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2020 EMR SUMMARY EMR Well Being Body substance isolation Immunizations Proper lifting techniques Proper precautions at haz-mat scenes EMR response to death or serious injury may lead to critical incident stress. Defusing- an early intervention that occurs at the scene or shortly after the scene of an incident, designed to stop the negative stress process that may occur in the hours immediately following a disaster response. Critical incident stress debriefing (CISD)-A psychological, emotional and educational group process to diminish the impact of critical incident stress Medical/Legal & Ethical Issues Golden Rule “Do unto others as you would have others do unto you” Public Health Law Article 30, Part 800 This contains the rules & regulations in reference to EMS & immunities. An EMR cannot be held liable unless gross negligence can be proven. GOOD SAMARITAN ACT (does not cover EMR in NYS) It is designed to protect private non - certified persons who assist in emergency treatment from legal action, with the exception of gross negligence. Staying within the scope of practice & standard of care for his/her level of training, combined with proper documentation will go a long way in preventing the EMR from being involved in litigation. NEGLIGENCE Deviation from the standard of care as recognized by law Criteria: Duty to act – An obligation to provide care to a patient Breech of duty Injury occurred Proximate cause – Injury resulted from improper action or failure to act. ASSAULT & BATTERY- In certain circumstances the EMR can be charged with assault & battery for treating an adult without consent. Assault verbal Battery Physical 1 Nassau County Fire Police EMS Academy NCPD EMR Summary Rev. 3/2020 2020 EMR SUMMARY CONSENT Agreement by the patient to accept medical intervention. INFORMED (ACTUAL) CONSENT A patient is told, in a manner they can understand, the nature and extent of the procedure to be performed and the possible risks. The patient fully understands the procedures, the risks involved, and accepts them. IMPLIED CONSENT The unconscious, mentally impaired, or child patient in a true emergency, in which there is a significant risk of death, disability or deterioration of the condition, the LAW assumes that the patient or guardian would give their consent. ABANDONMENT The termination of the EMR-patient relationship without the consent from the patient. Transferring a patient to another health care professional who is not of equal or higher training than you. DELEGATED PRACTICE The System Medical Physician delegates the rescuer to carry out actions on their behalf. Example is on line medical direction (medical control) or off-line medical direction (standing orders and/or protocols). Quality Improvement A system of internal & external audits, that monitor every aspect of prehospital care to achieve optimal excellence in patient services rendered. When quality issues are discovered, suggestions are made to prevent re-occurrence. DOCUMENTATION NYS PCR FORMS Includes: Legal Document Permanent part of the patient’s medical record’ Minimum Data Set All times from 9-1-1 to in service Chief Complaint Vital signs Demographics Information from the patient, bystanders, and a physical examination Subjective-Information based on opinions expressed by patients and others. Objective-findings are Physical findings (facts) Treatment rendered and changes in patient condition No personal comments from the EMR 2 Nassau County Fire Police EMS Academy NCPD EMR Summary Rev. 3/2020 2020 EMR SUMMARY Refusal of Medical Care by EMT or higher only EMR must not make an independent decision regarding a patient's refusal of medical care or transport. Prouncement of death by EMT or higher only Signs of Obvious Death Rigor mortis Dependent lividity De-composition Injury not compatible with life Patient submerged > 1 hour in any temperature water Advance Directives – must be present and valid (copies are acceptable with signatures) MOLST / eMOLST – appropriate directives should be honored NYS approved document, bracelets or necklaces NYS nursing home or Non-hospital DNR Healthcare Proxy and Living Will – contact Medical Control for direction. THE HUMAN BODY COMMON MEDICAL TERMINOLOGY COMMON PREFIX A or An - without Brady - slow Contra/Anti - against Dys - disorder/difficult Tachy - fast Vaso - Blood vessel COMMON WORDS Cardio - heart Cerebro - brain Cephalo - head Hemi - half Hypo - deficient/below Hyper - above/excess Inter - between Intra - inside 3 Nassau County Fire Police EMS Academy NCPD EMR Summary Rev. 3/2020 2020 EMR SUMMARY TERMS OF LOCATION Anterior (Ventral) - Towards the front of the body or body part Posterior (Dorsal) - Towards the back of the body or body part Superior - Above, upper Inferior - Below, lower Superficial - Near the surface Deep - Remote to the surface Internal - Inside External - Outside Proximal - Near to the point of attachment Distal - Farthest from the point of attachment Medial - Towards the midline of the body Lateral - Away from the midline of the body Coronal Plane - Divides body in half front & rear Medial Plane - Division of body down the middle left &right. TERMS OF DIRECTION Cranial (Cephalic) superior - towards the head Caudad (inferior) - towards the Feet TERMS OF POSITION AND MOVEMENT Supine - Lying on spine, face up Prone - Lying on stomach, face down Abduction - Movement away from the midline of the body Adduction - Movement towards the midline of the body Flexion - Act of bending Extension - Act of straightening TISSUE is a collection of specific cells, which carry out a specific function. Connective Tissue: Forms the supporting and connective surfaces of the body Muscle Tissue: Composed of cells specialized to contract Skeletal (striated) Involuntary (smooth) Cardiac Nervous Tissue: Specialized cells that receive stimuli and conduct nerve impulses to various organs 4 Nassau County Fire Police EMS Academy NCPD EMR Summary Rev. 3/2020 2020 EMR SUMMARY RESPIRATORY SYSTEM Anatomy Nose warms & humidifies air, traps dust Trachea Windpipe Pharynx Throat Carina Bifurcation of the Trachea Larynx Voice Box Alveoli Air Sacks Epiglottis Protects the Larynx Bronchi Passageway to Lungs Adequate Respiratory Rates Adult 12-20 breaths per min. Child 15-30 breaths per min. Infant 25-50 breaths per min. Inhalation - Diaphragm contracts, moves downward causing the chest cavity to enlarge decreasing pressure. Air flows in through open airway. This is an active process (uses energy). Exhalation - All muscles relax, chest cavity decreases in size, increasing pressure, air is expelled. This is a passive process. Ventilation – The process of moving air in and out of the lungs. Respiration – the exchange of Oxygen and Carbon dioxide. Terms Hypoxia - Inadequate O2 for cellular needs Hypercarbia – excess of Carbon Dioxide in the system Respiratory Patterns Apnea - Absence of breathing Dyspnea - Difficulty in breathing Hyperpnea - Deep ventilation Hyperventilation - Increased minute volume Hypoventilation - Decreased minute volume Orthopnea - Difficulty breathing while lying down Tachypnea - Rapid breathing Bradypnea - Slow breathing Abnormal Respiratory Sounds Snoring - Upper airway partially blocked, usually by the tongue Stridor, Crowing - Harsh high-pitched sound, caused by laryngeal spasms, child’s partial airway obstruction Wheezing - Whistling sound, heard in Asthma, COPD, CHF Rhonchi - Rattling noises, heard in throat and bronchi Rales and Crackles - Fine, moist sounds heard in lower airways 5 Nassau County Fire Police EMS Academy NCPD EMR Summary Rev. 3/2020 2020 EMR SUMMARY Assessment of the Respiratory System Inspection - Look for signs Auscultation - Listen (anterior & posterior) Palpate - Feel Respiratory Distress – Increased work of breathing. Signs of Respiratory Distress Inadequate Chest Rise Accessory Muscle Use Nasal Flaring Cyanosis Tracheal Tugging Retractions Respiratory Failure – Inadequate ventilations that will lead to apnea. Signs of Respiratory Failure Lethargy AMS Poor effort Cyanosis CARDIOVASCULAR SYSTEM Anatomy and Physiology Right atrium - receives deoxygenated blood from the body Pulmonary Circulation - Right Ventricle pumps blood into the Lungs Pulmonary Artery – Takes deoxygenated blood from Right Ventricle to Lungs Pulmonary Vein – Vein that carries oxygenated blood from lungs to Left Atria Left Atrium receives blood from the lungs Systemic Circulation - Left Ventricle pumps oxygenated blood to heart and body Coronary Arteries – Supply the heart tissue with oxygenated blood Myocardium - Heart Muscle Pericardium - Double layered sac that surrounds the Heart Systole – Ventricular contraction pressure used to push blood through arteries Diastole - Heart muscle relaxes, chambers refill 6 Nassau County Fire Police EMS Academy NCPD EMR Summary Rev. 3/2020 2020 EMR SUMMARY CENTRAL NERVOUS SYSTEM Anatomy and Physiology Brain Cerebrum - Mediates higher mental functions, such as reasoning, thought, memory, speech Cerebellum - Concerned with equilibrium, coordination, skilled movements Brain Stem - Maintenance of vital functions, medulla regulates respiration & heart activity Spinal Cord & Nerves Contains nerve tracts, controls position, sense, reflex activity Spinal Vertebrae 7 cervical, 12 thoracic, 5 lumber, 5 sacral & 4 coccygeal Muscloskeletal System Functions Protects Helps regulate temperature Absorbs shock Sensory Remember BLT with Mayo (Bones, ligaments, muscles and tendons) Tendons - Tie Muscle to bone Ligaments - Link bone to bone
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