21st Century Instructional Guide for Career Technical Education

Introduction to Medical Emergency Preparedness Health Science Education Cluster Medical Emergency Preparation Concentration

Title: Introduction to Medical Emergency Preparedness (0791)

Standard Introduction to Emergency Medical Systems Number: Students will demonstrate knowledge of the Emergency Medical System and the roles of EMS HSE.S.MEP.1 providers. Essential How does EMS fit into the overall healthcare system? Questions: (What changes in the healthcare system would be seen without the EMS?) Objectives: Students will Learning Plan & Notes to Instructor: Introduction to Emergency Medical Systems HSE.O.MEP.1.1 compare health care systems and components healthcare systems of the Emergency Medical Services (EMS)  home care systems.  physician’s offices  pre-hospital  hospital  rehabilitation centers  personal care homes  nursing homes components of the EMS system  regulation and policy  resources management  transportation  communication  education  medical oversight  trauma systems  evaluation  in-hospital care system

1 HSE.O.MEP.1.2 determine types of medical oversight that medical oversight affect the practice of EMS providers.  Medical Director  Medical Control o direct o indirect (standing orders and protocols) Note: First Responders are a designated agent of a medical director. HSE.O.MEP.1.3 distinguish lines of authority or chain of chain of command within EMS command within the Emergency Medical  First Responder Services system.  EMT-Basic  EMT-Intermediate  EMT-Paramedic  Medical Control  Local Medical Director  Regional Medical Director  State Medical Director HSE.O.MEP.1.4 differentiate roles and responsibilities of the roles of EMS providers EMS providers.  ensuring safety o yourself o patient o crew o bystanders  assessing patient for life threats  providing care based on assessment findings  assisting other EMS personnel responsibilities  guarding personal health and safety  maintaining composure  keeping a professional appearance  maintaining up-to-date knowledge and skills  maintaining current knowledge of EMS HSE.O.MEP.1.5 examine specific statutes and regulations Suggestions: review the West Virginia scope of within the state regarding the EMS system. practice for First Responders and for EMT-B; 2 review the West Virginia State protocols for EMS.

Standard Careers Number: Students will demonstrate knowledge of careers found within the Emergency Medical Services HSE.S.MEP.2 system. Essential Identify factors that influence the EMS system’s relationship with local hospitals and urgent care Questions: centers. Objectives: Students will Learning Plan & Notes to Instructor: Careers HSE.O.MEP.2.1 determine the career opportunities within the levels of training Emergency Medical Services system, including  First Responder duties and educational requirements of each  EMT-Basic career.  EMT-Intermediate  EMT-Paramedic  Emergency/Critical Care Nursing HSE.O.MEP.2.2 analyze the differences between certification, certification registration, and licensure.  has an educational/training program  meets standards established by a professional organization or government agency registration  required by some health occupations  regulatory body issues and exams  a current list (registry) is maintained of qualified personnel in a given health career licensure  government agency authorizes individuals to work in an occupation  must complete an approved educational program and pass a state board exam  standards must be met to maintain or renew license  certification and registration usually require continuing education and recertification every few years 3 Standard Disease Transmission and Prevention Number: Students will demonstrate knowledge and skills in principles of disease transmission and prevention. HSE.S.MEP.3 Essential In terms of infection control and disease transmission which is safer for the patient, home care or Questions: hospital care? Objectives: Students will Learning Plan & Notes to Instructor: Disease Transmission and Prevention HSE.O.MEP.3.1 differentiate the five main classes of classifications of microorganisms microorganisms.  virus  bacteria  fungal  parasites  rickettsiae HSE.O.MEP.3.2 examine the conditions necessary for microorganism transmission microorganisms to grow, recognizing the cycle  causative agent of microorganism transmission and prevention.  reservoir  portal of exit  mode of transmission  portal of entry  susceptible host Suggestion: review the underlying goal of breaking the chain as a means of prevention. prevention  PPE  immunizations  Standard Precautions  antisepsis/disinfection/sterilization conditions necessary for growth  susceptible host  warm  moist  dark

4  food source  aerobic vs. anaerobic HSE.O.MEP.3.3 apply principles of Standard Precautions. Standard Precautions  Occupational Safety and Health Administration (OSHA)  Bloodborne Pathogen Standards/regulations for health care facility employers  PPE  Needle stick Safety and Prevention Act/regulations for employers  Blood and body fluids o Bio-Hazard symbol o donning and removing gloves o cleaning spills o handling infectious waste HSE.O.MEP.3.4 demonstrate proper handwashing technique. demonstrate, practice, and perform handwashing with 100% accuracy Student Learning Activities: use Glitter Bug or Glo- Germ as a teaching resource; use HOSA Competitive Event(s) as a teaching/learning tool. Standard Body Mechanics and Safety Number: Students will demonstrate knowledge and skills in the use of body mechanics and environmental HSE.S.MEP.4 safety hazards. Essential What are the factors that must be considered when deciding to move a patient and can that action Questions: make their injury more severe? Objectives: Students will Learning Plan & Notes to Instructor: Body Mechanics and Safety HSE.O.MEP.4.1 articulate the meaning of terms related to body body mechanics mechanics, applying principles to safe transfer.  position your feet properly  use your legs to lift - not your back  keep the weight of the object close to your body  align shoulders, hips, and feet

5  reduce the height or distance you need to move the object HSE.O.MEP.4.2 determine safety precautions during precautions during patient transfers positioning and transferring patients.  height of the move  distance to move the patient  weight of the patient HSE.O.MEP.4.3 demonstrate common emergency and non- emergency moves emergency moves.  shirt drag  blanket drag  shoulder / forearm drag  piggyback carry  one-rescuer crutch  firefighter’s drag nonemergency moves  direct ground lift  extremity lift HSE.O.MEP.4.4 compare devices associated with moving a out of hospital devices for moving patients patient in the out-of-hospital environment.  wheeled stretcher  portable stretcher  scoop stretcher  basket stretcher  stair chair  backboards  vest-type immobilization device HSE.O.MEP.4.5 prioritize the components of scene size-up. components of scene size-up  personal safety  patient safety  bystander protection  mechanism of injury or nature of illness  determining the need and calling for additional resources HSE.O.MEP.4.6 analyze emergency scenarios, identifying identifying potential hazards potential hazards.  violence 6  weapons of any kind  signs of intoxication or drug use  fall dangers  fires  hazardous materials HSE.O.MEP.4.7 examine medical and nonmedical equipment equipment needed to respond to an emergency needed to respond to an emergency.  PPE  radios  patient care items  extrication equipment  safety equipment. HSE.O.MEP.4.8 determine phases through which all phases of response emergency medical services progress when  Plan responding to an out-of-hospital emergency.  Observe  React  Radio  Revaluate HSE.O.MEP.4.9 recognize steps to be taken by the rescuer at a MVC safety motor-vehicle collision scene before gaining  determine the type of MVC access to the victim/patient.  secure the scene to promote safety and access  traffic control  vehicle stabilization  gain access HSE.O.MEP.4.10 relate the role of the rescuer in extrication. role of rescuer  usually only concerned with patient care  should be first to have contact with patient  start assessment early  may have to assist in extrication if limited man power HSE.O.MEP.4.11 examine methods used to gain access to the gaining access victim/patient in various emergencies.  simple access - no tools needed o doors with no damage 7 o windows  complex access requires tools o heavy rescue equipment o saws o roll blocks o chains o hydraulic cutters HSE.O.MEP.4.12 examine the performance of the rescuer at the hazardous material situation scene of a hazardous material situation until  secure the scene appropriately trained personnel arrive.  stay away from contaminants  identify hazards – Hazardous Materials, The Emergency Response Handbook, U.S. Department of Transportation  establish command  notify hazardous materials team  setup response areas  do not treat patient for exposure until decontaminated Standard Legal Issues and Ethics Number: Students will demonstrate knowledge of legal responsibilities and ethics in the role of the Emergency HSE.S.MEP.5 Medical Services provider. Essential Discuss the statement “First Do No Harm” and whether or not it is a legal or ethical responsibility. Questions: Objectives: Students will Learning Plan & Notes to Instructor: Legal Issues and Ethics *(Refer to First Responder: National Standard Curriculum) HSE.O.MEP.5.1 differentiate between laws and ethics as laws related to emergency care.  legal limitation or expectation  defined by state law - their definition of right and wrong ethics  personal beliefs  our personal right and wrong definitions

8  includes maintaining competence as a practitioner and honesty in reporting HSE.O.MEP.5.2 determine scope of practice, standard of care, scope of practice and the precedent of duty to act in relationship  what a governing agency says you can do to the EMS provider.  legal responsibilities’ standard of care  the minimum care that any equally trained person would perform  what is the minimum expected care for a patient duty to act  when there is an obligation to provide care to a patient  differs from area to area Consider: Does an EMS provider always have a duty to act? HSE.O.MEP.5.3 examine advance directives and their advanced directives application to EMS.  living will  medical powers of attorney  Do Not Resuscitate (DNR)  advanced directives do not mean do not treat  treat all patients with the highest level of care available  if you do not know the patients wishes about advanced directives, treat as if there were no advanced directives HSE.O.MEP.5.4 differentiate between implied and expressed implied consent consent.  assume that any unresponsive person would want life-saving interventions  used for any person that can not make decisions for themselves o unconscious o drug use o alcohol 9 o altered mental status o children o mentally challenged  needs documentation stating why they are unable to make decisions expressed consent  patient verbally gives consent for treatment- must be competent and of age  patient is informed of procedures, all risks, benefits, and alternatives  must be obtained from every responsive, mentally competent adult prior to providing care  needs signature of the patient HSE.O.MEP.5.5 relate method for obtaining consent. methods for obtaining consent  identify yourself and talk with the patient. inform them of your level of training  explain procedures and inform them of worst possibilities  using family members to talk to the patient  law enforcement  medical control  patient’s own physician HSE.O.MEP.5.6 examine implications surrounding patient refusal of care refusal of care.  legal implication – they have the right to refuse care  death of the patient is a possibility  abandonment  informed of all risks to refusing treatment  First Responder must ensure that additional EMS resources will evaluate the patient  patient signature of understanding HSE.O.MEP.5.7 differentiate abandonment, negligence, abandonment battery, and confidentiality. 10  leaving a patient unattended  turning care over to someone not of equal or higher training negligence  failure to act  injury resulting from action or inaction  reach of duty to act battery  laying hands on a person without their permission  performing a procedure on a patient without permission  causing injury to another person confidentiality  keeping patient information private  passing patient information only to other healthcare personnel with a need to know HSE.O.MEP.5.8 articulate conditions that require notification of required notification of law enforcement law enforcement officials.  neglect  child abuse  geriatric abuse  any illegal activity HSE.O.MEP.5.9 relate actions taken to assist in the preservation of a crime scene preservation of a crime scene.  minimal contact with the scene  one person in to assess the patient  minimal amount of personnel needed to move the patient  touch nothing but the patient  if something needs moved, document where it was moved from and where it was moved to  document everything that you see and do on scene HSE.O.MEP.5.10 characterize signs and symptoms of child child abuse and neglect signs abuse and neglect. 11  500,000 to 4 million cases annually  multiple bruises in various stages of healing  injuries not consistent with mechanism of injury  patterns of injures suggest abuse  burns not consistent with history  repeated calls to same address  caregivers seem inappropriately unconcerned  conflicting stories  child seems afraid to discuss injuries  possible head injuries with no outward signs HSE.O.MEP.5.11 examine the medical-legal responsibility in responsibilities in suspected child abuse suspected child abuse.  remove the child from the abuser as safely as possible  notify law enforcement  never confront the abuser  notify receiving hospital of your suspicions  document your suspicions  keep the child safe HSE.O.MEP.5.12 determine basic components of components of documentation documentation.  chief complaint  history  assessment  treatment  reassessment  medical control  disposition HSE.O.MEP.5.13 interpret, pronounce and spell common terms Suggestion: refer to terminology lists for all related to legal responsibilities and ethics in chapters. emergency care. Standard Medical and Trauma Assessment Number: Students will demonstrate knowledge and skills in medical and traumatic assessments. HSE.S.MEP.6

12 Essential Discuss the rationale for forming a general impression of the patient including the reasoning for Questions: prioritizing a patient for car and ambulance transport. Objectives: Students will Learning Plan & Notes to Instructor: Medical and Trauma Assessment *(Refer to First Responder: National Standard Curriculum) HSE.O.MEP.6.1 measure and record vital signs for the adult, adult child, and infant.  pulse 60-100 bpm  respirations 12-20 rpm  B/P 100 -140 systolic 120/80  pain 0-10  temp 98.6  SpO2 94-100% child (age dependent)  pulse 100-140  respirations 20-40  B/P systolic 90+ (age x 2)  temp 98.6  SpO2 90-100% infant  pulse 130-160  respirations 30-60  B/P systolic 90 + (age x 2)  temp 98.6  Spo2 90-100% HSE.O.MEP.6.2 differentiate between a sign and a symptom. signs  objective  anything that can be seen during the assessment  can differ from patient to patient symptoms  subjective  any complaint that the patient has made  will differ from patient to patient

13  should be recorded in the patient/victim’s own words HSE.O.MEP.6.3 relate the reasons for forming a general general impression impression of the patient.  differentiate between medical and traumatic problems  beginning step of forming a plan of action  factor in deciding if advanced care is needed sooner  determine a starting diagnosis HSE.O.MEP.6.4 differentiate between common mechanisms of mechanisms of injury injury or nature of illness.  outside sources of injury-trauma  MVC  falls  GSW  penetrating trauma  blast injuries nature of illness  internal disease process  illness with no seen outside influence  colds  flu  cardiac problems  respiratory problems  ECT HSE.O.MEP.6.5 differentiate between medical and traumatic medical assessment assessment.  in-depth assessment  more thorough assessment  history plays a larger role in diagnoses  will change slightly with the underlining illness traumatic assessment  rapid assessment  used to find life-threatening problems  stabilization of the patient’s ABCD are priority

14  can be done as a focused assessment, if only non-life-threatening injuries are involved HSE.O.MEP.6.6 demonstrate questioning of patient/family/ SAMPLE history bystander to obtain a SAMPLE history.  S – signs and symptoms  A - allergies  M – medications  P - past medical history / pain  L – last oral intake  E – events leading up to the episode HSE.O.MEP.6.7 determine components of the initial initial assessment assessment of the adult, child, and infant.  little difference between adult, child, and infant  level of consciousness has to be assessed differently depending on age  airway, breathing, and circulation still primary concerns  need to use parents more with children and infants  remember to always speak to children when treating them  parents will help in controlling infant and young children for assessment HSE.O.MEP.6.8 differentiate between the assessment of mental status mental status in the adult, child, and infant. adult  AVPU (Alert Verbal Painful Unresponsive)  A alert: the patient has eyes open and talks to you.  V verbal: the patient opens eyes to respond to voice, may or may not talk to you.  P pain: the patient opens eyes or moves to painful stimulation.  U unconscious to any stimuli children  AVPU  response to pain and fear 15  reaction to parents  consolable  age appropriate response infants  alert or lethargic  moving or limp  age appropriate response to stimulation  consolable HSE.O.MEP.6.9 demonstrate techniques for assessing airway breathing/airway and circulation in the adult, adult, child child, and infant.  head-tilt chin-lift  jaw-thrust infant  head-tilt into a sniffing position  avoid hyperextension  tongue-primary cause of airway obstruction breathing  look, listen, and feel  chest rise and fall counts as one breath  number of breaths in 30 sec X 2  rate will differ depending on age  only enough air to raise the chest  volume control will reduce complications  infants have a higher likelihood of respiratory complications circulation  check at the neck (carotid) and wrist (radial) for adults and large children  under the arm (brachial) for small children and infants  rate will differ with age  child and infant rate should never be lower than 60 bpm

16  child and infant pulse rate at 60 or lower -CPR should be started  heart rate should not exceed 220 bpm regardless of age in any patient HSE.O.MEP.6.10 examine the components of the physical exam physical exam for the adult, child, and infant.  will differ with the age of the patient  will need to involve parents for children and infants  fear will have to be dealt with in children and infants  children and infants are unable to voice concerns and pain well  exam should be performed head-to-toe if possible  focuses on only life-threatening injuries at first  if no life-threatening injuries- do a focused exam on areas with pain or problems HSE.O.MEP.6.11 articulate the components of the on-going on-going assessment assessment.  repeat initial assessment  repeat general impression  repeat transport directions  repeat need for advanced care  repeat physical exam  focus on problem areas  update receiving facility about patient Standard Emergency Medical Care Number: Students will demonstrate knowledge and skills in performing basic emergency medical care. HSE.S.MEP.7 Essential Discuss the concept of consent including the legal implications of delivering care to a minor or an Questions: unconscious victim. Objectives: Students will Learning Plan & Notes to Instructor: Emergency Medical Care *(Refer to First Responder: National Standard Curriculum)

17 HSE.O.MEP.7.1 distinguish basic structure and functions of structure and functions of body systems body systems relating to emergency care. musculoskeletal system  support  movement  protection  two divisions of the skeletal system o axial o appendicular respiratory system  oxygen and carbon-dioxide exchange  waste removal  temperature control  ventilation consists of inhalation and exhalation  muscles of the rib cage and diaphragm  controlled by autonomic nervous system circulatory system  movement of oxygen and carbon-dioxide throughout the body  remove waste from the cells  provide nutrients to the cells  provide building materials for repair and growth  consists of heart, blood vessels, and blood  will have one of three problems - pump, container, or volume nervous system  composed of brain, spinal cord, and nerves  coordinates responses to stimuli  2 divisions o central nervous system o peripheral nervous system  voluntary components

18 o under conscious control o movement  involuntary components o controls involuntary and cardiac muscles o functions without voluntary control o lower brain functions skin (integumentary system)  largest organ  protects from injury and infection  maintains hydration  regulates body temperature  receptor for external stimuli  three main layers o epidermis (dead tissue) o dermis (living tissue) o subcutaneous (fatty tissue) digestive system  composed of alimentary tract and accessory organs  digestion actions o mechanical o chemical urinary system  maintains balance of chemicals and water  removes waste  composed of o kidneys o ureters o urinary bladder o urethra  urethra, shorter in females therefore prone to infection 19 endocrine system  secretes hormones into bloodstream  composed of glands- o hypothalamus o pituitary gland o thyroid o parathyroids o adrenal glands o pineal body o reproductive glands (which include the ovaries and testes)  regulates body functions reproductive system male  testes  ducts  accessory glands  penis  mainly external  unprotected female  ovaries  fallopian tubes  uterus  vagina  external genitals  mainly internal  protected by pelvis HSE.O.MEP.7.2 relate the general principles of first aid. general principles of first aid  preserve life  immediate care for life-threatening injuries  provide basic care for patients/victims until more advanced care is available 20  bleeding control  airway control  splinting  basic medical care for illness HSE.O.MEP.7.3 articulate routine precautions to be used in precautions for use of oxygen oxygen therapy.  oxygen should never be withheld from a patient who needs it  there is no absolute reason not to administer oxygen, but use caution  emphysema  chronic obstructive pulmonary disease (COPD)  infants  environmental considerations HSE.O.MEP.7.4 determine signs, symptoms, and treatment for shock signs and symptoms shock.  the body will sacrifice everything to save the brain, heart, and lungs ( the big 3 organs)  serious bleeding o 1 liter in an adult o .5 liters in a child o 100-200cc in an infant  state of hypoperfusion o inadequate delivery of oxygen and nutrients to cells  causes o failure of the heart (pump problem) o abnormal dilation of the blood vessels (container problem) o blood volume loss ( volume problem) (hole in the container)  compensated o maintains normal function o pale skin

21 o slightly rapid heart rate o normal blood pressure o anxiety o delayed capillary refill (unreliable)  decompensated o body can no longer compensate for hypoperfusion o blood shunted to keep vital organs perfused o mental status changes o increased heart rate o decreased blood pressure (late sign) o cool, moist skin that is pale, gray, cyanotic, or mottled  irreversible o cellular death o blood further shunted to brain and heart o unable to maintain blood pressure o blood pooling o extremely low blood pressure o very rapid heart rate o vital organ damage is permanent HSE.O.MEP.7.5 examine the signs and treatment for internal treatment for internal bleeding and external bleeding.  maintain open airway and adequate breathing  control external bleeding  keep warm  treat for shock  comfort the patient  treat external injuries external bleeding  types of bleeding o arteries o veins 22 o capillaries HSE.O.MEP.7.6 determine first aid treatment for wounds and All external wounds receive the same basic care (will the terms associated with each. have to be modified for the location of the wound)  direct pressure  elevate the extremity  apply more dressing  pressure points  support the patient’s needs  splints to prevent movement of fractures  tourniquets o last resort when other methods fail o can result in loss of the extremity HSE.O.MEP.7.7 differentiate first aid measures for sudden sudden illness and injury illness and injury (i.e. fainting, stroke, seizures,  fainting insulin shock, and diabetic coma). o lay patient flat o elevate legs 12” o if no improvement, call EMS  stroke o place patient in a position of comfort o call EMS immediately o record the time symptoms start o maintain airway and breathing  seizures o do not try to restrain the patient o remove anything the patient might hit during the seizure o maintain airway (may require placing patient on side to remove secretions) o if seizure lasts more than 2 min, call EMS o no history of seizures, call EMS o if victim is pregnant, call EMS o after seizure -supportive care as 23 needed  insulin shock (hypoglycemia) o patient will display different symptoms depending on the severity of hypoglycemia o if patient has a history of diabetes, feed patient food high in sugar until patient responds normally o if patient unable to swallow, call EMS immediately  diabetic coma (hyperglycemia) o if able, have patient drink water o support patient as needed o call EMS as soon as possible o if patient has insulin, help them retrieve it o help with insulin administration per local laws HSE.O.MEP.7.8 demonstrate first aid measures for bone and bone and joint injuries joint injuries (i.e. fracture, dislocation, sprain,  all bone and joint injuries need to be stabilized and strain). in position found, as long as blood and neuro checks are normal  if decrease in blood flow or sensation, rescuer may have to reposition the patient one time to see if there is any improvement  all injuries should be treated as a fracture until diagnosed by a physician with x-rays  apply cold to the area  control of bleeding as needed  check PMS (Pulse Motor Sensory) pre and post splinting HSE.O.MEP.7.9 recognize first aid measures used for specific first aid measures injuries involving the eyes, head, nose, ears, eyes chest, abdomen, and genital organs.  any object sticking into the eye should not re 24 removed for any reason  any eye exposure should be irrigated with large amounts of water, for no less than 15 min  injured eye should be covered till seen by physician  if object is in the eye, both eyes should be covered head  head wounds bleed profusely regardless of the size  have potential for large amounts of blood loss  not normally life-threatening  impaled objects should not be removed, unless they interfere with airway or breathing ears  impaled objects should not be removed  bleeding and fluid from ears can be signs of underlying injuries to the skull chest  impaled objects should not be removed, unless they interfere with chest compression, then only as a last resort  rib fractures need to be splinted to help breathing  open wounds should be coved with an occlusive dressing as soon as possible abdomen  impaled objects should not be removed  evisceration (bowel open to the air) should not be replaced back in the abdomen  treat for shock  position of comfort  high possibility for major internal injury 25 genital organs  injuries to the genitals are usually non-life- threatening  control bleeding  if crime scene, try not to disturb unless necessary  protect the patient’s privacy as much as possible HSE.O.MEP.7.10 characterize signs and symptoms of potential spinal injury spinal injury.  can occur in any part of the spine  worse injuries are higher up the spine  signs and symptoms o numbness o weakness o tingling in the extremities o loss of sensation o paralysis in extremities o incontinence o priapism HSE.O.MEP.7.11 demonstrate first aid measures for temperature temperature related injuries, including hot and cold hot exposure and burns.  watch for signs of heat stroke  cool patient- carefully lower temperature back to normal  use cold packs and wet wash cloths on major pulse points and on the back of the neck  try to keep core temp around 98.6-100 cold  remove the patient from area of cold to room temperature  care needs to be taken when moving a cold patient because of the increased chance of cardiac arrest

26  slowly re-warm the patient to 96-98.6  do not rub the patient or any area of the body that may be frozen  use warm air and warm blankets burns treatment will depend on the type and amount of area burned Note: All critical burns need to be sent to a burn center for treatment. first degree  only the first layer of skin involved  redness of the skin in the burn area  painful to the touch  cool and cover with moist dressing if less than 30% of BSA, dry dressing if more than 30% BSA  more than 30% of body surface area is critical burn  critical burn – rescuer must watch for signs of hypothermia second degree  involves the dermal layer of skin  redness and blisters to the skin  extremely painful to touch  blisters will fill with fluid (do not rupture)  cool burn area  area may be covered with moist dressing if less than 20% BSA, dry dressings if more than 20% BSA  more than 20% BSA is a critical burn  critical burn watch for signs of hypothermia third degree  burn involves all skin layers and may involve muscles 27  skin will be black or brown (leather-like) at the burn  around the burn skin will be red (will show signs of 1st and 2nd degree burns)  no pain at burn site, painful around the burn  skin may contract if circumvental  stop burn  apply a dry dressing only  10% BSA is a critical burn  high likelihood of hypothermia, hypotension  will need ALS intervention ASAP facial burns  possible respiratory involvement  soot in sputum  smell of smoke on breath  hoarseness  cough  difficulty breathing  respiratory distress HSE.O.MEP.7.12 determine first aid measures for poisoning, poisoning stings, bites, and allergic reactions.  identify the poison  call poison control stings  identify the animal  remove stinger (scrape, don’t pull)  treat reaction bites  identify the animal  treat wounds  bleeding control  clean wound thoroughly allergic reactions  identify the source

28  treat respiratory problems  maintain airway  call EMS  if patient has an EPI pen, help them to administer  document time and reaction to EPI HSE.O.MEP.7.13 relate first aid measures for victims of electric electric shock shock.  turn off electricity, if possible to do in a safe manner  remove patient from area once the scene is secured  CPR as needed  treat outside burns  remove any burned clothing  EMS transport, as soon as safe HSE.O.MEP.7.14 recognize signs and symptoms of an intoxication/drug abuse/drug overdose intoxicated/drug abuse/drug overdose patient.  confusion  change in behavior  may be combative  unresponsive  blood shot eyes  nervousness  violence  shaking  fear HSE.O.MEP.7.15 determine first aid measures for victims of drug treatment for drug and alcohol abuse and alcohol abuse.  calm the patient  law enforcement as needed  find out what was taken and how much  contact medical command  ALS intercept  airway control  suction 29  breathing control  CPR  may require more personnel to treat the patient  safety first  restraints used as a last resort Standard CPR and First Aid for Obstructed Airway Number: Students will perform cardiopulmonary resuscitation (CPR) and first aid for Foreign Body Airway HSE.S.MEP.8 Obstruction (FBAO). Essential Discuss compression only CPR and when its use is appropriate. Questions: (How has the performance of CPR, from past to present, impacted emergency care?) Objectives: Students will Learning Plan & Notes to Instructor: CPR and First Aid for Obstructed Airway *(Refer to First Responder: National Standard Curriculum) HSE.O.MEP.8.1 examine links in the adult and pediatric Chain adult chain of survival of Survival.  early access  early CPR  early defibrillation  early advanced care pediatric chain of survival  prevention of arrest  early and effective bystander CPR  rapid activation of the EMS system  early and effective advanced life support HSE.O.MEP.8.2 compare clinical and biological death. clinical death  from the last breath, 2-5min  cells still have activity  high possibility of resuscitation  little to no damage to body systems biological death  from last breath, 5-10 min  cells stop functioning  death of cells at a high rate

30  lower possibility of resuscitation  damage to body systems irreversible death  from last breath, after 10 min  all cellular functions stop  almost no chance of resuscitation  permanent injury to body systems HSE.O.MEP.8.3 articulate the meaning of cardiopulmonary cardiopulmonary resuscitation resuscitation.  providing artificial circulation and respiration  purpose – to keep blood flowing to critical areas (major organs) of the body until the heart can restart HSE.O.MEP.8.4 Examine the acronym, ABCD, in regards to ABCD CPR.  airway  breathing  circulation  defibrillation HSE.O.MEP.8.5 analyze risk factors for cardiovascular disease. risk factors  sex – males have increased risk  age  heredity  activity (smoking, lack of exercise/ activity)  food intake (high fat diet)  previous injury  obesity  high blood pressure HSE.O.MEP.8.6 determine signs and symptoms of a heart heart attack signs and symptoms attack.  chest pain (angina)  pain radiating form the chest to other parts of the body  denial  weakness  sweating 31  nausea  vomiting  shortness of breath  chest pain not relived by rest or nitroglycerin  feeling of doom or death HSE.O.MEP.8.7 examine cardiac arrest. cardiac arrest  failure of the circulatory system  heart muscles die due to lack of oxygen  vital organs do not get enough oxygen  heart stops working (electrically or mechanically) HSE.O.MEP.8.8 articulate signs and symptoms of a stroke. stroke signs and symptoms  numbness  weakness of any body part  confusion  trouble speaking or understanding  trouble seeing  trouble walking  dizziness  loss of balance or coordination  headache with no known cause  may be mistaken for low blood sugar HSE.O.MEP.8.9 analyze the impact of early intervention on the early intervention for stroke prognosis of stroke victims.  greater likely hood of positive outcome  able to reverse about 80% of damage if treatment started within 3 hours of onset  patients have a higher chance of returning to normal life HSE.O.MEP.8.10 demonstrate CPR, one-rescuer and two- Pass the skills assessment per AHA for one and two rescuer, for all ages (i.e. infant, child, and rescuer infant, child, adult CPR with no critical errors adult). and 85% of possible points HSE.O.MEP.8.11 demonstrate the correct use of an Automated Use an AED during two-rescuer CPR with no critical External Defibrillator (AED). errors, and 85% of possible points; no more than 30

32 seconds between arrival of AED and first shock; after shock CPR should resume within 10 sec. HSE.O.MEP.8.12 determine the modifications of CPR for a drowning CPR drowning or near drowning victim.  C-spine stabilization  move patient to a safe area to perform compressions  dry patient before the use of an AED, then use it in a dry area  suction any water in the airway HSE.O.MEP.8.13 recognize the signs and symptoms of an signs and symptoms of an obstructed airway obstructed airway.  poor or no air exchange  weak, ineffective cough or no cough  high-pitched noises while inhaling or no noise at all  possible cyanosis  increased respiratory difficulty  unable to speak  clutching the neck with thumb and fingers  unable to move air  wheezing HSE.O.MEP.8.14 demonstrate the Universal Distress Signal for Note: illustrate the universal distress signal for obstructed airway. obstructed airway (clutching the neck with thumb and fingers). HSE.O.MEP.8.15 demonstrate procedures to relieve airway Note: illustrate proper abdominal thrusts for adult ( 2 obstruction in an infant, child, and adult. hands), child (1 hand), and infant ( back blows and chest thrusts). HSE.O.MEP.8.16 examine devices used to relieve airway devices obstruction.  suction  tongue depressor  Magill forceps  laryngoscope HSE.O.MEP.8.17 determine the sequence of actions after relief after relief of choking.  stay with patient

33  place in position of comfort  watch for return of airway obstruction  auction as needed  follow up with advanced care HSE.O.MEP.8.18 analyze the use of Cricoid pressure or Sellick’s Cricoid pressure or Sellick’s technique technique.  used if third rescuer present  deceases gastric distention  use to assess with advanced airway control HSE.O.MEP.8.19 demonstrate the procedure for opening the Note: illustrate two ways to perform a modified jaw airway of a suspected head, neck or spine thrust and use of airway adjuncts. injured victim/patient. HSE.O.MEP.8.20 characterize agonal gasps. agonal gasps  uncontrolled muscle contractions  possible ineffective respirations  needs to have external assistance Standard Emotional Aspects of Emergency Care Number: Students will identify emotional aspects of the victim, victim’s family, and the care provider, associated HSE.S.MEP.9 with emergency care. Essential Discuss the necessity of a follow up (post conference) with health care providers after an unsuccessful Questions: resuscitation experience. Objectives: Students will Learning Plan & Notes to Instructor: Emotional Aspects of Emergency Care *(Refer to First Responder: National Standard Curriculum) HSE.O.MEP.9.1 analyze possible emotional reactions the emotional reactions of the rescuer rescuer may experience when faced with  victims will have different reactions to each trauma, illness, and death and dying. situation  having and showing emotion is part of caring for others  rescuer must control their emotions during care of the patient and family  emotional reactions can vary and change quickly HSE.O.MEP.9.2 examine the possible emotional reactions the emotional reactions of family members family member may exhibit when confronted  denial 34 with death and dying.  anger (directed toward other family members or providers)  depression  fear HSE.O.MEP.9.3 assess the rescuer’s approach to the family approaching the family with a dying or dead family confronted with death and dying. member  show concern for the family and patient  explain what you are doing and why  ask if there is anything you can do for them or if there is anyone they want you to call  provide comfort to the family as they need it  do not try to interject your feelings onto the family  beware of possible anger and danger from family HSE.O.MEP.9.4 determine the signs and symptoms of critical critical incident stress incident stress.  an accumulation of stress for one or multiple events signs and symptoms  will differ from person to person  lack of focus on the job  loss of care about their job  depression  increase in alcohol or drug use  distance from family and co-workers HSE.O.MEP.9.5 relate methods used by the rescuer to help reduction and alleviation of stress reduce/alleviate stress.  exercise – increases release of endorphins  counseling – with professional or talk with family  participate in relaxation exercises like Yoga, TaiChi  time off of work  change in job responsibilities- delegate

35 whenever possible  maintain strong work relationships  hobbies  keep your sense of humor Standard Emergency Preparedness and Disaster Planning Number: Students will demonstrate knowledge and skills in emergency preparedness and disaster planning. HSE.S.HCF.10 Essential Discuss how the terroristic events in the United States of America have affected EMS response and Questions: care. Objectives: Students will Learning Plan & Notes to Instructor: Emergency Preparedness and Disaster Planning HSE.O.MEP.10.1 examine the meaning of disaster. disaster  an event that utilizes multiple agencies  taxes or over loads an areas resources  usually a big event but not always HSE.O.MEP.10.2 differentiate types of potential disasters. types of potential disasters  weather  chemical  fire  radiation  biological HSE.O.MEP.10.3 recognize the importance of personal and importance of personal and community disaster community disaster planning. planning  how will the area respond  utilize available resources to the best of their abilities  maintain the rescuer’s personal safety during response to decrease the number of potential injuries HSE.O.MEP.10.4 determine elements of a personal or elements of disaster planning community disaster plan.  preplanning  execution  evaluation 36  changing  re-planning HSE.O.MEP.10.5 relate items essential in an emergency kit. items essential to an emergency kit  water (72 hr per person)  food (72 hr per person)  flashlight with extra batters  radio with extra batteries  money  important documents (copies)  clothing (five per person)  water proof containers  knife and tools  lighter and matches HSE.O.MEP.10.6 prioritize the components of basic triage. component of basic triage  access to patients  triage assessment o green (mild injuries, walking wounded) o yellow (moderate injuries, unable to move) o red (critical injuries, unable to move) o black (dead)  movement to treatment area  treatment area  transportation to hospital  morgue HSE.O.MEP.10.7 articulate the criteria for Multiple-Casualty criteria for Multiple – Casualty incidents Incidents (MCI).  any incident that taxes or exceeds local resources  can be as few as two critical patients  can be multiple patients that extends over an area HSE.O.MEP.10.8 compare the Incident Management System Incident Management System (IMS) to the normal EMS operation.  one overall command post and person 37  overall command person is responsible for all aspects of the MCI  each section will have a command person that reports to the overall commander  sections will have multiple people to assess patient needs HSE.O.MEP.10.9 prepare a plan to perform triage in a given plan for triage in a mass-casualty incident mass-casualty incident.  quick count of number of patients  personnel needs  equipment needed  extrication plan  transport to treatment area HSE.O.MEP.10.10 examine the meaning of bio-terrorism. bio-terrorism  use of biological agents in war or terrorist acts  can be any infectious agent  most have a relatively slow incubation period HSE.O.MEP.10.11 research the history of bio-terrorism. history of bio-terrorism  from the earliest wars, some form of bio- terrorism has been used  first recorded incident was in the 6th century B.C.  incidents have continued into recent times HSE.O.MEP.10.12 differentiate biological and chemical agents. agents biological: a living organism that occurs in nature altered for use in war chemical: made in a lab, non-living, usually have a use outside of war HSE.O.MEP.10.13 characterize four common types of biological common types of biological agents agents used in terrorism and as weapons of  bacteria mass destruction.  viruses  fungi  plague HSE.O.MEP.10.14 relate steps to be taken during a biological biological exposure emergency. 38  limit your exposure time  limit contact with others  quarantine  medical care  supportive care HSE.O.MEP.10.15 examine five classifications of chemical agents chemical agents used in terrorism and as weapons of mass  nerve agents destruction.  blister agents  blood agents  choking agents  irritating agents HSE.O.MEP.10.16 analyze possible signs of a chemical attack. review S.L.U.D.G.E., mnemonic device  salivation  lacrimation  urination  defecation  gastro-intestinal distress  emesis HSE.O.MEP.10.17 prioritize actions to be taken following a review LACES, mneumonic device chemical attack.  lookout  awareness  communications  escape routes  safety zones HSE.O.EMP.10.18 differentiate two types of potential nuclear types of nuclear incidents incidents.  thermonuclear reaction  dirty bomb HSE.O.MEP.10.19 characterize three main types of radioactive radioactive particles particles released in a nuclear incident.  Alpha rays  Beta rays  Gamma rays (most dangerous) HSE.O.MEP.10.20 determine the procedure for avoiding radiation avoiding radiation after a nuclear incident.  time of exposure 39  shielding  distance  amount of radioactive material HSE.O.MEP.10.21 articulate the decontamination process. decontamination process  done by local hazmat team  done in multiple steps o hot zone o warm zone o cold zone HSE.O.MEP.10.22 determine steps to be taken in the event of steps to be taken in event of entrapment entrapment, as a result of an explosion or fire.  personal safety first  stay low  look for escape routes  find ways to help rescuers HSE.O.MEP.10.23 assess the FEMA guidelines for use after Note: See FEMA guidelines on the FEMA web-site. natural disasters. HSE.O.MEP.10.24 participate in a community disaster readiness Note: work with local EMS and fire agencies for the program. community and school response to Critical Incidents.

Standard Childbirth Emergencies Number: Students will demonstrate knowledge and skills in emergency childbirth. HSE.S.MEP.11 Essential Discuss reasons for delaying transport of an expectant mother. Questions: Objectives: Students will Learning Plan & Notes to Instructor: Childbirth Emergencies HSE.O.MEP.11.1 examine the structure and functions of the Suggestion: review the anatomy and physiology of female reproductive system. the reproductive system HSE.O.MEP.11.2 determine the meaning of common medical Suggestion: review medical terms from the text and terms associated with labor and delivery. describe how they relate to anatomical placement. HSE.O.MEP.11.3 examine indications of an imminent delivery. imminent delivery  contractions 5 min or less apart  rupture of the amniotic sac  feeling of need to move bowels 40  increasing vaginal pressure  crowning  feel the need to push HSE.O.MEP.11.4 recognize steps in the pre-delivery preparation steps in pre-delivery preparation of the mother.  history (if time)  assessment (versus examination)  prepare delivery area  get OB (obstetrics) kit HSE.O.MEP.11.5 relate steps of the delivery process. delivery process  Stage One o fetal head moves down into the pelvis o mucus and bloody show appear o uterine contractions become regular o cervix starts to dilate o can last hours  Stage Two o cervix completely dilated o crowning starts o infant begins movement through the birth canal o continues till complete birth of the infant o usually takes 30 min or less  Stage Three o starts with the birth of the infant o lasts till the delivery of the after-birth o usually takes 30 min or less HSE.O.MEP.11.6 analyze possible complications before, during complications and after delivery.  prolapsed umbilical cord  breech presentation  meconium  multiple gestation  premature delivery  placental abruption 41  placenta previa  toxemia of pregnancy o pre-eclampsia o eclampsia HSE.O.MEP.11.7 determine care of the baby during the delivery care of the baby during and after delivery process.  suction airway  support as needed  stimulation of infant HSE.O.MEP.11.8 articulate steps in the delivery of the afterbirth. delivery of the afterbirth  apply light tension to the umbilical cord  light pressure on the abdomen with each contraction to help deliver the after birth  place sanitary pad on the patient  watch for severe bleeding HSE.O.MEP.11.9 examine steps in the emergency medical care emergency care post-delivery of the mother post-delivery.  supportive care  oxygen  Trendelenburg position, if large amount of blood loss  have mother hold the child, as soon as possible, to help the mother relax and initiate bonding HSE.O.MEP.11.10 relate care of the newborn after delivery. care of the newborn  APGAR score  supportive care  oxygen blow by  stimulation  suctioning  have the child with mother, as soon as possible  resuscitation, only if heart rate and breathing does not respond to stimulation HSE.O.MEP.11.11 correlate the terms miscarriage and miscarriage (spontaneous abortion)

42 spontaneous abortion.  happens early in the pregnancy  how the body deals with malformation and problems in the fertilized egg  occurs in clinically recognized pregnancies before the 20th week  occurs in 10 -15% of pregnancies  can have outside influences  usually the body’s way of dealing with severe problems or the death of a fetus (fetal demise) HSE.O.MEP.11.12 articulate care of the mother following o save fetal tissue spontaneous abortion. o apply a perineal pad o support the mother and treat for potential shock o transport immediately Standard Certification Number: Students will be provided the opportunity to obtain national certification in areas of Emergency Medical HSE.S.MEP.12 Services. Essential Why is obtaining certification in your chosen field important? Questions: Objectives: Students will Learning Plan & Notes to Instructor: Certification HSE.O.MEP.12.1 secure national certification in First Aid. See American Heart Association First Aid guidelines. HSE.O.MEP.12.2 secure national certification for adult, child, and See American Heart Association CPR guidelines. infant CPR and First Aid for Foreign Body Airway Obstruction (FBAO). HSE.O.MEP.12.3 prepare for First Responder national See National Registry exam guidelines. certification. Standard Information Technology Applications Number: The student will: HSE.S.MEP.13  use information technology applications.  demonstrate use as appropriate to healthcare applications. Essential How has the application of information technology impacted the emergency responder? Questions:

43 Objectives: Students will Learning Plan & Notes to Instructor: Information Technology Application HSE.O.MEP.13.1 implement the use of software, hardware, and the Use software, hardware, and Internet throughout Internet. delivery of CSOs. HSE.O.MEP.13.2 utilize the Internet as a resource/research tool. Use the Internet for resource/research for projects and assignments. 21st Century Learning Skills & Technology Tools Teaching Strategies Evidence of Skills Culminating Activity Success Information and 21C.O.9- Student analyzes and interprets Students use search Students identify Communication 12.1.LS2 visuals and recognizes the engines to complete an current information Skills: impact digital media influences online search for current on EMS law; (e.g. design, technique, and information on state laws analyze, interpret rate of speed) have on and the use of protocols and construct an audiences. The student’s visual impacting the provision of emergency medical products reflect a sophisticated emergency care. system model as understanding of subject, digital Students will relate demonstrated by media and design techniques. interpretation of these presentation of case 21C.O.9- Student creates information laws by applying concepts studies to peers; and 12.1.LS3 using advanced skills of to instructor designed accurately represent analysis, synthesis and scenarios that will require a scenarios/case evaluation and shares this the rescuer to make legal, study in which the information through a variety of moral, and ethical student must follow oral, written and multimedia judgments based on protocols relative to communications that target stated protocols. the condition of the academic, professional and victim. These technical audiences and projects will use purposes. current technology and be presented 21C.O.9- Student uses audio, video, orally to the class. 12.1.TT4 pictures, clip art, moviemaker programs, webpage design software, electronic documents and other files to collaborate for the creation of electronic

44 products that inform multiple audiences both inside and outside the school environment. 21C.O.9- Student uses advanced 12.1.TT9 telecommunication tools (e.g., email, video conferencing, interactive websites, newsgroups, video phones, chats) to create collaborative projects that are relevant to real world situations and contribute to the communication process among various groups. 21C.O.9- Student implements various 12.1.TT10 Internet search techniques (e.g., Boolean searches, meta- searches, web bots) to gather information; student evaluates the information for validity, appropriateness, content, bias, currency, and usefulness. Thinking and 21C.O.9- Student engages in a critical Students engage in an Students apply Reasoning Skills: 12.2.LS1 thinking process that supports analysis of client/patient knowledge and skills synthesis and conducts scenarios to interpret to demonstrate evaluation using complex stages of grief; deal with appropriate criteria. the family of a critically patient/victim 21C.O.9- Student draws conclusions injured or deceased responses to 12.2.LS2 from a variety of data sources victim; obtain, interpret complex real-world to analyze and interpret and analyze assessment healthcare situations systems. data; select appropriate and construct a 21C.O.9- Student collaborates with scene safety techniques healthcare systems 12.2.TT2 peers, experts and others to prior to caring for a patient model. contribute to a content-related at an accident site; select knowledge base by using appropriate PPE for given 45 technology to compile, patient scenarios, types of synthesize, produce, and organism, and systems; disseminate information, and select appropriate models, and other creative response given a variety works. of emergency scenarios. The teacher will provide scaffolding as applicable to learning goals and final products. Personal and 21C.O.9- Student independently Students will analyze real- Students apply Workplace Skills: 12.3.LS2 considers multiple perspectives world patient scenarios; acquired knowledge and can represent a problem in demonstrate positive and skills to draw more than one way, quickly and leadership as they work appropriate calmly changes focus and collaboratively with peers; conclusions and goals as the situation requires, engage in emergency select correct and actively seeks innovations preparedness for courses of action; (e.g. technology) that will participation in service seek assistance enhance his/her work. learning; model ethical when needed; and 21C.O.9- Student demonstrates ethical practices as they relate to demonstrate a 12.3.LS4 behavior and works responsibly working independently, in commitment to the and collaboratively with others groups, and with various final product and in the context of the school and technological resources. presentation. the larger community, and he/she demonstrates civic responsibility through engagement in public discourse and participation in service learning. 21C.O.9- Student exhibits positive 12.3.LS5 leadership through interpersonal and problem- solving skills that contribute to achieving the goal. He/she helps others stay focused, distributes tasks and 46 responsibilities effectively, and monitors group progress toward the goal without undermining the efforts of others. 21C.O.9- Student maintains a strong 12.3.LS6 focus on the larger project goal and frames appropriate questions and planning processes around goal. Prior to beginning work, student reflects upon possible courses of action and their likely consequences; sets objectives related to the larger goal; and establishes benchmarks for monitoring progress. While working on the project, student adjusts time and resources to allow for completion of a quality product. 21C.O.9- Student protects software, 12.3.TT1 hardware and network resources from viruses, vandalism, and unauthorized use and employs proper techniques to access, use and shut down technology equipment. 21C.O.9- Student works collaboratively to 12.3.TT2 acquire information from electronic resources, conducts online research, and evaluates information as to validity, appropriateness, usefulness, comprehensiveness and bias. 47 21C.O.9- Student models ethical 12.3.TT5 behavior relating to security, privacy, computer etiquette, passwords and personal information and demonstrates an understanding of copyright by citing sources of copyrighted materials in papers, projects and multi-media presentations. Student advocates for legal and ethical behaviors among peers, family, and community regarding the use of technology and information. 21C.O.9- Student uses technology to 12.3.TT8 seek strategies and information to address limits in their own knowledge. Entrepreneurship B.01-B.11, . Understands the personal Students will demonstrate Students display Skills: 17-.28 traits/behaviors associated with leadership, personal appropriate successful entrepreneurial management, leadership, performance. communication, and communication, and D.01-D.06, .08, . Understand concepts, interpersonal skills as they interpersonal 014, .17, . strategies, and systems engage in collaborative traits/behaviors in 21-.30, needed to interact effectively work, decision-making personal with others. processes, operate applications and H.04-06, .14-.18 Understand concepts and multimedia equipment, collaboration with strategies needed for career draw career conclusions, others. Students exploration, development, and and identify successfully use growth. entrepreneurial basic computer opportunities. operations to complete task and projects. Students draw conclusions regarding 48 educational requirements, job duties, and salary expectation in their area of interest. Culminating Assessment GRASP You arrive at a Mass Casualty Incident and note numerous critically injured patients. Your job is to Culminating function as the leader of the triage area and assist with follow through treatment of each victim. This Assessment: treatment will include reporting to appropriate healthcare facilities that will receive victims, dealing with patient families, and supporting co-workers. The support of co-workers will include assessing for signs of stress after the incident and suggesting ways to cope with the stress in a healthy manner.

End-Of-Course Final Exam Obtain industry certification in CPR and First Aid Industry Accreditation and Certification Industry Community First Aid & Safety Professional Rescuer Accreditation and American Heart Association: Basic Life Support (BLS), Healthcare Provider Certification American Red Cross, First Responder

Links and Other Resources

49 Links and Other Related Websites: Resources: First Responder National Standard Curriculum http://www.nremt.org http://www.dot.gov/ems

HOSA http://www.hosa.org

Center for Disease Control http://www.cdc.gov

American Heart Association http://www.americanheart.org

American Red Cross http://www.redcross.org

Pathways to Success http://careertech.k12.wv.us/pathwaystosuccess/

U.S. Department of Labor in the 21st Century http://www.dol.gov/

Advanced Distributed Learning www.adlnet.org

America's Career InfoNet www.acinet.org

America's Job Bank www.ajb.org

America's Service Locator www.servicelocator.org 50 CareerOneStop www.careeronestop.org

Employment & Training Administration www.doleta.gov

The Job Accommodation Network (JAN) http://www.jan.wvu.edu

Monthly Labor Review Online: Labor Force Archives http://www.bls.gov/opub/mlr/indexL.htm#Labor force

Occupational Information Network www.doleta.gov/programs/onet

Office of Disability Employment Policy www.dol.gov/odep

Career Voyages http://www.careervoyages.gov/index.cfm

Workforce West Virginia https://www.workforcewv.org/

West Virginia Earn A Degree Graduate Early (EDGE) http://www.wvtechprep.wvnet.edu/edge.htm

West Virginia Career and Technical Education http://careertech.k12.wv.us/

Contacts Contacts: HSE Teachers: See HSE Directory HSE Coordinators: Rebecca Davis [email protected] Cynthia Sundstrom [email protected] 51 OCTI Assistant Executive Director and EOCTST Coordinator: Donna Burge-Tetrick OCTI Executive Director: Gene Coulson

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