EMT unit 1

Regulation and policy

Each state EMS system must have in place enabling legislation, a lead EMS agency, a funding mechanism, regulations, policy, and procedure

Resource mangement

There must be centralized coordination of resources so that all victims of trauma or medical emergencies have equal access to basic emergency care and transport by certified personnel, in a licensed and equipped ambulance, to an appropriate facility

Human resources and training

At a minimum, all those transporting prehospital personnel should be trained to the EMT level using National EMS Education Standards that are taught by qualifies instructors

Transportation

Safe, reliable ambulance transportation is a critical component. Most patients can be effectively transported by ground ambulances. Other patients require rapid transportation, or transportation from remote areas, by helicopter or airplane.

Facilities

The seriously ill or injured patient must be delivered in a timely manner to the closest appropriate facility.

Communications

There must be an effective communications system that encompasses the universal system access number and dispatch-to-ambulance, ambulance-to-ambulance, ambulance-to-hospital, and hospital-to-hospital communications

Public information and education

EMS personnel may participate in efforts to educate the public about their role in the system, their ability to access the system, and prevention of injuries

Medical direction

Each EMS system must have a physician as a Medical Director who is accountable for the activities of EMS personnel within that system. The medical director must be involved in all aspects of the patient-care system, including protocol development, training, and quality improvement.

Trauma systems

In each state, enabling legislation must exist to develop a trauma system including one or more trauma centers, triage and transfer guidelines for trauma patients, rehabilitation programs, data collection, mandatory autopsies, and means for managing and ensuring the quality of the system

Evaluation

Each state must have a program for evaluation and improving the effectiveness of the EMS system, known as quality improvement program, a quality assurance program, or total quality management

EMS system

Patient→ citizen calls 911→ emergency dispatcher→ emergency medical responders→ EMTs→ emergency department staff→ allied health staff

EMR

This level of training is designed for the person who is often first at the scene. Many police officers, firefighters, and industrial health personnel function in this capacity. The emphasis is on activation the EMS system and providing immediate care for life-threatening injuries, controlling the scene, and preparing for the arrival of the ambulance.

EMT

In most areas, EMT certification is considered the minimum level of training for ambulance personnel. EMTs provide basic-level medical and trauma care and transportation to a medical facility and frequently work with advanced-level EMS provider.

AEMT

An AEMT provides basic-level care and transportation but also provides some advance-level care. Advance care may include use of advanced airway devices and administration of some fluids or medications via IV or IO routes.

Paramedic

The paramedic preforms all of the skills of the EMT and the AEMT plus additional advanced-level assessments, decision making, and skills. The paramedic provides the most advanced level of prehospital care.

Roles and responsibilities of the EMT

personal safety

safety of the crew, patient, and bystanders

working with other public safety professionals

patient assessment

patient care

lifting and moving

transport

transfer of care

patient advocacy

Quality care roles

carefully preparing written documents

becoming involved in the QI process

obtaining feedback from patients and the hospital staff

maintaining your equipment

continuing your education

Protocols

list of steps, such as assessments and interventions, to be taken in different situations. Protocols are developed by the medical director of an EMS system

Standing orders

a policy or protocol issued by a Medical Director that authorized EMTs and others to preform particular skills in certain situations

off-line medical direction

standing orders issued by the Medical Director that allows EMTs to give certain medications or preform certain procedures without speaking to the medical director or another physician

on-line medical directions

orders from the on-duty physician given directly to an EMT in the field by radio or phone

Patient outcomes

the long-term survival of patients

Evidence-based techniques

techniques or practices that are supported by scientific evidence of their safety and efficacy, rather than merely on a supposition and tradition

Well-being

maintaining solid personal relationships

exercise

sleep

eating right

limiting alcohol and caffeine intake

regular doctor appointments

pathogens

the organisms that cause infection, such as viruses and bacteria

Standard Precautions

a strict from of infection control that is based on the assumption that all blood and other body fluids are infectious

PPE

equipment that protects the EMS worker from infection and/or the dangers of rescue operations

contamination

the introduction of dangerous chemicals, disease, of infectious materials

AIDS

HIV-infected blood via intravenous drug use, unprotected sexual contact, blood transfusion, or accidental needlesticks.

incubation of several months or years

varicella

airborne droplets. Can also be spread by contact with open sores.

Incubation of 11-21 days

ebola

blood and body fluids (urine, saliva, feces, vomit, sweat, semen)

2-21 days

rubella

airborne droplet. Mothers may also pass the disease to unborn children.

10-12 days

influenza

respiratory droplet

1-7 days

hepatitis

blood, stool, or other body fluids, or contaminated objects

weeks to months depending on type

meningitis

oral and nasal secretions

2-10 days

mumps

droplets of saliva or objects contaminated by saliva

14-24 days

pneumonia

oral and nasal droplets and secretions

several days

staphylococcal skin infections

direct contact with infected wounds or sores or with contaminated objects

several days

TB

respiratory secretions, airborne or on contaminated objects

2-6 weeks

pertussis

respiratory secretions or airborne droplets

6-20 days

airborne disease exposure

you will be notified by your designated officer when you have been exposed to an airborne disease

blood or other infectious disease exposure

you may submit a request for a determination as whether you were exposed to a bloodborne or other infectious disease

stress

a state of physical and/or psychological arousal to a stimulus

stages of responses

first stage: alarm reaction

second stage: stage of resistance

third stage: exhaustion

PTSD

acute stress reaction

causes of stress

multiple-casualty incidents

calls involving children or infants

sever injuries

abuse or neglect

death of a coworker

dealing with stress

Develop more healthful and positive dietary habits

exercise

devote time for relaxing

reactions to death and dying

denial or not me

anger or why me

bargaining or ok but first let me

depression or ok but i haven’t

acceptance or ok i’m not afraid

steps you can take to help dying patient or their family

recognize the patients needs

be tolerant of angry reactions from the patient and family

listen empathetically

do not falsely reassure

offer as much comfort as realistically you can

power lift

a lift from a squatting position with weight to be lifted close to the body, feet apart and flat on the ground, body weight on or just behind the balls of your feet, and the back locked in. the upper body is raised before the hips

power grip

gripping with as much hand surface as possible in contact with the object being lifted all fingers bent at the same angle and hands at least 10 inches apart.

bariatric

having to do with patients who are significantly over weight

patients with suspected spinal injury

manual stabilization, placing a rigid cervical collar, and restricting movement of the neck and spine. long back board→ stretcher or scoop→ stretcher

extremity lift

used to carry a patient with no suspected spine or extremity injuries to a stair chair. a method of lifting and carrying a patient in which one rescuer slips their hands under the patient’s armpits and grasps the wrists while another rescuer grasps the patients knees.

direct ground lift

is preformed when a patient when a patient with no suspected spine injury needs to be lifted from the ground to a stretcher. a method of lifting and carrying a patient from ground level to stretcher in which two or more rescuers kneel, curl the patient to their chest, stand, then reverse the process to lower the patient to the stretcher

draw-sheet method

is one of the two methods that is preformed during transfers between hospitals and nursing homes or when a patient must be moved from home bed to stretcher. NO SUSPECTED SPINE INJURY

direct carry

direct ground lift but while standing up

scope of practice

a set of regulations and ethical considerations that define the scope or extent of limits of the EMT’s job

standard of care

for an EMT providing care for a specific patient in a specific situation, the care that would be expected to be provided by an EMT with similar training when caring for a patient in a similar situation

consent

permission from the patient for care or other action by the EMT

expressed consent

consent given by adults who are of legal age and are mentally competent to make a rational decision with regard to their medical well-being

in loco parentis

literally “in place of a parent” indicating a person who may give consent for care of a child when a parent is not present or able to give consent

implied consent

the consent is presumed patients or their parents or gradians would give if they could, such as an unconscious patient or a child whose parents could not be contacted when care is needed

in order for patients to refuse care or transport

patient must be legally able to consent

patients must be awake and oriented

patients must be fully informed

patients will be able to sign a “release” form

liability

being held legally responsible

how to try and convince patient to go to hospital

spend time speaking with patient

listen carefully to try to determine why the patient is refusing

inform the patient of the consequences of not going to the hospital. THIS PART IS ENSSENTIAL

consult medical direction

ask the patient if it is alright to call a family member

call law enforcement personnel if necessary

ask the patient to sign the refusal of care form used by your agency

unwanted care is seen as

assault or battery in court

negligence

a finding that there was failure to act properly in a situation in which there was a duty to act, that needed care as would reasonably be expected of the EMT was not provided, and that harm was caused to the patient as result

tort

a civil, not a criminal, offense; an action or injury caused by negligence from which a lawsuit may arise

res ipsa loquitur

the thing that speaks for itself

duty to act

an obligation to provide care to a patient

abandonment

leaving a patients after care has been initiated and before the patient has been transferred to someone with equal greater medical training

moral

regarding personal standards or principles of right and wrong

ethical

regarding a social system or social or professional expectations for applying principles of right and wrong

Good Samaritan laws

a series of laws varying by state, designed to provide limited legal protection for citizens when they are administering emergency care

HIPAA

the Health Insurance Portability and Accountability Act, which includes the Privacy Rule privacy of patient-specific health care information and providing the patient with control over how this information is used and distributed

Broncho/pulmo

lungs

cardi

heart

gastro

stomach

hepat

liver

neur

nerve

nas

nose/nassal

or

mouth/oral

pneumo

air or lungs

ab-

away from

ad-

toward or near

ante-

before

brady-

slow/below normal

contra -

against

dys-

difficult or painful

hyper-

above normal/ high

hypo-

below normal/low

inter-

between

intra-

within/inside

peri-

around

poly-

many

post-

after

pre-

before

sub-

below/under

super/supra-

above or in excess