Northern Ireland Ambulance Service

Standard Operating procedure

what is Northern Ireland Ambulance Service?

The Northern Ireland Ambulance Service is an HSC trust responsible for operating ambulances and answering and responding to urgent and emergency medical situations within Northern Ireland. The service responds to 999 and 111 phone calls, providing triage and advice to enable an appropriate level of response.

What is the COC ( chain of command ) ?

Paramedic Team Leader – VACANT

Advance Paramedic – VACANT

Paramedic – VANCANT

Student Paramedic – VANCANT

Basic Medical Training

Airway Adjuncts – You have 2 types of airway adjuncts these are called oropharyngeal airway (OPA) and Nasopharyngeal airway (NPA). An OPA prevents the tongue from covering the patients epiglottis which could stop them from breathing. An NPA opens up the nasal to allow a sustainable amount of oxygen going into the body, once the NPA is fitted it will leave a secure open airway. To fit an OPA it must be measured from the centre of the mouth to the angle of the jaw, after measuring the airway is then inserted into the patient’s mouth upside down. Once it has made contact with the back of the throat rotate it 180 degrees and leave it and it should hang to maintain an open airway. To fit an NPA you need to lubricate the nasal trumpet with water-soluble jelly, once this has been completed you need to insert it into the nostril vertically along the floor of the nose with a twisting action, you need to aim towards the back of  the opposite eyeball. DO NOT fit an NPA if you suspect a skull or brain injury.

Hs and Ts

The Hs and Ts method is used to determine when people will go into cardiac arrest or peri arrest [Cardiac arrest information and how to recognise will be able to be obtained in Basic Life Support  training guides]. If any 1 of the Hs and Ts is apparent in a person they may/will go into cardiac arrest in the next 5-10 minutes on a scene; these are:   

  • Hypoxia: low oxygen levels in the blood
  • Hypovolemia: low amount of circulating blood, either absolutely due to blood loss or relatively due to vasodilation
  • Hyperkalemia or hypokalemia: disturbances in the level of potassium in the blood, and related disturbances of calcium or magnesium levels.
  • Hypothermia/Hyperthermia: body temperature not maintained
  • Hydrogen ions (Acidosis)
  • Hypoglycemia: Low blood glucose levels
  • Tension pneumothorax: increased pressure in the thoracic cavity, leading to decreased venous return to the heart
  • Tamponade: fluid or blood in the pericardium, compressing the heart
  • Toxic and/or therapeutic: chemicals, whether medication or poisoning
  • Thromboembolism and related mechanical obstruction (blockage of the blood vessels to the lungs or the heart by a blood clot or other material)

Major Bleeds and Controlling

The arteries are the blood vessels that deliver oxygen-rich blood from the heart to the tissues of the body. Each artery is a muscular tube lined by smooth tissue and has three layers: The intima, the inner layer lined by a smooth tissue called endothelium.

Veins are blood vessels that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated blood to the heart.

A capillary is a small blood vessel from 5 to 10 micrometres (μm) in diameter, and having a wall one endothelial cell thick. They are the smallest blood vessels in the body: they convey blood between the arterioles and venules.

  1. Remove any clothing or debris on the wound. Don’t remove large or deeply embedded objects. Don’t probe the wound or attempt to clean it yet. Your first job is to stop the bleeding. Wear disposable protective gloves if available.
  2. Stop the bleeding. Place a sterile bandage or clean cloth on the wound. Press the bandage firmly with your palm to control bleeding. Apply constant pressure until the bleeding stops. Maintain pressure by binding the wound with a thick bandage or a piece of clean cloth. Don’t put direct pressure on an eye injury or embedded object.
    Secure the bandage with adhesive tape or continue to maintain pressure with your hands. If possible, raise an injured limb above the level of the heart.
  3. Help the injured person lie down. If possible, place the person on a rug or blanket to prevent loss of body heat. Calmly reassure the injured person.
  4. Don’t remove the gauze or bandage. If the bleeding seeps through the gauze or other cloth on the wound, add another bandage on top of it. And keep pressing firmly on the area.
  5. Tourniquets: A tourniquet is effective in controlling life-threatening bleeding from a limb. Apply a tourniquet if you’re trained in how to do so. When emergency help arrives, explain how long the tourniquet has been in place.
  6. Immobilize the injured body part as much as possible. Leave the bandages in place and get the injured person to an emergency room as soon as possible.

Celox is a type of bandage that we as use for blood clotting. Celox contains shellfish (If known allergy to Shellfish DO NOT administer celox). Celox is a fast response aid to major bleeding, it acts as a coagulant to any bleed; you must place Celox on the direct point of injury/bleed. Celox will not be active as a layering drug, this means that if a patient bleeds through 1 bandage you must take it off and replace it with another Celox if still bleeding; if bleeding has stopped leave the 1 used celox on the injury and then pack it with sterile clean non-Celox bandage. Celox is expensive and cost £3.50 for 1 bandage so do not use it more than needed. If a patient has been shot in the chest or any other body part and the bleed is coming from within the body cavity Celox will not work as no direct contact is gained. Celox has a outlayer of “dust” on the bandage that must be faced down to the injury.

Pneumothorax

A pneumothorax is a collapsed lung. A pneumothorax occurs when air leaks into the space between your lung and chest wall. This air pushes on the outside of your lung and makes it collapse.

Signs and Symptoms:

  • chest pain that usually has a sudden onset.
  • The pain is sharp and may lead to feelings of tightness in the chest.
  • Shortness of breath,
  • rapid heart rate,
  • rapid breathing,
  • cough,
  • and fatigue are other symptoms of pneumothorax.

Treatment:

Draining excess air. Needle aspiration and chest tube insertion are two procedures designed to remove excess air from the pleural space in the chest.

You will have to treat a Pneumothorax, this will be done by the above. You must find the 3rd or 4th intercostal space and insert a cannula/needle with a active workable valve on the open chest end, this must be able to turn on, when  on the chest must be able to release the trapped air within the chest cavity. 

A Pneumothorax occurs due to an air leak from the lungs. 

When hitting the lungs this will immediately cause a Pneumothorax and the symptoms of this are covered in the slides above. 

The air will leak out of a lung into the chest cavity, a cavity is a opening in the chest the doesn’t contain anything hence space that needs to be filled, If this is filled with air due to a Pneumothorax; the air can not escape.

The pressures within the chest cavity will become greater than inside the lung or atmospheric pressure causing the lung to collapse, to relieve this treatment on the slide above must be administered. Once this treatment has been carried out pressure will be equalised due to the air within the chest cavity escaping through the open valve of the needle and this will result in the lung reflating. This will not stop it from occurring again; you must release the valve everytime the patient feels short of breath or if unconscious every 5-10 minutes, listen for a hiss as air escapes; when the hiss stops close the valve.    

Airway Training

Oxygen – Oxygen should be given when a patient is finding it hard to breath or intake oxygen this can be done by hooking up an oxygen mask with an O2 bottle. Once this has been done you place it on top of the mouth allowing them to take in oxygen.

Bag Valve Mask [BVM] – A BVM is used when a patient isn’t breathing. To use a BVM you must hook it up to an O2 bottle and then place it over the patient’s mouth and squeeze the bag every 2-3 seconds depending on if CPR is being given
CPR – Chest compressions can be done by placing both hands firmly in between the chest and pressing down 2-3 centimetres this is manually pumping their heart. CPR is done in a sequence of 30 chest compressions then into 2 rescue breaths what can be done with a BVM. 

Other Equipment We carry

Defibrillator – A defibrillator sends a shock to the heart hoping for it to restart. To use a defibrillator you must apply two pads to either side of the chest shown on the defibrillator once this has been done you will power on the defibrillator and follow the instructions given. When told to shock you must stand clear from the patient as it could send you into cardiac arrest.

Tourniquets – A tourniquet is a device which applies pressure to a limb to stop the blood flow to a wound. This is used to control bleeding to s limb that causing major blood loss.

Cervical Collar – A cervical collar is used to immobilise a patient’s neck this is when there’s a possibility for a spinal injury . You can tell if there’s a spinal injury by checking if they have any feeling either side  of the body and if they can move their toes. To apply a cervical collar you must get the person to look in the air while keeping a straight head, and slide it around the head and clip it either side.

Suction – If an airway is blocked with blood then you place the suction and remove the product from their airway by squeezing.

Medical Reading Information 

Blood Pressure(BP)

High: 140/100 and above                                                                                              Normal: Between 120/80 – 140/90                                                                               Low: Anything Below 110/70   

Pulse/Heart Rate (HR)                                                                        High Pulse: Anything above 100                                                                                  Normal Pulse: Between 60 – 100                                                                              Low Pulse: Anything below 60                                                                                                                

Peri Arrest – When a patient feels like they are going to die
Respiratory Arrest – Patient stopped breathing but has a pulse
Cardiac Arrest – No pulse,  no breathing

Blood Sugar(BM)                                                                                                                                                  High Blood Sugar: Above 8.0                                                                                Normal Blood Sugar: Between 4.0 – 8.0                                                                 Low Blood Sugar: below 4.0

Oxygen Levels(SP02)                                                                                Normal SPo2 Level: Between 94% – 100%                                                              Low SPo2 Level: Anything below 94%                                                                              If PT Has breathing condition, SPo2 = 88% – 92%

Drugs a Student Paramedic can carry

Epinephrine ( 1:100) via epipen or vial
Oral Glucose Gel
Oxygen
Entonox
Amiodarone
Aspirin
GTN
Paracemtmol (Oral)
Ibuprofen
Calpol
Drugs can be administered under supervision by a paramedic that are not listed


Drugs a Paramedic can carry

Diazepam   
Tranexamic Acid (TXA)
Sodium Chloride 0.9%
Aspirin
Salbutamol
Furosemide
Atropine
Benzylpenicillin
Chlorphenamine
Clopidogrel
Dexamethasone
Glucagon
Glucose
Heparin
Narcan
Hydrocortisone

Ipratropium Bromide
Metoclopramide
Sodium Lactate
Syntometrine
Tenecteplase
Misoprostol
Morphine
Ondansetron
Reteplase


Congratulations you completed basic training

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