PRIMARY SURVEY

Respond Call & • Repeat call text back to Ops Center.

Call Caller • Confirm address/ask specific loca9on.
• No. of casual9es?
• What happened to pa9ent?
• Conscious? Breathing?
• Prepare pa9ent’s IC and medica9on.

Prepara9on • Don latex gloves and face mask.

• Trauma Bag, O2 Bag, Zoll, LSU, Blanket & Canvas

• RTA Vests? PPE (Helmet)?

Rescue Scene • Witness – Caller / Bystanders / Witnesses.

Evalua9on • Hazards – Solve two possible hazards from the environment.
• Environment – What is the environment like?
• MOI – Repeat call text for MOI.

(Remember the acronym WHEM).

Approach • Approaching pa9ent from the front.
Pa9ent • Ask pa9ent not to move their head.
• Catastrophic bleeding?
o If yes -> Proceed with ArresAng Haemorrhage Protocol.
• Any surrounding medica9on / weapons / belongings / hazards?
Introduc9on • Introduce self.
• Inform pa9ent of head grip.
• Ask buddy/abang perform head grip.
o Buddy head grip OR use trauma bag & o2 bag as head blocks.
LOC • Ask what happened?
o Alert
o Verbal (Repeat, but louder)
Verbalize
o Pain (Pinch trap. / Press nail)
o Unresponsive

• If pa9ent is unresponsive: Check C-B-A.

o No pulse -> Start CPR.
o No breathing -> Start rescue bagging (Bag every 5 secs).
Delicate Spine • Fall and Hit Head?
• Pain at neck?
• Bend down, palpate and inspect for DTBL.
o Deformi9es, Tenderness, Bruising, Lacera9ons

• If yes to any -> Maintain head grip and apply C-Collar later.
Airway • If pa9ent responded in LOC Stage -> Airway is patent.

• If pa9ent unresponsive in LOC Stage:

o Open airway (Head 9lt chin li^ / Modified Jaw Thrust).
o Inspect airway
o Remove obstruc9ons (if any).
o Measure, insert OPA.

Breathing • Chest rise and fall?

• Breathing rate and quality?
• SpO2?
• SOB? DIB?
• Hx of Asthma? COPD? Lung Problems?
• Presence of NTUCP?
o Nasal Flaring
o Tracheal Tugging
o Use of Accessory Muscles
o Cyanosis
o Pursed Lips
• Administer O2 Mask.

Nasal Cannula 2 – 4L/min

Simple Face Mask 6 – 8L/min
Nebulizer Mask 6 – 8L/min, for medicine
Non-Rebreathable Mask 10 – 15L/min

Circula9on • Pulse rate and quality?

Conscious Pa9ent Unconscious Pa9ent

Radial Pulse Caro9d Pulse
C – Collar • If paAent has D. Spine, follow ENSAPA to apply C-Collar.
ApplicaAon
- Applying C-Collar, helps to immobilize head and
Explain
neck.
- Place paAent in anatomical posiAon
Neutral - Align nose, chin & sternum notch.
PosiAon - Ensure eyes are perpendicular/parallel to
ground/surface.
- Measure from top of trapezius muscle to the
Sizing
imaginary line from the boTom of the chin.
- Adjust the height of the C-Collar (to fit the sizing)
Adjust
from the black line to the edge of the hard plasAc.
- Roll the C-Collar.
Preform
- Flip out the chin rest.
- Slide the blue strap behind paAent’s neck,
buddy/abang receive.
- Buddy/abang pull strap unAl white plasAc comes
Apply into view.
- Scoop chin rest under paAent’s chin, aligned with
the center of the face/neck.
- Pull Aght, secure Velcro strap.

Rapid Body • Going to conduct a RBS to check for life or limb threatening injuries,
Survey please allow me. Sound of if you feel any pain or discomfort.
o Head.
o Neck (Tracheal Devia9on).
o Chest.
o Abdomen (4 Quadrants, Circular mo9on).
30 secs
o Pelvis (Palpate, do no squeeze in).
o Lower Extremi9es.
o Upper Extremi9es.
o Back (While maintaining eye-contact).
• Anything unusual on gloves?

• Check for Jugular Vein DistenAon and Pedal Oedema.

C – Collar • Apply C-Collar if not done so already (follow C-Collar ApplicaAon step
ApplicaAon above).
Inves9ga9on & • Ausculta9on
Vital Signs
1 2nd intercostal space, mid-clavicular line
2 Mirror above
th
3 4 intercostal space, sternum border
4 Mirror above
th
5 6 intercostal space, mid-axillary line
6 Mirror above

• Blood Pressure
o AV Shunt/Fistula?
o Chest surgery? (Breast cancer removal)
o If any of the above, place PaAent Safety Tag.

• Electrocardiogram (ECG)
o 4 Lead

1 Below clavicle, meaty area

2 Mirror above
3 Below ribcage, away from stomach
4 Mirror above

o 12 Lead (Chest pain, Hx of Heart Problems, suspected SOB from

cardiac origin)

V1 4th intercostal space, right sternum border

V2 4th intercostal space, le@ sternum border
V3 Between V2 and V4
V4 5th intercostal space, mid-clavicular line
V5 Between V4 and V6
th
V6 5 intercostal space, mid-axillary line

• Hypocount

• Paramedic
o GCS

Pts Eyes Verbal Motor

6 Follows command
5 Right ans., Right context Ac9ve reac9on*
4 Alert Wrong ans., Right context Passive Reac9on*
3 Verbal Wrong ans., Wrong context Decor9cate*
2 Pain Sounds only, no words. Decerebrate*
1 Unresponsive Unresponsive Unresponsive*
*Response to pain.

o Severity Scale
 • Buddy (Closer to Arm)
o Capillary Refill Time
o SpO2
o Pulse Rate (Count)
o Blood Pressure

• Abang (Closer to Head)

o Respiratory Rate (Count)
o Skin Colour and Condi9on
o Temperature

Airway • Ask pa9ent ques9on.

• If pa9ent responds -> Airway is patent.

• If pa9ent unresponsive:
o Open airway (Head 9lt chin li^ / Modified Jaw Thrust).
o Inspect airway
o Remove obstruc9ons (if any).
• Measure, insert OPA.

Posi9on • Place pa9ent in a suitable & comfortable posi9on.

Breathless Giddy/Dizzy/Low BP
Sikng/Fowler Supine (Lying)

Decision Point • Pa9ent is unstable due to _______.

• I will Stay and Treat to see if I can ini5ate any protocols OR Load
and Go pa5ent.
• I am an FMV EMT, unable to send unstable cases, call for alpha to
convey. In the mean9me, con9nue to give treatment and monitoring
of pa9ent.

No9fica9on • Retrieve pa9ent’s IC.

• Request Alpha for unstable case of:
o Sex
o Race
o Age
o Case of? (With evidence)
o IC Number
o ETA?

Acronym: C P R A I L D A B C RBS S A P D N
 SECONDARY SURVEY
Chief • What is bothering you the most?
Complaint
Symptoms • Refer to LOTAARRRP

Loca9on - Where do you feel the [CC]?

Onset - When did you start feeling the [CC]?
- Type of Pain (Dull, Crushing, Sharp,
Stabbing)?
Type & Severity Scale - Harder to breathe in or out?
- Scale of 1-10, with 10 being the most
[CC].
Associa9ng Symptoms Have any other symptoms than the [CC]?
Aggrava9ng Factors Does anything make the [CC] worst?
Relieving Factors Does anything make the [CC] beoer?
Does the pain spread anywhere?
Radia9ng
(Breathlessness not applicable)
Reoccurrence Has this [CC] happened before?
What were you doing before feeling the
Precipita9ng Factor
[CC]?

Allergies • Allergic to any:

o Food
o Environmental
o Drugs
• What is your reacAon to the allergen?

Medica9on • Have you taken any medica9on prior to our arrival?

prior
Past Medical • Any past medical Hx?
History • Any surgical Hx?
• Any visits to the hospital in the past 5 years?
o What was the reason?

List of • Are you on any medica9on?

Medica9on o IdenAfy medicaAon.*
o Belong to paAent?
o Expired?
o Is paAent compliant with medicaAon?
*Refer to Common Medica1on List below.
Events • Mechanism of Injury?

Acronym: CC S A M P L E
 PROTOCOLS
Ini9a9ng • I will / have ini9ated the _______ protocol as pa9ent is having
Protocol (provide two pieces of evidence).
o Asthma
o Chronic Obstruc9ve Pulmonary Disease
o Chest Pain
o Conges9ve Cardiac Failure
o Hypoglycaemia
o Arres9ng Haemorrhage

• Ruling out Protocols:

o Pa9ent not complaining of chest pain -> Rule out Chest Pain.

o Pa9ent not complaining of SOB with evidence of Crackles, JVD,

Pedal Oedema & Pink frothy sputum -> Rule out CCF.

o Pa9ent not complaining of SOB with Hx of Asthma, wheezing ->

Rule out Asthma.

o Pa9ent not complaining of SOB with Hx of COPD, long-term

smoking, emphysema, chronic bronchi9s, wheezing -> Rule out
COPD.

o Pa9ent Hypocount > 4.0mmol/L -> Rule out Hypoglycaemia.

o Pa9ent not experiencing catastrophic bleeding -> Rule out

ArresAng Haemorrhage.

o Pa9ent sustained any injuries -> Proceed with appropriate So]

Tissue Injury management.

Administering • Rule out contraindica9ons.

Drugs • Inform pa9ent of purpose and side effects.
• Provide instruc9ons on how the drugs will be administered.
• Administer drugs.
IV Plug • Explain to pa9ent.
Therapy • Prepare equipment and items.
• Demonstrate correct technique in inser9ng the IV Cannula in asep9c
manner.
• Flush IV Cannula with 3ml Normal Saline.
• Ensure IV Cannula is anchored securely (Tegaderm).
Monitoring • Monitor unstable pa9ents every 5 minutes.
Pa9ent o Reassess pa9ent’s LOC & ABC.
o Monitor vital signs.
o Check dressing.
Head-to-Toe • Going to conduct a Head-to-Toe examina9on to see if I missed
anything during RBS. Please allow me.
• General Appearance
o Rashes, Jaundice, Cyanosis, Lethargy, Dehydra9on.
o Trauma

• Head and Face

Medical Trauma
Facial distor9on, Unusual breath Lacera9ons, Contusions,
odour, Burns, Pupils equal sign Ecchymosis, Racoon eyes, Baole
and reac9ve, Cyanosis, Drooling, signs, Blood, Clear fluid, Signs of
Foaming at mouth, etc. Trauma, Cyanosis of conjunc9va,
Periorbital oedema, etc.

• Neck

Medical Trauma
Jugular Vein Distension, Tracheal Lacera9on, Contusion, Rigidity,
Devia9on, etc. Signs of Trauma, etc.

• Chest

Medical Trauma
Opera9on scars, Use of Accessory Signs of Trauma, Penetra9ng
Muscles, Barrel Chest, injuries, Paradoxical mo9on,
Asymmetry, Unusual breath Contusion, Deformity, Sucking
sounds, Unequal air entry, etc. Chest Wound, etc.

• Abdomen

Medical Trauma
Guarding, Rigidity, Masses, etc. Contusion, Distension,
Penetra9ng injuries, Tenderness,
etc.
Record & • Follow IMIST AMBO ABCDO for handing over to Alpha crew.
Report
Iden9fica9on Follow SRA (Sex, Race, Age)
Mechanism of Injury Confirm latest MOI
Informa9on / Injuries Precipita9ng Factor
Signs Provide any abnormal vital signs
Treatment What protocol was ini9ated? Drugs
given?

Allergies Repeat Allergies from Secondary

Survey.
List of Medica9on Repeat List of Medica9on from
Secondary Survey.
Medical Background Repeat Past Medical Hx from
Secondary Survey.
Others Handover Pa9ent IC and Belongings.

Airway Equipment LMA? OPA? Etc.

Breathing Equipment Type of Mask? SpO2? Etc.
Circula9on Equipment BP Machine? Hypocount? ECG? Etc.
Delicate Spine Equipment Spinal Board? C-Collar? Etc.
Other Equipment Any other item/equipment used?
 Asthma / COPD Chest Pain / CCF Hypoglycaemia
Drug: Salbutamol / Ventolin Glyceryl Trinitrate Oral Glucose (Honey Sachet)
Dosage: 10mg (2ml NS : 2ml Salbutamol) 0.4mg (1 spray) 20g (Whole sachet)

1. Allergic to GTN.
1. Allergic to Salbutamol. 2. Not prescribed GTN. 1. Allergic to honey / pollen.
Contraindica9ons: 2. No Hx of Asthma / COPD. 3. Taken sexual enhancement drugs 2. Hypocount is more than 4.0mmol.
3. Presence of Cardiac Wheeze. (Viagra, Cialis, etc.) in the past 24 hours. 3. Pt is unconscious / Unable to swallow.
4. Systolic BP less than 90mmHg.

Purpose: Bronchodilator Vasodilator Increase blood glucose

1. Hypotension
1. Tachycardia
Side Effects: 2. Burning / Tingling sensa9on under 1. Depends on pa9ent
2. Tremors
tongue

1. Pa9ent to be seated / in fowler posi9on.

2. Clear contraindica9ons, explain purpose 1. Pa9ent to be seated / in fowler posi9on.
1. Pa9ent to be seated / in fowler posi9on.
and side effects to pa9ent. 2. Clear contraindica9ons, explain purpose
2. Clear contraindica9ons, explain purpose
3. Prepare Nebulizer mask. Ensure the and side effects to pa9ent.
and side effects to pa9ent.
funnel is present in the medicine 3. Prepare Oral Glucose.
3. Prepare GTN.
chamber. 4. Place a dab of Oral Glucose on pa9ent’s
4. Prime the GTN by spraying one 9me
4. Aspirate 2ml of Salbutamol into the lip. Ensure they can lick and swallow the
Administering: away from people.
medicine chamber, followed by 2ml of Oral Glucose.
5. Instruct the pa9ent to not speak, spit or
Normal Saline. 5. Allow pa9ent to self-administer Oral
swallow for one minute a^er
5. Connect the Nebulizer mask to O2 Tank Glucose, or allow bystander to feed
administering the GTN.
(6-8L/min) and check for mis9ng. pa9ent.
6. Spray 1 spray of GTN under the pa9ent’s
6. If mis9ng is not present, 9trate O2 up. 6. Ensure pa9ent finishes the en9re sachet
tongue.
7. Give Nebulizer mask to pa9ent, instruct of Oral Glucose.
them to breathe normally.
 Suffix Drug Name(s) IndicaJons
Cardiovascular Drugs
-sta9n Simvasta9n, Lovasta9n, Atorvasta9n Hyperlipidaemia (High Cholesterol)
-grel Clopidogrel, Prasugrel Myocardial Infarc9on, Unstable Angina
-rin Warfarin, Enoxaparin, Aspirin Myocardial Infarc9on, Pulmonary Embolism
-pril Captopril, Lisinopril, Enalapril Hypertension, Heart Failure
-sartan Losartan, Valsartan, Irbesartan Hypertension, Diabe9c Nephropathy
-lol Carvedilol, Metoprolol, Bisoprolol Hypertension, Heart Failure
-dipine Felodipine, Nifedipine, Amlodipine Hypertension, Chronic Stable Angina
Respiratory Drugs
-terol Salmeterol, Formoterol, Indacaterol Asthma, COPD
- bromide Ipratropium bromide, Tiotropium bromide COPD
-sone Flu9casone, Beclomethasone Asthma, Allergic Rhini9s, Nasal polyps
DiabeJc Drugs
Generic Diabetes Glipizide, Metormin, Tolbutamide, Gliclazide Diabetes (Non-Insulin Dependent Diabetes Mellitus Type 2)
 Asthma COPD Chest Pain CCF Hypoglycaemic
SpO2 88% – 92%

SOB Yes Yes Yes

NTUCP Yes Yes Yes

RBS Barrel Chest JVD, Pedal Oedema

Lung Sounds Wheezing Wheezing / Crackles Crackles

ECG ST-ElevaAon ST-Depression

Hypocount < 4.0 mmol

Chief Complaint Breathless Breathless Chest Pain Breathless Giddy / Dizzy / Headache

Onset Acute Chronic Acute

Type Dull, Crushing

Radia9ng Pain Yes

COPD, Emphysema,
Hx Asthma Chronic Bronchi9s, Heart Problems Diabetes
Smoker
Arres%ng Haemorrhage Protocol

1. Iden'fy Catastrophic Bleeding is present.

2. Ask buddy/abang to expose where bleeding is.
3. Examine the type of bleeding, and length and depth of wound.
a. Depth of the wound is equivalent to the width of the wound.
b.
Spur'ng blood
Arterial Bleeding
Bright red color
Steady, constant flow
Venous Bleeding
Dark, red color
Oozing blood
Capillary Bleeding
Slow, even flow

4. Crew leader apply direct pressure on the wound.

5. Ask buddy/abang to prepare:
a. Small / Large dressing pad.
b. Medium crepe bandage
c. Micropore tape
6. Buddy/abang take over from crew leader, applying pressure dressing to wound.
7. Whenever buddy/abang is done with pressure dressing, crew leader check quality
and ask: “Is there blood soaking through?”.
8. If / When there is the blood soaking through, proceed with applying tourniquet.
9. Apply tourniquet within 30 secs following certain rules:
a. Do not apply over clothing, apply directly to skin.
b. Do not apply over joints.
c. Apply the tourniquet 5cm (3 fingers) above the wound.
10. A^er each turn of the tourniquet rod, ask: “Has the bleeding stopped?”.
11. A^er successful applica'on of the tourniquet, be sure to check MSCP.
a. Movement (Reduced)
b. Sensa'on (Reduced)
c. Capillary Refill (Delayed)
d. Pulse (Weak)
So3 Tissue Prac%cal

Use a small / large dressing pad, and secure with a crepe

Lacera9on / Incision
bandage and micropore tape. No normal saline is needed.

Use non-adherent dressing, with the shiny side facing the

Abrasion
wound. Secure all 4 sides with micropore tape.

Contusion – Apply ice pack over the area, elevate the

limb. Avoid placing ice pack over vital areas
Contusion / Hematoma
(Head, Torso).
Hematoma – Inform paramedic.

Wet a large dressing pad with normal saline, place the

wet pad over the injure and secure all 4 sides with
Eviscera9on micropore tape. Place either a biohazard bag or Aluderm
(Shiny side) over the wet pad, secure all 4 sides with
micropore tape.

Flush the wound with normal saline, try to place the skin
flap back in place. If bleeding, use a small / large dressing
Avulsion
pad, and secure with a crepe bandage and micropore
tape.

Stump – Use a small / large dressing pad, secured with a

crepe bandage and micropore tape. Bandage
the top first, applying pressure, then wrap
around, and back to the top again.
Amputa9on
Limb – Wrap the amputated limb with a small / large
dressing pad soaked with normal saline. Place
into a sterile plas9c bag. Place that sterile plas9c
bag into another plas9c bag with (cold) water.

Wet a small / large dressing pad with normal saline.

Mangled Limbs Wrap the wet pad around the mangled limb. Apply a
C.A.T. Tourniquet if bleeding persists.
 Use dressing pads / FADs and micropore tape to secure
the base of the object. Use either donut dressings or
Impaled Objects more dressing pads / FADs to stabilize 3/4 of the height of
the object. A^er each layer of stabilizing, apply micropore
tape in the ‘under armour’ method.

Entry wound – Use sterile plas9c sheet and secure 3 sides

using micropore tape. Open side is to be
where blood is dripping down.
Exit wound – Use sterile plas9c sheet and secure all 4
Sucking Chest Wound sides with micropore tape.
Chest seal – Remove the tape from the Bolin chest seal,
apply it with the middle hole at the center of
the chest wound. Apply chest seal a^er
pa9ent has exhaled.

Place a small / large dressing pad both above and below

the protruding bone. Place a donut bandage followed by
a small / large dressing pad on top of the bone. Secure all
Open Fracture the pads and the donut dressing using a crepe bandage
and micropore tape. If bleeding is present, secure the
crepe bandage 9ghter. If bleeding persists, consider using
a C.A.T. Tourniquet.

Water gel dressing – Apply the appropriate dressing

directly to the burned area. Apply
following the instruc9ons on the
packaging. For vital areas, leave the
dressing on for no more than 20
Burn Kit minutes. If the dressing has dried,
change to a new burn dressing.
Aluderm – Cool the burned area using normal saline or
cool running water for 10 – 20 minutes. Cut
the aluderm to fit the size of the burn area
and apply with the shiny side down.

Bandage pa9ent’s head using a FAD. Secure the FAD with

Head Injuries
a triangular bandage.

Flail Chest / Rib Fracture Inform paramedic.

 Using micropore tape, secure the injured finger to an
Finger Fracture
uninjured finger, taping above and below the fracture.

Mould the Sam Splint to the uninjured arm. Aoach the

Sam Splint to the injured arm using the crepe bandage.
Keep the radial pulse area, fingers and injury site exposed.
Arm Fracture Fully open a triangular bandage, with the apex of the
bandage at the elbow, 9e the two ends around the neck
of the pa9ent. Tie an addi9onally broad triangular
bandage around the body and upper arm of the pa9ent.

Using a narrow triangular bandage, 9e a cow hitch at

pa9ent’s wrist. Using the ends of the bandage, 9e them
Single Clavicular Fracture up behind pa9ent’s neck. Tie an addi9onally broad
triangular bandage around the body and upper arm of
the pa9ent.

Drape a triangular bandage behind pa9ent’s back, with

the apex facing down. Bring the two ends of the bandage
in front of the pa9ent’s upper body and back through
Double Clavicular Fracture
their armpits. Pull the two ends back 9ght through the
armpits and 9e them together at pa9ent’s back. Tuck in
the apex of the bandage neatly.

Using a narrow triangular bandage, 9e a cow hitch at

pa9ent’s wrist. Tie the ends of the bandage around
Shoulder Disloca9on pa9ent’s waist. Tie addi9onal broad bandages around
pa9ent’s body and forearm, and pa9ent’s body and upper
arm.

Prepare 3 broad triangular bandages and 2 narrow

triangular bandages. The 3 broad bandages go at
pa9ent’s ankle, above the knee and mid-thigh. The 2
narrow bandages go directly above and below the
Lower Limb Fracture
fracture. If needed, place a cushion between pa9ent’s
legs. Tie the broad bandages first, star9ng from the ankle
(figure of 8) to the mid-thigh. Tie the 2 narrow bandages
from the booom to the top.
Cardiac Arrest Protocol

1. A^er Inves'ga'on and Vital Signs, there is a chance pa'ent will collapse.
2. If pa'ent collapses, check for pa'ent’s LOC, and do a quick check C-B-A*.
3. If no pulse, commence CPR (30-2).
4. Crew leader to give instruc'ons:
a. Abang can start compressions.
b. Crew leader can measure and insert OPA.
c. Buddy can use BVM and start bagging.
d. Crew leader place AED Pads on pa'ent.
5. When analysing, crew leader ensure that no one touches pa'ent.
6. A^er shock is given, crew leader can perform IV Plug Therapy.
7. If at any 'me, heart rhythm is not shockable, crew leader to do a quick check
C-B-A*.
8. Once pa'ent has pulse and breathing or wakes up, crew leader to check pa'ent’s
Vital Signs (9 vital signs).

*Refer to LOC stage for more details.