San Andreas Medical || Handbook

To understand our working system you need to read step by step.

Handbook Contents
1. Introduction
2. Tutorial
3. First Aid and CPR
4. Medication

1. Introduction

This
is the Medical Department original handbook. It contains valuable
information for the public so that they know the penalties, but also
for our paramedics. If you find that somebody is not following
procedure then you may file a complaint against them.


2. Tutorial


1.
When receive a call and arrive at the scene, try to get a picture of
the situation. This involves scene safety, treating immediate life
threats, and making a diagnose of the patient. Always be sure to read
the patient’s pulse and blood pressure.

2. Second stage is
establishing patient history, such as their chief complaint, signs and
symptoms, any medications they take, allergies, past medical history,
and events leading up to the incident.

Minor injuries can be treated within the ambulance.

Treat
the wounds of the patient, this involves stitching minor wounds, clean
and disinfect them, wrapping an arm into a sling, and he/she is good to
go. Examples:

Road Rash
This is what happens when you get dragged across the road. Simple to treat, but quite painful for the patient.

- Control Bleeding.
-Irrigate with Sterile Water
- Apply a topical disinfectant.
- Wrap the wound in gauze.

Major injuries patient is not in critical condition, but has to be taken to hospital.

When
you’ve stabilized the patient, lift him on a stretcher, strap him on it
and get the patient in the ambulance. If there are two EMT’s on the
scene, be sure one will monitor the patient while driving to a
hospital. Examples:

Broken Bones
Any type of fracture or crack in a bone.
- Control any bleeding.
-Elevate.
- Splint/Immobilize.
- Assess for Shock(hypo perfusion).
- Wrap in field dressings for large bones, gauze or small bones.

-Apply Oxygen at 15 L/min via a nonreturnable mask.

Major injuries, patient is in critical condition, and has to be taken to hospital urgently.

Hand
the patient over to the hospital personnel. Always mention the
following things: the condition of the patient, whether he has been in
cardiac arrest, what medication he’s received, other things the
hospital personnel needs to know before treating the patient further:

Bullet Wounds
A bullet wound is a simple way of describing a puncture wound.
- Control Bleeding
- Do NOT remove bullet until in a hospital setting.
- Contact law enforcement.
-Assess for shock(hypoperfusion)
-Apply Oxygen at 15 L/min via a nonrebreather mask.


Deep Cuts
Whether it's from a knife or glass, it's deep.
- Control Bleeding and Stabilize any impaled object.
- Move the skin back into place and close it as much as possible.
- Suture the wound with a curved needle and stitches.
- Wrap the wound in gauze.
-Apply Oxygen at 15 L/min via a nonrebreather mask.
-Assess for shock(hypoperfusion)

Drug Overdose
Whether they're out cold or seizing and foaming at the mouth, they're OD-ing.
- Secure the patient to the stretcher.
-Assess Mental Status
-Apply Oxygen at 15 L/min via a nonrebreather mask.
-Contact Law Enforcement
-Immediate Transport

3rd Degree Burns
3rd degree is a fatal injury over the body.
- Numb the area with morphine sulfate.
-Replace fluids via IV
-Apply Oxygen at 15 L/min via a nonrebreather mask.
- Apply dry sterile gauze.


Controlling Bleeding
If you dont immediately treat bleeding the patient will die. Treating bleeding is a simple step in the medical service.

-Apply direct pressure with sterile bandaging
-Elevate the wound

Assessing for Shock(Hypoperfusion)

Signs
and symptoms of shock include: Tachycardia(Fast heart rate)
Hypertension(High BP) poor circulation and altered mental status. In
treating shock you should:

-Apply Oxygen at 15 L/min via a nonrebreather mask.
-Place in the Trendelenburg's Position(on their back, feet elevated 12 inches.)
-Provide Warmth

Applying Oxygen
Oxygen
is a "magical drug" it can help in any situation. In pretty much all
medical and trauma cases you will apply oxygen to the patient. Turn on
the Oxygen Tank in the ambulance unit. Attach the mask, set the flow to
about 12-15 L/min and apply to the patient.

3. This is the time
to celebrate you’ve been able to treat the patient. Get yourself a
drink and get ready for more calls. In the case that you haven’t been
able to save the patient, get a drink, and get over it


C- Spine Stabilization
Upon
the event of an MVA or a patient suffering a neck or back injury the
patient needs immediate C-Spine stabilization. C-Spine Stabilization
keeps the patients spine straight and lined up to prevent further spine
injury that causes paralysis in the event of a possible spine injury.
C-Spine stabilization should be done immediately after controlling
bleeding, it can also be done by other personnel as another medic
controls bleeding or provides other care.
It is VERY important that
if the patient has a possible spine injury, that a person holds the
neck until someone can attach a c-collar.



To stabilize the c-spine, follow these following steps:

-Hold the patients neck completely still and prevent any movement of the patient
-Apply a c-collar firmly on the neck, having someone hold the neck still throughout the procedure
-Have
a partner assist you put the patient on a backboard by rolling the
patient carefully on his/her side and sliding the backboard under
-Roll the patient back down and strap the patient in place using t-bands or straps if the backboard has them on
-Splint any broken bones
-Transport



Fire department should be on scene at every MVA, take advantage of their presence and have them assist your unit.


3. First Aid and CPR

First
check for breathing. Other than blood, oxygen is the most important
thing for the human body. A person can bleed to death in about 5 to 10
minutes from a large wound, but a person can suffocate in about 1-2
minutes. Try holding your breath as long as you can without hurting
yourself. See how quick that was? Imagine how they feel. They don't
even know they aren't breathing so it's up to you to take care of it.
You can give your patient all the blood in the world, but if they
aren't breathing then they just keeled over.

- It's very easy to
check for breathing, either watch their chest, hold your ear next to
their nose/mouth area and listen, or hold some bare skin next to their
nose/mouth.
- If they aren't breathing then you need to get them breathing! GO through the standard procedure for CPR.

If
you did all correctly pass to the heartbeat. Even if they aren't
bleeding, their heart could be stopped and all the blood in the world
couldn't save them. Check for a pulse. Here is a list of some of the
many areas that you can check for a pulse:

- Wrist
- Pressure point under the jaw bone
- Pressure point on the collar bone adjacent to the base of the neck
- Inner elbow
- Inner knee
- Underneath the Achilles heel

Keep
in mind low pulse means unconsciousness, massive blood loss, or low
blood pressure (heart not beating enough). Normal simply means the
victim is calm. High pulse simply means the patient is panicking. This
can be expected from a conscious patient.


CPR can be used to
get a patient to resume breathing or to restart a non-beating heart.
When starting CPR, check the patient's airway. Just a simple look into
their open mouth will do. If something is in there, just simply reach
your finger in there and swipe it out. If it appears that something is
forcing the throat open, but obstructing breathing then perform the
Heimlich maneuver. About Heimlich maneuver:

If the victim is
standing, stand behind them. Wrap your arms under their arms and around
their waist. Form a fist with one hand, and place your thumb towards
the victim. Grab the fist with your other hand and place your fist just
above their belly button. Perform five upwards thrusts into the
abdomen, each thrust strong enough to dislodge the foreign body. You
are creating an artificial cough. Remain holding the victim as the
victim will likely pass out in the event that the Heimlich Maneuver is
ineffective. Repeat until foreign body is expelled. Be careful not to
place your fist on the ribcage. This could break a rib and cause the
rib to impale an organ.

If the patient still isn't breathing,
perform a rescue breath. Do this by holding open their mouth and
forcing two breaths into their lungs with your mouth. If you are in
your ambulance, you can use a breathing apparatus called the Bag Valve
Mask, or BVM, located in the third cabinet on the driver's side of the
ambulance. Just simply pump the air via



If the victim
still is not breathing or their heart is not beating, perform 30
pectoral thrusts. Place one hand over the other and press the sternum
into the chest approximately half-way through the torso. Perform the
thrusts at approximately 2 thrusts per second. After 30 thrusts, check
for breathing and a heart beat. If either are absent, perform 2 more
rescue breaths followed by 30 more pectoral thrusts. After 3 tries and
no heartbeat, get the defibrillator.

Remember:
A = Airway -1
B = Breathing -2
C = Compressions -30

AED - Automated External Defibrillation
Automated
External Defibrillation is the definitive treatment for the
life-threatening cardiac arrhythmias, ventricular fibrillation and
pulse-less ventricular. tachycardia. In layman's term, you shock the
patient back to life. Every unit has at least one AED. In the case of a
Cardiac Arrest patient, an AED needs to be applied ASAP. Start by
attaching the pads to the patients chest.



Simply press
the analyze button on the AED and the machine will analyze the patients
heart Rhythm. If the patient is confirmed to be in cardiac arrhythmia,
the AED will tell you "Shock advised" once it does, make sure the
patient is clear of all contact from people and water, and apply the
shock by pushing the shock button. Immediately check for a pulse after.
It is important you have someone continue CPR during the entire
procedure up to the shock, and immediately after if no pulse is found.

5. Medication

The
following is a list of recommended medications for average cases. This
should give you a feel of the strength of the medications. Personally
issue them one does of the medication to last the patient until they
are able to fill the prescription on their own time at a 24/7.
Medications can be found in the left-most cabinet on the passenger side
of the ambulance. Make sure to keep the mini-fridge well stocked with
water bottles (located under the medicine cabinet).

* Pure Oxygen - Helps in every medical situation.
* Advil/Tylenol - Good for fevers, minor headaches.
* Motrin - Good for migraines and minor pains.
* Loratab - Good for general pain such as a broken bone, tends to make patients drowsy, Low chance of addiction.
* Lidocain - Local anesthetic. Good for pain mangagement and stabalizing heart rhythm.
* Morphine Sulfate - Used to relieve moderate to severe pain
* Propofol - Local anesthetic.
* Asprin - Blood thinner. Prevent blockage of arteries.
* Nitroglycerin - Beta blocker. Dilates the blood vessels to improve circulation to the pulmonary arteries.
* Epinephrine - Used to prevent swelling during anaphylactic (allergic) reactions
* Ibuprofen - Allergy relief.

* Activated Charcoal - Used for ingested poisions, Will induce comiting.

* Amytal - Used for sedation of a combative patient. (puts them to sleep)

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