EMT training notes: Chapter 1 (Personal notes)

1. Always make fine, accurate, and complete documents.

   Annotations:

   • Well written can go a long way in assisting with lawsuits (to show liability if any) and research (to develop EMS to be more fact based.) They also help with showing who took what precautions to protect the EMT in case the patient had/has an illness that could infect the EMT in which they weren't prepared. ex, a call with a patient that has tuberculosis in which an EMT didn't wear a proper mask.
2. Always have another EMT or an advanced EMT look over your report before sending in.

   Annotations:

   • Another pair of eyes will verify that the information is accurate.

1. If a study was done correctly multiple sources will point to the same conclusion

   Annotations:

   • If a medical study was done properly the results can be replicated no matter who does it, where, and how many times it's repeated.
2. Comparing two vastly different groups can ruin studies.

   Annotations:

   • If you do a study that a particular device can increase the survival chances of trauma patients and compare two different groups with one being much sicker than the other. The results won't be accurate.
3. Not following instructions can ruin the finding of the research.

1. Quality improvement

   Annotations:

   • A system of continuous self review in the interest of continuous improvement.
2. Medical Direction

   Annotations:

   • Oversight of all aspects of the patient care system by the medical director
3. Protocols

   Annotations:

   • List of steps such as assessments and interventions to be used in different situations. Protocols are developed by the medical director.
4. Designated agent

   Annotations:

   • An EMT or other person authorized to give medications or medical care to patients 
5. Standing orders

   Annotations:

   • A policy or protocol that is issued by the medical director that allows the EMT or other medical personnel to perform certain procedures without first consulting a physician or medical director.
6. Offline-medical direction

   Annotations:

   • Standing orders issued by the medical director so EMT can perform certain medical procedures or give certain medications without speaking to the medical director or a physician.
7. On-line medical direction

   Annotations:

   • Orders from the on duty medical physician given directly to an EMT on the field via radio or phone

1. Check and maintain equipment regularly

   Annotations:

   • Although the ingenuity of the EMT should never be underestimated. It can be extremely dangerous to operate with sub-par, damaged, or missing equipment.

1. If patient assessment isn't enough you'll need to ask more questions.

   Annotations:

   • There are times when your initial assessment won't be enough to provide adequate medical care. In that event you will have to ask more questions and do more examinations to get everything you need to make a decision. 
2. Procedures not covered by standing order will require the EMT to contact the on duty physician

   Annotations:

   • For example, EMTs carry aspirin which is beneficial to many but not all patients whom have cardiac arrest symptoms. Before administering the medication the EMT will contact the on-duty medical physician via phone or radio to provide patient information to the physician. After receiving the information the instructor will inform you of whether and how to administer the medication.
3. On line medical advice can be requested anytime you feel it would be helpful for the patient.
4. Sometimes the most impactful thing you can do is provide emotional support for your patient.

Annotations:

• EMTs require certain traits to thrive in their field.

1. Responsibilities of the EMT
   1. Anything you do for a patient, from small to big, will have big effects

      Annotations:

      • Whether you're giving the doctors advice that will save the patients life or simply informing a loved one. Your small task will often provide comfort for a patient.
   2. Personal Safety

      Annotations:

      • You cannot provide adequate care for your patient if you're injured before you arrive or during care. Your first responsibility is to keep yourself safe because being on-the scene, while usually safe, is unpredictable. 
   3. Safety of crew, patients, and bystanders

      Annotations:

      • The same dangers you face while on scene could/will be faced by others at the scene. As an EMT it is your responsibility to be just as concerned for their safety as your own.
   4. Patient assessment

      Annotations:

      • One of the most important task of an EMT will be assessment of the patient. Patient assessment will give you enough information about what is wrong with the patient to adequately provide effective medical care. Assessment always comes before medical care.
   5. Patient care

      Annotations:

      • Patient care can range from anything between emotional support to life saving CPR and defibrillation. What type of care you provide to the patient is based off what information you gain from patient assessment.
   6. Patient lifting and moving

      Annotations:

      • Since EMTs are involved in transporting patients to the hospital you must be able to do so without injuring yourself or making the patients injuries worse.
   7. Transportation

      Annotations:

      • It is a very serious responsibility to operate an ambulance. Especially if there's a patient on-board.Safely driving the ambulance, as well as securing and caring for the patient on-board while in transport is a big part of being an EMT.
   8. Transfer of care

      Annotations:

      • Upon arrival at the hospital you will transfer care of the patient over to hospital personnel.You will provide the staff any information you have from patient assessment, the scene, or any other relevant information. Although transfer of care come at the end of a call it is VERY important and could save the patients life.
      1. Never abandon care until the transfer to hospital staff is successfully completed.

         Annotations:

         • Otherwise the patient will go without the much needed care that could save their life.
   9. Patient Advocacy

      Annotations:

      • As an EMT , you are there for the patient. You are an advocate, which means you will speak up for the patient and plead their cause. It is your responsibility to address the patient's needs and bring up any concerns with hospital staff. You will have built a rapport with the patient through your brief and but important time together. Which means you'll have a level of understanding with the patient and should do your best to transmit this understanding to the hospital staff.
2. Physical
   1. An EMT must have lots of strength, dexterity, and stamina.

      Annotations:

      • EMTs spend a lot of time walking, carrying(both patients and equipment) just as a general. In a serious emergency you may have to carry people upstairs, through buildings, to the ambulance, out of the ambulance, et. It require lots of strength and stamina.
3. Personal traits
   1. Pleasant

      Annotations:

      • To make people feel calm and confident
   2. Sincere

      Annotations:

      • To be able to convey an understanding of the situation and understand the patients feelings.
   3. Cooperative

      Annotations:

      • Teamwork makes the dream work
   4. Resourceful

      Annotations:

      • To fit an item or procedure to fit an unusual situation
   5. Self-starter

      Annotations:

      • Take the initiative to do what needs to be done without depending on others
   6. Emotionally stable

      Annotations:

      • Being an EMT is going to be stressful. You will need to put your emotions aside and deal with them at a later time when you're not in an emergency situation.
   7. Able to lead

      Annotations:

      • Able to lead so you can take the steps necessary to control the scene, organize bystanders, give emergency care, and take charge if needed
   8. Neat and clean

      Annotations:

      • People feel more confident when a person if a super clean and neat uniform is tending their wounds than if someone with an old, wrinkled, and unkempt one were doing the exact same procedures.
   9. Of good moral character and respectful to others.

      Annotations:

      • People are more likely to trust those that are respectful to them
   10. In control of personal habits.

       Annotations:

       • No smoking on duty or drinking within eight hours of work
   11. Controlled in conversations and able to communicate properly

       Annotations:

       • In order to make people feel confident and not anger the patient or bystanders or violate patient confidentiality 
   12. Able to listen to others

       Annotations:

       • To be compassionate and empathetic with patients and to be accurate in interviews.
   13. Nonjudgemental and fair

       Annotations:

       • To provide Everyone the best possible EMS care.
4. General reminders
   1. If you know how to prevent injuries you must report it to all necessary parties immediately

      Annotations:

      • If you visit a house and see dangerous chemicals where the children can reach, what should you do? Or if you visit the home of a woman with a broken hip and find a loose rug on the floor? Simple things like that are easy to fix and don't take a lot of time but could save someone's life.
   2. Always follow protocols
   3. EMS isn't always about getting patients to the hospital

      Annotations:

      • Sometimes the most important and impactful thing you can do for a patient is provide emotional support in the case of emergency.

1. EMS Today

   Annotations:

   • The systems that allow EMS to exist today.
   1. Enabling legislation, a lead EMS agency, a funding mechanism, regulations, policies, and procedures.

      Annotations:

      • In order for a state to have a working EMS system that must have enabling regulation (laws that allow the system to exist), A lead EMS agency (to take charge)A funding mechanism (so equipment can be replaced if needed)Regulations and Policies (to assure EMS keeps the highest standards) and finally. Procedures. (Procedures are in place so you can provide maximum care to the patient with tested and proven-effective methods.) 
   2. Medical Director

      Annotations:

      • Each EMS agency must have a physician as medical director whom delegates medical practice to non-physician providers (such as EMTs) and must be involved in all aspects of patient care in order to assure the highest standards.
      1. EMTs authority to give medicine and provide emergency care is an extension of the medical director's license to practice medicine.
   3. Quality Improvement

      Annotations:

      • Each state must have a program to evaluate and improve the effectiveness of the EMS system. Known as either quality improvement (QI), quality assessment (QA), or total quality management (TQM)
   4. Levels of EMS training
      1. Emergency Medical Responder (EMR) (Previously known as "first responder")

         Annotations:

         • This level of training is designed for the person who is first at the scene. Police officers, firefighters, and industrial personnel(?) can function as EMRs.  The main objective of EMRs is to provide immediate care to patients suffering life threatening injuries, control the scene, and prepare for the arrival of the ambulance.
         1. Emergency Medical Technician (EMT) (Previous called "EMT Basic")

            Annotations:

            • In many states EMT training is the minimum level of training for ambulance personnel. EMTs provide basic-level medical and trauma care as well as transport the patient/s to the hospital.
            1. Advanced Emergency Medical Technician (AEMT) (Previously called EMT-Intermediate)

               Annotations:

               • The AEMT provides basic-level care and transportation (just like an EMT) but also uses advanced-level care. Which includes use of advanced airway devices, monitoring blood glucose, and administration of certain medications.
               1. Paramedic (Sometimes called EMT-Paramedic)

                  Annotations:

                  • The paramedic has the skills/powers of both an EMT and AEMT plus more advanced skills. Paramedics provide the most advanced out of hospital care.
   5. Key components of EMS
      1. 911 or another emergency dispatch system.

         Annotations:

         • A citizen calls 911
         1. 911 dispatcher

            Annotations:

            • The person whom answers the phone and "sends forth the EMTs"
            1. EMRs and EMTs

               Annotations:

               • The people first at the scene then EMRs are the first people at the scene. They prepare the scene for the ambulance while prividing medical care to the patient. EMTs provide care for the patient till they're under the care of hospital staff.
               1. The hospital emergency department.

                  Annotations:

                  • Also known as "ER" is a medical facility specialized in emergency care.
                  1. Physicians (Doctors
                  2. Nurses
                  3. Physician's assistants
                  4. Along with other medical professionals
   6. Trauma systems

      Annotations:

      • In each state. Enabling legislation must exist to develop a trauma system. Including one or more trauma centers, triage and transfer guideline for trauma patients, patient rehabilitation programs, data collection, mandatory autopsies (to find the cause of death), and means for ensuring the quality of the system.
2. Refresher courses are required every 2 to 4 years

   Annotations:

   • Refresher courses are to ensure the EMT is up to date with the latest information so their skills don't become dull or they use improper procedures that were once correct but have since changed.
3. NREMT Test are required for most states.

   Annotations:

   • National Registry of Emergency Medical Technicians Test. It's basically national certification.