HSS 389 On and Off the Field Evaluations

Emergency Action Protocols (EAPs)

Plans that are essential for “life safety critical” events and highly important to ensure the fastest possible care in cases of critical injury; consist of compiled information for all emergency situations:

• Who is responsible for what?

• What equipment do we have access to?

• Where do you tell EMS to meet you?

• Who is notified & what is the chain of command?

Primary survey

An on the field assessment done initially and determines the existence of life-threatening situations: cardiopulmonary resuscitation (CPR), consciousness, airway obstruction, breathing, circulation, severe bleeding, and shock

• Life-threatening injuries take place over all other forms of injury

Unconscious

To be in a state of insensibility and lack of awareness; an be result of a blow to the head, the solar plexus, general shock, fainting (syncope), or inadequate blood flow to the brain

Best practices for treating an unconscious patient

• Call 911 or activate EAP procedures

• Note the body position, level of consciousness, and responsiveness

• Can utilize a sternum rub to respectfully inflict pain and check awareness

• CAB: circulation, airway, breathing

• **Assume injury to the neck or spine

• Rescuers should remove helmet and pads immediately that could impede CPR

• If the patient is supine and breathing, monitor until they come to

• If the patient is prone and not breathing, logroll and conduct CPR

• If the patient is prone and breathing, monitor until they come to, then logroll to a spine board.

• **Life support supersedes spinal motion, but consider its importance

CPR Ratios

• Adults: 30 compressions per 2 breaths

• Children: 15 compressions per 2 breaths

Hemorrhage

The abnormal discharge of blood

• Venous blood is dark red and continuous flow

• Capillary bleeding comes from tissue and is reddish

• Arterial bleeding flows in spurts and is bright red

How is external bleeding manage?

• Usually managed through direct pressure

• Elevate the part that is impacted

• If you apply a tourniquet, write down the time in which it was applied

• In the event of severe hemorrhaging with no tourniquet, pressure points can be utilized (e.g., brachial and femoral arteries)

Shock

Our “internal reset button”; vascular system loses its capacity to hold fluid due to dilation of blood vessels

Hypovolemic shock

Shock due to blood loss

Respiratory shock

Shock due to difficulty breathing/hyperventilation

Neurogenic shock

Shock due to the nervous system

Psychogenic shock

Fainting → shock due to a psychological event

Cardiogenic shock

Shock due to a heart issue (cardiac event)

Septic shock

Shock due to infection

Anaphylactic shock

Shock due to allergic reaction

Metabolic shock

Shock due to overexertion, difficulty processing energy, low energy level, etc.

Signs and symptoms of shock

• Low blood pressure (systolic pressure is usually below 90 mmHg)

• Pulse is rapid and weak

• Patient may be drowsy or sluggish

• Respiration is shallow and extremely rapid

• Skin pale, cool, clammy

Secondary survey

An off the field assessment that gathers specific information about the injury from the patient and to uncover any additional problems

• Recognizing vital signs: pulse, respiration, blood pressure, temperature, oxygen saturation, skin color, pupil size, level of consciousness, & abnormal nerve response

What are the four primary vital signs?

1. Pulse

2. Blood pressure

3. Respiration

4. Temperature

Normal pulse (bpm)

• Adults: 60-100 bpm

• Children: 80-100 bpm

Normal respiration rate (breaths per minute)

• Adults: 12-20 breaths per minute

• Children: 15-30 breaths per minute

Oxygen saturation level (SpO₂)

The measurement of oxygen that red blood cells are transporting; a pulse meter is used and should read between 95-100%

Normal blood pressure

<120/80

Elevated blood pressure

120-129/<80

High blood pressure — stage i

130-139 systolic or 80-89 diastolic

High blood pressure — stage 2

140+ systolic or 90+ diastolic

Hypertensive crisis

180+ systolic and/or 120+ diastolic

Normal body temperature

Typically 98.2 to 98.6 degrees F

Normal skin color

Normal skin tone is pink

• A flushed red skin could be related to vasodilation factors

• Pale, ashen, or white skin can be related to circulatory factors

• Yellowish skin tone (jaundice – liver issue)

Normal pupil reactions

PEARL → pupils are equal and reactive to light

• Sensitive to situations impacting nervous system

• Injury, alcohol, or drug poisoning may affect pupils

Inability to move parts of the body is most likely caused by _____ injury.

CNS

Hemiplegia

Inability to move one side of body (due to head injury or stroke)

Quadriplegia

Inability to move all four limbs (due to spinal cord injury)

Paraplegia

Inability to move lower limbs (due to spinal cord injury)

Neuropathy

Nerve pathology

Radiculopathy

A type of neuropathy characterized by radiating, sharp, shooting pain due