EMT Test (everything)

scope of practice

pertains to what a provider is allowed to do at various levels

outlines what care you are able to provide, usually defined by state law

medical director further defines by developing protocols and standing orders

public health law (NY state law)

allows EMTs to practice (article 30)

provides for certification of all advanced life support, first response services, and ambulance services

CQI

continuous quality improvement

goal is to minimize errors

responsibility of medical director

off-line medical direction

indirect, standing orders, protocols, don't need anyone to tell you that you can do something

on-line medical direction

direct

physician orders given over phone or radio

routes of transmission

direct contact

indirect contact

airborne

vector-borne

foodborne

sympathetic nervous system

fight or flight (alarm reaction)

tachycardia, tachypnea, hypertension, cool, clammy skin, dilated pupils, digestion slows, bladder & bowel prepare to evacuate

stages of resistance

resistance to an agent that provoked the initial response or to similar agents, get used to it, learn to cope

leads to either stage of recovery or stage of exhaustion

stages of grief

1. denial

2. anger

3. bargaining

4. depression

5. acceptance

consent

permission to render care

a pt must give consent for treatment

expressed consent

pt directly indicates consent

must be of legal age and rational

informed consent

pt must be aware of illness or injury

recommended tx and associated risks, must give alternative treatments, must express danger of refusing care

implied consent

pt is incapable of making informed decisions or minors without surrounding family

assume patient would consent if conscious (ex. AMS, unconscious)

consent for children and incompetent adults

consent required from guardian, implied in emergency in absence of guardian

involuntary consent

applies to pts who are mentally ill, in behavioral crisis, developmentally delayed

HIPAA

health insurance portability and accountability act (1996)

advanced directives

specify treatment if pt is unconscious or unable to make decisions

DNR/DNI

do not resuscitate or intubate

health care proxy

someone in charge of a person's medical decisions if they became incapacitated

standards of care

manner in which you must act or behave, established by statutes, professional standards, and textbooks

abandonment

unilateral termination of care by EMT without patient's consent and making provisions for continuing care

negligence

failure to provide same care that person with similar training would provide in same or similar situation, deviation from accepted standard of care, resulting in injury to patient

four elements of negligence

breach of duty: EMT doesn't act within an expected standard of care

causation: must have a reasonable cause-and-effect relationship

damages: physically/psychologically hurt

duty: obligation to provide care

assault

unlawfully placing person in fear of immediate bodily harm (ex. restraint)

battery

unlawfully touching a person (ex. providing care without consent)

kidnapping

seizing, confining, abducting, or carrying away by force (ex. transport against will)

defamation

communication of false information that damages reputation of person

libel

defamation if written

slander

defamation if spoken

gross negligence

conduct that constitutes willful or reckless disregard

why are records and reports important?

important safeguard against legal complications, action not recorded = not performed, incomplete or untidy reports = poor medical care

refusal of care

conscious, alert adults with decision-making capacity, have right to refuse/withdraw from treatment at any time, witness is valuable in these situations, encourages allowance of care

obvious signs of death

dependent lividity (blood settling), rigor mortis (stiffening), obvious mortal wound, putrefaction (decomposition)

medical examiner cases

notified in cases of DOA/DOS, death without previous medical care, suicide, violent death, suspicious criminal

crime scene cases

every DOA is a crime scene, do not enter until safe, remain alert for evidence/violence

documentation

patient's permanent medical record, demonstrates appropriate care was delivered

therapeutic communication

uses verbal/nonverbal communication, encourages patient to express how they feel, achieves a positive relationship with each patient

nonverbal communication

body language provides more information than words alone, be aware of your body language

verbal communication

use close-ended questions if patients cannot provide long answers

golden rules

keep eye contact, tell the truth, use language the patient can understand

patient care report

aka prehospital care report, legal document, written, or electronic

scope of practice

pertains to what a provider is allowed to do at various levels

outlines what care you are able to provide, usually defined by state law

medical director further defines by developing protocols and standing orders

public health law (NY state law)

allows EMTs to practice (article 30)

provides for certification of all advanced life support, first response services, and ambulance services

CQI

continuous quality improvement

goal is to minimize errors

responsibility of medical director

off-line medical direction

indirect, standing orders, protocols, don't need anyone to tell you that you can do something

on-line medical direction

direct

physician orders given over phone or radio

routes of transmission

direct contact

indirect contact

airborne

vector-borne

foodborne

sympathetic nervous system

fight or flight (alarm reaction)

tachycardia, tachypnea, hypertension, cool, clammy skin, dilated pupils, digestion slows, bladder & bowel prepare to evacuate

stages of resistance

resistance to an agent that provoked the initial response or to similar agents, get used to it, learn to cope

leads to either stage of recovery or stage of exhaustion

stages of grief

1. denial

2. anger

3. bargaining

4. depression

5. acceptance

consent

permission to render care

a pt must give consent for treatment

expressed consent

pt directly indicates consent

must be of legal age and rational

informed consent

pt must be aware of illness or injury

recommended tx and associated risks, must give alternative treatments, must express danger of refusing care

implied consent

pt is incapable of making informed decisions or minors without surrounding family

assume patient would consent if conscious (ex. AMS, unconscious)

consent for children and incompetent adults

consent required from guardian, implied in emergency in absence of guardian

involuntary consent

applies to pts who are mentally ill, in behavioral crisis, developmentally delayed

HIPAA

health insurance portability and accountability act (1996)

advanced directives

specify treatment if pt is unconscious or unable to make decisions

DNR/DNI

do not resuscitate or intubate

health care proxy

someone in charge of a person's medical decisions if they became incapacitated

standards of care

manner in which you must act or behave, established by statutes, professional standards, and textbooks

abandonment

unilateral termination of care by EMT without patient's consent and making provisions for continuing care

negligence

failure to provide same care that person with similar training would provide in same or similar situation, deviation from accepted standard of care, resulting in injury to patient

four elements of negligence

breach of duty: EMT doesn't act within an expected standard of care

causation: must have a reasonable cause-and-effect relationship

damages: physically/psychologically hurt

duty: obligation to provide care

assault

unlawfully placing person in fear of immediate bodily harm (ex. restraint)

battery

unlawfully touching a person (ex. providing care without consent)

kidnapping

seizing, confining, abducting, or carrying away by force (ex. transport against will)

defamation

communication of false information that damages reputation of person

libel

defamation if written

slander

defamation if spoken

gross negligence

conduct that constitutes willful or reckless disregard

why are records and reports important?

important safeguard against legal complications, action not recorded = not performed, incomplete or untidy reports = poor medical care

refusal of care

conscious, alert adults with decision-making capacity, have right to refuse/withdraw from treatment at any time, witness is valuable in these situations, encourages allowance of care

obvious signs of death

dependent lividity (blood settling), rigor mortis (stiffening), obvious mortal wound, putrefaction (decomposition)

medical examiner cases

notified in cases of DOA/DOS, death without previous medical care, suicide, violent death, suspicious criminal

crime scene cases

every DOA is a crime scene, do not enter until safe, remain alert for evidence/violence

documentation

patient's permanent medical record, demonstrates appropriate care was delivered

therapeutic communication

uses verbal/nonverbal communication, encourages patient to express how they feel, achieves a positive relationship with each patient

nonverbal communication

body language provides more information than words alone, be aware of your body language

verbal communication

use close-ended questions if patients cannot provide long answers

golden rules

keep eye contact, tell the truth, use language the patient can understand

patient care report

aka prehospital care report, legal document, written, or electronic

geriatrics

assessment and treatment of disease in person 65 years or older

nervous system changes in geriatric pts

brain shrinks, number of neurons decrease, all senses decline, reaction time slows

dementia

slow onset of progressive disorientation, shortened attention span, and loss of cognitive function

chronic, generally irreversible condition that causes progressive loss of cognitive abilities, psychomotor skills, and social skills

Alzheimers disease

irreversible progressive brain disorder, characteristic brain anomalies

delirium

sudden change in mental state, consciousness, or cognitive processes, reversible physical ailment

affects 15% to 50% of hospitalized people aged 70 or older

hearing in geriatric pts

difficulty hearing high-frequency sounds

vision in geriatric pts

decreased visual ability, depth perception, & ability to accommodate to light, decreased tear production, decreased night vision, inability to see up close

presbyopia

difficulty to see up close

cataracts

clouding of normally clear lens of eye

blurry vision

glaucoma

group conditions damage optic nerve, caused by increased pressure (S/S: patchy/tunnel vision, halo around lights)

macular degeneration

deterioration central portion retina, macula - focus central vision of eye, degeneration central vision

retinal detachment

sudden loss vision, continuous flashes of light

taste in geriatric pts

decreased number of taste buds, less interest in eating

gi system in geriatric pts

reduced saliva, decreased sense taste, dentures, reduced gastric secretions, decreased blood flow to liver

s/s of changes to gi system

hematemesis, melena, dyspepsia, hepatomegaly, constipation, diarrhea

melena

dark/tarry stool

dyspepsia

indigestion

depatomegaly

enlarged liver