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Prehospital Care
An ambulance is a vehicle for transporting sick or injured people, to, from or between places of treatment for an illness or injury. The term ambulance is used to describe a vehicle used to bring medical care to patients outside of the hospital and when appropriate, to transport the patient to hospital for follow-up care and further testing. In some jurisdictions there is a modified form of the ambulance used, that only carries one member of ambulance crew to the scene to provide care, but is not used to transport the patient. In these cases a patient who requires transportation to hospital will require a patient-carrying ambulance to attend in addition to the fast responder.

The term ambulance comes from the Latin word ambulare, meaning to walk or move about patients were moved by lifting or wheeling. The word is most commonly associated with the land-based, emergency motor vehicles that administer emergency care to those with acute illnesses or injuries, hereafter known as emergency ambulances. These are usually fitted with flashing warning lights and sirens to facilitate their movement through traffic. It is these emergency ambulances that are most likely to display the Star of Life, shown on the right, which represents the six stages of prehospital medical care. which is a reference to early medical care.

There are other types of ambulance, with the most common being the patient transport ambulance. These vehicles are not usually (although there are exceptions) equipped with life-support equipment, and are usually crewed by staff with fewer qualifications than the crew of emergency ambulances. Their purpose is simply to transport patients to, from or between places of treatment. In most countries, these are not equipped with flashing lights or sirens.
Other vehicles used as ambulances include trucks, vans, station wagons, buses, helicopters, fixed-wing aircraft, boats, and even hospital ships (wilkipedia).

So whatever we have, kind of vehicles can build up as an emergency rescue, at least the vehicle is safe and comfort for the crew. Safe a life with a professional services.

The philosophy of prehospital care can be summarised as "the appropriate intervention at the appropriate time." To this end it aims to bring the benefits of advanced medical care to the roadside or similar arena. However, it also requires careful judgment as to when it would be beneficial to perform an intervention, and when the delay involved would lead to a deterioration in the patient's condition.
The practice of prehospital care is a far cry from treating a patient in a well lit, warm, and spacious resuscitation room. The situations may be uncomfortable--for instance, managing a patient in a upturned car--and frequently environmental conditions are less than ideal, as incidents often occur in bad weather or at night.
The most important in prehospital care are:
1. Ambulance preparation intact with equipments and supplies, should be ready any time for an emergency call.
2. Communication; hand held radio fully charge battery, communication should short, loud and clear.
3. Stress control; knowledge and skill, familiar the location and learn from the previous case.
4. Action; immediate dispatch the Ambulance and crew, consent with an emergency services professional.
The simple guideline for our action systematically during an emergency, explained in diagram below:

Scene Size-Up Body Substance Isolation Precautions Scene Hazards Number of Patients Need for more Help or Equipment Mechanism of Injury

Initial Assessment General Impression of the Patient Level of Consciousness Airway Breathing Circulation

Load –and -Go Situation?

Rapid Trauma Survey

Focused Exam

Load - and – Go Situation

Detailed Exam

Ongoing Exam

Scene Size-Up

Which BSI Precautions do I need to take ?
Do I See , Hear , Smell , or Sense anything dangerous
Are there any other patients ?
Are additional Personnel or Resources needed ?
Do We need Special Equipments ?
What is the Mechanism of Injury here ?
Is it Generalised or Focussed ?
Is it Potentially Life-Threatening ?

Initial Assessment
What is my General Impression of the Patient as I approach ?
Level of Consciousness (AVPU)
Introduce Yourself and say “We are here to help you . Can you tell us What Happened ?”
Airway
Is the Airway Open and Clear ?
Breathing
Is the Patient Breathing ?
What is the Rate and Quality of Respiration ?
Ventilation Instructions
Order Oxygen for any Patient with abnormal Respiration , altered Mental Status, Shock or Major Injuries .
Delegate assisted Ventilation if the Patient is Hypoventilating ( <12>
Or if there is inadequate movement of air .
Hyperventilate only those Head injury Patients who are unresponsive and show signs of Cerebral Herniation.
Circulation
What is the Rate and Quality of Pulse at the Wrist ( and at the neck if not Palpable at the Wrist ) ?
Is major external bleeding present ?
What is the Skin color , condition , and Temperature ?
Decision
Is this a Critical Situation ?
Are there interventions that I must make now ?

Rapid Trauma Survey
Head and Neck
Are there obvious wounds of the Head or Neck ? Are the Neck Veins Distended ? Does the Trachea look and feel midline or deviated ? Is there deformity or tenderness of the Neck ?
Chest
Is the Chest Symetrical ? Is there Paradoxical movement? Is there any Obvious Blunt or penetrating trauma ? Are there any open wounds or Paradoxical movement? Is there TIC of the ribs ? Are the Breath sounds present and equal ? If breath sounds are not equal , is the chest hyperresonant or dull ? Are heart sounds normal or decreased ?
Abdomen
Are there Obvious wounds ? Is the abdomen soft , rigid , or distended ? Is there tenderness ? Pelvis Are there obvious wounds or deformity ? Is there TIC ?
Upper Legs
Are there obvious wounds , swelling , or deformity ? Is there TIC ?
Scan of Lower Legs and Arms
Are there obvious wounds , swelling , or deformity ? Is there TIC ? Can the patient feel / move fingers and toes ?
Exam of Posterior
( done during transfer to the Back Board ) Is there any deformity , contusions , abrasions , penetrations , burns , tenderness , Lacerations , or swelling (DCAP – BTLS ) of the patient’s posterior side ?
Decision
Is there a critical situation ? Are there interventions I must make now ?
History
What is SAMPLE history ? ( may have been obtained during the exam )
Vital Signs
Are the Vitals Signs abnormal ?
Disability
(Perform this exam now if there is altered mental status . Otherwise , Postpone this exam until you perform Detailed Exam. ) Are the Pupils equal and reactive ? What is the Glasgow Coma Score ? Are there signs of Cerebral Herniation (unconsciousness , dilated pupil (s) , Hypertension , bradycardia , posturing ) ? Does the patient have a medical identification device ?

Detailed Exam
SAMPLE History
(complete if not already done ) What is the Patient’s history ?
Vital Signs:
What are the Vital Signs ?
Neurological Exam
What is the LOC ?
What is the Blood Glucose (if altered mental Status ) ?
Are the pupils equal ? Do they respond to light?
Can the patient move his fingers and toes ?
Can the Patient feel me touch his fingers and toes ?
What is the Glasgow Coma Score (if altered mental status )?
Head
Is there DCAP-BTLS of the face or head ?
Is Battle’s sign or raccoon eyes present ?
Is there blood or fluid draining from the ears or nose ?
Is there pallor , cyanosis or diaphoresis ?
Airway
Is the airway open and clear ?
If there are burns of the face , are there signs of burns in the mouth or nose ?
Breathing
What is the rate and quality of respiration ?
Neck
Is there DCAP-BTLS of the neck ?
Are the neck veins normal , flat , or distended ? ,Is the trachea midline or deviated ?
Circulation
What is the rate and quality of the pulse ?
What is the skin color , condition ,and temperature (capillary refill in children )
Is all external bleeding still controlled ?
Chest
Is there DCAP-BTLS of the chest ?
Are there any open wounds or paradoxical movement ?
Are the breath sounds present and equal ?
If the breath sounds are not equal , is the chest hyperresonant or dull ?
Are heart sounds normal or decreased ?
If the patient is intubated , is the endotracheal tube still in position ?
Abdomen
Is there DCAP-BTLS of the abdomen ? Is the abdomen soft , rigid , or distended ?
Pelvis
( already examined in the initial assessment – no further exam should be done
Lower Extremities
Is there DCAP-BTLS of the legs ? Is there normal PMS ? Is range of motion normal ?
Upper Extremities
Is there DCAP-BTLS of the arms ? Is there normal PMS ? Is range of motion normal ?

Ongoing Exam
Subjective Changes
Are you feeling better or worse now ?
Mental Status
What is the LOC ?
What is puillary size ? Are they equal ? Do they react to light ?
If altered mental status , what is the Glasgow Coma Score now ?
Reassess ABCs
Airway
Is the airway open and clear ?
If there are burns of the face , are there signs of inhalation injury ?
Breathing and Circulation
What is the rate and quality of respiration ?
What is the rate and quality of the pulse ?
What is the blood pressure ?
What is the skin colour , condition , and temperature (capillary refill in children)
Neck
Is the trachea midline or deviated ?
Are the neck veins normal , flat , or distended ?
Is there increased swelling of the neck ?
Chest
Are the breath sounds present and equal ?
If breath sounds are unequal , is the chest hyperresonant or dull ?
Abdomen ( if mechanism suggests possible injury )
Is there any tenderness ?
Is the abdomen soft , rigid , or distended ?
Assessment of Identified Injuries
Have there been any changes in the condition of any of the injuries that I have found?
Check Interventions
As the appropriate question for your patient .
Is the ET still patent and in the correct position ?
Is the Oxygen rate correct ?
Is the Oxygen tubing connected ?
Are the IVs running at the correct rate ?
Is the Open Chest wound still sealed ?
Is the decompression needle still working ?
Are any of the dressings blood soaked ?
Are the splints in good position ?
Is the impaled object still well established ?
Is the pregnant patient tilted to the left ?
Is the Cardiac monitor attached and working ?
Is the Pulse Oximeter attached and working ?

Coordination with partner, other emergency crew and dispatcher as a team will help an emergency system run well, continue education will help the ambulance crew more confident and professional, and the reporting system will support the team to monitor and evaluate the crew and services.
WORK SAFETY and ACT SAFELY.