SECTION 1 STUDY GUIDE NOTE CARDS Flashcards
DISPATCHER / EMERGENCY MEDICAL DISPATCHER (EMD)
- PLAYS A ( ) () IN AN EMS CALL.
- RECEIVES, ( ) AND ( ) ALL INFORMATION ON THE CALL.
- RELAYS INFORMATION TO THE APPROPRIATE ( ).
- THEY MAY BE TRAINED AS AN EMD ().
- TASKED WITH GIVING SIMPLE ( - ) INSTRUCTIONS (ie , BLEED CONTROL).
DISPATCHER / EMERGENCY MEDICAL DISPATCHER (EMD)
- PLAYS A KEY ROLE IN AN EMS CALL.
- RECEIVES AND ENTERS, INTERPRETS ALL INFORMATION ON THE CALL.
- RELAYS INFORMATION TO THE APPROPRIATE RESOURCES.
- THEY MAY BE TRAINED AS AN EMD (EMERGENCY MEDICAL DISPATCHER).
- TASKED WITH GIVING SIMPLE PRE-ARRIVAL INSTRUCTIONS (ie CPR, BLEED CONTROL).
EMERGENCY MEDICAL RESPONDER
- UNTIL RECENTLY WAS KNOWN AS “( ) ( )”.
- IS USUALLY A PERSON TRAINED IN () AND/OR ( ).
- HAS COMPLETED A COURSE THAT COVERS THE NATIONAL EMS ( ) STANDARDS FOR THE EMR LEVEL.
- THIS TRAINING WILL HELP THE EMR:
- RECOGNIZE THE () OF A PATIENT’S CONDITION.
- PROVIDE () CARE.
- RELAY INFORMATION TO THE ().
- ESSENTIAL LEVEL OF PROVIDER TO THE EMS SYSTEM, ESPECIALLY IN ().
EMERGENCY MEDICAL RESPONDER
- UNTIL RECENTLY WAS KNOWN AS “FIRST RESPONDER”.
- IS USUALLY A PERSON TRAINED IN CPR AND/OR FIRST AID.
- HAS COMPLETED A COURSE THAT COVERS THE NATIONAL EMS EDUCATION STANDARDS FOR THE EMR LEVEL.
- THIS TRAINING WILL HELP THE EMR:
- RECOGNIZE THE SERIOUSNESS OF A PATIENTS CONDITION.
- PROVIDE BASIC CARE.
- RELAY INFORMATION TO THE PARAMEDIC.
- ESSENTIAL LEVEL OF PROVIDER TO THE EMS SYSTEM, ESPECIALLY IN RURAL AREAS.
EMERGENCY MEDICAL TECHNICIAN (EMT)
- () AND PRIMARY () LEVEL IN MANY EMS SYSTEMS.
- REQUIRED LEVEL OF () REQUIRED BEFORE BEING ABLE TO ENTER A () EDUCATION PROGRAM.
- SKILLS AND () LEVEL FROM STATE TO STATE.
- THEY MAY BE TRAINED IN:
- ADVANCED () INTERVENTION.
- LIMITED () ADMINISTRATION.
- INTRAVENOUS FLUID ().
- EMTs WITH THIS EXPANDED () OF PRACTICE ARE NOT RECOGNIZED AT A DIFFERENT () LEVEL PER THE NATIONAL EMS EDUCATION STANDARD.
- IN EMS, THERE ARE MORE () TRAINED AND CERTIFIED AT THE () LEVEL THAN AT ANY OTHER LEVEL.
EMERGENCY MEDICAL TECHNICIAN (EMT)
- BACKBONE AND PRIMARY PROVIDER LEVEL IN MANY EMS SYSTEMS.
- REQUIRED LEVEL OF CERTIFICATION REQUIRED BEFORE BEING ABLE TO ENTER A PARAMEDIC EDUCATION PROGRAM.
- SKILLS AND TREATMENTS LEVEL FROM STATE TO STATE.
- THEY MAY BE TRAINED IN:
- ADVANCED AIRWAY INTERVENTION.
- LIMITED MEDICATION ADMINISTRATION.
- INTRAVENOUS FLUID THERAPY.
- EMTs WITH THIS EXPANDED SCOPE OF PRACTICE ARE NOT RECOGNIZED AT A DIFFERENT CERTIFICATION LEVEL PER THE NATIONAL EMS EDUCATION STANDARD.
- IN EMS, THERE ARE MORE PROVIDERS TRAINED AND CERTIFIED AT THE EMT LEVEL THAN AT ANY OTHER LEVEL.
ADVANCED EMT
- FORMERLY CALLED EMT () (EMT-I).
- DEVELOPED IN ( ) AND WAS KNOWN AS THE EMT I-85 LEVEL
- RECENTLY, CHANGES IN THE () SCOPE OF PRACTICE HAVE () THE INTERMEDIATE LEVEL.
- REPLACED WITH THE () EMT (AEMT).
- TRAINED IN MORE ADVANCED (), AS WELL AS SOME () PROCEDURES SUCH AS:
- ESTABLISHING IV ().
- ADMINISTERING IV ().
- PERFORMING BLOOD GLUCOSE ().
- ADMINISTERING SEVERAL ().
- SOME ADVANCED () MANAGEMENT.
ADVANCED EMT
- FORMERLY CALLED EMT INTERMEDIATE (EMT-I).
- DEVELOPED IN 1985 AND WAS KNOWN AS THE EMT I-85 LEVEL
- RECENTLY CHANGES IN THE NATIONAL SCOPE OF PRACTICE HAVE ELIMINATED THE INTERMEDIATE LEVEL.
- REPLACED WITH THE ADVANCED EMT (AEMT).
- TRAINED IN MORE ADVANCED PATHOPHYSIOLOGY, AS WELL AS SOME ADVANCED PROCEDURES SUCH AS:
- ESTABLISHING IV ACCESS.
- ADMINISTERING IV FLUIDS.
- PERFORMING BLOOD GLUCOSE MONITORING.
- ADMINISTERING SEVERAL MEDICATIONS.
- SOME ADVANCED AIRWAY MANAGEMENT.
PARAMEDIC
- HIGHEST EMS SKILL LEVEL YOU CAN BE () AND () AT THE NATIONAL LEVEL.
- IN ( ) THE US DOT () CURRICULUM UNDERWENT MAJOR REVISIONS AND THE LEVEL OF TRAINING AND SKILLS () GREATLY.
- IN () WHEN THE NATIONAL EMS EDUCATION STANDARDS WERE COMPLETED, THE SKILLS AT THE PARAMEDIC LEVEL () TO SOME EXTENT.
- IN () TO TEST THROUGH (), A PARAMEDIC MUST HAVE ATTENDED AND () COMPLETED TRAINING AT AN () INSTITUTION.
- STATES REQUIRE PARAMEDICS TO FUNCTION DIRECTLY UNDER THE () OF A LICENSED () AND TO BE AFFILIATED WITH A () LEVEL SERVICE.
PARAMEDIC
- HIGHEST EMS SKILL LEVEL YOU CAN BE CERTIFIED AND LICENSED AT THE NATIONAL LEVEL.
- IN 1998 THE US DOT PARAMEDIC CURRICULUM UNDERWENT MAJOR REVISIONS AND THE LEVEL OF TRAINING AND SKILLS INCREASED GREATLY.
- IN 2009 WHEN THE NATIONAL EMS EDUCATION STANDARDS WERE COMPLETED, THE SKILLS AT THE PARAMEDIC LEVEL CHANGED TO SOME EXTENT.
- IN 2013 TO TEST THROUGH NREMT, A PARAMEDIC MUST HAVE ATTENDED AND SUCCESSFULLY COMPLETED TRAINING AT AN ACCREDITED INSTITUTION.
- STATES REQUIRE PARAMEDICS TO FUNCTION DIRECTLY UNDER THE GUIDANCE OF A LICENSED PHYSICIAN AND TO BE AFFILIATED WITH A PARAMEDIC LEVEL SERVICE.
PARAMEDIC INITIAL EDUCATION
- MOST STATES BASE THEIR PARAMEDIC () PROGRAMS ON THE NATIONAL EMS EDUCATION STANDARDS.
- MAJOR () WERE MADE TO THESE STANDARDS IN (), A MAJOR CHANGE WAS THE INCLUSION OF A COLLEGE-LEVEL ( ) AND () COURSE.
- STATES REQUIRE VARYING HOURS OF EDUCATION BUT THE NATIONAL AVERAGE FALLS BETWEEN () AND () HOURS OF COMBINED (), CLINICAL, AND FIELD EDUCATION.
PARAMEDIC INITIAL EDUCATION
- MOST STATES BASE THEIR PARAMEDIC EDUCATION PROGRAMS ON THE NATIONAL EMS EDUCATION STANDARDS.
- MAJOR REVISIONS WERE MADE TO THESE STANDARDS IN 2009, A MAJOR CHANGE WAS THE INCLUSION OF A COLLEGE-LEVEL ANATOMY AND PHYSIOLOGY COURSE.
- STATES REQUIRE VARYING HOURS OF EDUCATION BUT THE NATIONAL AVERAGE FALLS BETWEEN 1,000 AND 1,500 HOURS OF COMBINED CLASSROOM, CLINICAL, AND FIELD EDUCATION.
Body mechanics
a. A paramedic is required to lift and move a variety of patients.
b. Prepare yourself to lift most weight ranges using the following actions:
i. Minimize the number of total body lifts you have to perform.
(a) When patients need to be lifted, be prepared and plan the lift.
(b) In many cases, patients do not need to be lifted to a cot or any other location.
(c) Evaluate every situation to identify the easiest and safest way to lift or move a patient.
ii. Coordinate every lift prior to performing the lift.
(a) Advise your patients regarding what they may experience during the lift.
(b) Use clear communication to execute the lift.
(c) Example: “On the count of three, lift.”
(d) Clarify with everyone whether to lift on three, or after you say “three.”
iii. Minimize the total amount of weight you have to lift.
(a) If you have extra people available, ask for assistance.
(b) In some cases, your patient might be able to offer some assistance with moving.
(c) Remove any unneeded equipment from the cot.
iv. Never lift with your back.
(a) A back injury can be career ending, but you can prevent issues if you do not lift with your back.
(b) Always keep your back in a straight, upright position and lift without twisting.
(c) When lifting, spread your legs about 15 inches apart (shoulder width) and place your feet so that your center of gravity is properly balanced. Keep your head upright and facing forward.
(d) Hold your back upright as you bring your upper body down by bending your knees.
(e) Lift by raising your upper body and arms and by straightening your legs until you are standing.
(f) Always lift with your legs, not with your back!
(g) Breathe while lifting (do not hold your breath).
(h) If you are working with a partner while lifting, then be sure to plan your counting style and exactly how the lift will be performed.
v. Do not carry what you can put on wheels.
(a) Position the ambulance, and the cot, as close to the patient as you can.
(b) Most stair chairs now have tracks to make going downstairs easier and safer.
vi. Ask for help.
(a) Any time you need to move a patient who cannot or should not walk, consider asking an extra person to help you.
Body mechanics
a. A paramedic is required to lift and move a variety of patients.
b. Prepare yourself to lift most weight ranges using the following actions:
i. Minimize the number of total body lifts you have to perform.
(a) When patients need to be lifted, be prepared and plan the lift.
(b) In many cases, patients do not need to be lifted to a cot or any other location.
(c) Evaluate every situation to identify the easiest and safest way to lift or move a patient.
ii. Coordinate every lift prior to performing the lift.
(a) Advise your patients regarding what they may experience during the lift.
(b) Use clear communication to execute the lift.
(c) Example: “On the count of three, lift.”
(d) Clarify with everyone whether to lift on three, or after you say “three.”
iii. Minimize the total amount of weight you have to lift.
(a) If you have extra people available, ask for assistance.
(b) In some cases, your patient might be able to offer some assistance with moving.
(c) Remove any unneeded equipment from the cot.
iv. Never lift with your back.
(a) A back injury can be career ending, but you can prevent issues if you do not lift with your back.
(b) Always keep your back in a straight, upright position and lift without twisting.
(c) When lifting, spread your legs about 15 inches apart (shoulder width) and place your feet so that your center of gravity is properly balanced. Keep your head upright and facing forward.
(d) Hold your back upright as you bring your upper body down by bending your knees.
(e) Lift by raising your upper body and arms and by straightening your legs until you are standing.
(f) Always lift with your legs, not with your back!
(g) Breathe while lifting (do not hold your breath).
(h) If you are working with a partner while lifting, then be sure to plan your counting style and exactly how the lift will be performed.
v. Do not carry what you can put on wheels.
(a) Position the ambulance, and the cot, as close to the patient as you can.
(b) Most stair chairs now have tracks to make going downstairs easier and safer.
vi. Ask for help.
(a) Any time you need to move a patient who cannot or should not walk, consider asking an extra person to help you.
- When you are subjected to stress, your fight-or-flight response is activated.
a. This is the same system that is activated when you exercise or do something fun to promote the feeling of well-being (known as positive stress).
b. Preparation on how to react when this response activates is crucial.
i. If you are unconditioned or unprepared for stress, then you will not adapt as well when the fight-or-flight response is activated.
2. The fight-or-flight response creates physiologic responses to a stressor, including increased sympathetic tone, which results in the following:
a. Dilation of the pupils
b. Increased heart rate
c. Dilation of the bronchi
d. Mobilization of glucose
e. Shunting of blood away from the gastrointestinal tract and cerebrum
f. Increased blood flow to the skeletal muscles.
- These responses help you deal with the situation immediately.
a. To maintain your mental well-being for the long term, you need to be able to balance these situations by using appropriate coping skills. - As a paramedic, you will need to be in control of your emotions at all times, regardless of the situation.
a. A professional is someone who can remain calm and think clearly when everything else is in disarray.
b. Plan for your behavior to help control it.
i. There are many resources available to help you prepare, such as physical exercise programs or counseling.
- When you are subjected to stress, your fight-or-flight response is activated.
a. This is the same system that is activated when you exercise or do something fun to promote the feeling of well-being (known as positive stress).
b. Preparation on how to react when this response activates is crucial.
i. If you are unconditioned or unprepared for stress, then you will not adapt as well when the fight-or-flight response is activated.
2. The fight-or-flight response creates physiologic responses to a stressor, including increased sympathetic tone, which results in the following:
a. Dilation of the pupils
b. Increased heart rate
c. Dilation of the bronchi
d. Mobilization of glucose
e. Shunting of blood away from the gastrointestinal tract and cerebrum
f. Increased blood flow to the skeletal muscles.
- These responses help you deal with the situation immediately.
a. To maintain your mental well-being for the long term, you need to be able to balance these situations by using appropriate coping skills. - As a paramedic, you will need to be in control of your emotions at all times, regardless of the situation.
a. A professional is someone who can remain calm and think clearly when everything else is in disarray.
b. Plan for your behavior to help control it.
i. There are many resources available to help you prepare, such as physical exercise programs or counseling.
Confusion
(a) Can occur with anyone, but more common among older patients
(b) Furthered by the presence of unfamiliar people and equipment, which may seem overwhelming
(c) It is very important that you explain carefully at the outset who you are and what you plan to do.
(d) Allow the patient enough time (within reason) to gather his or her thoughts and become comfortable with the situation
Confusion
(a) Can occur with anyone, but more common among older patients
(b) Furthered by the presence of unfamiliar people and equipment, which may seem overwhelming
(c) It is very important that you explain carefully at the outset who you are and what you plan to do.
(d) Allow the patient enough time (within reason) to gather his or her thoughts and become comfortable with the situation
B. Stress is any event that causes a physical, emotional or mental reaction.
- Stress events may be:
a. Pleasant
b. Unpleasant
c. Mild
d. Intense - Hans Selye, MD, PhD, considered the “father of stress theory,” has defined biologic stress as the “nonspecific response of the body to any demand made upon it.”
- Stress is a reaction of the body to any agent or situation (stressor) that requires the person to adapt.
a. Adaptation is necessary for meeting the demands of everyday life.
b. By itself, stress is neither a good thing nor a bad thing.
c. Stress should not be avoided.
4. Selye classified stress into two categories:
a. Eustress is positive stress, the kind that motivates a person to achieve.
b. Distress is negative stress, the stress that a person finds overwhelming and debilitating.
Reactions to stress can be categorized as acute, delayed, or cumulative.
a. Acute stress reactions occur during a stressful situation.
i. As a paramedic, you may feel nervous and excited.
ii. Your ability to focus may increase.
iii. You may experience negative emotional and physical reactions to stress if the situation becomes too great.
b. Delayed stress reactions manifest after the stressful event.
i. During a crisis, you will be able to focus and function.
ii. You may be left with nervous, excited energy that continues to build after the crisis.
iii. As a new paramedic, you must identify events that may cause a delayed stress reaction and learn stress management techniques to improve your ability to effectively manage stress when it occurs.
c. Cumulative stress reactions can occur when you are exposed to prolonged or excessive stress.
i. After the stressful event is over, you may be unable to shake off the effects.
ii. Another stressful situation will inevitably occur and then another.
iii. Each time, you may find it harder to recover and you become more and more exhausted and overwhelmed.
iv. Cumulative stress can result in physical symptoms, which are your body’s way of saying there is a problem.
d. Cumulative stress can have the following physical symptoms:
i. Fatigue
ii. Changes in appetite
iii. Gastrointestinal problems
iv. Headaches
B. Stress is any event that causes a physical, emotional or mental reaction.
- Stress events may be:
a. Pleasant
b. Unpleasant
c. Mild
d. Intense - Hans Selye, MD, PhD, considered the “father of stress theory,” has defined biologic stress as the “nonspecific response of the body to any demand made upon it.”
- Stress is a reaction of the body to any agent or situation (stressor) that requires the person to adapt.
a. Adaptation is necessary for meeting the demands of everyday life.
b. By itself, stress is neither a good thing nor a bad thing.
c. Stress should not be avoided.
4. Selye classified stress into two categories:
a. Eustress is positive stress, the kind that motivates a person to achieve.
b. Distress is negative stress, the stress that a person finds overwhelming and debilitating.
Reactions to stress can be categorized as acute, delayed, or cumulative.
a. Acute stress reactions occur during a stressful situation.
i. As a paramedic, you may feel nervous and excited.
ii. Your ability to focus may increase.
iii. You may experience negative emotional and physical reactions to stress if the situation becomes too great.
b. Delayed stress reactions manifest after the stressful event.
i. During a crisis, you will be able to focus and function.
ii. You may be left with nervous, excited energy that continues to build after the crisis.
iii. As a new paramedic, you must identify events that may cause a delayed stress reaction and learn stress management techniques to improve your ability to effectively manage stress when it occurs.
c. Cumulative stress reactions can occur when you are exposed to prolonged or excessive stress.
i. After the stressful event is over, you may be unable to shake off the effects.
ii. Another stressful situation will inevitably occur and then another.
iii. Each time, you may find it harder to recover and you become more and more exhausted and overwhelmed.
iv. Cumulative stress can result in physical symptoms, which are your body’s way of saying there is a problem.
d. Cumulative stress can have the following physical symptoms:
i. Fatigue
ii. Changes in appetite
iii. Gastrointestinal problems
iv. Headaches
EMS providers:
a. Have more opportunities for prevention education than other health care professionals
b. Are widely distributed in the population
c. May be the most medically sophisticated person in a rural community
d. Are considered advocates of the health care consumer and work in concert with their patients and their patient’s families
e. Are welcome in schools and other environments
f. Considered authorities on injury and prevention
One of the most visible ways EMS professionals interact with public health agencies is through the provision of immunizations.
a. EMS professionals are ideally suited to reach at-risk populations because:
i. Their inherent mobility allows them to reach widely dispersed populations.
ii. There is a typically positive perception of EMS in small communities.
iii. Many EMS providers have the requisite clinical training in:
(a) Medication security
(b) Aseptic technique
(c) Medication administration
(d) Post-injection care
(e) Documentation of informed consent for treatment
(f) How to discuss risks, benefits, and possible side effects with the patient
EMS providers:
a. Have more opportunities for prevention education than other health care professionals
b. Are widely distributed in the population
c. May be the most medically sophisticated person in a rural community
d. Are considered advocates of the health care consumer and work in concert with their patients and their patient’s families
e. Are welcome in schools and other environments
f. Considered authorities on injury and prevention
One of the most visible ways EMS professionals interact with public health agencies is through the provision of immunizations.
a. EMS professionals are ideally suited to reach at-risk populations because:
i. Their inherent mobility allows them to reach widely dispersed populations.
ii. There is a typically positive perception of EMS in small communities.
iii. Many EMS providers have the requisite clinical training in:
(a) Medication security
(b) Aseptic technique
(c) Medication administration
(d) Post-injection care
(e) Documentation of informed consent for treatment
(f) How to discuss risks, benefits, and possible side effects with the patient
Radio systems
a. Simplex
i. All transmissions on the same frequency
ii. Allow multiple users to communicate with each other using one common frequency
iii. Usually used only for short-range communications
b. Duplex
i. Radio signals are transmitted on one frequency and received on a second frequency.
ii. Semi duplex systems allow communication in only one direction at a time; full-duplex systems allow continuous communication in both directions at the same time.
c. Multiplex
i. Utilize radio signals to carry multiple streams of audio and/or data at the same time
ii. Used to transmit voice and ECG tracings (biotelemetry)
d. Digital
i. Allow the transmission of digital signals (computer) or analog (voice) signals that have been digitized and compressed by a computer
ii. Can communicate with other digital and analog radios
Communication system components
1. Base stations
a. Transmitter output power of up to 275 W
b. Have a fixed location (dispatch center or hospital)
c. Serve as dispatch and coordination areas
d. Have a large antenna
i. Usually situated on top of a building or a tall mast
e. Often capable of operating on multiple frequencies and bands
2. Mobile transceivers
a. Two-way radios mounted on vehicles and aircraft
b. Antenna externally mounted on the vehicle
c. Output power from 5 to 50 W
d. 15 miles
3. Portable transceivers
a. Small battery-powered units
b. Also known as “handhelds” or “walkie-talkies”
c. Range is usually limited to 3–5 miles
d. Useful when you must work at a distance from your vehicle
e. 1-5 watts
There are two types of interview questions:
a. Open-ended questions
i. Allows patients to give you feedback and information
ii. Allows you to judge patient’s mentation
iii. Example open-ended question: “How are you feeling at this moment?”
b. Closed-ended question
i. Also known as direct questions
ii. Used to elicit a specific answer
iii. Example closed-ended question: “What year were you born?”
2. Always start with open-ended questions.
Strategies to elicit useful responses to questions
1. Reflection
a. Repeating a word or phrase a patient has used to encourage more detail.
i. Example: Patient says, “I can’t catch my breath.” You say, “You said you can’t catch your breath.” The patient may then respond more fully, explaining the condition and circumstances in more detail.
b. This technique can produce more information than the patient originally gave.
2. Empathy
a. Putting yourself in the patient’s position
i. Example: If a patient expresses sadness or despondency about a situation, such as a recent death, you may say something like, “I am terribly sorry. I don’t know how I would feel in that situation, but I am sure I would feel similarly.”
3. Confrontation
a. This involves making your patients aware that you understand something is inconsistent about their story.
b. Remain professional and nonjudgmental.
i. Example: If a patient is in a motor vehicle accident, and denies drinking alcohol, say, “Anything you tell me is confidential, and I detect the smell of alcohol on your breath. There were also some empty bottles in your vehicle. It is important you tell me the truth so I can make sure that we and the hospital staff can take proper care of you.”
c. This technique helps you assess the patient’s level of distress and/or aggressiveness.
4. Interpretational.
a. Vocalize what you think the patient is saying and invite the patient to correct you.
b. This can be used when:
i. You are not sure what a patient is telling you.
ii. A patient refuses to give needed information.
c. Example: If a teenager acts distressed and says she is afraid she might hurt her parents if she tells them what is wrong and says her parents don’t like her boyfriend, you might ask a question like, “This may be totally wrong, but I must ask the question so I can inform the doctor for your well-being. Do you think you are pregnant?”
d. Interpretation requires your best intuition and diplomatic skills.
i. Possible phrase, to begin with, is, “So if I understand what you are saying correctly . . .”
5. Facilitation
a. Use phrases to encourage patients to provide more information.
i. Examples: “Please say more,” or “Please feel welcome to tell me about it.”
6. Silence
a. If patients seem to be trying to put something into words, be patient and do not say anything for a few seconds.