Paramedics and emergency medical technicians (EMTs) care for the sick or injured in emergency medical settings. People’s lives often depend on their quick reaction and competent care. They respond to emergency calls, performing medical services and transporting patients to medical facilities. They work both indoors and outdoors, in all types of weather. Their work is physically strenuous and can be stressful, sometimes involving life-or-death situations.
They are not the same, in fact EMTs are the basic entry level in providing EMS.
EMTs complete a course which spans between 120-150 hours in comparison to the course paramedics take which is 1,200 to 1,800 hours. The courses consist of lectures, hands-on skills training, and clinical and/or field internships. EMTs are not allowed to provide treatments that requiring breaking the skin: that means no needles.
Paramedics are advanced providers of emergency medical care and are highly educated in topics such as anatomy and physiology, cardiology, medications, and medical procedures. These are the guys who are experts at resuscitation and supporting patients with significant problems such as heart attacks and traumas.
[1] Medical Equipment
[2] What Does a Paramedic Do?
[3] Receiving a Call
[4] Medical Procedures
[5] Codes
BLS (Basic Life Support) Ambulance Equipement
A. Ventilation and Airway Equipement
1. Portable Oxygen Apparatus
2. tubing
3. transparent mask, both nonbreathing and valvless
4. Bag-valve mask
6. Nasopharyngeal and Oropharyngeal
B. Monitoring and Defibrilation
1. AED (Automated External Defibrillator)
C. Immobilization Devices
1. Cervical collars
2. Splints
3. Spineboard
D. Bandages
1. Normal Bandages with 2 safety pins each
2. Sterile miltitrauma dressings
3. Gauze sponges
4. Gauze rolls
5. Occlusive dressing
6. Adhesive tape
E. Obstetrical Kit
1. Towel
2. Sterile Scissors
3. Sterile Gloves
4. Blankets
5. Thermal absorbent blankets
F. Miscellaneous
1. Sphyngmomanometer
2. Stethoscope
3. Thermometer
4. Cold Pack
5. Saline solution 1000ml bags
6. Flashlights
7. Folding Stretcher
8. Carry Chair
A. Airway and Ventilation Equipement
1. Laryngoscope blades
2. Endotracheal tubes
3. Forceps
B. Vascular Access
1. Crystalloid solutions, e.g. Ringer's Lactate
2. Antiseptic solution, i.e. alcohol wipes and povidone-idoine wipes
3. Intravenous-fluid pole
4. Intravenous catheters
5 Syringes of various sizes
6. Needles of various sizes
7. Intravenous administration sets
C. Cardiac
1. Portable defibrillator
2. ECG
3. Peacemaker
D. Other Advanced Equipment
1. Glucometer
2. Large-bore needle (for needle chest decompression)
E. Medications
1. Cardiovascular medications such as epinephrine, atropine, betablockers, nitroglycerin tablets, aspirin.
2. Cardiopulmonary respiratory medications such as albuterol and ipratorpium bromide.
3. 50% dextrose solution
4. Analgesic (painkillers) i.e. codeine, morphine
5. Antipileptic medications such as diazepam or midazolam
6. Naloxone hydrochloride, Activated Charcoal
A1. Analgesics (Morphine Codeine)
Usage:
As a painkiller
Mechanism:
Block pain receptors
Dosage:
Morphine: 10mg orally; 1mg injection
Codeine: 60mg maximum orally
A2. Antipileptic (diazepam or midazolam)
Usage:
epilepsy (epileptic seizure)
Mechanism:
Diazepam appears to act on areas of the limbic system, thalamus, and hypothalamus, inducing anxiolytic effects. The muscle relaxant properties of diazepam are produced via inhibition of polysynaptic pathways in the spinal cord.
Dosage:
Injection 5 mg/ml for intravenous, intramuscular or subcutaneous usage
A3. Atropine
Usage:
Injections of atropine are used in the treatment of bradycardia (an extremely low heart rate) and asystole (flat line pattern)
Mechanism:
The main action of the vagus nerve of the parasympathetic system on the heart is to decrease heart rate. Atropine blocks this action and, therefore, may speed up the heart rate.
Dosage:
0.5 to 1mg IV every three to five minutes up to max dosage 00.4mg/kg
B. Betablockers
Usage:
Heartattacks, hypertension
Mechanism:
Betablockers reduce the effect of excitement/physical exertion on heart rate and force of contraction, dilation of blood vessels and opening of bronchi, and also reduce tremor and breakdown of glycogen.
Dosage:
Depends on the betablocker used
Examples:
Propranolol in capsules 80mg (dosage 80mg)
Toprol in tablets 50mg (large dosage 50mg)
Nebivolol 5 mg (dosage above 10mg doesn't give a better effect)
E. Epinephrine (epi)
Usage:
In cases of asthma, bronchitis, empysema and anaphylactic shock
Mechanism:
Epinephrine is a powerful bronchodilator (relaxes bronchial muscles). It also constricts pulmonary vessels (in the lung), and inhibits the release of histamines triggered by allergic reactions.
Dosage:
approx. 0.3mg
Note: Epinephrine can be also in EpiPen autoinjector
D. Dextrose
Usage:
Hypoglycemia (low blood sugar)
Mechanism:
Dextrose is a sugar
Dosage:
25 grams through the IV line
N1. Naloxone
Usage:
Used to counter the effects of opioid overdose, for example heroin or morphine overdose.
Mechanism:
Naloxone is a μ-opioid receptor competitive antagonist, and its rapid blockade of those receptors often produces rapid onset of withdrawal symptoms.
Dosage:
In prepared ampoules
Usually injected intramuscularly for fastest action.
N2. Nitroglycerin tablets
Usage:
Heart attack
Mechanism:
Nitroglycerin will dilate veins more than arteries, decreasing cardiac preload and leading to decrease blood pressure and increase heart rate.
Dosage:
One tablet placed under the tongue
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Paramedics and EMTs typically do the following:
[1] Respond to 911 calls for emergency medical assistance, such as cardiopulmonary resuscitation (CPR)
[2] Assess a patient’s condition and determine a course of treatment
[3] Follow guidelines that they learned in training and that they receive from physicians who oversee their work
[4] Use backboards and restraints to keep patients still and safe in an ambulance for transport
[5] Help transfer patients to the emergency department of a healthcare facility and report their observations and treatment to the staff
[6] Create a patient care report; documenting the medical care they gave the patient
[7] Replace used supplies and check or clean equipment after use
[8] If a patient has a contagious disease, paramedics and EMTs decontaminate the interior of the ambulance and may need to report these cases to the proper authorities.
When taking a patient to the hospital, one EMT or paramedic may drive the ambulance while the other monitors the patient's vital signs and gives additional care. Some work as part of a helicopter's flight crew to transport critically ill or injured patients to a hospital. Some patients may just need to be transferred to a hospital that specialises in treating their injury or illness or to a facility that provides long-term care, such as a nursing home. Paramedics and EMTs are often asked to do this.
Paramedics and EMTs must provide emotional support to patients in an emergency, especially patients who are in life-threatening situations or extreme mental distress. They almost always work on teams and must be able to coordinate their activities closely with others in stressful situations. They need to listen to patients to determine the extent of their injuries or illnesses. They also need to be physically fit. Their job requires a lot of bending, lifting, and kneeling. They need strong problem-solving skills. They must evaluate patients’ symptoms and administer the appropriate treatments. They need to be able to comfort and explain procedures to the patient, give orders, and relay information to others.
Part One:
1.General outline for every call:
1a.You are given your dispatch info, you respond, you arrive on scene
2. Are there any hazards?
2a. Heavy traffic
2b. Vehicle/house fires
2c. Gunshots nearby
3. How many patients do you have?
3a. One?
3b. More then one?
3c. Too many for you to take care of on your own?
4. Do you need backup and extra resources?
4a. Do you need police assistance if there are shots fired and you cant get to your patient.
4b. Was it a car crash, has the fire department been called already?
4c. Another ambulance?
5. What is your general impression of the patient?
5a. Is he calm?
5b. Is he screaming in pain?
5c. Is he aggressive?
6. What is the mechanism of injury?
6a. Was he shot?
6a. A car accident?
6c. Did he fall off a building?
6d. If your patient is complaining of neck or back pain in a car accident, or they have fallen from a height more than 10 feet, you need to place a cervical collar around their neck.
1. AVPU
1a. Is your patient A-Alert?
1b. Is your patient only alert to V-Verbal
1c. Is your patient only alert to P-Pain (rubbing his chest, poking him in a pressure point to arrouse him)
1d. Is your patient U-Unresponsive (dead, Coma, overdose, drunk)
2. Now you can assess his ABCD's
2a. A- Airway
2ai. Is it open and clear? is there blood? is he vomiting blood? Are there broken teeth in his airway? You may need to suction it out.
2b. B- Breathing
2bi. What is the rate and quality of his breathing?
2bii. Normal breathing rate is 12 - 20 breaths per minute, count it out for 15 seconds and multiply that number by 4 for a quick answer.
2biii. Is he having trouble breathing? Shallow breaths? laboured breathing? Is he not breathing?
2biv. At this point you can place the patient on Oxygen and you might possible have to intubate
2bv. If they are breathing ok you can place them on an oxygen mask. If your patient is not breathing you need to use a BVM (see procedure V)
2c. C - Circulation
2ci. Check the pulse at their wrist for the rate. Normal pulse should be between 60 - 100 beats per minute.
2d. D - Deadly wet check
See of your patient wet himself, or if you can find blood when you feel around them, this will give you an idea where the injury was or where that gunshot may be.You are also trying to find any major bleeds such as from a cut on the head that's bleeding a lot, or an amputation that is bleeding all over the place.
1. Rapid Trauma Survey
1a. This is a quick assessment of your patient to find out where they are injured.
2. HEENT - Head, Ears, Eyes, Nose, Throat
2a. Look for any obvious trauma or cuts to the patient, check for any bruises around the eyes or behind the ears, this may mean they have a serious head injury.
2b. Check for any knife wounds or gun shots. Check the patients neck, feel down his spine. Is there any pain?
3. Chest
3a. Look for any gun shots or stab wounds on their chest, if they have a hole in their chest and it punctures a lung, this is called a pnumothorax.
3b. What helps relieve this is needle decompression. This is where you stab a intravenous needle into their lung to help relieve the pressure on the lung from leaking air.
4. Abdomen
4a. Look for any gun shots or stab wounds, is it rigid when you feel it? this might mean internal bleeding.
5. Pelvis
5a. Is it stable? if it isn't then they could have a fractured pelvis, you will have to be careful when moving them so you don't make it worse.
6. Legs
6a. Any trauma or injury? gunshots or stab wounds? Check the pulses in the feet. Make sure they are there, if there are any fractures to the legs and you can't feel a pulse in the foot, try to realign the leg. If that fails, then you need to hurry to the nearest hospital with the patient or they might need an amputation. (See procedure B. )
7. Arms
7a. Any trauma or injury? gunshots or stab wounds?
8. Back
8a. Just because you have been looking at the patients front, don't forget to look at their back for any obvious injury or trauma.
1. Does your patient need to be intubated?
2. When you encounter a bleed, what do you do ?
2a. Direct pressure with gause over the wound. If that doesn't stop it go on to step 2b
2b. Elevate the extremity. If that doesn't stop or slow the bleeding go on to step 2c
2c. Hold pressure over the nearest pulse point (for example, you are bleeding from your forearm, hold pressure on the pulse under your biceps) If that doesn't stop or slow the bleeding move on to step 2d.
2d. Apply a tourniquet. You are tying it tight to tighten the veins and arteries and hopefully stop the bleeding. But there is a high chance that the patient will lose that part of the body and have to get it surgically removed from tissue death if its prolonged.
3. Your patient has a gunshot or a stab wound? (See procedures G & F. )
Get some bandages, place it over the injury or hole and tape it down on all 4 sides. If there is a lot of blood, return to the 4 steps for stopping a bleed.
4. Car accident with a patient complaining of neck and back pain (See procedure N. )
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1. An automated external defibrillator is used in cases of life threatening cardiac arrhythmias which lead to cardiac arrest.
2. AEDs, like all defibrillators, are not designed to shock asystole ('flat line' patterns) as this will not have a positive clinical outcome.
3. Unlike regular defibrillators, an automated external defibrillator requires minimal training to use. It automatically diagnoses the heart rhythm and determines if a shock is needed.
Procedure:
1a. First ensure that the adhesive AED pads are attached to a cable, which is plugged into the AED machine.
2a. Place the negative pad on the patients upper chest wall, the positive electrode on the patients left chest side just below the nipple and pectoral muscle.
3a. Ensure that nobody is touching the patient and push the analyze button on the AED machine. Shout CLEAR!
4a. If the AED indicates that a shock is required make sure that everyone is clear from the patient, then press the shock button.
5a. Immediately following the shock begin CPR for 5 cycles.
Note: Do not use AED on a trauma patient or a victim with pulse.
1. It's medical condition in which there is a break in the continuity of the bone.
Procedure:
1a. Stabilize the break with a splint to prevent movement of the injured part.
2a. If the patient is in pain administer analgesics.
3a. Take the patient to the hospital for the doctor to see him.
1. Its an emergency medical procedure for a victim of cardiac arrest or, in some circumstances, respiratory arrest.
Procedure:
1a. Open the victim's airway using the head-tilt, chin-lift method.
2a. Check if the patient is breathing
3a. If there is no breathing, pinch the victim's nose; make a seal over the victim's mouth with yours.
4a. Give the victim a breath big enough to make the chest rise. Let the chest fall, then repeat the rescue breath once more.
5a. Place the heel of your hand in the middle of the victim's chest.
6a. Compress the chest about 1-1/2 to 2 inches (4-5 cm)
7a. Compress the chest at a rate equal to 100/minute. Perform 30 compressions at this rate.
1. Laryngoscope is a tool used in intubation and detection of voice problems, evaluates difficulty in swallowing, injures of the throat.
2. Intubation is a procedure that is preformed when the patient cannot breath on his own due to air not arriving to the lungs.
Procedure:
1a. Standing behind the patient, with your left hand, insert the curved blade of the laringiscope into the mouth over the right side of the tongue displacing it to the left and upwards.
2a. Advance the laryngoscope slightly until the the end of epiglottis can be seen posterior to the back of the tongue.
3a. Advance the laryngoscope blade between the epiglottis and the tongue.
4a. Lift up the tongue and the epiglottis to display the vocal cords.
5a. With your right hand insert the endotracheal tube from the right hand side directly between the chords.
6a. The markings on the tube will show between 21 and 23.
7a. Check the placement with the stethoscope.
Procedures:
1a. Place the occlusive dressing on the wound
2a. Press the dressing to the wound and tape it down
3a. Set an IV with Ringer's Lactate.
4a. Inform the ER about the gunshot wound patient and take him to the hospital immediately.
1. Intravenous therapy or IV therapy is the giving of liquid substances directly into a vein.
2. The IV fluid used commonly is a crystalloid fluid, saline which is close to concentration in the blood
3. Ringer's acetate is another isotonic solution often used for large-volume fluid replacement.
4. A solution of 5% dextrose in water, sometimes called D5W, is often used instead if the patient is at risk for having low blood sugar or high sodium.
5. IV is set to replace fluids in the body. i.e. Blood loss, dehydration etc. and also to administer drugs.
Procedure:
1a. Place the bag with the fluid you are using on the Intravenous-fluid pole.
2a. Remove the protective cap from the tubing.
3a. Insert it to the opening of the bag.
4a. With the tubing occluded in the rollerclamp squeeze the chamber till it will be half full.
5a. Unroll the rollerclamp.
6a. Flush the tubing.
7a. Place the tourniquet on the patients arm to make the veins swell so they can be easier to find.
8a. After finding the vein clean the site with an alcohol wipe.
9a. Insert the catheter needle into the vein.
10a. Connect the tube and the line to the catheter.
1. It occurs wherein air or gas is present in the pleural cavity.
2. It can also occur as the result of disease or injury to the lung, or due to a puncture to the chest wall.
Procedure:
1a. Immediately cover the wound with occlusive dressing or a pressure bandage.
2a. air-tight with clean plastic sheeting.
3a. If air is present in the pleural cavity pierce the chest with a syringe without a plunger.
Procedures:
1a. Place a Cervical Collar on the patients neck
2a. Place the patient on the spineboard
3a. Be sure that the patient wont move his head before applying the Cervical Collar.
1. Ventilation can be performed by the use of NRB (Non Rebreathable Mask) or BVM (Bag Valve Mask)
2. If the patient is breathing not adequately use NRB or BVM to aid him in oxygenation.
3. If the patient is not breathing use BMV or perform intubation (See procedure I. )
Procedure in using NRB (Non Re breathable Mask):
1a. Place the mask on the patients face.
2a. Strap it tightly.
3a. connect the mask to the oxygen tank.
4a. release the oxygen flow.
Procedures in using BVM (Bag Valve Mask):
1a. Place the mask on the patients mouth
2a. Squeeze the bag once every 5 seconds.
: A time critical case with a lights and sirens ambulance response. An example is a cardiac arrest or serious traffic accident.
Code 2: An acute but non-time critical response. The ambulance does not use lights and sirens to respond. An example of this response code is a broken leg.
Code 3: A non-urgent routine case. These include cases such as a person with ongoing back pain but no recent injury
Sometimes priority codes are used:
Priority 0 - D.O.A.
Priority 1 - Critical
Priority 2 - Emergency
Priority 3 - Non-Emergency
10 Codes:
10-7 Committed to scene / out at hospital
10-8 Back in service area
10-12 Additional person(s)will be riding in the ambulance.
10-13 Send police!
10-14 Out of service
10-15 Station unmanned
10-16 En route to hospital
10-19 En route to station
10-23 Switching to channel:
10-24 Send rescue unit to:
10-25 Ambulance mechanical problem
10-26 Send additional ambulance
10-27 Send fire department
10-21 On scene
10-38 Arrived at station
10-39 Possible intoxicated person
10-40 Possible DOA
10-41 Possible heart attack
10-42 Mental patient
10-43 poisoning
10-46 Emergency transfer or a Code 2 response
10-47 Routine transfer or a Code 1 response
10-48 Overdose
10-49 Suicide
10-50 Working fire
10-99 No pulse.
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