Preface

The purpose of this course is to help you prepare for the advanced EMT examination. As an Advanced EMT, you will have a great many more responsibilities than EMTs of lesser skill levels. There is an increased autonomy in the practice of an advanced EMT, which will give you responsibilities you may not have had before in the EMS system. You should already have an understanding of medical terminology, anatomy and physiology, and some pathophysiological mechanisms. You will need this knowledge and skills to pass the examination, along with the new knowledge you will gain in this course.

Chapter one in the course introduces the practice of the advanced EMT by talking about the different EMS systems in the world and the role of the different players in the system. Also discussed are things like ambulance operations, ethics and legal issues in the EMT practice, EMT safety, and the different cultural and religious backgrounds the AEMT might encounter as part of their job.

There is a great deal to cover in chapter two. Human developmental stages are first discussed because EMTs will handle patients from all age groups. The basics of human anatomy and physiology are important to review as the basis for the entire rest of the course. Finally, you will encounter numerous disease states as part of your patient encounters so some of the common ones are discussed in this chapter as well.

Chapter three in the course involves a discussion of the different drugs carried by the advanced EMT and how they work. The different routes of administration and elimination of drugs is discussed. This brings us to a discussion of toxicology in emergency medical services. There are certain toxic exposures that need to be managed, starting in the field. Drug overdoses are common reasons for an EMT encounter. These are also covered as part of this chapter.

The focus of chapter four is patient assessment and the initial management of the sick or injured patient. Scene size-up will be a part of the advanced EMT examination so you will need to learn the principles involved. Vital sign evaluation and a SAMPLE history

will be part of the initial evaluation so this is discussed. After the primary survey, a secondary survey is obtained, particularly on trauma patients. All patients need reevaluation, which varies according to their stability. These are covered as part of this chapter.

Chapter five in the course covers the basic advanced EMT skills you may have to know as part of your patient encounters. If you need to be trained in starting IVs, this chapter covers the different IV catheter types and how to start an intravenous line. If IV access is unavailable, you should know how to start an intraosseous line. Performing and reading the basic electrocardiogram are covered as well as the basic types of intravenous fluids you may need to use on different patients.

The focus of chapter six is resuscitation. The advanced EMT will need to be able to evaluate the patient s airway and use airway adjuncts if necessary. There are different ways of ventilating the patient, including the bag-valve mask and CPAP, which is continuous positive pressure ventilation. In some cases, the patient will need full resuscitation if there is complete cardiac arrest. Patients in shock require resuscitation as well, which is covered as part of this chapter.

Chapter seven in the course covers the different respiratory emergencies. A relatively urgent respiratory emergency is foreign body aspiration, which can lead to complete or incomplete obstruction. Dyspnea is a common complaint in EMS so it is covered as part of this chapter. As an advanced EMT, you will be called to assess and manage asthma exacerbation and COPD exacerbations, the treatment for which can be started in the field. Respiratory failure can result from many things; it can lead to respiratory arrest if not aggressively treated.

The purpose of chapter eight is to discuss cardiac emergencies. The advance EMT must manage the prehospital care of the patient with acute coronary syndrome and acute myocardial infarction because prehospital care does affect outcomes. There are many different arrhythmias that need to be recognized, even though there aren t a lot of management options in the prehospital setting. Hypertensive emergencies can be partially managed in the field so this is part of the discussion in the chapter.

Chapter nine in the course covers several different medical emergencies not otherwise covered in other chapters. Some abdominal medical emergencies include the acute abdomen, peritonitis, and GI bleeding, which are discussed in this chapter. Urological emergencies are many and sometimes require prehospital diagnosis and treatment. There are several obstetric emergencies, such as placenta previa, preeclampsia, placental abruption, and emergency childbirth, which are covered in the chapter.

Neurological emergencies are the topic of discussion of chapter ten. These include the EMT s role in determining the patient s level of consciousness, the evaluation and treatment of seizures, the recognition and emergency management of an acute stroke, the initial management and recognition of traumatic brain injuries, the evaluation of headache emergencies, and the emergency treatment of syncope or fainting.

Chapter eleven in the course covers the different psychiatric emergencies that an EMS provider might handle. The behavioral emergency can span many different kinds of mental illnesses and crises. You need to be able to recognize these, remain safe yourself, and decide what to do with the patient after evaluation. The suicidal patient and the psychotic patient represent unique challenges to the EMS worker. In some cases, restraints need to be used.

The purpose of chapter twelve is to discuss the management of traumatic injuries. The first thing you ll need to learn is how to evaluate trauma in a real-world setting. The different traumatic injuries you may encounter include cervical spine injuries, chest injuries, and abdominal injuries. In some cases, trauma can mean dealing with patients who have burns or frostbite injuries. Also included in this chapter are environmental injuries, such as hypothermia, heat exhaustion, and heat stroke.

Chapter thirteen in the course covers special operations that an advanced EMT might be involved in. The EMT may be part of certain rescue operations in cases where the patient is initially inaccessible. There are different ways of transporting patients, depending on the severity of the illness and the distance from the facility. Triage is discussed as part of dealing with mass casualty incidents. Some incidents are related to terrorism or hazmat situations, which are covered in the chapter. The basics of wilderness medical issues are discussed as well as how to manage them.