National Emergency Medical Services

Education Standards
Emergency Medical Technician Instructional Guidelines

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

shorter. increasing to 10-15 ml/kg by 1 year c. Vital signs a.average systolic blood pressure increases from 70 at birth to 90 at 1 year d. Heart rate i. Airways. Blood pressure -. less stable. and fluid loss Page 34 of 212 . more easily obstructed b. Normally drops 5 to 10 percent in the first week of life c. Infancy (Birth to 1 Year) A. Diaphragmatic breathing h. Temperature ranges -. dropping to 30-40 after first few minutes of life iii. Physiology 1.98 to 100 degrees Fahrenheit is the thermoneutral range 2. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level. Weight a. Chest wall less rigid g. narrower. PLUS the following material: I. Life Span Development EMT Education Standard Applies fundamental knowledge of life span development to patient assessment and management. Infants primarily nose breathers until four weeks c.0-3. Lung tissue is fragile and prone to trauma from pressure d. Pulmonary system a. Rapid respiratory rates lead to rapid heat. 100 to 160 beats per minute during first 30 minutes ii. susceptible to early fatigue f. slowing to 20-30 by one year iv. Fewer alveoli with decreased collateral ventilation e. initially 40-60 ii. tidal volume v.5 kg at birth b. 6-8 ml/kg initially vi. Normally 3. Infants head equal to 25 percent of the total body weight 3. Respiratory rate i. settling around 120 beats per minute b. Accessory muscles immature.

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

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

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

Affectionate love 3. Cancer strikes in this age group often 7. Approach problems more as challenges than threats 2.6 degrees Fahrenheit 2. Romantic love b. thickening ii. increased peripheral vascular resistance iii. Temperature—98. Physiological 1. Blood vessels i. Respiratory rate—average 16 to 20 breaths per minute c. This period is less associated with psychological problems related to well being VI. Psychological 1. Temperature—98. Vital signs a. Vital signs a. Weight control more difficult 8. Cholesterol levels increased 6. Cardiovascular function changes a. Vision changes 4. Cardiac output decreases throughout this period b. Life expectancy—average length based on year of birth 4. Cardiovascular health becomes a concern a. reduced blood flow to organs Page 38 of 212 . Life span—maximum approximately 120 years 3. Empty-nest syndrome 3. Love develops a. B. Body still functioning at high level with varying degrees of degradation 3. Blood pressure—depends on patient’s physical and health status d. Childbirth most common in this age group 4. Often burdened by financial commitments for elderly parents as well as young adult children VII. Menopause in women in late 40s early 50s B. Heart rate—average 70 beats per minute b. Blood pressure—average 120/80 mmHg d. Experience highest levels of job stress during this time 2. Physiological 1. Respiratory rate—depends on patient’s physical and health status c. Middle Adulthood (41 to 60 Years) A. Heart rate—depends on patient’s physical and health status b. Late Adulthood (61 Years and Older) A. Psychological 1. Hearing less effective 5.6 degrees Fahrenheit 2.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Page 102 of 212

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Page 121 of 212

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

and personnel safety. EMS Operations Hazardous Materials Awareness EMT Education Standard Knowledge of operational roles and responsibilities to ensure patient. public.120 (q)(6)(i) -First Responder Awareness Level B. 29 CFR 1910. Risks and Responsibilities of Operating in a Cold Zone at a Hazardous Material or Other Special Incident A. 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. I. 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.

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

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

DOT HS 811 077C January 2009 .