NREMT EMT 4: Patient Treatment and Transport - Transport Decision, Destination Selection, Trauma Center vs Community Hospital, Mode of Transport, Ground vs Air Ambulance, Interfacility Transfer

Transport Decision Study Guide

What This Is

A transport decision is choosing the best place to take a patient who needs medical help. This is like deciding which road to take to get to the hospital – you want to choose the one that will get the patient there safely and quickly. In real life, this decision can be crucial, like when a patient is having a heart attack or a severe injury.

Key Steps / Core Facts

• Trauma Center vs. Community Hospital: A trauma center is a hospital with specialized staff and equipment to treat severe injuries. Choose a trauma center for severe injuries, like a car accident or a fall from a height. (Use the "ABC" rule: Airway, Breathing, Circulation)
• Ground vs. Air Ambulance: Ground ambulances are faster and more cost-effective for short distances, while air ambulances are faster for long distances or in remote areas. Choose air ambulance for patients who need immediate, specialized care or are in a life-threatening situation. (Use the "FAST" rule: Flight, Air, Speed, Time)
• Interfacility Transfer: This is when a patient is transferred from one hospital to another for specialized care. Choose a hospital with the necessary equipment and staff for the patient's condition.
• Patient Condition: Assess the patient's condition using the "OPQRSTI" method: Onset, Provocation, Quality, Region, Severity, Time, and Injuries.
• Transport Time: Aim for a transport time of less than 30 minutes for emergency patients.
• Mode of Transport: Choose the mode of transport based on the patient's condition and the distance to the destination.
• Communication: Communicate with the patient, family, and medical team about the transport decision and any changes.
• Documentation: Document the transport decision and any changes in the patient's condition.
• Red Flags: Watch for red flags like severe injuries, difficulty breathing, or cardiac arrest.
• Normal Vital Sign Ranges: Heart rate: 60-100 beats per minute, Blood pressure: 90-140/60-90 mmHg, Respiratory rate: 12-20 breaths per minute.
• CPR Compression Depth: At least 2 inches – like pushing down a soda can.
• CPR Compression Rate: 100-120 compressions per minute – like a metronome.
• CPR Ratio: 30:2 – 30 compressions followed by 2 breaths.

What Laypeople Can Do

• If someone collapses, first check for danger (oncoming traffic, fire). Then shout and tap their shoulder.
• If someone is having a heart attack, call 911 and try to keep them calm.
• If someone is injured, try to keep them still and comfortable until help arrives.

Common Mistakes

• Mistake: Choosing the wrong hospital based on distance rather than the patient's condition.
• Fix: Assess the patient's condition using the "OPQRSTI" method and choose the hospital with the necessary equipment and staff.
• Mistake: Not communicating with the patient, family, and medical team about the transport decision.
• Fix: Communicate clearly and regularly with all parties involved.
• Mistake: Not documenting the transport decision and any changes in the patient's condition.
• Fix: Document all changes and decisions in the patient's chart.

Quick Practice Scenarios

• A patient is having a heart attack and needs to be taken to a hospital with a cardiac catheterization lab. What should you do first?
• Answer: Call 911 and try to keep the patient calm.

• Reason: This will get the patient the specialized care they need as quickly as possible.

• A patient is severely injured in a car accident and needs to be taken to a trauma center. What should you do first?

• Answer: Call 911 and try to keep the patient still and comfortable.

• Reason: This will help prevent further injury and get the patient the specialized care they need.

• A patient is having difficulty breathing and needs to be taken to a hospital with a respiratory therapy department. What should you do first?

• Answer: Call 911 and try to keep the patient calm.
• Reason: This will get the patient the specialized care they need as quickly as possible.

Last-Minute Exam Cram

• Agonal breathing is NOT normal breathing – start CPR.
• Normal heart rate: 60-100 beats per minute.
• Normal blood pressure: 90-140/60-90 mmHg.
• Normal respiratory rate: 12-20 breaths per minute.
• CPR compression depth: at least 2 inches.
• CPR compression rate: 100-120 compressions per minute.
• CPR ratio: 30:2 – 30 compressions followed by 2 breaths.
• Trauma center vs. community hospital: choose based on patient condition, not distance.
• Interfacility transfer: choose hospital with necessary equipment and staff.
• Mode of transport: choose based on patient condition and distance.
• Communication: communicate with patient, family, and medical team.
• Documentation: document transport decision and changes in patient condition.