Operations Center 118 and pre-arrival instructions.

The 118 Operations Center represents the first and irreplaceable link in the chain of medical aid for the purpose of reducing avoidable mortality and serious disability resulting from health emergencies, regardless of the causes that determined them.

Main activities of the 118 Operations Center are:

1) Locate the place of the event, or where the territorial health assistance intervention is required;

2) Identify the “informative capacity” of the telephone caller in relation to the conditions of the scenario and of the victim (s);

3) Acquire the basic information necessary to be able to define the present scenario, the safety of the scene, the need for joint intervention by other Bodies responsible for technical rescue or indispensable for support during the intervention phase;

4) Identify the main symptom (or event that occurred), the reason for the call, to “target” the interview and subsequent data collection;

5) Proceed with the interview aimed at gathering the information necessary for identifying the priority indicators, useful for assigning the criticality code (clinical, dynamic, situational indicators);

6) Define the “summary judgment” by attributing the priority code (colour code) including the code relating to the place where the event occurred and the presumed pathology;

7) Provide, if necessary, the information and pre-arrival instructions to those present on the scene awaiting the arrival of help if possible in hands-free mode.

8) Activate the appropriate territorial operational resources (health and non-health) for carrying out the rescue intervention;

9) Coordinate and manage the rescue until the end.

Instructions to facilitate the intervention of the rescue teams

x Open doors or gates and turn on the external lighting

x If possible, a person waits in the street or at the window or balcony

x Have the lift find free and open on the ground floor

x If there are animals, remove or contain them only if possible in safety

x Leave the telephone line free for any subsequent contacts

x Call back if the patient’s condition changes

Generic instructions

x Do not move the patient. Do not give food or drink

x Reassure the patient, keep him calm and at an appropriate temperature

x Undo tight or constricting clothing

x If at home, look for / prepare the medications that the patient takes and any health documents

In the most serious health events such as cardiac arrest, suffocation, loss of consciousness, hasty birth, the role of the bystander witness is fundamental for an immediate and qualified treatment with remote support from the 118 Operations Center through the “Telephone Life Saving Instructions” pending the arrival on site of professional rescuers.

In the event of Cardiac Arrest, survival triples when the Cardio-pulmonary resuscitation(CPR) is initiated by the bystander. Considering the inexperience of bystanders and / or the great emotional impact that a cardiac arrest can have, it is necessary that CPR be guided and supported by the 118 Operations Center operator after a quick identification of the cardiac arrest. , immediately after identifying the place to send the emergency vehicles at the same time.

There CPR procedure it must be dictated using the “Compression Only CPR” methodology, without ever interrupting communication with the user. It is necessary to ask to put the phone on speakerphone.

The communication with the user must be interrupted, if absolutely essential, only for the period necessary to alert the crew to be sent and immediately afterwards the conversation must be resumed following the procedures to be carried out in each phase, verifying their correct execution. trying to make sure that the compressions are done with the right depth and rhythm without interruption.

After having assessed that the patient is unconscious and not breathing, the following instructions should be dictated (it is preferable to give your voice to create a better climate of empathy):

X Place the patient on the floor straight, with the head back.

X If you are alone, get someone to help you (neighbours, if possible).

x Place your hands on top of each other straight in the center of your chest.

x Start pressing with your hands by pushing up and down deeply.

x Press hard and fast.

x Don’t stop pressing until help arrives.

x Every two minutes (if you’re not alone) get replaced.

1)            The current AHA guidelines provide that the layman can hyper-extend the head even in the presence of trauma since the state of need to clean the airways, dictated by cardio-respiratory arrest, may involve risks considered certainly lower. compared to the loss of life.

2)            If the bystander is completely alone, the patient is on the bed and you cannot lay him on the floor, put a rigid surface behind the patient’s back (such as a pastry board for rolling out dough, large steel tray without handles, oven not switched on).

Pre-arrival instructions are also essential to be able to implement other life-saving or life support procedures such as:

x foreign body obstructions in adults and infants,

x loss of consciousness with preserved breathing,

x chest pain from acute coronary artery disease,

x acute breathing difficulties from allergic reaction,

x acute respiratory distress from asthma crisis,

x psychomotor agitation

x possible carbon monoxide poisoning

x imminence of childbirth

Foreign body unblocking (adult suffocation)

The procedure for clearing the airways should be dictated early, just after assessing that the patient is still conscious but can no longer breathe well due to an obstruction of the airway from a foreign body.

They go dictate the following instructions(it is preferable to give yourself to create a better climate of empathy):

X If the patient is still coughing, observe him but let him continue coughing encouraging him.

x If the patient stops coughing (puts his hands to his throat, turns blue in the face):

• get behind him;

• wrap it with your arms;

• put your right hand in a fist with the thumb in the center of the stomach just below the ribs;

• put your left hand behind your right;

• start pushing with both hands inwards and just upwards;

• he continues this maneuver until he is able to expel what is choking him out.

x If you lose consciousness:

• Support him as he falls, put the patient upright on the ground;

• put your hands on top of each other straight in the center of the chest;

• start pressing hard doing up and down;

• from time to time open your mouth and see if there is something inside;

•  if you see something try to catch it with a bent finger without pushing it inside. Do not stop until help arrives or until you start breathing normally again.

Foreign body unblocking (suffocation in the infant)

There procedure from unblocking from the ways areas In the suckling needs to  be dictated without to interrupt never communicating with the user immediately after assessing that the infant is conscious (coughing) but can no longer breathe well due to an obstruction of the airways by a foreign body. They go dictated the FOLLOWING INSTRUCTIONS (And preferable give of the you for create a best climate from empathy):

x If the baby is still coughing, observe him but let him continue coughing.

X if the baby (less than one year old) stops coughing (cannot cry, turns blue in the face):

• grab the jaw with one hand and put the body on the stomach on the same arm;

• put your head a little lower than your body;

• with the other hand he starts patting the back 5;

• then turn him on his stomach;

• put 2 fingers in the center of the chest and press straight and deeply 5 times;

• repeat the same thing alternating the two maneuvers.

x If the child loses consciousness:

• put it on a rigid plane;

• put two fingers straight in the middle of the chest;

• start pressing up and down;

• press deeply;

• from time to time open your mouth;

• if you see something try to catch it with your bent little finger without knocking it down. Do not interrupt until the 118 System help arrives.

Position Lateral of Security

In case of communication by the user of an unconscious patient who is breathing,

after sending of the vehicle, confirmed the state of unconsciousness of the patient and at the same time verified whether he has normal or abnormal / absent breathing (in the latter case, the indications for cardiac massage must be provided). After assessing that the patient is unconscious but breathing, dictate the following instructions:

x Unfold the patient, turn and place the patient on their side.

X Put your head back by pushing your chin back (except in situations where trauma cannot be ruled out).

X Check that the patient can breathe well (undo his tie, unbutton his shirt collar, etc.).

If the patient vomits, clean up the vomit immediately (so that the airways can be cleared).

Chest pain

The management of the call for typical chest pain includes the provision of instructions to take aspirin to the patient with a history of ischemic heart disease already in therapy. The operator of the CO118, after verifying that the patient is not allergic to aspirin, has not noticed the presence of blood in the stool or a recent history of black stools or other bleeding, should recommend the intake of aspirin ( 160-300 mg).

Acute breathing difficulty from allergic reaction

Patients with acute respiratory distress due to an allergic reaction may have adrenaline available in a self-injection pack prescribed by a doctor.

If not yet done, the CO 118 operator will ask these patients to take the drug as directed by their doctor.

Acute respiratory distress from asthma crisis

Patients with acute respiratory distress due to asthma crisis may have physician-prescribed aerosol bronchodilator medications available.

The CO 118 operator will ask these patients – if not yet done – to take the drug as directed by their doctor.

Psychomotor agitation

If the person is violent, ask those present to make themselves safe.

x Move away or remove, if possible, any dangerous or blunt objects (kitchen knives, weapons, etc.).

x Avoid, if possible, that the person can lock himself in a confined space (bathroom, bedroom).

x Do not provoke the person further in an attempt to calm them down.

X Wait for help, supporting the person as much as possible.

Situational indicators of possible carbon monoxide poisoning

Ventilate the room if possible, without remaining in a confined environment in order to avoid the risk of contamination.

Delivery assistance instructions (in case of a hasty delivery)

The procedure for assisting the imminent hasty birth (<2 minutes between uterine contractions, with or without loss of amniotic fluid) must be dictated without ever interrupting communication with the requesting aid; it is necessary to ask to put the telephone on speakerphone and not to interrupt the communication with the user except to alert the crew to be sent; immediately afterwards, the conversation must be resumed following the procedures to be carried out in each phase, verifying their correct execution.

If the pregnant woman feels the pressure (irrepressible feeling of having to push)

Conversation with bystander dictates the following instructions:

x Keep calm, you and the pregnant woman.

x Let her breathe slowly and deeply between contractions.

X If possible, stretch the patient and have her legs bend in the gynaecological position (as she does during the examination).

X Put a clean towel / clean cloth / newspaper under mom’s butt so you have a clean floor.

X If there is another person, whoever does not take the baby must stay next to the mother so as to be able to give her physical and emotional support.

X When the baby’s head appears, keep pushing hard whenever he feels the need to push.

X When the head has come out, hold it without pulling it and without pulling the umbilical cord (be careful because the baby is slippery).

X As soon as the baby is out, clean the mouth and nose with sterile gauze (or clean handkerchiefs / cloths).

x Check how the baby breathes whether regular or not.

X If the baby is breathing regularly, place him naked on his mother’s belly for a short time.

x Quickly cover both of them with clean towels.

X If possible, have the baby latch on to the mother’s breast (sucking stimulates the production of oxytocin which allows the uterus to contract to reduce the risk of postpartum bleeding)

If the situation occurs at home, the following indications can be added (if possible):

X Take 3-4 very large, clean towels, a common alcohol-free disinfectant, sterile gauze, or clean handkerchiefs / cloths.

X Wash your hands (have them washed if there is another person who will assist the birth) with plenty of soap.

X If possible, disinfect the vaginal area by dabbing the area with a gauze moistened with disinfectant