- Follow the Universal Precautions protocol.
- Follow the Airway Management protocol to open and maintain a patent airway.
- Follow the Oxygen Administration protocol when appropriate.
- Loosen tight clothing and reassure the patient.
- Place the patient in the position of comfort unless contraindicated by injuries and/or symptoms.
- Completely assess the patient, including vital signs.
- Obtain an appropriate history
- Refer to appropriate protocol according to patient condition.
- 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.
- Patient's body temperature should be preserved, especially infants, children, and the elderly
- Establish IV access:
- to administer pre-hospital medications, or
- for fluid replacement, or
- if the patient’s condition is likely to deteriorate before arriving at the hospital.
- The IV solution is to be NORMAL SALINE or LACTATED RINGERS unless otherwise stated. (See Vascular Access Procedures)
- 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.
- Pre-existing vascular access devices (PVAD) may be used only if:
- The patient is in cardiac arrest, or
- 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)
Suspected acute MI
Acute neurological deficits of < 6 hours duration
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