Chapter 13 Emergency Medical Services Health Care Science Technology Copyright © The McGraw-Hill Companies, Inc

Chapter 13Emergency Medical Services

Health Care Science Technology

Copyright © The McGraw-Hill Companies, Inc.

Chapter 132 Copyright © The McGraw-Hill Companies, Inc.

Objectives

Compare the roles and responsibilities of the First Responder, Emergency Medical Technician-Basic, Intermediate, and Paramedic.

Identify safety rules when using oxygen for therapy.

Identify the use and flow requirement of a nasal cannula and nonrebreather mask.


Objectives (cont.)

Define the role of the Automated External Defibrillator in cardiac arrest and identify the safety requirements for operating it.

Identify situations requiring the use of the Automated External Defibrillator.

Successfully complete 3 EMS procedures.


Careers in Emergency Medical Services (EMS)

First Responder Emergency Medical

Technicians


First Responder

Arrives first at the scene of an accident or incident.– Usually, firefighters, law

enforcement officers, industry workers, private citizens, or neighbors.

– Individuals have taken an approved First Responder Program.


First Responder (cont.)

First Responder Responsibilities– Take appropriate body substance

isolation precautions.– Identify the cause of the injury or the

nature of the illness.– Determine the total number of clients.– Request additional help, if necessary.


First Responder (cont.)

First Responder Responsibilities (cont.)– Safely gain access to the client. – Determine what is wrong with the client

and provide emergency medical care.– Lift or remove a client only when required.– Transfer the client and information to

trained personnel.


Emergency Medical Technicians

Work all hours in all weather at the scene of an accident.


Emergency Medical Technicians (cont.)

Responsibilities– Assess the situation to determine if it’s

safe.– Take appropriate precautions.– Interview and examine the client.– Provide appropriate out-of-hospital care

according to established local procedures and guidelines.

– Transport the client to a medical facility.



EMT Equipment – Cervical collars – immobilize

neck, back, and spinal injuries.

– Automatic external defibrillator (AED) – device used to restore the normal heart rhythm of a cardiac arrest victim.



Responsibilities of the EMT–Basic– Ensure personal safety and safety of

the crew, client, and bystanders.– Examine and interview the client to

determine appropriate emergency care.

– Provide client care based upon exam and interview.



Responsibilities of the EMT–Basic (cont.)– Lift, move, and transport the client to a

medical facility.– Transfer care of the client to the medical

staff at the receiving medical facility.– Speak on behalf of the client by reporting

concerns and findings to the medical staff.



Responsibilities of EMT–Intermediate– Initiate intravenous (IV) lines.– Perform advanced airway techniques.– Interpret electrocardiogram (ECG).– Use manual defibrillators.– Administer certain medications beyond

those permitted at the EMT – B level.



Responsibilities of EMT–Paramedic– Effectively understand the local EMS system’s

policies and procedures.– Utilize local communication systems.– Possess strong leadership skills, including self-

confidence, inner strength, decision-making skills, and willingness to accept responsibility.



Responsibilities of EMT–Paramedic– Be able to size up the scene.– Examine and interview the client.– Assign of priorities of care, develop an

action plan, and perform emergency care.


Section 13-1 Apply Your Knowledge #1

Which two levels of EMTs are allowed to defibrillate the client?

Answer:

1. EMT – intermediate.

2. EMT – paramedic.



Why do you think all EMT personnel must use body substance isolation precautions at all times?

Answer:To protect themselves and the client from transfer of infection.


Emergency Medical Services Procedures

Client Assessment ProcessAirway ManagementAdditional Career SkillsEmergency Childbirth


Client Assessment Process

The client assessment process consists of the following:– Scene size-up.– Initial assessment.– Focused history and physical exam.– Detailed physical exam.– Ongoing assessment.– Communication.– Documentation.


Client Assessment Process (cont.)

Evaluation includes evaluating:– Safety of the scene for the provider, other

responders, the client, and bystanders.– Body substance isolation (BSI) precautions.– Mechanism of injury or nature of illness.– Number of clients.– Need for additional resources or assistance.



Initial assessment includes 6 assessments:– Form a general impression.– Determine level of responsiveness.– Assess the airway.– Assess breathing.– Assess circulation, including

presence of pulse and bleeding.– Make a decision regarding the

priority or urgency of the client.



Focused history and physical exam include the following:– In 90 seconds check head, eyes, neck, chest,

abdomen, pelvis, arms, legs and back according to standard procedures.

– Take complete set of vital signs.– Take SAMPLE history, if time permits.



Detailed assessment requires: – A more detailed exam en route to the

medical facility.



Ongoing assessment requires:– Continuous reevaluation of initial

assessments.



Communication– Converse with client and family.– Communicate with dispatcher and

medical facility.– Hand-off report at medical facility.



Documentation– Written reports of pertinent

information.


Airway Management

First Responders and EMTs manage life-threatening problems of airway, breathing, and circulation.

One of the greatest threats to the airway is the tongue.

Use head tilt-chin lift to open the airway. Use jaw-thrust if neck or back injury is

suspected.


Airway Management (cont.)

Airway Adjuncts:– Maintain an open airway.– Two types:

Oropharyngeal airway (OPA) – used in mouth and throat.

Nasopharyngeal airway (NPA) – used in nasal passage.


Additional Career Skills

Oxygen therapy is used at the scene for illnesses that create tremendous stress on the body such as:– Respiratory or cardiac arrest.– Heart attack.– Shock.– Severe blood loss.– Lung disease or disorders.– Stroke.– Drug overdose.– Severe bone injuries.


Additional Career Skills (cont.)

Oxygen Therapy Equipment– Oxygen cylinders.– Oxygen regulator.– Oxygen flow meter.– Oxygen delivery devices.

Nasal cannulaNonrebreather mask



Automated External Defibrillator (AED)– Used to treat ventricular fibrillation, a

chaotic heart rhythm (the most common cause of cardiac arrest).

– American Heart Association recommends using in the first 5 minutes to improve chance of survival.



Automated External Defibrillator (AED) (cont.)– Attaches to chest. – Analyzes the rhythm.– Determines the need for a

shock.– Can deliver shock manually or

automatically.– Use only when no response,

breathing, or circulation.



Automated External Defibrillator (AED) (cont.)– Modify procedures if:

Client is wet or on a wet surface.Client is less than 8 years old or weighs 55

to 65 pounds.Client has pacemaker or internal

defibrillator.Client is lying on a metal surface.Client has medication patches.



How to Attach the AED– Bare and dry the chest.– Position first pad over collarbone and

not on the breast bone.– Position second pad below and to the

left of the left nipple.– Connect the lead cables.



Principles and Operation of the AED– Do not delay.– Turn on machine and attach pads.– Check machine for picture of the

placement of pads.– Do not touch client during analysis or

shock.– Say “Clear” before applying a shock.– Check machine’s battery periodically.



Spinal Immobilization Skills – Spinal cord injuries occur from:

Automobile collisions.Diving accidents.Motorcycle collisions.Falls.In the case of children: falls or being struck

by a motor vehicle.



Signs of Spinal Injury:– Paralysis to arms and/or legs.– Loss of feeling in arms or legs.– Pain or tenderness at back of neck or

spine.– Pain with or without movement.– Loss of bowel or bladder control.– Labored breathing with little chest

movement.


Emergency Childbirth

The mother should be taken to the hospital if possible.

Know date when the baby is due.– Gestation is approximately 9 months.– Gestation is divided into three 3-month

periods, or trimesters.


Emergency Childbirth (cont.)

Anatomy and Physiology– Placenta – allows oxygen and nutrients to go

to fetus while carbon dioxide and wastes are eliminated by the mother.

– Umbilical cord – cordlike structure attached between fetus and placenta.

– Amniotic sac – thin, membranous sac.Allows fetus to float freely, cushioning it

from shock.Contains from 1 to 2 liters of fluid.



Labor– Uterus contractions in the ninth

month signaling childbirth.– Has 3 stages.



Labor – First Stage– Regular contractions of uterus and gradual

dilation of cervix become shorter as delivery is imminent.

– Could last from 4 hours to more than 24 hours.

– Typically longer for first-time mothers.– Probable watery or bloody discharge and

rupture of amniotic sac.– Ends with full dilation of cervix.



Labor – Second Stage– Baby enters birth canal until born.– Contractions become intense and frequent.– Crowning occurs as baby’s head bulges from

vaginal opening.– Ends when baby is born.



Labor – Third Stage– Starts after baby is born and lasts until

delivery of placenta and umbilical cord is complete.

– Contractions continue a little longer as uterus prepares to deliver the placenta.

– Typically lasts from 10 to 20 minutes.– Ends with delivery of placenta.



Why is it essential to perform a thorough client assessment?

Answer: The information obtained during the assessment provides the basis for the treatment given. It must be accurate to ensure proper treatment and survival. This information is also provided to the medical facility.



Why are a clear airway and breathing always given the top priority when providing care for your clients?

Answer: The airway must be clear and breathing must be present to ensure the client survives the accident or injury. It is the most life-threatening concern.


Procedures in Student Text

13A1 Inserting an Oropharyngeal Airway Adjunct

13A2 Inserting a Nasopharyngeal Airway Adjunct

13B Operating of the Semiautomatic Defibrillator


Additional Procedures in Lab Activity Manual

LM13-1A Preparing an Oxygen Cylinder

LM13-1B Providing OxygenLM13-2A Manual Stabilization of the

Head and NeckLM13-2B Applying Cervical CollarsLM13-3 Emergency Childbirth

During a Normal Delivery


Chapter 13 Credits

Slide 5 Kenneth Murry/Photo ResearchersSlide 10 J.S. Reid/Custom Medical Stock PhotoSlide 14 Tim CourlasSlide 21 Aaron HauptSlide 28 Spencer Grant/PhotoEditSlide 32 Wolfgang Spunbarg/PhotoEdit

Documents

Chapter 13 Emergency Medical Services Health Care Science Technology Copyright © The McGraw-Hill Companies, Inc