2. Emergency Medical Responder  EMR’s-the first person to arrive at the scene of an incident.  Gain access to patients, assess their condition and provide care.  Can be firefighters, law enforcement or private citizens that have passed an approved EMR course.  Educational Requirement-Minimum of 48 hours in an approved training program.  Certification through State Dept. of Health or National Registry.

3. Responsibilities of the EMR  Evaluate the scene for safety. Determine total number of patients Identify cause of injury of nature of the illness Request additional help  Duties gain access to the patient, using simple tools when needed. determine what is wrong and provide care. move patient only when necessary transfer patient and information to more highly trained individual when they arrive at the scene.

4. Emergency Medical Technician  Works with fire and police personnel in all types of environments and can be called upon at any time.  Requires 150 hours in an approved training program, including at least 10 hours of internship with 10 patient assessments.  Certifications through State Dept. of Health or National Registry of EMT’s.  Responsibilities: assess the situation to check for safety, takes appropriate infection control precautions, interviews and examines the patients, seeks additional medical advice from MD’s if needed, provides out-of –hospital care if needed per protocol, transports patient to a medical facility.  Skills: Basic life support, use of oral and nasal airways, cervical collars, AED’s, med. Administration, immobilization of injuries.

5. Advanced Emergency Med. Tech.  EMT requirements with additional approved training with a minimum o f 150-250 hours of total instruction including classroom, practical, clinical and field internship.  Certification through State Dept. of Health or National EMT registry.  AEMT has same qualifications as EMT with additional skills to evaluate and manage trauma accidents, cardiac, respiratory and other medical emergencies. Can administer meds. past the EMT level, start and IV, give meds using an mechanical IV pump and set up and maintain a Manual/Automated Transport Ventilator.

6. Paramedic  Additional approved paramedic training equal to 1000 hours or more including classroom, practical, clinical and field internship.  Completion of program may lead to a two year associate degree or higher.  State Certification. Some states require the National Registry EMTs certification exam, paramedic.  In addition to AEMT, paramedics may administer meds by the oral, IV, SQ, IM and Intraosseous routes, perform advanced airway techniques and use monitors and other complex medical equipment.  Skills: Understanding of local EMS policies and procedures, communication, leadership, ability to size up the scene, determine safety, etc, expertise to examine patient, ability to prioritize.

7. Patient Assessment  Seven steps of patient assessment: 1. Scene Size –up-ensure safety, take standard precautions, determine mechanism and nature of illness, number of patients. 2. Primary Assessment-Form general impression, determine level of responsiveness, assess airway and any life threatening problems, assess breathing, assess circulation, perform rapid body scan, make decision regarding urgency of condition. 3. History taking – Present history and SAMPLE history. Find out chief complaint. Use the acronym SAMPLE to help with process. S-S/SX, A- allergies, M-medications, P-pertinent past medical hx, L-last oral intake, E-event preceding. 4. Secondary Assessment-V/S (TPR and B/P), skin color, pupil size and reaction, etc. 5. Reassessment-while providing care, always reevaluate the primary complaint of the patient. 6. Communication- with client and family as well as dispatchers, medical, staff, etc. 7. Documentation- Always document findings and what was done. If it isn’t documented, it isn’t done!!!!

8. Airway Management  Airway-the passage by which air enters an exits the body.  Airway structures: nose, mouth, pharynx, larynx, trachea, bronchi, and lungs. Greatest threat to our airway is our tongue. Head tilt/chin lift or jaw thrust (in a person w/suspected neck injury) are ways to open the airway.  Airway Adjuncts: 1. Oropharyngeal Airway-inserted into the mouth. Most effective on patients with no gag reflex. 2. Nasopharyngeal Airway-inserted into the nose. Adjunct of choice in patients with seizures, strokes or a conscious patient. **Never use an NPA in a patient where you suspect head injury where there is clear fluid draining from the nose.

9. Immobilization Skills  Most Common Causes of Spinal Injury 1. Automobile of motorcycle collisions 2. Shallow water of diving accidents 3. Falls 4. In Children: falls from heights two to three times the child’s height- bicycle, tricycle, struck by a motor vehicle.  Common S/Sx or Spinal Injury 1. to arm or leg 2. Weakness, tingling or numbness, loss of feeling in the arms or legs 3. Pain or tenderness along the back of the neck or spine 4. Pain with our without movement 5. Loss of bowel or bladder control 6. Difficult or labored breathing with little or no movement of the chest.  Manual stabilization to the head and neck when an injury is suspected is the first thing to do.  https://www.youtube.com/watch?v=EAW71i6x6K4

10. Shock Treatment  S/SX of Shock 1. Rapid, shallow breathing 2. Cold, clammy skin 3. Rapid, weak pulse 4. Fainting and/or dizziness 5. Weakness 6. Pallor  Treatment of Shock 1. Call 911 2. Lay person down if possible 3. Begin CPR if necessary 4. Treat obvious injuries 5. Keep person warm and comfortable 6. Follow up

11. Triage  Triage refers to the evaluation and categorization of the sick or wounded when there are insufficient resources for medical care of everyone at once. Historically, triage is believed to have arisen from systems developed for categorization and transport of wounded soldiers on the battlefield. Triage is used in a number of situations in modern medicine, including:  In mass casualty situations, triage is used to decide who is most urgently in need of transportation to a hospital for care (generally, those who have a chance of survival but who would die without immediate treatment) and whose injuries are less severe and must wait for medical care.  Triage is also commonly used in crowded emergency rooms and walk-in clinics to determine which patients should be seen and treated immediately.  Triage may be used to prioritize the use of space or equipment, such as operating rooms, in a crowded medical facility.  In a walk-in clinic or emergency department, an interview with a triage nurse is a common first step to receiving care. He or she generally takes a brief medical history of the complaint and measures vital signs (heart rate, respiratory rate, temperature, and blood pressure) in order to identify seriously ill persons who must receive immediate care.blood pressure