1. BLS ALS TRANSPORT In Whatcom County

2. Do you need help? 78 y.o. female, GLF, hip pain Patient is lying on her side on the bathroom floor. Gasping Pale and sweaty No radial pulse

3. What if you find… Pt. seated beside the bed. Conscious and alert Vitals are stable Pain is 5/10, but she shrieks whenever you touch the leg or try to move her.

4. Objective Demonstrate patient indicators to help determine when BLS transport is appropriate. Discuss particular EMS responses which often require upgrade or cancellation of paramedics.

5. BLS Patient Assessment Initial Assessment Mechanism Sick/ not sick Chief complaint Head to toe Ongoing Assessment Abnormal vitals? Pertinent history Pain control? Reassess vitals

6. BLS Rule: Upgrade Fast Cancel Slow

7. ALS Indicators: Upgrade Trauma > 10 Second/third degree burns > 10% BSA Fall 10 feet or more Thrown 10 feet or more Car vs. Pedestrian @ > 10 mph

8. Falls

9. MVA: Big Mechanism = Sick Patient Death Ejection High speed Significant vehicle deformity Abdominal trauma to pregnant woman

10. Upgrading an MVA

11. Sick or Not Sick? If Sick Get Help Pale, diaphoretic skin Labored breathing Unconscious No radial pulse Patient age: 60 gets sicker quicker

12. ALS Indicators – Trauma Upgrade Big Breaks Femur fracture Pelvis fracture Multiple fracture sites Paralysis Pain control

13. Vital Signs Too Fast – Too Slow Too High – Too Low UPGRADE

14. ALS Vital Signs HR 120 or greater, sustained HR < 50 BP 200 systolic BP > 110 diastolic Respiratory Rate 30 Blood Sugar 350 Core temp 103°

15. BLS Indicators – M edical is Historical Abdominal Pain: rule out – syncope –orthostatic changes –ectopic pregnancy, AAA, or MI. Low Blood Sugar: –Food & juice return DEX to > 90 –not on oral diabetes medications –has help.

16. BLS Indicators – M edical is Historical Seizure –Single Seizure with history –Seizure is consistent with pt.’s regular pattern –Pt.’s level of consciousness is improving. _____ ______

17. Pain Is not life threatening. Signs of severe pain: –Pt. cannot be distracted from the pain –Pain is consistently reproduced –Skin signs and vital signs change when people are in pain  Get ALS for severe pain Pain is Relative Each patient has a unique 1-10 scale

18. BLS/ALS Decision Points Upgrade fast, cancel slow Upgrade Trauma > 10 Big Mechanism = Sick Patient If Sick Get Help Upgrade Big Breaks Vital Signs: Too fast, slow, high, low = upgrade Medical is Historical

19. You are dispatched to… 74 y.o. male fell in his driveway, unknown extent of injuries. On arrival you find him lying beside a ladder which has tipped over. He has been bleeding from the back of his head. He groans when you shake him, but does not wake up.

20. You are dispatched to… 54 y.o. male was in seizure, now postictal. Confused, but responds to questions. Skin looks good. Breathing is unlabored. Vital signs: BP 154/94, HR 124, SpO2 98% RR 24, DEX 140, Oral T° 99.3. Pt. has Seizure history, no change in meds, typical seizure for this pt.

21. BLS ALS TRANSPORT In Whatcom County