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Index Note: Page references in italics refer to Figures; those in bold refer to Tables 1% rule 92–3 endotracheal intubation 24–5 asthma 27, 28, 31, 126–7, 126, 127 30-second drills 25, 48, 48 supraglottic airway devices (SADs) 23–4, 24 Australasia, training in PHEM in 1–2 airway obstruction, causes 20 automatic vehicle location system (AVLS) 4 ABC system 18, 18, 18 alcohol gel 9 AVPU (alert, voice, pain, unresponsive) score 60 ABCDEF approach 151 alkali burns 90–1, 91 abdominal injury 81–3 altitude injury 141–3 bag-valve-mask (BVM) 29–30, 30, 161 essential drugs 143 analgesia 82 ballistic injuries 76, 103 physiology at altitude 141 assessment 82 abdominal 81 Alzheimer’s disease 166 blunt trauma 81 airway management 107, 107 American National Standards Institute 9 in children 163 breathing management 107–8 amputation 87–8, 88–9, 89 evisceration 82, 82 catastrophic haemorrhage control 106–7 blast/ballistic 108 extent of abdomen 82, 82 cervical spine immobilization 107 crush injury 101 impalement 83, 83 circulation management 108 anaesthesia, prehospital 44–50 mechanisms 81 disability 108 30-second drills 48, 48 penetrating trauma 81 exposure 108 clinical assessment 45 prehospital management 82–3 firearm injuries 103 drugs 45–6, 46 resuscitation 82 management 106–8, 106 equipment checklist 47, 47 triage 83 ballistic jacket 105, 105 evidence base 44–5 abuse bariatric ambulance 171 general principles 46 child 164, 167 guidelines 44–5 bariatric patient 168–71 elderly 167 indications 44 barotrauma 147 acclimatization 141, 141 induction and intubation 47–8 basal skull fracture 72 acetaminophen 52 key points summary box 49 ‘bends’ 147 acid burns 90 minimum monitoring standards 45 benzodiazepine 54 activation of prehospital services 3–4, 4 minimum standards for practice 45, 46 binder, pelvic 39, 39 Acute Coagulopathy of Trauma Shock pediatrics 49 biological hazards 13 (ACoTS) 36 post intubation 48 biological patient idolation unit 188, 188 acute mountain sickness (AMS) 141–2, 141 pre-induction 47 blast bowel 104 advance directive 123, 204 preparation 46, 47 blast brain 104 Advanced Medical Priority Despatch System procedural summary 46–8, 49 blast ear 104 (AMPDS) 3–4 COPYRIGHTEDteam approach 45 MATERIALblast injuries 103–4 advanced trauma life support (ATLS) training and skills 45 approach to scene 105 90, 93 transfer 48–9 dynamic risk assessment 105 approach to burns 94 analgesia forensic considerations 105 adverse drug-related events (ADREs) 166 in abdominal injury 82 four Cs approach 105 air ambulance services 1 in children 163 incident management 104–5 airbags, car 15 crush injury 101 personal protective equipment 104–5, 105 aircraft, prehospital monitoring in 62 definition 51 triage 106, 106 Airwave 4 extremity injury 87 blast lung 104, 108 airway assessment 20–1 prehospital and sedation 51–4 blast wave 103 difficult 21 analgesia ladder 163 blood administration, prehospital 41 feel 20–1 anaphylaxis 36, 129 blood draw request 204, 205 listen 20 AND (Allow Natural Death) 123 blood loss, masking of 14 look 20 angel dust 53 blood pressure airway management 21–6 antepartum haemorrhage 152 invasive 60, 61 algorithm 22 arrhythmias 129 non-invasive 60 basic airway adjuncts 23 arterial gas embolization 148 blood sugar, high 130 cricothyroidotomy 25–6, 25 Asherman seal 32 body armour 10 209 210 Index body mass index (BMI) 93 CABC system 18, 18 body proportions 159 chart 168 call handling 3 size and weight 159 Bolin seal 32 call prioritization 3–4 assessment 160 Bone Injection Gun 40, 40 Caller Line Identification (CLI) 3 airway and breathing 160, 160 boots 9 Canadian C-Spine rules 77, 77 circulation 160, 161 bougie, intubating 48, 48 capillary refill 60 disability (neurological) 161, 161 Boyle’s Law 146–7, 146 capnography 25, 48, 55, 59, 59, 60,77 primary 160 brain injury non-invasive 28–9, 29 breathing 160 gunshot 108 waveform 119 cardiac arrest, resuscitation following 122–3 head injury and 71 car seat, infant immobiliation in 80 circulation 160 breathing assessment 27–9 cardiac arrest 118–25 common childhood illnesses 162 life-threatening problems 27 ethics of resuscitation 123–5 disability 160 listen 28 International Cardiac Arrest dosages 164 look 27–8 Guidelines 118–20 medical emergencies, management 161–2, 162 monitor 28–9 paediatric resuscitation 122–3 MVC 16 respiratory failure 27 predictors of poor outcome 124–5 prehospital anaesthesia 49 breathing management 29–34 prehospital emergency thoracotomy presence of parents 52 oxygen administration 29 122, 122 psychosocial aspects 160 patient positioning 31, 31 in prehospital environment 120 respiratory failure, effect of 160 transport ventilators 30–1, 31 reversible causes 120, 124 safeguarding 164 ventilation 29–30 termination of resuscitative efforts 124–5 seriously ill/injured child, initial breathlessness, life-threatening problems in trauma victim 120–2 management 161 medical 33–4 cardiac asthma 126 airway 162 trauma 31–3 cardiac emergencies 128–9 breathing 161 breech presentation 153–4, 154 cardiogenic shock 36, 36,43 circulation 161 British Association of Immediate Medical Care cardiopulmonary resuscitation (CPR) 118 trauma emergencies, management of 162–3 (BASICS) 1 cardiovascular collapse 55 abdominal injury 163 Broca formula 170, 170 casualty clearing station (CCS) 181, 183 analgesia 163 bronchospasm 29, 36, 127, 187 catecholamines 14 burns 163 burns 90–7 catheters, suction 21 chest injury 163 airway burns 94–5 cavitation 103, 103 head and neck injury 163 assessment 92 CBRN (Chemical Biological Radiological and primary survey 163 chemical 90–1, 90 Nuclear) incidents 10–11, 183, 183, 185–9 scene assessment 162–3 liquid 95 biological casualties 188 vital signs 160, 160 powder 95 chemical casualties 187–8 chin lift 21, 22, 22 in children 163 hazards 7 chlorine damage 188 contact 97 patient decontamination 186–7, 187 ‘chokes’ 148 cooling 94 radiological and nuclear casualties 188–9 cholera 35 depth 93 release 105 chronic obstructive pulmonary disease dressings 94 rescuer decontamination 187, 187 (COPD) 27 electrical 91, 92 scene management 185 chronic obstructive pulmonary/airway disease extent 92–3 assessment and safety 185 (COPD/COAD) 28, 127–8 fasciotomy and escharotomy 95–6 incident layout 186 circulation assessment and management 35–43 flash 94, 95 provider protection 186, 186 in shock 36, 36 fluid resuscitation 94 scene organization 185–6 circulatory access, in shock 40–1 IV vs oral 94 central venous lines 41, 41 clinical gloves 8–9 oral 94 cerebral artery gas embolism (CAGE) 147 clinical governance 195–200 history taking 90 cerebral perfusion pressure (CPP) 72 clinical audit 198–9 hypovolaemic shock 35 cerebrovascular accident 130 clinical effectiveness 197–8 incidence and impact 90 certification of death 183–4 clinical information management 199–200, inhalational injury 95 cervical collar in spinal cord injury 78, 78 200 chemical injury 95 in severe head injury 78 human resource management 196 thermal injury 95 CHALETS mnemonic 180 personal and professional development 196 initial management 93–4 charcoal, contraindications to 131 pillars of 195, 195 minor burns 93–4 chemical protection PPE 11 risk management 199 significant burns 94 chemical, biological, radiation and nuclear see service user involvement 195–6 management 95, 96 CBRN codeine 52 chemical 95 chest injury, in children 163 cold as hazard 13 electrical 95 chest ultrasound cold injury 134–6 liquid 95 baubles or walking ants 64 at altitude 143 mass casulaties 96 comet tail artefacts 64, 65 management 136 pain 52 multiple comet artefacts 65, 65 prevention 136, 138 referral pathways 96 pleural or lung sliding 64 risk factors for 135 thermal 90, 91 children 159–64 cold tolerance 134 types 90 abuse 164, 167 colloids 41 UK Consensus guidelines 93 anatomy and physiology 159–60 Combat Application Tourniquet (CAT) 38 BURP pressure 25 airway 159–60, 159 communication 14 Index 211 compartment syndrome 41, 96, 100, 101 diving emergencies 146–9 head injury 72 compensated shock 36, 37 ascent emergencies 147–9 obesity and 169 computer-aided dispatch (CAD) screen 3 depth emergencies 147 optimization 25 confidentiality 204, 204 descent emergencies 147 ultrasound and 64, 64 conscious sedation see procedural sedation dive physics and physiology 146–7 energy, sources of, as hazards 13, 14 consent 203 DKA 35 Enhanced Information Service for Emergency controlled mandatory ventilation (CMV) 30–1 DNA-CPR (Do Not Attempt CPR) 123 Calls (EISEC) 3 cooling methods 139 Do Not Resuscitate (DNR) orders 123 Entonox 52, 53 cord prolapse 153 Doppler ultrasound 62 envenomation 139–40, 139, 140 coronary syndromes, acute 128 Down’s syndrome 76 environmental injuries 134–40, 134 CRASH 2 trial 42 dressings, haemostatic 38–9, 39 epiglottitis 27 crepitus 28 drops, as hazard 13 epistats, nasal 39 cricothyroidotomy 25–6, 25 drowning 144–5 escape hoods, personal issue 10–11, 11 criminal law 201 definitions 144 escharotomy 95–6 crush injury 98–102 key points 144 ethics 201–2, 202, 203 acute kidney injury 100 pathophysiology 144 evacuation method 16 alkaline diuresis 101–2 predictors of survival 145 evisceration 82, 82 analgesia 101 resuscitation 145 extended duration breathing apparatus hyperkalaemia 101 drug-assisted intubation (DAI) 44 (EDBA) 186 isolation and movement to safety 100–1 Durable (Enduring) Power of Attourney for extremity injury 87–9 management 100–1 Health Care 203 aetiology 87 muscle and soft-tissue trauma 99–100 duties to treat 202–3, 205 amputation 87–8, 88–9, 89 staged tourniquet release strategy 101, 101 dynamic risk assessment 199, 199