Emergency Medical Care Libro CAp 1

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Introduction to Emergency
1 Medical Care
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning,

C HAPTE LLC N E
R OUTLI © Jones & Bartlett Learning, LLC
The Emergency Medical Services System and the EMT
Overview of the Emergency Medical Services System
The Healthcare System
Roles and Responsibilities© of
Jones & Bartlett Learning, LLC
the EMT
Professional Attributes of the EMT
Quality Improvement
Medical Direction
1
© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.
2 Chapter 1 Introduction to Emergency Medical Care
Scenario The origins of EMS date back to antiquity, as in the story of

© Jones & Bartlett Learning, LLC © Jones
the “Good& Samaritan.”
Bartlett Learning, LLC
The response to another human in need
It is your first day as an emergency medical technician (EMT), and NOT is FOR SALE OR DISTRIBUTION
the driving force for the EMSS and for all individuals who
you respond to a call to aid a victim in a motor vehicle crash. On ar- participate when called to aid someone in distress.
rival at the scene, you find police directing traffic, making the scene
safe. Fire department rescue personnel are removing the driver’s Battlefields as Laboratory
side door to gain access to the patient, and a trained first responder The growth and development of EMS has occurred primarily
is in the vehicle stabilizing the©victim’s
Jones & Bartlett Learning,over
head to prevent further spi- LLCthe past 50 years. Although ©much
Jones & Bartlett
of this growth hasLearning,
re- LLC
nal injury. You enter the vehicleNOT FOR SALE OR DISTRIBUTION
and perform your initial assess- sulted from increased knowledgeNOT FOR SALE OR DISTRIBUTION
and technological advances,
ment. The patient is complaining of pain in the neck and abdomen the value of a coordinated response to expected injury was first
and is breathing rapidly, and you note the skin is pale and sweaty. identified, ironically, on the battlefields. Ambulances were de-
You work with the firefighters to remove the patient from the vehi- ployed during the Napoleonic Wars, when a French Army sur-
cle, continue your assessment and treatment, and begin transport. geon, Baron Dominique-Jean Larrey, introduced his ambulance
You notify © theJones & Bartlett Learning, LLC
local trauma center of the patient’s condition and © Jones
volantes, a French & Bartlett
term meaning “flying fiLearning, LLC
eld hospital.” Patients
approximate NOT FOR SALE OR DISTRIBUTION
time of arrival. were delivered NOT FOR SALE OR DISTRIBUTION
by ambulances to fi eld hospitals, where surgeons
On arrival at the emergency department, the trauma team is wait- would tend to their wounds. Before this time, soldiers often
ing and continues care. Before you leave, the trauma surgeon tells you were left to die on the field of battle (Table 1-1).
he suspects the patient has a neck fracture and a ruptured spleen. In the United States, horse-drawn ambulances were intro-
duced during the Civil War, under the direction of Dr. Jonathan
© Jones & Bartlett Learning, LLC © Jones & (Bartlett
Letterman Figure 1-1).Learning, LLC
NOT FOR SALEOBJECTIVE
LEARNING OR DISTRIBUTION NOT FOR SALE
Emergency OR DISTRIBUTION
treatment applied in the field of battle included
traction splinting of fractured femurs. Originally developed by
• Define emergency medical services (EMS) system.
the orthopedic surgeon Hugh Owen Thomas (1834-1891) in
Liverpool, the “Thomas splint” decreased the mortality of com-
pound fractures of the femur from 80% in 1916 to less than 8%
The Emergency Medical © Jones Services
& BartlettSystem
Learning,inLLC © Jones
1918. The traction splint is still applied to& fractures
BartlettofLearning,
the LLC
and the EMT NOT FOR SALE OR DISTRIBUTION femur. NOT FOR SALE OR DISTRIBUTION
During the Korean War in the 1950s, helicopters were used
An emergency is an unforeseen combination of circumstances to evacuate wounded soldiers to mobile army surgical hospi-
or the resulting state that calls for immediate action. The term tals (MASH units), where, if necessary, immediate lifesaving
medical means relating to or concerned with the practice of surgery was performed before transfer to more permanent
medicine.©Service
Jones &toBartlett
refers Learning,
the occupation LLCof serv- care units. The©Vietnam
or function Jones War & Bartlett
experienceLearning, LLC
reinforced the value
ing, or a contribution to the welfare of others. Finally, system of rapid NOT FOR SALE OR DISTRIBUTION
transport and early surgery for trauma victims. The
refers to a regular interaction or interdependent group of items death rates of battle casualties who reached a hospital decreased
forming a unified whole. An emergency medical services system from 8% in World War I, to 4.5% in Korea, to less than 2% in
(EMSS) is the planned configuration of community resources Vietnam.
and personnel necessary to provide immediate medical care to The medical and transport strategies developed during war
patients with sudden or unexpected illness or injury. An EMSS © Jones
also & as
served Bartlett Learning,
a model for LLC life. Physicians who
change in civilian
can be local, regional,
NOT FOR SALE OR DISTRIBUTION or statewide. worked as surgeons in
NOT FOR SALE OR DISTRIBUTION Korea and Vietnam came to appreciate
The key word in this definition is “service.” By becoming the value of early field care and transport. When they returned
an emergency medical technician (EMT), you have decided home, they were keenly aware that some victims who died from
to serve a community. Indeed, you will help a wide variety motor vehicle crashes might have been saved if they had the
of people in need of care. Some patients, such as victims of same care as was provided during their wartime experience.
sudden cardiac death, will©depend Jones & Bartlett Learning,This
on you to literally save LLC revelation led many physicians© Jones & Bartlett
to become Learning, LLC
the “champi-
their lives. Others will rely on your support and
NOT FOR SALE OR DISTRIBUTION care for ons” of civilian EMSS development.
what may seem a relatively minor complaint to you but that
has caused them to become a patient in need. In either case, Civilian Evolution
you are playing a critical role in the healthcare system. You The civilian evolution of EMS varied greatly from region to
will often be the first medical provider to see and care for region. In rural areas, undertakers had routinely transported
the patient. © Jones
victims of “accidents” & Bartlett
because Learning,
their vehicles were wellLLC
suited
Historical NOT FOR SALE OR DISTRIBUTION

Perspective
to transport NOT FOR SALE OR DISTRIBUTION
people on their back. In many communities, fire
departments and volunteer ambulance companies, who still
Emergency medical services (EMS) is a relatively new and ex- provide EMS coverage for many rural populations today, re-
citing field that is still evolving. In the 1950s, EMS was little placed undertakers. In urban areas, EMS was often provided by
more than first aid and often was provided by the local mor- paid services based at hospitals, fire departments, police depart-
tician and a hearse. Current systems link ambulances and © Jones
ments, or&independent
ambulance companies. Organized vol-
hospitals to optimize care for patients with many different NOT FOR SALE OR DISTRIBUTION
unteer EMS squads often provided the ambulance service for a
conditions. local community or supplemented service, even in urban areas,

http://evolve.elsevier.com/Henry/EPC 3
Table 1-1 Emergency Medical Services (EMS) Chronology

NOT FORYear
SALEEvent OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION
1797 Napoleon’s chief physician implements a “prehospital system” designed to triage and transport injured soldiers from the
battlefield to aid stations.
1860s Civilian ambulance services begin in Cincinnati and New York City.
1915 First known air© Jones
medical & Bartlett
transport Learning,
occurs during the retreatLLC ©
of the Serbian army from Albania. Jones & Bartlett Learning, LLC
1920s First volunteer NOT FOR organize
rescue squads SALE in
OR DISTRIBUTION
Roanoke, NOT
Virginia, and along the New Jersey coast. FOR SALE OR DISTRIBUTION
1958 Dr. Peter Safar demonstrates the efficacy of mouth-to-mouth ventilation.
1960 Cardiopulmonary resuscitation (CPR) is shown to be efficacious.
1966 National Academy of Sciences–National Research Council publishes Accidental Death and Disability: the Neglected Disease of
Modern Society.
1966 © Jones
Highway & Bartlett
Safety Learning,
Act of 1966 establishes LLC
the Emergency Medical Services© Jones
Program & U.S.
in the Bartlett Learning,
Department LLC
of Transportation.
1972 NOT
U.S.FOR SALE
Department OR DISTRIBUTION
of Health, Education and Welfare allocates $16 million NOT
to EMS FOR SALEprograms
demonstration OR DISTRIBUTION
in five states.
1973 Robert Wood Johnson Foundation appropriates $15 million to fund 44 EMS projects in 32 states and Puerto Rico.
1973 Emergency Medical Services Systems (EMSS) Act provides additional federal guidelines and funding for the development of
regional EMS systems; the law establishes 15 components of EMS systems.
1981 Omnibus Budget Reconciliation Act consolidates EMS funding into state preventive health and health services block grants and
© Jones & Bartlett Learning,
eliminates fundingLLC
under the EMSS Act. © Jones & Bartlett Learning, LLC
NOT FOR1984
SALEEMS
ORforDISTRIBUTION
Children program, under the Public Health Act, NOT
providesFOR SALE
funds for ORtheDISTRIBUTION
enhancing EMS system to better serve pediatric patients.
1985 National Research Council publishes Injury in America: a Continuing Public Health Problem, describing deficiencies in the
progress of addressing the problem of accidental death and disability.
1988 National Highway Traffic Safety Administration (NHTSA) initiates the Statewide EMS Technical Assessment program based on 10
key components of EMS systems.
1990
Trauma Care Systems and Development Act encourages development of inclusive trauma systems and provides funding to
NOTsystem
states for trauma FORplanning,
SALEimplementation,
OR DISTRIBUTIONand evaluation. NOT FOR SALE OR DISTRIBUTION
1993 Institute of Medicine publishes Emergency Medical Services for Children, which points out deficiencies in the U.S. healthcare
system’s ability to address the emergency medical needs of pediatric patients.
1995 U.S. Congress does not reauthorize funding under the Trauma Care Systems and Development Act.
Data from NHTSA; US Health and Human Services, Public Health Services, Health Resources and Services Administration, Maternal and Child Health Bureau: Emergency medical systems
education agenda for the future: a systems approach, Washington, DC, 2000, US Department of Transportation.
working alongside paid EMS providers. This practice continues
in many EMS systems today.
The first hospital-based ambulance services were at major ur-
© Jones & Bartlett
ban Learning,
hospitals, such as CincinnatiLLC © Jones & Bartlett Learning, LLC
General and Bellevue Hospitals
NOT FOR SALE OR DISTRIBUTION ambulances were placed
in the mid-1860s. The fi rst motorized NOT FOR SALE OR DISTRIBUTION
into service by Michael Reese Hospital of Chicago in 1899 and
St. Vincent’s Hospital in New York (Figure 1-2). As automotive
technology progressed, the style and capabilities changed ac-
cordingly (Figure 1-3). Many early ambulances were cramped
and provided little room © toJones & Bartlett
work during Learning,
transport. The intro- LLC © Jones & Bartlett Learning, LLC
duction of trucks and modifi ed vans in the 1960s
NOT FOR SALE OR DISTRIBUTION allowed EMS NOT FOR SALE OR DISTRIBUTION
providers to stand up inside the patient compartment. In 1972,
St. Anthony’s Hospital in Denver, Colorado, began Flight for
Life, which was the first private air ambulance. This offered a
faster mode of transport to specialized hospitals such as trauma
© Jones
centers. & BartlettareLearning,
Current ambulances “high-tech” LLC
mobile intensive Figure 1-1©AJones & Bartlett
horse-drawn ambulance.Learning, LLC
Courtesy Flushing Hospital,
care units capable of bringing advanced medical care to patients NOT
Flushing, New FOR SALE OR DISTRIBUTION
York.
in need. The patient care areas are spacious enough to accom-
modate several healthcare workers and equipment.
seventh leading cause of death in the United States. It is now
Trauma: a Force for Change in EMS the fifth leading cause of death, with motor vehicle crashes ac-
Preventable injury is the leading cause of death in © Jones
persons & Bartlett
counting Learning,
for approximately LLCfatalities.
half these
1 to 45 years of age. In civilian life the automobile has NOT FOR SALE OR DISTRIBUTION
caused a When the battle-experienced physicians and surgeons saw
powerful surge in deaths from trauma. In 1900, trauma was the that many of these patients could have been saved with earlier

Figure 1-3 An ambulance of the 1930s. Courtesy Flushing Hospital,
Figure 1-2 An early motorized ambulance. The early models Flushing, New York.
lacked the space and head clearance of modern ambulances.
Courtesy Flushing Hospital, Flushing, New York.
care, they helped focus national attention on the need for the (ECG) monitoring, defibrillation, intravenous (IV) therapy,
rapid prehospital intervention that had been successfully dem- administration of medications, insertion of endotracheal
onstrated on battlefields. Simple steps were recognized, includ- (ET) tubes, and other invasive medical skills. Dr. William
ing bleeding control at the scene, safe patient handling, spinal Grace at St. Vincent’s Hospital in New York City quickly
© Jones &toBartlett
immobilization, and rapid transportation organizedLearning,
trauma LLC this innovation so that©physicians,
adopted Jones &nurses, Bartlett Learning, LLC
and am-
centers. NOT FOR SALE OR DISTRIBUTION bulance personnel could NOT FOR SALE OR DISTRIBUTION
respond to cardiac emergencies in
In 1966 the U.S. National Academy of Sciences published the lower Manhattan.
landmark paper Accidental Death and Disability: the Neglected Until this point, only physicians were providing advanced
Disease of Modern Society, documenting that more Americans care in the prehospital setting. The introduction of biotelemetry
died from accidental injuries in 1965 than died on the battlefields (transmission of electrocardiogram [ECG] by radio) extended
in Vietnam.© Further,
Jonesif&seriously
Bartlett Learning,
wounded, a personLLC
would have prehospital care© byJones
allowing&EMSBartlett Learning,
providers LLC
to deliver advanced
a better chance of survival in a combat zone than on an average life support NOT FOR SALE OR DISTRIBUTION
under the direction of a physician at a base hospital.
city street. The newly created Department of Transportation As part of its role in studying cardiovascular emergencies and
(DOT) and National Highway Traffic Safety Administra- treatment, every 5 years the American Heart Association (AHA)
tion (NHTSA), a division of the DOT, were empowered with offers the Emergency Cardiovascular Care (ECC) guidelines,
regulating EMSS, offering $48 million in grants between 1966 adopted by most agencies as the standard of care.
and 1973. © Jones & Bartlett Learning, LLC
In 1973, federal The Physician and Emergency Medical Services
NOT FOR SALE OR legislation
DISTRIBUTIONprovided funding for the devel- NOT FOR SALE OR DISTRIBUTION
opment of EMS systems throughout the United States. After The physician’s role in the development of EMS systems
demonstrations of effective trauma systems in Illinois and has been extremely important. Medical societies such as the
Maryland, these grants accounted for the rapid growth of EMS American Academy of Orthopedic Surgeons and the Ameri-
systems across the country. Money was allocated for the devel- can College of Surgeons played a significant part in early
opment of training programs, © Jones & Bartlett Learning,EMSS
communication systems, hospi- LLCdevelopment. The DOT Bureau © Jones & Bartlett
of Traffi Learning, LLC
c Safety asked
tal designations, and other essential system components.
NOT FOR SALE OR DISTRIBUTION Many these physician groups to develop
NOT FOR SALEcurricu-
a standardized OR DISTRIBUTION
EMS systems developed as a direct result of this legislation and lum for ambulance personnel. Physicians still work closely
funding. with the EMS Division of NHTSA under DOT to ensure the
Medical knowledge and related technology were incorpo- continued development of national training curricula at all
rated into EMS care as new advances became available. For levels.
example, © in Jones & Bartlett Learning, LLC
the 1960s, cardiopulmonary resuscitation (CPR) © Jones
Physician groups such&asBartlett
the American Learning,
College ofLLCEmer-
using chestNOT FOR SALE OR DISTRIBUTION
compression and positive-pressure ventilation was gency NOT FOR SALE OR DISTRIBUTION
Physicians and the National Association of EMS
introduced, and portable defibrillators to resuscitate victims Physicians have joined their surgical colleagues and have
of cardiac arrest became available. Physicians brought resusci- an active leadership role in national EMSS development.
tation equipment into the field to reach their patients earlier, Physicians are the “medical conscience” of EMS. All levels
when they had a better chance of survival. of EMS provider function under the direction of a physician
The first advanced life support unit was introduced © Jones
advisor or& Bartlett Learning,
medical director. MedicalLLC directors work locally
in Belfast, Ireland, under the direction of Dr. Frank Pan- NOT FOR SALE OR DISTRIBUTIONpatient care, and
with services to establish protocols, monitor
tridge. Advanced life support included electrocardiographic provide continuing education.

Although physicians have functioned as prehospital pro-

© Jones & Bartlett
viders in someLearning, United States, their role as fi©
areas in the LLC Overview
eldJones & Bartlett of Learning,
the Emergency LLC Medical
providers has been
NOT FOR SALE OR DISTRIBUTION limited since the 1940s. For many NOT FOR
rea- Services
SALESystem
OR DISTRIBUTION
sons, including resource allocation and costs, nonphysicians
currently staff almost all ambulances in North America. In As described in the EMS Agenda for the Future, EMS systems
some countries, such as Russia, Norway, France, Brazil, and require many components to function effectively. Each compo-
Germany, physicians still routinely respond in ambulances or nent must be carefully designed and based on the needs of the
helicopters. © Jones & Bartlett Learning, LLC individual EMSS. © Jones & Bartlett Learning, LLC
The Future of EMSNOT FOR SALE OR DISTRIBUTION
Public Access NOT FOR SALE OR DISTRIBUTION
The EMS Agenda for the Future, developed in cooperation with Because an EMSS involves a large number of resources, some
several national organizations, provides recommendations to method of coordination and communication is essential. In
refine and continue development of EMS systems over the many areas, simple and convenient access has been accom-
© years,
coming Jones & Bartlett Learning, LLC
as follows: © Jones
plished through & Bartlett
the 9-1-1 emergency Learning, LLC This
telephone system.
NOT FOR SALE OR DISTRIBUTION system NOT FOR SALE OR DISTRIBUTION
allows rapid access to all elements of emergency care and
Emergency medical services (EMS) of the future will be commu- support services, including EMS, fire department, and police. In
nity-based health management that is fully integrated with the overall the 9-1-1 system a central dispatch center coordinates resources
health care system. It will have the ability to identify and modify illness and personnel within the system.
and injury risks, provide acute illness and injury care and follow-up, Some EMS systems have “enhanced 9-1-1” (E-911) commu-
© Jones &
andBartlett
contribute Learning,
to treatment ofLLC
chronic conditions and community © Jones & Bartlett
nication Learning,
systems. E-911 allows theLLCdispatcher to track the call-
health monitoring. This new entity will be developed from redistribu-
NOT FORtion
SALE ORhealth
of existing DISTRIBUTION NOT FOR SALE OR DISTRIBUTION
care resources and will be integrated with other
er’s exact location. This knowledge becomes important when
health care providers and public health and public safety agencies. It
the caller disconnects, becomes unconscious during the call, or
will improve community health and result in more appropriate use of when a bystander unfamiliar with an area calls for help. In the
acute health care resources. EMS will remain the public’s emergency case of some natural disasters a “reverse 9-1-1” system has been
medical safety net. used to notify residents of a community to evacuate. With the
© Jones & Bartlett Learning, LLC wide use of cell phones, new©technologies
Jones &are Bartlett Learning, LLC
being introduced
The agenda lists 14NOT FOR
essential SALE OR
components: DISTRIBUTION
integration of to track the caller’s location NOT and aidFOR SALE
response. SomeOR DISTRIBUTION
vehicles are
health services, EMS research, legislation and regulation, system now equipped with tracking and monitoring equipment such
finance, human resources, medical direction, education systems, as Onstar. With this equipment a vehicle can notify the central
public education, prevention, public access, communication dispatch center if the vehicle has been involved in a collision
systems, clinical care, information systems, and evaluation. and can alert authorities of the vehicle’s location.
A© Jones
partner & Bartlett
document to the Learning,
agenda is theLLC EMS Education Other © Jones
areas still rely&onBartlett Learning,
different seven-digit LLC num-
telephone
Agenda NOT FOR SALE OR DISTRIBUTION
for the Future. Focusing on the educational structure for bers to NOT FOR SALE OR DISTRIBUTION
access emergency assistance.
EMS, this document identifies a specific scope of practice for
each level, then replaces the “DOT objectives” with “education Elements of a Communication System
standards” for each level (Figure 1-4). A modern EMSS may contain several communication compo-
nents. A dispatch system receives the call for help and sends the
© Jones & Bartlett Learning, LLC © Jones & Bartlett
appropriate responseLearning, LLC
vehicles to the scene. An ambulance com-
NOT FOR The
SALE ORof DISTRIBUTION
universe Periodic NOT FOR SALE OR DISTRIBUTION provider in the field
munication system allows the prehospital
National EMS
EMS knowledge updates of to communicate with dispatch, with receiving hospitals, and
core content
and skills these three
documents
with medical control.
Delineation of The Dispatch System

National EMS
provider practice
levels
© Jones
scope & Bartlett
Learning, LLC
of practice The dispatch center receives© Jones
calls, & Bartlett
categorizes Learning,
them according to LLC
priority,
NOT FOR SALE OR DISTRIBUTION provides first-aid instructions to callers, and
NOT FOR SALE OR DISTRIBUTIONdispatches
the closest appropriate emergency service vehicle (e.g., police,
Replaces the
current national National EMS fire), rescue personnel, and equipment. Many emergency ser-
standard curriculaeducation standards vice vehicles have vehicle locators so that the dispatcher can see
the vehicle’s exact location in respect to the call. Dispatch serves
© Jones & Bartlett Learning, LLC © Jones point
as a communication & Bartlett
through Learning,
which an EMTLLC can call for
National EMS
certification
National EMS education
program accreditation
additionalNOT FOR SALE OR DISTRIBUTION
resources. The dispatch center may also relay infor-
mation from the scene of an incident to the receiving facility
and advise the EMT on facility selection and availability of other
Figure 1-4 The EMS education agenda for the future: a systems
rescue personnel (Figure 1-5). The dispatcher may also advise
approach. A single agency for each function. Redrawn from
the caller or bystanders on initial treatment steps to help the
National Highway Traffic Safety Administration: National EMS
agenda for the future, Washington, DC, 2005, US Department of
© Jones & Bartlett
patient Learning,
until the ambulance LLC
arrives.
NOT FORTransportation.
SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION
A formal national training program has been developed to
train dispatch personnel to deal with the complexities of their

Figure 1-5 © Jones & Bartlett

A computerized Learning,in LLC
dispatch workstation a commu- © Jones & Bartlett Learning, LLC
nication center. NOT FOR SALE OR DISTRIBUTION
Figure 1-7 An EMT in the field communicates by a portable

voice radio. Learning,
Cellular phones LLC
and landline phones are also used
NOT FOR SALE OR DISTRIBUTION to communicate with dispatch
NOT FOR SALE OR DISTRIBUTION or medical direction.
as alerting the trauma team or preparing an isolation room for

a patient with a possible infectious disease.

LEARNING OBJECTIVE
NOT FOR SALE OR DISTRIBUTION NOTofFOR
• Differentiate the role and responsibilities the EMTSALE OR
from those of DISTRIBUTION
other prehospital care providers.
Levels of Training
Figure 1-6 Online medical direction. A physician at a hospital
© Jones
communication & Bartlett
base station Learning,
can speak directly withLLC
the EMT A wide range © of Jones & Bartlett
illnesses and Learning,
injuries require emergency LLCcare.
NOT FOR
about a patient’s SALE
status and OR DISTRIBUTION
give orders regarding treatment NOT FOR SALE OR DISTRIBUTION
Every year approximately 16 million patients in the United States
and transport. are transported by ambulance to emergency departments, usu-
ally because of chest pain, shortness of breath, abdominal pain,
injury from a motor vehicle crash or other accident, convul-
sions, or general weakness. Persons presenting with imminent
job. Emergency Medical Dispatch (EMD) is now a recognized pro- © Jones
childbirth, & poisoning,
Bartlett Learning,
or uncontrolled LLCbleeding are examples
gram. EMD professionals
NOT FOR SALE OR DISTRIBUTION are skilled coordinators of emergency of the types of emergencies
NOT FOR SALE OR DISTRIBUTION for which immediate attention is
care communication and play a vital role in EMS systems. required. For each patient category, distinct interventions can
improve the patient’s chances for survival.
Ambulance-to-Hospital Communication Systems Patients themselves should know the signs and symptoms of
Many EMS systems provide communication from the field illnesses that require immediate intervention and how to access
personnel to the physician © at Jones & Bartlett
a base hospital Learning,
or medical di- theLLCEMSS. They also should know©some Jonesbasic & Bartlett
self-help Learning, LLC
measures
rection center, often referred to as online medical
NOT FOR SALE OR DISTRIBUTION direction in the event that immediate help from
NOT FOR SALEavailable.
bystanders is not OR DISTRIBUTION
(Figure 1-6; see later discussion). These communication sys-
tems may include both voice and biotelemetric components. Lay Rescuers
Field providers may consult medical direction for advice about Often the first person to recognize an emergency condition is
treatment and transportation decisions or to speak directly another member of the community. For certain conditions that
with patients who are refusing care or transport to the hospital render someone © Jones & Bartlett
helpless, actions Learning,
by bystanders LLC
and those first
(Figure 1-7 ). to respond NOT FOR SALE OR DISTRIBUTION
can make the critical difference. Simple knowledge,
Biotelemetry allows transmission of ECG data from the pa- such as how to open an airway or control bleeding, may be all
tient in the field to the physician at the base hospital or medi- that is necessary to save a life.
cal control facility. Cellular phones and radio transmission are When performed in a timely fashion, CPR and use of an au-
used for both voice communication and biotelemetry. tomated external defibrillator (AED) may save thousands of lives
© JonesMost
& Bartlett
hospitals Learning,
have dedicatedLLC phones or radio equipment © Jones each year&(Figure
Bartlett1-8).Learning,
Training in CPRLLCand other basic first-
for communication with EMTs in the fi eld. In some cases the NOT FOR SALE OR DISTRIBUTION
aid skills may result in certifi cation that permits laypeople to
hospital makes special preparations for the EMT’s arrival, such serve as responders in the workplace or other environments.

Provider
National Provider level 4
EMS core Provider level 1 Provider level 3
content level 2
Figure 1-9 Four levels of EMS providers. Provider level 1: Emergency

Medical Responder (EMR); level 2: Emergency Medical Technician
(EMT); level 3: Advanced EMT; level 4: Paramedic. Redrawn from
Figure 1-8 A lay responder performs one-person cardiopulmo-
nary resuscitation (CPR).
NOT Traffi
National Highway FORc Safety
SALE OR DISTRIBUTION
Administration: National EMS
scope of practice model, Washington, DC, 2005, US Department of
Transportation.
R E A L Wo r ld
In recognition of the importance of bystander care, NHTSA has
© Jones &developed
Bartletta bystander
Learning, care LLC
program entitled First There, First© Jones & Bartlett Learning, LLC
NOT FOR SALE
Care. ThisOR DISTRIBUTION
campaign
Education
NOT FOR
identifies target audiences, develops outreach SALE andOR
Scope of Practice
DISTRIBUTION
strategies for the general public, and provides tools for conducting The NHTSA provides a widely used national curriculum for
local training to teach bystander care. various levels of EMT. A paradigm shift in EMS education, how-
The program is designed to educate the public on five life- ever, is now underway. The concept is simple: a core content of
sustaining skills that can be used at a motor vehicle crash: (1) stop to knowledge and skills for EMS providers. The National EMS Core
©assess
help, (2) call for help, (3) Jones & Bartlett
the victim, Learning,
(4) start the breathing, LLC
Content serves as the total © Jones
domain & Bartlett
of knowledge fromLearning,
which LLC
and (5) stop the bleeding. The purpose is to teach the public that
NOT FOR SALE OR DISTRIBUTION the National EMS Scope of NOT FOR SALE OR DISTRIBUTION
Practice Model derives national EMS
bystander involvement can sustain a life until EMS arrives. provider levels. The National EMS Education Standards will de-
rive educational objectives to guide EMS training in the future.
The AHA’s bystander program is structured around the EMTs at various levels provide the foundation of EMS educa-
“chain of survival” concept that defines four critical links for tion for the future. Currently, there are four national levels of
© Jones
bystanders treating& persons
Bartlett withLearning,
heart attack, LLC
stroke, choking, © Jones
EMT described & Bartlett
in the scope Learning,
of practice LLC 1-9).
document (Figure
and respiratory and cardiac arrest. The four links include early Emergency Medical Responders (First
NOT FOR SALE OR DISTRIBUTION a Responders). Sometimes
access to 9-1-1, early CPR, early defibrillation, and early ad- community will plan for a formal response to the call for help
vanced care. Bystanders are encouraged to deliver the first three by training certain people to administer emergency care before
links in the chain, including CPR and early defibrillation using EMTs in an ambulance arrive. For example, EMTs, Advanced
an AED (see Chapter 12). EMTs, or paramedics may respond in first-responder vehicles
This type of program recognizes that the time from © Jones
collapse and & Bartlett
arrive Learning,
at a patient’s LLCthe ambulance, shorten-
side before
to provision of
NOT FOR SALE OR DISTRIBUTION care plays an essential role in victim survival. ing the time from
NOT FOR SALE OR DISTRIBUTION the emergency event to patient care. Other
For example, the chances of survival for victims of cardiac ar- trained first responders may include police officers, firefighters,
rest resulting from ventricular fibrillation decrease by 7% to industrial workers, teachers, coaches, and other volunteers.
10% for each minute that passes from the time of collapse until First responders, or emergency medical responders (EMRs),
defibrillation is provided. Performance of CPR can extend that have a wider range of skills than most bystanders, including
critical period by delivering© Jones
oxygen to & the
Bartlett
heart and Learning,
brain until LLC © Joneschildbirth,
management of medical emergencies, & Bartlett andLearning,
specific LLC
defibrillation is used to NOT restoreFORa normal heart rhythm.
SALE OR DISTRIBUTION pediatric emergencies. First responders are often equipped
NOT FOR SALE OR DISTRIBUTION with
Community education programs that provide the public oxygen, AEDs, and airway equipment and may respond in po-
with basic first-aid skills may be taught by several different lice cars, fire apparatus, or special first responder vehicles.
community groups. Programs taught in school systems, scuba First responders may take a course following a national stan-
diving training, Boy Scouts and Girl Scouts, and other organi- dard. The first responder is trained to recognize emergencies,
© Jones
zations educate a&signifi Bartlett
cant crossLearning,
section of LLC
the community. © Jones
initiate care, and have& theBartlett
necessary Learning,
skills to save aLLC
life with the
OtherNOTeven FOR SALE OR DISTRIBUTION
more basic actions, such as recognizing the signs use of a NOT FOR SALE OR DISTRIBUTION
minimum of equipment.
of a heart attack and stroke, and calling 9-1-1 for help, are of- Emergency Medical Technician. There are hundreds of thou-
ten taught in the mass media to reach even more people in the sands of registered EMTs nationwide and the numbers con-
community. tinue to grow. They provide the foundation for prehospital care
As an EMT, you should value the contribution made by by- (Figure 1-10). DOT defines an emergency medical technician
standers since they serve as the “bridge of life support” © Jones
from (also&called
Bartlett Learning,
EMT-Basic LLC
) as someone who has successfully com-
collapse to your arrival. You can also play an educational NOT FOR SALE OR DISTRIBUTION
role by pleted a training program according to the NHTSA Emergency
becoming a CPR, AED, and first-aid instructor. Medical Technician National Standard Curriculum or is trained

Figure 1-10©An
Jones & Bartlett
EMT administers Learning,
treatment LLCpatient.
to an injured Figure© Jones
1-11 & Bartlett
A modern emergencyLearning,
LLC
department.
within the new educational paradigm meeting the scope of prac- training is available through programs sponsored by hospitals,
tice proposed by NHTSA and having the requisite knowledge of community colleges, and other agencies.
the EMS core content. This is the course that you are taking Paramedics also may be used for critical care transport op-
© Jones
now& forBartlett Learning,
initial or refresher LLC
training. © Jones
erations.& In Bartlett
these typesLearning,
of services, EMS LLC providers are involved
The EMT curriculum involves attending lectures and receiv- NOT FOR SALE OR DISTRIBUTION
primarily in the transfer of acutely ill and injured patients from
ing practical and clinical instruction in the assessment and man- one care center to another. Often EMS providers who function
agement of the acutely ill or injured patient. The EMT provides in this role have additional training in specialized devices, such
basic emergency medical care and transportation for critical as intravenous pumps (devices that deliver IV fluids more pre-
and emergent patients who access the EMS system. EMTs func- cisely) and balloon pumps (devices that enhance circulation in
tion as part of a system under © Jones & Bartlett
medical oversight and Learning,
perform LLC with cardiovascular failure).
patients © Jones & Bartlett
Paramedics Learning, LLC
or critical care
interventions with basic equipment on an ambulance. EMTs nurses also are used in medical NOT FOR SALE OR DISTRIBUTION
evacuation (medevac) helicop-
may assist patients with their medications and, under medical ter programs. These programs often are designed to transport
direction, may give medication such as aspirin to patients with critically ill patients from the scene of the emergency or a local
chest pain and oral glucose to patients with low blood glucose. community hospital to specialized care facilities.
In many communities, it is the EMT providing the large por-
© Jones &care.
tion of out-of-hospital Bartlett
In ruralLearning,
areas, they may LLCrepresent © Jones & Bartlett Learning, LLC
the highestNOT FOR SALE OR DISTRIBUTION
level of EMS care. The EMT’s care is based on assess- The Healthcare System
ment findings. Their scope of practice is limited to basic skills
that are effective and can be performed in an out-of-hospital Emergency Departments
setting with medical oversight and limited training. Modern emergency departments (EDs) are vital centers of acute
Advanced Emergency Medical Technician. The advanced emer- medical and trauma care that serve as the intersection between
gency medical technician (AEMT) is also called the EMT- © Jones & Bartlett
the prehospital Learning,
and hospital phases ofLLC care (Figure 1-11). In the
Intermediate (EMT-I).
NOT FOR SALE OR DISTRIBUTION ED the patient is evaluated
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With additional training, EMTs may function at a more ad- about the need for further care, including admission to the hos-
vanced level. Various designations are used for advanced EMTs, pital, transfer to an operating room, or discharge home. Hospi-
but the trend is toward standardizing certification to three lev- tals may have specialty teams that respond quickly to patients
els: the EMT, the advanced EMT, and the paramedic. with time-critical illness and injury, such as stroke, trauma, and
Advanced training includes © Jones & Bartlett Learning,cardiac
skills such as ECG interpreta- LLC conditions. © Jones & Bartlett Learning, LLC
tion, advanced or alternative airway management
NOT FOR SALE OR DISTRIBUTION (i.e., ET The standards for EDs also have NOT advanced
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DISTRIBUTION
intubation, dual-lumen airway device), IV fluid therapy, and years. Many communities have developed minimum standards
administration of certain IV medications. for staff, space, equipment, and availability of specialists (e.g.,
Advanced EMT training is shorter and more focused than the neurosurgeons, orthopedists). The National EMSS Act of 1973
paramedic level. Advanced EMT programs are more often used stimulated much of this progress, citing hospital facilities as
in rural volunteer EMS systems, where attending longer training a key component © Jonesof EMS& Bartlett
systems. Learning,
Currently, LLC
these standards
programsNOT may notFOR SALE OR DISTRIBUTION
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various organizations, including state departments of
Paramedic. The highest level of training for advanced health, The Joint Commission (TJC; formerly Joint Commis-
EMTs is usually referred to as paramedic. A paramedic has sion on Accreditation of Healthcare Organizations [JCAHO]),
completed a course that followed the standardized national and other professional organizations.
curriculum as prescribed by NHTSA or meets the standards of The acutely ill or injured patient may be admitted to the hos-
the new educational paradigm. A paramedic performs advanced © Jones
pital. Some& patients
Bartlett mayLearning,
go directly fromLLC the ED to the operating
techniques, such as ECG interpretation, drug therapy, inva- NOT FOR SALE OR DISTRIBUTION
room, cardiac catheterization laboratory, or a critical care unit for
sive airway techniques, and manual defibrillation. Paramedic additional treatments, monitoring, or both (Figure 1-12). Various

Figure©1-12
Jones &inBartlett
Surgery Learning,
an operating room may LLC
be part of © Jones
Figure 1-13 Patients & Bartlett
may Learning,
be admitted to a criticalLLC
care unit.
additional emergency treatment. NOT FOR SALE OR DISTRIBUTION
types of critical care or intensive care units exist for patients with Liaison with Other Public Safety Workers
different problems, such as cardiac, respiratory, surgical, pediat- The EMT interacts with various public safety personnel at the
ric, and high-risk obstetric and neonatal (Figure 1-13). scene of a call. Police, fire service, public utility workers, and
state&andBartlett
federal lawLearning,
enforcement LLCofficers are key resources at
NOT FOR SALE
R E A L WoORr ld DISTRIBUTION NOT FOR SALE OR DISTRIBUTIONcrime or motor vehicle
general medical or trauma emergencies,
crash scenes, mass casualty incidents, and behavioral emergen-
Of all patients transported to emergency departments, 14% arrive cies. Become familiar with the resources in your region and
by ambulance. For patients under 15 years of age, 3.8% arrive by how to contact them when needed. Understand and respect
ambulance. For patients over 75 years, 40.9% are transported by the roles, responsibilities, and authority of various resources at
ambulance. © Jones & Bartlett Learning, LLC emergency scenes. © Jones & Bartlett Learning, LLC
Can you think of reasons for such a difference at these extremes
of age? NOT FOR SALE OR DISTRIBUTION Many systems provide a NOT FOR SALE
tiered response ORcalls.
to certain DISTRIBUTION
For
Data from Institute of Medicine: EMS at the crossroads, Washington, example, police or fi re service personnel may be dispatched
DC, 2006. as first responders to provide immediate care (e.g., AED use,
bleeding control) before arrival of the ambulance. Police offi-
cers often assume responsibility for notification of family, se-
© Jones
Specialty Referral &Centers
Bartlett Learning, LLC © Jones
curing valuables & Bartlett
or property, Learning,
and assisting LLCpatients
with violent
SomeNOT FOR SALE OR DISTRIBUTION
patients have unique needs that require the care of spe- or other NOT FOR SALE OR DISTRIBUTION
behavioral emergencies.
cially trained individuals, using highly specialized equipment. When multiple agencies are needed at an emergency incident,
Specialty referral services include trauma centers, burn centers, the roles and command function are assigned by the nature of
pediatric intensive care, neonatal (newborn) centers, cardiac the incident. In general, police take charge at any crime scene
centers, and hyperbaric centers for victims of diving injuries or or where crowd or traffic control may be needed. Fire personnel
poisoning with carbon monoxide. EMTs may transport © Jones
certain would& take
Bartlett
charge Learning,
at a fire scene.LLC
An EMT’s primary concern is
patients directly
NOT FOR SALE OR DISTRIBUTIONto a specialty referral center, at times bypassing patient care. The EMT
NOT FOR SALE OR DISTRIBUTION must know the roles of the various agen-
other hospitals. cies in the region so that all can work in a coordinated and a safe,
effective manner. An incident management system, also known
Hospital Personnel as an “incident command system,” has been established to al-
The EMT is part of a larger team of personnel who care for the low for clear lines of authority and responsibilities at the scene
patient at each phase of©the Jones & Bartlett Learning, LLC
EMSS. These individuals also can of an emergency when many ©agencies
Jonesrespond
& Bartlett Learning,
and must work LLC
serve as a resource for information, feedback about
NOT FOR SALE OR DISTRIBUTION a patient’s together to resolve the emergency situation (see Chapter
NOT FOR SALE OR DISTRIBUTION 28).
condition, and continuing education. Mutual respect and ap-
preciation of each team member’s contribution are essential to Local Emergency Medical Services System
promote effective communication and continuity of care. The To perform optimally for the patient, EMTs should become
hospital team members include the following: familiar with the components of their local EMSS. All the
• The©physician,
Jones & Bartlett Learning, LLC
who is responsible for the overall management components © Jones & Bartlett
just described are partLearning,
of everydayLLC EMT prac-
of the patient in the prehospital and hospital phases of care. tice. NOT FOR SALE OR DISTRIBUTION
Familiarity with the access and communication system
• The nurse, who coordinates care in the ED, operating room, is an essential first step. Knowing the levels of training allows
critical care units, and other general medical-surgical units in the EMT to interact appropriately with first responders and
addition to directing patient care duties. advanced-level EMTs who may also arrive at the scene. Treat-
• Other health professionals, such as physician assistants, nurse ment, triage (sorting according to medical need), and transport
practitioners, respiratory therapists, radiology © Jones
technicians, & Bartlett
protocols should be Learning,
learned and LLCcarried in the vehicle, because
and a host of personnel who tend to the various needs ofNOT FOR SALE OR DISTRIBUTION
the they describe the key patient care decisions and interaction with
patient in the hospital. medical direction. Familiarity with the designations of specialty

Figure 1-14©EMTs
Jones
using&personal
Bartlett Learning,
protective LLC
equipment © Jones & Bartlett Learning, LLC
during CPR.NOT FOR SALE OR DISTRIBUTION NOT FOR
Figure 1-15 A high-effi ciencySALE ORairDISTRIBUTION
particulate (HEPA) respira-
tor is an important defense against diseases spread by airborne
transmission, such as tuberculosis, chickenpox, measles,
receiving hospitals is necessary when critical patients with spe- and smallpox. From Chapleau W, Pons P: Emergency medical
cial needs, such as for burn or trauma center care, are identified technician, St Louis, 2007, Mosby-Elsevier.
© Jones &fiBartlett
in the eld. EMTs Learning,
must know theLLC initial steps to take when as- © Jones & Bartlett Learning, LLC
sisting at a disaster. NOT FOR SALE OR DISTRIBUTION
Orientation sessions and review of policies and protocols assist The choice of a particular piece of equipment depends on the
the EMT in gathering this important information. Continuing ed- circumstances of a given call. For example, gloves are used
ucation and studying current local and state EMS updates allow the routinely when exposure to blood or body fluids may occur,
EMT to retain essential information and stay abreast of change. such as when bandaging a minor wound. Goggles are used when
© Jones & Bartlett Learning,there LLC © Jones
is a potential for an eye splash & body
of blood or Bartlett Learning, LLC
fluid. This
LEARNING OBJECTIVES NOT FOR SALE OR DISTRIBUTION can happen during suctioning NOT FOR SALE OR DISTRIBUTION
or administration of positive-
• Describe the roles and responsibilities of the EMT related to per- pressure ventilation. A special mask is used if tuberculosis or
sonal safety. another airborne pathogen is suspected (see Chapter 2).
• Discuss the roles and responsibilities of the EMT toward the safety of Prevention is the key in matters of safety. Developing good
the crew, the patient, and bystanders. habits early in your clinical experience ensures the safest pos-
© Jones & Bartlett Learning, LLC sible approach.©You Jones & Bartlett
will learn more aboutLearning, LLC
the specifics of safety
NOT FOR SALE OR DISTRIBUTION later in this NOT FOR SALE OR DISTRIBUTION
chapter and in Chapter 2.
Roles and Responsibilities of the EMT Patient Assessment
The work of an EMT is diversified and provides challenge and Assessment is one of your primary responsibilities as an EMT.
gratification. As an EMT, you will function in several roles that It involves the systematic collection and analysis of information
call for medical, technical, clerical, and social interaction skills. © Jones
received & Bartlett
through Learning,
a patient LLCsigns, and a physical
history, vital
Many of these skills
NOT FOR SALE OR DISTRIBUTIONwill be acquired during classroom training examination ( Figure
NOT FOR SALE OR DISTRIBUTION1-16 ). Become a skilled observer who can
sessions. Other skills will develop during clinical field experi- recognize problems quickly and respond accordingly.
ence under the supervision of senior EMTs or instructors. Patient assessment is probably the most difficult skill to
master as an EMT because it involves many different areas of
Primary Responsibilities knowledge. You will learn to obtain a concise history from a
© Jones & Bartlett Learning,patient LLC who may be in severe pain, © confused,
Jones & or Bartlett Learning, LLC
hysterical. This
Personal Safety and Safety of Others will require patience and much practice. You will learnORwhich
NOT FOR SALE OR DISTRIBUTION NOT FOR SALE DISTRIBUTION
Primary concern for safety is the first and most important step facts are relevant to each type of chief complaint and how to
on every call. Scene safety is the first part of patient assessment. avoid unnecessary questioning that wastes time.
The use of cones and flares, proper positioning of emergency
vehicles, and wearing reflective clothing at the scene are all basic Patient Care Based on Assessment Findings
defenses against personal injury. Other conditions that may be Your training ©willJones
prepare &youBartlett
to respondLearning,
to a variety ofLLC
critical
consideredNOT FOR SALE OR DISTRIBUTION
include hazardous materials or toxic gases, aggressive problems, NOT FOR SALE OR DISTRIBUTION
ranging from immobilization of a fractured leg to re-
animals, violent patients or bystanders, and electrical hazards. suscitation of a cardiac arrest victim (Figure 1-17). In some cases,
The risk of exposure to communicable disease is real and time may not allow a prolonged analysis because many true emer-
should be taken seriously. The primary defenses against dis- gencies require treatment while assessment continues. Significant
ease transmission are personal protective equipment (PPE) loss of blood or complete airway blockage requires a reflex reac-
and handwashing ( Figure 1-14 ). Gloves, eye protection, gowns, © Jones
tion that &
youBartlett
can developLearning, LLC classroom and clini-
only with intensive
and high-effi ciency particulate air (HEPA) respirator masks NOT FOR SALE OR DISTRIBUTION
cal practice. Other treatments you will learn include CPR, oxygen
are examples of basic PPE carried by an EMT (Figure 1-15). therapy, assisting at childbirth, management of poisoning and

©Figure
Jones1-16 &
AnBartlett Learning,
EMT performs LLC
patient assessment. Figure 1-18©The
Jones
patient&isBartlett
secured to Learning, LLCdevice.
an immobilization
Figure 1-19 An EMT presents a patient history to the emergency

physician, providing details gathered from the time of first con-
© Jones & Bartlett Learning, LLC tact, which
©can play a major
Jones role in diagnosis
& Bartlett Learning,and treatment.
LLC
Figure 1-17 An EMT performs cardiopulmonary resuscitation. you take on a great responsibility. Although the law allows certain
exemptions while you are operating an emergency vehicle, you are
overdose, treatment of shock states, and psychological first aid. still responsible for maintaining control of the vehicle at all times.
Knowing when to transport a patient and when to choose a special You must be familiar with the best possible routes in your
institution (e.g., burn center) is also important. © Jones &You
area. Bartlett Learning,
should know the trafficLLC
patterns at all times of the day
NOT FORLifting
SALE OR DISTRIBUTION and the alternate routes
NOT FOR SALE OR DISTRIBUTION in the event that your original route is
and Moving obstructed.
Many patients you encounter will be injured and require care- The safe and appropriate transport of your patient is another
ful handling. A victim with a suspected spinal injury should be aspect of emergency vehicle operation. Contrary to popular be-
immobilized to prevent further injury during transport (Figure lief, most patients do not benefit from a frantic ride to the hos-
1-18). As an EMT, you©will Jones & Bartlett Learning, LLC
become familiar with a variety of pital with lights flashing and©siren Jones & Bartlett Learning, LLC
blaring.
spinal immobilization NOT methods, splinting, different
FOR SALE OR DISTRIBUTION types of When you arrive at the ED with
NOT FOR your patient,
SALEyou OR should be
DISTRIBUTION
stretchers, and rapid removal techniques. ready to transfer care of the patient to the ED staff. You may need
The needs of patients vary widely, from an elderly patient who to continue certain aspects of care, such as resuscitation, until
needs a stair chair to be helped to the ambulance, to a seriously the nurse, physician, or other healthcare professional assumes
injured patient who must be rapidly extricated from a burning responsibility. You should present a brief report that highlights
automobile. As an EMT, you become an expert in movement, key aspects © ofJones & Bartlett
the assessment Learning,
and treatment LLC in the
performed
matching a particular strategy with the needs of a patient. You fi eld ( NOT FOR SALE OR DISTRIBUTION
Figure 1-19 ).
should carefully learn and practice these techniques during and
after your EMT course. Record Keeping
Accurate records play an important role in the management of
Transport and Transfer of Care the patient because they become the reference point for infor-
If your rapid response to a call results in a preventable © Jones
injury to mation& Bartlett
after your Learning,
departure from LLC
the hospital (Figure 1-20).
yourself, your partner, or a patient, you have defeated your NOT FOR SALE OR DISTRIBUTION
pur- Prehospital assessment fi ndings and the chronology of prehos-
pose. When you get behind the wheel of an emergency vehicle, pital events and treatments are very important because they

Prehospital Care Report

© Jones & Agency
Bartlett Learning,
Unit # LLCTrip # © Jones & Bartlett Learning, LLC
Type of incident Date of service
Medical Trauma
No patient
Refusal # of Patients / /
Incident location Pt. destination Transport by

Attendant Certification level Attendant Certification level Driver Certification level
Patient’s age Sex F M Chief complaint Mechanism of injury
Narrative © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC
NOT FOR SALE ORhistory
Previous medical DISTRIBUTION NOT FOR SALE OR DISTRIBUTION
Medications
Allergies Charted by
Patient Vital Signs
Time
Blood
pressure
Pulse
rate
© Jones
Rhythm
& Bartlett
Respirations Pupils Learning, LLC Glasgow
Movement of extremities
rate Rhythm/quality L R R - arm - L R - leg - L Eyes Verbal Motor
Pulse oximeter
SaO2 O2LPM
Cardiac rhythm
/
/
/
IV Therapy NOT FOR SALE OR DISTRIBUTION
Medications
Time Solution Site Size Rate Initials S/U Medication Dose Route Time Time Time Time Order from Response to treatment
Total infused cc Response
Times
Tone Responding On scene ALS on Departed Arr hosp In service
Patient Information
Name DOB / / SS# Telephone (
NOT FOR SALE OR DISTRIBUTION NOT FOR) SALE OR DISTRIBUTION
Address Next of kin
City, State, Zip Relationship
Hospital notification Assistance Call outcome
Med channel #_________ Base physician Police Fire Response code 2 3 Transported to facility
© Jones & Bartlett
Cellular
Learning, LLCSheriff
Amb dispatch Other
© Jones & Bartlett
Transport code 2 3
Learning, LLC
Care transferred in field
NOT
Landline
FOR SALE
Other
OR DISTRIBUTION
State Patrol Air Life
NOT
Flight for Life
FOR SALE
Helicopter transport
OR DISTRIBUTION
Cancelled
Figure 1-20 A prehospital care report. Modified from HealthONE EMS Patient Care Report, courtesy HealthONE EMS, Englewood, Colo.

symptoms can be caused by serious conditions such as carbon

monoxide Learning,
poisoning LLC (e.g., meningitis, an-
or serious infections
thrax). Intoxication can often mask a serious underlying injury.
Once again, you should focus on the patient.
Other Responsibilities
Public Education
NOT FOR SALE OR DISTRIBUTION An important responsibilityNOT FORisSALE
of the EMT OR
to educate theDISTRIBUTION
public
and help prevent injuries. Programs such as community CPR
classes can go a long way in increasing the chance of survival of
a heart attack victim. Bicycle helmet and safety programs help
prevent injuries.
© Figure
Jones 1-21&An
Bartlett Learning,
EMT should LLC
show compassion. © Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION Extrication
Although extrication is not a primary EMT responsibility,
are the only source of documentation from the scene. When sometimes you may be called on to gain access to and free peo-
you leave the hospital, physicians and nurses will refer to the ple trapped in automobiles. This activity is usually the function
prehospital care report to retrieve essential information. You of specialized rescue personnel within EMS, police department,
© Jones & Bartlett
should developLearning,
good habits andLLC record pertinent data from© theJones
or fi& Bartlett Learning,
re department. However, when LLC these units are not imme-
time of the initial patient encounter until arrival at the NOT FOR SALE OR DISTRIBUTION incorporate these
hospital. diately available, or when regional systems
Many EMS systems are using electronic prehospital care reports functions into the EMT’s protocols, you must be prepared to
whereas others are still using handwritten forms. Regardless of bring about a safe and efficient rescue. In most situations, you
the type of program your system uses, your documentation will perform “light extrication,” or extrication with the use of
must be thorough, chronological, and clear. Accuracy is another basic tools, such as screwdrivers, crowbars, and hacksaws.
necessary ingredient in©effective
Jonesdocumentation.
& Bartlett Learning,Times, vital LLC If “heavy extrication” is assigned
© Jones & Bartlett
through Learning, LLC
regional protocols,
sign values, and other NOT FOR SALE OR DISTRIBUTION
diagnostic fi ndings should be recorded specialized programs are NOT FOR SALE OR DISTRIBUTION
usually conducted to teach the proper
carefully to aid in further assessment of the patient. Your re- use of the larger and more powerful devices typically used by
porting of vital signs provides a baseline that can help track the rescue personnel.
progress or deterioration of the patient’s condition. Before extrication can occur, you may need to gain control
of the scene. This may mean setting up visual warning devices
© Jones
Patient Advocacy& Bartlett Learning, LLC © Jones
on a highway & Bartlett
or choosing someoneLearning,
to direct traffiLLC
c or crowd
At theNOT
moment FOR SALE OR DISTRIBUTION
of encounter, you become the primary health- control. NOT FOR SALE OR DISTRIBUTION
care representative for the patient during the prehospital phase
of care. Patients may not be familiar with the EMSS and depend Communications
on you, the EMT, for advice about the best course of action The proper use of the radio or other communication device is
for their problem. Often your actions or advice may be guided part of your training. Radio communications should be short
by protocols or directives regarding patient care, hospital © Jones
selec- and & Bartlett
clear. The radioLearning, LLC
is a useful tool for mobilizing essential re-
tion, decisions regarding
NOT FOR SALE OR DISTRIBUTION who can ride with the patient in the sources, notifying
NOT FOR SALE OR DISTRIBUTIONhospital personnel of the arrival of an acutely
ambulance, and many other issues. ill patient, and documenting unusual circumstances that may
It is important to treat patients as a whole and to consider all have medicolegal implications later. For example, a patient
aspects of their condition, their ability to care for themselves, who leaves the scene against your advice and without a proper
notification of family members, and other social and psychologi- signature on a release form can be documented by relaying
cal issues. A good rule for © Jones & Bartlett Learning, LLC
the EMT is to treat the patient as you the information to the dispatcher© Jones & Bartlett
or medical Learning,
control. Many LLC
would want a family member to be treated under
NOT FOR SALE OR DISTRIBUTION similar condi- systems record all conversations to provide another
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tions. Sometimes such treatment means “going that extra mile” by documentation.
contacting a family member or advising the nurse at the hospital Importantly, you also must learn to be an effective commu-
of the need for social service intervention. As a patient advocate, nicator with patients, family members, and hospital personnel.
your attitude and actions shift from a purely clinical point of view
© Jones
to a more humanistic& Bartlett
approach to Learning,
patient care (LLC
Figure 1-21). Vehicle and Equipment
© Jones Maintenance
& Bartlett Learning, LLC
AtNOT
times,FORpatientsSALE OR DISTRIBUTION
may present with seemingly minor com- Vehicles NOT FOR SALE
and equipment OR
that are wellDISTRIBUTION
maintained last longer
plaints. Although these may not be emergent problems, stay and perform better for you and the patient. It is frustrating and
aware and do not jump to conclusions. Adopting a “help- dangerous to attempt resuscitation or another task, only to dis-
based” approach rather than a “thrill-seeking” focus will help cover that essential equipment is not serviceable or is missing.
prevent burnout and poor patient care. What initially may seem Proper inspection and maintenance of the vehicle and restock-
minor may easily become serious. Back pain and © Jones
headaches & Bartlett
ing equipment areLearning,
roles of every LLC
EMT (Figure 1-22). Cleaning
can be caused by serious vascular problems, such as NOT FOR SALE OR DISTRIBUTION
dissection the ambulance and equipment is part of a planned program of
of the aorta or a hemorrhage (bleeding) in the brain. Flulike infection control and respect for EMT and patient safety.

Box 1-1 Emergency Medical Technician’s Oath

NOT FOR SALE OR DISTRIBUTION NOTBeFOR SALE
it pledged as anOR DISTRIBUTION
Emergency Medical Technician, I will honor
the physical and judicial laws of God and man. I will follow that
regimen which, according to my ability and judgment, I consider
for the benefit of patients and abstain from whatever is deleteri-
ous and mischievous, nor shall I suggest any such counsel. Into
whatever homes I enter, I will go into them for the benefit of
only the sick and injured, never © Jones
revealing what& IBartlett
see or hearLearning,
in LLC
NOT FOR SALE OR DISTRIBUTION the lives of men unless requiredNOTby law.FOR SALE OR DISTRIBUTION
I shall also share my medical knowledge with those who
may benefit from what I have learned. I will serve unselfishly
and continuously in order to help make a better world for all
A mankind.
While I continue to keep this oath unviolated, may it be
© Jones & Bartlett Learning, LLC granted to me©toJones
enjoy life,& Bartlett
and Learning,
the practice LLC
of the art, respected
NOT FOR SALE OR DISTRIBUTION by all men, inNOT FOR
all times. SALE
Should OR DISTRIBUTION
I trespass or violate the oath,
may the reverse be my lot. So help me God.
© 1994, National Association of Emergency Medical Technicians (NAEMT). Written by
Charles Gillespie, MD.

fact that & Bartlett
you often areLearning, LLC
judged by your appearance, and dress
appropriately.
The attitude of the EMT is even more important than the
outer appearance. You should show an interest in your job
and possess a sensitive awareness of your environment and the
needs of others around you. The provision of medical care is a
B
© Jones & Bartlett Learning,giving LLCprofession and should not©beJones & Bartlett
taken lightly. Learning, LLC
The attributes
Figure 1-22 A, Restocking ofNOT FORB,SALE
the vehicle. InspectingOR DISTRIBUTION of quality we seek to deliver are NOT FOR SALE OR DISTRIBUTION
well articulated in a report by
the engine. the Institute of Medicine on quality in America’s health care
(Box 1-2).
You should put the patient’s needs first while protecting and
Professional Attributes of the EMT preserving the safety of bystanders, other rescuers, and yourself.
You are not useful &ifBartlett
to others you become Learning, LLC A
a victim yourself.
As a medical professional, you have a unique and special body fi rst step in NOT FOR SALE OR DISTRIBUTION
arrival at the scene of every emergency is to ensure
of knowledge that is to be used for the benefit of society. You scene safety. EMTs must maintain awareness of the safety of
are expected to demonstrate skill and knowledge for the good of the environment throughout the call, from arrival to transport
the patient. You also are expected to promote high standards of to the hospital. Evolving or escalating hazards can range from
behavior and medical practice within the profession. Also, as a street traffic, violence, fire scenes, and emotionally disturbed
professional, you are expected to add to the body of knowledge © Jones & Bartlett
patients and Learning,
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to communicable diseases.
to continue to advance
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The term that probably best embodies these basic values is
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“acting requisite to the body of knowledge which defines the
service and abilities of the professional…according to the oath
of the profession.” Although©the Jones & Bartlett
term professional Learning,
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loosely now, the expectations of behavior can easily
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stood by reading a traditional medical oath. Box 1-1 provides
the EMT’s oath.
Appearance and Attitude

© Jones
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Because emergency care providers have little time to estab-
lish rapport with their patients, the sight of an EMT in a clean
and appropriate uniform helps establish a sense of respect and
trust. Of course, wearing a uniform may not always be possible
Figure 1-23 A properly attired EMT inspires confidence.
© Jones
(e.g.,&a Bartlett Learning,
volunteer EMT LLC
responding from home or work). Be- © Jones & Bartlett Learning, LLC
From Aehlert B: Paramedic today: above and beyond, St Louis, 2010,
NOT FOR SALE
cause you oftenORneedDISTRIBUTION
to gain a stranger’s cooperation and trust NOT FOR SALE OR DISTRIBUTION
Mosby-Elsevier.
quickly in EMS, however, you should take advantage of the

by one state of the validity of the EMT certification granted

Six Quality Aims of Institute of Medicine (IOM)
© Jones & Box 1-2 Learning,
Bartlett LLC
“Quality Chasm” Report
©Jones & Bartlett
by another. Learning,
The National LLC
Registry of EMTs also maintains CE
requirements that encourage the professional development of
• Health care should be: EMTs nationwide. EMTs can be registered at either the basic or
• Safe—Avoiding injuries to patients from the care that is in- the advanced level.
tended to help them.
• Effective—Providing services based on scientific knowledge to National Association of Emergency Medical Technicians
all who could benefi© Jones & Bartlett Learning, LLC
t, and refraining from providing services The NAEMT is an organization © Jones & Bartlett
that represents Learning, LLC
EMTs through-
to those not likely to benefit.
NOT FOR SALE OR DISTRIBUTION out the United States. It NOT FOR SALE OR
was founded in 1975 with DISTRIBUTION
the support
• Patient centered—Providing patient care that is respectful to of the National Registry and other national organizations and
and responsive of individual patient preferences, needs, and val- leaders to serve as a national voice for prehospital providers.
ues, and ensuring that patient values guide all clinical decisions.
The NAEMT maintains three societies that serve other subdivi-
• Timely—Reducing waits and sometimes harmful delays for
sions of prehospital care: the National Society of EMS Admin-
both those who receive and those who give care.
©cient
• Effi Jones & Bartlett
—Avoiding Learning,
waste, including waste LLC
of equipment, © Jones
istrators, the National& Bartlett
Society Learning,
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Coordinators,
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energy. the NOT FOR SALE OR DISTRIBUTION
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• Equitable—Providing care that does not vary in quality be- The NAEMT works for legislative change in EMS, provides
cause of personal characteristics such as gender, ethnicity, continuing education, represents EMTs in other national or-
geographic location, and socioeconomic status. ganizations, provides job placement for EMTs, and in general,
From IOM Committee on Quality of Health Care in America: Crossing the quality chasm: works for the development and recognition of EMTs nation-
© Jones &a new
Bartlett
health systemLearning, LLC DC, 2001, National Academies Press,© Jones
for the 21st century, Washington, wide.&Among
Bartlett Learning,
the CE LLC
efforts offered by NAEMT are an annual
pp 5-6.
national educational conference and Prehospital Trauma Life
Support (PHTLS), a CE trauma program.
LEARNING OBJECTIVE American Heart Association

• State the specific statutes and regulations in your state regarding the In cooperation with other healthcare organizations, the AHA
EMS system. © Jones & Bartlett Learning,
LLC © Jones
establishes CPR and emergency & Bartlett
cardiovascular Learning, LLC
care guidelines
for both hospital and NOT FOR SALE OR DISTRIBUTION
prehospital providers. Approximately
every 5 years, the AHA publishes the International Guidelines
Maintenance of Up-to-Date Knowledge for CPR and Emergency Cardiovascular Care, which provides
and Skills recommendations for CPR performance and cardiac protocols
Your EMT training is the foundation of your EMS education. used in prehospital care.
Each ©state
Jones & Bartlett
establishes license Learning, LLC
or certification requirements © Jones & Bartlett Learning, LLC
for the practicing EMT that may include written, practical, LEARNING NOT FOR SALE OR DISTRIBUTION
OBJECTIVE
and clinical requirements. Although there are variations, the • Define quality improvement, and discuss the EMT’s role in the
NHTSA curricula and the scope of practice documents usually process.
provide the framework for programs throughout the United
States. Different states or other countries may also add various
© Jones & Bartlett
training Learning,
modules that enhance LLC © Jones
the local or regional provision & Bartlett
Quality Learning, LLC
Improvement
NOT FOR SALE OR DISTRIBUTION trauma programs, emer-
of prehospital care, such as specialized NOT FOR SALE OR DISTRIBUTION
gency vehicle operation, extrication training, hazardous materi- The effectiveness of any organization depends on a continuing pro-
als training, domestic preparedness, and other programs. cess of evaluation and change called quality improvement (QI).
Recertification is usually required every 2 to 3 years (al- EMS quality improvement is defined in the National Standard
though the interval may be longer) and may involve ongoing Curriculum for Emergency Medical Technicians as “a system of in-
continuing education (CE) © Jones & Bartlett Learning, LLC
requirements, challenge testing, or ternal and external reviews and© audits
Jones of all&aspects
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of an EMS sys- LLC
attendance at a formalized refresher program. Continuing
NOT FOR SALE OR DISTRIBUTION edu- tem so as to identify those aspects needing improvement
NOT FOR SALE OR DISTRIBUTION to assure
cation takes many forms: attendance at local, state, and national that the public receives the highest quality of prehospital care.”
conferences; reading EMS journals; and attending call review. Quality improvement takes many forms and may include
Several national organizations contribute to EMS education. As the following:
an EMT, you should also be familiar with the specific statutes • Reviewing prehospital documentation to ensure appropriate
and regulations related to EMS in your state. © Jones & Bartlett Learning, LLC
record keeping.
NOT FOR SALE OR DISTRIBUTION • ReviewingNOT FOR SALE
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runs to determine the type of care pro-
National Registry of Emergency Medical Technicians vided and the quality of care.
The National Registry of EMTs was developed to establish a • Gathering feedback from patients and hospital personnel on
high-quality and standardized competency level for all levels the quality of care.
of EMTs. The National Registry provides written and practical • Providing continuing education.
© Jones & Bartlett
testing and a Learning, LLC program at the basic ©
continuing education andJones & Bartlett
• Ensuring Learning,
preventive maintenanceLLCof the emergency vehicle
advanced levels. This registry is used by many states to NOT FOR SALE OR DISTRIBUTION
provide and equipment.
reciprocity to EMTs and paramedics. Reciprocity is recognition • Maintaining personal skills.

As an EMT, you should be an active participant in the QI

© Jones & Bartlett
process by helpingLearning,
with audits and LLC maintaining a positive at- © Jones Offline&Medical
Bartlett Direction
Learning, LLC
titude about feedback.
NOT FOR SALE OR DISTRIBUTION Viewing QI feedback as a mechanism for NOTOffl FOR
ine SALE
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is medical guidance from the physi-
personal growth rather than criticism provides the best atmo- cian to the EMT in the form of written protocols, policies, or
sphere for ongoing individual and system development. procedures to guide patient triage, transportation, and trans-
port decisions. Offline medical direction is accomplished with-
out direct voice-to-voice contact. Rather, it is determined in
LEARNING OBJECTIVE
© Jones & Bartlett Learning,advance LLC by the medical director©ofJones the EMSS & or
Bartlett
a regionalLearning,
or LLC
• Define medical direction, and discuss the EMT’s role in the process.
NOT FOR SALE OR DISTRIBUTION state medical advisory committee. NOT FOR SALE OR DISTRIBUTION
A protocol may consist of
standing orders, a requirement to contact medical direction via
Medical Direction radio or telephone, or both. Standing orders are the aspects of
the protocol that the EMT initiates without a requirement to
Medical direction is defined as the accountability for the medi- contact medical direction. Some protocols, such as administra-
cal conduct © Jones & Bartlett Learning, LLC
of EMS personnel by a physician knowledgeable in tion of a certain © medication,
Jones & may Bartlett
requireLearning, LLC
contact with medical
prehospital NOT FOR SALE OR DISTRIBUTION
emergency care. The type of care provided in the direction before NOT FOR SALE OR DISTRIBUTION
treatment. Another aspect of medical direction
field should be carefully considered and judged to be medically is the responsibility for review of the QI program.
prudent by physicians who are expert in emergency medicine.
Depending on the size of the service, more than one physician Scenario Follow-up
may share in accepting this responsibility.
© JonesEvery
& Bartlett
ambulanceLearning, LLC
service or rescue squad must have physician © Jones The motor & vehicle
Bartlett crashLearning, LLC
victim had ultrasound at the bedside,
medical direction. State laws address the practice of medicine and NOT FOR SALE OR DISTRIBUTION
which identifi ed free blood near the spleen. Emergency computed
delegate responsibility to physician extenders, such as EMTs, para- tomography (CT) scan of the head and neck revealed no head in-
medics, and physician assistants. The relationship of the EMT to jury or neck fracture. The patient was brought emergently to the
medical direction is best understood by reference to the medical operating room, where the bleeding from the spleen was stopped,
practice act in your state. In general, however, the EMT might be an otherwise fatal injury.
considered to be a designated© Jones
agent & Bartlett
of the medical directorLearning,
and the LLC © Jones
Many people in diverse roles responded to this&individual.
A fellow
care rendered an extension ofNOT FOR SALE OR DISTRIBUTION
the medical director’s authority. motorist, who had read a “First NOT FOR SALE OR car
There, First Care” poster, saw the DISTRIBUTION
The type of medical direction can vary. The term medical over- off the road, called the dispatch center for help, went to the patient’s
sight has been offered by the National Association of EMS Physi- side, and remained there until help arrived. Police and rescue person-
cians in reference to system-wide responsibility. Within an EMSS, nel arrived to secure the scene and help extricate the victim. Both
there may be many individuals who assume responsibilities for an emergency medical responder (EMR) and an emergency medical
© Jones
medical direction. From& the
Bartlett
ground Learning,
up, it would startLLC with the technician (EMT) © cared
Jones & Bartlett
for the patient. The Learning,
EMT identified LLC
that the
ambulanceNOT serviceFOR SALE OR DISTRIBUTION
medical director, who takes responsibility for patient met NOT FOR SALE OR DISTRIBUTION
criteria for direct transport to a trauma center. This com-
the medical conduct of that service’s EMTs. Within a region, med- munity had organized in advance to identify hospitals willing and able
ical directors from the hospitals and ambulance services may join to deliver emergency, lifesaving care to injured patients.
together to promote uniform treatment protocols. Other physi- Who saved this life? Without all the partners and prior planning,
cians may provide online medical direction for particular patients it may have been lost. The credit goes to all who developed and
© Jones
from&a medical
Bartlett Learning,
control LLC
console, often located in a regional hospi- © Jones & Bartlett
participated Learning,
in this emergency LLC system (EMSS).
medical service
tal where physicians
NOT FOR SALE OR DISTRIBUTION familiar with the EMS system offer 24-hour NOT FOR SALE OR DISTRIBUTION
direct contact with the EMTs regarding patient care issues. Some
systems only provide this service for advanced EMS providers. Summary
An EMS system medical director may assume responsibility for
the medical conduct of the system as a whole. Medical directors of EMTs work in cooperation with many people in providing
© Jones & Bartlett Learning,timely
training programs assume responsibility for the clinical accuracy LLCand effective medical care. © Jones
Other workers& Bartlett
includeLearning,
lay LLC
of the educational offerings, provide critical input regarding
NOT FOR SALE OR DISTRIBUTION prac- rescuers, dispatchers, fi rst responders, fi re and police
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tical skills, and help to oversee and arrange for clinical rotations. nel, and physicians and nurses in receiving hospitals. As an
EMT, you must be familiar with your primary responsibili-
Online Medical Direction ties, which include personal safety and the safety of others, pa-
Online medical direction involves the direct, real-time contact tient assessment, prompt patient care, safe transportation and
by telephone© Jones & Bartlett Learning, LLC
or radio with a physician who guides treatment, © Jones
transfer, appropriate & Bartlettand
documentation, Learning,
record keeping,LLC and
transport,NOT FOR SALE OR DISTRIBUTION
and triage decisions at the scene. The EMT might communication NOT FOR SALE OR DISTRIBUTION
of findings with medical directors and hospital
contact medical direction for a treatment order, such as whether personnel. Most important is your responsibility as a patient
to assist a patient in administration of the patient’s nitroglyc- advocate. You may be the first medical professional the patient
erin for chest pain. The EMT might contact medical direction encounters in an EMSS. A caring and empathetic attitude is an
for assistance in triage of multiple casualties at the scene. Other essential characteristic of an effective EMT. You should review
uses of online medical direction include a physician resource © Jones & Bartlett
the following Learning,
learning checklist LLC and help retain the
to reinforce
for patients who are refusing medical assistance but who are NOT FOR SALE OR DISTRIBUTION
information you learned in this chapter. Good luck in your
believed to have critical illnesses that warrant emergency care. EMS work!

© Jones & Bartlett © Jones & Bartlett Learning, LLC

The Learning, LLC
Bottom Line NOT FOR SALE OR DISTRIBUTION
Learning Checklist interventions with basic equipment typically found on an

ambulance, under medical oversight, linking the patient
✓ An emergency medical © Jones & Bartlett Learning, LLC from the scene to the emergency
services system (EMSS) is the planned © Jones & Bartlett
healthcare system.Learning, LLC
configuration of community resources and personnel neces- ✓ An advanced emergency NOT FOR SALE(AEMT)
medical technician pro-
OR DISTRIBUTION
sary to provide immediate medical care to patients with sud- vides basic and limited advanced care, including administra-
den or unexpected illness or injury. tion of certain drugs.
✓ Although most growth and development of EMS systems oc- ✓ A paramedic is an allied health professional whose primary
curred over the past 40 years, several key historical events focus is to provide advanced emergency medical care for
helped to shape EMS over the last century: critical© Jones
and emergent& patients.
BartlettParamedics
Learning, LLC
possess complex
✓ NOT
DuringFOR SALE OR DISTRIBUTION
the Napoleonic Wars, army surgeon Baron Dom- knowledge and skills necessary
NOT FOR SALE OR DISTRIBUTION to perform basic and ad-
inique-Jean Larrey introduced his ambulance volantes. vanced interventions with equipment found on an ambu-
✓ Horse-drawn ambulances were introduced during the lance, under medical oversight.
Civil War, under the direction of Dr. Jonathan Letterman. ✓ Primary responsibilities of the EMT include personal safety
✓ During the Korean War in the 1950s, helicopters were and safety of others, patient assessment, lifting and moving,
© Jones & Bartlett
used to Learning,
rapidly evacuateLLC the wounded to mobile army © Jonestransport
and transfer of care,LLC
record keeping, and patient
surgical hospitals (MASH units). advocacy.
✓ One of the first hospital-based ambulance services was ✓ Other responsibilities of the EMT include extrication, com-
initiated by Cincinnati General Hospital in the mid- munications, and vehicle and equipment maintenance.
1860s. The first motorized ambulance is said to have ✓ EMTs should dress appropriately to instill confidence, show
been provided by Michael Reese Hospital of Chicago and interest in their job, and possess a sensitive awareness of their
© Jones
St. Vincent’s Hospital in 1899.& Bartlett Learning, LLC environment and the needs © Jones
of others & Bartlett
around them. Learning, LLC
✓ CPR and portable NOT FOR SALE OR DISTRIBUTION
defi brillators were introduced in the ✓ EMTs should maintain NOT FOR SALE OR
up-to-date knowledge andDISTRIBUTION
skills
1960s. through continuing education and refresher training.
✓ Introduction of biotelemetry in the late 1960s allowed for ✓ EMTs play several important roles in quality assurance,
advanced life support. including reviewing prehospital documentation to ensure
✓ Medical societies played a significant part in the devel- accuracy, reviewing ambulance runs to ensure that the
©opment
Jones & Bartlett
of EMSS, Learning,
including the National LLCEMT Training © Jones
prehospital care was& appropriate,
Bartlett Learning, LLC from
gathering feedback
Curriculum currently used. The curriculum was an out- NOT FOR SALE OR DISTRIBUTION
patients and hospital personnel on the quality of care, pre-
growth of work by these physician groups in the 1960s. ventive maintenance of the vehicle and equipment, and
✓ In 1966 the National Academy of Sciences published the maintaining personal skills.
landmark paper Accidental Death and Disability: the Ne- ✓ Medical direction is the oversight of clinical patient care by a
glected Disease of Modern Society. physician.
✓ In 1973, federal legislation provided funding for the de- ✓
© JonesOnline
& Bartlett
medicalLearning, LLCthe direct, real-time con-
direction involves
velopment of EMSS throughout the United States. tact by telephone or radio with a physician who directs treat-
✓ The EMS Agenda for the Future is a modern document ment, transport, and triage decisions at the scene or while en
that defines 14 elements of an effective EMS system. route to the hospital.
✓ The EMS Education Agenda for the Future, the National ✓ Offline medical direction is medical guidance from the phy-
EMS Core Content, the National EMS Scope of Practice sician to the EMT in the form of written protocols, policies,
© Jones & Bartlett Learning, LLCor procedures that guide©patient
Model, and the National EMS Education Standards en- Jones & Bartlett
triage, Learning,
transportation, and LLC
compass multipleNOT stepsFOR
intended to enhance effective transport decisions.
SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION
EMS education and practice.
✓ The National Highway Traffic Safety Administration Key Terms
(NHTSA) provides leadership for EMS on a federal level.
✓ Emergency medical responders (EMRs, or first responders), Advanced emergency medical technician (AEMT) An AEMT
such as police and fi refi ghters, are often equipped with oxy- © basic
provides Jones & Bartlett
and limited advancedLearning,
care, includingLLC
adminis-
tration of certain drugs under medical oversight to critical and
gen, automated defi brillators, and airway equipment and NOT FOR SALE OR DISTRIBUTION
may respond in first-responder cars or police or fire vehicles. emergent patients who access the EMS system. Also called
They possess knowledge and skills to provide lifesaving in- EMT-Intermediate (EMT-I).
terventions while awaiting additional EMS response and can Biotelemetry Method by which biological data are transferred
assist higher level personnel on the scene. from one location to another by radio or telephone.
✓ Emergency medical technicians (EMTs) provide basic © Jones & Bartlett Learning, LLC
emer-
gency medical care and transportation for critical and emer- NOT FOR SALE OR DISTRIBUTION
gent patietns who access the EMS system. They perform

18 Chapter 1 Introduction to Emergency Medical Care http://evolve.elsevier.com
© Jones & Bartlett

Emergency medicalLearning, LLCOften arriving before the © Jones
responder (EMR) & following,
3. Of the Bartlettwhich
Learning, LLC
is the leading cause of trauma deaths?
ambulance, EMRs such as police and firefighters are equipped
a. Electrocution
with oxygen, automated defibrillators, and airway equipment b. Motor vehicle crashes
and may respond in first-responder cars or police or fire ve- c. Falls
hicles. They possess knowledge and skills to provide lifesaving d. Burn injuries
interventions while awaiting additional EMS response and can
© on
assist higher-level personnel Jones & Bartlett Learning, 4.LLC
the scene. An EMT is caring for a patient © Jones & Bartlett
with cardiac chest pain Learning,
and LLC
Emergency medical technician NOT FOR SALE OR DISTRIBUTION
(EMT) EMTs provide basic emer- wants to administer aspirin NOT FOR SALE OR call
to the patient. The EMT must DISTRIBUTION
gency medical care and transportation for critical and emergent and consult with a physician before the aspirin can be admin-
patients who access the EMS system. They perform interven- istered. This is best described by which of the following?
tions with basic equipment typically found on an ambulance a. Offline medical direction
under medical oversight, linking the patient from the scene to b. Quality assurance
the emergency healthcare system. c. Online© Jones
medical & Bartlett Learning, LLC
direction
Medical direction The active participation of physicians oversee- d. NOT FOR SALE OR DISTRIBUTION
Telemetry
ing medical care in an EMS system; includes protocol devel-
opment, needs assessment of the system, education, quality Match the following descriptions with the EMS system
improvement, and outcome studies, as well as online medical role (a-e).
direction. Also called “medical control.” Column A Column B
© Jones & Bartlett
Offline Learning,
medical direction LLC
The accountability by a physician for © Jones
5. The & BartlettofLearning,
intersection hospital and LLC a. Emergency medical
EMS providers through the use of protocols, quality improve- NOT FOR SALE OR DISTRIBUTION
prehospital care. responder
ment activities, educational endeavors, and other measures to 6. Trained individual who provides b. Emergency depart-
ensure effective field care. initial life-sustaining care (AED, ment
Online medical direction The accountability of field care by a CPR) with minimal equipment. c. Critical care unit
physician though the use of radio or telephone communica- 7. Responsible for prioritizing calls, d. Emergency medical
tions. © Jones & Bartlett Learning, LLC communicating with EMS © Jonesdispatcher
pro- & Bartlett Learning, LLC
Paramedic Allied health professional whose primary focus is viders, and giving phone NOT FOR SALE OR DISTRIBUTION
instruc- e. EMT
to provide advanced emergency medical care for critical and tions to bystanders.
emergent patients. Paramedics possess complex knowledge 8. Usually the first medical person
and skills necessary to perform basic and advanced interven- to see the patient.
tions with equipment found on an ambulance, under medical
9. Which of the following best defines the physician’s involve-
oversight. © Jones & Bartlett Learning, LLC
ment and participation in all phases of the EMS system to
Personal protective equipment (PPE) Variety of safety equip- NOTcare?
ensure quality FOR SALE OR DISTRIBUTION
ment ranging from gloves, goggles, clothing, and masks to
self-contained breathing apparatus (SCBA) designed to protect
a. Categorization
the EMT at the scene.
b. Standardization
Quality improvement (QI) Methods of ensuring a high level of
c. Systemization
d. Medical direction
© Jonespatient
& Bartlett
care. Learning, LLC © Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION NOT
ForFOR SALEReview
Further OR DISTRIBUTION
Review Questions
1. Which of the following is a system of resources and person- In the Student Workbook
nel necessary to provide immediate care to ill and injured • Multiple-choice questions
patients? © Jones & Bartlett Learning,• LLC Matching questions © Jones & Bartlett Learning, LLC
NOT FOR
a. Emergency medical services systemSALE OR DISTRIBUTION • Fill in the blank questions NOT FOR SALE OR DISTRIBUTION
b. Ambulance service • Short answer questions
c. “Enhanced 9-1-1” dispatching system • True/false questions
d. Hospital emergency service • Case scenario questions
• Crossword puzzle
2. Which© ofJones & Bartlett
the following Learning,
most affected the earlyLLC
growth and © Jones & Bartlett Learning, LLC
NOT FOR
development SALE OR
of prehospital DISTRIBUTION
emergency care? On EvolveNOT FOR SALE OR DISTRIBUTION
a. Disaster drills
b. Outpatient clinics • Weblinks
c. War • Lecture notes
d. Laboratory animal research • Exercises

© Jones Learning
& Bartlett Objectives
Learning, LLC © Jones & Bartlett
• Defi Learning, LLC
ne quality improvement, and discuss the EMT’s role in
NOT FOR SALE OR DISTRIBUTION NOT FORtheSALE
process.OR DISTRIBUTION
Cognitive Objectives • Define medical direction, and discuss the EMT’s role in the
process.
• Define emergency medical services (EMS) system.
• Differentiate the roles and responsibilities of the EMT from Affective Objectives
those of other prehospital care providers. © Jones
• Assess areas of personal attitude & Bartlett
and conduct of theLearning,
EMT. LLC
• Describe the roles and responsibilities of the EMT related to
NOT FOR SALE OR DISTRIBUTION • Characterize the variousNOT FOR
methods usedSALE
to OR
access DISTRIBUTION
the EMS
personal safety.
system in your community.
• Discuss the roles and responsibilities of the EMT toward the
safety of the crew, patient, and bystanders.
• State the specific statutes and regulations in your state re-
© Jones
garding the EMS& system.
Bartlett Learning, LLC © Jones & Bartlett Learning, LLC
References
George Washington Medical Faculty Associates: AED program: AED FAQ’s, National Highway Traffic Safety Administration: National EMS Core Content,
© Jones &Washington,
BartlettDC, Learning,
2007. LLC © JonesWashington,
DC, 2005 US DepartmentLLCof Transportation.
NOT FORGillespie
SALE OR DISTRIBUTION
C: Emergency NOT FOR
Medical Technician’s Oath, 1994, National Association SALE
National Highway OR
TrafficDISTRIBUTION
Safety Administration: National EMS scope of practice
of Emergency Medical Technicians (NAEMT). model, DOT HS 810 657, Washington, DC, February 2007, US Department
Institute of Medicine: Committee on the Future of Emergency Care in the of Transportation.
United States Health System: EMS at the crossroads, Washington, DC, 2006, National Highway Traffic Safety Administration: US Department of Health and
National Academies Press. Human Services, Public Health Services, Health Resources and Services Ad-
Institute of Medicine: Committee on Quality of Health Care in America: Cross- ministration, Maternal and Child Health Bureau: EMS agenda for the future,
ing the quality chasm: a new ©health
Jones system&for Bartlett Learning,
the 21st century , Washington, LLCWashington, DC, 1996, US Department
© Jones & Bartlett
of Transportation . Learning, LLC
DC, 2001, National Academies Press. National Highway Traffic Safety Administration: US Department of Health and
McCaig LF, Burt CW: National NOT FOR
Hospital SALEMedical
Ambulatory OR DISTRIBUTION
Care Survey: Human Services, Public Health NOTServices, FOR SALEand
Health Resources OR DISTRIBUTION
Services Ad-
2003 emergency department summary—advance data from Vital and Health ministration, Maternal and Child Health Bureau: Emergency medical services
Statistics 358, Hyattsville, Md, 2005, National Center for Health Statistics. education agenda for the future: a systems approach, Washington, DC, 2000,
Miniño AM, et al: National Vital Statistics Report 55(19):8, 2007. US Department of Transportation.
National Academy of Sciences–National Research Council: Accidental death
and disability: the neglected disease of modern society, Washington, DC, 1966,
© Jones
National & Bartlett
Academy Press . Learning, LLC © Jones & Bartlett Learning, LLC

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NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning,

Scenario The origins of EMS date back to antiquity, as in the story of

Historical NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

Table 1-1 Emergency Medical Services (EMS) Chronology

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

Although physicians have functioned as prehospital pro-

Delineation of The Dispatch System

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Figure 1-5 © Jones & Bartlett

Figure 1-7 An EMT in the ﬁeld communicates by a portable

as alerting the trauma team or preparing an isolation room for

© Jones & Bartlett Learning, LLC

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

Figure 1-9 Four levels of EMS providers. Provider level 1: Emergency

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

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Figure 1-19 An EMT presents a patient history to the emergency

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

Prehospital Care Report

Incident location Pt. destination Transport by

Patient’s age Sex F M Chief complaint Mechanism of injury

Patient Vital Signs

City, State, Zip Relationship

Hospital notification Assistance Call outcome

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symptoms can be caused by serious conditions such as carbon

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Box 1-1 Emergency Medical Technician’s Oath

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Appearance and Attitude

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by one state of the validity of the EMT certiﬁcation granted

LEARNING OBJECTIVE American Heart Association

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As an EMT, you should be an active participant in the QI

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© Jones & Bartlett © Jones & Bartlett Learning, LLC

Learning Checklist interventions with basic equipment typically found on an

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© Jones & Bartlett

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

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