[Paramedic]

Hello there!
Welcome to my guide about medicalRP for the job 'Paramedic'.

Why should you bother reading this guide? Well you don't have to if you don't want to, you can be the boring paramedic that just goes to a call, heals people and goes back to doing nothing. Or you can pretend to be a pro!
Rules of Engagement for Paramedics:
1. Scene safety, you can't help if you're dead.
2. Keep the patient calm, inform them of everything you do, unknown things are scary if you've just been hurt.

3. Scene safety.


1. Your kit.
As a paramedic in an emergency response vehicle (Ambulance or Rapid Response Car) you should have acces to the
following:

• • BLS bag (Basic Life Support bag): Contains diagnostic equipment, airway management and basic first aid items.
    
  • Oxygen tank with regulator
    
  • ALS bag (Advanced Life Support bag) containing diagnostic equipment, airway management and medications. Also carries Saline for Intravenous access.
    
  • ECG Defibrilator with Blood Pressure cuff and Sp02 (Oxygen saturation) meter
    
  • Suction device (Automatic and manual)
    
  • Carry Chair (Ambulance only)
    
  • Stretcher (Ambulance only)
    
  • Scoop stretcher (Ambulance only)
    
  • Spineboard with blocks (Ambulance only)
    

2. Abbreviations and assesment types.

ABCDE: The most used assesment, means Airway, Breathing, Circulation, Disability, Exposure

Airway: Is their airway clear? Is it blocked by anything such as blood, vomit or foreign objects?

Breathing: Are they breathing? Are they breathing evenly with both lungs?

Circulation: How's their blood circulation? Are they pale? Are they bleeding?

Disability: Examine the pupils (size, equality and reaction to light).Make a rapid initial assessment of the patient’s conscious level using the AVPU method: Alert, responds to Vocal stimuli, responds to Painful stimuli or Unresponsive to all stimuli. Check their glucose levels to ensure they're not suffering from hypoglycemia (Low blood sugar).

Exposure: To examine the patient properly full exposure of the body may be necessary. Respect the patient’s dignity and minimise heat loss.

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AVPU: Used for conciousness level, means Alert, Responds to Verbal, Responds to Pain, Unconcious / unresponsive.

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SAMPLE method, for basic assessments of a person during a (medical) incident.


(S)ymptoms
What symptoms have you been noticing before, during or after the incident? Have you had these symptoms before?

(A)llergies
Do you have any allergies? Have you always had these allergies or did you develop them over time?

(M)edication
Did you take any medicine before or after the incident? Do you always take this medication? Was this the first time you took this medication?

(P)ast
Are there any (similar) incidents in your past? Do you have a medical history that I need to know of that might help my assessment?

(L)ast meal
What was the last thing you ate before the incident? Did you eat something after the incident?

(E)vent
What exactly happened that caused the incident?


3. Your job as a paramedic.

Your job is simple, to ensure your patient doesn't injure themselves further and stabilise them until you can get them to hospital.

4. Differential diagnosis

On many cases you'll get a bunch of values that can be caused by a million things.

Blood pressure:

If they have low blood pressure, (Below 90/60) it can be because of:

Hypovolaemia (Low amount of fluid in the body, both blood and otherwise)
Medication such as beta blockers and anti-depressants.
Heart conditions
Sepsis (Severe infection)

If they have high bloodpressure (Above 140/90) it can be because of:

Your inability to record it properly (Removing clothing from the upper arm will help)
Acute pain
Anxiety
Pregnancy and birth control
Chronic Kidney disease
Hormonal disorders
Prescription and recreational drugs (stimulants)

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Oxygen saturation: In the pre-hospital environment (Where you as a paramedic work), you measure the oxygen saturation through a pulse oximeter, which sends a small red beam into the skin and out onto the other side of the pulse oximeter, measuring the amount of oxygen in your blood. Regular levels are about 95-100%

If they have low oxygen saturation it can be because of:

• COPD (including chronic bronchitis and emphysema)
  
• acute respiratory distress syndrome
  
• asthma
  
• collapsed lung
  
• anemia
  
• congenital heart defects
  
• heart disease
  
• pulmonary embolism
  

A measurement of 100% on a pulse oximeter is normally very good, but if the patient has carbon monoxide in the blood, it'll give a false reading, this needs to be immediately treated with oxygen therapy.

. Scenario 1: Patient fell on their bike, minor injuries. Code 2 response.

You get a call, "Male fell off bike, minor injuries, Code 2 response to Local PD parking please."

Code 2 means go there no lights and sirens (But swiftly!), you arrive to see a patient in their mid-thirties, his jeans are ripped and he has some small cuts on his arms along with some abrasions. He's talking to a bystander who called for the ambulance.


Already on arrival we know two things.

- The patient is awake, has clear airway and has steady breathing as they're talking to someone.
- The scene is safe-ish.

Next up is scene safety! Making sure you and the patient don't die. You put on your lights if necessary and get them to the side of the road if possible, moving the bike well away from your patient to prevent any further damage.

Once the scene is safe, grab your BLS bag and defibrilator and go to your patient and say. "Hi, my name is <First name>, I'm a paramedic with <County> Ambulance Service, what's your name?"

If your patient says 'I don't remember' chance is they're concussed and should get checked out at hospital. For the scenario we'll say the patient is called Mike.

What you want to do now is what's called taking basic Obs, basic observation of the patients vitals, meaning blood pressure and sp02 measurement, you do these by opening the pouches on either side of your defibrilator, wrapping the cuff around his upper arm (Removing any clothing covering the overarm, either by cutting it or getting the patient to remove it), tell him to take a few deep breaths and not to talk while you're taking the BP measurement, then press the BP button on your defibrilator, it'll the inflate and deflate before displaying a measurement on the monitor.

** 160/90 **

You make a note of it and grab the Pulse oximeter. Say to the patient:  "Just need to check your oxygen levels too, can I pop this on one of your fingers on your left hand?" You pop it onto his finger, a brief moment later, the monitor shows a saturation of.

** 98% **

Now that the basics are out of the way, you can clean up the cuts and scratches he has, use some saline to clean the wound then bandage it. Once done, get another blood pressure measurement.

** 130/70 **

Within normal parameters again, you get the chap onto the ambulance and sit him on the stretcher, he's then taken to the hospital where you give the following handover.

"This is Mike, Mike fell on his bike around <time>, fully concious throughout, alert upon our arrival, Airway and breathing were both clear, BP was a little high but final measurement before transport was 130/70. Some cuts and scratches that were cleaned and bandaged but apart from that we haven't found any other injuries. No pain relief given."

No longer than that. It needs to take a minute at most for a handover, the quicker you get it done, the quicker the ER staff can take over.




Rest of the guide is WIP, constructive criticism is welcome.

[Lord Octagon]

Ewww, automatic BP measurement. Aneroid sphygmomanometer or nothing plz.

[jess]

I think I'll stick to my

/ me does first aid

[Paramedic]

Ewww, automatic BP measurement. Aneroid sphygmomanometer or nothing plz.

Thought I'd keep it basic,

[Paramedic]

If any First Aid, EMT or Paramedics (Or Doctors, but doubt it) have any criticism or want to add to the guide, feel free to PM me, I don't bite.

[Wesley Lawrence]

Nice guide! I am sure someone like @Toxic‍, @Firav‍ and @PilotC‍ as well as some other (volunteer) FF / EMTs - or so - around here can appreciate it too.

I am not in the medical sector (my profession requires you to be a certified first responder though) but here's a quick thing I thought I could add from my most recent re-certification.


First with AVPU, I've learned that U stands for Unresponsive. Though comparing it to Unconscious, it isn't much of a difference.

Another thing would be the (S)AMPLE method, for basic assessments of a person during a (medical) incident. It might be because it's irrelevant for ALS, but I'd say for BLS it could be useful?


(S)ymptoms
What symptoms have you been noticing before, during or after the incident? Have you had these symptoms before?

(A)llergies
Do you have any allergies? Have you always had these allergies or did you develop them over time?

(M)edication
Did you take any medicine before or after the incident? Do you always take this medication? Was this the first time you took this medication?

(P)ast
Are there any (similar) incidents in your past? Do you have a medical history that I need to know of that might help my assessment?

(L)ast meal
What was the last thing you ate before the incident? Did you eat something after the incident?

(E)vent
What exactly happened that caused the incident?


Again, nice going on the thread!

[Oneshott]

Well done on the guide! Nicely detailed.

[Toxic]

Scene Safety is paramount to effective patient care.

BEFORE ANYTHING ELSE, MAKE SURE YOUR SCENE IS SAFE.

You're unable to provide patient care if you become a patient yourself. It is important that you NEVER enter a scene that is unsafe, and to remove yourself from a scene that was safe, which has now become unsafe. Use your better judgment. For example, seeing an armed individual or group at a call location (save for law enforcement en masse) would make the scene unsafe for emergency medical responders. The apparatus operator should move to a reasonably safe distance from the location and put in a request for PD response as soon as possible.

[Monkey]

Thanks a lot! I do a lot of FireRP and MedicalRP, but my medical roleplay is never consistent. Now I have a written down set of standards to follow.

[Ekron]

An excellent guide. I do like Paramedic Rp, but i have to bodge and BS a lot of things when people decide they want to actually roleplay as an injured person. So thanks!

[PilotC]

"Disclaimer: This is just a guide for medicalRP, this is not real medical advice, please do not use this for IRL medical advice or training."

Disappointed in this sentence; this is the easy 101 guide I wish I had in EMT and now Paramedic school. On that note, use this guide you'll certainly be thanked for your service.

[Paramedic]

"Disclaimer: This is just a guide for medicalRP, this is not real medical advice, please do not use this for IRL medical advice or training."

Disappointed in this sentence; this is the easy 101 guide I wish I had in EMT and now Paramedic school. On that note, use this guide you'll certainly be thanked for your service.

Really? Thanks man! I've drummed a lot of it from my medicalRP experience and IRL learning.