Pre-hospital goals of traumatic and non-traumatic neurological emergencies are aimed at minimizing secondary brain or spinal cord injury, consider the following: adequate oxygenation requirements, appropriate ventilation requirements, cerebral perfusion requirements, management of ICP, seizure control and transport to an appropriate receiving facility.
Prehospital goals of seizure management are focused on maintenance of airway patency, oxygenation, ventilation and treatment of seizures mindful of specific etiologies.
Pre-hospital goals of managing traumatic and non-traumatic respiratory emergencies or urgencies are aimed at correcting the imbalance of oxygen supply and demand in the setting of hypoxemic respiratory failure, and managing the ventilation status of patients in hypercapneic respiratory failure. These disease processes can be categorized by restrictive or obstructive lung disease.
Pre-hospital management of cardiovascular emergencies focuses on treatment of underlying causes, maintenance of hemodynamic stability, ensuring adequate oxygen supply, and relief of symptoms. Choice of destination for specialty procedures (i.e. cardiac catheterization) is necessary to provide prompt treatment and decrease the need for secondary transfer. Likely CVS emergencies encountered in the field may include but are not limited to STEMI, NSTEMI/ACS, Cardiogenic Shock and HTN Crisis.
Pre-hospital goals of traumatic and non-traumatic GI/GU emergencies are aimed at maintaining airway patency, maintaining hemodynamic stability, and providing symptom relief. Consideration should be given to destination choice in some cases, recognizing the need for treatments such as surgery, ICU care, or interventional radiology. GI/GU emergencies likely to be encountered in a pre-hospital capacity include but are not limited to trauma, variceal bleeding, hematemesis, lower GI bleeding, acute abdomen, vaginal bleeding, nausea/vomiting and abdominal pain NYD.
Obstetrical and gynecological emergencies occurring in the field are commonly divided into imminent delivery (with or without complications) and prenatal emergencies (i.e. PIH, eclampsia etc.). Goals of treatment are to deliver child and/or treat underlying complications.
Pre-hospital goals of toxicological emergencies are centered around issues of safety for the crews and patient, identification of the noxious substance, generalized supportive care, and specific treatments or antidotes. Decontamination should be addressed in conjunction with other agencies in cases where a hazardous materials threat is identified. In the case of specific overdose or poisoning the Poison Control Centre and/or a toxicologist should be consulted. Consideration should be given to destination choice recognizing the need for ICU care, dialysis, or other special management.
In the prehospital environment common immunological emergencies will include anaphylaxis and sepsis. In the case of either of these disease processes early and prompt care will improve patient outcomes.
CCP pre-hospital multi-system trauma care can be complex and often requires consideration of competing interests. Care should be focused on meeting evidence-based physiological goal of known importance, providing ventilator and hemodynamic supportive care, limiting scene and transport time, and selection of appropriate receiving facility.
Pre-hospital treatment of psychiatric emergencies can be challenging from both a medical and legal standpoint. All attempts should be made to obtain patient consent prior to initiating treatment. If a patient is unable to provide consent, look for a secondary decision maker (i.e. ETP) and/or law enforcement.
Pre-hospital goals regarding environmental emergencies include removing the patient from the environment, providing supportive ventilatory and hemodynamic care, and correcting specific physiological abnormalities.