EMS Pediatric Populations - Infant Emergencies

EMS providers should be well-prepared to handle common infant emergencies, especially those related to respiratory illness and household accidents. 

Here's a guide for EMS providers on these aspects:

Common Infant Respiratory Emergencies:

Bronchiolitis:

• Typically caused by respiratory syncytial virus (RSV).

• Infants may present with wheezing, coughing, and respiratory distress.

• Administer oxygen and consider bronchodilators. Transport promptly if needed.

Croup:

• Viral infection causing inflammation of the upper airway.

• Characterized by a barking cough and stridor.

• Provide humidified oxygen and consider corticosteroids. Transport if respiratory distress persists.

Pneumonia:

• Bacterial or viral infection affecting the lungs.

• Signs include fever, cough, and respiratory distress.

• Administer oxygen and transport promptly for appropriate medical intervention.

Apnea:

• Sudden cessation of breathing, particularly in premature infants.

• Administer positive pressure ventilation as needed and transport urgently.

Foreign Body Aspiration:

• Infants are at risk of inhaling small objects.

• Perform back blows and chest thrusts if airway obstruction is suspected. Transport for further evaluation.

Household Accidents:

Choking:

• Infants are prone to choking on small objects.

• Perform age-appropriate choking maneuvers (e.g., back blows, chest thrusts).

• Assess and manage the airway. Transport if necessary.

Falls:

• Common household hazard.

• Assess for signs of injury and transport for further evaluation if needed.

Burns:

• Scald burns from hot liquids are common.

• Cool burns with tepid water. Do not use ice. Transport for further care.

Poisoning:

• Infants may ingest household products.

• Contact poison control for guidance and transport for medical evaluation.

Sudden Infant Death Syndrome (SIDS):

• Sudden, unexplained death of an otherwise healthy infant.

• Focus on providing emotional support to the family and prompt transport to a medical facility.

General Considerations:

1. Airway Management:

Maintain a clear airway and provide appropriate respiratory support.

2. Oxygen Administration:

Administer supplemental oxygen as needed.

3. Monitoring:

Continuously monitor vital signs and assess the infant's overall condition.

4. Transport Decisions:

Transport infants promptly, especially in cases of respiratory distress or when there is uncertainty about the severity of the situation.

5. Family Communication:

Provide clear and compassionate communication with the family, keeping them informed about the infant's condition and the plan of care.

EMS providers should receive specialized training in pediatric emergencies, stay updated on protocols, and collaborate with healthcare professionals for the best outcomes in infant emergencies.

EMS Pediatric Populations - Pediatric Emergencies

EMS providers should have knowledge and skills to effectively manage pediatric emergencies.

Here are some key points they should know:

1. Pediatric Assessment: Understanding the differences in anatomy, physiology, and vital signs between adults and children is crucial. Providers should be skilled in performing a thorough pediatric assessment, including assessing airway, breathing, circulation, disability, and exposure (ABCDE).

2. Airway Management: Pediatric airways are smaller and more easily obstructed than adult airways. Providers should be proficient in managing pediatric airway emergencies, including using appropriate airway adjuncts and techniques such as bag-mask ventilation and endotracheal intubation.

3. Respiratory Distress: Common respiratory emergencies in children include asthma, bronchiolitis, and croup. Providers should be familiar with respiratory assessment, oxygen therapy, and administering nebulized medications.

4. Cardiac Arrest and CPR: Pediatric cardiac arrest requires prompt recognition and intervention. Providers must be skilled in pediatric cardiopulmonary resuscitation (CPR), including chest compressions, ventilation, and the use of automated external defibrillators (AEDs).

5. Fever and Sepsis: Fever is a common presentation in pediatric patients. EMS providers should recognize signs of serious bacterial infections, sepsis, and know how to provide appropriate supportive care during transport.

6. Allergic Reactions: Anaphylaxis and severe allergic reactions can be life-threatening. Providers should be trained in recognizing and managing allergic emergencies, including the administration of epinephrine.

7. Trauma: Pediatric trauma may present differently than adult trauma. Providers should know how to assess and manage common pediatric injuries, including fractures, head injuries, and burns. They should also consider the psychological needs of the child and provide age-appropriate support.

8. Seizures: Seizures can occur in children due to various causes. Providers should be familiar with seizure recognition, seizure management, and appropriate administration of anti-seizure medications.

9. Dehydration: Children are more prone to dehydration due to their smaller fluid reserves. Providers should be able to assess and manage pediatric patients with suspected dehydration, including fluid resuscitation if necessary.

10. Communication and Psychological Support: Effective communication with both the child and their parents or caregivers is vital. Providers should use age-appropriate language, provide reassurance, and involve parents or caregivers in the decision-making process.

These are general considerations, and ongoing training and education in pediatric emergency care are essential for EMS providers to ensure optimal care for children in emergencies.

EMS Medical Emergencies - COPD

EMS providers should be aware of several key points regarding Chronic Obstructive Pulmonary Disease (COPD).

COPD is a chronic respiratory condition characterized by airflow limitation and difficulty breathing. Here are some important aspects to consider:

1. Presentation: Patients with COPD typically experience symptoms such as shortness of breath, wheezing, coughing (often with sputum production), and chest tightness. These symptoms may vary in severity and can be exacerbated by triggers like respiratory infections or exposure to irritants.

2. Prehospital Treatment: The primary goals of prehospital treatment for COPD exacerbations are to relieve symptoms, improve oxygenation, and prevent further deterioration.

This can be achieved through various interventions, including:

- Administering Supplemental Oxygen: High-flow oxygen should be provided to maintain oxygen saturation above 90%.

- Bronchodilator Therapy: Albuterol is a commonly used bronchodilator that helps relax the airway smooth muscles, improving airflow. It can be delivered via nebulization or metered-dose inhalers (MDIs) with a spacer.

- Corticosteroids: Oral or intravenous corticosteroids (e.g., prednisone) help reduce airway inflammation and improve lung function.

3. Potential Care: In addition to the immediate treatments mentioned above, EMS providers should consider the following aspects of care:

- Assessing and monitoring vital signs, including oxygen saturation, heart rate, and respiratory rate.

- Ensuring patient comfort and positioning, such as allowing the patient to sit upright or in a position that aids breathing.

- Transporting the patient to an appropriate healthcare facility, especially if symptoms are severe or if the patient's condition is not improving with initial interventions.

- Collaborating with the receiving facility's healthcare professionals to provide a smooth transition of care.

Remember, COPD is a chronic condition, and EMS providers should be prepared to manage acute exacerbations while considering long-term management strategies and the patient's overall care plan.

EMS Patient Assessment - Jugular Venous Distention (JVD)

In the prehospital setting, EMS providers should be aware of Jugular Venous Distension (JVD) as it can provide important information about a patient's cardiovascular status.

JVD refers to the visible bulging of the jugular veins in the neck, which indicates increased central venous pressure.

Here's some key information:

Causes: JVD can be caused by various conditions that lead to increased pressure in the right side of the heart or the superior vena cava.

Some common causes include heart failure, cardiac tamponade, pulmonary hypertension, constrictive pericarditis, and tension pneumothorax.

Presentation: When assessing for JVD, EMS providers should have the patient positioned at a 45-degree angle, with the head slightly elevated. This helps to accentuate the prominence of the jugular veins.

JVD is typically observed as visible distension or pulsation of the jugular veins in the neck, particularly in the right side. It is important to differentiate JVD from other causes of neck swelling, such as airway obstruction or local trauma.

Treatment: The treatment of JVD in the prehospital setting primarily involves addressing the underlying cause. EMS providers should focus on providing appropriate interventions for conditions contributing to increased central venous pressure.

For example, in cases of heart failure, administering oxygen, diuretics, and initiating positive pressure ventilation may be necessary.

In cardiac tamponade, pericardiocentesis may be required. The specific treatment will depend on the underlying condition and the patient's overall clinical presentation.

Remember, JVD is just one aspect of a comprehensive assessment. EMS providers should consider other signs and symptoms, such as respiratory distress, vital signs, and overall clinical stability, to guide appropriate treatment and transport decisions.

EMS Ethics & Professional Conduct - Elijah McClain: The Wrong Treatment

Elijah McClain was a young man who died in 2019 after an encounter with law enforcement and subsequent administration of ketamine by paramedics.

The case raised significant concerns and highlighted important considerations for EMS providers. Here are some key points to know:

1. Medical Neutrality: EMS providers should prioritize patient safety and well-being, regardless of the circumstances or involvement of law enforcement. Upholding medical neutrality is crucial to ensure unbiased care.

2. Recognition of Potential Bias: It is essential for EMS providers to be aware of their own biases and prejudices, as these can influence patient assessment, treatment decisions, and overall care. Providing equitable care to all patients is of utmost importance.

3. Communication & De-Escalation: Effective communication skills and de-escalation techniques are vital for EMS providers. Collaborating with law enforcement and other responders to maintain a non-threatening environment can help prevent misunderstandings and minimize the risk of harm to patients.

4. Cultural Competence: Understanding and respecting diverse cultural backgrounds and individual differences is crucial for providing appropriate care. Cultural competence training can help EMS providers deliver care sensitive to each patient's needs and beliefs.

5. Proper Use of Sedation & Restraints: When administering sedatives like ketamine or using restraints, EMS providers must follow established protocols and guidelines. Close monitoring of the patient's vital signs and reassessment throughout the intervention is essential to ensure their safety.

6. Quality Improvement and Transparency: The Elijah McClain case has sparked discussions around the need for transparent investigations, quality improvement initiatives, and accountability within EMS systems. EMS providers should actively participate in these efforts to enhance patient care and safety.

Conclusion

By staying informed about cases like Elijah McClain's and integrating the lessons learned into their practice, EMS providers can contribute to improved patient outcomes, equitable care, and a safer healthcare environment.

Further Reading:

Alfonseca, K. 2022) Amended Elijah Mcclain Autopsy Report Released.  Accessed November 20, 2022

Bruun, H., Milling, L., Mikkelsen, S., & Huniche, L. (2022) Ethical Challenges Experienced by Prehospital Emergency Personnel: A Practice-based Model of Analysis. BMC Medical Ethics 23 (1): 80-94 Accessed December 10, 2023

Larkin G. L. & Fowler, R. L. (2002) Essential Ethics for EMS: Cardinal Virtues and Core Principles. Emergency Medicine Clinics of North America 20 (4): 887-911 Accessed December 12, 2023

Mion, G. (2017) History of Anesthesia: The Ketamine Story - Past, Present, and Future. European Journal of Anesthesiology 34 (9): 571–575

National Association of Emergency Medical Technicians (2022) Code of Ethics for EMS Practitioners. NAEMT. Accessed December 4, 2023

Obasogie, O. K. (2021) Excited Delirium and Police Use of Force. Virginia Law Review 107 (8): 1545-1620

Sandman, L. & Nordmark, A. (2006) Ethical Conflicts In Prehospital Emergency Care. Nursing Ethics 13 (6): 592-607

Scheppke, K. A., Braghiroli, J., Shalaby, M., Chait, R. (2014) Prehospital Use of Ketamine for Sedation of Violent and Agitated Patients. Western Journal of Emergency Medicine 15 (7): 736-41

Schoenly, L. (2015) Excited Delirium: Medical Emergency – Not Willful Resistance. EMS1. Accessed November 20, 2022

Young, D. (2019) The Investigation into the Death of Elijah Mcclain. District Attorney's Office, 17th Judicial District, Adams and Broomfield Counties, Colorado. Accessed November 20, 2022

EMS Incident Management - RAMP Triage System

The RAMP (Rapid Assessment and Medical Prioritization) triage system is an approach used by EMS Providers to quickly assess and prioritize patients in a mass casualty incident. Here's what EMS providers need to know about the RAMP triage system:

1. Purpose: The RAMP triage system aims to efficiently allocate limited medical resources by categorizing patients into different priority levels based on their severity of injury or illness.

2. Triage Categories: RAMP uses four triage categories:

- Red: Immediate (highest priority) - Patients with life-threatening conditions requiring immediate intervention.

- Yellow: Delayed (second priority) - Patients with significant injuries or illnesses but who can wait a short time for treatment.

- Green: Minimal (third priority) - Patients with minor injuries or illnesses who can wait longer for treatment.

- Black: Expectant (lowest priority) - Patients with severe injuries or illnesses that are unlikely to survive even with medical intervention.

3. Triage Criteria: EMS providers assess patients based on specific criteria such as breathing, circulation, mental status, and injuries. These criteria help determine the appropriate triage category for each patient.

4. Simple and Rapid Assessment: The RAMP system emphasizes a quick evaluation process to ensure efficient triage in a mass casualty incident. It allows providers to rapidly assess a large number of patients and identify those in immediate need of critical care.

5. Flexibility: The RAMP triage system is designed to be flexible and adaptable to various situations. It can be modified based on available resources, such as the number of personnel, equipment, and medical supplies.

Remember that specific protocols and guidelines may vary between different EMS systems and regions. It's important for EMS providers to receive training and familiarize themselves with the triage system implemented in their area to effectively respond to mass casualty incidents.

EMS Incident Management - JumpSTART Triage System

The JumpSTART triage system is a method used by EMS Providers to assess and prioritize pediatric patients in a mass casualty incident. The system was developed at the Miami, Florida Children's Hospital in 1995 by Dr. Lou Romig.

Here's what EMS Providers need to know about the JumpSTART triage system:

1. Focus on Pediatric Patients: JumpSTART is specifically designed for triaging infants and children (typically aged 1 to 8 years) during mass casualty incidents. It takes into account the unique physiological and anatomical characteristics of pediatric patients.

2. Triage Categories: The JumpSTART triage system uses four triage categories:

- Green: Walking Wounded. Patients who can walk and have minor injuries. Lowest priority.

- Yellow: Delayed. Patients who require medical attention but are not in immediate danger. Middle priority

- Red: Immediate. Patients with life-threatening injuries who require immediate intervention. Highest priority.

- Black: Deceased or Expectant. Patients who are deceased or have injuries incompatible with survival. Lacking priority

3. START Assessment: JumpSTART utilizes a simplified version of the START (Simple Triage and Rapid Treatment) assessment for pediatric patients. EMS providers quickly evaluate each patient's respiratory status, perfusion, and mental status to assign a triage category.

4. Focused on Breathing: JumpSTART places significant emphasis on respiratory status. Children who can walk, follow commands, and have a respiratory rate of less than 45 breaths per minute are classified as green. Those with respiratory rates above 45, altered mental status, or poor perfusion are assigned higher triage categories.

5. Age-Appropriate Assessments: The JumpSTART system recognizes that different age groups may exhibit varying physiological responses. EMS providers use age-appropriate methods to evaluate respiratory status, such as observing chest rise, auscultating breath sounds, or assessing the patient's ability to speak.

6. Ongoing Reassessment: Like other triage systems, JumpSTART emphasizes the importance of ongoing reassessment. Patients initially classified as green or yellow may deteriorate, requiring a change in the triage category as their condition evolves.

Remember, that specific protocols and guidelines may vary between different EMS systems and regions.

It's crucial for EMS providers to receive training and familiarize themselves with the triage system implemented in their area to effectively respond to mass casualty incidents involving pediatric patients.

EMS Incident Management - START v SALT Triage Systems

EMS providers need to be knowledgeable about the skill of triaging, which involves prioritizing patients based on the severity of their condition in order to allocate resources effectively.

When comparing the START (Simple Triage and Rapid Treatment) and SALT (Sort, Assess, Lifesaving Interventions, Treatment/Transport) models, here are some pros and cons to consider:

START Model:

START was developed by the Newport Beach Fire and Marine Department and Hoag Hospital in Newport Beach, California in 1983.

Pros:

1. Simplicity: The START model is straightforward and easy to learn, allowing for rapid implementation in chaotic situations.

2. Speed: It enables quick initial assessment and sorting of patients, allowing prioritization of resources for those with the most critical injuries.

3. Field-based: The START model is primarily designed for use in prehospital or field settings, making it suitable for EMS providers.

Cons:

1. Limited Assessment: The START model focuses primarily on identifying patients who require immediate lifesaving interventions, potentially overlooking patients with less severe injuries or illnesses.

2. Lack of Treatment Guidance: It provides minimal guidance on treatments beyond immediate lifesaving interventions, which may be a limitation in certain situations.

3. Overtriage: There is a tendency for a higher rate of overtriage, which means some patients may be categorized as more severe than they actually are, potentially diverting resources from those who need them most.

SALT Model:

It was developed as a national all-hazards mass casualty initial triage standard for all patients.

Pros:

1. Comprehensive Assessment: The SALT model incorporates a more thorough assessment of patients, including physiological and anatomical criteria, to triage patients effectively.

2. Treatment Considerations: It provides guidance on appropriate treatments based on the patient's condition, facilitating decision-making for EMS providers.

3. Flexibility: The SALT model can be adaptable to different scenarios and can be used in both prehospital and hospital settings.

Cons:

1. Complexity: Compared to the START model, the SALT model may require additional training and practice to ensure accurate implementation.

2. Time-Consuming: The comprehensive assessment involved in the SALT model may take longer to complete, potentially delaying the allocation of resources in time-sensitive situations.

3. Potential Subjectivity: The SALT model relies on clinical judgment, which introduces the possibility of variability in decision-making between different providers.

Ultimately, the choice between the START and SALT models depends on the specific needs of the EMS provider and the context in which they are operating.

Both models have their advantages and disadvantages, and it is crucial for EMS providers to receive proper training in the chosen model to ensure effective triage in emergency situations.

EMS Incident Management - Ten Second Triage

The Ten Second Triage (TST) tool, developed by NHS England, is designed to address the need for rapid triage in major incidents when assessing casualties' physiology may not be practical initially. Here's what EMS providers need to know about TST and how it compares to established models like START and RAMP:

1. Speed of Assessment: TST focuses on rapid assessment, aiming to triage a casualty within ten seconds. This allows for immediate life-saving interventions to be performed simultaneously.

2. Mechanism of Triage: TST utilizes a mechanism called "Threat, Breathing, Circulation" to prioritize casualties. It emphasizes identifying threats to life, assessing breathing, and evaluating circulation to make triage decisions quickly.

3. Simplicity and Training: TST is designed to be simple, intuitive, and easy to learn. It requires minimal training for EMS providers, enabling quick implementation in the field.

4. Comparison to Established Models: Established triage models like START (Simple Triage and Rapid Treatment) and RAMP (Rapid Assessment, Management, and Prioritization) focus on assessing physiological parameters.

In comparison, TST prioritizes threats to life and emphasizes immediate interventions.

It's important to note that the effectiveness of TST, START, and RAMP may vary depending on the specific context and the resources available during a major incident. EMS providers should be familiar with multiple triage methods and adapt their approach based on the situation at hand.

Additional Reading:

https://journals.sagepub.com/doi/10.1177/14604086231156219

EMS Mnemonics - TICLS

The TICLS mnemonic is a useful tool for EMS providers during pediatric patient assessments.

Here's what you should know:

T - Tone: Assess the child's muscle tone. Are they floppy or rigid?

I - Interactiveness: Observe their level of interaction. Are they responsive or unresponsive?

C - Consolability: Determine if the child can be consoled or comforted.

L - Look or Gaze: Assess their eye contact and gaze. Are they making appropriate eye contact?

S - Speech or Cry: Evaluate the quality of speech or cry. Is it appropriate for their age?

Using the TICLS approach helps providers quickly assess the child's neurological status and identify any abnormalities or concerns.

It's important to remember that this is just one component of a comprehensive pediatric assessment, and additional assessments and interventions may be necessary based on the specific situation.

EMS Obstetric Emergencies - OB Terminology

In the prehospital setting, EMS providers may encounter these obstetric (OB) terms when assessing and caring for pregnant patients:

1. Gravida: Gravida refers to the number of times a woman has been pregnant, regardless of the outcome. It includes both pregnancies that resulted in live births and those that ended in miscarriages or abortions. The gravida number indicates the total number of pregnancies a woman has experienced.

2. Para: Para indicates the number of viable births a woman has had after 20 weeks of gestation. It includes pregnancies that resulted in live births, regardless of the number of infants (e.g., singletons, twins). Para does not include miscarriages or abortions.

3. Abortus: Abortus refers to pregnancies that ended in miscarriage or abortion before 20 weeks of gestation. It indicates the number of pregnancies that did not reach viability.

Let's consider an example:

During an emergency response, EMS providers encounter a pregnant patient. As part of their assessment, they gather information about the patient's obstetric history using the OB terms.

If the patient states that she has been pregnant four times, with three of those pregnancies resulting in live births and one ending in a miscarriage, the OB notation for this patient would be G4P3A1 (Gravida 4, Para 3, Abortus 1). 

This means that the patient has been pregnant four times in total, including the miscarriage, and has had three viable births after 20 weeks of gestation.

Understanding these terms can help EMS providers gather important information about a patient's obstetric history, enabling them to provide appropriate care and consider potential complications during pregnancy-related emergencies.

EMS Equipment - Shock Pants

EMS providers should be aware of the following key points regarding Military Anti-Shock Trousers (MAST) and Pneumatic Anti-Shock Garment (PASG):

1. Purpose: MAST and PASG are devices used to manage hemorrhagic shock and hypovolemia. They help stabilize patients by applying external pressure to the lower extremities, which helps redirect blood to vital organs and increase blood pressure.

2. Mechanism of Action: MAST and PASG apply circumferential pressure to the legs and lower abdomen. This pressure compresses the blood vessels, reducing blood pooling in the lower extremities and promoting blood flow back to the heart and brain.

3. Application: MAST consists of a pair of inflatable trousers, while PASG is a single-piece garment that wraps around the patient's lower body. They are typically applied to patients with suspected or confirmed hemorrhagic shock or hypovolemia. The garments are inflated using a manual or automatic pump until a specific pressure is achieved.

4. Considerations: EMS providers should be cautious when applying MAST or PASG, as these devices may have contraindications and potential complications. It is essential to follow proper application techniques and adjust the pressure according to the patient's condition and vital signs. Regular reassessment of the patient is crucial to ensure adequate perfusion.

5. Limitations: MAST and PASG are considered adjuncts to other resuscitative measures and should not replace definitive interventions or delay transportation to a medical facility. They are not suitable for patients with certain injuries or conditions, such as fractures, burns, or abdominal trauma.

6. Training and Familiarity: EMS providers should receive appropriate training on the correct application, monitoring, and potential complications associated with MAST and PASG. Familiarity with local protocols and guidelines is crucial for safe and effective use.

Remember, the use of MAST or PASG should be based on specific protocols, medical direction, and individual patient assessment. Always consult local guidelines and medical control when considering the use of these devices.

Additional Reading:

https://www.ncbi.nlm.nih.gov/books/NBK534783/

https://www.hmpgloballearningnetwork.com/site/emsworld/article/10325078/ems-myth-1-medical-anti-shock-trousers-mast-autotransfuse-significant-amount-blood-and-save-lives

EMS Pharmacology - Aspirin (Acetylsalicylic Acid)

EMS Providers should have knowledge of aspirin administration including, amongst other things, its mechanism of action, the effect, and contraindications 

Here are key points to know:

Indications: Aspirin is commonly used in emergency situations to treat suspected heart attacks (myocardial infarctions). It helps prevent blood clot formation and reduces the risk of further cardiac damage.

Mechanism of Action (MOA): Acetylsalicylic acid is an antiplatelet agent. It works by inhibiting the activity of an enzyme called cyclooxygenase (COX). COX is involved in the production of prostaglandins, which play a role in platelet aggregation (clumping) and vasoconstriction.

Effect: By inhibiting COX, aspirin reduces the formation of thromboxane A2, a substance that promotes platelet aggregation and vasoconstriction. As a result, aspirin makes platelets less sticky and less likely to form blood clots. It primarily affects platelet function and is often used to prevent arterial thrombosis, such as in cases of myocardial infarction (heart attack) or stroke.

Dosage: The recommended dosage of acetylsalicylic acid for suspected heart attacks is typically 4 x 81 mg ‘baby aspirin’. EMTs should follow local protocols and medical direction regarding the specific dosage and formulation used.

Route: Aspirin is usually administered orally, which means EMTs may give the patient chewable or crushed aspirin tablets to be swallowed. It is important to ensure the patient can safely swallow the medication and has no contraindications.

Contraindications: EMTs should be aware of contraindications for aspirin administration, such as a known allergy to aspirin, active bleeding, or a history of gastrointestinal bleeding or ulcers. 

If the patient has any contraindications, aspirin should not be administered, and medical direction should be sought.

Documentation: EMS Providers should document the administration of aspirin, including the dosage, time, and the patient's response. Accurate documentation helps ensure continuity of care and provides important information to healthcare providers, including whether the patient has already taken aspirin.

Communication: EMTs should inform receiving healthcare providers about the administration of aspirin, including the dosage and timing. This helps ensure appropriate follow-up care and treatment continuation.

Remember, EMS Providers should always adhere to their local protocols and receive proper training on aspirin administration. They should work under medical direction and consult with a physician or follow local guidelines when administering aspirin to patients.

EMS Neurological Emergencies - Different Strokes

EMS providers play a crucial role in recognizing and assessing stroke patients. Here's what they need to know about ischemic and hemorrhagic strokes, as well as transient ischemic attacks (TIAs):

1. Ischemic Stroke: It occurs when a blood clot blocks a blood vessel in the brain, leading to reduced blood flow and oxygen supply. EMS providers should be aware of common symptoms like sudden weakness or numbness on one side of the body, difficulty speaking or understanding, and facial drooping.

2. Hemorrhagic Stroke: This type of stroke happens when a blood vessel bursts, causing bleeding into the brain. EMS providers should look for signs such as a severe headache, vomiting, altered consciousness, and neck stiffness. Rapid recognition and transport to a specialized stroke center are critical.

3. Transient Ischemic Attack (TIA): Often referred to as a "mini-stroke," a TIA is caused by a temporary disruption of blood flow to the brain. Symptoms are similar to an ischemic stroke but usually resolve within 24 hours. EMS providers should consider TIAs as warning signs of a future stroke and ensure prompt medical evaluation.

To recognize the difference between these conditions, EMS providers should assess the patient's symptoms, their medical history, and conduct a thorough neurological examination. They should also obtain a detailed timeline of symptom onset and duration. It's important to remember that differentiating stroke types accurately is challenging in the prehospital setting, and prompt transport to a stroke center is crucial regardless of the stroke type suspected.

EMS providers should follow established stroke protocols, initiate appropriate interventions, provide supportive care, and communicate with the receiving hospital to facilitate optimal stroke management. Regular training and staying updated on the latest guidelines will enhance their ability to recognize and assess stroke patients effectively. 

EMS Mnemonics - BE FAST

EMS providers should be familiar with the BE FAST mnemonic as it relates to stroke recognition and assessment. BE FAST helps us identify common stroke symptoms and prompt appropriate action.

Here's what EMS providers need to know:

B - Balance: Check if the person has a sudden loss of balance or coordination. Watch for stumbling, difficulty walking, or a sudden onset of dizziness.

E - Eyes: Look for sudden vision changes, such as blurred or double vision, or vision loss in one or both eyes. Ask the person if they are experiencing any visual disturbances.

F - Face: Ask the person to smile and check for facial drooping or asymmetry. A lopsided smile or drooping on one side of the face is a potential sign of a stroke.

A - Arms: Have the person raise both arms and observe if one arm drifts downward or cannot be held up. Weakness or numbness in one arm or hand is indicative of a stroke.

S - Speech: Listen for slurred or garbled speech. Ask the person to repeat a simple phrase and watch for difficulty speaking or understanding. Incoherent or abnormal speech may suggest a stroke.

T - Time: Time is critical in stroke cases. If any of the above symptoms are present, please note when they started. The sooner the person receives medical attention, the better their chances of receiving appropriate treatment.

By using the BE FAST mnemonic, EMS providers can quickly assess stroke symptoms and initiate appropriate care. It's important to remember that this is a screening tool and not a definitive diagnosis. Timely transportation to a stroke center is crucial for further evaluation and treatment.

EMS Discussion - Speaking of Death

Thanatology is the study of death, dying, and bereavement. While it may not be a primary focus for EMS providers, having a basic understanding of thanatology can be valuable in their line of work. Here are a few key points for EMS providers to know:

1. Cultural Sensitivity: Different cultures have diverse beliefs and practices surrounding death and dying. Being sensitive to these cultural differences can help EMS providers provide appropriate care and support to patients and their families.

2. Grief & Bereavement: Understanding the grieving process can enable EMS providers to provide compassionate care to individuals who have experienced a loss. Recognizing common grief reactions and offering empathy can make a significant difference during difficult times.

3. Communication: Effective communication is crucial when dealing with end-of-life situations. Developing good communication skills can help EMS providers navigate sensitive conversations with patients, families, and other healthcare professionals involved in end-of-life care.

4. Palliative & Hospice Care: Familiarity with the principles of palliative and hospice care can enhance an EMS provider's ability to provide comfort and pain management to patients with life-limiting illnesses. Collaborating with palliative care teams and understanding the goals of care can improve the overall patient experience.

5. Ethical Considerations: EMS providers may encounter situations where difficult decisions need to be made, such as withholding or withdrawing life-sustaining treatments. Understanding the ethical principles involved and having knowledge of advance directives and legal frameworks can guide decision-making processes.

While thanatology may not be a primary focus in EMS training, having a basic understanding of these aspects can contribute to providing more holistic and compassionate care to patients and their families during end-of-life situations.

Additional Reading:

https://limmereducation.com/article/death-and-dying-ems/

EMS Operations - Landing Zones

EMS providers play a crucial role in facilitating helicopter operations and setting up landing zones for patient transport.

Here are key points they need to know:

Landing Zone Criteria:

- The landing zone should be a minimum of 100’x100', suitable for both day and night operations.

- Ensure the site is free of obstacles, hazards, and debris.

- Opt for a firm surface and avoid slopes greater than five degrees whenever possible.

- Soft sand or dirt landing sites should be avoided, but can be wet down as a last resort.

Obstruction Assessment:

- Conduct a thorough survey of the landing site to identify overhead power lines, telephone wires, antennas, buildings, or tall trees.

- Attempt to remove or limit any obstructions from the landing location.

- If obstructions cannot be removed, inform the flight crew, and be prepared to find an alternative location if necessary.

Marking the Landing Zone:

- Mark the landing zone using weighted cones or position emergency vehicles at the corners, with headlights facing inward to form an X.

- Clearly visible markings help pilots identify the designated landing area, especially during low-light conditions.

Weather Considerations:

- Inform the flight crew of wind direction and speed, particularly if strong winds exist.

- Weather conditions can impact helicopter operations, and pilots need this information to make informed decisions.

Safety Buffer:

- Ensure all nonessential personnel, bystanders, and vehicles are at least 200 feet away from the landing zone.

- This safety buffer protects individuals from potential hazards associated with helicopter operations.

Personal Protective Equipment (PPE):

- Responders operating near the landing zone should wear appropriate PPE, including helmets with chin straps, ear protection, and face shields or other eye protection.

- Be prepared for high wind and noise associated with helicopter take-offs and landings.

Communication:

- Maintain effective communication with the flight crew before, during, and after the landing.

- Be prepared to provide updated information about the landing zone, weather conditions, and any changes in the situation.

- By adhering to these guidelines, EMS providers can contribute to the safe and efficient operation of helicopter transports, ensuring the well-being of both the patient and the emergency response team.

https://www.lifeflight.cc/site_pages/landing_zone.html

EMS Trauma Tuesdays - Amputations

EMS providers should have a basic understanding of amputations and how to treat them.

Here are some key points to consider:

1. Scene Safety: Ensure the scene is safe for both the patient and responders before approaching an amputation.

2. Control Bleeding: Apply direct pressure to the wound using a sterile dressing or clean cloth. If bleeding is severe, use a tourniquet proximal to the injury site.

3. Preserve the Amputated Part: If the amputated part is available, handle it with care. Wrap it in a sterile, moist gauze or plastic bag, place it in a sealed container, and keep it cool without freezing.

4. Airway and Breathing: Assess the patient's airway, breathing, and circulation. Provide appropriate support as needed.

5. Stabilize the Patient: Immobilize the patient and the injured limb to prevent further injury during transportation. Use splints or bandages to secure the amputated part separately, if available.

6. Pain Management: Administer appropriate pain relief measures, such as analgesics, according to your protocols and the patient's condition.

7. Transport: Arrange for immediate transportation to a facility equipped to manage amputations and traumatic injuries.

Remember, these are general guidelines, and the specific protocols and procedures may vary based on your local EMS system and medical direction.

It is crucial to consult your organization's guidelines and receive proper training on amputation management.

EMS Mnemonics - SAMPLE

The SAMPLE mnemonic is a useful tool for EMS Providers to gather important information during the initial assessment of a patient.

It helps ensure a systematic and thorough evaluation of the patient's condition.

Here's what EMS Providers need to know about the SAMPLE mnemonic:

Signs and Symptoms: This refers to the physical signs and symptoms the patient is experiencing. EMS providers should assess the patient's complaints, such as pain, shortness of breath, or dizziness. It's essential to listen carefully to the patient's description of their symptoms and note any obvious signs of distress.

Allergies: Determine if the patient has any known allergies, especially to medications or substances. Allergies are crucial to know because administering a medication or treatment that a patient is allergic to can have serious consequences.

Medications: Find out what medications the patient is currently taking. This includes prescription medications, over-the-counter drugs, and any herbal or dietary supplements. Knowing the patient's medications can help avoid potential drug interactions and guide treatment decisions.

Past Medical History: Ask about the patient's past medical history, including chronic conditions, surgeries, and significant illnesses. Understanding the patient's medical history can provide insights into their current condition and help in decision-making.

Last Oral Intake: Determine when the patient last ate or drank anything. This information is crucial if the patient requires surgery or sedation because it helps prevent complications related to anesthesia. It's also relevant for patients with certain medical conditions.

Events Leading Up to the Present Illness or Injury: Ask the patient or any available witnesses about the events leading up to the current illness or injury. This can help in understanding the mechanism of injury and identifying any potential contributing factors.

By following the SAMPLE mnemonic, EMS providers can collect vital information that assists in the assessment and management of the patient.

This information is essential for making informed decisions regarding treatment, transport, and communication with medical facilities. Additionally, it contributes to better patient care and safety.

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EMS Anatomy & Physiology - Curvature of the Spine

 

EMS Providers should have a basic understanding of skeletal issues like kyphosis, lordosis, and scoliosis, as well as related problems, to provide appropriate care for patients.

Here are a few key points:

Identification: EMS providers should be able to identify these skeletal issues through visual observation and patient history.

1. Kyphosis: Kyphosis refers to an excessive forward curvature of the upper spine, leading to a rounded or hunched posture. It can be caused by several factors, including poor posture, osteoporosis, spinal fractures, or certain medical conditions. EMS providers should be aware of the potential for compromised breathing and mobility in patients with severe kyphosis.

2. Lordosis: Lordosis is an excessive inward curvature of the lower spine, commonly known as swayback. It can be caused by various factors such as obesity, pregnancy, muscle imbalances, or certain medical conditions. EMS providers should be cautious of potential back pain and difficulty maintaining a supine position in patients with pronounced lordosis.

3. Scoliosis: Scoliosis is a medical condition characterized by an abnormal sideways curvature of the spine. This condition can manifest in various degrees of severity and is often idiopathic, meaning the cause is unknown. However, it can also result from congenital factors, neuromuscular conditions, or trauma.

Symptoms: Be aware of common symptoms associated with these conditions, such as pain, limited range of motion, and respiratory difficulties, which can occur due to the abnormal spinal curvature.

Assessment: Conduct a thorough physical assessment to evaluate the severity of the condition, including the degree of curvature, associated deformities, and neurological symptoms.

Stabilization: When immobilizing the patient, EMS providers should consider the unique spinal curvature and use appropriate spinal immobilization techniques to ensure patient comfort and safety. This may involve padding and positioning devices to accommodate the curvature.

Transport: Ensure safe and appropriate transport of patients with these conditions. They may require specialized equipment, such as scoop stretchers or vacuum mattresses, to maintain proper spinal alignment.

Communication: Effective communication with the patient is crucial. Ensure the patient is comfortable and aware of the care being provided. Also, obtain a medical history to determine if there are underlying causes or exacerbating factors related to the skeletal issue.

Related Problems: Understand that these skeletal issues can lead to other medical problems. For example, kyphosis and lordosis can cause respiratory issues by reducing lung capacity, so monitor the patient's respiratory status carefully. They might also be at a higher risk of spinal fractures or other spinal cord injuries. Additionally, scoliosis can sometimes be associated with cardiac and pulmonary complications, which should be considered during patient assessment.

Medication and Pain Management: Be aware of any medications the patient is taking, as well as their potential side effects and interactions. Patients with these conditions may require pain management during transport, so be prepared to administer appropriate pain relief under medical direction.

Special Considerations: Individuals with skeletal issues may require special handling, including assistance with transfers, lifting, or moving the patient. Consider the patient's comfort and any potential complications that may arise from moving them.

Collaboration: Work closely with other healthcare providers, including receiving facilities and specialists, to ensure a seamless transition of care and to address any specific needs related to the patient's condition.

Conclusion

Remember that each patient's needs may vary, so adapt your care accordingly. Additionally, staying updated on current guidelines and protocols for spinal immobilization and care of patients with skeletal issues is essential to providing appropriate care in the field.

It is always important to work collaboratively with other healthcare professionals to ensure optimal care for patients with these conditions.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice Volume 1 (6th Ed) Pearson.  

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell

EMS Medical Terminology - Cushing's Triad

Cushing's Triad is named after Dr. Harvey Cushing, an American neurosurgeon who made significant contributions to the field of neurosurgery. This is an example of eponymous medical terminology.

Dr. Cushing described a set of clinical signs and symptoms associated with increased intracranial pressure in his work "Intracranial Tumours: Notes upon a Series of Two Thousand Verified Cases with Surgical Mortality Percentages Pertaining Thereto." 

This work was published in 1901, and it was one of the earliest descriptions of the physiological changes associated with intracranial pressure.

Recognizing Cushing's Triad is crucial for EMS Providers, as it is suggestive of a potentially life-threatening situation due to various adverse conditions, including head injuries and brain pathologies. 

As such, the need for urgent medical intervention is paramount.

Cushing's Triad consists of the following three key signs:

Hypertension (High Blood Pressure):

A significant increase in systolic blood pressure is a common feature of Cushing's Triad. This is a response to the body's attempt to maintain cerebral perfusion (blood flow to the brain) in the face of elevated intracranial pressure.

Bradycardia (Slow Heart Rate):

Cushing's Triad often includes a slow heart rate (bradycardia), particularly as a result of increased ICP. This is a compensatory mechanism intended to decrease the heart's pumping strength, reducing blood flow to the brain and thereby minimizing the risk of further brain damage.

Irregular or Abnormal Respiratory Patterns:

The third component of Cushing's Triad is abnormal breathing patterns, typically characterized by irregular or irregularly deep respirations. This is often referred to as "agonal" or "Cheyne-Stokes" breathing.

These respiratory changes are a response to the brain's attempt to restore oxygen levels and eliminate excess carbon dioxide, which can occur due to impaired blood flow or brainstem compression.

Recognizing Cushing's Triad in a patient is a critical finding for EMS providers, as it may indicate an impending brain herniation, which is a life-threatening condition. 

Patients displaying Cushing's Triad should be managed promptly and transported to a specialized facility for further evaluation and potential surgical intervention.

Here are some key points for EMS Providers:

- Perform a detailed neurological assessment, including monitoring vital signs, level of consciousness, and pupillary response.

- Administer supplemental oxygen to ensure adequate oxygenation.

- Maintain cervical spine immobilization to prevent further spinal cord injury, if applicable.

- Communicate with the receiving medical facility to ensure they are prepared for the patient's arrival and can provide neurosurgical expertise if necessary.

- Avoid hyperventilation, as it may worsen cerebral ischemia.

- Cushing's Triad is a critical clinical finding that requires immediate attention and transport to a higher level of care. 

- EMS providers should follow their local protocols and seek medical direction when managing patients with Cushing's Triad.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Ebright, C. (2024) Unique Patient Signs: A Case Study. EMS1. https://www.ems1.com/patient-assessment/articles/unique-patient-signs-a-case-study-f4CQBuoUo9uTCHrZ/ Accessed May 1, 2024

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell