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Chapter 13 Emergency Medical Services

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

2 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. Chapter 13

3 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. Chapter 13

4 Careers in Emergency Medical Services (EMS)
First Responder Emergency Medical Technicians Chapter 13

5 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. Chapter 13

6 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. Chapter 13

7 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. Chapter 13

8 Emergency Medical Technicians
Work all hours in all weather at the scene of an accident. Chapter 13

9 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. Chapter 13

10 Emergency Medical Technicians (cont.)
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. Chapter 13

11 Emergency Medical Technicians (cont.)
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. “Examining and interview” probably should be “examining and interviewing” on page 5 second bullet under “basic” Chapter 13

12 Emergency Medical Technicians (cont.)
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. “Examining and interview” probably should be “examining and interviewing” on page 5 second bullet under “basic” Chapter 13

13 Emergency Medical Technicians (cont.)
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. Chapter 13

14 Emergency Medical Technicians (cont.)
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. Since EMT-I administers meds beyond EMT-B level, should it be mentioned that EMT-B administers meds in its resp? Chapter 13

15 Emergency Medical Technicians (cont.)
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. Chapter 13

16 Section 13-1 Apply Your Knowledge #1
Which two levels of EMTs are allowed to defibrillate the client? Answer: EMT – intermediate. EMT – paramedic. Chapter 13

17 Section 13-1 Apply Your Knowledge #2
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. Chapter 13

18 Emergency Medical Services Procedures
Client Assessment Process Airway Management Additional Career Skills Emergency Childbirth Chapter 13

19 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. Chapter 13

20 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. On page 6 there is an inconsistency between the preview in Client Assessment Process. #1 is called “Scene size-up” and then called “Scene Evaluation” in the 1st sub-section Chapter 13

21 Client Assessment Process (cont.)
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. Chapter 13

22 Client Assessment Process (cont.)
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. Chapter 13

23 Client Assessment Process (cont.)
Detailed assessment requires: A more detailed exam en route to the medical facility. Inconsistency- On page 6 list says “detailed physical exam, but on page 10 sub-topic says ”detailed assessment” Chapter 13

24 Client Assessment Process (cont.)
Ongoing assessment requires: Continuous reevaluation of initial assessments. Chapter 13

25 Client Assessment Process (cont.)
Communication Converse with client and family. Communicate with dispatcher and medical facility. Hand-off report at medical facility. Chapter 13

26 Client Assessment Process (cont.)
Documentation Written reports of pertinent information. Chapter 13

27 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. Chapter 13

28 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. Chapter 13

29 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. Chapter 13

30 Additional Career Skills (cont.)
Oxygen Therapy Equipment Oxygen cylinders. Oxygen regulator. Oxygen flow meter. Oxygen delivery devices. Nasal cannula Nonrebreather mask Chapter 13

31 Additional Career Skills (cont.)
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. Chapter 13

32 Additional Career Skills (cont.)
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. Chapter 13

33 Additional Career Skills (cont.)
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. Chapter 13

34 Additional Career Skills (cont.)
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. Chapter 13

35 Additional Career Skills (cont.)
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. Chapter 13

36 Additional Career Skills (cont.)
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. Chapter 13

37 Additional Career Skills (cont.)
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. Chapter 13

38 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. Chapter 13

39 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. Chapter 13

40 Emergency Childbirth (cont.)
Labor Uterus contractions in the ninth month signaling childbirth. Has 3 stages. Chapter 13

41 Emergency Childbirth (cont.)
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. Chapter 13

42 Emergency Childbirth (cont.)
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. Chapter 13

43 Emergency Childbirth (cont.)
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. Chapter 13

44 Section 13-2 Apply Your Knowledge #1
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. Chapter 13

45 Section 13-2 Apply Your Knowledge #2
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. Chapter 13

46 Procedures in Student Text
13A1 Inserting an Oropharyngeal Airway Adjunct 13A2 Inserting a Nasopharyngeal Airway Adjunct 13B Operating of the Semiautomatic Defibrillator Chapter 13

47 Additional Procedures in Lab Activity Manual
LM13-1A Preparing an Oxygen Cylinder LM13-1B Providing Oxygen LM13-2A Manual Stabilization of the Head and Neck LM13-2B Applying Cervical Collars LM13-3 Emergency Childbirth During a Normal Delivery Chapter 13

48 Chapter 13 Credits Slide 5 Kenneth Murry/Photo Researchers
Slide 10 J.S. Reid/Custom Medical Stock Photo Slide 14 Tim Courlas Slide 21 Aaron Haupt Slide 28 Spencer Grant/PhotoEdit Slide 32 Wolfgang Spunbarg/PhotoEdit Chapter 13


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