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.
6 - Communication and Documentation
3 - Focused History
and Physical Exam
No signicant MOI,
Single injury, or
Alert Mental Status
RECONSIDER
THE MECHANISM
OF INJURY
Signicant MOI,
Mutiple Injuries, or
Altered Mental Status
Consider Advance
Life Support
Resources?
TRANSPORT
Record History:
Signs and
Symptoms,
Alergies,
Medications, Past
Mediacl History,
Last Oral Intake,
and any
Envioronmental
Conditions.
Perform Focused
History and
Physical Exam
Take Baseline
Vital Signs:
PRBELLS
ALERT &
Uninjured
UNCONSCIOUS
or Obvious Injury
Perform Needed
Components of a
Detailed Physical
Exam
Continue Inline
Stabilization
Reconsider
Transport Decision?
Continually
Reassess Mental
Status
Perform RAPID
Trauma
Assessment
Take Baseline
Vital Signs:
PRBELLS
Record SAMPLE
History:
PUAHA
Unresponsive
CONSIDER
MENTAL STATUS
Responsive
TRANSPORT
Record History:
Signs and
Symptoms,
Alergies,
Medications, Past
Mediacl History,
Last Oral Intake,
and any
Envioronmental
Conditions.
Take Baseline
Vital Signs:
PRBELLS
Altered
LOC 3+
Assess Complaints
Signs and
Symptoms
(OPQRST)
Consider Transport
Decision?
Perform a Focused
Medical
Assessment
YES
Position Patient
Record SAMPLE
History:
Take Baseline
Vital Signs:
PRBELLS
Perform a RAPID
Medical
Assessment
NO
TRAUMA
Patient
Suspect
Spinal Injury?
Assess Mental
Status (AVPU)
Establish In-line
Stabilization
YES
NO
Assess
Airway
Assess
Breathing
Assess
Circulation
Perform Jaw-
thrust Manuver
CLOSED
O
P
E
N
Begin Positive
Pressure
Ventilation with
Supplemental
Oxygen
INADEQUATE
MOI
BEGIN CPR
Assess
Bleeding
NO PULSE
P
U
L
S
E
APPLY AED
CONTROL
BLEEDING
BLEEDING
TRANSPORT
ASSESS SKINS
P.M.S.
NONE
MED
Assess Mental
Status (AVPU)
Assess
Airway
Head-Tilt, Chin-Lift
Assess
Breathing
Assess
Circulation
ASSESS SKINS
EYES
BEGIN CPR
APPLY AED
P
U
L
S
E
NO PULSE
A
D
E
Q
U
A
T
E
INADEQUATE
CLOSED
TRANSPORT
MEDICAL
Patient

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
Change in
Patient Condition?
Reassess
Vital Signs
Repeat Focused
History and
Physical Exam
Worse Stable
Reassess
Emergency Care
REPEAT
Ongoing
Assessment
Provide
Emergency Care
Assess
Effectiveness of
Emergency Care
Reassess
Vital Signs
Every 5 min.
5 - Ongoing Assessment
A
D
E
Q
U
A
T
E
SAFE
Emergency Medical Technition Decision Tree
and NR-EMT Study Guide
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1666 Garnet, #619, San Diego, CA 92109
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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
Control Scene
Move Patients
Correct Hazzard
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
O
P
E
N
3 - Focused History
and Physical Exam
2 -
INITIAL
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)
Emergency Medical Technician
Decision Tree Flow Chart
RECONSIDER
MENTAL STATUS
Responsive
Alert
Reassess
Vital Signs:
Pulse, Respiration,
Blood Pressure,
Eyes, LOC, Last
Oral Intake, Skins
Perform
Components of
Detailed Physical
Exam based on
patients's Injuries
and Complaints
4 - Detailed Physical Exam
Unresponsive
Declining
Reassess
Vital Signs:
PRBELLS
Position Patient
Assess the HEAD:
Feel for soft spots, DECAPBTLS
Assess the EARS:
Look for Fluid
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
Assess the POSTERIOR BODY:
Spinal line, DECAPBTLS
KEY
Decision
?
ACTION
# Section
Symptom
Procedure
Loop
TRAUMA AREA
MEDICAL AREA
UNSAFE!
Begin Positive
Pressure
Ventilation with
Supplemental
Oxygen