incidents
Acronyms and Plan of Acton
77
Infecton Preventon & Control
Useful Informaton
91
Key Contacts
Phone Numbers
96
Notes
Extra Space
97
References
Credits and Informaton Sources
99

4



Adults
Algorithms and Charts
Adult Basic Life Support 5
Adult Advanced Life Support 6
Adult Cardiac Arrest 7
Adult Bradycardia 8
Adult Tachycardia (With Pulse) 9
Adult Chocking Treatment 10
In Hospital Resuscitaton 11
AED Algorithm 12
Adult Glasgow Coma Scale 13
Adult Normal Ranges & Drug Dosages 14
Normal Peak Flow Readings 15
Normal Peak Flow Readings Chart - Men 16
Normal Peak Flow Readings Chart - Women 17
Adult Analgesic Ladder 18







5


Adult Basic Life Support
10

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6

Adult Advanced Life Support
10

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7


Adult Cardiac Arrest
10

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8
Adult Bradycardia
10

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9

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A
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1
0

10
Adult Choking Treatment
10

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11


In Hospital Resuscitaton
10

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12

AED Algorithm
10

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13


Adult Glasgow Coma Scale
Eyes



Verbal



Motor


4 Opens Eyes Spontaneously
3 Opens Eyes in Response to Voice
2 Opens Eyes in Response to Painful Stmuli
1 Does Not Open Eyes
5 Oriented, Converses Normally
4 Confused, Disoriented
3 Uters Inappropriate Words
2 Incomprehensible Sounds
1 Makes No Sounds
6 Obeys Commands
5 Localizes Painful Stmuli
4 Flexion / Withdrawal to Painful Stmuli
3 Abnormal Flexion to Painful Stmuli (Decortcate)
2 Extension to Painful Stmuli (Decerebrate)
1 Makes No Movements
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14

Adult Normal Ranges & Dosages
Parameter Unit Value
Heart Rate BPM 60 - 100
Respiratory Rate BPM 12 - 19
SpO2 % 95
BP Systolic mmHg 100 - 170
BP Diastolic mmHg 60 - 80
Blood Glucose (BM) mmol/L 5 - 10.9
Energy 1
st
Shock Joules 200
Energy 2
nd
Shock Joules 300
Energy 3
rd
Shock Joules 360
Adrenaline 1:10000 mg (ml) 1 (10)
Amiodarone mg (ml) 300 (10)
Amiodarone (Refractory VF/VT) mg (ml) 150 (5)
A
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15


Normal Peak Flow Readings
8

EU/EN13826 PEF Meters Only
A
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16
A
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17

A
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8


18

Adult Analgesic Ladder
(12 Years and Older)
Pain Score Medical Pain
Trauma,
Orthopaedic,
Musculoskeletal &
Sof tssue Pain
0 3
Mild
Pain
Consider Entonox
+/-
Ibuprofen 400MG
Consider Entonox
+/-
Ibuprofen 400MG
4 6
Moderate Pain
Consider Entonox
+/-
Morphine
2.5 to 5mg
(Max 20mg)
Consider Entonox
+/-
Ibuprofen 400MG
7 10
Severe
Pain
Consider Entonox
+/-
Morphine
2.5 to 5mg
(Max 20mg)
Consider Entonox
+/-
Ibuprofen 400MG
+/-
Morphine
2.5 to 5mg
(Max 20mg)
For Cardiac Related Chest Pain
Morphine Should be Considered in the First Instance
A
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19




Paediatrics
Paediatric Basic Life Support 20
Paediatric Advanced Life Support 21
Paediatric Cardiac Arrest 22
Newborn Advanced Life Support 23
Paediatric Chocking Treatment 24
Paediatric Glasgow Coma Scale 25
Paediatric Arrest Calculatons 26
Paediatric Normal Ranges & Arrest Dosages 27
Normal Peak Flow Readings Chart - Paediatric 28
Pain Assessment Faces 29
FLACC Scale Pain Assessment 30
Paediatric Analgesic Ladder 31











20

Paediatric Basic Life Support
10

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s

21


Paediatric Advanced Life Support
10

P
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22

Paediatric Cardiac Arrest
10

P
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s

23


Newborn Life Support
10

P
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s

24
Paediatric Choking Treatment
10

P
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s

25


Paediatric Glasgow Coma Scale
Eyes


Verbal


Motor


4 Opens Eyes Spontaneously
3 Opens Eyes in Response to Speech
2 Opens Eyes in Response to Painful Stmuli
1 Does Not Open Eyes
5 Smiles, Orients to Sounds, Objects, Interacts
4 Cries but Consolable, Inappropriate Interactons
3 Inconsistently Inconsolable, Moaning
2 Inconsolable, Agitated
1 No Verbal Response
6 Infant Moves Spontaneously or Purposefully
5 Infant Withdraws from Touch
4 Infant Withdraws from Pain
3 Abnormal Flexion to Pain for Infant (Decortcate)
2 Extension to Pain (Decerebrate)
1 No motor response
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26

Paediatric Arrest Calculatons
10

WEIGHT

ENERGY

TUBE SIZE

FLUID

ADRENALINE AMIODARONE

GLUCOSE

Age Formula
0 12 Months Weight (kg) = (Age in Months x 0.5) + 4
1 5 Years Weight (kg) = (Age in Years x 2) + 8
6 12 Years Weight (kg) = (Age in Years x 3) + 7
Age Formula
0 12 Years Joules = Weight (kg) x 4j
Age Formula
Pre Term 2.5mm
Neonates 3 3.5mm
1 10 Years
Internal diameter (mm) = (Age/4) + 4
Length (cm) = (Age/2) + 12
Type Formula (0 12 Years)
Medical Bolus (ml) = Weight (kg) x 20ml
Trauma Bolus (ml) = Weight (kg) x 10ml
Concealed Haem Bolus (ml) = Weight (kg) x 5ml
Formula (1:10,000) (0 12 Years)

Formula (300mg in 10ml) (0 12 Years)
Dose (mcg) =
Weight (kg) x 10mcg (0.1ml)

Dose (mg) = Weight (kg) x 5mg
Then mls = Dose (mg) / 30)
Age Formula
0 12 Years Dose (ml) 10% Glucose = Weight (kg) x 2ml
Resuscitaton Council UK 2010
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27

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28

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31


Paediatric Analgesic Ladder
(Under 12 Years)
Pain Score Medical Pain
Trauma,
Orthopaedic,
Musculoskeletal &
Sof tssue Pain
0 3
Mild
Pain
Consider Entonox
+/-
Ibuprofen &/or
Paracetamol
Consider Entonox
+/-
Ibuprofen &/or
Paracetamol
4 6
Moderate
Pain
Consider Entonox
+/-
Morphine
Consider Entonox
+/-
Ibuprofen &/or
Paracetamol
7 10
Severe
Pain
Consider Entonox
+/-
Morphine
Consider Entonox
+/-
Ibuprofen &/or
Paracetamol
+/-
Morphine
For Cardiac Related Chest Pain
Morphine Should be Considered in the First Instance
P
a
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s


32



Obstetrics
Algorithms and Charts
APGAR Score for Newborns 33
Mechanics of Normal Birth 34
Shoulder Dystocia 35
Breech Birth Delivery 36
















33


APGAR Score for Newborns
Appearance


Pulse


Grimace


Actvity


Respiraton

1 Blue or Pale All Over
2 Blue at Extremites, Body Pink
3 No Cyanosis, Body and Extremites Pink
1 Absent
2 <100
3 100
1 No Response to Stmulaton
2 Grimace/Feeble Cry when Stmulated
3 Cry or Pull Away when Stmulated
1 None
2 Some Flexion
3 Flexed Arms and Legs that Resist Extension
1 Absent
2 Weak, Irregular, Gasping
3 Strong, Lusty Cry
O
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34

Mechanics of Normal Birth
5

O
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s

35


Shoulder Dystocia
4

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


36

Breech Birth Delivery
5


1

4

2

5

3

6
O
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t
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c
s

37




Equipment
Instructons and Guidance
Laerdal Sucton Unit 38
ParaPAC Operaton 39
Fitng a Collar 40
Fitng a Donway 41
Fitng a Donway Contnued 42
Fitng a KED 43
Fitng a KED Contnued 44















38

Laerdal Sucton Unit
6

Procedure for Daily Test.
1 Ensure that tubing is unwound and un-occluded
2
Ensure the sucton catheter adapter is removed from the
holder (if applicable)
3
Ensure the canister lid, T-bar, angled connector and tubing
are securely fastened.
4
To run the test, press and hold the test buton while setng
the operatng switch to 500+mmHg. Do not release the test
buton untl a minimum of 2 seconds afer the operatng
switch has been set to 500mmHg. The test will start
immediately.
5
As soon as LED 2 from the botom of the batery status
indicator comes on (takes approximately 1 second) fully
occlude the patent sucton tubing untl all 4 LEDs have
illuminated and LED 1 lights up again.
6 Keep the tubing blocked while LED 2, 3 and 4 lights up.
7 Release the tubing when LED 1 comes on again.
8 Evaluate the test results.
9
Afer evaluatng the test results, turn the operatng switch to
0 to exit the device test.
E
q
u
i
p
m
e
n
t

39


P
a
r
a
P
A
C

O
p
e
r
a
t
o
n

1
1

E
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p
m
e
n
t


40

F
i
t
n
g

a

C
e
r
v
i
c
a
l

C
o
l
l
a
r

9

E
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i
p
m
e
n
t

41


F
i
t
n
g

a

D
o
n
w
a
y

9

E
q
u
i
p
m
e
n
t


42

F
i
t
n
g

a

D
o
n
w
a
y

C
o
n
t
n
u
e
d

9

E
q
u
i
p
m
e
n
t

43


F
i
t
n
g

a

K
E
D

9

E
q
u
i
p
m
e
n
t


44

F
i
t
n
g

a

K
E
D

C
o
n
t
n
u
e
d

9

E
q
u
i
p
m
e
n
t

45




Assessment & History Taking
Aid memoirs, Acronyms and Diagnosis
Patent Assessment Triangle 46
Body Assessment - DCAPBTLS 47
Neurological Assessment - 5Ps 47
Chest Assessment - TWELVEFLAPS 48
Chest Assessment ATOMFC 49
Chest Trauma 49
Chest Pain - History Taking 50
Abdominal Pain - History Taking 51
Abdominal Pain Locatons 52












46

Patent Assessment Triangle
Airway &
Appearance
Circulaton/Skin
Breathing
Efort


General Impression (First View of Patent)
Normal Abnormal
A
Normal cry or speech. Responds
to parents or to environmental
stmuli such as lights, keys, or
toys. Good muscle tone. Moves
extremites well.
Abnormal or absent cry or speech.
Decreased response to parents or
environmental stmuli. Floppy or rigid
muscle tone or not moving.
B
Breathing appears regular
without excessive respiratory
muscle efort or audible
respiratory sounds.
Increased/excessive (nasal faring,
retractons or abdominal muscle use)
or decreased/absent respiratory
efort or noisy breathing.
C
Colour appears normal for racial
group of child. No signifcant
bleeding.
Cyanosis, motling, paleness/pallor or
obvious signifcant bleeding.
Inital Assessment (Primary Survey)
Normal Abnormal
A
Clear and maintainable. Alert on
AVPU scale.
Obstructon to airfow. Gurgling,
stridor or noisy breathing. Verbal,
Pain or Unresponsive on AVPU scale.
B
Easy, quiet respiratons.
Respiratory rate within normal
range. No central cyanosis.
Presence of retractons, nasal faring,
stridor, wheezes, gruntng, gasping or
gurgling. Respiratory rate outside
normal range. Central cyanosis.
C
Colour normal. Capillary refll at
palms, soles, forehead or central
body 2 sec. Strong peripheral
and central pulses with regular
rhythm.
Cyanosis, motling, or pallor. Absent
or weak peripheral or central pulses;
Pulse or systolic BP outside normal
range; Capillary refll > 2 sec with
other abnormal fndings.
A
s
s
e
s
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m
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n
t

47


Body Assessment

Body Assessment
DCAPBTLS
D Deformity
C Contusions
A Abrasions
P Penetratons
B Burns
T Tenderness
L Laceratons
S Swelling
5Ps
P Pain
P Paralysis (Movement)
P Paraesthesia (Sensaton)
P Pulses and Capillary Refll
P Pallor (Skin Colour and Temperature)
S Swelling
A
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48

Chest Assessment
TWELVEFLAPS
T Tracheal deviaton (Is it central?)
W
Wounds / Bleeding (Check the neck, must be
sealed to prevent air embolus / haemorrhage)
E
Emphysema (Surgical, may indicate tension
pneumothorax)
L
Laryngeal Injury (Is there crepitus, indicatng
injury?)
V
Veins (Distended?, if so may indicate a tension
pneumothorax or cardiac tamponade)
E Expose & Examine the thorax
F
Feel (Flail segments, wounds, symmetrical
expansion, crepitus, fractures)
L
Look (Equal rise and fall, paradoxical breathing,
bruising, wounds)
A
Auscultaton (Equal sounds, absent, diminished,
added sounds?)
P
Percussion (Dullness, hyper-resonance,
symmetry)
S Search sides and back
A
s
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49


Chest Assessment
ATOMFC
A
Airway obstructon (Tongue, trauma, foreign
object, vomit etc)
T Tension Pneumothorax
O Open sucking wound (Open Pneumothroax)
M Massive Haemorrhage (Haemothroax)
F Flail Chest
C Cardiac Tamponade

Chest Trauma
Diferental Diagnosis
Conditon
Chest
Expansion
Trachea Percussion
Breath
Sounds
Pneumothorax Decreased Unchanged Resonant Reduced
Tension
Pneumothorax
Hyper
expanded
Deviated
away from
tension
Hyper
Resonant
Absent of
afected
side
Haemothorax
Possibly
reduced
Undeviated Dullness
Reduced or
absent
Collapse /
consolidaton
Reduced
May
deviate
towards
collapse
May be dull
Reduced or
bronchial
breathing
Pleural efusion
Possibly
reduced
Undeviated Dullness
Reduced or
absent
A
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50

Chest Pain - History Taking
SOCRATES
S
Site - Where is the pain or discomfort? Can you point to the
area with one fnger?
O
Onset - What were you doing when the pain frst started?
What do you think may have caused this pain or discomfort?
C
Character - Can you describe the type of pain? Is it: dull ache,
sharp, stabbing, cramping, tearing, tghtness, crushing,
burning? Is it there all the tme or does it in waves?
R
Radiatng - Does the pain stay in one place or does it radiate?
Does it follow a certain patern?
A
Associated Symptoms - Pale, clammy, dyspnoea,
tachypnoea, SOB, dizzy, syncope, lethargy, confusion,
vomitng, haemoptysis, productve cough, fever,
haematemesis, pulse abnormalites, impending doom. Have
you had a recent cough or been vomitng? When did you last
eat? Have you had any difculty swallowing?
T
Time - How long have you had the pain? Has it been there
ever since? Have you ever had a similar episode like this
before?
E
Exacerbate / Relieve - Does anything ease the pain?
(Analgesia, patent positoning, restng. Does anything make
the pain worse? (Walking, leaning forward, lying down,
coughing, movement, inhalaton or expiraton.
S
Severity - If you were to score the pain out of 10, 1 being no
pain and 10 being the worst imaginable, what would you
score it?

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

Risk Factors - Family history, smoker, overweight, heavy
drinker, sedentary life style, hypertension,
hypercholesterolemia, long travel / pregnancy, diabetes.
A
s
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t

51


Abdominal Pain - History Taking
SOCRATES
S
Site - Where is the pain or discomfort? Can you point to the area
with one fnger?
O
Onset - What were you doing when the pain frst started? What
do you think may have caused this pain or discomfort?
C
Character - Can you describe the type of pain? Is it: dull ache,
sharp, stabbing, cramping, tearing, tghtness, crushing, burning?
Is it there all the tme or does it in waves?
R
Radiatng - Does the pain stay in one place or does it radiate?
Does it follow a certain patern?
A
Associated Symptoms - Pale, clammy, dyspnoea, tachypnoea,
SOB, dizzy, syncope, lethargy, confusion, nausea, vomitng,
diarrhoea? Have you notced anything abnormal when passing
water? For example: Increased or reduced frequency, dark or of
colour urine. Does it have a strong odour, burning sensaton?
Have you notced anything abnormal when passing a bowel
moton? Increased or reduced frequency, pain, loose or hard
stools, dark coloured or bright red.
T
Time - How long have you had the pain? Has it been there ever
since? Have you ever had a similar episode like this before?
E
Exacerbate / Relieve - Does anything ease the pain? (Analgesia,
patent positoning, restng, applying pressure, passing wind or
bowel moton?) Does anything make the pain worse? (Lying
down, coughing, movement, inhalaton, expiraton, palpaton,
passing water or bowel moton?)
S
Severity - If you were to score the pain out of 10, 1 being no pain
and 10 being the worst imaginable, what would you score it?

Birth Bearing Age - Any chance you could be pregnant? Are there
any changes to your menstruaton cycle: early, late, abnormal
colour, odours, increased pain? Have you had any vaginal
discharge?

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

Risk Factors - Family history, overweight, heavy drinker,
sedentary life style, hypertension, hypercholesterolemia, long
travel / pregnancy, diabetes.
A
s
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e
s
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n
t


52

Abdominal Pain Locatons
1

A
s
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e
s
s
m
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t

53




Trauma & Medical Emergencies
Useful Informaton and Charts
Rule of Nines 54
Submersion/Immersion Drowning 55
Key Points - Submersion/Immersion 55
Shock Comparison 56
Stages of Shock 57
Catastrophic Haemorrhage Tourniquet 58
Removing a Helmet 59
Fitng a Triangular Bandage 60
Routes of Drug Administraton 61















54

Rule of Nines
Paediatric & Adult
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55


Submersion/Immersion Drowning
The pulse may be extremely slow if hypothermia is
present, and external cardiac compression may be
required. Bradycardia ofen responds to improved
ventlaton and oxygenaton. Drugs such as adrenaline
and atropine are less efectve in HYPOTHERMIA, and
must not be repeatedly used. These drugs may pool in
the statc circulaton of the drowned casualty, and then,
afer re-warming and circulaton has been restored, act
as a dangerous bolus of drug as they are circulated.

In hypothermic cardiac arrest, defbrillaton will be
unsuccessful where the core temperature remains low.
At 28C the ventricle may spontaneously fbrillate.
Defbrillaton may not succeed untl the core
temperature rises above 30-32C.
T
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&

M
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a
l

Key Points Submersion/Immersion
Ensure own personal safety
Successful resuscitatons have occurred afer prolonged
submersion/immersion.
Near drowning is ofen associated with hypothermia.
Special consideratons in cardiac arrest treatment in the
presence of hypothermia.
Severe complicatons may develop several hours afer
submersion/immersion.

56
T
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a
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a

&

M
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d
i
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a
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T
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e

R
R

H
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a




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S
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57

T
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a

&

M
e
d
i
c
a
l


S
t
a
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e
s

o
f

S
h
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k

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B
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m
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a
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1

<
1
5
%

7
5
0

N
o
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a
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B
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P
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a
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2

1
5

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3
0
%

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0

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1
5
0
0

T
a
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P
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0

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0

b
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%

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0

E
x
t
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7
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,

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,

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58

C
a
t
a
s
t
r
o
p
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c

H
a
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m
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q
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9

T
r
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a

&

M
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d
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a
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59


R
e
m
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v
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a

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9

T
r
a
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m
a

&

M
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d
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a
l


60

F
i
t
n
g

a

T
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a
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g
u
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a
r

B
a
n
d
a
g
e

9

T
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a

&

M
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a
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61


Routes of Drug Administraton
Code Route Descripton
BUC Buccal
Administraton directed toward the
cheek, from within the mouth.
ET Endotracheal Administraton down the ET tube.
IM Intramuscular Administraton within a muscle.
INH Inhaled Administraton by breathing.
IO Intraosseous
Administraton within the bone
marrow.
IV Intravenus
Administraton within or into a vein
or veins.
NASAL Nasal
Administraton to the nose;
administered by way of the nose.
NEB Nebulised Administraton in the form of mist.
PO Oral
Administraton to or by way of the
mouth.
PR Rectal Administraton to the rectum.
SC Subcutaneous
Administraton beneath the skin;
hypodermic.
SL Sublingual
Administraton beneath the
tongue.
TOPIC topical
Administraton to a partcular spot
on the outer surface of the body.
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62



Anatomy
Diagrams and Terminology
Palpable Pulse Locatons 63
Bones - General 64
Bones Spinal Colum 65
Anatomical Terms of Locaton 66
Patent Positoning 67
















63


Palpable Pulse Locatons
A
n
a
t
o
m
y


64

Bones - General
A
n
a
t
o
m
y

65


Bones Spinal Colum
A
n
a
t
o
m
y


66

Anatomical Terms of Locaton
Term Defniton
Anterior
Posterior
From front (Anterior) to back
(Posterior).
Dorsal
Ventral
From top (Dorsal) to botom
opposite end of body (Ventral).
Lateral (Lef)
Lateral (Right)
From lef to right side of the body.
Medial (Lef/
Right)
From centre of organism to one or
other side
Proximal
Distal
from tp of an appendage (distal) to
where it joins the body (proximal)
A
n
a
t
o
m
y

67


Patent Positoning
7








A
n
a
t
o
m
y


68



ECG & ETCO2 Interpretaton
Examples and Explanatons
ECG Lead Placement 69
Normal ECG 70
ECG Assessment Guide 71
ECG Arrhythmias 1 72
ECG Arrhythmias 2 73
ECG Arrhythmias 3 74
ECG Arrhythmias 4 75
Interpretaton of ETCO2 Waveform 76















69


ECG Lead Placements
9

E
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G

&

E
T
C
O
2


70

Normal ECG
3





I Lateral aVR V1 Septal V4 Anterior
II Inferior aVL Lateral V2 Septal V5 Lateral
III Inferior aVF Inferior V3 Anterior V6 Lateral
Interval Time in Seconds
PR Interval 0.12 to 0.22
QRS Complex 0.08 to 0.12
QT Interval 0.35 to 0.42
E
C
G

&

E
T
C
O
2

71


ECG Assessment Guide
3

Point Descripton
What is the rhythm? Regular, Irregular
What is the Rate? Fast, Normal, Slow
Are there P Waves
Present?
YES - Atrial Foci
NO - Junctonal or Ventricle Foci
Are all the P Waves
the Same?
YES - Then Same Foci
No - Then Diferent Foci
Is there a P Wave
before each QRS?
YES - Atrial Foci
NO - Junctonal or Ventricle Foci
Is there a QRS afer
every P Wave?
NO - Ventricular Standstll or Possible Heart Block
Is the P-R Interval
Normal?
YES - 0.12 to 0.20 Seconds (3-5 small squares)
NO - If >0.0 seconds its First Degree Heart Block
Is the QRS Normal?
YES - 0.04 to 0.12 secconds (1-3 small squares)
NO Bundle Branch Block
Is the ST Segment
Isoelectric?
If Elevated its Myocardial Infarcton
If Depressed its Ischemia or Angina
Is the T Wave
Normal?
YES 3 Times the Height of the P Wave
NO Inverted?
E
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72

ECG Arrhythmias 1
3


Normal Sinus

1st Degree
Heart Block

Missing QRS Complex
2nd Degree
Heart Block
Type 1

Multple Missing QRS Complexes
2nd Degree
Heart Block
Type 2

3rd Degree
Heart Block
E
C
G

&

E
T
C
O
2

73


ECG Arrhythmias 2
3

E
C
G

&

E
T
C
O
2


Atrial
Fibrillaton

Atrial Fluter

Asystole

Bundle Branch
(Determine
Lef/Right from
12 Lead)

Sinus
Bradycardia

74

ECG Arrhythmias 3
3

E
C
G

&

E
T
C
O
2


Idioventricular
Rhythm

Junctonal
Rhythm

Multfocal
Premature
Ventricular
Contracton

Compensatory Pause
Premature
Atrial
Contracton

Paced Rhythm
75


ECG Arrhythmias 4
3


Compensatory Pause
Premature
Junctonal
Contracton

Super
Ventricular
Tachycardia

Unifocal
Premature
Ventricular
Contracton

Ventricular
Fibrillaton

Ventricular
Tachycardia
E
C
G

&

E
T
C
O
2


76

Interpretaton of ETCO2 Waveform

Sudden loss of
waveform, ETCO
near zero.
ET Tube,
disconnected,
dislodged, kinked or
obstructed.
Loss of circulatory
functon.

Decreasing ETCO
with loss of plateau.
ET tube cuf leak or
defated cuf
ET tube in
hypopharynx
Partal obstructon


CPR Assessment.
Atempt to maintain
minimum of
10mmHg

Sudden Increase in
ETCO2.
Return of
spontaneous
circulaton
E
C
G

&

E
T
C
O
2

77




Major Incidents
Acronyms and Plan of Acton
Approach - Think STEP 123 78
Approach - Scene Assessment - CSCATTT 78
Dynamic Operatonal Risk Assessment 79
Plan of Acton - SitRep - METHANE 80
Plan of Acton - Briefng Structure - IIMARC 80
Primary Triage 81
Triage Categories 82
Pre-Alert - ASHICE 83
Handover - Trauma MIST 84
Handover Medical MIST 84
EH20 Escape Hood 85
NAAK Presentaton 86
NAAK Indicatons 87
NAAK Directons for Use 88
Electronic Personal Dosimeter (EPD) 89
EPD Alarm Descriptons 90





78

Approach
Think STEP 123
S Safety
T Triggers for
E Emergency
P Personnel
1 Casualty, approach using normal procedures
2
Casualtes, approach with cauton, consider all
optons
3
Casualtes or more, without obvious cause, do
not approach scene
Scene Assessment - CSCATTT
C Command and Control
S Safety
C Communicaton
A Assessment
T Triage
T Treatment
T Transport
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Dynamic Operatonal Risk Assessment
A dynamic risk assessment is undertaken and applied to
tasks or situatons that are in the main unforeseeable or
unpredictable or during which the circumstances,
environment or behaviour of the patent or those at
scene may be subject to rapid change.
M
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80

Plan of Acton

Situaton Report to Control - METHANE
M Major Incident Standby or Declared
E Extracton Locaton
T Type of Incident
H Hazards (Present and Potental)
A Access (Egress)
N Number of Casualtes
E Emergency Services (On Scene or Required)

Briefng Structure - IIMARC
I
Informaton Overview of incident, locaton,
what is involved and when it happened
I Intenton What are we going to do
M Method How are we going to achieve it
A Administraton What records are required
R
Risks DORA, hazards, Minimising them and
contngency plans
C
Talk groups, mobile phones, de-brief
arrangements
M
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Primary Triage
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Triage Categories
Tag Colour Defniton
EXPECTANT
/ DEAD
Victm unlikely to survive given severity
of injuries, level of available care, or
both.
Palliatve care and pain relief should be
provided
Priority 1
Victm can be helped by immediate
interventon and transport
Required medical atenton within
minutes for survival (up to 60)
Includes compromises to patents
Airway, Breathing, Circulaton
Priority 2
Victms transport can be delayed
Includes serious and potentally life
threatening injuries, but status not
expected to deteriorate signifcantly
over several hours
Priority 3
Victm with relatvely minor injuries
Unlikely to deteriorate over days
May be able to assist in own care
Walking wounded
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Pre-Alert
ASHICE
A Age
S Sex
H History
I Illness / Injuries / Interventon
C
Conditon HR, RR, SpO2 Air / O2, BP, BM,
Temp, GCS, ECG.
E Estmated Time of Arrival
RED
Cardiac Arrest.
Peri-Arrest.
Any patent elicitng MTC outcome
using Major Trauma Pathfnder.
Currently ftng.
GCS 12 or less.
PPCI.
AMBER
Cardiac chest pain
New Stroke (regardless of symptom
tme).
Any other clinical concern.
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Handover
Trauma - MIST
M Mechanism of Injury
I Injuries
S Signs (Vitals)
T Treatment
Medical - MIST
M Medical History (PMH/Allergies)
I Illnesses (PC/HPC)
S Signs (Vitals)
T Treatment
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EH20 Escape Hood
2



For use when the crew believe that they have been
potentally exposed to a form of hazardous
contaminaton. One size fts all. It will provide 20
minutes of respiratory protecton to escape the scene.
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NAAK Presentaton












Services carry a supply of 10 packs of Nerve Agent
Antdote Kits on every Emergency ambulance for self-
administraton by the crew in the event of accidental
exposure to nerve agents.
They consist of 2 preflled automatc intramuscular
injecton devices linked by a plastc clip and housed in a
foam pouch. Atropen containing 2.0mg of Atropine and
a Combopen containing 600mg Pralidoxime Chloride.
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NAAK Indicatons
The Nerve Agent Antdote Kit (NAAK) should be self-
administered or assisted by their crew mate if they are
incapacitated on occasions where they suspect that they
have been accidentally exposed to nerve agents such as
Organo Phosphates (deliberate or accidental release),
and are sufering the efects listed below.
Clinical Diagnosis:
History of exposure
Miosis
Respiratory distress
Bronchorrhoea
Depressed level of consciousness
Bronchospasm
Muscle Twitching
Convulsion
Including one or more of the following:
Bronchorrhoea
Bronchospasm
Severe Bradycardia (<40 bpm)
User may experience the following side efects:
Impairment of psychomotor functon
Disorientaton
Loss visual accommodaton
Photophobia
Transient bradycardia then tachycardia
Palpitatons
Arrhythmias
CNS depression
Circulatory/respiratory failure
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NAAK Directons for Use

1
Remove Pen No 1 marked ATROPINE from
the plastc holder this removes the safety
cap and extreme care must be taken.


2
Place the GREEN cap of the auto injector
against the upper quadrant of the thigh
making sure that that it is clear of anything
in the trouser pocket. Press hard untl the
injector functons, count to ten slowly and
then withdraw. Bend the needle on any
hard surface untl it breaks of. Record tme
of administraton.


3
Remove Pen No 2 marked PRALIDOXIME
from the plastc holder this removes the
safety cap and extreme care must be
taken.


4
Place the BLACK cap of the auto injector
against the upper quadrant of the thigh
making sure that that it is clear of anything
in the trouser pocket. Press hard untl the
injector functons, count to ten slowly and
then withdraw. Bend the needle on a hard
surface untl it snaps of. Record tme of
administraton. Hold both injectors in your
hand untl help arrives.
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Electronic Personal Dosimeter (EPD)
An Electronic Personal Dosimeter (EPD) is a small pager sized
device that will monitor for the presence of ionising radiaton.
It is designed to allow for normal every day background levels
of radiaton, but should it detect a rise in levels of radiaton in
the vicinity of the wearer it will actvate an internal audible
alarm to alert the wearer to look at the display and take acton
according to the reading and the perceived local
circumstances.
Default Screen

This example shows the Dose Rate
on the display screen in micro-
Sieverts/hour (Sv/h).
Test Display Screen

At the beginning of every shif the
wearer should perform a
confdence test. From the default
display screen press and hold the
operatng buton untl TEST is
displayed.
Confdence Test Display

Double press the operatng buton
to initate the confdence test,
which confrms operaton of visual
display and the visual and audible
alarms. The display screen will
show all icons at once, the audible
alarm will sound and the visual
indicator will fash.
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EPD Alarm Descriptons
Alert Descripton
Low Batery
Warning
There is a low batery warning, which is an
intermitent slow tone. This indicated there is
about ten hours batery life lef. This will be
the most common warning heard (the data in
the EPD will be stored for about a month
without a batery).
Alarm 1
Primary Alert
Signal
The frst tone or Primary Alert Signal is an
intermitent double fast chirp and the LED
will illuminate RED and indicates the presence
of a level of radiaton just above background.
This tone will also sound whenever the
batery is replaced and is a functon of the
auto test process. It also acts as a reminder of
the alerts for the wearer. The user should be
aware of this facility and is NOT to change
bateries at incident sites. The Primary Alert
Signal should be the only actvaton alarm the
wearer will ever hear whilst performing their
dutes, the most common will be the low
batery warning.
Alarm 2
Secondary
Alert Signal
The second tone, the Secondary Alert Signal is
a slow two-tone alarm and indicated a level of
radiaton approximately equivalent to that
received annually by normal means. Under
normal circumstances where this level of
radiaton is present, Ambulance staf will not
be deployed forward to assist casualtes.
Alarm 3
Tertary Alert
Signal
The third alert tone, the Tertary Alert Signal
is a contnuous single high tone. This tone
indicated that the wearer has been exposed
to a potentally signifcant or high dose.
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Infecton Preventon & Control
Useful Informaton
Mops and Buckets 92
Hand Washing Technique 93
Hand Hygiene 94
Protectve Clothing 94
Sharp/Splash Injury Procedure 95

















92

Mops and Buckets




Mops and their corresponding colour coded buckets
must not be interchanged. If any mop becomes
contaminated with blood or body fuids, then the
head should be discarded as clinical waste and a
replacement fted immediately. All mop heads
should be routnely replaced every month.
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Hand Washing Technique
12

Good and efcient hand hygiene is the single most important
factor in the preventon and control of the spread of infecton.
Second to hand washing, consistent use of barrier methods,
especially wearing gloves, is the most important step in
preventng cross-contaminaton of staf and patents.
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Hand Hygiene
12

Use the hand washing technique:

Protectve Clothing
Circumstance/Actvity Appropriate PPE
Circumstance/Actvity
Appropriate PPE
Circumstance/Actvity
Appropriate PPE
Exposure to blood/body
fuids antcipated, but low
risk of splashing.
Wear gloves, plastc apron
and sleeve protectors.
Wear gloves, plastc apron
and sleeve protectors.
Wear gloves, plastc apron
and sleeve protectors.
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Sharp/Splash Injury Procedure
Inoculaton/blood splash injuries include any sharp
object that pierces the skin, bites or any other exposure
to blood or body fuids.
Bleed it Apply pressure, but DO NOT suck the wound.
Wash it Wash with soap under warm running water for
2 minutes.
Dry it Do not scrub the injury or pat it dry.
Dress it Cover the injury with a dressing.
For splashes to the eyes Irrigate with saline or water.
For splashes to the mouth Rinse with copious amounts
of water and wash your face.
Donor Identfy and document the source of the
inoculaton injury include: Name, DOB and home address
if possible.
Inform Contact EOC and inform them of the situaton.
Atend Go to the nearest Emergency Department
without delay.
Report it Report the incident to occupatonal health as
soon as possible. Telephone your local Occupatonal
health service. Write Numbers Below:









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Key Contacts
Phone Numbers and Addresses



















97





Notes




















98




Notes



















99


1. Ansari, P (2012) Acute Abdominal Pain [Online] URL: htp://
www.merckmanuals.com/professional/gastrointestnal_disorders/
acute_abdomen_and_surgical_gastroenterology/
acute_abdominal_pain.html
2. Avon Protecton Systems (2011) EH20 Data Sheet, Melksham/England: Avon
Protecton Systems.
3. Evans, S (2004) A Guide Through the Maze of ECGs, 3rd Editon, Somerset/
England: Associaton of Professional Ambulance Personnel.
4. Fikac, L (2000) Shoulder Dystocia [Online] URL: htp://
www.capefearvalley.com/outreach/outreach/peapods/obemergencies/
shoulderdystocia.htm
5. Kochenour, N (1997) The Mechanism of Normal Labor [Online] URL: htp://
library.med.utah.edu/kw/human_reprod/lectures/physiology_labor/#2
6. Laerdal (2013) Laerdal Sucton Unit: Instructon Manual, Kent/England:
Laerdal Medical Limited
7. Medtrng (2012) Postures and Directon of Movement [Online] URL: htp://
www.medtrng.com/posturesdirecton.htm
8. Peak Flow (2004) Mini-Wright Peak Flow Meter: Predictve Normal Values
(Nomogram, EU scale), Essex/England: Clement Clarke Internatonal.
9. Queensland Ambulance Service (2011) Clinical Practce Manual [Online] URL:
htp://www.ambulance.qld.gov.au/medical/CPM.asp
10. Resuscitaton Council UK (2010) Resuscitaton Guidelines 2010, London/
England: RCUK.
11. Smiths Medical (2008) Emergency Transport and Ventlaton [Online] URL:
htp://www.smiths-medical.com/Upload/products/product_relateddocs/
EmergencyTransport.pdf
12. World Health Organisaton (2009) Clean Care is Safer Care: Clean Your
Hands, Geneva/Switzerland: WHO.



References and Credits

100

Handover





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