Table of Contents

Contributors viii


Foreword xiv


Preface xv


Abbreviations, xvi


About the companion website, xix


Volume 1: Clinical aspects of EMS


1 History of EMS 1
Robert R. Bass


Section I: Airway


2 EMS airway management 19
Francis X. Guyette and Henry E. Wang


3 Airway procedures 30
Jestin N. Carlson, and Henry E. Wang


4 Airway management: special situations 43
Brendan Anzalone and Henry E. Wang


Section II: Breathing


5 Respiratory distress 53
Jason Oost and Mohamud Daya


6 Oxygenation and ventilation 60
Vincent N. Mosesso and Angus M. Jameson


Section III: Circulation


7 Hypotension and shock 69
Ronald N. Roth, Raymond L. Fowler and Francis X. Guyette


8 Vascular access 78
Jocelyn M. De Guzman, Bryan B. Kitch and Jeffrey D. Ferguson


Section IV: Medical Problems


9 The challenge of the undifferentiated patient 87
Andrew Travers and Ronald D. Stewart


10 Altered mental status 92
Mark R. Quale and Jefferson G. Williams


11 Cardiac arrest systems of care 98
Bryan McNally, Paul M. Middleton and Marcus Ong


12 Cardiac arrest: clinical management 109
Jon C. Rittenberger and Vincent N. Mosesso, Jr


13 Chest pain and acute coronary syndrome 120
Joseph P. Ornato, Michael R. Sayre and James I. Syrett


14 Cardiac dysrhythmias 129
Christian C. Knutsen and Donald M. Yealy


15 Cardiac procedures and managing technology 137
T.J. Doyle


16 Abdominal pain 144
Jeffrey D. Ferguson and Jennifer Monroe


17 Submersion injuries/drowning,= 151
Robert Lowe


18 Choking 155
Gregory H. Gilbert


19 Syncope 158
David J. Schoenwetter


20 Seizures 163
J. Stephen Huff


21 Stroke 171
Todd J. Crocco, Allison Tadros and Stephen M. Davis


22 Allergic reactions 179
Debra G. Perina and Douglas R. Gallo


23 Diabetic emergencies 184
José G. Cabañas, Jorge L. Falcon-Chevere and Jane H. Brice


24 Renal failure and dialysis 190
Bryan B. Kitch and Jocelyn M. De Guzman


25 Infectious and communicable diseases 198
Russell D. MacDonald


Section V: Trauma Problems


26 Trauma Systems of Care 211
Jeffrey P. Salomone and Joseph A. Salomone


27 Blunt trauma considerations 216
Sabina A. Braithwaite and Jeffrey M. Goodloe


28 Motor vehicle crashes 222
Stewart C. Wang and Carla Kohoyda-Inglis


29 Penetrating trauma 228
Michelle Welsford and Alim Pardhan


30 Traumatic brain injury 237
Kraigher O’Keefe


31 Electrical injuries 243
Jeffrey Lubin


32 Blast injury 248
John McManus and Richard B. Schwartz


33 Thermal and chemical burns 253
John McManus, Richard B. Schwartz and Sabina A. Braithwaite


34 Crush injury 261
Ken Miller


35 Hemorrhage control 265
Neil B. Davids and Robert L. Mabry


36 Orthopedic injuries 272
Sean Kivlehan, Benjamin T. Friedman and Mary P. Mercer


37 Ocular trauma 280
Eric Hawkins and Michael D. Mills MD, MPH


38 Bites, stings, and envenomations 284
Adam Frisch, Andrew King and Stephanie Outterson


39 Field trauma triage 289
Hiren Patel and Scott M. Sasser


40 Trauma-stabilizing procedures 297
Derek R. Cooney and David P. Thomson


Section VI: Obstetrics and Gynecological Problems


41 Physiology of pregnancy: EMS implications 307
David J. Hirsch


42 Emergencies of pregnancy 312
W. Scott Gilmore


43 Normal childbirth 318
Stephanie A. Crapo


44 Childbirth emergencies 322
Angus M. Jameson and Micha Campbell


45 Perimortem cesarean section 325
Christian Martin-Gill


Section VII: Toxicological Problems


46 Principles of toxicology 333
Christine M. Murphy


47 Treatment and evaluation of specific toxins 341
Michael C. Beuhler


Section VIII: Environmental Problems


48 Cold exposure illness and injury 351
Jonnathan Busko


49 Heat-related illness 358
Gerald (Wook) Beltran


50 High-altitude illnesses 363
Hawnwan Philip Moy, MD


51 Effects of flight 368
David P. Thomson


52 Diving injury 372
Anthony J. Frank Jr


Section IX: Special Populations


53 The special needs of children 381
Susan Fuchs


54 Pediatric medical priorities 386
Toni Gross and Susan Fuchs


55 Pediatric trauma priorities 393
Joseph L. Wright


56 Technology-dependent children 397
Brent D. Kaziny and Manish I. Shah


57 Approach to the geriatric patient 401
Thomas V. Caprio and Manish N. Shah


58 Bariatric patient challenges 407
Jeremy T. Cushman


59 Behavioral health emergencies 412
Jay H. Reich and Aaron Stinton


Section X: Special Considerations


60 Intimate partner violence 423
Petra Norris


61 Sexual assault 430
Petra Norris


62 Child maltreatment 435
Deborah Flowers and Molly Berkoff


63 Ethical challenges 439
Dave W. Lu and James G. Adams


64 End-of-life issues 444
Aaron Case, Dana Zive, Jennifer Cook and Terri A. Schmidt


65 Termination of resuscitation in the out-of-hospital setting, 453
Laurie J. Morrison, Ian R. Drennan, and P. Richard Verbeek


66 Family and bystanders, 462
Lynne Dees


67 Analgesia, 470
Michael T. Hilton and Paul M. Paris


68 Point-of-care testing in EMS, 477
Alix J.E. Carter


69 Ultrasound applications in EMS, 483
Rachel Liu


Section XI: Safety and Quality


70 Culture of patient safety, 491
Blair L. Bigham and P. Daniel Patterson


71 A historical view of quality concepts and methods, 500
Dia Gainor and Robert Swor


72 Defining, measuring, and improving quality, 509
Kevin E. Mackey and Scott S. Bourn


73 Data management and information systems, 517
Greg Mears


74 EMS quality improvement and the law, 526
Maria B. Abrahamsen


Appendix, 531


Index, 541


Volume 2: Medical Oversight of EMS


Section I: System Infrastructure


1 Principles of EMS system designs 3
Mic Gunderson


2 Air medical services 17
Thomas Judge and Stephen H. Thomas


3 Interfacility transportation 29
Jacob B. Keeperman


4 Legislation, regulation, and ordinance 36
Dan Manz


5 State EMS offices 44
Douglas F. Kupas, Lee B. Smith, and Dean Cole


6 EMS personnel 51
David C. Cone


7 Principles of finance 60
Paul Hinchey and Jeffrey M. Goodloe


Section II: Clinical Leadership and Oversight


8 Medical oversight of EMS systems 71
Robert R. Bass, Benjamin Lawner, Debra Lee, and Jose V. Nable


9 Leadership and team building 85
Mike Taigman and Stephen Dean


10 EMS dispatch 94
Jeff J. Clawson


11 Communications 113
Kevin McGinnis


12 Emergency care regionalization 123
Raymond L. Fowler


13 EMS–public health interface 134
John P. Serra and Christopher A. Kahn


14 Political realities for the medical director 140
Norm Dinerman


15 EMS physicians as public spokespersons 146
Paul E. Pepe, Linda B. Pepe, Robert M. Davis, Paul Mann, and Robin Whitmeyer


16 Legal issues 160
W. Ann “Winnie” Maggiore


17 Due process 182
E. Fremont Magee and Sarah M. Sette


18 Risk management 192
Karen Pickard, Raymond L. Fowler, and Melanie J. Lippmann


Section III: Human Resources


19 EMS provide reducation 201
Beth Lothrop Adams and Debra Cason


20 EMS provider wellness 211
P. Daniel Patterson, Matthew D.Weaver, and David Hostler


21 Occupational injury prevention and management 217
P. Daniel Patterson, Matthew D. Weaver, and David Hostler


22 Ambulance safety and crashes 222
Brian J. Maguire


23 Medical surveillance of emergency response personnel 231
Mike McEvoy


24 Prevention and intervention for psychologically stressful events 236
Richard Gist and Vickie Harris Taylor


25 Protection of EMS personnel from occupationally acquired infections 243
Sandy Bogucki


Section IV: Extraordinary Circumstances


26 Incident command system and national incident management system 257
Sandy Bogucki, Craig DeAtley, and Kevin Schulz


27 Medical management of mass gatherings 264
John F. Brown, Joshua G. Smith, and Katie Tataris


28 Disaster preparedness and management 272
Alexander P. Isakov


29 The federal medical response to disasters 278
Kevin Horahan and Richard C. Hunt


30 Special considerations in disaster zones 283
Ryan Carter


31 Prehospital triage for mass casualties 288
E. Brooke Lerner, Richard B. Schwartz, and Joanne E. McGovern


32 Mass casualty management 292
Charles M. Miramonti, Dan P. O’Donnell, Andrew C. Stevens, Elizabeth Weinstein, Josh D. Mugele, Kacy L. Allgood, and Bobby A. Courtney


33 Mass casualty evacuation and patient movement 303
Joanne McGovern and Sandy Bogucki


34 Temporary treatment facilities 313
Roy L. Alson


Section V: Special Hazards


35 Medical support for hazardous materials response 323
Thomas Blackwell, Kenneth Brennan, Craig DeAtley, and Allen Yee


36 Chemical properties of hazardous materials 334
Joshua B. Gaither and Robert N.E. French


37 Radiation and radiation injury 339
John C. White


38 Weapons of mass destruction 349
Jonathan L. Burstein


Section VI: Special Environments


39 Tactical EMS 355
David K. Tan, William P. Bozeman, and Denis FitzGerald


40 EMS on the fireground 363
Edward T. Dickinson, Sandy Bogucki, and Carin M. van Gelder


41 Confined space and limited access situations 373
David C. Cone


42 Care in the wilderness 377
Seth C. Hawkins, Michael G. Millin, and William “Will” R. Smith


43 Telemedicine and emerging telecommunications 392
David G. Ellis, Kaori P. Tanaka, and Brian M. Clemency


Section VII: Advancing Knowledge


44 EMS research basics 403
E. Brooke Lerner, David C. Cone, and Donald M. Yealy


45 Informed consent for EMS research 410
Lynn J. White


46 Cardiac arrest-related research methodology 415
Michael R. Sayre


47 Trauma-related research methodology 420
Peter P. Taillac and Edward P. Sloan


48 Pediatric-related research methodology 427
David Markenson


49 Economic evaluation of EMS-related interventions 433
Graham Nichol


50 Data handling and statistics essentials 439
Craig D. Newgard and Roger J. Lewis


Appendix, 449 

About the Author

David C. Cone, MD (Editor-in-Chief), Professor of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA Jane H. Brice, MD, MPH, Orange County EMS Director, Professor of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Theodore R. Delbridge, MD, MPH, Professor of Emergency Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA J. Brent Myers, MD, MPH, Director | Medical Director, Wake County EMS System, Raleigh, NC, USA