Safety First: Secondary Decision


Study Notes:

  1. 1.How sick is your patient?

  2. 2.What treatment protocol should you be using?

  3. 3.What is the patient’s transport priority?

“Secondary Decision”


“Safety First” ... Table of Contents

Safety    Use your BSI - Biological Safety

              F is for Fire - Scene Safety

I                 I is for Incident: MOI/NOI          

R                Determine the numbeR of patients

S                Send for help

T                Trauma to the C-spine?

G                General impression of the patient

E                Estimate LOAs

T                Threats to you or your patient?

1°A             1° Airway

1°B             1° Breathing

1°C             1° Circulation

1°D             1° Decision

2°A             2° Airway

2°B             2° Breathing

2°C             2° Circulation

2°D             2° Decision

Decision Time

We’ve come to the end of our mnemonic, there’s just one last step left ... it’s decision time again.  Specifically, we need to make three important decisions.

  1. 1.How sick is your patient?

  2. 2.What treatment protocol do they fall under? (roughly)

  3. 3.What is their transport priority? (has it changed?)

Let’s look at each one...

There is a lot of confusing terminology in medicine regarding how to describe how sick someone is.  We use terms like stable/unstable, acute/subacute, etc.  These terms aren’t very clear.  I like to use four, very simple terms:  not sick, sick, very sick and dead.  For a more detailed description of how to use these, read this.

Secondly, we need to take a look at what we think we’re going to be doing to help the patient.  Most paramedics work under protocols.  For example, we have ‘Chest Pain’ protocols, ‘Shortness of Breath’ protocols, ‘Traumatic Cardiac Arrest’ protocols, and many (many!) others.  At this point in the call you should have a rough idea of which protocol you think your patient is going to fall under, and you should be thinking along those lines.  Does that particular protocol fit, or are their exclusions that your patient has?  Is there a better protocol?  What should you be doing now to start treating under the most appropriate protocol?

Finally, ask yourself (again) about transport.  If you initially thought you had time to stay on-scene, has that opinion changed?  Has this changed into a load-and-go situation?  If you are already getting under way, is the hospital you were planning to go to still the most appropriate one, or is there a better one in light of new information?  Should you triage to a trauma, stroke, pediatric, cardiac or other specialized facility?

That’s it!  Your done.  You’ve completed the first few minutes of the call - specifically you’ve entered the scene and done your rapid  and focused assessment of your patient.

Next, you’ll need to make sure you’ve done all the steps you need to do in order to finish the call.  We’ll cover that with a second mnemonic (and a whole new section) entitled ...

“I See I HAD Vitals Assessed and Treated”