National Emergency Medical Services

Education Standards
Emergency Medical Technician Instructional Guidelines

Preparatory
EMS Systems
EMT Education Standard
Applies fundamental knowledge of the EMS system, safety/well-being of the EMT, and
medical/legal and ethical issues to the provision of emergency care.

EMT-Level Instructional Guideline
The EMT Instructional Guidelines in this section include all the topics and material at the EMR
level PLUS the following material:

I. The Emergency Medical Services System
A. History
1. 1960s
2. Evolution to current EMS systems
B. NHTSA Technical Assistance Program Assessment Standards
1. Regulation and policy
2. Resource management
3. Human resources and training
4. Transportation
5. Facilities
C. Access to Emergency Medical Services
D. Education
1. Levels of EMS licensure
2. National EMS Education Agenda for the Future: A Systems Approach
E. Authorization to Practice
1. Legislative decisions on scope of practice
2. State EMS office oversight
3. Medical oversight
a. Clinical protocols
i. Offline
ii. Online
iii. Standing orders
b. Quality improvement
c. Administrative
4. Local credentialing
5. Administrative
6. Employer policies and procedures

II. Roles, Responsibilities, and Professionalism of EMS Personnel
A. Roles and Responsibilities
1. Maintain vehicle and equipment readiness

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2. Safety
a. Personal
b. Patient
c. Others on the scene
3. Operate emergency vehicles
4. Provide scene leadership
5. Perform patient assessment
6. Administer emergency medical care to a variety of patients with varied
medical conditions
7. Provide emotional support
a. Patient
b. Patient’s family
c. Other responders
8. Integration with other professionals and continuity of care
a. Medical personnel
b. Law enforcement
c. Emergency management
d. Home healthcare providers
e. Other responders
9. Resolve emergency incident
10. Maintain medical and legal standards
11. Provide administrative support
12. Enhance professional development
13. Develop and maintain community relations
B. Professionalism
1. Characteristics of professional behavior
a. Integrity
b. Empathy
c. Self-motivation
d. Appearance and hygiene
e. Self-confidence
f. Time management
g. Communication
i. verbal
ii. written
h. Teamwork and diplomacy
i. Respect for patients, co-workers and other healthcare professionals
j. Patient advocacy
k. Careful delivery of service
2. Maintenance of certification and licensure
a. Personal responsibility
b. Continuing education
c. Skill competency verification
d. Criminal implications
e. Fees

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III. Quality Improvement
A. System for Continually Evaluating and Improving Care
B. Continuous Quality Improvement (CQI)
C. Dynamic Process

IV. Patient Safety
A. Significant – One of the Most Urgent Health Care Challenges
B. High-Risk Activities
1. Hand-off
2. Communication issues
3. Dropping patients
4. Ambulance crashes
5. Spinal immobilization
C. How Errors Happen
1. Skills-based failure
2. Rules-based failure
3. Knowledge-based failure
D. Preventing Errors
1. Environmental
a. Clear protocols
b. Light
c. Minimal interruptions
d. Organization and packaging of drugs
2. Individual
a. Reflection in action
b. Constantly question assumptions
c. Reflection bias
d. Use decision aids
e. Ask for help

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Formulate a question about appropriate treatments 2. The Challenge for EMS Is the Relative Lack of Prehospital Research D. adopt the new therapy allowing for unique patient needs Page 4 of 212 . Appraise evidence for validity and reliability 4. If evidence supports a change in practice. Medical knowledge 2. High-Quality Patient Care Should Focus on Procedures Proven Useful in Improving Patient Outcomes C. safety/well-being of the EMT. Search medical literature for related research 3. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level plus the following material: I. and medical/legal and ethical issues to the provision of emergency care. Intuition 3. Evidence-Based Decision-Making A. Judgment B. Traditional Medical Practice Is Based on 1. Evidence-Based Decision-Making Technique 1. Preparatory Research EMT Education Standard Applies fundamental knowledge of the EMS system.

Preparatory Workforce Safety and Wellness EMT Education Standard Applies fundamental knowledge of the EMS system. Bargaining 4. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level plus the following material: I. Personal Protective Equipment III. Denial 2. Acute stress reaction 2. Adherence to Standard Precautions/OSHA Regulation C. Acceptance Page 5 of 212 . Recognize response to family and friends 4. Stress Management 1. Occupational Health and Blood borne Pathogens 1. Change in work environment 5. Dealing With Death and Dying (stages) 1. Anger 3. Balance in life 3. safety/well-being of the EMT. Types of Stress Reactions 1. Sharps II. Safe Operation of EMS/Patient Care Equipment D. Immunizations 2. Hand washing B. Change in lifestyle 2. Environmental Control E. Cumulative stress reaction B. Standard Safety Precautions A. Delayed stress reaction 3. Seek professional assistance C. and medical/legal and ethical issues to the provision of emergency care. Depression 5. Stress Management A.

Hazard awareness F. Prevention of Work-Related Injuries A. Techniques Page 6 of 212 . Correct reaching for log rolls 6. Correct carrying procedure d. inadequate breathing iii.IV. Emergency moves a. Lifting techniques 1. Correct carrying procedure on stairs 5. Lifting and Moving Patients A. Safe lifting techniques C. Adherence to Standard Precautions/OSHA regulations G. Safe Lifting of Cots and Stretchers 1. altered mental status ii. Reaching a. Blood borne V. Pushing and pulling guidelines a. Guidelines for lifting B. Safety Precautions 2. Emergency move i. Power-lift or squat lift position 2. Non-urgent move 7. Danger to patient b. patient’s location or position (e. Adequate sleep D. Disease transmission prevention 1. Vehicle restraint systems B. gain access to other patients in a vehicle who need life- saving care v. fire or danger of fire ii. Power grip 3. Indications for urgent move i.g. explosives or other hazardous materials iii. Carrying a. shock (hypoperfusion) c. Precautions for carrying b. One-handed carrying technique e. Guidelines for reaching b. Application for reaching techniques c. Back in locked-in position 4. Guidelines for carrying c. Communicable 2. Physical fitness and nutrition E.. a cardiac arrest patient sitting in a chair or lying on a bed) b. other hazards at the scene iv.

Pregnant patient with hypotension 5. Transfer of supine patient from bed to stretcher i. Portable stretcher c. A patient with chest pain. Standard 3. Reasonable Prevention of Harm a. draw sheet method D. Ramps e. Winches G. and upkeep E. Danger to patient b. Suicidal b. Unresponsive patient without suspected spine injury 2. Ambulances d. Extremity lift (no suspected extremity or back injuries) c. backboards) i. Techniques C. long ii. or difficulty breathing 3. Patient Positioning 1. Direct ground lift (no suspected spine injury) b. Homicidal c. A patient who is nauseated or vomiting 6. Equipment 1. Techniques 1. Bariatric stretcher g. Stair chair d. 8. cleaning. Use of Force Doctrine 2. A patient with suspected spine injury 4. short 4. Neonatal Isolette 5. direct carry ii. Flexible stretcher f. Medical Restraint 1. Bariatric patients 7.e. Personnel Considerations VI. Disease Transmission Page 7 of 212 . Wheeled stretcher b. Stretchers/cots a. repair. Maintenance—follow manufacturer’s directions for inspection. Scoop or orthopedic stretcher e. discomfort. Pneumatic or electronic stretchers 2. Non-urgent moves a. Tracked systems (i. Patient Size F. Urgent moves a.

Physical Fitness a. Wellness Principles A. Alcohol and drug issues 2. Injury prevention B. Stress management 4. Mental Wellbeing 1. Disease prevention 4. Muscle flexibility 2. Relationship issues Page 8 of 212 . Smoking cessation 3. Cardiovascular endurance b.VII. Physical Wellbeing 1. Muscle strength c. Sleep 3.

and any changes upon arrival at the receiving facility ii. service statistics Page 9 of 212 . Preparatory Documentation EMT Education Standard Applies fundamental knowledge of the EMS system. billing ii. Minimum Dataset 1. Accurate and synchronous clocks B. Time of arrival at patient d. Legal document i. Educational—used to demonstrate proper documentation and how to handle unusual or uncommon cases d. information should include objective and subjective information and be clear c. Time of arrival at destination f. Functions a. Initial assessment c. Time of transfer of care 3. Time unit notified c. safety/well-being of the EMT. documented what emergency medical care was provided. the status of the patient on arrival at the scene. Administrative information a. Time incident reported b. Prehospital Care Report 1. Patient demographics 2. Chief complaint b. the person who completed the form ordinarily must go to court with the form iii. Vital signs d. and medical/legal and ethical issues to the provision of emergency care. Principles of Medical Documentation and Report Writing A. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Patient information a. Administrative i. Time unit left scene e. Continuity of care b.

Documentation of Patient Refusal 1. traditional written form with check boxes and a section for narrative ii. Uses a. informed decision Page 10 of 212 . e. don’t conclude b) include pertinent negatives c) record important observations about the scene d) avoid radio codes e) use abbreviations only if they are standard f) when information of a sensitive nature is documented. When an error of omission or commission occurs. Distribution e. Falsification Issues a. Research f. Before leaving the scene a. do not chart that the patient was given oxygen C. run data ii. Evaluation and continuous quality improvement 2. narrative section (if applicable) a) describe. Confidentiality d. note the source of that information g) State reporting requirements h) be sure to spell words correctly. Sections i. record time and findings v. check boxes a) be sure to fill in the box completely b) avoid stray marks iv. Ensure the patient is able to make a rational. computerized version where information is filled in by means of an electronic device or over the Internet b. treatment—if a treatment like oxygen was overlooked. especially medical words i) for every reassessment. Falsification of information on the prehospital care report c. Try again to persuade the patient to go to a hospital b. Health Information Portability and Accountability Act of 1996 (HIPAA) 3. Types i. Specific areas of difficulty i. document what did or did not happen and what (if any) steps were taken to correct the situation b. vital signs—document only the vital signs that were actually taken ii. patient data iii. other State or local requirements c. Competent adult patients have the right to refuse treatment 2.

or bystander sign the form verifying that the patient refused to sign. Errors discovered while/after completing an electronic report i. Multiple-Casualty Incidents (MCI) a. draw a single line through the error. care EMT wished to provide for the patient iv. and the EMT’s initials c. document any assessment f. document that the patient did not allow for proper assessment and document whatever assessments were completed iii. If the patient refuses to sign the refusal form. preferably in a different color ink. If the patient still refuses. if information was omitted. if the patient refused care or did not allow a complete assessment. initial and date it. have a family member. the EMT will need to fill out the report later Page 11 of 212 . Have a family member. most electronic prehospital care report systems have a method for entering and amending the report ii. Complete the prehospital care report i. the date. Errors discovered while the report form is being hand-written i. police officer or bystander sign the form as a witness. police officer. complete patient assessment ii. and add a note with the correct information ii. state willingness to return D. and write the correct information beside it ii. add a note with the correct information. do not try to obliterate the error—this may be interpreted as an attempt to cover up a mistake b. offer alternative methods of gaining care vi. When there is not enough time to complete the form before the next call. c. including potential death v. Special Situations/Reports/Incident Reporting 1. Correction of errors a. statement that the EMT explained to the patient the possible consequences of failure to accept care. Inform the patient why he should go and what may happen to him if he does not d. Errors discovered after a hand-written report form is submitted i. Consult medical direction as directed by local protocol e. draw a single horizontal line through the error. initial it. g. if there is no way to electronically submit a change or addendum one should follow the correction method used for a handwritten report that has already been submitted on the printout of the electronic report 2.

should be submitted to the authority described by local protocol f. as appropriate e. Used to document events that should be reported to local authorities. Information gathered from the prehospital care report can be used to analyze various aspects of the EMS system 5. Injury 4. The local MCI plan should have some means of recording important medical information temporarily c. The report. Should be submitted in timely manner and should include the names of all agencies. Should be accurate and objective. and facilities involved c. Special situation reports a. EMT should keep a copy of this transfer report for use as a reference during the primary prehospital care report and should submit the copy with the final prehospital care report Page 12 of 212 . or to amplify and supplement primary report b. The standard for completing the form in an MCI is not the same as for a typical call 3. people. be descriptive and don’t make conclusions d. The EMT should keep a copy for his own records. This information can then be used to improve different components of the system and prevent problems from occurring 6. Exposure g. b. and copies if appropriate. Drop report/transfer report a. Goal should be to provide a report prior to departing from the hospital – needs to contain minimum data set and a transfer signature b.

Cellular telephones B. Response to the scene a. Mobile transmitters usually transmit at lower power than base stations (typically 20-50 watts) c. Base station 2. Handheld device b. Dispatcher must be notified b. safety/well-being of the EMT. Arrival at the receiving facility or rendezvous point – dispatcher must be notified 6. EMS Communication System A. Mobile radios (transmitter/receivers) a. System Components 1. Preparatory EMS System Communication EMT Education Standard Applies fundamental knowledge of the EMS system. Arrival at the scene – dispatcher must be notified 4. medical/legal and ethical issues to the provision of emergency care. Typically have power output of 1-5 watts. The dispatcher needs to be notified that the call was received b. Radio frequencies 2. Vehicular mounted device b. Radio Communications 1. limiting their range 4. Typical transmission range is 10-15 miles over average terrain 3. Repeater/base station 5. Prolonged on-scene times with absence of communications 5. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Depart the scene a. Dispatch needs to know that the unit is en route 3. Arrival for service after patient transfer – dispatcher must be notified Page 13 of 212 . Digital radio equipment 6. Portable radios (transmitter/receivers) a.

” “thank you. When the transmission is finished. Communication With Other Health Care Professionals A. courtesy is assumed. make sure the radio is on and volume is properly adjusted ii. speak clearly. Communication With Receiving Facilities 1. speak with lips about two to three inches from the microphone v. address the unit being called. the airwaves are public and scanners are popular xv.” use “affirmative” and “negative” xviii. Orders that are unclear or appear to be inappropriate should be questioned or clarified for the EMT B. Medical control a.g. the unit being called will signal that the transmission should start vii. listen to the frequency and ensure it is clear before beginning a transmission iii. one should limit saying “please. avoid codes or agency-specific terms xi. then give the individual digits xiv. After receiving an order for a medication or procedure—repeat the order back word for word 5. give the number. At a separate site 2. keep transmissions brief ix. EMT having the right room. do not use profanity on the air xvii. indicate this by saying “over” Page 14 of 212 . use clear text x. equipment. and personnel prepared or allow the facility to plan for the patient 2. and slowly in a monotone voice viii. calmly. when transmitting a number that might be confused (e. Communication With Medical Control 1.” and “you’re welcome” xiii. EMTs must be accurate 4. At the receiving facility b.II. press the “press to talk” (PTT) button on the radio and wait for one second before speaking iv. EMTs may need to contact medical control for consultation and to get orders for administration of medications 3. and then give the name of the unit vi. Patient reporting concepts a. use the standard format for transmission of information xix. avoid words that are difficult to hear like “yes” and “no. When speaking on the radio.. avoid meaningless phrases like “be advised” xii. a number in the teens). keep these principles in mind: i. remain objective and impartial in describing patients xvi.

Notify the dispatcher when the unit leaves the scene c. avoid codes xxi. current patient condition iv. Communication equipment needs to be checked to ensure that a radio is not drifting form its assigned frequency 2. Phone/Cellular Communications 1. The essential elements of such a report. Arrival at the hospital i. Arrival at the station – dispatcher should be notified C. major past illnesses ix. response to emergency medical care d. xx. Leaving the hospital for the station – dispatcher should be notified g. The EMT should also have a familiarity with cellular technologies and knowledge of the location of cellular dead spots in the area 4. Should be treated similar to radio communications when it comes to content and strategies for delivery of pertinent information 2. the dispatcher must be notified ii. and EMS system must provide back-up D. the EMT will continue to assess the patient e. are: i. mental status vi. the hospital should also be notified f. identify unit and level of provider (can utilize the name of the provider giving the report as well as the unit identification) ii. patient’s age and sex v. As technology changes. pertinent history of the present illness viii. new equipment becomes available that may have a role in EMS systems 3. There should be another plan for when a cellular transmission fails during a report or communication with another agency Page 15 of 212 . in some systems. estimated time of arrival iii. emergency medical care given xii. The EMT should be familiar with important and commonly utilized telephone numbers. avoid offering a diagnosis of the patient’s problem xxii. System Maintenance 1. chief complaint vii. a verbal report should be given. When communicating with medical direction or the receiving facility. pertinent findings of the physical exam xi. EMT need to be able to consult on-line medical direction. brief. use EMS frequencies only for EMS communication xxiii. After giving this information. such as medical control. dispatch centers 3. baseline vital signs x. in an order that is efficient and effective. reduce background noise b. local hospital Emergency Departments.

if appropriate 3. Communication A. The EMT should self-introduce at the start of any conversation 2. Non-English Speaking Populations and Use of Interpreters—Be Positioned to Address Any of These Special Situations Page 16 of 212 . Allow the patient enough time to answer a question before asking the next one 11. Speak calmly. Use language the patient can understand and avoid medical jargon 6. confident manner B. slowly and distinctly 8. Be honest with the patient 5. Team Communication and Dynamics IV. Interpersonal Communication 1. If a patient has difficulty hearing. clearly. Be aware of your own body language 7. Use the patient’s proper name. When practical. speak clearly with lips visible 10. Make and keep eye contact. either first or last. Communication With Hearing-Impaired. position yourself at a level lower than the patient or on the same level 4.III. depending on the circumstances 9. Act and speak in a calm.

Preparatory Therapeutic Communication EMT Education Standard Applies fundamental knowledge of the EMS system. safety/well-being of the EMT. medical/legal and ethical issues to the provision of emergency care. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Patients with special needs (i. language barrier Page 17 of 212 . Adjusting Communication Strategies 1. Transcultural considerations i. Native Americans. space a) intimate zone b) personal distance c) social distance d) public distance vi. introduce yourself and the way in which you want to be called ii.e. Indochinese. cultural imposition v. Differing cultures a. ethnocentrism iv. touch viii. both the EMT and the patient will bring cultural stereotypes to a professional relationship iii. and Arabs may consider direct eye contact impolite or aggressive vii. Principles of Communicating With Patients in a Manner That Achieves a Positive Relationship A. cultural issues a) variety of space b) accept the sick role in different ways c) nonverbal communication may be perceived differently d) Asians. Stage of development 3. Age-appropriate 2. hearing-impaired patients) 4.

Leading or biased questions d. interviewer ii. adult ii. Hazards of interviewing a. Encoding 2. Posture and gestures i. Using questions a. Family presence issues a. children iii. elderly b. B. Closed or direct questions c. Decoding Page 18 of 212 . Open-ended questions b. Family preference II. Interrupting f. Family Presence Issues 1. Choose language the patient understands 3. Using “why” questions g. Authority h. Non-verbal skills a. Giving advice c. One question at a time d. Maintain professional non-threatening demeanor D. Talking too much e. Build rapport with patient b. interviewer ii. Message 3. Interviewing a Hostile Patient a. EMT response d. patient b. Physical appearance i. Interviewing Techniques 1. patient iii. Providing false assurance or reassurance b. Professional jargon C. Verbal Defusing Strategies 1. Situations i. Communication A. gestures a) facial expressions b) eye contact c) voice d) touch 2. Communication Process and Components 1. Department policies c.

Communication With Pediatric Patient 1. Potential for auditory deficit 3. 4. Strategies to Ascertain Information A. Attempt to use open-ended questions c. Patients Under the Influence of Street Drugs or Alcohol C. Defense mechanisms 4. Put Yourself at Ease V. Explanation I. Interpretation H. Distraction VI. Continue to ask questions f. Reflection D. Silence C. Start the interview in the normal manner b. Put the Patient at Ease B. Obtaining Information on Complaints 1. Communication With Elderly 1. Potential for visual deficit 2. Clear explanations Page 19 of 212 . Obtain glasses and hearing aid D. Developing Patient Rapport A. Empathy E. Summary IV. Patients Unmotivated to Talk 1. Confrontation G. Shifting focus 3. Facilitation B. Make sure the patient understands the questions e. Feedback III. Types of Responses A. Techniques to use a. Clarification F. Utilize language line if available B. Resistance 2. Provide positive feedback d. Receiver 5. Most patients are more than willing to talk 2. Use parent and caregiver 2. Special Interview Situations A.

Emancipation i. homicidal b. Physical incapacitation b. Types of Consent 1. armed services iii. suicidal ii. in loco parentis ii. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. married ii. Alternatives B. Implied consent (emergency doctrine) a. refusal) d. Mental health b. Treatments recommendations c. Incarceration 5. safety/well-being of the EMT. Nature of illness b. Informed consent -. non-punitive C. Minors a. Mental incapacitation 4. Abandonment 2. Risks (i. reasonable prevention of harm i. Consent to Care a. Involuntary consent a. Expressed consent -.use of force doctrine a. Parental permission i. independence 6.Research 3. medical/legal and ethical issues to the provision of emergency care. emergency doctrine b.e.Non-verbal 2. Consent/Refusal of Care A. Legal Complications Related to Consent 1. False imprisonment Page 20 of 212 . Medical restraint -. Preparatory Medical/Legal and Ethics EMT Education Standard Applies fundamental knowledge of the EMS system.

Kidnapping 2. Education 3. Living wills 3. Patient must be informed of the risks of refusing care (e. death) 3. Assault 4. Patient must be alert and oriented to person. Durable power of attorney IV. Against medical advice a. Criminality 1. Mandatory reporting requirements a. medical control b. Abuse and assault i. Assault b.g. Patient must be informed if problems return/persist they should call EMS or see a physician 4. Responsibility Arising From Physician – Patient Relationship 1. Slander III. Battery D. Confidentiality A. and time 2. 3. Legally mandated a. Breach of Confidentiality 1. Release of medical information E. Refusal of Care and/or Transportation 1. Patient Self-Determination Act 1. Health Information Portability and Accountability Act (HIPAA) C. Treatments rendered D. Subpoena 4.. Breaches of conduct a. Tort and Criminal Actions A. Third party billing 5. place. Do Not Resuscitate (DNR) 2. Due diligence i. standard of care ii. Need to know 2. Battery c. child abuse or neglect Page 21 of 212 . Child abuse reported b. Advanced Directives A. Privileged Communications 1. Libel 2. Documentation II. Assessment findings 2. Obligation to Protect Patient Information B.

Protection from liability i. Res Ispa Loquitur b. penetrating trauma a) gunshot b) stab wounds c. Legal liability for failure to report V. Morals – concept of right and wrong Page 22 of 212 . Proximate causation e. pain and suffering) iii. Communicable diseases i. psychological (e. domestic violence b. standard of care iii. statute of limitations iv. Breach of duty c. Ethical Principle/Moral Obligations A.. ii. governmental immunity iii. Elements of negligence a. Concept of Negligence a.g. punitive d. Defenses i. physical (e. Legally compelled to notify authorities a. Duty to act b. good samaritan ii. Negligence per se 2. Statutory Responsibilities VII. professionalism ii.. sexual assault ii. Mandatory Reporting 1. Damages to plaintiff i. elder abuse iii. animal bites B. lost earnings) ii.g. Abuse b. liability insurance C. contributory negligence f. Arises from special relationship with patient 3. Evidence Preservation VI. Mandatory Reporting VIII. Civil Tort 1. reportable ii. Criminality i. Neglect 2.

g.. Use of Ethical Values) D. Ethics 1. Futility of care (cardiac arrest in the wilderness) 2.. Ethical Conflicts 1. Allocation of limited resources – medical rationing (e..g. Applied Ethics (i.e. Economic triage (e. Triage) 3. patient dumping) Page 23 of 212 . Branch of philosophy 2. Professional misconduct (e. patient abuse) 4.g..B. Study of morality C.

cardiac b. skull ii. lower extremities b. Skeletal a. PLUS the following material: I. Anatomy and Physiology EMT Education Standard Applies fundamental knowledge of the anatomy and function of all human systems to the practice of EMS. Types i. upper extremities vii. Muscular a. Standard Anatomic Terms C. Anatomical Planes 1. Respiratory system a. Frontal or coronal plane 2. Body Systems 1. smooth iii. Anatomy and Body Functions A. Function 3. Components i. Sagittal or lateral plane 3. thorax v. face iii. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level. Structures i. Function 2. upper airway a) nose b) mouth/teeth c) tongue/jaw d) nasopharynx e) oropharynx Page 24 of 212 . Joints c. Transverse or axial plane B. pelvis vi. skeletal ii. vertebral column iv.

heart a) chambers b) coronary arteries ii. blood buffer Page 25 of 212 . venous a) venae cava b) veins c) venules b. Circulatory system a. Function i. alveolar/capillary gas exchange iv. clotting factors iv. respiration iii. buffer 4. red blood cells ii. reservoir iv. white blood cells iii. Structures i. Function i. capillaries a) pulmonary b) tissue/cells iv. structures that support ventilation a) chest wall b) pleura c) diaphragm d) intercostal muscles e) phrenic nerve f) pulmonary capillaries b. tissue/cell gas exchange iii. perfusion ii. ventilation ii. arterial a) aorta b) arteries c) arterioles iii. plasma c. f) epiglottis g) larynx ii. Blood components i. lower airway a) trachea b) bronchi c) bronchioles d) alveoli iii. Anatomic differences between pediatric and adult airway anatomy c.

adrenal glands a) epinephrine b) norepinephrine b. Functional i. Structures i. central nervous system (CNS) a) brain b) spinal cord ii. Integumentary (skin) a. sensory function iii. Function i. autonomic a) sympathetic b) parasympathetic c. stimulate sympathetic nervous system a) receptors b) beta 2 stimulation Page 26 of 212 . dermis iii. subcutaneous layer b. Digestive system a. esophagus ii. pancreas 8. liver v. pancreas ii. Structures i. Structures i. Functions of the nervous system i. consciousness a) cerebral hemispheres b) reticular activating system (center of consciousness) ii. stomach iii. protection ii. epidermis ii. intestines iv. control of blood glucose level ii. v. Structural division i. Endocrine system a. fight-or-flight response 6. coagulation 5. infections response vi. peripheral nervous system (PNS) b. Functions of the Skin i. temperature control 7. Nervous system a. motor function iv.

Male i. Aerobic metabolism i. Glucose c. Removal of carbon dioxide and other waste products 3. low ATP (energy) production ii. Renal system a. Female i. high ATP (energy) production ii. structures a) ovaries b) fallopian tubes c) uterus d) vagina ii. Perfusion a. byproduct of water and carbon dioxide b. kidneys ii. Alveolar/capillary gas exchange b. Cell/capillary gas exchange 2. Cell environment a. Anaerobic metabolism i. urethra b. 9. Function i. functions a) reproduction b) hormones II. structures a) testicles b) penis ii. Oxygenation a. Fundamental Elements 1. bladder iii. Life Support Chain A. blood filtration ii. Oxygen b. Reproductive system a. fluid balance iii. Structures i. byproduct of lactic acid Page 27 of 212 . functions a) reproduction b) urination c) hormones b. buffer 10.

Ventilation/perfusion ratio 6. Age-Related Variations for Pediatrics and Geriatrics (see Special Patient Populations) Page 28 of 212 . Patency of the airway 3. Transport of gases 7. Blood volume 8. Vessel size and resistance (systemic vascular resistance) 10. B. Effects of acid on cells and organs III. Effectiveness of the heart as a pump 9. Issues Impacting Fundamental Elements 1. Mechanics of ventilation 4. Regulation of respiration 5. Composition of ambient air 2.

Medical Terminology EMT Education Standard Uses foundational anatomical and medical terms and abbreviations in written and oral communication with colleagues and other health care professionals. Root Words C. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level. Standard Medical Abbreviations and Acronyms Page 29 of 212 . Medical Terms A. Suffixes D. PLUS the following material: I. Associated With Body Systems C. Associated With Body Direction or Position III. Combining Forms II. Prefixes B. Associated With Body Structure B. Medical Terminology A.

Fraction of Delivered Oxygen II. Fraction of Inspired Oxygen E. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level. Causes of obstruction III. Anatomic boundaries of the thorax 2. Respiratory Compromise A. Pharynx d. Muscles of ventilation 4. Anatomical Considerations B. Exhalation a. Airway Obstruction 1. Changes in intrapleural and intrapulmonary pressures c. Pleural lining 3. Oropharynx c. Patency of the Airway A. Larynx e. Nasopharynx b. Nitrogen C. Carbon Dioxide D. Oxygen B. Trachea f. Various anatomic levels a. Muscle activity b. Active process 6. Pathophysiology EMT Education Standard Applies fundamental knowledge of the pathophysiology of respiration and perfusion to patient assessment and management. Changes in Structure or Function of 1. Composition of Ambient Air A. PLUS the following material: I. Accessory muscles of ventilation 5. Bronchi 2. Inhalation a. Muscle activity Page 30 of 212 .

Base of Lung C. Stretch receptors C. Perfusion and Shock A. Tidal volume b. Alteration in Regulation of Respiration Due to Medical or Traumatic Conditions A. Alveolar ventilation 11. Dissolve in plasma 2. Cell Hypoxia Related to Oxygen Transport Disturbance F. Perfusion Disturbance Related to Hypoxemia VI. Chemoreceptors B. Oxygen 2. Attached to hemoglobin B. Carbon dioxide E. Oxygen 2. Alveolar ventilation a. Carbon dioxide D. Passive process 7. Hypercarbia Related to Carbon Dioxide Transport Disturbance Page 31 of 212 . Apex of Lung B. Minute ventilation b. Respiratory rate 9. Bicarbonate C. Effects of arterial carbon dioxide and oxygen content on respiration rate and depth E. Hypoxia caused by respiratory regulation disturbance V. Medulla rhythm centers D. Ventilation/Perfusion (V/Q) Ratio and Mismatch A. Dissolved in plasma 2. Alveolar/Capillary Gas Exchange 1. b. Signs of mechanical ventilation impairment 10. Effects of inadequate tidal volume and respiratory rate a. Respiratory rate 8. Minute ventilation a. Hypoxia caused by poor mechanical ventilation IV. Oxygen 1. Cell/Capillary Gas Exchange 1. Attached to hemoglobin 3. Dead air space c. Changes in intrapleural and intrapulmonary pressures c. Tidal volume b. Ventilation Disturbance Related to Hypoxemia D. Carbon Dioxide 1.

preload ii. afterload c. Anatomy of the vessel 2. Heart g. Systemic Vascular Resistance (SVR) 1. Arteries b. Blood Volume 1. Platelets 2. Venules e. Heart rate b. Sympathetic b. Distribution a. Composition of blood a. Pulmonary veins 3. myocardial contractility iii. Red blood cells c. Microcirculation A. Effects of blood volume and vessel size on pressure inside the vessel VII. True Capillaries B. G. Capillaries d. neural ii. Arteriole-Venule Shunt Page 32 of 212 . hormonal a) epinephrine b) norepinephrine b. low blood volume iv. Parasympathetic I. high blood pressure 2. Parasympathetic 3. Impairment of cardiac output i. low hear rates iii. high heart rates ii. White blood cells d. decrease in myocardial contractility v. Plasma b. Stroke volume i. Myocardial Effectiveness 1. Sympathetic i. Plasma oncotic pressure H. Hydrostatic pressure 4. Cardiac output a. Influence of autonomic nervous system on cardiac output a. Veins f. Arterioles c. Influence of autonomic nervous system on SVR a.

Sodium/potassium pump shutdown b. Energy (ATP) released 4. Cell membrane rupture c. Lack of oxygen 3. Lack of glucose 2. Water B. Decrease in heart rate 3. Decrease in SVR F. Increase in heart rate 2. Increase in stroke volume 4. Carbon dioxide b. Lack of oxygen 3. Influence on Capillary 1. Baroreceptors D. Effects of Changes in Systemic Vascular Resistance on Blood Pressure 1. Decrease in stroke volume E. Alteration of Cell Metabolism A. Cardiac Output B. Local 2. Hormonal VIII. Anaerobic Metabolism 1. C. Oxygen 3. Effects of Inadequate Perfusion on Cells 1. Energy (ATP) released 4. Neural 3. Lack of energy a. Effects of Changes in Cardiac Output on Blood Pressure 1. Systemic Vascular Resistance C. Effects of Changes of Blood Pressure on Perfusion of Cells 1. Increase in SVR 2. Lactic acid b. Effects of acidic environment on cell structure and function C. Byproducts a. Aerobic Metabolism 1. Cell death Page 33 of 212 . Glucose delivery IX. Blood Pressure A. Byproducts a. Glucose 2. Oxygen delivery 2. Glucose 2.

settling around 120 beats per minute b. Diaphragmatic breathing h. Physiology 1. 100 to 160 beats per minute during first 30 minutes ii. Rapid respiratory rates lead to rapid heat. more easily obstructed b. Accessory muscles immature.98 to 100 degrees Fahrenheit is the thermoneutral range 2. Blood pressure -.5 kg at birth b. less stable. Infants head equal to 25 percent of the total body weight 3. susceptible to early fatigue f. increasing to 10-15 ml/kg by 1 year c. Chest wall less rigid g. Heart rate i. narrower. Normally drops 5 to 10 percent in the first week of life c. Airways.0-3. Fewer alveoli with decreased collateral ventilation e. shorter.average systolic blood pressure increases from 70 at birth to 90 at 1 year d. PLUS the following material: I. dropping to 30-40 after first few minutes of life iii. initially 40-60 ii. Vital signs a. Normally 3. and fluid loss Page 34 of 212 . Weight a. tidal volume v. Life Span Development EMT Education Standard Applies fundamental knowledge of life span development to patient assessment and management. Respiratory rate i. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level. slowing to 20-30 by one year iv. Lung tissue is fragile and prone to trauma from pressure d. Temperature ranges -. 6-8 ml/kg initially vi. Pulmonary system a. Infants primarily nose breathers until four weeks c. Infancy (Birth to 1 Year) A.

Vital signs a. Passive immunity retained through the first six months of life b. Physiological 1. preschoolers—20 to 30 breaths per minute c.8 to 99. Basic cry b. posterior fontanelle closes at three months ii. coordinated suck and gag ii. ma.6 degrees Fahrenheit Page 35 of 212 . preschoolers—80 to 120 beats per minute b. di) iii. Temperature—96. Heart rate i. fontanelles may provide an indirect estimate of hydration 6. anterior fontanelle closes between 9 and 18 months iii. toddlers—20 to 30 breaths per minute ii. Fontanelles i.g. Anger cry c. Toddler (12 to 36 Months) and Preschool Age (3 to 5) A. extremities move equally when infant is stimulated b. preschoolers—80 to 110 mmHg d. two months a) tracks objects with eyes b) recognizes familiar faces ii. 4. six months a) sits upright in a highchair b) makes one syllable sounds (e. Protest b. Pain cry 2. Withdrawal II. strong. Respiratory rate i. toddlers—80 to 130 beats per minute ii. Nervous system a. Psychosocial development 1. Rapid changes over first year i. 12 months a) walks with help b) knows own name B. well flexed extremities iii.. Immune system a. Systolic blood pressure i. Growth and development in infants a. toddlers—70 to 100 mmHg ii. Movements i. Despair c. mu. Situational crisis – parental separation reactions a. Crying a. Based on maternal antibodies 5. Reflexes c. da.

Develops separation anxiety—approximately 18 months 2. School-Age Children (6 to 12 Years) A. Develops immunity to common pathogens as exposure occurs 4. Vital signs a. Heart rate—70 to 110 beats per minute b. more interaction with adults and children a. 2. Immune system a. Basics of language mastered by approximately 36 months. Terminal airways continue to branch b. begin comparing themselves with others b. psychologically ready between 18 and 30 months iii. Physiological 1. Muscle mass increases b. Adolescence (13 to18 Years) A. Musculoskeletal system a. Begin to display competitiveness III. Development allows effortless walking and other basic motor skills c. Play a. Temperature—98. Brain function increases in both hemispheres b. Nervous system a. Toilet training i. Bodily functions a. Develop self-concept (i.6 degrees Fahrenheit 2. Elimination patterns a. Alveoli increase in number 3. Psychosocial 1. Cognitive a. Passive immunity lost. more susceptible to minor respiratory and gastrointestinal infections b.e. Psychosocial 1. with continued refinement throughout childhood b. Respiratory rate—20 to 30 breaths per minutes c. Loss of primary teeth and replacement with permanent teeth begins B. average age for completion – 28 months B. Bone density increases 6. Understands cause and effect between 18-24 months c. develop self-esteem IV. Brain 90 percent of adult brain weight b. Fine motor skills developing 5. Systolic blood pressure—80 to 120 mmHg d. physiologically capable by 12 to 15 months ii. Pulmonary system a. Able to play simple games and follow basic rules b. Physiological Page 36 of 212 .

Most experience a rapid two. begins distally with enlargement of feet and hands ii. enlargement of the arms and legs follows iii. Self-destructive behaviors begin i.6 degrees Fahrenheit 2. Muscle mass and bone growth nearly complete B. Self-consciousness increases b. chest and trunk enlarge in final stage b. Accidents are a leading cause of death in this age group Page 37 of 212 . Temperature—98. Depression and suicide more common than any other age group V. tobacco ii. Blood pressure—average 120/80 mmHg d. Secondary sexual development occurs d. Peak physical conditioning between 19 and 26 years of age 3. Interest in the opposite sex increases d. Heart rate—average 70 beats per minute b. Respiratory rate—12 to 20 breaths per minute c. Vital signs a. boys are mostly done growing by age 18 c. Family a. All body systems at optimal performance 5. Girls are mostly done growing by age 16.to three-year growth spurt i. Heart rate—55 to 105 beats per minute b. Adults develop lifelong habits and routines during this time 4. Peer pressure increases c. Psychological 1. alcohol iii. Growth rate a. 1. Blood pressure—100 to 120 mmHg d. continual comparison amongst peers ii. Develop identity a. Reproductive maturity f. Endocrine changes e. Conflicts arise 2. Vital signs a. Body image of great concern i. eating disorders are common g.6 degrees Fahrenheit 2. Temperature—98. Respiratory rate—average 16 to 20 breaths per minutes c. illicit drugs h. Anti-social behavior peaks around eighth or ninth grade f. Want to be treated like adults e. Physiological 1. Early Adulthood (20 to 40 Years) A.

Weight control more difficult 8. Often burdened by financial commitments for elderly parents as well as young adult children VII. Empty-nest syndrome 3. Physiological 1. Affectionate love 3. increased peripheral vascular resistance iii. Cardiac output decreases throughout this period b.6 degrees Fahrenheit 2. Late Adulthood (61 Years and Older) A. Blood pressure—depends on patient’s physical and health status d. Middle Adulthood (41 to 60 Years) A.6 degrees Fahrenheit 2. Approach problems more as challenges than threats 2. Temperature—98. Cardiovascular function changes a. Life span—maximum approximately 120 years 3. reduced blood flow to organs Page 38 of 212 . Love develops a. Body still functioning at high level with varying degrees of degradation 3. Blood vessels i. Life expectancy—average length based on year of birth 4. Experience highest levels of job stress during this time 2. Heart rate—depends on patient’s physical and health status b. Psychological 1. Blood pressure—average 120/80 mmHg d. Vision changes 4. Romantic love b. B. Cardiovascular health becomes a concern a. Cholesterol levels increased 6. Hearing less effective 5. Temperature—98. Vital signs a. Vital signs a. Psychological 1. Physiological 1. Childbirth most common in this age group 4. Heart rate—average 70 beats per minute b. Menopause in women in late 40s early 50s B. Cancer strikes in this age group often 7. Respiratory rate—average 16 to 20 breaths per minute c. Respiratory rate—depends on patient’s physical and health status c. thickening ii. This period is less associated with psychological problems related to well being VI.

Diffusion through alveoli diminished e. Reproductive organs atrophy in women 7. Financial burdens d. Diminished kinesthetic sense e. diaphragm elasticity diminished ii. Reaction time diminished g. Decreased glucose metabolism b. Declining well-being c. 95 percent of older adults live in communities 3. Neuron loss b. Challenges a. Hearing loss 10. myocardium is less able to respond to exercise iii. Visual acuity diminished f. Nervous system a. Changes in mouth. GI secretions decreased c. Decreased insulin production c. and lungs b. Abnormal glomeruli more common c. weakened bone structure 6. Sleep-wake cycle disrupted B. Sensory changes a. Coughing ineffective i. and saliva changes b. increased workload ii. Decreased elimination 9. Heart i. Metabolic changes lead to decreased lung function c. weakened chest wall ii. Olfactory diminished c. Muscular changes i. tachycardia not well tolerated c. teeth. Renal system a. Vitamin and mineral deficiencies 8. Self-worth b. Diminished pain perception d. chest wall weakens d. Death or dying of companions Page 39 of 212 . Loss of taste buds b. Gastrointestinal system a. Blood cells 5. Endocrine system changes a. Mouth. Lung capacity diminished f. Respiratory system a. nose. Psychological 1. b. Wisdom attributed to age in some cultures 2. 50 percent of nephrons lost b.

Public health differs from individual patient care 4. patient care reports may provide information on epidemics of disease 3. Public Health Laws. Declining infectious disease d. Disease surveillance i. Clean drinking water and sewage systems c. health screenings b. Roles for EMS in public health a. secondary prevention—preventing the complications and/or progression of disease iii. EMS Interface With Public Health 1. Role of Public Health 1. Reduction in use of tobacco products f. Incorporate public health services into EMS system c. PLUS the following material: I. and Guidelines C. primary prevention—preventing disease development a) vaccination b) education ii. Regulations. Public health mission and functions 3. EMS provides a critical public health function b. Basic Principles of Public Health A. Health prevention and promotion i. Many definitions 2. EMS providers are first line care givers ii. Injury prevention a. Prenatal care g. Safety equipment Page 40 of 212 . Fluoridated water e. EMS is a public health system a. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level. Collaborations with other public health agencies 2. Review accomplishments of public health a. Others B. Public Health EMT Education Standard Uses simple knowledge of the principles of illness and injury prevention in emergency care. Widespread vaccinations b.

Injury surveillance Page 41 of 212 . falls vi. Education i.b. fire c. helmet use iv. car seat safety ii. driving under the influence v. seat belt use iii.

Liquids a. Kinds of Medications Used in an Emergency A. Oral (e. Enteral (ingested) b. intravenous III..g. Basic Medication Terminology A.. intramuscular iii. subcutaneous ii. Gases. Pharmacology Principles of Pharmacology EMT Education Standard Applies fundamental knowledge of the medications that the EMT may assist/administer to a patient during an emergency. Tablets – compressed powders c. Enteral (ingested) a.g.g. Pills b. Trade Page 42 of 212 .g. Injection (e.. Generic 2. Sublingual (e. Parenteral (injected) 3. Routes of Medication Administration 1. Powder – inhalation 2. oxygen) b. Inhaled (e. aerosols – inhalation B. Forms of Medication 1. nitroglycerin) b. epinephrine) c. Solid a. Medication safety II. Drug Name 1. glucose) 2. Methods of injection i.. Parenteral (injected and inhaled) a. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I.

Unintended effects b. Route C. Prescribing Information Page 43 of 212 . Drug Profile 1. Untoward effects 4.B. Actions a. Side effects a. Contraindications 3. Dose 5. Indication c. Pharmacodynamics – impact of age and weight upon medication administration b. Intended effects 2.

Pharmacology Medication Administration EMT Education Standard Applies fundamental knowledge of the medications that the EMT may assist/administer to a patient during an emergency. Administration versus Assistance of Medications 1. Administering medication 3. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Techniques of Medication Administration 1. Intramuscular injection by Auto injector a. Right medication – patient condition c. The “rights” of drug administration a. Right patient – prescribed to patient b. Oral a. Off-line. verbal order a) Confirmation – echo technique b) Confusion – clarification B. Sublingual a. Disadvantages c. Advantages b. Assisting patients in taking prescribed medications 2. Techniques Page 44 of 212 . Assist/Administer Medications to a Patient A. written protocols b. Right dose – prescribed to patient e. standing orders. Disadvantages c. Advantages b. Right route – patient condition d. On-line. Medical Direction a. Techniques 2. Advantages b. Right time – within expiration date C. Techniques 3. Medication Administration Procedure 1. Disadvantages c.

Data – indications for medication 2. 4. Reassessment 1. Advantages b. Techniques D. Documentation Page 45 of 212 . Response – effect of medication E. Inhalation a. Action – medication administered 3. Disadvantages c.

Epinephrine 3. and any specific administration considerations. I. dose. Oral glucose 3. complications. Nitroglycerin Page 46 of 212 . routes of administration. mechanism of action. for all of the following emergency medications. side effects. interactions. Oxygen B. indications. Specific Medications A. Pharmacology Emergency Medications EMT Education Standard Applies fundamental knowledge of the medications that the EMT may assist/administer to a patient during an emergency. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: The EMT must know the names. Aspirin 2. Inhaled bronchodilators 2. EMT – Assisted Medications 1. Individual training programs have the authority to add any medication used locally by EMTs. contraindications. EMT – Administer Medications 1.

Mouth and oral cavity a. Airway Management. Nose – warm and humidify air 2. Alternative airway. especially in emergency b. Airway Anatomy A. Hollow tubes which further divide into lower airways of the lungs b. Epiglottis – muscular structure which protects the airway of conscious patients during swallowing b. Hollow tube which passes air to the lower airways b. Supported by cartilage Page 47 of 212 . Respiration. Bronchi a. and Artificial Ventilation Airway Management EMT Education Standard Applies knowledge (fundamental depth. and respiration for patients of all ages. Jaw 4. Cricoid ring B. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Trachea a. Thyroid cartilage d. Oropharynx c. foundational breadth) of anatomy and physiology to patient assessment and management in order to assure a patent airway. Supported by cartilage rings 2. Laryngopharyx 5. Tongue 3. Vocal cords – thin muscles which are the center for speech and protect the lower airways c. Also involved in the production of speech d. Entrance to the digestive system c. Carina – the bifurcation of the trachea into the two mainstem bronchi 3. Pharynx a. Nasopharynx b. adequate mechanical ventilation. Larynx a. Upper Airway Tract 1. Lower Airway Tract 1.

Vomit d. Foreign body C. Nasopharyngeal a. Indications c. Manual Airway Maneuvers -. Contraindications Page 48 of 212 . the end of the airway ii. Food c. remain open through smooth muscle tone b. thin hollow tubes leading to the alveoli ii. Alveoli i. Signs of Adequate Airway 1. Airway is open. site where oxygen and carbon dioxide (waste) are exchanged c. No air movement (apnea) 4. Swelling Due to Trauma or Infection III. Mechanical Airway Devices 1. Lungs a. 4. Purpose b. Airway obstruction a. Techniques of Assuring a Patent Airway A. Review and elaborate on the mechanical airway maneuvers used by EMRs 2. Teeth f. Awake patient is unable to speak or sounds hoarse 3. Bronchioles i. Sound of the voice is normal for the patient B. Unusual sounds are heard with breathing a. millions of thin walled sacs iii. the vessels return oxygenated blood to the heart II. blood vessels that begin as capillary surrounding each alveolus ii. Pulmonary capillary beds i. snoring 2. stridor b. Tongue b. can hear/feel air move in and out 2. Patient is speaking in full sentences 3. each alveolus surrounded by capillary blood vessels iv. with adequate blood volume and blood pressure. Airway Assessment A. Signs of Inadequate Airway (Not every sign listed below is present in every patient who has inadequate airway) 1. Blood e.review and elaborate on the manual airway maneuvers used by EMRs B.

Consider Age-Related Variations in Pediatric and Geriatric Patients (see Special Patient Populations Section) Page 49 of 212 . Procedure C. Relief of Foreign Body Airway Obstruction (refer to current American Heart Association guidelines) D.review and elaborate on all material from the EMR Level IV. Upper Airway Suctioning -. d. Complications e.

diaphragm 4. Vascular Structures Which Support Respiration 1. drives systemic circulation c. Arteries. receives pulmonary circulation ii. Cells must excrete waste products. receives systemic circulation ii. foundational breadth) of anatomy and physiology to patient assessment and management in order to assure a patent airway. capillaries. The heart a. Muscles a. Phrenic nerve innervation C. and Artificial Ventilation Respiration EMT Education Standard Applies knowledge (fundamental depth. Pleura 5. Chest cage 2. Includes All Airway Anatomy Covered in the Airway Management Section B. Ribs 3. Anatomy of the Respiratory System A. All cells perform a specific function 2. Additional Respiratory System Anatomy 1. venules. Airway Management. drives pulmonary circulation b. Cells 1. glucose. Left heart i. Pulmonary capillary structures 2. Intercostal b. adequate mechanical ventilation. including oxygen. Tissue/cellular beds D. Automaticity 3. veins 4. and respiration for patients of all ages. Respiration. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. and electrolytes a. Cells require chemicals in order to function. Right heart i. Aerobic versus anaerobic respiration Page 50 of 212 . including carbon dioxide and water b. arterioles.

Oxygenation is required for. Adequate ventilation is necessary for. Minute volume f. each cell of the body performs a specific function ii. but does not assure. Inhalation b. Oxygenation is the process of loading oxygen molecules onto hemoglobin molecules in the bloodstream 2. oxygen and sugar are essential to produce energy for cells to perform their function iii. internal respiration C. Respiratory Rate e. Vital capacity d. The mechanics of ventilation a. Respiration 1. Pulmonary Ventilation 1. Respiratory regulation – influenced by carbon dioxide and oxygen levels in the blood and spinal fluid 4. Dead space c. External respiration – the exchange of respiratory gases between the alveoli and the pulmonary capillary bed b. produce carbon dioxide as a waste product Page 51 of 212 . Physiology of Respiration A. Alveolar Ventilation a. Respiration is the exchange of oxygen and carbon dioxide and is essential for life a. Exhalation 4. Ventilation is the movement of air in and out of the lungs 2. Residual volume B. Respiration. Internal respiration – the exchange of respiratory gases between the systemic capillaries and their surrounding tissue beds c. adequate respiration 3. Tidal volume b. Cellular respiration and metabolism – the use of oxygen and carbohydrates to produce energy and the creation of carbon dioxide and water as a by-product of metabolism II. pulmonary ventilation – the movement of air in and out of the lungs a. Internal respiration – exchange of oxygen and carbon dioxide between the capillaries of the body tissues and the individual cells c. External respiration – exchange of oxygen and carbon dioxide between the alveoli and the blood in the pulmonary capillaries b. Cellular respiration i. but does not assure. 3. Oxygenation 1.

Circulation compromise 1. Vasodilatory shock Page 52 of 212 . Pathophysiology of Respiration A. Drugs b. Altitude b. drowning 3. tension pneumothorax iii. Closed environments c. environmental/occupational exposure v. Internal a. pulmonary edema iii. Oxygenation C. Pathology typically related to changes in alveolar – capillary gas exchange b. Cellular D. Adequate external ventilation and perfusion are required for. Bronchoconstriction 4. heart failure iv. Toxic or poisonous environments 2. Foreign body obstruction d. internal respiration III. Anemia c. Allergic reactions e. but do not assure. Respiration 1. Obstruction of blood flow i. Structural damage to the thorax 3. external respiration 3. Typical disease processes a. cardiac tamponade b. Typical disease processes i. Trauma c. emphysema ii. but does not assure. Pathology typically related to derangement of pulmonary and systemic perfusion and oxygenation 2. Trauma/burns c. Pulmonary Ventilation 1. 2. Adequate ventilation is required for. Infection b. Disruption of airway patency a. Hypovolemia d. pneumonia iv. Interruption of nervous control a. Unconsciousness (loss of muscle tone) B. Muscular dystrophy 2. pulmonary embolism ii. External a.

Signs of adequate ventilation a. silent chest v. Signs of inadequate ventilation (not every sign listed below is present in every patient who has inadequate ventilation and/or oxygenation) a. nasal flaring iii. anterior ii. breath sounds are unequal a) trauma b) infection c) pneumothorax c. toxic v. Abnormal work of breathing i. retractions ii. Minute volume (respiratory rate x tidal volume) d. rapid respiratory rate without clinical improvement E. Tidal volume d. crackles iv. wheezing iii. Irregular respiratory pattern i. trauma a) paradoxical b) splinting c) penetrating e. Hypoxia 2. posterior c. Abnormal breath sounds i. Respiratory rate is normal b. Assessment of Adequate and Inadequate Ventilation A. E. Ventilation. or Oxygenation Problem as They May Coexist and One Can Cause Another D. stridor ii. abdominal breathing iv. head trauma ii. Hypoglycemia 3. metabolic iv. stroke iii. Chest wall movement or damage i. Cells 1. Minute volume 2. It May Be Difficult to Determine If You Have a Respiration. Internal Respiration is Necessary for Life B. Assessment of Respiration Page 53 of 212 . Infection IV. diaphoresis b. Breath sounds are clear on both sides of the chest i. Assessment of Ventilation 1. It Is Sometimes Difficult to Assess Internal Respiration C.

Skin color normal c. Pallor – etiology c. contraindications iv. baseline b. Management of Adequate and Inadequate Respiration A. Level of consciousness 3. purpose a) assesses oxygenation b) quantify hemoglobin saturation c) assess adequacy of oxygen delivery during positive pressure ventilation d) assess impact of interventions ii. Pulse oximetry i. Oxygen b. Mottling – etiology 4. Pulse oximeter reading within acceptable level e. Supplemental oxygen therapy replaces some of the inert gas with oxygen and can improve internal respiration Page 54 of 212 . Skin color/mucosa is not normal a. High altitude c. Enclosed space b. Mental status i. Cyanosis – etiology b. Nitrogen c. procedure a) refer to the manufacturer’s instructions for the device being used b) considered alternative measurement sites V. Supplemental Oxygen Therapy 1. indications – routine vital sign iii. Poison gas 2. Ambient air is a. Ambient air is abnormal a. Carbon dioxide 2. Assure an Adequate Airway B. 1. Assessment of oxygenation a. complications a) hypoperfusion b) carbon monoxide c) cold extremity d) time lag in detection of respiratory insufficiency v. Oral mucosa normal d.

complications v. purpose ii. Portable oxygen cylinder i. changing a cylinder a) safe residual for operation is 200 psi b) calculating cylinder duration iv. indications iii. procedure e. procedure Page 55 of 212 . purpose ii. Partial re-breather face mask i. procedure d. contraindications iv.3. indications iii. contraindications iv. Nasal cannula i. cylinder size ii. indications iii. complications v. Liquid oxygen 4. contraindications iv. indications iii. indications iii. purpose ii. complications v. purpose ii. procedure f. Oxygen sources a. tracheostomy mask i. contraindications iv. securing and handling cylinders b. complications v. Venturi mask i. purpose ii. contraindications iv. assembly and use of cylinders iii. Humidifiers i. complications v. procedure b. purpose ii. contraindications iv. indications iii. procedure c. complications v. Oxygen delivery devices a. Non-rebreather i.

Shows signs and symptoms of inadequate ventilation i. inadequate minute ventilation iii. Complications a. Place the mask over the patient’s nose and mouth c. Squeeze the bag each time the patient begins to inhale e. Risk of gastric inflation and vomiting 4. fatigue from work of breathing iv. appropriate rate and volume are determined by minute ventilation VI. Combative/hypoxic patients b. To improve oxygenation b. altered mental status ii. Over the next 5-10 breaths i. Explain the procedure to the patient b. others 3. Inadequate mask seal c. Consider Age-Related Variations in Pediatric and Geriatric Patients (see Special Patient Populations) Page 56 of 212 . Procedure a. Assisting Ventilation in Respiratory Distress/Failure 1. Initially assist at the rate at which the patient has been breathing d. slowly adjust the rate and the delivered tidal volume ii. C. Indications a. Purpose a. Over pressure causing injury to the lung d. To improve ventilation 2.

Assure an Adequate Airway B. reduces rescuer fatigue during extended transport times b. Advantages b. Disadvantages i. requires oxygen however. Artificial Ventilation Devices 1. and Artificial Ventilation Artificial Ventilation EMT Education Standard Applies knowledge (fundamental depth. Bag-valve-mask with reservoir a. The Management of Inadequate Ventilation A. Advantages i. allows for a single rescuer to use both hands to maintain a mask-to-face seal while providing positive pressure ventilation to a patient ii. high ventilatory pressures may damage lung tissue 3. Airway Management. Automatic Transport Ventilator/Resuscitator a. requires special unit and additional training for use in pediatric patients v. requires oxygen. Manually triggered ventilation device a. difficult to maintain adequate ventilation without assistance ii. Disadvantages i. may require an external power source Page 57 of 212 . Disadvantages 2. the rescuer is unable to easily assess lung compliance vi. and respiration for patients of all ages. Respiration. Advantages b. Supplemental Oxygen Therapy C. typical adult ventilation consumes 5 liters per minute O2 versus 15-25 liters per minute for a bag-valve-mask iii. foundational breadth) of anatomy and physiology to patient assessment and management in order to assure a patent airway. adequate mechanical ventilation. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. typically used on adult patients only iv. however typical adult ventilation consumes 5 liters per minute 02 versus 15-25 liters per minute for a bag-valve-mask ii.

Normal ventilation 2. Positive pressure ventilation a. Ventilation of an Apneic Patient 1. Procedure II. Blood return from the body happens naturally b. Normal ventilation 2. Negative intrathoracic pressure b. Amount of blood pumped out of the heart is reduced C. Procedure E. Reduces amount of air in stomach Page 58 of 212 . Purpose 2. Use during positive pressure ventilation b. Esophageal Opening Pressure 1. Positive pressure ventilation B. barotrauma D. iii. Contraindications 4. Indications 3. Purpose 2. Walls are pushed out of normal anatomical shape b. must have bag-valve-mask device available iv. Air is pushed into the stomach during ventilation b. Normal ventilation a. may interfere with timing of chest compressions during CPR v. Positive pressure ventilation a. Positive pressure ventilation a. The Differences Between Normal and Positive Pressure Ventilation A. Contraindications 4. Sellick’s maneuver (cricoid pressure) a. Blood is pulled back to the heart during normal breathing 2. Airway Wall Pressure 1. must monitor to assure full exhalation vi. Indications 3. Venous return is decreased during lung inflation b. Complications 5. More volume is required to have the same effect as normal breathing D. Ventilation of the Protected Airway 1. Blood Movement 1. Gastric distention may lead to vomiting 3. Air Movement 1. Normal ventilation a. Air is sucked into lungs 2.

Positive pressure ventilation may cause a. identify cricoid cartilage ii. Procedure i. Over Ventilation (Either by Rate or Volume) Can Be Detrimental to the Patient 1. Gastric distention c. Consider Age-Related Variations in Pediatric and Geriatric Patients (see Special Patient Considerations) Page 59 of 212 . apply firm backward pressure to cricoid cartilage with thumb and index finger d. Other unintended consequences III. patient is vomiting or starts to vomit ii. c. Hypotension b. Do not use if i. breathing tube has been placed by advanced level providers E. patient is responsive iii.

extrication hazards ii. roadway operation dangers b. Determine mechanism of injury b. Impact of the Environment on Patient Care 1. No -. Yes -. patient history. Special situations B. Patient Assessment Scene Size-Up EMT Education Standard Applies scene information and patient assessment findings (scene size-up. No -. reassessment) to guide emergency management. Chemical b. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Yes -. Bystanders c.is it possible to quickly make the scene safe? a. Trauma a. Scene Safety A. Violence a. Common Scene Hazards 1. Biological 3. Environmental 2. Medical a. primary and secondary assessment.is the scene safe? 1. Hazards at the trauma scene Page 60 of 212 .establish patient contact and proceed with patient assessment. Motor vehicle collisions i.do not enter any unsafe scene until minimizing hazards 3. Rescue a. Request specialized resources immediately II. Crime scenes 4. Evaluation of the Scene -. Patient b. Determine nature of illness b.assess patient b. Hazardous substances a. 2. Scene Management A. Hazards at medical emergencies 2.

Unstable conditions B. Based on the principle that all blood. Violence 1. Fire hazard – fire department c. in any healthcare delivery setting Page 61 of 212 . secretions. Specialized rescue equipment may be necessary for difficult or complicated extrications c. After making the scene safe for the EMT. Multiple patients – additional ambulances b. Secondary collapse and falls d. Standard Precautions 1. and mucous membranes may contain transmissible infectious agents b. Nature of the illness C. Mechanism of injury b. Need for Additional or Specialized Resources 1. Include a group of infection prevention practices that apply to all patients. A variety of specialized protective equipment and gear is available for specialized situations a. Scan the scene for information related to a. Ascent or descent gear may be necessary for specialized rescue situations 2. Protect the bystanders a. Only specially trained responders should wear or use the specialized equipment E. Park away from the scene and wait for the appropriate law enforcement officials to minimize the danger D. Traffic or violence issues – law enforcement 4. If the EMT cannot minimize hazards. Minimize conditions that represent a hazard for bystanders b. regardless of suspected or confirmed infection status. Protect the patient a. Weather or extreme temperatures b. remove bystanders from the scene 3. Overview a. If the EMT cannot alleviate the conditions that represent a health or safety threat to the patient. Toxins and gases c. EMTs should not enter a scene or approach a patient if the threat of violence exits 2. Request resources a. Chemical and biological suits can provide protection against hazardous materials and biological threats of varying degrees b. Addressing Hazards 1. excretions (except sweat). Environmental considerations a. move the patient to a safer environment 2. body fluids. 3. the safety of the patient becomes the next priority b. non-intact skin.

gloves iii. self-contained breathing apparatus v. weather or extreme temperatures ii. Number of patients and need for additional support a. Need for additional resources a. masks v. Personal protective equipment includes clothing or specialized equipment that provides some protection to the wearer from substances that may pose a health or safety risk b. Implementation a. protective eyewear 3. body fluid. Does the dispatch suggest the need for additional support? c. Universal precautions were developed for protection of healthcare personnel d. or pathogen exposure i. leather gloves F. How many patients? b. Personal Protective Equipment a. Protection of the patient i. unstable conditions d. c. remove ii. hand washing ii. Wear PPE appropriate for the potential hazard i. heat-resistant outerwear iv. barricade 2. Consider if this level of commitment is required Page 62 of 212 . helmets iii. Protection of bystanders i. isolate iii. steel-toe boots ii. Multiple-Patient Situations 1. Incident Command System (ICS or IMS) b. Standard precautions focus on protection of patients 2. gowns iv. The extent of standard precautions used is determined by the anticipated blood.

the human body will either attempt to move away from the stimulus or will attempt to move the stimulus away from the body b) acceptable stimuli i) pinch the patient’s ear Page 63 of 212 . Initial General Impression – Based on the Patient’s Age-Appropriate Appearance 1. patient history. reassessment) to guide emergency management. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. primary and secondary assessment. Level of Consciousness 1. the patient opens his/her eyes in respond to the EMT’s voice ii. Speak to the patient and determine the level of response b. Primary Survey/Primary Assessment A. Patient Assessment Primary Assessment EMT Education Standard Applies scene information and patient assessment findings (scene size-up. Responds to painful stimuli i. Appears stable but potentially unstable 3. Appears stable 2. While approaching the patient or immediately upon patient contact attempt to establish level of consciousness a. Patient response a. Alert i. EMT should identify himself or herself c. Responds to verbal stimuli i. patient responds only when the EMT applies some form of irritating stimulus a) when an irritating stimulus is encountered. the patient neither acknowledges the presence of the EMT nor responds to loud voice ii. the patient responds appropriately to a simple command c. EMT should explain that he or she is there to help 2. the patient acknowledges the presence of the EMT b. the patient appears to be awake ii. Appears unstable B.

see the current American Heart Association guidelines for the steps in performing this procedure for victims of all ages b. Unresponsive patient a.foreign body or substances in the mouth may impair the airway and must be removed i. open and maintain the airway with head-tilt. Circulatory Status 1. Breathing Status 1. Irregular rate 2. Patient unresponsive a. Responsive patient a. Breathing is too slow (<8 breaths per minute) d. Radial pulse absent 3. If the patient speaks. Assess if major bleeding is present Page 64 of 212 . Breathing is absent E. Patient responsive a. Normal rate b. chin-lift technique ii. Breathing is inadequate c. suction (liquids) b. Unresponsive – the patient does not respond to any stimulus C. trauma c. open and maintain the airway with modified jaw thrust technique while maintaining manual cervical stabilization ii. Breathing is too fast (>24 breaths per minute) c. Medical patients i. swelling iii. inspiration may produce a high-pitched whistling sound known as stridor i. Trauma patients i. Slow d. finger sweep (solid objects) ii. Airway patency must be continually reassessed D. Fast c. If the upper airway becomes narrowed. see the current American Heart Association guidelines for the steps in performing this procedure for victims of all ages 2. the airway is functional but may still be at risk -. ii) trapezius squeeze iii) others d. foreign body ii. Breathing is adequate (rate and quality) b. Radial pulse present (rate and quality) a. Airway Status 1. Breathing absent (choking) 2. Breathing is adequate (rate and quality) b.

Skin color b. Primary Assessment: Stable B. Stable – assess nature of illness or mechanism of injury G. Perfusion status a. Evaluating Priority of Patient Care and Transport A. 4. Primary Assessment: Unstable Page 65 of 212 . Primary Assessment: Potentially Unstable C. Skin temperature c. Integration of Treatment/Procedures Needed to Preserve Life III. Identifying Life Threats 1. Assess patient and determine if the patient has a life-threatening condition a. Skin moisture d. Capillary refill (as appropriate) F. treat immediately b. Assessment of Vital Functions II. Unstable – if a life threatening condition is found.

Detailed evaluation of the chief complaint 2. Accurately document all times 3. Factors Influencing the Data Collection 1. Bystanders e. Medical identification jewelry or other medical information sources 2. How reliable is the data? C. Friends d. Patient i. Consider medical identification tag Page 66 of 212 . Public safety personnel f. The Chief Complaint Is a Very Brief Description of the Reason for Summoning EMS to the Scene B. History of the Present Illness 1. Medical 2. clear. Obtain correct dates 2. Trauma 3. Surgical 4. Age b. Provides a full. Components of a Patient History A. Statistical and Demographic 1. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Family c. primary and secondary assessment. Sex c. What is the source of the information? a. reassessment) to guide emergency management. patient history. Identifying data a. Investigation of the Chief Complaint A. usually the best source for information b. chronological account of the signs and symptoms II. Patient Assessment History-Taking EMT Education Standard Applies scene information and patient assessment findings (scene size-up. Past Medical History (Pertinent to the Medical Event) 1. Race B.

Diet f. Use of safety measures (in and out of the home) j. open-ended question 2. Mrs. Environmental conditions 3. Individual factors a. Family history III. or Ms. repeating the patient’s words encourages additional responses ii. drugs and related substances e. Use a general. actions. Avoid the use of unfamiliar or demeaning terms such as “granny” or “honey” C. Most patients comfortable with note-taking B. Environment – personal space 2. Be aware of body language b. EMS personnel demeanor and appearance a. Allergies c. Current medications b. and professional 3. Mr. Refer to the patient by their last name with the proper title i. Note-taking a. Environmental hazards i. Alcohol. Determine Chief Complaint 1. Setting the Stage 1. Difficult to remember all details b. Techniques of History Taking A. typically does not bias the story or interrupt the patient’s train of thought c. Facilitation i. Immunizations h. Screening tests g. Learning About the Present Illness 1. Reflection i. C. making eye contact or saying phrases such as “go on” or “I’m listening” may help the patient to continue b. Current Health Status (Pertinent to the Medical Event) 1... neat. ii. Focuses on present state of health 2. if they inform you to address them by their first name. Refer to the patient by name a. posture. Follow the patient’s lead a. Clarification – used to clarify ambiguous statements or words Page 67 of 212 . do so b. Tobacco use d. Clean. or words should encourage the patient to say more ii.

Pertinent negative(s) 10. Standardized Approach to History-Taking A. palliative. Tobacco use 2. Birth control / erectile dysfunction Page 68 of 212 . Duration b. 1-10 7. Over the counter (OTC) b. For trauma patients. Assess Past Medical History (Pertinent to the Medical Event) 1. Onset (when did it start?) 3. What makes it worse? b. Medications 3. Social history. Associated signs and symptoms 9. A = Allergies a. Prescribed c. Utilize the scale. Family history 5. How long does it last? 8. Severity a. S = Signs and symptoms 2. Confrontation – some issues or responses may require you to confront patients about their feelings f. d. Medication b. What makes it better? c. travel history F. Attempt to quantify the pain b. Environmental 3. requires you to make an inference D. Location (where is it?) 2. Pre-existing medical conditions or surgeries 2. Interpretation – goes beyond confrontation. Provocative. Radiation (does it move anywhere?) 6. and other related substances 3. and positioning a. Quality (what is it like?) 5. Allergies 4. What position is the patient comfortable? 4. M = Medications a. determine the mechanism of injury E. drugs. History of the Present Illness 1. Vitamins and herbal d. Use of alcohol. SAMPLE History 1. Empathetic responses – use techniques of therapeutic communication to interpret feelings and your response e. Diet IV. When did it start? c. Time a. Current Health Status 1.

Special Challenges 1. however. Patient with multiple symptoms 4. O = Onset – time the signs or symptoms started 2. and positioning a. Silent patient a. e. Recreational drugs 4. burning ii. Be alert for nonverbal clues of distress c. Q = Quality of the discomfort a. P = Provocative. L = Last oral intake a. in what position is the patient found? ii. Overly talkative patients a. Sexual History D. T = Time a. Other substances 6. Summarize frequently 3. Other people’s medications f. Taking History on Sensitive Topics A. Pain scale 6. Silence is often uncomfortable b. R = Radiation a. Does the discomfort move in any direction? 5. more definitive in regards to initial onset in the history V. What makes it worse? b. S = Severity a. stabbing iii. should the patient remain in that position? 3. Relating to onset. P = Past pertinent medical history – relevant information concerning the illness or injury 5. Give the patient free reign for the first several minutes b. E = Events leading to the illness or injury a. Anxious patient a. Food c. Fluids b. Patient’s ability to describe the type of discomfort i. Positioning i. What was taking place just prior to the illness or injury? B. Silence may be the result of the interviewer’s lack of sensitivity 2. OPQRST History 1. palliative. What makes it better? c. Anxiety is natural Page 69 of 212 . Physical Abuse or Violence C. Alcohol and Drugs B. crushing 4.

Avoid trapping them in small areas d. Patient with limited cognitive abilities a. Patient with hearing problem – if the patient can write. Expect history to take more time Page 70 of 212 . Patient with confusing behavior or history 10. Do not overlook the ability of these patients to provide you with adequate information b. Try to find a third party who can help you get the whole story VI. EMT-patient language barrier – take every possible step to find a translator 12. Do not get angry in return 6. Treat with dignity. Intoxicated patient a. have the patient write down questions and answers on paper 13. despite their intoxication 7. Age-Related Variations for Pediatric and Geriatric Assessment and Management A. Be sensitive to nonverbal clues c. Pediatric (see Special Patient Population section) B. Be alert for signs of depression b. Angry and hostile patient a. Be alert for omissions 11. Often the anger is displaced toward the clinician c. Geriatric (see Special Patient Population section) 1. Understand that anger and hostility are natural b. Be willing to listen and be non-judgmental 9. b. Talking with family and friends a. Reassurance 5. this may aggravate them c. Do not attempt to have the patient lower their voice or stop cursing. Depressed patient a. not challenging b. Obtain eye glasses and hearing aids 2. Be accepting. Patient with visual impairment – be careful to announce presence and provide careful explanations 14. Some patients may not be able to provide you with all information b. Crying patient may provide valuable insight 8.

Patient Assessment Secondary Assessment EMT Education Standard Applies scene information and patient assessment findings (scene size-up. Pulse a. Predictable d. Keep in mind that most patients view a physical exam with apprehension and anxiety—they feel vulnerable and exposed 4. Cardiovascular System 1. common locations ii. Rhythm c. Presence of breath sounds c. Techniques of Physical Examination A. Location i. Retractions 4. Respiratory effort a. Auscultation a. patient history. Adjust timing for irregularity e. Expose the chest as appropriate for the environment 2. reassessment) to guide emergency management EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Place special emphasis on areas suggested by the present illness and chief complaint 3. Respiratory System 1. Strength f. Examine the patient systematically 2. General Approach 1. Technique – medical versus trauma b. Accessory muscle use b. Maintain professionalism throughout the physical exam while displaying compassion towards your patient B. primary and secondary assessment. Chest shape and symmetry 3. Rate b. Absence of breath sounds C. pelation to perfusion Page 71 of 212 .

Blood pressure i. methods of measurement a) auscultation b) palpation vi. relation to perfusion D. Neurological System 1. facial expression a) anxiety b) depression c) anger d) fear e) sadness f) pain b. Perfusion a. appropriateness a) slurred b) garbled c) aphasia Page 72 of 212 . Mental status a. assess for level of consciousness (AVPU) a) alert b) response to verbal stimuli i) drowsiness ii) stupor (a) state of lethargy (b) person seems unaware of surroundings c) response to painful stimuli d) unresponsive i) coma (a) state of profound unconsciousness (b) absence of spontaneous eye movements (c) no response to verbal or painful stimuli (d) patient cannot be aroused by any stimuli ii. observe posture and motor behavior iii. position of patient iv. position of arm v. rate ii. equipment size ii. placement of cuff iii. 2. Appearance and behavior i. Speech and language i.

range of motion ii. place iii. Overview i. Mood i. surface findings b. Thought and perceptions i. sensory iii. nature ii. temperature of lower legs iii. suicidal ideation d. range of motion ii. assess perceptions a) unusual b) hearing things c) seeing things e. General physical findings i. symmetry ii. Memory and attention i. Upper extremities a. Tenderness 2. strength iii. motor function iv. assess thought content a) unusual thoughts b) unpleasant thoughts iii. intensity iii. General physical findings i. c. tenderness ii. circulatory function c. Lower extremities a. Peripheral vascular system i. time iv. person ii. distal pulses 3. Musculoskeletal System 1. Symmetry b. sensory iii. motor function iv. symmetry ii. circulatory function Page 73 of 212 . assess thought processes a) logic b) organization ii. surface findings b. purpose E. Overview i. Pelvic region a.

pupil size. arm drift 4. spinal column tenderness F. Auscultation i. General physical findings i. chest shape and symmetry iii. v. Skull c. Masses d. hydration iii. shape. Symmetry c. odor ii. condition of teeth 2. contour iii. appropriate facial expression d. fluid in nares g. and response a) normal – equal and reactive to light b) abnormal i) constricted ii) dilated iii) unequal ii. Chest a. surface findings – inspection b. expose appropriately ii. lung sounds a) presence of breath sounds – wheezes Page 74 of 212 . Head a. Arterial pulses 3. Mouth and pharynx i. symmetry ii. Ears – fluids f. Neck a. Physical findings b. Eyes i. Back a. Nose i. technique – medical versus trauma ii. conjunctiva color and hydration e. symmetry of expression ii. Overview i. Overview i. respiratory effort iv. All Anatomical Regions 1. surface findings b. Face i. Scalp b. symmetry ii. flank tenderness ii.

shape and size iii. Posterior chest i. Special Considerations for Pediatric and Geriatric Patients (see Special Patient Populations section) Page 75 of 212 . masses iii. findings associated with pregnancy – physical changes of contour and shape II. spinal column 4. Abdomen a. auscultation findings – lungs ii. intercostal muscle use iii. Physical findings i. organ margins iv. symmetry ii. Anterior chest i. position patient for examination ii. softness vi. contour v. Overview i. b) absence of breath sounds c. retraction d. tenderness vii. palpation method a) four quadrants b) palpate affected area last b. auscultation ii.

Assess oxygenation 2. reassessment) to guide emergency management. Hypoperfusion b. Patient Assessment Monitoring Devices EMT Education Standard Applies scene information and patient assessment findings (scene size-up. Assess adequacy of oxygen delivery during positive pressure ventilation 3. Limitations 1. primary and secondary assessment. Refer to the manufacturer’s instructions for the specific device being used 2. Routine vital sign 2. Obtaining blood pressure after manual blood pressure B. patient history. Procedure 1. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Procedure 1. Pulse Oximetry A. Purpose 1. Appropriateness of use b. Cold extremity d. Indication 1. Carbon monoxide c. Purpose 1. Refer to the manufacturer’s instructions for the specific device being used D. Erroneous readings or values Page 76 of 212 . Limitations 1. Does not indicate whether body cells can utilize the oxygen present 2. Indications C. Continuous monitoring of patient C. Considered alternative measurement sites D. Specific a. Time lag in detection of respiratory insufficiency II. Assess impact of interventions B. General a. Non-Invasive Blood Pressure A. Does not provide a direct measurement of blood oxygen content c.

State regulatory processes may elect to expand. As Additional Monitoring Devices Become Recognized as the “Standard of Care” in the Out-of-Hospital Setting. Those Devices Should Be Incorporated Into the Primary Education of Those Who Will Be Expected to Use Them in Practice B. or modify the monitor devices in this section Page 77 of 212 .III. Other Monitoring Devices A. delete.

Airway – Recheck the Airway for Patency C. Unstable Patients – Every Five Minutes. Interventions V. or as Often as Practical Depending on the Patient’s Condition B. Primary Assessment B. Monitor the patient’s condition B. Level of Consciousness – Is the Patient Maintaining the Same Level of Responsiveness or Becoming More/Less Alert? B. patient history. How and When to Reassess II. Monitor the effectiveness of interventions C. primary and secondary assessment. Identify and Treat Changes in the Patient’s Condition in a Timely Manner A. Reassessments Should Be Performed at Regular Intervals A. A Reassessment Includes: A. reassessment) to guide emergency management. Breathing – Reassess the Adequacy of Breathing by Monitoring Both Breathing Rate and Tidal Volume D. Identify trends in the patients vital signs III. Patient Assessment Reassessment EMT Education Standard Applies scene information and patient assessment findings (scene size-up. Stable Patients – At Least Every 15 Minutes or as Deemed Appropriate by the Patient’s Condition IV. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Compare to the Baseline Status of That Component A. Circulation – Reassess the Adequacy of Circulation by Checking Both Central and Peripheral Pulses Page 78 of 212 . Chief Complaint D. Vital Signs C.

Blood pressure 4.VI. Interventions – Reassess the Effectiveness of Each Intervention Performed and Consider the Need for New Interventions or Modifications to Care Already Being Provided IX. Respirations 2. Pupils VII. Determine If Their Pain/Discomfort Is Remaining the Same. or Getting Better C. Age-Related Considerations for Pediatric and Geriatric Assessment and Management Page 79 of 212 . Attention Should Be Paid to: 1. Vital Signs A. Pulse 3. Repeat Vital Signs as Necessary B. Chief Complaint A. Be Sure to Ask If There Are Any New or Previously Undisclosed Complaints VIII. Constantly Reassess the Patient’s Chief Complaint or Major Injury B. Getting Worse.

Requires a balance of knowledge and skill to obtain a thorough and accurate history c. Environment C. Distracting Injuries G. Standard Precautions B. Pill containers b. Patient Cooperation I. Medical jewelry Page 80 of 212 . Major Components of the Patient assessment A. Verbal or non-verbal 3. Unresponsive patient a. Tunnel Vision H. Non-Life Threatening Conditions F. Primary component of the overall assessment of the medical patient b. EMT Attitude 1. Scene Size-Up C. Labeling II. Biases 2. Primary reason for EMS response 2. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Chief Complaint 1. Scene Safety B. SAMPLE History 1. Helps to ensure the proper care will be provided for the patient 2. Life-Threatening Conditions E. Assessment Factors A. General Impression D. Medicine Medical Overview EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient. Initial Assessment E. Possibly misleading D. Importance of a Thorough History a.

Medical devices 3. question: when did your problem/pain/discomfort first begin? F. T – time i. focuses on the duration of the problem/pain/discomfort ii. Q – quality i. questions a) Can you describe your pain/discomfort? b) What does if feel like? c) Is it sharp? Dull? d) Is it steady or does it come and go? d. Bystanders e. focuses on what the patient was doing when the problem began ii.region/radiate i. c. family members iv. question: does anything you do make the problem better or worse? c. P – provoke i. focuses on what might provoke the problem for the patient ii. bystanders 4. Responsive patient a. Obtained directly from the patient b. focuses on the specific area of the pain/discomfort ii. OPQRST mnemonic for evaluation of pain a. Additional history may be obtained from evidence at the scene i. focuses on the patient’s own description of the problem ii. O – onset i. pill containers ii. question: what were you doing when the problem began? b. Baseline Vital Signs G. Family members d. questions a) Can you point with one finger where you fee the pain/discomfort the most? b) Does the pain/discomfort radiate to any other areas of your body? e. medical jewelry iii. Focused on the patient’s chief complaint c. focuses on the severity of the pain/discomfort ii. R . S – severity i. questions a) Use a pain scale to ask the patient: How would you rate your pain right now? b) How would you rate your pain when it first began? c) Has there been any change since it first began? f. Secondary Assessment Page 81 of 212 .

pain ii. pink moist conjunctiva d. Neck i. nasal flaring f. May not be appropriate to perform a complete secondary assessment on all medical patients 2. medication patches viii. pink and moist mucosa g. drainage e. Designed to identify any signs or symptoms of illness that may not have been revealed during the initial assessment a. Nose i. scars v. Head/scalp i. pain ii. scars vii. pain ii. symmetry b. equality and reactivity to light iii. rigidity iii. equal rise and fall iii. pain ii. pupil size ii. Chest i. accessory muscle use iii. retractions vi. medical devices Page 82 of 212 . guarding iv. pain ii. medical jewelry v. Ears i. pain ii. Face i. Eyes i. Abdomen i. pain ii. foreign body ii. distention iv. breath sounds v. symmetry of facial muscles c. stoma h.1. jugular vein distention iv. Mouth i. loose dentures iii. medical devices i.

Consider the need for ALS backup Page 83 of 212 . Arms i. distal circulation iii. pain ii. transport the patient in the recovery position to help ensure a patent airway 2. medical jewelry l. distal circulation iii. track marks vi. motor function v. pain ii. sensation iv. When practical. incontinence k. pain ii. scars H. pain ii. Back i. j. Pelvis/genital i. motor function v. Legs i. track marks vi. Continued Assessment 1. medical jewelry m. sensation iv.

Headache 9. tongue deviation 5. Other stroke scales E. Hemorrhage 2. Stroke/TIA A. Pulse oximetry 4. Decreased or absent sensation in one or more extremities or other areas of body 10. Transient Ischemic Attack (TIA) Page 84 of 212 . Rapid transport G. Facial drooping. Assessment Findings and Symptoms 1. Double vision or blurred vision 6. Stroke Alert Criteria 1. Confused. inability to swallow. Cincinnati Prehospital Stroke Scale 2. dizzy. Difficulty speaking or absence speech 7. ABCs /position 2. Decreased or absent movement of one or more extremities 8. Coma D. weak 2. Clot B. Combative or uncooperative or restless 4. Medicine Neurology EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Management of Patient With Stroke Assessment Findings or Symptoms F. Oxygen/suction 3. Emotional support 5. Scene Safety and Standard Precautions 1. Decreasing or increasing level of consciousness 3. Review of Anatomy and Function of the Brain and Cerebral Blood Vessels C. Causes 1.

Oxygen/suction 4. Assessment Findings 1. Bite tongue. Pulse oximetry 5. Safety of patient/position 2.II. Management B. Causes C. Sweating 4. increased secretions 3. Tonic c. Causes of altered mental status in children 5. Pathophysiology 4. consider nasopharyngeal airway 3. As a Neurological Condition C. Age-Related Variations for Pediatric and Geriatric Assessment and Management A. Generalized tonic – clonic a. Seizures 8. Anatomic and physiologic differences in children 3. Management 1. Management IV. As a Symptom B. Headache A. Seizures A. Assessment a. Postictal 2. Cyanosis 5. Assessment Findings and Symptoms D. Incidence B. Emotional support III. muscle contractions 2. Aura b. Epidemiology 2. Geriatrics – Stroke Common in This Age Group Page 85 of 212 . Pediatrics 1. Meningitis 7. ABCs. Status epilepticus D. Incontinent 8. Partial seizures 3. Types of Seizures 1. Spasms. Altered mental status 9. Amnesia of event E. Unconscious gradually increasing level of consciousness 6. Clonic d. History b. Physical findings 6. May cause shaking or tremors and no loss of consciousness 7.

Transport Decisions -.Rapid Transport to Appropriate Facility Page 86 of 212 . Communication and Documentation VI.V.

Normal Findings—Soft Non-Tender C. Pancreas I. Assessment and Symptoms A. Urinary Bladder F. Esophagus D. Inspection 2. Palpation B. Excessive b. Define Acute Abdomen II. Kidney J. Constipation b. Abnormal Findings 1. Liver G. Hematemesis 2. Urination a. Medicine Abdominal and Gastrointestinal Disorders EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Anatomy of the Organs of the Abdominopelvic Cavity A. Spleen E. Dark tarry stool 3. Frequency Page 87 of 212 . Reproductive Organs III. Pain b. Stomach B. Techniques 1. Gall Bladder H. Change in bowel habits/stool a. Diarrhea c. Nausea/vomiting a. Intestines C.

Other IV. and Specific Prehospital Management A. Assessment Findings and Symptoms. Physical findings a. GI Bleeding 3. and Circulation C. Geriatric 1. Communication and Documentation for Patients With an Abdominal or Gastrointestinal Condition or Emergency IX. Weight loss 5. Ulcerative Diseases VI. Belching/flatulence 6. General Management for Patients With an Acute Abdomen A. Abdominal pain related to cardiac conditions VIII. Complications. Pain. Transport Decisions Page 88 of 212 . guarding. Scene Safety and Standard Precautions B. Vomiting e. c. Acute and Chronic Gastrointestinal Hemorrhage B. Odor 4. Emotional Support V. Ventilatory. Assessment 1. Management D. Anatomic and Physiologic Differences in Children B. Abdominal pain from constipation d. May not exhibit rigidity or guarding 2. Peritonitis C. Airway. Position D. Appendicitis common in children c. Concurrent chest pain 7. Causes. tenderness. Consider Age-Related Variations for Pediatric and Geriatric Assessment and Management VII. History 2. Pathophysiology C. distension 8. Color d. Pediatrics A. Vomiting causes dehydration b. Specific Acute Abdominal Conditions—Definition.

Wheezing. Definition of Terms 1. Increased Capillary Permeability B. Rapid and Labored Breathing. Assessment Findings for Allergic Reaction A. Tightness in Chest. Swelling Locally or Generalized. Hypotension C. Hives. Allergic reaction 2. The Speed of the Response III. Wheezing to Silent Chest B. Risk Factors and Common Allergens II. Respiratory System—Severe Respiratory Distress. or Cyanotic D. Cardiovascular—Increased Heart Rate C. Anaphylaxis B. The Type of Response (Local versus Systemic) C. Vasodilation C. Bronchoconstriction D. Introduction A. The Purpose of the Response B. Dizziness V. Skin—Pale or Redness. Fundamental Pathophysiology A. Assessment Findings for Anaphylaxis A. Other—Anxiety. Skin—Pale. Basic Immune System’s Response to Allergens A. Cough. Medicine Immunology EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Respiratory System—Sneezing. Red. Itchy and Watery Eyes. Cardiovascular—Rapid Pulse. Stridor B. Increased Mucus Production IV. Itching D. Other—Decreasing Mental Status Page 89 of 212 .

Management A. Auto injection Systems 1. Indications – Severe Allergic Reaction or Hypersensitivity to Exposed Substance B. ABCs B. Cardiac Arrhythmias E. Vitals F. remove needle cover 4. Oxygen D. push against thigh. Contraindications – Not Patient’s Drug. Anxiety. Consider Age-Related Variations for Pediatric and Geriatric Assessment and Management A. Transport Decisions Page 90 of 212 . Physician order 2. or Discolored C. Communication and Documentation X. Dispose properly VIII. hold until drug fully injected 5. Assist With Patient’s Auto injector G. Side Effects – Increased Pulse Rate and B/P. Monitor patient response 6. Geriatric – Possible Contraindication in Coronary Artery Disease IX. Expiration date and patient prescription 3.VI. Raises B/P. Prep site. Dilates the Bronchioles D. Lateral thigh. Expired. Actions – Slows Allergic Response. Remove Allergen If Possible VII. Position C. Epinephrine as a Treatment for Allergic Reaction A. Pediatric – Pediatric Weight-Based Auto injector Available B. Emotional Support E.

Communication and Documentation for a Patient With a Communicable or Infectious Disease V. Fungi 4. Transport Decisions Including Special Infection Control Procedures Page 91 of 212 . Causes of Infectious Disease A. Consider Age-Related Variations in Pediatric and Geriatric Patients as They Relate Assessment and Management of Patients With a Gastrointestinal Condition or Emergency IV. Bacteria 2. Recommendations for Cleaning or Sterilization of Equipment E. Hand Washing Guidelines C. Recommendations for Decontaminating the Ambulance III. Recommendations for PPE D. Protozoa 5. Recommendations for Disposing of Contaminated Linens and Supplies Including Sharps F. Body Substance Isolation. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Helminths (worms) II. Viruses 3. and Cleaning and Disposing of Equipment and Supplies A. Personal Protective Equipment. Principles of Body Substance Isolation B. Infectious Agents 1. Medicine Infectious Disease EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient.

Current recommended treatment modalities and follow-up 2. Prevention of exposure or immunizations/vaccines VII.VI. Exposure of Health Care Provider 1. Required Reporting to the Health Department or Other Health Care Agency Page 92 of 212 . Legal Requirements Regarding Reporting Communicable or Infectious Diseases/Conditions A.

Incidence 2. Introduction A. Explanation of relationship of glucose and insulin 3. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Hyperglycemia. Complications Page 93 of 212 . Combative or uncooperative or restless 4. Insulins b. Diabetic medications a. Type 2 (formerly known as Non-Insulin Dependent Diabetes or Type II) i. Medicine Endocrine Disorders EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient. syncope 2. Hypoglycemia 3. vertigo. Confusion. oral agents ii. General Assessment Findings and Symptoms 1. Type 1 (formerly known as Insulin Dependent Diabetes or Type I) b. Movement and sensation changes II. Speech changes 7. Decreasing level of consciousness 3. Definition of Terms 1. Types a. diabetic ketosis B. headache. Overview of Condition 1. diet-controlled 5. Normal Blood Glucose Levels (BGL) 4. Diabetes—types I and II 2. Anatomy and Function of the Pancreas C. Increasing level of consciousness 5. Visual changes 6. Diabetes A. Oral agents 6.

Pediatric a. History and assessment findings a. Causes 2. rapid shallow respirations e. Prone to seizures d. Dehydration. Causes 3. and vomiting e. History and assessment findings a. Rapid full pulse. pale. Indication/contraindications b. Position c. coma late f. Polyuria. polyphagia g. Dose and route e. Weak and rapid pulse f. Seizures. Late stages of hyperglycemia may have cerebral edema c. shaking c. Oxygen d. Bizarre behavior. Management a. Hypoglycemia 1. Medical alert identification 3. Consider Age-Related Variations for Pediatric and Geriatric Assessment and Management 1. Pathophysiology 2. oxygen b. Oral glucose a. Actions c. hunger d. Sweating. Onset – rapid changes in mental status b. polydipsia. May be undiagnosed Page 94 of 212 . poor skin tugor. onset—slow changes in mental status b. Management a. acetone breath c. Prone to dehydration e. Emotional support C. When in doubt if hyper/hypoglycemia. Medical alert identification 4. Medical control role f. Emotional support 4. Pulse oximetry e. Usually insulin dependant called juvenile diabetes b.B. tremors. Oral glucose as indicated (must be able to control airway) c. warm and dry d. nausea. Other h. give glucose D. ABCs (airway adjunct) b. ABCs. Kussmaul’s breathing. Hyperglycemia/Diabetic Ketoacidosis 1. Side effects d. Weakness.

Geriatric a. Prone to dehydration and infections III. 2. Communication and Documentation IV. Can mask signs and symptoms of myocardial infarction b. Transport Decisions—Rapid Transport for Altered Level of Consciousness Page 95 of 212 .

Excessive cold 8. Excessive heat 9. Psychogenic – resulting in psychotic thinking. and Alcohol or Drugs B. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Behavior B. Medical Illnesses. Psychiatric Problems. Memory. and Attention IV. Thought. Mental Status F. Seizure disorders 11. Define A. Meningitis 10. Epidemiology of Psychiatric Disorders III. Behavioral Emergency II. Medicine Psychiatric EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient. Factors That May Alter a Patient’s Behavior – May Include Situational Stresses. Judgment. Behavioral Change A. Posture/Gait E. Hypoperfusion 4. Speech C. Assessment A. Toxic ingestions – overdose 12. Withdrawal of drugs or alcohol Page 96 of 212 . Perception. Skin D. Head trauma 5. Mood. depression or panic 7. Psychiatric Disorder C. Common Causes of Behavioral Alteration 1. General Appearance B. Lack of oxygen 3. Mind altering substances 6. Low blood sugar 2.

avoid threatening actions. Determine suicidal tendencies c. Job or financial loss o. agitation. Assessment for Suicide Risk 1. Is there trauma involved? f. orientation iii. Feeling trapped. Purposelessness d. Risk factors/signs or symptoms a. etc. Acute Psychosis B. Hopelessness g. Ideation or defined lethal plan of action which has been verbalized and/or written b. Relational or social loss p. unable to sleep or sleeping all the time e. Withdrawal from friends. Patient assessment i. Agitated Delirium 1. utilize therapeutic interviewing techniques a) engage in active listening b) supportive and empathetic c) limit interruptions d) respect patient’s territory. Establish rapport i. CHF. Anxiety.V. Alcohol and substance abuse c. personal safety b. family and society h. Interventions? C. approach slowly and purposefully c. limit physical touch ii. Certain cultural and religious beliefs 3. Easy access to lethal means q. no way out f. statements and questions iii. Is there a medical problem? e. Depression 2. Important questions a. How does the patient feel? b. Previous suicide attempt n. Some major physical illness (cancer. memory iv. Emergency medical care a. Psychiatric Emergencies A. Recklessness or engaging in risky activities j. intellectual functioning ii. Scene size-up.) m. concentration Page 97 of 212 . Anger and/or aggressive tendencies i. Lack of social support and sense of isolation r. History of trauma or abuse l. Dramatic mood changes k. Is patient threat to self or others? d.

Transport Against Patient Will VII. Medical-Legal Considerations A. If overdose. bring medications or drugs found to medical facility VI. Consider Age-Related Variations for Pediatric and Geriatric Assessment and Management A. agitation b) level of alertness. v. consider need for law enforcement e. hallucinations c) unusual worries. Restrain if necessary f. judgment vi. dress ii) psychomotor activity d. elation. Geriatrics -. Aggressive behavior may be a symptom of an underlying disorder or disability B. mood a) anxiety. fears vii. language a) speech pattern and content b) garbled or unintelligible viii. hygiene. Calm the patient – do not leave the patient alone. Types of Restraints B. distractibility i) appearance.suicide issues/depression common Page 98 of 212 . thought content a) disordered thoughts b) delusions. unless unsafe situation. Transport g. depression. Pediatric Behavioral Emergencies 1. Teenage suicide concerns 2.

Heart 1. Diastole Page 99 of 212 . Vessels 1. White blood cells 3. Automaticity 7. Blood 1. Myocardial muscle cells 5. Vena cava C. Red blood cells 2. Blood supply to myocardium 4. Arteries 3. Venules 6. Autonomic system control a. Chambers 2. Platelets 4. Parasympathetic B. Aorta 2. Specialized electrical cells 6. Veins 7. Sympathetic – “fight or flight” b. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Medicine Cardiovascular EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient. Cardiac Cycle 1. Capillaries 5. Arterioles 4. Systole 2. Plasma II. Valves 3. Anatomy of the Cardiovascular System A. Physiology A.

Factors governing adequate perfusion a. Volume G. Oxygenation of Tissues 1. Systolic 2. Inappropriate circulating volume IV. Inadequate circulation of blood and/ or perfusion of vital processes or organs 2. Delivery of oxygenated blood 2. B. Cardiac Output 1. Inadequate pumping 5. Rate and depth b. Atherosclerosis a. Removal of tissue wastes III. Rate-related compromise 4. Central pulses C. Assessment A. Pump c. Occlusion e. anxiety b. Rate b. Cardiac Compromise 1. Obstruction of blood flow c. Blood Circulation Through a Double Pump 1. Plaque buildup in lumen of artery b. Ischemia is a result of decreased blood flow 3. Respiratory system a. Oxygenated blood back to heart 2. Breathing a. Restlessness. Primary Survey 1. Feeling of impending doom 2. Level of responsiveness a. Blood Pressure 1. Body E. Heart rate X blood volume ejected/beat F. Peripheral Pulses 2. Perfusion 1. Effort Page 100 of 212 . Pathophysiology A. Airway 3. Diastolic D. Deoxygenated blood to lungs b. Function of red blood cells in oxygen delivery 2. Pulses 1. Interference with dilation and constriction of vessel d.

c. Breath sounds
d. Significance of findings
4. Circulation
a. Pulse
i. rate
ii. quality
b. Skin
i. color
ii. temperature
iii. moisture
iv. edema
c. Blood pressure
B. History
1. Chief complaint
2. History of the present illness
a. Chest discomfort/pain
i. signs and symptoms
ii. OPQRST evaluation
b. Respiratory
i. dyspnea
a) continuous
b) exertional
c) non-exertional
d) orthopneic
ii. cough
a) dry
b) productive
c. Related signs and symptoms
i. nausea/vomiting
ii. fatigue
iii. palpitations
iv. headache
v. recent trauma
3. Past medical history
a. SAMPLE history
b. Previous heart disease/surgery
i. angina
ii. previous AMI
iii. hypertension
iv. heart failure
v. valve disease
vi. aneurysm
vii. pulmonary disease
viii. diabetes
ix. COPD
x. renal disease

Page 101 of 212

c. Current/past medications
i. prescribed
ii. over-the-counter
iii. home remedies
iv. recreational drug use
d. Family history
C. Secondary Survey

V. Management (refer to the current American Heart Association guidelines)
A. Place in proper position
B. Evaluation and appropriate management of ventilations/respirations
1. Oxygen saturation evaluation
2. pulse oximetry
C. May be unreliable in cardiac arrest, toxic inhalation
1. Appropriate management of any related ventilatory/respiratory
compromise
a. BVM assistance
b. PEEP
c. CPAP/BiPAP
d. MTV/ATV
2. Appropriate oxygen therapy
D. Evaluation and appropriate management of cardiac compromise
1. Manual and auto BP
2. Mechanical CPR
3. AED
E. Pharmacological interventions
1. Aspirin
2. Nitroglycerin
3. Oral glucose
F. Consider AEMT/Paramedic assistance at the scene
G. Appropriate transportation

VI. Specific Cardiovascular Emergencies (refer to current American Heart Association
guidelines)
A. Acute Coronary Syndromes (ACS) Heart Failure
B. Hypertensive Emergencies
1. Systolic BP greater than 160 mmHg
2. Diastolic BP greater than 94 mmHg
3. Signs and symptoms
a. Strong, bounding pulse
b. Skin warm, dry, or moist
c. Headache
d. Ringing in ears
e. Nausea/vomiting
f. Nose bleed
4. Assessment
C. Cardiogenic Shock

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D. Cardiac Arrest

VII. Pharmacological Agents
A. Aspirin
1. Generic and trade names
2. Indications
3. Contraindications
4. Actions
5. Side effects
6. Precautions
7. Expiration date
8. Dosage
9. Administration
B. Nitroglycerin
1. Generic and trade names
2. Indications
3. Contraindications
4. Actions
5. Side effects
6. Precautions
7. Expiration date
8. Dosage
9. Administration
C. Role of Medical Oversight in Medication Administration
D. Patient Assisted Administration
E. Documentation

VIII. Consider Age-Related Variations for Pediatric and Geriatric Patients for Assessment and
Management of Cardiac Compromise
A. Pediatric
1. Cardiac problems typically associated with congenital heart condition
2. Cardiovascular compromise often caused by respiratory compromise
B. Geriatric -- typical MI presentation often related to other underlying disease
processes
1. Diabetes
2. Asthma
3. COPD

Page 103 of 212

Medicine
Toxicology
EMT Education Standard
Applies fundamental knowledge to provide basic emergency care and transportation based on
assessment findings for an acutely ill patient.

EMT-Level Instructional Guideline
The EMT Instructional Guidelines in this section include all the topics and material at the EMR
level PLUS the following material:

I. Introduction
A. Define Toxicology, Poisoning, Overdose
B. National Poison Control Center
C. Routes of Absorption
1. Ingestion
2. Inhalation
3. Injection
4. Absorption

II. Poisoning by Ingestion
A. Examples
B. Assessment Findings
C. General Management Considerations

III. Poisoning by Inhalation
A. Examples
B. Assessment Findings
C. General Management Considerations

IV. Poisoning by Injection
A. Examples
B. Assessment Findings
C. General Management Considerations

V. Poisoning by Absorption
A. Examples
B. Assessment Findings
C. General Management Considerations

Page 104 of 212

Common causative agents 2. ventilation. Hallucinations and seizures 4. Scene Safety Issues B. Poisonous plants VIII. Assessment Findings and Symptoms. Respiratory depression/arrest d. Seizures and coma 3. Decreased level of consciousness. Management for a Patient With Medication Overdose Page 105 of 212 . Common Causative Agents. Assessment findings and symptoms for patients with alcohol abuse and alcohol withdrawal 5. Respiratory depression c. Opiates/Narcotics 1. Drugs of Abuse A. Assessment Findings and Symptoms for Patients With Medication Overdose C. Common Causes of Overdoses (Other Than Drugs of Abuse) 1. Pesticides 2. Management for a patient using alcohol or withdrawing from alcohol — airway. Alcohol abuse a. Management for a patient using opiates B. Psychiatric medications 3. Non-prescription pain medications including Salicylates and Acetaminophen 4. CNS changes—agitation to sedation to altered level of consciousness b. Nausea and vomiting d. Barbiturates/sedatives/ hypnotics VII. Common Causative Agents. Cardiac medications 2. Alcohol withdrawal a. Medication Overdose A.VI. Management 1. sedation b. Alcohol 1. Poisonings and Exposures A. Hypotension c. Management 1. Household cleaning poisonings 4. and circulation C. Uncoordination 3. Assessment Findings and Symptoms. Hallucinogens 3. Chemicals 3. sweating weakness b. pinpoint pupils e. Tremors. Overview of alcoholism including long-term effects 2. Cannabis 2. Other B. Assessment findings and symptoms a. Nausea. Stimulants 4.

Transport Decisions Page 106 of 212 .Alcoholism is common in elderly XI. Use of Activated Charcoal 1. Indications/contraindications/side effects 2. Dose X. Airway Control D. Geriatric -. Circulation F. Ventilation and Oxygenation E. Consider Age-Related Variations for Pediatric and Geriatric Assessment and Management A. Pediatric 1.IX. Physician order 3. Communication and Documentation for Patients With Toxicological Emergencies XII. Standard Precautions and Decontamination C. Toddler-aged prone to ingestions of toxic substance 2. Adolescent prone to experimentation with drugs of abuse B. Scene Safety B. General Treatment Modalities for Poisonings A.

Lungs and Accessory Structures II. Lower Airway C. Skin color changes f. Anatomy of the Respiratory System A. Shortness of breath b. Transport Page 107 of 212 . Changes in respiratory rate or rhythm e. Management of respiratory distress a. Upper Airway B. position c. Retractions i. Pulse oximetry e. Oxygen/suction d. Normal Respiratory Effort III. Altered mental status j. Tripod position 2. Coughing l. Assessment a. ABCs. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Scene safety and Standard Precautions b. Restlessness c. Increased pulse rate d. Respiratory Distress 1. Assessment Findings and Symptoms and Management for Respiratory Conditions A. Abdominal breathing k. Inability to speak h. Abnormal sounds of breathing/lung sounds g. Emotional support f. Medicine Respiratory EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient.

EMT Role in Assisting B. Epiglottitis d.e. Croup b. Assessment Findings and Symptoms. Cystic Fibrosis J. Consider Age-Related Variations for Pediatric and Geriatric Assessment and Management A. Specific Respiratory Conditions—Definition. Dose and Route F. Upper airway obstruction (i.IV. Foreign body lower airway obstruction e. Foreign body aspiration c. Pulmonary Embolism G. Pertussis f. Upper airway obstruction a. Cystic fibrosis VIII. Viral Respiratory Infections V. Side Effects E. Complications. Asthma B. Pertussis I. Lower airway disease (i. Geriatrics—Pneumonia and Chronic Conditions Such as COPD Common 1. foreign body lower airway obstruction) B. Pediatric 1. Bronchiolitis c. Spontaneous Pneumothorax F. Pneumonia E. foreign body aspiration or tracheostomy dysfunction) 2. Lower airway disease a. Asthma b. and Specific Prehospital Management and Transport Decisions A. Transport Decisions Page 108 of 212 . Tracheostomy dysfunction 2.e. Pulmonary Edema C. Medical Control Role VI. Causes. Chronic Obstructive Pulmonary Disease D. Communication and Documentation for Patients With Respiratory Emergencies VII. Indication/ Contraindications C. Actions D. Pneumonia d. Epiglottis H. Metered-Dose Inhaler and Small Volume Nebulizer A. Environmental/Industrial Exposure/ Toxic Gasses K.

General Management 1. Skin 3. Transport considerations 4. Psychological/communication strategies IV. Genitourinary B. White blood cells 3. Level of consciousness 2. Anatomy and Physiology A. Pediatrics B. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Blood-Forming Organs 1. Blood 1. Airway. Plasma C. General Assessment 1. and circulation 2. Clotting Disorders V. ventilation. Skeletal 6. Red cell destruction II. Cardiorespiratory 7. Pathophysiology of Sickle Cell III. Red blood cells 2. Consider Age-Related Variations A. Red cell production 2. Oxygen 3. Sickle Cell Crisis A. Platelets B. Medicine Hematology EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient. Gastrointestinal 5. Geriatrics Page 109 of 212 . Visual disturbances 4.

Infection at access site E. Pulmonary edema IV. ABCs. Hypotension 2. Pathophysiology A. Obtaining B/P D. Peritoneal Dialysis C. Shunt 2. Support Ventilation B. Complications/Adverse Effects of Dialysis 1. Management for a Patient With a Dialysis Emergency A. Missed Dialysis Treatment 1. Weakness 2. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Stop Bleeding From Shunt as Needed C. Urinary Catheter Management Page 110 of 212 . Anatomy and Physiology of Renal System II. Nausea/vomiting 4. Muscle cramps 3. Hemodialysis 1. Graft B. Kidney Stones III. Position—Flat If Shocky. Dialysis A. Special Considerations for Hemodialysis Patients 1. Hemorrhage especially from access site 5. Upright If Pulmonary Edema V. Medicine Genitourinary/Renal EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient. Fistula 3. Kidney Failure B.

VI. Communication and Documentation VIII. Transport Decisions Page 111 of 212 . Consider Age-Related Variations in Pediatric and Geriatric Patients VII.

Vaginal Bleeding B. Sexual Assault — Legal Issues C. Introduction A. Causes. Syncope III. Communication and Documentation VII. Specific Gynecological Emergencies—Definition.Menarche could be cause of bleeding B. Age-Related Variations for Pediatric and Geriatric Assessment and Management A. External Genitalia 2. General Management A. Communication Techniques C. Assessment Findings A. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Transport Decisions Page 112 of 212 . Vaginal Bleeding C. Abdominal Pain or Vaginal Pain B. Sexually Transmitted Diseases V. Pediatrics -. Vaginal Discharge D. Management A. Assessment Findings. Infections — Pelvic Inflammatory Disease D. Internal Organs and Structures II. Protect Privacy and Modesty B. Fever E. Medicine Gynecology EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient. Risk Factors. Female Reproductive System Anatomy and Physiology 1. Geriatrics -. Nausea and Vomiting F.Menopausal women can get pregnant VI. Consider Pregnancy and/or Sexually Transmitted Diseases IV.

Sensation Changes E. Airway. Geriatric Page 113 of 212 . Swelling C. and Circulation B.e. Management A. Bones B. Assessment A. Communications and Documentation V. Abnormal or Loss of Movement D. Anatomy and physiology review A. Deformity IV. Pain or Tenderness B. Consider Age-Related Variations A. cancer or osteoporosis) III. Splinting C. Ventilation. Circulatory Changes F. Pathophysiology A. Medicine Non-Traumatic Musculoskeletal Disorders EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient. Muscles II. Pediatric B. Non-Traumatic Fractures (i. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Transport Considerations D.

Tell patient not to sniffle or blow nose Page 114 of 212 . High blood pressure B. Can block airway if patient is unresponsive C. General Assessment Findings and Symptoms 1. Vomits swallowed blood 4. Nosebleed A. and Throat EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient. Nose. Dryness b. Pinch the nostrils together firmly 3. Ears. Bleeding from nose 3. Trauma 2. Medicine Diseases of the Eyes. EMT-Level Instructional Guideline I. Pain or tenderness 2. Causes 1. Sit patient up and lean forward 2. Medical a. Techniques to Stop Bleeding in Conscious Patient If No Risk of Spine Injury 1.

Anatomy and Physiology Review A. respiratory failure or arrest. Vascular System a. Four chambers b. Cardiovascular System 1. femoral pulse iii. and post-resuscitation management. Respiratory Failure A. to deliver oxygen and nutrients to the tissues ii. and management of shock. Respiratory System 1. pathophysiology. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Withholding Resuscitation Attempts 1. Pathophysiology 1. Respiratory waste products to leave the blood and lungs B. Provide Emotional Support for Family II. Do Not Resuscitate (DNR) orders B. carotid pulse ii. Arteries carry blood to tissues i. Pumps blood around the body i. Ethical Issues in Resuscitation A. Shock and Resuscitation EMT Education Standard Applies a fundamental knowledge of the causes. radial pulse iv. brachial pulse b. to remove waste products from the tissues 2. cardiac failure or arrest. Constrictive 2. Veins carry blood to heart III. Pumps blood to the lungs to pick up oxygen c. Heart a. Passageway for fresh oxygen to enter the lungs and blood supply 2. Destructive Page 115 of 212 . Obstructive 3. Irreversible death 2.

911-pre-arrival instructions and dispatcher directed CPR Page 116 of 212 . Neurological symptoms 4. Sudden death and heart disease 2. Ventilatory support a. Carbon dioxide clearance b. Oxygenated blood is circulated to the brain and other vital organs B. rapid notification before CPR starts — "phone first" b. Medical emergencies 4. Ventilatory support a. Artificial ventilation — oxygenates the blood b. Trauma VI. especially in infants and children 3. rapid recognition of a cardiac emergency ii. Oxygen therapy 2. Brain damage begins 4-6 minutes after the patient suffers cardiac arrest — damage becomes irreversible in 8-10 minutes 3. Breathing stops. B. Treatment 1. Pulmonary symptoms 2. Treatment 1. Cardio-pulmonary resuscitation (CPR) a. Cardiac Arrest A. Pharmacological therapy IV. General Reasons for the Heart to Stop Beating 1. Oxygen therapy 2. Assessment B. Other symptoms C. System Components to Maximize Survival 1. Resuscitation A. Organ damage begins quickly after the heart stops b. Public education and awareness i. The body cannot survive when the heart stops a. Pathophysiology 1. External chest compressions — pushing on the chest squeezes the heart and simulates a contraction c. Carbon dioxide clearance b. Advanced airways V. Cardiovascular symptoms 3. Assessment 1. If the heart stops contracting. Respiratory Arrest A. no blood will flow 2. Early access a.

Basic Airway adjuncts 2. Transdermal medication patches VIII. Perfusion is the passage of blood and oxygen and other essential nutrients to the body’s cells 2. Emergency Medical Responders 3. Early Advanced Care B. While delivering these essentials to the body’s cells. family ii. Wet patients 3. the circulatory system is also removing waste such as carbon dioxide from the cells Page 117 of 212 . Child CPR and foreign body airway obstruction 3. Load-Distributing Band or Vest CPR VII. Definition 1. Special AED situations 1. Mechanical Piston Device c. Slow compression rate c. Adult AED Use B. Adult CPR and foreign body airway obstruction 2. Frequent interruptions 2. Factors which decrease effectiveness a. Child AED Use C. bystanders b. Early Defibrillation 4. Lay public i. Infant AED Use D. Automated External Defibrillation (AED) (Refer to the current American Heart Association guidelines) A. Ventilation a. Sub-maximum recoil d. Delivery of excessive rate or depth of ventilation reduces blood return to the right side of the hear b. Airway Control and Ventilation 1. 2. Chest Compressions 1. Impedance Threshold Device b. Infant CPR and foreign body airway obstruction C. Devices to assist circulation a. Compression that are too shallow b. Pacemaker 2. Early CPR a. Basic Cardiac Life Support (Refer to the Current American Heart Association Guidelines) 1. Reduces the overall blood flow that can be generated with CPR D. Shock (Poor Perfusion) A.

Functioning pump/heart i. Leaky or dilated container/vessels a. pulmonary ii. Disruptions That Can Cause Shock 1. Loss of nervous control b. blood flow controlled by cellular tissue demands C. arteries surrounded by smooth muscle contract and dilate to deliver blood to tissue ii. Shock is a state of hypoperfusion. Physiology of respiration a. veins are low pressure vessels responsible for returning blood to the heart iv. Gas exchange i. or inadequate perfusion of blood through body tissues 4. systemic 3. Inadequate fluid/blood – blood/water loss 2. 3. controlled by the autonomic nervous system during shock b. Damage to cardiac muscle 3. Essential components for normal perfusion a. Intact container/vessels i. Anatomy and Physiology Review 1. pump collects blood from the body iii. Massive infection d. capillary beds are the site where perfusion occurs iii. smooth muscle and sphincters controlled by the autonomic nervous system to constrict or dilate v. Circulation i. Failing pump/heart a. Severe allergic reactions c. blood contains formed elements a) RBCs transport oxygen b) WBCs fight infection c) platelets form blood clots d) clots are very unstable and prone to rupture ii. Hypoperfusion can lead to death if not corrected B. pump delivers blood to the tissue ii. alveolar level ii. plasma is the fluid that transports the formed elements c. Disease or injury to conduction system b. Hypothermia Page 118 of 212 . tissue level b. Adequate volume i. Heart/Blood vessels 2.

Neurogenic a. Manual in-line spinal stabilization. Irreversible shock E. Obtains a relevant history 4. Breathing a. Do not give food or drink 4.D. Signs and symptoms 2. Cardiogenic a. Sepsis a. Complete a scene size-up 2. Signs and symptoms F. Comfort. Compensated shock 2. Perform a primary assessment 3. Categories of Shock 1. and reassure the patient while awaiting additional EMS resources 3. Shock Due to Fluid Loss 1. Airway control – adjuncts. Oxygen administration (high-flow/high-concentration) b. Shock Due to Container Failure 1. Signs and symptoms G. Examples b. Begin transport at the earliest possible moment 9. Shock Due to Pump Failure 1. Anaphylaxis a. Examples b. as needed 2. Signs and symptoms 3. Signs and symptoms H. Decompensated shock 3. Keep patient warm – attempt to maintain normal body temperature 7. Pneumatic anti-shock garment (PASG) application 8. Position patient appropriately for all ages c. Examples b. Perform secondary assessment 5. Patient Assessment 1. Management 1. Attempt to control obvious uncontrolled external bleeding b. Assist ventilation. Treat any additional injuries that may be present Page 119 of 212 . Hypovolemic a. Circulation a. as needed 5. as needed 6. calm. Perform a reassessment I. Examples b. Examples b.

fluid loss iii. CNS iv. maintain body temperature vii. breathing a) higher resting respiratory rate b) lower tidal volume c) less elasticity/compliance of chest wall Page 120 of 212 . positioning vi. anaphylaxis v. airway a) decreased cough reflex b) cervical arthritis c) loose dentures iv. vital signs changes a) CNS b) hypoxia iii. control bleeding v. trauma ii. transport 2. Common causes of shock i. Pediatrics a. vital signs c. if indicated ii. Assessment i. cardiovascular ii. skin signs iii. inline spinal stabilization. Geriatrics a.J. congenital heart disease vi. as needed iii. decreased fluid output v. chest wall injury b. high oxygen concentration iv. suction. infection iv. Age-related variations 1. body system changes affecting presentation of shock a) CNS b) cardiovascular c) respiratory d) skin e) renal f) GI ii. Management i. Presentation of Shock i.

v. circulation
a) higher resting heart rate
b) irregular pulses
vi. skin
a) dry, less elastic
b) cold
c) fever, not common
d) hot
b. Management
i. inline spinal stabilization, if indicated
ii. suction, as needed
iii. high oxygen concentration
iv. control bleeding
v. positioning
vi. maintain body temperature
vii. transport

Page 121 of 212

Trauma
Trauma Overview
EMT Education Standard
Applies fundamental knowledge to provide basic emergency care and transportation based on
assessment findings for an acutely injured patient.

EMT-Level Instructional Guideline
The EMT Instructional Guidelines in this section include all the topics and material at the EMR
level PLUS the following material:

I. Identification and Categorization of Trauma Patients
A. Entry-level students need to be familiar with the National Trauma Triage Protocol
1. Centers for Disease Control and Prevention. Guidelines for Field Triage
of Injured Patients: Recommendations of the National Expert Panel on
Field Triage. MMWR 2008:58 RR-1:1-35.
2. http://cdc.gov/fieldtriage contains the National Trauma Triage Protocols
and additional instructional materials.

II. Pathophysiology of the Trauma Patient
A. Blunt Trauma
1. Non-bleeding
2. Multiple forces and conditions can cause blunt trauma
B. Penetrating Trauma -- high, medium, and low velocity

II. Assessment of the Trauma Patient
A. Major Components of the Patient Assessment
1. Standard precautions
2. Scene size-up
3. General impression
4. Mechanism of injury
5. Primary assessment
6. Baseline vital signs
7. History
8. Secondary assessment
9. Re-assessment
B. Mechanism of Injury (MOI)
1. Significant MOI (including, but not limited to)
a. Multiple body systems injured
b. Vehicle Crashes with intrusion
c. Falls from heights
d. Pedestrian versus vehicle collision

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e. Motorcycle crashes
f. Death of a vehicle occupant in the same vehicle
2. Non-significant MOI (including, but not limited to)
a. Isolated trauma to a body part
b. Falls without loss of consciousness (adult and pediatric)
3. Pediatric considerations
a. Falls >10 feet without loss of consciousness
b. Falls <10 feet with loss of consciousness
c. Bicycle collision
d. Medium- to high-speed vehicle collision (>25 mph)
4. Re-evaluating the MOI
5. Special Considerations
a. Spinal precautions must be initiated soon as practical based on the
MOI
b. When practical, roll the supine patient on their side to allow for an
appropriate assessment of the posterior body
c. Consider the need for ALS backup for all patients who have
sustained a significant MOI
C. Primary Survey
1. Airway
a. Clear airway; jaw thrust, suction
b. Protect airway
2. Breathing
a. Assess ventilation
b. Administer high concentration oxygen
c. Check thorax and neck
i. deviated trachea
ii. tension pneumothorax
iii. chest wounds and chest wall motion
iv. sucking chest wound
v. neck and chest crepitation
vi. multiple broken ribs
vii. fractured sternum
d. Listen for breath sounds
e. Circulation
i. Apply pressure to sites of external bleeding
ii. Radial and carotid pulse locations, B/P determination
iii. Jugular venous distention
f. Hypovolemia
g. Disability
i. brief neurological exam
ii. pupil size and reactivity
iii. limb movement
iv. Glasgow Coma Scale

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h. Exposure
i. completely remove all clothes
ii. logroll as part of inspection
D. Secondary Assessment - Head-to-Toe Physical Exam
1. Described in detail in Patient Assessment: Secondary Survey
E. Secondary Assessment
1. Rapid Method
2. Modified secondary assessment
F. Trauma Scoring
1. Glasgow Coma Score
2. Revised Trauma Score

III. Management of the Trauma Patient
A. Rapid Transport and Destination Issues
1. Scene time
2. Air versus ground
B. Destination Selection
C. Trauma System Components
1. Hospital categorizations
2. Levels and qualifications
D. Transport Considerations

Page 124 of 212

Trauma
Bleeding
EMT Education Standard
Applies fundamental knowledge to provide basic emergency care and transportation based on
assessment findings for an acutely injured patient.

EMT-Level Instructional Guideline
The EMT Instructional Guidelines in this section include all the topics and material at the EMR
level PLUS the following material:

I. Pathophysiology
A. Type of Traumatic Bleeding
1. Internal
2. External
3. Arterial
a. Bright red bleeding “spurting”
b. Difficult to control, due to size of vessels, volume of blood, and
pressure that blood is pushed through arteries
c. As blood pressure drops, amount of spurting blood drops
4. Venous
a. Darker red blood can vary from slow to severe stream, depending
on size of vein
b. Can be difficult to control, but easier to control than arterial bleeds
c. Bleeding can be profuse and life-threatening
5. Capillary – blood oozes from wound
a. Usually easy to control or stop without intervention
b. Clots spontaneously
B. Severity – Related to
1. Volume of blood loss
2. Rate of blood loss
3. Age and pre-existing health of patient
C. Physiological Response to Bleeding
1. Clotting and clotting disorders
2. Factors that affect clotting
a. Movement of injured area
b. Body temperature
c. Medications
d. Removal of bandages
3. Localized vasoconstriction

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Primary Survey 1. multiple dressings may be necessary. Direct pressure i. Splints i. Skin parameters D. Mental status C. Lung sounds 3. some patients may be quiet and calm due to excessive blood loss ii. Internal and External Bleeding Control 1. Pulse oximetry 2. Peripheral perfusion 4. Signs and symptoms – bleeding may not slow after much blood loss i. Pediatric Considerations 1. Airway Patency – May be obstructed if unconscious C. History – Pre-Existing Illnesses E. Oxygenation and Ventilation 1. General Assessment A. Vital sign variations 2.II. Body Substance Isolation B. Total fluid volume less than adults F. Tourniquet – if severe bleeding is not controlled by direct pressure d. in cases of heavier bleeding or major wounds. Management Strategies A. soft ii. Apply oxygen D. using a gloved hand and dressings. the wound is covered and firm pressure applied until bleeding is controlled iii. External bleeding a. Identify and manage life threats related to bleeding 2. Blood pressure is not a reliable indicator of early shock 2. the patient may move Page 126 of 212 . Geriatric Considerations III. rigid iii. pressure splints c. traction splint iv. Physical Exam 1. do not remove existing dressings but apply additional dressings on top of existing dressings in cases of continuing hemorrhage b. the amount of blood at the scene does not always indicate the amount of blood loss. application of even pressure to an open injury that includes the area just proximal and distal to the injury ii. usually effective in capillary and minor venous bleeding iv. Mechanism of Injury B.

iii. guarding. Signs and symptoms i. bleeding from a body orifice. rigidity. Definition/description i. distention iv. discoloration of the affected area ii. signs. ALS mutual aid Page 127 of 212 . and symptoms) b. Psychological Support G. blood in urine. deformity. assess for signs and symptoms of shock 2. internal bleeding can be severe and life threatening. estimating the amount of blood loss by the size of a blood pool or the amount on clothing is not accurate iv. may initially go undetected without proper assessment (mechanism of injury. guarding. any bleeding in a cavity or space inside the body. Transport Considerations 1. ii. Internal bleeding a. tenderness. abdominal tenderness. v. rectal bleeding iii. coughing up blood. Aeromedical transport 3. Stabilize Body Temperature F. signs of shock E. iii. Trauma center 2.

Changes in intrathoracic pressure Page 128 of 212 . Role of the Chest in Systemic Oxygenation 1. Lungs G. Heart I. Bronchi F. Esophagus J. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Energy and Injury III. Musculoskeletal structure 2. Penetrating C. Morbidity B. Trauma Chest Trauma EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely injured patient. Mortality II. Anatomy of the Chest A. Blunt B. Intercostal muscle 3. Diaphragm 4. Muscles C. Trachea E. Mediastinum IV. Accessory muscle 5. Incidence of Chest Trauma A. Skin B. Physiology A. Bones D. Vessels H. Mechanism of Injury for Chest Trauma A.

Blood in lungs 2. Chest. Bruising of lung tissue VI. active process ii. Impaired Cardiac Output Related to 1. General Assessment Findings A. Jugular vein distension 2. normal chest rise iii. Decreases when patient near arrest from shock or hypoxia 3. Penetrating Injury Page 129 of 212 . Level of Consciousness E. Blunt Injury I. Pathophysiology of Chest Trauma A. Associated Injuries H. Physical Exam 1. Pulse a. Inspection 2. Respiratory rate and effort – respiratory distress B. Normal inspiration i. Minute volume – volume of air exchanged between lungs and environment per minute V. Blood loss (external and internal) B. Temperature. Head. Medications 2. Paradoxical movement D. Ventilation 1. Impaired Ventilation 1. Collapse of lung 2. Medical History 1. Trauma that affects the heart a. Auscultation – breath sounds present or absent 3. Normal expiration – passive process 2. Blood pressure 2. Respiratory/cardiovascular diseases F. Chest wall movement – intact chest wall 3. Increases initially if hypoxia or shock b. negative pressure in chest allows air to flow in b. Gas exchange depends on a. Heart can’t refill with blood b. Skin – Color. Neck. Moisture C. and Abdomen 1. Vital Signs 1. B. Palpation G. Multiple rib fractures C. Impaired Gas Exchange 1. Blood return to the heart is blocked 2.

irregular pulse ii. Management – apply non-porous (occlusive) dressing h. Signs and symptoms of heart injury i.VII. Age-Related Variations for Pediatric and Geriatric Assessment and Management A. Sternal fracture – consider underlying injury d. hypo-perfusion k. chest pain iii. Mechanism of Injury 1. Occlusion of open wounds 2. Specific injuries a. Assessment of lung injury – presence or absence of lung sounds g. Pediatric B. decreased or absent lung sounds due to open chest injuries f. Specific injuries a. Signs and symptoms of lung injury i. Penetrating injury from weapons 2. General Management A. Management X. oxygenation changes due to open chest injuries ii. Airway and Ventilation 1. Closed Chest Injury 1. Flail segment – stabilizing a flail is contraindicated c. Clavicle fracture e. Air in pleural space causes lung to collapse (pneumothorax) i. Blunt Trauma or Closed Chest Injury A. Assessment l. Increasing amounts of air in space causing pressure on vessels and heart (tension pneumothorax) d. Positive pressure ventilation – to support flail chest B. Blood in chest due to injury (hemothorax) e. Penetrating injury secondary to blunt chest wall trauma 3. Rib fractures b. open (sucking chest wound) c. Myocardial injury i. Circulation VIII. Open Chest Injury A. Lung Injury b. Penetrating – effect on pumping action of the heart and blood loss with blood in the sac surrounding the heart restricting heart’s ability to pump (pericardial tamponade) j. Geriatric Page 130 of 212 . closed ii. Commotio Cordis IX.

Specific Injuries A. Closed Abdominal Trauma 1. Hollow Organs C. Distention – rise in abdomen between pubis and xiphoid process Page 131 of 212 . Physiology A. Mortality II. Morbidity B. Falls g. Vascular Structures IV. Assault h. Deceleration c. Anatomy A. Signs and Symptoms a. Compression b. Blast injuries 2. Intraperitoneal Structures D. Pedestrian injuries f. Mechanism of Injury a. Surface Anatomy of the Abdomen C. Reproductive Organs III. Quadrants and Boundaries of the Abdomen B. Guarding c. Trauma Abdominal and Genitourinary Trauma EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely injured patient. Retroperitoneal Structures E. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. MVA d. Motorcycle collisions e. Solid Organs B. Pain b. Incidence A.

Assessment a. Inspection – look for exit wounds including posterior c. Many signs and symptoms of closed abdominal wounds could also be present along with a puncture wound 5. Inspection b. Assessment a. Noting pain with movement d. Lower rib fractures g. consider injury to underlying organ 2. air in peritoneal cavity Page 132 of 212 . Signs and Symptoms of penetrating abdominal trauma a. Small bowel c. Cover wounds b. Bleeding b. Use non-porous dressing if chest may be involved c. High velocity penetration – gunshot wound 4. Tenderness – on movement f. Penetrating/Open Abdominal Trauma 1. Stomach b. Treat for shock d. Management a. Discoloration of abdominal wall e. Large bowel d. Transport decision C. Oxygen e. Puncture wounds – entrance and exits c. Low-velocity penetration – knife wound. Noting position of the patient c. Treat for shock – internal bleeding B. Gallbladders e. Medium velocity penetration – shot gun wound 3. Considerations of signs and symptoms of hollow organ injuries i. May be overlooked in multi-system injuries h. Management a. Blood loss through rectum or vomit 4. Hollow organs injuries a. infection – delayed complication which may be fatal iii. pain – may be intense with open wounds to the stomach or small bowel ii. Clothing removal b. Oxygen b. Considerations in Abdominal Trauma 1. d. Urinary bladder f. Transport in position of comfort if indicated c. tear of abdominal wall. Suspicion based on mechanism of injury 3. Auscultation – little value e. Noting position of patient 6.

Recognition and Prevention of Shock J. blood in urine g. Pancreas – injury with penetrating trauma f. Palpation H. injured with lower right rib fractures or penetrating trauma d. External and Internal Hemorrhage – Monitor Vital Signs Closely With Suspicion E. Identification of Life-Threatening Injury Page 133 of 212 . abnormal respiratory sounds ii. Pain With Abdominal Trauma Is Often Masked Due to Other Injuries C. Blood in the abdomen does not acutely produce abdominal pain b. motorcycles ii. Associated Trauma – Provide Emergency Staff With History of Events Causing Trauma I. Control External Hemorrhage F. Oxygenation and Ventilation D. Airway Patency D. Abdominal pain from solid organ penetration or rupture is of slow onset c. High Index of Suspicion B. Auscultation 3. Airway Management C. Spinal Immobilization G. vascular ii. Diaphragm i. left shoulder pain e. Spinal Immobilization Considerations E. Inspection 2. 2. Identification and Management of Life Threats F. Kidney i. very vascular leading to hypo-perfusion iii. Retroperitoneal structures – the abdomen can hold a large volume of blood due to injuries of solid organs and major blood vessels V. largest organ ii. falls. injured with lower left rib fractures or penetrating trauma iii. Solid organ injuries a. Transportation Decisions to Appropriate Facility VI. shortness of breath h. Scene Safety / Standard Precautions B. General Assessment A. Physical Exam 1. Liver i. General Management A. injured in auto crashes. Spleen i. bicycle accidents. PASG for Pelvic Fracture Stabilization K.

May be due to penetrating or blunt trauma 2. Transportation to Appropriate Facility 1. Vaginal Bleeding Due to Trauma 1. Sexual Assault 1. Special Considerations of Abdominal Trauma A. Transport to trauma center 4. Pediatric 1. Patient confidentiality 3. Apply sterile absorbent vaginal pad 4. ALS mutual aid J. Determine mechanism of injury 5. Use of PASG (fracture stabilization) B. Application and Inflation of PASG for Pelvic Fracture Stabilization H. Communication and Documentation VII. Mechanism of injury as pedestrian 2. Age-Related Variations for Pediatric and Geriatric Assessment and Management A. Abdominal Trauma May Be Masked by Other Body System Trauma I. No transport decisions 2. Criminal implications and evidence management 2. Transport to acute care facility 3. G. Do not insert gloved fingers for instruments in vagina Page 134 of 212 . Assess to determine pregnancy 3. Treat wounds as other soft tissue injuries B. Geriatric VIII.

Scapula b. Lower extremity B. Indirect force 3. Pediatric Considerations C. Extremity Structures 1. Vascular structure a. Bony structure a. Geriatric Considerations D. Metacarpals h. Upper extremity 2. Subcutaneous Layers C. Humerus d. Radius e. Skin Layers B. Ulna f. Venous b. Twisting force II. Anatomy A. Incidence A. ileum ii. Direct force 2. ischium Page 135 of 212 . Muscles 3. Morbidity/Mortality 1. Pelvis i. Mechanism of Injury 1. Arterial 2. Clavicle c. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Phalanges i. Carpals g. Trauma Orthopedic Trauma EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely injured patient.

greater trochanter ii. Phalanges g. Phalanges D. Femur i. Open – hemorrhage significance 5. Rotation IV. Tibia l. Mechanism of Injury A. Skull 2. Axial Structures 1. Direct 3. Extension 4. Metacarpal e. Metatarsals q. Upper Extremity 1. Structures a. Joints 2. Head 2. lesser trochanter k. Ligaments b. Joints 2. Components of a Long Bone 1. Function of Musculoskeletal System 1. Tendons c. Amputations Page 136 of 212 . Physiology A. acetabulum j. iii. Indirect 4. Tarsals p. Talus n. Humerus b. Sprains/strains 7. Cartilage d. Calcaneus o. Clavicle h. Shaft III. Vertebral column E. Carpal f. Ulna d. Fibula m. Support a. pubis iv. Flexion 3. Radius c. Closed – hemorrhage significance 6.

Structures a. Wrist 5. Tarsals h. Closed 5. Calcaneus g. Pelvis b. Open 4. Loss of Tissue D. Oblique C. Metatarsals i. Fibula e. Specific Injuries 1. Greenstick B. Anterior d. Associated with fracture 6. Direct 2. Patella Page 137 of 212 . Lower Extremity 1. Anterior c. Dislocations A. Interruption of Blood Supply G. Transverse D. Posterior c. Shoulder 3. Femur c. Talus f. Descriptions of Fractures A. Pregnancy With Pelvic Fracture VI. Contamination E. Indirect 3. Phalanges V. Acromio-clavicular 2. Comminuted E. Instability C. Knee a. Elbow 4. Long-Term Disability F. Hemorrhage B. Hip b. Spiral VII. B. Posterior b. Tibia d. Metacarpal-phalanx a. Complications A.

Palpation b. Foot 8. General Assessment A. Paresthesia 4. Ankle B. Mechanism of Injury C. Primary injury 2. Management – PASG (Pelvic Stabilization) X. Pallor 3. Mechanism of Injury 1. Scene safety/standard precautions 2. Incidence B. Pressure E. Secondary injury C. Pelvic Fracture A. Management 1. Scene Safety/Standard Precautions B. Limb threatening D. Life threatening 2. Associated Injuries Page 138 of 212 . Management IX. Physical Exam F. Pulses 5. Paralysis 6. Splinting VIII. 7. Guarding/Self-Splinting H. External 2. Movement 2. Pain a. Assessment C. Bleeding 1. Hand 9. Determine Life Threat 1. Limb-threatening injury 3. Signs and Symptoms D. Mechanism of Injury B. Assessment E. Internal G. Sprains/Strains A. Six P’s of Assessment 1.

Traction splint with fracture B. Neurologic exam before and after splinting 4. Direct pressure b. Transport to Appropriate Facility G. Elevate 2. Transport with patient e. Bandage/dress wounds before immobilization 5. Description a. Equipment needed for splinting C. Control Hemorrhage 1. Immobilize injury E. Sprain b. Associated Injuries F. General Considerations for Immobilization/Splinting 1. Appropriate Communication and Documentation XII. Sprains/Strains 1. Specific Injuries A. Control bleeding of stump a. Internal 2. Tourniquet 2. Bones above and below for joints 9. Pain Management 1. Color. In position found 6. Strain Page 139 of 212 . Cold 3. Place bag on crushed ice (do not freeze) d. Transport to appropriate resource hospital B. External a. Amputation 1. Neurologic/Circulatory Examination 1. Motor/sensory 2. Locate and Transport Amputate. Management a. Tourniquet c. Above and below the joint for fractures 8. temperature D. moist gauze and place in plastic bag c. Remove jewelry 7. PASG for pelvic fracture 2. Wrap in sterile. Direct pressure b. Clean b. Complications of improper splinting 10.XI. Distal pulses 3. Capillary refill 4. General Management A. Traction for femur fracture 3.

Pelvic 1. Splint to opposite leg F. Shoulder 1. Sling 2. Difficult to differentiate from a fracture 3. Pneumatic splint 2. Traction D. Rigid B. Apply PASG (pelvic stabilization) D. Clavicle – Sling I. Humerus 1. Manage as fracture C. Shock 2. Swathe G. Vascular and nerve damage 2. Knee 1. Swathe J. Elevate XIII. Long Spine Board XIV. vascular. Traction splinti a. Sling 2. Pillow/Blanket G. Immobilize on long spine board 3. Assess for soft tissue. No traction splint H. Formable C. Long spine board 3. application 2. Geriatric – Osteoporosis (Decreased Bone Density) Increases the Likelihood of Fractures With Minimal Trauma Page 140 of 212 . Age-Related Variations for Pediatric and Geriatric Assessment and Management A. Long spine board splint 3. Types of Splints A. Air E. Pediatric B. types b. Splint 2. 2. Tibia/Fibula 1. and nerve damage E. Forearm 1. Short Spine Board H. Femur 1. Vacuum F.

Sound of a “snap” when muscle tears b. Elastic wrap c. Strain – muscle pull a. shoulders B. Sprains a. Sound of a “snap” with injury c. Sprains/Strains A. Severe weakness of the muscle c. Special Assessment Findings 1.XV. Review previous knowledge 2. Tearing of stabilizing connective tissue b. Point tenderness C. knees. Elevation c. Review previous knowledge 2. Strains a. Immobilization if needed e. May range from minute separation to complete rupture 3. Extreme point tenderness 3. Sharp pain immediately with occurrence d. Produced by abnormal contraction c. tear or rip of muscle itself b. synovial membrane and tendons crossing the joint c. Most vulnerable – ankles. Strains a. articular capsule. Review previous knowledge 2. Special Management Considerations 1. Injury to ligaments. Elastic wrap to control swelling d. Apply cold and pressure b. Pain management Page 141 of 212 . Sprain a. Apply cold and pressure b. Pathophysiology 1. Stretch. Pain relief d. Elevation of part 3. Sprains a. Edema at joint b.

Layers of the Skin B. Open Soft Tissue Injury A. Mortality B. sensation distal to injury D. Discoloration 2. Hematoma 3. Pain C. Abrasions 2. Avulsions 4. Trauma Soft Tissue Trauma EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely injured patient. Signs and Symptoms 1. Cold 2. Assessment 1. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Type of Injuries 1. Crush injuries B. Contusion 2. Management 1. Pulse. Swelling 3. Function of the Skin III. suspect underlying organ trauma/injury 2. Diffuse or generalized soft tissue trauma can be critical 3. Lacerations and incisions 3. Morbidity II. Bites Page 142 of 212 . Mechanism of injury. Incidence of Soft Tissue Injury A. Anatomy and Physiology of Soft Tissue Injury A. Type of Injuries 1. Closed Soft Tissue Injury A. Splinting if necessary IV. movement.

5. Flap of skin attached V. Neck trauma – increased bleeding VI. Safety of Environment / Standard Precautions B. Signs and Symptoms of Open Soft Tissue Injuries 1. Airway Patency C. Concepts of Open Wound Dressings/Bandaging 1. Mechanisms of infection b. Sterile 2. Wet 6. Shock 3. Bleeding 2. Entrance and exit wounds 9. Tourniquet 8. Bleeding – shock 2. Hemorrhage Control 1. Airway Management B. Loss of extremity 8. Complications of Soft Tissue Injury 1. Prevention of Shock Page 143 of 212 . Face 3. Tourniquets F. Blast injuries/High Pressure 8. Non-sterile 3. General Assessment A. Impaled objects 7. Management A. Respiratory Distress D. Penetrating/Punctures B. Pressure dressing 2. Complications of dressings/bandages E. Amputations 7. Impaled objects 6. Hemorrhage 5. Risk factors C. Dry 7. Control Hemorrhage – Dress/Bandage Open Wounds C. Contaminated wounds 6. Infection a. Airway 2. Non-occlusive 5. Pain 4. Associated Injuries 1. Occlusive 4. Pain 3.

Anatomy and Physiology of Burns A. Depth Classification of Burns 1. open space 3. concentration of chemical iii. Inhalation a. Superficial 2. Scalds with unusual history patterns may be abuse 2. Body Surface Area of Burns 1. Place skin in anatomic position if flat avulsion VII. Incidence of Burn Injury A. Complete avulsion often has serious infection concerns 3. Airway obstruction due to swelling may be very rapid b. Control hemorrhage 2. D. Never remove skin flap regardless of size 2. type of chemical ii. Severity related to i. Electrical a. Avulsions 1. Entrance and exit wounds c. External burns may not indicate seriousness of burn b. Rule of ones (palm) Page 144 of 212 . Enclosed space versus open d. Morbidity/Mortality B. Partial-thickness 3. Solutions and powders are different 4. Enclosed space vs. Prevent Infection E. Full-thickness C. duration of exposure b. Rule of nines 2. Chemical a. Bites 1. exposure time ii. Types b. Risk Factors VIII. Transport to the Appropriate Facility F. Severity related to i. temperature c. Carbon monoxide inhalation c. Types of Burns 1. Bites often lead to serious infection G. Lighting strikes may cause cardiac arrest 5. Radiation B. May cause cardiac arrest d. Thermal a.

Complications of Circumferential Burns X. Prevent Hypothermia I. Pediatric a. After initial cooling of burn 2. Moist dressing if burn less than ten percent body surface area F. Hypothermia F. Scene Safety/Standard Precautions 1. D. Airway Management C. Dry. Sterile. Geriatric Considerations Page 145 of 212 . Classification of Burn Depth E. Remove Jewelry and Clothing G. Transportation to Appropriate Facility 1. Assist ventilation if indicated 3. Severe IX. Circulatory E. Shock C. Administer high concentration oxygen 2. Severity of Burns 1. Airway Patency C. Pediatric Considerations 1. Hypoxia D. Airway Obstruction E. Increased risk of hypothermia 2. Non-Adherent Dressing 1. Hypovolemia G. Identification of burn type 2. Infection B. Position with head elevated if spine injury not suspected D. Treat Shock H. General Management A. General Assessment of Burn Injuries A. Respiratory Distress 1. ALS mutual aid 2. Moderate 3. Complications of Burn Injuries A. Respiratory Distress D. Rule of nines b. Stop the Burning B. Criteria for burn center J. Percentage of Body Surface Area Burned F. Minor 2. Possibility of inhalation injury B. Abuse K. Severity XI.

Sometimes electric current crosses the chest and causes cardiac arrest or arrhythmias 4. Chemical burns treatments can be specific to the burning agent and labels should be read 4. Edema of mucosa of airway can be rapid -. Percentage of surface area in a burn patient 2. Liquid chemicals – flush with water 2. Geriatrics Page 146 of 212 . Time in contact with heat increases damage B. Other toxic gasses 2. Burns in enclosed spaces without ventilation cause inhalation injuries C. Radiation – radiation burns require special rescue techniques XIII. such as: a.consider ALS backup if signs and symptoms of edema are present. Complications are related to toxic chemicals within inhaled air a. Pediatric 1. The type of electric current. Burns of face d. Cyanide c. No patient should be touched while in contact with current 3.XII. May be associated with an inhalation injury 3. Inhalation 1. Alteration in calculating the burned area B. Chemical 1. Dry dressing help prevent infection and provide comfort 6. Large burns may cause hypovolemia and hypothermia 4. Singed nasal or facial hair c. amperage and volts. have effect on seriousness of burns 2. Age-Related Variations A. Burns at industrial sites may have experts available on scene D. Carbon in sputum 3. Specific Burn Injury Management Considerations A. Carbon monoxide b. Dry powder chemicals and need brushed off to remove chemicals 3. Cool small burns or those remaining hot (patient who has just been rescued from fire) 5. Many underlying injuries to organs and the nervous system may be present E. Thermal 1. Electrical 1. Complete general management 2. Hoarseness b.

and Spine Trauma EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely injured patient. Veins C. Trauma Head. Nerves D. Hair 2. Face injury 3. Cervical spine injury II. Nasal 2. Muscle Page 147 of 212 . Penetrating trauma 5. Sports 3. Blunt trauma C. and Neck (Non-Spine) Injury 1. Airway compromise 2. Arteries B. Neck injury B. Falls 4. Mandible 6. Skull E. Face. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. and Neck A. Maxilla 5. Face. Neck. Motor vehicle crashes 2. Bones 1. Facial. Head/scalp 2. Associated Injuries 1. Morbidity and Mortality D. Zygoma/Zygomatic arch 3. Mechanisms of Head. Subcutaneous tissue 3. Incidence 1. Introduction A. Scalp 1. Review of Anatomy and Physiology of the Head. Orbital 4.

Oropharynx b. Cornea 4. General Patient Assessment A. Jugular veins 2. Pupil 6. Level of consciousness b. Optic nerve III. Carotid arteries b. Neck 1. Pupils – anisocoria 5. Iris 5. Open wounds bleed heavily b. Larynx c. Primary Survey 1. F. Closed wounds c. Identify and manage life threats IV. Bony orbit 2. Scene Size-Up B. Open wounds b. Disability a. Scalp 1. Tongue e. Mouth/Throat 1. Airway 2. Direct pressure is complicated with underlying skull injury Page 148 of 212 . Ventilation and oxygenation 3. Blood vessels a. and Neck A. Airway a. Face. Assessment a. Consider underlying injury 2. Signs and Symptoms a. Airway – trachea 3. Motor/sensory response c. Lens 7. Specific Injuries to Head. Sclera 3. Retina 8. Trachea d. Circulation 4. Gastrointestinal – esophagus H. Teeth G. Eye 1. Expose 6.

down. May need frequent suctioning d. Soft tissue injuries b. Signs/symptoms a. Dressings and bandages should not close mouth B. Eye examination i. Nasal fractures may cause bleeding h. d. Palpation – facial bones c. can read regular print iii. etc. c. but swelling may be more severe b. Eye injuries d. no blood visible in iris area 4. Oral injuries may cause airway management complications 3. open wounds ii. Fractures of facial bones c. Soft tissue injuries are similar to others. Excessive pressure on the eye may “blow out” bones in the orbit g. tooth avulsion 2. punctures. Types a. chemical burns. Facial Injuries 1. lacerations. Injuries above the ears may be more serious d. Bring broken teeth to hospital with patient e. Facial bones may fracture causing airway and ventilation obstruction c. Flush eyes contaminated with chemicals with copious amounts of water Page 149 of 212 . Eye injuries may cause vision disturbances e. Inspection i. deformity of bones iv. Eyes injured with chemicals need flushing with copious amounts of water f. swelling iii. Battle’s sign is a delayed finding of basal skull fracture 3. eye symmetry vi. bone alignment in anatomical position b. Oral/dental injuries i. eye clarity without foreign objects v. follows finger up. mandibular fractures ii. Eye injuries suffer soft tissue type injuries. Maintain patent airway b. Management considerations a. abrasions. lateral ii. maxillar fractures iii. Assessment considerations in facial and eye injuries a. Management considerations in facial and eye injuries a. Nasopharyngeal airways are contraindicated c. Apply pressure to control bleeding b.

Bandaging should not occlude the mouth C. Types of Injuries a. Neck Injuries (Non-Spinal) 1. Blunt Page 150 of 212 . Blunt b. Patients with these injuries may be more comfortable sitting up – if no risk of spinal injury k. Swelling may be related to air escape under the skin which can “crackle” with digital pressure d. Air may enter the circulatory system if there is penetrating injury to a large blood vessel in the neck 4. Penetrating 2. Eye injuries require patching of both eyes h. Blunt trauma 2. Types of Injury a. Single digital pressure (gloves on) to control bleeding of carotid artery or jugular veins may be necessary b. Assessment considerations in neck injuries a. May have underlying spinal injury b. Impaled objects in cheeks may be removed if bleeding obstructs the airway j. Monitor airway throughout care b. Types of Vision a. Patient may not be able to swallow with esophageal injury c. abrasions – cornea ii. Assessment – epistaxis 3. Airway passages may be obstructed 3. Nasal Fractures 1. f. Peripheral 2. Occlusive dressing for large vessel wounds (after bleeding controlled) – to prevent air entry into circulatory system D. Larynx injuries will cause changes in voice sounds e. ALS intercept or air medical transport may be necessary in severe cases of airway compromise c. Penetrating i. Eye/Orbital 1. Mechanism of Injury a. Control simple nose bleeds by pinching nostrils g. Considerations in neck injuries a. lacerations – eyelid b. Stabilize impaled objects in the eye i. Open wounds b. Management E. foreign body iii. Management considerations in neck injuries a. Open wounds may bleed profusely and cause death c. Central b.

hematoma. Cervical spine injury 6. Soft tissue and fascia b. burns a) acid b) alkali c. acid ii. Blunt b. Assessment 3. pale skin c. Blast e. Signs/symptoms 4. Assessment a. Dental 1. Neck bruising. Stabilize impaled objects if not obstructing airway Page 151 of 212 . Laryngeal Injuries 1. Penetrating – do not remove 3. Control bleeding i. Avulsions 3. c. Mechanism of Injury a. Burns to cornea i. Management a. Management a. or bleeding b. blunt injury a) positioning b) bandage i) one/both ii) no pressure ii. Foreign Body F. Airway b. Cyanotic. Mechanism of Injury 2. Assessment 4. Definition 2. Oxygenation and ventilation b. Associated Injuries a. alkali iii. penetrating a) positioning b) moist bandage c) stabilize impaled object d) patch both eyes iii. ultraviolet d. Sputum in wound d. Cervical immobilization (avoid rigid collars) c. Management – bring tooth with patient G. Subcutaneous air 5.

Seizure activity j. Blunt 4. Elevated blood pressure k. Management a. Definition 2. Neurological exam 5. Shock prevention i. hypotension Page 152 of 212 . Discoloration around eyes c. Airway patency b. Nausea and/or vomiting i. Pathophysiology of head/brain injury a. Ventilation c. Definition 2. Skull deformity e. Assist ventilation if indicated e. Penetrating b. Direct or indirect injury i. Slow heart rate 4. Cerebral spinal fluid – clear drainage from ears or nose b. Head Injury 1. Increased intracranial pressure (ICP) b. Signs/Symptoms 3. Penetrating b. bleeding iii. Unequal pupils h. Administer oxygen d. Vital signs d. control bleeding ii. Discoloration around ears d. Open d. Standard precautions b. Immobilize spine f. Blunt c. Associated injuries 6. Irregular breathing pattern g. Pupils e. Closed 3.H. Brain Injury 1. Assessment a. edema ii. Mechanism of injury a. body positioning I. Mechanism of Injury a. Decreased mentation f. Manage airway c. Signs/symptoms of fractures and other injuries a.

subdural a) signs/symptoms b) assessment c) management iii. initially localize to painful stimuli vi.5. Types of Injury a. increased blood pressure and slowing pulse rate iii. pupils still reactive iv. Assessment a. subarachnoid a) signs/symptoms b) assessment c) management b. Indicators of increasing ICP i. seizures d. intracerebral a) signs/symptoms b) assessment c) management iv. decreased level of consciousness ii. management 6. assessment iii. Concussion i. Hypothalamus – vomiting c. signs/symptoms a) delayed motor and verbal responses b) inability to focus attention c) lack of coordination d) disorientation e) inappropriate emotional responses f) memory deficit g) inability to recall simple concepts. posturing iv. Brain Stem i. vagus nerve pressure – bradycardia ii. Intracranial hematoma i. Cerebral cortices b. epidural a) signs/symptoms b) assessment c) management ii. words h) nausea/vomiting i) headache ii. Cheyne Stokes respirations v. respiratory centers iii. all effects reversible at this stage Page 153 of 212 .

Bilateral pupil size and reaction – fixed and dilated h. Secure airway if patient cannot maintain an adequate airway c. Management a. Hypotension j. use of lights and sirens i. Pediatric -. Glasgow coma scale i. Geriatric considerations 7. Age-Related Variations A. Position – elevate head of backboard 30 degrees h. Control external bleeding f. Assist ventilation if indicated e. Geriatric Page 154 of 212 . Cushing’s phenomenon e. types of helmets b. vii. History of unconsciousness or amnesia of event i. Suspect cervical spine injury based on mechanism of injury at scene assessment i. middle brain stem involved a) wide pulse pressure and bradycardia b) pupils nonreactive or sluggish c) central neurogenic hyperventilation d) extension viii. Transport considerations i. Administer oxygen d. Pediatric considerations – pre-verbal Glasgow coma scale l. identify need for rapid intervention and transportation ii. Vital signs g. management of a patient wearing a helmet – consideration for removal of helmet ii. Hypoxemia k. head injury classified according to score a) mild – 13-15 b) moderate – 8-12 c) severe – <8 f. lower portion of brain stem involved/medulla a) pupil blown – same side as injury b) ataxic respirations c) flaccid response to painful stimuli d) pulse rate e) diminished blood pressure ix. Disability – repeated assessment crucial g. Psychological support j. Effective communication and appropriate documentation V. trauma center iii.modifications for Glasgow coma scale B.

Brain 1. Brain stem – center for involuntary functions. Meninges a. Gray matter – composed of nerve cells 4. Cervical 3. Spinal Fluid B. Basal 2. Mortality II. Dura mater b. Spine 1. nerve function transmissions 6. White matter – covered nerve pathways that conduct messages of the brain 5. Compressed Page 155 of 212 . Arachnoid mater c. Cerebrum – main part of brain. Cerebellum – center for equilibrium and coordination 8. Lumbar 5. respiratory and heart rate. Skull 2. Trauma Nervous System Trauma EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely injured patient. Morbidity B. Incidence A. Pia mater 3. Anatomy and Physiology of the Brain and Spine A. Types of Skull Fractures 1. temperature regulation. Spinous process 2. with four lobes 7. Spinal Cord C. Thoracic 4. Cerebral spinal fluid D. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Meninges – coverings of the brain 9. divided into two hemispheres.

Assess orientation i. General Assessment Considerations for Brain Trauma Patients A. Assess for adequate ventilation B. Airway and Ventilation 1. Assess the need to remove the helmet with proper spinal considerations if airway compromise or bleeding under the helmet is present C. person ii. purpose b. Concussion – temporary disruption to brain without injury due to closed trauma 2. Maintain airway 2. Alert b. Consider the potential for blunt head trauma based on mechanism of injury 2. Unresponsive 2. In patients with head injuries with altered mental status 2. Facial expression 4. Thoughts and perceptions a. may be acute or chronic 5. Responds to verbal stimuli c. may be diffuse or localized to one area 3. Mechanism of Injury 1. Logical b. Respiratory Status -. Speech and language 5. Epidural bleed – typically arterial with high emergent risk b. Responds to painful stimuli d. Ability to make decisions 6. Cerebral laceration 4. Linear E. Mechanism of injury that suggests the possibility of trauma to the spine D. Knowledge of recent events Page 156 of 212 . Types of Brain injuries 1. Subdural – typically venous. Observe posture and motor behavior – appropriate movement 3.brain injuries can cause irregular breathing patterns due to injuries affecting the brain stem E. Appearance and behavior a. time iv. place iii. Space occupying lesions a. Memory and attention a. Spinal Immobilization 1. Penetrating wounds III. 3. Complete a Neurological Exam 1. Open 4. Contusion – bruise of brain matter.

posterior Page 157 of 212 . Refer to Brain Injury Foundation Guidelines IV. General Assessment Considerations in Spinal Trauma 1. Head trauma patients must be transported to appropriate trauma centers 3. Transport Considerations 1. Administer oxygen by non-rebreather mask – maintain oxygen saturation >90 percent at all times 3. Adequate airway. hypotension is associated with poorer outcomes in head injured patients b. Types of Associated Spinal Injuries 1. Pulse rate – may be slower than normal if severe head injury F. ventilation. Extension B. Spinal Cord Injuries A. Often present with other injuries a. Fractures 2. Assist ventilation if indicated – avoid hyperventilation. Blood pressure i. Head trauma patients may deteriorate rapidly and may need air medical transport 4. Head trauma patients with impaired airway or ventilation. Equal b. or who do not respond to painful stimuli may need rapid extrication 2. systolic pressure increase ii. Open wounds 4. except in specific circumstances G. Geriatric V. Head trauma b. and oxygenation are critical to the outcome of head trauma patients 5. Nasopharyngeal airways should not be used 4. Head trauma patient frequently have seizures H. Pupils a. Dislocations 3. Age-Related Variations for Pediatric and Geriatric Assessment and Management of Brain Injury A. Pediatric B. anterior ii. Vital signs a. Flexion 5. React to light 8. abnormal vital signs. open wounds. Head trauma patients frequently vomit – keep suction available 6. Penetrating trauma i. 7. Maintain airway throughout care 2. Management Considerations With Brain Trauma 1.

Manual immobilization of spine when airway opened 2. Car crashes and multi-system trauma f. Direct blunt trauma d. priapism ii. abdominal Excursion c. present throughout body ii. Seated patient spinal immobilization 6. Other signs or symptoms associated with spinal cord trauma i. Consideration for pneumatic antishock garment use VI. numbness. Use of child safety seats Page 158 of 212 . Respiratory ability i. Rigid b. ii. Immobilization principles 3. Head size and anatomical positioning during immobilization 2. Sensation i. altered sensation distal to injury – jingling. Pain and tenderness present at site e. Cervical collars a. “electric shocks” d. Proper size 5. Age-Related Variations for Pediatric and Geriatric Assessment and Management of Spinal Injury A. Rapid moves for patient with suspected spinal injury 9. Pediatric 1. Helmet removal if present with airway complications 10. c. Standing patient spinal immobilization 7. absent or weak ii. Vital signs i. Heart rate may be slow or fail to increase in response to hypotension f. absent – note the specific level of impairment iii. note level of impairment b. Neurological examination considerations a. Lifting and moving patient with suspected spinal injury 8. inability to maintain body temperature iii. General Management Considerations With Spinal Trauma 1. chest wall movement ii. Hypotension may be present with cervical or high thoracic spine injuries. Log-roll patient with suspected spinal trauma to move or examine back 4. Movement of extremities i. Rapid deceleration injuries 2. History for patient with suspected spinal trauma C. Falls or diving injuries e. loss of bowel or bladder control 3.

Unusual spinal anatomy due to aging 2.B. Geriatric 1. Special modifications of spinal immobilization techniques Page 159 of 212 .

Susceptible to falls and physical abuse 2. Unique Assessment Considerations for Pregnant Patients Involved in Trauma 1. Cardiac arrest due to trauma D. Shock in a third trimester patient may be difficult to detect d. Decreased gastrointestinal motility increases risk of vomiting and aspiration after trauma C. Unique Types of Injuries and Conditions of Concern for Pregnant Patients Involved in Trauma 1. immobilize and tilt the long spine board to the left if spinal injury is suspected Page 160 of 212 . Cardiovascular a. Mother i. Trauma Special Considerations in Trauma EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely injured patient. Third trimester fetus size can affect venous return in patients lying flat on their backs e. Physiology. Abdominal pain b. Mechanism of injury a. and Pathophysiology Considerations 1. Two patients to consider a. Increase in maternal heart rate in third trimester c. Fetal distress due to hypoxia or hypovolemia/shock 2. Increase to total vascular volume b. Special Unique Considerations for Pregnant Patient Involved in Trauma 1. Vaginal bleeding often present c. High risk of fetal death 3. Fetal injury from penetrating trauma 4. Special Anatomy. Trauma in Pregnancy A. Pregnant patients can sustain all types of trauma b. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Separation of the placenta from the uterine wall a. Fetal considerations – trauma to an expectant mother can have effects on fetal health B. Seat belts 5.

Unique Management Considerations for the Pregnant Patients Involved in Trauma 1. Circulation 3. Trauma centers – inform them that pregnant patient is involved in the trauma II. size of fetus is important (number of weeks pregnant) ii. oxygenation a. Unique Assessment Considerations for a Pediatric Patient Who Has Sustained Trauma 1. Special Unique Considerations for Pediatric Patient Involved in Trauma 1. and oxygenation a. internal blood loss is difficult to assess as signs of shock are masked iii. Transport considerations a. Drowning 4. Assure bilateral breath sounds are present c. vaginal exam may be present iv. Physiology. Falls 6. Trauma in the Pediatric Patient A. Accessory muscle use more prominent during respiratory distress 3. Assist ventilation if inadequate 2. Assess brachial pulse in infants Page 161 of 212 . Airway. Penetrating trauma B. Transport on left side b. Heavy head with weak neck muscles in children increases risk of cervical spine injury 2. Pedestrian versus vehicle collisions 3. ventilation. Work of breathing c. Appearance b. Fetus i. difficult to assess so treat mother aggressively if severe trauma E. Chest wall flexibility produces flail chest C. Pediatric assessment triangle a. ii. and Pathophysiology Considerations of Injured Pediatric Patients 1. Major trauma may need ALS intercept or air medical resources c. increased risk of aspiration from decreased gastrointestinal motility b. ventilation. Vehicle crashes 2. Burns 5. Anticipate vomiting – have suction available b. Unique Anatomy. Vital signs a. Respiratory rates vary by age b. Airway. Keep oxygenation levels high (100%) – administer oxygen by non- rebreather mask d. Circulation 2.

Vehicle crashes 2. especially vital signs b. Brain shrinks leading to higher risk of cerebral bleeding following head trauma 5. and musculoskeletal systems make older patients susceptible to trauma 2. and Pathophysiology Considerations of Injured Geriatric Patients 1. Use pulse oximetry to monitor oxygenation b. Unique Assessment Considerations for Injured Geriatric Patients 1. Blood clotting 4. May have decrease in cough reflex so suctioning is important c. Loss of strength. Special Considerations for Geriatric Patients Involved in Trauma 1. Breathing a. Prevent hypothermia in shock 4. Changes in pulmonary. Pulse rates vary by age c. Skeletal changes cause curvature of the upper spine that may require padding during spinal immobilization 6. Transport to appropriate facility 5. Blood pressure varies by age f. Shaken baby syndrome may cause brain trauma 3. Penetrating trauma 6. b. Normal blood pressure may be present in compensated shock D. and medical illness increase risk of falls C. Ventilate bradycardic pediatric patient III. Unique Anatomy. Dentures may cause airway obstruction b. neurologic. Circulation changes lead to inability to maintain normal vital signs during hemorrhage. Manage hypovolemia and shock as for adults 2. Minor chest trauma can cause lung injury 3. Assessment. Blood pressure for age 3 or younger unreliable e. Physiology. Fall 4. Multiple medications are more common and may affect a. Unique Management Considerations for Pediatric Patients Involved in Trauma 1. Elder abuse B. Pedestrian versus vehicle collisions 3. Pad beneath child from shoulders to hips during cervical immobilization to prevent flexion of the neck 6. Slow pulse rate indicates hypoxia d. cardiovascular. Burns 5. blood pressure drops sooner 3. Circulation Page 162 of 212 . Curvature of the spine may require padding to keep patient supine 2. sensory impairment. Trauma in the Elderly Patient A. Airway a.

Pain perception may be altered 3. Unique Considerations for Injured Cognitively Impaired Patients 1. Broken bones are common – traction splints are not used to treat hip fractures 5. Unique Assessment Consideration for Cognitive Impaired Patients Involved in Trauma 1. and Pathophysiology Considerations for Injured Cognitively Impaired Patients 1. Sensory loss related to aging and disease may increase risk of injury and alter the patient’s response to injury 2. Poor historians of past medical history or events of trauma 2. Autistic disorders e. D. Suctioning is important in elderly due to decrease cough reflex 2. Patient may be bed ridden or under nursing home care D. Unique Management Consideration for Cognitively Impaired Patients Involved in Trauma 1. Stroke 2. Physiology. Musculoskeletal strength due to aging or impairment 3. Cardiovascular changes with dementia C. Involve usual care givers in emergency treatment Page 163 of 212 . Types of cognitive impairment a. Prevent hypothermia 4. Unique Anatomy. Vascular dementia c. Falls leading to trauma must be investigated as to the reason for the fall IV. Mechanism of injury – cognitively impaired patients are more susceptible to trauma B. Alzheimer’s disease b. Cognitively impaired patient special care 2. Psychological implications of trauma may be different 4. Trauma in the Cognitively Impaired Patient A. Memory loss with Alzheimer’s disease will alter patient assessment 4. Brain injury f. Unique Management Considerations for Injured Geriatric Patients 1. Decrease muscle size in the abdomen may mask abdominal trauma 3. Down’s syndrome d.

Little difference in patient lungs regardless of what type of water submersion occurred 2. Submersion in very cold water can produce cardiac disturbances 6. ventilation. Submersion in cold water results in better survival than warm water 3. Assessment Considerations 1. Agonal breaths if prolonged submersion c. Incidence 3. Skin may be cold E. Types 1. Hypoxia from submersion is major factor in death 7. Salt water C. May be coughing if early rescue b. Age is a factor due to cardiovascular health 4. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Skin is cyanotic c. Airway. Definition 2. Submersion Incidents A. Predictors of morbidity and mortality B. Oxygen saturation may be difficult to obtain if patient is cold Page 164 of 212 . Respiratory arrest if very prolonged submersion 3. Circulation a. Duration under water effects outcome 5. Airway – obstructed with water immediately after rescue 2. and oxygenation a. Pathophysiology 1. Breathing a. Prolonged hypoxia causes death of brain tissue D. Drowning 1. May be in cardiac arrest b. Unique Signs and Symptoms 1. Diving in shallow water can cause spinal trauma 8. Trauma Environmental Emergencies EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely injured patient. Fresh water 2.

position lateral recumbent if no risk of spinal injury b. ventilation. Respiration 3. Generalized cold injury (hypothermia) b. and oxygenation a. refer to current American Heart Association guidelines b. Low environmental temperatures generalized exposure i. How the body loses heat a. Airway. Obtain past medical history F. Radiation d. Convection c. Localized cold injury c. Cold-related illness b. Use spinal precautions when opening airway to assess if risk of spinal trauma is possible c. factors that contribute to risk of cold injury a) clothing of the patient b) age c) time of exposure Page 165 of 212 . Circulation a. If cardiac arrest is present. Auscultate breath sounds 2. Management Considerations 1. Conduction b. Cold-related injuries a. Administer oxygen by non-rebreather mask if breathing is adequate 2. Ventilate with bag-mask if impaired ventilation or respiratory arrest c. Temperature-Related Illness A. Suction and maintain open airway i. Assess for presence of other injuries 3. Incidents 1. All patients who had submersion injury with any report of signs and symptoms during or after submersion need transport to the hospital II. Evaporation e. Transport Considerations a. Heat-related illness 2. Defibrillate with AED if indicated (refer to current American Heart Association guidelines) 3. Transport to appropriate facility b. Pathophysiology 1. anticipate vomiting ii. Type of temperature-related illness a. Generalized heat injury – may affect full body or muscle groups B. b. Temperature-related illness a.

Signs and Symptoms 1. impairs local blood flow iv. d) alcohol or other medication ingestion e) suicide f) activity level of the victim g) pre-existing injury or illness ii. environment factors that contribute to risk of cold injury a) ambient temperature b) wind speed c) moisture b. moist skin i. Shivering i. seen on hot. Slow pulse and breathing in later stages e. local exposure of body appendage to cold – ears. Impaired motor function i. Extreme hypothermia i. age iv. medical illness or injury iii. exertion v. body unable to regulate temperature e. temperature will drop quickly when shivering stops d. Local cold exposure i. alcohol or other medication use c. cardiac insufficiency Page 166 of 212 . ice crystals form iii. Cold-related illness – (generalized) hypothermia a. true emergency ii. pale. dry skin i. cool skin – excessive fluid and salt loss d. and toes very susceptible ii. ambient temperature ii. no acclimation to heat ii. fingers. Cool abdominal skin below clothing f. Patient with moist. Heat-related illness a. humid days in patients with fluid and salt loss iii. Environmental factors that contribute to risk of heat-related illness i. humidity b. true emergency ii. Patient with hot. muscle contractions help to increase body temperature ii. Patient with hot. Decreased level of consciousness b. altered balance c. Patient factors that contribute to risk of heat injury i. rigidity ii. temporary or permanent tissue damage – may lead to amputation 2. seen when extreme exertion exceeds the body’s ability to regulate temperature C.

Rewarm with hot packs in groin. rapid pulse e. Apply pulse oximetry 4. keep patient warm iv. Loss of color c. If unconscious and in cardiac arrest follow AHA recommendations for CPR 2. Management Considerations 1. Nausea and vomiting f. may have no palpable pulse iii. Weakness d. Rewarm slowly h. ii. Provide warm clear liquids if conscious and not vomiting g. with moist. pale. Heat-related illness. Remove from hot environment b. Rapid breathing d. Cold-related illness – (generalized) hypothermia a. pale skin) a. Frozen extremity b. dizziness c. Loss of movement d. immerse part in tepid (100 – 105 degrees Farenheit) water ii. Cover with warm blankets e. Transport i. Seizures D. after rewarming. Heat-related illness (hot skin) a. arm pits – use caution to avoid burns f. Little or no perspiration – in exertional heat stroke the skin may be sweaty and hot b. apply sterile dressings iii. Change in level of consciousness. Move the patient from the cold environment b. Weak. Administer oxygen – warmed and humidified if available d. Handle gently to decrease risk of ventricular fibrillation k. Cold-related illness (localized) a. Rapid pulse e. Heat-related illness (moist. Move patient out of cold environment b. cardiac arrest 2. Consider active rewarming if no chance of re-injury i. Cold-related illness (localized) a. Pain 3. Loss of consciousness c. cool skin a. Administer oxygen Page 167 of 212 . Muscle cramps b. transport as soon as possible 3. Passive rewarming is best delivered at the appropriate facility j. Remove any wet clothing c. Administer oxygen c.

Splash the patient with cool water 4. Signs and Symptoms 1. Progressive weakness d. initial 6-8 hours of care is essential 3. Transport immediately f. Spider bites 2. Chest or abdominal pain depending on bite site c. Nausea and vomiting e. Time of bite to care is important b. Snake bites -. patient age and size cause different effects c.inject neurotoxins 2. Signs of anaphylaxis D. wasp. may be fatal 2. wasps. Assist ventilation if inadequate d. Bites and Envenomations A. Remove clothing d. Localized swelling initially b. Dangerous in children. This is true emergency III. Cool packs to armpits. Spider bite (black widow) a.rattlesnake is most common in United States a. Bee. Vision problems g. neck e. Cause allergic reactions in sensitized (allergic) people b. ants. Hymenoptera a. Hymenoptera (bees. yellow jackets) B. c. Swelling c. Unique Management Considers of Bites and Stings 1. toxins affect blood and nervous system both at the bite site and systemically b. Seizures f. groin. Spider bite (black widow) a. Changes in level of consciousness 3. May lead to anaphylactic response C. Snake bites 3. and other stings a. Rattlesnake bite a. Pain at site b. Pathophysiology of Bites and Envenomations 1. Pain at site c. Remove patient from hot environment b. Spider bites (black widow) -. Signs of allergic reaction d. Heat-related illness with hot skin a. amount of toxin injected is related to toxicity (often none at all) d. Injuries of Concern 1. Ice pack to area of bite Page 168 of 212 . Administer high concentration oxygen c.

Rattlesnake bite a. and other stings a. Electrical A. Pathophysiology 1. Administer high-concentration oxygen 2. Slow venous return c. Electrical 1. Cough 4. Compressed air in blood at depth expands upon ascent. Skin wounds may not indicate seriousness of burn 2. Mechanism of Injury 1. Cyanosis 3. Transport immediately with supportive care 2. Radiation VII. Bees. Pain in joints D. Position extremity f. Transport rapidly for recompression therapy at the appropriate facility V. Unique Management Considerations 1. b. Occur after the patient raises to the surface too fast following dive at depths 2. Note time of bite to transport b. turning into bubbles in blood which obstruct blood flow C. Respiratory distress 5. Repeated dives at depth on the same day B. Immobilize extremity e. Diver remains at depth too long 2. Lighting strikes may cause cardiac arrest VI. Clean bite site with soap and water g. Entrance and exit wounds 3. May cause cardiac arrest 4. Clean wound with soap and water c. If anaphylaxis develops follow protocol IV. Identify snake if possible 3. Age-Related Variations for Pediatric and Geriatric Assessment and Management Page 169 of 212 . Signs and Symptoms 1. Remove stinger or venom sac b. wasps. Keep patient calm d. SCUBA diving at greater depths for long periods of time 2. Diving Emergencies (Dysbarism) A.

car with object ii. frontal impacts ii. low energy (stabbings) ii. Blunt trauma a. organs collide inside body b. Kinematics of Trauma A. Energy levels have effect i. Looking at a trauma scene and attempting to predict what injuries might have resulted based on an evaluation of the motion involved 2. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. some rifles) iii. Penetrating Trauma a. side impacts iv. distance from shooter ii. medium energy (handguns. Definition 1. rear impacts iii. rollovers 4. velocity of weapon b. patient with part of car iii. Kinetic energy – function of weight of an item and its speed – speed is the most import variable 3. high energy (military weapons) Page 170 of 212 . size of bullet iii. Unbelted drivers and front seat passengers suffer multi-system trauma due to multiple collisions of the body and organs c. Damage is influenced by i. Deceleration Injuries 5. Trauma Multi-System Trauma EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely injured patient. Direction of the force has impact on type of injury i. cavitation v. Objects collide during crashes i. rotational impacts v. fragmentation iv.

Determination of additional resources 3. and oxygenation are key elements to success a. extremities II. Multi-system trauma treatment involves a team of physicians to treat the patient. Rapid transport considerations d. and orthopedic surgeons 4. Airway. abdomen iv. Airway must be opened and clear throughout care Page 171 of 212 . Mechanism of injury b. High index of suspicion 4. Chest and multiple extremity trauma 3. Safety of rescue personnel and patient 2. Typically a patient considered to have “multi-system trauma” has more than one major system or organ involved a. c. ‘Platinum 10 Minutes’ 11. head ii. This may include specialists such as neurosurgeons. Control external hemorrhage 8. Supine patients 10. Almost all trauma affects more than one system 2. Identify and manage life threats 5. Standing patients b. thoracic surgeons. Sitting patients c. Splint musculoskeletal injuries 9. Kinematics a. Prone patients e. Basic shock therapy a. Chest and abdominal trauma c. Maintain spinal immobilization on long spine board a. Closest appropriate facility c. Secondary survey after treatment of life threats C. Maintain normal body temperature b. Definition 1. Multi-system trauma has a high level of morbidity and mortality B. Golden period b. Obtain medical history 12. Transportation considerations a. Head and spinal trauma b. chest iii. The Golden Principles of Out-of-Hospital Trauma Care 1. Support ventilation and oxygenation – oxygen saturation greater than 95 percent 7. Signs and symptoms will vary according to the organ struck i. Airway management while maintaining cervical spinal immobilization 6. Multi-System Trauma A. ventilation. Critical Thinking in Multi-System Trauma Care 1.

hostile environments iv. Oxygenation cannot occur when patients are bleeding profusely a. Rapid extrication should be considered for critically injured patients d. Personal safety a. Not all treatments are linear. Do not develop “tunnel” vision by focusing on patients who complain of pain and are screaming for your help while other quiet patients who may be hypoxic or bleeding internally can not call out for help because of decreases in level of consciousness b. Transport to the appropriate facility is critical – know your local trauma system capabilities 5. At times care must be adjusted depending on the needs of the patient. b. Administration of high concentrations of oxygen 2. Be sure to assess your environment i. hazardous situation iii. Most important when arriving on scene. It is essential to keep important care principles in mind during management Page 172 of 212 . Trauma care is a leading cause of death of young people. The definitive care for multi-system trauma may be surgery which cannot be done in the field b. b. Stop arterial bleeding rapidly b. Use of advanced life support intercept and air medical resources in a multi-trauma patient should be highly considered e. Example: i. Consider use of tourniquets if severe extremity bleeding cannot be controlled with direct pressure 3. much care can be done en route 4. control arterial bleeding in an awake patient first ii. Rapid transport is essential a. passing automobiles ii. and throughout care. Adequate ventilation must occur – patients with low minute volume need assisted ventilation c. Early notification of hospital resources is essential f. Sequence of treating patients a. Sometimes an obvious injury does not have the most potential for harm c. an injured EMT can not provide care b. Backboards – serve as entire body splints when patients are appropriately secure in unstable patients 6. On scene time is critical and should not be delayed c. Experience a. unsecured crime scenes v. suicide patients who may become homicidal 7.

Pathophysiology a. Blast Injuries 1. Multi-system injury sign and symptom patterns i. respiratory distress ii. Hollow organs are injured first i. Multi-casualty care Page 173 of 212 . Release i. Blast waves cause disruption of major blood vessels. lungs ii. ground shock iv. Management considerations in blast injuries a. blast waves ii. rupture of major organs. blast winds iii. Types of Blast Injuries (explosions) a. Specific Injuries Related to Multi-System Trauma A. major blood vessels 4. Multi-system trauma care b. and lethal cardiac disturbances when the victim is close to the blast b. heat 2. Signs/symptoms a. hearing impaired b.III. Blast winds and ground shock can collapse buildings and cause trauma 3. heart iii. Immediate transport to appropriate facility c.

and Management A. Physiology A. Vagina 5. Identify Normal Events of Pregnancy C. development. Cardiovascular system 4. Special Patient Populations Obstetrics EMT Education Standard Applies a fundamental knowledge of growth. Embryonic stage 5. Respiratory system 3. Physiological. Normal Anatomical. Implantation 4. Introduction A. Fertilization 3. Premonitory Signs of Labor 1. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Breasts B. Musculoskeletal system B. aging and assessment findings to provide basic emergency care and transportation for a patient with special needs. Conception and Fetal Development 1. Cervix 3. Anatomy and Physiology Review of the Female Reproductive System 1. Ovulation 2. Reproductive system 2. Cultural Values Affecting Pregnancy D. Lightening 2. Fetal stage D. Female Reproductive Cycle C. Braxton Hicks 3. Uterus 2. and Psychological Changes in Pregnancy 1. Ovaries 4. Functions of the Placenta III. Cervical changes Page 174 of 212 . Assessment. Special Considerations of Adolescent Pregnancy II. General System Physiology.

Preeclampsia 3. Obstetrical history 6. Treatment modalities a. Substance Abuse C. Diabetes Mellitus D. Signs of hemorrhage IV. Non-pharmacological intervention – positioning E. Stages of Labor and Delivery 1. Complications. Antepartum and Intrapartal Assessment Findings 1. Complications. Postpartum Care 1. Complications. and Management 1. Placental separation b. Airway. SAMPLE history 4. Hypertensive Disorders: Pathophysiology. Assessment. Eclampsia Page 175 of 212 . Abortion a. First stage 2. and Management 1. Management of a Normal Delivery Obstetrical Patient 1. Other B. Ectopic pregnancy E. Assessment. Elective abortion b. Inspect for crowning D. Placental Problems: Pathophysiology. Second stage a. Abruption placenta 2. Rupture membranes 6. Fetal movement b. Placental delivery C. Placenta previa F. Physical examination a. Oxygen b. Initial assessment 3. Spontaneous birth b. Fundal massage 2. and Management 1. Pregnancy-induced hypertension 2. Vital signs 5. Bloody show 5. Assessment. Third stage a. Bleeding: Pathophysiology. Positional changes of the fetus 3. Spontaneous abortion 2. circulation 2. breathing. Abuse B. 4. Complications of Pregnancy A.

Late B. Complications of Delivery: Pathophysiology. Complications. Meconium Staining D. Assessment. Premature Rupture of Membranes B. and Management A. Intrauterine Fetal Death VI. and Management A. and Management A. Early 2. Post-Term Pregnancy C. Prolapse of Cord VIII. Nuchal Cord D. Multiple Gestation E. Precipitous Labor and Birth B. Cephalic Presentation B. Breech C. Assessment. Increase Risk of Embolism Page 176 of 212 . Complications. Complications. Complications.V. High-Risk Pregnancy: Pathophysiology. Assessment. and Management A. Postpartum Complications: Pathophysiology. Hemorrhage 1. Assessment. Preterm Labor VII. Complications of Labor: Pathophysiology.

Physiologic Response to Birth 1. Initial Care of the Neonate A. Assessment Page 177 of 212 . Stimulation C. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Routine care 1. Special Patient Populations Neonatal Care EMT Education Standard Applies a fundamental knowledge of growth. Cardiovascular adaptations 3. Dry 3. Temperature regulation B. Airway 6. Respiratory adaptations 2. development. Support 2. Warm 4. aging and assessment findings to provide basic emergency care and transportation for a patient with special needs. Position 5.

Anatomy and Physiology A. Epiglottis of Infants and Toddlers Long. Implications for Health Care Provider 1. Posterior displacement of the tongue may cause airway obstruction 3. Floppy. Essential to suction the nares of infants in respiratory distress 2. Sunken fontanelle in an ill-appearing infant suggests dehydration II. Smaller airways more easily obstructed by a. inflammation) can cause obstruction III. Tracheal Cartilage is Softer and More Collapsible E. Examine Fontanelles in Infants 1. Infants are Nasal Breathers D. Flexion or hyperextension b. Chest and Lungs Compared to an Adult’s A. development. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Ribs More Cartilaginous and Pliable B. Particulate matter (including mucus) c. Increased incidence of blunt head trauma 2. Airway Compared to an Adult’s A. Securing the airway may be difficult. Narrow and Extends at a 45- Degree Angle Into Airway F. to open the airway and obtain “sniffing” position may require a towel or roll under the shoulders D. Bulging fontanelle in an ill-appearing non-crying infant suggests increased intracranial pressure 2. Excessive heat loss may occur from head 3. Jaw Smaller With Infant’s Tongue Taking Up More Room in the Oropharynx C. Head is Proportionally Larger to Body Size C. Pediatric Head versus Adult’s B. Soft tissue swelling (injury. Less Overlying Muscle and Fat to Protect Ribs and Vital Organs Page 178 of 212 . Implications for the Health Care Provider 1. aging and assessment findings to provide basic emergency care and transportation for a patient with special needs. Special Patient Populations Pediatrics EMT Education Standard Applies a fundamental knowledge of growth. Smaller in Diameter and Shorter in Length B.

Thin Chest Wall Easily Transmits Breath Sounds E. Implications for the Health Care Provider 1. Effective diaphragmatic excursion essential for adequate ventilation 2. Therefore Less Protection of Rib Cage B. Larger surface can lead to large fluid and heat losses 3. Smaller Lung Oxygen Reserves C. Liver and Spleen Proportionally Larger C. when present represent significant energy transmission accompanied by multi-system injury (e. Continually B. C. Err on using a larger bag for ventilating the pediatric patient (regardless of the size of the bag used for ventilation. and kidneys are more frequently injured 3. spleen. Higher oxygen demand with less reserve increases risk of hypoxia with apnea or ineffective bagging 2. quickly. Seemingly insignificant forces can cause serious internal injury 2. Extremities Compared to Adult’s A. and deeply burned 2. Implications for the Healthcare Provider 1. Respiratory System Compared to an Adult’s A. Implications for the Health Care Provider VI. So Injury to Growth Plate Can Result in Length Discrepancies C. Brain Tissue and Vascular System More Fragile and Prone to Bleeding From Injury Page 179 of 212 .. Hypothermia can complicate resuscitative efforts VII. use only enough force to make the chest rise slightly) VIII. Abdominal Difference A. Bones Softer B. Nervous System and Spinal Column Compared to an Adult’s A. Open Growth Plates Are Weaker Than Ligaments and Tendons. Rib fractures less common due to pliability. Implications for the Health Care Provider 1. Lungs prone to pneumothorax from excessive pressures while bag-mask ventilating IV. Larger Surface Area to Body Mass Ratio B. Implications for the Health Care Provider 1. Multiple organ injury common V. Young Children Breathe Primarily With Their Diaphragms D. pulmonary contusion) 3. Higher Oxygen Demand per Kilogram of Body Weight (Twice That of an Adult’s) B. Liver. Less-Developed Abdominal Muscles and Organs Situated More Anteriorly.g. Skin more easily. Integumentary Differences A.

Keep the infant or child warm during treatment and transport 2. Cover the head (not the face. Subarachnoid Space Is Relatively Smaller. sleep accounts for up to 16 hours a day iii. Implications for the health care provider i. Physical development i. infants sleep a lot. Head momentum may result in bruising and damage to the brain 3. Cervical spine injuries more commonly ligamentous injuries IX. persistent crying or irritability in a 0. control gazing at faces. persistent crying can be a sign of significant illness c. when obvious reasons for crying have been addressed.to 2-month-old can be a symptom of serious illness ii. Two to six months a. turning their heads. 70 percent of babies sleep through the night by six months iv. crying form of communication ii. Cognitive development i. however should arouse easily. inability to arouse a baby should be considered an emergency iii. though) to minimize heat loss 3. Physical development i. Birth to two months a. Brain and Spinal Cord Less Well Protected F. Metabolic Differences Compared to an Adult A. as this can worsen their neurologic outcomes X. The large cerebral blood flow requirement increases risk of hypoxia. With Less Cushioning Effect for Brain D. Newborns and Infants Less Than One Month Most Susceptible to Hypothermia C. Implications for the Health Care Provider 1. Spinal cord injuries less common 4. C. Growth and Development A. begin to hold their heads up Page 180 of 212 . Newborns should not be overwarmed. head control is limited 2. Implications for the Health Care Provider 1. and sucking ii. uses both hands to examine objects iii. infants have a relatively large surface area which predisposes them to hypothermia b. Infancy 1. intentional rolling over begins v. hypoxia and hypotension in a child with a head injury can cause ongoing damage 2. infants cry for obvious reasons such as hunger and needing to be changed iii. voluntarily smile and increasing eye contact ii. Pediatric Brain Requires Nearly Twice the Cerebral Blood Flow As Does an Adult’s E. Limited Glucose Stores B.

develop a pincer grasp. Cognitive development i. persistent crying or irritability can be a symptom of serious illness ii. reduce separation anxiety by keeping the child and parent together during evaluation and involving the parent in the treatment if appropriate iv. at-risk for foreign body aspiration and poisoning due to exploration of environment with their mouths iii. lack of eye contact in a sick infant could be a sign of significant illness or depressed mental status or delayed development 3. Cognitive development i. begin to crawl iv. Implications for the health care provider i. Physical development – begin to walk and explore their environments b. children may not be able to grind up food before swallowing. Physical development i. begin babbling and by 12 months learn their first word ii. explore bodies c. imitate older children and parents ii. Cognitive development i. increased awareness of surroundings ii. increased mobility increases exposure to physical dangers and injury iv. Twelve to 18 months a. persistent crying or irritability can be a symptom of serious illness ii. everything goes to the mouth iii. Six to 12 months a. Toddler Years 1. babies should make eye contact. crawling and walking increase exposure to physical dangers B. by six months. develop “separation anxiety” from parents c. Implications for the health care provider i. b. persistent crying or irritability can be a symptom of serious illness ii. due to lack of molars. begin getting teeth and eating soft foods b. know major body parts iii. Implications for the health care provider i. sit without support ii. know four to six words c. increasing risk of food aspiration iii. distracting a child with a flashlight or toy may aid in physical exam Page 181 of 212 .

Cognitive development a. Think logically b. Middle Childhood Years (6-12 Years) 1. begin to label objects iii. permanent teeth come in 2. Tantrums around control issues c. Implications for the health care provider a. ten to 15 words becomes 100 by 24 months c. Toilet training 2. Emotional development a. this magic smoke will help you breathe better [nebulizer]) D. Irrational fears 3. Loss of baby teeth. begin to understand cause and effect ii. Learn acceptable behaviors b. like a blanket d. attachment to a special object. Physical development a. School important Page 182 of 212 . Modesty developing 4. Preschool Years (2-5 Years) 1. Cognitive development a. allow a child to hold objects of importance to them (e.g. Appealing to their magical thinking may allow you to do more (e. Eighteen to 24 months a. Implications for the health care provider i. clinginess with parents ii. Rules tend to be absolute d. Magical thinking c. Respect modesty c. kicking c. persistent crying or irritability can be a symptom of serious illness ii. Perfectly normal walking and running b. children no longer require shoulder rolls to limit flexion of the neck when bag-valve-mask ventilating or intubating iv. Most rapid increase in language b. begin to run and climb b. painful procedures make lasting impressions C..g. improved gait and balance ii.. catching. Foreign body airway obstruction risk continues to be high d. Physical development a. 2. Begin throwing. blanket) iii. Rapid increase in language enhances ability to understand care explanations b. Physical development i. Emotional development i. Cognitive development i.

Popularity and peer pressure important b. Develop morals 3. pregnancy. Emotional development a. Respect patient’s modesty and cover after the physical exam d. Asking about school will often allow patients to warm up to you faster E. concerned parents and family is an important aspect of one’s responsibilities at the scene of an ill infant or child 4. increases risk for substance abuse. Assessment A. Children with chronic illness or disabilities very self-conscious c. utilize the parent/guardian to help the infant or child be more comfortable with your exam and therapies 3. and dangerous sexual practices XI. Begin to understand who they are and begin to be comfortable with that c. Relationships generally transition to those of the opposite sex 4. Adolescence time of hormonal surges. Assessment is an ongoing process continuing until care is transferred to the receiving facility B. emotions. Assembling age-appropriate equipment b. self-endangerment. Communicating with scared. Explain things clearly and honestly as you would to an adult b. 3. Adolescence (12-20 Years) 1. Provide simple explanations for illness and treatments b. Implications for the health care provider a. Reviewing age-appropriate vital signs and anticipated development Page 183 of 212 . Ability to reason b. Begin to understand that death is final 4. Respect modesty and cover after the physical exam d. Many components of the initial evaluation can be done by careful observation without touching the patient 2. Physical development – puberty begins 2. Preparing for arrival a. reassure f. Address concerns and fears about the lasting effects of their injuries (especially cosmetic) and if appropriate. General Considerations 1. Be honest about procedures which will cause discomfort e. When appropriate. Cognitive development a. Do not see possibilities as real things which could happen to them c. Implications for health care provider a. Assessment Process 1. Give choices when appropriate c. Self-conscious about body image b. Emotional development a. and peer pressure. Provide sense of control by giving choices if possible c.

or indifferent? ii. etc. does the child seem comforted by them or scared by them? 3. child abuse: injury must be consistent with history given and physical/developmental capabilities of the patient iii..e. medicine bottles. ii. tripoding) iii) retractions (i. wheeze. alcohol. chemicals. general a) Provides a 15. Observe and note parents’/guardians’/caregivers’ interactions with the child i.2.. note position and location in which patient is found c.to 30-second assessment of the severity of the patient’s illness or injury b) Use prior to addressing “the ABCs” c) Does not require touching the patient. chest wall. nasal flaring) c) Circulation to the skin i) pallor ii) mottling iii) cyanosis iii. grunting) ii) abnormal positioning (i. stridor. Pediatric assessment triangle i. just looking and listening ii. ingestions or toxic exposures: pills. Patient assessment a. or other primary CNS abnormality e) stable patient Page 184 of 212 . Scene survey a. possible physiologic states based upon the above three components a) respiratory distress or failure b) cardiovascular shock c) cardiopulmonary failure or arrest d) isolated head injury. are they appropriately concerned.e.. components a) appearance i) muscle tone ii) interactiveness iii) consolability iv) eye contact v) speech or cry b) work of breathing i) abnormal airway noise (i. drug paraphernalia. Evaluate the scene for clues related to the chief complaint i. ingestion.e. Evaluate the scene for safety threats to patient and health care providers b. angry.

constricted. open and remove if possible. iii. oxygen saturation c. Airway i. chin lift. and urine output history d) history of vomiting. or foreign body(ies) ii. Additional assessment a. or unmaintainable (in need of advanced airway care) b. initial triage and transport decision based on physiologic state a) urgent—begin rapid ABCs assessment and treatment. swelling. diarrhea. Hands-on ABCs a. Detailed physical exam—“Head to Toe” i. promptly cover to prevent hypothermia 5. Breathing/oxygenation i. central and peripheral pulse quality: strong or weak iii. respiratory rate and effort ii. examine for additional injuries and rashes ii. Circulation i. quality of fontanelles. determine level of consciousness ii. reactive. iv. key events leading to the injury or illness b. heart rate ii. medications taking and medication allergies iii. secretions. blood. neurological motor deficit or moving all extremities equally v. pain assessment using standardized pain scale e. Exposure i. assess pupils: dilated. oral or nasal airway). Disability i. auscultation for wheezes. drinking. crackles. symptoms and duration a) fever b) activity level c) recent eating. past medical problems or chronic illnesses iv. Focused history i. with help (jaw thrust. etc. blood pressure d. if present Page 185 of 212 . begin transport starting potential therapies en route 4. transport once treatment has begun b) stable patient—proceed with ABCs assessment followed by focused history and complete physical exam. and active bleeding iv. or abdominal pain e) note any rashes ii. head: bruising. extremity skin temperature. or fixed iv. AVPU scale iii. maintainable on its own. assess capillary refill time.

Age and situation appropriate airway clearance measures (finger sweep. Bronchiolitis c. tenderness. Croup b. Assessment. Respiratory Distress 1. Lower airway disease and reactive airway disease a. Assessment a. abdomen: distention. ii. Foreign body lower airway obstruction e. Respiratory failure c. Physiologic differences Page 186 of 212 . Pneumonia d. Anatomic and physiologic differences in children 2. Airway adjuncts (nasopharyngeal and oropharyngeal airways) d. suctioning) c. Airway positioning (chin lift. Oxygen e. Respiratory arrest 3. swellings. identifiable odors. History b. and Management A. inability to move neck if febrile vi. back blows. Epiglottitis e. Pathophysiology a. seat belt abrasions or bruising viii. Introduction a. Upper airway obstruction a. abdominal thrusts. Respiratory distress b. Introduction a. Bacterial tracheitis d. Assisted ventilation (bag mask) B. Anatomic differences b. Asthma b. Foreign body aspiration c. bleeding v. mouth: loose teeth. or pain on movement XII. nose: drainage obstructing ability to breathe through nose iii. Pertussis 6. neck: abnormal bruising or swelling. Shock 1. Physical findings 4. Inhaled medications (albuterol) f. injuries. ears: drainage suggestive of trauma or infection iv. Tracheostomy dysfunction 5. chest and back: bruises. Epidemiology b. or rashes vii. extremities: deformities. Management a. Specific Pathophysiology. jaw thrust) b.

Specific Conditions a. assess and intervene for increased intracranial 6. Meningitis b. febrile/afebrile ii. Pathophysiology a. Causes of altered mental status in children b. Causes of seizures i. Physiologic differences 2. Diarrhea 3. Assessment a. Neurology 1. History b. Seizures i. Assessment a. Management C. Vomiting and diarrhea Page 187 of 212 . Seizures b. Introduction a. Pathophysiology a. Decompensated shock 3. Introduction – anatomic and physiologic differences in children 2. Vomiting b. Altered mental status i. Anatomic differences b. Shock shock b. Physical findings 4. Pathophysiology a. Physical findings 4. fractures 5. assess for need to protect airway ii. Management D. Management a. afebrile 3. Assessment a. status epilepticus c. 2. Gastrointestinal 1. History b. febrile ii. Closed head injury i. bleeding inside skull ii. Physical findings 4. Altered mental status d. History b.

Local EMS criteria for death in the field b. Caregiver support G. Introduction a.E. Assessment a. Evaluation for signs of abuse 3. Definition of SIDS b. Clinical signs of death c. Toxicology 1. Physical findings c. Management a. Risk factors 2. Inhalation F. Introduction 2. Notification of appropriate authorities c. Assessment a. Sudden Infant Death Syndrome (SIDS) 1. Cardiopulmonary status b. Ingestion d. Pediatric Trauma Page 188 of 212 . History b.

Muscular changes 5. aging and assessment findings to provide basic emergency care and transportation for a patient with special needs. Cardiovascular Changes in the Elderly 1. ventilatory. lightheaded. Airway. Epigastric and abdominal pain d. and circulatory support b. Changes in circulation b. Treatment a. Assessment tools 4. Recognition of the types of chest pain that occur in the elderly i. Possible changes in physical assessment a. cyanotic mottled skin c. Typical ii. Associated signs and symptoms a. pale. atypical b. Increased peripheral edema 3. Dizziness. Cardiac output 7. Cardiovascular System Anatomical and Physiological Changes. Evaluation of patient treatment through reassessment Page 189 of 212 . Degeneration of conduction system 3. Myocardial Infarction 1. Vascular changes 4. Fatigue f. Special Patient Populations Geriatrics EMT Education Standard Applies a fundamental knowledge of growth. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Adventitious or decrease breath sounds d. Oxygen with adjuncts appropriate to patient condition c. Degeneration of valves 2. Dyspnea c. Dysrhythmias B. and Pathophysiology A. Diaphoresis. development. syncope g. Nausea and vomiting e. Stroke volume 6. Confusion 2.

Loss of elastic recoil in the chest wall resulting in air trapping and increase in lung capacity and residual volume 2. Heart Failure – A Condition Caused by Left and Right Ventricular Failure With Accompanying Pulmonary Edema 1. Airway. Productive cough c. Possible changes in physical assessment a. Immune system compromise d. Anxiety h. Institutionalized b. Diaphoresis and Cyanosis c. Decreased cough reflex 6. Tachypnea d. Chronic disease processes c. C. Orthopnea c. Respiratory System Anatomical and Physiological Changes. Hypertension early and hypotension as a late sign 3. Exertional dyspnea b. Chronic Obstructive Pulmonary Disease e. Respiratory Changes in the Elderly 1. Treatment a. wheezing. Dyspnea – on exertion and paroxysmal nocturnal dyspnea b. Accessory muscle use to breath f. Aspiration 2. Evaluation of pathophysiology through history and possible risk factors a. Decreased ability of cilia to move mucus upward B. Pneumonia – Infection of the Lung From Bacterial Viral or Fungal Causes 1. Changes in circulation b. Pulmonary edema e. Chest discomfort and pain d. ventilatory. Inhaled toxins g. Associated signs and symptoms a. Associated signs and symptoms a. Loss of alveoli 3. Wheezing e. Assessment tools – blood pressures 4. Inability to increase rate of respiratory effort 5. Chest Pain g. Headache Page 190 of 212 . Reduction in oxygen and carbon dioxide exchange 4. and Pathophysiology A. Cancer f. and rales d. Adventitious breath sounds to include crackles. Tachycardia e. Oxygen with adjuncts appropriate to patient condition II. and circulatory support b. Fatigue 2.

Pulmonary Embolism – Sudden Blockage of the Pulmonary Artery by a Venous Clot 1. dry mucosa. f. and rhonchi b. Pulse oximetry 4. Cardiac arrest 2. dry skin. rales. Changes in circulation b. or rhonchi. Weight loss i. Blood pressure b. Diminished breath sounds with adventitious noises of wheezing. Shoulder/back/chest pain c. Changes in circulation b. possible fever c. Airway. Airway. Tachycardia e. Leg pain/redness/unilateral pedal edema g. Cyanosis and pallor. Hypotension 3. Tachycardia c. Assessment tools a. rales. Possible changes in physical assessment a. Associated signs and symptoms a. Confusion 3. Assessment a. and circulatory support Page 191 of 212 . Temperature: oral or core c. Nausea and vomiting g. ventilatory. Adventitious noises such as wheezing. Supportive measures d. pale. Anxiety/apprehension e. and furrowed tongue d. Fatigue h. Musculoskeletal pain h. Hypotension 4. rales or decrease breath sounds d. Decreased pulse oximetry reading of 70 percent or lower e. Evaluation of patient treatment through reassessment C. Treatment a. Fever f. Sudden onset of dyspnea b. Orthostatic pressures d. increased vocal f. Possible changes in physical assessment a. Oxygen with appropriate adjuncts c. Treatment a. Wheezing. Syncope d. and circulatory support b. percussion will produce a dull sound. ventilatory. Increased skin turgor. Pulse oximetry 5.

b. Heart rate c. Tumors f. and Pathophysiology A. Inability to perform daily routines with decreased ability to communicate and confusion over environment c. Infections h. and pain 3. Parkinson’s disease i. Sensory perception – including audio. Neurovascular Changes in the Elderly 1. Cognitive and short-term memory effects b. Evaluation of pathophysiology through history. Alzheimer’s disease c. and Social Skills 1. Neuropathy B. Oxygen with appropriate adjunct. Work history with metals or organic or airborne toxins 3. Dementia – A Chronic. Psychomotor Skills. Various forms of encephalitis d. Neurovascular System Anatomical and Physiological Changes. Hunger and thirst e. Rate and depth of breathing b. decreased attention span b. Trauma g. Eye and ear problems e. Alcohol e. Huntington’s chorea 4. Progressive loss of cognitive function. olfactory. Metabolic and endocrine disorders d. Evaluation of patient treatment through reassessment III. Atrophy of the brain tissue a. touch. visual. Drug overdose b. Associated signs and symptoms a. Respiratory and cardiac arrest management according to current ACLS standards or area protocol d.and long-term memory problems. Deterioration of the nervous system function in controlling a. and risk factors and current medications a. Emotional disorders c. Temperature f. Cerebrovascular accidents b. Generally Irreversible Condition That Causes a Progressive Loss of Cognitive Abilities. Mood often angry Page 192 of 212 . Known reversible causes of dementia a. Delayed verbal response 2. Demographics 2. short. events may necessitate aggressive management c. Blood pressure d.

Poor historian. dehydration. disorientation c. Reduced level of consciousness 4. and current medications a. Auscultation of breath sounds to detect adventitious noises 6. Dental problems 2. Associated signs and symptoms a. Treatment a. Intoxication or withdrawal from alcohol b. Gastrointestinal (GI) Changes in the Elderly 1. Decrease in saliva 3. Possible changes in physical assessment a. days b. Mortality rates 2. Environmental emergencies 3. or Cognitive Processes Generally Due to a Reversible Physical Ailment 1. Gastrointestinal System Anatomical and Physiological Changes. Malnutrition/vitamin deficiencies h. Withdrawal from sedatives c. Adventitious breath sounds 5. Airway. Changes in circulation b. Alterations in absorption of nutrients Page 193 of 212 . memory loss. impaired judgment b. depression) g. and Pathophysiology A. Onset of minutes. Problems associated with management of patient with dementia a. Anxiety over movement out of home or current establishment e. Venous access IV. Unable to follow commands d. and acid reflux 4.. hours. Consciousness. febrile episodes may increase risk e. Delusions e. Changes in response to motor tests d. Hyper/hypoglycemia f. 5. Psychiatric disorders (i. Evaluation of pathophysiology through history. Oxygen with adjuncts appropriate to patient condition c. Medical conditions as urinary tract infections/ Bowel obstructions d. Changes in response of pupils c. ventilatory. Blood pressures b. Hallucinations d. Decrease in hydrochloric acid in the stomach 5. Disorganized thoughts: inattention.e. Inability to vocalize areas of pain and current symptoms c. Assessment tools a. cardiovascular disease. and circulatory support b. possible risk factors. Anxiety and fear of treatment of current medical problems C. Poor muscle tone of smooth muscle sphincter between esophagus and stomach can cause regurgitation leading to heartburn. Delirium – A Sudden Change in Behavior.

Associated signs and symptoms a. and standing noting any change of 10 mm/Hg or more lower as the patient moves to an upright position b. Inflammation. Tachycardia g. Pale or yellow. Dyspepsia e. Oxygen with adjuncts appropriate to patient condition 5. Hematamesis b. Hypertension e. Genitourinary System Anatomical and Physiological Changes. Peripheral. and circulatory support b. Melena d. sitting. Agitation. Liver shrinks 9. Fever f. Reduction in renal function 2. Treatment: a. and standing noting any change of 10 beats per minute more higher as the patient moves to an upright position c. 6. Rectal sphincter may become weak resulting in fecal incontinence 8. sacral. thin skin. Gastrointestinal Bleeding Caused by Disease Processes. Slowing peristalsis causing constipation 7. Hepatomegaly f. Airway. lying. Decreased bladder capacity Page 194 of 212 . lying. Changes in circulation b. Oxygen with adjuncts appropriate to patient condition V. Dizziness 2. Jaundice g. Airway. Infection and Obstruction of the Upper and Lower Gastrointestinal Tract 1. Tubule degeneration 4. Possible changes in physical assessment a. Auscultation of breath sounds to detect adventitious noises. Constipation. inability to find a comfortable position i. ventilatory and circulatory support b. Blood pressures. Genitourinary Changes in the Elderly 1. Treatment: a. or foreign bodies 6. diarrhea h. Blood flow to the liver declines 10. Assessment tools – blood pressure 4. 50 percent reduction in renal blood flow 3. frail musculoskeletal system c. Hemetemesis c. ventilatory. Assessment tools a. and Pathophysiology A. and periorbital edema d. Dyspnea 3. Pulses. Decrease metabolism in the liver B. sitting.

Atrophy of muscles and muscle wasting 2. and circulatory support b. Decreased metabolism of thyroxine 2. Temperature 4. Oxygen with adjuncts appropriate to patient condition VII. Reduction of the hormones secreted by the hypothalamus and pituitary gland 5. oral mucosa. Dizziness d. Associated signs and symptoms a. Assessment tools a. Increase in secretion of antidiuretic hormone and atrial natriuretic hormone causing fluid imbalance 6. pale. Resulting in Dehydration 1. Endocrine Changes in the Elderly 1. Tachycardia e. Altered mental status f. and Pathophysiology A. Reduction in pancreatic beta cell secretion causing hyperglycemia 4. and Pathophsysiology A. Blood pressures b. 5. Loss of strength Page 195 of 212 . Hyperglycemia b. Airway. Distal pulses c. furrowed tongue c. Possible changes in physical assessment a. Musculoskeletal System Anatomical and Physiological Changes. Increase in levels of norepinephrine B. Blood glucose levels greater than 500 mg/dL 3. Decline in sphincter muscle control 6. Musculoskeletal Changes in the Elderly 1. Increase in nocturnal voiding 8. In males benign prostatic hypertrophy VI. Unlike DKA the Resulting High Blood Glucose Levels Do Not Cause Ketosis. and Shift of Fluid to the Intravascular Space. Polydipsia c. poor skin turgor. Treatment a. but Rather Lead to Osmotic Diuresis. Confusion e. dry. Auscultation of breath sounds to detect adventitious noises d. Hypotension and shock d. Hyperosmolar Hyperglycemic (Nonketotic Coma) Is a Diabetic Complication of Type 2 (Formerly NIDDM of Type II) in the Elderly. Seizures 2. Decreased conversion of thyroxine to triiodothyronine 3. Degenerative changes and loss of bone 3. Decline in voiding senses 7. ventilatory. Endocrine System Anatomical and Physiological Changes. Warm. flushed skin. Changes in circulation b.

Vision 1. Decreased kidney function 2. Macular degeneration c. Altered gastrointestinal absorption 3. Inability to hear high frequency sounds 3. Adverse Reactions Occur When a Drug or Drugs Taken Together Change the Pharmacokinetics or Pharmacodynamics in the Body IX. Toxicological Emergencies A. Retinal detachment B. Disease processes a. Decreased visual acuity – inability to accommodate 2. Thinning of cartilage and thickening of synovial fluid B. Pain Perception 1. Impaired Cognitive. Non-Compliance of Medication Can Occur From Financial Inability. Degenerative changes in joints 5. Use of hearing aids C. Decreased tear production 5. Often Prescribed by Different Doctors That Can Cause Adverse Reactions in the Patient D. Osteoporosis Is a Bone Disease That Decreases Bone Density VIII. Decrease vascular flow in the liver altering metabolism and excretion B. Inability to differentiate hot from cold Page 196 of 212 . Loss of elasticity in ligaments and tendons 6. Glaucoma b. 4. Pathophysiological Changes That Cause the Elderly to Be Susceptible to Toxicity 1. Development of cataracts 6. Polypharmacy is the Use of Multiple Medications. Medics Should Check Prescription Dates and Number of Pills Available to Access Compliance of Medication Use C. Inability to differentiate colors 3. Vision and Hearing Ability. a Motor Inability to Open Caps. Hearing 1. Sensory Changes in the Elderly A. Alteration of pain perception 2. Decreased night vision 4. Presbycusis 2.

Special Patient Populations
Patients With Special Challenges
EMT Education Standard
Applies a fundamental knowledge of growth, development, aging, and assessment findings to
provide basic emergency care and transportation for a patient with special needs.

EMT-Level Instructional Guideline
The EMT Instructional Guidelines in this section include all the topics and material at the EMR
level PLUS the following material:

I. Abuse and Neglect
A. Child Abuse
1. Types of abuse
a. Neglect
b. Physical abuse
c. Sexual abuse
d. Emotional abuse
2. Assessment
a. History or scene findings to concern for abuse or neglect
b. Caregiver’s behavior
c. Physical findings
3. Management
a. Reporting
b. Safely transporting
c. Role of child/adult protective services
4. Legal aspects
5. Documentation
B. Elder Abuse
1. Types of abuse
a. Neglect
b. Physical abuse
c. Sexual abuse
d. Emotional abuse
e. Financial abuse
2. Epidemiology
3. Assessment
4. Management
5. Legal aspects
6. Documentation

Page 197 of 212

II. Homelessness/Poverty
A. Advocate for Patient Rights and Appropriate Care
B. Identify Facilities That Will Treat Regardless of Payment
C. Prevention Strategies Will Likely Be Absent, Increasing the Probability of
Disease
D. Familiarity With Assistance Resources Offered in Community

III. Bariatric Patients
A. Increased Risk for
1. Diabetes
2. Hypertension
3. Heart disease
4. stroke
B. Patient Handling Issues to
1. Prevent back injuries
2. Position the patient to breathe

IV. Technology Assisted/Dependent
A. Ventilation Devices
B. Apnea Monitoring/Pulse Oximetry
C. Long-Term Vascular Access Devices
D. Dialysis Shunts
E. Nutritional Support (i.e. gastric tubes)
F. Colostomy or Ileostomy

V. Hospice Care and Terminally Ill
A. What is Hospice?
1. Comfort care versus curative care
2. Terminally ill as verified by physician
3. Typically cancer, heart failure, Alzheimer’s disease, AIDS
B. EMS Intervention
C. DNR (Do Not Resuscitate) Orders

VI. Tracheostomy Care
A. Tracheostomy: Surgical Opening From the Anterior Neck Into the Trachea
B. Consists of
1. Stoma
2. Outer cannula
3. Inner cannula
C. Routine Care
1. Keep stoma clean and dry
2. Suction as needed
D. Acute Care

Page 198 of 212

VII. Sensory Deficits
A. Sight
1. Service dogs
2. Allow patient to take your arm
3. Other
B. Hearing Impaired
1. Hearing aid issues
2. Communication
a. Face patient (so he can lip read)
b. Lighted area
c. Communicate by writing
d. Obtain sign language interpreter

VIII. Homecare
A. Common for Patients Over Age 65
B. Various Reasons for Calls

IX. Patient With Developmental Disability
A. Respect as With Any Other Patient
B. Family or Friends May Supply Additional Information
C. Take Special Care to Provide Explanations

Page 199 of 212

EMS Operations
Principles of Safely Operating a Ground Ambulance
EMT Education Standard
Knowledge of operational roles and responsibilities to ensure patient, public, and personnel
safety.

EMT-Level Instructional Guideline
The intent of this section is to give an overview of emergency response to ensure EMS
personnel, patient, and other’s safety during EMS operations. This does not prepare the entry-
level student to be an experienced and competent driver.

Information related to the clinical management of the patient during emergency response is
found in the clinical sections of the National EMS Education Standards and Instructional
Guidelines for each personnel level.

The EMT Instructional Guidelines in this section include all the topics and material at the EMR
level PLUS the following material:

I. Risks and Responsibilities of Emergency Response
A. Safety Issues During Transport
1. All personnel and others riding in or on apparatus are properly seated and
secured with safety belts.
2. All patients are properly secured and all stretcher straps are appropriately
in place and tightened.
3. All equipment is appropriately secured
a. Cab areas
b. Rear of ambulances
c. Compartments
4. Consideration of use of lights and sirens
a. Risk/benefit analysis
i. status of patient interventions
ii. patient condition
b. Audible warning devices
i. asking for right of way of others
ii. not to be used to clear traffic
5. Transport with due regard
6. High-risk situations
a. Intersections
b. Highway access
c. Speeding

Page 200 of 212

using mobile radio iv. Driving alone i. global Positioning Systems iii. Unpaved roadways (see Federal Highway Administration definition) h. Driver Distractions i. Inclement weather f. Fatigue Page 201 of 212 . vehicle stereo vi. Aggressive drivers g.d. mobile computer ii. eating/drinking e. operating visual and audible devices v. wireless devices vii.

EMS Operations Incident Management EMT Education Standard Knowledge of operational roles and responsibilities to ensure patient. Establish and Work Within the Incident Management System A. or equivalent 2. I. Entry-Level Students Need to Be Certified in 1. public. and personnel safety. An Introduction B. EMT-Level Instructional Guideline Information related to the clinical management of the patient within components of the Incident Management System (IMS) is found in the clinical sections of the National EMS Education Standards and Instructional Guidelines for each personnel level. FEMA IS-700: NIMS. ICS-100: Introduction to ICS. This Can Be Done as a Co requisite or Prerequisite or as Part of the Entry-Level Course Page 202 of 212 .

START c. triage tape or labels used iii. Other B. Primary triage used on scene to rapidly categorize patient’s condition i. re-triage of patients ii. Triage A. Techniques of Triage a. Secondary triage used at treatment area i. Information related to the clinical management of the patients during a multiple casualty incident is found in the clinical sections of the National EMS Education Standards and Instructional Guidelines for each personnel level. The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Center for Disease Control (CDC) Guidelines b. document location of patient and transport needs ii. Performing 1. EMS Operations Multiple Casualty Incidents EMT Education Standard Knowledge of operational roles and responsibilities to ensure patient. Re-Triage C. Primary versus secondary a. and personnel safety. public. EMT-Level Instructional Guideline The intent of this section is to give an overview of operating during a multiple casualty incident when a multiple casualty incident plan is activated.An Event That Places a Great Demand on Resources. focus on speed to sort patients quickly b. not always necessary 2. Destination Decisions 1. Patient distribution 2. Be It Equipment or Personnel II. paper tags usually used iii. Hospital surge capacity Page 203 of 212 . Multiple Casualty Incidents (MCI) -.

Specialty patient needs (burn. Access to debriefing Page 204 of 212 . pediatric. Should be part of post-incident SOP 2. Ongoing coordination and communication D. 3. Roles of debriefing for an MCI 1.) 4. etc. Post-Traumatic and Cumulative Stress 1. Access to defusing during the MCI 3.

Landing zone E. Airspeed limitations 4. public. Disadvantages 1. Fixed wing B. Weather/environmental 2. equipment 2. Securing loose objects b. supplies. Safe Air Medical Operations A. Landing Zone Selection and Preparation F. Approaching the Aircraft G. Aircraft cabin size 5. Rapid transport 3. Cost D. Advantages 1. and personnel safety. I. Approaching the aircraft c. Access to remote areas 4. Altitude limitations 3. EMS Operations Air Medical EMT Education Standard Knowledge of operational roles and responsibilities to ensure patient. Types 1. Patient Transfer 1. Helicopter hospital helipads C. EMT-Level Instructional Guideline The intent of this section is to give an overview of operating safely in and around a landing zone during air medical operations and transport. Specialized care – skills. Terrain 6. Information related to the clinical management of the patients during air medical operations is found in the clinical sections of the National EMS Education Standards and Instructional Guidelines for each personnel level. Rotorcraft 2. Scene safety a. Interacting with flight personnel 2. Patient preparation 3. Communication Issues Page 205 of 212 .

State guidelines a. Search and rescue B. Activation 1. City/county/district ordinance standards Page 206 of 212 . State statutes b. Criteria for Utilizing Air Medical Response A. Trauma 3. Administrative rules c. Indications for Patient Transport 1. Local guidelines 2.II. Medical 2.

Patient Safety 1. Use of lights and other warning devices c. Designate a traffic control person 2. Keep them informed of your actions 2. Setting up protective barrier d. I. 360-degree assessment a. Situational Safety 1. Safe Vehicle Extrication A. EMT-Level Instructional Guideline The intent of this section is to give an overview of vehicle extrication to ensure EMS personnel and patient safety during extrication operations. Control traffic flow a. Role of EMS in Vehicle Extrication 1. Information related to the clinical management of the patient being cared for during vehicle extrication is found in the clinical sections of the National EMS Education Standards and Instructional Guidelines for each personnel level. This does not prepare the entry-level student to become a vehicle extrication expert or technician. Provide patient care 2. Proper positioning of emergency vehicles i. public. Downed electrical lines b. First priority for all EMS personnel 2. protect scene b. upwind/uphill ii. Broken glass e. Protect from further harm D. and personnel safety. Personal Safety 1. EMS Operations Vehicle Extrication EMT Education Standard Knowledge of operational roles and responsibilities to ensure patient. Scene size-up C. Smoke or fire d. Perform simple extrication B. Appropriate personal protective equipment for conditions 3. Mechanism of injury Page 207 of 212 . Leaking fuels or fluids c. Trapped or ejected patients f.

Equipment-intensive e. 3. Disconnect battery or power source g. Multi-step process c. Others 6. HAZMAT 5. Disentanglement of vehicle from patient b. Law enforcement d. Turn off vehicle ignition d. Access to patient i. Undeployed vehicle safety devices c. Air medical g. Put vehicle in “park” or in gear b. seat belt pretensioners ii. Determine Number of Patients (implement local multiple casualty incident protocols if necessary) II. Vehicle stabilization a. Extrication equipment b. undeployed air bags iii. Set parking brake c. Hammer B. simple a) try to open doors b) ask patient to unlock doors c) ask patient to lower windows ii. Pry Bar Page 208 of 212 . Fire suppression c. Rescuer-intensive d. Alternative-fuel vehicles b. complex iii. Time-intensive f. Utility companies f. Unique hazards a. Identify and avoid hazardous vehicle safety components i. Cribbing/Chocking e. Evaluate the need for additional resources a. tools a) hand b) pneumatic c) hydraulic d) other E. Move seats back and roll down windows f. Use of Simple Hand Tools A. HAZMAT e. other 4. Extrication considerations a. Center Punch C.

Assist With Rapid Extrication C. D. Use Path of Least Resistance Page 209 of 212 . Removing Patient 1. Provide critical interventions B. Maintain manual cervical spine stabilization 2. Complete primary assessment 3. Use Sufficient Personnel E. Move Patient. Hack Saw E. Not Device D. Special Considerations for Patient Care A. Come-Along III.

and personnel safety. EMS Operations Hazardous Materials Awareness EMT Education Standard Knowledge of operational roles and responsibilities to ensure patient. This Can Be Done as a Co requisite or Prerequisite or as Part of the Entry-Level Course Page 210 of 212 . Risks and Responsibilities of Operating in a Cold Zone at a Hazardous Material or Other Special Incident A. 29 CFR 1910. EMT-Level Instructional Guideline Information related to the clinical management of the patient exposed to hazardous materials is found in the clinical sections of the National EMS Education Standards and Instructional Guidelines for each personnel level.120 (q)(6)(i) -First Responder Awareness Level B. I. Entry-Level Students Need to Be Certified in: Hazardous Waste Operations and Emergency Response (HAZWOPER) standard. public.

Role of EMS 1. Dangers of the secondary attack 2. Signs and symptoms of biological. Concept of “greater good” as it relates to any delay e. Time. EMT-Level Instructional Guideline The intent of this section is to give an overview of operating during a terrorist event or during a natural or manmade disaster. nuclear. and shielding for self-protection e. Treating terrorists/criminals Page 211 of 212 . and personnel safety. Personal safety 2. Information related to the clinical management of patients exposed to a terrorist event is found in the clinical sections of the National EMS Education Standards and Instructional Guidelines for each personnel level. Risks and Responsibilities of Operating on the Scene of a Natural or Man-Made Disaster A. First priority for all EMS personnel b. Safety 1. I. Scene size-up d. incendiary. EMS Operations Mass Casualty Incidents Due to Terrorism and Disaster EMT Education Standard Knowledge of operational roles and responsibilities to ensure patient. chemical and explosive (B-NICE) substances d. distance. Emergency responders are targets f. Initiate/operate in an incident command system (ICS) 4. public. Appropriate personnel protective equipment for conditions c. Provide patient care 3. Protect from further harm c. Patient a. Personal a. Keep them informed of your actions b. Assist with operations B.

Safe disposal of auto injector devices after activation Page 212 of 212 . Ongoing scene assessment for potential secondary events d. Communicate with law enforcement at the scene of an armed attack e. Safe use of an auto injector for self and peers b. Outward signs and protective actions of biological. EMS operations during terrorist. nuclear. Outward signs and characteristics of terrorist incidents b. Perimeter use to protect rescuers and public from injury g. incendiary. chemical. Initially distance from scene and approach when safe c. All hazards safety approach b. 360-degree assessment and scene size-up a.3. Outward signs of a weapons of mass destruction (WMD) incident c. Determine number of patients (implement local multiple-casualty incident (MCI) protocols as necessary) 5. Initiate or expand incident command system as needed f. and explosive (B-NICE) weapons 4. Escape plan and a mobilization point at a terrorist incident 7. weapons of mass destruction. disaster events a. Care of emergency responders on scene a. Evaluate need for additional resources 6.

DOT HS 811 077C January 2009 .

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