Clinical Reference Cards & Emergency Protocols: The Complete Guide

In the high-stakes world of emergency medicine, clear communication and rapid assessment can mean the difference between life and death. Clinical acronyms like SITREP, IMIST-AMBO, and MARCH PAWS are not just jargon; they are structured frameworks that ensure nothing is missed. But what do they actually mean, and how can you master them?

This guide is the ultimate resource for Australian paramedics, nurses, first responders, and students. We will break down the most critical clinical protocols, explain what they're used for, and help you choose the best clinical reference cards to keep this vital information at your fingertips.

What is SITREP? The Cornerstone of Clinical Handover

SITREP stands for Situation Report. It is a concise, structured method for communicating a patient's status, typically during handover to another clinician or when providing an update to a hospital. The query "sitrep" generates over 17,000 searches in Australia every six months, highlighting a significant need for clear, accessible information on this topic. The primary goal of a SITREP is to paint a clear, accurate picture of the situation quickly.

METHANE / ETHANE: The Chief Prehospital SitRep Structure

When a major incident occurs, the gold-standard structure for a situation report is the METHANE mnemonic (sometimes simplified as ETHANE). This framework ensures that the first responder on scene delivers a clear, standardized message to control rooms, hospitals, and incoming crews.

METHANE Breakdown:

• M – Major incident declared
• E – Exact location
• T – Type of incident
• H – Hazards present
• A – Access & egress routes
• N – Number of patients (casualties, severity)
• E – Emergency services required

ETHANE is a streamlined version, dropping the initial “Major incident declared” step but keeping the rest intact.

When to use METHANE/ETHANE:

• Declaring a major incident to dispatch or control.
• Coordinating multi-agency response (police, fire, ambulance).
• Providing rapid scene updates during mass casualty events.

This structure is considered the chief SitRep format in prehospital major incident management because it prioritises scene safety, resource allocation, and incident control before patient-level detail.

SITREP as a Handover Tool

When to use SITREP:

• Handing over a patient to an emergency department team.
• Providing an update / prenotification to a receiving hospital via radio or phone.
• Briefing a senior clinician arriving on scene.

SITREP Components Breakdown:

A standard SITREP format includes:

• S - Situation: Your unit ID, patient's age, and gender. (e.g., "This is Medic 1 with a 68-year-old male.")
• I - Injury/Illness: The patient's chief complaint. (e.g., "Patient is complaining of central chest pain.")
• T - Treatment: Key treatments you have administered. (e.g., "We have administered aspirin and GTN with no relief.")
• R - Response: The patient's response to your treatment. (e.g., "Pain remains 8 out of 10, and vital signs are unchanged.")
• E - ETA: Your estimated time of arrival at the hospital. (e.g., "Our ETA is 15 minutes.")
• P - Plan: Any further planned interventions. (e.g., "We are planning to acquire a 12-lead ECG en route.")

Pro Tip: Keep your SITREP under 60 seconds. It is a summary, not the full history. The goal is to prepare the receiving team, not overwhelm them.

 

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Clinical Handover Protocols: IMIST-AMBO vs. ISBAR

While SITREP is a great summary, a more detailed handover is often required at the bedside. This is where IMIST-AMBO comes in.

IMIST-AMBO

IMIST-AMBO is a comprehensive handover mnemonic designed for pre-hospital to hospital communication.

• I - Identification: Patient's name, age, and gender.
• M - Mechanism/Medical Complaint: What happened or what is the primary medical issue.
• I - Injuries/Information: A head-to-toe list of injuries or relevant medical history.
• S - Signs: The patient's vital signs (HR, BP, RR, SpO2, GCS, BGL).
• T - Treatment: All treatments and interventions performed.
• A - Allergies: Known allergies.
• M - Medications: The patient's regular medications.
• B - Background: Relevant past medical history.
• O - Other: Any other pertinent information (social situation, scene details).

For a durable, reusable tool to perfect your handovers, consider the Reusable A6 IMIST-AMBO Handover Card. It’s an essential piece of kit for any paramedic.

ISBAR

ISBAR is another common framework, often used for communication between clinicians within a hospital.

• I - Identification: Introduce yourself, your role, and the patient.
• S - Situation: State the immediate problem.
• B - Background: Provide relevant context.
• A - Assessment: What you think the problem is.
• R - Recommendation: What you need from the other person.

 

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Emergency Assessment Frameworks: From DRSABC to MARCH PAWS

Before you can hand a patient over, you need to assess them. These frameworks provide a systematic approach to ensure life-threatening conditions are identified and managed first.

DRSABC: The Foundation of First Aid

DRSABC is the primary survey taught in all Australian first aid courses. It is the first thing you should do when encountering a potentially unwell person.

• D - Danger: Check for any dangers to yourself, bystanders, or the patient.
• R - Response: Check for a response. Ask their name, squeeze their shoulders.
• S - Send for help: Call Triple Zero (000) for an ambulance.
• A - Airway: Open the patient's mouth and check for foreign material. If present, place in the recovery position and clear the airway.
• B - Breathing: Look, listen, and feel for normal breathing for 10 seconds.
• C - CPR: If not breathing normally, start cardiopulmonary resuscitation (CPR).

The Trauma Diamond & Diamond of Death

The "Diamond of Death," builds on the well Lethal Triad of Trauma, which refers to the deadly combination of Hypothermia, Acidosis, and Coagulopathy. This concept is critical in the management of major trauma patients. The Trauma Triad of Death consists of:

Hypothermia: A drop in core body temperature. Trauma patients lose heat rapidly due to exposure and blood loss.

Acidosis: A build-up of acid in the blood, often from poor perfusion (shock).

Coagulopathy: The blood's inability to clot properly. Hypothermia and acidosis both worsen coagulopathy, leading to a vicious cycle of bleeding.

The Diamond of Death adds hypocalcaemia into the mix due to it's role in clotting, cardiac contractility, and vascular tone, making haemorrhage and shock more difficult to control.

• Traditional “Lethal Triad”:
  • Hypothermia, acidosis, and coagulopathy — a vicious cycle in trauma that leads to uncontrolled bleeding and death.
• Expanded “Diamond of Death”:
  • Adds hypocalcaemia as the fourth corner, based on growing evidence that calcium levels are crucial in trauma resuscitation.

Managing the Trauma Diamond involves keeping the patient warm, controlling bleeding, ensuring adequate oxygenation and, if capable, considering calcium infusion to prevent this deadly spiral.

 

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MARCH PAWS: The Tactical Assessment Framework

MARCH PAWS is a mnemonic used in tactical and military medicine for managing trauma casualties. It prioritises interventions based on the leading causes of preventable death on the battlefield.

• M - Massive Haemorrhage: Control life-threatening bleeding with tourniquets and haemostatic dressings.
• A - Airway: Ensure a patent airway.
• R - Respirations: Assess for and manage breathing problems, such as a tension pneumothorax.
• C - Circulation: Manage non-life-threatening bleeding and establish IV/IO access.
• H - Hypothermia Prevention / Head Injury: Keep the patient warm and assess for head injuries.
• P - Pain Management: Administer analgesia.
• A - Antibiotics: Administer broad spectrum antibiotics for open wounds.
• W - Wounds: Dress all other wounds.
• S - Splinting: Immobilise fractures.

Keep this critical framework in your pocket with the Wallet ID MARCH PAWS Trauma Reference Card.

ECG Rulers and Diagnostic Tools

An ECG ruler is an essential tool for quickly interpreting electrocardiograms. It's a transparent plastic card with markings to measure heart rate, PR interval, QRS duration, and the QT interval directly on an ECG strip.

How to use an ECG Ruler:

Follow the 8-step Method of ECG Interpretation laid out on the ECG Ruler:

1. Determine Heart Rate: Align the 'START' mark with an R-wave and record the number which aligns with the next R-wave. Using the Rule of 300 rate guide on the ruler helps you find the corresponding heart rate.

2. Rhythm – Assess if the rhythm is regular, sinus, or abnormal.
3. P Waves – Check presence, morphology, and relationship to QRS.
4. Measure PR Intervals: Use the blocks on the right-hand side of the card to determine whether the millimeter/millisecond duration of the PR interval is within normal limits.
5. QRS Complex – Assess width, morphology, and axis. Use the blocks on the right-hand side of the card to assess width. Use the Axis Key on the top right to determine axis.
6. ST Segment – Look for elevation or depression. Use the vertical ruler and align the horizontal axis with the isoelectric line. STEMI Criteria by age and sex are unique features to our CG Reference Card & Overlay Ruler. 
7. T Waves – Evaluate shape, inversion, or abnormality. Six key morphologies to assess are listed on our card.
8. Measure QT Interval: Use the blocks on the right-hand side of the card to determine whether the millimeter/millisecond duration of the PR interval is within normal limits. QTc values for males and females are listed on our card

Mastering this skill is easier with a high-quality tool. Our ECG Reference Card & Overlay Ruler is a favourite among students and professionals alike.

 

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Choosing the Right Reference Cards

With so many protocols, having a set of high-quality, durable reference cards is essential. Here’s what to look for:

Our Top Recommendations:

• For Students: The Essential Paramedic Book Bundle provides a great foundation with comprehensive texts and reference materials.
• For Graduate Paramedics: The Paramedic Emergency Medical Reference Cards (Full Set) is our most comprehensive and popular option, covering a vast range of clinical scenarios.
• For All Levels: The Reusable A6 IMIST-AMBO Handover Card is a must-have for every kit, ensuring your handovers are always clear and structured.

Explore the full Clinical Reference Cards Collection to find the perfect set for your needs.

Frequently Asked Questions (FAQ)

What does SITREP stand for?

SITREP stands for Situation Report. It's a structured communication tool used by paramedics and other emergency personnel to provide a concise patient update to a receiving hospital or another clinician.

What is the Trauma Diamond of Death?

The Trauma Diamond, or Lethal Triad, is the dangerous combination of Hypothermia (low body temperature), Acidosis (acidic blood), and Coagulopathy (impaired blood clotting) in a major trauma patient. Each condition worsens the others, creating a vicious cycle that is a leading cause of preventable death.

What does IMIST-AMBO stand for?

IMIST-AMBO is a comprehensive handover mnemonic. It stands for Identification, Mechanism/Medical Complaint, Injuries/Information, Signs, Treatment, Allergies, Medications, Background, and Other. It is designed for detailed pre-hospital to hospital patient handovers.

What is MARCH PAWS?

MARCH PAWS is a tactical trauma assessment framework that prioritises interventions based on the leading causes of preventable death. It stands for Massive haemorrhage, Airway, Respirations, Circulation, Hypothermia/Head Injury, Pain, Antibiotics, Wounds, and Splinting.

What does DRSABC stand for?

DRSABC is a primary survey framework used in first aid. It stands for Danger, Response, Send for help, Airway, Breathing, and CPR. It is the first set of actions to take when encountering a potentially unwell person.