Emergency Care and Transportation of the Sick and Injured

Title Page
Copyright Page
Celebrating 50 Years of EMS Education and Innovation
Brief Contents
Contents
Skill Drills
Preface
Acknowledgments
1 EMS Systems
	Introduction
	EMT Training: Focus and Requirements
	Licensure Requirements
	Overview of the EMS System
		History of EMS
	Levels of Training
		Public Basic Life Support and Immediate Aid
		Emergency Medical Responder
		Emergency Medical Technician
		Advanced Emergency Medical Technician
		Paramedic
	Components of the EMS System
		Public Access
		Human Resources
		Medical Direction
		Legislation and Regulation
		Integration of Health Services
		Mobile Integrated Health Care and Community Paramedicine
		Information Systems
		Evaluation
		System Finance
		Education Systems
		Prevention and Public Education
		EMS Research
	Roles and Responsibilities of the EMT
		Professional Attributes
2 Workforce Safety and Wellness
	Introduction
	General Health, Wellness, and Resilience
		Wellness and Stress Management
		Sleep
		Disease Prevention and Health Promotion
		Balancing Work, Family, and Health
	Infectious and Communicable Diseases
		Routes of Transmission
		Risk Reduction and Prevention for Infectious and Communicable Diseases
		Immunity
		General Postexposure Management
	Scene Safety
		Scene Hazards
		Scenes of Violence
		Protective Clothing: Preventing Injury
	Caring for Critically Ill and Injured Patients
		Techniques for Communicating With the Critical Patient
		Locating and Notifying Family Members
		Injured and Critically Ill Children
		Coping With the Death of a Child
		Helping the Family
	Death and Dying
		The Grieving Process
		What Can the EMT Do?
		Assisting Patient and Family Members
	Stress Management on the Job
		Posttraumatic Stress Disorder
		Burnout
		Compassion Fatigue
		Responder Risk for Suicide
		Emotional Aspects of Emergency Care
		Stressful Situations
	Workplace Issues
		Cultural Diversity on the Job
		Sexual Harassment
		Substance Abuse
		Injury and Illness Prevention
3 Medical, Legal, and Ethical Issues
	Introduction
	Consent
		Expressed Consent
		Implied Consent
		Involuntary Consent
		Minors and Consent
		Forcible Restraint
	The Right to Refuse Treatment
	Confidentiality
		Health Insurance Portability and Accountability Act
		Social Media
	Advance Directives
	Physical Signs of Death
		Presumptive Signs of Death
		Definitive Signs of Death
		Medical Examiner Cases
	Special Situations
		Organ Donors
		Medical Identification Insignia
	Scope of Practice
	Standards of Care
		Standards Imposed by Local Custom
		Standards Imposed by Law
		Professional or Institutional Standards
		Standards Imposed by Textbooks
		Standards Imposed by States
	Duty to Act
	Negligence
	Abandonment
	Assault and Battery and Kidnapping
	Defamation
	Good Samaritan Laws and Immunity
	Records and Reports
	Special Mandatory Reporting Requirements
		Abuse of Children, Older People, and Others
		Injury During the Commission of a Felony
		Drug-Related Injuries
		Childbirth
		Other Reporting Requirements
		Scene of a Crime
		The Deceased
	Ethical Responsibilities
	The EMT in Court
4 Communications and Documentation
	Introduction
	Therapeutic Communication
		Age, Culture, and Personal Experience
		Nonverbal Communication
		Verbal Communication
	Written Communications and Documentation
		Patient Care Report
		Types of Forms
		Standardized Narrative Formats
		Reporting Errors
		Documenting Refusal of Care
		Special Reporting Situations
	Communications Systems and Equipment
		Base Station Radios
		Mobile and Portable Radios
		Repeater-Based Systems
		Digital Equipment
		Cellular/Satellite Telephones
		Other Communications Equipment
	Radio Communications
		Responding to the Scene
		Communicating With Medical Control and Hospitals
		Maintenance of Radio Equipment
5 Medical Terminology
	Introduction
	Anatomy of a Medical Term
		Word Roots
		Prefixes
		Suffixes
		Combining Vowels
	Word Building Rules
	Plural Endings
	Special Word Parts
		Numbers
		Colors
		Positions and Directions
	Common Direction, Movement, and Position Terms
		Directional Terms
		Movement Terms
		Other Directional Terms
		Anatomic Positions
	Breaking Terms Apart
	Abbreviations and Symbols
		Abbreviations
		Symbols
	Master Tables
6 The Human Body
	Introduction
	Topographic Anatomy
		The Planes of the Body
	From Cells to Systems
	The Skeletal System: Anatomy
		Bones
		Joints
		The Axial Skeleton
		The Appendicular Skeleton
		The Pelvis
		The Lower Extremities
	The Skeletal System: Physiology
	The Musculoskeletal System: Anatomy
		Skeletal Muscle
	The Musculoskeletal System: Physiology
	The Respiratory System: Anatomy
		The Upper Airway
		The Lower Airway
		Mechanics of Breathing
	The Respiratory System: Physiology
		Respiration
		Ventilation
		Characteristics of Normal Breathing
		Inadequate Breathing in Adults
	The Circulatory System: Anatomy
		The Heart
		Arteries
		Capillaries
		Veins
		Blood Composition
		The Spleen
	The Circulatory System: Physiology
		Normal Circulation in Adults
		Inadequate Circulation in Adults
		The Function of Blood
		Nervous System Control of the Cardiovascular System
	The Nervous System: Anatomy and Physiology
		The Central Nervous System
		The Peripheral Nervous System
	The Integumentary System (Skin): Anatomy
	The Integumentary System (Skin): Physiology
	The Digestive System: Anatomy
		The Abdomen
		Mouth
		Oropharynx
		Esophagus
		Stomach
		Pancreas
		Liver
		Small Intestine
		Large Intestine
		Appendix
		Rectum
	The Digestive System: Physiology
	The Lymphatic System: Anatomy and Physiology
	The Endocrine System: Anatomy and Physiology
	The Urinary System: Anatomy and Physiology
	The Genital System: Anatomy and Physiology
		The Male Reproductive System and Organs
		The Female Reproductive System and Organs
	Life Support Chain
	Pathophysiology
		Respiratory Compromise
		Shock
		Alteration of Cellular Metabolism
7 Life Span Development
	Introduction
		Vital Signs
	Neonates (Birth to 1 Month) and Infants (1 Month to 1 Year)
		Physical Changes
		Psychosocial Changes
	Toddlers (1 to 3 Years) and Preschoolers (3 to 6 Years)
		Physical Changes
		Psychosocial Changes
	School-Age Children (6 to 12 Years)
		Physical Changes
		Psychosocial Changes
	Adolescents (12 to 18 Years)
		Physical Changes
		Psychosocial Changes
	Early Adults (19 to 40 Years)
		Physical Changes
		Psychosocial Changes
	Middle Adults (41 to 60 Years)
		Physical Changes
		Psychosocial Changes
	Older Adults (61 Years and Older)
		Physical Changes
		Psychosocial Changes
8 Lifting and Moving Patients
	Introduction
	The Wheeled Ambulance Stretcher
	Backboards
	Moving and Positioning the Patient
	Body Mechanics
		Anatomy Review
	Principles of Safe Reaching and Pulling
	Principles of Safe Lifting and Carrying
		Patient Weight
		Lifting and Carrying a Patient on a Backboard or Stretcher
		Moving a Patient With a Stair Chair
		Moving a Patient on Stairs With a Stretcher
		Loading a Wheeled Stretcher Into an Ambulance
	Directions and Commands
	Emergency Moves
	Urgent Moves
		Rapid Extrication Technique
	Nonurgent Moves
		Direct Ground Lift
		Extremity Lift
		Transfer Moves
	Geriatrics
	Bariatrics
	Additional Patient-Moving Equipment
		Bariatric Stretchers
		Pneumatic and Electronic Powered Wheeled Stretchers
		Binder Lift
		Portable/Folding Stretchers
		Flexible Stretchers
		Short Backboards
		Vacuum Mattresses
		Basket Stretchers
		Neonatal Isolettes
		Decontamination
	Patient Positioning
	Personnel Considerations
9 The Team Approach to Health Care
	Introduction
	An Era of Team Health Care
		Community Paramedicine and Mobile Integrated Healthcare Teams
		Differences Among Teams
	Types of Teams
		Regular Teams
		Temporary Teams
		Special Teams
	Groups Versus Teams
		Groups
	Dependent, Independent, and Interdependent Groups
		Dependent
		Independent
		Interdependent
	Effective Team Performance
		A Shared Goal
		Clear Roles and Responsibilities
		Diverse and Competent Skill Sets
		Effective Collaboration and Communication
		Supportive and Coordinated Leadership
	Transfer of Patient Care
		General Guidelines
	BLS and ALS Providers Working Together
		Where BLS Care Ends and ALS Care Begins
	Assisting With ALS Skills
	Critical Thinking and Clinical Decision Making in EMS
		Stages of the Decision-Making Process
		Decision Traps
	Troubleshooting Team Conflicts
10 Patient Assessment
	Introduction
	Scene Size-up
		Ensure Scene Safety
		Determine Mechanism of Injury/Nature of Illness
		Take Standard Precautions
		Determine Number of Patients
		Consider Additional/Specialized Resources
	Primary Assessment
		Form a General Impression
		Scan for Signs of Uncontrolled External Bleeding
		Assess Level of Consciousness
		Assess the Airway
		Assess Breathing
		Assess Circulation
		Performing a Rapid Exam to Identify Life Threats
		Determine Priority of Patient Care and Transport
	History Taking
		Investigate the Chief Complaint (History of Present Illness)
		Obtain SAMPLE History
	Secondary Assessment
		Systematically Assess the Patient—Secondary Assessment
		Systematically Assess the Patient—Focused Assessment
		Assess Vital Signs Using the Appropriate Monitoring Device
	Reassessment
		Repeat the Primary Assessment
		Reassess Vital Signs
		Reassess the Chief Complaint
		Recheck Interventions
		Identify and Treat Changes in the Patient’s Condition
		Reassess Patient
11 Airway Management
	Introduction
	Anatomy of the Respiratory System
		Anatomy of the Upper Airway
		Anatomy of the Lower Airway
	Physiology of Breathing
		Ventilation
		Oxygenation
		Respiration
	Pathophysiology of Respiration
		Factors in the Nervous System
		Ventilation/Perfusion Ratio and Mismatch
		Factors Affecting Pulmonary Ventilation
		Factors Affecting Respiration
		Circulatory Compromise
	Patient Assessment
		Recognizing Adequate Breathing
		Recognizing Abnormal Breathing
		Assessment of Respiration
	Opening the Airway
		Head Tilt–Chin Lift Maneuver
		Jaw-Thrust Maneuver
		Opening the Mouth
	Suctioning
		Suctioning Equipment
		Techniques of Suctioning
	Basic Airway Adjuncts
		Oropharyngeal Airways
		Nasopharyngeal Airways
	Maintaining the Airway
	Supplemental Oxygen
		Supplemental Oxygen Equipment
		Procedures for Operating and Administering Oxygen
		Hazards of Supplemental Oxygen
	Oxygen-Delivery Equipment
		Nonrebreathing Masks
		Nasal Cannulas
		Partial Rebreathing Masks
		Venturi Masks
		Tracheostomy Masks
		Humidification
	Assisted and Artificial Ventilation
		Assisting Ventilation in Respiratory Distress/Failure
		Artificial Ventilation
	Continuous Positive Airway Pressure
		Mechanism
		Indications
		Contraindications
		Application
		Complications
	Stomas and Tracheostomy Tubes
	Foreign Body Airway Obstruction
		Recognition
		Emergency Medical Care for Foreign Body Airway Obstruction
		Dental Appliances
		Facial Bleeding
	Assisting With ALS Airway Procedures
		Assisting With Placement of Advanced Airways
12 Principles of Pharmacology
	Introduction
	How Medications Work
		Medication Names
		Routes of Administration
	Medication Forms
		Tablets and Capsules
		Solutions and Suspensions
		Metered-Dose Inhalers
		Topical Medications
		Transcutaneous Medications
		Gels
		Gases for Inhalation
	General Steps in Administering Medication
		Medication Administration Cross-Check Procedure
	Medication Administration and the EMT
	Medications Used by EMTs
		Oral Medications
		Sublingual Medications
		Intramuscular Medications
		Intranasal Medications
		Inhalation Medications
	Patient Medications
		Implications for EMS Providers
	Medication Errors
13 Shock
	Introduction
	Pathophysiology
		Perfusion
	Causes of Shock
	Types of Shock
		Cardiogenic Shock
		Obstructive Shock
		Distributive Shock
		Hypovolemic Shock
	The Progression of Shock
	Patient Assessment for Shock
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Emergency Medical Care for Shock
		Treating Cardiogenic Shock
		Treating Obstructive Shock
		Treating Septic Shock
		Treating Neurogenic Shock
		Treating Anaphylactic Shock
		Treating Psychogenic Shock
		Treating Hypovolemic Shock
		Treating Shock in Older Patients
14 BLS Resuscitation
	Introduction
	Elements of BLS
	The Components of CPR
	Assessing the Need for BLS
		Basic Principles of BLS
	Automated External Defibrillation
		AED Usage in Children
		Special AED Situations
	Positioning the Patient
	Check for Breathing and a Pulse
		Provide External Chest Compressions
		Proper Hand Position and Compression Technique
	Opening the Airway and Providing Artificial Ventilation
		Opening the Airway in Adults
		Recovery Position
		Breathing
		Provide Artificial Ventilations
	One-Rescuer Adult CPR
	Two-Rescuer Adult CPR
		Switching Positions
	Devices and Techniques to Assist Circulation
		Active Compression-Decompression CPR
		Impedance Threshold Device
		Mechanical Piston Device
		Load-Distributing Band CPR or Vest CPR
	Infant and Child CPR
		Determining Responsiveness
		Check for Breathing and a Pulse
		Airway
		Provide Rescue Breathing
	Interrupting CPR
	When Not to Start CPR
	When to Stop CPR
	Foreign Body Airway Obstruction in Adults
		Recognizing Foreign Body Airway Obstruction
		Removing a Foreign Body Airway Obstruction in an Adult
	Foreign Body Airway Obstruction in Infants and Children
		Removing a Foreign Body Airway Obstruction in a Child
		Removing a Foreign Body Airway Obstruction in Infants
	Special Resuscitation Circumstances
		Opioid Overdose
		Cardiac Arrest in Pregnancy
	Grief Support for Family Members and Loved Ones
	Education and Training for the EMT
	Education and Training for the Public
15 Medical Overview
	Introduction
	Types of Medical Emergencies
	Patient Assessment
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Management, Transport, and Destination
		Scene Time
		Type of Transport
		Destination Selection
	Infectious Diseases
		General Assessment Principles
		General Management Principles
		Epidemic and Pandemic Considerations
	Common or Serious Communicable Diseases
		Influenza
		Herpes Simplex
		HIV Infection
		Hepatitis
		Meningitis
		Tuberculosis
		Whooping Cough
		Methicillin-Resistant Staphylococcus aureus
		Global Health Issues
		Travel Medicine
	Conclusion
16 Respiratory Emergencies
	Introduction
	Anatomy of the Respiratory System
	Physiology of Respiration
	Pathophysiology
		Carbon Dioxide Retention and Hypoxic Drive
	Causes of Dyspnea
		Upper or Lower Airway Infection
		Acute Pulmonary Edema
		Chronic Obstructive Pulmonary Disease
		Asthma, Hay Fever, and Anaphylaxis
		Spontaneous Pneumothorax
		Pleural Effusion
		Obstruction of the Airway
		Pulmonary Embolism
		Hyperventilation
		Environmental/Industrial Exposure
	Patient Assessment
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Emergency Medical Care
		Metered-Dose Inhaler and Small-Volume Nebulizer
		Administration of an MDI
		Administration of a Small-Volume Nebulizer
	Treatment of Specific Conditions
		Upper or Lower Airway Infection
		Acute Pulmonary Edema
		Chronic Obstructive Pulmonary Disease
		Asthma, Hay Fever, and Anaphylaxis
		Spontaneous Pneumothorax
		Pleural Effusion
		Obstruction of the Airway
		Pulmonary Embolism
		Hyperventilation
		Environmental/Industrial Exposure
		Foreign Body Aspiration
		Tracheostomy Dysfunction
		Asthma
		Cystic Fibrosis
17 Cardiovascular Emergencies
	Introduction
	Anatomy and Physiology
		Circulation
	Pathophysiology
		Atherosclerosis
		Acute Coronary Syndrome
		Cardiogenic Shock
		Congestive Heart Failure
		Hypertensive Emergencies
	Patient Assessment
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Emergency Medical Care for Chest Pain or Discomfort
		Administering Nitroglycerin
	Cardiac Monitoring
		Placing the Electrodes
		Performing Cardiac Monitoring
		Reviewing the ECG Tracing
	Heart Surgeries and Cardiac Assistive Devices
		Automatic Implantable Cardiac Defibrillators
		External Defibrillator Vest
		Left Ventricular Assist Devices
	Cardiac Arrest
		Automated External Defibrillation
	Emergency Medical Care for Cardiac Arrest
		Preparation
		Performing Defibrillation
18 Neurologic Emergencies
	Introduction
	Anatomy and Physiology
	Pathophysiology
	Headache
	Stroke
		Types of Stroke
		Signs and Symptoms of Stroke
		Conditions That May Mimic Stroke
	Seizures
		Causes of Seizures
		The Importance of Recognizing Seizures
		The Postictal State
		Syncope
	Altered Mental Status
		Causes of Altered Mental Status
	Patient Assessment
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Emergency Medical Care
		Headache
		Stroke
		Seizure
		Altered Mental Status
19 Gastrointestinal and Urologic Emergencies
	Introduction
	Anatomy and Physiology
		The GI System
		Additional Abdominal Organs
		The Genital System
		The Urinary System
	Pathophysiology
		Abdominal Pain
		Causes of Acute Abdomen
		Urinary System
		Kidneys
		Female Reproductive Organs
		Other Organ Systems
	Patient Assessment
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Emergency Medical Care
	Dialysis Emergencies
20 Endocrine and Hematologic Emergencies
	Introduction
	Endocrine Emergencies
		Anatomy and Physiology
		Pathophysiology
	Patient Assessment of Diabetes
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Emergency Medical Care for Diabetic Emergencies
		Giving Oral Glucose
	The Presentation of Hypoglycemia
		Seizures
		Altered Mental Status
		Misdiagnosis of Neurologic Dysfunction
		Relationship to Airway Management
	Hematologic Emergencies
		Anatomy and Physiology
		Pathophysiology
	Patient Assessment of Hematologic Disorders
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Emergency Medical Care for Hematologic Disorders
21 Allergy and Anaphylaxis
	Introduction
	Anatomy and Physiology
	Pathophysiology
	Common Allergens
		Insect Stings
	Patient Assessment of an Immunologic Emergency
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Emergency Medical Care of Immunologic Emergencies
		Epinephrine
22 Toxicology
	Introduction
	Identifying the Patient and the Poison
	How Poisons Enter the Body
		Inhaled Poisons
		Absorbed and Surface Contact Poisons
		Ingested Poisons
		Injected Poisons
	Patient Assessment
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Emergency Medical Care
	Specific Poisons
		Alcohol
		Opiates and Opioids
		Sedative-Hypnotic Drugs
		Abused Inhalants
		Hydrogen Sulfide
		Sympathomimetics
		Synthetic Cathinones (Bath Salts)
		Marijuana
		Hallucinogens
		Anticholinergic Agents
		Cholinergic Agents
		Miscellaneous Drugs
	Food Poisoning
	Plant Poisoning
23 Behavioral Health Emergencies
	Introduction
	Myth and Reality
	Defining a Behavioral Crisis
	The Magnitude of Mental Health Disorders
	Pathophysiology
		Organic
		Functional
	Safe Approach to a Behavioral Crisis
	Patient Assessment
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Acute Psychosis
		Schizophrenia
	Delirium
	Excited Delirium
	Restraint
		Risks Associated With Patient Restraint
		The Process of Restraining a Patient
		Performing Patient Restraint
	The Potentially Violent Patient
	Suicide
	Posttraumatic Stress Disorder and Returning Combat Veterans
		Signs and Symptoms of PTSD
		Caring for the Combat Veteran
	Medicolegal Considerations
		Consent
		Limited Legal Authority
24 Gynecologic Emergencies
	Introduction
	Anatomy and Physiology
	Pathophysiology
		Pelvic Inflammatory Disease
		Sexually Transmitted Diseases
		Vaginal Bleeding
	Patient Assessment
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Emergency Medical Care
	Assessment and Management of Specific Conditions
		Pelvic Inflammatory Disease
		Sexual Assault and Rape
25 Trauma Overview
	Introduction
	Energy and Trauma
	MOI Profiles
	Blunt and Penetrating Trauma
	Blunt Trauma
		Vehicular Crashes
		Car Versus Pedestrian
		Car Versus Bicycle
		Car Versus Motorcycle
		Falls
	Penetrating Trauma
	Blast Injuries
		Tissues at Risk
	Multisystem Trauma
		Golden Principles of Prehospital Trauma Care
	Patient Assessment
		Injuries to the Head
		Injuries to the Neck and Throat
		Injuries to the Chest
		Injuries to the Abdomen
	Management: Transport and Destination
		Scene Time
		Destination Selection
		Type of Transport
		Special Considerations
26 Bleeding
	Introduction
	Anatomy and Physiology of the Cardiovascular System
		The Heart
		Blood Vessels and Blood
	Pathophysiology and Perfusion
	External Bleeding
		The Significance of External Bleeding
		Characteristics of External Bleeding
	Internal Bleeding
		Mechanism of Injury for Internal Bleeding
		Nature of Illness for Internal Bleeding
		Signs and Symptoms of Internal Bleeding
	Patient Assessment for External and Internal Bleeding
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Emergency Medical Care for External Bleeding
		Wound Packing and Hemostatic Dressings
		Tourniquets
		Junctional Tourniquets
		Splints
		Pelvic Binder
		Bleeding From the Nose, Ears, and Mouth
	Emergency Medical Care for Internal Bleeding
27 Soft-Tissue Injuries
	Introduction
	Anatomy and Physiology of the Skin
		Anatomy
		Physiology
	Pathophysiology of Closed and Open Injuries
		Closed Injuries
		Open Injuries
	Patient Assessment of Closed and Open Injuries
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Emergency Medical Care for Closed Injuries
	Emergency Medical Care for Open Injuries
		Abdominal Wounds
		Impaled Objects
		Neck Injuries
		Bites
	Burns
		Pathophysiology of Burns
		Complications of Burns
		Burn Severity
	Patient Assessment of Burns
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Emergency Medical Care for Burns
		Management of Specific Burns
	Dressing and Bandaging
		Sterile Dressings
		Bandages
28 Face and Neck Injuries
	Introduction
	Anatomy and Physiology
		The Eye
	Injuries of the Face and Neck
		Soft-Tissue Injuries
		Dental Injuries
	Patient Assessment
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Emergency Medical Care
	Emergency Medical Care for Specific Injuries
		Injuries of the Eyes
		Injuries of the Nose
		Injuries of the Ear
		Facial Fractures
		Dental Injuries
		Injuries of the Cheek
		Injuries of the Neck
		Laryngeal Injuries
29 Head and Spine Injuries
	Introduction
	Anatomy and Physiology
		Nervous System
		How the Nervous System Works
		Skeletal System
	Head Injuries
		Scalp Lacerations
		Skull Fracture
		Traumatic Brain Injuries
		Intracranial Pressure
		Concussion
		Contusion
		Other Brain Injuries
	Spine Injuries
	Patient Assessment
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Emergency Medical Care of Head Injuries
		Managing the Airway
		Circulation
	Emergency Medical Care of Spinal Injuries
		Managing the Airway
		Spinal Motion Restriction of the Cervical Spine
	Preparation for Transport
		Supine Patients
		Sitting Patients
		Standing Patients
		Spinal Motion Restriction Devices
	Helmet Removal
		Preferred Method
		Alternative Method
30 Chest Injuries
	Introduction
	Anatomy and Physiology
	Mechanics of Ventilation
	Injuries of the Chest
		Signs and Symptoms of Chest Injury
	Patient Assessment
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Complications and Management of Chest Injuries
		PPE in Chest Injuries
		Pneumothorax
		Hemothorax
		Cardiac Tamponade
		Rib Fractures
		Flail Chest
	Other Chest Injuries
		Pulmonary Contusion
		Other Fractures
		Traumatic Asphyxia
		Blunt Myocardial Injury
		Commotio Cordis
		Laceration of the Great Vessels
31 Abdominal and Genitourinary Injuries
	Introduction
	Anatomy and Physiology of the Abdomen
		Abdominal Quadrants
		Hollow and Solid Organs
	Abdominal Injuries
		Closed Abdominal Injuries
		Open Abdominal Injuries
		Hollow Organ Injuries
		Solid Organ Injuries
	Patient Assessment of Abdominal Injuries
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Emergency Medical Care of Abdominal Injuries
		Closed Abdominal Injuries
		Open Abdominal Injuries
	Anatomy of the Genitourinary System
	Injuries of the Genitourinary System
		Injuries of the Kidneys
		Injuries to the Urinary Bladder
		Injuries of the External Male Genitalia
		Injuries of the Female Genitalia
	Patient Assessment of the Genitourinary System
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Emergency Medical Care of Genitourinary Injuries
		Kidneys
		Urinary Bladder
		External Male Genitalia
		Female Genitalia
		Rectal Bleeding
	Sexual Assault and Rape
32 Orthopaedic Injuries
	Introduction
	Anatomy and Physiology of the Musculoskeletal System
		Muscles
		The Skeleton
	Musculoskeletal Injuries
		Mechanism of Injury
		Fractures
		Dislocations
		Sprains
		Strain
		Amputations
		Complications
		Assessing the Severity of Injury
	Patient Assessment
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Emergency Medical Care
		Splinting
		Transportation
	Specific Musculoskeletal Injuries
		Injuries of the Clavicle and Scapula
		Dislocation of the Shoulder
		Fracture of the Humerus
		Elbow Injuries
		Fractures of the Forearm
		Injuries of the Wrist and Hand
		Fractures of the Pelvis
		Dislocation of the Hip
		Fractures of the Proximal Femur
		Femoral Shaft Fractures
		Injuries of Knee Ligaments
		Dislocation of the Knee
		Fractures About the Knee
		Dislocation of the Patella
		Injuries of the Tibia and Fibula
		Ankle Injuries
		Foot Injuries
		Sprains and Strains
		Amputations
	Compartment Syndrome
33 Environmental Emergencies
	Introduction
	Factors Affecting Exposure
	Cold Exposure
		Hypothermia
		Local Cold Injuries
	Assessment of Cold Injuries
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	General Management of Cold Emergencies
		Emergency Care of Local Cold Injuries
	Cold Exposure and You
	Heat Exposure
		Heat Cramps
		Heat Exhaustion
		Heatstroke
	Assessment of Heat Emergencies
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Management of Heat Emergencies
		Heat Cramps
		Heat Exhaustion
		Heatstroke
	Drowning
		Spinal Injuries in Submersion Incidents
		Recovery Techniques
		Resuscitation Efforts
	Diving Emergencies
		Descent Emergencies
		Emergencies at the Bottom
		Ascent Emergencies
	Assessment of Drowning and Diving Emergencies
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Emergency Care for Drowning or Diving Emergencies
		Other Water Hazards
		Prevention
	High Altitude
	Lightning
		Emergency Medical Care
	Bites and Envenomation
		Spider Bites
		Hymenoptera Stings
		Snake Bites
		Scorpion Stings
		Tick Bites
	Injuries From Marine Animals
34 Obstetrics and Neonatal Care
	Introduction
	Anatomy and Physiology of the Female Reproductive System
	Normal Changes in Pregnancy
	Complications of Pregnancy
		Diabetes
		Hypertension in Pregnancy
		Bleeding
		Abortion
		Abuse
		Substance Abuse
	Special Considerations for Trauma and Pregnancy
		Maternal Cardiac Arrest
		Assessment and Management
	Cultural Value Considerations
	Teenage Pregnancy
	Patient Assessment
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Stages of Labor
	Normal Delivery Management
		Preparing for Delivery
		The Delivery
		Postdelivery Care
	Neonatal Assessment and Resuscitation
		Additional Resuscitation Efforts
		The Apgar Score
	Complicated Delivery Emergencies
		Breech Delivery
		Presentation Complications
		Spina Bifida
		Multiple Gestation
		Premature Birth
		Postterm Pregnancy
		Fetal Death
	Postpartum Complications
35 Pediatric Emergencies
	Introduction
	Communication With the Patient and the Family
	Growth and Development
		The Infant
		The Toddler
		The Preschool-Age Child
		School-Age Years
		Adolescents
	Anatomy and Physiology
		The Respiratory System
		The Circulatory System
		The Nervous System
		The Gastrointestinal System
		The Musculoskeletal System
		The Integumentary System
	Patient Assessment
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Respiratory Emergencies and Management
		Airway Obstruction
		Asthma
		Pneumonia
		Croup
		Epiglottitis
		Bronchiolitis
		Pertussis
		Airway Adjuncts
		Oxygen Delivery Devices
		Cardiopulmonary Arrest
	Circulation Emergencies and Management
		Shock
		Bleeding Disorders
	Neurologic Emergencies and Management
		Altered Mental Status
		Seizures
		Meningitis
	Gastrointestinal Emergencies and Management
	Poisoning Emergencies and Management
		Dehydration Emergencies and Management
	Fever Emergencies and Management
		Febrile Seizures
	Drowning Emergencies and Management
	Pediatric Trauma Emergencies and Management
		Physical Differences
		Psychological Differences
		Injury Patterns
		Injuries to Specific Body Systems
		Burns
		Injuries of the Extremities
		Pain Management
	Disaster Management
	Child Abuse and Neglect
		Signs of Abuse
		Symptoms and Other Indicators of Abuse
		Sexual Abuse
	Sudden Unexpected Infant Death and Sudden Infant Death Syndrome
		Patient Assessment and Management
		Scene Assessment
		Communication and Support of the Family After the Death of a Child
		Apparent Life-Threatening Event
		Brief Resolved Unexplained Event
36 Geriatric Emergencies
	Introduction
	Generational Considerations
	Communication and Older Adults
		Communication Techniques
	Common Complaints and the Leading Causes of Death in Older People
	Changes in the Body
	Changes in the Respiratory System
		Anatomy and Physiology
		Pathophysiology
	Changes in the Cardiovascular System
		Anatomy and Physiology
		Pathophysiology
	Changes in the Nervous System
		Anatomy and Physiology
		Pathophysiology
	Changes in the Gastrointestinal System
		Anatomy and Physiology
		Pathophysiology
	Changes in the Renal System
		Anatomy and Physiology
		Pathophysiology
	Changes in the Endocrine System
		Anatomy and Physiology
		Pathophysiology
	Changes in the Immune System
	Changes in the Musculoskeletal System
		Anatomy and Physiology
		Pathophysiology
		Changes in Skin
	Toxicology
	Behavioral Emergencies
		Depression
		Suicide
	The GEMS Diamond
	Special Considerations in Assessing a Geriatric Medical Patient
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Trauma and Geriatric Patients
		Anatomic Changes and Fractures
		Environmental Injury
	Special Considerations in Assessing Geriatric Trauma Patients
		Scene Size-up
		Primary Assessment
		History Taking
		Secondary Assessment
		Reassessment
	Assessment of Falls
	Response to Nursing and Skilled Care Facilities
	Dying Patients
		Advance Directives
	Elder Abuse and Neglect
		Assessment of Elder Abuse
		Signs of Physical Abuse
37 Patients With Special Challenges
	Introduction
	Developmental Disability
		Autism Spectrum Disorder
		Down Syndrome
		Patient Interaction
	Sensory Disabilities
		Visual Impairment
		Hearing Impairment
	Physical Disabilities
		Cerebral Palsy
		Spina Bifida
		Paralysis
	Bariatric Patients
		Interaction With Patients With Obesity
		Interaction With Patients With Morbid Obesity
	Patients With Medical Technology Assistance
		Tracheostomy Tubes
		Home Oxygen
		Mechanical Ventilators
		Apnea Monitors
		Internal Cardiac Pacemakers
		Ventricular Assist Devices
		External Defibrillator Vest
		Central Venous Catheter
		Gastrostomy Tubes
		Shunts
		Vagus Nerve Stimulators
		Colostomies, Ileostomies, and Urostomies
	Patient Assessment Guidelines
	Home Care
	Hospice Care and Terminally Ill Patients
	Poverty and Homelessness
38 Transport Operations
	Introduction
	Emergency Vehicle Design
	Phases of an Ambulance Call
		The Preparation Phase
		The Dispatch Phase
		En Route to the Scene
		Arrival at the Scene
		The Transfer Phase
		The Transport Phase
		The Delivery Phase
		En Route to the Station
		The Postrun Phase
	Defensive Ambulance Driving Techniques
		Driver Characteristics
		Safe Driving Practices
	Air Medical Operations
		Helicopter Medical Evacuation Operations
		Establishing a Landing Zone
		Landing Zone Safety and Patient Transfer
		Special Considerations
		Medevac Issues
39 Vehicle Extrication and Special Rescue
	Introduction
	Safety
	Vehicle Safety Systems
	Fundamentals of Extrication
		Preparation
		En Route to the Scene
		Arrival and Scene Size-up
		Hazard Control
		Support Operations
		Gaining Access
		Emergency Care
		Removal of the Patient
		Transfer of the Patient
		Termination
	Specialized Rescue Situations
		Technical Rescue Situations
		Search and Rescue
		Trench Rescue
		Tactical Emergency Medical Support
		Structure Fires
40 Incident Management
	Introduction
	National Incident Management System
	Incident Command System
		ICS Roles and Responsibilities
		Communications and Information Management
		Mobilization and Deployment
	EMS Response Within the ICS
		Preparedness
		Scene Size-up
		Establishing Command
		Communications
	The Medical Branch of Incident Command
		Triage Supervisor
		Treatment Supervisor
		Transportation Supervisor
		Staging Supervisor
		Physicians on Scene
		Rehabilitation Supervisor
		Extrication and Special Rescue
		Morgue Supervisor
	Mass-Casualty Incidents
	Triage
		Triage Categories
		Triage Tags
		START Triage
		JumpSTART Triage for Pediatric Patients
		Triage Special Considerations
		Destination Decisions
	Disaster Management
	Introduction to Hazardous Materials
	Recognizing a Hazardous Material
		Occupancy and Location
		Senses
		Containers
		The Department of Transportation Marking System
		Other Considerations
		Identification
		Hazmat Scene Operations
		Classification of Hazardous Materials
		Personal Protective Equipment Level
		Caring for Patients at a Hazmat Incident
41 Terrorism Response and Disaster Management
	Introduction
	What Is Terrorism?
	Active Shooter Events
	Weapons of Mass Destruction
		Chemical Terrorism/Warfare
		Biologic Terrorism/Warfare
		Nuclear/Radiologic Terrorism
	EMT Response to Terrorism
		Recognizing a Terrorist Event (Indicators)
		Response Actions
	Chemical Agents
		Vesicants (Blister Agents)
		Pulmonary Agents (Choking Agents)
		Nerve Agents
		Metabolic Agents (Cyanides)
	Biologic Agents
		Viruses
		Bacteria
		Neurotoxins
		Other EMT Roles During a Biologic Event
	Radiologic/Nuclear Devices
		What Is Radiation?
		Sources of Radiologic Material
		Radiologic Dispersal Devices
		Nuclear Energy
		Nuclear Weapons
		Symptomatology
		Medical Management
		Protective Measure
	Incendiary and Explosive Devices
		Mechanisms of Injury
Glossary
Index