State of Alaska
EMT-1 INSTRUCTOR
TRANSITION TO THE NATIONAL EMS
EDUCATION STANDARDS GUIDE
DECEMEBER 2014
2
Table of Contents
This guide should be helpful to Alaska’s EMT-1 Instructor. The content in the curriculum
updates the Alaska EMT-1 1994 Based Guidelines (as adopted by reference, 2002)
Page #
Content
4.
DHSS – EMS Program Office Staff (2014)
5.
Purpose of this document – EMS Agenda for the Future
6.
Alaska EMS & National EMS Standards
7.
Value of EMS Data (ImageTrend & Aurora Data Systems)
8.
New National Standard EMT Curriculum – How does it differ?
9.
Outlining the Changes in National EMS Education Standards
14.
National EMS Core Content Categories
15.
How to Use this Transition Plan
16.
National EMS Education Standards Core Content Curriculum Details
31.
Common Drug List of the National Standard Scope of Practice
42.
Side-by-Side Comparison of AK EMT-1 & Nat’l EMS Ed. Guidelines
56.
Instructor Clinical Evaluation & Education Course Infrastructure
59.
EMT-1 Skills List
64.
Helpful EMS Links from the Internet for the EMS Instructor
66.
Bibliography
67.
Appendix
Cover design: Jopeel Quimpo, NREMT, Data & Certification Assistant, Alaska DHSS-EMS
3
State of Alaska DHSS / EMS Staff - 2014
The State of Alaska, Department of Health & Social Services, Section of Emergency
Programs – EMS Unit is located at:
410 Willoughby Ave, Room 101
PO Box 110616 Juneau, AK 99811-0616
Office Hours: 0800 – 1600 (individual staff schedules differ)
Webpage: http://dhss.alaska.gov/dph/Emergency/Pages/ems/default.aspx
Public Portal –
 Main Phone Number:
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EMS Manager
EMS Data
EMS-Children
EMS Certification
EMS Certification & Data Assistant
EMS Training & Education
907-465-8741
Mark.Miller@alaska.gov
Todd.McDowell@alaska.gov
Marna.Schwartz@alaska.gov
Carin.Marter@alaska.gov
Jopeel.Quimpo@alaska.gov
Ron. Quinsey@alaska.gov
907-465-8633
907-465-8634
907-465-5467
907-465-3029
907-465-2262
907-465-8508
In 2013, the office of Emergency Medical Services was staffed with three people. As of January 2015, the office
is near fully staffed.
4
Purpose of this document
In pursuit of improving EMS in Alaska, steps have been made over the past couple of years to follow EMS Best
Practices by incorporating evidence-based directions outlined in national documents such as the EMS Agenda
for the Future. Other guiding documents include:
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National EMS Core Content
National EMS Scope of Practice
National EMS Education Standards
National EMS Certification
National EMS Program Accreditation
As this document focuses on EMS education standards within the State of Alaska, other improvements to the
EMS system are occurring simultaneously. The backbone of quality EMS care directly relates to the quality
of the education and training the EMS professional receives. For too long, the EMS educators in Alaska
have not been supported through updates in State Regulations nor policies that supported curriculum changes
when they occur, or the continuing education systems that could establish parity of education and training across
the state. This document should be considered the beginning to that effort.
EMS in Evolution
“Emergency care has made important advances in recent decades: emergency 9-1-1 service now links virtually all
ill and injured Americans to immediate medical response; organized trauma systems transport patients to
advanced, lifesaving care within minutes; and advances in resuscitation and lifesaving procedures yield outcomes
unheard of just two decades ago.” i
Alaska’s uniquely diverse geography and historic cultures require an EMS strategy that is both based in secured
tradition and adaption to current evidence-based medical practices. Collaborations between Public Health, Native
Health Services and the hospital industry can improve Alaska’s quality health care system’s future. Key in this
development is EMS care beginning with the needs from emergency scene and transportation of the emergency
patient, both ground and air, to patient delivery to the appropriate level of care facility. Improvement will not occur
by accident, strategic focus can only come from information.
Future development of Alaska healthcare and EMS systems will be constructed through robust data and evidence
based Best Practices. All stakeholders play an important part in that goal.
Alaska must analyze data from patient care reports (PCR), hospital informational systems such as Alaska’s
Trauma Registry, analysis and reports produced by the DHSS Department of Epidemiology to develop the best
EMS response across all the communities of Alaska. The value of data collection cannot be overstated enough.
Data is invaluable in directing the right resources and efficiencies across Alaska. It means the where, how, why,
when and to whom questions of pre-hospital EMS incidents is necessary to move this healthcare system forward.
Executing quality EMS care across Alaska requires information and information comes from data. Currently,
State of Alaska, DHSS-EMS uses AURORA (Alaska Universal Response Online Reporting Access);
ImageTrend, is the corporation that services Alaska’s EMS data management system. In addition patient care
data, ImageTrend is also used for certification/license and EMS education course approvals. Improvements from
technology as these have proven valuable in supporting Alaska’s EMS system’s evolution.
i National Institutes of Health – EMS at the Crossroads; 2006, 2009
5
Alaska Emergency Medical Services & National EMS Standards
In 1996, the National Highway Traffic Safety Administration
(NHTSA) and the Health Resources and Services Administration
(HRSA) published the highly regarded consensus document titled the
EMS Agenda for the Future, commonly referred to as the Agenda.
This was a federally funded position paper completed by the National
Association of EMS Physicians (NAEMSP) in conjunction with the
National Association of State EMS Directors (NASEMSD).
The intent of the Agenda was to create a common vision for the
future of EMS. This document was designed for use by government
and private organizations at the national, state, and local levels to
help guide planning, decision making, and policy regarding EMS.
The Agenda addressed 14 attributes of EMS, including the EMS
education system.
“The National Standards
define the competencies,
clinical behaviors, and
judgments that must be
met by entry-level EMS personnel to meet
practice guidelines defined in the National EMS Scope of Practice
Model." (NHTSA, 2009)
The Agenda provided the following overall vision for EMS in the
future:
Emergency Medical Services (EMS) of the future will be community-based
health management that is fully integrated with the overall health care
system. It will have the ability to identify and modify illness and injury
risks, provide acute illness and injury care and follow-up, and contribute to
treatment of chronic conditions and community health monitoring. This
new entity will be developed from redistribution of existing health care
resources and will be integrated with other health care providers and
public health and public safety agencies. It will improve community health and result in a more appropriate use of
acute health care resources. EMS will remain the public’s emergency medical safety net.
EMS education is of high quality and represents the intersection of the EMS professional and the formal
educational system. The content of the education is based on National EMS Education Standards.
There is significant flexibility to adapt to local needs and develop creative instructional programs. Programs are
encouraged to excel beyond minimum educational quality standards. EMS education is based on sound
educational principles and is broadly recognized as an achievement worthy of formal academic credit.
Where referenced – the 1994 EMT-Basic curriculum is the same curriculum outlined as the Alaska
Emergency Medical Technician-1 Curriculum (adopted by reference, 2002). The National EMS Education
Standard curriculum is the curriculum instructors will incorporate in their EMT-1 initial courses,
beginning January 2015. In some cases, teaching this new curriculum as designed may not be possible.
Therefore, adaptation is encouraged and the State of Alaska EMS Unit is here to assist the instructor.
6
Key Values with National EMS Education Standards
EMS INSTRUCTORS become EMS EDUCATORS
EMS instructors are respected for their committed experience as EMS
providers who combine evidence-based pre-hospital treatment principles
and education methodologies to share with those they consider future
EMS providers and peers. EMS education must be dynamic (everchanging), resourceful to accommodations as needed and consistent to
patient care standards. Who better than those persons who dedicate
themselves to pre-hospital service, than EMS educators?
It was 2009 when the National EMS Education Standards were
promoted, yet never totally adopted by Alaska. In 2014 the State of Alaska
Department of Health and Social Services, Emergency Medical Services,
the State Medical Director, the Governor’s Alaska Council on EMS
(ACEMS), its Training Sub-committee and EMS Regional Councils adopted
the National EMS Standards that included the National EMS Education
Standards. Adoption of this educational curriculum was supported by the
National Highway Traffic Safety Administration (NHTSA) team in their, May
2014, reassessment of the Alaska EMS System.
http://dhss.alaska.gov/dph/Emergency/Documents/ems/documents/2014%20Alaska%20EMS%20Reassessment%20Final%20Report%20May%202014.pdf
January 2015, the State of Alaska will begin implementing improvements in basic EMS training and education
with the incorporation of a new State certification exam for EMT-1 certification applicants. Some EMS educational
institutions and instructors have already been using this new curriculum and are familiar with the value it brings.
EMT-1 Instructors should include the new teaching points in their lesson plans, improving what is learned from the
old Alaska EMS Education Guidelines (2002) to National EMS Educational Standards curriculum when they
teach. This education Agenda is focused, for now, only on the initial education of EMS (EMT-1) providers. Future
continued education or continued competency assurance mechanisms would incorporate these educational
objectives.
Benefits of these improvements:
 EMS objectives are researched and evidenced-based EMS practices
 Instructors shall find this significantly flexible, with abilities to stimulate learning methodologies
 Designed to encourage creativity in educational delivery methods
o Problem-based learning methods
o Computer-aided learning methods
o Distance learning abilities
o Programmed self-instruction verses all lessons must be lectured based
 Technical competencies reinforces critical thinking decision making as done in the field today
 Socially conscious and cultural sensitivity are imperatives to education lessons
 Core competencies focused vs. specific timed based lessons (teach to effect not to a clock)
Removed from the Alaska EMT-1 Certification Exam: Alaska Specific Education Objectives
EMT instructors, when teaching an initial EMT course, can utilize the Alaska specific objectives (Trauma and Cold
Injuries Guidelines) to emphasize the lessons but Alaska criteria will not be tested in the EMT Certification
examination. The intent is to develop an Alaska Specific education module that is not tested.
7
NEW National Standard EMT Curriculum?
How does it differ from the Alaska EMT-1 Curriculum?
The order of content is not meant to imply the order of delivery
Current Regulations (7AAC 26.050) do not allow for a wholesale correction in Alaska’s EMS education system.
Although Regulation changes are in progress, to remain progressive and meet current ‘Standard of Care’ State of
Alaska DHSS-EMS has a policy (DHSS-EMS Policy 13-002, July 13, 2013) that allows for curriculums that ‘meet
or exceed’ current 1994 Alaska EMT-1 Curriculum Guidelines as adopted by reference, 2002.
What that means is, DHSS-EMS cannot disallow education coordinators from making application to instruct an
EMT-1 course using the Alaska EMS Guidelines from 2002, although DHSS-EMS can accept and approve
education and training that utilizes current National EMS Education Standards. The information included in this
document only updates the 2002 EMT-1 educational guidelines; it does not apply a wholesale change to it.
The guidelines enclosed here are a tool for experienced Alaska EMS instructors to use in their lessons they teach
at an EMT-1 Initial Course and that it follows the National EMS Education Standards. Alaska EMS instructors
may find benefit with commercially made lesson plans. Enclosed in the Alaska National EMS Education
Standards Transition Package are examples of commercial curriculums, lesson plans, PowerPoint slides, .pdf
handouts as well as other materials to assist the instructor with this effort. Instructors looking for additional
assistance can email: EMSTraining@alaska.gov or call 907-465-8508 (EMS Training Manager).
Emergency Medical Technician: New Course Benefits
When planning and conducting a new EMT (initial) course, the Program Director or Course Coordinator must
incorporate all considerations at the EMR levels plus, National Highway Traffic Safety Administration EMS
curriculums; elements which are designed to build upon one another (EMR, EMT, AEMT, Paramedic). EMR
criteria have been merged into this EMT Core Content outlined in this document.
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The National Standard Curriculum (2009) is based off past curriculums with an emphasis on
developing the EMT (EMT-1) to be Job Ready.
Primary & Secondary Patient Assessment is recognized (Focused and Detailed pertains to
specifics within the assessment). Therefore, both terms are used.
Ten (10) Patient Assessments outlined in the National EMS Education Standards is not always
possible in Alaska. Instructors are encouraged to adopt methods that incorporate direct patient
contacts or real-life scenarios wherever possible. Creative adaption is encouraged. The
inclusion of a course Medical Director requirement is optional at this time.
Review and verify integration of the clinical behavior/judgment. Does the student understand
what they are doing and do they know why the doing it? Do they understand how to adapt to
change in circumstances or when new information indicates a different treatment approach?
Focus EMT instruction on competency – not by a clock. EMS Educators uses the time given to
a topic as a means of what emphasis might be required. Instructors now can spend the time
where necessary and not on a time-weighted lesson; students may require a little more or a little
less to show competency. Instructors should include affective evaluation and professional
behavior when assessing the student. Does the student demonstrate competency (combination
of knowledge, skills and ability) to perform as an EMT? That is the question.
8
Outlining the Changes in the National
EMS Education Standards
This gives a summary of the National
EMS Education Standards for an
EMT (Alaska EMT-1)
9
Emergency Medical Technician: Skills Removed
For a current EMT-Basic (based on 1994 EMT-B National Standard Curriculum) transitioning to 2009
Emergency Medical Technician (EMT), the following skills are no longer taught:
 Insertion of nasogastric and orogastric tubes (Not in the 1994 EMT-B National Standard Curriculum but in
the 2002 Advanced Airway supplement) – (removed)
 Activated charcoal removed from formulary medication – (removed)
 Pressure points and elevation for hemorrhage control – (removed)
EMT Skills – National EMS Education Standards
For 1994 EMT-Basic transitioning to 2009 Emergency Medical Technician EMT, the following skills are new:
 Use of supplemental oxygen and oxygen humidfiers
 Use of nasal cannula
 Use of non-rebreather face mask
 Use of oxygen humidifiers
 Use of partial rebreather masks
 Use of simple face masks
 Use of Venturi masks
 Obtaining a pulse oximetry value
 Use of automated transport ventilators
 Determining blood glucose using a glucose meter
 Use of the automated external defibrillator (AED)
 Use of a bag-valve-mask
 Use of an auto-injector (self or peer)
 Obtaining manual blood pressures
 Use of mechanical CPR devices (requires additional specialty training and device approval) – where
available
 Application of mechanical patient restraint (1994 EMT-B National Standard Curriculum contains an
approach now deemed inappropriate and a risk to the patient—i.e. forceful restraint in a prone position,
with wrists & ankles tightly tied together ("hobbled") behind the back.)
 Assisting a patient with his/her prescribed medications, nebulized/aerosolized (1994 EMT-B National
Standard Curriculum advocated assisting a patient with hand-held aerosol inhalers, but not administer
nebulized medications to a patient)
 Administration of aspirin by mouth
 Use of an auto-injector (self or peer)
 Performing eye irrigation
Emergency Medical Technician Content – National EMS Education Standards
The following is a syllabus of the National EMS Education Standards with reference to the difference of the
1994 EMT-Basic curriculum.
Preparatory – EMS Systems
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EMS Systems – more detailed discussion on patient safety issues, decreasing medical errors, and
required affective/behavioral characteristics
Research – extremely limited information on evidence based decision making
Workforce Safety and Wellness – emphasizes the difference between body substance isolation and
personal protective equipment; brief discussion on bariatric issues, neonatal isolettes and medical
restraint
Documentation - Health Insurance Portability and Accountability Act (HIPAA) did not exist when the
1994 EMT-B National Standard Curriculum was authored
Therapeutic Communications – more detailed information about improving communication with the
patient
Medical/Legal/Ethics – Health Insurance Portability and Accountability Act (HIPAA) did not exist when
the 1994 EMT-B National Standard Curriculum was authored; should include a state-specific discussion
on privileged communication; includes a brief discussion on living wills, surrogate decision makers, and
civil and criminal court cases; ethics
10
Anatomy and Physiology
 The respiratory information found in the 2000 Supplemental Airway and Ventilation Module should be
added; more detailed discussion on the life support chain focusing on oxygenation, perfusion, and the
cellular environment
Medical Terminology
Minimal new content added to this level
Pathophysiology
 This content is new to this level but only focuses on respiratory and perfusion dysfunction along with shock
 Life-Span Development - New information at this level
 Public Health - New information at this level; related to EMS Agenda for the Future issues
Pharmacology
 Medication administration – added the five rights of medication administration
 Emergency Medications – aspirin added to this level
 Airway Management, Respiration, and Oxygenation
 Anatomy and Physiology – much more detailed than in the previous 1994 EMT-B National Standard
Curriculum
 Respiration - much more detailed than in the previous 1994 EMT-B National Standard Curriculum
 Artificial Ventilation - more detailed than in previous 1994 EMT-B National Standard Curriculums
Patient Assessment
 Scene Size-Up – no new information here; re-emphasis on the need for scene safety for everyone
present
 Primary Assessment - new terminology that more closely mimics other health care professionals
 History Taking - new terminology that more closely mimics other health care professionals
 Secondary Assessment - new terminology that more closely mimics other health care professionals;
more thorough than in the previous curriculum
 Monitoring Devices – pulse oximetry added
Medicine
 Medical Overview – re-use of the new assessment terminology; with focus on medical patient
 Neurology – in the previous curriculum, most of the neurological conditions were bundled together into
altered mental status. This new section requires a greater assessment and differentiation; stroke is a
rapidly changing area. Local standards and various national organizations should serve as a resource for
currently accepted assessment and treatment
 Abdominal and Gastrointestinal Disorders – minimal new content added to this level
 Immunology - the term anaphylaxis did not appear in the 1994 EMT-B National Standard Curriculum;
some geriatric information added
 Infectious Diseases – this section should include updated infectious disease information, for example
Methicillin-Resistant Staphylococcus Aureus (MRSA) and Acquired Immune Deficiency Syndrome (AIDS)
update; should include a discussion on cleaning and sterilizing equipment and decontaminating the
ambulance
 Endocrine – increased emphasis on pathophysiology and acknowledgement of the increasing
prevalence and incidence of diabetes in the community
 Psychiatric – includes new material on excited delirium; the 1994 EMT-B National Standard Curriculum
has incorrect and dangerous information about the use of restraint and should no longer be presented
(i.e. “hog-tied” or hobble technique)
 Cardiovascular – increased emphasis on anatomy, physiology and pathophysiology; increased
emphasis on specific cardiovascular emergencies, addition of aspirin information for acute coronary
syndrome
 Toxicology – poison control information included; addition of drugs of abuse
 Respiratory – more in-depth evaluation of a patient with respiratory problems.
 Hematology – brief discussion of sickle cell disease
 Genitourinary/Renal – more detailed discussion of this organ system
 Gynecology – brief discussion of sexually transmitted diseases and pelvic inflammatory disease
 Non-Traumatic Musculoskeletal Disorders – new information at this level
11
Shock and Resuscitation
Shock content was moved from trauma to emphasize the fact that it occurs in contexts other than trauma; the
cardiac arrest information was moved from cardiology for 2009 National EMS Education Standards Gap
Analysis Template for the same reason; brief discussion on devices to assist circulation, although subject to
local protocol; shock should be taught in a more comprehensive context rather than simply as a consequence
of bleeding.
Trauma
 Overview – discussion on the Centers for Disease Control (CDC) Field Triage Tool for transport decision:
The National Trauma Triage Protocol; assessment focuses on trauma patient; the term fracture was
placed back into the vocabulary – Alaska Trauma Transport Guidelines in re-write
 Chest Trauma – more detailed discussion
 Abdominal Trauma – more detailed discussion
 Orthopedic Trauma - the term fracture was placed back into the vocabulary
 Head, Facial, Neck, and Spine Trauma – more detail about neck, eye, oral and brain injuries; emphasizes
the harm of hyperventilation in most circumstances
 Nervous System Trauma - the old curriculum was separated into soft tissue and injuries to the head and
spine; more detail on brain anatomy; emphasizes the harm of hyperventilation; references the Brain
Trauma Foundation; increased emphasis on neurological assessment
 Special Considerations in Trauma – added discussion on the elderly, pediatrics, the pregnant patient,
the cognitively impaired
 Environmental – more in depth discussion on submersion, bites, envenomation, diving injuries (subject
to local protocols) and radiation exposure
 Multi-system Trauma – new material at this level; discussion of kinematics and blast injury
Special Patient Populations
 Pregnant Patient – more detailed discussion on complications of pregnancy; uses the terms
preeclampsia, eclampsia and premature rupture of membranes (which do not require a lengthy
discussion)
 Pediatrics – this section is more detailed than in the previous version; add reporting requirement
 Geriatrics – all new section for this level; add reporting requirement
 Patients with Special Challenges – elder abuse, homelessness, poverty, bariatric, more technology
dependent, hospice, sensory deficit, homecare, and developmental disabilities added
EMS Operations
 Principles of Safely Operating a Ground Ambulance - increased depth of discussion on the risks of
emergency response and leaving the scene
 Incident Management – references the incident management system and the federal requirements for
compliance
 Multiple Casualty Incidents – SMART or similar triage tool for multiple patients; reference Centers for
Disease Control (CDC) Field Triage for transport decision
 Air Medical – all material at this level represents the same depth and breadth as at the EMR level
(Alaska will still recognize Medevac Certification Course)
 Vehicle Extrication – all material at this level represents the same depth and breadth as the EMR level –
nothing changed
 Hazardous Materials Awareness – all material at this level represents the same depth and breadth as
the EMR level
 Mass Casualty Incidents Due to Terrorism or Disaster – all material at this level represents the same
depth and breadth as the EMR level.
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National EMS Core Content Categories
PREPARATORY AND OPERATIONS
1.
EMS Systems
2.
The Roles and Responsibilities of the EMS
Providers
3.
The Well-Being of the EMS Provider
4.
Illness and Injury Prevention
5.
Medical / Legal Issues
6.
Ethics
7.
General Principles of Pathophysiology
8.
Pharmacology
9.
Venous Access and Medication
Administration
10. Therapeutic Communications
11. Life Span Development
12. Ambulance Operations
13. Medical Incident Command
14. Rescue Awareness and Operations
15. Hazardous Materials Incidents
16. Crime Scene Awareness
17. Communications
18. Documentation
19. Airway Management and Ventilation
20. History Taking
21. Techniques of Physical Examination
22. Patient Assessment
TRAUMA
23. Trauma Systems
24. Mechanism of Injury
25. Hemorrhage and Shock
26. Soft Tissue Trauma
27. Burns
28. Head and Facial Trauma
29. Spinal Trauma
30. Thoracic Trauma
31. Abdominal Trauma
32. Musculoskeletal Trauma
MEDICAL
33. Pulmonary
33.1 Acute/adult respiratory distress syndrome
33.2 Obstructive airway diseases
33.2.1 Asthma
33.2.2 Chronic bronchitis
33.2.3 Emphysema
33.3 Pneumonia
33.4 Pulmonary edema
33.5 Pulmonary thromboembolism
33.6 Neoplasms of the lung
33.7 Upper respiratory infection
33.8 Spontaneous pneumothorax
33.9 Hyperventilation syndrome
34. Cardiology
35. Neurology
36. Endocrinology
37. Allergies and Anaphylaxis
38. Gastroenterology
39. Renal/Urology
40. Toxicology
41. Hematology
42. Environmental Conditions
43. Infectious and Communicable Diseases
44. Behavioral and Psychiatric Disorders
45. Gynecology
46. Obstetrics
47. Neonatology
48. Pediatrics
49. Geriatrics
50. Abuse and Assault
51. Patients with Special Challenges
52. Acute Interventions for the Chronic Care
Patient
13
How to Use this EMT-1 Instructor Transition Plan
The State of Alaska is committed to the value and support of the State’s EMS Instructors contribution to the
EMS system. Moving to the National EMS Education Standards should not be burdensome. It does require
a new way of thinking of how they teach. No longer does the EMT curriculum require specific time criteria to
a topic. Where emphasis is required, the instructor takes the necessary time to confirm the ‘terminallearning objective’ is understood and met by the student; i.e. the old saying: “Alaska doesn’t have a snake
problem” is true, more emphasis should be paid to specific cold injuries and treatments. This Transitional
Plan is outlined in different ways, be it the full curriculum content, only the new content or side by side
comparison of the new content modules to the Alaska EMT-1 Instructional Guidelines from 2002.
EMT-1 Instructors Transition
Improvements in EMT-1 initial education and training must now, as of January 2015, include National EMS
Standards. Some EMS (EMT-1) instructors have been using this curriculum for many years and have great
familiarity. Some may have less familiarity. The information contained in this document provides an EMT-1
instructor elements of improvement to the EMT-1 Instruction Guidelines (2002) to meet National EMS
Education Standards. Information included in the electronic files in the AK EMT-1 Instructor Transition
Packet provides support material for their lesson plans. With these improvements to the Alaska EMS
education systems EMS instructors have the flexibility to use this curriculum to their goals of providing the
best education they can as does other professional educator(s).
EMT-1 Initial Test Requirement for EMT-1 Instructors
The culmination of this improvement is the requirement that all EMT-1 instructors must complete the 2015
EMT-1 Initial Alaska State Certification Exam. Unlike required for instructor certification, this requirement is
for familiarity of what is included in the EMT-1 Certification exam. Instructors must request access to the
EMT-1 Initial Exam via an email to the State of Alaska EMS Office: EMSTraining@Alaska.gov
National EMS Education Standards Gap Analysis
Only specific of differences between the Alaska EMS Education Guidelines and the National Standards are
outlined. If there is no change in EMS education criteria – there would be no reference. Time in this
spreadsheet is for “emphasis” on the topic only. It can be helpful for the instructor when outlining their
course schedule. However, there is no requirement that the topic must fit to time requirement; however,
instructors may use their class schedule from the past as a guide for their new lesson plans.
Knowledge and Skill Comparison (Emergency Medical Technician)
Emergency Medical Technician: New Course Considerations - When planning and conducting a new EMT
course, the Program Director or Course Coordinator must incorporate all considerations at the EMR levels
plus,
Clinical Experience – an attempt to witness or participate with 10 patients contacts
Student should experience some clinical time in a Ride-Alone with an ambulance crew or time in an
Emergency Department, Community Clinic or Medical Office (this component is encourage but not required)
or in subsitution
An experienced EMS professional shall review 10 real emergency using the Case Review Template (this is
meant to give students details of a real EMS from the person who actually participated – students are
encouraged to ask questions.
Alaska Preceptors of the EMT student should (where and when allowed):
 Review and verify integration of the clinical behavior/judgment section of the Education Standards
particularly related to lab and clinical and field activities.
 Include affective evaluation and professional behavior in student assessment
14
National EMS Education Standards
Core Content
Curriculum Details
(element by element)
The order of content is not meant to imply the order of delivery.
15
National EMS Education Standards Core Content - Details
The core content criteria, as outlined in above, are National EMS Education Standards. This information
uses Core Content from Emergency Medical Responder and Core Content. The details that update the
Alaska EMT-1 curriculum (2014), as described below, is a marriage of EMR and EMT objectives.
What’s New?
Anatomy and Physiology
Much more detailed than in the previous 1994 EMT-B National Standard Curriculum. More detailed
discussion on the life support chain focusing on oxygenation, perfusion, and the cellular environment.
 terminology " primary assessment"
 terminology "secondary assessment"
 terminology history taking
Medical Terminology
Medical New assessment terminology – EMT level
 (nurology) add stroke updates
 (immunology) term anaphylaxis
 (infectious disease) MRSA, AIDS, decontamination of unit
 (endocrine) pathophysiology - diabetes
 (psychiatric) excited delirium - restraint change
 (toxicology) Poison control info - drugs of abuse
 (respiratory) more depth
 (hematology) sickle cell disease
 (gyn) PID sexually transmitted disease
 (cardiology) A&P aspirin
Pathophysiology
 This content is new to this level but only focuses on respiratory and perfusion dysfunction along with
shock
Life-Span Development
 New information at this level.
Public Health
New information at this level; related to EMS Agenda for the Future issues. EMS/Public Health integration
Pharmacology
 Medication administration basics – added the five rights of medication administration
Emergency Medications – aspirin added to this level
Airway Management, and Ventilation
 Anatomy and Physiology – much more detailed than in the previous 1994 EMT-B National Standard
Curriculum
 Respiration - much more detailed than in the previous 1994 EMT-B National Standard Curriculum
 Artificial Ventilation - much more detailed than in the previous 1994 EMT-B National Standard
Curriculum
 Patient Assessment
 Scene Size-Up – no new information here but a re-emphasis on the need for scene safety for everyone
present
 Primary Assessment - new terminology that more closely mimics other health care professionals
 History Taking - new terminology that more closely mimics other health care professionals
 Secondary Assessment - new terminology that more closely mimics other health care professionals;
more thorough than in the previous curriculum
 Monitoring Devices – pulse oximetry added
16
Patient Assessment
 Scene Size-Up – no new information here but a re-emphasis on the need for scene safety for everyone
present
 Primary Assessment - new terminology that more closely mimics other health care professionals
 History Taking - new terminology that more closely mimics other health care professionals
 Secondary Assessment - new terminology that more closely mimics other health care professionals;
more thorough than in the previous curriculum
 Monitoring Devices –blood glucose monitoring, non-invasive blood gas and chemistry monitoring (e.g.
capnography, pulse oximetry, etc.)
Medicine
 Medical Overview – re-use of the new assessment terminology; with focus on medical patient
 Neurology – in the previous curriculum, most of the neurological conditions were bundled together into
altered mental status. This new section requires a greater assessment and differentiation; stroke is a
rapidly changing area. Local standards and various national organizations should serve as a resource
for currently accepted assessment and treatment
 Abdominal and Gastrointestinal Disorders – minimal new content added to this level
 Immunology - the term anaphylaxis did not appear in the 1994 EMT-B National Standard Curriculum;
some geriatric information added
 Infectious Diseases – this section should include updated infectious disease information, for example
methicillin-resistant Staphylococcus aureus (MRSA) and Acquired Immune Deficiency Syndrome (AIDS)
update; should include a discussion on cleaning and sterilizing equipment and decontaminating the
ambulance
 Endocrine – increased emphasis on pathophysiology and acknowledgement of the increasing
prevalence and incidence of diabetes in the community
 Psychiatric – includes new material on excited delirium; the 1994 EMT-B National Standard Curriculum
has incorrect and dangerous information about the use of restraint and should no longer be presented
(i.e. “hog-tied” or hobble technique)
 Cardiovascular – increased emphasis on anatomy, physiology and pathophysiology; increased
emphasis on specific cardiovascular emergencies, addition of aspirin information for acute coronary
syndrome
 Toxicology – poison control information included; addition of drugs of abuse
 Respiratory – more in-depth evaluation of a patient with respiratory problems.
 Hematology – brief discussion of sickle cell disease
 Genitourinary/Renal – more detailed discussion of this organ system
 Gynecology – includes brief discussion of sexually transmitted diseases and pelvic inflammatory disease
 Non-Traumatic Musculoskeletal Disorders – new information at this level
Shock and Resuscitation
 This shock content was moved from trauma to emphasize the fact that it occurs in contexts other than
trauma; the cardiac arrest information was moved from cardiology for 2009 National EMS Education
Standards Gap Analysis Template for the same reason; brief discussion on devices to assist circulation,
although subject to local protocol; shock should be taught in a more comprehensive context rather than
simply as a consequence of bleeding
Trauma
 Overview – discussion on the Centers for Disease Control (CDC) Field Triage Decision Scheme: The
National Trauma Triage Protocol; assessment focuses on trauma patient; the term fracture was placed
back into the vocabulary
 Chest Trauma – more detailed discussion
 Abdominal Trauma – more detailed discussion
 Orthopedic Trauma - the term fracture was placed back into the vocabulary
 Head, Facial, Neck, and Spine Trauma – more detail about neck, eye, oral and brain injuries;
emphasizes the harm of hyperventilation in most circumstances
 Nervous System Trauma - the old curriculum was separated into soft tissue and injuries to the head and
spine; more detail on brain anatomy; emphasizes the harm of hyperventilation; references the Brain
Trauma Foundation; increased emphasis on neurological assessment
 Special Considerations in Trauma – added discussion on the elderly, pediatrics, the pregnant patient,
the cognitively impaired
17


Environmental – more in depth discussion on submersion, bites, envenomations, diving injuries (subject
to local protocols) and radiation exposure
Multi-system Trauma – new material at this level; includes discussion of kinematics and blast injury
Special Patient Populations
 Pregnant Patient – more detailed discussion on complications of pregnancy; uses the terms
preeclampsia, eclampsia and premature rupture of membranes (which do not require a lengthy
discussion)
 Pediatrics – this section is more detailed than in the previous version
 Geriatrics – all new section for this level
 Patients with Special Challenges – elder abuse, homelessness, poverty, bariatric, more technology
dependant, hospice, sensory deficit, homecare, and developmental disabilities added
EMS Operations
 Principles of Safely Operating a Ground Ambulance - increased depth of discussion on the risks of
emergency response and leaving the scene
 Incident Management – references the incident management system and the federal requirements for
compliance
 Multiple Casualty Incidents – references Centers for Disease Control (CDC) Field Triage Decision
Scheme: The National Trauma Triage Protocol
 Air Medical – all material at this level represents the same depth and breadth as at the EMR level
 Vehicle Extrication – all material at this level represents the same depth and breadth as the EMR level
 Hazardous Materials Awareness – all material at this level represents the same depth and breadth as
the EMR level
 Mass Casualty Incidents Due to Terrorism or Disaster – all material at this level represents the same
depth and breadth as the EMR level.
Respiration (specific details)
Much more detailed than in the previous 1994 EMT-B National Standard Curriculum.
Artificial Ventilation- Much more detailed than in the previous 1994 EMT-B National Standard Curriculum.
Addition of (this was previously in the curriculum but removed in 1994): Partial Rebreather Mask, Simple
Face Mask, Venturi Mask, Pulse Oximetry, Ventilator AVT), use of oxygen humidifiers.
Objectives:
 Review Airway Management anatomy and physiology terminology
 Review Respiration and the mechanics of ventilation with more emphasis on anatomy and
physiology.
 Identify Artificial Ventilation devices and know how to use them.
Declarative: (1 Hour)
Define (students should have a basic understanding of the different types of Respiratory Disorders)
 Apnea – absence of breathing – respiratory arrest
 Bronchoconstriction –constriction of the smooth muscle of the bronchi and bronchioles.
 Bronchodilator – a drug that relaxes the smooth muscle of the bronchi and bronchioles and reverses
bronchoconstriction
 Hypercarbia – increased carbon dioxide levels in the blood. Also called hypercapnia
 Respiratory Distress – Increased respiratory effort resulting from impaired respiratory function.
 Respiratory Failure – inadequate respiratory rate and /or tidal volume.
 Hypoxemia – decreased oxygen levels in the blood
 Dyspnea – shortness of breath or perceived difficulty in breathing.
 Hypoxia – the absence of sufficient oxygen in the body cells.
Chronic Bronchitis – a disease process that affects primarily the bronchi and bronchioles usually
associated with cigarette smoking. Characterized by a productive cough for at least three consecutive
months out of the year for at least two consecutive years.
18
Assessment findings for Chronic Bronchitis
 Typically are over weight
 Chronic cyanotic complexion
 Difficulty in breathing
 Vigorous productive cough
 Coarse rhonchi
 Wheezes and possibly crackles at the bases
Treatment: Assist the patient with his meter dosed inhaler if he has one and has not yet used it. Oxygen
as needed to keep patient alert. A non-rebreather at 15 liters a minute may be in order or a simple nasal
cannula at 2 -3 liters. Some protocols allow for use of CPAP in severe cases. Place these patients on a
pulse ox and monitor it during care.
Emphysema - A permanent disease process that is the destruction of the alveolar walls and distention of
the alveolar sacs. More common in men than women and usually associated with cigarette smoking.
Assessment findings for Emphysema Patients:

Thin, barrel- chest appearance

Coughing with little sputum

Prolonged exhalation

Diminished breath sounds

Wheezing and rhonchi on auscultation

Pursed-lip Breathing

Extreme difficulty of breathing on minimal exertion

Pink complexion – “pink puffers”

Tachypnea – breathing faster than 20 per minute

Tachycardia – heart rate faster than 100 per minute

Diaphoresis

Tripod position

May be on home oxygen
Treatment is similar to Chronic Bronchitis above.
Asthma – an increased sensitivity of the lower airways to irritants and allergens, causing bronchospasms.
This results in narrowing of the bronchi and swelling of the airway or edema in the lining of the
bronchiole.
Assessment findings for Asthma
 Moderate Distress:
 Dyspnea
 Non-productive cough
 Wheezing on auscultation
 Tachypnea
 Tachycardia
 Anxiety and apprehension
 Possible fever
 Typical allergic signs and symptoms
 Chest tightness
 Inability to sleep
 SpO2 < 95% before oxygen administration
Severe Distress:
 Extreme fatigue
 Inability to speak
 Cyanosis to the core of the body
 Heart rate > 150 beats per minute or a slow rate
 Quiet or absent breath sound on auscultation of the lungs – silent chest
19
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



Tachypnea (respiratory rate >32 breaths per minute)
Excessive diaphoresis
Accessory muscle use (neck, chest, abdomen)
Confusion
SPO2 < 90% with patient on oxygen.
Treatment of Asthma- immediately place the patient on oxygen. If severe, assist with ventilations using
a BVM. Calm the patient. Use the patient’s inhaler or small volume nebulizer or updraft to administer a
beta agonist. If pulse oximeter is available – use an assessment prior (if possible) and post oxygen
administration.
Pneumonia – an acute infectious disease caused by bacterium or a virus that affects the lower respiratory
tract and causes lung inflammation and fluid or pus-filled alveoli.
Assessment of the pneumonia patient:
 Malaise and decreased appetite
 Fever
 Cough
 Dyspnea
 Tachypnea and tachycardia
 Chest pain on inspiration or coughing
 Decreased chest wall movement and shallow respirations
 Splinting of thorax with arm
 Crackles, localized wheezing, and rhonchi heard on auscultation
 Altered mental status, especially in the elderly
 Diaphoresis
 Cyanosis
 SPO2 < 95%
Treatment for Pneumonia- place on humidified oxygen, consider use of meter dosed inhaler if available
or updraft.
Acute Pulmonary Embolism – a sudden blockage of blood flow through a pulmonary artery or one of
its branches. The embolism prevents blood from flowing to the lungs.
Assessment of pulmonary embolism patient:
 Sudden onset of unexplained dyspnea
 Signs of difficulty in breathing or respiratory distress
 Sudden onset of sharp, stabbing chest pain
 Cough
 Tachypnea
 Syncope
 Cool, moist skin
 Restlessness anxiety or sense of doom
 Decrease in blood pressure
 Cyanosis
 Distended neck veins
 Crackles
 Fever
 SPO2 < 95%
 Signs of complete circulatory collapse
Treatment: NRB oxygen and be prepared to use BVM if patient’s condition warrants. Immediately
transport to appropriate facility.
Acute Pulmonary Edema – an excessive amount of fluid collects in the spaces between the alveoli
and the capillaries disturbing normal gas exchange causing hypoxia.
20
Assessment of the pulmonary edema patient:
 Dyspnea
 Difficulty in breathing when lying flat (orthopnea)
 Frothy sputum
 Tachycardia, anxiety, apprehensions, confusion
 Tripod position with legs dangling
 Fatigue
 Crackles and possibly wheezing
 Cyanosis
 Pale, moist skin
 Distended neck veins
 Swollen lower extremities
 Cough
 Symptoms of cardiac compromise
 SPO2 < 95%
Treatment: Positive pressure ventilations. Pulse Ox. Use CPAP if available. 100% oxygen.
Spontaneous Pneumothorax – a portion of the visceral pleural lining around the lungs ruptures. This
occurs without trauma, hence- spontaneous. This allows air to enter into the pleural cavity disrupting the
normally negative pressure and causing the lung to collapse. Known as a ruptured bleb.
Assessment of the spontaneous pneumothorax patient.
 Sudden onset of shortness of breath
 Decreased breath sounds to one side of the chest
 Subcutaneous emphysema
 Tachypnea
 Tachycardia
 Diaphoresis
 Pallor
 Cyanosis
 SPO2 <95%
Treatment: BVM ventilations with minimal tidal volume needed to inflate lungs. Pulse Ox. Use 100%
oxygen. Contact ALS unit.
Epiglotitis – the epiglottis at the base of the tongue covers the vocal chords when swallowing to prevent
aspiration become inflamed along with surrounding structures making it difficult toswallow.
Assessment of the epiglotitis patient
 Dyspnea
 High fever
 Sore throat
 Inability to wallow with drooling
 Anxiety and apprehension
 Tripod position, with jaw jutted forward
 High-pitched inspiratory stridor
 Cyanosis
 Trouble speaking
 SPO2 <95%
Treatment: Do not inspect the airway and mouth as it might cause additional swelling. Place patient on
NRB 100% oxygen. Pulse Ox. Reassure patient. Call for ALS back up.
Pertussis – commonly known as the whooping cough starts out similar to a cold but progresses within 2
weeks or so to rapid coughing about 15 to 24 episodes in close sequence. The body attempts to expel
21
thick mucus from the airway following a crowing or whooping sound made during inhalation as the
patient breaths deeply.
Assessment of the pertussis patient:
 History of upper respiratory infection
 Sneezing , runny nose, low-grade fever
 General malaise
 Increase in frequency and severity of coughing
 Coughing fits, usually more common at night
 Vomiting
 Inspiratory “whoop” heard at the end of coughing burst
 Possible development of cyanosis during coughing burst
 Lowering pulse ox readings
 Exhaustion from expending energy during coughing busts
 Trouble speaking and breathing during burst
Treatment: BSI. NRB Oxygen Mask with humidified oxygen. Pulse Ox. Keep patient calm and expedite
transport to hospital. Consider ALS intercept.
Cystic Fibrosis - disease that causes an overabundant production of mucus in the respiratory tree
causing excessive mucus to collect. This collection of mucus must be continuously expelled. Repeated
lung infections occur causing scaring of the lung tissue and permanent damage to the lung. This all
leads to pulmonary failure and death.
Assessment of cystic fibrosis patient:
 Known history of this disease
 Recurrent coughing
 General malaise
 Expectorant of thick mucus during coughing
 Recurrent episodes or history of pneumonia, bronchitis, an sinusitis
 Gastrointestinal complaints that may include diarrhea, and greasy and/or foul smelling bowl
movements.
 Abdominal pain from intestinal gas
 Malnutrition or low weight despite a healthy appetitie
 Dehydration
 Clubbing of digits
 Trouble speaking and breathing
 Signs of pneumonia
Treatment: Relieve respiratory distress by administering oxygen, humidified at 100% NRB or BVM if
necessary. In severe cases call for ALS.
Meter Dose Inhaler or Small Volume Nebulizer



Actions:
Side Effects:
Indications:


Contraindication;
Dosage:
Steps in using a SVN – Small volume Nebulizer
1) Ensure right patient, right medication, right dose, right route and right date. Determine if the patient is
alert enough to use the nebulizer and if any doses have already been administered prior to your
arrival.
2) Obtain an order, either on-line or off-line, from medical direction for administration of the medication.
3) Disassemble the medication chamber from the mouthpiece by unscrewing it. While holding the
medication reservoir upright, pour in the medication and reassemble the device.
22
4) Attach the tubing extending from the bottom of the drug reservoir to the nebulizer compressor and turn
it on, or attach the tubing to an oxygen tank with the liter flow set to 8 – 10 LPM. You should note the
mist coming from the mouthpiece almost immediately.
5) Remove the non-rebreather mask from the patient, instruct the patient to take the nebulizer in his hand
and hold it upright. If the patient is unable to hold the device, you may have to do this for the patient,
being sure to continuously hold it upright for optimal nebulization of the medication.
6) Have the patient exhale fully.
7) Instruct the patient to place his lips around the mouthpiece of the nebulizer. Another technique is to
have the patient open his mouth and place the mouthpiece 1 – 1.5 inches from the front of the lips,
estimated by two finger widths.
8) Have the patient begin to slowly and deeply breathe in the mist.
9) Instruct the patient to occasionally (every 2 -3 breaths) hold his breath after inhalation as long as he
comfortably can, to assist with medication distribution throughout the respiratory tree.
10) Have the patient exhale normally, and occasionally (every 2 -3 breaths) instruct the patient to cough
during exhalation to facilitate removal of any mucus or secretions that may be present.
11) You may need to occasionally shake the nebulizer to dislodge any medication that tends to collect on
the sides of the drug reservoir. In about 5 - 10 minutes, the misting of medication should cease and the
liquid medication you placed in the nebulizer will be gone. Replace the oxygen mask on the patient.
12) Reassess the patient and consult with medical direction if additional doses are needed. If an
additional dose is recommended, wait at least 2 minutes between each administration or longer based
on the medication being administered or medical direction’s order.
Add:
Simple face mask
A simple mask is used to deliver moderate to high concentrations of oxygen. It can deliver from 40% to
60% oxygen at a flow rate of 2.64‐3.17 gal (10‐12 L) per minute.
Venturi Mask
The venturi mask, also known as an air-entrainment mask, is a medical device to deliver a known
oxygen concentration to patients on controlled oxygen therapy. Venturi masks are considered high-flow
oxygen therapy devices. This is because venturi masks are able to provide total inspiratory flow at a
specified FIO2 to patients therapy
Partial Rebreather Mask
A partial rebreather mask is used to deliver high concentrations of oxygen. It can deliver 70% to 90%
oxygen at a flow of1.58‐3.96 gal (6‐15 L) per minute.
Monitoring – Pulse Oximetry;
Purpose for pulse oximetry is to assess oxygenation, assess adequacy of oxygen delivery during
positive pressure ventilation, and assess impact of interventions. The pulse oximetry works by
measuring the oxygen saturation on the hemoglobin.
Technique:
1) Place the pulse oximetry probe on the finger where the light from the oximeter shines through arterial
blood flow.
2) Turn the device on and wait a few seconds for the device to detect the pulse and the reading to
appear.
3) If a poor signal is detected some devices may have an error reading or dashed lines. If this happens
check the patient for nail polish, or cool extremities.
4) Once a proper reading has occurred, record the reading every 5 minutes in seriously ill patients, every
15 minutes in stable patients.
How it works:
The red light and infrared light shines through the tissue and into the blood to a photo sensor on the
opposite side of the devise.
The sensor detects the amount of hemoglobin in the blood that is saturated with oxygen and the amount
of hemoglobin that is not saturated with oxygen. The recording of oxygen saturation is recorded as
%SpO2. Normal readings are typically in the upper 90’s. SpO2 lags behind actual blood concentrations
by about one and a half minutes.
23
Indications for use of Pulse Oximetry- This device should be used any time there is concern that oxygen
in the blood stream may be affected. Pulse ox is sometimes referred to as the sixth vital sign.
Limitations – A good pulse in the extremity being monitored is necessary for the pulse-ox to work
properly. Any condition that causes poor blood flow to the finger will affect the accuracy of the pulse
oximetry device. Cold extremities, shock, low blood pressure, and anemia are a few.
Another concern is that the pulse oximetry measures saturation of the hemogloblin, if the hemoglobin is
saturated with something else like carbon monoxide it will give you a false reading for oxygen saturation.
Ventilator (ATV) - AUTOMATIC TRANSPORT VENTILATOR
I. INTRODUCTION
Use of an Automatic Transport Ventilator requires Medical Control, is at the sole discretion of the
base hospital medical director, and must be appropriately documented when used. The medic must
be trained in use of specific provider ventilator to be used for transport.
II. INDICATIONS
A. Any patient requiring ventilatory assistance in conjunction with advanced airway adjuncts.
B. Any patient requiring ventilatory assistance in conjunction with basic airway adjuncts.
C. Any patient requiring ventilatory assistance in conjunction with manual airway maintenance.
III. CONTRAINDICATIONS
A. Patients weighing less than 16 Kg. (35 lbs.)
B. Pneumothorax - tension pneumothorax
C .Pulmonary over pressurization syndrome (blast injury, water ascent injury, etc.)
IV. PROCEDURE
A. Determine that a need for the use of the ATV exists.
B. Assure that all tubing is free from kinks.
C. Determine the proper tidal volume setting. This is done by determining the patient ideal weight
(approx. weight for any physically fit patient having the same sex, height, frame) and multiplying it by
8-10 ml./kg. Begin with the lowest tidal volume limit.
D. Set Breaths per Minute (BPM) control to rate of 8-15 per minute.
E. Check alarm by occluding the patient valve assembly outlet. The audible pressure limit alarm
should sound as the ventilator cycles through the delivery phase.
F. Assess lung compliance and chest rise with a bag valve device. Tidal volume may be adjusted
lower if poor lung compliance is found.
G. Attach the patient valve assembly to the airway device or mask used on the patient.
H. Assess the ventilation. Listen for bilateral lung sounds. Observe for proper chest rise . . . this
should look normal and be symmetrical.
I. Count the number of complete ventilator cycles for a full minute. The number should be the same
as the setting (+/-1).
J. Assess and manage the airway as you normally would for any patient with controlled ventilation.
K. If spontaneous breathing begins, it may be desirable to turn the BPM down as long as patient's
spontaneous rate is 10-12 per minute. L. Check oxygen cylinder pressure level frequently. This
device will deplete a "D" cylinder rapidly.
V. SPECIAL CONSIDERATIONS
A. Due to COPD, chest rise may not appear full - Do not increase tidal volume (TV) past upper TV
limit.
B. If lung sounds are absent or on one side only: rule out airway obstruction, improper tube
placement, or pneumothorax, and check tidal volume ml/bpm settings.
C. If chest expansion is not adequate, the rescuer should slowly increase tidal volume until chest
expansion is adequate, or the uppermost limit (for the patient's ideal weight) is reached.
D. If chest appears to over expand, decrease tidal volume.
Topic: Cardiovascular/Circulation
All Levels: EMT, AEMT, & Paramedic
24
Notable Content Removed: Pressure Point for hemorrhage control has been removed and tourniquet
application has moved up the decision tree.
Hemorrhage ‐ Tourniquet (15 minutes didactic; 15 minutes laboratory all levels) Comment: no problem
Cognitive Objectives:
Discuss the need for assessing the patient for external bleeding.
Differentiate between arterial, venous and capillary bleeding.
State methods of emergency medical care of external bleeding.
Psychomotor Objectives:
Demonstrate the techniques for assessing the patient for external bleeding.
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 for external bleeding.
Demonstrate the use of tourniquets as a method of emergency medical care of external bleeding.
Demonstrate the care of the patient exhibiting signs and symptoms of shock (hypoperfusion).
Declarative (EMS Educational Standards)
Mechanical CPR devices
(15 minutes didactic; 0 laboratory all levels) Comment: no problem
(Requires additional specialty training)
Cognitive Objective:
 Review local EMS mechanical CPR devices.
 Discuss the procedures that must be taken into consideration for standard operations of cardiac
arrest.
 Discuss the various mechanical devices that are available and approved by the ILCOR standards.
Psychomotor Objectives: Uses assessment information to recognize shock, respiratory failure or
arrest, and cardiac arrest based on assessment findings and manages the emergency.
Management (refer to the current American Heart Association guidelines)
Evaluation and appropriate management of cardiac compromise
1. Manual and auto BP
2. Mechanical CPR
Devices to Support Circulation - Active Compression-Decompression CPR
Active compression‐decompression CPR (ACD‐CPR) is performed with a hand‐held device
equipped with a suction cup to actively lift the anterior chest during decompression. ACD‐CPR may be
considered for use in the in‐hospital setting when providers are adequately trained
(Class IIb). There is insufficient evidence to recommend for or against the use of ACD‐CPR in the
prehospital setting
Impedance Threshold Device (Class Indeterminate).
The impedance threshold device (ITD) is a valve that limits air entry into the lungs during chest recoil
between chest compressions. It is designed to reduce intrathoracic pressure and enhance venous return
to the heart. Recent studies indicate that ITD can be used with an endotracheal tube or with a good face
mask seal. Although increased long‐term survival rates have not been documented, when the ITD
issued by trained personnel as an adjunct to CPR in intubated adult cardiac arrest patients, it can
improve hemodynamic parameters and ROSC (Class IIa).
Mechanical Piston Device
The mechanical piston device depresses the sternum via a compressed gas‐powered plunger mounted
on a backboard. Mechanical piston CPR may be considered for patients in cardiac arrest in
circumstances that make manual resuscitation difficult (Class IIb). The device should be programmed to
deliver standard CPR based on the 2005 AHA guidelines.
Load-Distributing Band CPR or Vest CPR
25
The load‐distributing band (LDB) is a circumferential chest compression device composed of a
pneumatically or electrically actuated constricting band and backboard. Evidence from a case control
study of 162 adults (LOE 4)51 documented improvement in survival to the emergency department when
LDB‐CPR was administered by adequately trained rescue personnel to patients with cardiac arrest in
the out‐of‐hospital setting. LDB‐CPR may be considered for use by properly trained personnel as an
adjunct to CPR for patients with cardiac arrest in the out‐of‐hospital or in‐hospital setting (Class IIb).
Phased Thoracic-Abdominal Compression-Decompression
 CPR With a Hand‐Held Device
 Phased thoracic‐abdominal compression‐decompression CPR (PTACD‐CPR) combines the
concepts of
 IAC‐CPR and ACD‐CPR. A hand‐held device alternates chest compression and abdominal
decompression with chest decompression and abdominal compression. There is insufficient
evidence to support the use of PTACD‐CPR outside the research setting (Class Indeterminate).
References:
National EMS Educational standards
http://www.nhtsa.gov/staticfiles/DOT/NHTSA/ems/811077a.pdf
Currents. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and
Emergency Cardiovascular Care; volume 112, issue 24 Supplement; December 13, 2005
Patient Restraint (no didactic or laboratory hours assigned)
Physical restraint
Review as necessary
Removed: using spine boards to “sandwich patients”; Tying patient prone
Note: Dangers of positional asphyxiation
Cognitive Objectives:
Define consent and discuss the methods of obtaining consent.
Differentiate between expressed and implied consent.
Discuss the implications for the EMT-Basic in patient refusal of transport.
Discuss the issues of abandonment, negligence, and battery and their implications to the EMTBasic.
State the conditions necessary for the EMT-Basic to have a duty to act.
State the conditions that require an EMT-Basic to notify local law enforcement officials.
Psychomotor Objectives:
Demonstrate various techniques to safely restrain a patient with a behavioral problem
Declarative (EMT) - EMT Guidelines:
Preparatory
Workforce Safety and Wellness
I. Medical Restraint
A. Use of Force Doctrine (Protocol)
B. Reasonable Prevention of Harm
1. Suicidal
2. Homicidal
3. Ambulances
4. Ramps
5. Winches
C. Medical/Legal & Ethics
1. Medical restraint -- use of force doctrine
a. reasonable prevention of harm
i. suicidal
ii. homicidal
b. non-punitive
26
Psychiatric
II. Agitated Delirium
A. Emergency medical care
1. Scene size-up, personal safety
2. Establish rapport
a. utilize therapeutic interviewing techniques
1. engage in active listening
2. supportive and empathetic
3. limit interruptions
4. respect patient’s territory, limit physical touch
b. avoid threatening actions, statements and questions
c. approach slowly and purposefully
3. Patient assessment
a. intellectual functioning
b. orientation
c. memory
d. concentration
e. judgment
f. thought content
1) disordered thoughts
2) delusions, hallucinations
3) unusual worries, fears
g. language
1) speech pattern and content
2) garbled or unintelligible
h. mood
1) anxiety, depression, elation, agitation
2) level of alertness, distractibility
a) appearance, hygiene, dress
b) psychomotor activity
4. Calm the patient – do not leave the patient alone, unless unsafe situation; consider need for
law enforcement
5. Restrain if necessary
6. Transport
7. If overdose, bring medications or drugs found to medical facility
Medication Administration - EMT level – Monte Gagliard
Medication Administration – EMT Level
Time Frame: 60 minutes
Cognitive Objectives:
Identify the medications that an EMT can administer/assist patient with medication administration
Discuss the “five rights” of medication administration
Explain the indications and contraindications for administration of aspirin, nitroglycerine, epinephrine
Demonstrate effective use of an epinephrine auto-injector
Demonstrate set up and administration of inhaled bronchodilator medication using a nebulizer
Identify the signs and symptoms of a severe allergic reaction
Explain the signs and symptoms associated with ischemic chest pain
I Review Five Rights (and Patient Allergies)





Right Patient
Right Medication
Right Dose
Right Route
Right Time
II Aspirin:


Actions: Help prevent blood from clotting
Indications: Signs and Symptoms of Ischemic Chest Pain
27



Authorized by Medical Direction or Standing Order
Patient is able to chew without endangering airway
Patient did not take aspirin prior to arrival of EMT
Contraindications:
 Allergic to aspirin
 Unable to swallow
 Patient has GI ulcer and/or recent bleeding or bleeding disorder
 Already taking aspirin or other anticoagulant (Coumadin, Plavix, etc)
 Pregnancy
 Recent surgery
Dosage:
 162-324mg (two to four 81mg chewable tablets)
 Administered only once during patient encounter
Side Effects:
 Nausea/vomiting
 Heartburn
 Cough and Wheezing
 Bleeding
III Nitroglycerin:
Actions: Relaxes blood vessels, Decreases workload of heart
Indications: Patient complains of chest pain
 Patient has prescription for NTG, (non expired)
 Systolic blood pressure greater than 100mmhg
 Authorized by medical direction
 Patient has not recently taken medication for erectile dysfunction
Contraindications:
 Hypotension
 Patient has a head injury
 Patient already taken maximum prescribed dose
 Patient recently taken medication for erectile dysfunction
Dosage:
 One spray or one tablet sublingual (under tongue)
 Per medical direction/protocol: repeat in 5 minutes if less than Complete relief and blood pressure
remains above 100 systolic. If authorized by medical direction up to a maximum of 3 doses:
(emphasize blood pressure assessments before each dose and
 Ascertaining relief of pain or pressure) Recheck blood pressure 2 Minutes after each dose.
Side Effects:
 Hypotension (lowers blood pressure)
 Headache
 Dizziness/feel like they may pass out
 *Emphasize supine positioning, high flow oxygen, if patient becomes hypotensive secondary to NTG
IV. Epinephrine Auto Injector:
Actions: Constricts blood vessels and relax air passages
Indications: Authorization by medical direction (protocols)/and/or assisting patient with their prescribed
auto injector
Signs and Symptoms of severe allergic reaction (anaphylaxis)
28
Contraindications:
Caution in patients with cardiac history (medical direction)
Dosage: Prefilled dose in auto injector given in thigh.
Side Effects: Rapid heart rate
 Elevated blood pressure
 Restlessness
 Headache
*Review signs and symptoms of severe allergic reaction: ie: hives, airway and facial edema, low blood
pressure. Emphasize importance of early administration in patients with severe allergic reaction
Demonstrate/Student Practice administration with auto injector practice pens.
V. Bronchodilators: (Albuterol, Ipratropium Bromide (Atrovent)
Actions: Dilate/relax air passages in bronchial tree
Indications: Authorization by medical direction/and/or assisting patient
 With metered dose inhaler or nebulized breathing treatment.
 Relief of bronchospasm/respiratory difficulty in patients with a history of asthma, emphysema or
bronchitis.
Contraindications:
 Allergic to bronchodilators
 Caution in patients with symptoms of ischemic chest pain
Dosage: Per Protocol: 2 metered dose inhalation sprays with 5 min interval between each spray
Severe asthma: 4 inhalation sprays in succession
Nebulized treatment: (per protocol) 1 amp of medication in nebulizer delivered with oxygen at 67l/min. Medical direction may suggest 1/2 amp dose in pediatric patients. Nebulized Dose may be
repeated at 5-15 min intervals per patient response and medical direction.
Side Effects: Rapid heart rate
 Restlessness
 Practice set-up and delivery of nebulized inhalation treatments for both adult and pediatric
administration.
 Emphasize coaching patients inhalation breaths to get full effect of drug
 Emphasize that severe asthma and emphysema patients may require back to back nebulized
treatments enroute to hospital per medical direction
 Demonstrate delivery techniques for pediatric and adult patients unable to hold nebulizer: (venti
mask, neb delivered under mask, etc.)
29
Common Drug List
(National Standard Scope of Practice, 2009)
30
Trauma
I. Pathophysiology
A. Type of Traumatic Bleeding
1. External
2. Arterial
3. Venous
4. Capillary
B. Severity
1. Volume of blood loss
2. Rate of blood loss
3. Age and preexisting health of patient
C. Physiological response of bleeding
1. Clotting and clotting disorders
2. Factors that affect clotting
a. Movement of injured area
b. Body temperature
c. Medications
d. Removal of bandages
3. Localized vasoconstriction
II. General Assessment
A. Mechanism of injury
III. Management Strategies
A. Body Substance Isolation
B. Airway Patency – May be obstructed if unconscious
C. Oxygenation and Ventilation
1. Pulse oximetry
2. Apply oxygen
D. Internal and External Bleeding Control
1. External bleeding
a. Direct pressure: application of even pressure to an open injury that include the area just
proximal and distal to the injury using a gloved hand and dressings the wound is covered and
firm pressure applied until bleeding is controlled usually effective in capillary and minor venous
bleeding in cases of heavier bleeding or major wounds. Multiple dressings may be necessary;
do not remove existing dressings but apply additional dressings on top of existing dressings in
cases of continuing hemorrhage.
b. Splints
i. Soft
Ii. Rigid
iii. Traction splint
iv. Pressure splints
c. Tourniquet – if severe bleeding is not controlled by direct pressure Use as a last resort to
control bleeding of an amputated extremity when all other methods of bleeding control
have failed. Note: Application of a tourniquet can cause permanent damage to nerves, muscles
and blood vessels resulting in the loss of an extremity.
Basic Procedures for applying a tourniquet (use commercial device when possible):
1) Use a bandage 4 inches wide and 6 to 8 layers deep.
2) Wrap it around the extremity twice at a point proximal to the bleeding but as distal on the
extremity as possible.
3) Tie one knot in the bandage and place a stick or rod on top of the knot and tie the ends of
the bandage over the stick in a square knot.
4) Twist the stick until the bleeding stops.
5) Once the bleeding has stopped, secure the stick or rod in position.
31
6) Notify other emergency personnel who may care for the patient that a tourniquet has been
applied.
7) Document the use of a tourniquet and the time applied in the prehospital patient report. A
continuously inflated blood pressure cuff may be used as a tourniquet until bleeding stops.
Commercially available tourniquets are available. Follow directions of manufacturer.
Precautions with the use of a tourniquet:
1) Use a wide bandage and secure tightly.
2) Never use wire, rope, a belt, or any other material that may cut into the skin and underlying
tissue.
3) Do not remove or loosen the tourniquet once it is applied unless directed to do so by
medical direction.
4) Leave the tourniquet in open view.
5) Do not apply a tourniquet directly over any joint, but as close to the injury as possible.
IV. Orthopedic Trauma
A.. General Management
Control Hemorrhage
 Internal
 External
 Direct pressure
 Tourniquet (see Above: [III., D., 1., c.])
 Traction splint with fracture
B. Specific Injuries
Amputation
a. Control bleeding of stump
b. Direct pressure
c. Tourniquet (see III., D., 1., c.)
Soft Tissue Trauma
General Assessment
(1) Safety of Environment / Standard Precautions
(2) Airway Patency
(3) Respiratory Distress
(4) Concepts of Open Wound Dressings/Bandaging
(a) Sterile
(b) Non-sterile
(c) Occlusive
(d) Non-occlusive
(e) Wet
(f) Dry
(5) Tourniquet
Complications of dressings/bandages
(1) Hemorrhage Control
(2) Pressure dressing
(3) Tourniquets
Associated Injuries
(1) Airway
(2) Face
(3) Neck trauma – increased bleeding
VI. Multi-System Trauma



Oxygenation cannot occur when patients are bleeding profusely
Stop arterial bleeding rapidly
Consider use of tourniquets if severe extremity bleeding cannot be controlled with direct pressure
32
NEEDED CHANGES IN DEFINED AREAS TRAUMA SECTION
The 1994 National Standard Curriculum for Emergency Medical Technicians: Basic defines trauma in
Module 5. It teaches bleeding and shock, signs and symptoms, trauma airway management, internal
bleeding signs and symptoms, etc. Teaching this is still equally important, but with more detail in certain
areas. Listed below is the area of more needed detail and content to be covered.
CHEST TRAUMA: Give the detailed assessment and management of chest injuries. Stress what all can be
involved in chest trauma and the potential for long term problems.
Blunt Trauma: Give good examples and use illustration on manikins to show the injury patterns.
Compare blunt and penetrating and show organ involvement.
Hemothorax: Give good illustration of blood loss and stages of shock that will be encountered during
this. Teach early recognition of breath sounds and patient condition to treat early. Discuss index of
suspicion based on MOI.
Pneumothorax: Discuss each type and the causes and treatment by the basic as well as advanced
care. Teach to call for advanced help early if this is suspected.
Cardiac Tamponade: Discuss what the causes are and signs of this may be. Discuss treatment if any,
and the need for advance care. Discuss heart sounds and what you should expect to hear
Overview Discussion on the Center for Disease Control (CDC) Filed Triage Transportation Tool.
Terminology Fracture being placed back into the vocabulary
CHEST TRAUMA
Cognitive Objectives: Discuss the path physiology of the different type of chest trauma management.
 Blunt versus penetrating
 Hemothorax ( describe causes and effects)
 Pneumothorax
 Simple
 Open
 Tension
 Cardiac Tamponade
 Rib Fractures
 Flail Segments
 Commotio cordis
Psychomotor Objective: Demonstrate to the students what is expected to be seen in the all the chest
trauma areas. Demonstrate treatment and what is the expected outcome are if treatment are performed
correctly.
ABDOMINAL TRAUMA
Cognitive Objective: Discuss in detail about the path physiology of the abdominal area and the seriousness
of abdominal trauma. Give examples of the following organs and the effects they can have on the body:
 Solid and hollow organs injuries
 Blunt versus penetrating mechanisms
 Evisceration
 Psychomotor Objective
 General Assessment;
 Mechanism of injury
 Treatment Plan
 BSI
 Airway Patency
 Be aware and treat for hypoperfusion (shock)
ORTHOPEDIC TRAUMA:
Cognitive Objective: Discuss in detail about the path physiology of the different types of fracture. Give
33
examples of the different fractures types and what you can expect to seen. Give example of the following
factures types and complication involved:
Upper and Lower extremity fractures
 Open fractures
 Closed fractures
 Dislocations
 Sprain/Strain
 Pelvic fractures
 Amputatuions/replantation
Psychomotor Objective: Demonstrate to the students what is expected to be seen the different types of
fractures and treatment plan. Give examples of different splinting methods and proper way to perform each.
HEAD, FACE, NECK, AND SPINAL TRAUMA:
Cognitive Objective: Give detailed discussion about neck, eye, oral and brain injuries; emphasize the harm
of hyerventatilation in most circumstances. Discuss about the possibility of ICP in head injury patients.
Discuss the management and recognition of the following injuries:
 Penetrating neck trauma
 Laryngeotracheal injuries
 Spinal trauma
 Facial fracture
 Skull fractures
 Foreign bodies in eye
 Dental trauma
Psychomotor Objective: Demonstrate proper treatment and airway management for the entire listed
trauma injuries. Demonstrate proper methods of oxygenation and the different types of device that can be
used.
NERVOUS SYSTEM TRAUMA
Cognitive Objective: Discuss the anatomy of the brain and what can happen if nervous system trauma
occurs. Emphasize the harm of hyperventilation to patients. Give a detailed dissuasion on the importance of
a good neurological assessment. Introduce students to the Brain Trauma Foundation website:
https://www.braintrauma.org/
Psychomotor Objective: Discussion only
SPECIAL CONSIDERATIONS IN TRAUMA
Cognitive Objective: Discuss the management and assessment of the following situations. Give examples
of the following types of trauma situations, and the difference that will be seen. Discuss treatment plans for
the following situations.:
 Pregnant patients
 Pediatric patients
 Geriatric patients
 Cognitively impaired patients
Psychomotor Objective: Discussion only
ENVIROMENTAL TRAUMA
Cognitive Objective: Discuss more in depth the on submersion, bite, stings, diving injuries and radiation
espouser. Discuss the path physiology, assessment and management of the following injuries
Near Drowning
 Temperature related illness
 Bites and stings
 Dysbarism
 Electrical injury
 Radiation exposure
Psychomotor Objective: Discussion only
34
Guidelines for Field Triage of Injured Patients
CDC Field Triage Decision Scheme: know in Alaska as the Field Triage Decision Transportation Tool – A
National Trauma Triage Protocol http://www.cdc.gov/fieldtriage
Objectives:
1. Global Impact
2. Reducing the Impact of Injury
3. Roles of Trauma Centers
4. Initiate Treatment of Traumatically Injured Patient
5. Adult Prehospital Triage Criteria & Decision Scheme
6. Pediatric Prehospital Triage Criteria & Decision Scheme
7. Rapid Transport and Contact with the Appropriate medical facility
8. Indications to NOT activate the EMS System
9. Trauma Systems Transport Standard/Guidelines
10. Arkansas Trauma Communication Center (ATCC)
Declarative:
1. Global Impact‐ Burden of Injury
a. Injury is a major public health problem. Approximately 5 million deaths worldwide are attributed
each year to injuries from all causesi, representing approximately 10% of all deathsii.
b. Millions of persons are disabled either temporary or permanently every year as a result of
injuriesiii.
c. In the United States, injury is the leading cause of death for persons aged 1‐ 44 years of age.
2. Reducing the Impact of Injury
a. The way to reduce morbidity, mortality, and economic consequences of injures is to prevent their
occurrence. Community involvement and prevention programs must be implemented to target high
risk behavior.
b. Emergency medical services providers must ensure that patients receive prompt and appropriate
emergency care at the scene and are transported to a healthcare facility for further evaluation and
treatment.
c. Emergency care of the traumatically injured patient is best accomplished using an inclusive, multilevel trauma care systems approach.vi
d. Triage, transport, and transfer protocols are developed to ensure that trauma patients will receive
prompt and potentially lifesaving treatment.
e. Extrication of the traumatically injured patient shall be initiated as quickly and safely as possible
by the prehospital professional.
f. Not all injured patients can or should be transported to a Level I trauma center.
Roles of Trauma Centers Patients with less severe injuries might be served better by transport to a closer emergency department.
or clinic. The transporting all injured patients to Level I trauma centers, regardless of the severity of their
injuries, could burden those facilities unnecessarily and make them less available for the most severely
injured patients. Alaska has no Level 1 Center
1. Roles of Trauma Centers - LEVELS
a. Level I (MAJOR)
i. Regional resource hospital that is central to trauma care systems
ii. Provides total care for every aspect of injury, from prevention through rehabilitation
iii. Maintains resources and personnel for patient care, education, and research (usually in
university‐ based teaching hospital)
iv. Provides leadership in education, research, and system planning to all hospitals caring for injured
patients in the region
b. Level II: (COMPREHENSIVE)
i. Provides comprehensive trauma care, regardless of the severity of injury
ii. Might be most prevalent facility in a community and manage majority of trauma patients or
supplement the activity of a Level I trauma center
iii. Where no Level I trauma center exists, is responsible for education and system leadership
c. Level III: (GENERAL) * None in Alaska as of 2014
i. Provides prompt assessment, resuscitation, emergency surgery, and stabilization and arrange
transfer to a higher‐ level facility when necessary
35
ii. Maintains continuous general surgery coverage
iii. Has transfer agreements and standardized treatment protocols to plan for care of injured patients
d. Level IV: (BASIC)
i. Rural facility that supplements care within the larger trauma system
ii. Provides initial evaluation and assessment of injured patients
iii. Must have 24‐ hour emergency coverage by a physician
iv. Has transfer agreement and a good working relationship with the nearest Level I, II, III trauma
center
2. Initiate Treatment of Traumatically Injured Patient (Refer to CDC or Alaska Trauma Triage Tool)
a. Traumatically injured patients will be appropriately assessed using the Prehospital
Triage Criteria and Decision criteria as defined in the Alaska’s Trauma Systems
b. Basic Life Support interventions (establishment of patient airway, hemorrhage control, spinal
immobilization, fracture immobilization, etc) will be initiated by thecprehospital provided following
local protocols.
c. Treatment during transport shall follow established local protocols.
d. Adult Prehospital Triage citeria & decision tool
i. Assess Vital Signs & Level of Consciousness
If any of the following occurs initiate Rapid Transport and Trauma Treatment as per your protocol
if not continue assessment and follow local protocol.
1. Shock: Systolic: Blood pressure of 90 or less with other signs/symptoms of shock
2. Respiratory Distress: Respiratory rate of 10 or less; or 29 or higher, Evidence of stridor or
retractions
3. Altered Mentation: Glasgow Coma Scale of 13 or less, Trauma Score of 11 or less
ii. Assess Anatomy of Injury
If any of the following occurs initiate Rapid Transport and Trauma Treatment Protocol, if not
continue assessment and follow local protocol.
1. Penetrating injury to the head/open or depressed skull fracture
2. Penetrating injury to the neck torso, or groin
3. Amputation above the wrist or ankle‐ near or complete amputation
4. Spinal cord injury with limb paralysis or alteration of SMSs
5. Flail Chest
6. Pelvic fracture
7. Two or more obvious long bone fractures above the elbows or knees
8. Major burns: 15% or greater
9. High voltage electrical burns
10. Severe maxillofacial injuries
iii. Assess Mechanism of Injury
If any of the following occurs initiate Rapid Transport and Trauma Treatment Protocol, if not
continue assessment and follow local protocol.
1. Speed 40 mph or greater
2. Vehicle rollover
3. Death of same vehicle occupant
4. Pedestrian or pedal cyclist vs. vehicle 20 mph or greater
5. Falls 20 feet or greater (consider pediatric rules if applicable)
6. Vehicle deformity 20” or greater
7. Ejection from moving vehicle
8. Motorcycle 20 mph or greater
Iv. If none of the above applies, transport to the closest appropriate trauma center which
depending on the system may not be the highest level trauma center.
v. Co‐ morbid Factors
The following factors may compound the severity of injury and shall increase the index of
suspicion:
1. Extreme of age: 55 or more
2. Hostile environment (e.g.; extremes of heat or cold)
3. Medical illness (e.g.; COPD, CHF, renal failure0
4. Presence of intoxicants/substance abuse
5. Pregnancy > 20 weeks
6. Anti‐ coagulation and bleeding disorders
7. EMS provider judgment (For example cases of prolonged extrication)
8. Time sensitive extremity injury (Potential Vascular Injury)
36
Rapid Transport and Contact with the Appropriate medical facility
a. Patient transport will be initiated by the prehospital care provider following established local
protocols.
b. Contact with the receiving hospital will be made as soon as possible. An accurate description
of the incident, injuries, current medical interventions based upon established protocols, and
patient status will be relayed to the facility.
c. Further management guidance will be requested from the receiving hospital medical control as
required during transport.
4. Indications to NOT activate the EMS System (follow AS 18.08.089. Authority to Pronounce Death)
a. Decomposition
b. Rigor mortis
c. Normothermic asystole secondary to trauma (as determined by Advanced Life
Support providers only; does not apply to Basic Life Support providers.)
5. Trauma Systems Transport Standard/Guidelines
a. Patient meeting trauma criteria Patients who meet the trauma criteria as outlined in the Adult or
Pediatric Prehospital Triage Criteria and Decision Scheme shall be transported to a Level I or
Level II Facility unless:
The prehospital care provider is unable to establish or maintain an adequate airway or control
excessive hemorrhage; in this case, the patient should be transported to the nearest licensed
facility to provide the appropriate care:
1. If transport time to a Level I or Level II Facility is greater than 45 minutes by ground; transport
the patient to a closer Level III Facility unless the Section of EMS & Trauma Systems has
approved a deviation from these guidelines.
2. If transport time to a Level II Facility (determined upon EMS Medical Direction & Trauma
Guidelines) the Section of EMS & Trauma Systems has approved a deviation from these
guidelines. Override of criteria by Medical control Medical control may override the transport
requirement outlined in the Adult or Pediatric Prehospital Triage Criteria and Decision Tool under
the following conditions:
i. The hospital is unable to meet resource standards as defined for its designated Level.
ii. Multiple patients are involved.
iii. The patient needs specialized care and is stable.
6. Alaska Trauma Communication Center (To Be Designed)
Geriatrics
Objectives
1. Define key terms
2. Summarize age‐ related anatomical and physiological changes for each of the following systems in
the Elderly patient:
a. Cardiovascular
b. Respiratory
c. Musculoskeletal
d. Renal
e. Endocrine
f. Neurological
g. Gastrointestinal
3. Discuss common cardiac medical emergencies and their treatments found in the elderly population.
a. Myocardial Infarction, Congestive Heart Failure, Silent Heart Attack and Pulmonary edema
i. See Cardiac Section for Sign, symptoms and treatment.
ii. Possible changes in physical assessment
iii. What different assessment tools will be needed
b. Pulmonary Embolism
i. See Respiratory Section for Signs, symptoms and treatment.
ii. Possible changes in physical assessment
iii. What different assessment tools will be needed.
c. Respiratory Changes in the Elderly and medical emergencies they may cause.
i. Loss of elastic recoil in the chest walls
ii. Loss of alveoli
37
iii. Less O2 and Carbon Dioxide exchanges
iv. Decrease cough reflex (Pneumonia)
v. Decrease in the Cilia
d. Discuss the Signs, symptoms, and treatment of :
i. Pneumonia
ii. COPD
iii. Aspiration Pneumonia
4. Dementia is a chronic, irreversible condition that can be worsened by infection
a. Discuss the signs and symptoms of dementia
b. Known Reversible causes of dementia
i. Drug overdose
ii. Emotional disorder
iii. Tumors
iv. Parkinson’s Disease
v. Huntington’s Disease
vi. Several Others
c. Discuss the treatment of Dementia
5. Toxicological Emergencies
6. Sensory Changes in the Elderly
7. Hearing impairment
8. Pain Perception
Special Patient Populations
Changes in Defined Areas
Patients with Special Challenges:
Elder abuse
Homelessness
Poverty
Bariatric
Technology dependant
Sensory deficit
Homecare
Developmental disabilities
Elder Abuse: Defined as when an elderly person is harmed by people the older person knows or with
whom they have a relationship, such as a spouse, partner or family member, a friend or neighbor, or
people that the older person relies on for services. Many forms of elder abuse are recognized as types of
domestic violence or family violence.
Objective
1. Define Key Word
2. Types of Elderly Abuse
a. Physical
b. Psychological/emotional
c. Financial
d. Sexual;
e. Neglect
f. Signs:
i. Depressed
ii. Will never accept invitations to spend time away from the family and/or caregiver
iii. Appears afraid to make their own decisions
iv. Seems t be hiding something abort a caregiver
v. Never seems to have any spending money
vi. May put off going to the doctor
vii. Seems to have too many household “accidents”
g. Injury found in elder abuse:
i. Trauma (see Trauma section)
ii. Overdose
iii. Bed sores
iv. Malnutrition
v. Decrease in mental status
38
h. Treatment (See section related to injury)
i. Know to whom elder abuse should be reported.
Homelessness and poverty: Homelessness is the condition and social category of people who do not
have a regular house or dwelling because they cannot afford, pay for, or are otherwise unable to
maintain regular, safe and adequate housing, or they lack “fixed, regular, and adequate nighttime
residence. Homeless people are more likely to suffer injuries and medical problems from their lifestyle on
the street.
Objectives:
1. Define Key Terms”
2. Emergencies seen in the homeless person
a. Poor nutrition
b. Substance abuse
i. Signs, symptoms and Treatment ( see pharmacology emergencies)
c. Exposure to severe weather:
i. Signs, symptoms and Treatment
d. High exposure to violence (robberies, beatings, sexual abuse)
e. Little or no medical care
Bariatric: The field of medicine that offers treatment for the person who is clinically overweight with a
comprehensive program including diet, exercise, behavior modification, lifestyle changes and, when
indicated, the addition of appetite suppressants and other appropriate medications. Bariatrics also
includes research into overweight, its causes, prevention, and treatment. There are many effects of
excess weight on the body systems:
Objectives:
1. Discuss the effects of the following in regards to obesity:
a. Hypertension, coronary artery disease, congestive heart failure and stroke.
Tx: (see cardiac emergencies)
b. Sleep apnea, asthma, and COPD:
Tx: (See respiratory emergencies)
c. Diabetic emergencies
d. Depression and Suicide
e. Immobility
2. Accommodations and moving for the Bariatric (obese) patient
a. Airway and breathing
b. Sitting upright (not supine)
c. O2 need/use
3. Weight concerns
a. Will the cot hold the patient – maximum cot limits
b. Need for additional help
Pregnant Patients: Expansion of terminology to use preeclampsia, eclampsia and premature rupture of
membranes ( may require a lengthy discussion). More detailed discussion on complications.
Objectives:
1. Identify the major objectives and treatment of pregnant patients with:
a. Preeclampsia
i. Form of high blood pressure
ii. Called Toxemia of Pregnancy
iii. Can develop into eclampsia
b. Eclampsia
i. More severe that preeclampsia
ii. May include seizures
iii. Generally develops after 20th week
iv. May develop after delivery
c. Affect on Infant
i. Low birth weight
ii. May need early delivery
iii. Seizure threatens life of Mother and baby
iv. Placental abruption
d. Treatments:
39
i. Oxygen
ii. Position of comfort
iii. Treatment for shock
iv. Treatment for seizure
v. Maternal and infant support
2. Identify symptoms and treatment of Premature Rupture of Placental Membranes (PROM)
a. Terminology:
i. PROM (premature rupture of amniotic sac)
ii. PPROM (preterm premature rupture of membranes)
i. Before 37 weeks of gestation
ii. Baby may be born within one week
iii. Amniotic sac
iv. Chorioamnionitis ( serious infection of placental membranes)
b. Causes of PROM
i. Natural weakening of membrane near term
ii. Force of contractions
iii. Infection of the uterus (PPROM)
iv. Low socioeconomic conditions (no prenatal care)
v. STD (clamydia – gonorrhea)
vi. Previous preterm birth
vii. Vaginal bleeding
viii. Cigarette smoking during pregnancy
ix. Unknown additional causes
c. Complicates as many as 1/3 of premature births
EMS Operations
 safely operating ground ambulance
 add lifting and moving
 incident management (review location of ICS 100, 200, 700, 800)
Air medical (See Alaska Medevac Training Program / Medevac Training Escort Training Program
40
Side-by-Side Comparison of
Alaska EMT-1 Education Guidelines
and
National EMS Education Standards
(Alaska EMT-1 Lessons to National Core Content)
41
Core
Content
1
Lesson
Module
EMT Core Content
(old AK
EMT 2002)
1-1
Preparatory
1-1
2
EMS Systems
11
Public Health
1-1
Research
2
3
1-2
1-6
Workforce
Safety &
Wellness
(Welling-Being of
the EMT)
18
1-3
Documentation
17
3-7
EMS System
Communication
10
3-2
Therapeutic
Communication
(Interviewing
techniques)
Est.
Hours
Use simple knowledge of the EMS system, safety/wellbeing of the first responders. Safety/well-being of the
EMT, medical/legal issues at the scene of an emergency
while awaiting a higher level of care.
Simple depth, foundational breadth:
• EMS systems
• History of EMS
• Roles/ responsibilities/ professionalism of EMS
personnel
• Quality improvement
• Patient safety
Have an awareness of local public health resources and
the role EMS personnel play in public health
emergencies. Knowledge of the principles of illness and
injury prevention in emergency care.
Simple depth, simple breadth
• Evidence-based decision making; impact of research on
EMS care
• Data collection
• Standard safety precautions
• Personal protective equipment
• Stress management
- Dealing with death and dying
• Prevention of work related injuries
• Lifting and moving patients
• Disease transmission
• Wellness principles
Simple depth, simple breadth
Recording patient findings
• Principles of medical documentation and report writing
• EMS communication system
Call for Resources
• Transfer care of the patient
• Interact within the team structure
• Communication with other health care professionals
• Team communication and dynamics
Principles of communicating with patients in a manner
that achieves a positive relationship
1-4Interviewing techniques
• Adjusting communication strategies for age, stage of
development, patients with special needs, differing
cultures
• Interviewing techniques
• Verbal defusing strategies
• Family presence issues
Fundamental depth, foundational breadth
• Consent/refusal of care
42
5
1-3
Medical/Legal
and Ethics
6
1-4
Anatomy and
Physiology
1-4
Pathophysiology
1-4
Life Span
Development
6
4-1
Pharmacology
8
4-1
Principles of
Pharmacology
9
4-1
8
9
19
3-4
2-1
Medication
Administration
Emergency
Medications
Airway
Management,
Respiration
and
Artificial
Ventilation
• Confidentiality
• Advanced directives
• Tort and criminal actions
• Evidence preservation
• Statutory responsibilities
• Mandatory reporting
• Ethical principles/moral obligations
• End-of-life issues
Simple knowledge of the anatomy and function of the
upper airway, heart, vessels, blood, lungs, skin, muscles,
and bones
Uses fundamental knowledge of the pathophysiology of
shock respiration compromise, body response to life
threats and perfusion to patient assessment and
management.
Applies fundamental knowledge of life span development
(age), related differences to patient assessment and
management.
Uses simple knowledge of the medications, selfadminister or administer to a peer in an emergency.
Applies fundamental knowledge of the medications that
the EMT may assist/administer to a patient during an
emergency.
Simple depth, simple breadth
• Medication safety
• Kinds of medications used during an emergency
Simple depth, simple breadth how to
• Self-administer medication
• Peer-administer medication
Fundamental depth, foundational breadth
Within the scope of practice of the EMT how to
• Assist/administer medications to a patient
Within the scope of practice of the EMT
• Names
• Effects - Actions
• Indications
• Contraindications
• Complications
• Routes of administration
• Side effects
• Interactions
• Dosages for the medications administered
Applies knowledge (fundamental depth, foundational
breadth) of general anatomy and physiology to patient
assessment and management in order to assure a patent
airway, adequate mechanical ventilation, and respiration
of patients of all ages.
Fundamental depth, foundational breadth Within the
scope of practice of the EMT
43
19
6
19
20
21
22
33
43
19
33
14
15
16
20
21
22
24
3
13
14
15
16
24
11
20
21
22
24
25
10
11
12
20
22
2-1
2-1
Airway
Management
Respiration
2-2
Artificial
Ventilation
3-1
Assessment
3-1
3-3
3-4
Scene Size-Up
Primary
Assessment
History Taking
• Airway anatomy
• Airway assessment
• Techniques of assuring a patent airway
Fundamental depth, simple breadth
• Anatomy of the respiratory system
• Physiology and pathophysiology of respiration
- Pulmonary ventilation
- Oxygenation
- Respiration
- External
- Internal
- Cellular
• Assessment and management of adequate and
inadequate respiration
• Supplemental oxygen therapy
Fundamental depth, foundational breadth - Assessment
and management of adequate and inadequate ventilation
• Artificial ventilation
• Minute ventilation
• Alveolar ventilation
• Effect of artificial ventilation on cardiac output
Use scene information and simple patient assessment
findings to identify and manage immediate life threats
and injuries. Applies scene information and patient
assessment findings (scene size up, primary and
secondary assessment, patient history, and
reassessment) to guide emergency management,
Complex depth, comprehensive breadth
• Scene safety
• Scene management
• Multiple patient situations
- Impact of the environment on patient care
- Addressing hazards
- Violence
- Need for additional or specialized resources
- Standard precautions
• Primary assessment for all patient situations
- Level of consciousness
- ABCs
- Identifying life threats
- Assessment of vital functions
• Begin interventions needed to preserve life
• Integration of treatment/procedures needed to preserve
life
Simple depth, simple breadth
• Determining the chief complaint
• Mechanism of injury/nature of illness
• Associated signs and symptoms
• Investigation of the chief complaint
44
24
6
21
to
40
7
20
21
33
21
22
3-5
Secondary
Assessment
3-6
Monitoring
Devices
3-6
Reassessment
6
7
8
4-6
Medicine
6
7
12
3-4
Medical
Overview
6
21
22
24
35
6
7
21
22
25
31
38
5-4
Neurology
3-4
3-5
Abdominal and
Gastrointestinal
Disorders
• Mechanism of injury/nature of illness
• Past medical history
• Associated signs and symptoms
• Pertinent negatives
Simple depth, simple breadth
• Performing a rapid full body scan
• Focused assessment of pain
• Assessment of vital signs
Techniques of physical examination
• Respiratory system
- Presence of breath sounds
• Cardiovascular system
• Neurological system
• Musculoskeletal system
• All anatomical regions
Simple depth, simple breadth
Within the scope of practice of the EMT - Obtaining and
using information from patient monitoring devices
including (but not limited to)
- Puse oximetry
- Non-invasive blood pressure
Fundamental depth, foundational breadth• How and when
to perform a reassessment for all patient situations
Recognizes and manages life threats based on
assessment findings of a patient with a medical
emergency while awaiting additional emergency
response. Applies fundamental knowledge to provide
basic emergency care and transportation based on
assessment findings for an acutely ill patient.
Simple depth, simple breadth Assessment and
management of a
• Medical complaint Pathophysiology, assessment, and
management of a medical complaints to include
• Transport mode
• Destination decisions
Fundamental depth, foundational breadth Anatomy,
physiology, pathophysiology, assessment and
management of
• Stroke/ transient ischemic attack (FAST assessment)
• Decreased level of responsiveness
• Seizure
• Status epilepticus
• Headache
Fundamental depth, foundational breadth Anatomy,
physiology, pathophysiology, assessment, presentations
and management of shock associated with abdominal
emergencies
• Acute and chronic gastrointestinal hemorrhage
Simple depth, simple breadth
• Peritonitis
45
39
6
7
20
22
45
3
6
7
12
20
6
7
36
3
5
10
44
49
51
6
7
20
21
22
34
52
6
7
8
20
40
6
7
8
10
21
22
• Ulcerative diseases
4-7
Immunology
Infectious
Diseases
4-4
4-8
4-3
Endocrine
Disorders
Psychiatric
(Behavioral
Emergency)
Cardiovascular
4-6
Toxicology
4-2
Respiratory
Fundamental depth, foundational breadth Anatomy,
physiology, pathophysiology, assessment, and
management of hypersensitivity disorders and/or
emergencies - Anaphylactic reactions
Simple depth, simple breadth
Assessment and management of
• A patient who may have an infectious disease
• How to decontaminate the ambulance and equipment
after treating a patient
Fundamental depth, foundational breadth - Anatomy,
physiology, pathophysiology, and awareness of Diabetic
emergencies cause altered mental status assessment
and management of Acute diabetic emergencies
Simple depth, simple breadth
Recognition of Behaviors that pose a risk to the EMT,
patient or others
• Basic principles of the mental health system
Fundamental depth, foundational breadth Assessment
and management of - Acute psychosis
• Suicidal/risk
• Agitated delirium
Anatomy, physiology, pathophysiology, assessment,
signs, symptoms and management
• Chest pain
• Cardiac arrest
• Acute coronary syndrome
- Angina pectoris
- Myocardial infarction
• Aortic aneurysm/dissection
• Thromboembolism Simple depth, simple breadth
• Heart failure
• Hypertensive emergencies
Fundamental depth, foundational breadth Anatomy,
physiology, pathophysiology, assessment, a Recognition
and management of
- Carbon monoxide poisoning
- Nerve agent poisoning
• How and when to contact a poison control center
• Inhaled poisons
• Ingested poisons
• Injected poisons
• Absorbed poisons
• Alcohol intoxication and withdrawal
Anatomy, physiology, pathophysiology, assessment, and
management of Fundamental depth, foundational breadth
• Epiglottitis
• Spontaneous pneumothorax
• Pulmonary edema
• Asthma
• Chronic obstructive pulmonary disease
• Environmental and industrial exposure
46
33
37
43
49
52
6
7
10
20
22
41
6
7
20
21
22
39
6
7
10
20
21
22
43
45
6
7
20
21
22
48
49
50
52
6
20
22
6
7
10
21
22
25
34
6-1
Hematology
3-4
Genitourinary
Renal
4-9
Gynecology
3-4
NonTraumatic
Musculoskelet
al Disorders
Diseases of the
Eyes, Ears,
Nose, and
Throat
4-3
5-1
Shock and
Resuscitation
• Toxic gas
Simple depth, simple breadth
• Pertussis
• Cystic fibrosis
• Pulmonary embolism
• Pneumonia
• Viral respiratory infections
Simple depth, simple breadth Anatomy, physiology,
pathophysiology, assessment, and management of
• Sickle cell crisis
• Clotting disorders
Simple depth, simple breadth
Anatomy, physiology, pathophysiology, assessment,
management
• Blood pressure assessment in hemodialysis patients
• Complications related to
- Renal dialysis
- Urinary catheter management (no insertion)
• Kidney stones
Simple depth, simple breadth
Anatomy, physiology, assessment findings, recognition
and management of shock associated with
• Vaginal bleeding
• Sexual assault (to include appropriate emotional
support)
Simple depth, simple breadth
• Infections
Fundamental depth, foundational breadth Anatomy,
physiology, pathophysiology, assessment and
management of
• Non-traumatic fractures
Simple depth, simple breadth Recognition and
management of
• Nose bleed
Uses assessment information to recognize shock,
respiratory failure or arrest, and cardiac arrest based on
assessment findings and manages the emergency and
applies fundamental knowledge of the causes,
pathophysiology, and management of shock, respiratory
failure or arrest, cardiac failure or arrest, and post
resuscitation management.
47
2
12
23
24
6
7
12
13
14
23
24
25
6
24
25
6
7
20
21
22
24
25
30
6
7
20
21
22
31
6
7
14
20
21
22
24
32
6
5-1
Trauma
5-1
Trauma
Overview
5-1
Bleeding
5-1
5-3
Chest Trauma
5-2
Abdominal and
Genitourinary
Trauma
5-3
5-4
Orthopedic
Trauma
Applies fundamental knowledge to provide basic
emergency care and transportation based on assessment
findings for an acutely injured patient
Fundamental depth, foundational breadth
Pathophysiology, assessment, and management of the
trauma patient
• Trauma scoring
• Rapid transport and destination issues
• Transport mode
Uses and activates Alaska Trauma system according to
Trauma Triage Transportation guidelines (CDC Trauma
Tool)
Simple depth, simple breadth
Recognition and management of
• Bleeding
Fundamental depth, simple breadth - Pathophysiology,
recognition, assessment and management
• Blunt versus penetrating mechanisms
• Open chest wound
• Impaled object
• Hemothorax
• Pneumothorax
- Open
- Simple
- Tension
• Cardiac tamponade
• Rib fractures
• Flail chest
• Commotio cordis
Fundamental depth, simple breadth Pathophysiology,
assessment and management of
• Solid and hollow organ injuries
• Blunt versus penetrating mechanisms
• Evisceration
• mpaled object
• Injuries to the external genitalia
• Vaginal bleeding due to trauma
• Sexual assault
Pathophysiology, assessment, and management of
fundamental depth, foundational breadth
• Upper and lower extremity orthopedic trauma
• Open fractures
• Closed fractures
• Dislocations
• Sprains/strains
• Pelvic fractures
• Amputations/replantation
Fundamental depth, foundational breadth
Pathophysiology, assessment, recognition and
48
7
14
20
21
22
23
24
25
26
27
6
7
14
21
22
24
28
29
29
32
6
7
21
22
24
28
29
5-2
5-4
5-4
6
7
11
23
24
48
49
7
21
14
24
26
5-1
Soft Tissue
Trauma
Head, Facial,
Neck, and
Spine trauma
Nervous
System
Trauma
management
• Wounds
- Avulsions
- Bite wounds
- Lacerations
- Puncture wounds
- Incisions
• Burns
- Electrical
- Chemical
- Thermal
- Radiation
• Chemicals in the eye and on the skin
• Crush syndrome
Fundamental depth, foundational breadth
Pathophysiology, assessment, recognition and
management of
• Life threats
• Spine trauma
• Penetrating neck trauma
• Laryngeotracheal injuries
• Spine trauma
Simple depth, simple breadth
• Facial fractures
• Skull fractures
• Foreign bodies in the eyes
• Dental trauma
Fundamental depth, foundational breadth
Pathophysiology, assessment, and management of
• Traumatic brain injury
• Spinal cord injury
Special
Considerations
in Trauma
Fundamental depth, foundational breadth
Pathophysiology, assessment, and management of
trauma in the
• Pregnant patient
• Pediatric patient
• Geriatric patient
• Cognitively impaired patient
Multi-System
Trauma
Fundamental depth, foundational breadth
Pathophysiology, assessment, and management of
• Multi-system trauma
• Blast injuries
49
32
6
7
20
21
22
42
11
22
47
48
49
51
52
6
7
20
21
22
46
6
7
22
47
6
7
10
4-7
6-1
Environmental
Emergencies
Special Patient
Populations
4-9
Obstetrics
6-1
Neonatal care
6-1
Pediatrics
Fundamental depth, foundational breadth
Pathophysiology, assessment, recognition and
management of
• Submersion incidents
• Temperature-related illness
• Near drowning
• Temperature-related illness
• Bites and envenomations
• Dysbarism
- High-altitude
- Diving injuries
• Electrical injury
• Radiation exposure
* Alaska Cold Injuries Guidelines highlighted
Recognizes and manages life threats based on simple
assessment findings for a patient with special needs
while awaiting additional emergency response.
Applies a fundamental knowledge of growth,
development, and aging and assessment findings to
provide basic emergency care and transportation for a
patient with special needs.
Fundamental depth, foundational breadth Anatomy and
physiology of normal pregnancy
• Normal delivery
• Vaginal bleeding in the pregnant patient
• Pathophysiology of complications of pregnancy
• Assessment of the pregnant patient Management of
- Normal delivery
- Abnormal delivery
- Nuchal cord
- Prolapsed cord
- Breech delivery
- Third trimester bleeding
~ Placenta previa
~ Abruptio placenta
- Spontaneous abortion/miscarriage
- Ectopic pregnancy
- Preeclampsia/Eclampsia
Fundamental depth, foundational breadth
Assessment and management
• Newborn
• Neonatal resuscitation
Fundamental depth, foundational breadth Age-related
assessment findings, age-related, and developmental
stage related assessment and treatment modifications for
pediatric specific major diseases and/or emergencies
• Upper airway obstruction
• Lower airway reactive disease
50
• Respiratory distress/failure/arrest
• Shock
• Seizures
• Sudden Infant Death Syndrome
• Gastrointestinal disease
11
20
21
22
48
6
7
10
11
20
21
22
49
Geriatrics
6
7
10
11
20
21
22
51
2
12
2
3
14
2
13
2
13
23
2
3
12
23
2
12
14
2
Patients with
Special
Challenges
7-1
7-1
7-3
7-3
7-2
EMS
Operations
Principles of
Safely
Operating a
Ground
Ambulance
Incident
Management
Multiple
Casualty
Incidents
Fundamental depth, foundational breadth 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
• impact of age-related changes on assessment and care
• Cardiovascular diseases
• Respiratory diseases
• Neurological diseases
• Endocrine diseases
• Alzheimer’s
• Dementia
Simple depth, simple breadth - Healthcare implications of
• Abusev / Neglect
• Homelessness / Poverty
• Bariatrics
• Technology dependent
• Hospice/ terminally ill
• Tracheostomy care/dysfunction
• Homecare
• Sensory deficit/loss
• Developmental disability
• Sensory deficit/loss
Knowledge of operational roles and responsibilities to
ensure safe patient, public, and personnel safety
Simple depth, foundational breadth
• Risks and responsibilities of transport
Fundamental depth, foundational breadth
Establish & work within the incident management system
Simple depth, simple breadth
• Triage principles
• Resource management
Air Medical
Simple depth, simple breadth
• Safe air medical operations
• Criteria for utilizing air medical response
Vehicle
Extrication
Simple depth, simple breadth
• Safe vehicle extrication
• Use of simple hand tools
Simple depth, simple breadth
51
3
15
12
13
14
17
7-3
7-3
Hazardous
Materials
Awareness
Mass Casualty
Incidents due to
Terrorism and
Disaster
• Risks and responsibilities of operating in a cold zone at
a hazardous material or other special incident
Simple depth, simple breadth
• 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)
52
Instructor Clinical Evaluation
and
Education Course Infrastructure
53
Clinical Behavior / Judgment
Assessment
Therapeutic communication
and cultural competency
Psychomotor Skills
Professionalism
Decision Making
Record Keeping
Patient Complaints
Perform a basic history and physical examination to identify
acute complaints and monitor
Changes identify the actual and potential complaints of
emergency patients.
Communicate in a culturally sensitive manner.
Safely and effectively perform all psychomotor skills within
the National EMS Scope of Practice Model AND state Scope
of Practice at this level.
Airway and Breathing
• Nasopharyngeal airway
• Positive pressure ventilation
• Manually-triggered ventilators
• Automatic transport ventilators
• Supplemental oxygen therapy
• Humidifiers
• Partial-rebreather mask
• Venturi mask Assessment
• Pulse oximetry
• Automatic B/P
Pharmacologic interventions
• Assist patients in taking their own prescribed medications
• Administration of OTC medications with medical oversight
• Oral glucose for hypoglycemia
• Aspirin for chest pain
Medical/Cardiac care
• Mechanical CPR
• Assisted complicated delivery
Trauma care
• Spinal immobilization
• Cervical collars
• Seated
• Longboard
• Rapid extrication
• Splinting
• Extremity
• Traction
• PASG
• Mechanical patient restraint
• Tourniquet
Demonstrate professional behavior including: but not limited
to, integrity, empathy, self-motivation, appearance and
personal hygiene, self-confidence, communications, time
management, teamwork/ diplomacy, respect, patient
advocacy, and careful delivery
of service.
Initiates basic interventions based on assessment findings
intended to mitigate the emergency and provide limited
symptom relief while providing access to definitive care
Record simple assessment findings and interventions
multiple trauma, nausea/vomiting, pain, paralysis, pediatric
crying/fussiness, poisoning, rash, rectal pain, shock, sore
54
Scene Leadership
Scene Safety
throat, stridor/drooling, syncope, urinary retention, visual
disturbances, weakness, and wheezing.
Entry-level EMTs serve as an
EMS team member on a real or mock emergency call with
more experienced personnel in the lead role. EMTs may
serve as a team leader following additional training and/or
experience.
Ensure the safety of the rescuer and others during an
emergency
Educational Course Infrastructure
Educational
Facilities
Student Space
Instructional
Resources
Instructor
Preparation
Resources
Storage Space
Sponsorship
Programmatic
Approval
Faculty
Medical Director
Oversight
Facility sponsored or approved by sponsoring agency
• ADA compliant facility
• Sufficient space for class size
• Controlled environment
• Provide space sufficient for students to attend classroom sessions, take
notes and participate in classroom activities
• Provide space for students to participate in kinematic learning and
practice activities
• Provide basic instructional support material • Provide audio, visual, and
kinematic aids to support and supplement didactic instruction
• Provide space for instructor preparation
• Provide support equipment for instructor preparation
• Provide adequate and secure storage space for instructional materials
• Sponsoring organizations shall be one of the following:
• Accredited educational institution, or
• Public safety organization, or
• Accredited hospital, clinic, or medical center, or
• Other State approved institution or organization
• Sponsoring organization shall have programmatic approval by authority
having jurisdiction for program approval (State)
The course primary instructor should
• be educated at a level higher than he or she is teaching; however, as a
minimum, he or she must be educated at the level he or she is teaching
• Have successfully completed an approved instructor training program or
equivalent
• Provide medical oversight for all medical aspects of instruction
55
Course & Instructor Guidelines
Assessing Student Achievement
This training program includes several methods for assessing student achievement. As mentioned before,
quizzes of the cognitive and psychomotor domains should be provided at the completion of each lesson. Time
is allocated at the end of each module of instruction for a cognitive and psychomotor evaluation. The primary
instructor in conjunction with the course coordinator is responsible for the design, development, administration
and grading of all written and practical examinations. The program should feel free to use outside agencyapproved psychomotor evaluation instruments or those found in texts. All written examinations used within the
program should be valid and reliable and conform to psychometric standards. Instructors should be encouraged
to use outside sources to validate examinations and/or as a source of classroom examination items.
The primary purpose of this course is to meet the entry-level job expectations as indicated in the job
description. Each student, therefore, must demonstrate attainment of knowledge, attitude, and skills in each
area taught in the course, e.g. competency. It is the responsibility of the course coordinator, medical director,
primary instructor and educational institution to assure that students obtain proficiency in each module of
instruction before they proceed to the next area. If after counseling and remediation a student fails to
demonstrate the ability to learn specific knowledge, attitudes and skills, the program director should not hesitate
to dismiss the student.
The level of knowledge, attitude and skills attained by a student in the program will be reflected in his/her
performance on the job as an EMT-Basic. This is ultimately a reflection on the program director, primary
instructor, medical director and educational institution. It is not the responsibility of the certifying examination to
assure competency over successful completion of the course. Program directors should recommend only
qualified candidates for licensure, certification or registration.
Requirements for successful completion of the course are as follows:
Cognitive
Students must receive passing grades on all module examinations and the final examination. Special remedial
sessions may be utilized to assist in the completion of a lesson or module of instruction. Scores should be in
accordance with accepted practices.
Affective
Students must demonstrate conscientiousness and interest in the program. Students who fail to do so should
be counseled while the course is in progress in order to provide them the opportunity to develop and exhibit the
proper attitude expected of an EMT-Basic.
Psychomotor
Students must demonstrate proficiency in all skills in each testing session of selected topic areas and mastery
of skills in the final examination. Special remedial sessions may be utilized to assist in the completion of a
lesson or module of instruction. Pass/fail scores should be in accordance with accepted practices. Usage of the
skill measurement instruments within this curriculum or developed by way of a valid process is strongly
recommended to achieve maximum results with the students. The additional areas that should be utilized for
evaluation of student achievement include:
Personal appearance
Each student should be neat, clean, well groomed and physically fit enough to perform the minimal entry-level
job requirements. Students who fail to exhibit good hygiene habits should be counseled in private while the
program is in session to provide them with the opportunity to correct the habits.
Attendance
Students are required to attend all lessons. At the discretion of the program director or designee, a student
missing a lesson may demonstrate the fulfillment of all skills and knowledge covered in the missed lesson.
Experience
Prior to certification of course completion, satisfactory clinical or field experience is required by the student.
Program Personnel
56
There will often be a number of individuals involved in the presentation of the EMT-B (Basic) program. For
clarity, the following terms are defined as they will be used throughout this document.
These identified roles and responsibilities are a necessary part of each EMT-B course. The individuals carrying
them out may vary from program to program and from locality to locality as the exact roles interface and
overlap. In fact, one person, if qualified, may carry out all of the roles in some programs.
Program Director:
An individual responsible for course planning,operation and evaluation. While the Program Director is
responsible for the overall operation of the education experience, this person need not be qualified or involved
in the actual instruction of specific course lessons. The Program Director is responsible for EMT Basic course
planning.
Course Coordinator:
The Course Coordinator is the individual responsible for coordinating and conducting the EMT-Basic program.
The Course Coordinator acts as the liaison between the students, the sponsoring agency, the local medical
community and the state-level certifying or licensing agency and is responsible for assuring that the course
goals and objectives (and those set forth by any licensing, registering, or certifying agency as applicable) are
met. The Course Coordinator may also serve as the Primary Instructor. This individual should have attended a
workshop that reviews the format, philosophy and skills of the new curriculum.
Primary Instructor:
This individual is expected to be knowledgeable in all aspects of prehospital emergency care, in the techniques
and methods of adult education, and managing resources and personnel. This individual should have attended
and successfully completed a program in EMS instruction methodology and an update on this curriculum.
This individual should be present at most, if not all, class sessions to assure program continuity and to be able
to identify that the students have the cognitive, affective and psychomotor skills necessary to function as an
Emergency Medical
Technician-Basic (Assistant Instructor):
This individual is responsible for the teaching of a specific lesson of the EMT-Basic course. This individual
should have attended a workshop that reviews the format, philosophy and skills of the new curriculum.
Assistant Instructor: This individual assists the primary instructor of any lesson in the demonstration and
practice designed to develop an evaluate student skill competencies.
Course Medical Director: The Course Medical Director of the EMT-Basic program should be a local physician
with emergency medical experience who will act as the ultimate medical authority regarding course content,
procedures, and protocols. The Course Medical Director, Course Coordinator and the Primary Instructor should
work closely together in the preparation and presentation of the program. The Course Medical Director can
assist in recruiting physicians to present materials in class, settling questions of medical protocol and acting as
a liaison between the course and the medical community. During the program the Medical Director will be
responsible for reviewing the quality of care rendered by the EMT-Basic in the clinical and field setting.
This Course Medical Director or a designee is responsible to verify student competence in the cognitive,
affective and psychomotor domains. The Course Medical Director should review all examinations. The Course
Medical Director may also serve as the Primary Instructor. Current in Alaska, a Medical Director is required for
EMT-1 course.
Philosophy of the Adult Learner
Individuals participating in this educational program should be considered adult learners, even in those
programs providing instruction to students younger than age 18. Adult learners are responsible for their own
learning. There are several characteristics regarding the adult learner as an EMT-Basic student.
 EMT-Basic students usually want to utilize knowledge and skills they have learned soon after they have
learned them.
 EMT-Basic students are interested in learning new concepts and principles; they enjoy situations that
require problem-solving, not necessarily learning facts. It is less difficult for them to use the concepts and
principles they have gained if they are able to participate actively in the learning process.
 EMT-Basic students learn best if they are able to proceed at their own pace.
57
 Motivation is increased when the subject content is relevant to the immediate interests and concerns of the
EMT-Basic student.
 Immediate feedback is essential to the EMT-Basic student, who needs to be kept informed of his progress
continuously.
The intent of this revised curriculum is to alter the methods of instruction provided by the instructor. This
curriculum has been designed and developed to reduce the amount of lecture time and move towards an
environment of discussion and practical skills. This way both learners and instructors are active in the process
of learning.
Principles of Adult Education
1. Attract and maintain the attention of the EMT-Basic student.
If instructors get off to a bad start, it is often because they fail to successfully gain and maintain the attention of
the student. In these situations, students start enthusiastic and may leave with some level of disappointment.
A clear statement of the purpose of each lesson is of utmost importance in gaining the student's attention. This
may be accomplished by using the information found in the motivational statement or the contextual statement
of the lesson plan. Sometimes, a real EMS story can provide a foundation of what the lesson is meant to
teach.
There are many methods that may be used to gain the student's attention, e.g., telling a relevant anecdote,
posing a unique situation, or asking how they would solve a problem. Once you have gained the attention of the
student, you must then maintain it throughout the entire lesson. After about 15-20 minutes of presentation, it is
essential that the student be re-involved in the learning process. There are three methods often utilized to keep
the students active in the process: Questioning, brainstorming, and demonstration.
Questions should be used to promote thought, to evaluate what has been learned, an of continuously move
students toward their desired goal. Questioning students keeps them actively involved and keeps them
thinking. It is also appropriate to ask rhetorical questions that are not meant to be answered by the student, but
that encourage thinking. Questions should be open-ended and should not have "yes" or "no" answers.
Questions should be a significant part of the lesson and should be used in both didactic and practical
presentation.
Another method of keeping students actively involved in their learning is to use brainstorming. Brainstorming is
a special and different type of questioning. This process generates a wide variety of creative ideas. There is no
right or wrong answer, only creative thinking. Pose a question to the students and then allow them to provide as
many answers as possible. After all the ideas have been presented, move the students toward the appropriate
and important points.
The third technique is demonstration. By providing the students with actual demonstration, you have bridged
the gap between theory and practice. When performing demonstration, it is beneficial to involve the students in
the process. It is encouraged that demonstration be used during the didactic component of the presentation to
assure breaking up long runs of lecture-type material.
Make the presentation clear and keep it organized. By using the lesson plans, your instruction should be clear
and organized. However, here are some additional tips that may assist you in your educational endeavors.
1. Tell the students what you are going to tell them.
2. Tell them.
3. Show them.
4. Let them try.
5. Observe.
6. Praise progress and redirect.
7. Tell them what you have told them.
8. Have them summarize what they have learned.
To help keep lessons clear, make sure the students have the objectives. The objectives should be presented to
the students on the first day of class. It may be beneficial to present students with entire lesson plans and allow
students to write additional information in the margins.
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Emergency Medical Technician (EMT-1): Skills
For a current EMT-Basic (based on 1994 EMT-B National Standard Curriculum) transitioning to 2009
Emergency Medical Technician (EMT), the following skills are no longer taught:
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
Insertion of a nasopharyngeal airway (removed)
Insertion of nasogastric and orogastric tubes (Not in the 1994 EMT-B National Standard Curriculum but
in the 2002 Advanced Airway supplement) (removed)
Activated charcoal removed from formulary (removed)
Pressure points and elevation for hemorrhage control (removed)
For a current 1994 EMT-Basic transitioning to 2009 Emergency Medical Technician EMT, the following skills
are new:










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
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
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Use of supplemental oxygen
Use of nasal cannula
Use of non-rebreather face mask
Use of oxygen humidifiers
Use of partial rebreather masks
Use of simple face masks
Use of Venturi masks
Obtaining a pulse oximetry value
Use of automated transport ventilators
Use of the automated external defibrillator (AED)
Use of a bag-valve-mask
Use of an auto-injector (self or peer)
Obtaining manual blood pressures
Use of mechanical CPR devices (requires additional specialty training and device approval) – where
available
Application of mechanical patient restraint (1994 EMT-B National Standard Curriculum contains an
approach now deemed inappropriate and a risk to the patient—i.e. forceful restraint in a prone position,
with wrists & ankles tightly tied together ("hobbled") behind the back.)
Assisting a patient with his/her prescribed medications, nebulized/aerosolized (1994 EMT-B National
Standard Curriculum advocated assisting a patient with hand-held aerosol inhalers, but not administer
nebulized medications to a patient)
Administration of aspirin by mouth
Use of an auto-injector (self or peer)
Performing eye irrigation
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Psychomotor Skills Evaluation
Safely and effectively perform all psychomotor skills within the National EMS Scope of Practice
Model AND state Scope of Practice.
Airway and Breathing
• Nasopharyngeal airway
• Positive pressure ventilation
• Manually-triggered ventilators
• Automatic transport ventilators
• Supplemental oxygen therapy
• Humidifiers
• Partial-rebreather mask
• Venturi mask Assessment
• Pulse oximetry
• Automatic B/P
Pharmacologic interventions
• Assist patients in taking their own prescribed medications
• Administration of OTC medications with medical oversight
• Oral glucose for hypoglycemia
• Aspirin for chest pain
Medical/Cardiac care
• Mechanical CPR
• Assisted complicated delivery
Trauma care
• Spinal immobilization
• Cervical collars
• Seated
• Longboard
• Rapid extrication
• Splinting
• Extremity
• Traction
• PASG
• Mechanical patient restraint
• Tourniquet
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Helpful EMS Links from the Internet
(please respect copyright of publishers and authors)
These links do not constitute endorsement my State of Alaska DHSS-EMS
EMT Textbooks, PowerPoint slides, .pdf support materials
Pearson Publishing Company – Emergency Care 12th Edition (2012) (.pdf & .ppt)
http://ronaldgagne.com/brady-emergency-care-twelve-edition.html
Pearson – Brady Books
http://www.bradybooks.com
Jones & Bartlett – Mosby’s EMT Textbook (.ppt handouts)
http://ems.jbpub.com/Stoy/EMT/Default.aspx
http://ems.jbpub.com/Stoy/EMT/WebLinks.aspx
Jones & Bartlett – AAOS
http://www.jblearning.com/ems/technician/
http://www.emtb.com/9e/
http://www.aaos.org/news/aaosnow/aug10/youraaos3.asp
Online EMT Links
Wikibooks – EMT Objectives Outlined (hyperlinked details)
http://en.wikibooks.org/wiki/EMT-Basic#Module_3:_Patient_Assessment
http://www.ems1.com/ems-products/education/articles/588845-The-EMT-Curriculum/
Software that downloads YouTube video into an savable video clip
http://www.computerhope.com/issues/ch001002.htm
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Photo / Video Links
The Transition Packet includes a Video folder that incorporate some of the videos below.
ReelDX – HIPAA compliant real medical emergencies – valid for education:
https://meded.reeldx.com/libraries/prehospital/cases
Baseline Vital Signs and History (Jones & Bartlett)
https://www.youtube.com/watch?v=Ayaj1Hv7wXo&list=PL-3afNhTWfjIuggVwVE7rsVzdH7sRaqYl
Patient Assessment – Medical
https://www.youtube.com/watch?v=q7DF5uZRuB0&list=PL3afNhTWfjIuggVwVE7rsVzdH7sRaqYl&index=2
Patient Assessment – Trauma
https://www.youtube.com/watch?v=q7DF5uZRuB0&list=PL3afNhTWfjIuggVwVE7rsVzdH7sRaqYl&index=2
Spinal Immobilization – Skills
https://www.youtube.com/watch?v=zoiNrFhjZcg
Seated
https://www.youtube.com/watch?v=DK-yP-pAD4g&list=PL8498F21DF6349837&index=5
MedicCast
http://www.mediccast.com/blog/
EMSWorld – Online Media Education
http://www.emsworld.com/training-education
62
Bibliography
63
Appendix
64
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