REMAC of N.Y.C. - A.L.S. Protocols

Regional Emergency Medical Advisory Committee of New York City
Prehospital Advanced Life Support Protocols
Copyright January 1996 (3/96)

APPENDIX B

ADULT PRIMARY SURVEY

	Assessment	Management
Airway	Breathing & pulse Quickcheck observe spinal precautions!	ž Jaw-thrust/manually stabilize the head/neck ž Suction patient's pharynx ž Insert oral/nasal airway PRN
Breathing	ž Check respiratory rate Assess the Chest ž Inspect ž Palpate ž Auscultate	ž Seal holes ž Stabilize flail segments ž Administer high flow/high % oxygen ž Ventilate
Circulation	ž Assess capillary refill ž Note skin color ž Check for pulses (BP estimation) Radial = 80+ Femoral = 70+ Carotid = 60+ ž Obtain baseline set of vital signs	ž Locate & control any obvious serious hemorrhage ž Support circulation ž Leg elevation (beware fractures) ž M.A.S.T. (beware pulmonary edema)
Disability	ž Assess the level of consciousness Alert - knows (1) their name (2) where they are (3) day of week Verbally Responsive (Not Alert x 3) Painful - Responds to pain only (smart response?) Unresponsive ž Assess the pupils ž Quick assessment of ability to move extremities	ž Apply rigid extrication collar & maintain head/neck stabilization
Expose	ž Remove clothing as appropriate to expose additional injuries

DETERMINE THE PATIENT STATUS

(C.U.P.S.)

CPR/Arrested Patient	Unstable Patient	Potentially Unstable Patient	Stable Patient
Cardiac Arrest Respiratory Arrest Patient being Ventilated	Severe Upper & Lower Respiratory Difficulties Serious Chest Trauma Decompensated Shock Rising Intercranial Pressure Uncontrollable External Hemorrhage Penetrating Injury to Head, Neck, Chest, Abdomen, Pelvis Respiratory depression CNS Depression Serious Burns ( 18% BSA) Early Signs of Decompensated Shock Near Drowning Altered Mental Status Kinematics Suggest "Hidden Injury"	Major Isolated Injury Respiratory Distress Moderate Burns ( >9% of BSA) Seizures, brief	Minor Isolated Injury Minor Illness Minor Burns Extremity Injuries (Uncomplicated)

Immediate Primary Resuscitation

Transport

Early Transportation Decision

Secondary Assessment &

Management Enroute to Hospital

Secondary Assessment &

Management on scene

More Time Taken for Routine Care, Splinting, etc.

PEDIATRIC PRIMARY SURVEY

	Assessment	Management
Airway	Breathing & pulse Quickcheck observe spinal precautions!	ž Chin Lift or Modified Jaw-Thrust ž Manually stabilize the head/neck ž Suction patient's pharynx ž Insert oral/nasal airway PRN
Breathing	ž Check respiratory rate Assess the Chest ž Inspect* ž Palpate ž Auscultate	ž Seal holes ž Stabilize flail segments ž Administer high flow/high % oxygen ž Ventilate as necessary
Circulation	ž Assess capillary refill ž Note skin color ž Check for pulses (BP estimation**) ž Obtain baseline set of vital signs	ž Locate & control any obvious serious hemorrhage ž Support circulation ž M.A.S.T.
Disability	ž Assess the level of consciousness Alert - moving spontaneously, verbal or crying, maintains eye contact Verbal - responds to verbal stimuli only Painful - Responds to painful stimuli Unresponsive - to any stimuli ž Assess the pupils ž Assess ability to move extremities ž Assess the Fontanel	ž Apply rigid extrication collar & maintain head/neck stabilization
Expose	ž Remove clothing as appropriate to expose additional injuries

DETERMINE THE PATIENT CUPS STATUS (C.U.P.S.)

* Assess respiratory effort

** Normal BP estimate: 90+ (2 x child's age)