National Emergency Medical Services

Education Standards
Emergency Medical Technician Instructional Guidelines

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Prefixes B. Standard Medical Abbreviations and Acronyms Page 29 of 212 . Associated With Body Direction or Position III. Combining Forms II. Medical Terminology 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. Suffixes D. Associated With Body Systems C. Medical Terminology EMT Education Standard Uses foundational anatomical and medical terms and abbreviations in written and oral communication with colleagues and other health care professionals. Root Words C. Medical Terms A. Associated With Body Structure B.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Action – medication administered 3. Reassessment 1. Data – indications for medication 2. 4. Disadvantages c. Advantages b. Response – effect of medication E. Documentation Page 45 of 212 . Techniques D. Inhalation 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: The EMT must know the names. Oxygen B. EMT – Administer Medications 1. EMT – Assisted Medications 1. Pharmacology Emergency Medications EMT Education Standard Applies fundamental knowledge of the medications that the EMT may assist/administer to a patient during an emergency. Individual training programs have the authority to add any medication used locally by EMTs. contraindications. Inhaled bronchodilators 2. routes of administration. Aspirin 2. indications. dose. complications. for all of the following emergency medications. Nitroglycerin Page 46 of 212 . Specific Medications A. side effects. interactions. and any specific administration considerations. I. Oral glucose 3. Epinephrine 3. mechanism of action.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Other Monitoring Devices A.III. State regulatory processes may elect to expand. or modify the monitor devices in this section Page 77 of 212 . As Additional Monitoring Devices Become Recognized as the “Standard of Care” in the Out-of-Hospital Setting. delete. Those Devices Should Be Incorporated Into the Primary Education of Those Who Will Be Expected to Use Them in Practice 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. A Reassessment Includes: A. Patient Assessment Reassessment EMT Education Standard Applies scene information and patient assessment findings (scene size-up. Chief Complaint D. Monitor the patient’s condition B. Circulation – Reassess the Adequacy of Circulation by Checking Both Central and Peripheral Pulses Page 78 of 212 . Vital Signs C. Identify and Treat Changes in the Patient’s Condition in a Timely Manner A. or as Often as Practical Depending on the Patient’s Condition B. Stable Patients – At Least Every 15 Minutes or as Deemed Appropriate by the Patient’s Condition IV. Identify trends in the patients vital signs III. Breathing – Reassess the Adequacy of Breathing by Monitoring Both Breathing Rate and Tidal Volume D. Airway – Recheck the Airway for Patency C. Level of Consciousness – Is the Patient Maintaining the Same Level of Responsiveness or Becoming More/Less Alert? B. Compare to the Baseline Status of That Component A. Primary Assessment B. patient history. Monitor the effectiveness of interventions C. reassessment) to guide emergency management. primary and secondary assessment. How and When to Reassess II. Reassessments Should Be Performed at Regular Intervals A. Interventions V. Unstable Patients – Every Five Minutes.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Page 101 of 212

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

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

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

Page 102 of 212

D. Cardiac Arrest

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

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

Page 103 of 212

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

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

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

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

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

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

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

Page 104 of 212

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

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

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

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

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

Position—Flat If Shocky. Shunt 2. Fistula 3. Anatomy and Physiology of Renal System II. Dialysis A. Nausea/vomiting 4. Kidney Failure B. Graft B. Kidney Stones III. ABCs. Hemorrhage especially from access site 5. Missed Dialysis Treatment 1. Obtaining B/P D. Support Ventilation B. Pulmonary edema IV. Upright If Pulmonary Edema V. Peritoneal Dialysis C. Pathophysiology 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. Special Considerations for Hemodialysis Patients 1. Hemodialysis 1. Medicine Genitourinary/Renal EMT Education Standard Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient. Urinary Catheter Management Page 110 of 212 . Infection at access site E. Hypotension 2. Muscle cramps 3. Complications/Adverse Effects of Dialysis 1. Stop Bleeding From Shunt as Needed C. Weakness 2. Management for a Patient With a Dialysis Emergency A.

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

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

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

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

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

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

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

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

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

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

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

Page 121 of 212

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Page 197 of 212

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

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

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

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

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

Page 198 of 212

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

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

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

Page 199 of 212

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

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

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

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

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

Page 200 of 212

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

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

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

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

Communication Issues Page 205 of 212 . Landing Zone Selection and Preparation F. Approaching the Aircraft G. Patient Transfer 1. Cost D. Helicopter hospital helipads C. Fixed wing B. equipment 2. and personnel safety. Access to remote areas 4. Aircraft cabin size 5. Scene safety a. Landing zone E. Safe Air Medical Operations A. Airspeed limitations 4. Patient preparation 3. Advantages 1. Securing loose objects b. I. Approaching the aircraft c. Altitude limitations 3. Disadvantages 1. Rapid transport 3. Rotorcraft 2. EMT-Level Instructional Guideline The intent of this section is to give an overview of operating safely in and around a landing zone during air medical operations and transport. Types 1. Specialized care – skills. Interacting with flight personnel 2. Information related to the clinical management of the patients during air medical operations is found in the clinical sections of the National EMS Education Standards and Instructional Guidelines for each personnel level. Terrain 6. EMS Operations Air Medical EMT Education Standard Knowledge of operational roles and responsibilities to ensure patient. Weather/environmental 2. supplies. public.

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

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

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

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

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

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

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

DOT HS 811 077C January 2009 .

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