Table 4 Phases and activities SPART model

S

Start

-Initiation of the EMS deployment. Emergency call-taking and EMS dispatch.

-Interpretation of the information provided by the dispatch center (first generation of clinical hypotheses).

-Pre-Arrival-Preparation (dividing tasks among the crew, anticipating the expected situation on the scene)

Situation (at arrival)

-First subjective, and intuitive interpretation of the scene.

-Ongoing generation of clinical hypotheses: “a wet read diagnosis.”

-Decision whether acute intervention is necessary.

P

Prologue

-Retrospective interpretation of factors leading to and influencing the presenting complaint, injury or health problem

-In case of an accident: interpretation of the accident mechanism.

Presentation (presenting complaint or symptom)

-Indicating the reason for the call for assistance.

-Performing focused questioning and targeted physical examination, focused on the primary complaint, injury or health problem.

A

Anamnesis

-Medical history taking.

-Inventory of medication and allergies.

-Identification of treatment restrictions.

Assessment

-General physical examination.

-Assessment of vitals (ECG, BP, HF, RR, SpO₂).

-Neurologic examination, if applicable.

-Taking blood samples, if applicable.

R

Reasoning, recapitulation

-The actual process of gathering, ordering, evaluating, and interpreting clinical information to formulate a working diagnosis and consider differential diagnoses.

-A clinical time out to overview the gathered information and detect information deficiencies.

Resolution

-The (clinical) decision on what to do or do not.

T

Treatment

-Therapy, if possible, and applicable in the pre-hospital setting.-Guided by protocols and guidelines.

Transfer

-Mandatory to conclude the EMS deployment.

-Three possible routes:

1. To the patient self. Clinical therapy or conveyance to the hospital or both are not necessary. Shared decision process. Informed consent. With dedicated attention to patients’ questions, fears and uncertainties.

2. Hand-over to other (professional) care provider (i.e., GP, midwife, mental health care provider).

3. Conveyance and hand-over to a hospital or other care facility.

-Evaluation and reflection