FINALS EMS

SAMPLE (woah! remember this from 1st aid class???????)

signs/symptoms

allergies

medication

past medical history

last oral intake

Events leading up to injury/illness

Else (“is there anything ELSE that I should know???”)

OPQRST

Onset

provocations

quality

radiation/region

severity (scale 1-10)

time (how long its been like that, what time it started being like that)

auscultation BP

finding BP with stethoscope 

skin colors

cyanotic (blus-ish skin): poor perfusion

pink: normal. On light skinned people check the face. On people with darker skin, check the nail beds, palms, and inside of lips.

red: a lot of blood flow

jaundice (yellow-ish): check whites of eyes or skin. Indicated liver issues, like liver failure

diaphoretic

being excessively sweaty

jaundice

yellowing of skin

trending

the practice of tracking and analyzing data over a period of time to identify patterns and predict outcomes

consent with obtaining med history

legally required to ask “would you mind if I asked you some questions?”

Signs of alert and oriented 

• who they are (person).

• where they are (place).

• time of day (time).

• their current situation (event).

A+OX2 would be alert and oriented + they know two things on the list.

A+OX4 would be alert and oriented + they know all things on the list

Rapid, shallow breaths

possible problems:
Shock, heart problems, heat emergency, diabetic emergency, heart failure, pneumonia

Deep, gasping, labored breaths

possible problems:

Airway obstruction, heart failure, lung disease, chest injury, diabetic emergency

Slowed breathing

possible problems:

Head injury, stroke, respiratory failure, narcotic overdose

Snoring

possible problems:

Stroke, fractured skull, drug or alcohol overdose, partial airway obstruction (BY TONGUE IS MOSTLY LIKELY OVERALL CAUSE)

Crowing

possible problems:

A high pitched sound often caused by a partial airway obstruction, swelling of the airway

Gurgling

possible problems:

Airway obstruction due to fluids, lung disease

Wheezing

possible problems:

Asthma, emphysema, airway obstruction, heart failure

Coughing blood

possible problems: 

Chest trauma, lung infection, punctured lung, internal injuries

assessing respirations

Grasp the patient’s wrist as if you were going to count the pulse rate. Hold their arm firmly against their upper abdomen. Do this because many patients will unknowingly alter their respiratory rate when someone is watching them breathe.

abnormal rates for adults is under 10 breaths per minute, or over 20 (normal is 12-20)

respiration rates per minute (by age)

elderly (81+): 10-30

older adult (65-80): 12-25

adult: 12 to 20

adolescent: 12 to 16

child (6-12): 18 to 30

young child (4-5): 22 to 34

Toddler (1-3): 24 to 40

Infant (less than 12 months): 30 to 60

what does low BP indicate (or slow pulse?)

blood might not be getting to all parts of the body

peripheral vs central pulses

peripheral are on extremities (brachial, radial, pedal)

central are on torso (carotid, femoral)

documenting respitations

(# of breaths per minute), (shallow, deep, or GTV), and (labored/unlabored)

16, GTV, and unlabored

how to document pulse

(BPM), (strong or weak), and (regular or irregular)

average pulse rates per minute (BY AGE)

adult: 60 to 100

child over 10: 60 to 100

child 2-10: 60 to 140

three months-2 years: 100 to 190

newborn to 3 months: 85 to 205

pulse quality and signs

rapid: Exertion, anxiety, pain, fever, dehydration, blood loss, shock

slow: Head injury, drugs, some poisons, some heart problems, lack of oxygen in children

irregular: Abnormal electrical heart activity (arrhythmia)

absent: cardiac arrest

what is blood pressure?

the measurement (in mm of mercury/HG) of the pressure of blood against the walls of the arteries, both when the heart beats and when it is at rest.

top number is systolic BP (pressure in arteries during contractions).

Bottom number is diastolic BP (when the artery relaxes and refills with blood)

blood pressure categories

normal: less than 120/80

elevated: systolic 120-129 AND diastolic of 80-less

stage 1: systolic 130-139 OR diastolic 80-89

stage 2: systolic 140-above OR diastolic 90-above

MEDICAL EMERGENCY: systolic above 180 AND/OR diastolic over 120

blood pressure averages (BY AGE)

adult: less than or equal to 120/less than or equal to 80

adolescent (13-17): 113-131/64-83

child (6-12): 96-115/57-76

toddlers and young children (2-5): 88-106/42-63

PERRL

pupils equal, round, (and) reactive (to) light

pupil looks and meaning

dilated, nonreactive: Shock, cardiac arrest, bleeding, certain medications, head injury

constricted, nonreactive: Central nervous system damage, certain medications

unequal pupils: stroke, head injury

What is the role of the National Highway Traffic Safety Administration, and how is it related to EMS?

responsible for reducing deaths, injuries, and economic costs from motor vehicle crashes on U.S. highways through research, education, and safety standards

what does NHTSA stand for

National Highway Traffic Safety Administration

what is the role of Disaster Medical Assistance Teams?

provide rapid-response, high-quality medical care during public health emergencies, disasters, and large-scale events

what does DMAT stand for

Disaster Medical Assistance Teams

who developed triage

Dominique Jean Larrey

Accidental Death and Disability: The Neglected Disease of Modern Society was an study, which led to what important thing?

Congress passing the National Highway Safety Act

what is the National Highway Traffic Safety Act

a gov agency that sets standards and guidelines to improve road safety and EMS training.

The EMS system - what happens

1. Witness of incident calls 911

2. The Emergency Medical Dispatcher (EMD) sends the appropriate resources.

3. Emergency Medical Responders arrive to assist the patient

4. EMTs and Paramedics continue care and transport the patient to the hospital.

5. Once at the hospital, care is transferred to emergency department personnel.

what are parts of an integrated health service

1. EMS research

2. Medical direction

3. Education systems

4. communication/dispatch

   NOT HEALTH INSURANCE

what is a Medical Director?

a physician who oversees and guides the medical care provided by EMS people

what are the 6 principles of EMS Agenda 2050?

1.inherently safe and effective,

2. integrated and seamless,

3. reliable and prepared,

4. socially equitable,

5. sustainable and efficient,

6. adaptable and innovative

what are the 4 Levels of EMS Education and Training.

1. EMR - often 1st on scene (police officers, firefighters, industrial workers, and other public service providers)

2. EMT - basic ambulance care, transportation, and assessment

3. AEMT (advanced EMT) - Intermediate EMT who did extra learning, like staring IV lines, advanced airway care, and giving more medication

4. Paramedic - advanced life support care, administer meds, interpret electrocardiograms, monitor cardiac rhythms, and perform cardiac defibrillation

Third-service or public utility model

In this model, services are typically operated by non-fire-based government entities within cities or counties.

Alliance model

involves a partnership between a fire service and a private ambulance service.

Crew Resource Management (CRM)

1. pointing out safety hazards

what is Public Safety Answering Point (PSAP)?

a designated 911 dispatch center

what is scope of practice?

1. It shows what jobs/skills each type of EMS is legally allowed to do.

2. MOST THE TIME what you can do is determined by state/regional laws.

3. shows what license/certification required

This model is nationally recognized

off-line medical direction

protocols (guidelines on how to treat stuff) and standing orders (permission to give interventions: med, oxygen)

on-line medical direction

orders on what to do from a physician directly

chief complaint

the main problem, the reason they needed med care

CQI

continuous quality improvement

DMAT

Disaster Medical Assistance Team - very fast EMS people

baseline health status

preemployment medical examination to determine overall health status prior to beginning a job.

what does OSHA stand for

Occupational Safety and Health Administration

OPIM

Other Potentially Infectious Materials (materials other than blood that might carry infectious pathogens)

vaccines one should get

COVID-19, Hepatitis A and B, Influenza, Measles, Meningitis, Mumps, and Tetanus

Standard Precautions Vs Universal Precautions

Standard: Guidelines to deduce risk of disease in health care recommended by CDC (Centers for Disease Control and Prevention)

Universal: approach were you consider everyone infectious until proven not (GUILTY UNTIL PROVEN INNOCENT)

what does NFPA stand for

NAtional Fire Protection Association

4 ways pathogens (disease) enter body

Ingestion (swallowing)

Injection (puncture, sting, bit, needle)

Absorption (through skin)

Inhalation (breathing)

Cleaning Vs Disinfection

Cleaning is removing dirt, dust, and debris from a surface, while disinfecting is killing germs on a previously cleaned surface

Airborn and Bloodborn Diseases (yes/no vaccine)

Air: COVID-19 (yes) + Tuberculosis (no)

Blood: Hepatitis (b - yes, C - no) + HIV/AIDS (no)

Zika

virus spread by bite of some mosquito types

signs/symptoms similar to common flu

can cause brain damage in fetus (if mother is bit)

Ebola (EVD, Ebola virus disease)

often fatal if not treated

Swine flu (H1N1), Avian Influenza

form of influenza

from pigs, spread to humans (swine)

from birds spread to humans (Avian)

SARS

Severe acute respiratory syndrome

Methicillin-resistant Staphylococcus aureus (MRSA)

antibiotic resistant

People with weakened immune systems are at a higher risk (like people in hospitals, healthcare facilities, nursing homes)

exposure control plan

rocedures designed to minimize the risk of infection following exposure to pathogens

Document exposure, report to company/agency, visit doctor

CRM

Crew Resource Management

• a behavioral training program focused on improving team performance and reducing human error in high-risk environments

Placards

identify hazardous materials with coded colors and numbers

codes are in US department of transportation Emergency Response Guidebook

what is CISM and CISD

Critical Incident Stress Management

Critical Incident Stress Debreifing (mental health pros and 1st respondents talking after hard call)

Anatomical position

sitting up, face forward, arms down, palms up

anterior vs posterior

anterior is front

posterior is back of body

lateral

is the side of the body, located away from the midline.

medial

anything towards the midline

superior vs inferior

closer to the top of the head (superior)

more towards the feet (inferior)

proximal vs distal

closer to the torso (proximal)

or further away from it (distal)

physiology

the study of the functions and processes of the body's systems and organs.

four main body cavities

cranial (head), thoracic (chest), abdominal (abdomen), and pelvic (pelvis) cavities.

RUQ and LLQ

r: right

l: left

L: lower (middle letter)

Q: quadrant

palpate

to examine by touch (3 fingers)

perfusion

circulation of blood through tissues.

tidal volume

the amount of air you can breathe in/out

veins vs arteries

arteries deliver blood AWAY from heart

veins deliver TO the heart

3 types of blood vessels

vasodilation (relaxed), Normal (normal tension), vasoconstriction (contracted)

3 types of muscle

smooth, cardiac, skeletal

glands in endocrine system

thyroid, pituitary, adrenal, pancreas, and gonads

neonate

birth to 28 days old

infant

birth to one year

toddler

1-3 years

early and middle childhood

early: 3-6

middle: 6-12

adolescence

12-18

early adulthood

18-30

middle adulthood

30-60

late adulthood

60 to death

when to move patient

when situation is dangerous for them to be in

when you can’t assess ABC or bleeding

if you need to get to someone else who needs lifesaving care (if Bob is in cardiac arrest inside a room and Jeff is sitting with a broken leg in the doorway, move Jeff to get to Bob)

body mechanics

LIFT WITH LEGS (feet shoulder width apart, back straight). If you break your back, you’re just one more person to treat

drags

clothing drag

blanket drag

shoulder drag

strap drag

when going downstairs, grab the patient under the shoulders and pull them headfirst as you walk backward

Emergent vs Standard move

emergent - relocating a patient immediately due to a life-threatening danger (e.g., fire, explosion risk), without time for spinal precautions.

standard - non-urgent patient transfer where proper assessment and spinal precautions can be taken to ensure safety

direct ground lift

moving patient from floor to bed/stretcher

One person supports upper body and head, other supports lower body.

start on one knee and then stand up together whole holding them

extremity lift

ground to chair or stretcher (or chair to stretcher)

one person holding knees. One person holding patient up from under the armpits and holding the patients wrists