Territorial Emergency Medicine 118: syndromic approach to Medical Emergencies

Territorial Emergency Medicine 118 characterized by peculiar ultra-specialized and multi-professional skills has established itself and is appreciated by citizens as a point of sure reference in the panorama of the NHS.

With the enormous growth of medical and technological knowledge applied to the territory, it has succeeded in significantly improving the clinical outcomes of all pathologies from heart attack to stroke, from major trauma to severe respiratory insufficiency, from maxi-emergence z to disasters. It is configured as a branch transversal to all other specialties: the 118 System Operators (doctors, nurses, driver-rescuers) in fact must be able to deal with any critical patient at 360 degrees!

In order to fulfil its Mission and respond to the health needs of citizens in any circumstance and situation, 118 Emergency Medicine has developed its own clinical diagnostic-therapeutic method. In addition to the knowledge of scientific notions (SAPERE) and practical procedures (SAPER FARE, skills), their application (SAPER ESSERE) is indispensable for the solution of clinical problems by making decisions that cannot be postponed and life-saving. The methodological tools that guide the diagnostic and therapeutic path are, therefore, respecting the roles, the skills. They concern both the cognitive sphere (clinical reasoning and the exercise of logic) and the relational one (the doctor-patient relationship, the ethical, anthropological and sociological components.

In System 118, the main symptom (or event that occurred), the reason for the call (patient’s need), is analysed to identify the possible causes that are rapidly dangerous to the life of the victim (RED code) and other causes with risk evolutionary (YELLOW code). They constitute the priority EMERGENCIES with respect to other requests for assistance. They require immediate life-saving treatment following a systematic, complete and rapid clinical reasoning based on the relief of symptoms of objective signs and on the analysis of differential diagnoses with a syndromic approach.

In the Alarm phase the CO 118 operator, having acquired the symptomatologic information, can provide pre-arrival instructions (chapter 3).

In the Territorial response phase, the rescuers on the scene verify the signs, the differential diagnoses with a syndromic approach and operationally proceed to the therapeutic treatment (chapter 4).

This Clinical Operative Method guides the diagnostic-therapeutic path, oriented primarily towards rapidly dangerous conditions rather than potentially evolutionary ones.

Schedules of pathways by symptom in Territorial Emergency Medicine 118.


Quickly dangerous causes

Cardiac arrest

Foreign body airway obstruction



Intoxication / Poisoning (including taking drugs and / or alcohol, tranquilizers)

Endocrine-metabolic disorders, hypoglycemia.



Carbon monoxide (CO) poisoning

Other causes

Brain tumors Hydroelectrolytic disorders

Febrile states with body temperature> 39 °

Psychiatric / neurological diseases

Meningitis / Encephalitis


Quickly dangerous causes


Myocardial infarction

Aortic aneurysm

Pulmonary embolism

Cardiac tamponade



Carbon monoxide (CO) poisoning

Other causes

Psychiatric diseases

Carotid sinus syndrome

Valvopathies / Cardiomyopathies

Parkinson’s disease autonomic neuropathies


Side effect or overdose of drugs (antidepressants, beta-blockers, antihypertensives)