This document provides information on pre-hospital emergency care, including transport modes, ambulance equipment types, response times, patient assessment, trauma management principles, and mass casualty incident response. It discusses concepts like the golden hour and platinum 10 minutes for trauma patients, and outlines standards for scene size-up, patient packaging and sorting in multi-casualty events.

1. KS Chew
Emergency Medicine Department
School of Medical Sciences
Universiti Sains Malaysia

2.  Transport Mode
 Scene Size up
 Pre-hospital Patient Assessment

4. To bring the right patient,
via the right mode of transportation,
to the right center within
the right time

5.  Land ambulances
◦ Examples: Type A1, A, B, FWD
◦ Private ambulances – for paying cases, often non-
emergencies
◦ Patients Transport Van
 Water ambulances
 Air Ambulances
 Motorcycle Squads

6. TYPE B TYPE A
 Immobilization
package
 Trauma Kit
 Triage Card
 Stretcher
 All Grade B Equipments
 Transport Ventilator
 Defibrillator
 Monitor
◦ Note: Type A1: additional
specialized equipments –
incubator, mini intensive
care facilities

7.  To reach persons in need as quickly as
possible with trained personnel
 To stabilize the patient’s condition to
prevent further deterioration
 To move the patient to a facility capable of
providing more extensive care or additional
services that will enhance patient outcome
 To offer the level of care equal to the
receiving institution recognizing the limits
inherent in traveling.

8.  Intra-hospital--transport of a patient from
one location to another within the hospital
 Inter-hospital--transport of a patient
between hospitals
 Scene run--transport of a patient from a
non-medical site to the nearest available or
designated hospital

9. • Advantages
– Door‐to‐door service/no
addi4onal transport
vehicle
– No landing zone required
– Ease of personnel training
– Few weather restric4ons
– Affordable and generally
reimbursable
– Family member rides too
• Disadvantages
– Mo4on sickness
– Limited pa4ent access,
light and electrical power
– Traffic delays
– Transport 4me
– Vibra4on/noise (69‐75 dB)
– Need to carry addi4onal
baReries/AC converters

16.  Transport‐related problem:
any event (expected @ unexpected), that
impacted adversely on the pa4ent stability
 Pa2ent‐related complica2ons:
any difficulty or complica4on, related directly
to the pa4ent’s patho‐physiology.
 Equipment‐related problems:
equipment/technical mishaps & transport
environmental factors that could result in
pa4ent instability

17. Hub
Ambulance
Centre
Admission
Centre
Relevant
Dept.
Mortuary
OT
Ambulance Base
Sta4on
Hospital
Clinic
NGO
Private
Hospital
Police/Fire
Social Worker
I
N
T
R
A
H
O
S
P
I
T
A
L
I
N
T
E
R
F
A
C
I
L
I
T
Y

18. Response Time Percent %
< 10 min 8.8
10 ‐20 min 38.3
20 – 30 min 30.9
> 30 min 22.1

21. Aim to:
Determining any threats to your own safety
or to the safety of your pa4ents or
bystanders, to determine the nature of the
call, and to decide if you will need addi4onal
help

23.  Body substance isolation review
 Scene safety
 Total number of patients
 Essential equipment and resources needed
on-scene
 Mechanism of injury

24. Toxic Substances or Hazmat

25. Mechanism of Injury
Motor Vehicle Collision–Head On

26. Mechanism of Injury:
Motor Vehicle Collision–Rear Impact

27. Mechanism of Injury:
Motor Vehicle Collision–Side Impact

28. Mechanism of Injury:
Motor Vehicle Collision–Rollover

29. One
Nation,
One
Number
999

30. Information to relay to when making an emergency call
 E = Exact Location - The precise location of the incident
 T = Type - The nature of the incident (trauma, non-trauma, heart
atack, motor-vehicle accident), including how many vehicles,
buildings etc. are involved
 H = Hazards - Both present and potential (e.g., explosion, spillage of
combustible materials, highly volatile hydrocarbons, chemicals, etc)
 A = Access - Best route for emergency services to access the site, or
obstructions and bottlenecks to avoid
 N = Numbers - Numbers of Casualties, Dead and Uninjured on scene
 E = Existing Emergency Services - Which services are already on
scene, and which others are required - s0 as not to duplicate
services, and for better utilization of services in other concurrently
emergency happenings.

32.  Sorting of patients according to:
◦ ABCDEs
◦ Available resources
 Multiple casualties
 Mass casualties
 Stay and play versus Scoop and Run

33. Good Early Trauma Management
Impacts
100%
50%
0%
Immediate
Deaths
Early
Deaths
Late
Deaths
% of
Deaths

34.  Time is a critical factor
for the patient with a
significant MOI
 Barring the need for
extrication, the rule of
the “Golden hour” and
the “Platinum 10
minutes” will apply

35.  The environment (ie: bottom of stairs, out in the
cold, tripod position, pool of blood)
 Patient’s MOI/NOI
 Patient’s age and sex
 Patient’s degree of distress
 Listen for the chief complaint
 Keep the priority of care in focus

36. Mechanism of Injury:
Motor Vehicle Collision–Vehicle Interior

37.  Are they conscious or unconscious? (if
unconscious do CPR quick-check)
 Introduce yourself
 What’s your name? (oriented to person)
 Do you know where you are? (oriented to
place)
 What day of the week is it? (oriented to day)
 How can I help you today? (chief complaint)

38.  Alert – oriented to person, place, and day
(“big three”)
 Verbal – cannot answer the “big three”
correctly
 Painful – either appropriate, inappropriate, or
posturing (decorticate/decerebrate)
 Unresponsive

39.  S – signs and symptoms
 A – allergies
 M – medications
 P – pertinent past medical history
 L – last oral intake
 E – events leading up to

40.  D – deformity
 C – contusions
 A – abrasions
 P – punctures/penetrations
 B – burns
 T – tenderness
 L – lacerations
 S – swelling

41.  D = Deformity
 O = Open Wound
 T = Tenderness
 S = Swelling

43.  Time is a critical factor
for the patient with a
significant MOI
 Barring the need for
extrication, the rule of
the “Golden hour” and
the “Platinum 10
minutes” will apply

44.  The maximum time
EMS providers stay on
the scene for a critical
trauma patient