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BRIEF CONTENTS

Photo Scans xxvii

Preface xxix
Acknowledgments xxxi
About the Authors xxxvii

SECTION 1 Preparatory 2
CHAPTER 1 Introduction to EMS Systems 4
CHAPTER 2 EMR Safety and Wellness 21
CHAPTER 3 Medical, Legal, and Ethical Issues 51
CHAPTER 4 Medical Terminology 70
CHAPTER 5 Anatomy and Physiology 82
CHAPTER 6 Life Span Development 113
Section 1 REVIEW 130

SECTION 2 Airway and Cardiac Resuscitation 136

CHAPTER 7 Airway 138
CHAPTER 8 Cardiac Resuscitation and Defibrillation 181
Section 2 REVIEW 212

SECTION 3 Patient Assessment 218

CHAPTER 9 Patient Assessment: Scene Size-Up 220
CHAPTER 10 Patient Assessment:
The Primary Assessment 242
CHAPTER 11 Patient Assessment: History
and Vital Signs 262
CHAPTER 12 Patient Assessment: Secondary
Assessment 282
CHAPTER 13 Communication and Documentation 304
Section 3 REVIEW 323

vii
 SECTION 4 Medical Emergencies 330
CHAPTER 14 Cardiac and Respiratory Emergencies 332
CHAPTER 15 Altered Mental Status 354
CHAPTER 16 Medical Emergencies 391
Section 4 REVIEW 408

SECTION 5 Trauma 414

CHAPTER 17 Overview of Trauma and Trauma Systems 416
CHAPTER 18 Bleeding and Shock 431
CHAPTER 19 Chest and Abdominal Emergencies 453
CHAPTER 20 Soft Tissue Injuries 474
CHAPTER 21 Injuries to the Head and Spine 504
CHAPTER 22 Musculoskeletal Injuries 535
CHAPTER 23 Environmental Emergencies 556
Section 5 REVIEW 582

SECTION 6 Special Patient Populations 588

CHAPTER 24 Obstetrics and Neonatal Care 590
CHAPTER 25 Pediatric Emergencies 618
CHAPTER 26 Geriatric Patients 656
CHAPTER 27 Special Populations and Situations 677
Section 6 REVIEW 692

SECTION 7 Operations 698

CHAPTER 28 Operations 700
CHAPTER 29 Incident Management 716
CHAPTER 30 Special Operations 726
CHAPTER 31 Terrorism and Natural Disasters 749
Section 7 REVIEW 763

APPENDIX A Glossary 769

APPENDIX B Answer key 785
Index 827

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DETAILED CONTENTS

Photo Scans xxvii

Preface xxix
Acknowledgments xxxi
About the Authors xxxvii

SECTION 1 Preparatory 2

CHAPTER 1 INTRODUCTION TO EMS SYSTEMS 4

Objectives 4
Introduction 5
The Big Picture The EMS System 6
The EMS System 8
911 8
EMS Systems 9
Classic Components of an EMS System 10
Ten Classic EMS System Components 10
Stop, Review, Remember 11
Emergency Medical Responder Practice 13
Roles and Responsibilities of the Emergency Medical Responder 13
Quality Improvement 15
Errors in EMS 15
Research in EMS 16
Research and You 16
The Last Word 18
Chapter Review 18

CHAPTER 2 EMR SAFETY AND WELLNESS 21

Objectives 21
Introduction 22
Scene Safety 23
Protecting Yourself from Violence 24
Cover and Concealment 24
Distraction and Retreat 24
Other Scene Hazards 25
Protection from Disease 26
Before the Response 27
During the Response—Personal Protective Equipment 28
Exposure to an Infectious Substance 32
Stop, Review, Remember 34

ix
 Stress 35
Dealing with Stress 36
Death and Dying 37
Dealing with Grief 38
Lifting and Moving Patients 38
Body Mechanics 38
The Lift 41
Positioning Patients for Safety and Comfort 41
Stop, Review, Remember 45
Patient Restraint 47
The Last Word 48
Chapter Review 48

CHAPTER 3 MEDICAL, LEGAL, AND ETHICAL ISSUES 51

Objectives 51
Introduction 52
Providing Legal and Ethical Care 53
Scope of Practice 53
Medical Oversight 53
Consent 53
Refusal of Care 54
Confidentiality 57
Stop, Review, Remember 58
Advance Directives 59
Ethics 61
Liability and Negligence 62
Stop, Review, Remember 63
EMS at the Crime Scene 64
Evidence Identification and Preservation 64
Mandatory Reporting 66
The Last Word 67
Chapter Review 67

CHAPTER 4 MEDICAL TERMINOLOGY 70

Objectives 70
Introduction 71
Medical Terminology 71
Anatomical Terms 72
Directional Terms 73
Stop, Review, Remember 75
Body Regions and Cavities 75
Stop, Review, Remember 79
The Last Word 79
Chapter Review 79

CHAPTER 5 ANATOMY AND PHYSIOLOGY 82

Objectives 82
Introduction 83

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 The Human Body 84
The Skeletal System 84
The Muscular System 87
Stop, Review, Remember 90
The Respiratory System 91
The Cardiovascular System 93
The Nervous System 96
Stop, Review, Remember 99
The Integumentary System (Skin) 100
The Digestive System 101
The Urinary System 101
Stop, Review, Remember 103
The Lymphatic/Immune System 104
The Endocrine System 104
The Reproductive System 104
Life Support Chain 107
The Last Word 108
Chapter Review 108

CHAPTER 6 LIFE SPAN DEVELOPMENT 113

Objectives 113
Introduction 114
Infancy (Birth to Age 1 Year) 114
Physiological 114
Psychosocial 116
Toddler Phase (12–36 Months) 117
Physiological 118
Psychosocial 118
Preschool Age (3–5 Years) 118
Physiological 118
Psychosocial 118
School Age (6–12 Years) 119
Physiological 119
Psychosocial 119
Adolescence (13–18 Years) 120
Physiological 120
Psychosocial 120
Stop, Review, Remember 122
Early Adulthood (20–40 Years) 123
Physiological 123
Psychosocial 124
Middle Adulthood (41–60 Years) 124
Physiological 124
Psychosocial 125
Late Adulthood (61 Years and Older) 125
Physiological 125
Psychosocial 126
The Last Word 126
Chapter Review 127
Section 1: Review and Practice Examination 130

DETAILED CONTENTS xi
 SECTION 2 Airway and Cardiac Resuscitation 136

CHAPTER 7 AIRWAY 138

Objectives 139
Introduction 139
The Big Picture Airway 140
Anatomy and Physiology Revisited 141
Assessing the Airway and Breathing 146
Stop, Review, Remember 148
Opening the Airway 149
Head-Tilt, Chin-Lift Maneuver 149
Jaw-Thrust Maneuver 150
Suction 150
Oropharyngeal Airways 154
EMR Patient Assessment: Breathing 155
Stop, Review, Remember 158
EMR Emergency Care: Breathing 160
Oxygen 160
Oxygen Delivery to Patients 161
Nasal Cannula 167
Ventilating Patients 170
Ventilation with the Pocket Face Mask 171
Ventilation with a Bag-Valve-Mask (BVM) Device 172
Foreign Body Airway Obstruction 175
The Last Word 178
Chapter Review 178

CHAPTER 8 CARDIAC RESUSCITATION AND DEFIBRILLATION 181

Objectives 181
Introduction 182
Cardiac Resuscitation and Defibrillation 183
The Heart 184
Cardiac Arrest 184
EMR Patient Assessment: Cardiac Arrest 185
The Chain of Survival 187
Stop, Review, Remember 188
EMR Emergency Care: Cardiac Arrest 189
One-Rescuer Adult CPR Sequence 191
Two-Rescuer Adult CPR Sequence 191
Complications of CPR 194
Stop, Review, Remember 195
Pediatric CPR 197
Resuscitate Now; Call Later 197
Pediatric Ventilations 198
Pediatric Compressions 198
One-Rescuer Pediatric (Infant and Child) CPR Sequence 199
Two-Rescuer Pediatric (Infant and Child) CPR Sequence 199

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 Alternative Compression Technique for Newborns and
Small Infants 200
Complications of Pediatric CPR 201
Stop, Review, Remember 202
Automated External Defibrillators (AEDs) 203
Lethal Arrhythmias 203
AED Safety 204
AED Use with Pediatric Patients 206
Continuing Quality Assurance and Call Review 206
Putting It All Together 208
Adult Resuscitation Sequence 208
Return of Spontaneous Circulation 208
Ethical Considerations of Cardiac Arrest 209
The Last Word 209
Chapter Review 210
Section 2: Review and Practice Examination 212

SECTION 3 Patient Assessment 218

CHAPTER 9 PATIENT ASSESSMENT: SCENE SIZE-UP 220

Objectives 220
Introduction 221
The Big Picture Scene Size-Up 222
Scene Safety 223
Identifying Violence 224
Response to Violence 224
Physical Hazards at the Scene 226
Hazardous Materials 226
Environmental Hazards 227
Stop, Review, Remember 228
Mechanism of Injury and Nature of Illness 229
Motor Vehicle Collisions 231
Injuries from Falls 234
Stop, Review, Remember 236
Resource Determination and Number of Patients 237
Number of Patients 237
Standard Precautions 238
The Last Word 239
Chapter Review 240

CHAPTER 10 PATIENT ASSESSMENT: THE PRIMARY ASSESSMENT 242

Objectives 242
Introduction 243
Eight Components of the Primary Assessment 243
The Big Picture Primary Assessment of the Medical Patient 244
The Big Picture Primary Assessment of the Trauma Patient 245
General Impression 246

DETAILED CONTENTS xiii

 Level of Consciousness 247
Airway 248
Stop, Review, Remember 252
Breathing 254
Circulation 254
Disability 256
Stop, Review, Remember 256
Expose 258
Priority/Updating Incoming EMS Units 258
The Last Word 258
Chapter Review 259

CHAPTER 11 PATIENT ASSESSMENT: HISTORY AND VITAL SIGNS 262

Objectives 262
Introduction 263
Patient History 264
Chief Complaint 264
SAMPLE History 267
Stop, Review, Remember 269
Vital Signs 270
Respirations 271
Pulse 272
Skin 273
Blood Pressure 273
Pulse Oximetry 275
Pupils 277
Stop, Review, Remember 278
The Last Word 279
Chapter Review 280

CHAPTER 12 PATIENT ASSESSMENT: SECONDARY ASSESSMENT 282

Objectives 282
Introduction 283
The Big Picture Assessment of the Medical Patient 284
The Big Picture Assessment of the Trauma Patient 285
General Principles of Assessment 286
Principles of Assessment 286
Assessment of the Trauma Patient 287
Stop, Review, Remember 288
Medical Versus Trauma Assessment 290
Head-to-Toe Examination 292
Stop, Review, Remember 297
Vital Signs 298
Reassessment 299
The Last Word 301
Chapter Review 301

CHAPTER 13 COMMUNICATION AND DOCUMENTATION 304

Objectives 304
Introduction 305

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 Communicating with Your Patient 306
Accurate and Efficient Communication 306
Patient Interview Techniques 309
Stop, Review, Remember 311
Communicating Patient Information to Other Providers 312
Radio Communication 313
Special Communication Situations 314
Stop, Review, Remember 315
Documentation 316
Components of the Prehospital Care Report 318
Special Reporting Situations 319
The Last Word 320
Chapter Review 321
Section 3: Review and Practice Examination 323

SECTION 4 Medical Emergencies 330

CHAPTER 14 CARDIAC AND RESPIRATORY EMERGENCIES 332

Objectives 332
Introduction 333
The Big Picture Cardiac and Respiratory Emergencies 334
Anatomy and Physiology: Respiratory System Review 335
Anatomy and Physiology: Cardiovascular System Review 336
Cardiac Emergencies 337
Signs and Symptoms of Cardiac Emergencies 339
EMR Patient Assessment: The Cardiac Patient 340
EMR Emergency Care: The Cardiac Emergency Patient 340
Stop, Review, Remember 343
Respiratory Emergencies 344
Common Respiratory Conditions 345
EMR Patient Assessment: Respiratory Complaints 346
Stop, Review, Remember 347
EMR Emergency Care: Respiratory Emergencies 350
The Last Word 351
Chapter Review 351

CHAPTER 15 ALTERED MENTAL STATUS 354

Objectives 354
Introduction 356
Altered Mental Status 356
EMR Patient Assessment: Altered Mental Status 357
EMR Emergency Care: Altered Mental Status 357
Diabetic Emergencies 358
EMR Patient Assessment: Hyperglycemia 359
EMR Patient Assessment: Hypoglycemia 359
EMR Emergency Care: Diabetic Emergency 361
Stop, Review, Remember 363

DETAILED CONTENTS xv
 Stroke 364
EMR Patient Assessment: Stroke 364
EMR Emergency Care: Stroke 367
Seizure 367
EMR Patient Assessment: Seizure 368
EMR Emergency Care: Seizure 368
Stop, Review, Remember 369
Poisoning 371
EMR Patient Assessment: Poisons 373
EMR Emergency Care: Poisons 374
Specific Types of Poisons 376
Ingested Poisons 376
EMR Patient Assessment: Ingested Poisons 376
EMR Emergency Care: Ingested Poisons 376
EMR Patient Assessment: Drug or Alcohol Emergency 378
EMR Emergency Care: Drug or Alcohol Emergency 378
Inhaled Poisons 379
EMR Patient Assessment: Inhaled Poisons 379
EMR Patient Assessment: Carbon Monoxide Poisoning 380
EMR Emergency Care: Carbon Monoxide Poisoning 380
Absorbed Poisons 381
EMR Patient Assessment: Absorbed Poisons 381
EMR Emergency Care: Absorbed Poisons 381
Injected Poisons 382
Stop, Review, Remember 382
Behavioral Emergencies 384
EMR Patient Assessment: Behavioral Emergency 384
Assessment for Suicide Risk 385
Methods to Calm Behavioral Emergency Patients 385
EMR Emergency Care: Behavioral Emergency 387
The Last Word 387
Chapter Review 388

CHAPTER 16 MEDICAL EMERGENCIES 391

Objectives 391
Introduction 392
General Medical Complaints 392
EMR Patient Assessment: General Medical Complaints 393
EMR Emergency Care: General Medical Complaints 393
Anaphylaxis 394
EMR Patient Assessment: Anaphylaxis 395
EMR Emergency Care: Anaphylaxis 395
Stop, Review, Remember 398
Abdominal Emergencies 399
EMR Patient Assessment: Abdominal Emergencies 400
EMR Emergency Care: Abdominal Emergencies 401
Stop, Review, Remember 402
Renal Emergencies 403
EMR Emergency Assessment: Dialysis Patients 403
EMR Emergency Care: Dialysis Patients 404

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 The Last Word 404
Chapter Review 405
Section 4: Review and Practice Examination 408

SECTION 5 Trauma 414

CHAPTER 17 OVERVIEW OF TRAUMA AND TRAUMA SYSTEMS 416

Objectives 416
Introduction 417
The History of Trauma Care 417
The Big Picture Trauma and Trauma Systems 418
Trauma Centers 419
EMR Assessment and Care: Identification and Categorization
of Trauma Patients 420
Trauma Assessment 420
Stop, Review, Remember 424
The Last Word 427
Chapter Review 428

CHAPTER 18 BLEEDING AND SHOCK 431

Objectives 431
Introduction 432
The Downward Spiral of Shock 432
The Big Picture Bleeding and Shock 433
Recognizing Shock 437
EMR Patient Assessment: Bleeding 439
Primary Assessment 439
Stop, Review, Remember 441
EMR Emergency Care: Bleeding 442
Standard Precautions and Personal Protective Equipment 443
Open the Airway and Ensure Adequate Breathing 443
Apply High-Concentration Oxygen 443
Control External Bleeding 443
Stop, Review, Remember 446
Special Situations 447
Nosebleeds 447
Treating a Nosebleed 448
Internal Bleeding 448
EMR Emergency Care: Shock 448
Anaphylactic Shock 449
Obstructive Shock 449
The Last Word 449
Chapter Review 450

CHAPTER 19 CHEST AND ABDOMINAL EMERGENCIES 453

Objectives 453
Introduction 454

DETAILED CONTENTS xvii

 The Chest 455
Open Chest Injuries 455
EMR Emergency Care: Open Chest Injury 456
Closed Chest Injuries 458
Blunt Trauma to the Chest 460
EMR Emergency Assessment: Chest Injuries 461
EMR Emergency Care: Chest Emergencies 462
Stop, Review, Remember 463
The Abdomen 464
Abdominal Pain 465
Open Abdominal Injuries 465
Closed Abdominal Injuries 466
EMR Emergency Assessment: Abdominal Injuries 467
EMR Emergency Care: Abdominal Injuries 468
Stop, Review, Remember 469
The Last Word 470
Chapter Review 470

CHAPTER 20 SOFT TISSUE INJURIES 474

Objectives 474
Introduction 475
Closed Wounds 476
EMR Patient Assessment: Closed Wounds 476
EMR Emergency Care: Closed Wounds 476
Open Wounds 477
Abrasions 477
Lacerations 478
Punctures and Perforations 478
EMR Patient Assessment: Open Wounds 479
EMR Emergency Care: Open Wounds 479
Stop, Review, Remember 480
EMR Emergency Care: Soft Tissue Injuries 482
Standard Precautions 482
Dressings 482
Types of Dressings 483
Bandages 484
Applying a Dressing and Bandage 484
Pressure Dressings 486
Special Circumstances 487
Impaled Objects 487
Neck Wounds 487
Amputations 487
Animal and Human Bites 489
Stop, Review, Remember 490
Burns 491
EMR Patient Assessment: Burns 491
EMR Emergency Care: Burns 495
Stop, Review, Remember 500
The Last Word 501
Chapter Review 502

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CHAPTER 21 INJURIES TO THE HEAD AND SPINE 504
Objectives 504
Introduction 505
Anatomy 505
Head Injuries 508
Closed Head Injuries 508
EMR Patient Assessment: Concussion 508
Open Head Injuries 509
EMR Patient Assessment: Open Head Injuries 509
EMR Emergency Care: Head Injuries 510
Stop, Review, Remember 510
Special Circumstances 512
EMR Patient Assessment and Care: Penetrating Wounds 512
EMR Patient Assessment and Care: Face, Ears, Nose,
and Throat 512
EMR Patient Assessment and Care: Soft Tissue Injuries of
the Face 512
EMR Patient Assessment and Care: Neck Injuries 513
EMR Patient Assessment: Eye Injuries 514
EMR Emergency Care: Eye Injuries 515
EMR Patient Assessment and Care: Foreign Objects in
the Eye 515
EMR Patient Assessment and Care: Impaled Objects in
the Eye 515
EMR Patient Assessment and Care: Globe Injuries and Extruding
Eyeballs 515
EMR Patient Assessment and Care: Orbit Injuries 516
EMR Patient Assessment and Care: Chemical Burns to
the Eye 516
EMR Patient Assessment and Care: Removing a Contact Lens 516
Stop, Review, Remember 518
Spinal Injuries 519
Assume Spinal Cord Injury 519
Mechanism of Injury 519
Spinal Precautions 521
EMR Patient Assessment: Spinal Cord Injury 521
EMR Emergency Care: The Spinal Cord Injury 522
EMR Emergency Care: The Seated Patient 527
Helmet Removal 529
The Last Word 531
Chapter Review 532

CHAPTER 22 MUSCULOSKELETAL INJURIES 535

Objectives 535
Introduction 536
The Musculoskeletal System 537
Mechanism of Injury 537
Specific Musculoskeletal Injuries 538
Stop, Review, Remember 540

DETAILED CONTENTS xix

 EMR Patient Assessment: Musculoskeletal Injuries 542
EMR Emergency Care: Musculoskeletal Injuries 543
Principles of Splinting 543
Rules of Splinting 544
Splinting Materials 544
Soft Splints 544
Rigid Splints 546
Traction Splints 547
Circumferential Splints 547
Improvised Splints 547
Stop, Review, Remember 548
EMR Patient Assessment and Emergency Care: Specific Circumstances 549
Upper Extremity Injuries 549
Lower Extremity Injuries 550
Amputations 552
The Last Word 553
Chapter Review 553

CHAPTER 23 ENVIRONMENTAL EMERGENCIES 556

Objectives 556
Introduction 557
Temperature Regulation 558
Cold Emergencies 559
Generalized Cold Emergencies 559
EMR Patient Assessment: Generalized Cold Emergencies 560
EMR Emergency Care: Generalized Cold Emergencies 562
Mild Hypothermia 562
Severe Hypothermia 563
Local Cold Emergencies 564
EMR Patient Assessment: Local Cold Emergencies 564
EMR Emergency Care: Local Cold Emergencies 564
Rewarming 565
Stop, Review, Remember 566
Heat Emergencies 568
Heat Cramps 568
Heat Exhaustion 568
Heatstroke 568
Contributing Factors 568
EMR Patient Assessment: Heat Emergencies 569
EMR Emergency Care: Heat Emergencies 570
Stop, Review, Remember 572
Submersion Emergencies 574
General Guidelines for Water Rescue 574
EMR Patient Assessment: Submersion Emergencies 576
EMR Emergency Care: Submersion Emergencies 577
The Last Word 578
Chapter Review 579
Section 5: Review and Practice Examination 582

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SECTION 6 Special Patient Populations 588

CHAPTER 24 OBSTETRICS AND NEONATAL CARE 590

Objectives 590
Introduction 591
Anatomy of Pregnancy 591
Stages of Labor 593
Stage One: Dilation of the Cervix 593
Stage Two: Expulsion 595
Stage Three: Delivery of the Placenta 595
Assisting in Childbirth 595
EMR Patient Assessment: Labor 595
EMR Patient Assessment: Supine Hypotension Syndrome 596
EMR Emergency Care: Preparation for Delivery 596
EMR Emergency Care: Assisting in Childbirth 599
Stop, Review, Remember 601
Caring for the Newborn 603
EMR Emergency Care: Resuscitation of the Newborn 604
Keeping the Newborn Warm 604
Cutting the Umbilical Cord 605
Caring for the Mother 605
Delivering the Placenta 606
Controlling Bleeding After Birth 606
Complications of Delivery 608
Prolapsed Umbilical Cord 608
Breech Birth 608
Limb Presentation 609
Multiple Births 609
Premature Birth 610
Complications of Pregnancy 610
EMR Patient Assessment: Preeclampsia 610
EMR Emergency Care: Seizure and Preeclampsia 610
EMR Emergency Care: Vaginal Bleeding 611
Stop, Review, Remember 612
The Last Word 614
Chapter Review 614

CHAPTER 25 PEDIATRIC EMERGENCIES 618

Objectives 618
Introduction 619
Pediatric Anatomical Differences 620
Determining the Age of a Pediatric Patient 621
Developmental Characteristics 621
Communication with the Pediatric Patient 622
Dealing with Caregivers 623
Using the Proper Equipment 623
Pediatric Process 624
Scene Size-Up 625
EMR Patient Assessment: Pediatrics 625

DETAILED CONTENTS xxi

 Airway and Breathing 628
Patient History and Physical Examination 630
Vital Signs 632
EMR Emergency Care: Pediatric Respiratory Emergencies 634
Anatomical Care Considerations 637
Croup 638
Epiglottitis 639
Asthma 639
Cardiac Arrest 640
Seizures 640
Stop, Review, Remember 643
Shock 645
EMR Patient Assessment and Emergency Care: Pediatric Shock 645
Trauma 645
Special Health Care Needs 646
Sudden Infant Death Syndrome (SIDS) 646
Managing the SIDS Call 647
Child Abuse and Neglect 647
Take Care of Yourself 649
Stop, Review, Remember 649
The Last Word 652
Chapter Review 652

CHAPTER 26 GERIATRIC PATIENTS 656

Objectives 656
Introduction 657
Physical Changes and Challenges 658
The Skin 658
Sensory Organs 658
Respiratory System 659
Heart and Blood Vessels 660
Digestive System 660
Urinary System 661
Musculoskeletal System 661
Nervous System 661
Immune System 661
Response to Medication 662
Stop, Review, Remember 662
Psychosocial and Economic Factors 663
Depression 663
Substance Abuse 664
Elder Abuse and Neglect 664
Socioeconomic Concerns 665
Illness and Injury in the Older Adult 666
Scene Size-Up 667
EMR Patient Assessment: The Primary Assessment 668
EMR Patient Assessment: Secondary Assessment 670
Stop, Review, Remember 671
The Last Word 673
Chapter Review 674

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CHAPTER 27 SPECIAL POPULATIONS AND SITUATIONS 677
Objectives 677
Introduction 678
Technological Advances 678
EMR Patient Assessment: Special Patient Populations 679
Congenital Diseases and Conditions 679
Acquired Diseases and Conditions 679
End of Life and Terminal Illness 680
Stop, Review, Remember 680
EMR Emergency Care: Physical Impairments 681
Hearing Loss 681
Mobility 682
EMR Emergency Care: Medical Devices 682
Tracheostomy Tubes 682
Insulin Pumps 683
Implanted Defibrillators 683
Left Ventricular Assist Device 685
Feeding Tubes 685
Indwelling Catheters 685
Urinary Catheters 685
Ostomy Pouches 685
Stop, Review, Remember 686
Abuse 687
EMR Patient Assessment: Abuse 687
EMR Emergency Care: Abuse 689
The Last Word 689
Chapter Review 690
Section 6: Review and Practice Examination 692

SECTION 7 Operations 698

CHAPTER 28 OPERATIONS 700

Objectives 700
Introduction 701
Apparatus and Equipment Readiness 702
Stop, Review, Remember 703
Responding to an Emergency Call 704
Warning Lights and Sirens 705
Driving in Emergency Traffic 705
Distractions 706
Passing a Vehicle 706
Intersections 706
Parking 706
Personal Protective Equipment 707
Stop, Review, Remember 708
Scene Management 709
Residential Scenes 709

DETAILED CONTENTS xxiii

 Approaching the Scene: Residence/Nonhighway 709
Transferring Care 711
Interaction with Other Emergency Responders 711
Stop, Review, Remember 711
The Last Word 714
Chapter Review 714

CHAPTER 29 INCIDENT MANAGEMENT 716

Objectives 716
Introduction 717
National Incident Management System 717
Command and Management 718
Preparedness 718
Resource Management 719
Communications and Information Management 719
Supporting Technologies 719
Ongoing Management and Maintenance 719
Stop, Review, Remember 719
Incident Command System 720
Stop, Review, Remember 723
The Last Word 724
Chapter Review 724

CHAPTER 30 SPECIAL OPERATIONS 726

Objectives 726
Introduction 727
Hazardous Materials 727
U.S. Department of Transportation Placard System 727
NFPA 704 Placard System for Buildings 730
Material Safety Data Sheets 732
Hazardous Materials Incident Safety 732
Stop, Review, Remember 733
Mass Casualty Incidents 735
Triage 735
Example of the Use of START Triage 735
The JumpSTART System 735
Stop, Review, Remember 739
Extrication 739
Vehicle Stabilization 740
Gaining Access 741
Stop, Review, Remember 742
Aeromedical Rescue 743
Indications for Aeromedical Transport 744
Calling for the Helicopter 744
The Landing Zone 744
Approaching the Aircraft 745
The Last Word 746
Chapter Review 747

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CHAPTER 31 TERRORISM AND NATURAL DISASTERS 749
Objectives 749
Introduction 750
Personal Safety 751
Mind-Set 751
Personal Protective Equipment (PPE) 752
Time, Distance, and Shielding 752
Responders as Targets/Secondary Attack 752
Patient Care Priorities 752
Inform the Patient of Your Actions 752
Protect from Harm 753
Greater Good 753
Treatment of All Patients 754
Stop, Review, Remember 754
Scene Size-Up 755
Determine Number of Patients 756
Evaluate Need for Additional Resources 757
Initial Actions—The “No Approach” Method 757
Secondary Events 758
Communicate with Other Responders 758
Stop, Review, Remember 759
The Last Word 760
Chapter Review 761
Section 7: Review and Practice Examination 763

APPENDIX A GLOSSARY 769

APPENDIX B ANSWER KEY 785
INDEX 827

DETAILED CONTENTS xxv

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