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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

extremities move equally when infant is stimulated b. Growth and development in infants a. Protest b. two months a) tracks objects with eyes b) recognizes familiar faces ii. di) iii. ma. Situational crisis – parental separation reactions a. toddlers—80 to 130 beats per minute ii.6 degrees Fahrenheit Page 35 of 212 . Reflexes c. Movements i. anterior fontanelle closes between 9 and 18 months iii.g. coordinated suck and gag ii. Systolic blood pressure i. Physiological 1. Basic cry b. mu. 12 months a) walks with help b) knows own name B. Crying a. posterior fontanelle closes at three months ii. Heart rate i. toddlers—20 to 30 breaths per minute ii. preschoolers—80 to 110 mmHg d. Respiratory rate i. Nervous system a. Anger cry c. Immune system a. preschoolers—80 to 120 beats per minute b. Fontanelles i. Vital signs a. Temperature—96. Toddler (12 to 36 Months) and Preschool Age (3 to 5) A. six months a) sits upright in a highchair b) makes one syllable sounds (e. strong. Withdrawal II. Rapid changes over first year i. well flexed extremities iii.. Pain cry 2. 4. preschoolers—20 to 30 breaths per minute c. toddlers—70 to 100 mmHg ii. Based on maternal antibodies 5. fontanelles may provide an indirect estimate of hydration 6.8 to 99. Passive immunity retained through the first six months of life b. da. Despair c. Psychosocial development 1.

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

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

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

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

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

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

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

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

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

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

Aspirin 2. interactions. and any specific administration considerations. Individual training programs have the authority to add any medication used locally by EMTs. Pharmacology Emergency Medications EMT Education Standard Applies fundamental knowledge of the medications that the EMT may assist/administer to a patient during an emergency. complications. dose. Specific Medications A. EMT – Assisted Medications 1. Oxygen B. indications. 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. contraindications. routes of administration. I. Inhaled bronchodilators 2. Epinephrine 3. Oral glucose 3. Nitroglycerin Page 46 of 212 . mechanism of action. EMT – Administer Medications 1. side effects. for all of the following emergency medications.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

reassessment) to guide emergency management. primary and secondary assessment. the human body will either attempt to move away from the stimulus or will attempt to move the stimulus away from the body b) acceptable stimuli i) pinch the patient’s ear Page 63 of 212 . Initial General Impression – Based on the Patient’s Age-Appropriate Appearance 1. Appears unstable B. EMT should explain that he or she is there to help 2. patient history. Primary Survey/Primary Assessment A. Patient response a. patient responds only when the EMT applies some form of irritating stimulus a) when an irritating stimulus is encountered. Level of Consciousness 1. Appears stable 2. Patient Assessment Primary Assessment EMT Education Standard Applies scene information and patient assessment findings (scene size-up. 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. Responds to painful stimuli 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. the patient acknowledges the presence of the EMT b. While approaching the patient or immediately upon patient contact attempt to establish level of consciousness a. Responds to verbal stimuli i. Appears stable but potentially unstable 3. Speak to the patient and determine the level of response b. the patient appears to be awake ii. the patient responds appropriately to a simple command c. EMT should identify himself or herself c. Alert i.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Standard Precautions B. Environment 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. Unresponsive patient a. Pill containers b. Biases 2. Verbal or non-verbal 3. Helps to ensure the proper care will be provided for the patient 2. Distracting Injuries G. General Impression D. Assessment Factors A. Scene Size-Up C. Chief Complaint 1. Scene Safety B. Requires a balance of knowledge and skill to obtain a thorough and accurate history c. Importance of a Thorough History a. Major Components of the Patient assessment A. Medical jewelry Page 80 of 212 . EMT Attitude 1. 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. Primary reason for EMS response 2. Labeling II. Primary component of the overall assessment of the medical patient b. Life-Threatening Conditions E. Initial Assessment E. Possibly misleading D. Non-Life Threatening Conditions F. SAMPLE History 1. Tunnel Vision H. Patient Cooperation I.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Landing Zone Selection and Preparation F. Communication Issues Page 205 of 212 . Helicopter hospital helipads C. Patient Transfer 1. Altitude limitations 3. Patient preparation 3. Fixed wing B. and personnel safety. Approaching the aircraft c. Approaching the Aircraft G. EMS Operations Air Medical EMT Education Standard Knowledge of operational roles and responsibilities to ensure patient. Rapid transport 3. Securing loose objects b. public. Specialized care – skills. Types 1. Terrain 6. Interacting with flight personnel 2. Weather/environmental 2. I. Cost D. Advantages 1. 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. Access to remote areas 4. Scene safety a. Safe Air Medical Operations A. Aircraft cabin size 5. Landing zone E. Airspeed limitations 4. Rotorcraft 2. Disadvantages 1. 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. supplies. equipment 2.

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

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

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

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

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

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

Communicate with law enforcement at the scene of an armed attack e. disaster events a. 360-degree assessment and scene size-up a. Outward signs and characteristics of terrorist incidents b. Safe disposal of auto injector devices after activation Page 212 of 212 . nuclear. Outward signs of a weapons of mass destruction (WMD) incident c. All hazards safety approach b. Determine number of patients (implement local multiple-casualty incident (MCI) protocols as necessary) 5.3. Care of emergency responders on scene a. chemical. Outward signs and protective actions of biological. Escape plan and a mobilization point at a terrorist incident 7. incendiary. Perimeter use to protect rescuers and public from injury g. and explosive (B-NICE) weapons 4. weapons of mass destruction. Initiate or expand incident command system as needed f. Ongoing scene assessment for potential secondary events d. Evaluate need for additional resources 6. Initially distance from scene and approach when safe c. Safe use of an auto injector for self and peers b. EMS operations during terrorist.

DOT HS 811 077C January 2009 .

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