Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

MASTER TEACHING NOTES

Detailed Lesson Plan Chapter 6 Abuse, Neglect and Assault 160–180 Minutes

• • • • • •

Teaching Tips Discussion Topics Critical Thinking Questions Class Activities Points to Emphasize Knowledge Application

Chapter 6 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline I.

Case Study

5

5

5

10

Master Teaching Notes Teaching Tips Have a student read the scenario. Tell students that the case will be reviewed after the lecture

II. Introduction A. Obtaining accurate statics is difficult, owing to underreporting.

B. Almost five children die per day from child abuse, elder abuse occurs at 700,000 to 1.1 million/year, and between 2 and 4 million women are battered each year.

C. Abuse transcends gender, race, age, and socioeconomic status.

D. Paramedic’s responsibilities include identification of victims of abuse, initiation of action, and reporting of incident to proper authorities.

E. Early detection is critical to breaking abuse cycle.

III. Partner Abuse A. Results when man or women subjects domestic partner to some form of physical or psychological violence B. May be wife, husband, girlfriend, boyfriend, roommate, same-sex partner C. Most widespread form of abuse is against women, but men can be abused by women.

D. Abusive relationships follow same patterns and cycles.

IV. Reasons for Not Reporting Abuse A. Fear of reprisals to themselves or children B. Humiliation at powerlessness and inability to stop abuse C. Hope that abuse will end, especially when abuser promises to change D. Abuser may justify abuse, stating that victim deserved it.

E. May lack financial means, job skills to seek help.

F. Report of abuse is usually last resort.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Points to Emphasize Stress to students that there are multiple forms of abuse.

Discussion Topics Discuss with students the different reasons why someone might not report abuse.

Discussion Topics Discuss with students the laws in your area regarding domestic violence.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 6 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

G. If intervention does not occur, victims are all too often are killed by abuser.

10

10

V. Identification of Partner Abuse A. Several categories of abuse: physical, verbal, sexual B. Physical – application of force in many ways C. Verbal – words chosen to control or harm a person D. Sexual – forced sexual contact and includes marital and date rape E. Ten generic risk factors: 1. Male who is unemployed 2. Male uses illegal drugs at least once a year 3. Different religious backgrounds 4. Family income below poverty level 5. Unmarried 6. Either partner violent toward children at home 7. Male did not graduate from high school 8. Male unemployed or has blue-collar job 9. Male between 18 and 30 years old 10. Male saw father hit mother VI. Characteristics of Partner Abusers A. Abuse occurs in all demographic groups.

B. Some characteristics of abusers include: 1. Trouble paying bills, or holding jobs 2. Unable to keep pace with technological changes, making their jobs obsolete 3. History of family violence 4. Abuser does not like being out of control, but powerless to change 5. Overly aggressive personality 6. Feelings of low self-esteem, insecurities, jealousy, unpredictable rages 7. Alcohol or drug use that increases feelings 8. Sense of remorse and shame after abusive episode, with promises to change 9. Cycle of violence repeats

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Critical Thinking Questions Why might the abuser call 911 several times before the abuse occurs?

Class Activities Have a police officer who specializes in domestic violence speak to the class.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 6 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes 10

10

5

Content Outline

Master Teaching Notes

VII. Characteristics of Abused Partners A. Primary risk factor is history of violence between parents.

B. Pregnancy increases risk in abusive relationship.

C. Substance abuse D. Emotional disorders E. May attempt to protect attacker F. May avoid eye contact, exhibit nervous behavior, or watch abuser G. Verbal clues: “I am always causing trouble,” “We have been having problems lately.”

Critical Thinking Questions

VIII. Approaching the Battered Patient A. Direct questioning is best during assessment.

B. Convey your awareness that partner may have caused harm, and be willing to discuss it; avoid judgmental statements.

C. Listen to abused patients, and encourage them to regain control over their lives.

D. Share your knowledge of community resources, such as shelters, counseling, support services.

E. Do not leave scene without advising patient to take all necessary precautions by rehearsing the quickest way to leave home, where patient will go/call, and so forth.

F. Abuser may be reported and taken into custody by police; you must inform patient that abuser can be released, and provide patient information about available protection programs.

Discussion Topics

IX. Elder Abuse A. Elder abuse is a widespread medical and social problem that is caused by many factors, such as: 1. Increased life expectancies, increased dependency on others, decreased productivity in later years 2. Physical and mental impairments, limited resources, economic factors that strain family resources, stress on middle-aged caregivers B. Elder abuse is expected to grow along with elderly population.

C. Paramedic responsibility includes remaining alert to signs of elder abuse.

Knowledge Application

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

What fears can you think of that might be felt by a person involved in an abusive relationship and prevent that person from leaving the relationship?

Discuss with students the various domestic abuse programs available in your area.

Class Activities Create a scenario involving domestic violence, including care provided. Have students compete a run report, focusing on appropriate documentation.

For homework, have students list signs and symptoms they may observe in an elder abuse victim.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 6 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes 5

5

5

5

Content Outline

Master Teaching Notes

X. Identification of Elder Abuse A. Domestic abuse – takes place when elder is being cared for in a homebased setting, usually by relatives B. Institutional elder abuse – elder being cared for by a person with legal or contractual responsibility to provide care, such as caregivers, nursing home staff, other professionals C. Both types of abuse can be acts of commission (physical, sexual, or emotional violence) or acts of omission (neglect).

D. Some signs are subtle, such as theft of belongings or loss of freedom; others are obvious, such as wounds, decubitus ulcers, poor hygiene.

Knowledge Application

XI. Theories about Domestic Elder Abuse A. Four main theories about causes of domestic elder abuse: 1. Caregivers feel stressed and overburdened 2. Patient’s physical and or mental impairment 3. Family history of violence 4. Personal problems of caregivers

Class Activities

XII. Characteristics of Abused Elders A. Affects all demographic groups B. Difficult to outline an accurate profile of abused elder C. Most common cases: 1. Elderly women abused by their sons 2. Elderly dependent on others for care 3. Elderly who are mentally and or physically challenged D. In cases of neglect: 1. Abused elders commonly live alone.

2. Fear asking for help due relatives complaining about helping, or threats to place in nursing home E. Elderly abuse victims tend to be reluctant to give information about abusers for fear of retaliation.

Critical Thinking Questions

XIII. Characteristics of Elder Abuse A. Difficult to profile abusers of elderly B. Several characteristics are commonly found in abusers: 1. Exhibit alcoholic behavior, drug addiction, or mental impairment 2. Dependent on income of elder, causing resentment, anger, or violence

Discussion Topics

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Have students research on the Internet different cases of elder abuse, including cases of financial abuse.

Have a representative from your local senior agency come in to discuss elder abuse.

Is abandoning an elderly family member in a safe place considered neglect?

What responses regarding injuries would you likely expect to hear from a patient who has suffered abuse?

Discuss with students the different stress factors that could be present in an elder abuser.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 6 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes 5

10

10

Content Outline

Master Teaching Notes

XIV. Child Abuse A. One of most difficult circumstances faced as a paramedic B. Child abuse ranges from physical, emotional, to neglect of child’s basic needs.

C. May be afflicted by parents, caregivers, foster parents, babysitters, stepparents, siblings, other relatives, or peers D. Damage lasts a lifetime; perpetuates a cycle of violence for generations

Teaching Tips

XV. Characteristics of Child Abusers A. Cannot relate child abuse to social class, income, or education B. Patterns that do emerge include: 1. History of abuse within own family 2. Physically or emotionally abused as children 3. Prefer to use other forms of discipline but buckle under stress 4. Tend to be male 5. One or both of abuser’s parents are abusers C. Behavioral traits include: 1. Use or abuse of drugs/alcohol 2. Immaturity or preoccupied with self 3. Lack of obvious feeling for the child, rarely looking at or touching child 4. Apparent lack of concern about child’s injury, treatment, or prognosis 5. Open criticism of child, with little indication of guilt or remorse for involvement in child’s condition 6. Little identification with the child’s pain, whether physical or emotional

Discussion Topics

XVI. Characteristics of Abused Children A. Child’s behavior is one of the most important indicators of abuse.

1. Under age 6 usually appear excessively passive 2. Over age 6 seem aggressive B. Other behavioral clues include: 1. Hopeless crying during treatment, or no crying at all 2. Avoiding the parents or showing little concern for parental absence 3. Unusual wariness or fear of physical contact 4. Apprehension and/or constant alertness for danger 5. Prone to sudden behavior changes, absence of nearly all emotions 6. Neediness, constantly requesting favors, food, or things C. Use your instincts and knowledge of age-appropriate behavior to guide first impression.

Discussion Topics

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

This is one of the most difficult responses that EMS will have to deal with. Go over ways in which the EMS provider can cope with abuse.

Discuss with students ways they think that the cycle of violence could be stopped.

Go over with students the various child abuse prevention programs.

Go over the age-appropriate behaviors observed in children.

Class Activities Have students list ways in which they may be able to gain the confidence of a child.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 6 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes 20

Content Outline XVII. Identification of the Abused Child A. Not all injured children are abused.

1. Child volunteers story of injury without hesitation.

2. Child’s story matches story told by parents.

B. Cases of parental or child behavior that raise index of suspicion create a challenge for the paramedic to distinguish between intentional injury and authentic accident C. Conditions that are commonly mistaken for abuse: 1. Car seat burns, staphylococcal scalded skin syndrome 2. Chickenpox, hematologic disorders that can cause bruising D. Physical Exam 1. Signs of physical mistreatment of child most often easiest to recognize 2. Soft tissue injuries, multiple bruises, bites, burns, and defensive wounds E. Burns and Scalds 1. Burn tend to be in certain common locations with distinct patterns.

2. Soles of the feet, palms of hands, back, or buttocks; may or may not present with other injuries 3. Children scald more easily due to thinner skin.

4. Home water tends to be 140°F, which will scald in about 5 seconds for an adult.

5. Accidental burns tend to have “splash” patterns created by spattering water.

6. Intentional scalding is characteristic of lack of “splash” patterns referred to as “dipping injuries” and are a common form of child abuse.

F. Fractures 1. Second most common form of abuse 2. Sites of fractures include skull, nose, facial structures, upper extremities, ribs.

3. Twisting and jerking the upper extremity 4. Neck injuries from shaking 5. Ribs are very pliable in children; with fractures at this site, maintain high index of suspicion for abuse.

G. Head Injuries 1. Over time, abuse injuries progress from extremities and trunk to the head.

2. Head injuries commonly found include scalp wounds, skull fractures, subdural hematomas, and repeated concussions.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Master Teaching Notes Teaching Tips Using pictures of injury patterns, go over with students the various injuries sustained in child abuse cases (this may be difficult for some students to view).

Discussion Topics Discuss with students the neglect of a child.

Have students list the signs of neglect.

Class Activities Have a social worker, police officer, or medical professional who deals with abuse of children come in to speak with students.

Points to Emphasize Remember that emotional abuse is just as damaging as any other abuse.

Knowledge Application Create a chart with the various injuries listed. For homework, have students list the identifying markers associated with each injury, along with treatment.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 6 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline H.

I.

J.

K.

L.

3. Head injuries claim the largest number of lives among abused children and account for most of the long-term disability.

Shaken Baby Syndrome 1. Frequently occurs when a parent or caregiver becomes frustrated with a crying infant and all other attempts to quiet the child have failed 2. Occurs when person picks up infant and shakes baby vigorously 3. Movement causes permanent brain damage, such as subdural hematomas or diffuse swelling, injuries to neck and spine, and retinal hemorrhage, leading to blindness 4. If shaken hard enough or repeatedly, child may die.

Abdominal Injuries 1. Small proportion of injuries suffered by child but usually very serious when they occur 2. Blunt trauma can cause injury to liver, spleen, or mesentery.

3. Look for swelling, pain, vomiting, and hemodynamic compromise.

Maternal Drug Abuse 1. Drug use during pregnancy is a subtle but devastating form of child abuse (fetal alcohol syndrome, “crack babies”).

2. Cocaine and alcohol use during pregnancy are associated with longterm problems in child.

Signs of Neglect 1. Child not provided with adequate food, clothing, shelter, or medical care 2. EMS has position to observe child’s home environment 3. Signs of neglect: a.

Malnutrition, severe diaper rash, diarrhea/dehydration b.

Hair loss; untreated medical conditions; inappropriate, dirty, or torn clothing or lack of clothing c.

Tired and listless attitude, near constant demands for physical contact or attention Signs of Emotional Abuse 1. Often hardest form of abuse to identify 2. Six forms of emotional abuse: a.

Ignore child, show indifference to needs, fail to provide stimulation b.

Reject, humiliate, or criticize child c.

Child isolated and deprived of normal human contact or nurturing d.

Terrorized or bullied through verbal assaults and threats, creating fear and anxiety

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Master Teaching Notes

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 6 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline e. f.

5

15

Master Teaching Notes

Parent/caregiver encourages destructive or antisocial behavior Child overpressured by unrealistic expectations of success

XVIII. Recording and Reporting Child Abuse A. Paramedics have responsibility to report suspected cases of child abuse and may have opportunity to provide early intervention.

1. Abusive adult may actively seek help by calling EMS several times within 24-hour period.

2. May summon help for inconsequential symptoms or demonstrate inability to handle impending crisis 3. Warning signs should be noted.

B. As the paramedic, conduct examination of abused child with another colleague present C. Keep personal reactions to yourself, document only objective observations; do not put assumptions in your report.

D. Final document should be objective, legible, and written with knowledge that it may be used in court.

E. Always put child’s interest first, treating with kindness and gentleness.

Teaching Tips

XIX. Sexual Assault A. Males and females of all backgrounds, from infancy to old age, can be victims of sexual assault B. Sexual assault – unwanted sexual contact, whether genital, oral, rectal, or manual (prosecuted as a crime) C. Rape – penile penetration of the genitalia or rectum without the consent of the victim (felony offense) D. Characteristics of victims of sexual assault/rape 1. Statistical patterns show that adolescent females younger than 18 are most likely group to be victimized; rape occurs every 2 minutes on average; most likely to be raped by someone she knows 2. One-third of all juvenile sexual abuse victims are younger than 6 years old; children raised in families where there is domestic violence are 8 times more likely to be sexually molested 3. Sexual assault victims may be physically injured or killed and commonly

Discussion Topics

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Obtain the number of the local agency to report suspected abuse.

Points to Emphasize Remember that documentation must be done in a professional manner with no opinions of others.

Knowledge Application Give students a child abuse scenario, along with the care provided. Have students complete a run report for homework, focusing on proper and complete documentation.

Discuss with students the steps they can take to preserve evidence in a sexual abuse case.

Discuss with students the different date rape drugs used in sexual assault, along with the medical side effects the patient may present with.

Critical Thinking Questions What range of emotions do you think you may see when administering care to a victim of sexual abuse?

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 6 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

E.

F.

G.

H.

suffer internal injuries, infections, sexually transmitted diseases (STDs), unwanted pregnancies.

4. Psychological damage includes shame, anger, lack of trust.

5. Children find it difficult to speak about molestation; likely they know the person and fear reprisal; causes confusion of situation, and child fears no one will believe him.

6. Symptoms of sexual abuse include nightmares, restlessness, withdrawal tendencies, hostility, phobias, regressive behaviors, truancy, promiscuity, drug and alcohol abuse.

Characteristics of Sexual Assailants 1. Assailants come from every background.

2. Some characteristics include abused as children, believe that domination is part of relationship, under influence of drugs or alcohol.

3. Victims may be drugged by assailant, which will cause signs of extreme intoxication without smell of alcohol, or drug-induced amnesia, which will make questioning difficult.

Date Rape Drugs 1. Medications that facilitate a sexual assault by rendering a person unresponsive, weaken the ability to resist attacker, cause amnesia of event 2. Drugs associated with rape (predator drugs) include Rohypnol, GHB, ketamine, MDMA. 3. Note any suspicions or observations that suggest use of date rape drugs.

EMS Responsibilities 1. Primary responsibility is safety for yourself, crew, and patient.

2. Provide safe environment.

3. Provide proper psychosocial care and privacy.

4. Use open-ended questions that allow patient to reestablish a sense of control.

Human Trafficking 1. Human trafficking including sex trafficking, labor trafficking, forced marriages, similar abuses.

2. Traffickers use violence, threats, deception, debt bondage, other manipulative tactics.

3. Vulnerable populations: children under 18 induced into commercial sex, adults over 18 induced into commercial sex, children and adults induced

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Master Teaching Notes Class Activities Have a police officer from your community who specializes in investigation of sexual assault speak with students about the characteristics of this abuse.

Points to Emphasize Remember to be nonjudgmental when dealing with sexual abuse patients.

Knowledge Application Give students a sexual abuse scenario, with the care provided. Have students complete a run report for homework, focusing on proper and complete documentation.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 6 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

to perform labor or services 4. Indicators: disconnected from friends, family and activities, stopped attending school, sudden change in behavior, engaged in commercial sex acts, disoriented or confused, show signs of abuse, act fearful or submissive, denied of care, someone else is in control of the situation, coached on what to say, live in unsuitable conditions, lack personal possessions, able to leave where they live, or unreasonable security measures 5. If you have identified someone in a human trafficking situation, contact law enforcement immediately.

I. Hate Crimes 1. Crime of hatred or prejudice in which target is particular victim(s) because of perceived membership in certain social group 2. Groups include racial, religious, sexual orientation, political, disability, other social groups.

3. Based on bias and referred to as bias-motivated crime 4. Involve vandalism, intimidation, assault, violence 5. EMS safety requires treating hate crimes as dangerous situations and involving law enforcement early.

J. Legal Considerations 1. Abuse and assault are crimes.

2. You have a responsibility for reporting suspected cases, accurately documenting your findings, and learning about available resources in your area.

3. Remember that evidence must be maintained.

5

XX. Summary A. You will likely experience an abuse case during your paramedic career.

B. Remember that you have a duty to report abuse situations, whether or not you transport the patient.

C. It is important to recognize the significant physical and emotional assessment findings, as well as the characteristics of victims and assailants, as you may be the only chance a victim has of being saved from further abuse.

XXI.

Case Study

5

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Class Activities Discuss the case with students now that they are familiar with the chapter.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 6 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

XXII.

You Make the Call

Class Activities Read and discuss the call and questions as a group.

XXIII.

Review Questions

Class Activities

5

5

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Pass out review questions before the lesson starts. Have students answer them.

Go over the questions again after the lecture to assess students’ understanding of the information.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

MASTER TEACHING NOTES

Detailed Lesson Plan Chapter 7 The Challenged Patient 100–120 Minutes

• • • • • •

Teaching Tips Discussion Topics Critical Thinking Questions Class Activities Points to Emphasize Knowledge Application

Chapter 7 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline I.

Case Study

5

5

25

Master Teaching Notes Teaching Tips Have a student read the scenario. Tell students that the case will be reviewed after the lecture.

II. Introduction A. During your EMS career, you will encounter patients who live with a variety of special needs.

B. Treating the “challenged” patient involves understanding and recognizing the special condition of your patient and making any needed accommodations.

III. Physical Challenges A. Physical impairment – condition that limits the use of one or more parts of the body B. Important to quickly recognize impairment and adjust assessment accordingly C. Hearing Impairments 1. Decrease or loss in ability to distinguish or hear sounds 2. Inability to hear is called deafness (complete or partial); can be present at birth or result from aging, accident, or illness.

3. Two types of deafness are conductive deafness and sensorineural a.

Conductive – any condition that prevents sound waves from being transmitted from external ear to middle/inner ear; can be temporary or permanent (otitis media, earwax, swimmer’s ear, obstructions, etc.) b.

Sensorineural deafness – inability of nerve impulses to reach auditory center of brain due to damage to inner ear or brain; usually

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed..

Teaching Tips Pull up common words used in EMS that are transferred to American Sign Language.

Discussion Topics Discuss with students ways in which they can avoid injuring themselves and their patients when providing care for individuals who are obese.

Discuss with students the different medical tests and assessments that may need to be altered in an obese patient (e.g., electrocardiogram [ECG] placement, blood pressure cuff size, lung sounds, etc.).

1

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 7 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline a permanent condition (congenital defect, birth injury, illness, tumor, concussion, injury, loud noises, presbycusis) 4. Recognition of deafness – repeat of questions, misunderstand answers, respond inappropriately, hearing aids, poor diction, use of hands for gesturing or sign language 5. Accommodations for deaf patients: Identify yourself, face patient, speak in normal voice or use low-pitched voice directly into ear, turn off background noises, offer pen and paper, use interpreter for sign language, notify hospital.

D. Visual Impairments 1. Important to note whether visual impairment is a permanent disability or new symptom 2. Many causes for visual impairments, such as injury, disease, congenital conditions, infection, and degeneration of retina, optic nerve, or nerve pathway 3. Injury – Penetrating injuries can cause enucleation (removal of eyeball); chemical/thermal burns can damage cornea and lead to permanent vision loss if not treated quickly.

4. Disease – Glaucoma increases intraocular pressure on optic nerve, leading to loss of peripheral vision and blindness if not treated (primary and secondary glaucoma); diabetic retinopathy results from diabetes, which causes disorders in blood vessels leading to retina, leading to slow loss of vision and blindness.

5. Congenital and degenerative disorders – cerebral palsy, premature birth, aging, cytomegalovirus (seen in AIDS) 6. Recognizing and accommodating visual Impairments – Identify yourself as you approach, describe everything you are doing, do not pet service dog and ask permission of patient to touch animal, have person take your arm for guidance.

E. Speech Impairments 1. Difficulty with communication can hinder treatment and information 2. Types of speech impairments include language, articulation, voice production, and fluency disorders.

3. Language disorders – Impaired ability to understand spoken or written word; loss of ability to communicate in speech, writing, or signs is known

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed..

Master Teaching Notes Discuss with students the different speech impairments listed. Have students list various medical conditions that can present with speech difficulties.

Discuss with students patients with halo devices. Have students discuss various ways they may have to make accommodations for transport.

Critical Thinking Questions What are ways in which you can prevent hearing loss as a result of your job?

Class Activities Have a student use ear plugs to limit hearing and wear a blindfold to limit sight.

Have another student interview the first student and perform an assessment, using various communication techniques.

Have students practice their lifting techniques using a stretcher, stair chair, Reeves, and other equipment.

Blindfold a student and have another student practice how to guide a patient with sight limitations.

Points to Emphasize Emphasize to students that patients who have visual, hearing, or speech limitations usually have normal intelligence. Stress how the other senses are usually heightened in these patients.

2

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 7 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline as aphasia.

Sensory aphasia – can no longer understand spoken word Motor aphasia – can no longer use the symbols of speech; will understand what you are saying, but cannot clearly articulate response c.

Global aphasia – patient has both sensory and motor aphasia; cannot understand nor respond 4. Articulation disorders – dysarthria; affect the way a person’s speech is heard by others 5. Voice production disorders – quality of person’s voice is affected (hoarseness, harshness, inappropriate pitch, abnormal nasal resonance, total loss of speech) 6. Fluency disorders – stuttering 7. Accommodations for speech impairments: Do not assume that patient lacks intelligence, may be impossible to complete a thorough interview, do not rush patient or predict answers, use questions that require short and direct answers, look directly at patient, ask to repeat if you do not understand, have patient write information.

F. Obesity 1. More than 40% of people in U.S. are considered obese.

2. Obesity more difficult for EMS in regard to lifting; exacerbation of medical problems from excess weight; leads to hypertension (HTN), heart disease, diabetes, joint and muscle problems 3. Etiologies a.

Occurs when person has an abnormal amount of body fat and weight is 20–30% heavier than normal b.

Occurs from caloric intake greater that amount of calories needed, genetic factors, low basal metabolic rate 4. Accommodations for obese patients: medical history, equipment accommodations due to excess adipose tissue (electrocardiogram [ECG] placement, large blood pressure [BP] cuff, lung sounds), lifting assistance, special weight-bearing stretchers G. Paralysis 1. Paraplegic (paralyzed from waist down) or quadriplegic (paralysis of all four extremities) a. b.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed..

Master Teaching Notes Knowledge Application Create a definition list of the various impairments. For homework, have students list the meaning of each impairment listed.

3

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 7 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

2. May be ventilator dependent if C3–C5 injury (keep suction close) 3. Halo traction may be in place if injury recent; call physician on how to assist if patient unable to inform.

4. May have colostomy appliance

15

IV. Mental Challenges and Emotional Impairments A. Present a special challenge to EMS providers B. Developmental Disabilities 1. Individuals with impaired or insufficient development of brain who are unable to learn at usual rate 2. May live in residential settings, on their own, with family, or in group homes 3. Causes include genetics, brain injury, or traumatic event C. Accommodations for Developmental Disabilities 1. May be difficult to recognize until you begin interview 2. Treat patient as you would anyone else 3. May need to obtain history and chief complaint from others if patient has severe disability 4. Establish trust with patient.

5. Keep primary caregiver with you at all times if disability is severe so that patient is comfortable and you can gather information.

D. Down Syndrome 1. Extra chromosome (chromosome 21 or 22) 2. Incident increases with increased age of mother.

3. Down syndrome presents with recognizable features: a.

Eyes sloped at outer corners, folds of skin on side of nose that cover inner corner of eyes, small face and facial features b.

Large and protruding tongue, flattening of back of head, short and broad hands c.

Mild to moderate developmental disabilities; may have heart defects, intestinal defects, and chronic lung problems; and can develop cataracts, blindness, and Alzheimer’s at an early age

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed..

Discussion Topics Discuss with students the characteristics of Down syndrome and fetal alcohol syndrome (FAS), along with typical medical conditions they may expect to respond to with these patients.

Class Activities Have a representative from your local board of developmental disabilities come in to discuss with students the different developmental disabilities.

4

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 7 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

4. Remember to consider the level of developmental delay during assessment and transport.

E. Fetal Alcohol Syndrome (FAS) 1. Preventable disorder caused by excessive alcohol consumption during pregnancy 2. Characteristics of FAS children include: a.

Small head with multiple facial abnormalities, small eyes with short slits, wide and flat nose bridge b.

Lack of groove between nose and lip, small jaw 3. Often exhibit delayed physical growth, mental disabilities, and hyperactivity

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed..

5

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

35

V. Pathological Challenges A. Patients with chronic conditions will be encountered by EMS, with interventions and transports possibly being higher than average.

B. Arthritis 1. Three common types include juvenile (before age 16), rheumatoid (autoimmune), osteoarthritis (degenerative) 2. Causes painful swelling and irritation of joints, joint stiffness, and limited range of motion; some smaller joints may become deformed 3. Treatment includes: aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids; some treatment may be for side effects of medications (upset stomach, vomiting, hyperglycemia); transport in position of comfort C. Cancer 1. Blanket term for many diseases that have a common ground of abnormal growth of cells in normal tissue; site of origin determines type of cancer; carcinoma – starts in epithelial tissue; sarcoma – starts in connective tissue 2. Signs of cancer may be difficult to see, although signs of cancer treatment may appear, such as hair loss, loss of appetite, weight loss, radiation tattoos, removal of tissue.

3. Treatment includes reduce exposure to infection because patient may be neutropenic (low levels of neutrophils), keep mask on patient, use sterile technique if you must start IV. D. Cerebral Palsy

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed..

Teaching Tips Using pictures, go over polio with students, including the use of iron lungs.

Critical Thinking Questions What medical procedures could increase the risk of infection in a patient undergoing chemotherapy?

Class Activities Create scenarios for each common chronic condition listed. Focus on signs and symptoms, and have students perform complete assessments, including treatment options. (This should be done over several lab sessions, as it can be time consuming.)

Hot glue tongue depressors into the fingers of a pair of gloves. Have students wear these gloves and attempt to pick up objects, button a coat, tie a shoe, and write with a pen (arthritis example).

6

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 7 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline 1. Group of disorders caused by damage to cerebrum in utero or trauma during birth (any event that leads to hypoxia in the fetus) 2. Causes include premature birth, brain damage from difficult delivery, encephalitis, meningitis, head injury 3. Patient have difficulty controlling motor functions, spasticity of muscles, may affect one or more limbs or entire body; some patients may have below-normal intellectual capacity, seizures; some patients highly intelligent 4. Three types of cerebral palsy: a.

Spastic – most common form, muscles in state of permanent stiffness and contracture b.

Athetosis – involuntary writhing movement c.

Ataxia – rarest form, problems with coordination of gait and balance 5. Treatment includes: do not assume patient cannot communicate with you, special devices may be used for mobility, make accommodations in transporting to prevent further injury.

E. Cystic Fibrosis (Mucoviscidosis) 1. Inherited disorder that involves exocrine glands, primarily in lungs and digestive system; causes thick mucus to form in lungs, obstructing bronchioles and collapsing alveoli; also causes blockages in the pancreas, leading to malnutrition.

2. History includes high concentration of chlorine in sweat (sweat test), lung infections, clay-colored stools, clubbing of fingers/toes 3. Medical advances have extended life of cystic fibrosis patient into 30s 4. Treatment includes: remember developmental stage of patient, comfort, O2, suctioning.

F. Multiple Sclerosis 1. Disorder of central nervous system (CNS) that usually strikes between ages 20and 40, affecting women more than men 2. Cause unknown, considered autoimmune 3. Characteristics include inflammation of myelin sheaths surrounding nerves, blocking nerve impulses to affected areas.

4. Slow onset, with slight change in strength of muscle, numbness/tingling, increasingly tired, unsteady gait, slurred speech, eye problems 5. Initial signs usually temporary, with return more frequent and lasting

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed..

Master Teaching Notes Make a mold of a kyphotic back using plaster of Paris. Insert this mold into a vest jacket. Have students immobilize each other wearing this vest (demonstrates the importance of padding when immobilizing patients).

Have a nurse who specializes in special needs patients come in to discuss the different emergencies seen by EMS.

Knowledge Application Create a chart that lists each common chronic condition listed. For homework, have students list signs and symptoms, definitions, and treatment.

7

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 7 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

longer; symptoms become more permanent, leading to weakness or paralysis.

6. Treatment includes supportive care, O2, comfort, bring assistive devices with you.

G. Muscular Dystrophy (MD) 1. Group of hereditary disorders characterized by progressive weakness and wasting of muscle tissue 2. Most common form is Duchenne MD, which affects boys between ages 3 and 6.

3. Progressive muscle weakness that leads to paralysis, affecting heart, and causing death at an early age 4. Other forms of MD are classified by age and muscles affected.

5. Treatment includes complete history, respiratory support, comfort.

H. Poliomyelitis 1. Communicable disease that affects gray matter of brain and spinal cord 2. Highly contagious, but immunization makes polio very rare in developed nations.

3. People born before polio vaccination may be affected.

4. Characteristics: enters through gastrointestinal (GI) tract, circulates, enters bloodstream, is carried to CNS, and alters nerve cells; paralytic polio causes asymmetrical muscle weakness and permanent paralysis 5. Signs include permanent paralysis of affected limb, use of assistive device, muscle atrophy, respiratory paralysis with tracheostomies and ventilators.

6. Post-polio syndrome develops in patients who suffered from polio more than 30 years ago; a condition that results from long-term weakness in affected nerves; patients tire easily, develop intolerance to cold.

7. Treatment includes supportive care.

I. Previous Head Injury 1. May be difficult to recognize initially; usually apparent once patient begins to speak 2. Signs include symptoms similar to a stroke without the hemiparalysis, aphasia, slurred speech, loss of vision or hearing, learning disability, short-term memory loss.

3. Treatment includes history, slow physical assessment, comfort. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed..

8

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 7 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

J. Spina Bifida 1. Congenital abnormality that falls under neural tube defects; defect in closure of backbone and spinal cord 2. Symptoms include depends on what part of spinal cord is protruding; may have paralysis of lower extremities, lack of bowel or bladder control; possible collection of fluid in brain, with shunt present.

3. Treatment includes: many spina bifida patients have latex allergy; take any assistive devices patient uses.

K. Myasthenia Gravis 1. Autoimmune disease characterized by chronic weakness of voluntary muscles and progressive fatigue 2. Results from problem with neurotransmitters, causing blockage of nerve signals to muscles; commonly occurs in women age 20–50.

3. Signs and symptoms include lack of energy, especially at night; eyelid drooping; difficulty chewing/swallowing; double vision; severe cases may include respiratory muscle paralysis.

4. Treatment includes supportive care, accommodation, assisted ventilation if in respiratory arrest.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed..

9

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 7 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes 10

5

Content Outline VI. Other Challenges A. Special situations that will affect quality of patient service provided B. Culturally Diverse Patients 1. Ethically required to care for all patients, regardless of race, gender, religion, ethnicity, or living condition 2. Remember that your patient who has decision-making capabilities has a right to self-determination.

3. Accommodating cultural diversity requires patience and ingenuity C. Terminally Ill Patients 1. Emotional challenge 2. Family may call ambulance at last minute, new condition may arise that can be treated, or medication may change.

D. Patients with Communicable Diseases 1. Always withhold personal judgment.

2. Take Standard Precautions as you would with any patient.

E. Patients with Financial Challenges 1. Part of your job is to inform patients where and how they can obtain medical care, regardless of financial situation.

2. Always treat the patient, not the financial condition of the patient.

Master Teaching Notes Discussion Topics Discuss with students different cultures and medical beliefs.

Discuss with students the various resources available in your area for patients with no health insurance.

Critical Thinking Questions Why might a patient with a communicable disease feel offended when you use universal precautions?

Class Activities Create a scenario in which a student has to provide care to an individual from a culture that does not accept blood products, male providers to female patients, and so forth.

Have students role-play their responses, and discuss how they can modify assessment and care to accommodate patients.

VII. Summary A. More and more patients with special challenges are living at home rather than in medical facilities.

B. EMS may be summoned for complications of chronic illnesses.

C. Keeping patients’ best interests in mind includes physical, emotional, financial, and spiritual aspects.

D. It is your responsibility to treat all patients with respect and dignity.

VIII.Case Study

5

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed..

Class Activities Discuss the case with students now that they are familiar with the chapter.

10

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 7 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

IX. You Make the Call

Class Activities Read and discuss the call and questions as a group.

X. Review Questions

Class Activities

5

5

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed..

Pass out review questions before the lesson starts. Have students answer them.

Go over the questions again after the lecture to assess students’ understanding of the information.

11

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

MASTER TEACHING NOTES

Detailed Lesson Plan Chapter 8 Acute Interventions for the Chronic Care Patient 110–130 Minutes

• • • • • •

Teaching Tips Discussion Topics Critical Thinking Questions Class Activities Points to Emphasize Knowledge Application

Chapter 8 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline I.

Case Study

5

5

35

Master Teaching Notes Teaching Tips Have a student read the scenario. Tell students that the case will be reviewed after the lecture.

II. Introduction A. Major trend in modern medicine is to place patients back in their homes as soon as possible, which has caused a huge increase in home health care needs.

B. More and more patients will receive treatment in out-of-hospital setting.

III. Epidemiology of Home Care A. Growth of home care includes enactment of Medicare; growth of health maintenance organizations (HMOs); improved medical technology, improved recovery rate, and lower costs with home care B. Implications of EMS include assumption of greater responsibility for treatment and ALS intervention.

C. In home care setting, numerous medical devices may be encountered.

D. Must be familiar with basic functions of medical devices to be able to provide patient care.

E. Patients Receiving Home Care 1. Almost 75% of home care patients are > 65 years old, almost two-thirds female and receive acute and chronic care from paid providers and family members/volunteers.

2. Average assistance is 4 hours per day, 7 days a week.

3. Government reduction of home health care has put tremendous strain on EMS and is partially responsible for hospital emergency department

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Discussion Topics With students, discuss the benefits and disadvantages of continuing care at home.

Attempt to obtain an estimated hospital bill for a 5-day stay for congestive heart failure (CHF). Compare this bill to a bill for the same length of time for a patient with the same condition who is being cared for at home.

Critical Thinking Questions What do you think the stress risks are for family members who care for other family members at home? What are ways to control the stress?

1

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 8 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline (ED) overcrowding.

F. ALS Response to Home Care Patients 1. Some situations that may require treatment include equipment failure, unexpected complication, absence of caregiver, need for transport, inability to operate device, and so forth.

2. Primary role of paramedic is to identify and treat any life-threatening problems.

3. Use home care providers as important source of information, as they are familiar with patient condition.

G. Typical Response 1. Home care patient usually in more fragile medical state 2. Monitor patient carefully, and be ready to intervene.

3. Typical responses include: a.

Airway complications – always utmost concern; problems include inadequate pulmonary output, alveolar ventilation, and alveolar oxygenation b.

Respiratory failure – most common includes: emphysema, bronchitis, asthma, cystic fibrosis, congestive heart failure (CHF), pulmonary embolus, sleep apnea, Guillain-Barré syndrome, myasthenia gravis c.

Cardiac decompensation – true medical emergency that can lead to life-threatening shock; patient at risk if cardiac demand more than cardiac ability; causes include CHF, acute myocardial infarction (AMI), hypertrophy, calcification of conduction system, heart transplant, sepsis d.

Alterations in peripheral circulation – limited mobility causes entire circulatory system to be weaker and less effective; as muscle tone decreases, so does flow of blood, which can lead to increased risk of infection and gangrene e.

Altered mental status – subtle or obvious change in mental status; always suspect other causes in addition to exacerbation of condition; risks include hypoxia, hypotension, sepsis, altered electrolytes, hypoglycemia, Alzheimer’s, tumor in brain, overdose, stroke f.

Gastrointestinal (GI)/genitourinary (GU) crisis – often revolves

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Master Teaching Notes What role does the caregiver play in your care? Do you think that it is to the patient’s advantage to include the caregiver in decisions? Why or why not?

Class Activities Obtain equipment and/or pictures of equipment that is commonly found in the home (e.g., oxygen concentrators, ventilators, continuous positive airway pressure [CPAP], apnea monitors, etc.).

With students, review the uses and common equipment failures of each.

Points to Emphasis Stress to students that these patients’ immune systems may already be compromised, due to condition and medication. Infection control is indicated with all patient care.

Knowledge Application Have students create a chart that lists the typical emergencies EMS may respond to, and what the causes may be.

2

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 8 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

around misplaced or removed catheter; inability to eat or urinate can compromise an already weakened patient g.

Infections/septic complications – always maintain high suspicion of infection, due to decreased immune response, poor general health, specific disease; be alert for infections involving indwelling devices h.

Patients with decreased sensorium are at risk for infection due to inability to feel area; general signs of infection include: redness or swelling at site, purulent discharge, warm skin at site, fever; sepsis signs include: redness, fever, altered mental status, poor skin turgor or color, signs of shock, vomiting, diarrhea i.

Equipment failure – power may go out, resulting in machine not functioning; machine may break; examples include ventilators, O2 delivery systems, apnea monitors, home dialysis machines j.

Other medical disorders and home care patients: brain or spinal trauma, arthritis, psychological disorders, cancers, hepatitis, AIDS, transplants, and so forth H. Commonly Found Medical Devices 1. If unfamiliar with a patient’s medical device, ask questions about its usage; do not endanger the patient by pretending to know the equipment if you don’t.

2. Glucometers, IV infusions and indwelling IVs, nebulizers, aerosol medication administrators, shunts, fistulas, venous grafts, O 2 concentrators, O2 tanks, liquid oxygen systems, O2 masks, tracheostomies, home ventilators, G-tubes, colostomies, urostomies, surgical drains, apnea monitors, cardiac monitors, pulse oximetry, wheelchairs, canes, walkers I. Intervention by a Home Health Care Practitioner or Physician 1. Usually require acute intervention for problems such as inadequate respiratory support, acute respiratory events, cardiac events, sepsis, GI/GU crisis 2. Determine whether another health care professional was present before your arrival and, if so, what instructions were conveyed 3. Hospice patients have special psychological needs due to situation.

4. Be alert for pharmacologic emergencies.

J. Injury Control and Prevention ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

3

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 8 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

1. Most effective intervention is prevention 2. Ten steps to injury prevention: a. Prevent creation of hazard. b. Reduce amount of hazard. c. Prevent release of existing hazard. d. Modify rate of distribution of hazard. e. Separate hazard and protect from time and space. f. Separate hazard and protect by barrier. g. Modify qualities of hazard. h. Make protection resistant to hazard. i. Counter damage already done. j. Stabilize and repair/rehabilitate damage.

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IV. General System Pathophysiology, Assessment, and Management A. Management 1. Becoming familiar with the pathophysiology of the particular diseases commonly found in the home care setting will allow for a more confident assessment 2. Emotional needs of patients and caregivers can affect patent condition 3. Sensitivity must be expressed, which will allow an efficient assessment B. Assessment 1. Same steps as with any other patient 2. Modify your assessment to look for unique conditions that may be observed in a home care patient.

C. Scene Size-Up 1. Look for any equipment alerting you to chronic problems (e.g., wheelchair ramp, O2 equipment, sharps container, hospital bed).

2. Make personal contact with all on scene.

3. Be aware of special hazards with infectious wastes, medical supplies, and equipment.

4. Observe patient environment (patient milieu) for cleanliness and safety.

D. Primary and Secondary Assessment 1. ABCs, existing problem versus new problem, treat patient as you see him, vital signs 2. Mental status evaluation may include caregivers and or family members; secondary assessment may show treatable cause if problem.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Discussion Topics Using pictures or PowerPoint, show slides of various medical equipment, and discuss with students what condition the patient may have that necessitates the particular piece of equipment.

Critical Thinking Questions Would it be poor patient care to transport a patient in his own equipped vehicle if there are no issues with the ABCs?

Class Activities Create a scenario with a patient who suffers from a chronic illness. Make the patient complaint acute and not pertaining to chronic illness. Review the scenario with students, focusing on the ABCs.

4

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 8 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

3. Inquire about do not resuscitate (DNR) orders.

E. Transport and Management Treatment Plan 1. Replacement of home care treatment with ALS 2. May have to support mechanisms on ambulance.

3. Use caregivers during transport to aid in care.

40

V. Specific Acute Home Health Situation A. Respiratory Disorders 1. Account for > 600,000 patients 2. Devices used include O2 equipment, suctioning, aerosol and nebulizers, incentive spirometers, home ventilators, tracheostomy tubes and collar.

3. Chronic diseases requiring home respiratory support: a.

Chronic obstructive pulmonary disease (COPD), bronchitis and emphysema, asthma, congestive heart failure (CHF), cystic fibrosis, bronchopulmonary dysplasia, neuromuscular degenerative diseases, muscular dystrophy, Guillain-Barré syndrome, myasthenia gravis, sleep apnea, patients awaiting lung transplants 4. Medical therapy found in the home setting: a.

Home oxygen therapy, artificial airways/tracheostomies 5. Management a.

If EMS has been called, it usually means that the caregiver and/or patient has not been able to solve the problem. b.

Ensure that ventilations are adequate. c.

Check all oxygen equipment for loose connections or tubing, and check patient for any obstructions. d.

Intubation of stoma may be necessary.

6. Home ventilation a.

Positive and negative pressure ventilators may be encountered. b.

Common reasons for ventilator include decreased respiratory drive, (spinal cord injury), ventilator muscle weakness (muscular dystrophy, polio, myasthenia gravis, Guillain-Barré syndrome), obstructive pulmonary disorders (COPD, sleep apnea, cystic fibrosis, bronchopulmonary dysplasia), other disorders (pediatric sleep apnea, chest wall deformities). c.

Positive pressure ventilators push air into lungs through face mask,

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Teaching Tips Using pictures or equipment, go over vascular access devices (VADs), urinary and gastrointestinal (GI) catheters, and feeding tubes and their various uses and complications.

Discussion Topics Discuss with students the common medications used by the home health care patient.

Critical Thinking Questions When would using a patient’s VAD be beneficial? What do you think the risks might be?

Class Activities Have students practice tracheal suctioning, removal and replacement, aerosols, CPAP, bilevel positive airway pressure (BiPAP), and bag-valve mask (BVM) through a stoma techniques during skills lab, along with any other special equipment indicated in your protocol.

When practicing suctioning, have students practice going through a stoma and the correct measurement of tubing, along with

5

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 8 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline nasal mask, or tracheostomy; features include variations in tidal volume, respiratory rate, flow rate, and pressure. d.

Negative pressure ventilators: with expansion, pull on chest, causing it to expand and allowing air to flow into lungs, mimicking normal breathing process; iron lung, poncho-wrap are examples, commonly used at night. e.

Positive end-expiratory pressure (PEEP), continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP): add pressure at various times in respiratory cycle; may be used full-time or part-time; danger of pneumothorax exists due to increased pulmonary pressure f.

PEEP: used to keep alveoli from collapsing; provides back pressure at end of expiration; can be used in premature newborns with insufficient surfactant, washout from acute pulmonary edema, acute respiratory distress syndrome (ARDS), drowning, COPD (pursed lips in a COPD patient is PEEP) g.

CPAP: used to keep pharyngeal structures from collapsing at end of a breath; often used for sleep apnea (Idea of CPAP same as PEEP; just that CPAP is through a mask, and PEEP is through an endotracheal tube [ET] tube.) h.

BiPAP: provides two levels of pressure, one on inspiration and one on expiration; used when higher levels of pressure are required 7. General management considerations a.

Primary assessment includes ABCs, level of consciousness (LOC), breathing and circulatory distress, including equipment used by patient.

B. Vascular Access Devices(VADs) 1. Used to provide any parenteral treatment on a long-term basis 2. Device depends on treatment and disease 3. Types of VADs a.

Hickman, Broviac, Groshong catheters – single, double or triple lumen; inserted into any central vein in trunk of body, subclavian most common; external port that looks like typical IV port; external hub sutured to skin; highest risk of infection is first 2 weeks; care consists of keeping site clean and dry, along with anticoagulant

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Master Teaching Notes insertion of normal saline to loosen secretions.

Have students practice assembling CPAP and BiPAP devices.

Create several scenarios using equipment that requires electricity. Focus your scenario on power failures and how students would provide care to patients when there is no electricity.

Using an extension set, have students practice flushing a line, along with locking it off.

Have a student sit in a wheelchair, hooked up to a nasal cannula and an oxygen cylinder. Have two other students attempt to pick the student up and transfer him or her to a stretcher. Discuss the difficulties and accommodations that must be made.

Ask a home health nurse to speak to the class to discuss care and equipment, along with the role of EMS.

Points to Emphasize Stress to students that if they do not know the equipment, they should ask. NEVER touch equipment you do not know.

Knowledge Application Create a list of various home health care equipment; for homework, have students 6

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 8 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline therapy.

Peripherally inserted central catheter (PICCs) – PICC lines, inserted into peripheral vein; allow for catheter to be inserted into central venous circulation; low complication rate due to insertion by radiology c.

Surgically implanted medication delivery system – Port-A-Cath, Medi-Port; infusion port is implanted below skin and requires a specially shaped needle to access; usually found in upper chest; never access unless protocol allows. d.

Dialysis shunts – used for patients undergoing hemodialysis to filter blood; AV shunt is a loop connecting an artery and vein, usually in distal arm; fistula connects an artery and a vein, creating an artificial blood vessel, usually found in upper extremity; both are surgically created and very delicate; avoid application of blood pressure and vascular access on extremity.

4. Anticoagulant therapy – used to flush device to prevent clot formation; patient’s natural clotting mechanism may be suppressed, leading to bleeding disorders.

5. VAD complication – most commonly result from obstructions; other complications include catheter kinking, catheter tip embolism, infection, hemorrhage.

6. Potential for air embolism – signs and symptoms include headache, shortness of breath (SOB) with clear lungs, hypoxia, chest pain, indications of myocardial infarction (MI), altered mental status.

C. Cardiac Conditions 1. Conditions for home health patients include post-MI recovery, postcardiac surgery, heart transplant, CHF, hypertension, implanted pacemaker, atherosclerosis, congenital malformation.

2. Equipment may include O2, electrocardiogram (ECG), bedside monitor, halter monitor, defibrillator.

D. GI/GU Disorders 1. Response may be ALS or a needs-based assessment.

2. Urinary tract devices a.

Devices that support patients with urinary tract dysfunction b.

External catheters – Texas catheter (condom catheter) b.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Master Teaching Notes list the different medical reasons a patient may require the equipment.

7

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 8 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

Internal catheters – Foley, indwelling catheter; long catheter with balloon tip d.

Suprapubic catheters – similar to internal catheters; inserted directly through abdominal wall e.

Urostomies – surgical diversion of urinary tract to a stoma (hole) in abdominal wall, with a collection device attached to stoma outside the body to collect urine 3. Urinary device complications a.

Most complications result from infection or device malfunction. b.

Signs of infection include foul-smelling urine, altered urine color, redness, swelling, heat, discharge, loss of skin integrity, systemic infection. c.

Malfunctions include accidental displacement, obstruction, balloon ruptures, leaking, changes to anatomy, kinks in tubing.

4. Gastrointestinal tract device a.

Wide variety of devices include nasogastric (NG) tubes, feeding tubes, gastrostomy tubes. b.

NG tubes – commonly seen, used to decompress gastric contents, lavage GI system c.

Feeding tubes – rest in either duodenum or jejunum, often weighted and used for supplemental nutrition d.

Gastrostomy tubes – used for longer-term supplemental nutrition; many forms that have different means of insertion, location, and function e.

Colostomy – bypasses part of large intestine and allows feces to be collected outside of body in collection bag 5. Gastrointestinal tract device complications a.

Complications often result from tube misplacement, obstruction, or infection. b.

Ensure patency of tube.

5. Psychosocial Implications: Most patients lead normal and active lives; may be self-conscious about condition. Be sensitive to patient needs.

E. Acute Infection 1. Wounds may be surgical or other loss of skin integrity.

2. Wound dressing, gauze packing, site drains, sutures, wires, staples, or c.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

8

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 8 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

adhesives may be present.

3. Assessment of wounds includes improper wound healing, redness, compromised state of patient, and increased risk of wound infection.

F. Maternal and Newborn Care 1. Short hospital admission with childbirth and rapid discharge may result in an unrecognized condition or complication stemming from delivery 2. Common maternal complications a.

Most common complications are postpartum bleeding and embolism. b.

Management of embolism same as for any other patient c.

Management of postpartum bleeding includes massage of uterus, administration of fluids, Pitocin, transport d.

Other complications include. postpartum depression, inexperience. e.

Always take parental concerns seriously.

3. Common infant/child complications a.

Cardiac, respiratory, or other congenital defects, as well as prematurity, dehydration, sepsis b.

Respiratory or cardiac signs include cyanosis, bradycardia (< 100), crackles, respiratory distress; treatment includes: bag-valve mask (BVM), endotracheal tube (ET), cardiopulmonary resuscitation (CPR) if heart rate < 80 after 30 seconds of O2, keep warm. c.

Dehydration treatment: IV and fluids, with blood glucose level (BGL) monitoring d.

Septic infants present with fever, tachycardia, irritability. e.

Common medical equipment for children with long-term health problems includes mechanical ventilators, O2 therapy, IV or IV nutrition, tracheostomies, feeding tubes, pulse oximeters, apnea monitors.

G. Hospice and Comfort Care 1. Provide support for the terminally ill and their families.

2. Up to 450,000 people per year receive hospice services funded by Medicare or Medicaid; thousands more receive care from private/volunteer agencies.

3. Goal is to provide palliative care; seeks to relieve symptoms, manage pain, and allow patients control over end of life. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

9

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 8 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

4. ALS Intervention: EMS may be summoned for intervention or transport.

5. A DNR order does not prevent palliative or comfort care.

6. Common diseases seen in hospice include CHF, cystic fibrosis, COPD, AIDS, Alzheimer’s disease, cancer.

7. Medications seen include morphine (high doses), Percocet, Oxycontin, Duragesic patch, portable pump.

8. Establish communication with health care worker, gaining understanding of patient wishes.

9. Not all terminally ill patients are under care of hospice; make sure to determine course of treatment.

10. Five stages of grief that patient and family encounter are denial, anger, depression, bargaining, and acceptance.

5

VI. Summary A. In your career, you will provide acute care to the chronic care patient.

B. Your assessment skills will be challenged; development of an effective management plan, which will include input from the home health care team, will also be challenging.

VII. Case Study

Class Activities Discuss the case with students now that they are familiar with the chapter.

VIII.You Make the Call

Class Activities Read and discuss the call and questions as a group.

IX. Review Questions

Class Activities

5

5

5

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Pass out review questions before the lesson starts. Have students answer them.

Go over the questions again after the lecture to assess students’ understanding of the information.

10

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

MASTER TEACHING NOTES

Detailed Lesson Plan Chapter 9 Ground Ambulance Operations 95–105 Minutes

• • • •

Teaching Tips Discussion Topics Class Activities Knowledge Application

Chapter 9 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline I.

Case Study

5

10

Master Teaching Notes Teaching Tips Have a student read the scenario.

Tell students that the case will be reviewed after the lecture.

II. Introduction A. Ambulance Standards 1. Standards are influenced by administrative rules and regulations.

2. Oversight usually falls to state governments and is written in state statutes or regulations.

3. State EMS code may regulate essential equipment carried on every ambulance.

4. States typically set minimum standards.

B. Ambulance Design 1. The Department of Transportation (DOT) KKK1822F specs attempt to influence safety standards as well as the look of ambulances. i.

Type I conventional truck cab-chassis with modular ambulance body ii.

Type II standard van forward control integral cab body iii.

Type III specialty van forward control integral cab body 2. Some states have chosen to develop their own standards and often use the federal standards as a starting point.

3. The National Highway Traffic Safety Administration (NHTSA) and National Institute for Occupational Safety and Health (NIOSH) are collaborating on a 4-year research project to improve existing

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Discussion Topics What are the advantages and disadvantages of each type of ambulance? What is used in your area, and how will it affect your care?

1

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 9 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

standards to make patients and EMS workers safer in the rear compartment.

C. Medical Equipment Standards 1. Occupational Safety and Health Administration (OSHA) has become more involved in ambulance standards. i.

OSHA helps to ensure the use of equipment lists calling for disinfecting agents, sharps containers, red bags, highefficiency particulate arresting (HEPA) masks, and personal protective equipment (PPE) D. Additional Guidelines 1. At the national level, the Commission on Accreditation of Ambulance Services (CAAS) provides a voluntary gold standard for the EMS community to follow. i.

It requires that on-board medical equipment comply with state and local regulations and also sets guidelines when unavailable. ii.

The guidelines meet or exceed those established by the American College of Surgeons.

10

III. Checking Ambulances A. An essential part of each paramedic’s duties includes completion of the ambulance equipment and supply checklist.

1. The components include the following: i. Patient infection control, comfort, and protection supplies ii. Initial and focused assessment equipment iii. Equipment for transfer of the patient iv. Equipment for airway maintenance, ventilation, and resuscitation v. Oxygen therapy and suction equipment vi. Equipment for assisting with cardiac resuscitation vii. Supplies and equipment for immobilization of suspected bone injuries viii. Supplies for wound care and treatment of shock ix. Supplies for childbirth x. Supplies, equipment, and medications for treatment of acute poisonings, snakebites, chemical burns, and diabetic emergencies

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Class Activities The class should become familiar with stocking and supply lists.

Have them check their equipment on a regular basis just as they would if they were working. Assign groups to specific areas, and rotate the responsibility for equipment, mannequins, and supplies.

Have students discuss their experience with “stretcher day.” If the class has had little experience, go and visit a local station to watch.

2

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 9 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

xi. ALS equipment, medications, and supplies xii. Safety and miscellaneous equipment xiii. Information on the operation and inspection of the ambulance itself 2. The vehicle itself should be regularly checked so that it is always in safe working order.

3. To meet OSHA requirements, you must make sure that the ambulance has been properly disinfected after transporting patients with potentially communicable diseases.

4. All scheduled checks, tests, maintenance, and calibrations of specific medical equipment should be completed, including: i. Defibrillators or automated external defibrillators (AEDs) ii. Glucometers iii. Cardiac monitors iv. Capnograph v. Oxygen systems vi. Automated transport ventilator vii. Pulse oximeter viii. Suction units ix. Laryngoscope blades and handles x. Lighted stylets xi. Penlights xii. Any other battery-operated equipment 10

IV. Ambulance Deployment and Staffing A. The strategy used by an EMS agency to maneuver its ambulances and crews in order to reduce response time is known as deployment.

1. It is based on a number of factors: i.

Location of facilities housing ambulances ii.

Location of hospitals iii.

Anticipated call volume iv.

Specific geographic and traffic considerations 2. Ideal deployment decisions must take into account past community responses and projected demographic changes.

3. Peak load, or highest volume of calls, should be described in terms of day of the week and time of day.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Teaching Tips Deployment depends on which organization is referred to.

Depending on your class and whom they represent or plan on working with, discuss the different factors in deployment and how they affect ambulances and fire departments.

Discussion Topics How is deployment structured in 3

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 9 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline 4.Primary areas of responsibility (PARs) are areas where ambulances are deployed in high-volume locations and can vary from a few blocks to a sector of town.

B. Traffic Congestion 1. Traffic congestion as well as railroad locations must be taken into account in deploying ambulances.

2. Other considerations include ongoing daily activities such as commuter traffic and school bus schedules.

3. A system status management (SSM) is a computerized personnel and ambulance deployment system designed to meet service demands with fewer resources and appropriate response times.

4. To meet reliability standards, many communities used a tiered response system utilizing trained public safety agencies as first responders.

C. Operational Staffing 1. Ambulance staffing should take into account the peak load of the system.

2. Services should also consider the need for reserve capacity or the ability to muster additional crews.

45

V. Safe Ambulance Operations A. Educating Providers 1. The first part of any proactive collision prevention program is recognition and definition of the problem. i.

Modern automobiles are better sealed and more soundproof, making it difficult to hear an approaching ambulance. ii.

Ambulances have increased in size and weight, and performance is significantly different from that of older models.

2. The majority of collisions (55%) take place on clear days, and 67% of all collisions take place during the day.

3. Nearly 75% of the collisions take place at an intersection.

B. Reducing Ambulance Collisions 1. Implementation of certain actions or standards can help to reduce collisions.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Master Teaching Notes your area?

Discussion Topics Collisions are a leading cause of injury and death to EMS providers.

What are some things we can each do to help prevent collisions and help our crews remain safe?

Class Activities Have the class diagram where they would park their ambulance in various situations. Use the board to draw out scenes and insert hazards. Let students plan their approach and parking.

4

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 9 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline i. ii.

Routine use of driver qualification checks Demonstrated driver understanding of preventative maintenance iii.

Provision of adequate hands-on driver training using experienced and qualified field officers iv.

Implementation of a slow-speed course for practice v.

Training that ensures that operators know how to react in an emergency vi.

Demonstrated driver knowledge of primary and backup routes vii.

Demonstrated driver knowledge of rules, regulations, and laws C. Standard Operating Procedures (SOPs) 1. Each EMS agency should have SOPs pertaining to vehicle operation. i.

Procedure for qualifying as an ambulance operator ii.

Procedure for handling and reporting collisions iii.

Procedure for investigating and reviewing collisions iv.

Process for implementing quality assurance in the aftermath of a collision v.

Method of using a spotter for backing vi.

Use of seat belts in the ambulance and procedures for transporting children vii.

Guidelines on what constitutes an emergency response and the exemptions allowed by law viii.

Guidelines on prudent speed ix.

Circumstances and procedures for use of escorts x.

Zero-tolerance policy for driving under the influence D. Due Regard Standard 1. Due regard exempts ambulance drivers from certain laws but at the same time holds them to a higher standard 2. State law typically exempts ambulance drivers who are operating in an emergency from posted speed limits, posted direction of travel, parking regulations, and red light requirements ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Master Teaching Notes Knowledge Application We typically respond with multiple vehicles on each call. Depending on where you work (fire or EMS) and how responses are structured, how can we avoid the complications involved with multiple units responding to the same scene?

5

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 9 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

3. Ambulances are never exempt at railroad crossings and school

zones or buses with flashing red lights 4. As an ambulance driver, you will always be held to a higher standard

than other drivers.

5. You must be attentive and prepared to shoulder the responsibilities

that come with the profession.

E. Lights and Siren: A False Sense of Security 1. Do not rely solely on lights and siren to alert other motorists of your approach.

2. Motorists are less inclined to yield when the siren is sounded continuously.

3. Many motorists think that right-of-way privileges are abused when siren is used.

4. Inexperienced motorists tend to increase driving speed by 10–15 mph when a siren is sounded.

5. The continuous sounding of a siren will increase patient anxiety.

6. Ambulance operators may also develop anxiety as well as hearing loss.

7. Use the siren sparingly and only when you must.

8. Never assume that all motorists will hear your siren.

9. Assume that some will hear your siren but will ignore it.

10.

Be prepared for erratic maneuvers when drivers do hear the siren.

11.

Never use the siren to scare someone.

12.

Several studies have shown that the use of lights and sirens reduced response times only a modest amount that was not clinically significant.

F. Escorts and Multiple-Vehicle Responses 1. Most EMS agencies no longer suggest the use of police escorts for ambulances. i.

Ambulances and police cars have different braking distances. ii.

They have different acceleration speeds. iii.

Other motorists are not likely to realize that two emergency ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

6

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 9 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

vehicles are traveling together.

2.In multiple-vehicle responses, the dangers are the same as with escorts.

G. Parking and Loading the Ambulance 1. Park at least 100 feet from the wreckage upwind and uphill if possible.

2. If you are first on scene, make sure you park in front of the wreckage so your warning lights can alert approaching motorists.

3. If the scene has been secured, park beyond the wreckage to prevent exposure to traffic.

4. Always be aware of hazards at the scene, and always try not to expose your patient or your crew to traffic.

H. The Deadly Intersection 1. Of all collisions, 72% occur at intersections.

2. Exercise extreme caution whenever you approach one of these hazards. i.

Stop at all red lights, then proceed with caution. ii.

Always proceed through an intersection slowly. iii.

Make eye contact with other motorists. iv.

If utilizing exemptions, use all warning lights and siren. v.

Remember that lights and siren only request the public to yield. vi.

Always go around stopped vehicles on the left side. vii.

Know how long it takes to pass through an intersection to help you judge whether you have enough time. viii.

Watch pedestrians carefully. ix.

Consider “covering the brake” to shorten stopping distances.

5

VI. Summary A. As a paramedic, you should be familiar with standards that influence ambulance design, equipment requirements, and staffing.

B. You should regularly complete all checklists, whether they apply to the vehicle, on-board equipment, or essential supplies.

C. Ambulance operators have a special responsibility whenever they take the wheel.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

7

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 9 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

D. It is your professional duty to recognize the profile of a typical ambulance collision and develop strategies for preventing it from occurring.

VII. Case Study 5

IX. You Make the Call 5 X. Review Questions 5

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Class Activities Discuss the case with students now that they are familiar with the chapter.

Class Activities Read and discuss the call and questions as a group.

Class Activities Pass out review questions before the lesson starts. Have students answer them. Go over the questions again after the lecture to assess students’ understanding of the information.

8

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

MASTER TEACHING NOTES

Detailed Lesson Plan Chapter 10 Air Medical Operations 90– 100 Minutes

• • • • •

Teaching Tips Discussion Topics Critical Thinking Questions Class Activities Knowledge Application

Chapter 10 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline I.

Case Study

5

5

Master Teaching Notes Teaching Tips Have a student read the scenario.

Tell students that the case will be reviewed after the lecture

II. Introduction A. The use of aircraft for emergency patient transport has become a critical component of modern EMS practice.

1. The first major use was for scene responses.

2. The most rapidly expanding use is interfacility transports between health care facilities.

3. Specialty care can be delivered by air directly to a patient.

4. Organ procurement is a time-sensitive endeavor affected by air transport.

5. Search and rescue relies on aircraft for success.

6. Aircraft can be particularly helpful in disaster situations in which ground ambulances cannot access a scene.

B. Air medical transport is an important asset that should be considered a medical procedure with benefits and risks.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Teaching Tips If you are able to arrange a meeting with the local flight program to allow students to see the aircraft, arrange it ahead of time. This will allow the flight crew to provide specific details of their procedures and capabilities.

1

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 10 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes 10

15

Content Outline

Master Teaching Notes

III. History A. Like most aspects of emergency medicine, air medical transport origins are deeply rooted in the military.

1. The first recorded use of an airplane to evacuate casualties was during World War I by a French aircraft in Serbia.

2. During the 1920s, a fully organized air ambulance operation was utilized by both the French and British militaries.

3. January 26, 1945, was the first recorded medical evacuation by helicopter, which took place in the jungles of Burma.

4. By the 1950s, helicopter usage was common in the Korean War for both observation and medical evacuation.

5. The use of more powerful gas engines enabled larger helicopters, and casualties could now be transported inside the helicopters.

B. The civilian use of aircraft was initiated in rural areas such as Australia and Canada.

1. The first dedicated air ambulance service in the United States was in Los Angeles in 1947.

2. In 1970, the Maryland State Police established the first nonmilitary helicopter medical evacuation program.

3. In 1972, St. Anthony’s Hospital in Denver founded the first civilian helicopter air ambulance program (HAA) called Flight for Life.

4. The majority were hospital based owing to the cost.

5. As of 2010, there were approximately 730 HAA bases with 900 aircraft in the U.S. 6. In 2015, it was determined that the term “helicopter EMS (HEMS)” was obsolete and the term “helicopter air ambulance (HAA)” should be used because flight decisions should be made based on the safety of the flight, rather than the condition of the patient.

Discussion Topics

IV. Aircraft A. Fixed-Wing Aircraft 1. Most air ambulances are turbine powered and have at least two engines.

2. They have pressurized cabins, allowing safe and comfortable travel at altitudes inaccessible by unpressurized aircraft.

Discussion Topics

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Discuss the local facilities and access to air medical transport.

How likely are you to use the service in your area, and how is it activated?

Discuss the options you have in your area. Think about normal weather patterns and how they will affect your resources.

2

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 10 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline 3. Fixed-wing aircraft are typically larger than helicopters and can

transport multiple patients.

4. They must take off and land at designated airports, requiring patients to be transported by ground to meet the aircraft, which delays definitive care.

B. Rotor-Wing Aircraft 1. Most EMS helicopters are medium to small in size and have a single pilot.

2. One of the most significant limitations facing helicopters is weather. i.

Visual flight rules (VFRs) require the pilot to be able to see a horizon while flying. a. Most programs are limited to VFR flying. b. Weather minimums vary but usually require 3 miles of horizontal visibility and 1,000 feet of clearance between the ground and the lowest clouds. ii.

Instrument flight rules (IFRs) allow the pilots to use specially designated routes and only instruments to fly when visibility is lost due to weather. a. Programs with IFR still have significant limitations due to weather 3. It is difficult to determine whether a flight will be accepted, so the paramedic should request the resource and allow the flight team to make the decision.

4. The obvious advantage of helicopters is the ability to take off and land almost anywhere, which can shorten out-of-hospital times for the patient.

15

V. Role in EMS A. In many EMS systems, air medical transport has been an important part of system operations for decades.

1. By the mid-1980s, almost every major community had access to an air ambulance.

2. In 2001, the government changed the reimbursement scheme for air medical transports, resulting in a significant increase in the number of air ambulances.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Master Teaching Notes Knowledge Application Given your local air medical requirements, how does that change your treatment priorities and transport options? How will weather affect your decisions?

Discussion Topics Discuss the options you have in your area. Have students share any experiences they have had with using the various aircrafts.

What type of situations have they experienced?

3

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 10 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes Critical Thinking Questions

B. Uses 1. Initially, air ambulances were used for trauma care on the basis of

the work and writings of Dr. R. Adams Cowley, who founded the Shock Trauma Center in Baltimore. i.

He defined the golden hour. ii.

He established the network of helicopters operated by the Maryland State Police.

2. There has been a significant expansion of medical helicopter usage for interfacility transport. i.

This results from the specialization of hospitals. ii.

Air transport is an efficient, effective, and timely method of moving patients between facilities.

3. Several studies have shown limited benefit from many helicopter transports, and strategies are being investigated to target patients who benefit most. i.

Patients who do not need rapid transport or a reduced outof-hospital time, or those who can receive adequate quality of care by ground transport personnel, should be transported by ground.

C. Limitations 1. Flight may be impossible during periods of inclement weather.

2. Air medical transport is expensive and should be only used when it benefits the patient.

3. There are significant space limitations within most small- to mediumsized helicopters, which are smaller than most ground ambulances.

4. Most aircraft have significant weight and size restrictions.

D. Staffing 1. Staffing and crew configurations vary greatly in the U.S. and around the world. i.

In most instances, modern medical helicopters are staffed by a pilot and two medical providers. a. Of U.S. programs, 95% use a nurse and a paramedic. i) Occasionally, a respiratory therapist or ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

As an exercise to let your students understand the many factors that go into deciding whether to use air medical transport, go through various scenarios and have students decide whether air medical transport should be used or not. If so, what factors do they need to consider? If air medical is transport is not used, why?

4

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 10 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

neonatal nurse will replace one of the medical crewmembers. b. The physician–nurse staffing model is popular outside of the U.S. E. Controversies 1. Even though air medical transport has become a fixture, significant concern has been raised about the increased rate of crashes involving medical helicopters.

2. The Federal Aviation Administration (FAA) and National Transportation Safety Board (NTSB) have begun to investigate the number of helicopters in service and the pressures exerted to accept a flight. i.

In 2008, there were 13 crashes resulting in 29 fatalities.

3. More programs are using night vision goggles (NVGs) for night responses as well as advanced terrain avoidance warning systems.

4. The authority to regulate operations rests exclusively with the FAA. 30

VI. Scene Operations A. Initial Information 1. Location of the scene i.

GPS coordinates ii.

Cross streets iii.

Closest city/town iv.

Actual address of location v.

Well-known landmarks 2. Launch information i.

Requesting agency ID ii.

Local weather conditions iii.

Presence of hazardous materials iv.

Number of patients and basic condition B. Landing Zone (LZ) 1. The LZ should be secured early and have an LZ officer whose duties include: i.

Selection of site

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Teaching Tips Even if you are unable to get students around the aircraft in the area, perhaps the local flight program can conduct a “ground school” that teaches EMS, fire services, and law enforcement exactly how to request and be ready for their particular aircraft, including LZ selection.

Discussion Topics What are some of the designated LZs in your area? Are you familiar with them and with the terrain and/or the obstructions? Who is responsible for setting up the LZ in 5

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 10 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline ii. iii. iv. v.

Site preparation Site protection and control Air-to-ground communications with incoming aircraft Updating incident commander (IC) on estimated time of arrival (ETA) of aircraft 2. The LZ should be 100 feet by 100 feet. i.

There should be little, if any, slope. ii.

It should be clear of debris and obstructions. iii.

If the area is dusty, consider wetting the area lightly. iv.

Mark the upwind side. v.

Avoid shining lights up toward the aircraft. vi.

Colored strobes except red and white are difficult to see with NVGs. vii.

LZ security is critical from the time of approach to departure. viii.

HOTSAW is used to remind crews of potential hazards: a. Hazards b. Obstructions c. Terrain d. Surface e. Animals (including people) f. Wind/Weather C. Helicopter Approach 1. The LZ officer should remain in contact with the incoming aircraft and respond to any requests made by the pilot. i.

Turn off flashing white lights. ii.

Use spotlights to mark obstacles. iii.

Do not shine lights at the helicopter.

2. The crew will notify you when they are close, and you should listen for them and notify them when you have confirmation.

3. Use clock-based terms, and consider the nose of the aircraft as 12 o’clock when describing actions or hazards.

4. If the LZ becomes unsafe at any time, instruct the pilot to abort the landing.

5. Never allow anyone to approach the aircraft until the crew has ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Master Teaching Notes your area?

Class Activities Have students practice setting up an LZ in the area. Talk about common LZs and their advantages and disadvantages. Have students practice guiding the helicopter to the LZ and describing hazards.

6

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 10 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

indicated to do so.

6. Never approach the tail of the aircraft.

7. Always approach from the front and only after directed by the crew.

8. Always approach from downhill, and exit the same way you entered.

9. Allow the crews to open doors and remove equipment.

D. Patient Handoff 1. The flight crew will typically come to the patient to ensure adequate packaging.

2. Give a brief but concise report of the patient’s condition and describe any care provided.

E. Aircraft Loading 1. Do not hold any equipment above your shoulders.

2. Always follow flight crew directions.

3. Use eye contact with the crew.

4. Always avoid the tail of the aircraft.

F. Aircraft Departure 1. Once the crew has secured the patient, leave the LZ and remain at a safe distance.

2. Immediately notify the pilot of any hazards, and remain in contact until the aircraft is clear of the area.

5

VII. Summary A. Air ambulances are part of the modern EMS system.

B. Because of the inherent danger and cost of using medical aircraft, the potential benefit must clearly outweigh the risks.

VIII.Case Study

5

IX. You Make the Call 5

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Class Activities Discuss the case with students now that they are familiar with the chapter.

Class Activities Read and discuss the call and questions as a group.

7

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 10 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline X. Review Questions

5

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Master Teaching Notes Class Activities Pass out review questions before the lesson starts. Have students answer them. Then go over the questions again after the lecture to assess students’ understanding of the information.

8

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

MASTER TEACHING NOTES

Detailed Lesson Plan Chapter 13 Hazardous Materials 120–130 Minutes

• • • • • •

Teaching Tips Discussion Topics Class Activities Points to Emphasize Knowledge Application Decision Points

Chapter 13 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline I.

Case Study

5

5

Master Teaching Notes Teaching Tips Have a student read the scenario.

Tell students that the case will be reviewed after the lecture

II. Introduction A. Hazardous materials (hazmat) are all around us.

1. In the U.S., 4 billion tons of hazardous materials are shipped by truck, pipeline, railroad, and tankers every year.

B. They can exist as solids, liquids, or gases.

1. They can irritate, burn, poison, corrode, or asphyxiate.

C. The Occupational Safety and Health Administration (OSHA) defines hazardous materials as “any substance which may pose unreasonable risk to health and safety of operating or emergency personnel, the public, and/or the environment if not properly controlled during handling, storage, manufacture, processing, packaging, use, disposal or transportation.”

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Points to Emphasize In the past, these dangers were once thought of as rare; however, with the rapid increase in terrorism, the chance that one of your students will respond to a hazmat event is increasing. It is important to understand the different weapons of mass destruction and how a paramedic is expected to respond.

1

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 13 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes 10

Content Outline III. Role of the Paramedic A. Hazardous materials incidents present some of the most challenging situations you will face as a paramedic.

1. Traditionally, paramedics do not perform defensive (containment) and offensive (control) functions at hazmat responses, but they are still an integral part of a community’s hazmat response system.

2. As first responders, they may size up the incident, assess the toxicologic risk, and activate the Incident Command System (ICS)) system.

B. Requirements and Standards 1. OSHA and the Environmental Protection Agency (EPA) have set forth a number of regulations and standards for dealing with hazmat emergencies. i. They provide specific response procedures, including use of ICS, use of personal protective equipment (PPE), use of a safety officer, and special training requirements.

C. Levels of Training 1. The awareness level applies to responders who may arrive first at a scene and discover a toxic substance. Training focuses on recognition of hazmat events, basic hazmat identification techniques, and individual protection from involvement in the incident 2. EMS Level 1 training (operations level) is required for those who may perform patient care in the cold zone or those who do not present a risk for secondary contamination.

3. EMS Level 2 (technician level) is required for those who may perform patient care in the warm zone on patients presenting risk for secondary contamination.

4. The level of training required for each individual depends on that person’s role in the hazmat response system.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Master Teaching Notes Discussion Topics Typically, these responses require specialized training. What types of training are available to you, and what types of requirements do local EMS organizations have?

2

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 13 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes 20

Content Outline IV. Incident Size-Up A. ICS and Hazmat Emergencies 1. Priorities for a hazmat incident are the same as in any other major incident: life safety, incident stabilization, and property conservation. i.

In performing early intervention, you face the challenge of avoiding exposure to the material yourself.

2. Never compromise scene safety during the early phase of a hazmat operation. i.

Quickly determine whether the hazmat emergency is an open or closed incident.

3. Triage must be ongoing because patient conditions change rapidly.

4. The most preferable site for deploying resources will be uphill and upwind of the incident, and a basic incident will require a command post, staging area, and decontamination corridor.

B. Incident Awareness 1. One of the most critical aspects is the simple awareness that a dangerous substance may be present. i.

Always keep the possibility of dangerous substances in mind whenever approaching the scene of an emergency.

2. Transportation accidents (auto, truck, or railroad) should raise the suspicion of the presence of hazardous materials. i.

Do not rule out the presence of hazardous materials just because you do not see a warning placard. ii.

Railroad accidents merit special attention because trains can carry large quantities of hazardous materials and several tank cars may be hitched together.

3. Fixed facilities store or manufacture hazardous materials i.

Chemical plants and manufacturing areas have tanks, storage vessels, and pipelines. ii.

Warehouses, hardware and agricultural stores, water treatment centers, and loading docks are other potential sites. iii.

Many communities have some types of fixed pipelines that

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Master Teaching Notes Teaching Tips Pick several chemicals or hazardous substances. If you have some in your area, use applicable ones. Use them in the class activity, and have students identify them.

Discussion Topics Discuss the potential hazards in your local area. Are there manufacturing plants, farms, or other types of hazards?

Class Activities Practice identifying hazards using placards, the ERG, and the other sources. Determine your needs to respond to each of the chemicals/hazards you identify.

3

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 13 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

can be damaged by nature, construction crews, accidents, or terrorism.

4. Terrorists may use any variety of chemical, biological, or nuclear device to strike at government or high-profile targets. i.

Weapons of mass destruction (WMDs) can be manufactured from materials as simple as those found on most farms. ii.

Potential targets include public buildings, multinational headquarters, shopping centers, workplaces, and sites of assembly.

C. Recognition of Hazards 1. Placard classifications i.

Placards are diamond shaped and indicate hazmat classification through use of a color code and hazard class number. ii.

Symbols are used to indicate hazard types. a. When combined with numbers and colors, these symbols aid in recognition of the specific nature of a hazardous material. iii.

Some substances require a placard; others require a placard only if transported in large quantities. iv.

The “dangerous” placard indicates two or more substances between 1,000 and 5,000 lb total weight. v.

Placards may be removed or may not have been applied, leading to difficulty in identifying a threat in the first place.

2. The National Fire Protection Association (NFPA) 704 System identifies hazardous materials at a fixed facility. i.

The diamond is divided into four sections and color coded. a. The top section (red) indicates flammability. b. The left segment (blue) indicates health hazard. c. The right segment (yellow) indicates instability. d. The bottom segment (white) indicates special information. e. Flammability, health hazard, and reactivity are ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

4

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 13 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

measured on a scale of 0–4.

D. Identification of Substances 1. Once you have determined that an incident involves hazardous materials, you must next try to identify the particular substance.

2. Try to locate two or more concurring reference sources.

3. The Emergency Response Guidebook (ERG) is published by the U.S. Department of Transportation (DOT) and should be carried on every emergency vehicle. i.

It lists more than a thousand hazardous materials along with placards, UN numbers, and chemical names and cross references for each number to a specific emergency procedure. ii.

It provides only basic treatment information and can be confusing because many chemicals have the same UN number.

4. Shipping papers or bills of lading typically list the specific substances carried. i.

These papers may not accompany the driver when he exits the vehicle.

5. Safety Data Sheets (SDSs) contain detailed information about all potentially hazardous materials found at a site, including health, fire, and reactivity dangers and equipment or techniques required for safe handling as well as suggested first aid.

6. Monitoring devices such as air and gas monitors, litmus paper, and colorimetric tubes may be able to identify a substance but require specific training to use.

7. Other sites include poison control, CHEMTREC, and CAMEO. E. Hazardous Materials Zones 1. Hot (red) zone is the site of contamination.

2. Warm (yellow) zone lies immediately adjacent to the hot zone and forms a buffer zone where a decontamination corridor is established.

3. Cold (green) zone is the area where the incident operations take place and includes the command post, medical monitoring and rehab ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

5

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 13 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

areas, and treatment and staging areas.

10

V. Specialized Terminology A. Terms for the Medical Hazmat Operations 1. Boiling point is the temperature at which a liquid becomes a gas.

2. Flammable/explosive limits are the range of vapor concentration in the air at which an ignition will initiate combustion.

3. Flash point is the lowest temperature at which a liquid will give off enough vapors to support combustion.

4. Ignition temperature is the lowest temperature at which a liquid will give off enough vapors to support combustion; it is slightly higher than the flash point.

5. Specific gravity is the weight of a volume of liquid compared with an equal volume of water.

6. Vapor density is the weight of a vapor or gas compared with the weight of an equal volume of air.

7. Vapor pressure is the pressure of a vapor against the walls of a container.

8. Water solubility is the ability of a chemical to dissolve in water.

9. Alpha radiation is the neutrons and protons released by the nucleus of a radioactive substance.

10.

Beta radiation is electrons released with great energy by a radioactive substance.

11.

Gamma radiation is high-energy photons.

B. Toxicologic Terms 1. Threshold limit value/time weighted average (TLV/TWA) is the maximum concentration of a substance in the air a person can be exposed to for 8 hours a day, 40 hours per week without adverse health effects.

2. Threshold limit value/short-term exposure limit (TLV/STEL) is the

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Knowledge Application How do these terms affect your treatment of a patient? What do they mean to you as a responder?

6

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 13 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

maximum concentration of a substance a person can be exposed to for 15 minutes not to be exceeded or repeated more than 4 times daily with 60-minute rests between each exposure.

3. Threshold limit value/ceiling level (TLV-CL) is the maximum concentration of a substance that should never be exceeded.

4. Lethal concentration/lethal doses (LCt/LD) are the concentration in air or dose that results in the death of 50% of test subjects.

5. Parts per million/parts per billion (ppm/ppb) is a representation of the concentration of a substance in the air or a solution.

6. Immediately dangerous to life and health (IDLH) is the level of a concentration of a substance that causes immediate threat to life.

15

VI. Contamination and Toxicology Review A. Types of Contamination 1. Primary contamination occurs when someone or something is directly exposed to a hazardous substance.

2. Secondary contamination takes place when a contaminated person comes into contact with an uncontaminated person.

B. Routes of Exposure 1.A person can be exposed to a hazardous material by: i.

Respiratory inhalation (most common) ii.

Topical absorption iii.

Parenteral injection iv.

GI ingestion C. Cycles and Actions of Poisons 1. Absorption is the rate at which a substance is delivered to the bloodstream; it varies with the type and dosage of the poison.

2. Acute effects include those signs and symptoms that manifest immediately.

3. Delayed effects may not become apparent for hours, days, weeks, months, or even years.

4. Local effects involve areas around the immediate site and should be evaluated on the basis of the rule of nines.

5. Systemic effects occur throughout the body and are most commonly

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Knowledge Application How do these poisons and toxins cause the signs and symptoms you see? What are the advantages of the treatment options? What are the disadvantages?

7

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 13 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

associated with the liver and kidneys.

6.Keep in mind that two substances or drugs may work together to produce effects neither can produce alone, termed synergism.

D. Treatment of Common Exposures 1. Treatment ranges from supportive care to specific antidotes.

2. After ensuring safety, all patients should receive supportive measures, including airway support, suctioning, respiratory support, oxygen, circulatory support, and IV access. i.

At least two sources should agree on the medication before pharmacologic support is given.

3. Corrosives, alkalis and bases, can be found in everyday materials i.

Depending on the concentration, the substances can damage skin and other tissues. ii.

Primary effects include skin and respiratory burns and edema. iii.

When decontaminating a patient, brush off dry particles, and in the case of liquid corrosives, flush with large quantities of water. iv.

Irrigate eye injuries with water. v.

Do not induce vomiting. vi.

Treat pulmonary edema with furosemide.

4. Pulmonary irritants can include fumes from chlorine and ammonia. i.

Primary exposures cannot be decontaminated, but you should remove the victim’s clothing to prevent further exposure to trapped gases. ii.

Flush any exposed skin with water. iii.

Treat pulmonary edema with furosemide.

5. Pesticides include primarily carbamates and organophosphates. i.

They act to block acetylcholinesterase, resulting in overstimulation of the muscarinic receptors and SLUDGE syndrome. ii.

They will be absorbed as long as they are on the skin; therefore, decontamination should include irrigation and ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

8

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 13 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

green soap.

Remove all clothing and jewelry, and support the ABCs. Primary treatment is copious amounts of atropine until symptoms resolve. v.

Pralidoxime is not indicated for carbamates.

6. Chemical asphyxiants include carbon monoxide (CO) and cyanides. i.

CO displaces oxygen in the red blood cells. a. Primary effects include mental status changes, hypoxia, and seizures. ii.

Cyanides inhibit cytochrome oxidase required for muscle energy. a. Primary effects include rapid loss of consciousness, seizures, and cardiac arrest. iii.

Decontamination is usually not necessary. iv.

Definitive treatment for carbon monoxide (CO) poisoning is oxygenation. v.

Definitive treatment for cyanides can be provided by one of two cyanide antidotes. a. The older system contains amyl nitrate, sodium nitrite, and sodium thiosulfate. b. The newer system contains hydroxocobalamin.

7.Hydrocarbon solvents can include many chemicals, such as xylene and methylene chloride. i.

Primary effects include arrhythmias, pulmonary edema, and respiratory failure. ii.

Delayed effects include central nervous system (CNS) and renal system damage. iii.

Treatment varies with the route of exposure. a. In topical exposure, decontaminate with large quantities of water. b. If the patient has ingested the solvent, do not induce vomiting. iii. iv.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

9

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 13 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes 15

Content Outline VII. Approaches to Decontamination A. Decontamination can be accomplished by physical or chemical means.

1. Decontamination reduces the dosage of the material to which patients are exposed and reduces the risk of secondary contamination.

B. Methods of Decontamination 1. Dilution involves the application of large quantities of water.

2. Absorption entails the use of pads or towels to blot the hazardous material and is usually applied after washing with water.

3. Neutralization occurs when one substance reduces or eliminates the toxicity of another; it is rarely used by EMS. 4. Isolation/disposal involves separating the patient or equipment from the substance.

C. Decontamination Decision Making 1. Modes of operation i.

Fast-break decision making a. Patients who are conscious will often self-rescue, and you must employ fast-break decision making to prevent rescuer contamination. b. All EMS units should be prepared for gross decontamination. c. Implement this mode for all incidents with critical patients and unknown materials. d. Perform a rapid risk-benefit assessment. ii.

Long-term decision making occurs at extended events a. This most often occurs with patients who have not self-extricated and remain in the hot zone. b. Traditionally, EMS personnel have not been equipped or trained to retrieve these patients. c. It provides a better opportunity for thorough decontamination as well as detailed research of the actual hazard.

D. Field Decontamination

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Master Teaching Notes Class Activities Practice setting up and simulating decontamination using both the two-step and the eight-step process.

10

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 13 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

1. Two-step process:

i.

Rescuers remove or instruct patients to remove all clothing and jewelry. ii.

Rescuers wash and rinse the patient with soap and water, making sure they do not stay in contact with runoff. a. Repeat the process, allowing the fluid to drain away.

2. Eight-step process: i.

Rescuers enter the decon area at the hot end and .mechanically remove contaminants from the victims. ii.

Rescuers drop equipment in a tool-drop area and remove outer gloves. iii.

Decon personnel shower and scrub all victims and rescuers using gross decontamination. iv.

Rescuers remove and isolate their self-contained breathing apparatus (SCBA). v.

Rescuers remove all protective clothing. vi.

Rescuers remove all personal clothing. vii.

Rescuers and victims receive a full body washing. viii.

Patients receive rapid assessment and stabilization before being transported to the hospital.

3. Transportation considerations i.

Semi-decontaminated patients may still need to undergo a more invasive decon process at a medical facility. ii.

Make sure field-decontaminated patients are transported to a facility capable of performing thorough decon procedures. iii.

Always recall that patients will still have contamination on or in them.

15

VIII.Hazmat Protection Equipment A. Level A provides the highest level of respiratory and splash protection.

1. It offers a high degree of protection against chemical breakthrough and fully encapsulates the rescuer, even the SCBA. B. Level B offers full respiratory protection where there is low probability of

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Teaching Tips Have each type of protection suit available for the class to see and operate. Give students the opportunity to practice donning the

11

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 13 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline dermal hazard and is nonencapsulating but chemically resistant.

1.The decon team typically wears level B PPE. C. Level C includes a nonpermeable suit, boots, and gear for protecting eyes and hands.

1. An air-purifying respirator is used in place of SCBA. 2. Level C clothing is usually used during transport of patients with potential for secondary contamination.

D. Level D consists of structural firefighter gear.

E. The level of hazmat PPE that is worn depends on the chemical or substance involved. EMS should not become involved without the proper PPE and training.

1. Latex gloves are not chemically resistant.

2. High-efficiency particulate arresting (HEPA) masks and double gloves offer good protection from some hazards.

3. Remember to don rubber boots, as leather absorbs substances.

10

IX. Medical Monitoring and Rehab A. Entry Readiness 1. Prior to entry, you or another EMS provider will asses rescuers’ blood pressure, pulse, respiratory rate, temperature, body weight, electrocardiogram (ECG), and mental status 2. Hazmat team members enter in groups of two, with two more members remaining outside the hot zone as backup.

3. Entry team personnel should prehydrate.

B. Post-Exit Rehab 1. After the hazmat team members exit the hot zone, they should report for post-exit monitoring.

2. Rehydration should occur.

3. Entry members should not be allowed to reenter until they are alert, nontachycardic, normotensive, and within a reasonable percentage of their normal body weight.

C. Heat Stress Factors 1. Primary considerations include temperature and humidity.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Master Teaching Notes suits. Use this in conjunction with the decontamination practice and entry/exit evaluations.

Class Activities Practice with each type of protective suit. This allows students to see how each one is applied and note the time it takes to do it properly.

Class Activities When practicing with the suits, decontamination, and hazard ID, integrate readiness evaluations into your practice.

Decision Points Given the nature of our work, how important is it to do readiness and exit evaluations? At what point do you keep a rescuer from entering the scene, and how do you balance this with your resources?

12

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 13 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

2. Prehydration, duration and degree of activity, and overall physical

fitness of team members should have a bearing on your evaluation.

3. The same suit that seals out hazards prevents heat loss by

evaporation, conduction, convection, and radiation, leading to the possibility of overheating.

5

5

X. Importance of Practice A. As a paramedic, you will play an important role at any hazmat incident.

B. You should practice skills you expect to use in most EMS systems.

1. Put on and take off level B suits.

2. Set up a rapid two-step decon process and an eight-step decon process.

3. Identify simulated chemicals, determine correct PPE, and establish the proper decontamination methods 4. Practice pre-entry and post-exit medical monitoring and documentation

Class Activities Practice should be done using a scenario including hazard identification, suit application, rescuer evaluation, and patient decontamination.

XI. Summary A. Every member of an EMS team should be prepared to face the challenges of a hazmat incident.

B. Keep in mind the high potential for rescuer involvement.

C. The primary consideration is your own safety.

XII. Case Study

Class Activities Discuss the case with students now that they are familiar with the chapter.

XIII.You Make the Call

Class Activities Read and discuss the call and questions as a group.

5

5

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

13

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 13 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline XIV.

Review Questions

5

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Master Teaching Notes Class Activities Pass out review questions before the lesson starts. Have students answer them. Go over the questions again after the lecture to assess students’ understanding of the information.

14

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

MASTER TEACHING NOTES

Detailed Lesson Plan Chapter 14 Crime Scene Awareness 80– 90 Minutes

• • • • •

Teaching Tips Discussion Topics Class Activities Knowledge Application Decision Points

Chapter 14 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline I.

Case Study

5

5

Master Teaching Notes Teaching Tips Have a student read the scenario.

Tell students that the case will be reviewed after the lecture

II. Introduction A. Violence can occur anywhere.

1. Although people of all ages and backgrounds commit acts of violence, the last two decades have seen a dramatic increase in violence among youth.

2. Approximately one in six victims of violent crimes will require medical attention.

3. EMS may be a victim’s only contact with professionals who can intervene to prevent further harm.

B. EMS providers find it almost impossible to predict exactly when and where a violent incident will occur.

1. You cannot let down your “crime scene awareness,” otherwise you risk becoming a victim or hostage of a violent situation.

2. Although you cannot predict violence hours in advance, you can remain alert to signs of danger.

3. Familiarize yourself with standard operating procedures (SOPs) for handling violent situations and/or the specialized resources that you can call on for backup.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Teaching Tips Police and EMS work closely on a regular basis. If you have the opportunity to have a law enforcement representative visit the class, have him or her discuss the important factors in selfprotection, recognition of potentially dangerous situations, and evidence preservation.

1

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 14 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes 15

Content Outline III. Approach to the Scene A. Your safety strategy begins as soon as you are dispatched on a call.

1. Even the most basic information can provide important tactical clues.

2. Some of your best information can come from your own experience and that of other crews.

B. Possible Scenarios 1. Advised of danger en route i.

When the dispatcher reports possible danger, do not approach the scene until it has been secured by law enforcement. ii.

Lights and sirens can draw a crowd and/or alert the perpetrator of a crime. iii.

Never follow police units to a scene. iv.

If you arrive first, keep the ambulance out of sight so that the rig does not attract the attention of bystanders or any of the parties involved in the incident. v.

Management of the incident depends on interagency cooperation. vi.

Work with police to determine when and if you should enter a scene. vii.

Violence can occur or resume even with the police present.

2. Observing danger on arrival i.

Even if dispatch has not alerted you to danger, you must still keep this possibility in mind upon arrival. ii.

One of the main purposes of the scene size-up is to search for any possible hazards. iii.

Observe for signs of trouble, such as crowds gathering on the street, an unusual silence, or a darkened residence. iv.

If you have any doubts about a call, park away from the scene. v.

Avoid getting between a residence and the lighted ambulance to prevent “backlighting” yourself. vi.

If you spot danger at any time during your approach, immediately stop and reevaluate the situation.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Master Teaching Notes Discussion Topics Many EMS responses turn out to be completely different from what was expected from the dispatch information. This occurs for several reasons but cannot be avoided. Discuss how you approach scene safety and are prepared for any possible situation.

Decision Points You have been dispatched to an area of town that is known for violence and drugs. What types of things do you consider en route?

What options are available to you, and how do you approach the scene?

2

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 14 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

3. Eruption of danger during care or transport

i. ii.

iii.

30

Remain alert throughout a call, especially in areas with a history of violence.

Even if treatment has begun, you must place your own safety first. a. Quickly package the patient and leave the scene. b. Retreat without the patient. c. Your choice of action depends on the level of danger.

Regardless of the situation, always have a way out.

IV. Specific Dangerous Scenes A. Highway Encounters 1. EMS units frequently report to roadside calls involving motor vehicle collisions, disabled vehicles, or sick and/or unresponsive people inside a vehicle.

2. Highway operations hold the risk of violence from occupants who may be intoxicated or drugged, fleeing from the police, or in possession of weapons.

3. Signs of possible danger include: i.

Violent or abusive behavior ii.

An altered mental state iii.

Grabbing or hiding items inside the vehicle iv.

Arguing or fighting among passengers v.

Lack of activity where activity is expected vi.

Physical signs of alcohol or drug abuse vii.

Open or unlatched trunks (a potential hiding spot) viii.

Differences among stories told by occupants 4. To make an approach safe, follow these steps: i.

Park the ambulance in a position that provides safety from traffic. ii.

Notify dispatch of the situation, location, vehicle make and model, and license plate number and state. iii.

Use a one-person approach. The driver should remain in the ambulance, which is elevated and provides greater visibility. iv.

The driver should remain prepared to radio for immediate

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Discussion Topics Discuss the strategies of ambulance placement in different scenarios, including the highway, at a dangerous scene, and in a crowd.

Knowledge Application What are some of the local areas known for violence and/or drugs?

How are responses handled in these areas? What are some of the local gangs, and how can you spot them?

3

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 14 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

help and to back or drive away rapidly once the other crew member returns. v.

At nighttime, use the ambulance lights to illuminate the vehicle, but do not walk between the ambulance and other vehicle to prevent backlighting yourself. vi.

Because police approach from the driver’s side, you should approach from the passenger’s side, which is an unexpected route. vii.

Use the A, B, and C door posts for cover. viii.

Observe the rear seat, and do not pass the C post unless you are sure there are no threats in the rear seat. ix.

Retreat to the ambulance at the first sign of danger. x.

Make sure you have mapped out your intended retreat and escape with your partner.

B. Violent Street Incidents 1. Murder, assault, and robbery i.

The most common location for violent crimes is on the streets, often within 5 miles of the victim’s home. ii.

In one-quarter of the incidents of violent crime, offenders use or threaten the use of a weapon. iii.

In the late 1990s and early 2000s, there was a rise in the incidence of hate crimes. a. Hate crimes are committed solely on the basis of the individual’s actual or perceived race, color, national origin, ethnicity, gender, disability, or sexual orientation. iv.

In responding to the scene of any violent crime, keep these precautions in mind: a. Dangerous weapons may have been used in the crime. b. Perpetrators may still be on the scene. c. Patients may sometimes exhibit violence toward.

EMS, particularly if they risk criminal penalties as a result of the original incident. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

4

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 14 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

C. Dangerous Crowds and Bystanders 1. You must remain aware of crowd dynamics whenever you respond to a street incident.

2. Whenever a crowd is present, be aware of the following: i.

Shouts or increasingly loud voices ii.

Pushing or shoving iii.

Hostilities toward anyone on the scene, including the perpetrator of a crime, the victim, and police iv.

Rapid increase in crowd size v.

Inability of law enforcement to control bystanders 3. Protect yourself, and constantly monitor the crowd.

4. Retreat if necessary.

5. If possible, take the patient with you so that you do not have to return.

D. Street Gangs 1. Gangs include groups of people who band together for a variety of reasons.

2. Youth gangs account for a disproportionate amount of youth violence.

3. Commonly observed gang characteristics include the following: i.

Gang members frequently wear unique clothing specific to the group. ii.

Gangs have definite territory or “turfs” and often mark them with graffiti broadcasting the gang’s logo. iii.

Many gang members often have tattoos or other body markings to identify their gang affiliation. iv.

Gangs commonly create their own methods of communication, including hand signals and slang.

4. EMS units venturing into gang territory must be extremely cautious because of the potential for violence.

E. Drug-Related Crimes 1. The sale of drugs goes hand in hand with violence.

2. Dealers protect their drug stashes and “shooting galleries” with booby traps, weapons, and abused dogs that are likely to attack. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

5

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 14 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

3. A number of signs can alert you to the involvement of drugs at an

EMS call: i.

Prior history of drugs in the neighborhood ii.

Clinical evidence that the patient has used drugs iii.

Drug-related comments iv.

Drug paraphernalia visible at the scene 4. Whenever you observe any of the above items, assume the presence of drugs at the scene.

5. Evaluate each situation carefully.

F. Clandestine Drug Labs 1. Drug dealers often set up laboratories to manufacture controlled substances or otherwise refine or convert a controlled substance to another more profitable or usable form.

2. Clandestine drug labs, or “clan labs,” have three requirements: i.

Privacy ii.

Utilities iii.

Equipment such as glassware, chemical containers, and heating mantles or burners 3. If you come across a clan lab, take the following actions: i.

Leave the area immediately. ii.

Do not touch anything. iii.

Never stop any chemical reactions already in progress. iv.

Do not smoke or bring any source of flame near the lab. v.

Notify the police. vi.

Initiate Incident Management System (IMS) and hazmat procedures. vii.

Consider evacuation of the area.

4. Labs can be found anywhere.

G. Domestic Violence 1. Domestic violence involves people who live together in an intimate relationship; violence may be physical, emotional, sexual, verbal, or economic.

2. When called to the scene of domestic violence, the abuser may turn on you or the other members of the crew; this is one of the highest©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

6

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 14 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

risk situations for police injury and death.

3. Your two main concerns are your own personal safety and the

protection of the patient from further harm.

4. Always retreat when the scene is unsafe because you will not be

able to care for the ill or injured patient if injured yourself.

I. 20

Tactical Considerations A. Safety Tactics 1. Your response to danger will be most effective if you practice your tactical options frequently. i.

Even on routine calls, think about safety, contact, cover, escape routes, and other strategies that can help you make a better decision when you are faced with actual danger.

2. Retreat i.

The prudent strategy is to retreat whenever you spot indicators of violence or potential physical confrontations. ii.

Ideally, you should retreat to the ambulance so that you can summon help. iii.

Your primary goal is to protect yourself from any potential danger. iv.

You must be out of the immediate line of sight. v.

Allow enough distance to react if a person or crowd attempts to move toward you again. vi.

As soon as possible, notify other responding units and agencies of the danger. vii.

Retreat does not mean the end of a call. viii.

You should seek to stage at a safe area until police secure the scene and you can respond safely.

3. Cover and concealment i.

Concealment hides your body. a. Crouching behind bushes, wallboards, or vehicle doors ii.

Cover provides protection. a. Hiding your body behind solid and impenetrable objects such as brick walls, rocks, large trees, or

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Teaching Tips Scene safety is always stressed before assessment of your patient.

Be sure to stress the importance of anticipating violence and responding appropriately when it is encountered.

Class Activities Have students practice each of these strategies. Have them look around the class, outside, and throughout the area to find sufficient locations for cover and concealment. Practice retreat, distraction, and evasion and contact and cover.

Knowledge Application You never know when violence can strike. Regardless of the situation, dispatch, or call type, it is important to always be aware of your surroundings and plan for the unexpected.

Discussion Topics The decision to use body armor is 7

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 14 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline telephone poles Keep in mind the following general rules: a. As you approach the scene, remain aware of the surroundings and any potential sources of protection. b. Choose your cover carefully, as you may have only once chance to pick your protection. c. Once you have made your choice of cover, conceal as much of your body as possible, and be conscious of any reflective clothing. d. Constantly look to improve your protection and location.

4. Distraction and evasion i.

Some specific techniques to avoid physical violence include: a. Throwing equipment to trip, slow, or distract an aggressor b. Wedging a stretcher in the doorway to block an attacker c. Using an unconventional path when retreating d. Anticipating the moves of the aggressor and taking countermoves e. Overturning objects in the path of the attacker f. Using preplanned tactics with your partner to confuse an aggressor ii.

The key to success is your own physical well-being.

B. Situational Awareness 1. Concentrating on the care of patients requires that you focus on the patient. i.

Can be taught and learned ii.

Focus is needed, but can be dangerous if surroundings are forgotten iii.

Need to scan the scene while providing care to evaluate for environmental dangers, unknown persons entering, return of person who caused injury, and other similar situations iii.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Master Teaching Notes an all-or-nothing decision. It is effective only if worn. What are the local policies and opinions concerning body armor?

8

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 14 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

iv.

Will factor in to knowing when to move patient to different location, load and go, or stop care and retreat.

2. Contact and cover i.

The concept of contact and cover was developed in San Diego by the police department. a. Several officers were injured or killed while interviewing suspects. b. They adopted an interview approach in which one officer contacts the suspect while the other stands 90 degrees to the side, allowing the second officer to provide cover to the first officer. ii.

The emphasis of this application is on observation and teamwork. iii.

In its most basic form, contact and cover means that you will watch your partner’s back while your partner watches yours.

3. Warning signs and communication i.

Communication forms a vital part of EMS, regardless of the situation. ii.

Devise prearranged verbal and nonverbal clues and practice them. iii.

Be sure to involve dispatch in the process, and choose a signal that will indicate a variety of circumstances while sounding harmless to an attacker.

C. Tactical Patient Care 1. Increased involvement of care providers in violent situations has raised discussion and debate over the tactical training and protection offered to the EMS community. i.

Interagency planning is essential, especially for clarifying the duties and roles of EMS and law enforcement agencies at crime scenes, riots, or terrorist events.

2. Body armor i.

Increasing numbers of EMS agencies have chosen to supply body armor or to provide a sum of cash toward its purchase. a. Body armor manufacturers have responded by ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

9

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 14 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

designing and marketing vests specifically for EMS applications. ii.

Most body armor is rated from level 1 to level 3 (least to most protective). iii.

For it to be effective, you must follow several guidelines: a. Keep in mind the limitations of body armor. b. Body armor does not cover the entire body. c. Even though body armor can prevent many types of penetration, you can still experience severe cavitation. d. For body armor to work, it must be worn.

3.Tactical EMS i.

The provision of care in violent or tactically “hot” zones necessitates risk far beyond those found on most EMS calls. ii.

Medical personnel assigned to such incidents require special training and authorization. iii.

The patient care offered by a tactical EMS (TEMS) medic differs from routine care in several ways: a. A major priority is extraction of the patient from the hot zone. b. Care may be modified to meet tactical considerations. c. Trauma patients are more frequently encountered. d. Treatment and transport interventions must always be coordinated with an incident commander. e. Patients must be moved to tactically cold zones for complete assessments, care, and transport. f. Metal clipboards, chemical agents, and other tools may be used as defensive weapons. iv.

Certification of SWAT medics and EMT-Tactical is offered by several organizations and includes additional training in law enforcement tactics and special situations.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

10

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 14 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes 10

Content Outline V. EMS at Crime Scenes A. A crime scene can be defined as a location where any part of a criminal act has occurred and where evidence relating to a crime may be found.

B. EMS and Police Operations 1. The key to cooperation between EMS and law enforcement is communication.

2. You should become aware of the nature and significance of physical evidence at a crime scene and, if possible, keep that evidence intact.

C. Preserving Evidence 1. To prevent future violent injuries, be aware that anything on and around the patient may be evidence. i.

Whenever in doubt, save or treat an object as evidence. ii.

If you are the first person at the scene, be aware that anything you touch, walk on, pick up, cut, wipe off, or move could be evidence. iii.

Observe the patient carefully, and disturb as little as possible iv.

Never cut through a gunshot or knife wound. a. Instead of placing the cut clothing in a plastic bag, put it in a brown paper bag to prevent condensation from destroying evidence.

2. When examining a patient, remember that you may be at risk, as the patient may have a concealed weapon or the perpetrator may still be at the scene.

3. If you have any suspicions about patient or scene safety, wait for law enforcement to secure the scene.

D. Types of Evidence 1. Prints include fingerprints, footprints, and tire prints. i.

Try not to disturb any fingerprint evidence that may be present. ii.

Do not leave behind your own fingerprints at a scene. a. Try to touch as little as possible. b. Wearing gloves will help to prevent leaving excess prints behind. c. Bring in only the necessary equipment.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Master Teaching Notes Teaching Tips Integrate preservation of evidence into all of your scenarios where applicable. Occasionally, when giving a trauma scenario that includes a victim of violent crime, integrate the different types of evidence to get students thinking about the importance of not overlooking evidence that may not be obvious.

11

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 14 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

iii.

Scan the approach to the scene and the scene itself for footprints or tire prints.

2. Blood and body fluids also give police a lot of information about a crime. i.

Blood spatter evidence can indicate the type of weapon used, the position of the attacker, and the direction or force used in the attack. ii.

Preserving blood evidence can be accomplished by the following: a. Avoid mixing samples of blood whenever possible. b. Avoid tracking blood on your shoes. c. If you must cut bloody clothing from a victim, place each piece in a separate brown paper bag. i. If it is wet, roll it in the paper bag to layer it and place in a second bag for protection. d. Do not throw clothes in a single pile or in a puddle of blood. e. Do not clean up or smudge blood spatter. f. If you leave behind blood from a venipuncture, notify police. g. Because blood is a biohazard, ask police whether the scene should be secured for evidence collection.

3. Particulate evidence is also called microscopic or trace evidence and cannot readily be seen by the human eye. i.

Minimal handling of a victim’s clothes by EMS may help to preserve this evidence.

4. Everything you and other crew members see or hear can serve as evidence. i.

If the victim is deceased by the time you arrive, any crew members not immediately needed should remain out of the immediate area. ii.

If a weapon is found, it should not be touched or moved unless it poses a direct danger to others. iii.

Record only the facts at a scene, and avoid opinions. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

12

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 14 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline iv.

5

Master Teaching Notes

Keep in mind local protocols, local laws, and ethical considerations in reporting certain crimes, such as child abuse, rape, geriatric abuse, and domestic violence.

VI. Summary A. Your first priority at any crime scene is your own safety.

1. Develop “crime scene awareness.”

B. Whenever you survey the scene of any call, keep in mind the telltale signs of potential violence.

C. When you do treat the victim(s) at a crime scene, keep in mind that the police and EMS must work together to preserve the evidence.

VII. Case Study

Class Activities Discuss the case with students now that they are familiar with the chapter.

IX. You Make the Call

Class Activities Read and discuss the call and questions as a group.

X. Review Questions

Class Activities

5

5

5

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Pass out review questions before the lesson starts. Have students answer them. Go over the questions again after the lecture to assess students’ understanding of the information.

13

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

MASTER TEACHING NOTES

Detailed Lesson Plan Chapter 15 Rural EMS 60–70 Minutes

• • • •

Teaching Tips Discussion Topics Class Activities Knowledge Application

Chapter 15 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

The information in this chapter is supplemental to the National EMS Education Standards.

Minutes

Content Outline I.

Case Study

5

5

15

Master Teaching Notes Teaching Tips Have a student read the scenario.

Tell students that the case will be reviewed after the lecture

II. Introduction A. Recent census data indicates that more than 350 million people in the U.S. live in rural areas.

1. Most rural dwellers face lack of easy access to health care facilities.

2. In the rural setting, resources such as full-service hospitals, fire departments, and EMS units are as thinly distributed as the population.

B. One of the challenges for rural EMS providers is to ensure that their patients receive the same high-quality care as people living elsewhere in the nation.

Teaching Tips

III. Practicing Rural EMS A. In general, the U.S. government defines rural areas in terms of their sparse populations and distances from cities, towns, or villages.

1. In relation to health care, rural areas can also be characterized by their higher percentage of people over age 65 and lower physician-topatient ratios.

2. Rural residents suffer a disproportionate number of serious injuries and chronic health conditions. i.

Because of greater distances to health care facilities, rural residents suffer a higher mortality associated with trauma

Discussion Topics

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Consider your students and their backgrounds as well as your local area. These issues may be very applicable or may not be a factor in the care your students will provide. It is important to discuss these topics, as they may be relevant in any medic’s future.

Consider the possibility that an area does not have access to 911.

How do people in this area access EMS? How do EMS units coordinate and dispatch responses? What are the options available in these communities?

Class Activities 1

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 15 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

The information in this chapter is supplemental to the National EMS Education Standards.

Minutes

Content Outline and medical emergencies.

B. Special Problems 1. In the case of natural disasters, EMS personnel may be the only available medical support until state or federal agencies can be transported into the area.

2. Rural EMS crews face a number of obstacles and challenges not found in most urban areas.

3. Distance and time i.

Rural EMS often relies on volunteer services, and volunteers must first travel varying distances to a squad building.

4. Communication difficulties hamper rural areas due to old or poor communication systems. i.

Antiquated fire phones or crash bars notify responders of an emergency call, but crew members have no way of communicating while en route. ii.

EMS providers may experience dead spots where they cannot transmit.

5. Enrollment shortages i.

Because many rural EMS providers work on a volunteer basis, units or squads can experience enrollment shortages. ii.

The greater distances and time involved can take volunteers from work or families for extended periods.

6. Training and practice i.

Access to training and continuing education is not readily available to many rural areas. a. For the volunteer, this means increased personal expense and time away from home. b. Members may experience “rust out,” an inability to keep current with new technologies and standards.

7. Inadequate medical support i.

Rural areas sometimes have inadequate medical direction, and local physicians may lack the training in EMS operations.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Master Teaching Notes Determine some online sources of EMS education and how to access them. Discuss other options for education and training. What are some incentives rural areas provide for students?

2

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 15 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

The information in this chapter is supplemental to the National EMS Education Standards.

Minutes

Content Outline

Master Teaching Notes

ii.

Rural areas may not have the budgets to buy new equipment and ambulances. iii.

Air medical support may not always be readily available. iv.

Hospitals and rural EMS may not always implement protocols or standards for prehospital care providers.

C. Creative Problem Solving 1. Improved communications i.

In recent years, some rural counties have been fortunate enough to receive grants to modernize equipment or supplement their communications equipment. ii.

In other areas, counties have joined together to share costs. iii.

Radio dead spots and crowded frequencies can be handled by requesting additional frequencies or by upgrading equipment. iv.

Through the use of cell phones, rural paramedics can communicate with emergency department physicians or medical directors.

2. Recruitment and certification i.

Issues of recruitment and certification can be addressed through flexible training sessions and ongoing education. ii.

Agencies can pool resources with neighboring squads to offer education. iii.

The use of computers and the Internet has greatly increased the access to education. a. Distance education helps to develop awareness of new standards and procedures.

3. Improved medical support i.

The National Association of EMS Physicians provides numerous educational opportunities for physicians who are interested in learning more about the supervision and oversight of EMS operations. ii.

Relationships with a hospital depend on good communication, and a medic should spend time at the ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

3

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 15 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

The information in this chapter is supplemental to the National EMS Education Standards.

Minutes

Content Outline

Master Teaching Notes

hospitals that serve his or her district and participate in training with the staff.

4. Ingenuity and increased responsibilities i.

As a rural paramedic, you can expect your role to grow as counties attempt to fill the health care gap between rural and urban areas. ii.

You may find yourself involved in outreach programs or providing nonemergent medical treatment. iii.

Governments in some rural areas are also considering the involvement of paramedics in the public health system when not responding to emergency calls.

20

IV. Typical Rural EMS Situations and Decisions A. The Distance Factor 1. Every paramedic knows the axiom about rapid transport and care, and in rural areas, you may find it impossible to meet the guideline.

2. In rural settings, it is often necessary to travel even greater distances, and as a result, you may spend more time with your patient in transport than at the scene.

3. Actions taken by a rural medic can have a definitive impact in the overall outcome of the patient.

4. Another factor to consider is the availability of emergency staff at the local hospital. i.

Some rural hospitals may only have a part-time emergency department. ii.

You may have to make a judgment call on whether to transport a critical patient to a more distant facility that is better equipped to handle the patient.

5. Because paramedics live in a world of advanced life support, you may have access to equipment that is unavailable at your local hospital.

6. You may see all phases of a patient’s death before reaching a distant medical facility.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Teaching Tips Some areas offer agricultural extrication courses that are specifically geared toward these types of emergencies. If one is offered in your area and is applicable, discuss it with your students and encourage further education.

Discussion Topics Is your area part of the agricultural industry? What types of machinery and industry are local to you? If you live in an area that is frequented for wilderness or outdoor activities, what resources are available for you? How do you summon them, and what is their medical certification level?

4

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 15 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

The information in this chapter is supplemental to the National EMS Education Standards.

Minutes

Content Outline 7.Rural paramedics must know when and how to use air transport.

B. Agricultural Emergencies 1. Emergencies related to farming or ranching can range from equipment-related injuries to pesticide poisoning to any number of medical problems exacerbated by agricultural labor.

2. You must place crew safety first.

3. Familiarize yourself with the range of equipment used on farms or ranches if you live in an agricultural area.

4. Place personnel who are familiar with the equipment in charge of shutting down all machinery. i.

Lock off the switch, and place a tag on it stating why it is shut off (lock-out/tag-off).

5. Hazardous materials can be found in many places on a farm. i.

Be wary of rescues involving grain tanks or silos. ii.

During fermentation, crops release high levels of carbon dioxide and methane. iii.

In rescues involving silos, you face the added risk of high angles, confined spaces, and the possibility of entombment under grain or silage.

6. The risk of serious agricultural accidents and injuries is increased by the equipment and machines routinely used by farmers. i.

In some cases, farmers rely on old or outdated equipment because they cannot afford to replace it. ii.

A wound may become contaminated by pesticides or manure. iii.

A patient can easily become entrapped under heavy equipment. a. Standard extrication devices may not be able to handle the added weight of farm machinery. b. Lengthy extractions can worsen the patient’s condition.

7.Suspect many different mechanisms of injury in accidents involving agricultural equipment.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Master Teaching Notes Class Activities When participating in patient care scenarios, add the distance factor to the scenario. Ask students to consider treatment options en route. Have them discuss how they would manage a patient for ½ hour, 1 hour, or even 2 hours during a transport.

Knowledge Application Natural disasters can isolate areas that seem urban or wipe out the availability of a hospital to provide care. This turns a seemingly urban area into an area that is isolated without medical care and requiring long transports to definitive care.

What are some options and resources available?

5

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 15 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

The information in this chapter is supplemental to the National EMS Education Standards.

Minutes

Content Outline

Master Teaching Notes

i.

Wrap points are areas where an appendage can get caught and significantly twisted. ii.

Pinch points occur when two objects come together and catch a portion of the body between them. iii.

Shear points result from two objects coming together; however, they meet or pass, causing amputation of a body part. iv.

Crush points are areas where two objects come together with sufficient weight or force to crush the affected appendage.

8.In general, you provide the same medical care as you would for any patient; however, you must also factor time and distance into your considerations.

C. Recreational Emergencies 1. Recreational activities have always drawn people to rural settings.

2. Depending on the season and activity, the population in a rural community can swell significantly.

3. As a rural paramedic, you must be familiar with the recreational or wilderness pursuits in your area.

4. Distance and extrication times compound your transport factors.

5. You must consider weather conditions and availability of suitable landing zones when considering air transport.

5

V. Summary A. Paramedics play an important party in filling the health care gap between rural and urban areas.

B. Because distance often increases the contact time between paramedics and their rural patients, decisions about the treatment and use of air transport can literally make the difference between life and death.

VI. Case Study

5

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Class Activities Discuss the case with students now that they are familiar with the chapter.

6

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 15 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

The information in this chapter is supplemental to the National EMS Education Standards.

Minutes

Content Outline

Master Teaching Notes

VII. You Make the Call

Class Activities Read and discuss the call and questions as a group.

VIII.Review Questions

Class Activities

5

5

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Pass out review questions before the lesson starts. Have students answer them. Go over the questions again after the lecture to assess students’ understanding of the information.

7

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

MASTER TEACHING NOTES

Detailed Lesson Plan Chapter 16 Responding to Terrorist Attacks 90–100 Minutes

• • • • •

Teaching Tips Discussion Topics Class Activities Knowledge Application Decision Points

Chapter 16 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline I.

Case Study

5

5

Master Teaching Notes Teaching Tips Have a student read the scenario.

Tell students that the case will be reviewed after the lecture

II. Introduction A. The events of September 11, 2001, have greatly impacted our society and our sensitivity to the threat of terrorist acts B. It is clear that the 21st century will bring new terrorism threats using more unconventional means, including weapons of mass destruction (WMDs) such as chemical, biological, radiological, and explosive (CBRNE) weapons C. With the increasing likelihood of a terrorist act, EMS personnel become responsible for maintaining a higher index of suspicion for such an event 1. Terrorists may be of foreign or domestic origin and are likely to target locations that are symbolic of the government or that represent the influence of a country.

D. Likely mechanisms of mass destruction used by terrorists include explosive and incendiary agents, nuclear detonation or contamination, and the release of either chemical or biological agents.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Teaching Tips The events of September 11, 2001, have greatly affected the way EMS providers respond to incidents. Take this opportunity to recognize what we sacrifice, and stress the importance of scene safety.

1

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 16 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes 10

15

Content Outline

Master Teaching Notes

III. Explosive Agents A. Explosives are the most likely method by which terrorists will strike.

1. The bomb may range from a suicide bomber carrying a few sticks of dynamite to a large vehicle filled with highly explosive material. i. The blast pressure wave causes compression/decompression injury as it passes through the lungs, ears, and other hollow, air-filled organs. ii. Debris thrown by the blast produces penetrating or blunt injuries. iii. Secondary combustion induces burn injury. iv. Structural collapse causes blunt and crushing injuries. v. Be wary of secondary explosives set intentionally to disrupt rescue and injure emergency responders.

2. Incendiary agents are a special subset of explosives with less explosive power and greater heat and burn potential. i. White phosphorous may spontaneously combust when exposed to air and may be part of military munitions or a terrorist weapon. ii. Magnesium burns vigorously at a high temperature. iii. Terrorists may choose to increase the effectiveness of their weapons by incorporating other agents with the explosives. a. They surround the explosive charge with old auto batteries, contaminating the scene with lead and sulfuric acid. b. Scrap metal, nails, screws, and other items act as shrapnel.

Discussion Topics

IV. Nuclear Detonation A. Nuclear detonation is the release of energy that is generated when heavy nuclei split (fission) or light nuclei combine (fusion) to form new elements.

1. The unleashed energy is tremendous and creates an explosion of immense proportion.

2. The damage associated with a typical nuclear detonation is extreme and results in concentric circles:

Knowledge Application

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Discuss the Oklahoma bombing and the World Trade Center attacks, and describe the responses to each.

In the aftermath of a nuclear attack, there will likely be chaos and uncertainty among society.

What are the response and activation plans of the local resources? How would you react 2

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 16 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline i.

Total destruction and very high mortality ii.

Heavy destruction and moderate mortality iii.

Light destruction and limited mortality 3. The explosive energy disrupts communications, power, water and waste service, travel, and EMS and public safety infrastructures.

4. The nuclear reaction generates particles of debris and dust that give off nuclear radiation. i.

Nuclear radiation cannot be felt, seen, or otherwise detected by any of the four senses. ii.

It damages the cells of the human body as it passes through them. iii.

As intensity and duration of exposure increase, so do the degree and extent of cell damage and risk to life.

B. Nuclear Incident Response 1. The first hour post-ignition is generally spent moving the injured into structures that will protect them from fallout.

2. Simultaneously, emergency responders organize, determine the direction of fallout movement, and begin to extricate the walking wounded and seriously injured from the outer perimeter of the explosion. i.

As the response is organized, egress and evacuation routes are cleared, the injured are located and evacuated, and the response moves closer to the epicenter. ii.

Most emergency medical care is provided at treatment sectors that are remote from the seriously damaged areas and away from where fallout is expected. iii.

Care for victims of a nuclear detonation involves decontamination (as necessary), treatment for conventional explosion injuries, and treatment for thermal burns. iv.

Before victims arrive at an emergency medical treatment sector, someone must monitor them for radioactive contamination. a. This is accomplished with a Geiger counter, which measures the passage of radioactive particles.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Master Teaching Notes to such an event?

Decision Points EMS providers have a duty to act, but in such an event, it is easy to worry about our own families and those close to us. How do you balance your professional obligations with those to your family?

3

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 16 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

b. During a response to a suspected nuclear incident, you will likely wear a dosimeter, which records total radiation exposure. v.

If the risk of fallout and continuing radiation is serious, paramedics may be asked to distribute potassium iodide tablets, which reduce the uptake of radioactive iodine by the thyroid. vi.

Generally, patients with serious radiation exposure present with nausea, fatigue, and malaise. a. Treatment is limited to supportive measures. b. The sooner the appearance of the symptoms, the more serious the exposure.

3. Radioactive contamination i.

Radioactive contamination may also be spread using conventional explosives in a “dirty bomb.” a. The explosion distributes radioactive material over a large area and into the surrounding air. b. The result is an explosion site with radioactive material contaminating the immediate vicinity. c. This may not be recognized until well after the incident.

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V. Chemical Agents A. Another terrorist weapon of mass destruction is the release of chemical agents.

1. Potential chemical weapons range from simple hazardous materials common in our society to sophisticated chemicals specifically designed to harm humans.

2. Volatility is the ease with which a chemical changes from a liquid to a gas. i.

Most chemical weapons are liquids that are moderately volatile.

3. Specific gravity refers to the density or weight of the vapor or gas compared with air. i.

A gas with a specific gravity greater than air sinks beneath it,

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Teaching Tips Many of the effects of chemical agents are similar to those of poisonings. Review the toxicology section, and discuss the effects with the class.

4

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 16 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

stays close to the ground, and accumulates in low places.

4.Environmental conditions affect the dispersal of chemical weapons i.

In strong winds, the gas or vapor mixes with large quantities of air and dilutes and disperses very quickly, limiting concentration and effectiveness. ii.

Light wind moves the cloud downwind as a unit, increasing its effectiveness and the area involved. iii.

Confined within a building, a chemical agent remains concentrated and deadly for a prolonged period.

B. Nerve Agents 1. Nerve agents and some pesticides damage nervous impulse conduction by inhibiting the degradation of a neurotransmitter. i.

This results in muscle twitching and spasms, convulsions, unconsciousness, and respiratory failure.

2. Nerve agents present as either vapor or liquid and are capable of being absorbed through the skin or inhaled and absorbed through the respiratory system. i.

Exposure quickly leads to a series of signs and symptoms known as SLUDGE (salivation, lacrimation, urination, diarrhea, gastrointestinal distress, and emesis).

3. The actions of nerve agents can generally be reversed if the antidote is administered shortly after exposure; however, many nerve agents permanently bind the agents reabsorbing the neurotransmitters and the effects become difficult to reverse.

4. Treatment includes administration of atropine and pralidoxome chloride. i.

The military carries combination kits called Mark I kits. ii.

The auto-injector is a convenient way to administer this regimen. iii.

The IV route is more rapid and is preferred when available and time permits.

C. Vesicants (Blistering Agents) 1. Vesicants are agents that damage exposed tissue, causing vesicles. i.

They are capable of causing damage to the skin, eyes, ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 16 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

respiratory tract, and lungs and can induce generalized illness as well.

2. Patients who have been exposed to vesicants present with the signs and symptoms of injury to the skin, mucous membranes, and lungs; exposed skin shows signs of a chemical burn 3. Emergency care is immediate decontamination. i.

The areas exposed should be irrigated with water from a hose using as little pressure as possible. ii.

Irrigate the eyes with a preference of saline over water, but do not delay.

D. Pulmonary Agents 1. Pulmonary agents cause chemical injuries primarily to the lungs. i.

These agents attack the mucous membranes of the respiratory system from the oral pharynx and nasal pharynx to the smaller respiratory bronchioles and alveoli.

2. Early signs and symptoms are related to irritation of the upper airway i.

Rhinorrhea; nasal, oral, and throat irritation; wheezing and cough ii.

Pulmonary edema is a late sign of exposure.

3. Emergency care for the exposed individual is removal from the environment, exposure to fresh air, high-concentration oxygen, and rest.

E. Biotoxins 1.A type of agent classified as a biological agent but behaving more like a chemical agent i.

These toxins are produced by living organisms but are not alive. a. Ricin is a by-product of castor oil production and inhibits the body’s ability to synthesize proteins. b. Staphylococcal enterotoxin is produced by a bacterium and is responsible for food poisoning. c. Botulinum is the most toxic agent known and is the result of improper canning; it is 15,000 times more potent than VX gas but is highly unstable, limiting its ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 16 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

usefulness as a WMD. d. Trichothecene mycotoxins are a group of biotoxins produced by fungus molds that inhibit protein and nucleic acid formation and affect body cells that divide rapidly.

2.Management of a biotoxin victim is supportive.

F. Incapacitating Agents 1. Incapacitating agents include riot control agents used by police and for personal protection. i.

These agents are intentionally selected or designed to incapacitate, not injure or harm, the recipient.

2. The exposed patient often complains of eye irritation and tearing as well as rhinorrhea. i.

If the agent is inhaled, these symptoms are often accompanied by airway irritation and dyspnea.

3. The signs and symptoms are relieved by removal from the source, exposure to fresh air, the administration of oxygen, and time.

G. Other Hazardous Chemicals 1. Any toxic chemical has a potential for use as a WMD. 2. The only difference between an accidental release and one that is intended to incite terror is that the intentional release will likely be optimized to affect the greatest number of people.

H. Recognition of a Chemical Agent Release 1. A chemical weapon release may be visible as a cloud of mist, vapor, or dust; as puddles; or it may be completely unrecognizable.

2. Suspect a chemical release if there are chemical odors when and where chemicals are not normally used.

3. Never search out an odor or touch any suspect liquid or material 4. You may notice clusters of patients with chemical exposure symptoms or dead birds or animals.

5. Be especially wary of large public gatherings or confined spaces such as public buildings and low spaces such as subway terminals.

6. A cardinal sign of a chemical release is the manifestation of similar signs and symptoms occurring rapidly among a group. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

7

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 16 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline I.

15

Master Teaching Notes

Management of a Chemical Agent Release 1. Approach the scene from upwind and uphill and remain a good distance from the site.

2. Once the public danger is reduced by scene isolation, make sure the injured are properly decontaminated before beginning care.

3. In addition to the specific emergency care noted earlier, most patients require decontamination, exposure to fresh air, oxygen administration, and possibly respiratory support.

4. Use personal protective equipment (PPE) including high-efficiency particulate arresting (HEPA) filter mask and nitrile gloves

VI. Biological Agents A. Biological agents are either living organisms or toxins produced by living organisms that are deliberately distributed to cause disease, incapacitation, and death.

1. They are grouped as noncontagious (e.g., anthrax and biotoxins) or as contagious and capable of spreading from human to human (e.g., smallpox, Ebola, and plague). i.

Contagious agents are the greatest concern because the people originally infected can spread the disease, often before the medical community has recognized that a biological weapon attack has occurred.

2. Identification of a biological release is difficult because there is often no noticeable cloud of gas or odor, and any signs and symptoms occur at the end of the incubation period, which can be days or weeks later. i.

Most commonly, a biological attack is recognized when numerous patients report to the emergency department (ED) or clinic with similar signs and symptoms or when a geographic cluster of patients is noted. ii.

By the time the outbreak is recognized as a bioterrorism event, secondary exposures from those affected may have already occurred.

B. Pneumonia-like Agents 1. Pneumonia-like bioterrorism agents include anthrax, plague,

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Teaching Tips Biological agents are very similar to infectious diseases. Review infectious diseases, and discuss them with the class.

Knowledge Application Given that many of the signs and symptoms do not show up until much later, what types of things will give you an indication of an intentional act versus an outbreak? Will that change your response? Who should be notified, and how do you notify the proper groups?

8

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 16 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

tularemia, and Q fever and are the most likely agents for a terrorist attack.

2.They generally cause cough, fever, and malaise C. Encephalitis-like Agents 1. Smallpox and Venezuelan equine encephalitis (VEE) are influenzalike diseases that cause headache, fever, and malaise and a higher rate mortality because they attack the central nervous system (CNS).

D. Other Agents 1. Cholera is a common disease in underdeveloped countries and is frequently linked to poor sanitation.

2. It is transmitted by the fecal–oral route and causes severe dehydration and shock secondary to profuse diarrhea.

3. Viral hemorrhagic fever (VHF) is a class of disease that includes the Ebola virus. i.

Hemorrhagic fever attacks the bloodstream and damages blood vessels, causing them to leak and the patient to bleed easily.

E. Protection Against Biological Agent Transmission 1. Protection against the most common biological weapons includes the prudent care steps used to prevent ordinary communicable diseases.

2. Gloves are very effective in protecting against biological agent transmission from body fluids, as is rigorous hand washing.

3. Almost all biological agents are transmitted by the respiratory route, so be sure to take droplet inhalation precautions.

4. The ambulance interior and any equipment should be vigorously cleaned.

5. Emergency care for most patients is limited to supportive care and, in some cases, IV fluids.

6. Once the organism is isolated, a regimen of antibiotics may be prescribed.

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VII. General Considerations Regarding Terrorist Attacks A. Scene Safety 1. One in every five victims of the World Trade Center collapse on September 11, 2001, was a member of an emergency response

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Discussion Topics Scene safety is paramount in our profession. Discuss the impact of September 11 on EMS and fire 9

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 16 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline team. i.

This underscores the importance of the need to recognize the dangers to EMS providers and ensure that safety is an active concern during the response to any potential terrorist act. ii.

Ensure that the scene is entered only by those properly equipped and trained to enter a hazardous or deadly environment.

B. Recognizing a Terrorist Attack 1. It is relatively easy to recognize a nuclear or conventional explosion; however, remember that radioactive fallout travels with the wind current. i.

Watch cloud movement and stay upwind. ii.

Terrorists may use the conventional explosion to distribute radioactive or other hazardous material. iii.

They may set secondary detonations. iv.

Be aware of structural collapse.

2. A chemical release may not be as obvious. i.

There may or may not be a cloud of gas or aerosolized material. ii.

There may or may not be unusual odors. iii.

Groups of victims will be complaining of similar symptoms, though development may take some time. iv.

Stay upwind and uphill of the site, and request that victims and potential victims evacuate or be evacuated to you. v.

Only personnel who are specially trained and equipped to deal with the hazard should enter the scene.

3. Identifying a biological agent at the time of release is probably impossible. i.

If you become aware of a possible exposure or notice the signs and symptoms of a contagious disease, contact the proper health resources.

C. Responding to a Terrorist Attack 1. Your first role in responding to a possible act of terrorism is to ensure ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Master Teaching Notes service. How does that affect the way we respond? How does it affect your attitude when responding to calls?

Class Activities Include these types of patients in your patient care scenarios. Ask your students to describe what additional resources they would request, how they would modify their response, and what precautions they would take. Be sure to include them as patients if they do not take proper precautions.

10

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 16 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes

your own safety and that of your patient, other rescuers, and the public.

2. Make certain all patients are properly decontaminated.

3. Begin to provide the appropriate emergency medical care.

4. Your role as an emergency care provider for a terrorist attack is very similar to your role in other emergency responses.

5. Use the training you already have for these situations, and follow your system’s protocols and disaster plans.

6. Once a WMD incident is identified, begin preparation for the casualties.

7. Carefully match the available resources against the nature, number, and severity of injuries.

5

VIII.Summary A. Many of the mechanisms of injury used by terrorists subtly induce their damage (e.g., toxic gases, radiation contamination, or biological agents), so there is little scene evidence.

B. Your responsibility is to maintain an enhanced lookout for any signs of CBRNE release or exposure and limit the contact you, the general population, and your patients have to such an agent.

IX. Case Study

Class Activities Discuss the case with students now that they are familiar with the chapter.

X. You Make the Call

Class Activities Read and discuss the call and questions as a group.

XI. Review Questions

Class Activities

5

5

5

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Pass out review questions before the lesson starts. Have students answer them. Go over the questions again after the lecture to assess students’ understanding of

11

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 16 objectives can be found on the opening chapter page.

These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.

Minutes

Content Outline

Master Teaching Notes the information.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Volume 5 - Chapter 1 Gynecology

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Student’s Name

HANDOUT 1-1 EVALUATION

CHAPTER 1 QUIZ Write the letter of the best answer in the space provided.

1. The term gynecology is derived from the Greek gynaik, which means: a. reproduction. c. vulvic. b. woman. d. disease.

2. All of the following structures are located within the pelvic cavity, except the: a. vagina. c. ovaries. b. pudendum. d. fallopian tubes.

3. The part of the female internal genitalia that provides an outlet for menstrual blood and tissue leaving the body is called the: a. vagina. c. fallopian tube. b. uterus. d. urethra.

4. During your assessment of the victim of a sexual assault, you should: a. ask specific questions about the assault to report to law enforcement. b. perform a brief vaginal exam to verify penetration. c. place bloody articles in a brown paper bag. d. allow the patient to clean up before the medical examination.

5. The protects the pubic symphysis. a. perineum c. urethra b. mons pubis d. labia 6. The sloughing of the uterine lining is referred to as: a. endometriosis. c. the menstrual cycle. b. pelvic inflammatory disease. d. menopause.

7. The Skene and Bartholin glands: a. produce the hormones that trigger menstruation. b. are responsible for proper adhesion of a fertilized egg to the uterine wall. c. regulate the vascular structures of the endometrium. d. provide lubrication during sexual stimulation.

8.

Ovulation takes place at the end of the: a. proliferative phase. c. ischemic phase. b. secretory phase. d. menstrual phase.

9. One of the two MOST common emergency gynecologic complaints is: a. vomiting. c. abdominal pain. b. fever. d. back pain. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

10. Severe discomfort during a woman’s menstrual period is known as: a.

PID. c. dyspareunia. b. dysmenorrhea. d. LMP. 11. The drains the urinary bladder. a. vagina c. prepuce b. mons pubis d. urethra 12. General guidelines in assessing and caring for a gynecologic emergency patient include: a. packing the vagina with sterile dressings to control excessive hemorrhage. b. performing a thorough internal vaginal exam in the field. c. realizing that psychological support may be more important than emergency medical care. d. application of direct pressure, over the uterus, to control vaginal hemorrhage.

13. Your patient is complaining of abdominal pain, which increases when she walks. To avoid this, she walks with a shuffling gait.

She also complains of fever, chills, nausea, and vomiting. She is MOST likely experiencing: a. an ectopic pregnancy. c. pelvic inflammatory disease. b. a ruptured ovarian cyst. d. endometritis.

14. The fundus is the: a. uppermost portion of the uterus, above where the fallopian tubes connect. b. lower portion of the uterus, also called the cervix. c. upper two-thirds of the uterus, composed of smooth muscle. d. body, or corpus of the uterus.

15. An ectopic pregnancy is a pregnancy in which the: a. baby is delivered prematurely. b. developing fetus implants outside the uterus. c. fetus develops in an abnormal position, such as buttocks superior. d. fetus is spontaneously expelled during the first trimester.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Student’s Name

HANDOUT 1-2 EVALUATION

CHAPTER 1 SCENARIO Review the following real-life situation. Then answer the questions at the end of the scenario.

As a paramedic working in the emergency department, you start the assessment of patients off with a battery of routine procedures: vital signs, weight, and IVs as needed. Today you encounter a 29-year-old female who has a complaint of severe abdominal pain. Unwilling to have her walk to the department, you place her in a wheelchair, where she draws her knees up into the seat—peculiar behavior, you think, for a woman wearing a dress.

After the patient disrobes in private and puts on the hospital gown, you reenter the room. The patient complains of diffuse abdominal pain that she characterizes as 8 on a scale of 0 to 10. She is presently having her menstrual period. She also relates that she has had a light yellow discharge from the vagina lately.

On physical examination, she is pale and diaphoretic. Her pulse is a sustained 120 beats per minute. Her blood pressure is 140/76, elevated according to the patient. Palpation elicits severe pain and rebound tenderness. Your medical director has indicated that you are to follow your prehospital protocols and then report your patient to either the charge nurse or the attending physician, depending on the severity of the patient’s condition.

1. What would be some of your leading working diagnoses for this patient?

2. How would you treat this patient?

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

HANDOUT 1-3

Student’s Name

REINFORCEMENT CHAPTER 1 REVIEW Write the word or words that best complete the following sentences in the space(s) provided.

1.

and support are the MOST important elements of care for the sexual assault victim.

2. When caring for a victim of sexual assault, consider the patient a(n) scene.

3. Treatment for vaginal bleeding includes blood flow, , and initiating therapy and access based on the patient’s condition.

4. Treatment for gynecologic abdominal pain includes making the patient and providing .

5. The implantation of a developing fetus outside of the uterus is called a(n) pregnancy.

6. The commonly used term to describe a pregnancy that ends before 20 weeks’ gestation is called a(n) , or spontaneous .

7. Painful urination often associated with cystitis is called .

8. is an infection of the urinary bladder.

9. An acute infection of the reproductive organs is called .

10. When caring for the female patient with vaginal bleeding, do NOT pack in the .

11. General management of gynecologic emergencies is focused on care.

12. Do NOT perform a(n) vaginal exam in the field.

13. When obtaining the history of any female patient of childbearing age, the paramedic should always document the patient’s last .

14. The two MOST common emergency gynecologic complaints are and .

15. The cessation of menses and ovarian function due to decreased secretion of estrogen is called .

16. During the phase, the ischemic endometrium is shed, along with a discharge of blood, mucus, and cellular debris.

17. Fertilization of the egg may take place during the phase of the menstrual cycle.

18. During the phase of the menstrual cycle, the uterine lining thickens and becomes engorged with blood.

19. The female sex hormones and control the ovarian–menstrual cycle, pregnancy, and lactation.

20. The function of the is to conduct the egg from the space around the ovaries into the uterine cavity.

21. The are the primary female gonads, or sex organs. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

22. The term refers to the onset of menses, usually occurring between ages 10 and 14 years.

23. The inner layer of the uterine wall where the fertilized egg implants is called the .

24. The fundal , measured in centimeters, is generally comparable to the of gestation.

25. The is the uppermost portion of the uterus.

26. The primary function of the is to provide a site for fetal development.

27. The is the female organ of copulation, forms the final passageway for the infant during childbirth, and provides an outlet for menstrual blood to leave the body.

28. Although NOT truly a part of the female reproductive system, the drains the urinary bladder.

29. The structures that protect the vagina and the urethra are the .

30. The is a roughly diamond-shaped, skin-covered muscular tissue that separates the vagina from the anus.

31. The female external genitalia are known collectively as the , or the .

32. The MOST important female reproductive organs are internal and are located within the .

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

HANDOUT 1-4

Student’s Name

REINFORCEMENT UNDERSTANDING FEMALE REPRODUCTIVE ANATOMY Write the name of each part of the female reproductive system indicated on the illustration in the spaces provided.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Student’s Name

HANDOUT 1-5 REINFORCEMENT

GYNECOLOGY TRUE OR FALSE Indicate if the following statements are true or false by writing T or F in the space provided.

1.

MOST gynecologic emergency patients experience either abdominal pain or vaginal bleeding.

2. The uterus produces LH and FSH. 3. The ovaries produce eggs for reproduction.

4. The perineum is the lining of the uterus that sloughs off during the menstrual period.

5. Women are more susceptible to bladder disease than men because they have longer urethras.

6. Actual menstruation occurs during the secretory phase of the menstrual cycle.

7. The number of times a woman has been pregnant is referred to as her gravidity.

8. The number of a woman’s pregnancies that have resulted in a viable infant are referred to as her parity.

9. The use of IUDs can cause hypertension, stroke, and pulmonary embolism.

10. The internal vaginal exam should be performed immediately after history taking.

11. Probably the MOST common cause of nontraumatic abdominal pain in women is PID. 12. PID may be difficult to distinguish from appendicitis in the field.

13. Patients with PID often draw their knees up to the chest as a way of decreasing tension on the peritoneum.

14. In an ectopic pregnancy, the egg implants in the uterus.

15. Ectopic pregnancy is a life-threatening condition.

16. Endometritis is caused by the rupture of an ovarian cyst.

17. The condition known as mittelschmerz is associated with the release of an egg from the ovary.

18. Any woman with significant abdominal pain should be transported to the hospital.

19. NEVER pack the vagina with any material or dressing to control bleeding.

20. If you are the FIRST person to reach a rape victim, question her to establish details of the incident while they are fresh in her mind.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 1 Answer Key Handout 1-1: Chapter 1 Quiz 1. b 5. b 9. c 13. c 2. b 6. c 10. b 14. a 3. a 7. d 11. d 15. b 4. c 8. a 12. c Handout 1-2: Chapter 1 Scenario 1. The symptom pattern is similar to that of either pelvic inflammatory disease or acute appendicitis. However, the possibility of an ectopic pregnancy cannot be ruled out.

2. The question of an ectopic pregnancy is pressing. According to the ectopic pregnancy/abdominal pain protocols, the patient should have a large-bore IV line established with a fluid bolus of 500 to 1,000 mL of NS or lactated Ringer’s solution. The patient should be prepared for the possibility of imminent shock as well. It is imperative that blood be drawn and sent to the lab to confirm or deny the presence of pregnancy.

Handout 1-3: Chapter 1 Review 1. Psychological, emotional 2. crime 3. absorbing, transport, oxygen, IV 4. comfortable, transport 5. ectopic 6. miscarriage, abortion 7. dysuria 8. Cystitis 9. pelvic inflammatory disease 10. dressings, vagina 11. supportive 12. internal 13. menstrual period 14. abdominal pain, vaginal bleeding 15. menopause 16. menstrual 17. proliferative 18. proliferative 19. estrogen, progesterone 20. fallopian tubes 21. ovaries 22. menarche 23. endometrium 24. height, weeks 25. fundus ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

26. uterus 27. vagina 28. urethra 29. labia 30. perineum 31. vulva, pudendum 32. pelvic cavity Handout 1-4: Understanding Female Reproductive Anatomy 1. Fimbriae of fallopian tube 2. Rectum 3. Cervix of uterus 4. Vagina 5. Anus 6. Fallopian tube 7. Ovary 8. Uterus 9. Urinary bladder 10. Symphysis of pubs 11. Urethra 12. Clitoris 13. Labium minor 14. Labium major 15. Vaginal orifice Handout 1-5: Gynecology True or False 1. T 2. F 3. T 4. F 5. F

6. F 7. T 8. T 9. F 10. F

11. T 12. T 13. T 14. F 15. T

16. F 17. T 18. T 19. T 20. F

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Volume 5 - Chapter 2 Obstetrics

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HANDOUT 2-1

Student’s Name

EVALUATION CHAPTER 2 QUIZ Write the letter of the best answer in the space provided.

1. If your patient complains of excruciating abdominal pain with the onset of labor and shows signs and symptoms of shock without external hemorrhage, consider: a. uterine inversion. c. uterine rupture. b. placenta previa. d. abruptio placentae.

2.

The release of an egg from the ovary is called: a. the preembryonic stage. c. menstruation. b. ovulation. d. gestation.

3.

If the umbilical cord is seen in the vagina (prolapsed cord), you should: a. insert a gloved hand to gently push the fetus back up the birth canal. b. immediately clamp and cut the cord. c. place the mother in the knee–chest position. d. encourage the mother to continue to push to speed up the delivery.

4.

Fertilization of the egg takes place in the: a. uterus. c. fallopian tube. b. vagina. d. cervix.

5.

Guidelines of neonatal resuscitation include: a. initiating chest compressions if the infant’s heart rate is below 100,and it does not respond to ventilations. b. assisting ventilations if the infant’s respiratory rate is below 30 and tactile stimulation does not increase the rate. c. intubating the infant and initiating ACLS procedures if the heart rate falls below 80. d. administering 25 percent dextrose IV if the infant’s respiratory rate is less than 15.

6.

The placenta, or “organ of pregnancy”: a. is an organ that is always present in the female uterus. b. is the organ in which the fetus will develop.

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c. secretes hormones necessary for fetal survival. d. becomes thick and engorged with blood at the time of fertilization.

7.

During the delivery of the baby, you should: a. pull gently on the umbilical cord to encourage the placenta to deliver. b. “milk” the cord toward the baby. c. suction the baby’s mouth first, then the nose. d. administer high-flow, high-concentration oxygen to the baby.

8.

Which of the following statements is TRUE regarding the umbilical cord? a. If it is found to be around the baby’s neck at the time of delivery, it must immediately be clamped and cut. b. It is a flexible, ropelike structure, usually several feet in length. c. It circulates amniotic fluid through the uterus. d. It contains two arteries and one vein.

9.

If you note crowning before transporting the patient to the hospital: a. have the mother cross her legs, and transport immediately. b. place the mother in the knee–chest position, and transport. c. prepare to deliver the baby, as the birth is imminent. d. place the mother in the Trendelenburg position, and transport.

10. When a pregnant patient advises you that her “water has broken,” she means that: a. contractions have begun. b. the mucus plug has been expelled. c. the membranes have ruptured. d. she is experiencing vaginal bleeding.

11. During the second stage of labor: a. contractions are usually mild, occurring every 10–20 minutes. b. the patient feels the urge to push or “bear down.” c. the placenta (afterbirth) is delivered. d. the cervix dilates to 10 cm.

12. The MOST significant pregnancy-related changes occur in the uterus. These changes include: a. an increase in weight of the uterus to approximately 2 pounds. b. an increase in the vascular system of the uterus to about onefourth of the mother’s total blood volume. c. the development of a layer of mucus on the lining of the uterus. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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d. an increase in the capacity of the uterus to nearly a liter of fluid.

13. The term “tocolysis” refers to: a. the acceleration of labor by administration of Pitocin. b. an infection acquired by the mother and passed on to the fetus. c. the process of stopping labor. d. the disruption of blood flow from the placenta to the fetus.

14. When maternal blood volume increases, pregnant women receive supplemental iron to prevent anemia. This is because: a. the mother’s red blood cells do not carry as much oxygen as they did before the pregnancy. b. there is a decrease in the number of the mother’s red blood cells because they are now shared with the fetus. c. although both red blood cells and plasma increase, there is slightly more plasma. d. there is only an increase in plasma, not in red blood cells.

15. Labor consists of uterine contractions that cause the dilation and effacement of the cervix. The term “effacement” means that the uterus is: a. thinning and shortening. c. releasing the placenta. b. thinning and lengthening. d. returning to its normal, prepregnancy size.

16. Hemodynamic changes of pregnancy include: a. the stroke volume progressively declining to term following a rise early in the pregnancy. b. cardiac output increasing 2.5–3 liters per minute during the first trimester. c. blood volume decreasing slightly, by 1–5%. d. heart rate remaining about the same.

17. Care for the eclamptic patient may include: a. administration of IV diazepam. b. transport of the patient in the left lateral recumbent position. c. administration of IV Lasix to reduce edema. d. two large-bore IVs of lactated Ringer’s solution, initiating a 250mL fluid challenge.

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18. Supine hypotensive syndrome occurs when the: a. heart is compressed by the gravid uterus when the mother lies supine. b. gravid uterus compresses the inferior vena cava when the mother lies in the supine position. c. body reacts to the mother lying in the supine position by dilation of the major blood vessels. d. fetus, lying at the same level as the mother when she is lying in the supine position, now requires more blood.

19. Sharp, tearing pain and a stiff, boardlike abdomen without vaginal bleeding in a pregnant patient indicate: a. a central abruption of the placenta. c. an ectopic pregnancy. b. placenta previa. d. spontaneous abortion.

20. Which of the following statements is TRUE regarding fetal development? a. Fetal heart tones may be detected with a stethoscope by the 16th week. b. The baby may be able to survive if born before the 20th week. c. By the 38th week, the baby is considered fully developed. d. The sex of the infant can usually be determined by 8 weeks gestation.

21. The hallmark of abruptio placente is: a. severe abdominal pain and vaginal bleeding. b. increased blood pressure and seizures. c. painless, bright red vaginal bleeding. d. abdominal pain accompanied by fever.

22. The fetus receives its blood from the placenta by means of the: a. umbilical arteries. c. pulmonary arteries. b. umbilical vein. d. pulmonary veins.

23. The abnormal implantation of the placenta on the lower half of the uterine wall, resulting in partial or complete coverage of the cervical opening, is called: ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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a. placenta previa. b. abruptio placentae.

c. prolapsed placenta. d. nuchal placenta.

24. A pregnant woman may develop diabetes during the pregnancy. This is called: a. gravid diabetes. c. gestational diabetes. b. obstetric diabetes. d. uterine diabetes.

25. An ectopic pregnancy refers to a pregnancy in which: a. delivery occurs within the first 24 weeks of the pregnancy. b. the egg has split in two, resulting in maternal twins. c. any aspect of it is abnormal. d. the fetus is implanted abnormally outside of the uterus.

26. Because cardiac output increases up to 30% during pregnancy, patients who have serious preexisting heart disease may develop: a. pulmonary embolism. c. palpitations. b. congestive heart failure. d. angina pectoris.

27. “Spontaneous abortion” is the term used to describe: a. an elective termination of pregnancy. b. the expulsion of the fetus before 8 weeks’ gestation. c. the loss of a fetus by natural means. d. the loss of a fetus due to a traumatic injury to the mother.

28. When caring for a pregnant patient who is experiencing vaginal bleeding, you should: a. gain information about the color, amount, and duration. b. assess the amount of bleeding by counting the number of sanitary pads used. c. save any passed clots or tissue for evaluation. d. all of the above.

29. When caring for a pregnant patient who has experienced a major trauma, remember that: a. the later in the pregnancy, the less the likelihood of injury to the uterus. b. the fetus may be in danger even though the mother is showing no signs or symptoms of shock. c. the primary cause of fetal mortality is direct injury to the fetus, while the mother survives. d. the amniotic fluid provides little protection to the fetus from blunt trauma. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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30. Indications of imminent delivery include: a. contractions less than 5 minutes apart for a patient who is pregnant for the first time. b. the bulging of the fetal head past the opening of the vagina during a contraction. c. pain in the lower back. d. all of the above.

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Student’s Name

HANDOUT 2-2 EVALUATION

CHAPTER 2 SCENARIO Review the following real-life situation. Then answer the questions that follow.

You respond to an “unknown medical” call to find a 19-year-old female complaining of vaginal bleeding and abdominal pain. The patient is lying in the fetal position in obvious distress when you arrive. Her vital signs are pulse 140; blood pressure 84/50; respirations 24 and normal; lungs clear; and skin cool, pale, and moist. While obtaining her history, you discover that she has been having irregular bleeding for approximately two weeks. She says her last menstrual period was almost two months ago. She denies pregnancy because she uses a protective device. Her abdomen is warm and tender to palpation to the right lower quadrant, causing severe pain. She denies any further medical problems.

1. On the basis of the evidence, what problem do you believe this patient is having? Why?

2. What other problems might she be having?

3. What other questions might help you in your diagnosis?

4. What treatment should be given this patient?

5. Is there a need for a visual exam? Why or why not?

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Student’s Name

HANDOUT 2-3 REINFORCEMENT

CHAPTER 2 REVIEW Write the word or words that best complete the following sentences in the space(s) provided.

1.

occurs when the uterus turns inside out after delivery.

2. The actual tearing of the uterus is called .

3.

occurs when the fetus passes feces into the amniotic fluid.

4. A delivery that occurs after less than 3 hours of labor is called a(n) delivery.

5. With limb presentation, place the mother in the position.

6. A(n) cord precedes the fetal presenting part.

occurs when the umbilical

7. After the delivery of the infant, place the first clamp on the umbilical cord cm from the baby and the second clamp cm above the first clamp.

8. The process of stopping labor is called

.

9. The thinning and shortening of the cervix during labor is called .

10.

occurs when the gravid uterus compresses the inferior vena cava when the mother lies in a supine position.

11. The difference between preeclampsia and eclampsia is the onset of .

12. The premature separation of a normally implanted placenta from the uterine wall is called .

13.

occurs as a result of abnormal implantation of the placenta on the lower half of the uterine wall.

14. Assume that any female of childbearing age with lower abdominal pain is experiencing a(n) . ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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15. Another term for miscarriage is .

16. Termination of pregnancy before the 20th week of gestation is called a(n) .

17. Transport all trauma patients at gestation.

weeks or more

18. The bulging of the fetal head past the opening of the vagina during a contraction is called , which is an indication of delivery.

19. A woman who has given birth to her FIRST child is called , while a woman who has delivered more than one baby is called .

20. The approximate date the infant will be born is called the of

.

21. Generally, pregnancy is divided into __________________ , each being 13 weeks long.

22. The normal duration of pregnancy is days, or

weeks, or calendar months.

23. The membranes that surround and protect the developing fetus throughout the period of intrauterine development are the .

24. The clear, watery fluid that surrounds and protects the developing fetus is called fluid.

25. The structure that connects the placenta and the fetus is the , which has artery(ies) and vein(s).

26. The organ that serves as a lifeline for the developing fetus is the .

27. The release of an egg from the ovary is called

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.

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Student’s Name

HANDOUT 2-4 REINFORCEMENT OBSTETRIC TERMINOLOGY MATCHING

Write the letter of the appropriate term in the space provided next to the description. a. Primigravida b. Nulligravida c. Multigravida d. Primipara e. Multipara f. Nullipara g. Ectopic pregnancy h. Abruptio placenta 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

i. Placenta previa j. Preeclampsia k. Eclampsia l. Supine hypotensive syndrome m. Cephalopelvic disproportion n. Prolapsed cord o. Shoulder dystocia

Woman who has NOT yet delivered her first child.

Pregnancy toxemia resulting in hypertension, edema, headache, and vision disturbances.

Woman who is pregnant for the FIRST time.

Woman who has delivered her FIRST child.

When the umbilical cord is the presenting part and is compressed in the birth canal.

When the baby’s head is too large for the birth canal.

Implantation of an egg other than in the uterus.

Woman who has delivered more than one baby.

Compression of the major vessels by the uterus.

Separation of the placenta from the uterine wall.

Woman who has NOT been pregnant.

When the baby’s shoulders are larger than the head.

Woman who has been pregnant more than once.

Low attachment of the placenta interfering with the cervix.

Pregnancy toxemia resulting in seizures.

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HANDOUT 2-5

Student’s Name

REINFORCEMNT OBSTETRICS TRUE OR FALSE Indicate if the following statements are true or false by writing T or F in the space provided.

1. Pregnant diabetics should generally be managed with oral drugs.

2. Women who were borderline hypertensive before becoming pregnant may become dangerously hypertensive when pregnant.

3. In cases involving abortions, the physical exam should include orthostatic vital signs if possible.

4. In cases of ectopic pregnancy, start an IV of D5W. 5. Patients suffering abruptio placenta MOST often report heavy bleeding with NO pain.

6. The definitive treatment for placenta previa is cesarean section.

7. The MOST common sign of placenta previa is brownish vaginal discharge.

8. Eclampsia is characterized by seizures.

9. Medical direction may order the administration of valium and/or magnesium sulfate to eclampsia patients.

10. Supine hypotensive syndrome is MOST common in the FIRST trimester.

11. Tocolysis is the recommended procedure in cases of preeclampsia.

12. Braxton-Hicks contractions are a TRUE medical emergency requiring rapid transport.

13. The presence of crowning indicates that delivery is imminent.

14. You should “milk” the umbilical cord after delivery to lessen the possibility of vaginal bleeding.

15. Cephalopelvic disproportion tends to develop MOST frequently in the primigravida.

16. It may be necessary to insert a gloved hand into the vagina and use the fingers to form an airway for the infant in cases of breech birth.

17. With a prolapsed cord, use a dressing moistened with sterile saline to push the cord back.

18. Pulmonary embolism is one of the MOST common causes of maternal death.

19. In cases of postpartum hemorrhage, administer oxygen and begin fundal massage.

20. In cases of uterine inversion, initiate IVs of normal saline or lactated Ringer’s solution immediately after pulling the placenta free.

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Chapter 2 Answer Key Handout 2-1: Chapter 2 Quiz 1. c 2. b 3. c 4. c 5. b 6. c

7. c 8. d 9. c 10. c 11. b 12. a

13. c 14. c 15. a 16. a 17. b 18. b

19. a 20. c 21. a 22. b 23. a 24. c

25.

26.

27.

28.

29.

30.

d b c d b b

Handout 2-2: Chapter 2 Scenario 1. There is a strong likelihood of an ectopic pregnancy, based on the irregular bleeding, missed period, tender lower right quadrant, and vital sign findings.

2. Acute abdomen and appendicitis are possibilities.

3. What type of birth control protection does she use? (IUD?) Were there any previous pelvic infections? Abdominal surgery? Tubal ligations? Any other pregnancy-related symptoms?

4. She should receive high-flow oxygen and an IV of LR or NS, with rapid transport.

5. No. If this is a delivery of a pregnancy, the dates would indicate a nonviable fetus.

Handout 2-3: Chapter 2 Review 1. Uterine inversion 2. uterine rupture 3. Meconium staining 4. precipitous 5. knee-chest 6. prolapsed cord 7. 10, 5 8. tocolysis 9. effacement 10. Supine hypotensive syndrome 11. seizures 12. abruptio placentae 13. Placenta previa 14. ectopic pregnancy 15. spontaneous abortion 16. abortion 17.

20 18. crowning, imminent ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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19. primipara, multipara 20. estimated date, confinement 21. trimesters 22. 40, 280, 9 23. amniotic sac 24. amniotic 25. umbilical cord, two, one 26. placenta 27. ovulation Handout 2-4: Obstetric Terminology Matching 1. f 2. j 3. a

4. d 5. n 6. m

7. g 8. e 9. l

10. h 11. b 12. o

13. c 14. i 15. k

Handout 2-5: Obstetrics True or False 1. F 2. T 3. T 4. F

5. F 6. T 7. F 8. T

9. T 10. F 11. F 12. F

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13. T 14. F 15. T 16. T

17.

18.

19.

20.

F T T F

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Volume 5 - Chapter 3 Neonatology

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Student’s Name

HANDOUT 3-1 EVALUATION

CHAPTER 3 QUIZ Write the letter of the best answer in the space provided.

1. Infants with a blood glucose screening test of less than 45 mg/dL: a. have developed hypoglycemia. b. have an elevated blood glucose level. c. will frequently develop hyperglycemia. d. have resistant hypoglycemia.

2. A neonate is an infant from the time of birth to: a. 1 week of age. c. 1 month of age. b. 2 weeks of age. d. 3 months of age.

3. Fever in a neonate: a. is not a cause for concern, since their immune systems are immature and they frequently develop mild infections. b. is not a cause for concern unless the infant is sweating heavily. c. should be treated with application of cold packs to lower the core temperature. d. should be considered a sign of meningitis or another lifethreatening infection until proven otherwise.

4. The term “newborn” or “newly born infant” is used to describe a neonate: a. until the umbilical cord is cut. b. during the time it spends in the delivery room. c. until it is discharged from the hospital. d. during the first few hours of life.

5. A newborn who is suspected of being hypovolemic should be given a bolus of: a. 10 mL/kg of Ringer’s lactate or normal saline. b. 10 mL/kg of D5LR or D5NS. c. 40 mL/kg of Ringer’s lactate or normal saline. d. 40 mL/kg of D5LR or D5NS. 6. The difference between primary apnea and secondary apnea in a ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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newborn is that: a. infants with primary apnea typically will respond to simple stimulation and oxygen, while those in secondary apnea will not. b. bradycardia is present in primary apnea but not in secondary apnea. c. infants with secondary apnea typically will respond to simple stimulation and oxygen, whereas those in primary apnea will not. d. bradycardia is present in secondary apnea but not in primary apnea.

7. The leading cause of shock in newborns is: a. sepsis. b. cardiac failure secondary to hypoxia. c. hypovolemia. d. hypoglycemia.

8. A normal newborn’s respiratory rate should average: a. 12–20 breaths per minute. b. 20–30 breaths per minute. c. 40–60 breaths per minute. d. 60–80 breaths per minute.

9. The MOST common factor causing respiratory distress and cyanosis in the newborn is: a. meconium aspiration. c. diaphragmatic hernia. b. prematurity. d. aspiration pneumonitis.

10. A newborn’s heart rate should normally be: a. 80–100 at birth, speeding to 140–160 thereafter. b. 150–180 at birth, slowing to 130–140 thereafter. c. 170–190 at birth, slowing to 80–100 thereafter. d. 60–80 at birth, speeding to 150–180 thereafter.

11. Premature infants are susceptible to hypothermia because: a. they have a large surface-to-volume ratio. b. they have small stores of subcutaneous fat and therefore less insulation. c. they are unable to shiver. d. all of the above.

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12. Which of the following statements about skin color in the newborn immediately after birth is CORRECT? a. Cyanosis of the extremities is common, but central cyanosis is abnormal. b. Central cyanosis is common, but cyanosis of the extremities is abnormal. c. Both cyanosis of the extremities and central cyanosis are common and normal. d. Both central cyanosis and cyanosis of the extremities are abnormal.

13. A premature newborn is an infant born before: a. 40 weeks gestation or with a weight less than 2.2 kg. b. 37 weeks gestation or with a weight less than 2.2 kg. c. 32 weeks gestation or with a weight less than 0.6 kg. d. 28 weeks gestation or with a weight less than 0.6 kg.

14. An infant is in distress and requires emergency intervention if its pulse rate is less than: a. 60. c. 100. b. 80. d. 120.

15. The MOST effective initial treatment for bradycardia in the newborn is to give: a. atropine. c. epinephrine. b. oxygen. d. D10W. 16. Determine the APGAR score for the following infant: Appearance—completely pink Pulse—over 100 Grimace—crying Activity—some flexion, slowly Respiration—strong cry a. 5 c. 9 b. 7 d. 10 17. The MOST common cause of bradycardia in the newborn is: a. increased intracranial pressure. c. hypoxia. b. acidosis. d. hypothyroidism.

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18. Determine the APGAR score for the following infant: Appearance—completely cyanotic Pulse—below 100 Grimace—frowns when stimulated Activity—limp Respiration—slow, irregular a. 1 c. 5 b. 3 d. 7 19. The CORRECT technique for two rescuer chest compressions and ventilations to a newborn would include positioning his head and thorax: a. higher than the abdomen and feet, placing a nasogastric or orogastric tube, and ventilating with a bag-valve mask while preparing to intubate. b. higher than the abdomen and feet, placing a nasogastric or orogastric tube, and withholding further bag-valve-mask ventilation until an endotracheal tube is placed. c. lower than the abdomen and feet, placing a nasogastric or orogastric tube, and withholding further bag-valve-mask ventilation until an endotracheal tube is placed. d. higher than the abdomen and feet, avoiding placement of a nasogastric or orogastric tube,; and ventilating with a bag-valve mask while preparing to intubate.

20. You have just delivered an infant. The baby is limp with central cyanosis. There is NO apparent respiratory effort. You should: a. begin resuscitation immediately. b. withhold resuscitation for 1 minute so that the APGAR score can be used to guide your efforts. c. give oxygen by blow-by, but withhold other resuscitative measures until a 1-minute APGAR score can be determined. d. position, dry, warm, suction, and stimulate the infant, but withhold other resuscitation until a 1-minute APGAR score can be determined.

21. An infant you have just delivered is in severe respiratory distress.

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sounds over the left lung field; and displacement of the heart sounds to the right. What problem do you suspect? a. Meconium aspiration c. Diaphragmatic hernia b. Omphalocele d. Meningomyelocele 22. An infant is considered to be in severe distress and in need of immediate resuscitation if its APGAR score is less than: a. 2. c. 6. b. 4. d. 8.

23. You are delivering the infant of a 17-year-old female who has been living in a shelter for the homeless. During your assessment of the mother, you notice needle tracks on her arms. Her speech is slurred, and she appears to be drowsy and apathetic. When you question her about drug abuse, she admits to “shooting up” with heroin about 2 hours ago to relieve the pain of labor. Which of the following statements BEST describes your considerations in this situation? a. The infant will probably suffer respiratory depression following delivery and should receive naloxone as quickly as possible to reverse this problem. b. The infant will probably not suffer significant problems, since narcotics do not cross the placental barrier easily.

C. The infant will probably suffer respiratory depression following delivery but should not be given naloxone, since a withdrawal reaction might occur. d. Naloxone should be given by IV push to the mother immediately to avoid serious respiratory depression in her newborn.

24. When you suction a newborn’s airway, you should: a. suction the mouth first so that there is nothing there to aspirate if the infant gasps when its nose is suctioned. b. suction the nose first so that there is nothing there to aspirate if the infant gasps when its mouth is suctioned. c. suction either the nose or the mouth first, depending on which you can reach most easily. d. squeeze the suction bulb only after placing it into the infant’s mouth.

25. Which of the following BEST describes the CORRECT technique for two rescuer chest compressions and ventilations to a newborn? a. Rate 120/minute; 30 compressions to 2 ventilations b. Rate 100/minute; 30 compressions to 2 ventilations ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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c. Rate 120/minute; 15 compressions to 2 ventilations d. Rate 100/minute; 15 compressions to 2 ventilations

26. Appropriate methods of stimulating a newborn include: A. flicking the soles of its feet, slapping its buttocks.

B. flicking the soles of its feet, gently rubbing its back.

C. vigorous rubbing, flicking the soles of the feet.

D. vigorous rubbing, slapping the buttocks.

27. Chest compressions should be initiated in a newborn if the heart rate is: a. less than 60 beats/minute. b. between 60 and 80 beats/minute, but does not increase with 30 seconds of oxygenation and ventilation. c. between 80 and 100 beats/minute and central cyanosis is present. d. either A or B. 28. “Milking” or stripping the umbilical cord is: a. contraindicated because it increases blood viscosity and produces polycythemia. b. indicated because it increases the newborn’s red cell mass and improves oxygenation. c. contraindicated because it decreases blood viscosity and causes hypovolemia. d. indicated because it helps to reverse hypovolemia that may have developed during birth.

29. A newborn initially presented with a heart rate of 152 and regular, unlabored respirations at 46. Since central cyanosis was present, oxygen was given by blow-by. After about a minute, the cyanosis was still present. You should: a. discontinue the oxygen, since the cause is probably not respiratory in nature. b. begin positive-pressure ventilation with a bag-valve mask. c. immediately intubate the newborn’s trachea, then ventilate with a bag-valve mask. d. begin chest compressions.

30. The FIRST priority following the birth of a baby is to: a. clamp and cut the umbilical cord. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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b. deliver the placenta. c. ensure that the infant’s airway and breathing are adequate. d. control maternal blood loss.

31. A newborn has a heart rate of 86 and regular, unlabored respirations at 40. Cyanosis of the extremities is present. You should: a. blow oxygen across the newborn’s face. b. wait for 1 minute, then reassess the pulse to see whether it is increasing. c. begin chest compressions immediately. d. immediately begin positive-pressure ventilation with a bag-valve mask.

32. Acceptable techniques for checking the heart rate of an infant include all of the following EXCEPT: a. listening over the cardiac apex with a stethoscope. b. lightly grasping the stump of the umbilical cord. c. palpating the femoral or brachial pulses. d. attaching the infant to an ECG monitor and watching the heart rate meter.

33. A newborn has a heart rate of 140 and regular, unlabored respirations at 42. Cyanosis of the chest and abdomen are present. You should: a. withhold oxygen, since central cyanosis is common in the first few minutes after birth. b. withhold oxygen, since high-concentration oxygen has been linked with blindness in newborn infants. c. give oxygen immediately using a bag-valve mask. d. give oxygen by blowing oxygen across the newborn’s face.

34. At 1540 hours, you respond to a call in a maternity store at a shopping mall, where you find a woman in labor. The physical exam reveals that the baby’s head is crowning, and the mother says that she needs to push. When you deliver the infant, it is covered with a greenish-black material. The infant’s respirations are gasping and are NOT moving air. You should: a. position the infant head down and rub its back to stimulate breathing. b. begin immediate ventilation with oxygen using the bag-valve mask. c. intubate the trachea and apply suction to the ET tube to remove ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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any foreign material from the lower airway. d. give blow-by oxygen and transport immediately.

35. A newborn should receive positive -pressure ventilations with a bagvalve mask if its heart rate is NOT at LEAST: a. 60. b. 80. c. 100. d. 120.

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Student’s Name

HANDOUT 3-2 EVALUATION

CHAPTER 3 SCENARIO Review the following real-life situation. Then answer the questions that follow.

At 2230 hours on a snowy winter evening, you are dispatched for a woman in preterm labor. Weather and traffic conditions slow your response, and a trip that normally would have taken 5 minutes requires 15. When you finally reach the location of the call, a suburban home, you discover that a 28-year-old female, assisted by her husband, has just delivered a 30-week-gestation boy.

The infant is flaccid with no spontaneous movement. He has no apparent respiratory effort. The pulse, felt at the base of the umbilical cord, is 44 beats/minute and weak. Central cyanosis is present. You estimate the infant’s weight at 1 kg. There are no obvious congenital abnormalities.

1. What is this newborn’s status and the most likely cause of this situation?

2. What should you do?

3. Thirty seconds after you begin ventilation, the baby’s heart rate is still 44 beats/minute. What should you do now?

4. After 30 seconds of CPR, the baby’s heart rate rises to 88 beats/minute.

What should you do now?

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Student’s Name

HANDOUT 3-3 REINFORCEMENT

CHAPTER 3 REVIEW Write the word or words that best complete the following sentences in the space(s) provided.

1. Any neonate with a fever should be considered to have until proven otherwise.

2. Newborns are extremely sensitive to environmental temperatures because of their increased to relationship.

3. Newborns of diabetic mothers have an increased risk of developing .

4. Hypoglycemia in the newborn is indicated by a blood glucose of less than .

5. Hypoglycemia in the newborn can be corrected by giving or .

6. Bradycardia in the newborn is MOST commonly caused by .

7. A premature newborn is an infant born before who weighs less than kg.

weeks or

8. The single MOST common factor causing respiratory distress and cyanosis in the newborn is .

9. The MOST common cause of shock in the newborn is 10. Fluid bolus resuscitation in the newborn consists of mL/kg of isotonic crystalloid.

11. Chest compressions should be initiated in a newborn if the heart rate is less than .

12. Chest compressions in the newborn should be performed at a rate of per minute.

13. Vascular access in the newborn can be MOST readily obtained by using the .

14. The administration of to a narcotic-addicted mother.

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is not indicated in an infant born

.

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15.

If you suspect a diaphragmatic hernia, DO NOT use , which can worsen the condition by causing gastric distention.

16. The MOST important indicator of neonatal distress is the .

17. The FIRST steps on the “inverted pyramid” of neonatal resuscitation are , , , , and .

18. If a newborn has central cyanosis and a heart rate greater than 100, you should administer .

19. An infant should receive positive-pressure ventilation if the infant has a heart rate less than , or persistence of after administration of oxygen.

20. An infant who needs positive-pressure ventilation should be ventilated at a rate of to breaths per minute.

21. As soon as you deliver a newborn’s head, suction the first, then the .

22. The dark green material that can be expelled from the intestine into the amniotic fluid during periods of distress is .

23. Two acceptable methods of stimulating a newborn who does NOT cry immediately are and .

24. Heat loss from the newborn can result from , , and 25. “Milking” or stripping the umbilical cord can cause and

, . .

26. Protrusion of abdominal contents into the thoracic cavity through an opening in the diaphragm is a(n)

.

27. Herniation of the spinal cord and membranes through a defect in the spinal column is a(n) .

28. A defect in the area of the umbilicus that results in herniation of the abdominal contents is a(n) .

29. The MOST common birth defect of the nose, which is due to the presence of a bony or membranous septum between the nasal cavity and the pharynx, is .

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30.A numerical system for distinguishing newborns who need only routine care from those who need greater assistance is the , which has five parameters: , , , , and .

31. The channel between the main pulmonary artery and the aorta in the fetus is the .

32. A condition in the newborn in which blood continues to bypass the fetal respiratory system resulting in ongoing hypoxia is .

33. The initial period of apnea in a hypoxic newborn that can be reversed with simple stimulation and exposure to oxygen is apnea.

34.

apnea is a condition characterized by falling heart rate, blood pressure, and oxygen saturation that is NOT responsive to stimulation and that will NOT spontaneously reverse.

35. Apnea in a newborn should always be assumed to be apnea.

36. An infant from the time of birth to 1 month of age is a(n) .

37. A baby in the FIRST few hours of life is referred to as a(n) . These infants also are sometimes called .

38. After an unscheduled delivery in the field, you have patients to manage, the and the

.

39. Factors present before onset of labor that indicate possible complications in newborns are called factors.

40. Factors occurring during childbirth that indicate possible complications in newborns are called factors.

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HANDOUT 3-4 Student’s Name REINFORCEMENT STEPS FOR UMBILICAL VEIN CATHETERIZATION 1. Fill baby bottle with saline (food coloring may be added to simulate blood).

2. Make two cross-slits in the nipple of the bottle.

3. Pull the umbilical cord through the nipple and attach the nipple to the bottle.

4. Cut the umbilical cord horizontally until the two arteries and the vein are easily seen.

5. Place umbilical tape at the base of the cord.

6. Fill a syringe and the umbilical catheter with saline.

7. Locate the orifice of the umbilical vein and insert the catheter.

8. Advance the catheter slowly until a fluid return is obtained.

(Note: When this procedure is performed on a newborn, the catheter should be advanced only a short distance to avoid entering the hepatic venous system.)

9. When there is good blood return, tighten the tape in a purse string.

(Note: This step should be demonstrated by your instructor but not practiced.)

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Student’s Name

HANDOUT 3-5 REINFORCEMENT

NEWBORN RESUSCITATION SCENARIO ONE: RESUSCITATION OF THE NORMAL NEWBORN At 2245 hours, you respond to a report of “abdominal pain” in a small community that is about 30 minutes from the closest emergency department. The patient is a 15-year-old female who is screaming as she lies on a couch in the living room of her home. The girl’s mother is standing by, perplexed. After a quick exam, you determine that the patient is pregnant and is in active labor.

What do you do?

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SCENARIO TWO: RESUSCITATION OF THE DISTRESSED NEWBORN At 1415 hours, you are dispatched to a report of a “woman in labor” at a shopping mall. When you arrive, mall security quickly escorts you to a maternity store, where you find a 28-year-old female in active labor. What do you do?

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Chapter 3 Answer Key

Handout 3-1: Chapter 3 Quiz

1. a

10. b

19. a

28. a

2. c

11. d

20. a

29. b

3. d

12. a

21. c

30. c

4. d

13. b

22. b

31. d

5. a

14. c

23. c

32. d

6. a

15. b

24. a

33. d

7. c

16. c

25. d

34. c

8. c

17. c

26. b

35. c

9. b

18. b

27. a

Handout 3-2: Chapter 3 Scenario

1. He is in cardiopulmonary failure, probably as a result of hypoxia.

2. Clamp and cut the umbilical cord. Dry, warm, position, suction, and stimulate the newborn. Reassess for breathing. Then begin bag-valve-mask ventilations at 40–60 breaths/minute with high-concentration oxygen. After 30 seconds, recheck the heart rate.

3. Check for adequate chest rise and air entry with bag-valve-mask ventilation.

Continue to ventilate while your partner begins chest compressions at a rate of 120/minute. Reassess heart rate in 30 seconds.

4. Stop chest compressions. Continue to ventilate with the bag-valvemask.

Reassess heart rate after 30 seconds. Check for spontaneous respirations and for central cyanosis. Make preparations to transport, including maximizing heat in the patient compartment of the ambulance.

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Handout 3-3: Chapter 3 Review

1. meningitis 2. surface, volume 3. hypoglycemia 4. 45 mg/dL 5. D10W, D25W 6. hypoxia 7. 37, 2.2 8. prematurity 9. hypovolemia 10. 10 11. 60 12. 120 13. umbilical vein 14. naloxone 15. bag-value-mask ventilation 16. heart rate 17. drying, warming, positioning, suction, tactile stimulation 18. oxygen 19. 100, apnea, central cyanosis 20. 40, 60 21. mouth, nose 22. meconium 23. rubbing his back, flicking his soles 24. conduction, evaporation, convection, radiation 25. increased blood viscosity, polycythemia 26. diaphragmatic hernia ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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27. meningomyelocele 28. omphalocele 29. choanal atresia 30. APGAR scale, Appearance, Pulse rate, Grimace, Activity, Respiratory effort 31. ductus arteriosus 32. persistent fetal circulation 33. primary 34. Secondary 35. secondary 36. neonate 37. newborn, newly born infants 38. two, mother, baby 39. antepartum 40. intrapartum

Handout 3-5: Newborn Resuscitation

Scenario 1: Resuscitation of the Normal Newborn Expected sequence of interventions 1. Obtained and opened OB kit.

2. Questioned mother about length of gestation and twins.

3. Observed for presence of meconium.

4. Assisted with delivery. a. Delivered infant’s head. b. Suctioned mouth, then nose with bulb syringe. c. Allowed mother to push on next contraction to complete delivery.

5. Received baby in sterile towel, warmed if possible.

6. At the perineum, positioned the infant’s head in a dependent position.

7. Suctioned mouth, then nose again. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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8. Stimulated respirations by drying infant with towel.

9. Assessed ABCs. 10. Continued stimulation/drying.

11. Reassessed breathing and circulation.

12. Applied cord clamps.

13. Cut umbilical cord.

14. Placed infant in new dry towel, dried thoroughly while observing.

15. Wrapped infant to prevent hypothermia.

16. Prepared for transport.

Scenario 2: Resuscitation of the Distressed Newborn Expected sequence of interventions 1. Obtained and opened OB kit.

2. Prepared suction and intubation equipment.

3. Questioned mother about length of gestation and twins.

4. Assisted with delivery. a. Delivered infant’s head. b. Suctioned mouth, pharynx, nose thoroughly. c. Allowed mother to push on next contraction to complete delivery.

5. Received baby in sterile towel, warmed if possible.

6. Clamped and cut the umbilical cord.

7. Positioned infant with head in slightly dependent position.

8. Intubated trachea; observed for presence of meconium on vocal cords during procedure.

9. Withdrew endotracheal tube while applying direct suction to endotracheal tube, using meconium aspiration adaptor.

10. Repeated intubation and suctioning until meconium was no longer returned.

11. Stimulated respirations by drying infant with towel.

12. Assessed ABCs. 13. Administered bag-valve-mask ventilation at 40 to 60 breaths/minute with 100 ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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percent oxygen.

14. Reassessed heart rate after 30 seconds of oxygenation and ventilation. a. Breathing (good chest rise with bag-valve-mask ventilation). b. Circulation (heart rate is 140).

15. Began chest compressions if heart rate was below 60, at a rate of 100 compressions per minute and a ratio of either 30 compressions to 2 ventilations for one rescuer or 15 compressions to 2 ventilations for two rescuers.

16. Reassessed heart rate after 30 seconds of oxygenation and ventilation.

17. Performed endotracheal intubation.

18. Wrapped infant to prevent hypothermia.

19. Prepared for transport.

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Volume 5 - Chapter 4 Pediatrics

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Student’s Name

HANDOUT 4-1

EVALUATION Chapter 4 Quiz Write the letter of the best answer in the space provided.

1. A 3-year-old and his brother were walking along a frozen irrigation ditch. The 3-year-old tried to retrieve a dropped toy and fell through the ice. He is apneic and pulseless with fixed, dilated pupils. No one knows how long he was underwater. ECG shows asystole. You should: a. start CPR immediately and transport. b. call for the police and the coroner. c. attempt to rewarm the patient as rapidly as possible. d. transport without doing CPR. 2. A 4-month-old male infant has been vomiting and having watery diarrhea for two days. His mother says the infant has not urinated at all today. The baby’s lips and oral mucosa are dry, and his fontanelles are sunken. The infant’s extremities are cold to the elbows and knees. Capillary refill is 5 seconds. Heart rate is 170.

ECG shows a narrow complex tachycardia with P waves visible.

Management should include: a. infusion of 20 mL/kg lactated Ringer’s. b. cardioversion at 0.5 to 1 j/kg. c. checking a “dex” stick with possible administration of D25W for hypoglycemia. d. both A and C. 3. A 3-year-old female ingested six 0.25-mg digoxin tablets about 2 hours ago. She is awake, alert, and taking the bottle. Pulse is 50, strong, and regular. Respirations are 30, regular, unlabored. Capillary refill is less than 2 seconds. Skin is pink and warm. BP is 90 by palpation. ECG shows a sinus bradycardia with a first-degree AV block. You should administer: a. 0.2 mg/kg atropine IV push. b. 0.01 mg/kg epinephrine IV push. c. 5 mg/kg calcium chloride IV push. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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d. oxygen by blow-by, monitor, and transport.

4. Indications that an intraosseous line has been successfully placed include which of the following? a. A change in resistance is felt as the marrow cavity is entered. b. The needle stands on its own without support. c. Bone marrow can be aspirated from the needle. d. All of the above 5. You are called to see a 9-month-old baby who has stopped breathing.

The mother’s boyfriend is babysitting and states that the infant fell off the couch. The baby is lying in the crib. There are no obvious signs of trauma. The child is lethargic and breathing slowly at a rate of 8/min.

Skin is warm, and capillary refill is normal. Heart rate is 140. The left pupil is dilated and fixed. The right pupil is mid-position and reactive.

Linear bruises are present on both upper arms. Management of the infant should include all of the following, EXCEPT: a. stabilization of the cervical spine. b. intubation and hyperventilation with high-concentration oxygen. c. infusion of 20 mL/kg of lactated Ringer’s solution. d. reporting of possible child abuse to the ER physician.

6. A 15-year-old male has been involved in a swimming accident at a spot that is popular with local teenagers. The boy was reported to have jumped or dove from a rock outcropping into the river. He did not surface immediately and was pulled from the water a few minutes later about 25 yards downstream. The patient is unresponsive. His respiratory rate is 8/min. His heart rate is 120/min. His extremities are cold. Management should include all of the following, EXCEPT: a. opening of the airway with a jaw-thrust and stabilization of the cervical spine. b. drying and wrapping in warm blankets. c. assisted ventilations with a bag-valve mask and oxygen, followed by possible endotracheal intubation. d. administration of sodium bicarbonate to correct acidosis.

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7. All of the following statements about the physical assessment of a patient with an acute asthma attack are true EXCEPT: a. sleepiness or stupor indicates severe hypercarbia, hypoxia, and acidosis. b. the disappearance of wheezing during a severe asthma attack is a good sign, because it indicates that bronchospasm has stopped. c. tenting of the skin and dryness of the mucous membranes can indicate dehydration due to the asthma attack. d. young children may not show the positional preferences of older children.

8. You are called to see a 6-year-old child because he has a very high fever. His mother tells you that he became ill about 4 hours ago and has been complaining of a severe sore throat. He will not eat or drink because he says it hurts to swallow. You find the child sitting upright in bed, crying and drooling noticeably. He appears very frightened.

His axillary temperature is 104°F. His respirations are 30 and shallow, and there is flaring of his nostrils on inhalation. His chest is clear to auscultation. All of the following are part of the management of this child, EXCEPT: a. administering high-concentration, humidified oxygen. b. deferring starting an IV because this may worsen the patient’s distress. c. carefully examining the throat to determine whether inflammation is present. d. transporting the child in the sitting position.

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9. A call comes in late at night for a sick child. When you arrive, a very distraught mother tells you that her six-year-old son has been “having fits.” He has been ill today with an upper respiratory infection and about half an hour ago began having seizures. He has had three seizures so far. The mother did not notice how the seizures started.

You find the child apparently asleep on his bed. He is difficult to arouse. As you examine him, his eyes suddenly open and deviate sharply to the right, and he rapidly develops another grand mal seizure. All of the following should be considered EXCEPT: a. administration of high-concentration, humidified oxygen. b. placing a bite block between his teeth to protect his tongue. c. checking blood glucose level and giving glucose if he is hypoglycemic. d. administering diazepam to terminate the seizures.

10. You are called to see a 3-year-old child who is in moderate respiratory distress. His mother says that he has appeared well during the day, but for the past two nights, he has been waking up around midnight with a high-pitched cough that sounds like a dog barking. You find the child lying in bed, looking very tired and miserable. Axillary temperature is 99.7°F. Respirations are stridorous at 30/min, with suprasternal retractions and accessory muscle use.

On auscultation of the chest, no wheezing or crackles are heard. All of the following would be included in the management of this patient EXCEPT: a. administration of high-concentration, humidified oxygen. b. performing direct laryngoscopy to be sure the airway is not obstructed. c. administering racemic epinephrine by nebulizer. d. transporting to the hospital in the position of comfort.

11. Which of the following age groups is usually associated with croup? a. 0 to 6 months

c. 4 to 12 years

b. 6 months to 4 years

d. over 12 years

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12. The assessment of a child who has had a seizure should include a check for: a. level of consciousness. b. evidence of fever or dehydration. c. signs of an injury that caused or was caused by the seizures. d. all of the above.

13. Which group of pediatric patients would generally be expected to be uncooperative? a. 2 to 3 years old

c. 6 to 10 years old

b. 4 to 5 years old

d. 10 to 14 years old

14. A pediatric patient is seen by paramedics for a seizure. The child has a fever of 101°F, was lethargic and irritable before the seizure, and has had no previous seizure activity. The child complained of a headache earlier in the day. What is the MOST likely problem? a. Febrile seizure

c. Hypoglycemia

b. Meningitis

d. Hypoxia

15. You are called to see a 6-month-old infant. The mother’s chief complaint is that the child has been irritable for the last few days, is not feeding well, is sweaty, and is “just not acting right.” On exam, you find a fussy infant who wants the bottle. Respirations are 40/min.

The skin is pink but is cool distally. Capillary refill is two seconds.

Pulses are very rapid at about 300/min. The ECG shows a narrow complex tachycardia with no P waves visible. You should: a. administer oxygen and transport. b. cardiovert immediately at 0.5 to 1 J/kg. c. administer verapamil. d. administer 20 mL/kg lactated Ringer’s solution.

16. You respond to a mottled, cyanotic 3-month-old, 5-kg infant who ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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responds only to painful stimuli. Proximal pulses are too rapid to count and thready proximally. Distal pulses are absent. The skin is pale and cold distally. Capillary refill is 5 seconds. Respirations are 65/min, and the patient is working hard to breathe. ECG shows a narrow complex tachycardia with no P waves visible. You should: a. administer oxygen and transport. b. cardiovert at 0.5 to 1 J/kg. c. administer verapamil. d. administer 20 mL/kg lactated Ringer’s solution.

17.You are called to evaluate an 8-month-old infant with a five-day history of vomiting and diarrhea. His mother states that the infant is “not acting right.” On initial observation, you note a lethargic infant with mottled skin and no spontaneous movement. Respirations are 60, unlabored. Pulse is 170 and weak. Capillary refill is 4 seconds.

Extremities are cool. The ECG shows a narrow complex tachycardia P waves are visible, and the rhythm is slightly irregular. You should: a. administer oxygen and transport. b. cardiovert at 0.5 to 1 J/kg. c. administer verapamil. d. administer 20 mL/kg lactated Ringer’s solution.

18. A 2-year-old male fell into a swimming pool and was submerged for about 2 minutes. The child is unresponsive, cyanotic, apneic, and pulseless. A firefighter who first responded on an engine is performing CPR. You are not able to quickly obtain vascular access, but you are able to place an endotracheal tube. EKG shows a sinus bradycardia with a rate of 32. You should: a. start an intraosseous line immediately. b. administer 0.01 mg/kg epinephrine 1:10,000 down the endotracheal tube. c. administer 0.1 mg/kg epinephrine 1:1000 down the endotracheal tube. d. administer 0.02 mg/kg atropine down the endotracheal tube.

19. A 5-year-old boy was struck by an automobile when he ran into the ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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street from between two parked cars. He is pale, confused, and sweating heavily. Capillary refill time is 5 seconds. Breath sounds are present bilaterally. The upper left quadrant of the abdomen is bruised and tender. Fluid resuscitation should consist of: a. two large-bore IVs with lactated Ringer’s infused as rapidly as possible. b. a single IV with lactated Ringer’s to avoid overhydrating the child. c. 20 mL/kg of lactated Ringer’s while monitoring him for signs of improved perfusion. d. two large-bore IVs of D5W infused as rapidly as possible because lactated Ringer’s should not be given to small children.

20. Children and infants who are burned are more likely to suffer more significant fluid loss than adults because: a. a larger portion of a pediatric patient’s body mass consists of water. b. IVs cannot be established as easily. c. their body surface area is larger in proportion to their body volume. d. crying associated with pain and anxiety will add to volume loss.

21. Differences in the anatomy of the airway that warrant differences in intubation techniques for infants and adults include: a. the infant’s tongue being larger in relation to other structures in the airway. b. the glottis being higher in the infant than in the adult. c. the epiglottis being narrower in the infant and the vocal cords slanting upward and backward. d. all of the above.

22. In which of the following age groups does sudden infant death syndrome (SIDS) most commonly occur? a. birth to 2 weeks b. 2 months to 4 months c. 6 months to 12 months d. 12 months to 18 months 23. What question(s) would be appropriate to ask about a child who has ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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had a seizure? a. Does the child have a history of previous seizures, head trauma, diabetes, recent headache, or stiff neck? b. Is the child taking any medications? c. How many seizures has the child had, and what did they look like? d. All of the above.

24. Which of the following statements about specific age groups of pediatric patients is CORRECT? a. 2- to 3-year-olds are usually cooperative and like to be touched by strangers. b. 4- to 5-year-olds are usually cooperative and like to “help out” the paramedic. c. School-age children usually do not like to be told what is being done to them. d. Adolescents usually are not concerned about lasting effects of injury or illness.

25. The endotracheal tube used in infant intubation is often NOT cuffed because of anatomical differences in the infant’s: a. pharynx.

c. glottis.

b. trachea.

d. mandible.

26. What procedure would be appropriate in examining a toddler? a. Decide which parts of the physical exam are essential, and get through them as quickly as possible.

B. Establish ground rules, for example, “It’s all right to cry, but not to bite or kick.” c. Obtain as much information as possible before touching the child. d. All of the above.

27. The patient is a 5-year-old child who is in respiratory arrest. The child should be ventilated once every: a. 3–5 seconds.

c. 5–6 seconds.

b. 2–4 seconds.

d. 6–8 seconds.

28. How many times a minute should an infant who is NOT breathing be ventilated? ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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a. 10–12

c. 12–20

b. 15–20

d. 25–30

29. A patient with epiglottitis would typically exhibit: a. inspiratory stridor, pain on swallowing, high fever, and drooling. b. expiratory wheezing, coughing, rales, and cyanosis. c. inspiratory stridor, “seal-bark” cough, low-grade fever, and orthopnea. d. expiratory wheezing, rales, coughing, high fever.

30. A patient with laryngotracheobronchitis would typically exhibit: a. inspiratory stridor, pain on swallowing, high fever, drooling. b. expiratory wheezing, coughing, rales, cyanosis. c. inspiratory stridor, “seal-bark” cough, low-grade fever, orthopnea. d. expiratory wheezing, rales, coughing, high fever.

31. The initial attempt to cardiovert a 30-kg child suffering from SVT is unsuccessful. How many joules should be used to repeat the synchronized cardioversion? a. 15

c. 30

b. 60

d. 45

32. Which of the following actions is associated with diazepam? a. Anticonvulsant

c. Bronchodilator

b. Antiarrhythmic

d. Antihistamine

33. The patient is a 4-year-old female who received an electrical shock.

The child has no pulse and no respirations. You should begin tworescuer CPR using a rate of: a. at least 100/minute; ratio 30:2; depth 1/3 to 1/2 chest diameter. b. 100/minute; ratio 15:2; depth 1/2 to 1 inch. c. 100/minute; ratio 15:2; depth 1/3 to 1/2 chest diameter. d. 100/minute; ratio 15:1; depth 1 to 11/2 inches.

34. If an infant has a complete airway obstruction that is NOT relieved by back blows, the rescuer should: ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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a. administer five abdominal thrusts. b. administer five additional back blows. c. administer five chest thrusts. d. perform a finger sweep.

35. Before beginning chest compressions on an infant, you should check for the presence of a pulse at which artery? a. Temporal

c. Brachial

b. Carotid

d. Femoral

36. Before beginning chest compressions on a child, you should check for the presence of a pulse at which artery? a. Temporal

c. Brachial

b. Carotid

d. Femoral

37. When compressing the chest of a child, you MOST typically use the: a. tips of the index and middle fingers of one hand. b. heel of one hand. c. heels of both hands. d. thumbs of both hands.

38. Which of the following statements BEST defines sudden infant death syndrome (SIDS)? a. The sudden, unexplained, and unexpected death of an infant before an autopsy to determine cause of death. b. The sudden, unexplained, and unexpected death of an infant where a thorough autopsy fails to reveal the cause of death. c. The sudden, unexpected death of an infant where the autopsy reveals the cause of death to be cardiovascular disease. d. The sudden, unexpected death of an infant in its sleep caused by suffocation in the bed clothing.

39. Which of the following statements about asthma and bronchiolitis is CORRECT? a. Asthma usually is associated with a family history of the disease, ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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whereas bronchiolitis is NOT. b. Bronchiolitis is common in infants less than 1 year of age, but asthma is uncommon in that age group. c. Asthma produces generalized wheezes, but bronchiolitis produces localized wheezes. d. Both A and B. 40. Assessment of a patient who is having an asthma attack would include examination for: a. state of consciousness, general appearance, vital signs, respiratory movement, skin turgor, and dryness of mucous membranes. b. state of consciousness, vital signs, general appearance, respiratory movement, and pedal edema. c. state of consciousness, general appearance, vital signs, respiratory movement, and abdominal rebound tenderness. d. general appearance, state of consciousness, vital signs, respiratory movement, and jugular vein distention.

41. You respond to a private residence to find a 4-month-old infant with a fractured humerus. Your examination also reveals numerous bruises and abrasions in various stages of healing on the child’s back and buttocks and what appear to be cigarette burns on the child’s palms and soles. The child’s mother says that the fracture was a result of the infant’s rolling off the bed onto the floor. You should: a. call the police and have the mother arrested for child abuse. b. lecture the mother sternly about her treatment of the child. c. transport the child and report your suspicions to the physician at the emergency department. d. keep what you suspect to yourself, because you may be liable if you falsely report child abuse.

42. Headache, seizures, a stiff neck, bulging fontanelles, and a rash consisting of tiny pinpoint hemorrhages under the skin indicate: a. meningitis. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

c. pneumonia.

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b. epiglottitis.

d. laryngotracheobronchitis.

43. The patient is a 5-year-old female who developed severe respiratory distress with inspiratory stridor about 30 minutes ago. Her mother tells you that the child “seemed to be perfectly healthy” until about 3 hours earlier, when she began to complain of a severe sore throat.

The patient is sitting on the side of her bed, leaning forward with her neck slightly extended. Respiratory distress with accessory muscle use and intercostal retractions is present. The child is drooling profusely, and when she tries to talk, her voice sounds muffled. She is suffering from a life-threatening emergency due to potential: a. seizures.

c. airway obstruction.

b. cardiac dysrhythmias.

d. respiratory arrest.

44. The patient is a 3-year-old male who awakened about 10 minutes ago with respiratory distress and stridor. He is sitting bolt upright in bed.

Accessory muscle use and intercostal retractions are present, but drooling is absent. Cyanosis of the lips and nail beds is present. The patient coughs frequently, producing a sound similar to a seal’s bark.

When he attempts to talk, he sounds very hoarse. His mother tells you that the patient has had a cold with a low-grade fever for “two or three days.” The treatment for this patient would include: a. systemic drug therapy with 1:1000 epinephrine. b. intubation and high-concentration oxygen. c. humidified oxygen and nebulized bronchodilators. d. systemic drug therapy with aminophylline.

45. The patient is a 7-year-old female who experienced a sudden onset of coughing and expiratory wheezing about 20 minutes ago. She has no history of pulmonary or cardiovascular disease. She states that she was eating peanuts immediately before the onset of the symptoms and that she “almost choked on one.” Auscultation of her chest reveals localized wheezing in the right lung field. She is MOST likely suffering from: a. an acute asthma attack. b. anaphylaxis. c. aspiration of a foreign body into the lower airways. d. pneumonia.

46. To select the proper-size pediatric endotracheal tube, choose one that is: ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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a. the same size as the patient’s age in months. b. the same size as the patient’s little finger. c. as long as the distance from nose to ear. d. the same size as the base of the child’s thumb.

47. The patient is a 3-month-old infant who suddenly developed cyanosis and audible expiratory wheezing. Retractions and nasal flaring with a respiratory rate of 80/minute are present. The patient’s mother reports that he has had a mild cold with a cough for two or three days. The patient has had a low-grade fever. There is no family history of asthma or allergies. The initial treatment of choice for this patient would be: a. epinephrine 1:1000 subcutaneous. b. humidified oxygen. c. nebulized racemic epinephrine. d. immediate endotracheal intubation.

48. Before administering epinephrine to a patient who is having an asthma attack, you should always obtain a medication history from the patient because: a. the patient already may have severe cardiac irritability from an overdose of bronchodilators from a home inhaler. b. medication in inhalers tends to antagonize the effects of epinephrine. c. the combination of epinephrine with drugs the patient has already taken may worsen bronchospasm. d. the combination of epinephrine with drugs the patient has already taken may slow the patient’s heart.

49. What should your initial energy dose be when defibrillating a child? a. 5–10 joules per kilogram b. 2 joules per kilogram c. 0.5–1.0 joules per kilogram d. 0.1–0.5 joules per kilogram 50. Status epilepticus refers to: ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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a. a severe seizure that cannot be stopped with diazepam. b. two or more seizures without a period of consciousness between them. c. a very mild type of seizure that is caused by fever. d. a type of grand mal seizure produced by hypoglycemia.

51. A prolonged asthma attack that cannot be broken with epinephrine is: a. status asthmaticus. b. beta-resistant primary bronchospasm. c. status epilepticus. d. sympathorefractory asthma.

52. The purpose of administering humidified oxygen in the treatment of asthma is to: a. dilate the bronchi. b. avoid drying of mucus secretions in the airway. c. increase the respiratory rate. d. correct alveolar dehydration.

53. Bronchiolitis is BEST described as a: a. viral infection causing inflammation of the larynx, trachea, and bronchi. b. bacterial infection causing inflammation of the bronchioles. c. bacterial infection causing inflammation of the larynx, trachea, and bronchi. d. viral infection causing inflammation of the bronchioles.

54. Asthma is BEST described as an: a. obstructive pulmonary disease characterized by distention of the pulmonary air spaces with destructive changes in their walls. b. obstructive pulmonary disease characterized by episodes of severe bronchospasm, bronchial edema, and hypersecretion of mucus in the lower airways. c. obstructive pulmonary disease characterized by excessive mucus production in the bronchial tree with a chronic productive cough. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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d. inflammation of the bronchioles caused by a viral infection.

55. Croup is BEST described as a: a. bacterial infection causing inflammation of the larynx. b. viral infection causing inflammation of the larynx. c. bacterial infection causing inflammation of the oropharynx and epiglottis. d. viral infection causing inflammation of the oropharynx and epiglottis.

56. The initial endotracheal dose of epinephrine for cardiac arrest in children is: a. 0.01 mg/kg of 1:10,000 solution. b. 0.1 mg/kg of 1:10,000 solution. c. 0.01 mg/kg of 1:1000 solution. d. 0.1 mg/kg of 1:1000 solution.

57. The initial intravenous dose of epinephrine for cardiac arrest in children is: a. 0.01 mg/kg of 1:10,000 solution. b. 0.1 mg/kg of 1:10,000 solution. c. 0.01 mg/kg of 1:1000 solution. d. 0.1 mg/kg of 1:1000 solution.

58. The MOST common cause of death following seizures is: a. hyperthermia.

c. dehydration.

b. anoxia.

d. head injury.

59. Which of the following groups of activities BEST describes the prehospital management of a patient with epiglottitis? a. Restrain the patient in a supine position, and intubate immediately. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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b. Administer humidified oxygen, allow the patient to assume the most comfortable position, and transport. c. Administer humidified oxygen for 5 minutes, start a TKO IV if doing this does not increase the patient’s distress, and attempt to intubate. d. Administer humidified oxygen, establish an IV with LR wide open, allow the patient to assume the most comfortable position, and transport.

60. The patient is a 6-month-old infant found unconscious by his mother.

The infant has no pulse, no blood pressure, and no respirations. You should begin two-rescuer CPR using a rate of at LEAST: a. 100/minute; ratio 15:2; depth 1/3 to 1/2 the depth of the chest. b. 100/minute; ratio 15:2; depth 1/2 to 1 inch. c. 100/minute; ratio 30:2; depth 1/3 to 1/2 the depth of the chest. d. 80/minute; ratio 5:1; depth 1 to 11/2 inches.

61. Cardiac arrest in infants and children usually results from: a. heart attack.

c. electric shock.

b. respiratory failure or arrest.

d.

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drowning.

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HANDOUT 4-1 STUDENT’S NAME

EVALUATION CHAPTER 4 SCENARIO Review the following real-life scenario. Then answer the questions that follow.

At 2330 hours, you are called to evaluate a 2-year-old male with a five-day history of vomiting and diarrhea. The patient’s mother says that she called because the child “is not acting right.” On initial observation, you note that the child has mottled skin and no spontaneous movement. He is unresponsive to painful stimuli. Respirations are 60/minute, shallow, and regular. Radial pulses are absent. Carotid pulse is 170, weak, and regular. Capillary refill is 5 seconds.

The patient’s extremities are cool. The ECG shows a narrow complex tachycardia at rate of 170. P waves are visible.

1. What problem does the patient appear to have?

2. What is the significance of the patient’s cool, mottled skin?

3. Why is the patient tachypneic?

4. When you attempt to start an IV on this patient, you cannot find any veins.

What alternative route is available for vascular access?

5. How do you know that you have achieved vascular access via this route?

6. Once you have achieved vascular access, what method would you use to infuse fluid? Why? 7. You decide to endotracheally intubate the patient. How would you select the proper endotracheal tube size?

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Student’s Name

HANDOUT 4-3 REINFORCEMENT

CHAPTER 4 REVIEW Write the word or words that best complete each sentence in the space(s) provided.

1. Common causes of lower airway distress include FBAO, asthma, bronchiolitis, and .

2. A slight increase in is one of the earliest signs of shock in the pediatric patient.

3. The child in septic shock may require therapy.

4. is an abnormality or defect in the heart that is present at birth.

5. MOST of the pediatric seizures that paramedics encounter are .

6. Bacteria and viruses can cause the infection of the GI system known as .

7. In the prehospital setting, hypoglycemia in pediatric patients usually results from diabetes.

8. MOST poisonings treated by EMS result from accidental .

9.

are the single MOST common cause of injury in children.

11. In assessing and treating pediatric patients, it is important to keep in mind

that they are NOT simply .

12. The federally funded program that is aimed at improving the health of

pediatric patients who suffer from life-threatening illnesses and injuries is

for . ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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13. Foremost in approaching any pediatric emergency is consideration of the

patient’s

and development.

14. When assessing or treating a pediatric patient, always use

that is appropriate for the age of the child.

15. An infant up to 1 month of age is known as a(n) .

16. Infants should have by 5 or 6 months of age.

their birth weight

17. deaths in patients aged 1 to 15 years.

are the leading cause of injury

18. When examining school-age children, give

the responsibility of providing the history.

19. If you must perform a detailed physical exam on an adolescent patient, respect the patient’s sense of .

20. Never use a(n)

on a child with midface or head trauma.

21. When intubating a pediatric patient, you should use a laryngoscope with a(n)

blade.

22. If gastric distention is present in a pediatric patient, consider placement of

a(n) .

23. The initial dosage of fluid in a pediatric patient suffering from hypovolemia

should be

of an isotonic fluid.

24. The LAST stage of respiratory compromise, to which the patient will progress

if NOT treated, is respiratory

.

25. The viral infection common in children from 6 months to 4 years of age that

usually occurs in fall and winter months is .

26. If the pediatric patient with epiglottitis is maintaining the airway, do NOT put

anything . ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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27. In severe asthma attacks, an ominous sign is a lack of

.

28. The pediatric patient’s head is proportionally than the adult’s, and the

occipital region is significantly

.

29. A child’s larynx is

than an adult’s and

extends into the

.

30. Pediatric patients are prone to

because of their greater BSA-to-weight ratio.

31. The three components of the

are appearance, breathing, and circulation.

32.

and problems are the MOST common cause of cardiac arrest in infants and children.

33. The normal respiration rate for a preschooler is

to breaths per minute.

34. For a patient under five years, one of the signs of a risk of cardiopulmonary

arrest is a heart rate greater than less than

or per minute.

35. A severe patient would be one with a Glasgow Coma Scale score of less than

or equal to 36.

.

is a late and often sudden sign of cardiovascular decompensation in pediatric patients.

37. For conscious infants less than one year old with foreign body airway

obstruction, deliver five , followed by five .

38. NEVER do

in infant or child FBAO patients.

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Student’s Name

HANDOUT 4-4 REINFORCEMENT

CHAPTER 4 SHORT ANSWER A Answer each of the following questions.

1. What is the proper finger position for performing chest compressions on an infant?

2. What are the proper depth and rate for chest compressions on an infant? On a child?

3. How is hypovolemic shock corrected in pediatric patients? Why is this technique used?

4. Should flow-restricted, oxygen-powered breathing devices (demand valves) be used to ventilate children? Why? 5. How is the proper size of endotracheal tube selected for pediatric patients?

6. Why are uncuffed endotracheal tubes sometimes used on infants and children less than eight years old?

7. What is the suggested initial setting for defibrillation of pediatric patients?

What energy is used on subsequent shocks?

8. What three routes are available for drug administration to children during cardiopulmonary arrest?

9. What drug is always used FIRST in the management of symptomatic bradycardia in pediatric patients?

10. What is the initial IV dose of epinephrine in pediatric cardiac arrest?

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Student’s Name

HANDOUT 4-5 REINFORCEMENT

CHAPTER 4 SHORT ANSWER B Answer each of the following questions.

1. Why do infants and small children require special precautions to prevent them from becoming cold?

2. Match the age group with the typical characteristics of that group.

Adolescents

a. Dislike strange people; strong assertiveness; high mobility, low common sense

Toddlers

b. Totally subjective worldview; think magically; do not separate fantasy and reality; intense fear of injury, pain, blood loss

School-age children

c. Master environment through information; can make compromises, think objectively

Preschoolers

d. Seeking self-determination; fragile selfesteem; very acute body image; high need for modesty

3. What is the MOST common form of shock in pediatric patients?

4. What are the fontanelles? What change occurs in the fontanelles of a dehydrated infant?

5. What is status asthmaticus?

6. Why should skin turgor be checked in patients who are having an asthma attack?

7. Why is it important to determine the medications taken by an asthmatic before beginning any therapy?

8. Why should oxygen be humidified when it is administered to an asthma patient?

9. What is the prehospital treatment for croup?

10. What is the principal danger facing a patient with epiglottitis?

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Student’s Name

HANDOUT 4-6 REINFORCEMENT

CHAPTER 4 PEDIATRIC CARE SCENARIOS Answer each of the following questions.

1. An 18-month-old male with a history of nausea, vomiting, and diarrhea for three days presents with listlessness and a decreased level of consciousness. Skin and mucous membranes are dry. Skin turgor is decreased. Respirations are rapid and shallow. Peripheral pulses are rapid and weak. Capillary refill is slow. Describe your management of this patient.

2. A 6-month-old infant was found unconscious and unresponsive. The baby’s skin is cool and pale. Capillary refill is greater than 5 seconds. Radial pulses are absent. Carotid and femoral pulses are thready. The ECG shows a narrow complex tachycardia with a rate of 300 and no visible P waves. How would you manage this patient?

3. A 7-month-old infant responds only to painful stimuli. The skin is pale and mottled. Peripheral pulses are weak, and capillary refill is greater than 4 seconds. The infant’s respirations are 52/minute but are unlabored. Rectal temperature is 105°F. What problem do you suspect? How would you manage this patient?

4. A 9-month-old infant’s mother called you because she says the baby “turns a funny color and sweats” when he feeds and won’t take the entire bottle. The infant is awake and alert. His skin is warm and pink. Capillary refill is less than 2 seconds. Radial and pedal pulses are palpable but very fast. How would you manage this patient?

5. A 2-year-old was found floating facedown in a neighbor’s swimming pool. He is unconscious and unresponsive. Pulses and respirations are absent. The ECG shows a sinus bradycardia. How would you manage this patient?

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Student’s Name

HANDOUT 4-7 REINFORCEMENT

CHAPTER 4: PEDIATRIC JUMPSTART MATCHING Match the following pediatric patients using the JumpSTART system with the appropriate triage tag color. a. Green b. Yellow c. Red d. Black 1.

Patient with a minor laceration to the left leg. Bleeding is controlled. Patient is to walk and follow directions.

2.

Patient is found unresponsive and is NOT breathing. After the airway is opened, spontaneous respirations return.

3.

Infant who is crying. There are NO apparent injuries.

4.

Unresponsive patient who is NOT breathing. Spontaneous respirations do NOT return after opening the airway and there are peripheral pulses noted. After five ventilations, apnea persists.

5.

Nonambulatory patient who is spontaneously breathing at a rate of 11 breaths per minute.

6.

Unresponsive patient found NOT breathing. Spontaneous respirations do NOT return after opening the airway and there are peripheral pulses noted. After five ventilations, spontaneous respirations return but the patient remains unresponsive.

7.

Patient with spontaneous respirations of 28 who complains of right ankle pain. Upon examination, you notice swelling and discoloration to the right ankle.

8.

Nonambulatory patient with spontaneous respirations at a rate of 48 breaths per minute.

9.

Patient with spontaneous respirations of 32, obvious left leg deformity, and absent peripheral pulses in the left leg.

10. Unresponsive patient who is NOT breathing. Spontaneous respirations do NOT return after opening the airway, and there are NO peripheral pulses. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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Chapter 4 Answer Key Handout 4-1: Chapter 4 Quiz

1. a 2. d 3. d 4. d 5. c 6. d 7. b 8. c 9. b 10. b 11. b 12. d 13. a 14. b 15. a 16. b 17. d 18. c 19. c 20. c 21. d 22. b 23. d 24. b 25. b ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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26. d 27. a 28. c 29. a 30. c 31. b 32. a 33. d 34. c 35. c 36. b 37. b 38. b 39. d 40. a 41. c 42. a 43. c 44. c 45. c 46. b 47. b 48. a 49. c 50. b 51. a 52. b 53. d 54. b ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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55. b 56. d 57. a 58. b 59. b 60. a 61. b

Handout 4-2: Chapter 4 Scenario 1. The patient is suffering from volume depletion (dehydration) and hypovolemic shock.

2. Early in hypovolemic shock, patients vasoconstrict to shunt blood to the body core. As shock persists, compensatory mechanisms begin to fail and dilation begins to occur in localized parts of the periphery. This produces the patchy appearance called mottling. Mottling suggests decompensated shock.

3. Hypoperfusion causes cells to convert to anaerobic metabolism. A byproduct of anaerobic metabolism is lactic acid. This lactic acid is buffered by the carbonate buffer system to produce carbon dioxide. Removal of this carbon dioxide by increased respirations helps compensate for the metabolic acidosis produced by shock.

4. The intraosseous route.

5. Resistance is lost as the needle passes through the cortex of the bone; the needle stands by itself; marrow can be aspirated through the needle; IV fluid will flow freely through the needle.

6. 20 mL/kg boluses of lactated Ringer’s or normal saline would be infused.

After each bolus, perfusion would be reassessed. This technique restores adequate volume while minimizing the risk of volume overload.

7. Use a device such as the Broselow tape; use the formula (age + 16)/4; select a tube the same size as the child’s little finger.

Handout 4-3: Chapter 4 Review

1. pneumonia ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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2. heart rate 3. pressor 4. Congenital heart disease 5. febrile 6. gastroenteritis 7. type I 8. ingestion 9. Falls 11. small adults 12. emergency medical services, children 13. emotional, psychological 14. language 15. neonate 16. doubled 17. Accidents 18. them (the patients) 19. privacy 20. nasopharyngeal airway 21. straight 22. nasogastric tube 23. 20 mL/kg 24. arrest 25. croup 26. in the mouth 27. wheezing 28. larger, larger 29. higher, pharynx 30. hypothermia 31. pediatric assessment triangle ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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32. Airway, respiratory 33. 22, 34 34. 180, 80 35. 8 36. Hypotension 37. back blows, chest thrusts 38. blind finger sweeps

Handout 4-4: Chapter 4 Short Answer A

1. One finger-width below the nipple line.

2. Compression depth is 1/3 to 1/2 the diameter of the chest at a rate of 100 compressions/min for both infants and children.

3. With 20 mL/kg fluid boluses, reassessing perfusion between boluses.

Because children have smaller cardiovascular systems, they are at increased risk for volume overload.

4. No. Flow-restricted, oxygen-powered breathing devices deliver high pressures and do not allow the operator to feel pulmonary compliance.

Therefore, they are more likely to cause pneumothorax in children.

5. Use a length-based resuscitation system such as the Broselow tape; compare the tube to the child’s little finger; use the formula (age+ 16)/4.

6. The narrowest part of the child’s airway is below the glottis at the cricoid ring. This structure can form a functional cuff on the endotracheal tube.

7. 2 J/kg, 4 J/kg 8. endotracheal, intravenous, intraosseous 9. oxygen 10. 0.01 mg/kg of 1:10,000 solution

Handout 4-5: Chapter 4 Short Answer B

1. Infants and small children have a high surface-to-volume ratio; therefore, they

tend to lose heat more rapidly than adults. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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2. B, D, C, A 3. hypovolemic 4. The fontanelles are areas in the infant’s skull that have not yet fused. The

fontanelles of a dehydrated infant become sunken.

5. Status asthmaticus is a severe, prolonged asthma attack that cannot be

broken by aggressive use of beta-adrenergic agonists.

6. Increased respiratory water losses and decreased fluid intake during an

asthma attack can lead to dehydration.

7. Asthmatics in distress frequently overuse their inhalers; therefore, an

asthmatic may be suffering from increased cardiac irritability from the effects of beta-agonists.

8. If oxygen is not humidified, it will tend to dry the mucus in the asthmatic’s

airways, worsening the plugging that already is present.

9. Humidified high-concentration oxygen, nebulized racemic epinephrine or

albuterol, continuous monitoring of oxygen saturation and ECG, transport.

An IV should not be established, because it will increase the patient’s anxiety.

10. Loss of airway.

Handout 4-6: Pediatric Care Scenarios

1. Give high-concentration oxygen. Consider assisting ventilations. Establish vascular access. Give 20 mL/kg isotonic crystalloid. Reassess perfusion, respirations, and lung sounds. Repeat fluid boluses until adequate perfusion is restored. Also check blood glucose level. If patient is hypoglycemic secondary to decreased intake, give D25W. 2. Give high-concentration oxygen. Perform synchronized cardioversion at 0.5– 1 J/kg.

3. Septic shock. Give high-concentration oxygen. Establish vascular access.

Give 20 mL/kg isotonic crystalloid. Reassess perfusion, respirations, and lung sounds. Repeat fluid boluses until adequate perfusion is restored.

4. Give high-concentration oxygen and transport.

5. Begin chest compressions and ventilations with high-concentration oxygen.

If the child does not respond, place an endotracheal tube. If the child still does not respond, establish vascular access, and administer epinephrine.

Remember that epinephrine also can be given via the endotracheal tube. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Handout 4-7: Pediatric JumpSTART Matching

1. a 2. c 3. a 4. d 5. c 6. c 7. b 8. c 9. c 10. D

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Volume 5 - Chapter 5 Geriatrics

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Student’s Name

HANDOUT 5-1

EVALUATION CHAPTER 5 QUIZ Write the letter of the best answer in the space provided.

1.

Special problems that may be encountered in geriatric patients may include: a. increased susceptibility to general deterioration as a result of illness. b. depressed pain and temperature-regulating mechanisms. c. increased susceptibility to confusion and depression. d. all of the above.

2.

The key symptom in patients with bowel infarction is: a. vomiting of fecal material. b. pain out of proportion to physical findings. c. uncontrollable diarrhea. d. melena.

3.

Which of the following findings is NOT typical of a patient with Parkinson’s disease? a. Tremor combined with pill-rolling motion of the hands b. Shuffling gait with short steps c. Masklike face with no expression d. Tendency to speak rapidly and loudly

4.

You respond to a report of a “person seizing.” The patient is a 74year-old female who is experiencing uncontrollable movements of the skeletal muscles in her extremities and face. She is awake, alert, and extremely agitated and restless. The patient has NO history of cerebrovascular accident, seizures, or other neurologic disease. You discover that the patient’s physician recently placed her on a new medication, but neither she nor her family can remember what the name of the drug is. Which of the following drugs would be MOST likely to produce these effects? a. Elavil c. Librium b. Thorazine d. Lithium carbonate

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5.

Which of the following statements about suicide and suicide risk in the elderly is TRUE? a. The elderly have the lowest suicide rate of any age group in the United States. b. The elderly are less likely to seek help for depression and suicidal ideation than younger people. c. Elderly women are more likely to commit suicide than elderly men. d. The elderly are less likely to turn anger and sorrow inward rather than expressing these emotions outward.

6.

An 82-year-old female presents with vague complaints about feeling weak and fatigued. She denies chest pain, dizziness, nausea, or shortness of breath. She has a long history of cardiovascular and respiratory problems. She takes numerous medications but cannot recall their names or which ones she has taken today. During the physical exam, you note pedal edema, weak pedal pulses, and fine bibasilar crackles (rales). Which of the following statements about this patient is TRUE? a. Absence of chest pain does not exclude myocardial infarction as a possible problem. b. Her crackles and peripheral edema may be normal findings for her. c. Her risk of death is highest during the first few hours following the onset of symptoms. d. All of the above.

7. A 78-year-old nursing home patient is found to have severe pedal edema. His neck veins are flat. No adventitious sounds are present in the lung fields. There is no abdominal distention. The patient reportedly spends 12 to 14 hours a day sitting in front of the TV with his feet in a dependent position. The edema of his ankles and feet probably results from: a. right-sided heart failure. b. immobility and the dependent position of his feet. c. liver disease. d. left-sided heart failure.

8. Kyphosis in a geriatric patient will MOST likely result in the paramedic having to modify: a. interviewing techniques because kyphosis causes hearing loss. b. methods for spinal stabilization because kyphosis results in excessive curvature of the upper back and neck. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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c. drug dosages because kyphosis is a result of liver damage. d. sedation because kyphosis is associated with manic-depressive disorder.

9. In the United States, the best known form of dementia among older persons is: a. psychosis. c. drug and alcohol abuse. b. Alzheimer’s disease. d. depression.

10.Which of the following medications poses the GREASTEST risk of adverse effects in the geriatric patient if given at normal adult doses? a. Lidocaine c. Midazolam b. Adenosine d. Narcan 11.The MOST common psychiatric disorder among geriatric patients is: a. schizophrenia. b. paranoia. c. depression. d. posttraumatic stress disorder.

12. Which of the following statements about elder abuse is NOT true? a. Elder abuse generally is limited to low socioeconomic situations. b. Injuries that cannot be explained are the primary finding. c. The victim frequently is no longer able to be independent, and the family has difficulty upholding commitments to provide care. d. It may be important to note inconsistencies between the histories obtained from the patient and from family members.

13. A 67-year-old male fell while trying to get up from a chair. He had begun to experience pain in his lower back about 15 minutes before. When he tried to get up, he discovered that his legs were weak and numb. The patient has a history of hypertension for about 15 years. He smokes two packs of cigarettes a day. Vital signs are blood pressure 102/60; pulse 120 weak, regular; respirations 18 shallow, regular. He is awake and alert, and he responds appropriately to questions. Breath sounds are present and equal bilaterally with NO adventitious sounds. Abdomen is very obese and nontender. The lower abdomen is mottled. The lower extremities are mottled and have no spontaneous movement and no response to pain. There are no pedal pulses. The back is nontender to palpation. Upper extremities move spontaneously with equal grip strengths and normal sensation. What problem do ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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you suspect? a. Cerebrovascular accident b. Lumbar spine fracture

c. Abdominal aortic aneurysm d. Silent acute myocardial infarction

14. A 76-year-old male called 911 because he could not breathe. He pants as he speaks and must take several breaths between each word. He is diaphoretic, and his lips and nailbeds are cyanotic. The problem has been worsening for about four days. When he breathes, he has a sharp pain in his left lower chest that is not constant and lasts only a few seconds at a time. He has a chronic cough and smokes three packs of cigarettes a day. He says he has no history of cardiovascular disease. Vital signs are blood pressure 130/88; pulse 130 strong, regular; respirations 42 labored. The patient’s temperature is 102°F. Crackles (rales) and wheezes are present in the left lower chest. The MOST appropriate medications to use in managing this patient would be: a. oxygen, nitroglycerin, and morphine. b. oxygen, nitroglycerin, morphine, and furosemide. c. oxygen and morphine. d. oxygen and albuterol.

15. In distinguishing between delirium and dementia, you should recall that delirium: a. is a chronic, slowly progressive process; dementia is rapid in onset and has a fluctuating course. b. tends not to affect memory; dementia tends to impair memory. c. may be reversed if treated early; dementia is an irreversible disorder. d. causes global cognitive deficits; dementia causes focal cognitive deficits.

16.

A 90-year-old female has been experiencing episodes of nocturnal confusion for several weeks. Her lower extremities are swollen, with large, translucent fluid-filled areas resembling blisters on the skin. These areas probably are caused by: a. an allergic reaction to medication. b. toxicity from an antidepressant medication the patient is taking. c. increased hydrostatic pressure caused by right-sided CHF and sleeping sitting up. d. degenerative effects of old age on the skin of the lower extremities.

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17. A 77-year-old male has been experiencing dizziness and weakness when he attempts to stand quickly. Causes that should be considered include: a. beta-blocker use. b. use of vasodilators for treatment of hypertension. c. hypovolemia secondary to diuretic use or depressed thirst mechanisms. d. all of the above.

18. An 89-year-old female presents with multiple bruises on her face and upper extremities. She lives with her son, who tells you that the patient is always falling down and is just generally clumsy. The patient appears malnourished and frightened. She cowers when you approach and is reluctant to allow you to examine her. Her son seems to be hostile toward you and your partner and nervously attempts to explain each bruise. In this case you should do all of the following EXCEPT: a. obtain a complete patient and family history. b. report suspicions of elder abuse to the emergency department staff. c. be honest and open with the patient’s son about your concerns. d. listen carefully for inconsistencies in stories.

19. When you are assessing or managing an older patient, you should: a. use physical contact to compensate for loss of sight or hearing. b. talk more loudly than normal because most of the elderly have hearing loss. c. separate the patient from friends or family as quickly as possible to reduce anxiety. d. call the patient “dear” or “honey” to make the patient feel cared for.

20. Patients taking diuretics such as furosemide are at special risk for developing which of the following electrolyte imbalances? a. Hypocalcemia c. Hypercalcemia b. Hypokalemia d. Hyperkalemia 21. Which of the following combinations of signs and symptoms would be MOST suggestive of acute myocardial infarction in a geriatric patient? a. Extreme weakness, malaise, syncope, and jaundice b. Extreme weakness, syncope, loss of bowel and bladder control, and malaise c. Syncope, loss of bowel and bladder control, confusion, stiff ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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neck and headache d. Extreme weakness, headache

confusion,

syncope,

stiff

neck

and

22. Which of the following statements about medical emergencies in geriatric patients is NOT true? a. Dyspnea may be the only symptom with which acute myocardial infarction presents. b. Syncope in the elderly is rarely significant. c. Congestive heart failure may present with episodes of nocturnal restlessness and confusion. d. Occlusive strokes (thrombus formation) tend to be more common in the elderly.

23. What effect will hypokalemia have if a patient is taking digitalis? a. It will enhance the effects of digitalis, possibly resulting in digitalis toxicity. b. It will antagonize the action of digitalis, making the digitalis ineffective. c. It will NOT produce any significant effects. d. It will antagonize the effects of digitalis if the patient is digitalis toxic but will enhance the effects if the patient is NOT digitalis toxic.

24. Which of the following statements about the care of geriatric trauma patients is NOT true? a. The heart’s ability to increase its rate and stroke volume to compensate for hypovolemia may be decreased. b. The patient may require a greater amount of IV fluid to support the higher arterial pressures that are needed to perfuse the vital organs. c. In the geriatric patient, tissues and organs have less tolerance of hypoxia and hypoperfusion. d. Physical deformities may require modification of packaging procedures.

25. A 73-year-old female has been experiencing episodes of weakness and dizziness. You have placed her on oxygen by nonrebreather ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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mask and attached an ECG monitor. As you continue to take her history, she suddenly complains of feeling light-headed and weak.

You look at the monitor and notice that the patient has gone into complete AV block with no escape rhythm. After about 15 seconds of generating only P waves, the patient returns to a sinus rhythm, and her symptoms quickly resolve. The patient has experienced a problem that can result in: a. cardiac syncope. c. sick sinus syndrome. b. transient ischemic attack. d. autonomic dysreflexia.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Student’s Name

HANDOUT 5-2

EVALUATION CHAPTER 5 SCENARIO 1 Review the following real-life situation. Then answer the questions that follow.

On a Saturday morning at 0930 hours, you respond to a report of “difficulty breathing” in a residential neighborhood. The patient is a 68-year-old female who complains of weakness and shortness of breath that have increased gradually over the previous three days. She denies any history of heart or lung disease. Her only past history has been severe osteoarthritis, for which she has been taking “a lot of aspirin.” The patient is awake and alert, and she responds to questions appropriately. Vital signs are pulse 114 strong, regular; respirations 22 regular, unlabored; blood pressure 116/86. Her skin is pale, warm, and dry.

Pupils are equal and react briskly to light. Breath sounds are present and equal bilaterally with no adventitious sounds. The abdomen is soft and nontender.

1. What problem should you suspect?

2. What questions might you ask?

3. What other problem should you consider as a possible cause for her weakness and dizziness?

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Student’s Name

HANDOUT 5-3

EVALUATION CHAPTER 5 SCENARIO 2 Review the following real-life situation. Then answer the questions that follow.

At 1030 hours on a Tuesday morning, you respond to a report of a motor vehicle collision. The patient is an 82-year-old male who appears to have lost control of his car, which struck a utility pole. The patient is awake, alert, restless, and anxious. Respirations are rapid and shallow at 24 breaths/minute. Radial pulses are weak at 80 beats/minute. The patient’s blood pressure is 128/86. The left lower chest is bruised and is tender to palpation. The left upper abdominal quadrant is tender. Breath sounds are present and equal bilaterally. The patient also complains of pain in his left shoulder. However, there is no bruising, tenderness, or deformity of this area. The patient takes a “blood pressure pill,” but he cannot remember its name and does not have the bottle with him.

1. On the basis of the mechanism of injury and your physical findings, what problem do you suspect?

2. Is the patient’s heart rate consistent with this problem? Why or why not?

3. If the patient’s heart rate is not consistent with the problem you suspect, how do you explain your findings?

4. Is the patient’s blood pressure consistent with the suspected problem? If not, how do you explain your findings?

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Student’s Name

HANDOUT 5-4

REINFORCEMENT CHAPTER 5 REVIEW Write the word or words that best complete the following sentences in the space(s) provided.

1.

The drugs that are widely used to treat hypertension, angina pectoris, and dysrhythmias and that are commonly associated with toxicity in the elderly are .

2.

An exaggerated feeling of depression or unrest, characterized by a mood of general dissatisfaction, restlessness, discomfort, and unhappiness, is .

3.

The syndrome in which an elderly person is physically or psychologically injured by another is .

4.

The MOST common fall-related fracture in the elderly patient is of the or .

5.

, a degeneration of the vertebral body, is common in the elderly.

6.

The MOST common initial sign of is a resting tremor combined with a pillrolling motion.

7.

The paramedic should NOT rule out complicating factor in cases of hypoglycemia.

8.

Gastritis and esophageal varices are likely causes of GI bleeding.

9.

Elderly patients are more likely to develop the ischemic damage and subsequent necrosis affecting the skin that is known as a(n) .

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as a

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

10. The leading cause of disability among those 65 and older is .

11.

The diminished vigor of the immune response to the challenge and rechallenge by pathogens is referred to as .

12.

The seventh leading cause of death among those 65 and older is .

13.

The leading cause of death in the elderly is .

14.

Unlike younger cardiac patients, the elderly are more apt to suffer a(n) .

15.

The BEST-known form of dementia is .

16.

The condition that can mimic senility and organic brain syndrome and can inhibit patient cooperation with the paramedic is .

17.

By the time people reach age 65, vital capacity may be reduced by as much as percent.

18.

Overall there is an average reduction in brain weight from age 20 to age 90.

19.

, in which a portion of the stomach protrudes upward into the mediastinal cavity, while not age-related per se, can have severe consequences for the elderly.

20.

primarily causes inflammation of the joints between the vertebrae of the spine and the sacroiliac joints in the pelvis.

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percent

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21.

Another complicating factor in the assessment and care of the elderly is , in which there is concurrent use of a number of drugs.

22.

injuries represent the leading cause of accidental death among the elderly.

23.

The inability to retain urine or feces because of loss of sphincter control or cerebral or spinal lesions is .

24.

In the elderly, efforts to force a bowel movement can lead to or

25.

.

Elderly patients are more likely to suffer from , a ringing in the ears, or from , a condition characterized by vertigo, nerve deafness, and a roar or buzzing in the ears.

26.

When a paramedic is presented with a DNR, he should follow state laws and local EMS system .

27.

The program under which federal and state governments share responsibility for providing health care to the aged poor, the blind, the disabled, and low-income families with dependent children is .

28.

In treating the elderly, the BEST intervention is .

29.

A person with a decreased ability to meet daily needs on an independent basis suffers from a(n) .

30.

A complicating factor in the assessment of the elderly is having more than one disease at a time, a condition known as .

31.

The elderly who are age 80 or older are referred to as the -

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.

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32.

The scientific study of the effects of aging and age-related diseases on humans is known as .

33.

Discrimination against old people is termed

34.

A living arrangement in which the elderly live in, but do NOT own, individual apartments or rooms and receive select services is .

35.

A legal document prepared when a person is alive, competent, and able to make informed decisions about health care is a(n) .

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.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Student’s Name

HANDOUT 5-5

REINFORCEMENT THE PHYSIOLOGY OF AGING Answer each of the following questions in the space provided.

1. What effect does aging have on dermal blood supply and thickness? How does this affect wound healing? How does this affect severity of burn injuries in the elderly?

2. What effect does aging have on bone resorption? Which gender is particularly affected? What effect does this have in victims of sudden deceleration trauma?

3. What effect does aging have on respiratory reserve capacity? What effect does this have on the ability of older patients to compensate for chest trauma or acute respiratory disease such as pulmonary embolism, spontaneous pneumothorax, or pneumonia?

4. What effect does aging have on myocardial reserve capacity? What effect does this have on volume resuscitation of the older trauma patient?

5. What effect does aging have on the peripheral blood vessels? What effect does this have on the older patient’s ability to compensate for volume loss? What effect does this have on the older patient’s ability to tolerate hot or cold environments?

6. What effect does aging have on the kidneys? What effect does this have on the response of the patient to drugs? What effect does this have on the response of the patient to fluid therapy for hypovolemia?

7. What effect does aging have on the conduction velocity of the nerves?

What effect does this have on the ability of the older patient to feel pain?

8. What effect does aging have on the thirst mechanisms? What effect does this have on patients?

9. What effect does aging have on the size of the brain relative to the size of the cranial cavity? What effect does this produce regarding the onset of signs and symptoms from a subdural hematoma? ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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10. If a patient is on beta-blocker therapy, what effect does this have on your ability to detect the early signs of shock? Why? 11. What effect does aging have on the cervical spine and spinal canal? What effect do these changes have on the risk of an older person sustaining a cervical spinal cord injury?

12. What effect does aging have on hepatic blood flow and on the ability of the liver to metabolize drugs? What change does this effect dictate for the dosing of most drugs?

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Chapter 5 Answer Key Handout 5-1: Chapter 5 Quiz 1. d 2. b 3. d 4. b 5. b 6. d 7. b

8. b 9. b 10. a 11. c 12. a 13. c

14. d 15. c 16. c 17. d 18. c 19. a

20. b 21. b 22. b 23. a 24. b 25. a

Handout 5-2: Chapter 5 Scenario 1 1. Anemia caused by gastrointestinal hemorrhage caused by excessive aspirin use.

2. Ask the patient about changes in her stool. A dark, tarry consistency helps to confirm your suspicions.

3. Silent myocardial infarction Handout 5-3: Chapter 5 Scenario 2 1. Intra-abdominal hemorrhage and hypovolemic shock, probably from an injury to the spleen.

2. No. If the patient is compensating for volume loss secondary to hemorrhage, the heart rate should be increased.

3. If the “blood pressure pill” is a beta-blocker, the patient may be unable to accelerate his heart rate adequately in response to hypovolemia.

4. It does not appear to be, until the history of hypertension is considered.

Even with treatment, a hypertensive patient may have a blood pressure significantly above “normal.” Therefore, this patient may be hypotensive relative to his “normal” blood pressure.

Handout 5-4: Chapter 5 Review 1. beta-blockers 2. dysphoria 3. geriatric abuse 4. hip, pelvis ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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5. Spondylosis 6. Parkinson’s disease 7. alcohol 8. upper 9. pressure ulcer 10. osteoarthritis 11. immune senescence 12. pneumonia 13. cardiovascular disease 14. silent myocardial infarction 15. Alzheimer’s disease 16. depression 17. 50 18. 10 19. Hiatal hernia 20. Ankylosing spondylitis 21. polypharmacy 22. Fall-related 23. incontinence 24. transient ischemic attack, syncope 25. tinnitus, Meniere’s disease 26. protocols 27. Medicaid 28. prevention ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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29. functional impairment 30. comorbidity 31.

old-old

32. gerontology 33. ageism 34. congregate care 35. advance directive Handout 5-5: The Physiology of Aging 1. The dermal blood supply decreases, and the dermis thins. Wound healing takes longer. Burns tend to be deeper and heal more slowly.

2. The rate of bone resorption increases, resulting in a decrease in bone mass and density. Females tend to be affected more frequently. Fractures can occur with less force and at lower velocities than in younger patients.

3. Respiratory reserve capacity in the elderly decreases. This diminishes the ability to compensate for chest trauma or acute respiratory disease.

4. Myocardial reserve capacity decreases. The elderly develop volume overload more easily than younger patients. Volume resuscitation must be carried out cautiously with careful monitoring for signs of overload, particularly pulmonary edema.

5. Peripheral vessel walls become sclerotic and less able to vary the diameter of the vessel. Older patients cannot vasoconstrict as efficiently in response to volume loss. Because the elderly cannot vary the diameter of their peripheral blood vessels effectively, they cannot thermoregulate as well as younger patients.

6. Reductions in the number of nephrons and in renal blood flow occur.

Drugs are excreted less effectively via the renal route, so drug action is prolonged. Excess fluid is excreted less effectively, so patients are prone to volume overload.

7. Nerve conduction velocity decreases. Pain sensation in the elderly is diminished.

8. Thirst diminishes with age. The elderly frequently do not have adequate fluid intake and often are chronically dehydrated. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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9. The brain decreases in size relative to the cranial cavity. Onset of signs and symptoms of subdural hematoma may be delayed.

10. Detection of shock may be more difficult. By blocking the beta effects of sympathetic stimulation, beta-blockers mask early signs and symptoms of shock.

11. The spinal canal tends to narrow, and degeneration tends to occur in the vertebral bodies. The risk of cervical spine fracture and of spinal cord injury increases.

12. Hepatic blood flow and ability to metabolize drugs decrease. Doses of most drugs must be decreased to compensate.

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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Volume 5 - Chapter 6 Abuse, Neglect, and Assault

Student’s Name

HANDOUT 6-1 EVALUATION

CHAPTER 6 QUIZ Write the letter of the best answer in the space provided.

1.

Your primary responsibility at a call to a scene of suspected abuse is: a. preserving the chain of evidence. b. discovering the identity of the abuser. c. your safety and that of the patient. d. psychological support.

2.

The number of states that require health care workers to report suspected cases of child abuse is: a. 35. b. 40. c. 45. d. 50.

3.

The physical or emotional violence or neglect that is carried out when an elder is being cared for by a person paid to provide care is: a. professional elder abuse. b. institutional elder abuse. c. common elder abuse. d. mercenary elder abuse.

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4.

In cases of neglect, the elders MOST commonly: a. have incomes less than $75,000 a year. b. live alone. c. live with grandchildren. d. have a chronic medical condition that requires medication.

5.

All of the following are characteristic of abusers of women EXCEPT: a. unemployment. b. use of illegal drugs at least once a year. c. family income over $95,000 a year. d. different religious background from the woman.

6.

All of the following are common characteristics of abused children EXCEPT: a. constant crying or no crying during treatment. b. absence of emotion or constant neediness for attention from the EMS provider. c. avoiding parents or constantly asking for parents’ attention. d. sudden behavioral changes during interview and treatment.

7.

Which of the following is NOT one of the common characteristics of child abusers? a. History of having been abused themselves b. Overly concerned with child’s welfare and severity of any injury during interview c. Pattern over time of becoming more frequently and more severely abusive d. Immaturity and preoccupation with self

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8.

All of the following are correct correlations between the age of a bruise and its skin appearance EXCEPT: a. 0–2 days and a reddened, swollen, tender appearance. b. 10 or more days and a yellow color. c. 0–5 days and blue or purple color. d. 5–7 days and a green color.

9.

Which of the following medical conditions is NOT easily mistaken for a sign of abuse? a. chickenpox b. car seat burns c. blood disorders that cause easy bruising d. measles

10.

Common characteristics of victims of sexual assault include all of the following EXCEPT: a. celibacy and denial of own sexuality. b. phobias related to the offender. c. regressive behavior such as bed-wetting. d. withdrawal tendencies.

11.

All of the following are common clues that a child is being neglected EXCEPT: a. severe diaper rash. b. malnutrition and underweight condition. c. a child patient ignoring and avoiding physical contact with EMS provider. d. untreated medical conditions.

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12.

All of the following injuries in a child should give you a high level of suspicion that child abuse is involved EXCEPT: a. burns on the soles of the feet, palms of the hands, back, or buttocks. b. head injuries. c. fractures of the skull, nose, or ribs. d. burns in a “splash” pattern.

13.

Elder abusers are often all EXCEPT which of the following individuals? a. A grandchild b. An adult child c. Spouse d. A different kind of familial relative

14.

Characteristics of abused partners include all of the following EXCEPT:

15.

a. pregnancy in a female partner.

c. substance abuse.

b. chronic physical condition.

d. emotional disorders.

Which of the following is NOT one of the several common reasons why a domestic partner does not report that he or she is being abused? a. Fear of reprisal by the abusing partner b. Lack of knowledge of how to report abuse or seek help c. Fear that he or she will not be believed d. Denial that the situation is one of abuse

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HANDOUT 6-2

Student’s Name CHAPTER 6 SCENARIO

Review the following real-life situation. Then answer the questions that follow.

A team is called to a neighborhood nursing home to check on “an elderly woman who fell.” On arrival, the team waits in the lobby until an aide comes for them.

They walk down the hall and find an elderly lady sitting up in bed, clutching the side rails with both hands. Her hair is uncombed, and she looks vacantly out before her. The aide says that she is busy and cannot stay and then leaves the team with the patient.

They introduce themselves, and the lady says her name is Lillian Good and that she is 84 years old. Kerry starts to ask her whether she fell when a nurse comes into the room and answers the question by saying, “Lillian knew she shouldn’t get out of bed without help, but she tried anyway.” Lillian is quiet. Kerry says that she needs to examine the patient but then has to squeeze past the nurse to get to the bedside. Kerry asks Mrs. Good about the fall as she gently takes a hand to check a pulse and looks closely at the patient.

Kerry notes that Mrs. Good looks and smells as if she has not bathed recently, and there is a clear odor of urine. The bottom sheet is crisp and white in contrast to the top sheet, which has a variety of food stains on it. As Kerry gently asks her question about the fall again, the nurse interrupts to say that Mrs. Good falls often and a new aide called the paramedics. “It was really a mistake,” she says. “We don’t need your help. If you just want to check her vital signs, you can leave.”

1.

On the basis of initial impressions, what, if any, problems do you suspect in addition to your need to work up the alleged fall?

2.

Does the nurse’s behavior arouse your index of suspicion? Why or why not?

3.

On the basis of this impression, are there any signs you should look for while conducting a physical examination of the patient?

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4.

If your physical is within normal limits, the patient does not supply any information, and there is no evidence of injury from the (alleged) fall, is there anything more you should do before discussing the case with medical direction?

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Student’s Name

HANDOUT 6-3

REINFORCEMENT CHAPTER 6 REVIEW Write the word or words that best complete each sentence in the space(s) provided.

1.

A green bruise on a child who has been abused is to days old.

2.

The paramedic can frequently recognize the source of intentional burns to children by their

and/or .

3.

may occur when a parent or caregiver becomes frustrated with a crying child.

4.

Neglected children are frequently

,

causing them to be underweight, sometimes by up to 30 percent.

5.

Neglected children may also exhibit or attitudes or make near constant demands for .

6.

When speaking with an abused partner, be prepared to share your knowledge of .

7.

takes place when an elder is being ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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cared for in a home situation;

elder

abuse occurs when an elder is being cared for by a person who is paid for such care.

8.

One of the four main theories about the causes of elder abuse is that caregivers feel

or .

9.

Elder abuse can be either acts of (physical, sexual, or emotional violence) or acts of (neglect).

10. make up the largest group of perpetrators of domestic elder abuse.

11. The pattern of abuse and assault forms a(n) that is difficult to break.

12. Victims of partner abuse hesitate or fail to report the problem because of fear of

, fear of humiliation, denial,

lack of knowledge, and lack of .

13. Partner abuse may be categorized as abuse, the MOST obvious form, abuse, which damages selfesteem, and

abuse, a form of

physical abuse.

14. A history of makes a person more likely to repeat the pattern of partner abuse as an adult.

15. The three characteristics of abused partners are (45% of abused women),

, and emotional disorders such as ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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, evasiveness, anxiety, and suicidal behavior.

16. MOST were physically or emotionally abused as children.

17. In cases of reported physical child abuse, perpetrators tend to be .

18. Abused children may be unusually wary and fearful of

.

19. Abused children under age six usually appear excessively , while those over age six appear .

20. Frequent behavioral traits of child abusers include immaturity and preoccupation with

; seeming about a child’s injury, treatment, or

prognosis; and little indication of

or for involvement in the child’s

condition.

21. is unwanted sexual contact, while is generally defined as penile penetration of the genitalia or rectum.

22. The group MOST likely to be the victims of sexual assault/rape are younger than age .

23. Government figures show that approximately one-third of all juvenile victims of assault/rape are younger than years of age.

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24. In cases of date rape, the assailant may have drugged the victim with , known by the street names of Roofie, Roche, Rib, and Rope.

25. As well as physical care, the paramedic is responsible for providing proper care for the victims of assault and rape.

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Student’s Name

HANDOUT 6-4

REINFORCEMENT Abuse and Assault True or False Indicate whether the following statements are true or false by writing T or F in the space provided.

1. Elder abuse commonly takes place in homes but NOT in institutional settings such as a nursing home.

2. Abuse and assault in the United States involve persons of each gender and of every race, age, and socioeconomic status.

3. Partner abuse can involve heterosexual couples or same-sex couples, but men are always the abusers in any relationship that involves a man.

4. You may find that an abuse victim who is a patient of yours has both direct injury and indirect injury, with the latter represented by aggravation of an existing medical condition such as asthma or diabetes.

5. When you are talking with a patient who has been physically battered, you will find that direct, nonjudgmental questioning generally works best.

6. Approximately one million women in the United States are battered by their spouses each year.

7. Nearly three million children in the United States suffer abuse each year.

8. Battery is not a problem between same-sex couples.

9. Many women suffer some form of battery during pregnancy.

10. One of the most common theories holds that caregivers in cases of elder abuse feel stressed and overburdened.

11. A child’s behavior is one of the most important indicators of abuse.

12. Because rib fractures are common in children, they are not a good indicator of abuse.

13. When confronted with a case of child abuse, try to conduct the examination with another colleague present.

14. The group most likely to be raped is made up of adolescent females younger than age 18.

15. In a case of rape, allow the victim to urinate or defecate if it will calm her.

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Chapter 6 Answer Key

Handout 6-1: Chapter 6 Quiz 1. c 2. d 3. b 4. b

5. c 6. c 7. b 8. b

9. d 10. a 11. c 12. d

13. a 14. b 15. c

Handout 6-2: Chapter 6 Scenario 1. There should be a high level of suspicion of institutional elder neglect or abuse. There are signs that the patient’s personal hygiene has not been adequately addressed (uncombed hair, indications that she hasn’t bathed or been bathed), her environment has not been adequately cared for (top sheet with old and new food stains, indicating it hasn’t been changed), and she hasn’t had needed care (the clear smell of urine and signs that the bottom sheet has just been changed).

2. The nurse is excluding the patient from conversation with the paramedics and is dismissive of the incident. She clearly wants the team to leave as soon as possible.

3. There may be signs of direct abuse or further evidence of neglect. Signs of abuse might include bruises of various ages. Signs of neglect might include bedsores on the buttocks, heels, or elbows or evidence of urine or fecal material on the bedding, clothing, or patient. Other potential signs of abuse or neglect would include any indications of dehydration or malnutrition.

4. You must organize the reasons for your suspicion of elder abuse or neglect for yourself and document them thoroughly. You must further evaluate your impressions of the nurse as well as any other staff members you encounter while on scene and notify medical direction of any concerns you may have for the patient’s safety if the patient is not transported to a facility for evaluation. You should also ask (if it is not ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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clear per local protocol) whether the nurse or another member of the nursing home staff can refuse transport of the patient.

Handout 6-3: Chapter 6 Review 1.

5, 7

2.

shape, pattern

3.

Shaken baby syndrome

4.

malnourished

5.

tired, listless, physical contact

6.

community resources

7.

Domestic elder abuse, Institutional

8.

stressed, overburdened

9.

commission, omission

10. Adult children 11. cycle 12. reprisal, financial resources 13. physical, verbal, sexual 14. family abuse 15. pregnancy, substance abuse, depression 16. child abusers 17. men 18. physical contact 19. passive, aggressive 20. self, unconcerned, guilt, remorse 21. Sexual assault, rape 22. females, 18 23. 6 24. flunitrazepam (Rohypnol) ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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25. psychosocial

Handout 6-4: Abuse and Assault True or False

1. F 5. T 9. T 13. T 2. T 6. F 10. T 14. T 3. F 7. T 11. T 15. F 4. T 8. F 12. F

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Volume 5 - Chapter 7 The Challenged Patient

Student’s Name

HANDOUT 7-1

EVALUATION CHAPTER 7 QUIZ Write the letter of the best answer in the space provided.

1.

Causes of permanent vision loss include all of the following EXCEPT: a. glaucoma. c. cmv infection. b. diabetic retinopathy. d. corneal abrasion.

2.

Persons with impaired maturation of the brain who are unable to learn at the usual rate are considered to have what type of challenge? a. Physical c. Mental b. Developmental d. Pathological

3.

It is particularly important to explain all standard precautionary procedures as they arise with patients who: a. have a communicable disease. c. have cystic fibrosis. b. have had recent chemotherapy. d. are terminally ill.

4.

Which one of the following is NOT a cause of conductive hearing impairment? a. Neonatal asphyxia b. Childhood otitis media c. Impacted cerumen d. Trauma to the mandible or ear

5.

Whenever possible when dealing with a culturally diverse patient, you should: a. maintain face-to-face positioning. b. remember that folk remedies do not interact with medical therapies. c. work through an interpreter, if possible, when you don’t understand the language. d. document the fact that the patient is culturally diverse.

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6.

The types of speech impairments are called: a. articulation disorders. c. fluency disorders. b. language disorders. d. aphasia disorders.

7.

Persons who may have difficulty walking to the ambulance when ill do NOT include patients with: a. myasthenia gravis. c. post-polio syndrome. b. multiple sclerosis. d. spina bifida occulta.

8.

Patients with have been ill for their entire lives, and you need to remember that the last thing they want is another exposure to the medical system or another hospitalization. a. multiple sclerosis c. muscular dystrophy b. cystic fibrosis d. spina bifida

9.

A full third of persons with cerebral palsy are: a. developmentally challenged. b. of normal intelligence. c. unable to communicate in any way. d. mentally challenged.

10. Always assume that patients with which condition have a latex allergy? a. Cerebral palsy c. Cystic fibrosis b. Cancer d. Spina bifida 11. Individuals who may need to be transported with the patient for medical reasons include all of the following EXCEPT a(n): a. home nurse. b. interpreter (either sign language or spoken language). c. caregiver for the severely mentally impaired. d. assistance dog.

12. Clues that a person may have cancer include all of the following EXCEPT: a. alopecia (hair loss). c. thirstiness and frequent urination. b. significant weight loss. d. implanted infusion port.

13. One cause of temporary vision loss is: a. enucleation. c. glaucoma. b. deployment of vehicle air bag. d. diabetic retinopathy.

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14. Assume that a person who has recently undergone chemotherapy as a form of cancer therapy is neutropenic and thus is vulnerable to: a. infection. c. bradycardia. b. hypoglycemia. d. tachypnea.

15. Common accommodations that you should make for persons with severe hearing impairment do NOT include which of the following? a. Make initial connection with the patient via movement or by gentle touch. b. Maintain a face-to-face position. c. Exaggerate facial and body language to make points more clear. d. Reduce background noise to the lowest possible level.

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Student’s Name

HANDOUT 7-2

REINFORCEMENT CHAPTER 7 SCENARIO Review the following situation, and then answer the questions that follow.

You and your partner are called out shortly after 3:30 A.M. to the site of a single-vehicle collision. When you arrive at the scene, you see a fair amount of debris in the right lane that looks like cardboard or paneling and an apparently undamaged car on the shoulder. A police officer is talking with an older man who appears to be physically unhurt. As you walk toward them, you see an older woman standing quietly on the far side of the car.

The two men explain that the couple, Mr. and Mrs. Barrett, had been awakened by a phone call that their daughter had gone into labor with her first child. The couple dressed quickly and set out for the hospital. Unfortunately, Mr. Barrett did not see the debris in his lane until too late, and the car went over some of the cardboard as he tried to swerve away into another lane. Mr. Barrett tells you that both he and his wife were wearing their seat belts, and he thinks they were “just a bit shaken up.”

Your partner, who is standing near Mrs. Barrett, gestures, and you walk over to them. He tells you in a quiet voice that she only shook her head in response to his questions and, although he can’t see any blood or bruises in the darkness, he is worried about head injury.

You touch Mrs. Barrett gently on her arm, and she looks up, almost surprised to see you. She doesn’t say anything when you ask her whether she has any discomfort anywhere, but she continues to watch your face. Suddenly, you get an idea, and you tell her you’d like to walk over to the ambulance and talk there. As you take her arm gently, she says, “All right” and willingly walks with you toward the lights of the ambulance. As you glance at her, you see no sign of injury.

1. What clues, if any, suggest that Mrs. Barrett may have a type of challenge rather than head trauma? What type of challenge do you suspect?

2. When you reach the relatively well-lit area beside the ambulance, what accommodations should you make, on the assumption Mrs. Barrett may be hearing impaired, as you try to begin an interview with her?

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3. When you ask Mrs. Barrett whether she can hear you all right, she reaches up to touch her ears and says “Oh, my! I forgot to put my hearing aids in.”

What question should you ask next?

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Student’s Name

HANDOUT 7-3

REINFORCEMENT CHAPTER 7 REVIEW Write the word or words that best complete each sentence in the space(s) provided.

1.

Signs of myasthenia gravis that are readily observed in the face are and difficulty with or .

2.

One axiom about caring for patients with monetary challenges is to care for the , NOT the .

3.

Remember that every patient who has decision-making ability has the right to ; if this occurs, be sure that it is documented properly.

4.

If you use an interpreter for any reason, be sure to document the and the .

5

Because distress is highly probable in patients with cystic fibrosis, be prepared to give oxygen therapy.

6.

Even though it is due to a form of toxic injury during pregnancy, syndrome is sometimes confused with Down syndrome because of similar facial characteristics.

7.

Remember that individuals with Down syndrome may have other physical conditions involving one or more of these three organs: , , and .

8.

It may be necessary to spend extra time on the physical examination of an adult with a(n) disability if the person does not have sufficient cognitive or communicative skills to give you history information.

9.

If a patient is wearing a halo device, be sure to before transport.

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10.

Be sure to have ready when you treat quadriplegic patients in case there are excess secretions in the airway.

11.

An individual with paralysis due to an injury of the cervical vertebrae may have compromise of muscles and require use of a home .

12.

When speaking with a person who has a speech impairment, try to phrase questions so that they can be answered with , direct responses.

13.

A person with aphasia cannot understand the spoken word, whereas a person with aphasia cannot clearly articulate a response to what you say.

14.

When obesity complicates positioning of ECG electrodes, remember that you can place electrodes on the and instead of on the chest.

15.

Physical challenges include sensory impairments such as visual or hearing loss, as well as speech impairments and physical states such as or .

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Student’s Name

HANDOUT 7-4

REINFORCEMENT THE MANY TYPES OF CHALLENGED PATIENTS Fill in the blanks to complete the information on different types of challenged patients.

1. Examples of a. Arthritis. b. c. d. e.

F. g. h. Previous i.

j.

challenges (chronic conditions): . palsy. (mucoviscidosis).

(MS).

(MD). syndrome. . with occultaor cystica.

and post-

gravis.

2. Examples of physical challenges: a. impairment with deafness and deafness. b. impairment. c. impairment with aphasia, aphasia, and aphasia. d. . e. with possible paraplegia or quadriplegia.

3.

challenges and impairment (including the psychoses, mood disorders, personality disorders, and responses to a traumatic experience).

4.

disabilities (including patients with Down syndrome, fetal alcohol syndrome, and disabilities of many other origins).

5. Other challenges include: a. b. c. Patients with d. Patients with ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

patients. patients. diseases. challenges.

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Chapter 7 Answer Key Handout 7-1: Chapter 7 Quiz 1. d 2. b 3. a 4. a 5. c 6. d 7. d 8. b 9. b 10. d 11. a 12. c 13. b 14. a 15. c Handout 7-2: Chapter 7 Scenario 1. The undamaged appearance of the car, the uninjured appearance and settled voice of Mr. Barrett, and the information that the couple were both wearing seat belts by no means rule out head injury in Mrs. Barrett, but neither do they raise your level of concern. Her surprise when you walk close to her and her fixing on your face in the darkness are clues that she might be hearing impaired. It is difficult to assess her status in the darkness.

You realize that the poor light—if she has a hearing impairment—is making it harder for her, especially after the news of her daughter’s labor and the minor car accident, to focus on and respond to what you say.

The fact that she said, “All right” clearly when you asked her to walk over to the

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ambulance does not rule out a speech impairment, but it does make it somewhat less likely than hearing impairment.

2. You should assume a directly face-to-face position. Speak clearly in a lowpitched voice and without exaggeration. Look for a hearing aid. Ask her directly whether she can hear you properly because you need to ask her a few questions about how she feels. Reduce background noise as much as possible. (For example, make sure the radio is turned down or your partner sits in ambulance to listen to any incoming calls. Stand at the side farther from the highway to muffle any road noise.)

3. Any question that directly calls for a response on whether she can hear you well enough to answer a few questions is proper. If she can’t hear well enough, ask her husband to stand with her, and ask them questions jointly to ascertain whether either has been injured sufficiently to require intervention. Be matter-of-fact. Hearing impairment is a complication in a patient interview but is not a problem itself.

Handout 7-3: Chapter 7 Review 1. drooping eyelid, swallowing, chewing 2. patient, financial condition 3. refuse treatment 4. person’s name, information the person provided 5. respiratory 6. fetal alcohol 7. heart, intestines, lungs 8. developmental 9. stabilize traction 10. suction 11. respiratory, ventilator 12. short 13. sensory, motor (expressive) 14. arms, thighs 15. obesity, paralysis Handout 7-4: The Many Types of Challenged Patients 1. pathological a. Arthritis b. Cancer c. Cerebral d. Cystic fibrosis e. Multiple sclerosis f. Muscular dystrophy ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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g. Poliomyelitis, polio h. head injury i. Spina bifida, spina bifida, spina bifida j. Myasthenia 2. a. Hearing, conductive, sensorineural b. Visual c. Speech, sensory, motor (expressive), global d. Obesity e. Paralysis 3. Mental, emotional 4. Developmental 5. a. Culturally diverse b. Terminally ill c. communicable d. financial

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Volume 5 - Chapter 8 Acute Interventions for the Chronic Care Patient

Student’s Name

HANDOUT 8-1 EVALUATION CHAPTER 8 QUIZ

Write the letter of the best answer in the space provided.

1. Common causes for calls from patients with cystic fibrosis include all of the following EXCEPT: a. pneumothorax. c. cor pulmonale. b. hemoptysis. d. hematemesis.

2. Common reasons for ALS intervention in home care settings include all of the following EXCEPT: a. equipment failure. c. unexpected complications. b. absence of a caregiver. d. arguments between caregiver and patient.

3. Signs and symptoms of respiratory distress include all of the following EXCEPT: a. tachypnea. c. upright posturing. b. use of accessory muscles. d. wheezing or rales on auscultation.

4. Patients with which disease are at high risk for unhealed wounds or ulcers, particularly on the feet? a. Atherosclerosis c. Coronary heart disease b. Diabetes mellitus d. Deep vein thrombophlebitis (DVT) 5. A surgical diversion of the large intestine to a stoma, or hole, in the abdominal wall is called a(n): a. colonostomy. c. cytostomy. b. colostomy. d. ostomy.

6. Pressure sores are classified: a. by the depth of tissue destruction. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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b. as diabetes-related and non-diabetes-related. c. by the location on the body. d. as gravity-dependent or nongravity-dependent.

7. Common diseases that you will see in a hospice setting include all of the following EXCEPT: a. congestive heart failure (CHF). b. chronic obstructive pulmonary disease (COPD). c. cerebral palsy. d. Alzheimer’s disease.

8. Settings in which the scope of treatment is beyond your training include all of the following EXCEPT: a. chemotherapy. c. hospice care. b. pain management. d. home ventilators.

9. Signs and symptoms of cardiac or respiratory insufficiency in newborns include all of the following EXCEPT: a. hypotension. c. bradycardia. b. cyanosis. d. lung crackles.

10. Bronchopulmonary dysplasia (BPD) primarily affects: a. older persons, especially heavy smokers. b. children with cystic fibrosis. c. infants of low birth weight. d. older persons with hypertension.

11. Signs of postpartum depression include: a. colic. b. child rearing inexperience. c. maternal hypotension. d. the mother’s inability to care for herself.

12. Chronic overproduction of mucous is termed: a. atelectasis. c. chronic bronchitis. b. bronchiectasis. d. bronchopneumonia.

13. Signs and symptoms of an air embolus include all of the following EXCEPT: a. shortness of breath with clear lung sounds. b. chest pain. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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c. back pain. d. headache.

14. What form of ventilation is the recommended support for acute respiratory disorders? a. Positive-pressure ventilation (PPV) b. Negative-pressure ventilation (NPV) c. Positive end-expiratory pressure (PEEP) d. Bilevel positive airway pressure (BIPAP) 15. Types of vascular access devices used in the home setting include all of the following EXCEPT: a. heparin lock. b. Hickman or Broviac catheter. c. peripherally inserted central catheter. d. dialysis shunt.

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Student’s Name

HANDOUT 8-2

REINFORCEMENT CHAPTER 8 SCENARIO Review the following situation, and then answer the questions that follow.

The dispatcher assigns you to investigate a “hysterical” caller reporting a man who “is coughing up blood.” As you pull up to the house, a young woman runs down the lawn toward your unit, and you recognize her as the wife of a previous patient, a man in his early 30s with advanced cystic fibrosis. He had a DNR order in place when you transported him to the hospital last month for diarrhea and dehydration.

Her husband is sitting on the floor of the living room with his back against the couch. He is breathing rapidly, shallowly, and with great effort; the muscles in his neck stand out as he leans forward. He is staring blankly at the blood that is on his hands and the front of his sweatshirt. His nasal cannula hangs loosely from his neck. As your partner goes to his side, the woman tells you that he “has had bronchitis” but had been “doing so well” on antibiotics. She says she heard coughing and came into the living room in time to see him start “coughing up all that blood” and slump from the couch to the floor.

Your partner rapidly replaces the nasal cannula, dials up the oxygen, and suctions the patient’s airway. He no longer sounds as if he is choking, but he begins to cough again. He doesn’t seem to be responding to your partner’s presence. Your partner shakes her head at you and reaches out to take his pulse and grab her stethoscope.

1. List two pieces of information that you need to know right away to provide the appropriate level and type of intervention for the patient.

The patient’s wife says that she didn’t call the cystic fibrosis clinic because “they’re so negative. He needs help!” In response to your request to see current orders and plans, she reluctantly gives you information that states that he has been accepted into hospice care and gives contact information for the service. The DNR order stipulates that the patient may receive oxygen and airway protection (for example, suctioning), but intubation and ventilatory assistance are precluded. You note the patient’s signature on the form, as well as his doctor’s.

The patient is still in a semiseated position on the floor with your partner kneeling behind him. She says he has a very rapid (about 180 beats/min), weak pulse and that she can’t hear any clear areas in his lung fields. As he coughs, more blood comes out of his mouth. She suctions. The wife leans against the wall and begins to cry helplessly. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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2. What is the immediate medical need? What is the immediate need in terms of coordinating your care with the established plan?

A large amount of blood comes from the man’s mouth, and he falls forward so that he is lying across your partner’s lap. She continues to suction, and the blood continues to come. She leans over him closely, then looks up and says, “He isn’t breathing, and he’s nonresponsive.” She places her hand over his carotid and says, “His pulse is weakening, too.”

As his wife clings to you, crying and trembling, you look over again, and your partner shakes her head once. Then she gently lays the man’s body out on the floor and begins to wipe the blood off his face. Without looking, she extends her arm backward to turn off the oxygen.

3. What is your immediate medical responsibility to the patient? To his wife?

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Student’s Name

HANDOUT 8-3

REINFORCEMENT CHAPTER 8 REVIEW Write the word or words that best complete each sentence in the space(s) provided.

1. For the mother who has recently given birth, the MOST common complications are and .

2. MOST complications related ato urinary support devices result from or .

3. The MOST common complications seen in patients with VADs result from of various types.

4. are used to provide any parenteral treatment on a long-term basis.

5. The MOST common problems faced by tracheostomy patients include of the airway by and a dislodged .

6. Common home treatments for respiratory illnesses include oxygen, or medications, and possibly a ventilator utilizing , , or .

7. Many home care patients suffer from COPD, which is a triad of diseases including , , and .

8.

habits,

intake,

and minor or can have a dramatic effect on the seriously ill home-bound patient.

9. When making a home care call, try to ascertain from the primary care provider (if present) a(n) presentation for the patient.

10. The one thing home care calls have in common is their .

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11. A program of palliative care and support services that addresses the physical, social, economic, and spiritual needs of terminally ill patients and their families is .

12. The disease that is characterized by episodic muscle weakness triggered by an autoimmune attack on the acetylcholine receptors is .

13. The primary goal of the ALS provider in home care situations is to identify and treat any problems.

14. Almost 65 or older.

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percent of home care patients are age

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Student’s Name

HANDOUT 8-4 REINFORCEMENT

ACUTE INTERVENTIONS TRUE OR FALSE Indicate whether each statement is true or false by writing T or F in the space provided.

1.

Almost 75% of home care patients are age 65 or older, and about 75% are female.

2.

A home care patient is more likely to decompensate and go into crisis more quickly than a patient in the general population.

3.

Cardiac decompensation is considered a true medical emergency in patients with preexisting cardiac or pulmonary compromise.

4.

A high risk of infection is not seen in all patients with decreased immune response.

5.

A stage 2 pressure sore involves the epidermis, whereas a stage 3 sore involves the full thickness of the skin, exposing subcutaneous tissue.

6.

On any call involving a home care patient, ask whether another health care professional, in addition to EMS, has been called.

7.

Many home care patients have a baseline lung capacity that only minimally meets their normal requirements.

8.

Home care patients usually have a high dosing regimen, which may make them more responsive to additional medication.

9.

When treating a patient with cystic fibrosis, always inquire about the stage of the disease and about any standing orders.

10.

Pulmonary congestion or frank pulmonary edema may develop in infants with bronchopulmonary dysplasia when excessive amounts of fluid have been given.

11.

Tracheostomy patients who have had a laryngectomy do NOT have any remaining air connection with the nasopharynx, so it is not necessary to block nose and mouth when ventilating the patient.

12.

Tracheostomy stomas close slowly when the tube is NOT replaced.

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13. Some common reasons patients use a home ventilator include decreased respiratory drive, weakness of respiratory muscles, obstructive pulmonary disorders, and sleep apnea.

14. Do not obtain vascular access or blood pressure readings in an extremity with a shunt.

15.

Have a high index of suspicion for infection in the wounds of home care patients.

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Student’s Name

HANDOUT 8-5 REINFORCEMENT

ACUTE INTERVENTIONS ABBREVIATIONS Interpret the following Chapter 8 abbreviations by writing out their meanings in the spaces provided.

1. PICC 2. DNR 3. NPV 4. DNAR 5. PPV 6. GI/GU 7. ARDS 8. PEG 9. TPN 10. G-tube 11. IMV 12. COPD 13. BPD 14. VAD 15. CF 16. PEEP 17. CHF 18. CPAP 19. CNS 20. BIPAP

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Student’s Name

HANDOUT 8-6 REINFORCEMENT

HOME CARE SAFETY GUIDELINES In responding to any home care situation, keep in mind the following guidelines about scene safety.

1. Any patient with limited movement may be contaminated with feces, urine, or emesis.

2. Any bed-bound patient may have weeping wounds, bleeding, or decubitus ulcers (bedsores).

3. Sharps may be present.

4. Collection bags for urine or feces sometimes leak.

5. Tracheostomy patients clear mucus by coughing, which can spray.

6. Any electrical machine has the potential for electric shock.

7. A hospital bed, wheelchair, or walker could be contaminated with body fluid.

8. Contaminated medical devices, such as a nebulizer, may be left unprotected.

9. Oxygen in the presence of flame has the potential for fire or explosion.

10. Equipment may be in the way and cause you to fall, or it may be unstable and fall on you.

11. Medical wastes may not be properly contained or discarded.

Be sure that the following safety tips on home use of oxygen are followed.

1. Alert the local fire department to the presence of oxygen in the home.

2. Keep a fire extinguisher on hand.

3. If a fire does start, turn off the oxygen immediately and leave the house.

4. Don’t smoke—and do not allow others to smoke—near the oxygen system. (NO open flames or smoking within 10 feet of oxygen.)

5. Do not use electrical equipment near oxygen administration.

6. Store the oxygen tank in an approved, upright position. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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7. Keep a tank or reservoir away from direct sunlight or heat.

8. Ground all oxygen cylinders.

Additional guidelines on oxygen use that you should know include the following.

1. Ensure the ability of the patient/home care provider to administer oxygen.

2. Make sure the patient knows what to do in case of a power failure.

3. Evaluate sterile conditions, especially disinfection of reusable equipment.

4. As with any patient with chronic respiratory problems, remain alert to signs and symptoms of hypoxemia.

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Chapter 8 Answer Key Handout 8-1: Chapter 8 Quiz 1. d 2. d 3. c 4. b 5. b 6. a 7. c 8. d 9. a 10. c 11. d 12. c 13. c 14. a 15. a Handout 8-2: Chapter 8 Scenario 1. You need to ask the patient’s wife whether she called his physician or other telephone contact and, if so, what instructions were given. Second, you need to determine exactly what DNR or other orders are currently in place.

2. Medically, you and your partner need to support airway, breathing, and circulation to the extent that you can do so within the DNR order. You need to ask the patient’s wife once again whether she has called anyone—doctor at the clinic, hospice service, or other family—and what, if anything, she was told.

3. You and your partner need to confirm lack of heartbeat and respiration and notify medical direction of the patient’s death. After an initial cleanup of the patient’s ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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body, one of you needs to assist his wife in sitting with and grieving him. The other needs to call hospice to see what support they will get in place for the patient’s wife before you leave. Finally, you need to attend to whatever responsibilities are yours in the situation of a home death from natural causes.

Handout 8-3: Chapter 8 Review 1. postpartum bleeding, embolus 2. infection, device malfunctions 3. obstructions 4. Vascular access devices 5. blockage, mucus, cannula 6. nebulized, aerosol, PEEP, CPAP, BIPAP 7. emphysema, chronic bronchitis, asthma 8. Eating, fluid, illnesses, injuries 9. baseline 10. diversity 11. hospice 12. myasthenia gravis 13. life-threatening 14. 75 Handout 8-4: Acute Interventions True or False 1. F

5. T

9. T

13. T

2. T

6. T

10. T

14. T

3. T

7. T

11. F

15. T

4. F

8. F

12. F

Handout 8-5: Acute Interventions Abbreviations 1. Peripherally inserted central catheter

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2. Do Not Resuscitate 3. Negative-pressure ventilation 4. Do Not Attempt Resuscitation 5. Positive-pressure ventilation 6. Gastrointestinal/genitourinary 7. Acute respiratory distress syndrome 8. Percutaneous endoscopic gastrostomy (tube) 9. Total parenteral nutrition 10. Gastrostomy tube 11. Intermittent mandatory ventilation 12. Chronic obstructive pulmonary disease 13. Bronchopulmonary dysplasia 14. Vascular access device 15. Cystic fibrosis 16. Positive end-expiratory pressure 17. Congestive heart failure 18. Continuous positive airway pressure 19. Central nervous system 20. Bilevel positive airway pressure

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Chapter 10 Air Medical Operations

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Student’s Name

HANDOUT 10-1 EVALUATION

CHAPTER 10 QUIZ Write the letter of the best answer in the space provided.

1. The type of aircraft that is used to transport a patient is usually determined by all of the following EXCEPT: a. patient request. c. availability. b. distance. d. medical needs.

2. What is perhaps the MOST significant limitation faced by helicopters? a. Patient weight. c. Darkness. b. Weather. d. Terrain.

3. The “T” in the mnemonic HOTSAW stands for: a. terrain. c. tail rotor. b. trauma. d. thunder.

4. The benefit of using fixed-wing aircraft over rotor-wing aircraft for patient transport is that: a. they can access more rural locations. b. they can usually fly faster. c. they have a higher quality of care. d. ground ambulance times will be reduced.

5. Generally, can a civilian helicopter respond to a scene location where the weather on-scene requires IFR flight? a. Yes, but only if the aircraft and pilot are both capable of IFR flight. b. No, because civilian helicopters are restricted to VFR flight only. c. Yes, as long as Air Traffic Control approves the flight. d. No, because helicopters usually cannot fly under IFR conditions to random points on the ground.

6. A benefit of air medical transport is: a. the ability to move morbidly obese patients quickly. b. an increased out-of-hospital time. c. a higher quality of care. d. the relatively low cost to the patient.

7. It was during that helicopters FIRST became a common way to evacuate infantry casualties. a. the Vietnam war c. the Gulf war b. World War II d. the Korean war 8. Emergency personnel should approach a helicopter only from the . ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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a. uphill side c. side b. rear d. front 9. IFR-capable helicopters can usually operate in all conditions EXCEPT: a. icing. c. heavy cloud cover. b. rain. d. wind.

10. If an ambulance is used to move a patient to a waiting helicopter, the vehicle should never get closer than from the aircraft. a. 250 feet c. 100 yards b. 1/4 mile d. 25 feet

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Student’s Name

HANDOUT 10-2 EVALUATION

CHAPTER 10 SCENARIO Review the following real-life situation. Then answer the questions that follow.

It is 1645 hours on an overcast, wet Monday, and you and your partner are posted in the parking lot of an old, defunct gas station adjacent to the interstate, which is beginning to slow considerably signaling the onset of rush hour. Just as you glance at your watch and begin to calculate the hours until the end of your shift, the truck’s mobile data terminal begins blinking. You acknowledge the alert and are directed to a motorcycle vs. automobile collision 10 miles west of the city on a long strech of freeway.

You arrive on scene to find the driver and passengers in the car uninjured and shaken up, but the motorcyclist is lying in a heap on the pavement, unresponsive when you call out to him.

Your partner appropriately blocks the affected lanes with the assistance of an arriving highway patrol officer as you carefully step over and around the broken pieces of motorcycle, which are scattered across the pavement. You squat down next to the man. Blood runs freely from several open fractures on his legs, and he has deep, snoring respirations, which you can clearly hear over the crunching tires of the cars being rerouted around the scene.

1. Would this be a good situation to consider an air medical response? Why or why not?

2. Ideally, at what point in the progression of this scene operation would an air medical response have been requested if it was warranted? Explain your reasoning.

3. What two things might affect your ability to get an air medical response to this patient?

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Student’s Name

HANDOUT 10-3 REINFORCEMENT

CHAPTER 10 REVIEW Write the word or words that best complete each sentence in the space(s) provided.

1. The use of aircraft for emergency patient transport has become a(n) of modern EMS practice.

2. In 1970, the State Police established the FIRST nonmilitary helicopter medical evacuation program.

3.

-wing aircraft provide comfort, , and significant especially when compared with ground ambulances.

4. The initial use of medical helicopters in EMS was for 5. All aircraft must give

, .

a wide berth.

6. The decision to summon a medical helicopter should be made early in .

7. The limitation of

as air ambulances is that they must from established .

and

8. LZ is of critical importance from the time of initial approach until the aircraft departs. personnel and all vehicles and equipment must be kept clear of the LZ during this period.

9. The to operation of air ambulances (helicopter and fixedwing) is exclusively that of the .

10.

aircraft can access hard-to-reach locations and provide transport that is often than that available in ground ambulances.

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HANDOUT 10-4

Student’s Name

REINFORCEMENT AIR MEDICAL OPERATIONS TRUE OR FALSE Indicate whether the following statements are true or false by writing T or F in the space provided.

1.Helicopters fly faster than airplanes.

2.The authority to regulate air ambulance programs lies solely with the FAA. 3.It is important to have a fully charged fire hose at the LZ and to keep it trained on the aircraft until touch-down.

4.A helicopter should be requested to a scene location only after the patient has been extricated and fully evaluated.

5.The term “brownout” refers to blowing dust caused by the spinning blades of a helicopter.

6.If it is necessary to provide guidance to the approaching aircraft, use clock-based directional terms. Always consider the point of reference for the pilot (the nose of the aircraft) to be the six o’clock position.

7.Because of the inherent danger and cost of using medical aircraft, they should rarely be utilized.

8.You should never approach a medical aircraft, whether rotor- or fixedwing, unless the flight crew clearly directs you to.

9.Many helicopters use special vision imaging systems during night operations and require ground personnel to extinguish all light sources within 100 feet of the LZ. 10. The American College of Emergency Physicians (ACEP) recognizes that helicopter air medical care is a crucial component in a tiered response.

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HANDOUT 10-5

Student’s Name

REINFORCEMENT AIR MEDICAL OPERATIONS ABBREVIATIONS Fill in the words for each abbreviation used in the chapter.

1. NVG 2. FLIR 3. MASH 4. RFDS 5. FAA 6. MAST 7. HEMS 8. VFR 9. IFR 10. ATC 11. CAMTS

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Chapter 10 Answer Key Handout 10-1: Chapter 2 Quiz 1. a

4. b

7. d

2. b

5. d

8. d

3. a

6. c

9. a

10. d

Handout 10-2: Chapter 2 Scenario 1. This would be a good example of when air medical could benefit the patient.

Since the traffic in and around the city is heavy because of the time of day, the scene location is distant from the city center (and most likely the trauma center location), and the patient would be considered critical, a helicopter would most likely be the best option for transport.

2. Because of the time of day (rush hour) and the relatively long distance to the scene location, an air medical response would have ideally been requested simultaneously with the ground ambulance dispatch. By the time the ground crew reached the scene, the helicopter crew would be well on their way to responding, possibly even already in the air. If it was determined that no air transport was warranted, they could easily be canceled, and if it was warranted, there would be no delay in their arrival (as there would be had the request been delayed until ground units got on scene first).

3. Aircraft availability is always the first variable in these situations; the crew may already be on another transport or not in service. Second is the weather. It is possible that with its being “overcast and wet,” the pilot may decline to accept the transport request because of the weather conditions. It is important to never assume that an air ambulance will be available—or able—to respond to the scene.

Handout 10-3: Chapter 10 Review 1. critical component 2. Maryland 3. Fixed, speed, range 4. trauma care 5. thunderstorms ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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6. scene operations 7. airplanes, land, take off, airports 8. security, Nonessential 9. authority, regulate, FAA 10. Rotor-wing, quicker Handout 10-4: Ambulance Operations True or False 1. F

4.

F

7. F

2. T 3. F

5.

6.

T F

8. T 9. F

10. T

Handout 10-5: Ambulance Operations Abbreviations 1. night vision goggles 2. forward looking infrared 3. Mobile Army Surgical Hospital 4. Royal Flying Doctor Service 5. Federal Aviation Administration 6. Military Assistance to Safety and Traffic 7. Helicopter Emergency Medical Services 8. visual flight rules 9. instrument flight rules 10. Air Traffic Control 11. Commission on Accreditation of Medical Transport Services

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Chapter 11 Multiple Casualty Incidents and Incident Management

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Student’s Name

HANDOUT 11-1 EVALUATION

CHAPTER 11 QUIZ Write the letter of the best answer in the space provided.

1. Patients who are deceased are triaged as: a. red. c. yellow. b. white. d. black.

2. The individual who runs the management of a mass/multiple-casualty incident (MCI) and has ultimate authority for decision making is called the: a. incident senior official. c. incident coordinator. b. incident commander. d. incident manager.

3. Ideally, it should take patient. a. less than 20 seconds b. less than 30 seconds

to triage each c. roughly 30 to 45 seconds d. roughly 45 to 60 seconds

4. Incident priorities during scene size-up include all of the following EXCEPT: a. life safety. c. incident containment. b. incident stabilization. d. property conservation.

5. Medical materials that should be carried by the triage officer include all of the following EXCEPT: a. a bag-valve-mask (BVM) device. c. oral airways. b. infection control supplies. d. trauma dressings.

6. In all cases of a(n) , it is better to request more resources than are needed rather than to request an insufficient amount. a. multiple-casualty incident c. open incident b. closed incident d. unified incident 7. Use of triage tags provides quick recognition of: a. who did the triage. b. priority of patient treatment. c. the patient’s name. d. the facility to which the patient should be sent.

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8. Incident commanders should radio a brief progress report roughly every minutes until the incident has been stabilized. a. 5 c. 15 b. 10 d. 20 9. The JumpSTART triage tool is developed specifically for the triage of: a. adult MCI patients. c. pregnant MCI patients. b. geriatric MCI patients. d. pediatric MCI patients.

10.The use of by the incident commander and other senior officers makes identification easier for incoming personnel. a. special reflective vests c. special reflective jackets b. special reflective hats d. special reflective tags on CP positions 11. In triage, the BEST way to assess perfusion is: a. capillary refill. c. radial pulse. b. carotid pulse. d. assessment of mental status.

12. At an MCI, the monitors all actions to ensure that NO potentially harmful conditions are created. a. scene officer c. size-up officer b. hazards officer d. safety officer 13. Under the START triage system, the FIRST distinction among patients is based on their: a. ability to tell you their name. b. ability to walk. c. ability to follow a simple command. d. ability to breathe spontaneously at a rate of 30 breaths per minute or less.

14. The functions of the EMS branch of operations include all of the following EXCEPT: a. triage. c. staging. b. treatment. d. transport.

15. In triage, the highest priority is given to patients tagged with the color: a. black. c. green. b. yellow. d. red.

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Student’s Name

HANDOUT 11-2 REINFORCEMENT

CHAPTER 11 SCENARIO Review the following real-life situation. Then answer the questions that follow.

You and your partner are called out at 9:07 P.M. for a motor vehicle collision involving two cars, injuries unknown. The night is foggy, and you have to drive fairly slowly. Fortunately, the scene is only minutes away from your station, and the two cars are clearly visible in the right lane and shoulder of the highway. You park in front of the cars and set your lights to bright flashers so that the scene will be as visible as possible to oncoming traffic. No other responders are on the scene yet, and there are no bystanders.

A quick survey of the two cars reveals that one rear-ended the other, sending the first car into the sign for an exit ramp. The driver of the second car is sitting, apparently stunned, in his seat. You note that he looks up as you approach, that there is no visible blood, and that he is wearing his seat belt. The car, which is an older model, does not have an airbag. The driver’s side door appears to be intact.

The first car is significantly more damaged, with rear-end damage from the collision and a broken windshield from the impact with the exit sign. The driver is sitting in her seat, contained between an ai rbag and the seat back. She is not moving and does not respond to your presence. She is clearly breathing. A young woman in the front passenger seat is also contained by an air bag. She is yelling, “Help!” and trying to wipe blood and loose hair from her face. A toddler in the backseat is half in, half out of a car seat that has swung across the rear seat, and you can see bruising and abrasions on the side of her face that hit the side window. She is crying. The driver’s side door appears to be intact, but the front passenger door has caved inward somewhat, and the highway sign has been bent over the front bumper; it hangs over the windshield and the forward part of the passenger door. The rear doors appear to be intact. As you check the rear doors of the car, you realize that there is a faint smell of gasoline.

1. Does this appear to be a mass/multiple-casualty incident (MCI)? If so, what type?

2. What roles should the EMS responders assume, and what should they do next?

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3. Should the EMS responders call in more resources as they size up the scene? If so, what resources?

4. A police cruiser pulls up while the incident commander is on the radio. What, if any, briefing and instructions should the commander give the officers?

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HANDOUT 11-3

Student’s Name

REINFORCEMENT CHAPTER 11 REVIEW Write the word or words that best complete each sentence in the space(s) provided.

1. The area at an MCI is the location established to support on-scene rescuers, and the is the ambulance crew dedicated to standing by to treat any ill or injured rescuer.

2. The routing of patients to getting them to an ambulance.

is as important as

3. Any triage tags you use should meet these two criteria: easy to and provide rapid visual identification of .

4. The four components of START are the signs/symptoms of , , / 5.

, and .

takes place after patients have been moved to a treatment area and is done to determine any changes in status.

6. The operations section at an MCI may have many , each of which represents one functional level based on role or geographic location.

7. At an MCI, the coordinates all operations that involve outside agencies.

8. Command is transferred only but complete briefing on incident status.

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, with a short

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9.

forms the cornerstone of the Incident Management System (IMS).

10. Never forget the importance of assigning early in the incident.

11. In , one individual is responsible for coordinating response to an incident, whereas managers from different jurisdictions such as law enforcement, fire, and EMS coordinate activity in the process of .

12. The major elements of IMS can be remembered with the mnemonic C-FLOP: C for , F for / , L for , O for , and P for .

13. A key element in the management of any incident that spans jurisdictions is the , which is a site from which civil government officials (e.g., municipal, county, state, and/or federal) exercise direction and control in an emergency or disaster.

14. The standardized, national structure that is used to handle large-scale emergencies is called the ( ), and it covers coordination of response elements such as triage, treatment, transport, and staging.

15. Whenever or more units respond to an emergency, it is a sound idea to implement IMS.

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HANDOUT 11-4

Student’s Name

REINFORCEMENT MEDICAL INCIDENT MANAGEMENT ABBREVIATIONS Write the words represented by the following abbreviations in the spaces provided.

1. CP 2. IO 3. CISM 4. START 5. NIMS 6. MCI 7. MVC 8. IMS 9. ICS 10. IC

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Chapter 11 Answer Key Handout 11-1: Chapter 11 Quiz 1. d

5. a

9. d

13. b

2. b

6. c

10. a

14. c

3. b

7. b

11. c

15. d

4. c

8. b

12. d

Handout 11-2: Chapter 11 Scenario 1. This is a mass/multiple-casualty incident with four known victims. It is an uncontained (or open) incident because there is traffic on the highway, visibility is very poor, and thus there is real potential for additional collisions near or with the involved vehicles. IMS (Incident Management System) should be implemented because of the number of victims and the potential for more injuries from additional collisions or gasoline-related fire or explosion.

2. One provider should act as incident commander and size up the scene with three priorities: A. Life safety. Is there a visible gasoline spill, and what is the fire or explosion risk? What needs to be done to secure rescuer safety? Are there additional victims (perhaps from the second car) who are not in a car but are nearby and in need of help?

B. Incident stabilization. The ambulance has already been parked in position to alert oncoming motorists to the accident. However, the second vehicle is still in the right travel lane.

C. Property conservation. This is not a primary issue during scene size-up on the highway.

The other provider conducts triage of the four victims.

3. The incident commander needs to call dispatch and initiate IMS. At least one additional ambulance unit will be needed, depending on the findings of the triage officer and the presence of any additional victims outside of the cars.

Police will need to be on scene to handle traffic and any bystanders who arrive and to document any legal aspects of the collision. The fire ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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department will need to be called because of the possible gasoline leak, and there are also questions about possible need for extrication of at least one passenger (the young woman in the front passenger seat) from the first car.

4. The incident commander holds singular command unless the situation changes. He should direct the police to help stabilize the incident (by putting out flares and taking any other measures necessary to block off and protect the accident scene, making their own assessment of gasoline risk, and making a second check for other possible victims) and to make their initial report to their base command.

Handout 11-3: Chapter 11 Review 1. rehabilitation, rapid intervention team 2. hospitals 3. use, priorities 4. ability to walk, respiratory effort, pulses/perfusion, neurologic status 5. Secondary triage 6. branches 7. liaison officer 8. face-to-face 9. Communications 10. command 11. Singular command, unified command 12. Command, Finance/Administration, Logistics, Operations, Planning 13. Mutual Aid Coordination Centers 14. Incident Management System (IMS) 15. two

Handout 11-4: Medical Incident Management Abbreviations 1. command post ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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2. information officer 3. Critical Incident Stress Management 4. Simple Triage and Rapid Transport 5. National Incident Management System 6. mass/multiple-casualty incident 7. motor vehicle collision 8. Incident Management System 9. Incident Command System 10. incident commander

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Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 12 Rescue Awareness and Operations

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Student’s Name

HANDOUT 12-1 EVALUATION

CHAPTER 12 QUIZ Write the letter of the best answer in the space provided.

1.

One of the MOST serious threats in a confined-space rescue is: a. physical instability. b. the presence of toxic or caustic substances. c. oxygen deficiency. d. the presence of sharp or otherwise hazardous objects.

2.

General factors in a person’s survivability profile for a water accident include all of the following EXCEPT: a. age. c. water temperature. b. lung volume. d. use of alcohol and/or other drugs.

3.

Recirculating currents, strainers, foot/extremity pins, and dams/hydroelectric intakes are examples of what type of scenario? a. Freshwater c. Water obstacle b. Swift-water d. Hazardous water

4.

Factors contributing to the death of a hypothermic patient include all of the following EXCEPT: a. inability to grasp a line or flotation device. b. inability to follow simple directions. c. bronchospasm, which increases risk of drowning. d. laryngospasm, which increases risk of drowning.

5.

HELP (Heat Escape Lessening Position) is an in-water position that is designed to reduce heat loss by as much as: a. 40%. c. 75%. b. 60%. d. 90%.

6.

While en route to the hospital, you should perform ongoing assessments at these intervals if the patient is stable/unstable: a. 3 minutes/5 minutes. c. 5 minutes/15 minutes. b. 5 minutes/10 minutes. d. 5–7 minutes/17–20 minutes.

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7. It is paramount that the rescuer know how to prevent further patient injury by adapting techniques of: a. disentanglement. c. packaging. b. removal. d. transport.

8. Methods that are used to disentangle the patient must constantly be analyzed: a. to look for the shortest method of release. b. on a risk-to-benefit basis. c. to look for the technique that allows greatest paramedic access. d. to look for the methods that are safest for rescuers and the patient.

9. The use of force to free a patient from entrapment is called: a. extrication. c. release. b. disentrapment. d. removal.

10. Because of the possibility of extended time in the field, for rescue patients, you must be prepared to provide: a. ongoing assessment. c. treatment protocols. b. stabilization techniques. d. psychological support.

11. The goals of rescue assessment include all of the following EXCEPT: a. identification and care for existing patient problems. b. anticipation of changes in patient condition. c. anticipation of changes in physical environment. d. advance determination of needed assistance and equipment.

12. Hazards that may NOT be visible during scene size-up include all of the following EXCEPT the presence of: a. infected material. b. poisonous substances. c. potential sources of violence or emotional trauma. d. a potentially unstable environment.

13. The presence of electrical wires at the rescue scene indicates a possible threat of: a. fire. c. shock. b. explosion. d. both A and C. 14. Vital rescuer protective equipment includes all of the following EXCEPT: a. protective shielding. c. hearing protection. b. respiratory protection. d. a helmet. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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15. The use of is paramount in any rescue situation. a. appropriately skilled personnel b. safety equipment c. appropriate time-saving measures d. portable medical equipment and supplies

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HANDOUT 12-2 EVALUATION

CHAPTER 12 SCENARIO Review the following real-life situation. Then answer the questions that follow.

It is 10:40 P.M., and you and your partner are about to finish your shift on this pleasantly cool summer night. Then dispatch calls and sends you to a nearby residential neighborhood for “a woman who fell in a swimming pool.”

You and your partner grab your personal flotation jackets as you leave the ambulance. When you arrive at the pool area, you find a middle-aged man standing by lawn chairs. When you look in the water, you see a woman on the far side of the pool crying and struggling to hold onto a ladder. She repeatedly tries to climb up the ladder but appears unable to coordinate her movements enough to get out of the pool.

Your partner jogs to the far side of the pool toward the woman while you turn toward the man. You notice that he is dressed in light summer clothing, not swimwear, and there is a distinct odor of alcohol. He quickly tells you that the woman is his wife and she fell in the swimming pool while they were walking to the house from the garage. “Got home from a party,” he says. “She just lost her balance. Stupid, really.”

He sits in a pool chair while you join your partner. A quick scan of the scene shows no flotation devices or other floatable object for you to throw or hand to the woman. The area around the pool is dry and level. There is nothing visible in the pool except the woman, who you notice is struggling to hold the ladder with one hand and pull up a skirt with the other. Your partner, who has knelt beside her, tells you that the woman’s name is Frances and she is unable to say what happened except that she feels sick and can’t pull herself up and out of the pool.

She has blood dripping from the left temple and what appears to be the beginning of a black eye on the same side. You don’t see any other obvious injuries, but the lighting is poor. She is spitting out some water but appears to be breathing relatively easily.

1. Is this a rescue situation? Do you see any potential hazards during your scene size-up?

2. Do you need any additional resources? If so, what?

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3. What should be done to care for the patient while you wait for additional help (if you decide to wait)?

4. What steps will you need to take to remove the woman safely from the pool when the proper time comes?

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HANDOUT 12-3 REINFORCEMENT

CHAPTER 12 REVIEW Write the word or words that best complete each sentence in the space(s) provided.

1.

For rescuer safety, suspect involving commercial vehicles.

2. whereas 3.

4.

at any scene

glass can produce glass dust or fracture into long shards, glass fractures into many small beads of glass.

Three types of hazardous terrain are terrain, with obstructions.

terrain, and

Be aware of the in mission, crew training, and capabilities of helicopters that do air medical care and those of helicopters that do rescue.

5. Good

skills are mandatory in hazardous terrains, but limit skills to those that are really needed. Do not complicate any already complicated operation.

6.

The three phases of in-water patient immobilization are in-water , application, and , and extrication from the water.

7.

It takes only one spark to trigger an explosion: Always be careful of all potential sources of .

8.

If a collapsed trench or cave-in has caused a burial, a(n) is likely.

9.

is the largest single hazard associated with EMS highway operations.

10. Do NOT hazards.

a vehicle until you have ruled out all electrical

11. The checklist for backcountry work includes protective equipment for , provisions for personal , snacks, temporary , lighter, and redundant . ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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12. Most rescue calls have at least seven defined phases: size-up, control, access, , , patient , and and transport.

13.

and

triggers the technical beginning of the rescue.

14. During the fourth rescue phase, medical treatment, the paramedic has three responsibilities: initiation or , maintenance of procedures during disentanglement, and accompaniment of the patient during and .

15. The area in which special rescue teams operate is known as the .

16. Actions to delay hypothermia include use of ( ), use of ( .

17. The water rescue model is called .

), and -

-

18. _____________ plays a role in many water accidents, including nearly 50 percent of fatal boating accidents.

19. Always put on a(n)

whenever you approach water.

20. Water rescue patients are never dead until they are .

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and

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HANDOUT 12-4 REINFORCEMENT

RESCUE AWARENESS TRUE OR FALSE Indicate whether the following statements are true or false by writing T or F in the space provided.

1.

Nearly all incidents in and around water are preventable.

2.

Water causes heat loss 10 times faster than air.

3.

Water entry is a last-resort measure.

4.

It is always unsafe to walk in fast-moving water over midcalf depth because of the danger of entrapping a foot or extremity.

5.

The mammalian diving reflex is more pronounced in adults than in children.

6.

Failure to train paramedics in rescue awareness will eventually end in the injury or death of EMS personnel, patients, or both.

7.

In general, all paramedics should have the training and personal protective equipment to allow them to access and assess the patient and establish incident command.

8.

Confined space is defined as any space with limited access/egress that is not designed for human occupation.

9.

Over half of all fatalities associated with confined spaces are rescuers, not the original victim(s).

10. Personal flotation devices need to be worn only if you operate in water.

11. Personnel screening for rescue unit training should include physical and psychological testing.

12. Practice exercises with clear protocols and simulated patients will give you and your unit ample opportunity to train and to utilize IMS in rescue situations.

13. If you are the first unit on-scene, be careful not to underestimate your ability to handle a rescue situation: Remember not to stretch resources farther than necessary.

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14. During the access phase, key medical, technical, and other personnel should confer with the incident commander on the safest strategy to accomplish the rescue.

15. Disentanglement may be the most technical and time-consuming portion of the rescue.

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HANDOUT 12-5 REINFORCEMENT

RESCUER PROTECTIVE EQUIPMENT • Helmets: The best helmets have a four-point, nonelastic suspension system.

Avoid helmets with nonremovable “duck bills” in back because they can compromise your ability to wear the helmet in tight spaces. A compact firefighting helmet that meets NFPA standards is adequate for most vehicle and structural applications.

• Eye protection: Two essential pieces of eye gear include goggles (vented to prevent fogging) and industrial safety glasses. These should be ANSI approved. Do not rely on the face shields found in fire helmets. They usually provide inadequate eye protection.

• Hearing protection: High-quality earmuff styles provide the best hearing protection. However, you must take into account other factors such as practicality, convenience, availability, and environmental considerations. In high-noise areas, for example, you might use the multibaffled rubber earplugs used by the military or the spongelike disposable earplugs.

• Respiratory protection: Surgical masks or commercial dust masks prove adequate for most occasions. These should be routinely carried on all EMS units.

• Gloves: Leather gloves usually protect against cuts and punctures. They allow for free movement of the fingers and ample dexterity. As a rule, heavy, gauntlet-style gloves are too awkward for most rescue work.

• Foot protection: As a rule, the best general boots for EMS work are high-top, steel-toed and/or shank boots with a coarse lug sole to provide traction and prevent slipping. For rescue operations, lace-up boots offer greater stability and better ankle support by limiting the range of motion. They also do not come off as easily as pull-on boots in walking through deep mud.

• Flame/flash protection: Whenever there is the potential for fire, turnout gear, coveralls, and jumpsuits all offer some arm and leg protection and help to prevent damage to your uniform. They have the added advantage of quick and easy application. For protection against the sharp, jagged metal or glass found at many motor vehicle collisions or structural collapses, turnout gear generally works best.

• Personal flotation devices (PFDs): If your service includes areas where water emergencies can result, your unit should carry PFDs that meet the U.S. Coast Guard standards for flotation. They should be worn whenever you are operating in or around water. You should also attach a knife, strobe light, and ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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whistle to the PFD so that they are easily accessible.

• Lighting: Depending on the type and location of the rescue, you might also consider portable lighting. Many rescuers carry at least a flashlight or, better yet, a headlamp that can be attached to a helmet for hands-free operation.

• Hazmat suits or SCBA (self-contained breathing apparatus): These items should be made available only to the personnel who have been trained to use them.

• Extended, remote, or wilderness protection: If your unit provides service to a remote or wilderness area, you would be advised to have a backcountry survival pack as part of your gear. This backpack should be loaded with PPE for inclement weather, provisions for personal drinking water (iodine tablets/water filter), snacks for a few hours, temporary shelter, butane lighter, and some redundancy in lighting in case of light source failure.

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Chapter 12 Answer Key Handout 12-1: Chapter 12 Quiz 1. c

5. b

9. a

13. d

2. d

6. c

10. d

14. a

3. b

7. c

11. c

15. b

4. c

8. b

12. d

Handout 4-2: Chapter 4 Scenario 1. This is a rescue situation because the woman is unable to get herself out of the pool and she has traumatic injury, although you cannot yet determine the specifics. The presence of an early black eye and bleeding from the left temple suggests the possibility of a head injury.

You should examine the rest of the pool perimeter for potential safety hazards and for evidence of where she fell into the pool (such as the presence of blood at the edge of the pool if she hit her head while falling into the pool).

There is already evidence of potential hazard at the scene: The man is under the influence of alcohol and shows no concern about his wife. Not only has he not been helpful, he is a potential risk to you and your partner.

The situation also has some indications of possible domestic violence, further complicating matters for you and your partner and suggesting that the woman may have injuries unrelated to her exposure in the pool.

2. You should call for immediate police backup and consider a second EMS unit to help you evaluate the woman’s condition in the pool and assist in her rescue.

3. While you wait for the scene to be secured, your partner should continue to talk with the patient to get any historical information about the incident or admission of complicating factors (such as the possibility that she did not fall into the pool on her own) and as part of an ongoing assessment of mental status. You also need to monitor for any signs of hypothermia or other change in condition that would override a delay in removal until the scene is clearly secured and sufficient help is on hand.

4. When the scene has been secured for your safety, you will need to perform in-water spinal immobilization, apply a rigid cervical collar, and apply a backboard before removing the patient from the water. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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Handout 12-3: Chapter 12 Review 1. hazardous materials 2. Safety, tempered 3. low-angle, high-angle, flat terrain 4. differences 5. BLS, ALS 6. spinal immobilization, rigid cervical collar, back boarding 7. electricity 8. secondary collapse 9. Traffic flow 10. touch 11. inclement weather, drinking water, shelter, butane, lighting 12. arrival, hazard, patient, medical treatment, disentanglement, packaging, removal 13. Access 14. patient assessment, patient care, removal, transport 15. active rescue zone 16. personal flotation devices (PFDs), Heat Escape Lessening Position (HELP), huddling together 17. reach-throw-row-go 18. Alcohol 19. PFD 20. warm, dead

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Handout 12-4: Rescue Awareness True or False 1. T

6. T

11. T

2. F

7. F

12. F

3. T

8. T

13. F

4. F

9. T

14. F

5. F

10. F

15. T

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Chapter 13 Hazardous Materials

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Student’s Name

HANDOUT 13-1 EVALUATION

CHAPTER 13 QUIZ Write the letter of the best answer in the space provided.

1. The MOST hazardous type of radiation is called: a. alpha radiation. c. delta radiation. b. beta radiation. d. gamma radiation.

2. The toxicological term used to express the level of exposure safe for someone with full-time occupational exposure is abbreviated as: a. Ld. c. TLV/TWA. b. TLV/CL. d. IDLH. 3. Secondary contamination is quite likely with: a. liquids and particulates. b. gases and liquids. c. gases, liquids, and particulates. d. liquids only.

4. In hazmat incidents, the LEAST common route of exposure is: a. respiratory inhalation. c. gastrointestinal ingestion. b. topical absorption. d. parenteral injection.

5. Decontamination for pesticide exposure features: a. topical administration of water and green soap. b. oral administration of water. c. inhalation administration with high-flow oxygen. d. IV administration of sodium nitrite.

6. Among the general methods of decontamination, the one almost never used by EMS personnel is: a. dilution. c. isolation/disposal. b. absorption. d. neutralization.

7. At a fixed facility, suggested emergency first-aid treatment may be found: a. at a central safety office. c. on the container label. b. on the NFPA placard. d. on a material safety data sheet.

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8. Colorimetric tubes are used to: a. measure approximate pH of a liquid. b. measure approximate concentration of a given gas in the air. c. search air for specific chemicals. d. measure approximate concentration of oxygen in air.

9. Early in scene size-up of a hazmat incident, make sure to: a. evacuate all people from the scene of the incident. b. evacuate uncontaminated people from the region around the incident. c. rescue uncontaminated people from the scene of the incident. d. triage contaminated people at the scene of the incident.

10. The lowest temperature at which a liquid will give off enough vapors to ignite is called the: a. lower ignition limit. c. ignition temperature. b. flash point. d. vapor density temperature.

11. Roles of EMS providers who are the first responders to a hazmat incident include all of the following EXCEPT: a. assessment of toxicologic risk. b. activation of IMS. c. initial containment procedures. d. establishment of incident command.

12. The three levels of training that an EMS provider may acquire include all of the following EXCEPT: a. awareness level. c. operations level. b. supervisory level. d. technician level.

13. The transportation warning placard for a flammable gas will have: a. red or green color and a flame symbol. b. red or green color and a ball-on-fire symbol. c. orange color and a flame symbol. d. yellow color and a ball-on-fire symbol.

14. At fixed facilities, the diamond segments of the hazmat placard give information on all of the following EXCEPT: a. health hazards. c. fire hazards. b. explosion hazards. d. reactivity.

15. CHEMTREC is an example of a: a. telephone hotline. b. computerized database. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

c. printed reference book. d. poison control center.

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HANDOUT 13-2 EVALUATION

Chapter 13 Scenario Review the following real-life situation. Then answer the questions that follow.

You and your partner are called to an area near the railroad tracks that is frequented by homeless adults. The dispatcher tells you that a small fire has been reported and there may be casualties.

When you arrive, you and your partner walk through a dumping area to reach a sheltered area near a bridge. Firefighters have already doused the fire, which burned down a makeshift tent made of cardboard and plastic sheeting.

Two adult males are sitting on a pile of tires near the fire scene: Each has visibly labored breathing, and they are leaning forward and straining to breathe. One man looks as if he is barely conscious. A firefighter runs up to tell you that the two men stayed in the shelter after it started to burn because it was so cold outside. He moved them to their current position. He is concerned about smoke inhalation injury and possible hypothermia.

1. During initial scene size-up, what, if any, clues are present that might indicate a hazmat incident?

2. What needs to be done to confirm scene and personal safety?

3. Assume that there is no evidence of hazardous substances other than those to which the men were exposed while they were in the burning shelter. What decontamination and treatment steps do you take?

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HANDOUT 13-3 REINFORCEMENT

CHAPTER 13 REVIEW Write the word or words that best complete each statement in the space(s) provided.

1. Hazardous materials may be present in any setting: residential, business, or highway. If you suspect hazmat, use to inspect the scene from a distance.

2. When hazardous materials are transported in , the use of a placard may NOT be required.

3. With the NFPA system, the scale of 0 to 4 represents on one end of the scale and on the other end.

4. Even a small-scale hazmat incident may turn into a multijurisdictional event, triggering use of the (

).

5. The federal agencies that have published the most important requirements and standards are and .

6. Never compromise during the early phase of a hazmat operation or you risk becoming a patient yourself.

7. Basic IMS structure at a hazmat incident includes a(n) , a(n) , and a(n) .

Be sure you establish backup plans in case wind conditions or other environmental factors change quickly.

8. The two measures in two-step decontamination are removal of and and . ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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9. The four MOST common decontamination solvents are , , , and .

10. Another term for a field-decontaminated patient is a patient.

11. After you have determined that one or more hazardous materials is present at a scene, you need to find or more concurring reference sources regarding identification before taking any specific actions.

12. Two limitations of the North American Emergency Response Guidebook (ERG) are the presence of only information on medical treatment and the fact that more than one may have the same UN number.

13. The three control zones at a hazmat incident are coded as red (hot, exclusionary) zone, ( , ) zone, and ( ) zone.

,

14. Unless you or your crew have appropriate training, support, and equipment, you should remain inside the zone.

15. Specific gravity compares a chemical with , whereas vapor density compares a chemical with .

16. Two sets of terms used to describe the action of a poison are or effects and or effects.

17. Primary respiratory exposure cannot be decontaminated; however, you should and to release any trapped gas.

18. Assess patients with smoke inhalation for these two by-products of combustion: ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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and .

19. The four general methods of decontamination are , , and / 20. The first rule of EMS in hazmat situations is: DO NOT !

21. Fast-break decision making is often employed at incidents with injured patients and unknown or lifethreatening materials.

22. When possible, use advantages.

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decision making because of its many

, .

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HANDOUT 13-4 REINFORCEMENT

HAZMAT ABBREVIATIONS Write out the term represented by each of the abbreviations used in Chapter 5.

1. IDLH 2. SLUDGE 3. SCBA 4. APR 5. ERG 6. CAMEO 7. CHEMTREC 8. CHEMTEL 9. MSDS 10. LEL 11. UEL 12. TLV/TWA 13. PEL 14. TLV/STEL 15. TLV/CL 16. DOT 17. IMS 18. OSHA 19. EPA 20. ppb 21. NFPA 22. MVC ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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23. WMD 24. UN 25. NA 26. LCt 27. LD 28. ppm

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HANDOUT 13-5 REINFORCEMENT

HAZARDOUS MATERIALS REFERENCE TABLES Complete the following tables and keep them for reference.

Table 1: HAZARD CLASSES AND PLACARD COLORS Hazard Class

Hazard Type

Color Code

1 2 3 4 5 6 7 8 9

Table 2: SYMBOLS FOR DIFFERENT TYPES OF HAZARDS Hazard Flammable Oxidizer Radioactive Poisonous Reacts with water

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Symbol

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Chapter 13 Answer Key Handout 13-1: Chapter 13 Quiz 1. d

5. a

9. b

13. a

2. c

6. d

10. b

14. b

3. a

7. d

11. c

15. a

4. c

8. c

12. b

Handout 13-2: Chapter 13 Scenario 1. Fire always produces by-products, among them carbon monoxide and cyanides. Every patient with smoke inhalation has a possible exposure to one or both compounds. In addition, this fire involved burning plastic (a chemical compound) and may have involved one or more of the dumped items in the area. Thus, there is the potential for other hazardous substances to be present.

2. You should check with the firefighters to see what, if any, steps they took to identify possible hazards and remove them from the fire scene. Either you or your partner should make a quick scene check for possible hazardous substances while the other evaluates the two patients for possible surface contamination and then for medical needs. Both you and your partner should have donned personal protective gear, including rubber boots and other protection (Level C or D gear, depending on local protocol).

3. Both patients show respiratory distress or respiratory failure.

Decontamination for carbon monoxide and cyanides would include immediate removal of clothing and personal items. (Watch for signs of hypothermia.) Field medical treatment for carbon monoxide is oxygenation.

Cyanide exposure is treated with use of a cyanide kit, which contains amyl nitrite, sodium nitrite, and sodium thiosulfate. Medical care still includes support of the ABCs, prevention or treatment of hypothermia, and any other needs suggested by patient assessment.

Handout 13-3: Chapter 13 Review 1. binoculars 2. small quantities 3. no hazard, extreme hazard ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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4. Incident Management System (IMS) 5. OSHA, EPA 6. scene safety 7. command post, staging area, decontamination corridor 8. clothing, personal effects, gross decontamination 9. water, green soap, isopropyl alcohol, vegetable oil 10. semi-decontaminated 11. two 12. general, chemical 13. yellow (warm, contamination reduction), green (cold, safe) 14. green 15. water, air 16. acute, delayed, local, systemic 17. remove all clothing, personal effects 18. carbon monoxide, cyanides 19. dilution, absorption, neutralization, isolation/disposal 20. become a patient 21. critically 22. long-term

Handout 13-4: Hazmat Abbreviations 1. immediately dangerous to life and health 2. salivation, lacrimation, urination, diarrhea, gastrointestinal distress, emesis 3. self-contained breathing apparatus 4. air-purifying respirator 5. Emergency Response Guidebook ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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6. Computer-Aided Management of Emergency Operations 7. Chemical Transportation Emergency Center 8. Chemical Telephone, Inc. 9. material safety data sheets 10. lower explosive limit 11. upper explosive limit 12. threshold limit value/time weighted average 13. permissible exposure limit 14. threshold limit value/short-term exposure limit 15. threshold limit value/ceiling limit 16. Department of Transportation 17. Incident Management System 18. Occupational Safety and Health Administration 19. Environmental Protection Agency 20. parts per billion 21. National Fire Protection Association 22. motor vehicle collision 23. weapons of mass destruction 24. United Nations 25. North America(n) 26. lethal concentration 27. lethal dose 28. parts per million

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Handout 13-5: Hazardous Materials Reference Tables Table 1: Hazard Classes and Placard Colors Hazard Class

Hazard Type

Color Code

1

Explosives

Orange

2

Gases

Red or green

3

Liquids

Red

4

Solids

Red and white

5

Oxidizers and organic peroxides

Yellow

6

Poisonous and etiological agents

White

7

Radioactive materials

Yellow and white

8

Corrosives

Black and white

9

Miscellaneous

Black and white

Table 2: Symbols for Different Types of Hazards Hazard

Symbol

Flammable

Flame

Oxidizer

Ball-on-fire

Radioactive

Propeller

Poisonous

Skull-and-crossbones

Reacts with water

W with a line through it

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Chapter 14 Crime Scene Awareness

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Student’s Name

HANDOUT 14-1 EVALUATION

CHAPTER 14 QUIZ Write the letter of the best answer in the space provided.

1.

Evidence that you may be asked to provide includes all of the following EXCEPT: a. clothing or other personal items that you removed from the patient. b. your scene size-up regarding possible safety threats. c. your on-scene observations of setting and persons present. d. precautions that you took to preserve blood evidence.

2.

The BEST material in which to collect potential evidence is: a. a plastic bag. c. any airtight container. b. a brown paper bag. d. a glass container.

3.

Differences in care offered by a TEMS unit and a standard EMS unit include all of the following EXCEPT: a. the major priority of patient extraction from the hot zone. b. the fact that trauma patients are more frequently encountered than medical patients. c. the use of metal clipboards and chemical agents. d. consultation with incident commander regarding treatment and transport.

4.

With the use of contact and cover, the contact provider is responsible for all of the following EXCEPT: a. initiating direct patient care. b. providing limited function such as handling equipment. c. performing patient assessment. d. handling most interpersonal contacts at the scene.

5.

Which tactic can be integrated into any withdrawal from a scene? a. Distraction and evasion c. Contact and cover b. Retreat d. Cover and concealment

6.

Common safety tactics include all of the following EXCEPT: a. contact and cover. c. distraction and evasion. b. retreat. d. persuasion and retreat.

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7.

The difference between cover and concealment relates to the degree to which you: a. can rapidly exit if needed. b. are protected from bullets. c. can be seen by others. d. can be identified by law enforcement.

8.

Signs of impending danger in the setting of a crowd include all of the following EXCEPT: a. hostilities toward anyone on the scene. b. increasingly loud voices. c. inability of police to control bystanders. d. rapid decrease in crowd size.

9.

Arrest rates for violent crime have risen MOST in which age group? a. 10 to 20 years c. 15 to 34 years b. 15 to 25 years d. 35 to 50 years

10.

Safety information about a location for an upcoming call commonly comes from all of the following EXCEPT: a. information from CAD on the location. b. information from law enforcement officers on the location. c. your familiarity with the neighborhood. d. your experience (or lack of it) at that address.

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HANDOUT 14-2 Student’s Name EVALUATION CHAPTER 14 SCENARIO Review the following real-life situation. Then answer the questions that follow.

Dispatch calls at 10:43 P.M. on a hot summer night with a call for “person down in the street” in an area of the city that you know well during daylight hours: a neighborhood with two hospitals, medical offices, and other businesses. The dispatcher has no additional information on the call because the caller hung up before she could ask any questions.

As your partner drives down a main street in the neighborhood, you notice how few people are walking by. There is not much vehicular traffic either. When your partner turns in to the street given in the call, you do not see any cars or pedestrians, and almost all of the buildings are completely dark.

Partway down the block, a young man runs into the street and starts waving his arms. You decide to get out and approach the man by walking up the opposite sidewalk. Your partner agrees to park on that side of the street near the corner. He will radio for police backup and come out to cover you from the street if you signal him. If you think that the scene is insecure, you are to retreat toward him, and he will drive forward to pick you up.

The young man looks frightened and is waving his arms frantically. He calls, “Hurry up, man! He’s bleeding! You have got to help him!” He points to a figure slumped on the sidewalk in the shadow of an office building.

You turn toward your partner and use your agreed-upon signal that he should call for police backup, move the ambulance somewhat closer, and then get out to cover you. The young man says, “Thanks, man,” touches your shoulder gently, and moves toward the figure, who you see is another young man in similar clothes. The second man looks up, sees you, and says, “Please help me. He stuck me with a knife. I am bleeding.”

1. List the information given in the case study that would raise your suspicion of the possibility of danger at the scene or the possibility that the call involves violent crime.

2. The paramedic crew chose to use contact and cover as a safety tactic. Do you agree or disagree with their choice? Explain. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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3. Is there any additional information that might have been available to the paramedics that might have influenced their choice of tactic?

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Student’s Name

HANDOUT 14-3 REINFORCEMENT

CHAPTER 14 REVIEW Write the word or words that best complete each sentence in the space(s) provided.

1.

Potentially dangerous scenes include , , to name a few.

, , and

2.

should be well thought out in advance of the response to a hate crime.

3.

Remember that EMS and law enforcement officials are on the same side.

Be sure to have good with law enforcement.

4.

Types of evidence include , and .

5.

Record only the them accurately.

6.

If you must or crime scene, remember to tell the police.

7.

Your most important safety tactic is an ability to identify

, at the scene of a crime, and record an item at a

as soon as possible.

8.

A(n) ( ) unit is designed and staffed to handle on-site medical support to law enforcement.

9.

Never follow a(n) scene of a call: Use lights and siren

10.

to the .

Two factors that might lead bystanders to confuse EMS providers with police officers are use of and on a vehicle and similarity in or .

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HANDOUT 14-4

Student’s Name

REINFORCEMENT CRIME SCENE AWARENESS TRUE OR FALSE Indicate whether each statement is true or false by writing T or F in the space provided.

1. Because a significant number of people do not report violent crime to the police, an EMS provider may be the only contact a victim has with a professional who can intervene to prevent further harm.

2. Most current body armor will prevent many types of penetration and severe cavitation.

3. On arrival at a scene, you should rule out all immediate hazards before you knock on a door for entrance.

4. If you have to move a gun, do not handle it on the grips or handles because that will destroy potentially valuable fingerprints.

5. Remember that there are only a few cases in which you can legally and ethically retreat without taking the patient with you.

6. Remember that everything that you and your EMS colleagues see or hear can become evidence in a criminal case.

7. If you have to limit assessment and proceed with rapid transport of a patient because of on-scene danger, be sure to document your reasons for acting quickly.

8. Never jeopardize patient care for the sake of evidence, but do treat every object that may be important as potential evidence in your handling and documentation.

9. Retreat signals the end of the call: Thorough documentation will reduce liability and refute charges of abandonment.

10. The effectiveness of body armor is largely unaffected by wetness or temperature, although it can get uncomfortably warm when worn in hot conditions.

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HANDOUT 14-5

Student’s Name

REINFORCEMENT CRIME SCENE AWARENESS REFERENCE SHEET Some potential warning signs of danger in a vehicle include: • Violent or abusive behavior • An altered mental state • Grabbing or hiding items from inside the vehicle • Arguing or fighting among passengers • Lack of activity where activity is expected • Physical signs of alcohol or drug abuse, such as liquor bottles, beer cans, or syringes • Open or unlatched trunks, which are a potential hiding spot for people or weapons • Differences among stories told by occupants To make a safe approach to a vehicle at a roadside emergency, follow these steps: • Park the ambulance in a position that provides safety from traffic.

• Notify dispatch of the situation, location, the vehicle make and model, and the state and number of the license plate.

• Use a one-person approach. The driver should remain in the ambulance, which is elevated and provides greater visibility.

• The driver should remain prepared to radio for immediate help and to back or drive away rapidly once the other medic returns.

• At night, use the ambulance lights to illuminate the vehicle. However, do NOT walk between the ambulance and the other vehicle. You will be backlit, forming an easy target.

• Since police approach vehicles from the driver’s side, you should approach from the passenger’s side—an unexpected route.

• Use the A, B, and C door posts for cover.

• Observe the rear seat. Do NOT move forward of the C post unless you are sure there are NO threats in the rear seat or foot wells.

• Retreat to the ambulance (or another strategic position of cover) at the FIRST sign of danger. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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• Make sure you have mapped out your intended retreat and escape route with the ambulance driver.

In responding to the scene of any violent crime, keep these precautions in mind: • Dangerous weapons may have been used in the crime.

• Perpetrators may still be on scene or could return to the scene.

• Patients may sometimes exhibit violence toward EMS, particularly if they risk criminal penalties as a result of the original incident.

Whenever a crowd is present, look for these warning signs of impending danger: • Shouts or increasingly loud voices • Pushing or shoving • Hostilities toward anyone on scene, including the perpetrator of a crime, the victim, the police, and so on • Rapid increase in crowd size • Inability of law enforcement officials to control bystanders Commonly observed gang characteristics include the following: • Appearance—Gang members frequently wear unique clothing that is specific to the group. Because the clothing is often a particular color, even a bandana can signify gang membership. Within the gang itself, members sometimes wear different articles to signify rank.

• Graffiti—Gangs have definite territories, or “turfs.” Members often mark their turf with graffiti broadcasting the gang’s logo, warning away intruders, bragging about crimes, insulting rival gangs, or taunting police.

• Tattoos—Many gang members wear tattoos or other body markings to identify their gang affiliations. Some gangs even require these tattoos. The tattoos will be in the gang’s colors and often contain the gang’s motto or logo.

• Hand signals/language—Gangs commonly create their own methods of communication. They give gang-related meanings to everyday words or create codes. Hand signals provide quick identification among gang members, warn of approaching law enforcement, or show disrespect to other gangs.

Gang members often perform signals so quickly that an uninformed outsider may NOT spot them, much less understand them.

There are a number of signs that can alert you to the involvement of drugs at an EMS call. These include the following: • Prior history of drugs in the neighborhood of the call • Clinical evidence that the patient has used drugs of some kind ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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• Drug-related comments by bystanders • Drug paraphernalia visible at the scene such as: • tiny zip-top bags or vials • sandwich bags with the corners torn off (indicating drug packaging) or untied corners of sandwich bags (indicating drug use) • syringes or needles • glass tubes, pipes, or homemade devices for smoking drugs • chemical odors or residues If you ever come upon a clandestine laboratory, take these actions: • Leave the area immediately.

• Do NOT touch anything.

• Never stop any chemical reactions already in progress.

• Do NOT smoke or bring any source of flame near the lab.

• Notify the police.

• Initiate IMS and hazmat procedures.

• Consider evacuation of the area.

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Chapter 14 Answer Key Handout 14-1: Chapter 6 Quiz 1. b 2. b

3. c 4. b

5. a 6. d

7. b 8. d

9.

10.

c b

Handout 14-2: Chapter 14 Scenario 1. Answers include the following: • • • • • • • •

The call to 911 itself is suspicious: It comes long after dark and notes only that a person is down in a nonresidential area. The dispatcher cannot elicit any details because the caller hangs up right away.

In addition, there may be an element of concern at time of dispatch that any possible crime would involve drugs, given that the area has hospitals and doctors’ offices.

While driving to the scene, you note there are few vehicles or pedestrians, which means that you are more isolated.

In addition, the street location itself has no vehicles or pedestrians and is deserted and dark.

At the scene, you see only one person, a young man (in the age group [15 to 34 years] most likely to commit violent crime) who is visibly distraught.

The apparent patient, described only as “bleeding,” is in a poorly lit, isolated spot.

The patient is another young man wearing clothes similar to the distraught man’s, which might signal possible gang involvement.

The patient says that he was stabbed, which makes it a crime scene.

2. There is no one way to handle an incident, and wisdom often comes only with hindsight. In the scenario, the contact provider decided that the scene was sufficiently safe to initiate patient contact with appropriate cover given by his partner (and with the knowledge that police had been notified). He may have noted that the man in the street seemed genuinely frightened and concerned for the patient and showed no hostility or fear toward the paramedic. In fact, the man seemed grateful for help.

A more conservative option would have been to call for police backup and wait for its arrival before exiting the ambulance. The unit would then have been capable of quickest retreat. This option could have been justified on the basis of the following: • •

The isolated nature of the scene The lack of bystanders

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• • •

The darkness of the scene (which could have been concealing individuals intent on harming the paramedics or stealing drugs from the ambulance) The possibility of street crime or gang involvement The presence of a number of doctors’ offices, any of which could have been robbed for drugs or medical equipment

3. Answers might include any of the following: • • •

Information from the dispatcher (or personal knowledge) about whether there had been incidents of attacks/thefts from ambulance crews in the city, particularly in that neighborhood Information from the dispatcher (or personal knowledge) about whether the area had a high incidence of street crime, gang-related violence, or drug-related violence Information from the dispatcher (or personal knowledge) of average time for police backup to arrive in that area at that time of night

Handout 14-3: Chapter 14 Review 1. Any four of the following are acceptable: highway encounters, violent street incidents, murders/assaults/robberies, dangerous crowds, street gangs, drug-related crimes, clandestine drug labs, domestic violence 2. Crew assignments 3. ongoing communication 4. Any three of the following are acceptable: prints (fingerprints, footprints, tire prints, and so on), blood and blood splatter, body fluids, particulate evidence, on-scene EMS observations 5. facts 6. touch, move 7. potentially violent situations 8. tactical EMS (TEMS) 9. police car, cautiously (if at all) 10. lights, siren, uniforms, badges Handout 14-4: Crime Scene Awareness True or False 1. F 2. F

3. F 4. F

5. T 6. T

7. T 8. T

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9.

10.

F F

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Chapter 15 Rural EMS

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Student’s Name

HANDOUT 15-1 EVALUATION

CHAPTER 15 QUIZ Write the letter of the best answer in the space provided.

1.

Challenges faced by volunteer EMS squads correlate with all of the following EXCEPT: a. aggravation of the distance/time factor because volunteers must travel from home or work to the ambulance before leaving for the scene. b. squad makeup is more constant over time than in cities because of low turnover. c. ongoing training is paid by the volunteer, forcing a time and monetary sacrifice to remain up-to-date. d. low call volume may lead to inadequate experience with certain procedures to remain fully competent.

2.

Which of the following statements about rural U.S. settings is NOT true? a. Residents have a disproportionately high incidence of chronic medical conditions. b. There is a disproportionately low number of doctors who practice in the area. c. There is a higher level of mortality associated with trauma and medical emergencies. d. There is roughly the same age distribution of residents as found in urban/suburban areas.

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3.

Reasons to consider putting a helicopter on standby include all of the following EXCEPT: a. the mechanism of injury is a fall of 15 feet. b. the mechanism of injury is ejection from a vehicle. c. a lengthy extrication is required. d. the victim was in an unrestrained motor vehicle collision.

4.

Hospital agencies that provide limited care and nonemergent medical treatment are called:

5.

a. hospital satellites.

c. prompt care facilities.

b. limited care facilities.

d. rural hospital affiliates.

The safety tactic for eliminating accidental restart of farm machinery is called: a. equipment shut down. c. equipment lock-out/tag-out. b. equipment power kill.

6.

d. equipment stabilization.

One contraindication to helicopter transport is: a. high-altitude conditions, such as HAPE or HACE. b. posttrauma cardiac arrest. c. need for a hyperbaric chamber. d. smoke inhalation with altered level of consciousness.

7.

The development of toxic shock in a patient who had circulation to a part of the body cut off for a period of time is called: a. anoxia syndrome. b. compartment syndrome. c. amputation syndrome. d. circulatory syndrome.

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8.

Possible hazards around grain tanks and silos include all of the following EXCEPT: a. presence of gases such as nitrogen oxides and methane. b. possible need for high-angle rescue. c. possible need for confined-space rescue. d. presence of chemicals used to preserve grain.

9.

A tractor rollover may produce severe injury through the mechanism of: a. ejection.

c. exhaust inhalation.

b. crush injury. d. wrap injury.

10.

Common mechanisms of injury involving agricultural equipment include all of the following EXCEPT: a. pinch points. c. crush points. b. shear points. d. torque points.

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Student’s Name

HANDOUT 15-2 EVALUATION

CHAPTER 15 SCENARIO Review the following real-life situation. Then answer the questions that follow.

You work with a paramedic crew that serves as ALS backup for four local, volunteer EMS services. On a summer Sunday afternoon, you get a call simultaneously with one of the local units for a multivehicle collision on an interstate highway. As your partner checks the map, he says that you are probably 30 to 35 minutes from the accident scene. You will almost certainly be the first EMS responders because the local unit will not be able to roll until volunteers assemble, and the unit itself is garaged at least 20 to 25 minutes away from the scene.

As you drive to the accident location, the dispatcher comes back with additional information obtained by cell phone from an eyewitness at the scene: The accident involved a tractor-trailer truck and two cars. The first car, which clipped the truck while trying to change lanes, has gone down a steep embankment but has not rolled. The eyewitness told the dispatcher that two of the occupants seemed to be badly injured. The truck overturned and came to rest in the right travel lane and shoulder. The condition of the driver was not mentioned. The second car was traveling behind the truck and swerved off the road when trying to miss the colliding vehicles. It went down a less steep embankment and hit a tree before coming to rest. The eyewitness said that the passengers in the front seats seemed to be badly injured. He had no specifics on type of injury or whether the occupants of the truck and cars were still in their vehicles. He did add that a fluid was leaking from the truck, but he was unsure whether it was gasoline or something contained in the cargo trailer.

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1. Assume that you will not be able to obtain more information from the scene via cell phone or other means before your unit arrives. Your local protocol encourages implementation of IMS before arrival on scene if you believe it highly likely this IMS is required on the basis of dispatcher information. What is your size-up based on dispatcher information, and what types of additional equipment, if any, do you activate before arrival?

2. What, if any, elements of this scenario are unique to rural EMS care?

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Student’s Name

HANDOUT 15-3 REINFORCEMENT

CHAPTER 15 REVIEW Write the word or words that best complete each sentence in the space(s) provided.

1. The toxic fumes produced by the fermentation of grains in an enclosed space is known as .

2. Every decision that a paramedic makes in a rural setting needs to be made with the thought of / in mind.

3. Rural paramedics must think ahead and ask for orders in anticipation of medical conditions that might develop during a(n)

.

4. In wilderness rescues,

and

play critical roles in your decision making.

5. Access to computers and the Internet enhances educational opportunities and medical care:

and are two examples.

6. Rural paramedics can improve or maintain good communications with their hospitals by spending time there and requesting to sit in on relevant inservice for the hospital staff.

7. A rural paramedic whose territory includes a lake should be well versed in emergencies. ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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8. Indiscriminate use of

can delay

treatment time and, in some cases, cause further patient injury.

9. occur when two objects come together and catch a portion of the patient’s body between them.

10. A basic safety principle to keep in mind when you are dealing with a patient who has been injured by farm machinery is / -

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.

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HANDOUT 15-4

Student’s Name

REINFORCEMENT STEPS FOR REMOVAL FOR A PINCH-POINT INJURY PATIENT 1. Determine whether machinery is operated by other equipment such as a tractor. If so, use the machinery to extricate the patient. Then lock-out/tag-out the appropriate levers or switches.

2. Stabilize both fractures and circulatory injuries during extrication.

3. Provide rapid treatment for shock, especially if the call for help was delayed for a lengthy period.

4. Package and transport the patient to the nearest appropriate medical facility, using the most effective means of transport.

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Chapter 15 Answer Key Handout 15-1: Chapter 15 Quiz 1. b 4. c

7. b 9. b

2. d 5. c

8. d 10. d

3. a 6. b

Handout 15-2: Chapter 15 Scenario 1. Size-up: IMS should be implemented on the basis of its being a multivehicle, multiple-casualty accident. The number of patients is unknown, as are the nature and degree of injuries. The number of EMS units activated before assessment depends on the number of units covering the area and the local protocols for activation. Additional units that should be activated include police and fire units. One or more occupants of the cars may require mechanical extrication from the vehicle. In addition, low-angle rescue, high-angle rescue, or both may be required for one or more occupants. Air transport may be required for transport to a trauma center, and a hazmat team may be required to evaluate and handle the leaking fluid.

2. The elements of distance/time to the scene and to the trauma center are rural concerns, as is the low level of EMS coverage per geographic area.

The volunteer nature of the BLS units compounds the problem of distance/time. In addition, it probably takes longer to assemble the required specialty teams (rescue hazmat), if appropriately trained personnel are available at all, than it would take in an urban setting.

Handout 15-3: Chapter 15 Review 1. silo gas 2. distance/time 3. radio dead spot (or communications blackout, or similar wording) ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

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4. distance, extrication time 5. any two of the following: distance learning, interagency interface/communication, networking, computer simulation software, interactive CD-ROM 6. training programs 7. water 8. helicopter (air transport) 9. Pinch points 10. lock-out/tag-out

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Chapter 16 Responding to Terrorist Acts

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Student’s Name

HANDOUT 16-1 EVALUATION

CHAPTER 16 QUIZ

Write the letter of the best answer in the space provided.

1.

Which of the following is the MOST likely and MOST dependable clue to the release of a chemical agent? a. Strange smell b. Cloud of vapor c. Multiple patients with similar signs and symptoms d. Large numbers of dead insects found crushed on your windshield

2.

Which of the following statements about the time of release of a biological agent is CORRECT? a. The patient’s breath usually has a strange odor. b. You can see a cloud of vapor above storage containers. c. Multiple patients immediately complain of similar symptoms. d. There may be no indication of an agent being released at all.

3.

Who MOST likely will recognize a biological agent release? a. Emergency department personnel b. Hazardous materials team c. EMT-Intermediates d. First responders

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4.

Which of the following is the recommended and MOST effective form of protection against an infectious biological agent? a. Standard Precautions b. Self-contained breathing apparatus c. 10% hypochlorite solution d. Mark I kit

5.

The victim of a chemical or nuclear attack needs which of the following before you begin care? a. Iodine tablets b. Proper decontamination c. Application of a HEPA respirator d. Administration of the Mark I kit contents

6.

A volatile chemical agent does which of the following? a. Gathers in low spots such as a subway b. Converts quickly to a gas from a liquid c. Causes blistering and respiratory injury d. Interrupts the transmission of central nervous system impulses

7.

8.

9.

The chemical agent that produces the SLUDGE signs is a: a. vesicant.

c. nerve agent.

b. biotoxin.

d. pulmonary agent.

One of the MOST deadly toxic agents known is a: a. vesicant.

c. nerve agent.

b. biotoxin.

d. pulmonary agent.

Which of the following agents is MOST likely to produce blistering? a. Vesicant

c. Nerve agent

b. Biotoxin

d. Pulmonary agent

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10.

Which of the following is considered a weapon of mass destruction?

11.

a. Nuclear bomb

c. Biological agent

b. Chemical weapon

d. All of the above

Which of the following injuries is NOT expected from a conventional explosive blast? a. Blunt trauma

c. Severe and extensive burns

b. Penetrating trauma d. Compression/decompression injury 12.

Which of the following is considered an incendiary agent? a. Tularemia b. Napalm

13.

c. Sarin d. Ebola

The danger that separates the conventional from the nuclear detonation is: a. radiation.

c. high incidence of burn injury.

b. strength of the explosion. d. all of the above.

14.

The site of a nuclear detonation is generally radiation free from moments after the blast until hour(s) postignition.

15.

a. 1

c. 12

b. 6

d. 48

In addition to an explosive agent, the “dirty bomb” contains which of the following? a. Chemical agent

c. Biological agent only

b. Radioactive material

d. Both chemical and biological

agents

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Student’s Name

HANDOUT 16-2 EVALUATION

CHAPTER 16 SCENARIO Review the following real-life situation. Then answer the questions that follow.

It is a warm, summer weekend, and your community’s annual street festival is in full swing. Officials report that this is the largest turnout in the festival’s history.

You are dispatched to the main grandstand area, where a large crowd has gathered to hear a highly publicized band performance. Tony and Hilda are on duty and are dispatched to the festival’s first-aid station for a burn patient. Upon arriving at the first-aid station, you are advised that there are additional patients, all presenting with similar signs and symptoms. After calling for additional assistance, you begin to evaluate and triage the patients. Common signs and symptoms include burns to exposed arms and legs, some blistering; rhinorrhea, cough, and dyspnea; and nausea and vomiting.

1. Given your initial assessment of the scene and patients, what is the probable mechanism of injury?

2. How should additional ambulances respond to the scene? How should the other spectators be managed?

3. What treatment should be provided for these patients?

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Student’s Name

HANDOUT 16-3 REINFORCEMENT

CHAPTER 16 REVIEW

Write the word or words that best complete each sentence in the space(s) provided.

1. A(n) is an instrument that is used to detect and measure the radiation given off by an object or area.

2. A(n)

is an instrument that measures

the cumulative amount of radiation absorbed.

3. A conventional explosive device that distributes radioactive material over a large area is called a(n) .

4. The term

refers to the ease with

which a chemical changes from a liquid to a gas.

5. refers to the density or weight of a vapor or gas as compared to air.

6. The term refers to chemicals that restrict the degradation of neurotransmitters such as acetylcholine and quickly facilitate a nervous system overload.

7. Called

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

, the chemical, biological, and nuclear weapons used by terrorists are meant to create a maximum number of casualties.

8. The use of violence to provoke fear and influence behavior for political, social, religious, or ethnic goals is called a(n) act.

9.

agents are chemicals that primarily cause injury to the lungs.

10. A(n)

is a poison that is produced by

living organisms but is itself NOT alive.

11. A(n)

agent is either a living

organism or a toxin produced by a living organism that is deliberately distributed to cause disease and death.

12. A special subset of explosives, agents have less explosive power but greater heat and burn potential.

13. Radioactive dust and particles that threaten the lives of people far from the epicenter of a nuclear detonation are called .

14. The

is a two-part autoinjector set that the military uses as treatment for nerve-agent exposure.

15. A(n)

is an agent that damages

exposed skin, frequently causing vesicles (blisters).

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

Chapter 16 Answer Key Handout 16-1: Chapter 16 Quiz 1. c

5. b 9. a

13. d

2. d 6. b 10. d

14. a

3. a 7. c

15. b

11. c

4. a 8. b 12. b Handout 16-2: Chapter 16 Scenario 1. Exposure to a chemical agent, most likely a vesicant.

2. Approach from an upwind direction. Spectators and others should be evacuated to an area away from the scene and evaluated for exposure to the chemical.

3. Immediate decontamination by irrigating exposed areas with low-pressure water. Apply loose sterile dressings to burns. Consider medication for pain management.

Handout 16-3: Chapter 16 Review 1. Geiger counter 2. dosimeter 3. dirty bomb 4. volatility 5. Specific gravity 6. nerve agent 7. weapons of mass destruction 8. terrorist 9. Pulmonary (or choking) 10. biotoxin ©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.

Test Bank For Paramedic Care Principles & Practice, Vols. 5 5th Edition by Bryan Bledsoe

11. biological 12. incendiary 13. fallout 14. Mark I kit 15. vesicant

©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 5, 5th Ed.