Sei sulla pagina 1di 71
Basic Life Support - Adult Version D 0.9 K EMT P CPG 1a AP From
Basic Life Support - Adult
Version D 0.9 K
EMT
P
CPG 1a
AP
From
Cardiac
CPG 4a
Arrest
AP
Request
Change defibrillator
to manual mode
Initiate mobilisation of 3 to 4
practitioners / responders
on site to assist with cardiac
arrest management
ALS
Arrest witnessed
Yes
No
by practitioner
Attach AED defibrillation pads
Commence CPR
Commence CPR while AED is being
30 Compressions : 2 ventilations.
prepared only if 2 nd person available
30 Compressions : 2 ventilations.
Oxygen therapy
Continue CPR for 2 minutes
Attach AED defibrillation pads
Oxygen therapy
Assess
Shockable
VF or pulseless VT
Rhythm
Non - Shockable
Asystole or PEA
Give 1
shock
Immediately resume CPR
x 2 minutes
Rhythm check *
Go to
Go to
VF/ VT
ROSC
CPG 3a
CPG 19
Go to
Go to
Asystole
PEA
CPG 3a(i)
CPG 3a(ii)

* *

=/- +/- pulse Pulse check: check: Pulse pulse check check after after 2 2 minutes minutes of of CPR CPR if if potentially potentially perfusing perfusing rhythm rhythm

Version D 0.10 K
Version D 0.10 K

Basic Life Support – Child (1 to 8 years)

CPG 1b

EMT P AP
EMT
P
AP
From CPG xx
From
CPG xx
Cardiac arrest
Cardiac
arrest
Commence CPR 30 Compressions : 2 ventilations. Continue CPR for 2 minutes

Commence CPR 30 Compressions : 2 ventilations. Continue CPR for 2 minutes

Commence CPR 30 Compressions : 2 ventilations. Continue CPR for 2 minutes
Commence CPR 30 Compressions : 2 ventilations. Continue CPR for 2 minutes
Oxygen therapy Request ALS
Oxygen therapy
Request
ALS
Initiate mobilisation of 3 to 4 practitioners / responders on site to assist with cardiac
Initiate mobilisation of 3 to 4 practitioners / responders on site to assist with cardiac

Initiate mobilisation of 3 to 4 practitioners / responders on site to assist with cardiac arrest management

One rescuer CPR Two rescuer CPR

30 : 2 15 : 2

compressions : Ventilations

AP Switch to manual 2 J/kg
AP
Switch to manual
2 J/kg
Apply paediatric system AED pads
Apply paediatric system AED pads
Apply paediatric system AED pads
Apply paediatric system AED pads
Apply paediatric system AED pads
Apply paediatric system AED pads
Apply paediatric system AED pads

Apply paediatric system AED pads

Apply paediatric system AED pads
Apply paediatric system AED pads
Apply paediatric system AED pads
Apply paediatric system AED pads
Apply paediatric system AED pads
Apply paediatric system AED pads
Apply paediatric system AED pads
Assess Rhythm
Assess
Rhythm

Shockable VF or pulseless VT

Give 1 shock
Give 1
shock
Assess Rhythm Shockable VF or pulseless VT Give 1 shock Non - Shockable Asystole or PEA
Assess Rhythm Shockable VF or pulseless VT Give 1 shock Non - Shockable Asystole or PEA

Non - Shockable Asystole or PEA

pulseless VT Give 1 shock Non - Shockable Asystole or PEA Immediately resume CPR x 2
Immediately resume CPR x 2 minutes

Immediately resume CPR x 2 minutes

Immediately resume CPR x 2 minutes
Immediately resume CPR x 2 minutes
Asystole or PEA Immediately resume CPR x 2 minutes   Rhythm check *   VF/ VT
 

Rhythm check *

 

VF/ VT

ROSC

Asystole / PEA

 
Go to CPG xx
Go to
CPG xx
Go to CPG xx
Go to
CPG xx
Go to CPG xx
Go to
CPG xx

* +/- Pulse check: pulse check after 2 minutes of CPR if potentially perfusing rhythm

Basic & Advanced Life Support – Infant (4 weeks to 1 year)

CPG 1c

From CPG xx
From
CPG xx
Support – Infant (4 weeks to 1 year) CPG 1c From CPG xx Cardiac arrest or
Support – Infant (4 weeks to 1 year) CPG 1c From CPG xx Cardiac arrest or

Cardiac arrest or pulse < 60 per minute

Cardiac arrest or pulse < 60 per minute
Cardiac arrest or pulse < 60 per minute
Cardiac arrest or pulse < 60 per minute
1c From CPG xx Cardiac arrest or pulse < 60 per minute Commence CPR 30 Compressions

Commence CPR

Commence CPR
Commence CPR 30 Compressions : 2 ventilations. Oxygen therapy
Commence CPR 30 Compressions : 2 ventilations. Oxygen therapy

30 Compressions : 2 ventilations. Oxygen therapy

Commence CPR 30 Compressions : 2 ventilations. Oxygen therapy
Commence CPR 30 Compressions : 2 ventilations. Oxygen therapy
Commence CPR 30 Compressions : 2 ventilations. Oxygen therapy
CPR 30 Compressions : 2 ventilations. Oxygen therapy Continue CPR Attach ECG monitor Request ALS Immediate
Continue CPR Attach ECG monitor

Continue CPR Attach ECG monitor

Continue CPR Attach ECG monitor
Continue CPR Attach ECG monitor
Request ALS
Request
ALS
Immediate IO access if no IV in situ Continue CPR

Immediate IO access if no IV in situ Continue CPR

Immediate IO access if no IV in situ Continue CPR
Immediate IO access if no IV in situ Continue CPR
ALS Immediate IO access if no IV in situ Continue CPR AP Epinephrine (1:10 000), 0.01
AP
AP
Epinephrine (1:10 000), 0.01 mg/kg IV/IO Repeat every 3 to 5 min prn

Epinephrine (1:10 000), 0.01 mg/kg IV/IO Repeat every 3 to 5 min prn

Epinephrine (1:10 000), 0.01 mg/kg IV/IO Repeat every 3 to 5 min prn
Epinephrine (1:10 000), 0.01 mg/kg IV/IO Repeat every 3 to 5 min prn
Epinephrine (1:10 000), 0.01 mg/kg IV/IO Repeat every 3 to 5 min prn
Version D 0.9 K
Version D 0.9 K
EMT P AP
EMT
P
AP
Initiate mobilisation of 3 to 4 practitioners / responders on site to assist with cardiac
Initiate mobilisation of 3 to 4 practitioners / responders on site to assist with cardiac

Initiate mobilisation of 3 to 4 practitioners / responders on site to assist with cardiac arrest management

One rescuer CPR Two rescuer CPR

30 : 2 15 : 2

compressions : Ventilations

For two rescuer CPR use two thumb-encircling hand chest compression
For two rescuer CPR use two thumb-encircling hand chest compression

For two rescuer CPR use two thumb-encircling hand chest compression

Epinephrine 1 mL/10 kgrescuer CPR use two thumb-encircling hand chest compression Assess VF or VT Asystole or PEA Rhythm

Assess VF or VT Asystole or PEA Rhythm *
Assess
VF or VT
Asystole or PEA
Rhythm *
CPR for 2 minutes CPR for 2 minutes Amiodarone, 5 mg/kg IV/IO Reassess Transport infant
CPR for 2 minutes
CPR for 2 minutes
Amiodarone, 5 mg/kg IV/IO
Reassess
Transport infant
Check blood glucose
continuing CPR
en-route
CPR for 2 minutes

* +/- Pulse check: pulse check after 2 minutes of CPR if potentially perfusing rhythm

Version D 0.8 K
Version D 0.8 K

Basic & Advanced Life Support - Neonate

CPG 1d

P AP
P
AP
From Birth CPG XX
From
Birth
CPG XX
Life Support - Neonate CPG 1d P AP From Birth CPG XX Term gestation Amniotic fluid
Life Support - Neonate CPG 1d P AP From Birth CPG XX Term gestation Amniotic fluid
Term gestation Amniotic fluid clear Breathing or crying Good muscle tone Pink colour No Request
Term gestation
Amniotic fluid clear
Breathing or crying
Good muscle tone
Pink colour
No
Request
ALS
Initiate mobilisation of 3 to 4 practitioners / responders on site to assist with cardiac
Initiate mobilisation of 3 to 4 practitioners / responders on site to assist with cardiac

Initiate mobilisation of 3 to 4 practitioners / responders on site to assist with cardiac arrest management

Yes

on site to assist with cardiac arrest management Yes Provide warmth Position; Clear airway if necessary
on site to assist with cardiac arrest management Yes Provide warmth Position; Clear airway if necessary
Provide warmth Position; Clear airway if necessary Dry, stimulate, reposition Provide warmth Dry baby Assess
Provide warmth
Position; Clear airway if necessary
Dry, stimulate, reposition
Provide warmth
Dry baby
Assess respirations,
heart rate & colour
Breathing, HR > 100 & Pink
Apnoeic or HR < 100
Breathing, HR >
100 but Cyanotic
Give Supplementary O 2
Persistent
No, Pink
Cyanosis
Yes
Provide positive pressure ventilation for 30 sec
Assess Heart
HR < 60
HR 60 to 100
Rate
CPR (ratio 3:1) for 30 sec
Breathing well, HR > 100 & Pink
to 100
Assess Heart
Breathing well, HR > 100 & Pink
Rate
HR < 60
Epinephrine (1:10 000) 0.01 mg/kg IV/ IO
Every 3 to 5 minutes prn
If mother is IVDU consider
Naloxone, 0.01 mg/kg IV
Or
Naloxone, 0.01 mg/kg IM
Consider
NaCl 0.9%, 10 mL/kg IV/IO
0.01 mg/kg IV Or Naloxone, 0.01 mg/kg IM Consider NaCl 0.9%, 10 mL/kg IV/IO HR 60

HR 60

Consider blood glucose check
Consider blood
glucose check
0.01 mg/kg IV Or Naloxone, 0.01 mg/kg IM Consider NaCl 0.9%, 10 mL/kg IV/IO HR 60
Version D 0.5 K
Version D 0.5 K

Foreign Body Airway Obstruction – Adult

CPG 2a

EMT P
EMT
P
Are you From FBAO choking? CPG 1a Severe FBAO Mild (no cough) Severity (cough present)
Are you
From
FBAO
choking?
CPG 1a
Severe
FBAO
Mild
(no cough)
Severity
(cough present)
No
Conscious
Yes
Encourage cough
1 to 5 back blows
followed by
1 to 5 abdominal thrusts
as indicated
Yes
Request
Consider
Adequate
No
Conscious
No
Effective
Yes
Yes
ventilations
ALS
Oxygen therapy
No
One cycle of CPR
Ventilate
Yes
Effective
Yes
Was CPR,
Abdominal
thrusts or O 2
required
No
No
one cycle of CPR
Effective
Yes
Yes
Persistent cough,
difficulty swallowing
or sensation of object
in the throat
No
No
Go to
CPG xx
Consider
discharge
into care of
relative or
friend
After each cycle of CPR open mouth and look for object If visible attempt once
After each cycle of CPR open mouth and look for object If visible attempt once

After each cycle of CPR open mouth and look for object If visible attempt once to remove it

Version D 0.8 K
Version D 0.8 K

Foreign Body Airway obstruction – Paediatric (13 years)

CPG 2b & 2c

EMT P
EMT
P
Are you From FBAO choking? CPG 1a Severe FBAO Mild (no cough) Severity (cough present)
Are you
From
FBAO
choking?
CPG 1a
Severe
FBAO
Mild
(no cough)
Severity
(cough present)
No
Conscious
Yes
1 to 5 back blows followed
by 1 to 5 thrusts
(child – abdominal thrusts)
(infant – chest thrusts)
as indicated
Encourage cough
Yes
Request
Consider
Breathing
No
Conscious
No
Effective
Yes
Yes
adequately
Oxygen therapy
ALS
No
Open mouth and look for
object
If visible one attempt to
remove it
Give
rescue
breaths
(10/ min)
Attempt 5 Rescue Breaths
One cycle of CPR
Yes
Effective
No
one cycle of CPR
Effective
Yes
No
Go to
CPG xx
After each cycle of CPR open mouth and look for object If visible attempt once
After each cycle of CPR open mouth and look for object If visible attempt once

After each cycle of CPR open mouth and look for object If visible attempt once to remove it

VF or Pulseless VT - Adult (> 8 years) Version D 0.10 K EMT P
VF or Pulseless VT - Adult (> 8 years)
Version D 0.10 K
EMT
P
CPG 3a
AP
From
CPG xx
VF or VT
arrest
Rhythm check *
Consider causes and treat as
appropriate:
AP
VF/VT
No
Immediate IO access if IV
not immediately accessible
Yes
Hydrogen ion acidosis
Hyper/ hypokalaemia
Hypothermia
2 nd Shock
Epinephrine (1:10 000) 1 mg IV/ IO
Every 3 to 5 minutes prn
CPR x 2 minutes
Hypovolaemia
Hypoxia
Thrombosis – pulmonary
Tension pneumothorax
Thrombus – coronary
Tamponade – cardiac
Toxins
Trauma
Rhythm check *
VF/VT
No
Yes
3 rd Shock
Go to
ROSC
CPG 19
Amiodarone 300 mg (5 mg/kg) IV/ IO
CPR x 2 minutes
Rhythm check *
Go to
Assess rhythm
PEA
CPG xx
Advanced airway
AP
management -
VF/VT
No
intubation
Following successful Advanced
Airway management:-
Yes
Advanced airway
P
management –
Go to
LMA/LT
4 th Shock
Asystole
CPG 3a(i)
Consider
i) Ventilate at 8 to 10 per minute.
ii) Unsynchronised chest
compressions continuous at 100
per minute
mechanical
CPR x 2 minutes
CPR assist
Rhythm check *
VF/VT
No
Yes
5 th Shock
Amiodarone 150 mg (2.5 mg/kg) IV/ IO
CPR x 2 minutes
Rhythm check *
Initiate mobilisation of 3 to 4
practitioners / responders
on site to assist with cardiac
arrest management
VF/VT
No
Yes
6 th Shock
If torsades de pointes, consider
Magnesium Sulphate 2 g IV
CPR x 2 minutes
Rhythm check *
VF/VT
No
If no ALS available
Yes
* +/- Pulse check: pulse check after 2 minutes of CPR if potentially perfusing rhythm

Version D 0.10 KCardiac Arrest Asystole - Adult CPG 3a(i) AP P AP From Asystole CPG xx Immediate

Cardiac Arrest Asystole - Adult

CPG 3a(i)

AP
AP
P AP
P
AP
From Asystole CPG xx
From
Asystole
CPG xx
Asystole - Adult CPG 3a(i) AP P AP From Asystole CPG xx Immediate IO access if
Asystole - Adult CPG 3a(i) AP P AP From Asystole CPG xx Immediate IO access if
Immediate IO access if IV not immediately accessible
Immediate IO access if IV not immediately accessible
Immediate IO access if IV not immediately accessible

Immediate IO access if IV not immediately accessible

Epinephrine (1:10 000) 1 mg IV/ IO Every 3 to 5 minutes prn

CPR x 2 minutes

Rhythm check * Asystole No Yes CPR x 2 minutes Rhythm check * Asystole No
Rhythm check *
Asystole
No
Yes
CPR x 2 minutes
Rhythm check *
Asystole
No
Atropine 3 mg IV/ IO Advanced airway management - intubation Advanced airway management – LMA/
Atropine 3 mg IV/ IO
Advanced airway
management -
intubation
Advanced airway
management –
LMA/ LT
Consider
mechanical
CPR assist
Following successful Advanced
Airway management:-
i) Ventilate at 8 to 10 per
minute.
ii) Unsynchronised chest
compressions continuous at 100
per minute
chest compressions continuous at 100 per minute Go to VF/VT CPG 3a Go to Rosc CPG
Go to VF/VT CPG 3a Go to Rosc CPG 19 AP Go to PEA CPG
Go to
VF/VT
CPG 3a
Go to
Rosc
CPG 19
AP
Go to
PEA
CPG xx
Yes
Yes

CPR x 2 minutes

Rhythm check * If persistent asystole for greater than 20 minutes consider ceasing resuscitation Go
Rhythm check *
If persistent asystole for
greater than 20 minutes
consider ceasing
resuscitation
Go to
CPG 3b
Consider causes and treat as appropriate: Hydrogen ion acidosis Hyper/ hypokalaemia Hypothermia Hypovolaemia Hypoxia
Consider causes and treat as appropriate: Hydrogen ion acidosis Hyper/ hypokalaemia Hypothermia Hypovolaemia Hypoxia

Consider causes and treat as appropriate:

Consider causes and treat as appropriate: Hydrogen ion acidosis Hyper/ hypokalaemia Hypothermia Hypovolaemia Hypoxia

Hydrogen ion acidosis Hyper/ hypokalaemia Hypothermia Hypovolaemia Hypoxia Thrombosis – pulmonary Tension pneumothorax Thrombus – coronary Tamponade – cardiac Toxins Trauma

Initiate mobilisation of 3 to 4 practitioners / responders on site to assist with cardiac
Initiate mobilisation of 3 to 4 practitioners / responders on site to assist with cardiac

Initiate mobilisation of 3 to 4 practitioners / responders on site to assist with cardiac arrest management

Consider ceasing resuscitation only if patient is NOT: Hypothermic or Cold water drowning or Poisoning
Consider ceasing resuscitation only if patient is NOT: Hypothermic or Cold water drowning or Poisoning

Consider ceasing resuscitation only if patient is NOT:

Consider ceasing resuscitation only if patient is NOT: Hypothermic or Cold water drowning or Poisoning or

Hypothermic or Cold water drowning or Poisoning or Overdose or Pregnant or < 18 years

* +/- Pulse check: pulse check after 2 minutes of CPR if potentially perfusing rhythm

Version D 0.10 K
Version D 0.10 K
From CPG xx
From
CPG xx
P EMT AP
P
EMT
AP

Cardiac Arrest PEA -Adult

CPG 3a(ii)

PEA
PEA
AP
AP
Immediate IO access if IV not immediately accessible
Immediate IO access if IV not immediately accessible
Immediate IO access if IV not immediately accessible

Immediate IO access if IV not immediately accessible

Epinephrine (1:10 000) 1 mg IV/ IO Every 3 to 5 minutes prn

CPR x 2 minutes

   
3 to 5 minutes prn CPR x 2 minutes     Rhythm check * Go to
Rhythm check * Go to VF/VT CPG 3a Go to PEA No ROSC CPG 19
Rhythm check *
Go to
VF/VT
CPG 3a
Go to
PEA
No
ROSC
CPG 19
Yes
CPR x 2 minutes
Go to
Asystole
CPG xx
Rate less
No
than 60
Yes
CPR x 2 minutes
Rhythm check *
If persistent PEA continue CPR
If no ALS available
If no ALS available
AP Advanced airway management - intubation Advanced airway P management – LMA/ LT
AP
Advanced airway
management -
intubation
Advanced airway
P management –
LMA/ LT
Consider mechanical CPR assist
Consider
mechanical
CPR assist
compressions continuous at 100 per minute Atropine 1 mg IV/ IO Every 3 to 5
compressions continuous at 100 per minute Atropine 1 mg IV/ IO Every 3 to 5
compressions continuous at 100 per minute Atropine 1 mg IV/ IO Every 3 to 5
compressions continuous at 100 per minute Atropine 1 mg IV/ IO Every 3 to 5
compressions continuous at 100 per minute Atropine 1 mg IV/ IO Every 3 to 5
compressions continuous at 100 per minute Atropine 1 mg IV/ IO Every 3 to 5
compressions continuous at 100 per minute Atropine 1 mg IV/ IO Every 3 to 5
compressions continuous at 100 per minute Atropine 1 mg IV/ IO Every 3 to 5
compressions continuous at 100 per minute Atropine 1 mg IV/ IO Every 3 to 5
compressions continuous at 100 per minute Atropine 1 mg IV/ IO Every 3 to 5
compressions continuous at 100 per minute Atropine 1 mg IV/ IO Every 3 to 5
compressions continuous at 100 per minute Atropine 1 mg IV/ IO Every 3 to 5
compressions continuous at 100 per minute Atropine 1 mg IV/ IO Every 3 to 5

compressions continuous at 100 per minute

compressions continuous at 100 per minute Atropine 1 mg IV/ IO Every 3 to 5 minutes
compressions continuous at 100 per minute Atropine 1 mg IV/ IO Every 3 to 5 minutes
compressions continuous at 100 per minute Atropine 1 mg IV/ IO Every 3 to 5 minutes
compressions continuous at 100 per minute Atropine 1 mg IV/ IO Every 3 to 5 minutes

Atropine 1 mg IV/ IO Every 3 to 5 minutes to 3 mg max

Atropine 1 mg IV/ IO Every 3 to 5 minutes to 3 mg max Following successful
Atropine 1 mg IV/ IO Every 3 to 5 minutes to 3 mg max Following successful

Following successful Advanced

Airway management:- i) Ventilate at 8 to 10 per minute. ii) Unsynchronised chest

3 mg max Following successful Advanced Airway management:- i) Ventilate at 8 to 10 per minute.
Consider causes and treat as appropriate: Hydrogen ion acidosis Hyper/ hypokalaemia Hypothermia Hypovolaemia Hypoxia
Consider causes and treat as appropriate: Hydrogen ion acidosis Hyper/ hypokalaemia Hypothermia Hypovolaemia Hypoxia

Consider causes and treat as appropriate:

Consider causes and treat as appropriate: Hydrogen ion acidosis Hyper/ hypokalaemia Hypothermia Hypovolaemia Hypoxia

Hydrogen ion acidosis Hyper/ hypokalaemia Hypothermia Hypovolaemia Hypoxia Thrombosis – pulmonary Tension pneumothorax Thrombus – coronary Tamponade – cardiac Toxins Trauma

* +/- Pulse check: pulse check after 2 minutes of CPR if potentially perfusing rhythm

Initiate mobilisation of 3 to 4 practitioners / responders on site to assist with cardiac
Initiate mobilisation of 3 to 4 practitioners / responders on site to assist with cardiac

Initiate mobilisation of 3 to 4 practitioners / responders on site to assist with cardiac arrest management

Version D 0.6 K
Version D 0.6 K

Cardiac Arrest - Asystole - Decision Tree

3b

P AP
P
AP
AP Advanced Paramedics: From Asystole CPG 3a(i) continue to end of asystole algorithm and make
AP
Advanced Paramedics:
From
Asystole
CPG 3a(i)
continue to end of
asystole algorithm and
make clinical decision on
ceasing resuscitation
Yes
Patient is;
Hypothermic or
Cold water drowning or
Poisoning/ Overdose or
Pregnant or
< 18 years
No
Unwitnessed
arrest & no CPR prior
to arrival
No
Yes
Resuscitation continuous for
at least 20 minutes
Confirm Asystolic Cardiac Arrest
Unresponsive
No signs of life; absence of central pulse and respiration
Confirm that (two minutes of CPR and
no shock advised) x 3 are completed
Consider ceasing
No
resuscitation efforts
Yes
Record two rhythm strips
x
10 sec duration
Record on ECG strips
PCR No
Patient’s name
Date and time
Inform Ambulance
Control
Emotional support
If
present, inform
next of kin
for relatives should
be considered before
leaving the scene
Complete PCR and flag for
mandatory clinical audit
Follow local
protocol for
care of
deceased
Version D 0.10 K
Version D 0.10 K

Recognition of Death - Resuscitation not indicated

3c

P AP
P
AP
Apparent dead body Go to Signs of Life Yes Primary survey No End stage of
Apparent
dead body
Go to
Signs of Life
Yes
Primary
survey
No
End stage of
terminal illness
Yes
No
Recent & reliable written
or verbal information from
family, caregivers or patient,
stating that patient did not want
resuscitation
No
Yes
Consensus
between caregiver and
practitioner on not
resuscitating
No
Yes
Definite
indicators of
No
Death
Yes
Definitive indicators of death:
1. Decomposition
2. Obvious rigor mortis
3. Obvious pooling (hypostasis)
4. Incineration
5. Decapitation
It is inappropriate to
commence resuscitation
6. Injuries totally incompatible with life
7. Unwitnessed traumatic cardiac arrest following
blunt trauma
Inform Ambulance
Control
Complete all
appropriate
documentation
Emotional support
Inform next of kin,
if present
for relatives should
be considered before
leaving the scene
Follow local
protocol for care
of deceased
Version D 0.8 K
Version D 0.8 K
From CPG xx
From
CPG xx

VF or Pulseless VT – Child (1 to 8 years)

CPG 3d (i)

VF/VT confirmed

VF/VT confirmed
VF/VT confirmed
VF/VT confirmed
VF/VT confirmed
VF/VT confirmed
VT – Child (1 to 8 years) CPG 3d (i) VF/VT confirmed 2 n d Shock

2 nd Shock (4 joules/Kg)

EMT P AP
EMT
P
AP
Epinephrine (1:10 000), 0.01 mg/kg IV/IO Repeat every 3 to 5 minutes prn Amiodarone, 5
Epinephrine (1:10 000), 0.01 mg/kg IV/IO
Repeat every 3 to 5 minutes prn
Amiodarone, 5 mg/kg, IV/IO
AP
Consider advanced
airway management
- intubation
Following successful Advanced
Airway management:-
i) Ventilate at 8 to 10 per
minute.
ii) Unsynchronised chest
compressions continuous at 100
per minute
Consider causes and treat as
appropriate:
Hydrogen ion acidosis
Hyper/ hypokalaemia
Hypothermia
Hypovolaemia
Hypoxia
Thrombosis – pulmonary
Tension pneumothorax
Thrombus – coronary
Tamponade – cardiac
Toxins
Trauma
CPR x 2 minutes Immediate IO access if IV not immediately accessible Rhythm check *
CPR x 2 minutes
Immediate IO access if IV
not immediately accessible
Rhythm check *
VF/VT
No
Yes
3 rd Shock (4 joules/Kg)
CPR x 2 minutes
Rhythm check *
Go to
ROSC
CPG xx
VF/VT
No
Yes
Go to
Asystole/ PEA
CPG xx
4 th Shock (4 joules/Kg)
CPR x 2 minutes
Rhythm check *
Check blood glucose
VF/VT
No
Yes
5 th Shock (4 joules/Kg)
CPR x 2 minutes
Rhythm check *
VF/VT
No
Yes
6 th Shock (4 joules/Kg)
CPR x 2 minutes
Rhythm check *
VF/VT
No
If no ALS available
Yes

* +/- Pulse check: pulse check after 2 minutes of CPR if potentially perfusing rhythm

Version D 0.8 K
Version D 0.8 K

Asystole / PEA - Child (1 to 13 years)

CPG 3d(ii)

EMT P AP
EMT
P
AP
From CPG xx
From
CPG xx

Asystole/ PEA

confirmed

Asystole/ PEA confirmed
Asystole/ PEA confirmed
Asystole/ PEA confirmed
Asystole/ PEA confirmed
3d(ii) EMT P AP From CPG xx Asystole/ PEA confirmed AP Immediate IO access if IV
AP
AP
Immediate IO access if IV not immediately accessible
Immediate IO access if IV not immediately accessible
Immediate IO access if IV not immediately accessible

Immediate IO access if IV not immediately accessible

Epinephrine (1:10 000) 0.01 mg/kg IV/IO Repeat every 3 to 5 minutes prn

Epinephrine (1:10 000) 0.01 mg/kg IV/IO Repeat every 3 to 5 minutes prn
Epinephrine (1:10 000) 0.01 mg/kg IV/IO Repeat every 3 to 5 minutes prn
Epinephrine (1:10 000) 0.01 mg/kg IV/IO Repeat every 3 to 5 minutes prn
AP Consider advanced airway management - intubation
AP
Consider advanced
airway management
- intubation
Following successful Advanced Airway management:- i) Ventilate at 8 to 10 per minute. ii) Unsynchronised
Following successful Advanced Airway management:- i) Ventilate at 8 to 10 per minute. ii) Unsynchronised

Following successful Advanced Airway management:- i) Ventilate at 8 to 10 per minute. ii) Unsynchronised chest compressions continuous at 100 per minute

CPR x 2 minutes

Rhythm check * Go to ROSC CPG xx Asystole No or PEA Yes Go to
Rhythm check *
Go to
ROSC
CPG xx
Asystole
No
or PEA
Yes
Go to
VF/VT
CPG xx
Check blood glucose
Check blood glucose
Check blood glucose

Check blood glucose

Check blood glucose
Check blood glucose
If persistent Asystole / PEA continue CPR

If persistent Asystole / PEA continue CPR

If persistent Asystole / PEA continue CPR
If persistent Asystole / PEA continue CPR
blood glucose If persistent Asystole / PEA continue CPR Consider causes and treat as appropriate: Hydrogen
Consider causes and treat as appropriate: Hydrogen ion acidosis Hyper/ hypokalaemia Hypothermia Hypovolaemia Hypoxia
Consider causes and treat as appropriate: Hydrogen ion acidosis Hyper/ hypokalaemia Hypothermia Hypovolaemia Hypoxia

Consider causes and treat as appropriate:

Consider causes and treat as appropriate: Hydrogen ion acidosis Hyper/ hypokalaemia Hypothermia Hypovolaemia Hypoxia

Hydrogen ion acidosis Hyper/ hypokalaemia Hypothermia Hypovolaemia Hypoxia Thrombosis – pulmonary Tension pneumothorax Thrombus – coronary Tamponade – cardiac Toxins Trauma

* +/- Pulse check: pulse check after 2 minutes of CPR if potentially perfusing rhythm

Version D 0.7 K
Version D 0.7 K

Traumatic Cardiac Arrest – Adult

CPG 3e

P AP
P
AP
EMS Unwitnessed Traumatic Arrest EMS Witnessed Traumatic Arrest Go to Apnoeic, appropriate No Pulseless and
EMS Unwitnessed
Traumatic Arrest
EMS Witnessed
Traumatic Arrest
Go to
Apnoeic,
appropriate
No
Pulseless and
CPG
Asystolic
Yes
Blunt trauma
No
Yes
<18 years
Hypothermia
Drowning
Ye
s to any
Commence
CPR and ALS
Lightning strike
Electrical injury
No to all
Request
ALS
Low impact
single vehicle
Yes
incident
Rapid transport towards ALS
No
Consider ceasing
No
resuscitation
Patient responds
to resuscitation or
ALS provision within
15 min
Yes

Reference: Hopson, L et al, 2003, Guidelines for withholding or termination of resuscitation in prehospital traumatic cardiac arrest, Position paper for National Association of EMS Physicians, Prehospital Emergency Care, Vol 7 p141-146

Version D 0.6 K
Version D 0.6 K

Primary Survey Medical - Adult

CPG 4a

EMT P AP
EMT
P
AP
Take standard infection control precautions

Take standard infection control precautions

Take standard infection control precautions
Take standard infection control precautions
4a EMT P AP Take standard infection control precautions Consider pre-arrival information Scene safety Scene survey
Consider pre-arrival information

Consider pre-arrival information

Consider pre-arrival information
Consider pre-arrival information
Scene safety Scene survey Scene situation
Scene safety
Scene survey
Scene situation
Assess responsiveness

Assess responsiveness

Assess responsiveness
Assess responsiveness
Head tilt/chin lift Suction OPA No Airway patent Yes Maintain P NPA Go to Airway
Head tilt/chin lift
Suction
OPA
No
Airway patent
Yes
Maintain
P NPA
Go to
Airway
Yes
No
CPG
2a
obstructed
Give 2 initial Ventilations Consider No Breathing Yes Oxygen therapy Oxygen therapy Go to Pulse
Give 2 initial
Ventilations
Consider
No
Breathing
Yes
Oxygen therapy
Oxygen therapy
Go to
Pulse
No
CPG 1a
Yes
Adequate
Go to
No
respirations
CPG xx
Yes

AVPU assessment

Life threatening Request ALS Go to appropriate CPG
Life
threatening
Request
ALS
Go to
appropriate
CPG
Clinical status
Clinical status
Clinical status
Clinical status
Clinical status
Clinical status
Clinical status

Clinical status

Clinical status
Clinical status
Clinical status
Clinical status
Clinical status
Clinical status
Clinical status
Life threatening Request ALS Go to appropriate CPG Clinical status Serious or Non serious Go to
Serious or

Serious or

Non serious

Non serious

Serious or Non serious
Serious or Non serious
Go to CPG 5a
Go to
CPG 5a

Primary Survey Trauma - Adult

CPG 4a

Take standard infection control precautions

Take standard infection control precautions

Take standard infection control precautions
Take standard infection control precautions
- Adult CPG 4a Take standard infection control precautions EMT P AP Version D 0.6 K
EMT P AP
EMT
P
AP
Version D 0.6 K
Version D 0.6 K
Consider pre-arrival information

Consider pre-arrival information

Consider pre-arrival information
Consider pre-arrival information
Scene safety Scene survey Scene situation No Mechanism of injury suggestive of spinal injury C-spine
Scene safety
Scene survey
Scene situation
No
Mechanism of
injury suggestive
of spinal injury
C-spine
Yes
control
injury suggestive of spinal injury C-spine Yes control Assess responsiveness Jaw thrust (Head tilt/chin lift)
Assess responsiveness

Assess responsiveness

Assess responsiveness
Assess responsiveness
Jaw thrust (Head tilt/chin lift) Suction OPA No Airway patent Yes Maintain P NPA Go
Jaw thrust
(Head tilt/chin lift)
Suction
OPA
No
Airway patent
Yes
Maintain
P NPA
Go to
Airway
Yes
No
CPG
2a
obstructed
Give 2 initial Ventilations Consider No Breathing Yes Oxygen therapy Oxygen therapy
Give 2 initial
Ventilations
Consider
No
Breathing
Yes
Oxygen therapy
Oxygen therapy
Go to Pulse No CPG 1a Yes Adequate Go to No respirations CPG xx Yes
Go to
Pulse
No
CPG 1a
Yes
Adequate
Go to
No
respirations
CPG xx
Yes
Arrest major external haemorrhage

Arrest major external haemorrhage

Arrest major external haemorrhage
Arrest major external haemorrhage
respirations CPG xx Yes Arrest major external haemorrhage AVPU assessment Expose & check obvious injuries Treat

AVPU assessment

xx Yes Arrest major external haemorrhage AVPU assessment Expose & check obvious injuries Treat life threatening
Expose & check obvious injuries

Expose & check obvious injuries

Expose & check obvious injuries
Expose & check obvious injuries
Treat life threatening injuries only at this point
Treat life threatening injuries only at this point
Treat life threatening injuries only at this point

Treat life threatening injuries only at this point

Treat life threatening injuries only at this point
Treat life threatening injuries only at this point
Clinical status
Clinical status
Clinical status
Clinical status
Clinical status
Clinical status
Clinical status

Clinical status

Clinical status
Clinical status
Clinical status
Clinical status
Clinical status
Clinical status
Clinical status
Go to Request appropriate CPG ALS
Go to
Request
appropriate
CPG
ALS
Life threatening
Life threatening
Life threatening
Life threatening

Life

threatening

point Clinical status Go to Request appropriate CPG ALS Life threatening Go to CPG 5a Serious
Go to CPG 5a
Go to
CPG 5a

Serious or

Non serious

Serious or Non serious
Serious or Non serious
Serious or Non serious
Serious or Non serious
point Clinical status Go to Request appropriate CPG ALS Life threatening Go to CPG 5a Serious
Version D 0.8 K
Version D 0.8 K

Primary Survey Medical – Paediatric (13 Years)

CPG 4b

Take standard infection control precautions

Take standard infection control precautions

Take standard infection control precautions
Take standard infection control precautions
Years) CPG 4b Take standard infection control precautions Consider pre-arrival information EMT P AP Paediatric
Consider pre-arrival information

Consider pre-arrival information

Consider pre-arrival information
Consider pre-arrival information
EMT P AP
EMT
P
AP
Paediatric Assessment Triangle Scene safety Scene survey Scene situation Paediatric Assessment Triangle Work of
Paediatric Assessment Triangle
Scene safety
Scene survey
Scene situation
Paediatric Assessment Triangle
Work of
Appearance
Breathing
P
Sick child
No
Circulation
to skin
Yes
Head tilt/ chin lift
Suction
OPA
No
Airway patent
Yes
Maintain
P NPA (> 1year)
Go to
Airway
Yes
No
CPG
2b
obstructed
Give 2 effective Ventilations up to 5 attempts No Breathing Yes Oxygen therapy Oxygen therapy
Give 2 effective
Ventilations up
to 5 attempts
No
Breathing
Yes
Oxygen therapy
Oxygen therapy
Go to CPG 1c
Go to
CPG 1c

Yes

Yes Oxygen therapy Oxygen therapy Go to CPG 1c Y e s   Confirm Primary Survey
 
 

Confirm Primary

Survey findings

 
   
 
No > 1 year Yes Pulse/ Go to Pulse < 60 No circulation CPG 1b
No
> 1 year
Yes
Pulse/
Go to
Pulse < 60
No
circulation
CPG 1b
No
Yes
Go to Pulse < 60 No circulation CPG 1b No Yes Adequate respirations Yes N o
Adequate respirations Yes
Adequate
respirations
Yes

No

Normal rates

 

Age

Pulse 100 – 160 90 – 150 80 – 140 70 – 120

Respirations 30 – 60 24 – 40 22 – 34 18 – 30

Infant

Toddler

Pre school

School age

Go to CPG xx
Go to
CPG xx

AVPU assessment

Go to Request appropriate CPG ALS
Go to
Request
appropriate
CPG
ALS
Life threatening or Serious
Life threatening or Serious

Life threatening

or Serious

Clinical status
Clinical status
Clinical status
Clinical status

Clinical status

Clinical status
Clinical status
Clinical status
Clinical status
assessment Go to Request appropriate CPG ALS Life threatening or Serious Clinical status Go to CPG
assessment Go to Request appropriate CPG ALS Life threatening or Serious Clinical status Go to CPG
Go to CPG 5b
Go to
CPG 5b

Non serious

Primary Survey Trauma – Paediatric (≤ 13 years) Version D 0.8 K EMT P CPG
Primary Survey Trauma – Paediatric (≤ 13 years)
Version D 0.8 K
EMT
P
CPG 4b
Take standard infection control precautions
AP
Consider pre-arrival information
Paediatric Assessment Triangle
Scene safety
Scene survey
Scene situation
Paediatric Assessment Triangle
Work of
Appearance
Breathing
Circulation
C-spine
Yes
No
to skin
Mechanism of
injury suggestive
of spinal injury
control
P
Sick child
No
Yes
Jaw thrust
(Head tilt/ chin lift)
Suction
OPA
No
Airway patent
Yes
Maintain
P NPA (> 1 year)
Go to
Airway
Yes
No
CPG
2b
obstructed
Give 2 effective
Ventilations up
to 5 attempts
No
Breathing
Yes
Oxygen therapy
Oxygen therapy
Confirm Primary
Survey findings
No
> 1 year
Yes
Go to
Pulse/
Go to
Yes
Pulse < 60
No
CPG 1c
circulation
CPG 1b
No
Yes
Adequate
Go to
No
respirations
CPG xx
Normal rates
Age
Infant
Yes
Toddler
Pre school
Arrest major external haemorrhage
School age
Pulse
100 – 160
90 – 150
80 – 140
70 – 120
Respirations
30 – 60
24 – 40
22 – 34
18 – 30
AVPU assessment
Expose & check obvious injuries
Treat life threatening injuries only
Go to
Request
Life threatening
Go to
appropriate
Clinical status
Non serious
or Serious
CPG 5b
CPG
ALS

Version D 0.2Secondary Survey Trauma - adult CPG 5a (i) P AP From Primary CPG xx Survey

Secondary Survey Trauma - adult

CPG 5a (i)

P AP
P
AP
From Primary CPG xx Survey Markers for multi- system trauma present No
From
Primary
CPG xx
Survey
Markers for multi-
system trauma
present
No

Examination of

obvious injuries

Monitor and record vital signs & GCS SAMPLE history
Monitor and
record vital signs
& GCS
SAMPLE history

Yes

Yes
Identify positive findings and initiate care management
Identify positive findings and initiate care management
Identify positive findings and initiate care management
Identify positive findings and initiate care management
Identify positive findings and initiate care management
Identify positive findings and initiate care management
Identify positive findings and initiate care management
Identify positive findings and initiate care management

Identify positive findings and initiate care management

Identify positive findings and initiate care management
Identify positive findings and initiate care management
Identify positive findings and initiate care management
Identify positive findings and initiate care management
Identify positive findings and initiate care management
Identify positive findings and initiate care management
Identify positive findings and initiate care management
Identify positive findings and initiate care management
Request ALS
Request
ALS
Go to appropriate CPG
Go to
appropriate
CPG
Complete a detailed physical exam (head to toe survey) as history dictates Check for medications
Complete a detailed
physical exam (head to
toe survey) as history
dictates
Check for medications
carried or medical
alert jewellery
Requires
definitive
Yes
medical care
No
Go to
CPG xx
Markers for multi-system trauma GCS < 13 Systolic BP < 90 Respiratory rate < 10
Markers for multi-system trauma GCS < 13 Systolic BP < 90 Respiratory rate < 10

Markers for multi-system trauma GCS < 13 Systolic BP < 90 Respiratory rate < 10 or > 29 Heart rate > 120 Revised Trauma Score < 12 Mechanism of Injury

Revised Trauma Score

Ventilatory 10 – 29

4

Rate

> 29

3

6

– 9

2

1

– 5

1

0

0

Systolic BP > 89

4

 

76

– 89

3

50

– 75

2

1

– 49

1

no pulse

0

GCS

13 – 15

4

9

– 12

3

6

– 8

2

4

– 5

1

< 4

0

RTS = Total score

 

Reference: McSwain, N. et al, 2003, PHTLS Basic and advanced prehospital trauma life support, 5 th Edition, Mosby

Secondary Survey Medical - adult Version D 0.2 P AP CPG 5a (ii) From Primary
Secondary Survey Medical - adult
Version D 0.2
P
AP
CPG 5a (ii)
From
Primary
CPG xx
Survey
Record vital signs
& GCS
Patient acutely
Yes
Markers identifying acutely unwell
Cardiac chest pain
MEWS Score of ≥ 5
Acute pain > 5
unwell
No
Focused medical
history of presenting
complaint
SAMPLE history
Request
Relevant family &
social history
Go to
Identify positive findings
and initiate care
management
ALS
appropriate
CPG
Check for medications
carried or medical
alert jewellery
Examine body systems as
appropriate
Requires
definitive
Yes
medical care
No
Go to
CPG xx
Requires definitive Yes medical care No Go to CPG xx Reference: Sanders, M. 2001, Paramedic Textbook

Reference: Sanders, M. 2001, Paramedic Textbook 2 nd Edition, Mosby Gleadle, J. 2003, History and Examination at a glance, Blackwell Science Rees, JE, 2003, Early Warning Scores, World Anaesthesia Issue 17, Article 10

Version D 0.3
Version D 0.3

Secondary Survey – Paediatric ( 13 years)

CPG 5b

P AP
P
AP
From Primary CPG xx Survey
From
Primary
CPG xx
Survey
Make appropriate contact with patient and or guardian

Make appropriate contact with patient and or guardian

Make appropriate contact with patient and or guardian
Make appropriate contact with patient and or guardian
Survey Make appropriate contact with patient and or guardian Identify presenting complaint and exact chronology from
Identify presenting complaint and exact chronology from the time the patient was last well

Identify presenting complaint and exact chronology from the time the patient was last well

Identify presenting complaint and exact chronology from the time the patient was last well
Identify presenting complaint and exact chronology from the time the patient was last well
exact chronology from the time the patient was last well Observe both patient and guardian -

Observe both patient and guardian

- do they relate normally to each other

- is the guardian calm and not anxious

- will patient separate from guardian

- does the patient play and interact normally

- is the patient distractible

play and interact normally - is the patient distractible Identify patient’s weight Head to toe examination
Identify patient’s weight

Identify patient’s weight

Identify patient’s weight
Identify patient’s weight
- is the patient distractible Identify patient’s weight Head to toe examination (toe to head for

Head to toe examination (toe to head for younger children) Observing for

- pyrexia

- rash

- pain

- tenderness

- bruising

- wounds

- fractures

- medical alert jewellery

- wounds - fractures - medical alert jewellery Check for normal patterns of - feeding -

Check for normal patterns of

- feeding

- toilet

- sleeping

Check vital signs
Check vital signs

Check for current medications

- sleeping Check vital signs Check for current medications Identify positive findings and initiate care management
Identify positive findings and initiate care management
Identify positive findings and initiate care management
Identify positive findings and initiate care management
Identify positive findings and initiate care management
Identify positive findings and initiate care management

Identify positive findings and initiate care management

Identify positive findings and initiate care management
Identify positive findings and initiate care management
Identify positive findings and initiate care management
Identify positive findings and initiate care management
Identify positive findings and initiate care management
Identify positive findings and initiate care management
Identify positive findings and initiate care management
Identify positive findings and initiate care management
Identify positive findings and initiate care management
Identify positive findings and initiate care management
Go to appropriate CPG
Go to
appropriate
CPG
Use age appropriate language for patient
Use age appropriate language for patient
Use age appropriate language for patient

Use age appropriate language for patient

Children and adolescents should always be examined with a chaperone (usually a parent)
Children and adolescents should always be examined with a chaperone (usually a parent)

Children and adolescents should always be examined with a chaperone (usually a parent)

Estimated weight Age x 2 + 9 Kg

Normal rates

Age

Infant

Toddler

Pre school

School age

Pulse 100 – 160 90 – 150 80 – 140 70 – 120

Respirations 30 – 60 24 – 40 22 – 34 18 – 30

If non accidental injury or child abuse suspected

If non accidental injury or child abuse suspected

If non accidental injury or child abuse suspected
If non accidental injury or child abuse suspected
18 – 30 If non accidental injury or child abuse suspected Report findings as per Child

Report findings as per Child Protection Guidelines to ED staff in a confidential manner

Report findings as per Child Protection Guidelines to ED staff in a confidential manner

Reference:

Miall, Lawrence et al, 2003, Paediatrics at a Glance, Blackwell Publishing

Version D 0.6 K
Version D 0.6 K

Burns - Adult

CPG 6a

Cease contact with heat source Isolated superficial injury (excluding FHFFP)
Cease contact with heat source
Isolated
superficial injury
(excluding FHFFP)

No

Inhalation and or facial injury
Inhalation and or
facial injury

Airway management

EMT P AP F: face H: hands F: feet F: flexion points P: perineum
EMT
P
AP
F: face
H: hands
F: feet
F: flexion points
P: perineum
Burn or Scald
Burn or
Scald

Yes

Inadequate Go to Yes respirations CPG A3 Minimum 15 minutes cooling of area is recommended
Inadequate
Go to
Yes
respirations
CPG A3
Minimum 15 minutes cooling
of area is recommended
No
Consider humidified
Oxygen therapy
Brush off powder & irrigate
chemical burns
Follow local expert direction
Commence local
cooling of burn area
Equipment list
Acceptable dressings
Remove burned clothing (unless stuck) & jewellery
Burns jel
if < 10% TBSA
Cling film
Sterile dressing
if > 10%
TBSA
Clean sheet

Yes

Dressing/ covering of burn area Pain > 2/10
Dressing/ covering
of burn area
Pain > 2/10
Commence local cooling of burn area Dressing/ covering of burn area Go to Pain >
Commence local
cooling of burn area
Dressing/ covering
of burn area
Go to
Pain > 2/10
Yes
CPG
13b
No Request TBSA burn No Yes > 10% ALS Caution with the elderly, circumferential &
No
Request
TBSA burn
No
Yes
> 10%
ALS
Caution with the elderly,
circumferential & electrical burns
ECG & SpO 2
monitoring
No
> 25% TBSA
and or time from
injury to ED
> 1 hour
Yes
Consider
Hartmann’s Solution, 500 mL, IV
Hartmann’s Solution, 1000 mL, IV
No
Solution, 500 mL, IV Hartmann’s Solution, 1000 mL, IV No Monitor body temperature P Paramedics are
Monitor body temperature

Monitor body temperature

Monitor body temperature
Monitor body temperature
Solution, 1000 mL, IV No Monitor body temperature P Paramedics are authorised to continue the established
P
P

Paramedics are authorised to continue the established infusion in the absence of an Advanced Paramedic or Doctor during transportation

Appropriate history and burn area ≤ 1% Yes Go to CPG xx
Appropriate
history and burn
area ≤ 1%
Yes
Go to
CPG xx

Reference: Allison, K et al, 2004, Consensus on the prehospital approach to burns patient management, Emerg Med J 2004; 21:112-114 Sanders, M, 2001, Paramedic Textbook 2 nd Edition, Mosby

Version D 0.4 K
Version D 0.4 K

Spinal Immobilisation - Adult

CPG 7a

P AP
P
AP

Trauma Indications for spinal immobilisation

Trauma Indications for spinal immobilisation
Trauma Indications for spinal immobilisation
Trauma Indications for spinal immobilisation
Return head to neutral position unless on movement there is Increase in Pain, Resistance or
Return head to neutral position unless on movement there is Increase in Pain, Resistance or
Return head to neutral position unless on movement there is Increase in Pain, Resistance or

Return head to neutral position unless on movement there is Increase in Pain, Resistance or Neurological symptoms

Return head to neutral position unless on movement there is Increase in Pain, Resistance or Neurological
Return head to neutral position unless on movement there is Increase in Pain, Resistance or Neurological
is Increase in Pain, Resistance or Neurological symptoms Remove helmet (if worn) Use clinical judgement If

Remove helmet

(if worn)

Use clinical judgement If in doubt, immobilise

Do not forcibly restrain a patient that is combatitive
Do not forcibly restrain a patient that is combatitive
Do not forcibly restrain a patient that is combatitive

Do not forcibly restrain a patient that is combatitive

Life No Threatening Apply cervical collar Yes Patient in Yes sitting position
Life
No
Threatening
Apply cervical collar
Yes
Patient in
Yes
sitting position
No Use extrication device Rapid extrication with long board and cervical collar Load onto vacuum
No
Use extrication device
Rapid extrication with long
board and cervical collar
Load onto vacuum mattress
or long board
Consider Vacuum
mattress
vacuum mattress or long board Consider Vacuum mattress Dangerous mechanism include; Fall ≥ 1 meter/ 5
Dangerous mechanism include; Fall ≥ 1 meter/ 5 steps Axial load to head MVC >
Dangerous mechanism include; Fall ≥ 1 meter/ 5 steps Axial load to head MVC >

Dangerous mechanism include; Fall 1 meter/ 5 steps Axial load to head MVC > 100 km/hr, rollover or ejection ATV collision Bicycle collision Pedestrian v vehicle

Low risk factors Simple rear end MVC (excluding push into oncoming traffic or hit by
Low risk factors Simple rear end MVC (excluding push into oncoming traffic or hit by

Low risk factors Simple rear end MVC (excluding push into oncoming traffic or hit by bus or truck) No neck or back pain Absence of midline c-spine or back tenderness

Are all of the factors listed present; GCS = 15 Communication effective with patient No

Are all of the factors listed present; GCS = 15 Communication effective with patient No dangerous mechanism, distracting injury or penetrating trauma No numbness or tingling in extremities Presence of low risk factors which allow safe assessment of range of motion Patient voluntarily able to actively rotate neck 45 o left & right pain free Patient can walk pain free

Yes

Patient voluntarily able to actively rotate neck 45 o left & right pain free Patient can
& right pain free Patient can walk pain free Yes Immobilisation may not be indicated Consider

Immobilisation may not be indicated

Consider treat Go to & discharge CPG xx
Consider treat
Go to
& discharge
CPG xx

Equipment list

Extrication device Long board Vacuum mattress Orthopaedic stretcher Rigid cervical collar

Version D 0.5
Version D 0.5

Limb Fractures - Adult

CPG 8a

Equipment list

Traction splint Box splint Frac straps Triangular bandages Vacuum splints Long board Orthopaediac stretcher

Isolated limb fracture Consider need for pain relief Go to CPG 13b Dress open fractures
Isolated limb
fracture
Consider need for
pain relief
Go to
CPG 13b
Dress open fractures
Provide manual stabilisation for
fractured limb
Expose and examine limb
Check CSMs distal to
fracture site
No
CSMs intact
Reposition limb
Yes
(two attempts)
Recheck CSMs
Yes
Fracture mid
shaft of femur
No
Apply traction
Apply
splint
appropriate
splinting device
Recheck CSMs
P AP
P
AP
Version D 0.4 K
Version D 0.4 K

Pre- Hospital Emergency Childbirth

CPG 9a

P AP
P
AP
Query labour
Query labour
Hospital Emergency Childbirth CPG 9a P AP Query labour Take SAMPLE history If no progress with
Take SAMPLE history

Take SAMPLE history

Take SAMPLE history
Take SAMPLE history
If no progress with labour consider transporting patient Patient in No labour Yes Birth imminent
If no progress with
labour consider
transporting patient
Patient in
No
labour
Yes
Birth imminent or
travel time too long
No
Yes
Request
ALS
Contact GP / midwife/ medical team as required
by local policy to come to scene or meet en route
Position mother and prepare
equipment for birth
Consider
Entonox
Monitor vital signs and BP
Go to
Cord
Yes
CPG 9b
complication
No
Go to
Breech
Yes
CPG 9c
birth
No
Support baby
throughout delivery
Dry baby and
check ABCs
Go to
Baby
No
CPG 1d
stable
Yes
Clamp & cut cord
Wrap baby and
present to mother
Clamp cord at 10, 15
& 20 cm from baby
Cut cord between 15
and 20 cm clamps
Go to
Mother
No
CPG 4a
stable
Yes

If placenta delivers, bring to hospital with mother

If placenta delivers, bring to hospital with mother
If placenta delivers, bring to hospital with mother
If placenta delivers, bring to hospital with mother
If placenta delivers, bring to hospital with mother
If placenta delivers, bring to hospital with mother
Yes If placenta delivers, bring to hospital with mother Equipment list Cord Clamps Bulb syringe Towels

Equipment list

Cord Clamps Bulb syringe Towels Surgical gloves Surgical apron Gauze swaps 10 x 10 cm Umbilical cord scissors Clinical waste bag

Reassess
Reassess
Version D 0.5 K
Version D 0.5 K

Umbilical Cord Complications

CPG 9b

P AP
P
AP
From Cord CPG 9a complication
From
Cord
CPG 9a
complication
Contact GP / midwife/ medical team as required by local policy to come to scene
Contact GP / midwife/ medical team as required by local policy to come to scene

Contact GP / midwife/ medical team as required by local policy to come to scene or meet en route

Request ALS Oxygen therapy
Request
ALS
Oxygen therapy
come to scene or meet en route Request ALS Oxygen therapy Cord rupture Apply additional clamps
come to scene or meet en route Request ALS Oxygen therapy Cord rupture Apply additional clamps
come to scene or meet en route Request ALS Oxygen therapy Cord rupture Apply additional clamps
come to scene or meet en route Request ALS Oxygen therapy Cord rupture Apply additional clamps
Cord rupture Apply additional clamps to cord
Cord rupture
Apply additional
clamps to cord
AP
AP
Cord around baby’s neck
Cord around
baby’s neck

Attempt to slip the cord over the baby’s head

Prolapsed cord Mother to adopt knee chest position
Prolapsed cord
Mother to adopt
knee chest position
Apply direct pressure with sterile dressing Successful No Clamp cord in two places and cut
Apply direct pressure
with sterile dressing
Successful
No
Clamp cord in two places and
cut between both clamps
Ease the cord from
around the neck
Go to
CPG 9a
Hold presenting part off the cord using fingers

Hold presenting part off the cord using fingers

Hold presenting part off the cord using fingers
Hold presenting part off the cord using fingers
to CPG 9a Hold presenting part off the cord using fingers Maintain cord temperature and moisture
Maintain cord temperature and moisture

Maintain cord temperature and moisture

Maintain cord temperature and moisture
Maintain cord temperature and moisture
Yes

Yes

Consider inserting an indwelling catheter into the bladder and run 500 mL of NaCl into
Consider inserting an indwelling catheter
into the bladder and run 500 mL of NaCl
into the bladder and clamp catheter
In labour & foetal heart beat present No Yes Consider Nifedipine, 20 mg, PO
In labour &
foetal heart beat
present
No
Yes
Consider
Nifedipine, 20 mg, PO
beat present No Yes Consider Nifedipine, 20 mg, PO AP Pre alert hospital as urgent caesarean
AP
AP
Pre alert hospital as urgent caesarean section will be required
Pre alert hospital as urgent caesarean section will be required

Pre alert hospital as urgent caesarean section will be required

alert hospital as urgent caesarean section will be required Reference: Sweet, BR, 2000, Mayes’ Midwifery, 12

Reference: Sweet, BR, 2000, Mayes’ Midwifery, 12 th Edition, Bailleire Tindall Katz Z et al, 1988, Management of labor with umbilical cord prolaps: A 5 year study. Obstet. Gynecol. 72(2): 278-281 Duley, LMM, 2002, Clinical Guideline No 1(B), Tocolytic Drugs for women in preterm labour, Royal College of Obstetricians and gynaecologists

Version D 0.4 K
Version D 0.4 K

Breech birth

CPG 9c

P AP
P
AP
From Breech birth CPG 9a presentation Request ALS Contact GP / midwife/ medical team as
From
Breech birth
CPG 9a
presentation
Request
ALS
Contact GP / midwife/ medical team as
required by local policy to come to scene
Oxygen therapy
Mother to adapt the lithotomy position
Support the baby as it emerges –
avoid manipulation of the baby’s body
Go to
Successful
Yes
No
CPG 9a
delivery
No
P
Consider
Entonox
Nape of neck
anteriorly visible at
vulva
No
Yes
Place one hand, palm up, onto
baby’s face
Grasp both baby’s ankles in other
hand
Rotate baby’s legs in an ark
in an upward direction as
contractions occur
Go to
Yes
CPG 9a
Successful
delivery after 5
contractions
No
Place hand in the vagina with palm towards baby’s face
Form a V with fingers on each side of baby’s nose and
gently push baby’s head away from vaginal wall
Await arrival
of medical
assistance
Version D 0.9 K From CPG xx
Version D 0.9 K
From
CPG xx

Cardiac Chest Pain – Acute Coronary Syndrome

CPG 10

Acute Coronary

Acute Coronary

Syndrome

Syndrome
Acute Coronary Syndrome
Acute Coronary Syndrome
Acute Coronary Syndrome CPG 10 Acute Coronary Syndrome Oxygen therapy Request ALS Apply monitoring leads, apply
Acute Coronary Syndrome CPG 10 Acute Coronary Syndrome Oxygen therapy Request ALS Apply monitoring leads, apply
Oxygen therapy Request ALS Apply monitoring leads, apply SPO 2 monitor Aspirin 300 mg PO
Oxygen therapy
Request
ALS
Apply monitoring leads,
apply SPO 2 monitor
Aspirin 300 mg PO
Chest Pain
Chest Pain
P AP
P
AP

Indication for Thrombolysis

Patient conscious, coherent and understands therapy Patient consent obtained

<

75 years

MI

Symptoms 20 minutes to 6 hours

ST

elevation > 1 mm in two or more

contiguous leads

Contraindications for thrombolysis

Contraindications Haemorrhagic stroke or stroke of unknown origin at any time Ischemic stroke in preceding 6 months Central nervous system damage or neoplasms Recent major trauma/ surgery/ head injury (within 3 weeks) Gastro-intestinal bleeding within the last month Active peptic ulcer

Known bleeding disorder Oral anticoagulant therapy Aortic dissection Transient ischemic attack in preceding 6 months Pregnancy within 1 week post partum Non-compressible punctures Traumatic resuscitation Refractory hypertension (sys BP > 180 mmHg) Advanced liver disease Infective endocarditis

Yes

GTN 0.4 mg SL Repeat prn to max of 1.2 mg SL Pain relief Yes
GTN 0.4 mg SL Repeat prn to max of 1.2 mg SL Pain relief Yes
GTN 0.4 mg SL
Repeat prn to max of 1.2 mg SL
Pain relief
Yes
effective
No
Morphine 2 mg IV

No

Consider Cycilizine 50 mg IV slowly Acquire & interpret 12 lead ECG
Consider
Cycilizine 50 mg IV slowly
Acquire & interpret
12 lead ECG
Repeat Morphine at not < 2 min intervals if indicated. Max 10 mg
Repeat Morphine at not < 2 min intervals if indicated. Max 10 mg

Repeat Morphine at not < 2 min intervals if indicated. Max 10 mg

Clopidogrel 300 mg PO

Clopidogrel 300 mg PO
Clopidogrel 300 mg PO
Clopidogrel 300 mg PO
Yes STEMI No Tenecteplase Symptoms Yes No < 60 kg 30 mg ≤ 3 hours
Yes
STEMI
No
Tenecteplase
Symptoms
Yes
No
<
60 kg
30 mg
≤ 3 hours
60
– 70 kg
35 mg
70
– 80 kg
40 mg
80
– 90 kg
45 mg
> 90 kg
50 mg
No
Primary PCI
available within 60
min from 999 call
Tenecteplase IV
Yes
Followed by
Enoxaparin 30 mg IV
Notify &
transport to
Primary PCI
facility
> 25 minutes
from ED
No
Yes
Enoxaparin 1 mg/kg SC
> 25 minutes from ED No Yes Enoxaparin 1 mg/kg SC STEMI = ST elevation MI
STEMI = ST elevation MI
STEMI = ST elevation MI
STEMI = ST elevation MI

STEMI = ST elevation MI

PCI = Percutaneous

Coronary Intervention

Reference: Reducing the Risk: A Strategic Approach, 2006, The Report of the Task Force on Sudden Cardiac Death

Version D 0.5 K
Version D 0.5 K

Altered level of consciousness - Adult

CPG 11a

P AP
P
AP
V, P or U on AVPU scale
V, P or U on
AVPU scale
- Adult CPG 11a P AP V, P or U on AVPU scale Maintain airway Consider
Maintain airway Consider recovery position
Maintain airway
Consider
recovery position
Obtain SAMPLE history from patient, relative or bystander

Obtain SAMPLE history from patient, relative or bystander

Obtain SAMPLE history from patient, relative or bystander
Obtain SAMPLE history from patient, relative or bystander
Obtain SAMPLE history from patient, relative or bystander ECG & SpO 2 monitoring Calculate GCS Check

ECG & SpO2 monitoring Calculate GCS

or bystander ECG & SpO 2 monitoring Calculate GCS Check temperature Check pupillary size & response
Check temperature Check pupillary size & response Check for skin rash

Check temperature Check pupillary size & response Check for skin rash

Check temperature Check pupillary size & response Check for skin rash
Check temperature Check pupillary size & response Check for skin rash
Check for medications carried or medical alert jewellery Check blood glucose Differential Diagnosis
Check for medications
carried or medical
alert jewellery
Check blood glucose
Differential
Diagnosis
jewellery Check blood glucose Differential Diagnosis Go to CPG xx Blood loss Go to (shock) CPG
Go to CPG xx
Go to
CPG xx
Blood loss Go to (shock) CPG xx Go to Drowning CPG xx
Blood loss
Go to
(shock)
CPG xx
Go to
Drowning
CPG xx
Go to Head injury CPG xx
Go to
Head injury
CPG xx
Go to CPG xx
Go to
CPG xx

Inadequate

respirations

Inadequate respirations
Inadequate respirations
Anaphylaxis
Anaphylaxis

Anaphylaxis

Go to Bradycardia CPG xx
Go to
Bradycardia
CPG xx
Go to CPG xx
Go to
CPG xx
Glycaemic emergency
Glycaemic emergency

Glycaemic

emergency

Go to Hypothermia CPG xx
Go to
Hypothermia
CPG xx
Go to CPG 18
Go to
CPG 18
Post Go to resuscitation CPG xx care
Post
Go to
resuscitation
CPG xx
care
Go to Septic shock CPG xx Go to Taser gun CPG xx
Go to
Septic shock
CPG xx
Go to
Taser gun
CPG xx
Poison
Poison
Poison
Poison

Poison

Poison
Go to Seizures CPG xx
Go to
Seizures
CPG xx
Go to CPG 18
Go to
CPG
18
Stroke
Stroke

Stroke

Stroke
Version D 0.3
Version D 0.3

Mental Health Emergency

CPG 12a

EMT P
EMT
P
Behaviour abnormal RMP or RPN in attendance or have made arrangements for voluntary/ assisted admission
Behaviour
abnormal
RMP or RPN
in attendance or have made
arrangements for voluntary/
assisted admission
No
RMP – Registered Medical Practitioner RPN – Registered Psychiatric Nurse
RMP – Registered Medical Practitioner RPN – Registered Psychiatric Nurse
RMP – Registered Medical Practitioner RPN – Registered Psychiatric Nurse

RMP – Registered Medical Practitioner RPN – Registered Psychiatric Nurse

Practitioners may not compel a patient to accompany them or prevent a patient from leaving
Practitioners may not compel a patient to accompany them or prevent a patient from leaving

Practitioners may not compel a patient to accompany them or prevent a patient from leaving an ambulance vehicle

Yes

or prevent a patient from leaving an ambulance vehicle Yes If potential to harm self or
If potential to harm self or others ensure minimum two people accompany patient in saloon
If potential to harm self or others
ensure minimum two people
accompany patient in saloon of
ambulance at all times
Obtain a history from patient and or
bystanders present as appropriate
Yes
Potential
to harm self or
others
Request control
to inform Gardaí
No
harm self or others Request control to inform Gardaí No Reassure patient Explain what is happening
Reassure patient Explain what is happening at all times Avoid confrontation

Reassure patient Explain what is happening at all times Avoid confrontation

Reassure patient Explain what is happening at all times Avoid confrontation
Reassure patient Explain what is happening at all times Avoid confrontation
Explain what is happening at all times Avoid confrontation Attempt verbal de-escalation Co-operate as appropriate with
Attempt verbal de-escalation

Attempt verbal de-escalation

Attempt verbal de-escalation
Attempt verbal de-escalation
Co-operate as appropriate with medical or nursing team

Co-operate as appropriate with medical or nursing team

Co-operate as appropriate with medical or nursing team
Co-operate as appropriate with medical or nursing team
Co-operate as appropriate with medical or nursing team
Co-operate as appropriate with medical or nursing team
Co-operate as appropriate with medical or nursing team Transport patient to an Approved Centre Hallucinations Yes

Transport patient to an Approved Centre

Hallucinations Yes or Paranoia Request No ALS
Hallucinations
Yes
or Paranoia
Request
No
ALS
Centre Hallucinations Yes or Paranoia Request No ALS Patient agrees No to travel Yes Request  
Patient agrees No to travel Yes
Patient agrees
No
to travel
Yes

Request

 

- Gardaí

- Medical Practitioner

- Medical Practitioner

- Mental health team

 
 
- Medical Practitioner - Mental health team   Reference; Reference Guide to the Mental Health Act

Reference; Reference Guide to the Mental Health Act 2001, Mental Health Commission HSE Mental Health Services

Version D 0.3
Version D 0.3

Behavioural emergency

CPG 12b

Behaviour abnormal
Behaviour
abnormal
D 0.3 Behavioural emergency CPG 12b Behaviour abnormal Obtain a history from patient and or bystanders
D 0.3 Behavioural emergency CPG 12b Behaviour abnormal Obtain a history from patient and or bystanders
Obtain a history from patient and or bystanders present as appropriate

Obtain a history from patient and or bystanders present as appropriate

Obtain a history from patient and or bystanders present as appropriate
Obtain a history from patient and or bystanders present as appropriate
Yes Potential to harm self or others Request control to inform Gardaí No
Yes
Potential
to harm self or
others
Request control
to inform Gardaí
No
harm self or others Request control to inform Gardaí No Reassure patient Explain what is happening
Reassure patient Explain what is happening at all times Avoid confrontation

Reassure patient Explain what is happening at all times Avoid confrontation

Reassure patient Explain what is happening at all times Avoid confrontation
Reassure patient Explain what is happening at all times Avoid confrontation
Explain what is happening at all times Avoid confrontation Attempt verbal de-escalation Patient agrees to travel
Attempt verbal de-escalation

Attempt verbal de-escalation

Attempt verbal de-escalation
Attempt verbal de-escalation
Patient agrees to travel
Patient agrees
to travel
No

No

EMT P AP
EMT
P
AP
Practitioners may not compel a patient to accompany them or prevent a patient from leaving
Practitioners may not compel a patient to accompany them or prevent a patient from leaving

Practitioners may not compel a patient to accompany them or prevent a patient from leaving an ambulance vehicle

If potential to harm self or others ensure minimum two people accompany patient in saloon
If potential to harm self or others ensure minimum two people accompany patient in saloon

If potential to harm self or others ensure minimum two people accompany patient in saloon of ambulance at all times

accompany patient in saloon of ambulance at all times Await arrival of doctor or Gardaí or
Await arrival of doctor or Gardaí or receive implied consent Injury or illness potentially serious
Await arrival of doctor or Gardaí or receive implied consent Injury or illness potentially serious
Await arrival of doctor or Gardaí or receive implied consent Injury or illness potentially serious

Await arrival of doctor or Gardaí or receive implied consent

arrival of doctor or Gardaí or receive implied consent Injury or illness potentially serious or likely
arrival of doctor or Gardaí or receive implied consent Injury or illness potentially serious or likely
arrival of doctor or Gardaí or receive implied consent Injury or illness potentially serious or likely
arrival of doctor or Gardaí or receive implied consent Injury or illness potentially serious or likely

Injury or illness potentially serious or likely to cause lasting disability

Yes

Inform patient of potential consequences of treatment refusal

No

Offer to treat and or transport patient

   
   
   

No

Treatment only

No Treatment only Request control to inform Gardaí and or Doctor Is patient competent to make
Request control to inform Gardaí and or Doctor Is patient competent to make informed decision
Request control
to inform Gardaí
and or Doctor
Is patient
competent to
make informed
decision
Yes
only Request control to inform Gardaí and or Doctor Is patient competent to make informed decision

Yes

   
to make informed decision Yes Yes     Advise alternative care options and to call ambulance
Advise alternative care options and to call ambulance again if there is a change of

Advise alternative care options and to call ambulance again if there is a change of mind

Advise alternative care options and to call ambulance again if there is a change of mind
Advise alternative care options and to call ambulance again if there is a change of mind
Advise alternative care options and to call ambulance again if there is a change of mind

Document refusal of treatment and or transport to ED

Document refusal of treatment and or transport to ED
and to call ambulance again if there is a change of mind Document refusal of treatment

No

No
and to call ambulance again if there is a change of mind Document refusal of treatment
and to call ambulance again if there is a change of mind Document refusal of treatment
and to call ambulance again if there is a change of mind Document refusal of treatment
and to call ambulance again if there is a change of mind Document refusal of treatment

Yes

Aid to Capacity Evaluation

1. Patient verbalizes/ communicates

understanding of clinical situation?

2. Patient verbalizes/ communicates

appreciation of applicable risk?

3. Patient verbalizes/ communicates

ability to make alternative plan of care? If no to any of the above consider Patient Incapacity

alternative plan of care? If no to any of the above consider Patient Incapacity Reference: HSE

Reference: HSE Mental Health Services

Version D 0.11 K
Version D 0.11 K
Pain management - Adult EMT P CPG 13b AP Pain Pain assessment Nitrous Oxide &
Pain management - Adult
EMT
P
CPG 13b
AP
Pain
Pain assessment
Nitrous Oxide & Oxygen, inhalation
Analogue Pain Scale
0 = no pain……
10
= unbearable
Adequate relief
Yes
No
of pain
≥ 5 on pain
scale -
severe
No
3 to 4 on
pain scale -
moderate
Paracetamol 1 g PO
And or
Ibuprofen 400 mg PO
Request
< 5 on pain
scale
No
ALS
Yes
Morphine, 2 mg, IV
Repeat Morphine at
not < 2 min intervals
if indicated.
Max 10 mg
Consider
Cycilizine, 50 mg IV slowly
AP
Go back
to
originating
If IV not accessible
Morphine 10 mg IM
may be administered
provided no cardiac
chest pain present
CPG
EMT
EMT

Registered Medical Practitioners may authorise the use of IM

P
P

Morphine by Paramedic or EMT practitioners for patients in inaccessible locations

Decisions to give analgesia must be based on clinical assessment and not directly on a linear scale

Version D 0.9 K
Version D 0.9 K
Pain management – Paediatric (≤ 13) EMT P CPG 13b AP Pain Pain assessment Nitrous
Pain management – Paediatric (≤ 13)
EMT
P
CPG 13b
AP
Pain
Pain assessment
Nitrous Oxide & Oxygen, inhalation
Analogue Pain Scale
0 = no pain……
10
= unbearable
Adequate relief
Yes
No
of pain
≥ 6on pain
scale -
severe
No
2 to 5 on
pain scale -
moderate
Paracetamol 20 mg/kg PO
And or
Ibuprofen 5 mg/kg PO
Request
< 6 on pain
scale
No
ALS
Yes
Morphine, 0.05 mg/kg, IV
OR
Morphine, 0.1 mg/kg, PO
Repeat IV Morphine at not
< 2 min intervals if
indicated
Max 0.15 mg/kg IV
Consider
Cycilizine, 0.7 mg/kg IV slowly
Go back
to
originating
CPG

Decisions to give analgesia must be based on clinical assessment and not directly on a linear scale

Wong – Baker Faces for 3 years and older

Wong – Baker Faces for 3 years and older Reference: From Wong D.L., Hockenberry-Eaton M., Wilson

Reference:

From Wong D.L., Hockenberry-Eaton M., Wilson D., Winkelstein M.L., Schwartz P.: Wong’s Essentials of Paediatric Nursing, ed.6, St. Louis, 2001, p1301. Copyrighted by Mosby, Inc. Reprinted by permission.

Version D 0.9 K
Version D 0.9 K

Glycaemic Emergency - Adult

CPG 13e

P AP
P
AP
Abnormal blood glucose level < 4 mmol/L Blood Glucose > 20 mmol/L Sweetened drink 15
Abnormal
blood glucose
level
< 4 mmol/L
Blood Glucose
> 20 mmol/L
Sweetened drink
15 to 20 mmol/L
Or
Consider
Glucose gel, 10-20 g buccal
ALS
Or
Glucagon 1 mg IM
Or
Sodium Chloride 0.9% 1 L IV infusion
Dextrose 10%, 250 mL IV infusion
Reassess
Allow 5 minutes to elapse
following administration of
medication
Reassess
Blood Glucose
> 4 & < 15 mmol/L
No
Yes
Patient is fully alert and
makes an informed decision
not to attend ED
No
Yes
Consider treat
Complete; After care Instructions – Diabetes
and give a copy to the patient or carer
& discharge
Go to
CPG xx
Version D 0.8 K
Version D 0.8 K

Glycaemic Emergency – Paediatric (13)

CPG 13e

P AP
P
AP

Abnormal

blood glucose

level

< 3 mmol/L Blood Glucose > 20 mmol/L Request ALS Consider Glucose gel 5-10 g
< 3 mmol/L
Blood Glucose
> 20 mmol/L
Request
ALS
Consider
Glucose gel 5-10 g Buccal
No
Yes
No
Dehydration
Glucagon 0.5 mg IM
Dextrose 10%, 5 mL/kg IV bolus
Repeat x 1 prn
Yes
Sodium Chloride 0.9% 20 mL/kg
IV bolus
Reassess
prn Yes Sodium Chloride 0.9% 20 mL/kg IV bolus Reassess Reference: Dehydration- Paramedic Textbook 2 n

Reference: Dehydration- Paramedic Textbook 2 nd E p 1229

Version D 0.4 K
Version D 0.4 K

Major Emergency (Major Incident) – First ambulance crew

CPG 14a

Irish (Major Emergency) terminology in black UK (Major Incident) terminology in blue
Irish (Major Emergency) terminology in black UK (Major Incident) terminology in blue
Irish (Major Emergency) terminology in black UK (Major Incident) terminology in blue

Irish (Major Emergency) terminology in black UK (Major Incident) terminology in blue

EMT P AP
EMT
P
AP

Possible Major

Emergency

Possible Major Emergency
Possible Major Emergency
Possible Major Emergency
Possible Major Emergency
terminology in blue EMT P AP Possible Major Emergency Take standard infection control precautions Consider
Take standard infection control precautions

Take standard infection control precautions

Take standard infection control precautions
Take standard infection control precautions
Emergency Take standard infection control precautions Consider pre-arrival information PPE (high visibility jacket
Consider pre-arrival information

Consider pre-arrival information

Consider pre-arrival information
Consider pre-arrival information
PPE (high visibility jacket and helmet) must be worn
PPE (high visibility jacket and helmet) must be worn
PPE (high visibility jacket and helmet) must be worn
PPE (high visibility jacket and helmet) must be worn
PPE (high visibility jacket and helmet) must be worn
PPE (high visibility jacket and helmet) must be worn
PPE (high visibility jacket and helmet) must be worn

PPE (high visibility jacket and helmet) must be worn

PPE (high visibility jacket and helmet) must be worn
PPE (high visibility jacket and helmet) must be worn
PPE (high visibility jacket and helmet) must be worn
PPE (high visibility jacket and helmet) must be worn
PPE (high visibility jacket and helmet) must be worn
PPE (high visibility jacket and helmet) must be worn
PPE (high visibility jacket and helmet) must be worn
PPE (high visibility jacket and helmet) must be worn
Practitioner 1
Practitioner 1

Park at the scene as safety permits and in liaison with Fire & Garda if present

Leave blue lights on as vehicle acts as Forward Control Point pending the arrival of the Mobile Control Vehicle

Confirm arrival at scene with Ambulance Control and provide an initial visual report stating Major Emergency (Major Incident) Standby or Declared

Maintain communication with Practitioner 2

Leave the ignition keys in place and remain with vehicle

Carry out Communications Officer role until relieved

Practitioner 2 (MIMMS trained)
Practitioner 2
(MIMMS trained)

Carry out scene survey

Give situation report to ambulance control using METHANE message

Carry out HSE Controller of Operations (Ambulance Incident Officer) role until relieved

Liaise with Garda Controller of Operations (Police Incident Officer) and Local Authority Controller of Operations (Fire Incident Officer)

Select location for Holding Area (Ambulance Parking Point)

Set up key areas in conjunction with other Principle Response Agencies on site;

- Site Control Point (Ambulance Control Point),

- Casualty Clearing Station

METHANE message

M

– Major Emergency declaration / standby

E

– Exact location of the emergency

T

– Type of incident (transport, chemical etc.)

H

– Hazards present and potential

A

– Access / egress routes

N

– Number of casualties (injured or dead)

E

– Emergency services present and required

The first ambulance crew does not provide care or transport of patients as this interferes with their ability to liaise with other services, to assess the scene and to provide continuous information as the incident develops

The principles and terminology of Major Incident Medical management and Support (MIMMS) has been used with the kind permission of the Advanced Life Support Group, UK

Version D 0.6 K
Version D 0.6 K

Major Emergency (Major Incident) – Operational Control

CPG 14b

EMT P AP
EMT
P
AP
Irish (Major Emergency) terminology in black UK (Major Incident) terminology in blue
Irish (Major Emergency) terminology in black UK (Major Incident) terminology in blue
Irish (Major Emergency) terminology in black UK (Major Incident) terminology in blue

Irish (Major Emergency) terminology in black UK (Major Incident) terminology in blue

If Danger Area identified entry to Danger Area is controlled by a Senior Fire Officer or an Garda Síochána

Traffic Cordon Outer Cordon Inner Cordon Danger Area Casualty Body Site Control Clearing Holding Point
Traffic Cordon
Outer Cordon
Inner Cordon
Danger Area
Casualty
Body
Site Control
Clearing
Holding
Point
Station
Area
HSE
Garda
LA
Holding
Holding
Holding
Ambulance
Area
Area
Area
Loading
Point
One way ambulance circuit
Area Area Area Loading Point One way ambulance circuit Entry to Outer Cordon ( Silver area

Entry to Outer Cordon (Silver area) is controlled by an Garda Síochána

Entry to Inner Cordon (Bronze Area) is limited to personnel providing emergency care and or rescue Personal Protective Equipment required

Management structure for; Outer Cordon, Tactical Area (Silver Area) On-Site Co-ordinator HSE Controller of Operations
Management structure for; Outer Cordon, Tactical Area (Silver Area) On-Site Co-ordinator HSE Controller of Operations

Management structure for; Outer Cordon, Tactical Area (Silver Area) On-Site Co-ordinator HSE Controller of Operations (Ambulance Incident Officer) Site Medical Officer (Medical Incident Officer) Local Authority Controller of Operations (Fire Incident Officer) Garda Controller of Operations (Police Incident Officer)

Management structure for; Inner Cordon, Operational Area (Bronze Area) Forward Ambulance Incident Officer ( Forward
Management structure for; Inner Cordon, Operational Area (Bronze Area) Forward Ambulance Incident Officer ( Forward

Management structure for; Inner Cordon, Operational Area (Bronze Area) Forward Ambulance Incident Officer (Forward Ambulance Incident Officer) Forward Medical Incident Officer (Forward Medical Incident Officer) Fire Service Incident Commander (Forward Fire Incident Officer) Garda Cordon Control Officer (Forward Police Incident Officer)

Other management functions for; Major Emergency site Casualty Clearing Officer Triage Officer Ambulance Parking Point
Other management functions for; Major Emergency site Casualty Clearing Officer Triage Officer Ambulance Parking Point

Other management functions for; Major Emergency site Casualty Clearing Officer Triage Officer Ambulance Parking Point Officer Ambulance Loading Point Officer Communications Officer Safety Officer

LOCAL AUTHORITY CONTROLLER
LOCAL AUTHORITY
CONTROLLER
HSE CONTROLLER
HSE
CONTROLLER
GARDA CONTROLLER
GARDA
CONTROLLER

Ref; A Framework for Major Emergency Management, 2006, Inter-Departmental Committee on Major Emergencies (Replaced by National steering Group on Major Emergency Management)

The principles and terminology of Major Incident Medical management and Support (MIMMS) has been used with the kind permission of the Advanced Life Support Group, UK

Triage Sieve Version D 0.5 K EMT P CPG 14c AP Multiple casualty incident Priority
Triage Sieve
Version D 0.5 K
EMT
P
CPG 14c
AP
Multiple casualty
incident
Priority 3
(Delayed)
Can casualty
Yes
walk
GREEN
No
Is casualty
Yes
No
breathing
Open airway
one attempt
Breathing now
No
DEAD
Yes
Respiratory rate
< 10 or > 29
Yes
Priority 1
No
(Immediate)
RED
Capillary refill > 2 sec
Or
Pulse > 120
Yes
Priority 2
No
(Urgent)
YELLOW
Triage is a dynamic process
Triage is a
dynamic
process

The principles and terminology of Major Incident Medical management and Support (MIMMS) has been used with the kind permission of the Advanced Life Support Group, UK

Version D 0.4 K
Version D 0.4 K

Triage Sort

CPG 14d

P AP
P
AP

Multiple casualty

incident

Multiple casualty incident
Multiple casualty incident
Multiple casualty incident
Multiple casualty incident
K Triage Sort CPG 14d P AP Multiple casualty incident Triage is a dynamic process Cardiopulmonary
Triage is a dynamic process