To read the first part of the case scenario, please see last week’s blog post by clicking here.


<BEEP> “Medical call at 555 Oak St, cross of Adams Ave and Chester Ln for Paramedic Engine 65 and Medic 62. Engine 65 and Medic 62 you are responding on a 49 year old female who has had a syncopal episode, is conscious and now vomiting”

*syncope is the medical term for a loss of consciousness or fainting/passing out

The 911 dispatch will go out to a police officer, a fire department and a paramedic unit. Frequently, they arrive in that order although police does not always respond. Recently, there has been a big push to put a paramedic on every fire engine, so that medical care can be delivered quickly.

Firefighter/Paramedic: “Hi, my name is John, can you tell me your name?

John will ask Mrs. Smith a series of questions to determine if she is “Alert and oriented.” He will ask her how she feels, what symptoms she has, what she was doing and when they started. He will go through a head to toe assessment that includes vital signs (blood pressure, pulse); assessment of her skin signs (pale/flushed, sweaty/dry); a neurological assessment (pupils, ability to follow commands, one-sided weakness). At the same time, either he or another medically trained member on the fire engine will start an IV and put her on oxygen. They will give her medications based on their assessment of her symptoms.

Paramedics follow a pathway of treatment based on their assessment and in accordance with their county EMS protocols. Although every county or district has their own protocols, they are all very similar nationwide. What medications a paramedic can give and for what reason is dictated by these protocols. Which hospital they take the patient to is also based on the EMS protocols. The EMS protocols dictate the Standards of Care for the paramedics in that specific county.  Many counties post their protocols online.

Once the ambulance arrives, the goal will be to “load and go” to get the patient to the ED as quickly as possible so that care can be rendered within the “Golden Hour.” The team will work together to reach that goal and in most instances, the care will be transferred to the paramedic on the ambulance. If there is no paramedic on the ambulance and it is serviced by two Emergency Medical Technicians (EMT’s), OR if the patient needs more than one person to care for her than the paramedic from the fire engine will ride in the ambulance to assist.

The “Golden Hour” of medicine started after World War II and was based on traumatic injuries. The concept is that invasive care must be delivered within one hour or the prognosis significantly drops. This theory has been adopted for many other emergency medical conditions, such as heart attacks and stroke. Every moment in the field ticks off that golden hour and it continues in the ED where an assessment must take place before invasive procedures can be performed. 


This month’s civil topic is “911 to ER – Pathway of Care.”  Topics covered are:

  • Case Scenario (7/7/14)
  • Emergency Medical Services  (7/14/14)
  • Emergency Department (7/21/14)
  • Discharge (7/28/14)

Note: To see all posts in this topic, click here.

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