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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

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Chapter 22

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  1. Chapter 22 Emergency Medical Services

  2. 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

  3. Roles and Responsibilities ofan 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

  4. Figure 22-2 Firefighters are often called on to assist EMS crews with patient care.

  5. (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

  6. 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

  7. 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.

  8. Legal Considerations for Emergency Care Providers • Emergency care providers should understand several important legal issues: • Standard of care • Consent • Implied consent • Abandonment

  9. Interacting with EmergencyMedical 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

  10. 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

  11. Analyzing the Safety ofthe 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

  12. Figure 22-9 Team working together in patient care.

  13. Firefighter Physical andMental 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

  14. 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

  15. Figure 22-10 The most effective means of reducing the risk of spreading disease is hand washing.

  16. Figure 22-11 Proper hand washing involves vigorous lathering with soap and water for fifteen seconds (or longer) followed by thorough rinsing.

  17. 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?

  18. Performing an Initial Assessment • Initial assessment covers the following: • Level of consciousness • Airway • Breathing • Circulation • Major bleeding • Done quickly on conscious patient who is alert and talking • Unconscious patients require closer examination

  19. (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.

  20. 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

  21. Table 22-3 Average Vital Sign Ranges, by Age

  22. 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 • Initial assessment • Focused history • Physical exam • Patient’s vital signs • All patient fact-finding

  23. Figure 22-19 Examples of pupil size.

  24. CardiopulmonaryResuscitation/ 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

  25. Figure 22-22 Firefighters learning CPR.

  26. Bleeding Control andShock 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

  27. Internal and External Bleeding • Internal bleeding occurs when there is bleeding within body • 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

  28. Caring for Patients withInternal 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

  29. Caring for Patients withExternal 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

  30. Figure 22-26 Using pressure points in the upper arm and the leg to decrease blood flow to a wound.

  31. Types of Wounds RequiringFirst Aid • There are several type of wounds that firefighters should be able to recognize: • Abrasion • Avulsion • Amputation • Laceration or incision • Puncture

  32. 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

  33. 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

  34. 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

  35. Emergency Care forCommon Emergencies • No two emergency medical calls are the same • Must learn basics of first-aid treatment and adopt them to each emergency

  36. Trouble Breathing • Very common emergency • Common signs and symptoms: • Wheezing • Gasping for air • Shallow breathing • Pale or bluish skin color • Anxiety • Unconsciousness

  37. Guidelines for Trouble Breathing • 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

  38. Guidelines for TroubleBreathing (cont’d.) Reassure the patient and keep him calm Monitor vital signs frequently Recognize this is a serious emergency and activate EMS immediately

  39. 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

  40. Guidelines for Chest Pain • 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

  41. Guidelines for ChestPain (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

  42. 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

  43. Guidelines for Medical Illness • Ensure scene safety • Don appropriate BSI • Complete initial assessment • Ensure airway is open and patient is breathing adequately

  44. 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 Guidelines for Medical Illness (cont’d.)

  45. Allergic Reactions • Result from body’s reaction to a substance • Some allergic reactions can be severe • Can result from a variety of substances • Food • Environment • Bites and stings • Medications

  46. Guidelines for Allergic Reactions • Ensure scene safety • Don appropriate BSI • Complete initial assessment • Ensure airway is open and patient is breathing adequately

  47. Guidelines for AllergicReactions (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

  48. 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

  49. (B) (C) (A) Figure 22-28 (A) Superficial burns, (B) partial thickness burns, and (C) full thickness burns.

  50. Guidelines for Thermal Burns • 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

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