EMT Unit 1

Chapter 2: Workforce Safety and Wellness

National EMS Education Standard Competencies

Medicine
- Medicine applies fundamental knowledge to provide basic emergency care and
transportation based on assessment findings for an acutely ill patient
Infectious Diseases
- Awareness of-
o How to decontaminate equipment after treating a patient
- Assessment and management of-
o How to decontaminate the ambulance and equipment after treating a patient
Preparatory
- Applies fundamental knowledge of the emergency medical services EMS system,
safety/well-being of the emergency medical technician EMT, medical/legal, and ethical
issues to the provision of emergency care
Workforce Safety and Wellness
-Standard safety precautions
-Personal protective equipment
-Stress management
-Dealing with death and dying
-Prevention of response related injuries
-Prevention of work-related injuries
-Lifting and moving patients
-Disease transmission
-Principles of Wellness and resilience i
Introduction
- To take care of others we must first take care of ourselves
- Recognition of head of hazards to your health safety and well-being is important
o Personal neglect
o Environmental and human made threats
o Mental and physical stress
- The emotional well-being of the EMT and the patient are intertwined especially in high
stress rescues
General Health Wellness and Resilience
- Health is a complex interaction between physical mental and emotional connections
- Chronic physical mental or emotional stress can worsen or increase the chance for
developing health conditions
- Wellness and stress management
- Not all reactions to stress are negative
o Eustress (good stress) creates a positive response
o Distress can cause a negative stress response
- Wellness is the active pursuit of a state of good health
 - Resilience is the capacity of an individual to cope with and recover from distress the
following practices can help increase resilience
o Eat a healthy and well-balanced diet
o Ensure a minimum of seven to nine hours of sleep per day
o Strengthen positive relationships with close family and friends
o Build relationships with peers and colleagues
o Incorporate daily stretching movement and exercise
o Build habits of mindful and positivity
Strategies to Manage Stress
- Minimize or eliminate stressors
- Change partners to avoid a negative or hostile personality
- Change work hours
- Change the work environment
- Cut back on overtime
- Change your attitude about the stressor
- Talk about your feelings
- Seek professional counseling if needed
- Do not obsess over frustrating situations
- Try to adopt a relaxed physiological outlook
- Expand your social support system
- Develop friends and interests outside emergency services
- Limit intake of caffeine, alcohol, and tobacco
Nutrition
- Eat regular, well-balanced meals
- Limit consumptions of sugars, fats, sodium and alcohol.
o Complex carbohydrates are comparable to simple sugars in their ability to
produce energy complex called carbohydrates. Pasta rice and vegetables are
among the most reliable source of long-term energy production Fats are easily
converted to energy but eating too much fat can lead to obesity cardiac disease
- Maintain adequate fluid intake
Exercise and Relaxation
- Regular exercise will enhance the benefits of maintaining good nutrition and adequate
hydration
- When you are in good physical condition you can handle stress more easily
- Engage in at least 30 minutes of moderate or vigorous physical activity 5 days per week
including cardiovascular endurance muscle strength etc
Sleep
- The National Sleep Foundation and the American Academy of Sleep Medicine
recommends that adults sleep a minimum of seven to 10 hours per night
- Half of EMS personnel get less than six hours of sleep per 24 hours and report severe
mental and physical fatigue
o Short term effects of sleep deprivation can lead to medical errors, vehicle
crashes, and other harm to patients, bystanders, and other EMS providers long
 term effects include hypertension sleep apnea diabetes depression and other
medical conditions
o Increased stress can contribute to sleep deprivation and fatigue issues
- Evidence based guidelines for fatigue management have been developed under the US
department of transportation (DOT) and through the national association of state EMS
officials
- Recommendations to combat fatigue
o Get an adequate duration and quality of sleep
o Take 20-30 min naps during shift work
o Increased physical activity
o Be careful about caffeine consumption
o Engage in mental exercise
- Recommendations to improve sleep quality
o Avoid caffeine and nicotine for at least 4 hours before bedtime
o Ensure your sleep environment is dark, quiet, and cool
o Exercise early and allow enough time to relax
o Nap early
o Avoid heavy pre sleep meals
o Balance fluid intake
o Establish a calming pre sleep routine
o Sleep when truly tired
o Don’t watch the clock
o Keep a consistent sleep schedule
o Expose yourself to natural light during your waking hours
Disease Prevention and Health Promotion
- Disease prevention
o Focuses on medical care and prevention to avoid the effects of disease
- Health Promotion
o Focuses on personal practices and social habits to improve one’s health
- Smoking, vaping, or chewing nicotine can lead to cardiovascular and respiratory illness,
as well as cancer
- Strategies are available to assist quitting nicotine containing products
- Alcohol abuse
o Acceptable alcohol consumption is described to be one drink per day for women
and two drinks per day for men
o Excessive alcohol use can adversely affect many body systems (nervous, cardiac,
etc) and increase the risk of developing certain cancers
- Drug Use
o Both prescription medications and illegal or illicit drugs may be abused or
misused
o Many EMS agencies drug testy their employees for illegal and prescription drugs
Balancing Work, Family, and Health
- Rotate your schedule to give yourself time off
 - Take vacations
- Seek help when stress becomes more than you can handle
Infectious and Communicable Diseases
- Infectious diseases is caused by organisms within the body
- Communicable diseases can be spread
o From person to person
o From one species to another
- Infection risk can be minimized by
o Immunizations
o Protective Techniques
o Handwashing
- Terminology
o Pathogen
 Microorganism that can cause disease in a susceptible host
o Contamination
 The presence of infectious organisms on or in objects such as dressings,
water, food, needles, wounds, or a patient’s body
o Exposure
 A situation in which a person has had contact with blood, body fluids,
tissues, or air borne particles in a manner than suggests disease
transmission may occur
o PPE
Routes of Transmission
- Routes Include:
o Direct contact- bloodborne pathogen
o Indirect contact- needlestick
o Airborne transmission- sneezing
o Foodborne transmission- contaminated food
o Vector-borne transmission- fleas/ticks
Risk Reductions and Prevention for Infectious and Communicable Diseases
- All EMTs are trained in handling bloodborne pathogens
- CDC developed standard precautions
o Hand hygiene
o Personal protective equipment
 Gloves
 Gown
 Mask, eye protection, face shield
Donning and Doffing PPE
- Donning: Putting on full PPE
- Doffing: Removal of full PPE
- Preform in a consistent sequence to reduce the risk of contamination
Proper Hand Hygiene
- Handwashing is the simplest, yet most effective way to control disease transmission
 - Wash hands before and after patient contact, even if you wear gloves
- If there is no running water, use a waterless substitute, such as alcohol
Gloves
- Wear gloves if there is any possibility for exposure to blood or bodily fluids
- Vinyl, nitrile, and latex gloves are effective protection
- Change gloves between patients and wash hands
- Removing gloves requires a special technique
o Avoid contaminating yourself with materials on the outside of the gloves
Eye Protection and Face Shields
- Eye protection protects from blood splatters
- Prescription glasses are not adequate
- Goggles or face shields are best
Gowns
- Provide protection from extensive blood splatter
- Worn in situations such as
o Aerosol-generating procedures
o Field delivery of a baby
o Major trauma
Masks, Respirators, and Barrier Devices
- Standard surgical mask for fluid splatter
- Surgical mask on patients with communicable diseases
o Masks with particulate air respirator (N95) on yourself if disease is tuberculosis,
flu, or covid-19
- If patient needs oxygen do non rebreathing mask and do 10 per minute
- Mouth to mouth resuscitation may transmit diseases
- With an infected patient, use:
o Pocket mask
o Bag mask device- avoid in epidemic such as covid
- Dispose of these devices according to local guidelines
Proper Disposal of Sharps
- Proper disposure helps avoid HIV and hepatitis
o Do not recap, break, or bend needles
o Dispose of used sharp items in an approved closed container
Employer Responsibilities
- No guarantee of a 100% risk-free environment
o Risk of exposure to communicable disease is a hazard of your job
o Follow OSHA and other national guidelines
o Know your departments infection control plan and follow it
Establishing an Infection Control Routine
- Infection control should be part of your daily routine
- Clean the ambulance after each run and daily
- Cleaning should be done at the hospital whenever possible
Immunity
 - Even if germs reach you, you may not become infected
o You may be immune
- Preventative measures
o Maintain your personal health
o Receive immunizations
Immunizations
- The CDC recommends immunizations for
o Hepatitis B
o Influenza yearly
o Measles, mumps, rubella (MMR)
o Varicella vaccine or having had chickenpox
o Tetanus, diphtheria, pertussis (Tdap)
- Skin test for tuberculosis
General Exposure Management
- If you are exposed to a patient’s blood or bodily fluids
o Turn over patient care to another EMS provider
o Clean the exposed area
o Rinse your eyes if necessary (20 minutes)
o Activate your departments infection control plan
o Complete an exposure report
Scene Safety
- Begin protecting yourself as soon as you are dispatched
- Continue to protect yourself on scene
- Wear seatbelt while responding and use PPE make park at safe distance wear reflector,
etc
Scene Hazards
- Hazardous materials
o Identify what you can from a distance
o Do not enter unless safe to do so
- Electricity
o Beyond the scope of EMT training
o Mark off a danger zone
o Lightning
 A repeat strike can occur
 Either a direct hit or ground hit is possible
- Fire
o Fire hazards include smoke, oxygen deficiency, high temperatures, toxic gases,
and building collapses
o Use proper protection
- Vehicle crashes-
o Common events for EMS providers. Be careful of
 Traffic
 Unstable vehicle
  Downed power lines
 Sharp objects
 Use protective gear
Scenes of Violence
- Assaults
- Hostage situations
- Riots
- Mass violence
o Know who is in command
o Remain vigilant for the potential of violence
o Allow law enforcement to clear the scene
o At scenes involving projectiles find protection
 Cover
 Concealment
- Recommendation for preventing violence
o Training and practice identifying scenes of potential violence
o Training and practice with de-escalation strategies and techniques
o Training and practice improving interpersonal communication
o Dispatch identification and alerting of past potential threats of violence
- Recommendations for protection against violence
o Training and practice of self-defense and escape techniques
o Training and practice with physical and chemical escape techniques
o Fitting and use of body armor
o Training and practice in operations with law enforcement
Protective Clothing: Preventing Injury
- Critical to personal safety
- Become familiar with various types
- Cold-weather clothing
o Three layers
- Turnover gear
o Heat, fire, sparks, and flashover
- Gloves
o Heat, cold, cuts
o May reduce dexterity
- Helmets
o Protect from falling objects
- Boots
o Steel-toed is preferred
- Eye-protection
o Glasses with side shield
- Ear-protection
o Foam earplugs
- Skin protection
 o Sunblock
- Body Armor
o Vests
Caring for Critically Ill and Injured Patients
- Let the patient know who you are and what you are doing
- Let the patient know you are attending to his or her immediate needs
- Communicating with the critical patient
o Avoid sad and grim comments
o Orient the patient
o Be honest
o Deal with possible initial refusal of care
o Allow for hope
o Locate and notify family members
- Injured and critically ill children
o Ask a responsible adult to accompany the child to reduce anxiety, etc
- Death of a child
o A tragic event
o Help the family in any way you can
o Let the family’s actions be your guide
o Prepare the parents
o Shock and denial are common
Death and Dying
- Death occurs
o Quite suddenly
o After a prolonged, terminal illness
- The EMT will face death
- Stages of grieving
o Denial
o Anger, hostility
o Bargaining
o Depression
o Acceptance
- The EMT’s role
o Ask how you can help
o Reinforce reality
o Be honest
o Allow the patient and family to grieve
o DO NOT say I know how you feel
Stress Management on the Job
- EMS is a high-stress job
- Important to know causes and how to deal with stress
o Include emotional, physical and environmental situations
- General adaptation syndrome
 o Alarm response to stress
o Reaction and resistance
o Recovery- or exhaustion
- Physiologic signs of stress
o Increased respirations and heart rate
o Increased blood pressure
o Cool, clammy skin
o Dilated pupils
o Tensed muscles
o Increase blood glucose level
o Perspiration
o Decreased blood flow to gastrointestinal tract
Stressful Situations
- Dangerous situations
- Physical and psychological demands
- Critically ill or injure patients
- Dead and dying patients
- Overpowering sights, smells, and sounds
- Multiple patients situations
- Angry or upset patients, family, or bystanders
- Unpredictability and demands of EMS
Stress Reactions
- Acute stress reactions
o Occur during a stressful situation
- Delayed stress reactions
o Manifest after stressful event
- Cumulative stress reactions
o Prolonged or excessive stress
- Physical symptoms of stress
o Fatigue
o Changes in appetite
o GI problems
o Headaches
o Insomnia or hypersomnia
o Irritability
o Inability to concentrate
o Hyperactivity or underactivity
- Psychological symptoms
o Fear
o Dull or nonresponsive behavior
o Depression
o Guilt
o Oversensitive, anger, irritability, and frustration
 - Critical incident stress is caused by acute severe stressors
o Mass-casualty incidents
o Serious injury or traumatic death of a child
o Crashes with injuries caused by emergency provider while traveling to or from a
call
o Death or serious injury of a coworker in the line of duty
Posttraumatic Stress Disorder
- May develop following a psychologically distressing event
- Characterized by reexperiencing the event and overresponding to stimuli that recall the
event
- Critical incident stress management
o Used to help providers relieve stress
o Can occur formally or at an ongoing scene
o Facilitated by trained professionals
o Debriefing happens 24-48 hours after an event
o Don’t be afraid to get counseling
Burnout
- A combination of exhaustion, cynicism, and reduced performance resulting from long-
term job stress
- Affects the bell being of the EMT along with that of their crew members and patients
- Can result in increased medical errors
- Contributes to lower work moral
- Increase in job turnover
Compassion Fatigue
- Also known as secondary stress disorder
- Characterized by gradual lessening of compassion
- Symptoms:
o High absenteeism
o Inability to work in teams
o Lack of empathy for patients
o Judgmental attitude towards patients
Responder Risk for Suicide
- Suicide rate among emergency responders is higher than the rest of the population
- Job stress is considered the largest contributing factor to suicide
- Several organizations and mental health services are available to provide emotional
support
Emotional Aspects of Emergency Care
- At times health care providers have trouble overcoming personal reactions and
proceeding without hesitation
- The struggle to remain calm in the face of horrible circumstances contributes to
emotional stress
Stressful Situations
- Many factors influence how a patient reacts to the stress of an EMS incident
 - Quickly and calmly assess the actions of the patient, family members, and bystanders
- Use a professional tone and show courtesy
- Allow the patient to express their fear
- Respect religious customs and needs
Workplace Issues
- Cultural diversity on the job
o You are expected to work with coworkers of varying backgrounds, beliefs, and
values
o Culture includes nationality, age, disability, sex, sexual orientation, marital
status, work experience, and education
o Communicate in a way that is sensitive to everyone’s needs
o Remain curious and openminded
- Sexual harassment
o Two types
 Quid pro quo- request for sexual favors
 Hostile work environment- jokes, touching, glaring, etc
o Report harassment to your supervisor immediately and keep notes
- Substance abuse
o Increase risks on the job
o Leads to poor decision making
o Seek help or find a way to confront an addicted coworker
o Employee assistance programs (EAPs) are often available
- Inury and Illness prevention
- Program should contain
o Management leadership
o Worker participation
o Hazard identification and assessment
o Hazard prevention and control

Chapter 3: Medical, Legal, and Ethical Issues

National EMS Education Standard Competencies

Preparatory
- Applies fundamental knowledge of the emergency medical services (EMS) systems,
safety/well-being of the emergency medical technician (EMT), medical/legal, and ethical
issues to the provision of emergency care
Medical/Legal and Ethics
- Consent/refusal of care
- Confidentiality
- Advance directives
- Tort and criminal actions
- Evidence preservation
- Statutory responsibilities
 - Mandatory reporting
- Ethical principles/moral obligations
- End-of-life issues
Introductions
- A basic principle of emergency care is to do no further hard
- A health care provider usually avoids legal exposure if he or she acts
o In good faith
o According to an appropriate standard of care
Consent
- Consent is permission to render care
- A person must give consent for treatment
- If the person is conscious and rational, he or she has a legal right to refuse care
- The foundation of consent is decision-making capacity
o Can understand information provided
o Can make informed choice regarding medical care
- Patient autonomy is the right of the patient to make decisions about his or her health
- Is the patient’s intellectual capacity impaired? Dementia? Drugs? Alcohol? Oriented
Expressed Consent
- The patient acknowledges he or she wants you to provide care or transport
- To be valid, the patient must provide informed consent
o You have explained the treatment, risks, and benefits to the patient,
consequences of refusing
Implied Consent
- Applies to patients who are
o Unconscious
o Otherwise incapable of making an informed decision
- Should never be used unless there is a threat to life or limb
- Principle of implied consent is known as the emergency doctrine
- Try to get consent from a spouse or relative
Involuntary Consent
- Applies to patients who are
o Mentally ill
o In behavioral crisis
o Developmentally delayed
- Obtain consent from guardian or conservator
o Not always possible, so understand local provisions
Minors and Consent
- Parents or legal guardian gives consent
- In some states, a minor can give consent
o Emancipated minors (married, armed services, parents)
- Teachers and school officials may act in place of parents
- If a true emergency exists and no consent is available
o Treat the patient
 o Consent is implied
Forcible Constraint
- Sometimes necessary with combative patients
- Legally permissible
o Consult medical control
o May require law enforcement
o Need permission to restrain someone physically and take against will
- Once applied do not remove restraints en route unless they pose a risk to the patient
- Consider calling ALS backup to provide chemical pharm restraint
The Right to Refuse Treatment
- Conscious, alert adults with decision-making capacity
o Have the right to refuse treatment
o Can withdraw from treatment at any time, even if the result is death or serious
injury
- Calls involving refusal are frequently litigated
- Involved online medical control and document this consultation
- Asses the patient’s ability to make an informed decision
o Ask and repeat questions
o Asses the patient’s answers
o Observe the patient’s behavior
- If the patient appears confused or delusional, you cannot assume that the decision to
refuse is an informed refusal
- Providing treatment is a much more defensible position than failing to treat a patient
o Do not endanger yourself
o Use the assistance of law enforcement to ensure your own safety
- Before you leave a scene where a patient, parent, or caregiver has refused care
o Encourage the individual again to allow care
o Ask the individual to sign a refusal of care form
o A witness is valuable in these situations
o Document all refusals
o Remind to call 911 again if they change their mind
Confidentiality
- Confidential information includes
o Patient history
o Assessment findings
o Treatment provided
- Information generally cannot be disclosed except
o If the patient signs a release
o If a legal subpoena is presented
o If it is needed by billing personnel
- Talking generally about a call is ok but be general no identifying info
- Health Insurance Portability and Accountability Act of 1996 (HIPAA)
o Contains a section on patient privacy
 o Strengthens privacy laws
o Safeguards patient confidentiality
o Considers information to be protected health information (PHI)
- Failure to abide by the provisions of HIPAA laws can result in civil and/or criminal action
- The general public is often permitted by law to record identifying and protected patient
information and images
- Social media
o Avoid agency logos, uniforms, vehicles, or other marking associated with your
agency while off duty
o Conduct yourself professionally on and off duty
o Free speech does not mean that everyone has a right to say anything under any
circumstances and without repercussions
Advance Directives
- An advanced directive specifies treatment should the patient become unconscious or
unable to make decisions
- A do not resuscitate (DNR) order is an advance directive that gives permission not to
resuscitate
o Do not resuscitate” does not mean “do not treat”
o Even with DNR you are obligated to give supported measures like oxygen, pain
relief, etc
- Other names for advance directives
o Living wills
o Health care directive
- DNR orders must meet the following requirements
o Statement of the patient’s medical problems
o Signature of the patient or legal guardian
o Signature of physician or health care provider
o Not expired
- Physician orders for life-sustaining treatment (POLST) and medical orders for lfe-
sustaining treatment (MOLST)
o Explicitly describe acceptable interventions for the patient
o Must be signed by an authorized medical provider
o Contact medical control for guidance
- Some patients may have named surrogates to make decisions for them
o Durable powers of attorney for health care
o Also known as health care proxies
- Due to the growing number of hospice home health programs, you may face this
situation
Physical Signs of Death
- A physician determines the cause of death
- Presumptive signs of death
o Unresponsive to painful stimuli
o Lack of carotid pulse or heartbeat
 o Absence of breath sounds
o No deep tendon or corneal reflexes
o Absence of eye movement
o No systolic blood pressure
o Profound cyanosis
o Lowered or decreased body temperature
- Definitive signs of death
o A body in parts (decapitation)
o Dependent lividity (blood settling to low part of body causing discoloration to
skin)
o Rigor mortis (stiffening)
 Occurs between 2-12 hours after death
o Algor mortis
 Colling of the body until it matches the ambient environment
o Putrefaction (decomposition)
 Occurs between 40-96 hours after death
Medical Examiner Cases
- Involvement depends on nature/scene of death
- Examiner notified in cases of
o Dead on arrival (DOA)/dead on scene (DOS)
o Death without previous medical care
o Suicide
o Violent death
o Poisoning, known or suspected
o Death from accidents
o Suspicion of a criminal act
o Infant or child deaths
Special Situations
- Organ donors
o Expressed a wish to donate their organs
o Evidence by information on
 Organ donor card and or
 Driver’s license
o Your priority is to save the patient’s life
o Remember that organs need oxygen
- Medical identification insignia
o Bracelets, necklace, keychain, or card indicating
 DNR orders
 Allergies
 Diabetes, etc
o Some patients wear a medical bracelet with a USB flash drive
Scope of Practice
- Outlines the care you can provide
 - Usually defined by state law
- Medical director further defines by developing
o Protocols
o Standing orders
- Carrying out procedures outside scope of practice may be considered
o Negligence
o Criminal offense
Standards of Care
- Way you must act or behave
- You must be concerned about the safety and welfare of others
- Standards of care are established by
o Local custom
o Law
 Statuetes, ordinances, administrative regulation, or case law
o Professional or institutional standards
 Example: AHA CPR guidlines
o Textbooks
 Example: NHTSA
o Standards imposed by states
 Medical practices act
 Licensure
 Certification
 Credentialling
Duty to Act
- Individual’s responsibility to provide patient care
- Duty to act applies
o Once your ambulance responds to a call
o Once treatment is begun
Negligence
- Failure to provide the same care that a person with similar training would provide in
same or similar situation
- All four of the following factors must be present for negligence to apply
o Duty
o Breach of duty
o Damages
o Causation- something you did or did not do caused damages
- Res ipsa loquitur (theory)
o The cause of the injury was in the control of the EMT, generally does not occur
unless there is negligence
- Negligence per se (theory)
o The conduct of the person being sued is alleged to that occurred in clear
violation of a statute
o Example- EMT does ALS skill that hurt patient
 - Torts
o Civil wrongs
Abandonment
- Unilateral termination of care by EMT without
o Patient consent
o Making provisions for continuing care
- Abandonment may take place
o At the scene
o In the emergency department
- Always obtain a signature on your patient care record of the person assuming care
Assault and Battery, and Kidnapping
- Assault: unlawfully placing person in fear of immediate bodily hard
o Example- restraint
- Battery: unlawfully touching a person
o Example- proving care without consent
- Kidnapping: seizing, confining, abducting, or carrying away by force
o Example- transport against will
- False imprisonment: unauthorized confinement of a person
Defamation
- Communication of false information that damages reputation of a person
o Libel- written
o Slander- spoken
Good Samaritan Law and Immunity
- If you reasonably help another person, you will not be held liable for errors or omissions
- Good Samaritan conditions to be met
o Good faith
o Without expectation of compensation
o Within scope of training
o Did not act in grossly negligent manner
- Gross negligence: conduct that constitutes a willful or reckless disregard
- Immunity statutes apply to EMS systems that are considered governmental agencies
o Sovereign immunity: provides limitations on liability and immunity is not
complete
Records and Reports
- Compile a record of all incidents involving sick or injured patients
- Important safeguard against legal complications
- Courts consider
o An action no recorded was not preformed
o Incomplete or untidy reports is evidence of poor emergency medical care
- National EMS Information Systems (NEMSIS)
o Provides the ability to collect, store, and share standardizes EMS data
o Used to improve the speed and accuracy of data collection
Special Mandatory Reporting Requirements
 - Most states have a reporting obligation
o Abuse of children, older persons, or others
o Injured during commission of a felony
o Drug-related injuries
o Childbirth
o Attempted suicides
o Dog bites
o Communicable diseases
o Assaults
o Domestic violence
o Sexual assault or rape
o Exposures to infectious disease
o Transport of patients in restraints
o Scene of a crime
o The deceased
Ethical Responsibilities
- Ethics- philosophy of right and wrong, moral duties, and ideal professional behavior
- Morality- code of conduct affecting character, conduct, and conscience
- Bioethics- specifically addresses issues that arise in the practice of health care
- Require you to evaluate and apply ethical standards
o Your own
o Those of your profession
- Allow rules, laws, and policies to guide your decision making
The EMT in Court
- You can end up in court as
o A witness
o A defendant
- Case can be civil or criminal
- Whenever called to testify, notify
o Your service director
o Legal counsel
- As witness
o Remain neutral
o Review run report before court
- As a defendant, an attorney is required
- Defenses may include
o Statute of limitations
o Governmental immunity
o Contributory negligence
- Discovery allows both sides to obtain more information through
o Interrogatories
 Written requests or questions
o Depositions
  Oral requests or questions
- Most cases are settled following the discovery phase during the settlement phase
- If not settled, the case goes to trial
- Damages that may be rewarded
o Compensatory damages
o Punitive damages- deter defendant from re doing
- Any EMT charged with a criminal offense should secure the services of a highly
experienced criminal attorney immediately

Chapter 5:
National EMS Education Standard Competencies
Medical Terminology
- Uses foundational anatomical and medical terms and abbreviations in written and oral
communication with colleagues and other health care professionals
o With patients use clear plain English NOT med term
Introduction
- EMTs need a working knowledge of medical terminology
- They need to understand
o Key terms
o Symbols
o Abbreviations
- Determine the meaning of an unknown word by
o Understanding how terms are formed
o Learning the definitions for parts of a term
- Understanding medical jargon leads to effective communication
Anatomy of a Medical Term
- Medical terms are made of distinct parts that preform specific functions
- Changing or deleting any part can change the function (meaning) of a word
- Components that comprise medical terms include the
o Word root
o Prefix
o Suffix
o Combining vowels
- How the parts of a term are combined determines its meaning
o Accurate spelling is essential
o -phasia meaning speaking, -phagia means eating or swallowing
o Dys- means difficult or painful
 Dysphagia means difficulty speaking
 Dyyphagia means difficulty eating or swallowing
o Its also important to know
 Knowledge of anatomy
 Context of how words are used
- Word root
 o Main part or stem of a word
 Conveys the essential meaning
 Frequently indicates a body part
o Add or change a prefix or suffix to change the meaning of the term
 Cardiopulmonary breaks down into
 Cardia is a word root meaning “heart”
 Pulmon is a word root meaning “lungs”
- Prefixes
o Appear at the beginning of a word
o Usually describe location or intensity
o Give the word root its specific meaning
- Suffixes
o Appear at the end of words
o Usually indicate a
 Procedure
 Condition
 Disease
 Part of speech
- Combining vowels
o Connects word root to suffix or other word root
o Most cases, its an o: may also be an I or e
o Used when joining
 A suffix that begins with a consonant
 Another word root
Word Building Rules
- Summary of rules
- The prefix is at the beginning of a term
- The suffix is at the end of a term
- Use a combining vowel when
o The suffix beginning with a consonant (to ease pronunciation)
o A term that has more than one word root
Plural Endings
- Apply these rules
o Sometimes you add an s (lung to lungs)
o Words ending in
 A change to oe (vertebra to vertebrae)
 Is change to es (diagnosis to diagnoses)
 Ex or ix change to ices (apex to apices)
 On or um change to o (ganglion to ganglia, ovum to ova)
 Us change to I (bronchus to bronchi)
Special Word Parts
- Prefixes can indicate
o Numbers
 o Colors
o Positions and directions
- Numbers
o Some prefixes indicate that a term involves a number or two (or more) parts or
sides
 Example- uni, multi, bi, etc
- Colors
o Several word roots describe color
 Example- cyan/o, leuk/o, etc, erythr/o, etc
- Positions and directions
o Prefixes can describe a position, direction, or location
 Example- ab-, ad-, circum-, etc
Common Direction, Movement, and Position Terms
- Directional terms
o Needed to discuss
 When an injury is located
 How pain radiates in the body
- Superior or inferior
o Superior
 Nearer to the head
o Inferior
 Nearer to the feet
o Terms describe the relationship of one structure to another
 Example- the knee is superior to the foot and inferior to pelvis
- Lateral and Medial
o Lateral (outer)
 Body parts that is far from midline
o Medial (inner)
 Lie closer to midline
- Proximal and distal
o Describe the relationship of any two structures on an extremity
 Proximal- closer to the trunk
 Distal- farther from the trunk/nearer to the free end of the extremity
- Superficial and deep
o Superficial
 Means closer to or on the skin
o Deep
 Means farther inside the body/tissue, and away from the skin
- Ventral and dorsal- most common in 4 leg animals
o Ventral
 Refers to the belly side or anterior (front)
o Dorsal
 Refers to the spinal side of body or posterior (back)
  Posterior surface of the body (ex- dorsal fin of a dolphin)
o More commonly used term are;
 Anterior: front of body
 Posterior: back of body
- Palmar and plantar
o Palmer Surface
 Front region of the hand (the palm)
o Plantar surface
 Bottom of the foot
- Apex (apices)
o Tip(s) of a structure
o Example- the apex of the heart is the bottom (inferior portion) of the ventricles
- Movement terms
o Flexion- bending of a joint
o Extension- straightening of a joint
o Adduction- moving toward the midline
o Abduction- moving away from the midline
- Other directional terms
o Bilateral- both sides of midline
 Structures inside the body also appear on both sides of midline
o Unilateral- only one side of the body
- Anatomic positions
o Prone or supine
 Prone means lying face down
 Supine means lying face up
o Fowler position
 Semi reclining with head elevated
o Semi-fowler
 Patient sits at a 45-degree angle
o High- fowler
 Patient sits at a 90-degree angle
Breaking Terms Apart
- Using the meaning of parts to decipher the term
- Define in this order
o The suffix
o The prefix
o The word root
- Hypothermia
o Hypo- below normal
o Therm- heat
o Ia- condition
- Nephropathy
o Nephr/o/pathy
 o -pathy (means “disease”)
o O (combining form)
o Nephr (meaning “kidney”)
o Nephropathy= disease of the kidney
Abbreviations, Acronyms, and Symbols
- Shorthand used for communication
o Developed for speed
 DO NOT trade speed for accuracy
 Only use commonly understood acronyms and abbreviations to minimize
errors
 Some agencies limit the use of abbreviations
- Abbreviations
o Take the place of words to shorten notes/documentation
o Use only accepted ones to avoid confusion/errors
o Be familiar with abbreviations in your service area
- Symbols
o Sometimes used as shortcut
o Use only accepted symbols to avoid confusion/errors

Chapter 6: Human Body

Introduction
- Having a fundamental knowledge of anatomy is important
- Terminology
o Anatomy- the study of the physical structure of the body and its systems
o Physiology- examines how the body systems work
o Pathophysiology- the study of the functional changes that accompany a disease
or syndrome
Topographic Anatomy
- Helps everyone refer to the body in the same way
- Applies to the body being in anatomical position
o Patient facing you, arms at their side, with palms facing forward
- Planes of the body
o Coronal (frontal)- divides the body front and back
o Sagittal (lateral)– divides the body left and right
o Midsagittal (midline)- divides the body into equal left and right halves
o Transverse (axial)- dives body horizontally into top and bottom sections
Imaginary Lines
- Further define different areas of the body to help describe different injuries
o Midclavicular line
 Vertical line through the middle portion of the clavicle (collarbone) and
parallel to the midline
o Midaxillary line
  Vertical line drawn through the axilla to the waist
o Anterior axillary line
 Parallel line down just an inch or so in front of the midaxillary line
o Posterior axillary line
 A parallel line drawn an inch or so behind the midaxillary line
Anatomy As a Whole
- Cell- tissue- organ – organ system- organism
Skeletal System Anatomy
- The skeleton gives us our recognizable human form
- Composed of 206 bones
o Axial skeleton- skull, face, thorax, and verterbral column
o Appendicular skeleton- upper and lower extremity
o Pelvis
Joints
- Occur whenever bones come in contact
- Consist of the ends of the bones and the connecting and supporting tissues ex- synovial
fluid
- Two types of joints
o Ball and socket joint
 Allow rotation and bending
o Hinge joint
 Motion restricted to flexion and extension
The Axial Skeleton
- Skull
o Cranium: Made up of 4 bones (occipital, temporal, parietal, and frontal)
o Face: made up of 14 bones
 Orbit= zygoma, frontal, and maxilla
The Axial Skeleton
- Spinal column
o Composed of 33 bones (vertebrae)
o Divides into 5 sections
 Cervical 7
 Thoracic 12
 Lumbar 5
 Sacrum 5
 Coccyx 4
o C1- atlas holds up head
o C2- axis allows rotate head back and forth
o 12 pairs of ribs
o Vertebrae connected by intervertebral disks and this is shock absorber
o Thorax
 Formed by 12 thoracic vertebrae and 112 pairs of ribs
 Thoracic cavity contains
  Heart
 Lungs
 Esophagus
 Great vessels (superior and inferior vena cava and aorta)
o Midline of chest is sternum made of manubrium, body, and xyphoid process
The Appendicular Skeleton
- Arms, legs, and their connection points, and pelvis
- Includes
o Joints
o Upper extremities
o Pelvis
o Lower extremities
Upper Extremities
- Upper extremity extends from the pectoral girdle to fingertips
o Composed of arms, forearms, hands, and fingers
- Starts by clavicle over by shoulder and goes all the way to fingertips
- Shoulder girdle: three bones that come together
o Clavicle
o Scapula
o Humerus
- Shoulder is ball and socket joint
- Arm
o Humerus is the supporting bone
o Forearm consists of the radius and ulna
o Radius on lateral side
o Ulna on medial side
- Wrist and hand
o Ball and socket joint
o Principal bones
 Carpals
 Metacarpals
 Phalanges
The Pelvis
- The pelvic girdle consists of
o Two coxae (hip bones)
o Sacrum
o Coccyx
- Each pelvic bone is formed by fusion of the ilium, ischium, and pubis
- Posteriorly, the ilium, ischium, and pubis bones are joined by the sacrum
- Anteriorly, the pubic symphysis is where the right and left pubis are joined
- Pelvis is highly vascular area there is femoral veins which come up to the inferior vena
cava
- The descending aorta starts to branch off to femoral arteries that come off each side
Lower Extremities
- Femur
o Longest bone in the body
o Connects into the acetabulum (pelvic girdle) by a ball and socket joint
o The greater and lesser trochanter are where the major muscles of the thigh
connect to the femur
- Knee connects the upper leg to the lower leg
o Kneecap (patella)
- Lower leg
o Tibia (shinbone)
 Anterior of leg
o Fibula
 Lateral side of leg
- Tarsals
o Talus and calcaneus are largest
o Talus joins with distal tibia and fibula to form the ankle joint
o Calcaneus forms the prominence of the heel
- Metatarsals
- Phalanges- 2 in big toe 3 in every other
- Dorsum- top of foot
- Plantar- bottom of foot
The Skeletal System: Physiology
- The skeletal system
o Gives the body its shape
o Protects fragile organs
o Allows for movement
o Stores calcium
The Musculoskeletal System: Anatomy
- Musculoskeletal system provides
o Form
o Upright posture
o Movement
o Protection of vital internal organs
- Three types of muscle that are going to be found within the body
o Skeletal muscle
 Skeletal muscle is also referred to as voluntary muscle and have a nerve
impulse sent for it to move
o Smooth muscle
 Smooth muscle would be referred to as involuntary muscle which kind of
just does its thing. The nervous system does kind of keep control over
that, but it is found with everything that has those automatic functions
o Cardiac muscle
  Cardiac muscle we're going to find within the part itself and is unique and
it can generate its own electrical impulses so the other thing about
skeletal muscle is we can kind of see in the picture here because of its
characteristic strength appearance there's little stripes that go through
the muscle it is referred to as striated muscle
The Musculoskeletal System: Anatomy
- Contraction and relaxation of system make it possible to move and manipulate the
environment
o A by-product of this movement is heat
- Another function of the muscles is to protect the structures under them
The Respiratory System: Anatomy
- Structures of the body that contribute to respiration (the process of breathing)
- Two parts
o Upper airway-
 Larynx is dividing line between upper and lower airway
 Function- warm the air we breathe in, filter the air, humidify the air we
breathe in
 After larynx is trachea then the left and right bronchi
 Diving part into bronchi is the carina
 From there bronchi break to bronchioles then alveoli
 Alveoli is where respiration happens
 Gas exchange
 Oxygen in
 Co2 exhaled
 Diaphragm is voluntary and involuntary at the same time
 We breath without having conscious thought or can take in deep breath
so there is some control
 Includes
 Nose
 Mouth
 Tongue
 Jaw
 Larynx
o Divides upper and lower airway
 Pharynx
 Nasopharynx
 Oropharynx
 Laryngopharynx
 Trachea- made of cartilage rings
o Epiglottis- leaf shaped flap prevent things from getting into
trachea
o Lower airway
 Thyroid cartilage
  Adam’s apple
 Cricoid cartilage- immediately below the thyroid cartilage
 Cricothyroid membrane
 Trachea
 Ends at carina, diving into right and left bronchi leading to
bronchioles
Lungs
- The lungs are held in place by
o Trachea
o Arteries and veins
o Pulmonary ligaments
- Divided into two lobes (5 lobes total)
o Right lung has upper, middle, and lower lobes (3)
o Left lung has upper and lower lobes (2)
- Within the lobes are bronchi, bronchioles, and alveoli
o Allow for gas exchange
- Pleura: a layer of smooth, glistening tissue that covers each lung and lines the chest
cavity
o Between the two layers is a small amount of fluid that allows the tissue to glide
smoothly
Muscles of Breathing
- Diaphragm is the primary muscle of breathing
- Also involved are
o Neck (cervical muscles)
o Intercostal muscles (between ribs)
o Abdominal muscles
o Pectoral muscles (in upper portion of chest)
Inhalation
- Diaphragm and intercostal muscles contract
- Pressure in the thoracic cavity decreases
- Lungs fill with air
- Active part of the respiratory cycle, requires energy
Exhalation
- Diaphragm and intercostal muscles relax
- Thoracic cavity returns to its normal shape and volume
- Passive portion of the respiratory cycle
- Forces air and carbon dioxide out of lungs
The Respiratory System: Physiology
- Function is to provide body with oxygen and eliminate carbon dioxide
- Ventilation and respiration are two separate, interdependent functions of the
respiratory system
- Respiration is the exchange of oxygen and carbon dioxide in the alveoli and tissues
o Provide oxygen to the cells and removes waste carbon dioxide
 o Diffusion: passive process in which molecules move from an area of higher
concentration to an area of lower concentration
- Chemical control of breathing
o Brainstem controls breathing by monitoring carbon dioxide in blood and spinal
fluid
o Primary reason for breathing is to lower carbon dioxide levels
o Hypoxic drive
o The medulla oblongatta sends messages via the phrenic nerve
- Nervous system control of breathing
o The medulla initiates ventilation cycles
 Stimulated by high carbon dioxide levels
o The pons has two areas that help augment respirations during emotional or
physical stress
- Ventilation is simple air movement into and out of the lungs
o Requires chest rise and fall
o Tidal volume- amount of air moved into or out of the lungs during a single
breath
o Residual volume- the gas that remains in the lungs to keep the lungs open
- Dead space- the portion of the respiratory system that has no alveoli and where little or
no exchange of gas between air and blood occurs
- Respiratory rate x tidal volume= minute volume
Characteristics of Normal Breathing
- Normal rate and depth (tidal volume)
- Regular rhythm or pattern of inhalation and exhalation
- Clear, audible breath sounds on both sides of chest
- Regular rise and fall movement on both sides of the chest
- Movement of the abdomen
- Normal Respiratory Rate Ranges
o Adults- 12-20 breaths/min
o Children- 12-40 breaths/min
o Infants- 30-60 breaths/min
Inadequate Breathing Patterns in Adults
- Labored breathing
- Muscle retractions
- Pale, cyanotic, cool, damp skin
- Tripod position
- Agonal gasps
The Circulatory System: Anatomy
- Complex arrangement of connected tubes
o Arteries, arterioles, capillaries, venules, and veins
- Two circuits
o Systemic circulation (body)
o Pulmonary circulation (lungs)
The Heart
- Hollow muscular organ
- Made of specialized cardiac muscle
- Muscle tissue of the heart is called myocardium
- Works as two paired pumps
- Each side is divided into
o Atrium (upper chamber)
o Ventricle (lower chamber)
- Circulation
o The heart receives blood from the aorta
o Right side receives deoxygenated blood from the veins
o Left side receives oxygenated blood from the lungs
- Valves- designed to keep blood flowing in the right direction
o Pulmonary valve
o Aortic valve
o Bicuspid valve (mitral)
o Tricuspid valve- 3 cusps connected to chordae tendinea
- Normal resting heart rate (HR) is 60-100 beats per min
- Stroke volume (SV)
o Amount of blood moved by one beat
- Cardiac output (CO)
o Amount of blood moved in 1 minute
o HR x SV= CO
- Electrical conduction system
o Specialized tissue capable of initiating and conducting electrical current
o Causes smooth, coordinated contractions
o Contractions produce pumping action
o Electrical impulse of the heart usually begins at the sinoatrial node to AV note
then bundle branches then mechanize fibers
Arteries
- Arteries carry blood from the heart to all body tissues
- Aorta branches into
o Coronary arteries
o Carotid arteries
o Hepatic arteries
o Renal arteries
o Mesenteric arteries
- Pulmonary artery
o Carries oxygen poor blood to the lungs
- Arteries branch into smaller arteries and then into arterioles
o Arterioles branch into a series of increasingly smaller vessels until they connect
to the capillaries
- Pulse
 o Palpated most easily at the neck, wrist, or groin
o Created by forceful pumping blood out of the left ventricle and into the major
arteries
- The artery that can be palpated on the anterior surface of the foot is the dorsalis pedis
- Central pulses
o Carotid artery- at upper portion of neck
o Femoral artery- in the groin
- Peripheral pulses
o Radial artery- at the wrist at base of thumb
o Brachial artery- on the medial aspect of the arm, midway between the elbow
and shoulder
o Posterior tibial artery- posterior to the medial malleolus
o Dorsalis pedis artery- on the top of the foot
Capillaries
- Connect arterioles to venules
- Fine end divisions of arterial system
- Allow contact between blood and cells
Veins
- Return oxygen-depleted blood to the heart
- The superior vena cava carries blood returning from the head, neck, shoulder, and
upper extremities
- The inferior vena cava carries blood from the abdomen, pelvis, and lower extremities
- Join at right atrium
The Spleen
- Solid organ located under the rib cage
- Filters blood
- Particularly susceptible to injury from blunt trauma
- Blood
o Plasma 55%
o Platelets 0.01% blood clots
o Red blood cells 41%
o White blood cells 4%
The Circulatory System: Physiology
- Blood pressure- pressure that blood exerts against the walls of the arteries
- Systole- when the left ventricle of the heart contracts, it pumps blood from the
ventricles into the aorta
- Diastole- when the muscle of the ventricle relaxes, the ventricle fills with blood
- Blood pressure readings
o Systolic blood pressure- high point of wave
o Diastolic blood pressure- low point of wave
- Preload- amount of blood returning to the heart
- Afterload- pressure to be overcome when left ventricle contracts
Normal Circulation in Adults
 - Automatically adjusted and controlled
- Perfusion- circulation of blood in organ or tissue in adequate amounts to meet the
needs of cells
- Hypoperfusion- inadequate blood supply to organs, tissues, and cells
Inadequate Circulation in Adults
- The system can adjust to small blood loss
o Vessels constrict
o The heart pumps more rapidly
- With a large loss, adjustment fails, and the patient goes into shock
- Mean arterial pressure (during systole and diastole) can help deter shock
Functions of Blood
- Fighting infection
- Transporting oxygen
- Transporting carbon dioxide
- Controlling pH
- Transporting wastes and nutrients
- Clotting (coagulation)
Nervous System Control of the Cardiovascular System
- Sympathetic nervous system is responsible for fight or flight response
o Sends commands to adrenal glands
o Epinephrine (adrenaline) and norepinephrine (noradrenaline) are secreted to
stimulate heart and blood vessels
o Blood vessels have alpha-adrenergic receptors
o The heart and lungs have beta-adrenergic receptors
o Baroreceptors sense pressure in the blood vessels
o The sympathetic and parasympathetic nervous system balance each other
 - In an otherwise healthy adult, blood loss would cause vascular constriction and
tachycardia
The Nervous System: Anatomy and Physiology
- The nervous system is perhaps the most complex organ in the body
- Divided into two pain portions
o Central nervous system (CNS)
o Peripheral nervous system
Central Nervous System
- Brain
o Controlling organ of the body
o Subdivisions
 Cerebrum
 Frontal lobe- movement
 Parietal lobe- special recognition
 Temporal lobe- taste, hearing, understand words
 Occipital lobe- seeing
 Cerebellum- balance, coordination, posture
 Brainstem- controls body functions needed for life including respiratory
and cardiac
 Midbrain
 Pons
 Medulla oblongata
 Reticular activating system- regulates consciousness and sleep
 - Cerebrospinal fluid
o Cushions and protects the brain and spinal cord
- Circulation to the head
o Deoxygenated blood is supplied via carotid arteries
o Deoxygenated blood is brained by the internal and external jugular veins
- Spinal cord
o Extension of the brainstem
o Transmit messages between the brain and body
Peripheral Nervous System
- Divided into two main portions
o Somatic nervous system
o Autonomic nervous system
- Somatic nervous system
o Transmits signals from brain to voluntary muscles
- Autonomic nervous system
o Involuntary actions
- Split into two areas
o Sympathetic nervous system (fight or flight)
o Parasympathetic nervous system (slows body/ rest and digest)
- Two different types of nerves within peripheral nervous system
o Sensory nerves carry information from body to CNS
o Motor nerves carry information from CNS to muscles
The Integumentary System (Skin): Anatomy
- Two layers
o Epidermis (superficial)
o Dermis (deeper)
- Subcutaneous tissues lies beneath the skin
o Fat that insulates and serves as energy reservoir
- Skin is the largest organ in the body
- Three major functions
o Protect the body in the environment
o Regulates body temperature
o Transmits information from environment to brain
- Germinal layer
- Stratum corneum
The Digestive System: Anatomy
- Gastrointestinal system
- Abdomen: the second major body cavity
o Contains major organs of digestions and excretion
o Organized into 4 quadrants
 Right upper
 Liver, gallbladder, and portion of colon
 Left upper
  Stomach, spleen, and a portion of the colon
 Right lower
 Two portions of the large intestine
 Left lower
 Descending and sigmoid portions of colon
o Small intestines, pancreas, large intestines, urinary bladder lie in more than one
quadrant
o Kidneys and pancreases lie in retroperitoneal space
- Mouth
- Lips, cheeks, gums, teeth, tongue
- Salivary glands
- Oropharynx
- Esophagus- contracts to let food down
- Stomach
- Pancreas
- Liver
o Bile duct
- Small intestine
- Large intestine
- Appendix
- Rectum
The Digestive System: Physiology
- Enzymes are added to food
o By salivary glands, stomach, liver, pancreas, and small intestines
- Food is converted to basic sugar, fatty acids, and amino acids
o Further processed by liver
o Circulated via blood throughout body
o Small intestine absorbs
The Lymphatic System
- Elements of the lymphatic system
o Spleen
o Lymph nodes
o Lymph
o Lymph vessels
o Thymus gland
o Other components
- Supports the circulatory system and immune system
- Lymph is a thin, straw-colored fluid that carries oxygen and nutrients to cells and waste
products away
o Helps to rid the body of toxins and other harmful materials
The Endocrine System: Anatomy and Physiology
- Complex message and control system
- Integrates many body functions
 - Hormones are released directly into the bloodstream
o Epinephrine, norepinephrine, insulin
- The brain controls the release of hormones
- Excesses or deficiencies in hormones can cause disease
- Pancreas creates insulin
- Adrenal medulla release epinephrine
The Urinary System: Anatomy and Physiology
- Controls the discharge of certain waste materials filtered from the blood by the kidneys
- Controls fluid balance in the body
- Filters and eliminates wastes
- Controls pH balance
- Kidneys
- Ureter
- Urinary bladder
The Genital System: Anatomy and Physiology
- Controls reproductive processes
- Male system consists of
o Testicles
o Epididymis
o Vasa differentia
o Prostate gland
o Seminal vesicles
o Penis
- Female system consists of
o Varies
o Fallopian tubes
o Uterus
o Cervix
o Vagina
Life Support Chain
- All cells in body require oxygen, nutrients, and removal of waste
- The circulatory system is the carrier of these supplies and wastes
- If interference occurs, cells become damaged and die
- Cells use oxygen to turn nutrients into chemical energy through metabolism
- Aerobic metabolism uses oxygen
- Cells switch to anaerobic metabolism (produces lactic acid) when oxygen is limited
- Movement of oxygen, waste, and nutrients occur by diffusion
- pH is critical to diffusion
- The body expends a large amount of energy to maintain normal pH
Pathophysiology
- The study of functional changes that occur when body reacts to disease
- Respiratory compromise is the inability of the body to move gas effectively
o Hypoxia
 o Hypercarbia
- Factors that impair ventilation
o Blocked airway
o Impairment of the muscles of breathing
o Airway obstructed physiologically (asthma)
o Other factors
- Factors that impair respiration
o Change in atmosphere
o High altitudes
o Impaired movement of the gas across cell membrane
- V/Q ratio
o How much gas is being moved effectively through the lungs
o How much blood is flowing around the alveoli where perfusion occurs
o Mismatch occurs when one variable is abnormal
- Effects of respiratory compromise on the body
o Oxygen levels fall and carbon dioxide levels rise
o Respiratory rate increase
o Blood becomes more acidic
o The brain sends commands to the body to breath
o Cells move from aerobic to anerobic metabolism
Shock
- Occurs when organs and tissue do not receive enough oxygen
o Impaired oxygen delivery causes cellular hypoxia
- Categorized into several types depending on the cause
- Effects of shock on the body
o The level of oxygen supplied to the tissues falls
o Cells engage in anaerobic metabolism
o Severe metabolic acidosis ensues
o Baroreceptors initiate the release of epinephrine and norepinephrine
o The heart rate increases
o Interstitial fluid moves into the capillaries
Impairment of Cellular Metabolism
- Results in the inability to properly use oxygen and glucose at the cellular level
- Cells create energy through anaerobic metabolism
o Can result in metabolic acidosis
- Brain cells cannot use alternative fuels
- Cellular injury may become irreversible

Chapter 7: Lifespan Development

National EMS Education Standard Competencies

Preparatory
 - Applies fundamental knowledge of the emergency medical services EMS system,
safety/well-being of the emergency medical technician EMT, medical/legal, and ethical
issues to the provision of emergency care
Life Span Development
- Applies fundamental knowledge of life span development to patient assessment and
management
Introduction
- Humans develop throughout their lives
- EMTs must be aware of the physical changes a person undergoes at various stages of life
o May affect the approach to patient care
Neonates and Infants
- Neonates
o Birth to 1 month
- Infants
o 1 month to 1 year
o Develop at a startling rate
- Weight
o Neonate weighs 6 to 8 lb (3 to 3.5 kg) at birth
o The head accounts for 25% of body weight
o Growth of about 1 oz per day
o Weight triples by the end of the first year
- Cardiovascular system
o At birth, neonate makes transition from fetal to independent circulation
- Pulmonary system
o Infants younger than 6 months are prone to nasal congestion
o Infants have longer tongue and shorter, narrower airways, so airway obstruction
is more common than in older children or adults
- Nervous system
o Evolution continues after birth
o Moro reflex- neonate opens arms wide, spreads fingers and seems to grab at
things
o Palmar group- occurs when an object is placed into the neonate’s palm
o Rooting reflex- neonate instinctively turns head when something touches its
cheek
o Sucking reflex- occurs when a neonate’s lips are stroked
- Fontanelles
o Spaces between the bones that eventually fuse to form the skull
o Posterior fontanelle fuses by 3 months
o Anterior fontanelle fuses between 9 and 18 months
o 2 months of age tracking objects with their eyes and recognize familiar faces
o 6 months of age- sitting upright and babbling
o 12 months of age- walking with minimal assistance
- Immune system
 o Maintains some of the mother’s immunities
o Infants can also receive antibodies via breastfeeding
- Psychosocial changes
o Begin at birth and evolve as the infant interacts with the environment

o Crying is the main method of communicating distress

o Infants develop relationships with their parents or caregivers at different rates
o Bonding is based on a secure attachment
o Anxious- avoidant attachment is found in infants who are repeatedly rejected
o Separation anxiety is common in older infants
o Trust and mistrust involve an infant’s needs being met
Toddlers and Preschoolers
- The cardiovascular system of a toddler (1-3 years) or preschooler (4-6 years) is not
dramatically different from an adult
 - Preschoolers (3-6 years)
o Pulse- 80 to 1400 beats/min
o Respiratory rate- 20 to 25 breaths/min
o Systolic blood pressure- 80 to 100 mm Hg
o Do not have well-developed lung musculature
o Weight gain should level off
o Passive immunity is lost
o Neuromuscular growth also makes considerable progress at this age
o Average age for completion of toilet training is 28 months
- Psychosocial changes
o Learn to speak and express themselves
o Master basic language
o Interact and play games with other children
o Begin to understand cause and effect
o Learn to recognize gender differences by observing role models
School-Age Children
- 6 to 12 years old
- Physical traits and functions continue to mature at a rapid rate
- Growth of 4lb and 2.5 inches every year
- Permanent teeth come in
- Brain activity increases in both hemispheres
- Psychosocial changes
o Preconventional reasoning- children act to avoid punishment and get what they
want
o Conventional reasoning- children look for approval from peers and society
o Postconventional reasoning- children make decisions guided by their conscience
o Self-concept and self-esteem develop
Adolescents (Teenagers)
- 12 to 18 years old
- Vital signs level off
o Pulse- 60 to 100 beats/min
o Respirations- 12 to 20 breaths/min
o Systolic blood pressure- 90 to 110 mm Hg
- 2–3-year growth spurt
o Girls finish by 16 years, boys by 18 years
- Reproductive system matures
o Secondary sexual development takes place
o Voices start to change
o Menstruation begins
o Acne can occur
- Psychosocial changes
o Adolescence and their families often deal with conflict
o Privacy becomes an issue
 o Self-consciousness increases
o Adolescents may struggle to create their own identity
o Antisocial behavior and peer pressure peak at age 14 to 16 years
 Smoking, illicit drug use, unprotected sex
 Eating disorders
o Code of ethics develops
o High risk of suicide and depression
Early Adults
- 19 to 40 years
- Vital signs do not vary greatly
o Pulse- 60 to 100 beats/min
o Respiratory rate- 12 to 20 breaths/min
o Systolic blood pressure- 90 to 120 mm Hg
- From age 19 to 25 years, the body should be functioning at its optimal level
o Lifelong habits are solidified
- Psychosocial changes
o Life centers on work, family, and stress
o Settling down, marriage, and family
o One of the more stable periods of life
Middle Adults
- 41 to 60 years
- Vital signs remain the same
o Pulse- 60 to 100 beats/min
o Respiratory rate- 12 to 20 breaths/min
o Systolic blood pressure- 90 to 140 mm Hg
- Vulnerable to vision and hearing loss
- Cancer incidence increases
- Menopause occurs in late 40s or early 50s
- Diabetes, hypertension, and weight problems are common
- Exercise and healthy diet can diminish the effects of aging
- Psychosocial changes
o Focus on achieving life goals
o Readjust lifestyle as children leave home
o Generally have the physical, emotional, and spiritual reserves to handle life’s
issues
o Finances become a concern
o May be caring for both children leaving for college and aging parents
Older Adults
- 61 years and older
- Life expectancy is constantly changing
o Now approximately 78 years
- Cardiovascular system
o Declines with age largely due to artheroscolosis
 o Heart rate and cardiac output decreases
o Vascular system becomes stiff
o Ability to produce replacement blood cells declines, so does blood volume
- Respiratory system
o Size of airway increases
o Surface area of alveoli decreases
- Natural elasticity of the lungs decreases
o Breathing becomes more labor intensive
o Vital capacity decreases
o Chest becomes more rigid and fragile
o Cough and gag reflex diminishes
o Greater risk for aspiration and airway obstruction
o More susceptible to lung infections
- Endocrine system
o Insulin production drops off
o Metabolism decreases
o The reproductive system changes to some extent
- Digestive system
o Taste sensation decreases
o Saliva secretion decreases
o Ability of intestines to contract and move food diminishes
o Gallstones become increasingly common
o Anal sphincter changes can produce fecal incontinence
- Renal System
o Filtration function declines
o Kidney mass decreases by 20%
o Diminished blood flow to the kidneys
o Decreased ability to clear wastes from the body and ability to conserve fluids
when needed
- Nervous system
o Motor and sensory neural networks become slower
o Neurons are lost but there is no loss of knowledge or skill
o Sleep patterns change
o Age-related shrinkage creates a void between the brain and the outermost layer
of the meninges
o Peripheral nerve sensation is diminished
o Increased reaction times cause longer delays between stimulation and motion
o Slowdown in reflexes and decreased kinesthetic sense may contribute to falls
and trauma
- Sensory changes
o Most older adults can see and hear well
o May need glasses or hearing aids
 o Visual distortions are common
o Hearing loss is four times more common than vision loss
- Psychosocial changes
o Until about 5 years before death, most people retain high brain function
o Statistics indicate that 95% of the elderly live at home
o Financial limits may restrict access to health care or medications
o More than 50% of all single women in the US who are 60 or older are living at or
below the poverty line
o Elderly need to face their own mortality
o Isolation and depression can be challenges

Chapter 8: Lifting and Moving

National EMS Education Standard Competencies

EMS Operations
- Knowledge of operational roles and responsibilities to ensure patient, public, and
personnel safety
Introduction
- During a call, you will have to move patients to provide emergency medical care and
transport
- To move patients without injury, you need to learn the proper techniques
- Knowledge of proper body mechanics and a power grip is important
The Wheeled Ambulance Stretcher
- Wheeled ambulance stretcher
o Also called an ambulance stretcher or gurney
o Most used device
- The wheeled ambulance stretcher weights 40-145 lb.
- Generally, not taken up or down stairs or where the patient must be carried for any
significant distance
- Moving a patient by rolling, using a stretcher or other wheeled device is preferred when
the situation allows and helps prevent injuries from carrying
- Before going on a call, familiarize yourself with the specific features of the stretcher you
ambulance carries
- General features
o Head end and foot end
o Strong metal frame to which all the other parts are attached
o Hinges at center allow for elevation of head/back
o Guardrails prevent the patient from rolling out
o Undercarriage frame allows adjustment to any height
o Mattress must be fluid resistant
o The patient is secured with straps
 Helps protect patient from further injury
Backboard
 - Long, flat, and made of rigid rectangular material (mostly plastic)
- Used to carry and immobilize patients with suspected spinal injury or other trauma
- Commonly used for patients found lying down
- Used to move patients out of awkward places
- 6-7 feet long
- Holes serve as handles and as a place to secure straps
Moving and Positioning the Patient
- When you move a patient, take care that injury does not occur
o To you
o To your team
o To the patient
- Patient lifting and moving are technical skills that require repeated training and practice
- Using proper body mechanics and maintain physical fitness greatly reduce the chance of
injury
- Move patients in an orderly, planned, and unhurried manner
- Master the skills necessary for the equipment you will be using
Body Mechanics
- Sacrum is weight bearing
- Lifting position
o Shoulder girdle should be aligned over pelvis
o Hands should be held close to legs
o Force then goes essentially straight down spinal column
o Very little strain occurs
- You may injure your back
o If you lift while leaning forward
o If you lift with your back straight but bent significantly forward at the hips
- Lifting technique (power lift)
o Legs should be spread about 15 inches apart (shoulder width)
o Place feet so the center of gravity is balanced
o With your back held upright, bring your upper body down by balancing the legs
o Grasp the patient/stretcher
o Lift the patient by raising your upper body and arms and straightening your legs
until standing
o Keep the weight close to your body
o Keep your arms the same distance apart
- The power grip gets maximum force from the hands
o Palms up
o Hands about 10 inches apart
o All fingers at the same angle
o Fully support handle on curved palm
- When directly lifting a patient, tightly grip the patient in a place and manner that will
ensure that you will not lose your grasp on the patient
Principles of Safe Reaching and Pulling
 - Body drags
o The same body mechanics and principles apply to moving, lifting, and carrying a
patient
o Keep your back locked by tightening your abdominal muscles
o Kneel
o Extend your arms no more than 15-20 inches in front of you
o Alternate between pulling the patient by flexing your arms and repositioning
yourself
- To drag a patient across a bed
o Kneel on the bed to avoid reaching beyond the recommended distance
o Drag the patient to within 15-20 inches
o Complete the drag while standing at the side of the head
o Use the sheet or blanket under the patient rather than dragging the patient by
his or her clothing
- In the hospital, transfer the patient from the stretcher to a bed with a body drag
o The stretcher should be the same height or slightly higher than the bed
o You and a partner should kneel on the bed and drag in increments
- Log roll the patient onto his or her side to place a patient on a backboard
o Kneel as close to the patient’s side as possible
o Keep your back straight and lean solely from the hips
o Roll the patient without stopping until the patient is resting on his or her side
and braced against your thighs
o Pulling toward you allows your legs to prevent the patient from rolling over
completely
Principles of Safe Lifting and Carrying
- Whenever possible, use a device that can be rolled
- When a wheeled device is not available, make sure that you understand and follow the
guidelines for carrying a patient on a stretcher
- Patient weight
o Estimate the patient’s weight before lifting
 Adults often weight 120-220 lb.
 Two EMTs should be able to safely lift this weight
o Try to use four providers to lift when possible
 More stability
 Requires less strength
o Do not attempt to lift a patient who weighs more than 250lb with fewer than
four providers
o Know the weight limitations of the equipment and how to handle patients who
exceed the weight limitations
o Special bariatric techniques and equipment are used when patients weigh more
than 350 lb. (159 kg)
- Lifting and carrying a patient on a backboard or stretcher
 o More of the patient’s weight rests on the head half of the device than on the
foot half
o The diamond carry and the one-handed carry use one EMT at the head and the
foot, and one on each side of the patient’s torso
o Use four providers- one providers at each corner of the stretcher to provide an
even lift
o When rolling the wheeled ambulance stretcher, make sure that it is in the fully
elevated position
- Moving a patient with a stair chair
o Use a stair chair to carry a consious patient up or down a flight of stairs
o This lightweight, wheeled folding chair has a molded seat, adjustable safety
straps, and fold out handles at both the head and feet
- Moving a patient on stairs with a stretcher
o A backboard should be used instead for a patient who
 Is unresponsive
 Must be moved in supine position
 Must be immobilized
o Carry the patient on the backboard down to the prepared stetcher
o Place the strongest EMTs at the head and foot ends, with the taller person at the
foot end
o Place both the backboard and the patient on the stretcher, secure both to the
stretcher with additional straps
- Loading a wheeled stretcher into an ambulance
o Ensure the frame is held firmly between two hands so it does not tip
o New models are self-loading, allowing you to push the stretcher into the
ambulance
o Other models need to be lowered and lifted to the height of the floor of
ambulance
o Clamps in the ambulance hold the stretcher in place
Direction and Commands
- Team actions must be coordinated
- Team leader
o Indicates where each team member should be
o Rapidly describes the sequence of steps to preform before lifting
- Preparatory commands are used
o Example- leader says stop or all ready
- Countdowns are also used
- Carefully plan ahead
- Select the methods that will involve the least amount of lifting and carrying
o Consider where there is an option that will cause less strain
Emergency Moves
- Use when there is potential for danger
 - Use when you cannot properly assess the patient or provide immediate care because of
the patient’s location or position
- Use techniques to help prevent aggravation of patient spinal injury
o Clothes drag
o Blanket drag
o Arm drags
o Arm to arm drag
- To remove an unconscious patient from a vehicle alone
o Move the patient’s legs clear of the pedals
o Rotate the patient so the back is toward the open car door
o Place your arms through the armpits and support the head against your body
o Drag the patient from the seat to a safe position
Urgent Moves
- Necessary to move patient
o With altered level of consciousness
o With inadequate ventilation
o In shock
o In extreme weather conditions
- Rapid extraction technique requires a team of knowledgeable EMTs
- Rapid extraction technique should be used only if urgency exists
- The patient can be moved within 1 minute
- This technique increases the risk of damage if the patient has a spinal injury
- Look at all options before using an urgent move
Nonurgent Moves
- Used when both the scene and the patient are stable
- Carefully plan how to move the patient
- Team leader should plan the move
o Personnel
o Obstacles identified
o Equipment
o Procedure and path
- Choose between
o Direct ground lift
 For patients with no suspected spinal injury and in supine
 Patients who need to be carried over some distance
 EMTs stand side by side to stand and carry the patient
o Extremity lift
 For patients with no suspected spinal injury and in supine
 Helpful when patient is in small setting
 One EMT at patients head one EMT at patient’s feet
 Coordinate movement verbally
- Transfer moves
o Direct carry
  Move patient using direct carry method
o Draw sheet method
 Move patient using blanket or sheet
o Scoop stretcher
Geriatrics
- Most patients transported by EMS are geriatric patients
- Skeletal changes may cause brittle bones, rigidity, and spinal curvatures that present
special challenges
- Allay the patient’s fears with a sympathetic and compassionate approach
Bariatrics
- Refers to management of obesity
- 76 million US adults are obese
o 30-40% of adults are obese
o About 17% of children are obese
- Back injurie account for the largest number of missed days of work
- Stretchers and equipment are being produced with higher capacities
o Does not address danger to users of that equipment
o Mechanical ambulance lifts are uncommon in the US
Additional Patient-Moving Equipment
- Bariatric stretchers
o Specialized for overweight or obese patients
o Wider wheelbase
- Pneumatic and electronic-powered wheeled stretchers
- Limit the risk of injury to providers and patients
- Portable/folding stretcher
o Strong rectangular tubular metal frame with fabric stretched across it
o Used in areas that are difficult to reach
- Flexible stretchers
o Excellent for storage and carrying
o Conform around a patient’s sides
o Useful for confined spaces
- Short backboards
o Used to immobilize seated patients
 Ex- the KED vest-type device
- Vacuum mattresses
o Alternative to backboards for immobilizing geriatric and pediatric patients
o Air is removed from the device, allowing it to mold around the patient
o Provides immobilization, comfort, and thermal insulation
- Basket stretchers
o Rigid stretchers
o Used for patient removal in remote locations, including in water rescues and
technical rope rescues
 o If the patient has a spinal injury, secure the patient to the backboard and place it
inside the basket stretcher to carry the patient out of the location
o When you return to ambulance, lift the backboard out of basket stretcher and
place it on the wheeled stretcher
- Scoop stretchers
o Splits into two or four pieces
 Pieces fit around the patient who is laying on a flat surface and then
reconnect
o Both sides of the patient must be accessible
o The patient must be stabilized and secured on a scoop stretcher
- Neonatal isolette
o Neonates cannot be transported on a wheeled stretcher
o The isolette keeps the neonate warm, and protects the child from noise, draft,
infection, and excess handling
o The isolette may be secured to a wheeled ambulance stretcher or freestanding
Decontamination
- Decontaminate equipment after use for
o Your safety
o The safety of the crew
o The safety of the patient
o Preventing the spread of disease
Patient Positioning
- Proper position depends on the chief complaint
o A patient reporting chest pain or respiratory distress should be placed in a
position of comfort- typically a fowler or semi-fowler position
o Patients in shock should be placed supine
o Patients in late stages of pregnancy should be positioned and transported on
their left side
o An unresponsive patient with no suspected spinal injury should be placed in the
recovery position
o A patient who is nauseated or vomiting should be transported in a position of
comfort
Medical Restraint
- Evaluates for correctible causes of combativeness
o Head injury, hypoxia, hypoglycemia
- Follow local protocols
- Restraint requires five personnel
- Restraint the patient in a supine position
o Positional asphyxia may develop in the prone position
- Apply a restraint to each extremity
- Access ABCs, mental status, and distal circulation after restraints are applied
- Document all information
Personnel Considerations
 - Questions to ask before moving a patient-
o Am I physically strong enough to lift/move the patient?
o IS there adequate room to get the proper stance to lift
o Do I need addition personnel for lifting assistance?
- Injured EMTs can’t help anyone

Chapter 9: A Team Approach to Healthcare

National EMS Education Standard Competencies

- Applies fundamental knowledge of patient safety to the provision of emergency care
- Applies fundamental knowledge of transferring care; how to interact within the team
structure; and team communication and dynamics
Introduction
- You are a critical member of the emergency health care team
- A key goal of EMS Agenda 2050 is EMS systems that are inherently safe
o Minimize exposure to injury, infections, illness, or stress
o Culture of safety
o Just culture
An Era of Team Health Care
- Community paramedicine and mobile integrated healthcare (MIH) teams may be the
best examples of the team concept of continuum of care
- The structure and effectiveness of emergency health care teams differs from system to
system
Types of Teams
- Regular teams
o EMTs consistently interact with the same partner or team
- Temporary teams
o EMTs work with providers with whom they do not regularly interact or may not
even know
- Special teams
o Fire team
o Rescue team
o Hazardous materials (hazmat) teams
o Tactical EMS team
o Special event EMS team
o EMS bike team
o In-hospital patient care technicians
o MIH technicians
Groups Versus Teams
- A group consists of individual health care providers working independently to help the
patient
o Triage
o Treatment
 o Transport
- A team consists of a group of health care providers who are assigned specific roles and
are working independently in a coordinated manner under a designated leader
- Five essential elements of a group
o A common goal
o An image of themselves as a “group”
o A sense of continuity of the group
o A set of shared values
o Different roles within the group
Dependent, Independent, and Interdependent
- Dependent groups
o Everyone is told what to do, and often how to do it, by his or her supervisor or
group leader
- Independent group
o Everyone is responsible for his or her own area
- Interdependent group
o Everyone works together with shared responsibilities, accountability, and a
common goal
Effective Team Performance
- A shared goal
- Clear roles and responsibilities
- Diverse and competent skill sets
- Effective collaboration and communication
- Supportive and coordinated leadership
- Communication and team dynamics fostered from crew resource management and
team situational awareness
- CRM recommends the use of the PACE mnemonic
o Probe
o Alert
o Challenge
o Emergency
Transfer of Patient Care
- Transfers introduce the possibility of patient care errors
- General guidelines for a smooth transfer
o Uninterrupted critical care
o Minimal interference
o Respectful interaction
o Common priorities
o Common language or system
BLS and ALS Providers Working Together
- BLS and ALS care connote exist without each other
- BLS efforts must continue throughout the continuum of care
 - What may be a “paramedic only” skill in your EMS system may be common for an EMT
to perform in another
Assisting with ALS Skills
- Assisting follows a four-step process
o Patient preparation
o Equipment
o Performing the procedure
o Continuing care
Critical Thinking and Decision Making in EMS
- Effective decisions are based on
o Sound, up to date knowledge
o Information provided by the patient for patient history
o Physical examination
- Stages of the decision-making process
o Prearrival
o Arrival
o During the call
o After the call
- Decision traps
o Bias
o Anchoring- EMT settles and did not consider other options
o Overconfidence
Troubleshooting Team Conflicts
- Remember
o The patient comes first
o Do not engage
o Keep your cool
o Separate the person from the issue
o Choose your battles
Practice Question
- Which of the following is a characteristic of a regular team?
o Members consistently act with the same partner
- Essential elements of a group that people must share include:
o Working with a set of shared values
- Members of an interdependent group:
o Work together with shared responsibilities, accountability, and a common goal
- When a team member speaks, you should repeat the message back to him or her. This is
an example of:
o Closed-loop communication