TRANSPORT PATIENT

Key Points (1 of 4)
• Safety of providers and patients
– Number one priority
• Prearrival preparedness and scene
assessment
– Assessment begins before arriving at the
scene
• Sufficient resources?
– How many patients are involved?
– Are there special scene needs?
 Key Points (2 of 4)
• Access to patient
• General impression
– History and mechanism of injury (kinematics)
• Identify immediate life threats and manage
them
– Primary assessment
• Transport and destination decisions
 Key Points (3 of 4)
• Physically immobilize the patient as
needed
– Manually, then mechanically
• Patient extrication
• Assess and treat identified injuries and
resulting conditions
– Principles versus preferences
• Transportation and destination
• Communication and documentation
 Key Points (4 of 4)
• Principle is what needs to be done for a
patient based upon the assessment.
• Preference is how the principle is
accomplished.
– This will change depending on the:
• Situation at the scene
• Severity of the patient
• Knowledge and skills of the prehospital care
provider
• Resources available
 Identify and Manage
Immediate Life Threats (1 of 5)
• Airway and breathing
– Manually stabilize
cervical spine as
indicated
– Suction as needed
– Provide supplemental
oxygen early
– Support ventilations
as necessary
 Identify and Manage
Immediate Life Threats (2 of 5)
• Airway and breathing (cont’d)
– Use simple interventions before complex
• Example: Bag-mask device before intubation
– Ventilate before and between intubation
attempts
– Maintain a proper rate of ventilation
 Identify and Manage
Immediate Life Threats (3 of 5)
• Circulation
– Control obvious bleeding
• Conserve red blood cells
• Immobilize major fractures
– Maintain body temperature
 Identify and Manage
Immediate Life Threats (4 of 5)
• Circulation (cont’d)
– IVs can be started while en route
– Provide no more fluid than necessary
• Avoid over-resuscitation that can lead to increased
blood loss
 Identify and Manage
Immediate Life Threats (5 of 5)
• Disability
– Maintain manual cervical stabilization until
immobilization is complete
– Calculate GCS score
– Reassess for changes in the patient’s
condition over time
 Transportation and
Destination (1 of 2)
• Patient handling
– Identify patients requiring rapid extrication
– Maintain manual stabilization while performing
extrication
– Recognize the limitations of immobilization
devices
– Maintain a team approach
 Transportation and
Destination (2 of 2)
• Transportation
– Transport to appropriate destination without
delay
– Utilize appropriate transport method and
mode
 Communication and
Documentation
• Communication
– Provide clear, concise, accurate, timely, and
complete communication with the receiving
facility
• Documentation
– Complete documentation is important for
continued care, research, and accountability
 Potential Pitfalls (1 of 2)
• Ignoring or failing to recognize scene
hazards
• Focusing on distracting,
non-life-threatening injuries
• Performing secondary assessment before
life-threatening conditions have been
assessed and managed
• Not performing a secondary assessment
when indicated
 Potential Pitfalls (2 of 2)
• Missing life-threatening conditions by not
exposing and assessing the patient
• Not maintaining body temperature
• Prolonged scene times
• Inappropriate selection of destination
 Golden Principles (1 of 7)
• Ensure the safety of the prehospital care
providers and the patient
• Assess the scene situation to determine
the need for
additional
resources
 Golden Principles (2 of 7)
• Recognize the
kinematics that
produced the
injuries
• Use the primary
assessment to
identify
life-threatening Courtesy of Mark Woolcock

conditions
 Golden Principles (3 of 7)
• Provide appropriate airway management
while maintaining cervical spine
stabilization as indicated
• Support ventilation and deliver oxygen to
maintain an SpO2 greater than 95%
 Golden Principles (4 of 7)
• Control any significant external
hemorrhage
• Provide basic shock therapy, including
appropriately splinting musculoskeletal
injuries and restoring and maintaining
normal body temperature
 Golden Principles (5 of 7)
• Maintain manual spinal stabilization until
the patient is immobilized
• For critically injured trauma patients,
initiate transport
to the closest
appropriate facility
as soon as possible
after EMS arrival
on scene
Courtesy of Rick Brady
 Golden Principles (6 of 7)
• Initiate warmed intravenous fluid
replacement en route to the receiving
facility
• Ascertain the patient’s medical history
and perform a secondary assessment
when life-threatening problems have
been satisfactorily managed or have
been ruled out
• Provide adequate pain relief
 Golden Principles (7 of 7)
• Provide thorough and accurate
communication regarding the patient and
the circumstances of the injury to the
receiving facility
• Above all, do no further harm