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Devices for Assessing Oxygenation and Ventilation

Spirometry For patients with acute exacerbations of asthma and chronic obstructive pulmonary disease (COPD), accurately estimating the severity of airflow obstruction is a critical component of their care. A focused history plus physical examination is the cornerstone of this assessment in the practice of emergency medicine. Wide variation exists in the ability to accurately diagnose airway obstruction, and a significant proportion of patients with marked airflow…

Vital Signs Measurement

Measuring the temperature, pulse, respiratory rate (RR), blood pressure, and pulse oximetry is generally recommended for all emergency department (ED) patients, in addition to assessment of pain in the appropriate patient population. For very minor problems or for some fast-track patients (e.g., suture removal), a full set of vital signs may not be required, and this is best decided on a case-by-case basis rather than by…

Transport of Patients with Highly Hazardous Communicable Diseases

Questions and Answers 1 Your crew arrives on scene to a call dispatched as a “sick person.” They find a 35-year-old male who recently returned from Saudi Arabia and is complaining of feeling unwell and has a cough. What measures can be taken by the crew to protect themselves and minimize exposure to others? Emergency responders should adopt an identify, isolate, and inform strategy to ensure…

Telemedicine and Emerging Telecommunications

Questions and Answers Case: You arrive on scene to a 55-year-old male with chest pain. While on scene, you take vitals, obtain a history, and perform a 12-lead electrocardiogram (EKG). The patient asks you how his EKG looks and after telling him that it looks ok, he does not want to go to the hospital. How might telemedicine influence your ability to treat and transport this…

Procedures in the Trauma Patient

Questions and Answers 1 What is one of the most important things to remember before performing any prehospital procedures? The most important thing to remember in any patient encounter is your safety and health. The patients that you encounter in the prehospital environment could possibly have any number of communicable diseases. This means that for every patient encounter, proper BSI (body substance isolation) is required. At…

EMS Point-of-Care Testing

Questions and Answers 1 What is “point-of-care” testing? Point-of-care testing (POCT) is medical diagnostic testing done in a setting remote from a centralized laboratory facility. These tests are generally simple and can be performed at the bedside. This is in contrast to centralized laboratory facilities that perform a variety of testing in one location that does not perform patient care. 2 Which POCT has been performed…

Perimortem Caesarian Section

Questions and Answers 1 What is a perimortem caesarian section (PMCS)? PMCS is the delivery of a baby by means of a surgical incision into the uterus, in the event the mother is in cardiac arrest. The steps to perform a perimortem C-section are essentially the same as those done in a normal caesarian section. The main difference between PMCS and a normal caesarean section is…

Hemorrhage Control

Questions and Answers Case: You are dispatched to a call for “hemorrhage”; you arrive to find a woman who is pale and diaphoretic and looks to be in distress with a large pulsatile bleed from a left arm fistula site. 1 How is massive or life-threatening hemorrhage defined? There is not a universally accepted definition of massive hemorrhage. It is bleeding that is rapid, large volume,…

Field Amputation

Questions and Answers 1 Who can perform a field amputation? Field amputation is a rare procedure; therefore, preplanning is necessary. EMS providers in some areas may be faced with the prospect of having to perform a field amputation. It would be desirable to be in contact with medical control to discuss the procedure before proceeding. Having multiple trained providers will also facilitate a smooth procedure. Additional…

CPR, AED, and Mechanical Compression

Questions and Answers CPR and Manual Compressions 1 What is meant by cardiopulmonary resuscitation (CPR)? CPR is a lifesaving intervention performed when an individual’s heart stops beating in order to maintain blood flow and promote oxygen delivery to one’s vital organs. To most, “CPR” refers to basic life support (BLS), consisting of chest compressions and rescue breathing. To other healthcare providers, it can also encompass advanced…

Care of the Agitated/Suicidal Patient

Questions and Answers Case: A 911 call comes in for a suicidal patient. The basic life support (BLS) unit is dispatched. They arrive at a residence where police are already on the scene. You learn that the mother called for assistance when she arrived home from work 30 minutes ago to find her 18-year-old daughter locked in the bathroom after discovering a suicide note on the…

Analgesia

Questions and Answers Case: You are dispatched to a local athletic field for a player down on the field with a leg injury. A 21-year-old male was playing soccer when he was tackled from behind, causing him to have ankle pain. You arrive on scene to find him with a deformed right ankle and screaming in pain. He is otherwise uninjured and is neurovascularly intact in…

Airway Management, Oxygenation, and Ventilation

Questions and Answers 1 What is the point of airway management in the prehospital setting? The point is the same regardless of setting: to ensure adequate oxygenation and ventilation while protecting the patient from aspiration. Oxygenation is the process of oxygen diffusing to cells down a concentration gradient, while ventilation is the process of gas movement down a pressure gradient. It is possible to have oxygenation…

Poisonings and Toxic Exposures

Questions and Answers Case: EMS responds to a home where an 18-month-old child may have ingested some of his grandmother’s medications. The child is found awake and alert. The child was under the care of the grandparents who were babysitting. While briefly unattended, he got into his grandmother’s purse. The contents of the purse are scattered. Pills from a medication organizer are spilled. It is unclear…

End-of-Life Issues

Questions and Answers Healthcare Decision Makers at the End of Life Case: EMS receives a call for an 85-year-old female who had an unwitnessed fall at a skilled nursing facility. The patient has a past medical history of lung cancer with metastasis, chronic obstructive pulmonary disease (COPD), and dementia. The nurse assigned to the patient called 911 after she heard a loud noise from this patient’s…

Intimate Partner Violence, Sexual Assault, and Child Maltreatment

Questions and Answers Intimate Partner Violence Case: EMS is called to a 29-year-old female who “fell down the stairs.” Upon arrival, EMS notices that the patient’s partner answers questions for her and jokes about how clumsy his partner is. The astute EMT notes the home has only three steps leading into the living room, and the patient has extensive injuries that include a deformity to her…

Community Paramedicine

Questions and Answers 1 What is community paramedicine? The healthcare landscape is changing rapidly. Hospitals, health systems, and insurers are increasingly focusing on efforts to expand access to care for a wider population. There is an accelerating shift toward the concept of value-based healthcare , where providers and facilities are paid based on patient outcomes, rather than the traditional fee-for-service healthcare delivery model. As these movements…

Aeromedical Transport

Questions and Answers 1 What is aeromedical transport? Aeromedical transport was born out of the need to move wounded service members during World War I. Injured soldiers could be transported to more definitive care in a shorter time, increasing survivability. Throughout the 20th and 21st centuries, the US Military advanced the field of aeromedical transport and battlefield evacuation to include point of injury care with rotor-wing…