Emergency Care and Transportation of the Sick and Injured

Title Page
Copyright Page
Celebrating 50 Years of EMS Education and Innovation
Brief Contents
Contents
Skill Drills
Preface
Acknowledgments
1 EMS Systems
Introduction
EMT Training: Focus and Requirements
Licensure Requirements
Overview of the EMS System
History of EMS
Levels of Training
Public Basic Life Support and Immediate Aid
Emergency Medical Responder
Emergency Medical Technician
Advanced Emergency Medical Technician
Paramedic
Components of the EMS System
Public Access
Human Resources
Medical Direction
Legislation and Regulation
Integration of Health Services
Mobile Integrated Health Care and Community Paramedicine
Information Systems
Evaluation
System Finance
Education Systems
Prevention and Public Education
EMS Research
Roles and Responsibilities of the EMT
Professional Attributes
2 Workforce Safety and Wellness
Introduction
General Health, Wellness, and Resilience
Wellness and Stress Management
Sleep
Disease Prevention and Health Promotion
Balancing Work, Family, and Health
Infectious and Communicable Diseases
Routes of Transmission
Risk Reduction and Prevention for Infectious and Communicable Diseases
Immunity
General Postexposure Management
Scene Safety
Scene Hazards
Scenes of Violence
Protective Clothing: Preventing Injury
Caring for Critically Ill and Injured Patients
Techniques for Communicating With the Critical Patient
Locating and Notifying Family Members
Injured and Critically Ill Children
Coping With the Death of a Child
Helping the Family
Death and Dying
The Grieving Process
What Can the EMT Do?
Assisting Patient and Family Members
Stress Management on the Job
Posttraumatic Stress Disorder
Burnout
Compassion Fatigue
Responder Risk for Suicide
Emotional Aspects of Emergency Care
Stressful Situations
Workplace Issues
Cultural Diversity on the Job
Sexual Harassment
Substance Abuse
Injury and Illness Prevention
3 Medical, Legal, and Ethical Issues
Introduction
Consent
Expressed Consent
Implied Consent
Involuntary Consent
Minors and Consent
Forcible Restraint
The Right to Refuse Treatment
Confidentiality
Health Insurance Portability and Accountability Act
Social Media
Advance Directives
Physical Signs of Death
Presumptive Signs of Death
Definitive Signs of Death
Medical Examiner Cases
Special Situations
Organ Donors
Medical Identification Insignia
Scope of Practice
Standards of Care
Standards Imposed by Local Custom
Standards Imposed by Law
Professional or Institutional Standards
Standards Imposed by Textbooks
Standards Imposed by States
Duty to Act
Negligence
Abandonment
Assault and Battery and Kidnapping
Defamation
Good Samaritan Laws and Immunity
Records and Reports
Special Mandatory Reporting Requirements
Abuse of Children, Older People, and Others
Injury During the Commission of a Felony
Drug-Related Injuries
Childbirth
Other Reporting Requirements
Scene of a Crime
The Deceased
Ethical Responsibilities
The EMT in Court
4 Communications and Documentation
Introduction
Therapeutic Communication
Age, Culture, and Personal Experience
Nonverbal Communication
Verbal Communication
Written Communications and Documentation
Patient Care Report
Types of Forms
Standardized Narrative Formats
Reporting Errors
Documenting Refusal of Care
Special Reporting Situations
Communications Systems and Equipment
Base Station Radios
Mobile and Portable Radios
Repeater-Based Systems
Digital Equipment
Cellular/Satellite Telephones
Other Communications Equipment
Radio Communications
Responding to the Scene
Communicating With Medical Control and Hospitals
Maintenance of Radio Equipment
5 Medical Terminology
Introduction
Anatomy of a Medical Term
Word Roots
Prefixes
Suffixes
Combining Vowels
Word Building Rules
Plural Endings
Special Word Parts
Numbers
Colors
Positions and Directions
Common Direction, Movement, and Position Terms
Directional Terms
Movement Terms
Other Directional Terms
Anatomic Positions
Breaking Terms Apart
Abbreviations and Symbols
Abbreviations
Symbols
Master Tables
6 The Human Body
Introduction
Topographic Anatomy
The Planes of the Body
From Cells to Systems
The Skeletal System: Anatomy
Bones
Joints
The Axial Skeleton
The Appendicular Skeleton
The Pelvis
The Lower Extremities
The Skeletal System: Physiology
The Musculoskeletal System: Anatomy
Skeletal Muscle
The Musculoskeletal System: Physiology
The Respiratory System: Anatomy
The Upper Airway
The Lower Airway
Mechanics of Breathing
The Respiratory System: Physiology
Respiration
Ventilation
Characteristics of Normal Breathing
Inadequate Breathing in Adults
The Circulatory System: Anatomy
The Heart
Arteries
Capillaries
Veins
Blood Composition
The Spleen
The Circulatory System: Physiology
Normal Circulation in Adults
Inadequate Circulation in Adults
The Function of Blood
Nervous System Control of the Cardiovascular System
The Nervous System: Anatomy and Physiology
The Central Nervous System
The Peripheral Nervous System
The Integumentary System (Skin): Anatomy
The Integumentary System (Skin): Physiology
The Digestive System: Anatomy
The Abdomen
Mouth
Oropharynx
Esophagus
Stomach
Pancreas
Liver
Small Intestine
Large Intestine
Appendix
Rectum
The Digestive System: Physiology
The Lymphatic System: Anatomy and Physiology
The Endocrine System: Anatomy and Physiology
The Urinary System: Anatomy and Physiology
The Genital System: Anatomy and Physiology
The Male Reproductive System and Organs
The Female Reproductive System and Organs
Life Support Chain
Pathophysiology
Respiratory Compromise
Shock
Alteration of Cellular Metabolism
7 Life Span Development
Introduction
Vital Signs
Neonates (Birth to 1 Month) and Infants (1 Month to 1 Year)
Physical Changes
Psychosocial Changes
Toddlers (1 to 3 Years) and Preschoolers (3 to 6 Years)
Physical Changes
Psychosocial Changes
School-Age Children (6 to 12 Years)
Physical Changes
Psychosocial Changes
Adolescents (12 to 18 Years)
Physical Changes
Psychosocial Changes
Early Adults (19 to 40 Years)
Physical Changes
Psychosocial Changes
Middle Adults (41 to 60 Years)
Physical Changes
Psychosocial Changes
Older Adults (61 Years and Older)
Physical Changes
Psychosocial Changes
8 Lifting and Moving Patients
Introduction
The Wheeled Ambulance Stretcher
Backboards
Moving and Positioning the Patient
Body Mechanics
Anatomy Review
Principles of Safe Reaching and Pulling
Principles of Safe Lifting and Carrying
Patient Weight
Lifting and Carrying a Patient on a Backboard or Stretcher
Moving a Patient With a Stair Chair
Moving a Patient on Stairs With a Stretcher
Loading a Wheeled Stretcher Into an Ambulance
Directions and Commands
Emergency Moves
Urgent Moves
Rapid Extrication Technique
Nonurgent Moves
Direct Ground Lift
Extremity Lift
Transfer Moves
Geriatrics
Bariatrics
Additional Patient-Moving Equipment
Bariatric Stretchers
Pneumatic and Electronic Powered Wheeled Stretchers
Binder Lift
Portable/Folding Stretchers
Flexible Stretchers
Short Backboards
Vacuum Mattresses
Basket Stretchers
Neonatal Isolettes
Decontamination
Patient Positioning
Personnel Considerations
9 The Team Approach to Health Care
Introduction
An Era of Team Health Care
Community Paramedicine and Mobile Integrated Healthcare Teams
Differences Among Teams
Types of Teams
Regular Teams
Temporary Teams
Special Teams
Groups Versus Teams
Groups
Dependent, Independent, and Interdependent Groups
Dependent
Independent
Interdependent
Effective Team Performance
A Shared Goal
Clear Roles and Responsibilities
Diverse and Competent Skill Sets
Effective Collaboration and Communication
Supportive and Coordinated Leadership
Transfer of Patient Care
General Guidelines
BLS and ALS Providers Working Together
Where BLS Care Ends and ALS Care Begins
Assisting With ALS Skills
Critical Thinking and Clinical Decision Making in EMS
Stages of the Decision-Making Process
Decision Traps
Troubleshooting Team Conflicts
10 Patient Assessment
Introduction
Scene Size-up
Ensure Scene Safety
Determine Mechanism of Injury/Nature of Illness
Take Standard Precautions
Determine Number of Patients
Consider Additional/Specialized Resources
Primary Assessment
Form a General Impression
Scan for Signs of Uncontrolled External Bleeding
Assess Level of Consciousness
Assess the Airway
Assess Breathing
Assess Circulation
Performing a Rapid Exam to Identify Life Threats
Determine Priority of Patient Care and Transport
History Taking
Investigate the Chief Complaint (History of Present Illness)
Obtain SAMPLE History
Secondary Assessment
Systematically Assess the Patient—Secondary Assessment
Systematically Assess the Patient—Focused Assessment
Assess Vital Signs Using the Appropriate Monitoring Device
Reassessment
Repeat the Primary Assessment
Reassess Vital Signs
Reassess the Chief Complaint
Recheck Interventions
Identify and Treat Changes in the Patient’s Condition
Reassess Patient
11 Airway Management
Introduction
Anatomy of the Respiratory System
Anatomy of the Upper Airway
Anatomy of the Lower Airway
Physiology of Breathing
Ventilation
Oxygenation
Respiration
Pathophysiology of Respiration
Factors in the Nervous System
Ventilation/Perfusion Ratio and Mismatch
Factors Affecting Pulmonary Ventilation
Factors Affecting Respiration
Circulatory Compromise
Patient Assessment
Recognizing Adequate Breathing
Recognizing Abnormal Breathing
Assessment of Respiration
Opening the Airway
Head Tilt–Chin Lift Maneuver
Jaw-Thrust Maneuver
Opening the Mouth
Suctioning
Suctioning Equipment
Techniques of Suctioning
Basic Airway Adjuncts
Oropharyngeal Airways
Nasopharyngeal Airways
Maintaining the Airway
Supplemental Oxygen
Supplemental Oxygen Equipment
Procedures for Operating and Administering Oxygen
Hazards of Supplemental Oxygen
Oxygen-Delivery Equipment
Nonrebreathing Masks
Nasal Cannulas
Partial Rebreathing Masks
Venturi Masks
Tracheostomy Masks
Humidification
Assisted and Artificial Ventilation
Assisting Ventilation in Respiratory Distress/Failure
Artificial Ventilation
Continuous Positive Airway Pressure
Mechanism
Indications
Contraindications
Application
Complications
Stomas and Tracheostomy Tubes
Foreign Body Airway Obstruction
Recognition
Emergency Medical Care for Foreign Body Airway Obstruction
Dental Appliances
Facial Bleeding
Assisting With ALS Airway Procedures
Assisting With Placement of Advanced Airways
12 Principles of Pharmacology
Introduction
How Medications Work
Medication Names
Routes of Administration
Medication Forms
Tablets and Capsules
Solutions and Suspensions
Metered-Dose Inhalers
Topical Medications
Transcutaneous Medications
Gels
Gases for Inhalation
General Steps in Administering Medication
Medication Administration Cross-Check Procedure
Medication Administration and the EMT
Medications Used by EMTs
Oral Medications
Sublingual Medications
Intramuscular Medications
Intranasal Medications
Inhalation Medications
Patient Medications
Implications for EMS Providers
Medication Errors
13 Shock
Introduction
Pathophysiology
Perfusion
Causes of Shock
Types of Shock
Cardiogenic Shock
Obstructive Shock
Distributive Shock
Hypovolemic Shock
The Progression of Shock
Patient Assessment for Shock
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Emergency Medical Care for Shock
Treating Cardiogenic Shock
Treating Obstructive Shock
Treating Septic Shock
Treating Neurogenic Shock
Treating Anaphylactic Shock
Treating Psychogenic Shock
Treating Hypovolemic Shock
Treating Shock in Older Patients
14 BLS Resuscitation
Introduction
Elements of BLS
The Components of CPR
Assessing the Need for BLS
Basic Principles of BLS
Automated External Defibrillation
AED Usage in Children
Special AED Situations
Positioning the Patient
Check for Breathing and a Pulse
Provide External Chest Compressions
Proper Hand Position and Compression Technique
Opening the Airway and Providing Artificial Ventilation
Opening the Airway in Adults
Recovery Position
Breathing
Provide Artificial Ventilations
One-Rescuer Adult CPR
Two-Rescuer Adult CPR
Switching Positions
Devices and Techniques to Assist Circulation
Active Compression-Decompression CPR
Impedance Threshold Device
Mechanical Piston Device
Load-Distributing Band CPR or Vest CPR
Infant and Child CPR
Determining Responsiveness
Check for Breathing and a Pulse
Airway
Provide Rescue Breathing
Interrupting CPR
When Not to Start CPR
When to Stop CPR
Foreign Body Airway Obstruction in Adults
Recognizing Foreign Body Airway Obstruction
Removing a Foreign Body Airway Obstruction in an Adult
Foreign Body Airway Obstruction in Infants and Children
Removing a Foreign Body Airway Obstruction in a Child
Removing a Foreign Body Airway Obstruction in Infants
Special Resuscitation Circumstances
Opioid Overdose
Cardiac Arrest in Pregnancy
Grief Support for Family Members and Loved Ones
Education and Training for the EMT
Education and Training for the Public
15 Medical Overview
Introduction
Types of Medical Emergencies
Patient Assessment
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Management, Transport, and Destination
Scene Time
Type of Transport
Destination Selection
Infectious Diseases
General Assessment Principles
General Management Principles
Epidemic and Pandemic Considerations
Common or Serious Communicable Diseases
Influenza
Herpes Simplex
HIV Infection
Hepatitis
Meningitis
Tuberculosis
Whooping Cough
Methicillin-Resistant Staphylococcus aureus
Global Health Issues
Travel Medicine
Conclusion
16 Respiratory Emergencies
Introduction
Anatomy of the Respiratory System
Physiology of Respiration
Pathophysiology
Carbon Dioxide Retention and Hypoxic Drive
Causes of Dyspnea
Upper or Lower Airway Infection
Acute Pulmonary Edema
Chronic Obstructive Pulmonary Disease
Asthma, Hay Fever, and Anaphylaxis
Spontaneous Pneumothorax
Pleural Effusion
Obstruction of the Airway
Pulmonary Embolism
Hyperventilation
Environmental/Industrial Exposure
Patient Assessment
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Emergency Medical Care
Metered-Dose Inhaler and Small-Volume Nebulizer
Administration of an MDI
Administration of a Small-Volume Nebulizer
Treatment of Specific Conditions
Upper or Lower Airway Infection
Acute Pulmonary Edema
Chronic Obstructive Pulmonary Disease
Asthma, Hay Fever, and Anaphylaxis
Spontaneous Pneumothorax
Pleural Effusion
Obstruction of the Airway
Pulmonary Embolism
Hyperventilation
Environmental/Industrial Exposure
Foreign Body Aspiration
Tracheostomy Dysfunction
Asthma
Cystic Fibrosis
17 Cardiovascular Emergencies
Introduction
Anatomy and Physiology
Circulation
Pathophysiology
Atherosclerosis
Acute Coronary Syndrome
Cardiogenic Shock
Congestive Heart Failure
Hypertensive Emergencies
Patient Assessment
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Emergency Medical Care for Chest Pain or Discomfort
Administering Nitroglycerin
Cardiac Monitoring
Placing the Electrodes
Performing Cardiac Monitoring
Reviewing the ECG Tracing
Heart Surgeries and Cardiac Assistive Devices
Automatic Implantable Cardiac Defibrillators
External Defibrillator Vest
Left Ventricular Assist Devices
Cardiac Arrest
Automated External Defibrillation
Emergency Medical Care for Cardiac Arrest
Preparation
Performing Defibrillation
18 Neurologic Emergencies
Introduction
Anatomy and Physiology
Pathophysiology
Headache
Stroke
Types of Stroke
Signs and Symptoms of Stroke
Conditions That May Mimic Stroke
Seizures
Causes of Seizures
The Importance of Recognizing Seizures
The Postictal State
Syncope
Altered Mental Status
Causes of Altered Mental Status
Patient Assessment
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Emergency Medical Care
Headache
Stroke
Seizure
Altered Mental Status
19 Gastrointestinal and Urologic Emergencies
Introduction
Anatomy and Physiology
The GI System
Additional Abdominal Organs
The Genital System
The Urinary System
Pathophysiology
Abdominal Pain
Causes of Acute Abdomen
Urinary System
Kidneys
Female Reproductive Organs
Other Organ Systems
Patient Assessment
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Emergency Medical Care
Dialysis Emergencies
20 Endocrine and Hematologic Emergencies
Introduction
Endocrine Emergencies
Anatomy and Physiology
Pathophysiology
Patient Assessment of Diabetes
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Emergency Medical Care for Diabetic Emergencies
Giving Oral Glucose
The Presentation of Hypoglycemia
Seizures
Altered Mental Status
Misdiagnosis of Neurologic Dysfunction
Relationship to Airway Management
Hematologic Emergencies
Anatomy and Physiology
Pathophysiology
Patient Assessment of Hematologic Disorders
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Emergency Medical Care for Hematologic Disorders
21 Allergy and Anaphylaxis
Introduction
Anatomy and Physiology
Pathophysiology
Common Allergens
Insect Stings
Patient Assessment of an Immunologic Emergency
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Emergency Medical Care of Immunologic Emergencies
Epinephrine
22 Toxicology
Introduction
Identifying the Patient and the Poison
How Poisons Enter the Body
Inhaled Poisons
Absorbed and Surface Contact Poisons
Ingested Poisons
Injected Poisons
Patient Assessment
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Emergency Medical Care
Specific Poisons
Alcohol
Opiates and Opioids
Sedative-Hypnotic Drugs
Abused Inhalants
Hydrogen Sulfide
Sympathomimetics
Synthetic Cathinones (Bath Salts)
Marijuana
Hallucinogens
Anticholinergic Agents
Cholinergic Agents
Miscellaneous Drugs
Food Poisoning
Plant Poisoning
23 Behavioral Health Emergencies
Introduction
Myth and Reality
Defining a Behavioral Crisis
The Magnitude of Mental Health Disorders
Pathophysiology
Organic
Functional
Safe Approach to a Behavioral Crisis
Patient Assessment
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Acute Psychosis
Schizophrenia
Delirium
Excited Delirium
Restraint
Risks Associated With Patient Restraint
The Process of Restraining a Patient
Performing Patient Restraint
The Potentially Violent Patient
Suicide
Posttraumatic Stress Disorder and Returning Combat Veterans
Signs and Symptoms of PTSD
Caring for the Combat Veteran
Medicolegal Considerations
Consent
Limited Legal Authority
24 Gynecologic Emergencies
Introduction
Anatomy and Physiology
Pathophysiology
Pelvic Inflammatory Disease
Sexually Transmitted Diseases
Vaginal Bleeding
Patient Assessment
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Emergency Medical Care
Assessment and Management of Specific Conditions
Pelvic Inflammatory Disease
Sexual Assault and Rape
25 Trauma Overview
Introduction
Energy and Trauma
MOI Profiles
Blunt and Penetrating Trauma
Blunt Trauma
Vehicular Crashes
Car Versus Pedestrian
Car Versus Bicycle
Car Versus Motorcycle
Falls
Penetrating Trauma
Blast Injuries
Tissues at Risk
Multisystem Trauma
Golden Principles of Prehospital Trauma Care
Patient Assessment
Injuries to the Head
Injuries to the Neck and Throat
Injuries to the Chest
Injuries to the Abdomen
Management: Transport and Destination
Scene Time
Destination Selection
Type of Transport
Special Considerations
26 Bleeding
Introduction
Anatomy and Physiology of the Cardiovascular System
The Heart
Blood Vessels and Blood
Pathophysiology and Perfusion
External Bleeding
The Significance of External Bleeding
Characteristics of External Bleeding
Internal Bleeding
Mechanism of Injury for Internal Bleeding
Nature of Illness for Internal Bleeding
Signs and Symptoms of Internal Bleeding
Patient Assessment for External and Internal Bleeding
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Emergency Medical Care for External Bleeding
Wound Packing and Hemostatic Dressings
Tourniquets
Junctional Tourniquets
Splints
Pelvic Binder
Bleeding From the Nose, Ears, and Mouth
Emergency Medical Care for Internal Bleeding
27 Soft-Tissue Injuries
Introduction
Anatomy and Physiology of the Skin
Anatomy
Physiology
Pathophysiology of Closed and Open Injuries
Closed Injuries
Open Injuries
Patient Assessment of Closed and Open Injuries
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Emergency Medical Care for Closed Injuries
Emergency Medical Care for Open Injuries
Abdominal Wounds
Impaled Objects
Neck Injuries
Bites
Burns
Pathophysiology of Burns
Complications of Burns
Burn Severity
Patient Assessment of Burns
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Emergency Medical Care for Burns
Management of Specific Burns
Dressing and Bandaging
Sterile Dressings
Bandages
28 Face and Neck Injuries
Introduction
Anatomy and Physiology
The Eye
Injuries of the Face and Neck
Soft-Tissue Injuries
Dental Injuries
Patient Assessment
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Emergency Medical Care
Emergency Medical Care for Specific Injuries
Injuries of the Eyes
Injuries of the Nose
Injuries of the Ear
Facial Fractures
Dental Injuries
Injuries of the Cheek
Injuries of the Neck
Laryngeal Injuries
29 Head and Spine Injuries
Introduction
Anatomy and Physiology
Nervous System
How the Nervous System Works
Skeletal System
Head Injuries
Scalp Lacerations
Skull Fracture
Traumatic Brain Injuries
Intracranial Pressure
Concussion
Contusion
Other Brain Injuries
Spine Injuries
Patient Assessment
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Emergency Medical Care of Head Injuries
Managing the Airway
Circulation
Emergency Medical Care of Spinal Injuries
Managing the Airway
Spinal Motion Restriction of the Cervical Spine
Preparation for Transport
Supine Patients
Sitting Patients
Standing Patients
Spinal Motion Restriction Devices
Helmet Removal
Preferred Method
Alternative Method
30 Chest Injuries
Introduction
Anatomy and Physiology
Mechanics of Ventilation
Injuries of the Chest
Signs and Symptoms of Chest Injury
Patient Assessment
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Complications and Management of Chest Injuries
PPE in Chest Injuries
Pneumothorax
Hemothorax
Cardiac Tamponade
Rib Fractures
Flail Chest
Other Chest Injuries
Pulmonary Contusion
Other Fractures
Traumatic Asphyxia
Blunt Myocardial Injury
Commotio Cordis
Laceration of the Great Vessels
31 Abdominal and Genitourinary Injuries
Introduction
Anatomy and Physiology of the Abdomen
Abdominal Quadrants
Hollow and Solid Organs
Abdominal Injuries
Closed Abdominal Injuries
Open Abdominal Injuries
Hollow Organ Injuries
Solid Organ Injuries
Patient Assessment of Abdominal Injuries
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Emergency Medical Care of Abdominal Injuries
Closed Abdominal Injuries
Open Abdominal Injuries
Anatomy of the Genitourinary System
Injuries of the Genitourinary System
Injuries of the Kidneys
Injuries to the Urinary Bladder
Injuries of the External Male Genitalia
Injuries of the Female Genitalia
Patient Assessment of the Genitourinary System
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Emergency Medical Care of Genitourinary Injuries
Kidneys
Urinary Bladder
External Male Genitalia
Female Genitalia
Rectal Bleeding
Sexual Assault and Rape
32 Orthopaedic Injuries
Introduction
Anatomy and Physiology of the Musculoskeletal System
Muscles
The Skeleton
Musculoskeletal Injuries
Mechanism of Injury
Fractures
Dislocations
Sprains
Strain
Amputations
Complications
Assessing the Severity of Injury
Patient Assessment
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Emergency Medical Care
Splinting
Transportation
Specific Musculoskeletal Injuries
Injuries of the Clavicle and Scapula
Dislocation of the Shoulder
Fracture of the Humerus
Elbow Injuries
Fractures of the Forearm
Injuries of the Wrist and Hand
Fractures of the Pelvis
Dislocation of the Hip
Fractures of the Proximal Femur
Femoral Shaft Fractures
Injuries of Knee Ligaments
Dislocation of the Knee
Fractures About the Knee
Dislocation of the Patella
Injuries of the Tibia and Fibula
Ankle Injuries
Foot Injuries
Sprains and Strains
Amputations
Compartment Syndrome
33 Environmental Emergencies
Introduction
Factors Affecting Exposure
Cold Exposure
Hypothermia
Local Cold Injuries
Assessment of Cold Injuries
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
General Management of Cold Emergencies
Emergency Care of Local Cold Injuries
Cold Exposure and You
Heat Exposure
Heat Cramps
Heat Exhaustion
Heatstroke
Assessment of Heat Emergencies
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Management of Heat Emergencies
Heat Cramps
Heat Exhaustion
Heatstroke
Drowning
Spinal Injuries in Submersion Incidents
Recovery Techniques
Resuscitation Efforts
Diving Emergencies
Descent Emergencies
Emergencies at the Bottom
Ascent Emergencies
Assessment of Drowning and Diving Emergencies
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Emergency Care for Drowning or Diving Emergencies
Other Water Hazards
Prevention
High Altitude
Lightning
Emergency Medical Care
Bites and Envenomation
Spider Bites
Hymenoptera Stings
Snake Bites
Scorpion Stings
Tick Bites
Injuries From Marine Animals
34 Obstetrics and Neonatal Care
Introduction
Anatomy and Physiology of the Female Reproductive System
Normal Changes in Pregnancy
Complications of Pregnancy
Diabetes
Hypertension in Pregnancy
Bleeding
Abortion
Abuse
Substance Abuse
Special Considerations for Trauma and Pregnancy
Maternal Cardiac Arrest
Assessment and Management
Cultural Value Considerations
Teenage Pregnancy
Patient Assessment
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Stages of Labor
Normal Delivery Management
Preparing for Delivery
The Delivery
Postdelivery Care
Neonatal Assessment and Resuscitation
Additional Resuscitation Efforts
The Apgar Score
Complicated Delivery Emergencies
Breech Delivery
Presentation Complications
Spina Bifida
Multiple Gestation
Premature Birth
Postterm Pregnancy
Fetal Death
Postpartum Complications
35 Pediatric Emergencies
Introduction
Communication With the Patient and the Family
Growth and Development
The Infant
The Toddler
The Preschool-Age Child
School-Age Years
Adolescents
Anatomy and Physiology
The Respiratory System
The Circulatory System
The Nervous System
The Gastrointestinal System
The Musculoskeletal System
The Integumentary System
Patient Assessment
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Respiratory Emergencies and Management
Airway Obstruction
Asthma
Pneumonia
Croup
Epiglottitis
Bronchiolitis
Pertussis
Airway Adjuncts
Oxygen Delivery Devices
Cardiopulmonary Arrest
Circulation Emergencies and Management
Shock
Bleeding Disorders
Neurologic Emergencies and Management
Altered Mental Status
Seizures
Meningitis
Gastrointestinal Emergencies and Management
Poisoning Emergencies and Management
Dehydration Emergencies and Management
Fever Emergencies and Management
Febrile Seizures
Drowning Emergencies and Management
Pediatric Trauma Emergencies and Management
Physical Differences
Psychological Differences
Injury Patterns
Injuries to Specific Body Systems
Burns
Injuries of the Extremities
Pain Management
Disaster Management
Child Abuse and Neglect
Signs of Abuse
Symptoms and Other Indicators of Abuse
Sexual Abuse
Sudden Unexpected Infant Death and Sudden Infant Death Syndrome
Patient Assessment and Management
Scene Assessment
Communication and Support of the Family After the Death of a Child
Apparent Life-Threatening Event
Brief Resolved Unexplained Event
36 Geriatric Emergencies
Introduction
Generational Considerations
Communication and Older Adults
Communication Techniques
Common Complaints and the Leading Causes of Death in Older People
Changes in the Body
Changes in the Respiratory System
Anatomy and Physiology
Pathophysiology
Changes in the Cardiovascular System
Anatomy and Physiology
Pathophysiology
Changes in the Nervous System
Anatomy and Physiology
Pathophysiology
Changes in the Gastrointestinal System
Anatomy and Physiology
Pathophysiology
Changes in the Renal System
Anatomy and Physiology
Pathophysiology
Changes in the Endocrine System
Anatomy and Physiology
Pathophysiology
Changes in the Immune System
Changes in the Musculoskeletal System
Anatomy and Physiology
Pathophysiology
Changes in Skin
Toxicology
Behavioral Emergencies
Depression
Suicide
The GEMS Diamond
Special Considerations in Assessing a Geriatric Medical Patient
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Trauma and Geriatric Patients
Anatomic Changes and Fractures
Environmental Injury
Special Considerations in Assessing Geriatric Trauma Patients
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment
Reassessment
Assessment of Falls
Response to Nursing and Skilled Care Facilities
Dying Patients
Advance Directives
Elder Abuse and Neglect
Assessment of Elder Abuse
Signs of Physical Abuse
37 Patients With Special Challenges
Introduction
Developmental Disability
Autism Spectrum Disorder
Down Syndrome
Patient Interaction
Sensory Disabilities
Visual Impairment
Hearing Impairment
Physical Disabilities
Cerebral Palsy
Spina Bifida
Paralysis
Bariatric Patients
Interaction With Patients With Obesity
Interaction With Patients With Morbid Obesity
Patients With Medical Technology Assistance
Tracheostomy Tubes
Home Oxygen
Mechanical Ventilators
Apnea Monitors
Internal Cardiac Pacemakers
Ventricular Assist Devices
External Defibrillator Vest
Central Venous Catheter
Gastrostomy Tubes
Shunts
Vagus Nerve Stimulators
Colostomies, Ileostomies, and Urostomies
Patient Assessment Guidelines
Home Care
Hospice Care and Terminally Ill Patients
Poverty and Homelessness
38 Transport Operations
Introduction
Emergency Vehicle Design
Phases of an Ambulance Call
The Preparation Phase
The Dispatch Phase
En Route to the Scene
Arrival at the Scene
The Transfer Phase
The Transport Phase
The Delivery Phase
En Route to the Station
The Postrun Phase
Defensive Ambulance Driving Techniques
Driver Characteristics
Safe Driving Practices
Air Medical Operations
Helicopter Medical Evacuation Operations
Establishing a Landing Zone
Landing Zone Safety and Patient Transfer
Special Considerations
Medevac Issues
39 Vehicle Extrication and Special Rescue
Introduction
Safety
Vehicle Safety Systems
Fundamentals of Extrication
Preparation
En Route to the Scene
Arrival and Scene Size-up
Hazard Control
Support Operations
Gaining Access
Emergency Care
Removal of the Patient
Transfer of the Patient
Termination
Specialized Rescue Situations
Technical Rescue Situations
Search and Rescue
Trench Rescue
Tactical Emergency Medical Support
Structure Fires
40 Incident Management
Introduction
National Incident Management System
Incident Command System
ICS Roles and Responsibilities
Communications and Information Management
Mobilization and Deployment
EMS Response Within the ICS
Preparedness
Scene Size-up
Establishing Command
Communications
The Medical Branch of Incident Command
Triage Supervisor
Treatment Supervisor
Transportation Supervisor
Staging Supervisor
Physicians on Scene
Rehabilitation Supervisor
Extrication and Special Rescue
Morgue Supervisor
Mass-Casualty Incidents
Triage
Triage Categories
Triage Tags
START Triage
JumpSTART Triage for Pediatric Patients
Triage Special Considerations
Destination Decisions
Disaster Management
Introduction to Hazardous Materials
Recognizing a Hazardous Material
Occupancy and Location
Senses
Containers
The Department of Transportation Marking System
Other Considerations
Identification
Hazmat Scene Operations
Classification of Hazardous Materials
Personal Protective Equipment Level
Caring for Patients at a Hazmat Incident
41 Terrorism Response and Disaster Management
Introduction
What Is Terrorism?
Active Shooter Events
Weapons of Mass Destruction
Chemical Terrorism/Warfare
Biologic Terrorism/Warfare
Nuclear/Radiologic Terrorism
EMT Response to Terrorism
Recognizing a Terrorist Event (Indicators)
Response Actions
Chemical Agents
Vesicants (Blister Agents)
Pulmonary Agents (Choking Agents)
Nerve Agents
Metabolic Agents (Cyanides)
Biologic Agents
Viruses
Bacteria
Neurotoxins
Other EMT Roles During a Biologic Event
Radiologic/Nuclear Devices
What Is Radiation?
Sources of Radiologic Material
Radiologic Dispersal Devices
Nuclear Energy
Nuclear Weapons
Symptomatology
Medical Management
Protective Measure
Incendiary and Explosive Devices
Mechanisms of Injury
Glossary
Index