Emergency Medical Services Key Concepts

Personal Safety and Preparation

  • Personal safety is a high priority.

    • Verify location and route of travel.

    • Utilize all available information to prepare for emergencies.

    • Anticipate the highest probability "what ifs."

    • Preassign team roles for efficiency and safety.

Course Guidelines

  • Pre-lecture preparation required:

    • Read the chapter before attending lectures.

    • Note that not all chapters are covered in class discussions.

    • A final grade of 75.9 is achievable in the course.

    • Students can miss up to 23 hours of class.

Chapter 1: Emergency Medical Services (EMS)

EMS Definition

  • Health care, public health, and public safety are all relevant to EMS.

Primary Roles in Emergency Response

  • Team Leader

    • Directs the operation and maintains the highest level of care.

  • Supervisor

  • Documentor

  • Law Interpreter

  • Social Worker

  • Conflict Resolution Specialist

Response Priorities

Primary Responsibility Assessment

  1. General Appearance

  2. Responsiveness

  3. ABC (Airway, Breathing, Circulation) assessment.

  4. Make decisions on whether to continue assessment or transport.

  5. Collect Patient History.

  6. Monitor patient status consistently.

Scene Size-Up Procedure

  • Begins as soon as a call is dispatched.

    • Review all available information related to the incident.

    • Anticipate the response to the Mechanism of Injury (MOI) or Nature of Illness (NOI).

Upon Arrival at Scene

  • Evaluate scene safety first.

  • Report to dispatch using the 5 W's: Who, Where, What, When, Why.

Components of Situational Awareness (SA)

  1. Perceive environmental elements and events relative to time and space.

  2. Comprehend the meaning of these elements.

  3. Project their future status.

Specific Personnel Responsibilities

  • Stabilize wreckage.

  • Turn off electrical power to avoid hazards.

  • Mitigate any hazardous materials.

  • Call for Law Enforcement (LE) to control traffic and crowds.

  • Manage cases of violence appropriately.

Managing Combative Patients

  • Assess intent behind an attack.

    • An attacker, not a patient, can be dangerous.

    • Analyze body language and verbal cues for clues to their intent.

Physical Indicators of Escalation to Violence

  • Flushed or pale face.

  • Diaphoresis (excessive sweating).

  • Pacing or erratic movements.

  • Trembling.

  • Clenched jaw or fists.

  • Violent gestures.

  • A change in voice or loud speech.

  • Tachypnea (rapid breathing).

  • Use of abusive language.

  • Avoiding eye contact or glaring.

  • Violating personal space.

  • Displaying intentional uncooperativeness.

Primary Assessment

History Considerations

  • Document any recent or past violence.

  • Consider the effects of alcohol or stimulant influence on the patient.

  • Conduct physiological reviews quickly to identify life-threatening pathophysiological concerns.

Initial Steps

  • Begin assessment at the time of dispatch by gathering a sense of the scene environment.

    • Anticipate the critical nature of the illness or injury based on scene information that dictates:

      • Safety concerns.

      • The need to shift to multi-patient triage.

      • Issues accessing patients.

Major Questions During Assessment

  1. Is the patient dead or alive?

    • Look for signs incompatible with life (e.g., rigor mortis, dependent lividity, massive brain damage).

  2. Is the patient sick or not?

    • Use general impressions to dictate the speed and location of the primary assessment.

    • Examples of patients deemed "really sick":

      • Severe hemorrhage (address bleeding immediately).

      • Apneic patients showing agonal respirations.

      • Check carotid pulse in pulseless situations.

      • CAB (circulation, airway, breathing) with ACLS (Advanced Cardiac Life Support) trained care.

Assessing the Patient

Assessment Triangle Components

  • Appearance

  • Work of Breathing

  • Circulation

Important Considerations

  • Chronic illnesses can complicate assessments, generating a larger list of possible diagnoses and treatments.

  • Stabilize the cervical spine if needed.

  • For unconscious patients, airway stabilization is crucial.

  • For conscious patients, assess for clearance before proceeding.

Past General Impression Assessment

  • Monitor baseline mental status using AVPU (Alert, Voice, Pain, Unresponsive) scale and Orientation (AO).

  • Provide organized, coherent answers to questions asked during assessment.

  • Monitor reaction to verbal and painful stimuli.

Airway Management and Ventilation

Assessment Techniques

  • Check for airway patency:

    • If unconscious, utilize head-tilt/chin-lift or jaw thrust maneuver.

  • Instruct on airway management:

    • Use OPA (Oropharyngeal Airway) or NPA (Nasopharyngeal Airway) as needed.

    • Manage obstructive airway issues with suction or repositioning as required (e.g., gurgling or snoring sounds).

Breathing Assessment

  • Look, listen, and palpate the chest area for:

    • Rate of respiration (too fast or too slow).

    • Auscultation for wheezing or asymmetric lung sounds.

    • Observation for abnormal rhythmic breathing.

    • Asymmetrical chest wall movement or any visible holes.

Circulation Management

  • Assess and manage potential exsanguinating hemorrhages.

  • Pulses need to be checked in the carotid (for unconscious patients) or radial, femoral (for conscious).

    • Monitor rate: Is it too fast or too slow?

    • Check for regularity.

Secondary Assessment Process

  • Consists of repeating the primary assessment.

  • Conduct a physical examination focused on body areas and systems related to patient complaints.

Reassessment Needs

  • Monitor mental status throughout patient transport: perform AVPU exam frequently.

  • Any deterioration in mental status warrants reassessment of ABCs.

  • Changes in skin color, temperature, and conditions are indicators of hemodynamic status.

    • Cyanosis indicates decreased oxygen levels.

    • Pallor or coolness indicates poor circulation.

    • Hives may signal an allergic reaction.

Pathophysiology

Key Structures in Homeostasis

  • Homeostasis is maintained primarily through the:

    • Hypothalamus

    • Medulla oblongata

    • This involves the nervous system and hormone release.

Definitions

  • Physiology: Study of how living systems function during homeostasis.

  • Pathophysiology: Study of disordered physiological processes associated with disease or injury; involves disruption of homeostasis.

Components of the Body

  • Hierarchical Structures: cells → tissues → organs → organ systems → organism (human has 11 organ systems).

Acid-Base Balance

  • pH Scale: Ranges from 0-14, indicating acidity or alkalinity:

    • Higher values = more alkaline (basic).

    • Lower values = more acidic.

    • Water is neutral at 7.0.

    • Normal arterial blood pH is typically between 7.35 - 7.45, which is optimal for homeostasis.

Body Response to Imbalance

  • Acidosis leads to:

    • Increased respiratory rate to expel CO2.

  • Alkalosis leads to:

    • Decreased respiratory rate leading to CO2 retention.

Cellular Function

Factors Influencing Cell Life

  • Too Little Water: Causes cell dehydration, leading to cell death.

  • Too Much Water: Can result in cellular disruption, causing cells to burst.

  • Water also plays a role in electrolyte balance, impacting cellular function and electrical activity.

Metabolism Types

  • Aerobic Metabolism: Utilizes oxygen for energy production.

  • Anaerobic Metabolism: Occurs without oxygen, producing less energy and more waste, increasing acidity.

Electrolytes Role and Types

  • Electrolytes: Substances that dissociate into charged ions when dissolved in water.

    • Cations (positive ions): Sodium (Na+), Potassium (K+), Calcium (Ca++), Magnesium (Mg++).

    • Anions (negative ions): Chloride (Cl-), Bicarbonate, Phosphate.

Cell Injury and Death Mechanisms

  • Causes of Cell Injury: Include hypoxia (decreased oxygen availability) and ischemia (diminished blood flow).

    • Ischemia can worsen acidosis.

    • Oxidative Stress: Free radicals causing damage to cells.

    • Chemical Injury: Direct toxic substances harming cell functionality.

Immune Response Overview

  • Components: Heart as a pump, blood as fluid, blood vessels as pipes.

  • Ischemia results in hypoxia, leading to anaerobic metabolism.

  • During hypoperfusion, the body compensates by increasing heart rate and contractility.

Phases of Inflammation

  1. Acute Inflammation: Blood vessels contract and dilate; white blood cells and plasma proteins move into tissues, causing redness and swelling.

  2. Chronic Inflammation: Macrophages attack infectious agents; dead cells may form pus.

  3. Granuloma Formation: Bodies encapsulate infectious materials.

  4. Healing Phase: Tissues regenerate; scar formation may occur.

Pharmacology

Drug Classifications

  1. Primary Use: The therapeutic purpose of the drug.

  2. Body Systems Affected: Determines target areas of drugs.

  3. Mechanism of Action: How the drug interacts with the body.

CNS and PNS Overview

  • CNS (Central Nervous System): Comprises the brain and spinal cord.

  • PNS (Peripheral Nervous System): All other nerves, encompassing both voluntary (somatic) and involuntary (autonomic) functions.

Types of CNS Drugs

  • Analgesics: Medications relieving pain (e.g., Opioids and Non-Opioid Analgesics).

  • Anesthetics: Drugs causing CNS depression and blocking specific nerve pathways.

Autonomic Nervous System Medications

  • Parasympatholytic (Anticholinergic): Drugs blocking neurotransmitter effects.

  • Parasympathomimetic (Cholinergic): Drugs stimulating effects at the synapse.

  • Neuromuscular Blockers: Induce paralysis without loss of consciousness.

  • Sympathomimetics: Stimulate epinephrine/norepinephrine release, affecting cardiovascular functions.

Legal Aspects in Pharmacology

  • Federal regulations aim to protect against mislabeled drugs and control substance distribution.

  • Includes the establishment of the FDA to enforce standards.

Components of a Drug Profile

  • Names: Generic and sometimes trade names.

  • Classification: Based on intended use and effects.

  • Pharmacokinetics vs. Pharmacodynamics:

    • Kinetics: Absorption, metabolism, excretion, dictated route and dosage.

    • Dynamics: Effects on the body and anticipated outcomes.