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121 Cards in this Set
- Front
- Back
History of Emergency Medical Services; When did emergency care emerge?
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During warfare in the 20th century
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At what time did emergency care lag? Why?
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By the 1960s, because it was often limited to large urban areas
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What was recommended to fix the 'Accidental Disease and Disability: The Neglected Disease of Modern Society? (4 points)
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1)Development of training
2)Development of federal guidelines and policies 3)Provide emergency care and transport 4)Establish staffed emergency departments |
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What created funding for EMTs?
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Highway Safety Act and Emergency Medical Act
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Who developed the first National Standard Curriculum for training EMTs in the early 1970s?
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DOT (Department of Transportation)
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EMS established in most of the United States by...?
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1980
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Levels of Training?
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Lay Rescuer
First Responder EMT-Basic EMT-Intermediate EMT-Paramedic |
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Components of the EMS System? Access?
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Easy access in an emergency is essential.
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Administration and Policy?
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Policies and procedures are essential.
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Medical Direction and Control?
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* Each EMS system must have a medical director.
* Medical control may take place online or off-line. |
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Quality Control and Improvement?
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Process used to ensure patient care meets standards.
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Other physician input?
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Local, state, and national specialists provide guidance.
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State-specific statutes and regulations?
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All EMS systems are subject to state regulations.
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Equipment?
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Properly maintained equipment is essential.
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Ambulance?
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EMT-Bs must be familiar with the ambulance and its functions.
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Specialty Centers?
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Focusing on care for certain types of patients
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Interfacility Transports?
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Transportation of patients from one care facility to another
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Hospital Staff?
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EMS is part of the whole continuum of care.
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Working with Public Safety Agencies?
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EMT-Bs should understand the role of each agency.
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Training?
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Quality of care depends on training.
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Providing a Coordinated Continuum of Care? (4 phases)
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1st Phase—access to EMS system
2nd Phase—out of hospital care 3rd Phase—emergency department care 4th Phase—definitive care |
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Roles and Responsibilitiesof the EMT-B: Personal safety?
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Safety of crew, patient, and bystanders
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Patient assessment?
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Patient care based on assessment findings
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Other roles? (4 roles)
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Lifting and moving patients safely
Transport and transfer of care Record keeping/data collection Patient advocacy/confidentiality |
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Professional Attributesof the EMT-B? (5)
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Puts patient’s needs as a priority without endangering self
Maintains professional appearance and manner Performs under pressure Treats patients and families with understanding, respect, and compassion Respects patient confidentiality |
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Continuing Education? (3)
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Continuing education required to renew certification
Keep up-to-date on new procedures and issues on local, state, and national levels Maintain knowledge and skills |
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The Well-Being of the EMT-B (3)
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Personal health, safety, and well-being are vital to an EMS operation.
Hazards vary greatly. Mental and physical stresses are part of the job. |
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Self-Control is achieved thru? (4)
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Proper training
Experience Strategies to cope with stress Dedication to serving others |
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Emotional Aspects of Emergency Care?
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Even the most experienced *providers have difficulty overcoming personal reactions.
*Emotions must be kept under control at the scene. |
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Death and Dying?
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*Changes in society have altered people’s attitudes toward death.
*Few people have actually witnessed a death. *Life expectancy has increased. *Death is something you will have to face. *Coming to grips with death is part of delivering care. |
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The Grieving Process? (5 steps)
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1. Denial: Refusal to accept
2. Anger: Blaming others 3. Bargaining: Promising to change 4. Depression: Openly expressing grief 5. Acceptance: The simple “yes” |
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What Can an EMT-B Do? (4)
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1) Provide gentle, caring support.
2) Make helpful statements and comments. 3)Be yourself and sincere. 4)Understand that grief is a process that must be worked through. |
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Dealing With Family Members? (4)
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1) Be calm. Family members may express rage, anger, and despair.
2) Use a gentle tone of voice and a reassuring touch, if appropriate. 3) Respect the family’s wishes and privacy. 4) Do not create false hope. |
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Initial Care of the Dying,Critically Ill, or Injured Patient?
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Anxiety
Pain and fear Anger and hostility Depression Dependency Guilt Mental health problems Receiving unrelated bad news |
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Caring for Critically Ill and Injured Patients?
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Avoid sad and grim comments.
Orient the patient. Be honest. Acknowledge the seriousness of the condition. Allow for hope. Locate and notify family members |
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Injured and Critically Ill Children?
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Basic treatments remain the same.
Consider variations between children and adults. Being accompanied by a relative may relieve the child’s anxiety. |
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Dealing With the Death of a Child?
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A child’s death is a tragic event for both EMT-Bs and the family.
How the family deals with the death will affect its stability. EMT-B is responsible for helping the family. |
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Helping the Family?
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Acknowledge the fact of the child’s death in a private place.
Tell the parents that they may see their child. Do not overload the parents with information. Parents should be encouraged to talk about their feelings. |
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Stressful Situations?
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Mass-casualty situations
Infant and child trauma Amputations Abuse Death or injury of a coworker |
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Factors Affecting Patient Reactions to Stressful Situations?
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Fear of medical personnel
Alcohol/substance abuse Chronic diseases Mental disorders Medication reactions Age Nutritional status Guilt feelings Past experience |
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Uncertain Situations?
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When uncertain if the patient’s condition is an emergency, contact medical control.
Minor symptoms may be early signs of severe illness or injury. When in doubt, err on the side of caution |
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Stress Warning Signs and theWork Environment?
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EMS is a high-stress job.
Understand the causes of stress. Prevent stress from negatively affecting you. |
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Physiological Manifestations of theFight-or-Flight Response?
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Rise in respirations and pulse
Increase in blood pressure Cool, clammy skin Dilated pupils Tensed muscles Increase blood glucose levels Perspiration Decreased circulation to GI tract |
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Physical Symptoms of Stress?
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Fatigue
Changes in appetite Headaches Insomnia/hypersomnia Irritability |
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Psychological Reactionsto Stress?
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Fear
Depression Anger Frustration |
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Critical Incidents?
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Mass-casualty incidents
Traumatic injury or death of child Automobile crash caused by EMS personnel Serious injury or death of coworker |
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Signs and Symptoms of Posttraumatic Stress Disorder?
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Depression
Startle reactions Flashback phenomena Amnesia of event |
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Critical Incident StressManagement?
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Confronts responses to critical incidents and defuses them
Process designed to help EMS personnel deal with responses to critical incidents Composed of trained peers and mental health professionals |
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Stress and Nutrition?
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Prolonged stress drains the body’s reserves.
Under stress, body’s fuel sources are consumed in large quantities. Glucose Quickest source of energy Taken from glycogen stored in liver Proteins Drawn from muscles Long-term source of glucose Fats Used by tissues for energy Water Conserved by retaining sodium Vitamins and minerals Depletes vitamins B, C, and most minerals that are not stored in large amounts by the body |
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Benefits of Exercise andProper Nutrition?
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Muscles will grow and retain protein.
Bones store calcium and become stronger. Well-balanced meals provide necessary nutrients to body. |
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Critical Incident StressDebriefing (CISD)?
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Held within 24 to 72 hours of a major incident
All information is confidential. CISD leaders and mental health personnel offer suggestions for overcoming the stress. |
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Components of CISM System ?
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Preincident stress education
On-scene peer support Disaster support services Defusings CISD Follow-up services Spouse and family support Community outreach programs Other wellness programs |
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Stress Management?
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There are positive and negative ways of handling stress.
Stress is unavoidable. Understand the effects of stress. Find balance in life. |
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Strategies to Manage Stress?
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Change or eliminate stressors.
Change partners to avoid negative or hostile personality. Stop complaining or worrying about things you cannot change. Expand your social support system. Minimize the physical response by: Taking a deep breath Stretching Regular physical exercise Progressive muscle relaxation |
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Workplace Issues?
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Cultural diversity
Your effectiveness as an EMT-B Avoiding sexual harassment Substance abuse |
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Scene Safety and Personal Protection?
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Prepare yourself when dispatched.
Wear seat belts and shoulder harnesses. Ensure scene is well marked. Check vehicle stability. |
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Communicable Diseases?
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A disease transmitted from one person to another
Minimize risk of contracting disease with proper protection |
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Routes of Transmission?
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Direct
Being sneezed on Vehicle (indirect) Touching contaminated linen Vector-borne Bitten by a tick Airborne Inhaling contaminated droplets |
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Common Terms?
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Exposure
Contact with blood, bodily fluids, tissues, or airborne droplets directly or indirectly Universal precautions Protective measures developed by the CDC to prevent workers from direct or indirect contact with germs Body substance isolation (BSI) Infection control techniques based on the assumption that all bodily fluids are infectious Exposure control plan Comprehensive plan to reduce the risk of exposure |
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Body Substance Isolation (BSI)?
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Handwashing
Gloves and eye protection Mask and gowns Proper disposal of sharps |
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Reducing Risk of Infection?
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Follow the exposure control plan.
Always follow BSI precautions. Always use a barrier between you and the patient. Be careful when handling needles. Always wash your hands. Make sure all immunizations are current. |
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Immunizations?
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Recommended:
Tetanus-diphtheria boosters (every 10 years) Measles, mumps, rubella (MMR) Influenza vaccine (yearly) Hepatitis B vaccine |
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Duty to Act?
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The EMT-B cannot deny act to a patient with a suspected communicable disease, even if the patient poses a risk to safety.
To deny care is considered abandonment or breach of duty; the EMT-B may also be considered negligent. |
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Diseases of Special Concern?
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HIV infection
Infection that causes AIDS Currently has no vaccine Not easily transmitted in work setting Can be transmitted to a rescuer from a contaminated needle Hepatitis Hepatitis results in inflammation of the liver. Hepatitis B and C are transmitted through blood contact. A person that carries the disease can appear healthy. Vaccinations are available and recommended for EMS providers. Meningitis Inflammation to the lining of the brain Can be caused by viruses or bacteria Usually not contagious except for Meningococcus meningitidis Wear gloves and masks. Notify a physician, if exposure suspected. Tuberculosis Bacterial disease affecting the lungs Detected by screening Recovery 100% if identified and treated early Notify supervisor of suspected exposure. |
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Other Diseases Causing Concern ?
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Syphilis
Can be a bloodborne disease May result from needle stick Whooping Cough Airborne disease caused by bacteria Usually occurs in children Wear a mask to avoid exposure Newly recognized diseases Escherichia coli Hantavirus Severe acute respiratory syndrome (SARS) |
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General Postexposure Management?
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Ryan White Law requires notification of exposure.
You should be screened immediately after any exposure. All exposures need to be reported to company’s designated officer. |
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Establishing an InfectionControl Routine?
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Make infection control procedures a part of your daily routine.
Routinely clean the ambulance after each run. Properly dispose of medical waste. Remove contaminated linen. |
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Scene Hazards?
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Hazardous materials
Never approach an object marked with placards. Electricity Do not touch downed power lines. Recognize the signs before a lightning strike. Fire Do not approach unless trained and protected. |
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Protective Clothing?
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Cold weather clothing
Should have three layers Turnout gear Provides head-to-toe protection Gloves Type depends on job being performed Eye and ear protection Should be used on rescue operations Skin protection Use sun block when working outdoors. Body Armor Worn by EMS responders in some areas for personal protection |
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Violent Situations?
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Civil disturbances
Domestic disputes Crime scenes Large gatherings |
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Safety?
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If personal safety is in doubt, do not place yourself at risk.
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Behavioral Emergencies?
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Determinants of violence
Past history Posture Vocal activity Physical activity |
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Medical, Legal, and Ethical Issues?
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Scope of practice
Defined by state law Outlines care you can provide Further defined in protocols and standing orders Authorized through online and off-line medical direction |
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Standard of Care?
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Standard imposed by local custom
Often based on locally accepted protocols Standard imposed by the law May be imposed by statutes, ordinances, administrative guidelines, or case law Professional or institutional standards Recommendations published by organizations and societies Specific rules and procedures of your service or organization |
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Standards Imposed by States?
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Medical Practices Act
Exempts EMT-Bs from licensure requirements Certification Process of evaluating and recognizing that EMT-B has met certain predetermined standards |
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Duty to Act?
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Individual’s responsibility to provide patient care.
Responsibility to provide care comes from either statute or function. Legal duty to act begins once an ambulance responds to a call or treatment is initiated. No legal duty to act when off duty |
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Negligence?
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Failure to provide the same care that a person with similar training would provide
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Negligence Determination?
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Duty
Responsibility to act reasonably based on standard of care Breech of duty Failure to act within expected and reasonable standard of care Damages Physical or psychological harm created in a noticeable way Cause Existence of reasonable cause and effect. All four must exist for negligence to apply. |
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Abandonment?
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Termination of care without patient’s consent
Termination of care without provisions for continued care Care cannot stop unless someone of equal or higher training takes over |
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Consent?
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Expressed consent
Implied consent Minors Mentally incompetent adults Forcible restraints |
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Assault and Battery?
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Assault
Unlawfully placing a person in fear of immediate bodily harm without consent Battery Unlawfully touching a person Some states have grades of assault, no battery |
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Refusal of Treatment?
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Mentally competent adults have the right to refuse care.
Patients must be informed of risks, benefits, treatments, and alternatives. EMT-B should obtain a signature and have a witness present, if possible. |
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Good Samaritan Laws and Immunity?
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Good Samaritan
Based on the principle that you should not be liable when assisting another in good faith Immunity Usually reserved for governments |
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Advance Directives?
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Specifies medical treatments desired if patient is unable to make decisions
Do not resuscitate (DNR) orders Patients have the right to refuse resuscitative efforts. Require a written order from one or more physicians When in doubt, begin resuscitation. |
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Ethical Responsibilities?
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Make the physical/emotional needs of the patient a priority.
Practice/maintain skills to the point of mastery. Critically review performances. Attend continuing education/refresher programs. Be honest in reporting. |
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Confidentiality?
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Information received from or about a patient is considered confidential.
Disclosing information without permission is considered a breach of confidentiality. Generally, information can only be disclosed if the patient signs a written release. |
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HIPAA?
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Safeguards patient confidentiality.
Limits EMS providers from obtaining follow-up information. Releases health information only with patient’s permission. |
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Records and Reports?
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Complete documentation is a safeguard against legal complications.
If an action or procedure is not recorded, courts assume it was not performed. An incomplete or untidy report is considered evidence of incomplete or inexpert care. |
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Special Reporting Requirements?
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Abuse of children, elderly, and spouse
Injury during the commission of a felony Drug-related injury Childbirth Infectious disease exposure Crime scene Deceased |
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Physical Signs of Death?
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Death is the absence of circulatory and respiratory function.
If the body is still warm, initiate care. If hypothermia is present, initiate care. |
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Presumptive Signs of Death?
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Unresponsive to painful stimuli
Lack of pulse or heartbeat Absence of breath sounds No deep tendon or corneal reflexes Absence of eye movement No systolic blood pressure Profound cyanosis Decreased body temperature |
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Definitive Signs of Death?
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Obvious mortal injury
Dependent lividity Rigor mortis Putrefaction (decomposition of body) |
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Medical Examiner Cases?
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DOA
Unknown cause of death Suicide Violent death Poisoning Accidents Suspicion of criminal action |
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Special Situations?
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Organ donors
Medical identification insignia |
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The Planes of the Body?
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Anterior
Posterior Midline Midclavicular line Midaxillary |
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Directional Terms?
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Right and left
Superior and inferior Lateral and medial Proximal and distal Superficial and deep Ventral and dorsal Palmer and planter Apices and bilateral |
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Movement Terms?
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Extension-Flexion
Abduction-Adduction |
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Anatomic Positions?
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Supine, Prone, Shock position (recovery)
Trendelenburg’s position (legs elevated) Fowler’s position (sitting) |
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The Skeletal System?
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Gives form to the body
Protects vital organs Consists of 206 bones Acts as a framework for attachment of muscles Designed to permit motion of the body |
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The Skull?
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Slide 9 ch. 4
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Functions of theMusculoskeletal System?
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Gives the body shape
Protects internal organs Provides for movement Consists of more than 600 muscles |
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Types of Muscle?
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Skeletal (voluntary) muscle
Attached to the bones of the body Smooth (involuntary) muscle Carries out the automatic muscular functions of the body Cardiac muscle Involuntary muscle Has own blood supply and electrical system Can tolerate interruptions of blood supply for only very short periods |
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Diaphragm?
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Has characteristics of both voluntary and involuntary muscles
Dome-shaped muscle Divides thorax from abdomen Contracts during inhalation Relaxes during exhalation |
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Breathing Process: Inhalation?
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Diaphragm and intercostal muscles contract, increasing the size of the thoracic cavity.
Pressure in the lungs decreases. Air travels to the lungs. |
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Breathing Process: Exhalation?
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Diaphragm and intercostal muscles relax.
As the muscles relax, all dimensions of the thorax decrease. Pressure in the lungs increases. Air flows out of the lungs. |
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Exchange of Oxygen andCarbon Dioxide?
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Oxygen-rich air is delivered to alveoli with inspiration.
Oxygen diffuses into the blood. The body does not use all the inhaled oxygen |
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Control of Breathing?
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Brain stem controls breathing.
Increases breathing rate if the carbon dioxide level in blood becomes too high Hypoxic drive is a “backup system.” Activates when oxygen levels fall to stimulate breathing |
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Normal Breathing Characteristics?
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Normal rate and depth
Regular rhythm Good breath sounds in both lungs Regular rise and fall movements in the chest Easy, not labored |
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Normal Breathing Rates?
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Adults 12 to 20 breaths/min
Children 15 to 30 breaths/min Infants 25 to 50 breaths/min |
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Recognizing Inadequate Breathing?
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Irregular rhythm
Labored breathing Muscle retractions Pale or blue skin Cool, clammy skin Faster respiratory rate |
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Infant and Child Anatomy?
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Structures less rigid
Airway smaller Tongue proportionally larger Dependent on diaphragm for breathing |
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Normal Heart Rates?
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Adults 60 to 100 beats/min
Children 70 to 150 beats/min Infants 100 to 160 beats/min |
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Major Arteries and Veins?
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Aorta
Pulmonary Carotid Femoral Brachial Radial Superior vena cava Inferior vena cava Pulmonary |
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Components of Blood?
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Plasma
Red blood cells White blood cells Platelets |
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Physiology of theCirculatory System?
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Pulse
The wave of blood through the arteries formed when the left ventricle contracts Can be felt where an artery passes near the skin surface and over a bone Blood pressure Amount of force exerted against walls of arteries Systole: Left ventricle contracts Diastole: Left ventricle relaxes Perfusion Circulation of blood within an organ or tissue If inadequate, the patient goes into shock. |
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The Nervous System?
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The nervous system controls the body’s voluntary and involuntary actions.
Somatic nervous system Regulates voluntary actions Autonomic nervous system Controls involuntary body functions |
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Peripheral Nervous System?
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Links the organs of the body to the central nervous system.
Sensory nerves carry information from the body to the central nervous system. Motor nerves carry information from the central nervous system to the muscles of the body. |
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The Skin?
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Protects the body from the environment
Regulates body temperature Transmits information from environment to the brain |
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Endocrine System?
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Complex message and control system
Made up of seven glands Glands produce and release hormones. |
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Endocrine Glands?
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Adrenal
Ovary Pancreas Parathyroid Pituitary Testes Thyroid |
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Digestive System?
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Mouth
Salivary glands Oropharynx Esophagus Stomach Pancreas Liver Bile ducts Small intestine Large intestine Appendix Rectum |