Emergency Medical Responder: First

Responder in Action 2nd Edition,

(Ebook PDF)
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Marvin Hudson, AAS, NREMT-P Steve Peterson, CPhT, BS, MEd

Richmond Community College Director of Education, Fortis College
Hamlet, NC Phoenix, AZ
Craig Jacobus, BA/BS, DC, NREMT-P, EMSI Lorna Ramsey, RN, MSN, NREMT-P
PHTLS Region 3 Coordinator Program Director, Emergency Medical Services
EMS Education Tidewater Community College
Metropolitan Community College Virginia Beach, VA
Fremont, NE
Steve Rollin, Paramedic
FF/PM, Schuyler Fire Department, Schuyler, NE
BLS Program Coordinator
Charlene Jansen, BS, MM, EMT-P Yavapai College Public Services
EMS Programs Coordinator Prescott Valley, AZ
St. Louis Community College
Dawn Sgro, NREMT-P, BS, EMSI
St. Louis, MO
Program Director
Shawn Komorn, MA, LP Allied Health and Nursing
Director of Initial Education/Assistant Professor Lorain County Community College
Department of Emergency Health Sciences Elyria, OH
University of Texas Health Science Center
Kristal Smith
San Antonio, TX
Paramedic Technology
Dean C. Meenach, RN, BSN, AAS, CEN, EMT-P Central Georgia Technical College
Director of EMS Education Macon, GA
Mineral Area College
Todd E. R. Strom, JD, MS, NREMT-P
Park Hills, MO
Paramedic Instructor
Keith A. Monosky, PhD(c), MPM, EMT-P Hennepin County Medical Center
Associate Professor Minneapolis, MN
Department of Nutrition, Exercise, and Health Sciences
Adriana Laura Torrez, LP, AAS
Central Washington University
EMS Education Coordinator
Ellensburg, WA
Methodist Health Systems of Dallas
Kenneth Moorhouse Dallas, TX
Assistant Professor Karen Urick, EMT, SEI
School of Emergency Services EMT Program Coordinator
Daytona State College North Seattle Community College
Daytona Beach, FL Seattle, WA
Kevin O’Hara
Lance Villers, PhD, LP
Nassau County EMS Academy
Assistant Professor and Chair,
East Meadow, NY
Department of Emergency Health Sciences
Donna Olafson, MA, NREMT-P University of Texas Health Science Center
Director, EMT/MICT Program San Antonio, TX
Kansas City, KS

vi  Author and Contributors

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Technical Editors
Lynn Browne-Wagner, RN, BSN Dean C. Meenach, RN, BSN, AAS, CEN, EMT-P
EMS Program Director Director of EMS Education
Northland Pioneer College Mineral Area College
Holbrook, AZ Park Hills, MO

Thomas Falvo, DO, MBA Bonnie L. Pastorino, AAS

Department of Emergency Medicine EMT Department
York Hospital Northland Pioneer College
York, PA Holbrook, AZ
Medical Director
Newberry Township Fire Department & EMS, Inc.
Etters, PA

Author and Contributors  vii

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Brief Contents
1 4
Preparatory 1 Airway Management, Respiration,
 CHAPTER 1 and Ventilation 198
EMS Systems and Research 2  CHAPTER 10
 CHAPTER 2 Airway Management, Respiration,
Workforce Safety and Wellness 30 and Ventilation 199
 CHAPTER 3
Legal and Ethical Issues
and Documentation
79 5
Patient Assessment 234
 CHAPTER 4
EMS System Communications 104  CHAPTER 11
Therapeutic Communications
 CHAPTER 5 and Patient History 235
Medical Terminology 116
 CHAPTER 12
Patient Assessment 249
2
Function and Development 6
of the Human Body 130
Medical Emergencies 301
 CHAPTER 6  CHAPTER 13
The Human Body 131
Medical Overview 304
 CHAPTER 7  CHAPTER 14
Pathophysiology 161 Neurologic Disorders 309
 CHAPTER 8  CHAPTER 15
Life Span Development 170 Endocrine Disorders 322
 CHAPTER 16
3 Respiratory Disorders 331
 CHAPTER 17
Pharmacology 185 Cardiovascular Disorders 348
 CHAPTER 9  CHAPTER 18
Pharmacology 186 Abdominal and Gastrointestinal Disorders 368

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 CHAPTER 19 9
Genitourinary and Renal Disorders 376
 CHAPTER 20 Special Patient Populations 594
Gynecologic Disorders 385  CHAPTER 35
 CHAPTER 21 Obstetrics 595
Anaphylaxis 394  CHAPTER 36
 CHAPTER 22 Neonatal Care 616
Toxicology 406  CHAPTER 37
 CHAPTER 23 Pediatrics 622
Psychiatric Disorders 421  CHAPTER 38
 CHAPTER 24 Older Adults 643
Diseases of the Nose 431  CHAPTER 39
Patients with Special Challenges 655
7
Shock 434
10
 CHAPTER 25 EMS Operations 665
Shock 435  CHAPTER 40
Principles of Emergency Response
8 
and Transportation 667
CHAPTER 41
Trauma 441 Incident Management 682
 CHAPTER 26  CHAPTER 42
Trauma Overview 443 Multiple-Casualty Incidents 687
 CHAPTER 27  CHAPTER 43
Bleeding and Soft Tissue Trauma 449 Air Medical Transport 693
 CHAPTER 28  CHAPTER 44
Chest Trauma 482 Vehicle Extrication 697
 CHAPTER 29  CHAPTER 45
Abdominal and Genitourinary Trauma 491 Hazardous Materials Awareness 706
 CHAPTER 30  CHAPTER 46
Trauma to Muscles and Bones 498 Terrorism and Disaster Response 714
 CHAPTER 31
Head, Face, Neck, and Spine Trauma 524 Appendixes
 CHAPTER 32 Appendix A: Cardiopulmonary Resuscitation 725
Special Considerations in Trauma 546 Appendix B: Rural and Frontier EMS 745
 CHAPTER 33 Glossary 749
Environmental Emergencies 561
 CHAPTER 34 Credits 775
Multisystem Trauma 589 Index 777

Brief Contents  ix
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Contents
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Kickass Torrents | The Pirate Bay | ExtraTorrent
Foreword xvii Patient Positioning 63
Preface xviii Skill Drill 2-5: Direct Carry 64
Skill Drill 2-6: Draw Sheet Transfer 66
Equipment 67
1 Death and Dying 72
On the Scene: Wrap-Up 77
Preparatory 1 Sum It Up 77

៑ CHAPTER 1 ៑ CHAPTER 3
EMS Systems and Research 2 Legal and Ethical Issues
On the Scene 3 and Documentation 79
Introduction: The Emergency Medical Responder 3
On the Scene 80
Origins of Emergency Medical Services 4
Introduction: The Importance of Legal
Overview of the Emergency Medical Services and Ethical Care 80
System 9
The Legal System 81
Phases of a Typical EMS Response 17
Scope of Practice 82
Characteristics of Professional Behavior 19
Consent 84
Duties as an EMR 22
Refusals 85
EMS Research 27
Advance Directives and Do not
On the Scene: Wrap-Up 28 Resuscitate Orders 88
Sum It Up 28 Assault and Battery 90
Abandonment 90
៑ CHAPTER 2 Negligence 90
Workforce Safety and Wellness 30 Confidentiality 92
On the Scene 32 Special Situations 93
Introduction 33 Documentation 94
Wellness 33 On the Scene: Wrap-Up 101
Preventing Disease Transmission 38 Sum It Up 101
Skill Drill 2-1: Removing Gloves 42
Injury Prevention 46 ៑ CHAPTER 4
Lifting and Moving Patients 49 EMS System Communications 104
Body Mechanics and Lifting Techniques 50 On the Scene 104
Skill Drill 2-2: Two-Person Power Lift 53 Introduction 105
Emergency Moves 54 Communications Systems 105
Urgent Moves (Rapid Extrication) 60 The Call 108
Nonurgent Moves 60 Legal Considerations 114
Skill Drill 2-3: Three-Person Direct Ground Lift 61 On the Scene: Wrap-Up 114
Skill Drill 2-4: Two-Person Extremity Lift 62 Sum It Up 114
Transferring a Supine Patient from Bed to
Stretcher 62

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៑ CHAPTER 5 ៑ CHAPTER 8
Medical Terminology 116 Life Span Development 170
On the Scene 116 On the Scene 170
Introduction 117 Introduction: Life Span Development 171
Word Parts 117 Infants 171
Plural Medical Terms 121 Toddlers 174
Body Positions and Directional Preschoolers 175
Terms 121 School-Age Children 177
Common Medical Abbreviations Adolescents 178
and Acronyms 124 Early Adulthood 180
On the Scene: Wrap-Up 129 Middle Adulthood 181
Sum It Up 129 Late Adulthood 181
On the Scene: Wrap-Up 183

2 Sum It Up 184

Function and Development

of the Human Body 130
3
Pharmacology 185
៑ CHAPTER 6
The Human Body 131 ៑ CHAPTER 9
On the Scene 132 Pharmacology 186
Introduction: Understanding the Structure On the Scene 187
and Function of the Body 133 Introduction 187
Body Systems 133 Drug Sources, Names, and References 187
Homeostasis 133 Drug Forms 188
Body Cavities 133 Routes of Drug Administration 190
The Musculoskeletal System 134 Drug Administration 191
The Respiratory System 142 On the Scene: Wrap-Up 197
The Circulatory System 148 Sum It Up 197
The Nervous System 152
The Integumentary System 154
The Digestive System 155
The Endocrine System 156
4
The Reproductive System 157 Airway Management,
The Urinary System 158 Respiration, and
On the Scene: Wrap-Up 159 Ventilation 198
Sum It Up 160
៑ CHAPTER 10
៑ CHAPTER 7 Airway Management, Respiration,
Pathophysiology 161 and Ventilation 199
On the Scene 161 On the Scene 200
Introduction: Pathophysiology 162 Introduction: Airway Emergencies 201
Cell Function and Injury 162 The Respiratory System 201
Factors Affecting Cell Function 162 Airway Management 204
Disease Risk Factors 166 Inspecting the Airway 206
Causes of Disease 167 Clearing the Airway 208
On the Scene: Wrap-Up 168 Keeping the Airway Open: Airway Adjuncts 210
Sum It Up 169 Skill Drill 10-1: Sizing and Inserting an Oral Airway 212

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Assessment of Ventilation 214

Skill Drill 10-2: Sizing and Inserting a Nasal
Airway 215
6
Assessment of Oxygenation 217 Medical Emergencies 301
Management of Adequate and Inadequate
Respiration 217 ៑ CHAPTER 13
Skill Drill 10-3: Setting Up an Oxygen Delivery Medical Overview 304
System 220
On the Scene 304
Skill Drill 10-4: Discontinuing and Oxygen Delivery
Introduction 304
System 222
The Responsive Medical Patient 305
Management of Inadequate Ventilation 224
The Unresponsive Medical Patient 307
Skill Drill 10-5: Mouth-to-Mask Ventilation 227
On the Scene: Wrap-Up 308
Special Considerations 231
Sum It Up 308
On the Scene: Wrap-Up 232
Sum It Up 233
៑ CHAPTER 14
Neurological Disorders 309
On the Scene 310

5 Introduction 310
Altered Mental Status 310
Patient Assessment 234 Seizures 311
Stroke 315
៑ CHAPTER 11 Syncope 318
Therapeutic Communications On the Scene: Wrap-Up 320
and Patient History 235 Sum It Up 320

On the Scene 236

Introduction 236 ៑ CHAPTER 15
The Communication Process 236 Endocrine Disorders 322
Communicating with the Patient 237 On the Scene 322
Patient History 244 Introduction 323
On the Scene: Wrap-Up 248 Glucose 323
Sum It Up 248 Types of Diabetes Mellitus 324
Complications of Diabetes Mellitus 325
៑ CHAPTER 12 Hypoglycemia 325
Patient Assessment 249 Hyperglycemia 326
Patient Assessment 327
On the Scene 251
Age-Related Considerations 328
Introduction 251
Emergency Care 328
Scene Size-Up 251
On the Scene: Wrap-Up 329
An Overview of Patient Assessment 262
Sum It Up 329
Performing the Primary Survey 264
Performing the Secondary Survey 274
Skill Drill 12-1: Measuring Blood Pressure
៑ CHAPTER 16
by Auscultation 280 Respiratory Disorders 331
Skill Drill 12-2: Measuring Blood Pressure On the Scene 332
by Palpation 281 Introduction 332
Skill Drill 12-3: Performing the Secondary Survey 287 Assessing the Patient with Breathing Difficulty 332
Reassessment 294 Specific Respiratory Disorders 337
Skill Drill 12-4: Reassessment 295 On the Scene: Wrap-Up 346
On the Scene: Wrap-Up 297 Sum It Up 346
Sum It Up 297

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៑ CHAPTER 17 Introduction 395

Causes of Allergic Reactions 395
Cardiovascular Disorders 348
What Happens in an Allergic Reaction 395
On the Scene 349 Patient Assessment 399
Introduction 349 Emergency Care 401
Cardiovascular Disease 350 Skill Drill 21-1: Assisting the Patient with a Prescribed
Cardiac Arrest 355 Epinephrine Autoinjector 403
Skill Drill 22-1: Adult Automated External Defibrillator Age-Related Considerations 404
Sequence 364 On the Scene: Wrap-Up 405
On the Scene: Wrap-Up 365 Sum It Up 405
Sum It Up 366

៑ CHAPTER 18 ៑ CHAPTER 22
Toxicology 406
Abdominal and Gastrointestinal
On the Scene 407
Disorders 368
Introduction 407
On the Scene 368
What Is a Poison? 407
Introduction 369
Commonly Misused and Abused Substances 408
The Acute Abdomen 369
Ingested Poisons 415
Patient Assessment 372
Inhaled Poisons 416
Emergency Care 373
Injected Poisons 418
On the Scene: Wrap-Up 373
Absorbed Poisons 418
Sum It Up 373
On the Scene: Wrap-Up 419
Sum It Up 419
៑ CHAPTER 19
Genitourinary and Renal Disorders 376 ៑ CHAPTER 23
On the Scene 377 Psychiatric Disorders 421
Introduction 377 On the Scene 422
Review of Urinary System 377 Introduction 422
Renal Disorders 378 Behavior 422
Patient Assessment 381 Behavioral Change 422
Emergency Care 383 Psychological Crises 423
On the Scene: Wrap-Up 383 Excited Delirium 427
Sum It Up 383 Assessment and Emergency Care for Patients
with Psychiatric Disorders 427
Medical and Legal Considerations 429
៑ CHAPTER 20 On the Scene: Wrap-Up 429
Gynecologic Disorders 385 Sum It Up 429
On the Scene 386
Introduction 386
Review of the Female Reproductive System 386
៑ CHAPTER 24
Assessment of the Gynecologic Patient 387 Diseases of the Nose 431
Emergency Care of the Gynecologic Patient 388 On the Scene 431
Nontraumatic Gynecologic Conditions 388 Introduction 432
Traumatic Gynecologic Emergencies 391 Causes of Epistaxis 432
On the Scene: Wrap-Up 392 Assessment Findings and Symptoms 432
Sum It Up 392 Emergency Care 433
On the Scene: Wrap-Up 433
Sum It Up 433
៑ CHAPTER 21
Anaphylaxis 394
On the Scene 395

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Introduction 483
7 Anatomy of the Chest Cavity 483
Categories of Chest Injuries 483
Shock 434 Closed Chest Injuries 483
Open Chest Injuries 489
៑ CHAPTER 25 On the Scene: Wrap-Up 490
Shock 435 Sum It Up 490
On the Scene 435
Introduction 436
Types of Shock 436 ៑ CHAPTER 29
The Stages of Shock 437 Abdominal and Genitourinary Trauma 491
Shock in Infants and Children 439 On the Scene 491
Shock in Older Adults 439 Introduction 492
On the Scene: Wrap-Up 440 Abdominal Trauma 492
Sum It Up 440 Genitourinary Trauma 495
Patient Assessment 495

8 Emergency Care 496

On the Scene: Wrap-Up 496
Sum It Up 496
Trauma 441
៑ CHAPTER 26 ៑ CHAPTER 30
Trauma to Muscles and Bones 498
Trauma Overview 443
On the Scene 499
On the Scene 443
Introduction 499
Introduction 444
The Musculoskeletal System 499
Reconsidering the Mechanism
Musculoskeletal Injuries 504
of Injury 444
Patient Assessment 507
Trauma Patient with Significant Mechanism
of Injury 445 Emergency Care 508
Trauma Patient with No Significant Mechanism Splinting 509
of Injury 447 Care of Specific Musculoskeletal Injuries 513
On the Scene: Wrap-Up 448 Skill Drill 30-1: Immobilizing a Shoulder Injury 514
Sum It Up 448 Skill Drill 30-2: Applying the SEFRS Adaptor 518
On the Scene: Wrap-Up 522
៑ CHAPTER 27 Sum It Up 522
Bleeding and Soft Tissue Trauma 449
On the Scene 450
៑ CHAPTER 31
Head, Face, Neck, and Spine Trauma 524
Introduction 451
On the Scene 525
Anatomy Review 451
Introduction 525
Bleeding 451
Anatomy and Physiology Review 525
Soft Tissue Injuries 458
Injuries to the Head 528
Burns 468
Injuries to the Face 531
Emotional Support 475
Injuries to the Neck 535
Dressing and Bandaging 475
Injuries to the Brain and Spinal Cord 538
Skill Drill 34-1: Applying a Roller Bandage 479
On the Scene: Wrap-Up 544
On the Scene: Wrap-Up 480
Sum It Up 544
Sum It Up 480
៑ CHAPTER 32
៑ CHAPTER 28 Special Considerations in Trauma 546
Chest Trauma 482 On the Scene 547
On the Scene 482 Introduction 547

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Trauma in Pregnancy 547

Emergency Care of Pregnancy
Pediatric Trauma 551
Complications 613
Trauma in Older Adults 555
On the Scene: Wrap-Up 614
Trauma in the Cognitively Impaired Patient 557
Sum It Up 614
On the Scene: Wrap-Up 558
Sum It Up 558
៑ CHAPTER 36
៑ CHAPTER 33 Neonatal Care 616
Environmental Emergencies 561 On the Scene 617
On the Scene 561 Introduction 617
Introduction 562 Caring for the Newborn 617
Body Temperature 562 On the Scene: Wrap-Up 620
Exposure to Cold 564 Sum It Up 620
Exposure to Heat 570
Water-Related Emergencies 572 ៑ CHAPTER 37
Bites and Stings 577 Pediatrics 622
On the Scene: Wrap-Up 587 On the Scene 623
Sum It Up 587 Introduction 623
៑ CHAPTER 34 Anatomic and Physiologic Differences
in Children 624
Multisystem Trauma 589 Assessment of the Infant and Child 628
On the Scene 589 Common Problems in Infants and Children 634
Introduction 590 On the Scene: Wrap-Up 641
Multisystem Trauma 590 Sum It Up 641
Blast Injuries 591
On the Scene: Wrap-Up 592
Sum It Up 592
៑ CHAPTER 38
Older Adults 643

9 On the Scene 643

Introduction 644
Assessment of the Older Adult 644
Special Patient Common Health Problems in Older Adults 646
Populations 594 On the Scene: Wrap-Up 653
Sum It Up 653
៑ CHAPTER 35
Obstetrics 595
On the Scene 596
៑ CHAPTER 39
Introduction 596 Patients with Special Challenges 655
Anatomy and Physiology Review 596 On the Scene 656
Normal Pregnancy 599 Introduction 656
Assessing the Pregnant Patient 600 Child Abuse and Neglect 656
Normal Labor 601 Elder Abuse 658
Normal Delivery 603 Homelessness 659
Pregnancy and Birth—Cultural Bariatric Patients 660
Considerations 609 Patients with Special Healthcare Needs 660
Premature Birth 610 Hospice Care 662
Multiple Gestation 611 On the Scene: Wrap-Up 663
Complications of Delivery 611 Sum It Up 663

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10 ៑ CHAPTER 45
Hazardous Materials Awareness 706
EMS Operations 665 On the Scene 706
Introduction 707
៑ CHAPTER 40 Hazardous Materials 707
Principles of Emergency Response On the Scene: Wrap-Up 713
and Transportation 667 Sum It Up 713
On the Scene 668
Introduction 668 ៑ CHAPTER 46
Principles of Emergency Response 669 Terrorism and Disaster Response 714
On the Scene: Wrap-Up 681 On the Scene 715
Sum It Up 681 Introduction 715
Types of Weapons of Mass Destruction 716
៑ CHAPTER 41 Weapons of Mass Destruction Incident
Incident Management 682 Response 720
On the Scene 682 On the Scene: Wrap-Up 722
Introduction 682 Sum It Up 722
Incident Command System 683
NIMS Components 683 Appendixes
On the Scene: Wrap-Up 686 Appendix A: Cardiopulmonary Resuscitation 725
Sum It Up 686 Skill Drill A-1: One-Rescuer Adult Cardiopulmonary
Resuscitation 726
៑ CHAPTER 42 Skill Drill A-2: Two-Rescuer Adult Cardiopulmonary
Multiple-Casualty Incidents 687 Resuscitation 729
Skill Drill A-3: One-Rescuer Child Cardiopulmonary
On the Scene 687
Resuscitation 732
Introduction 688
Skill Drill A-4: One-Rescuer Infant Cardiopulmonary
Multiple-Casualty Incidents 688 Resuscitation 735
On the Scene: Wrap-Up 692 Skill Drill A-5: Adult Automated External Defibrillator
Sum It Up 692 Sequence 737
Skill Drill A-6: Clearing a Foreign Body Airway
៑ CHAPTER 43 Obstruction in a Conscious Adult 738
Skill Drill A-7: Clearing a Foreign Body Airway
Air Medical Transport 693 Obstruction in an Unconscious Adult 740
On the Scene 693 Skill Drill A-8: Clearing a Foreign Body Airway
Introduction 693 Obstruction in a Conscious Child 741
Air Medical Transport Considerations 693 Skill Drill A-9: Clearing a Foreign Body Airway
On the Scene: Wrap-Up 696 Obstruction in an Unconscious Child 742
Sum It Up 696 Skill Drill A-10: Clearing a Foreign Body Airway
Obstruction in a Conscious Infant 743
Skill Drill A-11: Clearing a Foreign Body Airway
៑ CHAPTER 44 Obstruction in an Unconscious Infant 744
Vehicle Extrication 697
Appendix B: Rural and Frontier EMS 745
On the Scene 697
Emergency Response in Rural and Frontier
Introduction 698
Areas 745
Role of the EMR on an Extrication Scene 698
The Challenges of Rural and Frontier EMS 745
Equipment 698
Stages of Extrication 698
Additional Scene Hazards 704
Glossary 749

On the Scene: Wrap-Up 705 Credits 775

Sum It Up 705
Index 777

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Foreword
The science that guides Emergency Medical Services has evolved. Now more than
ever we know that the first arriving medical personnel make a real difference in
patient outcome. In 2007 the National Highway Traffic Safety Administration
(NHTSA) released the National EMS Scope of Practice Model. This project re-
named the first level of emergency medical services as emergency medical re-
sponder (EMR). This change was important so the public could distinguish
between first responding personnel. It also acknowledged the important medical
care provided at this level. At the same time, the EMS community recognized that
in many areas of this country the EMR is on the scene with patients for prolonged
periods of time before other EMS personnel arrive. This meant they needed to
perform other skills. Thus was born the “new” EMR.
In 2009 NHTSA published new EMS Education Standards to guide EMS in-
struction. This text follows the new EMS Education Standards. The text adds this
new knowledge and places more emphasis on key areas where the EMR plays a
pivotal role in patient survival. The enhanced content in the areas of airway and
cardiology and new content such as basic pharmacology reflect those changes.
Barbara Aehlert wrote this text with great depth and clarity. The text design
helps the reader understand key content. Each chapter opens with a scenario to
grab your interest and reflective questions that will make the reading more mean-
ingful. This is augmented by “Stop and Think” boxes that enhance the content.
The emergency medical responder (EMR) bridges the gap between the pub-
lic and other emergency providers. EMR are stationed throughout our communi-
ties. Highly skilled emergency medical responders can be found on barges or
ships on our nation’s waterways, in police cars, on fire trucks, in industrial settings
and on college campuses—to name just a few. They provide rapid care to sick or
injured patients until other members of the EMS team arrive. Many EMRs volun-
teer their time in our community. This dedication strengthens our EMS service
and widens the safety net for our communities. We are thankful for your decision
to become an emergency medical responder—we couldn’t do our job as effec-
tively without you.

Kim D. McKenna RN BSN CEN EMT-P

Director of Education
St. Charles County Ambulance District
St. Peters, MO

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Preface
This book and the materials that accompany it are designed to teach you how to
safely and efficiently provide immediate care to an ill or injured person in accor-
dance with the guidelines established by the Department of Transportation (DOT)
National Emergency Medical Services Education Standards. Although they may be
used alone to increase your awareness about what to do in an emergency situation,
these materials are best used in an EMR training program.
This book has been divided into ten modules (divisions) that contain chapters
with information relevant to each module. Each chapter begins with a list of knowl-
edge, attitude, and skill objectives that describe what you should be able to do
after completing the chapter and related exercises.
Before studying a chapter, first read the knowledge objectives. These objec-
tives will give you an idea of the information you should obtain from reading the
material in this book. Next, read the attitude objectives to learn about the behav-
iors that you are expected to develop as a healthcare professional. Then read the
skill objectives to discover the procedures you should be able to perform after
reading about, observing, and practicing each skill.
After reviewing the objectives, begin reading the chapter. Each chapter con-
tains illustrations, tables, and other features to help you understand the informa-
tion presented. For example, most skills discussed in this book are also demonstrated
on the DVD that accompanies this text. When you have finished reading the chap-
ter, go through the objectives again to be sure that you have met them.
At the end of each module of the EMR course, time is allowed for skill practice,
review, and evaluation. Watch the skills on the DVD to help you learn and master
each skill. Use the practice questions in the accompanying workbook to help you
assess your mastery of the knowledge objectives presented in the course. Flashcards
are provided on the DVD to help you prepare for the final examination.
Additional information that is related to your role as an EMT is located in the
appendixes at the end of this book.
I hope you find this text helpful. If you have comments or suggestions about
how I could improve this text, please drop me a line. I would like to hear from you.

Barbara Aehlert, RN
Southwest EMS Education, Inc.
Phoenix, AZ/Pursley, TX

Changes to the Second Edition

The second edition of Emergency Medical Responder: First Responder in Action has been
completely rewritten to conform to the new National EMS Education Standards
published by the National Association of EMS Educators (NAEMSE) in January
2009. Specific differences between the first and second editions are outlined below:
• Chapter 1: New coverage on characteristics of professional behavior; additional
coverage on primary duties as an EMR.

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• Chapter 2: New content on wellness; updated content on injury prevention, lift-

ing and moving patients, body mechanics and lifting techniques, emergency
and urgent moves, patient positioning, using restraint, and death and dying.
• Chapter 3: Updated information on the ethics, the legal system, and docu-
mentation.
• Chapter 4 (Chapter 14 in first edition): Updated content on EMS system com-
munication.
• Chapter 5: New content on medical terminology, including root words, prefixes,
suffixes, combining forms, plural medical terms, body positions and directional
terms (Figures 5-1 and 5-2), and a list of common abbreviations and acronyms.
• Chapter 6 (Chapter 4 in the first edition): Enhanced content on the human body
including three full-page color plates of anatomical figures (Plates A, B, and C).
• Chapter 7: All new content on pathophysiology, including cell function, factors
affecting cell function, disease risk factors, and causes of disease.
• Chapter 8 (Chapter 13 and Appendix 3 in the first edition): Expanded content
on life span development covering infants, toddlers, preschoolers, school-age
children, adolescents, early adulthood, middle adulthood, and late adulthood.
• Chapter 9: All new content on the principles of pharmacology.
• Chapter 10 (Chapter 6 in first edition): Updated content on airway management.
• Chapter 11: New content on therapeutic communications and history taking.
• Chapter 12 (Chapter 8 in the first edition): Updated content on reassessment.
• Chapter 13: All new content on medical overview, the responsive medical pa-
tient, and the unresponsive medical patient, including an updated algorithm on
assessment of the medical patient (Figure 13-1).
• Chapter 14: All new content on neurological disorders: seizures, stroke, syncope,
and headache.
• Chapter 15: All new coverage of endocrine disorders, including coverage of dia-
betes, hypoglycemia, and hyperglycemia.
• Chapter 16 (Chapter 13 in first edition): Expanded coverage of respiratory dis-
orders, including determining the patient’s level of respiratory distress, pertus-
sis, cystic fibrosis, and spontaneous pneumothorax.
• Chapter 17 (Chapter 7 in first edition): New information on the chain of survival.
• Chapter 18: New content on abdominal and gastrointestinal disorders; review of
digestive system anatomy and physiology, and the acute abdomen; new images
include referred pain (Figure 18-3) and the best position for abdominal exami-
nation (Figure 18-4).
• Chapter 19: New content on genitourinary/renal disorders, including review of
urinary system, renal disorders, and new images of AV shunts (Figure 19-2) and
arteriovenous fistulas (Figure 19-3).
• Chapter 20: New content on gynecologic emergencies, including nontraumatic
and traumatic gynecological conditions such as PID, STDs, ovarian cyst, and ap-
parent sexual assault.
• Chapter 21: New content on immunology, including age-related consider-
ations.
• Chapter 22: New content on toxicology.
• Chapter 23 (section of Chapter 9 in first edition): Updated and expanded con-
tent on psychiatric disorders, including new content on excited delirium.
• Chapter 24 (section of Chapter 10 in first edition): Expanded coverage on dis-
eases of the nose, epistaxis.
• Chapter 25 (section of Chapter 10 in first edition): Greatly expanded coverage
on shock, including shock in older adults.

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• Chapter 26: New coverage on trauma overview, including reconsidering the

MOI, and trauma patient with significant MOI.
• Chapter 27 (Chapter 10 in first edition): Expanded coverage of bleeding and
soft tissue trauma.
• Chapter 28 (section of Chapter 10 in first edition): Updated and expanded cov-
erage of chest trauma, including new content on rib fractures, flail chest, and
simple, tension, and open pneumothorax.
• Chapter 29 (section of Chapter 10 in first edition): Expanded coverage of abdomi-
nal and genitourinary trauma, including closed and open abdominal injuries.
• Chapter 30 (Chapter 11 in first edition): Updated content on orthopedic trauma
including a new Skill Drill 30-2 (Application of the SEFRS Adaptor).
• Chapter 31 (section of Chapter 10 in first edition): Expanded coverage, includ-
ing injuries to the face and injuries to the neck.
• Chapter 32: Expanded content on special considerations in trauma, including
trauma in pregnancy and pediatric trauma (sections of Chapters 12 and 13 in
first edition), and new content on trauma in older adults.
• Chapter 33 (section of Chapter 9 in first edition): Expanded coverage of envi-
ronmental emergencies.
• Chapter 34: New content on multisystem trauma, including blast injuries.
• Chapter 35 (Chapter 12 in first edition): Updated coverage of obstetrics, includ-
ing abuse, substance abuse, and diabetes mellitus as complications of pregnancy;
high-risk pregnancy; and postpartum complications.
• Chapter 36 (section of Chapter 12 in first edition): Expanded coverage on neo-
natal care.
• Chapter 37 (Chapter 13 in first edition): Expanded coverage, including new im-
ages of anatomy of children (Figure 37-2), epiphyseal growth plates (Figure
37–3), and using a bulb syringe (Figure 37-9).
• Chapter 38 (section of Appendix 3 in first edition): Greatly expanded content
on older adults, including common health problems in older adults, such as
problems of the cardiovascular and respiratory systems and metabolic and endo-
crine problems.
• Chapter 39 (section of Appendix 3 in first edition): Expanded content on pa-
tients with special challenges, including sections on child abuse and neglect, el-
der abuse, homelessness, bariatric patients, patients with special healthcare
needs, and hospice care.
• Chapter 40 (Chapter 14 in first edition).
• Chapter 41 (section of Chapter 14 in first edition): Expanded content on inci-
dent management, including coverage of NIMS components of command and
management, preparedness, resource management, communications and infor-
mation management, supporting technologies, and ongoing management and
maintenance.
• Chapter 42 (section of Chapter 14 in first edition): Expanded coverage of multiple-
casualty incidents, including algorithms for START and JumpSTART triage sys-
tems (Figures 42-2 and 42-4).
• Chapter 43 (section of Chapter 14 in first edition): Expanded coverage of air med-
ical transport, including schematic of a helicopter landing zone (Figure 43-3).
• Chapter 44 (section of Chapter 14 in first edition): Updated coverage, including
new content on hazard control and safety considerations such as information on
alternative fuels and renewable fuels.
• Chapter 45 (section of Chapter 14 in first edition): Expanded coverage of haz-
ardous materials.
• Chapter 46 (Appendix 1 in first edition).

xx  Preface
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Supplements
The supplements for the second edition of Emergency Medical Responder are de-
signed around the student and are based on the new Education Standards re-
leased in January 2009 by the DOT NHTSA Office of EMS.

For the Student

• Emergency Medical Responder Workbook Includes features to help you study and
master the material in each chapter: Reading Assignment, Sum It Up, Tracking
Your Progress, Chapter Quiz, and Quiz Answers.
• Connect™ Assignments Web-based assignments that are tied to the Education
Standards and the textbook material.
• Media Rich eBook Electronic book that incorporates video and animation di-
rectly into the pages of the textbook.
• LearnSmart An online diagnostic learning system that determines the level of
student knowledge, then feeds the student appropriate content. Students take
an online pretest to qualify medical terms they already know, think they know,
or don’t know at all. Based on a new approach to learning, students are forced
to think about whether they really know the terms, which will generate stronger
metacognitive skills.
• ActivSim A web-based EMS field simulator that prepares students for certifica-
tion and enables them to hone their medical skills by using virtual patients with
real-life cases and real-time feedback.

For the Instructor

• Asset Map Correlates the Aehlert textbook chapters to the NAEMSE Education
Standards and all available McGraw-Hill resources.
• Instructor Manual Contains objectives, class preparation and personnel, key
terms, skills, lesson outlines that are linked to the objectives and the PowerPoint
slides, and lesson enhancements including chapter quizzes, quiz answers, and
activities.
• McGraw-Hill Connect™ Web-based gradable assignment and assessment plat-
form that helps students connect to their coursework, helps instructors become
more efficient, and helps administrators report results. The Connect content is
tied to the NAEMSE Education Standards and the Aehlert objectives.
• FISDAP Test Bank Contains over 1000 test questions developed by FISDAP to
prepare students for National Registry exams. The questions are tied to the text-
book and mapped to the Education Standards and Bloom’s taxonomy.
• Resource Table Located on the Connect site, the Resource Table includes files
of the textbook assets (art files, videos, animations, and text) for those instruc-
tors who prefer to create their own PowerPoint presentations or lectures.

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Acknowledgments
No book is published without the assistance of many people. My heartfelt thanks
to Laura Horowitz for her assistance with all of the components of this book. You
have been a joy to work with. Thanks also to the staff at McGraw-Hill. A special
thanks to Rick Hecker, whose attention to detail during the production process
was sincerely appreciated.
The contributors for this book and the materials that accompany it were se-
lected because of their experience in EMS. Whether a physician, nurse, or para-
medic, they each treat their patients with compassion and respect, and display
professionalism every day they are on the job. Their commitment to excellence
and professionalism in EMS is evident throughout this book. Thank you to Gary
Smith, MD; Lynn Browne-Wagner, RN; Andrea Lowrey, RN; Terence Mason, RN;
Suzy Coronel, CEP; Paul Honeywell, CEP; Captain Randy Budd, CEP; Captain
Holly Button, CEP; Captain Sean Newton, CEP; and Major Raymond Burton. Special
thanks to Janet Fitts, RN, and Edith Valladares for their invaluable contributions to
the Spanish Guide to Patient Assessment for the Emergency Medical Responder featured on
the student CD.
Thanks to Kim McKenna, RN, for her suggestions for the first edition of this
book and to Steve Kidd and the staff of Delve Productions, who worked very hard
to make sure that the DVD that accompanies this book is easy to use and useful for
emergency medical responders. Rick Brady did an outstanding job taking the
photos that appear in this book. Thanks to Carin Marter, CEP; the City of Mesa
Fire Department, the City of Tempe Fire Department, and AirEvac Services
(Phoenix, AZ) for providing additional photos.
Thanks to the many EMS professionals who reviewed this text and the materi-
als that accompany it. Each reviewer provided valuable comments and suggestions
that were carefully read and discussed. Modifications have been made where
needed based on your comments.

Barbara Aehlert, RN
Southwest EMS Education, Inc.
Phoenix, AZ/Pursley, TX

xxii  Preface
aeh19804_fm_i-xxviii.indd Page xxiii 12/3/09
Features to Help You Study and Learn
Knowledge, Attitude,
and Skill Objectives
Knowledge Objectives alert students to what they
should expect as they progress through the chapter.
The Knowledge Objectives are tied to the new
National Emergency Medical Services Education
Standards.
The use of knowledge, attitude, and skill objectives is easier for studentss
to grasp.
—Karen Bowlin
Mid-Plains Community College – North Platte
On the Scene and On the
Scene: Wrap-Up
Setting the stage with a description
of an EMS call, Think About It
questions give EMT students a feel
for scene size-up and the primary
survey. At the end of the chapter,
the Wrap-Up completes the case
study by outlining the primary
survey and emergency care for
the patient.
The On the Scene and Wrap-Up sections provide
the students an opportunity to apply the knowledge gee
that they have just gained to real-life situations.
—Dawn Sgro
Lorain County Community College
1:14:31 PM user-s176 /Volumes/MHBR-New/MHBR125/MHBR125-FM
Guided Tour
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CHAPTER
EMS System Communications
4
By the end of this chapter, you should be able to:
Knowledge Objectives 1. Define communications.
2. Describe the role of the Federal Communications Commission in EMS
system communications.
3. Describe the following components of an EMS communications system: base
station, mobile two-way radio, portable radio, repeater, digital radio equipment,
cellular telephone.
4. Discuss the role of an emergency medical dispatcher in a typical EMS event.
5. List the proper methods of initiating and terminating a radio call.
6. List the correct radio procedures during each phase of a typical EMS call.
7. Discuss the communication skills that should be used when interacting with
individuals from other agencies.
8. Identify the essential components of the verbal report.
9. Explain the importance of effective communication of patient information
in the verbal report.
10. State legal aspects to consider in verbal communication.
Attitude Objectives 11. Explain the rationale for providing efficient and effective radio
communication and patient reports.
Skill Objectives 12. Perform a simulated, organized, concise radio transmission.
13. Make a brief, organized report to give to an emergency medical technician or
aeh19804_ch11_234-248.indd Page 236 10/22/09 8:02:57 PM user-s178 paramedic arriving
p g at an incident scene where you
y were the first on the scene.
You and your EMT partner respond to a private ate res
a residence for a report of
On the Scene abdominal pain. You arrive to find a 17-year-old female
emale ly
e lying on her right side in
her bed. The patient is awake and reports that sshe ha has been feeling ill since
yesterday. She is complaining of a fever and severe
ere abd
e abdominal pain. ■
You are excited about having just completed your emergency medical
On the Scene THINK ABOUT
the localITfire
responder training. You were issued a pager and
department earlier in the day. Later that evening
radio for
As you
yourread thisgoes
pager chapter,
notifying you of your first call. A “million” thoughts run through your head
off,think about the following
wing qu
 After being dispatched to the call, when should
as you inform dispatch of your response to the scene. At the scene, you
questions:
hould you
h y make contact with
the dispatcher?
are the first EMR to arrive. Your gloves are already on as you knock on the
 You summon an advanced life support unit to
door. An elderly man greets you at the door of the residence
into the kitchen where his wife is seated. You immediately
and leads you
arrive quickly.
thinkWhat
of the
o the sc
information should you re
relay
scene, and the paramedics
elay to the paramedics?
aeh19804_ch11_234-248.indd Page 248 10/22/09 8:03:12 PM user-s178
questions needed to gather a thorough patient history. You begin asking
the patient questions and move on to the next question with barely a
pause for breath. ■
THINK ABOUT IT
As you read this chapter, think about the following questions:
 How does your ability to be an active listener affect patient care?
 What is the most effective method of interviewing a patient?
 What questions are pertinent to a patient interview, and how quickly
should the questions be asked?
 Is there a benefit to establishing rapport with your patient?
 How do the answers to your questions affect your treatment plan?
With the exception of signs and symptoms, the com-
Problems
ponents of the SAMPLE with communication
memory can occur atany
aid have been previously
patient’s dignity, and treat the patient with respect.
When
step talking
in with family members, friends, and by-
Introduction this process. standers, avoid interrupting when they are talking.
discussed. You will recall from Chapter 7 that a sign is any
medical or trauma condition displayed by the patient that
Speak clearly and use common words (avoid using
medical terms). Speak at an appropriate speed or
rying agescan
Your patients are individuals of varying withbea seen, Thesmelled,
wide heard, Sender measured, or felt. A symp-
range of life experiences, knowledge, tomabilities,
ge, reasoning is any condition described bystarts
Communication the patient.
with anSigns and
information
pace, not too rapidly and not too slowly.
source.
 The history is part of the patient assessment
The patient
mmunicatesymptoms
skills, and medical needs. To communicate effectivelywill besource
discussed
of in morecommunication
verbal detail in Chapteris12.spoken orduring
writtenwhich you find out pertinent facts about the
with them, you must understand that communication words. A message is the information to be communi- patient’s medical history. Components of the patient
requires more than knowing the proper
roper words and their
meaning. Communicating in a respectful
spectful manner
On the may
Scene
cated. The sender decides the message he wants
Wrap-Up
vey and then encodes it. Encoding
to con-
history
g is the act of present
include the chief complaint, history of the
placing aillness, past medical history (pertinent to
mean the difference between acquiring
cquiring information message into words or images so that it is understood
and missing it. This chapter focusess on the basic require- similarly by the sender and receiver. Successfulnent
As you prepare to interview the patient, you force your-
the medical event), and current health status (perti-
commu-
to the medical event).
ments for successfully communicating
ing with your patients. nication depends, in part, on the sender’s ability to con-
self to take a deep breath and slow down. You begin the
vey information clearly and simply. When you ask
patient assessment by kneeling next to the patient’s
 When asking questions to find out the patient’s
medical history, use open-ended questions when
questions of a patient or relay information to her, you
The Communication Process
Proccess knee, remembering not to kneel directly in front of the
are the sender. To ensure that the message you are
patient. You proceed to introduce yourself and ask the
possible. Open-ended questions require that the pa-
tient answer with more than a yes or no. Questions
sending is clear, give careful thought to the words you
patient for her name. She responds by asking you to call that require a yes or no answer are called closed or
Objectives 1, 2
In Chapter 4, you learned that communication most
ommunication is theof the
choose and be confident that the information you relay
her “Linda” and then tells you that she has felt dizzy
to the patient is accurate.
morning. You assure her that you are there
direct questions.
 The chief complaint is the reason the patient called
The sender selects the path (channel) for transmit-
exchange of thoughts and messages sages thattooccurs
help herbyand all of the crew will take good care of her.
ting the message to the receiver. Examples of for assistance. The history of the present illness is a
channels
sending and receiving information. She smiles and thanks you for understanding how she
on. The communica- chronological record of the reason the patient is
include air, light, electricity, radio waves, paper, and
ments: feels. You are able
tion process involves six basic elements: to ask her all the proper questions,
postal systems. When communicating with a patient,medical assistance. It includes the patient’s
seeking
pausing politely after each question to allow her time to
1. A source (the sender) you use your mouth (sound) and body (gesture)complaint
chief to and the patient’s answers to ques-
answer. You also know that your questions should not
2. Encoding create and alter your message. In face-to-facetions commu-about the circumstances that led up to the re-
“lead” the patient to an answer and that you should not quest for
nication, the communication channels used consist of medical help. The conclusion you reach
3. The message answer the questions for her. You are able to comfort about what is wrong with your patient is called a
air (sound) and light (gesture), enabling the exchange
4. The channel your patient and begin the proper treatment based on
of information between you and the patient. field impression.
5. A receiver (decoder) your interaction. The patient expresses her thanks, stat-  OPQRST
When interacting with patients and their families, is a memory aid that may help identify the
ing she is thankful that you were there to help her. ■
6. Feedback awareness of nonverbal behavior is also important. type and location of a patient’s pain or discomfort.
OPQRST stands for Onset, Provocation/palliation/
position, Quality, Region/radiation, Severity, and
Sum It Up Time.
 The Wong-Baker FACES Pain Rating Scale is a tool
 The communication process involves six basic ele- used to assess pain in children 3 years or older.
ments: source, encoding, message, channel, receiver  SAMPLE is a memory aid used to standardize the
(decoder), and feedback. The source of verbal com- approach to history taking. SAMPLE stands for
munication is spoken or written words. A message is Signs and symptoms, Allergies, Medications, Past
the information to be communicated. The sender de- medical history, Last oral intake, and Events lead-
cides the message he wants to send and then encodes ing to the injury or illness. It is important to obtain
it. Encoding is the act of placing a message into words a SAMPLE history from all responsive patients. A
or images so that it is understood by the sender and sign is any medical or trauma condition displayed
receiver. The sender selects the path (channel) for by the patient that can be seen, heard, smelled,
transmitting the message to the receiver. The receiver measured, or felt. A symptom is any condition
is the person or group for whom the sender’s message described by the patient.
Contents  xxiii
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Always practice proper lifting techniques. Learn-

Stop and Think!
Practical advice and safety tips for EMTs.
Very comprehensive text, student friendly.
—Kevin Dobbe
Coconino Community College Page 210
aeh19804_ch10_198-233.indd
ing to lift by using proper body mechanics takes
training and practice. When practicing, use “spot-
ters” to alert you when you are performing a tech-
nique incorrectly. Practice and practice again until
using correct lifting techniques become a habit.
One bad lift can damage your back for the rest of
10/22/09 8:16:43 PM user-s178
your life!

Carrying Patients and Equipment

W
Objectiveg 33
y p , ( p ),
listen
n (auscultate), and then feel (palpate) body areas
dentify Guidelines
to identify for avoiding
potential injuries. injury
Use your when
sense carrying
of smell to
identify patients and equipment:
tify unusual odors during the exam, such as alco-
hol on the patient’s breath, body, or clothing. Because
it can cause pain, palpation should be performed last.
Memory Aids DCAP-BTLS is a helpful memory aid to remember
what to look and feel for during the physical exam:
Memory aids are shown in color to help the
students find and remember them. DCAP-BTLS
Deformities
Keeps simple things simple and clarifies difficult concepts. Contusions (bruises)
—Chris Coughlin
Abrasions (scrapes)
Glendale Community College
Punctures/penetrations
Burns
Tenderness
Lacerations (cuts)
Swelling p
Another memoryto aaid
midline position
that may as possible.
be helpful The patient’s
is DOTS: nt’s
n
head, torso, and shoulders should move at tthe
Deformities
same time without twisting.
Openɀ injuries
Place the patient’s right hand under the side
de o
d of
Tenderness
his face.
Swelling
ɀ Continue to monitor the patient while she is i in
your care.

ɀ Do not place a patient with a known or suspected

Remember This spinal injury in the recovery position, but assess
the need for suctioning frequently.
Information that is important for the EMT
ɀ There is a potential risk for nerve and vessel
to remember in the field. injury if the patient lies on one arm for a
[These boxes] bridge the gap between the “textbook world” prolonged period in the recovery position. To
and the “real world” very effectively. avoid these types of injuries, it may be necessary
—Jason Segner to roll the patient to the other side.
Blinn College

Keeping the Airway Open:

Airway Adjuncts

xxiv ៑ Contents
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You Should Know

Lists the assessment findings and symptoms Assessment Findings and Symptoms
of Pulmonary Embolism
Assessment Findings and Symptoms
of Acute Pulmonary Edema
for the medical and trauma conditions Common findings and symptoms:  Restlessness, anxiety
 Sudden onset of dyspnea
covered in the text.  Apprehension, restlessness
 Dyspnea on exertion
 Orthopnea
 Increased respiratory rate
 Paroxysmal nocturnal dyspnea
Provide the student with excellent reinforcement.  Increased heart rate
 Frothy, blood-tinged sputum
—James Norris Possible findings and symptoms:  Cool, moist skin
 Pleuritic chest pain
 Use of accessory muscles
Jefferson State Community College  Cough
 Jugular venous distention
 Blood-tinged sputum
 Wheezing
A straightforward presentation of the key information.  Hypotension
 Crackles (rales)
Easy to read and understand.  Rapid, labored breathing
 Increased heart rate
—Mike Ditolla Emergency Care  Increased or decreased blood pressure
University of Utah Allow the patient to assume a position of comfort un- (depending on severity of edema)
less hypotension is present. If the patient is alert but

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Making a Difference Making a Difference

Highlights how healthcare professionals can Taking a medical history is not simply a matter of
make a difference in the lives of their patients. asking a series of rapid-fire questions in order to
aeh19804_ch11_234-248.indd Page 246 10/22/09 8:03:10 PM user-s178 complete a report. Obtaining a useful medical his-
tory is an art. It requires thoughtful questions, good
listening skills, and practice.
Making a Difference
The patient who has an isolated arm injury is often
most comfortable in a sitting or semisitting position. Questions that can be answered with yes or no or
If the patient’s condition requires that he be posi- with one-
tioned on his back, the weight of the patient’s arm
Making
M a or two-word responses are called closed or di-
Difference
rect questions. There are times when asking questions
and splint on his chest and upper abdomen can Cultural
C Considerations
that require a simple yes or no answer is appropriate.
hamper chest movement. If the patient must be posi- SFor instance,
Some healthcare professionals
when asking theend an interview
patient if she haswith
a his-
tioned on his back and the arm must be immobi- atory childofbyhigh
patting her on
blood the head.
pressure, Although
diabetes, andthisother
ges- ill-
lized with the elbow bent, try to splint the patient’s tture is meant
nesses, a yes to
or show friendliness,
no answer it may be
is appropriate, asviewed
it is when
arm so that the weight of the arm and splint will be differently
d the patientbyispeople
having of other cultures.
difficulty For example,
communicating (because
supported on the patient’s upper legs, rather than tthis gesture
of severe is or
pain considered an insult or
difficulty breathing bya Southeast
language bar-
on his chest or abdomen. Using a soft pillow under Asians.
A Theytype
rier). This believe the head isis the
of questioning alsoseat of for
useful the focusing
soul
the injured extremity will help alleviate pain and aand the most
on specific sacredFor
points. part of the body.
example, “Do you Intentionally
have any aller-
distribute the weight more evenly across the chest ttouching
gies?” and a “Is
child’s head
this the without
first thehave
time you consent
ever of
had the
chest
and allow better lung expansion if the patient must parents
ppain?” may make closed
However, the parents or relatives
questions do not angry.
allow an op-
absolutely be transported flat on his back. portunity for the patient to explain what is wrong.
In some situations, the patient will not be able to
answer your questions. For example, the patient may
The Sager Emergency Fracture Response System beWhen you are caring
unresponsive for patients,
or too short of breatha “yes” answerde-
to provide
pe
pertaining to an illness or injury indicates a pertinent
(SEFRS) includes the SX405 compact traction splint and
po
positive, or positive, finding. A “no” indicates a pertinent
SEFRS Adaptor. The SEFRS compact kit treats any limb
negative, or negative, finding. For example, when you
ne
fracture in the body without traction and immobilizes
ar
are caring for a patient who has asthma, pertinent posi-
tiv
tive findings would include shortness of breath and/or a
fe
feeling of tightness in the throat or chest. Pertinent neg-

xxv
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Skill Drills Applying the Sager SX 405 Unipolar Traction Splint

Presents step-by-step procedures for
essential skills.
This text goes into great detail and gives good examples.
—Kevin J. O’Hara
Nassau County EMS Academy
STEP 1  Expose the fracture site. Ask an assistant to STEP 2  Remove and unfold the outer shaft
stabilize the patient’s leg while you remove assembly.
the patient’s shoe and assess distal pulses,
movement, and sensation in the injured leg.

STEP 3  Remove, unfold, and lock the inner shaft STEP 4  Insert the inner shaft assembly into the
assembly. outer shaft assembly. The splint is now
ready to be applied.

STEP 5  Position the splint between the patient’s
legs: Rest the ischial perineal cushion (the
saddle) against the ischial tuberosity, with
the shortest end of the articulating base
toward the ground.
STEP 6  Press down on the (saddle) cushion while
pulling the thigh strap laterally under the
thigh to seat the saddle against the ischial
tuberosity.

Figures
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PATIENT ASSESSMENT impression (also called a first impression) is an “across-  Place the patient’s right hand under the side of
the-room” assessment. As you approach a patient, you his face.
Initial Assessment
will form a general impression of her complaint with-  Continue to monitor the patient while he is in
out her telling you what it is. You can complete it in 60 your care.
Scene Size-up seconds or less. The purpose of forming a general im-
pression is to decide whether the patient looks “sick” or
Primary Survey Secondary Survey “not sick.” A variation of the sick or not sick approach
 Do not place a patient with a known or suspected
consists of three questions:
spinal injury in the recovery position, but assess
General impression: Vital signs
Appearance  Does the patient appear stable? the need for suctioning frequently.
(Work of) Breathing  Does the patient appear stable but is potentially  There is a potential risk for nerve and vessel
Circulation Focused history
(SAMPLE, OPQRST) unstable? injury if the patient lies on one arm for a FIGURE 12-12  Oral airways are available in a variety of
 Does the patient appear unstable? prolonged period in the recovery position. To sizes.
Airway + avoid these types of injuries, it may be necessary
Level of responsiveness Head-to-toe (or focused) If the patient looks sick (unstable), you must act
Cervical spine protection physical exam to roll the patient to the other side.
quickly. As you gain experience, you will develop an
instinct for quickly recognizing when a patient is sick.
Breathing
(Ventilation)
Keeping the Airway Open:
Circulation
(Perfusion)
Airway Adjuncts
Your patient’s condition can change at any time. A
patient that initially appears not sick may rapidly Airway adjuncts are devices used to help keep a pa-
Disability worsen and become sick. Reassess your patient often. tient’s airway open. When using an airway adjunct, you
(Minineurological exam)
must first open the patient’s airway by using one of the
techniques already described. You should then insert
Expose the airway adjunct and maintain the proper head posi-
Before you speak to your patient and find out what is
tion while the device is in place.
Reassessment wrong, stop a short distance from her (Figure 17-13).
Look and listen: (a)
FIGURE 17-12  Patient assessment.  What things stand out in your mind when you first
see her? The use of an airway adjunct does not eliminate the
 Does the patient look ill (medical patient) or need for maintaining proper head positioning.
made safe and you have gained access to the patient injured (trauma patient)? If the patient looks ill,
(Figure 17-12). It usually requires less than 60 seconds are there clues around you that suggest the nature
to complete. However, it may take longer if you must of the illness? For example, the presence of an Oral Airway
provide emergency care to correct an identified prob- oxygen tank suggests that someone in the home
lem. Remember to wear appropriate personal protec- has a chronic medical condition. If the patient is
Objective 17
tive equipment before approaching the patient. injured, what is the mechanism of injury? An oral airway is a curved device made of rigid plastic.
An oral airway is also called an oropharyngeal airway
The primary survey has several parts: (OPA). An OPA is inserted into the patient’s mouth
 General impression and used to keep the tongue away from the back of the
 Airway, level of responsiveness, cervical spine throat. It may be used only in unresponsive patients
protection without a gag reflex.
 Breathing (ventilation) OPAs are available in a variety of sizes (Figure 12-12).
 Circulation with bleeding control (perfusion) Before inserting an OPA, you must determine the cor- (b)
 Disability (minineurological exam)
rect size for your patient. To select the correct size, hold
FIGURE 12-13  (a) An oral airway that is too long can
the OPA against the side of the patient’s face. Select an
 Expose (for examination) press the epiglottis against the entrance of the larynx,
OPA that extends from the corner of the patient’s mouth
 Identification of priority patients resulting in a complete airway obstruction. (b) An oral
to the tip of the earlobe, or from the center of the pa- airway that is too short may come out of the mouth or it
tient’s mouth to the angle of the jaw. If you select an air- may push the tongue into the back of the throat, causing
General Impression way of the wrong size, you can cause an airway obstruction. an airway obstruction.
An airway that is too long can press the epiglottis against
Objective 29 the entrance of the larynx, resulting in a complete airway (Figure 12-13b). A properly sized OPA is one of the best
Whenever you meet someone for the first time, you obstruction (Figure 12-13a). An OPA that is too short tools for maintaining an open airway (Figure 12-14).
form a first impression—sometimes without realizing it. FIGURE 17-13  Form a general impression by pausing a may come out of the mouth or it may push the tongue Skill Drill 12-1 shows the steps for sizing and insert-
You will do the same thing with every patient. A general short distance from the patient. into the back of the throat, causing an airway obstruction ing an oral airway.

xxvi  Contents
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Tables TABLE 17-6 Normal Blood Pressure at Rest

Life Stage Age Systolic Pressure Diastolic Pressure

Newborn Birth to 1 month 74 to 100 50 to 68

This is a modern up-to-date text. It follows the Infant 1 to 12 months 84 to 106 56 to 70

Education Standards and the author has expanded Toddler 1 to 3 years 98 to 106 50 to 70

further in many of the sections past the minimum Preschooler 4 to 5 years 98 to 112 64 to 70

standards. School-age child 6 to 12 years 104 to 124 64 to 80

—Gregory Neiman Adolescent 13 to 18 years 118 to 132 70 to 82

Virginia Office of EMS Adult 19 years and older 100 to 119 60 to 79

The pictures and tables are excellent resources for the

students who are learning the material while trying to
work full time jobs.
—Kristie Skala
Aims Community College

Sum It Up
Summarizes all of the chapter’s content succinctly. Sum It Up
The Sum It Up section does just that—hits on all of the key points
 The communication process involves six basic ele-
once again.
—Craig Schambow ments: source, encoding, message, channel, receiver
Gateway Technical College (decoder), and feedback. The source of verbal com-
munication is spoken or written words. A message is
the information to be communicated. The sender de-
cides the message he wants to send and then encodes
it. Encoding is the act of placing a message into words
or images so that it is understood by the sender and
receiver. The sender selects the path (channel) for
transmitting the message to the receiver. The receiver
is the person or group for whom the sender’s message

xxvii
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Module 1
Preparatory
 CHAPTER 1
EMS Systems and Research 2

 CHAPTER 2
Workforce Safety and Wellness 30

 CHAPTER 3
Legal and Ethical Issues and Documentation 79

 CHAPTER 4
EMS System Communications 104

 CHAPTER 5
Medical Terminology 116
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CHAPTER

1
EMS Systems and Research

By the end of this chapter, you should be able to:

Knowledge Objectives 1. Define the components of Emergency Medical Services (EMS) systems.
2. Differentiate the roles and responsibilities of the emergency medical
responder (EMR) from those of other prehospital care professionals.
3. Define the terms certification, licensure, credentialing, and scope of practice.
4. Describe the benefits of EMR continuing education.
5. Define medical oversight and discuss the emergency medical responder’s role
in the process.
6. Discuss the types of medical oversight that may affect the medical care given
by an EMR.
7. Explain quality management and the EMR’s role in the quality management
process.
8. Describe the phases of a typical EMS response.
9. Describe examples of professional behaviors in the following areas: integrity,
empathy, self-motivation, appearance and personal hygiene, self-confidence,
communication, respect, time management, teamwork and diplomacy,
patient advocacy, and careful delivery of service.
10. List the primary and additional responsibilities of the EMR.
11. Define the role of the EMR relative to the responsibility for personal safety
and the safety of the crew, the patient, and the bystanders.
12. Describe the importance and benefits of research.

Attitude Objectives 13. Characterize the various methods used to access the EMS system in your
community.
14. Defend the importance of continuing education and skills retention.
15. Demonstrate professional behaviors in the following areas: integrity,
empathy, self-motivation, appearance and personal hygiene, self-confidence,
communication, time management, teamwork and diplomacy, respect,
patient advocacy, and careful delivery of service.
16. Accept and uphold the responsibilities of an EMR in accordance with the
standards of an EMS professional.
17. Assess areas of personal attitude and conduct of the EMR.
18. Explain the rationale for maintaining a professional appearance when on
duty or when responding to calls.
19. Describe why it is inappropriate to judge a patient on the basis of a cultural,
gender, age, or socioeconomic model and to vary the standard of care ren-
dered because of that judgment.
20. Value the need to serve as a patient advocate.

2
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21. Assess personal practices relative to the responsibility for personal safety and
the safety of the crew, the patient, and the bystanders.
22. Advocate the need for supporting and participating in research efforts aimed
at improving EMS systems.

Skill Objectives No skill objectives are identified for this lesson.

Minutes from quitting time, you are startled by an overhead page for a “blue
On the Scene team” response to the maintenance building. Grabbing the emergency kit
you carefully checked this morning, you walk quickly to the scene. Fellow
employees recognize your emergency team shirt and wave you to the back
of the building. A worker has been injured while repairing a gear in a lawn
tractor. His hand is stuck in the engine, which still roars loudly. He is in
severe pain and is soaked in sweat. Several of his fingers have been cut off.
Blood is pooling on his forearm and dripping to the floor. Your coworkers
gather around, waiting for you to take action. ■

THINK ABOUT IT
As you read this chapter, think about the following questions:
ɀ What is your most important concern as you approach this and all
emergencies?
ɀ How will you call for additional emergency care?
ɀ Which emergency medical responder skills might you need in this situation?
What other skills may need to be provided by an emergency medical
technician or a paramedic?
ɀ How can your medical protocols assist in this situation?
ɀ What components of the emergency care system is this patient likely to need?

ɀ Designated industrial or commercial medical

Introduction response teams
ɀ Truck drivers
The Emergency Medical Responder ɀ Park rangers
ɀ Coaches
You, the emergency medical responder, are an important
ɀ Athletic trainers
and essential part of the Emergency Medical Services
(EMS) system. An emergency medical responder (EMR) As an emergency medical responder, you will be
is an individual with medical training who is the first to tasked with providing medical assistance and enlist-
arrive at the scene of an emergency, such as a motor ing the aid of other emergency caregivers as needed.
vehicle crash, a life-threatening medical situation, or a You will often have a limited amount of equipment
disaster. Emergency medical responders may be paid or with which to assess a patient, provide emergency
may volunteer as care, and assist other healthcare professionals. The
ɀ Fire department personnel emergency medical responder course will help you
ɀ Law enforcement officers gain the knowledge, attitude, and skills necessary to
be a competent, productive, and valuable member of
ɀ Military personnel
the healthcare team. The curriculum for this pro-
ɀ Members of the ski patrol gram was developed by representatives of federal and
ɀ Teachers state agencies, professional medical organizations,
ɀ Lifeguards and education experts.

The Emergency Medical Responder ្ 3

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Making a Difference
The Goals of Emergency Medical
Responder Training
When you successfully complete an emergency
medical responder training program, you will have
gained the knowledge, attitude, and skills to do the
following:
ɀ Recognize and assess the seriousness of a
patient’s condition or the extent of injuries to
determine the emergency medical care the
patient requires
ɀ Safely and efficiently provide initial emergency
medical care for a victim of a sudden illness or
injury
Origins of Emergency
Medical Services
Ancient Times to the 1800s
As an EMR, you will be giving emergency care to ill
or injured patients. An emergency is an unexpected
illness or injury that requires immediate action to
avoid risking the life or health of the person being
treated. Emergency medical care has been given by
one person to another for hundreds of years. The
Egyptians splinted and dressed wounds. The ill or
injured were treated at the site where the emergency
happened or were carried to a designated healer or
helper. The Good Samaritan stopped to provide care
to a man who had been beaten and left lying on the
side of the road. He wrapped bandages around the in-
jured man’s wounds and then transported him by
donkey to the nearest hotel. The Romans and Greeks
used chariots to remove injured soldiers from the
battlefield.
EMS probably began in 1797 in the Napoleonic
Wars, during which a system of service was provided to
the injured. Baron Dominique-Jean Larrey, a French
surgeon general, used light carriages to transport
casualties from the field to aid stations. The medical
crews operating the carriages were trained to control
severe bleeding and splint fractures. The first civilian
ambulance services in the United States began as hos-
pital-based services in Cincinnati (in 1865) and New
York City (in 1869).
1900 to 1960
The first known air medical transport occurred dur-
ing the retreat of the Serbian army from Albania in
1915. In 1922, the American College of Surgeons
4 ៑ Chapter 1 EMS Systems and Research
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established the Committee on Treatment of Fractures,
which later became the Committee on Trauma.
In the mid-1940s, rural communities recognized
the need for local fire protection and first aid and
began volunteer services to meet the need for these
services. In the 1950s, Mobile Army Surgical Hospital
(MASH) units used helicopters for evacuation in the
Korean War. The rapid evacuation of patients
increased survival. In 1958, Dr. Peter Safar demon-
strated the importance of mouth-to-mouth ventila-
tion. Cardiopulmonary resuscitation (CPR) was shown
to be useful in 1960.
1960 to 1970
In the 1960s, hospital-based mobile coronary care unit
ambulances were successfully being used to treat pre-
hospital cardiac patients in Belfast, Ireland. Meanwhile,
in the United States, volunteers untrained in emer-
gency care provided minimal stabilization at the scene
of an emergency. Transport to the nearest hospital was
provided by funeral homes, taxis, and automobile tow-
ing companies as an optional service.
This fragmented system of care continued in the
United States until the late 1960s. In 1966, the National
Academy of Sciences–National Research Council
(NAS/NRC) published a paper called Accidental Death
and Disability, the Neglected Disease of Modern Society. This
document is commonly called the “white paper” or
“landmark paper.” It exposed the gaps in providing
emergency care in the United States. Some of the areas
identified that needed improvement included the
following:
ɀ Improving citizen knowledge of basic first aid
ɀ Improving ambulance design and equipment
ɀ Improving the training of emergency responders
(ambulance attendants, police and fire personnel)
ɀ Providing physician oversight (medical direction)
ɀ Improving the care provided by hospital emer-
gency departments
ɀ Improving communications and record keeping
ɀ Increasing local government support to provide
the best possible EMS
The Highway Safety Act of 1966 charged the
Department of Transportation (DOT) National High-
way Traffic Safety Administration (NHTSA) with the
responsibility of improving EMS. This act provided
funding for the development of highway safety pro-
grams to reduce the number of deaths related to
highway accidents. The act also established national
standards for the training of emergency medical
technicians and the minimum equipment required
on an ambulance.
aeh19804_ch01_001-029.indd Page 5 9/3/09 1:27:17 PM user-s180
Passage of the Highway Safety Act of 1966 was the
first national commitment to reducing highway-
related injuries and deaths.
The American College of Emergency Physicians
(ACEP) was founded in 1968. In the same year, the
FCC and AT&T designated 9-1-1 as the universal emer-
gency telephone number, and the American Trauma
Society was established. In 1969, the first nationally
recognized EMT-Ambulance (EMT-A) curriculum was
published.
1970 to 1980
The National Registry of emergency medical techni-
cians (NREMT) was founded in 1970. The NREMT
contributes to the development of professional
standards. It also verifies the competency of EMS pro-
fessionals by preparing and conducting examinations.
Recognizing a need for an EMS training program for
law enforcement personnel, NHTSA developed the
Crash Injury Management for the Law Enforcement Officer
training program in the early 1970s. This 40-hour
course later evolved into the First Responder National
Standard Curriculum in 1979.
In 1971, the television program Emergency! aired, fea-
turing paramedics Johnny Gage and Roy Desoto. This
program increased the public’s awareness of EMS. The
Department of Labor officially recognized EMT-A as an
occupational specialty in 1972. In the same year, demon-
stration projects were begun in some states to develop
model regional EMS systems. The Emergency Medical
Services System (EMSS) Act was enacted in 1973. This
law mandated that there should be 15 components of
EMS systems. The components identified were:
 Manpower  Patient transfer
 Training  Coordinated patient
 Communications record keeping
 Transportation  Public information
 Facilities and education
 Review and
 Critical care units
evaluation
 Public safety agencies
 Disaster plan
 Consumer
 Mutual aid
participation
 Access to care
By this time, it was clear that patient care could be
improved if the components of an EMS system worked
together. The EMSS Act provided grant funding to
states and communities that developed EMS systems as
described in the law.
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In 1975, the National Association of emergency
medical technicians (NAEMT) was founded. In the
same year, a study in Seattle, Washington, showed that
the survivability of heart attack victims was improved
with early involvement of advanced life support (ALS)
personnel. In 1977, national standards were developed
for paramedics. In 1979, the American College of
Surgeons Committee on Trauma published Optimal
Hospital Resources for Care of the Injured Patient. To im-
prove hospital capabilities to care for injured patients,
this document identified the need for designation of
three levels of trauma centers.
1980 to 1990
In 1984, the EMS for Children (EMSC) Program
provided funds to improve the EMS system and better
serve the needs of infants and children. In 1985, the
National Research Council published Injury in
America: A Continuing Public Health Problem. This docu-
ment described deficiencies in the progress of
addressing the problem of accidental death and dis-
ability. In 1986, the Injury Prevention Act (followed
by the Injury Control Act of 1990) established the
Division of Injury Epidemiology and Control at the
Centers for Disease Control and Prevention(changed to
the National Center for Injury Prevention and Control
in 1992) to provide leadership for a variety of injury-
related public health activities. In 1987, the American
College of Emergency Physicians published Guidelines for
Trauma Care Systems. This document identified essential
criteria for trauma systems, especially prehospital care
components. In 1988, NHTSA began a statewide EMS
system Technical Assistance Program (TAP). This pro-
gram identified 10 essential parts of an EMS system
and the methods used to assess these areas. States use
the standards set by NHTSA to evaluate how effective
their EMS system is.
Components of the NHTSA Technical Assistance
Program Assessment Standards
 Regulation and policy
 Resource management
 Human resources and training
 Transportation
 Facilities
 Communications
 Public information and education
 Medical direction
 Trauma systems
 Evaluation
Origins of Emergency Medical Services  5
Another random document with
no related content on Scribd:
 DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI

Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
 FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)

The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
 Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA

I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
 The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.

MAKONDE LOCK AND KEY AT JUMBE CHAURO

 This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
 “We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
 Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
 BRAZIER

Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

 FINISHING THE BOTTOM

LAST SMOOTHING BEFORE

BURNING

FIRING THE BRUSH-PILE

 LIGHTING THE FARTHER SIDE OF
THE PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
 Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

 BEATING THE BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT

MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN