EMT All 41 Chapters

EMS system

Team of health care professionals providing prehospital emergency care and transport; governed by state laws

After completing the EMT course you may take

The National Registry of EMTs exam or your state's certification exam; passing makes you eligible to apply for state licensure

Four training and licensure levels

EMR, EMT, AEMT, Paramedic

EMT course length

About 150 hours

EMT role

Backbone of the US EMS system; responsible for assessment, care, packaging, and transport of the patient

Licensure requirements (typical)

High school diploma or equivalent, proof of immunization, background check and drug screening, valid driver's license, completed course and exam, physical and mental ability for the job

Americans with Disabilities Act (ADA)

Prohibits employers from failing to provide full and equal employment

Origins of EMS

Volunteer ambulances in WWI, field care in WWII, field medics and helicopter evacuation in Korea

1966 EMS milestone

Accidental Death and Disability: The Neglected Disease of Modern Society established EMS

Early 1970s EMS milestone

DOT published the first EMT training curriculum (AAOS published the first EMT textbook in 1971)

National standardization of EMS

1970s DOT National Standard Curriculum; 1980s advanced EMT levels; 1990s NHTSA EMS Agenda for the Future

Federal role in EMS training

National EMS Scope of Practice Model provides guidelines

State role in EMS

Laws regulate EMS operations

Local role in EMS

Medical director provides oversight and support

Public BLS and immediate aid

Laypeople trained in BLS/CPR; public access AEDs

Emergency Medical Responder (EMR)

First responders (police, firefighters) who give immediate BLS and urgent care with limited equipment

AEMT

Adds IV therapy, advanced airway adjuncts, and a limited number of medications

Paramedic training length

1,000 to more than 1,300 hours

Paramedic skills

Endotracheal intubation, emergency pharmacology, cardiac monitoring (minimum level for field cardiac monitoring)

Number of EMS system components

14

14 components of EMS

Public access, clinical care, medical direction, integration of health services, information systems, prevention, EMS research, communication systems, human resources, legislation and regulation, evaluation, system finance, public education, education systems

911 system

Lets the public access public safety; dispatchers obtain information and dispatch resources

Emergency medical dispatch (EMD)

Dispatchers provide medical instructions before EMS arrives

Clinical care component

Equipment and scope of practice; familiarizes EMTs with their primary service area (PSA) and ambulance controls

Human resources component

The people who deliver care; EMS Agenda for the Future encourages protecting provider well-being

Physician medical director

Authorizes EMTs to provide medical care in the field; maintains quality control; liaison with the medical community

Standing orders and protocols

Describe appropriate care and establish medical direction for providers

Off-line (indirect) medical control

Standing orders, training, supervision

Online (direct) medical control

Physician directions given by phone or radio

Standing order example

EMT defibrillates a cardiac arrest patient and begins CPR, then contacts medical control

Legislation and regulation

Training, protocols, and practices follow state law; a senior EMS official handles scheduling, personnel, budgets, purchasing, vehicle maintenance

Integration of health services

Treatment started in the field continues in the ED; ensures continuity of care

Mobile integrated health care (MIH)

Community-based care by a team of professionals; came from the Affordable Care Act; includes community paramedicine

Continuous quality improvement (CQI)

Reviews and audits the EMS system; goal is minimizing errors; includes run report review, discussing needs, remedial training; not negative feedback

Information systems

Computer systems document patient care; data improves care

System finance

EMTs may gather insurance information, get signatures, and obtain permission to bill insurance; personnel may be paid, volunteer, or mixed

Education systems

Instructors licensed in most states; ALS training at colleges, career centers, hospitals; refresher courses maintain skills

Prevention and public education

The two components focused on public health; primary and secondary prevention with public health agencies

EMS research

Evidence-based practice; EMTs may help by gathering data

EMT roles and responsibilities

Keep vehicles ready, ensure safety, drive, lead on scene, size up the scene, call resources, access patients, assess, give care, emotional support, continuity of care, uphold legal standards, protect privacy, administrative support, ongoing education, community relations

Professional attributes of the EMT

Integrity, empathy, self-motivation, appearance and hygiene, self-confidence, time management, communications, teamwork, respect, patient advocacy, careful delivery of care

HIPAA

Health Insurance Portability and Accountability Act; protects patient confidentiality

EMT highest priority

Personal safety

Violent scene (yelling, breaking glass)

Retreat to a safe place until police secure the scene

Who is ultimately responsible for EMS quality control?

The medical director

Medical director is NOT responsible for

Evaluating patient insurance information (billing department)

Disqualifying event for certification

Felony such as DUI (juvenile misdemeanor or corrected hearing impairment typically not)

First phase of emergency care

Incident recognition, then activation of EMS, initial prehospital care, definitive care

Remaining calm under stress

Professional responsibility of the EMT; give report to ED staff including nurses

Wellness

A state of complete mental, physical, and social well-being

EMT focus areas under stress

Personal safety, scene safety (including others), patient care

Strategies to manage stress

Change partners, hours, environment, or attitude; cut overtime; talk about feelings; seek counseling; expand social support; develop interests outside EMS; minimize physical response to stress

Wellness habits

Nutritious food, exercise and relaxation, regular sleep, disease prevention, work-family-health balance

Food is the fuel that makes the body run

Nutritious eating supports the energy output EMS demands

Infectious disease

Caused by organisms within the body

Communicable disease

Can be spread person to person or species to species

Routes of transmission

Direct contact, indirect contact, airborne, foodborne, vector-borne

Risk reduction measures

Blood-borne pathogen handling, CDC standard precautions, PPE, patient care environment, special circumstances

Standard precautions

Protective measures that prevent health care workers from contacting germs

Hand hygiene

Wash before and after every patient; use waterless substitute if no running water; most effective way to prevent disease spread

Gloves

Wear if any chance of blood or body fluid exposure; vinyl, nitrile, or latex; remove with technique that avoids touching outside

Eye protection

Protects from splatter; prescription glasses are not adequate; goggles or face shields are best

Gowns

Protect from extensive splatter; may be impractical

Masks and respirators

Surgical mask for fluid spatter; particulate respirator for airborne agents; barrier device for ventilations

Sharps disposal

Do not recap, break, or bend needles; use approved closed container

Employer responsibility

Know and follow your department's infection control plan

Infection control routine

Clean the ambulance after each run and daily; clean at the hospital when possible

Immunity

You may not become infected even if exposed; maintain health and get immunizations

Exposure

Contact with blood or body fluids (direct or indirect); not always infection

Postexposure management

Turn over patient care, clean the area, rinse eyes 20 minutes if needed, activate infection control plan, complete exposure report

Scene safety

Begin protecting yourself at dispatch and continue on scene

Scene hazards

Hazardous materials, electricity, fire, vehicle crashes

Protective clothing

Cold-weather gear, turnout gear, gloves, helmets, boots, eye, ear, and skin protection

Placards

Used on buildings and transportation vehicles; labels are used on individual packages

Five structural fire hazards

Smoke, oxygen deficiency, high ambient temperatures, toxic gases, building collapse

Caring for the critically ill

Say who you are and what you are doing; avoid grim comments; orient the patient; be honest; allow hope; notify family

Critical patient responses

Anxiety, pain and fear, anger, depression, dependency, guilt

Injured or ill children

Ask a responsible adult to accompany the child; help the family in any way you can

Stages of grief

Denial, anger/hostility, bargaining, depression, acceptance

Anger stage of grief

Commonly results in blame toward the EMT

Bargaining stage

Patient tries to make a deal

EMT role with death and dying

Ask how you can help, reinforce reality, be honest, allow grieving

General adaptation syndrome

Stage 1 alarm response; stage 2 reaction and resistance; stage 3 recovery (or exhaustion if stress is prolonged)

Physiologic signs of stress

Faster respirations and HR, cool clammy skin, dilated pupils, tensed muscles, increased blood glucose, perspiration, decreased GI blood flow

Acute stress reaction

Occurs during a stressful situation

Delayed stress reaction

Occurs after the event

Cumulative stress reaction

From prolonged or excessive stress

PTSD

Reexperiencing an event and overresponding to stimuli that recall it

Critical incident stress management (CISM)

Developed to decrease the likelihood of PTSD

Violent situations

Civil disturbance, domestic disputes, crime scenes; law enforcement secures scene first; do not disturb evidence

Behavioral emergencies

No clear physical cause; cause may turn out physical (hypoglycemia, head trauma); use caution

Sexual harassment types

Quid pro quo and hostile work environment

Workplace issues

Cultural diversity, substance abuse, suicide prevention, injury and illness prevention

Basic principle of emergency care

Do no further harm; act in good faith and within the standard of care

Consent

Permission to render care

Competent patient who can refuse

Conscious, rational, capable of informed decisions

Expressed (actual) consent

Patient verbally or nonverbally allows care or transport (holding out an arm for a BP)

Informed consent

Expressed consent after the EMT explains treatment, risks, and benefits

Implied consent (emergency doctrine)

For unconscious patients or those unable to decide; only when life or limb is threatened

Involuntary consent

May apply to mentally ill, behavioral crisis, or developmentally delayed patients; obtain consent from guardian