EMS Basics
There are 4 (main) levels of medical first responders.
5 steps of patient assessment
What is scene size up, primary Assessment, history taking, secondary assessment, and reassessment?
Cyanosis describes this condition.
What is poor peripheral circulation that appears pale, ashen, or gray on the skin due to low levels of oxygen.
AVPU Scale tests patients responsiveness based on this criteria.
Awake and alert, responsive to verbal stimuli, responsive to pain and unresponsive.
You are dispatched to the home of a 62 year-old female complaining of chest pains for 12 minutes.
“I’m putting on my gloves for BSI. I’m checking to make sure my scene is safe.” “Ok my scene is safe.” You may want to introduce yourself to the patient at this time and ask questions to determine NOI.
“The nature of illness is chest pain and I have one patient. I’m going to call for an ALS unit. I’ve considered C-spine, but don’t find it necessary based on the patient’s complaint of chest pain.”
There are 5 important parts of scene size up.
What is ensuring scene safety (ex: highway, electrical malfunctions, fire, cars, etc), mechanism of injury or nature of illness, take standard precautions (PPE), determine number of patients, and consider any additional resources.
SAMPLE is an acronym.
What is Signs/Symptoms, Allergies, Medications, Pertinent past medical history, Last oral Intake, and Events leading up to injury?
What is deviation from the trachea from midline in the neck.
Checking for orientation of patient's mental status involves 4 things.
Person, place, time, and event.
You are dispatched to a street address where a 24 year-old male is lying supine on the sidewalk after being shot once.
“I’m putting on gloves for BSI and I’m checking to make sure the scene is safe.” “The scene is safe. The mechanism of injury is a gunshot wound (GSW).” “It appears I have one patient. I’m going to call for an ALS unit and have my partner hold c-spine.”
Technique commonly used for picking up patients with 2-3 people.
What is log roll?
The 7 important factors to primary assessment
What is forming a general impression, assessing level of consciousness, assessing ABC (exception: profuse bleeding), primary assessment, and determining priority of patient care and transport.
The Golden Hour is crucial and describes this.
What is the period where the care of injured patients (mostly shock and traumatic injuries) is most critical and has the highest potential for survival?
Factors to note about skin
What is color, temperature, and moisture.
A co-worker has fallen about 30' from a scaffold onto the dirt floor of a large open air pit. You respond with the ERT. As you approach you find him laying his back with obvious deformity to the right arm and blood on pants at right femur. He is not moving or moaning. It appears that his chest is rising and falling
“I’m putting on gloves for BSI and I’m checking to make sure the scene is safe such as loose equipment, spilled chemicals, etc. If scene is safe, I consider ways to extricate patient. My general impression is that the patient is and adult male, unmoving. He has obvious deformities and trauma. I’m going to call for help and have my partner hold c-spine.”
Cycle for one rescuer adult CPR.
What is scene safe, responsive, getting 911, assess ABCs, and30 compressions 2 breaths at rate or 100-120?
Rapid Exam performed goes in this order and looks for what threats.
What is DCAP-BTLS. Head, neck, chest, abdomen, pelvis, extremities, back, and buttocks.
High priority patients who should be transported immediately have some some of these conditions:
What is unresponsive, poor general impression, difficulty breathing, uncontrolled bleeding, responsive but unable to follow commands, severe chest pain, pale skin, complicated birth, severe pain to any area of the body?
Prominent places where circulation can be measured.
What is jugular, brachial, pedal, and radial pulse?
You are dispatched at 2am to a single-car crash with possible injuries. Law enforcement and the fire department are also en route. Upon arrival, you observe a mid-size sedan that had crashed head on into an oak tree on the shoulder of a poorly lit rural road.
Scene size up; checking to see if it is safe. If law enforcement is not there to clear the scene or direct traffic then you wait. Proper PPE is put on and patient are assessed to determine if they can be removed.
The 8 skills EMTs need to know in field.
What is
Secondary Physical Assessment.
What is face, eyes, ears, head, zygomas, maxillae, mouth/nose, mandible, breath, neck, chest, ribs, medaxillary/midclavicular, adbdomen/pelvis, extremities, and back?
Signs of respiratory distress.
What is agitation, anxiety, restlessness, stridor, wheezing, accessory muscle use, tachypnea, tachycardia, seesaw breathing ,head bobbing, sniffing position, and nasal flaring? Noted through lethargy, agonal respirations, inadequate chest rise, poor respiratory rate/effort, bradycardia, and diminished muscle tone.
The normal range of heart rate, breathing, oxygen, and blood pressure.
What is 60 - 100 bpm, 12 - 20 breaths/min, 98% oxygen, and 120/80 mmHg (systolic/diastolic)?
You are dispatched to a local bar for the report of an unresponsive female patient found in the bathroom. As you approach the scene, you notice a large crowd outside the front door holding beer bottles. The group has pulled the patient outside. As you approach the scene, people from the group start yelling, "Do something! She's not breathing."
Scene size up; the large crowd that has been drinking and is now yelling at you. Patient safety and privacy are important factors as well as your own. Consider contacting law enforcement or pulling patient away.