Key Terms
Embolism- obstruction of an artery
Edema- fluid buildup; swelling
PMS- pulse, motor, sensory
Ischemia- inadequate blood supply to a part of the body
Hematoma- collection of blood outside of a blood vessel
Aneurysm- localized enlargement of an artery caused by a weakening in the artery wall
Dilation- opening
Dyspnea- labored breathing
Syncope- temporary loss of consciousness, or fainting
Incontinence- lack of voluntary control over urination or defecation
EMS Systems
Most states have four training and licensure levels:
-EMR (Emergency Medical Responders)
-EMT (Emergency Medical Technicians)
-AEMT (Advanced EMT)
-has training in ALS (advanced life support) including:
-IV therapy (Intravenous)
-administration of certain emergency medications
-Paramedic
History of EMS:
-Origins include: volunteer ambulances in WW1, field care in WW2, field medic and
rapid helicopter evacuation in Korean conflict
-EMS as we know it originated in 1966 with the publication of Accidental Death
and Disability: The Neglected Disease of Modern Society
-DOT (Department of Transportation) published first EMT training curriculum in early
1970s
-EMS care is governed and part of the Department of Transportation
-National Highway Traffic Safety Administration (NHTSA)
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EMS Types:
-Anglo-American model (ours)
-brings patient to the hospital
-Franco-German model (Europe)
-brings the hospital to the patient
Levels of training:
-Federal level: National EMS Scope of Practice Model provides guidelines for EMS skills
-State level: Laws regulate EMS provider operations
-Local level: Medical director decides day-to-day limits of EMS personnel
-every 3 years resubmit for recertification (40 hours of continuing educ. required)
Public BLS (basic life support):
-millions of laypeople are trained in BLS/CPR
-teachers, coaches. child care providers
Emergency Medical Responders (EMR):
-law enforcement, firefighters, park rangers, ski patrol, etc.
-initiate immediate care and assist EMT’s on their arrival
-good samaritans trained in first aid and CPR
Emergency Medical Technicians (EMT):
-has knowledge and skills to provide basic emergency care
-responsibility for assessment
-emergency care
-package and transport of patient
Advanced Emergency Medical Technicians (AEMT):
-adds knowledge and skills in specific aspects of ALS
-IV therapy
-advanced airway adjuncts
-medication administration
Paramedics:
-extensive course training
-wide range of ALS skills
-endotracheal intubation
-emergency pharmacology
-cardiac monitoring; use of electrocardiogram (EKG)
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Medical Direction:
-physician medical director authorizes EMTs to provide medical care in field
-appropriate care is described in standing orders and protocols
-medical control can be off-line or online
-Online (direct)
-directions given over phone or radio
-Offline (indirect)
-standing orders or protocols
Evaluation:
-medical director maintains quality control
-continuous quality improvement (CQI)
-reviews and audits EMS system
-refresher training or continuing education
-minimizing errors is the goal
On-Scene Patient Assessment
-BSMNHS (Bald Short Men Never Have Sex)
-BSI
-Scene Safety
-Mechanism of Injury/ Nature of Illness
-Number of patients
-Help (additional resources)
-Spine Immobilization
-GLCAB5C5D (Girls Love Compliments)
-General impression
-Level of Consciousness (AVPU)
-Chief Complaint
-Airways
-Breathing (5)
-(Y/N), (R,R,Q), oxygen intervention, make sure O2 working, mgt. of
injuries
-Circulation (5)
-(Pulse R,R,Q), major bleeding, (skin color, temp., condition), shock
Management (HOTTI)
-Decision to Transport
-Trauma Pt assessment vs. Medical Pt assesment
-Medical Pt then take history
-Then VFIT
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-Vitals
-Field impression
-Intervention/Treatment
-Trauma Pt
-Then take vitals and attempt to get SAMPLE history
-Begin secondary assessment
-DCAP BTLS
-Eyes check for PEARRL
-check extremities for PMS (pulse, motor, sensory)
-Manage secondary injuries
-Reassessment
-Stable: every 15 mins. take vitals
-Unstable: every 5 mins. take vitals
*Key things to remember: PMS before & after immobilization
*When backboarding, slide the patient down and then up
-See Trauma Patients for more details
Airway Management
Key terms
-Apneic: no longer breathing
-Alveoli: tiny air sacs of the lungs which allow for rapid gaseous exchange
-Capillaries: smallest blood vessels
-Pleural Cavity: thin fluid-filled space between the two pulmonary pleurae (visceral and parietal)
of each lung
-Visceral pleura- OUTER layer
-Parietal pleura- INNER layer
-Positive Pressure Ventilation (PPV): process of forcing air into a patient’s lungs (aka artificial
ventilation)
-Patent airway: open airway
Respiratory assessment
-Adequate breathing:
-between 12-20 breaths/min
-regular pattern
-bilateral (both sides) clear and equal lung sounds
-equal chest rise and fall
-adequate depth (tidal volume)
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