EMERGENCY
MEDICAL
TECHNICIAN
Review – 1st half
Compiled by Barry Barkinsky EMS-I
Preparatory
The EMS System
Components of the
Emergency Medical
Services (EMS) System
System Access
 Enhanced 911
 911
 Non-911
Bystanders
Emergency Medical Dispatcher
First Responders
Emergency Medical Technician-Basic
Advanced Life Support (ALS)
Emergency Department Staff
Specialty Facilities
 Trauma Centers
 Burn Centers
 Pediatric Centers
 Poison Control Centers
Roles and Responsibilities

Scene Safety
Patient Assessment / Care
Lifting and Moving
Transport / Transfer of Care
Documentation

Patient Advocacy
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Quality Improvement

Provides documentation

Reviews & audits runs
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Gathers feedback from patients & hospital staff

Conducts preventive maintenance

Continues education

Maintains skills
Medical Direction
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Medical Director
Sponsor Hospital
Medical Direction
On-Line – radio, phone patch
 Off-Line – standing orders

Well - Being
Well Being of the EMT
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Emotion and Stress
Scene safety
Exposure Control Plan
Lifting and Moving
Emotion and Stress
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Causes
Signs and Symptoms
Dealing with Stress
CISD
Understanding of Death and Dying
Scene Safety
Scene safety starts on arrival and
continues throughout the call!
Medical / Legal
What is …?
Medical / Legal
Scope of Practice
Medical / Legal
Expressed Consent
Medical / Legal
Implied Consent
Medical / Legal
DNR
Medical / Legal
LIVING WILL
Medical / Legal
Abandonment
Medical / Legal
Negligence
Medical / Legal
Refusal
Medical / Legal
Special Reporting
Situations
Medical / Legal
Crime Scene
DOCUMENTATION
Documentation

Your written prehospital care report (PCR) is
the only true factual record of events.

Your PCR is your sole permanent, complete
written record of events during the
ambulance call.
Uses for PCR’s

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Medical
Administrative
Research
Legal
General Considerations


Use appropriate medical
terminology.
Use acceptable and approved
abbreviations and acronyms.
If you do not know how to spell a word, look it up or use
another word…
Communications

The communications with the
hospital are another important
item to document.

Document ANY medical advice or
orders you receive and the results of
implementing that advice and those orders.
Pertinent Negatives


Document all findings of your assessment,
even those that are normal.
Remember you are building a case to support
your clinical impression
Oral Statements

Whenever possible, quote the patient—or
other source of information—directly.
Example: Bystanders state the patient was “acting
bizarre and threatening to jump in front of the next
passing car.”
Elements of Good Documentation

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Accuracy
Legibility
Timeliness
Absence of alterations
Professionalism
Professionalism

Never include slang, biased
statements, or irrelevant
opinions.

Include only objective
information.

Always write and speak clearly.
Narrative Writing

Subjective part of your narrative comprises any
information that you elicit during your patient’s
history.

Objective part of your narrative usually includes
your general impression and any data that you
derive through inspection, palpation, auscultation,
percussion, and diagnostic testing.
Special Considerations



Patient refusals
Services not needed
Mass casualty incidents
Patient Refusals

Patients retain the right to refuse
treatment or transportation if they
are competent to make that decision.

Two main types of refusals:


Person who is not seriously
injured and does not want to go to
the hospital
The patient refuses even though
you feel he needs it. Also known as AMA
A patient’s refusal of care requires
careful documentation.
Airway Management
Airway Management
Anatomy
Airway Management
Upper Airway
Comprised of ?
Airway Management
Airway Management
Lower Airway
Airway Management
Airway Management
Opening the Airway
- No trauma
Airway Management
Opening the Airway
(Trauma)
Airway Management
Breathing
***Ventilation
versus oxygenation
Airway Management
Signs and Symptoms
Adequate / Inadequate
Breathing
Can you list them?
Airway Management
Suctioning
How, how long?
Suctioning
Purpose
 Devices

 Measurement

Time
 Procedure
Airway Management
Airway Management
Artificial
Ventilations
Adjuncts-name, measure,
insert
Oxygen devices
Non-Invasive Respiratory
Monitoring
Pulse Oximeter
PATIENT
ASSESSMENT
BSI
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B Body

S Substance

I
Isolation
MOI / NOI
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M Mechanism
O of
I Injury
N Nature
O of
I Illness
SAMPLE
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S
A
M
P
L
E
Signs and Symptoms
Allergies
Medications
Past Medical History
Last Oral Intake
Events Leading to the Injury / Illness
OPQRST
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O
P
Q
R
S
T
Onset
Provocation
Quality
Radiation
Severity
Time
DCAP-BTLS
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D
C
A
P
Deformity
Contusions
Abrasions
Punctures / Penetrations
B
T
L
S
Burns
Tenderness
Lacerations
Swelling
Baseline Vital Signs

Respirations

Pulse

Skin

Pupils

Blood Pressure

Pulse Ox

Temperature
Ongoing Assessment

Repeat Initial Assessment

Reassess Vital Signs

Repeat Focused Assessment

Check Interventions
Ongoing Assessment
Stable Patient
How often?
Ongoing Assessment
Unstable Patient
How often?
Rapid Trauma Assessment
(Check for DCAP-BTLS)
Head
 Neck
 Chest
 Abdomen
 Pelvis
 Extremities (PMS)
 Posterior

Head
DCAP-BTLS
Ears
DCAP-BTLS + Drainage
Neck: DCAP-BTLS + Jugular Vein
Distention and Crepitation
Chest: DCAP-BTLS + Crepitation and
Breath Sounds (Presence and Equality)
Listen to both sides of the chest.
Is air entry present? Absent?
Equal on both sides?
Compare left side to right side.
Mid-clavicular
Mid-axillary
Abdomen: DCAP-BTLS +
Firmness and Distention
Pelvis: DCAP-BTLS
(Compress Gently)
Extremities: DCAP-BTLS + Distal
Pulse, Sensation, Motor Function
Posterior: DCAP-BTLS
TYPES OF
PATIENTS
Medical Patient

Scene Size Up

Safety

BSI

MOI / NOI

Patients / Resources
Medical Patient
Responsive Patient

Initial

General Impression

Mental Status

ABC’s

Priority of Patient
Medical Patient
Responsive Patient

Focused History and Physical Exam

Physical Exam

OPQRST

SAMPLE
Medical Patient
Unresponsive Medical Patient

Initial

ABC’s

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Rule out Trauma
Focused Exam

Rapid Assessment

Vitals / SAMPLE

Ongoing
Patient Assessment
Trauma Patient

Determine MOI
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Significant / Non-Significant
Initial Assessment
ABC’s
Patient priority
Focused History and Physical Exam
DCAP- BTLS
 Rapid trauma assessment

Patient Assessment
Trauma Patient

Rapid Trauma Assessment
C-Collar
 Inspect, palpate, auscultate
 DCAP-BTLS
 SAMPLE
 Detailed Exam
 Ongoing

Patient Assessment
Trauma Patient

Rapid Trauma Assessment
C-Collar
 Inspect, palpate, auscultate
 DCAP-BTLS
 SAMPLE
 Detailed Exam
 Ongoing

Trauma Patient
No Significant MOI

Initial Assessment

Focused History and Physical Exam

Ongoing Assessment
Pharmacology
Pharmacology
Medications on
Ambulance
Oxygen, charcoal
Pharmacology
Prescribed Medications
Which ones can you assist
the patient in taking?
After what?
Pharmacology
Indications
Pharmacology
Contraindications
Pharmacology
The 4 Rights to Med
Administration
Medical Emergencies
Seizures
Seizures

Generalized Seizures

Tonic-Clonic

Aura

Loss of Consciousness

Tonic Phase

Clonic Phase

Postseizure

Postictal
Seizures

Partial Seizures

Simple Partial Seizures
Involve one body area.
 Can progress to generalized seizure.
 Also known as focal seizures


Complex Partial Seizures
Characterized by auras.
 Typically 1–2 minutes in length.
 Loss of contact with surroundings.

Seizures

Assessment

Differentiating Between Syncope & Seizure

Bystanders frequently confuse syncope and seizure.
Seizures

Management
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Scene safety & BSI.
Maintain the airway.
Administer high-flow
oxygen.
Treat hypoglycemia if
present.
Do not restrain the
patient.


Protect the patient
from the
environment.
Maintain body
temperature.
Seizures

Management

Position the patient.

Suction if required.

Provide a quiet
atmosphere.

Transport.
Seizures

Status Epilepticus

Two or More Generalized Seizures

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Seizures occur without a return of consciousness.
Management

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Management of airway and breathing is critical.
Monitor the airway closely.
Medical Emergencies
Stroke (CVA)
Stroke & Intracranial Hemorrhage

Occlusive Strokes

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Embolic & Thrombotic Strokes
Hemorrhagic Strokes
Stroke & Intracranial Hemorrhage

Signs
Facial Drooping
 Headache
 Aphasia/Dysphasia
 Hemiparesis
 Paresthesia
 Gait Disturbances
 Incontinence

Symptoms
Confusion
Agitation
Dizziness
Vision Problems
Stroke & Intracranial Hemorrhage

Transient Ischemic Attacks
Indicative of carotid artery disease.
 Symptoms of neurological deficit:

Symptoms resolve in less than 24 hours.
 No long-term effects.

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Evaluate through history taking:
History of HTN, prior stroke, or TIA.
 Symptoms and their progression.

Stroke & Intracranial Hemorrhage

Management
Scene safety & BSI
 Maintain the airway.
 Support breathing.
 Obtain a detailed history.
 Position the patient.
 Protect paralyzed extremities.

Medical Emergencies
Allergic Reaction
(Anaphylaxis)
Allergies and Anaphylaxis

Allergic Reaction


An exaggerated response by the immune system
to a foreign substance
Anaphylaxis
An unusual or exaggerated allergic reaction
 A life-threatening emergency
 The most severe form of allergic reaction

Anaphylaxis

Causes
Assessment Findings
in Anaphylaxis

Focused History & Physical Exam

Focused History

SAMPLE & OPQRST History
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Rapid onset, usually 30–60 seconds following exposure.
Speed of reaction is indicative of severity.
Previous allergies and reactions.
Physical Exam

Presence of severe respiratory difficulty is key to
differentiating anaphylaxis from allergic reaction.
Assessment
Findings in
Anaphylaxis

Physical Exam
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Facial or laryngeal edema
Abnormal breath sounds
Hives and urticaria
Hyperactive bowel sounds
Vital sign deterioration as
the reaction progresses
Epi-Auto Injector
Indications
anaphylaxis
requires??
anaphylaxis
 Difficulty
Breathing
 Systemic Skin reactions
 Hypotension
Epi-Auto Injector
Contraindications
Epi-Auto Injector
Dosage
Epi-Auto Injector
Actions
Epi-Auto Injector
Side Effects
Epi-Auto Injector
Administration
In a Nutshell…..
SHOCK is…
INADEQUATE
TISSUE
PERFUSION
OB / GYN
OB / GYN
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Labor
Bloody Show
Crowning
Predelivery Emergencies
Labor
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Stage One
(Dilation)
Stage Two
(Expulsion)
Stage Three
(Placental Stage)
Management of a Patient
in Labor

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
Transport the patient in labor unless delivery is
imminent.
Maternal urge to push or the presence of
crowning indicates imminent delivery.
Delivery at the scene or in the ambulance will be
necessary.
Field Delivery

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Set up delivery area.
Give oxygen to mother and
start
Drape mother with toweling
from OB kit.
Monitor fetal heart rate.
As head crowns, apply gentle
pressure.
Suction the mouth and
then the nose.
Clamp and cut the cord.
Dry the infant and keep it
warm.
Deliver the placenta and
save for transport with the
mother.
OB / GYN ( Normal Delivery)
OB / GYN ( Normal Delivery)
OB / GYN ( Normal Delivery)
OB / GYN ( Normal Delivery)
OB / GYN ( Normal Delivery)
OB / GYN ( Normal Delivery)
Apgar Scoring
OB / GYN ( Normal Delivery)
Care of Newborn
OB / GYN
(Resuscitation)
HR Less than 100
OB / GYN
(Resuscitation)
HR less than 80
OB / GYN
(Resuscitation)
HR less than 60
Neonatal Resuscitation



If the infant’s respirations are below 30 per minute
and tactile stimulation does not increase rate to
normal range, assist ventilations using bag valve
mask with high-flow oxygen.
If the heart rate is below 80 and does not respond
to ventilations, initiate chest compressions.
Transport to a facility with neonatal intensive care
capabilities.
Causes of Bleeding
During Pregnancy

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Abortion
Ectopic pregnancy
Placenta previa
Abruptio placentae
Ectopic Pregnancy


Assume that any female of childbearing age
with lower abdominal pain is experiencing an
ectopic pregnancy.
Ectopic pregnancy is life-threatening.
Transport the patient immediately.
Placenta Previa




Usually presents with
painless bleeding.
Never attempt vaginal
exam.
Treat for shock.
Transport
immediately—
treatment is delivery
by
c-section.
Abruptio Placentae




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Signs and symptoms
vary.
Classified as partial,
severe, or complete.
Life-threatening.
Treat for shock, fluid
resuscitation.
Transport left lateral
recumbent position.
Abnormal Delivery Situations
OB / GYN (Abnormal
Deliveries)
Breech
Breech Presentation


The buttocks or both feet present first.
If the infant starts to breath with its face
pressed against the vaginal wall, form a “V”
and push the vaginal wall away from infant’s
face. Continue during transport.
OB / GYN (Abnormal
Deliveries)
Prolapsed Cord
Prolapsed Cord

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
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The umbilical cord precedes the fetal presenting part.
Elevate the hips, administer oxygen, and keep warm.
If the umbilical cord is seen in the vagina, insert two
gloved fingers to raise the fetus off the cord. Do not
push cord back.
Wrap cord in sterile moist towel.
Transport immediately; do not attempt delivery.
OB / GYN (Abnormal
Deliveries)
Limb Presentation
Limb Presentation
With limb presentation, place the
mother in knee–chest position,
administer oxygen, and transport
immediately. Do not attempt delivery.
Other Abnormal Presentations


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Whenever an abnormal presentation or position of
the fetus makes normal delivery impossible, reassure
the mother.
Administer oxygen.
Transport immediately.
Do not attempt field delivery in these circumstances.
Other Delivery Complications
OB / GYN (Abnormal
Deliveries)
Multiple Births
Multiple Births



Follow normal guidelines, but have additional
personnel and equipment.
In twin births, labor starts earlier and babies
are smaller.
Prevent hypothermia.
OB / GYN (Abnormal
Deliveries)
Meconium
Meconium Staining


Fetus passes feces into the amniotic fluid.
If meconium is thick, suction the
hypopharynx and trachea using an
endotracheal tube until all meconium has
been cleared from the airway.