Transcript Working As A Team: ALS Tiered Response

Presence Regional EMS System
February 2015
 Describe
the relationship between First
Responder EMS departments and responding
transport agencies
 List ways in which different levels of EMS
agencies interact in a tiered response situation
 Discuss the importance of good interpersonal
communications in a patient hand off
 Using a variety of scenarios, determine ways to
improve and expedite patient care between
EMS agencies.
 911
is called: Who shows up?
 #1 Response Team
• Local Fire Department
• Rescue Team
• BLS Ambulance
 Transport Team
• BLS Ambulance
• ILS Ambulance
• ALS Ambulance
• Helicopter
 More
than one level of provider responds
to the same call for help
 Each level provides care within their
scope of practice
 Each level that arrives adds a layer to the
level of care available to the patient
 Sometimes
only one level of response is
required.
 Many calls need more than one level.
• First Responder Rescue
• BLS Non-Transport Rescue
• Transport Agency
 BLS Transport
 ILS Transport
 ALS Transport
 Helicopter
 Communicate
effectively
• Use the same patient assessment
• Use the same terminology
• Use the same protocols
• Be courteous and professional
 Scene Size Up
• Access -- In and out of scene
• Safety -- Providers and patients
 Initial
good
•
•
•
•
Assessment – Fix whatever is not
Level of Consciousness
Airway
Breathing
Circulation
 History
• SAMPLE
 Care
provided by protocol
 Help
with continued care
• What types of care/tasks could you be (have you
been) asked to do?
Make a list and then check that against the list on
the next page.
 Provide
care that is within your scope of
practice.
 Understand what you are asked to do
• CPR
• BVM ventilation
• Lifting and Moving (patient, equipment,
furniture)
• Pressure on bleeding wounds
• Manual splinting
• Driving the ambulance
 If
you don’t know how to do what is asked
of you
• Let the Transport Team know
• Ask for clarification
 Look
at the inside of the ambulance
 Do you know how to drive this type of
vehicle?
 Do you need some orientation to the
lights and sirens?
 Who will bring you back?
 Communication
with the family/friends
• #1 Response usually a small community
• #1 Response team are known to patient/family
• Act as go-between with patient/family/friends
and Transport Team
• Fill in any known family dynamics to Transport
Team
• Comfort family and friends when needed
 Goal
is to provide care in a seamless
manner
 Smooth hand off of care from #1
Response Team to Transport Team
 Use a template to organize information so
that all important details are included
 Hand off to transport team should take 90
seconds or less
 Scene Size Up – Report to Dispatch
• How to get in and out of scene
• How to get in and out of house
• Mechanism of Injury or Nature of Illness
• Scene Safety –
 Potential hazards




Pets
Dangerous people
Fire
Structures
 Police presence
• How many patients are there
• How much help is there
• Is more help needed
• Is special help/equipment needed
 Initial Assessment (when
• Level of consciousness
• Airway
found)
 Did you have to do anything to open/maintain the airway
• Breathing
 Did you have to assist with breathing
 Did you give the patient oxygen
• Circulation
 Does the patient have radial pulses
 Did you have to begin CPR
 Did you have to use an AED? Did you deliver a shock?
• Chief complaint
 If
there is time to get a history from a
reliable source:
• Signs and symptoms
• Allergies
• Medications
• Past Medical History (Pertinent to this call)
• Last Meal
• Events that brought on this emergency
 What
have you and your team done for
the patient so far?
 How did the patient respond to what has
been done?
• Getting better
• No response
• Getting worse
 Report
to Transport Team
• Be organized
• Use standard terms
• Use standard format
 Scene Size Up
 Initial Assessment
 History
 Care given
 Response of patient
 Have
someone greet the Transport Team
and walk them to the patient
• This is a good time to update information
 If
possible write down information to
pass on to Transport Team
 Keep your voice calm and professional
 Give good details in a short amount of
time following standard assessment
 Give
the Transport Team time to assess
the patient
• Not “re-doing” your assessment
• Validating your findings
• Looking for changes in condition
 Be
available to answer questions and
clarify
 Don’t
get mad
 Continue patient care
 When the call is over talk to the Transport
Team in a confidential manner
 If
this does not work let the PREMSS
office know
 Unprofessional behavior by any provider
is not tolerated
 Answer
the following questions as a group.
 If doing this CE individually, please e-mail
your answers to:
[email protected]
 Use “February 2015 Basic CE” in subject
box.
 You will receive an e-mail confirmation.
Print this confirmation for your records,
and document the CE in your PREMSS CE
record book.
 IDPH site code: 067100E1215
 For
each of the following scenarios
determine what is important for a
seamless Tiered Response/Patient Hand
Off.
 Make note of what would need to be
communicated for:
•
•
•
•
Scene size up
Initial Assessment
History
Care given
 It
is February. The area has had 6 inches
of snow in the last eight hours with
blowing conditions.
 The roads are drifting and snowplows are
getting behind.
 The transport team
is coming from 10 miles
away to your small town.
 You
are called for a 3 year old girl with
seizures.
 The
child is in a family home. It is warm
and there are no apparent dangers.
 The
child’s mother states the child has a
high fever and had a seizure that lasted
3-5 minutes about 15 minutes ago.
 The
child is sleepy but responds to her
name.
 Airway is open
 Breathing is regular at 28 per minute
 She is pale, hot and sweaty, with radial
pulses of 120 beats/per minute.
 She is still in her flannel pajamas with a tshirt, panties and socks.
 Signs
and symptoms: cold/flu for 24
hours
 Allergies – none
 Medications – Children’s Tylenol every 6
hours (last dose 5 hours ago)
 Past History –Healthy child
 Last meal – 3 hours ago
 Events – had a seizure; never had one
before (Mommy and Daddy are freaked
out).
 What
care do you need to give to this
child?
 What do you need to communicate to the
Transport Team before they arrive at the
scene?
 What needs to be included in your
patient hand off?
 Will you need to go with the Transport
Team?
 It
is early October and you are called to a
wooded area for a hunter who fell 12 feet
out of a tree stand.
 It is after 4 pm and getting dark. It is 48
degrees out with misty rain.
 The man is about 300 yards from a paved
road along a dirt trail that is very muddy.
 Can
you take your primary vehicle down
the dirt road in these conditions?
 The
patient is a 50 year old man who is
awake and talking.
 His breathing is rapid and shallow.
 His color is pale. He has weak radial
pulses at a rate of 110. His skin is very
cold, pale and sweaty.
 He says he hurts all over.
 Rapid
Head to Toe
• Head and Neck – no injuries
• Chest: sternum sinks in with inhalation and
•
•
•
•
moves out with exhalation. Breath sounds faint.
Abdomen – no injuries
Pelvis – unstable
Legs – abrasions (good movement, poor
sensation due to cold and poor pulses)
Arms – abrasions
 Signs
and symptoms as found
 Allergies – penicillin
 Medications – blood pressure pill
 Past Medical History – High blood
pressure, borderline diabetic
 Last meal – lunch at noon
 Events – came out hunting about 1 pm.
Fell shortly after that. His son found him
about 30 minutes ago. He was lying in the
wet leaves for at least 2 hours.
 What
do you need to do for this man?
 What do you need to communicate to the
Transport Team before they arrive at the
scene?
 What needs to be included in your
patient hand off?
 Will you need to go with the Transport
Team?
 Called
to the home of an 84 year old
woman who is short of breath.
 It is a warm June afternoon
 It is a nice ranch house in an established
neighborhood.
 Will there be
any problems
getting in?
 The
lady collects china figurines. The
house has at least 3 china cabinets in the
living room full of glass and china
objects.
 The
patient is sitting in a recliner in the
living room .
 She is awake but anxious.
 She can only say one word between
breaths.
 Her breathing is rapid and labored.
 She is pale, cool and sweaty with an
irregular pulse.
 You
can hear her breathing rattling
without a stethoscope. She has to sit up
to breathe.
 Her feet are swollen.
 Signs
and symptoms: difficulty and noisy
breathing.
 Allergies – codeine
 Medications – lasix, lanoxin, nitrobid,
glucophage.
 Past History – congestive heart failure
and Type II diabetes
 Last Meal – 6 hours ago
 Events – It is getting harder to breathe.
 What
do you need to do for this woman?
 What do you need to communicate to the
Transport Team before they arrive at the
scene?
 What needs to be included in your
patient hand off?
 Will you need to go with the Transport
Team?
 You
get called to the edge of town for a
man who will not answer his door.
 You know the address. Hank is in is 80s.
His wife died 2 years ago and you have
heard that he isn’t doing well.
A
neighbor meets you at the door and
tells you that he hasn’t seen Hank since
yesterday.
 You can hear Hank’s dogs barking in the
house, but Hank doesn’t answer the door.
 What do you want to do?
 Once
the door is opened
you find this in the first room.
it smells of rotten food
and body fluids.
 You
find Hank in a back room, that is in
similar condition. He is laying on a bed.
 He opens his eyes to his name but does
not speak.
 He has some mucus in his airway.
 His breathing is regular and deep
 His skin is warm and dry. He has a strong
radial pulse.
 Hank’s
speech is slurred.
 His mouth is drooped to the left.
 He can’t move his right arm or leg.
 He has been incontinent.
Hank’s speech is too garbled to get any
history.
What do you think is going on?
 What
do you need to do for Hank?
 What do you need to communicate to the
Transport Team before they arrive at the
scene?
 What needs to be included in your
patient hand off?
 How are you going to get Hank out of the
house?
 Will you need to go with the Transport
Team?
 You
are called to this address for an
unresponsive female.
 You
are met at the door by the woman’s
son who is very upset and says “Mom’s
not breathing”.
 He takes you to an upstairs bedroom
where you find an elderly lady face down
on the bed.
 What should you do first?
 You
roll her over and find that she is not
responsive.
 Her airway is open but she is not
breathing and she has no pulse.
 She is pale, but not stiff and has no
lividity.
 Now what do you do?
 This
is the way back down the stairs
 What
do you need to do for this woman?
 What do you need to communicate to the
Transport Team before they arrive at the
scene?
 What needs to be included in your
patient hand off?
 How are you going to get her down to the
ambulance?
 Will you need to go with the Transport
Team?
 You
are called out with police for a
domestic dispute. You respond with
police to a house on the edge of town.
 The house is down a dark road and has
no house number or other marking.
 At the scene police tell
you that the guns are
secure and it is safe
to come in.
 You
find Jim laying on the kitchen floor.
 He is awake and swearing but agrees to
be treated.
 His airway is open and his is breathing
rapidly.
 He is pale, cool and sweaty with a fast
radial pulse. Blood is spurting out of a
large hole in his right thigh.
 The only injury you can find is the hole in
his right thigh.
 Signs
and symptoms as found
 No allergies
 No medications
 No past medical history’
 Jim has been drinking beer for several
hours.
 Events: “the b#$^* shot me”
 What
do you need to do for Jim?
 What do you need to communicate to the
Transport Team before they arrive at the
scene?
 What needs to be included in your
patient hand off?
 Will you need to go with the Transport
Team?
 Good
things get better when you put
them together.
 EMS is a Team Sport