[Guide] Paramedic procedures

[Darkkel]

Disclaimer : This manual has been written by several IRL paramedic, medic and FD Search & Rescue members and by myself (Darkel, called DarkGhost at the time of this manual writting). If you want to copy it, please send me a PM so I can send you the file instead.

Note to admins reviewing : Fixed version, sorry for the other one that failed miserably.

List of Ambulance Equipement.

Spoiler :

BLS (Basic Life Support) Ambulance Equipement

A. Ventilation and Airway Equipement

1. Portable Oxygen Apparatus
2. tubing
3. transparent mask, both nonbreathing and valvless
4. Bag-valve mask
6. Nasopharyngeal and Oropharyngeal

B. Monitoring and Defibrilation

1. AED (automated external defibrillator)

C. Immobilization Devices

1. Cervical collars
2. Splints
3. Spineboard

D. Bandages

1. Normal Bandages with 2 safety pins each
2. Sterile miltitrauma dressings
3. Gauze sponges
4. Gauze rolls
5. Occlusive dressing
6. Adhesive tape

E. Obstetrical Kit

1. Towel
2. Sterile Scissors
3. Sterile Gloves
4. Blankets
5. Thermal absorbent blankets

F. Miscellaneous

1. Sphyngmomanometer
2. Stethoscope
3. Thermometer
4. Cold Pack
5. Saline solution 1000ml bags
6. Flashlights
7. Folding Stretcher
8. Carry Chair

ALS (Advanced Life Support) Ambulance Equipement

A. Airway and Ventilation Equipement

1. Laryngoscope blades
2. Endotracheal tubes
3. Forceps

B. Vascular Access

1. Crystalloid solutions, e.g. Ringer's Lactate
2. Antiseptic solution, i.e. alcohol wipes and povidone-idoine wipes
3. Intravenous-fluid pole
4. Intravenous catheters
5 Syringes of various sizes
6. Needles of various sizes
7. Intravenous administration sets

C. Cardiac

1. Portable defibrillator
2. ECG
3. Peacemaker

D. Other Advanced Equipement

1. Glucometer
2. Large-bore needle (for needle chest decompression)

E. Medications

1. Cardiovascular medications such as epinephrine, atropine, betablockers, nitroglycerin tablets, aspirin.
2. Cardiopulmonary respiratory medications such as albuterol and ipratorpium bromide.
3. 50% dextrose solution
4. Analgesic (painkillers) i.e. codeine, morphine
5. Antipileptic medications such as diazepam or midazolam
6. Naloxone hydrochloride, Activated Charcoal

EMS Procedure Manual

Spoiler :

Part One:

1.General outline for every call:

---1a.You are given your dispatch info, you respond, you arrive on scene

2.Do you have any hazzards?

---2a. Heavy traffic,

---2b. Vehicle/house fires,

---2c. Gunshots nearby

3. How many patients do you have?

---3a. One?

---3b. More then one?

---3c. Too many for you to take care of on your own?

4. Do you need backup and extra resources?

---4a. Do you need police assistance if there are shots fired and you cant get to your patient.

---4b.Do you need more people to help?

---4c. Another ambulance?

5. What is your general impression of the patient?

---5a. Is he calm?

---5b. Is he screaming in pain?

---5c. Is he agressive?

6. What is my mechanism of injury?

---6a. Was he shot?

---6a. A car accident?

---6c. Did he fall off a building?

---6d. If your patient is complaining of neck or back pain in a car accident, or they have fallen from a hight more then 10 feet, you need to place a cervical collar around their neck.

Part Two:

1.AVPU

---1a. Is your patient A-Alert?

---1b. Is your patient only alert to V-Verbal

---1c. Is your patient only alert to P-Pain (rubbing his chest, poking him in a pressure point to arrouse him)

---1d. Is your patient U-Unresponsive (dead, Coma, overdose, drunk)

2. Now you can assess his ABCD's

---2a. A- Airway

Is it open and clear? is there blood? is he vomiting blood? Are there broken teeth in his airway? you may need to suction it out.

---2b. B- Breathing

-----2ba. What is the rate and quality of his breathing?

-----2bb. Normal breathing rate is 12 - 20 breaths per
minute, count it out for 15 seconds and multiply that number by 4 for
a quick answer.

-----2bc. Is he having trouble breathing? Shallow breaths? labored breathing? Is he not breathing?

-----2bd. At this point you can place the patient on Oxygen and you might possible have to intubate

-----2be. If they are breathing ok you can place them on an oxygen mask. If your patient is not breathing you need to use a
BVM

---3c. C - Circulation

-----Check the pulse at their wrist for the rate. Normal pulse should be between 60 - 100 beats per minute.

---4d. D - Deadly wet check

See of your patient wet himself, or if you can find blood when you feel around them, this will give you an idea where
the injury was or where that gunshot may be.You are also trying to find any major bleeds such as from a cut on the
head thats bleeding alot, or an amputation that is bleeding all over the place.

Part Three:

1. RAPID TRAUMA SURVEY

---1a. This is a quick assessment of your patient to find out where they are injured.

2. HEENT - Head, Ears, Eyes, Nose, Throat

---2a. Look for any obvious trauma or cuts to the patient, check for any bruises around the eyes or behind the ears, this may
mean they have a serious head injury.

---2b. Check for any knife wounds or gun shots. Check the patients neck, feel down his spine. Is there any pain?

3. Chest

---3a. Look for any gun shots or stab wounds on their chest, if they have a hole in their chest and it punctures a lung, this is
called a pnumothorax.

---3b. What helps relieve this is needle decompression. This is where you stab a Intraveinous needle into their lung to help
relieve the pressure on the lung from leaking air.

4. Abdomin

---4a. Look for any gun shots or stab wounds, is it rigid when you feel it? this might mean internal bleeding.

5. Pelvis

---5a. Is it stable? if it isnt then they could have a fractured pelvis, you will have to be careful when moving them so you dont
make it worse.

6. Legs

---6a. Any trauma or injury? gunshots or stab wounds? Check the pulses in the feet. Make sure they are there, if there is any
fractures to the legs and you cant feel a pulse in the foot, try to realign the leg. If that fails, then you need to hurry to
the nearest hospital with the patient or they might need an amputaion. (See Procedures Point B. )

7. Arms

---7a. Any trauma or injury? gunshots or stab wounds?

8. Back

---8a. Just because you have been looking at the patients front, dont forget to look at their back for any obvious injury or
trauma.

Part Four :

1. Does your patient need to be intubated ?

2. When you encounter a bleed, what do you do ?

---2a. Direct pressure with gause over the wound

-----if that doesnt stop it go on to step 2b

---2b. Elevate the extremity

-----If that doesnt stop or slow the bleeding go on to step 2c

---2c. Hold pressure over the nearest pulse point (for example, you are bleeding from your forearm, hold pressure on the pulse
under your bicep)

-----If that doesnt stop or slow the bleeding move on to step 2d

---2d. Apply a tourniquet. You are tieing it tight to tighten the veins and arteries and hopefully stop the bleeding. But there is a
high chance that the patient will lose that part of the body and have to get it surgicaly removed from tissue death if its
prolonged.

3. Your patient has a gunshot or a stab wound ? (See Procedures Letter G. & F. )

Get some bandages, place it over the injury or hole and tape it down on all 4 sides. If there is alot of blood, return to the 4
steps for stoping a bleed.

4. Car accident with a patient complaining of neck and back pain (See Procedures Point N. )

Medical Procedures.

Spoiler :

A. AED (automated external defibrillator)

1. An automated external defibrillator is used in cases of life threatening cardiac arrhythmias which lead to cardiac arrest.

2. AEDs, like all defibrillators, are not designed to shock asystole ('flat line' patterns) as this will not have a positive clinical outcome.

3. Unlike regular defibrillators, an automated external defibrillator requires minimal training to use. It automatically diagnoses the heart rhythm and determines if a shock is needed.

Procedure:

1a. First ensure that the adhesive AED pads are attached to a cable, which is plugged into the AED machine.

2a. Place the negative pad on the patients upper chest wall, the positive electrode on the patients left chest side just below the nipple and pectoral muscle.

3a. Ensure that nobody is touching the patient and push the analyze button on the AED machine. Shout CLEAR!

4a. If the AED indicates that a shock is required make sure that everyone is clear from the patient, then press the shock button.

5a. Immediately following the shock begin CPR for 5 cycles.

Note: Do not use AED on a trauma patient or a victim with pulse.


B. Broken Fracture (FRX)

1. It's medical condition in which there is a break in the continuity of the bone.

Procedure:

1a. Stabilize the break with a splint to prevent movement of the injured part.

2a. If the patient is in pain administer analgesics.

3a. Take the patient to the hospital for the doctor to see him.


C. Cardiopulmonary resuscitation (CPR)

1. Its an emergency medical procedure for a victim of cardiac arrest or, in some circumstances, respiratory arrest.

Procedure:

1a. Open the victim's airway using the head-tilt, chin-lift method.

2a. Check if the patient is breathing

3a. If there is no breathing, pinch the victim's nose; make a seal over the victim's mouth with yours.

4a. Give the victim a breath big enough to make the chest rise. Let the chest fall, then repeat the rescue breath once more.

5a. Place the heel of your hand in the middle of the victim's chest.

6a. Compress the chest about 1-1/2 to 2 inches (4-5 cm)

7a. Compress the chest at a rate equal to 100/minute. Perform 30 compressions at this rate.


L. Laryngoscope and Intubation.

1. Laryngoscope is a tool used in intubation and detection of voice problems, evaluates difficulty in swallowing, injures of the throat.

2. Intubation is a procedure that is preformed when the patient cannot breath on his own due to air not arriving to the lungs.

Procedure:

1a. Standing behind the patient, with your left hand, insert the curved blade of the laringiscope into the mouth over the right side of the toungue displacing it to the left and upwards.

2a. Advance the laringoscope slightly untill the the end of epiglottis can be seen posterior to the back of the tongue.

3a. Advance the laringoscope blade between the epiglottis and the tongue.

4a. Lift up the tongue and the epiglottis to display the vocal cords.

5a. With your right hand insert the endotracheal tube from the right hand side directly between the chords.

6a. The markings on the tube will show between 21 and 23.

7a. Check the placement with the stethoscope.


F. Flesh Wound. (small trauma)

1. Flesh wound is a mechanical damage of the soft tissue of the body.

2. Flesh wounds can be deep or shallow

Procedure:

1a. Use the Povidone to clean the wound and the area around it

2a. Take the tweezers and remove any dead tissue or impurities from the wound. I.e. glass shards, small stones etc.

3a. In case of a shallow wound take the bandage and bandage the wound.

4a. If the wound is deep use the needle and stiches to saw it shut.

5a. after stiching the wound bandage it.


G. Gunshot wound

Procedures:

1a. Place the occlusive dressing on the wound

2a. Press the dressing to the wound and tape it down

3a. Set an IV with Ringer's Lactate.

4a. Inform the ER about the gunshot wound patient and take him to the hospital immediately.


I. Intravenous.

1. Intravenous therapy or IV therapy is the giving of liquid substances directly into a vein.

2. The IV fluid used commonly is a crystalloid fluid, saline which is close to concentration in the blood

3. Ringer's acetate is another isotonic solution often used for large-volume fluid replacement.

4. A solution of 5% dextrose in water, sometimes called D5W, is often used instead if the patient is at risk for having low blood sugar or high sodium.

5. IV is set to replace fluids in the body. i.e. Blood loss, dehydration etc. and also to administer drugs.

Procedure:

1a. Place the bag with the fluid you are using on the Intravenous-fluid pole.

2a. Remove the protective cap from the tubing.

3a. Insert it to the opening of the bag.

4a. With the tubing occluded in the rollerclamp squize the chamber till it will be half full.

5a. Unroll the rollerclamp.

6a. Flush the tubing.

7a. Place the torniquet on the patients arm to make the veins swell so they can be easier to find.

8a. After finding the vein clean the site with an alcohol wipe.

9a. Inser the catheter needle into the vein.

10a. Connect the tube and the line to the catheter.


P. Pneumothorax (sucking chest wounds)

1. It occurs wherein air or gas is present in the pleural cavity.

2. It can also occur as the result of disease or injury to the lung, or due to a puncture to the chest wall.

Procedure:

1a. Immediatelly cover the wound with occlusive dressing or a pressure bandage.

2a. air-tight with clean plastic sheeting.

3a. If air is present in the pleural cavity pierce the chest with a syringe without a plunger.


N. Neck Injury

Procedures:

1a. Place a Cervical Collar on the patients neck

2a. Place the patient on the spineboard

3a. Be sure that the patient wont move his head before applying the Cervical Collar.


V. Ventilation

1. Ventilation can be performed by the use of NRB (Non Rebreathable Mask) or BVM (Bag Valve Mask)

2. If the patient is breathing not adequately use NRB or BVM to aid him in oxygenation.

3. If the patient is not breathing use BMV or perform intubation (See point I. )

Procedure in using NRB (Non Rebreathable Mask):

1a. Place the mask on the patients face.

2a. Strap it tightly.

3a. connect the mask to the oxygen tank.

4a. release the oxygen flow.

Procedures in using BVM (Bag Valve Mask):

1a. Place the mask on the patients mouth

2a. Squeez the bag once every 5 seconds.
EMS Procedure Manual

Medications

Spoiler :

A1. Analgesics (Morphine Codeine)

Usage:

As a painkiller

Mechanism:

Block pain receptors

Dosage:

Morphine: 10mg orally 1mg injection (( if i remember it right not really sure))
Codeine: 60mg maximum orally (( sure about the max dosage dont remember the injection ))


A2. Antipileptic (diazepam or midazolam)

Usage:

epilepsy (epileptic seizure)

Mechanism:

Diazepam appears to act on areas of the limbic system, thalamus, and hypothalamus, inducing anxiolytic effects. The muscle relaxant properties of diazepam are produced via inhibition of polysynaptic pathways in the spinal cord.

Dosage:

Injection 5 mg/ml for intravenous, intramuscular or subcutaneous usage


A3. Atropine

Usage:

Injections of atropine are used in the treatment of bradycardia (an extremely low heart rate) and asystole (flat line pattern)

Mechanism:

The main action of the vagus nerve of the parasympathetic system on the heart is to decrease heart rate. Atropine blocks this action and, therefore, may speed up the heart rate.

Dosage:

0.5 to 1mg IV every three to five minutes up to max dosage 00.4mg/kg


B. Betablockers

Usage:

Heartattacks, hypertension

Mechanism:

Betablockers reduce the effect of excitement/physical exertion on heart rate and force of contraction, dilation of blood vessels and opening of bronchi, and also reduce tremor and breakdown of glycogen.

Dosage:

Depends on the betablocker used

examples:

Propranolol in capsules 80mg (dosage 80mg)

Toprol in tablets 50mg (large dosage 50mg)

Nebivolol 5 mg (dosage above 10mg dont give better effect)


E. Epinephrine (epi)

Usage:

In cases of asthma, bronchitis, empysema and anaphylactic shock

Mechanism:

Epinephrine is a powerful bronchodilator (relaxes bronchial muscles). It also constricts pulmonary vessels (in the lung), and inhibits the release of histamines triggered by allergic reactions.

Dosage:

approx. 0.3mg

Note: Epinephrine can be also in EpiPen autoinjector


D. Dextrose

Usage:

Hypoglycemia (low blood sugar)

Mechanism:

Dextrose is a sugar

Dosage:

25 grams through the IV line


N1. Naloxone

Usage:

Used to counter the effects of opioid overdose, for example heroin or morphine overdose.

Mechanism:

Naloxone is a μ-opioid receptor competitive antagonist, and its rapid blockade of those receptors often produces rapid onset of withdrawal symptoms.

Dosage:

In prepared ampules
Usually injected intramuscularly for fastest action.


N2. Nitroglycerin tablets

Usage:

Heart attack

Mechanism:

Nitroglycerin will dilate veins more than arteries, decreasing cardiac preload and leading to decrease blood pressure and increase heart rate.

Dosage:

One tablet placed under the tongue

[Adman]

Approved.

Very nice work.

[GhostRider]

Very detailed guide. You've put a lot of effort making it, keep it up!

[Commander Fi5h]

Very good!

If only there were paramedics on Fearless that RP'ed using some of these procedures. It would be great. But people aren't interested in RP'ing when they need to be revived. All they care about is not losing there guns!

[GeneralSirens]

I try to rp but they don't let me.

[aviator]

That is a very good guide. At least now we have a suitable one for Paramedics to roleplay with. It will take a while for me to learn it all. Very detailed. Nice work.

[Darkkel]

That is a very good guide. At least now we have a suitable one for Paramedics to roleplay with. It will take a while for me to learn it all. Very detailed. Nice work.

I tend to let it opened in background and check what I need at the moment I need it. Learning it all is just TOTALLY impossible, except if you plan to become an IRL medic/paramedic.

And it took like 3-4 months to get this manual done with 1 IRL Search & Rescue (from the Fire Department) from Norway, one IRL paramedic from UK and 1 IRL medic from forgot where, USA I think, plus myself to get it all together and readable.

And thanks Adman.

If only there were paramedics on Fearless that RP'ed using some of these procedures. It would be great. But people aren't interested in RP'ing when they need to be revived. All they care about is not losing there guns!

Lack of serious roleplay, that's what I really miss to stick around ...

Edit :

Spoilers were used to avoid having to read a damn long manual just to get to the part you require at that precise moment. :x

[JackHarkness]

Nice Guide, Only if the patient lasted long enough to use these procedures in-game.