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BLS ALS TRANSPORT

BLS ALS TRANSPORT. In Whatcom County. 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 . What if you find…. Pt. seated beside the bed. Conscious and alert Vitals are stable

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BLS ALS TRANSPORT

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

  6. BLS Rule: Upgrade Fast Cancel Slow

  7. ALS Indicators:UpgradeTrauma > 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:BigMechanism = 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: < 6 or > 60 gets sicker quicker

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

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

  14. ALS Vital Signs • HR 120 or greater, sustained • HR < 50 • BP < 90 or > 200 systolic • BP > 110 diastolic • Respiratory Rate < 10 or > 30 • Blood Sugar < 70 or > 350 • Core temp < 94° or > 103°

  15. 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. BLS Indicators –Medical is Historical

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

  17. 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 PainIs not life threatening.

  18. BLS/ALSDecision 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 ALSTRANSPORT In Whatcom County

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