Transcript BLS / ALS TRANSPORT - Whatcom County EMS

BLS ALS
TRANSPORT
In Whatcom County
Do you need
help?
• 78 y.o. female, GLF, hip pain
• Patient is lying on her side on the
bathroom floor.
• Gasping
• Pale and sweaty
• No radial pulse
What if you find…
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Pt. seated beside the bed.
Conscious and alert
Vitals are stable
Pain is 5/10, but she shrieks whenever
you touch the leg or try to move her.
Objective
• Demonstrate patient indicators to help
determine when BLS transport is appropriate.
• Discuss particular EMS responses which
often require upgrade or cancellation of
paramedics.
BLS Patient Assessment
Initial Assessment
• Mechanism
• Sick/ not sick
• Chief complaint
• Head to toe
Ongoing Assessment
• Abnormal vitals?
• Pertinent history
• Pain control?
• Reassess vitals
BLS Rule:
Upgrade Fast
Cancel Slow
ALS Indicators:
Upgrade Trauma > 10
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Second/third degree burns > 10% BSA
Fall 10 feet or more
Thrown 10 feet or more
Car vs. Pedestrian @ > 10 mph
Falls
MVA:
Big Mechanism =
Sick Patient
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Death
Ejection
High speed
Significant vehicle deformity
Abdominal trauma to pregnant
woman
Upgrading an MVA
Sick or Not Sick?
If Sick Get Help
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Pale, diaphoretic skin
Labored breathing
Unconscious
No radial pulse
Patient age: < 6 or > 60 gets sicker quicker
ALS Indicators – Trauma
Upgrade Big
Breaks
Femur fracture
Pelvis fracture
Multiple fracture sites
Paralysis
Pain control
Vital Signs
Too Fast – Too Slow
Too High – Too Low
UPGRADE
ALS Vital Signs
•HR 120 or greater, sustained
•HR < 50
•BP < 90 or > 200 systolic
•BP > 110 diastolic
•Respiratory Rate < 10 or > 30
•Blood Sugar < 70 or > 350
•Core temp < 94° or > 103°
BLS Indicators –
Medical is Historical
• Abdominal Pain: rule out
– syncope
– orthostatic changes
– ectopic pregnancy, AAA, or MI.
• Low Blood Sugar:
– Food & juice return DEX to > 90
– not on oral diabetes medications
– has help.
BLS Indicators –
Medical is Historical
• Seizure
– Single Seizure with history
– Seizure is consistent with pt.’s regular pattern
– Pt.’s level of consciousness is improving.
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Pain
Is not life threatening.
• Signs of severe pain:
– Pt. cannot be distracted from the pain
– Pain is consistently reproduced
– Skin signs and vital signs change
when people are in pain
Get ALS for severe pain
Pain is Relative
Each patient has a unique 1-10 scale
BLS/ALS Decision Points
Upgrade fast, cancel slow
Upgrade Trauma > 10
Big Mechanism = Sick Patient
If Sick Get Help
Upgrade Big Breaks
Vital Signs: Too fast, slow, high,
low = upgrade
Medical is Historical
You are dispatched to…
74 y.o. male fell in his driveway, unknown
extent of injuries.
On arrival you find him lying beside a ladder
which has tipped over.
He has been bleeding from the back of his
head.
He groans when you shake him, but does
not wake up.
You are dispatched to…
54 y.o. male was in seizure, now postictal.
Confused, but responds to questions.
Skin looks good. Breathing is unlabored.
Vital signs: BP 154/94, HR 124, SpO2 98%
RR 24, DEX 140, Oral T° 99.3.
Pt. has Seizure history, no change in meds,
typical seizure for this pt.
BLS ALS
TRANSPORT
In Whatcom County