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PROBLEM CARD 0 – 000 FIRE OVERFLOW
“The Fire Appliance is being sent. I need to ask you some more questions about the incident”
Are you calling from the residence that is on fire?
Where is the fire located in the house?
What is burning?
Is anyone in the house and if so where?
Is there any other relevant information?
DISPATCH PRIORITY:
Not created on ACTAS
CAD – ACT F&R only.
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Additional Information
Pre-Arrival Advice
If the patient is not conscious, but still breathing normally –
place patient on their side – regardless of their injury/illness.
Tilt head back gently. Keep checking breathing
Allow the patient, if conscious, to get comfortable. Legs
elevated if feeling faint or dizzy unless injury to legs
IF BLEEDING – direct pressure over wound to stop bleeding.
If no other injury, try to elevate bleeding part
Stay with patient
Keep patient at temperature comfortable to them
Do not move conscious patient unless in significant danger
Do not give them anything to eat or drink
Unlock the front door
(Night) Outside light on
If possible, have someone meet the ambulance
If patient’s condition changes – ring back 000
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PROBLEM CARD 1 – 000 AMBULANCE OVERFLOW
“An ambulance is being sent. I need to ask you some more questions about the incident”
How old is the patient?
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
What is the nature of the problem?
Any priority signs & symptoms?
(Breathing difficulties, chest pain, sudden behavioural changes, dizziness/fainting, sweating/very pale skin)
Is there any bleeding?
(No, Minimal, Significant)
DISPATCH PRIORITY:
Has anyone attempted first aid?
Does the patient have any other medical conditions? Any other relevant medical information?
P1
To be revised by Clinician or
Dispatcher if created by ACTF&R
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Additional Information
Pre-Arrival Advice
000 Ambulance Overflow is to be reviewed by the Clinician
If the patient is not conscious, but still breathing normally – place
patient on their side – regardless of their injury/illness. Tilt head
or the Dispatcher when created by ACTF&R
back gently. Keep checking breathing
The case type will then be changed to accurately reflect the
Allow the patient, if conscious, to get comfortable. Legs elevated
if feeling faint or dizzy
nature of the case – and priority adjusted appropriately
IF BLEEDING – direct pressure over wound to stop bleeding. If no
If created by ACTAS operator – this will remain as original
other injury, try to elevate bleeding part
case type for closure when Interstate Comcen has been
Stay with patient
contacted
Keep patient at temperature comfortable to them
Do not move conscious patient unless in significant danger
Do not give them anything to eat or drink
Unlock the front door if able
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 2 – ABDOMINAL PAIN
“An ambulance is being sent. I need to ask you some more questions about the incident”
How old is the patient?
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
How long has the patient had the pain?
Consider if patient could be pregnant.
SUDDEN ONSET <4 hours duration
Any previous episodes?
Any associated pain?
(Check especially for chest, back, groin pain) Any other symptoms?
(Syncope, Dizziness, Sweating, Pale skin)
DISPATCH PRIORITY:
LONG STANDING PAIN >4 hours duration
Has this condition been treated by a doctor in the past?
What is the diagnosis? And is the episode similar to the previous problem?
P2
Does the patient have any other medical conditions? Any other relevant medical information?
P1 if high risk
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Additional Information
Pre-Arrival Advice
Severity of pain is not a good indicator of seriousness of
If the patient is not conscious, but still breathing normally –
underlying condition
place patient on their side – regardless of their injury/illness.
Tilt head back gently. Keep checking breathing
Be suspicious in older patients with past history of heart
Allow the patient, if conscious, to get comfortable. Legs
disease or aortic aneurysm
elevated if feeling faint or dizzy unless injury to legs
HIGH RISK IF:
Stay with patient
Keep patient at temperature comfortable to them
Sudden onset AND age >45
AND/OR syncope/dizziness
Do not give them anything to eat or drink
AND/OR pain radiating to back, groin or
Get patient’s medications together
chest
Unlock the front door
THEN UPGRADE TO P1 – Clinician to review all abdo pain
cases
(Night) Outside light on
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 3 – ALLERGIC REACTIONS
“An ambulance is being sent. I need to ask you some more questions about the incident”
How old is the patient?
Is the patient awake/talking?
Is there any difficulty breathing or swallowing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
When did this start?
Any idea what might have caused this reaction?
Any previous reactions?
DISPATCH PRIORITY:
Any other signs/symptoms?
(Rash/itching, dizziness/fainting, abdominal pain, vomiting)
Does the patient have any self-administered medication to be used for this problem?
P1
Has it been given?
(consider EPI-Pen or Anapen administration)
Does the patient have any other medical conditions? Any other relevant medical information?
P2 if low risk
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Additional Information
Pre-Arrival Advice
LOW RISK IF:
NO decreased LOC AND
If the patient is not conscious, but still breathing normally – place
patient on their side – regardless of their injury/illness. Tilt head
NO breathing difficulties AND
back gently. Keep checking breathing
NO change is symptoms and signs for >1
hour since reaction began
If patient has self-administered medication suggest to take as per
THEN DOWNGRADE TO P2
instructions. If patient has EpiPen (adrenaline) advise to
administer only if it appears patient has significant difficulty
breathing or swallowing
Let patient get comfortable usually sitting if has breathing
difficulties; if dizzy or faint – lying down with legs elevated unless
injury to legs
Stay with patient
Keep patient at temperature comfortable to them
Do not give them anything to eat or drink
Get patient’s medications together
Unlock the front door
(Night) Outside light on
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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Epi-Pen instructions
Ana-Pen instructions
Remove the EpiPen from its packaging (protective carry tube)
Remove by pulling the black needle shield. This may require
Be careful of the black tip as it holds the needle. Always hold the
reasonable force to remove.
middle of the pen – not the ends
Check solution through the “viewing window” on the pen to
Do not dispose of this cap. It can be used to transport the used
ensure the fluid is clear
ANAPEN® to the hospital for safe disposal.
Make a fist around the EpiPen with your thumb nearest to the
grey safety cap
Remove by pulling the grey safety cap from the red firing button
Remove the grey safety cap with your other hand
The EpiPen is now ready to inject
The ANAPEN is now activated and ready use, Be careful of
Hold the EpiPen at right angles to, and about 5cm away from the
the needle tip.
fleshy upper outer part of the thigh. The black tip should be
pointing toward to thigh
Do not touch Red button until needle end is placed against thigh
Expose area of skin if possible – if not, administer through clothing
and ready to administer.
Jab the black tip
HARD into the upper outer part of the thigh until
a click is heard or felt
Hold needle end firmly against the outer thigh at 900angle.
Keep pressing the EpiPen against the thigh for 10 seconds
Gently remove the EpiPen and be careful of the needle that will
Press the red firing button so it clicks and hold for 10 seconds, if
now be sticking out of the black tip
necessary, inject through clothing. This will ensure that the full
Note the time
dose is administered.
Gently massage the injection site for approximately 10 seconds
after removal
Note the time.
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PROBLEM CARD 4 – ASSAULT
“An ambulance is being sent. I need to ask you some more questions about the incident”
Is the assailant still present?
NOTIFY THE AFP How old is the patient?
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
What injuries does the patient have?
Consider Stabbing/Shooting
Is there any bleeding?
(No, Minimal, Significant)
DISPATCH PRIORITY:
Does the patient have any other medical conditions? Any other relevant medical information?
P2
P1 if high risk
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Additional Information
Pre-Arrival Advice
Includes all types of assault
If the patient is not conscious, but still breathing normally – place patient
on their side – regardless of their injury/illness. Tilt head back gently.
Keep checking breathing
Ensure crew safety - provide all relevant details to the crew
(mindful of next point); AFP notification; use of address
Allow patient to get comfortable usually lying down. Legs elevated if
flagging capacity
feeling faint or dizzy, unless injury to leg/s
If bleeding – direct pressure over wound to stop bleeding. If no other
Be cautious of providing sensitive case details over the radio
injury, try to elevate the bleeding part
Stay with patient
Keep patient at temperature comfortable to them
HIGH RISK IF:
Do not move patient unless in significant danger
Altered LOC OR
Do not give them anything to eat or drink
Breathing not normal OR
In case of sexual assault – advise not to change clothes, shower or have a
Significant bleeding
bath
Get patient’s medications together
THEN UPGRADE TO P1
Unlock the front door
(Night) Outside light on
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 5 – BACK PAIN/INJURY
“An ambulance is being sent. I need to ask you some more questions about the incident”
How old is the patient?
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
Is this pain caused by an injury? (<24 hours)
IF YES
What happened?
When did it happen?
Any other injuries?
(if yes provide details) Is the patient able to move their arms and legs ok?
DISPATCH PRIORITY:
IF NO
When did the pain occur?
What was the patient doing when the pain came on?
P2
Does the patient have pain anywhere else?
(Details)
Does the patient have any other signs/symptoms?
(Sweating, Dizziness/fainting, tingling/
Weakness/numbness in arms or legs)
P1 if high risk
Does the patient have any other medical conditions? Any other relevant medical information?
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Additional Information
Pre-Arrival Advice
Most cases of back pain or injury do not warrant an urgent
If the patient is not conscious, but still breathing normally – place
response
patient on their side – regardless of their injury/illness. Tilt head
back gently. Keep checking breathing
Be more suspicious of elderly patients – irrespective of cause
Do not move patient if recent injury – otherwise allow patient to
get comfortable, usually lying down.
If able, elevate legs if feeling faint or dizzy unless injury to legs
Stay with patient
HIGH RISK IF:
Any LOC
Keep patient at temperature comfortable to them
OR breathing difficulties
Do not move patient unless in significant danger
OR significant mechanism of injury
OR suspected spinal cord problem
Do not give them anything to eat or drink
OR patient over 50 years with sudden onset Get patient’s medications together
of back pain with sweating, dizziness or
fainting
Unlock the front door
(Night) Outside light on
THEN UPGRADE TO P1 – Clinician to review all back
If possible, have someone meet the ambulance
pain/injury cases
If patient’s condition changes – ring back on 000
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PROBLEM CARD 6 – BITES/STINGS
“An ambulance is being sent. I need to ask you some more questions about the incident”
Are you safe from the animal/creature?
How old is the patient?
Is the patient awake/talking?
Is the patient breathing and/or swallowing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
Can you further identify the animal/creature without touching it?
What part of the body is involved?
DISPATCH PRIORITY:
When did the bite occur
Does the patient have any other signs/symptoms?
(Bleeding, swelling, sweating, pain, nausea/vomiting)
P1
Any previous reactions to stings/bites?
(Details) Consider revising case type to ALLERGIC
REACTION
P2 if low risk
Does the patient have any other medical conditions? Any other relevant medical information?
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Additional Information
Pre-Arrival Advice
If the patient is not conscious, but still breathing normally – place patient
Assume all snake bites are venomous unless absolutely
on their side – regardless of their injury/illness. Tilt head back gently.
reliable information to the contrary. This will usually only be
Keep checking breathing
available if bitten by an identified snake in captivity
Avoid further contact with creature
Assume all spider bites by largish black spiders are serious
If snake or large black spider – DO NOT allow patient to move around.
Keep bitten limb down. Bandage – firm; over bite, down limb then all the
High risk: - facial or neck involvement with any bite or sting.
way back up again. Splint limb if possible and keep still. DO NOT elevate
bite site
- extremes of age; any bite or sting,
- multiple bites / stings (any creature)
If definite identification of red-back spider – use cold compresses on bite
- large animal involvement ( bull terriers;
area. Do not bandage
Rottweilers; exotic animals)
If animal bite + bleeding – place direct pressure over wound to stop
bleeding. Try to elevate bleeding part
LOW RISK IF:
Allow patient to get comfortable
Isolated animal bite (not snake or spider) to
limb with no significant bleeding
Stay with patient
Insect/spider bite with no significant
Keep patient at temperature comfortable to them
symptoms and no history of reaction
Do not give them anything to eat or drink
Get patient’s medications together
THEN DOWNGRADE TO P2
Unlock the front door
(Night) Outside light on
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 7 – BLEEDING
“An ambulance is being sent. I need to ask you some more questions about the incident”
How old is the patient?
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
Where is the blood coming from?
Is the blood squirting out?
IF YES – APPLY DIRECT PRESSURE
How much blood loss?
(minimal or significant)
DISPATCH PRIORITY:
How did the bleeding start?
If vaginal, could the patient be pregnant?
If yes, how many weeks?
P1
Does the patient take any blood thinning medications or have a bleeding disorder?
P2 if low risk
Does the patient have any other medical conditions? Any other relevant medical information?
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Additional Information
Pre-Arrival Advice
If the patient is not conscious, but still breathing normally – place
patient on their side – regardless of their injury/illness. Tilt head
LOW RISK IF:
back gently. Keep checking breathing
Minimal bleeding from any area
Allow patient to get comfortable usually lying down. Legs elevated
AND no signs of shock
if feeling faint or dizzy, unless injury to legs
AND no decreased LOC
AND no breathing difficulties
If bleeding – direct pressure over wound to stop bleeding. If no
other injury, try to elevate the bleeding part
AND no high risk mechanism of injury
AND no anticoagulants or bleeding disorder
If nose bleed – sit up, head forward, pinch nose just under the
bony part
THEN DOWNGRADE TO P2
Stay with patient
Keep patient at temperature comfortable to them
Do not move patient unless in significant danger
Do not give them anything to eat or drink
Get patient’s medications together
Unlock the front door
(Night) Outside light on
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 8 – BREATHING DIFFICULTY
“An ambulance is being sent. I need to ask you some more questions about the incident”
A diagnosis of hyperventilation due to anxiety is not to be made over the phone
How old is the patient?
Is the patient awake/talking?
Tell me how they are breathing?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
Can the patient talk in normal sentences/short sentences/just words/too breathless to speak?
Do they appear pale? Blue? Sweaty?
DISPATCH PRIORITY:
Has this come on suddenly?
Does the patient have any other medical conditions? Any other relevant medical information?
If asthma – does the patient have action plan/medications? If so – have they used it?
P1
P2 if low risk
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Additional Information
Pre-Arrival Advice
If the patient is not conscious, but still breathing normally –
LOW RISK IF – reliable information only:
place patient on their side – regardless of their injury/illness.
Tilt head back gently. Keep checking breathing
No sudden onset
Allow patient to get comfortable usually sitting up
AND present for >4 hours with no deterioration
AND able to speak in sentences
If patient has specific medications for this condition – assist
them in using it. If allergic reaction consider Epi-Pen PAA
AND no cyanosis
Stay with patient
THEN DOWNGRADE TO P2
Keep patient at temperature comfortable to them
Do not give them anything to eat or drink
Get patient’s medications together
Unlock the front door
(Night) Outside light on
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 9 – BURNS
“An ambulance is being sent. I need to ask you some more questions about the incident”
How old is the patient?
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
What caused the burn?
On what part of the body are the burns?
Are there any other injuries?
DISPATCH PRIORITY:
Does the patient have any other medical conditions? Any other relevant medical information?
P1
P2 if low risk
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Additional Information
Pre-Arrival Advice
Ensure scene safety
Remove patient from problem
LOW RISK IF:
Extinguish smouldering clothes, then remove unless they stick to the
skin. Remove jewellery if possible
No decreased LOC
If patient not conscious, but still breathing normally – place patient on
No breathing difficulty
side. Tilt head back gently. Keep checking breathing
No burn to face or eyes
Not caused by explosion, chemical or electrical
Cool burnt area with water; make sure patient does not get too cold
injury
Allow patient to get comfortable, usually lying down. Legs elevated if
No other injuries
feeling faint or dizzy, unless injury to legs
Sunburn
Stay with patient
Patient is not <5 yrs or >65 yrs old
Keep patient at temperature comfortable to them
THEN DOWNGRADE TO P2
Do not give them anything to eat or drink
Get patient’s medications together
Unlock the front door
(Night) Outside light on
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 10 – CHEST PAIN/PALPITATIONS/TACHYCARDIA
“An ambulance is being sent. I need to ask you some more questions about the incident”
How old is the patient?
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
Any chest pain present now?
How long has it been present?
Can you describe the pain?
(Heavy, crushing, sharp, tight, vague, unspecified)
DISPATCH PRIORITY:
Past cardiac history?
Any other priority signs/symptoms?
(SOB, nausea, sweating, palpitations, fainting/dizziness)
P1
Does the pain go anywhere else?
Does the patient have any other medical conditions? Any other relevant medical information?
P2 if low risk
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Additional Information
Pre-Arrival Advice
If patient not conscious, but still breathing normally – place
All chest pain is not cardiac in origin but ALL chest pains are
patient on side. Tilt head back gently. Keep checking breathing
potentially life threatening
Patients over 35 years are initially assumed to have cardiac
Let patient get comfortable – usually sitting; if dizzy or faint – lying
chest pain
down
Watch for atypical presentations – especially in older or
diabetic patients
Does the patient have any medication to take under the tongue
for this condition? If not already used, take as directed on the
LOW RISK CHEST PAIN IF:
label and recline the patient
Patient <35 years old AND
Stay with patient
No cardiac history AND
Keep patient at temperature comfortable to them
“Non-typical” chest pain AND
No associated priority signs/symptoms AND
Do not give them anything to eat or drink
No history of diabetes
Get patient’s medications together
LOW RISK PALPITATIONS/TACHYCARDIA IF:
Unlock the front door
Patient <35 years old AND
No cardiac history AND
(Night) Outside light on
No chest pain AND
If possible, have someone meet the ambulance
No associated priority signs/symptoms
If patient’s condition changes – ring back on 000
THEN DOWNGRADE TO P2
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FULL PRE-ARRIVAL ADVICE
CARDIO-PULMONARY RESUSCITATION - ADULT
If not responsive OR not moving OR not conscious AND not breathing normally
What does the patient look and feel like?
(White, Blue, Cold?) (“Funny” or gasping breathing?)
Is there someone there who can help you?
YES – stay on the phone – relay advice
NO – can you move the patient closer or take the phone to the patient?
Can you put the phone on loudspeaker or speakerphone?
Have you ever learned CPR? If not, I will talk you through it
Make sure the patient is on a hard surface
e.g. ground – NOT A BED Does the patient have anything in their mouth?
If YES – turn their head gently to the side and scoop it out with 2 fingers.
If this is a Choking event – disregard this step
Gently tilt the patient’s head back and squeeze the nose shut with your fingers
If you are willing (and it’s ok, if you aren’t)
Place your mouth over their mouth – blow out gently until you see the chest rise. Do that once more
NOTE – Problems with the resuscitation are usually with the mouth to mouth. If there is any difficulty encountered with the first attempt of mouth
to mouth then this step should be abandoned and compressions only continued
Expose the patient’s chest and place the heel of one hand in the middle of the patient’s chest then place your other hand on top of the first hand
Lean forward over the top of the patient, keeping your arms straight and lean down onto the chest so that it is pushed down about 2in/5cm
(1/3 chest depth) Do that 30 times
(count the rate on the phone if possible and correct if slow). Aim for 10 compressions every 6 seconds or so
Talk rescuer through repeating 2 breaths and 30 compressions (until the ambulance crew arrives) “Push hard. Push Fast”
Do you have an AED?
IF YES – Get someone to go and get it. Do not stop the compressions. Have the other person follow instructions
IF NO – Continue with CPR
Place the pads on the patient’s chest. Turn machine on. Follow prompts
If the prompt says “Press to Shock” make sure no one is touching the patient
After a “shock” or “no shock” advised, go straight back to compressions. After 2 minutes, check the patient
If the patient vomits – roll them onto their side and clear their mouth with your 2 fingers or a cloth and return the patient to their back.
Cease mouth
to mouth and continue compressions only.
Aim for 100 compressions per minute. If there are 2 rescuers, rotate every 2 minutes
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FULL PRE-ARRIVAL ADVICE
CARDIO-PULMONARY RESUSCITATION – CHILD – less than 9 years
If not responsive OR not moving OR not conscious AND not breathing normally
What does the patient look and feel like?
(White, Blue, Cold?) (“Funny” or gasping breathing?)
Is there someone there who can help you?
YES – stay on the phone – relay advice
NO – can you move the patient closer or take the phone to the patient?
Can you put the phone on loudspeaker or speakerphone?
Have you ever learned CPR? If not, I will talk you through it
Make sure the patient is on a hard surface
e.g. ground – NOT A BED Does the patient have anything in their mouth?
If YES – turn their head gently to the side and scoop it out with 2 fingers.
If this is a Choking event – disregard this step
Gently tilt the patient’s head back and squeeze the nose shut with your fingers
If you are willing (and it’s ok, if you aren’t)
Place your mouth over their mouth – blow out gently until you see the chest rise. Do that once more
NOTE – Problems with the resuscitation are usually with the mouth to mouth. If there is any difficulty encountered with the first attempt of mouth
to mouth then this step should be abandoned and compressions only continued
Expose the patient’s chest and place the heel of one hand in the middle of the patient’s chest then place your other hand on top of the first hand
Lean forward over the top of the patient, keeping your arms straight and lean down onto the chest so that it is pushed down about 2in/5cm
(1/3 chest depth) Do that 30 times
(count the rate on the phone if possible and correct if slow). Aim for 10 compressions every 6 seconds or so
Talk rescuer through repeating 2 breaths and 30 compressions (until the ambulance crew arrives) “Push hard. Push Fast”
If the patient vomits – roll them onto their side and clear their mouth with your fingers or a cloth and return the patient to their back.
Cease mouth to
mouth and continue compressions only.
Aim for 100 compressions per minute. If there are 2 rescuers, rotate every 2 minutes
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FULL PRE-ARRIVAL ADVICE
CARDIO-PULMONARY RESUSCITATION – INFANT/NEONATE – 12 months or less
If not responsive OR not moving OR not conscious AND not breathing normally
What does the patient look and feel like?
(White, Blue, Cold?) (“Funny” or gasping breathing?)
Is there someone there who can help you?
YES – stay on the phone – relay advice
NO – can you move the patient closer or take the phone to the patient?
Can you put the phone on loudspeaker or speakerphone?
Have you ever learned CPR? If not, I will talk you through it
Where is the patient?
If a bed or chair or lounge – you need to move the patient onto a hard surface OR hold the baby in your hand and up forearm
Does the patient have anything in their mouth?
If YES – turn their head gently to the side and scoop it out with a finger
If this is a Choking event – disregard this step
Gently lift the chin and keep the head level
Hold the patient’s chin between your thumb and first finger and hold the mouth open
Place your mouth over their mouth and nose – blow out gently until you see the chest rise. Do that once more
NOTE – Problems with the resuscitation are usually with the mouth to mouth. If there is any difficulty encountered with the first attempt of mouth
to mouth then this step should be abandoned and compressions only continued
Expose the patient’s chest and place two fingers in the middle of the patient’s chest
Push down with your two fingers onto the chest so that it is pushed down about 1in/2-3cm
(1/3 chest depth) Do that quickly 30 times
(count the rate on the phone if possible and correct if slow). Aim for 10 compressions every 6 seconds or so
Talk rescuer through repeating 2 breaths and 30 compressions (until the ambulance crew arrives) “Push hard. Push Fast”
If the patient vomits – roll them onto their side and clear their mouth with your finger or a cloth and return the patient to their back.
Start compressions and breathing again
If vomiting occurs more than twice, cease mouth to mouth and continue cardiac compressions only
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PROBLEM CARD 11 – CHOKING
“An ambulance is being sent. I need to ask you some more questions about the incident”
How old is the patient?
Is the patient still choking?
Is the patient conscious and awake?
IF NO – then COMMENCE CPR IMMEDIATELY
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
Can the patient talk/cough?
If yes, then go to Choking Mild PAA
If no then:
Are they breathing normally?
DISPATCH PRIORITY:
If no then go to Choking Severe PAA
What is the patient’s skin colour – especially around the mouth?
P1
Any idea on what they might have choked on?
Does the patient have any other medical conditions? Any other relevant medical information?
P2 if low risk
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Additional Information
Pre-Arrival Advice
MILD
Choking should be considered a possibility in the setting of a
sudden collapse while eating or sudden unconsciousness in a
Patient able to talk/cough/breathe = mild or partial obstruction
previously healthy child under 6 years
Encourage the patient to cough repeatedly –
DO NOT attempt
back blows, chest thrusts or to remove any objects
Cardiac arrests may be described by the caller as a choking
episode. Conversely, unrelieved choking episodes can lead to
Assist to a sitting position
cardiac arrests
Stay with patient and provide reassurance
LOW RISK IF:
Keep patient at temperature comfortable to them
Do not give them anything to eat or drink
Patient appears not to be still choking
AND talking and breathing normally
Get patient’s medications together
AND not cyanosed
Unlock the front door
THEN DOWNGRADE TO P2
(Night) Outside light on
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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Pre-Arrival Advice
Pre-Arrival Advice
SEVERE – Adult or Child
SEVERE – Infant
Warning – Ensure incident priority is 1
CONSCIOUS – Patient not able to talk or cough effectively?
CONSCIOUS – Patient not able to talk or cough effectively?
Is there someone there who can help you?
Is there someone there who can help you?
YES – stay on the phone – relay advice
YES – stay on the phone – relay advice
NO – can you move the patient closer or take the phone to the patient?
NO – can you move the patient closer or take the phone to the patient?
Can you put the phone on loudspeaker or speakerphone?
Can you put the phone on loudspeaker or speakerphone?
Attempt to put patient into head down position (lean across chair or
Put patient into a head down position (lay across lay or arm) with
table). If this is too difficult, abandon and move patient into a
face to the floor. Ensure the patient’s head is gently supported
position where you can access their back – standing or sitting
Give 5 short sharp back blows using the heel of one hand between
Give 5 short sharp back blows using the heel of one hand between
the shoulder blades.
the shoulder blades.
Check after each blow to see if the obstruction has cleared
Check after each blow to see if the obstruction has cleared
If still obstructed, give 5 chest thrusts. Roll patient onto their back
If still obstructed, give 5 chest thrusts. Ensure the patient’s back is
ensuring that the head is gently supported. Give 5 short sharp chest
supported by either a chair/wall/lying down/another person. Give 5
thrusts using the same hand placement as for CPR.
short sharp chest thrusts using the same hand placement as for CPR.
Check after each blow to see if the obstruction has cleared
Check after each blow to see if the obstruction has cleared
If not cleared, alternate between 5 back blows and 5 chest thrusts,
If not cleared, alternate between 5 back blows and 5 chest thrusts,
remembering to check between each
remembering to check between each
UNCONSCIOUS – Check airway for any visible material and remove gently
UNCONSCIOUS – Check airway for any visible material and remove gently
with fingers. If patient is not conscious, COMMENCE CPR
with fingers. If patient is not conscious, COMMENCE CPR
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PROBLEM CARD 12 – DIABETIC
“An ambulance is being sent. I need to ask you some more questions about the incident”
How old is the patient?
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
Any changes in behaviour/personality?
Have they been sick in the last week?
Any other priority symptoms?
(Pale, sweaty, confused, chest pain, breathing difficulty, fitting)
DISPATCH PRIORITY:
Does the patient have any other medical conditions? Any other relevant medical information?
P1
P2 if low risk
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Additional Information
Pre-Arrival Advice
Hypoglycaemic patients may appear intoxicated. Be highly
If the patient is not conscious, but still breathing normally –
suspicious of patients with a history of diabetes & alcohol
place patient on their side – regardless of their injury/illness.
consumption.
Tilt head back gently. Keep checking breathing
Allow the patient, to get comfortable. Legs elevated if
Patients with insulin dependent diabetes may have non-
feeling faint or dizzy
typical presentations of serious underlying conditions such as
ischaemic heart disease.
Stay with patient & keep checking patient
LOW RISK IF:
Do not give them anything to eat or drink (NB – Confused
Patient feels unwell but no:
patient behaving abnormally can be considered for a sweet
drink – if they are able to talk)
Decreased LOC
Keep patient at temperature comfortable to them
Chest pain
Breathing difficulties
Get patient’s medications together
Behavioural changes
Fitting
Unlock the front door
(Night) Outside light on
THEN DOWNGRADE TO P2
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 13 – DROWNING (NEAR)
“An ambulance is being sent. I need to ask you some more questions about the incident”
How old is the patient?
Is the patient out of the water?
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
Any other injuries? (If yes, provide details)
Does the patient have any other medical conditions? Any other relevant medical information?
DISPATCH PRIORITY:
P1
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Additional Information
Pre-Arrival Advice
All near drowning cases require an urgent response, even if
Patient still in water – attempt rescue only if safe to do so,
talking at time of call
and if you are sure of your capabilities
If patient not conscious, but still breathing normally – place
Under no circumstances will a near drowning case not be
patient on their side. Tilt head back gently. Keep checking
resourced by the Communications Centre
breathing
Stay with patient
Dry patient off and keep warm
Do not give anything to eat or drink
Unlock the front door
(Night) Outside light on
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 14 – ELECTROCUTION (INCLUDING LIGHTNING STRIKE)
“An ambulance is being sent. I need to ask you some more questions about the incident”
Is there still an electrical threat to the patient/others?
If yes – go to first 3 steps in PAA How old is the patient?
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
Has the patient fallen or been thrown?
(If yes, how far?)
Does the patient have any injuries?
DISPATCH PRIORITY:
Does the patient have any other medical conditions? Any other relevant medical information?
Do you know what voltage the electrical current was?
(e.g. 12V, 240V)
P1
P2 if low risk
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Additional Information
Pre-Arrival Advice
ENSURE YOU ARE SAFE!!
LOW RISK IF ALL THE FOLLOWING:
Turn off power at meter box if possible
Domestic current (240V) AND
Don’t approach patient if any doubt as to safety. Be especially cautious if
NO decreased LOC
any water about
NO fall of significance
If patient not conscious, but still breathing normally – place patient on
NO obvious injury
their side. Tilt head back gently. Keep checking breathing
NO significant past medical history
Allow patient to get comfortable usually lying down. Don’t move if fallen
or thrown
THEN DOWNGRADE TO P2
Cool burnt areas with water; make sure patient does not get too cold
(Don’t do this if any likelihood of power still being on)
Keep patient at temperature comfortable to them
Stay with patient
Do not give anything to eat or drink
Get patient’s medications ready
Unlock the front door
(Night) Outside light on
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 15 – EYE EMERGENCIES
“An ambulance is being sent. I need to ask you some more questions about the incident”
How old is the patient?
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
When did this happen/how long has it been going on?
Any pain? Any change in vision?
If injury What happened?
DISPATCH PRIORITY:
If chemical involvement – which chemical?
Consider Chemical Database search
Any fluid leaking out of the eye?
P2
Does the patient have any other relevant medical conditions? Any other relevant medical
information?
P1 if high risk
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Additional Information
Pre-Arrival Advice
If patient not conscious, but still breathing normally – place
Eye emergencies such as small foreign bodies and corneal
patient on their side. Tilt head back gently. Keep checking
abrasions are painful but not high risk
breathing
Burns to the face with eye involvement (other than
If eye injured – do not let patient move around; don’t flush with
chemicals) should be managed as for burns
water; attempt to cover both eyes with eye pads
If chemical injury –stop washing with copious amounts of water if
recommended
HIGH RISK IF:
Any object poking out of eye – DO NOT TOUCH!
Decreased LOC
Stay with patient
OR chemical involvement
OR acute decrease in vision
Keep patient at temperature comfortable to them
OR penetrating injury
Do not give anything to eat or drink
OR fluid leaking from eye
OR significant mechanism of injury
Unlock the front door
THEN UPGRADE TO P1
(Night) Outside light on
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 16 – FALLS
“An ambulance is being sent. I need to ask you some more questions about the incident”
How old is the patient?
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
Does the patient appear to have been injured?
Is there any serious bleeding?
Is the patient able to move all limbs?
DISPATCH PRIORITY:
How far did the patient fall?
Does the patient have any other relevant medical conditions? Any other relevant medical
information?
P2
P1 if high risk
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Additional Information
Pre-Arrival Advice
If patient not conscious, but still breathing normally – place
Falls usually mean a fall on one level
patient on their side. Tilt head back gently. Keep checking
breathing
Be suspicious of falls in elderly people - there may be an
underlying reason for the fall that is more serious than the
Allow patient to get comfortable – usually lying down. Legs
actual fall
elevated if feeling faint or dizzy, unless injury to leg/s
If significant mechanism or height of injury, attempt to keep
patient as still as possible
HIGH RISK IF:
If bleeding – direct pressure over wound to stop bleeding. If no
Altered LOC or
other injury, try to elevate the bleeding part
Unknown/uncertain LOC or
Stay with patient
Fall >2 metres or
Serious bleeding or
Keep patient at temperature comfortable to them
Breathing difficulties or
Do not move patient unless in significant danger
Suspected major fracture (pelvis or femur) or
Multiple fractures
Do not give anything to eat or drink
Unlock the front door
THEN UPGRADE TO P1
(Night) Outside light on
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 17 – FITTING
“An ambulance is being sent. I need to ask you some more questions about the incident”
Is the patient still fitting? If yes – how long?
How old is the patient?
If not still fitting - is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
Have they ever had a fit before?
If NO – Consider cardiac arrest, especially in adults who have been sleeping
Have there been any other recent medical problems?
(Injury to head, Severe headache, Diabetic, Overdose, Unusual behaviour/speech,
Pregnancy, Child – illness with increased temperature)
DISPATCH PRIORITY:
Does the patient have any other relevant medical conditions? Any other relevant medical
information?
P1
P2 if low risk
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Additional Information
Pre-Arrival Advice
Still fitting – gently attempt to roll onto side; do not attempt to
Seizures may be the obvious manifestation of a great range
restrain patient; protect patient from injury
of more serious underlying conditions (e.g. cardiac arrest;
drug overdose; hypoglycaemia; stroke, overheating)
Don’t put anything in patient’s mouth
Breathing assessment is difficult, as initially all seizure
Fit stopped – roll onto side; tilt head back gently. Keep checking
patients will have absent or unusual breathing
patient, especially breathing
Most seizures in children under 5 are febrile convulsions
Child with temperature – remove clothes down to singlet and
nappy – Do not let them shiver
Stay with patient
LOW RISK IF:
Keep patient at temperature comfortable to them
Previous seizure history AND
Do not give anything further to eat or drink
No active fitting AND
Talking
Get patient’s medications together
Unlock the front door
THEN DOWNGRADE TO P2
(Night) Outside light on
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 18 – HEADACHE
“An ambulance is being sent. I need to ask you some more questions about the incident”
How old is the patient?
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
Does the patient have any of the following – strange feeling in arms/legs, Inability to move arms/legs, nausea & vomiting, sudden confusion,
new or sudden visual disturbances, or new or sudden speech deficit?
Did it come on suddenly?
DISPATCH PRIORITY:
How long has the patient had the headache?
How severe is the headache? Mild, Moderate or Severe?
P2
Does the patient have any other relevant medical conditions? Any other medical information?
P1 if high risk
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Additional Information
Pre-Arrival Advice
If patient not conscious, but still breathing normally – place
Most headaches cases are not urgent – however it is vital to
patient on side. Tilt head back gently. Keep checking breathing
establish those that may be serious
Allow the patient to get comfortable, preferably sitting up a little
Stay with patient
Keep patient at temperature comfortable to them
HIGH RISK IF (any):
If photophobic adjust lights
New or sudden inability to speak normally
Do not give anything to eat or drink
Decreased LOC or
Sudden confusion or
Get patient’s medications together
Sudden onset visual disturbances or
Sudden onset “worst headache ever”
Unlock the front door
(Night) Outside light on
THEN UPGRADE TO P1 – Clinician to review all headache
cases
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 19 – HEAT AND COLD EMERGENCIES
“An ambulance is being sent. I need to ask you some more questions about the incident”
How old is the patient?
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
Is the patient complaining of – Chest pain, SOB, faint/dizziness, altered LOC/unusual behaviour, any other symptoms?
What is the nature of the exposure?
What is the length of the exposure?
IF HEAT:
Is the patient experiencing sweatiness, flushed/red skin, pale or dry skin, nausea and/or vomiting?
Are they sunburnt? If so where?
DISPATCH PRIORITY:
Do they feel hot to touch?
IF COLD:
P1
Does the patient have blue or pale skin? Are they shivering?
Do they feel cold to touch?
Do they have any frostbite? If so where?
P2 if low risk
Does the patient have any other relevant medical conditions? Any other relevant medical
information?
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Additional Information
Pre-Arrival Advice
HEAT
If patient not conscious, but still breathing normally – place
Exposure to heat or cold may not be immediately apparent
patient on side. Tilt head back gently. Keep checking breathing
as the cause of the initial problem
Move patient to light, shaded and cool area if possible
Remove outer clothing
Underlying conditions may be made worse by heat/cold
Apply cool water to skin with fanning if possible
exposure
Conscious patient, not nauseated – give ice to suck or small sips of
cool water
People of extremes of age are most at risk – the very young
Rest the patient
and the very old
COLD
If patient not conscious, but still breathing normally – place
patient on side. Tilt head back gently. Keep checking breathing
Keep patient warm and protected from environment
LOW RISK IF:
Do not vigorously rub patient
Do not move unless unavoidable; gentle handling
Do not give anything to eat or drink (including alcohol)
Normal LOC AND
No significant priority symptoms
GENERAL
Keep checking patient
THEN DOWNGRADE TO P2
Allow the patient to get comfortable, usually lying down
Stay with patient
No alcohol
Unlock the front door
(Night) Outside light on
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 20 – INJURED PERSON
“An ambulance is being sent. I need to ask you some more questions about the incident”
How old is the patient?
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
How was the patient injured?
What part of the body appears to be injured?
Does the patient appear trapped? If yes – how?
DISPATCH PRIORITY:
Are there any hazards?
(gas, electricity, chemicals, leaking fuel, etc)
Does the patient have any other relevant medical conditions? Any other relevant medical
P2
information?
P1 if high risk
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Additional Information
Pre-Arrival Advice
If the patient is not conscious, but still breathing normally – place
HIGH RISK IF:
patient on their side – regardless of their injury/illness. Tilt head
back gently. Keep checking breathing
Decreased LOC OR
Allow patient to get comfortable usually lying down. Legs elevated
Breathing difficulties OR
if feeling faint or dizzy, unless injury to the leg/s
Entrapment of major body part OR
If significant mechanism or height of injury, attempt to keep
Multiple major fractures OR
patient as still as possible
Significant mechanism of injury
If bleeding – direct pressure over wound to stop bleeding. If no
other injury, try to elevate the bleeding part
THEN UPGRADE TO P1
Stay with patient
Keep patient at temperature comfortable to them
Do not move patient unless in significant danger
Do not give them anything to eat or drink
Unlock the front door
(Night) Outside light on
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 21 – MOTOR VEHICLE/BIKE ACCIDENT
“An ambulance is being sent. I need to ask you some more questions about the incident”
How many vehicles are involved?
How many people are injured?
Are injured people still in the vehicles,
(If NO ) are they moving around?
Does there appear to be anyone unconscious?
Does anyone appear to be trapped?
What types of vehicles are involved?
(E.g. bus, truck, etc)
Are the vehicles on or off the road?
If vehicle is off the road, attempt to collect the following information:
Where is the vehicle located?
(E.g. down slope, river bed, etc) What is the best access point?
DISPATCH PRIORITY:
Approximate distance from main road?
Is the time of the accident known?
Do they have a GPS – what are the co-ordinates?
P1
Are the vehicles easily accessed from the road?
Are there any hazards?
(E.g. gas, electricity, chemicals, leaking fuel)
P2 if low risk
Any other relevant medical information?
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Additional Information
Pre-Arrival Advice
If the patient is not conscious, but still breathing normally – place
patient on their side – regardless of their injury/illness. Tilt head
back gently (even is still in vehicle). Keep checking breathing
Allow patient to get comfortable usually lying down. Legs elevated
if feeling faint or dizzy, unless injury to the leg/s
If bleeding – direct pressure over wound to stop bleeding. If no
other injury, try to elevate the bleeding part
If motorcycle accident – Do not remove helmet
Stay with patient
Keep patient warm
Do not move patient unless in significant danger
Do not give them anything to eat or drink
Unlock the front door
(night) outside light on
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 22 – OVERDOSE OR POISONING
“An ambulance is being sent. I need to ask you some more questions about the incident”
How old is the patient?
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
What substance/s are involved? Prescription drugs, Chemicals, Illicit drugs, Alcohol?
Do you have any idea how much was taken?
IF YES:
Strength?
DISPATCH PRIORITY:
Number of tablets?
Volume of fluid?
When did this occur?
P1
Any other priority symptoms? Sweaty, Confused, Chest Pain, SOB, Fitting, Nausea/vomiting?
Is this thought to be a suicide attempt?
P2 if low risk
Does the patient have any other relevant medical conditions? Any other relevant information?
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Additional Information
Pre-Arrival Advice
Consider Poisons Information or a VISION CAD Chemical
Ensuring your own safety – remove patient from danger/exposure
database search
If carbon monoxide – ensure engine is not running, open
windows/doors, move patient outside if possible
Alcohol involvement, alone or in combination, is a significant
problem, & still requires an urgent response in combination
If the patient is not conscious, but still breathing normally – place
with other factors
patient on their side – regardless of their injury/illness. Tilt head
back gently. Keep checking breathing
LOW RISK IF:
Don’t induce vomiting. However – if patient has already vomited,
try to keep vomited material
Very reliable information as to what has been
Stay with patient
taken, when and how much AND
Recent exposure AND
Do not give them anything to eat or drink
Patient talking AND
Keep patient at temperature comfortable to them
NO priority symptoms
Keep packaging of anything patient may have taken. Get patient’s
THEN DOWNGRADE TO P2 – This will generally only be in
usual medication together
the setting of an accidental overdose
Unlock the front door
(Night) Outside light on
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 23 – PEDESTRIAN & PUSHBIKE ACCIDENT
“An ambulance is being sent. I need to ask you some more questions about the incident”
How old is the patient?
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
Down slope, river bed, on road, etc
What is the best access point?
Approximate distance from main road?
Do they have a GPS – what are the co-ordinates?
What happened?
DISPATCH PRIORITY:
When did the accident occur?
P1
What part of the body appears injured?
Is there any bleeding?
(No, Minimal, Significant)
P2 if low risk
Does the patient have any other relevant medical conditions? Any other relevant information?
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Pre-Arrival Advice
If the patient is not conscious, but still breathing normally – place
patient on their side – regardless of their injury/illness. Tilt head
back gently. Keep checking breathing
LOW RISK:
Allow patient to get comfortable, usually lying down. Legs
No decreased LOC AND
elevated if feeling faint or dizzy unless injury to leg/s
No breathing difficulties AND
If bleeding – direct pressure over wound to stop bleeding. If no
No significant bleeding AND
other injury, try to elevate bleeding part
No major fractures AND
Do not remove helmet
No high risk mechanism of injury AND
No entrapment
Stay with patient
Accident <4 hours and no significant symptoms and
Do not move patient unless in significant danger
signs
Do not give them anything to eat or drink
THEN DOWNGRADE TO P2
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 24 – PREGNANCY - CHILDBIRTH
“An ambulance is being sent. I need to ask you some more questions about the incident”
How old is the mother?
Is the she awake/talking?
Is the she breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
Has the baby been born yet?
IF YES – Is the baby alert/crying?
IF baby NOT alert and crying – go to Neonate CPR
IF baby not born yet – go onto next questions
How many other children has she given birth to?
How many months/weeks pregnant?
Is any part of the baby showing? If yes – what part?
What is the frequency of the pain/contractions?
(How many in 10 minutes/How long do they last?)
DISPATCH PRIORITY:
Does the mother have an urge to push/have bowels open?
Is there any bleeding?
(No, Minimal, Significant) Are there any other signs/symptoms?
(Sweaty, Faint, Dizzy, Severe headache) Was this a normal pregnancy? (If not, describe)
P1
Does the patient have any other medical conditions? Any other relevant information?
Is this a homebirth/or is a mid-wife with you?
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Pre-Arrival Advice
Pre-Arrival Advice - Delivery
Baby born
Is there someone there who can help you?
YES – stay on the phone – relay advice
If mother not conscious, but still breathing – place her onto side.
NO – can you move the patient closer or take the phone to the patient?
Tilt head back gently. Keep checking breathing
Can you put the phone on loudspeaker or speakerphone?
Check if mother has clothes covering the birthing area –
if yes advise to
Imminent birth – got to Birth PAA
remove
Check position of the mother – if in a position of comfort and you are
Baby already delivered – place on mother’s abdomen or chest, do
able to view the birth then don’t change
not pull the cord. Cover baby with dry towel. Keep baby warm
If unable to view suggest – lie on back with knees bent or kneel on all fours
Get towels/sheets beneath the mother’s buttocks and have more
available
Keep mother and baby at temperature comfortable to them
The baby’s head should appear first
Support head as the rest of the baby is delivered – DO NOT push or pull
Stay with mother and baby – ensure there is no significant
Fluid/blood will come with the baby – this is normal
haemorrhage
As baby is delivered – check the cord is not around the neck.
If so, refer
immediately to Clinician
Unlock the front door
Do not pull or cut the cord
Place the baby on mother’s abdomen or chest – careful not to pull the cord
(Night) Outside light on
Check baby is breathing OK – if not, rub gently but firmly with towel
If baby does not start breathing – go to Infant CPR
Cover baby and mother with a dry towel/sheet. Keep baby dry and warm
If possible, have someone meet the ambulance
Now check the mother – ensure she is awake/talking, bleeding has
stopped, does everything seem to be ok?
If no – refer to Clinician
If mother or baby’s condition changes – ring back 000
BREECH PRESENTATION (Foot, arm or buttocks first presenting part)
Place mother in kneeling or squatting position
Support baby with your hands
DO NOT attempt to pull baby by arm or leg –
REFER TO CLINICIAN
PROLAPSED CORD
Place mother in kneeling position with her head down and buttocks
raised in the air
DO NOT TOUCH THE CORD
DO NOT allow mother to lie flat –
REFER TO CLINCIAN
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PROBLEM CARD 25 – PREGNANCY PROBLEM
“An ambulance is being sent. I need to ask you some more questions about the incident”
How old is the patient?
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
How many weeks/months pregnant?
1st trimester – 0 to 3 months or 0 to 12 weeks
2nd trimester – 4 to 6 months or 13 to 24 weeks
3rd trimester – 7 to 9 months or 25 to 40 weeks
Does the patient have abdominal pain/back pain/cramping/period-like pain?
If yes & >22 weeks – to go Pregnancy Childbirth
Does the patient have any – nausea, headache, confusion, altered behaviour?
DISPATCH PRIORITY:
Is the patient fitting?
If yes – consider change case type to Fitting
Is there any bleeding?
(No, Minimal, Significant)
P1
Has there been any injury to the abdomen? If yes, what happened?
Does the patient have any other medical conditions? Any other relevant information?
P2 if low risk
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Pre-Arrival Advice
LOW RISK IF:
If the patient is not conscious, but still breathing normally –
place patient on their side – regardless of their injury/illness.
“Cramps”; minor bleeding AND <20 weeks
Tilt head back gently. Keep checking breathing
pregnant
Illness or injury while pregnant with no
Allow the patient, if conscious, to get comfortable. Legs
elevated if feeling faint or dizzy
significant mechanism of injury or priority
symptoms
IF BLEEDING – direct pressure over wound to stop bleeding.
If no other injury, try to elevate bleeding part
THEN DOWNGRADE TO P2
Stay with patient
Keep patient at temperature comfortable to them
Do not move conscious patient unless in significant danger
Do not give them anything to eat or drink
Unlock the front door
(Night) Outside light on
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 26 – PSYCHIATRIC
“An ambulance is being sent. I need to ask you some more questions about the incident”
How old is the patient?
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
Where is the patient now?
Does the patient have any previous mental health issues? If yes – what is the patient’s name?
Has the patient attempted to harm themselves? If yes, how?
Is the patient aggressive towards other people?
DISPATCH PRIORITY:
Are there any weapons involved or easily available?
IF YES – request urgent AFP assistance and notify ACTAS Duty Officer
P2
Was this a sudden onset of behaviour?
Does the patient have any other medical conditions? Any other relevant information?
P1 if high risk
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Additional Information
Pre-Arrival Advice
Leave if you feel threatened or in danger
Be suspicious of behavioural problems in people with no
previous mental health issues
Protect yourself and the patient if appropriate
If the patient is not conscious, but still breathing normally –
place patient on their side – regardless of their injury/illness.
HIGH RISK IF:
Tilt head back gently. Keep checking breathing
Actual or potential serious medical problem
or injury
Stay with patient; watch them; keep them calm if possible
Suicide attempt by unknown method
Do not give them anything to eat or drink
Third party and/or unreliable information
Sudden onset of behavioural problems in
Unlock the front door
patient with Diabetes or complex health
(Night) Outside light on
problems
If possible, have someone meet the ambulance
THEN UPGRADE TO P1
If patient’s condition changes – ring back on 000
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PROBLEM CARD 27 – SHOOTING OR STABBING
“An ambulance is being sent. I need to ask you some more questions about the incident”
When did this occur?
Is this an assault or is it self-inflicted?
IF ASSAULT:
Is the assailant still present?
NOTIFY AFP and request URGENT attendance
How old is the patient?
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
DISPATCH PRIORITY:
Type of weapon/what happened?
Location of wound/s?
P1
Number of wounds?
Is there any bleeding?
(No, Minimal, Significant)
P2 is low risk
Does the patient have any other medical conditions? Any other relevant information?
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Pre-Arrival Advice
Ensure safety, especially if assailant nearby
LOW RISK IF:
If the patient is not conscious, but still breathing normally – place patient
Single peripheral injury below elbow or knee
on their side – regardless of their injury/illness. Tilt head back gently.
Keep checking breathing
AND conscious
If bleeding – direct pressure over wound to stop bleeding. If no other
AND no significant blood loss
injury, try to elevate the bleeding part
OR old injury - >4 hours; conscious with no
Do not remove any impaled object
priority symptoms
Try not to move weapons/disturb crime scene
THEN DOWNGRADE TO P2
Allow patient to get comfortable, usually lying down. Legs elevated if
feeling faint or dizzy unless injury to legs
Stay with patient
Keep patient at a temperature comfortable to them
Do not move patient unless in significant danger
Do not give them anything to eat or drink
Unlock the front door
(Night) Outside light on
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 28 – SICK PERSON
“An ambulance is being sent. I need to ask you some more questions about the incident”
How old is the patient?
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
What is the nature of the problem?
Any of the following sign/symptoms – SOB, Chest Pain, Sudden behavioural changes, Dizziness/fainting, sweating/very pale skin?
IF YES – consider changing case type to specific complaint – i.e. Cardiac Problem or Breathing Difficulty
DISPATCH PRIORITY:
Is there any bleeding?
(No, Minimal, Significant)
Does the patient have any other medical conditions? Any other relevant information?
P2
P1 if high risk
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Additional Information
Pre-Arrival Advice
If the patient is not conscious, but still breathing normally –
These calls require careful questioning to elicit relevant
place patient on their side – regardless of their injury/illness.
information. Some important information may be
Tilt head back gently. Keep checking breathing
volunteered – this must also be carefully considered
Allow the patient, if conscious, to get comfortable. Legs
Be very cautious with patients who are elderly, diabetic or
elevated if feeling faint or dizzy
who have a complex medical history
IF BLEEDING – direct pressure over wound to stop bleeding.
If no other injury, try to elevate bleeding part
HIGH RISK IF:
Stay with patient
Decreased LOC or
Breathing difficulties or
Keep patient at temperature comfortable to them
Significant bleeding or
Do not move conscious patient unless in significant danger
Chest pain or
Sudden behavioural changes with no
Do not give them anything to eat or drink
previous history
Unlock the front door
THEN UPGRADE TO P1
(Night) Outside light on
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 29 – STROKE
“An ambulance is being sent. I need to ask you some more questions about the incident”
How old is the patient?
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
Does the patient have any of the following?:
Facial droop?
Can they move their arms normally?
Speaking normally?
Sudden behavioural changes?
DISPATCH PRIORITY:
When did this occur?
Does the patient have any other medical conditions? Any other relevant information?
P1
P2 if low risk
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Pre-Arrival Advice
If the patient is not conscious, but still breathing normally –
Talking is obviously not as reliable a sign of level of
place patient on their side – regardless of their injury/illness.
consciousness with stroke. Use term “alert” as an
Tilt head back gently. Keep checking breathing
alternative.
Allow the patient, if conscious, to get comfortable. Some
stroke patients can encounter significant swallowing
LOW RISK IF:
problems – even while conscious. Continually check that
patient is maintaining an adequate airway. If airway
Patient conscious and alert AND
maintenance is a problem, the patient needs to be placed on
No signs or symptoms present OR
their side to allow saliva to drain. Tilt head back gently. Keep
checking breathing
Signs or symptoms completely resolved
Stay with patient
THEN DOWNGRADE TO P2
Keep patient at temperature comfortable to them
Do not give them anything to eat or drink
Unlock the front door
(Night) Outside light on
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 30 – UNCONSCIOUS OR ALTERED CONSCIOUSNESS
“An ambulance is being sent. I need to ask you some more questions about the incident”
How old is the patient?
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
Did you see/hear the patient collapse?
Any other recent episodes of collapse?
Does the patient have any other medical conditions? Any other relevant information?
DISPATCH PRIORITY:
P1
P2 if low risk
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Additional Information
Pre-Arrival Advice
If decreased level of consciousness – put patient on their
Many conditions will lead to a period of unconsciousness.
side and tilt head slightly backwards. Keep checking patient
Some are critical and some are not
Allow the patient to get comfortable, usually lying down.
Always assume a cardiac arrest event if unconscious and not
Legs elevated if feeling faint or dizzy unless injury to legs
breathing normally
Stay with patient
LOW RISK IF:
Keep patient warm
Patient <50 years old AND
Do not move patient unless in significant danger
No significant medical history AND
Do not give them anything to eat or drink
Single episode with rapid recovery and
patient now fully conscious
Get patient’s medications together
Unlock the front door
THEN DOWNGRADE TO P2
(Night) Outside light on
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 31 – MEDI-ALERT ACTIVATION
“An ambulance is being sent. I need to ask you some more questions about the incident”
How old is the patient?
Is there voice contact with the patient?
IF YES – go to question 3
IF NO – go to question 7
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Where exactly is the patient located?
(Ward, Room #, Level, Wing, Shop, etc)
What is the phone number of the address?
DISPATCH PRIORITY:
(If voice contact established) What is the patient complaining of?
Are there any special entry instructions for this address?
P1
What medical history do you have on record for this patient?
What is the name, phone number and relationship of this patient’s primary contact?
P2 if low risk
Does the patient have any other medical conditions? Any other relevant information?
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Additional Information
Pre-Arrival Advice
If the patient is not conscious, but still breathing normally –
ACTAS should always attempt to establish voice contact with
place patient on their side – regardless of their injury/illness.
the patient
Tilt head back gently. Keep checking breathing
The medi-alert company may need to disconnect their call
Allow the patient, if conscious, to get comfortable. Legs
with the address in order for direct communication to be
elevated if feeling faint or dizzy unless injury to leg/s
established
IF BLEEDING – direct pressure over wound to stop bleeding.
In case of voice contact by ACTAS – case type may be revised
If no other injury, try to elevate bleeding part
to accurately reflect presenting problem
Stay with patient
If case type changed – use specific PAA
Keep patient at temperature comfortable to them
LOW RISK IF:
Do not move conscious patient unless in significant danger
Voice contact established by ACTAS with low
Do not give them anything to eat or drink
acuity presentation – i.e. Fall AND/OR
Unlock the front door
Primary contact in contact with ACTAS and
on scene with low acuity presentation
(Night) Outside light on
If possible, have someone meet the ambulance
THEN DOWNGRADE TO P2
If patient’s condition changes – ring back on 000
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PROBLEM CARD 32 – UNKNOWN INCIDENT
“An ambulance is being sent. I need to ask you some more questions about the incident”
Can you see a patient?
IF YES then continue
IF NO – then go to question 10
How old is the patient?
Is the patient awake/talking?
Is the patient breathing normally?
Early recognition of cardiac arrest can often be delayed because of misunderstanding of the severity of breathing status.
If unconscious or not breathing normally – COMMENCE CPR
Is the patient male or female?
Male/Female/Unknown
Did you hear them talk or cry?
What is the patient doing now?
Standing?
Sitting down?
Lying down?
DISPATCH PRIORITY:
Where exactly is the patient?
Location can often suggest the type of problem. For example:
Bank or golf course – cardiac arrest or fitting
Garage – electrocution or carbon monoxide poisoning
P1
Park – injured person or assault
Restaurant – choking or allergic reaction
Street or intersection – MVA or pedestrian accident
P2 if low risk
Does the patient have any other medical conditions? Any other relevant information?
What makes you believe an ambulance is required?
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Additional Information
Pre-Arrival Advice
If the patient is not conscious, but still breathing normally –
place patient on their side – regardless of their injury/illness.
LOW RISK IF:
Tilt head back gently. Keep checking breathing
No LOC AND
Allow the patient, if conscious, to get comfortable. Legs
Normal breathing AND
elevated if feeling faint or dizzy unless injury to leg/s
No serious bleeding AND
IF BLEEDING – direct pressure over wound to stop bleeding.
No significant mechanism of injury AND
If no other injury, try to elevate bleeding part
Patient can be seen or accessed
Stay with patient
THEN DOWNGRADE TO P2
Keep patient at temperature comfortable to them
Do not move conscious patient unless in significant danger
Do not give them anything to eat or drink
Unlock the front door
(Night) Outside light on
If possible, have someone meet the ambulance
If patient’s condition changes – ring back on 000
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PROBLEM CARD 33 – URGENT TRANSFER
“An ambulance is being sent. I need to ask you some more questions about the incident”
Is the transfer time critical?
The following presentations are considered to be time critical:
Cardiac STEMI
AAAs
Head injuries
Presenting problem/reason for transfer?
Patient’s pick up location?
Hospital/ward/unit/room Patient name?
Date of birth?
Requesting or authorising senior doctor? Best phone contact for same?
Patient destination: Hospital and ward/unit?
Ensure crew is aware of patient destination
DISPATCH PRIORITY:
Is the receiving hospital aware of the transfer?
IF NO – refer to the Clinician
If Clinician is unavailable, collect remaining information and inform caller the Clinician will review
the request and call back shortly.
P2A
Who is the receiving medical officer?
Is there an escort?
If yes, what type – EN, RN, MD, other
Special equipment/medications/requirements?
(Consider excessive weight/girth) Any other relevant information?
P3 if low acuity
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Pre-Arrival Advice
Urgent transfers must be triaged above all other
P2 case types and be resourced immediately.
LOW RISK IF:
Low acuity presenting condition/injury
following consultation with the Clinician
THEN DOWNGRADE TO P3
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