Emergency Care 14th Edition Study Notes

Emergency Care 14th Edition: Authorship and Publication Information

• Original Authors and Editors:     * Daniel Limmer, AS, LP, I/C.     * Michael F. O’Keefe, NRP.     * Medical Editor: Edward T. Dickinson, MD, NRP, FACEP.     * Legacy Authors: Harvey D. Grant, Robert H. Murray, Jr., and J. David Bergeron.

• Pearson Editorial Team:     * Senior Vice President, Product Management: Adam Jaworski.     * Director, Product Management: Katrin Beacom.     * Content Manager: Kevin Wilson.     * Development Editor: Rachel Bedard.     * Vice President, Content Production and Digital Studio: Caroline Power.     * Managing Producer, Health Science: Melissa Bashe.     * Content Producer: Faye Gemmellaro.     * Operations Specialist: Maura Zaldivar-Garcia.     * Director, Digital Production: Amy Peltier.     * Digital Studio Producer: William Johnson.     * Digital Content Team Lead: Brian Prybella.     * Product Marketing Coordinator: Brian Hoehl.     * Inventory Manager: Vatche Demirdjian.     * Manager, Rights & Permissions: Gina Cheselka.

• Production and Design:     * Full-Service Project Management and Composition: SPi Global.     * Interior and Cover Design: Studio Montage.     * Cover Art: Pearson photo by Michal Heron.     * Managing Photography Editor: Michal Heron.     * Photographers: Michal Heron, Kevin Link, Maria Lyle, Isaac Turner.     * Back Cover Photo: © Daniel Limmer.     * Printer/Binder: LSC Communications, Inc.

Clinical Notices and Legal Disclaimers

• Notice on Care Procedures: The textbook is intended for use in formal EMT education programs taught by qualified instructors and supervised by a licensed physician. Procedures reflect currently accepted clinical practice but are not absolute recommendations. Regulations from federal, state, and local agencies change rapidly and take precedence.

• Notice on Medications: Equipment, doses, and schedules were correct at the time of publication. Prehospital providers must have authorization from their Medical Director in accordance with local laws. Users are advised to consult package inserts for equipment and drugs before administration.

• Notice on Gender and Scenarios: The text uses non-gender-preferential language except in case studies. "Street Scenes" and "Scenarios" use fictitious names and situations.

• Copyright Details: © $2021$, $2016$, $2012$ by Pearson Education, Inc. (Hoboken, NJ).     * ISBN-10: $0-13-662126-0$.     * ISBN-13: $978-0-13-662126-3$.

Section 1: Foundations

• Chapter 1: Introduction to Emergency Medical Services: Overview of the EMS system, history, and roles.

• Chapter 2: Well-Being of the EMT: Focuses on safety, personal protection ($PPE$), and stress management.

• Chapter 3: Lifting and Moving Patients: Body mechanics and patient-carrying devices.

• Chapter 4: Medical, Legal, and Ethical Issues: Scope of practice, consent, and confidentiality.

• Chapter 5: Medical Terminology: Language components of medicine.

• Chapter 6: Anatomy and Physiology: Structures and functions of the body.

• Chapter 7: Principles of Pathophysiology: How illness and injury affect the body.

• Chapter 8: Life Span Development: Physical and psychosocial patterns from birth to late adulthood.

Chapter 1: Introduction to Emergency Medical Services

• The Modern EMS System:     * Definition: A system designed to provide prehospital or out-of-hospital care to get trained personnel to the patient and provide care on the scene and en route to the hospital.

• History of EMS:     * $1790s$: French transport wounded soldiers from battlefields to physicians (earliest documented service).     * American Civil War: Clara Barton established service and later the American Red Cross.     * World War I: Volunteer battlefield ambulance corps.     * Korean and Vietnam Wars: Advances in field care and specialized trauma centers.     * Early $1900s$: Nonmilitary ambulance services in major U.S. cities (transport only).     * Late $1940s$: Smaller communities developed services, often using hearses provided by local undertakers.     * $1960s$: Development of the modern system began.     * $1966$: National Highway Safety Act charged the U.S. Department of Transportation ($DOT$) with developing EMS standards.     * $1970$: National Registry of Emergency Medical Technicians ($NREMT$) founded.     * $1973$: National Emergency Medical Services Systems Act passed by Congress.

• NHTSA Standards for EMS Systems:     1. Regulation and Policy: Enabling legislation, lead agency, funding, and regulations.     2. Resource Management: Centralized coordination for equal access to care.     3. Human Resources and Training: Personnel trained to EMT level by qualified instructors.     4. Transportation: Safe, reliable transport via ground or air (helicopter/airplane).     5. Facilities: Delivery to the closest appropriate facility (e.g., trauma centers).     6. Communications: Universal $911$ access and dispatch-to-hospital systems.     7. Public Information and Education: Participation in injury prevention education.     8. Medical Direction: Physician oversight of protocols and quality improvement.     9. Trauma Systems: Triage/transfer guidelines and data collection.     10. Evaluation: Quality Improvement ($QI$) programs ($QA$ or $TQM$).

EMS System Components and Access

• The Chain of Human Resources:     * Patient -> $911$ Caller -> Emergency Medical Dispatcher ($EMD$) -> Emergency Medical Responders ($EMR$) -> EMTs/AEMTs/Paramedics -> Emergency Department Staff -> Allied Health Staff (Physicians, Nurses, Therapists).

• Specialty Hospitals:     * Trauma Centers: Surgery teams available $24$ hours a day.     * Other Specialties: Burn centers, pediatric centers, cardiac centers, and stroke centers.

• Accessing the System:     * $911$ System: Telephone access reported to a dispatcher. Approximately $240 \times 10^6$ calls annually in the U.S., with over $80\%$ from mobile devices.     * Enhanced $911$: Automatically identifies caller's landline phone number and location.     * Wireless Phase 1: Provides the dispatcher with the mobile number.     * Wireless Phase 2: Identifies the actual physical location of the mobile device.     * Emergency Medical Dispatchers ($EMD$): Specially trained to provide pre-arrival medical instructions (e.g., $CPR$, bleeding control).

• Levels of EMS Training:     1. Emergency Medical Responder ($EMR$): First at the scene (police, fire); focused on activating the system and immediate life-saving care.     2. Emergency Medical Technician ($EMT$): Minimum level for ambulance personnel; provides basic medical and trauma care.     3. Advanced Emergency Medical Technician ($AEMT$): Basic care plus advanced airway devices, $IV$ fluids, and some medications.     4. Paramedic: Most advanced level; perform advanced assessment and decision-making skills.

Roles, Responsibilities, and Traits of the EMT

• Key Responsibilities:     * Personal Safety: First responsibility is to keep oneself safe from human, animal, or environmental dangers.     * Safety of Others: Crew, patient, and bystanders.     * Patient Assessment: Identifying what is wrong with the patient.     * Patient Care: Actions from emotional support to $CPR$/defibrillation.     * Lifting and Moving: Performing moves without causing further injury.     * Transport: Safe operation of the ambulance.     * Transfer of Care: Providing information to hospital staff for continuity of care.     * Patient Advocacy: Speaking up for the patient's needs and concerns.

• Physical Traits:     * Good health and fitness.     * Ability to lift and carry up to $125\,lb$ ($57\,kg$).     * Coordination, dexterity, and excellent eyesight (corrected if necessary).     * Color vision is critical for assessing skin, lips, and nail beds.     * Ability to communicate orally and in writing.

• Personal Traits:     * Pleasant, sincere, cooperative, and resourceful.     * Self-starter, emotionally stable, and able to lead.     * Neat, clean, of good moral character, and respectful.     * Nonjudgmental and fair (treating all equally regardless of race or culture).     * Self-control (e.g., no alcohol within $8$ hours of duty, no smoking around equipment).

Quality Improvement and Medical Direction

• Quality Improvement ($QI$):     * Definition: Continuous self-review to identify and correct system aspects requiring improvement.     * EMT Role: Preparing neat/accurate documentation, participating in call critiques, maintaining equipment, and continuing education.

• Medical Direction:     * Medical Director: A physician responsible for the patient-care aspects of the EMS system.     * Protocols: Lists of steps for assessment and interventions developed by the Medical Director.     * Standing Orders: Protocols allowing EMTs to perform specific skills (e.g., naloxone administration) without contacting a physician.     * Off-line Medical Direction: Standing orders issued behind the scenes.     * On-line Medical Direction: Orders given directly via radio or telephone by an on-duty physician.

EMS Research and Public Health

• Research in EMS:     * Patient Outcomes: Focus on long-term survival rather than just reaching the hospital.     * Evidence-based Techniques: Practices supported by scientific evidence rather than tradition.     * Scientific Method:         1. General observations.         2. Hypothesis (unproven theory).         3. Predictions and testing.     * Peer Reviewed: Research submitted to journals and reviewed by professional peers to ensure accuracy.

• Public Health Role:     * Injury prevention for geriatric patients (e.g., fall prevention).     * Injury prevention for youth (e.g., car-seat clinics, bicycle helmets).     * Public vaccination programs.     * Disease surveillance (tracking trends such as flu or opioid overdoses).     * Mobile Integrated Healthcare: Programs using EMS providers in innovative public health roles outside of emergencies.

Questions & Discussion: Point of View and Street Scenes

• Point of View (Patient Perspective):     * The Choking/Allergic Reaction Patient: Recalls the rapid onset of an inability to breathe, raspy voice, and the life-saving effect of epinephrine administered by EMTs.     * The Car Crash Patient: Describes the sensation of the crash ("thunder seem like a whisper"), the feeling of foggy mental status, and the profound impact of a reassuring voice from a firefighter providing manual stabilization.

• Think Like an EMT: Critical Decisions:     * Scenario 1: A $16$-year-old asthma patient who is nodding off. (Indicates potential respiratory failure).     * Scenario 2: A $72$-year-old with pneumonia, rapid breathing, and diminished lung sounds. (Indicates unstable status).     * Scenario 3: A $35$-year-old drooling, sitting bolt upright (sniffing position). (Indicates potential epiglottitis or severe airway obstruction).     * Scenario 4: A $16$-month-old with a seal-like barking cough. (Indicates croup; currently stable but requires monitoring).

• Street Scene: Chuck vs. Susan:     * Chuck Hartley (Unprofessional): Unkempt uniform, failed to introduce himself, used inappropriate terms ("hon"), criticized the new EMT in front of the patient, and ignored the patient's urgent attempts to communicate.     * Susan Miller (Professional): Neat uniform, provided a proper orientation, checked equipment first, introduced members of the crew at the scene, reassured the patient that calling for help was the right decision, and used a mistake as a teaching moment with a supportive attitude.