Survive First-Aid Pocket Handbook

This book has been developed as a pocket reference for those that have completed a course with Survive First Aid Pty Ltd.

First Aid Courses should be refreshed every 3 years, with CPR, Asthma and Anaphylaxis training refreshed annually.

Content/Guidelines have been sourced from the list of providers on the Home page of this app.

Contents

Abbreviations
First-Aid Aims and Principles
- Primary Survey
Observations & Vital Signs Ranges
I.M.I.S.T A.M.B.O
Level of Consciousness (LOC) AVPU
Heart Rate (HR)/Pulse
Respiratory Rate (RR)
Skin Color: Temperature: Moisture, (SCTM)
Pupils
Total Body Exam (Head to Toe)
Enquire (SAMPLE history)
Calling Emergency Services
International Phonetic Alphabet
Two-way Radio Guide
Triage
Choking
Anaphylaxis
Asthma
Pressure Immobilisation
Heart Attack
Stroke
Burns
Heat Stress / Hyperthermia
Hypothermia
Helicopter Evacuation Guidelines
Evacuation Guidelines
N.O.T.E.S Form

Abbreviations

Abbreviation	Definition
A	Absence of
AMS	Acute Mountain Sickness
Angio	Vessel
Anterior	Front
Anti	Against
Arterio	Artery
Bi	Two
BLS	Basic Life Support
B.O.M	Bites, Odors, Medi-Alerts
BP	Blood Pressure
Brady	Slow
BSI	Body Substance Isolation
cap	Capsule of Medicine
Cardio	Heart
CC	Chief Compliant
cm	Centimeters
CO	Carbon Monoxide
CPR	Cardio Pulmonary Resuscitation
Crani	Skull
CSMS	Circulation, Sensation, Motion & Strength
Derm	Skin
Distal	Away from the body
Dys	Difficult
Ectomy	Removal
Encephalo	Brain
Entero	Intestine
g	Grams
Gastro	Stomach
HACE	High Altitude Cerebral Edema
Haemo	Blood
HAPE	High Altitude Pulmonary Edema
Hemi	Half
Hepato	Liver
HPI	History of Present Illness
HR	Heart Rate
Hyper	High
Hypo	Low
ICP	Intra-cranial Pressure
IM	Intramuscular
Inferior	Lower
Itis	Inflammation
IV	Intravenous
L/min	Litres per minute
LLF	Look Listen Feel
Lateral	Side
Lingual	Tongue
LLS	Lake Lousie Score
LOC	Level of Consciousness
m	Metres
Medial	Middle
mg	Milligrams
MI	Myocardial Infarction
min	Minutes
MOI	Mechanism of Injury
Myo	Muscle
Neuro	Nerve
NSAID	Non Steroidal Anti- inflammatory Drug
Ologist	Specialist
ORS	Oral Rehydration Solution
Ostomy	Opening
OTC	Over the counter
Oxia	Oxygen
PEARL	Pupils, Equal & Reactive to Light
Pedi	Children
Pnea	B - Normal Breathing?
Pneumo	Air
Poly	Many
Post	After
Posterior	Back
Pre	Before
Prone	Lying on front
Proximal	Closer to the body
Psych	Mind
Retro	Behind
RICE	Rest Ice Compression Elevation
ROM	Range of Motion
RR	Respiratory Rate
S/S	Signs and Symptoms
SC	Sub Cutaneous (Under the Skin)
Scleros	Hardening
Scopy	look at or into
SOB	Shortness of Breath
Superior	Upper
Supine	Lying on back
tab	Tablet
Tachy	Fast
tsp	Teaspoon
tbsp	Tablespoon
Thorax	Chest
TM	Trademark
TX	Treatment
Uni	One
Uria	Urine
Vasc	Vessel
Viscera	Internal organs

First-Aid Aims and Principles

First Aid is the care given to an injured or Ill person before medical assistance arrives or is sourced. Whilst administering any First Aid it is important the following aims are adhered too:

Maintain Life
Protect the Unconscious
Prevent the Condition Getting Worse
Promote Recovery
Seek Medical Assistance
And Above all DO NO HARM!

Whilst administering First Aid it can be very difficult to recognize the variety of illness or injuries and therefore decide what appropriate treatment to administer.

It is important First Aiders adhere to a system and structure provided through training and then provide care to a patient based on a Patients, Signs (what you see or hear), Symptoms (what a patient feels or tells you) and Medical History (what happened and what pertinent history there is). Throughout First Aid it is imperative that you treat a patient with care and reassurance as this will undoubtedly help the situation and improve the chance that the patient will respond to treatment.

Primary Survey

When first initiating First Aid it is important to undertake the Primary Survey in the appropriate order of DRSABCD and to follow the Emergency Response Plan.

Basic Life Support
EMERGENCY ACTION PLAN
Unconscious Patient

ANZCOR Basic Life Support Flowchart

D - Dangers?
R - Responsive?
S - Send for Help
A - Open Airway
B - Normal Breathing?
C - Start CPR
D - Defibrillator & Deadly Bleeds

Check for dangers to:

Self
Bystanders
Patient

Questions:

What are some specialised dangers we need to consider when working in a remote or wilderness environment?
What should we do if the dangers to ourselves is too much?

Dangers

D - Dangers?
R - Responsive?
S - Send for Help
A - Open Airway
B - Normal Breathing?
C - Start CPR
D - Defibrillator & Deadly Bleeds

The AVPU Scale

ALERT: person, place, time, event
VERBAL: R - Responsive? to a verbal command? (eg: squeeze my hand)
PAIN: R - Responsive? to a painful stimuli? (eg: trapezius squeeze)
UNRESPONSIVE: no R - Responsive? to any of the above

Responsive

D - Dangers?
R - Responsive?
S - Send for Help
A - Open Airway
B - Normal Breathing?
C - Start CPR
D - Defibrillator & Deadly Bleeds

Call 000

H.E.L.P

Make sure that you have the following information ready before you call:

Hazards
Emergency type
Location
Patient details

Help

D - Dangers?
R - Responsive?
S - Send for Help
A - Open Airway
B - Normal Breathing?
C - Start CPR
D - Defibrillator & Deadly Bleeds

Make sure that the airway is:

Open
Clear

Use the Head Tilt and Chin Lift technique

Remember: Airway always trumps spinal!

Airway

D - Dangers?
R - Responsive?
S - Send for Help
A - Open Airway
B - Normal Breathing?
C - Start CPR
D - Defibrillator & Deadly Bleeds

Make sure that the breathing is:

Normal
Equal

Look, Listen and Feel for 10 seconds

Breathing

D - Dangers?
R - Responsive?
S - Send for Help
A - Open Airway
B - Normal Breathing?
C - Start CPR
D - Defibrillator & Deadly Bleeds

Ensure that you consider the following:

Is the surface suitable for CPR?
Is my hand and body position correct?
Am I compressing 1⁄3 of chest depth?
Is my timing correct?
Are my rescue breaths effective?

30 COMPRESSIONS : 2 BREATHS 5 CYCLES : 2 MINUTES 100 BEATS PER MINUTE

HANDS-ONLY CPR IS OK!!

CPR

D - Dangers?
R - Responsive?
S - Send for Help
A - Open Airway
B - Normal Breathing?
C - Start CPR
D - Defibrillator & Deadly Bleeds

ATTACH DEFIB ASAP

Make sure you consider:

Do I need to dry or shave the patient?
Am I putting the pads in the right place?
Is the environment suitable?

STOP DEADLY BLEEDS ASAP

Make sure you remember:

Direct pressure on the wound
Positional pressure on the limb
Do I need to use a tourniquet?

Basic Life Support
EMERGENCY ACTION PLAN
Conscious Patient

E.A.P

D - Dangers?
R - Responsive?
S - Send for Help
A - Open Airway
B - Normal Breathing?
C - Start CPR
D - Defibrillator & Deadly Bleeds
E - Evaluate Injury & Environment
F - Find out the Facts
G - Get Ready to Go

Evaluate Injury & Environment

Treat life threatening injuries and illness
- Asthma, anaphylaxis, hypoglycaemia etc.
Treat distracting injuries
- Long-bone fractures, burns,
Treat for environment
- Remove wet clothing, hypo-wrap etc.

Environment

Find out the Facts

Follow the N.O.T.E.S sheet format:
- Need to know?
- Observations
- Total Body Exam
- Enquire
- Summary + Spinal Assess

Remember:

Record vital signs at regular intervals
Get “down to skin” in total body exam
Ask plenty of questions!

Facts

Get Ready to Go & Final Treatments

Complete any treatments or packaging
Prepare an IMIST AMBO handover
Re-assess evacuation plans
Make sure that all rescue team members are on the same page
Smooth and steady movements- especially if lifting or carrying

Observations & Vital Signs Ranges

VITAL SIGNS	NORMAL	MODERATE	SEVERE
LEVEL OF CONSCIOUSNESS	A+O x 4	ALERT ONLY	V, P or U
HEART RATE	60 - 100	100 - 120	120+ (without cause)
RESPIRATORY RATE	8 - 16	16 - 22	22+ (without cause)
SKIN	Pink, warm, dry	Pale, cool, clammy	Pale, cold, blue
PUPILS	PEARL	Dilated/sluggish/pinpoint	Dilated/fixed
BLOOD SUGAR	4 - 6 mmol	2 - 4 mmol	Low

I.M.I.S.T A.M.B.O

Identify the patient
Mechanism of injury/ nature of illness
Injuries or info related to complaint
Signs
Treatment
Allergies
Medications
Background
Other pertinent info

Level of Consciousness (LOC) AVPU

Key to the AVPU Scale

A&O x 4 - Patient knows Person, Place, Time and Event
A&O x 3 - Patient knows Person, Place and Time
A&O x 2 - Patient knows Person and Place
A&O x 1 - Patient knows Person
A - Patient responds but doesn’t know who they are
V - Patient responds to a verbal stimulus
P - Patient only responds to a Pain Stimulus
U - Patient is Unresponsive

Heart Rate (HR)/Pulse

The rate of a normal pulse can vary greatly and be between 50 – 100 beats per minute for an adult and as much as 160 in an infant. Details of the HR can however tell you if a patient is stable over time and give you an indication of the extent of the injury/illness.

Note: It is best to take the Radial Pulse of a patient, as this is both less invasive for the patient and also important when assessing Blood Pressure.

Respiratory Rate (RR)

In general it is effortless to breathe however if this becomes labored it is an indication that your patient has something wrong. The respiratory rate is best done by sight or feel of the chest rising and falling. As with the HR detail the Rate (Breaths per minute), Rhythm (Regular or Irregular) and Quality (Deep or Shallow).

Skin Color: Temperature: Moisture, (SCTM)

Every person irrespective of their ethnic/cultural background and genetics will have pink skin on the inside of their mouth, soles of feet and palms of hands.

Examples of SCTM:

PWD - Pink, Warm & Dry - Normal
PCC - Pale, Cool & Clammy - Shock
RHD - Red, Hot & Dry - Hyperthermia

Pupils

Normal Pupils are equal in size, round in shape and have a normal reaction to light. They become smaller with increased light and larger with less light. This is described as PEARL, (Pupils, Equal and Reactive to Light). A patients Pupils can be tested by shining a torch briefly in each eye or use sun light by covering each eye and then exposing to the light again.

Anything that is different to PEARL should be noted, as it may be a significant discovery with regards to an injury or illness, i.e. Fixed, Dilated, Unequal.

Total Body Exam (Head to Toe)

This is a systematic, physical check of the whole body for any injuries sustained. Whilst conducting this physical check, it is worth remembering to conduct a B.O.M check (Bites, Odors, Medi-alerts) and ensure you Look Ask and Feel (LAF) as you systematically move down the body. Look for bruising, bleeding, swelling, or anything out of the ordinary. Ask about pain or tenderness. Feel for deformities, unusual hardness or softness.

If you find a painful area ensure to expose it to skin level and examine before moving on. The objective of this ‘Exam” is to ensure you get a full picture of all the injuries that have been sustained.

Start at the head and work towards the feet using broad hands and explaining to the patient what you are doing at all times (even if the patient is unconscious)

If there is any pain or an injury with the neck, back or pelvis always suspect a spinal injury and treat accordingly. Ensure you check Circulation, Sensation, Motion and Strength (CSMS) in all four extremities. Please note that the Chief Complaint (CC) should already have been exposed and possibly treated in an earlier stage of your Emergency Action Plan (Evaluating Injury and Shock) prior to commencing this component of your secondary survey.

It is important during the Full Body Exam that you respect the individual’s cultural background and ensure that the exam is always undertaken with their permission. Continually talk to the patient during the exam explaining what you are about to do and ensure they are comfortable and at ease.

Head to Toe

Enquire (SAMPLE history)

A Sample medical history is an important part of the Secondary Survey and allows you to really investigate how the patient is feeling. Be compassionate and confident (good bedside manner), ask non-leading through questions, and record the information you receive. Again it is important to respect the cultural/ethnic background of your patient and ensure you speak to them in a respectful and appropriate manner.

SYMPTOMS - How do you feel? Open ended Questions?
ALLERGIES - What To? Severity of Reaction? Medication?
MEDICATIONS - Prescription, Homeopathic, Illegal?
PERTINENT MEDICAL HISTORY - What, When, Is it Related?
LAST INS & OUTS - Urine, Faeces, Vomit, Diarrhea, Menstrual?
EVENTS - What events occurred to make you feel like this?

Pain

ONSET – Sudden or Gradual?
PROVOKES – Movement, Touch?
QUALITY – Dull or Sharp?
RADIATES – Does the pain move?
SEVERITY – Out of 10?
TIME – How Long?

Calling Emergency Services

The person who calls emergency services should provide clear concise information to the operator. Other appropriate information to give to the operator would be the callers name, phone number or details and how to get back in contact.

When speaking to an operator you may need to spell words to ensure the information given is accurate. In such a case the use of the International Phonetic Alphabet will help

H.E.L.P

Hazards– Detail any hazards emergency services attending need to be aware off.
Emergency Type – Detail what has happened and what help you require
Location - Detail exact location of where you are (nearest road head is often required)
Patient Details – Describe what is going on with your Patient(s)

International Phonetic Alphabet

LETTER	WORD	PRONUNCIATION
A	Alpha	Al fah
B	Bravo	Brah Voh
C	Charlie	Char Lee
D	Delta	Dell Tah
E	Echo	Eck Oh
F	Foxtrot	Foks Trot
G	Golf	Golf
H	Hotel	Hoh Tell
I	India	In Dee Ah
J	Juliet	Jew Lee Ett
K	Kilo	Key Loh
L	Lima	Lee Mah
M	Mike	Mike
N	November	No Vem Ber
O	Oscar	Oss Car
P	Papa	Pah Pah
Q	Quebec	Keh Beck
R	Romeo	Row Me Oh
S	Sierra	See Air Rah
T	Tango	Tang Go
U	Uniform	You Nee Form
V	Victor	Vick Tah
W	Whisky	Wiss Key
X	X-Ray	Ecks Ray
Y	Yankee	Yang Key
Z	Zulu	Zoo Loo

Two-way Radio Guide

When using the Two-way Radio Network it is vital that you are clearly understood. To do this it is important to understand the differences between a telephone and a two-way radio. Two-way radios are not like a telephone. Telephones and mobile phones are “full-duplex” which means you can talk and listen at the same time. Two way radios are “simplex” which means you cannot hear anyone while you have the talk button pressed.

It is extremely important to take turns talking. To help with this, standard radio procedures have been created.
The single most important mistake people make is failing to identify themselves. There may be several people using the same channel as you, so it’s important to know who you are directing your transmission to. To call someone, say the name of the person you want to call, followed by the words “THIS IS,” then say your name and “OVER.”

Example: “Susan, THIS IS John, OVER.”
It’s important to say the name of the person you want to contact before saying your name, as this will get their attention, and they will listen to the rest of your message. The word “OVER” leaves no doubt about whose turn it is to talk and avoids any confusion. It’s important to say “OVER”, so they know when you are done speaking.
It’s basic “radio etiquette” to establish contact and make sure that you have the other person’s attention before you start your message. If you hear someone calling you, acknowledge his or her call by saying, “GO AHEAD” or “STAND BY” This lets the caller know that you heard them. Also remember, it may take someone a while to get to their radio and respond. Be patient in waiting for a reply.
Because only one person can talk at a time, it is more important to LISTEN on a 2-way radio than to talk!
When your business is finished, the person who started the conversation should end it by saying their name and the word “OUT,” which leaves no mistake that contact has ended.
Always release the push-to-talk (PTT) button whenever you stop talking. If you forget and keep it pushed down while you are trying to think of something to say, the radio continues to transmit, making your battery run down faster and making “dead air” so that nobody else can speak or be heard. In an emergency, it could prevent someone with vital information from getting through. If you need to collect your thoughts, release the PTT so that somebody else can break in case they have an emergency or additional information
It is always best to speak in short simple phrases on the radio and toss the conversion back and forth with the word “OVER.”
Don’t speak immediately when you press the PTT (push to talk), especially with digital radios which among all their benefits have slightly longer delay. Ideally, wait 2-3 seconds. If you speak as soon you press the PTT button, it can chop off your the first syllable or word, making you hard to understand.

Radio User’s Language

Expression	Meaning
Go Ahead	Resume transmission
Say Again	Re-transmit your message
Stand-by	Transmission has been acknowledged, but I am unable to respond now
Roger	Message received and understood
Affirmative	Yes (avoid yup, nope, etc.)
Negative	No
Over	Transmission finished
Out	Communication is over and the channel is available for others.

Sample Dialog

Below is a sample dialog that puts these standards to use.

Adam: Mike, this is Adam. Over.

Mike: Adam, this is Mike, Stand By. Over.

Mike: Adam, this is Mike, Go Ahead. Over.

Adam: Mike, there is a fire at 123 Main St. Over.

Mike: Adam, this is Mike, confirming a fire at 123 main St. The fire department will be notified. Over.

Adam: Mike, this is Adam, address is confirmed, thanks for the help. Over and Out.

Radio Usage Tips

Be brief and to the point.
Stay off the radio unless absolutely necessary.
Engage your brain before your mouth.
Think about how best to make yourself understood.
Listen before you begin your transmission.
Make sure the channel is clear. Wait a full second AFTER you push-to-talk and BEFORE you begin to speak. This will insure the beginning of your message is heard.
Speak ACROSS the microphone rather than into it to improve intelligibility. Use a natural speaking voice. The only way to overcome loud ambient noise is to shield the microphone from the wind, point it away from the source of noise or wait until the noise passes.
You should be aware that any portable radio is much less effective when worn on your belt, because your body absorbs the radio signal. This is very noticeable with low powered radios.
DO NOT shout into the radio. It only distorts your transmission.
DO NOT turn the volume all the way up. This drains the battery and causes distortion. It also has no effect on outgoing transmission quality.

Triage

Priority One – Red Tag (require immediate surgery or other life-saving intervention). Immediate resuscitation and stabilization required

Control of severe bleeding required
Open and stabilize airway in an unconscious casualty

Priority Two – Orange Tag (condition stable, but requires close monitoring and will need hospital care)

Treatment but no active resuscitation required
Burns, Crush injury, Spinal, Head, Chest, Abdominal

Priority Three – Green Tag (will require care but not immediately)

Walking wounded
Cuts, Grazes, Sprains, Closed Fractures

Priority Zero - Black Tag (deceased or in such life- threatening medical crisis that they are unlikely to survive given the care available)

Decapitation
Massive head or torso injuries

Choking

Anaphylaxis

Asthma

Pressure Immobilisation

When treating a patient that requires a Pressure Immobilisation Bandage, there are two components that must be satisfied:

pressure over the bitten limb, and
general immobilisation.

This involves the application of:

A broad (minimum 7.5 cm wide) elastic bandage to the entire bitten limb at a very firm pressure of at least 40 mmHg for an arm and 55 mmHg for a leg. The SMART Snake Bandage is perfect for this.
Splints to effectively immobilize the entire limb, in combination with laying the patient down and completely still to minimize any movement.

TREATMENT:

Keep the victim at rest, reassured and under constant observation
Commence resuscitation if necessary, following ANZCOR Guideline 8: Cardiopulmonary Resuscitation
Apply a Pressure Immobilisation Bandage to the entire limb:
Apply a broad pressure bandage over the bite site as soon as possible
- The bandage should be firm and tight, you should be unable to easily slide a finger between the bandage and the skin
- To further restrict lymphatic flow and to assist in immobilisation of the limb, apply a further pressure bandage, commencing at the fingers or toes of the bitten limb and extending upward covering as much of the limb as possible.
- Splint the limb including joints on either side of the bite, to restrict limb movement.
- Rapid evacuation for any patient who requires a Pressure Immobilisation Bandage

DO NOT…

DO NOT cut or excise the bitten area, or attempt to suck venom from the bite site

DO NOT wash the bitten area

DO NOT apply an arterial tourniquet

DO NOT try to catch, chase or kill the snake, as this may lead to another bite

DO NOT give alcohol, tea, stimulants, food or medications without medical advice

DO NOT wash the wound, apply hot or cold packs, apply electric shocks, and

DO NOT suck the wound or use suction from any device

DO NOT allow the patient to walk or run after a snake bite

DO NOT remove or loosen the pressure immobilisation bandages unless advised to do so by medical personnel

DO NOT ignore the urgency of obtaining medical assistance in favour of reliance on traditional medicines or home remedies

Pit

Heart Attack

Stroke

Burns

Burns Adult Burns Child

Heat Stress / Hyperthermia

Heat Stress

Hypothermia

Hypothermia 1 Hypothermia 2

Helicopter Evacuation Guidelines

General Guidelines

Approach and depart helicopter from the front or forward-sides- ideally in the space defined by ‘10 + 2’ on a clock.
Always establish visual contact with the pilot before approaching. If unsure, do not approach.
Where possible, maintain radio communications with the pilot at all times.
When approaching at night, await a predetermined signal such as a the flashing of a head-torch or vehicle headlights.
Never approach or depart toward the tail of the helicopter; always be aware of the tail rotor.
Always approach and depart from the downhill slope (if present)
Carry all equipment and patients below waist level.
Secure all loose equipment on the ground (including wind-socks, lights and flares).
Protect patients by using natural features or building a small fortress (using packs, bags, etc), between them and the aircraft.
At night, designate the landing zone by crossing vehicle headlights or using head-torches in a similar manner.
Small fires may be lit to designate landing zone corners, however must be well-controlled and attended at all times.
Never shine lights or laser beams directly at the pilot.
All non-essential lights should be extinguished.
Always be aware that helicopters will approach and land from a downwind direction

Landing Zone Specifications

Landing zones should, ideally, measure a 30m x 30m square, with minimal ground debris or overhead structures in the vicinity.
The landing zone should be as flat as possible. In the case where flat land is not available, the slope should not exceed 5 degrees.
A wind-sock should be placed on the upwind edge of the square, securely fastened. A small fire may serve this purpose.
On a beach or similar surface, a large ‘H’ can be used to designate the middle of the landing zone.
The landing zone must be kept free of personnel and debris at all times.

Helo 1

Helo 2

Helo 3

Helo 4

Evacuation Guidelines

Please be aware that these are recommendations only.
They are based on best-practice and the most current available information.
Every first-aid scenario is dependent on responder training, patient presentation, environmental considerations and available resources- all of which should be taken into account and form part of your treatment and evacuation plan.

RAPID EVACUATION FOR ANY UNRESPONSIVE PATIENT

PRESENTATION	CONSIDER EVACUATION	CONSIDER RAPID EVACUATION
Unresponsive- CPR	RAPID	Rapid evacuation for all unresponsive patients (including deteriorating LOC) and unstable vital signs
Unresponsive- Breathing	RAPID	Rapid evacuation for all unresponsive patients (including deteriorating LOC) and unstable vital signs
Spinal Injury	All patients with relevant MOI	All patients with relevant MOI and any signs and symptoms of spinal injury
Shock	All patients with injuries significant enough to cause uncontrolled shock	Deteriorating patients, uncontrollable bleeding, airway problems and unstable vital signs
Abdominal	Sudden unexplained onset of severe pain or constant unexplained pain lasting more than 24 hrs	Blood in urine, faeces or vomit; any acute abdo pain associated with women of childbearing age; any complications of pregnancy
Anaphylaxis	Any abnormal reaction or first time exposure with systemic involvement	Any patient who requires EpiPen administration
Asthma	Any persistent asthma event or where the trigger cannot be removed	Any asthma event unresponsive to salbutamol and/or any patient with underlying comorbidities (eg: chest infection)
Chest Pain	Any patient complaining of cardiac chest pain	If patient has no medication, has never experienced chest pain before or symptoms last more than 10 mins
Choking	Any patient requiring back blows/chest thrusts that doesn’t rapidly improve with clearing of the obstruction	Any patient who becomes unresponsive
Diabetes- HYPO	For known diabetics, monitor resolved hypoglycaemia for 24hrs (provided patient does not have compounding issues- eg: trauma). Consider evac for relapse or first-time presentations	If patient shows no signs of improvement, relapses, has altered level of consciousness (including persistent behavioural changes) or becomes unresponsive
Diabetes- HYPER	All T2/NIDDM patients experiencing hyperglycemia in a wilderness setting; monitor T1/IDDM regularly and consult/manage according to diabetes action plan	Altered level of consciousness, unresponsive
Seizures	For known epileptics, monitor resolved seizures for 24hrs (provided patient does not have compounding issues- eg: trauma). Consider evacuation for relapses	Seizures related to head injury, trauma, unknown causes or lasting longer than 5 mins. Evacuation for ALL first-time seizures
Stroke	RAPID	Any patient who ‘fails’ the F.A.S.T test
Bleeding- External	Controlled bleeding with associated unstable vital signs	Any patient requiring a tourniquet or haemostatic dressing
Bleeding- Internal	All patients with suspected internal bleeding	Immediate evacuation for internal bleeding with compromised vital signs
Burns	Partial thickness burn greater than 10% of TBSA; Any full thickness burn	Major burns of the hand, face, feet or genitals; burns with inhalation injury; electrical burns; circumferential burns; burns to a medically ill patient
Blisters/ Minor Lacerations + Wounds	Related to patient comfort and logistical considerations- should be considered for any patient showing signs of localised infection	Any patient with signs of systemic infection
Head Injury	All patients who have a relevant MOI, changes in LOC caused by a head injury (including concussion) should be assessed by a health professional; Acute onset of unexplained headache	Any persistent decreased LOC or deterioration
Limb + Joint Injuries	Directly related to patient comfort and logistical considerations- should be considered for any patient with uncontrollable pain levels or persistent dislocation	Any patient with signs of distal hypoperfusion
Penetrating Injury	Any patient with a penetrating injury	Any patient with signs of shock or breathing problems as a result of injury
Bites and Stings	Directly related to patient comfort and logistical considerations- should be considered for any patient with uncontrollable pain	Any patient with systemic effects, breathing or circulatory problems. Any patient who requires a Pressure Immobilisation Bandage
Hypothermia	Any patient that doesn’t respond to rewarming interventions	Persistent moderate/ severe patients
Hyperthermia	Any patients that don’t respond to cooling interventions	Altered LOC or seizing patients
Hyponatraemia	Any patients that don’t respond to cooling interventions	Altered LOC or seizing patients
Lightning	RAPID	Anyone suspected of a lightning strike injury
Drowning	RAPID	Anyone suspected of a drowning episode
Altitude Emergencies	Descent for all patients showing persistent signs of AMS lasting longer than 24 hours	Rapid descent for all patients showing signs of advanced AMS (HAPE, HACE), breathing problems or decreased LOC
Diving Emergencies	RAPID	Pain or breathing issues after diving, any altered LOC, any complications of rapid ascent
Avalanche Emergencies	RAPID	Any patient that has required rescue (self or bystander) following an avalanche emergency (possible unknown internal injuries)
Mental Health	Patients who show a deteriorating level of mental health where responder intervention does not improve situation	Any patient at risk of harm to themselves or others; suicidal ideations; psychotic episodes

N.O.T.E.S Form

Notes