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Emergency
Care and Transportation of the Sick and Injured
Series Editor:
Andrew N. Pollak, MD, FAAOS
Lead Editors:
Dennis Edgerly, BS, EMT-P
Kim D. McKenna, MEd, RN, EMT-P
David A. Vitberg, MD
Celebrating 45 years of EMS education and innovation.
In 1971, the American Academy of Orthopaedic Surgeons (AAOS) published the first edition of Emergency Care and
Transportation of the Sick and Injured with its now-familiar orange cover and laid the foundation of EMS training. Today,
the AAOS’s commitment and dedication to excellence has transformed how EMS education is delivered throughout the
world and helped develop and train countless world-class EMS providers.
In 1997, the AAOS partnered with Jones & Bartlett Publishers (JB Learning) to release Emergency Care and
Transportation of the Sick and Injured, Revised Sixth Edition. Since the publication of that edition, the AAOS and JB
Learning have worked together to transform all levels of EMS training, from emergency medical responder to paramedic.
Our partnership has resulted in market-leading resources that go beyond initial training into assessment, continuing
education, and professional resources to support EMS providers through every step of their education and career.
Today, the AAOS suite of EMS educational resources, from first aid and CPR to critical care transport, are the gold
standard in training programs with exceptional content and instructional resources that meet the diverse needs of today’s
educators and students.
JB Learning is proud and honored to congratulate our esteemed partner, the American Academy of Orthopaedic Surgeons,
on the 45th anniversary of their first publication of the Orange Book.
To explore other AAOS publications, programs, and products on orthopaedic trauma and other practice areas, please visit
www.aaos.org/Education.
Brief Contents
Section 1: Preparatory
EMS Systems
CHAPTER 2 Workforce Safety and Wellness
CHAPTER 3 Medical, Legal, and Ethical Issues
CHAPTER 4 Communications and Documentation
CHAPTER 5 Medical Terminology
CHAPTER 6 The Human Body
CHAPTER 7 Life Span Development
CHAPTER 8 Lifting and Moving Patients
CHAPTER 1
Section 2: Patient Assessment
CHAPTER 9
Patient Assessment
Section 3: Airway
CHAPTER 10 Airway
Management
Section 4: Pharmacology
CHAPTER 11 Principles of Pharmacology
Section 5: Shock and Resuscitation
CHAPTER 12 Shock
CHAPTER 13 BLS Resuscitation
Section 6: Medical
CHAPTER 14 Medical Overview
CHAPTER 15 Respiratory
Emergencies
CHAPTER 16 Cardiovascular Emergencies
CHAPTER 17 Neurologic Emergencies
CHAPTER 18 Gastrointestinal and Urologic Emergencies
CHAPTER 19 Endocrine and Hematologic Emergencies
CHAPTER 20 Immunologic Emergencies
CHAPTER 21 Toxicology
CHAPTER 22 Psychiatric Emergencies
CHAPTER 23 Gynecologic Emergencies
Section 7: Trauma
CHAPTER 24 Trauma Overview
Bleeding
CHAPTER 26 Soft-Tissue Injuries
CHAPTER 27 Face and Neck Injuries
CHAPTER 28 Head and Spine Injuries
CHAPTER 29 Chest Injuries
CHAPTER 30 Abdominal and Genitourinary Injuries
CHAPTER 31 Orthopaedic Injuries
CHAPTER 32 Environmental Emergencies
CHAPTER 25
Section 8: Special Patient Populations
Obstetrics and Neonatal Care
CHAPTER 34 Pediatric Emergencies
CHAPTER 35 Geriatric Emergencies
CHAPTER 36 Patients With Special Challenges
CHAPTER 33
Section 9: EMS Operations
Transport Operations
CHAPTER 38 Vehicle Extrication and Special Rescue
CHAPTER 39 Incident Management
CHAPTER 40 Terrorism Response and Disaster Management
CHAPTER 37
Section 10: The Team Approach to Health Care
CHAPTER 41
GLOSSARY
INDEX
A Team Approach to Health Care
Contents
Section 1: Preparatory
EMS Systems
Introduction
Course Description
EMT Training: Focus and Requirements
Licensure Requirements
Overview of the EMS System
History of EMS
Levels of Training
Public Basic Life Support and Immediate Aid
Emergency Medical Responders
Emergency Medical Technician
Advanced Emergency Medical Technician
Paramedic
Components of the EMS System
Public Access
Communication Systems
Clinical Care
Human Resources
Medical Direction
Legislation and Regulation
Integration of Health Services
Mobile Integrated Healthcare
Evaluation
Information Systems
System Finance
Education Systems
Prevention and Public Education
EMS Research
Roles and Responsibilities of the EMT
Professional Attributes
Prep Kit
CHAPTER 1
Workforce Safety and Wellness
Introduction
General Health and Wellness
Wellness and Stress Management
Sleep
Infectious and Communicable Diseases
Routes of Transmission
Risk Reduction and Prevention for Infectious and Communicable Diseases
Establishing an Infection Control Routine
Immunity
General Postexposure Management
Scene Safety
Scene Hazards
Protective Clothing: Preventing Injury
Cold Weather Clothing
CHAPTER 2
Turnout Gear
Gloves
Helmets
Boots
Eye Protection
Ear Protection
Skin Protection
Body Armor
Long/Loose Hair, Rings, Jewelry
Caring for Critically Ill and Injured Patients
Responses of the Critical Patient
Techniques for Communicating With the Critical Patient
Locate and Notify Family Members
Injured and Critically Ill Children
Dealing With the Death of a Child
Helping the Family
Death and Dying
The Grieving Process
What Can the EMT Do?
Dealing With the Patient and Family Members
Stress Management on the Job
Emotional Aspects of Emergency Care
Stressful Situations
Workplace Issues
Cultural Diversity on the Job
Avoiding Sexual Harassment
Substance Abuse
Suicide Prevention
Injury and Illness Prevention
Prep Kit
Medical, Legal, and Ethical Issues
Introduction
Consent
Expressed Consent
Implied Consent
Involuntary Consent
Minors and Consent
Forcible Restraint
The Right to Refuse Treatment
Confidentiality
HIPAA
Advance Directives
Physical Signs of Death
Presumptive Signs of Death
Definitive Signs of Death
Medical Examiner Cases
Special Situations
Organ Donors
Medical Identification Insignia
Scope of Practice
Standards of Care
Standards Imposed by Local Custom
Standards Imposed by Law
Professional or Institutional Standards
CHAPTER 3
Standards Imposed by Textbooks
Standards Imposed by States
Duty to Act
Negligence
Abandonment
Assault and Battery and Kidnapping
Defamation
Good Samaritan Laws and Immunity
Records and Reports
Special Mandatory Reporting Requirements
Abuse of Children, Older People, and Others
Injury During the Commission of a Felony
Drug-Related Injuries
Childbirth
Other Reporting Requirements
Scene of a Crime
The Deceased
Ethical Responsibilities
The EMT in Court
Prep Kit
Communications and Documentation
Introduction
Therapeutic Communication
Age, Culture, and Personal Experience
Nonverbal Communication
Verbal Communication
Written Communications and Documentation
Patient Care Report
Types of Forms
Reporting Errors
Documenting Refusal of Care
Special Reporting Situations
Communications Systems and Equipment
Base Station Radios
Mobile and Portable Radios
Repeater-Based Systems
Digital Equipment
Cellular/Satellite Telephones
Other Communications Equipment
Radio Communications
Responding to the Scene
Communicating With Medical Control and Hospitals
Maintenance of Radio Equipment
Prep Kit
CHAPTER 4
Medical Terminology
Introduction
Anatomy of a Medical Term
Word Roots
Prefixes
Suffixes
Combining Vowels
Word Building Rules
Plural Endings
CHAPTER 5
Special Word Parts
Numbers
Colors
Positions and Directions
Common Direction, Movement, and Position Terms
Directional Terms
Movement Terms
Other Directional Terms
Anatomic Positions
Breaking Terms Apart
Abbreviations, Acronyms, and Symbols
Abbreviations
Symbols
Master Tables
Prep Kit
The Human Body
Introduction
Topographic Anatomy
The Planes of the Body
The Skeletal System: Anatomy
The Axial Skeleton
The Spinal Column
The Thorax
The Appendicular Skeleton
The Pelvis
The Lower Extremities
The Skeletal System: Physiology
The Musculoskeletal System: Anatomy
Skeletal Muscle
The Musculoskeletal System: Physiology
The Respiratory System: Anatomy
The Upper Airway
The Lower Airway
Lungs
The Respiratory System: Physiology
Respiration
Ventilation
Characteristics of Normal Breathing
Inadequate Breathing Patterns in Adults
The Circulatory System: Anatomy
The Heart
Arteries
Capillaries
Veins
The Spleen
Blood Composition
The Circulatory System: Physiology
Normal Circulation in Adults
Inadequate Circulation in Adults
The Function of Blood
Nervous System Control of the Cardiovascular System
The Nervous System: Anatomy and Physiology
The Central Nervous System
The Peripheral Nervous System
CHAPTER 6
The Integumentary System (Skin): Anatomy
The Integumentary System (Skin): Physiology
The Digestive System: Anatomy
The Abdomen
Mouth
Oropharynx
Esophagus
Stomach
Pancreas
Liver
Small Intestine
Large Intestine
Appendix
Rectum
The Digestive System: Physiology
The Lymphatic System: Anatomy and Physiology
The Endocrine System: Anatomy and Physiology
The Urinary System: Anatomy and Physiology
The Genital System: Anatomy and Physiology
The Male Reproductive System and Organs
The Female Reproductive System and Organs
Life Support Chain
Pathophysiology
Respiratory Compromise
Shock
Alteration of Cellular Metabolism
Prep Kit
Life Span Development
Introduction
Neonates (Birth to 1 Month) and Infants (1 Month to 1 Year)
Physical Changes
Psychosocial Changes
Toddlers (1 to 3 Years) and Preschoolers (3 to 6 Years)
Physical Changes
Psychosocial Changes
School-Age Children (6 to 12 Years)
Physical Changes
Psychosocial Changes
Adolescents (12 to 18 Years)
Physical Changes
Psychosocial Changes
Early Adults (19 to 40 Years)
Physical Changes
Psychosocial Changes
Middle Adults (41 to 60 Years)
Physical Changes
Psychosocial Changes
Older Adults (61 Years and Older)
Physical Changes
Psychosocial Changes
Prep Kit
CHAPTER 7
Lifting and Moving Patients
Introduction
CHAPTER 8
The Wheeled Ambulance Stretcher
Backboards
Moving and Positioning the Patient
Body Mechanics
Anatomy Review
Principles of Safe Reaching and Pulling
Principles of Safe Lifting and Carrying
Patient Weight
Lifting and Carrying a Patient on a Backboard or Stretcher
Moving a Patient With a Stair Chair
Moving a Patient on Stairs With a Stretcher
Loading a Wheeled Stretcher Into an Ambulance
Directions and Commands
Emergency Moves
Urgent Moves
Rapid Extrication Technique
Nonurgent Moves
Direct Ground Lift
Extremity Lift
Transfer Moves
Geriatrics
Bariatrics
Additional Patient-Moving Equipment
Bariatric Stretchers
Pneumatic and Electronic Powered Wheeled Stretchers
Portable/Folding Stretchers
Flexible Stretchers
Short Backboards
Vacuum Mattresses
Basket Stretchers
Scoop Stretchers
Neonatal Isolettes
Decontamination
Patient Positioning
Medical Restraints
Personnel Considerations
Prep Kit
Section 2: Patient Assessment
Patient Assessment
Introduction
Scene Size-up
Ensure Scene Safety
Determine Mechanism of Injury/Nature of Illness
Take Standard Precautions
Determine Number of Patients
Consider Additional/Specialized Resources
Primary Assessment
Form a General Impression
Assess Level of Consciousness
Assess the Airway
Assess Breathing
Assess Circulation
Performing a Rapid Exam to Identify Life Threats
CHAPTER 9
Determine Priority of Patient Care and Transport
History Taking
Investigate the Chief Complaint (History of Present Illness)
Obtain SAMPLE History
Secondary Assessment
Systematically Assess the Patient—Secondary Assessment
Systematically Assess the Patient—Focused Assessment
Assess Vital Signs Using the Appropriate Monitoring Device
Reassessment
Repeat the Primary Assessment
Reassess Vital Signs
Reassess the Chief Complaint
Recheck Interventions
Identify and Treat Changes in the Patient’s Condition
Reassess Patient
Prep Kit
Section 3: Airway
Airway Management
Introduction
Anatomy of the Respiratory System
Anatomy of the Upper Airway
Anatomy of the Lower Airway
Physiology of Breathing
Ventilation
Oxygenation
Respiration
Pathophysiology of Respiration
Factors in the Nervous System
Ventilation/Perfusion Ratio and Mismatch
Factors Affecting Pulmonary Ventilation
Factors Affecting Respiration
Circulatory Compromise
Patient Assessment
Recognizing Adequate Breathing
Recognizing Abnormal Breathing
Assessment of Respiration
Opening the Airway
Head Tilt–Chin Lift Maneuver
Jaw-Thrust Maneuver
Opening the Mouth
Suctioning
Suctioning Equipment
Techniques of Suctioning
Basic Airway Adjuncts
Oropharyngeal Airways
Nasopharyngeal Airways
Maintaining the Airway
Supplemental Oxygen
Supplemental Oxygen Equipment
Procedures for Operating and Administering Oxygen
Hazards of Supplemental Oxygen
Oxygen-Delivery Equipment
Nonrebreathing Masks
CHAPTER 10
Nasal Cannulas
Partial Rebreathing Masks
Venturi Masks
Tracheostomy Masks
Humidification
Assisted and Artificial Ventilation
Assisting Ventilation in Respiratory Distress/Failure
Artificial Ventilation
Continuous Positive Airway Pressure
Mechanism
Indications
Contraindications
Application
Complications
Special Considerations
Stomas and Tracheostomy Tubes
Foreign Body Airway Obstruction
Recognition
Emergency Medical Care for Foreign Body Airway Obstruction
Dental Appliances
Facial Bleeding
Prep Kit
Section 4: Pharmacology
Principles of Pharmacology
Introduction
How Medications Work
Medication Names
Routes of Administration
Medication Forms
Tablets and Capsules
Solutions and Suspensions
Metered-Dose Inhalers
Topical Medications
Transcutaneous Medications
Gels
Gases for Inhalation
General Steps in Administering Medication
Medication Administration and the EMT
Medications Used by EMTs
Oral Medications
Sublingual Medications
Intramuscular Medications
Intranasal Medications
Inhalation Medications
Patient Medications
Medication Errors
Prep Kit
CHAPTER 11
Section 5: Shock and Resuscitation
Shock
Introduction
CHAPTER 12
Pathophysiology
Perfusion
Causes of Shock
Types of Shock
Cardiogenic Shock
Obstructive Shock
Distributive Shock
Hypovolemic Shock
Respiratory Insufficiency
The Progression of Shock
Patient Assessment for Shock
Emergency Medical Care for Shock
Treating Cardiogenic Shock
Treating Obstructive Shock
Treating Septic Shock
Treating Neurogenic Shock
Treating Anaphylactic Shock
Treating Psychogenic Shock
Treating Hypovolemic Shock
Treating Respiratory Insufficiency
Treating Shock in Older Patients
Prep Kit
BLS Resuscitation
Introduction
Elements of BLS
The Components of CPR
Assessing the Need for BLS
Basic Principles of BLS
Automated External Defibrillation
AED Usage in Children
Special AED Situations
Positioning the Patient
Check for Breathing and a Pulse
Provide External Chest Compressions
Proper Hand Position and Compression Technique
Opening the Airway and Providing Artificial Ventilation
Opening the Airway in Adults
Recovery Position
Breathing
Provide Artificial Ventilations
One-Rescuer Adult CPR
Two-Rescuer Adult CPR
Switching Positions
Devices and Techniques to Assist Circulation
Active Compression-Decompression CPR
Impedance Threshold Device
Mechanical Piston Device
Load-Distributing Band CPR or Vest CPR
Infant and Child CPR
Determining Responsiveness
Check for Breathing and a Pulse
Airway
Provide Rescue Breathing
Interrupting CPR
CHAPTER 13
When Not to Start CPR
When to Stop CPR
Foreign Body Airway Obstruction in Adults
Recognizing Foreign Body Airway Obstruction
Removing a Foreign Body Airway Obstruction in an Adult
Foreign Body Airway Obstruction in Infants and Children
Removing a Foreign Body Airway Obstruction in a Child
Removing a Foreign Body Airway Obstruction in Infants
Special Resuscitation Circumstances
Opioid Overdose
Cardiac Arrest in Pregnancy
Grief Support for Family Members and Loved Ones
Education and Training for the EMT
Education and Training for the Public
Prep Kit
Section 6: Medical
Medical Overview
Introduction
Types of Medical Emergencies
Patient Assessment
Management, Transport, and Destination
Scene Time
Type of Transport
Destination Selection
Infectious Diseases
General Assessment Principles
General Management Principles
Epidemic and Pandemic Considerations
Common or Serious Communicable Diseases
Influenza
Herpes Simplex
HIV Infection
Hepatitis
Meningitis
Tuberculosis
Whooping Cough
Methicillin-Resistant Staphylococcus Aureus
Global Health Issues
Travel Medicine
Conclusion
Prep Kit
CHAPTER 14
Respiratory Emergencies
Introduction
Anatomy of the Respiratory System
Physiology of Respiration
Pathophysiology
Carbon Dioxide Retention and Hypoxic Drive
Causes of Dyspnea
Upper or Lower Airway Infection
Acute Pulmonary Edema
Chronic Obstructive Pulmonary Disease
Asthma, Hay Fever, and Anaphylaxis
CHAPTER 15
Spontaneous Pneumothorax
Pleural Effusion
Obstruction of the Airway
Pulmonary Embolism
Hyperventilation
Environmental/Industrial Exposure
Patient Assessment
Emergency Medical Care
Metered-Dose Inhaler and Small-Volume Nebulizer
Administration of a Metered-Dose Inhaler
Administration of Small-Volume Nebulizer
Treatment of Specific Conditions
Upper or Lower Airway Infection
Acute Pulmonary Edema
Chronic Obstructive Pulmonary Disease
Asthma, Hay Fever, and Anaphylaxis
Spontaneous Pneumothorax
Pleural Effusion
Obstruction of the Airway
Pulmonary Embolism
Hyperventilation
Environmental/Industrial Exposure
Foreign Body Aspiration
Tracheostomy Dysfunction
Asthma
Cystic Fibrosis
Prep Kit
Cardiovascular Emergencies
Introduction
Anatomy and Physiology
Circulation
Pathophysiology
Atherosclerosis
Acute Coronary Syndrome
Cardiogenic Shock
Congestive Heart Failure
Hypertensive Emergencies
Patient Assessment
Emergency Medical Care for Chest Pain or Discomfort
Administering Nitroglycerin
Cardiac Monitoring
Heart Surgeries and Cardiac Assistive Devices
Automatic Implantable Cardiac Defibrillators
External Defibrillator Vest
Left Ventricular Assist Devices
Cardiac Arrest
Automated External Defibrillation
Emergency Medical Care for Cardiac Arrest
Preparation
Performing Defibrillation
Prep Kit
CHAPTER 16
Neurologic Emergencies
Introduction
CHAPTER 17