Essentials of Fire Fighting 6th Edition Firefighter I Chapter 22 — Emergency Medical Care for Fire Department First Responders

Learning Objective 1 Describe the roles the fire service may take in providing emergency medical care.

DISCUSSION QUESTION Why are firefighters often cross-trained as emergency medical technicians (EMTs) or Paramedics?

The fire service is a key participant in providing emergency medical service. EMS Treatment on scene Transport to definitive healthcare facility If no ambulance unit Respond as first responder Treat until ambulance arrives

Ambulance services are provided in several ways. Fire-based EMS Third service EMS Hospital-based EMS

Reasons firefighters are requested to respond Fire departments provide on scene medical care at various service levels. Reasons firefighters are requested to respond Can respond faster than EMS Areas have multiple stations, few ambulances May have more medical calls than ambulances Service provided by Personnel with limited EMS training Paramedics with same resources as on ambulance

REVIEW QUESTION What are the roles the fire service may take in providing emergency medical care?

Learning Objective 2 Summarize patient confidentiality requirements.

DISCUSSION QUESTION What information is included in the protected medical information (PMI) of a patient?

Patient confidentiality centers around protected medical information (PMI). Personal data Medical history Condition

Medical information privacy is covered by applicable laws. Health Insurance Portability and Accountability Act (HIPPA) Greater regulations on use, distribution, storage Requires designated privacy officer, compliance training

Release to others only with patient consent Good professional practice is to be as discreet as possible with all PMI. Disclose only if legitimate need Law enforcement EMS Hospital staff Release to others only with patient consent

REVIEW QUESTION What does the Health Information Portability and Accountability Act (HIPPA) of 1996 require regarding patient confidentiality?

Learning Objective 3 Distinguish among commonly encountered communicable diseases.

Learning Objective 4 Summarize immunization considerations for first responders.

Infection control measures can be used to reduce the risk of infection. Ability to identify signs and symptoms Use proper body substance isolation (BSI)

There are several commonly encountered communicable diseases. Hepatitis Tuberculosis HIV/AIDS (Cont.)

CAUTION Medical equipment and surfaces should be decontaminated immediately following soiling to prevent the possible spread of infectious diseases to responders and other patients.

There are several commonly encountered communicable diseases. Multi drug-resistant organisms Others Outbreaks H1N1 flu Avian flu

Immunizations may be required by your jurisdiction. Various types may be required or recommended Test for tuberculosis may be administered

REVIEW QUESTION What are the communicable diseases commonly encountered by firefighters? What types of immunizations may first responders be required to have?

Learning Objective 5 Explain the importance of body substance isolation (BSI).

Pathogens to protect against are both bloodborne and airborne. Numerous routes of exposure Open wounds, cuts, sores Contact with eyes, nose, mouth Any break in skin

Proper body substance isolation (BSI) is the best way to protect yourself. Hand washing Proper use of personal protective equipment (PPE) Proper disposal/ cleaning of soiled items

Hand washing is one part of maintaining proper BSI. Reduces transmission Should be frequent Wash in methodical manner Use alcohol based solution as alternative

BSI also requires the proper use of different types of PPE. Gloves Eye protection Masks Gowns Spare uniforms

Cleaning and disposal of contaminated items is another part of proper BSI. Clean with disinfectant Follow NFPA® 1581 and local SOPs

REVIEW QUESTION What are some basic ways first responders can practice body substance isolation (BSI)?

Learning Objective 6 Explain actions taken for basic patient assessment.

Patient assessment must be completed before treatment can begin. Airway B Breathing C Circulation/Compressions

The airway is an assessment of the passage where air travels when breathing.

Look, listen, and feel to determine breathing assessment.

Circulation/compressions are easily determined by feeling for a pulse.

REVIEW QUESTION What actions are taken to assess a patient’s condition?

Learning Objective 7 Compare and contrast CPR techniques for adults, children, and infants.

Learning Objective 8 Explain when to administer and when to discontinue CPR.

Clinical death, known as cardiac arrest, may require defibrillation. Heart not beating, no longer breathing Can lead to biological death Caused by heart failure Defibrillation may be required to resume heart

Cardiopulmonary resuscitation (CPR) may be required for several reasons. Heart’s condition may not warrant defibrillation Defibrillation may not be successful Outside intervention is needed to slow cellular death

Chest compressions, the main component of CPR, are performed differently depending on patient age. Compress heart to circulate blood Don appropriate PPE, determine patient condition Do not administer if obvious signs of death (Cont.)

Chest compressions, the main component of CPR, are performed differently depending on patient age. (Cont.) For adults

Chest compressions, the main component of CPR, are performed differently depending on patient age. (Cont.) For children

Chest compressions, the main component of CPR, are performed differently depending on patient age. For infants

REVIEW QUESTION How do CPR techniques for adults, children, and infants differ from one another?

Once begun, CPR should only be discontinued in specific circumstances. Patient regains consciousness or begins to move Patient has pulse You are unable to continue due to exhaustion You hand over care to higher trained rescuer You are instructed to stop by medical control physician

You should understand the emotional nature of cardiac events. You may be subject to anger when deciding to begin, end CPR Speak calmly, keep in mind feelings when discussing with other responders

REVIEW QUESTION When should a first responder administer and discontinue CPR?

Learning Objective 9 Describe basic types of external bleeding.

Learning Objective 10 Explain the use of direct pressure and elevation to control external bleeding.

Bleeding control is an extremely important aspect of medical treatment. Typical causes of external bleeding

Arterial Venous Capillary You should recognize the signs of the three types of external bleeding. Arterial Venous Capillary

REVIEW QUESTION What are the basic types of external bleeding?

Methods used to control external bleeding depend on the type. May use one or more methods Follow department medical protocols Use proper PPE

The direct pressure method is the first and most commonly used method.

The elevation method is used to raise an extremity above a patient’s heart.

REVIEW QUESTION How can direct pressure and elevation control external bleeding?

Learning Objective 11 Describe the signs and symptoms of internal bleeding.

Internal bleeding, not seen externally, still shows several signs or symptoms. Significant bruising Bleeding from openings in body Bloody stool, urine Painful, swollen, rigid abdomen Vomiting substance that looks like coffee grounds Cool, pale, clammy skin

Internal bleeding has several causes and is a true medical emergency. Traumatic Medical Actions Treat for shock Immediately transport by ambulance to hospital

Learning Objective 12 Describe the role that recognizing the types, signs, and symptoms of shock plays in shock management.

Shock occurs when the body is unable to keep vital organs functioning. Hypovolemic Cardiogenic Neurogenic Others Anaphylactic Septic

You should know the signs and symptoms of the two stages of shock. Compensated Only slight changes No visible changes Decompensated Pale, cool, and/or clammy skin Confusion Nausea and/or vomiting Changes to vital signs Others such as dizziness, dilated pupils, and loss of consciousness

Patients exhibiting signs of shock should be treated and prepared for transport immediately. Do not delay transport Control any bleeding noticed Cover patient with blanket

REVIEW QUESTION Why is it important that a first responder recognize the types, signs, and symptoms of shock?

Summary Providing Emergency Medical Services is a critical function of the fire service, especially as aging populations create an increased demand. Properly trained firefighters are needed because they can often make the difference between life and death, not only for victims but for other firefighters as well.