Sunday, November 26, 2023

EMS Operations - Landing Zones

EMS providers play a crucial role in facilitating helicopter operations and setting up landing zones for patient transport.

Here are key points they need to know:

Landing Zone Criteria:

- The landing zone should be a minimum of 100’x100', suitable for both day and night operations.

- Ensure the site is free of obstacles, hazards, and debris.

- Opt for a firm surface and avoid slopes greater than five degrees whenever possible.

- Soft sand or dirt landing sites should be avoided, but can be wet down as a last resort.

Obstruction Assessment:

- Conduct a thorough survey of the landing site to identify overhead power lines, telephone wires, antennas, buildings, or tall trees.

- Attempt to remove or limit any obstructions from the landing location.

- If obstructions cannot be removed, inform the flight crew, and be prepared to find an alternative location if necessary.

Marking the Landing Zone:

- Mark the landing zone using weighted cones or position emergency vehicles at the corners, with headlights facing inward to form an X.

- Clearly visible markings help pilots identify the designated landing area, especially during low-light conditions.

Weather Considerations:

- Inform the flight crew of wind direction and speed, particularly if strong winds exist.

- Weather conditions can impact helicopter operations, and pilots need this information to make informed decisions.

Safety Buffer:

- Ensure all nonessential personnel, bystanders, and vehicles are at least 200 feet away from the landing zone.

- This safety buffer protects individuals from potential hazards associated with helicopter operations.

Personal Protective Equipment (PPE):

Responders operating near the landing zone should wear appropriate PPE, including helmets with chin straps, ear protection, and face shields or other eye protection.

- Be prepared for high wind and noise associated with helicopter take-offs and landings.


- Maintain effective communication with the flight crew before, during, and after the landing.

- Be prepared to provide updated information about the landing zone, weather conditions, and any changes in the situation.

- By adhering to these guidelines, EMS providers can contribute to the safe and efficient operation of helicopter transports, ensuring the well-being of both the patient and the emergency response team.

Friday, November 24, 2023

EMS Trauma Tuesdays - Amputations

EMS providers should have a basic understanding of amputations and how to treat them.

Here are some key points to consider:

1. Scene Safety: Ensure the scene is safe for both the patient and responders before approaching an amputation.

2. Control Bleeding: Apply direct pressure to the wound using a sterile dressing or clean cloth. If bleeding is severe, use a tourniquet proximal to the injury site.

3. Preserve the Amputated Part: If the amputated part is available, handle it with care. Wrap it in a sterile, moist gauze or plastic bag, place it in a sealed container, and keep it cool without freezing.

4. Airway and Breathing: Assess the patient's airway, breathing, and circulation. Provide appropriate support as needed.

5. Stabilize the Patient: Immobilize the patient and the injured limb to prevent further injury during transportation. Use splints or bandages to secure the amputated part separately, if available.

6. Pain Management: Administer appropriate pain relief measures, such as analgesics, according to your protocols and the patient's condition.

7. Transport: Arrange for immediate transportation to a facility equipped to manage amputations and traumatic injuries.

Remember, these are general guidelines, and the specific protocols and procedures may vary based on your local EMS system and medical direction.

It is crucial to consult your organization's guidelines and receive proper training on amputation management.

Wednesday, November 22, 2023

EMS Mnemonics - SAMPLE

The SAMPLE mnemonic is a useful tool for EMS Providers to gather important information during the initial assessment of a patient.

It helps ensure a systematic and thorough evaluation of the patient's condition.

Here's what EMS Providers need to know about the SAMPLE mnemonic:

Signs and Symptoms: This refers to the physical signs and symptoms the patient is experiencing. EMS providers should assess the patient's complaints, such as pain, shortness of breath, or dizziness. It's essential to listen carefully to the patient's description of their symptoms and note any obvious signs of distress.

Allergies: Determine if the patient has any known allergies, especially to medications or substances. Allergies are crucial to know because administering a medication or treatment that a patient is allergic to can have serious consequences.

Medications: Find out what medications the patient is currently taking. This includes prescription medications, over-the-counter drugs, and any herbal or dietary supplements. Knowing the patient's medications can help avoid potential drug interactions and guide treatment decisions.

Past Medical History: Ask about the patient's past medical history, including chronic conditions, surgeries, and significant illnesses. Understanding the patient's medical history can provide insights into their current condition and help in decision-making.

Last Oral Intake: Determine when the patient last ate or drank anything. This information is crucial if the patient requires surgery or sedation because it helps prevent complications related to anesthesia. It's also relevant for patients with certain medical conditions.

Events Leading Up to the Present Illness or Injury: Ask the patient or any available witnesses about the events leading up to the current illness or injury. This can help in understanding the mechanism of injury and identifying any potential contributing factors.

By following the SAMPLE mnemonic, EMS providers can collect vital information that assists in the assessment and management of the patient.

This information is essential for making informed decisions regarding treatment, transport, and communication with medical facilities. Additionally, it contributes to better patient care and safety.

#PatientAssessment #SignsAndSymptoms #Allergies #Medications #PastMedicalHistory #PertinentMedicalHistory #LastOralIntake #EventsLeadingUpTo

Monday, November 20, 2023

EMS Anatomy & Physiology - Curvature of the Spine


EMS Providers should have a basic understanding of skeletal issues like kyphosis, lordosis, and scoliosis, as well as related problems, to provide appropriate care for patients.

Here are a few key points:

Identification: EMS providers should be able to identify these skeletal issues through visual observation and patient history.

1. Kyphosis: Kyphosis refers to an excessive forward curvature of the upper spine, leading to a rounded or hunched posture. It can be caused by several factors, including poor posture, osteoporosis, spinal fractures, or certain medical conditions. EMS providers should be aware of the potential for compromised breathing and mobility in patients with severe kyphosis.

2. Lordosis: Lordosis is an excessive inward curvature of the lower spine, commonly known as swayback. It can be caused by various factors such as obesity, pregnancy, muscle imbalances, or certain medical conditions. EMS providers should be cautious of potential back pain and difficulty maintaining a supine position in patients with pronounced lordosis.

3. Scoliosis: Scoliosis is a medical condition characterized by an abnormal sideways curvature of the spine. This condition can manifest in various degrees of severity and is often idiopathic, meaning the cause is unknown. However, it can also result from congenital factors, neuromuscular conditions, or trauma.

Symptoms: Be aware of common symptoms associated with these conditions, such as pain, limited range of motion, and respiratory difficulties, which can occur due to the abnormal spinal curvature.

Assessment: Conduct a thorough physical assessment to evaluate the severity of the condition, including the degree of curvature, associated deformities, and neurological symptoms.

Stabilization: When immobilizing the patient, EMS providers should consider the unique spinal curvature and use appropriate spinal immobilization techniques to ensure patient comfort and safety. This may involve padding and positioning devices to accommodate the curvature.

Transport: Ensure safe and appropriate transport of patients with these conditions. They may require specialized equipment, such as scoop stretchers or vacuum mattresses, to maintain proper spinal alignment.

Communication: Effective communication with the patient is crucial. Ensure the patient is comfortable and aware of the care being provided. Also, obtain a medical history to determine if there are underlying causes or exacerbating factors related to the skeletal issue.

Related Problems: Understand that these skeletal issues can lead to other medical problems. For example, kyphosis and lordosis can cause respiratory issues by reducing lung capacity, so monitor the patient's respiratory status carefully. They might also be at a higher risk of spinal fractures or other spinal cord injuries. Additionally, scoliosis can sometimes be associated with cardiac and pulmonary complications, which should be considered during patient assessment.

Medication and Pain Management: Be aware of any medications the patient is taking, as well as their potential side effects and interactions. Patients with these conditions may require pain management during transport, so be prepared to administer appropriate pain relief under medical direction.

Special Considerations: Individuals with skeletal issues may require special handling, including assistance with transfers, lifting, or moving the patient. Consider the patient's comfort and any potential complications that may arise from moving them.

Collaboration: Work closely with other healthcare providers, including receiving facilities and specialists, to ensure a seamless transition of care and to address any specific needs related to the patient's condition.

Remember that each patient's needs may vary, so adapt your care accordingly. Additionally, staying updated on current guidelines and protocols for spinal immobilization and care of patients with skeletal issues is essential to providing appropriate care in the field.

It is always important to work collaboratively with other healthcare professionals to ensure optimal care for patients with these conditions.

#Kyphosis #Lordosis #Scoliosis #PreHospitalCare #CurvatureOfTheSpine #AnatomyAndPhysiology

Saturday, November 18, 2023

EMS Eponymous Condition - Cushing's Triad

Cushing's Triad is named after Dr. Harvey Cushing, an American neurosurgeon who made significant contributions to the field of neurosurgery.

Dr. Cushing described a set of clinical signs and symptoms associated with increased intracranial pressure in his work "Intracranial Tumours: Notes upon a Series of Two Thousand Verified Cases with Surgical Mortality Percentages Pertaining Thereto."

This work was published in 1901, and it was one of the earliest descriptions of the physiological changes associated with intracranial pressure.

Recognizing Cushing's Triad is crucial for EMS Providers, as it is suggestive of a potentially life-threatening situation due to various adverse conditions, including head injuries and brain pathologies. As such, the need for urgent medical intervention is paramount.

Cushing's Triad consists of the following three key signs:

Hypertension (High Blood Pressure):

A significant increase in systolic blood pressure is a common feature of Cushing's Triad. This is a response to the body's attempt to maintain cerebral perfusion (blood flow to the brain) in the face of elevated intracranial pressure.

Bradycardia (Slow Heart Rate):

Cushing's Triad often includes a slow heart rate (bradycardia), particularly as a result of increased ICP. This is a compensatory mechanism intended to decrease the heart's pumping strength, reducing blood flow to the brain and thereby minimizing the risk of further brain damage.

Irregular or Abnormal Respiratory Patterns:

The third component of Cushing's Triad is abnormal breathing patterns, typically characterized by irregular or irregularly deep respirations. This is often referred to as "agonal" or "Cheyne-Stokes" breathing.

These respiratory changes are a response to the brain's attempt to restore oxygen levels and eliminate excess carbon dioxide, which can occur due to impaired blood flow or brainstem compression.

Recognizing Cushing's Triad in a patient is a critical finding for EMS providers, as it may indicate an impending brain herniation, which is a life-threatening condition.

Patients displaying Cushing's Triad should be managed promptly and transported to a specialized facility for further evaluation and potential surgical intervention.

Here are some key points for EMS Providers:

Perform a detailed neurological assessment, including monitoring vital signs, level of consciousness, and pupillary response.

Administer supplemental oxygen to ensure adequate oxygenation.

Maintain cervical spine immobilization to prevent further spinal cord injury, if applicable.

Communicate with the receiving medical facility to ensure they are prepared for the patient's arrival and can provide neurosurgical expertise if necessary.

Avoid hyperventilation, as it may worsen cerebral ischemia.

Cushing's Triad is a critical clinical finding that requires immediate attention and transport to a higher level of care.

EMS providers should follow their local protocols and seek medical direction when managing patients with Cushing's Triad.

#EponymousCondition #CushingsTriad #Hypertension #Bradycardia #IrregularRespirations

Thursday, November 16, 2023

EMS Anatomy & Physiology - The Brain

EMS Providers should have a basic understanding of the functions of the cerebrum, cerebellum, and brainstem, as these are the three primary regions of the brain, each with distinct roles.

Here's what EMS providers need to know about the functions of these brain regions:

1. Cerebrum: the largest and most prominent part of the brain, occupying the uppermost portion of the cranial cavity.


- Higher Cognitive Functions: The cerebrum is responsible for complex cognitive processes, including thinking, reasoning, problem-solving, and decision-making.

- Sensory Perception: It processes sensory information received from the body's sensory organs, allowing us to perceive the external environment. This includes functions like vision, hearing, taste, and touch.

- Voluntary Motor Control: The cerebrum controls conscious and voluntary movements of the body, allowing us to perform tasks such as walking, talking, and reaching for objects.

- Memory and Emotions: It plays a crucial role in forming and storing memories and regulating emotional responses.

- Language Processing: Language comprehension and production, as well as communication, are governed by various regions of the cerebrum.

- Assessment Considerations: EMS providers should assess the patient's level of consciousness, cognitive function, and signs of abnormal behavior, which could be indicative of cerebrum dysfunction.

2. Cerebellum: located at the base of the brain, posterior to the brainstem.


- Coordination and Balance: The cerebellum is primarily responsible for coordinating voluntary muscle movements and maintaining balance and posture.

- Fine Motor Control: It fine-tunes and refines motor movements, enabling precise activities such as handwriting, playing musical instruments, and detailed tasks.

- Proprioception: The cerebellum receives sensory information about the body's position and movements and adjusts muscle contractions accordingly.

- Assessment Considerations: EMS providers should assess for signs of ataxia (a lack of coordination), balance problems, and abnormal movements, as these may suggest cerebellar dysfunction.

3. Brainstem: the lower part of the brain that connects to the spinal cord.


- Vital Functions: The brainstem is responsible for essential life functions, including controlling breathing, heart rate, blood pressure, and maintaining arousal and consciousness.

- Reflexes: It controls reflex actions, such as coughing, sneezing, and swallowing.

- Regulation of Sleep and Wake Cycles: The brainstem is involved in regulating the sleep-wake cycle.

- Assessment Considerations: EMS providers should monitor vital signs, assess for signs of altered consciousness, and be alert to any abnormalities in breathing, heart rate, and blood pressure, as dysfunction in the brainstem can have life-threatening consequences.

Understanding the functions of these brain regions is important for EMS providers to assess and manage patients with neurological symptoms and to recognize potential issues that may require prompt medical attention.

Sunday, November 12, 2023

EMS Peculiar Patient Presentations - Angioedema

Angioedema is a condition characterized by localized swelling, typically involving the face, lips, tongue, throat, or extremities. It occurs due to the rapid swelling of the deeper layers of the skin and underlying tissues. In some cases, it can be accompanied by hives or itching.

In the prehospital setting, EMS Providers should be aware of the following key points regarding angioedema:

1. Airway Management: Angioedema can cause swelling of the airway, potentially leading to respiratory distress or obstruction. EMS providers should closely monitor the patient's airway and be prepared to intervene with advanced airway management techniques if necessary.

2. Assessment: A thorough assessment should be conducted to determine the severity of angioedema and any associated symptoms. This includes evaluating the patient's breathing, vital signs, and level of distress.

3. Allergies and Medical History: It is important to gather information about the patient's medical history, including any known allergies or previous episodes of angioedema. This information can help in identifying potential triggers and guiding treatment decisions.

4. Treatment: The primary goal of treatment is to maintain a patent airway and alleviate symptoms. Depending on the severity and underlying cause, interventions may include administering oxygen, providing nebulized bronchodilators, administering epinephrine, or initiating intravenous access for medications such as antihistamines or corticosteroids.

5. Transport: Patients with angioedema should be transported to a medical facility for further evaluation and management. Ongoing monitoring of the patient's airway and vital signs during transport is crucial.

Remember, angioedema can have various causes, including allergic reactions, medications, hereditary factors, or other underlying medical conditions. Prompt recognition and appropriate management by EMS providers can help ensure the best possible outcome for the patient.

#Angioedema #AirwayManagement #Assessment #Allergies #MedicalHistory, #Treatment #PreHospitalCare #Transport #EMS

Friday, November 10, 2023

EMS Trauma Emergencies - Thoracic Injuries

The "Deadly Dozen" is a term used in emergency medicine and prehospital care to refer to a list of twelve potentially life-threatening chest injuries. 

EMS Providers need to be familiar with these injuries because prompt recognition and appropriate management are crucial for the survival and well-being of the patient. 

Here are the Deadly Dozen Chest Injuries and why they are important for EMS providers to know about:

1. Lung Contusion: A lung contusion is a bruising of lung tissue caused by chest trauma, leading to impaired gas exchange and respiratory distress. Monitoring for signs of respiratory compromise is crucial.

2. Tracheobronchial Injury: Trauma to the trachea or bronchi can lead to airway compromise and respiratory distress. EMS providers should maintain a high index of suspicion for this injury in patients with chest trauma.

3. Diaphragmatic Injury: A diaphragmatic injury can lead to herniation of abdominal contents into the chest, causing respiratory compromise and other complications. EMS providers should be aware of the potential signs and manage accordingly.

4. Esophageal Injury: Trauma to the chest can cause damage to the esophagus, leading to leakage of gastric contents into the chest cavity. EMS providers should be vigilant for signs of mediastinitis and infection.

5. Open Pneumothorax (Sucking Chest Wound): An open wound in the chest allows air to enter the pleural space, leading to a pneumothorax. It can impair ventilation and lead to respiratory distress. EMS providers must apply airtight seals to manage it.

6. Tension Pneumothorax: This occurs when air accumulates in the pleural space and compresses the lung, causing pressure on the heart and other vital structures. It can lead to cardiovascular collapse and requires immediate intervention, such as needle decompression.

7. Massive Hemothorax: This injury involves the accumulation of blood in the pleural space, which can impair lung function and cause hypovolemic shock. It may result from chest trauma, and EMS providers need to identify and manage it.

8. Flail Chest: A flail chest occurs when a segment of the ribcage becomes detached due to multiple rib fractures. It can impair ventilation and lead to respiratory failure. Stabilization and pain management are essential.

9. Cardiac Tamponade: This is a condition where blood or fluid accumulates in the pericardial sac, compressing the heart and impairing its function. It can cause hemodynamic instability and requires immediate intervention.

10. Aortic Disruption: Trauma can cause a tear or rupture in the aorta, which can lead to massive internal bleeding and shock. Early recognition and rapid transport are essential.

11. Myocardial Contusion: Blunt chest trauma can lead to a bruising or injury to the heart muscle, causing arrhythmias, myocardial infarction, or heart failure. EMS providers need to monitor for signs of cardiac injury.

12. Pulmonary Contusion: Similar to lung contusion, pulmonary contusion involves bruising of lung tissue, which can lead to impaired gas exchange and respiratory distress. EMS providers should monitor for signs of respiratory compromise.

EMS providers need to be aware of these chest injuries and their potential consequences because early recognition and appropriate management can be life-saving. 

Proper assessment, stabilization, and rapid transport to a medical facility for definitive care are critical in the prehospital setting for patients with these injuries.

Wednesday, November 08, 2023

EMS Anatomy & Physiology - Mammalian Gag Reflex

The gag reflex is a protective mechanism that helps prevent choking. It involves the contraction of the muscles at the back of the throat in response to stimulation, such as when objects touch the back of the tongue or throat.

In the prehospital setting, EMS Providers need to be aware of the gag reflex for several reasons:

1. Airway Management: The gag reflex can impact airway management. If a patient has an intact gag reflex, inserting certain airway devices or suctioning the airway may trigger a strong gag reflex response, potentially causing complications.

2. Assessment: The presence or absence of the gag reflex can provide valuable information about the patient's neurological status. Its absence may indicate a potential neurological problem or a compromised airway.

3. Interventions: EMS providers should take precautions to minimize stimulation of the gag reflex during procedures, such as intubation or suctioning, to prevent complications and ensure patient comfort.

4. Patient Safety: Being aware of the gag reflex helps EMS providers identify patients who may be at a higher risk of aspiration or choking, ensuring appropriate precautions are taken to protect their airway during transport.

Overall, understanding the gag reflex and its implications is crucial for EMS Providers to effectively manage airways and provide safe care in the prehospital setting.

#AirwayManagement #firstresponders #Assessment #GagReflex #PatientSafety