Chapter 13
Emergency Medical Services
Health Care
Science
Technology
Copyright © The McGraw-Hill Companies, Inc.
Objectives
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2
Compare the roles and responsibilities of
the First Responder, Emergency Medical
Technician-Basic, Intermediate, and
Paramedic.
Identify safety rules when using oxygen
for therapy.
Identify the use and flow requirement of a
nasal cannula and nonrebreather mask.
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Chapter 13
Objectives (cont.)
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3
Define the role of the Automated
External Defibrillator in cardiac arrest
and identify the safety requirements for
operating it.
Identify situations requiring the use of
the Automated External Defibrillator.
Successfully complete 3 EMS
procedures.
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Chapter 13
Careers in Emergency Medical
Services (EMS)
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4
First Responder
Emergency Medical
Technicians
Copyright © The McGraw-Hill Companies, Inc.
Chapter 13
First Responder

Arrives first at the scene of an
accident or incident.
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Usually, firefighters, law
enforcement officers, industry
workers, private citizens, or
neighbors.
Individuals have taken an
approved First Responder
Program.
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Chapter 13
First Responder (cont.)
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First Responder Responsibilities
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Take appropriate body substance
isolation precautions.
Identify the cause of the injury or the
nature of the illness.
Determine the total number of clients.
Request additional help, if necessary.
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Chapter 13
First Responder (cont.)
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First Responder Responsibilities (cont.)
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Safely gain access to the client.
Determine what is wrong with the client
and provide emergency medical care.
Lift or remove a client only when required.
Transfer the client and information to
trained personnel.
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Chapter 13
Emergency Medical Technicians
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8
Work all hours in all weather at
the scene of an accident.
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Chapter 13
Emergency Medical Technicians
(cont.)
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Responsibilities
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Assess the situation to determine if it’s
safe.
Take appropriate precautions.
Interview and examine the client.
Provide appropriate out-of-hospital care
according to established local procedures
and guidelines.
Transport the client to a medical facility.
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Chapter 13
Emergency Medical
Technicians (cont.)

EMT Equipment
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Cervical collars – immobilize
neck, back, and spinal
injuries.
Automatic external
defibrillator (AED) – device
used to restore the normal
heart rhythm of a cardiac
arrest victim.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 13
Emergency Medical Technicians
(cont.)

Responsibilities of the EMT–Basic
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Ensure personal safety and safety of
the crew, client, and bystanders.
Examine and interview the client to
determine appropriate emergency
care.
Provide client care based upon exam
and interview.
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Chapter 13
Emergency Medical Technicians
(cont.)

Responsibilities of the EMT–Basic (cont.)
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Lift, move, and transport the client to a
medical facility.
Transfer care of the client to the medical
staff at the receiving medical facility.
Speak on behalf of the client by reporting
concerns and findings to the medical staff.
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Chapter 13
Emergency Medical Technicians
(cont.)

Responsibilities of EMT–Intermediate
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Initiate intravenous (IV) lines.
Perform advanced airway techniques.
Interpret electrocardiogram (ECG).
Use manual defibrillators.
Administer certain medications beyond
those permitted at the EMT – B level.
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Chapter 13
Emergency Medical Technicians
(cont.)

Responsibilities of EMT–Paramedic
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Effectively understand the local EMS system’s
policies and procedures.
Utilize local communication systems.
Possess strong leadership skills, including selfconfidence, inner strength, decision-making
skills, and willingness to accept responsibility.
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Chapter 13
Emergency Medical Technicians
(cont.)

Responsibilities of EMT–Paramedic
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Be able to size up the scene.
Examine and interview the client.
Assign of priorities of care, develop an
action plan, and perform emergency
care.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 13
Section 13-1
Apply Your Knowledge #1
Which two levels of EMTs are
allowed to defibrillate the client?
Answer:
1. EMT – intermediate.
2. EMT – paramedic.
16
Copyright © The McGraw-Hill Companies, Inc.
Chapter 13
Section 13-1
Apply Your Knowledge #2
Why do you think all EMT personnel
must use body substance isolation
precautions at all times?
Answer:
To protect themselves and the client
from transfer of infection.
17
Copyright © The McGraw-Hill Companies, Inc.
Chapter 13
Emergency Medical Services
Procedures
Client Assessment Process
 Airway Management
 Additional Career Skills
 Emergency Childbirth

18
Copyright © The McGraw-Hill Companies, Inc.
Chapter 13
Client Assessment Process

The client assessment process consists
of the following:
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Scene size-up.
Initial assessment.
Focused history and physical exam.
Detailed physical exam.
Ongoing assessment.
Communication.
Documentation.
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Chapter 13
Client Assessment Process (cont.)

Evaluation includes evaluating:
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Safety of the scene for the provider, other
responders, the client, and bystanders.
Body substance isolation (BSI) precautions.
Mechanism of injury or nature of illness.
Number of clients.
Need for additional resources or assistance.
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Chapter 13
Client Assessment Process
(cont.)

Initial assessment includes 6
assessments:
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Form a general impression.
Determine level of responsiveness.
Assess the airway.
Assess breathing.
Assess circulation, including
presence of pulse and bleeding.
Make a decision regarding the
priority or urgency of the client.
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Chapter 13
Client Assessment Process (cont.)

Focused history and physical exam
include the following:
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In 90 seconds check head, eyes, neck, chest,
abdomen, pelvis, arms, legs and back
according to standard procedures.
Take complete set of vital signs.
Take SAMPLE history, if time permits.
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Chapter 13
Client Assessment Process
(cont.)

Detailed assessment requires:
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A more detailed exam en route to the
medical facility.
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Chapter 13
Client Assessment Process (cont.)

Ongoing assessment requires:
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Continuous reevaluation of initial
assessments.
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Chapter 13
Client Assessment Process (cont.)

Communication
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Converse with client and family.
Communicate with dispatcher and
medical facility.
Hand-off report at medical facility.
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Chapter 13
Client Assessment Process (cont.)

Documentation
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Written reports of pertinent
information.
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Chapter 13
Airway Management
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First Responders and EMTs manage lifethreatening problems of airway,
breathing, and circulation.
One of the greatest threats to the airway
is the tongue.
Use head tilt-chin lift to open the airway.
Use jaw-thrust if neck or back injury is
suspected.
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Chapter 13
Airway Management

(cont.)
Airway Adjuncts:
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Maintain an open airway.
Two types:
 Oropharyngeal
airway (OPA)
– used in mouth and throat.
 Nasopharyngeal airway
(NPA) – used in nasal
passage.
28
Copyright © The McGraw-Hill Companies, Inc.
Chapter 13
Additional Career Skills

Oxygen therapy is used at the scene for
illnesses that create tremendous stress
on the body such as:
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Respiratory or cardiac arrest.
Heart attack.
Shock.
Severe blood loss.
Lung disease or disorders.
Stroke.
Drug overdose.
Severe bone injuries.
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Chapter 13
Additional Career Skills (cont.)

Oxygen Therapy Equipment
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Oxygen cylinders.
Oxygen regulator.
Oxygen flow meter.
Oxygen delivery devices.
 Nasal cannula
 Nonrebreather mask
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Chapter 13
Additional Career Skills (cont.)

Automated External Defibrillator
(AED)
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Used to treat ventricular fibrillation, a
chaotic heart rhythm (the most
common cause of cardiac arrest).
American Heart Association
recommends using in the first 5
minutes to improve chance of survival.
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Chapter 13
Additional Career Skills (cont.)

Automated External
Defibrillator (AED) (cont.)
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Attaches to chest.
Analyzes the rhythm.
Determines the need for a
shock.
Can deliver shock manually or
automatically.
Use only when no response,
breathing, or circulation.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 13
Additional Career Skills (cont.)

Automated External Defibrillator
(AED) (cont.)
–
Modify procedures if:
 Client
33
is wet or on a wet surface.
 Client is less than 8 years old or weighs 55
to 65 pounds.
 Client has pacemaker or internal
defibrillator.
 Client is lying on a metal surface.
 Client has medication patches.
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Chapter 13
Additional Career Skills (cont.)

How to Attach the AED
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Bare and dry the chest.
Position first pad over collarbone and
not on the breast bone.
Position second pad below and to the
left of the left nipple.
Connect the lead cables.
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Chapter 13
Additional Career Skills (cont.)

Principles and Operation of the AED
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Do not delay.
Turn on machine and attach pads.
Check machine for picture of the
placement of pads.
Do not touch client during analysis or
shock.
Say “Clear” before applying a shock.
Check machine’s battery periodically.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 13
Additional Career Skills (cont.)

Spinal Immobilization Skills
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Spinal cord injuries occur from:
 Automobile
collisions.
 Diving accidents.
 Motorcycle collisions.
 Falls.
 In the case of children: falls or being struck
by a motor vehicle.
36
Copyright © The McGraw-Hill Companies, Inc.
Chapter 13
Additional Career Skills (cont.)

Signs of Spinal Injury:
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Paralysis to arms and/or legs.
Loss of feeling in arms or legs.
Pain or tenderness at back of neck or
spine.
Pain with or without movement.
Loss of bowel or bladder control.
Labored breathing with little chest
movement.
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Chapter 13
Emergency Childbirth
The mother should be taken to the
hospital if possible.
 Know date when the baby is due.

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Gestation is approximately 9 months.
Gestation is divided into three 3-month
periods, or trimesters.
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Chapter 13
Emergency Childbirth (cont.)

Anatomy and Physiology
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Placenta – allows oxygen and nutrients to go
to fetus while carbon dioxide and wastes are
eliminated by the mother.
Umbilical cord – cordlike structure attached
between fetus and placenta.
Amniotic sac – thin, membranous sac.
 Allows fetus to float freely, cushioning it
from shock.
 Contains from 1 to 2 liters of fluid.
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Chapter 13
Emergency Childbirth (cont.)

Labor
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Uterus contractions in the ninth
month signaling childbirth.
Has 3 stages.
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Chapter 13
Emergency Childbirth
(cont.)

Labor – First Stage
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Regular contractions of uterus and gradual
dilation of cervix become shorter as delivery
is imminent.
Could last from 4 hours to more than 24
hours.
Typically longer for first-time mothers.
Probable watery or bloody discharge and
rupture of amniotic sac.
Ends with full dilation of cervix.
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Chapter 13
Emergency Childbirth
(cont.)

Labor – Second Stage
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Baby enters birth canal until born.
Contractions become intense and frequent.
Crowning occurs as baby’s head bulges from
vaginal opening.
Ends when baby is born.
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Chapter 13
Emergency Childbirth
(cont.)

Labor – Third Stage
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Starts after baby is born and lasts until
delivery of placenta and umbilical cord is
complete.
Contractions continue a little longer as
uterus prepares to deliver the placenta.
Typically lasts from 10 to 20 minutes.
Ends with delivery of placenta.
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Chapter 13
Section 13-2
Apply Your Knowledge #1
Why is it essential to perform a
thorough client assessment?
Answer:
The information obtained during the assessment
provides the basis for the treatment given. It
must be accurate to ensure proper treatment and
survival. This information is also provided to the
medical facility.
44
Copyright © The McGraw-Hill Companies, Inc.
Chapter 13
Section 13-2
Apply Your Knowledge #2
Why are a clear airway and breathing
always given the top priority when
providing care for your clients?
Answer:
The airway must be clear and breathing must
be present to ensure the client survives the
accident or injury. It is the most lifethreatening concern.
45
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Chapter 13
Procedures in Student Text
13A1
13A2
13B
46
Inserting an Oropharyngeal
Airway Adjunct
Inserting a Nasopharyngeal
Airway Adjunct
Operating of the Semiautomatic
Defibrillator
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Chapter 13
Additional Procedures
in Lab Activity Manual
LM13-1A
LM13-1B
LM13-2A
LM13-2B
LM13-3
47
Preparing an Oxygen
Cylinder
Providing Oxygen
Manual Stabilization of the
Head and Neck
Applying Cervical Collars
Emergency Childbirth
During a Normal Delivery
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Chapter 13
Chapter 13 Credits
Slide 5
Slide 10
Slide 14
Slide 21
Slide 28
Slide 32
48
Kenneth Murry/Photo Researchers
J.S. Reid/Custom Medical Stock Photo
Tim Courlas
Aaron Haupt
Spencer Grant/PhotoEdit
Wolfgang Spunbarg/PhotoEdit
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Chapter 13