Standards

xState Standard ¨ Institutionally Developed College: not applicable

EMS 122 - Emergency Medical Technology - Intermediate

Course Description

This course covers the U.S. Department of Transportation 1985 Emergency Medical Technician - Intermediate Curriculum and the U.S. D.O.T. Training Guidelines for Hazardous Material Awareness Level - I. The EMT-I course is designed to provide additional training and increased knowledge and skills in specific aspects of advanced life support. This course is for individuals who have successfully completed the EMT-Basic course as a prerequisite. Topics include: roles and responsibilities, EMS systems, medical legal, communications, documentation, medical terminology, body systems, patient assessment, advanced airway, shock, trauma, shock management, IV administration, intraosseous infusion, medical emergencies I, medical emergencies II, diabetic emergencies and dextrose 50% administration, hazardous material awareness, patient handling, and extrication.

Competency Areas	Hours
Roles and Responsibilities of the EMT-Intermediate	Class	7
EMS Systems	D. Lab	2
Medical-Legal Aspects	P. Lab/O.B.I.	3
Communication	Credit	9
Medical Terminology
Body Systems
Patient Assessment
Advanced Airway
Shock
Trauma
Shock Management
IV Administration
Intraosseous Infusion
Medical Emergencies I
Medical Emergencies II
Diabetic Emergencies and Dextrose 50% Administration
Hazardous Material Awareness
Patient Handling
Extrication

Prerequisite:  EMS 120, EMS 121 or National Registry EMT-Basic Certificate

Corequisite:

Course Guide

Competency	After completing this section, the student will:	Hours
		Class	D.Lab	P.Lab/ O.B.I.
ROLES AND RESPONSIBILITIES OF THE EMT - INTERMEDIATE		3	0	0
Medical Ethics and Professionalism	Identify and describe those activities performed by the EMT-I in the field.
	Define the role of the EMT-I.
	Describe and contrast the difference between an EMT-Ambulance and EMT-Intermediate training program.
	Define the terms “ethics” and “professionalism.”
	Describe the differences between ethical behavior and legal requirements.
	State specific activities that are most appropriate to ethical behavior.
	Identify whether a specific activity is unethical or illegal, given certain patient care situations.
	Identify whether a specific activity is ethical or legal, given certain patient care situations.
	Define the term “professional.”
	Define the term “Health Care Professional.”
	Identify whether a particular activity is professional or unprofessional, given certain patient care situations.
	State certain activities that are most appropriate to professional behavior.
	List current Georgia requirements for EMT-I continuing education.
	Define and discuss at least three reasons why continuing education is important for the EMT-I.
	Define the terms “certification,” “licensure” and “registration.”
	Name and describe current state legislation outlining the scope of pre-hospital ALS.
	State the reason it is important to keep EMT-I certification current.
	State the major purposes of a national association.
	State the major purposes of a national registration agency.
	State the major benefits of subscribing to and reading professional journals.
	State the major benefits of EMT-I’s teaching in their community.
	Identify and describe those activities performed by the EMT-I in the field.
EMS SYSTEMS		1	0	0
	Discuss citizen access and various mechanisms of obtaining it.
	Discuss pre-hospital care as an extension of hospital care.
	Define stabilization of patients.
	Differentiate between situations when the EMT-I should attempt to stabilize the patient on-scene and situations that require rapid and immediate transport to the hospital.
	List the members of the EMS team.
	Define and describe medical control.
	Describe physician responsibility for Medical Control.
	Describe the relationship between the physician on the scene, EMT-I and the physician on the radio: Physician who is with the patient when the EMT-I arrives Physician who arrives on the scene after the EMT-I has started evaluating and treating the patient
	Describe the benefits of EMT- I follow-up on patient condition, diagnosis, and retrospective review of pre-hospital care.
	Describe GSA/KKK Ambulance standards.
	Define the national standard levels of pre-hospital provider as defined by curriculum, respectively.
	Discuss ambulance placement and the parameters that should be utilized in its development, including the differences in urban. suburban and rural settings.
	Discuss the medical community role in overseeing pre-hospital care.
	Define protocols and standing orders.
	Define local training standards.
	Describe the legislation in the EMT-I's state as regards pre-hospital care.
	Describe integration of pre-hospital care into the continuum of total patient care with the emergency department phase of hospital care.
	Discuss replacement of equipment and supplies.
	Discuss the EMT-I's initial responsibilities when arriving on the scene.
	Discuss the varying philosophies between the management of medical patients and trauma patients, pre-hospital.
	Describe the transition of patient care from the EMT-I, including: 1.      Transfer of responsibility (legal and medical 2.      Reporting of patient status to physician or nurse
	Describe the ability of physician run critique based on documentation.
	Describe retrospective evaluation of patient care, including run report review, continuing education, skill practice, and skill deterioration.
MEDICAL - LEGAL ASPECTS		2	0	0
	Discuss the significance and scope of the following in relationship to EMT practice: State Medical Practice Act Good Samaritan Act/Civil Immunity State EMS statutes State motor vehicles codes State and local guidelines for “Do Not Resuscitate”
	Define the following: Negligence Medical liability Tort Duty to act Battery Slander Informed consent Expressed consent Implied consent Abandonment Liable Assault False imprisonment
	Describe the significance of accurate documentation and record keeping in substantiating incident.
	Identify situations that require the EMT-I to report those incidents to appropriate authorities.
	Describe the four elements to prove negligence.
	Describe the significance of obtaining expressed consent.
	Describe the extent to which force and restraint may be used to protect the EMT, the patient, and the third party.
	Describe the provisions of COBRA that relate to the EMT-I and the transfer of patients.
EMS COMMUNICATIONS		1	0	0
	Describe the phases of communications necessary to complete a typical EMS event.
	Name the possible components of an EMS communications system and explain the function of each.
	Describe maintenance procedures for the field radio equipment.
	Describe the position of the antenna on a portable transmitter/receiver that will deliver maximum coverage.
	Describe the proper use of a digital encoder.
	Describe proper use of both mobile and portable radios to receive and transmit information.
	Describe basic functions and responsibilities of the Federal Communications Commission (FCC).
	Name the information that must be gathered from a caller by the dispatcher.
	Describe two purposes for verbally communicating patient information to the hospital.
	List the patient assessment information that should be verbally reported to the physician.
	Organize a list of patient assessment information in the correct order for transmission to the physician using an accepted format.
	Describe three communications techniques that influence the clarity of radio transmissions.
	Describe the responsibilities of an EMS dispatcher.
	Name information items that must be gathered from a caller by the dispatcher.
	Describe the ten-code used in the local community.
DOCUMENTATION		1	0	0
	List the reasons for patient care documentation.
	Rationalize the need for EMS systems to gather data.
	Identify the components of the written EMS report and list the information that should be included on the written report.
	Describe the steps to be followed when a mistake in documentation is made.
	Define special considerations that must be exercised with a patient refusal of services.
MEDICAL TERMINOLOGY		1	0	0
	Explain the meaning of medical terminology.
	Provide three examples of each of the following: Word root Prefix Suffix Combining form Combining vowel
	Identify various medical terms given to various anatomical parts of the body.
	Identify common medical abbreviations from a list.
	Identify common root words and determine their meaning. identify and define common prefixes and suffixes.
	Locate one or more medical terms in a medical dictionary.
	Describe the four planes of the human body.
	Describe the main directional terms for the human body.
	Describe the six normal body movements.
	Describe the anatomic positions of the body.
BODY SYSTEMS		2	0	0
	Define the term “connective tissue.”
	Identify the human body cavities.
	Define the following terms: joints, cartilage, ligaments and tendons.
	Identify the two major divisions of the skeletal system and describe the function of each.
	Describe the structure and function of the muscular system and identify three types of muscles.
	Describe the structure and function of the circulatory system.
	Describe the structure and function of the respiratory system.
	Describe the structure and function of the nervous system.
	Identify the four quadrants of the abdomen.
	Describe the structure and function of the urinary system.
	Describe the structure and function of the male and female reproductive systems.
	Describe the structure and function of the immune system.
	Describe the structure and function of the endocrine system.
PATIENT ASSESSMENT		2	0	0
	Establish priorities of care based on threat to life conditions.
	Describe the six phases of patient assessment.
	Discuss the possible environmental hazards that the EMT-I may encounter and the means of protecting him/her in this environment.
	Describe the environmental hazards which an EMT-I or a patient might encounter.
	Describe the problems an EMT-I might encounter in a hostile situation and describe mechanisms of management.
	Describe the various types of protective equipment available to the EMT-I for self-protection and patient protection.
	Based on medical needs, define and describe the various classifications of emergencies which an EMT-I will encounter.
	Describe the primary survey and what areas are critical to evaluate.
	Describe the need for and methods of cervical spine immobilization throughout the phases of patient assessment.
	Describe techniques for evaluating the effectiveness of ventilation.
	Describe the anatomy of the following: upper airway, tongue, hypopharynx, nasopharynx, oropharynx, larynx, and vocal cords.
	Describe the mechanism of evaluating the effectiveness of perfusion including pulse and skin color.
	Define a priority patient and discuss illnesses or suspected injuries that you lead you to classify a patient into this category.
	Describe the components of the focused assessment for both the medical and the trauma patient.
	Describe the components of the detailed assessment and discuss various conditions that determine if this phase of assessment is required.
	Describe the need for the on-going assessment; list the components and discuss the frequency of this part of the patient assessment.
	Discuss factors to be considered when determining to which hospital a patient is transported.
	Describe the need for communication with the receiving hospital or medical direction when transporting a patient.
	Discuss the benefits of accurate documentation.
PRACTICE LAB I		0	2	0
EVALUATION MODULE I		2	2	0
Written Examination
Practical Examination
ADVANCED AIRWAY		8	0	0
	Describe the anatomy of the upper airway including the mouth, nose, pharynx, epiglottis and larynx.
	Describe the flow of air from outside the body into the trachea.
	Describe the reasons for and mechanism of humidification and warming of the air as it passes through the naso-and oral pharynx.
	Recall the anatomic relationship of the larynx to the tongue, pharynx, epiglottis, vocal cords, and esophagus.
	Relate the difference between true and false vocal cords.
	Recall and demonstrate the essential elements of assessing airway patency, breathing effectiveness and oxygenation in the ill or injured patient.
	Describe and demonstrate the procedures used to manually open the airway.
	Describe the methods and management of an obstructed airway.
	Discuss indications, contraindications, methods of insertion and use of the following: oropharyngeal airway, nasopharyngeal airway, EOA, Combitube, EGTA, and pharyngotracheal lumen airway.
	Describe the anatomy of the following: Lungs Trachea Alveolus Diaphragm Thoracic wall Pleural space
	Describe how pulmonary ventilation (inhalation and exhalation) is accomplished.
	Describe the gaseous exchange across the alveoli-capillary membrane (O and CO).
	Describe the pulmonary problems that can complicate exhalation and inhalation, the mechanisms by which they reduce ventilation and management of each problem, including: 1. Open pneumothorax 2. Diaphragmatic injury 3. Closed pneumothorax (simple and tension) 4. Flail chest
	Describe the problems of ventilation.
	Define mouth-to-mask ventilation, its benefits and limitations.
	Discuss the bag-valve-mask (BVM), its benefits and limitations.
	Discuss the techniques for evaluating the effectiveness of ventilation.
	Demonstrate effective mouth-to-mask ventilation.
	Demonstrate effective bag-valve ventilations with the following: Mask EOA Combitube
	Demonstrate the manual methods of airway management.
	Demonstrate the methods of management of an obstructed airway.
	Demonstrate the mechanical methods of airway management: Nasal Oral EQ
	Demonstrate the use of various types of portable and fixed suction devices.
	Describe anatomy of the mouth, hypopharynx. trachea, and larynx.
	Describe the relationship between the following: Cords and larynx Esophagus and larynx Epiglottis and larynx Tongue and larynx True cords and false cords Pharynx and larynx
	Given a list of arterial oxygen concentrations, the student should be able to select the normal P0 for a young adult breathing air.
	Given a list of arterial carbon dioxide concentrations, the student should be able to select the normal PCO.
	Given an increase in arterial PCO, the student should be able to name this condition and describe its effect on respiratory activity and on blood pH in the normal individual.
	Given a decrease in arterial P0, the student should be able to name this condition and describe its effect on respiratory activity in the normal individual.
	Given an increase in CO2 production, the student should be able to list at least two ways in which this increase may occur.
	Given an increase in CO2 elimination, the student should be able to describe how this elimination can occur.
	Given a list of statements, the student should be able to identify the statement that best describes the purpose of suctioning a patient.
	Given a diagram of a piston-powered suction unit, the student should be able to label and describe the operation and cleaning of each component and attached part.
	Given that there are various types of suction units, the student should be able to list at least four different types of units determined by the method in which the suction effect is obtained.
	Given that there are various types of suction catheters, the student should be able to list at least three different types, determined by difference in use and material composition.
	Given a list of situations describing patients who require suctioning, the student should indicate which type of catheter should be used.
	Given a list of statements, the student should be able to identify the statement that best describes the purpose of using the esophageal obturator airway.
	Given a list of situations describing patients with airway maintenance problems or potential airway maintenance problems, the student should be able to identify situations in which the use of the esophageal obturator airway is indicated and contraindicated.
	Given a list of situations, the student should be able to identify those situations in which the esophageal airway may be removed.
	Given a list of advantages, the student should be able to identify the advantages of using the esophageal obturator airway over other methods of airway control.
	Given a list of airway adjuncts, advantages, and disadvantages, the student should be able to match the airway adjuncts with the advantages and disadvantages.
	Given an adult manikin, oropharyngeal and nasopharyngeal airways, pocket mask, oxygen cylinder, and bag-valve-mask, the student should be able to demonstrate the procedure for administering intermittent positive pressure ventilation using: Pocket mask Bag-valve-mask and oropharyngeal airway Bag-valve-mask with oxygen Nasopharyngeal airway with bag-valve-mask
ADVANCED AIRWAY LAB		0	4	0
	Given a bag-valve mask, the student should be able to demonstrate the assembly, disassembly, and cleaning of the bag-valve-mask unit.
	Given an adult manikin, an oropharyngeal airway, and a demand-valve unit, the student should be able to demonstrate the procedure for performing intermittent positive-pressure ventilation.
	Given a demand-valve unit, the student should be able to demonstrate the assembly, disassembly, and cleaning of the unit
	Given a list of disadvantages, the student should be able to identify the disadvantages of using the esophageal obturator airway over other methods of airway control.
	Given a diagram of the esophageal obturator airway, the student should be able to label and describe the function of all component.
	Given a list of equipment and materials. the student should be able to identify those items that must be available before esophageal obturation is begun.
	Given that a patient requires an esophageal obturator airway, the student should be able to list the procedures for insertion of the esophageal airway, including all steps in the proper sequence.
	Given a list of errors, the student should be able to identify common errors involved in the use of the esophageal obturator airway.
	Describe laryngoscope, suction, endotracheal tube and bag-valve mask.
	Discuss indications and contraindications of endotracheal intubation.
	Discuss alternatives to endotracheal intubation.
	Discuss skill deterioration and methods of prevention.
	Discuss need for rapid placement of ET tube.
	Discuss methods of assuring and maintaining correct placement of ET tube.
	Given that a patient needs suctioning and already has an endotracheal tube in place, the student should be able to describe the difference between endotracheal suctioning and oropharyngeal suctioning including: 1.      Dangers 2.      Precautions
	Given an adult intubation manikin, an esophageal obturator airway, 30-cc syringe, and a bag-valve unit, the student should be able to demonstrate the technique for the insertion of an esophageal obturator airway. He/she should further be able to demonstrate endotracheal intubation with the esophageal obturator in place and subsequent correct removal of the obturator.
EVALUATION MODULE II		2	2	0
Written Examination
Practical Examination
SHOCK/TRAUMA		2	0	0
	Define shock based on aerobic and anaerobic metabolism.
	Discuss red blood cell oxygenation in the lungs based on alveolar  levels and transportation across the alveolar capillary wall.
	Discuss tissue oxygenation based on tissue perfusion and release of oxygen.
	Discuss the role played by respiration, inadequate ventilation in the management of shock.
	Describe perfusion and the mechanisms of improvement of cardiac output based on the strength and rate of contractions.
	Discuss the fluid component of the cardiovascular system and the relationship between the volume of the fluid and the size of the container.
	Discuss systemic vascular resistance, the relationship of diastolic pressure to the SVR, and the effect of diastolic pressure on coronary circulation.
	Discuss the container size in its relationship to the fluid volume and the effect on blood returning to the heart.
	Discuss body fluids based on total body water, intracellular fluid, and extracellular fluid.
	Identify the significant anions and cations in the body.
	Describe the role of protein.
	Define isotonic fluids, hypotonic fluids, and hypertonic fluids.
	Define and discuss diffusion.
	Define active transport.
	Describe the mechanisms of concentration of electrolytes.
	Define acid-base balance.
	Discuss acid-base balance based on hydrogenion concentration, pH, buffer systems.
	Define and discuss the following: Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis
	Describe the mechanism of the body response to perfusion change.
	Identify the role of the baroreceptor.
	Describe how the actions of the baroreceptor affect blood pressure and perfusion.
	Describe compensated shock.
	Describe uncompensated shock, both cardiac and peripheral effects.
	Discuss the assessment of the patient’s perfusion status based on physical observations within the primary survey, including pulse, skin, temperature, capillary refill.
	Discuss the relationship of the neurological exam to assessment of hypoperfusion and oxygenation.
	Describe the information provided by the following in physical examination: pulse, blood pressure, diastolic pressure, systolic pressure, skin color, appearance, temperature, and respiration.
	List examples of blunt and penetrating trauma.
	List three signs associated with a skull fracture.
	Describe Cheyne-Stokes respirations.
	Describe the Cushing reflex.
	Describe decorticate and decerebrate posturing.
	Describe the mechanism of hypoperfusion.
	List four mechanisms of spinal injury.
	List three types of devices used to assist with spinal immobilization.
	Identify four instances in which rapid extrication techniques may be necessary.
	Describe a flail chest.
	List three signs of a pneumothorax.
	List two early and three late signs or symptoms of a tension pneumothorax.
	State the importance of rapid transport to the hospital.
	List four signs or symptoms of abdominal trauma.
	Describe the position for a pregnant trauma patient to be placed to optimize the venous return to her heart.
	Describe the care of an amputated body part.
	List three types of burns.
	Identify one difference between an open and a closed bone injuries.
	Identify three complications of musculoskeletal trauma.
SHOCK MANAGEMENT		4	0	0
	Discuss management of a shock patient, including red cell oxygenation, tissue ischemic sensitivity, IV fluids, the pneumatic antishock garment.
	Describe the beneficial and detrimental effects of the pneumatic antishock garment.
	Describe the indication and contraindications for the pneumatic antishock garment.
	Discuss fluid replacement, the types of fluid that are available, the benefits and detrimental effects of each.
	Discuss how fluid replacement is monitored and controlled.
	Discuss the routes of fluid replacement and the advantages and disadvantages of each.
	Demonstrate in order of priority the steps of shock resuscitation.
	Demonstrate the use of the pneumatic antishock garment (PASG).
	Demonstrate the proper technique to insert an intravenous catheter.
INTRAVENOUS INFUSION THERAPY		3	1	0
	Define the term “intravenous cannulation.”
	Recall the indications and contraindications for IV cannulation.
	Identify the equipment and supplies needed to perform an IV cannulation.
	Select preferred solutions for use in the management of both medical and trauma patients.
	Select the appropriate administration to be used for various medical and trauma patients.
	Describe the methods used to determine the proper IV flow rate.
	State the proper ratio of fluid replacement to blood loss in hypovolemic patients.
	List and discuss the advantages, disadvantages and complications associated with use of peripheral veins.
	Identify the veins commonly used for IV sites.
	Recall the steps top be followed to establish a peripheral IV.
	Determine problems associated with an IV that is not functioning properly to determine the cause and correct the problem.
	Discuss complications associated with IV therapy.
	Demonstrate the steps involved in establishing and discontinuing an IV.
IV/INTRAOSSEOUS INFUSION THERAPY		3	1	0
	Identify the five conditions that must exist prior to considering intraosseous needle place.
	From a list of l0 patient situations, determine those in which an intraosseous infusion is indicated.
	Identify on a diagram the proper location for needle placement.
	Identify on a diagram the pertinent anatomical landmark (s ) referenced in performing intraosseous needle placement including the tibial tuberosity, the epiphyseal plate and the medial malleolus.
	Identify on a diagram the internal anatomy of a bone to include the periosteum, the yellow marrow cavity, the red marrow cavities, and the emissary veins.
	From a list of equipment, select the appropriate devices and supplies for performing an intraosseous infusion.
	From a list of drugs and fluids, identify those which should not be infused or should be infused with caution via the intraosseous route.
	Identify four potential complications of intraosseous infusion therapy.
	Identify three relative or absolute contraindications to intraosseous infusion therapy.
	List, in proper sequence, the steps in performing an intraosseous infusion.
	Affirm the rationale for placement of an intraosseous needle in an infant or toddler.
	Demonstrate how to locate the primary and three alternate sites for establishing an I.O. infusion.
	Demonstrate preparing the patient and necessary equipment for an I.O. infusion.
	Using an I.O. mannequin or fresh raw chicken leg, demonstrate correct placement of an I.O. infusion and infuse 5cc of fluid.
	Demonstrate at least two methods of rapid infusion of fluids through an intraosseous site.
	Demonstrate how to properly troubleshoot a malfunctioning I.O. infusion.
	Demonstrate the steps in properly discontinuing an I.O. infusion.
EVALUATION MODULE III		2	2	0
Written examination
Practical Examination
MEDICAL EMERGENCIES I		4