Part 2: Preparing To Become An EMT Flashcards
Where is the origin of modern EMS?
Funeral home ambulances
The White Paper is the nickname for what document?
Accidental death and disability: the neglected disease of modern society (1966)
What is considered the birth of modern EMS?
White paper
Purpose of white paper
Snow inadequacies of prehospital care in US (especially in trauma)
When was The first EMT National standard curriculum developed? By who?
Early 1970s; US dept of transportation (DOT)
When was the first EMT textbook created?
1970s
What EMT advances happened in 1970s
DOT develops first EMT NSC
First EMT Textbook (Orange Book) published
DOT publishes first paramedic NSC
What EMT advances happened in 1980s?
AHA increased focus on CVD prevention, science, education
Additional levels of training added to existing EMT and paramedic education
What EMT advances happened in 1990s?
NREMT advocates for national training curriculum
NHTSA begins work on “EMS agenda for the future” document
Increased public access and layperson AED use/training
Which organization created EMS agenda for The future?
National Highway Transportation Safety Administration (NHTSA)
What new curriculum did the NHTSA develop in the 2000s to replace EMT NSC
National Emergency Medical Services Education Standards (NEMSES)
When were the 4 levels of EMS licensure/certification created?
2000s
Components of EMS system (14)
Public access Clinical care Medical direction Integrated health services Information systems Prevention Research Communications Human Resources Legislation and regulation Evaluation Finance Public education Education systems
Enhanced 911 systems allow for what?
Automatic number and location identification by dispatcher
Emergency Medical responder
Provides basic immediate care, including bleeding control, CPR, AED, and emergency childbirth
Emergency Medical technician
Includes all EMR skills plus: Advanced O2 and ventilation skills, pulse ox, noninvasive bp monitoring, and admin of certain meds
Advanced EMT
Includes all EMT skills plus: advanced airways, IV and IO access, blood glucose monitoring, and admin of add’l meds
Paramedic
Includes all preceding training levels plus: advanced assessment and management skills, various invasive skills, and extensive pharmacology interventions
Highest level of prehospital care
Paramedic
Specialty facilities
Stroke center, cardiac center, trauma center, denavioral center, pediatric center, obstetric center, poison center
EMT activities that are high risk to parent
Transfer of patent care Lifting and moving patients Transporting patient in ambulance spinal precautions Administration of medications
3 error types
Failure to perform Skills adequately
Lack of knowledge leading to poor decision making
Failure to follow established protocols
Medical director
Physician responsible for providing medical oversight
Online medical direction
Direct contact between physician and EMT via phone or radio
Offline medical direction
Written guidelines and protocol
Continuous quality improvement (cqi)
Continuous audit and review of all aspects of EMS system to identify areas of improvement
EMT‘s safety priorities after personal safety
Partner then patient then bystander
components of maintaining scene safety
addressing scene specific hazards
appropriate infection control precautions
safe lifting and moving techniques
types of stress
acute, delayed, and cumulative
acute stress
immediate physiological and psychological reaction to specific event; fight or flight reaction triggered
delayed stress
stress reaction that develops after the stressful event
PTSD is an example of which type of stress
delayed
cumulative stress
the result of exposure to exposure to stressful situations over a prolonged period of time
critical incident stress management (CISM)
a formalized process to help emergency workers deal with stress
defusing session
CISM session held within 4 hours of incident
debriefing session
CISM session held 24 to 72 hours after incident
stages of grief
- denial
- anger
- bargaining
- depression
- acceptance
infectious diseases are caused by…
invading pathogen
which type of infections respond to antibiotics? which are antibiotic-resistant?
bacterial; viral
OSHA
occupational safety and health administration; oversees regulations concerning workplace safety
standard precautions
safety precautions to be implemented for all patient contacts, based on the assumption that all body fluids pose the risk of infection
standard precautions
safety precautions to be implemented for all patient contacts ,
single most important way to prevent spread of infection
handwashing
ppe
equipment and supplies necessary to implement standard precautions for a specific for a specific patient encounter
minimum PPE
gloves and eye protection should be used during any patient contact situation
expanded PPE for significant contact with body fluid
disposable gown and mask
expanded PPE for suspected airborne disease exposure
high-efficiency particulate air mask or N-95 respirator
recommended immunizations and vaccines for EMTs
regular TB testing hepatitis B vaccination series tetanus shot flu vaccine MMR vaccine varicella vaccine
power lift
keep object close to body, use legs to lift, use power grip with palms up and all fingers wrapped around the object
emergency moves
used when scene is dangerous and patient must be moved before providing patient care; armpit-forearm drag, shirt drag, blanket drag
urgent moves
used when patient has potentially life-threatening injuries or illness and must be moved quickly for evaluation and transport; rapid extrication
rapid extrication
urgent move used for patients in motor vehicle; requires multiple rescuers and a long backboard
patient is rotated onto backboard with manual c-spine precautions and removed from vehicle
non-urgent moves
used when there are no hazards and no life-threatening conditions apparent; direct ground lift, extremity lift, direct carry method, and draw sheet method
wheeled stretcher
stretcher that secures in ambulance for transport; usually safest way to move patient; most models can accommodate at least 300 pound; newer models have automated lift system
portable stretcher
lightweight and compact stretcher that allows more accessibility than wheeled stretchers
stair chair
patient movement device that works well for staircases and small elevators; does not allow manual c-spine protection, CPR, or artificial ventilation
backboard
lightweight patient movement device; allows CPR, artificial ventilation, and c-spine immobilization; requires 4 person lift
scoop stretcher
patient movement device; separates into 2 long pieces; allows easy positioning with minimal patient movement; good for reducing patient discomfort
neonatal isolette
movement device to keep neonatal patients warm during transport
special considerations for patients with skeletal abnormalities
patients with unusual curvature of spine, such as kyphosis or lordosis, may not be capable of lying supine without special padding
special considerations for transporting pregnant patients in later stages of pregnancy
they should not be layed supine; place them on their left side
how to transport pregnant patient with possible cervical spine trauma
lay them on their back on a backboard and tilt backboard to the left about 20 degrees
when can medical restraints be used
if patient poses a significant, immediate threat to you, your partner, or others
use of force doctrine
the emt must act reasonably to prevent harm to a patient being forcibly restrained; use of force should be protective, not punitive
scope of practice
the actions a provider is legally allowed to perform based on his or her license or certification level
standard of care
the degree of care a reasonable person with similar training would provide in a similar situation
types of consent
informed consent expressed consent implied consent minor consent involuntary consent
informed consent
required of all alert and competent patients;
patient must be informed of your care plan and associated risks of accepting or refusing care and transport
expressed consent
requires the patient to be alert and competent;
can be given verbally or nonverbally
to obtain consent for basic assessments/procedures
implied consent
assumed consent for emergency care from an unresponsive or incompetent patient;
can also be used to treat a patient who initially refused care but later lost consciousness
minor consent
because minors are not competent to accept or refuse care, consent is required from parent or guardian;
implied consent can be used if unable to reach parent or guardian and treatment is needed;
not required for emancipated minors
involuntary consent
used for mentally incompetent adults or those in custody of law enforcement
advanced directives
written instructions, signed by patient, specifying patient’s wishes regarding treatment and resuscitative efforts;
DNRs an Living Wills
DNR (Do Not Resuscitate)
type of advanced directive specific to resuscitation efforts; do not affect treatment prior to patient entering cardiac arrest
Living Will
type of advanced directive that addresses health-care wishes prior to entering cardiac arrest; includes use of advanced airways, ventilators, feeding tubes, etc; broader than DNR
Good Samaritan Laws
laws designed to protect some who renders care as long as he or she is not being compensated and gross negligence is not committed
criminal law
government entity vs a person; includes assault and battery
assault
if you inflict harm on someone or even if someone perceives that you intended to inflict harm on them
battery
physically touching another person without their consent
civil law
individual (plaintiff) sues EMT (defendant); plaintiff seeks monetary compensation
reasons for civil lawsuits against EMT
negligence, abandonment, false imprisonment, hospital destination, patient refusals
negligence
unintentional harm to the patient
4 things plaintiff must prove for negligence suit
duty to act, breech of duty, damage, causation
duty to act
obligation to respond and provide care
breech of duty
failure to assess, treat, or transport patient according to standard of care
damage
Plaintiff experiences damage or injury by legal system as worthy of compensation
causation
injury to plaintiff was, at least in part, directly due to EMTs breech of duty
gross negligence
an indifference to, and violation of, a legal responsibility; reckless patient care that is clearly dangerous to patient
abandonment
termination of care without transferring the patient to an equal or higher medical authority
false imprisonment
transporting a competent patient without consent
times when EMT can release confidential patient info without consent
info is necessary for continuity of care
info is necessary to facilitate billing for services
EMT has received valid subpoena
reporting possible crimes, abuse, assault, neglect, certain injuries, or communicable diseases
HIPAA
federal law established 1996 that improves privacy protection of patient health care records
2 acts that guarantee public access to emergency care and stop inappropriate transfer of patient (Patient dump)
COBRA and EMTALA
presumptive signs of death
indicate need to b begin resuscitation; include unresponsiveness, pulselessness, apnea
definitive/obvious signs of death
indicate that resuscitation should not be initiated; decomposition, rigor mortis, dependent lividity, decapitation
decomposition
physical decay of body components
rigor mortis
stiffening of body after death
dependent lividity
settling of blood within body
decapitation
patients head is no longer attached to body
when must law enforcement or medical examiner be notified at the scene?
any scene where patient is dead on arrival, suicide attempts, assault or sexual assault, child or elder abuse, suspected crime scene, childbirth
bioethics
ethical issues related to healthcare
bioethics
ethical issues related to healthcare
