Paramedic CPGs December 07

Version D 0.
9 K Basic Life Support - Adult EMT P

CPG 1a
AP
From Cardiac
CPG 4a Arrest
AP
Change defibrillator
Request to manual mode
Initiate mobilisation of 3 to 4
practitioners / responders ALS
on site to assist with cardiac
arrest management
Arrest witnessed
Yes No
by practitioner
Attach AED defibrillation pads Commence CPR

Commence CPR while AED is being 30 Compressions : 2 ventilations.
prepared only if 2nd person available Continue CPR for 2 minutes
30 Compressions : 2 ventilations. Attach AED defibrillation pads
Oxygen therapy Oxygen therapy
Shockable Assess Non - Shockable

VF or pulseless VT Rhythm Asystole or PEA
Give 1
shock
Immediately resume CPR

x 2 minutes
Rhythm check *
Go to Go to
VF/ VT ROSC
CPG 3a CPG 19
Go to Go to
Asystole PEA
CPG 3a(i) CPG 3a(ii)
* =/-
+/- pulse
Pulse check:
check: Pulse
pulse check after 2 minutes of CPR if potentially perfusing rhythm
Version D 0.10 K Basic Life Support – Child (1 to 8 years) EMT P
CPG 1b
AP
From Cardiac
CPG xx arrest
Commence CPR
Initiate mobilisation of 3 to 4 30 Compressions : 2 ventilations. One rescuer CPR 30 : 2
practitioners / responders Continue CPR for 2 minutes Two rescuer CPR 15 : 2
on site to assist with cardiac compressions : Ventilations
arrest management
Oxygen therapy
Request
ALS
Switch to manual Apply paediatric system

AP 2 J/kg AED pads
Shockable Assess Non - Shockable

VF or pulseless VT Rhythm Asystole or PEA
Give 1
shock
Immediately resume CPR

x 2 minutes
Rhythm check *
Go to Go to
VF/ VT ROSC
CPG xx CPG xx
Asystole / PEA
Go to
CPG xx
* +/- Pulse check: pulse check after 2 minutes of CPR if potentially perfusing rhythm
Version D 0.9 K Basic & Advanced Life Support – Infant (4 weeks to 1 year) EMT P
CPG 1c
AP
From
CPG xx
Cardiac arrest
or
pulse < 60 per minute
practitioners / responders
arrest management Commence CPR One rescuer CPR 30 : 2
30 Compressions : 2 ventilations. Two rescuer CPR 15 : 2
Oxygen therapy compressions : Ventilations
Continue CPR
Attach ECG monitor For two rescuer CPR use two
thumb-encircling hand chest
compression
Request
ALS
AP Immediate IO access if no IV in situ

Continue CPR
Epinephrine (1:10 000), 0.01 mg/kg IV/IO

Epinephrine
Repeat every 3 to 5 min prn
1 mL/10 kg
Assess
VF or VT Asystole or PEA
Rhythm *
CPR for 2 minutes CPR for 2 minutes
Amiodarone, 5 mg/kg IV/IO
Reassess
Transport infant
Check blood glucose continuing CPR
en-route
CPR for 2 minutes
Version D 0.8 K Basic & Advanced Life Support - Neonate P AP
CPG 1d
From
Birth CPG XX
Term gestation
Amniotic fluid clear
Breathing or crying Yes
Initiate mobilisation of 3 to 4 Good muscle tone
practitioners / responders Pink colour
arrest management
No
Request
ALS
Provide warmth Provide warmth

Position; Clear airway if necessary Dry baby
Dry, stimulate, reposition
Assess respirations,
Breathing, HR > 100 & Pink
heart rate & colour
Apnoeic or HR < 100
Breathing, HR > 100 but Cyanotic
Give Supplementary O2
Persistent No, Pink

Cyanosis
Yes
Provide positive pressure ventilation for 30 sec
Assess Heart
HR < 60 HR 60 to 100
Rate
CPR (ratio 3:1) for 30 sec

Breathing well, HR > 100 & Pink
HR 60 to 100
Assess Heart
Breathing well, HR > 100 & Pink
Rate
HR < 60
Epinephrine (1:10 000) 0.01 mg/kg IV/ IO

Consider blood Every 3 to 5 minutes prn
glucose check
If mother is IVDU consider

Naloxone, 0.01 mg/kg IV
Or
Naloxone, 0.01 mg/kg IM
Consider
NaCl 0.9%, 10 mL/kg IV/IO
Version D 0.5 K Foreign Body Airway Obstruction – Adult EMT P
CPG 2a
From Are you

FBAO CPG 1a choking?
Severe FBAO Mild

(no cough) Severity (cough present)
No Conscious Yes Encourage cough
1 to 5 back blows
followed by
1 to 5 abdominal thrusts
as indicated
Yes
Request Consider
Adequate
No Conscious No Effective Yes Yes
ventilations Oxygen therapy
ALS
No
One cycle of CPR

Ventilate
Was CPR,
Yes Abdominal
Effective Yes
thrusts or O2
required
No
No
one cycle of CPR
Persistent cough,
Effective Yes difficulty swallowing
Yes
or sensation of object
in the throat
No
Go to No
CPG xx
Consider
discharge
into care of
relative or
friend
After each cycle of CPR open

mouth and look for object
If visible attempt once to remove it
Version D 0.8 K Foreign Body Airway obstruction – Paediatric (≤ 13 years) EMT P
CPG 2b & 2c
From Are you

FBAO CPG 1a choking?
Severe FBAO Mild

(no cough) Severity (cough present)
No Conscious Yes
1 to 5 back blows followed

by 1 to 5 thrusts Encourage cough
(child – abdominal thrusts)
(infant – chest thrusts)
as indicated
Yes
Request Consider
No No Breathing
Conscious Effective Yes Yes
adequately Oxygen therapy
ALS
No
Open mouth and look for
object
If visible one attempt to Give
remove it rescue
breaths
(10/ min)
Attempt 5 Rescue Breaths
One cycle of CPR
Effective Yes
No
one cycle of CPR
Effective Yes
No
Go to
CPG xx
After each cycle of CPR open

mouth and look for object
If visible attempt once to remove it
Version D 0.10 K
VF or Pulseless VT - Adult (> 8 years) EMT P
CPG 3a
AP
From VF or VT
CPG xx arrest
Rhythm check *
Consider causes and treat as
AP appropriate:
VF/VT No Hydrogen ion acidosis
Immediate IO access if IV Hyper/ hypokalaemia
not immediately accessible Yes Hypothermia
Hypovolaemia
2nd Shock Hypoxia
Thrombosis – pulmonary
Epinephrine (1:10 000) 1 mg IV/ IO Tension pneumothorax
Every 3 to 5 minutes prn CPR x 2 minutes Thrombus – coronary
Tamponade – cardiac
Toxins
Trauma
Rhythm check *
VF/VT No
Yes
3rd Shock
Go to
ROSC
CPG 19
Amiodarone 300 mg (5 mg/kg) IV/ IO CPR x 2 minutes
Rhythm check *
Go to
Assess rhythm PEA
CPG xx
Advanced airway
AP VF/VT No
management -
intubation Following successful Advanced
Airway management:- Yes
Advanced airway
P management – i) Ventilate at 8 to 10 per minute.
Go to
LMA/LT ii) Unsynchronised chest 4th Shock Asystole
compressions continuous at 100 CPG 3a(i)
Consider per minute
mechanical CPR x 2 minutes
CPR assist
Rhythm check *
VF/VT No
Yes
5th Shock
Amiodarone 150 mg (2.5 mg/kg) IV/ IO CPR x 2 minutes
Rhythm check * practitioners / responders
arrest management
VF/VT No
Yes
6th Shock
If torsades de pointes, consider
Magnesium Sulphate 2 g IV
CPR x 2 minutes
Rhythm check *
VF/VT No
If no ALS available
Yes
Version D 0.10 K Cardiac Arrest Asystole - Adult P AP
CPG 3a(i)
From
CPG xx
Asystole
AP
Immediate IO access if IV
not immediately accessible
Epinephrine (1:10 000) 1 mg IV/ IO CPR x 2 minutes
Every 3 to 5 minutes prn
Rhythm check *
Go to
VF/VT
Asystole CPG 3a
No
Yes
Atropine 3 mg IV/ IO CPR x 2 minutes Go to

Rosc
CPG 19
Advanced airway Rhythm check *

AP management -
intubation Following successful Advanced
Advanced airway
Airway management:- Go to
management – PEA
i) Ventilate at 8 to 10 per CPG xx
LMA/ LT
minute. Asystole No
Consider ii) Unsynchronised chest
mechanical compressions continuous at 100 Yes
CPR assist per minute
CPR x 2 minutes
Rhythm check *
If persistent asystole for

greater than 20 minutes
consider ceasing
resuscitation
Go to
CPG 3b
Consider ceasing
resuscitation only if patient
appropriate:
is NOT:
Hydrogen ion acidosis
Hypothermic
Hyper/ hypokalaemia
or
Hypothermia
Cold water drowning
Hypovolaemia
or
Hypoxia Poisoning
Thrombosis – pulmonary or
Tension pneumothorax Overdose
Thrombus – coronary Initiate mobilisation of 3 to 4
or
Tamponade – cardiac practitioners / responders
Pregnant
Toxins on site to assist with cardiac
or
Trauma arrest management
< 18 years
Version D 0.10 K Cardiac Arrest PEA -Adult EMT P
CPG 3a(ii)
AP
From
CPG xx
PEA
AP
Epinephrine (1:10 000) 1 mg IV/ IO CPR x 2 minutes

Every 3 to 5 minutes prn
Rhythm check * Go to
VF/VT
CPG 3a
Go to
PEA No ROSC
CPG 19
AP Advanced airway Yes

management -
intubation
Advanced airway CPR x 2 minutes Go to
management – Asystole
P CPG xx
LMA/ LT
Consider
mechanical Rate less No
CPR assist than 60
Yes
Atropine 1 mg IV/ IO
Every 3 to 5 minutes to 3 mg max CPR x 2 minutes
Rhythm check *
Following successful Advanced

Airway management:-
i) Ventilate at 8 to 10 per minute. If persistent PEA continue CPR
ii) Unsynchronised chest
compressions continuous at 100
per minute
If no ALS available

appropriate: Initiate mobilisation of 3 to 4
Hydrogen ion acidosis practitioners / responders
Hyper/ hypokalaemia
arrest management
Hypothermia
Hypovolaemia
Hypoxia
Tension pneumothorax
Thrombus – coronary
Toxins
Trauma
Version D 0.6 K Cardiac Arrest - Asystole - Decision Tree P AP
3b
AP
Advanced Paramedics:
From continue to end of
Asystole CPG 3a(i) asystole algorithm and
make clinical decision on
ceasing resuscitation
Patient is;
Hypothermic or
Cold water drowning or
Yes No
Poisoning/ Overdose or
Pregnant or
< 18 years
Unwitnessed
arrest & no CPR prior No
to arrival
Resuscitation continuous for

Yes at least 20 minutes
Confirm Asystolic Cardiac Arrest

Unresponsive
No signs of life; absence of central pulse and respiration
Confirm that (two minutes of CPR and

no shock advised) x 3 are completed
Consider ceasing
No resuscitation efforts
Yes
Record two rhythm strips

x 10 sec duration
Record on ECG strips

PCR No
Patient’s name
Date and time
Inform Ambulance
Control
Emotional support
If present, inform for relatives should
next of kin be considered before
leaving the scene
Complete PCR and flag for

mandatory clinical audit
Follow local
protocol for
care of
deceased
Version D 0.10 K Recognition of Death - Resuscitation not indicated P AP
3c
Apparent
dead body
Go to
Signs of Life Yes Primary
survey
No
End stage of
Yes
terminal illness
No
Recent & reliable written

or verbal information from
family, caregivers or patient, No
stating that patient did not want
resuscitation
Yes
Consensus
between caregiver and
No
practitioner on not
resuscitating
Yes
Definite
indicators of No
Death
Yes
Definitive indicators of death:
1. Decomposition
2. Obvious rigor mortis
3. Obvious pooling (hypostasis)
4. Incineration
It is inappropriate to
5. Decapitation
commence resuscitation
6. Injuries totally incompatible with life
7. Unwitnessed traumatic cardiac arrest following
blunt trauma
Inform Ambulance
Control
Complete all
appropriate
documentation
Emotional support
Inform next of kin, for relatives should
if present be considered before
leaving the scene
Follow local
protocol for care
of deceased
VF or Pulseless VT – Child (1 to 8 years)
Version D 0.8 K EMT P
CPG 3d (i)
AP
From
CPG xx
VF/VT confirmed
2nd Shock (4 joules/Kg)
Epinephrine (1:10 000), 0.01 mg/kg IV/IO CPR x 2 minutes Immediate IO access if IV
Repeat every 3 to 5 minutes prn
Rhythm check *
VF/VT No
Yes
3rd Shock (4 joules/Kg)
Amiodarone, 5 mg/kg, IV/IO CPR x 2 minutes
Rhythm check * Go to
ROSC
CPG xx
VF/VT No
Yes
Go to
Asystole/ PEA CPG xx
4th Shock (4 joules/Kg)
AP
Consider advanced
airway management CPR x 2 minutes
- intubation
Rhythm check * Check blood glucose

Airway management:- VF/VT No
i) Ventilate at 8 to 10 per
minute. Yes
per minute 5th Shock (4 joules/Kg)
CPR x 2 minutes
Rhythm check *

appropriate:
VF/VT No
Hyper/ hypokalaemia Yes
Hypothermia
Hypovolaemia
Hypoxia 6th Shock (4 joules/Kg)
CPR x 2 minutes
Toxins Rhythm check *
Trauma
VF/VT No
If no ALS available
Yes
Asystole / PEA - Child (1 to ≤ 13 years)
CPG 3d(ii)
AP
From Asystole/ PEA

CPG xx confirmed
AP
Epinephrine (1:10 000) 0.01 mg/kg IV/IO
CPR x 2 minutes
Repeat every 3 to 5 minutes prn
Rhythm check *
AP
Go to
Consider advanced ROSC
CPG xx
airway management
- intubation Asystole
No
or PEA
Check blood glucose
Yes Go to
VF/VT
CPG xx
If persistent Asystole / PEA

continue CPR

Airway management:-
i) Ventilate at 8 to 10 per minute.
per minute

appropriate:
Hyper/ hypokalaemia
Hypothermia
Hypovolaemia
Hypoxia
Toxins
Trauma
Version D 0.7 K
Traumatic Cardiac Arrest – Adult AP
P
CPG 3e
EMS Unwitnessed EMS Witnessed

Traumatic Arrest Traumatic Arrest
Go to Apnoeic,
appropriate No Pulseless and
CPG Asystolic
Yes
Blunt trauma No
Yes
<18 years
Hypothermia
Commence
Drowning Yes to any
Lightning strike
CPR and ALS
Electrical injury
No to all
Request
ALS
Low impact
single vehicle Yes
incident
Rapid transport towards ALS
No
Patient responds
Consider ceasing to resuscitation or
No
resuscitation ALS provision within
15 min
Yes
Reference: Hopson, L et al, 2003, Guidelines for withholding or termination of resuscitation in prehospital traumatic cardiac arrest, Position paper for National
Association of EMS Physicians, Prehospital Emergency Care, Vol 7 p141-146
Version D 0.6 K
Primary Survey Medical - Adult
EMT P
CPG 4a
AP
Take standard infection control precautions
Consider pre-arrival information
Scene safety
Scene survey
Scene situation
Assess responsiveness
Head tilt/chin lift

Suction No Yes
Airway patent Maintain
OPA
P NPA
Go to Airway
Yes No
CPG 2a obstructed
Give 2 initial
Consider
Ventilations Yes
No Breathing
Oxygen therapy
Oxygen therapy
Go to
Pulse No
CPG 1a
Yes
Adequate Go to
No
respirations CPG xx
Yes
AVPU assessment
Life Serious or
Clinical status
threatening Non serious
Request
ALS
Go to
Go to
appropriate
CPG 5a
CPG
Primary Survey Trauma - Adult P
Version D 0.6 K EMT
CPG 4a
Take standard infection control precautions AP
Scene safety
Scene survey
Scene situation
Mechanism of
C-spine
No injury suggestive Yes control
of spinal injury
Assess responsiveness
Jaw thrust
(Head tilt/chin lift)
Suction No Airway patent Yes Maintain
OPA
P NPA
Go to Airway
Yes No
CPG 2a obstructed
Give 2 initial
Consider
Ventilations
No Breathing Yes
Oxygen therapy
Oxygen therapy
Go to
Pulse No
CPG 1a
Yes
Adequate Go to
No
respirations CPG xx
Yes
Arrest major external haemorrhage
AVPU assessment
Expose & check obvious injuries
Treat life threatening injuries only

at this point
Go to Request
appropriate
Life Serious or Go to
Clinical status
threatening Non serious CPG 5a
CPG ALS
Primary Survey Medical – Paediatric (≤ 13 Years)
CPG 4b
AP
Paediatric Assessment Triangle Scene safety

Scene survey
Scene situation
Paediatric Assessment Triangle

Work of
Appearance
Breathing
P
Sick child No
Circulation
to skin
Yes
Head tilt/ chin lift

Suction No Yes
Airway patent Maintain
OPA
NPA (> 1year)
P
Go to Airway
Yes No
CPG 2b obstructed
Confirm Primary
Survey findings
Give 2 effective
Ventilations up
to 5 attempts No Breathing Yes Oxygen therapy
Oxygen therapy
No > 1 year Yes
Go to Pulse/ Go to
Yes Pulse < 60 No
CPG 1c circulation CPG 1b
No Yes
Normal rates
Age Pulse Respirations
Infant 100 – 160 30 – 60 Adequate Go to
No
Toddler 90 – 150 24 – 40 respirations CPG xx
Pre school 80 – 140 22 – 34
School age 70 – 120 18 – 30
Yes
AVPU assessment
Go to Request
Life threatening Go to
appropriate Clinical status Non serious
CPG ALS or Serious CPG 5b
Primary Survey Trauma – Paediatric (≤ 13 years)
Version D 0.8 K
CPG 4b EMT P
Take standard infection control precautions AP
Paediatric Assessment Triangle Scene safety

Scene survey
Scene situation
Paediatric Assessment Triangle
Work of
Appearance
Breathing
Mechanism of
Circulation Yes C-spine
No injury suggestive
to skin control
of spinal injury
P
Sick child No
Yes
Jaw thrust
(Head tilt/ chin lift)
Suction No Airway patent Yes Maintain
OPA
NPA (> 1 year)
P
Go to Airway
Yes No
CPG 2b obstructed
Give 2 effective
Ventilations up
to 5 attempts No Breathing Yes Oxygen therapy
Oxygen therapy
Confirm Primary
Survey findings
No > 1 year Yes
Go to Pulse/ Go to
Yes Pulse < 60 No
CPG 1c circulation CPG 1b
No Yes
Adequate Go to
No
Normal rates respirations CPG xx
Infant 100 – 160 30 – 60 Yes
Toddler 90 – 150 24 – 40
Pre school 80 – 140 22 – 34
Arrest major external haemorrhage
School age 70 – 120 18 – 30
AVPU assessment
Expose & check obvious injuries
Treat life threatening injuries only
Go to Request
Life threatening Go to
appropriate Clinical status Non serious
CPG ALS or Serious CPG 5b
Version D 0.2
Secondary Survey Trauma - adult P AP
CPG 5a (i)
From Primary
CPG xx Survey
Markers for multi-

system trauma Yes
present
No
Examination of
obvious injuries
Monitor and
record vital signs
& GCS
Request
Go to Identify positive findings SAMPLE history
appropriate and initiate care ALS
CPG management
Complete a detailed
physical exam (head to
toe survey) as history
dictates
Check for medications

carried or medical
alert jewellery
Requires
definitive Yes
medical care
No
Markers for multi-system trauma

GCS < 13
Systolic BP < 90 Go to
Respiratory rate < 10 or > 29 CPG xx
Heart rate > 120
Revised Trauma Score < 12
Mechanism of Injury
Revised Trauma Score

Ventilatory 10 – 29 4
Rate > 29 3
6–9 2
1–5 1
0 0
Systolic BP > 89 4
76 – 89 3
50 – 75 2
1 – 49 1
no pulse 0
GCS 13 – 15 4
9 – 12 3
6–8 2
4–5 1
<4 0
RTS = Total score
Reference: McSwain, N. et al, 2003, PHTLS Basic and advanced prehospital trauma life support, 5th Edition, Mosby
Version D 0.2
Secondary Survey Medical - adult P AP
CPG 5a (ii)
From Primary
CPG xx Survey
Record vital signs
& GCS
Patient acutely
Yes
Markers identifying acutely unwell unwell
Cardiac chest pain
MEWS Score of ≥ 5
Acute pain > 5 No
Focused medical
history of presenting
complaint
SAMPLE history
Request
Relevant family &
social history
Go to Identify positive findings ALS
appropriate and initiate care
CPG management
carried or medical
alert jewellery
Examine body systems as

appropriate
Requires
definitive Yes
medical care
No
Go to
CPG xx
Reference: Sanders, M. 2001, Paramedic Textbook 2nd Edition, Mosby

Gleadle, J. 2003, History and Examination at a glance, Blackwell Science
Rees, JE, 2003, Early Warning Scores, World Anaesthesia Issue 17, Article 10
Secondary Survey – Paediatric ( ≤13 years)
Version D 0.3 P AP
CPG 5b
From Primary
CPG xx Survey
Make appropriate contact Use age appropriate

with patient and or guardian language for patient
Identify presenting complaint and

exact chronology from the time the
patient was last well Children and adolescents should
always be examined with a
chaperone (usually a parent)
Observe both patient and guardian

- do they relate normally to each other
- is the guardian calm and not anxious
- will patient separate from guardian
- does the patient play and interact normally
- is the patient distractible
Identify patient’s weight

Estimated weight
Age x 2 + 9 Kg
Head to toe examination
(toe to head for younger children)
Observing for
- pyrexia
Go to Identify positive findings - rash
appropriate and initiate care - pain
CPG management - tenderness
- bruising
- wounds
- fractures
- medical alert jewellery
Check for normal patterns of

- feeding
- toilet
- sleeping Normal rates
Infant 100 – 160 30 – 60
Toddler 90 – 150 24 – 40
Check vital signs Pre school 80 – 140 22 – 34
School age 70 – 120 18 – 30
Check for current

medications
If non accidental
injury or child abuse suspected
Report findings as per Child

Protection Guidelines to ED
staff in a confidential manner
Reference:
Miall, Lawrence et al, 2003, Paediatrics at a Glance, Blackwell Publishing
Version D 0.6 K Burns - Adult EMT P
CPG 6a
AP
Burn or
Cease contact with heat source
Scald
F: face
H: hands
Inhalation and or F: feet
Isolated facial injury F: flexion points
Yes superficial injury No P: perineum
(excluding FHFFP)
Airway management
Inadequate Go to
Yes
respirations CPG A3
Minimum 15 minutes cooling
of area is recommended No
Consider humidified
Oxygen therapy
Commence local Brush off powder & irrigate Commence local

cooling of burn area chemical burns cooling of burn area
Follow local expert direction
Equipment list
Acceptable dressings
Remove burned clothing (unless stuck) & jewellery Burns jel if < 10% TBSA
Cling film
Sterile dressing if > 10%
Dressing/ covering Dressing/ covering Clean sheet TBSA
of burn area of burn area
Go to
Pain > 2/10 Yes Yes Pain > 2/10
CPG 13b
No
Request
TBSA burn
No Yes
> 10%
ALS
ECG & SpO2

Caution with the elderly, monitoring
circumferential & electrical burns
> 25% TBSA

and or time from
No Yes
injury to ED
> 1 hour
Consider
Hartmann’s Solution, 500 mL, IV Hartmann’s Solution, 1000 mL, IV
Appropriate
history and burn No
area ≤ 1%
Yes Monitor body temperature P Paramedics are authorised

to continue the established
infusion in the absence of an
Go to Advanced Paramedic or
CPG xx
Doctor during transportation
Reference: Allison, K et al, 2004, Consensus on the prehospital approach to burns patient management, Emerg Med J 2004; 21:112-114
Sanders, M, 2001, Paramedic Textbook 2nd Edition, Mosby
Version D 0.4 K Spinal Immobilisation - Adult P AP
CPG 7a
Trauma
Indications for spinal immobilisation Use clinical
judgement
If in doubt,
Do not forcibly restrain a Return head to neutral position unless on immobilise
patient that is combatitive movement there is Increase in
Pain, Resistance or Neurological symptoms
Remove helmet
(if worn)
Life
No
Threatening
Apply cervical collar

Yes
Patient in
Yes
sitting position
No
Rapid extrication with long Use extrication device
board and cervical collar
Load onto vacuum mattress

or long board
Consider Vacuum
mattress
Dangerous mechanism include;

Fall ≥ 1 meter/ 5 steps Low risk factors
Axial load to head Simple rear end MVC (excluding push into
MVC > 100 km/hr, rollover or ejection oncoming traffic or hit by bus or truck)
ATV collision No neck or back pain
Bicycle collision Absence of midline c-spine or back tenderness
Pedestrian v vehicle
Are all of the factors listed present;

GCS = 15
Communication effective with patient
No dangerous mechanism, distracting injury or penetrating trauma
No numbness or tingling in extremities
Presence of low risk factors which allow safe assessment of range of motion
Patient voluntarily able to actively rotate neck 45o left & right pain free
Patient can walk pain free
Yes
Immobilisation
may not be
indicated
Equipment list
Extrication device
Long board
Consider treat Go to Vacuum mattress
& discharge CPG xx Orthopaedic stretcher
Rigid cervical collar
Version D 0.5 Limb Fractures - Adult P AP
CPG 8a
Isolated limb
Equipment list
fracture
Traction splint
Box splint Consider need for Go to
Frac straps pain relief CPG 13b
Triangular bandages
Vacuum splints
Long board
Orthopaediac stretcher Dress open fractures
Provide manual stabilisation for

fractured limb
Expose and examine limb
Check CSMs distal to

fracture site
No CSMs intact
Reposition limb
Yes
(two attempts)
Recheck CSMs
Fracture mid
Yes No
shaft of femur
Apply traction Apply

splint appropriate
splinting device
Recheck CSMs
Version D 0.4 K
Pre- Hospital Emergency Childbirth
CPG 9a P AP
Query labour
Take SAMPLE history
If no progress with
labour consider Patient in
transporting patient labour No
Yes
Birth imminent or
No
travel time too long
Yes
Request
Equipment list
ALS
Cord Clamps
Bulb syringe
Towels
Contact GP / midwife/ medical team as required Surgical gloves
by local policy to come to scene or meet en route Surgical apron
Gauze swaps 10 x 10 cm
Umbilical cord scissors
Position mother and prepare Clinical waste bag
equipment for birth
Consider
Entonox
Monitor vital signs and BP
Go to Cord
Yes
CPG 9b complication
No
Go to Breech
Yes
CPG 9c birth
No
Support baby
throughout delivery
Dry baby and

check ABCs
Go to Baby
No
CPG 1d stable
Yes
Clamp & cut cord Clamp cord at 10, 15
& 20 cm from baby
Cut cord between 15
Wrap baby and
and 20 cm clamps
present to mother
Go to Mother
No
CPG 4a stable
Yes
If placenta delivers, bring to

Reassess
hospital with mother
Umbilical Cord Complications
Version D 0.5 K
CPG 9b P AP
From Cord
CPG 9a complication
Contact GP / midwife/
Request medical team as required
by local policy to come to
ALS scene or meet en route
Oxygen therapy
Cord around
baby’s neck Cord rupture Prolapsed cord
Apply additional
Attempt to slip the cord Mother to adopt
clamps to cord
over the baby’s head knee chest position
Apply direct pressure

with sterile dressing AP Hold presenting part off
Yes Successful
the cord using fingers
No
Maintain cord temperature
Clamp cord in two places and and moisture
cut between both clamps
Ease the cord from AP Consider inserting an indwelling catheter

into the bladder and run 500 mL of NaCl
around the neck into the bladder and clamp catheter
Go to In labour &
CPG 9a foetal heart beat No
present
Yes
Consider
Nifedipine, 20 mg, PO
Pre alert hospital as urgent
caesarean section will be required
Reference: Sweet, BR, 2000, Mayes’ Midwifery, 12th Edition, Bailleire Tindall
Katz Z et al, 1988, Management of labor with umbilical cord prolaps: A 5 year study. Obstet. Gynecol. 72(2): 278-281
Duley, LMM, 2002, Clinical Guideline No 1(B), Tocolytic Drugs for women in preterm labour, Royal College of Obstetricians and gynaecologists
Version D 0.4 K Breech birth P AP
CPG 9c
From Breech birth

CPG 9a presentation
Request
ALS
Contact GP / midwife/ medical team as

required by local policy to come to scene
Oxygen therapy
Mother to adapt the lithotomy position
Support the baby as it emerges –

avoid manipulation of the baby’s body
Go to Successful
Yes No
CPG 9a delivery
No
Consider
Nape of neck
Entonox anteriorly visible at No
vulva
Yes
Place one hand, palm up, onto

baby’s face
Grasp both baby’s ankles in other

hand
Rotate baby’s legs in an ark

in an upward direction as
contractions occur
Successful
Go to
Yes delivery after 5
CPG 9a
contractions
No
Place hand in the vagina with palm towards baby’s face

Form a V with fingers on each side of baby’s nose and
gently push baby’s head away from vaginal wall
Await arrival
of medical
assistance
Version D 0.9 K Cardiac Chest Pain – Acute Coronary Syndrome P AP
CPG 10
From Acute Coronary

CPG xx Syndrome
Oxygen therapy
Indication for Thrombolysis Request Contraindications for thrombolysis

Patient conscious, coherent and
understands therapy ALS Contraindications
Patient consent obtained Haemorrhagic stroke or stroke of unknown origin at any time
< 75 years Ischemic stroke in preceding 6 months
MI Symptoms 20 minutes to 6 hours Central nervous system damage or neoplasms
ST elevation > 1 mm in two or more Apply monitoring leads, Recent major trauma/ surgery/ head injury (within 3 weeks)
contiguous leads apply SPO2 monitor Gastro-intestinal bleeding within the last month
Active peptic ulcer
Known bleeding disorder
Aspirin 300 mg PO Oral anticoagulant therapy
Aortic dissection
Transient ischemic attack in preceding 6 months
Pregnancy within 1 week post partum
Non-compressible punctures
Traumatic resuscitation
Refractory hypertension (sys BP > 180 mmHg)
Advanced liver disease
Yes Chest Pain Infective endocarditis
GTN 0.4 mg SL
No
Repeat prn to max of 1.2 mg SL
Pain relief
effective Yes
No
Repeat Morphine at not < 2 min
Morphine 2 mg IV intervals if indicated.
Max 10 mg
Consider
Acquire & interpret
Cycilizine 50 mg IV slowly 12 lead ECG
Clopidogrel 300 mg PO
Yes STEMI No
STEMI = ST elevation MI
Tenecteplase Symptoms
Yes No
< 60 kg 30 mg ≤ 3 hours
60 – 70 kg 35 mg
70 – 80 kg 40 mg
80 – 90 kg 45 mg Primary PCI
> 90 kg 50 mg No available within 60
min from 999 call PCI = Percutaneous
Coronary Intervention
Tenecteplase IV
Followed by Yes
Enoxaparin 30 mg IV
Notify &
transport to
Primary PCI
facility
> 25 minutes
No
from ED
Yes
Enoxaparin 1 mg/kg SC
Reference: Reducing the Risk: A Strategic Approach, 2006, The Report of the Task Force on Sudden Cardiac Death
Altered level of consciousness - Adult
Version D 0.5 K P AP
CPG 11a
V, P or U on
AVPU scale
Maintain airway
Consider
recovery position
Obtain SAMPLE history from

patient, relative or bystander
ECG & SpO2 monitoring

Calculate GCS
Check temperature
Check pupillary size & response
Check for skin rash
Go to Blood loss Go to
Anaphylaxis
CPG xx (shock) CPG xx
carried or medical
alert jewellery
Go to
Go to Drowning
Bradycardia CPG xx
CPG xx
Check blood glucose
Go to Glycaemic Go to
Head injury
CPG xx emergency CPG xx
Differential
Diagnosis
Go to Inadequate Go to
Hypothermia
CPG xx respirations CPG xx
Go to Post
Poison Go to
CPG 18 resuscitation
CPG xx
care
Go to Go to
Seizures Septic shock
CPG xx CPG xx
Go to Go to
Stroke Taser gun
CPG 18 CPG xx
Version D 0.3 Mental Health Emergency EMT P
CPG 12a
Behaviour
RMP – Registered Medical Practitioner
abnormal RPN – Registered Psychiatric Nurse
Practitioners may not

compel a patient to RMP or RPN
accompany them or in attendance or have made
prevent a patient from Yes
arrangements for voluntary/
leaving an ambulance assisted admission
vehicle
No
Co-operate as
If potential to harm self or others Obtain a history from patient and or appropriate with
ensure minimum two people bystanders present as appropriate medical or nursing
accompany patient in saloon of team
ambulance at all times
Potential
Yes to harm self or Transport patient to an
others Approved Centre
Request control
No
to inform Gardaí
Reassure patient
Explain what is happening at all times
Avoid confrontation
Attempt verbal de-escalation
Hallucinations Yes
or Paranoia
Request
No
ALS
Patient agrees
No
to travel
Yes
Request
- Gardaí
- Medical Practitioner
- Mental health team
Reference; Reference Guide to the Mental Health Act 2001, Mental Health Commission
HSE Mental Health Services
Version D 0.3 Behavioural emergency EMT P
CPG 12b
AP
Behaviour
abnormal
Practitioners may not Obtain a history from patient and or

compel a patient to bystanders present as appropriate
accompany them or
prevent a patient from
leaving an ambulance
vehicle Potential
Yes to harm self or
others
Request control
No
to inform Gardaí
Reassure patient
Explain what is happening at all times
If potential to harm self or others
Avoid confrontation
ensure minimum two people
accompany patient in saloon of
ambulance at all times
Attempt verbal de-escalation
Patient agrees
No
to travel
Injury or illness Yes

potentially serious or
No
likely to cause lasting
disability
Offer to treat and or
Yes transport patient
Inform patient of potential

consequences of treatment
refusal
Treatment only No
Request control
Yes
to inform Gardaí
and or Doctor
Is patient
competent to
No
make informed
decision Aid to Capacity Evaluation
1. Patient verbalizes/ communicates
Yes understanding of clinical situation?
2. Patient verbalizes/ communicates
appreciation of applicable risk?
Await arrival of doctor or Advise alternative care options and 3. Patient verbalizes/ communicates
Gardaí to call ambulance again if there is a ability to make alternative plan of care?
or change of mind If no to any of the above consider
receive implied consent Patient Incapacity
Document refusal of treatment

and or transport to ED
Reference: HSE Mental Health Services

Version D 0.11 K Pain management - Adult
EMT P
CPG 13b
AP
Pain
Pain assessment
Nitrous Oxide & Oxygen, inhalation Analogue Pain Scale

0 = no pain……..10 = unbearable
≥ 5 on pain
Adequate relief
Yes No scale -
of pain
severe
No
3 to 4 on
pain scale -
moderate
Paracetamol 1 g PO
And or
Ibuprofen 400 mg PO
Request
< 5 on pain
No
scale
ALS
Yes
Morphine, 2 mg, IV Repeat Morphine at

not < 2 min intervals
if indicated.
Max 10 mg
Consider
Cycilizine, 50 mg IV slowly
AP
If IV not accessible
Morphine 10 mg IM
Go back may be administered
to provided no cardiac
originating chest pain present
CPG
EMT Registered Medical Practitioners

may authorise the use of IM
P Morphine by Paramedic or EMT
practitioners for patients in
inaccessible locations
Decisions to give analgesia must be based on clinical assessment and not directly on a linear scale
Pain management – Paediatric (≤ 13)
CPG 13b
AP
Pain
Pain assessment
Nitrous Oxide & Oxygen, inhalation Analogue Pain Scale

0 = no pain……..10 = unbearable
≥ 6 on pain
Adequate relief
Yes No scale -
of pain
severe
No
2 to 5 on
pain scale -
moderate
Paracetamol 20 mg/kg PO
And or
Ibuprofen 5 mg/kg PO
Request
< 6 on pain
No
scale
ALS
Yes
Morphine, 0.05 mg/kg, IV Repeat IV Morphine at not

OR < 2 min intervals if
indicated
Morphine, 0.1 mg/kg, PO
Max 0.15 mg/kg IV
Consider
Cycilizine, 0.7 mg/kg IV slowly
Go back
to
originating
CPG
Decisions to give analgesia must be based on clinical assessment and not directly on a linear scale
Wong – Baker Faces for 3 years and older
Reference:
From Wong D.L., Hockenberry-Eaton M., Wilson D., Winkelstein M.L., Schwartz P.: Wong’s Essentials of Paediatric Nursing, ed.6, St. Louis, 2001, p1301.
Copyrighted by Mosby, Inc. Reprinted by permission.
Version D 0.9 K
Glycaemic Emergency - Adult
P AP
CPG 13e
Abnormal
blood glucose
level
< 4 mmol/L Blood Glucose > 20 mmol/L
Sweetened drink
15 to 20 mmol/L
Or Consider
Glucose gel, 10-20 g buccal
ALS
Or
Glucagon 1 mg IM
Or
Sodium Chloride 0.9% 1 L IV infusion
Dextrose 10%, 250 mL IV infusion
Reassess
Allow 5 minutes to elapse

following administration of Reassess
medication
Blood Glucose
No
> 4 & < 15 mmol/L
Yes
Patient is fully alert and

makes an informed decision No
not to attend ED
Yes
Consider treat Complete; After care Instructions – Diabetes

& discharge and give a copy to the patient or carer
Go to
CPG xx
Glycaemic Emergency – Paediatric (≤ 13)
CPG 13e
Abnormal
blood glucose
level
< 3 mmol/L Blood Glucose > 20 mmol/L
Request
ALS
Consider
Glucose gel 5-10 g Buccal
No Yes
No Dehydration
Glucagon 0.5 mg IM Dextrose 10%, 5 mL/kg IV bolus
Repeat x 1 prn
Yes
Sodium Chloride 0.9% 20 mL/kg

IV bolus
Reassess
Reference: Dehydration- Paramedic Textbook 2nd E p 1229

Version D 0.4 K Major Emergency (Major Incident) – First ambulance crew EMT P
CPG 14a
AP
Irish (Major Emergency) terminology in black
UK (Major Incident) terminology in blue
Possible Major
Emergency
PPE (high visibility jacket and helmet) must be worn
Practitioner 2
Practitioner 1
(MIMMS trained)
Park at the scene as safety permits and in liaison with Fire & Garda Carry out scene survey
if present
Give situation report to ambulance control using METHANE message
Leave blue lights on as vehicle acts as Forward Control Point
pending the arrival of the Mobile Control Vehicle Carry out HSE Controller of Operations (Ambulance Incident Officer)
role until relieved
Confirm arrival at scene with Ambulance Control and provide an
initial visual report stating Major Emergency (Major Incident) Liaise with Garda Controller of Operations (Police Incident Officer)
Standby or Declared and Local Authority Controller of Operations (Fire Incident Officer)
Maintain communication with Practitioner 2 Select location for Holding Area (Ambulance Parking Point)
Leave the ignition keys in place and remain with vehicle Set up key areas in conjunction with other Principle Response
Agencies on site;
Carry out Communications Officer role until relieved - Site Control Point (Ambulance Control Point),
- Casualty Clearing Station
METHANE message
M – Major Emergency declaration / standby
E – Exact location of the emergency
T – Type of incident (transport, chemical etc.)
H – Hazards present and potential
A – Access / egress routes
N – Number of casualties (injured or dead)
E – Emergency services present and required
The first ambulance crew does not

provide care or transport of
patients as this interferes with their
ability to liaise with other services,
to assess the scene and to provide
continuous information as the
incident develops
The principles and terminology of Major Incident Medical management and Support (MIMMS) has been used with the kind permission of the Advanced
Life Support Group, UK
Version D 0.6 K Major Emergency (Major Incident) – Operational Control EMT P
CPG 14b
AP
Irish (Major Emergency) terminology in black
UK (Major Incident) terminology in blue
If Danger Area identified entry to
Danger Area is controlled by a Senior
Fire Officer or an Garda Síochána
Traffic Cordon
Outer Cordon
Inner Cordon
Danger Area
Body Casualty Site Control

Holding Clearing Point
Area Station HSE Garda LA
Holding Holding Holding
Ambulance
Area Area Area
Loading
Point
Entry to Outer Cordon (Silver area)

One way ambulance circuit is controlled by an Garda Síochána
Entry to Inner Cordon (Bronze Area) is
limited to personnel providing
emergency care and or rescue
Personal Protective Equipment required
Management structure for; Management structure for;

Outer Cordon, Tactical Area (Silver Area) Inner Cordon, Operational Area (Bronze Area)
On-Site Co-ordinator Forward Ambulance Incident Officer (Forward Ambulance Incident Officer)
HSE Controller of Operations (Ambulance Incident Officer) Forward Medical Incident Officer (Forward Medical Incident Officer)
Site Medical Officer (Medical Incident Officer) Fire Service Incident Commander (Forward Fire Incident Officer)
Local Authority Controller of Operations (Fire Incident Officer) Garda Cordon Control Officer (Forward Police Incident Officer)
Garda Controller of Operations (Police Incident Officer)
Other management functions for;

Major Emergency site
Casualty Clearing Officer
Triage Officer
Ambulance Parking Point Officer
Ambulance Loading Point Officer
Communications Officer
Safety Officer
LOCAL AUTHORITY HSE GARDA

CONTROLLER CONTROLLER CONTROLLER
Ref; A Framework for Major Emergency Management, 2006, Inter-Departmental Committee on Major Emergencies
(Replaced by National steering Group on Major Emergency Management)
Version D 0.5 K Triage Sieve EMT P
CPG 14c
AP
Multiple casualty
incident
Priority 3
Can casualty (Delayed)
Yes
walk
GREEN
No
Yes Is casualty
No
breathing
Open airway
one attempt
Breathing now No DEAD
Yes
Respiratory rate
Yes
< 10 or > 29
Priority 1
No
(Immediate)
RED
Capillary refill > 2 sec
Or Yes
Pulse > 120
No Priority 2
(Urgent)
YELLOW
Triage is a
dynamic
process
Version D 0.4 K Triage Sort
P AP
CPG 14d
Multiple casualty
incident
Triage is a
dynamic
Cardiopulmonary function Measured value Score Insert score process
10 – 29 / min 4
> 29 / min 3
Respiratory Rate 6 – 9 / min 2 A
1 – 5 / min 1
None 0
≥ 90 mm Hg 4
76 – 89 mm Hg 3
Systolic Blood
50 – 75 mm Hg 2 B
Pressure
1 – 49 mm Hg 1
No BP 0
13 – 15 4
9 – 12 3
Glasgow Coma Score 6–8 2 C
4–5 1
3 0
Triage Revised Trauma Score A+B+C
Priority 1
(Immediate)
1 - 10
RED
Priority 2
(Urgent)
11
YELLOW
Revised
Trauma
Score
Priority 3
(Delayed)
12
GREEN
Spontaneous 4
To Voice 3 0 DEAD
Eye Opening
To Pain 2
None 1
5
Oriented
4
Verbal Confused
3
Response Inappropriate words
2
Incomprehensible sounds
1
Obeys commands 6
Localises pain 5
Motor Withdraw (pain) 4
Response Flexion (pain) 3
Extension (pain) 2
None 1
Glasgow Coma Score
Version D 0.3 K Epistaxis EMT P
CPG 16
AP
From From
CPG 4a
Medical Trauma CPG 4a
Advise patient to
sit forward
Apply digital pressure for

3 to 5 minutes
Advise patient to breath

through mouth only and not
to blow nose
Request
Go to
Yes Hypovolaemic
CPG xx
ALS
No
Haemorrhage
No
controlled
Yes
Consider
ALS
Version D 0.7 K Poisons - Adult EMT P
CPG 17a
From Poison
CPG xx source
Ingestion Inhalation Injection Absorption
Yes Corrosive No No Site burns Yes
Sips of water
or milk Cool area
Caution with Consider decontamination

oral intake Go to Adequate prior to transportation
No
CPG A3 ventilations
Yes
Consider
Request
ALS
Poison type
Paraquat Other Alcohol
Do not give Check blood

oxygen Oxygen therapy
glucose
BG
Go to
No > 4 or > 15 Yes
CPG xx
mmol/L
P Note:
CPG A3, Inadequate respirations, authorises the
administration of Naloxone IM for opiate
overdose for Paramedics
Reference:
Dr, Joe Tracey, Director, National Poison Information Centre
Version D 0.5 K
Stroke
P AP
CPG 18
acute neurolocical
symptoms
Obtain GCS
Positive FAST
No
assessment
Yes
Maintain airway
Oxygen therapy
Check blood glucose
BG
Go to
Yes > 4 or > 15
CPG xx
mmol/L
No
12 lead ECG
ECG & SPO2

monitoring
Onset < 3
No
hours
Yes
Specialised
Stroke Unit No
available
Yes
Transport patient to
hospital with
Specialised Stroke Unit
(under local protocol)
F – facial weakness
Can the patient smile?, Has their mouth or eye drooped? Which side?
A – arm weakness
Can the patient raise both arms and maintain for 5 seconds?
S – speech problems
Can the patient speak clearly and understand what you say?
T – time to transport now if positive FAST
Reference
Prof R Boyle, 2006, Mending hearts and brains, Clinical case for change: Report by Prof R Boyle, National Director for Heart Disease and Stroke, NHS
AHA, 2005, Part 9 Adult Stroke, Circulation 2005; 112; 111-120
A. Mohd Nor, et al, Agreement between ambulance paramedic- and physician- recorded neurological signs with Face Arm Speech Test (FAST) in
acute stroke patients, Stroke 004; 35;1355-1359
Jeffrey L Saver, et al, Prehospital neuroprotective therapy for acute stroke: results of the field administration of stroke therapy-Magnesium (FAST-MAG)
pilot trial, Stroke 2004; 35; 106-108
Post Resuscitation Care - Adult
Version D 0.5 P AP
CPG 19
Return of
Spontaneous Maintain Oxygen therapy
Circulation
Request Initiate mobilisation of 3 to 4
practitioners / responders
ALS on site to assist with cardiac
Equipment list arrest management
Low reading thermometer

Cold packs Conscious Yes
No
Adequate
No
ventilation
Ventilate at 10 to 12
Yes
per minute
ECG & SpO2

monitoring
Post VF/VT and

No
unresponsive
Yes
Commence active cooling to

target temperature of 32o C
Cold packs to arm pits,
abdomen & groin
appropriate:
Hyper/ hypokalaemia NaCl (4o C) 500 mL IV
Hypothermia Repeat x 1 if required
Hypovolaemia
Hypoxia
Maintain patient at rest
Toxins
Trauma 12 lead ECG
Monitor blood pressure

and GCS
Symptomatic
Yes No
bradycardia
If Amiodarone used to convert VF/VT
and persistent tachyarrhythmia
Atropine 0.5 mg IV Consider
Amiodarone, 1 mg/min, IV infusion
500 mL / 300 mg Amiodarone = 1.7

1 mg = 1.7 mL
Check blood glucose
IV giving set; X gtt = 1 mL
X gtt x 1.7 mL = 1 mg/ min
Monitor vital signs
Transport
quietly and
smoothly
Reference: ILCOR Guidelines 2005
AHA Guidelines 2005, Part 7.5 Postresuscitation Support
Post Partum Haemorrhage
Version D 0.4 K AP
CPG 20 P
2nd stage of
labour complete
Apply absorbent pad to perineum

area
Estimate
blood loss
Mother is
Yes haemodynamically No
unstable
Oxygen therapy
Request
ALS
External massage of the uterus
Check/ ask mother re Syntometrine, 1 mL IM Reassess

multiple births prior to (if not already administered)
administration of
Syntometrine
Elevate lower limbs
AP Consider
inserting a urinary
catheter
Go to
CPG A13
Version D 0.3 K Haemorrhage in pregnancy prior to delivery P AP
CPG 21
Query pregnant Pregnancy

< 24 weeks ≥ 24 weeks
Early pregnancy Anti partum
haemorrhage haemorrhage
Left lateral tilt
Do not examine
abdomen or vagina
Apply absorbent pad to perineum

area
Oxygen therapy
Patient is
Yes haemodynamically No
unstable
Request
ALS
Reassess
Go to
CPG A13
Version D 0.5
Conducted Electrical Weapon (Taser)
P AP
CPG 25
Prior to touching the patient ensure

Taser
that the Garda has disconnected
gun used
the wires from the hand held unit
Go to
Complete
appropriate
primary survey
CPG
Cut wire connection proximal

to barbs
Monitor ECG & SpO2

for minimum 15 minutes
Go to
Behavioural
Yes appropriate
emergency
CPG
No
Remove barbs
Patient care takes precedent Clean and dress wounds Barbs shall not be removed if
over removal of barb they are embedded in the face,
eye, neck, or groin
Monitor GCS, temperature

& vital signs
Monitor for signs of

Excited Delirium
Consider
Oxygen therapy
Ensure Garda accompany

patient at all times
Note:
This CPG was developed in conjunction with
Dr. Donal Collins, Chief Medical Officer, An
Garda Síochána
Reference:
DSAC Sub-committee on the Medical Implications of Less-lethal Weapons 2004, Second statement on the medical implications of the use of the M26
Advanced Taser.
United States Government Accountability Office, 2005, The use of Taser by selected law enforcement agencies
Manitoba health Emergency Medical Services, 2007 Taser Dart Removal Protocol
Ada County Paramedics, Idaho 2006 Taser Protocol
Version D 0.2 Head injury - Adult P AP
CPG 27
Maintain Airway See

Head trauma (Consider Advanced airway) CPG xx
Oxygen therapy
Equipment list
Extrication device
Long board Control external haemorrhage
Vacuum mattress
Orthopaedic stretcher
Rigid cervical collar Maintain in-line immobilisation
Oxygen saturation monitor
LoC history No
Yes
Apply cervical collar

Consider cervical
collar application
and long board use
Secure to long board
SpO2 & ECG

monitoring
Request
Yes GCS < 12 No
ALS
GCS ≤ 8 No
Yes
10o head tilt
See
Maintain SBP > 120 mmHg
CPG xx
Transport to
most appropriate
ED according to
local protocol
See
Blood glucose level < 4 mmol/L
CPG xx
Go to
Yes Seizures No
CPG xx
Consider Vacuum
mattress
Reference;
Mc Swain, N, 2003, Pre Hospital Trauma Life Support 5th Edition, Mosby
Version D 0.6 K Advanced Airway Management - Adult
P AP
CPG A1
Apnoea or special
clinical considerations
Able to Go to
No
Special clinical considerations ventilate CPG 2a
GCS = 3
SpO2 < 92% Yes
RR ≤ 9
BVM ineffective
(All of the above must be present)
Position for
Yes intubation No
restricted
AP Endotracheal
intubation
Maintain adequate
ventilation and Successful Yes
oxygenation throughout
procedures
No
AP 2nd attempt
Endotracheal
intubation
Laryngeal Mask Airway or

No Successful Yes
Laryngeal tube insertion
Successful Yes
No
2nd attempt
Laryngeal Mask Airway or
Laryngeal tube insertion
Successful Yes
No
Ensure CO2 detection

Revert to basic airway
device in ventilation
management
circuit
Check tube placement after each

patient movement or if any patient
deterioration
Continue ventilation and oxygenation
Go to
appropriate
CPG
Reference: International Liaison Committee on Resuscitation, 2005, Part 4: Advanced life support, Resuscitation (2005) 67, 213 – 247
Version D 0.10 K
Inadequate Respirations – Adult AP
P
CPG A3
Life threatening asthma

Inadequate Request Any one of the following in a patient with severe asthma;
PEF < 33% best or predicted
respirations ALS SpO2 < 92%
Silent chest
Cyanosis
Feeble respiratory effort
Assess and maintain airway Bradycardia
Arrhythmia
Hypotension
Oxygen therapy Exhaustion
Confusion
Unresponsive
Respiratory
assessment
Inadequate rate or depth Congestion /

Bronchospasm
Asymmetrical movement crepitations
assessment
Severe Mild /Moderate

Possible Hx of
No (1) (2)
Narcotic overdose
Yes
Salbutamol, 5 mg, nebule
Repeat x 1 at 15 minutes prn
Naloxone 0.4 mg IM
Repeat x one prn
Naloxone 0.4 mg IV/IO/IM Salbutamol, 5 mg, nebule

Repeat x one prn Repeat x 1 at 15 minutes prn
OR
Hx of CHF and Salbutamol, 4 puffs, metered

Tension
features of pulmonary No aerosol
No Pneumothorax
oedema Repeat x 1 at 15 minutes prn
suspected
Yes Yes
AP GTN, 0.8 mg, SL

Needle Repeat x 1 prn
decompression Silent chest,
< 2 words per
Reassess No
breath or SpO2
< 92%
Reassess
Yes
Frusemide, 40 mg, IV
Positive pressure ventilations Consider

Max 10 per minute Magnesium Sulphate 1.5 g
IV infusion over 20 min
GCS = 3
SpO2 < 92%
BVM ineffective No
RR ≤ 9
ECG & SpO2
Yes monitoring
Consider
Go to
CPG xx
Acute severe asthma (1)

Any one of; Moderate asthma exacerbation (2)
PEF 33-50% best or predicted Increasing symptoms
Respiratory rate ≥ 25/ min PEF > 50-75% best or predicted
Heart rate ≥ 110/ min No features of acute severe asthma
Inability to complete sentences in one breath
Reference: British Thoracic Society, 2005, British Guidelines on the Management of Asthma, a national clinical guideline
Version D 0.5 K
Symptomatic Bradycardia - Adult
EMT P
CPG A8
AP
Symptomatic
Bradycardia
Oxygen therapy
Request
ALS
ECG & SPO2

monitoring
Atropine, 0.5 mg IV
P
12 lead ECG
Reassess
Type II 2nd degree

Yes AV block or No
3rd degree AV block
excluded
Atropine, 0.5 mg IV
Repeat at 3 to 5 min intervals prn to max 3 mg
Septic Shock – Paediatric (≤ 13)
Version D 0.2 P AP
CPG A54(ii)
Septic shock
Oxygen therapy
Request
ALS
Hartmann’s Solution 20 mL/kg IV/IO
Meningoccal
disease Yes
suspected
No Benzylpenicillin IV/IO over 3 to 5 minutes or IM

< 1 year 300 mg Check
1 – 8 years 600 mg medication
> 8 years 1 200 mg (1.2 g) with meningitis
Foundation
Hartmann’s Solution, 20 mL/kg IV/IO aliquots * Radial pulse in

to maintain palpable brachial pulse * older children
P
Paramedics are authorised
Advanced Paramedic or
Shock from Blood Loss – Paediatric (≤ 13)
Version D 0.2 P AP
CPG A54(i)
Haemorrhalogic
shock
Oxygen therapy
Request
ALS
Patient trapped No
Yes
Hartmann’s Solution 20 mL/kg IV/IO
Reassess
Hartmann’s Solution, 20 mL/kg IV/IO aliquots * Radial pulse in

to maintain palpable brachial pulse * older children
Continue fluid therapy until

handover at ED
P
Reference:
American Academy of Pediatrics, 2000, Pediatric Education for Prehospital Prefessionals, Jones and Bartlett.
Version D 0.4
Inadequate Respirations – Paediatric (≤ 13) AP
P
CPG A56
Request
Inadequate
respirations ALS
Assess and maintain airway
Regard each emergency asthma call

Oxygen therapy as for acute severe asthma until it is
shown otherwise
Chest
Auscultation
Inadequate rate or depth

Asymmetrical movement Bronchospasm
assessment
Mild /
Severe
Possible Hx of Moderate
Narcotic overdose No
Salbutamol
Yes < 5 years 2.5 mg nebule
≥ 5 years 5 mg nebule
Repeat at 15 minutes prn
Naloxone 0.01 mg/kg, IM
Repeat x one prn
Salbutamol
Naloxone 0.01 mg/kg, IV/IO/IM < 5 years 2.5 mg nebule
Repeat x one prn Silent chest, ≥ 5 years 5 mg nebule
< 2 words per breath, Repeat x 1 at 15 minutes prn
No
cannot feed or SpO2 OR
< 92% Salbutamol, 2 puffs, metered
Tension
No Pneumothorax aerosol
suspected Repeat x 1 at 15 minutes prn
Yes
Yes
Consider
AP Ipratropium bromide 0.250 mg
Needle decompression nebule & salbutamol (age
specific dose) nebule mixed
Reassess
Positive pressure ventilations

– 12 to 20 per minute
Consider
ECG & SpO2

monitoring
Life threatening asthma Acute severe asthma

Any one of the following in a patient with severe asthma; Any one of;
Silent chest Inability to complete sentences in one breath or too
Cyanosis breathless to talk or feed
Poor respiratory effort Respiratory rate > 30/ min for > 5 years old
Hypotension > 50/ min for 2 to 5 years old
Exhaustion
Confusion Heart rate > 120/ min for > 5 years old
Unresponsive > 130/ min for 2 to 5 years old
Reference: British Thoracic Society, 2005, British Guidelines on the Management of Asthma, a national clinical guideline
Stridor – Paediatric (≤ 13)
Version D 0.1
EMT P
CPG 27
AP
Stridor
Assess &
maintain airway
Do not distress
Travel in position of comfort
Humidified O2 – as high a
concentration as tolerated
Oxygen therapy
ECG & SpO2

monitoring
Anaphylaxis - Adult
CPG – A4
Anaphylaxis
Oxygen therapy
Mild Moderate Severe
Epinephrine
administered pre
No
arrival? (within 5
minutes)
Epinephrine (1:1 000) 0.5 mg (500 mcg) IM

Yes Repeat at 5 minute intervals if no improvement
Monitor
reaction
Request
ALS
Reassess
If bronchospasm consider
Reoccurs /
nebulizer
No deteriorates /
Salbutamol 5 mg nebule no improvement
Yes
ECG & SpO2

Reassess monitor
ECG & SpO2

monitor
Request
Deteriorates Yes Epinephrine (1:1 000) 0.5 mg (500 mcg) IM
ALS
No Hartmann’s Solution 1 000 mL IV infusion
nebulizer
Salbutamol 5 mg nebule
Reassess
Repeat Hartmann’s Solution 1 000 mL IV

infusion X 1 if indicated
Severe anaphylaxis
Mild anaphylaxis Moderate anaphylaxis Moderate symptoms +
Urticaria and or angio Mild symptoms + simple haemodynamic and or
oedema bronchospasm respiratory compromise
Anaphylaxis – Paediatric (≤ 13 years)
Version D 0.6 K
CPG – A55 P AP
Anaphylaxis
Oxygen therapy
Mild Moderate Severe
Epinephrine
administered pre
No
arrival? (within 5
minutes) Epinephrine (1:1 000) IM
< 6 months: 0.05 mg (50 mcg) IM
6 months to 5 years: 0.125 mg (125 mcg) IM
Yes 6 to 8 years: 0.25 mg (250 mcg) IM
Monitor > 8 years: 0.5 mg (500 mcg) IM
reaction
Request Repeat Epinephrine

at 5 minute intervals
ALS if no improvement
Reassess
nebulizer Reoccurs /
Salbutamol nebule No deteriorates /
< 5 yrs: 2.5 mg no improvement
≥ 5 yrs: 5 mg
Yes
Reassess
ECG & SpO2
monitor
ECG & SpO2
monitor
Epinephrine (1:1 000) IM

Deteriorates Yes
See age related doses above
No
Hartmann’s Solution 20 mL/kg IV/IO bolus
nebulizer
Salbutamol nebule
See age related doses above
Reassess
Repeat Hartmann’s Solution 20 mL/kg IV/IO

bolus X 1 if indicated
Severe anaphylaxis
Mild anaphylaxis Moderate anaphylaxis Moderate symptoms +
Urticaria and or angio Mild symptoms + simple haemodynamic and or
oedema bronchospasm respiratory compromise
Version D 0.2 Crush Injury
P AP
CPG 26
Request
Patient
trapped ALS
Maintain AcBC
Oxygen therapy
Significant
Co-ordinate with compression force No
rescue personnel on maintained
release timing
Yes
Consider Mobile Surgical Team

(for amputation)
Large bore x 2
Go to Consider
CPG xx pain relief
NaCl 0.9% 20 mL/kg IV
Prepare all required patient

carrying devices and have on
standby following extrication ECG & SPO2
monitoring
Inform rescue leader that the patient must not

be released until IV fluids have commenced
Apply standard trauma care

during and post extrication
Go to
appropriate
CPG
Reference:
Crush Injury Syndrome (# 7102) Patient Care Policy, Alameda County EMS Agency (CA)
Crush Injuries, Clinical Practice Manual, Queensland Ambulance Service
Version D 0.7 Hypothermia EMT P
CPG 23
Query
hypothermia
Immersion Yes
Members of rescue teams
should have a clinical
Remove patient horizontally from liquid
leader of at least EFR level No
(Provided it is save to do so)
Protect patient from wind chill
Complete primary survey Pulse check for

(Commence CPR if appropriate) 30 to 45 seconds
Warmed O2
Oxygen therapy
if possible
Hypothermic patients
should be handled gently
& not permitted to walk Remove wet clothing by cutting
Place patient in dry blankets/ sleeping

bag with outer layer of insulation
Mild Moderate/ severe

(Responsive) (Unresponsive)
Request
Give hot sweet
drinks ALS
If Cardiac arrest follow CPGs but

- no active re-warming
Hot packs to
armpits & groin
Check blood
glucose
Equipment list
Transport in head down position
Survival bag Helicoptor: head forward
Space blanket Boat: head aft
Warm air rebreather
Reference: Golden, F & Tipton M, 2002, Essentials of Sea Survival, Human Kinetics
AHA, 2005, Part 10.4: Hypothermia, Circulation 2005:112;136-138
Soar, J et al, 2005, European Resuscitation Council Guidelines for Resuscitation 2005, Section 7. Cardiac arrest in special circumstances,
Resuscitation (2005) 6751, S135-S170
Pennington M, et al, 1994, Wilderness EMT, Wilderness EMS Institute
Version D 0.8 K Seizure / convulsions – Adult P AP
CPG – A 11
Seizure / convulsion
Consider other
causes of seizures Protect from harm
Meningitis
Head injury
Oxygen therapy
Hypoglycaemia
Eclampsia
Fever
Seizing currently Seizure status Post seizure
Request
ALS
No Yes
Diazepam, 10 mg PR
Repeat by one prn Diazepam 5 mg IV
Or Repeat by one prn
Midazolam 10 mg buccal
Check blood glucose
MAG decision required

Internasal Midazolam?
Go to Blood glucose
CPG 13e Yes
< 4 or > 15 mmol/L
No
Reassess
Anti convulsant
medication Yes
administered
No
The patient;
was not seizing on arrival
has history of seizures No
has no injury
Yes
Patient is fully alert and

Go to Consider treat &
Yes makes an informed decision No
CPG xx discharge
not to attend ED
Version D 0.11 K Seizure / convulsions – Paediatric (≤ 13) P AP
CPG – A 57
Seizure / convulsion
Protect from harm

Consider other
causes of seizures
Meningitis Oxygen therapy
Head injury
Hypoglycaemia
Eclampsia
Fever
Seizing currently Seizure status Post seizure
Request
ALS
No Yes
Diazepam PR
< 3 years: 2.5 mg PR
≥ 3 years: 5 mg PR
Repeat by one prn Diazepam 0.2 mg/kg IV
Or Repeat by one prn
Midazolam 0.5 mg/kg buccal
If pyrexial – cool child
MAG decision required Consider

Internasal Midazolam?
Paracetamol PR
< 1 year: 60 mg PR
1 – 3 years: 180 mg PR
4 – 8 years: 360 mg PR
Or
Paracetamol, 20 mg/kg, PO
Check blood glucose
Go to Blood glucose
CPG 13e Yes
< 3 or > 20 mmol/L
No
Reassess
Version D 0.4 K Symptomatic Bradycardia – Paediatric EMT P
CPG A52
AP
Symptomatic
Bradycardia
Oxygen therapy
Signs of poor perfusion Ventilate

Unresponsive or drowsy
Cold peripheries
Delayed capillary refill
Request
ALS
HR < 60 No
Yes
AP
CPR
ECG & SPO2

monitoring
Hartmann’s Solution 20 mL/Kg IV/IO
Reassess
Epinephrine (1:10 000) 0.01 mg/kg (10 mcg/kg) IV/ IO

Every 3 – 5 min prn
Persistent
No
bradycardia
Yes
AP Consider advanced
airway management
if prolonged CPR
Continue
CPR
Reference: International Liaison Committee on Resuscitation, 2005, Part 6: Paediatric basic and advanced life support, Resuscitation (2005) 67, 271 – 291
Shock from Blood Loss – Adult
CPG A13 (i)
Hypovolaemia
Oxygen therapy
Request
ALS
Patient trapped No
Yes
Hartmann’s Solution 500 mL IV
Yes Trauma No
Head injury
Yes No
with GCS ≤ 8
Hartmann’s Solution, 250 mL IV

Hartmann’s Solution, 250 mL IV Hartmann’s Solution, 250 mL IV
aliquots to maintain palpable radial
aliquots to maintain SBP 120 mmHg aliquots to maintain SBP 100 mmHg
pulse (SBP 90 - 100 mmHg)

handover at ED
P
Version D 0.3 K
Septic Shock – Adult
P AP
CPG A13 (ii)
Hypovolaemia
Oxygen therapy Ensure appropriate PPE worn;

Mask and goggles
Request
ALS
Meningitis
Yes
suspected
No
Benzylpenicillin, 1 200 mg IV/IM
over 3 to 5 minutes
Hartmann’s Solution, 250 mL IV

aliquots to maintain SBP 100 mmHg

handover at ED
P
Version D 0.5 K
External Haemorrhage - Adult
EMT P
CPG 15a
Open AP
wound
Yes Blood still

flowing
Posture
No
Elevation
Examination
Pressure
Apply sterile dressing
Consider
Oxygen therapy
Haemorrhage No
controlled
Apply additional
Yes
dressing(s)
Haemorrhage
Yes
controlled
No
P
Depress proximal
pressure point
Haemorrhage
Yes
controlled
No
P
Apply tourniquet
Significant Go to
Yes
blood loss CPG A13
No
Small
Yes superficial No
wound
Isolated wound
& no relevant medical No
history
Yes
Advise to clean
wound with soap
EMT & water and apply
fresh dressing
Consider treat & Go to

discharge CPG xx
External Haemorrhage – Paediatric (≤13 years)
CPG 15b
Open AP
wound
Yes Blood still

flowing?
Posture
No
Elevation
Examination
Pressure
Apply sterile dressing
Consider
Oxygen therapy
Haemorrhage No
controlled
Apply additional
Yes
dressing(s)
Haemorrhage
Yes
controlled
No
P
Depress proximal
pressure point
Haemorrhage
Yes
controlled
No
P
Apply tourniquet
Significant Go to
Yes
blood loss CPG A13
No
Small
Yes superficial No
wound
Isolated wound
& no relevant medical No
history
Yes
Advise to clean
wound with soap
EMT & water and apply
fresh dressing
Consider treat & Go to

discharge CPG xx
Treat & Discharge Medical
Version D 0.2 P AP
CPG 25 (i)
Satisfactory
From
CPG xx
treatment of
clinical condition
Clinical
impression
Hypoglycaemia Seizure
Confirm the following; History of

1. History of diabetes No
seizures
2. Latest blood glucose > 4.5
Yes to all
3. > 30 days since last episode Yes
No to any
Confirm the following;
Confirm the following;
1. Multiple seizures this episode
1. On oral hypoglycaemics No to all No to all
2. Received Anticonvulsant
2. Glucagon administered
3. In postictal state
Yes to any
Yes to any
Zero on
No
MEWS Score
Yes
Patient competent
No or carer takes
Aid to Capacity Evaluation
responsibility
Patient verbalizes/ communicates;
1. understanding of clinical situation?
2. appreciation of applicable risk?
3. ability to make alternative plan of care? Yes
If no to any of the above consider
Patient Incapacity
Discharge
into care of
competent
person
Complete; After care Instructions and give a

copy to the patient or carer
If a patient expresses a wish to

attend an Emergency Department
then arrangements shall be made
to transport him/her there
Reference: British Thoracic Society, 2005, British Guidelines on the Management of Acute Asthma
C O’Donnell, 2007, Hypoglycaemia Treat and Discharge Protocol
Version D 0.3 Treat & Discharge - Trauma
P AP
CPG 25 (ii)
From
CPG xx
Minor injury
Injury assessment;
1. LoC experienced
2. Joint mobility reduced Yes to any
3. CSMs not intact
4. Pain score > 2/10
No to all
Injury
type
Burn / scald Closed wound Open wound
Superficial
Haematoma No
Yes Open wound assessment;

Burn/ scald assessment; 1. Haemorrhage uncontrolled
1. Skin broken 2. Punctured wound
No to all No to all
2. Circumferential injury 3. Suture(s) required
3. TBSA > 1% 4. Foreign body imbedded
5. Wound requires debriding
Yes to any
Yes to any
Zero on
No
MEWS Score
Yes
Patient
Competent or
No
carer takes
responsibility
Yes
Discharge
into care of
competent
person
Complete; After care Instructions and give a

copy to the patient or carer
Aid to Capacity Evaluation

If a patient expresses
Patient verbalizes/ communicates; a wish to attend an
1. understanding of clinical situation? Emergency
2. appreciation of applicable risk? Department then
3. ability to make alternative plan of care? arrangements shall
If no to any of the above consider be made to transport
Patient Incapacity him/her there
Spinal Immobilisation – Paediatric (≤ 13 years)
Version D 0.4 P AP
CPG 7a (i)
Trauma
Indications for spinal immobilisation Use clinical
judgement
If in doubt,
Return head to neutral position unless on
movement there is Increase in Do not forcibly restrain immobilise
Pain, Resistance or Neurological symptoms a paediatric patient that
is combatitive
Remove helmet
(if worn)
Paediatric spinal injury indications
Pedestrian v auto
Passenger in high speed vehicle collision
Life Ejection from vehicle
No
Threatening Sports/ playground injuries
Falls from a height
Apply cervical collar Axial load to head
Yes
Patient in
Yes
sitting position
Patient in
Rapid extrication with long No No undamaged Yes
board/ peidi board and child seat
cervical collar
Use extrication device Immobilise in child seat
Load onto vacuum mattress,

pedi board or long board
Consider Vacuum
mattress
Are all of the factors listed present;

GCS = 15
Communication effective with patient Low risk factors
No dangerous mechanism, distracting injury or penetrating trauma Simple rear end MVC (excluding push into
No numbness or tingling in extremities oncoming traffic or hit by bus or truck)
Presence of low risk factors which allow safe assessment of range of motion No neck or back pain
Patient voluntarily able to actively rotate neck 45o left & right pain free Absence of midline c-spine or back tenderness
Patient can walk pain free
Yes
Immobilisation
may not be
indicated
Equipment list
Extrication device
Long board
Paediatric board
Vacuum mattress
Orthopaedic stretcher
Rigid cervical collar
Note: equipment must be

age appropriate
References;
Viccellio, P, et al, 2001, A Prospective Multicentre Study of Cervical Spine Injury in Children, Pediatrics vol 108, e20
Slack, S. & Clancy, M, 2004, Clearing the cervical spine of paediatric trauma patients, EMJ 21; 189-193
Version D 0.2 Submersion incident EMT P
CPG 22
Request AP
Submerged
in liquid ALS
Remove patient from liquid
(Provided it is safe to do so)
Remove horizontally if possible

(consider C-spine injury) Spinal injury indicators
History of;
Ventilations may be - diving
commenced while the - trauma
Complete primary survey - water slide use
patient is still in water
(Commence CPR if appropriate) - alcohol intoxication
by trained rescuers
Inadequate Go to
Yes
respirations CPG xx
No
Higher pressure may be
Oxygen therapy required for ventilation
because of poor
compliance resulting from
SPO2 & ECG monitoring pulmonary oedema
Indications
Yes of respiratory
distress
No
Monitor Pulse,
If bronchospasm consider Respirations & BP
Salbutamol 5 mg nebule
Patient is Go to
Yes
hypothermic CPG xx
No
Check blood glucose
Do not delay on site Transport to ED for

Continue algorithm en route investigation of
secondary drowning
insult
Reference: Golden, F & Tipton M, 2002, Essentials of Sea Survival, Human Kinetics
Verie, M, 2007, Near Drowning, E medicine, www.emedicine.com/ped/topic20570.htm
Shepherd, S, 2005, Submersion Injury, Near Drowning, E Medicine, www.emedicine.com/emerg/topic744.htm
AHA, 2005, Part 10.3: Drowning, Circulation 2005:112;133-135
Soar, J et al, 2005, European Resuscitation Council Guidelines for Resuscitation 2005, Section 7. Cardiac arrest in special circumstances,
Resuscitation (2005) 6751, S135-S170
Version D 0.2 Decompression Illness (DCI) P
CPG 24 EMT
AP
SCUBA diving
within 48 hours
Complete primary survey
Consider diving (Commence CPR if appropriate)
buddy as possible
patient also
Treat in supine position
Oxygen therapy
100% O2
Request
ALS
Conscious No
Maintain airway
Yes
Go to Entonox absolute Pain relief

Yes
CPG xx contraindicated required
No
Monitor ECG & SpO2
Notify control of query DCI & alert

hyperbaric unit
Transport is completed at an
altitude of < 300 meters above
Transport dive computer
incident site or aircraft pressurised
and diving equipment
equivalent to sea level
with patient, if possible
Reference: The Primary Clinical Care Manual 3rd Edition, 2003, Queensland Health and the Royal flying doctor Service (Queensland Section)
Version D 0.4 K Burns – Paediatric (≤13 years) EMT P
CPG 6a (i)
Burn or AP
Cease contact with heat source
Scald
F: face
H: hands
Inhalation and or F: feet
Isolated facial injury F: flexion points
Yes superficial injury No P: perineum
(excluding FHFFP)
Airway management
Inadequate Go to
Yes
respirations CPG xx
Minimum 15 minutes cooling

No
of area is recommended
Consider humidified
Oxygen therapy
Commence local Brush off powder & irrigate Commence local

cooling of burn area chemical burns cooling of burn area
Follow local expert direction
Remove burned clothing (unless stuck) & jewellery
Dressing/ covering Equipment list

Dressing/ covering
of burn area of burn area Acceptable dressings
Burns jel if < 10% TBSA
Cling film
Sterile dressing if > 10%
Go to Clean sheet TBSA
Pain > 2/10 Yes Yes Pain > 2/10
CPG 13b
No
Request
TBSA burn
No Yes
> 5%
ALS
ECG & SpO2

monitoring
Caution with the very young,
circumferential & electrical burns
> 10% TBSA

and or time from
No
injury to ED
> 1 hour
Yes
AP
Immediate IO access if IV Hartmann’s Solution IV
not immediately accessible 10 – 14 years = 500 mL
5 – 10 years = 250 mL
Appropriate
history and burn No
area ≤ 1%
P Paramedics are authorised
Yes Monitor body temperature to continue the established
Go to Advanced Paramedic or
CPG xx Doctor during transportation
Reference: Allison, K et al, 2004, Consensus on the prehospital approach to burns patient management, Emerg Med J 2004; 21:112-114
Sanders, M, 2001, Paramedic Textbook 2nd Edition, Mosby
American Academy of Pediatrics, 2000, Pediatric Education for Prehospital Professionals, Jones & Bartlett

Paramedic CPGs December 07

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Version D 0.

9 K Basic Life Support - Adult EMT P

Attach AED defibrillation pads Commence CPR

Shockable Assess Non - Shockable

Immediately resume CPR

Switch to manual Apply paediatric system

Shockable Assess Non - Shockable

Immediately resume CPR

AP Immediate IO access if no IV in situ

Epinephrine (1:10 000), 0.01 mg/kg IV/IO

CPR for 2 minutes CPR for 2 minutes

Amiodarone, 5 mg/kg IV/IO

CPR for 2 minutes

Provide warmth Provide warmth

Breathing, HR > 100 but Cyanotic

Persistent No, Pink

Provide positive pressure ventilation for 30 sec

CPR (ratio 3:1) for 30 sec

Epinephrine (1:10 000) 0.01 mg/kg IV/ IO

If mother is IVDU consider

From Are you

Severe FBAO Mild

No Conscious Yes Encourage cough

One cycle of CPR

After each cycle of CPR open

From Are you

Severe FBAO Mild

1 to 5 back blows followed

One cycle of CPR

one cycle of CPR

After each cycle of CPR open

Amiodarone 150 mg (2.5 mg/kg) IV/ IO CPR x 2 minutes

Atropine 3 mg IV/ IO CPR x 2 minutes Go to

Advanced airway Rhythm check *

If persistent asystole for

Epinephrine (1:10 000) 1 mg IV/ IO CPR x 2 minutes

AP Advanced airway Yes

Following successful Advanced

Consider causes and treat as

Resuscitation continuous for

Confirm Asystolic Cardiac Arrest

Confirm that (two minutes of CPR and

Record two rhythm strips

Record on ECG strips

Complete PCR and flag for

Recent & reliable written

2nd Shock (4 joules/Kg)

3rd Shock (4 joules/Kg)

Amiodarone, 5 mg/kg, IV/IO CPR x 2 minutes

Rhythm check * Check blood glucose

Following successful Advanced

Consider causes and treat as

From Asystole/ PEA

If persistent Asystole / PEA

Following successful Advanced

Consider causes and treat as

EMS Unwitnessed EMS Witnessed

Take standard infection control precautions

Consider pre-arrival information

Head tilt/chin lift

Take standard infection control precautions AP

Consider pre-arrival information

Arrest major external haemorrhage