chapter 13 emergency medical services health care science technology copyright © the mcgraw-hill...

Chapter 13Emergency Medical Services

Health Care Science Technology

Copyright © The McGraw-Hill Companies, Inc.


Key Terms AED

– Automated external defibrillator

BLS– Basic Life Support

– Cervical collars – – immobilize neck, back,

and spinal injuries. ALS

– Advanced life supportChapter 132


Key Terms cont.

EMS– Emergency medical services

EMT– Emergency Medical Technician

PPE– Personal Protective Equipment

Chapter 133


Key Terms cont. CPR

– Cardiopulmonary Resuscitation

Myocardial infarction (MI) – heart attack

Cardiac Arrest– Heart stops

Respiratory Arrest– Breathing stops

ASAP– Immediately!!!!!!!!!

Chapter 134


EMS Careers

Persons who are trained to help others in a medical emergency.

Links in the chain of emergency management– 911– Dispatcher– EMS personnel

Chapter 135


EMS Careers

– When the patient is stabilized, he or she is transported by the EMS crew to the hospital via an ambulance. On the scene and during the ambulance ride, the EMS crew communicates the patient’s status to the emergency room staff. At the hospital, the crew hands off the patient to

– The physicians and nurses in the emergency room — the final link in the EMS chain

Chapter 136

Copyright © The McGraw-Hill Companies, Inc. Chapter 137

Links in the EMS Chain

911

Dispatcher

EMSPractitioner

Dr. & Nurses In the ER


EMS practitioners work for city or county fire departments, private ambulance services, hospitals or other agencies. They may be volunteer or paid, and some may be cross-trained as firefighters


First Responder

Arrives first at the scene of an accident or incident.– Usually, firefighters, law

enforcement officers, industry workers, private citizens, or neighbors.

– Individuals have taken an approved First Responder Program.

Need high school diploma


First Responder (cont.)

First Responder Responsibilities (cont.)– Assess the client. – Provide emergency medical care.– Lift or remove a client only when required.– Transfer the client and information to

trained personnel.


First Responders

Certified first responders take between 40 and 60 hours of classes. They learn scene safety and basic patient assessment.

Chapter 1311


Emergency Medical Technicians - B

EMT-Basics (EMT-Bs) – respond to all sorts of medical emergencies. – They know how to perform CPR and artificial

ventilation, administer oxygen, defibrillate a patient using an AED, immobilize spinal injuries and monitor vital signs. Their training includes handling cardiac arrests, seizures, diabetic emergencies, respiratory problems and traumatic injuries


EMT-B

Need High School Diploma EMT-B students take about 120 hours of

classes They learn emergency care skills, including

managing bleeding, fractures, airway obstruction, cardiac arrest and emergency childbirth, as well as patient assessment skills.

Chapter 1313


EMT - basic

Formal courses are often combined with time in an emergency room or ambulance.

students learn how to use and maintain common emergency equipment, such as backboards, suction devices, splints, oxygen delivery systems and stretchers.

The course concludes with written and practical exams

Chapter 1314


Emergency Medical Technicians - I

Responsibilities of EMT–Intermediate– Initiate intravenous (IV) lines.– Perform advanced airway techniques.– Interpret electrocardiogram (ECG).– Use manual defibrillators.– Administer certain medications beyond

those permitted at the EMT – B level.


EMT-1

EMT-I students take about 40 hours of classes beyond the EMT-B course, in which they learn additional patient assessment skills, as well as how to use advanced airway devices and how to start Ivs


Chapter 1316


Emergency Medical Technicians paramedic

Has the most education Act as the eyes, ears, and hands of the dr. Responsibilities

– Administer O2– Start IV fluid– Defibrillate– Administer medications


Paramedic

Paramedic students take about 1,000 hours of classes, during which they learn emergency care skills, including advanced airway management and medication administration, as well as anatomy and physiology. Formal courses are often combined with time in an emergency room or ambulance


Chapter 1318


Air ambulanceFlight crew members

Include– Helicopter pilot– Physicians– Registered Nurses– EMT – paramedics– Respiratory Therapist

Chapter 1319


Air ambulance

Responsibilities– Rescuing people from an accident scene– Transporting critically ill patients from one site to

another– Transport organs– Transport donor & recipient to medical center where

harvest and transplant will take place

Chapter 1320


Where the Jobs Are:

Private ambulance services: 40 percent Local governments: 30 percent Hospitals: 20 percent Other: 10 percent

Chapter 1321


Annual Incomes

EMT basic– $1700 - $2,800 per month

EMT paramedic– 2,800 - $4,800 per month– $37,456.00 national average per year

Chapter 1322


Future Job Market

According to the U.S. Department of Labor, employment for EMS practitioners is expected to grow faster than the average for all occupations through 2016. This segment is expected to have 19 percent growth, which is due in part to paid personnel replacing volunteers in some parts of the country, as well as the aging Baby Boomer population’s increased need for emergency medical care.

Chapter 1323


Client Assessment Process

Evaluation includes evaluating:– Safety of the scene for the provider, other

responders, the client, and bystanders.– Body substance isolation (BSI) precautions.– Mechanism of injury or nature of illness.– Number of clients.– Need for additional resources or assistance.


Assessment Process

The client assessment process consists of the following:– Scene size-up.– Initial assessment.– Focused history and physical exam.– Detailed physical exam.– Ongoing assessment.– Communication.– Documentation.


Client Assessment Process (cont.)

Initial assessment includes 6 assessments:– Form a general impression.– Determine level of responsiveness.– Assess the airway.– Assess breathing.– Assess circulation, including

presence of pulse and bleeding.– Make a decision regarding the

priority or urgency of the client.



Focused history and physical exam include the following:– In 90 seconds check head, eyes, neck, chest,

abdomen, pelvis, arms, legs and back according to standard procedures.

– Take complete set of vital signs.– Take SAMPLE history, if time permits.



Communication– ALWAYS ask for permission to help

– Converse with client and family.– Communicate with dispatcher and

medical facility.– Hand-off report at medical facility.


Airway Management

First Responders and EMTs manage life-threatening problems of airway, breathing, and circulation.

One of the greatest threats to the airway is the tongue.

Use head tilt-chin lift to open the airway. Use jaw-thrust if neck or back injury is

suspected.


Airway Management (cont.)

Airway Adjuncts:– Maintain an open airway.– Two types:

Oropharyngeal airway (OPA) – used in mouth and throat.

Nasopharyngeal airway (NPA) – used in nasal passage.


Additional Career Skills

Oxygen therapy is used at the scene for illnesses that create tremendous stress on the body such as:– Respiratory or cardiac arrest.– Heart attack.– Shock.– Severe blood loss.– Lung disease or disorders.– Stroke.– Drug overdose.– Severe bone injuries.


Additional Career Skills (cont.)

Oxygen Therapy Equipment– Oxygen cylinders.– Oxygen regulator.– Oxygen flow meter.– Oxygen delivery devices.

Nasal cannula Nonrebreather mask



Automated External Defibrillator (AED)– Used to treat ventricular fibrillation, a

chaotic heart rhythm (the most common cause of cardiac arrest).

– American Heart Association recommends using in the first 5 minutes to improve chance of survival.



Automated External Defibrillator (AED) (cont.)– Attaches to chest. – Analyzes the rhythm.– Determines the need for a

shock.– Can deliver shock manually or

automatically.– Use only when no response,

breathing, or circulation.



Automated External Defibrillator (AED) (cont.)– Modify procedures if:

Client is wet or on a wet surface.Client is less than 8 years old or weighs 55

to 65 pounds.Client has pacemaker or internal

defibrillator.Client is lying on a metal surface.Client has medication patches.



How to Attach the AED– Bare and dry the chest.– Position first pad over collarbone and

not on the breast bone.– Position second pad below and to the

left of the left nipple.– Connect the lead cables.



Principles and Operation of the AED– Do not delay.– Turn on machine and attach pads.– Check machine for picture of the

placement of pads.– Do not touch client during analysis or

shock.– Say “Clear” before applying a shock.– Check machine’s battery periodically.



Spinal Immobilization Skills – Spinal cord injuries occur from:

Automobile collisions.Diving accidents.Motorcycle collisions.Falls.In the case of children: falls or being struck

by a motor vehicle.



Signs of Spinal Injury:– Paralysis to arms and/or legs.– Loss of feeling in arms or legs.– Pain or tenderness at back of neck or

spine.– Pain with or without movement.– Loss of bowel or bladder control.– Labored breathing with little chest

movement.


Emergency Childbirth

The mother should be taken to the hospital if possible.

Know date when the baby is due.– Gestation is approximately 9 months.– Gestation is divided into three 3-month

periods, or trimesters.


Emergency Childbirth (cont.)

Anatomy and Physiology– Placenta – allows oxygen and nutrients to go

to fetus while carbon dioxide and wastes are eliminated by the mother.

– Umbilical cord – cordlike structure attached between fetus and placenta.

– Amniotic sac – thin, membranous sac.Allows fetus to float freely, cushioning it

from shock.Contains from 1 to 2 liters of fluid.



Labor– Uterus contractions in the ninth

month signaling childbirth.– Has 4 stages.



Labor – First Stage– Regular contractions of uterus and gradual

dilation of cervix become shorter as delivery is imminent.

– Could last from 4 hours to more than 24 hours.

– Typically longer for first-time mothers.– Probable watery or bloody discharge and

rupture of amniotic sac.– Ends with full dilation of cervix.


Labor: Stage 1: Phases Phase 1

– Dilation of cervix from 0-3– Mom nervous, happy, excited

Phase 2– Dilation of cervix from 4-7– Mom uncomfortable, can relax between contractions

Phase 3– Dilation of cervix from 8-10– Mom may become irritable, irrational, very tired

Chapter 1344



Labor – Second Stage– Baby enters birth canal until born.– Contractions become intense and frequent.– Crowning occurs as baby’s head bulges from

vaginal opening.– Ends when baby is born.



Labor – Third Stage– Starts after baby is born and lasts until

delivery of placenta and umbilical cord is complete.

– Contractions continue a little longer as uterus prepares to deliver the placenta.

– Typically lasts from 10 to 20 minutes.– Ends with delivery of placenta.


Emergency Childbirth(cont)

Labor and Delivery – Fourth Stage– First hour after birth

Mom: vitals checked, fundus checked, episiotomy sutured Infant: physical, antibiotics in eyes, vit-K injection, mom

may nurse infant

Chapter 1347


Websites for birth videos

http://videos.howstuffworks.com/health/childbirth-videos-playlist.htm#video-6892

Chapter 1348

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