Emergency Medical Services

fractures, and dislocations Splinting Reductions with (and without) medications Special considerations: partial or complete amputations and neurovascular injuries Conclusion References CHAPTER 37: Ocular trauma Introduction Epidemiology Evaluation Specific eye injuries Summary References CHAPTER 38: Bites, stings, and envenomations Introduction Animal bites Animal‐specific concerns Transport Summary References CHAPTER 39: Field trauma triage Background History of the field triage decision schemes Accuracy of field triage Field triage decision scheme Pediatric concerns Conclusion References CHAPTER 40: Trauma‐stabilizing procedures Introduction Needle thoracostomy Tube and finger thoracostomy Pericardiocentesis Spinal motion restriction Application of cervical collar Application of a long spine board (backboard) Summary Acknowledgments References SECTION VI: Obstetrics and Gynecology Problems CHAPTER 41: Physiology of pregnancy Introduction General considerations Pregnancy Effects by System (Box 41.3) Summary References CHAPTER 42: Emergencies of pregnancy Introduction Evaluation and transport of the pregnant patient Miscarriage Ectopic pregnancy Placental abruption Placenta previa Hypertension during pregnancy Preeclampsia Eclampsia Conclusion Acknowledgment References CHAPTER 43: Normal childbirth Introduction Pregnancy Evaluation of the pregnant patient Labor and delivery Postdelivery: care of the neonate Challenges of prehospital deliveries Special considerations References CHAPTER 44: Childbirth emergencies General considerations and resource management Management of abnormal presentations Conclusion References CHAPTER 45: Perimortem cesarean section Background Potential benefits of perimortem C‐section Performance of perimortem C‐section in the field Indications for perimortem C‐section Education Procedure Ethical and legal considerations Conclusion References SECTION III: Toxicological Problems CHAPTER 46: Principles of toxicology Introduction Evaluation Toxidromes Treatment Special considerations Protocols Summary Acknowledgments References CHAPTER 47: Treatment and evaluation of specific toxins Introduction Specific agents Summary References SECTION VIII: Environmental Problems CHAPTER 48: Cold exposure illness and injury Introduction Accidental hypothermia Nonfreezing cold injuries of the foot Frostbite/Freezing Cold Injury Cold‐water immersion Conclusion References Additional References CHAPTER 49: Heat‐related illness Introduction Physiology of thermoregulation Pathophysiology Heat edema Heat syncope Heat tetany Heat cramps Heat exhaustion Heat stroke Cooling techniques Summary References CHAPTER 50: High‐altitude illnesses Introduction Physiology Acute mountain sickness High‐altitude cerebral edema High‐altitude pulmonary edema Portable hyperbaric chambers Considerations for the medical director Conclusion References CHAPTER 51: Effects of flight Introduction Aerodynamic forces Effects on humans Summary References CHAPTER 52: Diving injury Introduction Types of diving Overview of diving physics Diving injuries Conclusion Acknowledgment References SECTION IX: Special Populations CHAPTER 53: The special needs of children Epidemiology of prehospital pediatric care Evaluation of children References CHAPTER 54: Pediatric medical priorities Introduction Respiratory and airway problems Brief resolved unexplained events (BRUE) Seizures and seizure mimics Shock Cardiac arrest Medication dosing safety Summary References CHAPTER 55: Pediatric trauma priorities Introduction Anatomical/physiological considerations and resulting injury patterns Resuscitation and management priorities Summary References CHAPTER 56: Technology‐dependent children Introduction The caregiver as a resource and the emergency information sheet The technology Conclusion References CHAPTER 57: Approach to the geriatric patient Introduction Changes of normal aging Assessment of the geriatric patient Geriatric medical conditions Cardiac arrest Social emergencies Special considerations Nursing homes and assisted living facilities Public health Summary References SECTION X: Special Considerations Chapter 58: Behavioral health emergencies Introduction Evaluation of the problem Assessment and treatment The suicidal patient The agitated and violent patient Patient restraint Verbal de‐escalation Physical restraint Medication to treat agitation Benzodiazepines Butyrophenones Ketamine Excited delirium syndrome Other situations Controversies and common mistakes Summary Acknowledgment References CHAPTER 59: Bariatric patient challenges Introduction Airway Breathing Circulation Bariatric surgery Patient packaging and movement Summary References CHAPTER 60: Intimate partner violence Introduction Scope of the problem Risks and vulnerabilities Understanding IPV IPV as a health care issue EMS clinician safety Assessment and examination [R]espond Additional considerations for EMS personnel Summary Acknowledgment Recommended Resources: References CHAPTER 61: Sexual assault Background Transgender sexual assault Psychological care of the patient Physical care of the patient Culture and sexual assault Legal aspects Mandatory reporting Sexual assault nurse examiners and sexual assault response team programs Summary Acknowledgment References CHAPTER 62: Child maltreatment Introduction Role of the prehospital clinician Child maltreatment Medical conditions that may be confused with child abuse Sexual abuse Responding to intimate partner violence calls Medicolegal duties Summary References CHAPTER 63: Human Trafficking Introduction Definitions Myths The scope of the problem The traffickers and the victims Red flags and indicators Clinical practice: EMS patient evaluation and care System oversight/medical direction considerations Conclusion Acknowledgment References CHAPTER 64: Ethical challenges Introduction Refusal of treatment and transport Triage decisions Termination of resuscitation Confidentiality Truth‐telling and error disclosure Personal risk Training and research Treatment of minors Summary References CHAPTER 65: Death, dying, and end of life issues Introduction Ethical foundations of end of life care Background Culture, customs, and racial disparity Advance directives The Physician Orders for Life‐Sustaining Treatment Program (POLST) Do not resuscitate orders End of life resources and other considerations Care of the grieving survivors Considerations during a pandemic Summary Dedication References CHAPTER 66: Family and bystanders Introduction Family support in patient care Ethnicity and culture of EMS clinicians The future of EMS and the role of family Social isolation Bystanders Spontaneous volunteers and civilian‐led rescue Bystanders and physicians on the scene EMS and violent bystanders Summary References CHAPTER 67: Analgesia Introduction Oligoanalgesia Opioids Nitrous oxide Ketamine Nonsteroidal anti‐inflammatory drugs (NSAIDs) Acetaminophen Nonpharmacological interventions Assessment of pain Addressing common myths Summary References CHAPTER 68: Point‐of‐care testing in EMS Introduction Is POC right for EMS? Is this POC test right for my service ? Specific POC tests for consideration in the EMS setting Unique aspects of POC testing in mobile integrated health/community paramedicine Conclusion References CHAPTER 69: Ultrasound applications in the prehospital setting Introduction Why Prehospital Ultrasound? Settings of Field Use Indications Disaster and Mass Casualty Triage Military Role of Non‐Physicians/EMS Training Tele‐ultrasound Feasibility of Ultrasound in the Field Future Directions References Appendix: Chapter Mapping to the 2019 Core Content of EMS Medicine Glossary Index

3 Volume II Title Page Copyright Page Contributors Foreword Preface References About the Companion Site SECTION I: Principles of Oversight and Design CHAPTER 70: Medical oversight of EMS systems Introduction The evolution of the subspecialty of EMS State requirements for EMS medical direction Barriers to effective medical oversight of EMS Indirect medical oversight Direct medical oversight Direct patient care in the field Conclusion Acknowledgment References CHAPTER 71: Principles of EMS system design Introduction System Design Goals Services Vehicles Equipment and Supplies Delivery Settings Provider Organization Considerations Deployment Planning Performance Standards and Assurances Acknowledgments References CHAPTER 72: Emergency care regionalization Regionalization A case example The emergency medical care system Historical background Categorization and designation Federal efforts: Public Law 101‐590 Simultaneous processing Outcomes Diversion and bypass Payer and funding issues Future directions Conclusion References CHAPTER 73: Telemedicine and emerging telecommunications Introduction EMS telemedicine applications Conclusion References CHAPTER 74: Interfacility transportation Introduction Level of care Clinical indications for interfacility transportation Hazards associated with interfacility transportation Medical oversight of interfacility transport Legal considerations in interfacility transportation EMTALA Summary Acknowledgments References CHAPTER 75: Air medical services Introduction Background: History to Current System Design, Growth, and Costs Clinical Efficacy, Appropriateness, and Outcomes Safety, Quality, and Standards Integration and Regulations Regulation Operations Summary References SECTION II: Human Resources CHAPTER 76: EMS personnel Introduction Scope of practice The interdependent relationship between education, certification, licensure, and credentialing Regulating health care professions Summary: the synergy of three layers of public protection Acknowledgments References CHAPTER 77: Protection of EMS personnel from occupationally acquired infections Introduction Standards, laws, and regulations Blood‐borne pathogens Human immunodeficiency virus Airborne, droplet, and contact transmission of infection Recommended immunizations Reporting an exposure Summary Acknowledgment References CHAPTER 78: Medical surveillance of emergency response personnel Regulatory framework Overview Initial employment exam Baseline exam Annual or periodic examination On‐scene medical monitoring Exposure‐specific examination Termination or exit exam Summary References CHAPTER 79: EMS clinician wellness Introduction References CHAPTER 80: Occupational Injury Prevention and Management Introduction Occupational fatalities Occupational injuries Injury prevention Comparing studies References CHAPTER 81: Prevention and intervention for psychologically stressful events Introduction Emergence of occupational behavioral health as a fire and EMS priority Occupational health approach; organizational systems perspective Help seeking predilections vs. help delivery systems Building an integrated system The final fundamental: personal wellness and fitness Summary References CHAPTER 82: EMS practitioner education Introduction Theories of adult learning Language of learning Continuing education in EMS Conclusion References SECTION III: Legal and Legislation CHAPTER 83: Legal issues Introduction The legal framework of the physician/EMT relationship Sources of authority Sources of accountability Areas of liability Liability System concerns Summary Acknowledgments References CHAPTER 84: Legislation, regulation, and ordinance Introduction and brief history The role of legislation, regulation, and ordinance The language and structure of legislation, regulation, and ordinance Authorities established by states and examples of state‐specific language Federal legislation, regulation and policy affecting EMS The future of EMS legislation, regulation, and ordinance Summary Acknowledgment References CHAPTER 85: Due Process Introduction Law in the federal system Due process of law An opportunity to present reasons why the proposed action should not be taken Life, liberty, or property Impartiality of tribunal Notice Time for hearing Standard of proof Right to counsel Summary Acknowledgments References CHAPTER 86: Risk management Introduction Components of prehospital risk management Future directions–prehospital medical error Summary References CHAPTER 87: Politics and advocacy for the EMS physician Introduction Case Studies What is Advocacy? A History of EMS Advocacy Political Action Committees Navigating the Politics of Medical Direction Philosophy, Perspective, and Bias Preparing Yourself Principles of Action Sustaining the Drive Summary Acknowledgment References SECTION IV: Dispatch and Communications CHAPTER 88: Dispatch Introduction Emergency medical dispatch Use of L&S Anatomy of an EMD program Quality improvement Summary References CHAPTER 89: Ambulance safety Introduction Contributing Factors Recommendations Conclusions Acknowledgments References CHAPTER 90: Communications Introduction The context of EMS information communications technology System readiness/access/demand management Field clinician interaction and collaboration with medical direction A further note on telehealth/telemedicine The evolution of current‐day information communication system infrastructure and technical components VHF radio systems Evolving system infrastructure and components Resources for communications planning References SECTION V: Finance and Public Interfaces CHAPTER 91: Principles of finance Managerial accounting Productivity analysis Applying theory to real‐world decisions Conclusion References CHAPTER 92: State EMS Offices Introduction System leadership, organization, regulation, and policy Resource management–financial Resource management–human resources Resource management–transportation Resource management–facility and specialty care regionalization Public access and communications Public information, education, and prevention Clinical care, integration of care, and medical oversight Information, evaluation, and research Large‐scale event preparedness and response Conclusion References CHAPTER 93: EMS–public health interface Introduction Understanding public health Surveillance and databases Cardiac arrest: a public health emergency Mass vaccinations and paramedics Conclusion Acknowledgments References CHAPTER 94: EMS physicians as public spokespersons Introduction Perspectives and Caveats About Public Speaking The Challenges of Bite‐Speak Press Conferences Ten Golden Rules for Public Speakingor Dealing with Media Summary Acknowledgments References SECTION VI: Extraordinary Circumstances CHAPTER 95: Incident command system and National Incident Management System ICS standardization Summary Acknowledgments References CHAPTER 96: Medical management of mass gatherings Introduction Mass gathering types, definitions, and goals Mass gathering risk management Mass gathering event planning and operations Mass gathering personnel needs Mass gathering event training and drills Converting into MCI operations and postevent review Conclusion Acknowledgment References Chapter 97: Disaster preparedness and management Introduction Federal Framework for Disaster Management Catastrophic Events Health and Medical Resources Allocation of Scarce Resources Provider Credentialing Issues References CHAPTER 98: The federal medical response to disasters Introduction Overview of federal medical response to disasters National Response Framework Organization Base document Annexes ESF‐8: Public Health and Medical Services Select response components of ESF‐8 Legal authorities Disclaimer and Acknowledgment References CHAPTER 99: Prehospital triage for mass casualties Introduction Primary Triage Systems Primary Triage Categories SALT Triage START Triage The Evidence Base for Primary Triage Triage Tags Secondary Triage Tertiary Triage Population‐Based Triage Conclusion References CHAPTER 100: Mass casualty management Philosophy Mitigation and preparedness Response Recovery Special considerations Summary References CHAPTER 101: Mass casualty evacuation and patient movement Introduction Estimate Regional transportation Planning Execution Summary References CHAPTER 102: Temporary treatment facilities Introduction Type of event Planning and design of temporary treatment facilities Staff support Other considerations Summary References SECTION VII: Special Hazards CHAPTER 103: Medical support for hazardous materials response Introduction Developing standard operating procedures Identifying potential threats Medical response planning Personal Protective Equipment Accompanying accessories and attachments Responding to hazardous materials Decontamination Chemical removal techniques Medical monitoring of response personnel Conclusion References CHAPTER 5: Chemical properties of hazardous materials Introduction Types of Contamination General categories of hazardous materials Basic properties of hazardous materials General chemical properties of hazardous materials Identifying basic properties of hazardous materials Conclusion References CHAPTER 105: Radiological and nuclear response Radiation: definition and effects Normal radiation environment Radiation threats Types of ionizing radiation What radiation does

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