Common Moonlighting

Emergencies
Carlos Primero Gundran, MD, MScDM, FPCEM
Consultant, Department of Emergency Medicine
UP-PGH
 Objectives
• 1. How to Run a Code
• 2. Approach to the Unconscious Patient
• 3. Approach to a Hypotensive Patient
• 4. How to give Inotropes
• 5. Alcohol Intoxication
• 6. Seizures
• 7. Anaphylaxis
• 8. Other Common ER Cases (except OB
and Trauma
 Vignette
• A. Clinical Case vignette ( hx, sigbs, and
symptoms short condensed form)
• B. How to Diagnose at the Level of a
Moonlighter
• C. How to Treat at the Level of a
Moonlighter
Is there a specific mindset
you should have during
Emergencies?
 Initial Actions
• D angers
• R esponsiveness
• A irway
• B reathing
• C irculation
• D efibrillation
 Priorities
Problems Primary Problems Secondary
Survey Survey

Circulation No Pulse CPR Inadequate IV and meds

Airway Obstructed HTCL Needs AA

protection

Breathing No Breathing RB Inadequate BVM

Breathing Ventilation

Defibrillation Shockable Shock No 6-H

Improvement 6-T
 Primary Survey
• Problem • Solution

•A • Obstructed • HTCL/JT

•B • Not Breathing • Rescue Breathing

•C • No Pulse • CC

•D • Shockable • Defibrillate
 Secondary Survey
• Problem • Solution

•A • Needs Protection • Intubation/AA

• Inadequate
•B Breathing • Assisted Ventilation

•C • Inadequate • IV Insertion, IV meds

•D • No Improvement • Differentials
 Priorities
Problems Primary Problems Secondary
Survey Survey

Circulation No Pulse CPR Inadequate IV and meds

Airway Obstructed HTCL Needs AA

protection

Breathing No Breathing RB Inadequate BVM

Breathing Ventilation

Defibrillation Shockable Shock No 6-H

Improvement 6-T
 How to Run a Code?

Megacode
“Resuscitation Simulation Exercise”
15/37AUGUSTO A. TEODORO, JR., MD, DPBECP
 Megacode
AW

AW: Airway Manager

€
ET: Electrical therapist ET

IV: IV therapist
CC: Chest Compressor

CC IV

16/37
17/37AUGUSTO A. TEODORO, JR., MD, DPBECP
18/37AUGUSTO A. TEODORO, JR., MD, DPBECP
NAME: AGE/SEX: DATE:

Resuscitation Sheet
EKG TIME VITAL SIGNS D IVF DRUG DOSE AND ROUTE ETC.
H M B P R T
E EPI AMI LID Mg BC AT
O I P R R F
U N I
R B
Ventricular Fibrillation 12 00 CPR

Ventricular Fibrillation 12 02 CPR

200 J insert
1
Ventricular Fibrillation 12 04 200 J mg/IV CPR

Ventricular Fibrillation 12 06 200 J 300 Intubated

mg/IV

12 07 1
mg/IV
Ventricular Fibrillation
12 08 200 J CPR

RESUSCITATION TEAM
Team Leader: _______________________
Airway Specialist: _______________________
Electrical Therapist: _______________________
CPR Man: _______________________
IV Therapist:
19/37
_______________________
INSTRUCTOR:
 Code Organization

• Phase I: Anticipation
• Phase II: Entry
• Phase III: Resuscitation
• Phase IV: Maintenance
• Phase V: Family Notification
• Phase VI: Transfer
• Phase VII: Critique

20/37
 P1: Anticipation

• RESUS team either moves to the scene

of possible cardiac arrest or await
arrival of a possible cardiac arrest

21/37
 P1: Anticipation

Necessary steps:
• Analyze initial data
• Assemble the RESUS team
• Identify the team leader
• Assign critical tasks
• Prepare and check equipments
• Position the team leader and team
members to begin resuscitation

22/37
 23/37

P1: Anticipation
Check Defibrillator
• Battery charge
• Cables
• Electrodes
• Paddles
• Pads for TCP
• Gel
• ECG Paper
• Spare Defibrillator
 24/37

P1: Anticipation
• Personal Protective Devices
• Protective eyewear
• Surgeon’s mask
• Gloves
• Gown
 P1: Anticipation

Airway management devices

• Bag-valve mask devices with O2 reservoir
• Suction device/tips
• Laryngoscope set
• ET tubes (all sizes) 6.5, 7.0, 7.5, 8.0 mm
• Stylet/Gel/10cc syringe
• Pulse Oximeter
• Oro-/Naso-pharyngeal airways
• Stethoscope
25/37
 P1: Anticipation

Airway management devices

• Alternative airway devices:
LMA
Combitube
• Surgical airway kit

26/37
 P1: Anticipation

Airway management devices

• Needle thoracostomy set
• Pericardiocentesis set
• Chest tube thoracostomy set

27/37
P1: Anticipation
Keep at least 1 resuscitation bed available

AUGUSTO A. TEODORO, JR., MD, DPBECP

 P1: Anticipation

RESUS Team:
• Team leader
• Members:
• Airway Management
• CPR
• Defibrillation
• Vascular access and medication administration

29/37
 P2: Entry

• Team leader identifies himself

• Necessary steps:
• Transfer patient to a stretcher in safe and
orderly manner
• Obtain baseline ABCD information
• Evaluate information at hand and act on
that information

30/37
 P3: Resuscitation

• Team leader:
• Be Decisive
• Be Professional
• Speak in a firm, confident tone
• Communicate observations to team
members
• Be open to and actively seek suggestions
from team members
• Focus on the ABCD of resuscitation
31/37
 P3: Resuscitation

• Team Members
• State vital signs every 3 to 5 minutes or with any
change in ABCDs of resuscitation
• State when procedures and medications are
completed
• E.g., IV started – left antecubital vein
1 mg 1:10000 epinephrine given IV
• Clarify order as needed
• Prove primary and secondary ABCD information

32/37
 Primary ABCD Survey

• Airway
• Breathing
• Circulation
• Defibrillation

33/37
Attach Monitor/Defibrillator

3-lead monitor cables Quick look paddle

34/37
 35/37

Lethal Rhythms
Pulse QRS Rhythm

Ventricular Wide
No pulse complex; Regular
tachycardia
opposite T

Wide
Ventricular Irregular
No pulse complex;
fibrillation
opposite T

Pulseless
Electrical No pulse Any
Activity

Asystole No pulse
 36/37

Lethal Rhythms
Pulse QRS Rhythm

Ventricular Wide
No pulse complex; Regular
tachycardia
opposite T

Wide
Ventricular Irregular
No pulse complex;
fibrillation
opposite T

Pulseless
Electrical No pulse
Activity

Asystole No pulse
 37/37

Lethal Rhythms
Pulse QRS Rhythm

Ventricular Wide
No pulse complex; Regular
tachycardia
opposite T

Wide
Ventricular Irregular
No pulse complex;
fibrillation
opposite T

Pulseless
Electrical No pulse
Activity

Asystole No pulse
 P4: Maintenance

• Return of Spontaneous Circulation

(ROSC)
• Necessary steps
• Anticipate and prevent patient
deterioration
• Stabilize vital signs
• Secure tubes and lines
• Trouble shoot any problem
• Prepare patient for transport or transfer
38/37
 P5: Family Notification
• Tell family members that resuscitation efforts
have begun; periodically update them
• Tell them the result of resuscitation effort
with honesty and compassion
• Speak slowly in a quiet, calm voice and use
simple terms, not medical terminology. Pause
every few seconds to ask if they understand
what is being said
• Enlist assistance of a social worker or clergy
as needed

39/37
 P6: Transfer

• The responsibility of the RESUS team

continues until patient is transferred to
a healthcare team of equal or greater
expertise
• When transferring care, provide
information that is well organized,
concise and complete

40/37
 P7: Critique

• Regardless of outcome and length, the

team leader must ensure that the
RESUS effort is critiqued by the team
• An opportunity to express grieving
• An opportunity for education (“teachable
moment”)
• Feedback to hospital and prehospital
personnel regarding the efforts of the team

41/37
Core Concepts

CARLOS PRIMERO D. GUNDRAN, MD, FPCEM

Emergency Physician

University of the Philippines-Manila

Philippine General Hospital
Department of Emergency Medicine
RESUS
First, treat the patient, not the
monitor.

43/37
Apply different interventions
whenever appropriate
indications exist.

44/37
 Adequate airway, ventilation,
oxygenation, chest compressions and
defibrillation are more important
than administration of medications

A
B
C
45/37
After each IV medication, give a 20 to
30 ml bolus of IVF and immediately
elevate the extremity

ormal
Lactated aline
Ringer’s
Solution

46/37
 Conduct during Code

• Act professionally.
• Do not laugh during a code.
• Anticipate.
• Time and record everything.
• Treat the patient not the monitor.

47/37
How to Approach an
Unconscious Patient
 Initial Approach
• D- are there any dangers?
Gloria Ramirez, aged 31, died
of kidney failure in
California. The body was
taken to Riverside hospital,
and a doctor found that her
skin was covered in an oily
sheen. When her blood
sample was taken, everyone
felt some kind of fume
evaporation in the air. Her
blood sample was full of
strange white crystals.
Nothing was explained. And
all who were in contact with
her were affected. The doctor
suffered damage of the liver
and lungs, as well as bone
necrosis.
 Check for Responsiveness
• Unresponsive • Responsive
• Call First • No need for CPR “yet”
• CPR First • Proceed to Secondary
• CPR/CABD Survey
 Differential Diagnosis in 2’
Survey
Search for and treat possible contributing factors:

§Hypovolemia §Toxins
§Hypoxia §Tamponade, cardiac
§Hydrogen ion- acidosis §Tension pneumothorax
§Hyper-/hypokalemia §Thrombosis, cardiac
§Hypothermia §Thrombosis, pulmonary
§Hypoglycemia §Trauma
Causes of Altered Sensorium
• Arrhythmias • C
• Heart Attack • A
• Vasovagal • B
• Stroke • D
• Brain Neoplasms • Metabolic
• Head Injury
• Hypoglycemia
• Seizures
Causes of Altered Sensorium:
C
• Stroke/TIA
• Head Injury
• AMI
• CHF
• Ventricular
Arrhythmia
• Dehydration
Causes of Altered Sensorium:
A/B
• Stroke/TIA
• Head Injury
• Hypoxia
• Hypercarbia
Causes of Altered Sensorium:
D/Others
• Dementia • Hypothermia
• Delirium • Hepatic
• Seizures with post- Encephalopathy
ictal state • Uremia
• Depression • Acute Systemic
• Hyperglycemia Infection
• Hypoglycemia • Bipolar Disorder
• Electrolyte • Acute Psychosis
imbalance
Causes of Altered Sensorium:
D/Others
• Drug
Toxicity/Withdrawal
• Alcohol
Toxicity/Withdrawal
• Hip Fracture
• Pulmonary Embolism
 Assessment
• AVPU
• GCS
• Lateralizing signs
• Sensory
• Motor
• Reflex
 Case 1
• 50 year old male, unemployed
• Found this morning on the sidewalk
besides his house
• Carried and brought home by relatives
• Brought to your ER at 11pm
 Case 1
• What is your Impression?
• What will be your Management?
 Alcohol Intoxication
• Supportive: • Blood glucose
• IV D5 containing. detertmination
• B1: Thiamine • r/o other problems
(suspected • Diagnostics limited
malnutrition/ by finances.
starvation)
100mg/IV prior to
D50/50
• Multivitamin/IV
 Case 2
• A 3 y/o male brought to the Emergency
Room by the grandmother because of
high grade fever and rigidity followed
by jerking of extremities.?
 Seizures
• Priority Problems in Active Seizures
• Airway and Breathing
• Airway Adjuncts (OPA/NPA)
• Bite Guard
• Recovery position
• Suction ready
• Supportive and protective
• IV anticonvulsants (>5 mins)
 Seizures
• With history of seizures
• Missed a maintenance dose?
• Determine anticonvulsant levels
• Refer to attending.
• Any precipitating conditions?
• Can you increase /adjust the maintenance?
• Make sure they will follow-up with attending
in 1-3 days
 Seizures
• First unprovoked seizure
• Determine the etiology
• Admit: with identifiable underlying
condition
• Pregnancy >20wks, (HPN, edema, proteinuria)
• Discharge: N Neurologic examinations and
CT Scan, no acute/chronic medical
comorbidities, N mental status
 Seizure Treatments
• Benzodiazepines
• MgSO4- for pre-eclampsia
• Correct underlying condition:
• Metabolic, infection, poisoning,
temperature
•x
 Drug Dosage
• Diazepam
• 0.2mg/kg BW IV (10mg for a 50kg adult)
• Pedia: 0.2-0.5mg/kg IV q 15-30mins max
10mg
• Midazolam
• 0.07-0.2mg/kg BW IV (3.5-10mg for a 50kg
adult)
• Pedia: 0.4-0.5mg/kg, max 15mg
 Drug Dosage
• Phenytoin
• 20mg/kg loading dose max 1000mg
(1000mg for a 50 kg adult).
 Case 3

• 19 year old male was

trekking with friends
in a nearby mountain
• In severe pruritus
• anxious
• With noisy breathing
 Priority Problems
• A-B-C
• Decontamination
• Epinephrine
• IV crystalloids
• Maintain Pulse Ox> 90%
 Epinephrine
• No signs of cardiovascular collapse
• 0.3-0.5mg (0.3-0.5mL of 1:1000 dilution)
• Epipen
• Pedia
• 0.01mg/kg (0.01mL/kg of 1:1000 dilution)
• Epipen Junior
• 0.15mg
 Epinephrine
• With Cardiovascular collapse
• Adult
• 1mL 1:1000 dilution + 500mL PNSS
• Infuse at 0.5mL/min, titrste dose as needed
• 1microgram/min starting rate
• 1-2 liters IV bolus
• Pedia
• 0.1-0.3 ug/kg/min titrate as needed, max
1.5ug/kg/min
• 10-20mL/kg IV bolus
 Epi Auto-Injector

• Supplied as solution in auto-injector

unit
 2nd Line
• Antihistamines (Diphenhydramine)
• 25-50mg q 6h; IV,IM or PO (adult)
• 0.1mg/kg q 6h; IV, IM, PO (pedia)
• Steroids
 Bronchospasm
• Albuterol
• Ipratropium Bromide
 Case 4
• 35 y/o male, 50 kgs, with a stab
wound in the abdomen came in
unconscious, bp= palpatory 60,
cardiac rate 127/min, respiratory
rate of 28/min, and a temperature
of 37.5’C.
• How will you manage this
patient?
 CASE 5
• A 42 y/o Australian was brought to the
ER because of fainting. He is 90 kgs,
came in awake and oriented but weak.
He claims to suffer from diarrhea for
the last 5 days and has not had UO
since yesterday morning. Vital signs
were 90/60, cr 98, rr 18, t 36.9’c.
• How will you manage this patient?
 Shock
Circulatory insufficiency causing an
imbalance between tissue oxygen
supply (delivery) and oxygen
consumption (demand).
 Classifications of Shock
Hypovolemic
• Inadequate circulating volume
Cardiogenic
• Inadequate cardiac pump
Obstructive
• extra-cardiac obstruction to blood flow
Distributive
• Metabolic derangements that impair
cellular respiration such as sepsis, cyanide
toxicity,..
 Management
• Fluid Resuscitation
• Vasopressors
• When there is inadequate response to
volume resuscitation or there are CI to
volume infusion.
 IV Therapy
• Isotonic non D5 containing
• NSS- risk of inducing hyperchloremic
metabolic acidosis.
• LRS- risk of inducing hyperkalemia in
patients with renal acidosis.
• Do not remain in the intravascular
compartment (every 1 Liter, 250mL
remains in IV space) “3:1” rule in ATLS
• Results in neutrophil activation causing
SIRS
 IV Therapy
Colloids
• Exerts its volume effects by attracting free
water molecules (oncotic effect).
• Albumin
• Dextran- earliest and cheapest, but
increases the risk for bleeding and renal
failure.
• Gelatin- have the shortest volume effects
and best for renal patients.
 IV Therapy
• Colloids
• Starch solutions- HES, has a high water
binding capacity and plateau effect
• Avoided in sepsis
 Stages of Hypovolemic
Shock
Blood Clinical Crystalloid Colloid/Blood
Volume Loss Indicators
Stage I <15% Asymptomatic
Stage 2 15-30% Tachycardia
3x 1:1
Stage 3 30-40% Hypotension
Stage 4 >40% Altered
sensorium

The fluid deficit can be predicted for proper fluid

replacement.
 Vasopressors
• Dopamine
• 200mg/250mL
• renal <5ug/kg/min
• Cardiac >5ug/kg/min
• Septic shock
• Formula
• Wt ( 5ug/kg/min) (preparation)
(10gtts/mL)= gtts/min
• Gtts/min (60min/hr)(1mL/10gtts)=
mL/Hr
Compute the Dopamine renal dose for a 50 kg
man in septic shock.
(50kg) x (5ug/kg/min) x (250mL/200000ug)
(0.3125mL/min) x(10gtts/mL)=3.125gtt/min
(3.125gtts/min) x (60min/Hr)= 187.5gtts/Hr
(187.5gtts/Hr) x (1mL/10gtts)= 18.75mL/Hr
18.75ugtts/min
• Shortcut
• [(Wt in Kg) x (dose)] / 13.3 = ugtts/min
Vasopressors
Dobutamine
• 250mg/250mL
• Ugtts/min= (dose x Kg)/ 16.6
• Usually used to treat heart
failure to increase CO.
• Ideally used in cardiogenic
shock.
 Vasopressors
Norepinephrine
• 1mg/mL, 2 and 4mL
preparations
• 12mg + 250mL at 30mL/Hr.
• 2ug/min increased by
increments every 3-5mins.
• Max dose= 30ug/min
• Used in septic shock, adjunct
in cardiac arrest
 Vasopressors
Epinephrine
• Anaphylactic shock
 Monitoring
CVP= 8-12 mmHg
UO= >0.5mL/kg/hr
MAP= 65-90mmHg
Vital signs
 Case 4
• 35 y/o male, 50 kgs, with a stab
wound in the abdomen came in
unconscious, bp= palpatory 60,
cardiac rate 127/min, respiratory
rate of 28/min, and a temperature
of 37.5’C.
• How will you manage this
patient?
 CASE 5
• A 42 y/o Australian was brought to the
ER because of fainting. He is 90 kgs,
came in awake and oriented but weak.
He claims to suffer from diarrhea for
the last 5 days and has not had UO
since yesterday morning. Vital signs
were 90/60, cr 98, rr 18, t 36.9’c.
• How will you manage this patient?
 Hypertension
Hypertensive Episode
Hypertensive Crisis
Hypertensive Emergency
 Oral Anti Hypertensives
Actions Contraindications

Propranolol, Metoprolol Beta Blocker- Bradykardias, Reactive

diminishes the effect of Airway Disease
epinephrine
Captopril ACE Inhibitor Renal Artery Sclerosis

Clonidine Alpha 2 receptor Sick Sinus Syndrome

agonist – decrease in
sympathetic tone
Nifedipine Calcium Channel Acute MI, Ischemia
Blocker
 IV Anti Hypertensives
• Nicardipine HCl- (5-15mg/hr)
• Nitroglycerin- (5-100ug/min)
• Control BP according to MAP
• = systolic + (diastolic x 2)/ 3
 Case 6
• 48 y/o female
• Hospital accountant, who
came in the ER at 2pm
because of headache.
• BP: 130/80, CR:88, RR:
24, T: 37.0
• Impression?
• Management?
 Case 7
• 20 y/o male
• CC: Epigastric pain
• BP: 100/70,
CR:90/min, RR:
18/min, T:37
• Impression?
• Management?
 Case 8
• 70 y/o male
• Abdominal pain
• Distended abdomen
• Fecaloid breath
• Impression?
• Management?
 Case 9
• 30 y/o male
• Sudden unresponsiveness
• Eating in a restaurant with
friends
• BP: 0, CR:0, RR:0
• They initially did chest
compressions without
ventilation at the scene.
 Case 10
• 40 y/o male
• Vehicular Crash,
• BP: 80 palp, CR 120, RR
24, T: 36.5
• Responsive to painful
stimulus
• Deformed right thigh
 Case 11
• 40 y/o male
• Stab wound in the chest
• BP: 80 palp CR: 120, RR:
27/min
 Case 12
• You are working in a private
hospital.
• An ambulance arrived at your
emergency room with a
patient (vagabond).
• CPR ongoing inside the
ambulance.
• What will you do?
 Case 13
• You were assigned to accompany the
ambulance during a house call.
• Upon arrival, you find the patient
unresponsive, not breathing.
• What will you do?
 Case 14
• A patient was
brought to your
emergency room.
• He was found
unresponsive in his
room late in the
afternoon.
• Lividity is noted on
the back.
• What will you do?
 Case 15
• You were assigned to accompany the
ambulance during a house call.
• Upon arrival, you find the patient
unresponsive, not breathing.
• You noted that the neck is already rigid.
• Frothy saliva coming out of the mouth.
• What will you do?
 Case 16
• A 30 y/o patient was brought to your
ER unresponsive. He was accompanied
by his 8y/o son.
• After 30 mins of resuscitation he was
revived, with dilated pupils and
palpatory BP.
• What will you do?
 Case 17
• A 17y/old patient was brought to your
ER who was stabbed and is currently
fighting for his life.
• He was accompanied by his 16 y/o
girlfriend and their 2 year old son.
• What will you do?
 Case 18
• You were on your way
home from a department
store .
• You ride a bus.
• Robbery was declared.
• A passenger behind you
was shot in the chest.
• What will you do
 RA 8344
• August 25, 1997
• AN ACT PENALIZING THE REFUSAL OF HOSPITALS
AND MEDICAL CLINICS TO ADMINISTER
APPROPRIATE INITIAL MEDICAL TREATMENT AND
SUPPORT IN EMERGENCY OR SERIOUS CASES,
AMENDING FOR THE PURPOSE BATAS PAMBANSA
BILANG 702, OTHERWISE KNOWN AS "AN ACT
PROHIBITING THE DEMAND OF DEPOSITS OR
ADVANCE PAYMENTS FOR THE CONFINEMENT OR
TREATMENT OF PATIENTS IN HOSPITALS AND
MEDICAL CLINICS IN CERTAIN CASES"
LALAKI, PATAY MATAPOS
ATAKEHIN SA PUSO;
RUMESPONDENG
AMBULANSYA, SINISI
• AKSYON | Isang lalaki ang natagpuang patay
matapos umanong atakihin sa puso sa Quezon
Avenue kagabi. Pero ang pamilya ng biktima, sinisisi
ang ambulansya ng Barangay South Triangle na
unang rumesponde. Hindi kasi nito agad isinugod sa
ospital ang biktima.
• July 17, 2015
 When to Stop CPR (BLS)
• victim recovers
• another trained person takes over
• you are too exhausted to continue
• a valid DNAR order is presented to
the rescuer
 When not to start CPR

1. Body in advanced
stage of
decomposition
2. Injuries
incompatible with
Survival e.g.
Decapitation
3. Rigor mortis
4. Lividity
 SURROGATE DECISION
MAKERS
• When a patient has lost the capacity to make
medical decisions, a close relative or friend
can become a surrogate decision maker for
the patient.
• Most states have laws that designate the legal
surrogate decision maker (guardian) for an
incompetent patient who has not designated
a decision maker through a durable power of
attorney for health care.
 SURROGATE DECISION
MAKERS
The law recognizes the following order of priority
for guardianship in the absence of a previously
designated decision maker:
(1) spouse
(2) adult child
(3) parent
(4) any relative
(5) person nominated by the person caring for the
incapacitated patient
(6) specialized care professional as defined by law.
 SURROGATE DECISION
MAKERS
Surrogates should base their decisions on:
• the patient’s previously expressed
preferences if known
• patient’s best interest
 Death Certificate
• Accomplish the blue
form in
handwriting.
• Sequence of
arrangement: BLUE-
WHITE-BLUE-
BLUE
• Make sure the
recipients
acknowledges the
receipt of 3 forms
and sign the 4th
Medico-Legal
Death
• Death within 24 hours of
arrival to the hospital. (ER
and beyond).
• Suspicion of foul play,
victims of violence, sex
crimes, accidents, self-
inflicted injuries,
intoxications, addictions,
unidentified patients
• Never issue a death
certificate.
 Disposition of Cadavers
(Medico-Legal Cases)*

• Issue only a provisional slip

• Needs autopsy done by NBI or PNP
accredited morgue.

• Death Certificates can only be officially

issued by the medico-legal officer who
performed the autopsy.
YEAR MORTALITY MORBIDITY
RANK RANK
1980 7th 7th

1985 7th 6th

1990 9th 5th

1995 6th 5th

1998 5th 5th

UNDERREPORTED???
2002 3rd 4th
IO Device
Intraosseus
Pre-Hospital Care
Emergency Medical Service
A comprehensive system which provides the
arrangements of personnel, facilities, and
equipment for the effective, coordinated and
timely delivery of health and safety services
to victims of sudden illness or injury.

AIM- to provide timely care to victims of

sudden and life-threatening injuries or
emergencies in order to prevent needless
mortality or long term morbidity
 Search and Rescue
• “Is the Search for and the Provision of
Aid to people who are in distress or
imminent danger.”- Wikipedia
• Specialty Sub-fields
• Mountain
• Ground
• USAR
• Combat
• Air/Sea
EMS or SAR?
 ATLS
• November 18-20
• 09178480830/
09228580830
• eastin.borlongan
@yahoo.com
• http://www.pcs.
org.ph
 Questions?
• carlosprimerogundran@yahoo.com