Initial Medical Care



  1. Follow the Universal Precautions protocol.

  3. Follow the Airway Management protocol to open and maintain a patent airway.

  5. Follow the Oxygen Administration protocol when appropriate.

  7. Loosen tight clothing and reassure the patient.

  9. Place the patient in the position of comfort unless contraindicated by injuries and/or symptoms.

  11. Completely assess the patient, including vital signs.

  13. Obtain an appropriate history

  15. Refer to appropriate protocol according to patient condition.

  17. Reassess patient and record vital signs every 5-10 minutes as condition warrants. Transported patients must have at minimum 2 sets of complete vitals documented. Weight will be recorded in kilograms for all pediatric, overdose/poisoning, and any adult receiving medications.

  19. Patient's body temperature should be preserved, especially infants, children, and the elderly



  21. Establish IV access:

    1. to administer pre-hospital medications, or
    2. for fluid replacement, or
    3. if the patient’s condition is likely to deteriorate before arriving at the hospital.


  23. The IV solution is to be NORMAL SALINE or LACTATED RINGERS unless otherwise stated. (See Vascular Access Procedures)

  25. If an IV cannot be established and an urgent need for vascular access exists, establish IO access. (See Vascular Access Procedures). Note: Avoid LR in pediatric patients or if blood products are given in the same line.

  27. Pre-existing vascular access devices (PVAD) may be used only if:

    1. The patient is in cardiac arrest, or
    2. There is an emergent need to administer fluids or IV medications and a peripheral IV cannot be established and an IO is not appropriate due to the patient’s condition. (See Vascular Access Procedures)


Medical Alert Criteria


    Suspected acute MI
    Suspected Sepsis
    Acute neurological deficits of < 6 hours duration
    Inspiratory stridor




    Systolic BP (SBP) < 90 mmHg or vital signs outside of physiologic ranges for pediatrics
    GCS < 13
    Respiratory rate < 10 or > 30 (adults), < 15 or > 45 (peds)
    Heart rate < 40 or > 120
    Temp < 92°F or > 105°F
      Usually determined in the transferring ED
    Oxygen saturation < 88%


    Healthcare provider discretion