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

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

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

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

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

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

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

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

Drop report/transfer report a. as appropriate e. EMT should keep a copy of this transfer report for use as a reference during the primary prehospital care report and should submit the copy with the final prehospital care report Page 12 of 212 . The standard for completing the form in an MCI is not the same as for a typical call 3. or to amplify and supplement primary report b. Used to document events that should be reported to local authorities. people. and facilities involved c. Goal should be to provide a report prior to departing from the hospital – needs to contain minimum data set and a transfer signature b. Information gathered from the prehospital care report can be used to analyze various aspects of the EMS system 5. b. and copies if appropriate. 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. Should be submitted in timely manner and should include the names of all agencies. Exposure g. be descriptive and don’t make conclusions d. This information can then be used to improve different components of the system and prevent problems from occurring 6. The EMT should keep a copy for his own records. Special situation reports a. Injury 4. The report. Should be accurate and objective.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Play a. physiologically capable by 12 to 15 months ii. Fine motor skills developing 5. Heart rate—70 to 110 beats per minute b. more susceptible to minor respiratory and gastrointestinal infections b. with continued refinement throughout childhood b. Musculoskeletal system a. Develop self-concept (i. Pulmonary system a. Develops separation anxiety—approximately 18 months 2. more interaction with adults and children a. Elimination patterns a. Terminal airways continue to branch b. Development allows effortless walking and other basic motor skills c. Systolic blood pressure—80 to 120 mmHg d. average age for completion – 28 months B. Bodily functions a. Understands cause and effect between 18-24 months c. Alveoli increase in number 3. develop self-esteem IV. Physiological Page 36 of 212 . Begin to display competitiveness III. begin comparing themselves with others b. Cognitive a. Brain 90 percent of adult brain weight b. Loss of primary teeth and replacement with permanent teeth begins B. Psychosocial 1. psychologically ready between 18 and 30 months iii.e. Basics of language mastered by approximately 36 months. Brain function increases in both hemispheres b. Bone density increases 6. School-Age Children (6 to 12 Years) A. Nervous system a. Adolescence (13 to18 Years) A. Respiratory rate—20 to 30 breaths per minutes c. Passive immunity lost. Temperature—98. 2. Able to play simple games and follow basic rules b. Psychosocial 1. Physiological 1. Toilet training i. Develops immunity to common pathogens as exposure occurs 4.6 degrees Fahrenheit 2. Immune system a. Muscle mass increases b. Vital signs a.

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

Cholesterol levels increased 6. Cancer strikes in this age group often 7. Affectionate love 3. Empty-nest syndrome 3. Psychological 1. Vital signs a. Psychological 1. Vital signs a. Respiratory rate—depends on patient’s physical and health status c. Blood vessels i. This period is less associated with psychological problems related to well being VI. reduced blood flow to organs Page 38 of 212 . Hearing less effective 5. Approach problems more as challenges than threats 2. Blood pressure—depends on patient’s physical and health status d. Blood pressure—average 120/80 mmHg d. Love develops a. Life expectancy—average length based on year of birth 4. increased peripheral vascular resistance iii. Physiological 1. Childbirth most common in this age group 4.6 degrees Fahrenheit 2.6 degrees Fahrenheit 2. thickening ii. Cardiovascular function changes a. Cardiovascular health becomes a concern a. B. Middle Adulthood (41 to 60 Years) A. Often burdened by financial commitments for elderly parents as well as young adult children VII. Temperature—98. Respiratory rate—average 16 to 20 breaths per minute c. Physiological 1. Late Adulthood (61 Years and Older) A. Weight control more difficult 8. Heart rate—depends on patient’s physical and health status b. Life span—maximum approximately 120 years 3. Body still functioning at high level with varying degrees of degradation 3. Cardiac output decreases throughout this period b. Romantic love b. Heart rate—average 70 beats per minute b. Experience highest levels of job stress during this time 2. Vision changes 4. Menopause in women in late 40s early 50s B. Temperature—98.

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

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

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

Forms of Medication 1. Medication safety II. Injection (e.g.. Enteral (ingested) b. Liquids a. Parenteral (injected) 3. Pharmacology Principles of Pharmacology EMT Education Standard Applies fundamental knowledge of the medications that the EMT may assist/administer to a patient during an emergency. aerosols – inhalation B. glucose) 2. Enteral (ingested) a. Parenteral (injected and inhaled) a.g. Pills b. Generic 2. Sublingual (e. Tablets – compressed powders c. Inhaled (e. oxygen) 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. Kinds of Medications Used in an Emergency A.g.g.. Drug Name 1. Basic Medication Terminology A. epinephrine) c. intravenous III. Oral (e. Methods of injection i. Trade Page 42 of 212 ... subcutaneous ii. Powder – inhalation 2. intramuscular iii. Solid a. Routes of Medication Administration 1. Gases. nitroglycerin) b.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Urinary Bladder F. Normal Findings—Soft Non-Tender C. Abnormal Findings 1. Excessive b. Nausea/vomiting a. Change in bowel habits/stool a. Inspection 2. Liver G. Dark tarry stool 3. Urination a. Palpation B. Techniques 1. Gall Bladder H. Reproductive Organs III. Medicine Abdominal and Gastrointestinal Disorders EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient. Kidney J. Frequency Page 87 of 212 . Intestines C. Constipation b. Diarrhea 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. Pancreas I. Esophagus D. Hematemesis 2. Pain b. Assessment and Symptoms A. Define Acute Abdomen II. Spleen E. Anatomy of the Organs of the Abdominopelvic Cavity A. Stomach B.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Page 101 of 212

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

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

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

Page 102 of 212

D. Cardiac Arrest

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

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

Page 103 of 212

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

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

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

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

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

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

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

Page 104 of 212

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

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

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

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

Gastrointestinal 5. Pathophysiology of Sickle Cell III. Skin 3. General Assessment 1. Blood-Forming Organs 1. Plasma C. Red blood cells 2. Cardiorespiratory 7. Oxygen 3. Red cell destruction II. Transport considerations 4. Pediatrics B. Skeletal 6. ventilation. Medicine Hematology EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient. Genitourinary B. Psychological/communication strategies IV. Sickle Cell Crisis A. Clotting Disorders V. Blood 1. Airway. General Management 1. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Red cell production 2. White blood cells 3. Geriatrics Page 109 of 212 . Consider Age-Related Variations A. Level of consciousness 2. Anatomy and Physiology A. and circulation 2. Visual disturbances 4. Platelets 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. Anatomy and Physiology of Renal System II. Fistula 3. Urinary Catheter Management Page 110 of 212 . Pathophysiology A. Dialysis A. Kidney Failure B. Hypotension 2. Special Considerations for Hemodialysis Patients 1. Hemodialysis 1. Complications/Adverse Effects of Dialysis 1. Medicine Genitourinary/Renal EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient. Missed Dialysis Treatment 1. Nausea/vomiting 4. Graft B. Peritoneal Dialysis C. Weakness 2. Shunt 2. Obtaining B/P D. Pulmonary edema IV. Support Ventilation B. Muscle cramps 3. Management for a Patient With a Dialysis Emergency A. Stop Bleeding From Shunt as Needed C. Kidney Stones III. Position—Flat If Shocky. ABCs. Infection at access site E. Hemorrhage especially from access site 5. Upright If Pulmonary Edema V.

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

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

Geriatric Page 113 of 212 . EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. and Circulation B. Consider Age-Related Variations A. Ventilation. Pathophysiology A. Transport Considerations D. Communications and Documentation V. Bones B. Sensation Changes E. Non-Traumatic Fractures (i. Circulatory Changes F. cancer or osteoporosis) III. Abnormal or Loss of Movement D. Assessment A. Anatomy and physiology review A. 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. Deformity IV. Airway. Swelling C. Pediatric B. Pain or Tenderness B.e. Management A. Splinting C. Muscles II.

Vomits swallowed blood 4. Can block airway if patient is unresponsive C. Trauma 2. General Assessment Findings and Symptoms 1. Nose. 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. Tell patient not to sniffle or blow nose Page 114 of 212 . Bleeding from nose 3. Dryness b. Causes 1. Medicine Diseases of the Eyes. Ears. High blood pressure B. EMT-Level Instructional Guideline I. Sit patient up and lean forward 2. Techniques to Stop Bleeding in Conscious Patient If No Risk of Spine Injury 1. Pain or tenderness 2. Pinch the nostrils together firmly 3. Medical a.

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

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

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

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

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

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

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

Page 121 of 212

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Carpals g. EMT-Level Instructional Guideline The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: I. Incidence A. Ulna f. Morbidity/Mortality 1. Humerus d. Twisting force II. Metacarpals h. Muscles 3. ileum ii. Anatomy A. Phalanges i. Mechanism of Injury 1. Arterial 2. Lower extremity B. Indirect force 3. Geriatric Considerations D. Trauma Orthopedic Trauma EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely injured patient. Pelvis i. Upper extremity 2. Radius e. Pediatric Considerations C. Direct force 2. Scapula b. Extremity Structures 1. Clavicle c. Skin Layers B. Bony structure a. ischium Page 135 of 212 . Subcutaneous Layers C. Vascular structure a. Venous b.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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 . 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. I. ICS-100: Introduction to ICS. EMS Operations Incident Management EMT Education Standard Knowledge of operational roles and responsibilities to ensure patient. or equivalent 2. public. An Introduction B. Entry-Level Students Need to Be Certified in 1. FEMA IS-700: NIMS.

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

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

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

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

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

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

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

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

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

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

DOT HS 811 077C January 2009 .

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