EMT Notes
Chapter 1 Notes
EMS systems
All EMTs can drive ambulance
Check all equipment before shift
Medical director authorizes EMTs to provide care
o Tells you what to do
o Cannot do things without their permission
o Quality control to ensure appropriate standards are met
Medical control by radio or phone or indirectly
o Authorized by medical director
Errors
o Rules-based, breaking legal rights
o Knowledge-based, not knowing enough
o Skills-based, equipment is not operating
CoAEMSP establishes national standards
Primary prevention is before it has happened
o Proactive
Secondary prevention is reducing effects
45% of EMTs by fire dept
PSA (primary service area) is where you operate
Public health looks at entire populations to prevent health problems
Public safety access point is call center
History of EMS
Corpsmen in military to care in field
First aid by police, fewer ambulances in 70s
90s, NHTSA national EMS exam
o EMS Agenda for the Future
National EMS Scope of Practice Model outlines skills performed
White Paper revealed inadequacy of prehospital emergency care/transport
EMS administered through Department of Transportation
EMT is foundation, basic emergency care
o Can assist in complicated delivery
AEMT can administer inhaled beta-agonist (for dyspnea and wheezing)
Paramedic can perform needle chest decompression
EMR < EMT < AEMT < Paramedic
Roles/responsibilities/professionalism of EMS personnel
Respect is most important
Patient advocacy is centered around needs of patient
Attention to detail and safety
, Only disclose info to receiving nurse/physician
Advanced life support = cardiac monitoring, IV, airway adjuncts
Community paramedicine = training to provide additional services
Continuous quality improvement is reviews and audits
Emergency medical dispatch = helps select the appropriate units
EMR is first trained professional to help
Licensure is when state allows a regulated act to be performed
Mobile integrated healthcare is within community rather than at hospital
Chapter 2 Notes
Stress Management
Stress is anything perceived as a threat
Personal safety > scene safety > patient care
Limit sugar, fats, sodium, alcohol
o Rely on complex carbohydrates
At least 30 mins exercise weekly
Vitamins B (water-soluble) and C subject to depletion
Delayed stress reaction occurs after the stimulus is gone
Acute stress reactions are in-the-moment
Cumulative stress reactions are from everything piling on at once
General adaptation syndrome: alarm, reaction and resistance, recovery/exhaustion
Quid pro quo is requesting sex in exchange for something else
Critical incident stress management directs emergency services to equilibrium
OSHA develops, publishes, enforces workplace safety guidelines
Caring for Critically Ill and Injured Patients
Reduce patient anxiety
Encourage patients to express pain/fear
Illness
Vector-borne transmission is by animals or insects
Report exposure to infection control officer
Communicable disease means can be spread
CDC in United States
o Standard precautions to avoid risk
Hepatitis from viral infection = inflamed liver, causes fever, loss of appetite, jaundice,
fatigue
Infection control to prevent spread of illness
If patient has Tb, put surgical mask on them and N95 on you
Prevention of Injury
Gloves and eye protection are minimum
Block traffic with heavy vehicle
If unsure about safety, wait for further personnel to arrive before approaching
, Keep distance if there are hazardous materials
o Until instructed by trained hazardous materials responders
Lightning can be direct strike and ground strike
With electric hazards, wear a helmet with chin strap and face shield
With falling hazards, have a hat with top and side protection and chin strap
Fire hazards
o Smoke
o Oxygen deficiency
o High ambient temperatures
o Toxic gases
o Building collapse
o Equipment
o Explosions
o Breathing [CO2] above 10-12% = death in a few minutes
o CO is responsible for most fire deaths
Cover and concealment uses an impenetrable barrier
Chapter 3 Notes
Consent
From every conscious adult
o Implied consent if unconscious (durable power of attorney for health care)
o Advance directive: written document that specifies what care to provide if
patient cannot make decisions
Aka living will
Expressed consent is like reaching out arm to allow you to take blood pressure
Patient autonomy: patient can make health decisions about self
If cannot contact a minor’s parents, keep treating them
o Implied consent
o Employment is not emancipation of minor, but army, marriage, and parenthood
are
Need a release form if someone denies care
o And get a witness to see them sign it
If someone denies care, keep asking them questions to try and get them to consent
Wait for law enforcement if patient is combative and poses a risk to others
Standard of care: how reasonably a person with similar training acts under similar
circumstances
Credentialing: determine qualifications necessary to practice a profession
DNR, still treat just do not resuscitate
o If has an expiration date, must be dated within preceding year to be valid
o If written orders are not present, resuscitate
o Must detail specific case
MedicAlert bracelet has patient info on a foundation
, Res ispa loquitor: EMT held liable even when unable to demonstrate how injury
occurred
Death
Definitive signs of death (at least 2 of the following)
o Obvious mortal damage (decapitation)
o Dependent lividity (discoloration from blood pooling at lower body) and Rigor
mortis
o Putrefaction (decomposition)
Presumptive signs of death
o No systolic blood pressure
o No response to pain
o Lack of carotid pulse or heartbeat
o Absence of chest rise/fall
o No deep tendon or corneal reflexes
o Absence of pupillary reactivity
o Profound cyanosis
o Lowered or decreased body temperature
Moral Obligations
Bioethics: ethics of healthcare
Immunity laws do not provide immunity when injury is from negligence or willful
misconduct
Spoken defamation is called slander
o Written is libel
Contributory negligence: when defendant feels that the conduct of patient contributed
to their injuries
Scope of practice is what you can legally provide
Standard of care is how you must behave
EMT not judged for level of training
o Not same standard of care as physician
If you volunteer off duty, you must continue to provide care until an equal or higher
authority assumes care
Negligence determined by
o Duty
o Breach of duty
o Damages
o Causation
False imprisonment is keeping someone for a long amount of time
o In the ambulance
Good Samaritan law requires
o Acted in good faith
o Rendered care without expecting compensation
Chapter 1 Notes
EMS systems
All EMTs can drive ambulance
Check all equipment before shift
Medical director authorizes EMTs to provide care
o Tells you what to do
o Cannot do things without their permission
o Quality control to ensure appropriate standards are met
Medical control by radio or phone or indirectly
o Authorized by medical director
Errors
o Rules-based, breaking legal rights
o Knowledge-based, not knowing enough
o Skills-based, equipment is not operating
CoAEMSP establishes national standards
Primary prevention is before it has happened
o Proactive
Secondary prevention is reducing effects
45% of EMTs by fire dept
PSA (primary service area) is where you operate
Public health looks at entire populations to prevent health problems
Public safety access point is call center
History of EMS
Corpsmen in military to care in field
First aid by police, fewer ambulances in 70s
90s, NHTSA national EMS exam
o EMS Agenda for the Future
National EMS Scope of Practice Model outlines skills performed
White Paper revealed inadequacy of prehospital emergency care/transport
EMS administered through Department of Transportation
EMT is foundation, basic emergency care
o Can assist in complicated delivery
AEMT can administer inhaled beta-agonist (for dyspnea and wheezing)
Paramedic can perform needle chest decompression
EMR < EMT < AEMT < Paramedic
Roles/responsibilities/professionalism of EMS personnel
Respect is most important
Patient advocacy is centered around needs of patient
Attention to detail and safety
, Only disclose info to receiving nurse/physician
Advanced life support = cardiac monitoring, IV, airway adjuncts
Community paramedicine = training to provide additional services
Continuous quality improvement is reviews and audits
Emergency medical dispatch = helps select the appropriate units
EMR is first trained professional to help
Licensure is when state allows a regulated act to be performed
Mobile integrated healthcare is within community rather than at hospital
Chapter 2 Notes
Stress Management
Stress is anything perceived as a threat
Personal safety > scene safety > patient care
Limit sugar, fats, sodium, alcohol
o Rely on complex carbohydrates
At least 30 mins exercise weekly
Vitamins B (water-soluble) and C subject to depletion
Delayed stress reaction occurs after the stimulus is gone
Acute stress reactions are in-the-moment
Cumulative stress reactions are from everything piling on at once
General adaptation syndrome: alarm, reaction and resistance, recovery/exhaustion
Quid pro quo is requesting sex in exchange for something else
Critical incident stress management directs emergency services to equilibrium
OSHA develops, publishes, enforces workplace safety guidelines
Caring for Critically Ill and Injured Patients
Reduce patient anxiety
Encourage patients to express pain/fear
Illness
Vector-borne transmission is by animals or insects
Report exposure to infection control officer
Communicable disease means can be spread
CDC in United States
o Standard precautions to avoid risk
Hepatitis from viral infection = inflamed liver, causes fever, loss of appetite, jaundice,
fatigue
Infection control to prevent spread of illness
If patient has Tb, put surgical mask on them and N95 on you
Prevention of Injury
Gloves and eye protection are minimum
Block traffic with heavy vehicle
If unsure about safety, wait for further personnel to arrive before approaching
, Keep distance if there are hazardous materials
o Until instructed by trained hazardous materials responders
Lightning can be direct strike and ground strike
With electric hazards, wear a helmet with chin strap and face shield
With falling hazards, have a hat with top and side protection and chin strap
Fire hazards
o Smoke
o Oxygen deficiency
o High ambient temperatures
o Toxic gases
o Building collapse
o Equipment
o Explosions
o Breathing [CO2] above 10-12% = death in a few minutes
o CO is responsible for most fire deaths
Cover and concealment uses an impenetrable barrier
Chapter 3 Notes
Consent
From every conscious adult
o Implied consent if unconscious (durable power of attorney for health care)
o Advance directive: written document that specifies what care to provide if
patient cannot make decisions
Aka living will
Expressed consent is like reaching out arm to allow you to take blood pressure
Patient autonomy: patient can make health decisions about self
If cannot contact a minor’s parents, keep treating them
o Implied consent
o Employment is not emancipation of minor, but army, marriage, and parenthood
are
Need a release form if someone denies care
o And get a witness to see them sign it
If someone denies care, keep asking them questions to try and get them to consent
Wait for law enforcement if patient is combative and poses a risk to others
Standard of care: how reasonably a person with similar training acts under similar
circumstances
Credentialing: determine qualifications necessary to practice a profession
DNR, still treat just do not resuscitate
o If has an expiration date, must be dated within preceding year to be valid
o If written orders are not present, resuscitate
o Must detail specific case
MedicAlert bracelet has patient info on a foundation
, Res ispa loquitor: EMT held liable even when unable to demonstrate how injury
occurred
Death
Definitive signs of death (at least 2 of the following)
o Obvious mortal damage (decapitation)
o Dependent lividity (discoloration from blood pooling at lower body) and Rigor
mortis
o Putrefaction (decomposition)
Presumptive signs of death
o No systolic blood pressure
o No response to pain
o Lack of carotid pulse or heartbeat
o Absence of chest rise/fall
o No deep tendon or corneal reflexes
o Absence of pupillary reactivity
o Profound cyanosis
o Lowered or decreased body temperature
Moral Obligations
Bioethics: ethics of healthcare
Immunity laws do not provide immunity when injury is from negligence or willful
misconduct
Spoken defamation is called slander
o Written is libel
Contributory negligence: when defendant feels that the conduct of patient contributed
to their injuries
Scope of practice is what you can legally provide
Standard of care is how you must behave
EMT not judged for level of training
o Not same standard of care as physician
If you volunteer off duty, you must continue to provide care until an equal or higher
authority assumes care
Negligence determined by
o Duty
o Breach of duty
o Damages
o Causation
False imprisonment is keeping someone for a long amount of time
o In the ambulance
Good Samaritan law requires
o Acted in good faith
o Rendered care without expecting compensation
