NREMT EMT 2: Primary Assessment - Decision on Priority Patient Transport, Load and Go vs Stay and Play

What This Is

When someone is injured or sick, we need to decide whether to take them to the hospital right away (load & go) or stay and treat them at the scene (stay & play). This decision is crucial because it can affect how quickly and effectively we can save their life. Think of it like a fire: if the fire is small, we can put it out with a small bucket of water (stay & play), but if it's huge, we need to call the fire department and get them to take us to the fire station (load & go).

Key Steps / Core Facts

• Assessment: Quickly check the patient's airway, breathing, and circulation (ABCs). This matters because it helps us figure out what's wrong and how to fix it. Example: if someone is not breathing, we need to start CPR.
  • (AVPU: Alert, Verbal, Pain, Unresponsive)
• Vital Signs: Check the patient's pulse, breathing rate, and blood pressure. This matters because it helps us see if they're stable or not. Example: if someone's pulse is 40 beats per minute, it's too slow and we need to call for help.
  • Normal pulse: 60-100 beats per minute
  • Normal breathing rate: 12-20 breaths per minute
• Injury Severity: Look for signs of severe injury, such as bleeding, broken bones, or severe burns. This matters because it can affect how quickly we need to get them to the hospital. Example: if someone has a severe head injury, we need to get them to the hospital right away.
  • Red flags: severe bleeding, difficulty breathing, severe burns
• Medical History: Ask the patient or their family about any medical conditions they have. This matters because it can affect how we treat them. Example: if someone has a peanut allergy, we need to avoid giving them peanuts.
  • Common medical conditions: diabetes, heart disease, allergies
• Treatment: Provide basic life support, such as CPR, oxygen, and bleeding control. This matters because it can help save their life. Example: if someone is not breathing, we need to start CPR.
  • CPR compression depth: at least 2 inches (like pushing down a soda can)
  • CPR rate: 100-120 compressions per minute
• Transport Decision: Decide whether to take the patient to the hospital or stay and treat them at the scene. This matters because it can affect how quickly and effectively we can save their life. Example: if someone has a severe head injury, we need to get them to the hospital right away.
  • Load & go: take the patient to the hospital immediately
  • Stay & play: stay and treat the patient at the scene

What Laypeople Can Do

• If someone collapses, first check for danger (oncoming traffic, fire). Then shout and tap their shoulder.
• If someone is bleeding, apply pressure with a clean cloth or gauze. Elevate the injured area above heart level if possible.
• If someone is not breathing, start CPR by pushing down on their chest 100-120 times per minute.
• If someone has a severe allergic reaction, call 911 and administer epinephrine (if available).

Common Mistakes

• Mistake: Not checking the patient's airway, breathing, and circulation (ABCs) first.
  • Fix: Always check the ABCs before starting treatment. This matters because it helps us figure out what's wrong and how to fix it.
• Mistake: Not calling for help when a patient has a severe medical condition.
  • Fix: Always call for help when a patient has a severe medical condition. This matters because it can affect how quickly and effectively we can save their life.
• Mistake: Not providing basic life support, such as CPR or oxygen.
  • Fix: Always provide basic life support when necessary. This matters because it can help save the patient's life.

Quick Practice Scenarios

1. A patient is having a severe allergic reaction and is not breathing. What should you do first?
   • Answer: Call 911 and administer epinephrine (if available).
   • Reason: This is a life-threatening emergency that requires immediate attention.
2. A patient is bleeding severely and is losing consciousness. What should you do first?
   • Answer: Apply pressure with a clean cloth or gauze and elevate the injured area above heart level if possible.
   • Reason: This can help stop the bleeding and prevent further injury.
3. A patient is having a heart attack and is experiencing severe chest pain. What should you do first?
   • Answer: Call 911 and provide basic life support, such as CPR or oxygen.
   • Reason: This is a life-threatening emergency that requires immediate attention.

Last-Minute Exam Cram

• Normal pulse: 60-100 beats per minute
• Normal breathing rate: 12-20 breaths per minute
• CPR compression depth: at least 2 inches (like pushing down a soda can)
• CPR rate: 100-120 compressions per minute
• Agonal breathing is NOT normal breathing – start CPR
• A patient with a severe head injury needs to be taken to the hospital immediately
• Always check the patient's airway, breathing, and circulation (ABCs) first
• Always call for help when a patient has a severe medical condition
• Always provide basic life support when necessary