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Classic features of aortic dissection include tearing chest/back pain, pulse/BP differential, and possible neuro deficits from branch vessel involvement. Field care focuses on gentle handling, analgesia per protocol, and rapid transport to a center capable of surgical or endovascular repair. Excessive fluids may increase aortic wall stress; nitroglycerin is not primary therapy and may complicate hypotension or mask symptoms. Thrombolytics are contraindicated and catastrophic in dissection. Paramedic objectives emphasize early suspicion from history/exam, avoidance of unnecessary exertion, and pre-alerting receiving teams to expedite definitive imaging and management.

Effective leadership ensures coordination, role assignment, and closed-loop communication. Multiple leaders create confusion, silence risks missed information, and independent actions cause errors. Paramedic preparatory objectives stress team dynamics, clear leadership, and shared mental model to improve patient outcomes.

START triage directs walking wounded to Green (Minor). They are initially asked to walk to a designated area. Red = life-threatening but treatable. Yellow = serious but not immediate. Black = deceased/expectant. Effective triage maximizes survival at MCIs.

HIPAA (Health Insurance Portability and Accountability Act) mandates confidentiality of patient information. EMTALA prevents patient dumping, OSHA regulates worker safety, NFPA sets fire/EMS standards. Paramedics must secure charts, avoid unauthorized disclosures, and ensure patient privacy.

Mid-shaft femur fractures bleed significantly and cause extreme pain and muscle spasm. A traction splint (Hare, Sager, or equivalent) realigns fragments, reduces bleeding, decreases spasm, and improves comfort. Contraindications include pelvic or proximal femur/hip fractures and partial amputations. Circumferential bandaging alone does not adequately control motion or length. Pelvic binders are for pelvic instability, not isolated femoral shaft fractures. Tourniquets are indicated for uncontrolled external hemorrhage, not closed fractures with intact distal pulses. Paramedic trauma objectives stress neurovascular checks before/after splinting, pain control, gentle handling, and rapid transport when other injuries are suspected.