Emergency Medical Services

1 Cover

2 Volume I Volume I Title Page Copyright Page Contributors Foreword Preface References About the Companion Site CHAPTER 1: History of emergency medical services Before 1966: Historical Perspectives 1973–1978: Rapid Growth of EMS Systems 1978–1981: EMS at Midpassage 1996‐2008: The Role of the Federal Government Matures, the United States Faces Terrorism, and EMS is at the Breaking Point 2009–2020: A Period of Incremental Progress EMS Agenda 2050 Acknowledgment References SECTION I: Airway CHAPTER 2: EMS airway management: system considerations The skills of airway management:an illustrative vingnette Introduction Challenges of airway managementin the field Airway management protocol development and equipment selection Quality management Research References CHAPTER 3: Airway procedures Introduction Personal protective equipment during airway interventions Basic airway interventions Noninvasive positive‐pressure ventilation Surgical airways Confirmation of airway placement Methods for securing endotracheal tubes and supraglottic airways Drug‐facilitated intubation Conclusion References CHAPTER 4: Airway management: special situations Introduction Ground‐level airway management Face‐to‐face intubation Intubating under low light conditions Minimizing airway management equipment Telemedicine‐assisted airway management Airway management in the tactical setting Pandemic airway management Conclusion Acknowledgment References SECTION II: Breathing CHAPTER 5: Respiratory distress Introduction Prehospital assessment and diagnosis General treatment Summary References CHAPTER 6: Oxygenation and ventilation Introduction Assessment of Oxygenation Assessment of Ventilation Assisting Oxygenation and Ventilation Noninvasive Positive‐Pressure Support Bag‐Valve‐Mask Ventilation Mechanical Ventilation Summary References SECTION III: Circulation CHAPTER 7: Hypotension and Shock Introduction Pathophysiology Evaluation Additional Modalities to Assess Shock Treatment Shock Interventions Controversies Protocol Conclusion References CHAPTER 8: Vascular access Introduction Benefits Risks PERIPHERAL IV ACCESS Intraosseous Access Central intravenous access Special considerations Ultrasound‐guided IV access Conclusion References CHAPTER 9: Chest pain and acute coronary syndromes Introduction General approach Role of emergency medical dispatch The 12‐lead electrocardiogram Medications Prehospital fibrinolysis Systems of care for STEMI EMS transport Other common causes of chest discomfort Summary References CHAPTER 10: Cardiac dysrhythmias Introduction Evaluation Controversies Protocols Summary References CHAPTER 11: Cardiac procedures and managing technology Introduction Short‐term mechanical circulatory support devices Long‐term mechanical circulatory support devices Electrical cardiac support devices Pericardiocentesis Conclusion Acknowledgment References CHAPTER 12: Cardiac arrest systems of care Introduction Epidemiology of Cardiac Arrest Elements of a Community Cardiac Arrest Care System Role of the Medical Director Optimizing System Design Summary References CHAPTER 13: Cardiac arrest: clinical management Introduction Specific interventions Principles of management Post cardiac arrest care Summary References SECTION IV: Medical Problems CHAPTER 14: The challenge of the undifferentiated patient Introduction History Taking Physical Examination The truly Undifferentiated Patient Conclusion References CHAPTER 15: Altered mental status Introduction Assessing mental status Approach to the patient with AMS Presentations, etiologies, and treatments Conclusion References CHAPTER 16: Syncope Introduction Pathophysiology Assessment Differential diagnosis Treatment Disposition Summary References CHAPTER 17: Seizures Introduction Pathophysiology Differential diagnosis Classification of seizure types Symptomatic seizures Status epilepticus EMS evaluation and response Pharmacological interventions Seizure‐associated trauma Continuing management Refractory generalized convulsive status epilepticus Conclusion References CHAPTER 18: Stroke Introduction Emergency medical dispatch Prehospital care Definitive treatment options EMS transport Innovations in prehospital stroke management Disparities Summary Acknowledgments References CHAPTER 19: Abdominal pain Introduction Approach to the patient with abdominal pain Anatomy and physiology considerations History and physical examination Management Disposition Special populations Summary References CHAPTER 20: Diabetic emergencies Introduction Prehospital assessment Prehospital treatment Protocols Summary References CHAPTER 21: Allergic reactions Introduction Physiology of allergic reactions Causative agents Assessment and general approach Prehospital treatment Special considerations Conclusion References CHAPTER 22: Renal failure and dialysis Introduction A brief review Renal replacement therapy Renal transplant Complications of renal disease Complications of hemodialysis Complications of peritoneal dialysis Special considerations EMS pearls References CHAPTER 23: Infectious and communicable diseases Introduction EMS Clinician and Patient General Approach and Patient Assessment Specific Illnesses Biological Weapons Viral Hemorrhagic Fevers Conclusion References CHAPTER 24: Choking Introduction Pathophysiology and epidemiology Patient assessment Management Medical oversight considerations Controversies Summary References CHAPTER 25: Submersion injuries and drowning Introduction Epidemiology Pathophysiology of drowning Clinical management Grief reactions References SECTION V: Trauma Problems CHAPTER 26: Trauma systems of care Trauma system organization Trauma care facilities Communications Emergency response Medical oversight Data collection Emergency management Injury prevention Summary References CHAPTER 27: Blunt trauma considerations Introduction Effect on EMS Training for EMS clinicians Resuscitation and initial assessment Constellations of blunt traumatic injury Issues in specific patient populations Medical oversight issues in trauma Guidelines for out‐of‐hospital management Prevention and other public health issues References CHAPTER 28: Motor vehicle crashes Introduction Effect on EMS MVC injury biomechanics Safety restraints MVC types Crashes involving vulnerable road users EMS crash assessment priorities Unique MVC problems Emerging technology Available education References Chapter 29: Penetrating trauma Introduction Physics and mechanics of penetrating trauma Types of weapons High‐velocity projectile injury Resuscitation and initial assessment Transport issues Penetrating chest trauma Penetrating abdominal trauma Penetrating neck trauma Penetrating head and facial trauma Penetrating extremity trauma Prevention and public health issues Medicolegal issues Forensic issues Prehospital termination of resuscitation in penetrating trauma Summary References CHAPTER 30: Traumatic Brain Injury Introduction Primary assessment Secondary assessment Prehospital intubation Additional treatments Concussion and Sports‐Related Head Injuries Pediatrics Transportation and Destination Decisions Summary References CHAPTER 31: Electrical injuries Introduction Pathophysiology Evaluation and treatment Assessment and management Special circumstances Conclusion References CHAPTER 32: Blast injury Introduction Explosive devices Blast injury Prehospital resuscitation and treatment Medical oversight Improvised explosive devices and terrorist activity Community risk assessment Summary References CHAPTER 33: Thermal and chemical burns Introduction Pathophysiology Severity Depth Burn size Inhalation injury Specific training requirements Burn‐specific patient assessment and care Special considerations Guidelines for out‐of‐hospital management Prevention Conclusion References CHAPTER 34: Crush injury Definition and concepts Pathophysiology of crush injuries Management of crush injury Management of crush injury with suspected crush syndrome Transport destination considerations Conclusion Acknowledgment References CHAPTER 35: Hemorrhage control Introduction Assessment Diagnosis of hemorrhagic shock Treatment modalities Nonmedical personnel training Internal occlusion Advanced hemostatic agents Second generation: Combat Gauze Adjunctive therapy Prevention of hypothermia Transfusion Medications Antiplatelet and anticoagulation medications Summary References CHAPTER 36: Orthopedic injuries Introduction Anatomy,