0. Case Entry Protocol

Question 1

Rule 1

Answer 1

If the complaint description includes scene safety issues, choose the Chief Complaint Protocol that best addresses those issues.

Question 2

Rule 2

Answer 2

If the complaint description involves TRAUMA, choose the Chief Complaint Protocol that best addresses the mechanism of injury.

Question 3

Rule 3

Answer 3

Use of the Breathing Verifiocation Detector is not necessary when UNCERTAIN BREATHING or INEFFECTIVE BREATHING is associated with unconsciousness.

Question 4

Rule 4

Answer 4

1st party callers using phrases like “I can’t breath” or “I can barely breath” may be further assessed by ability to speak normally or in complete sentences, their level of apparent distress or agitation, and the presence of airway noises. Breathing effectiveness ranges from normal breathing to mild shortness of breath to difficulty speak between breaths to fighting for air. When in doubt, the EMD should err on the side of patient safety.

Question 5

Rule 5

Answer 5

When cardiac arrest appears to be TRAUMATIC in nature, choose the Chief Complaint Protocol that best fits scene safety concerns and the mechanism of injury.

Question 6

Rule 6

Answer 6

If the complaint description appears to be MEDICAL in nature, choose the Chief Complaint Protocol that best fits the patient’s foremost symptom, with priority symptoms taking precedence.

Question 7

Rule 7

Answer 7

If the complaint description involves hazardous materials (toxic substances) that pose a threat to bystanders or responders, go to Protocol 8.

Question 8

Rule 8

Answer 8

When the complaint description is seizure, go to Protocol 12 regardless of consciousness and breathing status.

Question 9

Rule 9

Answer 9

If the Chief Complaint and status of consciousness and breathing are unknown initially (3rd party caller), go to Protocol 32.

Question 10

Rule 10

Answer 10

When the complaint description involves both NON-TRAUMATIC chest pain/heart attack symptoms and breathing problems, choose the Chief Complaint Protocol that best fits the patient’s foremost symptom, with ECHO-level conditions taking precedence. (≥ 16, alert, no reported STROKE symptoms) Use the Aspiring Diagnostic & Instruction Tool on either protocol as appropriate.

Question 11

Rule 11

Answer 11

When the complaint description is breathing-related tracheostomy (trach or stoma) problems in the conscious patient, go to Protocol 6.

Question 12

Rule 12

Answer 12

Some critical patient care instructions may be necessary prior to the “send” point. Any significant scene safety concerns take precedence and must be addressed before the provision of instructions.

Question 13

Rule 13

Answer 13

Case Entry Questioning must always be completed after PDIs when directed by (hanging, underwater, choking, person on fire).

Question 14

Rule 14

Answer 14

A sudden, unexplained collapse resulting in unconsciousness, even when reported as a ground level-fall, should be considered as MEDICAL cardiac arrest until proven otherwise

Question 15

Axiom 1

Answer 15

UNCERTAIN BREATHING status indicates a 2nd party caller who has seen the patient and is still unsure. This is considered NOT BREATHING until proven otherwise.

Question 16

Axiom 2

Answer 16

Unknown breathing status indicates a 3rd or 4th party caller who cannot personally verify the patient’s status.

Question 17

Axiom 3

Answer 17

After an ECHO response, completing all Case Entry and Chief Complaint Key Questions ensures that the proper knowledge regarding safety issues and the appropriate warnings and/or advice are immediately and always passed on to the responders and potential scene helpers.

Question 18

Axiom 4

Answer 18

Prompt recognition of AGONAL BREATHING is critical to the treatment of cardiac arrest because it reduces the time to compressions and defibrillation. MEDICAL Arrest PAIs should be instituted immediately after ECHO coding and associated pDIs when an unconscious patient’s breathing status is INEFFECTIVE or UNCERTAIN (AGONAL BREATHING Detector use is not necessary)

Question 19

INEFFECTIVE BREATHING

Answer 19

Barely breathing, can’t breath, fighting for air, not breathing, turning purple, turning blue

Question 20

AGONAL BREATHING

Answer 20

Gasping for air, just a little, making funny noises