ALS Upgrades/TTT

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  1. Universal ALS upgrades
    • s/s of shock
    • any blood loss or suspected fluid loss with auscultated systolic BP below 90 or absent radial pulses
    • pulse below 50 or above 130
    • unconscious
    • status epilepticus
    • step 1 or step 2 trauma
    • intoxicated step 3 or step 4 trauma
    • SOB with RR less than 10 or greater than 36 or noisy or absent lung sounds
    • airway compromise
    • uncontrollable bleeding
    • prolonged extrication
  2. ALS upgrades for abdominal/back pain
    • upper abdominal pain, age greater than 35
    • lower abdominal pain, women ages 12-50 with dizziness, syncope, or heavy vaginal bleeding
    • abdominal/back pain with syncope/near syncope if age greater than 50
    • acutely distended, rigid or tender abdomen
    • unequal or absent femoral pulses
  3. ALS upgrades for Allergic Reactions
    pt is presenting with signs and/or symptoms of an anaphylactic reaction within 1 hour of exposure to an allergen and has a history or anaphylactic reactions to this allergen

    difficulty swallowing or swelling in throat, lips or tongue

    severe abdominal cramps, nausea, vomiting or diarrhea with urticaria or flushing

    any use of epinephrine (requires ALS transport)
  4. ALS upgrades for animal bites
    • bite from poisonous snakes or reptiles
    • serious injury to the neck or face
  5. ALS upgrades for breathing difficulty
    • systolic BP greater than 250 or diastolic BP greater than 150 with associated signs or symptoms
    • altered or decreased metal status
  6. ALS upgrades for chest pain/discomfort/heart problems
    • pts presenting with typical or atypical symptoms of acute coronary syndrome
    • chest discomfort associated with the use of street drugs
    • upper abdominal pain, age greater than 35
  7. ALS upgrades for choking
    • inability to speak/cry/cough
    • s/s of anaphylaxis
  8. ALS upgrades for diabetic emergencies
    altered or decreased mental status
  9. ALS upgrades for environmental emergencies
    • altered or decreased mental status
    • rectal temp less than 95 or greater 105
    • pt very cold to the touch without shivering
  10. ALS upgrades for headache
    • altered or decreased metal status
    • severe or multiple episodes of vomiting
    • unequal pupils (greater than 2mm difference)
    • systolic BP greater than 250 or diastolic BP greater than 110
    • when asked "how does this compare to other headaches you've had?" pt states, "this is the worst headache of my life"
    • lateralizing signs
    • seizures
  11. ALS upgrades for metal/emotional/psych
    violent/combative pt requiring restrain for transportation from the scene to the hospital
  12. ALS upgrades for OD/poisoning (toxic exposure)
    • polypharmacy
    • OD on tylenol, ASA, or iron
    • intentional OD with prescription meds
    • seizure without history
    • on recommendation of Washington Poison Center
    • Pt with impaired gag reflex
  13. ALS upgrades for pregnancy/childbirth/OB-GYN
    • Imminent delivery: contractions 2 mins apart (first pregnancy), contractions less than 5 minutes apart (other pregnancy), urge to push/move bowels, crowning or buldging
    • recently completed childbirth
    • abdominal trauma greater than 20 weeks gestation with uterine contractions
    • vaginal bleeding greater than 20 weeks gestation, more than a few streaks
    • lower abdominal pain, women ages 12-50 with dizziness, syncope, or heavy vaginal bleeding
    • infant transfer situation
    • BP greater than 160 systolic or greater than 90 diastolic
    • seizure
    • pre-eclampsia
  14. ALS upgrades for seizures
    • actively seizing upon arrival
    • first time seizure with unknown history
    • seizure with pregnancy, street drug use, recent head injury, or abrupt onset of severe headache
  15. ALS upgrades for stroke
    • altered level of concsiouness
    • uncontrolled nausea/vomiting
    • systolic BP greater than 250 or diastolic BP greater than 110 with new onset stroke symptoms
    • dysarthria with absent gag reflex
  16. ALS upgrades for unconscious/syncope
    • altered or decreased metal status
    • severe abdominal or back pain
    • severe headache
  17. ALS upgrades for abdominal trauma
    • altered or decreased level of consciousness
    • impaled object
    • evisceration of abdominal organ(s)
    • pelvic fracture
  18. ALS upgrades for burns
    • partial/full thickness or chemical burns to the face, or suspicion or airway involvement
    • partial/full thickness or chemical burns greater than 10% BSA
    • partial/full thickness or chemical burns if pt less than 5 y/o
    • electrical burns
    • hydrofluoric acid (HFA) burns
  19. ALS upgrades for chest trauma
    • penetrating chest injury
    • flail chest
    • unilateral decreased lung sounds
  20. ALS upgrades for extremity trauma
    no distal pulses
  21. ALS upgrades for head and neck trauma
    • repetitive
    • severe or multiple episodes of vomiting
  22. ALS upgrades for spinal trauma
    paralysis secondary to the trauma
  23. ALS upgrades for submersion injury
    • paralysis following a diving/jumping injury
    • SCUBA diving accident
  24. What constitutes a step 1 trauma pt
    • glasgow coma scale less than 14
    • systolic BP less than 90 in adult pt or s/s of shock
    • respiratory rate less than 10 or greater than 20 breaths/minute (less than 20 in infant less than one year)
  25. what constitutes a step 2 trauma pt
    • all penetrating injuries to head, neck, torso, and extremities proximal to elbow and knee
    • flail chest
    • two or more long bone fractures
    • crushed, degloved, or mangled extremity
    • amputation proximal to wrist and ankle
    • pelvic fracture
    • open or depressed skull fracture
    • paralysis
  26. what constitutes a step 3 trauma pt
    • falls: adults greater than 20 ft (one story is equal to 10 ft), children greater than 10 ft or 2-3 times the height of the child
    • high-risk auto crashes: intrusion greater than 12 in. on occupant site or greater than 18 in. any site, ejection (partial or complete) from automobile, death in same passenger compartment, vehicle telemetry data consistent with high risk of injury
    • Auto vs. pedestrian/bicyclist thrown, run over, or with significant (greater than 20 mph) impact
    • motorcycle crash greater than 20 mph
  27. What constitutes a step 4 trauma pt
    • age: older adults - risk of injury death increases after age55 years, children - should be triaged preferentially to pediatric-capable trauma centers
    • anticoagulation and bleeding disoders
    • burns: without other trauma mechanism - triage to burn facility, with trauma mechanism - triage to trauma center
    • time sensitive extremity injury
    • end-stage renal disease requiring dialysis
    • pregnancy greater than 20 weeks
    • EMS provider judgement
  28. What is the purpose of policy 27?
    to ensure a mechanism for providing patients with the most rapid availability to ALS measures
Card Set:
ALS Upgrades/TTT
2013-06-11 22:42:05
Thurston County EMT

All the ALS upgrades per Thurston County Protocols
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