Transcript Chapter 22

Chapter 22
Emergency Medical
Services
Introduction
• There is more to being a fireman
than putting out fires
• Community relies on firemen to be
creative problem solvers
• Emergency medical responses
constitute more than 50% of total
emergency responses
• With technology today, firefighters
can deliver lifesaving techniques to
stabilize patients
22.2
Roles and Responsibilities of
an Emergency Care provider
• Firefighters often act as providers of
emergency care and first aid
• Many call on firefighters to assist
emergency medical technicians and
paramedics
• Working knowledge of basic
emergency medical care is very
important
22.3
Figure 22-2 Firefighters are often called on to assist
EMS crews with patient care.
22.4
(A)
(C)
(B)
Figure 22-3 (A) EMS calls begin when firefighters leave the
station, (B) continue throughout the time on the scene, and
(C) do not end until firefighters have cleaned the equipment
and restocked the supplies.
22.5
Key Responsibilities
• Firefighter responsibilities:
– Ensure their own safety, safety of their
team, and patient’s safety
– Act safely from the minute they step on the
fire engine
– Act in a professional manner
– Never make a situation worse
– Practice and update emergency care skills
– Know and practice use of EMS equipment
– Gather and document important patient
information
22.6
Figure 22-4 Firefighters should always treat patients with
respect. They should treat patients as they would want to
be treated in the same situation.
22.7
Legal Considerations for
Emergency Care Providers
• Emergency care providers should
understand several important legal
issues:
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Standard of care
Consent
Implied consent
Abandonment
22.8
Interacting with Emergency
Medical Services Personnel
• Interact with emergency personnel while
on scene of an emergency
• Interact with emergency medical
personnel who have arrived by helicopter
• Important to understand different levels of
care provided by EMS crews
• EMS personnel rely on firefighters on
scene to give critical patient information
22.9
Safety Considerations
• Safety of caregiver or individual
firefighter performing patient care
• Safety of emergency response team
• Safety and infection control should
remain a primary consideration
• Responders who get sick become
part of the problem
22.10
Analyzing the Safety of
the Emergency Scene
• Observe each and every scene for
unsafe situations
• Check for scene safety prior to
entering
• Carefully observe emergency scene
and people present before entering
• Ask for additional assistance when
safety concerns are present
22.11
Figure 22-9 Team working together in patient care.
22.12
Firefighter Physical and
Mental Health
• Firefighting is a strenuous
occupation
• Healthy lifestyle generally includes:
– Regular exercise
– Proper diet
– Getting the right amount of sleep
• Back injury is a common problem
• Emergency medical calls can take
their toll on mental health
22.13
Infection Control
• Safety includes protection from
contracting communicable or infectious
diseases:
– Prevention of exposure to infectious diseases
– Body substance isolation
• Treat all body fluids as if they were
infectious
• Protective gloves are an important barrier
device only if used properly
• Immunization
22.14
Figure 22-10 The most effective means of
reducing the risk of spreading disease is hand
washing.
22.15
Figure 22-11 Proper hand washing involves vigorous
lathering with soap and water for fifteen seconds (or
longer) followed by thorough rinsing.
22.16
Patient Assessment
• A quick visual assessment should
reveal:
– How many patients are there?
– Is the patient awake?
– Is the patient in a harmful situation or
environment?
– What position is the patient in?
– What people or objects are in the
emergency scene?
– What is the skin color of the patient?
– Is the patient having trouble breathing?
22.17
Performing an Initial
Assessment
• Initial assessment covers the following:
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–
–
–
–
Level of consciousness
Airway
Breathing
Circulation
Major bleeding
• Done quickly on conscious patient who is
alert and talking
• Unconscious patients require closer
examination
22.18
(A)
(B)
(C)
Figure 22-17 Locating pulses in (A) the carotid artery in the neck, (B)
the radial artery in the wrist, and (C) the brachial artery in an infant’s
upper arm.
22.19
Vital Signs and the Focused
History and Physical Exam
• After initial assessment, firefighter
continues to a focused history and
patient exam:
– Patient fact-finding
– Vital signs
– Head-to-toe survey of patient
• Fact-finding with patient or family
members, friends, or bystanders if
patient is unconscious
22.20
Table 22-3 Average Vital Sign Ranges, by Age
22.21
Patient Findings
• Be sure to document findings of the
assessment and patient’s vital signs
• Everything found must be passed
on to emergency medical providers
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Initial assessment
Focused history
Physical exam
Patient’s vital signs
All patient fact-finding
22.22
Figure 22-19 Examples of pupil size.
22.23
Cardiopulmonary
Resuscitation/ AED
• One of the most basic and widely learned
emergency response skills
• Coronary heart disease and
cardiovascular diseases are the leading
killer in United States
• Several organization support CPR
training, education, and research
• Automated external defibrillators (AEDs)
have become a critical part of emergency
care
22.24
Figure 22-22 Firefighters learning CPR.
22.25
Bleeding Control and
Shock Management
• Cardiovascular system is a closed
system with a pump and tubing
• Damage to heart or blood vessels
may result in a lower volume of
blood
22.26
Internal and External Bleeding
• Internal bleeding occurs when there is
bleeding within body
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Bruising, pale, or cold and clammy skin
Dilated pupils
Obvious bone deformities
Rigid and tender abdomen
Blood in urine or from rectum
Blood from mouth or nose, or in vomitus
• Arterial bleeding is bleeding from arteries
• Capillary bleeding is bleeding from
capillaries
22.27
Caring for Patients with
Internal Bleeding
• Cannot be brought under control by
first-aid actions
• For minor internal bleeding, apply
an ice pack or cold pack to affected
site
• Major internal bleeding requires
rapid medical attention
22.28
Caring for Patients with
External Bleeding
• Firefighters should remember to
wear gloves
• Three methods are used:
– Pressure on site of bleeding, or direct
pressure
– Elevate site of bleeding
– Use pressure points
22.29
Figure 22-26 Using pressure points in the upper arm and
the leg to decrease blood flow to a wound.
22.30
Types of Wounds Requiring
First Aid
• There are several type of wounds
that firefighters should be able to
recognize:
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Abrasion
Avulsion
Amputation
Laceration or incision
Puncture
22.31
What is Shock?
(Hypoperfusion)
• Condition caused by a problem with
or failure of circulatory system
• Results in a decreased supply of
oxygen and vital nutrients
• Shock can result from a problem
with the heart
• Severe dehydration can cause
shock
22.32
Recognizing the Signs and
Symptoms of Shock
(Hypoperfusion)
• Some signs and symptoms of shock:
– Pale or bluish tint to skin, cool
temperature
– Sweating or moist skin
– Pupils larger than normal
– Rapid, shallow breathing
– Rapid weak pulse
– Complaints of nausea, thirst
– Restlessness or anxiety
22.33
Caring for Patients in Shock
• Firefighters should follow this basic
treatment:
– Ensure scene safety
– Assess patient’s level of consciousness
– Ensure airway is open and patient is breathing
adequately
– Treat injuries present and control major
bleeding
– Keep patient warm and positioned properly
– Raise legs of the patient
– Provide reassurance
22.34
Emergency Care for
Common Emergencies
• No two emergency medical calls
are the same
• Must learn basics of first-aid
treatment and adopt them to each
emergency
22.35
Trouble Breathing
• Very common emergency
• Common signs and symptoms:
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Wheezing
Gasping for air
Shallow breathing
Pale or bluish skin color
Anxiety
Unconsciousness
22.36
Guidelines for Trouble Breathing
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Ensure scene safety
Don appropriate BSI
Complete initial assessment
Ensure airway is open and patient is
breathing adequately
• Treat injuries present and control
major bleeding
22.37
Guidelines for Trouble
Breathing (cont’d.)
• Reassure the patient and keep him
calm
• Monitor vital signs frequently
• Recognize this is a serious
emergency and activate EMS
immediately
22.38
Chest Pain
• Another common emergency
• If related to heart problem:
– Tightness or squeezing feeling in chest
– Pain in jaw, abdomen, or arm
• Chest pain can result from:
– Respiratory disorders
– Traumatic injuries
– Stomach problems
22.39
Guidelines for Chest Pain
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•
•
•
Ensure scene safety
Don appropriate BSI
Complete initial assessment
Ensure airway is open and patient is
breathing adequately
• Treat injuries present and control
major bleeding
22.40
Guidelines for Chest
Pain (cont’d.)
• Reassure the patient and keep him
calm
• Monitor vital signs frequently
• Recognize this is a serious
emergency and activate EMS
immediately
• Observe the patient for signs and
symptoms of shock
22.41
Medical Illnesses
• Range from stomach problems like
nausea and vomiting to general
illnesses
• Care and guidelines:
– Assess scene, don BSI, perform initial
assessment and attend to major
problems
– Reassure patient
– Recognize that this could be a serious
emergency
– Look for symptoms of shock
22.42
Guidelines for Medical Illness
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•
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•
Ensure scene safety
Don appropriate BSI
Complete initial assessment
Ensure airway is open and patient
is breathing adequately
22.43
Guidelines for Medical
Illness (cont’d.)
• Treat injuries present and control
major bleeding
• Reassure the patient and keep him
calm
• Monitor vital signs frequently
• Observe the patient for signs and
symptoms of shock
22.44
Allergic Reactions
• Result from body’s reaction to a
substance
• Some allergic reactions can be
severe
• Can result from a variety of
substances
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Food
Environment
Bites and stings
Medications
22.45
Guidelines for Allergic
Reactions
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•
Ensure scene safety
Don appropriate BSI
Complete initial assessment
Ensure airway is open and patient is
breathing adequately
22.46
Guidelines for Allergic
Reactions (cont’d.)
• Reassure the patient and keep the
patient calm
• Remove the cause of the reaction
from the patient
• Monitor vital signs frequently
• Observe the patient for signs and
symptoms of shock
22.47
Thermal Burns
• Caused by heat
• Simple as sunburn or life
threatening as severe burns across
much of the body
• Divided into three categories:
– Superficial burns
– Partial thickness burns
– Full thickness burn
22.48
(A)
(B)
(C)
Figure 22-28 (A) Superficial burns, (B) partial thickness
burns, and (C) full thickness burns.
22.49
Guidelines for Thermal Burns
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Ensure scene safety
Don appropriate BSI
Complete initial assessment
Ensure airway is open and patient is
breathing adequately
• Remove the patient from the
environment to stop the burning
process
22.50
Guidelines for Thermal
Burns (cont’d.)
• Reassure the patient and keep the
patient calm
• Remove the cause of the reaction
from the patient
• Monitor vital signs frequently
• Observe the patient for signs and
symptoms of shock
22.51
Chemical Burns
• Caused by chemical substances
that come in contact with skin or
tissues of body
• Creates caustic reaction
• Variety of chemical substances can
cause a chemical burn
22.52
Guidelines for Chemical Burns
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Ensure scene safety
Don appropriate BSI
Complete initial assessment
Ensure airway is open and patient
is breathing adequately
22.53
Guidelines for Chemical
Burns (cont’d.)
• Remove the chemical by brushing off if
it is a powder or flush the substance
with large volumes of water.
• Remove the patient’s jewelry and
clothing
• Monitor vital signs frequently
• If substance has gotten into the patients
eyes, flush thoroughly for at least 20
minutes
22.54
Poisoning
• Ingestion or inhalation of a caustic
substance
• Result from ingestion of a large
quantity of a normally harmless
substance:
– Over-the-counter medications
– Household substances
• Local poison control centers are
very valuable
22.55
Guidelines for Poisoning
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•
Ensure scene safety
Don appropriate BSI
Complete initial assessment
Ensure airway is open and patient is
breathing adequately
22.56
Guidelines for Poisoning (cont’d.)
• Reassure the patient, keep the patient
calm, and monitor vital signs
frequently
• Do investigative work to find out
exactly what substance was inhaled
or ingested
• Do not give the patient any liquid or
food to ingest
• Contact local poison control center
22.57
Fractures and Sprains
• Fracture is a medical term for a
broken bone
• Sprain is an injury to the ligaments
• Firefighter may notice swelling and
tenderness to area of a fracture or
sprain
• In the case of fracture, there may be
deformity to bone and body
structure
22.58
Guidelines for Fractures and
Sprains
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Ensure scene safety
Don appropriate BSI
Complete initial assessment
Ensure airway is open and patient is
breathing adequately
• Reassure the patient, keep the
patient calm, and monitor vital signs
frequently
22.59
Guidelines for Fractures
and Sprains (cont’d.)
• Do not move the patient and protect
the cervical spine in cases of
suspected trauma
• Do not move the injured body part
and carefully protect the area
• Apply cold packs as needed to reduce
swelling
22.60
Figure 22-30 Firefighter stabilizing a leg injury until
the EMS unit arrives.
22.61
Lessons Learned
• Emergency medical care is a major
part of most firefighters’
responsibilities
• Fire service has played an
increasing role in providing first
response medial care
• Most important tool is the
firefighter’s brain
• Firefighter should use their senses
22.62