What are the initial steps for prehospital treatment?

Prehospital Treatment: Initial Steps

The initial steps for prehospital treatment prioritize correcting vital functions through systematic assessment and stabilization of Airway, Breathing, and Circulation (ABC), followed by early diagnostic work-up with 12-lead ECG for cardiac presentations, and rapid transport to appropriate facilities. 1

Primary Assessment and Stabilization

Airway, Breathing, Circulation (ABC) Priority

• Immediately assess and secure the airway, breathing, and circulation as the foundation of all emergency resuscitation—without a secure airway, resuscitation is futile. 2, 3
• Establish airway patency first, as cardiac arrest causes cerebral anoxia within seconds and irreversible brain damage within 3-5 minutes. 2
• For trauma patients specifically, management of immediately life-threatening injuries (major hemorrhage control, airway compromise, tension pneumothorax) takes priority over advanced airway insertion. 4, 5
• In opioid overdose with respiratory arrest, maintain rescue breathing or bag-mask ventilation until spontaneous breathing returns; standard BLS/ACLS measures continue if breathing does not return. 1

Vital Signs and Monitoring

• Obtain vital signs immediately, including heart rate, blood pressure, respiratory rate, and oxygen saturation. 1
• Establish continuous ECG monitoring and secure intravenous access for all patients with suspected cardiac conditions or arrhythmias—this is mandatory. 1
• For severe preeclampsia, monitor blood pressure every 15 minutes and assess continuously for seizure activity. 6

Diagnostic Work-Up

ECG Acquisition (Cardiac Presentations)

• Acquire a 12-lead ECG as early as possible at the scene—this is the critical data point for diagnosis and decision-making in chest pain, not something to defer until later. 1
• The traditional sequence of assess airway/breathing/circulation, obtain history, assess rhythm, then initiate treatment before ECG is outdated; the 12-lead ECG should be prioritized and performed early. 1
• Transmit the prehospital ECG to the receiving hospital immediately after acquisition to allow preparation time—wireless transmission can achieve hospital availability within 2-4 minutes. 1

Time-Critical Information

• Document the "last known well time"—when the patient was last known to be normal without symptoms—as this single piece of information determines treatment eligibility for time-sensitive interventions. 1
• For stroke patients, establish this time within 15 minutes of certainty; if unavailable, use standardized time parameters (morning, afternoon, evening, overnight). 1

Initial Treatment Interventions

Oxygen and Vascular Access

• Provide supplemental oxygen to patients with hypoxemia. 1
• Establish intravenous access early in the assessment sequence. 1
• Check blood glucose level and avoid glucose-containing fluids unless the patient is hypoglycemic. 1

Condition-Specific Treatments

• For chest pain with suspected acute coronary syndrome, initiate treatment with oxygen (if hypoxemic), aspirin, nitroglycerin, and morphine as indicated. 1
• For severe preeclampsia (SBP ≥160 mmHg and/or DBP ≥110 mmHg persisting >15 minutes), administer antihypertensive medication and magnesium sulfate for seizure prevention. 6
• For opioid overdose with respiratory arrest and definite pulse, administer naloxone in addition to standard BLS/ACLS care; however, for cardiac arrest, focus on high-quality CPR rather than naloxone. 1

Transport Decisions

Destination Selection

• Transfer patients to facilities appropriate for their specific condition: PCI-capable centers for STEMI, intensive care units for hemodynamically unstable patients, specialized obstetric facilities for severe preeclampsia. 1, 6
• For STEMI identified on prehospital ECG, minimize scene time and expedite transport; consider bypassing non-PCI hospitals when appropriate. 1
• Activate the catheterization laboratory while the patient is en route based on prehospital ECG findings. 1

Pre-Arrival Notification

• Provide advance notification to the receiving facility about the patient's condition, treatments administered, and estimated time of arrival. 6
• This allows the hospital to prepare resources, streamline evaluation, and minimize delays to definitive treatment. 1

Common Pitfalls to Avoid

• Do not delay emergency response system activation while awaiting patient response to interventions like naloxone—rescuers cannot be certain of the underlying condition. 1
• Do not prioritize advanced airway insertion over hemorrhage control in trauma patients—control life-threatening bleeding first. 4
• Do not defer 12-lead ECG acquisition until after completing all other assessments in cardiac presentations—it should be performed early at the scene. 1
• For stroke patients, avoid administering glucose-containing fluids unless hypoglycemia is documented. 1