Emergency Medical Services Clinical Practice and Systems Oversight, 2 Volume Set

Emergency Medical Services: Clinical Practice and Systems Oversight is the official textbook of the National Association of EMS Physicians™ (NAEMSP™) National EMS Medical Directors Course and Practicum™.

Now paired with a companion website featuring self-assessment exercises, audio and video clips of EMS best practices in action, and more, this essential study aid guides students through the core knowledge they need to successfully complete their training and begin their careers as EMS physicians.

Emergency Medical Services: Clinical Practice and Systems Oversight consists of:

• Volume 1: Clinical Aspects of EMS
• Volume 2: Medical Oversight of EMS
• Companion website featuring supportive self-assessment exercises, audio and video clips

David C. Cone, MD (Editor-in-Chief), Professor of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA

Jane H. Brice, MD, MPH, Orange County EMS Director, Professor of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

Theodore R. Delbridge, MD, MPH, Professor of Emergency Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA

J. Brent Myers, MD, MPH, Director | Medical Director, Wake County EMS System, Raleigh, NC, USA

Contributors viii

Foreword xiv

Preface xv

Abbreviations, xvi

About the companion website, xix

Volume 1: Clinical aspects of EMS

1 History of EMS 1
Robert R. Bass

Section I: Airway

2 EMS airway management 19
Francis X. Guyette and Henry E. Wang

3 Airway procedures 30
Jestin N. Carlson, and Henry E. Wang

4 Airway management: special situations 43
Brendan Anzalone and Henry E. Wang

Section II: Breathing

5 Respiratory distress 53
Jason Oost and Mohamud Daya

6 Oxygenation and ventilation 60
Vincent N. Mosesso and Angus M. Jameson

Section III: Circulation

7 Hypotension and shock 69
Ronald N. Roth, Raymond L. Fowler and Francis X. Guyette

8 Vascular access 78
Jocelyn M. De Guzman, Bryan B. Kitch and Jeffrey D. Ferguson

Section IV: Medical Problems

9 The challenge of the undifferentiated patient 87
Andrew Travers and Ronald D. Stewart

10 Altered mental status 92
Mark R. Quale and Jefferson G. Williams

11 Cardiac arrest systems of care 98
Bryan McNally, Paul M. Middleton and Marcus Ong

12 Cardiac arrest: clinical management 109
Jon C. Rittenberger and Vincent N. Mosesso, Jr

13 Chest pain and acute coronary syndrome 120
Joseph P. Ornato, Michael R. Sayre and James I. Syrett

14 Cardiac dysrhythmias 129
Christian C. Knutsen and Donald M. Yealy

15 Cardiac procedures and managing technology 137
T.J. Doyle

16 Abdominal pain 144
Jeffrey D. Ferguson and Jennifer Monroe

17 Submersion injuries/drowning,= 151
Robert Lowe

18 Choking 155
Gregory H. Gilbert

19 Syncope 158
David J. Schoenwetter

20 Seizures 163
J. Stephen Huff

21 Stroke 171
Todd J. Crocco, Allison Tadros and Stephen M. Davis

22 Allergic reactions 179
Debra G. Perina and Douglas R. Gallo

23 Diabetic emergencies 184
José G. Cabañas, Jorge L. Falcon-Chevere and Jane H. Brice

24 Renal failure and dialysis 190
Bryan B. Kitch and Jocelyn M. De Guzman

25 Infectious and communicable diseases 198
Russell D. MacDonald

Section V: Trauma Problems

26 Trauma Systems of Care 211
Jeffrey P. Salomone and Joseph A. Salomone

27 Blunt trauma considerations 216
Sabina A. Braithwaite and Jeffrey M. Goodloe

28 Motor vehicle crashes 222
Stewart C. Wang and Carla Kohoyda-Inglis

29 Penetrating trauma 228
Michelle Welsford and Alim Pardhan

30 Traumatic brain injury 237
Kraigher O’Keefe

31 Electrical injuries 243
Jeffrey Lubin

32 Blast injury 248
John McManus and Richard B. Schwartz

33 Thermal and chemical burns 253
John McManus, Richard B. Schwartz and Sabina A. Braithwaite

34 Crush injury 261
Ken Miller

35 Hemorrhage control 265
Neil B. Davids and Robert L. Mabry

36 Orthopedic injuries 272
Sean Kivlehan, Benjamin T. Friedman and Mary P. Mercer

37 Ocular trauma 280
Eric Hawkins and Michael D. Mills MD, MPH

38 Bites, stings, and envenomations 284
Adam Frisch, Andrew King and Stephanie Outterson

39 Field trauma triage 289
Hiren Patel and Scott M. Sasser

40 Trauma-stabilizing procedures 297
Derek R. Cooney and David P. Thomson

Section VI: Obstetrics and Gynecological Problems

41 Physiology of pregnancy: EMS implications 307
David J. Hirsch

42 Emergencies of pregnancy 312
W. Scott Gilmore

43 Normal childbirth 318
Stephanie A. Crapo

44 Childbirth emergencies 322
Angus M. Jameson and Micha Campbell

45 Perimortem cesarean section 325
Christian Martin-Gill

Section VII: Toxicological Problems

46 Principles of toxicology 333
Christine M. Murphy

47 Treatment and evaluation of specific toxins 341
Michael C. Beuhler

Section VIII: Environmental Problems

48 Cold exposure illness and injury 351
Jonnathan Busko

49 Heat-related illness 358
Gerald (Wook) Beltran

50 High-altitude illnesses 363
Hawnwan Philip Moy, MD

51 Effects of flight 368
David P. Thomson

52 Diving injury 372
Anthony J. Frank Jr

Section IX: Special Populations

53 The special needs of children 381
Susan Fuchs

54 Pediatric medical priorities 386
Toni Gross and Susan Fuchs

55 Pediatric trauma priorities 393
Joseph L. Wright

56 Technology-dependent children 397
Brent D. Kaziny and Manish I. Shah

57 Approach to the geriatric patient 401
Thomas V. Caprio and Manish N. Shah

58 Bariatric patient challenges 407
Jeremy T. Cushman

59 Behavioral health emergencies 412
Jay H. Reich and Aaron Stinton

Section X: Special Considerations

60 Intimate partner violence 423
Petra Norris

61 Sexual assault 430
Petra Norris

62 Child maltreatment 435
Deborah Flowers and Molly Berkoff

63 Ethical challenges 439
Dave W. Lu and James G. Adams

64 End-of-life issues 444
Aaron Case, Dana Zive, Jennifer Cook and Terri A. Schmidt

65 Termination of resuscitation in the out-of-hospital setting, 453
Laurie J. Morrison, Ian R. Drennan, and P. Richard Verbeek

66 Family and bystanders, 462
Lynne Dees

67 Analgesia, 470
Michael T. Hilton and Paul M. Paris

68 Point-of-care testing in EMS, 477
Alix J.E. Carter

69 Ultrasound applications in EMS, 483
Rachel Liu

Section XI: Safety and Quality

70 Culture of patient safety, 491
Blair L. Bigham and P. Daniel Patterson

71 A historical view of quality concepts and methods, 500
Dia Gainor and Robert Swor

72 Defining, measuring, and improving quality, 509
Kevin E. Mackey and Scott S. Bourn

73 Data management and information systems, 517
Greg Mears

74 EMS quality improvement and the law, 526
Maria B. Abrahamsen

Appendix, 531

Index, 541

Volume 2: Medical Oversight of EMS

Section I: System Infrastructure

1 Principles of EMS system designs 3
Mic Gunderson

2 Air medical services 17
Thomas Judge and Stephen H. Thomas

3 Interfacility transportation 29
Jacob B. Keeperman

4 Legislation, regulation, and ordinance 36
Dan Manz

5 State EMS offices 44
Douglas F. Kupas, Lee B. Smith, and Dean Cole

6 EMS personnel 51
David C. Cone

7 Principles of finance 60
Paul Hinchey and Jeffrey M. Goodloe

Section II: Clinical Leadership and Oversight

8 Medical oversight of EMS systems 71
Robert R. Bass, Benjamin Lawner, Debra Lee, and Jose V. Nable

9 Leadership and team building 85
Mike Taigman and Stephen Dean

10 EMS dispatch 94
Jeff J. Clawson

11 Communications 113
Kevin McGinnis

12 Emergency care regionalization 123
Raymond L. Fowler

13 EMS–public health interface 134
John P. Serra and Christopher A. Kahn

14 Political realities for the medical director 140
Norm Dinerman

15 EMS physicians as public spokespersons 146
Paul E. Pepe, Linda B. Pepe, Robert M. Davis, Paul Mann, and Robin Whitmeyer

16 Legal issues 160
W. Ann “Winnie” Maggiore

17 Due process 182
E. Fremont Magee and Sarah M. Sette

18 Risk management 192
Karen Pickard, Raymond L. Fowler, and Melanie J. Lippmann

Section III: Human Resources

19 EMS provide reducation 201
Beth Lothrop Adams and Debra Cason

20 EMS provider wellness 211
P. Daniel Patterson, Matthew D.Weaver, and David Hostler

21 Occupational injury prevention and management 217
P. Daniel Patterson, Matthew D. Weaver, and David Hostler

22 Ambulance safety and crashes 222
Brian J. Maguire

23 Medical surveillance of emergency response personnel 231
Mike McEvoy

24 Prevention and intervention for psychologically stressful events 236
Richard Gist and Vickie Harris Taylor

25 Protection of EMS personnel from occupationally acquired infections 243
Sandy Bogucki

Section IV: Extraordinary Circumstances

26 Incident command system and national incident management system 257
Sandy Bogucki, Craig DeAtley, and Kevin Schulz

27 Medical management of mass gatherings 264
John F. Brown, Joshua G. Smith, and Katie Tataris

28 Disaster preparedness and management 272
Alexander P. Isakov

29 The federal medical response to disasters 278
Kevin Horahan and Richard C. Hunt

30 Special considerations in disaster zones 283
Ryan Carter

31 Prehospital triage for mass casualties 288
E. Brooke Lerner, Richard B. Schwartz, and Joanne E. McGovern

32 Mass casualty management 292
Charles M. Miramonti, Dan P. O’Donnell, Andrew C. Stevens, Elizabeth Weinstein, Josh D. Mugele, Kacy L. Allgood, and Bobby A. Courtney

33 Mass casualty evacuation and patient movement 303
Joanne McGovern and Sandy Bogucki

34 Temporary treatment facilities 313
Roy L. Alson

Section V: Special Hazards

35 Medical support for hazardous materials response 323
Thomas Blackwell, Kenneth Brennan, Craig DeAtley, and Allen Yee

36 Chemical properties of hazardous materials 334
Joshua B. Gaither and Robert N.E. French

37 Radiation and radiation injury 339
John C. White

38 Weapons of mass destruction 349
Jonathan L. Burstein

Section VI: Special Environments

39 Tactical EMS 355
David K. Tan, William P. Bozeman, and Denis FitzGerald

40 EMS on the fireground 363
Edward T. Dickinson, Sandy Bogucki, and Carin M. van Gelder

41 Confined space and limited access situations 373
David C. Cone

42 Care in the wilderness 377
Seth C. Hawkins, Michael G. Millin, and William “Will” R. Smith

43 Telemedicine and emerging telecommunications 392
David G. Ellis, Kaori P. Tanaka, and Brian M. Clemency

Section VII: Advancing Knowledge

44 EMS research basics 403
E. Brooke Lerner, David C. Cone, and Donald M. Yealy

45 Informed consent for EMS research 410
Lynn J. White

46 Cardiac arrest-related research methodology 415
Michael R. Sayre

47 Trauma-related research methodology 420
Peter P. Taillac and Edward P. Sloan

48 Pediatric-related research methodology 427
David Markenson

49 Economic evaluation of EMS-related interventions 433
Graham Nichol

50 Data handling and statistics essentials 439
Craig D. Newgard and Roger J. Lewis

Appendix, 449 

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