Fire & Rescue
Scene Safety
Scene safety is the first priority during any emergency response. EMS personnel must ensure the environment is safe for themselves, the patient, and any bystanders before beginning patient care.
Personnel should evaluate the scene for potential hazards such as:
Primary Survey (ABCDE)
The Primary Survey is a rapid assessment used to identify and treat immediate life-threatening conditions. EMS personnel must follow the ABCDE approach in order of priority.
A – Airway
Assess whether the airway is open and unobstructed. If the airway is compromised, open it using appropriate techniques and remove any obstructions.
**B – Breathing**
Assess breathing rate, depth, and effort. Determine whether the patient is breathing adequately. If breathing is inadequate or absent, initiate assisted ventilation immediately.
**C – Circulation**
Assess pulse, skin color, temperature, and signs of bleeding. Control major hemorrhage and begin circulatory support if necessary.
**D – Disability (Neurological Status)**
Evaluate the patient’s level of consciousness using tools such as:
* AVPU (Alert, Verbal, Pain, Unresponsive)
* Glasgow Coma Scale (if applicable)
Check pupil response and identify any obvious neurological deficits.
**E – Exposure / Environment**
Expose the patient as necessary to identify injuries or medical conditions that may not be visible. Protect the patient from environmental hazards such as hypothermia during this process.
Life-threatening issues identified during the Primary Survey must be treated immediately before continuing further assessments.
Secondary Survey
Once life threats have been managed, conduct a **Secondary Survey**, which consists of a systematic head-to-toe examination.
The purpose of the secondary assessment is to identify injuries or medical conditions that were not immediately apparent during the primary survey.
Assess the following areas:
* Skin condition
* Head and scalp
* Eyes, ears, nose, and throat
* Neck
* Chest and respiratory movement
* Abdomen
* Pelvis
* Extremities
* Back and spine
During the secondary survey, EMS personnel should obtain a patient history using **SAMPLE** and **OPQRST** assessment tools.
Patient History Assessment
SAMPLE
**S – Signs and Symptoms**
What symptoms is the patient experiencing?
**A – Allergies**
Does the patient have any known allergies to medications, foods, or environmental factors?
**M – Medications**
What medications is the patient currently taking?
**P – Past Medical History**
Does the patient have any known medical conditions or prior illnesses?
**L – Last Oral Intake**
When did the patient last eat or drink, and what was consumed?
**E – Events Preceding the Illness/Injury**
What was the patient doing when the symptoms began?
OPQRST (Pain Assessment)
**O – Onset**
Did the pain begin suddenly or gradually?
**P – Provocation / Palliation**
What makes the pain better or worse?
**Q – Quality**
How does the patient describe the pain (sharp, dull, burning, etc.)?
**R – Region / Radiation**
Where is the pain located? Does it radiate to other areas?
**S – Severity**
Rate the pain on a scale of 1–10.
**T – Time**
How long has the pain been present?
Vital Sign Monitoring
Vital signs provide critical information about the patient’s overall condition.
EMS personnel must routinely monitor and document:
* Heart Rate (Pulse)
* Blood Pressure
* Respiratory Rate
* Oxygen Saturation (SpO₂)
* Temperature
* Level of Consciousness
Vital signs should be reassessed regularly and whenever the patient's condition changes.
Scene safety is the first priority during any emergency response. EMS personnel must ensure the environment is safe for themselves, the patient, and any bystanders before beginning patient care.
Personnel should evaluate the scene for potential hazards such as:
- Traffic or roadway dangers
- Fire or smoke conditions
- Hazardous materials or chemical exposure
- Violent individuals or unsafe crowds
- Environmental hazards such as unstable structures
Primary Survey (ABCDE)
The Primary Survey is a rapid assessment used to identify and treat immediate life-threatening conditions. EMS personnel must follow the ABCDE approach in order of priority.
A – Airway
Assess whether the airway is open and unobstructed. If the airway is compromised, open it using appropriate techniques and remove any obstructions.
**B – Breathing**
Assess breathing rate, depth, and effort. Determine whether the patient is breathing adequately. If breathing is inadequate or absent, initiate assisted ventilation immediately.
**C – Circulation**
Assess pulse, skin color, temperature, and signs of bleeding. Control major hemorrhage and begin circulatory support if necessary.
**D – Disability (Neurological Status)**
Evaluate the patient’s level of consciousness using tools such as:
* AVPU (Alert, Verbal, Pain, Unresponsive)
* Glasgow Coma Scale (if applicable)
Check pupil response and identify any obvious neurological deficits.
**E – Exposure / Environment**
Expose the patient as necessary to identify injuries or medical conditions that may not be visible. Protect the patient from environmental hazards such as hypothermia during this process.
Life-threatening issues identified during the Primary Survey must be treated immediately before continuing further assessments.
Secondary Survey
Once life threats have been managed, conduct a **Secondary Survey**, which consists of a systematic head-to-toe examination.
The purpose of the secondary assessment is to identify injuries or medical conditions that were not immediately apparent during the primary survey.
Assess the following areas:
* Skin condition
* Head and scalp
* Eyes, ears, nose, and throat
* Neck
* Chest and respiratory movement
* Abdomen
* Pelvis
* Extremities
* Back and spine
During the secondary survey, EMS personnel should obtain a patient history using **SAMPLE** and **OPQRST** assessment tools.
Patient History Assessment
SAMPLE
**S – Signs and Symptoms**
What symptoms is the patient experiencing?
**A – Allergies**
Does the patient have any known allergies to medications, foods, or environmental factors?
**M – Medications**
What medications is the patient currently taking?
**P – Past Medical History**
Does the patient have any known medical conditions or prior illnesses?
**L – Last Oral Intake**
When did the patient last eat or drink, and what was consumed?
**E – Events Preceding the Illness/Injury**
What was the patient doing when the symptoms began?
OPQRST (Pain Assessment)
**O – Onset**
Did the pain begin suddenly or gradually?
**P – Provocation / Palliation**
What makes the pain better or worse?
**Q – Quality**
How does the patient describe the pain (sharp, dull, burning, etc.)?
**R – Region / Radiation**
Where is the pain located? Does it radiate to other areas?
**S – Severity**
Rate the pain on a scale of 1–10.
**T – Time**
How long has the pain been present?
Vital Sign Monitoring
Vital signs provide critical information about the patient’s overall condition.
EMS personnel must routinely monitor and document:
* Heart Rate (Pulse)
* Blood Pressure
* Respiratory Rate
* Oxygen Saturation (SpO₂)
* Temperature
* Level of Consciousness
Vital signs should be reassessed regularly and whenever the patient's condition changes.
Fire & Rescue
Airway Management
Maintaining a **patent airway** is essential for oxygenation and ventilation.
Common airway management techniques include:
* Head-Tilt / Chin-Lift (non-trauma patients)
* Jaw Thrust Maneuver (suspected spinal injury)
EMS personnel must also remove any airway obstructions such as vomit, blood, or foreign objects.
Basic airway adjuncts include:
* Oropharyngeal Airway (OPA)
* Nasopharyngeal Airway (NPA)
Advanced airway procedures may include endotracheal intubation when performed by authorized personnel.
Breathing Interventions
Assess breathing for:
* Rate
* Depth
* Effort
* Symmetry
If respiratory distress or failure is present, interventions may include:
* Oxygen therapy via nasal cannula or non-rebreather mask
* Bag-Valve-Mask (BVM) ventilation
* Positive pressure ventilation
* Needle decompression for suspected tension pneumothorax (ALS protocols)
Continuous monitoring of respiratory status is required throughout treatment and transport.
Circulation Support
Circulatory support may include:
* Establishing IV access
* Administration of IV fluids
* Hemorrhage control
* Medication administration under approved protocols
EMS personnel must monitor for signs of shock and intervene accordingly.
Cardiopulmonary Resuscitation (CPR)
High-quality CPR must be performed according to current guidelines established by the **American Heart Association (AHA)**.
Key principles include:
* Immediate recognition of cardiac arrest
* High-quality chest compressions
* Early defibrillation using an AED
* Minimal interruptions in compressions
* Proper ventilation
CPR must continue until:
* Return of spontaneous circulation (ROSC)
* Care is transferred to advanced providers
* Medical control directs termination of efforts
Use of Medical Equipment
All EMS personnel must be trained and proficient in the use of department-issued medical equipment.
Key expectations include:
* Ensuring equipment is clean and operational
* Checking equipment at the start of each shift
* Reporting damaged or malfunctioning equipment
* Practicing equipment use regularly during training
Medical equipment must **never be used outside official duty or emergency response situations.**
Maintaining a **patent airway** is essential for oxygenation and ventilation.
Common airway management techniques include:
* Head-Tilt / Chin-Lift (non-trauma patients)
* Jaw Thrust Maneuver (suspected spinal injury)
EMS personnel must also remove any airway obstructions such as vomit, blood, or foreign objects.
Basic airway adjuncts include:
* Oropharyngeal Airway (OPA)
* Nasopharyngeal Airway (NPA)
Advanced airway procedures may include endotracheal intubation when performed by authorized personnel.
Breathing Interventions
Assess breathing for:
* Rate
* Depth
* Effort
* Symmetry
If respiratory distress or failure is present, interventions may include:
* Oxygen therapy via nasal cannula or non-rebreather mask
* Bag-Valve-Mask (BVM) ventilation
* Positive pressure ventilation
* Needle decompression for suspected tension pneumothorax (ALS protocols)
Continuous monitoring of respiratory status is required throughout treatment and transport.
Circulation Support
Circulatory support may include:
* Establishing IV access
* Administration of IV fluids
* Hemorrhage control
* Medication administration under approved protocols
EMS personnel must monitor for signs of shock and intervene accordingly.
Cardiopulmonary Resuscitation (CPR)
High-quality CPR must be performed according to current guidelines established by the **American Heart Association (AHA)**.
Key principles include:
* Immediate recognition of cardiac arrest
* High-quality chest compressions
* Early defibrillation using an AED
* Minimal interruptions in compressions
* Proper ventilation
CPR must continue until:
* Return of spontaneous circulation (ROSC)
* Care is transferred to advanced providers
* Medical control directs termination of efforts
Use of Medical Equipment
All EMS personnel must be trained and proficient in the use of department-issued medical equipment.
Key expectations include:
* Ensuring equipment is clean and operational
* Checking equipment at the start of each shift
* Reporting damaged or malfunctioning equipment
* Practicing equipment use regularly during training
Medical equipment must **never be used outside official duty or emergency response situations.**
Fire & Rescue
Bleeding Control
External bleeding must be controlled immediately to prevent shock and death.
Control methods include:
* Direct pressure using sterile dressings
* Pressure bandages
* Tourniquet application for severe extremity bleeding
* Hemostatic dressings when appropriate
Early hemorrhage control is a critical life-saving intervention.
Fracture Management
Fractures and dislocations must be stabilized prior to patient transport.
Proper management includes:
* Immobilizing the affected limb using splints
* Supporting joints above and below the injury
* Assessing **CMS (Circulation, Motor function, Sensation)** before and after splinting
Pain management should be provided when authorized.
Spinal Immobilization
Spinal precautions should be considered in patients involved in:
* Motor vehicle collisions
* Falls from height
* Significant blunt trauma
* Patients reporting neck or back pain
Spinal stabilization methods include:
* Cervical collars
* Long backboards
* Kendrick Extrication Device (KED) for seated extrications
Minimize spinal movement during patient removal and transport.
Shock Management
Shock occurs when the body is unable to deliver adequate oxygen to tissues.
Types of shock include:
* Hypovolemic
* Cardiogenic
* Obstructive
* Distributive
* Septic
Management may include:
* Oxygen therapy
* IV fluid resuscitation
* Patient positioning
* Medication administration per protocol
Continuous monitoring is required to evaluate patient response to treatment.
External bleeding must be controlled immediately to prevent shock and death.
Control methods include:
* Direct pressure using sterile dressings
* Pressure bandages
* Tourniquet application for severe extremity bleeding
* Hemostatic dressings when appropriate
Early hemorrhage control is a critical life-saving intervention.
Fracture Management
Fractures and dislocations must be stabilized prior to patient transport.
Proper management includes:
* Immobilizing the affected limb using splints
* Supporting joints above and below the injury
* Assessing **CMS (Circulation, Motor function, Sensation)** before and after splinting
Pain management should be provided when authorized.
Spinal Immobilization
Spinal precautions should be considered in patients involved in:
* Motor vehicle collisions
* Falls from height
* Significant blunt trauma
* Patients reporting neck or back pain
Spinal stabilization methods include:
* Cervical collars
* Long backboards
* Kendrick Extrication Device (KED) for seated extrications
Minimize spinal movement during patient removal and transport.
Shock Management
Shock occurs when the body is unable to deliver adequate oxygen to tissues.
Types of shock include:
* Hypovolemic
* Cardiogenic
* Obstructive
* Distributive
* Septic
Management may include:
* Oxygen therapy
* IV fluid resuscitation
* Patient positioning
* Medication administration per protocol
Continuous monitoring is required to evaluate patient response to treatment.
Fire & Rescue
Patient Care Reports (PCR)
Accurate documentation is essential for both patient care and legal accountability.
Each call requires completion of a Patient Care Report (PCR) including:
Patient demographics
Incident Reporting
Critical incidents or protocol deviations must be reported through the department's incident reporting system.
Examples include:
Accurate documentation is essential for both patient care and legal accountability.
Each call requires completion of a Patient Care Report (PCR) including:
Patient demographics
- Assessment findings
- Vital signs
- Treatments performed
- Medications administered
- Patient response to treatment
Spoiler
Code: Select all
[hr]
[center][size=150][b]BLAINE COUNTY FIRE DEPARTMENT[/b][/size]
[size=120][b]EMS PATIENT CARE REPORT (PCR)[/b][/size][/center]
[b]Incident Information[/b]
[list]
[*][b]Incident Number:[/b]
[*][b]Date:[/b]
[*][b]Time Dispatched:[/b]
[*][b]Time On Scene:[/b]
[*][b]Time Transporting:[/b]
[*][b]Time At Hospital:[/b]
[*][b]Unit / Call Sign:[/b]
[*][b]Crew Members:[/b]
[*][b]Location of Incident:[/b]
[/list]
[b]Patient Information[/b]
[list]
[*][b]Patient Name:[/b]
[*][b]Date of Birth / Age:[/b]
[*][b]Gender:[/b]
[*][b]Contact Information:[/b]
[*][b]Next of Kin / Emergency Contact:[/b]
[/list]
[b]Chief Complaint[/b]
[quote]
Describe the primary reason EMS was requested.
[/quote]
[b]Primary Assessment (ABCDE)[/b]
[list][*][b]Airway:[/b]
[*][b]Breathing:[/b]
[*][b]Circulation:[/b]
[*][b]Disability (Neurological):[/b]
[*][b]Exposure / Environment:[/b][/list]
[b]Secondary Assessment[/b]
[b]Head & Neck:[/b]
[b]Chest:[/b]
[b]Abdomen:[/b]
[b]Pelvis:[/b]
[b]Extremities:[/b]
[b]Back / Spine:[/b]
[b]Skin Condition:[/b]
[b]SAMPLE History[/b]
[list][*][b]Signs & Symptoms:[/b]
[*][b]Allergies:[/b]
[*][b]Medications:[/b]
[*][b]Past Medical History:[/b]
[*][b]Last Oral Intake:[/b]
[*][b]Events Prior to Incident:[/b][/list]
[hr]
[b]OPQRST (If Pain Present)[/b]
[list][*][b]Onset:[/b]
[*][b]Provocation / Palliation:[/b]
[*][b]Quality:[/b]
[*][b]Region / Radiation:[/b]
[*][b]Severity (1-10):[/b]
[*][b]Time:[/b][/list]
[b]Treatment Provided[/b]
[quote]
List all treatments performed (oxygen, splinting, IV access, CPR, etc.)
[/quote]
[b]Transport Information[/b]
[list]
[*][b]Transport Decision:[/b] Transported / Refused / Treated on Scene
[*][b]Destination Hospital:[/b]
[*][b]Transport Priority:[/b] Emergency / Non-Emergency
[*][b]Patient Condition During Transport:[/b]
[/list]
[b]Narrative Report[/b]
[quote]
Provide a full narrative of the call including dispatch information, patient assessment, treatments performed, and outcome.
[/quote]
[b]Receiving Facility Handover (SBAR)[/b]
[list]
[*][b]Situation:[/b]
[*][b]Background:[/b]
[*][b]Assessment:[/b]
[*][b]Recommendation:[/b]
[/list]
[b]Reporting EMT / Paramedic[/b]
[list]
[*][b]Name:[/b]
[*][b]Rank / Certification:[/b]
[*][b]Signature:[/b]
[/list]
Incident Reporting
Critical incidents or protocol deviations must be reported through the department's incident reporting system.
Examples include:
- Medication errors
- Equipment failures
- Injuries to personnel
- Unusual or high-risk incidents
Fire & Rescue
Drug Dosages and Routes
EMS personnel must understand proper medication administration, including:
Medication Administration Guidelines
All medications must be administered according to department protocols.
Personnel must:
Common EMS Medications
Acetaminophen (Tylenol)
Indications: Mild to moderate pain, fever
Contraindications: Known allergy, severe liver disease
Dosage: 650–1000 mg
Route: Oral (PO)
Oxygen (O₂)
Indications: Hypoxia, respiratory distress, cardiac conditions, shock
Contraindications: None in emergency situations (use caution in certain COPD patients)
Dosage:
Nasal Cannula: 2–6 L/min
Non-Rebreather Mask: 10–15 L/min
Route: Inhalation
Nitroglycerin (Nitro)
Indications: Chest pain suspected to be cardiac in origin (angina), acute coronary syndrome
Contraindications:
Systolic blood pressure below protocol threshold (commonly <90–100 mmHg)
Recent use of erectile dysfunction medications (e.g., sildenafil)
Head injury or suspected intracranial pressure
Dosage: 0.4 mg
Route: Sublingual (SL) tablet or spray
Repeat: Every 5 minutes per protocol, usually up to 3 doses
Morphine
Indications: Moderate to severe pain, chest pain associated with myocardial infarction
Contraindications: Respiratory depression, hypotension, altered mental status, allergy
Dosage: 2–4 mg initially
Route: Intravenous (IV) slow push
Repeat: May repeat in small increments per protocol
EMS personnel must understand proper medication administration, including:
- Indications
- Contraindications
- Dosage calculations
- Routes of administration
- Oral (PO)
- Intravenous (IV)
- Intramuscular (IM)
- Subcutaneous (SQ)
- Inhalation
Medication Administration Guidelines
All medications must be administered according to department protocols.
Personnel must:
- Verify medication name and dosage
- Check expiration dates
- Confirm patient identity
- Document medication administration and patient response
Common EMS Medications
Acetaminophen (Tylenol)
Indications: Mild to moderate pain, fever
Contraindications: Known allergy, severe liver disease
Dosage: 650–1000 mg
Route: Oral (PO)
Oxygen (O₂)
Indications: Hypoxia, respiratory distress, cardiac conditions, shock
Contraindications: None in emergency situations (use caution in certain COPD patients)
Dosage:
Nasal Cannula: 2–6 L/min
Non-Rebreather Mask: 10–15 L/min
Route: Inhalation
Nitroglycerin (Nitro)
Indications: Chest pain suspected to be cardiac in origin (angina), acute coronary syndrome
Contraindications:
Systolic blood pressure below protocol threshold (commonly <90–100 mmHg)
Recent use of erectile dysfunction medications (e.g., sildenafil)
Head injury or suspected intracranial pressure
Dosage: 0.4 mg
Route: Sublingual (SL) tablet or spray
Repeat: Every 5 minutes per protocol, usually up to 3 doses
Morphine
Indications: Moderate to severe pain, chest pain associated with myocardial infarction
Contraindications: Respiratory depression, hypotension, altered mental status, allergy
Dosage: 2–4 mg initially
Route: Intravenous (IV) slow push
Repeat: May repeat in small increments per protocol
Fire & Rescue
Transport Decision Making
EMS personnel must determine the most appropriate destination for patient transport.
Factors to consider include:
Preparing Patients for Transport
Before transport, ensure the patient is properly secured and stabilized.
This includes:
Patient Handover at the Hospital
A clear and concise patient report must be given to the receiving hospital staff.
Use structured communication such as "SBAR" process:
EMS personnel must determine the most appropriate destination for patient transport.
Factors to consider include:
- Severity of the patient's condition
- Required level of care
- Distance to appropriate medical facilities
- Specialty centers such as trauma or cardiac centers
Preparing Patients for Transport
Before transport, ensure the patient is properly secured and stabilized.
This includes:
- Securing the patient to the stretcher
- Monitoring vital signs
- Maintaining airway management
- Continuing necessary treatments during transport
Patient Handover at the Hospital
A clear and concise patient report must be given to the receiving hospital staff.
Use structured communication such as "SBAR" process:
- Situation – Patient condition and chief complaint
- Background – Relevant medical history and events
- Assessment – Findings and vital signs
- Recommendation – Treatments provided and next steps
Fire & Rescue
Vehicle Safety
Operating emergency vehicles requires a high level of responsibility and attention.
Personnel must:
Defensive Driving
EMS drivers must practice defensive driving techniques at all times.
Key practices include:
Operating emergency vehicles requires a high level of responsibility and attention.
Personnel must:
- Follow all traffic laws when responding to emergencies
- Use emergency lights and sirens appropriately
- Ensure patients and crew are secured before moving the vehicle
Defensive Driving
EMS drivers must practice defensive driving techniques at all times.
Key practices include:
- Maintaining safe following distances
- Adjusting speed based on weather and road conditions
- Anticipating actions of other drivers/locals
- Frequently checking mirrors and blind spots