What are the next steps for treatment as a primary care paramedic (Primary Care Paramedic)?

Primary Care Paramedic Treatment Protocol

As a primary care paramedic, your first priority is to follow the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure) for all emergency situations, focusing on high-quality CPR if cardiac arrest is present.

Initial Assessment

1. Scene Safety

• Ensure scene safety before approaching the patient 1
• Call for help/additional resources as needed 1

2. Primary Assessment (ABCDE)

A - Airway

• Check for responsiveness 1
• Open airway using head tilt-chin lift maneuver 2
• Remove any visible obstructions from the mouth 2
• If unresponsive with abnormal or absent breathing, proceed to CPR 1

B - Breathing

• Assess for normal breathing or only gasping 1
• Provide rescue breathing if patient has pulse but inadequate breathing (1 breath every 6 seconds) 1
• Administer high-flow oxygen if available 2

C - Circulation

• Check pulse (simultaneously with breathing check) 1
• If no pulse, begin high-quality CPR immediately 1
• Control obvious bleeding with direct pressure 2
• Establish IV/IO access if within your scope of practice 1

D - Disability

• Assess level of consciousness using Glasgow Coma Scale 2
• Check pupillary size and reactivity 2
• Assess for focal neurological signs 2

E - Exposure

• Expose patient as necessary to assess for injuries while maintaining dignity and preventing hypothermia 2

Cardiac Arrest Management

High-Quality CPR

• Begin chest compressions at a rate of 100-120 compressions/minute 2
• Ensure adequate depth (at least 2 inches/5 cm in adults) 2
• Allow complete chest recoil between compressions 2
• Minimize interruptions in compressions 2
• Use a 30:2 compression-to-ventilation ratio if no advanced airway is in place 1
• If advanced airway is placed, provide continuous compressions with 8-10 breaths per minute 1

Defibrillation

• Apply AED as soon as it is available 1
• Follow AED prompts for analysis and shock delivery 1
• Resume CPR immediately after shock delivery or if no shock is advised 1
• Continue cycles of CPR and rhythm checks every 2 minutes 1

Medication Administration (if within scope)

• For pulseless arrest: Administer epinephrine 1 mg IV/IO every 3-5 minutes 1, 2
• For shockable rhythms (VF/pVT): Consider amiodarone or lidocaine if available and within scope 1

Special Considerations

Airway Management

• Consider advanced airway placement if trained and authorized 1
• Bag-mask ventilation is an acceptable alternative to advanced airway 1
• Confirm tube placement with clinical assessment and end-tidal CO2 if available 1

Opioid Overdose

• Administer naloxone if available and opioid overdose is suspected 1, 2
• Continue to monitor patient after naloxone administration 2

Trauma Patients

• Control hemorrhage as priority 2
• Maintain minimal acceptable blood pressure 2
• Consider rapid transport to trauma center 2

Transport Decisions

Destination Selection

• Transport to specialized cardiac arrest center if available 1
• Consider direct transport to PCI-capable facility for suspected STEMI 1
• Minimize on-scene time for time-sensitive conditions 2

Handover

• Provide clear, concise handover to receiving facility 1
• Include timing of events, interventions performed, and patient response 1

Common Pitfalls to Avoid

• Delaying CPR to perform other interventions 1
• Interrupting chest compressions for prolonged periods 1
• Failing to secure airway in unconscious patients 2
• Missing reversible causes of cardiac arrest (H's and T's) 2
• Inadequate compression depth or rate 2

Remember that high-quality CPR with minimal interruptions is the cornerstone of successful resuscitation. Your actions in the first few minutes can significantly impact patient survival and neurological outcomes.