Course
RFD Cardiac-Trauma-Operations-Medical (RFD ATOM) Part 3
Name
EMS-4202Y4
Available Classes
Not currently offered.
Description Course Outline Requirements Intended Audience More Details
Intended Audience
EMTs seeking recredential
Description
This course is designed to meet the minimum requirements of the EMS National Continued Competency Program (NCCP). The course covers stroke; hemorrhage and penetrating trauma; field triage, including disasters and mass-casualty incidents (MCIs); and immunological emergencies, including allergic reactions and anaphylaxis. Upon completion, students should be able to demonstrate the knowledge and skills necessary to function in these situations.
Course Objectives
  1. Identify the options for out-of-hospital stroke assessment tools
  2. Explain oxygen administration during a stroke emergency
  3. Discuss the importance of knowing a timeline of stroke events
  4. Discuss the importance of needing rapid transport to the most appropriate stroke hospital
  5. Identify and treat severe hemorrhage
  6. Differentiate among indications, effects and contraindications for the use of:
    o Tourniquets
    o Junctional Tourniquets
    o Hemostatic agents
  7. Relate MUCCs impact on the development of the CDC Field Triage Decision Scheme and SALT
  8. Analyze the triage methods for
    o SALT
    o START
    o JumpSTART
  9. Identify the triage criteria in the CDC’s Field Triage Decision Scheme
Outline of Instruction
  1. RFD Con-Ed Session 3 May-June
    Course Code: RFD-ATOM Part 3
    Course Outline
    STROKE (1hr CEU)
    INSTRUCTOR PREPARATIONS
    • National EMS Education Standards
    • Review current AHA Guidelines
    • American Heart/Stroke Association—FAST

    LESSON OBJECTIVES
    • Identify the types of strokes and their causes
    • Identify common presentations of stroke patients
    • Identify the options for out-of-hospital stroke assessment tools
    o Wake County EMS Procedure ASP-8 Stroke Screen and VAN Scoring
    • Explain oxygen administration during a stroke emergency
    • Discuss the importance of knowing a timeline of stroke events
    • Identify crucial actions that can reduce on-scene time
    • Identify patients needing rapid transport to the most appropriate stroke hospital

    LESSON CONTENT

    I. Stroke
    a. Definition
    b. Ischemic vs Hemorrhagic
    c. Assessment Findings and Symptoms
    d. Definitive care for the stroke patient is delivered at a hospital that specializes in the management for stroke patients.
    e. Optimal out-of-hospital care for the stroke patient is recognition and rapid transport.
    f. Evaluate blood glucose levels
    1. Treat only if hypoglycemic in accordance with local protocol
    2. Hyperglycemia is associated with a poor clinical outcome
    3. Hypoglycemia may mimic stroke
    g. Pediatric strokes, while rare, do happen
    II. Out-of-hospital stroke assessment tool
    a. Specific tool used will be determined by local protocol
    1. Examples include
    1. Cincinnati Prehospital Stroke Scale, 1999
    2. Los Angeles Prehospital Stroke Screen-LAPSS, 2000
    3. Miami Emergency Neurologic Deficit Checklist, 2001
    b. Signs and Symptoms assessed by these tools
    1. Symmetry of the face
    2. Weakness of extremities
    3. Speech difficulties
    4. Coordination
    c. Communicate assessment findings to the hospital while en route
    1. Allows for early activation of the stroke team
    d. WCEMS Procedure ASP – 8 Stroke Screen
    1. Modified LA Prehospital
    2. VAN Scoring
    III. Management of stroke patients
    a. Provide supportive care
    b. Maintain an SpO₂ of 94% to 99% to avoid oxygen toxicity
    1. Consider 2 L/min O2 via nasal cannula instead of O2 via high flow mask
    1. High flow oxygen decreases cerebral blood flow
    2. High levels of oxygen produce free-radicals
    a. May cause cerebral edema and vasodilation
    c. Rapid transport to an appropriate receiving facility
    IV. Importance of accurately determining the time that the patient was last seen normal
    a. Some strokes are treated with fibrinolytics (tPA) which has a limited therapeutic window
    b. Some strokes are treated with endovascular interventions
    1. Angioplasty and stenting
    2. Mechanical clot disruption
    3. Clot extraction



    Hemorrhage Control/Penetrating Trauma (1hr CEU)


    INSTRUCTOR PREPARATIONS
    • National EMS Education Standards
    • Pre-hospital Haemostatic Dressings: A Systematic Review

    LESSON OBJECTIVES
    • Discuss various aspects of penetrating trauma
    • Discuss developing problems associated with penetrating trauma
    • Identify and treat severe hemorrhage.
    • Differentiate among indications, effects, and contraindications for the use of:
    • Tourniquets
    • Junctional Tourniquets
    • Hemostatic agents

    LESSON CONTENT

    I. Penetrating trauma overview
    a. Low, medium and high speed penetrating trauma
    b. Cavitation
    II. Identifying developing problems in penetrating trauma patients
    a. Bleeding/Shock
    b. Decreasing Mental Status
    1. Changes in behavior
    c. Respiratory
    1. SOB, asymmetry, decrease in mental status, JVD, subcutaneous emphysema
    d. Narrowing pulse pressure
    III. Identify severe hemorrhage
    a. External bleeding that cannot be controlled by direct pressure
    IV. Tourniquets
    a. Indications
    1. External bleeding from an extremity that cannot be controlled by direct pressure
    2. Multiple tourniquets may be required
    b. Effects
    1. Correctly applied tourniquets should block arterial blood flow
    1. Confirmed by the absence of a distal pulse
    c. Contraindications of tourniquet use
    1. None in an emergency situation
    V. Junctional Tourniquets
    a. Indications
    1. Treat wounds that are located in the “junctional” areas of the body – where the extremities meet the torso
    b. Committee on Tactical Combat Casualty Care (CoTCCC) approved a number of devices for these types of wounds
    1. Some of these devices have been fielded by the US military for use in combat
    2. Their use in the civilian setting has not, as of yet, been defined.
    c. Examples include:
    1. SAM Junctional Tourniquet
    2. Combat Ready Clamp
    3. Junctional Emergency Treatment Tool
    d. Additional references/resources
    1. SAM Medical-Junctional Tourniquet (YouTube)
    2. Combat Ready Clamp (YouTube)
    3. JETT-Junctional Emergency Treatment Tool (YouTube)
    VI. Hemostatic agents
    a. Reference: Pre-hospital Haemostatic Dressings: A Systematic Review
    b. Types
    1. Powder that is poured onto the wound
    2. Gauze that is impregnated with hemostatic material
    c. Indications
    1. Bleeding that cannot be stopped with direct pressure and is located on an area of the body where a tourniquet is not practical.
    d. Effects
    1. Enhances clotting when packed appropriately into a wound
    2. Once applied, direct pressure must be held for a minimum of three minutes
    3. Hemostatic impregnated gauze can be combined with the technique of wound packing for greater effectiveness
    1. Consult local protocol
    a. RFD does not use

    EMT HEMORRHAGE CONTROL SKILLS (WAKE COUNTY REQUIRED SKILL)
    1. Apply a tourniquet
    2. Apply 2nd and 3rd tourniquets as needed



    Field Triage – Disasters/MCIs (0.5hr CEU)

    INSTRUCTOR PREPARATIONS
    • National EMS Education Standards
    • National Implementation of the Model Uniform Core Criteria for Mass Casualty Incident Triage 2013 (MUCC)

    LESSON OBJECTIVES
    • Relate MUCCs impact on the development of the CDC Field Triage Decision Scheme and SALT
    • Analyze the triage methods for
    o SALT
    o START
    o JumpSTART
    • Identify WCEMS triage method
    • Discuss RFD’s Active Threat Protocol

    LESSON CONTENT
    I. MUCC (Model Uniform Core Criteria)
    a. Reference:
    i. National Implementation of the Model Uniform Core Criteria for Mass Casualty Incident Triage 2013 (MUCC)
    b. A science and consensus-based national guideline that recommends 24 core criteria for all mass casualty triage systems
    c. Used as the basis for CDC Field Triage Decision scheme and SALT (Sort, Assess, Lifesaving Interventions, Treatment/Transport)
    II. SALT Triage
    a. Reference: Sort, Assess, Lifesaving interventions, Treatment/transport
    b. Steps to consider during triage
    i. Sort: Global sorting
    1. Obvious life threat
    2. Purposeful movement
    3. Walk
    ii. Individual assessment
    1. Perform lifesaving interventions as indicated
    2. Perform ongoing reassessments
    iii. Treatment and/or transport
    III. START (adult triage)
    a. Reference: Simple Triage and Rapid Treatment
    b. Steps to consider during triage
    i. Assess respirations
    ii. Assess perfusion
    iii. Assess mental status
    c. Immediate or delayed transport depends on the assessment findings
    IV. JumpSTART (pediatric triage)
    a. Reference: Pediatric MCI Triage Tool
    b. First, triage patients who do not walk independently (based on age)
    c. Steps to consider during triage
    i. Assess respirations
    ii. Assess perfusion
    iii. Assess mental status
    d. Determine immediate or delayed transport based on assessment findings



    Trauma Triage (0.5hr CEU)


    INSTRUCTOR PREPARATIONS
    • National EMS Education Standards
    • CDC—Guidelines for Field Triage of Injured Patients, 2011

    LESSON OBJECTIVES
    • Identify the triage criteria in the CDC’s Field Triage Decision Scheme
    • State the four steps of the CDC’s Field Triage Decision Scheme
    • Examine local protocols
    • Discuss WCEMS Protocol TDP-TRM/BRN

    LESSON CONTENT
    I. CDC Field Triage Decision Scheme
    a. Reference:
    i. CDC—Guidelines for Field Triage of Injured Patients, 2011
    b. Four specific steps to consider during triage
    i. Step 1—Assess vital signs and level of consciousness; they are good predictors of patient’s potential outcomes
    1. Glasgow Coma Scale (GCS)
    2. Systolic blood pressure
    3. Respiratory rate
    ii. Step 2—Assess anatomy of injury
    1. Consider priority transport to a trauma facility if patient is found with:
    a. Penetrating injuries above the knee
    b. Unstable chest wall
    c. Proximal long bone fractures (two or more)
    d. Extremity that is crushed, degloved, mangled, or pulseless
    e. Amputation proximal to wrist or ankle
    f. Pelvic fractures
    g. Skull fractures (open or depressed)
    h. paralysis
    iii. Step 3—Assess mechanism of injury and evidence of high energy impact
    1. Consider priority transport to a trauma facility if the mechanism of injury (MOI) meets any of the following criteria, despite patient assessment findings in steps 1 and 2
    a. Falls
    i. Adults >20 feet
    ii. Children >10 feet or >2x child’s height
    b. Auto crash
    i. Intrusion >12 inches where occupied or >18 inches on any side
    ii. Partial or complete ejection from automobile
    iii. Death in same automobile
    iv. Vehicle telemetry data that indicates a high risk of injuries
    c. Pedestrian/bicyclist vs. automobile
    i. Thrown
    ii. Run over
    iii. Impact at speeds >20 mph
    d. Motorcycle crash >20 mph
    iv. Step 4—Assess special patient or system considerations
    1. Consider priority transport to a trauma facility if patient meets these special considerations:
    a. Older adults
    i. 55 years and older have increased chances of injury/death
    ii. 65 years and older my present with shock if SBP is <110
    iii. Mechanism is low impact (ground height falls)
    b. ChildrenConsider transporting all children to pediatric trauma centers
    c. Anticoagulants and bleeding disorders
    i. Head injuries may present with rapid deterioration
    d. Burns
    i. No other trauma—triage to burn facility
    ii. Other trauma findings—triage to trauma center
    e. Pregnancy >20 weeks
    f. Use provider judgement
    II. Transport according to local protocol
    a. When in doubt transport to a trauma center
    b. WCEMS Protocol TDP-TRM/BRN EMS Trauma and Destination Plan



    Immunological Emergencies – Allergic Reaction & Anaphylaxis (1hr CEU)


    INSTRUCTOR PREPARATIONS
    • National EMS Education Standards
    • National Institute of Health: Visual Representation of …Criteria for Anaphylaxis

    LESSON OBJECTIVES
    • Discuss the physiology related to allergies and anaphylaxis
    • Differentiate between a mild/localized allergic reaction and anaphylaxis
    • Explain the actions of medications used to treat anaphylaxis
    o Epinephrine

    LESSON CONTENT
    I. Allergic reaction
    a. Hyperactive, localized immune response to an allergen
    b. Some histamine is released
    c. Localized: redness, swelling, hives, itching
    d. May cause nausea, vomiting, and/or diarrhea
    e. Usually requires minimal supportive therapies
    f. Repeat exposures may lead to anaphylaxis (e.g., insect stings, foods, etc.)
    II. Anaphylaxis
    a. Multiple body systems are affected, not just a localized reaction like allergies
    b. Life threatening reaction of the immune system to an allergen
    c. Large quantities of histamine are released throughout the body
    d. Vasodilation and increased capillary permeability
    e. May lead to shock
    f. Bronchoconstriction and mucous production
    g. May lead to respiratory distress
    i. Soft tissue swelling of the upper airway
    ii. Airway obstructions
    III. Treatment for Anaphylaxis
    a. Out-of-hospital treatment
    i. Ensure adequate airway, ventilation, and oxygenation
    ii. SpO2 <94% administer oxygen
    iii. Assist patient with epinephrine auto-injector if available
    iv. Transport to an appropriate facility for evaluation
    IV. Discuss WCEMSS Procedure USP – 4 Injections: Subcutaneous and Intramuscular
    a. “5 Rights” of medication administration
    b. RFD may administer albuterol only if indicated and only if the patient states they have had a breathing treatment before
    i. WCEMS callback slide re:hx of ALB

    EMT IMMUNOLOGICAL EMERGENCIES SKILLS (WAKE COUNTY REQUIRED SKILL)
    1. Properly demonstrate an IM injection of 1:1000 epinephrine according to WCEMSS Procedure USP – 4 Injections: Subcutaneous and Intramuscular
Contact Hours
4
CEU's
0.4
Industry Standard, State, or National Certification
No
CE to CU Articulation
No
Prerequisites
EMT Certification
Text and Supplies Needed
N/A
Clinical Site/Special Facilities
N/A
Requirements for Successful Completion of this Course
  1. Attendance 100%
  2. Participation
Accreditation/Special Approval Requirements
N/A
Intended Audience
EMTs seeking recredential
Specific Industry or Business Support Needs
Industry or Job Titles Related to training Outcomes for Employment
Related Courses
Course Contact Information
John Wilson
jcwilson10@waketech.edu
919-747-0128