U1 Review

Who oversees medical protocols & provider competence?

Medical DIRECTORS

What government bodies REGULATES EMS at both STATE & FEDERAL level?

NHTSA= National Highway Traffic Safety

If you believe your partner is impaired by alcohol or drugs, what should you do?

REPORT it to HR

What are protocols and how do they differ from standing orders?

Standing orders - treatments that can be performed without contacting the medical control physician for permission.

Protocols - treatment guidelines that should only be carried out with direct medical control from a physician unless a "standing order" policy has been established for a particular protocol.

Whose safety is your primary concern? Know what to do if a scene becomes unsafe.

-YOUR safety is YOUR primary concern

-IF a scene becomes unsafe: HAUL ASS out of there. It is NOT pt abandonment if YOU leave in a DANGEROUS situation; ex: active shooting

• Understand the situation

• Watch for dangerous conditions

• Consider cultural differences

• Wait for the police to secure violent scenes

• Remember your safety gear and equipment

• Operate the ambulance as safely as possible

• Perform a pre-shift vehicle checkout

• Watch your back

eSCAPe

e= EVERY pt

S= SOCIAL support

C= CHOICE & CONTROL

A= ANTICIPATE

P= PLAN & ORGANIZE

e= every TIME

Emancipated Minor (In TX)

- 16 y/o AND

-RESIDES separate AND apart (housing) and is

-Managing OWN FINANCIAL AFFAIRS

• may consent to care for pregnancy

• if unmarried, may consent for care of own child

Legally, what can emancipated minors do?

• may consent to care for pregnancy

• if unmarried, may consent for care of own child

• Diagnosis/treatment of an INFECTIOUS/CONTAGIOUS/COMMUNICABLE DISEASE

• EXAMINATION/ Treatment for DRUGS & ALCOHOL

EXPRESSED consent

-consent given by LEGAL ADULTS
-AOX4 to make a RATIONAL decision for their wellbeing

IMPLIED consent

PT who is UNABLE to VERBALIZE consent is TREATED under the legal premise that they WANT it

In loco parentis ("in the place of a parent")

LEGAL RESPONSIBILITY of a person/ organization to take on SOME of the FUNCTIONS/RESPONSIBILITIES of a PARENT.

Involuntary Transportation

- Patient considered A THREAT to THEMSELVES/ OTHERS
- COURT order
- Usually a DECISION by MENTAL HEALTH PROFESSIONAL/POLICE OFFICER
- If PT is RESTRAINED, ensure the PT'S HEALTH and WELL-BEING

What does a DNR (DO NOT RESUSCITATE) order allow you as an EMT to do?

- can’t perform (CPR, Intubation, Defibrillation)
- May be part of POLST (Physician Order for Life Sustaining Treatment)
- Be FAMILIAR c/ LIVING wills and HEALTHCARE PROXIES

What SHOULD and SHOULDN'T you do when abiding by a DNR order?

-A pt with a DNR does NOT mean you don't treat them
-For ANY reason you decide to NOT treat a pt because of DNR that counts as NEGLIGENCE

Pt refusal (AMA: can VS can NOT)

-Pt must be LEGALLY ABLE --> consent
-Pt MUST be AxO4
-Pt MUST be FULLY INFORMED
-Pt must SIGN care refusal form (must have WITNESSES present)
**Pts can refuse treatment at ANY time, do NOT subject them to UNWANTED care/transport, that is considered ASSAULT and/or BATTERY**

Is parental/guardian consent for an injured minor absolutely necessary to initiate treatment and transport?

NO

When you CAN reach parents, what should you do?

-IF it is possible to reach the parents/guardian then obtain consent, HOWEVER

When you can NOT reach parents, what should you do?

-If parents/guardians are UNAVAILABLE, consent is IMPLIED
Other exceptions (CHECK LOCAL LAW)
-In loco parentis
-EMANCIPATED MINORS (children in armed forces/have kids)

Whose responsibility is it to make sure that your EMS certification(s) stay current?

it is YOUR responsibility.

ECA, EMT, AEMT

emergency care assistant, emergency medical technician (BLS ONLY,) Advanced Emergency Medical Technician (BLS & ALS)

Paramedic-CERTIFIED

COMPLETED a paramedic COURSE, but NOT a DEGREE

Paramedic-LICENSED

Anyone that has a 2 OR 4 year EMS degree in ANY field

Routes by which communicable diseases can be spread.

-Airborne
-Droplet transmission (respiratory)
-STDs
-Animal/insect
-Food/Water
-Hospice care (think of sepsis!)

Ways to PREVENT SPREADING of an infectious disease

EMS agencies:
-Provide TRAINING
-PPE
-Vaccinations
-Exposure control plan
-Housekeeping/Labeling
-Postexposure evaluation + follow-up

What are some things that can be done to AVOID LITIGATION?

Adhere to:
-Standard of Care
-Duty to Act (ON duty)
-Scope of Practice

Does an EMT have a LEGAL "Duty to Act" if, while OFF DUTY, he/she witnesses a person collapse at the mall?

DUTY TO ACT OFF DUTY IS NOT ALWAYS CLEAR
-Follow LOCAL LAWS & PROTOCOLS
-Follow YOUR OWN conscience

• most circumstances —> not legally required to act

• BUT failing to act in an emergency could qualify as a civil tort if the inaction —> injury, illness or death

Eustress

(+) POSITIVE form of stress; helps those work under pressure and RESPOND EFFECTIVELY

Distress

(-) NEGATIVE, CAUSES STRESS --> LONGTERM health problems w/ health and well-being

S/S of Stress

-irritability
-anxiety
-insomnia
-guilt
-loss of interest in working
-inability to concentrate

What are the FIVE CAUSES of stress?

1. MCI (mass casualty incident)
2. Infants/children
3. SEVERE injuries
4. Abuse/neglect
5. Coworker death

what to do if you have an ACCIDENTAL STICK by a CONTAMINATED NEEDLE?

-WASH the affected area
-FACT CHECK the used needle (for HIV, Hep B or C)
-Get TREATED IMMEDIATELY
Post-exposure prophylaxis:
-Vaccine for Hep B and/or C, additional immunization shots etc
-REPORT incident

ACUTE Stress Reaction

-CATASTROPHE linked

-S/S develop quickly

-NORMAL REACTIONS --> EXTRAORDINARY situations

DELAYED Stress Reaction

-PTSD
-S/S NOT evident until LONG after an incident
Delay --> dealing with stress becomes more DIFFICULT (pt may NOT recognize the problem)

CUMULATIVE Stress Reaction

Progresses to:

-LOSS of emotional control

May present as:

*SEVERE withdrawal

*SUICIDAL THOUGHTS

SIX PHYSIOLOGICAL signs of stress

1. Irritability
2. INABILITY to CONCENTRATE
3. CHANGES in daily activities/loss of interest in work
4. Anxiety
5. Indecisiveness
6. Isolation

Methods for coping with stress

Lifestyle changes:
-More HELPFUL and POSITIVE DIETARY HABITS
-EXERCISE
-RELAXATION
-LIGHTER call volume, DIFFERENT call types, more FAMILY TIME

OSHA (Occupational Safety and Health Administration)

GOVERNMENT agency in the Department of LABOR to maintain a SAFE and HEALTHY work environment

TYPES of PPE and WHEN to use them

-Gloves: Changed BETWEEN pts; HEAVY weight and TEAR resistant

-Eye & Face Protection: PREVENTS SPLASHING/spraying FLUIDS

-Masks (2): Blood/fluid=SURGICAL; Tuberculosis=N95/HEPA (approved by OSHA)

-Face Shield: Protection of the ENTIRE face

-Gowns: Wear if pt has...
*ARTERIAL BLEED
*CHILDBIRTH
*MULTIPLE injuries

Ryan White Care Act

Allows EMS providers to determine EXPOSURE to LIFE-THREATENING diseases during pt. care provision

THREE STAGES of STRESS

1st Stage= Alarm reaction (FIGHT or FLIGHT)
2nd Stage= RESISTANCE (coping)
3rd Stage= Exhaustion (LOSS of ability to resist/adapt to stressor)

4 THINGS: Proving a Negligence claim!!

MUST prove:
1. EMT had a duty to ACT
2. BREACH of duty
3. EMT FAILED to provide the standard of care expected or failed to act
4. Proximate CAUSATION- pt suffered HARM due to EMT actions/inaction

Negligence

Something that should have been done
was not done or was done incorrectly

Abandonment

LEAVING a pt AFTER care INITIATION, BEFORE being transferred to someone with equal or greater medical training.

Good Samaritan Act

Grant IMMUNITY from LIABILITY if rescuer acts in GOOD faith (within the level of training)
*May NOT cover EMTs in SOME situations
*DOES NOT protect persons from GROSS NEGLIGENCE/law VIOLATIONS

ALL stages of GRIEF (5)

1. DENIAL or "not me."
2. ANGER or "WHY me??"
3. BARGAINING "OK, but first let me..."
4. DEPRESSION or "OK, but I haven't..."
5. ACCEPTANCE --> "OK, I'm not afraid."

As we treat our patients, what should we do to help EASE their ANXIETY?

-RECOGNIZE pt needs
-TOLERANCE of angry reactions
-LISTEN empathetically
-NO FALSE reassurance
-OFFER as much COMFORT (realistically)

Describe the BODY MECHANICS utilized when MOVING ANY PT.

CONSIDER:
-The OBJECT
-Its WEIGHT and ADDITIONAL HELP requirements (for lift)
-YOUR limitation
-COMMUNICATION, plan to communicate w/ your PARTNER

• feet shoulder width apart

• use legs not back

• never twist and turn

• keep weight as close as possible

Critical incident stress debriefing (CISD)

-Helps responders DIFFUSE after incident
-Team of peer counselors/mental health professionals
*MAJOR incident 24-72hrs post-incident
-Helps responders DEAL with STRESS

DEATH: ALL stages

1. LOSS of Appetite
2. DECREASE in the body's CIRCULATION
3. Restlessness (as the body continues to shut down)

• bargaining: trading good behavior for health

• depression: anticipatory grief (pt mourns prospect of death)

• acceptance: says goodbyes & divides possessions

How does HIPAA protect patients?

- Gives pts more CONTROL over their medical RECORDS
- Pts can make INFORMED CHOICES about the uses of their PHI
- SETTING BOUNDARIES on the use and release of health records
- Holding violators accountable if privacy is VIOLATED

Crime scenes: Navigation

KNOW what evidence is and PRESERVE it!!!
-REMEMBER what you TOUCH
-MINIMIZE your impact (on SCENE)
-WORK with police

Morality vs. Ethics

MORALITY= WHAT is the right action
ETHICS= WHY an action is right

Mandatory Reporting

REQUIRED to report:
-GSW (gunshot wounds)
-VIOLENT stabbings
-INFECTIOUS diseases (public health matter)
-Births/Deaths
-Elder abuse

How do Safe Haven laws AFFECT EMTs?

PROTECTS children from being ABANDONED or harmed by NEGLIGENT CARETAKERS or those UNABLE to care for them

EMERGENCY moves may be necessary​ if:

there is a threat of FIRE or possible EXPLOSION.

URGENT moves are required when:

LIFE THREATS exist but there is time for PRECAUTIONS for SPINAL injuries.

NON-URGENT movement/lift is used when:

BOTH the PT & SCENE is SAFE

BASKET stretcher (A.K.A. Stokes)

TUNNEL rescues and tight spaces

SCOOP stretcher

SPLITS in TWO or FOUR sections, so it can be used where LARGER stretchers CAN NOT fit.

BARIATRIC stretcher

Stretcher for OBESE pts

Stair Chair

Used to carry patients up and down stairs

Recovery position

A SIDE-lying position is used to MAINTAIN A CLEAR AIRWAY in UNCONSCIOUS PTS W/O injuries who are BREATHING ADEQUATELY.

What is the CORRECT way to lift a stretcher?

1. LOCK your BACK & STRAIGHTEN your LEGS
2. When grasping a stretcher/backboard, your HANDS should be 10 INCHES/25 CM APART
3. LIFT BY EXTENDING the properly placed LEGS

Lateral

AWAY from the MIDLINE

Medial

TOWARD the MIDLINE

Transverse

DIVISION of the body into the TOP & BOTTOM

Bilateral

On BOTH SIDES of the midline

Unilateral

ONE side of the body

Proximal

NEAR the TRUNK of the body

Distal

NEAR the TRUNK of the body

Sagittal

LEFT and RIGHT halves of the body

RUQ

right UPPER quadrant
-liver
-gallbladder
-duodenum
-HEAD of pancreas
-RIGHT kidney and adrenal
-hepatic FLEXURE of COLON
-part of ASCENDING and
TRANSVERSE colon

RLQ

right LOWER quadrant
-Appendix
-UPPER PORTION of colon
-RIGHT ovary & fallopian tube (women)

LUQ

Left UPPER quadrant
-Stomach
-Spleen
-LEFT portion of the liver
-MAIN pancreas
-LEFT portion of kidney + adrenal glands
-SPLENIX colon flexure
-BOTTOM colon

LLQ

Left LOWER quadrant
-TRANSVERSE, DESCENDING, SIGMOID colon sections
-PART of SMALL INTESTINE
-URETER (LEFT kidney)
-ILIAC FOSSA (hip bone + pelvis)

Fowler

semi-sitting position with SLIGHT elevation of the knees

Semi-fowler

Pt sits at a 45-degree angle

skeletal system functions

• Gives the body shape

• Protects vital internal organs

• Provides for body movement

Mandible

LOWER jaw bone; gives the lower face its shape

Maxillae

the TWO FUSED bones FORMING the UPPER JAW; supports the UPPER teeth

Nasal bones

form the BRDIGE of the NOSE; PROTECTS nasal cavity from EXTERNAL factors

Orbits

the bony structures AROUND the EYES; the eye SOCKETS

Parts of the skull

frontal, parietal, temporal, occipital

Spinal Column

bone tissue surrounding the SPINAL CAVITY

Thorax

pleural cavity, chest; provides LUNG LUBRICATION

Pelvis

hip bone; attachment point between the TORSO and LOWER extremities

Joints VS Muscles

Joint: An are where 2 or MORE bones come TOGETHER; structural integrity of the body

Muscle: Enable MOVEMENT

Hinged joint

FLEXION and EXTENSION; elbow, knee, finger

Pivotal joint

allows movement from SIDE--> SIDE and UP and DOWN

atlantoaxial joint which is formed between vertebra

Ball and Socket joint

shoulder and hip

Saddle joint

type of joint found at the BASE of EACH THUMB ; allows GRASPING and ROTATION

Condyloid joint

synovial (fluid filled joint cavity) joint that does everything EXCEPT ROTATING

Gliding joint

allows ONE BONE TO SLIDE OVER ANOTHER; found in WRISTS and ANKLES

SKELETAL muscle

striated and voluntary

SMOOTH muscle

Involuntary muscle found inside many internal organs of the body

CARDIAC muscle

Muscle of the heart

Anatomy of the Airway

1. Nose or open mouth. Nose is always open
2. Air goes into the nasopharynx and/or oropharynx and down through the larynx
3. At the level of the larynx and above is the upper respiratory trac
4. The air passes through the larynx and into the lower respiratory tract of the trachea

Know the background and history of EMS from its inception until now

1790s

• French began to transport wounded
  soldiers away from the scene of battle
  for care by physicians.

• Earliest documented Emergency
  Medical Service

Civil War

Clara Barton began emergency service
for wounded and later helped establish
American Red Cross

Know the background and history of EMS from its inception until now

WWI

• Volunteer ambulance corps

  Korea/Vietnam
  – Medical teams produced advances in field care.
  – Battlefield advances led to civilian advances such as specialized emergency medical centers devoted to the treatment of trauma.

Nonmilitary ambulance services began operating in early
1900s in U.S.
- Transport services only with little or no emergency
care
– Did not develop in smaller communities until late
1940s
– Operated by local undertaker or fire service
– Need to organize systems for emergency prehospital
care and train personnel recognized

EMS Today

• 1966 Department of Transportation charged

  with developing E M S standards

• 1970 Founding of the National Registry of E M Ts (N R EM T)

• 1973 National Emergency Medical Service Systems Act passed by Congress