These notes are from using the following textbook.
Emergency Care and Transport of the Sick and Injured, 12th edition.
Copyright 2021 by the American Academy of Orthopaedic Surgeons
Published by Jones & Bartlett Learning. www.jblearning.com
Jones & Bartlett Learning Public Safety Group www.psglearning.com
ISBN 9781284204308 (paperback)
YouTube channel covering the book chapters.
Hint: If you use an Android based phone you can install NewPipe and download the video, or just the audio, to playback without an internet connection.
Flashcard sets on Quizlet for each chapter.
page 101
Abandonment
The book gives a poor example scenario to demonstrate a patient abandonment issue. A better example scenario would be an EMS crew leaving a patient at a busy (possibly on divert) ER without properly handing over the patient to the hospital staff that results in a patient not getting care that the EMS crew and/or hospital had a duty to provide. Or an EMT getting mad, or offended, by a patient's speech/behavior and then the EMT witholds care that the EMT had a duty to provide care. Patient abandonment is not likely to ever be an issue for most EMS providers. You really have to try at this one to be guilty. It essentially comes down to did you have a duty to provide care to the patient and did you provide that care?
But where there's a will, there's a way. As this crew found a way for a possible abandonment case. Don't let your ego steer you wrong.
Raw footage of that incident. And a news report.
A good article on the topic: Patient Abandonment: Stop the nonsense
BLS Protocols that may be relevant where patient abandonment may be a concern:
111 Non-Treatment and/or Transport of Patient
112 Non-Transport of Patients or Cancellation of Response
150 Rehabilitation at Fire/Incident Scene
This next case isn't abandonment, but here is another case of EMS facing criminal and civil penalties. As you can see, it's really easy to not do the things that can land you in jail in EMS.
AP News video
Full incident video
page 105
Scene of a Crime - relevant BLS Protocol 919 Crime Scene.
The Deceased - The book states: "In most states, EMTs do not have the authority to pronounce a patient dead." As far as I can tell...at least for Pennsylvania... "pronouncing" someone dead is essentially the act of filling out the paperwork for a death certificate. Only certain people are authorized to create death certificates. So, according to me as a non-lawyer who you should not listen to, an EMT in the Commonwealth of Pennsylvania can say someone is dead. However, they cannot do the paperwork to create a death certificate which is the "pronouncement of death." See: Vital Statistics Law of 1953 Act of Jun. 29, 1953, P.L. 304, No. 66.
BLS Protcols that may be relevant when you have a deceased person are:
201 Initial Patient Contact
322 DOA
324 OOH-DNR
331 Cardiac Arrest
332 Trauma Cardiac Arrest
919 Crime Scene
Cardiovascular Emergencies
The EMT lecture I wish I had starting out - The Paramedic Coach
Chapter 17 from textbook
Page 925 has the old guidelines. Those guidelines are no longer maintained by the CDC (as of 2012), they're now maintained by the American College of Surgeons. A new guideline was published in 2021 based on new data and an expert panel. National Guidline for the Field Triage of Injured Patients, 2021. It's worth noting that this is not for use for mass casualty triage. This is for making a transportation decision for where to take an individual trama patient that is not part of a mass casualty incident. They really should rename this guideline.
Shock is the condition caused by inadequate perfusion of the organs. (Lack of blood to the organs.)
MAP = Mean Arterial Pressure
The minimum MAP considered adequate for perfusion of the organs is 65.
MAP can be determined from a blood pressure with the following equation. 1/3 systolic + 2/3 diastolic = MAP
My source for the equation to calculate MAP is a Khan Academy video on shock hemodynamics. Link to video (equation part starts at 5:56): https://www.youtube.com/watch?v=j_s5p0mLZ7s