Patient Assesment

Assessing vital signs is an important EMT function. You will take vital signs on every patient you encounter. These vital signs are typically the first one's taken in the emergency situation and are often used as the baseline from which the medical team gauges changes in the patients condition. You will take several sets of vital signs to attempt to identify trends in the patients condition and if he is improving or deteriorating.

The six vital signs you will be taking are respiration's, pulse, skin, pupils, blood pressure, and pulse oximetry.

If the patient is stable you assess every 15 mins. For an unstable patient, you assess every 5 mins.

Obtaining history is important in determining the condition of the patient and what emergency care is necessary, especially in the medical patient.

Closed-ended questions are used in the trauma patient.
Open-ended questions are used for a medical patient.

Communication

Communication is a very important aspect of am EMT being successful or not. You must know the standards of communicating within your area. a basic way of communicating when you are communicating to dispatch is the acronym :
SBAR.
S-situation
B-background
A-assessment
R- recommendation

Be sure to look up the standards in your area.

Ch. 10 Airway Management , Artificial Ventilation, and Oxygenation

Ch.9 Life Span Development-Objective

This chapter will insure your understanding of Life Span Development.

Identify the age ranges associated with each following terms:

• neonate: refers to the child from birth to 1 month of age
• infant: refers to the child from one month to 1 year.
• toddler: a child 1-3 years
• preschooler: child from 3-6years
• school age: child from 6-12 
• adolesent: child between 12-18
• early adulthood: from 20-40 years
• middle adulthood: from 41-60
• late adulthood:  age 61 and older

Discuss the key physical and psycho-social characteristics of individuals in each of the following age groups:

• neonates and infants: 
• toddlers
• preschool-age 
• school-age
• adolescents
• early adulthood
• middle adulthood
• late udulthood.

Ch. 8 Pathophysiology Key Term-Definition

• aerobic metabolism: is the breakdown of molecules such as glucose through a series of reactions energy within cells in the presence of oxygen.
• galycolysis: occur in the fluid portion of the cell and does not require oxygen.
• anerobic metabolism: is the breakdown of molecules in the cells without the presence of oxygen 
• laryngeal spasm: a contraction of the vocal cords that causes them to close and prevents air from passing through into the trachea.
• Boyle law:the concept that the volume of gas is inversely proportionate to the pressure.
• airway resistance: the restriction of airflow that is related to the diameter of the airways.
• compliance:the measure of the ability of the chest wall and lungs to stretch, distend, and expand.
• dead air space: (Vd) anatomical areas in the respiratory where no gas exchange occurs but air collects during inhalation
• central chemoreceptors:
• chemorreceptors: monitor arterial content of oxygen, CO2 and blood.
• periphearal chemorereceptors: locate in the aortic arch and the cartid bodies.
• stretch reseptors:
• apneustic center: the respiratory center in the brain stem that intensifies and prolongs inhalation.
• dorsal respiratory group:
• pneumotaxic center: the respiratory center in the brain stem that intensifies and prolongs inhalation.
• respitory  control centers:
• ventilation/perfusion (V?Q) ratio
• ventral repiratory group:
• deoxyhhemoglobin: it does not have any oxygen moleules attached.
• oxyhemoglobin: hemoglobin that has atleast 1 oxegen molecule attached to it.
• hydrostatic pressure: the, effect forces fluid out of the inside a capillary bed generated  by the conraction of the heart and the blood pressure that exerts, push that forces out of the vessel.
• plasma oncotic pressure: the force responsible for keeping fluid inside a vessel, pull.
• cardiac output: the volume of the blood generated by the left ventricle.
• Frank-starling law of the heart: the stretch of the muscle fiber in the left ventrical at the end of distial determins the force necessary to eject the blood contained with in it.
• stroke volume:
• preload: the pressure generated in the ventrical in resting phase.
• afterload: the force of contraction that the left ventricle has to generate to overcome the resistance in the aorta to eject the blood.
• glycosis:
• stsemic vascular resistance: the resistance of blood flow through a vessel based on the diameter of the vessel.
• micracirculation:  the flow of blood in the site of exchange of gases, nutirents, and waste products with the cells.
• baroreceptors: stretch sensitve receptors located in the aortic arch and carotoid bodies that constantly measure the blood pressure

Ch. 7 Definitions of the human body. Q and A

Describe each of the following terms of position:                             

•  Anatomical position: unless otherwise indicated , all references to the human body assume the anotomical position.
•  Supine: The patient id lying on his back.
•  Prone: The patient is lying face down on his stomach
• Lateral recumbant: the patient is lying on his left or right side.
• Fowler position: the patient on his back with his upper body elevated at a 45 dgrees 
• Semi-Fowler position: the patient is lying on his back with his upper body elevated less than 45 degree.
• Trendelenburg position: The patient is lying on his back with his legs elevated higher than the head and the body is on a inclined plane.
• Shock position: the feet and legs are elevated approximatly  12 inches.

Identify each of the following anatomical terms:

• Midline: Visualize the normal anatomic position (patient facing you).Now imagine a line vertically from the middle of the patient's body. it divides the body into equal halves.
• Sagittal plane: a vertical plane that does not have to be equal on both sides.
• Frontal plane: divides the body into front and back halves.
• Transverse: horizontal plane which is parallel with the ground and divides the upper and lower body in half. axial plane.
• Midaxillary line: the patient is standing in profile. this plane go vertically from the armpit to the ankle.
• Midclavicular line: refers to the center of each of the collarbones 
• Anterior and posterior'anterior id toward the front. Posterior is toward the back.
• Dorsal and ventral: Dorsal means toward the back or backbone spine. Ventral means toward the front or belly.
• Right and left: always the patients right or left.
• Superior and inferior: superior means toward the head or above the point of reference. In inferior means toward the feet.
• Medial and lateral: medial means toward the midline or center of the body. Lateral refers to the left or right of the midline, or away from the midline of the body.
• Proximal and distal: near the point of reference. Distal is distant, or far from the point of reference.
• Plantar: refers to the sole of the foot..
• Palmar: refers to the palm of the hand.
• Abdominal quadrants: 
• left upper quadrant: liver (small portion), spleen, left kidney, stomach,colon, pancreas(small portion),small intestines.
• left lower quadrant: colon, small intestines,left ureter, left ovary (female), left fallopian tube(female)
• right upper quadrant: Liver, rt. kidney, colon, pancreas(small portion) gallbladder, small intestines.
• right lower quadrant: colon, small intestines, right ureter,appendix, right ovary (female), right fallopian tube (female)

State the function of each of the following musculoskeletal system structures:

• Skeletal muscle: makes it 
• Tendons
• Ligaments
• bone

Describe each of the following components of the skeleton, including it's location, the bones that make it up, and it's function:

• Skull
• Cranium
• Face

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• Spinal column
• Cervical spine
• Thoracic spine
• Lumbar spine
• Sacral spine
• Coccyx

--------

• Thorax:
• sternum (including manubrium, body, and xiphoid process)
• Ribs

------- 

• Pelvis
• Ilium and iliac crest
• Ischium
• pubis
• Acetabulum:

-------

• Upper extremities:
• Clavical
• Scapula, including olecranon process
• Carpals
• Metacarpals
• Phalanges

--------

• Lower extremities:                                                                      
• Femur                                                                                              
• Patella
• Tibia, including medial malleolus
• Fibula, including lateral malleolus
• Tarsals, including the calcaneus
• Metatarsals
• Phalanges 

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Demonstrate each of the following joint movements:

• Flexion and extension
• Adduction and abduction
• Circumduction
• Pronstion and supination

Describe each of the following types of joints:

• Ball-and-socket
• Hinge
• Pivot
• Gliding
• Saddle
• Conyloide

Differentiate between skeletal (voluntary), smooth (involuntary), and cardiac muscle:

Identify the basic functions of the repirtory system:

Identify the following structures of the respiratory system:

• Upper airway: nose, mouth, pharynx, nasopharynx, larynx:
• Lower airway: trachea, bronchi, bronchioles, alveoli
• epigottis
• lungs
• pleura
• diaphram

Identify important difference in respirtory system anatomy in children:

Describe the basic maechanics and physiology of normal ventilation, respiration, and oxygenation, including:

• Inhalation and exhalation
• use of intercostal muscles and diaphragm
• negitive and positve pressure
• nervous system control of respiration
• alveolar/capillary exchange of oxygen and carbon dioxide
• Capillary/cell exchange of oxygen and carbon dioxide

Identify characteristics of both adequate and inadequate breathing.

List the functions of the circulatory (cardiovascular) system.

Describe the anatomy and physiology of the heart to include:

• location and size                                                                                   
• tissue layers
• chambers
• valves
• blood supply
• blood flow through the heart
• Conduction system

Discuss the anatomy and physiology of the blood, circulation, purfusion, and metabolism to convey basic comprehension of:

• Arteries and arterioles
• capillaries
• veins and venules
• blood composition
• perfusion and capillary exchange
• cell metabolism

Describe the basic functions of the nervous system.

Differentate between the structural components and basic functions of the central nervous system and peripheral nervous system:

• voluntary (somatic) nervous system
• involuntary (autonomic) nervous system
• sympathetic division
• parasympathetic division

Describe the basic role of the reticular activationg systems (RSM) and cerebral hemisheres in conciousness and unconsciousnes.

Explain the overall function of the endocrine system:

• Tyroid gland 
• parathyroid glands
• adreal glands 
• gonads
• islets of langerhans of the pancreas of the pancreas, insulin, and glucagon
• pituatary gland

Describe the general actions of epinephrine and norepinephrine on beta1, beta2, alpha1, alpha2 receptors of the symathetic nervous system.

List the general fuctions of the integumentary system.

Identify  the structures of the integumentary system, including the epidermis, dermis, and subcutanous layer.

Describe the basic anatomy and physiology of each of the following structures of the digestive system:

• stomach
• pancreas
• liver
• gallbladder
• small in testine (duodenum, jejun, ileum)
• colon

List the basic structure and function of the organs of the urinary or renal system to include:

• kidneys
• ureters
• uninary bladder
• urethra

State the basic structure function of the organs of the male and female reproductive systems:

• Male
• testes
• accessory glands
• penis
• Female
• ovaries
• fallopian tubes
• uterus
• vagina
• external genitalia

                                                                                                                                                                                                                        

                                                                                                               






































                                                                                                               

                                                                                         

Part 2-Ch.7 "Anatomy, Physiology, and Medical terms" Key terms

• Anatomy: The study of the structure of the body and the relationship of it's parts to each other.
• circulatory system: the body system that transports blood to all parts of the body. Includes the heart, blood vessels, and blood. Also called the cardiovascular system.
• digestive system; the structure and organs that ingest and carry food so that absorption and waste elimination can occur..
• endocrine system: a system of ductless glands that produce hormones that regulate body functions.
• integumentary system: the skin.
• musculoskeletal system: the systems of bones and muscle plus connective tissue that provides support and protection to the body.
• nervous system: the body system including the brain, spinal cord, and nerves that controls the voluntary and involuntary activity of the human body. 
• physiology: the study of the function of the living body and it's parts.
• reproductive system: the male and female organs of reproduction.
• respiratory system: the organs involved in the exchange of gases between an organism and the atmosphere.
• urinary/renal system: the organs and structures that filter and excrete wastes from the blood. 

                                                           

Ch 6. Case Study - Follow up

Lifting and Moving the Patient:
After taking her history and her vital signs, you listen as your training officer explains the procedure to the patient. At the top of the stairs, your training officer explains exactly what will be done next. You get behind the chair at the head. Your partner who is taller than you, stands at the foot facing the patient. The training officer moves to the front of the stairs to spot. As you tilt the chair back, your partner grasps it by the legs. You then open the space between your feet, tighten your muscles and lock your back, make sure your hands and fingers are properly positioned, and bend at the hips to pick up the patient. You make sure you can keep the weight and arms as close to your body as possible. When you are both ready you say so. Your training officer tells you how many steps below. Both of you start to the descent. The trainer counts as you descend. You and the other carrier are keeping pace and checking in. The three of you sound like this.
One step. Okay.Okay
Two step. Okay, too fast slow down
and so on.
You take a rest when you get to the bottom. You check the street and make sure it is safe to transport.

Reassessment:
You make sure the patient is comfortable. You and your partner transfer her to hospital staff, and you complete necessary paperwork, clean up your ambulance for the next call.

Ch.6 Case Study

The Dispatch:
EMS Unit 101-you have a 72 year-old patient has a routine transfer to Dover General-time out 0910 hours.

Upon Arrival:
You are a probationary EMT accompanied by a training officer and an experienced EMT. Your training officer tells you that she knows the patient, Amanda, and that is one of three prescheduled visits she takes to the hospital dialysis center every week. She tells you she can not walk and that you have to help her down a flight of stairs. Your partner remarks that there is still snow on the ground and maybe ice.

How would you proceed to package and transport this patient?

Ch. 6 "Lifting and moving patients" Key terms and definitions

                

• Body mechanics: applying safe methods of moving the body, correcting posture, and lifting.
• krphosis: abnormal curvature of the spine with convexity backward. Also called slouch.
• lordosis: abnormal anterior convexity of the spine. Also called swayback.
• power grip: recommended griping technique. The palm and fingers come in complete contact with the object and all fingers are bent at the same angle.
• power lift: recommended technique for lifting. Feet apart, knees bent, back and as straight as possible, lifting force driven through heels and arches, upper body rising before hips.
• emergency move: made when there is immediate danger to the patient or the rescuer.
• urgent move: made when there is immediate threat to life because of the patient's condition and the patient must be moved quickly to transport.
• nonurgent move: made when no immediate threat to life exists.

Ch. 5 Case Study- Follow Up

Primary Assessment:
Your impression of the patient is of a male in his 40's, injured and alert. He responds fully to all your questions. You assess his radial pulse on the injured hand and find that it's fast, but strong. No blood appears to be dripping, so the bleeding seems to be controlled.

Secondary Assessment:
He shows you that he cut his hand on a blade of a saber saw. You now expose the area, carefully removing the towel. You notice a 3 in laceration across the bottom of his palm. You apply sterile dressing to the wound and bandage it in place.You and your partner obtain a set of baseline vital signs. His blood pressure is 148/86 mmHg. His heart rate is 92 per minute. His respiration's are 14 per minute, full and adequate. His skin color is normal, warm and moist. You take a history, it reveals he is not taking any medications, he is allergic to penicillin and he denies that there was anything abnormal before the accident. You explain to him that he should get the cut looked at and you will transport him. He refuses by saying, " it's bad enough that i had to call you for a dumb mistake." He agrees to ride on the jump seat and you secure him for transport.

Reassessment:
Your partner checks the wound again and everything looks stable. She then radios the hospital: "Columbia, this is Unit 2 in route with ETA of 10 minutes. We have a 46 yr old male with a 3 inch laceration on the right hand caused by a saber saw. The patient is alert and orientated:", she then proceeds with the examination findings, and the care they gave. As you pull up to the hospital you radio dispatch, " Dispatch this is unit 2 arriving at Columbia hospital." Dispatch acknowledges with , "unit 2 at hospital at 1152 hours". Upon arrival you inform staff all of your findings. The nurse takes charge while your partner fills out the PCR. You begin to clean the ambulance. Then you radio, "Dispatch this is unit 2 we are available for assignment". Dispatch replies Unit 2 available for assignment at 1207 hours." Then you start back to base and will radio dispatch when you arrive.

Ch. 5 Case Study

The Dispatch:
EMS unit 2-You have a man bleeding heavily in the driveway there. Time out is 1128 hours.

Upon Arrival:
Because the dispatch did not give you a lot of information you approach in caution. It's possible that the injury was sustained with violence. After you assess the scene you drive up closer to the man who is sitting in his driveway. Your partner radios, "unit 2 to dispatch. We are on scene" . Dispatch responds, "unit 2 on the scene at 1137 hours." Because you knew of the bleeding on the patient you and your partner put on gloves and eyewear. Your partner grabs the jump kit and you approach the patient, still using caution and assessing constantly. You see a man that you think is in his 40's approaching you. You notice that he has a blood soaked towel wrapped around his right hand and his shirt and pants are blood stained.

How would you proceed to assess and care for this patient? How would you use your communication skills and equipment during contact with this patient?

Ch. 5 :Communication" Key terms and definitions

• Base station: serves as a dispatch and coordination area and ideally in with contact with all other elements of the system.
• encoder: digitalized radio equipment is common today. with such equipment, an encoder breaks down sound waves into unique digital codes.
• decoder: recognizes and responds to only those codes.
• mobile data terminal: Included in digital communication is the use of a mobile data terminal that is mounted in the cab of the ambulance that receives and displays information on a screen.
• repeaters: are devices that receive transmissions from a relatively low-powered source such as a mobile or portable radio and rebroadcast them at another frequency and higher power.
• SBAR: acronym for situation, background, assessment, and recommendation; a method of organizing communications about a patient.
• communication: using verbal and non-verbal expressions as messages that are received and interpreted by others.
• decoding: process of translating and interpreting a message.                  
• encoding: process of converting information into a message.
• feedback: any information that an individual receives about his behavior.
• defense mechanisms: psychological coping strategies individuals use to protect them selves from unwanted feelings or thoughts.
• gestures: nonverbal body movements that convey meanings to others.
• haptics: the study of touching
• intimate zone: in American culture. the space within less than 1 1/2 feet of an individual.
• closed questions: questions that call for specific information from the patient.
• leading questions: question that suggest an answer.
• open-ended questions: questions that allow the patient to respond in his own words.
• culture: the thoughts, communications, actions and values of a racial, ethnic, religious, or social group.
• ethnocentrism: the view that one way of doing things is the right way and any other way is inferior

Ch. 4 Case Study-Follow Up

PRIMARY ASSESSMENT:
You and your partner remain calm and introduce yourselves and you say," I understand you've had some problems. We are certaintly not here to create any more for you, we just want to make sure you are ok. Are you feeling alright? Do you have any pain?, the witness noticed you had your head slummped over at the wheel, did you lose consciousness you think?" He replies, "no no I just rested my head on the wheel for a second", you see no bleeding, and his skin color is fine." I am sorry I got so upset, it's just been a really bad day". You note that the patient is aleart and breathing fine. He refuses stabilazation, but agrees to take his pulse. It is a little high but within normal.

SECONDARY ASSESSMENT:
You explain to him that you would like to do a physical exam to make sure he does not have any injuries. He becomes angry and says, " Come on, I'm ok.I don't need that", you ask him if you can take his vitals, he say's, "No no I'm really fine".  Your partner discreetly calls dispatch to say, "Patient is refusing emergency care and transport. We will inform you of status shortly".

DOCUMENTATION:
You realize that you are not going to have any success in persuading him to accept care, you explain to him that before he leaves he must sign a refusal-of-care form. You prepare the PCR and the refusal forms. On the PCR you note that he hit his head and your initial findings regarding his alert mental status, his airways, absence of bleeding and condition indicating adequate perfusion. And that he denies losing consciousness.
You show the document to him and allow him to read it. While he is reading it you asks for a witness while he sings the documents. You suggest that he sees a doctor as soon as possible and if he feels dizzy or pain increases do not hesitate to call 911. Your partner contacts dispatch and states that the patient has refused treatment and transport. You unit is now clear and in service.

Ch. 4 Case Study

The Dispatch:
EMS unit 19- You have a man injured when his vehicle struck a parked car. Time out is 1321 hours.

Upon Arrival:
You and your partner arrive at 1327 hours. As you drive up you observe four people standing around two vehicles. As you get out of the ambulance, a woman comes up to you. She say's " I am the one who called I was in the house and I heard a crash and realized that a car had struck mine". When she looked closely at  the car a man was slumped over at the wheel. So she called 911 right away. When she came out of the house the driver seemed to be ok, as she points to the man pacing up and down. We approach him and he says, " oh great!, as if I didn't have enough to deal with already, I have to deal with you guys, go away!, I don't need any help".

How Would You Proceed to Assess, Care for, and document This Patient Contact?

Ch. 4 "Documentation" Terms and definitions

                                 

• Prehopital care report: The type of PCR report varies widely among EMS systems and states; however, the information collected is basically the same.The documentation you generate and report via the PCR and other special reporting forms is important for other reasons as well.
• minimum data: The DOT created a standard for data that will help the educational out look on the future of EMS's. This minimum set is; chief complaint, level of responsiveness, skin perfusion for patients less than 6 years old, skin color, temperature and condition, pulse rate, respiratory rate and effort, patient demographics (sex, age, race, weight).
• triage tag: the record that is attached to the patient for gathering all the information.
• SOAP:  This mnemonic SOAP stands for subjective, objective, assessment, and plan.  
•          subjective-refers to the information a patient must tell you, how they are feeling etc.
•          objective-refers to the information you identify in the physical examination through inspection,        palpation, and auscultation.
•          assessment-refers to the field assessment, the general idea you form based on the subjective and objective assessments along with scene assessment and other information provided by bystanders or family.
•           plan-refers to the plan of action and the emergency care provided to the patient.

• pertinent negatives: In questioning a patient be aware of pertinent negatives. this refers to the signs and symptoms that might be expected, based on chief complaint, but that the patient denies having.
• administration data: Includes administration information as well as, the EMS unit number, names of crew members and their levels of certification, the address to which the unit was dispatched.

Ch.3 Case Study-Follow up

                                         
Patient Assessment:
Your general impression of the patient is that he is conscious but disoriented and experiencing abdominal pain. His wife is unsure of his age so you approximate he is in his 80's.His airway is open; breathing and circulation appears normal. Trying to obtain a complete history is impossible so you do a head-to-toe assessment. After palpation of his stomach he reaches his hand to go away. This could be a sign of refusal for treatment. However, because of his disorientation, you continue care.Mrs. Schuman is completely distracted and disorientated.

AN ETHICAL OBLIGATION:
After transferring the patient to hospital care, you contact the hospital's social services department. as you are required to do in a case of elderly abuse or neglect.You believe that the Schuman's are not capable of caring for themselves. Two weeks later you see the social worker you tells you that Mr. Schuman was diagnosed with a gastric ulcer and organic brain syndrome. Additionally, Mrs. Schuman was diagnosed with Alzheimer disease. Both are now in local extended care nursing homes, under 24 hour supervision. The social worker thanks you for your attention in this matter.

Ch. 3 Case study

              


The Dispatch:
EMS unit 105-you have an elderly male with abdominal pain.

Upon Arrival:
An elderly woman, who tells you she is Mrs. Schuman, meets you and your partner on the front porch of the home. She is wearing only a nightgown and it is 38 degrees F. She says, "it's my husband. Something is wrong. I just can't handle him anymore." You quickly take her inside with you scan the scene for hazards. As soon as you enter you notice that the house is in shambles. You and your partner can barley pass through. She leads you to the bedroom, where you find the patient lying on the bed, his eyes are open and he is moaning softly. The sheets are stained with urine, the smell is very strong and it is very cold in the room.

How would you  proceed with this case?

Ch. 3 "Medical, Legal and Ethical issues". Key terms-definitions

                                      

• scope of practice: EMT's are legally allowed to perform by the state in which they are providing emergency medical care.
• standard of care: The care that is expected to be provided by an EMT.
• duty to act: EMT's legal obligation to provide service, weather you think the patient need an ambulance or not.
• Good Samaritan law: Protects a person that is not being paid for his services from liability for acts performed in good faith unless those acts constitute gross negligence.
• consent: a conscious patient has the right to refuse medical care so it is necessary to obtain consent before providing care.
• implied consent: Occurs when you assume that the patient is unconscious in unable to make a rational decision.
• informed consent: Before treatment the patient must be informed of the care being provided and possible risks.
• minor consent: Must be obtained by a parent or guardian, or others who have been granted rights to make a decision on the minors behave be for treatment. implied consent can be used.
• involuntary consent: can be implied when you are dealing with a mentally incompetent patient.Or with an patient who is in custody of law enforcement or is incarcerated.
• expressed consent: Must be obtained by every conscious, mentally competent adult before treatment is started.
• do not resuscitate (DNR) order: is a legal document or order that most often governs resuscitation issues only.
• durable power of attorney: also known as health care proxy, designates a person who is legally empowered to make health decisions for the signer of the document if can't do it for himself.
• living will: is more often used to cover general health issues, including life support.
• advance directive: Instructions written in advance against resuscitation, signed by the patient.
• physician orders for life-sustaining treatment (POLST): are used in patients with serious or terminally ill who are not expected to survive longer than a year. It is geared to make the decision to resuscitate or not to resuscitate a patient.
• tort: A civil action if the EMT/defendant is accused of wrongful act, injury or damage.
• intentional tort: is an action knowingly committed by an individual that is considered to be civilly wrong according to the law
• abandonment: If you stop treatment with out transferring the care to another competent professional of equal or higher level training and certification or licensure.
• negligence: deviation of standard care.
• proximate cause: If accused of tort it must be determined that the injuries suffered by the patient were the direct result of the EMT"s negligence.
• assault: is a willful threat to inflict harm on a patient.
• battery: is the act of touching a patient unlawfully without his consent.
• defamation: If you release information to the public in either writing or spoken word.
• false imprisonment: results from from intentionally a competent patient without his consent.
• slander: is the spoken word of defamation.
• libel: is putting false information in written form or via mass media.
• Consolidated Omnibus Budget: Active Labor Act(EMTALA): are federal regulations that insure the public's access to emergency care regardless of the ability to pay. also known as "anti-patient-dumping statute". if a patient is turned away at the door because of inability to pay.
• Health Insurance Portability and Accountability Act:of 1996 is a federal that protects the privacy of patient health care and gives the patient control over how the information is distributed.

Ch. 2 Case Study-Follow Up

       

Case Study Follow-Up
     Two hours later you are still not permitted to approach. The husband releases the two children and they are transported by another EMS unit. The husband appears at the door shooting. The special tactics team returns fire and the man falls to the ground. After the police secure the scene, you and your partner approach with Standard Precautions. Primary assessment shows that the downed officer is dead. The gunman is also dead. You and your partner return to the ambulance and notify dispatch that there will be no additional transports. The commander releases you and your partner from the scene.

CRITICAL INCIDENT FOLLOW-UP
     During the drive back to the station, your partner is very quiet and tense. At the station, you try to get him to discuss the call. He responds angrily and tells you he is going to quit EMS. You both summon your supervisor meets with the EMT and encourages him to contact the employee assistance program. He arranges to meet with a mental health professional to discuss the call. He returns to his next shift relaxed and confident that he can perform competently.
 

Ch 2 Case Study - Scene safety

The Dispatch: EMS units 111 and 112-both units respond to a possible domestic dispute with reported gunfire-called in by the police department.


Upon Arrival. You immediately identify three city police cruisers outside a house. Patrol officers are kneeling behind their units with guns drawn and pointed to the house. One of the officers is gesturing for you and your partner to keep back. Your partner stops the ambulance a good distance away. As you survey the scene with binoculars, you identify a downed police officer at the front door of the house. He seems to be bleeding profusely. You both hear gunfire. How will you proceed?

Ch. 2 " Workforce Safety- wellness of EMT" Key terms and definitions.

• burnout: state of exhaustion and irritability. A cumulative stress reaction as a result of constant exposure to stressful situations that build up over time.
• critical incident: develop signs of burnout, maybe seeing a scene in their head over and over of a critical incident. May have thoughts of leaving the career.
• critical incident  stress debriefing: is ideally held with in 24-72 hours of critical incident. A team of peer counselors work through phases to review the facts and the feelings of the EMS worker. 
• defusing: is a version of debriefing that is held with 1-4 hours following a critical incident. It lasts from 30-45 minutes. Its an opportunity to let the feelings out of a worker, before larger problems can arise.
• Standard Precautions: Protecting yourself from disease transmission through exposure to blood and other body fluids.
• pathogens: Microorganisms that are typically visible only through a microscope and maybe found in an environment or on or within a patient you are treating.
• personal protective equipment: Eye protection (goggles), Protective gloves, Gowns, and Masks.
• sterilization: Is the process by which an object is subject to a chemical or physical substance that kills all microorganisms on the surface of that object.cleaning: washing a solid object with soap and water.
• disinfecting: includes cleaning but involves a disinfectant or germicide to kill any microorganisms on the surface of the object.
• purified protein derivative (PPD) tuberculin test:  Tuberculosis test every year and before you begin active duty.

                                                   

Ch. 1 "EMS Systems, Research, Health" Key Terms and Definitions

                       

• Key historical events: What happens to an injured patient before he reaches a hospital is critical. Wars helped teach us this lesson. The Korean and Vietnam wars made it evident that soldiers injured on the battlefield with medical care on the field before transport had the most success rate.The modern EMS has evolved beginning in the 1960's when The President's committee for Traffic Safety showed a need to reduce injuries and deaths on highways. The Highway Safety Act of 1966 took a leadership role in the development of EMS.

• Advanced Emergency Medical Technician (AEMT): Provides all skills of the EMT(see below EMT) and in addition the use advanced airway devices, monitoring blood glucose, initiation of intravenous and introsseous (in the bone) infusions and the administration of select number of medications.
• American with Disabilities Act (ADA):Protects those who have disabilities from being denied initial or continued employment.
• Emergency Medical Responder (EMR): First Responder level, provides immediate lifesaving care to those who have accessed the EMS system, while waiting for response from a higher-level EMS practitioner. EMR use basic airway, ventilation, and oxygen devises;takes vital signs; provides stabilization; eye irrigation, bleeding control, emergency moves, CPR, AED, and emergency child-birth care.
• Emergency Medical Technician (EMT): provides emergency care and transportation to patients who access the EMS System. EMT's use basic level equipment on the ambulance. In addition to EMS skills, we provide advanced oxegen therapy, ventilation equipment, pulse oximetry, use of automated blood pressure monitoring equipment as well as limited medication administration.
• Emergency Medical Services (EMS) System: Permits patient care to begin at scene of injury or illness through to rehabilitation or discharge.
• evidence-based medicine: Focuses on Research provided with clear evidence that certain procedures, medications, and equipment improve the patients out come.
• medical director: The physician who is legally responsible for the clinical and patient care aspects of the EMS System. They oversee continuing education and quality improvement systems.
• medical direction: The director is responsible for medical direction, establishing protocols- guidelines under which the EMS personnel function.
• medical oversight:(emerging term) The medical Directors responsibilities.
• off-line medical direction: Provided by a set of guidelines that are predetermined to allow EMT's to use their judgment to administer medical care without having to contact a physician.
• on-line medical direction: requires EMT's to receive permission from a physician(via cellphone, radio etc..) prior to administering specific emergency care.
• Paramedic: In addition to EMT and AEMT skills, Paramedics are the highest level of prehospital care. They perform advanced assessments, provide invasive and drug interventions and transport. Paramedics care is designed to reduce disability and death to those who have accessed the EMS System.
• prehospital care: Emergency medical treatment given to patients before they are transported to a hospital or other facility.
• protocols: Comprise a full set of guidelines that define the entire scope of medical care.
• quality improvement: A system of internal and external reviews(audits) to ensure a high quality of care.
• standing orders: Preauthorized treatment procedures.

                                 

        

Welcome

Welcome to EMT Education. Follow me as I go through the my EMT course. I'm here to guide you through the step by step educational standards for becoming an EMT. Together we will learn from the beginning stages of EMT schooling through completion of EMT class. It's a University on-line.

We will learn:

• Public Health, Emergency Medical Services, Research, Medical and Legal Issues
• Ethical, Medical, and Legal Issues
• Anatomy and Physiology, Documentation,Communication, Moving patients
• Airway Management, Patient Assessment
• Musculoskeletal Trauma, Spinal Cord Trauma
• Complete to the end of my EMT Course