Emergency Medical Services Fundamentals

Personal Safety and Response Preparation

• Personal safety is a high priority in emergency situations.

  • Verify location and route of travel.

  • Utilize all available information to prepare for responses.

  • Anticipate the highest probability "what ifs" for critical thinking.

  • Preassign team roles to ensure clarity and efficiency in action.

Course Management Details

• Students are advised to read chapters prior to lectures, as not all chapters are covered in class.

• Final course grading reflection: 75.9 as a consideration in performance evaluation.

• Attendance policy: Students can miss up to 23 hours of class time without penalty.

Chapter 1 Overview: EMS and Public Safety Roles

• The fields covered include health care, public health, and public safety.

  • Primary roles within this context are:

  • Team leader - responsible for overall coordination.

  • Supervisor - oversees operations in the field.

  • Documentor - responsible for keeping records of incidents.

  • Law interpreter - interprets legal obligations during emergencies.

  • Social worker - addresses mental health needs of patients.

  • Conflict resolutionist - mediates disputes and diffuses tensions.

Assessment Priorities

• Primary Responsibilities in Patient Assessment:

  • General appearance evaluation.

  • Assessment of responsiveness and vital signs (ABC: Airway, Breathing, Circulation).

  • Continuous monitoring of patient conditions.

Scene Size-Up

• This process begins as soon as a call is dispatched.

  • Review all available information regarding the situation.

  • Anticipate responses based on Mechanism of Injury (MOI) or Nature of Illness (NOI).

Upon Arrival at Scene

• Evaluate the safety of the scene before proceeding.

• Report essential details to dispatch using the 5 W's:

  • Who: Identify involved parties.

  • Where: Exact location of the incident.

  • What: Description of the incident.

  • When: Time of occurrence.

  • Why: Reason for response.

3 Components of Safety Awareness (SA)

• Perceive environmental elements and events related to time and space.

• Comprehend the meaning behind observed phenomena.

• Project future status and implications of the situation.

Response Protocols

• Specific personnel roles for effective scene management:

  • Stabilize wreckage and assess hazards (e.g., turn off electrical power, mitigate hazardous materials).

  • Call for Law Enforcement (LE) to control traffic and crowds, especially in violent situations.

• Guidelines for Handling Combative Patients:

  • Recognize non-patient attackers.

  • Assess the potential intent based on words and actions of aggressors.

Indicators of Escalation Toward Violence

• Identify physical signs of potential violence:

  • Flushed or pale face.

  • Diaphoresis (sweating).

  • Pacing or significant body movements.

  • Trembling or clenching fists.

  • Violent gestures or changes in voice tone.

  • Breathing abnormalities like tachycardia.

  • Abusive language or negative eye contact.

  • Proximity violations or intentional uncooperativeness.

Primary Assessment Protocol (Volume 2 Chapter 1)

• Gather a history of any recent or past violence occurrences.

• Consider influences of alcohol or stimulant use on patient behavior.

• Conduct a rapid assessment of the patient's physiological state to identify life-threatening conditions.

Dispatch Considerations

• Initial scene evaluation should also occur during dispatch to gain insight into potential safety and medical needs.

• Assessment of initial impressions is crucial:

  • "Dead or Not Dead" Indicators:

  • Signs incompatible with life include rigor mortis, dependent lividity, severe brain damage, or decomposition.

  • "Sick or Not Sick" Indicators:

  • General impressions to guide assessment speed and patient prioritization.

Critical Indicators of Severe Conditions

• Patients presenting with severe hemorrhage should be prioritized for bleeding control measures.

• Assess for airway issues, such as apneic or agonal respirations.

• Use rapid checks for carotid pulse to guide further treatment decisions:

  • Perform CAB (Circulation, Airway, Breathing) with Advanced Cardiac Life Support (ACLS) protocols, if required.

  • Use Assessment Triangle to observe:

  • Appearance - is the patient conscious and responsive?

  • Work of Breathing - is breathing labored or strained?

  • Circulation - check for visible pulses and their quality.

Key Assessments for Airway Management

• Management of Airway and Breathing:

  • Use head tilt/chin lift or jaw thrust technique for airway management of unconscious patients.

  • Monitor for signs of airway obstruction (gurgling, snoring, stridor).

  • Use appropriate adjuncts (OPA/NPA) for airway maintenance.

Focused Assessment of Breathing

• Look, listen, and palpate for:

  • Relative respiratory rate and patterns.

  • Evidence of abnormal lung sounds.

  • Assess bilateral chest expansion and any deviations or abnormalities.

Managing Circulation

• Control any exsanguinating hemorrhage as first priority.

• Conduct pulse checks appropriately based on the patient's condition:

  • For unconscious or apneic patients check carotid pulse; for others, check radial, femoral, and carotid pulses.

  • Note rhythms and rates to detect any cardiac irregularities.

Transition to Secondary Assessment (Volume 2 Chapter 5)

• The secondary assessment begins with a recap of the primary assessment for continuity.

• Focus on physical examination targeting specific body systems relevant to the patient's complaints.

Reassessment Protocol

• Continual AVPU (Alert, Verbal, Painful stimuli, Unresponsive) assessment during patient transport.

• Respond immediately to any changes in mental status by reassessing ABCs.

• Changes in skin color, temperature, and conditions indicate underlying issues:

  • Cyanosis indicates decreased oxygen levels.

  • Pallor or coolness can reflect circulation problems.

Vital Signs Assessment

• Key vital signs include:

  • Rising pulse rate with increasing respiratory rate and dropping blood pressure indicate shock.

  • Decreasing pulse rates with irregular respiratory patterns and rising blood pressure indicate increased intracranial pressure.

  • Monitor critical patients every 5 minutes or sooner.

Conclusion and Additional Notes

• Maintain focus on the critical aspects of patient assessment, management of airway, breathing, circulation, and continual reassessment for optimal patient outcomes.

• Note that the information detailed above captures comprehensive procedural knowledge necessary for EMS and healthcare providers to respond to emergency situations effectively.