Chapter 22

Emergency Medical Services

Introduction• There is more to being a fireman

than putting out fires• Community relies on firemen to be

creative problem solvers• Emergency medical responses

constitute more than 50% of total emergency responses

• With technology today, firefighters can deliver lifesaving techniques to stabilize patients

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Roles and Responsibilities ofan Emergency Care provider

• Firefighters often act as providers of emergency care and first aid

• Many call on firefighters to assist emergency medical technicians and paramedics

• Working knowledge of basic emergency medical care is very important

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Figure 22-2 Firefighters are often called on to assist EMS crews with patient care.

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Figure 22-3 (A) EMS calls begin when firefighters leave the station, (B) continue throughout the time on the scene, and (C) do not end until firefighters have cleaned the equipment and restocked the supplies.

(A)

(B)

(C)

Key Responsibilities• Firefighter responsibilities:

– Ensure their own safety, safety of their team, and patient’s safety

– Act safely from the minute they step on the fire engine

– Act in a professional manner– Never make a situation worse– Practice and update emergency care skills– Know and practice use of EMS equipment– Gather and document important patient

information

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Figure 22-4 Firefighters should always treat patients with respect. They should treat patients as they would want to be treated in the same situation.

Legal Considerations for Emergency Care Providers

• Emergency care providers should understand several important legal issues:– Standard of care– Consent– Implied consent– Abandonment

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Interacting with EmergencyMedical Services Personnel

• Interact with emergency personnel while on scene of an emergency

• Interact with emergency medical personnel who have arrived by helicopter

• Important to understand different levels of care provided by EMS crews

• EMS personnel rely on firefighters on scene to give critical patient information

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Safety Considerations• Safety of caregiver or individual

firefighter performing patient care• Safety of emergency response team• Safety and infection control should

remain a primary consideration• Responders who get sick become

part of the problem

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Analyzing the Safety ofthe Emergency Scene

• Observe each and every scene for unsafe situations

• Check for scene safety prior to entering

• Carefully observe emergency scene and people present before entering

• Ask for additional assistance when safety concerns are present

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Figure 22-9 Team working together in patient care.

Firefighter Physical andMental Health

• Firefighting is a strenuous occupation

• Healthy lifestyle generally includes:– Regular exercise– Proper diet– Getting the right amount of sleep

• Back injury is a common problem• Emergency medical calls can take

their toll on mental health22.13

Infection Control• Safety includes protection from

contracting communicable or infectious diseases:– Prevention of exposure to infectious diseases– Body substance isolation

• Treat all body fluids as if they were infectious

• Protective gloves are an important barrier device only if used properly

• Immunization

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Figure 22-10 The most effective means of reducing the risk of spreading disease is hand washing.

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Figure 22-11 Proper hand washing involves vigorous lathering with soap and water for fifteen seconds (or longer) followed by thorough rinsing.

Patient Assessment• A quick visual assessment should

reveal:– How many patients are there?– Is the patient awake?– Is the patient in a harmful situation or

environment?– What position is the patient in?– What people or objects are in the

emergency scene?– What is the skin color of the patient?– Is the patient having trouble breathing?

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Performing an Initial Assessment

• Initial assessment covers the following:– Level of consciousness– Airway– Breathing– Circulation– Major bleeding

• Done quickly on conscious patient who is alert and talking

• Unconscious patients require closer examination

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Figure 22-17 Locating pulses in (A) the carotid artery in the neck, (B) the radial artery in the wrist, and (C) the brachial artery in an infant’s upper arm.

(A) (B) (C)

Vital Signs and the Focused History and Physical Exam• After initial assessment, firefighter

continues to a focused history and patient exam:– Patient fact-finding– Vital signs– Head-to-toe survey of patient

• Fact-finding with patient or family members, friends, or bystanders if patient is unconscious

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Table 22-3 Average Vital Sign Ranges, by Age

Patient Findings• Be sure to document findings of the

assessment and patient’s vital signs• Everything found must be passed

on to emergency medical providers– Initial assessment– Focused history– Physical exam– Patient’s vital signs– All patient fact-finding

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Figure 22-19 Examples of pupil size.

CardiopulmonaryResuscitation/ AED

• One of the most basic and widely learned emergency response skills

• Coronary heart disease and cardiovascular diseases are the leading killer in United States

• Several organization support CPR training, education, and research

• Automated external defibrillators (AEDs) have become a critical part of emergency care

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Figure 22-22 Firefighters learning CPR.

Bleeding Control andShock Management

• Cardiovascular system is a closed system with a pump and tubing

• Damage to heart or blood vessels may result in a lower volume of blood

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Internal and External Bleeding• Internal bleeding occurs when there is

bleeding within body– Bruising, pale, or cold and clammy skin– Dilated pupils– Obvious bone deformities– Rigid and tender abdomen– Blood in urine or from rectum– Blood from mouth or nose, or in vomitus

• Arterial bleeding is bleeding from arteries• Capillary bleeding is bleeding from

capillaries

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Caring for Patients withInternal Bleeding

• Cannot be brought under control by first-aid actions

• For minor internal bleeding, apply an ice pack or cold pack to affected site

• Major internal bleeding requires rapid medical attention

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• Firefighters should remember to wear gloves

• Three methods are used:– Pressure on site of bleeding, or direct

pressure– Elevate site of bleeding– Use pressure points

Caring for Patients withExternal Bleeding

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Figure 22-26 Using pressure points in the upper arm and the leg to decrease blood flow to a wound.

Types of Wounds RequiringFirst Aid

• There are several type of wounds that firefighters should be able to recognize:– Abrasion– Avulsion– Amputation– Laceration or incision– Puncture

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What is Shock? (Hypoperfusion)

• Condition caused by a problem with or failure of circulatory system

• Results in a decreased supply of oxygen and vital nutrients

• Shock can result from a problem with the heart

• Severe dehydration can cause shock

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Recognizing the Signs and Symptoms of Shock

(Hypoperfusion)• Some signs and symptoms of shock:

– Pale or bluish tint to skin, cool temperature

– Sweating or moist skin– Pupils larger than normal– Rapid, shallow breathing– Rapid weak pulse– Complaints of nausea, thirst– Restlessness or anxiety 22.33

Caring for Patients in Shock• Firefighters should follow this basic

treatment:– Ensure scene safety– Assess patient’s level of consciousness– Ensure airway is open and patient is breathing

adequately– Treat injuries present and control major

bleeding– Keep patient warm and positioned properly– Raise legs of the patient– Provide reassurance

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Emergency Care forCommon Emergencies

• No two emergency medical calls are the same

• Must learn basics of first-aid treatment and adopt them to each emergency

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Trouble Breathing• Very common emergency• Common signs and symptoms:

– Wheezing– Gasping for air– Shallow breathing– Pale or bluish skin color– Anxiety– Unconsciousness

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Guidelines for Trouble Breathing• Ensure scene safety• Don appropriate BSI• Complete initial assessment • Ensure airway is open and patient is

breathing adequately• Treat injuries present and control

major bleeding

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Guidelines for TroubleBreathing (cont’d.)

• Reassure the patient and keep him calm

• Monitor vital signs frequently• Recognize this is a serious

emergency and activate EMS immediately

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Chest Pain• Another common emergency• If related to heart problem:

– Tightness or squeezing feeling in chest– Pain in jaw, abdomen, or arm

• Chest pain can result from:– Respiratory disorders– Traumatic injuries– Stomach problems

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Guidelines for Chest Pain• Ensure scene safety• Don appropriate BSI• Complete initial assessment • Ensure airway is open and patient is

breathing adequately• Treat injuries present and control

major bleeding

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Guidelines for ChestPain (cont’d.)

• Reassure the patient and keep him calm

• Monitor vital signs frequently• Recognize this is a serious

emergency and activate EMS immediately

• Observe the patient for signs and symptoms of shock

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Medical Illnesses• Range from stomach problems like

nausea and vomiting to general illnesses

• Care and guidelines:– Assess scene, don BSI, perform initial

assessment and attend to major problems

– Reassure patient– Recognize that this could be a serious

emergency– Look for symptoms of shock

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Guidelines for Medical Illness

• Ensure scene safety• Don appropriate BSI• Complete initial assessment • Ensure airway is open and patient

is breathing adequately

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• Treat injuries present and control major bleeding

• Reassure the patient and keep him calm

• Monitor vital signs frequently• Observe the patient for signs and

symptoms of shock

Guidelines for MedicalIllness (cont’d.)

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Allergic Reactions• Result from body’s reaction to a

substance• Some allergic reactions can be

severe• Can result from a variety of

substances– Food– Environment– Bites and stings– Medications

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Guidelines for Allergic Reactions

• Ensure scene safety • Don appropriate BSI • Complete initial assessment • Ensure airway is open and patient is

breathing adequately

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Guidelines for AllergicReactions (cont’d.)

• Reassure the patient and keep the patient calm

• Remove the cause of the reaction from the patient

• Monitor vital signs frequently• Observe the patient for signs and

symptoms of shock

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Thermal Burns• Caused by heat• Simple as sunburn or life

threatening as severe burns across much of the body

• Divided into three categories:– Superficial burns– Partial thickness burns– Full thickness burn

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Figure 22-28 (A) Superficial burns, (B) partial thickness burns, and (C) full thickness burns.

(A) (B) (C)

Guidelines for Thermal Burns• Ensure scene safety • Don appropriate BSI • Complete initial assessment • Ensure airway is open and patient is

breathing adequately • Remove the patient from the

environment to stop the burning process

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Guidelines for ThermalBurns (cont’d.)

• Reassure the patient and keep the patient calm

• Remove the cause of the reaction from the patient

• Monitor vital signs frequently• Observe the patient for signs and

symptoms of shock

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Chemical Burns• Caused by chemical substances

that come in contact with skin or tissues of body

• Creates caustic reaction• Variety of chemical substances can

cause a chemical burn

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Guidelines for Chemical Burns• Ensure scene safety • Don appropriate BSI • Complete initial assessment • Ensure airway is open and patient is

breathing adequately

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Guidelines for ChemicalBurns (cont’d.)

• Remove the chemical by brushing off if it is a powder or flush the substance with large volumes of water.

• Remove the patient’s jewelry and clothing

• Monitor vital signs frequently• If substance has gotten into the patients

eyes, flush thoroughly for at least 20 minutes 22.54

Poisoning• Ingestion or inhalation of a caustic

substance• Result from ingestion of a large

quantity of a normally harmless substance:– Over-the-counter medications– Household substances

• Local poison control centers are very valuable

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Guidelines for Poisoning• Ensure scene safety • Don appropriate BSI • Complete initial assessment • Ensure airway is open and patient is

breathing adequately

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Guidelines for Poisoning (cont’d.)• Reassure the patient, keep the patient

calm, and monitor vital signs frequently

• Do investigative work to find out exactly what substance was inhaled or ingested

• Do not give the patient any liquid or food to ingest

• Contact local poison control center

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Fractures and Sprains• Fracture is a medical term for a

broken bone• Sprain is an injury to the ligaments• Firefighter may notice swelling and

tenderness to area of a fracture or sprain

• In the case of fracture, there may be deformity to bone and body structure

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Guidelines for Fractures and Sprains

• Ensure scene safety • Don appropriate BSI • Complete initial assessment • Ensure airway is open and patient is

breathing adequately • Reassure the patient, keep the

patient calm, and monitor vital signs frequently

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Guidelines for Fracturesand Sprains (cont’d.)

• Do not move the patient and protect the cervical spine in cases of suspected trauma

• Do not move the injured body part and carefully protect the area

• Apply cold packs as needed to reduce swelling

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Figure 22-30 Firefighter stabilizing a leg injury until the EMS unit arrives.

Lessons Learned• Emergency medical care is a major

part of most firefighters’ responsibilities

• Fire service has played an increasing role in providing first response medial care

• Most important tool is the firefighter’s brain

• Firefighter should use their senses

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