Presentation on theme: "Chapter 22 Emergency Medical Services. Introduction There is more to being a fireman than putting out fires Community relies on firemen to be creative."— Presentation transcript:
Chapter 22 Emergency Medical Services
Introduction There is more to being a fireman than putting out fires Community relies on firemen to be creative problem solvers Emergency medical responses constitute more than 50% of total emergency responses With technology today, firefighters can deliver lifesaving techniques to stabilize patients 22.2
Roles and Responsibilities of an Emergency Care provider Firefighters often act as providers of emergency care and first aid Many call on firefighters to assist emergency medical technicians and paramedics Working knowledge of basic emergency medical care is very important 22.3
22.4 Figure 22-2 Firefighters are often called on to assist EMS crews with patient care.
22.5 Figure 22-3 (A) EMS calls begin when firefighters leave the station, (B) continue throughout the time on the scene, and (C) do not end until firefighters have cleaned the equipment and restocked the supplies. (A) (B) (C)
Key Responsibilities Firefighter responsibilities: –Ensure their own safety, safety of their team, and patient’s safety –Act safely from the minute they step on the fire engine –Act in a professional manner –Never make a situation worse –Practice and update emergency care skills –Know and practice use of EMS equipment –Gather and document important patient information 22.6
22.7 Figure 22-4 Firefighters should always treat patients with respect. They should treat patients as they would want to be treated in the same situation.
Legal Considerations for Emergency Care Providers Emergency care providers should understand several important legal issues: –Standard of care –Consent –Implied consent –Abandonment 22.8
Interacting with Emergency Medical Services Personnel Interact with emergency personnel while on scene of an emergency Interact with emergency medical personnel who have arrived by helicopter Important to understand different levels of care provided by EMS crews EMS personnel rely on firefighters on scene to give critical patient information 22.9
Safety Considerations Safety of caregiver or individual firefighter performing patient care Safety of emergency response team Safety and infection control should remain a primary consideration Responders who get sick become part of the problem 22.10
Analyzing the Safety of the Emergency Scene Observe each and every scene for unsafe situations Check for scene safety prior to entering Carefully observe emergency scene and people present before entering Ask for additional assistance when safety concerns are present 22.11
22.12 Figure 22-9 Team working together in patient care.
Firefighter Physical and Mental Health Firefighting is a strenuous occupation Healthy lifestyle generally includes: –Regular exercise –Proper diet –Getting the right amount of sleep Back injury is a common problem Emergency medical calls can take their toll on mental health 22.13
Infection Control Safety includes protection from contracting communicable or infectious diseases: –Prevention of exposure to infectious diseases –Body substance isolation Treat all body fluids as if they were infectious Protective gloves are an important barrier device only if used properly Immunization 22.14
22.15 Figure The most effective means of reducing the risk of spreading disease is hand washing.
22.16 Figure Proper hand washing involves vigorous lathering with soap and water for fifteen seconds (or longer) followed by thorough rinsing.
Patient Assessment A quick visual assessment should reveal: –How many patients are there? –Is the patient awake? –Is the patient in a harmful situation or environment? –What position is the patient in? –What people or objects are in the emergency scene? –What is the skin color of the patient? –Is the patient having trouble breathing? 22.17
Performing an Initial Assessment Initial assessment covers the following: –Level of consciousness –Airway –Breathing –Circulation –Major bleeding Done quickly on conscious patient who is alert and talking Unconscious patients require closer examination 22.18
22.19 Figure Locating pulses in (A) the carotid artery in the neck, (B) the radial artery in the wrist, and (C) the brachial artery in an infant’s upper arm. (A)(B)(C)
Vital Signs and the Focused History and Physical Exam After initial assessment, firefighter continues to a focused history and patient exam: –Patient fact-finding –Vital signs –Head-to-toe survey of patient Fact-finding with patient or family members, friends, or bystanders if patient is unconscious 22.20
22.21 Table 22-3 Average Vital Sign Ranges, by Age
Patient Findings Be sure to document findings of the assessment and patient’s vital signs Everything found must be passed on to emergency medical providers –Initial assessment –Focused history –Physical exam –Patient’s vital signs –All patient fact-finding 22.22
22.23 Figure Examples of pupil size.
Cardiopulmonary Resuscitation/ AED One of the most basic and widely learned emergency response skills Coronary heart disease and cardiovascular diseases are the leading killer in United States Several organization support CPR training, education, and research Automated external defibrillators (AEDs) have become a critical part of emergency care 22.24
22.25 Figure Firefighters learning CPR.
Bleeding Control and Shock Management Cardiovascular system is a closed system with a pump and tubing Damage to heart or blood vessels may result in a lower volume of blood 22.26
Internal and External Bleeding Internal bleeding occurs when there is bleeding within body –Bruising, pale, or cold and clammy skin –Dilated pupils –Obvious bone deformities –Rigid and tender abdomen –Blood in urine or from rectum –Blood from mouth or nose, or in vomitus Arterial bleeding is bleeding from arteries Capillary bleeding is bleeding from capillaries 22.27
Caring for Patients with Internal Bleeding Cannot be brought under control by first-aid actions For minor internal bleeding, apply an ice pack or cold pack to affected site Major internal bleeding requires rapid medical attention 22.28
Firefighters should remember to wear gloves Three methods are used: –Pressure on site of bleeding, or direct pressure –Elevate site of bleeding –Use pressure points Caring for Patients with External Bleeding 22.29
22.30 Figure Using pressure points in the upper arm and the leg to decrease blood flow to a wound.
Types of Wounds Requiring First Aid There are several type of wounds that firefighters should be able to recognize: –Abrasion –Avulsion –Amputation –Laceration or incision –Puncture 22.31
What is Shock? (Hypoperfusion) Condition caused by a problem with or failure of circulatory system Results in a decreased supply of oxygen and vital nutrients Shock can result from a problem with the heart Severe dehydration can cause shock 22.32
Recognizing the Signs and Symptoms of Shock (Hypoperfusion) Some signs and symptoms of shock: –Pale or bluish tint to skin, cool temperature –Sweating or moist skin –Pupils larger than normal –Rapid, shallow breathing –Rapid weak pulse –Complaints of nausea, thirst –Restlessness or anxiety 22.33
Caring for Patients in Shock Firefighters should follow this basic treatment: –Ensure scene safety –Assess patient’s level of consciousness –Ensure airway is open and patient is breathing adequately –Treat injuries present and control major bleeding –Keep patient warm and positioned properly –Raise legs of the patient –Provide reassurance 22.34
Emergency Care for Common Emergencies No two emergency medical calls are the same Must learn basics of first-aid treatment and adopt them to each emergency 22.35
Trouble Breathing Very common emergency Common signs and symptoms: –Wheezing –Gasping for air –Shallow breathing –Pale or bluish skin color –Anxiety –Unconsciousness 22.36
Guidelines for Trouble Breathing Ensure scene safety Don appropriate BSI Complete initial assessment Ensure airway is open and patient is breathing adequately Treat injuries present and control major bleeding 22.37
Guidelines for Trouble Breathing (cont’d.) Reassure the patient and keep him calm Monitor vital signs frequently Recognize this is a serious emergency and activate EMS immediately 22.38
Chest Pain Another common emergency If related to heart problem: –Tightness or squeezing feeling in chest –Pain in jaw, abdomen, or arm Chest pain can result from: –Respiratory disorders –Traumatic injuries –Stomach problems 22.39
Guidelines for Chest Pain Ensure scene safety Don appropriate BSI Complete initial assessment Ensure airway is open and patient is breathing adequately Treat injuries present and control major bleeding 22.40
Guidelines for Chest Pain (cont’d.) Reassure the patient and keep him calm Monitor vital signs frequently Recognize this is a serious emergency and activate EMS immediately Observe the patient for signs and symptoms of shock 22.41
Medical Illnesses Range from stomach problems like nausea and vomiting to general illnesses Care and guidelines: –Assess scene, don BSI, perform initial assessment and attend to major problems –Reassure patient –Recognize that this could be a serious emergency –Look for symptoms of shock 22.42
Guidelines for Medical Illness Ensure scene safety Don appropriate BSI Complete initial assessment Ensure airway is open and patient is breathing adequately 22.43
Treat injuries present and control major bleeding Reassure the patient and keep him calm Monitor vital signs frequently Observe the patient for signs and symptoms of shock Guidelines for Medical Illness (cont’d.) 22.44
Allergic Reactions Result from body’s reaction to a substance Some allergic reactions can be severe Can result from a variety of substances –Food –Environment –Bites and stings –Medications 22.45
Guidelines for Allergic Reactions Ensure scene safety Don appropriate BSI Complete initial assessment Ensure airway is open and patient is breathing adequately 22.46
Guidelines for Allergic Reactions (cont’d.) Reassure the patient and keep the patient calm Remove the cause of the reaction from the patient Monitor vital signs frequently Observe the patient for signs and symptoms of shock 22.47
Thermal Burns Caused by heat Simple as sunburn or life threatening as severe burns across much of the body Divided into three categories: –Superficial burns –Partial thickness burns –Full thickness burn 22.48
22.49 Figure (A) Superficial burns, (B) partial thickness burns, and (C) full thickness burns. (A) (B)(C)
Guidelines for Thermal Burns Ensure scene safety Don appropriate BSI Complete initial assessment Ensure airway is open and patient is breathing adequately Remove the patient from the environment to stop the burning process 22.50
Guidelines for Thermal Burns (cont’d.) Reassure the patient and keep the patient calm Remove the cause of the reaction from the patient Monitor vital signs frequently Observe the patient for signs and symptoms of shock 22.51
Chemical Burns Caused by chemical substances that come in contact with skin or tissues of body Creates caustic reaction Variety of chemical substances can cause a chemical burn 22.52
Guidelines for Chemical Burns Ensure scene safety Don appropriate BSI Complete initial assessment Ensure airway is open and patient is breathing adequately 22.53
Guidelines for Chemical Burns (cont’d.) Remove the chemical by brushing off if it is a powder or flush the substance with large volumes of water. Remove the patient’s jewelry and clothing Monitor vital signs frequently If substance has gotten into the patients eyes, flush thoroughly for at least 20 minutes 22.54
Poisoning Ingestion or inhalation of a caustic substance Result from ingestion of a large quantity of a normally harmless substance: –Over-the-counter medications –Household substances Local poison control centers are very valuable 22.55
Guidelines for Poisoning Ensure scene safety Don appropriate BSI Complete initial assessment Ensure airway is open and patient is breathing adequately 22.56
Guidelines for Poisoning (cont’d.) Reassure the patient, keep the patient calm, and monitor vital signs frequently Do investigative work to find out exactly what substance was inhaled or ingested Do not give the patient any liquid or food to ingest Contact local poison control center 22.57
Fractures and Sprains Fracture is a medical term for a broken bone Sprain is an injury to the ligaments Firefighter may notice swelling and tenderness to area of a fracture or sprain In the case of fracture, there may be deformity to bone and body structure 22.58
Guidelines for Fractures and Sprains Ensure scene safety Don appropriate BSI Complete initial assessment Ensure airway is open and patient is breathing adequately Reassure the patient, keep the patient calm, and monitor vital signs frequently 22.59
Guidelines for Fractures and Sprains (cont’d.) Do not move the patient and protect the cervical spine in cases of suspected trauma Do not move the injured body part and carefully protect the area Apply cold packs as needed to reduce swelling 22.60
22.61 Figure Firefighter stabilizing a leg injury until the EMS unit arrives.
Lessons Learned Emergency medical care is a major part of most firefighters’ responsibilities Fire service has played an increasing role in providing first response medial care Most important tool is the firefighter’s brain Firefighter should use their senses 22.62