PHECC EMT cheat sheet

Adult normal respiratory rate is 12-20 breaths/min; <12 or >20 is abnormal and requires reassessment.

Insert an oropharyngeal airway only in an unresponsive patient with no gag reflex; measure from corner of mouth to angle of the jaw.

A nasopharyngeal airway is measured from nostril tip to earlobe and is avoided with suspected basal skull fracture or severe facial trauma.

Size a supraglottic or bag-mask seal by the two-hand EC-clamp technique: thumbs on the mask, fingers lifting the jaw.

Sellick manoeuvre (cricoid pressure) is applied to reduce gastric insufflation during bag-mask ventilation, not as a substitute for airway positioning.

For suspected tension pneumothorax with severe respiratory distress and haemodynamic compromise, needle decompression precedes transport.

Oxygen saturation target for most acutely ill adults is 94-98%; titrate to effect rather than giving high-flow oxygen indiscriminately.

Signs of inadequate ventilation include absent chest rise, silent chest, cyanosis, and a rising or falling respiratory rate with altered consciousness.

Adult CPR: compressions at 100-120/min, depth 5-6 cm, full recoil, and a compression-to-ventilation ratio of 30:2.

Defibrillation for shockable rhythms (VF/pulseless VT) is delivered as soon as available; minimise pauses to under 10 seconds between shocks and compressions.

Adrenaline 1 mg IV/IO every 3-5 minutes is given in adult cardiac arrest; amiodarone 300 mg follows the third shock in refractory VF/VT.

In a witnessed adult collapse with an AED nearby, apply the AED before starting compressions only if it can be done without delay; otherwise start compressions.

Recognise STEMI features: ST elevation in two or more contiguous leads; treat with aspirin 300 mg chewed and rapid transport.

For symptomatic bradycardia with adverse signs (hypotension, ischaemia, heart failure, shock), atropine 0.5 mg IV is first-line, repeated up to 3 mg total.

In supraventricular tachycardia with adverse features, synchronised cardioversion is indicated; unstable VT with a pulse also requires synchronised cardioversion.

Agonal gasps are not normal breathing; a patient with agonal gasps and no pulse is in cardiac arrest and requires immediate compressions.

Control catastrophic external haemorrhage with direct pressure; apply a tourniquet high and tight on the limb if pressure fails or the wound is not compressible.

Spinal motion restriction is indicated for mechanism plus symptoms (pain, tenderness, neurological deficit) or unreliable assessment, not for every trauma patient.

For suspected pelvic fracture with haemodynamic instability, apply a pelvic binder at the level of the greater trochanters.

Fracture management follows the 5 Ps assessment: pain, pallor, pulselessness, paraesthesia, and paralysis; check distal circulation before and after splinting.

Splint a suspected long-bone fracture in the position found unless there is neurovascular compromise; immobilise the joint above and below.

Burns are estimated using the rule of nines in adults: each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, head 9%, perineum 1%.

Hypovolaemic shock in trauma presents with tachycardia, narrow pulse pressure, delayed capillary refill, and altered mental status; treat with controlled fluid and rapid transport.

Amputation: control bleeding, wrap the stump, and transport the amputated part wrapped in sterile dressing, sealed in a bag, and cooled on ice without direct contact.

Primary survey follows A-B-C-D-E: airway, breathing, circulation, disability (GCS/pupils), and exposure.

GCS scoring: eye 1-4, verbal 1-5, motor 1-6; total 15 is normal, 8 or below indicates need for airway protection.

In suspected stroke, use FAST (face, arms, speech, time); note the exact time of symptom onset as it determines thrombolysis eligibility.

Hypoglycaemia is treated with oral glucose if the patient can swallow, or glucagon/IV glucose if not; recheck blood glucose after treatment.

Anaphylaxis is treated with intramuscular adrenaline 0.5 mg (1:1000) into the anterolateral thigh, repeated after 5 minutes if needed.

For asthma with severe distress, give oxygen and a salbutamol nebuliser; ipratropium may be added in severe or refractory cases.

Seizure: protect the patient from injury, do not restrain or insert objects into the mouth, and time the seizure; >5 minutes suggests status epilepticus.

OPQRST (onset, provocation, quality, radiation, severity, time) structures pain assessment; SAMPLE covers signs, allergies, medications, past history, last meal, events.

Informed consent requires capacity, adequate information, and voluntariness; a competent adult may refuse treatment even if refusal risks death.

Patient confidentiality may be breached only where law requires (e.g. notifiable disease, court order) or where there is a risk to others.

Documentation must be contemporaneous, factual, and objective; record observations, interventions, times, and the patient's response.

PHECC clinical practice guidelines are the standard of care for EMTs; deviations must be justified and documented.

Scope of practice: an EMT works under the PHECC scope and local protocols and must not perform interventions outside that scope.

Duty of care exists once a responder has begun assessment or treatment; abandoning a patient without handover constitutes a breach.

Report adverse incidents and near-misses through the local incident reporting system, separate from any clinical record.

Infection control uses standard precautions: hand hygiene, gloves, eye protection, and safe sharps disposal for all patients regardless of diagnosis.

The Mental Health Act and capacity assessment govern treatment of patients lacking decision-making capacity; treat in their best interests and document the rationale.

Radio and handover communication uses a structured format: patient age/sex, chief complaint, findings, treatment given, and response.

Do not accept gifts or inducements that could influence clinical decisions; declare conflicts of interest.

Consent for a minor is normally obtained from a parent or guardian, except in emergencies where treatment is necessary to save life or prevent serious harm.

Record and report safeguarding concerns (child protection, elder abuse, domestic violence) through the appropriate channels.

Maintain professional boundaries: do not disclose patient information to media or on social media, and do not photograph patients without consent.

Clinical waste, sharps, and soiled dressings are disposed of according to local infection-control policy, never in general waste.

A patient who refuses transport after assessment should be advised of risks, and refusal documented with the patient's signature and a witness where possible.

The EMT must be familiar with the PHECC registration and continuing professional competency requirements to maintain practice.

Decontamination and PPE selection follow the nature of the hazard: chemical, biological, or radiological incidents require specialist advice before entry.

Scene safety assessment precedes patient contact; do not enter an unsafe scene without appropriate resources.

Verbal and written handover should include the patient's condition, treatment, and any changes since first contact.

Data protection law governs patient records; access is limited to those involved in care.

Consent may be implied for an unconscious patient in a life-threatening emergency; document the basis for treatment.

The EMT must act within the limits of their competence and call for additional resources when the patient's needs exceed them.

Report all needlestick injuries and exposures immediately per local policy, including source and circumstances.

Professional behaviour includes introducing yourself, explaining procedures, and respecting dignity and privacy.

Records must be retained and transferred according to service policy; never alter a record after the fact without a dated addendum.

Reflective practice and case review support learning; incidents should be reviewed without blame where possible.