EMS Operations - Federal Emergency Management Agency (FEMA)

EMS Providers should become familiar with the Federal Emergency Management Agency (FEMA) and the National Incident Management System (NIMS) as they play crucial roles in emergency management. 

1. FEMA: FEMA is an agency within the U.S. Department of Homeland Security that coordinates response and recovery efforts in major disasters and emergencies. 

EMS providers should understand FEMA's role in disaster response, including resource allocation, funding, and support for local agencies.

2. NIMS: NIMS is a comprehensive framework for managing incidents, regardless of their size or complexity. It provides a standardized approach to incident management, including organizational structures, protocols, and terminology. 

EMS providers should be familiar with NIMS principles and terminology to effectively collaborate with other response agencies during incidents.

3. Incident Command System (ICS): ICS is a key component of NIMS and establishes a standardized organizational structure for incident management. 

EMS providers should understand ICS roles and functions, including the Incident Commander (IC), to effectively integrate into the overall incident response structure.

4. Coordination and Communication: EMS providers should know how to communicate and coordinate with FEMA and other response agencies during emergencies. 

This includes understanding how to request resources, share information, and participate in multi-agency coordination systems established under NIMS.

5. Training and Certifications: FEMA offers various training courses and certifications related to emergency management and incident response. 

EMS providers should consider taking relevant courses, such as ICS training, to enhance their knowledge and capabilities in working within the NIMS framework.

Almost all EMS organizations, ski patrols, SAR teams, etc., and certainly fire services, will also ask you to have done these also:

FEMA IS-100: Introduction to the Incident Command System

FEMA IS-200: Basic Incident Command System for Initial Response

FEMA IS-700: An Introduction to the National Incident Management System

FEMA IS-800: An Introduction to the National Response Framework

FEMA IS-05: Introduction to Hazardous Materials

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Congressional Research Service (2019) The Federal Emergency Management Agency (FEMA): An Overview. CRS Report. Accessed October 12, 2024

Haddow, G D., Bullock, J. A., & Coppola, D. P. (2020) Introduction to Emergency Management (6th Ed). Waltham, Massachusetts: Butterworth-Heinemann

Jones, J., & Schenk, T. (2017) NIMS Incident Command System Field Guide. Burlington, Massachusettes: Jones & Bartlett Learning

McEntire, D A. (2015) Disaster Response and Recovery: Strategies & Tactics for Resilience (2nd Ed). Hoboken, New Jersey:  Wiley Blackwell

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

EMS Mental Health & Wellness - World Mental Health Day

Today is World Mental Health Day, a global opportunity to raise awareness about mental health issues and mobilize efforts in support of mental well-being.

We understand the unique challenges faced by medical professionals, especially those working in extreme or high-pressure environments such as EMS.

Make Self-Care a Priority

• Prioritize Self-Care: Regularly engage in physical activity, healthy eating, and adequate sleep. Find an artistic or exercise outlet. SLEEP. Taking care of your body is key to maintaining mental resilience in high-stress environments.

• Set Boundaries and Debrief: Create emotional boundaries between work and personal life, and participate in debriefing sessions with colleagues to process difficult cases and avoid carrying stress home. Remember, it’s not your fault—you’re just trying to help.

• Seek Support and Use Resources: Don’t hesitate to seek professional mental health support when needed. Many organizations offer counseling or peer-support programs specifically for healthcare workers.

Practice Gratitude & Mindfulness

• Embrace Gratitude: Take a moment to focus on what you’re thankful for, even during tough shifts or stressful days. Gratitude can help shift your mindset and reduce stress.

• Manage What’s in Your Control: Focus on the tasks and challenges within your sphere of influence, and accept what you cannot change. This can help reduce feelings of overwhelm.

• Appreciate Your Growth: Medicine is a lifelong journey of learning. Take pride in your progress and personal development, not just in the end results.

• It’s OK Not to Be OK: It’s normal to experience emotional ups and downs. Acknowledge when you’re struggling, and seek support if needed.

• Reach Out: Don’t hesitate to connect with friends, colleagues, or a mentor when you need someone to talk to. Sharing your experiences can make all the difference.

Take Time for Yourself

• Reach Out: Talk to someone—whether it's a colleague, leader, or a friend. A different perspective can lift you up and provide clarity when your thoughts feel cloudy.

• Use Mindfulness Apps: Apps like Headspace are highly effective. They offer many useful strategies to help manage stress.

• Get Out: Sometimes it’s hard, but just "get out." Go for a walk, take a drive, or visit a friend or neighbor. It helps shift those stuck emotions and can move you toward a better mental space. Physically, a blast of fresh air and an endorphin boost can make a big difference.

Parting Thoughts

On this World Mental Health Day, let’s commit to prioritizing our mental health and supporting our colleagues in the medical field.

Remember, it’s okay not to be okay, and seeking help is a sign of strength, not weakness. By taking care of ourselves, we ensure we can provide the best care for others.

Reach out, connect, and remember: you are not alone.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Mountfort. S. & Wilson J. (2022) EMS Provider Health And Wellness. Treasure Island, Florida: StatPearls. Accessed September 30, 2024

National Association of Emergency Medical Technicians (2024) EMS Mental Health. Accessed September 30, 2024

Shearer, T. (2022) A Frontline Battle: The Mental Health Crisis in Emergency Medical Services. Journal of Emergency Medical Services. Accessed September 30, 2024.

Tozer, M. (2024)  EMS Mental Health & Wellness - Responder Support Organizations. Embrace The Elements. Accessed October 10, 2024

EMS Airway Management - Lungs Sounds

EMS Providers should have a solid understanding of normal lung sounds and be able to recognize those that are adventitious lung, as these can provide crucial information about a patient's respiratory status. 

Here’s an overview of the key points regarding lung sounds:

1. Normal Lung Sounds

• Vesicular Breath Sounds: These are the standard breath sounds heard over most of the lung fields. They are soft, low-pitched, and have a longer inspiratory phase than expiratory phase.
  • Characteristics: "Gentle rustling" sound, more prominent in the bases of the lungs.
  • Cause: Normal airflow through the large and small bronchi and alveoli.

2. Adventitious (Abnormal) Lung Sounds

Adventitious Sounds are additional lung sounds superimposed on normal breath sounds. They indicate an underlying pathology. They include:

Stridor

• Description: A high-pitched, harsh sound heard during inspiration.
• Cause: Caused by a partial obstruction of the upper airway (i.e., larynx).
• Common Conditions:
• Croup: Typically in children, caused by a viral infection that leads to inflammation.
• Epiglottitis: Life-threatening condition caused by bacterial infection.
• Airway Obstruction: Foreign body or severe anaphylaxis.
  
• Sound File: Stridor

Wheezing

• Description: High-pitched, musical sounds, typically heard during expiration (but can be heard on inspiration as well).
• Cause: Narrowing or obstruction of the lower airway (i.e., trachea)
• Common Conditions:
  • Asthma: Due to bronchospasm and inflammation.
  • COPD: From chronic airway obstruction.
  • Bronchiolitis: Inflammation of the small airways, common in infants.
• Sound File: Wheezing

Rhonchi

• Description: Low-pitched, snoring or gurgling sounds, often cleared with coughing.
• Cause: Secretions or mucus in the larger airways (i.e., bronchi; bronchioles)
• Common Conditions:
  • Chronic Bronchitis: Increased mucus production and obstruction.
  • Pneumonia: Accumulation of mucus and fluids.
  • Bronchiectasis: Chronic enlargement and inflammation of bronchi.
• Sound File: Rhonchi

Rales (Crackles)

• Description: Fine or coarse, popping or crackling sounds, more prominent during inspiration.
  • Fine Crackles: High-pitched, short, and intermittent.
  • Coarse Crackles: Low-pitched, bubbling or rattling.
• Cause: Fluid in the small airways (i.e., alveoli)
• Common Conditions:
  • Heart Failure (Pulmonary Edema): Fluid accumulation in the alveoli.
  • Pneumonia: Fluid or pus within alveoli due to infection.
  • Fibrosis: Stiffening of lung tissue.
• Sound File: Fine & Course

Pleural Friction Rub

• Description: Low-pitched, grating sound, like creaking leather, heard during both inspiration and expiration.
• Cause: Inflammation of the pleural layers causing them to rub together.
• Common Conditions:
  • Pleuritis: Inflammation of the pleura, often due to infection or autoimmune disorders.
  • Pulmonary Embolism: Can lead to pleuritic inflammation and pain.
• Sound File: Pleural Friction Rub

3. Other Abnormal Lung Findings

Pleural Effusion

• Description: Presence of fluid in the pleural space, usually causing a decrease in normal lung sounds over the affected area.

• Common Conditions:

  • Heart Failure: Increased hydrostatic pressure causes fluid leakage into the pleural space.
  • Infection (e.g., Pneumonia): Inflammatory fluid accumulation.
  • Cancer: Malignant pleural effusions.

• Physical Exam Findings:

  • Decreased breath sounds over the affected area.
  • Dullness to percussion due to fluid presence.

Key Points for EMS Providers

• Stridor is a red flag indicating upper airway obstruction — immediate airway assessment is critical.

• Wheezing typically suggests lower airway narrowing; listen carefully to both inspiratory and expiratory phases.

• Rhonchi may indicate the need for airway clearance (e.g., suctioning).

• Crackles (rales) suggest fluid in the lungs — think about causes like heart failure or infection.

• Pleural Friction Rub can indicate pleuritic pain and requires assessment for underlying conditions like pleuritis or PE.

• Assess for Patient Symptoms: Correlate lung sounds with symptoms (e.g., shortness of breath, cough, sputum production, chest pain) for a more complete clinical picture.

Recognizing and differentiating these sounds can help EMS providers make critical early decisions about management and transport.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bickley, L. S., & Szilagyi, P. G. (2020) Bates' Guide to Physical Examination & History Taking (13th Ed). Philadelphia, Pennsylvania: Wolters Kluwer.

Bohadana, A., Izbicki, G., & Kraman, S. S. (2014) Fundamentals of Lung Auscultation. New England Journal of Medicine, 370(8): 744-751. Accessed October 8, 2024

Brown, C. A. (2022) Walls Manual of Emergency Airway Management (5th Ed). Philadelphia, Pennsylvania: Lippincott, Williams & Wilkins.

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Sarkar, M., Madabhavi, I., Niranjan, N., & Dogra, M. (2015) Auscultation of The Respiratory System. Annals of Thoracic Medicine 10(3):158-168. Accessed October 8, 2024