Operations and Special Populations

2 primary system EMS models

Anglo American Model: The model used in the United States, which

focuses on bringing the patient to the hospital for definitive care.

● Franco German Model: A model common in Europe that focuses on bringing the hospital to the patient, often with a physician responding to

the scen

who is the primary governing body for ems

the Department of Transportation (DOT) is the

governing body for EMS and published the first EMS training curriculum in the

early 1970s.

EMR vs EMT vs AEMT vs Paramedic

EMR (Emergency Medical Responder): Provides basic immediate

care until more advanced personnel arrive. Examples include law

enforcement officers, firefighters, park rangers, and ski patrollers.

● EMT (Emergency Medical Technician): Provides basic life support

(BLS), including airway management, CPR, bleeding control, and

assisting with a limited set of medications.

● AEMT (Advanced Emergency Medical Technician): Provides all EMT

skills plus some advanced life support (ALS) skills, such as IV therapy,

administration of more medications, and use of advanced airway

adjuncts.

● Paramedic: The highest level of prehospital provider with extensive

training in ALS, including endotracheal intubation, emergency

pharmacology, and cardiac monitoring.

Who regulates EMS at federal state and local level

Federal Level: The National EMS Scope of Practice Model provides

guidelines for EMS skills.

● State Level: State laws regulate EMS provider operations and

licensure.

● Local Level: The agency’s medical director decides the day to day

limits of EMS personnel through protocols.

online vs offline medical direction vs standing orders

Online (Direct) Medical Control: Directions given over the phone or

radio by a physician.

● Offline (Indirect) Medical Control: Care is provided based on written standing orders and protocols.

● Standing Orders: A type of offline medical control that is part of a

protocol. An example is giving oxygen to a patient with chest pain. If an intervention requires contacting a physician for permission, it is not a standing order.

Continuous Quality improvement

Continuous Quality Improvement (CQI): A system of internal and

external reviews and audits of all aspects of the EMS system. Periodic

run review meetings are held to discuss patient care and identify areas

for improvement.

Quality control

The responsibility of the medical director to ensure

that the appropriate medical care standards are met on each call.

Cumulative vs delayed stress

● Cumulative Stress: Prolonged, excessive stress that can cause

fatigue, appetite changes, GI issues, and sleep pattern issues.

● Delayed Stress (PTSD): Posttraumatic stress disorder that can occur

after a critical incident.

general adaptation syndrome

A three stage response the body goes

through when exposed to stress: alarm, resistance, and exhaustion.

PPE and when required, how long wash hands?

handwashing: The most important practice. Wash hands vigorously for

at least 20 seconds.

● Personal Protective Equipment (PPE):

● Gloves: Must be worn for any potential contact with body fluids.

Should be removed by pinching the wrist and pulling the glove

inside out.

● Gown and Eye Protection: Required for situations with a high

risk of splashing, such as childbirth, uncontrolled bleeding,

vomiting, and suctioning.

● HEPA (N95) Mask: Required for patients with suspected

tuberculosis and when performing aerosol generating procedures

such as suctioning, CPR, and endotracheal intubation. It is NOT

required for bloodborne pathogens like HIV.

how to clean ambulance

: Use a bleach and water solution to clean the

stretcher, rails, and mattress after each run and daily. Do not use

alcohol or aerosol sprays on these surfaces.

when replace oxygen cylinders?

when reach designated safe residual pressure 200 or 500 PSI

lifting technique

Keep your back straight and locked. Spread your

legs and bend at the knees, not the waist. Keep the patient’s weight

close to your body. Lift with your palms facing upward and avoid

twisting. Communicate with your partners.

emergency move

Used when there is immediate risk of harm or you

cannot access another critical patient. The patient is dragged along the

long axis of the body without time for full immobilization. This can be

done by pulling on clothing at the neck/shoulder (unbuttoning the top

button), using a blanket, or grasping the wrists above the patient’s head.

long backboard vs scoop vs basket (Stokes) vs flexible stretcher vs vacuum mattress vs bariatric patients

Long Backboard: Used for spinal motion restriction. Assess

pulse, motor, and sensory function before and after securing the

patient.

● Scoop Stretcher: Fits around a patient in a supine position,

useful in confined spaces.

● Basket Stretcher (Stokes): Used for mountain, cliffside, or

technical rescues and vertical lifts. Can break into two sections.

● Flexible Stretcher: Used for moving patients through narrow

openings or down deep staircases.

● Vacuum Mattress: A device that molds around the patient as air

is removed, providing excellent immobilization.

● Bariatric Patients: Patients over 250 pounds require at least 4

providers. Request lifting assistance from dispatch.

Incident command system

A standardized management tool

used in mass casualty incidents (3+ patients) to ensure safety and

efficient use of resources. It does not train or evaluate EMS systems.

National ICS

): A system created to

standardize incident management for all hazards across all levels of

government.

ICS command section

ncludes the Incident Commander (IC), Public

Information Officer, Safety Officer, and Liaison officer

ICS functional sections

Finance, Logistics, Operations, Planning.

medical incident command roles

: triage, treatment, transport, staging, rehab, extrication

Mass casualty incidents and triage

Mass Casualty Incidents (MCIs) and Triage

An MCI involves 3 or more patients or has the potential to produce multiple

casualties, overwhelming initial resources.

● Initial Actions: Request additional resources, establish Incident

Command, and begin primary triage.

● Triage Principle: Treatment does not begin until initial triage is

complete.

● Triage Categories:

● Red (Immediate): Life threatening problems with airway,

breathing, circulation (shock), severe burns, open

chest/abdominal wounds.

● Yellow (Delayed): Serious injuries that are not immediately life

threatening, like major bone injuries or burns without airway

compromise.

● Green (Minimal): Minor injuries like minor fractures or soft tissue

injuries; the “walking wounded.”

● Black (Expectant): Non survivable injuries, such as major open

brain trauma, cardiac arrest, or respiratory arrest when resources

are limited

4 triage systems

START (Simple Triage and Rapid Transport): Used for adults.

Assesses Respirations, Perfusion (pulse/capillary refill), and

Mental Status (follows commands).

● JumpSTART: Used for pediatric patients. An apneic child with a

pulse receives 5 rescue breaths; if they start breathing, they are

tagged Red. If not, they are tagged Black. A respiratory rate less

than 15 or over 45 is tagged Red.

● SALT (Sort, Assess, Lifesaving Interventions,

Treatment/Transport): Allows for immediate lifesaving

interventions like tourniquets or needle decompression during

triage. Adds a Gray category for patients expected to die.

● Hartford Consensus (THREAT): A protocol for mass shootings:

Threat suppression, Hemorrhage control, Rapid Extrication,

Assessment by medical, Transport.

Hazard zones + where to always position yourself

upwind and uphill

Hot Zone: Contaminated area.

● Warm Zone: Decontamination corridor.

● Cold Zone: Safe area for command post and patient treatment.

chemical agents

Nerve Agents: Cause SLUDGEM symptoms (Salivation,

Lacrimation, Urination, Defecation, Gastric upset, Emesis,

Miosis).

● Vesicants: Blistering agents.

● Pulmonary/Choking Agents: Cause lung injury and respiratory

distress.

● Cyanide Agents: Interfere with cellular oxygen use.

Biologic agents

Examples include viral hemorrhagic fevers like Ebola

Radiological sources

● Radiological Sources: Can emit alpha, beta, gamma (X rays), or

neutron radiation. Delta is not a form of energy.

Blast injuries

Primary: Injury from the blast wave itself (e.g., blast lung,

ruptured eardrums).

● Secondary: Injury from flying debris.

● Tertiary: Injury from the body being thrown against an object.

● Quaternary: Miscellaneous injuries (burns, crush injuries, toxic

inhalation).

● Quinary: Illness caused by toxic materials absorbed from the

blast.

water rescue

Follow the sequence: Reach, Throw, Row, then Go. Be

aware of dangers like backwash, strainers, and boils.

motor vehicle collisions

Park 100 feet away in a “fend off” position.

Be aware of significant MOIs like rollovers, ejections, or death of

another occupant.

consent (expressed, implied, involuntary)

Expressed Consent: Permission given by a competent adult. Children

cannot give expressed consent.

● Implied Consent: Assumed for unresponsive or incompetent patients

who need emergency care.

● Involuntary Consent: Can be applied to mentally incompetent patients,

often with legal or law enforcement involvement.

duty to act

responsibility to provide care

negligence

failure to provide care

assault

place person in fear of bodily harm

battery

unlawfully touching a person

false imprisonment

anauthorized confinement of a person

HIPaA, when can patient info be disclosed

treatment, payment, legally required

What to include in patient care report, how to correct errors

Information Included: Patient info, chief complaint, LOC, vitals,

findings, treatment provided, and all relevant times.

● Correcting Errors: Draw a single line through the mistake, write the

correct information, and add your initials. It is not necessary to retrieve

the original report or file a report with a supervisor for a simple

correction.

● SOAP Method: Subjective, Objective, Assessment, Patient Care.

communiction dispatch information

Collects the nature of the call, location, callback

number, patient’s age, chief complaint, and number of patients.

what to include when radeoing hospital

be concise. Include your unit ID, ETA,

patient age/gender, chief complaint, brief history, key findings, treatment

provided, and the patient’s response. Do NOT include detailed medical

history or your personal opinion of the incident.

language barriers

you have to translate !!!!

objective vs subjective

● Objective (Sign): A finding that can be seen, heard, felt, or measured

(e.g., rash, bleeding, fever).

● Subjective (Symptom): Something the patient tells you (e.g., “I feel

dizzy”)

proximal vs distal

Proximal: Closer to the origin or point of attachment.

● Distal: Farther from the origin or point of attachment.

superior vs inferior

above or below

lateral vs medial

far from midline, close to

prone vs supine vs fowlers vs lateral recumbent

face down, face up, reclining, horizontal on side

Pedes airway differences

Airway is Smaller and Softer: A child’s airway is significantly

narrower in diameter (like a drinking straw compared to a garden

hose) and is more easily obstructed by swelling, mucus, or foreign

bodies. The trachea is more flexible and can be “kinked” or

occluded if the head is hyperextended or hyperflexed.

● Tongue is Proportionally Larger: The tongue takes up a much

larger percentage of the oropharynx, making it the most common

cause of airway obstruction in an unconscious child.

● Obligate Nose Breathers: Infants, for the first several months of

life, breathe primarily through their noses. Therefore, simple nasal

congestion from a cold can cause significant respiratory distress.

● Larynx is Funnel-Shaped (Cricoid Ring is the Narrowest

Point): In children under 8, the cricoid cartilage is the narrowest

part of the airway. This anatomical feature makes them more

susceptible to inflammatory conditions like croup, which cause

swelling in this area.

● Reliance on Diaphragm: Children are “belly breathers,” meaning

their diaphragm does most of the work of breathing. Signs of

respiratory distress often include prominent use of abdominal

muscles and retractions. Fatigue of these muscles leads to

respiratory failure.

pedes head and body differences

Head is Proportionally Larger: A child’s head is larger and

heavier relative to their body, with a weaker neck to support it.

This makes them prone to head injuries from falls and can cause

the neck to passively flex and obstruct the airway when lying

supine. Placing a small towel or pad under the shoulders and

torso is often necessary to achieve a neutral, patent airway

position.

● Larger Body Surface Area: Children have a larger body surface

area to mass ratio. This means they lose heat much more rapidly

and are highly susceptible to hypothermia, even in mild

conditions. Keeping a child warm is a critical intervention.

pedes cardiovascular differences

● Reliance on Heart Rate for Compensation: Children have a

smaller stroke volume (the amount of blood pumped with each

beat). To compensate for shock, they rely almost exclusively on

increasing their heart rate. Bradycardia (a slow heart rate) is a

grave sign, most often indicating severe hypoxia and impending

cardiac arrest.

● Hypotension is a Late Sign: Children can maintain their blood

pressure until they have lost a significant amount of blood volume.

When their blood pressure finally drops, they are in a state of

decompensated shock and will deteriorate very rapidly. Do not

wait for hypotension to treat for shock.

geriatric cardiovascular

arrteries stiffen (arteriosclerosis), leading to

hypertension and a wider pulse pressure. The heart’s electrical

conduction system can deteriorate, leading to arrhythmias like atrial

fibrillation. The heart’s ability to increase its rate and contractility to

compensate for shock is diminished.

geriatric respiratory system

: The chest wall becomes stiffer, and respiratory

muscles weaken. This decreases the vital capacity and the ability to

cough effectively, which significantly increases the risk of pneumonia.

geriatric neurological sysrem

The brain atrophies (shrinks), leaving more

space between the brain and the skull. This puts tension on the bridging

veins, making elderly patients highly susceptible to slow, chronic

geriatric musculoskeletal, skin and renal

● Musculoskeletal System: Osteoporosis (loss of bone density) makes

bones brittle and prone to fractures from minimal trauma. Hip fractures

after a fall are extremely common and can be a life-threatening event.

● Skin and Renal Systems: The skin becomes thinner, drier, and less

elastic, making it more susceptible to tearing. Kidney function declines,

which affects the body’s ability to clear medications and regulate fluid and electrolyte balance