Emergency Medical Services

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 Jose G. Cabanas, 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