Emergency Medical Technician Decision Tree Flow Chart

UNSAFE!

1 - SCENE SIZE-UP
1) Take the necessary Body Substance Isolation precautions 2) Assure Scene Safety for rescuer, patient, and bystanders 3) Determine Mechanism of Injury or Nature of Illness 4) Establish Number of Patients 5) Need for Additional Resources

SAFE

Control Scene Move Patients Correct Hazzard

TRAUMA Patient
Suspect Spinal Injury? NO Assess Mental Status (AVPU) YES

MOI

2INITIAL PATIENT ASSESSMENT

Form General Impression: Mechanism of Injury? Look, Feel Skins, Listen Breathing, L.O.C. DECIDE: TRAUMA, MEDICA, BOTH ? (A,B,Cs, Bleed and Shock)

MED

MEDICAL Patient

Establish In-line Stabilization

Assess Mental Status (AVPU) CLOSED Perform Jawthrust Manuver DECAP BTLS: Deformity Evisceration Contusion Abrasion Penetration Burns Tenderness Lacerations Swelling PMS: Pulse/Capalary Rel Motor Function Sensation PEARL: Pupils Equal And Reactive to Light JVD: Jugular Vein Distention SAMPLE: Signs and Symptoms, Allergies, Medications, Past History, Last Oral Intake, Environment OPQRST: Onset, Provocation, Quality of pain, Radiation and Severity of pain, Time (Interventions) PRBELLS: Pulse, Respiration, Blood Pressure, Eyes, Lung Sounds, LOC, Skins LOC: Level of Consciousness CLOSED Head-Tilt, Chin-Lift

Assess Airway O P E N Assess Breathing A D E Q U A T E Assess Circulation P U L S E

Assess Airway O P E N Assess Breathing A D E Q U A T E Assess Circulation P U L S E ASSESS SKINS EYES

INADEQUATE Begin Positive Pressure Ventilation with Supplemental Oxygen

INADEQUATE Begin Positive Pressure Ventilation with Supplemental Oxygen

NO PULSE

NO PULSE

BEGIN CPR

BEGIN CPR

APPLY AED Assess Bleeding BLEEDING

APPLY AED

NONE ASSESS SKINS P.M.S.

CONTROL BLEEDING

TRANSPORT

TRANSPORT

3 - Focused History and Physical Exam

UNCONSCIOUS or Obvious Injury

3 - Focused History and Physical Exam

LOC 3+

RECONSIDER THE MECHANISM OF INJURY

ALERT & Uninjured

CONSIDER MENTAL STATUS

Altered

Signicant MOI, Mutiple Injuries, or Altered Mental Status Continue Inline Stabilization Continually Reassess Mental Status Perform RAPID Trauma Assessment Consider Advance Life Support Resources? Reconsider Transport Decision? Take Baseline Vital Signs: PRBELLS Record SAMPLE History: PUAHA

No signicant MOI, Single injury, or Alert Mental Status

Responsive Assess Complaints Signs and Symptoms (OPQRST) Record History: Signs and Symptoms, Alergies, Medications, Past Mediacl History, Last Oral Intake, and any Envioronmental Conditions. Perform a Focused Medical Assessment Take Baseline Vital Signs: PRBELLS Consider Transport Decision? YES

Unresponsive

Perform Focused History and Physical Exam

Perform a RAPID Medical Assessment

Take Baseline Vital Signs: PRBELLS

Take Baseline Vital Signs: PRBELLS

Record History: Signs and Symptoms, Alergies, Medications, Past Mediacl History, Last Oral Intake, and any Envioronmental Conditions.

Position Patient

Record SAMPLE History:

Perform Needed Components of a Detailed Physical Exam

TRANSPORT
NO

TRANSPORT

4 - Detailed Physical Exam

Alert

RECONSIDER MENTAL STATUS

Declining

Responsive

Unresponsive Position Patient Assess the HEAD: Feel for soft spots, DECAPBTLS Assess the EARS: Look for Fluid

Perform Components of Detailed Physical Exam based on patients's Injuries and Complaints

Assess the FACE: Look for Asymmetry: DECAPBTLS Assess the EYES: PEARL, Colors, Symmetry Assess the NOSE: Fluid, Symmetry, Air ow Assess the MOUTH: Teeth, Tung, Lips, Throat Assess the NECK: JVD, Tracheal Deviation, C-SPINE Assess the CHEST: Paradoxical Movement, DECAPBTLS Assess the ABDOMEN: 4-Quadrents, DECAPBTLS Assess the PELVIS: Asymmetrical movement, Genitals Assess the EXTREMITIES: PMS, DECAPBTLS, Asymmetry

Reassess Vital Signs: Pulse, Respiration, Blood Pressure, Eyes, LOC, Last Oral Intake, Skins

KEY
# Section

Decision ?

Assess the POSTERIOR BODY: Spinal line, DECAPBTLS Reassess Vital Signs: PRBELLS

Symptom

ACTION

Procedure

5 - Ongoing Assessment
REPEAT INITIAL ASSESSMENT REASSESS: General Impression, Mental Status, Airway, Breathing Rate and Quality, Circulation; Pulse Rate and Quality, Skin Color, Temperature, Condition, Bleeding. Reestablish Patient Priority

Loop

TRAUMA AREA

MEDICAL AREA

Worse Repeat Focused History and Physical Exam Provide Emergency Care Assess Effectiveness of Emergency Care Reassess Vital Signs Every 5 min.

Change in Patient Condition?

Stable Reassess Vital Signs Reassess Emergency Care

REPEAT Ongoing Assessment

6 - Communication and Documentation

During your call you will communicate, at important points, with dispatch and with medical direction as well as with the staff of the medical facility to which you transport the patient. You must also communicate clearly with other EMS personnel, the patient, and others at the scene. A failure of clear communication - both in what they communicate to you or in what you communicate to others - can have a signicant effect upon the quality of assessment and care you and others provide. In addition a signicant portion of the value of patient assessment and care is lost if what you have learned about the patient's condition and the care you have given are not clearly and adequately documented in written reports.

Emergency Medical Technition Decision Tree and NR-EMT Study Guide

A product of Lifeguard Adventures.com, Copyright 2007 1666 Garnet, #619, San Diego, CA 92109 (619) 206-4361, Toll Free (888) 2-Swim-Safe INFO@LifeguardAdventures.com