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

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

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

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

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

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

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

preferably in a different color ink. care EMT wished to provide for the patient iv. document that the patient did not allow for proper assessment and document whatever assessments were completed iii. c. Errors discovered after a hand-written report form is submitted i. draw a single line through the error. Have a family member. do not try to obliterate the error—this may be interpreted as an attempt to cover up a mistake b. the date. offer alternative methods of gaining care vi. police officer. Inform the patient why he should go and what may happen to him if he does not d. if the patient refused care or did not allow a complete assessment. Correction of errors a. most electronic prehospital care report systems have a method for entering and amending the report ii. add a note with the correct information. have a family member. Special Situations/Reports/Incident Reporting 1. Multiple-Casualty Incidents (MCI) a. and write the correct information beside it ii. and the EMT’s initials c. If the patient refuses to sign the refusal form. Complete the prehospital care report i. g. If the patient still refuses. Consult medical direction as directed by local protocol e. the EMT will need to fill out the report later Page 11 of 212 . Errors discovered while the report form is being hand-written i. complete patient assessment ii. draw a single horizontal line through the error. and add a note with the correct information ii. Errors discovered while/after completing an electronic report i. if information was omitted. statement that the EMT explained to the patient the possible consequences of failure to accept care. or bystander sign the form verifying that the patient refused to sign. state willingness to return D. When there is not enough time to complete the form before the next call. police officer or bystander sign the form as a witness. document any assessment f. 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. initial and date it. including potential death v. initial it.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Standard Medical Abbreviations and Acronyms Page 29 of 212 . Associated With Body Structure B. Medical Terminology A. Prefixes B. Associated With Body Direction or Position III. Combining Forms II. Suffixes D. Root Words C. PLUS the following material: I. 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. Associated With Body Systems C. Medical Terms A. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level.

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

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

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

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

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

Crying a. preschoolers—20 to 30 breaths per minute c. well flexed extremities iii. Pain cry 2.. Despair c. Anger cry c.g. Vital signs a. toddlers—20 to 30 breaths per minute ii. Respiratory rate i. preschoolers—80 to 120 beats per minute b. Psychosocial development 1. Fontanelles i. di) iii. Passive immunity retained through the first six months of life b. Reflexes c. extremities move equally when infant is stimulated b. Withdrawal II. fontanelles may provide an indirect estimate of hydration 6. anterior fontanelle closes between 9 and 18 months iii. Heart rate i. Nervous system a. Basic cry b. Growth and development in infants a. coordinated suck and gag ii. toddlers—80 to 130 beats per minute ii. posterior fontanelle closes at three months ii. two months a) tracks objects with eyes b) recognizes familiar faces ii. Physiological 1. Toddler (12 to 36 Months) and Preschool Age (3 to 5) A. 12 months a) walks with help b) knows own name B.8 to 99. Situational crisis – parental separation reactions a. preschoolers—80 to 110 mmHg d. mu. 4. strong. Immune system a. ma. Based on maternal antibodies 5. toddlers—70 to 100 mmHg ii. Movements i. Rapid changes over first year i. Temperature—96.6 degrees Fahrenheit Page 35 of 212 . da. Protest b. six months a) sits upright in a highchair b) makes one syllable sounds (e. Systolic blood pressure i.

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

boys are mostly done growing by age 18 c. begins distally with enlargement of feet and hands ii. Endocrine changes e. Anti-social behavior peaks around eighth or ninth grade f. Family a. Heart rate—55 to 105 beats per minute b. Develop identity a. Respiratory rate—average 16 to 20 breaths per minutes c.to three-year growth spurt i. Self-consciousness increases b. Self-destructive behaviors begin i. Vital signs a. Girls are mostly done growing by age 16. Want to be treated like adults e. Peer pressure increases c. Psychological 1.6 degrees Fahrenheit 2.6 degrees Fahrenheit 2. All body systems at optimal performance 5. Growth rate a. Muscle mass and bone growth nearly complete B. Accidents are a leading cause of death in this age group Page 37 of 212 . Temperature—98. Conflicts arise 2. Peak physical conditioning between 19 and 26 years of age 3. eating disorders are common g. Temperature—98. chest and trunk enlarge in final stage b. Heart rate—average 70 beats per minute b. Respiratory rate—12 to 20 breaths per minute c. Most experience a rapid two. continual comparison amongst peers ii. Body image of great concern i. tobacco ii. Secondary sexual development occurs d. Physiological 1. Early Adulthood (20 to 40 Years) A. Reproductive maturity f. Blood pressure—average 120/80 mmHg d. Adults develop lifelong habits and routines during this time 4. Depression and suicide more common than any other age group V. Blood pressure—100 to 120 mmHg d. Interest in the opposite sex increases d. illicit drugs h. 1. Vital signs a. alcohol iii. enlargement of the arms and legs follows iii.

Vital signs a. Romantic love b. Physiological 1. Cholesterol levels increased 6. Heart rate—depends on patient’s physical and health status b. reduced blood flow to organs Page 38 of 212 . Cardiac output decreases throughout this period b. Physiological 1.6 degrees Fahrenheit 2. Psychological 1. Weight control more difficult 8. Blood vessels i.6 degrees Fahrenheit 2. Blood pressure—depends on patient’s physical and health status d. Childbirth most common in this age group 4. Body still functioning at high level with varying degrees of degradation 3. Often burdened by financial commitments for elderly parents as well as young adult children VII. Experience highest levels of job stress during this time 2. Respiratory rate—average 16 to 20 breaths per minute c. Cardiovascular health becomes a concern a. increased peripheral vascular resistance iii. Heart rate—average 70 beats per minute b. Temperature—98. Approach problems more as challenges than threats 2. Hearing less effective 5. B. Empty-nest syndrome 3. Love develops a. This period is less associated with psychological problems related to well being VI. Blood pressure—average 120/80 mmHg d. Cardiovascular function changes a. Cancer strikes in this age group often 7. Menopause in women in late 40s early 50s B. Affectionate love 3. Respiratory rate—depends on patient’s physical and health status c. thickening ii. Temperature—98. Vital signs a. Psychological 1. Life span—maximum approximately 120 years 3. Late Adulthood (61 Years and Older) A. Vision changes 4. Life expectancy—average length based on year of birth 4. Middle Adulthood (41 to 60 Years) A.

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

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

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

Oral (e. Parenteral (injected and inhaled) a. Liquids a. Medication safety 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.g. glucose) 2. Solid a. aerosols – inhalation B. epinephrine) c.g. Routes of Medication Administration 1. Tablets – compressed powders c. Sublingual (e. Trade Page 42 of 212 . Generic 2.. nitroglycerin) b.. oxygen) b. Enteral (ingested) a. Parenteral (injected) 3. intravenous III.g. Drug Name 1. Forms of Medication 1. Pills b. Kinds of Medications Used in an Emergency A. Enteral (ingested) b. Basic Medication Terminology A. Methods of injection i.g. Gases. subcutaneous ii. Injection (e. 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.. Powder – inhalation 2. intramuscular iii.. Inhaled (e.

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

Right route – patient condition d. standing orders. Sublingual a. Techniques of Medication Administration 1. Advantages b. Disadvantages c. Off-line. Assisting patients in taking prescribed medications 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. Assist/Administer Medications to a Patient A. Right patient – prescribed to patient b. Techniques 2. Medical Direction a. Techniques Page 44 of 212 . Disadvantages c. Techniques 3. written protocols b. Right time – within expiration date C. Intramuscular injection by Auto injector 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. Advantages b. Disadvantages c. Administering medication 3. Advantages b. Oral a. On-line. Right dose – prescribed to patient e. Administration versus Assistance of Medications 1. The “rights” of drug administration a. Right medication – patient condition c. Medication Administration Procedure 1. verbal order a) Confirmation – echo technique b) Confusion – clarification B.

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

Oxygen B. I. complications. Nitroglycerin Page 46 of 212 . 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. interactions. indications. Epinephrine 3. and any specific administration considerations. Aspirin 2. routes of administration. dose. side effects. EMT – Assisted Medications 1. EMT – Administer Medications 1. Individual training programs have the authority to add any medication used locally by EMTs. mechanism of action. Inhaled bronchodilators 2. Pharmacology Emergency Medications EMT Education Standard Applies fundamental knowledge of the medications that the EMT may assist/administer to a patient during an emergency. for all of the following emergency medications. contraindications. Oral glucose 3. Specific Medications 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. Laryngopharyx 5. Respiration. Mouth and oral cavity a. and respiration for patients of all ages. Epiglottis – muscular structure which protects the airway of conscious patients during swallowing b. Hollow tubes which further divide into lower airways of the lungs b. Supported by cartilage Page 47 of 212 . Pharynx a. Tongue 3. Larynx a. foundational breadth) of anatomy and physiology to patient assessment and management in order to assure a patent airway. and Artificial Ventilation Airway Management EMT Education Standard Applies knowledge (fundamental depth. adequate mechanical ventilation. Jaw 4. Nasopharynx b. Oropharynx c. Hollow tube which passes air to the lower airways b. Bronchi a. Airway Anatomy A. Alternative airway. Nose – warm and humidify air 2. Carina – the bifurcation of the trachea into the two mainstem bronchi 3. Vocal cords – thin muscles which are the center for speech and protect the lower airways c. Trachea a. Lower Airway Tract 1. Supported by cartilage rings 2. Thyroid cartilage d. Cricoid ring B. Entrance to the digestive system c. Also involved in the production of speech d. Airway Management. Upper Airway Tract 1. especially in emergency b.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

position of patient iv. 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. Speech and language i. Appearance and behavior i. facial expression a) anxiety b) depression c) anger d) fear e) sadness f) pain b. Blood pressure i. Perfusion a. 2. position of arm v. equipment size ii. Neurological System 1. rate ii. placement of cuff iii. methods of measurement a) auscultation b) palpation vi. Mental status a. relation to perfusion D. observe posture and motor behavior iii. appropriateness a) slurred b) garbled c) aphasia Page 72 of 212 .

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

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

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

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

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

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

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

Possibly misleading D. Requires a balance of knowledge and skill to obtain a thorough and accurate history c. General Impression D. Verbal or non-verbal 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. Assessment Factors A. Primary component of the overall assessment of the medical patient b. Chief Complaint 1. Labeling II. Initial Assessment E. Primary reason for EMS response 2. SAMPLE History 1. Life-Threatening Conditions E. Pill containers b. Importance of a Thorough History a. Unresponsive patient a. 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. Non-Life Threatening Conditions F. EMT Attitude 1. Medical jewelry Page 80 of 212 . Helps to ensure the proper care will be provided for the patient 2. Patient Cooperation I. Biases 2. Scene Size-Up C. Tunnel Vision H. Distracting Injuries G. Scene Safety B. Standard Precautions B. Environment C. Major Components of the Patient assessment A.

P – provoke i. focuses on what the patient was doing when the problem began ii. T – time i. Baseline Vital Signs G. Medical devices 3. 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. Secondary Assessment Page 81 of 212 . O – onset 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. focuses on what might provoke the problem for the patient ii. Focused on the patient’s chief complaint c. Bystanders e. focuses on the duration of the problem/pain/discomfort ii. focuses on the severity of the pain/discomfort ii. 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. pill containers ii. focuses on the specific area of the pain/discomfort ii. Responsive patient a. family members iv. medical jewelry iii.region/radiate i. Q – quality i. Additional history may be obtained from evidence at the scene i. question: what were you doing when the problem began? b. Obtained directly from the patient b. R . focuses on the patient’s own description of the problem ii. S – severity i. question: when did your problem/pain/discomfort first begin? F. bystanders 4. OPQRST mnemonic for evaluation of pain a. question: does anything you do make the problem better or worse? c. c. Family members d.

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

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

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

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

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

Constipation b. Nausea/vomiting a. Diarrhea c. Urinary Bladder F. 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. Intestines C. Esophagus D. Inspection 2. Normal Findings—Soft Non-Tender C. Techniques 1. Liver G. Dark tarry stool 3. Assessment and Symptoms 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. Pain b. Hematemesis 2. Excessive b. Abnormal Findings 1. Palpation B. Define Acute Abdomen II. Kidney J. Stomach B. Spleen E. Reproductive Organs III. Anatomy of the Organs of the Abdominopelvic Cavity A. Frequency Page 87 of 212 . Urination a. Change in bowel habits/stool a. Gall Bladder H. Pancreas I.

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

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

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

Recommendations for Disposing of Contaminated Linens and Supplies Including Sharps F. Protozoa 5. Bacteria 2. Infectious Agents 1. Transport Decisions Including Special Infection Control Procedures Page 91 of 212 . Recommendations for Cleaning or Sterilization of Equipment E. Personal Protective Equipment. Body Substance Isolation. and Cleaning and Disposing of Equipment and Supplies A. Helminths (worms) II. Hand Washing Guidelines C. Consider Age-Related Variations in Pediatric and Geriatric Patients as They Relate Assessment and Management of Patients With a Gastrointestinal Condition or Emergency IV. Viruses 3. Recommendations for PPE D. Principles of Body Substance Isolation B. 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. Recommendations for Decontaminating the Ambulance III. Causes of Infectious Disease A. Fungi 4. Communication and Documentation for a Patient With a Communicable or Infectious Disease V. 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.

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

vertigo. Definition of Terms 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. Normal Blood Glucose Levels (BGL) 4. Increasing level of consciousness 5. 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. Explanation of relationship of glucose and insulin 3. syncope 2. oral agents ii. Types a. Complications Page 93 of 212 . diabetic ketosis B. Insulins b. Hyperglycemia. Oral agents 6. Confusion. General Assessment Findings and Symptoms 1. Diabetic medications a. Decreasing level of consciousness 3. Diabetes—types I and II 2. Anatomy and Function of the Pancreas C. Visual changes 6. Overview of Condition 1. Introduction A. Speech changes 7. Diabetes A. Hypoglycemia 3. headache. diet-controlled 5. Combative or uncooperative or restless 4. Movement and sensation changes II. Type 1 (formerly known as Insulin Dependent Diabetes or Type I) b. Incidence 2.

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

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

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

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

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

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

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

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

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

Circulation F. Airway Control D. Consider Age-Related Variations for Pediatric and Geriatric Assessment and Management A. Transport Decisions Page 106 of 212 .IX. Pediatric 1. Use of Activated Charcoal 1.Alcoholism is common in elderly XI. Communication and Documentation for Patients With Toxicological Emergencies XII. Geriatric -. Indications/contraindications/side effects 2. Physician order 3. Ventilation and Oxygenation E. 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. Dose X.

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

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

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

Support Ventilation B. Urinary Catheter Management Page 110 of 212 . Peritoneal Dialysis C. Kidney Stones III. Infection at access site E. Management for a Patient With a Dialysis Emergency A. Pathophysiology A. Complications/Adverse Effects of Dialysis 1. ABCs. Nausea/vomiting 4. Upright If Pulmonary Edema V. Stop Bleeding From Shunt as Needed C. Muscle cramps 3. Hemodialysis 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. Graft B. Dialysis A. Shunt 2. Fistula 3. Anatomy and Physiology of Renal System II. 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. Obtaining B/P D. Special Considerations for Hemodialysis Patients 1. Kidney Failure B. Weakness 2. Hypotension 2. Pulmonary edema IV. Missed Dialysis Treatment 1. Hemorrhage especially from access site 5. Position—Flat If Shocky.

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

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

e. Pediatric B. Sensation Changes E. Geriatric Page 113 of 212 . Circulatory Changes F. 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. Ventilation. Communications and Documentation V. Bones B. and Circulation B. Transport Considerations D. Deformity IV. Non-Traumatic Fractures (i. Airway. 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. cancer or osteoporosis) III. Anatomy and physiology review A. Swelling C. Consider Age-Related Variations A. Muscles II. Splinting C. Assessment A. Management A. Pain or Tenderness B. Abnormal or Loss of Movement D. Pathophysiology A.

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

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

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

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

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

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

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

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

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

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

Muscles C. Penetrating C. Physiology A. 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. 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. Vessels H. Mechanism of Injury for Chest Trauma A. Accessory muscle 5. Blunt B. Mortality II. Trachea E. Lungs G. Musculoskeletal structure 2. Skin B. Intercostal muscle 3. Heart I. Incidence of Chest Trauma A. Changes in intrathoracic pressure Page 128 of 212 . Bones D. Role of the Chest in Systemic Oxygenation 1. Diaphragm 4. Esophagus J. Bronchi F. Morbidity B. Mediastinum IV. Anatomy of the Chest A.

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

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

Anatomy A. Motorcycle collisions 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. Physiology A. Solid Organs B. Falls g. Pain b. Specific Injuries A. MVA d. Deceleration c. Retroperitoneal Structures E. Compression b. Mortality II. 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. Vascular Structures IV. Guarding c. Blast injuries 2. Signs and Symptoms a. Assault h. Surface Anatomy of the Abdomen C. Pedestrian injuries f. Intraperitoneal Structures D. Reproductive Organs III. Incidence A. Quadrants and Boundaries of the Abdomen B. Distention – rise in abdomen between pubis and xiphoid process Page 131 of 212 . Closed Abdominal Trauma 1. Mechanism of Injury a. Hollow Organs C. Morbidity B.

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

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

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

Vascular structure a. Carpals g. Incidence A. Subcutaneous Layers C. Scapula b. Muscles 3. Clavicle c. Indirect force 3. Skin Layers 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. 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. Geriatric Considerations D. Bony structure a. Lower extremity B. Extremity Structures 1. Phalanges i. Morbidity/Mortality 1. ischium Page 135 of 212 . Upper extremity 2. Metacarpals h. Direct force 2. Venous b. Ulna f. Radius e. Pediatric Considerations C. Mechanism of Injury 1. Arterial 2. Humerus d. Twisting force II. ileum ii. Anatomy A. Pelvis i.

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

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

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

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

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

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

Assessment 1. Morbidity II. Pulse. Contusion 2. Bites Page 142 of 212 . Avulsions 4. Type of Injuries 1. Closed Soft Tissue Injury A. Discoloration 2. Lacerations and incisions 3. sensation distal to injury D. Swelling 3. Signs and Symptoms 1. Incidence of Soft Tissue Injury A. Hematoma 3. Layers of the Skin B. Cold 2. Mortality B. Mechanism of injury. Abrasions 2. suspect underlying organ trauma/injury 2. Management 1. Splinting if necessary 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. Type of Injuries 1. Anatomy and Physiology of Soft Tissue Injury A. 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. Pain C. movement. Crush injuries B. Open Soft Tissue Injury A. Function of the Skin III. Diffuse or generalized soft tissue trauma can be critical 3.

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

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

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

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

Cervical spine injury II. 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. Face. Hair 2. Sports 3. Falls 4. Motor vehicle crashes 2. Blunt trauma C. Skull E. Associated Injuries 1. Bones 1. Mandible 6. Trauma Head. Incidence 1. Nasal 2. Facial. Zygoma/Zygomatic arch 3. Scalp 1. Subcutaneous tissue 3. Face. Introduction A. Mechanisms of Head. Nerves D. Face injury 3. Neck. Neck injury B. Morbidity and Mortality D. Penetrating trauma 5. Orbital 4. Muscle Page 147 of 212 . Maxilla 5. and Neck (Non-Spine) Injury 1. Veins C. Head/scalp 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. Airway compromise 2. and Neck A. Review of Anatomy and Physiology of the Head. Arteries B.

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

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

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

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

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

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

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

Pia mater 3. Types of Skull Fractures 1. Cerebral spinal fluid D. Compressed Page 155 of 212 . Cerebellum – center for equilibrium and coordination 8. Spine 1. Spinous process 2. Anatomy and Physiology of the Brain and Spine A. Gray matter – composed of nerve cells 4. Dura mater b. with four lobes 7. White matter – covered nerve pathways that conduct messages of the brain 5. Skull 2. Basal 2. Morbidity B. Cervical 3. nerve function transmissions 6. Brain stem – center for involuntary functions. Spinal Cord C. Cerebrum – main part of brain. Brain 1. Meninges – coverings of the brain 9. divided into two hemispheres. Incidence A. respiratory and heart rate. Spinal Fluid B. Thoracic 4. temperature regulation. 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. Lumbar 5. Arachnoid mater 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. Mortality II. Meninges a.

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

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

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

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

High risk of fetal death 3. Special Anatomy. Vaginal bleeding often present 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 . Decreased gastrointestinal motility increases risk of vomiting and aspiration after trauma C. Unique Assessment Considerations for Pregnant Patients Involved in Trauma 1. Shock in a third trimester patient may be difficult to detect d. Mother i. Mechanism of injury a. Two patients to consider a. Increase in maternal heart rate in third trimester c. Fetal injury from penetrating trauma 4. Third trimester fetus size can affect venous return in patients lying flat on their backs e. Fetal distress due to hypoxia or hypovolemia/shock 2. 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. Susceptible to falls and physical abuse 2. 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. and Pathophysiology Considerations 1. Cardiac arrest due to trauma D. Separation of the placenta from the uterine wall a. Abdominal pain b. Cardiovascular a. Seat belts 5. Special Unique Considerations for Pregnant Patient Involved in Trauma 1. Increase to total vascular volume b. Physiology. Trauma in Pregnancy A. Fetal considerations – trauma to an expectant mother can have effects on fetal health B.

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

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

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

Oxygen saturation may be difficult to obtain if patient is cold Page 164 of 212 . Breathing a. ventilation. Prolonged hypoxia causes death of brain tissue D. Submersion in very cold water can produce cardiac disturbances 6. Duration under water effects outcome 5. Little difference in patient lungs regardless of what type of water submersion occurred 2. Drowning 1. Agonal breaths if prolonged submersion c. Submersion Incidents A. Hypoxia from submersion is major factor in death 7. Airway. Airway – obstructed with water immediately after rescue 2. Skin is cyanotic c. Definition 2. Submersion in cold water results in better survival than warm water 3. Fresh water 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. Unique Signs and Symptoms 1. Respiratory arrest if very prolonged submersion 3. 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. Age is a factor due to cardiovascular health 4. May be in cardiac arrest b. Assessment Considerations 1. May be coughing if early rescue b. Types 1. Incidence 3. and oxygenation a. Circulation a. Salt water C. Pathophysiology 1. Predictors of morbidity and mortality B. Skin may be cold E. Diving in shallow water can cause spinal trauma 8.

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

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

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

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

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

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. car with object ii. rear impacts iii. 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. frontal impacts ii. Kinematics of Trauma A. patient with part of car iii. Looking at a trauma scene and attempting to predict what injuries might have resulted based on an evaluation of the motion involved 2. fragmentation iv. rollovers 4. Definition 1. velocity of weapon b. Unbelted drivers and front seat passengers suffer multi-system trauma due to multiple collisions of the body and organs c. Kinetic energy – function of weight of an item and its speed – speed is the most import variable 3. Penetrating Trauma a. Deceleration Injuries 5. distance from shooter ii. low energy (stabbings) ii. high energy (military weapons) Page 170 of 212 . Energy levels have effect i. size of bullet iii. some rifles) iii. cavitation v. Objects collide during crashes i. side impacts iv. Damage is influenced by i. rotational impacts v. Direction of the force has impact on type of injury i. Blunt trauma a. medium energy (handguns. organs collide inside body b.

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

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

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

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

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

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

aging and assessment findings to provide basic emergency care and transportation for a patient with special needs. development. Initial Care of the Neonate A. Assessment Page 177 of 212 . Respiratory adaptations 2. Temperature regulation B. Dry 3. Special Patient Populations Neonatal Care EMT Education Standard Applies a fundamental knowledge of growth. Stimulation C. Routine care 1. Cardiovascular adaptations 3. Support 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. Position 5. Physiologic Response to Birth 1. Warm 4. Airway 6.

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

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

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

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

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

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

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. stridor. or other primary CNS abnormality e) stable patient Page 184 of 212 .. nasal flaring) c) Circulation to the skin i) pallor ii) mottling iii) cyanosis iii.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. Patient assessment a.2. or indifferent? ii. drug paraphernalia. etc. Observe and note parents’/guardians’/caregivers’ interactions with the child i. tripoding) iii) retractions (i. Pediatric assessment triangle i. medicine bottles. grunting) ii) abnormal positioning (i.e. Evaluate the scene for clues related to the chief complaint i. chest wall. general a) Provides a 15. angry.. does the child seem comforted by them or scared by them? 3. note position and location in which patient is found c. wheeze. Evaluate the scene for safety threats to patient and health care providers b. ii.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. Scene survey a. chemicals. just looking and listening ii.e. are they appropriately concerned. ingestion.. child abuse: injury must be consistent with history given and physical/developmental capabilities of the patient iii. alcohol. ingestions or toxic exposures: pills.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

FEMA IS-700: NIMS. or equivalent 2. ICS-100: Introduction to ICS. 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. I. Entry-Level Students Need to Be Certified in 1. Establish and Work Within the Incident Management System A. This Can Be Done as a Co requisite or Prerequisite or as Part of the Entry-Level Course Page 202 of 212 . EMS Operations Incident Management EMT Education Standard Knowledge of operational roles and responsibilities to ensure patient. and personnel safety. An Introduction B. public.

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

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

Landing Zone Selection and Preparation F. Disadvantages 1. Approaching the aircraft c. Patient preparation 3. EMS Operations Air Medical EMT Education Standard Knowledge of operational roles and responsibilities to ensure patient. Safe Air Medical Operations A. Interacting with flight personnel 2. Rotorcraft 2. Communication Issues Page 205 of 212 . Securing loose objects b. Patient Transfer 1. Cost D. 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. Airspeed limitations 4. 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. Weather/environmental 2. Aircraft cabin size 5. Altitude limitations 3. Fixed wing B. I. Types 1. Approaching the Aircraft G. Helicopter hospital helipads C. and personnel safety. public. Specialized care – skills. Landing zone E. supplies. Scene safety a. Rapid transport 3. equipment 2. Access to remote areas 4. Advantages 1.

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

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

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

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

public. I. 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. EMS Operations Hazardous Materials Awareness EMT Education Standard Knowledge of operational roles and responsibilities to ensure patient. Entry-Level Students Need to Be Certified in: Hazardous Waste Operations and Emergency Response (HAZWOPER) standard. This Can Be Done as a Co requisite or Prerequisite or as Part of the Entry-Level Course Page 210 of 212 . 29 CFR 1910. Risks and Responsibilities of Operating in a Cold Zone at a Hazardous Material or Other Special Incident A. and personnel safety.

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

Evaluate need for additional resources 6. chemical. Initially distance from scene and approach when safe c. Determine number of patients (implement local multiple-casualty incident (MCI) protocols as necessary) 5. Outward signs and protective actions of biological. Safe use of an auto injector for self and peers b. Outward signs of a weapons of mass destruction (WMD) incident c. Initiate or expand incident command system as needed f. Care of emergency responders on scene a. Safe disposal of auto injector devices after activation Page 212 of 212 . Communicate with law enforcement at the scene of an armed attack e. All hazards safety approach b. Outward signs and characteristics of terrorist incidents b. 360-degree assessment and scene size-up a. incendiary. Ongoing scene assessment for potential secondary events d. Escape plan and a mobilization point at a terrorist incident 7.3. EMS operations during terrorist. nuclear. weapons of mass destruction. disaster events a. Perimeter use to protect rescuers and public from injury g. and explosive (B-NICE) weapons 4.

DOT HS 811 077C January 2009 .

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