Clinical Approach

Stop
Standard precautions, gloves goggles, PPE, mask, vest Dangers Response Airway - Cervical spine immobilisation if required. Breathing Assisted ventilations if Vi inadequate. Circulation Commence CPR if required. Haemorrhage Control life threatening haemorrhage.	Immediate Mx + Sitrep required (Utilise ETHANE mnemonic)
Action
Rapport, Rest and Reassurance Posture / Position of comfort Oxygen as required (e.g. hypoxia, respiratory distress) Establish if Refusal of Treatment documented	In order of clinical need. If clinically applicable, assess Hx prior to physical contact with Pt e.g. VSS applying monitor, exposing chest
Assess - History
Brief clinical Hx Event prior to Ambulance call Past medical Hx (PHx) Pain - Verbal analogue score Medication Allergies	Accurate Hx + assessment essential for problem recognition
Assess - Vital Signs Survey
GCS PSA RSA Pattern / mechanism of injury / medical condition	Determine time criticality to Mx accordingly Accurate body system assessment in all Pts
Assess - Assessment Tools / Secondary Survey
Secondary Survey SPO2 Monitor/ECG (12 lead if available) Temp EtCO2 More detailed Hx BGL	Through physical examination - Head to toe - Inspection, palpitation, auscultation
Determine Main Presenting Problem
The combination of subjective (PHx, Hx, Med's) and objective (physical) data allows identification of clinical problems Multiple problems may be identified and prioritised to provide treatment order Some overlap in treatment may address multiple problems.	Confirm clinical reasoning with assessment data
Action
Further Sitrep / Resource requirements as required Consider time to hospital vs time to R/V with MICA Paramedic IV access if required Specific treatment - appropriate CPG applied to Mx clinical problems Transport to appropriate facility Reassess frequently and adapt Mx as appropriate Final assessment at destination/handover
This Clinical Approach is to be applied to all Pts as a basic level of care. There is an assumption in each CPG that this is the minimum level of care that the Pt will receive prior to the application of the Guideline. The exception to this rule is the Pt in immediate life threat that requires intervention during the Primary Survey.