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EMD Protocol Guidecards

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EMD Protocol Guidecards

Color-coded, cross-linked reference — Vital Points Questions, Code 3 / Code 1 response criteria, and Pre-Arrival Instructions for each chief complaint, plus Airway Control, CPR, AED, and Childbirth procedure cards.

Chief Complaint Protocols

Abdominal/Back Pain

Vital Points Questions

  • Is the patient short of breath or does it hurt to breathe?
  • Is the patient able to speak in full sentences?
  • Has the patient vomited? What does the vomit look like?
  • Are the patient's bowel movements different than normal? How would you describe them?
  • Is the pain above or below the belly button?
  • If the patient is a woman between 12–50 years, ask if she could be pregnant.
  • Has the patient had any fainting or dizziness? How does the patient act when they sit up?
  • How much? Where is it located?
  • Is the patient complaining of any other pain?
  • Does the patient have any other medical or surgical history?
  • Is the patient wearing a MEDIC ALERT tag?

Code 3 Response (emergency / send response) if:

  • Unconscious/not breathing normally
  • Difficulty breathing
  • Vomiting red blood
  • Black tarry stool
  • Upper abdominal pain, patient over 35 yrs.
  • Lower abdominal pain, woman 12–50 yrs. (if associated with dizziness or fainting or heavy vaginal bleeding, 3 pads or 2 tampons/hr)
  • Abdominal/back pain w/ fainting or near fainting, patient over 50 yrs
  • Fainting/near fainting when sitting
  • Pain w/ vomiting (coffee-ground-like material)
  • Flank pain/back (kidney stone)
  • Abdominal/Back pain (non-traumatic), patient over 50 yrs

Code 1 Response (non-emergency) if:

  • Pain unspecified. Abdominal/Back pain (non-traumatic), patient under 50 yrs
  • Chronic back pain
  • Swelling at bite site
  • Bite below neck, non-poisonous

Pre-Arrival Instructions

  • If unconscious, go to AIRWAY CONTROL (Non-trauma).
  • Nothing to eat or drink. Allow position of comfort.
  • Gather patient's medications, if any.
  • If at night, turn on porch light. Unlock door.
  • Send someone to show the ambulance where to go.
  • Call us back (if disconnecting) if anything changes, immediately.
Bleeding (Non-Traumatic)

Vital Points Questions

  • Is the patient sweating profusely? How does the patient feel when they sit up?
  • Does the patient have a history of vaginal bleeding, more than expected?
  • Is the patient vomiting? What does the vomit look like?
  • Are the patient's bowel movements different from normal? How much and how long?
  • Is the patient short of breath, or does it hurt to breathe?
  • What part of the body is the patient bleeding from?
  • Has there been any vaginal bleeding, fainting, or syncope if less than 20 weeks pregnant?
  • Does the patient have a previous medical or surgical history?

Code 3 Response (emergency / send response) if:

  • Unconscious/not breathing normally
  • Diaphoretic (sweating profusely)
  • Fainting episodes (multiple)
  • Fainting/near fainting while sitting
  • Vomiting blood (red/dark red)
  • Black tarry stool
  • Vaginal bleeding if over 20 weeks pregnant
  • Coughing up blood (red/dark red) more than 1/2 cup blood
  • Lower abdominal pain, women 12–50 yrs. (if associated with dizziness, fainting, or heavy vaginal bleeding, 3 pads or 2 tampons/hr)
  • Bleeding without critical symptoms
  • Vomiting coffee-ground-like substance
  • Weakness

Code 1 Response (non-emergency) if:

  • Vaginal spotting
  • Nosebleed without critical symptoms
  • Vaginal bleeding without syncope if less than 20 weeks pregnant
  • Rectal bleeding without symptoms
  • Uncontrolled nosebleed

Pre-Arrival Instructions

  • Have the patient lie down, except for nosebleed. Nothing by mouth, to eat or drink.
  • If external bleeding, use clean cloth and apply pressure directly over it. Do not remove. If cloth becomes soaked, add more cloth to what is already there.
  • If nosebleed, pinch nose closed and do not release.
  • Do not flush the toilet or throw away blood soaked items.
  • Gather patient's medications, if any.
  • If at night, turn on porch light. Unlock door.
  • Send someone to show the ambulance where to go.
  • Call us back (if disconnecting) if anything changes, immediately.

Short Report

  • Age
  • Sex
Breathing Difficulty

Vital Points Questions

  • Is the patient short of breath or does it hurt to breathe? Able to speak in full sentences?
  • What is the patient's age? Does the patient have any chest pain?
  • Has the patient ever had this problem before? What was the patient doing just prior?
  • Is the patient drooling or having a difficult time swallowing?
  • Is the patient acting different than normal?
  • Has the patient been diagnosed with asthma, or ever used medication for it?
  • Are they experiencing any tingling or numbness in the extremities or around the mouth?
  • Does the patient have any other medical or surgical history? Is the patient on oxygen?

Code 3 Response (emergency / send response) if:

  • Unconscious/not breathing normally
  • Difficulty breathing with chest pain
  • Unable to talk in full sentences
  • Inhaled substance
  • Recent childbirth/broken leg/hospitalization (2–3 months); history of asthma or respiratory problems
  • Children under 12 yrs.: history of asthma or hospitalization
  • Drooling/difficulty swallowing
  • Asthma, unresponsive to medication
  • Less than 50 yrs., without critical symptoms
  • Tingling or numbness in extremities/around mouth

Code 1 Response (non-emergency) if:

  • Pain unspecified

Pre-Arrival Instructions

  • If unconscious, go to AIRWAY CONTROL (Non-trauma).
  • Nothing to eat or drink. Allow patient's position of comfort.
  • Gather patient's medications, if any.
  • If at night, turn on porch light. Unlock door.
  • Send someone to show the ambulance where to go.
  • Call us back (if disconnecting) if anything changes, immediately.
Allergic Reaction

Vital Points Questions

  • What is the patient complaining of? Is the patient short of breath?
  • Is the patient able to speak in full sentences?
  • Does the patient have a history of reaction to anything? Describe the reaction.
  • Does the patient have a rash or hives? How long ago was the exposure?
  • Are the patient's symptoms getting worse?
  • Is the patient a diabetic? Wearing a MEDIC ALERT tag?
  • Is the patient taking any medications?

Code 3 Response (emergency / send response) if:

  • Unconscious/not breathing normally
  • Difficulty talking in full sentences
  • Cannot talk/cannot swallow, difficulty breathing
  • Swelling in throat
  • Fainting (syncope)
  • History of immediate severe breathing difficulty
  • Itching, hives, and/or immediate severe reaction
  • History of severe reaction
  • Call delayed longer than 30 minutes with a history of reaction
  • Reaction to medication
  • Concern about reaction, but no history (hours), no difficulty breathing

Code 1 Response (non-emergency) if:

  • Reaction present for a long time (hours), no difficulty breathing

Pre-Arrival Instructions

  • Have the patient rest in the most comfortable position.
  • Keep the neck straight — remove any pillows.
  • Brush off the stinger, if possible.
  • Gather any medications that the patient is taking, if any.
  • Does the patient have a reaction kit? If YES, has it been used? Use as the physician has directed.
  • If at night, turn on porch light. Unlock door.
  • Send someone to show the ambulance where to go.
  • Call us back (if disconnecting) if anything changes, immediately.

Short Report

  • Age
  • Sex
Animal Bites

Vital Points Questions

  • Is the patient bleeding? Does the bleeding stop when you apply pressure?
  • Is the patient short of breath or does it hurt to breathe?
  • Is the patient able to speak in full sentences?
  • What type of animal bit the patient? How long ago was the patient bitten?

Code 3 Response (emergency / send response) if:

  • Unconscious, not breathing normally
  • Uncontrolled bleeding
  • Difficulty breathing
  • Serious neck and face bites
  • Bite from poisonous animal
  • Controlled bleeding

Code 1 Response (non-emergency) if:

  • Oxygen bottle empty
  • Stuffed nose, cold symptoms
  • Patient assist

Pre-Arrival Instructions

  • Keep the patient calm. Allow patient to get in a comfortable position.
  • Tell the patient not to exert themselves or talk.
  • Gather patient medications, if any.
  • If at night, turn on porch light. Unlock door.
  • Send someone to show the ambulance where to go.
  • Call us back (if disconnecting) if anything changes, immediately.
Chest Pain/Heart Problems

Vital Points Questions

  • Where in the chest is the pain located? Does the patient feel pain anywhere else?
  • How long has the pain been present? Does it change when the person breathes or moves?
  • What is the age of the patient?
  • Is the patient short of breath? Does it hurt to breathe?
  • Is the patient sweating profusely? Nauseated or vomiting?
  • Is the patient experiencing rapid heart rate with chest pain?
  • Does the patient have a history of rapid heart rate? How does the patient act when they sit up?
  • Does the patient take nitroglycerin? Have they taken it?
  • Has the patient ever had a previous heart surgery or a heart attack?
  • Is the patient weak, dizzy, or faint? Has the patient recently used illegal drugs?

Code 3 Response (emergency / send response) if:

  • Unconscious/not breathing normally
  • Male over 35 yrs.
  • Female over 40 yrs. old with: Nausea, Diaphoretic (sweating profusely), Short of breath, Rapid heart rate with chest pain, or history of rapid heart rate, Fainting (syncope), Cocaine/crack (drug) use, Combined alcohol and drug overdose
  • Male under 35 yrs. without critical symptoms
  • Female under 40 yrs. without critical symptoms
  • Rapid heart rate without critical symptoms

Code 1 Response (non-emergency) if:

  • Male under 35 yrs or female under 40 yrs with chest wall trauma without critical symptoms

Pre-Arrival Instructions

  • If patient is not breathing, determine appropriate age group and go to CPR.
  • Keep the patient calm. Have the patient sit or lie down, whichever is more comfortable.
  • Does the patient have nitroglycerin? Has the patient taken it? If NO: have the patient sit down and take as the physician has directed.
  • Gather patient medications, if any.
  • If at night, turn on porch light. Unlock door.
  • Send someone to show the ambulance where to go.
  • Call us back (if disconnecting) if anything changes, immediately.
Choking

Vital Points Questions

  • Does the chest/air enter freely?
  • Is the patient able to speak or cry?
  • Is the patient turning blue?

Code 3 Response (emergency / send response) if:

  • Unconscious/not breathing normally
  • Unable to talk or cry
  • Turning blue
  • Exchanging air with no breathing difficulty

Code 1 Response (non-emergency) if:

  • Airway cleared, patient assist

Pre-Arrival Instructions

  • Determine the appropriate age group and go to Obstructed Airway Instructions.
  • If at night, turn on porch light. Unlock door.
  • Send someone to show the ambulance where to go.
  • Call us back (if disconnecting) if anything changes, immediately.

Short Report

  • Age
Diabetic

Vital Points Questions

  • Is the patient short of breath or does it hurt to breathe?
  • Can the patient respond to you and follow simple commands?
  • Does the patient know who and where they are?
  • How does the patient act when they sit up? Dizzy, weak, or feeling faint?
  • Is the patient complaining of any pain? Where is it located?
  • Is the patient acting in an unusual manner? What is different?
  • Is the patient sweating profusely? Has the patient had a seizure?
  • Is the patient on insulin? When did they last take their medication?
  • When did the patient last eat?

Code 3 Response (emergency / send response) if:

  • Unconscious/not breathing normally
  • Difficulty breathing
  • Decreased level of consciousness
  • Chest pain
  • Fainting (Syncope)
  • Unusual behavior/acting strange
  • Profuse sweating (Diaphoretic)
  • Seizure
  • Awake/alert. Not feeling well
  • Weakness

Code 1 Response (non-emergency) if:

None specified.

Pre-Arrival Instructions

  • Nothing by mouth, if the patient is unable to take by him/herself.
  • Give juice with sugar (2–3 tablespoons) if able to take by self.
  • Gather patient medications, if any.
  • If at night, turn on porch light. Unlock door.
  • Send someone to show the ambulance where to go.
  • Call us back (if disconnecting) if anything changes, immediately.

Short Report

  • Age
Environmental Emergencies

Vital Points Questions

  • What happened? Does the patient have any complaints or pain? Where?
  • Is the patient short of breath or does it hurt to breathe?
  • Can the patient answer your questions and follow simple commands?
  • Is the patient sweating profusely? How does the patient act when they sit up?
  • Is the patient acting abnormal for him or her?
  • What was the source of the heat, cold, or chemicals?
  • Is the patient still in contact with the exposure? What was the length of the exposure?
  • How far is the patient from the phone (in woods, etc.)? Strange odor, clouds?

Code 3 Response (emergency / send response) if:

  • Unconscious/not breathing normally
  • Difficulty breathing
  • Confused/disoriented
  • Fainting (Syncope)
  • Uncontrolled bleeding
  • Chemicals on patient's skin or clothing
  • Patient with uncontrolled shivering
  • Patient excessively hot
  • Other injuries without uncontrollable bleeding

Code 1 Response (non-emergency) if:

  • No injuries, but has been exposed

Pre-Arrival Instructions

  • Give nothing by mouth.
  • If bleeding, use clean cloth and apply pressure directly over it. Do not remove. If cloth becomes soaked, add more cloth to what is already there.
  • If chemicals are involved, do not touch the patient.
  • If the patient is cold and wet, remove the patient's clothing and cover the patient.
  • If the patient is over-heated, loosen clothing to assist cooling.
  • If at night, turn on porch light. Unlock door.
  • Send someone to show the ambulance where to go.
  • Call us back (if disconnecting) if anything changes, immediately.
Gynecology/Miscarriage

Vital Points Questions

  • Is the patient bleeding? How long has the patient been bleeding?
  • Is she sweating profusely? Faintness or fainting when the patient sits up?
  • Is she having contractions (cramping pains)? How many pads/tampons per hour?
  • Is the bleeding heavier than her normal menstrual cycle?
  • What is the patient's medical history/history of complications in previous pregnancies?

Code 3 Response (emergency / send response) if:

  • Unconscious/not breathing normally
  • Diaphoretic fainting with patient sitting up
  • Vaginal bleeding, fainting/near fainting with contraction
  • Bleeding if greater than 20 weeks pregnant
  • Lower abdominal pain, women 12–50 yrs. (if associated with dizziness, faintness, or heavy vaginal bleeding with 3 pads or 2 tampons/hr)
  • Vaginal bleeding without syncope
  • Bleeding, if less than 20 weeks pregnant, without contraction
  • Abdominal injury, without contraction if less than 20 weeks pregnant
  • Water broken

Code 1 Response (non-emergency) if:

  • Pregnant less than 20 weeks, and menstruation, with any of the following: Cramps, Pelvic Pain, Spotting

Pre-Arrival Instructions

  • Have the patient lie down on her left side. Keep the patient warm.
  • Do not flush the toilet.
  • Gather patient's medications, if any.
  • If at night, turn on porch light. Unlock door.
  • Send someone to show the ambulance where to go.
  • Call us back (if disconnecting) if anything changes, immediately.
Headache

Vital Points Questions

  • Can the patient respond to you and follow simple commands and answer your questions?
  • How is the patient acting? Is this different than normal?
  • Does the patient know who and where they are?
  • Did the headache come on suddenly or gradually?
  • Has the patient had a headache before? What is different?
  • What was the patient doing when the headache started?
  • Does the patient have pain anywhere else?
  • Has the patient had a recent illness or injury? Where?
  • Does the patient have a history of headaches? Wearing a MEDIC ALERT tag?

Code 3 Response (emergency / send response) if:

  • Unconscious/not breathing normally
  • Decreased level of consciousness
  • Mental confusion
  • Worst headache ever
  • Sudden onset
  • Headache after physical exertion
  • With head injury
  • Headache, without critical symptoms, with head injury (migraines)

Code 1 Response (non-emergency) if:

  • Headache, without critical symptoms, Migraines

Pre-Arrival Instructions

  • Do not give the patient anything to eat or drink by mouth.
  • Allow the patient to find a position of comfort.
  • Gather patient medications, if any.
  • If at night, turn on porch light. Unlock door.
  • Send someone to show the ambulance where to go.
  • Call us back (if disconnecting) if anything changes, immediately.
Mental/Emotional/Psychological

Vital Points Questions

  • What happened? Has the patient harmed themself? Where are the injuries?
  • Is the patient bleeding? How much and how long?
  • Is the patient acting in their normal manner? What is different?
  • Can the patient answer your questions? Can the patient talk to you?
  • Has the patient taken any drugs or alcohol?
  • Does the patient have any weapons or access to weapons?
  • Is the scene safe for medical personnel to respond?
  • Does the patient think they may harm himself/herself or others? With what? Why?

Code 3 Response (emergency / send response) if:

  • Unconscious/not breathing normally
  • Gunshot wound/stabs to head, neck, torso, or thigh
  • Unusual behavior associated with: Diabetes, Suicidal ideation, Altered mental status, Secondary to drug overdose, Pregnant, Known alcohol intoxication or ingestion, Street drug intoxication with other drugs (patient can be aroused), Lacerated wrist(s) with controlled bleeding, Altered behavior with a psychiatric history, Threats against self or others

Code 1 Response (non-emergency) if:

  • Police request for stand-by. Patient out of psych medication

Pre-Arrival Instructions

  • Keep the patient calm.
  • Keep the patient in the area if you feel you are in danger, leave the scene.
  • Gather the patient medications, if any.
  • If at night, turn on porch light. Unlock door.
  • Send someone to show the ambulance where to go.
  • Call us back (if disconnecting) if anything changes, immediately.
Overdose/Poisoning

Vital Points Questions

  • Is the patient short of breath, or does it hurt for the patient to breathe?
  • Can the patient talk in full sentences and follow simple commands?
  • Is the patient acting normally for them? What is different?
  • Do you have any idea what the patient took? What medications, were they prescription?
  • What medication did the patient take? How much?
  • If not medication, what kind of substance did the patient take?
  • Is the patient having difficulty swallowing? Complaining of any pain?
  • How old is the patient? Is the patient violent?
  • With alcohol? Where? If cocaine or crack, is the patient complaining of chest pain?
  • Does the patient have access to weapons? Has the patient vomited? Describe.

Code 3 Response (emergency / send response) if:

  • Unconscious/not breathing normally
  • Difficulty breathing
  • Decreased level of consciousness
  • Intentional/accidental ingestion of household cleaners, solvents, antifreeze, methanol, cyanide, insecticides
  • Difficulty swallowing
  • Acute alcohol and drug overdose with chest pain
  • Combined alcohol and drug overdose
  • Cocaine/crack (drug) use
  • 3rd party report, caller not with patient, unknown if medications or substances were taken
  • Reported O.D., patient denies taking medications, or intentional/accidental with nonprescription medications
  • Chemicals other than critical criteria (swallowed or splashed upon)

Code 1 Response (non-emergency) if:

  • Known alcohol intoxication, without other drugs, over 17 yrs., can be aroused

Pre-Arrival Instructions

  • If not breathing, determine appropriate age group and go to AIRWAY CONTROL (Non-trauma).
  • If unconscious, go to CPR.
  • Get container of substance taken if at the scene. Keep patient in area/house, if it's safe.
  • Do not force by mouth, including Ipecac, unless advised by poison control.
  • Give nothing by mouth. Don't force coffee or place patient in the shower.
  • If at night, turn on porch light. Unlock door.
  • Send someone to show the ambulance where to go.
  • Call us back (if disconnecting) if anything changes, immediately.
Pregnancy/Childbirth (Chief Complaint)

Vital Points Questions

  • Is she bleeding? How many pads/tampons per hour?
  • How does she feel when she sits up?
  • Is she having any contractions? How far apart?
  • Does she feel the urge to have a bowel movement?
  • Is this the first pregnancy?
  • During her previous delivery: How long was she in labor before delivery?
  • Was the delivery an injury? Were there any complications?
  • Has there been a seizure? Is the delivery vaginal or surgical?
  • Is the baby breathing?

Code 3 Response (emergency / send response) if:

  • Unconscious/not breathing normally
  • Vaginal bleeding with fainting
  • Fainting/near fainting with patient sitting up
  • Labor pains/contractions less than 2 min. apart (1st pregnancy) or less than 5 min. apart (2nd+ pregnancy)
  • Bleeding if greater than 20 weeks pregnant, lasting less than 1 hr
  • Premature active labor greater than 4 wks. prem.
  • Delivery
  • Vaginal bleeding without fainting if under 20 weeks pregnant
  • Seizure
  • Abdominal injury w/ contractions if greater than 20 weeks pregnant
  • 1st preg. w/ contractions greater than 2 min. apart
  • 2nd preg. w/ contractions greater than 5 min. apart
  • Abdominal injury, without contractions, if greater than 20 weeks pregnant
  • Water broke

Code 1 Response (non-emergency) if:

  • Pregnant less than 20 weeks with: Cramps, Pelvic Pain, or Spotting

Pre-Arrival Instructions

  • Do not let the patient go to the toilet.
  • Have the patient lie down on her left side.
  • Gather the patient's medications, if any.
  • For imminent and post delivery, go to CHILDBIRTH.
  • If at night, turn on porch light. Unlock door.
  • Send someone to show the ambulance where to go.
  • Call us back (if disconnecting) if anything changes, immediately.
Seizures

Vital Points Questions

  • Describe what the patient is doing. Is the patient still seizing?
  • If the seizure has stopped, is the patient breathing normally?
  • How long has the patient been seizing?
  • Has the patient had a seizure before? Is this different than normal?
  • Is the patient a diabetic? Does the patient have a MEDIC ALERT bracelet on?
  • Has the patient been sick or feel hot?
  • If female, is the patient pregnant? Is the patient a recreational drug user?
  • Is the child's age 6 or under? Has the patient had a first time seizure before?
  • Before or after the seizure? Within the last three days?

Code 3 Response (emergency / send response) if:

  • Not breathing after seizure stops
  • Extended seizures greater than 5 minutes
  • Multiple seizures, except children under 6 yrs
  • First time seizures
  • Diabetic
  • Pregnant
  • Secondary to drug overdose
  • Secondary to recent head injury
  • Any seizure that is different than normal
  • Seizure, unknown history
  • Any seizure in a child 6 years or younger
  • Single seizure with a history of seizure disorder

Code 1 Response (non-emergency) if:

None specified.

Pre-Arrival Instructions

  • Clear the area around the patient. Do not restrain the patient.
  • Do not place anything in the patient's mouth.
  • After the seizure has stopped, check to see if the patient is breathing.
  • If not breathing, determine appropriate age group and go to CPR instructions.
  • Have the patient lie on their side.
  • If patient is a child, remove clothing to cool patient if hot and feverish.
  • If unconscious after seizure, go to AIRWAY CONTROL (Non-trauma).
  • Gather patient medications, if any.
  • If at night, turn on porch light. Unlock door.
  • Send someone to show the ambulance where to go.
  • Call us back (if disconnecting) if anything changes, immediately.
Sick/Unknown

Vital Points Questions

  • Can I talk to the patient? If YES: what is the problem?
  • Are you short of breath or is it hard to breathe? If so, where?
  • Describe what the patient is doing. Does the patient answer your questions?
  • How does the patient look? What is the patient complaining of?
  • Is the patient acting normally for him/her?
  • If NO: Is the patient able to respond to you and follow simple commands?
  • How does the patient feel when they sit up?
  • Have you checked for a MEDIC ALERT tag? Is there insulin in the refrigerator?
  • Do you know if this was a sudden onset or if it was gradual?

Code 3 Response (emergency / send response) if:

  • Unconscious/not breathing normally
  • Decreased level of consciousness
  • Chest discomfort if older than 35 years
  • Multiple fainting episodes
  • Indigestion or feeling light-headed or dizzy
  • Generalized weakness
  • Light-headedness/dizzy when standing
  • 3rd party report, caller not with patient
  • Medic alert alarm company

Code 1 Response (non-emergency) if:

  • Flu symptoms
  • High blood pressure without critical symptoms
  • High temperature
  • Patient assist
  • Other

Pre-Arrival Instructions

  • Keep the patient warm. Allow the patient to find a position of comfort.
  • Gather patient medications, if any.
  • If at night, turn on porch light. Unlock door.
  • Send someone to show the ambulance where to go.
  • Call us back (if disconnecting) if anything changes, immediately.

Short Report

  • Age
  • Sex
Stroke (CVA)

Vital Points Questions

  • Describe what the patient looks like. What is the patient doing?
  • Can the patient respond to you and follow simple commands and answer your questions?
  • How is the patient acting? Is this different?
  • Is the patient short of breath, or does it hurt to breathe?
  • Is the patient able to speak in full sentences?
  • Is the patient complaining of any pain? Where is it located?
  • Is the patient a diabetic? Has the patient had a severe headache?
  • Has the patient had a seizure?
  • Does the patient have any other medical or surgical history?

Code 3 Response (emergency / send response) if:

  • Unconscious/not breathing normally
  • Patient is under 50 yrs
  • Decreased level of consciousness
  • Breathing difficulty
  • Chest pain
  • Diabetic
  • Seizure
  • Severe headache
  • Unilateral paralysis (one-sided)
  • Weakness, numbness
  • Trouble speaking
  • No breathing difficulty

Code 1 Response (non-emergency) if:

None specified.

Pre-Arrival Instructions

  • Keep the patient calm. Do not allow the patient to move around.
  • If unconscious or having difficulty breathing, keep neck straight and remove pillows.
  • Do not give the patient anything by mouth (to eat or drink).
  • Gather patient medications, if any.
  • If at night, turn on porch light. Unlock door.
  • Send someone to show the ambulance where to go.
  • Call us back (if disconnecting) if anything changes, immediately.
Unconscious/Unresponsive/Syncope

Vital Points Questions

  • Is this the first time today the patient has been unconscious?
  • Have you or anyone else tried to wake the patient up?
  • Has the patient taken any medications or recreational drugs with alcohol?
  • Is the patient short of breath or does it hurt to breathe?
  • Is the patient able to speak in full sentences?
  • What was the patient doing before they became unconscious?
  • Did the patient have any complaints before they became unconscious?
  • Is the patient acting normally? What is different?
  • Can the patient answer your questions? Respond to you and follow simple commands?
  • How does the patient act when they sit up?
  • Has the patient been drinking alcohol?
  • Does the patient have a MEDIC ALERT tag? What does it say?

Code 3 Response (emergency / send response) if:

  • Unconscious/not breathing normally
  • Multiple fainting (syncopal) episodes at time of call
  • Confirmed unconscious/unresponsive at time of call
  • Combined drug and alcohol overdose
  • Difficulty breathing
  • Fainting associated with headache, abdominal pain, chest pain/discomfort/palpitations if over 35 yrs.
  • Diabetic, GI/vaginal bleeding, decreased level of consciousness
  • Single fainting if over 50 yrs
  • Alcohol intoxication under the age of 17
  • Unconfirmed slumped over the wheel
  • Unconscious, but now conscious
  • 3rd party report — caller not with patient
  • Single fainting, if under 50 yrs., without critical symptoms
  • Conscious with minor injuries
  • Known alcohol intoxication without other drugs, over age 17 (can be aroused)

Code 1 Response (non-emergency) if:

None specified.

Pre-Arrival Instructions

  • If unconscious, go to AIRWAY CONTROL (Non-trauma).
  • If not breathing normally, determine appropriate age group and go to CPR instructions.
  • Have the patient lie down. If the patient is vomiting, lie the patient on their side.
  • Do not move the patient. Be prepared for CPR.
  • Gather the patient's medications, if any.
  • If at night, turn on porch light. Unlock door.
  • Send someone to show the ambulance where to go.
  • Call us back (if disconnecting) if anything changes, immediately.
Burns: Thermal/Electrical/Chemical

Vital Points Questions

  • Can the patient respond to you and follow simple commands and answer your questions?
  • Is the patient short of breath or does it hurt to breathe?
  • Is the patient having difficulty swallowing? Coughing?
  • Are there burns around the mouth and nose? Any burns on the front and back?
  • If male, is any facial hair burned?
  • How was the patient burned — dryer, stove, or other 220 volt source?
  • Is the patient still in contact with the electrical source?
  • Where is the patient burned — head or face?

Code 3 Response (emergency / send response) if:

  • Unconscious/not breathing normally
  • Decreased level of consciousness
  • Difficulty breathing
  • Burns to airway, nose, mouth
  • Hoarseness, difficulty talking or swallowing
  • Burns over 20% or more of body surface
  • Electrical burns/electrocution from 220 volts or greater, power lines/panel boxes
  • Spilled hot liquids
  • Battery electrical shock
  • Household electrical shock
  • Less than 20% burned
  • Chemical burns to the eyes
  • Sunburn

Code 1 Response (non-emergency) if:

  • Small burns from match, cigarette
  • Freezer burns

Pre-Arrival Instructions

  • If not breathing normally, go to CPR for the appropriate age group.
  • If unconscious, go to AIRWAY CONTROL (Trauma).
  • Turn off the power, if safe.
  • Have the patient remove contaminated clothing, if possible.
  • If chemical is powder, brush off. DO NOT USE WATER.
  • If chemical, get information on the chemical (MSDS Sheet, if available).
  • Flush chemical burns from eyes. Remove contact lenses.
  • Place burned area in cool water (not ice) if convenient.
  • Gather the patient's medications, if any.
  • If at night, turn on porch light. Unlock door.
  • Send someone to show the ambulance where to go.
  • Call us back (if disconnecting) if anything changes, immediately.
Drowning/Water-Related Injury

Vital Points Questions

  • Can the patient respond to you and follow simple commands?
  • Is the patient short of breath or does it hurt to breathe?
  • Is the patient able to speak in full sentences?
  • How long was the patient submerged? Was the patient on land or in a boat?
  • Is this a scuba diving accident? Has the patient been removed from the water?
  • What was the patient doing before the incident?

Code 3 Response (emergency / send response) if:

  • Unconscious/not breathing normally
  • Difficulty breathing
  • Patient confirmed submerged for over 1 minute
  • Scuba diving accident
  • Patient not submerged
  • Patient coughing
  • Other injuries: neck/back without critical symptoms
  • Fractured femur (thigh)

Code 1 Response (non-emergency) if:

  • Minor injury (lacerations/fractures) (except thigh)

Pre-Arrival Instructions

  • Do not attempt to rescue the patient.
  • If unconscious/not breathing, go to AIRWAY CONTROL (Trauma) for the appropriate age group.
  • Do not move the patient around. Keep patient warm.
  • Gather the patient's medications, if any.
  • If at night, turn on porch light. Unlock door.
  • Send someone to show the ambulance where to go.
  • Call us back (if disconnecting) if anything changes, immediately.
Falls/Accidents

Vital Points Questions

  • Can the patient respond to you and follow simple commands?
  • Is the patient short of breath, or does it hurt to breathe?
  • How far did the patient fall? What kind of surface did the patient land on?
  • Are there any obvious injuries?
  • Did the patient complain of any pain or illness just prior to the fall?
  • What part of the body did the patient land on?
  • Do you have any idea what the patient has amputated? Able to move the amputated parts?
  • Is the patient complaining of any pain? Bleeding? Is it controlled?
  • From where? How much?

Code 3 Response (emergency / send response) if:

  • Unconscious/not breathing normally
  • Decreased level of consciousness
  • Difficulty breathing
  • Falls greater than 10 feet
  • Falls associated with or preceded by: pain, discomfort in the chest, dizziness, headache, or penetrating injury to head, neck, torso, or thigh
  • Accident with crushing or penetrating injury
  • Amputation other than fingers/toes
  • Patient paralyzed
  • Unconscious, but now conscious
  • Falls less than 10 feet
  • Amputation/entrapment of fingers/toes
  • Neck or back pain without critical symptoms
  • Patient trapped, without obvious injury
  • Controlled bleeding
  • Multiple extremity fractures/single femur (thigh) fracture

Code 1 Response (non-emergency) if:

  • Cuts, bumps, or bruises
  • Patient assist
  • Isolated extremity fracture (except thigh)
  • Involved in accident, no complaints/refusal

Pre-Arrival Instructions

  • If unconscious, go to AIRWAY CONTROL (Trauma).
  • If machinery involved, turn it off (attempt to locate a maintenance person).
  • Do not move the patient if there are no hazards. Tell the patient not to move.
  • Cover the patient with a blanket and try to keep him/her calm.
  • If bleeding, use clean cloth and apply pressure directly over the wound. Do not remove. If it becomes soaked, add more cloth to what is already there.
  • Locate any amputated parts or skin and place in a clean plastic bag (not on ice). Place expelled teeth in milk.
  • Gather patient medications, if possible.
  • If at night, turn on porch light. Unlock door.
  • Send someone to show the ambulance where to go.
  • Call us back (if disconnecting) if anything changes, immediately.
Motor Vehicle Accident (MVA)

Vital Points Questions

  • Did the caller stop at the scene or drive by? How many people are injured?
  • Are the patients able to respond to you and follow simple commands?
  • Can the patient(s) describe where the pain is located?
  • Are all of the patients free of the vehicle? Is anyone trapped?
  • Was anyone thrown from the vehicle?
  • Are there any hazards present? Fire? Water involvement (river, pond, lake, stream, hydrant)?
  • Wire(s) down? Is road blocked/impassable?
  • Is fuel or chemical (HAZ-MAT) visible?
  • If cargo vehicle, is there anything leaking? Any placards visible? What number?

Code 3 Response (emergency / send response) if:

  • Unconscious/not breathing normally
  • Decreased level of consciousness
  • Chest pain prior to accident
  • Confirmed or unknown injuries with the following mechanisms: Vehicle (motorized vs. immovable object), Vehicle vs. vehicle (head-on, T-bone), Vehicle vs. pedestrian, Car vs. motorcycle or bicycle, Patient(s) ejected, Patient(s) trapped
  • Major incident response (greater than 10 patients)
  • Injury accident, no critical criteria
  • Vehicle roll over
  • Minor injury, patient walking

Code 1 Response (non-emergency) if:

  • Evaluation requested by on-scene personnel

Pre-Arrival Instructions

  • If unconscious/not breathing, go to AIRWAY CONTROL (Trauma) for the appropriate age group.
  • If unconscious, go to CPR for the appropriate age group.
  • Do not move the patient (if there are no hazards).
  • If bleeding, use clean cloth and apply pressure directly over the wound. Do not remove. If it becomes soaked, add more cloth to what is already there.
  • Gather patient's medications, if any.
  • If at night, turn on porch light. Unlock door.
  • Send someone to show the ambulance where to go.
  • Call us back (if disconnecting) if anything changes, immediately.
Neurological/Head Injuries

Vital Points Questions

  • Is the patient short of breath, or does it hurt to breathe?
  • Is the patient able to talk in full sentences and follow simple commands?
  • Can the patient answer your questions?
  • Is the patient acting normally? If not, what is different?
  • If having a seizure, go to guidecard on SEIZURES.
  • Is the patient combative (wanting to fight with you)?
  • Are there any hazards present? Fire, Water, Wires down
  • What caused the injury?

Code 3 Response (emergency / send response) if:

  • Unconscious/not breathing normally
  • Breathing difficulty
  • Decreased level of consciousness
  • Combative
  • Seizure after head injury
  • Fall, greater than 5 minutes of unconsciousness
  • Awake after less than 10 feet
  • Confused about what has happened

Code 1 Response (non-emergency) if:

  • Bump or laceration from fall without loss of consciousness

Pre-Arrival Instructions

  • If unconscious/not breathing, go to CPR (Trauma) instructions.
  • If unconscious, go to AIRWAY CONTROL (Trauma) instructions.
  • Do not move the patient (if there are no hazards). Nothing to eat or drink by mouth.
  • If bleeding, use clean cloth; add more cloth as needed, but do not remove.
  • Gather patient medications, if possible.
  • If at night, turn on porch light. Unlock door.
  • Send someone to show the ambulance where to go.
  • Call us back (if disconnecting) if anything changes, immediately.
Trauma with Injury

Vital Points Questions

  • Is the patient able to respond to you and follow simple commands?
  • Can the patient answer your questions?
  • What was the patient injured with? Can the patient(s) describe what happened?
  • Is the patient bleeding? Is it controlled with pressure? How much? How long?
  • Describe what happened. Is the suspect(s) still present?
  • Has law enforcement been notified? Is law enforcement on the scene?

Code 3 Response (emergency / send response) if:

  • Unconscious/not breathing normally
  • Decreased level of consciousness
  • Penetrating/crushing injury to the head, neck, chest, abdomen or thigh
  • Uncontrolled bleeding
  • Sexual assault under 12 years
  • Penetrating/crushing injury to extremities (below shoulders or knees)
  • Unknown or internal injuries
  • Minor injuries with weapons
  • Multiple extremity fractures/single femur (thigh) fracture
  • Sexual assault over 12 years

Code 1 Response (non-emergency) if:

  • Minor injuries without weapons
  • Concerned without apparent injuries
  • Isolated extremity fracture
  • Police request stand-by/check for injuries

Pre-Arrival Instructions

  • If unconscious, go to AIRWAY CONTROL (Trauma).
  • Have the patient lie down and keep calm.
  • Do not remove weapons or touch an impaled object. Do not touch weapons or disturb the scene.
  • If bleeding, use clean cloth and apply pressure directly over it. If the cloth becomes soaked, add another cloth to what is already there. Do not remove.
  • Tell the patient not to change clothing, bathe, or shower.
  • Keep the patient warm. Do not disturb anything.
  • Gather the patient's medications, if any.
  • If at night, turn on porch light. Unlock door.
  • Send someone to show the ambulance where to go.
  • Call us back (if disconnecting) if anything changes, immediately.

Age / Category Choosers

CPR — Choose Age Group

This step depends on patient age or category. Choose the correct card:

Airway Control — Choose Category

This step depends on patient age or category. Choose the correct card:

Obstructed Airway — Choose Age Group

This step depends on patient age or category. Choose the correct card:

Airway Control, CPR, AED & Childbirth

Airway Control — Non-Trauma

Breathing Normally: Non-Trauma

Listen carefully. I'll tell you what to do. Roll the patient onto his/her side. Have someone stay with the patient to watch his/her breathing. If the patient stops breathing normally or his/her condition changes, call me back so I can tell you what to do.

Blood/Vomiting: Non-Trauma

Listen carefully. I'll tell you what to do. Roll the patient onto his/her side and sweep out the mouth with your fingers. Continue watching the patient's breathing. If the patient stops breathing normally or his/her condition changes, call me back so I can tell you what to do.

If breathing stops:

Go to CPR for the appropriate age group.

Airway Control — Trauma

Breathing Normally: Trauma

Listen carefully — I'll tell you what to do. Gently remove any pillows that have been placed under the patient's head. Don't move the patient unless they are in danger. If you have to move the patient, try to keep the head and neck in line with the rest of the body and keep his/her head as still as possible.

Have someone stay with the patient to watch his/her breathing until help takes over.

Blood/Vomiting: Trauma

If the patient vomits, or there is blood in the mouth, try to keep the head and neck in line with the rest of the body. Use your fingers to sweep out the patient's mouth while keeping his/her head as still as possible.

If the patient stops breathing normally or his/her condition changes, call me back so I can tell you what to do.

If breathing stops:

Go to CPR for the appropriate age group.

Obstructed Airway — Infant (less than 1 year)

Instructions — Level of Consciousness

If they are unconscious, go to CPR INFANT Guidecard and instruct the caller to look for a foreign body in the mouth as well as after each set of compressions. Only if they see a foreign body in the mouth, remove it.

If conscious: Are they able to cry or cough?

(If YES)

Position the baby so that any secretions can drain out of their mouth.

(If NO)

Listen carefully. I'll tell you what to do.

Remove clothing from the baby's chest. Pick up the baby and turn them face down so they lie along your forearm. Rest your forearm on your thigh and support the jaw in your hand, but don't cover their mouth. Tilt the baby with the head down slightly. Use the heel of your other hand to strike the back firmly, five (5) times, right between the shoulder blades.

If they are still conscious but choking, turn them over so that they are face up, resting on your thigh and forearm, keeping the head lower than the chest. Place the heel of your hand in the middle of the chest and give five (5) quick chest thrusts about one and one half (1½) inches.

Keep repeating this until they are able to cry or cough. If they become limp or unconscious, tell me immediately.

If they become unconscious, go to CPR INFANT Guidecard and instruct the caller to look for a foreign body in the mouth as well as after each set of compressions.

Obstructed Airway — Adult and Child (1 year and older)

Instructions — Level of Consciousness

If they are unconscious, go to CPR ADULT AND CHILD Guidecard and instruct the caller to look for a foreign body in the mouth as well as after each set of compressions. Only if they see a foreign body, remove it.

If conscious: Are they able to talk or cough?

(If NO)

Listen carefully. I'll tell you what to do. If they are much shorter than you, you may need to kneel.

Stand to the side and just behind them. If they are conscious, support their body at the waist so they face the ground.

Place your arm across their chest and bend the person over at the waist. Using the heel of your other hand, strike the back firmly, five (5) times, right between the shoulder blades.

(If YES)

Encourage them to keep coughing if they are able to.

Did the object come out?

(If NO)

Get behind them and wrap your arms around their waist. Make a fist with one hand and place it against the middle of the stomach, slightly above the belly button. Grasp your fist with the other hand. Press into the stomach with quick inward and upward thrusts. Repeat the thrusts until the item is expelled.

Keep repeating this until they are able to cough or talk. If they pass out or become unconscious, tell me immediately.

If they become unconscious, go to CPR ADULT AND CHILD Guidecard and instruct the caller to look for a foreign body in the mouth as well as after each set of compressions.

Note:

If they inform you that the person is obese or late term pregnancy, chest thrusts may be performed with the heel of the hand in the center of the chest, on the lower half of the breastbone.

CPR Infant (less than 1 year)

Instructions

1. Is there an AED (Automatic External Defibrillator) available? If YES: Send someone to get it and let me know when you have it. When it arrives, go to AED Reference Guidecard.

(If NO) (Continue…) Listen carefully. I'll tell you what to do.

2. Lay the baby flat on their back on a table or floor. Position yourself by the baby's side.

3. Put the heel of one hand on the center of their chest, right between the nipples. Push down hard and fast, about one and one half (1½) inches, allowing the chest to return to its normal position between each pump. Try to pump twice every second. Count out loud and I'll help you count.

4. After 100 compressions, continue to Step 5.

5. Are you able to give mouth-to-mouth ventilations?

(If YES)

After 30 compressions, pinch the nose and lift the chin so that the head tilts back slightly. Completely cover the baby's mouth and nose with your mouth and give 2 quick breaths — just enough to see the chest rise. Then pump the chest 30 more times. Keep doing cycles of 30 compressions and 2 breaths. I'll help you count.

(If NO)

Continue hands-only compressions.

6. Continue until responders arrive. If they begin to breathe, move, or cough, go to Airway Control Guidecard.

If concern for obstructed airway, instruct the caller to look for a foreign body in the mouth after each set of compressions. Only if they see a foreign body, remove it. If they become conscious or begin to breathe, go to Obstructed Airway - Infant Guidecard.

If concern for opiate overdose, go to Naloxone Guidecard.

If the baby has a tracheostomy / stoma and the rescuer is able to provide ventilations: Completely cover the stoma with your mouth and put your hand over the mouth and nose. After 30 compressions, keep the head straight. Give 2 breaths and watch the chest rise. Then pump the chest 30 more times. Keep doing cycles of 30 compressions and 2 breaths.

Note: If the caller reports the stoma is encrusted with mucous, instruct the caller to clean the opening with a cloth.

CPR Adult and Child (1 year and older)

Instructions

1. Is there an AED (Automatic External Defibrillator) available? If YES: Send someone to get it and when it arrives, go to AED Reference Guidecard.

(If NO) (Continue…) Listen carefully. I'll tell you what to do.

2. Get them flat on their back on the floor or a hard surface. Kneel by their chest.

3. Put the heel of your hand on the center of their chest, on the lower half of the breastbone. Put your other hand on top of that hand.

4. Push down hard and fast, at least two inches, allowing the chest to return to its normal position between each pump. Try to pump twice every second. Count out loud and I'll help you count to a hundred.

After 100 compressions, continue to Step 5.

5. Are you able to give mouth-to-mouth ventilations?

(If YES)

After 30 compressions, pinch the nose and lift the chin so that the head tilts back. Give 2 breaths and watch for the chest to rise. Then pump the chest 30 more times. Keep doing cycles of 30 compressions and 2 breaths. I'll help you count.

(If NO)

Continue hands-only compressions.

6. Continue until responders arrive. If they begin to breathe, move, or cough, go to Airway Control Guidecard.

If concern for obstructed airway, instruct the caller to look for a foreign body in the mouth after each set of compressions. Only if they see a foreign body, remove it. If they become conscious or begin to breathe, go to Obstructed Airway – Adult and Child Guidecard.

If concern for opiate overdose, go to Naloxone Guidecard.

If the person has a tracheostomy / stoma and the rescuer is able to provide ventilations: Completely cover the stoma with your mouth and put your hand over the mouth and nose. After 30 compressions, keep the head straight. Give 2 breaths and watch the chest rise. Then pump the chest 30 more times. Keep doing cycles of 30 compressions and 2 breaths.

Note: If the caller reports the stoma is encrusted with mucous, instruct the caller to clean the opening with a cloth.

AED Reference

Instructions

1. Position the AED close to the person's head, on a dry, non-metallic surface free of any hazardous materials. They must be on their back.

2. Turn on the AED. You may have to press a power button or lift a cover to the “UP” position.

3. Remove the person's shirt to access their bare chest. If the chest is wet or sweaty, dry it off. If you see any medication patches (nitroglycerin or nicotine), remove them.

4. Apply the AED Pads:

If 8 years old or older, or unsure:

Use adult pads. Plug the pads into the machine and attach the self-adhesive pads directly to the bare skin of the person. One on the upper right side of the person's chest with the top of the collar bone, the other on the person's left chest with the pad a few inches below the arm pit. If the person has a pacemaker, the pads must be placed 3–5 inches from the pacemaker.

If 7 years old or younger:

If not available, use pediatric pads. Plug the pads into the machine and attach the self-adhesive pads directly to the bare skin of the child. Place one pad in the center of the child's chest and the other pad in the center of the child's back.

5. Follow the AED's prompts.

The machine may have an “analyze” button that needs to be pressed. When analyzing, ensure that no one is touching them.

6. If a shockable rhythm is present,

the device will announce through visual or auditory alarm that a shock is indicated. If it tells you to, press the shock button while making sure no one is touching the person.

7. As soon as the AED indicates to resume CPR,

re-start chest compressions until it instructs you to stop to analyze again.

After the AED is turned on, do not turn it off.

Childbirth

Labor: Imminent or Active Delivery

(Contractions less than 2 minutes apart, strong desire to push, crowning, etc.)

1. Listen carefully — I'll tell you what to do.

2. Have the patient lay flat on her back on a bed or the floor — don't let her use the toilet. Have her relax by taking slow, deep breaths through her mouth.

3. Ask her to remove her clothing below the waist and bend her knees. Place a clean towel under her buttocks and have additional towels ready if available.

4. The baby's head usually delivers first. As the head begins to deliver, support it gently to prevent the baby from coming out too fast. Do not push or pull on the baby.

5. Be sure the umbilical cord is not wrapped around the baby's neck; if it is, try to slip the cord gently over the baby's head using your fingers. If the caller reports leg, arm, buttocks, or umbilical cord presentation, GO TO COMPLICATIONS.

6.

Once the head is out, the rest of the body will usually be delivered with the next few contractions. There will be water and blood with the delivery — this is normal. Support the baby as it is delivered.

7.

Once the baby is delivered, clean out its mouth and nose with a clean dry cloth and wrap it up in a clean dry blanket or towel. Do not cut or pull on the cord.

8.

If the baby is not breathing or crying on its own, rub its back or gently tap the bottoms of the baby's feet. If NO Response, go to CPR INFANT Guidecard.

9.

Keep the baby warm and place it between the mother's legs, being sure to keep the baby at the same level as the mother. The contractions may start up again when the placenta is delivered — this is normal.

Childbirth Complications

(leg, arm, buttocks, or umbilical presentation)

Reassure the mother. Ask her to get up onto her hands and knees. Have her try to relax by taking slow, deep breaths through her mouth. Tell her not to push.

Labor: Non-Imminent Delivery

Have her lie in a comfortable position on her left side. Have her relax by taking slow, deep breaths through her mouth.