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

2. Key Terms AED – Automated external defibrillator BLS – Basic Life Support – Cervical collars – – immobilize neck, back, and spinal injuries. ALS – Advanced life support Chapter 13 2

3. Copyright © The McGraw-Hill Companies, Inc. Key Terms cont. EMS – Emergency medical services EMT – Emergency Medical Technician PPE – Personal Protective Equipment Chapter 13 3

4. Copyright © The McGraw-Hill Companies, Inc. Key Terms cont. CPR – Cardiopulmonary Resuscitation Myocardial infarction (MI) – heart attack Cardiac Arrest – Heart stops Respiratory Arrest – Breathing stops ASAP – Immediately!!!!!!!!! Chapter 13 4

5. Copyright © The McGraw-Hill Companies, Inc. EMS Careers Persons who are trained to help others in a medical emergency. Links in the chain of emergency management – 911 – Dispatcher – EMS personnel Chapter 13 5

6. Copyright © The McGraw-Hill Companies, Inc. EMS Careers – When the patient is stabilized, he or she is transported by the EMS crew to the hospital via an ambulance. On the scene and during the ambulance ride, the EMS crew communicates the patient’s status to the emergency room staff. At the hospital, the crew hands off the patient to – The physicians and nurses in the emergency room — the final link in the EMS chain Chapter 13 6

7. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 7 Links in the EMS Chain 911 Dispatcher EMS Practitioner Dr. & Nurses In the ER

8. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 8 EMS practitioners work for city or county fire departments, private ambulance services, hospitals or other agencies. They may be volunteer or paid, and some may be cross- trained as firefighters

9. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 9 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. Need high school diploma

10. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 10 First Responder (cont.) First Responder Responsibilities (cont.) – Assess the client. – Provide emergency medical care. – Lift or remove a client only when required. – Transfer the client and information to trained personnel.

11. Copyright © The McGraw-Hill Companies, Inc. First Responders Certified first responders take between 40 and 60 hours of classes. They learn scene safety and basic patient assessment. Chapter 13 11

12. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 12 Emergency Medical Technicians - B EMT-Basics (EMT-Bs) – respond to all sorts of medical emergencies. – They know how to perform CPR and artificial ventilation, administer oxygen, defibrillate a patient using an AED, immobilize spinal injuries and monitor vital signs. Their training includes handling cardiac arrests, seizures, diabetic emergencies, respiratory problems and traumatic injuries

13. Copyright © The McGraw-Hill Companies, Inc. EMT-B Need High School Diploma EMT-B students take about 120 hours of classes They learn emergency care skills, including managing bleeding, fractures, airway obstruction, cardiac arrest and emergency childbirth, as well as patient assessment skills. Chapter 13 13

14. Copyright © The McGraw-Hill Companies, Inc. EMT - basic Formal courses are often combined with time in an emergency room or ambulance. students learn how to use and maintain common emergency equipment, such as backboards, suction devices, splints, oxygen delivery systems and stretchers. The course concludes with written and practical exams Chapter 13 14

15. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 15 Emergency Medical Technicians - I 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.

16. Copyright © The McGraw-Hill Companies, Inc. EMT-1 EMT-I students take about 40 hours of classes beyond the EMT-B course, in which they learn additional patient assessment skills, as well as how to use advanced airway devices and how to start Ivs The course concludes with written and practical exams Chapter 13 16

17. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 17 Emergency Medical Technicians paramedic Has the most education Act as the eyes, ears, and hands of the dr. Responsibilities – Administer O2 – Start IV fluid – Defibrillate – Administer medications

18. Copyright © The McGraw-Hill Companies, Inc. Paramedic Paramedic students take about 1,000 hours of classes, during which they learn emergency care skills, including advanced airway management and medication administration, as well as anatomy and physiology. Formal courses are often combined with time in an emergency room or ambulance The course concludes with written and practical exams Chapter 13 18

19. Copyright © The McGraw-Hill Companies, Inc. Air ambulance Flight crew members Include – Helicopter pilot – Physicians – Registered Nurses – EMT – paramedics – Respiratory Therapist Chapter 13 19

20. Copyright © The McGraw-Hill Companies, Inc. Air ambulance Responsibilities – Rescuing people from an accident scene – Transporting critically ill patients from one site to another – Transport organs – Transport donor & recipient to medical center where harvest and transplant will take place Chapter 13 20

21. Copyright © The McGraw-Hill Companies, Inc. Where the Jobs Are: Private ambulance services: 40 percent Local governments: 30 percent Hospitals: 20 percent Other: 10 percent Chapter 13 21

22. Copyright © The McGraw-Hill Companies, Inc. Annual Incomes EMT basic – $1700 - $2,800 per month EMT paramedic – 2,800 - $4,800 per month – $37,456.00 national average per year Chapter 13 22

23. Copyright © The McGraw-Hill Companies, Inc. Future Job Market According to the U.S. Department of Labor, employment for EMS practitioners is expected to grow faster than the average for all occupations through 2016. This segment is expected to have 19 percent growth, which is due in part to paid personnel replacing volunteers in some parts of the country, as well as the aging Baby Boomer population’s increased need for emergency medical care. Chapter 13 23

24. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 24 Client Assessment Process 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.

25. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 25 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.

26. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 26 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.

27. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 27 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.

28. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 28 Client Assessment Process (cont.) Communication – ALWAYS ask for permission to help – Converse with client and family. – Communicate with dispatcher and medical facility. – Hand-off report at medical facility.

29. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 29 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.

30. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 30 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.

31. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 31 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.

32. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 32 Additional Career Skills (cont.) Oxygen Therapy Equipment – Oxygen cylinders. – Oxygen regulator. – Oxygen flow meter. – Oxygen delivery devices. Nasal cannula Nonrebreather mask

33. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 33 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.

34. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 34 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.

35. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 35 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.

36. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 36 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.

37. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 37 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.

38. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 38 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.

39. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 39 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.

40. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 40 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.

41. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 41 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.

42. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 42 Emergency Childbirth (cont.) Labor – Uterus contractions in the ninth month signaling childbirth. – Has 4 stages.

43. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 43 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.

44. Copyright © The McGraw-Hill Companies, Inc. Labor: Stage 1: Phases Phase 1 – Dilation of cervix from 0-3 – Mom nervous, happy, excited Phase 2 – Dilation of cervix from 4-7 – Mom uncomfortable, can relax between contractions Phase 3 – Dilation of cervix from 8-10 – Mom may become irritable, irrational, very tired Chapter 13 44

45. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 45 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.

46. Copyright © The McGraw-Hill Companies, Inc. Chapter 13 46 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.

47. Copyright © The McGraw-Hill Companies, Inc. Emergency Childbirth (cont) Labor and Delivery – Fourth Stage – First hour after birth Mom: vitals checked, fundus checked, episiotomy sutured Infant: physical, antibiotics in eyes, vit-K injection, mom may nurse infant Chapter 13 47

48. Copyright © The McGraw-Hill Companies, Inc. Websites for birth videos http://videos.howstuffworks.com/health/childbirt h-videos-playlist.htm#video-6892 Chapter 13 48