Chapter 1 Foundations of EMT-Intermediate

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division



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Preparatory












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1



Foundations of EMT-Intermediate


© Jones & Bartlett Learning, LLC NOT FOR SALE OR Case DISTRIBUTION History Key Terms



Certification

McCormack and Marquette, Emergency Medical Technician–Intermediates (EMT-Is) at Station 41, report to work 15 minutes before the start of the scheduled day shift to disContinuous Quality cover that the unit is returning from a trauma call. Their uniforms are clean, pressed, and Improvement © Jones & Bartlett Learning, LLC Jones & are Bartlett Learning, LLC the bulletin board starched, and their steel-toe© leather shoes polished. They both check for personnel memos and traffic thenOR sit down for a cup of coffee. Emergency NOT FOR SALE Medical OR DISTRIBUTION NOTnotices FOR and SALE DISTRIBUTION Medic 41 arrives approximately 5 minutes later; the EMT-Is begin checking the unit while Dispatcher (EMD) the night shift crew members give their report. The crew members report that the streets Emergency Medical department is working on a water main break at Waterford and Northwood and that four Services (EMS) ampules of naloxone and two prefilled syringes of lidocaine will expire next month. Both System © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC McCormack and Marquette make a note to avoid the roadwork area. While EMT-I MarNOT FOR SALE OR NOT FOR SALE OR DISTRIBUTION quette assesses all of the vehicle supplies and equipment, EMT-I McCormack checks theDISTRIBUTION EMT-Intermediate vehicle fluid levels, radios, tires, and batteries. (EMT-I) A 64-year-old man awakens at 7:30 AM with a crushing chest pain. He realizes that it Ethics must be a heart attack. He and his wife were trained in cardiopulmonary resuscitation (CPR) at the local hospital and learned to recognize the early warning signs and sympHealth Care © Jones & Bartletttoms. Learning, LLC that it is important to act © quickly. JonesHe & wakes Bartlett Learning, He also knows his wife and tells LLC her to Professional NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION activate the emergency medical services (EMS) system by dialing 9-1-1. The emergency Licensure medical dispatcher instructs the wife to tell her husband to sit quietly until EMS arrives. The wife is also told to gather the patient’s medications and, if the patient has no history Medical Direction of aspirin allergy or signs of active or recent gastrointestinal bleeding, to have him chew Performance an aspirin (160 mg to 325 mg) while awaiting the arrival of EMS providers. Improvement © Jones & Bartlett Learning, LLCWithin minutes a pumper©truck, Jones & Bartlettand Learning, LLC an ambulance, a police car arrive at the home. EMT-Is McCormack and Marquette rushSALE in, carrying jump kit, oxygen, and a cardiac Profession NOT FOR SALE OR DISTRIBUTION NOT FOR OR aDISTRIBUTION monitor/defibrillator. Working under established protocols, the EMT-Is place the man on Professional oxygen and obtain a brief history of the event. As an initial assessment is performed, electrocardiogram (ECG) electrodes are applied and an intravenous (IV) line is established. Professionalism EMT-I McCormack contacts on-line medical direction and gives the emergency department Protocols © Jones & Bartlett Learning, LLCtelemetry, the EMT-Is transmit © Jones & Bartlett Learning, LLC physician a brief patient report. Using the ECG to the hosforSALE evaluation. the man’s chest pain is still present his vital signs areDISTRIBUTIO Reciprocity NOTand FOR SALE OR NOT pital FOR OR Because DISTRIBUTION stable, the physician instructs EMT-I McCormack to place a nitroglycerin tablet under the Registration man’s tongue. The man has some relief from the pain and feels confident that he is receiving good patient care. The man is gently placed on a stretcher and rolled to the ambuResearch lance for transport to the emergency department. EMT-I Marquette tells the man’s wife that Run Critiques © Jones & Bartlettlights Learning, LLC © Jones & her Bartlett Learning, LLC and sirens are not being used in an effort to make husband less anxious. En route to the hospital, EMT-I McCormack performs an ongoing assessment of the man’s Standing Orders NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION pain and physical condition. The man is delivered to the emergency department within 30 minutes of his wife’s initial 9-1-1 call. The emergency department nurse and physician continue the man’s care and assessment. His suspicions about a heart attack are confirmed by 12-lead ECG. The © Jones & Bartlett Learning, LLC Jones & Bartlett Learning, LLC is prepared to cardiac catheterization lab, © already alerted by the emergency department, care for the patient. Within 30 minutes of SALE hospital OR arrival, the patient has a stent placed in NOT FOR SALE OR DISTRIBUTION NOT FOR DISTRIBUTION his left anterior descending (LAD) coronary artery. The physicians advise him that he has an excellent chance of full recovery. © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.

© Jones & Bartlett Learning, LLC Learning Objectives NOT FOR SALE OR DISTRIBUTION CHAPTER GOAL


On completion of this chapter, you will understand your roles and responsibilities as an EMT-Intermediate within an EMS system and how these roles and © Jones & Bartlett LLC responsibilities differ from those of otherLearning, levels of providers; understand the © Jones & Bartlett Learning, LLC role of medical direction in the out-of-hospital environment; be able to iden- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION tify the importance of primary injury prevention activities as an effective way to reduce death, disabilities, and health care costs; and value the role that ethics plays in decision making in the out-of-hospital environment.

Cognitive © JonesObjectives & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC As an EMT-Intermediate you should be able to do the following: NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

• Define the term EMS system. • Define the terms certification and registration. • Explain EMT-I licensure/certification, recertification, and reciprocity requirements. • Evaluate the importance of maintaining your EMT-I license/certification. © Jones &• Bartlett Learning, Describe the benefits ofLLC EMT-I continuing education. © Jones & Bartlett Learning, LLC • List current state requirements your state. NOT FOR SALE OR DISTRIBUTIONfor EMT-I education inNOT FOR SALE OR DISTRIBUTION • Define the terms profession, professionalism, and health care professional. • Describe the attributes of an EMT-I as a health care professional. • Describe how professionalism applies to an EMT-I while on and off duty. • Describe examples of professional behaviors in the following areas: integrity, empathy, © Jones Bartlett Learning, LLC communications, time © Jones & Bartlett Learning, LLC self-motivation, appearance and&personal hygiene, self-confidence, management, teamwork diplomacy, patient advocacy, and careful delivery ofNOT FOR SALE OR DISTRIBUTION NOTand FOR SALErespect, OR DISTRIBUTION service. • Provide examples of activities that constitute appropriate professional behavior for an EMT-I. • Describe the importance and benefits of quality EMS research to the future of EMS. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC • Define the terms medical direction and protocols. • Describe the role of theOR EMSDISTRIBUTION physician in providing medical direction. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE • Describe the benefits of medical direction, both on-line and off-line. • Describe the process for the development of local policies and protocols. • Provide examples of local protocols. • Describe the relationship between a physician at the scene, the EMT-I at the scene, and the EMS physician providing © Jones & Bartlett Learning, LLC on-line medical direction. © Jones & Bartlett Learning, LLC • Describe the components of continuous quality improvement. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION • Describe the incidence, morbidity, and mortality of unintentional and alleged unintentional events in relation to injury and illness prevention. • Identify the human, environmental, and socioeconomic impact of unintentional and alleged unintentional events in relation to injury and illness prevention. © Jones & Bartlett Learning, © Jones & Bartlett Learning, LLC • Identify health hazards and potential crime areas within theLLC community. • Identify local municipal and community resources available for physical and/or socioecoNOT FOR SALE OR DISTRIBUTIO NOT FOR SALE OR DISTRIBUTION nomic crises. • Identify the role of EMS in local municipal and community prevention programs. • Identify the local prevention programs that promote safety for all age populations. • Identify ethical responsibilities. © Jones & Bartlett Learning, Jones & Bartlett Learning, LLC • Explain the premise that should underlie LLC an EMT-I’s ethical decisions in©out-of-hospital care. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION • Explain the relationship between the law and ethics in EMS. • Identify the issues surrounding the use of advance directives in making an out-of-hospital resuscitation decision.

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4

DIVISION ONE

Preparatory

© Jones & Bartlett Learning, LLC Learning Objectives cont’d NOT FOR SALE OR DISTRIBUTION Affective Objectives


As an EMT-Intermediate you should be able to do the following: • Defend the importance of continuing medical education and skills retention. • Serve as a role model others & relative to professionalism EMS. ©for Jones Bartlett Learning,inLLC © Jones & Bartlett Learning, LLC • Exhibit professional NOT behavior in the following areas: integrity, empathy, self-motivation, appearance and personal NOT FOR SALE OR DISTRIBUTION FOR SALE OR DISTRIBUTION hygiene, self-confidence, communications, time management, teamwork and diplomacy, respect, patient advocacy, and careful delivery of service. • Value the need to serve as a patient advocate inclusive of those with special needs, alternative lifestyles, and cultural diversity. • Assess personal&attitudes and Learning, demeanor thatLLC may distract from professionalism. © Jones Bartlett © Jones & Bartlett Learning, LLC • Value the role that family dynamics plays in the total care of patients. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION • Defend the need to respect the emotional needs of dying patients and their families. • Assess personal practices relative to the responsibility for personal safety, the safety of the crew, the patient, and bystanders. • Advocate the need for supporting and participating in research efforts aimed at improving EMS systems. need for injury prevention, including abusive situations. © Jones •& Advocate Bartlettthe Learning, LLC © Jones & Bartlett Learning, LLC • Value and defend tenets of prevention for patients and communities served. NOT FOR SALE OR DISTRIBUTION NOT FORbeing SALE OR DISTRIBUTION • Value personal commitment to the success of prevention programs. • Advocate and practice the use of personal safety precautions in all scene situations. • Advocate the need to show respect for the rights and feelings of patients. • Defend personal beliefs about withholding or stopping patient care. • Defend the value of © advance medical directives.Learning, LLC Jones & Bartlett © Jones & Bartlett Learning, LLC • Assess your personalNOT commitment to protecting confidentiality. NOT FOR SALE OR DISTRIBUTION FOR SALE OR patient DISTRIBUTION • Reinforce the patient’s autonomy in the decision-making process. • Given a scenario, defend an EMT-I’s actions in a situation where a physician orders therapy that the EMT-I believes is detrimental to the patient’s best interests.

Psychomotor © Jones &Objectives Bartlett Learning, LLC • None identified this chapter. NOT FOR for SALE OR DISTRIBUTION


care of patients at the scene can minimize suffering, prevent Approach further injury, and reduce recuperationLLC time. As an EMT-I you © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, This text presents the knowledge and skills needed to funcplay an essential role in the continuum of care, serving as a NOT FOR SALE OR DISTRIBUTION tion as an EMT-Intermediate (EMT-I) in a professional, med- NOT FOR SALE OR DISTRIBUTION

link between patients experiencing an emergency and the hosically appropriate, and efficient manner. Basic and advanced pital or other acute care facility where they may receive definprinciples are presented, which serve as building blocks for itive care. Depending on the type of EMS agency for which the provision of quality patient care. This chapter describes you work, you may also be responsible for ensuring the conthe role of an EMT-I, what an EMS system is, and how you tinuum hospitals © Jones & Bartlett Learning, LLC of care during transfer of © patients Jonesbetween & Bartlett Learning, work within that system. and long-term care facilities.

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Few professions offer the excitement and adventure that you experience working as a prehospital care provider. One INTRODUCTION: WHAT IS AN EMTmorning you may deliver a baby, that afternoon treat a patient INTERMEDIATE? who has abdominal pain, and the next day extricate a trauma patient from the of an overturned automobile LLC on the © Jones & Bartlett Learning, LLC © wreckage Jones & Bartlett Learning, (EMT-I) • An emergency medical technician freeway. ❂ EMT-Intermediate NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION (EMT) who has completed training beyond the EMT-Basic (EMT-B) A career as an EMT-I can be exciting, but it can also challevel; the degree of training and skills practiced vary widely among lenge your safety, composure, and humanity. Think of how states and EMS systems. disheartening it can be to perform CPR for 20 minutes on a patient suffering cardiac arrest, carry him down three flights As & an Bartlett EMT-I youLearning, are trained inLLC advanced care of the acutely © Jones of stairs, & andBartlett deliver chest compressions while off-balance in © Jones Learning, LLC sick or injured. The actions you take as an EMT-I can make the back of a moving ambulance, only to have the patient NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION the difference between life and death. Proper handling and succumb to the cardiac condition in the hospital emergency


Chapter 1


5

can be almostLLC as frustrating to rush to the scene © Jones & Bartlett Learning, LLC © Jones &department. Bartlett ItLearning, of a reported serious emergency, only to find that someone NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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has called in a false alarm or greatly exaggerated the situation to get help there sooner. You are often required to perform your duties in uncontrolled and volatile circumstances and under considerable physical and emotional It may be necessary to place LLC © stress. Jones & Bartlett Learning, © Jones & Bartlett Learning, LLC your life at risk to ensure the safety and well-being of the NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION community you are sworn to serve. Long work hours, heavy workloads, lifting injuries, stress, violence, drugs, gangs, and exposure to bloodborne and airborne pathogens and hazardous materials, as well as other dangers, challenge your ability to remain&inBartlett the field setting. © Jones Learning, LLC © Jones & Bartlett Learning, LLC To survive as a prehospital care provider, you must be realNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION istic about the job. It is not all glory and excitement, nor is it mundane. With some cases it is necessary for you to use all of the skills you have been trained to perform, whereas in FIGURE 1-1 IV therapy is an important aspect of the EMT-I’s care for the other situations, simply holding the patient’s hand or offering patient. during transport to LLC the hospital is what is needed. The © Jones &comfort Bartlett Learning, © Jones & Bartlett Learning, LLC delivery of prehospital care centers on serving the public in NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION any type of call or situation. As an EMT-I you do not define the emergency and determine whether the call is “worth it.” The patient defines what an emergency is to them. To help deal with the stress inherent in the job, you must maintain an appropriate sense of compassion Engaging in pro- LLC © Jonesand & humor. Bartlett Learning, © Jones & Bartlett Learning, LLC fessional activities canNOT enhance yourSALE ability to deliver quality NOT FOR SALE OR DISTRIBUTION FOR OR DISTRIBUTION service. Bystanders

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The classification of EMT-I is a little more than a few decades old. It follows the evolution of the EMT during the past EMT-Intermediates century from stretcher bearer and ambulance driver to today’s health care professional. Today’s EMT-I possesses keyJones & Bartlett Learning, EMT-Paramedics © Jones & Bartlett Learning, LLCboth basic skills and © LLC advanced care skills, including additional patient assessment NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION skills, use of advanced airway adjuncts, IV therapy, techFIGURE 1-2 Pyramid of care. niques for managing tension pneumothorax, monitoring and interpreting basic cardiac dysrhythmias, administering key life-sustaining medications, and defibrillating patients (Figure 1-1). served as the pyramid of care©inJones the prehospital setting (Figure © Jones & Bartlett Learning, LLC & Bartlett Learning, LLC To practice as an EMT-I in most states, you are required 1-2). The 1999 EMT–Intermediate: National Standard CurNOT FOR SALE OR DISTRIBUTIO NOT FOR SALE OR DISTRIBUTION to complete a recognized EMT-I course, successfully comriculum was designed to address the educational needs of the plete a written and practical examination, become certified or traditional EMT-I and provide a solid foundation for profeslicensed, and receive authorization from the medical director sional practice and additional education with a heavy emphaof an EMS agency or facility where you work. When pracsis on clinical problem solving and decision making. ticing as an EMT-I you are Learning, working under a physician’s The National Highway TrafficLearning, Safety Administration © Jones & Bartlett LLC © Jones & Bartlett LLC license. This authorization, often referred to as “delegation of (NHTSA) and the Health Resources and Human Services NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION authority,” is granted through written protocols, standing Administration (HRSA) has issued the National EMS Scope orders, and on-line medical direction. of Practice Model and changed what EMS providers are Until 2010, the National Standard Curriculum served called to include: emergency medical responder, emergency as the foundation for training of the four levels of EMTs in medical technician, advanced EMT and paramedic. However, United States. This included not all states haveLearning, adopted the new scope of practice or the © Jones &the Bartlett Learning, LLC the first responder, EMT-B, © Jones & Bartlett LLC EMT-I, and EMT–Paramedic (EMT-P). Along with the delivnew terms. This textbook reflects the 1999 scope of practice NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ery of basic life support by bystanders, these four levels and terms used for the four levels of EMS providers.


6

DIVISION ONE

Preparatory

EMT-Intermediate Training The Certification ProcessLLC © Jones & Bartlett Learning, © Jones & Bartlett Learning, LLC Typically, certification as an EMT-B is a prerequisite for NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

KNOWLEDGE AND SKILL EXAMINATIONS enrollment in an EMT-I course. Proficiency in reading, writing, and math are also prerequisite skills because docuAt the completion of your training, you must successfully mentation skills at the advanced level rely heavily on correct complete written and skill examinations to demonstrate spelling and appropriate use of grammar, vocabulary, and and skills. This is in addiJones & Bartlett Learning,mastery LLC of the required knowledge © Jones & Bartlett Learning, LLC syntax, whereas sufficient © math skills are needed to calculate tion to course completion and may be required by state reguNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION dosages for medication administration. lations. Some states use their own testing process for EMT-Is, The EMT-I course averages 300 to 400 hours of instrucwhereas others use the National Registry of Emergency tion and includes didactic instruction, a skills laboratory, clinMedical Technicians (NREMT) EMT-I examination. Some ical education, and field internship (Figure 1-3). states also require both; you must have National Registry cerThe didactic instruction represents delivery of the knowltification, as well as successfully complete a certification/ © Jones Bartlett LLCin the © Jones & Bartlett Learning, LLC edge portion of the & training. It is Learning, typically delivered licensure examination. NOT FOR SALE OR discussions, DISTRIBUTION NOT FOR SALE OR DISTRIBUTION classroom using lectures, videos, demonstrations, and simulations. ❂ Registration • Act of enrolling one’s name in a “register” or book The skills laboratory is where you learn and practice the of record. needed skills, first learning each skill individually and then later incorporating some or most of the learned skills into sim© Jones & Bartlett Learning, LLC education is an essen- © Jones & Bartlett Learning, LLC ulated patient care cases. The clinical The NREMT is a private, nonprofit agency formed to provide NOT FOR SALE OR DISTRIBUTION FOR OR of DISTRIBUTION tial part of EMT-I education because this is where you have NOT testing andSALE registration EMTs on a nationwide basis. To a chance to apply what is learned in the classroom and labomeet the NREMT requirements for registration, you must do ratory settings to real patient care situations. Typically, your the following: clinical education takes place in both the hospital and field • Successfully complete an EMT-I training program that settings. A field internship, where you work in the field setting meets the U.S. Department© of Transportation (DOT) © Jones & Bartlett Learning, LLC Jones & Bartlett Learning, LLC under the direction of a practicing advanced level provider, standards. NOT FOR SALE OR NOT FOR SALE OR DISTRIBUTION may also be part of the training. • Successfully pass the EMT-I written examination and prac-DISTRIBUTION The national standard curriculum for the EMT-I includes tical skills testing of the NREMT. an educational model that outlines the topic areas that are In states in which National Registry certification is not included in the EMT-I training program and cognitive (knowlrequired, you should view becoming National Registry certiedge), psychomotor (skills), and affective (attitude) learning fied as a demonstration to excellence. To © that Jones Learning, © Jones of & commitment Bartlett Learning, LLC objectives serve & as Bartlett the roadmap for learning.LLC retain National Registry certification, reregistration at 2-year FOR SALE OR DISTRIBUTION NOT Attending FOR SALE OR DISTRIBUTION As anNOT EMT-I you often treat patients following standing intervals is required. a structured refresher program orders. For this reason, a significant portion of the instruction or obtaining the required continuing education during the regis devoted to enhancing your assessment skills and dealing istration period satisfies the reregistration requirement. with as many additional potential emergency situations as possible.


• ActionLearning, by which an agency ❂ Certification © Jones & Bartlett LLCor association grants recognition to an individual who has met its qualifications. NOT FOR SALE OR DISTRIBUTION

❂

Licensure • Process by which a government agency grants permission to an individual to engage in a given occupation on finding that the applicant has attained the minimum degree of competency LLC © Jones & Bartlett Learning, necessary.

© Jones & Bartlett Learning, NOT FOR SALE OR DISTRIBUTION Credentialing

LLC NOT FOR SALE OR DISTRIBUTIO

Following successful completion of the required training and testing, you must undergo a credentialing process. The objective of © credentialing to protect the publicLLC from © Jones & Bartlett Learning, LLC Jones & isBartlett Learning, incompetence and provide for professional identification. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Certification and licensure are common forms of credentialing used for today’s prehospital care providers. The process of credentialing varies from state to state. In some states, after meeting the necessary testing and training requirements, the process may be asLLC simple as filling out a © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, form that is signed by the training program FIGURE 1-3 An important part of the EMT-I course is learning and practicNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTIONmedical advisor ing new skills. and submitted to the state EMS office. The state EMS office


Chapter 1


7

a certification card that can be carried in a wallet.©InJones obtain specific amount of continuing & aBartlett Learning, LLC education each year. © Jones &issues Bartlett Learning, LLC other states, EMT-I certification or licensure is administered Some jurisdictions require successful completion of written NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION through the state department of health, board of medical examiners, or other state agency.

and/or skills testing to become recertified as an EMT-I. Failure to complete the necessary recertification procedures will result in your certification expiring. Whether you will be allowed to regain your certification or licensure will Meaning of EMT-Intermediate depend on your state law. Some states require you to take an © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Certification examination, whereas other states require you to retake the NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION It is important to understand what certification or licensure entire EMT-I course. represents. Most states or communities use certification or licensure to grant authority to an individual who has met predetermined qualifications to participate in an activity. A document by a LLC government or Benefits of Continuing © Jonesis& typically Bartlettissued Learning, © Jones & Bartlett Education Learning, LLC nongovernmental entity that certifies fulfillment of requireNOT FOR SALE OR DISTRIBUTION NOT FOR isSALE OR The EMT-I curriculum designed to DISTRIBUTION provide the fundamenments for practice in a field. There is an unfounded general tal knowledge and skills needed to serve as an entry-level belief that “licensed professionals” have greater status than EMT-I. Enrichment and continuing education are needed in those who are “certified” or “registered.” A “certification” some cases to bring you to full competency. Furthermore, it granted by a state, conferring a right to engage in a trade or is important to recognize that this curriculum does not provide in fact a “license.” © Jones &profession, BartlettisLearning, LLC © Jones Bartlett you & with extensiveLearning, knowledge inLLC hazardous materials, bloodCertification does not give you the right to work as an NOT FOR SALE OR DISTRIBUTION NOT FOR ORemergency DISTRIBUTION borne SALE pathogens, vehicle operations, or rescue EMT-I or to be selected for employment. Both volunteer and practices in unusual environments. Another important conpaid EMS systems may add other requirements, including sideration is that many of the skills and much of the knowlexaminations, internships, or other demonstrations of profiedge learned in the EMT-I course may not be used frequently, ciency before you are able to function in the field setting. and skill decay can occur rapidly. Continuing education helps © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC reduce the erosion of knowledge and skills (Figure 1-4). It FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION also keeps you current on NOT new procedures and treatments, allows a sharing of real-life experiences with other prehospiSTUDENT ALERT tal care providers, and encourages further professional As described earlier, in most states you must development. also be authorized by a medical director to function as an © EMT-I. Jones & Bartlett Learning, LLC



❂

© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Reciprocity

❂

Run Critiques • Sessions in which prehospital care providers and medical direction physicians (typically in a group setting) review run reports and/or case histories to identify positive and negative © Jones & Bartlett LLC aspects of care Learning, and documentation provided by EMT-Is in given cases. They allow EMT-Is to learn from others’ experiences. NOT FOR SALE OR DISTRIBUTION

Reciprocity • Mutual exchange of privileges or licenses by two certifying agencies.

It is not uncommon for EMT-Is who are certified in one state to relocate to another. Rather than requiring you to repeat the EMT-I training, most states have a & process in place called rec- LLC © Jones Bartlett Learning, iprocity that allows theNOT transfer of your certification or licenFOR SALE OR DISTRIBUTION sure. In some states, reciprocity is automatic, especially if you have National Registry certification.

RECERTIFICATION AND © Jones & Bartlett Learning, LLC CONTINUING EDUCATION NOT FOR SALE OR DISTRIBUTION



To maintain the right to function as an EMT-I, most states require recertification every 1 to 5 years (the average being 2 years). It is legally necessary to maintain certification or licenas long Learning, as you practiceLLC as an EMT-I. © Jones &sure Bartlett © Jones & Bartlett Learning, LLC In some states, recertification involves participating in a FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOT FIGURE 1-4 Continuing education activities. refresher course, whereas in other states, you are required to


8

DIVISION ONE

Preparatory

Continuing Education for the © Jones & Bartlett Learning, LLC EMT-Intermediate NOT FOR SALE OR DISTRIBUTION

PROFESSIONALISM © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION

Countless continuing education opportunities are available to ❂ Professional • A person who has certain special skills and knowlthe EMT-I. On a local level, EMS systems, EMS training proedge in a specific area and conforms to the standards of conduct grams, EMS associations, and hospitals often provide inand performance in that area. One does not need to be paid to be a professional. service training programs, seminars, and run critiques. On a © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC state and national level, a variety of conferences are held NOT FOR SALE OR DISTRIBUTION NOT FOR ORrange DISTRIBUTION annually. These conferences expose youSALE to a wide of ❂ Professionalism • Refers to conduct or qualities characterizing a nationally recognized experts in EMS, relaying the most practitioner in a particular field or occupation. current information (e.g., research updates, newest equipment, and new techniques) in EMS. ❂ Profession • Refers to a specialized body of knowledge or skills. Another common type of continuing education activity is © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC the 1- or 2-day training program. Examples include prehosNOTlife FOR SALE OR DISTRIBUTION FOR• SALE OR DISTRIBUTION Professional Properly trained and licensed or cer❂ Health CareNOT pital trauma support (PHTLS), advanced cardiac life tified provider of health care. support (ACLS), basic trauma life support (BTLS), pediatric advanced life support (PALS), prehospital education for prehospital professionals (PEPP), advanced medical life support STREET WISE (AMLS), geriatrics for EMS (GEMS), and weapons of mass © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC destruction (WMD) awareness. Brief, information-packed First impressions are often lasting, so make sure NOT FOR SALE OR DISTRIBUTION FOR ORpeople DISTRIBUTION firstSALE impression have of you as an EMT-I is courses such as these require only a modest time commitment NOT the a positive one! on your part while providing enormous knowledge, skills learning, and remediation. Maintaining current certification in some or all of these programs may also be required for state Professionalism recertification. © Jones & Bartlett Learning,Defining LLC © Jones & Bartlett Learning, LLC Alternatively, there are many excellent continuing educaThe educational experience that NOT you participate in to become FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION tion programs that can be conveniently reviewed while at certified should help you to become a professional EMT-I. home or on the job. These programs can be found in EMSProfessionalism is necessary to promote quality patient care, related textbooks, magazines, subscription videos, and cominstill pride in the prehospital environment, promote high puter programs, and on the Internet. standards, and earn the respect of other members of the health © Jones & Bartlett Learning, LLC © Jones care team (Figure 1-5). & Bartlett Learning, LLC Your professionalism canSALE positively a patient’s NOT FOR SALE OR DISTRIBUTION NOT FOR ORinfluence DISTRIBUTION judgment of the EMS system. People who are involved in EMS-Related Reading emergencies usually experience pain, fear, and great anxiety. EMS magazines help keep you aware of the latest changes Sick and injured patients feel vulnerable and helpless when in a constantly evolving industry and provide excellent depending on strangers for assistance. Patients who are made sources of continuing education to feel at&ease by your caring, confident, © Jones & Bartlett Learning, LLCto sharpen knowledge. © Jones Bartlett Learning, LLC and well-trained EMS magazines also list employment opportunities, EMS actions may show both psychological and physical improveNOT FOR SALEand ORconferences; DISTRIBUTION FOR SALE OR DISTRIBUTION seminars, provide details about new NOT ment (Figure 1-6). products and equipment; highlight tips that can be used on the job; and review various EMS-related books, videos, and computer software. An additional benefit of EMS magazines is that they provide you with an opportunity to write Learning, articles, © Jones & Bartlett LLC © Jones & Bartlett Learning, LLC communicating important information to other EMS NOT FOR SALE OR DISTRIBUTIO NOT FOR SALE OR DISTRIBUTION professionals.

Serving as an Instructor/Preceptor © Jones & Bartlett Learning, LLC Serving NOT as anFOR instructor in OR CPR,DISTRIBUTION use of the automated SALE


external defibrillator (AED), first aid, or in EMT-B and EMT-I courses is another way to keep your skills current. Teaching can also serve as a source of continuing education credit. Serving as a responsible educator also establishes you as a leader and a reliable resource in the © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC community. Professionalism is expressed in appearance and attitude. NOT FOR SALE OR DISTRIBUTION NOTFIGURE FOR1-5 SALE OR DISTRIBUTION


Chapter 1



9

ROLE AND RESPONSIBILITIES OF THE © Jones & Bartlett Learning, LLC EMT-INTERMEDIATE NOT FOR SALE OR DISTRIBUTION Role As an EMT-I your role is to provide basic and advanced care to persons experiencing medical and traumatic emergencies.



STUDENT ALERT


You should be familiar with the responsibilities of an EMT-I (Box 1-2).& Bartlett Learning, LLC © Jones

FIGURE 1-6 A gentle, appropriate touch can offer a great deal of reassurance and comfort to an ill or injured person.

NOT FOR SALE OR DISTRIBUTION Responsibilities Your foremost responsibility is to ensure your own safety and

the safety of fellow workers. AsLLC an EMT-I your duties typi© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, cally include those listed in Box 1-2. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Another point to consider is EMS personnel occupy posi-

tions of public trust. Society expects safety professionals to conduct themselves appropriately both on and off duty. As an ETHICS AND CONFIDENTIALITY EMT-I you are a highly visible role model. People look up to you and trust that you©will always&doBartlett the right thing. Like it LLC Jones Learning, © Jones & Bartlett Learning, LLC or not, you are no longer just an individual citizen. In addiEthics • The discipline dealing with FOR what is good and what bad. ❂ NOT SALE ORis DISTRIBUTION NOT FOR SALE OR DISTRIBUTION tion to representing yourself, you also represent many others, including your EMS agency; state, county, city, and/or district EMS office(s); and your peers. To a certain extent, you also represent the medical community. Unprofessional conduct, whether you are&onBartlett or off duty, hurts the image © Jones Learning, LLCof the EMS ©CLINICAL Jones &NOTE Bartlett Learning, LLC profession. Commitment to excellence is a daily activity that Socrates, the philosopher, questioned, “How NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION should one live?” This relates to how you as an individrequires constant vigilance to ensure that a professional image ual conduct yourself. is maintained. Attributes of professional conduct include those listed in Box 1-1.


© Jones & Bartlett LLC Meaning of Learning, Ethics NOT FOR SALE OR DISTRIBUTION

The word ethics is derived from the Greek word meaning “character” and sets standards for the rightness and wrongness of professional behavior. Ethics serve as a foundation for conduct as a practicing EMT-I and address your relationship STREET WISE with your peers, patients, patients’ families, and society in © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC To become proficient, you must be able to use general. Morals refer to social, religious, and personal stanall of the equipment and carry out procedures without NOT FOR SALE OR DISTRIBUTIO NOT FOR SALE OR DISTRIBUTION dards of right and wrong. having to think about them; in other words, the proceWhen faced with situations that call for a choice of behavdures must be “second nature.” One way to accomplish this goal is to practice frequently with the equipment and ior, you must act ethically. For example, it is unethical (and rehearse all necessary skills. Handling equipment gives some may even be illegal) to do the following: you a feel for&each device,Learning, making it easier to use the • Make © a statement to Bartlett a patient about a fellow health © Jones Bartlett LLC Jones & Learning, LLC care device under less than ideal conditions, such as when worker’s perceived faults. NOT FOR SALE OR NOT FOR SALE OR DISTRIBUTION the lighting is poor or you areDISTRIBUTION in a hurry. • Solicit a patient for a date. During the training program, you should visit the local • Give an attorney’s business card to the victim of a motor EMS station from time to time to observe how equipvehicle crash. ment is stored, maintained, and used. If you build a pos• Discourage a patient from going to the hospital because he itive relationship with the crew(s), they may be willing to has no insurance. © Jones & Bartlett LLC Bartlett Learning, LLC allow you Learning, to practice with the equipment during visits. © Jonesor&she • Fail to maintain confidentiality. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR patient DISTRIBUTION


10

DIVISION ONE

Preparatory

© Jones &Box Bartlett Learning, LLC 1-1 NOT FOR SALE ORofDISTRIBUTION Attributes Professional Conduct


• Integrity —Having integrity is the single most important examples of treating others with respect. You should call characteristic of professionalism. The public expects you patients by their proper name (e.g., Mr. Smith), not to be honest in all of your actions. Examples of behav“pops,” “gramps,” or “bub,” and avoid making negative © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC iors that demonstrate integrity include telling the truth, not comments about a person’s gender, race, sexual orienNOT appearance, FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION stealing, performing complete and accurate documentatation, ethnicity, religion, physical profestion, and maintaining patient confidentiality. sion, social status, or disability. • Empathy —Being empathetic involves identifying with • Having self-motivation/personal improvement —A profesand understanding the feelings, situations, and motives sional has an internal drive for excellence—always strivof others. You must demonstrate empathy to patients, ing to be the best he or she can be—and enthusiastically families, and other health care professionals. takes advantage of learning opportunities. Attending con© Jones & Bartlett Learning, LLCBehav© Jones & Bartlett Learning, LLC iorsNOT that demonstrate empathy include showing caring tinuing education activities, practicing skills, reading FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION and compassion for others; demonstrating an underEMS-related literature, and demonstrating a commitment standing of patient and family feelings; showing respect to continuous quality improvement are all examples of for others; exhibiting a calm, compassionate, and helpful self-motivation. A professional also continually demondemeanor toward those in need; and being supportive strates self-direction, taking the initiative to complete and reassuring of others. assignments, improve and/or correct behavior that is not © Jones •& ABartlett Learning, LLC © Jones & Bartlett Learning, LLC professional manner —You should be courteous, in up to par, and take on and follow through on tasks without NOT FOR SALE OR FOR SALE OR DISTRIBUTION control of yourDISTRIBUTION emotions, avoid inappropriate conversa- NOT constant supervision. A professional is also one who tion, and appear confident. You should not eat, drink, or accepts constructive feedback in a positive manner, smoke while caring for patients. looking for opportunities to make himself or herself better. • Good appearance and personal hygiene —How you • Self-confidence —As a professional you trust or have appear to others and to yourself is important. First reliance on yourself. You develop an accurate assessimpressions are often© theJones longest lasting. PeopleLearning, form an ment of your personal and professional strengths andLearning, LLC & Bartlett LLC © Jones & Bartlett opinion about you andNOT your qualifications to do a job with limitations. You believe in yourself in what you OR can DISTRIBUTION NOTand FOR SALE FOR SALE OR DISTRIBUTION their first look at you. Being well groomed and wearing do. an appropriate, clean, pressed uniform (that is in good • Maintaining good communication —Communication is repair) projects a professional image. You should also the exchange of thoughts, messages, and information. maintain good personal hygiene and grooming. Finally, Professionals develop the ability to convey information to personal protection apparel should be worn when indiothers verbally and in writing, as well as the ability to © Jones & Bartlett Learning, LLC Jones & verbal Bartlett Learning, LLC cated. understand©and interpret and written messages. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION • Appropriate general conduct —You should show interest Speaking clearly, writing legibly, listening actively, and and pride in your service. In striving to provide the bestadjusting communication strategies to various situations quality patient care, you also have a responsibility to be are examples of professional behavior. nondiscriminatory and nonjudgmental in dealing with • Exercising good time management —Professionals patients. You should work well as a member of the preorganize tasks to make maximum use of time, prioritize team, share equally in the workload, and com- © Jones tasks,&are punctual,Learning, and complete tasks and assign© Jones & hospital Bartlett Learning, LLC Bartlett LLC municate effectively with patients, bystanders, partner(s), ments on time. NOT FOR SALE OR DISTRIBUTION FOR SALE OR DISTRIBUTION fellow workers, and other safety professionals. This will NOT • Employing teamwork and diplomacy —Teamwork is the help you earn the respect of others. You also should instill ability to work with others to achieve a common goal, pride in the profession and strive for high standards. whereas diplomacy is tact and skill in dealing with • Being a patient advocate —A professional places all of people. Examples of teamwork and diplomacy include his or her efforts toward the patient’s welfare and does placing the success of the team above self-interest, not © Jones & Bartlett Learning, LLC © Jones & Bartlett not allow his or her own self-interest to come before the undermining the team, helping and supporting otherLearning, LLC needs of the patient. The professional also accepts team members, showing respect for all team members, NOT FOR SALE OR DISTRIBUTIO NOT FOR SALE OR DISTRIBUTION others’ right to differ and does not impose his or her remaining flexible and open to change, and communibeliefs on others. You must not allow personal (religious, cating with co-workers in an effort to resolve problems. ethical, political, social, legal) biases to affect patient • Careful delivery of service —As a professional you care. Advocacy also means ensuring patient safety, proalways deliver the highest quality of patient care with viding reassurance, protecting patient confidentiality, and careful attention to detail critically evaluating your © Jones & Bartlett Learning, LLC © Jones & while Bartlett Learning, LLC preventing patient embarrassment. performance and attitude. Examples of this include masNOTothers FORwith SALE OR DISTRIBUTION FOR SALE OR DISTRIBUTION • Treating respect —You must feel and show tering and NOT refreshing skills, performing complete equipdeferential regard for others, as well as display considment checks, operating the ambulance in a careful and eration and appreciation. Being respectful and polite to safe manner, and following policies, procedures, and proothers and not using derogatory or demeaning terms are tocols, as well as the orders of superiors.




Chapter 1

© Jones & Bartlett Box 1-2Learning, LLC NOT FOR SALE OR DISTRIBUTION Responsibilities of the EMT-I


11


• Being prepared to respond to the next emergency have a working knowledge of the clinical capabilities and call. This begins with being physically, mentally, and categorizations of all of the hospitals in the transport emotionally ready. Using positive health practices, having Does each facility have an emergency department, © Jones & Bartlett Learning, LLC area. © Jones & Bartlett Learning, LLC adequate knowledge, and maintaining skills help operating suite, postanesthesia recovery room or surgiFOR SALE OR DISTRIBUTION NOT FOR facilitate this. You must alsoSALE ensureOR the DISTRIBUTION availability cal intensive care unit,NOT and intensive care units for and proper working order of appropriate equipment and trauma patients? Are any of the hospitals capable of prosupplies. viding specialty care for trauma, pediatric, burn, cardiol• Driving the emergency vehicle to the scene in a safe, ogy, neurology emergencies, or high-risk delivery? Do timely, and lawful manner while exercising due regard for any of the hospitals have acute hemodialysis, acute spinal cord/head management, and/or special radi©others. Jones & Bartlett Learning, LLC © Jonesinjury & Bartlett Learning, LLC • NOT Assessing for and ensuring scene safety and determinological capability? What do they provide in the way of FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ing the mechanism of injury (where appropriate). rehabilitation, clinical laboratory service, toxicology, haz• Using protective equipment in hazardous or dangerous ardous materials/decontamination, hyperbarics, reperfusituations, including using BSI precautions. sion, and psychiatric care? • Interacting with first responders who are already at the You may also be responsible for making arrangements for scene providing care. other transportation, such as aeromedical evacuation of a © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC • Initially controlling the scene and regulating access to critically injured motor vehicle crash victim. Local protocols NOT FOR SALE OR DISTRIBUTION NOT FOR OR inDISTRIBUTION potentially harmful situations. Police or other emergency shouldSALE be followed determining whether a patient will be personnel often assume these duties on their arrival at transported via ground or air. You should also be familiar the scene. with any transfer agreements your EMS system has with • Determining the needs of those involved in the incident hospitals and other entities (Figure 1-7). and communicating that information to the dispatch • Communicating with medical direction when indicated for center, including © requesting response ofLearning, and coordi- LLC guidance on patient treatment and transfer, as well as Jonesthe & Bartlett © Jones & Bartlett Learning, LLC nating with supportive as needed. when patient referral is warranted. NOT FOR SALE OR DISTRIBUTION NOTagencies FOR SALE OR DISTRIBUTION • Using basic tools and procedures to gain access to and • Transferring care of patients to the emergency departextricate entrapped patients. ment staff (usually the emergency department nurse) in • Establishing rapport with patients and bystanders, mainan orderly and efficient manner. You must serve as the taining their confidentiality, and shielding them from patient’s advocate, providing a concise and factual briefonlookers. ing to the hospital staff. Jonespatients & Bartlett LLC compas- • Properly © completing Jones &the Bartlett Learning, • ©Treating with theLearning, appropriate dignity, run sheet (run report) LLC used by NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION sion, and respect. the EMS system. The EMS run report is the legal record • Rapidly assessing and managing life-threatening illof the events that occurred. It gives the hospital staff nesses and injuries. important information about the incident and patient • Performing a careful patient assessment; recognizing the history. Patient care reports must be thorough and accunature and seriousness of illnesses or injuries; prioritizrate and completed in a timely manner. ing assessment, care, LLC and transport of the patient(s); © andJones • Gathering and Learning, completing needed © Jones & Bartlett Learning, & Bartlett LLC billing information. determining the requirements for emergency medical You should be familiar with payers and insurance NOT FOR SALE OR DISTRIBUTION NOT FOR SALE ORcommunity. DISTRIBUTION care. systems in the • Following given protocols to provide prompt and efficient • Preparing for the next incident. You are responsible for care for illnesses or injuries. cleaning and maintaining equipment in proper working • Assessing the effects of treatment. order, which ensures that quality patient care can be pro• Establishing communications with medical direction, vided. You must return to service as soon as possible so © consultation, Jones & Bartlett Learning, LLCas to keep “downtime” to©aJones & Where Bartlett Learning, LLC including physician when needed. minimum. appropri• Recognizing when the limits of field care have been ate, debriefing of the crew may help to glean valuable NOT FOR SALE OR DISTRIBUTIO NOT FOR SALE OR DISTRIBUTION reached and when prompt transportation to the approinformation about the emergency call, what works or priate medical facility is needed. does not work, and what can be done better. • Lifting, moving, positioning, and handling patients in such • Recognizing when patient transport is not warranted a way as to minimize discomfort and further injury, includand following established protocols for handling such ing spinal immobilization, splinting fractures, and proper situations. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC lifting and carrying techniques. • Keeping the emergency vehicle adequately equipped, FOR SALE DISTRIBUTION NOT SALEYouOR • NOT Transporting patientsOR safely and expeditiously to an supplied, andFOR maintained. areDISTRIBUTION also responsible for appropriate medical facility. You must know what checking the expiration dates on IV solutions and medresources are available and be familiar with local protoications, as well as testing the laryngoscopes and other cols involving patient transportation. It is important to such equipment for proper function.




12

DIVISION ONE


Preparatory harmful & to the patient Learning, and will resultLLC in certain death, but it © Jones Bartlett is the patient’s wish that no resuscitative efforts be made. Thus NOT FOR SALE OR DISTRIBUTION

a decision must be made regarding what is in the patient’s best interest. The health care community can help establish parameters for this decision making by taking a number of actions. This that then serve as the © Jones & Bartlett Learning,includes LLC creating treatment protocols © Jones & Bartlett Learning, LLC norm (standard of care) for these types of cases, followed NOT FOR SALE ORbyDISTRIBUTION NOT FOR SALE OR DISTRIBUTION conducting research and having prospective and retrospective reviews of decisions to help guide future decision making. Within the public arena, laws can be enacted to help protect patient rights and define the use of advance directives. These help make the© patient’s wishes known and reduce the poten© Jones & Bartlett Learning, LLC Jones & Bartlett Learning, LLC FIGURE 1-7 Air and ground critical care transport units. tial for conflict. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Ethical Issues in Contemporary

It is essential for you to exemplify the principles and values EMT-Intermediate Practice of your profession. You must understand and agree to abide by & both the implicit and explicitLLC responsibilities. © Jones Bartlett Learning, © Jones & Bartlett Learning, LLC RESUSCITATION You are likely to be confronted with various ethical issues NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Probably the most challenging decisions are those surroundin the course of your work, such as having to decide whether ing resuscitation. As an EMT-I you may be confronted with a attempts should be made to preserve a terminally ill patient’s hysterical family member who, during the process of a loved life, meeting the needs of patients who are unable to pay, or one dying from a terminal illness, panics and insists that care dealing with a patient who is refusing service but who needs beLLC started even though a DNR © order is in place. Obviously, medical care. You may find©that a law is conflict with what Jones &inBartlett Learning, Jones & Bartlett Learning, LLC under normal conditions, you take quick action—any delayDISTRIBUTION is ethically right. Obviously thisFOR createsSALE dilemmas you NOT FOR SALE OR NOT ORthat DISTRIBUTION decreases the chances of the resuscitation efforts being sucmust work through. cessful. Now you are forced to quickly decide whether to Emotion should not be a factor when dealing with ethical honor the patient’s wishes or to follow the request of the hysquestions. Such questions must be answered with reason and terical family member. If you resuscitate the patient, he or she not based on what other people think is right or wrong. As an may experience days, weeks, or even months of additional individual as a professional, must answerLLC these ques© and Jones & BartlettyouLearning, © Jones & Bartlett Learning, LLC suffering that NOT he or she doesSALE not want. If you do not attempt tions yourself. yourOR ownDISTRIBUTION personal code of ethics NOT Maintaining FOR SALE FOR OR DISTRIBUTION resuscitation, the family member will likely be upset and may that is consistent with the professional code of ethics will help threaten litigation. Here you are forced to make an ethical you arrive at appropriate conclusions. decision. Begin by identifying what the patient really wants. When working through ethical issues, you have to ask If it is certain that the patient left clear instructions (such as yourself, “What is in the patient’s best interest? What are the an advance directive) and your state laws patient’s rights? Learning, Does the patient © Jones & Bartlett LLCunderstand the issues at © Jones & Bartlett Learning, LLCand local protocols permit, then you should follow those instructions. If there is hand? What is my professional, legal, moral, and ethical NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION any doubt, resuscitate as you normally would. The situation obligation?” First, determine what the patient really wants. gets a bit more complicated when resuscitation is started but Typically, you can use a number of sources to help you then an advance directive is found or a family member brings reach a conclusion. What does the patient tell you? Is there a it to your attention. Ethically and legally (depending on your written statement, such as an advance directive (e.g., do-notstate laws), you are obligated to care;&however, emoresuscitate [DNR] order, ©living will),& that spells Learning, out the Jones Bartlett LLC © stop Jones Bartlett Learning, LLC tionally you may want to continue. It is important to respect patient’s wishes? What input does the family offer? Although NOT FOR SALE OR DISTRIBUTIO NOT FOR SALE OR DISTRIBUTION the patient’s autonomy and stop doing that which he or she you may not necessarily agree with the patient’s wishes, it is did not want. If there is any question, follow the protocols for important to respect them. By following the patient’s wishes, these types of cases. It may be beneficial to contact on-line you are showing respect for the patient. If you place the medical direction for advice. patient’s well-being above all else when providing care and always do is in& theBartlett patient’s best interest, there is rarely © what Jones Learning, LLC © Jones & Bartlett Learning, LLC a need to worry about committing an unethical act. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION PATIENT CONFIDENTIALITY There are a number of global concepts that relate to proConfidentiality is a fundamental right. You must hold patient tecting patients. These include providing care that is of benefit care in strict confidence as required both legally and ethically. to the patient, not doing harm, and recognizing patient autonIt is unethical to divulge patients’ names, details of their omy. As an EMT-I you will face situations where these global illness or&care, or anyLearning, other aspect LLC of their care to anyone concepts are in Learning, conflict with LLC what is ethically right. An © Jones © Jones & Bartlett Bartlett except designated health care and law enforcement personnel. example is the patient who does not want to be resuscitated NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Telling friends or family about patients could result in a leak if he or she experiences cardiac arrest. Not providing care is


Chapter 1


13

confidential information.LLC As an EMT-I you cannot reveal “health plan” and in situations that involve patient “dumping” © Jones & Bartlett Learning, LLC © Jones &ofBartlett Learning, information about a patient to anyone, including the patient’s or economic triage. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

own family, without the patient’s permission. An exception to this rule, in some states, exists if the patient is a minor or is CONFLICTING PHYSICIAN ORDERS legally certified as incompetent and you are communicating information to a legal guardian. Violation of patient confiAs an EMT-I you may also find yourself dealing with ethical dentiality may be met©with civil or penalties. LLC issues in your role as a physician extender. What should you Jones & administrative Bartlett Learning, © Jones & Bartlett Learning, LLC Keep in mind that giving a thorough report to the emergency do if the physician orders something that you believe is conNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION department staff when transferring care is appropriate and not traindicated or that is medically acceptable but not in the a breech of confidentiality. Sometimes you are put into situapatient’s best interests? How should you handle a situation tions where you have knowledge of information that is where you believe the treatment is medically acceptable but required to be reported by state law. An example is neglect or morally wrong? First, the conflict may be caused by misabuse children&orBartlett elderly persons. Here the rule of conficommunication. For this reason, it isLearning, important to LLC repeat the © of Jones Learning, LLC © Jones & Bartlett dentiality must be breached for the public good. You must be orders back to the physician to make sure that the orders NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTIONare familiar with the requirements for reporting in your state. in fact what the physician wants to have done. If the treatment is what the physician wants done and you still believe it is inappropriate for the given situation, then you should ask the CONSENT physician for an explanation. If the physician is clear on what person has a right to accept he or&she wishes done and you still believe that it is inappro© Jones &Each Bartlett Learning, LLCor decline medical care. This © Jones Bartlett Learning, LLC is a fundamental element of the patient-physician relationship. priate for the situation, you will need to make an ethical deciNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Although it is not as problematic when the patient asks for sion. How far are you willing to go to be a patient advocate? What are the risks associated with not following orders from help, there still can be ethical dilemmas, such as “Does the a physician? Failure to follow orders will require you to patient understand the issues at hand?” or “Can the patient defend that action and may be met with a variety of responses, make an informed decision in his or her best interest?” Even including possible punitive © actions. On the other hand,Learning, carrymore questionable is when the patient is unable Learning, to express a LLC © Jones & Bartlett Jones & Bartlett LLC ing out orders known to be NOT contraindicated or adverse the willingness to be treated. patients who are FOR SALE OR to DISTRIBUTION NOTInFOR SALE ORunconscious, DISTRIBUTION patient’s well-being is also risky. you are obligated to initiate care based on the principle of implied consent. Here, as an EMT, you assume that if the patient were able to do so, he or she would consent to treatCode of Ethics ment. But do you really know that is what the patient wants? Many health care professions publish written codes of ethics What bring theLearning, patient back LLC to life but he or © happens Jonesif&you Bartlett © Jones & Bartlett Learning, LLC to help guide members who face difficult ethical decishe NOT spends FOR the restSALE of his orOR her life in a coma? Have you done DISTRIBUTION NOTtheir FOR SALE OR DISTRIBUTION sions. A code of ethics provides a model of ideal conduct. In the patient more harm than good? These become ethical issues January 1978, the National Association of Emergency with which you find yourself struggling. Medical Technicians issued a Code of Ethics for Emergency Medical Technicians. CARE IN FUTILE SITUATIONS code* states: © Jones & Bartlett Learning, LLC © JonesThe & Bartlett Learning, LLC Another ethical challenge involves dealing with cases that are NOT FOR SALE OR DISTRIBUTION NOT FOR SALE status OR DISTRIBUTION Professional as an Emergency Medical Technician is mainfutile—in other words, the patient who has no chance for surtained and enriched by the willingness of the individual practivival. Examples include the patient who is experiencing tioner to accept and fulfill obligations to society, other medical cardiac asystole and is unresponsive to treatment and the professionals, and the profession of Emergency Medical Technipatient who is in cardiac arrest following blunt trauma. cian. As an Emergency Medical Technician, I solemnly pledge professional ethics: Neither of these patients is likely & to be successfully resusci- LLCmyself to the following code © Jones Bartlett Learning, ©ofJones & Bartlett Learning, LLC A fundamental responsibility of the Emergency Medical Techtated. To best manage these types of ethical issues, the SALE ORhealth, DISTRIBUTIO NOT FOR SALE OR DISTRIBUTION nician is to conserve life, to NOT alleviateFOR suffering, to promote meaning of the term futile must first be determined. Then who to do no harm, and to encourage the quality and equal availabilmakes the decision that the situation is futile must be decided. ity of emergency medical care. Both of these questions must be addressed through local proThe Emergency Medical Technician provides services based tocols before you are confronted with this type of situation. on human need, with respect for human dignity, unrestricted by

© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION OBLIGATION TO PROVIDE CARE

considerations of nationality, race, creed, color, or status. © Jones & Bartlett Learning, LLC The Emergency Medical Technician does not use professional NOT FOR SALE OR DISTRIBUTION knowledge and skills in any enterprise detrimental to the public well-being. The Emergency Medical Technician respects and holds in confidence all information of a confidential nature obtained in the

Sometimes the question of whether there is an obligation to provide care creates a dilemma. In most states, you are not legally obligated to stop at a crash scene while off duty and yourLearning, own car. However, © Jones &driving Bartlett LLC you may have a moral © Jones & Bartlett Learning, LLC responsibility to stop and help. Ethical issues also arise with *The EMT Code ofOR Ethics.DISTRIBUTION Adopted by the National Association of Emergency NOT FOR SALE OR DISTRIBUTION NOT FOR SALE patients who are not able to pay for treatment or are not in the Medical Technicians, 1978.


14

DIVISION ONE

Preparatory

of professional work unless involved&in Bartlett the response, treatment, LLC or transport of patients Learning, © Jones course & Bartlett Learning, LLCrequired by law to divulge © Jones such information. are considered support services. These support services are NOT FOR SALE OR DISTRIBUTION The Emergency Medical Technician, as a citizen, understands NOT FOR SALE OR DISTRIBUTION

necessary to the overall operation of the EMS system.

and upholds the law and performs the duties of citizenship; as a professional the Emergency Medical Technician has the neverending responsibility to work with concerned citizens and other Types of Systems health care professionals in promoting a high standard of emergency medical care to all © people. Jones & Bartlett Learning,EMS LLCsystems evolve as a result © Jones & Bartlett Learning, LLC of geographic, political, The Emergency Medical Technician shall maintain profesdemographic, and economic pressures that are unique to each NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION sional competence and demonstrate concern for the competence community, resulting in vast differences from area to area. of other members of the Emergency Medical Services health care Although many different types of EMS systems exist around team. the country today, including (but not limited to) fire An Emergency Medical Technician assumes responsibility in service–based, third-service, private ambulance service, hosdefining and upholding standards of professional practice and © Jones & Bartlett Learning, LLC ©volunteer Jones systems, & Bartlett Learning, education. pital-based, and each system offers itsLLC own TheNOT Emergency Medical Technician assumes responsibility for unique advantages and disadvantages. FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION individual professional actions and judgment, both in dependent and independent emergency functions, and knows and upholds the laws that affect the practice of the Emergency Medical The Emergency Call Technician. An Emergency Medical Technician has the responsibility to be Think back to the case history presented at the beginning of © Jones & Bartlett Learning, LLCof legislation affecting the © Jones & Bartlett LLC aware of and participate in matters this chapter. EmergencyLearning, calls, regardless of the nature, follow Emergency Medical Technician and the Emergency Medical NOT FOR SALE OR DISTRIBUTION NOT FORevolution SALE OR DISTRIBUTION a similar that often includes the following (Figure Services System. 1-8): The Emergency Medical Technician adheres to standards of • Incident occurrence personal ethics that reflect credit upon the profession. • Recognition Emergency Medical Technicians, or groups of Emergency • System access and dispatch Medical Technicians, who advertise professional services, do so © Jones & Bartlett Learning,• LLC © Jones & Bartlett Learning, LLC in conformity with the dignity of the profession. Prehospital care NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION The Emergency Medical Technician has an obligation to • Patient stabilization and transport protect the public by not delegating to a person less qualified • Delivery to the hospital any service that requires the professional competence of an • Preparation for the next event Emergency Medical Technician. The Emergency Medical Technician will work harmoniously with, © andJones sustain confidence in, Emergency Medical Technician & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Incident Occurrence and Recognition associates, the nurse, the physician, and other members of the NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Emergency Medical Services health care team. The emergency call begins with the onset of illness or injury, The Emergency Medical Technician refuses to participate in such as the sudden onset of acute myocardial infarction, an unethical procedures, and assumes the responsibility to expose asthma attack, a motor vehicle crash, or a shooting incident. incompetence or unethical conduct of others to the appropriate The victims themselves, family members, friends, coauthority in a proper and professional manner.

workers, or bystanders then recognize the incident. Once the © Jones & Bartlett Learning, LLC that all EMTs should be © Jones & Bartlett Learning, LLC This code stems from the premise emergency is identified, the victim may receive care from NOT FOR SALEwith ORtheDISTRIBUTION FOR SALE OR DISTRIBUTION concerned welfare of others. It is a professional, NOT bystanders before arrival of the EMS system. Bystander care rather than legal, standard of behavior.

EMERGENCY

❂

may include such procedures as the following: • Relief of airway obstruction caused by a foreign body • CPR MEDICAL SERVICES SYSTEM AED application © Jones & Bartlett Learning,• LLC © Jones & Bartlett Learning, LLC • Bleeding control NOT FOR SALE OR DISTRIBUTIO NOT FOR SALE OR DISTRIBUTION • Comfort and reassurance

Emergency Medical Services (EMS) System • An organized approach to providing emergency care to the sick and injured.

System Access and Dispatch An EMS network ofLearning, coordinated services © system Jonesis &a Bartlett LLC that work as a unified whole to meet the emergency care needs of NOT FOR SALE OR DISTRIBUTION the community and to serve as a bridge between the community and the medical facilities that provide definitive health care. The primary responsibilities of an EMS system are to respond to requests for medical assistance, provide lifesaving or & stabilizing treatment, and transport Jones Bartlett Learning, LLC patients to definitive © medical care. All other components of the system indirectly

© NOT FOR SALE OR DISTRIBUTION

Next a decision made to& seek medical assistance. TheLLC EMS © isJones Bartlett Learning, system is thenNOT accessed, usually by telephone through a disFOR SALE OR DISTRIBUTION patch center. Callers in many communities reach the EMS dispatch center by dialing 9-1-1. Other communities may access EMS via a local sheriff, police, fire department, or centralized dispatch center. In some communities, people contact private ambulance or Learning, volunteer systems Jones & services Bartlett LLCdirectly rather than relying on a municipal service. NOT FOR SALE OR DISTRIBUTION


Chapter 1


15




© JonesB.&Recognition Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION

A. Incident occurrence






C. System access and dispatch © Jones & Bartlett

Learning, LLC NOT FOR SALE OR DISTRIBUTION

D. Prehospital care






© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIO E. Patient stabilization and transport


F. Delivery to hospital © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION


© Jones & Bartlett Learning, LLC DISTRIBUTION

FIGURE 1-8 Phases of emergency medical care. NOT FOR SALE OR


16

DIVISION ONE

Preparatory






© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION FIGURE 1-10 EMT-Is providing prehospital care.

FIGURE 1-9 Emergency medical dispatchers in a computerized dispatch

center. © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION

UNIVERSAL EMERGENCY NUMBER

© Jones & Bartlett Learning, LLC WISE NOT FOR STREET SALE OR DISTRIBUTION One of the oldest rules of patient care is “First, do no harm.” The Latin term for this is “Primum non nocere.”

The “universal” emergency telephone number 9-1-1 serves much of the United States.©This number need Jones & eliminates Bartlett the Learning, LLC © Jones & Bartlett Learning, LLC for separate telephone numbers for fire, police, and EMS NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Stabilization and Transport systems, as well as different access numbers for each community. As a result, help can be accessed more quickly. Serious and life-threatening conditions require that prehospital care be provided as soon as possible. For many patients, this care can be started and, to a great measure, completed Medical Dispatcher • A specially trained person who ❂ Emergency in the field. However, patients Learning, who require LLC blood © Jones & Bartlett Learning, LLC © Jonestrauma & Bartlett receives calls for emergency assistance and ensures proper EMS replacement and hemorrhage control OR can only be stabilized in NOT FOR SALE OR DISTRIBUTION NOT FOR SALE DISTRIBUTION response. the hospital. For these patients, resuscitation must be quickly initiated in the field or during rapid transport to the appropriate hospital (preferably a trauma center). Your ability to difMany dispatch centers are staffed with emergency medical ferentiate between patients who can be stabilized at the scene dispatchers (EMDs) (Figure 1-9). The EMD’s duties go and those&requiring prompt transport to the hospital is critical beyond answering telephones LLC and dispatching ambulances. © Jones © Jones & Bartlett Learning, Bartlett Learning, LLC for increasing long-term survival and reducing complications Often the EMD also receives extensive training in computerNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION and patient disability. aided dispatch, priority dispatch, delivery of prearrival In some cases, patient transport to the hospital may not be instructions, and system status management. Once the emernecessary. The call may be a false alarm; the patient may have gency call is processed, the EMD must select the most approgone to the hospital on his or her own by the time the ambupriate ambulance to dispatch to the scene. This decision lance arrives at the scene; or the © patient may & refuse treatment usually is based on the distance to the&call, the timeLearning, of day, © Jones Bartlett LLC Jones Bartlett Learning, LLC and/or transport. Some EMS systems also permit you to and the level of care needed to handle the emergency. NOT FOR SALE OR DISTRIBUTIO NOT FOR SALE OR DISTRIBUTION decide when patient transport to the hospital is not warranted. Referral to another means of transport may then be provided. Prehospital Care However, this must be done with great caution because it can expose you to increased risk of litigation as under some The treatment a patient receives before arrival at the hospital circumstances©this unilateral terminationLearning, of care can LLC fit the is referred to as prehospital care (Figure 1-10).LLC Prehospital © Jones & Bartlett Learning, Jones & Bartlett definition of abandonment. care is essentially an extension of hospital care. Prehospital NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION care providers now deliver lifesaving treatments that were performed only by physicians just a few decades ago. Delivery to the Hospital Although EMTs (i.e., EMT-B, EMT-I, and EMT-P) are On arrival at the hospital, the patient receives additional treatdelivering the care, the legal responsibility for providing ment in the emergencyLearning, department. You must ensure that an advanced management skills LLC still falls on the medical © Jones © Jones & Bartlett Learning, & Bartlett LLC appropriate transition from the ambulance crew to the hospidirection physician. However, that does not exempt EMS NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION tal staff takes place (Figure 1-11). This includes transferring from liability.


Chapter 1



17

MEDICAL DIRECTION © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION

❂

Medical Direction • Medical supervision of an EMS system and the field performance of EMTs.

© Jones & Bartlett Learning, LLC © Jones &EMT-I Bartlett Learning, LLC Many of the services you provide as an are derived FOR SALE NOT FOR SALE OR DISTRIBUTION from medical practices. TheNOT care provided in the OR field DISTRIBUTION is an

© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION FIGURE 1-11 Transfer of patient in hospital emergency department.


extension of hospital and physician services. As such, accepted standards of medical practice must be met. Medical direction ensures that you are providing appropriate highquality care. Physicians are regarded as the authorities on © Jones Bartlett Learning, issues of medical care,& and when properly educatedLLC and motiNOT FOR SALE OR DISTRIBUTION vated, physicians are a vital component of EMS. Although the system’s medical director is ultimately responsible for all of the medical care provided by his or her service, many duties may be delegated to other qualified colleagues.

© Jones & Bartlett Learning, LLC NOT FOR SALE• OR WrittenDISTRIBUTION instructions for the care of patients with spe❂ Protocols cific conditions, illnesses, or injuries. The medical director of an EMS system is responsible for developing these protocols.

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC The role of the EMS physician in providing medical direction includes the following: NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Educating and training of EMS personnel Participating in the personnel selection process Participating in equipment selection Developing clinical protocols in cooperation with expert © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC EMS personnel • Participating in quality and problem NOT FOR SALE OR DISTRIBUTION NOT FOR SALEimprovement OR DISTRIBUTION resolution FIGURE 1-12 Restoring the ambulance to its prerun condition. • Providing direct input into patient care • Serving as an interface between the EMS system and other health care agencies to an individual who is at an equivalent or higher level • Being an advocate for EMS within © Jones &care Bartlett Learning, LLC © Jones & Bartlett Learning, LLCthe medical community than your level of certification or licensure, informing the • Serving as the “medical conscience” NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTIONof the EMS system appropriate hospital staff of all pertinent patient information, • Being an advocate for quality patient care safely moving the patient from the ambulance cot to the emergency department bed, and completing the EMS run sheet so the hospital has a record of the prehospital care. STUDENT ALERT Following emergency department treatment,Learning, the patient LLC © Jones & Bartlett © Jones & Bartlett Learning, LLC may be admitted to the hospital for further care and recuperYou should know the difference betweenOR on-line NOT FOR SALE DISTRIBUTIO NOT FOR SALE OR DISTRIBUTION and off-line medical direction and be able to define the ation. After release from the hospital, the patient may need protocols for each. follow-up treatment and/or physical therapy as part of his or her rehabilitation. • • • •

Two types©ofJones medical&direction guide your day-to-day Bartlett Learning, LLCactivities. Direct medical direction, sometimes called on-line NOT FOR SALE OR DISTRIBUTION Following each emergency call, you must restore the ambumedical direction, is care rendered under direct orders, usually lance to its prerun condition. This includes completing all of over the radio or telephone (Figure 1-13). Direct medical the needed documentation, replacing any medical supplies direction is provided when you see a patient and contact used, and cleaning the ambulance and equipment used (Figure medical direction for instruction before rendering certain care. This must be done LLC in a timely fashion. Quick turnDirect direction may beLLC supplemented by telemetry. © Jones &1-12). Bartlett Learning, © Jones & medical Bartlett Learning, arounds of the ambulance are necessary because the dispatch Telemetry allows a patient’s ECG to be sent to the on-line NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION center may receive additional calls for help. physician for review and for help in determining appropriate

© Jones & Bartlett LLC Preparation for the Learning, Next Event NOT FOR SALE OR DISTRIBUTION


18

DIVISION ONE

Preparatory

treatment regimens. The hospitalLLC emergency department often © Jones perform & or treatments are allowed to deliver before conBartlett you Learning, LLC © Jones & Bartlett Learning, provides direct medical direction. Direct medical direction NOT sulting with medical direction are referred FOR SALE OR DISTRIBUTION to as standing NOT FOR SALE OR DISTRIBUTION

may also be provided at the scene by the EMS physician. In orders. You are expected to be familiar with your EMS some EMS systems, the medical director responds to emersystem’s protocols. When encountering a patient with a pargency calls. ticular illness or injury, you should initiate patient care based Indirect medical direction, or off-line medical direction, on the provisions of the protocol for that particular includes the development©ofJones a set of&written instructions, Bartlett Learning,emergency. LLC © Jones & Bartlett Learning, LLC known as protocols. Those procedures you are allowed to EMS physician involvement in indirect medical direction NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION has been divided into three phases: prospective, immediate (concurrent), and retrospective (Figure 1-14): • Prospective phase—Primarily administrative in nature. Duties include training; protocol development; system design; and selection& of equipment, supplies,LLC and © Jones & Bartlett Learning, LLC © Jones Bartlett Learning, personnel. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION • Immediate (concurrent) phase—Consists of both clinical and administrative responsibilities. The physician provides patient care, predominantly in the emergency department but sometimes in the field as well. The EMS physician participates in prehospital research studies. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC In addition, he or she performs concurrent review of the prehospital care NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION providers’ activities. This ongoing review process may take place in the field or in the emergency department. Finally, the EMS physician may give radio direction (direct medical direction). Retrospective phase—The physician reviews previous per© Jones & Bartlett Learning,• LLC © Jones & Bartlett Learning, LLC formance, including run report review, continuous NOT FOR SALEquality OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION improvement, continuing education, and risk management, in an attempt to improve future care. FIGURE 1-13 On-line medical direction from a physician at a hospital allows © Jones Bartlett Learning, LLC the physician to interact in&the care of a patient at the scene by using information supplied the EMSSALE provider. OR DISTRIBUTION NOTbyFOR


❂

Standing Orders • EMT-I field interventions that are completed © Jones & Bartlett Learning, LLC before contacting medical direction.


© Jones & Bartlett Learning, LLC MEDICAL NOT FOR SALE OR DISTRIBUTION DIRECTION

PROSPECTIVE

RETROSPECTIVE

© Jones & Bartlett Learning, LLC FOR SALE OR DISTRIBUTION

Initial training NOT Treatment protocols Triage protocols

© Jones & Bartlett Learning, LLC FOR SALE OR DISTRIBUTIO

Case reviews NOT Continuing education

CONCURRENT Emergency incident On-line medical direction Learning, Transport LLC guidelines © Continuous quality improvement

© Jones & Bartlett NOT FOR SALE OR DISTRIBUTION

Continuous quality improvement


Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION

Continuous quality improvement


FIGURE 1-14 Types of medical direction and oversight.


Chapter 1

19


systemsLearning, usually include andJones & Bartlett Learning, LLC © Jones &EMS Bartlett LLCa combination of direct © indirect medical direction. Commonly, protocols are followed Lay out NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION the for initial care of life-threatening problems, such as cardiac arrest, severe bleeding, major trauma, and shock. Once care has been provided to a certain point, you are required to Enforce contact the medical director for further instructions. Portions the plan of the protocols that are you are required to LLC © completed Jones &before Bartlett Learning, contact medical direction areFOR referred to as standing orders. NOT SALE OR DISTRIBUTION All EMTs function under some sort of medical direction. In some states, EMTs operate under the direction of a physician adviser. In other states, the use of a medical adviser or director is only recommended, not required. However, most states require active medical direction. Re-examine © Jones & Bartlett Learning, LLC © Jones

NOT FOR SALE OR DISTRIBUTION Medical Record Keeping

plan

Aid the problem

© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Continuous

quality improvement loop

Elaborate

& Bartlett Learning, LLC the cause NOT FOR SALE OR DISTRIBUTION Delineate

Accurate and thorough documentation of patient information the problem and treatment is an essential ingredient in maintaining the quality of the EMSLLC system. Documentation provides © Jones &overall Bartlett Learning, © Jones &FIGURE Bartlett Learning, LLC 1-15 Elements of continuous quality improvement. a record of what has taken place and conveys vital informaNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION tion about the patient and his or her emergency situation to other health care providers. Documentation also serves as a evaluations. The quality improvement process reveals probkey element in quality improvement activities designed to lems that may not otherwise be recognized. It can stimulate make the EMS system better. This includes retrieving the run changes in treatment protocols and be&used to justify the reports or electronic data, processing to obtain the necessary LLC © Jones & Bartlett Learning, © Jones Bartlett Learning, LLC acquisition of additional resources at budget time. also information for each case, storing for later retrieval when NOT FOR SALE ORItDISTRIBUTION NOTandFOR SALE OR DISTRIBUTION allows the EMS system’s management and medical direction indicated. Documentation is discussed in more depth in to evaluate and fix system problems in areas such as the Chapter 15. following: • Medical direction Continuous Quality Improvement • Financing © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC • Training NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION • Communication Continuous Quality Improvement • An evaluation of services ❂ • Out-of-hospital treatment and transport provided and the results achieved as compared with accepted standards. • Interfacility transport • Receiving facilities • Agency relationships © Jones &❂ Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Performance Improvement • A systematic process of discover• Specialty care units ing and analyzing human performance improvement gaps, then NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION • Dispatch developing cost-effective and ethically justifiable interventions to • Public information and education close performance gaps. • Quality improvement • Disaster planning The quality of an EMS system is reflected in the daily per• Mutual aid formance of its EMTs©and operational efficiency. The focus LLC Jones & Bartlett Learning, © Jones & Bartlett Learning, LLC A primary component of any quality improvement is of continuous quality improvement is on the EMS system and NOT FOR SALE program OR DISTRIBUTIO NOT FOR SALE OR DISTRIBUTION documentation. Patient care reports are checked for comnot on an individual. Ongoing quality improvement processes pleteness, accuracy of charting and assessment, adherence to should be in place to monitor and evaluate the delivery of system treatment protocols, and patterns of error or systemcare. Continuous quality improvement is considered an essenrelated problems. tial component of modern EMS systems. Another used to of performance Simply stated, quality improvement is the © Jones & continuous Bartlett Learning, LLC © way Jones & determine Bartlettlevels Learning, LLC is to directly observe the patient care you provide. Riding with you evaluation of EMS performance for the purpose of idenNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION as you respond to emergency calls and provide patient care tifying areas of needed improvement and implementing usually satisfies this evaluation. necessary corrections (Figure 1-15). Similarly, performance Response time data can be used to reveal operational effiimprovement strives to identify and correct gaps in perciency and can show the need for relocation of units or the formance that prevent optimum patient care. This evaluation acquisition of additional units. Other based on Learning, a comparisonLLC of the care delivered with © theJones © Jones &isBartlett & Bartlett Learning, LLCdata that are evaluated include dispatch tapes, prehospital care data, incident reports, accepted standards. Management personnel and physicians NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION and emergency department and inpatient records. responsible for system oversight most often complete these


20

DIVISION ONE

Preparatory

survival & andBartlett death. Effective public LLC information and educaaction must be taken Learning, © Jones Corrective & Bartlett Learning, LLC when improper care is © Jones tionFOR programs are needed to prepare the public to respond revealed. Likewise, proper or exceptional performance must NOT SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

appropriately to medical emergencies. These programs should teach the public how to do the following: • Recognize the signs and symptoms of serious illnesses or injuries. Access EMS (when, where, and how to use EMS). © Jones & Bartlett Learning,• LLC © Jones & Bartlett Learning, LLC • Provide lifesaving interventions such as CPR and AED NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Research use, relief of airway obstruction, and hemorrhage control Until recently, treatment protocols were often drawn directly (Figure 1-16). from the hospital setting. This occurred despite the marked Public information and education campaigns can also be used differences between the prehospital and hospital environto reduce or prevent disease and injuries, increase compliance ments. Furthermore, protocols and procedures with treatment©regimens, reduce unnecessary use of pre© Jones &many Bartlett Learning, LLC used Jonesand & Bartlett Learning, LLC today evolved without clinical evidence of their usefulness, cious EMS and non-EMS health care resources. Alternatives NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION safety, or even benefit to the patient. EMS providers must now such as identifying less expensive transportation options and begin to prove which patient care protocols and techniques referring persons to non–hospital emergency department clinare useful and beneficial. As changes in professional stanical providers and freestanding emergency clinics are effecdards, training, equipment, and procedures are contemplated, tive means of reducing misuse, as well as keeping the overall they be based on empiricalLLC data rather than “great ideas” © Jones cost of the operation down. These © Jones &must Bartlett Learning, & system Bartlett Learning, LLC campaigns can be developed cooperatively with health care organizations such or “new gadget” models. This is referred to as evidence-based NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION as hospitals, public health departments, or other provider medicine. agencies, thereby increasing the integration of EMS into the community’s health care system and public safety arena ❂ Research • The scientific study, investigation, and experimenta(Figure 1-17). tion conducted to establish facts and determine their significance. You should also be an advocate for citizen&involvement in © Jones & Bartlett Learning, LLC © Jones Bartlett Learning, LLC the EMS system. Citizens can assist in establishing needs andDISTRIBUTION NOT FOR SALE OR NOT FOR SALE OR DISTRIBUTION parameters for system improvement, as well as providing an Prehospital research can help eliminate much of the unceroutside, objective view into quality improvement and problem tainty associated with prehospital care. Questions such as resolution. This creates informed, independent advocates for “Why do we treat patients this way in the field?” “Does this the EMS system. treatment benefit many patients?” and “Does it harm some?” Marketing © campaigns an effectiveLearning, way of improving must be©asked to continually EMS practices Jones & Bartlettjustify Learning, LLC and Jones are & Bartlett LLC the image of the EMSFOR systemSALE by increasing visibility and proprotocols. NOT FOR SALE OR DISTRIBUTION NOT OR DISTRIBUTION jecting a positive image of the EMS providers. Many systems A number of benefits can be derived from conducting preuse off-duty personnel to conduct classes or deliver speeches hospital research. Most important, prehospital research has the immediate potential of saving lives or limiting morbidity by improving current and future patient care delivered in the field. is important that you recognize © Jones & ItBartlett Learning, LLC the difference between © Jones & Bartlett Learning, LLC research based on scientific method and a magazine article NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION based on the writer’s opinion. Research can also prove that prehospital care makes a difference and is valuable. This is particularly important in times of recession and slow growth, when budget cuts are seen in every area of medicine and public service. Research©also enhances recognition and Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC respect for EMS professionals. NOT FOR SALE OR DISTRIBUTIO NOT FOR SALE OR DISTRIBUTION be communicated to you to help reinforce the behavior. Most important, quality improvement must be linked with ongoing professional education. Finally, appropriate EMS research can help enhance quality improvement efforts.

PUBLIC INFORMATION AND EDUCATION Although on maintaining ©primary Jonesresponsibilities & Bartlettcenter Learning, LLC high© Jones & Bartlett Learning, LLC quality, NOT out-of-hospital emergency care, ancillary responsibilFOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ities may involve participating in public education and health promotion programs as deemed appropriate by the community. You serve as a role model; communities will look to you for leadership and direction in their public education and prevention activities.Learning, LLC © Jones & Bartlett © Jones & Bartlett Learning, LLC The ability to recognize a serious medical emergency and FIGURE 1-16SALE CPR courses the public to respond appropriately in a NOT FOR SALE OR DISTRIBUTION NOT FOR ORprepare DISTRIBUTION activate the system may mean the difference between patient cardiac emergency situation.


Chapter 1



21

• Nearly 60 million people are LLC injured in the United States © Jones & Bartlett Learning, annually, and injury accounts for 1 in 6 hospital NOT FOR SALE OR DISTRIBUTION

admissions. • The most common fatal injuries in this country result from motor vehicle crashes, followed closely by gunshot wounds. • In 2001, there were 42,116 people who died as a result of © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC motor vehicle crashes, and 3 million more were injured. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION • Driving while impaired by alcohol is the most frequent cause of fatal motor vehicle crashes and accounts for approximately 40% of traffic fatalities. An injury is intentional or unintentional damage to a person that is produced by acute exposure Learning, to thermal, mechanical, © Jones & Bartlett Learning, LLC © Jones & Bartlett LLC electrical, radiological, or chemical energy or by the lack of NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION such essentials as heat or oxygen. Approximately 75% of all FIGURE 1-17 Educating the community about the EMS system. injuries are caused by mechanical or kinetic energy during events such as motor vehicle crashes, falls, and firearms being to schools and civic organizations. These activities can also discharged. Examples of injuries that occur as a result of a used to recruit future employees or volunteers into © theJones lack & of Bartlett heat or oxygen are frostbite and drowning. © Jones &beBartlett Learning, LLC Learning, LLC EMS system. An accidental injury is referred to as unintentional. An NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION You are responsible and accountable to medical direction, injury that occurs because of a purposeful action either to the public, and your peers. You should seek to take part in oneself (e.g., suicide) or to another person (e.g., homicide) is lifelong professional development and peer evaluation and called an intentional injury. Approximately one third of all assume an active role in professional and community deaths from injury are caused by intentional injuries. organizations. lifeJones lost when injury results in © Jones & Bartlett Learning, LLC The years of productive © &an Bartlett Learning, LLC death are calculated by subtracting the ageSALE of deathOR from 65. NOT FOR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION For example, if a 35-year-old were killed in a car crash, it ILLNESS AND INJURY PREVENTION would be a loss of 30 years of productive life. This value can help determine the cost associated with trauma in relation to Throughout your career, as you treat ill and injured patients, the potential earnings a person may have over his or her you© may find yourself asking, “Why did this have lifetime. © Jones & Bartlett Learning, LLC Jones & Bartlett Learning, LLCto happen?” As an EMT-I, youSALE are likely to respond to many tragic cases A person’s surviveOR an injury is influenced by NOT FOR OR DISTRIBUTION NOTability FORtoSALE DISTRIBUTION that could have been avoided. Part of your role as an EMT-I factors such as physical size, age, and whether there is exisis to help reduce the incidence of injury by educating the tence of underlying disease. public on illness and injury prevention, such as safe driving Injury risks may be defined as the real or potential hazand crash avoidance practices. ardous situations that put individuals at risk for sustaining an injury. An example is riding aLLC bicycle without a helmet. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, Falling from the bicycle can cause a head injury. This would NOT FOR Epidemiology SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION be considered an injury risk. Injury surveillance is the ongoing systematic collection, analysis, and interpretation of injury INCIDENCE, MORBIDITY, AND MORTALITY data that are essential to the planning, implementation, and Epidemiology is the study of the elements that influence the evaluation of public health practice. You serve an important frequency, distribution, and causes of injury, disease, and LLC role because you are in a position to see cause ofLearning, many © Jones & Bartlett Learning, © Jones & the Bartlett LLC other health-related events in a population. To help understand injuries. This information can then be reported through instruNOT FOR SALE OR DISTRIBUTIO NOT FOR SALE OR DISTRIBUTION what epidemiology is, it is helpful to be familiar with several ments such as the EMS run report or other documents specifimportant concepts. Trauma is one of the most prevalent ically designed for this data collection. It is closely integrated health problems that the United States faces today. Think with the timely dissemination of these data to those who need about the following facts listed in the Annals of Emergency to know. The final link in the surveillance chain is the appliMedicine, June 2003: cation of © these data to&prevention control. To LLC expand on © Jones & Bartlett Learning, LLC Jones Bartlettand Learning, • Unintentional injury is the leading cause of death in the the example of the person who received a head injury as a NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION United States for people between the ages of 1 and 34 result of falling from a bicycle, this information could be used years. to develop and implement a public education program to • Annually, these injuries rob the nation of approximately 4 increase the wearing of helmets while riding bicycles. million years of potential life. Primary injury prevention is defined as keeping an injury There are Learning, as many as 148,000 from&ever occurring. Secondary LLC prevention and tertiary pre© Jones &• Bartlett LLC trauma deaths in the United © Jones Bartlett Learning, States each year, with direct and indirect health care costs vention are the care and rehabilitation activities (respectively) NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION estimated at $260 billion. that prevent further problems from resulting from an event


22

DIVISION ONE

Preparatory

budgetary& support should be established that&has already Learning, occurred. A teachable Bartlett Learning, LLC to reward and/or © Jones Bartlett LLC moment is the time © Jones remunerate participation. Where possible, EMS organizations after an injury has occurred when the patient and observers NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION remain acutely aware of what has happened and may be more receptive to learning about how the event could have been prevented.

should provide their EMS providers the opportunity for rotational assignments to prevention programs and salary for offduty injury prevention activities.

Jones & Bartlett Learning,RECOGNIZING LLC © FOR Jones & Bartlett Learning, LLC FEASIBILITY OF EMS© INVOLVEMENT THE NEED NOT FOR SALE OR DISTRIBUTION OUTSIDE RESOURCES NOT FOR SALE OR DISTRIBUTION More than 600,000 EMS providers in the United States are widely distributed amid the population and often reflect the composition of the community. In a rural setting, the EMS provider may be the most medically educated individual. Often EMS providers high-profile role models who are © Jones & are Bartlett Learning, LLC considered champions of the customer. Furthermore, EMS NOT FOR SALE OR DISTRIBUTION providers are welcome in schools and other environments and are considered authorities on injury and prevention.

Depending on the size of the community and its particular needs, conducting preventive education can be extremely challenging, if not impractical, for the EMS system to do alone. Many EMS agencies&collaborate other groups to © Jones Bartlett with Learning, LLC conduct some NOT or all ofFOR their preventive education campaigns. SALE OR DISTRIBUTION Community groups such as the American Red Cross, Mothers Against Drunk Driving (MADD), and junior auxiliaries are great resources for initiating community and school programs. Hospitals (particularly trauma centers and children’s hospiESSENTIAL LEADERSHIP ACTIVITIES tals) often their own preventiveLLC education programs in © Jones & Bartlett Learning, LLC © Jones & have Bartlett Learning, EMS organizations have an opportunity to save lives and which EMS agencies can partner. State highway safety offices NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION reduce injury by establishing and maintaining prevention proare often able to provide funding for traffic-related projects, grams in their community. The first step to take is to lead by such as those involving child safety seats, seat belts, and example. EMS management must emphasize and support the drunk driving. safety and wellness of its EMS providers. Policies should be The financial wherewithal may not be available for EMS put in place to promote safety throughout all aspects of work, agencies is necessary. © Jones & Bartlett Learning, LLC to do all of the public©education Jones that & Bartlett Learning, LLC particularly during the emergency response, at the The good news is that financial support can often be obtained NOT FOR SALE OR DISTRIBUTION NOT FOR SALEwhile OR DISTRIBUTION scene, and then during transport. EMS personnel should be from local businesses and local clubs such as the Rotary Club, provided with and required to don the proper body substance Masons, and so on. Large corporations will commonly donate isolation (BSI) and personal protective equipment (PPE) to funds or provide services in exchange for being listed as a guard against exposure to bloodborne and airborne pathogens, sponsor of a given program. Advertising agencies are often as well as hazards. Other topics such as proper willing to contribute billboard space for Learning, safety messages and ©environmental Jones & Bartlett Learning, LLC © Jones & Bartlett LLC lifting techniques; scene survival techniques (such as how to public service NOT announcements. Local OR television and radio staNOT FOR SALE OR DISTRIBUTION FOR SALE DISTRIBUTION defend against violent patients or other hostile attackers); tions are often willing to run public service messages at no vector control; and safe response to and management of cost. Local hospitals are frequently agreeable to including hazardous materials, temperature extremes, communicable safety messages in newsletters and flyers that are distributed disease, and structural risks (to name a few) should be taught to a community-wide audience. Another potential source of and&practiced. When the specific training is not available, in- © Jones funding for public education is local,LLC state, and federal grant © Jones Bartlett Learning, LLC & Bartlett Learning, house liaisons with public and private sector specialty groups programs. In short, there are a lot of sources of financial NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION can be established as a means of obtaining the needed edusupport for community injury prevention programs. cation and training. The next step to take is to implement the actual commuIMPLEMENTATION OF nity-based injury prevention program. A key to the success of PREVENTION STRATEGIES any prevention program is © to Jones get “buy-in” from employees at & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC every level. EMS personnel must recognize the need and In the normal course of your duties, there are many opportuNOT FOR SALE OR DISTRIBUTIO NOT FOR SALE OR DISTRIBUTION benefit of being involved in prevention activities. Education nities for you to provide on-scene trauma prevention educaabout the fundamentals of injury prevention can help to estabtion (Figure 1-18). An example is educating a child about the lish this understanding and appreciation. Information about rules for safely crossing the street following a non–lifeprevention programs is incorporated into most of today’s threatening injury that occurred because the child darted across instead© of looking ways Learning, and ensuringLLC safe primary © andJones continuing EMS education programs. & Bartlett Learning, LLC Jones & both Bartlett passage. However, an important point to emphasize is that this Individual EMS providers should be empowered to NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION education should never interfere with assessing and managconduct primary injury prevention activities in their commuing the incident or the patient’s injuries. nities. There are many activities that can be done both on and Begin by looking at each emergency response to an ill or off the job. It is essential that EMS managers identify and injured patient and identifying whether the necessary precauencourage interest and support. Where possible, internal




Chapter 1


23


community needs to LLC identify its own unique © JonesEach & Bartlett Learning, approaches to prevention. Conducting NOT FOR SALE OR DISTRIBUTIONformal needs assess-



ments will assist in identifying priorities. Consider the following types of programs: • Flu immunizations • Blood pressure screening • Elder care clinics © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC • Defensive driving classes NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION • Workplace safety courses • Alternative means of transportation • After care services • Rehabilitation • Grief support © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC • Bicycle helmet programs NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION • Drinking-while-driving prevention programs at high FIGURE 1-18 As part of handling emergency calls, EMT-Is should look for schools opportunities to provide on-scene prevention education. Prevention information also can be listed on the local EMS agency’s Internet website. The types and number of programs that & canBartlett be offeredLearning, are limitless. It really comes down to how © Jones & Bartlett Learning, LLC © Jones LLC tions have been taken to reduce or eliminate the risk factors much time and energy the organization NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTIONcan commit to prethat are associated with that type of emergency and then idenventive education programs. By collaborating with other tify whether there is a likelihood of possible recurrence of the organizations, an EMS agency can achieve a great deal more given behavior. If it is unlikely that the behavior will be than would be possible by itself. repeated, then the education is not needed unless it is aimed at educating others who are there & with the patient. © Jones Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Effective communication is anSALE important of the NOT FOR SALE OR DISTRIBUTION NOT FOR ORpart DISTRIBUTION educational process. Begin by establishing rapport with the patient and family members or friends (if appropriate). A sense of timing is important; recognize whether the moment is a teachable one. In other words, is the patient receptive to the education and&likely to accept and internalize it? Emotions © Jones Bartlett Learning, LLC © Jones & Bartlett Learning, LLC the NOT patient FOR is experiencing, suchDISTRIBUTION as anger or fear, can interSALE OR NOT FOR SALE OR DISTRIBUTION fere with his or her reception of your message. It is better to Case History Follow-Up wait for the right moment to pass along the message. It is also essential to come across in as nonjudgmental and objective a EMT-I McCormack’s supervisor pages him to call the manner as possible. Also be considerate of ethnic, religious, station as he is waiting for his lunch order. He calls the social diversity issues. If you offend a person in the course his cellLearning, phone and asks, “What’s up?” © Jones &and Bartlett Learning, LLC © Jonesunit & from Bartlett LLC “We have a group of students from Gurney Elemenof delivering your message, it is unlikely that the message will NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION tary coming in at 1:30 this afternoon. I’ll place your unit be accepted and the behavior changed. on backup; I want you to come in and show them your Typically, on-scene education involves telling persons how unit and answer their questions. Okay?” they can prevent recurrence and communicating the need for “That’s great, I really enjoy the kids. I hope we don’t or use of protective devices. Resources can be identified for miss anything good,” McCormack says. He walks back to the following: © Jones & Bartlett Learning, LLCthe table and says to Marquette, © Jones & got Bartlett Learning, LLC “We’ve a show-and• Safety devices tell this afternoon.” NOT FOR SALE OR DISTRIBUTIO NOT FOR SALE OR DISTRIBUTION • Child-protective services EMT-Is McCormack and Marquette know all of the • Food, shelter, and clothing questions and have all of the answers because they have Look for situations that are suggestive of sexual abuse, both done public presentations for many years: “What’s it domestic abuse, or elderly abuse. These should be reported to like to be an EMT-I?” “What do you do when someone isn’t breathing?” the worst thing you’ve ever the © receiving at theLearning, facility where the patient is Jonesphysician & Bartlett LLC © Jones“What’s & Bartlett Learning, LLC seen?” transported or to appropriate agencies in the comNOT FOR SALE ORprotective DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Both realize they cannot tell the children about the munity. Be sure to follow local and state policies. It may be worst thing they have ever seen, but they do enjoy recallworthwhile for you to develop a social services resource guide ing the story of when they delivered twin girls. for your organization to help in identifying solutions and ideas for these and other situations.


24

DIVISION ONE

Preparatory

SUMMARY © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION

• The number of hoursLearning, required for EMT-I © Jones & Bartlett LLC training averages 300 to 400 hours of instruction, including NOT FOR SALE OR DISTRIBUTIONclassroom time,

Important points to remember from this chapter include the instruction in practical skills, and clinical instruction. following: • Reciprocity allows the transfer of certification or • An EMS system is a network of coordinated services that licensure from one state to another. In some states, work as a unified whole to meet the emergency care needs reciprocity is automatic, especially if you are nationally of the community and© to Jones serve as & a bridge between the registered. Bartlett Learning, LLC © Jones & Bartlett Learning, LLC community and the medical facilities that provide defini• A professional is a person who hasFOR certainSALE specialOR skillsDISTRIBUTION NOT NOT FOR SALE OR DISTRIBUTION tive health care. and knowledge in a specific area and conforms to the stan• To practice as an EMT-I in most states you are required to dards of conduct and performance in that area. complete a recognized EMT-I course, successfully com• Attributes of professional behavior include having plete a written and practical examination, and become cerintegrity, empathy, a professional manner, good appeartified © or Jones licensed. & Bartlett Learning, LLC ance and © personal and appropriate Joneshygiene, & Bartlett Learning,general LLC


















Chapter 1


25

conduct; being a patient advocate; treating others with © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC respect; having self-motivation/personal involvement NOT and FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION self-confidence; maintaining good communications; exercising good time management; and employing teamwork, diplomacy, and careful delivery of service. • To maintain the right to function as an EMT-I, most states require you to become recertified every 1 to Learning, 5 years (the LLC © Jones & Bartlett average being 2 years). NOT FOR SALE OR DISTRIBUTION • Continuing education is essential for helping you reduce the erosion of knowledge and skills and to stay current on new procedures and treatment. It also encourages further professional development.



















Chapter 1 Foundations of EMT-Intermediate

Chapter 1 Foundations of EMT-Intermediate

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