Ambulance Service - Medical Emergencies and Pre-hospital Care
Ambulance Service - medical emergencies and pre-hospital care
This domain tests how you assess, stabilize and hand over a patient outside hospital: scene safety first, then a structured primary survey, resuscitation where needed, and a report the receiving team can act on.
The first five minutes
- Scene safety before patient contact - traffic, crowd, fire, live wires, violence. An injured rescuer becomes a second patient.
- cABCDE primary survey - catastrophic haemorrhage control (direct pressure, then tourniquet), Airway with manual in-line stabilization in trauma, Breathing (rate, symmetry, SpO2), Circulation (pulse, capillary refill, skin), Disability (GCS, pupils, glucose), Exposure with warming.
- GCS is scored E4 V5 M6: maximum 15, minimum 3. Record the three components, not only the total, so deterioration is visible.
Cardiac arrest and oxygen
Adult BLS: compressions 100–120/min, 5–6 cm deep, full recoil, ratio 30:2, AED attached as soon as it arrives, pauses kept under 10 seconds. Do not spend more than 10 seconds on a pulse check. Target SpO2 94–98% generally, but 88–92% in a COPD patient who retains carbon dioxide. Never delay transport of a time-critical case (chest pain, stroke, major trauma) for procedures you can perform en route.
Worked example
A man collapses in a busy bazaar. He is unresponsive, makes occasional snoring gasps, and has no visible bleeding. Reasoning: unresponsiveness plus abnormal, agonal breathing equals cardiac arrest until proven otherwise. Shout for help, begin compressions immediately, send a bystander to call and fetch the AED, continue 30:2, apply pads and follow the prompts, then hand over the number of cycles and shocks delivered.
Traps that cost marks
- Treating agonal gasps as "breathing" and withholding CPR.
- Prolonged pulse checks or moving the patient before starting compressions.
- Applying a tourniquet where direct pressure already controls bleeding.
- Failing to document a refusal of care and the capacity assessment behind it.