Transcript burns - State of New Jersey

State of New Jersey
Emergency Medical Dispatch Guidecards
Approved by the
State of New Jersey Department of Health and Senior Services
Office of Emergency Medical Services
Adopted by the
State of New Jersey
Office of Information Technology
Office of Emergency Telecommunications Services
January 2012
GUIDECARD INDEX
Traumatic Incident Types
Traumatic Incident Types
ANIMAL BITES
ASSAULT/DOMESTIC VIOLENCE / SEXUAL ASSAULT
BLEEDING / LACERATION
BURNS
EYE PROBLEMS / INJURIES
FALL VICTIM
HEAT / COLD EXPOSURE
INDUSTRIAL ACCIDENT
STABBING / GUNSHOT VICTIM / ASSAULT
TRAUMATIC INJURY
VEHICULAR RELATED INJURIES
Medical Chief
Types
Medical
ChiefComplaint
Complaint
Types
ABDOMINAL PAINS
ALLERGIES / STINGS
BACK PAIN
BREATHING PROBLEMS
CHEST PAIN / HEART PROBLEMS
DIABETIC PROBLEMS
HEADACHE
OD/POISONINGS / INGESTIONS
PSYCHIATRIC / BEHAVIORAL PROBLEMS
SEIZURES / CONVULSIONS
SICK PERSON
STROKE / CVA
UNKNOWN / PERSON DOWN
Time // Life-Critical
Life-Critical Events
Time
Events
CO POISONING / INHALATION / HAZMAT
CARDIAC ARREST / DOA
- ADULT CPR INSTRUCTIONS
- CHILD CPR INSTRUCTIONS
- INFANT CPR INSTRUCTIONS
CHOKING
- ADULT CHOKING INSTRUCTIONS
- CHILD CHOKING INSTRUCTIONS
- INFANT CHOKING INSTRUCTIONS
DROWNING (POSSIBLE)
ELECTROCUTION
PREGNANCY / CHILDBIRTH
- CHILDBIRTH INSTRUCTIONS
UNCONSCIOUS / FAINTING
INSTRUCTIONS
INSTRUCTIONS
- UNCONSCIOUS AIRWAY CONTROL (NON-TRAUMA)
- UNCONSCIOUS AIRWAY CONTROL (TRAUMA)
Miscellaneous
Miscellaneous
AIR MEDICAL DISPATCH PROCEDURE
AIRCRAFT / TERRORISM
HAZMAT
VEHICLE IN WATER
1. Where is your emergency? (Address or Location)
ALL CALLERS INTERROGATION
2. What is the number you are calling from?
3. What is the problem?
4. What is your name?
5. Is the patient conscious? (Able to talk)
NO
YES
Determine age, sex, chief complaint and turn
to appropriate card. DON’T hang up
Dispatch ALS & BLS, advise caller help has been dispatched.
6. Is the patient breathing NORMALLY?
NO
YES
UNCERTAIN
GO and SEE if the chest rises, then come back to the phone.
Go directly to Unconscious / Fainting Card.
7. ARE YOU ABLE TO
ASSIST THIS PATIENT?
... I’ll help you..
YES
Go to CPR Instructions for appropriate age group.
NO
I have dispatched help. Don’t hang up.
ALL CALLERS INTERROGATION - Page 1 of 1 (1/04)
ALL
CALLERS
INTERROGATION
1 “Where is your emergency?” (Address or Location)
2 “What is the number you are calling from?”
3 “What is the emergency?”
4 “What is your name?”
5 Determine age and sex of patient
6. “Is the patient conscious?” (Able to talk)
NO
YES
Dispatch ALS & BLS
7.” Is the patient breathing NORMALLY?”
7.” Is the patient breathing NORMALLY?”
YES
NO
Go to
CPR
Instructions
for age group
UNCERTAIN
Go to
CARDIAC
ARREST/DOA
NO / UNCERTAIN
YES
Go to
UNCONSCIOUS/
FAINTING
Determine chief
complaint and turn to
appropriate card.
Go to
BREATHING
PROBLEMS
ANIMAL BITES
K
e
y
Q
u
e
s
t
I
o
n
s
Is the patient short of breath or does it hurt to
breathe?
Is the patient bleeding?
IF YES,
From where?
How much?
How long?
Can it be controlled with pressure?
What part of the body was bitten?
How long ago did they receive the bite?
Is the animal contained?
What type of animal bit the patient?
SIMULTANEOUS ALS/BLS
D
I
s
p
a
t
c
h
State of New Jersey EMD Guidecards Version 1/04
BLS DISPATCH
Unconscious/not breathing normally.
Controlled bleeding.
Decreased level of consciousness.
Swelling at bite site.
Uncontrolled bleeding, after attempts to control.
Bite below neck, non-poisonous.
Serious neck or face, bites from animal attacks.
Bites from known poisonous animals
ANIMAL BITES
K
E
Y
Q
U
E
S
T
I
O
N
S
“Is the animal contained?”
“What type of animal bit the patient?”
“Is the patient short of breath or does it
hurt to breathe?”
“What part of the body was bitten?”
SIMULTANEOUS ALS/BLS
D
I
S
P
A
T
C
H
Unconscious/not breathing normally.
Decreased level of consciousness.
Uncontrolled bleeding, after attempts to control.
Serious neck or face bites from animal attacks.
Bites from known poisonous animals.
State of New Jersey EMD Guidecards Version 01/12
“Is the patient bleeding?”
IF YES,
“Can it be controlled with pressure?”
“How long ago did they receive the
bite?”
BLS DISPATCH
Controlled bleeding.
Swelling at bite site.
Bite below neck, non-poisonous.
ANIMAL BITES
Contain the animal, if possible.
Lock away any pets.
If severe bleeding go to
Pre-Arrival Instructions
For snake bites:
Apply direct pressure to the wound.
Do not elevate extremity.
BLEEDING/LACERATION
Pre-Arrival Instructions
If little or no bleeding, irrigate human and animal
bites with copious amounts of water.
Keep patient calm and still.
Do not use ice.
Do not attempt to remove venom.
For jellyfish stings:
Wash with vinegar or baking soda.
If the patient’s condition changes, call me back.
Prompts
Has law enforcement been notified?
Has Animal Control been notified?
FOLLOW AIR MEDICAL
DISPATCH GUIDELINES
BURNS
K
e
y
Q
u
e
s
t
I
o
n
s
How was the patient burned?
THERMAL
Is anything on the patient still
burning?
Stop the burning.
(Go to pre-arrival instructions).
ELECTRICAL Is the patient still in contact with
the electric source?
How was patient electrocuted?
If household, was it the stove,
clothes dryer or other 220 volt
source?
CHEMICAL What chemical caused the burn?
Can the patient answer your
questions?
SIMULTANEOUS ALS/BLS
D
I
s
p
a
t
c
h
Unconscious/not breathing normally.
Decreased level of consciousness.
Burns to airway, nose, mouth.
Hoarseness, difficulty talking or swallowing.
Burns over 20% of body surface.
Electrical Burns/electrocution from 220 volts or greater
power lines/panel boxes.
nd
rd
2 & 3 degree burns (partial or full thickness) to
Palms (hands)
Soles (feet)
Groin
State of New Jersey EMD Guidecards Version 1/04
Is the patient short of breath or does it hurt to breathe?
Is the patient having difficulty swallowing?
Where is the patient burned?
IF HEAD OR FACE
_ Are they coughing?
_ Are their nose hairs burned?
_ Are there burns around their mouth and nose?
If male, is any facial hair burned?
Are there any other injuries?
BLS DISPATCH
Less than 20% body surface burned.
Spilled hot liquids.
Chemical burns to eyes.
Small burn from match, cigarette.
Household electric shock.
Battery explosion.
Freezer burns.
BURNS
K
E
Y
Q
U
E
S
T
I
O
N
S
State of New Jersey EMD Guidecards Version 01/12
“How was the patient burned?”
THERMAL
“Is anything on the patient still
burning?”
If YES, Stop the burning.
“Place burned area in cool water (not
ice), if convenient”
ELECTRICAL
“Where is the patient burned?”
IF HEAD OR FACE:
“Is the patient short of breath, coughing or does it
hurt to breathe?”
“Is the patient having difficulty swallowing?”
“Are there burns around their mouth and nose?”
“Are there any other injuries?”
ELECTROCUTION
Go
to
SIMULTANEOUS ALS/BLS
D
I
S
P
A
T
C
H
CHEMICAL
“What chemical caused the burn?”
Decreased level of consciousness.
Burns to airway, nose, mouth.
Hoarseness, difficulty talking or swallowing.
Burns over 20% of body surface.
Electrical Burns/electrocution from 220 volts or greater
power lines/panel boxes.
2nd & 3rd degree burns (partial or full thickness) to
Palms (hands)
Soles (feet)
Groin
BLS DISPATCH
Less than 20% body surface burned.
Spilled hot liquids.
Chemical burns to eyes.
Small burn from match, cigarette.
Household electric shock.
Battery explosion.
Freezer burns.
ABDOMINAL PAIN
K
e
y
Q
u
e
s
t
I
o
n
s
State of New Jersey EMD Guidecards Version 1/04
Is patient alert?
Is patient breathing normally?
Is the pain due to an injury to the patient?
Has the patient vomited? If yes, What does the vomit look like?
Are the patient's bowel movements different than normal?
If yes, How would you describe them?
Is the pain above the belly button?
If the patient is a woman between 12-50 years, ask Could she be pregnant?
Has she said she felt dizzy?
Has there been vaginal bleeding? If yes, how much?
How does the patient act when he/she sits up?
Does the patient have any other medical or surgical history?
Is the patient wearing a Medic Alert tag? If yes, what does it say?
SIMULTANEOUS ALS/BLS
D
I
s
p
a
t
c
h
Unconscious/not breathing normally.
Decreased level of consciousness.
Vomiting blood (red/dark red) or coffee ground-like substance.
Black tarry stool.(Caution: Could be a resultant from diet supplements)
Lower abdominal pain, woman 12-50 years (if associated with
dizziness or fainting or heavy vaginal bleeding).
Upper abdominal pain with prior history of heart problem.
Abdominal pain with fainting or near fainting, patient over 50 yrs.
Fainting/near fainting when sitting. (hypotension)
BLS DISPATCH
Pain with vomiting.
Flank pain (Kidney stone).
Abdominal (non-traumatic).
Pain unspecified
ABDOMINAL PAIN
K
E
Y
Q
U
E
S
T
I
O
N
S
“Is the pain due to an injury to the patient?”
“How does the patient feel sitting up?”
“Is the pain above or below the belly
button?”
If the patient is female between 12-50 years:
“Could she be pregnant?”
“Has there been vaginal bleeding?” If yes,
“How much?
“Has she said she felt dizzy?”
SIMULTANEOUS ALS/BLS
D
I
S
P
A
T
C
H
Vomiting blood (red/dark red) or coffee ground-like
substance.
Pain with prior history of Addisons disease or adrenal
insufficiency.
Black tarry stool.
Lower abdominal pain, woman 12-50 years (if associated
with dizziness or fainting or heavy vaginal bleeding).
Upper abdominal pain with prior history of heart problem.
Abdominal pain with fainting or near fainting, patient over
50 yrs.
Fainting/near fainting when sitting. (hypotension)
State of New Jersey EMD Guidecards Version 01/12
“Has the patient vomited?”
If yes, “What does the vomit look like?”
“Are the patient's bowel movements black and
tarry?”
“Is the patient wearing a Medic Alert tag?”
If yes,” What does it say?”
“Does the patient have Addisons Disease, recent
trauma or any other medical or surgical history?”
BLS DISPATCH
Pain with vomiting.
Flank pain (Kidney stone).
Abdominal (non-traumatic).
Pain unspecified.
ADDISON’S DISEASE
Chronic Adrenal Insufficiency
Hypocortisolism
Hypoadrenalism
Thomas Addison first described the clinical presentation of primary
adrenocortical insufficiency (Addison disease) in 1855 in his classic paper, On
the Constitutional and Local Effects of Disease of the Supra-Renal Capsules.[1]
Addison's disease is a disorder that occurs when your body produces
insufficient amounts of certain hormones produced by your adrenal glands. In
Addison's disease, your adrenal glands produce too little cortisol and often
insufficient levels of aldosterone as well.
ADDISON’S DISEASE
Chronic Adrenal Insufficiency
Hypocortisolism
Hypoadrenalism
Addison's disease symptoms usually develop slowly, often over several months, and
may include:
Muscle weakness and fatigue
Weight loss and decreased appetite
Darkening of your skin (hyperpigmentation)
Low blood pressure, even fainting
Salt craving
Low blood sugar (hypoglycemia)
Nausea, diarrhea or vomiting
Muscle or joint pains
Irritability
Depression
ADDISON’S DISEASE
Chronic Adrenal Insufficiency
Hypocortisolism
Hypoadrenalism
Acute adrenal failure (addisonian crisis)
Sometimes the signs and symptoms of Addison's disease may appear suddenly. In
acute adrenal failure (addisonian crisis), the signs and symptoms may also include:
•Abnormal heart rhythms
•Pain in your lower back, abdomen or legs
•Severe vomiting and diarrhea, leading to dehydration
•Low blood pressure
•Loss of consciousness
•High potassium (hyperkalemia)
•Standard therapy involves intravenous injections of glucocorticoids and large
volumes of intravenous saline solution with dextrose (glucose), a type of sugar. This
treatment usually brings rapid improvement.
ADDISON’S DISEASE
Chronic Adrenal Insufficiency
Hypocortisolism
Hypoadrenalism
Caution must be exercised when the person with Addison's disease becomes
unwell with infection, has surgery or other trauma, or becomes pregnant. In such
instances, their replacement glucocorticoids, whether in the form of
hydrocortisone, prednisone, prednisolone, or other equivalent, often need to be
increased. Inability to take oral medication may prompt hospital attendance to
receive steroids intravenously.
A person with adrenal insufficiency should always carry identification stating their
condition in case of an emergency. The card should alert emergency personnel
about the need to inject 100 mg of cortisol if its bearer is found severely injured or
unable to answer questions.
Immediate medical attention is needed when severe infections, vomiting, or
diarrhea occur, as these conditions can precipitate an Addisonian crisis.
ABDOMINAL PAIN
Nothing to eat or drink.
Monitor for shock:
Skin cool and clammy or mottled, rapid shallow
breathing, fatigue, altered mental state, dilated
pupils.
Gather patient medications, if any.
If the patient’s condition changes, call me back.
Pre-Arrival Instructions
Symptoms of an Addison or “adrenal” crisis include:
•Severe vomiting and diarrhea
•Dehydration
•Low blood pressure
•Loss of consciousness
If not treated, an Addison crisis can be fatal.
Prompts
If unconscious, go to UNCONSCIOUS/ BREATHING NORMALLY
AIRWAY CONTROL.
If unconscious, NOT breathing normally, go to CPR for appropriate
age group.
Short Report
Age
Sex
Specific location
Chief complaint
Pertinent related symptoms
Medical/Surgical history, if any
Other agencies responding
Any dangers to responding
units
CHEST PAIN/HEART PROBLEMS
K
E
Y
Q
U
E
S
T
I
O
N
S
“Where in the chest is the pain located?”
“Does the patient feel pain anywhere else? If so,
where?”
“How long has the pain been present?”
“Is the patient sweating profusely?”
“Is the patient nauseated or vomiting?”
“Is the patient weak, dizzy, or faint?”
SIMULTANEOUS ALS/BLS
D
I
S
P
A
T
C
H
Decreased level of consciousness.
Patient complaining of chest pain with any of the
critical symptons:
Short of breath,nausea, diaphoretic (sweating
profusely), rapid heart rate, syncope (weak, dizzy or
faint) or with cocaine/crack (drug) use.
State of New Jersey EMD Guidecards Version 01/12
“How does the patient act when he/she sits
up?”
“Does the pain change when the person
breathes or moves?”
“Has the patient ever had a heart problem, heart
surgery, a device to help their heart work or a
previous heart attack?”
“Is the patient experiencing rapid heart rate
with chest pain?”
BLS DISPATCH
Patients under 35, without critical symptoms
CHEST PAIN/HEART PROBLEMS
“Does the patient have nitroglycerin?”
If yes: “Has the patient taken one?”
if not taken, “Take as the physician has directed”
(patient should be seated).
If the patient does not have nitroglycerin
Pre-Arrival Instructions
Have the patient sit or lie down, whichever is more
comfortable.
Keep patient calm.
Loosen any tight clothing.
Gather patient medications, if any.
If the patient’s condition changes, call me back.
“Can the patient take aspirin?”
If yes: “Have they had any bleeding from mouth
or rectum?”
If no bleeding, advise caller to assist patient to take 1 full
size (325mg) adult aspirin or 4 low dose (81mg) tablets.
Have the patient chew the pills before swallowing.
Prompts
If unconscious, go to UNCONSCIOUS/BREATHING NORMALLY AIRWAY CONTROL.
If unconscious, NOT breathing normally, go to CPR for appropriate age group.
If the patient has a ventricular assist device, (may be called a VAD, heart pump, RVAD, LVAD,
BVAD, or LVAS) do not perform chest compressions.
If patient has a pacemaker or internal defibrillator CPR can be performed if needed.
A Ventricular assist device, or VAD, is a mechanical circulatory device that is used
to partially or completely replace the function of a failing heart. Some VADs are
intended for short term use, typically for patients recovering from heart attacks or
heart surgery, while others are intended for long term use (months to years and in
some cases for life), typically for patients suffering from congestive heart failure.
VADs need to be clearly distinguished from artificial hearts, which are designed to
completely take over cardiac function and generally require the removal of the
patient's heart.
VADs are designed to assist either the right (RVAD) or left (LVAD) ventricle, or
both at once (BiVAD). Which of these types is used depends primarily on the
underlying heart disease and the pulmonary arterial resistance that determines
the load on the right ventricle.
Device
Manufacturer
Type
Novacor
World Heart
Pulsatile.
HeartMate XVE
Thoratec
Pulsatile.
HeartMate II
Thoratec
Rotor driven continuous axial flow, ball and cup bearings.
HeartMate III
Thoratec
Continuous flow driven by a magnetically suspended axial
flow rotor.
Incor
Berlin Heart
Continuous flow driven by a magnetically suspended axial
flow rotor.
Excor Pediatric
Berlin Heart
Jarvik 2000
Jarvik Heart
MicroMed DeBakey VAD
MicroMed
VentrAssist[dead link]
Ventracor[33]
C-Pulse
MiTiHeart
Corporation
Sunshine Heart
HVAD
HeartWare
DuraHeart
Terumo
Thoratec PVAD (Paracorporeal
Ventricular Assist Device)
Thoratec
IVAD - Implantable Ventricular
Assist Device
Thoratec
MTIHeartLVAD
Approval Status as of July 2009
Was approved for use in North America, European Union
and Japan. Now defunct and no longer supported by the
manufacturer.
FDA approval for BTT in 2001 and DT in 2003. CE Mark
Authorized. Rarely used anymore due to reliability
concerns.
Approved for use in North America and EU. CE Mark
Authorized. FDA approval for BTT in April 2008. Recently
approved by FDA in the US for Destination Therapy (as at
January 2010).
Clinical trials yet to start, uncertain future.
Approved for use in European Union. Used on
humanitarian approvals on case by case basis in the US.
Entered clinical trials in the US in 2009.
Approved for use in European Union. FDA granted
External membrane pump device designed for children.
Humanitarian Device Exemption for US in December 2011.
Currently used in the United States as a bridge to heart
transplant under an FDA-approved clinical investigation.
Continuous flow, axial rotor supported by ceramic bearings. In Europe, the Jarvik 2000 has earned CE Mark
certification for both bridge-to-transplant and lifetime
use. Child version currently being developed.
Approved for use in the European Union. The child
Continuous flow driven by axial rotor supported by ceramic
version is approved by the FDA for use in children in USA.
bearings.
Undergoing clinical trials in USA for FDA approval.
Approved for use in European Union and Australia.
Continuous flow driven by a hydrodynamically suspended Company declared bankrupt while clinical trials for FDA
centrifugal rotor.
approval were underway in 2009. Company now dissolved
and intellectual property sold to Thoratec.
Continuous flow driven by a magnetically suspended
Yet to start clinical trials.
centrifugal rotor.
Pulsatile, driven by an inflatable cuff around the aorta.
Currently in clinical trials in the US and Australia.
Miniature "third generation" device with centrifugal blood Obtained CE Mark for distribution in Europe, January
path and hydromagnetically suspended rotor that may be 2009. Initiated US BTT trial in October 2008 (completed
placed in the pericardial space.
February 2010) and US DT trial in August 2010.
Magnetically levitated centrifugal pump.
CE approved, US FDA trials underway as at January 2010.
Pulsatile system includes three major components: Blood CE Mark Authorized. Received FDA approval for BTT in
pump, cannulae and pneumatic driver (dual drive console 1995 and for post-cardiotomy recovery (open heart
or portable VAD driver).
surgery) in 1998.
Pulsatile system includes three major components: Blood CE Mark Authorized. Received FDA approval for BTT in
pump, cannulae and pneumatic driver (dual drive console 2004. Authorized only for internal implant, not for
or portable VAD driver).
paracorporeal implant due to reliability issues.
DO NOT PERFORM CPR IF PATIENT HAS A
Ventricular Assist Device
While the patient may appear unconscious and not seem to have a
pulse the pump is still circulating blood and can keeping the patient
in a viable condition.
Pressure on the chest may cause the tubing to detach from the
heart or damage the device itself causing sever internal blood loss.
CARDIAC ARREST
K
e
y
Q
u
e
s
t
I
o
n
s
If unsure about breathing, interrogate further:
a. Have the caller go and see if the chest rises, then come back to the phone.
b. Listen for the sound, frequency and description of breaths.
Agonal respirations are often reported as:
gasping, snoring, or gurgling
barely breathing
moaning weak or heavy
occasional
SIMULTANEOUS ALS/BLS
D
I
s
p
a
t
c
h
State of New Jersey EMD Guidecards Version 1/04
Is patient alert?
Is patient breathing normally?
If unsure about consciousness, interrogate further:
a. Does the patient respond to you?
Talk to you? Answer questions? Hear you?
b. Does the patient move?
Flinch? Move arms or legs?
c. Are the pupils fixed and dilated?
Unconscious/not breathing adequately or at all.
All possible DOA’s, until evaluated by responsible
personnel.
BLS DISPATCH
CARDIAC ARREST / DOA
K
E
Y
Q
U
E
S
T
I
O
N
S
If unsure about consciousness
:
“Does the patient respond to you? Talk to
you? Answer questions? Hear you?”
“Does the patient move? Flinch? Move arms
or legs?”
“Are the pupils fixed and dilated?”
SIMULTANEOUS ALS/BLS
D
I
S
P
A
T
C
H
Unresponsive
Unconscious/not breathing adequately (Agonal) or
not at all.
Possible DOA of unknown origin
Delayed response
State of New Jersey EMD Guidecards Version 01/12
If unsure about breathing:
“Look and see if the chest rises and falls.”
“Listen for the sound, frequency and
description of breaths.”
Agonal respirations are often reported as:
gasping, snoring, or gurgling
barely breathing
moaning
weak or heavy
occasional
BLS DISPATCH
FOLLOW LOCAL PROTOCOL
CONFIRMED HOSPICE
EXPECTED DEATH
CARDIAC ARREST / DOA
Pre-Arrival Instructions
.
Go to CPR card for the
appropriate age group.
Age 8 years and ABOVE
Age 1 year to 8 years
Age 0 to 1 year
ADULT CPR INSTRUCTIONS
CHILD CPR INSTRUCTIONS
INFANT CPR INSTRUCTIONS
Prompts
Short Report
Agonal respirations are ineffective breaths which occur after Cardiac
Arrest. Indicate the need for CPR.
Brief generalized seizures may be an indication of cardiac arrest.
Age
Sex
Specific location
Chief complaint
Pertinent related symptoms
Medical/Surgical history, if any
Other agencies responding
Any dangers to responding units
ADULT
CPRINSTRUCTIONS
INSTRUCTIONS
ADULT
CPR
“Does anyone there know
how to do CPR?”
NO
YES
“Do you need help in remembering the
procedures?”
YES
“Get the phone NEXT to the
patient if you can.”
OK
CAN’T
“Begin CPR on the patient now.
I’ll stay on the line if you need me until
help arrives.”
NO
“Do you have a cordless phone?”
“Is there a phone that may be closer to the patient?”
“Can someone there relay my instructions to you?”
[If not] “I’ll give you the instructions, then return to the phone.”
“If I’m not here, stay on the line.”
OK
“Listen carefully. I’ll tell you what to do.
Get the patient FLAT on their back,
on the floor.”
OK
“Is there anyone there that can help you gently roll or slide
the patient to the floor?”
[If not] “Can you get help and return to the phone?”
CAN’T
OK
NO HELP / CAN’T
Begin, make your best attempt.
ADULT CPR INSTRUCTIONS - Page 1 of 4 (01/12)
 CHOKING ADULT ENTRY POINT
“Is there an automatic defibrillator in the area?"
NO
DO NOT OPERATE AED IN/OR
AROUND:
Water, snow or ice.
Bathtubs, pools or Jacuzzis.
Metal, street ventilation gates.
Hazardous materials.
Any type of conductive medium.
YES
AED Instructions
If alone, have caller obtain AED and return to patient.
Open the machine and turn it on. Follow the voice prompts and
instructions from the machine. Use large size pads on adults.
.
If others are present have someone obtain AED while caller
begins CPR. When AED arrives instruct person to set up AED
for use without interrupting CPR in progress. Use large size
pads on adults.
Advise when AED is ready to use.
Stop CPR and turn on the AED.
Follow the voice prompts and instructions from the machine.
.
CPR Instructions
“Kneel at the patient’s side and bare the chest, do you see any tubes or wires coming out of the chest or
abdomen?”
If YES, STOP- DO NOT START CPR, Go to SPECIAL CONSIDERATIONS on Page 4
If NO
“Put the HEEL of your HAND on the CENTER of their CHEST, between the nipples”
“Put your OTHER HAND ON TOP of THAT hand.”
“PUSH DOWN on the HEELS of your hands, at least 2 inches.”
“Do it 30 times, PUSH HARD AND FAST.”
If not performing MOUTH TO MOUTH breathing, ADVISE caller to continue to PUMP the CHEST until
help arrives or until the patient shows any signs of movement or breathing.
If doing mouth to mouth:
“Then, PINCH the NOSE SHUT and LIFT the CHIN so the head BENDS BACK.”
“Completely cover their mouth with your mouth”
“Give TWO BREATHS each lasting 1 second, then PUMP the CHEST 30 times.”
“KEEP DOING IT UNTIL HELP CAN TAKE OVER.”
If an AED becomes available see AED Instructions on Page 2
If there is more
than one person
present that is
willing to perform
CPR have them
switch with the
person doing CPR
every 2 minutes
SPECIAL CONSIDERATIONS
Patient has tubes or wires protruding from chest or
abdomen:
“Does the patient have a ventricular assist device?”
(May be called a VAD, heart pump, RVAD, LVAD, BVAD,
or LVAS.)
If YES, Do not perform chest compressions.
If patients has a pacemaker or internal defibrillator
return to CPR instructions.
Patient has vomited
“Turn his/her head to the side.”
“Sweep it all out with your fingers before doing
mouth-to-mouth.”
“Resume CPR.”
Patient has a Stoma
Breathing Instructions
“Keep the patient’s head STRAIGHT.”
“COMPLETELY COVER the STOMA with your mouth.”
“COVER the patient’s MOUTH and NOSE with your
hand.”
“GIVE TWO BREATHS OF AIR inflating the patient’s
LUNGS.”
“Make sure the CHEST GENTLY RISES.”
CHOKING ADULT INSTRUCTIONS
START
PROMPT:
If the event is NOT WITNESSED and the patient is
UNCONSCIOUS: Go to CPR ADULT.
Is the patient able to TALK
or COUGH?
NO
YES
If mild obstruction is present and the victim is
coughing forcefully, do not interfere with the
patient’s spontaneous coughing and breathing
efforts.
Attempt to relieve the obstruction only if the
cough becomes silent, respiratory difficulty
increases or the victim becomes unresponsive.
Is the patient
CONSCIOUS?
NO
YES
Conscious Patient Instructions
“Listen carefully. I’ll tell you what to do next.
Stand BEHIND the patient.
Wrap your arms AROUND the waist.*
Make a fist with ONE hand and place the thumb side against
the STOMACH, in the MIDDLE, slightly above the NAVEL.
GRASP your fist with the other hand.
PRESS into the stomach with QUICK, UPWARD thrusts.
Repeat thrusts until the item is expelled.
*If unable to reach around waist or if patient is in late stage
of pregnancy, reach under the arms and place hands on
center of chest.
GRASP your fist with the other hand.
PRESS into chest with QUICK thrusts until item is expelled.
If the patient becomes unconscious, come back to the
phone”.
Unconscious Patient Instructions
Compressions Only
“Get the patient FLAT on their back on the floor.”
“Kneel at the patient’s side and bare the chest, do you see any tubes or wires coming out of the chest or
abdomen?”
If YES, STOP- DO NOT START CPR, Go to ADULT CPR SPECIAL CONSIDERATIONS
If NO:
If there is more
“Put the HEEL of your HAND on the CENTER of their CHEST between the nipples.”
than one person
“Put your OTHER HAND ON TOP of THAT hand.”
present that is
“PUSH DOWN on the HEELS of your hands, at least 2 inches.”
willing to perform
“Do it 30 times, PUSH HARD AND FAST.”
CPR have them
switch with the
“Then, PINCH the NOSE SHUT and LIFT the CHIN so the head BENDS BACK.”
person doing CPR
“LOOK IN THE MOUTH FOR OBJECT. If seen, remove it.”
every 2 minutes
“KEEP DOING IT UNTIL HELP CAN TAKE OVER or the patient starts breathing.”
GO TO
UNCONCIOUS AIRWAY CONTROL
If an AED becomes available go to
ENTRY POINT FROM ADULT CHOKING
Unconscious Patient Instructions
With Ventilations
“Get the patient FLAT on their back on the floor.”
“Kneel at the patient’s side and bare the chest, do you see any tubes or wires coming out of the chest or
abdomen?”
If YES, STOP- DO NOT START CPR, Go to ADULT CPR SPECIAL CONSIDERATIONS.
If there is more
If NO:
than
“Put the HEEL of your HAND on the CENTER of their CHEST between the nipples.” one person
present that is
“Put your OTHER HAND ON TOP of THAT hand.”
willing
to perform
“PUSH DOWN on the HEELS of your hands, at least 2 inches.”
CPR have them
“Do it 30 times, PUSH HARD AND FAST.”
switch with the
“Then, PINCH the NOSE SHUT and LIFT the CHIN so the head BENDS BACK.” person doing CPR
‘LOOK IN THE MOUTH FOR OBJECT,. If seen, remove it.”
every 2 minutes.
“Completely cover their mouth with your mouth.”
“Give TWO BREATHS each lasting 1 second then PUMP the CHEST 30 times.”
“KEEP DOING IT UNTIL HELP CAN TAKE OVER or the patient starts breathing.”
IF PATIENT STARTS BREATHING GO TO
UNCONCIOUS AIRWAY CONTROL
If an AED becomes available go to
ENTRY POINT FROM ADULT CHOKING
HAZMAT INCIDENT GUIDE
K
E
Y
Q
U
E
S
T
I
O
N
S
“Where is the emergency?” Actual incident location,
direction of travel, best access if applicable:
“Are you in a safe location?”
If YES: continue questioning.
If NO: advise caller to move to safe location and call
back.
“What happened?” (Type of hazardous material)
IF YES:
How many people are injured?
What is the nature of the injuries?
Refer to appropriate medical guidecard or local protocol
for MASS CASUALTY INCIDENT.
“What is the name and/or ID # of material?”
Use DOT Guidebook or NLETS to obtain information
Explosion, Odor Complaint, Fire, Air release, Motor Vehicle about substance.
Accident, Illegal dumping, Leak / Spill, Abandoned
container / materials, Other.
EMERGENCY MEDICAL DISPATCH
D
I
S
P
A
T
C
H
“Are there any injuries?”
Refer to the appropriate medical guidecard or
follow local protocol for Mass Casualty Incident.
Hazardous Materials Agency Dispatch
Notify County and all applicable agencies
(NJDEP, Local and/or County OEM, etc.)
per local protocol.
HAZMAT INCIDENT GUIDE
Pre-Arrival Instructions
If you are not in a safe location, leave the area and call back.
Gather available chemical information.
Deny entry to affected area. Secure premises, isolate area.
Isolate injured from scene if safely possible.
Prompts
Short Report
Amount spilled or released:
State of material:
Solid
Incident location
Liquid
Gas
Access route
Size / Type of container:
Type of HazMat incident
Is the release continuous, intermittent, or contained? Entering a waterway, a
storm drain or sewer?
Number and nature of injuries
Have personnel been evacuated? YES
Release type
NO
Are there any emergency responders or HAZMAT trained personnel on the scene?
brigade
security
other
Is chemical information available for responders?
(I.e.: MSDS, Hazardous Substance Fact Sheet.
IF YES: Please have it ready for the emergency responders.
Wind Direction: N
S
E W
(If not available from caller, obtain from weather service)
fire
Wind direction
VEHICLE IN WATER
K
E
Y
“What kind of water are you in?”
River, lake or flooded roadway
Q
U
E
S
T
I
O
N
S
“Is the car sinking?”
If the caller is a witness ask if they can relay
instructions to occupants of the vehicle. If so
go to Pre-Arrival Instructions
“Can you open the vehicle doors?”
If NO
“Can you open the vehicle windows?”
If NO go to Pre Arrival Instructions
SIMULTANEOUS ALS/BLS
D
I
S
P
A
T
C
H
State of New Jersey EMD Guidecards Version 01/12
Vehicle in water sinking, submerged or stuck in
fast moving water.
BLS DISPATCH
Vehicle in still water, not sinking, water not
rising.
VEHICLE IN WATER
Vehicle in still water
“Open vehicle doors or windows, exit vehicle
and wade to shore.
If unable to wade to shore
“Exit vehicle and go to vehicle roof.”
Vehicle in water and sinking
“Release your seatbelts and open the windows.
If your windows will not open, try to break them.
Hit the corner of the window with a key, seat belt
buckle or metal headrest post. Exit through the
window and get onto the roof of the vehicle.”
Pre-Arrival Instructions
Vehicle is under the water
“If you are unable to open a window there should
be enough air for the minute or two that it will take
to prepare to escape. When the car is nearly full of
water, take a deep breath and push a door open,
you may need to do this with your feet. Exhale
slowly as you swim to the surface.”
Prompts
If vehicle is sinking or in fast moving water concentrate on getting the
occupants out of the vehicle and onto the roof. Once on the roof, verify
location.
Consider need for boats, SCUBA or Tactical/Rapid Water Rescue.
Short Report
Specific location
Number of occupants
Any dangers to responding units
GUIDELINES TO REQUEST AN ON-SCENE HELICOPTER
Air transportation should be considered when emergency personnel have evaluated the individual circumstances and found any
one of the following situations present.
ENVIRONMENTAL FACTORS
State of New Jersey EMD Guidecards Version 01/12
•The time needed to transport a patient by ground to an appropriate facility poses a threat to the
patient’s survival and recovery.
•Weather, road, and traffic conditions would seriously delay the patient's access to Advanced Life
Support (ALS).
INDICATORS OF SEVERE ANATOMIC OR
PHYSIOLOGIC COMPROMISE
•Critical care personnel and equipment are needed to adequately care for the patient during
transport.
•Unconsciousness or decreasing level of consciousness.
•Falls of 20 feet or more.
•Systolic blood pressure less than 90 mmHg.
•Motor vehicle crash (MVC) of 20 MPH or more without restraints.
•Respiratory rate less than 10 per minute or greater than 29 per minute.
•Rearward displacement of front of car by 20 inches.
•Glasgow Coma Score less than 10.
•Rearward displacement of front axle.
•Compromised airway.
•Compartment intrusion, including roof: >12 inches occupant site; >18 inches any site.
•Penetrating injury to chest, abdomen, head, neck, or groin.
•Ejection of patient from vehicle.
•Two or more femur or humerus fractures.
•Rollover.
•Flail chest.
•Deformity of a contact point (steering wheel, windshield, dashboard).
•Amputation proximal to wrist or ankle.
•Death of occupant in the same vehicle.
•Paralysis or spinal cord injury.
•Pedestrian struck at 20 MPH or more.
•Severe burns.
1-800-332-4356
REMCS (Newark)