Chapter 4 Exam

Explain special considerations when responding to calls to nursing and skilled care facilities. (pp 1379-1380)

Calls to these facilities can sometimes be challenging. Patients often have an altered level of consciousness and may not be able to give NOI or MOI.

Define hazardous material; include the classification system used by the NFPA. (pp 1503, 1516)

Hazardous material - any substance that is toxic, poisonous, radioactive, flammable, or explosive and causes injury or death with exposure. Level 0 - little or no hazard Level 1 - slightly hazardous Level 2 - Slightly hazardous Level 3 - extremely hazardous Level 4 - minimal exposure causes death

Define obesity. (p 1402)

Obesity - a complex condition in which a person has an excessive amount of body fat.

Explain assessment of the pregnant patient. (pp 1253-1255)

Patient assessment, scene size up, primary assessment, history taking, secondary assessment, reassessment.

Summarize the tasks EMTs must complete in the postrun phase. (pp 1442-1443)

Perform routine inspections and refuel the vehicle. Use a written checklist to document needed repairs or replace equipment.

Name four different types of goals that commonly motivate terrorist groups to carry out terrorist attacks. (p 1529)

Religious extremist groups/ doomsday cults Extremist political groups Cyber terrorists Single-issue groups

.Explain the necessary care of the fetus as the head appears. (p 1263)

1. Crowning - the definitive sign that delivery is about to happen and transport should be delayed until after the child is born 2. Use your hands to support bony parts of the head as it emerges. The child's body will naturally rotate to the right or left at this point in the delivery. Continue to support the head and allow it to turn in the same direction. 3. As the upper shoulder appears, guide the head down slightly to deliver the shoulder. 4. Support the head and upper body as the lower shoulder delivers, guide the head up if needed. 5. Handle the newborn firmly but gently, support the head and keep the neck in a neutral position to maintain airway.

Differentiate among the three stages of labor. (pp 1255-1256)

1. Dilation of the cervix 2. Delivery of the fetus 3. Delivery of the placenta

List the three factors that dictate the use of lights and siren to the scene and to the hospital; include the risk-versus-benefit analysis regarding their use. (pp 1450-1451)

1. The unit, to the best of your knowledge, must be responding to a true emergency call as defined by local protocol. Audible and visual warning devices must be used simultaneously. The unit must be operated with due regard for the safety of all others, on and off the roadway.

13.Describe the procedure followed to clamp and cut the umbilical cord. (p 1264)

1. Wait 30 to 60 seconds for the umbilical cord to stop pulsing. Place a clamp on the cord. Place a second clamp 2 to 3 inches away from the first. 2. Cut between the clamps. 3. Allow the placenta to deliver itself. Do not pull on the cord to speed delivery.

Explain the responsibilities of EMTs when responding to calls for terminally ill patients who have DNR orders. (p 1411)

A time when respect, empathy, and sensitivity are most needed. Some homes with patients receiving hospice may be chaotic. Family members may have a difficult time coping. Treat everyone with compassion and understanding. Members of your team may be able to separate family members and speak to them privately to defuse intense emotions.

Describe the emergency care of a pediatric patient with an altered mental status, including common causes, signs, and symptoms. (p 1322)

AEIOU-TIPS mnemonic A- Alcohol, E- epilepsy, endocrine, electrolytes, I - Insulin, O - Opiates, and other drugs, U - Uremia, T - Trauma, temperature, I - Infection, P - Poisoning, psychogenic causes, S - Shock, stroke, syncope, seizure, space-occupying lesion Signs and symptoms range from confusion to coma Management of altered mental status focuses on ABCs and transport.

Explain the four triage categories used in the JumpSTART system for pediatric patients during disaster management. (pp 1335-1336)

Ability to walk (except in infants); presence of spontaneous breathing; respiratory rate of less than 15 or greater than 45 breaths/min; palpable peripheral pulse; appropriate response to painful stimuli on AVPU scale. Green tag - not in immediate need of treatment Yellow tag - breath spontaneously and have peripheral pulse Red tag - highest priority Black tag - deceased

Discuss the effects of aging on environmental emergencies. (p 1375)

About ½ of all deaths from hypothermia occur in older people, and most indoor hypothermia deaths involve geriatric patients. Internal temperature regulation slows with age because of a slowed endocrine system.

.Define an advance directive and explain its use with older patients. (pp 1380-1381)

Advance directive - written documentation that specifies medical treatment for a competent patient should the patient become unable to make decisions; also called a living will or health care directive. Has become more common for EMS providers because more people are electing to use hospice services and spend their final days at home.

Discuss the issues of poverty and homelessness in the United States, their negative effects on a person's health, and the role of the EMTs as patient advocates. (pp 1412-1413)

An impoverished family may have housing but may go without food or medication in order to pay for that housing. The homeless population includes people with mental illness, prior brain trauma, victims of domestic violence, people with addiction disorders. Significantly more likely to use EMS. Some hospitals have set up partnerships with homeless shelters to provide routine medical care and treatment for non-life threatening conditions.

Explain special considerations when performing the patient assessment process on a geriatric patient with a medical condition. (pp 1368-1373)

Assessing an older person may be challenging because - Communication issues, hearing and vision deficits, alteration in consciousness, complicated medical histories, previous injury, or illness.

Describe the purpose of the medical branch of the ICS and its organizational structure. (pp 1493-1495)

At incidents with a significant medical factor, the IC will designate someone as the chief of the medical branch under the operations section. The chief will supervise - triage, treatment, and transport of injured people. Medical branch director helps ensure EMS units responding to scenes are working with the ICS, each medical division or group receives a clear assignment before beginning work at the scene.

Name the medical equipment carried on an ambulance; include examples of supplies that are included in each main category of the ambulance equipment checklist. (p 1428)

Basic supplies Pillows, sterile sheets, blankets, towels, bedpan, urinals, blood pressure, wet wipes, restraining devices, sharps container Airway and Ventilation Equipment Infection control kids, OPA NPAs, CPAP, pulse ox, bag-mask devices, mounted suction Basic Wound Care Supplies Trauma shears, sterile sheets, sterile burn sheets, adhesive tape, roller bandages, gauze, tourniquets, wound packing Splinting supplies Traction splint, long backboard, short backboard, dead immobilization devices, variety of triangular bandages, variety of arm and leg splints. Childbirth supplies Emergency obstetric kit AED Patient transfer equipment Wheeled ambulance stretcher, Wheeled stair chair, Scoop stretcher, basket stretcher, transfer tarp Medications and other supplies Activated charcoal, oral glucose, oxygen, aspirin, narcan, portable radio, drinking cups

Explain patient care at a hazmat incident; include the special requirements that are necessary for those patients who require immediate treatment and transport prior to full decontamination. (pp 1517-1519)

Care at a hazmat incident must address the two issues: Any trauma that has resulted from other related mechanisms, such as vehicle crash, file, or explosion Injury and harm that have resulted from exposure to the hazardous substance

Describe child abuse and neglect and its possible indicators, including the medical and legal responsibilities of EMTs when caring for a pediatric patient who is a possible victim of child abuse. (pp 1336-1339)

Child abuse - a general term applying to all forms of abuse and neglect of children. C - consistency of the injury with the childs developmental age H - history inconsistent with injury I - innapropriate parental concerns L - lack of supervision D - Delay in seeking care A - affect B - bruises of varying ages U - unusual injury patterns S - suspicious circumstances E - environmental clues

Discuss the significance of burns in pediatric patients, their most common causes, and general guidelines EMTs should follow when assessing patients who have sustained burns. (pp 1333-1335)

Children do not tolerate burns as well as adults do. Children are more likely to go into shock, develop hypothermia, and experience airway problems. Most common - hot items on the stove, hot water in the bathtub. Pediatric patients are managed in the same manner as adults.

Describe the role of the EMT in establishing command under the ICS. (p 1493)

Command should be established by the most senior official, notification to other responders should go out, and necessary resources should be requested. Must be established early, preferably by the first arriving-most experiences public safety official from the most relevant service

Discuss the specific reference materials that EMTs use to recognize a hazmat incident. (pp 1510-1513)

DOTs Emergency response guidebook - a preliminary action guide for first responders operating at a hazardous materials incident in coordination with the US department of Transportation labels and placards marking system. Jointly developed by the DOT, the Secretariat of Communications and transportation of Mexico, and Transport Canada. Material safety data sheet - containing information about chemical composition, physical and chemical properties, health and safety hazards, emergency response, and waste disposal of specific material; also known as a safety data sheet.

Discuss the physiologic changes associated with the aging process and the age-related assessment and treatment modifications that result. (pp 1352-1365)

Decreased muscle mass Weakening of airway Alveoli in lung tissue can become enlarged and elasticity decreases Decreases immune response, chronic lower respiratory disease

Contrast a disaster with a mass-casualty incident. (p 1502)

Disaster - a widespread event that disrupts community resources and functions, in turn threatening public safety, citizens lives and property. MCI - usually lasts no longer than a few hours, disasters can last days to weeks or even months. Only an elected official can declare a disaster.

Explain the role of EMS response within the ICS. (pp 1491-1493)

EMS agencies should have written disaster plans that are regularly trained to carry out. Assess the scene for hazards, warn all other responders about hazardous materials, fuel spills, electrical hazards, or other safety concerns. Determine if incident is open or closed Open - one that is not yet contained, situation may still be ongoing Closed - incident that is contained and all casualties are accounted for

Discuss the prevalence of elder abuse and neglect; include why the extent of elder abuse is not well known. (pp 1381-1383)

Elder abuse - any action on the part of an older person's family member, caregiver, or other associated person that takes advantage of the older person's person, property, or emotional state. Extent is not often know because: Elder abuse is a problem that has a been largely hidden from society Victims of elder abuse are often hesitant to report the problem to law enforcement agencies or human and social welfare personnel.

.Discuss patient care considerations related to assisting with rapid extrication, providing emergency care to a trapped patient, and removing and transferring a patient. (pp 1473-1475)

Emergency care : Address any exsanguinating hemorrhage with direct pressure or a tourniquet if appropriate. Provide manual stabilization to protect the cervical spine, as needed. Open the airway. Provide high-flow oxygen, if indicated Assist or provide for adequate ventilation Control any significant external bleeding Treat all critical injuries One patient has been freed, rapidly assessing anything that was previously inaccessible. Apply a neck collar. Transport rapidly. After rescue, all equipment used on scene must be cleaned, repacked, and checked before loading again

Describe key scene safety considerations when preparing for a helicopter medevac, including establishing a landing zone, securing loose objects, mitigating onsite hazards, and approaching the aircraft. (pp 1455-1458)

Ensure the area is a hard or grassy level surface that measures 100x100. Ensure the area is clear of loose debris. Mark landing sight with weighted cones forming an X. Familiarize yourself with helicopter signals.

Discuss the effect of aging on behavioral emergencies. (pp 1367-1368)

For some adults, aging is characterized by physical pain, emotional distress, doubts about lifes accomplishments, financial concerns, loss of loved ones, which can cause hopelessness, depression, and even suidice.

2. Explain the normal changes that occur in the body during pregnancy. (pp 1246-1247)

Hormone levels increase to support fetal development and prepare the body for childbirth. The uterus grows, stretching to accommodate a full-term fetus. As the uterus grows, it pushes on the diaphragm, displacing it from its normal position and leading to reduced tidal volume with each breath. Increases the patients overall demand for oxygen as her metabolic demands and workload increase to support the developing fetus. Blood volume gradually increases throughout pregnancy to allow for adequate perfusion of the uterus as the fetus grows and to prepare for the blood loss that will occur during childbirth.

Contrast hospice and palliative care with curative care. (pp 1411-1412)

Hospice care provides comfort care, or palliative care, during a person's last days. Comfort care improves the patient's quality of life before death and allows the patient to be with family and friends.

.Describe how the three control zones are established at a hazmat incident and discuss the characteristics of each zone, and the responders who work within each one. (pp 1514-1515)

Hot zone - the area immediately surrounding a hazardous materials spill or incident site that endangers life and health. All responders working in this zone must wear appropriate protective clothing and equipment. Entry requires approval by the incident commander or other designated officer. Warm zone - the area located between the hot zone and the cold zone at a hazardous materials incident. The decontamination corridor is located in this zone. Cold zone - a safe area at a hazardous materials incident for the agencies involved in the operations. The incident commander, the command post, EMS providers, and other support functions necessary to control the incident should be located in this zone. Also referred to as the clean zone or the support zone.

Describe the purpose of the incident command system (ICS) and its organizational structure. (pp 1487-1488)

ICS - a system implemented to manage disasters and mass-casualty incidents in which section chiefs, including finance/ administration, logistics, operations, and planning, report to the incident commander. Organized into different sections, branches, divisions and groups. Command - in incident command, the position that oversees the incident, establishes the objectives and priorities, and develops a response plan. Finance/administration - the position in an incident responsible for accounting all expenditures Logistics - in incident command, the position that helps procure and stockpile equipment and supplies during an incident. Operations - in incident command, the position that carries out the orders of the commander to help resolve the incident. Planning - in incident command, the position that ultimately produces a plan to resolve any incident.

Explain the special patient care considerations required when providing emergency medical care to bariatric patients; include the best way to move bariatric patients. (pp 1402-1403)

If transport is necessary, plan early for extra help and do not be afraid to call for special equipment. You do not want to risk dropping the patient at any cost. Treat patients with dignity and respect. Ask the patient the best way to move them. Notify the facility early.

Discuss the specific considerations that are required to ensure scene safety; include personal safety, patient safety, and traffic control. (pp 1437-1440)

Immediately size up the scene - look for safety hazards, make sure to park the ambulance in a safe spot, stay away from hires, explosive hazards, downed wires, prevent secondary crashes during crash traffic.

Describe the indications of an imminent delivery. (p 1256)

Imminent - will occur within a few minutes Ask the following questions: How long have you been pregnant, when are you due, is this your first pregnancy, are you having contractions, how far apart are they, has your water broken, do you feel the need to push?

1. Identify the anatomy and physiology of the female reproductive system. (pp 1243-1245)

Includes the ovaries, fallopian tubes, uterus, cervix, vagina, and breasts.

Discuss the physical and cognitive developmental stages of an infant, including health risks, signs that may indicate illness, and patient assessment. (pp 1285-1286)

Infant - 0 to 2 months An infant should be aroused easily from a sleeping state, and it should be considered an emergency if this is not the case. Infants have poor thermoregulation Heads have relatively large surface area, predisposing them to hypothermia, so parents will often bundle infants to keep them warm. Unbundle infant during assessment. 2-6 months - persistent crying and irritability can be an indicator of serious illness. A lack of eye contact in a sick infant can also be a sign of significant illness, depressed mental status, or a delay in development.

Define international terrorism and domestic terrorism; include examples of incidents that have been caused by each one. (p 1528)

International terrorism - terrorism that is carriest out by people in a country other than their own; also known as cross-border terrorism. Domestic terrorism - terrirism that is carried out by people in their own country.

Describe how the ICS assists EMS in ensuring both personal safety and the safety of bystanders, health care professionals, and patients during an emergency. (pp 1492-1493)

Keep in mind - safety, incident stabilization, preservation of property and the environment Safety includes your life, your partner's life, and other responders lives. May have to work to isolate or stabilize the incident before providing care to injured people

Describe the four levels of personal protective equipment (PPE) required at a hazmat incident to protect responders from injury by or contamination from a particular substance. (pp 1516-1517)

Level A - the most hazardous, requires fully encapsulated, chemical-restrained protective clothing that provides full body protection, as well as SCBA and special, sealed equipment. Level B - requires nonencapsulated protective clothing or clothing that is designed to protect against a particular hazard. Level C - like level B, requires the use of nonpermeable clothing and eye protection. In additiation, face masks that filter all inhaled outside air must be used. Level D - requires a work uniform, such as coveralls, that affords minimal protection.

Describe the specific conditions that would define a situation as a mass-casualty incident (MCI); include examples. (pp 1496-1497)

MCI - an emergency situation involving three or more patients or that can place great demand on the equipment or personnel of the EMS system or has the potential to produce multiple casualties. A fire, a shooting, a bus crash

Describe some high-risk situations and hazards during both pre transport and transport that may affect the safety of the ambulance and its passengers. (pp 1436-1441, 1443-1453)

Make sure you fasten seatbelts, in dispatch to violent crime, may be asked to stage ambulance away from scene, consider staying out of sight of scene,

Name the key observations EMTs must make on every call to determine the potential of a terrorist attack. (pp 1532-1533)

Make the following observations on every call - Type of location Type of call Number of patients Victims statement Preincident indicators

Explain the different factors that must be considered before attempting to gain access to the patient during an incident that requires extrication. (pp 1470-1472)

Must consider : Is the patient in a vehicle or in some other structure? Is the vehicle or structure severely damaged? What hazards exist that pose a risk to the patient and responders? In what position is the vehicle? On what type of surface? Is the vehicle stable or is it likely to roll over. Severity of patients injuries - might need to do CPR.

Explain how the Department of Homeland Security (DHS) National Terrorism Advisory System (NTAS) relates to the actions and precautions EMTs must take while performing their daily activities. (pp 1532-1533)

Must constantly be aware of surroundings and understand the possible risks for terrorism associated with certain locations at certain times. It is important to know the current threat level issued by the federal government through the DHS. Alerts from NTAS contain a summary of the threat and the actions that first responders, government agencies, and the public can take to maintain safety.

Recognize the entry-level training or experience requirements identified by the HAZWOPER regulation for EMTs to respond to a hazmat incident. (p 1503)

Must first step back and assess the situation, rushing into an unsafe scene can have catastrophic results. Should have training in following areas: Understanding of what hazardous substances are and risks associated Understanding of the potential outcomes of an incident Ability to recognize the presence of hazardous substances Ability to identify hazardous substances Understanding of the role of first responder awareness Determine need for additional resources

Describe home care, the types of patients it serves, and the services it encompasses. (p 1411)

Occurs within a patient's home environment. Services offered include - meal delivery, house cleaning, laundry, yard maintenance, physical therapy, personal care. Home care personnel are usually familiar with patients surroundings and can obtain any health care documentation or medications that need to be transported to hospital.

.Explain the role of EMTs during a hazmat incident both before and after the hazmat team arrives; include the precautions required to ensure the safety of civilians and responders. (pp 1514-1515)

Once you have called for a hazmat team, focus efforts on activities that will ensure the safety and survival of the greatest number of people. Use the ambulance public address system to alert people who are near the scene and direct them to move far from damage.

Describe differences in the anatomy and physiology of the pediatric patient compared to the adult patient and their implications for EMTs, with a focus on the following body systems: respiratory, circulatory, nervous, gastrointestinal, musculoskeletal, and integumentary. (pp 1290-1293)

Pediatric airway is smaller in diameter and shorter in length, the lungs are smaller, and the heart is higher in a child's chest. The vocal cords are higher. Neck appears nonexistent. Pediatric brain requires a higher amount of cerebral blood flow, oxygen, and glucose than the adult brain. Abdominal muscle structures are less developed in children, resulting in less protection from blunt or penetrating trauma. Child's liver and spleen are proportionally larger. Child's bones are softer than an adults. Child's skin is thinner with less subcutaneous fat.

Describe the mechanisms of injury caused by incendiary and explosive devices; include the types and severity of wounds. (pp 1552-1553)

Primary blast injury - injuries caused by an explosive pressure wave to the hollow of the organs of the body. Injury seen in hollow organs of the body - lungs, intestines, and ears. Secondary blast injury - a penetrating or nonpenetrating injury caused by ordnance projectiles or secondary missiles. Tertiary blast injury - an injury from whole-body displacement and subsequent traumatic impact with environmental objects. Quaternary blast injury - a blast injury that falls into one of the following categories: burns, crush injuries, toxic inhalation, medical emergencies, or mental health disorders.

Describe what occurs during primary and secondary triage, how the four triage categories are assigned to patients on the scene, and how destination decisions regarding triaged patients are made. (pp 1497-1499)

Primary triage - a type of patient sorting used to rapidly categorize patients; the focus is on speed in locating all patients and determining an initial priority as warranted by their conditions. Secondary triage - a type of patient sorting used in the treatment area that involves retriage or patients. During primary triage - patients are briefly identified by attaching a triage tag or colored triage tape.

Discuss the history of nuclear/radiological devices, sources of radiologic materials and dispersal devices, medical management of patients, and protective measures EMTs must take during a nuclear/radiological incident. (pp 1549-1552)

Radioactive material is any material that emits radiation. It is unstable and attempts to stabilize itself by changing its structure in a natural process called decay. Energy emitted from a strong radiologic source is termed as - alpha radiation, beta radiation, gamma radiation, or neutron radiation. These materials can be found - Hospitals or other healthcare facilities, colleges and universities, nuclear power plants, chemical and industrial sites. Special Atomic Demolition Munitions - small suitcase-sized nuclear weapons that were designed to destroy individual targets, such as important buildings, bridges, tunnels, and large ships.

Describe the role of EMTs during a disaster operation. (p 1502)

Role in a disaster is to respond when requested and to report to the IC for assigned tasks. May mobilized medical and nursing teams with equipment and set up a mass casualty collection area. Provide medical care, perform triage, and transport patients to hospital on priority basis.

Explain how to perform the START and JumpSTART triage methods. (pp 1499-1501)

START triage - a patient sorting process that stands for Simple Triage And Rapid Treatment and uses a limited assessment of the patient's ability to walk, respiratory status, hemodynamic status, and neurologic status. JumpSTART triage - a sorting system for pediatric patients younger than 8 years or weighing less than 100 pounds. There is a minor adaptation for infants because they cannot ambulate on their own.

Explain the difference between simple access and complex access in vehicle extrication. (p 1472)

Simple access - access that is easily achieved without the use of tools or force. Complex access - entry that requires special tools and training and includes the use of force.

Describe examples of situations that would require special technical rescue teams and the EMT's role in these situations. (pp 1475-1479)

Special rescue situations: Cave rescue, confined space rescue, dive rescue, missing person search, mine rescue, mountain climbing, water rescue. Technical rescue situation - a rescue that requires special technical skills and equipment in one of many specialized rescue areas, such as technical rope rescue, cave rescue and dive rescue. When you arrive on scene, you will be met by a technical rescue group and directed to the staging area. Set up equipment in a dedicated staging area.

Discuss the guidelines for safely and defensively driving an ambulance. (pp 1443-1445)

Speed does not save lives, good care does. The driver and all passengers must wear seat belts and shoulder restraints at all times. Patients should be properly restrained. All equipment and cabinets must be secured.

Explain the critical response actions related to establishing and reassessing scene safety, personnel protection, notification procedures, and establishing command EMTs must perform at a suspected terrorist event. (pp 1532-1535)

Stage your vehicle a safe distance from the incident, wait for law enforcement to advise you the scene is safe. The best location for staging is upwind and uphill from the incident. Always the scene you are dealing with is not safe to enter. Greatest threat facing you in a WMD attack are contamination and cross-contamination.

Describe the key elements that must be included in the written patient report upon patient delivery to the hospital. (p 1441)

Summary of the history of the patient's current illness or injury with pertinent positives and negatives, MOI, and findings on your arrival. In addition, list vital signs, relevant past medical or surgical history, and information regarding medication and allergies. Also, be sure to document any treatment and the patient's response to treatment during the prehospital setting.

Explain the role of EMS in relation to syndromic surveillance and points of distribution (PODS) during a biologic event. (pp 1548-1549)

Syndromic surveillance - the monitoring, usually by local or state health departments, of patients presenting to emergency departments and alternative care facilities, the recording of EMS call volume, and the use of over the counter medications. Points of distribution - existing facilities used as mass distribution sites for antibiotics, antidotes, vaccinations, and other medications and supplies during an emergency.

Explain special considerations when performing the patient assessment process on a geriatric patient with a traumatic injury. (pp 1375-1378)

Trauma is never isolated to a single issue when assessing and caring for a geriatric patient. The same injury in an older patient than a younger patient may result in deterioration, shock, and life-threatening hypoxia.

List three categories of biologic agents, their routes of exposure, effects on the patient, and patient care. (pp 1542-1548)

Viruses - germs that require a living host to multiply and survive Bacteria - microorganisms that reproduce by binary fission. The single-cell creatures reproduce rapidly. Some can form spores when environmental conditions are harsh. Neurotoxins - biologic agents that are the deadliest substances known to humans; they include botulinum toxin and ricin.

Define weapon of mass destruction (WMD) and weapon of mass casualty (WMC); include examples of weapons considered WMDs. (p 1531)

Weapon of mass destruction - any agent designed to bring about mass death, casualties, and/or massive damage to property and infrastructure (bridges, tunnels, airports, and seaports); also known as a weapon of mass casualty (WMC) Weapon of mass casualty - any agent designed to bring about mass death, casualties, and/or massive damage to property and infrastructure (bridges, tunnels, airports, and seaports); also known as a weapon of mass casualty (WMD) B-NICE Biologic, nuclear, incendiary, chemical, and explosive weapons

Explain the responsibilities of an EMT in patient rescue and vehicle extrication. (p 1464)

Will not be responsible for rescue, but may assist with extinction. Must understand the basic concepts of extrication in order to function as part of a team.

Name the safety and operations equipment carried on an ambulance; include examples of how each item might be used by EMTs in an emergency. (pp 1433-1434)

Wrench, screwdriver, bolt cutter, folding shovel, rolls of duct tape, warning devices, fire extinguisher, portable floodlights, hard hats with face shields

Describe the purpose of the National Incident Management System (NIMS) and its major components. (pp 1486-1487)

components. (pp 1486-1487) National incident management system - a department of homeland security system designed to enable federal,state, and local governments and private-sector and nongovernmental organizations to effectively and efficiently prepare for, prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity, including acts of catastrophic terrorism. 3 major components - Communications and information management Resource management Command and coordination

Discuss the history of chemical agents, their four main classifications, routes of exposure, effects on the patient, and patient care. (pp 1535-1542)

hemical agents are liquids or gasses that are dispersed to kill or injure. During the cold war, many of these agents were perfected and stockpiled. Can be described as liquid, gas, or solid material. Route of exposure - how the agent most effectively enters the body. Chemical agents can have either a vapor or contact hazard. Blister agents -Vesicant - the primary route of entry for such agents is through the skin Skin irritation, burning, and reddening, immediate intense pain, large blisters, swollen eyes Nerve agents - a class of chemicals called organophosphates, they function by blocking an essential enzyme in the nervous system, which causes the body's organs to become overstimulated and burn out Can cause cardiac arrest within seconds. G agents - early nerve agents that were developed by German scientists in the period after WWI and into WWII. There are three such agents: sarin, soman, and tabun.

Know generational considerations when communicating with a geriatric patient. (pp 1350-1351)

Some older patients may have just lost a spouse, many live on a fixed income which can be very challenging, might not take all medications to save money, many fear losing independence. Treat patients with respect, avoid ageism. Do not assume a patient has dementia, is hard of hearing, or lives a sedentary lifestyle.

Describe the emergency care of a pediatric patient who has been poisoned, including common sources of poison, signs, and symptoms. (pp 1325-1326)

Common sources - alcohol, aspirin, cosmetics, cleaning products, iron, houseplants, vitamins Child may appear normal, or sleepy, confused, unconscious

Define polypharmacy and the toxicity issues that can result. (pp 1365-1367)

Polypharmacy - the use of multiple medications on a regular basis. Negative effects - overdosing and negative medication interactions Adverse reactions occur when medications taken together change the absorption, distribution, or excretion of medications in the body or the effects of the medications on the body.

List the nine phases of an ambulance call; include examples of key tasks EMTs perform during each phase. (pp 1426-1443)

Preparation for the call Dispatch En route Arrival at scene Transfer of the patient to the ambulance En route to the receiving facility (transport) At the receiving facility (delivery) En route to the station Post run

Recognize some of the special aspects of the lives of older people. (p 1350)

Present a unique challenge for health care providers because the classic presentations of injuries and illness are often altered by chronic conditions, multiple medications, and the physiology of aging.

Discuss how to ensure safety at the scene of a rescue incident, including scene size-up and the selection of the proper personal protective equipment and additional necessary gear. (pp 1464-1469)

Protective gear may include - turnout gear, a helmet, hearing protection, a fire extinguisher. Very important to wear blood and fluid impermeable gloves at all times during patient contact. If involved with extrication, wear a pair of leather gloves over disposable gloves.

Describe the specific, limited privileges that are provided to emergency vehicle drivers by most state laws and regulations. (p 1450)

Some states allow you to proceed through a red light or stop sign after you stop and make sure it is safe to go on. Other states allow you to proceed through a controlled intersection with due regard, using flashing lights and sirens. May proceed only if you consider the safety of all people.

List the contents of an obstetrics kit. (p 1257)

Surgical scissors, umbilical cord clamps, towels, drapes or sheets, 4x4 inch gauze and 2 x 10 inch gauze sponges. Sterile gloves, infant blanket, sanitary pads, a plastic bag

Describe the emergency care of a pediatric patient who has experienced a drowning emergency, including common causes, signs, and symptoms. (pp 1328-1329)

Symptoms - coughing, choking, airway obstruction, difficulty breathing, altered mental status, pale, cyanotic skin, vomiting. Request ALS, assess and manage the ABCs, administer oxygen, be prepared to suction vomit, apply cervical collar

Describe the emergency care of a pediatric patient with meningitis, including common causes, signs, symptoms, and special precautions. (pp 1323-1324)

Symptoms - fever and altered level of consciousness, headache or confusion, lethargy, may experience a seizure Signs - small, pinpoint, cherry-red spots or a larger purple or black rash.

Explain the GEMS diamond and its role in the assessment and care of the geriatric patient. (p 1368)

The GEMs diamond - G - geriatric patients: present atypically, deserve respect, experience changes with age E - environmental assessment - What is the physical condition of living space? Are pets well cared for? Is home secure? Are hazards present? M - medical assessment - do the whole thing S - social assessment - assess activities of daily living (eating, dressing, bathing, toileting), Are there any delayings in obtaining food? Are these activities being provided for the patient?

.Describe postpartum complications and how to treat them. (p 1274)

if bleeding continues after delivery of placenta, continue to massage the uterus, but check technique and hand placement. If a woman appears to be in shock, treat for shock. Administer oxygen if necessary, pulmonary embolism might occur.

Describe the 10 phases of vehicle extrication and the role of the EMT during each one. (pp 1466-1475)

1. Preparation 2. En route to the scene 3. Arrival and scene size-up 4. Hazard control 5. Support operations 6. Gaining access 7. Emergency care 8. Removal of the patient 9. Transfer of the patient 10. Termination

Discuss the responsibilities of EMTs when communicating with a family or loved ones following the death of a child. (pp 1340-1341)

Allow the family to express their grief in ways that may differ from your own cultural, religious, and personal practices. Provide emotional support in whatever ways you can. If the family insists you initiate CPR even though the child is clearly dead, you can initiate CPR and call med control.

Describe the emergency care of a pediatric patient who is dehydrated, including how to gauge the severity of dehydration based on key signs and symptoms. (pp 1326-1327)

An infant with mild dehydration - may have dry lips and gums, decreased saliva, and fewer wet diapers throughout the day. Skin may be loose and have no elasticity, may have sunken in eyes. Children who are moderately to severely dehydrated may have mottled, cool, clammy skin and delayed capillary response time. Respirations usually increased. Blood pressure may remain normal. Care - assess ABCs, obtain vitals, ALS backup if severe

Describe asthma; its possible causes, signs and symptoms; and steps in the management of a pediatric patient who is experiencing an asthma attack. (pp 1310-1311)

Asthma is an acute spasm of the smaller air passages, called bronchioles, associated with excessive mucus production and with swelling of the mucous lining of the respiratory passages. Will wheeze, possible cyanosis. May be frightened and frantically trying to breathe.

Explain the special patient care considerations required when providing emergency medical care to patients with intellectual disabilities, including patients with autism spectrum disorder (ASD), Down syndrome, or prior brain injuries. (pp 1393-1396)

Autism - Patients with autism have abnormal sensory responses. May not feel cold or pain. May laugh or remove clothing. When possible examine the patient beginning at the feet and moving upward, while explaining each step. Keep transport to a minimum, limit use of emergency lights and sirens. Down syndrome - Often have large tongues and small oral and nasal cavities. Airway management may be difficult. May have dental problems, can lead to speech abnormalities. At increased risk of complications. Brain injuries - Gather a complete medical history from patient, family, and friends. Interaction should be tailored to specific abilities. Talk in a calm soothing tone.

Describe the various types of hearing aids worn by patients; include strategies to troubleshoot a hearing aid that is not working. (pp 1398-1400)

Behind the ear - the working parts are contained in a plastic case that rests behind the ear. Conventional body - the older style is generally used by people with profound hearing loss In the canal and completely in the canal - these hearing aids are contained in a tiny case that fits partly or completely into the ear canal In the ear - all parts are contained in a shell that fits in the outer part of the ear.

List the different oxygen delivery devices that are available for providing oxygen to a pediatric patient, including the indications for the use of each and precautions EMTs must take to ensure the patient's safety. (pp 1316-1320)

Blow by technique at 6 L/min provides more than 21% oxygen concentration. Nasal cannula at 1 to 6 L/min provides 24% to 44% oxygen concentration Nonrebreather mask at 10 to 15 L/min provides up to 95% oxygen Bag-mask device at 15 L/min provides nearly 100% oxygen concentration.

Recognize complicated delivery emergencies including breech presentations, limb presentations, umbilical cord prolapse, spina bifida, multiple gestation, premature newborns, postterm pregnancy, fetal demise, and delivery without sterile supplies. (pp 1270-1274)

Breech presentation - a delivery in which the buttocks come out first. Limb presentation - a delivery in which the presenting part is a single arm or leg. Prolapse of the umbilical cord - a situation in which the umbilical cord comes out of the vagina before the fetus Spina bifida - a developmental defect in which a portion of the spinal cord or meninges may protrude outside of the body, usually at the lower third of the spine in the lumbar area. Multiple gestation - woman is carrying multiple fetuses Premature newborn - smaller and thinner than a full-term newborn, and head is proportionately larger in comparison to the rest of the body. Can be as small as 1 pound. Post Term pregnancy - gestation period is longer than 41 completed weeks of gestation.

List the possible causes of an upper and a lower airway obstruction in a pediatric patient and the steps in the management of foreign body airway obstruction. (pp 1308-1310)

Can obstruct airway with any object that can fit into the mouth Can also be caused by infections, pneumonia, croup, tracheitis. Signs of upper airway obstruction - hoarse voice, decreased or absent breath sounds, stridor Signs of lower airway obstruction - wheezing.

.Describe the capabilities, protocols, and methods for accessing air ambulances. (p 1453-1457)

Capable of bringing a higher level of care or specialized supplies. Call if a patient requires urgent initiation of specialized treatment that is not locally available. Requires advanced care that you are unable to provide. Patients suspected of having a stroke, heart attack, or serious traumatic injury.

Explain the special patient care considerations required when providing emergency medical care to patients who have cerebral palsy, spina bifida, or paralysis. (pp 1400-1402)

Cerebral Palsy - a group of disorders characterized by poorly controlled body movement. Closely observe the airway status of a patient with cerebral palsy because it may have increased secretion production and difficulty swallowing. Do not assume they have an intellectual disability. May have unsteady gaits and are prone to falls. Spina Bifida - development defect in which a portion of the spinal cord or meninges may protrude outside of the vertebrae and possibly even outside the body, usually at the lower third of the spine in the lumbar area. May have partial or full paralysis of the lower extremities, loss of bowel and bladder control, an extreme allergy to latex products. Ask patients how to move them best before transport. Paralysis - the inability to voluntarily move or one more body part. Diaphragms of some patients may not function correctly, requiring a ventilator. May have difficulty swallowing, creating a need for suction. Always use gentle touch because they cannot tell you when you are injuring them.

Explain some of the challenges inherent in providing emergency care to pediatric patients and why effective communication with both the patient and his or her family members is critical to a successful outcome. (p 1284)

Child may not be able to tell you what is wrong. Fear of EMS providers and pain can make a child difficult to assess. Child's parents or primary caregivers may be stressed, frightened, or behaving irrationally.

Give examples of patients with special challenges EMTs may encounter during a medical emergency. (p 1392)

Children who were born prematurely and who have associated respiratory problems. Infants or small children with heart diseases. Patients with neurological diseases. Patients with sensory deficits, such as hearing or visual impairments. Geriatric patients with chronic diseases

Discuss the physical and cognitive developmental stages of a school-age child, including health risks, signs that may indicate illness, and patient assessment. (pp 1288-1289)

Children with chronic illness or disabilities can become self-conscious because of concerns about fitting in. Present choices to the child so they feel like they have control. Rewarding the child after a procedure will help them in the future

Define the terms cleaning, disinfection, high-level disinfection, and sterilization. (p 1442)

Cleaning - process of removing dirt, dust, blood, or other visable contaminants from a surface or equipment Disinfection- the killing of pathogenic agents by directly applying a chemical made for that purpose to a surface or equipment High-level disinfection - the killing of pathogenic agents by using potent means of disinfection and use of thorough application processes Sterilization - a process, such as the use of heat, which removes all microbial contamination

Describe the emergency care of a pediatric patient who has experienced a seizure, including the different types of seizures, common causes, signs, and symptoms. (pp 1322-1323, 1328)

Common causes - child abuse, fever, infection, ingestion, lock of oxygen, medications, posioning, head trauma, seizure disorder Position the head to open the airway, and clear the airway with suction.

Describe the emergency care of a pediatric patient who is experiencing a fever emergency, including common causes. (pp 1327-1329)

Common causes - infection, pneumonia, meningitis, cancer, drug ingestion, arthritis May only require minimal interventions in the field. Provide rapid transport and manage patient ABCs.

Describe the emergency care of a pediatric patient who is in shock (hypoperfusion), including common causes, signs, and symptoms. (pp 1320-1321)

Common causes - traumatic injury with blood loss, dehydration, severe infection, diseases of the heart, collapsed lung, blood or fluid around heart. Signs of shock - tachycardia, poor capillary refill time, mental status changes Call for ALS, provide oxygen, blanket, rapid transport, supine

Describe the common complaints and the leading causes of death in older people. (p 1352)

Common conditions - hypertension, arthritis, heart disease, cancer, diabetes mellitus, asthma, stroke Leading causes of death - heart disease, cancer, injury, chronic lower respiratory disease, stroke, alzheimer disease, injury, diabetes mellitus, influenza.

Describe the special precautions the EMT should follow to protect the patient during a vehicle extrication. (pp 1470-1472)

Do not attempt to gain access to the patient or enter the vehicle until you are sure that the vehicle is stable and any hazards have been identified. Safest, most efficient way to reach the patient depends on the situation. Darkness, uneven terrain, tall grass, shrubbery, and wreckage may make patients hard to find. Support operations - lighting the scene, establishing tool and equipment staging areas, making helicopter landing zones. Cover the patient with a heavy, fire resistant blanket or place a backboard between the windshield and the patient to protect the patient from breaking glass, flying particles, always reassure the patient and explain everything you are doing.

.Explain the steps to take in neonatal assessment and resuscitation. (pp 1265-1270)

During the first minute, perform the initial four steps of newborn care - Airway positioning and suctioning, if needed Drying Warming Tactile stimulation Assess and support - ABCs and temperature Basic life support interventions - dry and warm, open airway, use bag mask if needed, provide tactile stimulation, perform chest compressions if no pulse.

Define the terms extrication and entrapment. (p 1465)

Extrication - removal of a patient from entrapment or a dangerous situation or position, such as removal from a wrecked hospital, industrial incident, or collapsed building. Entrapment - To be caught (trapped) within a vehicle, room, or container with no way out or to have a limb or other body part trapped.

Explain the steps involved in normal delivery management. (pp 1256-1265)

Gently spread the pregnant woman's legs apart Once labor has begun it cannot be slowed or stopped Do not attempt to hold the patients legs, assure that the sensation of needing to move her bowels is normal Use standard precautions at all times, administer oxygen to the patient if indicated. Limit distractions for yourself and the patient. Appear calm and reassuring while protecting the woman's privacy.

Define the term geriatrics. (p 1350)

Geriatrics - the assessment and treatment of disease in someone who is 65 years or older.

Describe the various types of hearing impairments and the special patient care considerations required when providing emergency medical care for hard-of-hearing patients, including tips on effective communication. (pp 1397-1398)

May have difficulty with pitch, volume, and speaking distinctly. Two most common forms are sensorineural deafness (nerve damage) or conductive hearing loss (faulty transmission of sound waves) Face the patient while you communicate so that he or she can see your mouth, don't exaggerate lip movement or look away. Try lowering the pitch of your voice. Ask the patient how they would like to communicate.

Recognize complications of pregnancy including abuse, substance abuse, hypertensive disorders, bleeding, spontaneous abortion (miscarriage), and gestational diabetes. (pp 1247-1251)

Gestational diabetes - diabetes that develops during pregnancy in women who did not have diabetes before pregnancy. Gestational hypertension - a blood pressure greater than or equal to 140 mm Hg systolic or 90 mmHg diastolic in a pregnant female in whom hypertension has not previously been diagnosed. Preeclampsia - a pregnancy complication that is characterized by new-onset hypertension (Systolic blood pressure greater than 140 mm Hg or diastolic blood pressure greater than 90 mm Hg) along with systemic effects, such as blurred vision, headache, or protein in the urine. Differentiated from eclampsia by the lack of seizure activity. Spontaneous abortion - the loss of a pregnancy prior to 20 weeks of gestation without any preceding surgical or medical intervention. Often called a miscarriage. Abuse during pregnancy increases the chance of spontaneous abortion, premature delivery, and low birth weight Fetal alcohol syndrome - a condition caused by the consumption of alcohol by a pregnant woman; characterized by growth and physical problems, mental retardation, and a variety of congenital abnormalities in her child.

Describe the different types of visual impairments and the special patient care considerations required when providing emergency medical care for visually impaired patients, depending on the level of their disability. (pp 1396-1397)

Look for -eyeglasses, a cane, or animal services. Tell the patient what is happening, describe situations and identify noises. Lead patient by light touch on arm or elbow, communicate any obstacles.

Discuss the importance of performing regular vehicle inspections; include the specific parts of an ambulance that should be inspected daily. (p 1435)

May be required to operate during bad weather or during emergency situations, must ensure it is in proper working condition at all times. Minimize the risk that your ambulance experiences a preventable mechanical failure. Should include, fuel level, oil level, transmission fluid level, batteries, brake fluid, horn, siren, ect.

Recognize acts of commission or omission by a caregiver that result in harm, potential harm, or threat of harm to a geriatric patient. (p 1381)

May consider older people to be management problems or categorize them as obstinate and undesirable patients.

Describe the emergency care of a pediatric patient who is experiencing a gastrointestinal emergency, including common causes, signs, and symptoms. (pp 1324-1325)

May not be able to pinpoint the exact site where the pain or discomfort originates. Patients must be monitored for signs and symptoms of shock, which include altered mental status, pale, skin cool, tachypnea, tachycardia, bradycardia. In most cases, you will be faced with a pediatric patient who is experiencing abdominal discomfort with nausea, vomiting, and or diarrhea.

Describe delivery of the placenta. (pp 1264-1265)

May take as long as 30 minutes. Do not pull on the end of the umbilical cord in an attempt to speed delivery of the placenta. Let the patient deliver it like normal.

Explain how to determine the correct size of an airway adjunct intended for a pediatric patient during an emergency. (p 1313)

Measure from the tip of the ear to tip of the mouth

7.Explain the significance of meconium in the amniotic fluid. (p 1254)

Meconium - fetal stool. When appearing as a dark green material in the amniotic fluid, it can indicate distress or disease in the newborn; it can be aspirated into the fetus's lungs during delivery.

Discuss the various factors related to ensuring situational safety at the site of a vehicle extrication, including controlling traffic flow, performing a 360-degree assessment, stabilizing the vehicle, dealing with unique hazards, and evaluating the need for additional resources. (pp 1466-1470)

Need pre incident training with rescue personnel for the various types of rescue situations to which you might respond. Review dispatch info enroute to call, assign specific initial duties and scene management tasks. Position ambulances to block traffic and create safety barriers. Hazardous material may be present - Any substance that is toxic, poisonous, radioactive, flammable, or explosive and causes injury or death with exposure. Size up - the ongoing process of information gathering and scene evaluation to determine appropriate strategies and tactics to manage an emergency. Look for the following: Mechanism of injury, downed power lines, leaking fuels or fluids, smoke or fire, broken glass, trapped or ejected patients, number of patients involved Evaluate need for: extrication equipment, fire department, law enforcement, hazmat unit, utility company, ALS units, air transport

Explain the steps in the primary assessment of a pediatric patient, including the elements of the pediatric assessment triangle (PAT), hands-on XABCs, transport decision considerations, and privacy issues. (pp 1293-1303)

Pediatric assessment triangle - a structured assessment tool used to rapidly form a general impression of the infant or child without touching him or her; consists of assessing appearance, work of breathing, and circulation to the skin. TICLS - characteristics of appearance Tone, Interactiveness, Consolability, Look or gaze, speech or cry Hands on XABCs X - exsanguination A - airway B - breathing C - circulation D - disability E - exposure

Describe the emergency care of a pediatric patient in respiratory distress, including the different causes of pediatric respiratory emergencies, the signs and symptoms of increased work of breathing, and the difference between respiratory distress and respiratory failure. (pp 1294-1297, 1308-1320)

Pediatric patients in respiratory distress still have compensatory mechanisms and the ability to exchange oxygen and carbon dioxide. In early stages a child may experience anxiety, restlessness, or combativeness. Signs and symptoms of increased work of breathing - nasal flaring, abdominal breath sounds, accessory muscle use, tripod position. Respiratory distress- child is working harder to breathe and will eventually go into respiratory failure Respiratory failure - patient has exhausted all compensatory mechanisms and waste products begin to collect.

Explain the steps in the secondary assessment of a pediatric patient, including what EMTs should look for related to different body areas and the method of injury. (pp 1304-1306)

Perform a secondary assessment when pediatric patients have the potential for hidden illnesses or injuries - such as if the patient is unresponsive or a trauma patient with significant MOI. Use DCAP BTLS

Discuss brief resolved unexplained event (BRUE), sudden unexpected infant death, and sudden infant death syndrome (SIDS), including its risk factors, patient assessment, and special management considerations related to the death of an infant patient. (pp 1339-1342)

SIDS - sudden infant death syndrome, death of an infant or young child that remains unexplained after a complete autopsy. BRUE - brief resolved unexplained event

Identify key steps EMTs should take to improve safety while en route to the scene, the hospital, and the station. (pp 1443-1453)

Select the shortest and least congested route to the scene. Avoid heavy traffic. Avoid one way streets. Watch for bystanders. Park an ambulance in a safe place. Drive within the speed limit. Drive defensively. Use a siren if you turn on emergency lights. Assume drivers will not hear sirens or see lights.

Describe examples of vehicle safety components that may be hazardous to both EMTs and patients following a collision and how to mitigate their dangers. (pp 1464-1465)

Shock-absorbing bumpers provide vehicle protection from low-speed impact Mandated to incorporate supplemental restraint systems, or airbags. Crash scenes may present many hazards - fuel spills, explosion risks, downed power lines, broken glass, and torn metal. Wear appropriate PPE such as eye protection to reduce risk of eye or lung irritation from airbag deployment.

Discuss the physical and cognitive developmental stages of an adolescent, including health risks, signs that may indicate illness, and privacy issues. (pp 1289-1290)

Simple injuries may be exaggerated due to anxiety about body image fear. Provide them with any information if they request it.

Discuss some positive ways EMTs may cope with the death of a pediatric patient and why managing posttraumatic stress is important for all health care professionals. (pp 1341-1342)

Some EMS systems arrange for home visits after death of chilf so EMS providers and family can come to some sort of closure together. Take some time before going back on the job, be alert for signs of posttraumatic stress.

Discuss special considerations involving pregnancy in different cultures and with teenage patients. (pp 1252-1253)

Some cultures may not permit a male health care provider, especially in prehospital settings to assess or examine a female. Some may see pregnancy as a means of achieving status and recognition within the family unit, others may experience a drop in self-esteem. Remember that a competent, rational adult has the right to refuse care. Pregnant teenagers may not know she is pregnant, or may be in denial.

List the minimum dispatch information required by EMS to respond to an emergency call. (p 1436)

The nature of the call, the name, current location, and call back number, location of the patient, number of patients and some idea of the severity of their conditions, and special problems

Discuss the physical and cognitive developmental stages of a preschool-age child, including health risks, signs that may indicate illness, and patient assessment. (pp 1287-1288)

The risk of foreign body airway obstruction continues to be high Can understand directions and are more specific when answering questions. Tell the child what you are going to do immediately before doing it, so they do not have time to develop any fear.

Discuss the common causes of pediatric trauma emergencies; include how to differentiate between injury patterns in adults, infants, and children. (pp 1329-1335)

The younger the child, the more flexible the bone structure. A fracture of the femur is rare in children. Childs heads are proportionately larger than that of an adult, it exerts greater stress on the neck structures during a deceleration injury. Children are more often injured because of their underdeveloped judgment and their lack of experience. Children are often injured in sports activities

Discuss the physical and cognitive developmental stages of a toddler, including health risks, signs that may indicate illness, and patient assessment. (pp 1286-1287)

Toddlers - use any comforting objects when available to help calm the toddler. Demonstrate the assessment on a stuffed animal or toy if possible before the child. Have trouble localizing or describing pain, allow them to play with tongue depressor or something because it might distract them. Begin assessment at the feet, or far away from the pain area.

Explain the special patient care considerations required when providing emergency medical care to patients who rely on a form of medical technological assistance, including the following: (pp 1403-1410)

Tracheostomy tube - a plastic tube within the tracheostomy site (stoma) Mechanical ventilator - can't breathe without assistance Apnea monitor - used when there is a history of sudden infant death syndrome or when an infant is premature. Internal cardiac pacemaker - implanted under the skin to regulate heart rate Left ventricular assist device (LVAD) - takes over the function of the left ventricle External defibrillator vest - vest with built-in monitoring electrodes and defib pads, worn by patients under their clothing, when it recognizes a dangerous rhythm it will deliver a shock. Central venous catheter - catheter that has its tip placed in the vena cava to provide venous access. Gastrostomy tube - placed into the stomach of patients who cannot adequately ingest fluids, food, or medication by mouth. Ventricular peritoneal shunt - drains excess fluid from the ventricles of the brain into the peritoneum of the abdomen. Vagus nerve stimulator - form of treatment used for seizures that are not controlled with antiepileptic medications or if the patient is not a good candidate for brain surgery. Colostomy bag, ileostomy bag, or urostomy bag - creates an opening from the small or large intestine to the surface of the body and allows for elimination of waste products.

Discuss the need to consider two patients—the woman and the unborn fetus—when treating a pregnant trauma patient. (pp 1251-1252)

Trauma to a pregnant woman may have a direct effect on the condition of the fetus. Fetal distress may be present well before signs and shock are evident in the pregnant woman When a woman sustains serious trauma, the blood supply to the fetus is actively reduced as a physiologic reflex so that the woman receives an adequate amount of blood.

Explain the assessment and care of a geriatric patient who has potentially been abused or neglected. (pp 1382-1383)

Try to obtain an explanation of what happened, suspect abuse when answers about what happened are inconsistent with medical findings. Also suspect abuse when given unbelievable answers. Be thorough, objective, and factual, avoiding unsupported opinions and personal judgment.

Explain the additional risks and special considerations posed by the use of police escorts, and the hazards and special considerations posed by crossing intersections. (pp 1451-1452)

Using a police escort is extremely dangerous practice. When other motorists hear a siren and see a police vehicle passing, they might assume it is the only emergency vehicle and not see the ambulance. Always be alert and careful when approaching an intersection. Change the siren tone before you reach the intersection. Scan intersection and mirrors before proceeding through.