3. ALS Skills

While many cases paramedics attend, involve helping someone off the floor, or taking someone to hospital who has no other way to get there, we also have a range of Advance Life Support (ALS) skills to be used in an emergency situation. Remember that we are often using these skills in crowded, less than ideal situations – for example the back of a wrecked car. These include:

  • Comprehensive assessments of all patients. This may include cardiovascular, respiratory, metabolic, mental health, neurological and many other assessments to determine how urgently they require care.
  • Electrical defibrillation to restart a heart in some cases of cardiac arrest
  • Airway management of patients who require it in the form of oral, nasal or laryngeal airway devices
  • Ventilation (i.e. taking over the breathing of someone who can’t do it themselves) of patients
  • Intravenous cannulation of patients. Obtaining IV access is an essential step in emergencies – we are skilled in placing both small IV cannulas (e.g. for pain relief) and large ones (e.g. for fluid resuscitation in a patient bleeding internally)
  • Intramuscular injections of medication
  • Chest decompression particularly in rural areas, patients who have experienced severe chest trauma may end up with a collapsed lung that needs to be re-inflated. ALS paramedics can insert a long needle into one or both sides of a patient’s chest to achieve this. This is a true life-saving procedure.
  • Fracture management including splinting of all bones, from traction splints, air splints, formable splints and spinal immobilisation.
  • Medication administration by various routes. The drugs carried by ALS paramedics include:

    o Adrenaline (for cardiac arrest, severe croup, severe asthma, anaphyaxis)
    o Aspirin (cardiac chest pain)
    o Atrovent (severe asthma)
    o Ceftriaxone (meningococcal & severe infections)
    o Fentanyl (pain relief)
    o Glyceral Trinitrate (cardiac chest pain, autonomic dysreflexia)
    o Glucose paste & Glucose IV (diabetic hypoglycaemia)
    o Glucagon (diabetic hypoglycaemia)
    o Lignocaine (local anaesthetic)
    o Maxolon (nausea & vomiting)
    o Morphine (pain relief)
    o Midazolam (seizures, sedation)
    o Misoprostol (maternal haemorrhage post baby delivery)
    o Narcan (narcotic overdose)
    o Normal Saline (fluid replacement)
    o Penthrane (pain relief)
    o Salbutamol (asthma)
    o Stemetil (nausea & vomiting, severe headache, vertigo)

    The majority of these medications are given intravenously or intramuscularly, and so paramedics must have intimate knowledge of the contraindications and side effects of these drugs as they are often irreversible if given in the wrong situation.

    Some of these drugs, particularly when administered to child patients, are given on a weight basis. So, for example to work out the dose of midazolam to give to a continually convulsing 13 year old child:

    1. Weight calculation – 13 x 3.3 = 43kg rounded off
    2. Drug calculation – 43kg x 0.1mg/kg = 4.3mg
    3. Dose calculation – (4.3mg / 15mg) x 3mL = 0.86mL

    As you can see, these 3 step drug calculations involving decimals and odd numbers aren’t easy. Now imagine how hard that would be with a seizing, non-breathing 13 year old turning blue in front of you. With their family stressed and crowding you. At 5.30am in the morning. After you haven’t slept for 20 hours and haven’t eaten for 8.

    The consequences for getting such calculations wrong are severe – in the case of midazolam a child may stop breathing completely if overdosed. With adrenaline, you may see a fatal heart rhythm develop.

    This is by no means a comprehensive list of skills paramedics practice – we are constantly given new skills and information as it becomes available. As you can see, despite our lowly pay our skills can be essential and life-saving in certain situations.

  • One Response to 3. ALS Skills

    1. kfelt says:

      you forgot acute pulmonary oedema for the GTN

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