Normal Vital Signs Guidelines for EMS

Compiled using Emergency Care and Transportation of the Sick and Injured, EMS Field Guide and Journal of Emergency Medical Services.

You will find it extremely valuable in the field (and for your national registry exam) to memorize these vital signs guidelines. To help you memorize them, I have organized them by type and by age group. You can decide which will be easier to remember.

Vital signs by type

Pulse
Descriptors: regular, irregular, strong or weak
Adult	60 to 100 beats per minute
Children - age 1 to 8 years	80 to 100
Infants - age 1 to 12 months	100 to 120
Neonates - age 1 to 28 days	120 to 160

Blood pressure

Systolic
Diastolic

Adult
90 to 140 mmHg
60 to 90 mmHg

Children - age 1 to 8 years
80 to 110 mmHg

Infants - age 1 to 12 months
70 to 95 mmHg

Neonates - age 1 to 28 days
>60 mmHg

Respirations

Descriptors: normal, shallow, labored, noisy, Kussmaul

Adult (normal)
12 to 20 breaths per minute

Children - age 1 to 8 years
15 to 30

Infants - age 1 to 12 months
25 to 50

Neonates - age 1 to 28 days
40 to 60

Vital signs by age

Adult vital signs
Pulse	60 to 100 beats per minute
Blood pressure	90 to 140 mmHg (systolic) 60 to 90 mmHg (diastolic)
Respirations	12 to 20 breaths per minute

Child vital signs (age 1 to 8 years)

Pulse
80 to 100 beats per minute

Blood pressure
80 to 110 mmHg systolic

Respirations
15 to 30 breaths per minute

Infant vital signs (age 1 to 12 months)

Pulse
100 to 140 beats per minute

Blood pressure
70 to 95 mmHg systolic

Respirations
25 to 50 breaths per minute

Neonatal vital signs (full-term, <28 days)

Pulse
120 to 160 beats per minute

Blood pressure
>60 mmHg systolic

Respirations
40 to 60 breaths per minute

Other references

Lung sounds
Crackles or rales	crackling or rattling sounds
Wheezing	high-pitched whistling expirations
Stridor	harsh, high-pitched inspirations
Rhonchi	coarse, gravelly sounds

Pulse oximetry

Range
Value
Treatment

Normal
95 to 100%
None or placebic

Mild hypoxia
91 to 94%
Give oxygen

Moderate hypoxia
86 to 90%
Give 100% oxygen

Severe hypoxia
<85%
Give 100% oxygen w/ positive pressure

Glasgow Coma Scale

ADULT

INFANT

Eye opening
E
Eye opening

Spontaneous
4
Spontaneous

To speech
3
To speech

To pain
2
To pain

No response
1
No response

Best motor response
M
Best motor response

Obeys verbal command
6
Normal movements

Localizes pain
5
Localizes pain

Flexion - withdraws from pain
4
Withdraws from pain

Flexion - abnormal
3
Flexion - abnormal

Extension
2
Extension

No response
1
No response

Best verbal response
V
Best verbal response

Oriented and converses
5
Coos, babbles

Disoriented and converses
4
Cries but consolable

Inappropriate words
3
Persistently irritable

Incomprehensible sounds
2
Grunts to pain/restless

No response
1
No response

E + M + V = 3 to 15

90% less than or equal to 8 are in coma

Greater than or equal to 9 not in coma

8 is the critical score

Less than or equal to 8 at 6 hours - 50% die

9-11 = moderate severity

Greater than or equal to 12 = minor injury

Coma is defined as not opening eyes, not obeying commands, and not uttering understandable words.

Additional references: Traumatic Brain Injury Resource Guide and House of DeFrance.

Apgar Scale (evaluate @ 1 and 5 minutes postpartum)

Sign 2 1 0

A Activity (muscle tone) Active Arms and legs flexed Absent

P Pulse >100 bpm <100 bpm Absent

G Grimace (reflex irritability) Sneezes, coughs, pulls away Grimaces No response

A Appearance (skin color) Normal over entire body Normal except extremities Cyanotic or pale all over

R Respirations Good, crying Slow, irregular Absent

Pain scale

The 0-10 pain scale is becoming known as the "fifth vital sign" in hospital and pre-hospital care. Adults can usually quantify their pain on a numeric scale, however children may need help in articulating their pain.

The International Association for the Study of Pain has developed the Pediatric Pain Sourcebook, which contains a universal tool to help children quantify their pain. Scroll to the bottom of the page to download either an English/French version or other languages version of the Faces Pain Scale - Revised to help you in your field assessment of pediatric pain (scroll to the bottom for links to the PDF).

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Updated 10.12.05

"Keep in mind that the true measure of an individual is how he treats a person who can do him absolutely no good."
—Ann Landers