ABEM EMS cheat sheet

Cardiac arrest: high-quality CPR targets compression rate 100-120/min, depth 5-6 cm, full recoil, and pauses under 10 seconds; defibrillate shockable rhythms as early as possible.

ST-elevation myocardial infarction field triage: 12-lead acquisition within 10 minutes of first medical contact; scene time target under 15 minutes when transport to a PCI center is feasible.

Anaphylaxis: intramuscular epinephrine 0.3 mg (1:1000) adult, 0.15 mg pediatric, lateral thigh; repeat every 5-10 minutes as needed; antihistamines and steroids are adjuncts only.

Severe asthma: continuous nebulized albuterol, ipratropium, early corticosteroids, and magnesium sulfate for refractory cases; avoid routine antibiotics.

Trauma hemorrhage control: direct pressure, tourniquet for life-threatening extremity bleeding, and permissive hypotension (SBP ~90 mmHg) until surgical control in penetrating trauma without TBI.

Adult hypotension in shock: 250-500 mL isotonic crystalloid boluses with reassessment; avoid over-resuscitation in cardiogenic and obstructive etiologies.

Stroke: last-known-well time is the decision anchor; activate stroke center transport for suspected large-vessel occlusion; glucose check excludes hypoglycemia mimics.

Pediatric weight-based dosing: use length-based tape or estimated weight (kg = (age+4) x 2) when actual weight is unknown; verify against a dosing reference before administration.

Opioid overdose: naloxone titrated to adequate ventilation, not full consciousness; support airway and ventilation as the primary intervention.

Response-time benchmarks commonly cited: BLS first response within 4-8 minutes urban, ALS within 8-12 minutes; agencies should track 90th percentile, not just mean, times.

Ambulance deployment models: static posting, dynamic/system status management, and hybrid; system status management repositions units by predicted demand.

Mutual aid and automatic aid agreements define resource sharing; automatic aid dispatches nearest unit regardless of jurisdiction, mutual aid is requested.

Medical direction structure: an agency medical director holds legal authority; offline (protocols) and online (direct) medical direction are both required components.

Documentation and data: NEMSIS is the national EMS data standard; ePCR data feed state and national registries and support QA/QI.

Crew safety: ambulance crash risk is highest during emergency response; seatbelt use, intersection caution, and driver training reduce injury.

Workforce: fatigue management, shift-length limits, and injury prevention programs address high rates of lifting injury and burnout.

Dispatch triage: EMD protocols (e.g., priority-based systems) determine response mode; over-triage of low-acuity calls strains resources.

Medical director responsibilities: credentialing, protocol approval, online consultation, case review, and quality oversight of clinical care.

Protocol development should be evidence-based, locally validated, and reviewed on a defined cycle (commonly annually or after sentinel events).

QA/QI cycle: identify indicator, collect data, analyze variance, implement intervention, re-measure; use run charts or statistical process control.

Continuing education: NCCP (National Continued Competency Program) model uses national, local, and individual components for recertification.

Skill maintenance: low-frequency high-risk skills (intubation, cricothyrotomy, pediatric dosing) require simulation and competency verification.

Just culture: distinguishes human error, at-risk behavior, and reckless behavior; supports reporting without punitive response to error.

Root cause analysis and morbidity/mortality review are structured methods to examine adverse events and system failures.

Credentialing and privileging: initial and periodic verification of licensure, certification, and competency before independent practice.

START triage (adults): Green walking; Yellow delayed; Red immediate (breathing after repositioning, perfusion, mental status); Black deceased or expectant.

JumpSTART pediatric triage adjusts respiratory rate thresholds and uses apnea-with-pulse as immediate; provides rescue breaths for children.

Triage priorities: immediate (red) patients are treated and transported first when resources are limited; expectant category used only when resources are overwhelmed.

Incident Command System: single Incident Commander, sections (Operations, Planning, Logistics, Finance/Administration); span of control 3-7 with optimal 5.

Hazardous materials: isolate, deny entry, and establish hot/warm/cold zones; only trained personnel in appropriate PPE enter the hot zone.

Terrorism and active threat: rescue task force model integrates law enforcement with EMS in warm zone; scene is not secure until cleared.

Surge capacity: standard of care may shift to crisis standards during declared disasters; documentation and ethical allocation frameworks apply.

Decontamination: remove clothing and gross contamination before transport; ambulatory patients self-decontaminate first to preserve resources.

Communications: interoperable radio systems and pre-designated talkgroups; establish a medical communications coordinator for large events.