Introduction to Emergency Medical Care

Transcription

1 I Introduction to Emergency Medical Care 1 Jones & Bartlett CHAPTER Learning, OUTLINE LLC The Emergency Medical Services System and the EMT Overview of the Emergency Medical Services System The Healthcare System Roles and Responsibilities of Jones the EMT & Bartlett Learning, LLC Professional Attributes of the EMT Quality Improvement Medical Direction 1..

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

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

4 4 Chapter 1 Introduction to Emergency Medical Care I Figure 1-2 An early motorized ambulance. The early models lacked the space and head clearance of modern ambulances. Courtesy Flushing Hospital, Flushing, New York. care, they helped focus national attention on the need for the rapid prehospital intervention that had been successfully demonstrated on battlefields. Simple steps were recognized, including bleeding control at the scene, safe patient handling, spinal immobili zation, and rapid transportation to organized trauma centers. In 1966 the U.S. National Academy of Sciences published the landmark paper Accidental Death and Disability: the Neglected Disease of Modern Society, documenting that more Americans died from accidental injuries in 1965 than died on the battlefields in Vietnam. Further, Jones if & seriously Bartlett wounded, Learning, a person LLC would have a better chance NOT of FOR survival SALE in a combat OR DISTRIBUTION zone than on an average city street. The newly created Department of Transportation (DOT) and National Highway Traffic Safety Administration (NHTSA), a division of the DOT, were empowered with regulating EMSS, offering $48 million in grants between 1966 Jones and & Bartlett Learning, LLC Figure 1-3 An ambulance of the 1930s. Courtesy Flushing Hospital, Flushing, New York. (ECG) monitoring, defibrillation, intravenous (IV) therapy, administration of medications, insertion of endotracheal (ET) tubes, and other invasive medical skills. Dr. William Grace at St. Vincent s Hospital in New York City quickly adopted this innovation so that physicians, nurses, and am- bulance personnel could respond NOT to cardiac FOR SALE emergencies OR DISTRIBUT in lower Manhattan. Until this point, only physicians were providing advanced care in the prehospital setting. The introduction of biotelemetry (transmission of electrocardiogram [ECG] by radio) extended prehospital care by Jones allowing & EMS Bartlett providers Learning, to deliver advanced LLC life support under NOT the FOR direction SALE of a physician OR DISTRIBUTION at a base hospital. As part of its role in studying cardiovascular emergencies and treatment, every 5 years the American Heart Association (AHA) offers the Emergency Cardiovascular Care (ECC) guidelines, adopted by most agencies as the standard of care. In 1973, federal legislation provided funding for the development of EMS systems throughout the United States. After The physician s role in the development of EMS systems The Physician and Emergency Medical Services demonstrations of effective trauma systems in Illinois and has been extremely important. Medical societies such as the Maryland, these grants accounted for the rapid growth of EMS American Academy of Orthopedic Surgeons and the American College of Surgeons played a significant part in early systems across the country. Money was allocated for the development of training programs, communication Jones & Bartlett systems, Learning, hospi- EMSS LLCdevelopment. The DOT Bureau of Traffic Safety asked tal designations, and other essential NOT FOR system SALE components. OR DISTRIBUTION Many these physician groups to develop NOT a FOR standardized SALE curriculum for ambulance personnel. Physicians still work closely OR DISTRIBUT EMS systems developed as a direct result of this legislation and funding. with the EMS Division of NHTSA under DOT to ensure the Medical knowledge and related technology were incorporated into EMS care as new advances became available. For continued development of national training curricula at all levels. example, in Jones the 1960s, & cardiopulmonary Bartlett Learning, resuscitation LLC(CPR) Physician groups Jones such & as Bartlett the American Learning, College of LLC Emergency Physicians NOT and FOR the SALE National OR Association DISTRIBUTION of EMS using chest NOT compression FOR SALE and positive-pressure OR DISTRIBUTION ventilation was introduced, and portable defibrillators to resuscitate victims Physicians have joined their surgical colleagues and have of cardiac arrest became available. Physicians brought resuscitation equipment into the field to reach their patients earlier, Physicians are the medical conscience of EMS. All levels an active leadership role in national EMSS development. when they had a better chance of survival. of EMS provider function under the direction of a physician Jones The & Bartlett first advanced Learning, life support LLC unit was introduced Jones advisor or & Bartlett medical director. Learning, Medical LLC directors work locally NOT FOR in Belfast, SALE Ireland, OR DISTRIBUTION under the direction of Dr. Frank Pantridge. Advanced life support included electrocardiographic provide continuing NOT with FOR services SALE to establish OR DISTRIBUTION protocols, monitor patient care, and education...

5 The Future of EMS The EMS Agenda for the Future, developed in cooperation with several national organizations, provides recommendations to refine and continue development of EMS systems over the coming years, Jones as follows: & Bartlett Learning, LLC Emergency medical services (EMS) of the future will be community-based health management that is fully integrated with the overall health care system. It will have the ability to identify and modify illness and injury risks, provide acute illness and injury care and follow-up, and contribute to treatment of chronic conditions and community 5 Although physicians have functioned as prehospital providers & Bartlett in some Learning, areas the LLC United States, their role as field Jones Overview & Bartlett of Learning, the Emergency LLC Medical Jones NOT FOR providers SALE OR has been DISTRIBUTION limited since the 1940s. For many reasons, including resource allocation and costs, nonphysicians NOT FOR Services SALE System OR DISTRIBUTION currently staff almost all ambulances in North America. In some countries, such as Russia, Norway, France, Brazil, and Germany, physicians still routinely respond in ambulances or As described in the EMS Agenda for the Future, EMS systems require many components to function effectively. Each component must be carefully designed and based on the needs of the helicopters. individual EMSS. I Public Access Because an EMSS involves a large number of resources, some method of coordination and communication is essential. In many areas, simple and convenient access has been accomplished through Jones the & Bartlett emergency Learning, telephone system. LLC This system allows NOT rapid FOR access SALE to all elements OR DISTRIBUTION of emergency care and support services, including EMS, fire department, and police. In the system a central dispatch center coordinates resources and personnel within the system. Some EMS systems have enhanced (E-911) commu- Jones nication & Bartlett systems. E-911 Learning, allows the LLC dispatcher to track the caller s exact SALE location. OR This DISTRIBUTION knowledge becomes important when health monitoring. This new entity will be developed from redistribution of existing health care resources and will be integrated with other NOT FOR the caller disconnects, becomes unconscious during the call, or health care providers and public health and public safety agencies. It will improve community health and result in more appropriate use of when a bystander unfamiliar with an area calls for help. In the acute health care resources. EMS will remain the public s emergency case of some natural disasters a reverse system has been medical safety net. used to notify residents of a community to evacuate. With the wide use of cell phones, new technologies Jones & are Bartlett being introduced Learning, LL The agenda lists 14 NOT essential FOR components: SALE OR integration DISTRIBUTION of to track the caller s location NOT and aid FOR response. SALE Some OR vehicles DISTRIBUT are health services, EMS research, legislation and regulation, system now equipped with tracking and monitoring equipment such finance, human resources, medical direction, education systems, as Onstar. With this equipment a vehicle can notify the central public education, prevention, public access, communication dispatch center if the vehicle has been involved in a collision systems, clinical care, information systems, and evaluation. and can alert authorities of the vehicle s location. A partner Jones document & Bartlett to the Learning, agenda is the LLC EMS Education Other areas Jones still rely & on Bartlett different seven-digit Learning, telephone LLC numbers to access NOT emergency FOR SALE assistance. OR DISTRIBUTION Agenda NOT for the FOR Future. SALE Focusing OR on DISTRIBUTION the educational structure for EMS, this document identifies a specific scope of practice for each level, then replaces the DOT objectives with education standards for each level (Figure 1-4 ). The universe of EMS knowledge and skills National EMS core content Elements of a Communication System A modern EMSS may contain several communication components. A dispatch system receives the call for help and sends the Jones appropriate & Bartlett response Learning, vehicles to the LLC scene. An ambulance com- Periodic NOT FOR munication SALE system OR allows DISTRIBUTION the prehospital provider in the field updates of to communicate with dispatch, with receiving hospitals, and these three with medical control. documents Delineation of The Dispatch System National EMS provider practice scope Jones of practice & Bartlett Learning, LLC The dispatch center receives calls, Jones categorizes & Bartlett them according Learning, to LL levels priority, provides first-aid instructions NOT FOR to callers, SALE and OR dispatches DISTRIBUT the closest appropriate emergency service vehicle (e.g., police, Replaces the current national National EMS fire), rescue personnel, and equipment. Many emergency service vehicles have vehicle locators so that the dispatcher can see standard curricula education standards the vehicle s exact location in respect to the call. Dispatch serves as a communication Jones point & Bartlett through Learning, which an EMT LLC can call for NOT National FOR EMS SALE OR DISTRIBUTION National EMS education additional NOT resources. FOR The SALE dispatch OR center DISTRIBUTION may also relay information from the scene of an incident to the receiving facility certification program accreditation and advise the EMT on facility selection and availability of other Figure 1-4 The EMS education agenda for the future: a systems rescue personnel (Figure 1-5 ). The dispatcher may also advise approach. A single agency for each function. Redrawn from the caller or bystanders on initial treatment steps to help the National Highway Traffic Safety Administration: National EMS Jones patient & Bartlett until the ambulance Learning, arrives. LLC agenda for the future, Washington, DC, 2005, US Department of NOT FOR A formal national training program has been developed to Transportation. SALE OR DISTRIBUTION train dispatch personnel to deal with the complexities of their..

6 6 Chapter 1 Introduction to Emergency Medical Care I Figure 1-5 A computerized Jones & Bartlett dispatch workstation Learning, LLC a communication center. Figure 1-7 An EMT in the field communicates by a portable Jones voice radio. & Bartlett Cellular phones Learning, and landline LLCphones are also used NOT to communicate FOR SALE with OR dispatch DISTRIBUTION or medical direction. Figure 1-6 Online medical direction. A physician at a hospital communication Jones base station & Bartlett can speak Learning, directly with LLC the EMT about a patient s NOT FOR status and SALE give orders OR DISTRIBUTION regarding treatment as alerting the trauma team or preparing an isolation room for a patient with a possible infectious disease. LEARNING OBJECTIVE Differentiate the role and responsibilities of the EMT from those of other prehospital care providers. Levels of Training A wide range of Jones illnesses and & Bartlett injuries require Learning, emergency LLC care. Every year approximately NOT FOR 16 million SALE patients OR DISTRIBUTION in the United States and transport. are transported by ambulance to emergency departments, usually because of chest pain, shortness of breath, abdominal pain, injury from a motor vehicle crash or other accident, convulsions, or general weakness. Persons presenting with imminent Jones job. Emergency & Bartlett Medical Learning, Dispatch (EMD) LLC is now a recognized program. SALE EMD professionals OR DISTRIBUTION are skilled coordinators of emergency NOT of the FOR types SALE of emergencies OR DISTRIBUTION for which immediate attention is Jones childbirth, & poisoning, Bartlett Learning, or uncontrolled LLC bleeding are examples NOT FOR care communication and play a vital role in EMS systems. required. For each patient category, distinct interventions can improve the patient s chances for survival. Patients themselves should know the signs and symptoms of illnesses that require immediate intervention and how to access Ambulance-to-Hospital Communication Systems Many EMS systems provide communication from the field personnel to the physician at a base hospital or medical di- Jones & Bartlett Learning, the LLC EMSS. They also should know some Jones basic & self-help Bartlett measures Learning, LL rection center, often referred NOT to as FOR online SALE medical OR direction DISTRIBUTION in the event that immediate help from NOT bystanders FOR SALE is not available. OR DISTRIBUT (Figure 1-6 ; see later discussion). These communication systems may include both voice and biotelemetric components. Lay Rescuers Field providers may consult medical direction for advice about Often the first person to recognize an emergency condition is treatment and transportation decisions or to speak directly another member of the community. For certain conditions that with patients Jones who are & refusing Bartlett care or Learning, transport to LLC the hospital render someone Jones helpless, actions & Bartlett by bystanders Learning, and those LLCfirst (Figure 1-7 NOT ). FOR SALE OR DISTRIBUTION to respond can NOT make FOR the critical SALE difference. OR DISTRIBUTION Simple knowledge, Biotelemetry allows transmission of ECG data from the patient in the field to the physician at the base hospital or medi- that is necessary to save a life. such as how to open an airway or control bleeding, may be all cal control facility. Cellular phones and radio transmission are When performed in a timely fashion, CPR and use of an automated external defibrillator (AED) may save thousands of lives used for both voice communication and biotelemetry. Jones Most & Bartlett hospitals Learning, have dedicated LLC phones or radio equipment Jones each year &(Figure Bartlett 1-8 ). Learning, Training CPR LLCand other basic firstaid FOR skills may SALE result OR in certification DISTRIBUTION that permits laypeople to NOT FOR for communication SALE OR DISTRIBUTION with EMTs in the field. In some cases the NOT hospital makes special preparations for the EMT s arrival, such serve as responders in the workplace or other environments...

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

8 8 Chapter 1 Introduction to Emergency Medical Care I Figure 1-10 An Jones EMT administers & Bartlett treatment Learning, to an injured LLCpatient. Figure 1-11 Jones A modern & Bartlett emergency Learning, department. LLC within the new educational paradigm meeting the scope of practice proposed by NHTSA and having the requisite knowledge of the EMS core content. This is the course that you are taking Jones now & for Bartlett initial or refresher Learning, training. LLC Paramedics also may be used for critical care transport operations. & In Bartlett these types Learning, of services, EMS LLC providers are involved Jones NOT FOR The SALE EMT curriculum OR DISTRIBUTION involves attending lectures and receiving practical and clinical instruction in the assessment and man- one care center to another. Often EMS providers who function NOT primarily FOR in SALE the transfer OR of DISTRIBUTION acutely ill and injured patients from agement of the acutely ill or injured patient. The EMT provides in this role have additional training in specialized devices, such basic emergency medical care and transportation for critical as intravenous pumps (devices that deliver IV fluids more precisely) and balloon pumps (devices that enhance circulation and emergent patients who access the EMS system. EMTs func- in tion as part of a system under Jones medical oversight & Bartlett and Learning, perform patients LLC with cardiovascular failure). Jones Paramedics & Bartlett or critical care Learning, LL interventions with basic equipment NOT FOR on an SALE ambulance. OR DISTRIBUTION EMTs nurses also are used in medical evacuation NOT FOR (medevac) SALE helicopter programs. These programs often are designed to transport OR DISTRIBUT may assist patients with their medications and, under medical direction, may give medication such as aspirin to patients with critically ill patients from the scene of the emergency or a local chest pain and oral glucose to patients with low blood glucose. community hospital to specialized care facilities. In many communities, it is the EMT providing the large portion of out-of-hospital Jones & care. Bartlett In rural Learning, areas, they may LLC represent the highest NOT level of FOR EMS SALE care. The OR EMT s DISTRIBUTION care is based on assessment findings. Their scope of practice is limited to basic skills that are effective and can be performed in an out-of-hospital setting with medical oversight and limited training. Advanced Emergency Medical Technician. The advanced emergency & medical Bartlett technician Learning, (AEMT) LLCis also called the Jones EMT- training is available through programs sponsored by hospitals, community colleges, and other agencies. The Healthcare System Emergency Departments Modern emergency departments (EDs) are vital centers of acute medical and trauma care that serve as the intersection between Jones the prehospital & Bartlett and hospital Learning, phases of LLC care (Figure 1-11 ). In the NOT ED FOR the patient SALE is evaluated OR DISTRIBUTION and treated, and decisions are made about the need for further care, including admission to the hospital, transfer to an operating room, or discharge home. Hospitals may have specialty teams that respond quickly to patients with time-critical illness and injury, such as stroke, trauma, and NOT FOR Intermediate SALE (EMT-I). OR DISTRIBUTION With additional training, EMTs may function at a more advanced level. Various designations are used for advanced EMTs, but the trend is toward standardizing certification to three levels: the EMT, the advanced EMT, and the paramedic. Advanced training includes skills such as ECG interpreta- Jones & Bartlett Learning, cardiac LLC conditions. tion, advanced or alternative NOT airway FOR management SALE OR (i.e., DISTRIBUTION ET The standards for EDs also have NOT advanced FOR SALE over the OR past 25 DISTRIBUT intubation, dual-lumen airway device), IV fluid therapy, and years. Many communities have developed minimum standards administration of certain IV medications. for staff, space, equipment, and availability of specialists (e.g., Advanced EMT training is shorter and more focused than the neurosurgeons, orthopedists). The National EMSS Act of 1973 paramedic level. Advanced EMT programs are more often used stimulated much of this progress, citing hospital facilities as in rural volunteer Jones EMS & systems, Bartlett where Learning, attending longer LLCtraining a key component Jones of EMS & systems. Bartlett Currently, Learning, these standards LLC programs NOT may not FOR be feasible SALE and OR call volumes DISTRIBUTION are lower. are set by various NOT organizations, FOR SALE including OR DISTRIBUTION state departments of Paramedic. The highest level of training for advanced health, The Joint Commission (TJC; formerly Joint Commission on Accreditation of Healthcare Organizations [JCAHO]), EMTs is usually referred to as paramedic. A paramedic has completed a course that followed the standardized national and other professional organizations. curriculum as prescribed by NHTSA or meets the standards of The acutely ill or injured patient may be admitted to the hospital. Some & patients Bartlett may Learning, go directly from LLC the ED to the operating Jones the new & Bartlett educational Learning, paradigm. A LLC paramedic performs advanced Jones NOT FOR techniques, SALE such OR as DISTRIBUTION ECG interpretation, drug therapy, invasive airway techniques, and manual defibrillation. Paramedic additional treatments, monitoring, or both (Figure 1-12 ). NOT room, FOR cardiac SALE catheterization OR DISTRIBUTION laboratory, or a critical care unit for Various..

9 9 I Figure 1-12 Jones Surgery & in Bartlett an operating Learning, room may LLC be part of additional NOT emergency FOR SALE treatment. OR DISTRIBUTION types of critical care or intensive care units exist for patients with different problems, such as cardiac, respiratory, surgical, pediatric, and high-risk obstetric and neonatal (Figure 1-13 ). REAL World Of all patients transported to emergency departments, 14% arrive by ambulance. For patients under 15 years of age, 3.8% arrive by ambulance. For patients over 75 years, 40.9% are transported by Hospital Personnel The EMT is part of a larger team of personnel who care for the patient at each phase of the Jones EMSS. & These Bartlett individuals Learning, also can LLC Figure 1-13 Jones Patients & may Bartlett be admitted Learning, to a critical LLC care unit. Liaison with Other Public Safety Workers The EMT interacts with various public safety personnel at the scene of a call. Police, fire service, public utility workers, and Jones state & and Bartlett federal law Learning, enforcement LLC officers are key resources at NOT FOR general SALE medical OR or trauma DISTRIBUTION emergencies, crime or motor vehicle crash scenes, mass casualty incidents, and behavioral emergencies. Become familiar with the resources in your region and how to contact them when needed. Understand and respect the roles, responsibilities, and authority of various resources at ambulance. emergency scenes. Can you think of reasons for such a difference at these extremes Many systems provide a tiered response to certain calls. For of age? Data from Institute of Medicine: EMS at the crossroads, Washington, example, police or fire service personnel may be dispatched DC, as first responders to provide immediate care (e.g., AED use, bleeding control) before arrival of the ambulance. Police officers often assume responsibility for notification of family, securing valuables Jones or property, & Bartlett and assisting Learning, with violent LLCpatients Some NOT patients FOR have SALE unique needs OR DISTRIBUTION that require the care of spe- or other behavioral NOT FOR emergencies. SALE OR DISTRIBUTION Specialty Jones Referral & Centers Bartlett Learning, LLC cially trained individuals, using highly specialized equipment. When multiple agencies are needed at an emergency incident, Specialty referral services include trauma centers, burn centers, the roles and command function are assigned by the nature of pediatric intensive care, neonatal (newborn) centers, cardiac the incident. In general, police take charge at any crime scene centers, and hyperbaric centers for victims of diving injuries or or where crowd or traffic control may be needed. Fire personnel Jones & poisoning Bartlett with Learning, carbon monoxide. LLC EMTs may transport certain Jones would & take Bartlett charge Learning, at a fire scene. LLC An EMT s primary concern is NOT FOR patients SALE directly OR DISTRIBUTION to a specialty referral center, at times bypassing NOT FOR patient SALE care. The OR EMT DISTRIBUTION must know the roles of the various agen- other hospitals. cies in the region so that all can work in a coordinated and a safe, effective manner. An incident management system, also known as an incident command system, has been established to allow for clear lines of authority and responsibilities at the scene of an emergency when many agencies Jones respond & Bartlett and must Learning, work LL serve as a resource for information, NOT FOR feedback SALE about OR DISTRIBUTION a patient s together to resolve the emergency NOT situation FOR SALE (see Chapter OR 28). DISTRIBUT condition, and continuing education. Mutual respect and appreciation of each team member s contribution are essential to Local Emergency Medical Services System promote effective communication and continuity of care. The To perform optimally for the patient, EMTs should become hospital team members include the following: familiar with the components of their local EMSS. All the The physician, Jones who & Bartlett is responsible Learning, for the overall LLCmanagement components Jones just described & Bartlett are part Learning, of everyday LLC EMT practice. Familiarity NOT FOR with the SALE access OR and DISTRIBUTION communication system of the NOT patient FOR in the SALE prehospital OR DISTRIBUTION and hospital phases of care. The nurse, who coordinates care in the ED, operating room, is an essential first step. Knowing the levels of training allows critical care units, and other general medical-surgical units in the EMT to interact appropriately with first responders and addition to directing patient care duties. advanced-level EMTs who may also arrive at the scene. Treatment, triage (sorting according to medical need), and transport Other health professionals, such as physician assistants, nurse Jones & practitioners, Bartlett Learning, respiratory LLC therapists, radiology technicians, Jones protocols & Bartlett should be Learning, learned and LLC carried in the vehicle, because NOT FOR SALE and a host OR of personnel DISTRIBUTION who tend to the various needs of NOT the FOR they describe SALE the OR key DISTRIBUTION patient care decisions and interaction with patient in the hospital. medical direction. Familiarity with the designations of specialty..

10 10 Chapter 1 Introduction to Emergency Medical Care I Figure 1-14 EMTs Jones using & personal Bartlett protective Learning, equipment LLC during CPR. Figure 1-15 A high-efficiency NOT FOR SALE particulate OR air DISTRIBUTION (HEPA) respirator is an important defense against diseases spread by airborne transmission, such as tuberculosis, chickenpox, measles, receiving hospitals is necessary when critical patients with special needs, such as for burn or trauma center care, are identified technician, St Louis, 2007, Mosby-Elsevier. and smallpox. From Chapleau W, Pons P: Emergency medical Jones in the & field. Bartlett EMTs Learning, must know the LLC initial steps to take when assisting SALE at a disaster. OR DISTRIBUTION NOT FOR Orientation sessions and review of policies and protocols assist The choice of a particular piece of equipment depends on the the EMT in gathering this important information. Continuing education and studying current local and state EMS updates allow the routinely when exposure to blood or body fluids may occur, circumstances of a given call. For example, gloves are used EMT to retain essential information and stay abreast of change. such as when bandaging a minor wound. Goggles are used when Jones & Bartlett Learning, there LLCis a potential for an eye splash Jones of blood or & body Bartlett fluid. This Learning, LL LEARNING OBJECTIVES can happen during suctioning NOT or administration FOR SALE of positivepressure ventilation. A special mask is used if tuberculosis or OR DISTRIBUT Describe the roles and responsibilities of the EMT related to personal safety. another airborne pathogen is suspected (see Chapter 2). Discuss the roles and responsibilities of the EMT toward the safety of Prevention is the key in matters of safety. Developing good the crew, the patient, and bystanders. habits early in your clinical experience ensures the safest possible approach. You Jones will learn & Bartlett more about Learning, the specifics of LLC safety later in this chapter NOT and FOR in Chapter SALE 2. OR DISTRIBUTION Roles and Responsibilities of the EMT The work of an EMT is diversified and provides challenge and gratification. As an EMT, you will function in several roles that Jones call for & Bartlett medical, technical, Learning, clerical, LLC and social interaction skills. Jones received & through Bartlett a patient Learning, history, vital LLCsigns, and a physical NOT FOR Many SALE of these skills OR DISTRIBUTION will be acquired during classroom training NOT examination FOR SALE (Figure OR 1-16 DISTRIBUTION ). Become a skilled observer who can sessions. Other skills will develop during clinical field experience under the supervision of senior EMTs or instructors. Primary Responsibilities Personal Safety and Safety of Others Primary concern for safety is the first and most important step on every call. Scene safety is the first part of patient assessment. The use of cones and flares, proper positioning of emergency vehicles, and wearing reflective clothing at the scene are all basic Patient Assessment Assessment is one of your primary responsibilities as an EMT. It involves the systematic collection and analysis of information recognize problems quickly and respond accordingly. Patient assessment is probably the most difficult skill to master as an EMT because it involves many different areas of knowledge. You will learn to obtain a concise history from a patient who may be in severe pain, confused, or hysterical. This will require patience and much NOT practice. FOR You SALE will learn OR which DISTRIBUT facts are relevant to each type of chief complaint and how to avoid unnecessary questioning that wastes time. Patient Care Based on Assessment Findings defenses against Jones personal & Bartlett injury. Other Learning, conditions LLC that may be Your training will Jones prepare & you Bartlett to respond Learning, to a variety of LLC critical considered NOT include FOR hazardous SALE materials OR DISTRIBUTION or toxic gases, aggressive problems, ranging NOT from FOR immobilization SALE OR of DISTRIBUTION a fractured leg to resuscitation of a cardiac arrest victim (Figure 1-17 ). In some cases, animals, violent patients or bystanders, and electrical hazards. The risk of exposure to communicable disease is real and time may not allow a prolonged analysis because many true emergencies require treatment while assessment continues. Significant should be taken seriously. The primary defenses against disease transmission are personal protective equipment (PPE) loss of blood or complete airway blockage requires a reflex reaction that & you Bartlett can develop Learning, only with intensive LLC classroom and clini- Jones and & handwashing Bartlett (Figure Learning, 1-14 ). Gloves, LLC eye protection, gowns, Jones NOT FOR and high-efficiency SALE OR DISTRIBUTION particulate air (HEPA) respirator masks NOT cal practice. FOR SALE Other treatments OR DISTRIBUTION you will learn include CPR, oxygen are examples of basic PPE carried by an EMT (Figure 1-15 ). therapy, assisting at childbirth, management of poisoning and..

11 11 I Figure Jones 1-16 & An Bartlett EMT performs Learning, patient assessment. LLC Figure 1-18 The Jones patient & is Bartlett secured to Learning, an immobilization LLCdevice. Figure 1-19 An EMT presents a patient history to the emergency physician, providing details gathered from the time of first contact, which can Jones play a major & Bartlett role in diagnosis Learning, and treatment. LLC Figure 1-17 An EMT performs cardiopulmonary resuscitation. you take on a great responsibility. Although the law allows certain exemptions while you are operating an emergency vehicle, you are overdose, treatment of shock states, and psychological first aid. still responsible for maintaining control of the vehicle at all times. Knowing when to transport a patient and when to choose a special You must be familiar with the best possible routes in your Jones & institution Bartlett (e.g., Learning, burn center) LLC is also important. Jones area. & You Bartlett should know Learning, the traffic LLC patterns at all times of the day Lifting and Moving obstructed. Many patients you encounter will be injured and require careful handling. A victim with a suspected spinal injury should be aspect of emergency vehicle operation. Contrary to popular be- The safe and appropriate transport of your patient is another immobilized to prevent further injury during transport (Figure lief, most patients do not benefit from a frantic ride to the hospital with lights flashing and siren Jones blaring. & Bartlett Learning, LL 1-18 ). As an EMT, you will Jones become & familiar Bartlett with Learning, a variety of LLC spinal immobilization NOT methods, FOR splinting, SALE different OR DISTRIBUTION types of When you arrive at the ED NOT with FOR your patient, SALE you OR should DISTRIBUT be stretchers, and rapid removal techniques. ready to transfer care of the patient to the ED staff. You may need The needs of patients vary widely, from an elderly patient who to continue certain aspects of care, such as resuscitation, until needs a stair chair to be helped to the ambulance, to a seriously the nurse, physician, or other healthcare professional assumes injured patient who must be rapidly extricated from a burning responsibility. You should present a brief report that highlights automobile. Jones As an & EMT, Bartlett you become Learning, an expert LLC in movement, key aspects of Jones the assessment & Bartlett and treatment Learning, performed LLC in the matching NOT a particular FOR SALE strategy OR with DISTRIBUTION the needs of a patient. You should carefully learn and practice these techniques during and after your EMT course. NOT FOR and the SALE alternate OR routes DISTRIBUTION in the event that your original route is field (Figure NOT 1-19 FOR ). SALE OR DISTRIBUTION Record Keeping Accurate records play an important role in the management of Transport and Transfer of Care the patient because they become the reference point for information & Bartlett after your Learning, departure from LLC the hospital (Figure 1-20 ). Jones & If your Bartlett rapid response Learning, to a call LLC results in a preventable injury to Jones NOT FOR yourself, SALE your OR partner, DISTRIBUTION or a patient, you have defeated your purpose. When you get behind the wheel of an emergency vehicle, pital events and treatments are very important because NOT FOR Prehospital SALE assessment OR DISTRIBUTION findings and the chronology of prehos- they..

12 12 Chapter 1 Introduction to Emergency Medical Care Agency Unit # Trip # Incident location Prehospital Care Report Type Jones of incident& Bartlett Learning, LLC Medical Trauma No patient Refusal # of Patients Pt. destination Transport by Date of service Attendant Certification level Attendant Certification level Driver Certification level / / Patient s age Narrative Sex F M Chief complaint Mechanism of injury I Previous medical history Medications Allergies Time Blood pressure / / / Pulse Respirations Pupils rate Rhythm rate Rhythm/quality L R Patient Vital Signs Movement of extremities Glasgow R - arm - L R - leg - L Eyes Verbal Motor Charted by Pulse oximeter SaO2 O2LPM Jones Cardiac rhythm & Bartlett Learning, LL NOT FOR SALE IV Therapy OR DISTRIBUTION NOT Medications FOR SALE OR DISTRIBUTION Time Solution Site Size Rate Initials S/U Medication Dose Route Time Time Time Time Order from Response to treatment Total infused cc Response Times Tone Responding On scene ALS on Departed Arr hosp In service Name Address City, State, Zip Patient Information DOB / / SS# Telephone ( ) Next of kin Relationship Hospital notification Assistance Call outcome Med channel # Landline Base physician Other Police Cellular Amb dispatch Sheriff State Patrol Fire Other Air Life Flight for Life Response code 2 3 Helicopter transport Transported to facility Transport code 2 3 Care transferred in field Cancelled Figure 1-20 A prehospital care report. Modified from HealthONE EMS Patient Care Report, courtesy HealthONE EMS, Englewood, Colo...

13 13 symptoms can be caused by serious conditions such as carbon Jones monoxide & Bartlett poisoning Learning, or serious infections LLC (e.g., meningitis, anthrax). SALE Intoxication OR DISTRIBUTION can often mask a serious underlying injury. NOT FOR Once again, you should focus on the patient. Other Responsibilities Public Education An important responsibility NOT of the EMT FOR is SALE to educate OR the DISTRIBUTI public Figure Jones 1-21 & An Bartlett EMT should Learning, show compassion. LLC are the only source of documentation from the scene. When you leave the hospital, physicians and nurses will refer to the prehospital care report to retrieve essential information. You Jones & should Bartlett develop Learning, good habits and LLCrecord pertinent data from the and help prevent injuries. Programs such as community CPR classes can go a long way in increasing the chance of survival of a heart attack victim. Bicycle helmet and safety programs help prevent injuries. Extrication Although extrication is not a primary EMT responsibility, sometimes you may be called on to gain access to and free people trapped in automobiles. This activity is usually the function of specialized rescue personnel within EMS, police department, Jones or fire & department. Bartlett Learning, However, when LLCthese units are not immediately SALE available, OR or DISTRIBUTION when regional systems incorporate these NOT FOR time SALE of the OR initial DISTRIBUTION patient encounter until arrival at the hospital. NOT FOR Many EMS systems are using electronic prehospital care reports functions into the EMT s protocols, you must be prepared to whereas others are still using handwritten forms. Regardless of bring about a safe and efficient rescue. In most situations, you the type of program your system uses, your documentation will perform light extrication, or extrication with the use of must be thorough, chronological, and clear. Accuracy is another basic tools, such as screwdrivers, crowbars, and hacksaws. necessary ingredient in effective Jones documentation. & Bartlett Learning, Times, vital LLCIf heavy extrication is assigned Jones through & Bartlett regional protocols, Learning, LL sign values, and other NOT diagnostic FOR findings SALE should OR be DISTRIBUTION recorded specialized programs are usually NOT conducted FOR SALE to teach OR the DISTRIBUT proper carefully to aid in further assessment of the patient. Your reporting of vital signs provides a baseline that can help track the rescue personnel. use of the larger and more powerful devices typically used by progress or deterioration of the patient s condition. Before extrication can occur, you may need to gain control of the scene. This may mean setting up visual warning devices Patient Jones Advocacy & Bartlett Learning, LLC on a highway Jones or choosing & Bartlett someone Learning, to direct traffic LLC or crowd At the NOT moment FOR of encounter, SALE OR you DISTRIBUTION become the primary healthcare representative for the patient during the prehospital phase control. of care. Patients may not be familiar with the EMSS and depend Communications on you, the EMT, for advice about the best course of action The proper use of the radio or other communication device is for their problem. Often your actions or advice may be guided part of your training. Radio communications should be short Jones & by Bartlett protocols or Learning, directives regarding LLC patient care, hospital selection, SALE decisions OR regarding DISTRIBUTION who can ride with the patient in NOT the FOR sources, SALE notifying OR hospital DISTRIBUTION personnel of the arrival of an acutely Jones and & clear. Bartlett The radio Learning, is a useful tool LLC for mobilizing essential re- NOT FOR ambulance, and many other issues. ill patient, and documenting unusual circumstances that may It is important to treat patients as a whole and to consider all have medicolegal implications later. For example, a patient aspects of their condition, their ability to care for themselves, who leaves the scene against your advice and without a proper notification of family members, and other social and psychological issues. A good rule for the Jones EMT is & to Bartlett treat the patient Learning, as you LLC the information to the dispatcher Jones or medical & Bartlett control. Learning, Many LL signature on a release form can be documented by relaying would want a family member NOT to FOR be treated SALE under OR similar DISTRIBUTION conditions. Sometimes such treatment means going that extra mile by documentation. systems record all conversations NOT to FOR provide SALE another OR form DISTRIBUT of contacting a family member or advising the nurse at the hospital Importantly, you also must learn to be an effective communicator with patients, family members, and hospital personnel. of the need for social service intervention. As a patient advocate, your attitude and actions shift from a purely clinical point of view to a more Jones humanistic & Bartlett approach to Learning, patient care (Figure LLC 1-21 ). Vehicle and Jones Equipment & Bartlett Maintenance Learning, LLC At NOT times, FOR patients SALE may present OR DISTRIBUTION with seemingly minor complaints. Although these may not be emergent problems, stay and perform better for you and the patient. It is frustrating and Vehicles NOT and equipment FOR SALE that are OR well DISTRIBUTION maintained last longer aware and do not jump to conclusions. Adopting a helpbased approach rather than a thrill-seeking focus will help cover that essential equipment is not serviceable or is missing. dangerous to attempt resuscitation or another task, only to dis- prevent burnout and poor patient care. What initially may seem Proper inspection and maintenance of the vehicle and restocking equipment & Bartlett are Learning, roles of every LLC EMT (Figure 1-22 ). Cleaning Jones & minor Bartlett may easily Learning, become serious. LLC Back pain and headaches Jones NOT FOR can SALE be caused OR by DISTRIBUTION serious vascular problems, such as dissection NOT FOR the ambulance SALE OR and equipment DISTRIBUTION is part of a planned program of of the aorta or a hemorrhage (bleeding) in the brain. Flulike infection control and respect for EMT and patient safety...

14 14 Chapter 1 Introduction to Emergency Medical Care A Jones fact that & you Bartlett often are Learning, judged by your LLC appearance, and dress NOT appropriately. FOR SALE OR DISTRIBUTION The attitude of the EMT is even more important than the outer appearance. You should show an interest in your job and possess a sensitive awareness of your environment and the needs of others around you. The provision of medical care is a B Jones & Bartlett Learning, giving LLCprofession and should not be Jones taken lightly. & Bartlett The attributes Learning, LL Figure 1-22 A, Restocking of NOT the vehicle. FOR B, SALE Inspecting OR DISTRIBUTION of quality we seek to deliver are NOT well articulated FOR SALE in a report OR DISTRIBUT by the engine. the Institute of Medicine on quality in America s health care (Box 1-2 ). You should put the patient s needs first while protecting and Professional Attributes of the EMT preserving the safety of bystanders, other rescuers, and yourself. You are not useful Jones to others & if Bartlett you become Learning, a victim yourself. LLC A As a medical NOT professional, FOR SALE you have OR a DISTRIBUTION unique and special body first step in arrival NOT at FOR the scene SALE of every OR emergency DISTRIBUTION is to ensure of knowledge that is to be used for the benefit of society. You scene safety. EMTs must maintain awareness of the safety of are expected to demonstrate skill and knowledge for the good of the environment throughout the call, from arrival to transport the patient. You also are expected to promote high standards of to the hospital. Evolving or escalating hazards can range from behavior and medical practice within the profession. Also, as a street traffic, violence, fire scenes, and emotionally disturbed Jones professional, & Bartlett you are Learning, expected to LLC add to the body of knowledge Jones patients and & Bartlett family members Learning, to communicable LLC diseases. NOT FOR to continue SALE to advance OR DISTRIBUTION progress in emergency medicine. The term that probably best embodies these basic values is professionalism. The dictionary describes professionalism as acting requisite to the body of knowledge which defines the service and abilities of the professional according to the oath of the profession. Although the Jones term professional & Bartlett is used Learning, more LLC loosely now, the expectations NOT of behavior FOR SALE can easily OR be understood by reading a traditional medical oath. Box 1-1 provides DISTRIBUTION the EMT s oath. Appearance and Attitude A professional appearance and attitude help evoke a sense of confidence in the patient and family members (Figure 1-23 ). Because emergency care providers have little time to establish rapport with their patients, the sight of an EMT in a clean and appropriate uniform helps establish a sense of respect and trust. Of course, wearing a uniform may not always be possible Box 1-1 Emergency Medical Technician s Oath Be it pledged as an Emergency Medical Technician, I will honor the physical and judicial laws of God and man. I will follow that regimen which, according to my ability and judgment, I consider for the benefit of patients and abstain from whatever is deleterious and mischievous, nor shall I suggest any such counsel. Into whatever homes I enter, I will go into them for the benefit of only the sick and injured, never revealing what I see or hear in the lives of men unless required by law. I shall also share my medical knowledge with those who may benefit from what I have learned. I will serve unselfishly and continuously in order to help make a better world for all mankind. While I continue to keep this oath unviolated, may it be granted to me to Jones enjoy life, & and Bartlett the practice Learning, of the art, respected LLC by all men, in all times. Should I trespass or violate the oath, may the reverse be my lot. So help me God. 1994, National Association of Emergency Medical Technicians (NAEMT). Written by Charles Gillespie, MD. I Figure 1-23 A properly attired EMT inspires confidence. Jones (e.g., & a Bartlett volunteer EMT Learning, responding LLC from home or work). Because you SALE often OR need DISTRIBUTION to gain a stranger s cooperation and trust NOT Mosby-Elsevier. FOR SALE OR DISTRIBUTION Jones From Aehlert & Bartlett B: Paramedic Learning, today: above and LLC beyond, St Louis, 2010, NOT FOR quickly in EMS, however, you should take advantage of the..