Chapter 1, 2, 3, and 9 Flashcards
“white paper”
“Accidental Death and Disability: The Neglected Disease of Modern Society”
- detailed # deaths/injuries
- identified issues with prehospital care
- made recommendations for improvements
EMS system
the continuum of patient care that extends from the time of injury or illness until rehabilitation or discharge
National Highway Traffic Safety Administration (NHTSA)
- part of the Department of Transportation
- leader in developing emergency services
- 2005 National EMS Core Content
- 2006 The National EMS Scope of Practice
Technical Assistance Program Assessment Standards (10)
- Regulation and Policy
- Resource management
- Human resources and training
- Transportation
- Facilities
- Communications
- Public information and education
- Medical direction
- Trauma systems
- Evaluation
Enhanced 911 System (E-911)
provides automatic number ID (ANI) and automatic location ID (ALI)
PSAP (public service answering point)
public service answering point:
- receive all 911 calls
- records call info
- alerts responding service
EMD
emergency medical dispatcher
- staff PSAP
- provide instructions for emergency care over the phone
Basic 911
wireless service providers must transmit cals to a PSAP regardless of subscription status
Phase I Enhanced 911
wireless service provider must provide PSAP with phone number and transmitting tower of caller
Phase II Enhanced 911
wireless service provider must provide latitude and longitude of caller
National EMS Scope of Practice Model
- released by NHTSA in 2005
- national standards
Identifies 4 levels of EMS practitioners:
1. Emergency Medical Responder (EMR)
2. Emergency Medical Technician (EMT)
3. Advanced EMT (AEMT)
4. Paramedic
EMR scope of practice
x
EMT Scope of Practice
x
AEMT Scope of Practice
x
Paramedic Scope of Practice
x
Hyperbaric Center
treatment of certain toxic exposures, diving emergencies, and other conditions
Obstetrical Center
for treatment of high-risk obstetric (birth) patients
State EMS Agency Role
- Overall planning of the statewide EMS system
- Coordination of the system
- Regulation of the system
- Licensing local EMS agencies and personnel
Medical Director
physician who is legally responsible for the clinical and patient care aspects of the EMS system
Medical Direction
Develop and establish protocols
Protocols
guidelines under which the EMS personnel function
Off-line medical direction
set of predetermined, written guidelines that allow EMTs to use their judgement to administer care without having to contact a physician
Standing Orders
subset of protocols that do not require real-time physician input (type of offline medical direction)
Medical Oversight
all of clinical and administrative functions and activities performed by the medical director
Continuous Quality Improvement (CQI)
system of internal and external reviews and audits of all aspects of an emergency medical system
Evidence-based Medicine
focuses on research to provide clear evidence that certain procedures, medications and equipment improve the patient’s outcome
- Formulate a question
- Search medical literature
- Appraise the evidence
- Change protocols and implement the change as needed
5 Emotional Stages (DABDA)
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
Acute Stress Reaction
results from exposure to a high-stress situation
Delayed Stress Reaction (PTSD)
- can occur months or years after incident
- nightmares, irritability, insomnia, inability to think clearly or concentrate…
Cumulative Stress Reaction
- result from extended exposure to stress
- Burnout: state of exhaustion and irritability, anxiety
Categories of Stress Reaction Symptoms
- Thinking
- Psychological
- Physical
- Behavioral
- Social
Critical Incident Stress Management (CISM)
process to deal with stress encountered by EMT
2 forms:
1. Debriefing (CSID)
2. Defusing
Critical Incident Stress Debriefing (CISD)
- held within 24-72 hours of the incident counselers help: 1. review facts of event 2. identify signs and symptoms 3. plan of action to return to job etc
Defusing
- version of CISD held within 1-4 hours of incident
- less organized, vent emotions, prepare for CISD
Bacteria
microscopic single-celled organisms that have the capability of reproducing on their own within a host
Virus
require a host cell to reproduce
Pathogens
- Bacteria
- Viruses
- Fungi
- Protozoa
- Helminths
Helminths
parasitic worms
Standard Precautions pg. 24
- developed by OSHA
- aka Body Substance Isolation (BSI)
- guidelines to protect EMT from infection and disease transmission
Standard precautions for TB
- Gloves
- Eyewear
- HEPA or N-95 Respirator
- hand washing
Cleaning
washing with soap and water
Disinfecting
cleaning plus a hospital-grad disinfectant or germicide
Sterilization
object is subject to a chemical or physical substance that kills all microorganisms on the surface of an object
Purified Protein Derivitave (PPD) test for TB
test every year
Nat. Standard for High-Vis… pg 33
developed by ANSI and ISEA
Scope of Practice
actions and care that EMTs are legally allowed to perform by the state
Standard of Care
performing the right assessment and care, or what to do and how to do it
“reasonable person standard”
Informed Consent
patient is informed of care, risks and consequences
Implied Consent
“emergency doctrine”
patient is unconscious or mentally impaired
Expressed Consent
patient clearly cooperates and consents with care
Minor Consent
Consent by parents or guardians to treat a minor
Advance Directives
- written in advance
- signed by patient and physician
Living Will
specific guidelines for care i.e. life support
Durable Power of Attorney
aka Health Care Proxy
-makes med decisions for patirent sdfa
Physician Orders for Life-Sustaining Treatment (POLST)
specifies the level/limits of treatment as desired by the patient (expected to live less than 1 year). w/ dr. contact info and dates
Signs of Death
- Lividity
- Rigor Mortis
- Decapitation
- Incineration
- Ivisceration?
If patient refuses care:
- Try to convince patient to go to the hospital
- Fully inform patients of rights
- Thoroughly document
- Patient signs AMA (release of liability), witness forms, etc.
- If unsure if patient is mentally sound, contact medical direction
EMTALA
hospital assumes care until release or transfer of patient
COBRA
with EMTALA
Involuntary Consent
mentally incompetent adult or individual in the custody or law enforcement or incarcerated
Neonate
child from birth to 1 month of age
Infant
child from 1 month to 1 year of age
Passive Immunity
- first 6 months of life
- antibodies from mother
Fontanelles
indirect estimate of hydration for babies
Neonate Vitals
30-40 respirations per minute
100-160 beats per min (bpm)
70-90 mmHg systolic blood pressure
98-100 degrees F
Toddler Vitals (1-3 years of age)
20-30 respirations per minute
80-130 bpm
70-100 systolic blood pressure
98.6 - 99.6 degrees
Adolescent Vitals (12-18 years)
12-20 respirations per minute
55-105 bpm
100-120 systolic bp
98.6 degrees
Adult Vitals
16-20 respirations per minute
70 bpm
120/80 bp
98.6 degrees
Vitals in Children
heart and respiratory rates decrease while systolic blood pressure increases
Kids Vitals (School Age)
20-30 respirations
70-110 bpm
80-120 systolic
98.6 degrees
