Transferring information about a patient is necessary for care. This takes place both in person to person or verbally over a radio or phone, and also in written documentation records.
Communication with a patient are both verbal and nonverbal. Providers need to establish a rapport with patients and adjust their communications for cultural, age and language abilities of the patient. Oral reports to other healthcare providers are used to transfer responsibility of care.
Terms/Concepts to Know: therapeutic communication, cultural imposition, open-ended questions, closed-ended questions, rapport
Patient contacts require written documentation and different forms often exist based on outcome of the contact. This can include transports, refusals of care, and special situations, such as a multi-casualty event. Errors should also be honestly recorded along with corrective actions.
Terms/Concepts to Know: patient care report (PCR), refusal of care
EMS systems rely on radio systems for communicating with dispatch centers and hospitals. Many types of radio systems exist and they may also be enhanced with cellular and telemetry communications for contacting medical control at hospitals. Systems need to be maintenance.
Terms/Concepts to Know: base station, channels, very high frequency (VHF), ultra high frequency (UHF), repeater, telemetry, simplex, duplex, multiplex, MED Channels, trunking, interoperable communications, mobile data terminal (MDT), Federal Communications Commission (FCC), paging, standing orders
Patient assessment is the foundation of all EMT care. It can be divided into 5 major parts: Scene size-up, primary assessment, history, secondary assessment, and reassessment.
This begins with the information provided by dispatch and continues with initial assessment upon arrival. Scene safety and identification of additional resource needs is an important component. Situational awareness for changing conditions must be maintained at all times.
Terms/Concepts to Know: scene size-up, situational awareness
The primary assessment is the beginning of patient assessment. It is similar to the scene size-up, with a goal of gaining an overall impression of how the patient is doing and the severity of their injuries/illness. The goal is to identify life threats that require immediate intervention.
Terms/Concepts to Know: symptom, sign, primary assessment, vital signs, general impression, perfusion, AVPU scale, responsiveness, orientation, altered mental status, spontaneous respirations, life threats, shallow respirations, retractions, distracting injuries, accessory muscles, nasal flaring, dyspnea, tripod position, sniffing position, labored breathing, pulse, palpate, cyanosis, jaundice, sclera, diaphoretic, capillary refill, hypothermia, frostbite, vasoconstriction, coagulate, DCAP-BTLS, crepitus, Golden Hour
The history of the current event and the patient’s past medical history can be crucial to determining the proper course of care. The history determines what event triggered the call for help and is often gathered concurrently with the primary assessment.
Terms/Concepts to Know: OPQRST, pertinent negatives, SAMPLE history,
The secondary assessment is a systematic, detailed examination of the patient. It is often focused on certain body systems by the chief complaint or injury. In critical patients, it may done en route to the hospital and may never be completed if the injury is life-threatening and requires more immediate attention.
Terms/Concepts to Know: secondary assessment, auscultate, focused assessment, stridor, breath sounds, tidal volume, wheezing, crackles, rales, rhonchi, tachycardia, bradycardia, blood pressure, systolic pressure, diastolic pressure, hypotension, hypertension, PEARL, subcutaneous emphysema, paradoxical motion, guarding, pulse oximetry, metabolism, carbon dioxide, capnography
This is performed at regular intervals during patient care and sometimes may even occur before the secondary assessment is complete, to see if primary assessment findings have changed. The main purpose is to check for improvement or deterioration of the patient.
Terms/Concepts to Know: reassessment
Lifting and moving patients is an integral part of EMS operations. Many different devices exist for safe patient movement and for lifting and moving in special situations.
The wheeled stretcher is the most basic piece of ambulance devices and is used for practically every transport. It can typically adjust to different heights to facilitate movement and has safety belts for securing the patient. It also has other specific features to ease movement through tight spaces and around corners.
Terms/Concepts to Know: wheeled ambulance stretcher
The backboard is a rigid, flat, rectangular device traditionally used to immobilize patients with potential spinal injuries. It has places for straps to secure the patient and handholds for lifting.
Terms/Concepts to Know: backboard, spine board, long backboard
This includes techniques to reduce provider injuries or dropping of the patient. Patient movement should also be done so that conditions aren’t worsened and the patient is comfortable.
Body mechanics pertain to the relationships between lifting forces and the structures of the body. Lifting techniques should be done in a manner that involves proper mechanics that reduce the chance of injury.
Terms/Concepts to Know: body mechanics, power lift, power grip
Reaching and pulling during patient movement is common and an easy source of injuries. Proper techniques should be practiced to reduce the risk of injury.
Moving a patient can provide many opportunities for EMT injury. It is important to know and use the proper techniques. They will not totally prevent all injuries to the EMT, but will greatly reduce the incidence of such injury.
Terms/Concepts to Know: diamond carry, stair chair
It is important that patient movements be coordinated among team members with clear commands for execution. Complicated moves may require pre-planning prior to execution.
At times it may be necessary to move patients quickly using rapid extrication techniques. This can occur due to scene dangers or imminent risk to the patient.
Terms/Concepts to Know: emergency move, rapid extrication technique
Patients will need to be moved from various positions in order to provide care and transport. Moves need to be planned among all caregivers to assure safety and not dropping the patient.
Terms/Concepts to Know: direct ground lift, extremity lift, draw sheet
Geriatric patients can present special movement challenges because of their fragility, which makes them susceptible to further injury. Bariatric patients present issues concerning having enough resources to safely move them.
Terms/Concepts to Know: bariatrics
Ambulances are equipped with many different devices for moving patients in specialized situations. This can include bariatric cots, to accommodate the weight and girth, and basket stretchers for rescue situations.
Terms/Concepts to Know: portable stretcher, bariatric stretcher, flexible stretcher, short backboard, Kendrick Extrication Device (KED), vacuum mattress, scoop stretcher, basket stretcher, neonatal isolette, powered cot
It can be necessary to place a patient in restraints when the patient is in danger of self-harm and is incompetent to refuse care. The safety of patient and staff is a priority.
Terms/Concepts to Know: restraints, asphyxia
EMTs always need to be aware of the dangers of lifting. They should assure that the lift can be completed safely and ask for help when necessary.
Terms/Concepts to Know: safe lifting capacity