General Medical Care

Designation of condition: Universal assessment and foundational management applied to all EMS patients, ensuring compliance with EMTALA and guiding providers toward conditionspecific guidelines based on findings.

Definition of a patient:

A patient is any individual who meets any of the following:

• Has a complaint suggesting potential medical, traumatic, or psychiatric illness, and requests evaluation (or another person on scene requests evaluation on their behalf)

• Has obvious evidence of medical, traumatic, or psychiatric illness

• Has experienced an acute event that could reasonably lead to medical, traumatic, or psychiatric illness

• Is found in circumstances that could reasonably result in medical, traumatic, or psychiatric illness When in doubt → treat the individual as a patient.

Medical assists (e.g., falls, lift assists) are patients.

Assessment:

• Perform full primary and secondary assessment

• Vital signs for all patients: mental status, blood pressure, pulse, respiratory rate, temperature

• Blood glucose as appropriate

• Orthostatic vitals if indicated

• Oxygen to maintain SpO₂ 94 percent or as clinically indicated for hypoxia

• Medication cross-check for all administered medications

• Identify need for ALS involvement or rapid transport for time-critical diagnoses

• Link to appropriate condition-specific guideline

Pediatric pearls:

• Use approved pediatric reference for medication dosing, electrical therapy, equipment sizes

• Start exam on uninjured areas to build trust

• Never lie to a child

History / Signs & Symptoms framework:

• Location

• Onset

• Precipitating events

• Quality

• Radiation

• Severity

• Time/duration

• Aggravating/alleviating factors

• Associated symptoms

• Prior similar episodes

Differential diagnosis:

• Vascular

• Infectious / inflammatory

• Trauma / toxins

• Autoimmune

• Metabolic

• Idiopathic

• Neoplastic

• Congenital

Management — EMT-Basic:

• Demonstrate professionalism; ensure scene and crew safety; appropriate PPE

• Use closed-loop communication and crew resource management

• Perform full assessment and physical exam

• Obtain complete vital signs

• Obtain glucose measurement as indicated

• Apply oxygen as needed

• Conduct medication cross-check before any administration

• Identify need for ALS intercept, ALS response, or rapid transport for critically ill patients

Management — Paramedic:

• ALS clinicians must continue to perform all indicated BLS skills and should not omit foundational BLS care when providing ALS-level interventions.

• IV/IO access as indicated

• Place on continuous cardiac monitoring and obtain pulse oximetry.

• Place and monitor EtCO₂ when clinically indicated

• Acquire 12-lead ECG and monitor rhythm as clinically indicated

• Provide ALS interventions per specific condition guideline

Rules and system considerations:

• If BLS crew encounters a patient requiring emergent ALS care:

– Begin immediate life-saving interventions

– Decide between:

a) Urgent transport to nearest hospital

b) Urgent transport + request for ALS intercept

c) Request urgent ALS response to scene while initiating stabilization

– Consider distance to ED, patient condition, on-scene assistance, environmental factors

• Time-critical diagnoses must be transported emergently.

• If BLS crew encounters a patient needing non-emergent ALS care:

– Determine best service option (wait for ALS vs. BLS transport with modification)

Online medical control — contact order:

1. WashU EMS line

2. Receiving hospital

Medical control communication tips:

• Start call with the question: “I am calling for a medication request” or “I am calling for advice on (feared condition or chief complaint)”

• Use closed-loop feedback communication

• Consult drug formulary for all adult and pediatric dosing

Minimum exam for all patients:

• Full vital signs

• Mental status including GCS

• Location and severity of complaint

• Pain scale

Continuation of care:

• Maintain all appropriate medications, infusions, and procedures already initiated by referral agencies or facilities during transport

Key points:

• Universal Care guideline forms the foundation; branch into specific guidelines as indicated

• When uncertain, consult online medical control early

• Thorough assessment, documentation, and communication are essential