Pre-Arrival Instructions

49 Pages·2012·1.13 MB·English

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

Traumatic Incident Types
GUIDECARD INDEX
ANIMAL BITES

ASSAULT/DOMESTIC VIOLENCE / SEXUAL ASSAULT
BLEEDING / LACERATION
BURNS Time / Life-Critical Events
EYE PROBLEMS / INJURIES CO POISONING / INHALATION
FALL VICTIM CARDIAC ARREST / DOA

HEAT / COLD EXPOSURE - ADULT CPR INSTRUCTIONS
- CHILD CPR INSTRUCTIONS
INDUSTRIAL ACCIDENT
STABBING / GUNSHOT VICTIM / ASSAULT - INFANT CPR INSTRUCTIONS

TRAUMATIC INJURY
CHOKING
VEHICULAR RELATED INJURIES
- ADULT CHOKING INSTRUCTIONS
Medical Chief Complaint Types - CHILD CHOKING INSTRUCTIONS
- INFANT CHOKING INSTRUCTIONS
ABDOMINAL PAINS
DROWNING (POSSIBLE)
ALLERGIES / STINGS ELECTROCUTION
BACK PAIN
PREGNANCY / CHILDBIRTH
BREATHING PROBLEMS
- CHILDBIRTH INSTRUCTIONS
CHEST PAIN / HEART PROBLEMS UNCONSCIOUS / FAINTING
DIABETIC PROBLEMS - UNCONSCIOUS AIRWAY CONTROL (NON-TRAUMA) INSTRUCTIONS
HEADACHE - UNCONSCIOUS AIRWAY CONTROL (TRAUMA) INSTRUCTIONS
OD/POISONINGS / INGESTIONS
PSYCHIATRIC / BEHAVIORAL PROBLEMS Miscellaneous

SEIZURES / CONVULSIONS AIR MEDICAL DISPATCH PROCEDURE

SICK PERSON AIRCRAFT / TERRORISM
STROKE / CVA HAZMAT
UNKNOWN / PERSON DOWN VEHICLE IN WATER
ALL
1. “Where is your emergency?” (Address or
CALLERS
Location)
INTERROGATION
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)

YES
NO Dispatch ALS & BLS

7.” Is the patient breathing NORMALLY?”
7.” Is the patient breathing NORMALLY?”

YES NO / UNCERTAIN

NO
UNCERTAIN YES
Determine chief

Go to Go to Go to complaint and turn Go to
CPR to appropriate card. BREATHING
UNCONSCIOUS/
Instructions CARDIAC PROBLEMS
FAINTING
for age group ARREST/DOA

ALL CALLERS INTERROGATION - Page 1 of 1 (01/12)

ANIMAL BITES
State of New Jersey EMD Guidecards Version 01/12

K “Is the animal contained?”
E
“Is the patient bleeding?”
Y
“What type of animal bit the patient?”
Q IF YES,
U “Is the patient short of breath or does it “Can it be controlled with
E hurt to breathe?” pressure?”
S
“How long ago did they receive
T
I “What part of the body was bitten?” the bite?”
O
N
S

SIMULTANEOUS ALS/BLS BLS DISPATCH

D Unconscious/not breathing normally. Controlled bleeding.
I Decreased level of consciousness.
S Uncontrolled bleeding, after attempts to control. Swelling at bite site.
P Serious neck or face bites from animal attacks.
A Bites from known poisonous animals. Bite below neck, non-poisonous.
T

C
H
ANIMAL BITES
Pre-Arrival Instructions

Contain the animal, if possible. For snake bites:
Lock away any pets. Apply direct pressure to the wound.
Do not elevate extremity.
If severe bleeding go to Do not use ice.
BLEEDING/LACERATION Do not attempt to remove venom.
Pre-Arrival Instructions
For jellyfish stings:
If little or no bleeding, irrigate human and Wash with vinegar or baking soda.
animal bites with copious amounts of water.
If the patient’s condition changes, call me back.
Keep patient calm and still.

Prompts

Has law enforcement been notified?

Has Animal Control been notified? FOLLOW AIR MEDICAL
DISPATCH GUIDELINES

ASSAULT / DOMESTIC, SEXUAL
State of New Jersey EMD Guidecards Version 01/12

K

E “Is the assailant nearby?” “What part of the patient is injured?”
Y
“Are you safe?” “Is the patient bleeding?”
Q IF YES, Go to B L E E D I N G / L A C E R A T ION
U “Was it a physical assault vs. sexual assault?”
E

S
“How was the victim assaulted?”
T
I (Stabbing, gunshot or major trauma go to
O appropriate card)
N
S

SIMULTANEOUS ALS/BLS BLS DISPATCH

D Unconscious/not breathing normally.
Penetrating/crushing injury to hands or feet.
I Decreased level of consciousness.
Isolated extremity fracture.
S Crushing injury (except to hands or feet.)
Minor injuries.
P Puncture injury (head, neck, torso, thigh.) Unknown injuries.
A Multiple extremity fractures.
Concerned caller without apparent injuries to victim.
T Femur (thigh) fracture.
C Uncontrolled bleeding. Police request stand-by/check for injuries.

H
ASSAULT / DOMESTIC, SEXUAL
Pre-Arrival Instructions

Remain in a safe place, away from the assailant. Advise patient not to change clothing, bathe or

shower.

Obtain description of assailant(s),
Keep patient warm.
Have patient lie down and keep calm.
Gather patient medications, if possible.
Do not touch weapons.
Do not allow the patient any food or drink.

If the patient’s condition changes, call me back.

Prompts

Has law enforcement been notified? Relay details of incident and

description of assailant(s).

FOLLOW AIR MEDICAL
DISPATCH GUIDELINES
Sexual Assault- non-injured, Follow County SART Protocols

Domestic Violence- non-injured, Follow local police protocols

BLEEDING / LACERATION
State of New Jersey EMD Guidecards Version 01/12

K “Where is the bleeding from?” “How much blood can you see?”
E

Y
If the patient is female with vaginal bleeding “How long have they been bleeding?”

“Could she be pregnant?”
Q
If YES, go to “Is blood squirting out?” (arterial bleeding)
U PREGNANCY/CHILDBIRTH

E

S “Does she have pain in the abdomen” “Is the patient a hemophiliac (a bleeder)?”
T If YES consider ABDOMINAL PAIN
I
O
N
S

SIMULTANEOUS ALS/BLS BLS DISPATCH

Decreased level of consciousness.
D Any arterial bleeding.
I Bleeding with history of Hemophilia. Minor bleeding from any other area that can be
controlled by direct pressure.
S Rectal bleeding with significant blood loss.
P Vomiting blood or coffee ground material.
A Bleeding from mouth with difficulty breathing.
T Bleeding from the neck, groin, or armpit with significant

C blood loss.
H Vaginal bleeding if over 20 weeks pregnant, associated
with lower abdominal pain or fainting.
BLEEDING / LACERATION
Pre-Arrival Instructions

If bleeding, use clean cloth and apply pressure
directly over wound. Do not remove. If cloth becomes If teeth, locate, DO NOT touch the root, and place
soaked, add more to what is already there. them in container with milk or clean water.

Elevate bleeding extremities.

Cover patient with blanket and try to keep them calm.

If nosebleed, tell the patient to apply direct pressure

by pinching the nose tightly between their index finger Nothing to eat or drink.
and thumb, sit forward and hold it until help arrives.
Attempt to spit out blood, swallowing may make Advise patient not to move.
patient nauseous.
Gather patient medications, if possible.
Locate any amputated part(s) and place in clean
plastic bag, NOT ON ICE. If the patient’s condition changes, call me back.
DO NOT add ice.
Prompts

Any bleeding that cannot be controlled by direct pressure should be
considered critical.
FOLLOW AIR MEDICAL

Use of tourniquets cannot be properly instructed over the phone. They DISPATCH GUIDELINES

should be used only by people who have had proper training.

BURNS
State of New Jersey EMD Guidecards Version 01/12

CHEMICAL
K
“How was the patient burned?” “What chemical caused the burn?”
E

Y
THERMAL “Where is the patient burned?”

“Is anything on the patient still burning?”
Q
If YES, Stop the burning. IF HEAD OR FACE:
U
“Place burned area in cool water (not ice), if “Is the patient short of breath, coughing or does it
E
S convenient” hurt to breathe?”
T “Is the patient having difficulty swallowing?”
“Are there burns around their mouth and nose?”
I ELECTRICAL

O
N Go to ELECTROCUTION “Are there any other injuries?”
S

SIMULTANEOUS ALS/BLS BLS DISPATCH

Decreased level of consciousness.
D Burns to airway, nose, mouth. Less than 20% body surface burned.
Spilled hot liquids.
I Hoarseness, difficulty talking or swallowing.
Chemical burns to eyes.
S Burns over 20% of body surface.
Small burn from match, cigarette.
P Electrical Burns/electrocution from 220 volts or greater Household electric shock.
A power lines/panel boxes.
T 2nd & 3rd degree burns (partial or full thickness) to Battery explosion.
C Palms (hands) Freezer burns.
H Soles (feet)
Groin
BURNS
Pre-Arrival Instructions

THERMAL
Place burned area in cool water (not ice), if convenient

CHEMICAL
Have patient remove contaminated clothing, if possible.
If chemical, get information on chemical
(MSDS Sheet if available).

If chemical is powder, brush off, no water.

Flush chemical burns from eyes with water.
Remove contact lenses if present.
Gather patient medications, if possible.
If the patient’s condition changes, call me back.

Prompts

Dispatch Fire Department/HAZMAT, according
to local protocol.

FOLLOW AIR MEDICAL

DISPATCH GUIDELINES

EYE PROBLEMS / INJURIES
State of New Jersey EMD Guidecards Version 01/12

K “What caused the injury?”
E
Y

“Is eyeball cut open or leaking fluid?”
Q
U “Are there any other injuries?”
E
If YES go to appropriate Guidecard
S

T
I
O
N
S

SIMULTANEOUS ALS/BLS BLS DISPATCH

D
I Unconscious/not breathing normally. Any eye injury.
Decreased level of consciousness.
S
P Uncontrolled bleeding.
A

T

C
H
EYE PROBLEMS / INJURIES
Pre-Arrival Instructions

Do not remove any penetrating objects.

Cover patient with blanket and try to keep them calm.
If eyeball is cut or injured, do not touch, irrigate, or
bandage.
Nothing to eat or drink.

If a chemical injury, flush immediately with water.
Gather patient medications, if possible.
Continue until help arrives. Remove contact lenses.

If the patient’s condition changes, call me back.
Advise patient not to move.

Have patient SIT down.

Prompts

Removing object from the eye, direct pressure or flushing with water
may cause further damage.
FOLLOW AIR MEDICAL
Large penetrating objects can cause damage to the upper airway. DISPATCH GUIDELINES
Monitor patient for breathing difficulties.

FALL VICTIM
State of New Jersey EMD Guidecards Version 01/12

K
E “How far did the patient fall?”
“ Is the patient able to move their fingers

Y
and toes?”
“What kind of surface did the patient land
(Do not have them move any other body part).
Q on?”

U
“Is the patient bleeding?”
ES “Are there any obvious injuries? What are IF YES, Go to BLEEDING/LACERATION
T they?”

I
“Did the patient complain of any pain or
O
illness just prior to the fall?”
N
S

SIMULTANEOUS ALS/BLS BLS DISPATCH

Decreased level of consciousness. Unconscious, but now conscious without

D Signs/symptoms of shock. critical symptoms.
I Falls greater than 10 feet. Falls less than 10 feet.
S
Falls associated with or preceded by pain, Neck or back pain without critical symptoms.
P discomfort in chest, dizziness, headache, or Controlled bleeding.
A
T diabetes. Cuts, bumps, or bruises.
Patient paralyzed.
C Isolated extremity fracture.
H Uncontrolled bleeding.
Multiple extremity fractures.
Femur (thigh) fracture.
FALL VICTIM
Pre-Arrival Instructions

Do not move the patient if there are no hazards.
Gather patient medications, if possible.

Advise patient not to move
If the patient’s condition changes, call me back.
Monitor for shock;
Skin cool and clammy or mottled, rapid shallow
breathing, fatigue, altered mental state, dilated
pupils.

Cover patient with blanket and try to keep them calm.

No food or drink.

Prompts

Is Rescue needed?

FOLLOW AIR MEDICAL
If unconscious, go to UNCONSCIOUS/BREATHING
DISPATCH GUIDELINES
NORMALLY AIRWAY CONTROL

If unconscious, NOT breathing normally, go to CPR for
appropriate age group.

HEAT / COLD EXPOSURE
State of New Jersey EMD Guidecards Version 01/12

K “What happened?”
E Cold Related

Y
“What was the source of the heat or cold?”

“Can the patient be moved to a warm
Q
Heat Related area?”
U
“Is the patient sweating profusely?” “What was the length of exposure?”
E

S “Is the patient confused, disoriented or acting “Is the patient complaining of pain? If so,
T strange?” where?”
I “Is the patient having hallucinations?” “Are there any obvious injuries?”
O “Is the patient dizzy, weak, or feeling faint?”
N “Is the patient taking any medications?”
S
SIMULTANEOUS ALS/BLS BLS DISPATCH

D
I Decreased level of consciousness. Patient with uncontrollable shivering.
High body temperature without sweating. Heat Exhaustion:
S
P Confused/disoriented/hallucinations. Nausea, vomiting, fatigue, headaches,
muscle cramps, dizziness, with no critical
A Fainting (Syncope).
symptoms.
T Cold Water Submersion.

C Narcotics and Psych Medications may exacerbate
H and/or mask symptoms
HEAT / COLD EXPOSURE
Pre-Arrival Instructions

Cold Related
Remove from hot/cold environment if possible.
If patient is cold and dry, move to a warm

Heat Related environment and cover patient.

If patient is over-heated, have them lie down in a If patient is cold and wet, move to a warm

cool place. Loosen clothing to assist cooling. environment, remove clothing and cover patient.

Nothing by mouth if heat stroke is indicated or Do not rub frostbitten extremities.
there is a decrease of consciousness.
Gather patient medications, if possible.

If the patient’s condition changes, call me back.

Prompts

Heat Exhaustion:
Nausea, vomiting, fatigue, headache, muscle cramps and dizziness.
FOLLOW AIR MEDICAL

DISPATCH GUIDELINES
Heat Stroke:

High body temperature, absence of sweating, rapid pulse, strange

behavior, hallucinations, agitation, seizure and/or coma.

INDUSTRIAL ACCIDENTS
State of New Jersey EMD Guidecards Version 01/12

K “What happened?” If bleeding: Go to B L EEDING/LACERATION
E

Y If burned: Go to B URNS
If patient is trapped in or under an object:

“What part of the person is trapped?
Q If Electrocution: Go to ELECTROCUTION

U
“Are there any obvious injuries? What are
E “Is the patient able to move their fingers and
they?”
S toes?”
T
(DO NOT have them move any other parts of
I If amputation:
their body).
O “What part of the body has been amputated?”
N “Do you have the amputated parts?
S
SIMULTANEOUS ALS/BLS BLS DISPATCH

Decreased level of consciousness.
D
I Accident with crushing or penetrating injury to: head, Unconscious, but now conscious without critical
neck, torso, thigh. symptoms.
S
Patient entrapped. PROMPT (Dispatch Rescue Unit) Amputation/entrapment of fingers/toes.
P Amputation other than fingers/toes. Neck or back pain without critical symptoms.
A
Patient paralyzed. Controlled bleeding.
T
Uncontrolled bleeding. Cuts, bumps, or bruises.
C
H Multiple extremity fractures. Patient assist.
Femur (thigh) fracture. Involved in accident, no complaints.
INDUSTRIAL ACCIDENTS
Pre-Arrival Instructions

If machinery involved, turn it off (attempt to locate Nothing to eat or drink.
maintenance person).

Locate any amputated parts and place in clean plastic

Do not move patient if there are no hazards. bag, NOT ON ICE.

Advise patient not to move. If teeth, locate, DO NOT touch the root, place in milk
or clean water.
Do not enter a confined space to tend to the patient.
Monitor for shock:

Have someone meet the ambulance to guide them to the Skin cool and clammy or mottled, rapid shallow
patient. breathing, fatigue, altered mental state, dilated
pupils.
Cover patient with blanket and try to keep them calm.
If the patient’s condition changes, call me back.

Prompts

If unconscious, go to UNCONSCIOUS/BREATHING NORMALLY
AIRWAY CONTROL. FOLLOW AIR MEDICAL
DISPATCH GUIDELINES
If unconscious, NOT breathing normally, go to CPR for appropriate
age group.

Is Fire Department /Rescue needed?

STABBING/GUNSHOT/ASSAULT
State of New Jersey EMD Guidecards Version 01/12

K “What part(s) of the body is injured?” “Is more than one person injured?”
E

Y “When did this happen? “Is there bleeding?”

Q IF YES, Go to BLEEDING/LACERATION
“Was it intentional or an accident?”
U
If intentional, “Is assailant still present?”
E

S
“What type of weapon was used?”
T
I
O “Is the weapon still present?”
N
S

SIMULTANEOUS ALS/BLS BLS DISPATCH

Unconscious/not breathing normally.
D
I Decreased level of consciousness. Wounds to the arms below the elbow or on the leg
Uncontrolled Bleeding. below the knee.
S
Leg injury above the knee.
P Wounds to head neck, torso, or thigh.
A
Multiple Casualty Incident.
T

C
H