NAEMSP® Review Guide for Emergency Medical Services Clinical Practice and Systems Oversight, Second Edition 2018 Edition Editor-in-Chief Ryan F. Coughlin, MD Department of Emergency Medicine Yale University School of Medicine New Haven, Connecticut Contributing Editors Krystal Baciak, MD Section of Emergency Medicine University of Chicago Medical Center Chicago, Illinois Brandon B. Bleess, MD Department of Emergency Medicine University of Illinois College of Medicine- Peoria OSF Healthcare Saint Francis Medical Center Peoria, Illinois Jesse Bohrer-Clancy, MD Department of Emergency Medicine Legacy Silverton Health Silverton, Oregon John F. Brown, MD, MPA Department of Emergency Medicine University of California, San Francisco San Francisco, California Kevin Burns, PA-C Department of Emergency Medicine Yale University School of Medicine New Haven, Connecticut Ryan Carter, MD, MPH Department of Emergency Medicine Yale University School of Medicine New Haven, Connecticut David C. Cone, MD Department of Emergency Medicine Yale University School of Medicine New Haven, Connecticut Maia Dorsett, MD, PhD Department of Emergency Medicine University of Rochester Medical Center Rochester, New York Jump to Contents 1 Cris Hall, MD Department of Emergency Medicine Wake Forest School of Medicine Winston-Salem, North Carolina Daniel Joseph, MD Department of Emergency Medicine Yale University School of Medicine New Haven, Connecticut Aurora Lybeck, MD Department of Emergency Medicine Aurora Health Care Milwaukee, Wisconsin Mary Mercer, MD, MPH Department of Emergency Medicine University of California San Francisco San Francisco, California Katherine Staats, MD Department of Emergency Medicine University of California San Diego San Diego, California Saranya Srinivasan, MD Department of Pediatric Emergency Medicine Texas Children’s Hospital Houston, Texas Jump to Contents 2 Amber Rice, MD, MS Department of Emergency Medicine Banner University Medical Center Tucson, Arizona C. Sam Smith, MD Department of Emergency Medicine Denver Health Denver, Colorado Katie Tataris, MD, MPH Section of Emergency Medicine University of Chicago Medical Center Chicago, Illinois Frank Tift, MD Department of Emergency Medicine University of Tennessee - Chattanooga Chattanooga, Tennessee Jump to Contents 3 Table of Contents Table of Contents 4 VOLUME 1: Clinical Aspects of EMS 9 1: History of EMS, Page 1 10 Section I: Airway 12 2: EMS Airway Management, 19 12 3: Airway Procedures, 30 13 4: Airway Management: Special Situations, 43 14 Section II: Breathing 15 5: Respiratory Distress, 53 15 6: Oxygenation and Ventilation, 60 17 Section III: Circulation 20 7: Hypotension and Shock, 69 20 8: Vascular Access, 78 22 Section IV: Medical Problems 23 9: The Challenge of the Undifferentiated Patient, 87 23 10: Altered Mental Status, 92 24 11 Cardiac arrest systems of care, 98 26 12 Cardiac arrest: clinical management, 109 28 13 Chest pain and acute coronary syndrome, 120 30 14 Cardiac dysrhythmias, 129 31 15 Cardiac procedures and managing technology, 137 33 16 Abdominal pain, 144 36 17 Submersion injuries/drowning, 151 37 18 Choking, 155 38 19 Syncope, 158 39 20 Seizures, 163 40 21 Stroke, 171 42 22 Allergic reactions, 179 44 24 Renal failure and dialysis, 190 46 25 Infectious and communicable diseases, 198 48 Section V: Trauma Problems 53 26 Trauma Systems of Care, 211 53 27 Blunt trauma considerations, 216 55 28 Motor vehicle crashes, 222 56 29 Penetrating trauma, 228 56 30 Traumatic brain injury, 237 58 31 Electrical injuries, 243 60 32 Blast injury, 248 62 33 Thermal and chemical burns, 253 64 34 Crush injury, 261 67 35 Hemorrhage control, 265 69 36 Orthopedic injuries, 272 70 37 Ocular trauma, 280 74 38 Bites, stings, and envenomations, 284 75 39 Field trauma triage, 289 77 Jump to Contents 4 40 Trauma-stabilizing procedures, 297 79 Section VI: Obstetrics and Gynecological Problems 82 41 Physiology of pregnancy: EMS implications, 307 82 42 Emergencies of pregnancy, 312 82 43 Normal childbirth, 318 84 44 Childbirth emergencies, 322 85 45 Perimortem cesarean section, 325 86 Section VII: Toxicological Problems 86 46 Principles of toxicology, 333 86 47 Treatment and evaluation of specific toxins, 341 90 Section VIII: Environmental Problems 94 48 Cold exposure illness and injury, 351 94 49 Heat-related illness, 358 97 50 High-altitude illnesses, 363 98 51 Effects of flight, 368 98 52 Diving injury, 372 100 Section IX: Special Populations 103 53 The special needs of children, 381 103 54 Pediatric medical priorities, 386 105 55 Pediatric trauma priorities, 393 107 56 Technology-dependent children, 397 108 57 Approach to the geriatric patient, 401 110 58 Bariatric patient challenges, 407 113 59 Behavioral health emergencies, 412 115 Section X: Special Considerations 117 60 Intimate partner violence, 423 117 61 Sexual assault, 430 119 62 Child maltreatment, 435 121 63 Ethical challenges, 439 122 64 End-of-life issues, 444 125 66 Family and bystanders, 462 128 67 Analgesia, 470 129 68 Point-of-care testing in EMS, 477 130 69 Ultrasound applications in EMS, 483 131 Section XI: Safety and Quality 132 70 Culture of patient safety, 491 132 71 A historical view of quality concepts and methods, 500 134 72 Defining, measuring, and improving quality, 509 136 73 Data management and information systems, 517 139 74 EMS quality improvement and the law, 526 141 VOLUME 2: Medical Oversight of EMS 144 Section I: System Infrastructure 145 1 Principles of EMS system design, 3 145 2 Air medical services, 17 148 3 Interfacility transportation, 29 152 4 Legislation, regulation, and ordinance, 36 154 5 State EMS offices, 44 155 6 EMS personnel, 51 158 Jump to Contents 5 7 Principles of finance, 60 161 Section II: Clinical Leadership and Oversight 164 8 Medical oversight of EMS systems, 71 164 9 Leadership and team building, 85 169 10 EMS dispatch, 94 172 11 Communications, 113 175 12 Emergency care regionalization, 123 180 13 EMS–public health interface, 134 182 14 Political realities for the medical director, 140 184 15 EMS physicians as public spokespersons, 146 186 16 Legal issues, 160 186 17 Due process, 182 190 18 Risk management, 192 194 Section III: Human Resources 196 19 EMS provider education, 201 196 20 EMS provider wellness, 211 198 21 Occupational injury prevention and management, 217 200 22 Ambulance safety, 222 200 23 Medical surveillance of emergency response personnel, 231 201 24 Prevention and intervention for psychologically stressful events, 236 204 25 Protection of EMS personnel from occupationally acquired infections, 243 206 Section IV: Extraordinary Circumstances 208 26 Incident command system and National Incident Management System, 257 208 27 Medical management of mass gatherings, 264 211 28 Disaster preparedness and management, 272 212 29 The federal medical response to disasters, 278 215 30 Special considerations in disaster zones 218 31 Prehospital triage for mass casualties, 288 219 32 Mass casualty management, 292 221 33 Mass casualty evacuation and patient movement, 303 225 34 Temporary treatment facilities, 313 227 Section V: Special Hazards 229 35 Medical support for hazardous materials response, 323 229 36 Chemical properties of hazardous materials, 334 231 37 Radiation and radiation injury, 339 233 38 Weapons of mass destruction, 349 235 Section VI: Special Environments 237 39 Tactical EMS, 355 237 40 EMS on the fireground, 363 239 41 Confined space and limited access situations, 373 241 42 Care in the wilderness, 377 242 43 Telemedicine and emerging telecommunications, 392 244 Section VII: Advancing Knowledge 244 44 EMS research basics, 403 244 45 Informed consent for EMS research, 410 247 46 Cardiac arrest-related research methodology, 415 251 47 Trauma-related research methodology, 420 253 48 Pediatric-related research methodology, 427 254 Jump to Contents 6 49 Economic evaluation of EMS-related interventions, 433 256 50 Data handling and statistics essentials, 439 257 Jump to Contents 7 Foreword The editors hope that you find this review guide helpful when studying for your board certification exam and participating in EMS fellowship education. Thank you to Drs Cone, Delbridge, Brice, and Myers, as well as the many other contributors to the textbook volumes, as their work is largely reflected here. Thank you to all of the authors and editors to stepping up to the difficult task of trying to summarize our entire subspecialty. Accompanying each chapter title is the corresponding page in the textbook for easy reference. Please remember that if you are studying for the ABEM EMS Subspecialty Certification exam, in order to arrive where you are now, you have already been very good at taking exams throughout your educational journey. If using review guides has not been helpful to you in the past, it may also not be helpful to you now. Please forward any suggestions, corrections, or other concerns to [email protected] so we can make this project better. Jump to Contents 8 VOLUME 1: Clinical Aspects of EMS Jump to Contents 9 1: History of EMS, Page 1 1966 - The National Academy of Sciences National Research Council Report (NAS-NRC) ● EMS in the United States = “woefully inadequate” [Figure 1.1] ● >47,000 deaths in 1965 in motor vehicle accidents ● Many deaths preventable ● Highway Safety Act of 1966 funded to develop EMS standards, improve ambulance services, and create demonstration projects and studies. ● The act prompted DOT (Department of Transportation) to contribute more than $142 million to regional EMS systems between 1968 and 1979. 10M on research alone. 1973 - The Emergency Medical Services Systems Act: ● The law and subsequent regulations emphasized a regional systems approach, a trauma orientation, and a requirement that each funded system address the 15 “essential components.” [Figure 1.2] Provided $300M. ● Money ran out in 1980s, but this helped create the infrastructure for EMS funding ● Universal 911 advocated in 1973. ○ Pros: ■ Started money flow for EMS nationally. ■ Created DHEW KKK 1822 - Standards for ambulance construction (one of 15 components) ○ Cons: ■ Lacked medical direction & oversight as important factors.