General Medical Care Guideline

Patient Care Goals

Facilitate appropriate initial assessment and management of any EMS patient as required by EMTALA and link to appropriate specific guidelines as dictated by the findings within the Universal Care guideline. 

Definition of a patient

A patient is anyone:
-with a complaint which suggests potential for medical, traumatic, or psychiatric illness, who requests or whom another individual in direct contact with them requests evaluation for such a complaint on their behalf.
-with obvious evidence of medical, traumatic, or psychiatric illness, who has experienced an acute event that could reasonably lead to medical, traumatic, or psychiatric illness,
-in a circumstance that could reasonably lead to medical, traumatic, or psychiatric illness.

This definition is to be applied in the broadest sense. If there is any question, the individual should be considered a patient and treated accordingly. Medical assist (i.e. fall out of wheelchair, etc) are considered patients.

Assessment

Pediatric Pearls: Signs & Symptoms: Differential: 
-Use approved reference document
for medication dosing, electrical
therapy, and equipment sizes. 

-Always start with uninjured areas
first to build trust

-Never lie to a child		-Location 
-Onset 
-Precipitating Event(s) 
-Quality 
-Radiation 
-Severity 
-Time/Duration 
-Aggravating/Alleviating 
-Associated Symptoms 
-Prior history of same/similar 		-Vascular 
-Infectious/Inflammatory 
-Trauma/Toxins 
-Autoimmune 
-Metabolic 
-Idiopathic 
-Neoplastic 
-Congenital 

Clinical Management Options

EMT-B
-Demonstrate professionalism and courtesy; Scene/Crew Safety/PPE; with appropriate equipment and medications to the patient side 
-Use closed looped communication and crew resource management with all on scene providers 
-Perform an initial assessment and physical exam 
-Obtain a full set of vital signs: Mental status, BP, pulse rate, respiratory rate, and body temperature 
-Obtain blood glucose level as appropriate 
-Orthostatic vital signs if appropriate for patient condition 
-Oxygen as needed to maintain SpO2 92 – 96% or as indicated by signs of hypoxia 
-Perform medication cross check for all medication administrations
-Identify need for ALS transportation or rapid transportation for critically ill patients and time critical diagnosis
Paramedic
-IV / IO access as appropriate for patient condition 
-Consider ET3 if applicable 
-Place and monitor EtCO2 as indicated 
-12 lead ECG acquisition and 4 lead ECG placement

Consult Online Medical Control as Needed

Rules 

  • If, at any time, a BLS crew finds themselves handling a patient requiring emergency Advanced Life Support (ALS) care, then the crew should begin immediate life-saving interventions as warranted while weighing the options to: a) proceed urgent to the nearest hospital, b) proceed urgent to the nearest hospital while requesting an ALS intercept, or c) request urgent ALS response to the scene while stabilizing the patient and awaiting ALS arrival. When choosing an option, consideration should include, but not be limited to, distance to closest appropriate Emergency Department, location of the call, condition of the patient, availability of on-scene assistance, level of medical training of on-scene assistance, road conditions, or any other exigent circumstances.
    • Time Critical Diagnosis should be emergently transported to the hospital
  • If, at any time, a BLS crew finds themselves handling a patient requiring non-emergency Advanced Life Support (ALS) care, then the crew should contact the on-duty Supervisor, discuss the situation, and determine the best customer and patient service option including staying with the patient while awaiting ALS response or accepting a facility modification to allow for BLS transport.
  • Medical Control should be contacted in the following order:
    • WashU EMS line
    • Receiving Hospital
    • Christian Hospital
  • Try to state the question first in a med control phone call. It can set up the conversation to be more successful
    • I.e. I’m calling for a medication request vs. I’m calling for advice
  • Use feedback communication both in medical control requests and on scene.
  • Refer to drug formulary charts for all medication dosing for both adults and pediatric patients. 
  • Minimum exam for all patients includes vital signs, mental status including GCS, location of injury or complaint, and pain scale. 
  • Maintain all appropriate medications and procedures that have been initiated at the referral agency or institution.