Emergency Medical Technician

Decision Tree Flow Chart

1 - SCENE SIZE-UP

UNSAFE!

Control Scene
Move Patients
Correct Hazzard

Suspect
Spinal Injury?

2INITIAL
PATIENT
ASSESSMENT

MOI

TRAUMA
Patient
YES

MED

Assess Mental
Status (AVPU)

Assess
Airway

Assess Mental
Status (AVPU)
DECAP BTLS:
Deformity
Evisceration
Contusion
Abrasion
Penetration
Burns
Tenderness
Lacerations
Swelling

CLOSED
Perform Jawthrust Manuver

O
P
E
N
Assess
Breathing
A
D
E
Q
U
A
T
E

INADEQUATE
Begin Positive
Pressure
Ventilation with
Supplemental
Oxygen

Assess
Circulation
P
U
L
S
E

SAMPLE:
Signs and Symptoms,
Allergies, Medications,
Past History, Last Oral
Intake, Environment

PMS:
Pulse/Capalary Refil
Motor Function
Sensation
PEARL:
Pupils Equal And
Reactive to Light

NO PULSE

CLOSED

INADEQUATE

O
P
E
N
Assess
Breathing
A
D
E
Q
U
A
T
E

Begin Positive
Pressure
Ventilation with
Supplemental
Oxygen

PRBELLS:
Pulse, Respiration,
Blood Pressure, Eyes,
Lung Sounds, LOC,
Skins

NO PULSE

LOC:
Level of
Consciousness

Assess
Circulation
P
U
L
S
E

BEGIN CPR

APPLY AED

APPLY AED

BLEEDING

ASSESS SKINS
EYES

CONTROL
BLEEDING

NONE

Assess
Airway

Head-Tilt, Chin-Lift

OPQRST:
Onset, Provocation,
Quality of pain,
Radiation and Severity
of pain, Time
(Interventions)

JVD:
Jugular Vein Distention

BEGIN CPR

Assess
Bleeding

MEDICAL
Patient

Form General Impression: Mechanism of Injury?

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

Establish In-line
Stabilization

NO

SAFE

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

TRANSPORT

TRANSPORT

ASSESS SKINS
P.M.S.

3 - Focused History
and Physical Exam

3 - Focused History
and Physical Exam
UNCONSCIOUS
or Obvious Injury

RECONSIDER
THE MECHANISM
OF INJURY

Significant MOI,
Mutiple Injuries, or
Altered Mental Status
Continue Inline
Stabilization

LOC 3+

No significant MOI,
Single injury, or
Alert Mental Status

Responsive

Unresponsive

Assess Complaints
Signs and
Symptoms
(OPQRST)

Perform a RAPID
Medical
Assessment

Perform Focused
History and
Physical Exam

Continually
Reassess Mental
Status

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

Consider Advance
Life Support
Resources?
PUAHA

Take Baseline
Vital Signs:
PRBELLS

Position Patient

Record SAMPLE
History:

Take Baseline
Vital Signs:
PRBELLS
YES

Consider Transport
Decision?

TRANSPORT

TRANSPORT
NO

4 - Detailed Physical Exam

Alert

Declining

RECONSIDER
MENTAL STATUS

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

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

Assess the MOUTH:

Teeth, Tung, Lips, Throat

Assess the EYES:

PEARL, Colors, Symmetry
Assess the NOSE:
Fluid, Symmetry, Air flow

Assess the NECK:

JVD, Tracheal Deviation, C-SPINE
Assess the CHEST:
Paradoxical Movement,
DECAPBTLS
Assess the ABDOMEN:
4-Quadrents, DECAPBTLS

KEY

Assess the PELVIS:

Asymmetrical movement, Genitals

# Section

Assess the EXTREMITIES:

PMS, DECAPBTLS, Asymmetry
Decision
?

Assess the POSTERIOR BODY:

Spinal line, DECAPBTLS
Reassess
Vital Signs:
PRBELLS

Symptom

ACTION

Procedure

5 - Ongoing Assessment
REPEAT INITIAL ASSESSMENT

Loop

TRAUMA AREA

REASSESS:
General Impression,
Mental Status, Airway,
Breathing Rate and
Quality, Circulation;
Pulse Rate and
Quality, Skin Color,
Temperature,
Condition, Bleeding.

MEDICAL AREA

Reestablish
Patient Priority

Worse

Change in
Patient Condition?

Stable

Repeat Focused
History and
Physical Exam

Reassess
Vital Signs

Provide
Emergency Care

Reassess
Emergency Care

Assess
Effectiveness of
Emergency Care
Reassess
Vital Signs
Every 5 min.

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 significant effect upon the quality of assessment and care you
and others provide.
In addition a significant 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
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Altered

Take Baseline
Vital Signs:
PRBELLS

Perform a Focused
Medical
Assessment

Perform Needed
Components of a
Detailed Physical
Exam

Record SAMPLE
History:

CONSIDER
MENTAL STATUS

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

Take Baseline
Vital Signs:
PRBELLS

Perform RAPID
Trauma
Assessment

Reconsider
Transport Decision?

ALERT &
Uninjured