**First Responder:**

**National Standard**

**Curriculum**

United States Department of Transportation

National Highway Traffic Safety Administration

United States Department of Health and Human Services

Maternal and Child Health Bureau

**First Responder: National Standard Curriculum**

**Project Director**

**Walt Alan Stoy, PhD, EMT-P**

*Director of Educational Programs*

*Center for Emergency Medicine*

*Research Assistant Professor of Medicine*

*University of Pittsburgh School of Medicine*

**Principal Investigators**

**Gregg S. Margolis, MS, NREMT-P Thomas E. Platt, NREMT-P**

*Associate Director of Education Coordinator of EMS Education*

*Center for Emergency Medicine Center for Emergency Medicine*

**Medical Directors**

**Nicholas H. Benson, MD, FACEP Herbert G. Garrison, MD, FACEP**

*Acting Chair, Department of Emergency Medicine Assistant Professor of
Medicine*

*East Carolina University School of Medicine University of Pittsburgh
School of Medicine*

**Curriculum Development Group**

**Michael O\'Keefe Bob W. Bailey**

*State Training Coordinator Chief, Office of EMS*

*Vermont North Carolina*

**William E. Brown, Jr., RN, REMT-P Philip Dickison, REMT-P**

*Executive Director Basic Level Coordinator*

*National Registry of EMTs National Registry of EMTs*

**Susan M. Fuchs, MD, FAAP**

*Associate Professor of Pediatrics*

*University of Pittsburgh School of Medicine*

**Contract Number DTNH22-94-C-05123**

**Table of Contents**

Preface vii

Acknowledgments viii

Process x

Cardiopulmonary Resuscitation x

Integration with the Blueprint xi

Medical Oversight Statement xii

**Instructor\'s Course GuideCurriculum**History 1

Course Goals 2

Diagram of Educational Model 4

Course Design 5

How to Use the Curriculum and Lesson Plans 9

**Instructors**Assessing Student Achievement 14

Philosophy Regarding Adult Learners 17

Some Principles of Adult Education 18

Continuing Education 20

**Students**Job Description - First Responder 21

Continuing Education and Its Importance in Lifelong Learning 23

**Environment**Classroom Environment 24

Clinical/Field Rotations 24

Maintaining Records 24

Credentialing 25

Program Evaluation 25

Facilities 26

Course Cost 26

**Instructor\'s Lesson Plans**

**Module 1: Preparatory**Lesson 1-1 Introduction to EMS Systems 1‑1

Lesson 1-2 The Well-Being of the First Responder 1‑11

Lesson 1-3 Legal and Ethical Issues 1‑23

Lesson 1-4 The Human Body 1‑33

Lesson 1-5 Lifting and Moving Patients 1‑43

Lesson 1-6 Evaluation: Preparatory 1‑53

**Module 2: Airway**Lesson 2-1 Airway 2‑1

Lesson 2-2 Practical Lab: Airway 2‑21

Lesson 2-3 Evaluation: Airway 2‑27

**Module 3: Patient Assessment**Lesson 3-1 Patient Assessment 3‑1

Lesson 3-2 Practical Lab: Patient Assessment 3‑15

Lesson 3-3 Evaluation: Patient Assessment 3‑21

**Module 4: Circulation**Lesson 4-1 Circulation 4‑1

Lesson 4-2 Practical Lab: Circulation 4‑9

Lesson 4-3 Evaluation: Circulation 4‑15

**Module 5: Illness and Injury**Lesson 5-1 Medical Emergencies 5‑1

Lesson 5-2 Bleeding and Soft Tissue Injuries 5‑19

Lesson 5-3 Injuries to Muscles and Bones 5‑33

Lesson 5-4 Practical Lab: Illness and Injury 5‑43

Lesson 5-5 Evaluation: Illness and Injury 5‑53

**Module 6: Childbirth and Children** Lesson 6-1 Childbirth 6‑1

Lesson 6-2 Infants and Children 6‑11

Lesson 6-3 Practical Lab: Childbirth and Children 6‑25

Lesson 6-4 Evaluation: Infants and Children 6‑31

**Module 7: EMS Operations**Lesson 7-1 EMS Operation 7‑1

Lesson 7-2 Evaluation: EMS Operations 7‑11

**Appendices**Appendix A Functional Job Analysis A-1

Appendix B BLS HeartSaver Information and Skill Sheets B‑1

Appendix C Adult and Pediatric Basic Cardiac Life Support Guidelines C‑1

Appendix D Enrichment Lesson Plan D‑1

Appendix E Remediation Sheet E‑1

Appendix F Patient Assessment Flow Sheets F‑1

Appendix G National EMS Education and Practice Blueprint G‑1

Appendix H Final Practical Skills Examination H‑1

**Preface**

The National Highway Traffic Safety Administration (NHTSA) has assumed
responsibility for the development of training courses that are
responsive to the standards established by the Highway Safety Act of
1966 (amended). Since these training courses are designed to provide
national guidelines for training, it is NHTSA\'s intention that they be
of the highest quality and be maintained in a current and up-to-date
status from the point of view of both technical content and
instructional strategy. To this end, NHTSA supported the current project
which involved revision of the *Emergency Medical Services: First
Responder Training Course,* deemed of high value to the states in
carrying out their training programs. This course revision is being
co-sponsored by the Maternal and Child Health Bureau, U.S. Department of
Health and Human Services. Additional funding for this project was
provided as in-kind services of the Center for Emergency Medicine and
through a Grant from the Pittsburgh Emergency Medicine Foundation. This
course is one of a series of courses making up a National EMS education
program for out-of hospital care. The First Responder is a designated
level of emergency medical care provider as outlined by the *National
EMS Education and Practice Blueprint*.

The First Responder is an integral part of the Emergency Medical
Services System. The term \"first responder\" has been applied to the
first individual who arrives at the scene regardless of the
individual\'s type of credential. It is the goal of the *First
Responder: National Standard Curriculum* to provide students with the
core knowledge, skills and attitudes to function in the capacity of a
first responder. The First Responder uses a limited amount of equipment
to perform initial assessment and intervention and is trained to assist
other EMS providers. This level of provider is not intended to be
utilized as the minimum staffing for an ambulance. Enrichment programs
and continuing education will help fulfill other specific needs for the
First Responder training.

It is recognized that there may be additional specific education that
will be required of First Responders who operate in the field. It is
also recognized that practice might differ from locality to locality,
and that each training program, or system should identify and provide
additional training requirements. Consistent with the intent and design
of the *National EMS Education and Practice Blueprint*, some EMS systems
will incorporate additional skills into the scope of practice of the
First Responder.

**Acknowledgments**

From the very beginning of this revision project, the Department of
Transportation relied on the knowledge, attitudes, and skills from
hundreds of experts. These individuals sought their own level of
involvement and contribution toward accomplishing the goals of this
project. These contributions varied from individual to individual, and
regardless of the level of involvement, everyone played a significant
role in the development of the curriculum. It is essential that those
who have assisted with the achievement of this worthy educational
endeavor be recognized for their efforts. For every person named, there
are 50 or more individuals who should be identified for their
contributions. For all who have contributed, named and unnamed, thank
you for sharing your vision. Your efforts have helped assure that the
educational/training needs of First Responders are met so that they can
provide appropriate and effective patient care.

Special thanks for the knowledge, expertise, and dedication given to
this project by the Project Director, Co-Principal Investigators,
Co-Medical Directors, and all the members of the Curriculum Development
Group.

NHTSA would also like to recognize the following individuals and/or
organizations for their significant contributions to this project:

**National Organizations**

National Registry of EMTs

William Brown, RN

Phil Dickison, REMT-P

**State of North Carolina**

Governor James B. Hunt, Jr.

**Department of Human Resources**

**Division of Facility Services**

**Office of Emergency Medical Services**

Bob W. Bailey, Chief

Ed Browning

Nicholas Benson, MD, FACEP

**North Carolina State Highway Patrol**

Col. R.A. Barefoot

Lt. Col. C. R. Wilkins

Maj. R. D. Jenkins

First Sergeant C. L. Garner

Sergeant G. D. Hayes

Trooper J. D. Henderson

Trooper E. C. Maness

Trooper G. W. Starling

Sergeant M. J. Benfield

**State of Minnesota**

Governor Arne Carlson

**Minnesota State Board of Technical Colleges**

> Carole M. Johnson, PhD, Chancellor

Adam D. Pishura, Director Fire/EMS Training

Mike Wilcox, MD, Medical Advisor

Joe Grafft, MS, EMS Specialist

Charles G. Coggins

Morris S. Miller, RN

Nona Niemeier, BA, NREMT-A

Gerald W. Otto

Brett A Rima, EMT-P

James V. Sinkbeil , MS, NREMT-A

Eric M. Weller, BS, NREMT

**Queen of Peace Hospital**

Sister Jean Juenemann

Diane Hrabe

Noreen Seurer

Food Service Department

**St. Wenceslaus School**

2nd Grade Class

Ann Christy

Pamela Theis

**Joint Powers Board South Central Minnesota EMS Regional Project**

**Center for Emergency Medicine**

Paul M. Paris, MD, FACEP

Donald Goodman, MBA

Debra A. Barclay, EMT-P

Pamela Westfall

Bonnie Rolison

Cheryl Butler,

Greg Lipson, MBA

**Pittsburgh Emergency Medicine Foundation**

Phil Davidson, President

**Individuals**

> Mike Smith, REMT-P for his invaluable assistance in developing
> Affective Objectives.
>
> Robert Elling, MPH, EMT-P for developing the patient care simulations.
>
> Jan Fazio for her exceptional editing of the Final Draft
>
> Zane Johnson, MAB Enterprises for providing pocket masks for the
> Minnesota Pilot Test

Audrey and Katelyn Zurn

**Mosby-Lifeline**

**Process**

The First Responder: National Standard Curriculum was designed and
developed by a Curriculum Development Group (CDG) of emergency medicine
and education experts. These experts met in person and via
teleconference to review, edit, and critique the developmental document.
The Co-Medical Directors reviewed, critiqued, and approved the medical
content of the curriculum. The Co-Principal Investigators and the
Project Director actually put the \"pen-to-paper\" once the objectives
and format were approved by the CDG.

Two pilot tests were conducted, one in Raleigh, North Carolina
(representing urban/metropolitan First Responders), and the other in New
Prague, Minnesota (representing rural First Responders). Eleven students
participated in the North Carolina Pilot, and 39 students participated
in the Minnesota Pilot. The project team was able to view and modify the
content of the curriculum based on insight gathered from the pilot test
process.

The National Registry of EMTs designed and developed modular
examinations and the final evaluation tools that were used in the pilot
test project. They also completed the tabulation and evaluation of the
test scores.

**Cardiopulmonary Resuscitation**

This curriculum contains many of the knowledge and skill objectives of
cardio-pulmonary resuscitation. In order to maintain an up-to-date
curriculum, the didactic material has not been reproduced. Instructors
must utilize the current American Heart Association Guidelines and
teaching strategies as the basis for instruction in Module 2: Airway and
Module 4: Circulation. In some states, or EMS systems, issuance of a
\"successful completion\" card for CPR may be required to practice as a
First Responder. Meeting the objectives of this program provides the
First Responder with the ability to perform CPR; but the program does
not contain all of the prevention and recognition material within the
guidelines established by the American Heart Association. During the
program, if issuance of a CPR card is desirable or required, additional
information must be added to the program. Testing and/or other course
requirements for issuance of a specific agency\'s CPR card will need to
be completed within the First Responder Training Program. Requirements
for issuing a successful completion card may be obtained from the local
CPR training agency or your State Office of Emergency Medical Services.

**Integration with the Blueprint**

*The National EMS Education and Practice Blueprint* (Appendix BP),
adopted through a national peer review and consensus process, guided the
development of this curriculum. This constitutes the
[minimum]{.underline} national knowledge and skill competencies for a
First Responder, who is identified in the Blueprint as an individual
who:

> *\"\...uses a limited amount of equipment to perform initial
> assessment and intervention and is trained to assist other EMS
> providers.\"*

As part of a consistent, organized, state-wide approach to the education
and certification/licensure of First Responders, state EMS offices may
wish to supplement this minimum national standard curriculum with
additional knowledge and skills. However, to be consistent with the
intent and philosophy of the *National EMS Education and Practice
Blueprint,* state-wide additions to the First Responder\'s education and
scope of care should reflect the Blueprint\'s continuum of knowledge and
skills.

Each level of knowledge and skill includes all previous levels. If
knowledge or skill items are \"out of synch\" with the logical
continuum, the utility and value of the Blueprint is significantly
decreased. For example, in the Core Component of CIRCULATION, Automated
Defibrillation is the next skill above First Responder and comes before
Pneumatic Anti-Shock Garment (PASG). Therefore, if the PASG is a skill
added by a state to the First Responder Program, consistency with the
Blueprint would require that AED be included also.

When knowledge and skills are added to the First Responder\'s scope of
care, the additional information should be consistent with the
corresponding levels of the next higher level of national curriculum.
For instance, if a state requires automated external defibrillation at
the First Responder level, the corresponding lesson from the *1994
EMT-Basic: National Standard Curriculum* should be used thus assuring a
logical, inclusive continuum of education.

Vital signs, supplemental oxygen, automated defibrillation, simple
immobilization and other knowledge or skills may be added to the First
Responder program and remain consistent with the Blueprint providing
they are allowable by the state EMS office, occur in the same order
identified in the Blueprint continuum, and reflect the content of the
*1994 EMT-Basic: National Standard Curriculum.*

**Medical Oversight Statement**

Medical oversight should exist for the First Responder to help ensure
quality care. This should occur in the context of the local EMS
System\'s medical oversight. The primary role of the physician will be
to supervise the development of patient care protocols and to respond to
questions about patient care issues.

Quality improvement is also a required component of EMS training. The
role of medical oversight is paramount in ensuring the highest quality
out-of-hospital care. Medical directors should work with individuals and
systems to review out-of-hospital cases and achieve a sound method of
continuous quality improvement.

**Curriculum**

**History**

The *First Responder: National Standard Curriculum* was last reviewed in
the late 1970s. The current revision came about as a result of the
National Highway Traffic Safety Administration\'s (NHTSA) January 1990
*Consensus Workshop on Emergency Medical Services Training Programs*.
Participants discussed the national training curricula needs of
Emergency Medical Service (EMS) providers. Using a nominal group
process, the participants identified the top priority needs for EMS
training in the United States.

The top priorities identified at that meeting led to issuance of a
Request for Proposal (RFP) by NHTSA to revise the *Emergency Medical
Service: First Responder Training Course* based upon the 1994
*EMT-Basic: National Standard Curriculum* and the *National EMS
Education and Practice Blueprint.* The following priorities from the
1990 consensus workshop recommendations played a directing role in the
revision of this First Responder Curriculum:

 Review and development of a blueprint/model and core curriculum for
each provider level, based upon task analysis focusing on field impact
(evaluating positive/negative outcomes) and the most utilized knowledge
and skill areas. Identify \"need to know\" versus \"nice to know\"
content. Conduct an analysis of interventions and outcomes for both the
patient and the care provider. (What are we really doing in EMS? What\'s
making a difference? Define what we want to do).

 Establish a Physician Board to review and approve all medical
curriculum content.

 Emphasize an assessment-based format rather than a diagnostic-based
format for all levels and all ages.

 Ensure that there is adequate focus on primary skills of assessment
and ABCs in all provider levels (with emphasis on airway).

 Include an objective assessment of all published studies in peer
journals when revising curricula.

 Emphasize rescuer and patient safety components, including infection
control, in all curricula.

 Ensure that out-of-hospital providers have adequate skills to care for
children and infants by integrating information throughout the curricula
at all levels, within the established course items.

 Build in clearly defined medical control for all levels, not just
EMT-Paramedic.

 Utilize measurable educational objectives (knowledge, skills,
judgement) to determine individuals\' learning needs and duration of
training program.

 Develop a nationally acceptable core curriculum for each provider
level, with a mechanism for customizing for local needs.

 Place curriculum revision emphasis on EMT-A and First Responder
courses.

 Revise basic course to be no more than 110 hours in length.

 Add automated defibrillation (fully automatic and semi-automatic) for
CPR by EMTs and First Responders.

 Develop an integrated/situational (real-world) approach for EMT
training.

 Develop a mechanism for consensus on EMS education among national
groups.

 Evaluate delivery methods of training.

 Include sufficient information in basic EMT-A curriculum to comply
with hazardous materials (HAZMAT) worker protection standard.

 Include more on medical emergencies as opposed to trauma (including
airway).

**Course Goals**

This instructor\'s course guide has been designed and developed to
assist the course coordinator, instructors, and others in planning,
managing and teaching the First Responder: National Standard Curriculum.
The goals and objectives of this curriculum are to improve the quality
of emergency medical care.

This course is designed to instruct a student to the level of First
Responder, who serves as a vital link in the chain of the health care
team. This curriculum includes skills necessary for the individual to
provide emergency medical care with a limited amount of equipment.
Specifically, after successful completion of the program, the student
will be capable of performing the following functions at the minimum
entry level:

 Recognize the seriousness of the patient\'s condition or extent of
injuries to assess requirements for emergency medical care;

 Administer appropriate emergency medical care for life threatening
injuries relative to airway, breathing and circulation;

 Perform safely and effectively the expectations of the job
description.

It is obvious that First Responders provide a service in an environment
requiring special skills and knowledge. They also serve as liaisons with
other emergency services. This course provides an introduction to these
concepts. Individual orientation to the specific systems and services
with which the First Responder will be affiliated is necessary to
achieve a full level of competency within a specific organization.

The entire curriculum is surrounded by continuing education, which is
designed to reflect two primary goals. First, during the instruction of
the First Responder: National Standard Curriculum, additional continuing
education in related content may be provided. Second, continuing
education is an integral component of any educational process and the
First Responder should be committed to continuous improvement of
knowledge and skills.

**FIRST RESPONDER: NATIONAL STANDARD CURRICULUM**

**DIAGRAM OF EDUCATIONAL MODEL**

+---+-----------------+-------------------------+-----------------+---+
|   |                 |                         |                 |   |
+---+-----------------+-------------------------+-----------------+---+
|   | CONTINUING      |                         | CONTINUING      |   |
|   | EDUCATION       |                         | EDUCATION       |   |
+---+-----------------+-------------------------+-----------------+---+
|   |                 | **I. PREPARATORY**      |                 |   |
+---+-----------------+-------------------------+-----------------+---+
|   |                 | Introduction to EMS     |                 |   |
|   |                 | Systems                 |                 |   |
|   |                 |                         |                 |   |
|   |                 | The Well-Being of the   |                 |   |
|   |                 | First Responder         |                 |   |
|   |                 |                         |                 |   |
|   |                 | Legal and Ethical       |                 |   |
|   |                 | Issues                  |                 |   |
|   |                 |                         |                 |   |
|   |                 | The Human Body          |                 |   |
|   |                 |                         |                 |   |
|   |                 | Lifting and Moving      |                 |   |
+---+-----------------+-------------------------+-----------------+---+
|   |                 | **II. AIRWAY**          |                 |   |
+---+-----------------+-------------------------+-----------------+---+
|   |                 | Airway                  |                 |   |
+---+-----------------+-------------------------+-----------------+---+
|   | **IV.           | **III. PATIENT          | **V. ILLNESS    |   |
|   | CIRCULATION**   | ASSESSMENT**            | AND INJURY**    |   |
+---+-----------------+-------------------------+-----------------+---+
|   | Circulation     | Patient Assessment      | Medical         |   |
|   |                 |                         | Emergencies     |   |
|   |                 |                         |                 |   |
|   |                 |                         | Bleeding and    |   |
|   |                 |                         | Soft Tissue     |   |
|   |                 |                         | Injuries        |   |
|   |                 |                         |                 |   |
|   |                 |                         | Injuries to     |   |
|   |                 |                         | Muscles and     |   |
|   |                 |                         | Bones           |   |
+---+-----------------+-------------------------+-----------------+---+
|   |                 | **VI. CHILDBIRTH AND    |                 |   |
|   |                 | CHILDREN**              |                 |   |
+---+-----------------+-------------------------+-----------------+---+
|   |                 | Childbirth              |                 |   |
|   |                 |                         |                 |   |
|   |                 | Infants and Children    |                 |   |
+---+-----------------+-------------------------+-----------------+---+
|   |                 | **VII. EMS OPERATIONS** |                 |   |
+---+-----------------+-------------------------+-----------------+---+
|   |                 | EMS Operations          |                 |   |
+---+-----------------+-------------------------+-----------------+---+
|   | CONTINUING      |                         | CONTINUING      |   |
|   | EDUCATION       |                         | EDUCATION       |   |
+---+-----------------+-------------------------+-----------------+---+

**Course Design**

**Module 1 Preparatory**

**Lesson 1-1**

**Introduction to EMS Systems**

Familiarizes the First Responder candidate with the introductory aspects
of emergency medical care. Topics include the Emergency Medical Services
system, roles and responsibilities of the First Responder, quality
improvement, and medical oversight.

**Lesson 1-2**

**Well-Being of the First Responder**

Covers the emotional aspects of emergency medical care, stress
management, introduction to Critical Incident Stress Debriefing (CISD),
scene safety, body substance isolation (BSI), personal protection
equipment (PPE), and safety precautions that can be taken prior to
performing the role of a First Responder.

**Lesson 1-3**

**Legal and Ethical Issues**

Explores the scope of practice, ethical respon­sibilities, advance
directives, consent, refusals, abandonment, negligence, duty to act,
confidentiality, medical identification symbols, and crime scenes.

**Lesson 1-4**

**The Human Body**

Enhances the First Responder\'s knowledge of the human body. A brief
overview of body systems, anatomy, and physiology will be given in this
session.

**Lesson 1-5**

**Lifting and Moving Patients**

Provides students with knowledge of body mechanics, lifting and carrying
techniques, and principles of moving patients.

**Lesson 1-6**

**Evaluation: Preparatory**

Evaluates the student\'s level of achieve­ment of the cognitive,
psychomotor, and affective objectives for this module of instruction.

**Module 2 Airway**

**Lesson 2-1**

**Airway**

Addresses airway anatomy and physiology, how to maintain an open airway,
pulmonary resuscitation, variations for infants and children, as well as
patients with laryngectomies. The use of airways, suction equipment, and
barrier devices will be dis­cussed in this lesson. Also included is the
management of foreign body airway obstructions.

**Lesson 2-2**

**Practical Lab: Airway**

Provides supervised practice for students to develop the psycho­mo­tor
skills of airway care. The use of airways, suction equipment, and
barrier devices will be included in this lesson. Students will have an
opportunity to practice the techniques of removing a foreign body airway
obstruction.

**Lesson 2-3**

**Evaluation: Airway**

Evaluates the student\'s level of achieve­ment of the cognitive,
psychomotor, and affective objectives for this module of instruction.

**Module 3 Patient Assessment**

**Lesson 3-1**

**Patient Assessment**

Enhances the First Responder\'s ability to evaluate a scene for
potential hazards, to determine the number of patients, whether
additional help is necessary, and to evaluate the mechanism of injury or
nature of illness. This lesson provides the knowledge and skills to
properly perform the initial assessment. In this session, the student
will learn about forming a general impression, determining
responsiveness, and assessing the airway, breathing, and circulation.
Students will discuss how to determine priorities of patient care. This
lesson also teaches the knowledge and skills required to continue the
assessment and management of the ill or injured patient.

**Lesson 3-2**

**Practical Lab: Patient Assessment**

Integrates the knowledge and skills learned thus far to assure that the
student has the knowledge and skills of assessment neces­sary to continue
with the management of patients with medical complaints and traumatic
injuries.

**Lesson 3-3**

**Evaluation: Patient Assessment**

Evaluates the student\'s level of achieve­ment of the cognitive,
psychomotor, and affective objectives for this module of instruction.

**Module 4 Circulation**

**Lesson 4-1**

**Circulation**

This lesson provides the First Responder with the knowledge and skills
of chest compressions and ventilations for adults, children, and
infants.

**Lesson 4-2**

**Practical Lab: Circulation**

Draws on the knowledge and skills learned thus far in this practical
lab. Students will be given the opportunity to practice CPR skills.

**Lesson 4-3**

**Evaluation: Circulation**

Evaluates the student\'s level of achieve­ment of the cognitive,
psychomotor, and affective objectives for this module of instruction.

**Module 5 Illness and Injury**

**Lesson 5-1**

**Medical Emergencies**

Discusses the recognition and management of general medical complaints,
seizures, altered mental status, environmental emergencies, behavioral
emergencies, psychological crisis, and typical patient situations.

**Lesson 5-2**

**Bleeding and Soft Tissue Injuries**

Reviews the cardiovascular system, describes the care of the patient
with internal and external bleeding, and teaches the management of soft
tissue injuries and burns. Techniques of dressing and bandaging wounds
will also be taught in this lesson.

**Lesson 5-3**

**Injuries to Muscles and Bones**

Reviews the anatomy of and injuries to the musculoskeletal system.
Presents information about injuries of the skeletal system. Reviews the
anatomy of the nervous system and the skeletal system. Discusses
injuries to the spine and head, including the mechanism of injury, signs
and symptoms of injury, and assessment.

**Lesson 5-4**

**Practical Lab: Illness and Injury**

Provides practice in assessing and managing patients with traumatic
injuries.

**Lesson 5-5**

**Evaluation: Illness and Injury**

Evaluates the student\'s level of achieve­ment of the cognitive,
psychomotor, and affective objectives for this module of instruction.

**Module 6 Children and Childbirth**

**Lesson 6-1**

**Childbirth**

Reviews the anatomical and physiological changes that occur during
pregnancy. Demonstrates deliveries and newborn care.

**Lesson 6-2**

**Infants and Children**

Presents information concerning anatomical differences in infants and
children, discusses common medical and trauma situations.

**Lesson 6-3**

**Practical Lab: Children and Childbirth**

Provides the First Responder student with the opportunity to interact
with infants and children and to practice the knowledge and skills
learned thus far concerning this special population.

**Lesson 6-4**

**Evaluation: Childbirth and Children**

Evaluates the student\'s level of achieve­ment of the cognitive,
psychomotor, and affective objectives for this module of instruction.

**Module 7 EMS Operations**

**Lesson 7-1**

**EMS Operations**

Presents an overview of the knowledge needed to function as a First
Responder in the out-of-hospital environment. In addition this lesson
provides the First Responder student with an overview of extrication and
rescue operations and informa­tion on hazardous materials, mass casualty
situa­tions, and basic triage.

**Lesson 7-2**

**Evaluation: EMS Operations**

Evaluates the student\'s level of achieve­ment of the cognitive,
psychomotor, and affective objectives for this module of instruction.

**How to Use the Curriculum and Lesson Plans**

There are seven modules of instruction in the core content. There are 26
lessons within the seven modules. Each lesson has the following
components:

**Objectives**

The objectives are divided into three categories: Cognitive, Affective,
and Psychomotor.

[Cognitive]{.underline} [Affective]{.underline}
[Psychomotor]{.underline}

**thinking\-- emotional response\-- physical process\--**

knowledge feelings physical movement

comprehension emotional intensity skilled activities

application

To assist with the design and development of a specific lesson, each
objective has a numerical value, e.g., 3-1.1. The first number is the
module of instruction, followed by a hyphen and the number of the
specific lesson. For example, 3-1.1 is:

Module 3: Patient Assessment

Lesson 3-1: Patient Assessment

> Objective 3-1.1 Recognize hazards/potential hazards. (C-1)

At the end of each objective is a letter for the type of objective: C =
Cognitive; A = Affective; and P = Psychomotor. (The example above is
cognitive). The number following the type of objective represents the
level of objective: 1 = Knowledge; 2 = Application; and 3 = Problem
Solving. (The example above is knowledge).

**Preparation**

Motivation \-- Each lesson has a motivational statement that should be
read by the instructor prior to teaching the lesson. It is not the
intent for the instructor to necessarily read the motivational statement
to the students, but more importantly to be familiar with its content
and to be able to prepare the students or explain why this lesson is
important.

**Prerequisites**

Prior to starting a lesson, the instructor should assure that the
students have completed the necessary prerequisites.

**Materials**

Audio Visual (AV) Equipment \-- In recent years, high quality video
materials have become available for the EMS community. They should be
used as an integral part of the instruction in this program. The course
coordinator should ensure in advance that the necessary types of AV
equipment are available for the class. If possible, the course
administrator should have a video library available for the student.

**Emergency Medical Services (EMS) Equipment**

Each lesson plan contains a list of equipment that should be available
for instruction.

**Personnel**

Primary Instructor

> Assistant Instructor

Program personnel are a primary instructor and an assistant instructor.
Their roles of the program personnel are discussed in more detail under
[Program Personnel]{.underline}.

**Recommended Minimum Time to Complete**

Each lesson plan has a recommended minimum time for completion. Although
the time for each lesson has been pilot tested, because of the varying
nature of adult learners the enrichment and the need for remediation may
require additional time. Time limits may be extended to bring the
students to the full level of competency.

**Presentation**

**[Declarative (What)]{.underline}** \-- This is the cognitive lesson
plan, the information that the instructor provides the students. This
may be accomplished by various methods, including lectures, small group
discussion, and the use of audio-visual materials. Demonstrations, if
the instructor desires, may be used as part of the instruction. The
instructor must be well versed in the entire content of the lesson plan.
It is not appropriate to read the lesson plans word for word to the
students. Lesson plans should be considered dynamic documents that
provide guidelines for the appropriate flow of information. The
instructor\'s lesson plans should be based upon local practice, national
standards, and scientific evidence approved by the Course Medical
Director. The instructor should feel free to write notes in the margins
and make the lesson plan his own.

**Application**

**[Procedural (How)]{.underline}**

This is the skills portion of the program. The students should be able
to demonstrate competency in all skills listed in each section. If the
declarative (what) content was presented as a lecture, the instructor
should perform demonstrations prior to having the students perform the
skills. If the instructor performed a demonstration as part of the
declarative component, the students may begin by practicing skills in
the practical setting.

When this component of the lesson is being conducted, there should be
one instructor for every six students. Students should be praised for
their progress. For those students having difficulty performing a skill
or skills, remediation is required. It is well known that a
demonstration must be followed by practice, which must be drilled to a
level that assures mastery of the skill. It has been proven that
demonstration followed as soon as possible by organized, supervised
practice enhances mastery and successful applications.

**[Contextual (When, Where, and Why)]{.underline}**

This section is designed to help the students understand the application
of their knowledge and skills relating to their performance as First
Responders. This section relates back to the motivational statement and
represents the reasoning as to why, where, and when a First Responder
would need to use the knowledge or perform the skills. It is of utmost
importance that the instructor be familiar with the intent of this
section and relay that intent to the students.

**Student Activities**

Students learn by various methods. The three learning styles are
auditory, visual, and kinesthetic (A-V-K). The intent of this section is
to ensure that the content of the curriculum is presented to meet the
needs of the three different types of learning styles. These three areas
should not necessarily be used separately from the lesson plan, but as
an adjunct to it. An attempt to provide instruction to the student with
these three types of modalities will enhance student learning.
Instructors should feel free to add additional A-V-K experiences
appropriate for each lesson.

**Auditory (Hearing)**

This section allows the instructor to provide material in an orally.
Students who learn best by hearing will benefit from this method of
instruction.

**Visual (Seeing)**

This section allows the instructor to provide material in a visually.
Visual learners will benefit from this method of instruc­tion.

**Kinesthetic (Doing)**

This section allows the instructor to teach material by having the
students perform the skill. Those students who learn best by doing will
benefit from this method of instruction.

**Instructor Activities**

This section is to remind the instructors that they should always
supervise student practice and praise progress. They should reinforce
student progress in cognitive, affective, and psychomotor domains. If
students are having difficulty understanding the content or performing
the skills, the instructor should redirect them. If additional time is
needed to complete this task beyond the assigned times of the program,
the instructor should complete a remediation form to schedule additional
assistance for the student or group of students experiencing difficulty
with the task.

**Evaluation**

**Written \--**The instructor should design and develop various quizzes,
verbal reviews, handouts, and any other desired materials for the
students. Ideally, the instructor should provide a brief quiz after
every lesson to determine if the students are comprehending the
material.

**Practical \--** The instructor should provide students with practical
evaluations when applicable. The skill sheets provided within the
curriculum will assist the students in preparing for field performance
and the final practical evaluation. State EMS Offices and program
personnel should work together to determine minimum performance for
successful course completion.

**Remediation**

The intent of this section is to ensure that the instructor meets the
needs of those students who are experiencing difficulty understanding
the material or performing practical skills. Remediation sheets supplied
in this guide will enable the instructor to keep track of those
students. If a student requires remediation frequently, a decision
should be reached as to whether the student should continue in the
program. (see Appendix E for Remediation sheet.)

**Enrichment**

This section is designed to allow the instructors, the course medical
director, the course coordinator, the region, or state to add additional
information, or augment the curriculum. Anything that is unique to your
area should be added. Refer to Appendix D for an Enrichment Lesson Plan.

**Instructors**

**Assessing Student Achievement**

This training program includes several methods for assessing student
achievement. As mentioned before, quizzes of the cognitive and affective
domains should be provided at the completion of each lesson. Time is
allocated at the end of each module of instruction for a cognitive and
psychomotor evaluation. The primary instructor in conjunction with the
course coordinator, program director, and course medical director is
responsible for the design, development, administration and grading of
all written and practical examinations. The instructor should feel free
to use outside agency-approved psychomotor evaluation instruments or
those found in texts. All written examinations used within the program
should be valid and reliable and conform to psychometric standards.
Instructors should be encouraged to use outside sources to validate
examinations and/or as a source of classroom examination items.

The primary purpose of this course is to prepare students to meet the
entry-level job expectations for a First Responder. Each student,
therefore, must demonstrate attainment of knowledge, attitude, and
skills in each area taught in the course. It is the responsibility of
the course coordinator, medical director, primary instructor, and
educational institution to assure that students obtain proficiency in
each module of instruction before they proceed to the next area. If
after counseling and remediation a student is not able to demonstrate
the ability to learn specific knowledge, attitudes, and skills, the
program director should not hesitate to dismiss the student. The level
of knowledge, attitude and skills attained by a student in the program
will be reflected in performance on the job as a First Responder. It is
not the responsibility solely of the certifying examination to assure
competency over successful completion of the course. Program directors
should recommend only qualified candidates for licensure, certification
or registration.

Requirements for successful completion of the course are as follows:

**Cognitive** - Students must obtain passing grades on all module
examinations and the final examination. Special remedial sessions may be
utilized to assist in the completion of a lesson or module of
instruction. Scores should be in accordance with accepted practices.

**Affective** - Students must demonstrate conscientiousness and interest
in the program. Students who do not should be counseled while the course
is in progress in order to provide them the opportunity to develop and
exhibit the proper attitude expected of a First Responder.

**Psychomotor** - Students must demonstrate proficiency in all skills in
each testing session of selected topic areas and mastery of skills in
the final examination. Special remedial sessions may be utilized to
assist in the completion of a lesson or module of instruction. Pass/fail
scores should be in accordance with accepted practices. Usage of the
skill measurement instruments within this curriculum or developed by way
of a valid process is strongly recommended to achieve maximum results
with the students.

The additional areas that should be utilized for evaluation of student
achievement include:

**Personal Appearance** - Each student should be neat, clean, well
groomed, and physically fit to perform the minimal entry-level job
requirements. Students who do not exhibit good hygiene habits should be
counseled while the program is in session to provide them with the
opportunity to correct the habits.

**Attendance** - Students are required to attend all lessons. At the
discretion of the program director or designee, a student missing a
lesson may demonstrate the fulfillment of all cognitive, affective, and
psychomotor objectives covered in the missed lesson.

**Clinical or Field Rotation Experience** - Prior to certification of
course completion, some states may require satisfactory clinical or
field experience.

**Program Personnel**

There are several sets of responsibilities required to present the First
Responder program. These identified roles and responsibilities are a
necessary part of each First Responder course. The individuals carrying
them out may vary from program to program and from locality to locality
as the roles may interface and overlap. In fact, one person, if
qualified, may carry out all of the roles in some programs.

For clarity, the following terms are defined as they will be used
throughout this document.

**Program Director:** The program director is responsible for course
planning, operation, and evaluation. While the Program Director is
responsible for the overall operation of the education experience, this
person need not be qualified or involved in the actual instruction of
specific course lessons. The Program Director is responsible for First
Responder course planning.

**Course Coordinator**: The Course Coordinator is the individual
responsible for coordinating and conducting the First Responder program.
The Course Coordinator acts as the liaison among the students, the
sponsoring agency, the local medical community, and the state-level
certifying or licensing agency and is respon­sible for assuring that the
course goals and objectives (and those set forth by any licensing,
registering, or certifying agency as applicable) are met. The Course
Coordinator may also serve as the Primary Instructor.

**Primary Instructor**: The Primary Instructor must be knowledgeable in
all aspects of out-of-hospital emergency medical care, in the techniques
and methods of adult education, and in managing resources and personnel.
This individual should have attended and successfully completed a
program in EMS instruction methodology. The Primary Instructor should be
present at most, if not all, class ses­sions to assure program continuity
and to be able to identify that the students have the cognitive,
affective, and psycho­motor skills necessary to function as a First
Responder. This person is responsible for the teaching of a specific
lesson of the First Responder course. This individual should have
attended a workshop that reviews the format, philosophy, and skills of
the new curriculum.

**Assistant Instructor**: This person assists the Primary Instructor of
any lesson in the demonstration and prac­tice designed to develop and
evaluate student skill competencies.

**Course Medical Director**: The program should have a course Medical
Director. The need for an active medical director increases as the state
adds enhancements to the scope of practice as reflected in the *National
EMS Education and Practice Blueprint*. When utilized, the Course Medical
Director, Course Coordinator, and the Primary Instructor should work
closely together in preparing and presenting the program. The Course
Medical Director may also serve as the Primary Instructor for one or
more or all lessons. The Course Medical Director must be a physician
knowledgeable of state EMS rules, EMS system configuration, national
standards of care, and educational principles.

**Philosophy Regarding Adult Learners**

Individuals participating in this educational program should be
considered adult learners even in those programs instructing students
younger than age 18. Adult learners are responsible for their own
learning. There are several characteristics regarding the adult learner
as a First Responder student.

1\. First Responder students usually want to utilize knowledge and
skills they have learned soon after they have learned them.

2\. First Responder students are interested in learning new concepts and
principles; they enjoy situations that require problem-solving, not
necessarily learning facts. It is less difficult for them to use the
concepts and principles they have gained if they are able to participate
actively in the learning process.

3\. First Responder students learn best if they are able to proceed at
their own pace.

4\. Motivation is increased when the content is relevant to the
immediate interests and concerns of the First Responder student.

5\. Immediate feedback is essential to the First Responder student, who
needs to be kept informed of progress continuously.

One intent of this revised curriculum is to alter the methods of
instruction used by the instructor. This curriculum has been designed
and developed to reduce the amount of lecture time and move towards an
environment of discussion and practical skills. This way both learners
and instructors are active in the process of learning.

**Some Principles of Adult Education**

**1. Attract and maintain the attention of the First Responder
student.**

If instructors get off to a bad start, it is often because they are not
able to successfully gain and maintain the attention of the student. In
these situations, students may be enthusiastic when they arrive and
disappointed when they leave.

A clear statement of the purpose of each lesson is of utmost importance
in gaining the student\'s attention. This may be accomplished by using
the information found in the motivational statement or the contextual
statement of the lesson plan.

There are many methods that may be used to gain the student\'s
attention, e.g., telling a relevant anecdote, posing a unique situation,
or asking how they would solve a problem. Once the attention of the
student is gained, it must be maintained throughout the entire lesson.
After about 15-20 minutes of presentation, it is essential that the
student be reinvolved in the learning process. Three methods are often
utilized to keep the students active in the process: questioning,
brainstorming, and demonstration.

Questions should be used to promote thought, to evaluate what has been
learned, and to continuously move students toward their desired goal.
Questioning students keeps them actively involved and keeps them
thinking. It is also appropriate to ask rhetorical questions that are
not meant to be answered by the student, but that encourage thinking.
Questions should be open-ended, that is questions should not have
\"yes\" or \"no\" answers. Questions should be a significant part of the
lesson and should be used in both didactic and practical presentation.

Brainstorming is a special and different type of questioning. This
process generates a wide variety of creative ideas. There is no right or
wrong answer, only creative thinking. A question is posed to the
students, and they are then allowed to provide as many answers as
possible. After all the ideas have been presented, the students can be
moved toward the appropriate and important points.

The third technique is demonstration, which bridges the gap between
theory and practice. When demonstrating, it is beneficial to involve the
students in the process. Demonstration should be used during the
didactic component of the presentation to break up long runs of lecture
material.

**2. Make the presentation clear and keep it organized.**

By following the lesson plans, instruction can be clear and organized.
However, there are some additional tips that may assist further.

1\. Tell the students what you are going to tell them.

2\. Tell them.

3\. Show them.

4\. Let them try.

5\. Observe.

6\. Praise progress and redirect.

7\. Tell them what you have told them.

8\. Have them summarize what they have learned.

To help keep lessons clear, the students should know the objectives. The
objectives should be presented to the students on the first day of
class. It may be beneficial to give students the written lesson plans
and allow them to write additional information in the margins.

**Conducting Patient Care Simulations in the Classroom**

Adults crave hands on training. One very effective method of teaching is
the use of a patient care simulation in the classroom. This is actually
acting out an EMS call to give the student the opportunity to respond
with equipment, evaluate the scene, assess the patient, control life
threats and do any of the treatments covered in the course which would
be appropriate while waiting for the ambulance to arrive.

Simulations give students the opportunity to demonstrate integration of
the courses cognitive, affective, and psychomotor objectives into a
real life scenario while working with a team of first responders. This
is an application which puts it all together for the student as they
will find patients in the field by incorporating their ability to hear,
see, and do as well as begin to emphasize teamwork and leadership
skills.

**Continuing Education**

It will be necessary to provide updates to the primary instructor and
assistant instructors regarding new curriculum material, and annual
updates should be scheduled to inform instructors of current trends in
out-of-hospital emergency medicine.

**Students**

**Job Description - First Responder**

The First Responder may function in the context of a broader role, i.e.,
law enforcement, fire rescue, or industrial response. With a limited
amount of equipment, the First Responder answers emergency calls to
provide efficient and immediate care to ill and injured patients. After
receiving notification of an emergency, the First Responder safely
responds to the address or location given.

 Functions in uncommon situations;

 Has a basic understanding of stress response and methods to ensure;
personal well-being;

 Has an understanding of body substance isolation;

 Understands basic medical-legal principles;

 Functions within the scope of care as defined by state, regional and
local regulatory agencies;

 Complies with regulations on the handling of the deceased, protection
of property and evidence at scene, while awaiting additional EMS
resources;

Before initiating patient care, the First Responder will \"size-up\" the
scene to determine that the scene is safe, to identify the mechanism of
injury or nature of illness, and the total number of patients, and to
request additional help if necessary. In the absence of law enforcement,
creates a safe traffic environment. Using a limited amount of equipment,
renders emergency medical care to adults, children, and infants based on
assessment findings. Duties include but are not limited to:

 Opening and maintaining an airway;

 Ventilating patients;

 Administering cardiopulmonary resuscita­tion;

 Providing emergency medical care of simple and multiple system trauma
such as:

>  Controlling hemorrhage,
>
>  Bandaging wounds,
>
>  Manually stabilizing injured extremities.

 Providing emergency medical care to:

>  Assist in childbirth
>
>  Manage general medical complaints, altered mental status, seizures,
> environmental emergencies, behavioral emergencies and psychological
> crises.

 Searching for medical identification emblems as a guide to appropriate
emergency medical care.

 Reassuring patients and bystanders by working in a confident,
efficient manner.

 Avoiding mishandling and undue haste while working expeditiously to
accomplish the task.

Where a patient must be extricated from entrapment, assesses the extent
of injury and assists other EMS providers rendering emergency medical
care and protection to the entrapped patient. Performs emergency moves
and assists other EMS providers in the use of the prescribed techniques
and appliances for safely removing the patient. Under the direction and
supervision of other EMS providers, assists in lifting the stretcher,
placing the stretcher in the ambulance, and seeing that the patient and
stretcher are secured. If needed, radios the dispatcher for additional
help or special rescue and/or utility services. In cases of multiple
patients, performs basic triage.

Reports directly to the responding EMS unit or communications center the
nature and extent of injuries, the number of patients, and the condition
of each patient. Identifies assessment findings that may require
communicating with medical oversight for advice.

Constantly assesses patient while awaiting additional EMS resources.
Administers additional care as indicated.

Orally reports their observations and emergency medical care of the
patient to the transporting EMS unit. Upon request, provides assistance
to the transporting unit staff.

After each call, restocks and replaces used supplies, cleans all
equipment following appropriate disinfecting procedures, and carefully
checks all equipment to ensure availability for next response.

Attends continuing education and refresher education programs as
required by employers, medical oversight, and licensing or certifying
agencies.

Meets qualifications within the functional job analysis. See Appendix A.

**Continuing Education and Its Importance in Lifelong Learning**

This curriculum is designed to provide the student with the essentials
to serve as a First Responder. Employers and service chiefs are strongly
encouraged to integrate new graduates into specific orientation training
programs.

It is important to understand that this curriculum does not provide
students with extensive knowledge in hazardous materials, blood-borne
pathogens, emergency vehicle operations, or rescue practices in unusual
environments. These areas are not core elements of education and
practice as identified in the *National EMS Education and Practice
Blueprint*. Identified areas of competency not specifically designed
within the First Responder: National Standard Curriculum may be taught
in conjunction with this program as a local or state option.

**Environment**

**Classroom Environment**

The intent of the revised curriculum is to allow for greater interaction
between students and instructors. The instruction should be highly
experiential and interactive. By using the procedural (how) section of
the application area of the lesson plan as well as the kinesthetic (do)
component of the student activity section, the instructor should be able
to enhance the educational experience for the students.

**Clinical/Field Rotations**

Some states may require that the student have patient interactions in a
clinical/field setting.

**Maintaining Records**

It is recommended that the Program Director/Course Coordinator maintain,
as a minimum, information on the following:

>  Student attendance and performance at each lesson, including
> comments as appropriate regarding need for improvement in skills,
> knowledge, attitudes, or personal habits.
>
>  Results of evaluation and counseling sessions.
>
>  Grades for each written examination and completed checklists for
> each skill evaluation.
>
>  Number and qualifications of the instructional team.
>
>  Instructor performance.
>
>  Cost: total program costs, costs for each program element, and costs
> per student.
>
>  Lists of enrichments and add-on courses taught in conjunction with
> the program.
>
>  Results of course entry examinations and qualifications as required
> by the certifying agency, state EMS office, course medical director,
> or training institution.

**Credentialing**

In addition to course completion state regulatory agencies may require
specific evaluation of cognitive and/or psychomotor performance prior to
official licensure, certification, or registration as a First Responder.
The National Registry of EMTs is a recognized agency that provides
examinations for such certification and registration. The program
director should contact the State Office of Emergency Medical Services
for licensure, certification, or registration information.

**Program Evaluation**

On-going evaluation of the program must be conducted to identify
instructional or organizational deficiencies affecting student
performance. The evaluation process should be two-fold in nature,
objective and subjective. Two main methods of objective evaluation
generally used are:

> 1\) How well do students measure up to standardized examination?
>
> 2\) How well do First Responders practice in accordance with
> established standards of care?

Group and individual deficiencies may indicate problems in the training
program.

Subjective evaluation should be conducted at regular intervals by
providing students with written questions on their opinions of the
program\'s strengths and weaknesses. Students should be given the
opportunity to comment on the primary and assistant instructors,
presenta­tion styles and effectiveness. Students should also be asked to
comment on the program\'s compliance with specified course of
instruction, the quality and quantity of psychomotor skills labs, and
the face validity of the examinations.

The purpose of this evaluation process is to strengthen future training
efforts. All information obtained as part of the subjective evaluation
should be reviewed for legitimacy and possible incorporation into the
course. Due to the important nature of this educational program, every
effort should be made to ensure instruction of the highest quality.

**Facilities**

The physical environment of the First Responder program is a critical
component for the success of the overall program. The facility should
have a large hall with sufficient space for seating all students.
Abundant space should be made available for demonstrations. Additional
rooms or adequate space should be available as a practice areas.

It is recommended that all the required equipment for the program be
stored at the facility for ready availability. The facility should be
well lit for adequate viewing of various types of visual aids and
demonstra­tions. Heating and ventilation should assure student and
instructor comfort, and the seats should be comfortable with desk tops
or tables for taking notes. There should be an adequate number of tables
for display of equipment, medical supplies, and training aids. A
chalkboard (flip chart or grease board) should be in the main hall. A
projection screen and appropriate audio visual equipment should be
located in the presentation facility. If possible, light switches should
be conveniently located in the presentation area. The practice areas
should be carpeted and large enough to accommodate six students, one
instructor, and the necessary equipment and medical supplies. Tables
should be available for practice areas, with appropriate and sufficient
equipment and medical supplies.

**Course Cost**

The cost for the provision of the First Responder education varies
widely across the nation. Training considerations provided in this
section may serve as a basis for estimating costs for conducting a First
Responder program. Additional costs will be incurred in the management
and evaluation of the program. Specifically, the course director should
consider costs associated with the following:

**1. Compensation**

>  Program director
>
>  Medical director
>
>  Course coordinator
>
>  Primary instructor
>
>  Assistant instructors

**2. Facilities**

>  Classroom and associated equipment (tables, chairs, audio-visual
> equipment)
>
>  Field and clinical training facilities
>
>  Office space and associated equipment (desks, chairs, files)

**3. Materials**

>  Emergency medical care equipment and supplies
>
>  Educational aids (slides, film, video, flip chart, projection
> equipment, screens, handouts)
>
>  Documents, e.g., Instructor\'s Course Guide, Instructor\'s Lesson
> Plans, text material, study guides, reference books
>
> Student and instructor recruiting materials, registration forms, data
> collection forms, records and reports, and postage should be
> considered in the formal budget.

**4. Travel and per diem, as appropriate**

>  Medical director
>
>  Program director
>
>  Course coordinator
>
>  Primary instructor
>
>  Assistant instructors
>
>  Students

**5. Examination and certification costs**

> Examination and certification costs are as specified by the state
> emergency medical services office. If it is necessary to provide
> instruction to the primary instructor or assistant instructors, that
> cost should also be considered in calculating the overall cost of the
> First Responder program. In addition, it will be necessary to provide
> updates to the primary instructor and assistant instructors regarding
> new curriculum material. Annual updates should be scheduled to inform
> instructors of current trends in out-of-hospital emergency medicine.

**Module 1: Preparatory**

**Lesson 1-1 Introduction to EMS Systems**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem-solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

1-1.1 Define the components of Emergency Medical Services (EMS) systems.
(C-1)

1-1.2 Differentiate the roles and responsibilities of the First
Responder from other out-of-hospital care providers. (C-3)

1-1.3 Define medical oversight and discuss the First Responder\'s role
in the process. (C-1)

1-1.4 Discuss the types of medical oversight that may affect the medical
care of a First Responder. (C-1)

1-1.5 State the specific statutes and regulations in your state
regarding the EMS system. (C-1)

**Affective Objectives**

1-1.6 Accept and uphold the responsibilities of a First Responder in
accordance with the standards of an EMS professional. (A-3)

1-1.7 Explain the rationale for maintaining a professional appearance
when on duty or when responding to calls. (A-3)

1-1.8 Describe why it is inappropriate to judge a patient based on a
cultural, gender, age, or socioeconomic model, and to vary the standard
of care rendered as a result of that judgement. (A-3)

**Psychomotor Objectives**

***No psychomotor objectives identified.***

**Preparation**

**Motivation:**

> The field of out-of-hospital emergency medical care is an evolving
> profession in which the reality of life and death is confronted at a
> moment\'s notice. EMS has developed from the days when the local
> funeral home served as the ambulance provider to a far more
> sophisticated system today. First Responders work within the EMS
> system to help deliver professional out-of-hospital emergency medical
> care. This course is designed to help the new First Responder gain the
> knowledge, skills, and attitudes necessary to be a competent,
> productive, and valuable member of the emergency medical services
> team.

**Prerequisites:**

None

**Materials**

**AV Equipment:**

> Utilize various audio-visual materials relating to emergency medical
> care. The continuous development of new audio-visual materials
> relating to EMS requires careful review to determine which best meet
> the needs of the program. Materials should be edited to ensure that
> the objectives of the curriculum are met.

**EMS Equipment:**

None required

**Personnel**

**Primary Instructor:**

> One First Responder Instructor knowledgeable in First Responder Course
> overview, administrative paperwork, certification requirements,
> Americans with Disabilities Act issues, and roles and responsibilities
> of the First Responder. The medical director should be present for the
> discussion of medical oversight.

**Assistant Instructor:**

None required

**Recommended Minimum Time to Complete:**

One hour

**Presentation**

**Declarative (What)**1. Course Overview

> A. Paperwork
>
> 1\. School
>
> 2\. State
>
> 3\. Local
>
> B. Course description and expectations
>
> C. Immunizations/physical exam
>
> D. Review criteria for certification
>
> 1\. Successful course completion
>
> 2\. Mentally/physically meet criteria of safe and effective practice
> of job functions. **(REFER TO APPENDIX A, Functional Job Analysis)**
>
> 3\. Written examination
>
> 4\. Practical examination
>
> 5\. State and local provisions
>
> E. Policy on the Americans with Disabilities Act (ADA)

1\. School policies

> 2\. State policies
>
> 3\. Local Policies
>
> F. Policy on harassment in the classroom environment
>
> 1\. School policies
>
> 2\. State policies
>
> 3\. Local Policies
>
> G. Advancement to the EMT-Basic Level

I. The Emergency Medical Services System and the First Responder

> A. Overview of the Emergency Medical Services system
>
> 1\. A network of resources to provide emergency care and transport to
> victims of sudden illness and injury
>
> a\. Prevention of injury
>
> b\. Occurrence of the event
>
> c\. Recognition of the event and activation of the system
>
> d\. Bystander care/dispatch instructions
>
> e\. Arrival of First Responders
>
> (1 Fire/Rescue Personnel
>
> (2 Law enforcement
>
> (3 Industrial response teams
>
> f\. Arrival of additional EMS resources
>
> g\. Emergency medical care at the scene
>
> h\. Transport to receiving facility
>
> i\. Transfer to in-hospital care system
>
> 2\. Ten Classic Components of an EMS System
>
> a\. Regulation and policy
>
> b\. Resource management
>
> c\. Human resources and training
>
> d\. Transportation
>
> e\. Facilities
>
> f\. Communications
>
> g\. Public information and education
>
> h\. Medical oversight
>
> i\. Trauma systems
>
> j\. Evaluation
>
> 3\. Access to the emergency medical services system
>
> a\. 9-1-1
>
> (1 Basic
>
> (2 Enhanced 9-1-1
>
> b\. Non 9-1-1
>
> 4\. Levels of training
>
> a\. First Responder
>
> b\. EMT-Basic
>
> c\. EMT-Intermediate
>
> d\. EMT-Paramedic
>
> 5\. The in-hospital care system
>
> a\. Emergency departments
>
> b\. Specialty facilities
>
> (1 Trauma centers
>
> (2 Burn centers
>
> (3 Pediatric Centers
>
> (4 Perinatal centers
>
> (5 Poison centers
>
> c\. Hospital personnel
>
> (1 Physicians
>
> (2 Nurses
>
> (3 Other allied health professionals
>
> 6\. Overview of the local EMS system
>
> B. Roles of the First Responder

1\. Personal, crew, patient, and bystander safety

> 2\. Gaining access to the patient
>
> 3\. First Responder patient assessment to identify life threatening
> conditions
>
> 4\. Continuation of care through additional EMS resources
>
> 5\. Initial patient care based on assessment findings
>
> 6\. Assisting with the additional care
>
> 7\. Participation in record keeping/data collection as per local/state
> requirements

8\. Liaison with other public safety workers

> a\. Local law enforcement
>
> b\. State and federal law enforcement
>
> c\. Fire departments
>
> d\. EMS Providers
>
> C. Responsibilities of the First Responder
>
> 1\. Personal health and safety
>
> 2\. Maintain caring attitude - reassure and comfort patient, family,
> and bystanders while awaiting additional EMS resources
>
> 3\. Maintain composure
>
> 4\. Neat, clean, and professional appearance
>
> 5\. Maintain up-to-date knowledge and skills
>
> a\. Continuing education
>
> b\. Refresher courses
>
> 6\. Put patient\'s needs as a priority without endangering self.
>
> 7\. Maintain current knowledge of local, state, and national issues
> affecting EMS.
>
> D. Medical Oversight
>
> 1\. Definition
>
> a\. A formal relationship between the EMS providers and the physician
> responsible for the out-of-hospital emergency medical care provided in
> a community.
>
> b\. This physician is often referred to as the system medical
> director.
>
> c\. Every EMS System must have medical oversight.
>
> 2\. Types of medical oversight
>
> a\. Direct medical control
>
> (1 Also called \"on-line\", \"base station\", \"immediate\", or
> \"concurrent\"
>
> (2 Simultaneous physician direction of a field provider.
>
> (3 Communication may be via radio, telephone, or actual contact with a
> physician on-scene
>
> b\. Indirect medical control
>
> (1 Also called \"off-line\", \"retrospective\", or \"prospective\"
>
> (2 Includes everything that is not direct medical control
>
> (3 System elements under medical oversight include:
>
> (a system design
>
> (b protocol development
>
> (c education
>
> (d quality management
>
> 3\. The relationship of the First Responder to medical oversight
>
> a\. The First Responder may be a designated agent of the physician
>
> b\. Care rendered may be considered an extension of the medical
> director\'s authority (varies by state law).
>
> E. Specific statutes and regulations regarding EMS in your state

**Application**

**Procedural (How)**

None identified for this lesson.

**Contextual (When, Where, Why)**

> The student will use this information throughout the course to enhance
> his understanding and provide direction for the First Responder\'s
> relationship to the individual components of the EMS system. The
> lesson will provide the student with a road map for learning the skill
> and knowledge domains of the First Responder. Additionally, this
> lesson will identify that not all students meet the mental and
> physical requirements of the career field. After completion of the
> course, the First Responder will use this information to understand
> the process of gaining and maintaining certification, as well as
> understanding state and local legislation affecting the profession.
> This lesson sets the foundation for the remaining teaching/learning
> process. A positive, helpful attitude presented by the instructor is
> *essential* to assuring a positive, helpful attitude from the student.

**Student Activities**

**Auditory (Hearing)**

> 1\. Students will hear specifically what they can expect to receive
> from the training program.
>
> 2\. Students will hear the specific expectations of the training
> program.
>
> 3\. Students will hear actual state and local legislation relative to
> EMS practice and certification.

**Visual (Seeing)**

> 1\. Students will see audio-visual materials explaining the components
> of the health care system, First Responder level of care, First
> Responder\'s roles and responsibilities, professional attributes, and
> certification requirements.
>
> 2\. Students will receive a copy of the cognitive, affective, and
> psychomotor objectives for the entire curriculum.
>
> 3\. Students will receive the final skill evaluation instruments.

**Kinesthetic (Doing)**

> 1\. Students will complete the necessary course paperwork.
>
> 2\. Students will practice situations in which First Responders
> portray professional attributes.
>
> 3\. Students will indicate if they will require/request assistance
> during the course or certification process based on the Americans with
> Disabilities Act. Additionally, students will provide the necessary
> documentation to support the requirements/request.

**Instructor Activities**

Facilitate discussion and supervise practice.

> Reinforce student progress in cognitive, affective, and psychomotor
> domains.
>
> Redirect students having difficulty with content. (Complete
> remediation form.)

**Evaluation**

**Written:**

> Develop evaluation instruments, e.g., quizzes, oral reviews, and
> handouts, to determine if the students have met the cognitive and
> affective objectives of this lesson.

**Practical:**

> Evaluate the actions of the First Responder students during role play,
> practice or other skill stations to determine their compliance with
> the cognitive and affective objectives and their mastery of the
> psychomotor objectives of this lesson.

**Remediation**

> Identify students or groups of students who are having difficulty with
> this subject content. Complete remediation sheet from the
> instructor\'s course guide.

**Enrichment**

> What is unique in the local area concerning this topic? Complete
> enrichment sheets from instructor\'s course guide and attach with
> lesson plan.

**Lesson 1-2**

**The Well-Being of the First Responder**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem-solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

1-2.1 List possible emotional reactions that the First Responder may
experience when faced with trauma, illness, death, and dying. (C-1)

1-2.2 Discuss the possible reactions that a family member may exhibit
when confronted with death and dying. (C-1)

1-2.3 State the steps in the First Responder\'s approach to the family
confronted with death and dying. (C-1)

1-2.4 State the possible reactions that the family of the First
Responder may exhibit. (C-1)

1-2.5 Recognize the signs and symptoms of critical incident stress.
(C‑1)

1-2.6 State possible steps that the First Responder may take to help
reduce/alleviate stress. (C-1)

1-2.7 Explain the need to determine scene safety. (C-2)

1-2.8 Discuss the importance of body substance isolation (BSI). (C-1)

1-2.9 Describe the steps the First Responder should take for personal
protection from airborne and bloodborne pathogens. (C-1)

1-2.10 List the personal protective equipment necessary for each of the
following situations:(C-1)

> \- Hazardous materials
>
> \- Rescue operations
>
> \- Violent scenes

\- Crime scenes

\- Electricity

\- Water and ice

\- Exposure to bloodborne pathogens

\- Exposure to airborne pathogens

**Affective Objectives**

At the completion of this lesson, the First Responder student will be
able to:

1-2.11 Explain the importance for serving as an advocate for the use of
appropriate protective equipment. (A-3)

1-2.12 Explain the importance of understanding the response to death and
dying and communicating effectively with the patient\'s family.

1-2.13 Demonstrate a caring attitude towards any patient with illness or
injury who requests emergency medical services. (A-3)

1-2.14 Show compassion when caring for the physical and mental needs of
patients. (A-3)

1-2.15 Participate willingly in the care of all patients. (A-3)

1-2.16 Communicate with empathy to patients being cared for, as well as
with family members, and friends of the patient. (A-3)

**Psychomotor Objectives**

At the completion of this lesson, the First Responder student will be
able to:

1-2.17 Given a scenario with potential infectious exposure, the First
Responder will use appropriate personal protective equipment. At the
completion of the scenario, the First Responder will properly remove and
discard the protective garments. (P-1,2)

1-2.18 Given the above scenario, the First Responder will complete
disinfection/cleaning and all reporting documentation. (P-1,2)

**Preparation**

**Motivation:**

> First Responders encounter many stressful situations when providing
> emergency medical care to patients. These range from death and
> terminal illness to major traumatic situations and child abuse. First
> Responders will treat angry, scared, violent, seriously injured and
> ill patients and family members. The First Responder is not immune to
> the personal effects of these situations. First Responders will learn
> during this lesson what to expect and how to assist the patient,
> patient\'s family, the First Responder\'s family, and other First
> Responders in dealing with the stress. This lesson discusses methods
> of talking to friends and family, without violating confidentiality,
> but as a means of helping them cope with involvement in EMS. Finally,
> aspects of personal safety will be discussed. It is important to
> realize this is only a brief overview and will be readdressed with
> each specific skill or topic. To put this in perspective, remember: A
> dead or injured First Responder is of little or no use to a patient.

**Prerequisites:**

None

**Materials**

**AV Equipment:**

> Utilize various audio-visual materials relating to emergency medical
> care. The continuous development of new audio-visual materials
> relating to EMS requires careful review to determine which best meet
> the needs of the program. Materials should be edited to ensure that
> the objectives of the curriculum are met.

**EMS Equipment:**

Eye protection, gowns, gloves, masks, forms for reporting exposures.

**Personnel**

**Primary Instructor:**

> One First Responder instructor knowledgeable in critical incident
> stress debriefing, identifying child/elderly abuse, stages of death
> and dying, and aspects of scene safety.

**Assistant Instructor:**

None required

**Recommended Minimum Time to Complete:**

One hour

**Presentation**

**Declarative (What)**1. Emotional Aspects of Emergency Medical Care

> A. Stressful situations
>
> 1\. Examples of situations that may produce a stress response
>
> a\. Mass casualties
>
> b\. Pediatric patients
>
> c\. Death
>
> d\. Infant and child trauma
>
> e\. Amputations
>
> f\. Violence
>
> g\. Infant/child/elder/spouse abuse
>
> h\. Death/injury of co-worker or other public safety personnel
>
> 2\. The First Responder will experience personal stress as well as
> encounter patients and bystanders in severe stress.
>
> B. Death and dying
>
> 1\. Everyone is affected by death (family, First Responder,
> bystanders)
>
> 2\. Response is highly individualized
>
> 3\. The grieving process helps people cope with death
>
> 4\. You will interact with people in all phases of the grieving
> process
>
> 5\. Familiarity with the normal grieving process may provide insight
> to reactions.
>
> a\. Denial/Disbelief
>
> (1 \"Not me.\"
>
> (2 Defense mechanism creating a buffer between shock of dying and
> dealing with the illness/injury.
>
> (3 Often families will be at the denial stage, which is difficult to
> deal with.
>
> b\. Anger
>
> (1 \"Why me?\"
>
> (2 First Responders may be the target of the anger.
>
> (a Don\'t take anger or insults personally.
>
> (b Be tolerant.
>
> (c Do not become defensive.
>
> (d Employ good listening and communication skills.
>
> (e Be empathetic.
>
> c\. Bargaining
>
> (1 \"OK, but first let me\...\"
>
> \(2\) Agreement that, in the patient\'s mind, will postpone the death
> for a short time.
>
> d\. Depression
>
> (1 Characterized by sadness and despair.
>
> (2 Patient is usually silent and retreats into his own world.
>
> e\. Acceptance
>
> (1 Does not mean the patient will be happy about dying.
>
> (2 The family will usually require more support during this stage than
> the patient.
>
> 6\. Dealing with the dying patient and family members
>
> a\. Patient needs include dignity, respect, sharing, communication,
> privacy, and control.
>
> b\. Allow family members to express rage, anger, and despair.
>
> c\. Listen empathetically.
>
> d\. Do not falsely reassure.
>
> e\. Use a gentle tone of voice.
>
> f\. Let the patient know that everything that can be done to help will
> be done.
>
> g\. Use a reassuring touch, if appropriate.
>
> h\. Comfort the family.
>
> C. Stress management
>
> 1\. Recognize warning signs
>
> a\. Irritability to co-workers, family, friends
>
> b\. Inability to concentrate
>
> c\. Difficulty sleeping/nightmares
>
> d\. Anxiety
>
> e\. Indecisiveness
>
> f\. Guilt
>
> g\. Loss of appetite
>
> h\. Loss of interest in sexual activities
>
> i\. Isolation
>
> j\. Loss of interest in work
>
> 2\. Life-style changes
>
> a\. Helpful for \"job burnout\"
>
> b\. Change diet
>
> (1 Reduce sugar, caffeine, and alcohol intake
>
> (2 Avoid fatty foods
>
> c\. Avoid alcohol
>
> d\. Exercise
>
> e\. Practice relaxation techniques, meditation, visual imagery
>
> 3\. Balance work, recreation, family, health, etc.
>
> 4\. EMS personnel and their families and friends responses
>
> a\. Lack of understanding
>
> b\. Fear of separation and being ignored
>
> c\. On-call situations cause stress
>
> d\. Frustration caused by wanting to share
>
> 5\. Work environment changes
>
> a\. Request work shifts allowing for more time to relax with family
> and friends.
>
> b\. Request a rotation of duty assignment to a less stressful
> assignment.
>
> 6\. Seek/refer professional help.
>
> a\. Mental health professionals
>
> b\. Social workers
>
> c\. Clergy

D. Comprehensive critical incident stress management includes:

> 1\. Pre-incident stress education
>
> 2\. On-scene peer support
>
> 3\. One-on-one support
>
> 4\. Disaster support services
>
> 5\. Critical Incident Stress Debriefing (CISD)
>
> 6\. Follow-up services
>
> 7\. Spouse/family support
>
> 8\. Community outreach programs
>
> 9\. Other health and welfare programs such as wellness programs
>
> E. Critical incident stress
>
> 1\. The normal stress response to abnormal circumstances
>
> 2\. A system has been developed to assist emergency workers to cope
> with stressful situations.
>
> 3\. Usually consists of a team of peer counsellors and mental health
> professionals.
>
> 4\. Designed to accelerate the normal recovery process after
> experiencing a critical incident.
>
> 5\. Techniques
>
> a\. Defusings
>
> \(1\) Much shorter, less formal and less structured version of CISD
>
> \(2\) Used a few hours after the event
>
> \(3\) Last 30-45 minutes.
>
> \(4\) Allow for initial ventilation
>
> \(5\) May eliminate the need for a formal debriefing
>
> \(6\) May enhance the formal debriefing.
>
> b\. Debriefings
>
> \(1\) Meeting is held within 24 to 72 hours of a major incident.
>
> \(2\) Open discussion of feelings, fears, and reactions
>
> \(3\) Not an investigation or interrogation
>
> \(4\) All information is confidential
>
> \(5\) CISD leaders and mental health personnel evaluate the
> information and offer suggestions on overcoming the stress.
>
> 6\. When to access CISD
>
> a\. Line of duty death or serious injury
>
> b\. Multiple casualty incident
>
> c\. Suicide of an emergency worker
>
> d\. Serious injury or death of children
>
> e\. Events with excessive media interest
>
> f\. Victims known to the emergency personnel
>
> g\. Event that has unusual impact on the personnel
>
> h\. Any disaster
>
> 7\. How to access the local CISD system

I. Body Substance Isolation (BSI)

> A. First Responders must be aware of the risks associated with
> emergency medical care.
>
> 1\. Barrier devices or ventilation masks should be used when
> ventilating a patient.
>
> 2\. Personal protective equipment should be utilized as needed or
> required by the local system.
>
> 3\. First responders are exposed to infectious diseases when treating
> patients.
>
> a\. Assess potential for risk
>
> b\. Take appropriate precautions
>
> B. OSHA/state regulations regarding BSI
>
> C. Infection Control
>
> 1\. Techniques to prevent disease transmission
>
> a\. Hand‑washing/personal hygiene
>
> b\. Equipment replacement, cleaning, and disinfection
>
> 2\. Body substance isolation
>
> a\. Eye protection
>
> \(1\) If prescription eyeglasses are worn, then removable side shields
> can be applied to them.
>
> \(2\) Goggles are NOT required.
>
> b\. Gloves (vinyl or latex, synthetic)
>
> \(1\) Needed for contact with blood or other body fluids.
>
> \(2\) Should be changed between contact with different patients.
>
> c\. Gloves (utility) - needed for cleaning vehicles and equipment
>
> d\. Gowns
>
> \(1\) Needed for large splash situations such as with childbirth and
> major trauma.
>
> \(2\) Change of uniform is preferred.
>
> e\. Masks
>
> \(1\) Surgical type for possible blood splatter (worn by care
> provider)
>
> \(2\) High Efficiency Particulate Air (HEPA) respirator (worn by
> provider) if patient is suspected of or diagnosed with tuberculosis.
> HEPA filters are primarily used in enclosed spaces - uncommon for
> First Responder
>
> \(3\) Airborne disease - surgical type mask (worn by patient)
>
> f\. Requirements and availability of specialty training
>
> 3\. Recommended immunizations
>
> a\. Tetanus prophylaxis
>
> b\. Hepatitis B vaccine
>
> c\. Tuberculin testing
>
> d\. Others
>
> e\. Access or availability of immunizations in the community
>
> D. Statutes/regulations reviewing notification and testing in an
> exposure incident

II\. Scene Safety

> A. Scene safety
>
> 1\. Definition - an assessment of the scene and surroundings that will
> provide valuable information to the First Responder and will help
> ensure the well-being of the First Responder.
>
> 2\. Personal protection - Is it safe to approach the patient?
>
> a\. Crash/rescue scenes
>
> b\. Toxic substances - low oxygen areas
>
> c\. Crime scenes - potential for violence
>
> d\. Unstable surfaces: slope, ice, water
>
> 3\. Protection of the patient - environmental considerations
>
> 4\. Protection of bystanders - do not let the bystander become ill or
> injured
>
> 5\. If the scene is unsafe, make it safe. Otherwise, do not enter.
>
> B. Personal Protection
>
> 1\. Hazardous materials
>
> a\. Identification of potential hazards
>
> \(1\) Binoculars
>
> \(2\) Placards
>
> \(3\) [Hazardous Materials, The Emergency Response
> Handbook,]{.underline} published by the United States Department of
> Transportation
>
> b\. First Responders provide care only after the scene is safe and
> containment is completed.
>
> c\. Hazardous materials scenes are controlled by hazardous materials
> teams.
>
> d\. Requirements and availability of specialty training
>
> e\. Accessing local teams
>
> 2\. Motor vehicle crashes
>
> a\. Identify and reduce potential life threats
>
> \(1\) Electricity
>
> \(2\) Fire
>
> \(3\) Explosion
>
> \(4\) Hazardous materials
>
> \(5\) Traffic
>
> b\. Dispatch rescue teams for extensive or heavy rescue
>
> 3\. Violence
>
> a\. Violent scenes should always be controlled by law enforcement
> personnel before the First Responder enters the scene and provides
> patient care.
>
> b\. Actions at crime scene
>
> \(1\) Do not disturb the scene unless required for medical care.
>
> \(2\) Maintain a chain of evidence.

**Application**

**Procedural (How)**

> 1\. The First Responder will know how to access additional information
> on hazardous materials and infectious disease exposure, notification
> and follow-up.

**Contextual (When, Where, Why)**

> 1\. The First Responder will use the aspects of scene safety and
> personal protection every day and on every emergency run.
>
> 2\. While the First Responder may not be a member of a hazardous
> material or heavy rescue team, this lesson should provide the personal
> incentive to seek out and attend continuing education programs
> relative to personal safety during hazardous material incidents,
> rescue situations, and violent crime scenes.
>
> 3\. If the First Responder fails to develop personal safety skills,
> his or her First Responder career may come to a premature end through
> serious injury or death.
>
> 4\. The well-being of the First Responder depends upon the ability to
> recognize that stressful traumatic situations do occur and that the
> effect of those situations is felt by the patient, family members, and
> the First Responder. In recognizing this, the First Responder must be
> aware of internal and external mechanisms to help himself or herself,
> the patient, the patient\'s family, First Responder\'s family, and
> other First Responder\'s deal with reactions to stress.
>
> 5\. The First Responder will use proper communication techniques when
> dealing with the grieving process.

**Student Activities**

**Auditory (Hearing)**

> 1\. The student should hear the instructor state methods of
> communicating with patients and family members of terminally ill
> patients.
>
> 2\. The student should hear the instructor state methods of
> communicating with friends and family members of a dead or dying
> patient.

**Visual (Seeing)**

> 1\. The student should see various audio-visual materials of scenes
> requiring personal protection.
>
> 2\. The student should see various audio-visual materials of personal
> protection clothing worn by hazardous material/rescue teams.
>
> 3\. The student should see the gown, gloves, masks, and eye protection
> associated with body substance isolation (BSI).

**Kinesthetic (Doing)**

> 1\. The student should role play, talking to patients in various
> stressful/traumatic situations.
>
> 2\. The student should practice putting on and removing gowns, gloves
> and eye protection gear.

**Instructor Activities**

Facilitate discussion and supervise practice.

> Reinforce student progress in cognitive, affective, and psychomotor
> domains.
>
> Redirect students having difficulty with content. (Complete
> remediation form.)

**Evaluation**

**Written:**

> Develop evaluation instruments, e.g., quizzes, oral reviews, and
> handouts, to determine if the students have met the cognitive and
> affective objectives of this lesson.

**Practical:**

> Evaluate the actions of the First Responder students during role play,
> practice or other skill stations to determine their compliance with
> the cognitive and affective objectives and their mastery of the
> psychomotor objectives of this lesson.

**Remediation**

> Identify students or groups of students who are having difficulty with
> this subject content. Complete remediation sheet from the
> instructor\'s course guide.

**Enrichment**

> What is unique in the local area concerning this topic? Complete
> enrichment sheets from instructor\'s course guide and attach with
> lesson plan.

**Lesson 1-3**

**Legal and Ethical Issues**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem-solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

1-3.1 Define the First Responder scope of care. (C-1)

1-3.2 Discuss the importance of Do Not Resuscitate \[DNR\] (advance
directives) and local or state provisions regarding EMS application.
(C‑1)

1-3.3 Define consent and discuss the methods of obtaining consent. (C-1)

1-3.4 Differentiate between expressed and implied consent. (C-3)

1-3.5 Explain the role of consent of minors in providing care. (C-1)

1-3.6 Discuss the implications for the First Responder in patient
refusal of transport. (C-1)

1-3.7 Discuss the issues of abandonment, negligence, and battery and
their implications to the First Responder. (C-1)

1-3.8 State the conditions necessary for the First Responder to have a
duty to act. (C-1)

1-3.9 Explain the importance, necessity and legality of patient
confidentiality. (C-1)

1-3.10 List the actions that a First Responder should take to assist in
the preservation of a crime scene. (C-3)

1-3.11 State the conditions that require a First Responder to notify
local law enforcement officials. (C-1)

1-3.12 Discuss issues concerning the fundamental components of
documentation. (C-1)

**Affective Objectives**

At the completion of this lesson, the First Responder student will be
able to:

1-3.13 Explain the rationale for the needs, benefits and usage of
advance directives. (A-3)

1-3.14 Explain the rationale for the concept of varying degrees of DNR.
(A-3)

**Psychomotor Objectives**

***No psychomotor objectives identified.***

**Preparation**

**Motivation:**

> Legal and ethical issues are a vital element of the First Responder\'s
> daily life. Should a First Responder stop and treat an automobile
> crash victim when off duty? Should patient information be released to
> the attorney on the telephone? Can a child with a broken arm be
> treated even though the parents are not at home and/or only the child
> care provider is around? These and many other legal and ethical
> questions face the First Responder every day. Guidance will be given
> in this lesson to answer these questions and learn how to make the
> correct decision when other legal and ethical questions arise.

**Prerequisites:**

None.

**Materials**

**AV Equipment:**

> Utilize various audio-visual materials relating to emergency medical
> care. The continuous development of new audio-visual materials
> relating to EMS requires careful review to determine which best meet
> the needs of the program. Materials should be edited to ensure that
> the objectives of the curriculum are met.

**EMS Equipment:**

None required.

**Personnel**

**Primary Instructor:**

> One First Responder instructor knowledgeable in the legal aspects and
> ethical issues that the First Responder will encounter.

**Assistant Instructor:**

None required

**Recommended Minimum Time to Complete:**

> One and a half hours

**Presentation**

**Declarative (What)**1. Scope of Care

> A. Legal duties to the patient, medical director, and public
>
> 1\. Provide for the well-being of the patient by rendering necessary
> interventions outlined in the scope of care.
>
> 2\. Defined by state law
>
> a\. Enhanced by medical oversight through the use of protocols and
> standing orders
>
> b\. Referenced to the National Standard Curricula
>
> 3\. Legal right to function as a First Responder may be contingent
> upon medical oversight.
>
> a\. Telephone/radio communications
>
> b\. Approved standing orders/protocols
>
> c\. Responsibility to medical oversight
>
> B. Ethical responsibilities
>
> 1\. Make the physical/emotional needs of the patient a priority.
>
> 2\. Practice of skills to the point of mastery.
>
> 3\. Attend continuing education/refresher programs.
>
> 4\. Review performances, seeking ways to improve response time,
> patient outcome, communication.
>
> 5\. Honesty in reporting

I. Competence

> A. Competence is the ability to understand the questions of the First
> Responder and to understand the implications of decisions made.
>
> B. In order for a First Responder to receive consent or refusal of
> care, the First Responder should determine competence.
>
> C. May not be possible in certain cases:
>
> 1\. Intoxication
>
> 2\. Drug ingestion
>
> 3\. Serious injury
>
> 4\. Mental incompetence

II\. Consent

> A. A competent patient has the right to make decisions regarding care.
>
> B. A patient must consent to emergency medical care.
>
> C. The acceptance of care based on the information provided
>
> D. Types of consent
>
> 1\. Expressed
>
> a\. Patient must be competent and of legal age
>
> b\. Patient must be informed of the steps of the procedures and all
> related risks.
>
> c\. Must be obtained from every responsive, mentally competent adult
> before rendering emergency medical care.
>
> d\. Methods of obtaining consent
>
> \(1\) Identify yourself
>
> \(2\) Inform the patient of your level of training
>
> \(3\) Explain the procedures to the patient
>
> \(a\) Identify the benefits
>
> \(b\) Identify the risks
>
> 2\. Implied
>
> a\. Consent assumed from the unresponsive patient requiring emergency
> intervention
>
> b\. Based on the assumption that the unresponsive patient would
> consent to life saving interventions
>
> E. Children and mentally incompetent adults
>
> 1\. Consent for emergency medical care must be obtained from the
> parent or legal guardian.
>
> a\. Emancipation issues
>
> b\. State regulations regarding age of minors
>
> 2\. When life threatening situations exist and the parent or legal
> guardian is not available for consent, emergency medical care should
> be rendered based on implied consent.

III\. Advance Directives/Do Not Resuscitate (DNR) orders

> A. Patient has the right to refuse resuscitative efforts.
>
> B. In general, requires written order from physician.
>
> C. Review state and local legislation/protocols relative to DNR orders
> and advance directives.
>
> D. When in doubt or when written orders are not present, the First
> Responder should begin resuscitation efforts.

IV\. Refusals

> A. Competent adult patients have the right to refuse emergency medical
> care.
>
> B. The First Responder should not make an independent decision
> regarding the refusal of care.
>
> C. The patient may withdraw from emergency medical care at any time.
> Example: an unresponsive patient regains responsiveness and refuses
> transport to the hospital.
>
> D. Refusals must be made by mentally competent adults following the
> rules of expressed consent.
>
> E. The patient must be informed of and fully understand all the risks
> and consequences associated with refusal of emergency medical care
>
> F. When in doubt, err in favor of providing care.
>
> G. The First Responder must ensure that additional EMS resources will
> evaluate the patient.
>
> H. While awaiting arrival of additional EMS resources the First
> Responder should:
>
> 1\. Try again to persuade the patient to accept care.
>
> 2\. Determine whether the patient is able to make a rational, informed
> decision, e.g., is not under the influence of alcohol or other drugs
> or illness/injury effects.
>
> 3\. Inform the patient why he/she should accept care and what may
> happen to him if he does not.
>
> 4\. Consult medical oversight as directed by local protocol.
>
> 5\. Consider assistance of law enforcement.
>
> 6\. Report any assessment findings and emergency medical care
> provided.

V. Assault/Battery

> A. Not a universal definition
>
> B. Unlawfully touching a patient without consent
>
> C. Providing emergency medical care when a competent patient does not
> consent to the emergency medical care

VI\. Abandonment - terminating care of the patient without insuring that
care will continue at the same level or higher.

VII\. Negligence

> A. Deviation from the accepted standard of care resulting in further
> injury to the patient.
>
> B. Components of negligence
>
> 1\. Duty
>
> a\. Duty to Act
>
> \(1\) A contractual or legal obligation must exist.
>
> \(2\) Formal - As part of First Responder\'s occupation, they are
> required to render emergency medical care.

\(3\) Implied

> \(a\) Patient calls for assistance and the dispatcher confirms that
> help is being sent.
>
> \(b\) The First Responders are dispatched as part of the EMS response.
>
> \(c\) Emergency medical care is begun on a patient.
>
> \(4\) \"Legal\" duty to act
>
> \(a\) Varies according to state law

\(b\) Moral considerations

> \(c\) Ethical considerations.
>
> \(5\) Specific state regulations regarding duty to act.
>
> b\. Duty to act appropriately
>
> \(1\) Following guidelines for standards of care
>
> \(2\) Acting as another prudent individual would in that situation
>
> 2\. Breach of the duty
>
> a\. Failure to act
>
> b\. Failure to act appropriately
>
> 3\. Injury/damages were inflicted
>
> a\. Physical
>
> b\. Psychological
>
> 4\. The actions or lack of actions of the First Responder caused the
> injury/damage.

VIII\. Confidentiality

> A. Confidential information
>
> 1\. Patient history gained through interview
>
> 2\. Assessment findings
>
> 3\. Emergency medical care rendered
>
> B. Releasing confidential information
>
> 1\. Release of information requires a written release form signed by
> the patient.
>
> 2\. Do not release any patient information on request, unless
> authorized in writing.
>
> 3\. Release are not required when:
>
> a\. Other health care providers need to know information to continue
> care.
>
> b\. State law requires reporting incidents (examples: rape, abuse or
> gun shot wounds).
>
> c\. Subpoena

IX\. Special Situations - Medical Identification Insignia

> A. Bracelet, necklace, card
>
> B. Indicates a medical condition of the patient
>
> 1\. Allergies
>
> 2\. Diabetes
>
> 3\. Epilepsy

X. Potential Crime Scene/Evidence Preservation

> A. Dispatch should notify police personnel.
>
> B. Responsibility of the First Responder
>
> 1\. Emergency medical care of the patient is the First Responder\'s
> priority.
>
> 2\. Do not disturb any item at the scene unless emergency medical care
> requires it.
>
> 3\. Observe and document anything unusual at the scene.
>
> 4\. If possible, do not cut through holes in clothing from gunshot
> wounds or stabbing.

XI\. Documentation

> A. Fundamental medical documentation
>
> 1\. System/local requirements for documentation
>
> 2\. State requirements for documentation
>
> B. Special Reporting Situations
>
> C. Established by state regulations or statutes and may vary from
> state to state
>
> D. Commonly required reporting situations
>
> 1\. Abuse
>
> a\. Child
>
> b\. Elderly
>
> c\. Spouse
>
> 2\. Crime
>
> a\. Wounds sustained or potentially sustained by violent crime
>
> b\. Sexual assault
>
> E. Infectious disease exposure

**Application**

**Procedural (How)**

None identified for this lesson.

**Contextual (When, Where, Why)**

> Legal and ethical issues are present in every aspect of patient care.
> Decisions to treat or not treat a patient, to release or not release
> information, to report or not report an incident all require a
> knowledge of current state and local legislation, policy, and
> protocol. Up-to-date knowledge of the current legal interpretation of
> issues such as negligence, battery, confidentiality, consent, and
> refusal of emergency medical care is essential for the First
> Responder.

**Student Activities**

**Auditory (Hearing)**

> 1\. Students should hear actual case law and common law decisions
> relative to First Responder care.

**Visual (Seeing)**

> 1\. Students should see actual copies of medical identification
> insignia, organ donor cards, Do Not Resuscitate orders, and
> information release forms.
>
> 2\. Students should see audio-visual materials of definitions of legal
> terms such as negligence, abandonment, battery, duty to act, consent,
> confidentiality.

**Kinesthetic (Doing)**

> 1\. Students should practice making decisions while role playing the
> various legal and ethical situations that occur in the EMS environment
> (including consent, abandonment, battery, duty to act, negligence, and
> confidentiality).
>
> 2\. Students should role play situations in which DNR orders are in
> effect.
>
> 3\. Students should role play situations of patients refusing
> emergency medical care.

**Instructor Activities**

Facilitate discussion and supervise practice.

> Reinforce student progress in cognitive, affective, and psychomotor
> domains.
>
> Redirect students having difficulty with content. (Complete
> remediation form.)

**Evaluation**

**Written:**

> Develop evaluation instruments, e.g., quizzes, oral reviews, and
> handouts, to determine if the students have met the cognitive and
> affective objectives of this lesson.

**Practical:**

> Evaluate the actions of the First Responder students during role play,
> practice, or other skill stations to determine their compliance with
> the cognitive and affective objectives and their mastery of the
> psychomotor objectives of this lesson.

**Remediation**

> Identify students or groups of students who are having difficulty with
> this subject content. Complete remediation sheet from the
> instructor\'s course guide.

**Enrichment**

> What is unique in the local area concerning this topic? Complete
> enrichment sheets from instructor\'s course guide and attach with
> lesson plan.

**Lesson 1-4**

**The Human Body**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem-solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

1-4.1 Describe the anatomy and function of the respiratory system. (C-1)

1-4.2 Describe the anatomy and function of the circulatory system. (C-1)

1-4.3 Describe the anatomy and function of the musculoskeletal

> system. (C-1)

1-4.4 Describe the components and function of the nervous system. (C-1)

**Affective Objectives**

***No affective objectives identified.***

**Psychomotor Objectives**

***No psychomotor objectives identified.***

**Preparation**

**Motivation:**

> To perform an adequate patient assessment, the First Responder must be
> familiar with the normal anatomy of the human body and topographical
> terminology. This information will provide a solid cornerstone on
> which the First Responder can build the essentials of quality patient
> assessment and management.

**Prerequisites:**

None

**Materials**

**AV Equipment:**

> Utilize various audio-visual materials relating to emergency medical
> care. The continuous development of new audio-visual materials
> relating to EMS requires careful review to determine which best meet
> the needs of the program. Materials should be edited to ensure that
> the objectives of the curriculum are met.

**EMS Equipment:**

Anatomy models (skeleton, respiratory system, airway, heart)

**Personnel**

**Primary Instructor:**

> One First Responder instructor knowledgeable in human body systems and
> topographical terminology.

**Assistant Instructor:**

None required.

**Recommended Minimum Time to Complete:**

One hour

**Presentation**

**Declarative (What)**1. Body Systems

> A. The Musculoskeletal system
>
> 1\. The Skeletal System
>
> a\. Function
>
> \(1\) Gives the body shape
>
> \(2\) Protects vital internal organs
>
> b\. Components
>
> \(1\) Skull - houses and protects the brain
>
> \(2\) Face
>
> \(3\) Spinal Column
>
> \(4\) Thorax
>
> \(a\) Ribs
>
> \(b\) Breastbone (sternum)
>
> i\) Xiphoid process - lowest portion of the sternum
>
> ii\) Landmark for determining hand position for chest compressions
>
> \(5\) Pelvis

\(6\) Lower extremities

> \(a\) Thigh (femur)
>
> \(b\) Knee cap (patella)
>
> \(c\) Shin (tibia and fibula)
>
> \(d\) Ankle
>
> \(e\) Feet
>
> \(f\) Toes
>
> \(7\) Upper extremities
>
> \(a\) Shoulder (collar bone and shoulder blade)
>
> \(b\) Upper arm (humerus)
>
> \(c\) Forearm (radius and ulna)
>
> \(d\) Wrist
>
> \(e\) Hand
>
> \(f\) Fingers
>
> \(8\) Joints - where bones connect to other bones
>
> 2\. The Muscular System
>
> a\. Function
>
> \(1\) Give the body shape.
>
> \(2\) Protect internal organs.
>
> \(3\) Provide for movement.
>
> b\. Components
>
> \(1\) Voluntary (skeletal)
>
> \(a\) Attached to the bones.
>
> \(b\) Under control of the nervous system and brain. Can be contracted
> and relaxed by the will of the individual.
>
> \(c\) Responsible for movement.
>
> \(2\) Involuntary (smooth)
>
> \(a\) Found in the walls of the tubular structures of the
> gastrointestinal tract and urinary system.
>
> \(b\) Also in the blood vessels and bronchi.
>
> \(3\) Cardiac
>
> \(a\) Found only in the heart.
>
> \(b\) Can tolerate interruption of blood supply for only very short
> periods.
>
> B. The Respiratory system
>
> 1\. Function
>
> a\. Deliver oxygen to the body
>
> b\. Remove carbon dioxide from the body
>
> 2\. Components/anatomy
>
> a\. Nose and mouth
>
> b\. Pharynx
>
> \(1\) Oropharynx
>
> \(2\) Nasopharynx
>
> c\. Epiglottis - a leaf‑shaped structure that prevents food and liquid
> from entering the trachea during swallowing.
>
> d\. Windpipe (trachea)
>
> e\. Voice box (larynx)
>
> f\. Lungs
>
> g\. Diaphragm
>
> 3\. Physiology
>
> a\. Diaphragm moves down, chest moves out, drawing air into the lungs
> (inhalation)
>
> b\. Exchange of oxygen and carbon dioxide in the lungs
>
> c\. Diaphragm moves up causing air to exit the lungs (exhalation)
>
> 4\. Infant and child anatomy and physiology considerations
>
> a\. All structures are smaller and more easily obstructed than in
> adults.
>
> b\. Infants\' and children\'s tongues take up proportionally more
> space in the mouth than adults.
>
> c\. The trachea is more flexible in infants and children.
>
> d\. The primary cause of cardiac arrest in infants and children is an
> uncorrected respiratory problem.
>
> C. The Circulatory system
>
> 1\. Function
>
> a\. Deliver oxygen and nutrients to the tissues
>
> b\. Remove waste products from the tissues
>
> 2\. Components/Anatomy
>
> a\. Heart
>
> \(1\) Atrium
>
> \(a\) Right - receives blood from the veins of the body
>
> \(b\) Left - receives blood from the lungs
>
> \(2\) Ventricle
>
> \(a\) Right - pumps blood to the lungs.
>
> \(b\) Left - pumps blood to the body.
>
> \(c\) Valves prevent back flow of blood.
>
> b\. Arteries
>
> \(1\) Carry blood away from the heart to the rest of the body.
>
> \(2\) Major arteries
>
> \(a\) Carotid
>
> i\) Major artery of the neck.
>
> ii\) Pulsations can be palpated on either side of the neck.
>
> \(b\) Femoral
>
> i\) The major artery of the thigh.
>
> ii\) Pulsations can be palpated in the groin area (the crease between
> the abdomen and thigh).
>
> \(c\) Radial
>
> i\) Major artery of the lower arm.
>
> ii\) Pulsations can be palpated at palm side of the wrist thumb-side.
>
> \(d\) Brachial
>
> i\) An artery of the upper arm.
>
> ii\) Pulsations can be palpated on the inside of the arm between the
> elbow and the shoulder.
>
> c\. Capillaries
>
> \(1\) Tiny blood vessels that connect arteries to veins
>
> \(2\) Found in all parts of the body
>
> \(3\) Allow for the exchange of oxygen and carbon dioxide
>
> d\. Veins - vessels that carry blood back to the heart
>
> e\. Blood
>
> \(1\) Fluid of the circulatory system
>
> \(2\) Carries oxygen and carbon dioxide
>
> 3\. Physiology
>
> a\. Left ventricle contracts, sending a wave of blood through the
> arteries.
>
> b\. Pulse can be felt anywhere an artery passes near the skin surface
> and over a bone.
>
> \(1\) Carotid
>
> \(2\) Femoral
>
> \(3\) Radial
>
> \(4\) Brachial

D. The Nervous system

> 1\. Function
>
> a\. Controls the voluntary and involuntary activity of the body.
>
> b\. Provides for higher mental function (thought, emotion)
>
> 2\. Components/Anatomy
>
> a\. Central nervous system
>
> \(1\) Brain - located within the cranium.
>
> \(2\) Spinal cord - located within the spinal column
>
> b\. Peripheral nervous system
>
> \(1\) Sensory - carries information from the body to the brain and
> spinal cord.
>
> \(2\) Motor - carries information from the brain and spinal cord to
> the body.
>
> E. Skin
>
> 1\. Function
>
> a\. Protects the body from the environment, bacteria and other
> organisms.
>
> b\. Helps regulate the temperature of the body.
>
> c\. Prevents dehydration
>
> d\. Senses heat, cold, touch, pressure and pain; transmits this
> information to the brain and spinal cord.

**Application**

**Procedural (How)**

None identified for this lesson.

**Contextual (When, Where, Why)**

> It is of utmost importance that the First Responder have a basic level
> of knowledge concerning the human body. To accurately communicate to
> other health professionals, the First Responder must be able to
> identify topographic anatomy.
>
> The First Responder must also understand the basic components of the
> body systems. Knowledge obtained in this lesson will be extremely
> beneficial in other modules throughout this curriculum.

**Student Activities**

**Auditory (Hearing)**

> 1\. The student should hear the instructor describe the various
> components of the human body.

**Visual (Seeing)**

> 1\. The students should see models of the human body.
>
> 2\. The students should see diagrams of the human body.
>
> 3\. The students should see a skeleton of the human body.

**Kinesthetic (Doing)**

> 1\. The students should identify various structures of the human body.
>
> 2\. The students should demonstrate their ability to identify
> topographic anatomy.

**Instructor Activities**

Facilitate discussion and supervise practice.

> Reinforce student progress in cognitive, affective, and psychomotor
> domains.
>
> Redirect students having difficulty with content. (Complete
> remediation form.)

**Evaluation**

**Written:**

> Develop evaluation instruments, e.g., quizzes, oral reviews, and
> handouts, to determine if the students have met the cognitive and
> affective objectives of this lesson.

**Practical:**

> Evaluate the actions of the First Responder students during role play,
> practice or other skill stations to determine their compliance with
> the cognitive and affective objectives and their mastery of the
> psychomotor objectives of this lesson.

**Remediation**

> Identify students or groups of students who are having difficulty with
> this subject content. Complete remediation sheet from the
> instructor\'s course guide.

**Enrichment**

> What is unique in the local area concerning this topic? Complete
> enrichment sheets from instructor\'s course guide and attach with
> lesson plan.

**Lesson 1-5**

**Lifting and Moving Patients**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem-solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

1-5.1 Define body mechanics. (C-1)

1-5.2 Discuss the guidelines and safety precautions that need to be
followed when lifting a patient. (C-1)

1-5.3 Describe the indications for an emergency move. (C-1)

1-5.4 Describe the indications for assisting in non-emergency moves.
(C-1)

1-5.5 Discuss the various devices associated with moving a patient in
the out-of-hospital arena. (C-1)

**Affective Objectives**

At the completion of this lesson, the First Responder student will be
able to:

1-5.6 Explain the rationale for properly lifting and moving patients.
(A‑3)

1-5.7 Explain the rationale for an emergency move. (A-3)

**Psychomotor Objectives**

1-5.8 Demonstrate an emergency move. (P-1,2)

1-5.9 Demonstrate a non-emergency move. (P-1,2)

1-5.10 Demonstrate the use of equipment utilized to move patient\'s in
the out-of-hospital arena. (P-1,2)

**Preparation**

**Motivation:**

> Many First Responders are injured every year because they attempt to
> lift or move patients improperly.

**Prerequisites:**

None

**Materials**

**AV Equipment:**

> Utilize various audio-visual materials relating to emergency medical
> care. The continuous development of new audio-visual materials
> relating to EMS requires careful review to determine which best meet
> the needs of the program. Materials should be edited to ensure that
> the objectives of the curriculum are met.

**EMS Equipment:**

None required.

**Personnel**

**Primary Instructor:**

> One First Responder instructor knowledgeable in the principles and
> techniques of lifting and moving patients.

**Assistant Instructor:**

> The instructor-to-student ratio should be 1:6 for psychomotor skills
> practice. Individuals used as assistant instructors should be
> knowledgeable about lifting and moving patients.

**Recommended Minimum Time to Complete:**

One hour

**Presentation**

**Declarative (What)**

I. Role of the First Responder

> A. Moving patients that are in immediate danger
>
> B. Position patients to prevent further injury
>
> C. Assist other EMS responders in lifting and moving

II\. Body Mechanics/Lifting Techniques

> A. Safety precautions
>
> 1\. Use legs, not back, to lift.
>
> 2\. Keep weight as close to body as possible.
>
> B. Guidelines for lifting
>
> 1\. Consider weight of patient and the need for help.
>
> 2\. Know physical ability and limitations.
>
> 3\. Lift without twisting.
>
> 4\. Have feet positioned properly.
>
> 5\. Communicate clearly and frequently with partner and other EMS
> providers.
>
> C. Work with the EMS system in your area to practice the guidelines
> and use of equipment.

III\. Principles of Moving Patients

> A. General considerations
>
> 1\. In general, a patient should be moved [immediately]{.underline}
> (emergency move) only when:
>
> a\. There is an immediate danger to the patient if not moved.
>
> \(1\) Fire or danger of fire.
>
> \(2\) Explosives or danger of explosion
>
> \(3\) Inability to protect the patient from other hazards at the
> scene.
>
> \(4\) Inability to gain access to other patients in a vehicle who need
> life-saving care.
>
> b\. Life-saving care cannot be given because of the patient\'s
> location or position, e.g., a cardiac arrest patient sitting in a
> chair or lying on a bed.
>
> 2\. If there is no threat to life, the patient when ready for
> transportation should be moved by the EMS crew.
>
> B. Emergency moves
>
> 1\. The greatest danger in moving a patient quickly is the possibility
> of aggravating a spine injury.
>
> 2\. In an emergency, every effort should be made to pull the patient
> in the direction of the long axis of the body to provide as much
> protection to the spine as possible.
>
> 3\. It is impossible to remove a patient from a vehicle quickly and at
> the same time provide much protection to the spine.
>
> 4\. If the patient is on the floor or ground, he can be moved by:
>
> a\. Pulling on the patient\'s clothing in the neck and shoulder area.
>
> b\. Putting the patient on a blanket and dragging the blanket.
>
> c\. Putting the First Responder\'s hands under the patient\'s armpits
> (from the back), grasping the patient\'s forearms and dragging the
> patient.
>
> d\. Never pull the patient\'s head away from the neck and shoulders.
>
> C. Non-urgent moves - performed with other responders
>
> 1\. Direct ground lift (no suspected spine injury)
>
> a\. Two or three rescuers line up on one side of the patient.
>
> b\. Rescuers kneel on one knee (preferably the same for all rescuers).
>
> c\. The patient\'s arms are placed on his/her chest if possible.
>
> d\. The rescuer at the head places one arm under the patient\'s neck
> and shoulder and cradles the patient\'s head. The rescuer places
> his/her other arm under the patient\'s lower back.
>
> e\. The second rescuer places one arm under the patient\'s knees and
> one arm above the buttocks.
>
> f\. If a third rescuer is available, he should place both arms under
> the waist and the other two rescuers slide their arms either up to the
> mid-back or down to the buttocks as appropriate.
>
> g\. On signal, the rescuers lift the patient to their knees and roll
> the patient in toward their chests.
>
> h\. On signal, the rescuers stand and move the patient to the
> stretcher.
>
> i\. To lower the patient, the steps are reversed.
>
> 2\. Extremity lift (no suspected extremity injuries)
>
> a\. One rescuer kneels at the patient\'s head and one kneels at the
> patient\'s side by the knees.
>
> b\. The rescuer at the head places one hand under each of the
> patient\'s shoulders while the rescuer at the foot grasps the
> patient\'s wrists.
>
> c\. The rescuer at the head slips his/her hands under the patient\'s
> arms and grasps the patient\'s wrists.
>
> d\. The rescuer at the patient\'s foot slips his/her hands under the
> patient\'s knees.
>
> e\. Both rescuers move up to a crouching position.
>
> f\. The rescuers stand up simultaneously and move with the patient to
> a stretcher.
>
> 3\. Transfer of supine patient from bed to stretcher
>
> a\. Direct carry
>
> \(1\) Position cot perpendicular to bed with head end of cot at foot
> of bed.
>
> \(2\) Prepare cot by unbuckling straps and removing other items.
>
> \(3\) Both rescuers stand between bed and stretcher, facing patient.
>
> \(4\) First rescuer slides arm under patient\'s neck and cups
> patient\'s shoulder.
>
> \(5\) Second rescuer slides hand under hip and lifts slightly.
>
> \(6\) First rescuer slides other arm under patient\'s back.
>
> \(7\) Second rescuer places arms underneath hips and calves.
>
> \(8\) Rescuers slide patient to edge of bed.
>
> \(9\) Patient is lifted/curled toward the rescuers\' chests.
>
> \(10\) Rescuers rotate and place patient gently onto cot.
>
> b\. Draw sheet method
>
> \(1\) Loosen bottom sheet of bed.
>
> \(2\) Position cot next to bed.
>
> \(3\) Prepare cot: Adjust height, lower rails, unbuckle straps.
>
> \(4\) Reach across cot and grasp sheet firmly at patient\'s head,
> chest, hips and knees.
>
> \(5\) Slide patient gently onto cot.
>
> D. Patient positioning
>
> 1\. An unresponsive patient without trauma should be moved into the
> recovery position by rolling the patient onto his/her side (preferably
> the left).
>
> 2\. A patient with trauma should not be moved until additional EMS
> resources can evaluate and stabilize the patient.
>
> 3\. A patient experiencing pain or discomfort or difficulty breathing
> should be allowed to assume a position of comfort.
>
> 4\. A patient who is nauseated or vomiting should be allowed to remain
> in a position of comfort; however, the First Responder should be
> positioned appropriately to manage the airway.

IV\. Equipment familiarity

> A. The First Responder should be familiar with equipment used in the
> local EMS system
>
> B. Typical equipment used in EMS Systems
>
> 1\. Stretchers/cots
>
> 2\. Portable stretcher
>
> 3\. Stair chair
>
> 4\. Backboards
>
> a\. Long
>
> b\. Short
>
> 5\. Scoop or orthopedic stretcher

**Application**

**Procedural (How)**

> 1\. Show examples of situations where emergency moves are appropriate.
>
> 2\. Demonstrate emergency moves.
>
> 3\. Demonstrate positioning patients with different conditions.
>
> A. Unresponsiveness
>
> B. Chest pain/discomfort or difficulty breathing
>
> C. Patients who are vomiting or nauseated

**Contextual (When, Where, Why)**

> When to move a patient is determined by both the patient\'s condition
> and the environment in which he/she is found. The determination of how
> to move the patient is made by considering the complaint, the severity
> of the condition and the location.

**Student Activities**

**Auditory (Hearing)**

> 1\. The student should hear instructor explanations of body mechanics.
>
> 2\. The student should hear the principles of lifting and moving.
>
> 3\. The student should hear the indications for emergency moves.

**Visual (Seeing)**

> 1\. The student should see situations where emergency moves are
> appropriate.
>
> 2\. The student should see emergency moves.
>
> 3\. The student should see non-emergency moves.
>
> 4\. The student should see various lifting and moving devices.
>
> 5\. The student should see patients with different conditions
> positioned properly.
>
> A. Unresponsiveness
>
> B. Chest pain/discomfort or difficulty breathing
>
> C. Patients who are vomiting or nauseated
>
> 6\. Students should see patients moved with various lifting and moving
> devices.

**Kinesthetic (Doing)**

> 1\. The student should practice determining whether emergency, urgent,
> or non-emergency moves are appropriate.
>
> 2\. The student should practice emergency moves.
>
> 3\. The student should practice non-emergency moves.
>
> 4\. The student should practice positioning patients with different
> conditions.
>
> A. Unresponsiveness
>
> B Chest pain/discomfort or difficulty breathing
>
> C Patients who are vomiting or nauseated
>
> 5\. The student should practice using equipment for lifting and moving
> patients.

**Instructor Activities**

Facilitate discussion and supervise practice.

> Reinforce student progress in cognitive, affective, and psychomotor
> domains.
>
> Redirect students having difficulty with content (complete remediation
> form)

**Evaluation**

**Written:**

> Develop evaluation instruments, e.g., quizzes, oral reviews, and
> handouts, to determine if the students have met the cognitive and
> affective objectives of this lesson.

**Practical:**

> Evaluate the actions of the First Responder students during role play,
> practice or other skill stations to determine their compliance with
> the cognitive and affective objectives and their mastery of the
> psychomotor objectives of this lesson.

**Remediation**

> Identify students or groups of students who are having difficulty with
> this subject content. Complete remediation sheet from the
> instructor\'s course guide.

**Enrichment**

> What is unique in the local area concerning this topic? Complete
> enrichment sheets from instructor\'s course guide and attach with
> lesson plan.

**Lesson 1-6**

**Evaluation: Preparatory**

**Objectives**

**Objectives Legend**

**C=Cognitive P=Psychomotor A=Affective**

1 = Knowledge level

2 = Application level

3 = Problem solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate competence in the cognitive objectives of Lesson 1-1:
Introduction to EMS System.

 Demonstrate competence in the cognitive objectives of Lesson 1-2:
Well‑Being of the First Responder.

 Demonstrate competence in the cognitive objectives of Lesson 1-3:
Legal and Ethical Issues.

 Demonstrate competence in the cognitive objectives of Lesson 1-4: The
Human Body.

 Demonstrate competence in the cognitive objectives of Lesson 1-5:
Lifting and Moving Patients.

**Affective Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate competence in the affective objectives of Lesson 1-1:
Introduction to EMS System.

 Demonstrate competence in the affective objectives of Lesson 1-2:
Well‑Being of the First Responder.

 Demonstrate competence in the affective objectives of Lesson 1-3:
Legal and Ethical Issues.

 Demonstrate competence in the affective objectives of Lesson 1-4: The
Human Body.

 Demonstrate competence in the affective objectives of Lesson 1-5:
Lifting and Moving Patients.

**Psychomotor Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate competence in the psychomotor objectives of Lesson 1-1:
Introduction to EMS System.

 Demonstrate competence in the psychomotor objectives of Lesson 1-2:
Well‑Being of the First Responder.

 Demonstrate competence in the psychomotor objectives of Lesson 1-3:
Legal and Ethical Issues.

 Demonstrate competence in the psychomotor objectives of Lesson 1-4:
The Human Body.

 Demonstrate competence in the psychomotor objectives of Lesson 1-5:
Lifting and Moving Patients.

**Preparation**

**Motivation:**

> Evaluation of the student\'s attainment of the cognitive and affective
> knowledge and psychomotor skills is an essential component of the
> First Responder\'s educational process. The modules are presented in a
> \"building block\" format. Once the students have demonstrated their
> knowledge and proficiency, the next lesson can be built upon that
> knowledge. This evaluation will help to identify students or groups of
> students having difficulty with a particular area. This is an
> opportunity for the instructor to evaluate their performance and make
> appropriate modifications to delivery of the material.

**Prerequisites:**

Completion of Lessons 1-1 through 1-5.

**Materials**

**AV Equipment:**

Typically none required.

**EMS Equipment:**

The EMS equipment used in the Lessons of Module 1.

**Personnel**

**Primary Instructor:**

One proctor for the written evaluation.

**Assistant Instructor:**

One practical skills examiner for each 6 students.

**Recommended Minimum Time to Complete:**

One hour

**Presentation**

**Declarative (What)**

I. Purpose of the evaluation

II\. Items to be evaluated

III\. Feedback from evaluation

**Application**

**Procedural (How)**

> 1\. Written evaluation based on the cognitive and affective objectives
> of Lessons 1-1 \> 1-5.
>
> 2\. Practical evaluation stations based on the psychomotor objectives
> of Lessons 1-1 \> 1-5.

**Contextual (When, Where and Why)**

> The evaluation is the final lesson in this module and is designed to
> bring closure to the module and to assure that students are prepared
> to proceed to the next module.
>
> This modular evaluation is done to determine the effectiveness of the
> presentation of materials and how well students have retained the
> material. This is an opportunity for the students to make necessary
> adjustments in study habits or for the instructor to adjust the manner
> in which material is presented.

**Instructor Activities**

> Supervise student evaluation.
>
> Reinforce student progress in cognitive, affective, and psychomotor
> domains.
>
> Redirect students having difficulty with content. (Complete
> remediation forms.)

**Remediation**

> Identify students and/or groups of students who are having difficulty
> with this subject content. Complete a remediation sheet from the
> instructor\'s course guide. If students continue to have difficulty
> demonstrating knowledge of the cognitive and affective objectives, or
> demonstrating proficiency in psychomotor skills, the students should
> be counseled, remediated and re-evaluated. If improvements in
> cognitive, affective or psychomotor skills are not achieved,
> consideration regarding the ability of the student to progress in the
> program should be taken into account.

**Module 2: Airway**

**Lesson 2-1 Airway**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem-solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

2-1.1 Name and label the major structures of the respiratory system on a
diagram. (C-1)

2-1.2 List the signs of inadequate breathing. (C-1)

2-1.3 Describe the steps in the head-tilt chin-lift. (C-1)

2-1.4 Relate mechanism of injury to opening the airway. (C-3)

2-1.5 Describe the steps in the jaw thrust. (C-1)

2-1.6 State the importance of having a suction unit ready for immediate
use when providing emergency medical care. (C-1)

2-1.7 Describe the techniques of suctioning. (C-1)

2-1.8 Describe how to ventilate a patient with a resuscitation mask or
barrier device. (C‑1)

2-1.9 Describe how ventilating an infant or child is different from an
adult. (C-1)

2-1.10 List the steps in providing mouth‑to-mouth and mouth-to-stoma
ventilation. (C-1)

2-1.11 Describe how to measure and insert an oropharyngeal (oral)
airway. (C‑1)

2-1.12 Describe how to measure and insert a nasopharyngeal (nasal)
airway. (C-1)

2-1.13 Describe how to clear a foreign body airway obstruction in a
responsive adult. (C-1)

2-1.14 Describe how to clear a foreign body airway obstruction in a
responsive child with complete obstruction or partial airway obstruction
and poor air exchange. (C-1)

2-1.15 Describe how to clear a foreign body airway obstruction in a
responsive infant with complete obstruction or partial airway
obstruction and poor air exchange. (C-1)

2-1.16 Describe how to clear a foreign body airway obstruction in a
unresponsive adult. (C-1)

2-1.17 Describe how to clear a foreign body airway obstruction in a
unresponsive child. (C-1)

2-1.18 Describe how to clear a foreign body airway obstruction in a
unresponsive infant. (C-1)

**Affective Objectives**

At the completion of this lesson, the First Responder student will be
able to:

2-1.19 Explain why basic life support ventilation and airway protective
skills take priority over most other basic life support skills. (A-3)

2-1.20 Demonstrate a caring attitude towards patients with airway
problems who request emergency medical services. (A-3)

2-1.21 Place the interests of the patient with airway problems as the
foremost consideration when making any and all patient care decisions.
(A-3)

2-1.22 Communicate with empathy to patients with airway problems, as
well as with family members and friends of the patient. (A-3)

**Psychomotor Objectives**

At the completion of this lesson, the First Responder student will be
able to:

2-1.23 Demonstrate the steps in the head-tilt chin-lift. (P‑1,2)

2-1.24 Demonstrate the steps in the jaw thrust. (P-1,2)

2-1.25 Demonstrate the techniques of suctioning. (P-1,2)

2-1.26 Demonstrate the steps in mouth-to-mouth ventilation with body
substance isolation (barrier shields). (P‑1,2)

2-1.27 Demonstrate how to use a resuscitation mask to ventilate a
patient. (P-1,2)

2-1.28 Demonstrate how to ventilate a patient with a stoma. (P‑1,2)

2-1.29 Demonstrate how to measure and insert an oropharyngeal (oral)
airway. (P‑1,2)

2-1.30 Demonstrate how to measure and insert a nasopharyngeal (nasal)
airway. (P‑1,2)

2-1.31 Demonstrate how to ventilate infant and child patients. (P-1,2)

2-1.32 Demonstrate how to clear a foreign body airway obstruction in a
responsive adult. (C-1)

2-1.33 Demonstrate how to clear a foreign body airway obstruction in a
responsive child. (C-1)

2-1.34 Demonstrate how to clear a foreign body airway obstruction in a
responsive infant. (C-1)

2-1.35 Demonstrate how to clear a foreign body airway obstruction in an
unresponsive adult. (C-1)

2-1.36 Demonstrate how to clear a foreign body airway obstruction in an
unresponsive child. (C-1)

2-1.37 Demonstrate how to clear a foreign body airway obstruction in an
unresponsive infant. (C-1)

**Preparation**

**Motivation:**

> A patient without an airway has no chance of survival. It is important
> for the First Responder to be able to manage an airway with and
> without airway adjuncts.

**Prerequisites:**

Preparatory

**Materials**

**AV Equipment:**

> Utilize various audio-visual materials relating to emergency medical
> care. The continuous development of new audio-visual materials
> relating to EMS requires careful review to determine which best meet
> the needs of the program. Materials should be edited to ensure that
> the objectives of the curriculum are met.

**EMS Equipment:**

> Resuscitation mask, barrier devices, oral airways, nasal airways,
> suction units (manual and battery powered), suction catheters, tongue
> blade, and lubricant.

**Personnel**

**Primary Instructor:**

One First Responder instructor knowledgeable in airway management.

**Assistant Instructor:**

> The instructor-to-student ratio should be 1:6 for psychomotor skill
> practice. Individuals used as assistant instructors should be
> knowledgeable in airway techniques and management.

**Recommended Minimum Time to Complete:**

Three Hours

**Presentation**

**Declarative (What)**1. The Respiratory system

> A. Function
>
> 1\. Deliver oxygen to the body
>
> 2\. Remove carbon dioxide from the body
>
> B. Components/anatomy
>
> 1\. Nose and mouth
>
> 2\. Pharynx
>
> a\. Oropharynx
>
> b\. Nasopharynx
>
> 3\. Epiglottis - a leaf‑shaped structure that prevents food and liquid
> from entering the trachea during swallowing.
>
> 4\. Windpipe (trachea)
>
> 5\. Voice box (larynx)
>
> 6\. Lungs
>
> 7\. Diaphragm
>
> C. Physiology
>
> 1\. Diaphragm moves down, chest moves out, drawing air into the lungs
> (inhalation)
>
> 2\. Exchange of oxygen and carbon dioxide in the lungs
>
> 3\. Diaphragm moves up causing air to exit the lungs (exhalation)
>
> D. Infant and child anatomy and physiology considerations
>
> 1\. All structures are smaller and more easily obstructed than in
> adults.
>
> 2\. Infants\' and children\'s tongues take up proportionally more
> space in the mouth than adults.
>
> 3\. The trachea is more flexible in infants and children.
>
> 4\. The primary cause of cardiac arrest in infants and children is an
> uncorrected respiratory problem.

I. Opening the Airway

> A. One of the most important actions that the first responder can
> perform is opening the airway of an unresponsive patient.
>
> 1\. An unresponsive patient looses muscle tone, and the soft tissue
> and base of the tongue may occlude the airway.
>
> 2\. The tongue is the most common cause of airway obstruction in an
> unresponsive patient.
>
> 3\. Since the tongue is attached to the lower jaw, forward
> displacement of the jaw will lift the tongue away from the back of the
> throat.
>
> B. Head-tilt chin-lift
>
> 1\. The method of choice for opening the airway in uninjured patients
>
> 2\. Research has indicated that the head-tilt chin-lift consistently
> provides the optimal airway.
>
> 3\. Used for uninjured, unresponsive patients
>
> 4\. Technique
>
> a\. Place your hand that is closer to the patient\'s head on his/her
> forehead, apply firm backward pressure to tilt the head back.
>
> b\. Place the fingers of your hand that is closer to the patient\'s
> feet on the bony part of his/her chin.
>
> c\. Lift the chin forward and support the jaw, helping to tilt the
> head back.
>
> 5\. Precautions
>
> a\. Finger must not press deeply into the soft tissues of the chin as
> this may lead to airway obstruction.
>
> b\. The thumb should not be used for lifting the chin.
>
> c\. The mouth must not be closed.
>
> C. Jaw thrust without head tilt
>
> 1\. This technique is an alternative method of opening the airway.
>
> 2\. Effective but fatiguing and technically difficult
>
> 3\. This is the safest approach to opening the airway in the patient
> with a suspected spinal injury.
>
> 4\. Indications
>
> a\. Used for trauma patients
>
> b\. Used for unresponsive patients
>
> 5\. Technique
>
> a\. Grasp the angles of the patient\'s lower jaw.
>
> b\. Lift with both hands displacing the mandible forward.
>
> c\. If the lips close, open the lower lip with your gloved thumb.

II\. Inspect the Airway

> A. An unresponsive patient may have fluid or solids in the airway that
> may compromise the airway.
>
> B. Responsive patients who cannot protect their airway should also
> have their airways inspected.
>
> C. Indications
>
> 1\. All unresponsive patients
>
> 2\. Responsive patients who may not be able to protect their own
> airways.
>
> D. Technique
>
> 1\. Open the patient\'s mouth with a gloved hand.
>
> 2\. Look inside the airway.
>
> a\. Clear (patent)
>
> b\. Blocked
>
> \(1\) Fluid
>
> \(2\) Solids
>
> \(3\) Teeth, including dentures

III\. Airway Adjuncts

> A. Oropharyngeal (oral) airways
>
> 1\. Oropharyngeal (OP) airways may be used to assist in maintaining an
> open airway in an unresponsive patient without a gag reflex.
>
> 2\. Patients with a gag reflex may vomit when this airway is placed.
>
> 3\. Technique
>
> a\. Select the proper size: Measure from the corner of the patient\'s
> lips to the tip of the earlobe or angle of jaw.
>
> b\. Open the patient\'s mouth.
>
> c\. Insert the airway upside down, with the tip facing toward the roof
> of the patient\'s mouth.
>
> d\. Advance the airway gently until resistance is encountered.
>
> e\. Turn the airway 180 degrees so that it comes to rest with the
> flange on the patient\'s teeth.
>
> 4\. Alternate technique - For use with infants and children
>
> a\. Select the proper size: Measure from the corner of the patient\'s
> lips to the bottom of the earlobe or angle of jaw.
>
> b\. Open the patient\'s mouth.
>
> c\. Use a tongue blade to press tongue down and away.
>
> d\. Insert airway in upright (anatomic) position.
>
> B. Nasopharyngeal (nasal) airways
>
> 1\. Nasopharyngeal (NP) airways are less likely to stimulate vomiting.
>
> 2\. May be used on patients who are responsive but need assistance
> keeping the tongue from obstructing the airway.
>
> 3\. Even though the tube is lubricated, this is a painful stimulus.
>
> 4\. Technique
>
> a\. Select the proper size: Measure from the tip of the nose to the
> tip of the patient\'s ear.
>
> b\. Also consider diameter of airway in the nostril. NP airways should
> not be so large that it causes blanching of the nostril.
>
> c\. Lubricate the airway with a water soluble lubricant.
>
> d\. Insert it posteriorly. Bevel should be toward the base of the
> nostril or toward the septum.
>
> e\. If the airway cannot be inserted into one nostril, try the other
> nostril.
>
> f\. Do not force this airway.

IV\. Clearing the Compromised Airway and Maintaining the Open Airway

> A. There are three ways that First Responders can clear or maintain an
> airway.
>
> B. These techniques are not sequential; the situation will dictate
> which technique is most appropriate.
>
> C. There are three methods of clearing the airway.
>
> 1\. The Recovery Position
>
> a\. The first step in maintaining an open airway
>
> b\. Uses gravity to keep the airway clear.
>
> c\. The airway is likely to remain open in this position.
>
> d\. Unrecognized airway obstructions are less likely to occur.
>
> e\. Monitor the patient until additional EMS resources arrive and
> assume care.
>
> f\. Allows fluids to drain from the mouth and not into the airway.
>
> g\. Used in unresponsive, uninjured patient, breathing adequately
>
> h\. Technique
>
> \(1\) Raise the patient\'s left arm above his/her head and cross the
> patient\'s right leg over the left.
>
> \(2\) Support the face and grasp the patient\'s right shoulder.
>
> \(3\) Roll the patient toward you onto his or her left side.
>
> \(4\) Place the patient\'s right hand under the side of his/her face.
>
> \(5\) The patient\'s head, torso, and shoulders should move
> simultaneously without twisting.
>
> \(6\) The head should be in as close to a midline position as
> possible.
>
> 2\. Finger sweeps
>
> a\. Uses your fingers to remove solid objects from the airway.
>
> b\. Use body substance isolation.
>
> c\. If foreign material or vomit is visible in the mouth, it should be
> removed.
>
> d\. Do this quickly.
>
> e\. Blind finger sweeps should not be performed in infants or
> children.
>
> f\. Technique
>
> \(1\) If uninjured, roll the patient to their side
>
> \(2\) Liquids or semi-liquids should be wiped out with the index and
> middle fingers covered with a cloth.
>
> \(3\) Solid objects should be removed with a hooked index finger.
>
> 3\. Suctioning
>
> a\. Uses negative pressure to keep the airway clear.
>
> b\. A patient needs to be suctioned immediately when a gurgling sound
> is heard during breathing or ventilation.
>
> c\. Suction is only indicated if the recovery position and finger
> sweeps are ineffective in draining the airway or trauma is suspected
> and the patient cannot be placed in the recovery position.
>
> d\. Purpose is to remove blood, other liquids, and food particles from
> the airway.
>
> e\. Most suction units are inadequate for removing solid objects like
> teeth, foreign bodies, and food
>
> f\. Portable suction equipment is available and may be manually or
> electrically operated.
>
> g\. Principles
>
> \(1\) Observe body substance isolation.
>
> \(2\) A hard or rigid \"tonsil sucker\" or \"tonsil tip\" is preferred
> to suction the mouth of an unresponsive patient.
>
> \(3\) The tip of the suction catheter should not be inserted deeper
> than the base of the tongue.
>
> \(4\) Because air and oxygen are removed during suction, it is
> recommended that you suction for no more than 15 seconds.
>
> \(a\) Decrease the time in infants and children.
>
> \(b\) Infants 5 seconds
>
> \(c\) Children 10 seconds
>
> \(5\) Watch for decreased heart rate in infants.
>
> \(6\) If a decrease in heart rate is noted, stop suctioning and
> provide ventilation. .

V. Determining Presence of Breathing

> A. Immediately after opening the airway, check for breathing
>
> B. As you determine the presence of breathing, look at the effort or
> work of breathing.
>
> 1\. Breathing should be effortless.
>
> 2\. Observe the chest for adequate rise and fall.
>
> 3\. Look for accessory muscle use.
>
> C. Techniques
>
> 1\. Responsive patients
>
> a\. Ask: \"Can you speak?\", \"Are you choking?\"
>
> b\. The ability to talk or make vocal sounds indicates that air is
> moving past the vocal cords
>
> 2\. Unresponsive patients
>
> a\. Maintain an open airway
>
> b\. Place your ear close to the patients mouth and nose
>
> c\. Assess for three to five seconds.
>
> \(1\) Look for the rise and fall of the chest
>
> \(2\) Listen for air escaping during exhalation
>
> \(3\) Feel for air coming from the mouth and nose
>
> d\. The first responder may observe the rise and fall of the chest
> even if an airway obstruction is present, but will not hear or feel
> air movement
>
> e\. Some reflex gasping (agonal respirations) may be present just
> after cardiac arrest. This should not be confused for breathing.
>
> D. Inadequate breathing is characterized by the following:
>
> 1\. Rate
>
> a\. Less than 8 in adults
>
> b\. Less than 10 in children
>
> c\. Less than 20 in infants
>
> 2\. Inadequate chest wall motion
>
> 3\. Cyanosis
>
> 4\. Mental status changes
>
> 5\. Increased effort
>
> 6\. Gasping
>
> 7\. Grunting
>
> 8\. Slow heart rate associated with slow respirations

VI\. Ventilation

> A. Once the airway has been assured, and breathing is assessed,
> breathing for the patient may be necessary.
>
> B. If the patient is not breathing they only have the oxygen in their
> lungs and their bloodstream remaining.
>
> C. In order to prevent death, the First Responder must ventilate the
> patient.
>
> D. There are many techniques for ventilation\--the first responder
> must be competent in the following three techniques of ventilation

VII\. Techniques of Ventilation

> A. The techniques of ventilation in order of preference are
>
> 1\. Mouth to mask
>
> 2\. Mouth to barrier device
>
> 3\. Mouth to mouth
>
> B. Mouth to mask ventilation
>
> 1\. Most effective First Responder technique
>
> 2\. Most masks have a one way valve to divert the patient\'s
> exhalations.
>
> 3\. Masks should be transparent so that vomiting can be recognized.
>
> 4\. Mouth to mask ventilation is very effective since you use two
> hands to seal around the mask.
>
> 5\. Technique
>
> a\. Place the mask around the patient\'s mouth and nose using the
> bridge of the nose as a guide for correct position. Mask position is
> critical since the wrong size mask will leak.
>
> b\. Seal the mask by placing the heal and thumb of each hand along the
> border of the mask and compressing firmly around the margin.
>
> c\. Place your index fingers on the portion of the mask that covers
> the chin.
>
> d\. Place your other fingers along the bony margin of the jaw and lift
> the jaw while performing a head tilt.
>
> e\. Give one slow (1-2 second) breath of sufficient volume to make
> the chest rise (usually 800-1200 ml in the average adult).
>
> f\. Too great a volume of air and too fast an inspiratory time are
> likely to allow air to enter the stomach.
>
> g\. Adequate ventilation is determined by:
>
> \(1\) Observing the chest rise and fall
>
> \(2\) Hearing and feeling the air escape during exhalation
>
> h\. Continue at the proper rate
>
> \(1\) 10-12 breaths per minute for adults with 1 - 2 second
> ventilation time
>
> \(2\) 20 breaths per minute for children and infants with 1 - 1
> second inspiratory time.
>
> \(3\) 40 breaths per minute for newborns with 1 to 1 second
> inspiratory time.
>
> i\. If the ventilation cannot be delivered, consider the possibility
> of an airway obstruction.
>
> C. Mouth-to-barrier device
>
> 1\. A barrier device should be used if available.
>
> 2\. Some rescuers may prefer to use a barrier device during
> ventilation.
>
> 3\. Barrier devices have no exhalation valve and air often leaks
> around the shield.
>
> 4\. Barrier devices should have low resistance to delivered
> ventilation.
>
> 5\. Technique
>
> a\. If ventilation is necessary, position the device over the
> patient\'s mouth and nose ensuring an adequate seal.
>
> b\. Keep the airway open by the head tilt-chin lift or jaw thrust
> maneuver.
>
> c\. Give one slow (1-2 second) breath of sufficient volume to make
> the chest rise (usually 800-1200 ml in the average adult).
>
> d\. Too great a volume of air and too fast an inspiratory time are
> likely to allow air to enter the stomach.
>
> e\. Adequate ventilation is determined by:
>
> \(1\) Observing the chest rise and fall
>
> \(2\) Hearing and feeling the air escape during exhalation
>
> f\. Continue at the proper rate
>
> \(1\) 10-12 breaths per minute for adults, with 1 - 2 second
> inspiratory time.
>
> \(2\) 20 breaths per minute for children and infants, with 1-1 second
> inspiratory time.
>
> \(3\) 40 breaths per minute for newborns, with 1 to 1 second
> inspiratory time.
>
> g\. If the ventilation cannot be delivered, consider the possibility
> of an airway obstruction
>
> D. Mouth to mouth
>
> 1\. The First Responder must be aware of the risks of performing mouth
> to mouth ventilation.
>
> 2\. Quick, effective method of delivering oxygen to the non-breathing
> patient
>
> 3\. Ventilating a patient with your exhaled breath while making mouth
> to mouth contact
>
> 4\. The rescuer\'s exhaled air contains enough oxygen to support life.
>
> 5\. Barrier devices and face masks with one way valves are available
> for use during ventilation.
>
> 6\. First Responders should always use these devices rather than the
> mouth to mouth technique.
>
> 7\. Mouth to mask/barrier device does not replace training in mouth to
> mouth ventilation.
>
> 8\. The decision to perform mouth to mouth ventilation by First
> Responders is a personal choice. Whenever possible, a barrier device
> or mouth to mask should be used.
>
> 9\. Technique
>
> a\. Keep the airway open by the head tilt-chin lift or jaw thrust
> maneuver.
>
> b\. Gently squeeze the patient\'s nostrils closed with the thumb and
> index finger of your hand on the patient\'s forehead.
>
> c\. When ventilating an infants, cover the infants mouth and nose.
>
> d\. Take a deep breath and seal your lips to the patient\'s mouth,
> creating an airtight seal.
>
> e\. Give one slow (1-2 second) breath of sufficient volume to make
> the chest rise.
>
> \(1\) Too great a volume of air and too fast an inspiratory time are
> likely to allow air to enter the stomach.
>
> \(2\) Adequate ventilation is determined by:
>
> \(a\) Observing the chest rise and fall
>
> \(b\) Hearing and feeling the air escape during exhalation
>
> f\. Continue at the proper rate
>
> \(1\) 12 breaths per minute for adults
>
> \(2\) 20 breaths per minute for children and infants
>
> \(3\) 40 breaths per minute for newborns
>
> g\. If the ventilation cannot be delivered, consider the possibility
> of an airway obstruction

VIII\. Foreign Body Airway Obstructions (FBAO) in the Adult

> A. Can be the cause of cardiac arrest
>
> 1\. Choking/food
>
> 2\. Bleeding into the airway
>
> 3\. Vomit
>
> B. Can be the result of cardiac arrest
>
> 1\. Vomiting
>
> 2\. Dentures
>
> 3\. Trauma
>
> 4\. Tongue
>
> C. Types of airway obstructions
>
> 1\. Partial
>
> a\. Good air exchange
>
> \(1\) Patient remains responsive
>
> \(2\) May be able to speak
>
> \(3\) Can cough forcefully
>
> \(4\) May be wheezing between coughs
>
> b\. Poor air exchange
>
> \(1\) Weak ineffective cough
>
> \(2\) High-pitched noise on inhalation
>
> \(3\) Increased respiratory difficulty
>
> \(4\) Possibly cyanotic
>
> 2\. Complete
>
> a\. No air can be exchanged.
>
> b\. Patient will be unable to speak, breathe, or cough.
>
> c\. Patient may clutch the neck with thumb and fingers\--the universal
> distress signal.
>
> d\. Death will follow rapidly if prompt action is not taken.
>
> D. Management of the Obstructed Airway
>
> **Refer to the American Heart Association Guidelines for the
> Management of Foreign Body Airway Obstruction - SEE APPENDICES B and
> C.**
>
> 1\. Partial with good air exchange
>
> 2\. Partial with poor air exchange or complete airway obstructions

IX\. Foreign Body Airway Obstructions in infants and Children

> A. More than 90% of childhood deaths from FBAO are in children below
> the age of 5.
>
> B. 65% of the patients are infants.
>
> C. FBAO in children is caused by
>
> 1\. Toys
>
> 2\. Balloons
>
> 3\. Small objects
>
> 4\. Food (hot dogs, round candies, nuts, and grapes)
>
> D. Should be suspected in infants and children who demonstrate a
> sudden onset of respiratory distress associated with coughing,
> gagging, stridor, or wheezing.
>
> E. Airway obstructions may be caused by infection.
>
> F. The First Responder should only attempt to clear a complete or
> partial airway obstruction with poor air exchange
>
> G. Blind finger sweeps are not done in infants or children.
>
> H. Management of foreign body airway obstructions in infants
>
> **Refer to current American Heart Association Guidelines for Foreign
> Body Airway Obstruction**
>
> I. Management of foreign body airway obstructions in children
>
> **Refer to current American Heart Association Guidelines for Foreign
> Body Airway Obstruction**

X. Special Considerations

> A. Patients with stomas
>
> 1\. Persons who have undergone a laryngectomy (surgical removal of the
> voice box) have a permanent opening (stoma) that connects the trachea
> to the front of the neck.
>
> 2\. When such person requires rescue breathing, mouth to stoma
> ventilations are required.
>
> 3\. Technique
>
> a\. Make an airtight seal around the stoma. Use a barrier device, if
> possible.
>
> b\. Deliver a ventilation slowly, allowing the chest to rise.
>
> c\. After delivering the ventilation, allow time for adequate
> exhalation.
>
> 4\. Some patients have partial laryngectomies. If, upon ventilating
> stoma, air escapes from the mouth or nose, close the mouth and pinch
> the nostrils.
>
> B. Infant and child patients
>
> 1\. Place an infant\'s head in neutral position, but extend a little
> past neutral if the patient is a child.
>
> 2\. Avoid excessive hyperextension of the head.
>
> 3\. An oral airway may be considered when other procedures fail to
> provide a clear airway.
>
> 4\. Gastric distension is more common in children.
>
> 5\. Gastric distension may significantly impair ventilation attempts
> in children.
>
> C. Dental appliances
>
> 1\. Dentures - ordinarily dentures should be left in place.
>
> 2\. Partial dentures (plates) may become dislodged during an
> emergency. Leave in place, but be prepared to remove it if it becomes
> dislodged.

**Application**

**Procedural (How)**

> 1\. Show diagrams of the airway and respiratory system of adults,
> children, and infants.
>
> 2\. Show examples of inadequate breathing.
>
> 3\. Demonstrate the head-tilt chin-lift method of opening the airway.
>
> 4\. Demonstrate the jaw thrust method of opening the airway.
>
> 5\. Demonstrate mouth-to-mouth ventilation of a patient.
>
> 6\. Demonstrate ventilation of a patient with a resuscitation mask and
> barrier device.
>
> 7\. Demonstrate insertion of an oropharyngeal (oral) airway.
>
> 8\. Demonstrate insertion of a nasopharyngeal (nasal) airway.
>
> 9\. Demonstrate how to check a suction unit.
>
> 10\. Demonstrate the techniques of suctioning.
>
> 11\. Demonstrate ventilation of a patient with a stoma.
>
> 12\. Demonstrate ventilation of an infant or child patient.

**Contextual (When, Where, Why)**

> Every patient must have a patent airway to survive. When the airway is
> obstructed, the First Responder must clear it as soon as possible
> using the methods described in this lesson.
>
> Once the airway has been opened, the First Responder must determine if
> breathing is adequate. Patients with inadequate breathing must be
> ventilated using mouth-to-mouth or mouth-to-mask.

**Student Activities**

**Auditory (Hearing)**

> 1\. The student should hear abnormal airway sounds such as gurgling,
> snoring, stridor, and expiratory grunting.
>
> 2\. The student should hear a resuscitation mask/barrier device used
> on a patient.
>
> 3\. The student should hear suction units being operated.

**Visual (Seeing)**

> 1\. The student should see audio-visual materials of the airway and
> respiratory system.
>
> 2\. The student should see normal breathing in other students.
>
> 3\. The student should see audio-visual materials of abnormal
> breathing.
>
> 4\. The student should see audio-visual aids or materials of patients
> with stomas.
>
> 5\. The student should see different kinds of oral and nasal airways.
>
> 6\. The student should see different devices for ventilating patients
> (resuscitation masks, barrier devices).
>
> 7\. The student should see different kinds of suction units.
>
> 8\. The student should see audio-visual materials of various dental
> appliances.

**Kinesthetic (Doing)**

> 1\. The student should practice evaluating breathing for adequacy.
>
> 2\. The student should practice opening the airway with the head-tilt
> chin‑lift maneuver.
>
> 3\. The student should practice opening the airway with the jaw
> thrust.
>
> 4\. The student should practice mouth-to-mouth ventilation.
>
> 5\. The student should practice ventilation of a patient with a
> resuscitation mask.
>
> 6\. The student should practice insertion of an oropharyngeal (oral)
> airway (adult, child, and infant) with and without tongue blade.
>
> 7\. The student should practice insertion of a nasopharyngeal (nasal)
> airway.
>
> 8\. The student should practice checking a suction unit.
>
> 9\. The student should practice suctioning.
>
> 10\. The student should practice ventilating a patient with a stoma.
>
> 11\. The student should practice ventilating an infant or child
> patient.

**Instructor Activities**

Facilitate discussion and supervise practice.

> Reinforce student progress in cognitive, affective, and psychomotor
> domains.

Redirect students having difficulty with content. (Complete remediation
form).

**Evaluation**

**Written:**

> Develop evaluation instruments, e.g., quizzes, oral reviews, and
> handouts, to determine if the students have met the cognitive and
> affective objectives of this lesson.

**Practical:**

> Evaluate the actions of the First Responder students during role play,
> practice, or other skill stations to determine their compliance with
> the cognitive and affective objectives and their mastery of the
> psychomotor objectives of this lesson.

**Remediation**

> Identify students or groups of students who are having difficulty with
> this subject content. Complete remediation sheet from the
> instructor\'s course guide.

**Enrichment**

> What is unique in the local area concerning this topic? Complete
> enrichment sheets from instructor\'s course guide and attach with
> lesson plan.

**Lesson 2-2 Practical Lab: Airway**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem-solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate the cognitive objectives of Lesson 2-1: Airway.

**Affective Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate the affective objectives of Lesson 2-1: Airway.

**Psychomotor Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate the steps in the head-tilt chin-lift. (P‑1,2)

 Demonstrate the steps in the jaw thrust. (P-1,2)

 Demonstrate the techniques of suctioning. (P-1,2)

 Demonstrate the steps in mouth-to-mouth ventilation with body
substance isolation (barrier shields). (P‑1,2)

 Demonstrate how to use a resuscitation mask to ventilate a patient.
(P-1,2)

 Demonstrate how to ventilate a patient with a stoma. (P‑1,2)

 Demonstrate how to measure and insert an oropharyngeal (oral) airway.
(P‑1,2)

 Demonstrate how to measure and insert a nasopharyngeal (nasal) airway.
(P‑1,2)

 Demonstrate how to ventilate infant and child patients. (P-1,2)

 Demonstrate how to clear a foreign body airway obstruction in a
responsive adult. (C-1)

 Demonstrate how to clear a foreign body airway obstruction in a
responsive child. (C-1)

 Demonstrate how to clear a foreign body airway obstruction in a
responsive infant. (C-1)

 Demonstrate how to clear a foreign body airway obstruction in an
unresponsive adult. (C-1)

 Demonstrate how to clear a foreign body airway obstruction in an
unresponsive child. (C-1)

 Demonstrate how to clear a foreign body airway obstruction in an
unresponsive infant. (C-1)

**Preparation**

**Motivation:**

> The practical lesson is designed to allow the students additional time
> to perfect skills. It is of utmost importance that the students
> demonstrate proficiency of the skill, cognitive knowledge of the steps
> to perform a skill, and a healthy attitude towards performing that
> skill on a patient.
>
> This is an opportunity for the instructor and assistant instructors to
> praise progress and redirect the students toward appropriate
> psychomotor skills. The material from all preceding lessons and basic
> life support should be incorporated into these practical skill
> sessions.

**Prerequisites:**

Preparatory

**Materials**

**AV Equipment:**

> Utilize various audio-visual materials relating to emergency medical
> care. The continuous development of new audio-visual materials
> relating to EMS requires careful review to determine which best meet
> the needs of the program. Materials should be edited to ensure that
> the objectives of the curriculum are met.

**EMS Equipment:**

> Ventilation manikins, resuscitation mask, barrier devices, oral
> airways, nasal airways, suction units (manual and battery powered),
> suction catheters, tongue blade, and lubricant.

**Personnel**

**Primary Instructor:**

One First Responder instructor knowledgeable in airway management.

**Assistant Instructor:**

> The instructor-to-student ratio should be 1:6 for psychomotor skill
> practice. Individuals used as assistant instructors should be
> knowledgeable in airway techniques and management.

**Recommended Minimum Time to Complete:**

Three hours

**Presentation**

**Declarative (What)** None identified for this lesson.

**Application**

**Procedural (How)**

> Instructor should demonstrate the procedural activities from Lesson
> 2-1: Airway.

**Contextual (When, Where, Why)**

Instructor should review contextual information from Lesson 2-1: Airway.

**Student Activities**

**Auditory (Hearing)**

> 1\. The student should hear abnormal airway sounds such as gurgling,
> snoring, stridor, and expiratory grunting.
>
> 2\. The student should hear a resuscitation mask/barrier device being
> used on a patient with an obstructed airway.
>
> 3\. The student should hear suction units being operated.

**Visual (Seeing)**

> 1\. The student should see audio-visual materials of the airway and
> respiratory system.
>
> 2\. The student should see normal breathing in other students.
>
> 3\. The student should see audio-visual materials of abnormal
> breathing.
>
> 4\. The student should see audio-visual materials of patients with
> stomas.
>
> 5\. The student should see different kinds of oral and nasal airways.
>
> 6\. The student should see different devices for ventilating patients
> (resuscitation masks, barrier devices).
>
> 7\. The student should see different kinds of suction units.
>
> 8\. The student should see audio-visual materials of various dental
> appliances.

**Kinesthetic (Doing)**

> 1\. The student should practice evaluating breathing for adequacy.
>
> 2\. The student should practice opening the airway with the head-tilt
> chin‑lift maneuver.
>
> 3\. The student should practice opening the airway with a jaw thrust.
>
> 4\. The student should practice mouth-to-mouth ventilation.
>
> 5\. The student should practice ventilation of a patient with a
> resuscitation mask.
>
> 6\. The student should practice insertion of an oropharyngeal (oral)
> airway (adult, child, and infant) with and without a tongue blade.
>
> 7\. The student should practice insertion of a nasopharyngeal (nasal)
> airway.
>
> 8\. The student should practice checking a suction unit.
>
> 9\. The student should practice suctioning.
>
> 10\. The student should practice ventilation of a patient with a
> stoma.
>
> 11\. The student should practice ventilation of an infant or child
> patient.

**Instructor Activities**

> Supervise student practice.
>
> Reinforce student progress in cognitive, affective, and psychomotor
> domains.
>
> Redirect students having difficulty with content. (Complete
> remediation forms.)

**Evaluation**

**Practical:**

> Evaluate the actions of the First Responder students during role play,
> practice, or other skills stations to determine their compliance with
> the cognitive and affective objectives and their mastery of the
> psychomotor objectives of this lesson.

**Remediation**

> Identify students or groups of students who are having difficulty with
> this subject content. Complete remediation sheet from the
> instructor\'s course guide.

**Enrichment**

> What is unique in the local area concerning this topic? Complete
> enrichment sheets from the instructor\'s course guide and attach with
> lesson plan.

**Lesson 2-3 Evaluation: Airway**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate competence in the cognitive objectives of Lesson 2-1:
Airway

**Affective Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate competence in the affective objectives of Lesson 2-1:
Airway

**Psychomotor Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate competence in the psychomotor objectives of Lesson 2-1:
Airway

**Preparation**

**Motivation:**

> Evaluation of the student\'s attainment of the cognitive and affective
> knowledge and psychomotor skills is an essential component of the
> First Responder\'s educational process. The modules are presented in a
> \"building block\" format. Once the students have demonstrated their
> knowledge and proficiency, the next lesson should be built upon that
> knowledge. This evaluation will help to identify students or groups of
> students having difficulty with a particular area. This is an
> opportunity for the instructor to evaluate their performance and make
> appropriate modifications to the delivery of material.

**Prerequisites:**

Completion of Lessons 2-1 through 2-2.

**Material**

**AV Equipment:**

Typically none required.

**EMS Equipment:**

The EMS equipment used in the Lessons of Module 2.

**Personnel**

**Primary Instructor:**

One proctor for the written evaluation.

**Assistant Instructor:**

One practical skills examiner for each 6 students.

**Recommended Minimum Time to Complete:**

One hour

**Presentation**

**Declarative (What)**

I. Purpose of the evaluation

II\. Items to be evaluated

III\. Feedback from evaluation

**Application**

**Procedural (How)**

> 1\. Written evaluation based on the cognitive and affective objectives
> of Lessons 2-1 \> 2-2.
>
> 2\. Practical evaluation stations based on the psychomotor objectives
> of Lessons 2-1 \> 2-2.

**Contextual (When, Where and Why)**

> The evaluation is the final lesson in this module and is designed to
> bring closure to the module and to assure that students are prepared
> to proceed to the next module.
>
> This modular evaluation is done to determine the effectiveness of the
> presentation of materials and how well students have retained the
> material. This is an opportunity for the students to make necessary
> adjustments in study habits or for the instructor to adjust the manner
> in which material is presented.

**Instructor Activities**

> Supervise student evaluation.
>
> Reinforce student progress in cognitive, affective, and psychomotor
> domains.
>
> Redirect students having difficulty with content. (Complete
> remediation forms.)

**Remediation**

> Identify students and/or groups of students who are having difficulty
> with this subject content. Complete a remediation sheet from the
> instructor\'s course guide. If students continue to have difficulty
> demonstrating knowledge of the cognitive and affective objectives, or
> demonstrating proficiency in psychomotor skills, the students should
> be counseled, remediated and re-evaluated. If improvements in
> cognitive, affective or psychomotor skills are not achieved,
> consideration regarding the ability of the student to progress in the
> program should be taken into account.

**Module 3: Patient Assessment**

**Lesson 3-1 Patient Assessment**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem-solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

3‑1.1 Discuss the components of scene size-up. (C-1)

3‑1.2 Describe common hazards found at the scene of a trauma and a
medical patient. (C-1)

3-1.3 Determine if the scene is safe to enter. (C-2)

3‑1.4 Discuss common mechanisms of injury/nature of illness. (C-1)

3‑1.5 Discuss the reason for identifying the total number of patients at
the scene. (C-1)

3‑1.6 Explain the reason for identifying the need for additional help or
assistance. (C-1)

3-1.7 Summarize the reasons for forming a general impression of the
patient. (C-1)

3-1.8 Discuss methods of assessing mental status. (C-1)

3-1.9 Differentiate between assessing mental status in the adult, child,
and infant patient. (C-3)

3-1.10 Describe methods used for assessing if a patient is breathing.
(C-1)

3-1.11 Differentiate between a patient with adequate and inadequate
breathing. (C-3)

3-1.12 Describe the methods used to assess circulation. (C-1)

3-1.13 Differentiate between obtaining a pulse in an adult, child, and
infant patient. (C-3)

3-1.14 Discuss the need for assessing the patient for external bleeding.
(C-1)

3-1.15 Explain the reason for prioritizing a patient for care and
transport. (C-1)

3-1.16 Discuss the components of the physical exam. (C-1)

3-1.17 State the areas of the body that are evaluated during the
physical exam. (C-1)

3-1.18 Explain what additional questioning may be asked during the
physical exam. (C-1)

3-1.19 Explain the components of the SAMPLE history. (C-1)

3-1.20 Discuss the components of the on-going assessment. (C-1)

3-1.21 Describe the information included in the First Responder
\"hand-off\" report. (C-1)

**Affective Objectives**

At the completion of this lesson, the First Responder student will be
able to:

3-1.22 Explain the rationale for crew members to evaluate scene safety
prior to entering. (A-2)

3-1.23 Serve as a model for others by explaining how patient situations
affect your evaluation of the mechanism of injury or illness. (A-2)

3-1.24 Explain the importance of forming a general impression of the
patient. (A-1)

3‑1.25 Explain the value of an initial assessment. (A-2)

3‑1.26 Explain the value of questioning the patient and family. (A-2)

3‑1.27 Explain the value of the physical exam. (A-2)

3‑1.28 Explain the value of an on-going assessment. (A-2)

3-1.29 Explain the rationale for the feelings that these patients might
be experiencing. (A-3)

3-1.30 Demonstrate a caring attitude when performing patient

> assessments. (A-3)

3-1.31 Place the interests of the patient with as the foremost
consideration when making any and all patient care decisions during
patient assessment. (A-3)

3-1.32 Communicate with empathy during patient assessment to patients as
well as with family members and friends of the patient. (A-3)

**Psychomotor Objectives**

At the completion of this lesson, the First Responder student will be
able to:

3-1.33 Demonstrate the ability to differentiate various scenarios and
identify potential hazards. (P-1)

3-1.34 Demonstrate the techniques for assessing mental status. (P-1,2)

3-1.35 Demonstrate the techniques for assessing the airway. (P-1,2)

3-1.36 Demonstrate the techniques for assessing if the patient is
breathing. (P-1,2)

3-1.37 Demonstrate the techniques for assessing if the patient has a
pulse. (P‑1,2)

3-1.38 Demonstrate the techniques for assessing the patient for external
bleeding. (P-1,2)

3-1.39 Demonstrate the techniques for assessing the patient\'s skin
color, temperature, condition, and capillary refill (infants and
children only). (P-1,2)

3-1.40 Demonstrate questioning a patient to obtain a SAMPLE history.

3-1.41 Demonstrate the skills involved in performing the physical exam.
(P-1,2)

3-1.42 Demonstrate the on-going assessment (P-1,2)

**Preparation**

**Motivation:**

> Size-up is the first aspect of patient assessment. It begins as the
> First Responder approaches the scene. During this phase, the First
> Responder surveys the scene to determine if there are any threats that
> may cause an injury to the First Responder, bystanders, or may cause
> additional injury to the patient.
>
> The initial assessment, physical exam, and patient/family questioning
> are used to identify patients who require critical interventions.

**Prerequisites:**

Preparatory, Airway Modules

**Materials**

**AV Equipment:**

> Utilize various audio-visual materials relating to emergency medical
> care. The continuous development of new audio-visual materials
> relating to EMS requires careful review to determine which best meet
> the needs of the program. Materials should be edited to ensure that
> the objectives of the curriculum are met.

**EMS Equipment:**

Exam gloves, airway management equipment, suction.

**Personnel**

**Primary Instructor:**

One First Responder instructor, knowledgeable in patient assessment.

**Assistant Instructor:**

> The instructor-to-student ratio should be 1:6 for psychomotor skill
> practice. Individuals used as assistant instructors should be
> knowledgeable about patient assessment.

**Recommended Minimum Time to Complete:**

Three hours

**Presentation**

**Declarative (What)**1. Scene Size-up

> A. Body substance isolation review
>
> 1\. Eye protection if necessary
>
> 2\. Gloves if necessary
>
> 3\. Gown if necessary
>
> 4\. Mask if necessary
>
> B. Scene Safety
>
> 1\. Is the scene safe?
>
> a\. Definition - an assessment of the scene and surroundings that will
> provide valuable information to the First Responder and will help
> ensure the well-being of the First Responder.
>
> b\. Personal protection - Is it safe to approach the patient?
>
> \(1\) Crash/rescue scenes
>
> \(2\) Toxic substances - low oxygen areas
>
> \(3\) Crime scenes - potential for violence
>
> \(4\) Unstable surfaces: slope, ice, water
>
> c\. Protection of the patient - environmental considerations
>
> d\. Protection of bystanders - do not let the bystander become ill or
> injured
>
> e\. If the scene is unsafe, make it safe. Otherwise, do not enter.
>
> C. What is the mechanism of injury or nature of illness?
>
> 1\. Mechanism of injury - an evaluation of the forces that caused an
> injury. May be beneficial in determining the presence of internal
> injuries.
>
> 2\. Trauma - Mechanism of injury - determine from the patient, family
> or bystanders and inspect the scene. What is the mechanism of injury?
>
> 3\. Medical - Nature of illness - determine from the patient, family,
> or bystanders why EMS was called.
>
> D. How many patients are involved?
>
> 1\. Obtain additional help prior to contact with patients: law
> enforcement, fire, rescue, ALS, utilities.
>
> 2\. First Responder is less likely to call for help if involved in
> patient care.
>
> 3\. Begin triage.
>
> E. Are additional EMS resources en route?

I. Initial Assessment

> A. The initial assessment is completed to assist the First Responder
> in identifying immediate threats to life.
>
> B. General Impression of the patient
>
> 1\. Based on the First Responder\'s immediate assessment of the
> environment and the patient\'s chief complaint.
>
> 2\. Determine if ill (medical) or injured (trauma).
>
> a\. Is this trauma?
>
> b\. Is this medical?
>
> c\. Is it unclear? - Treat as trauma
>
> 3\. Approximate age
>
> 4\. Sex
>
> C. Assess responsiveness - stabilize spine if trauma.
>
> 1\. Begin by speaking to the patient.
>
> a\. State your name
>
> b\. Tell the patient that you are a first responder
>
> c\. Explain that you are here to help.
>
> 2\. Levels of responsiveness
>
> a\. Alert
>
> b\. Verbal - responds to verbal stimuli
>
> c\. Painful - responds to painful stimuli.
>
> d\. Unresponsive
>
> 3\. Infant and child considerations
>
> a\. Infants and younger children will not respond to methods used to
> assess responsiveness in adults.
>
> b\. Assess interaction with environment and parents.
>
> D. Assess the patient\'s airway status.
>
> 1\. Responsive patient
>
> a\. Can the patient speak?
>
> b\. Is the airway patent?
>
> 2\. Unresponsive patient
>
> a\. Open the airway
>
> \(1\) Medical - Head tilt-chin lift
>
> \(2\) Trauma - Jaw-thrust without head-tilt
>
> b\. Inspect the airway
>
> c\. Clear the airway as needed
>
> E. Assess the patient\'s breathing
>
> 1\. Look at the work of breathing
>
> 2\. Responsive - Can the patient speak?
>
> 3\. Unresponsive
>
> a\. Maintain an open airway
>
> b\. Look, listen, and feel for presence of ventilations
>
> 4\. Ventilate as needed
>
> F. Assess the patient\'s circulation.
>
> 1\. Assess the patient\'s pulse.
>
> a\. Adults
>
> \(1\) Responsive - assess radial pulse
>
> \(2\) Unresponsive - assess carotid pulse
>
> b\. Infants - assess brachial pulse
>
> c\. Children
>
> \(1\) Unresponsive - assess carotid or femoral
>
> \(2\) Responsive - assess brachial or radial
>
> 2\. Assess if major bleeding is present. If bleeding is present,
> control bleeding as described in *Module 5: Illness and Injury, Lesson
> 5-2 Bleeding and Soft Tissue Injuries*
>
> 3\. Assess the patient\'s skin color and temperature
>
> G. Update responding EMS unit with a brief Radio Report
>
> 1\. Age and sex
>
> 2\. Chief complaint
>
> 3\. Responsiveness
>
> 4\. Airway and breathing status
>
> 5\. Circulation status
>
> 6\. Determine estimated time of arrival of additional EMS resources

II\. First Responder Physical Exam

> A. The First Responder physical exam is designed to locate and begin
> the initial management of the signs and symptoms of illness or injury.
>
> B. The First Responder should complete a physical exam on all patients
> following the initial assessment.
>
> C. Patient and injury specific, e.g., cut finger would not require the
> complete physical exam.
>
> D. As the First Responder locates signs and symptoms of illness or
> injury, there may be specific questions that the First Responder
> should ask. This material is described in specific lessons on Illness
> and Injury.
>
> E. Perform a physical examination on the patient to gather additional
> information.
>
> 1\. Inspect (look) and palpate (feel) for the following signs of
> injury:
>
> a\. Deformities
>
> b\. Open injuries
>
> c\. Tenderness
>
> d\. Swelling
>
> e\. The mnemonic D-O-T-S is helpful in remembering the signs of
> injury.
>
> 2\. Briefly assess the following body in a logical manner:
>
> a\. Head
>
> b\. Neck
>
> c\. Chest
>
> d\. Abdomen
>
> e\. Pelvis
>
> f\. All four extremities

III\. Obtain History from the Patient or Family

> A. Medical identification tags may be beneficial in assessing
> allergies, medications, or past medical history.
>
> B. For medical patients the SAMPLE history may be completed prior to
> the physical exam.
>
> C. SAMPLE History
>
> 1\. [S]{.underline}igns/Symptoms
>
> a\. \"Why did you call EMS today?\"
>
> b\. Sign - Any medical or trauma condition displayed by the patient
> and identifiable by the First Responder,
>
> \(1\) Hearing - respiratory distress
>
> \(2\) Seeing - bleeding
>
> \(3\) Feeling - skin temperature.
>
> c\. Symptom - any condition described by the patient,
>
> \(1\) Difficulty breathing
>
> \(2\) Headache
>
> \(3\) Pain
>
> 2\. [A]{.underline}llergies
>
> a\. \"Are you allergic to anything?\"
>
> b\. Medications
>
> c\. Environmental allergies
>
> d\. Food

3\. [M]{.underline}edications

> a\. \"Do you take any prescription or non-prescription medicine?\"
>
> b\. Prescription
>
> \(1\) Current
>
> \(2\) Recent
>
> c\. Non-prescription
>
> \(1\) Current
>
> \(2\) Recent
>
> 4\. [P]{.underline}ertinent Past History
>
> a\. \"Are you seeing a Doctor for anything?\"
>
> b\. \"Have you ever been in the hospital?\"
>
> c\. Medical
>
> d\. Surgical
>
> e\. Trauma
>
> 5\. [L]{.underline}ast oral intake: Solid or liquid
>
> a\. \"When was the last time you had anything to eat or drink?\"
>
> b\. Time
>
> c\. Quantity
>
> 6\. [E]{.underline}vents leading to the injury or illness
>
> a\. \"What were you doing when this happened?\"
>
> b\. \"Where there any other associated symptoms?\"

IV\. On-Going Assessment

> A. While awaiting additional EMS resources, the First Responder should
> continue to assess the patient.
>
> B. The initial assessment should be repeated.
>
> 1\. Repeat every 15 minutes for a stable patient
>
> 2\. Repeat every 5 minutes for an unstable patient
>
> 3\. Reassess mental status.
>
> 4\. Maintain an open airway.
>
> 5\. Monitor breathing for rate and quality.
>
> 6\. Reassess pulse for rate and quality.
>
> 7\. Monitor skin color, temperature, and condition.
>
> C. Repeat First Responder physical exam as needed.
>
> D. Check interventions to ensure that they are effective.
>
> E. In addition to the continued assessments, the First Responder
> should calm and reassure the patient.
>
> F. Upon arrival of EMS, the First Responder should provide a
> \"hand-off\" report.

1\. Age and sex

> 2\. Chief complaint
>
> 3\. Responsiveness
>
> 4\. Airway and breathing status
>
> 5\. Circulation status
>
> 6\. Physical findings
>
> 7\. SAMPLE history
>
> 8\. Interventions provided

**Application**

**Procedural (How)**

> The assessment is completed by visually inspecting, physically
> palpating and in some cases listening, and verbally communicating with
> the patient and family. The assessment is an input/output process,
> where assessment findings are the input and emergency medical care is
> the output.
>
> 1\. Review of scene size-up.
>
> 2\. Review of the initial assessment.
>
> 3\. Students should be shown audio-visual materials of various trauma
> scenes to evaluate the mechanism of injury.
>
> 4\. Demonstrate an initial patient assessment.
>
> 5\. Review airway patency and breathing assessment.
>
> 6\. Review methods of assessing mental status.
>
> 7\. Demonstrate obtaining radial, carotid, and brachial pulses.
>
> 8\. Demonstrate the First Responder physical exam
>
> 9\. Demonstrate an on-going assessment
>
> 10\. Demonstrate a hand-off report.

**Contextual (When, Where, Why)**

> Size-up represents the very beginning of patient assessment. It
> requires the First Responder to evaluate several aspects concerning
> the situation in a very short period of time. It is essential for
> assuring the safety of the First Responder and the patient. This
> information may be obtained as part of dispatch, but should always be
> reassessed upon arrival at the scene. For some situations, size-up is
> an on-going process. As additional information is obtained,
> modification is made to the size-up of the patient and the situation
> overall.
>
> Perform initial assessment on all patients after assuring scene and
> personal safety. If the scene is safe and the environment permits,
> perform the assessment before moving the patient. The initial
> assessment is a rapid means of understanding patient condition and
> priorities of care.
>
> The physical exam and questioning the patient and family are done
> after the initial assessment and correction of immediate threats to
> life. During this process, obtain additional information regarding the
> patient\'s condition.
>
> The on-going assessment is completed on all patients while awaiting
> additional EMS resources. This assessment allows the First Responder
> to calm and reassure the patient, and at the same time, to reassess
> the ABCs.

**Student Activities**

**Auditory (Hearing)**

> 1\. The student should hear simulations of various safe and unsafe
> scenes.
>
> 2\. Students should hear recordings of various patient conditions to
> listen for clues concerning the general impression.
>
> 3\. Students should hear normal and abnormal airway noises.
>
> 4\. Students should hear breathing.
>
> 5\. Students should hear information input from a simulated responsive
> patient or from others regarding signs and symptoms for patients that
> are unresponsive.
>
> 6\. The students should hear the components of scene size-up.
>
> 7\. The students should hear the components of the initial assessment.
>
> 8\. The students should hear the components of the physical exam.
>
> 9\. The students should hear the components of the on-going
> assessment.

**Visual (Seeing)**

> 1\. The student should see simulations of various safe and unsafe
> scenes.
>
> 2\. The student should see the flow charts from Appendix F.
>
> 3\. Students should see audio-visual materials of various injuries.
>
> 4\. Students should see the inspection and palpation of programmed
> patients for various injuries and patterns of injury.
>
> 5\. Students should see landmarks for palpation and inspection.

**Kinesthetic (Doing)**

> 1\. The student should role play actions to take at various safe and
> unsafe scenes.
>
> 2\. The student should use the flow chart from Appendix F.
>
> 3\. Students should practice establishing mental status on programmed
> patients (fellow students) with various mental statuses.
>
> 4\. Students should practice airway opening techniques on manikins and
> each other.
>
> 5\. Students should practice assessing breathing.
>
> 6\. Students should practice assessing pulses.
>
> 7\. Students should practice assessing for major bleeding.
>
> 8\. Students should practice recording assessment findings.
>
> 9\. Students should practice inspecting and palpating.
>
> 10\. Students should practice scene size-up.
>
> 11\. Students should practice the initial assessment.

12\. Students should practice the physical exam.

> 13\. Students should practice questioning the patient to obtain a
> SAMPLE history.
>
> 14\. Students should practice the on-going assessment.

**Instructor Activities**

> Facilitate discussion and supervise practice.
>
> Reinforce student progress in cognitive, affective, and psychomotor
> domains.
>
> Redirect students having difficulty with content. (Complete
> remediation form.)

**Evaluation**

**Written:**

> Develop evaluation instruments, e.g., quizzes, oral reviews, and
> handouts, to determine if the students have met the cognitive and
> affective objectives of this lesson.

**Practical:**

> Evaluate the actions of the First Responder students during role play,
> practice, or other skill stations to determine their compliance with
> the cognitive and affective objectives and their mastery of the
> psychomotor objectives of this lesson.

**Remediation**

> Identify students or groups of students who are having difficulty with
> this subject content. Complete remediation sheet from the
> instructor\'s course guide.

**Enrichment**

> What is unique in the local area concerning this topic? Complete
> enrichment sheets from instructor\'s course guide and attach with
> lesson plan.

**Lesson 3-2**

**Practical Lab: Patient Assessment**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem-solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate the cognitive objectives of Lesson 3-1: Patient
Assessment.

**Affective Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate the affective objectives of Lesson 3-1: Patient
Assessment.

**Psychomotor Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate the ability to differentiate various scenarios and
identify potential hazards. (P-1)

 Demonstrate the techniques for assessing mental status. (P-1,2)

 Demonstrate the techniques for assessing the airway. (P-1,2)

 Demonstrate the techniques for assessing if the patient is breathing.
(P-1,2)

 Demonstrate the techniques for assessing if the patient has a pulse.
(P‑1,2)

 Demonstrate the techniques for assessing the patient for external
bleeding. (P-1,2)

 Demonstrate the techniques for assessing the patient\'s skin color,
temperature, condition, and capillary refill (infants and children
only). (P-1,2)

 Demonstrate questioning a patient to obtain a SAMPLE history.

 Demonstrate the skills involved in performing the physical exam.
(P-1,2)

 Demonstrate the on-going assessment (P-1,2)

**Preparation**

**Motivation:**

> The practical lesson is designed to allow the students additional time
> to perfect skills. It is of utmost importance that the students
> demonstrate proficiency of the skill, cognitive knowledge of the steps
> to perform a skill, and a healthy attitude towards performing that
> skill on a patient.
>
> This is an opportunity for the instructor and assistant instructors to
> praise progress and redirect the students toward appropriate
> psychomotor skills. The material from all preceding lessons and basic
> life support should be incorporated into these practical skill
> sessions.

**Prerequisites:**

Preparatory Module, Airway Module

**Materials**

**AV Equipment:**

> Utilize various audio-visual materials relating to emergency medical
> care. The continuous development of new audio-visual materials
> relating to EMS requires careful review to determine which best meet
> the needs of the program. Materials should be edited to ensure that
> the objectives of the curriculum are met.

**EMS Equipment:**

Exam gloves, airway management equipment, suction.

**Personnel**

**Primary Instructor:**

One First Responder Instructor knowledgeable in patient assessment.

**Assistant Instructor:**

> The instructor-to-student ratio should be 1:6 for psychomotor skill
> practice. Individuals used as assistant instructors should be
> knowledgeable in airway techniques and management.

**Recommended Minimum Time to Complete:**

Two hours

**Presentation**

**Declarative (What)** None identified for this lesson.

**Application**

**Procedural (How)**

> Instructor should demonstrate the procedural activities from Lesson
> 3-1: Patient Assessment

**Contextual (When, Where, Why)**

> Instructor should review contextual information from Lesson 3-1:
> Patient Assessment

**Student Activities**

**Auditory (Hearing)**

> 1\. The student should hear simulations of various safe and unsafe
> scenes.
>
> 2\. Students should hear recordings of various patient situations to
> listen for clues concerning the general impression.
>
> 3\. Students should hear normal and abnormal airway noises.
>
> 4\. Students should hear breathing.
>
> 5\. Students should hear information input from a responsive simulated
> patient or from others regarding signs and symptoms for patients that
> are unresponsive.
>
> 6\. Students should hear the presence of breath sounds on fellow
> students.

**Visual (Seeing)**

> 1\. The student should see simulations of various safe and unsafe
> scenes.
>
> 2\. The student should see the flow chart from Appendix F.
>
> 3\. Students should see audio-visual aids or materials of various
> injuries.
>
> 4\. Students should see the inspection and palpation of programmed
> patients for various injuries and patterns of injury.
>
> 5\. Students should see landmarks for palpation and inspection.
>
> 6\. Students should see the flow chart from Appendix F.

**Kinesthetic (Doing)**

> 1\. The student should role play the actions to take at various safe
> and unsafe scenes.
>
> 2\. The student should use the flow chart from Appendix F.
>
> 3\. Students should practice establishing mental status on programmed
> patients (fellow students) with various altered mental statuses.
>
> 4\. Students should practice airway opening techniques on manikins and
> each other.
>
> 5\. Students should practice assessing breathing.
>
> 6\. Students should practice assessing pulses.
>
> 7\. Students should practice assessing for major bleeding.
>
> 8\. Students should practice recording assessment findings.
>
> 9\. Students should practice inspecting and palpating.

**Instructor Activities**

> Supervise student practice.
>
> Reinforce student progress in cognitive, affective, and psychomotor
> domains.
>
> Redirect students having difficulty with content. (Complete
> remediation forms.)

**Evaluation**

**Practical:**

> Evaluate the actions of the First Responder students during role play,
> practice, or other skills stations to determine their compliance with
> the cognitive and affective objectives and their mastery of the
> psychomotor objectives of this lesson.

**Remediation**

> Identify students or groups of students who are having difficulty with
> this subject content. Complete remediation sheet from the
> instructor\'s course guide.

**Enrichment**

> What is unique in the local area concerning this topic? Complete
> enrichment sheets from the instructor\'s course guide and attach with
> lesson plan.

**Lesson 3-3**

**Evaluation: Patient Assessment**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate competence in the cognitive objectives of Lesson 3-1:
Patient Assessment

**Affective Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate competence in the affective objectives of Lesson 3-1:
Patient Assessment

**Psychomotor Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate competence in the psychomotor objectives of Lesson 3-1:
Patient Assessment

**Preparation**

**Motivation:**

> Evaluation of the student\'s attainment of the cognitive and affective
> knowledge and psychomotor skills is an essential component of the
> First Responder\'s educational process. The modules are presented in a
> \"building block\" format. Once the students have demonstrated their
> knowledge and proficiency, the next lesson should be built upon that
> knowledge. This evaluation will help to identify students or groups of
> students having difficulty with a particular area. This is an
> opportunity for the instructor to evaluate their performance and make
> appropriate modifications to the delivery of material.

**Prerequisites:**

Completion of Lessons 3-1 through 3-2.

**Material**

**AV Equipment:**

Typically none required.

**EMS Equipment:**

The EMS equipment used in the Lessons of Module 3.

**Personnel**

**Primary Instructor:**

One proctor for the written evaluation.

**Assistant Instructor:**

One practical skills examiner for each 6 students.

**Recommended Minimum Time to Complete:**

One hour

**Presentation**

**Declarative (What)**

I. Purpose of the evaluation

II\. Items to be evaluated

III\. Feedback from evaluation

**Application**

**Procedural (How)**

> 1\. Written evaluation based on the cognitive and affective objectives
> of Lessons 3-1 \> 3-2.
>
> 2\. Practical evaluation stations based on the psychomotor objectives
> of Lessons 3-1 \> 3-2.

**Contextual (When, Where and Why)**

> The evaluation is the final lesson in this module and is designed to
> bring closure to the module and to assure that students are prepared
> to proceed to the next module.
>
> This modular evaluation is done to determine the effectiveness of the
> presentation of materials and how well students have retained the
> material. This is an opportunity for the students to make necessary
> adjustments in study habits or for the instructor to adjust the manner
> in which material is presented.

**Instructor Activities**

> Supervise student evaluation.
>
> Reinforce student progress in cognitive, affective, and psychomotor
> domains.
>
> Redirect students having difficulty with content. (Complete
> remediation forms.)

**Remediation**

> Identify students and/or groups of students who are having difficulty
> with this subject content. Complete a remediation sheet from the
> instructor\'s course guide. If students continue to have difficulty
> demonstrating knowledge of the cognitive and affective objectives or
> demonstrating proficiency in psychomotor skills, the students should
> be counseled, remediated, and re-evaluated. If improvements in
> cognitive, affective, or psychomotor skills are not achieved,
> consideration regarding the ability of the student to progress in the
> program should be taken into account.

**Module 4: Circulation**

**Lesson 4-1 Circulation**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem-solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

4-1.1 List the reasons for the heart to stop beating (C-1)

4-1.2 Define the components of cardiopulmonary resuscitation (C-1)

4-1.3 Describe each link in the chain of survival and how it relates to
the EMS system. (C-2)

4-1.4 List the steps of one-rescuer adult CPR (C-1)

4-1.5 Describe the technique of external chest compressions on an adult
patient. (C-1)

4-1.6 Describe the technique of external chest compressions on an
infant. (C-1)

4-1.7 Describe the technique of external chest compressions on a child.
(C-1)

4-1.8 Explain when the First Responder is able to stop CPR. (C-2)

4-1.9 List the steps of two-rescuer adult CPR (C-1)

4-1.10 List the steps of infant CPR (C-1)

4-1.11 List the steps of child CPR (C-1)

**Affective Objectives**

At the completion of this lesson, the First Responder student will be
able to:

4-1.12 Respond to the feelings that the family of a patient may be
having during a cardiac event. (A-3)

4-1.13 Demonstrate a caring attitude towards patients with cardiac
events who request emergency medical services. (A-3)

4-1.14 Place the interests of the patient with a cardiac event as the
foremost consideration when making any and all patient care decisions.
(A-3)

4-1.15 Communicate with empathy with family members and friends of the
patient with a cardiac event. (A-3)

**Psychomotor Objectives**

At the completion of this lesson, the First Responder student will be
able to:

4-1.16 Demonstrate the proper technique of chest compressions on an
adult. (P-1,2)

4-1.17 Demonstrate the proper technique of chest compressions on a
child. (P-1,2)

4-1.18 Demonstrate the proper technique of chest compressions on an
infant. (P-1,2)

4-1.19 Demonstrate the steps of adult one rescuer CPR. (P-1,2)

4-1.20 Demonstrate the steps of adult two rescuer CPR. (P-1,2)

4-1.21 Demonstrate child CPR. (P-1,2)

4-1.22 Demonstrate infant CPR. (P-1,2)

**Preparation**

**Motivation:**

> Over 600,000 patients die each year from cardiovascular diseases; half
> of these deaths occur outside the hospital, with sudden death
> (collapse) being the first sign of cardiac disease in 50% of the
> cases.
>
> Cardiopulmonary Resuscitation (CPR), which will be covered in this
> module, is the major determinant of survival in cardiac arrest.

**Prerequisites:**

Preparatory, Airway, Patient Assessment Modules

**Materials**

**AV Equipment:**

> Utilize various audio-visual materials relating to emergency medical
> care. The continuous development of new audio-visual materials
> relating to EMS requires careful review to determine which best meet
> the needs of the program. Materials should be edited to ensure that
> the objectives of the curriculum are met.

**EMS Equipment:**

> CPR manikins, artificial ventilation manikins, suction equipment,
> airway management equipment, eye protection, exam gloves.

**Personnel**

**Primary Instructor:**

One instructor knowledgeable in basic life support.

**Assistant Instructor:**

> The instructor-to-student ratio should be 1:6 for psychomotor skills
> practice. Individuals used as assistants should be knowledgeable in
> basic life support skills.

**Recommended Minimum Time to Complete:**

Two hours

**Presentation**

**Declarative (What)**1. Review of the Circulatory System

> A. Function
>
> 1\. Deliver oxygen and nutrients to the tissues
>
> 2\. Remove waste products from the tissues
>
> B. Components/Anatomy
>
> 1\. Heart
>
> a\. Atrium
>
> \(1\) Right - receives blood from the veins of the body
>
> \(2\) Left - receives blood from the lungs
>
> b\. Ventricle
>
> \(1\) Right - pumps blood to the lungs.
>
> \(2\) Left - pumps blood to the body.
>
> c\. Valves prevent back flow of blood.
>
> 2\. Arteries
>
> a\. Carry blood away from the heart to the rest of the body.
>
> b\. Major arteries
>
> \(1\) Carotid
>
> \(a\) Major artery of the neck.
>
> \(b\) Pulsations can be palpated on either side of the neck.
>
> \(2\) Femoral
>
> \(a\) The major artery of the thigh.
>
> \(b\) Pulsations can be palpated in the groin area (the crease between
> the abdomen and thigh).
>
> \(3\) Radial
>
> \(a\) Major artery of the lower arm.
>
> \(b\) Pulsations can be palpated at palm side of the wrist thumb-side.
>
> \(4\) Brachial
>
> \(a\) An artery of the upper arm.
>
> \(b\) Pulsations can be palpated on the inside of the arm between the
> elbow and the shoulder.
>
> 3\. Capillaries
>
> a\. Tiny blood vessels that connect arteries to veins
>
> b\. Found in all parts of the body
>
> c\. Allow for the exchange of oxygen and carbon dioxide
>
> 4\. Veins - vessels that carry blood back to the heart
>
> 5\. Blood
>
> a\. Fluid of the circulatory system
>
> b\. Carries oxygen and carbon dioxide
>
> C. Physiology
>
> 1\. Left ventricle contracts, sending a wave of blood through the
> arteries.
>
> 2\. Pulse can be felt anywhere an artery passes near the skin surface
> and over a bone.
>
> a\. Carotid
>
> b\. Femoral
>
> c\. Radial
>
> d\. Brachial
>
> 3\. A pulse is generated when the left ventricle contracts and sends a
> wave of blood through the arteries.
>
> 4\. A pulse can be felt in the major arteries.
>
> 5\. If the heart stops contracting, no blood will flow.
>
> 6\. The body cannot survive when the heart stops.
>
> a\. When the patient has lost a pulse, they are in cardiac arrest.
>
> b\. Organ damage begins quickly after the heart stops.
>
> c\. Brain damage begins 4-6 minutes after the patient suffers cardiac
> arrest.
>
> d\. Brain damage becomes irreversible in 8-10 minutes.
>
> e\. External chest compressions are used to circulate blood any time
> that the heart is not beating.
>
> f\. External chest compressions are combined with artificial
> ventilation to oxygenate the blood.
>
> g\. The combination of artificial ventilation and external chest
> compressions is called cardio-pulmonary resuscitation (CPR)
>
> 7\. General reasons for the heart to stop beating
>
> a\. Sudden death and heart disease
>
> b\. Respiratory arrest, especially in infants and children
>
> c\. Medical emergencies (stroke, epilepsy, diabetes, allergic
> reactions, electrical shock, poisoning, etc.)
>
> d\. Drowning, suffocation, congenital abnormalities
>
> e\. Trauma and bleeding
>
> f\. Regardless of the reason, the First Responder\'s emergency medical
> care of cardiac arrest is CPR.

I. Cardiopulmonary Resuscitation

> A. A combination of artificial ventilation and external chest
> compressions to oxygenate and circulate blood when the patient is in
> cardiac arrest.
>
> B. External chest compressions
>
> 1\. Depressing the sternum to change the pressure in the chest
>
> 2\. This causes enough blood to flow to sustain life for a short
> period of time.
>
> C. CPR is only effective for a short period of time
>
> 1\. Cannot sustain life indefinitely
>
> 2\. Must be started as early as possible
>
> 3\. Effectiveness decreases the longer you are doing CPR
>
> 4\. In many cases the patient needs to be defibrillated to survive
>
> 5\. CPR increases the amount of time that defibrillation will be
> effective
>
> D. The chain of survival and the EMS system
>
> 1\. Weak links in the chain lower survival rates
>
> 2\. Early access
>
> a\. Public education and awareness
>
> \(1\) Rapid recognition of a cardiac emergency
>
> \(2\) Rapid notification before CPR is started - \"phone first\"
>
> b\. 911-pre-arrival instructions and dispatcher directed CPR
>
> 3\. Early CPR
>
> a\. Lay public
>
> \(1\) Family
>
> \(2\) Bystanders
>
> b\. First Responders
>
> 4\. Early defibrillation
>
> a\. Is now an EMT-basic skill
>
> b\. Some EMS systems have taught First Responders the use of automated
> external defibrillation with great success
>
> 5\. Early advanced cardiac life support (ACLS)
>
> E. The steps of one rescuer adult CPR

**Refer to current American Heart Association Guidelines for CPR**

> F. The steps of two rescuer Adult CPR

**Refer to current American Heart Association Guidelines for CPR**

II\. Infant and Child CPR

> A. The steps of infant CPR

**Refer to current American Heart Association Guidelines for CPR**

> B. The steps of child CPR

**Refer to current American Heart Association Guidelines for CPR**

**Application**

**Procedural (How)**

> 1\. Demonstrate assessment, airway management, and emergency medical
> care of a manikin in a simulated cardiac arrest situation.

**Contextual (When, Where, Why)**

> The First Responder student must prepare to assess and manage patients
> with cardiac emergencies. The training laboratory must provide
> simulated cardiac arrest situations for the student to practice
> demonstrated skills. The student must be able to integrate many single
> skills into one simulated cardiac arrest scenario in order to perform
> effective practice after course completion.

**Student Activities**

**Auditory (Hearing)**

> 1\. The student should hear of actual cases where cardiac arrest
> resuscitation efforts were successful and unsuccessful and the reasons
> for the outcomes.

**Visual (Seeing)**

> 1\. The student should see an instructor team appropriately
> resuscitate a simulated cardiac arrest patient.
>
> 2\. The student should see re - enactments of cardiac arrest
> resuscitation efforts by First Responders.

**Kinesthetic (Doing)**

> 1\. The student should practice the assessment and emergency medical
> care of a patient in cardiac arrest.
>
> 2\. The student should practice assessment, airway management, and
> emergency medical care and transportation of a manikin in a simulated
> cardiac arrest situation outside the training laboratory.

**Instructor Activities**

Facilitate discussion and supervise practice.

> Reinforce student progress in cognitive, affective, and psychomotor
> domains.

Redirect students having difficulty with content. (Complete remediation
form.)

**Evaluation**

**Written:**

> Develop evaluation instruments, e.g., quizzes, oral reviews, and
> handouts, to determine if the students have met the cognitive and
> affective objectives of this lesson.

**Practical:**

> Evaluate the actions of the First Responder students during role play,
> practice, or other skill stations to determine their compliance with
> the cognitive and affective objectives and their mastery of the
> psychomotor objectives of this lesson.

**Remediation**

> Identify students or groups of students who are having difficulty with
> this subject content. Complete remediation sheet from the
> instructor\'s course guide.

**Enrichment**

> What is unique in the local area concerning this topic? Complete
> enrichment sheets from instructor\'s course guide and attach with
> lesson plan.

**Lesson 4-2**

**Practical Lab: Circulation**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem-solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate the cognitive objectives of Lesson 4-1: Circulation

**Affective Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate the affective objectives of Lesson 4-1: Circulation

**Psychomotor Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate the proper technique of chest compressions on an adult.
(P-1,2)

 Demonstrate the proper technique of chest compressions on a child.
(P-1,2)

 Demonstrate the proper technique of chest compressions on an infant.
(P-1,2)

 Demonstrate the steps of adult one rescuer CPR. (P-1,2)

 Demonstrate the steps of adult two rescuer CPR. (P-1,2)

 Demonstrate child CPR. (P-1,2)

 Demonstrate infant CPR. (P-1,2)

**Preparation**

**Motivation:**

> The practical lesson is designed to allow the students additional time
> to perfect skills. It is of utmost importance that the students
> demonstrate proficiency of the skill, cognitive knowledge of the steps
> to perform a skill, and a healthy attitude towards performing that
> skill on a patient.
>
> This is an opportunity for the instructor and assistant instructors to
> praise progress and re ‑ direct the students toward appropriate
> psychomotor skills. The material from all preceding lessons and basic
> life support should be incorporated into these practical skill
> sessions.

**Prerequisites:**

Preparatory

**Materials**

**AV Equipment:**

> Utilize various audio-visual materials relating to emergency medical
> care. The continuous development of new audio-visual materials
> relating to EMS requires careful review to determine which best meet
> the needs of the program. Materials should be edited to ensure that
> the objectives of the curriculum are met.

**EMS Equipment:**

> CPR manikins, artificial ventilation manikins, suction equipment,
> airway management equipment, eye protection, exam gloves.

**Personnel**

**Primary Instructor:**

> One First Responder instructor knowledgeable in basic life support and
> airway management.

**Assistant Instructor:**

> The instructor-to-student ratio should be 1:6 for psychomotor skill
> practice. Individuals used as assistant instructors should be
> knowledgeable in basic life support and airway management techniques.

**Recommended Minimum Time to Complete:**

Three hours

**Presentation**

**Declarative (What)** None identified for this lesson.

**Application**

**Procedural (How)**

> Instructor should demonstrate the procedural activities from Lesson
> 4-1: Patient Assessment

**Contextual (When, Where, Why)**

> Instructor should review contextual information from Lesson 4-1:
> Patient Assessment

**Student Activities**

**Auditory (Hearing)**

> 1\. The student should hear of actual cases where cardiac arrest
> resuscitation efforts were successful and unsuccessful and the reasons
> for the outcomes.

**Visual (Seeing)**

> 1\. The student should see an instructor team appropriately
> resuscitate a simulated cardiac arrest patient.
>
> 2\. The student should see re-enactments of cardiac arrest
> resuscitation efforts by First Responders.

**Kinesthetic (Doing)**

> 1\. The student should practice the assessment and emergency medical
> care of a patient in cardiac arrest.
>
> 2\. The student should practice assessment, airway management, and
> emergency medical care and transportation out of the training
> laboratory of a manikin in a simulated cardiac arrest situation.

**Instructor Activities**

> Supervise student practice.
>
> Reinforce student progress in cognitive, affective, and psychomotor
> domains.
>
> Redirect students having difficulty with content (complete remediation
> forms).

**Evaluation**

**Practical:**

> Evaluate the actions of the First Responder students during role play,
> practice or other skills stations to determine their compliance with
> the cognitive and affective objectives and their mastery of the
> psychomotor objectives of this lesson.

**Remediation**

> Identify students or groups of students who are having difficulty with
> this subject content. Complete remediation sheet from the
> instructor\'s course guide.

**Enrichment**

> What is unique in the local area concerning this topic? Complete
> enrichment sheets from the instructor\'s course guide and attach with
> lesson plan.

**Lesson 4-3**

**Evaluation: Circulation**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate competence in the cognitive objectives of Lesson 4-1:
Circulation

 Demonstrate competence in the cognitive objectives of Lesson 4-2:
Circulation

**Affective Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate competence in the affective objectives of Lesson 4-1:
Circulation

 Demonstrate competence in the affective objectives of Lesson 4-2:
Circulation

**Psychomotor Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate competence in the psychomotor objectives of Lesson 4-1:
Circulation

 Demonstrate competence in the psychomotor objectives of Lesson 4-2:
Circulation Practical

**Preparation**

**Motivation:**

> Evaluation of the student\'s attainment of the cognitive and affective
> knowledge and psychomotor skills is an essential component of the
> First Responder\'s educational process. The modules are presented in a
> \"building block\" format. Once the students have demonstrated their
> knowledge and proficiency, the next lesson should be built upon that
> knowledge. This evaluation will help to identify students or groups of
> students having difficulty with a particular area. This is an
> opportunity for the instructor to evaluate their performance and make
> appropriate modifications to the delivery of material.

**Prerequisites:**

Completion of Lessons 4-1 through 4-2.

**Material**

**AV Equipment:**

Typically none required.

**EMS Equipment:**

The EMS equipment used in the Lessons of Module 4.

**Personnel**

**Primary Instructor:**

One proctor for the written evaluation.

**Assistant Instructor:**

One practical skills examiner for each 6 students.

**Recommended Minimum Time to Complete:**

One hour

**Presentation**

**Declarative (What)**

I. Purpose of the evaluation

II\. Items to be evaluated

III\. Feedback from evaluation

**Application**

**Procedural (How)**

> 1\. Written evaluation based on the cognitive and affective objectives
> of Lessons 4-1 \> 4-2.
>
> 2\. Practical evaluation stations based on the psychomotor objectives
> of Lessons 4-1 \> 4-2.

**Contextual (When, Where and Why)**

> The evaluation is the final lesson in this module and is designed to
> bring closure to the module and to assure that students are prepared
> to proceed to the next module.
>
> This modular evaluation is done to determine the effectiveness of the
> presentation of materials and how well students have retained the
> material. This is an opportunity for the students to make necessary
> adjustments in study habits or for the instructor to adjust the manner
> in which material is presented.

**Instructor Activities**

> Supervise student evaluation.
>
> Reinforce student progress in cognitive, affective, and psychomotor
> domains.
>
> Redirect students having difficulty with content. (Complete
> remediation forms.)

**Remediation**

> Identify students and/or groups of students who are having difficulty
> with this subject content. Complete a remediation sheet from the
> instructor\'s course guide. If students continue to have difficulty
> demonstrating knowledge of the cognitive and affective objectives or
> demonstrating proficiency in psychomotor skills, the students should
> be counseled, remediated, and re-evaluated. If improvements in
> cognitive, affective, or psychomotor skills are not achieved,
> consideration regarding the ability of the student to progress in the
> program should be taken into account.

**Module 5: Illness and Injury**

**Lesson 5-1 Medical Emergencies**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem-solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

5-1.1 Identify the patient who presents with a general medical
complaint. (C-1)

5-1.2 Explain the steps in providing emergency medical care to a patient
with a general medical complaint. (C-1)

5-1.3 Identify the patient who presents with a specific medical
complaint of altered mental status. (C-1)

5-1.4 Explain the steps in providing emergency medical care to a patient
with an altered mental status. (C-1)

5-1.5 Identify the patient who presents with a specific medical
complaint of seizures. (C-1)

5-1.6 Explain the steps in providing emergency medical care to a patient
with seizures. (C-1)

5-1.7 Identify the patient who presents with a specific medical
complaint of exposure to cold. (C-1)

5-1.8 Explain the steps in providing emergency medical care to a patient
with an exposure to cold. (C-1)

5-1.9 Identify the patient who presents with a specific medical
complaint of exposure to heat. (C-1)

5-1.10 Explain the steps in providing emergency medical care to a
patient with an exposure to heat. (C-1)

5-1.11 Identify the patient who presents with a specific medical
complaint of behavioral change. (C-1)

5-1.12 Explain the steps in providing emergency medical care to a
patient with a behavioral change. (C-1)

5-1.13 Identify the patient who presents with a specific complaint of a
psychological crisis. (C-1)

5-1.14 Explain the steps in providing emergency medical care to a
patient with a psychological crisis. (C-1)

**Affective Objectives**

5-1.15 Attend to the feelings of the patient and/or family when dealing
with the patient with a general medical complaint. (A-3)

5-1.16 Attend to the feelings of the patient and/or family when dealing
with the patient with a specific medical complaint. (A-3)

5-1.17 Explain the rationale for modifying your behavior toward the
patient with a behavioral emergency. (A-3)

5-1.18 Demonstrate a caring attitude towards patients with a general
medical complaint who request emergency medical services. (A-3)

5-1.19 Place the interests of the patient with a general medical
complaint as the foremost consideration when making any and all patient
care decisions. (A-3)

5-1.20 Communicate with empathy to patients with a general medical
complaint, as well as with family members and friends of the patient.
(A-3)

5-1.21 Demonstrate a caring attitude towards patients with a specific
medical complaint who request emergency medical services. (A-3)

5-1.22 Place the interests of the patient with a specific medical
complaint as the foremost consideration when making any and all patient
care decisions. (A-3)

5-1.23 Communicate with empathy to patients with a specific medical
complaint, as well as with family members and friends of the patient.
(A-3)

5-1.24 Demonstrate a caring attitude towards patients with a behavioral
problem who request emergency medical services. (A-3)

5-1.25 Place the interests of the patient with a behavioral problem as
the foremost consideration when making any and all patient care
decisions. (A-3)

5-1.26 Communicate with empathy to patients with a behavioral problem,
as well as with family members and friends of the patient. (A-3)

**Psychomotor Objectives**

At the completion of this lesson, the First Responder student will be
able to:

5-1.27 Demonstrate the steps in providing emergency medical care to a
patient with a general medical complaint. (C-1)

5-1.28 Demonstrate the steps in providing emergency medical care to a
patient with an altered mental status. (C-1)

5-1.29 Demonstrate the steps in providing emergency medical care to a
patient with seizures. (C-1)

5-1.30 Demonstrate the steps in providing emergency medical care to a
patient with an exposure to cold. (C-1)

5-1.31 Demonstrate the steps in providing emergency medical care to a
patient with an exposure to heat. (C-1)

5-1.32 Demonstrate the steps in providing emergency medical care to a
patient with a behavioral change. (C-1)

5-1.33 Demonstrate the steps in providing emergency medical care to a
patient with a psychological crisis. (C-1)

**Preparation**

**Motivation:**

> Patients present with various medical conditions and complaints.
> Although some specific situations may require the First Responder to
> intervene with specific skills most will be listed as a common medical
> complaint. The First Responder must be prepared to provide appropriate
> emergency medical care to the various medical patients that they may
> encounter.

**Prerequisites:**

Preparatory, Airway, Patient Assessment, and Circulation Modules

**Materials**

**AV Equipment:**

> Utilize various audio-visual materials relating to emergency medical
> care. The continuous development of new audio-visual materials
> relating to EMS requires careful review to determine which best meet
> the needs of the program. Materials should be edited to ensure that
> the objectives of the curriculum are met.

**EMS Equipment:**

Personal protective equipment, hot and cold packs, and a space blanket.

**Personnel**

**Primary Instructor:**

One First Responder instructor, knowledgeable in medical emergencies.

**Assistant Instructor:**

> The instructor-to-student ratio should be 1:6 for psychomotor skill
> practice. Individuals used as assistant instructors should be
> knowledgeable about altered mental status, seizures, and environmental
> injuries.

**Recommended Minimum Time to Complete:**

One hour

**Presentation**

**Declarative (What)**

I. General Medical Complaints

> A. Patients may request emergency medical services for a variety of
> medical complaints.
>
> B. The First Responder should assess each patient to determine the
> patient\'s chief complaint as well as signs and symptoms present.
>
> C. Emergency medical care is based on the patient\'s signs and
> symptoms.
>
> D. Role of the First Responder
>
> 1\. Complete the First Responder assessment
>
> a\. Complete a scene size-up before initiating emergency medical care.
>
> b\. Complete an initial assessment on all patients.
>
> c\. Complete a physical exam as needed.
>
> d\. Complete on-going assessments.
>
> 2\. Comfort, calm, and reassure the patient while awaiting additional
> EMS resources

II\. Specific Medical Complaints

> A. Altered mental status
>
> 1\. A sudden or gradual decrease in the patient\'s level of
> responsiveness and understanding ranging from disorientation to
> unresponsive.
>
> 2\. There are many reasons for patients having altered mental status
>
> a\. Fever
>
> b\. Infections
>
> c\. Poisoning - including drugs and alcohol
>
> d\. Low blood sugar
>
> e\. Insulin reactions
>
> f\. Head injury
>
> g\. Decreased levels of oxygen in the brain
>
> h\. Psychiatric conditions
>
> 3\. Support the patient; do not worry about determining the cause of
> the altered mental status; maintain scene safety.
>
> 4\. The length of the altered mental status may be brief or prolonged.
>
> 5\. Role of the First Responder
>
> a\. Complete the First Responder assessment
>
> \(1\) Complete a scene size-up before initiating emergency medical
> care.
>
> \(2\) Complete an initial assessment on all patients.
>
> \(3\) Complete a physical exam as needed.
>
> \(4\) Complete on-going assessments.
>
> b\. Comfort, calm, and reassure the patient while awaiting additional
> EMS resources.

\(1\) Assure patency of airway.

> \(2\) Place patient in the recovery position if no possibility of
> spine trauma.
>
> \(3\) Do not put anything in the patient\'s mouth
>
> \(4\) Have suction available
>
> 6\. Relationship to airway management
>
> a\. Often patients with altered mental status cannot protect their own
> airway; consider the use of airway adjuncts.
>
> b\. The unresponsive patient should be placed in the recovery
> position.
>
> c\. Suction should be readily available.
>
> B. Seizures
>
> 1\. A sudden attack, usually related to nervous system malfunction.
>
> 2\. There are many types of seizures.
>
> 3\. There are many causes of seizures.
>
> a\. Chronic medical conditions
>
> b\. Fever
>
> c\. Infections
>
> d\. Poisoning including drugs and alcohol
>
> e\. Low blood sugar
>
> f\. Head injury
>
> g\. Decreased levels of oxygen
>
> h\. Brain tumors
>
> i\. Complications of pregnancy
>
> j\. Unknown causes
>
> 4\. Support the patient; do not worry about determining the cause of
> the seizure.
>
> 5\. Some seizures produce violent muscle contractions called
> convulsions.
>
> a\. Most patients are unresponsive and may vomit during the
> convulsion.
>
> b\. Patients are typically tired and sleep following the attack.
>
> 6\. Seizures are rarely life‑threatening, but a serious emergency.
>
> 7\. The length of the seizure may be brief (less than 5 minutes) or
> prolonged.
>
> 8\. Role of the First Responder
>
> a\. Complete the First Responder assessment
>
> \(1\) Complete a scene size-up prior to initiating emergency medical
> care.
>
> \(2\) Complete an initial assessment on all patients.
>
> \(3\) Complete a physical exam as needed.
>
> \(4\) Complete on-going assessments.
>
> b\. Comfort, calm, and reassure the patient while awaiting additional
> EMS resources.
>
> \(1\) Protect the patient from the environment.
>
> \(2\) Protect modesty - ask bystanders to leave the area
>
> \(3\) Assure patency of airway.
>
> \(4\) Place patient in the recovery position if no possibility of
> spine trauma.
>
> \(5\) Never restrain the patient.
>
> \(6\) Do not put anything in the patient\'s mouth.
>
> \(7\) Have suction available.
>
> \(8\) If the patient is bluish, assure airway and artificially
> ventilate.
>
> \(9\) Report assessment findings to EMS.
>
> \(10\) Observe and describe the seizure to EMS resources.
>
> \(a\) First Responder may be the only witness to seizure.
>
> \(b\) May be important in determining cause of seizure.
>
> 9\. Relationship to airway management
>
> a\. Often seizure patients will have significant oral secretions.
>
> b\. It is essential that these patients be placed in the recovery
> position when the convulsions have ended.
>
> c\. Patients who are actively seizing, bluish, and breathing
> inadequately should be ventilated, if possible.
>
> d\. Suction oral secretions as needed.
>
> C. Exposure to cold

1\. Generalized cold emergency

a\. Contributing factors

\(1\) Cold environment

\(2\) Age (very old/very young)

\(3\) Medical conditions

\(4\) Alcohol/drugs/poisons

b\. Signs and symptoms of generalized hypothermia

> \(1\) Obvious exposure

\(2\) Subtle exposure

\(a\) Underlying illness

\(b\) Overdose/poisoning

> \(c\) Ambient temperature decreased (e.g., cool home of elderly
> patient)
>
> \(3\) Cool/cold skin temperature
>
> \(a\) Place the back of your hand between the clothing and the
> patient\'s abdomen to assess the general temperature of the patient.
>
> \(b\) The patient experiencing a generalized cold emergency will
> present with cool or cold abdominal skin temperature.
>
> \(4\) Shivering
>
> \(5\) Decreasing mental status or motor function - correlates with the
> degree of hypothermia.

\(a\) Poor coordination

\(b\) Memory disturbances/confusion

> \(c\) Reduced or loss of touch sensation

\(d\) Mood changes

\(e\) Less communicative

> \(f\) Dizziness

\(g\) Speech difficulty

\(6\) Stiff or rigid posture

\(7\) Muscular rigidity

> \(8\) Poor judgment - patient may actually remove clothing.

\(9\) Complaints of joint/muscle stiffness.

2\. Role of the First Responder

> a\. Complete the First Responder assessment
>
> \(1\) Complete a scene size-up before initiating emergency medical
> care.
>
> \(2\) Complete an initial assessment on all patients.
>
> \(3\) Complete a physical exam as needed.
>
> \(4\) Complete on-going assessments.
>
> b\. Comfort, calm, and reassure the patient while awaiting additional
> EMS resources.
>
> \(1\) Assess pulses for 30-45 seconds before starting CPR.
>
> \(2\) Remove the patient from the cold environment.
>
> \(3\) Protect the patient from further heat loss.

\(4\) Remove any wet clothing and cover the patient with a blanket.

> \(5\) Handle the patient extremely gently.
>
> \(6\) Do not allow the patient to walk or exert himself.
>
> \(7\) The patient should not be given anything by mouth.
>
> \(a\) Do not allow the patient to eat or drink stimulants.
>
> \(b\) Coffee, tea, or smoking may worsen the condition

\(8\) Do not massage extremities.

> \(9\) Cover the patient with a blanket; keep the patient warm.
>
> 3\. Local cold emergencies
>
> a\. Freezing or near freezing of a body part
>
> b\. Usually occurs in fingers, toes, face, ears, and nose.

c\. Signs and symptoms of local cold injuries d. Local injury with clear
demarcation

\(1\) Early or superficial injury

> \(a\) Blanching of the skin - palpation of the skin in which normal
> color does not return.
>
> \(b\) Loss of feeling and sensation in the injured area
>
> \(c\) Skin remains soft.
>
> \(d\) If rewarmed, tingling sensation
>
> \(2\) Late or deep injury

\(a\) White, waxy skin

\(b\) Firm to frozen feeling upon palpation

\(c\) Swelling may be present.

\(d\) Blisters may be present.

> \(e\) If thawed or partially thawed, the skin may appear flushed with
> areas of purple and blanching or may be mottled and cyanotic.

4\. Role of the First Responder

> a\. Complete the First Responder assessment
>
> \(1\) Complete a scene size-up before initiating emergency medical
> care.
>
> \(2\) Complete an initial assessment on all patients.
>
> \(3\) Complete a physical exam as needed.
>
> \(4\) Complete on-going assessments.
>
> b\. Comfort, calm, and reassure the patient while awaiting additional
> EMS resources.

\(1\) Remove the patient from the environment.

> \(2\) Protect the cold - injured extremity from further injury.
>
> \(3\) Remove wet or restrictive clothing.

\(4\) If early or superficial injury

> \(a\) Manually stabilize the extremity.
>
> \(b\) Cover the extremity.

\(c\) Do not rub or massage.

> \(d\) Do not re-expose to the cold.

\(5\) If late or deep cold injury

> \(a\) Remove jewelry.

\(b\) Cover with dry clothing or dressings.

\(c\) Do not:

i\) Break blisters

ii\) Rub or massage area

iii\) Apply heat

iv\) Rewarm

> v\) Allow the patient to walk on the affected extremity

D. Exposure to heat

1\. Predisposing factors

> a\. Climate
>
> \(1\) High ambient temperature reduces the body\'s ability to lose
> heat by radiation.
>
> \(2\) High relative humidity reduces the body\'s ability to lose heat
> through evaporation.
>
> b\. Exercise and activity - can lose more than 1 liter of sweat per
> hour

c\. Age (very old/very young)

> d\. Pre-existing illness and/or conditions

e\. Drugs/medications

2\. Signs and symptoms

a\. Muscular cramps

b\. Weakness or exhaustion

c\. Dizziness or faintness

d\. Rapid heart rate

e\. Altered mental status to unresponsive

> 3\. Role of the First Responder
>
> a\. Complete the First Responder assessment
>
> \(1\) Complete a scene size-up before initiating emergency medical
> care.
>
> \(2\) Complete an initial assessment on all patients.
>
> \(3\) Complete a physical exam as needed.
>
> \(4\) Complete on-going assessments.
>
> b\. Comfort, calm, and reassure the patient while awaiting additional
> EMS resources.
>
> \(1\) Remove the patient from the hot environment and Place in a cool
> environment (air conditioned)
>
> \(2\) Cool patient by fanning, but may be ineffective in high humidity

\(3\) Place in recovery position

> E. Behavior
>
> 1\. Behavior - manner in which a person acts or performs; any or all
> activities of a person, including physical and mental activity.
>
> 2\. Behavioral emergency
>
> a\. A situation where the patient exhibits abnormal behavior that is
> unacceptable or intolerable to the patient, family, or community.
>
> b\. This behavior can be due to extremes of emotion leading to
> violence or other inappropriate behavior or due to a psychological or
> physical condition such as lack of oxygen or low blood sugar in
> diabetes.
>
> 3\. Behavioral change
>
> a\. General factors that may alter a patient\'s behavior have many
> causes.

b\. Common causes for behavior alteration

> \(1\) Situational stresses
>
> \(2\) Illness/injury
>
> \(a\) Low blood sugar
>
> \(b\) Lack of oxygen
>
> \(c\) Inadequate blood flow to the brain
>
> \(d\) Head trauma
>
> \(e\) Excessive cold
>
> \(f\) Excessive heat
>
> \(3\) Mind altering substances - alcohol and drugs
>
> \(4\) Psychiatric problems
>
> \(5\) Psychologic crises
>
> \(a\) Panic
>
> \(b\) Agitation
>
> \(c\) Bizarre thinking and behavior
>
> \(d\) Danger to self - self destructive behavior, suicide
>
> \(e\) Danger to others - threatening behavior, violence
>
> F. Role of the First Responder
>
> 1\. Complete the First Responder assessment
>
> a\. Complete a scene size-up before initiating emergency medical care.
>
> b\. Complete an initial assessment on all patients.
>
> c\. Complete a physical exam as needed.
>
> d\. Complete on-going assessments.
>
> 2\. Comfort, calm, and reassure the patient while awaiting additional
> EMS resources.
>
> a\. Calm the patient - do not leave patient alone.
>
> b\. Consider need for law enforcement.
>
> c\. If overdose, give medications or drugs found to transporting EMS
> resources.
>
> G. Principles for assessing behavioral emergency patients
>
> 1\. Identify yourself and let the person know you are there to help.
>
> 2\. Inform person of what you are doing.
>
> 3\. Ask questions in a calm, reassuring voice.
>
> 4\. Without being judgmental, allow the patient to tell what happened.
>
> 5\. Show you are listening by rephrasing or repeating part of what is
> said.
>
> 6\. Acknowledge the patient\'s feelings.
>
> 7\. Assess the patient\'s mental status.
>
> a\. Appearance
>
> b\. Activity
>
> c\. Speech
>
> d\. Orientation for time, person, and place
>
> H. Assessment of potential violence
>
> 1\. Scene size-up
>
> 2\. History - check with family and bystanders to determine if the
> patient has a known history of aggression or combativeness.
>
> 3\. Posture - stands or sits in a position which threatens self or
> others. May have fists clinched or lethal objects in hands.
>
> 4\. Vocal activity - is yelling or verbally threatens harm to self or
> others.
>
> 5\. Physical activity - moves toward caregiver, carries heavy or
> threatening objects, has quick irregular movements, muscles tense.
>
> I. Methods to calm behavioral emergency patients
>
> 1\. Acknowledge that the person seems upset and restate that you are
> there to help.
>
> 2\. Inform the person of what you are doing.
>
> 3\. Ask questions in a calm, reassuring voice.
>
> 4\. Maintain a comfortable distance.
>
> 5\. Encourage the patient to state what is troubling him/her.
>
> 6\. Do not make quick moves.
>
> 7\. Respond honestly to patient\'s questions.
>
> 8\. Do not threaten, challenge, or argue with disturbed patients.
>
> 9\. Tell the truth; do not lie to the patient.
>
> 10\. Do not \"play along\" with visual or auditory disturbances of the
> patient.
>
> 11\. Involve trusted family members or friends.
>
> 12\. Be prepared to stay at scene for a long time. Always remain with
> the patient.
>
> 13\. Avoid unnecessary physical contact. Call additional help if
> needed.
>
> 14\. Use good eye contact.
>
> J. Restraining patients
>
> 1\. Restraint should be avoided unless patient is a danger to self and
> others.
>
> 2\. When using restraints, have police present, if possible, and get
> approval from medical oversight.
>
> 3\. If restraints must be used, work in conjunction with the EMS
> providers.

4\. Avoiding unreasonable force

> a\. Reasonable force depends on what force is necessary to keep
> patient from injuring himself or others.
>
> b\. Reasonableness is determined by looking at all circumstances
> involved.
>
> \(1\) Patient\'s size and strength
>
> \(2\) Type of abnormal behavior
>
> \(3\) Sex of patient
>
> \(4\) Mental state of patient
>
> \(5\) Method of restraint
>
> c\. Be aware that after a period of combativeness and aggression some
> apparently calm patients may cause unexpected and sudden injury to
> self and others.
>
> d\. Avoid acts or physical force that may cause injury to the patient.
>
> e\. EMS personnel may use reasonable force to defend against an attack
> by emotionally disturbed patients.
>
> f\. Police and medical oversight involvement
>
> \(1\) Seek medical oversight when considering restraining a patient.
>
> \(2\) Ask for police assistance if during scene size-up the patient
> appears or acts aggressive or combative.
>
> g\. Protection against false accusations
>
> \(1\) Documentation of abnormal behavior exhibited by the patient is
> very important.
>
> \(2\) Have witnesses in attendance especially during transport, if
> possible.
>
> \(3\) Accusing First Responders of sexual misconduct is common by
> emotionally disturbed patients - have help, same sex attendants, and
> third party witnesses.
>
> K. Medical/legal considerations
>
> 1\. Emotionally disturbed patient who consents to care - legal
> problems greatly reduced.
>
> 2\. How to handle the patient who resists treatment
>
> a\. Emotionally disturbed patient will often resist treatment.
>
> b\. May threaten First Responders and others.
>
> c\. To provide care against patient\'s will, you must have a
> reasonable belief the patient would harm self or others.
>
> d\. If a threat to self or others, patient may be transported without
> consent after you contact medical oversight.
>
> e\. Usually law enforcement is required.

**Application**

**Procedural (How)**

> 1\. Demonstrate the steps in providing emergency medical care to a
> patient with a general medical complaint.
>
> 2\. Demonstrate the steps in providing emergency medical care to a
> patient with an altered mental status.
>
> 3\. Demonstrate the steps in providing emergency medical care to a
> patient with seizures.
>
> 4\. Demonstrate the steps in providing emergency medical care to a
> patient exposed to cold.
>
> 5\. Demonstrate the steps in providing emergency medical care to a
> patient exposed to heat.
>
> 6\. Demonstrate the steps in providing emergency medical care to a
> patient with a behavioral change.
>
> 7\. Demonstrate the steps in providing emergency medical care to a
> patient with a psychological crisis.

**Contextual (When, Where, Why)**

> The First Responder will now be able to treat patients with general
> and specific medical complaints.

**Student Activities**

**Auditory (Hearing)**

> 1\. The student should hear the instructor present the signs,
> symptoms, and management of patients with general medical complaints.
>
> 2\. The student should hear the instructor present the signs,
> symptoms, and management of patients with altered mental status.
>
> 3\. The student should hear the instructor present the signs,
> symptoms, and management of patients with seizures.
>
> 4\. The student should hear the instructor present the signs,
> symptoms, and management of patients exposed to cold.
>
> 5\. The student should hear the instructor present the signs,
> symptoms, and management of patients exposed to heat.
>
> 6\. The student should hear the instructor present the signs,
> symptoms, and management of patients with behavior problems.

**Visual (Seeing)**

> 1\. The students should see audio-visual material of patients with
> general medical complaints.
>
> 2\. The students should see audio-visual material of patients with an
> altered mental status.
>
> 3\. The students should see audio-visual material of patients with
> seizures.
>
> 4\. The students should see audio-visual material of patients exposed
> to cold.
>
> 5\. The students should see audio-visual material of patients exposed
> to heat.
>
> 6\. The students should see audio-visual material of patients with
> behavior problems.

**Kinesthetic (Doing)**

> 1\. The students should role play emergency medical care of a patient
> with a general medical complaint.
>
> 2\. The students should role play emergency medical care of a patient
> with altered mental status.
>
> 3\. The students should role play emergency medical care of a patient
> with a seizure.
>
> 4\. The students should role play emergency medical care of a patient
> exposed to cold.
>
> 5\. The students should role play emergency medical care of a patient
> exposed to heat.
>
> 6\. The students should role play emergency medical care of a patient
> with behavior problems.

**Instructor Activities**

Facilitate discussion and supervise practice.

> Reinforce student progress in cognitive, affective, and psychomotor
> domains.

Redirect students having difficulty with content. (Complete remediation
form.)

**Evaluation**

**Written:**

> Develop evaluation instruments, e.g., quizzes, oral reviews, and
> handouts, to determine if the students have met the cognitive and
> affective objectives of this lesson.

**Practical:**

> Evaluate the actions of the First Responder students during role play,
> practice, or other skill stations to determine their compliance with
> the cognitive and affective objectives and their mastery of the
> psychomotor objectives of this lesson.

**Remediation**

> Identify students or groups of students who are having difficulty with
> this subject content. Complete remediation sheet from the
> instructor\'s course guide.

**Enrichment**

> What is unique in the local area concerning this topic? Complete
> enrichment sheets from instructor\'s course guide and attach with
> lesson plan.

**Lesson 5-2**

**Bleeding and Soft Tissue Injuries**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem-solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

5-2.1 Differentiate between arterial, venous, and capillary bleeding.
(C‑3)

5-2.2 State the emergency medical care for external bleeding. (C-1)

5-2.3 Establish the relationship between body substance isolation and
bleeding. (C-3)

5-2.4 List the signs of internal bleeding. (C-1)

5-2.5 List the steps in the emergency medical care of the patient with
signs and symptoms of internal bleeding. (C-1)

5-2.6 Establish the relationship between body substance isolation (BSI)
and soft tissue injuries. (C-3)

5-2.7 State the types of open soft tissue injuries. (C-1)

5-2.8 Describe the emergency medical care of the patient with a soft
tissue injury. (C-1)

5-2.9 Discuss the emergency medical care considerations for a patient
with a penetrating chest injury. (C-1)

5-2.10 State the emergency medical care considerations for a patient
with an open wound to the abdomen. (C-1)

5-2.11 Describe the emergency medical care for an impaled object. (C-1)

5-2.12 State the emergency medical care for an amputation. (C-1)

5-2.13 Describe the emergency medical care for burns. (C-1)

5-2.14 List the functions of dressing and bandaging. (C-1)

**Affective Objectives**

At the completion of this lesson, the First Responder student will be
able to:

5-2.15 Explain the rationale for body substance isolation when dealing
with bleeding and soft tissue injuries. (A-3)

5-2.16 Attend to the feelings of the patient with a soft tissue injury
or bleeding. (A-3)

5-2.17 Demonstrate a caring attitude towards patients with a soft tissue
injury or bleeding who request emergency medical services. (A-3)

5-2.18 Place the interests of the patient with a soft tissue injury or
bleeding as the foremost consideration when making any and all patient
care decisions. (A-3)

5-2.19 Communicate with empathy to patients with a soft tissue injury or
bleeding, as well as with family members and friends of the patient.
(A-3)

**Psychomotor Objectives**

At the completion of this lesson, the First Responder student will be
able to:

5-2.20 Demonstrate direct pressure as a method of emergency medical care
for external bleeding. (P-1,2)

5-2.21 Demonstrate the use of diffuse pressure as a method of emergency
medical care for external bleeding. (P-1,2)

5-2.22 Demonstrate the use of pressure points as a method of emergency
medical care for external bleeding. (P-1,2)

5-2.23 Demonstrate the care of the patient exhibiting signs and symptoms
of internal bleeding. (P-1,2)

5-2.24 Demonstrate the steps in the emergency medical care of open soft
tissue injuries. (P-1,2)

5-2.25 Demonstrate the steps in the emergency medical care of a patient
with an open chest wound. (P-1,2)

5-2.26 Demonstrate the steps in the emergency medical care of a patient
with open abdominal wounds. (P-1,2)

5-2.27 Demonstrate the steps in the emergency medical care of a patient
with an impaled object. (P-1,2)

5-2.28 Demonstrate the steps in the emergency medical care of a patient
with an amputation. (P-1,2)

5-2.29 Demonstrate the steps in the emergency medical care of an
amputated part. (P-1,2)

**Preparation**

**Motivation:**

> Trauma is the leading cause of death in the United States in persons
> between the ages of 1 and 44. Traumatic injuries and bleeding are some
> of the most dramatic situations that the First Responder will
> encounter. The early control of major bleeding has great life saving
> potential.
>
> Soft tissue injuries are common and dramatic, but rarely life
> threatening. Soft tissue injuries range from abrasions to serious full
> thickness burns. It is necessary for the First Responder to become
> familiar with the emergency medical care of soft tissue injuries with
> emphasis on controlling bleeding, preventing further injury, and
> reducing contamination.

**Prerequisites:**

Preparatory, Airway, Patient Assessment, and Circulation Module

**Materials**

**AV Equipment:**

> Utilize various audio-visual materials relating to emergency medical
> care. The continuous development of new audio-visual materials
> relating to EMS requires careful review to determine which best meet
> the needs of the program. Materials should be edited to ensure that
> the objectives of the curriculum are met.

**EMS Equipment:**

> Personal protective equipment, sterile dressings, triangular bandages,
> universal dressings, occlusive dressings, 4 x 4 gauze pads, self
> adherent bandages, roller bandages.

**Personnel**

**Primary Instructor:**

> One First Responder instructor, knowledgeable in bleeding and soft
> tissue injuries.

**Assistant Instructor:**

> The instructor-to-student ratio should be 1:6 for psychomotor skill
> practice. Individuals used as assistant instructors should be
> knowledgeable about bleeding and soft tissues injuries.

**Recommended Minimum Time to Complete:**

One and a half hours

**Presentation**

**Declarative (What)**1. Bleeding

A. General considerations

> 1\. The First Responder must be aware of the risk of infectious
> disease from contact with blood or body fluids.
>
> 2\. The severity of blood loss must be based on the patient\'s signs
> and symptoms and the general impression of the amount of blood loss.
>
> 3\. The body\'s normal response to bleeding is blood vessel
> contractions and clotting.
>
> 4\. A serious injury may prevent effective clotting from occurring.
>
> 5\. Uncontrolled bleeding or significant blood loss leads to shock and
> possibly death.
>
> 6\. Bleeding may be external or internal.
>
> 7\. Internal and external bleeding can result in severe blood loss
> with resultant shock and subsequent death.

B. Types of external bleeding

1\. Arterial

> a\. The blood spurts from the wound.
>
> b\. Bright, red, oxygen rich blood.
>
> c\. Arterial bleeding is the most difficult to control because of the
> pressure at which arteries bleed.
>
> d\. As the patient\'s blood pressure drops, the amount of spurting may
> also drop.

2\. Venous

> a\. The blood flows as a steady stream.
>
> b\. Dark, oxygen poor blood.
>
> c\. Bleeding from a vein can be profuse; however, in most cases it is
> easier to control due to the lower venous pressure.

3\. Capillary

> a\. The blood oozes from a capillary and is dark red in color.
>
> b\. The bleeding often clots spontaneously.

4\. Role of the First Responder

> a\. Complete the First Responder assessment
>
> \(1\) Complete a scene size-up before initiating emergency medical
> care.
>
> \(2\) Complete an initial assessment on all patients.
>
> \(3\) Complete a physical exam as needed.
>
> \(4\) Complete on-going assessments.
>
> b\. Comfort, calm, and reassure the patient while awaiting additional
> EMS resources
>
> \(1\) The First Responder must be aware of the implications of not
> using body substance isolation precautions.

\(2\) Body substance isolation

> \(3\) Maintain airway/artificial ventilation.
>
> \(4\) Bleeding control
>
> \(a\) Apply finger tip pressure (use flat part of fingers) directly on
> the point of bleeding.
>
> \(b\) If no injury to the muscle or bone exists, elevation of a
> bleeding extremity may be used secondary to and in conjunction with
> direct pressure.
>
> \(c\) Large gaping wounds may require sterile gauze and direct hand
> pressure if finger tip pressure fails to control bleeding.
>
> \(d\) If bleeding does not stop, remove dressing and assess for
> bleeding point to apply direct pressure. If more than one site of
> bleeding is discovered, apply additional pressure.
>
> \(e\) Pressure points may be used in upper and lower extremities.
>
> C. Internal bleeding
>
> 1\. Injured or damaged internal organs commonly lead to extensive
> bleeding that is concealed.
>
> 2\. Painful, swollen, deformed extremities may also lead to serious
> internal blood loss.
>
> 3\. Signs and symptoms
>
> a\. Discolored, tender swollen or hard tissue
>
> b\. Increased respiratory and pulse rates
>
> c\. Pale, cool skin
>
> d\. Nausea and vomiting
>
> e\. Thirst
>
> f\. Mental status changes
>
> 4\. Role of the First Responder
>
> a\. Complete the First Responder assessment
>
> \(1\) Complete a scene size-up before initiating emergency medical
> care.
>
> \(2\) Complete an initial assessment on all patients.
>
> \(3\) Complete a physical exam as needed.
>
> \(4\) Complete on-going assessments.
>
> b\. Comfort, calm, and reassure the patient while awaiting additional
> EMS resources.

\(1\) Body substance isolation

> \(2\) Maintain airway/artificial ventilation.
>
> \(3\) Manage any external bleeding.
>
> \(4\) Reassure the patient.
>
> \(5\) Keep the patient calm and in position of comfort.
>
> \(6\) Keep the patient warm.
>
> \(7\) Treat for shock.
>
> D. Shock (hypoperfusion)
>
> 1\. Condition resulting from the inadequate delivery of oxygenated
> blood to body tissues.
>
> 2\. Can be a result of
>
> a.. Failure of the heart to provide oxygenated blood
>
> b\. Abnormal dilation of the vessels
>
> c\. Blood volume loss
>
> 3\. Signs and symptoms
>
> a\. Extreme thirst
>
> b\. Restlessness, anxiety

c\. Rapid, weak pulse

> d\. Rapid, shallow respirations

e\. Mental status changes

f\. Pale, cool, moist skin

> 4\. Role of the First Responder
>
> a\. Complete the First Responder assessment
>
> \(1\) Complete a scene size-up before initiating emergency medical
> care.
>
> \(2\) Complete an initial assessment on all patients.
>
> \(3\) Complete a physical exam as needed.
>
> \(4\) Complete on-going assessments.
>
> b\. Comfort, calm, and reassure the patient while awaiting additional
> EMS resources.
>
> \(1\) Maintain airway/ventilation.
>
> \(2\) Prevent further blood loss.
>
> \(3\) Keep patient calm, in position of comfort.
>
> \(4\) Keep patient warm - attempt to maintain normal body temperature.
>
> \(5\) Do not give food or drink.
>
> \(6\) Provide care for specific injuries.

I. Specific Injuries

> A. Types
>
> 1\. Abrasion
>
> a\. Outermost layer of skin is damaged by shearing forces.
>
> b\. Painful injury, even though superficial.
>
> c\. No or very little oozing of blood.
>
> 2\. Laceration
>
> a\. Break in skin of varying depth
>
> b\. May occur in isolation or together with other types of soft tissue
> injury.
>
> c\. Caused by forceful impact with sharp object.
>
> d\. Bleeding may be severe.

3\. Penetration/puncture

> a\. Caused by sharp pointed object
>
> b\. May be little or no external bleeding
>
> c\. Internal bleeding may be severe.
>
> d\. Exit wound may be present.
>
> e\. Examples:
>
> \(1\) Gun shot wound
>
> \(2\) Stab wound

B. Role of the First Responder

> 1\. Complete the First Responder assessment
>
> a\. Complete a scene size-up before initiating emergency medical care.
>
> b\. Complete an initial assessment on all patients.
>
> c\. Complete a physical exam as needed.
>
> d\. Complete on-going assessments.
>
> 2\. Comfort, calm, and reassure the patient while awaiting additional
> EMS resources.
>
> a\. Relationship to body substance isolation
>
> \(1\) Gloves
>
> \(2\) Gown
>
> \(3\) Eye protection
>
> \(4\) Hand washing
>
> b\. Maintain proper airway/artificial ventilation
>
> c\. Management of open soft tissue injuries.
>
> \(1\) Expose the wound.
>
> \(2\) Control the bleeding.
>
> \(3\) Prevent further contamination.
>
> \(4\) Apply sterile dressing to the wound and bandage securely in
> place.
>
> C. Special considerations
>
> 1\. Chest injuries -
>
> a\. An occlusive dressing should be applied to open wounds and sealed
> on three sides.
>
> b\. Position of comfort if no spinal injury suspected
>
> 2\. Impaled objects
>
> a\. Do not remove the impaled object unless it is through the cheek or
> it would interfere with airway management or chest compressions.
>
> b\. Manually secure the object.
>
> c\. Expose the wound area.
>
> d\. Control bleeding.
>
> e\. Utilize a bulky dressing to help stabilize the object.
>
> 3\. Eviscerations
>
> a\. Open injury with protruding organs
>
> b\. Do not attempt to replace protruding organs.
>
> c\. Cover with thick moist dressing.
>
> 4\. Amputations
>
> a\. Involves the extremities and other body parts
>
> b\. Massive bleeding may be present or bleeding may be limited.
>
> c\. Locate and preserve the amputated part.
>
> \(1\) Place the part in a plastic bag.
>
> \(2\) Place the plastic bag containing the part in a larger bag or
> container with ice and water.
>
> \(a\) Do not use ice alone.
>
> \(b\) Do not use dry ice.
>
> D. Burns
>
> 1\. Classification
>
> a\. According to depth
>
> b\. Superficial involves only the outer layer of the skin
>
> \(1\) Reddening of the skin
>
> \(2\) Swelling
>
> c\. Partial thickness involves the outer and middle layer of the skin
>
> \(1\) Deep intense pain
>
> \(2\) Reddening, blisters
>
> d\. Full thickness extends through all layers of the skin
>
> \(1\) Characteristics of partial thickness
>
> \(2\) Areas of charred skin
>
> 2\. Role of the First Responder
>
> a\. Complete the First Responder assessment
>
> \(1\) Complete a scene size-up before initiating emergency medical
> care.
>
> \(2\) Complete an initial assessment on all patients.
>
> \(3\) Complete a physical exam as needed.
>
> \(4\) Complete on-going assessments.
>
> b\. Comfort, calm, and reassure the patient while awaiting additional
> EMS resources.
>
> \(1\) Stop the burning process initially with water or saline.
>
> \(2\) Remove smoldering clothing and jewelry.
>
> \(a\) Be aware that some clothing may have melted to the skin.
>
> \(b\) If resistance is met when removing the clothing, it should be
> left in place.
>
> \(3\) Body substance isolation
>
> \(4\) Continually monitor the airway for evidence of closure.
>
> \(5\) Prevent further contamination.
>
> \(6\) Cover the burned area with a dry sterile dressing.
>
> \(7\) Do not use any type of ointment, lotion, or antiseptic.
>
> \(8\) Do not break blisters.
>
> 3\. Special Considerations
>
> a\. Chemical burns
>
> \(1\) Scene safety
>
> \(2\) Gloves and eye protection
>
> \(3\) Brush off dry powder.
>
> \(4\) Flush with copious amounts of water.
>
> \(5\) Consider eye burns if splash injury.
>
> b\. Electrical burns
>
> \(1\) Scene safety
>
> \(2\) Often more severe than external indications
>
> \(3\) Monitor the patient closely for respiratory or cardiac arrest.
>
> c\. Infant and child considerations
>
> \(1\) Greater surface area in relation to the total body size
>
> \(2\) Results in greater fluid and heat loss.
>
> \(3\) May need to keep environment warm when possible.
>
> \(4\) Consider possibility of child abuse.

II\. Dressing and Bandaging

> A. Function
>
> 1\. Stop bleeding.
>
> 2\. Protect the wound from further damage.
>
> 3\. Prevent further contamination and infection.
>
> B. Dressings
>
> 1\. Universal dressing
>
> 2\. 4 X 4 inch gauze pads
>
> 3\. Adhesive‑type
>
> 4\. Occlusive
>
> C. Bandages
>
> 1\. Holds dressing in place
>
> 2\. Types
>
> a\. Self‑adherent bandages
>
> b\. Gauze rolls
>
> c\. Triangular bandages
>
> d\. Adhesive tape

**Application**

**Procedural (How)**

> 1\. Review the methods of controlling external bleeding with an
> emphasis on body substance isolation.
>
> 2\. Demonstrate the procedure for treating an open soft tissue injury.
>
> 3\. Demonstrate the necessary body substance isolation when dealing
> with soft tissue injuries.
>
> 4\. Demonstrate the proper method for applying an occlusive dressing.
>
> 5\. Demonstrate the proper method for stabilizing an impaled object.
>
> 6\. Show a diagram illustrating a superficial, partial thickness, and
> full thickness burn.
>
> 7\. Demonstrate the proper emergency medical care for a superficial,
> partial thickness, and full thickness burn.
>
> 8\. Show the various types of dressings and bandages.
>
> 9\. Demonstrate the proper method for applying a universal dressing, a
> 4 X 4 inch dressing, and an adhesive type dressing.
>
> 10\. Demonstrate the proper method for applying bandages:
> self‑adherent, gauze rolls, triangular, and adhesive tape.
>
> 11\. Demonstrate the proper method for applying a pressure dressing.

**Contextual (When, Where, Why)**

> External bleeding is assessed during the initial patient assessment
> after securing the scene and ensuring personal safety. After airway
> and breathing control of arterial or venous bleeding will be done upon
> immediate identification.
>
> Soft tissue injuries, unless life threatening, will be treated after
> the initial assessment. Failure to treat soft tissue injuries could
> lead to severe bleeding, further damage to the injury, or further
> contamination.

**Student Activities**

**Auditory (Hearing)**

> 1 Students should hear simulations to identify signs and symptoms of
> external bleeding.
>
> 2\. The student should hear simulated situations in which the signs
> and symptoms of soft tissue injuries and procedures for treating soft
> tissue injuries are demonstrated.
>
> 3\. The student should hear the sounds made by open sucking chest
> wounds.

**Visual (Seeing)**

> 1\. The students should see audio-visual materials of the various
> types of external bleeding.
>
> 2\. The student should see audio-visual materials of the proper
> methods to control bleeding.
>
> 3\. The student should see a patient to identify major bleeding.
>
> 4\. The students should see, in simulated situations, the application
> of direct pressure, elevation, and pressure points in the emergency
> medical care of external bleeding.
>
> 5\. Show diagrams of the various types of soft tissue injuries.
>
> 6\. The student should see demonstrations of the treatment of an open
> soft tissue injury.
>
> 7\. The student should see demonstrations of necessary body substance
> isolation when dealing with soft tissue injuries.
>
> 8\. The student should see demonstrations of the proper method for
> applying an occlusive dressing.
>
> 9\. The student should see demonstrations of the proper method for
> stabilizing an impaled object.
>
> 10\. The student should see diagrams illustrating a superficial,
> partial thickness, and full thickness burn.
>
> 11\. The student should see demonstrations of the proper emergency
> medical care for superficial, partial thickness, and full thickness
> burns.
>
> 12\. The student should see the various types of dressing and
> bandages.
>
> 13\. The student should see demonstrations of the proper methods for
> applying a universal dressing, a 4 X 4 inch dressing, and an adhesive
> type dressing.
>
> 14\. The student should see demonstrations of the proper method for
> applying bandages: self‑adherent, gauze rolls, triangular, and
> adhesive tape.
>
> 15\. The student should see demonstrations of the proper method for
> applying a pressure dressing.

**Kinesthetic (Doing)**

> 1\. The student should practice the steps in the emergency medical
> care of open soft tissue injuries.
>
> 2\. The student should practice the steps in the emergency medical
> care of a patient with an open chest wound.
>
> 3\. The student should practice the steps in the emergency medical
> care of a patient with an open abdominal wound.
>
> 4\. The student should practice the steps in the emergency medical
> care of a patient with an impaled object.
>
> 5\. The student should practice the steps in the emergency medical
> care of a patient with superficial burns.
>
> 6\. The student should practice the steps in the emergency medical
> care of a patient with partial thickness burns.
>
> 7\. The student should practice the steps in the emergency medical
> care of a patient with full thickness burns.
>
> 8\. The student should practice the steps in the emergency medical
> care of a patient with an amputation.
>
> 9\. The student should practice the steps in the emergency medical
> care of the amputated part.
>
> 10\. The student should practice the steps in the emergency medical
> care of a patient with a chemical burn.
>
> 11\. The student should practice the steps in the emergency medical
> care of a patient with an electrical burn.

**Instructor Activities**

Facilitate discussion and supervise practice.

> Reinforce student progress in cognitive, affective, and psychomotor
> domains.

Redirect students having difficulty with content. (Complete remediation
form.)

**Evaluation**

**Written:**

> Develop evaluation instruments, e.g., quizzes, oral reviews, and
> handouts, to determine if the students have met the cognitive and
> affective objectives of this lesson.

**Practical:**

> Evaluate the actions of the First Responder students during role play,
> practice or other skill stations to determine their compliance with
> the cognitive and affective objectives and their mastery of the
> psychomotor objectives of this lesson.

**Remediation**

> Identify students or groups of students who are having difficulty with
> this subject content. Complete remediation sheet from the
> instructor\'s course guide.

**Enrichment**

> What is unique in the local area concerning this topic? Complete
> enrichment sheets from instructor\'s course guide and attach with
> lesson plan.

**Lesson 5-3**

**Injuries to Muscles and Bones**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem-solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

5-3.1 Describe the function of the musculoskeletal system. (C-1)

5-3.2 Differentiate between an open and a closed painful, swollen,
deformed extremity. (C-1)

5-3.3 List the emergency medical care for a patient with a painful,
swollen, deformed extremity. (C-1)

5-3.4 Relate mechanism of injury to potential injuries of the head and
spine. (C-3)

5-3.5 State the signs and symptoms of a potential spine injury. (C-1)

5-3.6 Describe the method of determining if a responsive patient may
have a spine injury. (C-1)

5-3.7 List the signs and symptoms of injury to the head. (C-1)

5-3.8 Describe the emergency medical care for injuries to the head.
(C-1)

**Affective Objectives**

At the completion of this lesson, the First Responder student will be
able to:

5-3.9 Explain the rationale for the feeling patients who have need for
immobilization of the painful, swollen, deformed extremity. (A-3)

5-3.10 Demonstrate a caring attitude towards patients with a
musculoskeletal injury who request emergency medical services. (A-3)

5-3.11 Place the interests of the patient with a musculoskeletal injury
as the foremost consideration when making any and all patient care
decisions. (A-3)

5-3.12 Communicate with empathy to patients with a musculoskeletal
injury, as well as with family members and friends of the patient. (A-3)

**Psychomotor Objectives**

At the completion of this lesson, the First Responder student will be
able to:

5-3.13 Demonstrate the emergency medical care of a patient with a
painful, swollen, deformed extremity. (P-1,2)

5-3.14 Demonstrate opening the airway in a patient with suspected spinal
cord injury. (P-1,2)

5-3.15 Demonstrate evaluating a responsive patient with a suspected
spinal cord injury. (P-1,2)

5-3.16 Demonstrate stabilizing of the cervical spine. (P-1,2)

**Preparation**

**Motivation:**

> Injuries to the bones and muscles are very common types of injuries
> encountered by the First Responder. These injuries are largely
> non-life threatening in nature but may be very dramatic. Prompt
> identification and emergency medical care of musculoskeletal injuries
> is crucial in reducing pain, preventing further injury and minimizing
> permanent damage.

**Prerequisites:**

Preparatory, Airway, Patient Assessment, and Circulation Modules

**Materials**

**AV Equipment:**

> Utilize various audio-visual materials relating to emergency medical
> care. The continuous development of new audio-visual materials
> relating to EMS requires careful review to determine which best meet
> the needs of the program. Materials should be edited to ensure that
> the objectives of the curriculum are met.

**EMS Equipment:**

Blanket, pillow, improvised splinting material, e.g. magazines, etc.

**Personnel**

**Primary Instructor:**

> One First Responder Instructor knowledgeable in musculoskeletal and
> head and spinal injuries.

**Assistant Instructor:**

> The instructor - to - student ratio should be 1:6 for psychomotor
> skills practice. Individuals used as assistant instructors should be
> knowledgeable in musculoskeletal care and the care of head and spinal
> injuries.

**Recommended Minimum Time to Complete:**

One and a half hours

**Presentation**

**Declarative (What)**

I. Review of the Musculoskeletal system

> A. The Skeletal System
>
> 1\. Function
>
> a\. Gives the body shape
>
> b\. Protects vital internal organs
>
> 2\. Components
>
> a\. Skull - houses and protects the brain
>
> b\. Face
>
> c\. Spinal Column
>
> d\. Thorax
>
> \(1\) Ribs
>
> \(2\) Breastbone (sternum)
>
> \(a\) Xiphoid process - lowest portion of the sternum
>
> \(b\) Landmark for determining hand position for chest compressions
>
> e\. Pelvis

f\. Lower extremities

> \(1\) Thigh (femur)
>
> \(2\) Knee cap (patella)
>
> \(3\) Shin (tibia and fibula)
>
> \(4\) Ankle
>
> \(5\) Feet
>
> \(6\) Toes
>
> g\. Upper extremities
>
> \(1\) Shoulder (collar bone and shoulder blade)
>
> \(2\) Upper arm (humerus)
>
> \(3\) Forearm (radius and ulna)
>
> \(4\) Wrist
>
> \(5\) Hand
>
> \(6\) Fingers
>
> h\. Joints - where bones connect to other bones
>
> B. The Muscular System
>
> 1\. Function
>
> a\. Give the body shape.
>
> b\. Protect internal organs.
>
> c\. Provide for movement.
>
> 2\. Components
>
> a\. Voluntary (skeletal)
>
> \(1\) Attached to the bones.
>
> \(2\) Under control of the nervous system and brain. Can be contracted
> and relaxed by the will of the individual.
>
> \(3\) Responsible for movement.
>
> b\. Involuntary (smooth)
>
> \(1\) Found in the walls of the tubular structures of the
> gastrointestinal tract and urinary system.
>
> \(2\) Also in the blood vessels and bronchi.
>
> c\. Cardiac
>
> \(1\) Found only in the heart.
>
> \(2\) Can tolerate interruption of blood supply for only very short
> periods.

II\. Injuries to Bones and Joints

> A. Mechanism of injury

1\. Direct force

2\. Indirect force

3\. Twisting force

> B. Bone or joint injuries
>
> 1\. Types
>
> a\. Open - break in the continuity of the skin

b\. Closed - no break in the continuity of the skin

> 2\. Signs and symptoms

a\. Deformity or angulation

b\. Pain and tenderness

c\. Grating

d\. Swelling

e\. Bruising (discoloration)

i\. Exposed bone ends

j\. Joint locked into position

> 3\. Emergency medical care of bone or joint injuries
>
> a\. Body substance isolation
>
> b\. After life threats have been controlled, allow patient to remain
> in a position of comfort
>
> c\. Application of cold pack to area of painful, swollen, deformed
> extremity to reduce swelling and pain
>
> d\. Manual extremity stabilization
>
> \(1\) Support above and below an injury
>
> \(2\) Cover open wounds with a sterile dressing.
>
> \(3\) Pad to prevent pressure and discomfort to the patient.
>
> \(4\) When in doubt, manually stabilize the injury
>
> \(5\) Do not intentionally replace the protruding bones.

III\. Injuries to the Spine

> A. Mechanism of injury
>
> 1\. Motor vehicle crashes
>
> 2\. Pedestrian - vehicle collisions
>
> 3\. Falls
>
> 4\. Blunt trauma
>
> 5\. Penetrating trauma to head, neck, or torso
>
> 6\. Motorcycle crashes
>
> 7\. Hangings
>
> 8\. Springboard or platform diving accidents
>
> 9\. Unresponsive trauma patients
>
> B. Signs and symptoms
>
> 1\. Tenderness in the area of injury
>
> 2\. Pain associated with moving
>
> a\. Do not ask the patient to move to try to find a pain response.
>
> b\. Do not move the patient to test for a pain response.
>
> 3\. Pain independent of movement or palpation
>
> a\. Along spinal column
>
> b\. Lower legs
>
> c\. May be intermittent
>
> 4\. Soft tissue injuries associated with trauma
>
> a\. Head and neck to cervical spine
>
> b\. Shoulders, back or abdomen - thoracic, lumbar
>
> c\. Lower extremities - lumbar, sacral
>
> 5\. Numbness, weakness or tingling in the extremities
>
> 6\. Loss of sensation or paralysis below the suspected level of injury
>
> 7\. Loss of sensation or paralysis in the upper or lower extremities
>
> 8\. Respiratory impairment
>
> 9\. Loss of bladder and/or bowel control
>
> 10\. Ability of the patient to walk, move extremities or feel
> sensation; lack of pain to spinal column does not rule out the
> possibility of spinal column or cord damage.
>
> C. Assessing the potential spine injured patient
>
> 1\. Responsive patient
>
> a\. Mechanism of injury
>
> b\. Questions to ask
>
> \(1\) Does your neck or back hurt?
>
> \(2\) What happened?
>
> \(3\) Where does it hurt?
>
> \(4\) Can you move your hands and feet?
>
> \(5\) Can you feel me touching your fingers?
>
> \(6\) Can you feel me touching your toes?
>
> 2\. Unresponsive patient
>
> a\. Maintain airway and breathing
>
> b\. Stabilize head and neck manually in the position found
>
> c\. Obtain information from others at the scene to determine mechanism
> of injury and patient mental status before the First Responder\'s
> arrival.
>
> D. Complications
>
> 1\. Inadequate breathing effort
>
> 2\. Paralysis
>
> E. Emergency medical care
>
> 1\. Body substance isolation
>
> 2\. Establish and maintain manual stabilization
>
> a\. Maintain constant manual stabilization
>
> b\. May be released when additional EMS resources have properly
> secured the patient to a backboard with the head stabilized.
>
> 3\. Perform initial assessment.
>
> a\. Whenever possible, airway control should be done without moving
> the patient\'s head.
>
> b\. Whenever possible, artificial ventilation should be done without
> moving the head.
>
> 4\. Assess pulse, motor, and sensation in all extremities.

IV\. Injuries to the Brain and Skull

> A. Head injuries
>
> 1\. May be open or closed
>
> a\. Open injuries may present with bleeding
>
> b\. Closed injury may present with swelling or depression of skull
> bones
>
> 2\. Injuries to the scalp
>
> a\. May bleed more than expected because of the large number of blood
> vessels in the scalp.
>
> b\. Control bleeding with direct pressure.
>
> 3\. Injury to the brain - injury of brain tissue or bleeding inside
> the skull may increase pressure on the brain.
>
> B. Emergency medical care
>
> 1\. Body substance isolation
>
> 2\. Maintain airway/artificial ventilation/oxygenation.
>
> 3\. Initial assessment with manual spinal stabilization should be done
> on scene.
>
> 4\. Closely monitor the mental status for deterioration.
>
> 5\. Control bleeding.
>
> a\. Apply enough pressure to control the bleeding, without disturbing
> the underlying tissue.
>
> b\. Dress and bandage open wound as indicated in the emergency medical
> care of soft tissue injuries.
>
> 6\. Be prepared for changes in patient condition.

**Application**

**Procedural (How)**

> 1\. Show diagrams of the muscular system.
>
> 2\. Show diagrams of the skeletal system.
>
> 3\. Show audio-visual materials of signs of open and closed bone and
> joint injuries.
>
> 4\. Demonstrate assessment of an injured extremity.
>
> 5\. Demonstrate manual stabilization techniques using the general
> rules of splinting.

**Contextual (When, Where, Why)**

> Injuries to bones and joints require immediate stabilization unless
> life‑threatening injuries are present. If life‑threatening injuries
> are present, ignore extremity injuries and address the immediate
> problem.
>
> Failure to stabilize a bone or joint injury can result in: damage to
> soft tissue, organs, nerves, muscles; increased bleeding associated
> with the injury; permanent damage or disability; conversion of a
> closed injury to an open injury; and an increase in pain.

**Student Activities**

**Auditory (Hearing)**

> 1\. The student should hear simulations of various situations
> involving musculoskeletal injuries and the proper assessment and
> emergency medical care.

**Visual (Seeing)**

> 1\. The student should see diagrams of the muscular system.
>
> 2\. The student should see diagrams of the skeletal system.
>
> 3\. The student should see audio-visual materials of open and closed
> bone and joint injuries.
>
> 4\. The student should see a demonstration of an assessment of an
> injured extremity.
>
> 5\. The student should see a demonstration of manual stabilization
> using general rules of stabilization.

**Kinesthetic (Doing)**

> 1\. The student should practice assessment of an injured extremity.
>
> 2\. The student should practice manual stabilization following the
> general rules of stabilization.

**Instructor Activities**

> Facilitate discussion and supervise practice.
>
> Reinforce student progress in cognitive, affective, and psychomotor
> domains.
>
> Redirect students having difficulty with content. (Complete
> remediation form.)

**Evaluation**

**Written:**

> Develop evaluation instruments, e.g., quizzes, oral reviews, and
> handouts, to determine if the students have met the cognitive and
> affective objectives of this lesson.

**Practical:**

> Evaluate the actions of the First Responder students during role play,
> practice, or other skill stations to determine their compliance with
> the cognitive and affective objectives and their mastery of the
> psychomotor objectives of this lesson.

**Remediation**

> Identify students or groups of students who are having difficulty with
> this subject content. Complete remediation sheet from the
> instructor\'s course guide.

**Enrichment**

> What is unique in the local area concerning this topic? Complete
> enrichment sheets from instructor\'s course guide and attach with
> lesson plan.

**Lesson 5-4**

**Practical Lab: Illness and Injury**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem-solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate the cognitive objectives of Lesson 5-1: Medical
Emergencies

 Demonstrate the cognitive objectives of Lesson 5-2: Bleeding and Soft
Tissue Injuries

 Demonstrate the cognitive objectives of Lesson 5-3: Injuries to
Muscles and Bones

**Affective Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate the affective objectives of Lesson 5-1: Medical
Emergencies

 Demonstrate the affective objectives of Lesson 5-2: Bleeding and Soft
Tissue Injuries

 Demonstrate the affective of Lesson 5-3: Injuries to Muscles and Bones

**Psychomotor Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate the steps in providing emergency medical care to a patient
with a general medical complaint. (C-1)

 Demonstrate the steps in providing emergency medical care to a patient
with an altered mental status. (C-1)

 Demonstrate the steps in providing emergency medical care to a patient
with seizures. (C-1)

 Demonstrate the steps in providing emergency medical care to a patient
with an exposure to cold. (C-1)

 Demonstrate the steps in providing emergency medical care to a patient
with an exposure to heat. (C-1)

 Demonstrate the steps in providing emergency medical care to a patient
with a behavioral change. (C-1)

 Demonstrate the steps in providing emergency medical care to a patient
with a psychological crisis. (C-1)

 Demonstrate direct pressure as a method of emergency medical care for
external bleeding. (P-1,2)

 Demonstrate the use of diffuse pressure as a method of emergency
medical care for external bleeding. (P-1,2)

 Demonstrate the use of pressure points as a method of emergency
medical care for external bleeding. (P-1,2)

 Demonstrate the care of the patient exhibiting signs and symptoms of
internal bleeding. (P-1,2)

 Demonstrate the steps in the emergency medical care of open soft
tissue injuries. (P-1,2)

 Demonstrate the steps in the emergency medical care of a patient with
an open chest wound. (P-1,2)

 Demonstrate the steps in the emergency medical care of a patient with
open abdominal wounds. (P-1,2)

 Demonstrate the steps in the emergency medical care of a patient with
an impaled object. (P-1,2)

 Demonstrate the steps in the emergency medical care of a patient with
an amputation. (P-1,2)

 Demonstrate the steps in the emergency medical care of an amputated
part. (P-1,2)

 Demonstrate the emergency medical care of a patient with a painful,
swollen, deformed extremity. (P-1,2)

 Demonstrate opening the airway in a patient with suspected spinal cord
injury. (P-1,2)

 Demonstrate evaluating a responsive patient with a suspected spinal
cord injury. (P-1,2)

 Demonstrate stabilizing of the cervical spine. (P-1,2)

**Preparation**

**Motivation:**

> The practical lesson is designed to allow the students additional time
> to perfect skills. It is of utmost importance that the students
> demonstrate proficiency of the skill, cognitive knowledge of the steps
> to perform a skill, and a healthy attitude towards performing that
> skill on a patient.
>
> This is an opportunity for the instructor and assistant instructors to
> praise progress and redirect the students toward appropriate
> psychomotor skills. The material from all preceding lessons and basic
> life support should be incorporated into these practical skill
> sessions.

**Prerequisites:**

Completion of Lessons 5-1 through 5-3

**Materials**

**AV Equipment:**

> Utilize various audio-visual materials relating to emergency medical
> care. The continuous development of new audio-visual materials
> relating to EMS requires careful review to determine which best meet
> the needs of the program. Materials should be edited to ensure that
> the objectives of the curriculum are met.

**EMS Equipment:**

> Hot packs, cold packs, and space blankets, sterile dressings,
> triangular bandages, universal dressings, occlusive dressings, 4 x 4
> gauze pads, self adherent bandages, roller bandages, blanket, pillow,
> improvised splinting material, e.g. magazines, umbrellas, etc.

**Personnel**

**Primary Instructor:**

One First Responder instructor knowledgeable in illness and injury.

**Assistant Instructor:**

> The instructor-to-student ratio should be 1:6 for psychomotor skill
> practice. Individuals used as assistant instructors should be
> knowledgeable in illness and injury management.

**Recommended Minimum Time to Complete:**

One and a half hours

**Presentation**

**Declarative (What)** None identified for this lesson.

**Application**

**Procedural (How)**

> Instructor should demonstrate the procedural activities from Lesson
> 5-1: Medical Emergencies
>
> Instructor should demonstrate the procedural activities from Lesson
> 5-2: Bleeding and Soft Tissue Injuries
>
> Instructor should demonstrate the procedural activities from Lesson
> 5-3: Injuries to Muscles and Bones

**Contextual (When, Where, Why)**

> Instructor should review contextual activities from Lesson 5-1:
> Medical Emergencies
>
> Instructor should review the contextual activities from Lesson 5-2:
> Bleeding and Soft Tissue Injuries
>
> Instructor should review the contextual activities from Lesson 5-3:
> Injuries to Muscles and Bones

**Student Activities**

**Auditory (Hearing)**

> 1\. The student should hear the instructor present the signs,
> symptoms, and management of patients with general medical complaints.
>
> 2\. The student should hear the instructor present the signs,
> symptoms, and management of patients with altered mental status.
>
> 3\. The student should hear the instructor present the signs,
> symptoms, and management of patients with seizures.
>
> 4\. The student should hear the instructor present the signs,
> symptoms, and management of patients exposed to cold.
>
> 5\. The student should hear the instructor present the signs,
> symptoms, and management of patients exposed to heat.
>
> 6\. The student should hear the instructor present the signs,
> symptoms, and management of patients with behavior problems.
>
> 7\. Students should hear simulations to identify signs and symptoms of
> external bleeding.
>
> 8\. The student should hear simulated situations in which the signs
> and symptoms of soft tissue injuries and procedures for treating soft
> tissue injuries are demonstrated.
>
> 9\. The student should hear the sounds made by open sucking chest
> wounds.
>
> 10\. The student should hear simulations of various situations
> involving musculoskeletal injuries and the proper assessment and
> emergency medical care of the injuries.

**Visual (Seeing)**

> 1\. The students should see audio-visual material of patients with
> general medical complaints.
>
> 2\. The students should see audio-visual material of patients with an
> altered mental status.
>
> 3\. The students should see audio-visual material of patients with
> seizures.
>
> 4\. The students should see audio-visual material of patients exposed
> to cold.
>
> 5\. The students should see audio-visual material of patients exposed
> to heat.
>
> 6\. The students should see audio-visual material of patients with
> behavior problems.
>
> 7\. The students should see audio-visual materials of the various
> types of external bleeding.
>
> 8\. The student should see audio-visual materials of the proper
> methods to control bleeding.
>
> 9\. The student should see a patient to identify major bleeding.
>
> 10\. The students should see, in simulated situations, the application
> of direct pressure, elevation, and pressure points in the emergency
> medical care for external bleeding.
>
> 11\. The student should see diagrams of the various types of soft
> tissue injuries.
>
> 12\. The student should see demonstrations of the procedure for
> treating an open soft tissue injury.
>
> 13\. The student should see demonstrations of the necessary body
> substance isolation that must be taken when dealing with soft tissue
> injuries.
>
> 14\. The student should see demonstrations of the proper method for
> applying an occlusive dressing.
>
> 15\. The student should see demonstrations of the proper method for
> stabilizing an impaled object.
>
> 16\. The student should see diagrams illustrating a superficial,
> partial thickness, and full thickness burn.
>
> 17\. The student should see demonstrations for the proper emergency
> medical care for a superficial, partial thickness, and full thickness
> burn.
>
> 18\. The student should see the various types of dressing and
> bandages.
>
> 19\. The student should see demonstrations of the proper methods for
> applying a universal dressing, 4 X 4 inch dressing, and adhesive type
> dressing.
>
> 20\. The student should see demonstrations of the proper method for
> applying bandages: self‑adherent, gauze rolls, triangular, adhesive
> tape, and air splints.
>
> 21\. The student should see demonstrations of the proper method for
> applying a pressure dressing.
>
> 22\. The student should see diagrams of the muscular system.
>
> 23\. The student should see diagrams of the skeletal system.
>
> 24\. The student should see audio-visual materials of open and closed
> bone and joint injuries.
>
> 25\. The student should see a demonstration of an assessment of an
> injured extremity.
>
> 26\. The student should see a demonstration of manual stabilization
> using general rules of stabilization.

**Kinesthetic (Doing)**

> 1\. The students should role play emergency medical care of a patient
> with a general medical complaint.
>
> 2\. The students should role play emergency medical care of a patient
> with altered mental status.
>
> 3\. The students should role play emergency medical care of a patient
> with a seizure.
>
> 4\. The students should role play emergency medical care of a patient
> exposed to cold.
>
> 5\. The students should role play emergency medical care of a patient
> exposed to heat.
>
> 6\. The students should role play emergency medical care of a patient
> with behavior problems.
>
> 7\. The student should practice the emergency medical care for open
> soft tissue injuries.
>
> 8\. The student should practice the emergency medical care of a
> patient with an open chest wound.
>
> 9\. The student should practice the emergency medical care of a
> patient with open abdominal wounds.
>
> 10\. The student should practice the emergency medical care of a
> patient with an impaled object.
>
> 11\. The student should practice the emergency medical care of a
> patient with superficial burns.
>
> 12\. The student should practice the emergency medical care of a
> patient with partial thickness burns.
>
> 13\. The student should practice the emergency medical care of a
> patient with full thickness burns.
>
> 14\. The student should practice the emergency medical care of a
> patient with an amputation.
>
> 15\. The student should practice the emergency medical care of an
> amputated part.
>
> 16\. The student should practice the emergency medical care of a
> patient with a chemical burn.
>
> 17\. The student should practice the emergency medical care of a
> patient with an electrical burn.
>
> 18\. The student should practice assessing of an injured extremity.
>
> 19\. The student should practice manual stabilization following the
> general rules of stabilization.

**Instructor Activities**

> Supervise student practice.
>
> Reinforce student progress in cognitive, affective, and psychomotor
> domains.
>
> Redirect students having difficulty with content. (Complete
> remediation forms.)

**Evaluation**

**Practical:**

> Evaluate the actions of the First Responder students during role play,
> practice, or other skills stations to determine their compliance with
> the cognitive and affective objectives and their mastery of the
> psychomotor objectives of this lesson.

**Remediation**

> Identify students or groups of students who are having difficulty with
> this subject content. Complete remediation sheet from the
> instructor\'s course guide.

**Enrichment**

> What is unique in the local area concerning this topic? Complete
> enrichment sheets from the instructor\'s course guide and attach with
> lesson plan.

**Lesson 5-5 Evaluation: Illness and Injury**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate competence in the cognitive objectives of Lesson 5-1:
Medical Emergencies

 Demonstrate competence in the cognitive objectives of Lesson 5-2:
Bleeding and Soft Tissue Injuries

 Demonstrate competence in the cognitive objectives of Lesson 5-3:
Injuries to Muscles and Bones

**Affective Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate competence in the affective objectives of Lesson 5-1:
Medical Emergencies

 Demonstrate competence in the affective objectives of Lesson 5-2:
Bleeding and Soft Tissue Injuries

 Demonstrate competence in the affective objectives of Lesson 5-3:
Injuries to Muscles and Bones

**Psychomotor Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate competence in the psychomotor objectives of Lesson 5-1:
Medical Emergencies

 Demonstrate competence in the psychomotor objectives of Lesson 5-2:
Bleeding and Soft Tissue Injuries

 Demonstrate competence in the psychomotor objectives of Lesson 5-3:
Injuries to Muscles and Bones

**Preparation**

**Motivation:**

> Evaluation of the student\'s attainment of the cognitive and affective
> knowledge and psychomotor skills is an essential component of the
> First Responder\'s educational process. The modules are presented in a
> \"building block\" format. Once the students have demonstrated their
> knowledge and proficiency, the next lesson should be built upon that
> knowledge. This evaluation will help to identify students or groups of
> students having difficulty with a particular area. This is an
> opportunity for the instructor to evaluate their performance and make
> appropriate modifications to the delivery of material.

**Prerequisites:**

Completion of Lessons 5-1 through 5-4.

**Material**

**AV Equipment:**

Typically none required.

**EMS Equipment:**

The EMS equipment used in the Lessons of Module 5.

**Personnel**

**Primary Instructor:**

One proctor for the written evaluation.

**Assistant Instructor:**

One practical skills examiner for each 6 students.

**Recommended Minimum Time to Complete:**

One hour

**Presentation**

**Declarative (What)**

I. Purpose of the evaluation

II\. Items to be evaluated

III\. Feedback from evaluation

**Application**

**Procedural (How)**

> 1\. Written evaluation based on the cognitive and affective objectives
> of Lessons 5-1 \> 5-4.
>
> 2\. Practical evaluation stations based on the psychomotor objectives
> of Lessons 5-1 \> 5-4.

**Contextual (When, Where and Why)**

> The evaluation is the final lesson in this module and is designed to
> bring closure to the module and to ensure that students are prepared
> to proceed to the next module.
>
> This modular evaluation is given to determine the effectiveness of the
> presentation of materials and how well students have retained the
> material. This is an opportunity for the students to make necessary
> adjustments in study habits or for the instructor to adjust the manner
> in which material is presented.

**Instructor Activities**

> Supervise student evaluation.
>
> Reinforce student progress in cognitive, affective, and psychomotor
> domains.
>
> Redirect students having difficulty with content. (Complete
> remediation forms.)

**Remediation**

> Identify students and/or groups of students who are having difficulty
> with this subject content. Complete a remediation sheet from the
> instructor\'s course guide. If students continue to have difficulty
> demonstrating knowledge of the cognitive and affective objectives or
> demonstrating proficiency in psychomotor skills, the students should
> be counseled, remediated, and re-evaluated. If improvements in
> cognitive, affective, or psychomotor skills are not achieved,
> consideration regarding the ability of the student to progress in the
> program should be taken into account.

**Module 6: Childbirth and Children**

**Lesson 6-1 Childbirth**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem-solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

6-1.1 Identify the following structures: birth canal, placenta,
umbilical cord, amniotic sac. (C-1)

6-1.2 Define the following terms: crowning, bloody show, labor,
abortion. (C-1)

6-1.3 State indications of an imminent delivery. (C-1)

6-1.4 State the steps in the pre-delivery preparation of the mother.
(C‑1)

6-1.5 Establish the relationship between body substance isolation and
childbirth. (C-3)

6-1.6 State the steps to assist in the delivery. (C-1)

6-1.7 Describe care of the baby as the head appears. (C-1)

6-1.8 Discuss the steps in delivery of the placenta. (C-1)

6-1.9 List the steps in the emergency medical care of the mother
post-delivery. (C-3)

6-1-10 Discuss the steps in caring for a newborn. (C-1)

**Affective Objectives**

At the completion of this lesson, the First Responder student will be
able to:

6-1.11 Explain the rationale for attending to the feeling of a patient
in need of emergency medical care during childbirth. (A-2)

6-1.12 Demonstrate a caring attitude towards patients during childbirth
who request emergency medical services. (A-3)

6-1.13 Place the interests of the patient during childbirth as the
foremost consideration when making any and all patient care decisions.
(A-3)

6-1.14 Communicate with empathy to patients during childbirth, as well
as with family members and friends of the patient. (A-3)

**Psychomotor Objectives**

At the completion of this lesson, the First Responder student will be
able to:

6-1.15 Demonstrate the steps to assist in the normal cephalic delivery.
(P-1,2)

6-1.16 Demonstrate necessary care procedures of the fetus as the head
appears. (P-1,2)

6-1.17 Attend to the steps in the delivery of the placenta. (P-1,2)

6-1.18 Demonstrate the post-delivery care of the mother. (P-1,2)

6-1.19 Demonstrate the care of the newborn. (P-1,2)

**Preparation**

**Motivation:**

> Childbirth in an out-of-hospital setting rarely occurs. Because of the
> infrequency, taking care of an anxious mother and newborn infant is a
> stressful emergency call for the First Responder. Knowledge and
> practice in simulated situations can decrease stress and lead to
> better mother and child care.

**Prerequisites:**

Preparatory, Airway, and Patient Assessment Modules

**Materials**

**AV Equipment:**

> Utilize various audio-visual materials relating to emergency medical
> care. The continuous development of new audio-visual materials
> relating to EMS requires careful review to determine which best meet
> the needs of the program. Materials should be edited to ensure that
> the objectives of the curriculum are met.

**EMS Equipment:**

Childbirth kit, airway management equipment, eye protection, gloves.

**Personnel**

**Primary Instructor:**

One First Responder Instructor familiar with childbirth.

**Assistant Instructor:**

> The instructor-to-student ratio should be 1:6 for psychomotor skill
> practice. Individuals used as assistant instructors should be
> knowledgeable in childbirth.

**Recommended Minimum Time to Complete:**

> One hour

**Presentation**

**Declarative (What)**1. Childbirth

> A. Reproductive anatomy, physiology and terminology
>
> 1\. Birth canal - vagina and lower part of the uterus
>
> 2\. Placenta (afterbirth) - organ through which fetus exchanges
> nourishment and waste products during pregnancy
>
> 3\. Umbilical cord - cord which is an extension of the placenta
> through which fetus receives nourishment while in the uterus
>
> 4\. Amniotic sac (bag of water) - the sac that surrounds the fetus
> inside the uterus
>
> 5\. Crowning - the bulging-out of the vagina which is opening as the
> fetus\'s head or presenting part presses against it.
>
> 6\. \"Bloody show\" - mucus and blood that may come out of the vagina
> as labor begins
>
> 7\. Labor - the time and process (defined in 3 or 4 stages) beginning
> with the first uterine muscle contraction until delivery of the
> placenta
>
> a\. Delivery is imminent
>
> b\. Crowning
>
> c\. In the process of delivering
>
> 8\. Abortion (miscarriage) - delivery of products of conception early
> in pregnancy.
>
> a\. Assess and treat for shock
>
> b\. Retain products of conception
>
> B. Delivery
>
> 1\. Is delivery imminent?
>
> a\. Questions
>
> \(1\) What is your due date?
>
> \(2\) Any chance of multiple births?
>
> \(3\) Any bleeding or discharge?
>
> \(4\) Does the patient feel as if she is having a bowel movement with
> increasing pressure in the vaginal area?
>
> b\. Examine for crowning if the patient answers yes to the preceding
> questions.
>
> 2\. If crowning is present, prepare for delivery.
>
> a\. Use body substance isolation.
>
> b\. Do not touch vaginal areas except during delivery and when your
> partner is present.
>
> c\. Do not let the mother go to bathroom.
>
> d\. Do not hold mother\'s legs together.
>
> 3\. If the head is not the presenting part this may be a complicated
> delivery.
>
> a\. Tell the mother not to push.
>
> b\. Update responding EMS resources.
>
> c\. Calm and reassure the mother.
>
> 4\. Delivery procedures
>
> a\. Ensure body substance isolation
>
> b\. Have mother lie on her back with knees drawn up and legs spread
> apart.
>
> c\. Place absorbent, clean materials (sheets, towels, etc.) under the
> patient\'s buttocks.
>
> d\. Elevate buttocks with blankets or pillow.
>
> e\. When the infant\'s head appears, place the palm of your hand on
> top of the delivering baby\'s head and exert very gentle pressure to
> prevent explosive delivery.
>
> f\. If the amniotic sac does not break or has not broken, tear it with
> your fingers and push it away from the infant\'s head and mouth.
>
> g\. As the infant\'s head is being born, determine if the umbilical
> cord is around the infant\'s neck.
>
> \(1\) Attempt to slip the cord over the baby\'s shoulder
>
> \(2\) If unsuccessful, attempt to alleviate pressure on the cord.
>
> h\. After the infant\'s head is born, support the head
>
> i\. Suction the mouth and then the nostrils two or three times with
> the bulb syringe.
>
> \(1\) Use caution to avoid contact with the back of the baby\'s mouth.
>
> \(2\) If a bulb syringe is not available, wipe the baby\'s mouth and
> then the nose with gauze.
>
> j\. As the torso and full body are born, support the infant with both
> hands.
>
> k\. Do not pull on the infant.
>
> l\. As the feet are delivered, grasp the feet.
>
> \(1\) Keep the infant level with the vagina.
>
> \(2\) You may place the infant on the mothers abdomen for warmth.
>
> m\. When the umbilical cord stops pulsating, it should be tied with
> gauze between the mother and the newborn and the infant may be placed
> on the mother\'s abdomen.
>
> n\. Wipe blood and mucus from the baby\'s mouth and nose with sterile
> gauze; suction mouth, then the nose again.
>
> o\. Dry the infant.
>
> p\. Rub the baby\'s back or flick the soles of its feet to stimulate
> breathing.
>
> q\. Wrap the infant in a warm blanket and place the infant on its
> side, head slightly lower than trunk.
>
> r\. There is no need to cut the cord in a normal delivery. Keep the
> infant warm and wait for additional EMS resources who will have the
> proper equipment to clamp and cut the cord.
>
> s\. Record time of delivery.
>
> t\. If there is a chance of multiple births, prepare for second
> delivery.
>
> u\. Observe for delivery of placenta. This may take up to 30 minutes.
>
> v\. If the placenta is delivered, wrap it in a towel with 3/4 of the
> umbilical cord and place in a plastic bag, and keep the bag at the
> level of the infant.
>
> w\. Place sterile pad over vaginal opening, lower mother\'s legs, help
> her hold them together.
>
> 5\. Vaginal bleeding following delivery
>
> a\. Up to 300 - 500 ml blood loss is well tolerated by the mother
> following delivery.
>
> b\. The First Responder must be aware of this loss so as not to cause
> undue psychological stress on himself or the new mother.
>
> c\. With continued blood loss, massage the uterus.
>
> \(1\) Use hand with your fingers fully extended.
>
> \(2\) Place the palm of your hand on lower abdomen above the pubis.
>
> \(3\) Massage (knead) over area.
>
> \(4\) If bleeding continues, check massage technique
>
> C. Initial care of the newborn
>
> 1\. Assessment of infant - normal findings
>
> a\. Pulse - greater than 100/min
>
> \(1\) Pulse can be assessed at the umbilical cord
>
> \(2\) May also assess at brachial artery
>
> b\. Respiratory status - \>40 breaths per minute, crying
>
> 2\. The most important care is to position, dry, keep warm, and
> stimulate the newborn to breathe.
>
> 3\. Wrap newborn in blanket and cover its head.
>
> 4\. Repeat suctioning if necessary.
>
> 5\. Continue to stimulate newborn if not breathing.
>
> a\. Flick soles of feet.
>
> b\. Rub infant\'s back.
>
> 6\. If newborn does not begin to breathe or continues to have
> breathing difficulty after one minute, the First Responder must
> consider the need for additional measures.
>
> a\. Ensure open and patent airway.
>
> b\. Ventilate at a rate of 40 breaths per minute.
>
> c\. Reassess after one minute.
>
> d\. If heart rate is less than 80 beats per minute, a second rescuer
> should perform chest compressions.
>
> D. Post delivery care of the mother
>
> 1\. Keep contact with the mother throughout the process.
>
> 2\. Monitor respirations and pulse.
>
> 3\. Keep in mind that delivery is an exhausting procedure.
>
> 4\. Replace any blood soaked sheets and blankets while awaiting
> transport.

**Application**

**Procedural (How)**

> 1\. Demonstrate a normal delivery.
>
> 2\. Demonstrate necessary care of the fetus as the head appears.
>
> 3\. Demonstrate initial care of the newborn.
>
> 4\. Demonstrate post-delivery care of the mother.
>
> 5\. Demonstrate emergency medical care of the mother with continued
> bleeding.

**Contextual (When, Where, Why)**

> Knowledge and skills practice in the laboratory setting, particularly
> for out-of-hospital childbirth, help the students maintain
> professionalism, understand these uncommon emergency medical care
> situations, and support the patient until additional EMS providers
> arrive at the scene.

**Student Activities**

**Auditory (Hearing)**

> 1\. The student should hear a video tape of a mother in the final
> stages of labor, providing a sample of the mother\'s actions during
> this painful process.

**Visual (Seeing)**

> 1\. The student should see audio-visual materials of labor and
> delivery showing:
>
> A. Late stages of labor and normal delivery
>
> B. Suctioning the infant\'s mouth and nose during delivery
>
> C. Assessment and care of the newborn
>
> D. Normal bleeding during delivery

**Kinesthetic (Doing)**

> 1\. Student should practice assisting in a normal delivery.
>
> 2\. Student should practice necessary care of the fetus as the head
> appears during delivery.
>
> 3\. Student should practice post-delivery care of mothers and
> neonates.

**Instructor Activities**

Facilitate discussion and supervise practice.

> Reinforce student progress in cognitive, affective, and psychomotor
> domains.

Redirect students having difficulty with content (complete remediation
form)

**Evaluation**

**Written:**

> Develop evaluation instruments, e.g., quizzes, oral reviews, and
> handouts, to determine if the students have met the cognitive and
> affective objectives of this lesson.

**Practical:**

> Evaluate the actions of the First Responder students during role play,
> practice, or other skill stations to determine their compliance with
> the cognitive and affective objectives and their mastery of the
> psychomotor objectives of this lesson.

**Remediation**

> Identify students or groups of students who are having difficulty with
> this subject content. Complete remediation sheet from the
> instructor\'s course guide.

**Enrichment**

> What is unique in the local area concerning this topic? Complete
> enrichment sheets from instructor\'s course guide and attach with
> lesson plan

**Lesson 6-2 Infants and Children**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem-solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

6-2.1 Describe differences in anatomy and physiology of the infant,
child, and adult patient. (C-1)

6-2.2 Describe assessment of the infant or child. (C-1)

6-2.3 Indicate various causes of respiratory emergencies in infants and
children. (C-1)

6-2.4 Summarize emergency medical care strategies for respiratory
distress and respiratory failure/arrest in infants and children. (C-1)

6-2.5 List common causes of seizures in the infant and child patient.
(C‑1)

6-2.6 Describe management of seizures in the infant and child patient.
(C-1)

6-2.7 Discuss emergency medical care of the infant and child trauma
patient. (C-1)

6-2.8 Summarize the signs and symptoms of possible child abuse and
neglect. (C-1)

6-2.9 Describe the medical - legal responsibilities in suspected child
abuse. (C‑1)

6-2.10 Recognize need for First Responder debriefing following a
difficult infant or child transport. (C-1)

**Affective Objectives**

At the completion of this lesson, the First Responder student will be
able to:

6-2.11 Attend to the feelings of the family when dealing with an ill or
injured infant or child. (A-1)

6-2.12 Understand the provider\'s own emotional response to caring for
infants or children. (A-1)

6-2.13 Demonstrate a caring attitude towards infants and children with
illness or injury who require emergency medical services. (A-3)

6-2.14 Place the interests of the infant or child with an illness or
injury as the foremost consideration when making any and all patient
care decisions. (A-3)

6-2.15 Communicate with empathy to infants and children with an illness
or injury, as well as with family members and friends of the patient.
(A-3)

**Psychomotor Objectives**

At the completion of this lesson, the First Responder student will be
able to:

6-2.16 Demonstrate assessment of the infant and child. (P-1,2)

**Preparation**

**Motivation:**

> Infant and child patients often cause anxiety for the First Responder.
> This is caused by a lack of dealing with this special population as
> well as a fear of failure. Understanding the special considerations in
> dealing with pediatric patients is important in their emergency
> medical care.

**Prerequisites:**

Airway, Patient Assessment, and Circulation Modules

**Materials**

**AV Equipment:**

> Utilize various audio-visual materials relating to emergency medical
> care. The continuous development of new audio-visual materials
> relating to EMS requires careful review to determine which best meet
> the needs of the program. Materials should be edited to enure that the
> objectives of the curriculum are met.

**EMS Equipment:**

None.

**Personnel**

**Primary Instructor:**

One First Responder instructor knowledgeable with infants and children.

**Assistant Instructor:**

> The instructor-to-student ratio should be 1:6 for psychomotor skills
> practice. Individuals used as assistant instructors should be
> knowledgeable in infant and child emergencies.

**Recommended Minimum Time to Complete:**

Two hours

**Presentation**

**Declarative (What)**1. Anatomical and Physiological Concerns

> A. Small airways are easily blocked by secretions and airway swelling.
>
> B. Tongue is large relative to small mandible and can block airway in
> an unresponsive infant or child.
>
> C. Positioning the airway is different in infants and children, do not
> hyperextend the neck.
>
> D. Infants are nose breathers, so suctioning a secretion - filled
> nasopharynx can improve breathing problems in an infant.
>
> E. Children can compensate well for short periods of time for
> respiratory problems and shock.
>
> 1\. Compensate by increasing breathing rate and increasing effort of
> breathing.
>
> 2\. Compensation is followed rapidly by decompensation due to rapid
> respiratory muscle fatigue and general fatigue.
>
> F. Risk of hypothermia; keep them warm.

I. Airway

> A. Essential skills - review from module 2-1, Airway, with emphasis on
> infants and children.
>
> 1\. Airway opening
>
> a\. Position to open airway is different - head-tilt chin-lift - do
> not hyperextend.
>
> b\. Place a folded towel under the shoulders to assist in maintaining
> position.
>
> c\. Jaw thrust with spinal stabilization
>
> 2\. Suctioning
>
> a\. Sizing
>
> b\. Depth
>
> c\. Technique
>
> d\. Use of the bulb syringe
>
> 3\. Clearing complete obstructions
>
> **Follow the American Heart Association guidelines of Foreign Body
> airway Obstructions in the infant and child**
>
> B. Airway adjuncts
>
> 1\. Oral airways
>
> a\. Adjunct, not for initial artificial ventilation
>
> b\. Patient should not have a gag reflex
>
> c\. Sizing - corner of the mouth to the tip of the ear
>
> d\. Techniques of insertion - use tongue depressor.
>
> \(1\) Insert tongue blade to the base of tongue.
>
> \(2\) Push down against the base of tongue while lifting upward.
>
> \(3\) Insert oropharyngeal airway following the anatomic curve
> (upright) without rotation.
>
> 2\. Nasal airways are usually not used in children by First Responders

II\. Assessment

> A. Be sure to involve the parents in your assessment and management of
> infants and children.
>
> 1\. Agitated parents = agitated child
>
> 2\. Calm parents = calm child
>
> B. General impression of well versus sick child can be obtained from
> overall appearance.
>
> 1\. Assess mental status.
>
> 2\. Effort of breathing
>
> 3\. Color
>
> 4\. Quality of cry/speech
>
> 5\. Interaction with environment and parents
>
> a\. Normal behavior for child of this age.
>
> b\. Playing
>
> c\. Moving around
>
> d\. Attentive versus non-attentive
>
> e\. Eye contact
>
> f\. Recognizes parents
>
> g\. Responds to parents calling
>
> 6\. Emotional state (crying, upset, scared)
>
> 7\. Response to the First Responder
>
> 8\. Tone/body position
>
> C. Approach to evaluation
>
> 1\. Begin assessment from across the room
>
> a\. Observe for mechanism of injury
>
> b\. Assess the surroundings
>
> c\. Respiratory assessment includes:
>
> \(1\) Chest expansion/symmetry
>
> \(2\) Effort of breathing
>
> \(3\) Nasal flaring
>
> \(4\) Stridor (high pitched inspiratory sound), crowing, or noisy
>
> \(5\) Retractions
>
> \(6\) Grunting
>
> \(7\) Respiratory rate
>
> 2\. Hands-on approach to infant or child patient assessment
>
> a\. Palpate brachial or femoral pulse
>
> b\. Compare central and distal pulses
>
> c\. Assess skin color, temperature, and condition

III\. Common Problems in Infants and Children

> A. Airway obstructions
>
> 1\. Partial airway obstruction - infant or child who is alert and
> sitting.
>
> a\. Stridor (high pitched inspiratory sound), crowing, or noisy
>
> b\. Retractions on inspiration
>
> c\. Pink
>
> d\. Good peripheral perfusion
>
> e\. Still alert, not unresponsive.
>
> f\. Emergency medical care
>
> \(1\) Allow position of comfort; assist younger child to sit up; do
> not lay down. May sit on parent\'s lap.
>
> \(2\) Do not agitate child
>
> 2\. Complete obstruction and altered mental status or cyanosis and
> partial obstruction
>
> a\. No crying or speaking and cyanosis
>
> \(1\) Child\'s cough becomes ineffective
>
> \(2\) Increased respiratory difficulty accompanied by stridor (high
> pitched inspiratory sound)
>
> \(3\) Patient loses responsiveness
>
> \(4\) Altered mental status
>
> b\. Clear airway.
>
> \(1\) Infant foreign body procedures
>
> \(2\) Child foreign body procedures
>
> c\. Attempt artificial ventilations with mouth-to-mask technique
>
> B. Respiratory emergencies
>
> 1\. Respiratory distress precedes respiratory failure and is indicated
> by any of the following:
>
> a\. Respiratory rate \>60 in infants
>
> b\. Respiratory rate \> 30/40 in children
>
> c\. Nasal flaring
>
> d\. Intercostal retraction (between the ribs), supraclavicular (neck
> muscles), subcostal retractions (below the margin of the rib)
>
> e\. Stridor (high pitched inspiratory sound)
>
> f\. Cyanosis
>
> g\. Altered mental status (combative, decreased mental status,
> unresponsive)
>
> h\. Grunting
>
> 2\. Respiratory failure/arrest
>
> a\. Breathing rate less than 10 per minute in a child
>
> b\. Breathing rate of less than 20 per minute in an infant
>
> c\. Limp muscle tone
>
> d\. Unresponsive
>
> e\. Slower, absent heart rate
>
> f\. Weak or absent distal pulses
>
> g\. Cyanosis and a slow heart rate
>
> 3\. Role of the First Responder
>
> a\. Complete the First Responder assessment
>
> \(1\) Complete a scene size-up before initiating emergency medical
> care.
>
> \(2\) Complete an initial assessment on all patients.
>
> \(3\) Complete a physical exam as needed.
>
> \(4\) Complete on-going assessments.
>
> b\. Provide mouth-to-mask or barrier device ventilations
>
> c\. Observe heart rate
>
> C. Circulatory failure
>
> 1\. Circulatory failure that is uncorrected is also a common cause of
> cardiac arrest in infants and children
>
> 2\. Signs and symptoms of circulatory failure
>
> a\. Increased heart rate
>
> b\. Unequal central and distal pulses
>
> c\. Poor skin perfusion
>
> d\. Mental status changes

3\. Role of the First Responder

> a\. Complete the First Responder assessment
>
> \(1\) Complete a scene size-up before initiating emergency medical
> care.
>
> \(2\) Complete an initial assessment on all patients.
>
> \(a\) Support oxygenation and ventilation
>
> \(b\) Observe for signs of cardiac arrest
>
> D. Seizures
>
> 1\. Seizures, including seizures caused by fever (febrile), should be
> considered potentially life-threatening.
>
> 2\. May be brief or prolonged.
>
> 3\. Assess for injuries which may have occurred during seizures.
>
> 4\. Caused by a variety of conditions
>
> a\. Fever
>
> b\. Infections
>
> c\. Poisoning
>
> d\. Low blood sugar
>
> e\. Trauma
>
> f\. Decreased levels of oxygen
>
> g\. Could be the result of an unknown cause in children.
>
> 5\. History of seizures. Ask the following questions:
>
> a\. Has the child had prior seizure(s)?
>
> b\. If yes, is this the child\'s normal seizure pattern?
>
> c\. Is the child on a seizure medications?
>
> d\. Could the child have ingested any other medications?
>
> 6\. Role of the First Responder
>
> a\. Complete the First Responder assessment
>
> \(1\) Complete a scene size-up before initiating emergency medical
> care.
>
> \(2\) Complete an initial assessment on all patients.
>
> \(3\) Complete a physical exam as needed.
>
> \(4\) Complete on-going assessments.
>
> \(5\) Observe and describe the seizure.
>
> b\. Comfort, calm, and reassure the patient while awaiting additional
> EMS resources.
>
> \(1\) Protect the patient from the environment.
>
> \(2\) Ask bystanders (except parents) to leave the area.
>
> \(3\) Assure patency of airway.
>
> \(4\) Place patient in the recovery position if no possibility of
> spine trauma.
>
> \(5\) Never restrain the patient.
>
> \(6\) Do not put anything in the patient\'s mouth.
>
> \(7\) Have suction available.
>
> \(8\) If the patient is bluish, assure airway and artificially
> ventilate.
>
> \(9\) Report assessment findings to additional EMS responses
>
> 7\. Relationship to Airway Module
>
> a\. Often seizure patients will have significant oral secretions.
>
> b\. It is essential that these patients be placed in the recovery
> position when the convulsions have ended.
>
> c\. Patients who are actively seizing, bluish, and breathing
> inadequately should be ventilated, if possible.
>
> E. Altered mental status
>
> 1\. Caused by a variety of conditions
>
> a\. Low blood sugar
>
> b\. Poisoning
>
> c\. Post seizure
>
> d\. Infection
>
> e\. Head trauma
>
> f\. Decreased oxygen levels

2\. Role of the First Responder

> a\. Complete the First Responder assessment
>
> \(1\) Complete a scene size-up before initiating emergency medical
> care.
>
> \(2\) Complete an initial assessment on all patients.
>
> \(3\) Complete a physical exam as needed.
>
> \(4\) Complete on-going assessments.
>
> b\. Comfort, calm, and reassure the patient while awaiting additional
> EMS resources.
>
> \(1\) Assure patency of airway.
>
> \(2\) Be prepared to artificially ventilate/suction.
>
> \(3\) Place in recovery position.
>
> F. Sudden infant death syndrome (SIDS)
>
> 1\. Signs and symptoms
>
> a\. Sudden death of infants in the first year of life.
>
> b\. Many causes are not clearly understood.
>
> c\. Baby is most commonly discovered in the early morning.
>
> 2\. Role of the First Responder
>
> a\. Complete the First Responder assessment
>
> \(1\) Complete a scene size-up before initiating emergency medical
> care.
>
> \(2\) Complete an initial assessment on all patients.
>
> b\. Comfort, calm, and reassure the parents while awaiting additional
> EMS resources.
>
> \(1\) Try to resuscitate unless the baby is stiff.
>
> \(2\) Parents will be in agony from emotional distress, remorse, and
> guilt.
>
> \(3\) Avoid any comments that might suggest blame to the parents.

IV\. Trauma

> A. Injuries are the leading cause of death in infants and children.
>
> B. Blunt injury is most common.
>
> C. The pattern of injury may be different from adults.
>
> 1\. Motor vehicle crashes
>
> a\. Motor vehicle passengers
>
> \(1\) Unrestrained passengers have head and neck injuries.
>
> \(2\) Restrained passengers have abdominal and lower spine injuries.
>
> \(3\) Infant and booster seats are often improperly fastened,
> resulting in head and neck injuries.
>
> b\. Struck while riding bicycle - head injury, spinal injury,
> abdominal injury
>
> c\. Pedestrian struck by vehicle - abdominal injury with internal
> bleeding, possibly painful, swollen, deformed thigh, head injury.
>
> 2\. Falls from height, diving into shallow water - head and neck
> injuries
>
> 3\. Burns
>
> 4\. Sports injuries - head and neck
>
> 5\. Child abuse and neglect
>
> D. Specific body systems
>
> 1\. Head
>
> a\. Proportionally larger and more easily injured.
>
> b\. The single most important maneuver is to ensure an open airway by
> means of the jaw thrust.
>
> 2\. Chest
>
> a\. Children have very soft pliable ribs.
>
> b\. There may be significant injuries without external signs.
>
> 3\. Abdomen
>
> a\. More common site of injury in children than adults.
>
> b\. Often a source of hidden injury.
>
> 4\. Extremities - extremity injuries are managed in the same manner as
> for adults.
>
> 5\. Role of the First Responder
>
> a\. Complete the First Responder assessment
>
> \(1\) Complete a scene size-up before initiating emergency medical
> care.
>
> \(2\) Complete an initial assessment on all patients.
>
> \(3\) Complete a physical exam as needed.
>
> \(4\) Complete on-going assessments.
>
> b\. Comfort, calm, and reassure the patient while awaiting additional
> EMS resources
>
> \(1\) Assure airway position and patency. Use jaw thrust.
>
> \(2\) Suction as necessary with large bore suction catheter.
>
> \(3\) Provide spinal stabilization.
>
> \(4\) Manually stabilize extremity injuries

V. Child Abuse and Neglect

> A. Definition of abuse - improper or excessive action so as to injure
> or cause harm.
>
> B. Definition of neglect - giving insufficient attention or respect to
> someone who has a claim to that attention.
>
> C. First Responder must be aware of condition to be able to recognize
> the problem.
>
> D. Physical abuse and neglect are the two forms of child abuse that
> the First Responder is likely to suspect.
>
> E. Signs and symptoms of abuse
>
> 1\. Multiple bruises in various stages of healing.
>
> 2\. Injury inconsistent with mechanism described.
>
> 3\. Patterns of injury
>
> a\. Cigarette burns
>
> b\. Whip marks
>
> c\. Hand prints
>
> 4\. Repeated calls to the same address.
>
> 5\. Fresh burns.
>
> a\. Not just any burns
>
> \(1\) Scalding
>
> \(2\) Glove, dip pattern
>
> b\. Burns inconsistent with the history presented
>
> c\. Untreated burns
>
> 6\. Parents seem inappropriately unconcerned.
>
> 7\. Conflicting stories
>
> 8\. Fear on the part of the child to discuss how the injury occurred.
>
> 9\. CNS injuries - shaken baby syndrome
>
> a\. Unresponsive/seizure
>
> b\. Severe internal injuries
>
> c\. No evidence of external injuries
>
> F. Signs and symptoms of neglect
>
> 1\. Lack of adult supervision.
>
> 2\. Malnourished appearing child.
>
> 3\. Unsafe living environment
>
> 4\. Untreated chronic illness; e.g., asthmatic with no medications.
>
> 5\. Untreated soft tissue injuries
>
> G. Do not accuse in the field
>
> 1\. Accusation and confrontation delays transportation.
>
> 2\. Report objective information to the transporting unit.
>
> H. Reporting required by state law
>
> 1\. Local regulations
>
> 2\. Remain objective
>
> a\. Report what you see and what you hear
>
> b\. Do not comment on what you think.

VI\. Need for First Responder Debriefing

> A. Especially in cases of abuse/neglect
>
> B. Serious injury/death of a child

**Application**

**Procedural (How)**

> 1\. Demonstrate the techniques of opening the airway of an infant or
> child.
>
> 2\. Demonstrate the techniques of suctioning an infant or child.
>
> 3\. Demonstrate the techniques for removing a foreign body airway
> obstruction in an infant or child.
>
> 4\. Demonstrate ventilating infants and children.
>
> 4\. Demonstrate assessment of the infant and child.
>
> 5\. Demonstrate the management of partial and complete airway
> obstructions in infants and children.
>
> 6\. Demonstrate the management of respiratory distress and respiratory
> arrest in infants and children.
>
> 7\. Demonstrate the management of seizures, altered mental status, and
> sudden infant death syndrome (SIDS).

**Contextual (When, Where, Why)**

> The First Responder must have an understanding of the unique aspects
> of dealing with infants and children. In addition, the First Responder
> must realize the aspect of having multiple patients. A child cannot be
> cared for isolated from the family. A calm, professional, reassuring
> First Responder may help to minimize psychological impact of transport
> to parent and child.

**Student Activities**

**Auditory (Hearing)**

> 1\. Students should hear various infant and child airway sounds.
>
> 2\. Students should hear parent information.

**Visual (Seeing)**

> 1\. Students should see audio-visual materials of infant and child
> patients with common medical or traumatic complaints.
>
> 2\. Students should see various infant or child equipment.

**Kinesthetic (Doing)**

> 1\. Students should practice the techniques of opening the airway of
> an infant or child.
>
> 2\. Students should practice the techniques of suctioning an infant or
> child.
>
> 3\. Students should practice the techniques for removing of a foreign
> body airway obstruction in an infant or child.
>
> 4\. Students should practice ventilating infants and children.
>
> 5\. Students should practice the assessment of the infant and child.
>
> 6\. Students should practice the management of partial and complete
> airway obstructions in infants and children.
>
> 7\. Students should practice the management of respiratory distress
> and respiratory arrest in infants and children.
>
> 8\. Students should practice the management of seizures, altered
> mental status, and sudden infant death syndrome (SIDS).

**Instructor Activities**

Facilitate discussion and supervise practice.

> Reinforce student progress in cognitive, affective, and psychomotor
> domains.

Redirect students having difficulty with content (complete remediation
form)

**Evaluation**

**Written:**

> Develop evaluation instruments, e.g., quizzes, oral reviews, and
> handouts, to determine if the students have met the cognitive and
> affective objectives of this lesson.

**Practical:**

> Evaluate the actions of the First Responder students during role play,
> practice, or other skill stations to determine their compliance with
> the cognitive and affective objectives and their mastery of the
> psychomotor objectives of this lesson.

**Remediation**

> Identify students or groups of students who are having difficulty with
> this subject content. Complete remediation sheet from the
> instructor\'s course guide.

**Enrichment**

> What is unique in the local area concerning this topic? Complete
> enrichment sheets from instructor\'s course guide and attach with
> lesson plan.

**Lesson 6-3**

**Practical Lab: Childbirth and Children**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem-solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate the cognitive objectives of Lesson 6-1: Childbirth

 Demonstrate the cognitive objectives of Lesson 6-2: Infants and
Children

**Affective Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate the affective objectives of Lesson 6-1: Childbirth

 Demonstrate the affective objectives of Lesson 6-2: Infants and
Children

**Psychomotor Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate the steps to assist in the normal cephalic delivery.
(P-1,2)

 Demonstrate necessary care procedures of the fetus as the head
appears. (P-1,2)

 Attend to the steps in the delivery of the placenta. (P-1,2)

 Demonstrate the post-delivery care of the mother. (P-1,2)

 Demonstrate the care of the newborn. (P-1,2)

 Demonstrate assessment of the infant and child. (P-1,2)

**Preparation**

**Motivation:**

> The practical lesson is designed to allow the students additional time
> to perfect skills. It is of utmost importance that the students
> demonstrate proficiency of the skill, cognitive knowledge of the steps
> to perform a skill, and a healthy attitude towards performing that
> skill on a patient.
>
> This is an opportunity for the instructor and assistant instructors to
> praise progress and redirect the students toward appropriate
> psychomotor skills. The material from all preceding lessons and basic
> life support should be incorporated into these practical skill
> sessions.

**Prerequisites:**

Completion of Lessons 6-1 through 6-2

**Materials**

**AV Equipment:**

> Utilize various audio-visual materials relating to emergency medical
> care. The continuous development of new audio-visual materials
> relating to EMS requires careful review to determine which best meet
> the needs of the program. Materials should be edited to ensure that
> the objectives of the curriculum are met.

**EMS Equipment:**

> Childbirth manikin, sheets and towels, pillow or blanket, gloves, eye
> protection, bulb syringe.

**Personnel**

**Primary Instructor:**

One First Responder instructor knowledgeable in childbirth and children.

**Assistant Instructor:**

> The instructor-to-student ratio should be 1:6 for psychomotor skill
> practice. Individuals used as assistant instructors should be
> knowledgeable in infants, children, and childbirth.

**Recommended Minimum Time to Complete:**

One hour

**Presentation**

**Declarative (What)** None identified for this lesson.

**Application**

**Procedural (How)**

> Instructor should demonstrate the procedural activities from Lesson
> 6-1: Childbirth
>
> Instructor should demonstrate the procedural activities from Lesson
> 6-2: Infants and Children

**Contextual (When, Where, Why)**

Instructor should review contextual activities from Lesson 6-1:
Childbirth

> Instructor should review the contextual activities from Lesson 6-2:
> Infants and Children

**Student Activities**

**Auditory (Hearing)**

> 1\. The student should hear a video tape of a mother in the final
> stages of labor, providing a sample of the mother\'s actions during
> this painful process.
>
> 2\. Students should hear various infant and child airway sounds.
>
> 3\. Students should hear parent information.

**Visual (Seeing)**

> 1\. The student should see audio-visual materials of labor and
> delivery showing:
>
> A. Late stages of labor and normal delivery
>
> B. Suctioning the infant\'s mouth and nose during delivery
>
> C. Assessment and care of the newborn
>
> D. Normal bleeding during delivery
>
> 2\. Students should see audio-visual materials of infant and child
> patients with common medical or traumatic complaints.
>
> 3\. Students should see various infant or child equipment.

**Kinesthetic (Doing)**

> 1\. Student should practice the steps to assist in the normal
> delivery.
>
> 2\. Student should practice necessary care of the fetus as the head
> appears during delivery.
>
> 3\. Student should practice post-delivery care of mothers and
> neonates.
>
> 4\. Demonstrate the techniques of opening the airway of an infant or
> child.
>
> 5\. Demonstrate the techniques of suctioning an infant or child.
>
> 6\. Demonstrate the techniques for removing a foreign body airway
> obstruction in an infant or child.
>
> 7\. Demonstrate ventilating for infants and children.
>
> 8\. Demonstrate the assessment of the infant and child.
>
> 9\. Demonstrate managing partial and complete airway obstructions in
> infants and children.
>
> 10\. Demonstrate managing respiratory distress and respiratory arrest
> in infants and children.
>
> 11\. Demonstrate the management of seizures, altered mental status,
> and sudden infant death syndrome (SIDS).

**Instructor Activities**

> Supervise student practice.
>
> Reinforce student progress in cognitive, affective, and psychomotor
> domains.
>
> Redirect students having difficulty with content. (Complete
> remediation forms.)

**Evaluation**

**Practical:**

> Evaluate the actions of the First Responder students during role play,
> practice, or other skills stations to determine their compliance with
> the cognitive and affective objectives and their mastery of the
> psychomotor objectives of this lesson.

**Remediation**

> Identify students or groups of students who are having difficulty with
> this subject content. Complete remediation sheet from the
> instructor\'s course guide.

**Enrichment**

> What is unique in the local area concerning this topic? Complete
> enrichment sheets from the instructor\'s course guide and attach with
> lesson plan.

**Lesson 6-4**

**Evaluation: Infants and Children**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate competence in the cognitive objectives of Lesson 6-1:
Childbirth

 Demonstrate competence in the cognitive objectives of Lesson 6-2:
Infants and Children

**Affective Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate competence in the affective objectives of Lesson 6-1:
Childbirth

 Demonstrate competence in the affective objectives of Lesson 6-2:
Infants and Children

**Psychomotor Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate competence in the psychomotor objectives of Lesson 6-1:
Childbirth

 Demonstrate competence in the psychomotor objectives of Lesson 6-2:
Infants and Children

**Preparation**

**Motivation:**

> Evaluation of the student\'s attainment of the cognitive and affective
> knowledge and psychomotor skills is an essential component of the
> First Responder\'s educational process. The modules are presented in a
> \"building block\" format. Once the students have demonstrated their
> knowledge and proficiency, the next lesson should be built upon that
> knowledge. This evaluation will help to identify students or groups of
> students having difficulty with a particular area. This is an
> opportunity for the instructor to evaluate their performance and make
> appropriate modifications to the delivery of material.

**Prerequisites:**

Completion of Lessons 6-1 through 6-3.

**Material**

**AV Equipment:**

Typically none required.

**EMS Equipment:**

The EMS equipment used in the lessons of Module 6.

**Personnel**

**Primary Instructor:**

One proctor for the written evaluation.

**Assistant Instructor:**

One practical skills examiner for each 6 students.

**Recommended Minimum Time to Complete:**

One hour

**Presentation**

**Declarative (What)**

I. Purpose of the evaluation

II\. Items to be evaluated

III\. Feedback from evaluation

**Application**

**Procedural (How)**

> 1\. Written evaluation based on the cognitive and affective objectives
> of Lessons 6-1 \> 6-3.
>
> 2\. Practical evaluation stations based on the psychomotor objectives
> of Lessons 6-1 \> 6-3.

**Contextual (When, Where and Why)**

> The evaluation is the final lesson in this module and is designed to
> bring closure to the module and to assure that students are prepared
> to proceed to the next module.
>
> This modular evaluation is done to determine the effectiveness of the
> presentation of materials and how well students have retained the
> material. This is an opportunity for the students to make necessary
> adjustments in study habits or for the instructor to adjust the manner
> in which material is presented.

**Instructor Activities**

> Supervise student evaluation.
>
> Reinforce student progress in cognitive, affective, and psychomotor
> domains.
>
> Redirect students having difficulty with content. (Complete
> remediation forms.)

**Remediation**

> Identify students and/or groups of students who are having difficulty
> with this subject content. Complete a remediation sheet from the
> instructor\'s course guide. If students continue to have difficulty
> demonstrating knowledge of the cognitive and affective objectives, or
> demonstrating proficiency in psychomotor skills, the students should
> be counseled, remediated, and re-evaluated. If improvements in
> cognitive, affective, or psychomotor skills are not achieved,
> consideration regarding the ability of the student to progress in the
> program should be taken into account.

**Module 7: EMS Operations**

**Lesson 7-1 EMS Operation**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem-solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

7‑1.1 Discuss the medical and non-medical equipment needed to respond to
a call. (C-1)

7‑1.2 List the phases of a out-of-hospital call. (C-1)

7-1.3 Discuss the role of the First Responder in extrication. (C-1)

7-1.4 List various methods of gaining access to the patient. (C-3)

7-1.5 Distinguish between simple and complex access. (C-3)

7-1.6 Describe what the First Responder should do if there is reason to
believe that there is a hazard at the scene. (C-1)

7-1.7 State the role the First Responder should perform until
appropriately trained personnel arrive at the scene of a hazardous
materials situation. (C-1)

7-1.8 Describe the criteria for a multiple‑casualty situation. (C-1)

7‑1.9 Discuss the role of the First Responder in the multiple‑casualty
situation. (C-3)

7-1.10 Summarize the components of basic triage. (C-1)

**Affective Objectives**

At the completion of this lesson, the First Responder student will be
able to:

7-1.11 Explain the rationale for having the unit prepared to respond.
(A‑3)

**Psychomotor Objectives**

At the completion of this lesson, the First Responder student will be
able to:

7-1.12 Given a scenario of a mass casualty incident, perform triage.
(P‑2)

**Preparation**

**Motivation:**

> A First Responder will be functioning as part of the EMS System. This
> lesson is designed to provide the student with a brief overview of
> some of the operational aspects of out-of-hospital care.
>
> The First Responder should be familiar with the medical and
> non-medical equipment for use in patient care. The First Responder
> should also be aware of the phases of a response and his/her role in
> each.
>
> Although the First Responder is not usually responsible for rescue and
> extrication, a fundamental understanding of the process is required.

**Prerequisites:**

> Preparatory, Airway, Patient Assessment, Circulation, and Illness and
> Injuries Modules

**Materials**

**AV Equipment:**

> Utilize various audio-visual materials relating to EMS operations. The
> continuous development of new audio-visual materials relating to EMS
> requires careful review to determine which best meet the needs of the
> program. Materials should be edited to ensure meeting the objectives
> of the curriculum.

**EMS Equipment:**

Triage Tags, Emergency Response Guidebook,

**Personnel**

**Primary Instructor:**

One First Responder instructor, knowledgeable in EMS operations.

**Assistant Instructor:**

> The instructor-to-student ratio should be 1:6 for psychomotor skill
> practice. Individuals used as assistant instructors should be
> knowledgeable in EMS operations procedures.

**Recommended Minimum Time to Complete:**

Two hours

**Presentation**

**Declarative (What)**1. Phases of a response

> A. Preparation for the call
>
> 1\. Recommended equipment
>
> a\. Medical
>
> \(1\) Basic supplies
>
> \(2\) Airways
>
> \(3\) Suction equipment
>
> \(4\) Artificial ventilation devices
>
> \(5\) Basic wound care supplies
>
> b\. Non-medical
>
> \(1\) Personal safety equipment per local, state, and federal
> standards
>
> \(2\) Planned routes or comprehensive street maps
>
> 2\. Personnel
>
> a\. Available for response
>
> 3\. Equipment
>
> a\. Checked and maintained
>
> b\. Restocked and repaired
>
> 4\. Utilization of safety precautions and seat belts
>
> B. Dispatch
>
> 1\. Central access
>
> 2\. 24‑hour availability
>
> 3\. Trained personnel
>
> 4\. Dispatch information
>
> a\. Nature of call
>
> b\. Name, location, and callback number of caller
>
> c\. Location of patient
>
> d\. Number of patients and severity
>
> e\. Other special problems
>
> C. En route to scene
>
> 1\. Seat belts
>
> 2\. Notify dispatch
>
> 3\. Essential information
>
> a\. Nature of the call
>
> b\. Location of the call
>
> D. Arrival at scene
>
> 1\. Notify dispatch
>
> 2\. Size-up
>
> a\. Body substance isolation
>
> \(1\) Should be a consideration before patient contact.
>
> \(2\) Use gloves, gowns, and eyewear when appropriate.
>
> b\. Scene safety - assess the scene for hazards.
>
> \(1\) Is the emergency vehicle parked in a safe location?
>
> \(2\) Is it safe to approach the patient?
>
> \(3\) Does the patient require immediate movement because of hazards?
>
> c\. Mechanism of injury/nature of illness
>
> \(1\) Medical
>
> \(a\) Mass casualty incident
>
> \(b\) Number of patients
>
> \(c\) Obtain additional help.
>
> \(d\) Begin triage.
>
> \(e\) Spine stabilization if necessary
>
> \(2\) Trauma
>
> \(a\) Mass casualty incident
>
> i\) Number of patients
>
> ii\) Obtain additional help.
>
> iii\) Begin triage.
>
> \(b\) Spine stabilization if necessary
>
> d\. Total number of patients
>
> e\. Need for additional help or assistance
>
> 3\. Actions at scene
>
> a\. Organized
>
> b\. Rapid/efficient
>
> E. Transferring the patient to the ambulance
>
> 1\. Assist the ambulance crew in preparing the patient for transport.
>
> 2\. Assist the ambulance crew with lifting and moving using the
> guidelines of the lifting/moving module.
>
> F. Post run

1\. Prepare for the next call.

> a\. Clean and disinfect equipment.
>
> b\. Restock the disposable supplies.
>
> c\. Refuel unit.
>
> 2\. File reports.
>
> 3\. Notify dispatch.

I. Air Medical Consideration

> A. Utilization
>
> B. Patient preparation
>
> C. Landing zones
>
> D. Safety

II\. Fundamentals of Extrication

> A. Role of the First Responder
>
> 1\. Administer necessary care to the patient before extrication and
> assure that the patient is removed in a way to minimize further
> injury.
>
> 2\. Patient care precedes extrication unless delayed movement would
> endanger life of the patient or rescuer.
>
> 3\. Working with others
>
> a\. In some instances, First Responders are also the rescue providers.
>
> b\. A chain of command should be established to ensure patient care
> priorities.
>
> B. Equipment
>
> 1\. Personal safety
>
> a\. The number one priority for all First Responders
>
> b\. Protective clothing that is appropriate for the situation should
> be utilized.
>
> 2\. Patient safety - after safety of the First Responder, the next
> priority is safety of the patient.
>
> a\. The patient should be informed of the unique aspects of
> extrication.
>
> b\. The patient should be protected from broken glass, sharp metal and
> other hazards, including the environment.
>
> C. Getting to the patient
>
> 1\. Simple access - does not require equipment.
>
> a\. Try opening each door.
>
> b\. Roll down windows.
>
> c\. Have patient unlock doors.
>
> 2\. Complex access - requires use of tools, special equipment. These
> are separate programs that should be taken (Trench Rescue, High Angle
> Rescue, Vehicle Rescue).
>
> D. Removing the patient
>
> 1\. Work under the direction of the EMS providers.
>
> 2\. Maintain spine stabilization.
>
> 3\. Complete initial assessment.
>
> 4\. Provide critical interventions.

III\. Hazardous Materials

> A. Common problem
>
> B. Actual extent unknown
>
> C. Safety is the primary concern
>
> 1\. First Responder and crew
>
> 2\. Patient
>
> 3\. Public
>
> D. Approaching the scene
>
> 1\. Identification
>
> a\. Occupancy
>
> b\. Containers - size/shape
>
> c\. Placards
>
> d\. Shipping papers
>
> e\. Senses
>
> 2\. General procedures
>
> a\. Park upwind/uphill from the incident, at a safe distance.
>
> b\. Keep unnecessary people away from area.
>
> c\. Isolate the area.
>
> \(1\) Keep people out.
>
> \(2\) Do not enter unless properly trained and fully protected.
>
> d\. Avoid contact with material.
>
> e\. Remove patients to a safe zone, if no risk to First Responder.
>
> f\. Do not enter a HazMat area unless you are trained as a HazMat
> Technician.
>
> E. Environmental hazards
>
> F. Resources
>
> 1\. Local hazardous materials response team
>
> 2\. *Hazardous Materials, The Emergency Response Handbook*, published
> by the United States Department of Transportation
>
> G. Review Occupational Safety and health Administration (OSHA) and
> National Fire Protection Association (NFPA) Haz Mat requirements for
> EMS providers including First Responders.

IV\. Mass casualty incidents

> A. Basic triage
>
> 1\. Sorting multiple casualties into priorities for emergency medical
> care or transportation to definitive care.
>
> 2\. Priorities are given in three levels.
>
> 3\. Triage categories
>
> a\. Highest priority
>
> \(1\) Airway and breathing difficulties
>
> \(2\) Uncontrolled or severe bleeding
>
> \(3\) Decreased mental status
>
> b\. Second priority
>
> \(1\) Burns without airway problems
>
> \(2\) Major or multiple painful, swollen, deformed extremities
>
> \(3\) Back injuries
>
> c\. Lowest priority
>
> \(1\) Minor painful, swollen, deformed extremities
>
> \(2\) Minor soft tissue injuries
>
> \(3\) Death

B. Procedures for First Responder arrival to a mass casualty incident

> 1\. Most knowledgeable EMS provider arriving on-scene first becomes
> triage officer, until relieved by a responder with a higher level of
> training.
>
> 2\. Confirms incident and establishes a command post.
>
> 3\. Additional help should be requested.
>
> 4\. Perform initial assessment on all patients first.
>
> 5\. Start triage tag for each patient.
>
> 6\. Assign available personnel and equipment to priority one patients.
>
> 7\. Triage officer remains at scene to assign and coordinate
> personnel, supplies, and vehicles.
>
> C. Procedures for responding to a mass casualty incident where
> incident command has been established
>
> 1\. Report to command post.
>
> 2\. Identify the Incident Commander, identify yourself and your level
> of training.
>
> 3\. Follow directions from the Incident Commander.

**Application**

**Procedural (How)**

> None identified for this lesson.

**Contextual (When, Where, Why)**

> The knowledge of EMS operations is applied throughout the career of
> the First Responder.
>
> Gaining access is intended to be an overview of the actions required
> to extricate a patient. It is not the intent of this lesson to teach
> the First Responder the techniques of extrication. A number of special
> classes are available to teach such specialized knowledge and skills.
> This lesson should emphasize the safety and medical aspects of this
> process.

**Student Activities**

**Auditory (Hearing)**

> 1\. Students should hear audio tapes of actual dispatch conversations
> with callers to the 9-1-1 system.
>
> 2\. Students should hear audio tapes of actual dispatch information.

**Visual (Seeing)**

> 1\. Students should see actual equipment or audio-visual materials of
> ambulance equipment.
>
> 2\. Students should see audio-visual materials depicting an actual
> ambulance run.
>
> 3\. Students should see various crash scenes to determine if
> additional help will be necessary to remove the patient.
>
> 4\. Students should see the various options of personal protective
> equipment.

**Kinesthetic (Doing)**

> 1\. Students should practice receiving and sending information to
> dispatch.
>
> 2\. Students should practice evaluating crash scenes to determine the
> need for complex rescue.

**Instructor Activities**

Facilitate discussion and supervise practice.

> Reinforce student progress in cognitive, affective, and psychomotor
> domains.

Redirect students having difficulty with content. (Complete remediation
form.)

**Evaluation**

**Written:**

> Develop evaluation instruments, e.g., quizzes, oral reviews, and
> handouts, to determine if the students have met the cognitive and
> affective objectives of this lesson.

**Practical:**

> Evaluate the actions of the First Responder students during role play,
> practice, or other skill stations to determine their compliance with
> the cognitive and affective objectives and their mastery of the
> psychomotor objectives of this lesson.

**Remediation**

> Identify students or groups of students who are having difficulty with
> this subject content. Complete remediation sheet from the
> instructor\'s course guide.

**Enrichment**

> What is unique in the local area concerning this topic? Complete
> enrichment sheets from instructor\'s course guide and attach with
> lesson plan.

**Lesson 7-2 Evaluation: EMS Operations**

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate competence in the cognitive objectives of Lesson 7-1: EMS
Operations

**Affective Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate competence in the affective objectives of Lesson 7-1: EMS
Operations

**Psychomotor Objectives**

At the completion of this lesson, the First Responder student will be
able to:

 Demonstrate competence in the psychomotor objectives of Lesson 7-1:
EMS Operations

**Preparation**

**Motivation:**

> Evaluation of the student\'s attainment of the cognitive and affective
> knowledge and psychomotor skills is an essential component of the
> First Responder\'s educational process. The modules are presented in a
> \"building block\" format. Once the students have demonstrated their
> knowledge and proficiency, the next lesson should be built upon that
> knowledge. This evaluation will help to identify students or groups of
> students having difficulty with a particular area. This is an
> opportunity for the instructor to evaluate their performance and make
> appropriate modifications to the delivery of material.

**Prerequisites:**

Completion of Lesson 7-1

**Material**

**AV Equipment:**

Typically none required.

**EMS Equipment:**

The EMS equipment used in the Lessons of Module 7.

**Personnel**

**Primary Instructor:**

One proctor for the written evaluation.

**Assistant Instructor:**

One practical skills examiner for each 6 students.

**Recommended Minimum Time to Complete:**

One hour

**Presentation**

**Declarative (What)**

V. Purpose of the evaluation

VI\. Items to be evaluated

VII\. Feedback from evaluation

**Application**

**Procedural (How)**

> 1\. Written evaluation based on the cognitive and affective objectives
> of Lesson 7-1
>
> 2\. Practical evaluation stations based on the psychomotor objectives
> of Lesson 7-1

**Contextual (When, Where and Why)**

> The evaluation is the final lesson in this module and is designed to
> bring closure to the module and to assure that students are prepared
> to move to the next module.
>
> This modular evaluation is given to determine the effectiveness of the
> presentation of materials and how well students have retained the
> material. This is an opportunity for the students to make necessary
> adjustments in study habits or for the instructor to adjust the manner
> in which material is presented.

**Instructor Activities**

> Supervise student evaluation.
>
> Reinforce student progress in cognitive, affective, and psychomotor
> domains.
>
> Redirect students having difficulty with content. (Complete
> remediation forms.)

**Remediation**

> Identify students and/or groups of students who are having difficulty
> with this subject content. Complete a remediation sheet from the
> instructor\'s course guide. If students continue to have difficulty
> demonstrating knowledge of the cognitive and affective objectives, or
> demonstrating proficiency in psychomotor skills, the students should
> be counseled, remediated, and re-evaluated. If improvements in
> cognitive, affective, or psychomotor skills are not achieved,
> consideration regarding the ability of the student to progress in the
> program should be taken into account.

**APPENDIX A**

**FUNCTIONAL JOB**

**ANALYSIS**

**APPENDIX AFUNCTIONAL JOB ANALYSIS**

The attached Functional Job Analysis was developed at the request of the
Board of Directors of the National Registry of EMTs. This job analysis
should be used to assist in meeting the requirements of the Americans
with Disabilities Act. Readers and persons interested in utilizing this
functional job analysis should refer questions related to specific
indicators to occupational health rehabilitation specialists for
interpretation.

**Functional Job Analysis**

**First Responder Characteristics**

The First Responder must be a person who can remain calm while working
in

difficult and stressful circumstances, as well as one who is capable of
combining

technical skills, theoretical knowledge, and good judgment to insure
optimal level

of fundamental emergency care to sick or injured patients while adhering
to specific guidelines within the given scope of practice.

The First Responder is expected to be able to work alone, but must also
be a team

player. Personal qualities such as the ability to \"take charge\" and
control the

situation are essential, as are the maintaining of a caring and
professional attitude,

controlling one\'s own fears, presenting a professional appearance,
staying physically fit, and keeping one\'s skills and abilities up to
date. The First Responder

must be willing to adhere to the established ongoing medical control and
evaluation

required for the maintenance of quality medical care.

Self‑confidence, a desire to work with people, emotional stability,
tolerance for

high stress, honesty, a pleasant demeanor, and the ability to meet the
physical and

intellectual requirements demanded by this position are characteristics
of the

competent First Responder. The First Responder also must be able to deal
with

adverse social situations which include responding to calls in districts
known to

have high crime rates. The First Responder ideally possesses an interest
in

working for the good of society and has a commitment to doing so.

**Physical Demands**

Aptitudes required for work of this nature are good physical stamina,
endurance,

and body condition that would not be adversely affected by having to
walk, stand,

lift, carry, and balance at times, in excess of 125 pounds. Motor
coordination is

necessary because over uneven terrain, the patient\'s and the First
Responder\'s

well being, as well as other workers\' well being must not be
jeopardized.

**Comments**

Use of the telephone or radio dispatch for coordination of prompt
emergency

services is essential. Accurately discerning street names through map
reading, and

correctly distinguishing house numbers or business addresses are
essential to task

completion in the most expedient manner. Concisely and accurately
describing

orally to dispatcher and other concerned staff, one\'s impression of
patient\'s

condition, is critical as the First Responder works in emergency
conditions where

there may not be time for deliberation. The First Responder must also be
able to

accurately report all relevant patient data, which is generally, but not
always,

outlined on a prescribed form. Verbal and reasoning skills are used
extensively.

The ability to perform mathematical tasks is minimal, however, it does
play a part

in activities such as taking vital signs, making estimates of time,
calculating the

number of persons at scene, and counting the number of persons requiring
specific

care.

**Job Analysis Schedule**

**1. ESTABLISH JOB TITLE:** First Responder

**2. CODE 079026 WTA GROUP:** Occupations in medicine and health

**3. JOB SUMMARY:** Activates the EMS system, surveys the scene for
hazards, contains those hazards, gains access to the injured or sick,
gathers relevant patient data, provides immediate emergency medical care
using a limited amount of equipment, controls the scene, and prepares
for the arrival of the ambulance.

**4. WORK PERFORMED ESTIMATES:**

  ----------------- ----------------- ----------------- -----------------
  Worker Functions  Data              People            Things

                    3                 7                 4
  ----------------- ----------------- ----------------- -----------------

3\. Compiling

7\. Serving

4\. Manipulating

Work Field: 294 Health, Caring, and Medical

M.P.S.M.S. 920 (**M**aterials, **P**roducts, **S**ubject **M**atter, and
**S**ervices) Medical and other health services.

**5. WORKER TRAITS RATINGS:**

GENERAL EDUCATION DEVELOPMENT (GED) encompasses three broad

areas which are rated independently in relation to the occupation being

assessed: Reasoning development, Mathematical development, and

Language development.

General Educational Development (GED) embraces those aspects of
education (formal and Informal) which contribute to the worker\'s
reasoning development, and ability to follow instructions, and to
acquisition of \"tool\" knowledge such as language and mathematical
skills. This is education of a general nature which does not have a
recognized, fairly specific occupational objective. Ordinarily, such
education is obtained in elementary school, high school, or college.
However, it may be obtained from experience and self study.

> Description of rating on the GED Scale: Level 1 ‑ lowest level; Level
> 6 ‑ highest level.

Lowest Highest

  ---------- ---------- ----------------- ---------- ---------- ---------- ----------
  GED        1          [M1,              3          R4         5          6
                        L2]{.underline}                                    

  ---------- ---------- ----------------- ---------- ---------- ---------- ----------

**Reasoning development (R)**

Level 4 ‑ Apply principles of rational systems to solve practical
problems and deal

with a variety of concrete variables in situations where only limited
standardization

exists. Interpret a variety of instructions furnished in written, oral,
diagrammatic,

or schedule form.

**Mathematical development (M)**

Level 2 ‑ Add, subtract, multiply and divide all units of measure.
Complete ratio,

rate, and percent. Perform the four operations with like on common
decimals,

fractions. Perform arithmetic operations involving all American monetary
units.

**NOTE:** In the analyst\'s opinion, the degree of math skills required
for this position is minimal, however, reducing the mathematical
component to a level 1, the lowest level, appears slightly too low. For
example, in Level 1, a person would only be required to add and subtract
up to two digit numbers. There could be instances where higher level
skills are required, such as the total number of persons with slight
injuries compared to those with more serious injuries.

**Language development (L)**

Level 2 ‑ Reading: Passive vocabulary of 5000‑6000 words; read at rate
of

190‑215 words per minute; read adventure stories and comic books;
looking up

unfamiliar words in dictionary for meaning, spelling and pronunciation;
and read

instructions for assembling model cars and airplanes.

Writing: Write compound and complex sentences using cursive style,
proper end

punctuation, and employing adjectives and adverbs.

Speaking: Speak clearly and distinctly with appropriate pauses and
emphasis,

correct pronunciation, variation in word order, using present, perfect,
and future

tenses.

SPECIAL VOCATIONAL PREPARATION (SVP) (Time requirement of 40 classroom

hours)

  ------- ------- ----------------- ------- ------- ------- ------- ------- ------- -------
  SVP     1       [2]{.underline}   3       4       5       6       7       8       9

  ------- ------- ----------------- ------- ------- ------- ------- ------- ------- -------

Explanation of scale:

**[Level]{.underline}** **[Time^1^]{.underline}**

> 1 Short demonstration only

2 Anything beyond short demonstration up to and including one month

> 3 Over one month up to and including three months

4 Over three months up to and including six months

5 Over six months up to and including one year

6 Over one year up to and including two years

7 Over two years up to and including four years

8 Over four years up to and including ten years

9 Over ten years

**NOTE:** The levels of this scale are mutually exclusive and do not
overlap

> ^1^Time that applies to General Educational Development is not
> considered in estimating SVP

Level 2.

> **NOTE:** In the analyst\'s opinion, the requirement of 40 hours of
> formal classroom study, and competency based on formal written and
> practical examination, when judged only by a time perspective, appear
> to qualify the preparation time as less than 30 days. While this may
> be true in some instances, preparation time may vary and span a longer
> period of calendar time, depending upon the student, the instructor,
> and the locality of training. First Responder applicants typically
> make application in writing at least thirty days before the start of
> the training program. This requirement will vary depending upon
> locality. Because First Responder program guidelines can permit a
> student up to six months for course completion, the SVP could, in
> essence, be as high as a Level 4.

APTITUDE LEVELS: G [3]{.underline} V [3]{.underline} N [4]{.underline} S
[3]{.underline} P [2]{.underline} Q [3]{.underline} K [2]{.underline} F
[2]{.underline} M [2]{.underline} E [2]{.underline} C [1]{.underline}

> **Scale:** Level 1 ‑ indicates the highest degree of particular
> aptitude; Level 5 indicates the lowest degree of an aptitude.

  -------------- -------------- -------------- -------------- --------------
  Lowest                                                      Highest

  5              4              3              2              1
  -------------- -------------- -------------- -------------- --------------

**G ‑ Intelligence**

Level 3

> Level G‑3:1 Renders general nursing care to patients in hospital,
> infirmary, sanitarium, or similar institution:

Intelligence is required to learn and apply principles of anatomy,
physiology, and patient care used in emergency medical care; to make
independent judgments in absence of doctor; and to determine methods and
treatments to use when caring for patients with varying illnesses or
injuries, and to exercise judgment concerning ethical and legal
considerations within scope of practice.

**V ‑ Verbal Aptitude**

Level 3

> Level V‑3:9 Questions patients to obtain their medical history,

personal data, and to determine if they are allergic to

dental drugs or have any complicating illnesses.

Converses with patient in reassuring manner; explains

post‑operative care, oral hygiene, and importance of

preventive dentistry to patients.

**N ‑ Numerical Aptitude (Perform arithmetic operations quickly and
accurately)**

Level 4 Lower degree of aptitude required. No illustrations in medical
area. Closely related skills appear comparable to 4:7 Records business
transactions in journals, ledgers, on special forms, and transfers
entries from one accounting record to another. Adds totals of entries
and original record and compares to check for posting errors.

**S ‑ Spatial Aptitude (Comprehend forms in space and understand
relationships to plane and solid objects)**

Level 3

Level S‑3:1 Spatial aptitude is required to visualize anatomic and the
relationship between the point of application of forces and the area
affected (as in traction); and to place treatment devices or administer
manual treatment in relationship to the affected body part.

**P ‑ Form Perception (Ability to make visual comparisons and
discriminations and see slight differences in shapes and shadings of
figures and widths and lengths of lines)**

Level 2

P ‑ 2:6 High degree of aptitude required. Form perception is

required to perceive pertinent details of size, shape, and

form in skeletal structure, organs, tissue, and specimens

of various animals.

**Q ‑ Clerical Perception (Ability to perceive pertinent detail in
verbal or tabular material‑proof read)**

Level 3

Q ‑ 3:13 Assists in care of hospital patients under direction of

nursing and medical staff. Clerical perception is required

to read and report such data as temperatures, pulse rate

and respiration rate, to report patient\'s food and fluid

intake and output, and to read charts and instructions

accurately. Generally completes documentation of

relevant data on pre‑printed form. Must be able to read

form accurately and report patient information in

appropriate allocated space. Occasionally, may be

required to submit short narrative report.

**K ‑ Motor Coordination (Ability to make a movement response quickly
and accurately and coordinate eye‑hand)**

Level 2

K ‑ 2:5 Renders general nursing care to patients in hospital, infirmary,
sanitarium, or similar institution. Aptitude and ability are required to
coordinate vision, finger and hand movements, to take vital signs, to
assist with freeing airway, and to balance self when lifting/moving or

stabilizing patients.

**F ‑ Finger Dexterity (Ability to move fingers and manipulate small
objects rapidly and quickly)**

Level 2 No illustrations in medical field. Recommended due to necessity
of ability to open and maintain airway, ventilate patient, control
hemorrhage, bandage wounds, and manually stabilize painful swollen and
deformed extremities.

**M ‑ Manual Dexterity (Ability to move the hands easily and
skillfully)**

Level 2 No illustrations given. Manual dexterity is required during
emergency situations to control and extinguish fires,

protect life and property, and maintain equipment as

volunteer or employee of city, township, or industrial

plant. Manual dexterity is also required in positioning

ladders and nets, clasping rungs to climb ladders, giving

artificial respiration, and in lifting of patient.

**E ‑ Eye‑Hand‑Foot Coordination (Ability to coordinate these)**

Level 2 No illustrations given. Recommended as job may require

balancing on ladders, stairs, or walking on uneven terrain

while assisting in carrying patients. In the interest of time

and safety, may be required to move quickly.

**C ‑ Color Discrimination (Ability to perceive difference in colors,
shades, or harmonious combinations, or to match colors)**

Level 1 High degree of aptitude and ability required. C‑1:4 Uses color
discrimination and color memory in making diagnosis of patients\'
affliction or condition, by recognizing any deviations in color of
diseased tissue

from healthy tissue; evaluating color characteristics such

as hue and saturation of affected body parts; and making

determination as to extent or origin of condition

.

TEMPERAMENT

  ----------------- ----------------- ----------------- ----- ----------------- ----------------- ----------------- ----------------- ----- ----------------- -----------------
  Temperament       [A]{.underline}   [D]{.underline}   F     [I]{.underline}   [J]{.underline}   [M]{.underline}   [P]{.underline}   R     [S]{.underline}   [V]{.underline}

  ----------------- ----------------- ----------------- ----- ----------------- ----------------- ----------------- ----------------- ----- ----------------- -----------------

Explanation of terms:

A ‑ Working alone or apart in physical isolation from others

D ‑ Directing, controlling or planning the activities of others.

I ‑ Influencing Adaptability to influencing people in their opinions,
attitudes, or judgments about ideas or things.

J ‑ Adaptability to making generalizations, evaluations or decisions
based on sensory or judgmental criteria.

M - Adaptability to making generalizations, judgments, or decisions
based on measurable or verifiable criteria.

P ‑ Adaptability to dealing with people beyond giving and receiving
instructions.

S ‑ Adaptability to performing under stress when confronted with
emergency, critical, unusual, or dangerous situations; or in situations
in which working where speed and sustained attention are make or break
aspects of the job.

V ‑ Adaptability to performing a variety of duties, often changing from
one task to another of a different nature without loss of efficiency or
composure.

INTERESTS

  ----------------- ---- ----- ----- ----- ----- ----- ----- ----- ----- -----
  Interests         1a   1b    2a    2b    3a    3b    4a    4b    5a    5b

  ----------------- ---- ----- ----- ----- ----- ----- ----- ----- ----- -----

4a ‑ A preference for working for the presumed good of the people.

PHYSICAL DEMANDS

  ---------------- ----- ----- ----- ----- ----------------- ----------------- ----------------- ----------------- ----------------- -----------------
  Physical Demands S     L     M     H     [V]{.underline}   [2]{.underline}   [3]{.underline}   [4]{.underline}   [5]{.underline}   [6]{.underline}

  ---------------- ----- ----- ----- ----- ----------------- ----------------- ----------------- ----------------- ----------------- -----------------

Explanation of terms:

1\. Strengths

S ‑ Sedentary (10 pounds maximum)

L ‑ Light work (10 pounds frequently, 20 pounds maximum)

M ‑ Medium work (25 pounds frequently, 50 pounds maximum)

H ‑ Heavy work (50 pounds frequently, 100 pounds maximum)

V ‑ Very heavy work (50 pounds frequently, no maximum)

2\. Climbing and/or balancing

3\. Stooping, kneeling, crouching and crawling

4\. Reaching, handling, fingering and/or feeling

5\. Talking and hearing

6\. Seeing

ENVIRONMENTAL CONDITIONS

<table>
<colgroup>
<col style="width: 25%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
</colgroup>
<tbody>
<tr class="odd">
<td><p>Environmental</p>
<p>Conditions</p></td>
<td><u>I</u></td>
<td><u>O</u></td>
<td><u>B</u></td>
<td><u>2</u></td>
<td><u>3</u></td>
<td><u>4</u></td>
<td><u>5</u></td>
<td><u>6</u></td>
<td><u>7</u></td>
</tr>
</tbody>
</table>

Explanation of terms:

> 1\. Work location (I = Indoors, O = Outdoors, B = Both)
>
> 2\. Extreme cold, with or without temperature changes.
>
> 3\. Extreme heat, with or without temperature changes.
>
> 4\. Wet and or/humid.
>
> 5\. Noise and/or vibration
>
> 6\. Hazards.

7\. Atmospheric Conditions

**NOTE:** In the analyst\'s opinion, the general environmental
conditions in which the First Responder works cannot be adequately
assessed in an indoor evaluative environment. First Responders in actual
situations are exposed to a variety of hot and cold temperatures and may
be, at times, exposed to hazardous fumes and areas which are unsafe.
Because of the variance in climate in the United States and because of
the infinite possibilities to which a First Responder may be expected to
respond, it must be assumed that some environments may be extremely
hazardous, i.e., mine shafts, high exposed places, explosives,
radiation, toxic chemicals, close proximity to moving vehicles or
mechanical parts. First Responders may be required to walk, climb crawl,
bend, pull, push, or lift and balance over less than ideal terrain, and
are also exposed to a variety of noise levels, which at times can be
quite high, particularly when multiple sirens are sounding, and
crowds/bystanders are upset and may be screaming or crying hysterically.

**U. S. Department of Labor**

**Manpower Administration**

**Analyst:** Cathy Cain, Ph.D. **Date:** 1/27/95

**Physical Demands and Environmental Conditions**

**ESTAB. JOB TITLE** First Responder **ESTAB. & SCHED. NO.**

**DOT TITLE & CODE** 079.010

**GOE CODE & TITLE** 100302 Medical services; SOC 3690

**Code:** F = Frequently

O = Occasionally

NP = Not Present

C = Constantly

**Job Summary:** Activates the EMS system, surveys the scene for
hazards, contains those hazards, gains access to the injured or sick,
gathers relevant patient data, provides immediate emergency medical care
using a limited amount of equipment, controls the scene, and prepares
for the arrival of the ambulance.

**Physical Comments**

**Demands**

**1. Strength**

**a. Standing** 47% 1a Walking and standing are major components

**Walking** 50% of this job. Sitting is necessary for

**Sitting** 3% for transportation to and from scene of emergency.

**b. Lifting** F 1b First Responders are required to assist in

**Carrying** F lifting and carrying injured or sick persons

**Pushing** O to ambulance. May be required to engage in

**Pulling** O pushing and/or pulling to assist other EMS

providers to extricate patient from scenes to

include but not limited to closed upright

vehicles, patient in closed overturned

vehicle, patient pinned beneath vehicle,

pinned inside vehicle, in vehicles with

electrical hazards.

**2. Climbing** F 2 Climbing and balancing may be required for

**Balancing** F First Responder to gain access to site of

emergency, i.e., stairs, hillsides, ladders, and

in safely assisting in transporting patient.

**3. Stooping** F 3 Patients are often found injured or sick in

**Kneeling** F locations where assessment of patient is

**Crouching** F possible only through the First Responder\'s

**Crawling** F stooping, kneeling, crouching, or crawling.

**4. Reaching** F 4 Required for assessing pulse, assessing

**Handling** F breathing, blocking nose and cheek for

**Fingering** F ventilation, lifting chin, head, or jaw for

**Feeling** F opening airway, following angle of ribs to

determine correct position for hands after

each ventilation, compressing sternum, and

assisting in lifting of patient. Extension of

arms to use hands and fingers to assess

vital signs, feeling and touching of patient\'s

skin to assess body warmth, handling

limited equipment, and transporting of

patient are important aspects of this

position.

**5. Talking** 5 Responding to patients, physicians, and

**Ordinary** F co‑workers through hearing is necessary in

**Other** transmitting patient information and

following directions.

May be required to shout for help and

additional assistance.

**Hearing** 5 Verbally responding to dispatcher\'s

**Ord. Conv.** F messages on phone or radio is necessary for **Other** F
quick efficient service that can be vital to life in emergency
situations. Communication on scene is critical for interviewing patient
and in some instances, significant others, and in relaying this
information in most expedient manner. Sounds of vehicles may alert First
Responder that additional help is on the way. Other sounds can alert
First Responder that other persons may be hurt or injured, i.e., someone
thrown behind a bush in a vehicle accident who cannot be seen and whose
voice may be barely audible.

**6. Seeing** 6 Sight is used to drive self, or in some cases,

**Acuity, Near** F ambulance to scene of injury or illness, to

**Acuity, Far** F visually inspect patient and area, and to

**Depth Perception** F administer treatment using limited

**Accomodat** F equipment.

**Color Vision** F

**Field of Vision** F

**7. General Education:** High school graduation or equivalency is not
required.

**8. Vocational Preparation:**

**a. College:** None

**b. Vocational Education Courses:** Forty hours of specialized training
at the First Responder Level

**c. Apprenticeship:** None

**d. In‑plant Training:** None

**e. On‑the‑Job‑Training:** None

**f. Performance on Other Jobs:** None

**9. Experience:** None

**10. Orientation:** Must be affiliated with public safety personnel
such as a law enforcement agency, fire department (either as an employee
or as a non‑paid volunteer), and/or as industrial safety personnel,
athletic trainers, ski patrol members, emergency management personnel,
disaster team personnel, first aid section attendants, lifeguards,
teachers, hotel employees, and others responsible for the safety of
others where there are gatherings of people. As such, the First
Responder will receive orientation relevant to tasks and scope of
practice.

**11. Licenses, Etc.:** Certification or licensure.

**12. Relation to Other Jobs and Workers:**

**Promotion:** In some locations, First Responders may take bridge
courses which will permit them, upon successful completion of written
and practical examination, to progress to higher level EMS providers.
First Responders may also take additional course hours which will permit
them to become trainers of First Responders.

> **Transfers:** None

**Supervision Received:** Physicians

**Supervision Given:** None

**13. Machines, Tools, Equipment, and Work Aids:**

> Radio/telephone, oral airway device, suction equipment, and
> resuscitation mask.

**14. Materials and Products:** Disposable latex gloves, bandages,
universal dressings such as gauze pads, tape, blankets, and pillows.

**Description of tasks**

Answers verbally to telephone or radio emergency calls from dispatcher
to provide

efficient and immediate care to critically ill and injured persons using
a limited

amount of equipment. Responds safely to the address or location as
directed by

radio dispatcher, Visually inspects and assesses or \"sizes up\" the
scene upon

arrival to determine if scene is safe, to determine the mechanism of
illness or

injury, and the total number of patients involved. Directly reports
verbally to the

responding EMS unit or communications center as to the nature and extent
of

injuries, the number of patients, and the condition of each patient, and
identifies

assessment findings which may require communication with medical
direction for

advice.

Assesses patient constantly while awaiting additional EMS resources,
administers

care as indicated. Requests additional help if necessary. Creates a safe
traffic

environment in the absence of law enforcement. Renders emergency care to

adults, children and infants based on assessment findings, using a
limited amount

of equipment. Opens and maintains patient airway, ventilates patient,
performs

cardiopulmonary resuscitation. Provides pre‑hospital emergency care of
simple and

multiple system trauma such as controlling hemorrhage, bandaging wounds,

manually stabilizing painful, swollen and deformed extremities. Provides
emergency

medical care to include assisting in childbirth, management of
respiratory problems,

altered mental status, and environmental emergencies.

Searches for medical identification as clue in providing emergency care.
Reassures

patients and bystanders while working in a confident and efficient
manner, avoids

misunderstandings and undue haste while working expeditiously to
accomplish the

task. Extricates patients from entrapment, assesses extent of injury,
assists other

EMS providers in rendering emergency care and protection to the
entrapped

patient. Performs emergency moves, assists other EMS providers in the
use of

prescribed techniques and appliances for safe removal of the patient.

Assists other EMS providers in lifting patient onto stretcher, placing
patient in

ambulance, and insuring that patient and stretcher are secured. Radios
dispatcher

for additional help or special rescue and /or utility services. Reports
verbally all

observations and medical care of the patient to the transporting EMS
unit, provides

assistance to transporting staff. Performs basic triage where multiple
patient

needs exist. Restocks and replaces used supplies, uses appropriate
disinfecting

procedures to clean equipment, checks all equipment to insure adequate
working

condition for next response. Attends continuing education and refresher
courses as

required by employers, medical direction, and licensing or certifying
agencies.

Meets qualifications within the functional job analysis.

**Qualifications**

Must be at least 18 years of age. Ability to communicate verbally; via
telephone

and radio equipment; ability to lift, carry, and balance up to 125
pounds (250 with

assistance); ability to interpret and respond to written, oral, and
diagnostic form

instructions; ability to use good judgment and remain calm in
high‑stress

situations; ability to work as the most basic fundamental unit of a team
with

personal recognition of limitations within the scope of practice of the
First

Responder.

Must have the ability to read road maps; drive vehicle, accurately
discern street

signs and address numbers; ability to communicate verbally to interview
patient,

family members, and bystanders; ability to document, in writing, all
relevant

information in prescribed format in light of legal ramifications of
such; ability to

converse with dispatcher and EMS providers via phone or radio as to
status of

patient. Proof of driver\'s license. Good manual dexterity with ability
to perform all

tasks related to level of care being provided. Ability to bend, stoop,
balance, and

crawl on uneven terrain; and the ability to withstand varied
environmental

conditions such as extreme heat, cold, and moisture. Ability to perform
basic

arithmetic.

Must have successful completion of approved curriculum, with achievement
of

passing scores on written and practical certification examinations as
defined by

programmatic guidelines, and be certified in cardiopulmonary
resuscitation (CPR) by

the American Heart Association or its equivalent. Reauthorization for
certification is

dependent upon an individual\'s currently being active as a pre‑hospital
emergency

care provider, successful completion of an inter‑agency approved First
Responder

refresher course, or successful completion of all requirements of a
higher level

training course such as EMT‑B, EMT‑I or EMT‑P. Conditional reciprocity
may be

granted to individuals who have completed a First Responder program in
another

state. Documentation of course completion of a DOT First Responder
course,

current recognition as a First Responder in the state in which the
individual was

originally trained, a resident of the state to which the individual is
applying and

successful completion of an inter‑agency approved written and practical

examination.

Activates EMS system and provides immediate emergency medical care to
sick and

injured persons using a limited amount of equipment. Controls the scene,
and

prepares for the arrival of the ambulance. Receives call from
dispatcher, responds

verbally to emergency calls, reads maps, uses most expeditious

route, and observes traffic ordinances and regulations. Uses own vehicle
to arrive

at site of emergency or designated public safety facility, drives
ambulance to

emergency site when called upon to do so. Works alone as well as member
of

team. Determines nature and extent of illness or injury,

takes pulse, blood pressure, visually observes changes in skin color,
establishes

priority for emergency care, renders appropriate emergency care (based
on the

competency level required of a First Responder). Uses limited equipment
to

open airways and ventilate patient, and improve patient\'s blood
circulation until

higher skilled EMS providers arrive on scene. Assists in lifting,
carrying, and

transporting patient to ambulance. Reassures patients and bystanders,
avoids

mishandling patient and undue haste, searches for medical identification
emblem to

aid in care. Extricates patient from entrapment, assesses extent of
injury, uses

prescribed techniques and appliances, radios dispatcher for additional

assistance or services, provides light rescue service if required,
provides additional

emergency care. Complies with regulations in handling deceased. Reports
verbally

and in writing observations about and care of patient at the scene,
provides

assistance to emergency staff as required. Checks and sanitizes all
equipment for

future readiness.

**APPENDIX B**

**BLS HEARTSAVER**

**INFORMATION**

**AND**

**SKILL SHEETS**

**APPENDIX C**

**ADULT AND PEDIATRIC**

**BASIC CARDIAC LIFE**

**SUPPORT GUIDELINES**

**REPRINTED FROM JAMA**

**APPENDIX D**

**ENRICHMENT LESSON PLAN**

**APPENDIX D**

The following enrichment lesson sheets should be copied and used as
needed to assist with augmenting the core curriculum.

These sheets are designed to be used as a template to ensure that added
materials are presented in format and similar style to the other
lessons. These sheets may be added to any of the lessons in the core
curriculum.

**Objectives**

**Objectives Legend**

C=Cognitive P=Psychomotor A=Affective

1 = Knowledge level

2 = Application level

3 = Problem solving level

**Cognitive Objectives**

At the completion of this lesson, the First Responder student will be
able to:







**Affective Objectives**

At the completion of this lesson, the First Responder student will be
able to:







**Psychomotor Objectives**

At the completion of this lesson, the First Responder student will be
able to:







**Preparation**

**Motivation:**

**Prerequisites:**

**Material**

**AV Equipment:**

**EMS Equipment:**

**Personnel**

**Primary Instructor:**

**Assistant Instructor:**

**Recommended Minimum Time to Complete:**

**Presentation**

**Declarative (What)**

**Application**

**Procedural (How)**

**Contextual (When, Where and Why)**

**Student Activities**

**Auditory (Hearing)**

1\.

2\.

3\.

**Visual (Seeing)**

1\.

2\.

3\.

**Kinesthetic (Doing)**

1\.

2\.

3\.

**Instructor Activities**

> Supervise student practice.
>
> Reinforce student progress in cognitive, affective, and psychomotor
> domains.
>
> Redirect students having difficulty with content (complete remediation
> forms).

**Evaluation**

**Written:**

> Develop evaluation instruments, e.g., quizzes, oral reviews, and
> handouts, to determine if the students have met the cognitive and
> affective objectives of this lesson.

**Practical:**

> Evaluate the actions of the First Responder students during role play,
> practice or other skill stations to determine their compliance with
> the cognitive and affective objectives and their mastery of the
> psychomotor objectives of this lesson.

**Remediation**

> Identify students or groups of students who are having difficulty with
> this subject content. Complete remediation sheet from the
> instructor\'s course guide.

**APPENDIX E**

**REMEDIATION SHEET**

**APPENDIX E**

The following remediation sheet should be completed after every class
for individual students or groups of students having difficulty with
knowledge, skills, and/or attitude. The primary instructor or an
assistant instructor should work with the individual or group as soon as
possible to ensure that they achieve success in the program.

First Responder National Standard Curriculum

Remediation Sheet

  ----------------------------------- -----------------------------------
  Date:                               Student:

  Area of Difficulty:                 

                                      

                                      

                                      

  Action Plan:                        

  Completed:                          
  ----------------------------------- -----------------------------------

  ----------------------------------- -----------------------------------
  Date:                               Student:

  Area of Difficulty:                 

                                      

                                      

                                      

  Action Plan:                        

  Completed:                          
  ----------------------------------- -----------------------------------

  ----------------------------------- -----------------------------------
  Date:                               Student:

  Area of Difficulty:                 

                                      

                                      

                                      

  Action Plan:                        

  Completed:                          
  ----------------------------------- -----------------------------------

  ----------------------------------- -----------------------------------
  Date:                               Student:

  Area of Difficulty:                 

                                      

                                      

                                      

  Action Plan:                        

  Completed:                          
  ----------------------------------- -----------------------------------

**APPENDIX F**

**PATIENT ASSESSMENT FLOW CHARTS**

**APPENDIX F**

The flow chart has been developed to assist in the assessment of all
patients, regardless of age or chief complaint. The five components of
assessment (scene size-up; initial assessment; focused history and
physical exam - medical and trauma; detailed assessment; and on-going
assessment) should be appropriately conducted. The flow chart should be
used in conjunction with the lesson plan for each specific area and
should be copied and given to each student before the lesson.

**APPENDIX G**

**NATIONAL EMS EDUCATION AND**

**PRACTICE BLUEPRINT**

**APPENDIX H**

**FINAL PRACTICAL SKILLS EXAM**

**ORIENTATION TO THE PRACTICAL SKILLS EXAMINER**

You should read and understand the following orientation information
before entering the specific skill station you will be evaluating. If
there is any information within this orientation that you do not
understand, you should contact the examination coordinator for
clarification.

On behalf of the training institute I would like to thank you for
donating your valuable time to assist with the evaluation of candidates
in the practical examination. Your role as a skill station examiner is
critically important. You are to serve as an observer and recorder of
the candidate\'s actions based on the criteria listed on the score
sheet. There are a number of ways to successfully perform a skill. You
should always remember that the way you were taught to perform a skill
is not the only correct way to perform the skill. The ultimate criterion
for successful completion of a skill is: \"Was effective patient therapy
rendered?\"

This is a formal examination and not a teaching situation. We discourage
excessive dialogue between the examiner and the candidate. Peripheral or
\"nice to know\" areas of prehospital EMS should not be discussed.
Situations or questions that require you to demonstrate a procedure
should be avoided. You should not ask leading questions. Do not condemn
or condone a candidate\'s actions by expression, gesture, tone of voice,
or attitude. Often, candidates interpret a word or action delivered in
jest as being indicative of pass or fail, a value judgment, or a
non-caring attitude. Pay special attention to verbal and non-verbal
language.

The reason you were asked to be an examiner for this station is that
your expertise adds to the credibility of the examination and gives you
the knowledge to ask the candidates related questions to substantiate or
define an action. If qualifying questions are necessary, they should be
asked at the end of the station. At no time should you discuss any phase
of the candidate\'s performance with the candidate.

Candidates are allowed to perform each skill once. If they appear overly
nervous when first starting the exam, you may stop them and allow them
to collect themselves before starting again. However, once a candidate
initiates a course of action the candidate must be evaluated on the
merits of that singular performance, as would happen in the field. You
must provide qualifying information in the comments section of the score
sheet for any performance that is identified as a mandatory failure
item.

Visitors are not allowed in the station while testing is being
conducted. The examination coordinator and the medical director may be
in the station if they are not obstructive to the testing.

You should meet the candidate at the door and introduce yourself. Print
the candidate\'s name, your name, and the date at the top of the score
sheet. Next, you should read aloud the \"Instructions to the Candidate\"
and ask if there are any questions. If there are no questions, start the
time clock and observe the candidate as he/she progresses through the
procedure.

The score sheets were designed to be generic so that the brand name of
the particular equipment used in the skill station would have no effect
on the scoring process. Points should be awarded on a full point
increment basis and fractions of a point are not allowed. Each task is
given a point value of one. If there are two tasks indicated in one
step, one point should be awarded for [each]{.underline} individual
task. If a task is not completed or is completed improperly, place a
zero in the \"points awarded\" column.

You must document in the comments section the reason you marked a
mandatory failure item. Additional comments are welcome, but remember to
be specific. Instead of writing \"He did a poor job\", write exactly
what the candidate did right or wrong. At no time should you discuss the
performance with the candidate. You should never condemn or condone the
candidate\'s actions by verbal or nonverbal means.

If the candidate reaches the time limit indicated on the score sheet
before completing the procedure, you must stop the candidate and direct
him/her to return to the staging area and wait for instructions to
report to the next station. All tasks not completed should be scored a
zero in the \"points awarded\" column.

Be very aware of the importance of consistency in giving instructions,
setting up scenarios, and making and recording observations. Every
effort should be made to ensure that all details of the examination
scenario are identical for each candidate. Be aware of your own fatigue
and if necessary take a break after notifying the examination
coordinator.

You should have received individual written instructions concerning the
specific skill and/or skill station you will be evaluating. If you do
not understand any part of these instructions, do not start the
evaluation process. Contact the examination coordinator for
clarification.

Some of the skill stations require the presence of a simulated victim
(i.e., - Trauma Assessment/Management). The simulated victim should be
trained at the level of the First Responder or higher. He should be
thoroughly briefed on the actions expected from him during the
candidate\'s performance. This will help ensure that the scenario and
skill station are identical for each candidate. Once a candidate has
successfully passed a skill station, he/she may be used as a simulated
victim in that skill station.

**INSTRUCTIONS TO THE PRACTICAL SKILLS EXAMINER**

**BLEEDING CONTROL/SHOCK MANAGEMENT**

This station is designed to test the candidate\'s ability to treat a
life threatening hemorrhage and subsequent hypoperfusion. This station
will be scenario based and will require some dialogue between the
candidate and the examiner. The candidate will be required to properly
treat a life threatening hemorrhage.

The victim will present with an arterial bleed from a severe laceration
of the extremity. The examiner will prompt the actions of the candidate
at predetermined intervals as indicated on the skill sheet. The
candidate will be required to provide the appropriate intervention at
each interval when the patient\'s condition changes. It is essential,
due to the purpose of this station, that the patient\'s condition not
deteriorate to a point where CPR would be initiated. This station is not
designed to test CPR.

The equipment and supplies needed at this station include field
dressings and bandages and a blanket.

The scenario in the \"Instructions to the Candidate\" is an example of
an acceptable scenario for this station. It is not intended to be the
only possible scenario for this station. Variations of the scenario are
possible and should be utilized in order to reduce the possibility of a
candidate knowing the scenario before entering the test. If the scenario
is to be changed, the following guidelines must be used:

> \- An isolated laceration to an extremity producing an arterial bleed
> must be present.

\- The scene must be safe.

> \- As the scenario continues the victim must present signs and
> symptoms of hypoperfusion.

It is essential that once a scenario is established for a specific test,
it remain the same for all candidates being tested on that date. This
will ensure a consistent examination for all candidates.

Due to the scenario format of this station, you are required to prompt
the student at various places during the exam. Controversy exists in the
national EMS community concerning the removal of dressings by First
Responders when controlling hemorrhage. This station does not require
the First Responder to remove any dressing once applied. When the
bleeding is initially managed with a pressure dressing and bandage, you
should inform the student that the wound is still bleeding. If the
candidate places a second pressure dressing over the first, you should
again state that the wound continues to bleed. After the candidate uses
an appropriate arterial pressure point to control the hemorrhage, you
should say that the bleeding is controlled. If the candidate attempts to
remove the initial dressing to apply direct finger tip pressure, you
should inform him/her, that for the purposes of this station, this step
is not required. Additionally, you should indicate to the candidate that
the victim is in a hypoperfused state by indicating signs and symptoms
appropriate for this level of shock (example: cool clammy skin,
restlessness, P 118, R 30).

This skill station requires the presence of one examiner and a victim.
The victim may be an appropriate mannequin or a live person. The
mannequin must be a hard shell anatomically accurate mannequin.

**INSTRUCTIONS TO THE CANDIDATE**

**BLEEDING CONTROL/SHOCK MANAGEMENT**

This station is designed to test your ability to control hemorrhage.
This is a scenario based testing station. As you progress through the
scenario, you will be offered various signs and symptoms appropriate for
the patient\'s condition. You will be required to manage the patient
based on these signs and symptoms. A scenario will be read aloud to you;
and you will be given an opportunity to ask clarifying questions about
the scenario; however, you will not receive answers to any questions
about the actual steps of the procedures to be performed. You may use
any of the supplies and equipment available in this room. You have 15
minutes to complete this skill station.

**SCENARIO (sample)**

**BLEEDING CONTROL/SHOCK MANAGEMENT**

You respond to a stabbing and find a 25 year old male victim. Upon
examination you find a 2-inch stab wound to the inside of the right arm
at the anterior elbow crease (antecubital fascia). Bright red blood is
spurting from the wound. The scene is safe and the patient is conscious
and alert. His airway is open and he is breathing adequately. Do you
have any questions?

**BLEEDING CONTROL/SHOCK MANAGEMENT**

**Points Points**

**Possible Awarded**

  ------------------------------------------------------------ ---- -----
  Takes or verbalizes body substance isolation precautions     1    

  Applies direct pressure to the wound                         1    

  Elevates the extremity                                       1    

  ***Note: The examiner must now inform the candidate that the      
  wound continues to bleed.***                                      

  Applies an additional dressing to the wound                  1    

  ***Note: The examiner must now inform the candidate that the      
  wound still continues to bleed. The second dressing does not      
  control the bleeding.***                                          

  Locates and applies pressure to appropriate arterial         1    
  pressure point                                                    

  ***Note: The examiner must now inform the candidate that the      
  bleeding is controlled***                                         

  Applies a dressing to the wound                              1    

  Bandages the wound                                           1    

  ***Note: The examiner must now inform the candidate that the      
  patient is showing signs and symptoms indicative of               
  hypoperfusion.***                                                 

  Properly positions the patient                               1    

  Initiates steps to prevent heat loss from the patient        1    

  Indicates need for immediate transportation                  1    

  **TOTAL:**                                                   10   
  ------------------------------------------------------------ ---- -----

**CRITICAL CRITERIA**

Did not take or verbalize body substance isolation precautions

Applies tourniquet before attempting other methods of bleeding control

Did not control hemorrhage in a timely manner

Did not indicate a need for immediate transportation

**INSTRUCTIONS TO THE PRACTICAL SKILLS EXAMINER**

**PATIENT ASSESSMENT/MANAGEMENT**

**TRAUMA**

This station is designed to test the candidate\'s ability to integrate
patient assessment and intervention skills on a victim with
multi-systems trauma. Since this is a scenario based station, it will
require some dialogue between the examiner and the candidate. The
candidate will be required to physically accomplish all assessment steps
listed on the skill sheet. However, all interventions should be spoken
instead of physically accomplished. Because of the limitations of
moulage, you must establish a dialogue with the candidate throughout
this station. If a candidate quickly inspects, assesses, or palpates the
patient in a way that makes you uncertain of the areas or functions
being assessed, you must immediately ask the candidate to explain the
actions. For example, if the candidate stares at the patient\'s face,
you must ask what he/she is assessing to precisely determine if he/she
was checking the eyes, facial injuries, or skin color. Any information
pertaining to sight, sound, touch, smell, or an injury that cannot be
realistically moulaged but would be immediately evident in a real
patient encounter, must be supplied by the examiner as soon as the
candidate exposes or assesses that area of the patient.

The victim will present with a minimum of an airway, breathing, or
circulatory problem and one associated injury or wound. The mechanism
and location of the injury may vary, as long as the guidelines listed
above are followed. It is essential that once a scenario is established
for a specific test site, it remain the same for all candidates being
tested at that site. This will ensure a consistent examination for all
candidates.

This skill station requires the presence of one victim and one
candidate. The victim should be briefed on his/her role in this station
as well as on how to respond while being assessed by the candidate.
Additionally, the victim should have read thoroughly the \"Instructions
to the Simulated Trauma Victim.\" Trauma moulage should be used as
appropriate. Moulage may range from commercially prepared moulage kits
to theatrical moulage. Excessive/dramatic use of moulage must not
interfere with the candidate\'s ability to expose the victim for
assessment.

Once the scene size-up and initial assessment are completed, the exact
location of vital signs within a prehospital assessment is dependent
upon the patient\'s condition. As an examiner, you should award one
point for vital signs as long as they are accomplished according to the
patient\'s condition.

The scenario format of a multi-trauma assessment/management testing
station requires that the examiner provide the candidate with essential
information throughout the examination process. Since this station uses
a simulated patient, the examiner must supply all information pertaining
sight, sound, smell, or touch. This information should be given to the
candidate **when the area of the patient is exposed or assessed**.

The examiner must present assessment findings that are appropriate for
the patient and the treatment that has been rendered. In other words, if
a candidate has correctly treated for hypoperfusion, do not offer
assessment findings that deteriorate the patient\'s condition. This may
cause the candidate to assume he/she has rendered inadequate or
inappropriate care. The examiner should not offer information that
overly improves or deteriorates a patient. Overly improving a patient
invites the candidate to discontinue treatment and may lead to the
candidate failing the examination. Overly deteriorating the patient may
lead to the candidate initiating C.P.R. This station was not designed to
test C.P.R.

Due to the scenario format and voiced treatments, a candidate may forget
what he/she has already done to the patient. This may result in the
candidate attempting to do assessment/intervention steps on the patient
that are physically impossible. As an examiner should remind the
candidate that previous treatment prevents assessing the area. This same
situation may occur with bandages.

Each candidate is required to complete a full patient assessment. The
candidate must complete all components of the physical examination with
the exception of those areas which are covered by dressings and
bandages.

NOTE: You may choose to write the exact steps the candidate follows
during this station as the sequence is performed. You may then use this
documentation to fill out the score sheet after the candidate completes
the station. This documentation may then be used to validate the score
on the skill sheet if questions arise later.

**INSTRUCTIONS TO THE SIMULATED TRAUMA VICTIM**

The following should be reviewed by the skill station examiner with the
person serving as victim.

When serving as a victim for the scenario today, make every attempt to
be consistent with every candidate in presenting the symptoms. The level
of respiratory distress acted out by you and the degree of pain you
describe at injury sites must be consistent for all candidates. As the
candidate progresses with the examination, be aware of any period in
which the candidate touched a simulated injured area. If the scenario
indicates that you are to respond with deep painful stimuli and the
candidate only lightly touches the area, do not respond. Only respond in
the situation as you feel a real victim would in a multiple trauma
situation. Do not give the candidate any clues while you are acting as a
victim. For example, it is inappropriate to moan that your wrist hurts
after you become aware that the candidate has not found that injury.
Please remember what areas have been assessed and treated because we may
need to discuss the candidate\'s performance after the candidate leaves
the room.

The skill station examiner may utilize information provided by the First
Responder trained and well coached victim as data in determining the
awarding of points for specific steps in the evaluation instrument.

**INSTRUCTIONS TO THE CANDIDATE**

**PATIENT ASSESSMENT/MANAGEMENT**

**TRAUMA**

This station is designed to test your ability to perform a patient
assessment of a victim of multi-system trauma and \"voice\" treat all
conditions and injuries discovered. You must conduct your assessment as
you would in the field including communicating with your patient. As you
approach the patient you should assume the scene is clear of safety
hazards. You may remove the patient\'s clothing down to shorts or
swimsuit if you feel it is necessary. As you conduct your assessment,
you should state everything you are assessing. Clinical information not
obtainable by visual or physical inspection, will be given to you after
you demonstrate how you would normally gain that information. You may
assume that you have two First Responders working with you and that they
are correctly carrying out the verbal treatments you indicate. You have
(10) ten minutes to complete this skill station. Do you have any
questions?

**TRAUMA SITUATION #1 - [PATIENT ASSESSMENT/MANAGEMENT]{.underline}**

**Mechanism of Injury**. You are called to the scene of a motor vehicle
accident where you find a victim who was ejected from the car. You find
severe damage to the front end of the car. The victim is found lying
face down in a field 30 feet from the upright car.

**Injuries** All injuries will be moulaged. Each examiner should program
the patient to respond appropriately throughout the assessment and
should assure that the victim has read the \"Instructions to the
Simulated Trauma Victims\". The patient will present with the following
injuries.

> 1\. Unresponsive
>
> 2\. Left side flail chest
>
> 3\. Decreased breath sounds, left side
>
> 4\. Cool, clammy skin; no distal pulses
>
> 5\. Distended abdomen
>
> 6\. Pelvis stable
>
> 7\. Open injury of the left femur with capillary bleeding

**PATIENT ASSESSMENT/MANAGEMENT**

**TRAUMA**

**Points Points Possible Awarded**

+-------------------------------+-----------------------------+---+---+
| Takes or verbalizes body      |                             | 1 |   |
| substance isolation           |                             |   |   |
| precautions                   |                             |   |   |
+-------------------------------+-----------------------------+---+---+
| **SCENE SIZE-UP**             |                             |   |   |
+-------------------------------+-----------------------------+---+---+
| Determines the scene is safe  |                             | 1 |   |
+-------------------------------+-----------------------------+---+---+
| Determines the mechanism of   |                             | 1 |   |
| injury                        |                             |   |   |
+-------------------------------+-----------------------------+---+---+
| Determines the number of      |                             | 1 |   |
| patients                      |                             |   |   |
+-------------------------------+-----------------------------+---+---+
| Requests additional help if   |                             | 1 |   |
| necessary                     |                             |   |   |
+-------------------------------+-----------------------------+---+---+
| Considers stabilization of    |                             | 1 |   |
| spine                         |                             |   |   |
+-------------------------------+-----------------------------+---+---+
| **INITIAL ASSESSMENT**        |                             |   |   |
+-------------------------------+-----------------------------+---+---+
| Verbalizes general impression |                             | 1 |   |
| of patient                    |                             |   |   |
+-------------------------------+-----------------------------+---+---+
| Determines chief              |                             | 1 |   |
| complaint/apparent life       |                             |   |   |
| threats                       |                             |   |   |
+-------------------------------+-----------------------------+---+---+
| Determines responsiveness     |                             | 1 |   |
+-------------------------------+-----------------------------+---+---+
| Assesses airway and breathing | Assessment                  | 1 |   |
|                               |                             |   |   |
|                               | Assures adequate            | 1 |   |
|                               | ventilation                 |   |   |
|                               |                             | 1 |   |
|                               | Injury management           |   |   |
+-------------------------------+-----------------------------+---+---+
| Assesses circulation          | Assesses for and controls   | 1 |   |
|                               | major bleeding              |   |   |
|                               |                             | 1 |   |
|                               | Assesses pulse              |   |   |
|                               |                             | 1 |   |
|                               | Assesses skin (color,       |   |   |
|                               | temperature and condition)  |   |   |
+-------------------------------+-----------------------------+---+---+
| Identifies priority           |                             |   | 1 |
| patients/makes transport      |                             |   |   |
| decision                      |                             |   |   |
+-------------------------------+-----------------------------+---+---+
| Obtains S.A.M.P.L.E. history  |                             |   | 1 |
+-------------------------------+-----------------------------+---+---+
| **PHYSICAL EXAMINATION**      |                             |   |   |
+-------------------------------+-----------------------------+---+---+
| Assesses the head             | Inspects and palpates the   | 1 |   |
|                               | head                        |   |   |
+-------------------------------+-----------------------------+---+---+
| Assesses the neck             | Inspects and palpates the   | 1 |   |
|                               | neck                        |   |   |
+-------------------------------+-----------------------------+---+---+
| Assesses the chest            | Inspects                    | 1 |   |
|                               |                             |   |   |
|                               | Palpates                    | 1 |   |
+-------------------------------+-----------------------------+---+---+
| Assesses the abdomen/pelvis   | Assesses the abdomen        | 1 |   |
|                               |                             |   |   |
|                               | Assesses the pelvis         | 1 |   |
+-------------------------------+-----------------------------+---+---+
| Assesses the extremities      | 1 point for each extremity  | 4 |   |
+-------------------------------+-----------------------------+---+---+
| Manages secondary injuries    |                             |   | 1 |
| and wounds appropriately      |                             |   |   |
|                               |                             |   |   |
| **1 point for appropriate     |                             |   |   |
| management of the secondary   |                             |   |   |
| injury/wound**                |                             |   |   |
+-------------------------------+-----------------------------+---+---+
| Verbalizes on-going           |                             |   | 1 |
| assessment                    |                             |   |   |
+-------------------------------+-----------------------------+---+---+
| **TOTAL:**                    |                             |   | 2 |
|                               |                             |   | 9 |
+-------------------------------+-----------------------------+---+---+

**CRITICAL CRITERIA**

Did not take or verbalize body substance isolation precautions

Did not assess for spinal protection

Did not provide for spinal protection when indicated

Did not evaluate and find conditions of airway, breathing, circulation
(hypoperfusion)

Did not manage/provide airway, breathing, hemorrhage control or
treatment for shock (hypoperfusion)

**INSTRUCTIONS TO THE PRACTICAL SKILLS EXAMINER**

**UPPER AIRWAY ADJUNCTS AND SUCTION**

This station is comprised of three separate skills. The candidate will
be required to measure, insert, and remove an oropharyngeal and a
nasopharyngeal airway and to suction the patient\'s upper airway.

The oropharyngeal airway, nasopharyngeal airway, and suction are in one
skill station for scoring purposes only. It should not be inferred, nor
are we implying, that there is a sequential connection between the three
skills. You should not test these as sequential skills but as three
distinct, isolated skills.

The technique for opening a patient\'s mouth and inserting an
oropharyngeal airway varies from text to text, i.e., - 90 degree
rotation, 180 degree rotation, direct insertion. Since concern for
spinal immobilization is not required at this station, the criteria for
appropriately opening the patient\'s mouth and inserting the
oropharyngeal airway should be that the tongue is not pushed
posteriorly.

The equipment needed at this station includes various sizes of
oropharyngeal nasopharyngeal airways and a suction device (manual or
battery operated device). Additionally, this station requires the
presence of a mannequin that can accept the insertion of an
oropharyngeal and nasopharyngeal airway. The mannequin may be an
intubation head; however, it should be life size and have anatomically
correct airway structures.

Once the candidate has the oropharyngeal airway in place, advise the
candidate that the patient is vomiting. If the candidate fails to
immediately remove the oropharyngeal airway, place a zero in the
\"points awarded\" column. Once the candidate has finished the procedure
for oropharyngeal airway insertion and removal, direct him/her to
demonstrate the proper procedure for suctioning a patient\'s upper
airway. Finally the candidate instruct the candidate to insert a
nasopharyngeal airway into the mannequin.

**INSTRUCTIONS TO THE CANDIDATE**

**UPPER AIRWAY ADJUNCTS AND SUCTION**

This station is designed to test your ability to properly measure,
insert, and remove an oropharyngeal and a nasopharyngeal airway as well
as to suction a patient\'s upper airway. This is an isolated skills test
comprised of three separate skills. You may use any equipment available
in this room. Do you have any question?

**UPPER AIRWAY ADJUNCTS AND SUCTION**

**OROPHARYNGEAL AIRWAY**

**Points Points**

**Possible Awarded**

  ------------------------------------------------------- ------- -------
  Takes or verbalizes body substance isolation            1       
  precautions                                                     

  Selects appropriate size airway                         1       

  Measures airway                                         1       

  Inserts airway without pushing the tongue posteriorly   1       

  ***NOTE: The examiner must advise the candidate that            
  the patient is gagging and becoming conscious***                

  Removes oropharyngeal airway                            1       

  **SUCTION**                                                     

  ***NOTE: The examiner must advise the candidate to              
  suction the patient\'s oropharynx/nasopharynx***                

  Turns on/prepares suction device                        1       

  Assures presence of mechanical suction                  1       

  Inserts suction tip without suction                     1       

  Applies suction to the oropharynx/nasopharynx           1       

  **NASOPHARYNGEAL AIRWAY**                                       

  ***NOTE: The examiner must advise the candidate to              
  insert a nasopharyngeal airway***                               

  Selects appropriate size airway                         1       

  Measures airway                                         1       

  Verbalizes lubrication of the nasal airway              1       

  Fully inserts the airway with the bevel facing toward   1       
  the septum                                                      

  **TOTAL:**                                              13      
  ------------------------------------------------------- ------- -------

**CRITICAL CRITERIA**

Did not take or verbalize body substance isolation precautions

Did not obtain a patent airway with the oropharyngeal airway

Did not obtain a patent airway with the nasopharyngeal airway

**INSTRUCTIONS TO THE PRACTICAL SKILLS EXAMINER**

**MOUTH-TO-MASK**

This station is designed to test the candidate\'s ability to effectively
ventilate a patient using a mouth-to-mask technique. This station is
testing an isolated skill. The candidate will be advised that the
patient is already being ventilated, mouth-to-mouth, by another first
responder. Upon entering the skill station, the candidate will be
required ventilate the patient using a mouth-to-mask technique. The
candidate may assume that the patient has a central pulse and that the
only patient management required is ventilation.

When ventilating the patient, the candidate must provide a minimum of
800 ml volume per breath. This equals the current standards established
for appropriate rescue breathing volumes during basic and advanced life
support.

This station requires a mannequin capable of being ventilated with
volumes of 800 ml or more. It must also be able to register successful
lung inflations of 800 ml to 1200 ml per breath. This may be
accomplished by using a system that lights up when successful volumes
are reached or a system that graphs successful volumes. The mannequin
must be life size, possess anatomically correct airway structures, and
meet the criteria listed above.

Due to the nature of this station, infection control measures must be
enforced. You should follow the current infection control measures
established by the American Heart Association for mannequin
disinfection.

You should observe the candidate ventilating the mannequin for a period
of 30 seconds. During this time you should pay close attention to
volumes. The volumes should be in the range of 800 ml - 1200 ml per
breath. If you observe one ventilation error or less in 30 seconds
(volume only), you should award 1 point. No point should be awarded if
you observe two ventilation errors or more in 30 seconds.

**INSTRUCTIONS TO THE CANDIDATE**

**MOUTH-TO-MASK**

This station is designed to test your ability to ventilate a patient
using a mouth-to-mask technique. This is an isolated skills test. You
may assume that mouth-to-mouth ventilation is in progress and that the
patient has a central pulse. The only patient management required is
ventilator support using a mouth-to-mask technique. You must ventilate
the patient for at least 30 seconds. You will be evaluated on the
appropriateness of ventilatory volumes. You may use any equipment
available in this room. Do you have any questions?

**MOUTH-TO-MASK**

**Points Points**

**Possible Awarded**

+-------------------------------------------------------+------+-------+
| Takes or verbalizes body substance isolation          | 1    |       |
| precautions                                           |      |       |
+-------------------------------------------------------+------+-------+
| Connects one-way valve to mask                        | 1    |       |
+-------------------------------------------------------+------+-------+
| Opens airway (manually or with adjunct)               | 1    |       |
+-------------------------------------------------------+------+-------+
| Establishes and maintains a proper mask to face seal  | 1    |       |
+-------------------------------------------------------+------+-------+
| Ventilates the patient at the proper volume and rate  | 1    |       |
|                                                       |      |       |
| *(800-1200 ml per breath/10-20 breaths per minute)*   |      |       |
+-------------------------------------------------------+------+-------+
| ***NOTE: the examiner must witness ventilations for   |      |       |
| at least 30 seconds***                                |      |       |
+-------------------------------------------------------+------+-------+
| **TOTAL:**                                            | 5    |       |
+-------------------------------------------------------+------+-------+

**CRITICAL CRITERIA**

Did not take or verbalize body substance isolation precautions

Did not provide proper volume per breath

> *(more than 2 ventilations per minute are below 800 ml)*

Did not ventilate the patient at 10-20 breaths per minute

Did not allow for complete exhalation