EMR-MODULE-1-2 PDF

MODULE 1: BASIC LIFE SUPPORT “Hey, Hey! Are you okay? Hey, Hey! Are you all right?” Should be done in less than 5 seconds General Concepts (& Objec...

MODULE 1: BASIC LIFE SUPPORT “Hey, Hey! Are you okay? Hey, Hey! Are you all right?” Should be done in less than 5 seconds General Concepts (& Objectives) CALL FOR HELP! BLS (Basic Life Support) is the foundation for saving lives after cardiac arrest. Activate the emergency response system as appropriate in your setting. Know the importance of HQCPR and its impact on survival Depending on your work situation, call your local emergency number from Perform High-Quality CPR, complete with proper assessment under valid your phone, mobilize the code team, or notify advanced life support. considerations. If you are alone, get the AED/Defibrillator (if available) and emergency Make use of a multi-conceptual framework that will equip providers with equipment. If someone else is available, send that person to get it. the knowledge and skill set to facilitate and/or act on when dealing with cardiac arrest (in Adults, Children & Infants) Emergency Response System - Hospital: Activating a specific hospital code, medical emergency team, or Age Definitions rapid response team. Adults: Adolescents (ei., after the onset of puberty) and older. - Pre-Hospital: Activating EMS, paramedics, medic units, or advanced life Children: 1 year of age to puberty. support or calling for back up. Infants: Less than 1 year of age (excluding new born infants in the delivery - Workplace/Facility/Home: Calling your local emergency number or room) activating specific work place emergency response protocols. CARDIAC ARREST OR HEART ATTACK? BREATHING & PULSE Sudden cardiac arrest occurs without warning or within minutes after Breathing: Scan the victim’s chest for rise and fall for no more than 10 symptoms appear. seconds. Heart Attack occurs when the blood flow to part of the heart muscle is o If the victim is breathing, monitor the victim until additional help blocked arrives. o If the victim is not breathing or is only gasping, this is not considered Sudden Cardiac Arrest Heart Attack normal breathing and is a sign of cardiac arrest. - results from an abnormal - occurs when a clot forms in a Pulse: Palpate the victim’s carotid pulse. heart rhythm. blood vessel carrying o If you do not feel a pulse within 10 seconds, begin HQCPR, starting oxygenated blood to the heart with chest compressions. muscle. o In all scenarios, by the time cardiac arrest is identified, the emergency - This rhythm causes the heart - If the blocked vessel is not response system or backup must be activated and someone must be to quiver so it can no longer reopened quickly, the muscle sent to retrieve the AED and emergency equipment. pump blood to the brain, normally nourished by that lungs, and other organs. vessel begins to die. CRITICAL CONCEPT: High-Quality CPR 1. Start COMPRESSIONS within 10 seconds after recognition of cardiac - It is often a “rhythm” problem. It is a “clot” problem. arrest 2. Push FAST: Compress at a rate of 100 to 120/min SUDDEN CARDIAC ARREST 3. Push HARD: at a depth of at least 5 cm (2 in) for adults/children and - Within seconds, the person becomes unresponsive and is not breathing or at least about 4 cm (1 ½ in), for infants. is only gasping. 4. Allow complete chest recoil 5. Minimize interruptions HEART ATTACK 6. Give effective breaths - Severe discomfort in the chest or other areas of the upper body 7. Avoid excessive ventilation - Shortness of breath Maintain a ratio of 30 compressions: 2 breaths (which is equal to 1 - Cold sweats cycle) - Nausea and/or Vomiting After 2 minutes (or 5 cycles of HQCPR): o SAS! (Stop, Analyze & Switch) WHEN TO STOP(S) CPR? Spontaneous Circulation has returned Trained personnel has arrived Operator is too exhausted Physician has announced that the patient is dead (S)cene is not safe. CHEST COMPRESSIONS -CONSIDERATIONS CAUTION: Do not move the victim during compressions! The importance of a FIRM SURFACE: a firm surface allows compression of the chest and heart to create blood flow. ALLOW COMPLETE CHEST RECOIL. ADULT BREATHS -CONSIDERATIONS BLS -ADULTS Opening the Airway o For breaths to be effective, the victim’s airway must be open. Two SCENE SAFETY AND ASSESSMENT methods for opening the airway are: Verify that the scene is safe for you and the victim. You do not want to o Head –tilt chin lift become a victim yourself. o Jaw thrust Include: Giving Breaths o Mechanism of injury or nature of illness. o Either by the mouth, barrier devices or a bag mask device o Determine the number of patients. RESPONSIVENESS Tap the victim’s shoulder, and shout on both ears  It is an emergency that, in certain situations, is potentially reversible if treated early. VENTILATION TECHNIQUES Mouth to Mouth: a quick, effective technique used to provide oxygen to an unresponsive adult or child. Mouth to mouth and nose: a technique that is preferred for infants. However, if you can’t cover the infant’s nose and mouth with your mouth, use mouth to mouth instead. ADULT BLS PUT IT ALL TOGETHER BLS SURVEY –HIGH QUALITY CPR CHILD BLS PRACTICE –AED AND 2 RESCUER BLS VENTILATION TECHNIQUES Rescue Breathing: giving breaths to an unresponsive victim who has a pulse but is not breathing. Rescue Breathing for Adults o 1 breath every 6 seconds Rescue Breathing for Children and Infants o 1 breath every 3 seconds Respiratory Arrest This type of arrest occurs when normal breathing stops, preventing essential oxygen supply and carbon dioxide exchange.  CHOKING MODULE 2: THE EMS SYSTEN AND PREPARATORY LESSON 1-3 LESSON 1: INTRODUCTION TO EMERGENCY MEDICAL CARE 18th and 19th centuries The first efforts of field care were developed by one of Napoleon’s surgeons. Barron Domenic-Jean Larrey, During the Austrian/Prussian conflicts in 1792. Even the American Civil War forced changes and advancements onto the medical system. TRIAGE, a method of sorting patients depending on it’s severity, was also developed during this time. HISTORY Early 1966-1970’s: The Department of Transportation developed the first National Standard Curriculum for EMS Late 1970’s – Early 1980’s: DOT Developed a recommended National Standard Curriculum for Paramedic 1970 –NREMT was founded to establish professional standards President Lyndon Johnson's Committee on Highway Traffic Safety recommended the creation of a national certification agency to establish uniform standards for training and examining personnel active in the delivery of emergency ambulance service. Circa 1980: EMS Established in USA 1969 - US Choking Relief –Responsive Adult/Child The EMT Ambulance program was made public. The First paramedic Use abdominal thrusts (Heimlich Maneuver) to relieve choking in a curriculum followed in 1977. responsive adult or child. Do not use abdominal thrusts to relieve choking in an infant. If the victim is pregnant or obese, perform chest thrusts instead of abdominal thrusts. Ford Econoline ambulance, the standard from 1968 until 1973 Choking Relief –Unresponsive Adult/Child If the patient is, or becomes unresponsive, immediately proceed in providing HQCPR. Each time you open the airway to give breaths, open the victim’s mouth wide. Look for the object. If you see it and can be easily removed, remove it with your fingers. If not, don’t do a blind finger sweep. A provider can tell if he/she has successfully removed an airway obstruction in an unresponsive if there is: o Air movement and chest rise is present when giving breaths.  1973 the First High-Top Dodge transfer vehicle was presented Human Resources and Training by Muskoka Ambulance Service - All personnel / staff ambulances must be trained to at least EMR or EMT 1977 –First Air ambulance was introduced/started. ‘ Essential Elements of an EMS System - Each state has control of its own EMS system - National highway Transport Safety Administration (NHTSA) Technical Assistance Program provides set of recommended standards Regulation and policy - Each state must have laws, regulations policies and procedures. - State level EMS agency to provide leadership TRAITS OF A GOOD EMERGENCY RESPONDER Resource management Personal traits - Each state must have laws, regulations policies and procedures Good personal traits enable the EMT to work cohesively with the EMS team - State level EMS agency to provide leadership and the patients Cooperative  Resourceful STAR OF LIFE Self-starter Designed by Leo R Schwartz, Chief of the EMS Branch, national highway Able to lead Traffic Safety Administration (NHTSA). In control of personal habits Was created after the American national red Cross complained in 1973. Able to communicate properly Each of the bars respresents the six system function of the EMS. Open minded Quality Improvement Prepare carefully written documentation Be involved in Quality Improvement Feedback/evaluation from patients and ED staff Maintenance of equipment and supplies Continuing education Medical Direction / Medical Control Physicians need to be involved in every step of pre-hospital emergency care Two components o Direct / Online medical control o Indirect / Offline medical control LESSON 2: WELL BEING OF THE EMT Safeguarding the EMT-B’s well-being is critical.- EMS is a stressful profession-caring for sick, injured, and dying EMTs deal not only with physical illnesses and injuries but also with the emotions of their clients and their own emotions. Personal protection Standard precaution - Equipment and procedures that protect you from blood and body fluids - Also known as Body Substance Isolation (BSI) Selection of standard precaution is a critical decision. Decision is made when you have seen the patient and reconsider the decision throughout the call. Personal protection Training Immunizations Personal Protective Equipment’s (PPE) Infection control: hand washing Exposure control plans/protocols Reporting exposure (Ryan White CARE Law) Personal Protective Equipment’s Protects you from all possible routes of contamination. Each PPE has its own guidelines for proper use. The type of activity will indicate which PPE should be used.  Do not falsely reassure Present reality, offer what you can Dealing with the dying patient and family members - Patient needs include dignity, respect, sharing, communication, privacy and control - Family members may express rage, anger and despair - Listen empathetically - Do not falsely reassure - Use a gentle tone of voice Emotional Stress - Let the patient know everything that can be done to help will be done - Use a reassuring touch, if appropriate Stress - Comfort the family - State of physical or psychological arousal to a stimulus. - Stress is a normal part of an EMT-B’s life You cannot help or provide emergency care if you are injured. o Environmental o Interpersonal o Intrapersonal LESSON 3 – MEDICAL, LEGAL, AND ETHICAL ISSUE Scope of Practice Function with the minimum and maximum performance guidelines May vary from countries or states Dictates what procedures, interventions, and modalities of treatment may be used by a professional CONSENT Consent to care Permission (from the patient) for any treatment or action taken by the EMT o Expressed o Implied o Minor or incompetent patients Dealing with Stressor/s Lifestyle changes Types of Consent Healthy and positive dietary habits Implied (non verbal) Exercise o Unconscious, physically or mentally incapacitated Devote time to relaxation o Consent may be assumed o Implied consent because a rational patient will consent to the Critical Incident Stress Debriefing (CISD) treatment Assist/facilitate how people deal with the stressors (24-72 hours after) Minor or Mentally Incompetent Help EMTs deal with critical incident stress o Obtained from parents or legal guardians Open discussion of feelings, fears, and reactions o Or from other people like teachers, principals o Implied consent for situations where an adult can not give Not an investigation or interrogation consent for the child All information is confidential o loco parentis. When minor children are entrusted by parents to CISD leaders and mental health workers evaluate information and offer a school, the parents delegate to the school certain suggestions on overcoming stress responsibilities for their children, and the school has certain liabilities. Understand reactions to death and dying Understand the patient and the family ASSAULT / BATTERY Recognize the patient’s needs - Unlawfully touching a patient without his/her consent Be tolerant of angry reactions Listen empathetically  - Providing emergency care when the patient does not consent to the - If there is no threat to safety, provide care. treatment Abandonment - Leave a patient to someone who has lesser medical REFUSAL training/competency Refusal to care Good Samaritan Laws Patient’s right - Grants immunity from liability if the rescuer acts in good faith to Make sure that the patient is fully aware of the situation and the potential provide care to the level of his training implications of his/her refusal Varies from states or countries Waiver Provides limited legal protection to Healthcare personel and citizens Confidentiality - Obligation not to reveal information obtained about a patient except to other HCP involved in the patient’s care May release information when: - Subpoena - Court of law - Patient signs a release of confidentiality CONDITIONS FOR A VALID REFUSAL Legally able –age or emancipation Mentally competent and oriented Fully informed Signed release form/waiver –liability issues Persuade Patients Persuade for their benefit - Spend time talking with the patient Legal Issues - Inform him/her of the consequences Libel–written form - Consult medical direction Slander–verbal form - Consult family members Information shared is false or injurious - Call law enforcement personnel Can occur even if shared information is true - Listen why the patient is refusing DNR ORDERS Do not resuscitate orders Advance directive Legal document Prevents unwanted resuscitation and awkward situation If family members request you to stop resuscitation and there is no DNR order –CONTINUE with care If family members ask you to ignore the DNR order and resuscitation be initiated –CONTACT medical control Special Situations –Crime Scene Evidences: - Condition of the scene –do mental or written notes - Patient - Fingerprints and footprints - Microscopic evidence –traces of blood,dirt, fibers Preserve evidence: - Remember what you touch - Use gloves - Remember what things/furniture you moved - Work with the police - Give statements objectively - Do not withhold information Minimize impact on the scene Legal Issues - Do not wander Duty to act - Move things/furniture as little as possible - Obligation to provide pre-hospital emergency care to a person. - Do not cut through holes in clothing