My name is Francisco, I am a Portuguese certified EMT/ EMT instructor, I am also a university student. I'm 23 years old at the moment and I've been training and working in this area for 5 and a half years now.

I'm writing this guide because I imagine that most people who buy this really good game probably have an interest in emergency medicine and want to learn more as well as you will be able to apply the principles taught here in-game to guide your judgment especially during calls.



More videos I made at the end of the guide

In real life, emergency situation can and usualy do present in very explosive and unpredictable ways. When people are in panic they will turn to the nearest, most credible figure of authority on the matter at hand.
In my real life activity as a medic in a firefighter squad this role often falls to me as a civilian and while leading emergency teams in the field.

• My goal with this guide is to give you pointers on how to use what you learned in game and what your limitations are as well as how you can excel.
  
• Refer to the glossary in the end section to understand what any underlined word or expression means.
  
• Please leave feedback, vote on the guide and mention any spelling mistake in the comment section. Thank you!
  
• You will find segments of the guide especially dedicated to the game, they will be well visible;

An emergency situation is any event where a person or property is in imminent danger.
MISUSE OF EMERGENCY SERVICES IS A CRIME!

• MEDICAL: Any medical emergency where a person is in immediate risk of life, serious injury or simply unable to go to a hospital by any means other than an emergency ambulance;
  
• SECURITY: Any situation where the present actions of a person or animal compromise the integrity of a person, animal, building or good;
  
• FIRE/TECHNICAL: Any situation where natural or elemental beings cause serious and actual danger to a person, animal, building or good. If a person or animal is trapped, a road is obstructed, electricity is causing concern by exposure;

Specific situations I mention here will be real things I saw.

• A person requires a non-urgent medical transport due to an appointment;
  
• Someone suffers a mild cut, injury, burn, has the flue, chickenpox, is mildly intoxicated, etc;
  
• Two people are arguing without reason to expect a fight, involvement of weapons, etc;
  
• A hairdryer created some smoke;
  
• Someone banged their knee and it is hurting a bit;
  
• You are drunk and called because your counscious - also drunk friend - is "in cardiac arrest";
  
• Someone stole an iPad from the shop's window, you just don't know when or if it was even there;
  
• A large blister on your lower back popped (didn't call the cops because he seemed to suffer from dementia);
  
• You got into a fight yesterday and just realised maybe it is a good idea to go to the hospital, why not? (got the person arrested for misuse of emergency services and threatning civil protection personnel)
  
• You want to sleep in the hospital (got the person arrested for misuse of emergency services);

As you can imagine, any emergency situation is a potential danger: someone is already hurt or about to and that means the likelihood of panic, violence or imminent danger is high.

• Don't become an issue while trying to solve one. If someone needs help and you get yourself in harm's way to do so, you risk creating an additional liability. Don't be a hero, they usually end up dead or injured, in need of help and creating more heroes who will end up dead or injured... Get the picture?
  
• Don't move a person unless absolutely necessary. A patient who suffered a fall, motor accident, injury with heavy machinery, who was involved in a fight, gunfight or any other situation where trauma is suspected may have his or her situation aggravated by unnecessary transportation. Spinal injury or head trauma are potentially life threatening and should be suspected! Also, bleeding can be worsened inducing shock, if not already present.
• Your job is to help until differentiated support arrives, you're not expected to work miracles. Therefore, contacting 911, 112, 999, or whatever the emergency number in your country is, must be a priority! You won't get help if you don't. If you know what you're doing, do not trust anyone else to do it or at least make sure they actually call. Listen to the conversation, make sure an address is correctly provided, the victim's situation is clearly explained and that the person calling is mentally stable and coherent.
  
• If you act you can make mistakes but if you don't act it will surely be worse. In many countries, abandoning a person in need of assistance without contacting emergency services is a crime, not to mention it is morally sickening. If you don't feel safe to stay, contact the injured or go into the area then please contact emergency services and move away.
  
• Avoid contact with body fluids at all costs. The use of gloves or improvised gloves is recommended at all times;
  
• GAME ONLY - Police and security personnel as well as firefighters are obliged to face danger in their professions even more often than EMS. This does not mean that a foolhardy attitude should be adopted. When sending in police officers and firefighters remember that relative safety can be achieved in numbers. In the event of a large fire send in several vehicles arriving at the same time for maximum effect in fighting fire while taking as little losses/injuries as possible. The same applies for police interventions where numerous armed suspects can be neutralized more efficiently with better equipped personnel arriving simultaneously.

First of all you should know that these numbers vary from country to country. 911, 999 and 112 are the most common ones but still you can find a complete list here[en.wikipedia.org].

Note that not all countries have the possibility of tracing a caller's location like we see in-game and when they do it isn't always reliable. Always begin by indicating the precise address of the emergency.

Let's now look at a list of the information you should have ready and the order it should be passed in:

• Full address (example: city, street, street number, floor, apartment)
  
• Sex
  
• Age
  
• Brief summary of the situation
  
• Status of the patient
  
• What you have done already

Good morning! I'm calling from London, Liberty Street, number 56, second floor apartment 10. I have with me a 6 year old boy who lost consciousness a minute ago and is seized for a few seconds for the first time in his life, he has had high fever for two days. I should add that he is breathing.
My wife has taken off some of his clothes and is currently placing wet towels over his head, between arms and legs as too cool him down

Whenever a person's state of consciousness is affected we must assume there might be a life threatening mechanism at work and proceed accordingly while eliminating conditions from most serious to most benign.

• Stroke
  
• Acute myocardial infarction
  
• Seizure
  
• Blunt trauma to the head
  
• Syncope - benign causes from low blood sugar to neurocardiogenic vasovagal syncope (neurological causes)
  
• Alcoholic intoxication or other substances

• Is the scene safe for me?
  
• Is the scene safe for the victim? Should I drag them somewhere safer?
  
• Are they conscious? Let's find out by shouting the person's name and tapping their shoulders. No response = unconscious (do not contact emergency services yet). Response = conscious (contact emergency services now and report the situation). If possible, in either case, get someone there to help you;
  
• Let's position the airway by placing a hand in their forehead and another in the chin and moving the head carefully backwards;
  
• Are they breathing? Position your head over theirs, listen for breath sounds, try to feel the air on your face and look at their chest and stomach for respiratory movements. Not breathing = cardio-respiratory arrest (contact emergency services ASAP and prepare for CPR).
  
• CPR - 30 compressions / 2 mouth to mouth breaths (optional). Apply compressions to the center of the thorax roughly halfway through the sternum. Mouth to mouth breathing should be provided only if you have adequate protection mask or you are confident that the person, being known to you, isn't a carrier of a contagious disease;
  
• Continue if you hear ribs breaking, if relatives or bystanders tell you to stop.
  Cease if person regains spontaneous breathing, if EMS arrives and orders you to stop, cease if DNR order is presented (call emergency services again to inform and transfer responsibility), if the scene is no longer safe, if you are absolutely exhausted and under no circumstance are able to maintain CPR;
  Do not start CPR at all if person is decapitated, severed across the chest, in decomposition or carbonized;

So you are given a call where you know a person is unconscious. The same line of reasoning should be used for triage:

• Get an address;
  
• Try to find out whether they really unconscious (presume they are);
  
• Try to find out if they are breathing;
  
• Brething?
  NO - Instruct CPR
  YES - Attempt to determine cause

Follow this link to see a simple CPR tutorial. This video was not made by me or do I have any relation, financial or otherwise, to the authors.

== work in progress ==


If not the most common, dyspnea is one of the most frequent causes of ambulance calls. Dyspnea means difficulty breathing. Many causes may arise but, not infrequently, they will be concerning: oxygen is an extremely important and vital substance without which we can't survive for long.

Common underlying conditions could include but are not limited to:
- Respiratory tract infection such as pneumonia;
- COPD exacerbation;
- Rib fracture with mobile rib fragment;
- Anxiety/panic attack;
- Asthma exacerbation;
- Myocardial ischemia;
- Physical exercise;
- Pleural effusion;
- ARDS;
- etc

The intervention will widely vary from cause to cause and even between patients with the same pathology. There are, however, several principles we may always apply:

- Guarantee access to medication and portable oxygen delivery systems when already available to the patient by previous prescription;
- If external agents are at work, they must be removed or the patient taken away from them: allergens (asthma/COPD with smoke, allergens,...) , fights, former lovers, crowds, small rooms, ... (anxiety);
- Assure the best conditions for breathing by sitting the patient up, not allowing them to lie down;


Although most calls with complaints of chest pain correspond to non life threatening situations like panic attacks, a chest pain should never be taken lightly. Here are some of the potential deadly causes:

• Acute myocardial infarction
  
• Pneumothorax
  
• Pneumonia
  
• Pulmonary embolism
  
• Several other possible causes

• Hypoglycemia - weakness, loss of consciousness, aggressive behavior, hunger, sweaty skin, shivers, tachycardia, other atypical symptoms.
  !! Always check for signs that insulin was administered !!
  
  
• Hyperglycemia - fruity smell, blurry vision, dry mouth, weakness, constant need to urinate, ketoacidosis might ensue

Alcohol, another very common cause of (mostly unnecessary) emergencies. In Europe, unlike in many parts of the USA, drinking alcohol in public or being publicly intoxicated is not illegal.
Portugal in particular has simultaneously the highest rate of people who do not drink at all and the highest rate of alcoholic problems. The government is progressively taxing alcohol harder and harder and raising drinking age as to fight the worst part of the statistic.

When facing an intoxicated person we should consider a couple of easy questions and we can deal with all but the most extreme situations:

1. Being intoxicated does not make you immune to other conditions: the person might be drunk and still complain about other things without having them dismissed over simply being drunk;
2. Are they with friends? Maybe they just need to go home and get some sleep, only call emergency medical services if the person is in immediate risk and needs proportional hospital care;
3. Do they have any relevant medical history?
4. Are they injured? Alcohol = lack of motor coordination + lack of balance = falling = getting injured;
5. When in doubt CALL 911 and ask for instructions/advisement;

==work in progress==
If we dive deeper into the subject of trauma, two obvious subjects come along - wounds and burns. Let's take a quick, closer look at them and learn what we should do and what we should never do.

• Open wound - An interruption in skin continuity caused by a traumatic event. Do not mistake for an ulcer, for example, where there is a pathological (not traumatic) process involved.
  
• Closed wound - A "wound" caused by an impact where tissues are damaged without rupture.
  
• 
  

• AED - "An automated external defibrillator (AED) is a portable electronic device that automatically diagnoses the life-threatening cardiac arrhythmias of ventricular fibrillation and ventricular tachycardia in a patient, and is able to treat them through defibrillation, the application of electrical therapy which stops the arrhythmia, allowing the heart to reestablish an effective rhythm." - in Wikipedia;
  
• ASAP - As Soon As Possible;

• CPR - Cardio-Pulmonary Resuscitation;

• DNR - Do Not Resuscitate - a declaration sign by the patient where they declare that they do not wish to receive assistance in case of cardio-respiratory arrest;

• glycemia - blood (-emia) sugar (glyc-), the amount of sugar in your blood, easily measured even by patient's own hand in a home setting;

• Hyper and hypo glycemia - check glycemia;

• Imminent danger - present, actual danger where someone or something may be (further) injured/damaged/worsened. Example: a person who just had a heart attack is in imminent danger because the condition will worsen without treatment;

• Perspiration - same as sweating or diaphoresis. Loss of water through pores in the skin as a means of decreasing body temperature through evaporation;

• Seizure - popularly known as a fit. A seizure is an acute neurological event with its presentation varying from a simple jerk to a generalized grand mal event commonly associated with high fever, epilepsy, ...;
  
• Shock - A life threatening medical condition consisting of an imbalance between the body's need for oxygen and the amount that actually is supplied. Examples would be hypovolemic shock (lack of circulating volume of liquids caused by diarrhea, bleeding, lack of water intake, excessive perspiration,...), anaphylactic shock (where the body creates an exaggerated allergic response to a certain stimulus), septic shock (severe infection eventually culminating in multiple organ failure), etc;
  
• Spinal injury - damage to the spinal cord causing nerve conduction damage, possibly even paralyzing a person and compromising sensation and motor capacity;
  
• Sternum - a bone (actually three bones) in the center of the thorax where the ribs fuse;
  
• Stroke - either the obstruction or rupture of a blood vessel in the brain. Life-threatening situation;
  
• Syncope - sudden, passing, loss of consciousness. Also, known as fainting, fainting spell, passing out, etc;

• Thorax - also known as chest;
  
• Trauma - Damage to one's body via an external force. Example: punch, car accident, fall, gunshot wound, stab,...;