National Emergency Medical Services

Education Standards
Emergency Medical Technician Instructional Guidelines

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Vital signs a. Temperature ranges -. Infants head equal to 25 percent of the total body weight 3. increasing to 10-15 ml/kg by 1 year c. Life Span Development EMT Education Standard Applies fundamental knowledge of life span development to patient assessment and management. susceptible to early fatigue f. settling around 120 beats per minute b. tidal volume v. Diaphragmatic breathing h. narrower. slowing to 20-30 by one year iv. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level. Blood pressure -. Pulmonary system a. Normally 3.5 kg at birth b.0-3.average systolic blood pressure increases from 70 at birth to 90 at 1 year d. Weight a. Accessory muscles immature. Normally drops 5 to 10 percent in the first week of life c. Infants primarily nose breathers until four weeks c. Lung tissue is fragile and prone to trauma from pressure d. Airways. shorter. initially 40-60 ii. Chest wall less rigid g. PLUS the following material: I.98 to 100 degrees Fahrenheit is the thermoneutral range 2. more easily obstructed b. Rapid respiratory rates lead to rapid heat. Infancy (Birth to 1 Year) A. less stable. 100 to 160 beats per minute during first 30 minutes ii. Respiratory rate i. dropping to 30-40 after first few minutes of life iii. and fluid loss Page 34 of 212 . 6-8 ml/kg initially vi. Heart rate i. Fewer alveoli with decreased collateral ventilation e. Physiology 1.

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

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

Self-destructive behaviors begin i. Develop identity a. Family a.6 degrees Fahrenheit 2. Heart rate—55 to 105 beats per minute b. Secondary sexual development occurs d. Anti-social behavior peaks around eighth or ninth grade f. Vital signs a. Heart rate—average 70 beats per minute b. enlargement of the arms and legs follows iii. 1. Peer pressure increases c. Girls are mostly done growing by age 16.6 degrees Fahrenheit 2. Self-consciousness increases b. Most experience a rapid two. Temperature—98. Respiratory rate—12 to 20 breaths per minute c. Respiratory rate—average 16 to 20 breaths per minutes c. Early Adulthood (20 to 40 Years) A.to three-year growth spurt i. Endocrine changes e. Muscle mass and bone growth nearly complete B. Growth rate a. Blood pressure—average 120/80 mmHg d. Reproductive maturity f. alcohol iii. Want to be treated like adults e. begins distally with enlargement of feet and hands ii. boys are mostly done growing by age 18 c. Conflicts arise 2. Interest in the opposite sex increases d. Body image of great concern i. Peak physical conditioning between 19 and 26 years of age 3. All body systems at optimal performance 5. Blood pressure—100 to 120 mmHg d. Temperature—98. chest and trunk enlarge in final stage b. tobacco ii. Psychological 1. Accidents are a leading cause of death in this age group Page 37 of 212 . continual comparison amongst peers ii. eating disorders are common g. Adults develop lifelong habits and routines during this time 4. illicit drugs h. Vital signs a. Physiological 1. Depression and suicide more common than any other age group V.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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D. Cardiac Arrest

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

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

Page 103 of 212

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

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

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

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

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

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

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

Page 104 of 212

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

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

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

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

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

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

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

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

Swelling C. Management A. Pathophysiology A. Abnormal or Loss of Movement D.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. Anatomy and physiology review A. Bones B. Sensation Changes E. Consider Age-Related Variations A. Splinting C. Geriatric Page 113 of 212 . cancer or osteoporosis) III. Assessment A. Pediatric B. Airway. Ventilation. Deformity IV. Non-Traumatic Fractures (i. Circulatory Changes F. Communications and Documentation V. Pain or Tenderness B. Muscles II. and Circulation B. Medicine Non-Traumatic Musculoskeletal Disorders EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient. Transport Considerations D.

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

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

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

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

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

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

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

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

Page 121 of 212

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

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

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

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

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

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

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

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

Page 124 of 212

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

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

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

Page 125 of 212

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

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

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

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

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

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

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

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

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

Clavicle c. ileum ii. Scapula b. 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. Ulna f. Carpals g. Arterial 2. Incidence A. Morbidity/Mortality 1. Geriatric Considerations D. Direct force 2. Radius e. Mechanism of Injury 1. Upper extremity 2. Humerus d. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Indirect force 3. Extremity Structures 1. Phalanges i. Muscles 3. Skin Layers B. Metacarpals h. Anatomy A. Bony structure a. Pediatric Considerations C. Vascular structure a. Lower extremity B. Pelvis i. Venous b. Subcutaneous Layers C. ischium Page 135 of 212 . Twisting force II.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Page 197 of 212

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

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

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

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

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

Page 198 of 212

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

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

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

Page 199 of 212

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

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

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

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

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

Page 200 of 212

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

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

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

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

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

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

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

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

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

public. 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 . I. and personnel safety. EMS Operations Hazardous Materials Awareness EMT Education Standard Knowledge of operational roles and responsibilities to ensure patient.120 (q)(6)(i) -First Responder Awareness Level B. 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. 29 CFR 1910. Entry-Level Students Need to Be Certified in: Hazardous Waste Operations and Emergency Response (HAZWOPER) standard.

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

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

DOT HS 811 077C January 2009 .

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