Book Description

Preface EMS in the third millennium involves a great deal more than simply transporting a patient to the hospital. The modern paramedic has tremendous responsibilities, both on the scene and in the community. In Volume 5,Special Considerations/ Operations of Paramedic Care: Principles & Practice,we have detailed important specialized information required of paramedics in the modern EMS system. In addition to a detailed discussion of special patients, we have provided crucial information on scene safety and operations as well as assessment-based patient management. This text has been designed to serve as both an initial course textbook as well as a reference source for the practicing paramedic. In this final volume ofParamedic Care: Principles & Practice,we have addressed the last three divisions of the1998 U.S. DOT EMT-Paramedic National Standard Curriculum.These include: Special Considerations—This section presents the essential information on special patient populations encountered in prehospital care including neonates, children, the elderly, the challenged, as well as chronically-ill patients. Assessment-Based Management—The 1998 EMT Paramedic curriculum was developed based upon the concept of assessment-based management. This division serves to tie together the various divisions of the curriculum previously presented (i.e., medical, trauma, and special patients) so that the paramedic can provide the necessary care based upon assessment findings. Operations—Modern EMS is very comprehensive. The paramedic must have detailed knowledge of hazardous material scenes, rescue scenes, multiple casualty incidents, disasters, and other emergencies. This division provides essential information about these important aspects of prehospital care. EMS is unique among the allied health professions. The modern paramedic, although functioning under the license and direction of the system medical director, is forced to make most patient care decisions in the field independently. Because of this, the modern paramedic must have a thorough knowledge of essential anatomy, physiology, and pathophysiology of the common emergencies encountered. Based on this knowledge, the paramedic must complete a detailed, yet focused patient assessment and determine the appropriate treatment plan. Although help is never more than a phone call or radio call away, the paramedic functions fairly autonomously in a dangerous environment that is constantly changing. Chapters in this volume correspond to theU.S. DOT 1998 EMT-Paramedic: National Standard Curriculum.The following are short descriptions of each chapter: Chapter 1 "Neonatology"introduces the paramedic student to the specialized world of neonatology. The neonate is a child less than one month of age. These patients have very different problems and their treatment must be modified to accommodate their size and anatomy. This chapter presents a detailed discussion of neonatology with a special emphasis on neonatal resuscitation in the field setting. Chapter 2 "Pediatrics"presents a detailed discussion of pediatric emergencies. Children are not "small adults." They have special needs and must be approached and treated in a fashion different from adults. This chapter provides an overview of the common, and uncommon, pediatric emergencies encountered in prehospital care with a special emphasis on recognition and treatment. Specialized pediatric assessment techniques and emergency procedures are presented in detail. Chapter 3 "Geriatric Emergencies"is a detailed presentation of emergencies involving the elderly. The elderly are the fastest growing aspect of our society. A significant number of EMS calls involve elderly patients. This chapter reviews the anatomy and physiology of aging. The chapter then presents a detailed discussion of the assessment and treatment of emergencies commonly seen in the elderly. Chapter 4 "Abuse and Assault"presents a timely discussion of the needs of the abuse or assault victim. This chapter provides important information that will aid the paramedic in detecting abusive or dangerous situations. EMS personnel are often the first, and occasionally the only, personnel to encounter the abuse or assault victim. Because of this, it is essential that abusive situations be recognized early and the appropriate personnel notified. Chapter 5 "The Challenged Patient"addresses patients with special needs. A medical emergency can be an extremely frightful event for the patient who is sensory or mentally challenged. Because of this, paramedics should be aware of strategies that reduce stress for patients with special challenges. Chapter 6 "Acute Interventions for the Chronic-Care Patient"offers an important discussion of the role of EMS personnel in treating home-care patients and patients with chronic medical conditions. With declining hospital revenues, more and more patients are being cared for at home—either by family members or home care personnel. Paramedics are often summoned when a home care patient deteriorates or otherwise suffers a medical or trauma emergency. It is essential that prehospital personnel have a fundamental understanding of home health care as well as a basic knowledge of the medical devices and technology routinely used in home care. This chapter details the paramedic's role in assessing, treating, and managing the home care patient. Chapter 7 "Assessment-Based Management"ties together the patient care material presented in this text. Paramedics are unique in that they function in an unstructured environment. They must often make field diagnoses and act upon these. This chapter details how to integrate the information learned from a comprehensive patient assessment and use that in formulating an appropriate treatment plan. This aspect of paramedic care is one of the fundamental differences between paramedicine and other allied health personnel. The paramedics of the 21st century are expected to not only have good patient care skills, they are also expected to have good field diagnostic skills. These skills are based upon the concept of assessment-based management. Chapter 8 "Ambulance Operations"serves to present, and in some cases review, the special world of EMS and ambulance operations. Patient care begins long before the call is received. The paramedic is responsible for keeping the ambulance and medical equipment in a constant state of readiness. In addition, the paramedic must understand the various EMS system operations so that he or she may interact accordingly. Chapter 9 "Medical Incident Command"provides a detailed discussion of the Incident Command System. The Incident Command System is a system for managing resources at the emergency scene, particularly at scenes involving multiple ambulances and multiple agencies. Paramedics must intimately understand the workings of the Incident Command System and apply them in daily operations. Chapter 10 "Rescue Awareness and Operations"presents a comprehensive discussion of rescue operations. The level of EMS involvement with rescue operations varies significantly. In many EMS systems, paramedics are responsible for rescue operations. In others, paramedics are primarily responsible for patient care while rescue operations are carried out by specially trained and equipped rescue teams. Regardless, the modern paramedic must have a thorough understanding of rescue operations with an emphasis on scene safety. Chapter 11 "Hazardous Materials Incidents"gives an overview of hazardous materials operations. More and more emergency scenes involve hazardous materials. Although most hazardous material scenes are handled by specialized "hazmat" teams, paramedics are responsible for patient care. The hazardous material scene can be extremely dangerous. Because of this, the modern paramedic must have a fundamental understanding of various hazardous materials and hazmat operations. Chapter 12 "Crime Scene Awareness"details the importance of protecting the crime scene. EMS personnel are often the first to arrive at a crime scene. Although their principle responsibility is patient care, they should take great effort to avoid disturbing important aspects of the crime scene. This chapter provides an overview of crime scene operations so that EMS personnel will recognize and protect essential elements of the crime scene. Chapter 13 "Rural EMS"provides an overview of the special needs of rural EMS. Although not a part of the 1998 U.S. DOT curriculum, this chapter has been added to enhance awareness of the challenges, such as distance, faced by rural EMS personnel and the creative problem-solving used to provide high-quality care to the nearly 53 million Americans who live in rural areas. This volume,Special Considerations/Operations,describes important information that the modern paramedic needs in order to function effectively on the emergency scene. This information should prove beneficial both in initial paramedic education programs as well as in future refresher programs.