Quiz 1 Flashcards
Define emergency medical services (EMS) systems.
EMS is a team of healthcare professionals who are responsible for and provide emergency care and transportation to the sick and injured
Name the four levels of EMT training and licensure
Emergency medical responder (EMR):
Basic emergency care and operations training
focused on managing the emergency scene and initiating immediate lifesaving care before the ambulance arrives
May perform roles under the direction of providers with more advanced training
Emergency medical technician (EMT):
Additional depth and breadth of training in basic emergency care and transportation of sick and injured patients
Most commonly focus on initial stabilization of the scene and fundamental emergency care
The primary link between the emergency scene and the healthcare system
Advanced EMT (AEMT):
Additional preparation beyond the EMT level that includes training and education in specific areas of advanced life support
Intravenous (IV) therapy
Advanced airway management
Administration of certain emergency medications
The primary focus is on more advanced assessment techniques and selected emergency interventions
Paramedic:
Greatest breadth and depth of education and training among emergency care providers
Focuses on ALS assessment
Interpretation of heart rhythms
Advanced airway management
Emergency pharmacology
Function as part of a collaborative response, working under medical direction with EMS providers of other levels to help extend the reach of the healthcare system
Describe EMT licensure criteria; include how the Americans With Disabilities Act (ADA) applies to employment as an EMT
High school diploma or equivalent
Proof of immunization against certain infectious diseases
Successful completion of a background check and drug screening
Valid driver’s license
Successful completion of a recognized health care provider basic life support (BLS)/cardiopulmonary resuscitation (CPR) course
Successful completion of stature-approved EMT course
Successful completion of a state-recognized practical certification examination (NREMT)
Successful completion of a state-recognized practical certification examination
Compliance with other state, local, and employer provisions
The Americans with disabilities act (ADA) of 1990 protects people who have a disability from being denied access to programs and services that state or local governments provide and prohibits employers from failing to provide full and equal employment to the disabled
Protects disabled EMTs
Employers with a certain number of employees are required to adjust processes so that a candidate with a disability can be considered for the position, and when possible, modify the work environment or how the job normally performed
Discuss the historical background of the development of the EMS system
Early use of motor vehicles in warfare
Volunteer ambulances were organized and personnel went overseas to provide care for the wounded in World War I
During World War II, the military trained special corpsmen to provide care in the field and bring the casualties to aid stations staffed by nurses and physicians
In the Korean War, field medics and rapid helicopter evacuation to nearby mobile army surgical hospital units had evolved, where immediate surgical interventions could be performed
Many advances in immediate care for trauma patients resulted from casualty experiences in the Korean and Vietnam wars
In the 1960s and early 1970s, emergency ambulance service and care varied widely across the US
In some places, it was provided by well-trained advanced first aid personnel who had well-equipped, modern ambulances.
In a few urban areas, it was provided by hospital-based ambulance services that were staffed with interns and early forms of prehospital care providers
In many areas, emergency and ambulance care was provided by local funeral homes using a hearse that could be converted to carry a cot and function as an ambulance
The police or fire department in some areas used station wagons that carried a cot and first aid kit
Basic first aid training was provided sometimes
Many communities did not have formal provisions for prehospital emergency care or transportation
Except in large urban centers, most hospitals did not have the emergency department (ED) staff available today
EMS today originated from the 1966 publication of Accidental Death and Disability: The Neglected Disease of Modern Society
Prepared by the committees of Trauma and shock of the National Academy of Sciences/National Research Council
Revealed the inadequacy of prehospital emergency care and transportation
As a result, congress mandated two federal agencies to address these issues
NHTSA enacted the Highway Safety Act of 1966
DHHS enacted the Emergency Medical Servies Development Act of 1973
1970s
Early 1970s: DOT developed and published the first curriculum to serve as the guideline for EMT training
1971: The American Academy of Orthopaedic Surgeons prepared and published the first EMT book: Emergency Care and Transportation of the Sick and Injured
States began developing their legislation and guidelines
Late 1970s: DOT developed a recommended National Standard Curriculum for the education training of paramedics
During the 1980s: many areas enhanced the EMT National Standard Curriculum by adding EMTs with advanced levels of training who could provide key components of ALS care and advanced life-saving procedures
1990s: NHTSA began an examination of EMS from a national perspective
2019: NHTSA revised document and published EMS agenda 2050
Describe the levels of EMT training in terms of knowledge, skills, and attitudes needed for each of the following: EMR, EMT, AEMT, and paramedic
EMR
Law enforcement officers, firefighters, park rangers, ski patrollers, or other organized rescuers who arrive at the scene before the ambulance and EMTs
Training provides the skills necessary to initiate immediate care and work with the EMTs on their arrival
Providing immediate care with limited equipment before the arrival of an ambulance
Familiarizes students with additional procedures, equipment, and packaging techniques
EMT
Apply KSAs to meet the minimum performance required to practice at the level of certification
EMT courses are 150 to 200 hours
On arrival at the scene, EMTs who have responded should assume responsibility for the assessment and care of the patient and follow the proper packaging and transport of the patient to the ED, if appropriate
AEMT
Add knowledge and skills in specific aspects of ALS to providers who have been trained and have experience in providing emergency care (EMTs)
IV and IO therapy
Advanced airway adjuncts
Administer medication (limited)
AEMT courses are 200 to 400 hours
Fill in gaps in areas where paramedics are limited
Paramedic
Extensive education and training that significantly increases knowledge and mastery of basic skills
Wide range of ALS skills
The course ranges from 1,000 to well over 2,00 hours
Classroom and internship training
Associate or Bachelor’s degrees are available
Explain the guiding principles of EMS Agenda 2050.
Multidisciplinary, national review of all aspects of EMS delivery
Develop a more cohesive and consistent system across the country
Guiding principles
Reliable and prepared, ensuring EMS care is delivered consistently and compassionately and is guided by sound research at all times, by all EMS providers, at all levels, or from all agencies
Socially equitable, so that access to care and the quality of care are not determined by a patient’s age, socioeconomic status, gender, ethnicity, or where they live
Sustainable and efficient, meaning systems must be fiscally responsible, providing value to the community with a minimum of waste and a maximum of accountability
Adaptable and innovative, evolving to meet the changing needs of the people whom they serve by continuously evaluating new tools and techniques, education programs, and system designs
Inherently safe and effective, so the entire system from start to finish is designed to minimize exposure to injury, infections, illness, or stress
Integrated and seamless, where EMS is fully integrated with all other aspects of health care and is engaged with other emergency services and within the communities in which they operate
Describe how medical direction in an EMS system works and the EMT’s role in the process
Each EMS has a physician medical director
Authorizes the EMTs in the service to provide medical care in the field either offline (indirect) or online (direct)
EMTs may not always encounter their medical director but in virtually all systems the appropriate care for each injury, condition, or illness encountered in the field is determined by the medical director (written orders and protocols)
If treatment problems arise or different procedures, medical directors determine and decide the course of action
Each EMT must know and follow the protocols developed by their medical director
Define mobile integrated health care and community paramedicine
Mobile integrated healthcare (MIH): a method of delivering healthcare that utilizes the prehospital spectrum of care resources
The goal is to improve access to healthcare at an affordable price
Healthcare is provided within the community rather than physician’s office or hospital
A team of healthcare providers, including EMS providers, deliver healthcare services in the community and connect patients with valuable services/resources
Community paramedicine: experienced paramedics who receive advanced education and training to equip them to provide services within a community
Services provided may include
Health evaluations
Monitoring chronic illnesses or conditions
Obtaining lab samples
Immunizations
Patient advocate
Explain the purpose of the EMS continuous quality improvement (CQI) process.
Continuous quality improvement (CQI): quality management process that encourages team members at every level of the health care system to ask “How are we doing now?” and “What can we do better?”
Capitalizes on strengths and addresses challenges
Helps prevent future errors and improve the quality of care (learning and improvement process)
Characterize the EMT’s role in disease and injury prevention and public education in the community
Primary prevention: strategies that will prevent the vent from ever happening
EMTs can become involved in programs that educate the community or teach certain life-saving procedures (first aid/CPR)
Secondary prevention: the event has already happened
EMTs can be involved in the surveillance of illness and injuries
Reports can be used to determine if the larger issue exists and improve worldwide knowledge and safety
Identify the body’s topographic anatomy, including the anatomic position and the planes of the body.
Anatomical position palms up and feet forward
Planes of the body
The coronal (frontal) plane divides the body front/back
The sagittal plane divides the body left/right
The midsagittal plane divides the body into equal left/right halves
The transverse plane divides the body top/bottom
Identify the anatomy and physiology of the skeletal system.
Skeletal system functions to provide structure/form to our body and protect our vital organs
Also helps produce red blood cells and absorb calcium
206 bones in the skeletal system
Axial: main trunk (skull, facial bones, thoracic cage, vertebral column)
Skull
Composed of 28 bones divided into 3 groups: facial, cranium, and three small bones in the ear
Cranium: frontal, temporal, parietal, occipital, ethmoid, and sphenoid
Fused, these bones protect the brain
The Foramen magnum is where the brainstem leaves the cranial vault
Facial: maxillary, zygomatic, mandible
Orbit is a cavity for the eye (eye socket)
Vertebral column
Intervertebral disks are between vertebrae in the column; shock absorption
Thorax
Contains the heart, lungs, esophagus, great vessels
Sternum: manubrium (uppermost), xiphoid process (lower part)
Appendicular: everything else (legs, arms)
Upper body
Extend distally from the pectoral girdle (shoulder, clavicle, scapula)
The thumb consists of only proximal and distal phalanges. Other fingers have proximal, middle, and distal
Lower body
Hip bones are also called coxae
The tibia is the most anterior and largest of the leg bones. Fibula is found lateral
Protrusions around ankle: malleolus
The foot contains calcaneus (heel), talus, tarsal, metatarsals, phalanges
Plantar: bottom
Dorsum: top
Physiology
Gives body shape, protects vital organs, and allows movement
Stores calcium
Important for strengthening bones
Produces red blood cells, white blood cells, and platelets in the marrow
Joints are where two bones meet. Ligaments help stabilize and reinforce bone-to-bone connection
Hinge (flexion/extension)
Ball-and-socket (rotation, flexion/extension)
Cartilage helps cushion articulating bones
Articular cartilage covers bones, allowing bones to glide more easily
The inner lining of joint capsules contains the synovial membrane where synovial fluid exists
Describe the anatomy and physiology of the musculoskeletal system
Three types of muscle
Skeletal
Attaches to the skeletal system (musculoskeletal)
Voluntary movement
Biceps anterior, triceps posterior
Smooth
In blood vessels and intestines
Involuntary
cardiac
Heart
Involuntary
Physiology
Produces heat (helps maintain homeostasis)
Protect underlying structures
Discuss the anatomy and physiology of the respiratory system
Upper airway:
Nasopharynx
Pharynx connects with the nasal cavity above the soft palate
Warm and filters air
Oropharynx
The pharynx in the back of the throat
Laryngopharynx
Where food, fluids, and air diverge
Food/fluids: esophagus (post.)
Air: trachea (ant.)
Larynx (divides the upper and lower airway)
The vocal cords
Does not tolerate food/fluid (causes coughing)
Epiglottis protects the larynx (like a lid)
Lower airway:
Trachea
~5 inches (13 cm)
Bronchial tree (bronchi, bronchioles)
At the carina of the trachea, the bronchi divide. In the lungs, bronchi further divide into bronchioles
Alveoli
Bronchioles has sac-like structures called the alveoli
Within these sacs are pulmonary capillaries which is where gas exchange occurs
Lungs
Held in place by trachea, arteries and veins, and the pulmonary ligaments
Divided into lobes
R lung: upper, middle, lower (bigger)
L lung: upper, lower
Covered in pleura with a fluid
Visceral (lungs)
Parietal (chest)
The diaphragm has characteristics of skeletal and smooth muscle
Physiology
Provide the body with oxygen and eliminate carbon dioxide
Ventilation is the movement of air and required chest rise and fall
Respiration is the exchange of gases
Balances pH
Breathing
Brainstem controls breathing
Breathing occurs as the result of a buildup of CO2 (decreases pH of CSF)
CSF regulates the acid-alkaline balance of the body
The medulla sends signals to the phrenic nerve to stimulate ventilation
Medulla controls rhythm, initiates inspiration, sets base patterns of respiration, sends signal to phrenic to contract diaphragm
Pons controls augments respiration during emotional or phyical stress
Hypoxic drive: backup system to control respiration
Stimulate breathing when O2 levels fall (not as sensitive as CO2 detection)
Children depend more heavily on the diaphragm to breathe
Tidal volume: the amount of air that is moved into or out of the lungs in a single breath
Inspiratory reserve volume is the deepest breath you can take after a normal breath
Expiratory reserve volume is the maximum air you expel after a normal breath
Residual volume: the amount of gas that remains in the lungs after exhalation
Dead space: area of the respiratory system that has no alveoli (where little to no gas exchange occurs)
Minute volume: the amount of air that moves in and out of the lungs within a minute
Respiratory rate x Tidal volume= minute volume
Normal respiratory rates
Children and adults: 12-20 breaths/min
Infants: 30-60 breaths/min
Discuss the anatomy and physiology of the circulatory system
Two circuits
Systemic circulation: body
Carries oxygenated blood from the left ventricle through the body and back to the right atrium
Pulmonary circulation: lungs
Carries deoxygenated blood from right ventricle through the lungs and back to the left atrium
Heart
Left side pumps blood to the body in high pressure pump
Lungs- Pulmonary veins-left atrium-mitral valve- left ventricle- contraction- aorta- body (oxygenated)
Right side pumps blood the the lungs in low pressure pump
Recieves blood from the veins of the body
Superior/inferior vena cava- enter right atrium-tricuspid valve- right ventricle- contraction- pulmonic valve- pulmonary circulation/arteries (deoxygenated)- to lungs
Heart is controlled by the autonomic nervous system
But has it own electrical system that allows it to pump without CNS
Cannot survive in anaerobic conditions
30% of blood is in the heart, arteries, and capillaries
Arteries
Arteries- arterioles- capillaries
Contract to accommodate blood loss and increase blood pressure
Tunica media: middle layer of artery formed by smooth muscle that contract and dilate
Moves head to feet
Veins
Venules- veins
Moves feet to head
Systemic vascular resistance (SVR): the resistance to blood flow within all blood vessels except pulmonary vessels
70% of blood is within veins and venules
Plasma: the liquid portion of the blood that carries blood cells, hormones, and nutrients
Water: 92%
Proteins: 7%
Oxygen, carbon dioxide, nitrogen, nutrients, cellular waste, hormones, others
Spleen helps support circulatory system
Old and degraded blood cells are digested in the spleen and liver
Has high vasculature; damage causes severe internal bleeding
Physiology
Blood prssure is the force of circulating blood against the walls of the arteries (systolic pressure/diastolic pressure)
Systole: phase in the cardiac cycle when the left ventricle of the heart contracts and pumps blood into the aorta
Pressue in the arteries during this time is called systolic blood pressure
Diastole: the time between contractions when the ventricle is relaxed and refilling with blood
Diastolic blood pressure
Loss of blood pressure indicates blood is no longer circulating efficiently to every organ in the body
Good blood pressure also does not indicate that its reaching all parts of the body
Reasons: organs, tissues, and cells are no longer adequately perfused or supplied with oxygen and fuel, and wastes accumulate
Hypoperfusion: inadequate perfusion
Affecting the entire body= shock
Stroke volume: the amount of blood ejected from the ventricle each cardiac cycle
Perfusion: the circulation of blood in an organ or tissue
Mean arterial pressure= (Heart rate x Stroke volume) x systemic vascular resistance
MAP= cardiac output x systemic vascular resistance
Sympathetic nervous system sends commands to adrenal glands to release epinephrine and norepinephrine to stimulate the heart and blood vessels
Alpha adrengic receptors are found in the blood vessels; Beta adrengic receptors in heart and lungs
When alpha adrenigc receptors are stimulated, the blood vessels constrict and increase blood pressure
When Beta adregnic receptors are stimulated…
Beta-1 causes heart rate to increase and squeeze hard with each contraction (increases cardiac output)
Beta-2 causes bronchi of the lungs to dilate (more airflow and increased oxygen available to cells)
Release of these hormones help cope with stress
How does the brain know? Baroreceptors (special pressure sensors)
