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.

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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…• 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

• 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• Death• Ejection• High speed • Significant vehicle deformity• Abdominal trauma to pregnant

woman

Upgrading an MVA

Sick or Not Sick?

If Sick Get Help• 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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PainIs 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 RelativeEach patient has a unique 1-10 scale

BLS/ALS Decision Points

Upgrade fast, cancel slowUpgrade fast, cancel slow

Upgrade Trauma > 10Upgrade Trauma > 10

Big Mechanism = Sick PatientBig Mechanism = Sick Patient

If Sick Get HelpIf Sick Get Help

Upgrade Big BreaksUpgrade Big Breaks

Vital Signs: Too fast, slow, high, Vital Signs: Too fast, slow, high, low = upgradelow = upgrade

Medical is HistoricalMedical 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 ALSBLS ALS

TRANSPORTTRANSPORTIn Whatcom County