EMT 101 Chapter 1,2,4

Standing orders
a policy or protocol issued by a Medical Director that authorizes EMTs and others to perform particular skills in certain situations.

Patient outcomes
the long-term survival of patients.

on-line medical direction
orders from the on-duty physician given directly to an EMT in the field by radio or telephone.

on- line medical direction
standing orders issued by the Medical Director that allow EMTs to give certain medications or perform certain procedures without speaking to the Medical Director or another physician.

Designated agent of the physician
This means that, as an EMT, your authority to give medications and provide emergency care is actually an extension of the Medical Director’s license to practice medicine.

Medical direction
oversight of the patient-care aspects of an EMS system by the Medical Director.

Evidence-based
description of medical techniques or practices that are supported by scientific evidence of their safety and efficacy, rather than merely by supposition and tradition.

Protocols
lists of steps, such as assessments and interventions, to be taken in different situations. Protocols are developed by the Medical Director of an EMS system.

Contamination
the introduction of dangerous chemicals, disease, or infectious materials.

critical incident stress management (CISM)
a comprehensive system that includes education and resources to both prevent stress and to deal with stress appropriately when it occurs.

decontamination
the removal or cleansing of dangerous chemicals and other dangerous or infectious materials

hazardous material
incident the release of a harmful substance into the environment.

multiple-casualty incident (MCI)
an emergency involving multiple patients.

pathogens
the organisms that cause infection, such as viruses and bacteria.

personal protective equipment (PPE)
equipment that protects the EMS worker from infection and/or exposure to the dangers of rescue operations.

Standard precautions
a strict form of infection control that is based on the assumption that all blood and other body fluids are infectious.

stress
a state of physical and/or psychological arousal to a stimulus.

Crime scene
crime scene
the location where a crime has been committed or any place that evidence relating to a crime may be found.

do not resuscitate (DNR) order
do not resuscitate (DNR) order
a legal document, usually signed by the patient and his physician, which states that the patient has a terminal illness and does not wish to prolong life through resuscitative efforts.

duty to act
duty to act
an obligation to provide care to a patient. ethical regarding a social system or social or professional expectations for applying principles of right and wrong.

expressed consent
expressed consent
consent given by adults who are of legal age and mentally competent to make a rational decision in regard to their medical well-being

Roles and Responsibilities of the EMT
• Personal safety. It is not possible to help a patient if you are injured before you reach him or while you are providing care, so your first responsibility is to keep yourself safe. Safety concerns include dangers from other human beings, animals, unstable buildings, fires, explosions, and more. Though emergency scenes are usually safe, they also can be unpredictable. You must take care at all times to stay safe.

• Safety of the crew, patient, and bystanders. The same dangers you face will also be faced by others at the scene. As a professional, you must be concerned with their safety as well as your own. • Patient assessment. As an EMT, one of your most important functions will be assessment of your patient, or finding out enough about what is wrong with your patient to be able to provide the appropriate emergency care. Assessment always precedes emergency care.

• Patient care. The actual care required for an individual patient may range from simple emotional support to lifesaving CPR and defibrillation. Based on your assessment findings, patient care is an action or series of actions that your training will prepare you to take to help the patient deal with and survive his illness or injury.

• Lifting and moving. Since EMTs are usually involved in transporting patients to the hospital, lifting and moving patients are important tasks. You must perform them without injury to yourself and without aggravating or adding to the patient’s existing injuries.

• Transport. It is a serious responsibility to operate an ambulance at any time, but even more so when there is a patient on board. Safe operation of the ambulance, as well as securing and caring for the patient in the ambulance, will be important parts of your job as an EMT.

• Transfer of care. Upon arrival at the hospital, you will turn the patient over to hospital personnel. You will provide information on the patient’s condition, your observations of the scene, and other pertinent data so that there will be continuity in the patient’s care. Although this part of patient care comes at the end of the call, it is very important. You must never abandon care of the patient at the hospital until transfer to hospital personnel has been properly completed.

• Patient advocacy. As an EMT, you are there for your patient. You are an advocate, the person who speaks up for your patient and pleads his cause. It is your responsibility to address the patient’s needs and to bring any of his concerns to the attention of the hospital staff. You will have developed a rapport with the patient during your brief but very important time together, a rapport that gives you an understanding of his condition and needs. As an advocate, you will do your best to transmit this knowledge to help the patient continue through the EMS and hospital systems. In your role as an advocate, you may perform a task as important as reporting information that will enable the hospital staff to save the patient’s life or as simple as making sure a relative of the patient is notified. Acts that may seem minor to you may often provide major comfort to your patient.

Limmer, Daniel; O’Keefe, Michael F.; Grant, Harvey; Murray, Bob; Bergeron, J. David; Dickinson, Edward T.. Emergency Care (EMT) (Page 8). Pearson Education. Kindle Edition.

NHTSA (The National Highway Traffic Safety Administration)
summary of standards
• Regulation and policy.
Each state EMS system must have in place enabling legislation (laws that allow the system to exist), a lead EMS agency, a funding mechanism, regulations, policies, and procedures.
• Resource management.
There must be centralized coordination of resources so that all victims of trauma or medical emergencies have equal access to basic emergency care and transport by certified personnel, in a licensed and equipped ambulance, to an appropriate facility.
• Human resources and training.
At a minimum, all those transporting prehospital personnel (those who ride the ambulances) should be trained to the EMT level using National EMS Education Standards that are taught by qualified instructors.
• Transportation.
Safe, reliable ambulance transportation is a critical component. Most patients can be effectively transported by ground ambulances. Other patients require rapid transportation, or transportation from remote areas, by helicopter or airplane.
• Facilities. The seriously ill or injured patient must be delivered in a timely manner to the closest appropriate facility.
• Communications. There must be an effective communications system, beginning with the universal system access number (911), dispatch-to-ambulance, ambulance-to ambulance, ambulance-to-hospital, and hospital-to-hospital communications.

• Public information and education. EMS personnel may participate in efforts to educate the public about their role in the system, their ability to access the system, and prevention of injuries.

• Medical direction.
Each EMS system must have a physician as a Medical Director accountable for the activities of EMS personnel within that system. The Medical Director delegates medical practice to nonphysician providers (such as EMTs) and must be involved in all aspects of the patient-care system.

• Trauma systems.
In each state, enabling legislation must exist to develop a trauma system including one or more trauma centers, triage and transfer guidelines for trauma patients, rehabilitation programs, data collection, mandatory autopsies (examination of a body to determine cause of death), and means for managing and ensuring the quality of the system.

• Evaluation. Each state must have a program for evaluating and improving the effectiveness of the EMS system, known as a quality improvement (QI) program, a quality assurance (QA) program, or total quality management (TQM).

Levels of EMS Training

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1. Emergency Medical Responder (EMR) (previously called first responder). This level of training is designed for the person who is often first at the scene. Many police officers, firefighters, and industrial health personnel function in this capacity. The emphasis is on activating the EMS system and providing immediate care for life-threatening injuries, controlling the scene, and preparing for the arrival of the ambulance.

2. Emergency Medical Technician (EMT) (previously called EMT-Basic). In most areas, the EMT is considered the minimum level of certification for ambulance personnel. EMTs provide basic-level medical and trauma care and transportation to a medical facility.

3. Advanced Emergency Medical Technician (AEMT) (previously called EMTIntermediate). The AEMT, like the EMT, provides basic-level care and transportation as well as some advanced-level care, including use of advanced airway devices, monitoring of blood glucose levels, and administration of some medications, which may include intravenous and intraosseous administration.

4. Paramedic (previously sometimes called EMT-Paramedic). The Paramedic performs all of the skills of the EMT and AEMT plus advanced-level skills. The Paramedic provides the most advanced level of prehospital care.

Good Samaritan laws
Good Samaritan laws
a series of laws, varying in each state, designed to provide limited legal protection for citizens and some health care personnel when they are administering emergency care.

HIPAA
HIPAA
The Health Insurance Portability and Accountability Act, a federal law protecting the privacy of patient-specific health care information and providing the patient with control over how this information is used and distributed.

implied consent
implied consent
the consent it is presumed a patient or patient’s parent or guardian would give if they could, such as for an unconscious patient or a parent who cannot be contacted when care is needed.

in loco parentis
.
in loco parentis
in place of a parent, indicating a person who may give consent for care of a child when the parents are not present or able to give consent.

liabillity
liability
being held legally responsible

libel
libel
false injurious information in written form.

Moral
moral
regarding personal standards or principles of right and wrong.

Negligence
negligence
a finding of failure to act properly in a situation in which there was a duty to act, that needed care as would reasonably be expected of the EMT was not provided, and that harm was caused to the patient as a result.

Physician Order for Life-Sustaining Treatment (POLST)
Physician Order for Life-Sustaining Treatment (POLST)
physician orders that state not only the patient’s wishes regarding resuscitation attempts but also the patient’s wishes of artificial feeding, antibiotics, and other life-sustaining care if the person is unable to state his desires later.

safe haven law
safe haven law
a law that permits a person to drop off an infant or child at a police, fire, or EMS station or to deliver the infant or child to any available public safety personnel. The intent of the law is to protect children who may otherwise be abandoned or harmed.

scope of practice
scope of practice
a set of regulations and ethical considerations that define the scope, or extent and limits, of the EMT’s job.

Slander
Slander
false injurious information stated verbally.

standard of care
standard of care
for an EMT providing care for a specific patient in a specific situation, the care that would be expected to be provided by an EMT with similar training when caring for a patient in a similar situation.

Tort
tort
a civil, not a criminal, offense; an action or injury caused by negligence from which a lawsuit may arise.

Hepatitis
Hepatitis, an infection that causes an inflammation of the liver, comes in several forms, including hepatitis A, B, C, and other strains. Hepatitis A is acquired primarily through contact with food or water contaminated by stool (feces). The other forms are acquired through contact with blood and other body fluids. The virus that causes hepatitis is especially hardy. Hepatitis B has been found to live for many days in dried blood spills, posing a risk of transmission long after many other viruses would have died. For this reason, it is critical for you to assume that any body fluid in any form, dried or otherwise, is infectious until proven otherwise. Hepatitis B can be deadly. Before hepatitis B vaccine was available, the virus (HBV) killed hundreds of health care workers every year in the United States, more than any other occupationally acquired infectious disease. There is no cure, but an effective vaccine that prevents contracting HBV is available. Today hepatitis C infects many EMS providers in the same way as hepatitis B, yet there is no vaccine against hepatitis C.

Tuberculosis
Tuberculosis (TB) is an infection that sometimes settles in the lungs and that in some cases can be fatal. It was once thought to be largely eradicated, but in the late 1980s it made a comeback. TB is highly contagious. Unlike many other infectious diseases, it can spread through the air. Health care workers and others can become infected even without any direct contact with a carrier. Because it is impossible for the EMT to determine why a patient has a productive cough, it is safest to assume that it could be the result of TB and that you should take the necessary respiratory precautions. This is especially true in institutions such as nursing homes, correctional facilities, or homeless shelters where there is an increased risk of TB.

AIDS
AIDS (acquired immune deficiency syndrome) is a set of conditions that results when the immune system has been attacked by HIV (human immunodeficiency virus) and rendered unable to combat certain infections adequately. Although advances are being made in the treatment of HIV/AIDS, no cure has been discovered at the time of publication of this text. However, HIV/AIDS presents far less risk to health care workers than hepatitis and TB because the virus does not survive well outside the human body. This limits the routes of exposure to direct contact with blood by way of open wounds, intravenous drug use, unprotected sexual contact, or blood transfusions. Puncture wounds into which HIV is introduced, such as with an accidental needlestick, are also potential routes of infection. However, less than half of 1 percent of such incidents result in infection, according to the U.S. Occupational Safety and Health Administration (OSHA), compared to 30 percent for the hepatitis B virus (HBV). The difference is due to the quantity and strength of HBV compared to HIV.

Ebola
Ebola is a viral disease that first appeared in Africa in 1976. In 2014, for the first time, Ebola has infected people in the United States. This disease is of particular concern because of the high rate of deaths and the lack of a definitive vaccination or treatment. Ebola causes initial symptoms that include fever, chills, and weakness. These progress to watery diarrhea, vomiting, and abdominal pain. Ebola is a hemorrhagic fever. Therefore, late signs may include bruising as well as internal and external bleeding. Refer to the most recent recommendations from the Centers for Disease Control and Prevention (CDC) and your EMS protocols for information on patient screening, preventing transmission of Ebola, and methods of decontamination. These will differ from those for many other diseases. Screening by dispatchers for the patient’s travel history or potential contacts with other symptomatic Ebola patients is important. Consideration of Ebola early in the call is crucial for preventing transmission of the disease to EMS personnel

MERS
Middle East Respiratory Syndrome (MERS) is viral respiratory illness that was recently recognized in humans. It was first reported in Saudi Arabia in 2012 and has since spread to several other countries, including the United States. Most people identified as infected with MERS-CoV developed severe acute respiratory illness, including fever, cough, and shortness of breath. Many of them have died.

Avian Flu
Avian flu is a disease found in poultry that can also affect humans. Outbreaks have been seen in Asia, the Near East, and Africa and have been fatal in about half the reported cases. The virus has not shown to be easily transmissible from human to human. Symptoms include traditional flulike symptoms that progress to more severe conditions such as pneumonia and acute respiratory distress syndrome.

aka “Bird Flu”

Influenza
Influenza has been around for hundreds of years. The influenza pandemic of 1918 killed between 30 and 50 million people around the world.

Critical elements of infection control plan standard
• Infection exposure control plan.

• Adequate education and training.

• Hepatitis B vaccination.

• Personal protective equipment.

• Methods of control.

• Housekeeping.

• Postexposure evaluation and follow-up.

Ryan White Care Act
Ryan White CARE Act The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act (also called the Ryan White CARE Act) was enacted by the U.S. Congress in 1990. It was named for Ryan White, a teenager who contracted AIDS from a tainted hemophilia treatment in 1984, became an advocate for AIDS research and awareness, and died from the disease in 1990. In 1994 the CDC issued the final notice for the Ryan White CARE Act Regarding Emergency Response Employees. This federal act, which applies to all fifty states, mandates a procedure by which emergency response personnel can seek to find out if they have been exposed to potentially life-threatening diseases while providing patient care. The procedures for exposure follow-up by emergency response personnel denoted in the act remain in force under its most recent extension as the Ryan White HIV/AIDS Treatment Extension Act of 2009. Emergency response personnel referred to in this act include firefighters, law enforcement officers, EMTs, and other individuals who provide emergency aid on behalf of a legally recognized volunteer organization.

NIOSH-approved N-95 and HEPA respirator
You are required to wear an N-95 or HEPA respirator when you are:

• Caring for patients suspected of having TB. High-risk areas include correctional institutions, homeless shelters, long-term care facilities for the elderly, and drug treatment centers.
• Transporting an individual from such a setting in a closed vehicle. If possible, keep the windows of the ambulance open and set the heating and air conditioning system on the nonrecirculating cycle.
• Performing high-risk procedures such as endotracheal suctioning and intubation.

Acute stress reaction
Acute stress reactions are often linked to catastrophes, such as a large-scale natural disaster, a plane crash, or a coworker’s line-of-duty death or injury. Signs and symptoms of an acute stress reaction will develop simultaneously or within a very short time following the incident.

Delayed Stress Reaction
Like an acute stress reaction, a delayed stress reaction, also known as posttraumatic stress disorder (PTSD), can be triggered by a specific incident; however, the signs and symptoms may not become evident until days, months, or even years later. This delay in presentation may make it harder to deal with the stress reaction since the individual has seemingly put the incident behind him and moved on with his life. Signs and symptoms may include flashbacks, nightmares, feelings of detachment, irritability, sleep difficulties, or problems with concentration or interpersonal relationships.

Cumulative Stress Reaction
Cumulative Stress Reaction

Cumulative stress reaction, or burnout, is not triggered by a single critical incident, but instead results from sustained, recurring low-level stressors—possibly in more than one aspect of one’s life—and develops over a period of years.

A multiple-casualty incident (MCI)
A multiple-casualty incident (MCI) is a single incident in which there are multiple patients. Examples range from a motor-vehicle crash in which two drivers and a passenger are injured to a hurricane that causes injuries to hundreds of people.

Eustress
Eustress is a positive form of stress that helps people work under pressure and respond effectively.

Distress
Distress is negative. It can happen when the stress of a scene becomes overwhelming. As a result, your response to the emergency will not be effective. Distress also can cause immediate and long-term problems with your health and well-being.

Critical incident stress management
Critical Incident Stress Management Critical incident stress management (CISM) is a comprehensive system that includes education and resources to both prevent stress and to deal with stress appropriately when it does occur. EMS systems and organizations have different systems for dealing with stress prevention, critical incident stress, and chronic stress, including wellness incentives, professional counseling, and peer support.

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