North Carolina EMS
Education Standards:
Paramedic Curriculum
Map
Funding for this Accreditation Alignment Project
Provided by a
Perkins Grant.
Grant Administrator: Kent Spitler, MSWd, RN, NRP, CPP
Grant Director: Carrie Stevenson, BS, NRP, CCEMT-P
Administrative Support: Diana Asbury, CIM
June 30, 2013
2
Diana Asbury; CIM
Administrative Support, EMS Curriculum
Alignment
Administrative Support
Gaston College
Dallas, North Carolina
Edward Page Chandler, RN, Paramedic, BS
EMS Program Coordinator
Forsyth Technical Community College
Winston-Salem, North Carolina
Greg Chapman, BS, RRT, CCEMT-P
Director
The Center for Prehospital Medicine
Department of Emergency Medicine
Carolinas Medical Center
Charlotte, North Carolina
Susan Crisp, BS, Med, EdD-Candidate
Assistant Professor
Western Carolina University
Cullowhee, North Carolina
Sara Houston, BSc, NRP
EMS Program Director
Durham Technical Community College
Durham, North Carolina
William B. Lineback, BS, EMT-P
Department Head, EMS
Wake Technical Community College
Raleigh, North Carolina
Eric Mayhew, BS, NRP, CICP, CEI-II
AEMT Curriculum Alignment Chair
EMS Curriculum Coordinator
EMS Program Coordinator/AHA Training
Center Coordinator
Carteret Community College
Morehead City, North Carolina
Thomas McNeilly, BS, NRP
EMS Coordinator
Cleveland Community College
Shelby, North Carolina
Rick Criste, BHS, NRP
EMS Department Chair
Fayetteville Technical Community College
Fayetteville, North Carolina
Tonja Mikell-Pool, BS, NRP
Paramedic Curriculum Alignment Chair
EMS Program Director
Catawba Valley Community College
Hickory, North Carolina
Michael Ennis, NRP, AAS
Coordinator: EMS & Fire Programs
Stanly Community College
Albemarle, North Carolina
Greg Miller, AS, EMT-P
EMS Clinical Coordinator
Durham Technical Community College
Durham, North Carolina
Tom Ferrell, MS, NRP
EMS Program Director
Sandhills Community College
Pinehurst, North Carolina
Stacey Montelongo, BS, NRP
EMS Instructor -Adjunct
Catawba Valley Community College
Hickory, North Carolina
Ken Fields, BS, NRP
Clinical Coordinator/EMS Faculty
Sandhills Community College
Pinehurst, North Carolina
Keith Owens, M.Ed., EMT-P
EMS Department Chair
Asheville-Buncombe Technical Community
College
Asheville, North Carolina
Chad Parlier, NRP, AAS, CCEMTP
EMS Curriculum Instructor - Adjunct
Gaston College
Dallas, North Carolina
Hank Stowe, BS, Paramedic
Faculty, EMS
Davidson County Community College
Lexington, North Carolina
Michael Price, BS, NRP
Program Director
Central Piedmont Community College
Charlotte, North Carolina
San Juan C. Timmons, EMT-P, BA, BCM
Department Chair EMS
Guilford Technical Community College
Jamestown, North Carolina
Ginny K. Renkiewicz, BS, EMT-P
EMS Coordinator
North Carolina State University
Raleigh, North Carolina
Advisory Committee
Christy Ridgill, Paramedic
EMS Training Supervisor
Guilford County EMS.
Greensboro, North Carolina
Rod Dorn
Program Director for Coastal Carolina
Community College
Renee Godwin Batts
North Carolina Community College System
Joel Faircloth
North Carolina Association of Rescue and
EMS
Robert Smith, MHS, NRP, CCEMT-P
EMR/EMT Curriculum Alignment Chair
EMS Curriculum Instructor - Adjunct
Med Center Air/Gaston College
Dallas, North Carolina
Henry Helton
North Carolina Association of Paramedics
Eric Hester
Southwestern Community College
Kent Spitler, MSEd, RN, NRP, CPP
Grant Administrator, EMS Curriculum
Alignment
Director for EMS Education
Gaston College
Dallas, North Carolina
Dr. Kevin D. Kupietz
Halifax Community College
William B. Lineback
Wake Technical Community College
Carrie Stevenson, BS, NRP, CCEMT-P
Grant Director, EMS Curriculum Alignment
Clinical Coordinator
Gaston College
Dallas, North Carolina
Dr. Darrell Nelson
North Carolina College of Emergency
Physicians
Keith Owens
Asheville-Buncombe Technical Community
College
Mick Stewart, BS, NRP
EMS Curriculum Program Director
Johnston Community College
Smithfield, North Carolina
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Kent Spitler
Gaston College
Dr. Dennis Taylor
North Carolina EMS Advisory Council
5
Table of Contents
Preparatory ................................................................................................................................................... 9
EMS Systems ............................................................................................................................................. 9
Research .................................................................................................................................................. 11
Workforce Safety and Wellness .............................................................................................................. 12
Documentation ....................................................................................................................................... 15
Ems System Communication................................................................................................................... 17
Therapeutic Communication .................................................................................................................. 19
Medical/Legal and Ethics ........................................................................................................................ 21
Anatomy and Physiology............................................................................................................................. 23
Medical Terminology .................................................................................................................................. 31
Pathophysiology.......................................................................................................................................... 32
Life Span Development ............................................................................................................................... 34
Public Health ............................................................................................................................................... 35
Pharmacology ............................................................................................................................................. 36
Principles of Pharmacology ..................................................................................................................... 36
Medication Administration ..................................................................................................................... 38
Emergency Medications.......................................................................................................................... 41
Airway Management, Respiration and Artificial Ventilation ...................................................................... 43
Airway Management............................................................................................................................... 43
Respiration .............................................................................................................................................. 51
Artificial Ventilation ................................................................................................................................ 53
Assessment ................................................................................................................................................. 54
Scene Size-Up .......................................................................................................................................... 54
Primary Assessment ................................................................................................................................ 55
History Taking ......................................................................................................................................... 60
Secondary Assessment............................................................................................................................ 63
Monitoring Devices ................................................................................................................................. 67
Reassessment.......................................................................................................................................... 68
Medicine ..................................................................................................................................................... 69
Medical Overview ................................................................................................................................... 69
Neurology................................................................................................................................................ 71
6
Abdominal and Gastrointestinal Disorders ............................................................................................. 74
Immunology ............................................................................................................................................ 77
Infectious Diseases.................................................................................................................................. 79
Endocrine Disorders ................................................................................................................................ 83
Psychiatric ............................................................................................................................................... 86
Cardiovascular......................................................................................................................................... 89
Toxicology ............................................................................................................................................... 94
Respiratory .............................................................................................................................................. 98
Hematology ........................................................................................................................................... 101
Genitourinary/Renal ............................................................................................................................. 103
Gynecology............................................................................................................................................ 105
Non-Traumatic Musculoskeletal Disorders........................................................................................... 107
Diseases of the Eyes, Ears, Nose and Throat ........................................................................................ 109
Shock and Resuscitation ........................................................................................................................... 111
Responding to the Field Code ............................................................................................................... 115
Management and Resuscitation of the Critical Patient ........................................................................ 117
Trauma ...................................................................................................................................................... 119
Trauma Overview .................................................................................................................................. 119
Bleeding ................................................................................................................................................ 121
Chest Trauma ........................................................................................................................................ 123
Abdominal and Genitourinary Trauma ................................................................................................. 127
Orthopedic Trauma ............................................................................................................................... 129
Soft Tissue Overview ............................................................................................................................. 132
Head, Facial, Neck and Spine Trauma ................................................................................................... 137
Nervous System Trauma ....................................................................................................................... 141
Special Considerations in Trauma ......................................................................................................... 143
Environmental Emergencies ................................................................................................................. 144
Multi-System Trauma............................................................................................................................ 146
Special Patient Populations ...................................................................................................................... 147
Obstetrics .............................................................................................................................................. 147
Neonatal Care ....................................................................................................................................... 150
Pediatrics............................................................................................................................................... 152
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Geriatrics ............................................................................................................................................... 155
Patients with Special Challenges........................................................................................................... 158
EMS Operations ........................................................................................................................................ 166
Principles of Safely Operating a Ground Ambulance ............................................................................ 166
Incident Management........................................................................................................................... 168
Multiple Casualty Incidents................................................................................................................... 169
Air Medical ............................................................................................................................................ 170
Vehicle Extrication ................................................................................................................................ 171
Hazardous Materials Awareness........................................................................................................... 173
Mass Casualty Incidents Due to Terrorism and Disaster ...................................................................... 179
8
Preparatory
EMS Systems
Summary: Integrates comprehensive knowledge of EMS systems, the safety/well-being of the
paramedic, and medical/legal and ethical issues, which is intended to improve the health of EMS
personnel, patients, and the community.
TARGET SKILLS:
 EMS systems
 Roles/ responsibilities/ professionalism of EMS personnel
 Quality Improvement
 History of EMS
 Patient safety
Key Terminology:
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Emergency Medical
Services (EMS)
Mobile Intensive
Care Units (MICUs)
Trauma Systems
Certification
Licensure
Medical Direction
Registration
Reciprocity
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Emergency Medical
Responder
Emergency Medical
Technician
Advanced
Emergency Medical
Technician
Paramedic
Health Care
Professional
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Profession
Online Medical
Control
Off-line Medical
Control
Protocol
Standing Order
Continuous Quality
Improvement (CQI)
Objectives:
DOT Objectives
 Describe key historical events that influenced
the development of national Emergency
Medical Services (EMS) systems.
 Identify the standards (components) of an
EMS System as defined by the National
Highway Traffic Safety Administration.
 Describe the importance of quality EMS
research to the future of EMS.
 Describe what is meant by "citizen
involvement in the EMS system."
 Identify local health care agencies and
transportation resources for patients with
special needs.
 Describe the role of the paramedic in health
education activities related to illness and injury
prevention.
 Describe the importance and benefits of
EMS Education Standards
 Describe key historical events that influenced
the development of national Emergency
Medical Services (EMS) systems.
 Identify the standards (components) of an
EMS System as defined by the EMS Agenda for
the future and EMS Education Agenda for the
future
 Describe the aspects of the research process
and be able to recognize the importance and
necessity of quality EMS research for the
practice of EMS and EMS Education
 Describe the role of the paramedic in health
education activities related to illness and injury
prevention
 Describe the need to serve as a patient
advocate inclusive to all patients
 Understand the role that family and
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research.
Explain the EMS provider’s role in data
collection.
Value the need to serve as the patient
advocate inclusive of those with special needs,
alternate life styles and cultural diversity.
Advocate the need for supporting and
participating in research efforts aimed at
improving EMS systems.
Value the role that family dynamics plays in
the total care of patients.
Advocate the need for injury prevention,
including abusive situations.
community dynamics play in total patient care.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based assessment pertinent to topic of instruction, quiz, and exam (didactic and
skills).
10
Research
Summary: Integrates comprehensive knowledge of research principles to interpret literature and
advocate evidence based practice which is intended to improve the health of EMS personnel, patients,
and the community.
TARGET SKILLS: Impact of research on EMR care to include:
 Data collection
 Evidence-based decision making
 Research principles to interpret literature and advocate evidence-based practice
Key Terminology:
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Evidence-based Practice
Research agenda
Research domain
Research consortium
Institutional review
board (IRB)
Qualitative Research
Quantitative Research
Retrospective research
Prospective research
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Cohort research
Case study
Cross-sectional design
Longitudinal design
Literature review
Systematic sampling
Alternative time
sampling
Convenience sampling
Sampling errors
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Parameters
Blinding
Unblended study
Descriptive statistics
Inferential statistics
Ethical
Peer review
Objectives:
DOT Objectives
 Discuss the importance of evidence-based
research as it pertains to EMS
 Discuss the methods of determining
treatments based on evidence-based decision
making.
 Emphasize the importance of documentation
that leads to data collection
EMS Education Standards
 Understand and discuss the research principles
to interpret literature and advocate evidencebased practice.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
 Research group project, evidence based scenarios, Q & A sessions
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
11
Workforce Safety and Wellness
Summary: Integrates comprehensive knowledge of the safety/well-being of the paramedic, which is
intended to improve the health of EMS personnel, patients, and the community.
TARGET SKILLS:
 Standard safety precautions
 Personal protective equipment
 Stress management
 Dealing with death and dying
 Prevention of work - related injuries
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Lifting and moving patients
Disease transmission
Wellness principles
Provider safety and well-being
Key Terminology:
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Well-being
 Physical
 Mental
 Emotional
 Spiritual
Stress
Stressor
Fight or flight syndrome
Acute stress reactions
Delayed stress reactions
Cumulative stress
reactions
Defense Mechanisms
 Denial
 Regression
 Projection
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 Displacement
Anxiety
Blind Panic
Depression
Overreaction
Conversion Hysteria
Burnout
Grieving Process
 Stage 1 – Denial
 Stage 2 – Anger
 Stage 3 – Bargaining
 Stage 4 – Depression
 Stage 5 – Acceptance
Posttraumatic Stress
Disorder (PTSD)
Critical Incident
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Critical Incident Stress
Management (CISM)
Infectious Disease
Communicable Disease
Infection
Transmission
Direct Contact
Bloodborne pathogens
Indirect contact
Airborne transmission
Universal precautions
Standard precautions
Infection control
Objectives:
DOT Objectives
EMS Education Standards
 Understand and value the importance of
 Understand, discuss, and demonstrate
personal wellness in EMS and serve as a
knowledge of EMS Systems, the safety/wellhealthy role model for peers.
being of the paramedic, and medical/legal and
ethical issues which is intended to improve the
 Discuss the concept of wellness and its
health of EMS personnel, patients and the
benefits.
community to include:
 Define the components of wellness.
 Provider safety and well-being
 Describe the role of the paramedic in
 Standard safety precautions
promoting wellness.
 Personal protective equipment
 Discuss the components of wellness associated
 Stress management
with proper nutrition.
 Prevention of work related injuries
 List principles of weight control.
 Lifting and moving patients
 Discuss how cardiovascular endurance, muscle
 Disease transmission
strength, and flexibility contribute to physical
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fitness.
Describe the impact of shift work on circadian
rhythms.
Discuss how periodic risk assessments and
knowledge of warning signs contribute to
cancer and cardiovascular disease prevention.
Differentiate proper from improper body
mechanics for lifting and moving patients in
emergency and non-emergency situations.
Describe the benefits and methods of smoking
cessation.
Describe the components of critical incident
stress management (CISM).
Provide examples of situations in which CISM
would likely be beneficial to paramedics.
Describe the unique challenges for paramedics
in dealing with the needs of children and other
special populations related to their
understanding or experience of death and
dying.
Discuss the importance of universal
precautions and body substance isolation
practices.
Describe the steps to take for personal
protection from airborne and bloodborne
pathogens.
Given a scenario in which equipment and
supplies have been exposed to body
substances, plan for the proper cleaning,
disinfection, and disposal of the items.
Explain what is meant by an exposure and
describe principles for management.
Advocate the benefits of working toward the
goal of personal wellness
Serve as a role model for other EMS providers
in regard to a total wellness lifestyle.
Value the need to assess his/her own lifestyle.
Challenge his/herself to each wellness concept
in his/ her role as paramedic.
Defend the need to treat each patient as an
individual, with respect and dignity.
Assess his/her own prejudices related to the
various aspects of cultural diversity.
Improve personal physical well-being through
achieving and maintaining proper body weight,
regular exercise and proper nutrition.
Defend the need to respect the emotional
13
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Wellness principles
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needs of dying patients and their families.
Advocate and practice the use of personal
safety precautions in all scene situations.
Advocate and serve as a role model for other
EMS providers relative to body substance
isolation practices.
Demonstrate safe methods for lifting and
moving patients in emergency and nonemergency situations.
Demonstrate the proper procedures to take
for personal protection from disease.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Suggested course to include: Escaping Violent Encounters for EMS/Fire (www.DT4EMS.com)
 Physical fitness, lifting and body mechanics
 Defense techniques
 Stress management survey to include substance abuse
 Diet assessment plan
 Consult a medical examiner or psychologist for death and dying.
 Bloodborne pathogens training
 Skills:
 Use of PPE
 Hand washing
 Disinfection of equipment
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
14
Documentation
Summary: Integrates comprehensive knowledge of principles of medical documentation and report
writing, which is intended to improve the health of EMS personnel, patients, and the community.
TARGET SKILLS: Recording patient findings and principles of medical documentation and report writing.
Key Terminology:
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Patient Care Report
(PCR)
Objective Information
Subjective Information
Health Insurance
Portability and
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Accountability Act
(HIPAA)
Medical Necessity
Minimum data set
Slander
SOAP Method
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CHARTE Method
Pertinent negatives
Libel
Approved Medical
Abbreviations
Objectives:
DOT Objectives
 Identify the general principles regarding the
importance of EMS documentation and ways
in which documents are used.
 Identify and use medical terminology
correctly.
 Recite appropriate and accurate medical
abbreviations and acronyms as described in
current edition of the NCCEP EMS Standards
document.
 Record all pertinent administrative
information.
 Analyze the documentation for accuracy and
completeness, including spelling.
 Describe the differences between subjective
and objective elements of documentation.
 Evaluate a finished document for errors and
omissions.
 Evaluate a finished document for proper use
and spelling of abbreviations and acronyms.
 Evaluate the confidential nature of an EMS
report.
 Describe the potential consequences of
illegible, incomplete, or inaccurate
documentation.
 Describe special considerations and reporting
requirements concerning patient refusal of
transport.
 Explain how to properly record direct patient
EMS Education Standards
 Categorize the essential components of a
patient care report.
 Discuss the importance of thorough and
proper documentation in patients refusing
medical care.
 Demonstrate accurate documentation
required to make an effective legal document
and emphasize the importance of same.
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or bystander comments.
Describe special considerations concerning
mass casualty incident documentation.
Apply the principles of documentation to
electronic charting using appropriate
available technology.
Identify and record the pertinent, reportable
clinical data of each patient interaction while
using a consistent narrative format.
Note and record “pertinent negative” clinical
findings.
Revise and amend documents, when
necessary, using locally-approved procedures.
Assume responsibility for self-assessment of
all documentation.
Demonstrate proper completion of an EMS
event record used locally.
Develop an understanding of the relevance
and importance of properly completed
documentation.
Maintain accurate and professional reporting.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Engage students in documenting lab scenarios and give students charting criteria to include:
 Different technology-based charting programs
 Mandatory reporting guidelines per your state laws.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
16
Ems System Communication
Summary: Integrates comprehensive knowledge of EMS communication systems, communication with
other healthcare personnel, and team communication and dynamics which is intended to improve the
health of EMS personnel, patients, and the community.
TARGET SKILLS: Communication needed to:
 Call for resources
 Transfer care of the patient
 Interact within the team structure
 EMS communication system
 Communication with other health care professionals
 Team communication and dynamics
Key Terminology:
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Emergency Medical
Dispatcher (EMD)
Therapeutic
Communications
Base Station
Dispatch
Transceiver
Repeater
Remote Console
Wavelength
Frequency
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Hertz (Hz)
Very High Frequency
(VHF) band
Ultrahigh Frequency
(UHF) band
Noise
Trunking
Federal Communications
Commission (FCC)
Simplex
Duplex
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Multiplex
Digital Radio
Cellular Telephones
Landline
Biotelemetry
Encoded
Ten-Code
Emergency Medical
Dispatch
Enhanced 9-1-1 System
Objectives:
DOT Objectives
 Follow an accepted format for dissemination
of patient information in verbal form, either in
person or over the radio.
 Identify technology used to collect and
exchange patient and/ or scene information
electronically.
 Recognize the legal status of patient medical
information exchanged electronically.
 Identify and differentiate among the following
communications systems:
 Trunked
 Digital communications
 Cellular telephone
 Facsimile
 Computer
EMS Education Standards
 Demonstrate an accepted format for
dissemination of patient information in verbal
report.
 Identify technology used to collect and
exchange patient and/ or scene information
electronically.
 Recognize the legal status of patient medical
information exchanged electronically.
 Identify and differentiate among
communications systems used in EMS
17
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
 Coordinate with Local 911 or radio center for communication skills to include proper radio
reporting.
 Team building for interpersonal communications dynamics
 Coordinate with inter disciplinary teams such as RN’s, Paramedics, and MD’s.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
18
Therapeutic Communication
Summary: Integrates comprehensive knowledge of positive patient communication strategies which is
intended to improve the health of EMS personnel, patients, and the community.
TARGET SKILLS: Principles of communicating with patients in a manner that achieves a positive
relationship to include:
 Interviewing techniques
 Adjusting communication strategies for age, stage of development, patients with special needs,
and differing cultures
 Verbal defusing strategies
 Family presence issues
 Dealing with difficult patients
 Factors that affect communication
 Adjusting communication strategies for age, stage of development, patients with special needs,
and differing cultures.
Key Terminology:
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Communication
Therapeutic
Communications
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Interpersonal
Communications
Open-ended Questions
Closed-ended Questions
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Non-verbal
communications
Pervasive developmental
disorders (PDDs)
Objectives:
DOT Objectives
 Integrate the principles of therapeutic
communication to effectively communicate
with any patient while providing care.
 Identify internal and external factors that
affect a patient/ bystander interview
conducted by a paramedic.
 Restate the strategies for developing patient
rapport.
 Provide examples of open-ended and closed or
direct questions.
 Discuss common errors made by paramedics
when interviewing patients.
 Identify the nonverbal skills that are used in
patient interviewing.
 Restate the strategies to obtain information
from the patient.
 Summarize the methods to assess mental
status based on interview techniques.
 Discuss the strategies for interviewing a
patient who is unmotivated to talk.
EMS Education Standards
 Integrate the principles of therapeutic
communication to effectively communicate
with any patient while providing care.
 Discuss and describe various patient interview
techniques and communication strategies for
age, stage of development, patients with
special needs, and differing cultures.
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Summarize developmental considerations of
various age groups that influence patient
interviewing.
Restate unique interviewing techniques
necessary to employ with patients who have
special needs.
Discuss interviewing considerations used by
paramedics in cross-cultural communications.
Serve as a model for an effective
communication process.
Advocate the importance of external factors of
communication.
Promote proper responses to patient
communication.
Advocate development of proper patient
rapport.
Value strategies to obtain patient information.
Exhibit professional behaviors in
communication with patient form different
cultures.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
 Discussion about body language and interpersonal communication.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
20
Medical/Legal and Ethics
Summary: Integrates comprehensive knowledge of medical/legal and ethical issues, which is intended
to improve the health of EMS personnel, patients, and the community.
TARGET SKILLS: Consent and refusal of care to include:
 Consent/refusal of care
 Confidentiality
 Advanced directives
 Tort and criminal actions
 Evidence preservation
 Statutory responsibilities
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Mandatory reporting
Ethical principles/moral obligations
End-of-life issues
Health care regulation
Patient rights/advocacy
Ethical tests and decision making
Key Terminology:
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Ethics
Morality
Liability
Civil Suit
Plaintiff
Defendant
Tort
Damages
Punitive Damages
Criminal Prosecution
Assault
Battery
False Imprisonment
Defamation
Libel
Slander
Due Process
Medical Practice Act
Scope of Practice
HIPAA
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EMTALA
Consent
Informed Consent
Expressed Consent
Implied Consent
Involuntary Consent
Decision-making
Capacity
In loco parentis
Emancipated minors
Triage
Negligence
Malfeasance
Misfeasance
Nonfeasance
Duty
Standard of Care
Ordinary Negligence
Gross Negligence
Res ipsa loquitor
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Negligence per se
Proximate cause
Abandonment
Patient autonomy
Advance directive
Living will
Health care power of
attorney
Surrogate decision
maker
Do Not Resuscitate
(DNR) Order
Statues of limitations
Contributory Negligence
Good Samaritan Law
Immunity
Qualified Immunity
Quid Pro Quo
Hostile Environment
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Objectives:
DOT Objectives
 Understand the legal issues that impact
decisions made in the out-of-hospital
environment.
 Describe how hospitals are selected to receive
patients based on patient need and hospital
capability and the role of the paramedic in
such selection.
EMS Education Standards
 Discuss, demonstrate, and understand the
legal and ethical issues that impact decisions
made in the out-of-hospital environment.
 Discuss, demonstrate, and understand the
legal and ethical issues that impact decisions
made in the out-of-hospital environment to
include but not limited to the following:
21
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Discuss the responsibilities of the paramedic
relative to resuscitation efforts for patients
who are potential organ donors.
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 Consent/refusal of care
 Confidentiality
 Advanced directives
 Tort & criminal actions
 Evidence preservation
 Statutory responsibilities
 Mandatory reporting
 Ethical principles
Moral obligations
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
22
Anatomy and Physiology
Summary: Integrates a complex depth and comprehensive breadth of knowledge of the anatomy and
physiology of all human systems.
TARGET SKILLS: At the end of this course, the student should be able to:
 Identify the basic levels of structural organization of the human body.
 Understand the concepts of cytology and histology.
 Understand the general anatomy and physiology of all human organ systems.
 Relate the significance of being a paramedic to human anatomy and physiology.
Key Terminology:
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Anatomy
Physiology
Homeostasis
Topographic
anatomy
Anatomic position
Coronal plane
Transverse (axial)
plane
Sagittal (lateral)
plane
Midsagittal plane
(Midline)
Cross section
Longitudinal section
Superior
Inferior
Lateral
Medial
Proximal
Distal
Superficial
Deep
Anterior
Ventral
Posterior
Dorsal
Palmar
Plantar
Apex
Range of motion
Flexion
Extension
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Abduction
Adduction
Hyperflexion
Hyperextension
Supination
Pronation
Internal rotation
External rotation
Bilateral
Unilateral
Quadrants
Prone
Supine
Trendelenburg
Position
Shock position\
Torso
Fowler Position
Matter
Elements
Atoms
Protons
Neutrons
Electrons
Atomic Number
Atomic weight
Isotope
Radioisotopes
Molecule
Ions
Ionic bond
Cations
Anions
23
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Covalent bonds
Hydrogen bonds
Compounds
Synthesis reaction
Decomposition
reaction
Exchange reaction
Reversible reaction
Enzymes
Electrolytes
Acids
Bases
pH
Acidosis
Alkalosis
Organic chemicals
Inorganic chemicals
Carbohydrates
Monosaccharides
Disaccharides
Oligosaccharides
Polysaccharides
Lipids
Triglycerides
Phospholipid
Steroid
Protein
Peptides
Polypeptides
Nucleic acids
Sex cells
Somatic cells
Cell membrane
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Semipermeable
Cytoplasm
Cytosol
Organelles
Nucleus
Chromosomes
Diffusion
Solutes
Concentration
gradient
Osmosis
Osmotic pressure
Crenation
Lysis
Hypertonic
Hypotonic
Isotonic
Facilitated diffusion
Active transport
meiosis
Mitosis
Cytokinesis
Differentiation
Stem cells
Adenosine
triphosphate (ATP)
Aerobic metabolism
Anaerobic
metabolism
Lactic acid
Epithelial tissues
Connective tissues
Muscle tissues
Nervous tissues
Basement
membrane
Avascular
Simple squamous
epithelium
Simple cuboidal
epithelium
Simple columnar
epithelium
Pseudostratified
columnar epithelium
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Stratified squamous
epithelium
Stratified cuboidal
epithelium
Stratified columnar
epithelium
Transitional
epithelium
Glandular epithelium
Exocrine glands
Matrix
Fibroblast
Mast cells
Macrophages
Dense connective
tissue
Loose connective
tissue
Adipose tissue
Areolar tissue
Reticular connective
tissue
Cartilage
Hyaline cartilage
Elastic cartilage
Fibrocartilage
Bone
Osteocytes
Skeletal muscle
tissue
Smooth muscle
tissue
Cardiac muscle tissue
Neurons
Neuroglial cells
Epithelial
membranes
Serous membranes
Mucous membranes
Cutaneous
membranes
Synovial membranes
Tendons
Ligaments
Epiphyses
Periosteum
24
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Endosteum
Medullary cavity
Bone marrow
Compact bone
Cancellous bone
Trabeculae
Joint (articulation)
Symphysis
Fibrous joint
Cartilaginous joint
Synovial joint
Joint capsule
Synovial fluid
Osteoblasts
Ossification
Endochondiral
ossification
Intramembranous
ossification
Osteoclast
Axial skeleton
Appendicular
skeleton
Thoracic cage
Thorax
Skull
Auditory ossicles
Cranium
Cranial vault
Foramen magnum
Sutures
Fontanelles
Mastoid process
Crista galli
Cribiform plate
Foramina
Olfactory bulb
Nasal cavity
Maxillae
Zygoma
Orbits
Nasal septum
Paranasal sinuses
Mandible
Temporomandibular
joint (TMJ)
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Hyoid bone
Adam’s Apple
Thyroid cartilage
Cricoid cartilage
Cricothyroid
membrane
Fascia
Sternocleidomastoid
muscle
Sternum
Vertebral column
Vertebrae
Cervical spine
Thoracic spine
Lumbar spine
Sacrum
Coccyx
Atlas
Atlanto-occipital
joint
Axis
Manubrium
Xiphoid process
Pulmonary artery
Shoulder girdle
Scapula
Clavicle
Acromion process
Glenoid fossa
Humerous
Radius
Ulna
Metacarpals
Phalanges
Carpometacarpal
joint
Saddle joint
Ilium
Ischium
Pubis
Sacroiliac joints
Pubic symphysis
Acetabulum
Femur
Femoral head
Greater trochanter
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Lesser trochanter
Patella
Tibia
Medial malleolus
Fibula
Lateral malleolus
Talus
Calcaneus
Metatarsals
Musculoskeletal
system
Involuntary muscle
Voluntary muscle
Motor neurons
Neurotransmitters
Neuromuscular
junction
Motor end plate
Motor unit
Troponin
Tropomyosin
Sliding filament
model
Nerve impulse
Action potentials
Depolarization
Polarized
Repolarization
Acetylcholine
Muscle impulse
Acetylcholinesterase
Creatine phosphate
Hemoglobin
Myoglobin
Oxygen debt
Origin
Insertion
Respiratory system
Nasopharynx
Oropharynx
Pharynx
Larynx
Esophagus
Trachea
Epiglottis
Mainstem bronchi
25
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Hilum
Secondary bronchi
Bronchioles
Alveolar ducts
Alveoli
Surfactant
Alveolocapillary
membrane
Lungs
Pleura
Visceral pleura
Parietal pleura
Pleural space
Diaphragm
Respiration
Ventilation
Hypoxic drive
Buffer
Buffer system
Dorsal respiratory
group (DRG)
Ventral respiratory
group (VRG)
Pneumotaxic
(pontine) center
Apneustic center
Hering-Breuer reflex
Tidal volume
Inspiratory reserve
volume
Expiratory reserve
volume
Residual volume
Vital capacity
Dead space
Minute volume
Labored breathing
Agonal gasps
Circulatory system
Systemic circulation
Pulmonary
circulation
Heart
Myocardium
Mediastinum
Pericardium
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Epicardium
Endocardium
Purkinje fibers
Ineratrial septum
Interventricular
septum
Atrium
Ventricle
Coronary sinus
Pulmonary veins
Fossa ovalis
Foramen ovale
Atrioventricular
valves
Tricuspid valve
Mitral valve
Cusps
Papillary muscle
Chordae tendineae
Semilunar valves
Pulmonic valves
Aortic valve
Superior vena cava
Inferior vena cava
Aorta
Bruit
Electrical conduction
system
Sinoatrial (SA) node
Atrioventricular (AV)
node
Bindle of HIS
Chronotropic effect
Dromotropic effect
Inotropic effect
Baroreceptors
Chemoreceptors
Heart rate
Contractility
Alpha effects
Beta effects
Catecholamines
Cardiac cycle
Systole
Diastole
Pulse pressure
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Afterload
Stroke volume (SV)
Cardiac output
Ejection fraction
Preload
Arteries
Veins
Arterioles
Capillaries
Tunica intima
Tunica media
Tunica adventitia
Coronary arteries
Left anterior
descending (LAD)
artery
Circumflex coronary
arteries
Ascending aorta
Aortic arch
Carotid artery
Descending aorta
Carotid bifurcation
Subclavian artery
Brachial artery
Femoral arteries
Popliteal artery
Dorsalis pedis artery
Posterior tibial artery
Jugular veins
Venous sinuses
Subclavian veins
Basilica vein
Cephalic vein
Axillary vein
Hepatic portal
system
Hepatic veins
Saphenous vein
Femoral vein
Blood
Plasma
Albumins
Globulins
Fibrinogen
Hematopoiesis
26
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Red blood cells
Erythropoiesis
Bilirubin
Antigens
Antibodies
White blood cells
Diapedesis
Granulocytes
Agranulocytles
Neutrophils
Eosinophils
Basophils
Histamine
Heparin
Lymphocytes
Monocytes
Platelets
Hemostasis
Tromboplastin
Prothrombin
Thrombin
Fibrin
Tissue Plasminogen
activator (t-PA)
Plasmin
Pulse
Blood pressure
Sphygmomanometer
Systemic vascular
resistance (SVR)
Perfusion
Shock
Interstitial space
Hydrostatic pressure
Oncotic pressure
Lymphatic system
Lymph
Lymph vessels
Lymph nodes
Thoracic duct
Thymus
Spleen
Innate (nonspecific)
defense
Adaptive (specific)
defense
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Immunity
Interferons
Complement
Mononuclear
phagocytic system
Hapten
T-lymphocytes (TCells)
B-lymphocytes (BCells)
Celluar immune
response
Plasma cells
Humoral immune
response
Allergen
Nervous system
Central nervous
system (CNS)
Peripheral nervous
system (PNS)
Somatic nervous
system
Autonomic nervous
system (ANS)
Axons
Dendrites
Neuroglia
Astrocytes
Ependymal cells
Microglial cells
Oligodendrocytes
Schwann cells
Nodes of Ranvier
White matter
Synapse
Presynaptic terminal
Synaptic cleft
Postsynaptic
terminal
Synaptic vesicles
Brain
Cerebrum
Corpus callosum
Cerebellum
Brainstem
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Midbrain
Pons
Medulla oblongata
Reticular activating
system
Spinal cord
Reflex arc
Meninges
Dura mater
Arachnoid
Pia mater
Cerebrospinal fluid
(CSF)
Subarachnoid space
Choroid plexus
Sympathetic nervous
system
Parasympathetic
nervous system
Sensory nerves
Motor nerves
Cranial nerves
Oculomotor nerves
Vagus nerve
Spinal nerves
Dermatones
Nerve plexus
Posterior column
pathway
Motor pathways
Sensory receptors
Perception
Adaptation
After-image
General senses
Referred pain
Phantom pain
Encapsulated nerve
endings
Free nerve endings
Neuropathy
Taste receptors
Primary taste
sensations
Olfactory cells
Globe
27
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Anterior cavity
Posterior cavity
Vitreous humor
Aqueous humor
Schlemm’s canal
Glaucoma
Extrinsic muscles
Refracting system
Lens
Cataracts
Cornea
Suspensory
ligaments
Myopia
Hyperopia
Presbyopia
Astigmatism
Sclera
Conjunctiva
Conjunctivitis
Lacrimal glans
Lacrimal sac
Choroid
Ciliary body
Pupil
Iris
Retina
Rods
Cones
Fovea centralis
Macula
Ganglion neurons
Optic disk
Optic chiasm
Binocular vision
\strabismus
Amblyopia
Pinna
Ear canal
Tympanic membrane
Eustachian tuve
Oval window
Bony labyrinth
Perilymph
Membranous
labyrinth
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Endolymph
Cochlea
Organ of Corti
Vestibular system
Otoliths
Saccule
Utricle
Proprioception
Subcutaneous tissue
Mucus
Epidermis
Scalp
Germinal layer
Stratum corneal
layer
Dermis
Hair follicles
Sweat glands
Sebaceous glands
Digestion
Abdomen
Cecum
Appendix
Retroperitoneal
Salivary glands
Chime
Pancreas
Liver
Bile ducts
Gallbladder
Small intestine
Large intestine
Rectum
Sphincters
Endocrine system
Endocrine glands
Hormones
Prostaglandins
Agonists
Antagonists
Pituitary glands
Hypothalamus
Adrenocorticotropin
hormone (ACTH)
Thyroid gland
Calcitonin
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Parathyroid glands
Parathyroid
hormone (PTH)
Alpha cells
Beta cells
Nyxedema
Hypothyroidism
Cretinism
Glycogen
Glycogenolysis
Gluconeogenesis
Hypoglycemia
Hyperglycemia
Diabetes mellitus
Delta cells
Somatostatin
Adrenal glands
Adrenaline
Epinephrine
Norepinephrine
Adrenal cortex
Corticosteroids
Cortisol
Gonads
Ovaries
Testes
Estrogen
Progesterone
Human chorionic
gonadotropin (hCG)
Inhibin
Urinary system
Kidneys
Reval pelvis
Renal medulla
Renal cortex
Nephrons
Renal arteries
Afferent arterioles
Reval vein
Renal corpuscle
Renal tubule
Glomerulus
Glomerular capsule
Efferent arteriole
Peritubular capillary
28
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Juxtaglomerular
apparatus
Glomerular filtration
Tubular reabsorption
Tubular secretion
Urine
Glomerular filtrate
Net filtration
pressure
Urea
Uric acid
Ureter
Peristalsis
Urinary bladder
Urethra
Renin-angiotensin
system
Intracellular fluid
(ICF)
Extracellular fluid
(ECF)
Intravascular fluid
(plasma)
Interstitial fluid
Fluid balance
Genital system
Gametes
Sperm
Oocytes
Haploid cell
Homologous
chromosome
Zygote
Diploid
Autosomes
Sex chromosomes
Alleles
Genotype
Phenotype
Prostate gland
Seminal vesicles
Scrotum
Seminiferous tubules
Speratogenic cells
Interstitial cells
Spermatogenesis
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Spermatogonia
Epididymides
Vasa deferential
Ejaculatory duct
Bulbourethral glands
Cowper glands
Semen
Penis
Glans penis
Erection
Orgasm
Emission
Ejaculation
Gonadotropins
Androgens
Testosterone
Puberty
Primordial follicles
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Oogenesis
Primary follicles
Ovulation
Uterine tubes
Uterus
Cervix
Endometrium
Myometrium
Perimetrium
Vagina
Hymen
Vulva
Labia majora
Labia minora
Clitoris
Vestibule
Vestibular gland
Menarche
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Corpus luteum
Metabolism
Basal metabolic rate
Kilocalories
Nutrients
Calorie
Vitamins
Minerals
Trace elements
Cellular metabolism
Anabolism
Catabolism
Substrate
Oxidation
Glycolysis
Thermoregulation
Objectives:
DOT Objectives
 Be able to integrate the physiological,
psychological, and sociological changes
throughout human development with
assessment and communication strategies for
patients of all ages.
 Compare the physiological and psychosocial
characteristics of an infant with those of an
early adult.
 Compare the physiological and psychosocial
characteristics of a toddler with those of an
early adult.
 Compare the physiological and psychosocial
characteristics of a preschool child with those
of an early adult.
 Compare the physiological and psychosocial
characteristics of a school-aged child with
those of an early adult.
 Compare the physiological and psychosocial
characteristics of an adolescent with those of
an early adult.
 Summarize the physiological and psychosocial
characteristics of an early adult.
 Compare the physiological and psychosocial
characteristics of a middle aged adult with
EMS Education Standards
 Integrates a complex depth and
comprehensive breadth of knowledge of the
anatomy and physiology of all human systems.
29
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
those of an early adult.
Compare the physiological and psychosocial
characteristics of a person in late adulthood
with those of an early adult.
Value the uniqueness of infants, toddlers, preschool, school aged, adolescent, early
adulthood, middle aged, and late adulthood
physiological and psychosocial characteristics.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
30
Medical Terminology
Summary: Integrates comprehensive anatomical and medical terminology and abbreviations into the
written and oral communication with colleagues and other health care professionals.
Key Terminology:
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
Combining form
Prefix
Root
Suffix
Objectives:
DOT Objectives
 Recognizes simple medical prefixes, suffixes,
and combination of words.
EMS Education Standards
 Define and demonstrate the ability to
integrate anatomical and medical terminology
and abbreviations into the written and oral
communication with colleagues and other
health care professionals.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
31
Pathophysiology
Summary: Integrates comprehensive knowledge of pathophysiology of major human systems.
TARGET SKILLS: Recognize the interrelations among structure and function at the tissue and organ
system to include:
 Discussing the etiology, pathogenesis, local, and systemic effects of cell injury.
 Applying the concepts of inflammation and healing, immune responses, fluid and electrolyte
imbalances, genetics, and age to common disorders in major body systems.
 Discussing the concept of stress, the body’s response to stress, and the relationship stress has to
the disease process.
 Defining and discussing hypoperfusion, the types of shock, and Multiple Organ Dysfunction
Syndrome (MODS).
Key Terminology:
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Acid
Acidosis
Adipose tissue
Adrenergic receptors
Alcoholic ketoacidosis
Alkalosis
Allergen
Anions
Antidiuretic hormone
(ADH)
Apoptosis
Asthma
Atopic
Atrophy
Autocrine hormes
Autosomal dominant
Axons
Baroreceptors
Base
Bradypnea
Buffers
Cations
Cell signaling
Chemoreceptors
Connective tissue
Dendrites
Detones
Dissociates
Dysplasia
Endocrine hormones
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Endothelial cells
Epithelium
Exocrine hormones
Feedback inhibition
Free radicals
Gram-negative
Gram-positive
Hemochromatosis
Hemolytic anemia
Hemophilia
Homeostasis
Hormones
Hypercalcemia
Hypercholesterolemia
Hyperkalemia
Hypermagnesemia
Hypernatremia
Hyperphosphatemia
Hyperplasia
Hypertonic solution
Hypertrophy
Hypocalcemia
Hypokalemia
Hypomagnesemia
Hyponatremia
Hypophosphatemia
Hypotonic solution
Incidence
Inflammatory response
Ions
32
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Isotonic solution
Ketoacidosis
Lactic acidosis
Leukocytles
Ligands
Metabolic acidosis
Metabolic alkalosis
Metaplasia
Mitochondria
Mixed acidosis
Mixed alkalosis
Morbidity
Mortality
Necrosis
Negative feedback
Neurotransmitters
Nucleus
Oliguria
Organelles
Osmolarity
Osmosis
Paracrine hormones
Pathophysiology
Peripheral nerves
pH
Phagocytes
Polyuria
Prevalence
Pyrogens

Renin-angiotensinaldosterone system
(RAAS)
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
Respiratory alkalosis
Ribonucleic acid (RNA)
Tonicity

Virulence
Objectives:
DOT Objectives
 Apply the general concepts of
pathophysiology for the assessment and
management of emergency patients.
 Discuss cellular adaptation.
 Describe the factors that precipitate disease
in the human body.
 Describe Multiple Organ Dysfunction
Syndrome (MODS).
 Describe the inflammation response.
 Discuss the role of mast cells as part of the
inflammation response.
 Describe the systemic manifestations of the
inflammation response.
 Describe deficiencies in immunity and
inflammation.
 List types of tissue.
 Describe the systemic manifestations that
result from cellular injury.
 Describe neuroendocrine regulation
EMS Education Standards
 Recognize the interrelations among structure
and function at the tissue and organ system.
 Discuss the etiology, pathogenesis, local and
systemic effects of cell injury.
 Apply the concepts of inflammation and
healing, immune responses, fluid and
electrolyte imbalances, genetics, and age to
common disorders in major body systems.
 Discuss the concept of stress, the body’s
response to stress and the relationship stress
has to the disease process.
 Define and discuss hypoperfusion, the types
of shock, and Multiple Organ Dysfunction
Syndrome (MODS).
 Describe the factors that precipitate disease
in the human body.
 Apply the general concepts of
pathophysiology for the assessment and
management of emergency patients.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
33
Life Span Development
Summary: Integrates comprehensive knowledge of life span development.
Key Terminology:
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Adolescents
Aneurysm
Anxious avoidant
attachment
Atherosclerosis
Authoritarian
Authoritative
Barotrauma
Bonding
Conventional reasoning
Despair phase
Early adults
Fontanelles
Growth plates
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Hypercarbia
Infants
Late adults
Life expectancy
Menarche
Middle adults
Moro reflex
Nephrons
Palmar grasp
Permissive
Postconventional
reasoning
Preconventional
reasoning
Preschoolers
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Protest phase
Rooting reflex
Scaffolding
School-age
Secure attachment
Self-concept
Self-esteem
Situational crisis
Sucking reflex
Terminal drop hypothesis
Toddlers
Trust and mistrust
Withdrawal
Objectives:
DOT Objectives
 Uses simple knowledge of age related
differences to assess and care for patients
EMS Education Standards
 Understand, discuss, and demonstrate
comprehensive knowledge of life span
development to include
 Infancy (birth to 1 year)
 Toddler (12-36 months)
 Pre-school (3-5 years)
 School-age children (6-12 years)
 Adolescents (13-18 years)
 Early adulthood (20-40 years)
 Middle adulthood (41-60 years)
 Late adulthood (61 years and older)
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
34
Public Health
Summary: Applies fundamental knowledge of principles of public health and epidemiology including
public health emergencies, health promotion, and illness and injury prevention.
TARGET SKILLS: Community needs assessment.
Key Terminology:
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Public health
Intentional injuries
Unintentional injuries
Years of potential life
lost
Morbidity
Health Insurance
Portability and
Accountability Act
(HIPAA)
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Protected Health
Information (PHI)
Limited data set
Interventions
Primary prevention
Secondary prevention
Risk
Passive interventions
Haddon Matrix
Surveillance
Risk Factors
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Mortality
Implementation Plan
Process objectives
Outcome (impact)
objectives
Evaluation
Injury prevention
Health promotion
Disease Surveillance
Objectives:
DOT Objectives
 Define public health and explain the goal of
the public health field
 List the major public health laws, regulations,
and guidelines in place in the United States,
and list the purpose of each
 Explain the paramedic’s role in promoting
public health both in terms of illness and injury
 Define primary prevention and secondary
prevention and give examples of each
 Explain why EMS providers are in a unique
position to promote public health
EMS Education Standards
 Discuss the integration of the principles of
public health and epidemiology including
public health emergencies, health promotion,
and illness and injury prevention.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
35
Pharmacology
Principles of Pharmacology
Summary: Integrates comprehensive knowledge of pharmacology to formulate a treatment plan
intended to mitigate emergencies and improve the overall health of the patient.
TARGET SKILLS:
 Medication safety
 Kinds of medications
used during an
emergency
 Medication
legislation
 Naming
 Classifications
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Storage and security
Autonomic
pharmacology
Metabolism and
excretion
Mechanism of action
Medication response
Relationships
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Medication
interactions
Toxicity
Schedules
Pharmacokinetics
Phases of medication
activity
Key Terminology:
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Absolute refractory period
Absorption
Acetylcholinesterase
Active metabolites
Active transport
Affinity
Agonist medications
Anaphylaxis
Antagonist medications
Antibiotics
Antifungals
Antimicrobials
Automaticity
Bioavailability
Biotransformation
Chelating agents
Cholinergic
Competitive antagonists
Competitive depolarizing
Cross-tolerance
Cumulative action
Cytochrome P-450 system
Dependence
Depolarization
Depressant
Distribution
Diuretic
Dose-response curve
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Dosing
Down-regulation
Duration of effect
Ectopic foci
Efficacy
Elimination
Endogenous
Exogenous
Extravasation
Facilitated diffusion
Fasciculation
Filtration
First-order elimination
Habituation
Half-life
Hematocrit
Hemolysis
Hydrophilic
Idiosyncratic
Inactive metabolites
Interference
Ions
Lipophilic
Medial lethal dose (LD50)
Medication monograph
Medication sensitivity
Noncompetitive
antagonists
36
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Nondepoloarizing
Nonionic
Onset
Osmosis
Osmotic
Paradoxical
Partial agonist
Peak
Pharmacodynamics
Pharmacokinetics
Pharmacology
Pinocytosis
Placebo effect
Plasma protein binding
Potency
Receptor
Relative refractory period
Stevens-Johnson
syndrome
Stimulant
Sympathomimetrics
Tachyphylaxis
Therapeutic index
Threshold level
Tolerance
Untoward effects
Vaughan-Williams
classification scheme

Volume of distribution

Water-soluble

Zero-order elimination
Objectives:
DOT Objectives
 Integrate pathophysiological principles of
pharmacology and the assessment findings to
formulate a field impression and implement a
pharmacologic management plan.
 Describe historical trends in pharmacology.
 At the end of this unit, the paramedic student
will be able to apply a process of clinical
decision making to use the assessment findings
to help form a field impression.
 Define the components, stages and sequences
of the critical thinking process for paramedics.
 Apply the fundamental elements of critical
thinking for paramedics.
 Summarize the six R’s of putting it all together:
 Read the patient
 Read the scene
 React
 Reevaluate
 Revise the management plan
 Review performance
EMS Education Standards
 Integrate pathophysiological principles of
pharmacology and the assessment findings to
formulate a field impression and implement a
pharmacologic management plan.
 Describe historical trends in pharmacology.
 Apply a process of clinical decision making to
use the assessment findings to help form a
field impression.
 Define the components, stages and sequences
of the critical thinking process for paramedics.
 Apply the fundamental elements of critical
thinking for paramedics.
 Summarize the six Rs of putting it all together:
 Read the patient
 Read the scene
 React
 Reevaluate
 Revise the management plan
 Review performance
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
37
Medication Administration
Summary: Integrates comprehensive knowledge of medication administration to mitigate emergencies
and improve the overall health of the patient.
TARGET SKILLS: Within the scope of practice of the Paramedic, how to:
 Self-administer medication
 Peer-administer medication
 Assist/administer medication to a patient.
 Routes of administration
Key Terminology:
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Access port
Acidosis
Active transport
Administration set
Alkalosis
Anion
Antecubital
Anticoagulant
Antidiuretic hormone
(ADH)
Antiseptics
Aseptic technique
Ataxia
Aural
Bivalent
blood tubing
Bolus
Bone Injection Gun (BIG)
Buccal
Butterfly catheter
Cannulation
Carpopedal spasms
Catheter shear
Cation
Celsius scale
Colloid solutions
Concentration
Concentration gradient
Crystalloid solutions
D5W
Dehydration
Depolarization
Desired dose
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Diaphysis
Diffusion
Diluent
Disinfectants
Drip chamber
Drug reconstitution
Electrolytes
Enternal medications
epiphyseal plate
epiphyses
external jugular (EJ) vein
Extracellular fluid (ECF)
EZ-10
Fahrenheit scale
Fascia
FASTI
Flash chamber
Gastric tubes
Gauge
gtt
Hemostasis
Hematoma
Homeostasis
Humerus placement
Hypercalcemia
Hyperkalemia
Hypertonic solution
Hypocalcemia
Hypokalemia
Hypotonic solution
Implanted vascular
access devices (VADs)
Infiltration
38
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Interstitial fluid
Intracellular fluid (ICF)
Intradermal
Intramuscular (IM)
Intranasal
Intraosseous
Intraosseous (IO) infusion
Intraosseous (IO) space
Intravascular fluid
Intravenous
Intravenous (IV) therapy
Ionic concentration
Ions
Isotonic solution
Isotonic crystalloids
Lactated Ringer’s )LR)
solution
Local reactions
Macrodrip
Medical asepsis
Metabolic
Metered-dose inhaler
(MDI)
Metric system
Microdrip sets
Milliequivalent (mEq)
Mix-o-Vial
Monovalent
Mucosal atomizer device
(MAD)
Nebulizer
Nonelectrolytes
Non-tunneling devices
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Normal saline
Occlusion
Ocular
Online (direct) medical
control
Osmolarity
Osmosis
Osteogenesis imperfect
Osteomyelitis
Over-hydration
Over-the-needle catheter
Parenteral route
Penrose drain
Percutaneous
Peripheral vein
cannulation
Phospholipid bilayer
Piercing spike
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Postural hypotension
Prefilled syringe
Pressure infuser device
Pulmonary embolism
Pyrogenic reaction
Radiopaque
Saline locks
Selective permeability
Self-sealing blood tubes
Sharps
Sodium-potassium (Na+K+) pump
Solute
Solution
Solvent
Standing orders
Subcutaneous (SC)
Sublingual
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Syncopal episodes
Systemic complications
Third spacing
Thrombophlebitis
Through-the-needle
catheters
Tibia placement
Total body water (TBW)
Toxicity
Track marks
Transdermal
Inhalation
Vacutainer
Varicose veins
Venous thrombosis
Volume on hand
Volutrol
Objectives:
DOT Objectives
 Safely and precisely access the venous
circulation and administer medications.
 Differentiate temperature readings between
the Centigrade and Fahrenheit scales.
 Discuss the "six rights" of drug administration
and correlate these with the principles of
medication administration.
 Describe the use of universal precautions and
body substance isolation (BSI) procedures
when administering a medication.
 Describe the indications, equipment needed,
techniques used, precautions, and general
principles of administering medications by
gastric tube.
 Comply with universal precautions and body
substance isolation (BSI).
 Use universal precautions and body substance
isolation (BSI) procedures during medication
administration.
 Demonstrate administration of medications by
the gastric tube.
 Demonstrate rectal administration of
medications.
EMS Education Standards
 Describe and integrate within the scope of
practice of the paramedic
 Routes of medication administration
 Administration of medications to a
patient
 Safely and precisely access the venous
circulation and administer medications.
 Differentiate temperature readings between
the Centigrade and Fahrenheit scales.
 Discuss the "six rights" of drug administration
and correlate these with the principles of
medication administration.
 Describe the use of universal precautions and
body substance isolation (BSI) procedures
when administering a medication.
 Describe the indications, equipment needed,
techniques used, precautions, and general
principles of administering medications by
gastric tube.
 Comply with universal precautions and body
substance isolation (BSI).
 Use universal precautions and body substance
isolation (BSI) procedures during medication
administration.
39
 Demonstrate administration of medications by
the gastric tube.
 Demonstrate rectal administration of
medications.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
40
Emergency Medications
Summary: Integrates comprehensive knowledge of emergency medications to formulate a treatment
plan intended to mitigate emergencies and improve the overall health of the patient.
TARGET SKILLS: Within the scope of practice of the Paramedic
 Names

 Effects

 Indications

 Routes of administration

 Dosages for the medications

administered

 Actions
 Indications
Contraindications
Complications
Routes of administration
Side effects
Interactions
Dosages for the medications
administered
Key Terminology:
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Adverse
reactions/side
effects
Class
Concentration
Contraindications
Desired dose
Drug interactions
Duration of action
Indications
Mechanism of action



Volume
Yield
AHA Classification of
Recommendations &
Level of Evidence:
 Class I
 Class IIa
 Class IIb
 Class III
 Class
Indeterminate


Pregnancy Category
Ratings for Drugs:
 Category A
 Category B
 Category C
 Category D
 Category X
Pharmacology Related
Abbreviations (see text)
Objectives:
DOT Objectives
 Identify the appropriate routes of medication
administration
 Be able to describe all drugs a Paramedic can
administer using the state formulary.
 Demonstrate the administration of emergency
medications with the state formulary
EMS Education Standards
 Proper use of approved medications in the
EMS profession setting.
 Describe and integrate emergency
medications within the scope of practice of
the paramedic, to include:
 Names
 Actions
 Indications
 Contraindications
 Complications
 Routes of administration
 Side effects
 Interactions
 Dosages for medications administered
41
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
42
Airway Management, Respiration and Artificial Ventilation
Airway Management
Summary: Integrates complex knowledge of anatomy, physiology, and pathophysiology into the
assessment to develop and implement a treatment plan with the goal of assuring a patent airway,
adequate mechanical ventilation, and respiration for patients of all ages.
TARGET SKILLS: Within the scope of practice of the paramedic:
 Airway anatomy
 Airway assessment
 Techniques of assuring a patent airway
Key Terminology:
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Patent
Upper airway
Pharynx
Nasoopharynx
Turbinates
Nasal septum
Paranasal sinuses
Cerebrospinal rhinorrhea
Cerebrospinal otorrhea
Oropharynx
Aspiration
Hyoid bone
Palate
Palatoglossal arch
Uvula
Palatopharyngeal arch
Palatine tonsils
Adenoid
Larynx
Thyroid cartilage
Cricoid cartilage
Cricothyroid membrane
Glottis
Vocal cords
Epiglottis
Thyroepiglottic ligament
Glossoepiglottic ligament
Hypoepiglottic ligament
Vallecula
Arytenoid cartilages
Piriform fossae
Laryngospasm
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Trachea
Bronchi
Carina
Goblet cells
Hilum
Visceral pleura
Parietal pleura
Bronchioles
Alveoli
Surfactant
Atelectasis
Ventilation
Inhalation
Boyle’s law
Accessory muscles
Positive-pressure
ventilation
Negative-pressure
ventilation
Partial pressure
Henry’s law
Alveolar volume
Tidal volume (VT)
Dead space volume (VD)
Physiologic dead space
Minute volume (VM)
Alveolar minute volume
(VA)
Respiratory rate
Inspiratory reserve
volume
43
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Functional reserve
capacity
Expiratory reserve volume
Residual volume
Vital capacity
Total lung capacity
Exhalation
Hering-Breuer reflex
Chemoreceptors
Dorsal respiratory group
Ventral respiratory group
Primary respiratory drive
Hypoxic drive
Oxygenation
Fraction of inspired
oxygen (F102)
Metabolism
Respiration
External respiration
Internal respiration
Cellular respiration
Aerobic metabolism
Anaerobic metabolism
Dyspnea
V/Q mismatch
Hypoventilation
Hyperventilation
Hypercarbia
Hypocarbia
Intrapulmonary shunting
Afterload
Preload
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



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

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Respiratory acidosis
Respiratory alkalosis
Adventitious
Cyanosis
Hypoxemia
Anoxia
Orthopnea
Retractions
Asymmetric chest wall
movement
Paradoxical motion
Pulsus paradoxus
Gag reflex
Eyelash reflex
Tracheal breath sounds
Vesicular breath sounds
Bronchovesicular sounds
I/E ratio
Wheezing
Rhonchi
Crackles
Stridor
Friction rub
Pulse oximeter
Hemoglobin (Hb)
Oxyhemoglobin (Hbo2
Reduced hemoglobin
Methermoglobin (metHb)
Carboxyhemoglobin
(COHb)
CO-oximeter
Peak expiratory flow
End-tidal (co2 (ETCO2)
Capnometer
Capnographer
Waveform capnography
Colorimetric
capnographer
Recovery position
Head tilt-chin lift
maneuver
Jaw-thrust maneuver
Tongue-jaw lift maneuver
Tonsil-tip catheter
Whistle-tip catheters
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Oropharyngeal (oral)
airway
Nasopharyngeal (nasal)
airway
Aphonia
Dysphonia
Lung compliance
Abdominal thrust
maneuver
Direct
Laryngoscopy
Magill forceps
Safe residual pressure
Therapy regulator
Pressure-compensated
flowmeter
Bourdon-gauge flowmeter
Nonrebreathing mask
Nasal cannula
Partial rebreathing mask
Venturi mask
Oxygen humidifier
Bag-mask device
Automatic transport
ventilator (ATV)
Continuous positive
airway pressure (CPAP)
Positive end-expiratory
pressure (PEEP)
Gastric distention
Gastric tube
Orogastric (OG) tube
Naso-gastric (NG) tube
Laryngectomy
Tracheostomy
Stoma
Total laryngectomy
Partial laryngectomy
Tracheostomy tube
3-3-2 rule
Mallampati classification
Endotracheal intubation
Orotracheal intubation
Nasotracheal intubation
Endotracheal (ET) tube
Murphy’s eye
44
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Laryngoscope
Straight laryngoscope
blade
Curved laryngoscope
blade
Atlanto-occipital joint
Gum elastic bougie
BURP maneuver
Esophageal detector
device
Trismus
Digital intubation
Transillumination
intubation
Retrograde intubation
Face-to-face intubation
Tracheobronchial
suctioning
Extubation
Sedation
Butyrophenones
Anxiolysis
Benzodiazepines
Anterograde amnesia
Barbiturates
Opioids
Etomidate
Paralytics
Acetylcholine (AVh)
Depolarizing
neuromuscular blocker
Succinylcholine chloride
Fasciculation
Nondepolarizing
neuromuscular blockers
Vecuronium
Rocuronium
Pancuronium
Rapid-sequence
intubation (RSI)
Multilumen airways
Combitube
Laryngeal mask airway
(LMA)
King LT airway


Cobra perilaryngeal
airway (CobraPLA)
Open cricothyrotomy



Seldinger technique
Shiley
Needle cricothyrotomy


Trans-laryngeal catheter
ventilation
Barotrauma
Objectives:
DOT Objectives
EMS Education Standards
 Explain the primary objective of airway
 Understand, demonstrate, and discuss
maintenance.
complex knowledge of anatomy, physiology,
and pathophysiology into the assessment to
 Identify commonly neglected prehospital
develop and implement a treatment plan with
skills related to airway.
the goal of assuring a patent airway,
 Identify the anatomy and functions of the
adequate mechanical ventilation, and
upper airway.
respiration for patients of all ages as it
 Describe the anatomy and functions of the
pertains to Airway Anatomy, Airway
lower airway.
Assessment, and Techniques for assuring a
 Explain the differences between adult and
patent airway.
pediatric airway anatomy.
 Differentiate and formulate age related
 Define normal tidal volumes for the adult,
variations as it pertains to airway
child, and infant.
management, respiration and artificial
 Define atelectasis.
ventilation.
 Define FiO2.
 Explain the relationship between pulmonary
circulation and respiration.
 List factors which cause decreased oxygen
concentrations in the blood.
 List the factors which increase and decrease
carbon dioxide production in the body.
 Describe the measurement of oxygen in the
blood.
 Describe the measurement of carbon dioxide
in the blood.
 List the concentration of gases which
comprise atmospheric air.
 List the factors which affect respiratory rate
and depth.
 Describe the voluntary and involuntary
regulation of respiration.
 Describe causes of upper airway obstruction.
 Define normal respiratory rates for adult,
child, and infant.
 Describe causes of respiratory distress.
 Define and differentiate between hypoxia and
hypoxemia.
 Define pulsus paradoxus.
 Describe the modified forms of respiration.
 Define gag reflex.
45
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
Explain safety considerations of oxygen
storage and delivery.
Identify types of oxygen cylinders and
pressure regulators (including a high-pressure
regulator and a therapy regulator).
List the steps for delivering oxygen from a
cylinder and regulator.
Describe the indications, contraindications,
advantages, disadvantages, complications,
liter flow range, and concentration of
delivered oxygen for supplemental oxygen
delivery devices.
Describe the use, advantages and
disadvantages of an oxygen humidifier.
Define, identify and describe a tracheostomy,
stoma, and tracheostomy tube.
Explain the risk of infection to EMS providers
associated with ventilation.
Describe the indications, contraindications,
advantages, disadvantages, complications,
and technique for ventilating a patient by:
 Mouth-to-mouth
 Mouth-to-nose
 Mouth-to-mask
 One person bag-valve-mask
 Two person bag-valve-mask
 Three person bag-valve-mask
 Flow-restricted, oxygen-powered
ventilation device
Explain the advantage of the two person
method when ventilating with the bag-valvemask.
Describe indications, contraindications,
advantages, disadvantages, complications,
and technique for ventilating a patient with
an automatic transport ventilator (ATV).
Describe the Sellick (cricoid pressure)
maneuver.
Describe the use of cricoid pressure during
intubation.
Compare the ventilation techniques used for
an adult patient to those used for pediatric
patients.
Define how to ventilate a patient with a
stoma, including mouth-to-stoma and bagvalve-mask-to-stoma ventilation.
Define complete airway obstruction.
46
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Define and explain the implications of partial
airway obstruction with good and poor air
exchange.
Describe complete airway obstruction
maneuvers.
Describe laryngoscopy for the removal of a
foreign body airway obstruction.
Identify types of suction catheters, including
hard or rigid catheters and soft catheters.
Explain the purpose for suctioning the upper
airway.
Identify types of suction equipment.
Describe the indications for suctioning the
upper airway.
Identify techniques of suctioning the upper
airway.
Identify special considerations of suctioning
the upper airway.
Describe the technique of tracheobronchial
suctioning in the intubated patient.
Define gastric distention.
Describe the indications, contraindications,
advantages, disadvantages, complications,
equipment and technique for inserting a
nasogastric tube and an orogastric tube.
Describe manual airway maneuvers.
Describe the use of an oral and nasal airway.
Describe the indications, contraindications,
advantages, disadvantages, complications,
and technique for inserting an oropharyngeal
and a nasopharyngeal airway.
Differentiate endotracheal intubation from
other methods of advanced airway
management.
Describe the indications, contraindications,
advantages, disadvantages and complications
of endotracheal intubation.
Describe the visual landmarks for direct
laryngoscopy.
Describe the methods of assessment for
confirming correct placement of an
endotracheal tube.
Describe methods for securing an
endotracheal tube.
Describe the indications, contraindications,
advantages, disadvantages, complications,
equipment and technique for extubation.
47
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Describe methods of endotracheal intubation
in the pediatric patient.
Describe the indications, contraindications,
advantages, disadvantages, complications,
equipment, and technique for using a dual
lumen airway.
Define, identify, and describe a laryngectomy.
Describe the special considerations in airway
management and ventilation for patients with
facial injuries.
Describe the special considerations in airway
management and ventilation for the pediatric
patient.
Defend oxygenation and ventilation.
Defend the necessity of establishing and/ or
maintaining patency of a patient’s airway.
Comply with standard precautions to defend
against infectious and communicable
diseases.
Perform body substance isolation (BSI)
procedures during basic airway management,
advanced airway management, and
ventilation.
Perform pulse oximetry.
Perform end-tidal CO2 detection.
Perform oxygen delivery from a cylinder and
regulator with an oxygen delivery device.
Deliver supplemental oxygen to a breathing
patient using the following devices:
 Nasal cannula
 Simple face mask
 Partial rebreather mask
 Non-rebreather mask
 Venturi mask.
Perform oxygen delivery with an oxygen
humidifier.
Perform medication administration with an
in-line small-volume nebulizer.
Demonstrate ventilating a patient by the
following techniques:
 Mouth-to-mask ventilation
 One person bag-valve-mask
 Two person bag-valve-mask
 Three person bag-valve-mask
 Flow-restricted, oxygen-powered
ventilation device
 Automatic transport ventilator
48
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
 Mouth-to-stoma
 Bag-valve-mask-to-stoma ventilation
Perform the Sellick maneuver (cricoid
pressure).
Ventilate a pediatric patient using the one
and two person techniques.
Perform complete airway obstruction
maneuvers, including:
 Heimlich maneuver
 Finger sweep
 Chest thrusts
 Removal with Magill forceps
Perform retrieval of foreign bodies from the
upper airway.
Demonstrate suctioning the upper airway by
selecting a suction device, catheter and
technique.
Perform tracheobronchial suctioning in the
intubated patient by selecting a suction
device, catheter and technique.
Demonstrate insertion of a nasogastric tube.
Demonstrate insertion of an orogastric tube.
Perform gastric decompression by selecting a
suction device, catheter and technique.
Perform manual airway maneuvers, including:
 Opening the mouth
 Head-tilt/ chin-lift maneuver
 Jaw-thrust without head-tilt maneuver
 Modified jaw-thrust maneuver
Perform manual airway maneuvers for
pediatric patients, including:
 Opening the mouth
 Head-tilt/ chin-lift maneuver
 Jaw-thrust without head-tilt maneuver
 Modified jaw-thrust maneuver
Demonstrate insertion of an oropharyngeal
airway.
Demonstrate insertion of a nasopharyngeal
airway.
Intubate the trachea by direct orotracheal
intubation.
Perform assessment to confirm correct
placement of the endotracheal tube.
Adequately secure an endotracheal tube.
Perform extubation.
Perform endotracheal intubation in the
pediatric patient.
49
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

Insert a dual lumen airway
Perform stoma suctioning
Perform replacement of a tracheostomy tube
through a stoma.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
50
Respiration
Summary: Integrates complex knowledge of anatomy, physiology, and pathophysiology into the
assessment to develop and implement a treatment plan with the goal of assuring a patent airway,
adequate mechanical ventilation, and respiration for patients of all ages.
TARGET SKILLS: Anatomy of the respiratory system, physiology, and pathophysiology of respiration to
include:
 Pulmonary ventilation
 Oxygenation
 Respiration
 External
 Internal
 Cellular
 Assessment and management of adequate and inadequate respiration
 Supplemental oxygen therapy
Key Terminology:
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
Acidosis
Aerobic metabolism
Alcoholic
ketoacidosis
Alkalosis
Anaerobic
metabolism
Apnea
Ataxic respiration
Atelectasis
Bradypnea
Cellular respiration
Central nervous
system depression
Cerebral perfusion
Cerebral vasodilation
Chemoreceptors
Dead space
Dissociate
Dorsal respiratory
group
Dyspnea
Dysrhythmia
Exhalation
External respiration
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Gag reflex
Hering-Breur reflex
Hypercarbia
Hypoperfusion
Hypovolemic shock
Hypoxemia
Hypoxia
Hypoxic drive
Inhalation
Internal respiration
Intrapulmonary
shunting
Ketoacidosis
Ketones
Kussmaul
Labored breathing
Lactic acidosis
Lung compliance
Metabolic acidosis
Metabolic alkalosis
Metabolism
Minute volume
Nasal cannula
51
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Nonrebreathing
mask
Oxygenation
Oxygen saturation
(SPO2)
Paradoxical motion
Parietal pleura
Partial pressure
Phrenic nerve
Pin-indexing system
Pulmonary edema
Pulse oximetry
Residual volume
Respiration
Respiratory acidosis
Respiratory alkalosis
Respiratory rate
Retractions
Surfactant
Tidal volume
Ventral respiratory
group
Vital capacity
V/Q mismatch
Objectives:
DOT Objectives
 Integrate pathophysiological principles and
assessment findings to formulate a field
impression and implement the treatment
plan for the patient with respiratory
problems.
 Demonstrate the application of a CPAP/
BiPAP unit.
EMS Education Standards
 Understand, discuss, and demonstrate the
complex knowledge of anatomy, physiology,
and pathophysiology into the assessment to
develop and implement a treatment plan with
the goal of assuring a patent airway,
adequate mechanical ventilation, and
respiration for patients of all ages.
 Demonstrate the various applications of
airway adjuncts and ventilation assist devices
to include anatomy of the respiratory system,
physiology of respiration, pathophysiology of
respiration, assessment of adequate and
inadequate respiration, management of
adequate and inadequate respiration,
supplemental oxygen therapy.
 Differentiates and formulates age related
variations as it pertains to airway
management, respiration, and artificial
ventilation.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
52
Artificial Ventilation
Summary: Integrates complex knowledge of anatomy, physiology, and pathophysiology into the
assessment to develop and implement a treatment plan with the goal of assuring a patent airway,
adequate mechanical ventilation, and respiration for patients of all ages.
TARGET SKILLS: Assessment and management of adequate and inadequate ventilation to include:
 Artificial ventilation
 Minute ventilation
 Alveolar ventilation
 Effect of artificial ventilation on cardiac output
Objectives:
DOT Objectives
EMS Education Standards
 Understand, discuss, and demonstrate the
complex knowledge of anatomy, physiology,
and pathophysiology into the assessment to
develop and implement a treatment plan with
the goal of assuring a patent airway,
adequate mechanical ventilation, and
respiration for patients of all ages as it
pertains to comprehensive ventilation
assessment, use of manual and mechanical
airway devices, assisting patient ventilations.
 Differentiate and formulate age related
variations as it pertains to airway
management, respiration, and artificial
ventilation.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
53
Assessment
Scene Size-Up
Summary: Integrate scene and patient assessment findings with knowledge of epidemiology and
pathophysiology to form a field impression. This includes developing a list of differential diagnoses
through clinical reasoning to modify the assessment and formulate a treatment plan.
TARGET SKILLS: Scene safety and scene management to include:
 Impact of the environment on patient care
 Addressing hazards
 Violence
 Need for additional or specialized resources
 Standard precautions
 Multiple patient situations
Key Terminology:
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



Field impression
Scene size-up
Mechanism of injury
(MOI)
Nature of illness (NOI)
Active shooter
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
Clandestine drug
laboratories
Concealment
Contact and cover
Cover
Physical evidence
Primary exit


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

Secondary exit
Situational awareness
Tactical paramedics
Testimonial evidence
Tunnel vision
Objectives:
DOT Objectives
 Integrate the principles of general incident
management and multiple casualty incident
(MCI) management techniques in order to
function effectively at major incidents.
 Describe the START (simple triage and rapid
treatment) method of initial triage.
EMS Education Standards
 Understand, demonstrate, and discuss scene
and patient assessment findings with
knowledge of epidemiology and
pathophysiology to form a field impression.
 Develop a list of differential diagnoses
through clinical reasoning to modify the
assessment and formulate a treatment plan
to include scene safety and scene
management.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
54
Primary Assessment
Summary: Integrate scene and patient assessment findings with knowledge of epidemiology and
pathophysiology to form a field impression. This includes performing a primary assessment, developing
a list of differential diagnoses through clinical reasoning to modify the assessment and formulate a
treatment plan.
TARGET SKILLS: Primary assessment for all patient situations including:
 Level of consciousness
 ABCs
 Identifying life threats
 Assessment of vital functions
 Initial general impression
 Begin interventions needed to preserve life
 Integration of treatment/procedures needed to preserve life.
Key Terminology:
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Primary assessment
General impression
AVPU
Perfusion
Rapid exam
Inspection
Palpation
Auscultation
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DCAP-BTLS
Crepitus
Poor general impression
Unresponsive patients
Responsive but does not
or cannot follow
commands
Difficulty breathing
Hypoperfusion or shock
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Complicated childbirth
Chest pain with a systolic
blood pressure of less
than 100 mm Hg
Uncontrolled bleeding
Severe pain anywhere
Multiple injuries
Objectives:
DOT Objectives
EMS Education Standards
 Recognize hazards/ potential hazards.
 Understand, demonstrate, and discuss scene
and patient assessment findings with
 Describe common hazards found at the scene
knowledge of epidemiology and
of a trauma and a medical patient.
pathophysiology to form a field impression.
 Determine hazards found at the scene of a
medical or trauma patient.
 Develop a list of differential diagnoses
through clinical reasoning to modify the
 Differentiate safe from unsafe scenes.
assessment and formulate a treatment plan
 Describe methods to making an unsafe scene
to include:
safe.
 Primary survey/primary assessment,
 Discuss common mechanisms of injury/ nature
 Integration of treatment/procedures
of illness.
needed to preserve life
 Recognize the importance of determining the
 Evaluation of patient care and
mechanism of injury.
transport.
 Discuss the reason for identifying the total
number of patients at the scene.
 Organize the management of a scene following
55
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size-up.
Explain the reasons for identifying the need for
additional help or assistance.
Summarize the reasons for forming a general
impression of the patient.
Discuss methods of assessing mental status.
Categorize levels of consciousness.
Discuss methods of assessing the airway.
Describe why the cervical spine is immobilized
during the assessment of the trauma patient.
Analyze a scene to determine if spinal
precautions are required.
Describe methods used for assessing if a
patient is breathing.
Differentiate between a patient with adequate
and inadequate minute ventilation.
Discuss the need for assessing the patient for
external bleeding.
Describe normal and abnormal findings when
assessing skin color.
Describe normal and abnormal findings when
assessing skin temperature.
Describe normal and abnormal findings when
assessing skin condition.
Explain the reason for prioritizing a patient for
care and transport.
Identify patients who require expeditious
transport.
Describe orthostatic vital signs and evaluate
their usefulness in assessing a patient in shock.
Apply the techniques of physical examination
to the medical patient.
Differentiate between the assessment that is
performed for a patient who is has an altered
mental status and other medical patients.
Discuss the reasons for reconsidering the
mechanism of injury.
State the reasons for performing a rapid
trauma assessment.
Recite examples and explain why patients
should receive a rapid trauma assessment.
Apply the techniques of physical examination
to the trauma patient.
Describe the areas included in the rapid
trauma assessment and discuss what should
be evaluated.
Differentiate cases when the rapid assessment
56
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may be altered in order to provide patient
care.
Discuss the reason for performing a focused
history and physical exam.
Describe when and why a detailed physical
examination is necessary.
Discuss the components of the detailed
physical exam in relation to the techniques of
examination.
State the areas of the body that are evaluated
during the detailed physical exam.
Explain what additional care should be
provided while performing the detailed
physical exam.
Distinguish between the detailed physical
exam that is performed on a trauma patient
and that of the medical patient.
Differentiate between patients requiring a
detailed physical exam from those who do not.
Discuss the reasons for repeating the initial
assessment as part of the on-going
assessment.
Describe the components of the on-going
assessment.
Discuss medical identification devices/
systems.
Explain the rationale for crew members to
evaluate scene safety prior to entering.
Serve as a model for others explaining how
patient situations affect your evaluation of
mechanism of injury or illness.
Explain the importance of forming a general
impression of the patient.
Explain the value of performing an initial
assessment.
Demonstrate a caring attitude when
performing an initial assessment.
Attend to the feelings that patients with
medical conditions might be experiencing.
Value the need for maintaining a professional
caring attitude when performing a focused
history and physical examination.
Explain the rationale for the feelings that these
patients might be experiencing.
Demonstrate a caring attitude when
performing a detailed physical examination.
Explain the value of performing an on-going
57
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assessment.
Recognize and respect the feelings that
patients might experience during assessment.
Explain the value of trending assessment
components to other health professionals who
assume care of the patient.
Demonstrate the techniques for assessing
mental status.
Demonstrate the techniques for assessing the
airway.
Demonstrate the techniques for determining if
the patient is breathing.
Demonstrate the techniques for determining if
the patient has a pulse.
Demonstrate the techniques for determining
the patient for external bleeding.
Demonstrate the techniques for determining
the patient's skin color, temperature, and
condition.
Using the techniques of examination,
demonstrate the assessment of a medical
patient.
Demonstrate the techniques for assessing a
patient who is responsive with no known
history.
Demonstrate the techniques for assessing a
patient who has an altered metal status.
Perform a rapid medical assessment.
Perform a focused history and physical exam
of the medical patient.
Using the techniques of physical examination
and demonstrate the assessment of a trauma
patient.
Demonstrate the rapid trauma assessment
used to assess a patient based on mechanism
of injury.
Perform a focused history and physical exam
on a non-critically injured patient.
Perform a focused history and physical exam
on a patient with life-threatening injuries.
Perform a detailed physical examination.
Demonstrate the skills involved in performing
the on-going assessment.
58
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
59
History Taking
Summary: Integrate scene and patient assessment findings with knowledge of epidemiology and
pathophysiology to form a field impression. This includes developing a list of differential diagnoses
through clinical reasoning to modify the assessment and formulate a treatment plan.
TARGET SKILLS: Determining the chief complaint including:
 Mechanism of injury/nature of illness
 Associated signs and symptoms
 Investigation of the chief complaint
 Past medical history
 Associated signs and symptoms
 Pertinent negatives
 Components of the patient history
 Interviewing techniques
 How to integrate therapeutic communication techniques and adapt the line of inquiry based on
findings and presentation.
Key Terminology:
 Patient history
 Chief complaint
 History of the present illness

Onset
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Provocation

Quality

Region/radiation/referral

Severity

Time
Signs
Symptoms
Past medical history
Current health status
Pertinent negatives
 Differential diagnosis
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Objectives:
DOT Objectives
 Use the appropriate techniques to obtain a
medical history from a patient.
 Describe the use of facilitation, reflection,
clarification, empathetic responses,
confrontation, and interpretation.
 Differentiate between facilitation, reflection,
clarification, sympathetic responses,
confrontation, and interpretation path
 Integrate the principles of history taking and
techniques of physical exam to perform a
patient assessment.
 Discuss common mechanisms of injury/
nature of illness.
 Predict patterns of injury based on
mechanism of injury.
 Serve as a model for others explaining how
EMS Education Standards
 Understand, demonstrate, and discuss scene
and patient assessment findings with
knowledge of epidemiology and
pathophysiology to form a field impression.
 Develop a list of differential diagnoses
through clinical reasoning to modify the
assessment and formulate a treatment plan
to include components of:
 Patient history
 Interviewing techniques
 Components of the patient history
 Cultural competence
 Special challenges
 Integration of therapeutic
communication,
 History taking techniques
60
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patient situations affect your evaluation of
mechanism of injury or illness.
Integrate the principles of assessment-based
management to perform an appropriate
assessment and implement the management
plan for patients with common complaints.
Explain strategies to prevent labeling and
tunnel vision.
Appreciate the use of scenarios to develop
high level clinical decision making skills.
While serving as team leader, assess a
programmed patient or mannequin, consider
differentials, make decisions relative to
interventions and transportation, provide the
interventions, patient packaging and
transportation, work as a team and practice
various roles for the following common
emergencies:
 Chest Pain
 Cardiac Arrest
 Traumatic Arrest
 Medical Arrest
 Acute abdominal pain
 GI Bleed
 Altered mental status
 Dyspnea
 Syncope
 Seizure
 Thermal / environmental problem
 Hazardous materials/ toxicology
 Trauma
 Isolated extremity fracture (tibia, fibula,
or radius, ulna)
 Femur fracture
 Shoulder dislocation
 Clavicular fracture or A-C separation
 Minor wound (no sutures required, high
risk wounds, with tendon and/or nerve
injury)
 Spine injury (no neurologic deficit, with
neurologic deficit)
 Multiple trauma-blunt
 Penetrating trauma
 Impaled object
 Elderly fall
 Athletic injury
 Head Injury (concussion,
61
Patient presentation
Assessment findings
Treatment plan
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subdural/epidural)
Allergic reactions/bites/envenomation
Local allergic reaction
Systemic allergic reaction
Envenomation
Behavioral
Mood disorders
Schizophrenic and delusional disorders
Suicidal
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
62
Secondary Assessment
Summary: Integrate scene and patient assessment findings with knowledge of epidemiology and
pathophysiology to form a field impression. This includes developing a list of differential diagnoses
through clinical reasoning to modify the assessment and formulate a treatment plan.
TARGET SKILLS: Performing a rapid full body scan including:
 Focused assessment of pain
 Assessment of vital signs
Techniques of physical examination including:
 Respiratory system
 Presence of breath sounds
 Cardiovascular system
 Neurological system
 Musculoskeletal system
 All anatomical regions
Assessment of lung sounds
Techniques of physical examination for all major:
 Body systems
 Anatomical regions
Key Terminology:
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Inspection
Palpation
Percussion
Auscultation
Secondary assessment
Pulse
Blood pressure
Systolic pressure
Diastolic pressure
Pulse oximetry
Sphygmomanometer
Ophthalmoscope
Otoscope
Full-body exam
Focused assessment
Alert and oriented (AxO)
Glasgow coma Scale
(GCS)
Epidermis
Dermis
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Fibroblasts
Turgor
Diaphoresis
Vasodilation
Pallor
Vasoconstriction
Cyanosis
Mottling
Ecchymosis
Tenting
Diplopia
Visual acuity
Battle sign
Cerumen
Bronchovesicular sounds
Vesicular sounds
Adventitious breath
sounds
Wheezing
Rhonchi
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Aspiration
Stridor
Pleural friction rubs
Bronchophony
Whispered pectoriloquy
Egophony
Splitting
Korotkoff sounds
Bruit
Murmur
Jugular venous distention
(JVD)
Lifts
Heaves
Thrills
Orthostatic vital signs
Ascites
Guarding
Hernia
Pathologic fracture
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Physiologic fracture
Rubor
Scoliosis
Reflexes
Primitive reflexes
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Proprioception
Dermatomes
Delirium
Dementia
Aphasia
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Parasthesias
Capnometry
Capnography
Objectives:
DOT Objectives
 Define the terms and techniques of inspection,
palpation, percussion, auscultation.
 Review the procedure for taking and
significance of vital signs (pulse, respiration,
and blood pressure.)
 Describe the evaluation of mental status.
 Evaluate the importance of a general survey.
 Describe the examination of skin and nails.
 Differentiate normal and abnormal findings of
the assessment of the skin.
 Distinguish the importance of abnormal
findings of the assessment of the skin.
 Describe the normal and abnormal assessment
findings of the head (including the scalp, skull,
face and skin).
 Describe the examination of the head
(including the scalp, skull, face, and skin).
 Describe the examination of the eyes.
 Distinguish between normal and abnormal
assessment findings of the eyes.
 Describe the examination of the ears.
 Differentiate normal and abnormal
assessment findings of the ears.
 Describe the examination of the nose.
 Differentiate normal and abnormal
assessment findings of the nose.
 Describe the examination of the mouth and
pharynx.
 Differentiate normal and abnormal
assessment findings of the mouth and
pharynx.
 Describe the examination of the neck and
cervical spine.
 Differentiate normal and abnormal
assessment findings the neck and cervical
spine.
 Describe the inspection, palpation, percussion,
EMS Education Standards
 Understand, demonstrate, and discuss scene
and patient assessment findings with
knowledge of epidemiology and
pathophysiology to form a field impression.
 Develop a list of differential diagnoses
through clinical reasoning to modify the
assessment and formulate a treatment plan
to include techniques of
 Physical examination
 Physical examination techniques
 Approach and overview
 Mental status
 Examination by anatomical region or
assessment
 Modification of the assessment for the
patient with a life threatening
emergency.
64
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and auscultation of the chest.
Describe the examination of the thorax and
ventilation.
Describe the examination of the anterior and
posterior chest.
Differentiate the percussion sounds and their
characteristics.
Differentiate the characteristics of breath
sounds.
Differentiate normal and abnormal
assessment findings of the chest examination.
Describe the examination of the arterial pulse
including rate, rhythm, and amplitude.
Distinguish normal and abnormal findings of
arterial pulse.
Describe the assessment and distinguish
normal and abnormal examination findings of
jugular venous distention.
Describe the examination of the heart.
Differentiate normal and abnormal
assessment findings of the heart.
Describe the auscultation of the heart.
Differentiate the characteristics of normal and
abnormal findings associated with the
auscultation of the heart.
Describe the examination of the abdomen.
Differentiate normal and abnormal
assessment findings of the abdomen.
Describe the examination of the female
external genitalia.
Differentiate normal and abnormal
assessment findings of the female external
genitalia.
Describe the examination of the male
genitalia.
Differentiate normal and abnormal findings of
the male genitalia.
Describe the examination of the extremities.
Differentiate normal and abnormal findings of
the extremities.
Describe the examination of the peripheral
vascular system.
Differentiate normal and abnormal findings of
the peripheral vascular system.
Describe the examination of the nervous
system.
Differentiate normal and abnormal findings of
65
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the nervous system.
Discuss the considerations of examination of
an infant or child.
Describe the general guidelines of recording
examination information.
Demonstrate a caring attitude when
performing physical examination skills.
Discuss the importance of a professional
appearance and demeanor when performing
physical examination skills.
Appreciate the limitations of conducting a
physical exam in the out-of-hospital
environment.
Demonstrate the examination of:
 skin and nails
 Head and neck
 Eyes, ears, nose, and mouth
 Neck
 Thorax and ventilation
 Anterior and posterior chest
 Heart
 Abdomen
 Male genitalia
 Peripheral vascular system
 Extremities
Demonstrate auscultation of the chest.
Demonstrate percussion of the chest.
Demonstrate the examination of the arterial
pulse including location, rate, rhythm, and
amplitude.
Demonstrate the assessment of jugular venous
pressure and pulsations.
Demonstrate auscultation of the abdomen.
Demonstrate the external visual examination
of the female external genitalia.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
66
Monitoring Devices
Summary: Integrate scene and patient assessment findings with knowledge of epidemiology and
pathophysiology to form a field impression. This includes developing a list of differential diagnoses
through clinical reasoning to modify the assessment and formulate a treatment plan.
TARGET SKILLS: Within the scope of practice of the paramedic obtaining and using information from
patient monitoring devices including (but not limited to):
 Pulse oximetry
 Non-invasive blood pressure
 Blood glucose determination
 Continuous ECG monitoring
 12-lead ECG interpretation
 Carbon dioxide monitoring
 Carbon monoxide monitoring
 Basic blood chemistry
Objectives:
DOT Objectives
 Demonstrate use of monitoring devices to
assist with formulating a field impression
and proper treatment of patients in an
emergent situation.

Demonstrate the use of monitoring
devices per state formulary.
EMS Education Standards
 Understand, demonstrate, and discuss scene
and patient assessment findings with
knowledge of epidemiology and
pathophysiology to form a field impression.
 Develop a list of differential diagnoses
through clinical reasoning to modify the
assessment and formulate a treatment plan
to include:
 Continuous ECG monitoring
 12-Lead ECG interpretation
 Carbon Dioxide Monitoring
 Carbon Monoxide Monitoring
 Capnography
 Basic Blood Chemistry
 Other monitoring devices
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
67
Reassessment
Summary: Integrate scene and patient assessment findings with knowledge of epidemiology and
pathophysiology to form a field impression. This includes developing a list of differential diagnoses
through clinical reasoning to modify the assessment and formulate a treatment plan.
TARGET SKILLS: How and when to reassess patients for all patient situations.
Key Terminology:
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Reassessment
Cushing reflex
Beck triad
Objectives:
DOT Objectives
 Describe why reassessment of patients is
vital to prehospital care.
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Explain why trending can guide a
treatment plan.
EMS Education Standards
 Understand, demonstrate, and discuss scene
and patient assessment findings with
knowledge of epidemiology and
pathophysiology to form a field impression.
 Develop a list of differential diagnoses
through clinical reasoning to modify the
assessment and formulate a treatment plan
to include:
 How and when to reassess
 Documentation
 Age-related considerations
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
68
Medicine
Medical Overview
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression and implement a comprehensive treatment/disposition plan for a patient
with a medical complaint.
TARGET SKILLS: Assessment and management of a medical complaint.
Pathophysiology, assessment, and management of medical complaints to include:
 Transport mode
 Destination decisions
 Field Impressions
Key Terminology:
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Acquired
immunodeficiency
syndrome (AIDS)
Hepatitis
Herpes simplex
Human
immunodeficiency
virus (HIV)
Index of suspicion
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Medical emergencies
Meningitis
Methicillin-resistant
staphylococcus
aureus (MRSA)
Nature of illness
(NOI)
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SARS (severe acute
respiratory
syndrome)
Trauma emergencies
Tuberculosis
Virulence
Whooping cough
Paramedic attitude
Objectives:
DOT Objectives
 Explain how effective assessment is critical to
clinical decision making.
 Explain how the Paramedic’s attitude affects
assessment and decision making.
 Explain how uncooperative patients affect
assessment and decision making.
 Explain strategies to prevent labeling and
tunnel vision.
 Develop strategies to decrease environmental
distractions.
 Describe how manpower considerations and
staffing configurations affect assessment and
decision making.
 Synthesize concepts of scene management
and choreography to simulated emergency
calls.
 Explain the roles of the team leader and the
EMS Education Standards
 Understand, demonstrate, and discuss the
assessment findings with principles of
epidemiology and pathophysiology to
formulate a field impression and implement a
comprehensive treatment/disposition plan
for a patient with a medical complaint to
include transport mode and destination
decisions.
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patient care person.
List and explain the rationale for carrying the
essential patient care items.
When given a simulated call, list the
appropriate equipment to be taken to the
patient.
Explain the general approach to the
emergency patient.
Describe how to effectively communicate
patient information face to face, over the
telephone, by radio, and in writing.
Explain the general approach, patient
assessment, and management priorities for:
 Patients who complain of chest pain
 Medical and traumatic cardiac arrest
patients
 Patients who complain of acute
abdominal pain
 Patients who complain of GI bleeding
 Altered mental status patients
 Patients who complain of dyspnea
 Trauma or multi trauma patients
 A patient who is having an allergic
reaction
 Pediatric patients.
Appreciate the use of scenarios to develop
high level clinical decision making skills.
Advocate and practice the process of
complete patient assessment on all patients
Value the importance of presenting the
patient accurately and clearly.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
70
Neurology
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression and implement a comprehensive treatment/disposition plan for a patient
with a neurological complaint.
TARGET SKILLS: Anatomy, presentations, and management of:
 Decreased level of responsiveness
 Seizure
 Stroke
Anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis,
assessment, and management of:
 Stroke/intracranial
 Neoplasms
 Neurologic
hemorrhage/transient
inflammation/infection
 Demyelinating
ischemic attack
disorders
 Spinal cord compression
 Seizure
 Parkinson’s disease
 Hydrocephalus
 Wernicke’s
 Status epilepticus
 Cranial nerve
encephalopathy
 Headache
disorders
 Dementia
 Movement disorders
Key Terminology:
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Abscess
Adrenal glands
Agnosia
Allerent nerves
Alzheimer disease
Amyotrophic lateral
sclerosis (ALS)
Anesthesia
Anisocoria
Apraxia
Ataxia
Aura
AVPU mnemonic
Bell palsy
Bradykinesia
Brainstem
Central nervous system
(CNS)
Cerebellum
Cerebral palsy (CP)
Clonic activity
coma
Common reality
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Corneal reflex
Daughter cells
Decerebrate posturing
Decorticate posturing
Decussation
Delusions
Dementia
Diencephalon
Dystonia
Efferent nerves
Endotoxins
Exotoxins
Expressive aphasia
Gait
Glasgow Coma Scale
(GCS)
Global aphasia
Guillain-Barr syndrome
Hallucination
Hemiparesis
Hemiplegia
Hemorrhagic
Hypothalamus
71
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Incidence
Intention tremor
Jacksonian march
Limbic system
Medulla oblongata
Metastasis
Midbrain
Multiple sclerosis (MS)
Mutation
Myasthenia gravis
Myelin
Myoclonus
Neoplasm
Neurotransmitters
Nystagmus
Paresthesia
Parkinson disease
Peripheral nervous
system (PNS)
Peripheral neuropathy
Pituitary gland
Poliomyelitis
Pons
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Postictal
Postpolio syndrome
Postural tremor
Posturing
Prevalence
Pronation
Psychosis
Ptosis
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Receptive aphasia
Rest tremor
Rigidity
Spina bifida
Status epilepticus
Supraorbital foramen
Synapse
Syncope
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Tonic activity
Transient ischemic
attacks (TIAs0
Tremors
Trismus
Uremia
Objectives:
DOT Objectives
 Integrate pathophysiological principles and
assessment findings to formulate a field
impression and implement the treatment
plan for the patient with a neurological
problem.
 Describe the incidence, morbidity, and
mortality of neurological emergencies.
 Discuss the pathophysiology of headache.
 Discuss the management/treatment plan of
headache.
 Describe the epidemiology, including the
morbidity/mortality and prevention strategies
for neoplasms.
 Discuss the pathophysiology of neoplasms.
 Describe the types of neoplasms.
 Discuss the management/treatment plan of
neoplasms.
 Recognize the signs and symptoms related to
neoplasms.
 Differentiate among the various treatment
and pharmacological interventions used in
the management of neoplasms.
 Describe the epidemiology, including the
morbidity/mortality and prevention
strategies, for abscess.
 Discuss the pathophysiology of abscess.
 Discuss the management/ treatment plan of
abscess.
 Recognize the signs and symptoms related to
abscess.
 Differentiate among the various treatment
and pharmacological interventions used in
the management of abscess.
 Describe the epidemiology, including the
EMS Education Standards
 Understand, demonstrate and discuss the
assessment findings with principles of
anatomy, physiology, epidemiology,
pathophysiology psychosocial impact,
presentations, prognosis and management of
a patient who a neurological complaint to
include:
 Stroke/intracranial
hemorrhage/transient ischemic attack
 Altered mental status
 Seizure
 Status epilepticus
 Headache
 Dementia
 Neoplasm
 Demyelinating neurological disorders
 Parkinson’s disease
 Cranial nerve disorders
 Movement disorders
 Neurologic inflammation/infection
 Spinal cord compression
 Hydrocephalus
 Wernicke’s Encephalopathy
 Differentiate and formulate age related
variations as it pertains to the management of
neurological disorders.
 Discuss considerations of patient with
neurological disorders as it pertains to:
 Communication and documentation
 Transport decisions
 Patient education
 Prevention of further neurological
complications.
72
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morbidity/mortality and prevention
strategies, for degenerative neurological
diseases.
Discuss the pathophysiology of degenerative
neurological diseases.
Discuss the management/ treatment plan of
degenerative neurological diseases.
Define the following:
 Muscular dystrophy
 Multiple sclerosis
 Parkinson’s disease
 Trigeminal neuralgia
 Bell’s palsy
 Amyotrophic lateral sclerosis
 Peripheral neuropathy
 Myoclonus
 Spina bifida
Recognize the signs and symptoms related to
degenerative neurological diseases.
Differentiate among the various treatment
and pharmacological interventions used in
the management of degenerative
neurological diseases.
Integrate the pathophysiological principles of
the patient with a neurological emergency.
Develop a patient management plan based on
field impression in the patient with
neurological emergencies.
Characterize the feelings of a patient who
regains consciousness among strangers.
Formulate means of conveying empathy to
patients whose ability to communicate is
limited by their condition.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
73
Abdominal and Gastrointestinal Disorders
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression and implement a comprehensive treatment/disposition plan for a patient
with an abdominal and/or gastrointestinal complaint.
TARGET SKILLS: Anatomy, presentation, and management of shock associated with abdominal
emergencies and gastrointestinal bleeding
Anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis,
assessment, and management of:
 Acute and chronic gastrointestinal hemorrhage
 Peritonitis
 Ulcerative diseases
 Liver disorders
 Irritable bowel syndrome
 Inflammatory disorders
 Pancreatitis
 Bowel obstruction
 Hernias
 Infectious disorders
 Gall bladder and biliary tract disorders
 Rectal abscess
 Rectal foreign body obstruction
 Mesenteric ischemia
Key Terminology:
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Digestion
Acute abdomen
Diarrhea
Peristalsis
Portal vein
Cardiac sphincter
Chime
Soft stool
Umbilical
Epigastric
Feculent
Striate
Protuberant
Scaphoid
Borborygmi
Hyperperistalsis
Tympanic
Visceral pain
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Parietal pain
Somatic pain
Referred pain
Rebound tenderness
Murphy sign
Orthostatic vital signs
Dehydration
Esophagogastric varices
Gastritis
Portal
Hypertension
Pruritis
Hematemesis
Melena
Endoscopy
Mallory-Weiss syndrome
Peptic ulcer disease
(PUD)
74
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Gastroesophageal reflux
disease (GERD)
Anal fissures
Hematochezia
Hepatitis
Peritonitis
Biliary tract disorders
Choleangitis
Cholelithiasis
Cholecystitis
Acalculus cholecystitis
Appendicitis
Diverticulitis
Diverticulum
Fistula
Pancreatitis
Uncreative colitis
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
Irritable bowel syndrome
(IBS)
Steatorrhea
Crohn disease
Acute gastroenteritis
Rectal abscess
Cirrhosis
Urticarial
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Acholic stools
Icteric
Hepatic encephalopathy
Intussusception
Volvulus
Incarcerated
Strangulated
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Incisional
Hernia
Mesenteric ischemia
Gastroschisis
Malrotation
Pyloric stenosis
Objectives:
DOT Objectives
 Integrate pathophysiological principles and
assessment findings to formulate a field
impression and implement the treatment
plan for the patient with a gastroenterologic
problem.
 Describe the incidence, morbidity, and
mortality of gastrointestinal emergencies.
 Identify the risk factors most predisposing to
gastrointestinal emergencies.
 Define somatic pain as it relates to
gastroenterology.
 Define visceral pain as it relates to
gastroenterology.
 Define referred pain as it relates to
gastroenterology.
 Define acute gastroenteritis.
 Discuss the pathophysiology of acute
gastroenteritis.
 Recognize the signs and symptoms related to
acute gastroenteritis.
 Describe the management for acute
gastroenteritis.
 Define colitis.
 Discuss the pathophysiology of colitis.
 Recognize the signs and symptoms related to
colitis.
 Describe the management for colitis.
 Define gastroenteritis.
 Discuss the pathophysiology of
gastroenteritis.
 Recognize the signs and symptoms related to
gastroenteritis.
 Describe the management for gastroenteritis.
 Define appendicitis.
EMS Education Standards
 Understand, demonstrate, and discuss the
assessment findings with principles of
anatomy, physiology, epidemiology,
pathophysiology psychosocial impact,
presentations, prognosis and management of
a patient with abdominal/gastrointestinal
disorders to include:
 Acute and chronic gastrointestinal
hemorrhage
 Liver disorders
 Infectious disorders
 Peritonitis
 Ulcerative diseases
 Irritable bowel syndrome
 Inflammatory disorders
 Bowel obstruction
 Hernias
 Gall bladder and biliary tract disorders
 Rectal abscess
 Rectal foreign body obstruction
 Mesenteric ischemia.
 Differentiate and formulate age related
variations as it pertains to the management of
abdominal/gastrointestinal disorders.
 Discuss considerations of patient with
neurological disorders as it pertains to:
 Communication and documentation
 Transport decisions
 Patient education
 Prevention of further
abdominal/gastrointestinal disorders
complications.
75
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Discuss the pathophysiology of appendicitis.
Recognize the signs and symptoms related to
appendicitis.
Describe the management for appendicitis.
Define Crohn’s disease.
Discuss the pathophysiology of Crohn’s
disease.
Recognize the signs and symptoms related to
Crohn’s disease.
Describe the management for Crohn’s
disease.
Define hemorrhoids.
Discuss the pathophysiology of hemorrhoids.
Recognize the signs and symptoms related to
hemorrhoids.
Describe the management for hemorrhoids.
Define cholecystitis.
Discuss the pathophysiology of cholecystitis.
Recognize the signs and symptoms related to
cholecystitis.
Describe the management for cholecystitis.
Define acute hepatitis.
Discuss the pathophysiology of acute
hepatitis.
Recognize the signs and symptoms related to
acute hepatitis.
Describe the management for acute hepatitis.
Integrate pathophysiological principles of the
patient with a gastrointestinal emergency.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
76
Immunology
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression and implement a comprehensive treatment/disposition plan for a patient
with an immunological complaint.
TARGET SKILLS: Recognition and management of shock and difficulty breathing related to anaphylactic
reactions.
Anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis,
assessment, and management of hypersensitivity disorders and/or emergencies including:
 Allergic and anaphylactic reactions
 Anaphylactoid reactions
 Hypersensitivity
 Collagen vascular disease
 Transplant related problems
Key Terminology:
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Allergen
Antibody
Antigen
Allergic reaction
Local reaction
Systemic reaction
Hypersensitivity
Anaphylaxis
Anaphylactoid reaction
Collagen vascular
diseases
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Systemic lupus
erythematous
Scleroderma
Immune system
Cellular immunity
Humoral immunity
Injection
Absorption
Inhalation
Ingestin
Primary response
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Sensitivity
Basophils cells
Mast cells
Chemical mediators
Immunity
Secondary response
Acquired immunity
Natural immunity
Histamine
Pruritus
Urticarial
Objectives:
DOT Objectives
 Define allergic reaction.
 Define anaphylaxis.
 Define allergens.
 Describe the common methods of entry of
substances into the body.
 List common antigens most frequently
associated with anaphylaxis.
 Describe physical manifestations in
anaphylaxis.
 Recognize the signs and symptoms related to
anaphylaxis.
 Differentiate among the various treatment
EMS Education Standards
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77
Understand, demonstrate, and discuss the
assessment findings with principles of
anatomy, physiology, epidemiology,
pathophysiology psychosocial impact,
presentations, prognosis and management of a
patient with common or major immune system
disorders and/or emergencies to include:
 Hypersensitivity
 Allergic and anaphylactic reactions
 Anaphylactoid reactions
 Collagen vascular disease
 Transplant related problems.
Differentiate and formulate age related
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and pharmacological interventions used in
the management of anaphylaxis.
Integrate the pathophysiological principles of
the patient with anaphylaxis.
Correlate abnormal findings in assessment
with the clinical significance in the patient
with anaphylaxis.
Develop a treatment plan based on field
impression in the patient with allergic
reaction and anaphylaxis.

variations as it pertains to the management of
a patient with common or major immune
system disorders and/or emergencies.
Discuss considerations of patient with
neurological disorders as it pertains to:
 Communication and documentation
 Transport decisions
 Patient education
 Prevention of further common or major
immune system disorders and/or
emergencies.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
78
Infectious Diseases
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression and implement a comprehensive treatment/disposition plan for a patient
with an infectious disorder complaint.
TARGET SKILLS: Anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, reporting
requirements, prognosis, and management of:
 A patient who may have an infectious
 Meningococcal meningitis
disease
 Tuberculosis
 How to decontaminate the ambulance
 Tetanus
and equipment after treating a patient
 Viral diseases
 A patient who may be infected with a
 Sexually transmitted disease
bloodborne pathogen
 Gastroenteritis
 HIV – related disease
 Fungal infections
 Hepatitis B
 Rabies
 Antibiotic resistant infections
 Scabies and lice
 Current infectious diseases prevalent in
 Lyme disease
the community
 Rocky Mountain Spotted Fever
 Hepatitis
 Antibiotic resistant infections
 Pneumonia
Key Terminology:
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Communicable disease
Infectious disease
Endemic
Epidemic
Pandemic
Bacteria
Viruses
Fungi
Parasites
Contact transmission
Bloodborne pathogens
Fomites
Droplet transmission
Airborne transmission
Vector
Other potential
infectious materials
(OPIM)
Needleless systems
Designated infection
control officer (DICO)
Source individual
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Standard precautions
Vaccines
Vaccinations
Immunization
Contaminated
Carriers
Virulence
Host resistance
Incubation period
Communicable period
Vesicles
Infection
Meningitis
Meningococcal
meningitis
Tuberculosis (TB)
Tuberculin skin test
Pneumonia
Respiratory syncytial
virus (RSV)
Mononucleosis
Influenza
79
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Sexually transmitted
diseases (STDs)
Gonorrhea
Syphilis
Chancre
Chlamydia
Scabies
Lice
Viral hepatitis
Serum hepatitis
Jaundice
Icterus
Human
immunodeficiency virus
(HIV)
Seropositive
Acquired
immunodeficiency
syndrome (AIDS)
Opportunistic infections
Infectious hepatitis
Zoonotic
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
West Nile Virus (WNV)
Lyme disease
Hantavirus
Rabies
Tetanus
Staphylococcus aureus
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
Colonized
Nosocomial infection
Measles
Rubella
Mumps
Chickenpox



Pertussis
Severe acute respiratory
syndrome (SARS)
Avian (bird) flu
Objectives:
DOT Objectives
 Integrate pathophysiological principles and
assessment findings to formulate a field
impression and implement a management
plan for the patient with infectious and
communicable diseases.
 Discuss public health principles relevant to
infectious/ communicable disease.
 Identify public health agencies involved in the
prevention and management of disease
outbreaks.
 In specific diseases, identify and discuss the
issues of personal isolation.
 Describe and discuss the rationale for the
various types of PPE.
 Discuss what constitutes a significant
exposure to an infectious agent.
 Discuss Hepatitis C including:
 The causative agent
 The organ affected
 Routes of transmission
 Susceptibility and resistance
 Signs and symptoms
 Patient management and protective
measures
 Immunization and control measures.
 Discuss tetanus including:
 The causative organism
 The body system affected
 Modes of transmission
 Susceptibility and resistance
 Signs and symptoms
 Patient management
 Protective measures
 Immunization.
 Discuss rabies and hantavirus as they apply to
regional environmental exposures including:
 The causative organisms
EMS Education Standards
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80
Understand, demonstrate, and discuss the
assessment findings with principles of
anatomy, physiology, epidemiology,
pathophysiology psychosocial impact,
reporting requirements, presentations,
prognosis and management of a patient with
infectious disorders to include:
 HIV-related disease
 Hepatitis
 Pneumonia
 Meningococcal meningitis
 Tuberculosis
 Tetanus
 Viral diseases
 Sexually transmitted disease
 Gastroenteritis
 Fungal infections
 Rabies
 Scabies/lice
 Lyme Disease
 Rocky Mountain Spotted Fever
 Antibiotic resistant infections
Discuss and identify public health principles
and agencies involved in the prevention and
management of disease outbreaks.
Differentiate and formulate age related
variations as it pertains to the management of
infectious diseases.
Discuss considerations of patient with
infectious diseases as it pertains to:
 Communication/documentation
 Transport decisions
 Patient/family teaching
 Legal requirements regarding reporting
of communicable or infectious diseases
regarding their spread.
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The body systems affected
Routes of transmission
Susceptibility and resistance
Signs and symptoms
Patient management and protective
measures
 Immunization and control measures.
Identify pediatric viral diseases.
Discuss the importance of immunization and
those diseases, especially in the pediatric
population, which warrant widespread
immunization (MMR).
Discuss pertussis (whooping cough) including:
 The causative organism
 The body organs affected
 Mode of transmission
 Susceptibility and resistance
 Signs and symptoms
 Patient management and protective
measures
 Immunization.
Discuss influenza including:
 Causative organisms
 The body system affected
 Mode of transmission
 Susceptibility and resistance
 Signs and symptoms
 Patient management and protective
measures
 Immunization.
Discuss mononucleosis including the:
 Causative organisms
 Body regions
 Organs
 Systems affected
 Modes of transmission
 Susceptibility and resistance
 Signs and symptoms
 Patient management
 Protective measures
 Immunization.
Discuss chlamydia including the:
 Causative organism
 Body regions
 Organs and systems affected
 Modes of transmission
 Susceptibility and resistance
81
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Signs and symptoms
Patient management and protective
measures
 Immunization.
Articulate the pathophysiological principles of
an infectious process given a case study of a
patient with an infectious/communicable
disease.
Value the importance of immunization,
especially in children and populations at risk.
Advocate respect for the feelings of patients,
family, and others at the scene of an
infectious/communicable disease.
Advocate empathy for a patient with an
infectious/communicable disease.
Value the importance of
infectious/communicable disease control.
Consistently demonstrate the use of body
substance isolation.
Demonstrate the ability to comply with body
substance isolation guidelines.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
82
Endocrine Disorders
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression and implement a comprehensive treatment/disposition plan for a patient
with an endocrine disorder complaint.
TARGET SKILLS: Awareness that diabetic emergencies may cause altered mental status. Anatomy,
physiology, epidemiology, psychosocial impact, presentations, prognosis, pathophysiology, assessment,
and management of:
 Acute diabetic emergencies
 Diabetes
 Adrenal disease
 Pituitary and thyroid disorders
Key Terminology:
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Glands
Hormones
Homeostasis
Exocrine glands
Endocrine glands
Target tissues
Agonists
Antagonists
Antidiuretic hormone
(ADH)
Hypothalamus
Pineal gland
Pituitary gland
Thyroid
Thyroxine
Iodine
Calcitonim
Thymus gland
Lymphocytes
Killer T cells
Helper T cells
Suppressor T cells
Lymphokines
Parathyroid hormone
(PTH)
Adrenal glands
Adrenal cortex
Adrenal medulla
Catecholamines
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Adrenocorticotropic
hormone (ACTH)
Cortisol
Aldosterone
Norepinephrine
Epinephrine
Pancreas
Islets of Langerhans
Glucagon
Insulin
Somatostatin
Gonads
Testes
Androgens
Testosterone
Ovaries
Estrogen
Progesterone
Luteinizing hormone (LH)
Diabetes mellitus
Necrosis
Lipolysis
Dyslipidemia
Microangiopathy
Ischemia
Type I diabetes
Type 2 diabetes
Insulin resistance
Gestational diabetes
Hypoglycemia
83
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Hyperglycemia
Diabetic ketoacidosis
(DKA)
Hyperosmolar nonketotic
come (HONK)
Nhyperosmolar
hyperglycemic
nonketotic come (HHNC)
Primary adrenal
insufficiency
Secondary adrenal
insufficiency
Corticosteroids
Addisonian crisis
Cushing syndrome
Pheochromocytoma
Congenital adrenal
hyperplasia (CAH)
Thyroid-stimulating
hormone (ISH)
Graves disease
Goiter
Exophthalmos
Pretibial myxedema
Hashimoto disease
Myxedema coma
Thyrotoxicosis
Thyroid storm
Panhypopituitarism
Inborn error of
metabolism (IEM)
Objectives:
DOT Objectives
EMS Education Standards
 Integrate pathophysiological principles and
 Understand, demonstrate, and discuss the
assessment findings to formulate a field
assessment findings with principles of
impression and implement a treatment plan
anatomy, physiology, epidemiology,
for the patient with an endocrine problem.
pathophysiology psychosocial impact,
presentations, prognosis and management of a
 Describe the incidence, morbidity, and
patient with endocrine disorders to include:
mortality of endocrinologic emergencies.
 Acute diabetic emergencies
 Identify the risk factors most predisposing to
 Diabetes
endocrinologic disease.
 Renal disease
 Discuss the anatomy and physiology of organs
 Pituitary and thyroid disorders
and structures related to endocrinologic
 Differentiate and formulate age related
diseases.
variations as it pertains to the management of
 Review the pathophysiology of endocrinologic
endocrine disorders.
emergencies.
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Discuss considerations of patient with
 Discuss the pathophysiology of thyrotoxicosis.
endocrine disorders as it pertains to:
 Recognize signs and symptoms of the patient
 Communication and documentation
with thyrotoxicosis.
 Transport decisions
 Describe the management of thyrotoxicosis.
 Patient education
 Discuss the management of the patient with
 Prevention.
thyrotoxicosis.
 Discuss the pathophysiology of myxedema.
 Recognize signs and symptoms of the patient
with myxedema.
 Describe the management of myxedema.
 Discuss the management of the patient with
myxedema.
 Discuss the pathophysiology of Cushing's
syndrome.
 Recognize signs and symptoms of the patient
with Cushing's syndrome.
 Describe the management of Cushing's
syndrome.
 Discuss the management of the patient with
Cushing’s syndrome.
 Discuss the pathophysiology of adrenal
Insufficiency.
 Recognize signs and symptoms of the patient
with adrenal insufficiency.
 Describe the management of adrenal
insufficiency.
 Discuss the management of the patient with
adrenal insufficiency.
84
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
85
Psychiatric
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression and implement a comprehensive treatment/disposition plan for a patient
with a psychiatric complaint.
TARGET SKILLS: Anatomy, physiology, epidemiology, psychosocial impact, presentations, prognosis,
pathophysiology, recognition of, assessment of, and management of:
 Behaviors that pose a risk to the paramedic, patient or others
 Basic principles of the mental health system:
Assessment and management of:
 Acute psychosis
 Suicidal/risk
 Agitated delirium
 Cognitive disorders
 Thought disorders
 Mood disorders
 Neurotic disorders
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Substance-related disorders/addictive
behavior
Somatoform disorders
Factitious disorders
Personality disorders
Patterns of violence/abuse/neglect
Organic psychoses
Key Terminology:
 Activities of daily living
(ADLs)
 Acute dystonic reaction
 affect
 Agoraphobia
 Anorexia nervosa
 Anxiety disorders
 Atropine-like effects
 Behavior
 Behavioral emergencies
 Bipolar mood disorder
 Borderline personality
disorders
 Bulimia nervosa
 Catatonic
 Circumstantial thinking
 Compulsions
 Confabulation
 Confrontation
 Covert behaviors
 delirium
 Delusions
 dementia
 Depression
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Disorganization
disorientation
Echolalia
Factitious disorder
Flat affect
Flight of ideas
Generalized anxiety
disorder (GAD)
phobic disorders
Hallucinations
Impulse control disorders
Inappropriate affect
Labile
Loosening of associations
Mania
Manic-depressive illness
Medication
noncompliance
Mental status
examination (MSE)
Mood disorders
Mutism
Neologisms
Neurotic disorders
86
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Organic brain syndrome
Overt behavior
Panic disorder
Perseveration
Personality disorders
Phobias
Phobic disorders
Posttraumatic stress
disorder (PTSD)
Pressure of speech
Psychiatric emergency
psychosis
Psychotropic drugs
Schizophrenia
Simple phobia
Somatoform disorder
Stereotyped movements
Substance abuse
Substance dependence
Substance intoxication
Substance use
Suicide
Tangential thinking
Thought broadcasting
 Thought insertion
 Thought withdrawal
 Violent behavior
Objectives:
DOT Objectives
EMS Education Standards
 Distinguish between normal and abnormal
 Understand, demonstrate, and discuss the
behavior.
assessment findings with principles of
anatomy, physiology, epidemiology,
 Discuss the pathophysiology of behavioral
pathophysiology psychosocial impact,
emergencies.
presentations, prognosis and management of
 Discuss appropriate measures to ensure the
a patient with a psychiatric emergency or
safety of the patient, Paramedic, and others.
disorder to include:
 Identify techniques for a physical assessment
 Acute psychosis
in a patient with behavioral problems.
 Agitated delirium
 Describe therapeutic interviewing techniques
 Cognitive disorders
for gathering information from a patient with
 Thought disorders
a behavioral emergency.
 Mood disorders
 List factors that may indicate a patient is at
 Neurotic disorders
increased risk for suicide.
 Substance-related disorders/addictive
 Describe circumstances in which relatives,
behavior
bystanders, and others should be removed

Somatoform disorders
from the scene.
 Factitious disorders
 Describe medical/ legal considerations for
 Fastidious disorders
managing a patient with a behavioral
 Impulse control disorders
emergency.
 Personality disorders
 List situations in which the Paramedic is
 Suicide
expected to transport a patient against his
 Patterns of violence/abuse/neglect
will.
 Organic psychoses
 Describe methods of restraint that may be

Discuss
and consider assessment findings for
necessary in managing a patient with a
patients with psychiatric conditions such as:
behavioral emergency.
 Mental status exam
 Formulate a field impression based on the
 Physiological changes
assessment findings for patients with
 Medical/social history
behavioral emergencies.
 Consider if patient is danger to self
 Develop a patient management plan based on
and/or others
the field impression for patients with
 Consider medical causes of acute
behavioral emergencies.
crises.
 Advocate for empathetic and respectful
 Discuss and demonstrate the provision of
treatment for individuals experiencing
empathetic and respectful management of
behavioral emergencies.
the psychiatric patient through:
 Demonstrate safe techniques for managing
 Communication techniques
and restraining a violent patient.
 Crisis intervention
 Skills and the use of force/restraints.
 Discuss consideration of patient with
psychiatric disorders as it pertains to age
related variations in pediatric and geriatric
87
patients, communication to medical facility
and documentation, and transport decisions.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
88
Cardiovascular
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression and implement a comprehensive treatment/disposition plan for a patient
with a cardiovascular complaint.
TARGET SKILLS: Anatomy, signs, symptoms, and management of:
 Chest pain
 Cardiac arrest
Anatomy, physiology, pathophysiology, assessment, and management of:
 Abdominal aortic aneurysm
 Acute coronary syndrome
 Arterial occlusion
 Angina pectoris
 Venous thrombosis
 Myocardial infarction
 Aortic aneurysm/dissection
 Aortic aneurysm/dissection
 Thromboembolism
 Thromboembolism
 Cardiac rhythm disturbances
 Heart failure
 Infectious diseases of the heart
 Hypertensive emergencies
 Endocarditis
 Non-traumatic cardiac tamponade
 Pericarditis
 Cardiogenic shock
 Congenital abnormalities
 Vascular disorders
Key Terminology:
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Dysrhythmias
Retrosternal
Point of maximal
impulse (PMI)
Epicardium
Myocardium
Endocardium
Pericardium
Coronary arteries
Circumflex coronary
artery
Collateral circulation
Coronary sulcus
Coronary sinus
Antrioventricular (AV)
valves
Tricuspid valve
Mitral valve
Chordae tendineae
Papillary muscles
Semilunar valves
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Pulmonary semilunar
valve
Aortic semilunar valve
Cardiac cycle
Diastole
Systole
Atrial kick
Interventricular septum
Vena cava
Right atrium
Right ventricle
Pulmonary artery
Pulmonary veins
Left atrium
Left ventricle
Preload
Afterload
Systemic circulation
Pulmonary circulation
Tunica adventitia
Tunica media
Tunica intima
89
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Lumen
Arteries
Aorta
Arteriole
Blood pressure
Veins
Venules
Capillaries
Cardiac output (CO)
Stroke volume (SV)
Heart rate (HR)
Ejection fraction (EF)
Frank-Starling
mechanism
Contractility
Inotropic effect
Chronotropic effect
Excitability
Conductivity
Automaticity
Pacemaker
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Electrical conduction
system
Sinoatrial (SA) node
Intermodal pathways
AV junction
atrioventricular (AV)
node
Bundle of His
Purkinje fibers
Dromotropic effect
Depolarization
Refractory period
Absolute refractory
period
Relative refractory
period
P wave
QRS complex
T waves
PR interval
ST segment
Isoelectric line
R-R interval
Autonomic nervous
system
Parasympathetic
nervous system
Vagus nerve
Valsalva maneuver
Acetylcholine (Ach)
Atropine
Sympathetic nervous
system
Norepinephrine
Adrenaline
Receptors
Vasoconstriction
Vasodilation
Bronchoconstriction
Bronchodilation
Paroxysmal nocturnal
dyspnea (PND)
Orthopnea
Syncope
Palpitations
Digitalis preparations
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Orthostatic hypotension
Opening snap
Ejection click
Pericardial friction rub
Murmur
Thrill
Pericardial knock
Pulse deficit
Pulsus paradoxus
Pulsus alternans
Limb leads
Artifact
Leads
Precordial leads
Bipolar leads
Augmented unipolar
leads
Isoelectric
Concordant precordial
pattern
Normal sinus rhythm
Sinus bradycardia
Sinus tachycardia
Sinus dysrhythmia
Transcutaneous pacing
Junctional rhythm
First-degree heart block
Idioventricular
Monomorphic
Unifocal
Multifocal
Couplet
Bigeminy
Trigeminy
Asystole
Arrhythmia
Agonal rhythm
Agonal
Axis deviation
Bundle branch block
Aberration
Fascicular block
Bifascicular block
Trifascicular block
Preexcitation
90
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Wolff-Parkinson-White
syndrome
Delta wave
Lown-Ganong-Levine
syndrome
Right atrial enlargement
Left atrial enlargement
Right ventricular
hypertrophy (RVH)
Left ventricular
hypertrophy (LVH)
Contiguous leads
Inferior wall MI
Fibrinolysis
Benign early
repolarization
Pericarditis
Pulmonary embolism
Hyperkalemia
Hypokalemia
U wave
Hypocalcemia
Hypertrophic
cardiomyopathy
Brugada syndrome
Long QT syndrome
Defibrillation
Automated external
defibrillator (AED)
Manual defibrillation
Synchronized
cardioversion
Cardiopulmonary arrest
Pulseless electrical
activity (PEA)
Coronary artery disease
(CAD)
Ischemia
Infarction
Atherosclerosis
Atheroma
Plaque
Thrombus
Arteriosclerosis
Bruits
Claudication
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Phlebitis
Thromboembolism
Angina pectoris
Prinzmetal angina
Stable angina
Unstable angina
Acute coronary
syndrome (ACS)
Acute myocardial
infarction (AMI)
Necrosis
Subendocardial
myocardial infarction
Transmural myocardial
infarction
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Pulmonary edema
Fibrinolytic therapy
Recanalization
Reperfusion
Plasmin
Percutaneous coronary
intervention (PCI)
Congestive heart failure
(CHF)
Left-sided heart failure
Right-sided heart failure
Cardiac tamponade
Beck’s triad
Aneurysm
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Dissection
Stanford classification
DeBakey classification
Abdominal aortic
aneurysms (AAAs0
Hypertensive
emergency
Hypertensive
encephalopathy
Endocarditis
Myocarditis
Rheumatic fever
Scarlet fever
Objectives:
DOT Objectives
 Describe the emergency medical care of the
patient experiencing chest pain/discomfort.
 List the indications for application of a cardiac
monitor.
 Define the role of the Paramedic in the
emergency cardiac care system.
 Explain the impact of age and weight on
defibrillation.
 Discuss the position of comfort for patients
with various cardiac emergencies.
 Establish the relationship between airway
management and the patient with
cardiovascular compromise.
 Predict the relationship between the patient
experiencing cardiovascular compromise and
basic life support.
 Discuss the fundamentals of early
defibrillation.
 Explain the rationale for early defibrillation.
 Explain that not all chest pain patients result
in cardiac arrest and do not need to be
attached to an automated external
defibrillator or cardiac monitor.
 Explain the importance of prehospital ACLS
intervention if it is available.
 Explain the importance of urgent transport to
a facility with Advanced Cardiac Life Support
if it is not available in the prehospital setting.
EMS Education Standards
 Understand, demonstrate, and discuss the
assessment findings with principles of
anatomy, physiology, electrophysiology,
epidemiology, pathophysiology psychosocial
impact, presentations, prognosis, and
management of a patient with cardiovascular
disorders/disease to include:
 Primary survey for cardiovascular
assessment
 History and physical
 Secondary survey for cardiovascular
assessment
 Electrocardiographic monitoring
 Management of the patient with an
arrhythmia
 Acute coronary syndrome
 Angina pectoris
 Myocardial infarction
 Heart failure
 Non-traumatic cardiac tamponade
 Hypertensive emergencies
 cardiogenic shock
 cardiac arrest
 vascular disorders
 Aortic aneurysm/dissection
 Thromboembolism
 Valvular heart disease
 Cardiac rhythm disturbances
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Differentiate between the fully automated
and the semi-automated defibrillator.
State the reasons for assuring that the patient
is pulseless and apneic when using the
automated external defibrillator.
Discuss the circumstances which may result in
inappropriate shocks.
Explain the considerations for interruption of
CPR when using the defibrillator.
Discuss the advantages and disadvantages of
defibrillators.
Summarize the speed of operation of
defibrillation.
Discuss the use of remote defibrillation
through adhesive pads.
Discuss the special considerations for rhythm
monitoring.
List the steps in the operation of the
defibrillator.
Discuss the standard of care that should be
used to provide care to a patient with
persistent ventricular fibrillation and no
available ACLS.
Discuss the standard of care that should be
used to provide care to a patient with
recurrent ventricular fibrillation and no
available ACLS.
Differentiate between the single rescuer and
multi-rescuer care with an automated
external defibrillator.
Explain the reason for pulses not being
checked between shocks with an automated
external defibrillator.
Discuss the importance of coordinating ACLS
trained providers with personnel using
automated external defibrillators.
Discuss the importance of post-resuscitation
care.
List the components of post-resuscitation
care.
Explain the importance of frequent practice
with the automated external defibrillator.
Discuss the need to complete the Automated
Defibrillator: Operator's Shift Checklist.
State the reasons why a case review should
be completed following the use of the
automated external defibrillator.
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 Coronary artery disease
 Infectious diseases of the heart
 Cardiomyopathy
 Congenital abnormalities
 Specific hypertensive emergencies.
Integration and application of
pathophysiological principles to the
assessment of a patient with cardiovascular
disease.
Differentiate and formulate age related
variations as it pertains to the management of
cardiovascular disorders and disease.
Discuss considerations of patient with
cardiovascular disorders and disease as it
pertains to communication and
documentation, transport decisions, patient
education and prevention.
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Discuss the goal of quality improvement in
automated external defibrillation
Recognize the need for medical direction of
protocols to assist in the emergency medical
care of the patient with chest pain.
List the indications for the use of
nitroglycerin.
State the contraindications and side effects
for the use of nitroglycerin.
Define the function of all controls on an
automated external defibrillator, and
describe event documentation and battery
defibrillator maintenance.
Defend the reasons for obtaining initial
training in defibrillation and the importance
of continuing education.
Defend the reason for maintenance of
defibrillators.
Explain the rationale for administering
nitroglycerin to a patient with chest pain or
discomfort.
Demonstrate the assessment and emergency
medical care of a patient experiencing chest
pain/discomfort
Perform the steps in facilitating the use of
nitroglycerin for chest pain or discomfort.
Practice completing a prehospital care report
for patients with cardiac emergencies.
Explain and perform the steps for utilizing
external transcutaneous pacing and
synchronized cardioversion.
Demonstrate and perform all AHA algorithms
for Acute Coronary Syndromes, VF,VT, Stroke,
and post arrest care.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
93
Toxicology
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression and implement a comprehensive treatment/disposition plan for a patient
with a toxicological complaint.
TARGET SKILLS: Recognition and management of:
 Carbon monoxide poisoning
 Nerve agent poisoning
 How and when to contact a poison control center
Anatomy, physiology, pathophysiology, assessment, and management of:
 Inhaled poisons
 Absorbed poisons
 Ingested poisons
 Alcohol intoxication and withdrawal
 Injected poisons
 Opiate toxidrome
Anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis,
and management of the following toxidromes and poisonings:
 Cholinergics
 Over-the-counter and prescription
medications
 Anticholinergics
 Carbon monoxide
 Sympathomimetics
 Illegal drugs
 Sedative/hypnotics
 Herbal preparations
 Opiates
Key Terminology:
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Absorption
Acetaminophen
Activated Charcoal
Agitated Delirium
Alcohols
Alcoholism
Alcohol
Abuse/Withdrawal
Alkalinization and
Sodium Bicarbonate
Ammonia
Anticholinergic
Atropine
Barbiturates
Beta-agonist
Bleach
Calcium Gluconate
Carbamate
Carbon Monoxide
Cardiac Damage
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Cardiac Medications
Caustics
Chemicals
Chemical Warfare
Childhood Poisoning
China Berry
Cholinergic
Chlorine
Circulation Support
Codeine
Cocaine
Coma
Cyanide
Cyanide Antidotes
Decadron
Decreased level of
consciousness
Diazepam
Dieffenbachia
Digibind
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Dimercapel
Dosage Errors
Ecstasy
End Organ Damage
Environmental Exposure
Euphoria
Facilitated Airway
Control
Fentanyl
Flumazenil
Fox Glove
Glucagon
Haldol
Hallucinogens
Halogenated
Hydrocarbon
Heroin
Household Poisons
Huffing Agent
Hydrocarbons
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Hydrogen Flouride
Hydrogen Sulfide
Hypertensive
Emergencies
Hypnotics
Hypotension
ICE
Idiosyncratic Reactions
Ingestion
Inhalation
Injection
Intentional
Poisoning/OD
Ipecac
Jimson Weed
Lortab
Lysergic Acid
Diethylamide (LSD)
Meperidine
Mescaline
Medication Overdose
Metals
Methamphetamine
Malignant Hyperthermia
Marijuana and Cannabis
Methadone
Methylene Blue
Mistletoe
Morphine
Mushrooms
Narcan
Nausea
Nerve Agent (Sarin,
Soman)
Occupational Exposure
Opiates
Organophosphate
Other
Oxides of Nitrogen
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Oxycontin
Peyote
Phencyclidine (PCP)
Physostigmine
Pine Oil Products
Pinpoint Pupils
Pralidoxime Chloride (2PAM)
Propoxyphene
Psychiatric Medications
Psychosis/Seizures
Pyrethrums (Raid)
Respiratory Arrest
Respiratory Depression
Respiratory Support
Salicylates
Sedation
Sedatives
Seizure
Solu-Medrol
Solvents
Sympathomimetics/Stim
ulates
Toxidrome
Warfarins
Licit
Illicit
Poison
Drug
Toxicologic emergencies
Toxidrome
Drug abuse
Habituation
Physical dependence
Psychological
dependence
Tolerance
Withdrawal syndrome
Drug addiction
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Antagonist
Potentiation
Synergism
Alcoholism
Delirium tremens (DTs0
Cocaine
Amphetamines
Methamphetamine
Rhabdomyolysis
Marijuana
Hallucinogen
Spice
Sedative-hypnotic
Barbiturates
Benzodiazepines
Narcotic
Opiate
Opioid
Organophosphates
Caustics
Hydrocarbons
Tricyclic antidepressants
(TCAs)
Monoamine oxidase
inhibitors (MAOIs)
Selective serotonin
reuptake inhibitors
(SSRIs)
Serotonin syndrome
Lithium
Salicylates
Theophylline
POISONOUS PLANTS:
Dieffenbachia
Caladium
Lantana
Foxglove
Castor bean
Objectives:
DOT Objectives
 Integrate pathophysiological principles and
assessment findings to formulate a field
impression and implement a treatment plan
EMS Education Standards
 Understand, demonstrate, and discuss the
assessment findings with principles of
anatomy, physiology, electrophysiology,
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for the patient with a toxic exposure.
Describe the incidence, morbidity, and
mortality of toxic emergencies.
Identify the risk factors most predisposing to
toxic emergencies.
Describe the routes of entry of toxic
substances into the body.
Discuss the assessment finding associated with
various toxidromes.
Recognize, correlate, and differentiate among
the signs and symptoms, assessment findings,
various treatments, and pharmacological
interventions related to the most common
poisoning by ingestion.
Recognize, correlate, and differentiate among
the signs and symptoms, assessment findings,
various treatments, and pharmacological
interventions related to the most common
poisoning by inhalation.
Recognize, correlate, and differentiate among
the signs and symptoms, assessment findings,
various treatments, and pharmacological
interventions related to the most common
poisoning by injection.
Recognize, correlate, and differentiate among
the signs and symptoms, assessment findings,
various treatments, and pharmacological
interventions related to the most common
poisoning by surface absorption.
Integrate pathophysiological principles and the
assessment findings to formulate a field
impression and implement a treatment plan
for patients with the most common poisonings
by ingestion, inhalation, injection, and surface
absorption.
Recognize, correlate, and differentiate among
the signs and symptoms, assessment findings,
various treatments, and pharmacological
interventions related to the most common
poisoning by overdose.
Integrate pathophysiological principles and the
assessment findings to formulate a field
impression and implement a treatment plan
for patients with the most common poisoning
by overdose.
Recognize, correlate, and differentiate among
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epidemiology, pathophysiology psychosocial
impact, presentations, prognosis and
management of a patient with toxicological
emergencies to include:
 Cholinergics
 Anticholinergics
 Marijuana & cannabis compounds
 Sympthomimetics/stimulants
 Barbiturates/sedatives/hypnotics
 Hallucinogens
 Opiates
 Huffing agent (halogenated
hydrocarbons)
 Alcohol intoxication and withdrawal
 Over-the-counter and prescription
medications
 Carbon monoxide
 Illegal drugs
 Herbal preparations
 Chemical poisons
 Household preparations
 Medication overdoses.
Consider general treatment modalities to
include:
 Facilitated airway control
 Respiratory support
 Circulatory support
 Antidote therapy
 Decontamination.
Differentiate and formulate age related
variations as it pertains to the management of
toxicological emergencies.
Discuss considerations of patient with
toxicological emergencies as it pertains to:
 Communication
 Documentation
 Transport decisions
 Patient education
 Prevention.
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the signs and symptoms, assessment findings,
various treatments, and pharmacological
interventions related to the most common
abused drugs.
Integrate pathophysiological principles and the
assessment findings to formulate a field
impression and implement a treatment plan
for patients using the most commonly abused
drugs.
Integrate pathophysiological principles and
assessment findings to formulate a field
impression and implement a treatment plan
for the patient with a toxic exposure.
List the toxic substances that are specific to
your region.
List the clinical uses, street names,
pharmacology, assessment finding, and
management for patients who have taken the
following drugs or been exposed to the
following substances:
 Drugs abused for sexual purposes/sexual
gratification
 Metal
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
97
Respiratory
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression and implement a comprehensive treatment/disposition plan for a patient
with a respiratory complaint.
TARGET SKILLS: Anatomy, signs, symptoms, and management of respiratory emergencies including
those that affect the upper and lower airway.
Anatomy, physiology, pathophysiology, assessment, and management of:
 Epiglottitis
 Pertussis
 Spontaneous pneumothorax
 Cystic fibrosis
 Pulmonary edema
 Pulmonary embolism
 Asthma
 Pneumonia
 Chronic obstructive pulmonary disease
 Viral respiratory infections
 Environmental/industrial exposure
 Obstructive/restrictive disease
 Toxic gas
 Pneumonia
Anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis,
and management of:
 Acute upper airway infections
 Spontaneous pneumothorax
 Pulmonary infections
 Neoplasm
Key Terminology:
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Ventilation
Hypoventilate
Retractions
Guillain-Barré syndrome
Botulism
Carpopedal spasm
Kussmaul respirations
Alveoli
Turbinates
Tracheotomy
Epistaxis
Oropharynx
Edema
Augioedems
Larynx
Glottis
Arytenoid cartilages
Piriform fossae
Cricoid cartilage
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Cricothyroid membrane
Tracheostomy
Carina
Cilia
Parenchyma
Goblet cells
Smooth muscle
Gas exchange
Surfactant
Shunt
Hypoxia
Polycythemia
Cor pulmonale
Dead space
Tidal volume (VT)
Restrictive lung diseases
Hemoglobin
Hering-Breuer reflex
Diuresis
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Paroxysmal nocturnal
dyspnea
Adventitious
Crackles
Monophonic
Polyphonic
Rales
Rhonchi
Snoring
Stridor
Tuberculosis
Purulent
Beta-2 agonist
Fowler’s position
Jugular venous distention
Tactile fremitus
Pulsus paradoxus
End-tidal carbon dioxide
Waveform capnography
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Spacers
Orthopnea
Laryngotracheobronchitis
Pneumonitis
Aspiration
Pseudomembrane
Palatine tonsils
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Pneumonia
Status asthmaticus
Reactive airway disease
Bronchospasm
Chronic bronchitis
Hypoxic drive
Atelectasis
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Hemoptysis
Metastasis
Pleural effusion
Greenfield filter
Cape cyanosis
Objectives:
DOT Objectives
 List the structure and function of the
respiratory system.
 State the signs and symptoms of a patient with
breathing difficulty.
 Describe the emergency medical care of the
patient with breathing difficulty.
 Recognize the need for medical direction to
assist in the emergency medical care of the
patient with breathing difficulty.
 Describe the emergency medical care of the
patient with breathing distress.
 Establish the relationship between airway
management and the patient with breathing
difficulty.
 List signs of adequate air exchange.
 State the generic name, medication forms,
dose, administration, action, indications, and
contraindications for the prescribed inhaler.
 Distinguish between the emergency medical
care of the infant, child, and adult patient with
breathing difficulty.
 Differentiate between upper airway
obstruction and lower airway disease in the
infant and child patient.
 Defend Paramedic treatment regimens for
various respiratory emergencies.
 Explain the rationale for administering an
inhaler.
 Demonstrate the emergency medical care for
breathing difficulty.
EMS Education Standards
 Understand, demonstrate, and discuss the
assessment findings with principles of
anatomy, physiology, electrophysiology,
epidemiology, pathophysiology psychosocial
impact, presentations, prognosis, and
management of a patient with a respiratory
emergency to include:
 General system pathophysiology,
assessment and management
 Upper airway disease
 Lower airway disease
 Epiglottitis
 Spontaneous pneumothorax
 Obstructive/restrictive lung disease
 Pulmonary infections
 Pneumonia
 Pulmonary edema
 Asthma
 Environmental/industrial exposure
 Toxic gas
 Neoplasm
 Pertussis
 Cystic Fibrosis
 Pulmonary embolism
 Viral respiratory infections
 Hyperventilation syndrome.
 Differentiate and formulate age related
variations as it pertains to the management of
respiratory emergencies.
 Discuss considerations of patient with
Respiratory Emergencies as it pertains to
communication and documentation,
transport decisions, patient education, and
prevention.
99
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
100
Hematology
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression and implement a comprehensive treatment/disposition plan for a patient
with a hematological complaint.
TARGET SKILLS: Anatomy, physiology, epidemiology, pathophysiology, psychosocial impact,
presentations, prognosis, assessment, and management of:
 Sickle cell crisis
 Lymphomas
 Clotting disorders
 Red blood cell disorders
 Blood transfusion complications
 White blood cell disorders
 Coagulopathies
 Hemostatic disorders
Key Terminology:
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Hematologic disorder
Hemolytic disorders
Hemostatic disorders
Hematopoietic system
Antibodies
Plasma
Erythrocytes
Leukocytes
Thrombocytes
Hemoglobin
Hematocrit
Stem cells
Hemostasis
Clotting factors
Antigens
Autoimmune disease
Humoral immunity
Cell-mediated immunity
ABO system
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Coagulation
Vasoconstriction
Clotting cascade
Coagulopathy
Sickle cell disease
Aplastic crisis
Hemolytic crisis
Sickle cell crisis
Vasoocclusive crisis
Acute chest syndrome
Splenic sequestration
crisis
Acute splenic
sequestration syndrome
Anemia
Iron deficiency anemia
Thalassemia
Leukopenia
Thrombocytopenia
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Petechiae
Leukemia
Lymphoid system
Lymphoblasts
Lymphomas
Polycythemia
Pruritus
Disseminated
intravascular coagulation
(DIC)
Hemophilia
Melena
Multiple myeloma
Neoplastic cells
Transfusion reactions
Transfusion-related lung
injury
Objectives:
DOT Objectives
 Integrate the pathophysiological principles of
the hematopoietic system to formulate a field
impression and implement a treatment plan.
 Explain the significance of the hematocrit
with respect to red cell size and number.
 Explain the correlation of the RBC count,
hematocrit, and hemoglobin values.
 Define anemia.
EMS Education Standards
 Understand, demonstrate, and discuss the
assessment findings with principles of
anatomy, physiology, electrophysiology,
epidemiology, pathophysiology psychosocial
impact, presentations, prognosis, and
management of a patient with a major
hematological disease and/or emergency to
include:
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Describe normal white blood cell (WBC)
production, function, and destruction.
Identify the characteristics of the
inflammatory process.
Identify the difference between cellular and
humoral immunity.
Identify alterations in immunologic response.
Describe platelets with respect to normal
function, life span and numbers.
Describe the components of the hemostatic
mechanism.
Describe the function of coagulation factors,
platelets and blood vessels necessary for
normal coagulation.
Describe the intrinsic and extrinsic clotting
systems with respect to identification of
factor deficiencies in each stage.
Identify blood groups.
Describe how acquired factor deficiencies
may occur.
Define fibrinolysis.
Describe the pathology and clinical
manifestations and prognosis associated with:
 Anemia
 Leukemia
 Lymphomas
 Polycythemia
 Disseminated intravascular
coagulopathy
 Hemophilia
 Sickle cell disease
 Multiple myeloma
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 Sickle cell disease
 Hematological conditions
 Blood transfusion complications
 Hemostatic disorders
 Lymphomas
 Red blood cell disorders
 White blood cell disorders
 Coagulopathies.
Differentiate and formulate age related
variations as it pertains to the management of
hematological emergencies.
Discuss considerations of patient with
hematological emergencies as it pertains to:
 Communication
 Documentation
 Transport decisions
 Patient education
 Prevention
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
102
Genitourinary/Renal
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression and implement a comprehensive treatment/disposition plan for a patient
with a Genitourinary/Renal complaint.
TARGET SKILLS: Blood pressure assessment in hemodialysis patients. Anatomy, physiology,
pathophysiology, assessment, and management of complications related to:
 Renal dialysis
 Urinary catheter management (not insertion)
 Kidney stones
Anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis,
and management of:
 Complications of
 Acid base disturbances
 Acute renal failure
 Fluid and electrolyte
 Chronic renal failure
 Infection
 Dialysis
 Male genital tract conditions
 Renal calculi
Key Terminology:
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Kidneys
Urine
Ureters
Urinary bladder
Urethra
Hilus
Renal fascia
Cortex
Medulla
Renal pyramids
Renal columns
Renal pelvis
Calyces
Afferent arteriole
Glomerulus
Efferent arteriole
Peritubular capillaries
Nephrons
Glomerular (Bowman’s)
capsule
Proximal convoluted
tubule (PCT)
Loop of Henle
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Distal convoluted tubule
(DCT)
Podocytes
Glomerular filtration rate
(GFR)
Vasa recta
Countercurrent
multiplier
Juxtaglomerular
apparatus
Renin
Antidiuretic hormone
(ADH)
Aldosterone
Adrenal glands
Diuretics
Micturition reflex
Visceral pain
Referred pain
Urinary tract infections
(UTIs)
Pyelonephritis
Urinary incontinence
Kidney stones
Hematuria
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Acute renal failure (ARF)
Oliguria
Anuria
Prerenal ARF
Intrarenal acute renal
failure (IARF)
Interstitial nephritis
Postrenal AF=RF
Chronis renal failure
(CRF)
Uremia
Azotemia
Uremic frost
End-stage renal disease
(ESRD)
Renal dialysis
Internal shunt
Disequilibration
syndrome
Air embolism
Epididymitis
Orchitis
Fournier gangrene
Priapism
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Phimosis
Paraphimosis
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Benign prostate
hypertrophy (BPH)
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Testicular torsion
Objectives:
DOT Objectives
 Integrate pathophysiological principles and
the assessment findings to formulate a field
impression and implement a treatment plan
for the patient with a renal or urologic
problem.
 Apply the epidemiology to develop
prevention strategies for urological
emergencies.
EMS Education Standards
 Understand, demonstrate, and discuss the
assessment findings with principles of
anatomy, physiology, electrophysiology,
epidemiology, pathophysiology psychosocial
impact, presentations, prognosis, and
management of a patient with
Genitourinary/renal emergencies to include:
 Acute renal failure
 Chronic renal failure
 Dialysis
 Renal calculi
 Acid base disturbances
 Fluid and electrolyte
 Infection
 Male genital tract conditions.
 Differentiate and formulate age related
variations as it pertains to the management of
genitourinary/renal emergencies.
 Discuss considerations of patient with
genitourinary/renal emergencies as it pertains
to communication, documentation, transport
decisions, patient education, and prevention.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
104
Gynecology
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression and implement a comprehensive treatment/disposition plan for a patient
with a gynecological complaint.
TARGET SKILLS: Recognition and management of shock associated with vaginal bleeding. Anatomy,
physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis, assessment
findings, and management of:
 Sexual assault (to include appropriate emotional support)
 Vaginal bleeding
 Infections
 Pelvic Inflammatory Disease
 Ovarian cysts
 Dysfunctional uterine bleeding
 Vaginal foreign body
Key Terminology:
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Pudendum
Mons pubis
Labia majora
Labia minora
Perineum
Clitoris
Prepuce
Vestibule
Vagina
Bartholin glands
Hymen
Imperforate hymen
Ovary
Oocyte
Fallopian tube
Uterus
Menstruation
Menstrual cycle
Cervix
Proliferative phase
Secretory phase
Menarche
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Menopause
Premenstrual syndrome
(PMS)
Amenorrhea
Gravida
Para
Dysmenorrhea
Vaginal bleeding
Dysfunctional uterine
bleeding
Hypermenorrhea
Polymenorrhea
Metrorrhagia
Ectopic pregnancy
Hemoperitoneum
Endometritis
Endometrium
Endometriosis
Pelvic inflammatory
disease (PID)
Contraceptive device
Vaginitis
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Vaginal yeast infections
Vulvovaginitis
Gardnerella vaginitis
Ovarian cyst
Ovarian torsion
Tubo-ovarian abscess
Ruptured ovarian cyst
Prolapsed uterus
Toxic shock syndrome
(TSS)
Bacterial vaginosis
Chancroid
Chlamydia
Cytomegalovirus (CMV)
Genital herpes
Gonorrhea
Genital warts
Syphilis
Trichomoniasis
Sexual assault
Rape
Objectives:
DOT Objectives
 Describe the anatomy and physiology of the
female reproductive system including the
developmental changes that occur during
puberty and menopause
 Describe the gynecological emergencies,
Including their causes, risk factors,
assessment findings, and patient
management considerations
 Discuss the importance of patient privacy and
communication of the gynecological patient
 Assessment and scene management of a
sexual assault/rape patient
EMS Education Standards
 Understand, demonstrate, and discuss the
assessment findings with principles of
anatomy, physiology, electrophysiology,
epidemiology, pathophysiology psychosocial
impact, presentations, prognosis, and
management of a patient with common or
major gynecological diseases and/or
emergencies to include:
 Vaginal bleeding
 Sexual assault
 Infection (including pelvic inflammatory
disease, Bartholi’s abscess, and
vaginitis/vulvovaginitis)
 Ovarian cyst and ruptured ovarian cyst
 Ovarian torsion
 Endometriosis
 Dysfunctional uterine bleeding
 Prolapsed uterus
 Vaginal foreign body.
 Differentiate and formulate age related
variations as it pertains to the management of
common or major gynecological diseases
and/or emergencies.
 Discuss considerations of patient with as it
pertains to common or major gynecological
diseases and/or emergencies communication,
documentation, transport decisions, patient
education, and prevention.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
106
Non-Traumatic Musculoskeletal Disorders
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression and implement a comprehensive treatment/disposition plan for a patient
with a non-traumatic musculoskeletal disorder complaint.
TARGET SKILLS: Anatomy, physiology, epidemiology, pathophysiology, psychosocial impact,
presentations, prognosis, assessment, and management of:
 Non-traumatic fractures
 Disorders of the spine
 Joint abnormalities
 Muscle abnormalities
 Overuse syndromes
Objectives:
DOT Objectives
 Integrate pathophysiological principles and
the assessment findings to formulate a field
impression and implement the treatment
plan for the patient with a musculoskeletal
injury.
 Predict injuries based on the mechanism of
injury, including:
 Direct
 Indirect
 Pathologic
 List the six "P"s of musculoskeletal injury
assessment.
EMS Education Standards
 Understand, demonstrate, and discuss the
assessment findings with principles of
anatomy, physiology, epidemiology,
pathophysiology psychosocial impact,
presentations, prognosis, and management of
a patient with common or major nontraumatic musculoskeletal disorders to
include:
 Bony abnormalities (including
osteomyelitis and tumors)
 Disorders of the spine (including disc
disorders, low back pain (cauda equine
syndrome, sprain, strain)
 Joint abnormalities (including arthritis
(septic, gout, rheumatoid, osteoarthritis)
and slipped capital femoral epiphysis)
 Muscle abnormalities (myalgia/myositis,
rhabdomyolsis)
 Overuse syndromes (including bursitis,
muscle strains, peripheral nerve
syndrome, carpal tunnel syndrome,
tendonitis)
 Soft tissue infections (fascitis, gangrene,
paronychia, flexor tenosynovitis of the
hand).
 Differentiate and formulate age related
variations as it pertains to the management of
common or major non-traumatic
musculoskeletal disorders.
 Discuss considerations of patient as it pertains
107
to:
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Common or major non-traumatic
musculoskeletal disorders
Communication
Documentation
Transport decisions
Patient education
Prevention.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
108
Diseases of the Eyes, Ears, Nose and Throat
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression and implement a comprehensive treatment/disposition plan for a patient
with a Disease of the Eyes, Ears, Nose and Throat complaint.
TARGET SKILLS: Recognition and management of nose bleed. Knowledge of anatomy, physiology,
epidemiology, pathophysiology, psychosocial impact, presentations, prognosis, and management of
common or major diseases of the eyes, ears, nose, and throat including nose bleed.
Key Terminology:
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Globe
Oculomotor nerve
Optic nerve
Sclera
Cornea
Cataract
Conjunctiva
Iris
Pupil
Lens
Retina
Anterior chamber
Aqueous humor
Posterior chamger
Vitreous humor
Visual cortex
Central vision
Peripheral vision
Lacrimal apparatus
Nasolacrimal duct
Diabetic retinopathy
Dysconjugate gaze
Adnexa
Conjunctivitis
Sympathetic eye
movement
Chalazion
Hordeolum
Glaucoma
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Hyphema
Iritis
Papilledema
Retinal detachment
Periorbital cellulitis
Orbital cellulitis
External ear
Middle ear
Inner ear
Auricle
Pinna
External auditory canal
Tympanic membrane
Ossicles
Cochlear duct
Oval window
Cochlea
Organ of Corti
Battle sign
Cerumen
Labyrinthitis
Meniere disease
Vertigo
Tinnitus
Otitis
Nasal septum
Turbinates
Paranasal sinuses
Epistaxis
109
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Cerebrospinal
rhinorrhea
Rhinitis
Sinusitis
Crown
Cusps
Pulp
Dentin
Alveoli
Alveolar ridges
Mastication
Hypoglossal nerve
Glossopharyngeal nerve
Trigeminal nerve
Dentalgia
Dental abscess
Oral candidiasis
Ludwig angina
Epiglottis
Dysphagia
Laryngitis
Tracheitis
Tonsillitis
Pharyngitis
Peritonsillar abscess
Temporomandibular
joint disorder
Objectives:
DOT Objectives

Demonstrate the care of the patient
exhibiting signs and symptoms of a
nose bleed/epistaxis
EMS Education Standards
 Understand, demonstrate, and discuss the
assessment findings with principles of
anatomy, physiology, epidemiology,
pathophysiology psychosocial impact,
presentations, prognosis, and management of
a patient with common or major diseases of
the eyes, ears, nose, and throat including
nose bleed.
 Differentiate and formulate age related
variations as it pertains to the management of
common or major diseases of the eyes, ears,
nose and throat including nose bleed.
 Discuss considerations of patient with
common or major diseases of the eyes, ears,
nose, and throat including nose bleed as it
pertains to:
 Communication
 Documentation
 Transport decisions
 Patient education
 Prevention.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
110
Shock and Resuscitation
Summary: Integrate comprehensive knowledge of causes and pathophysiology into the management of
cardiac arrest and peri-arrest states. Integrate a comprehensive knowledge of the causes and
pathophysiology into the management of shock, respiratory failure, or arrest with an emphasis on early
intervention to prevent arrest. Integrate assessment findings with principles of epidemiology and
pathophysiology to formulate a field impression to implement a comprehensive treatment/disposition
plan for an acutely injured patient.
Key Terminology:
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Anaphylactic shock
Anaphylaxis
Autonomic nervous
system
Baroreceptors
Cardiac output (CO)
Cardiac tamponade
Cardiogenic shock
Chemoreceptors
Chronotropic effects
Compensated shock
Cyanosis
Decompensated
shock
Dehydration
Distributive shock
Dromotropic effects
Edema
Fick principle
Homeostasis
Hypothermia
Hypovolemic shock
Inotropic effects
Irreversible shock
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Mean arterial
pressure (MAP)
Multiple-organ
dysfunction
syndrome (MODS)
Myocardial
contractility
Neurogenic shock
Obstructive shock
Orthostatic vital
signs
Perfusion
Preload
Psychogenic shock
Pulse pressure
Sensitization
Septic shock
Shock
Sphincters
Syncope
Systemic vascular
resistance (SVR)
Tension
pneumothorax
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Abdominal thrust
maneuver
Advanced life
support (ALS)
Basic life support
(BLS)
Cardiopulmonary
resuscitation (CPR)
Chest thrust
Gastric distention
Head-tilt chin-lift
maneuver
Impedance threshold
device (ITD)
Jaw-thrust maneuver
Load-distributing
band (LDB)
Mechanical piston
device
Recovery position
Return of
spontaneous
circulation (ROSC
Objectives:
DOT Objectives
 Describe the epidemiology, including the
morbidity, mortality and prevention
strategies for shock and hemorrhage.
 Discuss the various types and degrees of
hemorrhage and shock.
 Discuss the pathophysiology of hemorrhage
and shock.
EMS Education Standards
 Understand, discuss, and demonstrate
comprehensive knowledge of causes and
pathophysiology into the management of
cardiac arrest and peri-arrest states, shock,
respiratory failure or arrest with an emphasis
on early intervention to prevention arrest to
include:
111
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Discuss the assessment findings associated
with hemorrhage and shock.
Identify the need for intervention and
transport of the patient with hemorrhage or
shock.
Discuss the treatment plan and management
of hemorrhage and shock.
Discuss the management of external and
internal hemorrhage.
Differentiate between controlled and
uncontrolled hemorrhage.
Differentiate between the administration rate
and amount of IV fluid in a patient with
controlled versus uncontrolled hemorrhage.
Relate internal hemorrhage to the
pathophysiology of compensated and
decompensated hypovolemic shock.
Relate internal hemorrhage to the
assessment findings of compensated and
decompensated hypovolemic shock.
Describe the body's physiologic response to
changes in perfusion.
Describe the effects of decreased perfusion at
the capillary level.
Discuss the cellular ischemic phase related to
hemorrhagic shock.
Discuss the capillary stagnation phase related
to hypovolemic shock.
Discuss the capillary washout phase related
to hypovolemic shock.
Discuss the assessment findings of
hypovolemic shock.
Relate pulse pressure changes to perfusion
status.
Define compensated and decompensated
shock.
Discuss the pathophysiological changes
associated with compensated shock.
Discuss the assessment findings associated
with compensated shock.
Identify the need for intervention and
transport of the patient with compensated
shock.
Discuss the treatment plan and management
of compensated shock.
Discuss the pathophysiological changes
associated with decompensated shock.
112
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Ethical issues in resuscitation
Pre-morbid conditions
Anatomy and physiology review
Physiology of normal blood flow
Physiology of blood flow during CPR
Cardiac arrest
Resuscitation
Automated external defibrillation
Advanced life support
Special arrest and peri-arrest situations
Post-resuscitation support
Shock
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Discuss the assessment findings associated
with decompensated shock.
Identify the need for intervention and
transport of the patient with decompensated
shock.
Discuss the treatment plan and management
of the patient with decompensated shock.
Differentiate between compensated and
decompensated shock.
Relate external hemorrhage to the
pathophysiology of compensated and
decompensated hypovolemic shock.
Relate external hemorrhage to the
assessment findings of compensated and
decompensated hypovolemic shock.
Differentiate between the normotensive,
hypotensive, and profoundly hypotensive
patient.
Differentiate between the administration of
fluid in the normotensive, hypotensive, and
profoundly hypotensive patient.
Discuss the physiologic changes associated
with the pneumatic anti-shock garment
(PASG).
Discuss the indications and contraindications
for the application and inflation of the PASG.
Apply epidemiology to develop prevention
strategies for hemorrhage and shock.
Integrate the pathophysiological principles to
the assessment of a patient with hemorrhage
or shock.
Synthesize assessment findings and patient
history information to form a field impression
for the patient with hemorrhage or shock.
Develop, execute, and evaluate a treatment
plan based on the field impression for the
hemorrhage or shock patient.
Differentiate between the management of
compensated and decompensated shock.
Demonstrate the assessment of a patient
with signs and symptoms of hypovolemic
shock.
Demonstrate the management of a patient
with signs and symptoms of hypovolemic
shock.
Demonstrate the assessment of a patient
with signs and symptoms of compensated
113
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hypovolemic shock.
Demonstrate the management of a patient
with signs and symptoms of compensated
hypovolemic shock.
Demonstrate the assessment of a patient
with signs and symptoms of decompensated
hypovolemic shock.
Demonstrate the management of a patient
with signs and symptoms of decompensated
hypovolemic shock.
Demonstrate the assessment of a patient
with signs and symptoms of:
 External hemorrhage
 Internal hemorrhage
Demonstrate the management of a patient
with signs and symptoms of:
 External hemorrhage
 Internal hemorrhage
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
114
Responding to the Field Code
Summary: Integrate comprehensive knowledge of causes and pathophysiology into the management of
cardiac arrest and peri-arrest states. Integrate a comprehensive knowledge of the causes and
pathophysiology into the management of shock, respiratory failure, or arrest with an emphasis on early
intervention to prevent arrest. Integrate assessment findings with principles of epidemiology and
pathophysiology to formulate a field impression to implement a comprehensive treatment/disposition
plan for an acutely injured patient.
Key Terminology:
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Asynchronous
Automated external
defibrillator (AED)
Code team leader
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Code team member
Defibrillation
Manual defibrillation
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Return of spontaneous
circulation (ROSC)
SMART
Objectives:
DOT Objectives
 Apply concepts of anatomy and physiology
of the circulatory system to explain the
disruption of homeostasis that occurs in
the face of hemorrhage as well as the
body’s compensatory mechanisms for
attempting to maintain homeostasis.
 Describe the characteristics and concerns
associated with venous, arterial, and
capillary bleeding.
 Describe the process of hemostasis and
factors that can affect it.
 Given a variety of scenarios involving
external hemorrhage, demonstrate
appropriate measures to control it.
 Describe the indications, applications,
benefits, and consequences of tourniquet
use.
 Identify internal hemorrhage.
 Develop appropriate patient management
plans for patients with internal
hemorrhage
 Describe the pathophysiology and findings
associated with the four classes of
hemorrhage
 Describe the effects of hemorrhage on
categories of special patients, such as
pregnant women, athletes, obese patients,
children, and the elderly.
EMS Education Standards
Integrate comprehensive knowledge of causes and
pathophysiology into the management of cardiac
arrest and peri-arrest states. Integrate a
comprehensive knowledge of the causes and
pathophysiology into the management of shock,
respiratory failure, or arrest with an emphasis on
early intervention to prevent arrest. Integrate
assessment findings with principles of
epidemiology and pathophysiology to formulate a
field impression to implement a comprehensive
treatment/disposition plan for an acutely injured
patient.
115
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Describe the events of shock at the cellular
level.
Describe the cardiovascular events that
take place in shock.
Describe the transition from compensated
to decompensated to irreversible shock.
Describe each of the following
mechanisms of shock:
 Hypovolemic
 Cardiogenic
 Neurogenic
 anaphylactic
Demonstrate assessments that can
identify patients with hemorrhage and
shock
Demonstrate management plans for
patients with hemorrhage and shock.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
116
Management and Resuscitation of the Critical Patient
Summary: Integrate comprehensive knowledge of causes and pathophysiology into the management of
cardiac arrest and peri-arrest states. Integrate a comprehensive knowledge of the causes and
pathophysiology into the management of shock, respiratory failure, or arrest with an emphasis on early
intervention to prevent arrest. Integrate assessment findings with principles of epidemiology and
pathophysiology to formulate a field impression to implement a comprehensive treatment/disposition
plan for an acutely injured patient.
Key Terminology:
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Aerobic metabolism
Afterload
Anaerobic metabolism
Anaphylactic shock
Anchoring bias
Angioedema
Baroreceptors
Capacitance vessels
Cardiac output (CO)
Cardiogenic shock
Cardiovascular collapse
Central shock
Chemoreceptors
Chronotropic effect
Compensated shock
Confirmation bias
Critical patients
Decompensated shock
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Differential field
diagnosis
Diffusion
Distributive shock
Dromotropic effect
Fick principle
Hypoperfusion
Hypovikemic shick
Inotropic effect
Irreversible shock
Mean arterial pressure
(MAP)
Multiple-organ
dysfunction syndrome
(MODS)
Myocardial contractility
Neurogenic shock
Non-hemorrhagic shock
Obstructive shock
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Orthostatic hypotension
Perfusion
Peri-arrest period
Peripheral shock
Preload
Premorbid condition
Psychogenic shock
Pulse pressure
Resistance vessels
Sensitization
Septic shock
Shock
Sphincters
Spinal shock
Stroke volume (SV)
Systemic vascular
resistance (SVR)
Objectives:
DOT Objectives
No prior DOT objectives found
EMS Education Standards
 Integrate comprehensive knowledge of causes
and pathophysiology into the management of
cardiac arrest and peri-arrest states.
 Integrate a comprehensive knowledge of the
causes and pathophysiology into the
management of shock, respiratory failure, or
arrest with an emphasis on early intervention
to prevent arrest.
 Integrate assessment findings with principles
of epidemiology and pathophysiology to
formulate a field impression to implement a
comprehensive treatment/disposition plan for
an acutely injured patient.
117
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
118
Trauma
Trauma Overview
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression to implement a comprehensive treatment/disposition plan for an acutely
injured patient.
TARGET SKILLS: Pathophysiology, assessment, and management of the trauma patient to include:
 Trauma scoring
 Rapid transport and destination issues
 Transport mode
 Transport and destination issues
Key Terminology:
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Acceleration (a)
Angle of impact
Arterial air embolism
Avulsing
Barometric energy
Biomechanics
Blast front
Blunt trauma
Brisance
Cavitation
Chemical energy
Deceleration
Electrical energy
Entry wound
Exit wounds
Gravity (g)
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Implosion
Index of suspicion
Kinetic energy (KE)
Kinetics
Law of conservation of
energy
Mechanical energy
Mechanism of injury
(MOI)
Missile fragmentation
Multisystem trauma
Negative wave pulse
Newton’s first law of
motion
Newton’s second law of
motion
Pathway expansion
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Penetrating trauma
Permanent cavity
Positive wave pulse
Potential energy
Pulmonary blast injuries
Revised trauma score
(RTS)
Shearing
Spelling
Trauma
Trauma score
Tympanic membrane
Velocity (V)
Waddell triad
Whiplash
Objectives:
DOT Objectives
 Integrate the principles of kinematics to
enhance the patient assessment and predict
the likelihood of injuries based on the
patient’s mechanism of injury.
 List and describe the components of a
comprehensive trauma system.
 Describe the role of and differences between
levels of trauma centers.
 Describe the criteria and procedure for air
medical transport.
EMS Education Standards
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119
Understand, discuss, and demonstrate
assessment findings with principles of
epidemiology and pathophysiology to
formulate a field impression to implement a
comprehensive treatment/disposition plan
for an acutely injured patient to include:
 Identification and categorization of
trauma patients, specifically the
national trauma triage protocol
 Incidence/significance of trauma
 Trauma system
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Define energy and force as they relate to
trauma.
Define laws of motion and energy and
understand the role that increased speed has
on injuries.
Describe each type of impact and its effect on
unrestrained victims (e.g., down and under,
up and over, compression, deceleration).
Describe the pathophysiology of the head,
spine, thorax, and abdomen that result from
the above forces.
List specific injuries and their causes as
related to interior and exterior vehicle
damage.
Describe the kinematics of penetrating
injuries.
List the motion and energy considerations of
mechanisms other than motor vehicle
crashes.
Define the role of kinematics as an additional
tool for patient assessment.
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 Types of injury
 Trauma assessment
 Role of documentation in trauma
 Trauma scoring scales
 Trauma center designations
Transfer of patients to the most appropriate
hospital.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
120
Bleeding
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression to implement a comprehensive treatment/disposition plan for an acutely
injured Bleeding patient.
TARGET SKILLS: Recognition, pathophysiology, assessment, and management of bleeding and fluid
resuscitation.
Key Terminology:
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Afterload
Blood
Cardiac output (CO)
Compensated shock
(classes I and II)
Decompensated shick
(class III)
Ejection fraction (EF)
Erythrocytes
Hematemesis
Hematochezia
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Hematocrit
Hematuria
Hemoglobin
Hemophilia
Hemoptysis
Hemorrhage
Hemorrhagic shock
Hemostasis
Hematoma
Hypoperfusion
Hypovolemic shock
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Irreversible shock (class
IV)
Leukocytes
Melena
Perfusion
Plasma
Platelets
Preload
Shock
Stroke volume (SV)
Objectives:
DOT Objectives
 List the structure and function of the
circulatory system.
 Differentiate between arterial, venous, and
capillary bleeding.
 State methods of emergency medical care of
external bleeding.
 Establish the relationship between body
substance isolation and bleeding.
 Establish the relationship between airway
management and the trauma patient.
 Establish the relationship between
mechanism of injury and internal bleeding.
 List the signs of internal bleeding.
 List the steps in the emergency medical care
of the patient with signs and symptoms of
internal bleeding.
 List signs and symptoms of shock
(hypoperfusion).
 State the steps in the emergency medical
care of the patient with signs and symptoms
EMS Education Standards

121
Understand, discuss, and demonstrate
assessment findings with principles of
epidemiology and pathophysiology to
formulate a field impression to implement a
comprehensive treatment/disposition plan for
an acutely injured patient with bleeding to
include:
 Classifications of shock
 Assessment consideration in shock
 Shock management strategies and
considerations
 Bleeding considerations
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of shock (hypoperfusion).
Explain the sense of urgency to transport
patients that are bleeding and show signs of
shock (hypoperfusion).
Demonstrate direct pressure as a method of
emergency medical care of external bleeding.
Demonstrate the use of diffuse pressure as a
method of emergency medical care of
external bleeding
Demonstrate the use of pressure points and
tourniquets as a method of emergency
medical care of external bleeding.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
122
Chest Trauma
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression to implement a comprehensive treatment/disposition plan for an acutely
injured Chest Trauma patient.
TARGET SKILLS: Recognition, pathophysiology, assessment, and management of:
 Blunt versus penetrating mechanisms
 Rib fractures
 Open chest wound
 Flail chest
 Impaled object
 Commotio cordis
 Blunt versus penetrating mechanisms
 Traumatic aortic disruption
 Hemothorax
 Pulmonary contusion
 Pneumothorax
 Blunt cardiac injury
 Open
 Traumatic asphyxia
 Simple
 Tracheobronchial disruption
 Tension
 Diaphragmatic rupture
 Cardiac tamponade
Key Terminology:
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Angle of Louis
Atelectasis
Cardiac tamponade
Clavicle
Commotion cordis
Crepitus
Diaphragm
Emphysema
exophthalmos
Flail chest
Hemopneumothorax
Hemothorax
intercoastal space
Jugular vein distention
(JVD)
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Manubrium
Mediastinum
Myocardial contusion
Myocardial rupture
Needle decompression
Neurovascular bundle
Open pneumothorax
Pericardial sac
Pericardiocentesis
Pericardium
Pleura
Pneumothorax
Pulmonary contusion
Pulsus paradoxus
Scapula
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Sternum
Subconjunctival
hematcoma
Subcutaneous
Suprasternal notch
Tension pneumothorax
Thoracic inlet
Thorax
Traumatic aortic
disruption
Traumatic asphyxia
Xiphoid process
Objectives:
DOT Objectives
 Describe the incidence, morbidity, and
mortality of thoracic injuries in the trauma
patient.
 Discuss the anatomy and physiology of the
organs and structures related to thoracic
injuries.
 Predict thoracic injuries based on mechanism
EMS Education Standards
123
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Understand, discuss, and demonstrate
assessment findings with principles of
epidemiology and pathophysiology to
formulate a field impression to implement a
comprehensive treatment/disposition plan
for an acutely injured patient with chest
trauma to include:
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of injury.
Discuss the types of thoracic injuries.
Discuss the pathophysiology of thoracic
injuries.
Discuss the assessment findings associated
with thoracic injuries.
Discuss the management of thoracic injuries.
Identify the need for rapid intervention and
transport of the patient with thoracic injuries.
Discuss the epidemiology and
pathophysiology of specific chest wall
injuries, including:
 Rib fracture
 Flail segment
 Sternal fracture
Discuss the assessment findings associated
with chest wall injuries.
Identify the need for rapid intervention and
transport of the patient with chest wall
injuries.
Discuss the management of chest wall
injuries.
Discuss the pathophysiology of injury to the
lung, including:
 Simple pneumothorax
 Open pneumothorax
 Tension pneumothorax
 Hemothorax
 Hemopneumothorax
 Pulmonary contusion
Discuss the assessment findings associated
with lung injuries.
Discuss the management of lung injuries.
Identify the need for rapid intervention and
transport of the patient with lung injuries.
Discuss the pathophysiology of myocardial
injuries, including:
 Pericardial tamponade
 Myocardial contusion
Discuss the assessment findings associated
with myocardial injuries.
Discuss the management of myocardial
injuries.
Identify the need for rapid intervention and
transport of the patient with myocardial
injuries.
Discuss the pathophysiology of vascular
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124
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 Incidence of chest trauma
 Traumatic aortic disruption
 Pulmonary contusions
 Blunt cardiac injury
 Hemothorax
 Pneumothorax
 Cardiac tamponade
 Rib fractures
 Flail chest
 Commotio cordis
 Tracheobronchial disruption
 Diaphragmatic rupture
 Traumatic asphyxia.
Differentiate and formulate age related
variations as it pertains to the management of
the patient with chest trauma.
Discuss considerations of patient with chest
trauma as it pertains to:
 Communication
 Documentation
 Transport decisions
 Patient education
 Prevention
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injuries, including injuries to:
 Aorta disection/rupture
 Vena cava
 Pulmonary arteries/ veins
Discuss the assessment findings associated
with vascular injuries.
Discuss the management of vascular injuries.
Discuss the pathophysiology of diaphragmatic
injuries.
Discuss the assessment findings associated
with diaphragmatic injuries.
Discuss the management of diaphragmatic
injuries.
Discuss the pathophysiology of esophageal
injuries.
Discuss the assessment findings associated
with esophageal injuries.
Discuss the management of esophageal
injuries.
Discuss the pathophysiology of tracheobronchial injuries.
Discuss the assessment findings associated
with tracheo-bronchial injuries.
Discuss the management of tracheo-bronchial
injuries.
Discuss the pathophysiology of traumatic
asphyxia.
Discuss the assessment findings associated
with traumatic asphyxia.
Discuss the management of traumatic
asphyxia.
Differentiate between thoracic injuries based
on the assessment and history.
Value the implications of failing to initiate
timely interventions to patients with thoracic
trauma.
Demonstrate a clinical assessment for a
patient with suspected thoracic trauma.
Demonstrate the following techniques of
management for thoracic injuries:
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Needle decompression
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Fracture stabilization
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ECG monitoring
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Oxygenation and ventilation
125
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
126
Abdominal and Genitourinary Trauma
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression to implement a comprehensive treatment/disposition plan for an acutely
injured Abdominal and Genitourinary Trauma patient.
TARGET SKILLS: Recognition, pathophysiology, assessment, and management of:
 Blunt versus penetrating mechanisms
 Vaginal bleeding due to trauma
 Evisceration
 Sexual assault
 Impaled object
 Vascular injury
 Retroperitoneal injuries
 Solid and hollow organ injuries
 Injuries to the external genitalia
Key Terminology:
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Blunt trauma
Closed abdominal injury
Duodenum
evisceration
Hematuria
Hemoperitoneum
Kehr sign
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Mesentery
Open abdominal injury
Penetrating trauma
Peritoneal space
Peritoneum
Peritonitis
Periumbilical
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Pylorus
Retroperitoneal space
Somatic pain
Visceral pain
Objectives:
EMS Education Standards
DOT Objectives
 Integrate pathophysiologic principles and the
 Understand, discuss, and demonstrate
assessment findings to formulate a field
assessment findings with principles of
impression and implement the treatment
epidemiology and pathophysiology to
plan for the patient with suspected abdominal
formulate a field impression to implement a
trauma.
comprehensive treatment/disposition plan
for an acutely injured patient with abdominal
 Predict abdominal injuries based on blunt and
and genitourinary trauma to include:
penetrating mechanisms of injury.
 Incidence
 Describe the epidemiology, including the
 Vascular injury
morbidity/mortality and prevention strategies
 Solid and hollow organ injuries
for solid organ injuries.
 Blunt vs penetrating abdominal injury
 Apply the epidemiologic principles to develop
 Evisceration
prevention strategies for abdominal injuries.
 Impaled object
 Advocate the use of a thorough scene survey
 Retroperitoneal Injuries
to determine the forces involved in
 Injuries to external genitalia
abdominal trauma.
 Vaginal bleeding due to trauma
 Sexual assault.
 Differentiate and formulate age related
variations as it pertains to the management of
the patient with abdominal and genitourinary
trauma.
127
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Discuss considerations of patient with
abdominal and genitourinary trauma as it
pertains to:
 Communication
 Documentation
 Transport decisions
 Patient education
 Prevention
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
128
Orthopedic Trauma
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression to implement a comprehensive treatment/disposition plan for an acutely
injured Orthopedic Trauma patient.
TARGET SKILLS: Recognition, pathophysiology, assessment, and management of:
 Open fractures
 Pelvic fractures
 Closed fractures
 Amputations/replantation
 Dislocations
 Compartment syndrome
 Amputations/replantation
 Pediatric fractures
 Upper and lower extremity orthopedic
 Tendon laceration/transection/rupture
trauma
(Achilles and patellar)
 Sprains/strains
Key Terminology:
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6 Ps of musculoskeletal
assessment
Abduction
Acetabulum
Acromion
Adduction
Amputation
Angulation
Anterior tibial artery
Appendicular skeleton
Arthritis
Articulations
Atrophy
Avascular necrosis
Avulsion fracture
Axial skeleton
Axilla
Axillary artery
Bowing fracture
Boxer’s fracture
Brachial artery
Buckle fracture
Buddy splinting
Bursa
Bursitis
Calcaneus
Carpal tunnel syndrome
Carpals
Cartilage
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Cartilaginous joints
Cauda equine syndrome
Clavicle
Closed fracture
Comminuted fracture
Compartment syndrome
Complete fracture
Compound fracture
Crepitus
Crush syndrome
Cubital tunnel syndrome
Deep vein thrombosis
(DVT)
Depression fracture
Devascularization
Diaphysis
Diastasis
Digital arteries
Dislocation
Displaced fracture
Distraction injury
Dorsal
Dorsiflex
Endosteum
Epiphysis
Fascia
Fasciitis
Fatigue fractures
Fatigue injuries
129
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Femoral artery
Femoral shaft fractures
Femur
Fibrous joints
Fibula
Flat bones
Flexor tenosynovitis of
the hand
Fracture
Gangrene
Glenoid fossa
Gout
Greenstick fracture
Hematopoiesis
Humerus
Hypertrophy
Hyperuricemia
Ilium
Impacted fracture
Incomplete fracture
Indirect injury
Intertrochanteric
fractures
Irregular bones
Ischium
Joint
Joint capsule
Lactic acid
Lateral compression
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ligaments
Linear fracture
Long bones
Luxation
Malleolus
Mallet finger
March fractures
Medullary canal
Metacarpals
Metaphysis
Metatarsals
Muscle fatigue
Myalgia
Myositis
Neurovascular
compromise
Nondisplaced fracture
Nursemaid’s elbow
Oblique fracture
olecranon
Open-book pelvic
fracture
Open fracture
Ossification centers
Osteoarthritis (OA)
Osteoporosis
Overriding
Paresthesias
Paronychia
Patella
Pathologic fracture
Pectoral girdle
Pelvic girdle
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Periosteum
Phalanges
Physis
Plantar
Plantar flexion
Point tenderness
Polyneuropathy
Popliteal artery
Posterior tibial artery
Pronation
Pubic symphysis
Pubis
Pulmonary embolism
Radial artery
Radius
Range of motion (ROM)
Recruitment
Rhabdomyolysis
Rheumatoid arthritis (RA)
Round bones
Sacroiliac joints
Scaphoid
Scapula
Segmental fracture
Septic arthritis
Short bones
Silver fork deformity
Skeletal muscle
Slipped capital femoral
epiphysis (SCFE)
Snuffbox
Somatic motor neurons
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Spinal stenosis
Spiral fracture
Sprains
Straddle fracture
Strain
Stress fracture
Striated muscle
Subclavian artery
Subluxation
Supination
Supracondylar fractures
Synovial joints
Synovial membrane
Talus
Tarsals
Tendinitis
Tendons
Thompson test
Thromboembolic disease
Tibia
Torus fracture
Transverse fracture
Twisting injuries
Ulna
Ulnar artery
Vertical shear
volar
Volkmann ischemic
contracture
Voluntary muscle
Objectives:
DOT Objectives
 Describe the function of the musculoskeletal
system.
 Explain the anatomy and physiology of the
musculoskeletal system.
 Describe the different types of
musculoskeletal injuries including:
 Fractures
 Dislocations
EMS Education Standards
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130
Understand, discuss, and demonstrate
assessment findings with principles of
epidemiology and pathophysiology to
formulate a field impression to implement a
comprehensive treatment/disposition plan
for an acutely injured patient with
orthopedic trauma to include:
 Incidence
 Pediatric fractures
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 Amputations
 Sprains
 Strains.
Describe the four mechanisms of injury.
Differentiate between open and closed
fractures.
Explain how to assess the severity of an
injury.
Describe the treatment of a patient
experiencing an orthopedic injury.
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Tendon
lacerations/transection/rupture
(achilles and patellar)
 Open fractures
 Closed fractures
 Dislocations
 Compartment syndrome
 Upper and lower extremity orthopedic
trauma
 Pelvic fractures
 Amputations/replantation.
Differentiate and formulate age related
variations as it pertains to the management
of the patient with orthopedic trauma.
Discuss considerations of patient with
orthopedic trauma as it pertains to:
 Communication
 Documentation
 Transport decisions
 Patient education
 Prevention
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
131
Soft Tissue Overview
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression to implement a comprehensive treatment/disposition plan for an acutely
injured Soft Tissue Trauma patient.
TARGET SKILLS: Recognition, pathophysiology, assessment, and management of wounds to include:
 Avulsions
 High-pressure injection
 Bite wounds
 Burns
 Electrical
 Laceration
 Chemical
 Puncture wounds
 Thermal
 Incisions
 Radiation
 Chemicals in the eye and on the skin
 Crush syndrome
Key Terminology:
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Abrasion
Adipose
Amputation
Avulsion
Bandage
Chemotactic factors
Closed wound
Collagen
Compartment syndrome
Contusion
Crush injury
Crush syndrome
Deep fascia
Degloving
Degranulate
Dermis
Dressing
Ecchymosis
Elastin
Epidermis
Epithelialization
Erythema
Fasciotomy
Gangrene
Glomerular filtration
Granulocytes
Ground substance
Hematoma
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High-pressure injection
injuries
Homeostasis
Hyperkalemia
Hyperphosphatemia
Hypertrophic scar
Incision
Integument
Keloid scar
Laceration
Lymphangitis
Lymphocytes
Macrophages
Melanin
Mucopolysaccharidegel
Myoglobin
Necrotizing fasciitis
Neovascularization
Open wound
Pedicle
Puncture wound
Rabid
Rhabdomyolysis
Sebaceous gland
Sebum
Subcutaneous
Tension lines
Volkmann contracture
132
BURNS
 Acute radiation
syndrome
 Adipose tissue
 Burn shock
 Circumferential burns
 Collagen
 Comedo
 Consensus formula
 Contact burn
 Cutaneous
 Dermis
 Desquamation
 Elastin
 Epidermis
 Escharotomy
 Flame burn
 Flash burn
 Full-thickness burn
 Homeostasis
 Integument
 Joule’s law
 Lund and Browder chart
 Melanin
 Mucopolysaccharide gel
 Ohm’s law
 Partial-thickness burn
 Rule of nines
 Rule of palms
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Scald burn
Sebaceous gland
Sebum
Steam burn
Subcutaneous layer
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Superficial burn
Supraglottic
Thermal burn
Thermoregulation
Zone of coagulation
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Zone of hyperemia
Zone of stasis
Objectives:
DOT Objectives
 Integrate pathophysiological principles and
the assessment findings to formulate a field
impression and implement the treatment
plan for the patient with soft tissue trauma.
 Describe the layers of the skin, specifically:
 Epidermis and dermis (cutaneous)
 Superficial fascia (subcutaneous)
 Deep fascia
 Discuss the pathophysiology of wound healing
including:
 Hemostasis
 Inflammation phase
 Epithelialization
 Neovascularization
 Collagen synthesis
 Differentiate between the following types of
closed soft tissue injuries:
 Crush injuries
 Discuss the incidence, morbidity, and
mortality of blast injuries.
 Predict blast injuries based on mechanism of
injury including:
 Primary
 Secondary
 Tertiary
 Discuss the pathophysiology associated with
blast injuries.
 Discuss the effects of an explosion within an
enclosed space on a patient.
 Discuss the management of a patient with a
blast injury.
 Discuss the incidence, morbidity, and
mortality of crush injuries.
 Define the following conditions:
 Crush injury
 Crush syndrome
 Compartment syndrome
 Discuss the mechanisms of injury in a crush
EMS Education Standards
 Understand, discuss, and demonstrate
assessment findings with principles of
epidemiology and pathophysiology to
formulate a field impression to implement a
comprehensive treatment/disposition plan
for an acutely injured patient with soft tissue
trauma to include:
 Incidence of soft tissue injury
 Anatomy and physiology of soft tissue
injury
 Pathophysiology of wound healing
 Wounds
 Avulsions
 Bite wounds
 Lacerations
 Puncture wounds
 Lacerations
 Burns (electrical, chemical, thermal,
radiation)
 High pressure injections wounds
 Crush syndrome.
 Differentiate and formulate age related
variations as it pertains to the management of
the patient with soft tissue trauma.
 Discuss considerations of patient with soft
tissue trauma as it pertains to communication
and documentation, transport decisions,
patient education, and prevention.
133
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injury.
Discuss the effects of reperfusion and
rhabdomyolysis on the body.
Discuss the management of a patient with a
crush injury.
Discuss the management of wound healing.
Discuss the pathophysiology of wound
infection.
Discuss the management of wound infection.
Appreciate the importance of good follow-up
care for patients receiving sutures.
Integrate pathophysiological principles and
the assessment findings to formulate a field
impression and implement the management
plan for the patient with a burn injury.
Describe the specific anatomy and physiology
pertinent to a chemical burn injury and a
chemical burn injury to the eye.
Describe the pathophysiology of a chemical
burn injury, including types of chemicals and
their burning processes and a chemical burn
injury to the eye.
Identify and describe the depth classifications
of a chemical burn injury.
Identify and describe the severity of a
chemical burn injury.
Describe considerations which impact
management and prognosis of the patient
with a chemical burn injury and a chemical
burn injury to the eye.
Discuss mechanisms of burn injury and
conditions associated with a chemical burn
injury.
Describe the management of a chemical burn
injury and a chemical burn injury to the eye,
including airway and ventilation, circulation,
pharmacological, non-pharmacological,
transport considerations, and psychological
support/communication strategies.
Describe the epidemiology of an electrical
burn injury.
Describe the specific anatomy and physiology
pertinent to an electrical burn injury.
Describe the pathophysiology of an electrical
burn injury.
Identify and describe the depth classifications
of an electrical burn injury.
134
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Identify and describe the severity of an
electrical burn injury.
Describe considerations which impact
management and prognosis of the patient
with an electrical burn injury.
Discuss mechanisms of burn injury and
conditions associated with an electrical burn
injury.
Describe the management of an electrical
burn injury, including airway and ventilation,
circulation, pharmacological, nonpharmacological, transport considerations,
and psychological support/communication
strategies.
Develop, execute, and evaluate a
management plan based on the field
impression for the patient with a thermal
burn injury.
Develop, execute, and evaluate a
management plan based on the field
impression for the patient with a chemical
burn injury.
Develop, execute, and evaluate a
management plan based on the field
impression for the patient with an electrical
burn injury.
Value the changes of a patient's self-image
associated with a burn injury.
Value the impact of managing a burn injured
patient.
Advocate empathy for a burn injured patient.
Serve as a model for universal precautions
and body substance isolation (BSI).
Take body substance isolation procedures
during assessment and management of
patients with a burn injury.
Perform management of a thermal burn
injury, including airway and ventilation,
circulation, pharmacological, nonpharmacological, transport considerations,
psychological support/communication
strategies, and other management described
by local protocol.
Perform management of an inhalation burn
injury, including airway and ventilation,
circulation, pharmacological, nonpharmacological, transport considerations,
135
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psychological support/communication
strategies, and other management described
by local protocol.
Perform management of a chemical burn
injury, including airway and ventilation,
circulation, pharmacological, nonpharmacological, transport considerations,
psychological support/communication
strategies, and other management described
by local protocol.
Perform management of an electrical burn
injury, including airway and ventilation,
circulation, pharmacological, nonpharmacological, transport considerations,
psychological support/communication
strategies, and other management described
by local protocol.
Perform management of a radiation
exposure, including airway and ventilation,
circulation, pharmacological, nonpharmacological, transport considerations,
psychological support/communication
strategies, and other management described
by local protocol.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
136
Head, Facial, Neck and Spine Trauma
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression to implement a comprehensive treatment/disposition plan for an acutely
injured Head, Facial, Neck and Spine Trauma patient.
TARGET SKILLS: Recognition, pathophysiology, assessment, and management of:
 Life threats
 Mandibular fractures
 Spine trauma
 Unstable Facial fractures
 Penetrating neck trauma
 Skull fractures
 Laryngeotracheal injuries
 Foreign bodies in the eyes
 Spine trauma
 Dental trauma
 Dislocations/subluxations
 Orbital fractures
 Fractures
 Perforated tympanic membrane
 Sprains/strains
Key Terminology:
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Alveolar ridges
Alveoli
anisocoria
Anterior chamber
Aqueous humor
Auricle
Blowout fractures
Central vision
Cochlea
Cochlear duct
Conjunctiva
Conjunctivitis
Cornea
Craniofacial disjunction
Crown
Cusps
Dentin
Diplopia
Dysconjugate gaze
Dysphagia
Epistaxis
External auditory canal
External ear
Facial nerve
Globe
Glossopharyngeal nerve
Hard palate
Hemoptysis
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Hyoid bone
Hyphema
Hypoglossal nerve
Inner ear
Iris
Lacrimal apparatus
LeFort fractures
Lens
Malocclusion
Mandible
Mandibular nerve
Mastication
Maxillary nerve
Mediastinitis
Middle ear
Nasal septum
Nasolacrimal duct
Oculomotor nerve
Ophthalmic nerve
Optic nerve
Orbits
Organ of Corti
Ossicles
Oval window
Paranasal sinuses
Peripheral vision
Pinna
Posterior chamber
137
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Pulp
Pupil
Retina
Retinal detachment
Sclera
Spinal clearance
Sprain
Strain
Sympathetic eye
movement
Temporomandibular
joint (TMJ)
Tracheal transection
Trigeminal nerve
Tympanic membrane
Visual cortex
Vitreous humor
Whiplash
Anterior cord syndrome
Anterograde
(posttraumatic) amnesia
Arachnoid
Auditory ossicles
Autonomic dysreflexia
Autoregulation
Axon
Babinski reflex
Basal ganglia
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Basilar skull fractures
Battle sign
Biot respirations
Brain
Brainstem
Brown-Séquard
syndrome
Cauda equina
Cauda equine syndrome
Central cord syndrome
Central nervous system
Central neurogenic
hyperventilation
Cerebellum
Cerebral concussion
Cerebral contusion
Cerebral cortex
Cerebral edema
Cerebral perfusion
pressure (CPP)
Cerebrospinal fluid (CSF)
Cerebrum
Cheyne-Stokes
respirations
Choroid plexus
Complete spinal cord
injury
Coronal suture
Coup-contrecoup injury
Cranial vault
Cribriform plate
Crista galli
Critical minimum
threshold
Cushing triad
Decerebrate (extensor)
posturing
Decorticate (flexor)
posturing
Depressed skull fractures
Dermatomes
Diencephalon
Diffuse axonal injury
(DAI)
Diffuse brain injury
Dura mater
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Epidural hematoma
Facet joints
Facet injury
Focal brain injury
Fontanelles
Foramen magnum
Foramina
Frontal lobe
Galea aponeurotica
Glasgow Coma Scale
(GCS)
Hard palate
Head injury
Herniation
Hyperesthesia
Hyperextension
Hyperpyrexia
Hypothalamus
Incomplete spinal cord
injury
Intracerebral hematoma
Intracranial pressure
(ICP)
Lambdoid suture
Lamina
Limbic system
Linear skull fractures
Mastoid process
Mean arterial pressure
(MAP)
Medulla
Meninges
Myotomes
Nasal cavity
Nerve root injury
Neurogenic shock
Neuronal soma
Occipital condyles
Occipital lobe
Olfactory nerves
Palatine bone
Parasympathetic nervous
system
Parietal lobe
Pedicles
Periorbital ecchymosis
138
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Peripheral nerve injury
Pia mater
Plexus
Pons
Posterior cord syndrome
Posterior spinous process
Primary brain injury
Primary spinal cord injury
Proprioception
Raccoon eyes
Reticular activating
system (RAS)
Retrograde amnesia
Rotation-flexion injuries
Sagittal suture
Secondary brain injury
Secondary spinal cord
injury
Skull
Spinal clearance
Spinal cord
Spinal shock
sprain
Strain
Subarachnoid
hemorrhage
Subarachnoid space
Subdural hematoma
Subgaleal hemorrhage
Subluxation
Subthalamus
Supragaleal hematoma
Sympathetic nervous
system
Temporal lobe
Tentorium
Thalamus
Transverse spinous
processes
Traumatic brain injury
(TBI)
Trismus
Ventricles
Vertebral body
Vertical compression
Zygomataic arch
Objectives:
DOT Objectives
 Integrate pathophysiological principles and
the assessment findings to formulate a field
impression and implement a treatment plan
for the trauma patient with a suspected head
injury.
 Predict facial injuries based on mechanism of
injury.
 Predict other injuries commonly associated
with facial injuries based on mechanism of
injury.
 Predict head injuries based on mechanism of
injury.
 Define and explain the process involved with
each of the levels of increasing ICP.
 Explain the pathophysiology of diffuse axonal
injury.
 Develop a management plan for a patient
with a moderate and severe diffuse axonal
injury.
 Describe the various types of helmets and
their purposes.
 Relate priorities of care to factors
determining the need for helmet removal in
various field situations including sports
related incidents.
 Develop a management plan for the removal
of a helmet for a head injured patient.
 Integrate pathophysiological principles and
the assessment findings to formulate a field
impression and implement a treatment plan
for the patient with a suspected spinal injury.
 Predict spinal injuries based on mechanism of
injury.
 Describe the pathophysiology of traumatic
spinal injury related to:
 Quadriplegia/paraplegia
 Incomplete cord injury/cord
syndromes:
 Central cord syndrome
 Anterior cord syndrome
 Brown-Sequard syndrome
 Describe the pathophysiology of nontraumatic spinal injury, including:
EMS Education Standards
 Understand, discuss, and demonstrate
assessment findings with principles of
epidemiology and pathophysiology to
formulate a field impression to implement a
comprehensive treatment/disposition plan
for an acutely injured patient with head,
facial, neck, and spine trauma to include:
 Incidence, MOI, morbidity, mortality,
categories, causes, associated injuries
and prevention
 Unstable facial fractures
 Orbital fractures
 Perforated tympanic membrane
 Skull fractures
 Penetrating neck trauma
 Laryngeotracheal injuries
 Spine trauma (non-CNS involvement)
 Mandibular fractures
 Foreign bodies in the eyes
 Dental trauma.
 Differentiate and formulate age related
variations as it pertains to the management
of the patient with head, facial, neck, and
spine trauma.
 Discuss considerations of patient with head,
facial, neck, and spine trauma as it pertains
to communication, documentation,
transport decisions, patient education, and
prevention.
139
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 Low back pain
 Herniated intervertebral disk
 Spinal cord tumors
Describe the management of non-traumatic
spinal injuries.
Develop a patient management plan for nontraumatic spinal injury based on the field
impression.
Demonstrate helmet removal techniques.
Integrate pathophysiological principles and
the assessment findings to formulate a field
impression and implement a treatment plan
for a patient with a thoracic injury.
Predict thoracic injuries based on mechanism
of injury.
Advocate the use of a thorough scene survey
to determine the forces involved in thoracic
trauma.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
140
Nervous System Trauma
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression to implement a comprehensive treatment/disposition plan for an acutely
injured nervous system trauma patient.
TARGET SKILLS: Recognition, pathophysiology, assessment, and management of:
 Traumatic brain injury
 Cauda equina syndrome
 Spinal cord injury
 Nerve root injury
 Spinal shock
 Peripheral nerve injury
Objectives:
DOT Objectives
 Discuss the general pathophysiology of nontraumatic neurologic emergencies.
 Discuss the general assessment findings
associated with non-traumatic neurologic
emergencies.
 Identify the need for rapid intervention and
transport of the patient with non-traumatic
emergencies.
 Discuss the epidemiology, assessment
findings, and management for stroke and
intracranial hemorrhage.
 Discuss the epidemiology, assessment
findings, and management for transient
ischemic attack.
 Discuss the epidemiology, assessment
findings, and management of
epilepsy/seizure.
 Discuss the epidemiology, assessment
findings, and management for non-specific
coma or altered level consciousness/
syncope/ weakness/ headache.
 Develop a patient management plan based on
field impression in the patient with
neurological emergencies.
 feelings of a patient who regains
consciousness among strangers.
 Formulate means of conveying empathy to
patients whose ability to communicate is
limited by their condition.
EMS Education Standards
 Understand, discuss, and demonstrate
assessment findings with principles of
epidemiology and pathophysiology to
formulate a field impression to implement a
comprehensive treatment/disposition plan for
an acutely injured patient with Nervous
System trauma to include:
 Incidence
 Cauda equine syndrome
 Nerve root injury
 Peripheral nerve injury
 Traumatic brain Injury
 Spinal cord Injury
 Spinal shock.
 Differentiate and formulate age related
variations as it pertains to the management of
the patient with environmental emergencies.
 Discuss considerations of patient with
environmental emergencies as it pertains to:
 Communication
 Documentation
 Transport decisions
 Patient education,
 Prevention
141
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
142
Special Considerations in Trauma
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression to implement a comprehensive treatment/disposition plan for an acutely
injured patient.
TARGET SKILLS: Recognition, pathophysiology, assessment, and management of trauma in:
 Pregnant patient
 Pediatric patient
 Geriatric patient
 Cognitively impaired patient
Objectives:
DOT Objectives
 Recognition and management of trauma in
the:
 Pregnant Patient
 Pediatric Patient’
 Geriatric Patient
 Cognitively Impaired Patient
 Pathophysiology, assessment, and
management of the trauma in the:
 Pregnant Patient
 Pediatric Patient’
 Geriatric Patient
 Cognitively Impaired Patient
EMS Education Standards
 Understand, discuss, and demonstrate
assessment findings with principles of
epidemiology and pathophysiology to
formulate a field impression to implement a
comprehensive treatment/disposition plan
for an acutely injured patient with Special
Considerations in trauma to include:
 Trauma in pregnancy
 Pediatric trauma
 Geriatric trauma
 Cognitively impaired patient.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
143
Environmental Emergencies
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression to implement a comprehensive treatment/disposition plan for an acutely
injured Environmental Emergency patient.
TARGET SKILLS: Recognition and management of submersion incidents and temperature-related
illnesses.
Pathophysiology, assessment, and management of:
 Near drowning
 Temperature-related illness
 Bites and envenomations
 Dysbarism
 High-altitude
 Diving injuries
 Electrical injury
 Radiation exposure
 High altitude illness
Key Terminology:
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Acute lung injury
Acute mountain sickness
(AMS)
Afterdrop
Altitude illnesses
Arterial gas embolism
(AGE)
Ataxia
Atmosphere absolute
(ATA)
Barotrauma
Basal metabolic rate
(BMR)
Boyle’s law
Breath-hold diving
Chilblains
Classic heatstroke
Cold dieresis
Conduction
Convection
Core body temperature
(CBT)
Dalton’s law
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Decompression illness
(DCI)
Decompression sickness
(DCS)
Deep frostbite
Drowning
Envenomation
Environmental
emergencies
Evaporation
Exercise-associated
hyponatremia
Exertional heatstroke
Feet of seawater (fsw)
Frostbite
Frostnip
Gangrene
Heat cramps
Heat exhaustion
Heat illness
Heatstroke
Heat syncope
Henry’s law
144
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High-altitude cerebral
edema (HACE)
High-altitude pulmonary
edema (HAPE_
Homeostasis
Hyperthermia
Hypothalamus
Hypothermia
Laryngospasm
Loxoscelism
Malignant hyperthermia
Neuroleptic malignant
syndrome (NMS)
Nitrogen narcosis
Odynophagia
Orthostatic hypotension
Partial pressure
Pulmonary over
pressurization syndrome
(POPS)
Radiation
Saturation diving
Self-contained
underwater breathing
apparatus
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Shallow water blackout
Superficial frostbite
Surface-tended diving
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Thermogenesis
Thermolysis
Thermoregulation
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Trench foot
Wind chill factor
Objectives:
DOT Objectives
 Integrate pathophysiological principles and
assessment findings to formulate a field
impression and implement the treatment
plan for the patient with an environmentally
induced or exacerbated medical or traumatic
condition.
 Describe the function of the Divers Alert
Network (DAN) and how its members may aid
in the management of diving related illnesses.
 Define acute mountain sickness (AMS).
 Define high altitude pulmonary edema
(HAPE).
 Define high altitude cerebral edema (HACE).
EMS Education Standards
 Understand, discuss, and demonstrate
assessment findings with principles of
epidemiology and pathophysiology to
formulate a field impression to implement a
comprehensive treatment/disposition plan
for an acutely injured patient with
environmental emergencies to include:
 Incidence
 Submersion incidents
 Temperature-related illness
 Bites and envenomation
 Electrical injury-lightning strikes
 High altitude illness
 Dysbarism.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
145
Multi-System Trauma
Summary: Integrates assessment findings with principles of epidemiology and pathophysiology to
formulate a field impression to implement a comprehensive treatment/disposition plan for an acutely
injured Multi-System Trauma patient.
TARGET SKILLS: Recognition, pathophysiology, assessment, and management of multi-system trauma
and blast injuries.
Objectives:
DOT Objectives
 Describe muti-system trauma and special
consideration that are required for
patients who fit this category.

Demonstrate the ability to calculate a
trauma score and a glascow coma scale.
EMS Education Standards
 Understand, discuss, and demonstrate
assessment findings with principles of
epidemiology and pathophysiology to
formulate a field impression to implement a
comprehensive treatment/disposition plan
for an acutely injured patient with multisystem trauma to include:
 Kinematics of trauma
 Multi-system trauma
 Specific injuries related to multi
system trauma
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
146
Special Patient Populations
Obstetrics
Summary: Integrates assessment findings with principles of pathophysiology and knowledge of
psychosocial needs to formulate a field impression and implement a comprehensive
treatment/disposition plan for an Obstetric patient.
TARGET SKILLS: Recognition and management of normal delivery and vaginal bleeding in the pregnant
patient.
Anatomy and physiology of normal pregnancy to include:
 Pathophysiology of complications of pregnancy
 Assessment of the pregnant patient
Psychosocial impact, presentations, prognosis, and management of:
 Normal delivery
 Antepartum hemorrhage
 Abnormal delivery
 High risk pregnancy
 Nuchal cord
 Complications of labor
 Prolapsed cord
 Fetal distress
 Breech delivery
 Pre-term
 Third trimester bleeding
 Premature rupture of
 Placenta previa
membranes
 Abruptio placenta
 Rupture of uterus
 Spontaneous abortion/miscarriage
 Complications of delivery
 Ectopic pregnancy
 Post-partum complications
 Preeclampsia (pregnancy induced HTN)
 Hyperemesis gravidarum
 Eclampsia
 Post-partum depression
Key Terminology:
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Abortion
Abruption placenta
Amniotic fluid
Amniotic fluid embolism
Amniotic sac
Apgar scoring system
Bacterial vaginosis
Blastocyst
Bloody show
Breech presentation
Candidiasis
Cephalopelvic
disproportion
Cervical canal
Cervix
Chlamydia
Cholestasis
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Chronic hypertension
Complete abortion
Corpus luteum
Crowning
Cytomegalovirus (CMV)
Eclampsia
Ectopic pregnancy
Effacement
Elective abortion
Embryo
Endometrium
Episiotomy
Fallopian tubes
Fetal macrosomia
Fetus
First stage of labor
147
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Follicle-stimulating
hormone (FSH)
Fundus
Gestational period
Gonorrhea
Gravid
Gravidity
Habitual abortion
Herpes
Human
immunodeficiency virus
(HIV)
Human papilloma virus
(HPV)
Hydramnios
Hyperemesis gravidarum
Imminent abortion
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Incomplete abortion
Labor
Lightening
Lochia
Luteinizing hormone (LH)
Meconium
Missed abortion
Myometrium
Muchal cord
Oocyte
Ovulation
Ovum
Para
Parity
Perimetrium
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Placenta
Placenta previa
Postpartum
Preeclampsia
Pregnancy-induced
hypertension
Prenatal
Progesterone
Prolapsed umbilical cord
Rh factor
Rubella
Second stage of labor
Septic abortion
Shoulder systocia
Spontaneous abortion
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Supine hypotensive
syndrome
Syphilis
Third stage of labor
Threatened abortion
Toxoplasmosis
Transverse presentation
Trichomoniasis
Umbilical cord
Uterine cavity
Uterine inversion
Uterus
Vagina
Objectives:
DOT Objectives
 Apply an understanding of the anatomy and
physiology of the female reproductive system
to the assessment and management of a
patient experiencing normal or abnormal
labor.
 Establish the relationship between body
substance isolation and childbirth.
EMS Education Standards
 Understand, demonstrate, and discuss the
assessment findings with principles of
anatomy, physiology, epidemiology,
pathophysiology psychosocial impact,
presentations, prognosis, and management
of a patient with obstetric needs to include:
 Anatomy and physiology of pregnancy
 Pathophysiology of complications of
pregnancy
 Assessment of the pregnant patient
 Normal delivery
 Abnormal delivery (nuchal cord,
prolapsed cord, breech)
 Spontaneous abortion/miscarriage
 Ectopic pregnancy
 Eclampsia
 Antepartum hemorrhage
 Pregnancy Induced hypertension
 Third trimester bleeding (placenta
previa, Abruptio placenta)
 High risk pregnancy
 Complications of labor (fetal distress,
pre-term, premature rupture of
membranes, rupture of uterus)
 Complication of delivery
 Post-partum complication
 Hyperemesis gravidarum
 Postpartum depression.
148
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
149
Neonatal Care
Summary: Integrates assessment findings with principles of pathophysiology and knowledge of
psychosocial needs to formulate a field impression and implement a comprehensive
treatment/disposition plan for patients with a need for Neonatal Care.
TARGET SKILLS: Assessment and management of:
 Newborn care
 Neonatal resuscitation
 Anatomy and physiology of neonatal circulation
 Assessment of the newborn
Presentation and management of:
 Newborn
 Neonatal
 Resuscitation
Key Terminology:
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Acrocyanosis
Amniotic fluid
Apgar score
Apnea
Asphyxia
Atrial septal defect (ASD)
Bradycardia
Central cyanosis
Choanal atresia
Cleft lip
Cleft palate
Coarctation of the aorta
(CoA)
Congenital heart disease
(CHD)
Diaphragmatic hernia
Erb palsy
Fetal transition
Foramen ovale
Free-flow oxygen
Generalized seizure
Gestation
Grunting
Hypoglycemia
Hypoplastic left heart
syndrome (HLHS)
Hypothermia
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Hypotonia
Hypoxic ischemic
encephalopathy
Infantile hypertrophic
pyloric stenosis (IHPS)
Intercostal retractions
Intestinal atresia
Intestinal stenosis
Intussusception
Klumpke paralysis
Macroglossia
Malrotation
Meconium
Multifocal seizure
Nasal flaring
Neonate
Newborn
Oligohydramnios
Patent ductus arteriosus
(PDA)
Pathogenic
gastroesophageal reflux
(GER)
Persistent pulmonary
hypertension
Pierre Robin sequence
Placenta previa
150
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Polycythemia
Polyhydramnios
Positive-pressure
ventilation (PPV)
Post-term
Premature
Preterm
Primary apnea
Primigravida
Prolapsed cord
Pulmonary hypertension
Pulmonary stenosis
Retinopathy of
prematurity
Secondary apnea
Seizure
Small for gestation age
Surfactant
Term
Tetralogy of Fallot (Tof F)
Thermoregulation
Total anomalous
pulmonary venous return
(TAPVR)
Transposition of the
great arteries (TGA)
Tricuspid atresia
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Truncus arteriosus
Umbilical vein
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Ventricular septal defect
(VSD)
Objectives:
DOT Objectives
 Integrate pathophysiological principles and
assessment findings to formulate a field
impression and implement a treatment plan
for a neonatal patient.
 Identify the factors that lead to premature
birth and low birth weight newborns.
 Determine when an orogastric tube should be
inserted during positive pressure ventilation.
 Discuss the effects maternal narcotic usage
has on the newborn.
 Determine the appropriate treatment for the
newborn with narcotic depression.
 Demonstrate and advocate appropriate
interaction with a newborn/ neonate that
conveys respect for their position in life.
 Demonstrate appropriate insertion of an
orogastric tube
EMS Education Standards
 Understand, demonstrate, and discuss the
assessment findings with principles of
anatomy, physiology, epidemiology,
pathophysiology psychosocial impact,
presentations, prognosis, and management of
a neonatal care patient to include:
 Anatomy and physiology of neonatal
circulation
 Assessment of the newborn
 Presentation and management of the
newborn
 Neonatal resuscitation
 Specific situations (meconium stained
amniotic fluid, apnea, diaphragmatic
hernia, bradycardia, premature
infants, respiratory distress/cyanosis,
seizures, fever, hypothermia,
hypoglycemia, vomiting, diarrhea,
common birth injuries.
 Discuss considerations of the neonate patient
as it pertains to
 Communication
 Documentation
 Transport decisions
 Psychological support/communication
strategies.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
151
Pediatrics
Summary: Integrates assessment findings with principles of pathophysiology and knowledge of
psychosocial needs to formulate a field impression and implement a comprehensive
treatment/disposition plan for patients with a need for pediatric care.
TARGET SKILLS: Age-related assessment findings, age related anatomic and physiologic variations, agerelated, and developmental stage related assessment and treatment modifications for pediatric-specific
major or common diseases and/or emergencies to include:
 Respiratory Syncytial Virus
 Upper airway obstruction
(RSV)
 Lower airway reactive disease
 Pneumonia
 Foreign body (upper and lower) airway
 Croup
obstructions
 Epiglottitis
 Respiratory distress/failure/arrest
 Hyperglycemia
 Shock
 Hypoglycemia
 Seizures
 Pertussis
 Sudden infant death syndrome
 Cystic fibrosis
 Gastrointestinal disease
 Bronchopulmonary dysplasia
 Bacterial tracheitis
 Congenital heart diseases
 Asthma
 Hydrocephalus and ventricular shunts
 Bronchiolitis
Key Terminology:
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Absence seizures
Acrocyanosis
Apparent life-threatening
event (ALTE)
Bacterial tracheitis
Blow-by technique
Bronchiolitis
Bronchopulmonary
dysplasia
Central venous catheter
Child abuse
Child protective service
(CPS)
Complex febrile seizures
Complex partial seizures
Congenital adrenal
hyperplasia (CAH)
Congenital heart disease
Croup
Cystic fibrosis (CF)
Dilated cardiomyopathy
(DCM)
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Epiglottitis
Gastrostomy tube (Gtube)
Generalized seizures
Grunting
Hemophilia
Hydrocephalus
Hypertrophic
cardiomyopathy (HCM)
Hypopituitarism
Inborn errors of
metabolism (IEM)
Intussusception
Malrotation with
volvulus
Meckel diverticulum
Meningitis
Mottling
Myocarditis
Muchal rigidity
Obtunded
Ossification centers
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Panhypopituitarism
Partial seizures
Pediatric Assessment
Triangle (PAT)
Pertussis
Petechial
Pneumonia
Purpuric
Pyloric stenosis
Respiratory arrest
Respiratory distress
Respiratory failure
Respiratory syncytial
virus (RSV)
Retractions
Sepsis
Sickle cell disease (SCD)
Simple febrile seizures
Simple partial seizures
Sniffing position
Status epilepticus
Stoma
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Subglottic space
Sudden infant death
syndrome (SIDS)
Synchronized
cardioversion
Tenting
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Thrombocytopenia
Thrombosis
Tonic-clonic seizures
Tripoding
Vasoconstriction
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Ventilation-perfusion
mismatch
Ventricular shunt
Von Willebrand disease
Objectives:
DOT Objectives
EMS Education Standards
 Integrate pathophysiological principles and
 Understand, demonstrate, and discuss ageassessment findings to formulate a field
related assessment findings with principles of
impression and implement a treatment plan
anatomy, physiology, epidemiology,
for the pediatric patient.
pathophysiology, psychosocial impact,
presentations, age related assessment and
 Discuss the paramedic's role in the reduction
treatment modifications of the pediatricof infant and childhood morbidity and
specific major or common diseases and/or
mortality from acute illness and injury.
emergencies to include:
 Identify methods/ mechanisms that prevent
 Pediatric anatomical variations and
injuries to infants and children.
assessments
 Describe Emergency Medical Services for
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Growth and development
Children (EMSC).
 Foreign body (upper and lower airway)
 Discuss how an integrated EMSC system can
obstruction
affect patient outcome.
 Bacterial tracheitis
 Outline differences in adult and childhood
 Asthma
anatomy and physiology.
 Bronchiolitis (RSV)
 Discuss age appropriate vascular access sites
 Pneumonia
for infants and children.
 Croup
 Discuss anatomical features of children that
 Epiglottitis
predispose or protect them from certain
 Respiratory distress/failure/arrest
injuries.
 Shock
 Determine when pain management and
 Seizures
sedation are appropriate for infants and
 Sudden infant death syndrome
children.
 Hyperglycemia
 Define children with special health care needs.
 Hypoglycemia
 Define technology assisted children.
 Pertussis
 Discuss appropriate receiving facilities for low
 Shock
and high risk infants and children.
 GI disease
 Describe the epidemiology, including the
 Cystic fibrosis
incidence, morbidity/mortality, risk factors and
 Bronchopulmonary dysplasia
prevention strategies for neurological
 Congenital heart diseases
emergencies in infants and children.
 Hydrocephalus and ventricular shunts
 Describe the epidemiology, including the
 Toxicologic exposures
incidence, morbidity/mortality, risk factors and
 Abuse and neglect
prevention strategies for trauma in infants and
 Discuss considerations of the pediatric patient
children.
as it pertains to communication and
 Describe the epidemiology, including the
documentation, transport decisions,
incidence, morbidity/mortality, risk factors and
153
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prevention strategies for children with special
health care needs including technologyassisted children.
Discuss the pathophysiology of children with
special health care needs including
technology-assisted children.
Discuss the management/treatment plan for
children with special health care needs
including technology-assisted children.
Recognize and appreciate the physical and
emotional difficulties associated with
separation of the parent/guardian of a special
needs child
Demonstrate the ability to provide
reassurance, empathy and compassion for the
parent/guardian.
Demonstrate the use of a length-based
resuscitation device for determining
equipment sizes, drug doses and other
pertinent information for a pediatric patient.
Demonstrate proper placement of a gastric
tube in infants and children.
Demonstrate an appropriate technique for
administration of intramuscular, inhalation,
subcutaneous, rectal, endotracheal and oral
medication for infants and children.
Demonstrate an appropriate technique for
insertion of an intraosseous line for infants
and children.
Demonstrate appropriate parent/ caregiver
interviewing techniques for infant and child
death situations.
psychological support/communication
strategies.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
154
Geriatrics
Summary: Integrates assessment findings with principles of pathophysiology and knowledge of
psychosocial needs to formulate a field impression and implement a comprehensive
treatment/disposition plan for patients with a need for geriatric care.
TARGET SKILLS: Impact of age-related changes on assessment and care. Changes associated with aging,
psychosocial aspects of aging, and age-related assessment and treatment modifications for the major or
common geriatric diseases and/or emergencies to include:
 Cardiovascular diseases
 Respiratory diseases
 Neurological diseases
 Endocrine diseases
 Alzheimer’s
 Dementia
 Fluid resuscitation in the elderly
Normal and abnormal changes associated with aging, pharmacokinetic changes, psychosocial, and
economic aspects of aging, polypharmacy, and age-related assessment and treatment modifications for
the major or common geriatric diseases and/or emergencies to include:
 Cardiovascular diseases
 Respiratory diseases
 Neurological diseases
 Endocrine diseases
 Alzheimer’s
 Dementia
 Fluid resuscitation in the elderly
 Delirium
 Acute confusional state
 Herpes Zoster
 Inflammatory arthritis
Key Terminology:
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Adult protective services
(APS)
Alzheimer disease
Aortic sclerosis
Aortic stenosis
Arteriosclerosis
Atherosclerosis
Bereavement
Cataracts
Cellulitis
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Delirium
Dementia
Geriatrics
Glaucoma
Herpes zoster
Jomeostasis
Hospice
Meniere disease
Old-age dependency
ratio
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Osteoarthritis
Parkinson disease
Polypharmacy
Presbycusis
Pressure uncers
Proprioception
Rheumatoid arthritis
Sepsis
Spondylosis
Objectives:
DOT Objectives
 Integrate pathophysiological principles and
assessment findings to formulate a field
impression and implement the treatment plan
for the patient with cardiovascular disease.
 Identify the normal characteristics of the point
of maximal impulse (PMI)
 List the characteristics of a patient eligible for
thrombolytic therapy
 Describe the window of opportunity as it
pertains to reperfusion of a myocardial injury
or infraction
 Explain the clinical significance of paroxysmal
nocturnal dyspnea.
 Identify the limiting factor of pericardial
anatomy that determines intrapericardiac
pressure
 Specify the methods of supporting the patient
with a suspected ineffective implanted
defibrillation device.
 Apply knowledge of the epidemiology of
cardiovascular disease to develop prevention
strategies.
 Apply knowledge of the epidemiology of
cardiovascular disease to develop prevention
strategies.
 Complete a communication patch with
medical direction and law enforcement used
for termination of resuscitation efforts.
 Integrate the pathophysiological principles and
the assessment findings to formulate and
implement a treatment plan for the geriatric
patient.
 Discuss the problems with mobility in the
elderly and develop strategies to prevent falls.
 Describe principles that should be employed
when assessing and communicating with the
elderly.
 Describe the epidemiology for cardiovascular
diseases in the elderly, including incidence,
morbidity/ mortality, risk factors, and
prevention strategies for patients with
myocardial infarction, heart failure,
dysrhythmias, aneurism, and hypertension.
 Describe the epidemiology for endocrine
EMS Education Standards
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156
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Understand, discuss, and demonstrate normal
and abnormal changes associated with aging,
pharmacokinetic changes, psychosocial, and
economic aspects of aging, polypharmacy,
and age-related assessment and treatment
modification for the major or common
geriatric diseases and/or emergencies to
include:
 Cardiovascular disease
 Respiratory disease
 Neurological disease
 Endocrine diseases
 Alzheimer’s
 Dementia
 Delirium
 Herpes zoster
 Inflammatory arthritis
 Osteoarthritis
 Myocardial iInfarction
 Congestive heart failure
 Aortic dissection
 Syncope
 Hypertension
 Pneumonia
 Pulmonary embolism
 Asthma
 Emphysema and chronic bronchitis
 Stroke
 Transient ischemic attacks
 Gastrointestinal bleeding
 Biliary disease
 Chronic renal failure
 Urinary tract infection
 Immunological system anatomical and
physiological changes, and
pathophysiology
 Pressure ulcers.
Discuss considerations of the geriatric patient
as it pertains to:
 Communication
 Documentation
 Transport decisions
 Psychological support/communication
strategies.
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diseases in the elderly, including incidence,
morbidity/ mortality, risk factors, and
prevention strategies for patients with
diabetes and thyroid diseases.
Compare and contrast the pathophysiology of
diabetes and thyroid diseases in the elderly
with that of a younger adult.
Describe the epidemiology in the elderly,
including the incidence, morbidity/ mortality,
risk factors, and prevention strategies, for
patients with drug toxicity.
Describe the epidemiology for pressure ulcers
in the elderly, including incidence, morbidity/
mortality, risk factors, and prevention
strategies.
Compare and contrast the pathophysiology of
pressure ulcers in the elderly with that of a
younger adult.
Describe the epidemiology for trauma in the
elderly, including incidence, morbidity/
mortality, risk factors, and prevention
strategies for patients with orthopedic injuries,
burns and head injuries.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
157
Patients with Special Challenges
Summary: Integrates assessment findings with principles of pathophysiology and knowledge of
psychosocial needs to formulate a field impression and implement a comprehensive
treatment/disposition plan for patients with a need for special challenge care.
TARGET SKILLS: Recognizing and reporting abuse and neglect and the healthcare implications of:
 Abuse
 Neglect
 Homelessness
 Poverty
 Bariatrics
 Technology dependent
 Hospice/ terminally ill
 Tracheostomy care/dysfunction
 Homecare
 Sensory deficit/loss
 Developmental disability
Key Terminology:
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Abuse
Acoustic neuroma
Acute angle-closure
glaucoma (AAGG)
Adult protective Services
(APS)
Apraxia
Arthritis
Asynchrony
Auditory neuropathy
Autism
Bariatrics
Cancer
Cataract
Central auditory
processing disorder
(CAPD)
Cerebral palsy (CP)
Cerebrospinal fluid shunt
(CSF shunt)
Coining
Colostomy
Colostomy bag
Comfort care
Communicable disease
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Conductive hearing loss
Contagious disease
Conversion disorder
Cupping curative care
Cystic fibrosis (CF)
Deafness
Developmental delay
Developmental disability
Dialysis
Down syndrome
Dysarthria
Emotional abuse
False lumen
Fenestrated
Fistula
Flange
Glaucoma
Hemodialysis
Hemodynamic
monitoring
Heparinized solution
Hospice
Hydrocephalus
Hypovolemia
Ileus
158
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Inner cannula
Intra-aortic balloon
pump
Language-based learning
disability
Mandatory reporter
Meniere disease
Mental retardation
Mongolian spots
Multiple sclerosis (MS)
Muscular dystrophy
Myasthenia gravis
Myasthenic crisis
Myelomeningocele
Neglect
Obsess
Obturator
Ocular myasthenia gravis
Optic nerve hypoplasia
Osteoarthritis
Outer cannula
Palliative care
Paraplegia
Peritoneal dialysis
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Phonologic process
disorders
Physical abuse
Phytophotodermatitis
Poliomyelitis
Postpolio syndrome
Quadriplegia
Retinopathy
Rheumatoid arthritis (RA)
Semantic-pragmatic
disorder
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Sensorineural hearing
loss
Sexual abuse
Sexual exploitation
Spastic paralysis
Spastic tetraplegia
Spina bifida
Stenosis
Stoma
Surrogate decisionmaker
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Systemic lupus
erythematous
Terminal illness
Thrombosis
Tracheostomy 0trach)
tube
Transducer
Traumatic brain injury
(TBI)
Urostomy
Objectives:
DOT Objectives
 Integrate the assessment findings to
formulate a field impression and implement a
treatment plan for the patient who has
sustained abuse or assault.
 Discuss the incidence of abuse and assault.
 Describe the categories of abuse.
 Discuss examples of spouse abuse.
 Describe the characteristics associated with
the profile of the typical abuser of a spouse.
 Identify the profile of the "at-risk'' spouse.
 Discuss the legal aspects associated with
abuse situations.
 Identify community resources that are able to
assist victims of abuse and assault.
 Discuss the documentation associated with
abused and assaulted patient.
 Demonstrate sensitivity to the abused
patient.
 Value the behavior of the abused patient.
 Attend to the emotional state of the abused
patient.
 Recognize the value of non-verbal
communication with the abused patient.
 Attend to the needs for reassurance,
empathy and compassion with the abused
patient.
 Listen to the concerns expressed by the
abused patient.
 Demonstrate the ability to assess a spouse,
elder or child-abused patient.
 Integrate pathophysiological and psychosocial
EMS Education Standards
 Understand, demonstrate, and discuss the
assessment findings with principles of
anatomy, physiology, epidemiology,
pathophysiology psychosocial impact,
presentations, prognosis, and management of
patient with special needs to include:
 Abuse and neglect
 Homelessness/poverty
 Bariatric patients
 Technology assisted/dependent
 Hospice care and terminally ill
 Tracheostomy care/dysfunction
 Pediatrics developmental disabilities
 Emotionally impaired
 Physical needs/challenges
 Patients with communicable diseases
 Terminally ill patients
 Mental needs/challenges
 Specific challenges created by chronic
conditions.
 Discuss considerations of the patient with
special needs as it pertains to
 Communication
 Documentation
 Transport decisions
 Psychological support/communication
strategies.
159
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principles to adapt the assessment and
treatment plan for diverse patients and those
who face physical, mental, social and financial
challenges.
Describe the various etiologies and types of
hearing impairments.
Recognize the patient with a hearing
impairment.
Anticipate accommodations that may be
needed in order to properly manage the
patient with a hearing impairment.
Describe the various etiologies of visual
impairments.
Recognize the patient with a visual
impairment.
Anticipate accommodations that may be
needed in order to properly manage the
patient with a visual impairment.
Describe the various etiologies and types of
speech impairments.
Recognize the patient with speech
impairment.
Anticipate accommodations that may be
needed in order to properly manage the
patient with speech impairment.
Describe the various etiologies of obesity.
Anticipate accommodations that may be
needed it order to properly manage the
patient with obesity.
Describe paraplegia/quadriplegia.
Anticipate accommodations that may be
needed in order to properly manage the
patient with paraplegia/quadriplegia.
Define mental illness.
Describe the various etiologies of mental
illness.
Recognize the presenting signs of the various
mental illnesses.
Anticipate accommodations that may be
needed in order to properly manage the
patient with a mental illness.
Define the term developmentally disabled.
Recognize the patient with a developmental
disability.
Anticipate accommodations that may be
needed in order to properly manage the
patient with a developmental disability.
160
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Describe Down’s syndrome.
Recognize the patient with Down’s syndrome.
Anticipate accommodations that may be
needed in order to properly manage the
patient with Down’s syndrome.
Describe the various etiologies of emotional
impairment.
Recognize the patient with an emotional
impairment.
Anticipate accommodations that may be
needed in order to properly manage the
patient with an emotional impairment.
Define emotional/ mental impairment (EMI).
Recognize the patient with an emotional or
mental impairment.
Anticipate accommodations that may be
needed in order to properly manage patients
with an emotional or mental impairment.
Describe the following diseases/ illnesses:
 Arthritis
 Cancer
 Cerebral palsy
 Cystic fibrosis
 Multiple sclerosis
 Muscular dystrophy
 Myasthenia gravis
 Poliomyelitis
 Spina bifida
 Patients with a previous head injury
Identify the possible presenting sign(s) for the
following diseases/illnesses:
 Arthritis
 Cancer
 Cerebral palsy
 Cystic fibrosis
 Multiple sclerosis
 Muscular dystrophy
 Myasthenia gravis
 Poliomyelitis
 Spina bifida
 Patients with a previous head injury
Anticipate accommodations that may be
needed in order to properly manage the
following patients:
 Arthritis
 Cancer
 Cerebral palsy
161
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 Cystic fibrosis
 Multiple sclerosis
 Muscular dystrophy
 Myasthenia gravis
 Poliomyelitis
 Spina bifida
 Patients with a previous head injury
Define cultural diversity.
Recognize a patient who is culturally diverse.
Anticipate accommodations that may be
needed in order to properly manage a patient
who is culturally diverse.
Identify a patient that is terminally ill.
Anticipate accommodations that may be
needed in order to properly manage a patient
who is terminally ill.
Identify a patient with a communicable
disease.
Recognize the presenting signs of a patient
with a communicable disease.
Anticipate accommodations that may be
needed in order to properly manage a patient
with a communicable disease.
Recognize sign(s) of financial impairments.
Anticipate accommodations that may be
needed in order to properly manage the
patient with a financial impairment.
Integrate the pathophysiological principles
and the assessment findings to formulate a
field impression and implement a treatment
plan for the acute deterioration of a chronic
care patient.
Compare and contrast the primary objectives
of the ALS professional and the home care
professional.
Identify the importance of home health care
medicine as related to the ALS level of care.
Differentiate between the role of EMS
provider and the role of the home care
provider.
Compare and contrast the primary objectives
of acute care, home care and hospice care.
Summarize the types of home health care
available in your area and the services
provided.
Discuss the aspects of home care that result
in enhanced quality of care for a given
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patient.
Discuss the aspects of home care that have a
potential to become a detriment to the
quality of care for a given patient.
List complications commonly seen in the
home care patients which result in their
hospitalization.
Compare the cost, mortality and quality of
care for a given patient in the hospital versus
the home care setting.
Discuss the significance of palliative care
programs as related to a patient in a home
health care setting.
Define hospice care, comfort care and
DNR/DNAR as they relate to local practice,
law and policy
List the stages of the grief process and relate
them to an individual in hospice care
List pathologies and complications typical to
home care patients.
Given a home care scenario, predict
complications requiring ALS intervention.
Given a series of home care scenarios,
determine which patients should receive
follow-up home care and which should be
transported to an emergency care facility.
Describe airway maintenance devices
typically found in the home care
environment.
Describe devices that provide or enhance
alveolar ventilation in the home care setting.
List modes of artificial ventilation and an outof-hospital situation where each might be
employed.
List vascular access devices found in the
home care setting.
Recognize standard central venous access
devices utilized in home health care.
Describe the basic universal characteristics of
central venous catheters.
Describe the basic universal characteristics of
implantable injection devices.
List devices found in the home care setting
that are used to empty, irrigate or deliver
nutrition or medication to the GI/ GU tract.
Describe complications of assessing each:
 The airway
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 Vascular access
 GI/ GU devices described above.
Given a series of scenarios, demonstrate the
appropriate ALS interventions.
Given a series of scenarios, demonstrate
interaction and support with the family
members/ support persons for a patient who
has died.
Describe common complications with central
venous access and implantable drug
administration ports in the out-of-hospital
setting.
Describe the indications and
contraindications for urinary catheter
insertion in an out-of-hospital setting.
Identify the proper anatomy for placement of
urinary catheters in males or females.
Identify failure of GI/GU devices found in the
home care setting.
Identify failure of ventilatory devices found in
the home care setting.
Identify failure of vascular access devices
found in the home care setting.
Identify failure of drains.
Differentiate between home care and acute
care as preferable situations for a given
patient scenario.
Discuss the relationship between local home
care treatment protocols/SOPs and local EMS
Protocols/SOPs.
Discuss differences in individual’s ability to
accept and cope with their own impending
death.
Discuss the rights of the terminally ill.
Value the role of the home-care professional
and understand their role in patient care
along the life-span continuum.
Value the patient=s desire to remain in the
home setting.
Value the patient’s desire to accept or deny
hospice care.
Value the uses of long term venous access in
the home health setting, including but not
limited to:
Chemotherapy
Home pain management
Nutrition therapy
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Congestive heart therapy
Antibiotic therapy
Observe for an infected or otherwise
complicated venous access point.
Demonstrate proper tracheotomy care.
Demonstrate the method of accessing
vascular access devices found in the home
health care setting.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
165
EMS Operations
Principles of Safely Operating a Ground Ambulance
Summary: Knowledge of operational roles and responsibilities to ensure safe patient, public, and
personnel safety.
TARGET SKILLS: Risks and responsibilities of emergency response and transport.
Key Terminology:
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Air ambulances
Belt noise
Blind spots
Brake fade
Cleaning
Cushion of safety
Decontaminate
Disinfection
DOT KKK 1822
Drift
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Due regard
Heavy-duty ambulance
High-level disinfection
Hydroplaning
Landing zone
Medevac
Peak loads
Posting
Spotter
Steering play
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Sterring pull
Sterilization
Strategic deployment
Type I ambulance
Type II ambulance
Type III ambulance
Wheel bounce
Wheel wobble
Objectives:
DOT Objectives
 Discuss the medical and non-medical
equipment needed to respond to a call.
 List the phases of an ambulance call.
 Describe the general provisions of state laws
relating to the operation of the ambulance
and privileges in any or all of the following
categories:
 Speed
 Warning lights
 Sirens
 Right-of-way
 Parking
 Turning
 List contributing factors to unsafe driving
conditions.
 Describe the considerations that should be
given to:
 Request for escorts.
 Following an escort vehicle.
 Intersections.
EMS Education Standards
 Understand, demonstrate, and discuss the
knowledge of operations roles and
responsibilities to ensure safe patient, public,
and personnel safety to include risk and
responsibilities of the emergency response
and transport.
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Discuss "Due Regard for Safety of All Others"
while operating an emergency vehicle.
State what information is essential in order
to respond to a call.
Discuss various situations that may affect
response to a call.
Differentiate between the various methods
of moving a patient to the unitbased upon
injury or illness.
Apply the components of the essential
patient information in a written report.
Summarize the importance of preparing the
unit for the next response.
Identify what is essential for completion of a
call.
Distinguish among the terms:
 Cleaning
 Disinfection
 High-level disinfection
 Sterilization
Describe how to clean or disinfect items
following patient care.
Explain the rationale for appropriate report
of patient information.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
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Incident Management
Summary: Knowledge of operational roles and responsibilities to ensure safe patient, public, and
personnel safety.
TARGET SKILLS: Establish and work within the incident management system.
Key Terminology:
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Closed incident
Command
Critical incident stress
management (CISM)
Demobilization
Extrication supervisor
Finance
Freelancing
Hospital surge capacity
Incident action plan
Incident commander (IC)
Incident command system
(ICS)
Joint information center
(JIC)
Jump START triage
Liaison officer (LNO)
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logistics
Medial incident command
Morgue supervisor
Multiple-casualty incident
(MCI)
Mutual aid response
National Incident
Management System
(NIMS)
Open incident
Operations
Planning
Primary triage
Public information officer
(PIO)
Rehabilitation supervisor
Rescue supervisor
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Safety officer
Secondary triage
Single command system
Span of control
Staging supervisor
START triage
Termination of command
Transfer of command
Transportation supervisor
Treatment supervisor
Triage
Triage supervisor
Unified command system
Objectives:
DOT Objectives
EMS Education Standards
 Describe basic concepts of the national
 Understand, demonstrate, and discuss the
incident management system and its
knowledge of operations roles and
components.
responsibilities to ensure safe patient, public,
and personnel safety to include establishing
 Describe the ICS structure and the role of
and working within the incident management
EMS response within it.
system.
 Describe how ICS provides safety to patients,
providers, and bystanders at an incident
 Describe the Role of the Paramedic in
establishing command under ICS.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
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Multiple Casualty Incidents
Summary: Knowledge of operational roles and responsibilities to ensure safe patient, public, and
personnel safety.
TARGET SKILLS: Triage principles to include:
 Performing
 Re-triage
 Destination decisions
 Post Traumatic and cumulative stress
 Resource management
Objectives:
DOT Objectives
 Describe the criteria for a multiple-casualty
situation.
 Evaluate the role of the Paramedic in the
multiple-casualty situation.
 Summarize the components of basic triage.
 Describe the different types of triage methods
 Define the role of the Paramedic in a disaster
operation.
 Discuss different conditions that would define
the incident as mass causality and give
examples.
 Describe the triage principals as it pertains to
patients within an incident.
EMS Education Standards
 Understand, demonstrate, and discuss the
knowledge of operations roles and
responsibilities to ensure safe patient, public,
and personnel safety to include triage
principles and resource management.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
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Air Medical
Summary: Knowledge of operational roles and responsibilities to ensure safe patient, public, and
personnel safety.
TARGET SKILLS: Safe air medical operations including:
 Criteria for utilizing air medical response
 Medical risks/needs/advantages.
Objectives:
DOT Objectives
 Understand standards and guidelines that help
ensure safe and effective ground and air
medical transport.
 Describe the advantages and disadvantages of
air medical transport.
 Identify the conditions/ situations in which air
medical transport should be considered.
 Serve as a role model for others relative to the
operation of ambulances.
 Value the need to serve as the patient
advocate to ensure appropriate patient
transportation via ground or air.
EMS Education Standards
 Understand, demonstrate, and discuss the
knowledge of operations roles and
responsibilities to ensure safe patient, public,
and personnel safety to include:
 Safe air medical operations
 Criteria for utilizing air medical response
 Medical risks/needs/advantages.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
170
Vehicle Extrication
Summary: Knowledge of operational roles and responsibilities to ensure safe patient, public, and
personnel safety.
TARGET SKILLS: Safe vehicle extrication and Use of simple hand tools.
Key Terminology:
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Accountability system
Alternative powered
vehicles
Awareness
Belay
Body-over-frame
construction
Cold protective response
Cold zone
Complex access
Confined space
Cribbing
Entrapment
Hand tool
High-angle operations
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Hot zone
Immediately dangers to
life and health (IDLH)
Laminated glass
Low-angle operations
Operations
Personal flotation device
(PFD)
Rappelling
Scrambling
Search and rescue (SAR)
Secondary collapse
Self-rescue position
Shims
Shoring
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Simple access
Special weapons and
tactics (SWAT) team
Spoil pile
Step chocks
Tactical situation
Technical rescue incident
(TRI)
Technical rescue team
Technician
Tempered glass
Unibody construction
Warm zone
Wedges
Objectives:
DOT Objectives
 Describe the purpose of extrication.
 Discuss the role of the Paramedic in
extrication.
 Identify what equipment for personal safety
is required for the Paramedic.
 Define the fundamental components of
extrication.
 State the steps that should be taken to
protect the patient during extrication.
 Evaluate various methods of gaining access to
the patient.
EMS Education Standards
 Understand, demonstrate, and discuss the
knowledge of operations roles and
responsibilities to ensure safe patient, public,
and personnel safety.
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Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
172
Hazardous Materials Awareness
Summary: Knowledge of operational roles and responsibilities to ensure safe patient, public, and
personnel safety.
TARGET SKILLS: Risks and responsibilities of operating in a cold zone at a hazardous material incident or
other special incident.
Key Terminology:
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Absorption
Asphyxiant
Authority having
jurisdiction (AHJ)
Bill of lading
CAMEO
Carbon monoxide
Carboy
Cargo tank
Chemical asphyxiants
CHEMTREC (Chemical
Transportation Emergency
Center)
Container
Corrosives
Cyanide
Cylinders
Decontamination corridor
Dilution
Disposal
Dose effect
Drums
Dry bulk cargo tanks
Emergency
decontamination
Evacuation
Flammable range
Flash point
Hazardous material
HAZWOPER (HAZardous
Waste Operations and
Emergency Response)
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Ignition temperature
Immediately dangerous to
life and health (IDLH)
Intermodal tanks
Labels
Lethal concentration (LC)
Lethal dose (LD)
Level A ensemble
Level B ensemble
Level C ensemble
Level D ensemble
Local effect
Lower flammable limit
(LFL)
Mass decontamination
Material safety data
sheets (MSDS)
MC-306/DOT 406
flammable liquid tanker
MC-307/DOT 407
chemical hauler
MC-312/DOT 412
corrosive tanker
MC-331 pressure cargo
tanker
MC-338 cryogenic tanker
Medical monitoring
Neutralization
Nonbulk storage vessels
Permissible exposure limit
(PEL)
Placards
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Primary contamination
Secondary containment
Secondary contamination
Shelter-in-place
SLUDGEMsolvents
Specific gravity
Systemic effect
Technical
decontamination
Threshold limit value (TLV)
Threshold limit
value/ceiling (TLV/C)
Threshold limit
value/short-term
exposure limit (TLVSTEL)threshold limit
value/skin
Toxic products of
combustion
Tube trailer
Upper flammable limit
(UFL)
Vapor density
Vapor pressure
Water reactive
Water soluble
Waybill
Objectives:
DOT Objectives
 Integrate the principles of rescue awareness
and operations to safely rescue a patient from
water, hazardous atmospheres, trenches,
highways, and hazardous terrain.
 Explain the phenomenon of the cold
protective response in cold water drowning
situations.
 Identify the risks associated with low head
dams and the rescue complexities they pose.
 Given a picture of moving water, identify and
explain the following features and hazards
associated with:
 Hydraulics
 Strainers
 Dams/hydro-electric sites
 Explain why water entry or go techniques are
methods of last resort.
 Explain the rescue techniques associated with
reach-throw-row-go.
 Given a list of rescue scenarios, identify the
victim survivability profile and which are
rescue versus body recovery situations.
 Explain the self-rescue position if unexpectedly
immersed in moving water.
 Given a series of pictures identify which would
be considered "confined spaces" and
potentially oxygen deficient.
 Identify the hazards associated with confined
spaces and risks posed to potential rescuers to
include:
 Oxygen deficiency
 Chemical/toxic exposure/ explosion
 Engulfment
 Machinery entrapment
 Electricity
 Identify the poisonous gases
commonly found in confined spaces to
include:
 Hydrogen sulfide (H2S)
 Carbon dioxide (C02)
 Carbon monoxide (CO)
 Low/high oxygen concentrations (Fi02)
 Methane (CH4)
 Ammonia (NH3)
EMS Education Standards
 Understand, demonstrate, and discuss the
knowledge of operations roles and
responsibilities to ensure safe patient, public,
and personnel safety.
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 Nitrogen dioxide (NO2)
Explain the hazard of cave-in during trench
rescue operations.
Describe the effects of traffic flow on the
highway rescue incident including limited
access superhighways and regular access
highways.
List and describe the hazards associated with
the following auto/truck components:
 Energy absorbing bumpers
 Air bag/supplemental restraint
systems
 Catalytic converters and conventional
fuel systems
 Stored energy
 Alternate fuel systems
Given a diagram of a passenger auto, identify
the following structures:
 A, B, C, D posts
 Fire wall
 Unibody versus frame designs
Explain the difference between tempered and
safety glass; identify its locations on a vehicle
and how to break it safely.
Explain SRS or "air bag" systems and methods
to neutralize them.
Define the following terms:
 Low angle
 High angle
 Belay
 Rappel
 Scrambling
 Hasty rope slide
Explain the procedures for low angle litter
evacuation to include:
 Anchoring
 Litter/rope attachment
 Lowering and raising procedures
Explain techniques to be used in non-technical
litter carries over rough terrain.
Explain non-technical high angle rescue
procedures using aerial apparatus.
Explain the indications, contraindications and
methods of pain control for entrapped
patients.
Explain the pathophysiology of "crush trauma"
syndrome.
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Demonstrate litter securing techniques for
patients being evacuated by aerial apparatus.
Demonstrate donning and properly adjusting a
PFD.
Demonstrate use of a throw bag.
Evaluate hazardous materials emergencies,
call for appropriate resources, and work in the
cold zone.
Size-up a hazardous materials (hazmat)
incident and determine the following:
 Potential hazards to the rescuers,
public and environment
 Potential risk of primary
contamination to patients
 Potential risk of secondary
contamination to rescuers
Identify resources for substance identification,
decontamination and treatment information
including the following:
 Poison control center
 Medical control
 Material safety data sheets (MSDS)
 Reference textbooks
 Computer databases (CAMEO)
 CHEMTREC
 Technical specialists
 Agency for toxic substances and
disease registry
Explain the following terms/concepts:
 Primary contamination risk
 Secondary contamination risk
List and describe the following routes of
exposure:
 Topical
 Respiratory
 Gastrointestinal
 Parenteral
Explain the following toxicologic principles:
 Acute and delayed toxicity
 Route of exposure
 Local versus systemic effects
 Dose response
 Synergistic effects
Explain how the substance and route of
contamination alters triage and
decontamination methods.
Explain the limitations of field
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decontamination procedures.
Identify local facilities and resources capable
of treating patients exposed to hazardous
materials.
Determine the hazards present to the patient
and paramedic given an incident involving
hazardous materials.
Define the following and explain their
importance to the risk assessment process:
 Boiling point
 Flammable/ explosive limits
 Flash point
 Ignition temperature
 Specific gravity
 Vapor density
 Vapor pressure
 Water solubility
 Alpha radiation
 Beta radiation
 Gamma radiation
Define the toxicologic terms and their use in
the risk assessment process:
 Threshold limit value (TLV)
 Lethal concentration and doses (LD)
 Parts per million/ billion (ppm/ppb)
 Immediately dangerous to life and
health (IDLH)
 Permissible exposure limit (PEL)
 Short term exposure limit (TLV-STEL)
 Ceiling level (TLV-C)
Given a specific hazardous material, be able to
do the following:
 Research the appropriate information
about its physical and chemical
characteristics and hazards
 Suggest the appropriate medical
response
 Determine risk of secondary
contamination
Determine the factors that determine where
and when to treat a patient to include:
 Substance toxicity
 Patient condition
 Availability of decontamination
Explain the medical monitoring procedures of
hazardous material team members to be used
both pre and post entry, to include:
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 Vital signs
 Body weight
 General health
 Neurologic status
 ECG
Explain the factors that influence heat stress of
hazardous material team personnel to include:
 Hydration
 Physical fitness
 Ambient temperature
 Activity
 Level of PPE
 Duration of activity
Explain the documentation necessary for
HAZMAT medical monitoring and
rehabilitation operations to include:.
 The substance
 The toxicity and danger of secondary
contamination
 Appropriate PPE and suit
breakthrough time
 Appropriate level of decontamination
 Appropriate antidote and medical
treatment
 Transportation method
Given a simulated hazardous substance, use
reference material to determine the
appropriate actions.
Integrate the principles and practices of
hazardous materials response in an effective
manner to prevent and limit contamination,
morbidity, and mortality
Have an awareness of the human hazard of
crime and violence and the safe operation at
crime scenes and other emergencies.
Explain how EMS providers are often mistaken
for the police.
Describe police evidence considerations and
techniques to assist in evidence preservation.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
178
Mass Casualty Incidents Due to Terrorism and Disaster
Summary: Knowledge of operational roles and responsibilities to ensure safe patient, public, and
personnel safety.
TARGET SKILLS: Risks and responsibilities of operating on the scene of a natural or man-made disaster
(this section subject to ongoing collective and cooperative review and input from all stakeholders
including the Department of Transportation, Department of Homeland Security, and the Department of
Health and Human Services)
Key Terminology:
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Alpha
Ammonium nitrate
Anthrax
Apocalyptic violence
Asymmetric warfare
Bacteria
Beta
Botulinum
Buboes
Bubonic plague
Chlorine (CL)
Communicability
Contact hazard
Contagious
Covert
Cross-examination
Cyanide
Decay
Dirty bomb
Disease vector
Dissemination
Domestic terrorism
DuoDote
Elevated
G agents
Gamma (x-rays)
Guerilla warfare
Imminent
Incubation
International terrorism
Ionizing radiation
LD50
Lewisite (L)
Lymphatic system
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Lymph nodes
MARK 1
Miosis
Mutagen
National Terrorism
Advisory system (NTAS)
Nerve agents
Neurotoxins
Neutron radiation
Non-state-supported
terrorism
Off-gassing
Organophosphates
Persistency
Phosgene
Phosgene oxime (CX)
Pneumonic plague
Points of distribution
(PODs)
Radioactive material
Radiologic dispersal
device (RDD)
Ricin
Route of exposure
Sarin (GB)
Secondary device
Smallpox
Soman (GD)
Special atomic demolition
munitions (SADMs)
State-directed terrorism
State-sponsored terrorism
Suicide bombers
Sulfur mustard (H)
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Syndromic surveillance
Tabun (GA)
Terrorism
V agent (VX)
Vapor hazard
Vesticants
Viral hemorrhagic fevers
(VHFs)
Viruses
Volatility
Weapon of mass
destruction (WMD)
Weaponizaton
6-feet rule
After-action report(AAR)
All-hazards approach
Ashfall
Casualty collection points
Cold stress
Continuity of operations
plan (COOP)
Critical infrastructure
Directed area
Disaster
Disaster management
Dust suffocation
Emergency operations
center (EOC)
Epidemic
Forward surgical team
Incident command system
(ICS)
Lister bags
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Mutual aid agreements
(MAAs)overtopping
Pandemic
Point of distribution (POD)
Pyroclastic explosions
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Radio operators
Seasonal affective
disorder (SAD)
Shelter-in-place
Space junk
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Tg lines
Thermals
Unified command system
Water buffalo trailers
Objectives:
DOT Objectives
 Provide some examples of domestic and
international terrorism
 Provide examples of four different types of
goals that commonly motivate terrorist
groups to stage a terrorist attack.
 Define the terms weapons of mass
destruction (WMD) and weapons of mass
casualty (WMC), and list weapons that may
be utilized by terrorists.
 Discuss the history of chemical agents, their
four main classifications, routes of exposure,
effects on the patient, and patient care.
 Discuss three categories of biological agents,
routes of exposure, effects on the patient,
and patient care.
 Describe the history of nuclear/radiologic
devices, sources of radiological materials and
dispersal devices, medical management of
the patient, and protective measures that can
be taken by personnel.
 Describe how the Department of Homeland
Security (DHS) and Homeland Security
Advisory System relate to the daily activities
of the EMS provider and their ability to
respond to and survive a terrorist attack.
 Describe the key observations an EMS
provider must make on each call to assist in
the determination of whether an incident is
related to terrorism.
 Explain the colors and threat levels that are
used by the DHS daily to heighten awareness
of the current terrorist threat.
 Describe the critical response actions related
EMS Education Standards
 Understand, demonstrate, and discuss the
knowledge of operations roles and
responsibilities to ensure safe patient, public,
and personnel safety.
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to establishing and reassessing scene safety,
personnel protection, notification
procedures, and establishing command an
EMS provider must perform at a suspected
terrorist event.
Explain the role of EMS in relation to
syndromic surveillance and points of
distribution (PODS) during a biological event.
Activities/Resources: Use of auditory, visual, and kinesthetic aids to facilitate the student learning
environment for the topic of instruction.
Assessments: Scenario based training pertinent to topic of instruction, quiz, and exam (didactic and
skills).
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