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121 Cards in this Set

  • Front
  • Back
History of Emergency Medical Services; When did emergency care emerge?
During warfare in the 20th century
At what time did emergency care lag? Why?
By the 1960s, because it was often limited to large urban areas
What was recommended to fix the 'Accidental Disease and Disability: The Neglected Disease of Modern Society? (4 points)
1)Development of training
2)Development of federal guidelines and policies
3)Provide emergency care and transport
4)Establish staffed emergency departments
What created funding for EMTs?
Highway Safety Act and Emergency Medical Act
Who developed the first National Standard Curriculum for training EMTs in the early 1970s?
DOT (Department of Transportation)
EMS established in most of the United States by...?
1980
Levels of Training?
Lay Rescuer
First Responder
EMT-Basic
EMT-Intermediate
EMT-Paramedic
Components of the EMS System? Access?
Easy access in an emergency is essential.
Administration and Policy?
Policies and procedures are essential.
Medical Direction and Control?
* Each EMS system must have a medical director.
* Medical control may take place online or off-line.
Quality Control and Improvement?
Process used to ensure patient care meets standards.
Other physician input?
Local, state, and national specialists provide guidance.
State-specific statutes and regulations?
All EMS systems are subject to state regulations.
Equipment?
Properly maintained equipment is essential.
Ambulance?
EMT-Bs must be familiar with the ambulance and its functions.
Specialty Centers?
Focusing on care for certain types of patients
Interfacility Transports?
Transportation of patients from one care facility to another
Hospital Staff?
EMS is part of the whole continuum of care.
Working with Public Safety Agencies?
EMT-Bs should understand the role of each agency.
Training?
Quality of care depends on training.
Providing a Coordinated Continuum of Care? (4 phases)
1st Phase—access to EMS system
2nd Phase—out of hospital care
3rd Phase—emergency department care
4th Phase—definitive care
Roles and Responsibilities of the EMT-B: Personal safety?
Safety of crew, patient, and bystanders
Patient assessment?
Patient care based on assessment findings
Other roles? (4 roles)
Lifting and moving patients safely
Transport and transfer of care
Record keeping/data collection
Patient advocacy/confidentiality
Professional Attributes of the EMT-B? (5)
Puts patient’s needs as a priority without endangering self
Maintains professional appearance and manner
Performs under pressure
Treats patients and families with understanding, respect, and compassion
Respects patient confidentiality
Continuing Education? (3)
Continuing education required to renew certification
Keep up-to-date on new procedures and issues on local, state, and national levels
Maintain knowledge and skills
The Well-Being of the EMT-B (3)
Personal health, safety, and well-being are vital to an EMS operation.
Hazards vary greatly.
Mental and physical stresses are part of the job.
Self-Control is achieved thru? (4)
Proper training
Experience
Strategies to cope with stress
Dedication to serving others
Emotional Aspects of Emergency Care?
Even the most experienced *providers have difficulty overcoming personal reactions.
*Emotions must be kept under control at the scene.
Death and Dying?
*Changes in society have altered people’s attitudes toward death.
*Few people have actually witnessed a death.
*Life expectancy has increased.
*Death is something you will have to face.
*Coming to grips with death is part of delivering care.
The Grieving Process? (5 steps)
1. Denial: Refusal to accept
2. Anger: Blaming others
3. Bargaining: Promising to change
4. Depression: Openly expressing grief
5. Acceptance: The simple “yes”
What Can an EMT-B Do? (4)
1) Provide gentle, caring support.
2) Make helpful statements and comments.
3)Be yourself and sincere.
4)Understand that grief is a process that must be worked through.
Dealing With Family Members? (4)
1) Be calm. Family members may express rage, anger, and despair.
2) Use a gentle tone of voice and a reassuring touch, if appropriate.
3) Respect the family’s wishes and privacy.
4) Do not create false hope.
Initial Care of the Dying, Critically Ill, or Injured Patient?
Anxiety
Pain and fear
Anger and hostility
Depression
Dependency
Guilt
Mental health problems
Receiving unrelated bad news
Caring for Critically Ill and Injured Patients?
Avoid sad and grim comments.
Orient the patient.
Be honest.
Acknowledge the seriousness of the condition.
Allow for hope.
Locate and notify family members
Injured and Critically Ill Children?
Basic treatments remain the same.
Consider variations between children and adults.
Being accompanied by a relative may relieve the child’s anxiety.
Dealing With the Death of a Child?
A child’s death is a tragic event for both EMT-Bs and the family.
How the family deals with the death will affect its stability.
EMT-B is responsible for helping the family.
Helping the Family?
Acknowledge the fact of the child’s death in a private place.
Tell the parents that they may see their child.
Do not overload the parents with information.
Parents should be encouraged to talk about their feelings.
Stressful Situations?
Mass-casualty situations
Infant and child trauma
Amputations
Abuse
Death or injury of a coworker
Factors Affecting Patient Reactions to Stressful Situations?
Fear of medical personnel
Alcohol/substance abuse
Chronic diseases
Mental disorders
Medication reactions
Age
Nutritional status
Guilt feelings
Past experience
Uncertain Situations?
When uncertain if the patient’s condition is an emergency, contact medical control.
Minor symptoms may be early signs of severe illness or injury.
When in doubt, err on the side of caution
Stress Warning Signs and the Work Environment?
EMS is a high-stress job.
Understand the causes of stress.
Prevent stress from negatively affecting you.
Physiological Manifestations of the Fight-or-Flight Response?
Rise in respirations and pulse
Increase in blood pressure
Cool, clammy skin
Dilated pupils
Tensed muscles
Increase blood glucose levels
Perspiration
Decreased circulation to GI tract
Physical Symptoms of Stress?
Fatigue
Changes in appetite
Headaches
Insomnia/hypersomnia
Irritability
Psychological Reactions to Stress?
Fear
Depression
Anger
Frustration
Critical Incidents?
Mass-casualty incidents
Traumatic injury or death of child
Automobile crash caused by EMS personnel
Serious injury or death of coworker
Signs and Symptoms of Posttraumatic Stress Disorder?
Depression
Startle reactions
Flashback phenomena
Amnesia of event
Critical Incident Stress Management?
Confronts responses to critical incidents and defuses them
Process designed to help EMS personnel deal with responses to critical incidents
Composed of trained peers and mental health professionals
Stress and Nutrition?
Prolonged stress drains the body’s reserves.
Under stress, body’s fuel sources are consumed in large quantities.
Glucose
Quickest source of energy
Taken from glycogen stored in liver
Proteins
Drawn from muscles
Long-term source of glucose
Fats
Used by tissues for energy
Water
Conserved by retaining sodium
Vitamins and minerals
Depletes vitamins B, C, and most minerals that are not stored in large amounts by the body
Benefits of Exercise and Proper Nutrition?
Muscles will grow and retain protein.
Bones store calcium and become stronger.
Well-balanced meals provide necessary nutrients to body.
Critical Incident Stress Debriefing (CISD)?
Held within 24 to 72 hours of a major incident
All information is confidential.
CISD leaders and mental health personnel offer suggestions for overcoming the stress.
Components of CISM System ?
Preincident stress education
On-scene peer support
Disaster support services
Defusings
CISD
Follow-up services
Spouse and family support
Community outreach programs
Other wellness programs
Stress Management?
There are positive and negative ways of handling stress.
Stress is unavoidable.
Understand the effects of stress.
Find balance in life.
Strategies to Manage Stress?
Change or eliminate stressors.
Change partners to avoid negative or hostile personality.
Stop complaining or worrying about things you cannot change.
Expand your social support system.
Minimize the physical response by:
Taking a deep breath
Stretching
Regular physical exercise
Progressive muscle relaxation
Workplace Issues?
Cultural diversity
Your effectiveness as an EMT-B
Avoiding sexual harassment
Substance abuse
Scene Safety and Personal Protection?
Prepare yourself when dispatched.
Wear seat belts and shoulder harnesses.
Ensure scene is well marked.
Check vehicle stability.
Communicable Diseases?
A disease transmitted from one person to another
Minimize risk of contracting disease with proper protection
Routes of Transmission?
Direct
Being sneezed on
Vehicle (indirect)
Touching contaminated linen
Vector-borne
Bitten by a tick
Airborne
Inhaling contaminated droplets
Common Terms?
Exposure
Contact with blood, bodily fluids, tissues, or airborne droplets directly or indirectly
Universal precautions
Protective measures developed by the CDC to prevent workers from direct or indirect contact with germs
Body substance isolation (BSI)
Infection control techniques based on the assumption that all bodily fluids are infectious
Exposure control plan
Comprehensive plan to reduce the risk of exposure
Body Substance Isolation (BSI)?
Handwashing
Gloves and eye protection
Mask and gowns
Proper disposal of sharps
Reducing Risk of Infection?
Follow the exposure control plan.
Always follow BSI precautions.
Always use a barrier between you and the patient.
Be careful when handling needles.
Always wash your hands.
Make sure all immunizations are current.
Immunizations?
Recommended:
Tetanus-diphtheria boosters (every 10 years)
Measles, mumps, rubella (MMR)
Influenza vaccine (yearly)
Hepatitis B vaccine
Duty to Act?
The EMT-B cannot deny act to a patient with a suspected communicable disease, even if the patient poses a risk to safety.
To deny care is considered abandonment or breach of duty; the EMT-B may also be considered negligent.
Diseases of Special Concern?
HIV infection
Infection that causes AIDS
Currently has no vaccine
Not easily transmitted in work setting
Can be transmitted to a rescuer from a contaminated needle
Hepatitis
Hepatitis results in inflammation of the liver.
Hepatitis B and C are transmitted through blood contact.
A person that carries the disease can appear healthy.
Vaccinations are available and recommended for EMS providers.
Meningitis
Inflammation to the lining of the brain
Can be caused by viruses or bacteria
Usually not contagious except for Meningococcus meningitidis
Wear gloves and masks.
Notify a physician, if exposure suspected.
Tuberculosis
Bacterial disease affecting the lungs
Detected by screening
Recovery 100% if identified and treated early
Notify supervisor of suspected exposure.
Other Diseases Causing Concern ?
Syphilis
Can be a bloodborne disease
May result from needle stick
Whooping Cough
Airborne disease caused by bacteria
Usually occurs in children
Wear a mask to avoid exposure
Newly recognized diseases
Escherichia coli
Hantavirus
Severe acute respiratory syndrome (SARS)
General Postexposure Management?
Ryan White Law requires notification of exposure.
You should be screened immediately after any exposure.
All exposures need to be reported to company’s designated officer.
Establishing an Infection Control Routine?
Make infection control procedures a part of your daily routine.
Routinely clean the ambulance after each run.
Properly dispose of medical waste.
Remove contaminated linen.
Scene Hazards?
Hazardous materials
Never approach an object marked with placards.
Electricity
Do not touch downed power lines.
Recognize the signs before a lightning strike.
Fire
Do not approach unless trained and protected.
Protective Clothing?
Cold weather clothing
Should have three layers
Turnout gear
Provides head-to-toe protection
Gloves
Type depends on job being performed
Eye and ear protection
Should be used on rescue operations
Skin protection
Use sun block when working outdoors.
Body Armor
Worn by EMS responders in some areas for personal protection
Violent Situations?
Civil disturbances
Domestic disputes
Crime scenes
Large gatherings
Safety?
If personal safety is in doubt, do not place yourself at risk.
Behavioral Emergencies?
Determinants of violence
Past history
Posture
Vocal activity
Physical activity
Medical, Legal, and Ethical Issues?
Scope of practice
Defined by state law
Outlines care you can provide
Further defined in protocols and standing orders
Authorized through online and off-line medical direction
Standard of Care?
Standard imposed by local custom
Often based on locally accepted protocols
Standard imposed by the law
May be imposed by statutes, ordinances, administrative guidelines, or case law
Professional or institutional standards
Recommendations published by organizations and societies
Specific rules and procedures of your service or organization
Standards Imposed by States?
Medical Practices Act
Exempts EMT-Bs from licensure requirements
Certification
Process of evaluating and recognizing that EMT-B has met certain predetermined standards
Duty to Act?
Individual’s responsibility to provide patient care.
Responsibility to provide care comes from either statute or function.
Legal duty to act begins once an ambulance responds to a call or treatment is initiated.
No legal duty to act when off duty
Negligence?
Failure to provide the same care that a person with similar training would provide
Negligence Determination?
Duty
Responsibility to act reasonably based on standard of care
Breech of duty
Failure to act within expected and reasonable standard of care
Damages
Physical or psychological harm created in a noticeable way
Cause
Existence of reasonable cause and effect.
All four must exist for negligence to apply.
Abandonment?
Termination of care without patient’s consent
Termination of care without provisions for continued care
Care cannot stop unless someone of equal or higher training takes over
Consent?
Expressed consent
Implied consent
Minors
Mentally incompetent adults
Forcible restraints
Assault and Battery?
Assault
Unlawfully placing a person in fear of immediate bodily harm without consent
Battery
Unlawfully touching a person
Some states have grades of assault, no battery
Refusal of Treatment?
Mentally competent adults have the right to refuse care.
Patients must be informed of risks, benefits, treatments, and alternatives.
EMT-B should obtain a signature and have a witness present, if possible.
Good Samaritan Laws and Immunity?
Good Samaritan
Based on the principle that you should not be liable when assisting another in good faith
Immunity
Usually reserved for governments
Advance Directives?
Specifies medical treatments desired if patient is unable to make decisions
Do not resuscitate (DNR) orders
Patients have the right to refuse resuscitative efforts.
Require a written order from one or more physicians
When in doubt, begin resuscitation.
Ethical Responsibilities?
Make the physical/emotional needs of the patient a priority.
Practice/maintain skills to the point of mastery.
Critically review performances.
Attend continuing education/refresher programs.
Be honest in reporting.
Confidentiality?
Information received from or about a patient is considered confidential.
Disclosing information without permission is considered a breach of confidentiality.
Generally, information can only be disclosed if the patient signs a written release.
HIPAA?
Safeguards patient confidentiality.
Limits EMS providers from obtaining follow-up information.
Releases health information only with patient’s permission.
Records and Reports?
Complete documentation is a safeguard against legal complications.
If an action or procedure is not recorded, courts assume it was not performed.
An incomplete or untidy report is considered evidence of incomplete or inexpert care.
Special Reporting Requirements?
Abuse of children, elderly, and spouse
Injury during the commission of a felony
Drug-related injury
Childbirth
Infectious disease exposure
Crime scene
Deceased
Physical Signs of Death?
Death is the absence of circulatory and respiratory function.
If the body is still warm, initiate care.
If hypothermia is present, initiate care.
Presumptive Signs of Death?
Unresponsive to painful stimuli
Lack of pulse or heartbeat
Absence of breath sounds
No deep tendon or corneal reflexes
Absence of eye movement
No systolic blood pressure
Profound cyanosis
Decreased body temperature
Definitive Signs of Death?
Obvious mortal injury
Dependent lividity
Rigor mortis
Putrefaction (decomposition of body)
Medical Examiner Cases?
DOA
Unknown cause of death
Suicide
Violent death
Poisoning
Accidents
Suspicion of criminal action
Special Situations?
Organ donors
Medical identification insignia
The Planes of the Body?
Anterior
Posterior
Midline
Midclavicular line
Midaxillary
Directional Terms?
Right and left
Superior and inferior
Lateral and medial
Proximal and distal
Superficial and deep
Ventral and dorsal
Palmer and planter
Apices and bilateral
Movement Terms?
Extension-Flexion
Abduction-Adduction
Anatomic Positions?
Supine, Prone, Shock position (recovery)
Trendelenburg’s position (legs elevated)
Fowler’s position (sitting)
The Skeletal System?
Gives form to the body
Protects vital organs
Consists of 206 bones
Acts as a framework for attachment of muscles
Designed to permit motion of the body
The Skull?
Slide 9 ch. 4
Functions of the Musculoskeletal System?
Gives the body shape
Protects internal organs
Provides for movement
Consists of more than 600 muscles
Types of Muscle?
Skeletal (voluntary) muscle
Attached to the bones of the body
Smooth (involuntary) muscle
Carries out the automatic muscular functions of the body
Cardiac muscle
Involuntary muscle
Has own blood supply and electrical system
Can tolerate interruptions of blood supply for only very short periods
Diaphragm?
Has characteristics of both voluntary and involuntary muscles
Dome-shaped muscle
Divides thorax from abdomen
Contracts during inhalation
Relaxes during exhalation
Breathing Process: Inhalation?
Diaphragm and intercostal muscles contract, increasing the size of the thoracic cavity.
Pressure in the lungs decreases.
Air travels to the lungs.
Breathing Process: Exhalation?
Diaphragm and intercostal muscles relax.
As the muscles relax, all dimensions of the thorax decrease.
Pressure in the lungs increases.
Air flows out of the lungs.
Exchange of Oxygen and Carbon Dioxide?
Oxygen-rich air is delivered to alveoli with inspiration.
Oxygen diffuses into the blood.
The body does not use all the inhaled oxygen
Control of Breathing?
Brain stem controls breathing.
Increases breathing rate if the carbon dioxide level in blood becomes too high
Hypoxic drive is a “backup system.”
Activates when oxygen levels fall to stimulate breathing
Normal Breathing Characteristics?
Normal rate and depth
Regular rhythm
Good breath sounds in both lungs
Regular rise and fall movements in the chest
Easy, not labored
Normal Breathing Rates?
Adults 12 to 20 breaths/min

Children 15 to 30 breaths/min

Infants 25 to 50 breaths/min
Recognizing Inadequate Breathing?
Irregular rhythm
Labored breathing
Muscle retractions
Pale or blue skin
Cool, clammy skin
Faster respiratory rate
Infant and Child Anatomy?
Structures less rigid
Airway smaller
Tongue proportionally larger
Dependent on diaphragm for breathing
Normal Heart Rates?
Adults 60 to 100 beats/min
Children 70 to 150 beats/min
Infants 100 to 160 beats/min
Major Arteries and Veins?
Aorta
Pulmonary
Carotid
Femoral
Brachial
Radial
Superior vena cava
Inferior vena cava
Pulmonary
Components of Blood?
Plasma
Red blood cells
White blood cells
Platelets
Physiology of the Circulatory System?
Pulse
The wave of blood through the arteries formed when the left ventricle contracts
Can be felt where an artery passes near the skin surface and over a bone
Blood pressure
Amount of force exerted against walls of arteries
Systole: Left ventricle contracts
Diastole: Left ventricle relaxes
Perfusion
Circulation of blood within an organ or tissue
If inadequate, the patient goes into shock.
The Nervous System?
The nervous system controls the body’s voluntary and involuntary actions.
Somatic nervous system
Regulates voluntary actions
Autonomic nervous system
Controls involuntary body functions
Peripheral Nervous System?
Links the organs of the body to the central nervous system.
Sensory nerves carry information from the body to the central nervous system.
Motor nerves carry information from the central nervous system to the muscles of the body.
The Skin?
Protects the body from the environment
Regulates body temperature
Transmits information from environment to the brain
Endocrine System?
Complex message and control system
Made up of seven glands
Glands produce and release hormones.
Endocrine Glands?
Adrenal
Ovary
Pancreas
Parathyroid
Pituitary
Testes
Thyroid
Digestive System?
Mouth
Salivary glands
Oropharynx
Esophagus
Stomach
Pancreas
Liver
Bile ducts
Small intestine
Large intestine
Appendix
Rectum