EMT Crash Course Part 1

Patient packaging for air Medical Transport

1 if there is a hazardous material exposure, patient must be decontaminated before being loaded onto the aircraft. 2 notify air medical crew ASAP of any special circumstances, such as a large patient, Cardiac Arrest patient, traction splint applied, combative patient, or unstable Airway. 3 secure all loose equipment, blankets, Etc., before approaching a running aircraft. 4 never approach the aircraft without pilot or air medical crew authorization. 5 never approach a rotor Wing aircraft from the rear. Never back up.

Upon encountering a hazardous materials or Hazmat incident the EMT should do the following

1 maintain a safe distance and attempt to keep others out. 2 call for specially-trained HazMat responders. 3 look for placards without entering the scene, and utilize the Emergency Response Guidebook to determine evacuation distance the ERG is required in all emergency vehicles. 4 do not enter a Hazmat scene until cleared by the Hazmat specialists. 5 do not begin emergency care until patients have been decontaminated or otherwise cleared by Hazmat Crews. 6 if you as the responder are stuck in a hazardous material environment you must stay in that environment until Hazmat has said or cleared you to leave and you have been decontaminated.

Notification of authorities. Law enforcement or the medical examiner must typically be notified for situations including

1. Any seen one of the patient is Dead on Arrival 2. Suicide attempts 3. Assault or sexual assault 4. Child abuse or elder abuse 5. Suspected crime scene 6. Childbirth

How to manage stress continued

1. Critical incident stress management or (cism). CISM is a formalized process to help emergency workers deal with stress. Diffusing sessions, when needed, are held within 4 hours of an incident. Briefing sessions are held 24 to 72 hours after the incident. CISM teams consist of trained peer counselors and mental health experts. Participants can, but are not required to, share their feelings. CISM is meant to facilitate the process of dealing with critical incident stress. It is not used as a critique of patient care or any other type of performance evaluation. The information shared during a CISM session is confidential.

The following are typically considered obvious signs of death indicating that resuscitation should not be initiated

1. Decomposition, physical decay of the body's components 2. Rigor mortis, stiffening of the body after death 3. Dependent lividity, the setting of blood within the body 4. Decapitation, the patient's head is no longer attached to the body. *per LOC EMTs can pronounce death if one of those are present in your pt.

What are the five stages of grief?

1. Denial. The patient may experience a "not me" stage. 2. Anger. The patient may experience a why me" stage 3. Bargaining. The patient may experience a "I still need to ..." stage 4. Depression. The patient may experience a state of despair. 5. Acceptance. The patient may come to accept death.

Additional hazards requiring specially trained responders?

1. Downed power lines, fire situations, Etc. In those situations you would call for additional resources. 2. Terrorism incidents involving chemical, biological, radiological, nuclear, or explosive hazards. And those situations you must Park a certain distance away from that scene and must be cleared by the police. 3. High angle rescue, Swift water rescue, confined space rescue, Etc. May need additional resources to provide effective extrication.

Medical Direction

1. EMS providers operate under the license of their physician medical director(s). 2. It is essential for EMTs to know the standing orders, guidelines, and protocols for their state, agency, and medical director. 3. Always contact medical direction if you are unsure how to manage a patient.

Crime scenes?

1. EMS providers should not enter a crime scene unless law enforcement has determined it is safe. 2. EMS providers may be advised to respond to the call but maintain a safe distance away until cleared by law enforcement. This is sometimes called "staging for PD".

Crime scenes

1. Ensure scene safety 2. Provide patient care as needed 3. Avoid any unnecessary disturbance of scene 4. Remember and note the position of the patient or patient's 5. Remember and report everything you touched at the scene 6. Cut around not through holes in clothing when exposing the patient 7. Note anything or anyone suspicious on or near the scene 8. Discourage sexual assault patients from changing clothes or showering 9. Try to get a same-sex provider to assist with sexual assault patients 10. Leave once you are no longer needed on the scene

Patient confidentiality

1. In most cases, EMS providers cannot release confidential pt. Info without written consent 2. EMTs can release confidential pt info without consent when I. The info is necessary for continuity of care II. The info is necessary to facilitate billing for services III. The EMT has received a valid subpoena IV. Reporting possible crimes, abuse, assault, neglect, certain injuries, or communicable diseases.

Death determination

1. Local protocols vary on whether EMS personnel have the authority to declare death. Consult local protocol. When in doubt contact medical direction.

What are the causes of stress?

1. Long hours, low pay, lack of sleep 2. Dangerous situations, exposure to death and dying 3. Challenging interactions with patients, family members, Etc 4. Working holidays, birthdays, anniversaries, Etc 5. Non-emergency transports and aggressive system status management

Interfacility transports

1. Obtain a pt report from the transferring facility before departing. 2. Confirm the exact destination location, including department or admitting physician 3. Make sure the pt's condition does not exceed scope of practice 4. Obtain consent from the pt or guardian

Safe lifting techniques

1. Power lifts. Keep objects close to the body. Use the legs to left, not the back the legs bent and back straight. Use a power grip with Palms up and all fingers wrapped around the object. 2. Position the stretcher to reduce the heights of the lift. 3. Pre-plan the lift to reduce distance and avoid problems. 4. Get enough help. Emergency moves these are used when the scene is dangerous of the patient must be moved before providing patient care the farm kid forearm drag shift drag and blanket rack

Organ donors

1. Proof of intent to donate organs is usually obtained through a signed donor card or driver's license 2. Treat the patient as you normally would 3. Notify medical Direction and receiving Personnel at the hospital.

How to manage stress?

1. Recognize signs of stress or burnout, anxiousness, irritability, headache, poor concentration, loss of appetite, difficulty sleeping, loss of interest in sex, Hobbies, work, family, friends, increased use of alcohol or drugs. 2. Address modifiable risk factors for heart disease and stroke, tobacco use, hypertension, lack of exercise, and poor diet. 3. Find time for relaxing activities and interests, listen to observations of family and friends. They know you best. 4. Balance the demands of your personal and professional life. 5. Consider a change in your work environment, or get professional counseling.

What are the recommended immunizations and vaccines?

1. Regular TB testing at least annually. 2. Hepatitis B vaccination series. 3. Tetanus shot every 10 years. 4. Flu vaccine annually. 5. MMR vaccine, measles, mumps, rubella as needed. 6. Varicella vaccine as needed.

Interacting with the patient's family members during death and dying.

1. Show respect and empathy for patient and family. 2. Serve as a patient advocate. 3. Be supportive and keep the patient and family informed. 4. Do not use platitudes or offer false hope. 5. Allow family to be with the patient whenever possible.

Standard of care

1. Standard of care is the degree of care a reasonable person with similar training would provide in a similar situation. 2. Standard of care applies the "reasonable person test"; what a reasonable person with the same training do the same thing in the same situation? 3. Standard of care requires EMTs to competently perform the indicated assessment and treatment within their scope of practice.

Urgent move

1. Used when the patient has potentially life-threatening injuries or illness and must be moved quickly for evaluation and transport. 2. Rapid extrication and Urgent move used for patients in a motor vehicle, and it requires multiple Rescuers and a long backboard. The patient is rotated onto a backboard with manual cervical spine precautions and removed from the vehicle.

Non-urgent moves

1. Used when there are no hazards and no life-threatening conditions apparent. 2. Types of non urgent moves include direct ground lift, extremity lift, direct carry method, and draw sheet method.

Equipment for patient movement

1. Wheeled stretcher 2. Portable stretcher 3. Stair chair 4. Backboard 5. Scoop stretcher 6. Neonatal isolette 7. Patient packaging for air Medical Transport

the heart continued

1. a muscular organ with two pumps, one on the left side and another on the right I. the left pump receives oxygenated blood from the lungs and sends it throughout the body. It is the stronger of the two pumps, with a greater workload than the right pump. II. the right pump receives deoxygenated blood from the body and sends it to the lungs to drop off carbon dioxide and pick up oxygen on its way to the left heart. III. a septal wall divides the heart into left and right sides 2. three layers of heart muscle and pericardium I. endocardium, smooth, thin lining on the inside of the heart II. myocardium, thick muscular wall of the heart III. epicardium, outer most layer of the heart and innermost layer of the pericardium IV. pericardium, fibrous Sac surrounding the heart 3. the chambers and valves I. Atria, the two upper chambers of the heart. Blood returning to the heart on both sides enters the Atria. The Atria pump the blood into the ventricles just before the ventricles contract. This is called the "atrial kick" and helps increase cardiac output. II. ventricles, the lower and larger chambers of the heart. Ventricles receive blood from the Atria and send it out of the Heart during ventricular contraction. Under normal circumstances, this generates a palpable pulse. The left ventricle sense oxygen rich blood throughout the body under high pressure. The right ventricle sends oxygen depleted blood to the lungs under low pressure III. heart valves, one-way valves between the Atria and ventricles that allow blood to move in a downward Direction into the ventricles during atrial contraction. The valves then closed during ventricular contraction to prevent regurgitation of blood back into the Atria. 4. cardiac conduction system I. the heart has its own electrical system. It generates electrical impulses, which stimulate contraction of the heart muscle. II. the heart can generate electrical impulses from three different locations. The primary power plant, the sinoatrial node, SA node, normally generates impulses between 60 to 100 times per minute and the adult. That's why the normal heart rate and adult is 60 to 100 beats per minute. a. the atrioventricular Junction or AV node is the backup Pacemaker and generates electrical impulses at about 40 to 60 per minute b. the bundle of His is the final pacemaker for the heart. It generates impulses only at about 20 to 40 per minute III. the heart, like the brain, is extremely intolerant to a lack of oxygen. The heart receives its blood flow from the coronary arteries, which branch off of the aorta IV. cardiac output, circulation, will cease if the heart is unable to generate electrical impulses or if the heart muscle is too damaged to respond to the impulses

abnormal breathing

1. abnormal rate or Tidal volume 2. labored breathing 3. muscle retractions I. intercostal retractions, between the ribs II. supraclavicular retractions, above the clavicles III. use of abdominal muscles 4. abnormal skin color 5. tripod position, seated, leaning forward, and using the arms to help breathe 6. agonal breaths, dying gasps, slow and shallow, will not move air into alveoli

infants and children

1. anatomical differences from adults a. the Pediatric tongue is larger in portion to the airway b. the Pediatric Airway is more easily obstructed c. the Pediatric head is larger in portion to the body

cellular phones

1. cellular phones are quickly replacing radio communication with medical Direction. 2. advantages include easy, clear, inexpensive means of communication. 3. disadvantages include potential unreliability communication during Peak demand or a mass casualty incident.

Log roll technique

1. commonly used to place a patient on a backboard for assess the posterior. 2. Can be done while maintaining manual cervical spine precautions. 3. Should have at least three trained Personnel. The person controlling manual cervical spine protection should direct the log roll.

guidelines for radio communication

1. communication with dispatch I. confirm receipt of dispatch II. notify dispatch when en route to the call, on scene, and en route to the hospital, and at the hospital.

communicating with medical Direction

1. communication with medical Direction often involves relaying a lot of information clearly and a short period of time. 2. Details Matter, and mutual understanding is critical. 3. strong verbal communication skills are needed. Body language won't help over the phone or radio. 4. provide objective information, not subjective opinions. 5. each call and patient is different, however, patient information should always be relayed from high priority to low priority.

hypoxic Drive

1. hypoxic Drive is a backup system to the CO2 Drive 2. specialized sensors in the brain, aorta and carotid arteries monitor oxygen levels 3. low oxygen levels will stimulate breathing 4. the hypoxic drive is less effective than CO2 Drive

the DO's when dealing with communication

1. make sure you are on the correct frequency. 2. ensure there is no other radio traffic before transmitting. 3. depress the transmit button and wait one second before speaking. 4. identify who you are talking to first, then who you are. For example, "dispatch, this is Medic One." 5. use Clear text, not radio codes unless approved locally. 6. use "affirmative" or "negative," not "yes" or "no." 7. use "copy" to confirm receipt of a transmission. 8. always "Echo" orders from medical direction to confirm accuracy.

normal breathing

1. normal rate and tidal volume I. normal adult rate, 12 to 20 breaths per minute, BPM II. normal pediatric rate, 15 to 30 BPM III. normal infant rate, 25 to 50 BPM 2. non labored 3. regular rhythm 4. clear and equal breath sounds bilaterally

Bariatric or obese patients

1. obese patients pose additional challenges and risks to Providers during lifting and movement. Know what your equipment, stretcher, backboard, Etc. He is capable of holding. Request additional assistance. 2. some EMS systems have special bariatric ambulances with specialized equipment, automated lifting systems, and wire stretchers capable of a greater weight capacity.

mobile data computers or mdc's

1. relay digital information instead of voice Transmissions 2. can display the address of the call and routing information 3. allow digital communication with dispatch and other responding units 4. reduce the volume of routine radio traffic

Moral, Ethical, and Legal

1. sometimes, conflicts do arise. When in doubt, I. consider what is best for the patient. II. know the law and your protocols. III. get help from your partner, your supervisor, ALS Personnel, or medical Direction, Etc. 2. potential ethical conflicts, I. triage at mass casualty incidents. II. coercive refusals. III. futile resuscitation attempts.

body positions

1. supine: lying face up 2. prone: lying face down 3. shock/trendelenburg: supine w/ legs elevated 4. fowler's: seated with head elevated and knees bent

documentation (administrative info)

1. the address of call 2. date of call 3. your unit designation 4. the name or identifying number and certification level of all EMS providers on the call

important part of the PCR

1. the following times should be recorded I. dispatch time II. time enroute to call III. time on scene IV. patient contact time V. time enroute to hospital VI. arrival time at hospital VII. time transfer of care was completed 2. importance of time on the PCR I. accurate times are critical. The clock on the electrocardiogram Monitor and watches or phones of all EMS providers should be synchronized with the clock in the Dispatch Center. II. inaccurate times are an easy target for litigators. It calls into question the validity of your entire PCR. III. documentation rule number 3: if your times are proven inaccurate you may be in for a miserable deposition or courtroom experience

carbon dioxide Drive

1. this is the primary mechanism of breathing control for most people. 2. the brain stem monitors carbon dioxide levels in the blood and cerebrospinal fluid 3. high CO2 levels will stimulate an increase in respiratory rate and tidal volume

lung volumes

1. tidal volume, the amount of air inhaled or exhaled in one breath 2. residual volume, amount of air in the lungs after completely exhaling. The residual volume keeps the lungs open 3. inspiratory and expiratory Reserve volume, the amount of air you can still inhale or exhale after a normal breath 4. Dead Space, the amount of air and the respiratory system not including the alveoli 5. minute volume, respiratory rate X tidal volume

The DO NOT's in regard to communication

1. use unnecessary verbiage, such as "please" or "thank you." 2. relay protected information such as the patient's name.

transfer of care

1. verbal report. Transfer of care must include a verbal report, to an equal or higher medical Authority. Provide all revelant information similar to radio report, including any changes since the radio report. 2. a written copy of the patient care report must also be provided. 3. the same principles apply to the transfer of patients between prehospital providers

skeletal system continued

2. spinal column I. Central supporting structure, protects the spinal cord II. consists of 33 vertebrae, nine of them are fused III. the spinal column in descending order, Superior to inferior a. cervical spine, seven vertebrae, C1 to C7 b. thoracic spine, 12 vertebrae, T1 to T12 c. lumbar spine, 5 vertebrae, L1 to L5 d. sacrum, 5 Fused vertebrae e. coccyx, four fused vertebrae 3. thoracic cavity I. houses the heart, lungs, trachea, esophagus, and great vessels II. sternum, breastbone a. manubrium, upper portion of the sternum b. body, middle portion of the sternum c. xiphoid process, inferior tip of the sternum E. appendicular skeleton 1. includes the bones of the arms, legs, and pelvis 2. shoulder girdle, formed by the clavicle, scapula, humerus 3. arm I. humorous, arm II. radius, lateral bone of the forearm III. ulna, medial bone of forearm IV. carpal bones V. metacarpals, base of the fingers VI. phalanges 4. pelvis, a ring-shaped structure formed by three bones I. ilium, upper portion of the pelvis II. ischium, lower portion of the pelvis III. pubis anterior portion of the pelvis

Medical restraint continued

3. Guidelines for restraining a patient. A. Get additional help whenever possible, at least four people is recommended. B. Use the minimum amount of force necessary to protect yourself, the patient, and others. C. Secure patient supine with a backboard if able do not secure the patient in the prone position. D. Use soft, padded restraints. Avoid handcuffs, Flex cuffs, Etc. E. Monitor the patient's level of Consciousness, Airway, and distal circulation continuously. F. Thoroughly document the reason for restraining the patient, the method of restraint, the duration of restraint, and frequent reassessment of the patient while restrained. G. Do not ever restrain a patient in the prone position, hogtie a patient, or leave a restrained patient unsupervised.

Standard of care continued

4. Sources that helped establish standard of care A. National EMS education standards B. State protocols and guidelines C. Medical Direction D. EMS agencies policies and protocols E. Reputable textbooks F. Care considered acceptable by similarly trained providers in the same community

the heart continued

5. cardiac contraction I. myocardial contractility a. contractility refers to the heart's ability to contract b. adequate contractility requires adequate blood volume and muscle strength II. preload a. preload is the contraction pressure based on the amount of blood coming back to the heart b. increased preload leads to increased stretching of the ventricles and increased myocardial contractility III. afterload a. afterload is the resistance the heart must overcome during ventricular contraction b. increased afterload leads to decreased cardiac output C. blood flow through the cardiovascular system 1. oxygen rich blood exits the left heart through the aorta. the aorta branches off into arteries then arterioles and finally capillaries. On the venous side, capillaries feed into venules, then veins, and finally the Superior or inferior vena cava. 2. the vena cava returns blood to the right side of the heart into the right atrium. The right atrium pumps blood into the right ventricle, which pumps deoxygenated blood through the pulmonary arteries into the lungs. The carbon dioxide and oxygen exchange takes place between the alveoli and the pulmonary capillaries. Oxygen rich blood from the lungs returns to the left heart through the pulmonary veins into the left atrium. The left atrium pumps blood into the left ventricle, which then pumps it to the aorta for circulation throughout the body. 3. arteries always carry blood away from the heart, and veins always carry blood towards the heart. Note the pulmonary artery is the one artery in the body that carries deoxygenated blood. The pulmonary vein is the only vein in the body that carries oxygen rich blood. 4. systemic vascular resistance or svr I. svr is the resistance of blood flow throughout the body, excluding the pulmonary system II. svr is determined by the size of blood vessels a. constriction, reduced size, of blood vessels increases svr and can cause an increase in blood pressure b. dilation or increased size of blood vessels decreases svr and can lower blood pressure D. arterial pulses 1. central pulses I. Carotid pulse, can be felt by palpating the Carotid artery in the neck during contraction of the left ventricle II. femoral, can be felt by palpating the femoral artery in the groin area during contraction of the left ventricle 2. peripheral pulses I. radial pulse, palpated in the wrist on the radial side II. brachial pulse, palpated on the medial portion of the upper arm beneath the biceps muscle, can also be felt on the anterior medial area of the arm where the humerus meets the forearm III. dorsalis pedis, palpated on top of the foot

skeletal system continued

5. leg I. femur, thigh bone, the strongest bone of the body II. patella, knee cap III. tibia, medial bone to the lower leg, shinbone IV. fibula, lateral bone of the lower leg V. tarsal bones, ankle VI. metatarsal bones, base of the toes VII. phalanges, toes 6. joints, a joint exists where two long bones come together. I. symphysis, a joint with limited motion II. ball and socket joint. Joint where the distal end is capable of free motion, such as the shoulder III. hinge joint, a joint where the bones can move uniaxially, such as the knee F. muscles. There are three types of muscles 1. smooth muscles, involuntary muscle located within the blood vessels and the digestive tract 2. skeletal, voluntary muscle that attaches to the skeleton I. biceps, anterior humerus II. triceps, posterior humerus III. pectoralis, anterior chest IV. latissimus dorsi, posterior chest V. rectus abdominis, abdominal muscles VI. quadriceps, and anterior femur VII. biceps femoris, posterior femur, part of hamstring muscle VIII. gluteus, buttocks 3. cardiac, heart muscle

communicating with medical Direction continued

6. I. unit designation, certification level, destination, and estimated time of arrival, ETA II. patient's age, sex, Chief complaint III. patient's level of consciousness IV. history of present illness or mechanism of injury V. any Associated symptoms or pertinent negatives VI. patient's vitals VII. patient's physical exam VIII. patient's history, medications, allergies IX. treatment provided and responds to treatment X. any requests for additional interventions. XI. Echo any orders provided by medical Direction.

Delayed stress?

A stress reaction that develops after the stressful event. It does not interfere with the EMTs ability to perform during the stressful event. Post-traumatic stress disorder is an example of delayed stress

Wheeled stretcher

A stretcher that secures in the ambulance for transport and is usually the safest way to move a patient. Most models can accommodate at least 300 lb. No newer models have an automated lift system to further reduce the risk of injury.

documentation guidelines

A. F. A. C. T. Documentation 1. factual. Of the PCR should be fact-based, not opinion-based. 2. accurate. The PCR should be as accurate as possible. Never falsify the PCR. 3. complete. The PCR should be complete unless special circumstances dictate otherwise, such as a mass casualty incident. Complete does not mean you document things that were not actually done. If an area of the PCR was not completed, document "not completed" and document why. 4. timely. The PCR should be completed as soon as possible after transfer of care. It is a good idea to document the time the PCR was completed. B. documentation rule number 4: document objectively, not subjectively 1. objective documentation is based on facts, findings, or observations that are highly difficult to dispute. Objective documentation is not about being "right." 2. subjective documentation is based on opinion or perception is about being "right" about your opinion. subjective information from the patient, however, is acceptable and should generally be documented in quotations. 3. examples of objective and subjective documentation I. objective: "patient with pain and deformity to elbow. " subjective: "patient with dislocated elbow" C. Associated symptoms and pertinent negatives. It is important to document Associated symptoms and relevant pertinent negatives. 1. Associated symptoms: patient complains in addition to the chest complaint. For example, the chief complaint is chest pain, but the patient also complains of mild difficulty breathing 2. pertinent negatives: signs or symptoms you have reason to suspect but the patient denies having. For example, the patient experienced trauma but denies neck pain.

Medical restraint

A. Laws and protocols vary widely. In general, patients may be forcibly restrained if they pose a significant, and mediate threat to you, your partner, or others. 1. Restraining a patient against his will is a last resort. 2. Anticipate and plan. Request law enforcement assistance. No you're local protocols. Contact medical Direction when possible.

cellular Energy and Metabolism

A. adenosine triphosphate AKA ATP 1. the body uses oxygen to convert nutrients into cellular energy called ATP 2. cells receive exponentially more ATP if there is an adequate oxygen supply B. aerobic metabolism 1. aerobic metabolism is the creation of cellular energy with the use of oxygen. It is by far the most efficient means of energy production. 2. the heart and brain will cease function without an adequate supply of oxygen. The lungs and kidneys are also very sensitive to a lack of oxygen. 3. the waste products of aerobic metabolism are water and carbon dioxide. The human body is well-equipped to handle these byproducts through the respiratory and urinary systems C. anaerobic metabolism 1. anaerobic metabolism is the creation of energy without an adequate oxygen supply. Much of the body, not the heart or brain, can switch over to an anaerobic metabolism when necessary 2. the body will triage the oxygen supply when necessary, sending it to the most critical areas and forcing other areas into an anaerobic state 3. the byproducts of anaerobic metabolism include lactic acid. The body needs much longer to deal with byproducts of anaerobic metabolism and cannot complete the process until adequate oxygen supply is restored

Toddlers and preschoolers

A. age 1. toddlers, 1 to 3 years old 2. preschoolers, 3 to 6 years old B. vitals 1. toddlers I. respirations, about 20 to 30 BPM II. heart rate, about 90 to 140 beats per minute III. blood pressure, about 80 to 90 systolic 2. preschoolers I. respirations, about 20 to 25 BPM II. heart rate, 80 to 130 beats per minute III. blood pressure, about 90 - 110 systolic C. physiology 1. as the immune system develops, children at this age typically experienced a number of minor colds, viruses, flu-like symptoms, respiratory infection, Etc 2. fine motor skills improve, and the Brain grows rapidly in size D. toddlers typically walk, climb, distinguished basic shapes and colors and are potty trained E. preschoolers typically 1. are physically coordinated and communicate well verbally 2. know their name and address and can dress themselves 3. can count to 10 or Beyond F. recommendations 1. separation anxiety is common. Allow child to stay with a caregiver when possible 2. communicate directly with the child, not just the caregiver 3. choose your words carefully. They will probably be taken literally 4. do not lie

infants

A. ages 1. neonate, a newborn from birth to one month of age 2. infant, up to one year of age B. vital signs 1. respirations. Normal respiratory rate is about 3260 breaths per minute AKA BPM for newborns and about 25 to 50 BPM for infants 2. pulse. Normal pulse rate is about 140 to 160 beats per minute for newborns and about 100 to 140 beats per minute for infants 3. blood pressure. A newborn's blood pressure is about 70 systolic and will increase to about 90 systolic by 1 year of age C. physiology 1. the typical newborn weight is about 628 lb. The newborns weight will typically double by 6 months and triple by about one year. 2. the newborn's head makes about 25% of the body and a significant source of heat loss 3. during the first couple weeks, neonates often lose weight, and then begin to gain it back 4. the newborns fontanelles AKA soft spots on the skull, will be fully fused by about 18 months. Depressed fontanelles May indicate hypovolemia 5. infants are often nose breathers and can develop respiratory distress easily 6. rapid breathing can lead to fluid loss and loss of body heat 7. hyperventilation of infants presents a significant risk of barotrauma D. neonates typically have 1. startle reflex, opens arms wide, spreads the fingers 2. grip reflex, grips when something's placed in Palm 3. rooting reflex, turns towards a touch to the cheek 4. sucking reflex, stimulated by touching the lips E. infants 1. at six months, typically begin teething, can sit upright, and track objects visually 2. at 12 months I. typically know their name, recognize parents or caregivers, walk with assistance, and speak in few words II. still communicate distress primary through crying

therapeutic communication

A. compassion. Clearly communicate you are concerned for the patient's well-being. Show empathy, the ability to see things from the patient's perspective. B. competence. The EMT must communicate competence, both verbally and non-verbally C. confidence. Communicate that you are a professional and you know what needs to be done. D. conscience. Communicate, through your actions, that you are following the ethical standards established by your profession. E. commitment. Communicate to everyone you are committed to whatever is best for the patient. F. questioning patients 1. listen! Listening to your patients' responses is the most important part of being an EMT. 2. ask patients the most important questions first. 3. open ended questions are often preferred. For example çcan you tell us what's wrong today?" Instead of "are you having chest pain?" 4. used closed questions when you need specific information or the patient is unable to provide longer answers. 5. avoid judgemental or biased questions

blood, blood pressure, and perfusion

A. components of blood 1. plasma, the liquid component of blood, made mostly of water 2. red blood cells aka erythrocytes the oxygen-carrying component of blood 3. white blood cells AKA leukocytes, fights infection by defending against invading organisms 4. platelets, essential for clot formation to stop bleeding B. blood pressure. Blood pressure is a measurement of the pressure exerted against the walls of the arteries 1. systolic pressure, the blood pressure exerted during contraction of the left ventricle 2. diastolic pressure, the blood pressure in between contractions C. perfusion. Perfusion is the flow of blood throughout the body 1. adequate perfusion means blood flow is adequate to all the tissues and organs in the body 2. inadequate perfusion AKA hypoperfusion or shock means blood flow has been compromised to the point the entire body is at risk

purposes of the patient care report or PCR

A. continuation of care. Your PCR provides important information to those that will continue patient care after your work is done. B. legal document 1. your PCR becomes part of the patient's permanent medical record. 2. typically, the person who wrote the PCR will be the person subpoenaed to give a deposition or testify in court. 3. documentation rule number 1: if you did it, write it down. If you didn't do it, don't write that you did it. 4. documentation rule number 2: it is much better to document well than to explain later while you didn't. C. billing. Your PCR may be used to correctly Bill the patient or insurance company for the services provided. D. research and continuous quality improvement. Data from your PCR will likely contribute to numerous research and cqi projects

special reporting situations

A. in most EMS systems, certain circumstances require special documentation or notification in addition to or in place of the PCR. 1. mass casualty incidents. During a mass casualty incident, the triage tag may be the only documentation of patient care. 2. suspected cases of abuse or criminal activity 3. animal bites

electronic pcr's (e-pcr)

A. pros of E-PCR's 1. Improvement of data storage and retrieval 2. improved ability to use PCR information for cqi and research B. cons of E-PCR's 1. some find e-pcr's more difficult to "paint" a clear picture of the call 2. it is difficult to design software that is easy for users to adjust to and detailed enough to capture all necessary information. 3. transferring to E-PCR's during transfer of care can be challenging.

interpersonal Communications part a

A. sending and receiving verbal Communications 1. the message sender "encodes" the message, and the receiver "decodes" the message 2. while communicating, senders and receivers can trade roles often. 3. radio communication can limit transfer of rolls if only one person can transmit or receive at once. 4. what the sender meant to convey or imply may not be what the receiver interpreted or inferred.

adulthood

A. stages of adulthood 1. early adulthood, 20 to 40 years of age 2. mid adulthood, 40 to 60 years of age 3. late adulthood, over 60 years of age B. vitals 1. respirations, 12 to 20 BPM 2. blood pressure about 110 over 70 to 130 over 90 3. heart rate, 60 to 100 beats per minute

nervous system

A. structural and functional divisions of the nervous system 1. central nervous system AKA CNS I. the CNS consists of the brain and spinal cord II. the CNS is the command-and-control portion of the nervous system III. the brain receives information from the peripheral nervous system or pns, makes decisions, and sends orders to the pns IV. parts of the brain a. cerebrum, largest part of the brain, controls thought, memory, and the senses b. cerebellum, coordinates voluntary movement, fine motor function, and balance c. brainstem, includes midbrain, pons, and medulla; controls essential body functions, such as breathing and consciousness V. the spinal cord is the communication bridge between the brain and the peripheral nervous system or pns a. cerebrospinal fluid AKA CSF, is a clear fluid in and around brain and spinal cord, cushions the central nervous system or CNS and filters contaminants 2. peripheral nervous system I. the pns includes all other nervous system structures outside of the CNS, including cranial and peripheral nerves. II. the pns sends information to the CNS and carries out orders from the CNS. III. two divisions of the pns a. sensory division, sends sensory information to the CNS b. motor division, receives motor commands from the CNS. There are two divisions of the motor portion of pns -- somatic, voluntary portion of the pns -- autonomic nervous system AKA ANS, involuntary portion of the pns a. sympathetic, fight or flight portion of the autonomic nervous system, exerts greater control in times of stress or danger b. parasympathetic, feed and breed portion of the nervous system, exerts greater control in times of rest, digestion, or reproduction.

abdominal cavity

A. the abdominal cavity contains numerous organs of digestion and excretion B. it is separated from the thoracic cavity by the diaphragm C. it continues inferiorly into the pelvic cavity. The two continuous cavities are sometimes referred to as the abdominopelvic cavity. D. the abdominal cavity is divided into four quadrants by the transverse line and the midline E. organs 1. esophagus, collapsible digestive structure running from the mouth to stomach. The esophagus resides posterior to the trachea 2. stomach, Hollow digestive organ in the left upper quadrant. The stomach receives food, begins breaking it down, and sends it to small intestine 3. pancreas, solid organ. It aids in digestion, produces insulin, and helps regulate blood glucose levels 4. liver, solid organ, occupies most of the right upper quadrant. The liver helps break down fats, filter toxins, and produces cholesterol. it also partially resides in the left upper quadrant 5. gallbladder, a hollow organ positioned beneath the liver. The gallbladder collects and stores bile from the liver. It releases bile into the intestine to aid in digestion 6. small intestine, Hollow organ, occupies both lower abdominal quadrants. Food from the stomach is mixed with digestive enzymes to digest fat. Most of the contents are absorbed out of the small intestine and used or stored by the body 7. large intestine, Hollow organ, includes the colon and rectum. Occupies the outer border of the abdomen. The large intestine pulls most of the remaining liquid to form solid stool 8. appendix, a hollow organ in the right lower quadrant. It can become easily obstructed, causing inflammation, rapture, and life-threatening infection 9. spleen, a solid organ with little protection in the left upper quadrant. The spleen filters the blood. It has a rich blood supply and can be a source of severe internal bleeding 10 kidneys, solid organs, part of the urinary system. The kidneys control fluid balance, filter waste, and control pH balance.

skeletal system

A. the skeletal system provides shape, allows movement, and protects internal organs. B. there are 206 bones in the human body C. tendons, ligaments, and cartilage are also part of the skeletal system I. ligaments connect bone to bone II. tendons connect bone to muscle III. cartilage is connective tissue that allows smooth movement of joints D. axial skeleton. The axial skeleton consists primarily of the skull, spinal call him, and rib cage or thoracic cavity 1. skull I. frontal bone, the forehead II. parietal bone, top of head, between frontal and occipital bones III. occipital bone, posterior portion of the skull IV. temporal bone, lateral bones, above the cheekbones V. maxilla, forms the upper jaw, above upper teeth VI. mandible movable portion of lower jaw VII. zygomatic bone, cheekbones VIII. nasal bone, the nose IX. foramen magnum, opening in the occipital bone where brain connects to spinal cord

patient refusals

A. thoroughly document the patient's competency. B. document your assessment. If unable to complete an appropriate assessment, document why. C. document at least two sets of vitals. If two sets are not provided, document why. D. document any treatment provided and response to treatment. Document any attempted treatment the patient refused. E. document your recommendation the patient be treated and transported F. document your discussion about the possible risks of refusing treatment. G. document that the patient understood the information provided and made an informed decision to refuse treatment. H. document your discussion with medical Direction. I. document your recommendation the patient call again if he or she changes their mind or gets worse. J. obtain the patient's signature on the refusal form or aka the AMA form K. obtain a signature from a witness but not a fellow EMS provider.

respiratory system

A. upper Airway 1. components of the upper Airway include I. nose and mouth II. nasopharynx, upper part of the throat behind the nose III. oropharynx, area of the throat behind the mouth IV. larynx, voice box V. epiglottis, valve that protects the opening of the trachea 2. most of the manual Airway techniques and mechanical Airway adjuncts used by the EMT are designed to clear and protect of the upper Airway 3. foreign body Airway obstruction or fbao is a concern for the EMT. The tongue is by far the most common cause of upper Airway obstruction B. lower airway 1. components of lower airway include I. trachea II. carina , where the trachea branches into left and right mainstem bronchi III. left and right mainstem bronchi primary branches of the trachea leading to left and right lungs IV.bronchioles, smaller branches of the bronchi V. alveoli a. all Airways structures above the alveoli serve to get air to this point in the respiratory system b. this is the only place in the respiratory system where oxygen and carbon dioxide are exchanged c. alveoli are in contact with pulmonary capillaries d. pulmonary capillaries diffuse carbon dioxide from the body to the alveoli e. alveoli diffuse oxygen from the respiratory system to the body f. surfactant is a substance that helps keep the alveoli from collapsing

adolescence, 12 to 18 years old

A. vital signs 1. respirations, 12 to 20 BPM 2. heart rate, 60 to 100 beats per minute 3. blood pressure, about 100 to 120 systolic B. recommendations, for sensitive matters, talk with the Adolescent without caregivers present when possible.

school-age children, 6 to 12 years old

A. vitals 1. respirations, about 15 to 20 BPM 2. heart rate 70 - 110 beats per minute 3. blood pressure, about 90 to 120 systolic B. recommendations 1. communicate and understandable terms, but do not talk down to them 2. respect the Privacy rights for this age group

Types of stress include?

Acute stress, delayed stress, and cumulative stress

Pregnant patients

Ages of pregnancy should not be placed supine due to the risk of supine hypotensive syndrome. Place the pregnant patient on her left side. If patient has potential cervical spine trauma, tilt backward to the left about 20 degrees. Medical restraint

Implied consent

Allows assumption of consent for emergency care of an unresponsive or incompetent patient. A. Patients might be incompetent for many reasons, such as alcohol, drugs, head injury, hypoxia, hypoglycemia, or mental incompetency. B. Implied consent can be used to treat a patient who initially refused care but later loses Consciousness or becomes otherwise incapacitated.

Quality improvement

Also called continuous quality improvement continuous audit and review of all aspects of the EMS system to identify areas of improvement

Expressed consent

Also requires that the patient be alert and competent to give expressed consent. Expressed consent can be given verbally or non-verbally. A. Expressed consent is similar to informed consent, but not usually as in-depth has informed consent. B. Expressed consent is often used to obtain consent form or basic assessments or procedures.

Acute stress?

An immediate physiological and psychological reaction to a specific event. The event triggers the body's fight-or-flight response

interpersonal Communications Part B

B. factors that influence communication 1. nonverbal cues, such as body language, have a huge impact on communication. These can be lost during radio or Cellular communication 2. your attitude and tone have a significant impact on effectiveness of communication

interpersonal Communications part C

C. establishing rapport with the patient 1. you should introduce yourself. 2. ask for the patient's name and use it. 3. make eye contact with the patient. 4. be honest. 5. use age-appropriate techniques. 6. be aware of special needs, such as those for hearing impaired patients. 7. respect cultural differences.

respiratory system continued

C. lung expansion 1. pleura, too thin, smooth layers of tissue with thin film of fluid in between to allow frictionless movement across one another I. visceral pleura, lines the outer surface of the lungs II. parietal pleura, lines the inside surface of the chest cavity 2. during inhalation, as the chest expands, the parietal pleura pulls the visceral pleura, Which pull the lungs E. muscles of breathing 1. diaphragm I. the diaphragm is the pulmonary muscle of respiration II. it separates the thoracic cavity from the abdominal cavity III. it is usually under involuntary control but can be controlled voluntarily IV. the esophagus and great vessels pass through the diaphragm V. the diaphragm is dome-shaped until it contracts during inhalation. During inhalation, it moves down and expands the size of the thoracic cavity. 2. intercostal muscles. Located between the ribs, the intercostal muscles contract during inhalation and expand the thoracic cage. 3. respiration and ventilation I. in general the terms "respiration", "ventilation", and "breathing" refer to the movement of air in and out of the lungs. Although they are often used synonymously, there are some distinctions to be made. Ventilation is also called pulmonary ventilation. II. inhalation through negative pressure breathing a. the diaphragm and intercostal muscles contract, the thoracic cage expands, pressure in the chest cavity decreases, and the air rushes in. b. inhalation is a active process and requires energy c. atmospheric air contains 21% oxygen. III. exhalation a. the diaphragm and intercostal muscles relax, the thoracic cage contracts, pressure in the chest cavity Rises, and air is expelled b. exhalation is normally passive and does not require energy. c. exhaled air contains 16% oxygen IV. external respiration, the exchange of oxygen and carbon dioxide between the alveoli and Pulmonary capillaries V. internal respiration, gas exchange between the body's cells and the systemic capillaries VI. cellular respiration, better known as aerobic metabolism, uses oxygen to break down glucose to create energy

Portable stretcher

Compact stretcher that allows more accessibility than wheeled stretchers.

Patient refusal

Competent patients May refuse treatment regardless of the severity of their condition. I. Refusals present High liability risk for EMS providers. II. Negligence or abandonment can be much easier to prove if the patient is not transported. III. Consider requesting Advanced life support Personnel or contacting medical direction for local protocols. IV. Typically, competency requires awareness of at least four things I. Person. The patient knows his or her name. II. Place. The patient knows where he or she is. III. Time. The patient is aware of the date and time. IV. Event. The patient is aware of his or her present circumstances. V. Additional considerations affecting competency -- is the patient of legal age? -- Does the patient appear impaired by drugs or alcohol? -- Does the patient appear mentally impaired by significant illness or injury? -- Are there any communication barriers, such as language or ability to hear?

documentation guidelines continued

D. abbreviations 1. most agencies have a list of approved abbreviations. Abbreviations not on your agencies approved list should not be used. 2. documentation rule number 5: spelling counts! If your PCR has a spell check feature, use it. If your PCR is handwritten and you make more than two spelling errors, start over if time permits. E. errors and falsification 1. draw a single line through the middle of any mistake or mistakes. Initial the mistake and make the correction. Never scribble out a mistake so it cannot be read. 2. intentional falsification of a PCR jeopardizes patient care. It is also grounds for termination, revocation of certification, and possible legal action. Components commonly falsified on a PCR include Vital Signs, assessment and treatment areas, and times. 3. errors of omission. An error of omission means something that should have been included was left out of the PCR. 4. errors of commission. Something incorrect was included on the PCR.

interpersonal communication part D

D. when communicating with the patient, you should NOT 1. make promises you cannot deliver 2. lie to or mislead the patient 3. give advice beyond your scope of practice 4. use biased or judgemental questions such as "Why...." 5. interrupt the patient 6. use confrontational techniques or overexert your Authority 7. overuse medical terms or professional lingo

Neonatal isolette

Designed to keep neonatal patients warm during transport, require specialized training to operate.

Online medical Direction

Direct contact between the physician and EMT via phone or radio

Do not resuscitate AKA DNR

Dnr's are specific to resuscitation efforts and do not affect treatment prior to the patient entering cardiac arrest.

interpersonal communication part e

E. challenging communication situations 1. patients with special challenges such as hearing or visually impaired patients, patients who are developmentally disabled, patients who speak a different language 2. patients under the influence of drugs or alcohol 3. pediatric patients

Accident scenes?

Extrication situations. Federal Law requires EMS workers wear and approved High reflective traffic safety vest when working on roadways, around traffic, or at an accident scene.

EMT liability

Good Samaritan laws are designed to protect someone who renders care as long as he or she is not being compensated and gross negligence is not committed. I. Each state has some form of Good Samaritan law. Some protect Healthcare Providers, some do not II. Some states extend their Good Samaritan law to publicity and Floyd EMS providers but not to those in the private sector.

Criminal liability

Government entity taking legal action against a person. Criminal complaints include the following. I. Assault. A person can be guilty of assault even if another person only perceived that they intended to inflict harm. Physical contact is not required to be guilty of assault. II. Battery. Battery is physically touching another person without their consent. If an EMT is found to be criminally liable, he or she may face imprisonment and loss of certification

Gross negligence

I. Gross negligence exceeds simple negligence. Gross negligence involves an indifference to, and violation of, a legal responsibility. II. Reckless patient care that is clearly dangerous to the patient is grossly negligent. III. Gross negligence can result in civil and or criminal charges.

Civil liability

I. In civil law, an individual or plaintiff Sues and EMT which is the defendant for a wrongful act involving injury or damage. II. A civil suit may also involve multiple EMS providers, employees, supervisors, training programs, and medical directors. III. In a civil suit, the plaintiff or plaintiff seeks monetary compensation from the defendant(s).

Abandonment

I. Once care is initiated, EMS providers cannot terminate care without the patient's consent. Some patient encounters may also require direct contact with medical Direction prior to terminating care. Most EMS agencies have written protocols for terminating care without transporting location to a higher level of care. II. Abandonment is the termination of care without transferring the patient to an equal or higher medical Authority. Transfer of care must include a verbal transport to an equal or higher medical Authority. Most EMS systems allow EMTs to accept care from a paramedic or Advanced EMT for transport if an advanced level assessment or Advanced Care is not needed.

Negligence is the most common reason EMS providers are sued civilly.

I. The plaintiff has the burden of proof, not the EMT II. With negligence, the EMS provider is accused of unintentional harm to the plaintiff. III. The plaintiff must prove all four of the following, A. Duty to act. The EMT had an obligation to respond and provide care. B. Breach of Duty. The EMT failed to assess, treat, or transport patient according to the standard of care. C. Damaged. The plaintiff experience damage or injury recognized by the legal system as worthy of compensation. D. Causation also called proximate cause. The injury to the plaintiff was, at least in part, directly due to the EMTs breach of Duty.

Involuntary consent

Incompetent adults were those in custody of law enforcement. Consent must be obtained from the entire entity with the appropriate legal Authority.

Types of consent

Informed consent, expressed consent, implied consent, minor consent, and involuntary consent.

Medical director

Is a physician responsible for providing medical oversight

Informed consent

Is required from all patients who are alert and competent A. Patient must be informed of your care plan and Associated risks of accepting or refusing care and transport. B. Patient must be informed of, and understand, all information that would impact a reasonable person's decision to accept or refuse care and transport.

Living will

Living wills are broader than dnr's. They address Health Care wishes prior to entering Cardiac Arrest. This may include use of advanced Airways, ventilators, feeding tubes, Etc.

Minor consent

Minors are not competent to accept or refuse care. A. Consent is required from a parent or legal guardian. Implied consent can be used when unable to reach a parent or guardian and treatment is needed. B. Minor consent is not required for emancipated minors. Criteria for emancipation varies but usually includes minors who are married or pregnant, already apparent, a member of the Armed Forces, financially independent, or emancipated by the courts.

Skeletal abnormalities

Picture of the spine such as kyphosis or lordosis, may not be capable of laying supine without special padding.

Use of force Doctrine

Reasonably to prevent harm to a patient being forcibly restrained. The use of force must be protective, not punitive.

Cumulative stress?

The results of exposure to stressful situations over a prolonged period of time. This leads to burn out for many EMTs.

Scoop stretcher

Separate into two long pieces left and right, not top to bottom. Allows for easy positioning with minimal patient movement good for reduced patient discomfort during movement compared to other techniques.

Advanced directives

Signed by the patient, specifying the patient's wishes regarding treatment and resuscitative efforts. There are several types of advance directives Requirements for a legally recognized advance directive vary by state. Consult local protocols.

Stair chair

Stair chair excellent for staircases, small elevators, Etc. A stair chair however, does not allow for manual cervical spine protection, CPR, or artificial ventilation.

Scene safety

The EMTs first priority is always his or her own safety as this will not change the EMTs safety priorities after personal safety are his or her partner's then the patients and then by standards maintaining scene safety includes addressing scene specific hazards appropriate infection control precautions and safe lifting and moving techniques

EMT Wellness

These include physical well-being as maintaining mental well-being, EMTs must anticipate stress and develop a healthy plan to manage it

Emergency moves

Trash these are used when the scene is dangerous and the patient must be moved before providing patient care. Types of emergency moves include the armpit forearm drag, shirt drag and blanket drag.

Backboard

Used primarily for cervical spine and mobilization, payback for is lightweight and allows for CPR and artificial ventilation. Requires before person lift.

Patient refusal continued

V. During a refusal, the patient must be fully informed of the treatment recommended and the possible consequences of refusing treatment. VI. Reducing liability on a patient refusal I. Ensure the patient is absolutely competent. II. The EMTs best protection from liability is to provide excellent care and convince the patient to accept transport. III. The second best way for an EMT to protect him or herself is to ensure the patient is fully informed, contact medical Direction, and document extremely well. VII. Documentation. The patient is rarely, if ever, fully informed the first time he or she conveys the intent to refuse treatment. Documentation should reflect both the initial refusal and the secondary refusal after being fully informed. I. Document the patient's awareness of person, place, time and event. II. Document all the information you provide to the patient so he or she can make an informed decision. III. Document any advice given to the patient. IV. Document that the patient is aware he can always change his mind and call EMS again at any time. V. Accurately document all times, including patient contact and departure times, vitals, and any treatment, Etc. VI. Document at least two sets of vitals. VII. Accurately document the assessments and treatments that were performed, including response to treatment. VII. Document consultation with medical Direction and any orders received. IX. Obtain the patient's signature and the signature of a witness not another EMS provider. Stop X. If your agency has an approved refusal of care form use it!

Offline medical Direction

Written guidelines and protocols

False imprisonment

You may be guilty of false imprisonment if you transport a competent patient without consent.

base station

a transmitter / receiver in a fixed location that is in contact with all other components in the radio system.

Repeater

a type of base station that recieves low-power transmittions fr om portable or mobile radios and rebroadcasts at higher power to improve range.

the heart

blood from the body is brought back to the heart from the inferior and superior vena cava the blood is then dumped into the right atrium where the heart contracts from the SA node which causes a simultaneous contraction of the Atria. Once the Atria are contracted blood is then pushed into the right ventricle through the tricuspid valve. next the AV node fires an impulse which causes the ventricles to contract simultaneously. blood from the right ventricle is then forced into the pulmonary artery. the pulmonary artery delivers the blood to the lungs. the pulmonary vein brings oxygenated blood to the left atrium. once again the SA node fires an Impulse which caused the Atria to contract. the blood in the left atrium is then pushed into the left ventricle through the bicuspid valve or mitral valve. then again the AV node sends an Impulse which causes both ventricles to contract simultaneously. next the blood is forced from the left ventricle to the aorta. which is how the blood enters the circulatory system to the body.

portable radios

handheld transmitter / receiver with a very limited range, unless used with a repeater

Medical director

overseas medical improvement

EMS Communications

portable radios, mobile radios, repeater, base station, mobile data computers or mdc's, cellular phones, Federal Communications Commission or the FCC, and guidelines for radio communication.

The FCC

the FCC regulates all radio operations in the United States and has allocated specific frequencies for EMS use only.

documentation (narrative)

this is where the EMT "Paints the picture" of what happened. Usually, this is the first place readers will go to begin understanding the call.

mobile radios

vehicle mounted transmitters and receivers. These have a greater range than portable radios, but distance is still limited unless used with a repeater