BLS - Load and Go Patients Standard
From Paramedipedia - Ontario Paramedic Standards
- "Load and go" all patients who meet one or more of the following criteria:
- 1. Seriously injured multiple trauma patients and patients with isolated major injuries;
- 2. Non-trauma patients found to have unstable respiratory, circulatory and/or neurologic status or in whom instability is imminent or highly likely on the basis of assessment findings.
Medical and Traumatic Conditions
- 1. Airway obstruction unrelieved by mechanical methods, e.g. suctioning, positioning, obstructed airway clearance maneuvers, etc.
- 2. Vital signs absent - resuscitation initiated (unless other specific protocols apply).
- 3. Inadequate breathing due to:
- large open/sucking chest wound;
- large flail chest;
- tension pneumothorax;
- major blunt chest injury;
- acute cardiorespiratory disorders e.g. asthma, pulmonary edema.
- 4. Shock - no palpable radial pulse; impending shock - lethal cause obvious or suspect e.g. anaphylaxis, ruptured abdominal aortic aneurysm, ruptured ectopic pregnancy; severe, uncontrolled hemorrhage (wound, rectal, oral, vaginal).
- 5. Head injury - with unilaterally dilated pupil, and/or patient unconscious or level of consciousness decreased or decreasing during assessment.
- 6. Unresponsive - unconscious, coma.
- 7. Decreased level of consciousness - serious underlying disorder suspect or cannot be ruled out and/or no definitive field treatment is available.
- 8. Generalized convulsive seizure (on-going).
- 9. Chest pain - suspect AMI or other serious disorders (see BLS - Chest Pain Standard).
- 10. Burns with signs of inhalation injury, i.e. respiratory distress obvious or likely to develop based on assessment findings.
- 11. Extensive burns (includes chemical burns), e.g. any 3rd degree (child), 10% or greater 3rd degree (adult); 25% or greater 2nd degree (adult) or 20% or greater 2nd degree (child); 2nd/3rd degree burns to the face, hands, feet or perineum; lesser burns at extremes of age or complicated by other medical disorders.
- 12. Tender, distended abdomen secondary to blunt/penetrating trauma.
- 13. Unstable pelvis secondary to trauma.
- 14. Bilateral fractured femurs.
- 15. Complete amputations of a limb, thumb or penis; eye avulsion; partial limb amputation; partial amputations of thumb or penis, depending on severity of injury.
- 1. Vaginal bleeding with shock obvious or impending.
- 2. Eclampsia, severe pre-eclampsia (obvious, suspect); patient not in labour, or in early labour.
- 3. Umbilical cord prolapse - patient not in labour.
- 4. If the patient is in SECOND STAGE LABOUR: Load and go, prepare for possible delivery enroute:
- i) limb presentation;
- ii) umbilical cord prolapse - exception - if delivery appears imminent (for indicators of imminent delivery, see Note at the end of this section);
- iii) pre-eclampsia (obvious, suspect). - exception - if delivery appears imminent (for indicators of imminent delivery, see Note at the end of this section);
- iv) primips: presenting part not visible at any time (during or between contractions); no straining or urge to push with contractions; (contractions approximately 2 minutes apart); primips: presenting part visible only with "bearing down" contractions and transport time is short e.g. 10 minutes or less; (contractions usually <2 minutes apart);
- v) multips: contractions around 5 minutes apart; no urge to push; presenting part not visible at any time (during or between contractions);
- vi) if one or more complications exist, and delivery is not imminent (for indicators of imminent delivery, see Note at the end of this section):
- profuse vaginal bleeding - patient hypotensive or in shock;
- multiple births expected;
- premature labour (<35 completed weeks of gestation).
- vii) If a decision is made to deliver at scene and delivery has not occurred within 10 minutes of initial assessment, consider initiating rapid transport. Make decisions on a case-by-case basis (see BLS - Labour Standard for further discussion).
- Note: Indicators of imminent delivery:
- crowning, or,
- primips: presenting part visible during and between contractions; urge to push or bear down; restlessness; contractions <2 minutes apart, or,
- multips: contractions 5 minutes apart or less + any other signs of second stage labour (urge to push or bear down; heavy red show; presenting part or bulging membranes visible at the vaginal orifice during or between contractions).
Conditions Related to Environmental Mishaps
- 1. Arterial gas embolism (AGE) (see BLS - Scuba Diving Injuries/Disorders Standard);
- 2. Decompression sickness (DCS), with the exception of skin-only decompression sickness (see BLS - Scuba Diving Injuries/Disorders Standard);
- 3. Severe electrical injury (see BLS - Electrical Injury Standard for indicators of severity);
- 4. Severe hypothermia (see BLS - Cold Injury - Frostbite, Hypothermia Standard);
- 5. Venomous snake/insect bite - obvious/suspect and accompanied by one or more of the "load and go" conditions outlined in this standard, or if such conditions are likely to develop based on assessment findings (see BLS - Allergic Reaction - Known or Suspect Standard and BLS - Snake Bites Standard).
Manage all "Load and Go" patients as follows:
- 1. Perform appropriate primary survey interventions.
- 2. Transfer and secure the patient to a stretcher, long backboard or adjustable break away stretcher.
- 3. Load and secure the patient in the ambulance; transport return priority Code 4.
- 4. Perform further history, assessments and management enroute.
- 5. Notify, or have dispatch notify the receiving facility enroute.