National Registry Notes - EMT

Four Levels of EMS

1. EMR: Emergency Medical Responder

2. EMT: Emergency Medical Technician

3. AEMT: Advanced Emergency Medical Technician

4. Paramedic

BSI

Body Substance Isolation

Levels of Trauma Centers

1. Level 1 = everyone that is needed is on the scene

2. Level 2 = specific things are not they but they are on call

3. Level 3 = specific resources have to be there within 6 hours

Who to transfer care to

Of equal or higher authority

Patient Advocacy

• Important to be down the aisle in every situation

• Treat everyone with empathy

• No prejudice

Physical traits of an EMT

• Able to carry up to 125lbs

• Good eyesight

• Good communication skills

Personal traits of an EMT

• Self-starter

• Emotionally stable

• Good moral character and in control of habits

Quality Improvement

Continuous self-review with the purpose of identifying aspects of the system that require improvement

Medical director

All patients are under the direction of this entity, who has ultimate responsibility

Occupational Safety and Health Administration (OSHA)

Issued strict guidelines about precautions against exposure to blood borne pathogens

Best way to prevent disease spread from standard patient contact

Hand-washing

Best way to prevent blood/fluid splatter or air-borne disease (aerosolized droplets)

N-95 or HEPA respirator

Ryan White Care Act

Allows EMS providers to find out if they have been exposed to potentially life-threatening diseases while providing patient care

Stages of Stress

1. Alarm reaction

   • Fight-or-flight

2. Resistance

   • coping

3. Exhaustion

   • loss of ability to resist or adapt to the stressor

Delayed Stress Reaction

Airway physiology

Upper Airway

• Nasopharynx = upper portion, nose area

• Oropharynx = middle portion, mouth area

• Laryngopharynx = lower portion, boundary between upper and lower

Lower Airway

• Larynx →

• Trachea →

• Carina →

• Bronchi →

• Bronchioles →

• Alveoli →

• Pulmonary capillaries

Pediatric Airway Physiology

Airway structures of infants are shorter, narrower, and less rigid

• Mouth and nose are smaller

• Tongue is proportionately larger

• Newborns and infants are nose breathers

• Trachea is softer, more flexible, and narrower and easily obstructed by swelling and foreign objects

• Chest wall is softer

• Breathing is more dependent on the diaphragm

Audible Lung Sounds

• Stridor = high pitched whistling sound; upper airway obstruction

• Hoarseness = raspy change in voice; swelling around vocal cords

• Snoring = similar to snore during sleep; diminished muscle tone/ soft tissue obstruction

• Gurgling = bubbling sound; vomit, blood, or secretions in the airway

• Wheezing = heard during exhalation, high-pitched whistling sound; lower airway obstruction

• Rhonchi = lower-pitched, snoring or rattling; secretions in the airways; Pneumonia, bronchitis, aspiration

Ventilation

Process of moving air into and out of the chest

Tidal volume

Amount of air moved in and out in one breath

Minute volume

The amount of air moved into and out of the lunger per minute

Diffusion

Movement of gases from an area of high concentration to low concentration

Pulmonary respiration

Diffusion of oxygen and carbon dioxide between alveoli and blood

Cellular respiration

Diffusion of oxygen and carbon dioxide between the cells and blood

Chemoreceptors

Stimulate the respiratory system to breathe more rapidly

• Detect the amount of carbon dioxide

• Respiratory rate and heart rate increase and blood vessels constrict

Negative effects of PPV

Positive Pressure Ventilation

• Cardiac output and blood pressure drop

• Gastric distension

Tripod position

Patient is hunched over; takes gravity off of their lungs

Prevents alveoli from collapsing

Blowing oxygen or air continuously at low pressure into airway

COPD

Chronic Obstructive Pulmonary Disease

• Broad classification of chronic lung disease

• Includes emphysema, chronic bronchitis, and many undetermined respiratory illnesses

Pulmonary edema

Fluid in the lungs; in some severe cases, there can be pink, frothy sputum that indicates their lungs are full of mucus

Pneumonia

Infection of one or both lungs caused by viruses, or fungi; temperature over 100

Spontaneous pneumothorax

Lung collapses without injury or other obvious cause

• Jugular vein distension

• Easily tired

• Tracheal deviation

• Tachycardia

Pulmonary embolism

Blockage in blood supply in the lungs

• Sharp, stabbing, chest pain

• Caused by Deep Vein Thrombosis (DVT)

Epiglottitis

Inflammation of the epiglottis

• Can be life threatening for children

• Throat is so sore to the point they can’t swallow their own spit so they continuously drool

• Tripod position, fever

• Hold NRB by the face and give blow-by oxygen

Croup

Caused by a group of viral illnesses that result in inflammation of the larynx, trachea, and bronchi

• Sickness of upper airway

• Cough that sounds like a barking seal

Acute Coronary Syndrome

Cardiac compromise; any time the blood supply to the cells of the heart is blocked or disrupted

• Described as pressure, squeezing, or aching pain

Coronary Artery Disease

Caused by fatty deposit buildup on inner walls of arteries

Ectopic pregnancy

If fertilized ovum implants in fallopian tubes

• Mimics appendicitis

• Symptoms present 4-12 weeks after last menstrual period

Changes to the body with pregnancy

Cardiovascular system

• Increased blood volume, cardiac output, and heart rate

Respiratory system

• Increased oxygen demand and consumption

Gastrointestinal system

• Slowed digestion

• Nausea and vomiting

Supine Hypotensive Syndrome

When laying supine, the mother experiences a drop in blood pressure due to compression on the inferior vena cava

• Placenta, infant, amniotic fluid total to 20 → 24 lbs

• Cardiac output decreases

• Dizziness

Three stages of labor

First Stage

• Stars with regular contractions and ends when the cervix is fully dilated

Second Stage

• Baby enters the birth canal and the baby is born

Third Stage

• Begins after the baby is born and ends when the afterbirth is delivered

Braxton-Hicks contractions

Irregular, not sustained, and not indicative of impending delivery

Lightening

Fetus’s movement from high in the abdomen down toward the birth canal

Post-birth pulse

If the baby has a pulse less then 100bpm, perform rescue breaths every 1 → 3 seconds for 2 minutes and then reassess

• If less than 60bpm, perform CPR

Breech position

Any limp but the head is showing

Prolapsed umbilical cord

Cord is presenting before the baby

• Keep baby’s head away from the cord

• Elevate mom’s hips

• Transport mother to hospital while continuing pressure on the baby’s head

Meconium

Fetus’s fecal matter

• stains the amniotic fluid greenish or brownish yellow color

• do not stimulate infant before suctioning

• maintain open airway

• provide ventilations and/or chest compressions

• transport asap

Placenta previa

Placenta blocks the birth canal so the child cannot be born. If the placenta is damaged or torn, severe bleeding may occur.

Abruptio placentae

Placenta tears away from the uterine wall prematurely. Usually caused by trauma. Complete abruption causes massive hemorrhaging and is usually fatal for the fetus.

Placing 12-lead ECG

1. Remove clothing and jewelry from the chest area

   • Clean the skin with a towel to remove swear and dead skin cells

   • Shave any excessive chest hair if necessary

2. Place limb leads

   • Attach electrodes to the arms and legs. RA = right arm (white), LA = left arm (black), RL = right leg (blue), LL = left leg (red)

3. Chest Leads

   • V1 and V2 are placed on the fourth intercostal space on the right and left of the sternum

   • V3 placed in-between V2 and V4

   • V4 is placed in the fifth intercostal space along the anterior axillary line

   • V6 placed directly on the axillary line

4. Connect and acquire

   • Connect the leads to the ECG monitor

   • Press the “Acquire” button to obtain the ECG tracing

Major functions of the skin

• Protection

• Water balance

• Temperature regulation

• Excretion

• Shock (impact) absorption

Closed crush injuries

Force transmitted from exterior to internal structures

What to know about penetrating traumas

• The speed at which the object is moving

• The size of the object

• The exit wound if applicable

  • Entrance wounds typically smaller than exit wounds

Critical Burns

Any burns to:

• the airway

• the pubic region

• the hands

• the face

• a hinge joint

If patient is less than 10% burned, apply moist sterile dressing

If patient is more than 10% burned, apply dry sterile dressing

Dressing

Any material applied to a wound to control bleeding and prevent contamination

Bandaging

Any material used to hold dressing in place

Different types of ambulances

• Type I Ambulance = Built on truck-like chassis with a modular box

  • houses medical equipment and seating for emergency personnel

  • suitable for ALS

• Type II Ambulance = A modified van for BLS

  • More compact and maneuverable

• Type III Ambulance = Similar to Type I but with a cut-away van chassis

  • Features an integral cab and body

• Medium-Duty Ambulance = Build on a larger truck chassis

  • Accommodates additional equipment for specialty rescue operations

• Specialty response vehicles = Designed for specific tasks

Code 3

Light and sirens; you can only drive 10mph over the speed limit. Used for life-threatening emergency situations where immediate attention is required.

Code 2

Following standard driving laws; this is a non-emergency response. For situations that are not life-threatening but still require medical transport.

When on the highway or road

Make sure lights and sirens are on. Drop 3 cones or flares behind the ambulance at 10ft apart. Wear ANSI approved safety vest and helmet.

ICS

Incident Command System. A crucial component of the National Incident Management System (NIMS) used in the US to manage emergencies. It provides a structured framework for handling incidents, especially large-scale ones like multiple-casualty incidents (MCIs) or hazardous material situations.

NIMS

National Incident Command System. A comprehensive framework used by federal, state, and local governments in the US to manage emergencies. It is mandated by the Federal Emergency Management Agency (FEMA) and is designed to ensure a coordinated response to incidents of all sizes and complexities.

CFLOP

Acronym used within ICS to represent the 5 key functional areas that are essential for managing incidents effectively.

• Command: central function that oversees the entire incident management process. The person in command is responsible for overall incident management and may delegate specific tasks to others as needed.

• Operations: This function is responsible for carrying out the tactical activities necessary to achieve the incident objectives. It is often the most visible part of the incident management process.

• Logistics: This area focuses on providing the necessary support, resources, and services to meet the operational needs of the incident.

• Planning: This function involves collecting, evaluating, and disseminating information about the incident. It helps in developing he incident action plan and tracking the status of resources.

• Finance/Administration: This area handles the financial, administrative, and cost analysis aspects of the incident.

START

Simple Triage And Rapid Treatment

Triage Categories

• Priority-1 (RED): Patients with life-threatening conditions that are treatable. These individuals require immediate medical intervention to survive.

• Priority-2 (YELLOW): Patients with serious but not immediately life-threatening conditions. They need medical care but can wait a short time.

• Priority-3 (GREEN): Known as the “walking wounded,” these patients have minor injuries and can wait for treatment.

• Priority-4 or 0 (BLACK): Patients who are deceased or expected to die due to the severity of their injuries.

Triage Unit Leader

Second on Scene.

Oversees the triage process. Key responsibilities include assessment and prioritization, coordination, and on-scene management.

• Assessment and Prioritization: Assess all patient and assigns them a priority for receiving emergency care or transportation.

• Coordination: Call for additional help if needed and assign available personnel and equipment to patients. This involves coordinating with other supervisors, such as the transportation and treatment supervisors, to ensure efficient use of resources.

• On-Scene Management: The triage unit leader remains at the scene to manage and coordinate personnel, supplies, and vehicles, ensuring that the triage process runs smoothly and effectively.

Treatment Unit Leader

Set up red, yellow, and green treatment centers.

Responsible for managing the treatment area where patients receive medical care after being triaged. Key responsibilities are overseeing treatment, resource management, and coordination with other units.

Occlusive dressing

For sucking chest wounds

Marked Red

Respiratory rate 30 or above

Cap refill greater than 2 seconds

Obvious signs of arterial bleeding

Altered but unresponsive

Freelancing

People are doing whatever and no one is giving orders

Secondary triage

When patients arrive at the green, yellow, or red section, they can always be remarked.

Highway Safety- First Arrival

Should institute “blocking” to protect the work area. If no hazards, 50ft, if hazards (power lines down or fuel spill, 100ft. If power lines are down notify dispatch.

What to wear for highway safety

ANSI approved safety vests and helmet

Flare spacing

3 flares at 10ft intervals

Vehicle extraction

1. Turn ignition off

2. Put E-brake on

3. Cut battery cords

4. Disentangling patient

5. Use 15lb or 20lb ABC dry chemical fire extinguisher

6. Chocks or cribbing underneath car

7. Try before you pry

Definition of hazardous material

Any substance or material in a form which poses an unreasonable risk to health, safety, and property when transported in commerce.

Hot Zone

Area of contamination or danger

Warm zone

Decontamination corridor

Cold zone

Where equipment and emergency rescuers are staged

SDS

Safety Data Sheet

• Provided by manufacturers for hazardous materials. Informs employees about the substances they handle.

• Name and description of chemical

• Information about he chemical’s state, appearance, etc.

• Details on fire, explosion, and health hazards

• First aid measures and emergency response actions

CHEMTREC

Chemical Transportation Emergency Center

• Provides 24-hour assistance

• Offers guidelines on initial actions during a hazardous material accident

For types of hazardous people

• Uninjured and uncontaminated

• Injured and uncontaminated

• Uninjured and contaminated

• Injured and contaminated

Gross decontaminated

Initial decontamination

• Removal or chemical alteration of majority of contaminant

• One way flow of traffic for patients

• Take off all clothes

• Once rinsed, go through secondary

Secondary decontamination

Residual product contamination; more thorough.

3 pools

1. Rinsed for 2-5 minutes, starting from head

2. Jump into next pool

3. Rinsed and brushed

4. Jump into next pool

5. Rinsed and onesie

Definition of terrorism

The unlawful use of force or violence against persons or property to intimidate or coerce a government, the civilian population or any segments thereof, in furtherance of political or social objectives.

TRACEMP harms in hazardous material incidents

• T = Thermal harm: injuries from extreme heat or cold, such as burns or frostbite

• R = Radiological harm: exposure to radioactive materials can cause severe health effects, including radiation sickness

• A = Asphyxiation harm: when hazardous materials displace oxygen, leading to suffocation

• C = Chemical harm: chemicals can cause harm though inhalation, ingestion, or skin contact, leading to poisoning or chemical burns

• E = Etiologic harm: harm from biological agents, such as bacteria or viruses, which can cause infections or diseases

• M = Mechanical harm: physical injuries can result from explosions or flying debris

• P = Psychological harm: the stress and fear or exposure can lead to psychological distress, even if no physical harm occurs

SLUDGEM signs and symptoms of nerve agent poisoning

• S = Salivation: Excessive saliva

• L = Lacrimation: Increased tear production from the lacrimal glands

• U = Urination: Relaxation of the urethra’s internal sphincter muscle, leading to urination

• D = Defecation: Relaxation of the anal sphincter, causing defecation

• G = GI upset: Gastrointestinal disturbances due to changes in smooth muscle tone

• E = Emesis: Vomiting as a result of gastrointestinal effects

• M = Miosis: Constriction of pupils, leading to abnormal smallness

Nerve agents

Inhibit enzyme critical to proper nerve transmission, causing out of control parasympathetic nervous system

Injuries caused by blast patterns

• Lung injury: Bradycardia, apnea, and hypotension from blast wave

• Ear injury: Rupture of tympanic membrane

• Abdominal injury: Rupture of gas-containing section of intestine

• Brain injury: Concussion or mild traumatic brain injury (MTBI) from blast wave

Strategy

Broad general plans designed to achieve desired outcomes. What we want to accomplish.

Tactics

Specific operations actions responders take to accomplish assigned tasks. What we do to accomplish.