National Emergency Medical Services

Education Standards
Emergency Medical Technician Instructional Guidelines

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Blood vessels i. Vision changes 4. Vital signs a. Respiratory rate—depends on patient’s physical and health status c. Psychological 1. Blood pressure—average 120/80 mmHg d. Temperature—98. Affectionate love 3. Physiological 1. thickening ii. Cholesterol levels increased 6. Late Adulthood (61 Years and Older) A. Physiological 1. Heart rate—depends on patient’s physical and health status b. Childbirth most common in this age group 4. Heart rate—average 70 beats per minute b. Body still functioning at high level with varying degrees of degradation 3. Vital signs a. Cardiac output decreases throughout this period b. Romantic love b. Respiratory rate—average 16 to 20 breaths per minute c. B. Cardiovascular health becomes a concern a.6 degrees Fahrenheit 2. Blood pressure—depends on patient’s physical and health status d. Approach problems more as challenges than threats 2. Middle Adulthood (41 to 60 Years) A. Hearing less effective 5. Often burdened by financial commitments for elderly parents as well as young adult children VII. Menopause in women in late 40s early 50s B. Experience highest levels of job stress during this time 2. Life span—maximum approximately 120 years 3. Cardiovascular function changes a. Psychological 1. Love develops a. This period is less associated with psychological problems related to well being VI. increased peripheral vascular resistance iii. Weight control more difficult 8.6 degrees Fahrenheit 2. reduced blood flow to organs Page 38 of 212 . Life expectancy—average length based on year of birth 4. Empty-nest syndrome 3. Cancer strikes in this age group often 7. Temperature—98.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Page 101 of 212

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

V. Management (refer to the current American Heart Association guidelines)
A. Place in proper position
B. Evaluation and appropriate management of ventilations/respirations
1. Oxygen saturation evaluation
2. pulse oximetry
C. May be unreliable in cardiac arrest, toxic inhalation
1. Appropriate management of any related ventilatory/respiratory
a. BVM assistance
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
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
1. Diabetes
2. Asthma

Page 103 of 212

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

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

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

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

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

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

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

Page 104 of 212

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Page 121 of 212

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Fetal distress due to hypoxia or hypovolemia/shock 2. and Pathophysiology Considerations 1. Unique Assessment Considerations for Pregnant Patients Involved in Trauma 1. High risk of fetal death 3. Fetal injury from penetrating trauma 4. Mother i. Trauma Special Considerations in Trauma EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely injured patient. Vaginal bleeding often present c. 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. Abdominal pain b. Cardiac arrest due to trauma D. Seat belts 5. Pregnant patients can sustain all types of trauma b. 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. Susceptible to falls and physical abuse 2. Third trimester fetus size can affect venous return in patients lying flat on their backs e. Cardiovascular a. Shock in a third trimester patient may be difficult to detect d. Decreased gastrointestinal motility increases risk of vomiting and aspiration after trauma C. Physiology. Special Anatomy. Special Unique Considerations for Pregnant Patient Involved in Trauma 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. Increase to total vascular volume b. Two patients to consider a. Trauma in Pregnancy A. Increase in maternal heart rate in third trimester c. Mechanism of injury a.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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
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

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

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

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

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

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

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

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

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

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

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

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

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

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

DOT HS 811 077C January 2009 .

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