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Basic life support

Essentials 1 A patient with sudden out-of-hospital cardiac arrest (OHCA) requires activation of the Chain of Survival, which includes early high-quality cardiopulmonary resuscitation (CPR) and early defibrillation. The emergency medical dispatcher plays a crucial and central role in this process. 2 Over telephone, the dispatcher should provide instructions for external chest compressions only CPR to any adult caller wishing to aid a victim of OHCA. This…

Tactical Emergency Medical Support and Urban Search and Rescue

Key Concepts Tactical emergency medical support (TEMS) facilitates the overall success and safety of law enforcement missions during all phases of a tactical operation through the delivery of preventive, urgent, and emergency medical care. A fundamental principle in tactical medicine is that the medical mission may be subordinate to the overall law enforcement mission. Tactical combat casualty care (TCCC) has adapted civilian advanced life support principles…

Weapons of Mass Destruction

Foundations Besides managing the injuries and illnesses from common disasters such as earthquakes and airplane crashes, emergency clinicians should also have competence in treating victims generated by terrorist attacks with chemical, nuclear, biologic, or high-energy explosive weapons. Conventional explosives remain the most common weapon used by terrorists; however, the risk from nuclear, biologic, and chemical agents may increase over time. The nomenclature for these weapons is…

Disaster Preparedness

Key Concepts Comprehensive emergency management consists of four phases: mitigation, preparedness, response, and recovery. Mass casualty planning should account for the breakdown of traditional transportation and communications systems during a disaster. Field personnel should be specifically trained in mass casualty triage and stabilization because austere field conditions change management strategies. All plans must protect caregivers and rescue personnel. Critical incident stress management is highly desirable after…

Air Medical Transport

Key Concepts Air medical transport (AMT) is a critical component of a comprehensive health care system and a vital link for rural communities and critical access hospitals to distant emergency care. Boyle’s law and Dalton’s law have the greatest impact and explain the development of hypoxia and most common altitude-related symptoms. Other stresses of flight that can affect the patient or crew include temperature fluctuations, dehydration,…

Emergency Medical Services: Overview and Ground Transport

Key Concepts Published in 1966, Accidental Death and Disability: The Neglected Disease of Modern Society by the National Academy of Sciences–National Research Council was instrumental in emergency medical service (EMS) maturation in the United States. There are multiple models for EMS systems, including public and private services, those operating at basic and advanced levels of care, and those including single or multiple tiers of response capability.…

Forensic Emergency Medicine

Key Concepts Knowledge of wound mechanics, production, and appearance can provide practicing emergency clinicians with important clues regarding the forensic interpretations of injuries. Wounds and injuries should be diagrammed and photographed. The medical record should accurately document objective findings associated with a patient’s wounds. Emergency clinicians should not speculate about their mechanism or cause. For the chain of custody to be preserved, any evidence collected during…

Wellness, Stress, and the Impaired Physician

Key Concepts Physician Wellness: A quality of life that includes the presence of positive physical, mental, social, and spiritual well-being experienced in connection with activities and environments that allow physicians to develop their full potentials across personal and work-life domains. Physician Burnout: A work-related syndrome characterized by emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment. It is frequently associated with chronic stress and emotionally…

Patient Experience in the Emergency Department

Key Concepts Factors that can improve the patient experience in the emergency department include: Communication that expresses empathy Working as a high-functioning team Setting realistic expectations regarding wait time Clear discharge instructions Improvement in the patient experience has been shown to impact composite outcomes such as health-related quality of life to patients, reduced malpractice risk, and improved staff satisfaction. Foundations Patient experience is a growing area…

Quality Improvement and Patient Safety

Key Concepts The work of health care occurs within a complex socio-technical system so that a change in even one component has an impact on other parts of the system and ultimately on safety. Patient safety and mitigation of risk emerges from multifactorial interactions within the clinical work system. Incidents of patient or staff harm are most often the result of system failures, not individual human…

Emergency Medical Treatment and Labor Act and Medicolegal Issues

Key Concepts The Emergency Medical Treatment and Labor Act (EMTALA) governs virtually every aspect of hospital-based emergency services. Centers for Medicare and Medicaid Services (CMS) deems anyone on hospital property to have “come to the emergency department.” Hospital property consists of the entire main hospital campus, including parking lots, sidewalks, and driveways, and any ambulance owned and operated by the hospital, even if the ambulance is…

Bioethics

Key Concepts Bioethics is a method of using values and moral principles to come to defendable decisions for ethical dilemmas . In emergency medicine, many ethical dilemmas often go unrecognized. Ethical dilemmas arise from conflicts between multiple good options or multiple bad options, not between good and bad choices. Values come from a variety of sources: community, culture, religion, and family. The values driving medical decisions…

End of Life

Key Concepts Palliative care is physical, spiritual, psychological, and social support provided to patients and families at any stage of serious illness. Palliative care teams are specialized interdisciplinary teams that should be involved early in the course of illness. Hospice care is a care system for patients and families with a prognosis of 6 months or less if the disease runs its usual course; referral from…

The Geriatric Emergency Department

Key Concepts The rapid increase in the number of older adults in the United States (US) and around the world, as well as the unsustainable costs of the current US health care system, mandates improved emergency care systems for these vulnerable patients. Older adults are at high risk of experiencing harm from busy, crowded emergency departments (ED). While in the ED, they may experience prolonged lengths…

Emergency Ultrasound

Key Concepts Over the past 20 years, emergency ultrasound (EUS) has become an integral part of emergency medical care in the United States and has become standard in the evaluation of emergency medical conditions. EUS answers specific, often binary questions, and is therefore neither sufficient nor intended to diagnose all of the broad range of pathologic processes encountered in emergency medicine. During cardiac arrest, ultrasound can…

Humanitarian Aid in Disaster and Conflict

Key Concepts A key feature of humanitarian crises is the mass displacement of large numbers of people from their homes. Displaced populations are designated either as internally displaced persons (IDPs) or refugees. The international response community has developed practice guidelines that stem from international law, research, and expert consensus. Responders should be familiar with these international standards and laws to ensure that intervention is appropriate and…

Global Emergency Medicine

KEY CONCEPTS World Health Assembly resolution 72.16, “Emergency care systems for universal health coverage: ensuring timely care for the acutely ill and injured,” was passed in 2019 and calls for the strengthening of emergency care delivery through a detailed list of initiatives across the prehospital, facility, public health, and disaster preparedness fields. In low- and middle-income countries (LMICs), substantial excess mortality amenable to emergency health care…

Intimate Partner Violence and Abuse

KEY CONCEPTS Intimate partner violence encompasses a pattern of controlling behaviors, including intentional physical assault, sexual assault, psychological violence, and financial control. Intimate partner violence (IPV) patients are best served by a coordinated system response plan that includes staff training, social work, victim advocates, and a close relationship with area IPV service provider groups and law enforcement. The emergency clinician’s role in caring for patients affected…

Sexual Assault

Acknowledgment We would like to thank Judith A. Linden and Ralph J. Riviello for their significant contribution to the prior edition of this chapter. KEY CONCEPTS Sexual assault is most common in women but can happen to gay and heterosexual men and to lesbian, gay, bisexual, transgender, and gender-nonconforming individuals. Sexual assault often results in no physical signs of injury. Optimal care includes creating a safe…

Community Violence

Key Concepts It is important for prevention efforts, including those in hospitals and emergency departments, to consider unjust social conditions disproportionately experienced by minority communities, and especially by African Americans; these include generational poverty, residential segregation, and other forms of racism that limit opportunities to grow up in healthy and violence-free environments. Interventions should focus on altering the quality of life course for survivors of violence…