Emergency Medical Technician Tips

Every  EMT-Basic must read and understand the policies governing pre-hospital care.  The EMS authorities in many states now publish EMS regulations on the Internet.

If you want to be treated as a professional, you must look like a professional.

Read materials on performance improvement from other professions.  Discuss how the ideas may be adapted to your EMS system.

Stress in EMS is routine, not the exception.

Develop a healthy living plan for the first six months of your professional life in EMS.  Include time for exercise, relaxation, and a healthy diet.  At the end of six months, honestly evaluate yourself for the signs of stress.  Then, change your plan as necessary and practice it for another six months.

Be aware that others at the scene, especially immediate family members, may have underlying medical problems.  The stress of losing a loved one may worsen the problem, creating the need for emergency care.  For example, one individual of an elderly couple has died suddenly.  The surviving spouse, who has a history of heart disease, may begin to have chest pain.  Be prepared to treat or request additional resources for other patients, if necessary.

You need to read as much as you can about infection control.  There are many Internet sites related to infection control.  The Centers for Disease Control have the text of standard precautions on the World Wide Web.  The guidelines can be found in the hospital section of the CDC web page at www.cdc.gov

Avoid taking contaminated uniforms to a dry cleaner, to a public laundry or to your home for cleaning.  By doing so, you may contaminate other clothing and might transfer pathogens to others in your family or community.  Soiled uniforms should be treated in the same manner as soiled stretcher linen and washed at your agency's facility.

Many EMS agencies have an infection control officer, who has information about immunization requirements and their availability.  Another resource for this information is your county public health department.

Do not attempt to rescue a patient unless you are adequately trained, have the necessary personal safety equipment, and have specialized rescue equipment available.

Be aware of the legal requirements for certified or licensed EMT-Bs.  Your service agency may also have policies or procedures describing your duties.

In blunt trauma, the spleen is particularly vulnerable to laceration injury from the impact of the lower ribs.  Injury to the xiphoid process can cause laceration to the liver,  heart, or lungs.

The front of the elbow is sometimes called the antecubital region, or AC region.

Remember the "t" for toes in metatarsals so you do not confuse it with the metacarpals of the wrist.

Remember the word "up" within "sUPinated." Supinated means palms up, as if holding a bowel of soup.

When a child is abducted, he is taken away.  Abduction of the arm means to pull it away from the midline of the body.  Jumping jacks, or flapping your arms like a bird flying, is an example of abduction and adduction.

The epiglottis should close when we swallow food and should open when we speak.  When a person tries to talk and eat at the same time, the epiglottis may not close completely.  Food can enter the respiratory tree and obstruct the flow of air.  The epiglottis may also fail to close properly in normal activities, such as swallowing.

Cigarette smoking paralyzes the cilia, causing loss of the protective sweeping function.  When smokers quit, they initially notice more coughing and phlegm.  This occurs because the cilia wake up and begin to clean out the accumulated debris.

Noisy breathing indicates that the patient is having difficulty breathing due to some form of partial obstruction.

Varicose veins occur when the valves in the leg veins become weak and blood flows backward, causing the superficial veins to become distended.

Treat the patient based on his or her chief complaint and signs or symptoms, not only the vital sign measurements.

You cannot measure anxiety objectively.  You can measure signs associated with anxiety, such as rapid heart rate or breathing.

Be sure to use good body mechanics even while practicing moving.

Mastery of suction devices is an important skill.  Practice with as many different types of devices as possible.  Learn to use, clean, and troubleshoot each device.

Airway adjuncts do not prevent aspiration.

While inserting a Nasopharyngeal Airway (NPA), gently rotate the device.  Turn it back and forth slightly while applying gentle pressure.  Never force the airway into place.

If a patient with poor oxygenation has a good tidal volume and respiratory rate, provide supplemental oxygen instead of artificial ventilation.

An OPA or NPA may be necessary with the bag-valve-mask.  However, some patients who need ventilatory assistance cannot tolerate airways adjuncts.

In previous years, EMT-Basics used a variety of devices to provide oxygen.  Besides the nasal cannula, simple face masks and Venturi masks were common.  Be aware of differences in training and follow your local treatment protocols.

Note that critical interventions and transport may be required at any time during your assessment.  Use the patient's condition as a guide.

Never enter a hazardous scene or attempt a hazardous rescue unless you are trained and equipped to do so.

Use body substance isolation and standard precautions routinely for all patients.  This includes use of gloves, gowns, eye protection, and masks.

The head is the greatest area of heat loss.  When moving patients during cold or wet weather, make a protective hat from a towel or blanket to cover the patient's head.  this is particularly important in infants, children, and elderly patients.

If you permit bystanders to assist, you are responsible for their safety.

Remember that any trauma patient may have a cervical spine injury that requires spinal stabilization.

The best time to call for additional help is when you arrive at the scene, before getting out of the ambulance.

The difference between a patient who is alert and one who responds to verbal stimuli can be difficult to assess.  It is most important to establish a baseline response level and then watch for changes.

Do not attempt to control minor bleeding or other minor injuries during the initial assessment.  This may be difficult when minor wounds are actively bleeding.  Only treat bleeding that is life-threatening during this part of the patients assessment.

Complete the scene survey and initial assessment before beginning the rapid trauma assessment.  Maintain in-line spinal stabilization and recheck the ABCs, if indicated.

Remember that time is the enemy of a critically injured trauma patient.  You must be able to complete a focused history and physical exam quickly.  You do not have time to "stumble, fumble, and forget."

To evaluate for a pelvic fracture place you fist between the patient's knees.  Instruct the patient to squeeze the legs together.  Pain during this maneuver suggests a pelvic injury.

Do not allow history-taking to delay the assessment and treatment of critical injuries or illnesses.  If necessary, take a family member along in the ambulance to provide information while en route to the hospital.

Remember:  Maintaining the airway, breathing, and circulation takes priority in all patients.

Interference with emergency radio communication and the use of obscene or offensive language are strictly prohibited.

Run data requires accurate any synchronized times.  Be sure to check your clocks before beginning every shift.

If you have problems with spelling, carry a pocket-sized medical dictionary.

Drug containers or packages usually list the trade name, followed by the generic name in smaller print.  The generic name is sometimes followed by the abbreviation USP.

If you are not familiar with a certain medication, ask the patient why he or she is taking it.

Scars on the patient's chest are often a clue to previous open heart surgeries.  You may also find or be told that the patient has an implanted pacemaker or defibrillator.  This information should be noted on the run report.  Your care will not change because of this information.

According to the AHA, advanced cardiac life support represents the other end of the resuscitation continuum that begins with recognition of the emergency and initiation of basic life support.

Some agencies simply use the word "clear" or the phrase "clear the patient|" before defibrillation.  Whatever your agency advises, the intent is to ensure safety.

All contact with the patient must be avoided during analysis of rhythm as well as during a shock.

Defibrillation comes first.  Do not hook up oxygen or do anything that delays analysis of rhythm or defibrillation.

Interview bystanders and family for information about the circumstances of a cardiac arrest.  Do not delay care to get the history.

As always, use the appropriate BSI equipment and standard precautions

If in doubt whether a patient is suffering from low blood sugar or high blood sugar, treat the patient for hypoglycemia.

Think of a seizure as a short circuit inside the brain, causing various muscle groups to react wildly.

Treat all seizures as if they are life threatening.

Try to get the patient to talk to you, not just at you.

Be especially careful around persons threatening to end their lives.  A person intent on suicide may have no reservations about taking the lives of others.

Never begin treatment of a competent person against his or her will.  Consult medical direction or law enforcement.  In some areas, local protocol will guide your actions.

Avoid acts of physical force that could injury the patient.

As a precaution, find out if you are allergic to natural rubber latex.

Allergic reactions and anaphylaxis have many causes.  Be able to recognize whether a patient is in respiratory distress or has hypotension.

Secretions may be copious and thick.  Be prepared to suction.  Have sterile water available to clear the suction tubing.  when assisting ventilation, compressing the BVM may be difficult.  This is because of airway obstruction caused by broncholspasm (narrowing of the airway pathways.).

ALS personnel can provide additional therapy.  Advanced airway management, IVs, and medications may be needed to reverse the effects of an allergic reaction.  If available in your area, request ALS assistance early for serious allergic reactions.

Epinephrine can resolve airway compromise.  Medical direction may delay endotracheal intubation until the medication has been give.

If necessary, you can inject the medication through clothing,  This procedure is safe, and speeds administration.

If the airway is unstable due to swelling or irritation from toxic exposure, endotracheal intubation may be useful.

Try to get the correct spelling of the poison.  Many products have similar names.

A patient who has overdoses may be temporarily mentally incompetent.  Be very cautious if he or she refuses treatment.  The person may not be capable of making a rational decision.

A patient who is using illicit drugs such as cocaine or amphetamines may experience medical problems such as a heart attack or stroke.

If toxic fumes are suspected, park your vehicle uphill and upwind of the site.  To enter a site with hazardous materials, you must be specially trained and have appropriate protective equipment.

If you work in an area in which hypothermia is common, your vehicle should be equipped with a system to warm the supplemental oxygen supply.

Active rewarming is a potentially dangerous process.  Active rewarming of a hypothermic patient with an altered mental state can cause lethal heart rhythms.

Water-related emergencies are very dangerous due to the risks involved to both the rescuer and the victim.

Wasp stingers do not have an attached venom sac.

When giving a radio report about a pregnant woman, begin by stating her age.  Then give her gravida and para status followed by how many weeks pregnant she is.  For example, "The patient is a 23-year old G3, P1 female who is 39 weeks pregnant and in labor."  Follow local protocol.

A pregnant woman's normal vital signs are usually different than her vital signs when she is not pregnant.  Her blood pressure may be lower or her pulse may be faster when she is pregnant.

Many hospitals have staff members who are specially trained to assist patients during and after a miscarriage.  Encourage patients to seek support from these persons.

The blood pressure in a pregnant patient should be lower than in a non-pregnant adult.  A mildly elevated blood pressure in a pregnant woman suggests preeclampsia.

Out-of-the-hospital births involve a lot of blood and amniotic fluid.  Take BSA and standard precautions in all cases of possible prehospital childbirth.  Use Gloves, eye protection, face shield, and gown.  Handle blood and fluid soaked pads and lines carefully.  Discard these items in the proper containers.

Remember that newborns are covered with amniotic fluid and mucous membranes.  This makes them very slippery and difficult to hold.  Although it sounds obvious, be careful not to drop the baby.

Transporting the mother and newborn in the same emergency  vehicle is best.  If complications occur, request additional personnel to the scene to assist.  If extended resuscitation is required for either patient, separate transport units may be necessary.

A prolapsed cord is more common in preterm deliveries.  This happens because the fetal head is small.  The cord slips in front of the hear easily.  Prolapsed cord is also common in breech delivery.  Because of the shape of the fetus' buttocks, the cord may slip past, entering the vagina.

The APGAR score is not used to decide when to begin resuscitation.  Resuscitation is based on your evaluation of the breathing effort, heart rate, and color.  Follow local protocols.

You must routinely apply body substance isolation (BSI) and standard precautions (SP) when working around blood.  Use eye protection, gloves, gown, and a face mask.  Wash you hands thoroughly following each run.

Treating soft tissue injuries involves a high risk of exposure to blood and body fluids.  Always apply the techniques of body substance isolation and standard precautions.

Always place a cloth barrier between the patient's skin and a cold pack.  Applying a cold pack directly to the skin may cause additional tissue damage.  Intense cold could also cause the patient to move suddenly, aggravating the injury.

Remember the term abrasion by thinking of "abrasive" or scraping off the top layers of skin.

An an EMT-B, you will focus on finding and treating all wounds, not on identifying whether the injury is an entrance or exit wound.

If you must place the patient on a long backboard, examine his or her back while you perform the log roll.

Several specialized burn dressing products are used in EMS systems.  check local protocols for dressing a burn.

When caring for patients with chemical burns, always protect yourself.  Be alert to hazardous materials at the scene and chemical residue on the patient.  Use BSA and SP, especially eye protection and gloves.  If you have safety concerns or cannot identify the chemicals involved, wait for appropriately trained personnel to secure the scene before entering.

Never delay treatment of a life threatening wound because a proper dressing is not available.  You may have to be creative and use immediately available materials to dress a wound.  Examples include a clean washcloth, a towel, a T-shirt, a diaper, or a clean sanitary napkin.

While applying splinting material, ask the patient not to move the injured area.

For any patient with suspected head or spine injuries, open the airway using the jaw-thrust maneuver.

Whenever manual stabilization is provided, the EMT holding the patient's head is in charge of making the calls for any move (unless that responsibility has been shifted to someone in a better position to manage and see all movements).

After securing the middle and lower straps on the KED, you can keep the device from slipping down on the patient's torso by adding two straps or cravats.  Thread them through the loops in the back, then over the shoulders.  Fasten to the top chest strap.

It can be difficult to center a side-lying patient on the long board.  Position the head of the board 12 to 18 inches above the patient's head.  After completing the log roll, the patient will be about two-thirds of the way onto the board.  From here, you can slide the patient into position, using a diagonal motion to center him or her on the board.  This prevents strictly vertical or horizontal movement, which may aggravate injuries.

Even if an infant or child has not previous medical history and no obvious signs of infectious disease, BSI and standard precautions are always necessary.  Appearances can be deceiving and deadly.

Preschoolers and young school-aged children take everything literally.  They think in relative terms.  Be very careful when conversing with children.  Common words may be misinterpreted. "A little bit" to you may seem like a lot to a 3-foot tall child.

Any child who does not resist ventilation with a bag-valve-mask probably needs continued ventilatory support.

When questioning family members about possible SIDS deaths, avoid using word "you."  Simple, open-ended questions such as "What happened?" works well.

Repeating information received from the dispatch center to verify accuracy is useful.  This technique is called echoing.  Writing the information down as you receive it is also helpful.

Most seasoned EMS providers will tell you that any missing equipment or supplies are commonly needed when you least expect it.  Even if you have not used a piece of equipment for months, if you do not have it, you can bet it will be urgently needed on the next call.

Wash your hands immediately after cleaning the ambulance patient compartment.

Always think of personal, crew, patient, and bystander safety first.  If something at a scene does not seem right, be suspicious an do not enter the area.  Always use proper personal protective equipment.

Always apply the principles of BSI and standard precautions during orotracheal intubation.  You will look directly into the patient's mouth and airway.  This exposes you to blood, emesis, and other secretions.  You will need gloves, a mask, and protective eyewear.

Remember:  "Teeth and tube at 22." Have someone monitor the endotracheal tube before, during, and after tube placement.  Practice holding the tube at the maximum length you will use.  Use an effective tie-down method to keep the tube at the proper depth.  As with all technical EMS skills, practice your intubation skills frequently.

Judging how much pressure to apply during Sellick's maneuver may be difficult.  This exercise will help you to understand how much pressure is needed.  Pinch your thumb and index finger together.  Push on the bridge on your nose, or your partner's nose, until it hurts.  Pressure applied during Sellick's maneuver is about equal to the pressure it takes to cause pain.

Intubation should take 30 seconds or less.  Avoid taking longer than 30 seconds without ventilating the patient.  To judge the time, hold your breath while intubating.  If you need to breathe before the patient has been successfully intubated, stop and ventilate the patient before another attempt.

A helpful formula to determine tube size in children older than 1 year is to add 16 to the child's age in years and divide by 4.  Thus the tube size for a 4-year old child is 5.0.

When suctioning the mouth of an infant or child, use a rigid catheter.  Suction nasal passages with bulb suction or a French catheter connected to low or medium suction.

The FROPVD should never be used on a patient with COPD or emphysema because the lungs have lost their elasticity and cannot tolerate the pressure of the demand valve.

No airway procedures should be performed without adequate BSI and standard precautions.

Reevaluate vital signs after any change in the patient's mental status or condition.

In children with labored breathing, you may see significant use of the abdominal muscles.  This is characterized by seesaw motions of the chest and stomach.

Some patients and healthcare providers develop an allergy to latex.  The allergy results from repeated exposure to latex.  This can occur during an extended illness or during a healthcare career.  The allergy can be severe and can occasionally be life threatening.  when obtaining your SAMPLE history data, remember to ask patients if they have an allergy to latex.