Intermediate EMT
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TABLE OF CONTENTS Preface........................................................................................................ 1 Chapter One: EMS Basics ............................................................................ 1 The EMS System ...................................................................................................... 1 EMT Safety in the Workplace .................................................................................. 4 Lifting and Moving Patients..................................................................................... 5 Documentation in EMS ............................................................................................ 6 Legal Issues .............................................................................................................. 7 Cultural Issues .......................................................................................................... 8 Role of Religion ....................................................................................................... 11 Key Takeaways ....................................................................................................... 14 Quiz......................................................................................................................... 15 Chapter Two: Medical Terminology in EMS .............................................. 18 Body Directions and Planes ................................................................................... 18 Body Planes ............................................................................................................ 19 Body Cavities .......................................................................................................... 20 Suffixes ................................................................................................................... 21 Prefixes ................................................................................................................... 23 Root Words............................................................................................................. 26 Color-based Root Words ........................................................................................ 32 Key Takeaways ....................................................................................................... 33 Quiz......................................................................................................................... 34
Chapter Three: Anatomy and Physiology................................................... 37 Cellular Anatomy and Physiology .......................................................................... 37 Tissues of the Body................................................................................................. 40 Cardiovascular System ........................................................................................... 41 Respiratory System ................................................................................................ 47 Gastrointestinal System ......................................................................................... 49 Musculoskeletal System ......................................................................................... 51 Neurological System............................................................................................... 53 Urinary System ....................................................................................................... 56 Hematologic System............................................................................................... 59 Immunological System........................................................................................... 60 Reproductive System.............................................................................................. 62 Endocrine System .................................................................................................. 65 Key Takeaways ....................................................................................................... 68 Quiz......................................................................................................................... 69 Chapter Four: Pathophysiology ................................................................. 73 Cardiovascular System ........................................................................................... 73 Respiratory System ................................................................................................ 77 Gastrointestinal System ......................................................................................... 79 Neurological System............................................................................................... 81 Genitourinary System ............................................................................................ 83 Immunological System........................................................................................... 84 Reproductive System.............................................................................................. 85 Endocrine System .................................................................................................. 86
Key Takeaways .......................................................................................................88 Quiz......................................................................................................................... 89 Chapter Five: Patient Assessment ............................................................. 93 Vital Signs ............................................................................................................... 93 Scene Size-Up ......................................................................................................... 97 The SAMPLE History ............................................................................................. 98 Primary Assessment ............................................................................................. 100 Secondary Assessment ..........................................................................................101 Re-evaluating the Patient ..................................................................................... 102 Key Takeaways ..................................................................................................... 103 Quiz....................................................................................................................... 104 Chapter Six: Pharmacology and Toxicology ............................................. 107 Drugs Carried by the EMT-I ................................................................................ 107 Medication Administration and Elimination .......................................................110 Essential Medication Information ........................................................................ 111 Medication Toxicology .......................................................................................... 112 Environmental Toxicology .................................................................................... 113 Toxic Alcohol Ingestion......................................................................................... 113 Plant Toxins........................................................................................................... 115 Key Takeaways ...................................................................................................... 116 Quiz........................................................................................................................ 117
Chapter Seven: Cardiac Emergencies ...................................................... 120 MI and Acute Chest Pain...................................................................................... 120 Shock .................................................................................................................... 125 Cardiorespiratory Arrest and Resuscitation .........................................................127 Hypertensive Emergencies .................................................................................. 130 Key Takeaways ..................................................................................................... 132 Quiz....................................................................................................................... 133 Chapter Eight: Respiratory Emergencies and Airway Management .......... 137 Obstructed Airway.................................................................................................137 Airway Adjuncts ................................................................................................... 140 Intubation .............................................................................................................. 141 Nasotracheal Intubation ...................................................................................... 144 Administering Oxygen ......................................................................................... 144 Managing Respiratory Emergencies .................................................................... 146 Using a Nebulizer ................................................................................................. 147 Key Takeaways ..................................................................................................... 149 Quiz....................................................................................................................... 150 Chapter Nine: Neurologic Emergencies ....................................................153 Stroke.................................................................................................................... 153 Seizures................................................................................................................. 156 Syncope................................................................................................................. 158 Concussion ........................................................................................................... 159 Loss of Consciousness .......................................................................................... 160 Headache .............................................................................................................. 162
Key Takeaways ..................................................................................................... 164 Quiz....................................................................................................................... 165 Chapter Ten: Endocrine, Immunological, and Environmental Emergencies ............................................................................................................... 168 Hyperglycemia ..................................................................................................... 168 Hypoglycemia ....................................................................................................... 170 Septic Shock .......................................................................................................... 171 Anaphylaxis ...........................................................................................................172 Hyperthermia ........................................................................................................173 Hypothermia .........................................................................................................175 Key Takeaways ...................................................................................................... 177 Quiz....................................................................................................................... 178 Chapter Eleven: Gastrointestinal and Genitourinary Emergencies .......... 182 Abdominal Pain Evaluation ................................................................................. 182 Gastrointestinal Perforation ................................................................................ 184 Gastrointestinal Bleeding..................................................................................... 184 Genitourinary Emergencies ................................................................................. 186 Key Takeaways ..................................................................................................... 189 Quiz....................................................................................................................... 190 Chapter Twelve: OB/GYN Emergencies ................................................... 194 Early Pregnancy Losses ........................................................................................ 194 Approach to Pelvic Pain ....................................................................................... 195 Vaginal Bleeding................................................................................................... 197 Obstetrical Emergencies ...................................................................................... 197 Emergency Delivery ............................................................................................. 199
Care of the Newborn ............................................................................................202 Key Takeaways ..................................................................................................... 203 Quiz.......................................................................................................................204 Chapter Thirteen: Psychiatric Emergencies ............................................ 208 Approach to the Patient with a Psychiatric Emergency ..................................... 208 Assessing Suicidality ............................................................................................209 Patient Restraints ................................................................................................. 210 Approach to Psychosis .......................................................................................... 211 Key Takeaways ..................................................................................................... 213 Quiz....................................................................................................................... 214 Chapter Fourteen: Traumatic Injuries .................................................... 218 Trauma Systems and Multiple Victims ................................................................ 218 Abdominal Trauma .............................................................................................. 219 Chest Trauma ....................................................................................................... 221 Multisystem Injury ............................................................................................... 223 Burns .................................................................................................................... 224 Head Trauma........................................................................................................ 227 Key Takeaways ..................................................................................................... 229 Quiz....................................................................................................................... 230 Chapter Fifteen: EMS Operations ............................................................ 234 Ambulance Operations and Safety....................................................................... 234 Patient Extrication and Transport ....................................................................... 236 Hazardous Materials ............................................................................................ 237 Terrorism.............................................................................................................. 239
Key Takeaways ..................................................................................................... 241 Quiz....................................................................................................................... 242 Summary ................................................................................................ 246 Course Questions and Answers ............................................................... 250
PREFACE This course is designed to prepare you for the EMT-Intermediate examination. The EMT-I must understand the basics of anatomy, physiology, and pathophysiology or the study of disease states. There are also things you need to know about managing the different emergencies an EMT-I responds to as well as how the job is handled in the scheme of emergency medical services. Medical emergencies and traumatic emergencies are covered with a focus on those things the EMT-I can do as part of their duties. Chapter one in the course covers the basic things an EMT-I needs to know to be part of an EMS system. The EMS system is a collection of providers that respond to emergencies. Topics like EMT safety, documentation, and the lifting and carrying of patients safely are a part of what the EMT-I needs to understand. Legal and ethical issues are covered as part of this chapter as well as those things you’ll need to know about in order to work with patients of different cultures and religious backgrounds. Medical terminology is the topic of chapter two of the course. While at first it seems boring, it actually involves information that is very important for every health professional to know about. There are terms related to body directions, planes, and body cavities that help you to know certain medical terms related to the human body. Most medical terms you will talk about in your job as an EMT are going to consist of prefixes, suffixes, and root words that together will help you understand what a given medical term relates to. Chapter three is an overview of the anatomy and physiology of the human body. While nothing can replace taking a separate anatomy and physiology course, this chapter will help you remember the basics of how the human body is laid out and how it works. Cellular anatomy and physiology are discussed, along with the study of tissues and the various body systems within the body. The basics of pathophysiology are discussed in chapter four of this course. Like anatomy and physiology, whole textbooks can be written about this topic so, if
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interested in pathophysiology extensively, you will need to read a book on the subject. This chapter covers some of the basic diseases you may need to be familiar with as part of your job. The focus of chapter five is patient assessment. Vital signs are an important part of patient assessment; you will need to know the equipment necessary to obtain vital signs and how to use them. When approaching a patient, you will need to first do a scene size up and will have to obtain a history. There are two major parts of the patient survey, called the primary and secondary surveys. As you care for the patient, you should know when and how to reassess the patient during the patient contact. Chapter six in the course talks about the drugs an EMT can use, the basics of pharmacokinetics of drugs you may give, and toxicology. The repertoire of drugs used by EMT-I providers is not large but can be helpful to patients and, in some cases, can be life-saving. EMTs must also handle many different types of toxicological emergencies, from drug overdoses to toxic alcohol ingestions and to other environmental exposures. Recognizing these situations and rapidly handling them are important factors in the patient’s outcome. Cardiac emergencies from the perspective of the EMT are covered as part of chapter seven. This includes the management of chest pain and acute coronary syndrome, the types of shock and their treatment, and the management of cardiac arrest. Patients may also have hypertensive emergencies that will need to be recognized, treated, and rapidly transported to an emergency department. The focus of chapter eight in the course is airway management and the recognition and treatment of respiratory emergencies. These must be addressed as soon as possible if they are the main cause of the person’s initiation of EMS services. You will learn how to manage an obstructed airway, how to use airway adjuncts and intubate a patient, how to give oxygen through various methods, and the basic management of respiratory emergencies, including how to provide nebulizer treatment. The topics in chapter nine are neurological emergencies, usually related to the brain. These can include stroke, of which there are several types, concussion, headaches, syncope, and altered level of consciousness. There are not always a great many things
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an EMT can do with regard to neurological emergencies but they should be rapidly recognized, treated if possible, and directed to a facility that can further investigate and treat the problem. There are a variety of topics covered in chapter ten in the course. The major endocrine diseases an EMT routinely encounters are those related to diabetes mellitus. These can include hyperosmolar hyperglycemia, diabetic ketoacidosis, and hypoglycemia. Immunological disorders that may be seen include sepsis, septic shock, and anaphylaxis. Common environmental conditions encountered are hypothermia or low body temperature and hyperthermia or elevated body temperature. Chapter eleven talks about the different gastrointestinal emergencies and genitourinary emergencies. Every EMT will have learn to evaluate abdominal pain and to decide if the pain represents a true emergency or something less than that. Gastrointestinal bleeding may or may not have associated pain but can represent its own set of complications. There are several genitourinary emergencies you might encounter, which are covered as part of the chapter. The focus of chapter twelve in the course is OB/GYN emergencies. You should be able to recognize an early pregnancy loss and be able to evaluate pelvic pain, with or without bleeding. There are some emergencies that only occur in pregnancy that you might get called for. In some cases, you will have to attend to an emergency vaginal delivery and will need to care for the newborn during transport to the hospital. These are discussed as part of this chapter. The primary topic of chapter thirteen is how to handle psychiatric emergencies. You will need to learn about the basic approach to the patient with a psychiatric emergency, including how to assess the patient who might be suicidal. There are certain situations where you will need to apply restraints and you should know how to do this. There are certain features of psychosis you will need to recognize in order to adequately address the patient’s needs, which are covered in this chapter. Chapter fourteen in the course talks about trauma and the care of traumatic injuries. In a multiple victim situation, the EMT needs to understand the principles of triage. There are specific injuries that can be seen with trauma to the chest and abdomen, which are
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covered in this chapter. The care and treatment of the severely traumatized patient is difficult but not uncommon in things like motor vehicle accidents. Burns can be caused by many different things that are covered in in the chapter. Traumatic brain injuries can be extremely serious; they must be recognized and transported urgently to the appropriate facility. The focus of chapter fifteen is the different aspects of EMS operations, including ambulance operations and the different supplies an EMT-I crew should carry in their rig. Other topics are incident management, the basics of attending to hazmat situations, and the EMS response to terrorist situations.
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CHAPTER ONE: EMS BASICS This chapter covers the basic things an EMT-I needs to know to be part of an EMS system. The EMS system is a collection of providers that respond to emergencies. Topics like EMT safety, documentation, and the lifting and carrying of patients safely are a part of what the EMT-I needs to understand. Legal and ethical issues are covered as part of this chapter as well as those things you’ll need to know about in order to work with patients of different cultures and religious backgrounds.
THE EMS SYSTEM The EMS system or the emergency medical services system is a collection of providers and services that require rapid medical response needed by individuals in an out-ofhospital setting. Most EMS services are provided with the use of an ambulance but this isn’t invariably the case. EMS is generally activated by the public but it can be activated by the police or by medical facilities. EMTs also handle routine inter-facility transports. The EMS team generally provides some level of care or treatment at the scene and make decisions about whether or not to transport the patient. Most patients are transported to an emergency department within a hospital setting. There are three principles of first aid every EMT needs to remember. These are 1) prevent further injury, 2) preserve life, and 3) promote recovery. There are also six stages of good quality EMS care that should happen. These include the following: •
Early detection by the public or other agency
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Early reporting by calling 911 and providing details of the incident
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Early response by the first EMS responders
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On-scene or field care involving interventions that promote survival and recovery as soon as possible
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Care in transport is given in the ambulance en route to a healthcare facility
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Transfer to a facility that can provide definitive care, which might not be the closest facility
In some parts of the world, such as in French and German-speaking countries, care is physician-led and physicians attend to emergencies. In the US and other parts of the world, EMTs and paramedics lead the pre-hospital care. There is no consensus as to which type of approach is more successful. In the US, there are several levels of care. You should know about the different levels of care and where you fall in the different levels that can be provided. The first or initial level of care can be provided by volunteers, fire engine crews, or police officers, which offer things like CPR, saving a person from choking, and bandaging wounds. These are the providers that give first aid to the patient. Basic life support or BLS is the lowest level of ambulance training. These individuals can assist in higher levels of care and can give some drugs to the patient with a variety of health problems. There are few invasive treatments that can be given by a BLS ambulance crewmember. Intermediate Life Support or Limited Advanced Life Support is somewhat between BLS and advanced life support. Providers who have these skills often replace BLS providers when their expanded skills set is available to an EMS service. ALS or Advanced Life Support providers can interpret ECGs, start intravenous lines, and perform cricothyrotomies. These are also known as paramedics in most countries but, in physician-led systems, the ALS provider is a physician. Critical Care Transport is available in some countries only. This is not a pre-hospital care service but only operates between facilities for inter-facility transports. Nurses and physicians can go along on these types of transports to provide critical care to the patient who requires this type of care. In the BLS system, there are first responders that can be sent in order to provide first aid. They can use an AED, provide CPR, provide oxygen, and perform basic and advanced first aid. They are dispatched quickly to the scene. Many communities have volunteer first responders. Firefighters can perform this function in some areas. The
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driver may be trained or untrained but are skilled in radio communications. There can also be non-emergency attendants. Also in the BLS system, there are different levels of emergency medical training. These include EMT-Basic, EMT-Intermediate and EMT-Advanced or EMT-Paramedics. These individuals need certification every two years and must take refresher courses. The EMD or emergency medical dispatcher provides over the phone, scripted instructions to help bystanders manage emergencies before the EMTs have a chance to arrive. These EMDs have a zero-response time. Advanced life support is provided by paramedics, who can perform a variety of advanced and invasive cares. These have the highest degree of training of all prehospital providers. Within the paramedic system, there are advanced certifications, such as Flight Paramedic Certification, Wilderness ALS providers, and critical care paramedics. The critical care paramedic often works in air ambulances but can work in regular ambulances as well. Paramedics can use a variety of IV antibiotics and can use life-support systems like ventilators. They can manage chest tubes, arterial lines, and surgical airways. In some parts of the world, they can operate independently and can make their own prescribing decisions. Specialist EMS systems include air ambulances, which generally are used for major trauma situations. They can operate in remote areas in order to take very sick patients that require advanced cares. These were developed and first used in wartime situations. Their ability to travel long distances over a short period of time makes them useful in rural medical circles. Tactical emergency medical services are specialist teams used to care for individuals in dangerous situations or major incidents. They are used in urban areas in hazmat situations, natural disasters, active shooter situations, bombings, and tactical police operations. Wilderness EMS systems are designed to operate in extremely remote areas, where getting the patient out of the situation will be lengthy and difficult. Antibiotics and advanced airway systems can be given. Many of these teams operate in search and 3
rescue situations, in certain military settings, and in large national parks and other wilderness areas.
EMT SAFETY IN THE WORKPLACE EMTs must respond to medical emergencies at all hours of the day and on every day of the year. They respond to a variety of emergencies, including fires, behavioral crises, accidents, and other traumas. Because of the extreme circumstances they must work in, they need to work safely and with a great deal of self-care. One of the biggest risks for the EMT is exposure to blood and body fluids. With exposure to blood comes the risk of bloodborne pathogens, such as hepatitis C, hepatitis B, and HIV disease. Blood can be splashed in the eyes, come in contact with mucus membranes, or enter the body through an open wound or cut. Intact skin that can be washed is not a source of a bloodborne pathogen. In order to protect yourself as an EMT, you should wear long pants, long sleeves, and gloves. In some cases, safety goggles and a face shield can be used when blood splashing is likely. All open sores should be covered. Hands should be washed before smoking or consuming food and beverages. All work surfaces should be decontaminated. The drive itself to and from the scene can be dangerous. The driver should drive defensively and everyone should wear seatbelts. There should be a dedicated driver and adequate numbers of personnel dealing with the patient. There is a high risk of stress-related injuries associated with being an EMT. There can be signs and symptoms of PTSD and injuries from sleep-deprivation and poor concentration. Adequate rest and a proper diet should be followed at all times. Working odd hours can lead to the health problems associated with shift work. Injuries can happen because of the strenuous activity associated with the job. There can be injuries from lifting patients, bending, kneeling, and getting into difficult situations, such as with extrications and highway accidents. There are things that need to be done in order to avoid twisting injuries from getting supplies and reaching for things. There are ways to lift and carry patients properly, which will be discussed next.
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LIFTING AND MOVING PATIENTS Proper body mechanics involves using your body in the safest and most efficient ways so as to prevent a major injury. Always keep your shoulders stacked on your hips and knees with your body straight. Twisting injuries cause the most injuries in the EMT. Do not use your back muscles for lifting. Instead, use your leg muscles, hip muscles, and buttocks for lifting with tension of your abdominal muscles and not your back muscles. Keep the patient’s weight as close to your body as possible. There are certain techniques that should be used when lifting or otherwise manipulating the patient. You should use what’s called the “power lift”, which involves having the feet apart, abdominal muscles tense, and the back straight. A power grip is used by having the palms and fingers come in contact with each other in a firm grip. The squat lift involves having the weaker foot slightly forward and then doing the power lift. A onehanded carrying technique is done with the back straight and the weight held below your own waist with out leaning in or out for balance. There are certain emergency moves that are done without spinal stabilization in dangerous situations when removing the patient from a site is necessary to be done quickly. The armpit-forearm drag is used with the EMT reaching underneath the armpits, grabbing the patient’s forearms and then dragging. The shirt grab is done by dragging the patient by the shoulders and with their shirt for traction. The blanket drag involves dragging the patient after putting a blanket beneath them. Urgent moves are used with spinal immobilization and a safe scene. Nonurgent moves are used when the patient is stable and the scene is safe. A backboard should be used if a back injury is possible. There are several techniques that can be used in dragging or carrying the patient out of the scene and to the ambulance. There are several carrying devices that can be used by the EMT that you should be familiar with. These include the following: •
Wheeled stretcher—this is a stretcher that does not have to be carried. The patient can be wheeled to and from the ambulance.
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Portable stretcher—this is a lightweight stretcher that does not have wheels and needs to be carried.
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Scoop stretcher—this stretcher splits apart and comes together underneath the patient so the patient can be taken on the stretcher to the ambulance. C-spine immobilization should be done with a c-collar, if necessary.
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Basket stretcher—this is a stretcher that is surrounded by a protective guard so as to lift the patient from the field into a rescue helicopter, if necessary.
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Flexible stretcher—this is a foldable stretcher that can unfold in order to hold a patient.
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Bariatric stretcher—this is a stretcher for people as large as 1600 pounds that would have to be used on these types of people.
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Stair chair—this is a chair that has handles in order to carry a seated patient.
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Backboard—this is used in order to have spinal immobilization of the patient that has both hand holds and belts to keep the patient affixed to the board. These boards float.
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Vacuum mattress—this is a rigid mattress that has a vacuum creating the rigidity. It is used for spinal immobilization.
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KED—this is called the Kendrick Extrication Device. It is used to provide spinal immobilization to the patient who is seated, as can happen in a motor vehicle accident when the patient is still in a vehicle.
DOCUMENTATION IN EMS Documentation in EMS systems is a necessity. You will need to use your skills to create a legible medical document that is also a legal record. Because this is a legal record you will have to potentially defend in court, you should be able to read it and you should be careful about what you put in it. There are things you need to do and not do as part of this documentation project. Each document should stand alone. This means you should not copy information from a previous record about things like patient data, medications, and allergies. You should be specific about the symptoms the patient is describing, including quotations regarding
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what they say. If they have pain, be specific about the location of the pain and its quality. You should also describe the level of other symptoms, such as weakness or abnormal movements. You can use a pain scale to describe the patient’s pain. There are just a few situations in which the patient will be unable to sign for consent to treatment and the Centers for Medicare and Medicaid documents. If the patient truly cannot sign their form, you should document why they could not sign the form and have an authorized family member sign for the patient. You should also document why the transport of the patient is medically necessary because the diagnosis alone may not be enough for insurance companies and Medicare to make a decision on that. Be as specific as you can be about things like level of consciousness, pain level, vital signs, and physical findings. Be completely truthful about the visit as giving false information is a criminal offense. When giving treatments, note the treatment given and the time it is given. Be specific about what treatment was performed as well as the results of the treatment. This should be the case, even if you don’t see an effect of the treatment.
LEGAL ISSUES While there are a few federal legal standards and laws governing EMS services, most laws regulating emergency services come from the different states. The most common thing an EMS provider would be some type of negligence, which is generally considered a mistake that is done without any ill intent. In order to prove negligence, the legal system will have to determine that there was some type of duty related to the patient— written, implied, or verbal. This involves some type of contract for care. In order to prove negligence, the patient must show some type of duty to care existed and that this duty was breached or wasn’t done at all. Most commonly, the standard is what a reasonable provider of similar experience and education would have done under the same circumstances. This is what the standard of care is all about. A jury gets to decide what the standard of care should be and whether or not it was deviated from. Sometimes, the overseeing physician is brought into the lawsuit.
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Informed consent is extremely important in treating the emergency patient. Remember that consent can be written, verbal, or implied. Treating a patient without consent, even if it is to do something like starting an IV, can be called battery. Most consent in EMS care is implied unless the patient is alert, oriented, and able to sign a consent form. Implied consent involves caring for the patient who cannot give consent but any reasonable person would give similar consent if able to. People under the age of 18 years cannot give consent legally so a parent or legal guardian must give consent for them. A teacher or principal of the school will be able to give consent until the legal guardian becomes available. Only emancipated minors, such as those who are pregnant, in the armed services, or who are married are considered legally emancipated. Any adult or emancipated minor has the write to refuse medical care, regardless of reason. This is true, even if the lack of treatment is detrimental to themselves. What you have to do is prove that the patient understands the risks of treatment, the benefits, and the alternatives available. The EMS provider should document whether or not the patient has the capacity to refuse treatment. If things like restraints are necessary but refused, you should document why they are best for the patient’s safety or the safety of others. One federal law that is followed is the federal HIPAA law. This law specifically addresses confidentiality of patient care with the only exception being mandatory reporting. Mandatory reporting is necessary for things like gunshot victims, stabbings, sexual assault, elder abuse, or child abuse. EMS providers are mandatory reporters of these kinds of things.
CULTURAL ISSUES Healthcare in just about any part of the US can be complicated by language and cultural barriers. There are features of the western medical system that are not shared by everyone who receives it. There are differences in the medical concept of disease and the patient’s concept of illness. This is even more magnified when there are cultural
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differences between the patient and the providers. These things can stymie any attempt at treating the patient who is ill. The communication between patient and provider involves some type of socialization, diagnostic questioning, planning of care, negotiation, the setting of goals, treatment, and education. These things can all be interfered with because of cultural boundaries, which influence the patient’s reality about their illness. Complicating matters is the fact that the interaction between patient and provider tends to be provider-dominant. You need to remember that patients do not generally use just biomedical methods of solving their healthcare problem. They use other things, such as folk medicine, popular treatments, and religion. Just because they are asking you for care doesn’t mean they are not using other treatments and therapies. Popular and folk remedies may or may not work but you need to consider all of the possibilities for how these remedies will work for the patient. The culture of a patient involves a pattern of behaviors, customs, and ideas shared by a group of people. It is ever-changing. Cultures will evolve rapidly whenever there is migration of a group from one area to another. Cultures can be divided into those that are “collectivist” and those that are “individualist”. You should attempt to define what type of culture your patient comes from. Culture has a huge influence on health and healthcare. Culture will affect the patient’s perceptions of illness, health, and death, the causes of disease, how illness and pain are experienced, and what type of care the patient seeks. Both the provider and the patient will have cultural influences with regard to healthcare. While culture is important, it is always dynamic and evolving; there are many influences on culture so it is important not to over-generalize about it. It tends to be passed from generation to generation, and is shared by a group of people. It manifests itself through dress, language, music, and behaviors. It is integrated throughout the patient’s life and not just related to healthcare. There will be diversity within any single culture and there are many factors that influence a patient’s experience besides culture. The negative effects of cultural
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influences may be well-hidden by the patient. Migration to another area of the world will accelerate the changing of cultural influences, particularly in children. There is actually a continuum between collectivistic and individualistic cultures. These will give rise to different view on human health, the treatment of illness, the causes of disease, and the diagnoses. Family members will or will not be part of decision-making, depending on the culture. The differences between the two cultures involves the following: Collectivistic cultures focus on “we”. They promote interdependence between members and value connection to the family. Respect and obedience are valued and the focus is on group goals, harmony and cooperation among the members. The individualistic culture focuses on “I”. Autonomy is valued as is the ability to make individual personal choices. Individual achievement is emphasized and there is a lesser influence of group values and views. Culture helps patients view disease and health in different ways. The causes of disease are somewhat culture-dependent. Some cultures are more fatalistic about the outcome of a disease process, believing that things cannot be changed. Some cultures highly stigmatize certain diseases, particularly mental health issues. In some cultures, for example, being overweight is equated with being strong rather than being unhealthy. Other cultures believe in stoicism, while there are those that strongly express their pain. Compliance with cares is also very culture-dependent. Different cultures will have alternative theories about who should be told about an illness and when. Preventive care is something some cultures do not practice. Death and dying practices vary according to culture. If there is a language barrier, there might be some things that are not discussed through an interpreter. Eye contact can be thought of as polite or rude, depending on the culture. Gender roles are also culturebased. As a healthcare provider, you should understand your own belief system. You should understand the different cultural biases and work with them rather than against them. Listen for cultural influences on your patient’s behavior and presentation. Know that families and patients will often use alternative therapies or complementary treatments. 10
Use an interpreter when one is needed and speak back to your patient what you have understood about what they’ve said. Find out where the patient falls on the spectrum of being in their own culture and being in the culture they have migrated to.
ROLE OF RELIGION While there is diversity among religions, there are some things you need to understand when dealing with patients who come from different religion. Knowing these practical ways of dealing with different religions will help you understand how to understand the patient’s needs. Always consider using a pastoral care advisor when dealing with a patient who has certain religious beliefs. Like culture, you should not over-generalize about a patient’s religion or their religious beliefs. When dealing with Buddhist patients, know that they place an emphasis on mindfulness. For this reason, they may request time for peace and quiet when they meditate. There may be cultural beliefs about modesty, particularly around members of the opposite sex. Be prepared to feed these patients vegetarian foods and know that some medications are animal-based. They may refuse pain medications that might cloud their consciousness. Chanting or praying out loud can be part of this culture and there may be a request to burn incense or candles. Many of these patients will not want their consciousness clouded at the end of their life. Minimize intrusions as the patient and their family prepare for death. Death is perceived as a change or transition and family members may stay away from the patient at the time of death. Do not jostle the patient after death because they believe that the spirit will still reside in the body for a period of time. Religious rites may persist for hours after the patient’s death. In Catholic patients, receiving blessings and sacraments by a Catholic priest are important. This is especially important before any surgery or the possibility of death. Last rites or Sacrament of the Sick can be done by the priest on these patients. If the patient is dying, there may be an urgent request for a priest to pray for the patient or deliver last rites. Baptism is also very important if an infant is dying. Baptism can be done by anyone with proper intent if a priest is unavailable. You should know how to
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baptize an infant by saying their name, and saying “I baptize you in the name of the Father, Son, and Holy Spirit” and by pouring water on the head of the infant three times. Holy Communion may be requested for by the patient before surgery. This should be approved because it involves taking a tiny wafer into the mouth when they shouldn’t be eating anything. Expect religious objects to be worn by the patient or held in a bag near the patient during procedures. Not going to mass can be very stressful to the Catholic patient. Most patients will not want extraordinary measures but this is often negotiable. Non-meat diets may be necessary on Fridays during the 40 days before Easter, which is called Lent. Hindu patients also have cultural concern about modesty and may not talk about urogenital issues if the spouse is present. Hindus are strictly vegetarian and some will not eat onion or garlic. Fasting is commonly practiced in Hinduism. The washing of hands after a meal is standard practice. There are certain right-handed practices and certain left-handed practices, such as toileting, which need to be considered. Certain pieces of jewelry have religious significance. Death is considered a transition and many will want to die at home. The washing of the body after death is important. The dead patient’s family will often want someone to accompany the body after death. Jehovah’s witnesses have a strict belief against receiving any type of blood transfusion, even if it is the patient’s own stored blood. Certain blood products, like albumin and hemophiliac drugs may or may not be allowed, based on the individual belief system. Organ donation and transplantation are allowed. While prayers are said, they do not believe in faith healing practices. They do not believe in an immediate afterlife after death. Birthdays and Christian holidays are not practiced. Jewish patients often do not work on the Sabbath, which starts on sundown on Friday and ends on sundown on Saturday. This may involve not using things that involve electricity, like pushing a call button, or tearing sheets of toilet paper when toileting. Surgery and discharges should not be done on these days. Jewish holidays are very important as well. There may be dietary restrictions on those days. Some Jewish people keep a Kosher diet, while others do not. Modesty can be important and some will refuse
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life-sustaining measure. Burial should happen quickly after death without an autopsy, unless the examination is required. Family members may accompany the body. Amputated limbs should be buried with the rest of the body. Rabbis are frequently consulted with regard to medical decisions. A yarmulke may be worn at all times in some Jewish people. Remember that being Jewish is partially racial so some customs may be followed, even if the person is not religious. Muslims are also very concerned with modesty and women may cover their bodies at all times, especially when accompanied by men. There should be limited social contact between members of the opposite gender. Eye contact may be avoided. Many Muslims adhere to a specific diet, which avoids pork products and gelatin. It is not the same as a Kosher diet. Drugs containing gelatin are often avoided. Alcohol is not consumed by Muslim people. Washing in Muslim practices involves some type of running water before prayers, before meals, and after meals. Prayers are five times daily. The imam is the holy person used to help the patient make decisions about prayer and what is acceptable. Pain medications are often avoided. Amputated limbs are buried with the body if possible. They do not generally wish to withdraw or withhold life-sustaining therapy. Family members like to stay with the dying person and the head of the bed should face Mecca after death. Burial happens as soon as possible. Ramadan is a thirty-day period of fasting in which the patient does not eat during daylight hours. Fasting in summertime tends to be more stressful because of the long hours of daylight. Pentecostal patients often pray loudly, which can be difficult in a hospital setting. Speaking in tongues is practiced and is felt to be significant. Often, large groups of people are asked for as part of prayer activity. There is a strong belief in miracles and in miraculous healing.
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KEY TAKEAWAYS •
The EMS system involves a variety of different personnel in various educational stages.
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EMS safety involves protection against bloodborne pathogens, stress, and workplace injuries.
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There are specific lifting and carrying techniques that will help the EMT avoid injuries.
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Legal issues in EMS include things like HIPAA laws, laws around negligence, and mandatory reporting.
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Culture strongly affects how a person understands health and illness.
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There are specific religions that have practices important to know about in caring for these patients.
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CHAPTER TWO: MEDICAL TERMINOLOGY IN EMS Medical terminology is the topic of this chapter of the course. While at first it seems boring, it actually involves information that is very important for every health professional to know about. There are terms related to body directions, planes, and body cavities that help you to know certain medical terms related to the human body. Most medical terms you will talk about in your job as an EMT are going to consist of prefixes, suffixes, and root words that together will help you understand what a given medical term relates to.
BODY DIRECTIONS AND PLANES In medical terms, there will often be some mention of a body part or symptom related to a certain body direction or body plane. You should know these directional and planar terms and should use them in your job as an EMT-I. These are the directional terms you should understand: •
Cranial or superior—this refers to anything related to the head of the body. Something that is superior to another thing in the body is directed more toward the head.
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Caudal or inferior—this refers to anything toward the foot or away from the head. Caudal refers to the feet generally and not to the rump.
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Ventral or anterior—this refers to anything that is closer to or located in the front of the body.
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Dorsal or posterior—this refers to anything that is closer to or located in the back of the body.
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Medial—this is anything that is toward the middle of the body. The chest is considered medial to the shoulders and arms.
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Lateral—this is anything away from the middle of the body. The lateral collateral ligament is on the outside of the knee compared to the medial collateral ligament.
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Proximal—this describes something that is closer to the trunk. As an example, the femur is proximal to the tibia.
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Distal—this describes something that is away from the trunk. The hand, as an example, is distal to the elbow.
BODY PLANES Figure 1 shows the different body planes:
Figure 1.
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The body planes are those that divide the body into different components. These are the body planes you should know about: •
Coronal plane—this is referred to as the frontal plane. It is vertical and divides the front half (the ventral half) and the back half (the dorsal half) of the body.
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Sagittal plane—this is referred to as the lateral plane. It is vertical and divides the body into left and right halves.
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Axial plane—this is also called the transverse plane. It is horizontal and divides the body into the upper and lower parts.
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Median plane—this is a specific sagittal plane that separates equally the left and right halves of the body.
BODY CAVITIES Figure 2 describes the different body cavities:
Figure 2.
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