Emergency Medical Services
Domain focus
The Emergency Medical Services domain tests scene safety, triage, transport decisions, and handover. The exam expects system-level thinking and field priorities.
Core rules
- Scene safety first; do not enter an unsafe scene.
- Primary survey and immediate life threats; spinal motion restriction only when indicated.
- Triage: START for mass casualties-ambulatory green; breathing after airway positioning red; no breathing after airway black; respiratory rate >30 or <8 red; delayed capillary refill or absent radial pulse red; unable to follow commands red.
- Transport: time-critical STEMI, stroke, trauma, and obstetric emergencies to appropriate centers.
- Handover: identify patient, mechanism, vitals, interventions, response, and pending issues.
Worked example
At a bus crash, 12 patients are on scene. Use START: walking wounded to green; a patient with respiratory rate 6 after airway opening to red; a patient with no pulse and no breathing after airway to black. Reasoning: triage assigns resources by physiologic status, not by who screams loudest.
Traps
Entering an unsafe scene, ignoring scene hazards, and giving long reports without vitals are common. Do not transport all patients to the nearest hospital if a trauma center is needed.