EMT Training Unit 1

Briefly describe the history of EMS (5 points)

1. First instance is the French in 1790 carrying injured soldiers to be treated

2. Abraham Lincoln called for protocols for moving injured

3. 1900s America carried injured to hospital

4. 1940s America helped patients in the ambulance to stabilize.

5. Accidental death and Disability: The Neglected Disease of Modern Society called for standardization, and labeled trauma the #1 cause of death 1-44

NREMT did what? Stands for what?

NREMT:

National Registry of EMTs established a standardized certification requiring passing an initial course, along with a practical and cognitive exam.

Enhanced 911

Centers can identify the number and location of landlines, and sometimes wireless.

EMD

Emergency Medical Dispatcher. Specially trained dispatcher who have greater medical knowledge so can get more important info and give better instruction

4 Levels of EMS

1. Emergency Medical Responder

2. EMT

3. AEMT

4. Paramedic

Certification of all of these levels can come from the National Registry of EMTs or NREMT

Scope of Practice

What you're allowed to do

What's the medical director, what types of direction can they give, and what is medical direction? What's protocol?

A Medical Director is a physician who assumes ultimate responsibility for the patient-care aspects of EMS.

Offline Direction: Standing orders

Online Direction: Direct communication

Medical direction is oversight of patient-care aspects of EMS

Protocol is a list of steps to be taken in a specific situation

Responsibilities of EMT (3)

1. Keep yourself safe (kys)

2. Keep others safe

3. Patient Comfort (could go in either, it's okay if you didn't think of it)

Roles of EMT (4)

1. Assessing the patient,

2. lifting and moving, (also stabilizing)

3. transfer of care,

4. advocate for the patient

Recertification is required every...

Recertification is needed every 2 years.

NREMT offers NCCP.

NCCP

National Continued Competency Program

Quality Improvement

Identifying and then correcting aspects that require improvement.

Emergency Department

Patient first goes to the emergency department which stabilizes the patient until the operating room is ready.

1966 (name act) what organization was set to develop EMS

Highway Traffic Safety Act

Department of Transportation charged with developing EMS standards

What are physical traits needed for EMTs

Physical Traits:

Good fitness

Carry 125 pounds

Good Eyesight (or corrective lenses required)

Color Vision

Communication

Role of EMS in public health (4)

1. Preventing old people injuries

2. Preventing young people injuries

3. Public Vaccination

4. Detecting larger trends through their reports.

What is it called when you deliver healthcare outside of the hospital

Mobile Integrated Healthcare

How long does alcohol need to be spaced from EMT Shift?

At least 12 hours from the EMT shift.

What are the 4 main diseases of concern? What are 4 other rarer diseases of concern

The four diseases are 1. Hepatitis B 2. Hepatitis C 3. Tuberculosis 4. HIV/AIDS

Other than that, Ebola, MERS (Middle Eastern RS), SARS (Severe acute RS), and Avian flu.

What is Standard Precaution

Strict form of infectious control, assuming all liquids are infectious. And BSI (body substance isolation) with PPE.

OSHA, who oversees? What's the standard?

CDC oversees

OSHA Standard says that employers of emergency responders must take certain measures to protect employees, through training, equipment, and vaccinations. In return, employees must participate in this.

What is the Infection Exposure Control Plan? What are 4 components?

Identifies tasks which risk exposure, and outlines how the organization will protect it's employees from exposure.

1. Schedule of how and when the standards will be implemented

2. Methods used for communicating hazards to employees including labels

3. Post-exposure evaluation and followup.

4. Cleaning standards

Should all be free of charge. Also I'd imagine it would include like vaccines idk why it wasn't included in presentation.

What's that one AIDS Act?

Ryan White CARE Act

Made in 1990 to provide care for people with HIV/AIDS

Extended in 1994 with the "Ryan White HIV/AIDS Treatment Extension Act" to Emergency Response Employees, mandating a procedure to see if they've been exposed. Assigning a Designated Officer.

What are the two different notification systems for exposure

1. You'll be notified by the Designated Officer if you've been exposed to an Airborne pathogen

2. For bloodborne you will need to submit a request for a determination on whether or not you've been exposed.

Required immunizations/tests

1. Tetanus

2. Hepatitis B

3. Most healthcare organizations require TST, or Tuberculin Skin Test, at least every 6 months to a year.

What are the stages of stress and what process describes these stages?

GAS, or General Adaptation Syndrome, describes the process the body goes through in response to stress.

Stage 1: Alarm Reaction Phase, Fight-or-flight

Stage 2: Resistance Phase, body tries to repair itself, but if stress is still there it gets worse

Stage 3: Exhaustion Phase, the body can no longer resist or adapt to the stressor, leading to fatigue, burnout, etc.

What are the three types of reactions to stress?

1. Acute Stress Reaction, develops during or shortly after incident.

2. Delayed Stress Reaction, also known as PTSD, isn't evident till days, months, or years after. Often turn to drug abuse.

3. Cumulative Stress Reaction, also known as burnout, builds up over time when there is long term low-level stress.

Where was PTSD first identified? What were it's names?

In soldiers, it was called "Shell Shock" or "Battle Fatigue"

Common Causes of Stress for EMTs

1. MCI (Multiple Casualty Incident)

2. Calls involving children or infants

3. Severe injuries

4. Abuse or Neglect

5. Death of a coworker

What are the types of stress?

1. Eustress, positive form of stress, helpful

2. Distress, negative form of stress, unhelpful

Ways to deal with stress

1. Diet

2. Exercise

3. Relaxation time (like meditation)

4. Humor

CISM

Critical Incident Stress Management is a system that includes education & resources to prevent & deal with stress.

In the CISD model, the Critical Incident Stress Debriefing model, a group of counselors or mental health professionals meet with a group of rescuers who were on a stressful call.

Patient reactions to death, and how to properly handle these situations

Reactions often go through the five stages of grief (though not all patients go through all, more rapid deaths are unpredictable)

These situations are best handled through recognizing the patient's needs, talking directly to the patient, listening emphatically and tolerantly, and do not falsely reassure, but do comfort the patient.

Scene size up

Determine the level of precautions, then continue to look for any changes throughout the call.

In what cases will alcohol cleaners not be sufficient?

What situations call for what kinds of masks?

If your hands are visibly soiled or when anthrax is present.

1. Surgical type masks to protect against fluid spatter

2. If Tuberculosis is possible then you wear an N-95 or HEPA (High-Efficiency Particulate Air) respirator.

Worn with high risk procedures or high risk areas.

What needs to approve the masks for us to wear them?

National Institute for Occupational Safety and Health

or NIOSH

What is the acronym and explanation for dealing with PTSD

eSCAPe

every patient

provide Social support

give patient Choices

help patient Anticipate what will happen next

help patient Plan (giving choices + anticipating in one)

every time (just another reminder ig, for the sake of the mnemonic)

Response to danger

1. Plan

Protective, but not cumbersome, equipment. And radio.

2. Observe

Be cautious, do not stand in front of doors when knocking, look for signs of danger.

3. React

3 R's, Respond (place 2 major obstacles), Radio for help, and Re-evaluate when it's safe you go in but stay cautious.

What is body mechanics?

What are some examples? It's okay if you can't name them just try to review them at least.

Proper use of body to facilitate moving and prevent injury

1. Position feet on stable surface

2. Use legs not your back

3. Never turn or twist

4. Don't compensate if you lift with one hand

5. Keep the weight close to your body

6. Use a stair chair when carrying the patient over stairs

7. Use wheels if viable

8. Even number of lifters

Power lift, other name, and what is it?

also known as squat lift.

You go from squatting position, push with legs, keep back locked, feet are apart and on the flat ground, weight on balls of feet, and keep weight close to body.

What is the power grip

it's used with the power lift, using as much contact with surface as possible, at least 10 inches apart, bent at same angle.

Types of moves (not describing, that's later)

Emergency moves

Urgent moves

Non-urgent moves

Emergency move, when is it performed? How is it done? What are the types?

Performed before assessment or treatment due to immediate threat to patient's life (Including needing to perform CPR), or if you need to move this patient to reach another patient in immediate risk.

You always move the patient in direct of the long axis

The two types of moves are drags and carries

Urgent move, when is it performed? How is it done? What are the types?

Similar to emergency move, but performed with precaution for spinal injury but not comfort.

Non-urgent move, when is it performed?

How is it done?

Performed when there is no immediate threat to life. Completed after assessment and treatment.

Placed on patient-carrying device.

Two-Rescuer Assist

Place the patient's arms around the necks of two rescuers to the patient's sides, the rescuers hold their wrists. The rescuers also hold the patient's waist to help them walk.

Firefighter's carry with an assist

Someone lifts the patient and another helps position the patient.

Clothes Drag

Drag the patient by their shirt, rescuer toward head side of patient.

Shoulder drag

Hands on arm pits, rescuer toward head side of patient.

Incline drag

Arms under arm pits and holding wrists, rescuer toward head side of patient.

Foot drag

Drag a patient by their feet, rescuer toward the foot side.

Firefighter's drag

Wrap the patient's hands together, place head inbetween hands, crawl.

Blanket Drag

roll patient toward your knees so that you can place the blanket under them when you roll them onto the blanket. keep patients head low to the floor to prevent spinal injury.

One-Rescuer Assist

Like a two rescuer assist but with one rescuer.

Cradle carry

Place on arm across the patient's back with your hand under the patient's arm and the other arm under their knees. have them place their nearest arm over your shoulder.

Pack strap carry

Place their arms over your shoulder and hold their hands while you face away and they face toward you.

Log Roll

One person stabilizes head, other people support rest of body, someone turns them to their side and the stretcher is placed under.

Describe types of stretchers

1. Power stretcher: Use motors or hydraulics.

2. Portable stretchers can fold up so are good for MCI, ends look like folding chairs

3. Flexible/Reeves stretcher, just flat made of flexible material.

4. Scoop/Orthopedic stretcher, is two parts that can come together under the patient. No spinal support

5. Basket/Stokes Stretcher, used for rough terrain or between different levels

6. Vacuum Mattresses, prioritize comfort

What do we do for patient's with no spine injury

1. Extremity Lift

2. Direct Ground Lift

3. Draw Sheet Method

4. Direct Carry

What's recovery position and who is it used on? who is it not used on?

Recover position is positioned on your side.

It's used on people who are unresponsive.

It's not used on people who have spine injuries.

What are the slightly upright positions called? Why are they used? when are they not used?

Fowler or semi-Fowler positions.

Helps breathing but shouldn't be used on patients with spine issues or if it'll cause transportation issues.

Positioning for shock:

What's the position called?

Who is it not done on?

What do we not do anymore?

The position is called supine position.

It's probably fine if they're already there, but if they experienced trauma don't move them.

We don't elevate legs anymore.