Prehospital Emergency Care: Pearson New International Edition

1429 Pages·2013·56.062 MB·English

by  Joseph J. Mistovich, Keith J. Karren, Brent Hafen

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Prehospital Emergency Care
ISBN 978-1-29203-924-4
Joseph J. Mistovich Keith J. Karren
Brent Hafen
Tenth Edition
9 781292 039244
Pearson New International Edition

Prehospital Emergency Care
Joseph J. Mistovich Keith J. Karren
Brent Hafen
Tenth Edition
International_PCL_TP.indd 1 7/29/13 11:23 AM
ISBN 10: 1-292-03924-8
ISBN 13: 978-1-292-03924-4
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ISBN 10: 1-292-03924-8
ISBN 10: 1-269-37450-8
ISBN 13: 978-1-292-03924-4
ISBN 13: 978-1-269-37450-7
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A catalogue record for this book is available from the British Library
Printed in the United States of America
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P E A R S O N C U S T O M L I B R AR Y
Table of Contents
1. Emergency Medical Care Systems, Research, and Public Health
Joseph J. Mistovich/Keith J. Karren 1
2. Workforce Safety and Wellness of the EMT
Joseph J. Mistovich/Keith J. Karren 19
3. Medical, Legal, and Ethical Issues
Joseph J. Mistovich/Keith J. Karren 43
4. Documentation
Joseph J. Mistovich/Keith J. Karren 61
5. Communication
Joseph J. Mistovich/Keith J. Karren 79
6. Lifting and Moving Patients
Joseph J. Mistovich/Keith J. Karren 101
7. Anatomy, Physiology, and Medical Terminology
Joseph J. Mistovich/Keith J. Karren 129
8. Pathophysiology
Joseph J. Mistovich/Keith J. Karren 179
9. Life Span Development
Joseph J. Mistovich/Keith J. Karren 209
10. Airway Management, Artificial Ventilation, and Oxygenation
Joseph J. Mistovich/Keith J. Karren 223
11. Baseline Vital Signs, Monitoring Devices, and History Taking
Joseph J. Mistovich/Keith J. Karren 289
12. Scene Size-up
Joseph J. Mistovich/Keith J. Karren 319
13. Patient Assessment
Joseph J. Mistovich/Keith J. Karren 339
I
444555666677788889247268025926803792519515391577571357
14. Pharmacology Medication and Administration
Joseph J. Mistovich/Keith J. Karren 425
15. Shock and Resuscitation
Joseph J. Mistovich/Keith J. Karren 441
16. Respiratory Emergencies
Joseph J. Mistovich/Keith J. Karren 479
17. Cardiovascular Emergencies
Joseph J. Mistovich/Keith J. Karren 525
18. Altered Mental Status, Stroke, and Headache
Joseph J. Mistovich/Keith J. Karren 561
19. Seizure and Syncope
Joseph J. Mistovich/Keith J. Karren 585
20. Acute Diabetic Emergencies
Joseph J. Mistovich/Keith J. Karren 603
21. Anaphylactic Reactions
Joseph J. Mistovich/Keith J. Karren 629
22. Toxicologic Emergencies
Joseph J. Mistovich/Keith J. Karren 651
23. Abdominal, Hematologic, Gynecologic, Genitourinary, and Renal Emergencies
Joseph J. Mistovich/Keith J. Karren 695
24. Environmental Emergencies
Joseph J. Mistovich/Keith J. Karren 727
25. Submersion Incidents: Drowning and Diving Emergencies
Joseph J. Mistovich/Keith J. Karren 767
26. Behavioral Emergencies
Joseph J. Mistovich/Keith J. Karren 785
27. Trauma Overview: The Trauma Patient and the Trauma System
Joseph J. Mistovich/Keith J. Karren 807
28. Bleeding and Soft Tissue Trauma
Joseph J. Mistovich/Keith J. Karren 831
29. Burns
Joseph J. Mistovich/Keith J. Karren 873
30. Musculoskeletal Trauma and Nontraumatic Fractures
Joseph J. Mistovich/Keith J. Karren 895
31. Head Trauma
Joseph J. Mistovich/Keith J. Karren 927
II
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32. Spinal Column and Spinal Cord Trauma
Joseph J. Mistovich/Keith J. Karren 949
33. Eye, Face, and Neck Trauma
Joseph J. Mistovich/Keith J. Karren 993
34. Chest Trauma
Joseph J. Mistovich/Keith J. Karren 1017
35. Abdominal and Genitourinary Trauma
Joseph J. Mistovich/Keith J. Karren 1039
36. Multisystem Trauma and Trauma in Special Patient Populations
Joseph J. Mistovich/Keith J. Karren 1051
37. Obstetrics and Care of the Newborn
Joseph J. Mistovich/Keith J. Karren 1065
38. Pediatrics
Joseph J. Mistovich/Keith J. Karren 1105
39. Geriatrics
Joseph J. Mistovich/Keith J. Karren 1173
40. Patients with Special Challenges
Joseph J. Mistovich/Keith J. Karren 1203
41. The Combat Veteran
Joseph J. Mistovich/Keith J. Karren 1233
42. Ambulance Operations and Air Medical Response
Joseph J. Mistovich/Keith J. Karren 1245
43. Gaining Access and Patient Extrication
Joseph J. Mistovich/Keith J. Karren 1271
44. Hazardous Materials
Joseph J. Mistovich/Keith J. Karren 1289
45. Multiple-Casualty Incidents and Incident Management
Joseph J. Mistovich/Keith J. Karren 1311
46. EMS Response to Terrorism Involving Weapons of Mass Destruction
Joseph J. Mistovich/Keith J. Karren 1329
Appendix: ALS-Assist Skills
Joseph J. Mistovich/Keith J. Karren 1349
Appendix: Advanced Airway Management
Joseph J. Mistovich/Keith J. Karren 1357
Index 1397
III
IV
Emergency Medical Care
Systems, Research,
and Public Health
The following items provide an overview to the purpose and content of this chapter. The Standard and Competency are
from the National EMS Education Standards.
STANDARDS (cid:116)(cid:1) Preparatory (Content Areas: EMS Systems; Research); Public Health
COMPETENCIES(cid:1) (cid:116)(cid:1) Applies fundamental knowledge of the EMS system, safety/well-being of the EMT, medical/legal and ethi-
cal issues to the provision of emergency care.
Uses simple knowledge of the principles of illness and injury prevention to the provision of emergency care.
OBJECTIVES (cid:116)(cid:1) After reading this chapter, you should be able to:
1. Define key terms introduced in this chapter. h. Medical direction
2. Describe the key historical events that have shaped i. Trauma systems
the development of the emergency medical services j. Evaluation
(EMS) system, including: 4. Discuss the differences between 911 and non-911 EMS
a. Lessons learned in trauma care from experiences access systems, including the features and benefits of
in the Korean and Vietnam conflicts 911 systems.
b. Publication of Accidental Death and Disability: The 5. Compare and contrast the scopes of practice of the
Neglected Disease of Modern Society following levels of EMS providers:
c. Highway Safety Act of 1966 a. Emergency Medical Responder (EMR)
d. Emergency Medical Services System Act of 1973 b. Emergency Medical Technician (EMT)
e. Public CPR courses c. Advanced Emergency Medical Technician (AEMT)
f. Publication of the National Emergency Medical d. Paramedic
Services Education and Practice Blueprint 6. Explain the importance of the EMT’s understanding of
g. Publication of EMS Agenda for the Future and The the health care resources available in the community.
EMS Education Agenda for the Future: A Systems 7. Give examples of how EMTs can carry out each of the
Approach following roles and responsibilities:
h. Development of National EMS Core Content, Na- a. Personal safety and the safety of others
tional EMS Scope of Practice Model, and National b. Patient assessment and emergency care
EMS Education Standards c. Safe lifting and moving
i. The Institute of Medicine report The Future of EMS d. Transport and transfer of care
Care: EMS at the Crossroads e. Record keeping and data collection
3. Briefly explain each of the components of the Techni- f. Patient advocacy
cal Assistance Program Assessment Standards: 8. Describe the expectations of EMTs in terms of each of
a. Regulation and policy the following professional attributes:
b. Resource management a. Appearance
c. Human resources and training b. Knowledge and skills
d. Transportation c. Physical demands
e. Facilities d. Personal traits
f. Communications e. Maintaining certification and licensure
g. Public information and education
continued
From Chapter 1 of Prehospital Emergency Care, Tenth Edition. Joseph J. Mistovich, Keith J. Karren. Copyright © 2014
by Pearson Education, Inc. All rights reserved. (cid:20)
EEmmeerrggeennccyy MMeeddiiccaall CCaarree SSyysstteemmss,, RReesseeaarrcchh,, aanndd PPuubblliicc HHeeaalltthh
9. Discuss the purposes of medical direction/oversight in 13. Discuss steps that you can take to minimize mistakes
the EMS system. and injuries in EMS.
10. Describe the purpose of quality improvement/ 14. Discuss the steps of evidence-based decision making.
continuous quality improvement programs in EMS. 15. Explain the limitations of evidence-based decision
11. Explain the EMT’s roles and responsibilities in quality making in EMS.
improvement. 16. Describe the relationship between EMS and public health.
12. Identify activities in EMS that pose a high risk of mis- 17. List the ten greatest public health achievements in the
takes and injuries. United States in the 20th century.
KEY TERMS (cid:116) Page references indicate first major use in this chapter. For complete definitions, see the Glossary.
Advanced Emergency Medical Technician evidence-based medicine Paramedic
(AEMT) medical direction prehospital care
Americans with Disabilities Act (ADA) medical director protocols
Emergency Medical Responder (EMR) medical oversight quality improvement (QI)
Emergency Medical Technician (EMT) off-line medical direction standing orders
EMS system on-line medical direction
Case Study
The Dispatch Upon Arrival
EMS Unit 121—respond to 10915 Pine Lake Road You position your ambulance in the driveway of the resi-
in Perry Township—you have an elderly male at that dence to afford an easy exit. As you leave the unit, the police
location—victim of a fall—Perry Township Fire Depart- officer—a First Responder who radioed for EMS help—tells
ment has been notified and is en route—time out 1032 you that a 65-year-old male fell about 30 feet down a very
hours. steep embankment behind his house. He’s been at the bot-
tom for about 30 minutes. The patient, Edgar Robinson, is
En Route
conscious and is able to tell you that his right arm and leg are
While you confirm the address with dispatch, your part- injured. The rescue squad from the fire department is prepar-
ner pulls out the county map. “I know that location,” he ing to rappel down the embankment to extricate the patient.
says. “Yes, here. We need to head north on Lincoln.” You
pull your unit out of the garage. Your partner operates How would you proceed?
the emergency lights and sirens. Within 8 minutes, you During this chapter, you will read about the roles and respon-
turn onto Pine Lake Road and spot a police car and a fire sibilities of an EMT. Later, we will return to the case study
truck. and put in context some of the information you learned.
INTRODUCTION expectations for the course and the job, inform you of
required or available immunizations, and outline your
One of the most critical health problems in the United state and local provisions for certification as an EMT.
States today is the sudden loss of life and disability
caused by catastrophic accidents and illnesses. Every year
THE EMERGENCY MEDICAL
thousands of people in this country die or suffer perma-
nent harm because of the lack of adequate and available SERVICES SYSTEM
emergency medical services. As an Emergency Medical
Technician (EMT), you can make a positive difference.
A Brief History
This course is designed to help you gain the knowl-
edge, skills, and attitudes necessary to be a competent, Emergency medical care has developed from the days
productive, and valuable member of the Emergency when the local funeral home was the ambulance pro-
Medical Services (EMS) team. As you begin, your instruc- vider and patient care did not begin until arrival at
tor will provide the necessary paperwork, describe the the hospital. By contrast, the modern, sophisticated
(cid:21)
Emergency Medical Care Systems, Research, and Public Health
EMS system (Emergency Medical Services system) per- support to the public. Completion of a CPR course is
mits patient care to begin at the scene of the injury or now a prerequisite to the EMT course.
illness, and EMS is part of a continuum of patient care (cid:116)(cid:1)The National Registry of EMTs in 1993 released the
that extends from the time of injury or illness until reha- National Emergency Medical Services Education and
bilitation or discharge. Today, when a person becomes Practice Blueprint, which defined issues related to
ill or suffers an injury, he has easy access to EMS by EMS training and education and was intended to
telephone, gets a prompt response, and can depend on guide the development of national training curricula.
getting high-quality prehospital emergency care from (cid:116)(cid:1)The National Highway Traffic Safety Administration
trained professionals. in 1996 published the EMS Agenda for the Future
What happens to an injured person before he document with the intent to make EMS a greater
reaches a hospital is of critical importance. Wars helped component in the health care system in the United
to teach us this lesson. During the Korean and Vietnam States. In 2000, a follow-up document, The EMS Edu-
conflicts, for example, it became obvious that injured cation Agenda for the Future: A Systems Approach,
soldiers benefited from emergency care in the field prior was released to address the issue of consistency in
to transport. This realization helped the civilian EMS the education, training, and certification and licen-
system evolve from a mere provider of fast transport by sure of entry-level EMS personnel nationally.
poorly trained or untrained individuals who provided (cid:116)(cid:1)The National Highway Traffic Safety Administration
little or no care to a system in which highly trained EMS and Health Resources and Services Administration
personnel provide professional care at the scene and in 2005 published the National EMS Core Content,
en route to the hospital. We continue to learn about which defined the domain of knowledge found in the
trauma care from the wars in Iraq and Afghanistan and National EMS Scope of Practice Model. It promotes
to implement changes in EMS practice based on the out- universal knowledge and skills for EMS personnel.
comes of those patients. (cid:116)(cid:1)The National Highway Traffic Safety Administration
The modern EMS system has evolved from its be- in 2006 published The National EMS Scope of Practice
ginnings in the 1960s when the President’s Committee Model, which defines four levels of EMS licensure and
for Traffic Safety identified a need to reduce the injuries the corresponding knowledge and skills necessary at
and deaths related to highway crashes. In 1966, the Na- each level. The Scope of Practice will be discussed
tional Academy of Sciences National Research Council later in the chapter.
published a report entitled Accidental Death and Dis- (cid:116)(cid:1)The Institute of Medicine report The Future of EMS
ability: The Neglected Disease of Modern Society. This re- Care: EMS at the Crossroads in 2006 recommended
port became known as the “white paper,” detailing the that all state governments adopt a common scope of
number of deaths and injuries related to traffic crashes practice that allows for reciprocity between states, na-
in the United States. The “white paper” also identified tional accreditation for all paramedic programs, and
severe deficiencies in the delivery of prehospital care in national certification as a prerequisite for state licen-
the United States and made recommendations intended sure and local credentialing.
to change ambulance systems, training requirements, (cid:116)(cid:1)The National Highway Traffic Safety Administration’s
and the provision of prehospital care. The following are National EMS Education Standards outline the mini-
some of the significant developments that have had a mum terminal objectives for entry-level EMS person-
profound effect on emergency medical services: nel based on the National EMS Scope of Practice
Model. The contents of this text are based on the
(cid:116)(cid:1)The Highway Safety Act of 1966 required each state National EMS Education Standards.
to establish a highway safety program that met pre-
scribed federal standards and included emergency Advances continue to be made in emergency medi-
services. The Department of Transportation, through cal services design and response, equipment, research,
its National Highway Traffic Safety Administration and the education of EMTs. Many lives have been saved
(NHTSA), took a leadership role in the develop- and unnecessary disabilities avoided because of these
ment of emergency medical services. An early focus advances in emergency medical services.
was improving the education of prehospital person-
nel. One initiative was the development of national
Technical Assistance Program
standard curricula. The EMT programs of today have
gradually evolved from this charge and continue to
Assessment Standards
use a national standard curriculum.
(cid:116)(cid:1)The Emergency Medical Services System Act of 1973 Each state has control of its own EMS system, inde-
provided access to millions of dollars of funding pendent of the federal government. However, the Na-
geared to EMS system planning and implementation, tional Highway Traffic Safety Administration (NHTSA)
personnel availability, and training. provides a set of recommended standards called the
(cid:116)(cid:1)The American Heart Association began to teach “Technical Assistance Program Assessment Standards.”
cardiopulmonary resuscitation (CPR) and basic life A brief description of these standards follows. They will
(cid:22)