Are we there yet?
Maryland's designated specialty center for isolated eye trauma.
Wilmer Eye Institute at Johns Hopkins Hospital
All Maryland scene helicopter requests go through this communications center.
SYSCOM
(EMRC acceptable)
For a thermal burn, this is the first priority once the patient is removed from the source.
Stop the burning process and begin appropriate burn care
Maximum score for eyes.
4 points
Your patient has a nearly amputated lower leg with life-threatening hemorrhage. The tourniquet stops the bleeding, but BP is 78 systolic. Paramedics are ten minutes away. Do you remain on scene?
No - manage the XABC's, prevent heat loss, manage for shock, rapid transport, and rendezvous with ALS
Maryland's designated hand/upper-extremity specialty center.
Curtis National Hand Center at MedStar Union Memorial Hospital
Aka union
If you can arrive at the trauma/specialty center by ground in less than this amount of time, helicopter transport generally provides little benefit.
30 minutes
A child with a significant burn requiring specialty care should be transported to one of these two pediatric burn centers listed in the Maryland protocols.
Johns Hopkins Children’s Center
or
Children’s National Medical Center
Maximum score for motor
6
Stab wound to the chest. Patient is increasingly dyspneic, pale, tachycardic, and has markedly diminished breath sounds on one side. What can the EMT do while ALS is coming?
Manage airway/ventilation and oxygenation, seal an open chest wound if present, rapid transport, and rendezvous with ALS
You have a pediatric trauma patient but Johns Hopkins Children's Center is on Code Black. Where else can you go?
Children's National Medical Center
These two Trauma Decision Tree categories require receiving-trauma-center medical consultation when determining whether helicopter transport provides clinical benefit.
Charlie and Delta categories
Your patient has partial-thickness burns covering only about 3% of their body. The burns completely encircle the forearm. Local, trauma, or burn center?
Burn center
Circumferential burn goes to burn center
The patient is saying incomprehensible sounds. Verbal score.
Verbal 2
Head-injured patient deteriorates from GCS 13 to 8 and begins vomiting. ALS has been requested. Your immediate BLS priorities?
Airway protection, suction, appropriate adjunct/BVM support as needed, spinal motion restriction when indicated, and rapid transport/rendezvous
You have an adult patient that has been severely burned. You can go here.
Johns Hopkins Bayview Medical Center
OR
MedStar Washington Hospital Center
The minimum helicopter landing-zone dimensions specified by Maryland are this.
150 feet x 150 feet
A burn patient also has significant traumatic injuries from the same event. Your destination should be here.
Closest appropriate trauma center
When burns + trauma, go to trauma center
The patient is decordicating. Motor score.
Motor score 3.
MVC patient has a badly angulated femur fracture, BP 82/48, HR 130. ALS is eight minutes away. What should BLS be doing now?
Control hemorrhage, stabilize the injury as time allows, keep the patient warm, begin rapid transport, and rendezvous with ALS
Your patient has a severe facial injury, including eye trauma, but also has a mangled arm on the same side. We transport this patient to Wilmer or to trauma center?
Closest appropriate trauma center
Your proposed landing zone has a 15-degree slope but is otherwise enormous and obstruction-free. Suitable or unsuitable?
Unsuitable. Maximum slope is 10 degrees.
You are evaluating a burn patient for possible inhalation injury. Name two findings that should make you especially concerned about airway involvement.
Facial burns, soot around the mouth/nose, singed nasal hairs, hoarseness/voice change, stridor, respiratory distress, or burns from an enclosed-space fire
Eyes open to pain. The patient makes no verbal response and extends both arms to painful stimulation
GCS 5
E2 + V1 + M2
After a high-speed MVC, your patient has severe pelvic pain, an unstable pelvis, HR 128, pale/diaphoretic skin, and a BP of 84/56. ALS is responding. What should BLS do while awaiting/rendezvousing with ALS?
Treat for hemorrhagic shock, apply pelvic stabilization/binder when indicated, minimize movement, keep the patient warm, provide airway/oxygenation support as needed, and rapidly transport/rendezvous with ALS