National EMS Education Standard Competencies

Chapter 1: EMS Systems

National EMS Education Standard Competencies

Preparatory

Uses simple knowledge of the emergency medical services (EMS) system,safety/well-being of the emergency medical responder (EMR), medical/legal issues at the scene of an emergency while awaiting a higher levelof care.

EMS Systems

EMS systems(p 51)

Roles/responsibilities/professionalism of EMSpersonnel(pp6–7)

Quality improvement(p 15)

Research

Impact of research on EMR care(p 8)

Data collection(p 15)

Public Health

Have an awareness of local public health resources and the role EMSpersonnel play in public health emergencies.

Knowledge Objectives

1. Describe the different elements of an EMS system. (p 5)

2. Discuss the four levels of EMS training and licensure. (p 7)

3. Describe the role of public health resources and how this role appliesto EMS providers. (pp 7–8)

4. Discuss the historic background of the development of the EMSsystem. (p 8)

5. List the 10 standard components of an EMS system. (pp 8–9)

6. Describe how the seriousness of the patient’s condition is used todetermine the urgency of transportation to an appropriate medicalfacility. (p 9)

7. Understand and describe the four general goals of your EMRtraining. (pp 10–11)

8. Define the roles and responsibilities of an EMR. (p 12)

9. Explain the importance of documentation. (p 13)

10. Describe the attributes that an EMR is expected to possess. (p 13)

11. Define medical oversight and discuss the EMR’s role in the process.(p 15)

12. Explain the quality improvement process and why quality improvement is important for good patient care. (p 15)

13. Describe the impact of research on patient care. (p 15)

Skills Objectives

There are no skills objectives for this chapter.

Chapter 2: Workforce Safety and Wellness

National EMS Education Standard Competencies

Preparatory

Uses simple knowledge of the emergency medical service (EMS) system,safety/well-being of the emergency medical responder (EMR), andmedical/legal issues at the scene of an emergency while awaitinga higher level of care.

Workforce Safety and Wellness

Standard safety precautions (pp28–29)
Personal protective equipment (p 28)
Stress management (pp23–25)

Dealing with death and dying (p22)

Prevention of response-related injuries (p27)

Medicine

Recognizes and manages life threats based on assessment findings of apatient with a medical emergency while awaiting additional emergencyresponse.

Infectious Diseases

Awareness of

A patient who may have an infectious disease (p27)
How to decontaminate equipment after treating a patient (p33)

Knowledge Objectives

1. Describe the emotional aspects of emergency care encountered bypatients, patients’ families, and EMRs. (p 21)

2. Describe the five stages in the normal reaction to death anddying. (p 22)

3. Explain how to confront death and dying with integrity, empathy,respect, and careful delivery of service. (p 22)

4. Describe issues the EMR must face concerning care of the dyingpatient, death, and the grieving process of family members. (p 22)

5. List at least six signs and symptoms of stress. (p 23)

6. State the steps that contribute to wellness, and describe theirimportance in managing stress. (pp 23–25)

7. Explain the types of actions an EMR can take to reduce or alleviatestress. (p 25)

8. List hazards commonly encountered by EMRs. (p 27)

9. Describe the routes of disease transmission. (p 27)

10. Describe the standard precautions for preventing infectious diseasesfrom airborne and bloodborne pathogens. (pp 28–29)

11. Discuss the importance of standard precautions. (pp28–29)

12. Explain proper handwashing techniques. (p 29)

13. Explain how to remove gloves properly. (p 29)

14. List the steps to take if your clothing comes in contact with body fluidfrom a patient. (p 31)

15. Describe the safety equipment that EMRs should have available fortheir protection. (p 31)

16.Describe three phases of safety when responding to the scene. (p 31)

17. Describe 11 types of hazards to look for when assessing the scene forunsafe conditions. (pp 32–34)

Skills Objectives

1. Demonstrate integrity, empathy, respect, and careful delivery ofservice when confronted with patient death and dying. (p 22)

2. Demonstrate proper handwashing techniques. (p 29)

3. Demonstrate how to remove medical gloves safely. (p 30)

4. Demonstrate how to treat clothing that has come into contact witha patient’s body fluid. (p 31)

5. Demonstrate proper use of safety equipment needed for EMRs. (p 31)

6. Demonstrate scene assessment of a real or simulated rescue eventfor safety hazards. (p 31)

Chapter 3: Medical, Legal, and Ethical Issues

National EMS Education Standard Competencies

Preparatory

Uses simple knowledge of the emergency medical service (EMS) system,safety/well-being of the emergency medical responder (EMR), medical/legalissues at the scene of an emergency while awaiting a higher level of care.

Medical/Legal and Ethics

Consent/refusal of care (pp 40–41)
Confidentiality (p 44)
Advance directives (pp 41–42)
Tort and criminal actions (p 39)
Evidence preservation (p 45)
Statutory responsibilities (pp 39–40)
Mandatory reporting (p 45)
Ethical principles/moral obligations (p 40)
End-of-life issues (p 42)

Knowledge Objectives

1. Explain how to comply with the standard of care. (p 39)

2. Discuss the ethical responsibilities of an EMR. (p 40)

3. Describe the EMR’s legal duty to act. (p 39)

4. Define consent, and describe how it relates to decision-making. (p 40)

5. Differentiate between expressed consent and implied consent. (p 40)

6. Discuss the giving of consent by minors for treatment or transport.(p 40)

7. Discuss consent in cases of mentally ill patients. (p 41)

8. Discuss the EMR’s role and obligations if a patient refuses treatmentor transport. (p 41)

9. Discuss the different types of advance directives and how they impactpatient care. (pp 41–42)

10. Discuss the legal concepts of abandonment, persons dead at the scene, negligence, and confidentiality. (pp 42, 44)

11. Understand that communication with patients is confi dential andprotected by the Health Insurance Portability and Accountability Act(HIPAA). (pp 44–45)

12. Understand the role of Good Samaritan laws. (p 45)

13. Explain the reporting requirements for special situations. (p 45)

14. Explain the reasons for documentation. (p 46)

Skills Objectives

There are no skills objectives in this chapter.

Chapter 4: Communications and Documentation

National EMS Education Standard Competencies

Preparatory

Documentation

Recording patient findings (p61)

EMS System Communication

Communication needed to:

Call for resources (pp 51–52)

Transfer care of the patient (p54)

Interact within the team structure (pp 52–54)

Therapeutic Communication

Principles of communicating with patients in a manner that achieves a positive relationship

Interviewing techniques (pp 56–57)

Medical Terminology

Uses simple medical and anatomic terms.

Knowledge Objectives

1. Describe the importance of communication and documentationfor EMRs. (pp 56, 61)

2. Describe the different types of equipment used by EMRs in voice,radio, telephone, and data systems. (pp 51–52)

3. Explain the functions of radio communications during the followingphases of a response:

a. Dispatch (p 53)

b. Response to the scene (p 53)

c. Arrival at the scene (p 53)

d. Update of responding EMS units (p 54)

e. Transfer of patient care to other EMS personnel (p 54)

f. Postrun activities (p 55)

4. Explain the guidelines for radio communication. (p 55)

5. Discuss the techniques of effective verbal communication. (p 55)

6. Describe guidelines for effective communication with patients. (pp 56–57)

7.Explain the skills that will help you communicate with:

a. Hearing-impaired patients (pp 57–58)

b. Visually impaired patients (pp 58–59)

c. Non–English-speaking patients (p 59)

d. Geriatric patients (p 59)

e. Pediatric patients (p 59)

f. Developmentally disabled patients (p 60)

g. Persons displaying disruptive behavior (p 60)

8.Explain the role of medical terminology. (p 60)

9. Describe the legal significance of documentation. (p 61)

10. List the areas (topics) that should be included in a patient care reportto ensure proper documentation. (p 61)

Skills Objectives

1. Demonstrate proper radio communication. (p 55)

2. Demonstrate an understanding of the rules of communication withcolleagues, patients, and bystanders as an EMS professional. (p 56)

3. Demonstrate the techniques of successful cross-culturalcommunication. (p 57)

4. Demonstrate completion of a patient care report. (p 61)

Chapter 5: The Human Body

National EMS Education Standard Competencies

Anatomy and Physiology

Uses simple knowledge of the anatomy and function of the upper airway,heart, vessels, blood, lungs, skin, muscles, and bones as the foundation ofemergency care.

Life Span Development

Uses simple knowledge of age-related differences to assess and care forpatients.

Knowledge Objectives

1. Understand the body’s topographic anatomy, including the anatomicposition and the planes of the body. (p 69)

2. Discuss the anatomy and physiology of the respiratory system. (p 70)

3. Discuss the anatomy and physiology of the circulatory system. (pp 70–72)

4. Identify the anatomy and physiology of the skeletal system. (pp 72–75)

5. Describe the anatomy and physiology of the muscular system. (p 75)

6. Discuss the anatomy and physiology of the nervous system. (p 75)

7. Discuss the anatomy and physiology of the digestive system. (p 75)

8. Describe the anatomy and physiology of the genitourinarysystem. (p 76)

9. Describe the anatomy and the physiology of the skin. (p 76)

10. Describe changes that occur in development and vital signs atdifferent ages. (pp77, 79–80)

Skills Objectives

1. Identify selected topographic anatomy on a real or simulatedpatient. (p 69)

Chapter 6: Airway Management

National EMS Education Standard Competencies

Airway Management, Respiration, and Artificial Ventilation

Applies knowledge (fundamental depth, foundational breadth) of generalanatomy and physiology to assure a patent airway, adequate mechanicalventilation, and respiration while awaiting additional EMS response forpatients of all ages.

Airway Management

Within the scope and practice of the EMR:

Airway anatomy (p91)
Airway assessment (pp92–93)
Techniques of ensuring a patent airway (pp93–97)

Respiration

Anatomy of the respiratory system (pp90–92)
Physiology and pathophysiology of respiration (p 91)
Pulmonary ventilation (p92)
Oxygenation (p 92)
Respiration (p92)
External (p 91)
Internal (pp91–92)
Cellular (p 92)
Assessment and management of adequate and inadequate respiration (p102)
Supplemental oxygen therapy (p119)

Artificial Ventilation

Assessment and management of adequate and inadequate ventilation

Artificial ventilation (p 103)

Minute ventilation (p 92)
Alveolar ventilation (p 92)
Effect of artificial ventilation on cardiac output (p 92)

Pathophysiology

Uses simple knowledge of shock and respiratory compromise to respondto life threats.

Medicine

Recognizes and manages life threats based on assessment findings of apatient with a medical emergency while awaiting additional emergencyresponse.

Respiratory

Anatomy, signs, symptoms, and management of respiratory emergenciesincluding those that affect the:

1. Upper airway (pp 102–109)

2. Lower airway (pp 102–109)

Knowledge Objectives

1. Identify the anatomic structures of the respiratory system and statethe function of each structure. (pp 90–92)

2. State the differences in the respiratory systems of infants, children,and adults. (p 92)

3. Explain how to check a patient’s level of responsiveness. (p 93)

4. Describe how to perform the head tilt–chin lift maneuver. (p 93)

5. Describe how to perform the jaw-thrust maneuver. (pp 93–95)

6. Explain how to check for fluids, solids, and dentures in a patient’smouth. (p 95)

7. List the steps needed to clear a patient’s airway using finger sweepsand suction. (p 95)

8. Describe the steps required to maintain a patient’s airway using therecovery position, oral airways, and nasal airways. (pp 97–102)

9. Describe how to check a patient for the presence of breathing. (p 103)

10. Describe the signs of adequate breathing, the signs of inadequatebreathing, the causes of respiratory arrest, and the major signs ofrespiratory arrest. (p 102)

11. Describe how to perform rescue breathing using a mouth-to-maskdevice, a mouth-to-barrier device, mouth-to-mouth techniques, and abag-mask device. (pp 103–109)

12. Describe, in order, the steps for recognizing respiratory arrestand performing rescue breathing in infants, children, and adults.(pp 109–112)

13. Describe the differences between the signs and symptoms of amild airway obstruction and those of a severe or complete airwayobstruction. (p 112)

14. List the steps in managing a foreign body airway obstruction ininfants, children, and adults. (pp 113–117)

15. Describe the special considerations of airway care and rescuebreathing in children and infants. (pp 109–110)

16. Describe the indications for using supplemental oxygen. (pp 117–118)

17. Describe the equipment used to administer oxygen. (pp 118–119)

18. Describe the safety considerations and hazards of oxygenadministration. (p 119)

19. Explain the steps in administering supplemental oxygen toa patient. (p 119)

20. Describe the function and operation of a pulse oximeter. (pp 120–121)

21. List the special considerations needed to perform rescue breathing inpatients with stomas. (p 121)

22. Describe the hazards that dental appliances present during theperformance of airway skills. (p 123)

23. Describe the steps in providing airway care to a patient in a vehicle.(p 124)

Skills Objectives

1. Demonstrate how to check a patient’s level of responsiveness. (p 93)

2. Demonstrate the head tilt–chin lift maneuver for opening blockedairways. (p 93)

3. Demonstrate the jaw-thrust maneuver for opening blocked airways.(pp 93–95)

4. Demonstrate how to check for fluids, solids, and dentures in a patient’sairway. (p 95)

5. Demonstrate how to correct a blocked airway using finger sweeps andsuction. (pp 95–97)

6. Demonstrate how to place a patient in the recovery position. (p 97)

7. Demonstrate the insertion of oral and nasal airways. (pp 100–101)

8. Demonstrate how to check for the presence of breathing. (p 103)

9. Demonstrate how to perform rescue breathing using a mouth-to-maskdevice, a mouth-to-barrier device, mouth-to-mouth, and a bag-maskdevice. (pp 103–109)

10. Demonstrate the steps in recognizing respiratory arrest and performingrescue breathing on an adult, a child, and an infant. (pp 109–111)

11. Demonstrate the steps needed to remove a foreign body airwayobstruction in an infant, a child, and an adult. (pp 113–116)

12. Demonstrate administration of supplemental oxygen using a nasalcannula and a nonrebreathing mask. (p 120)

13. Demonstrate the operation of a pulse oximeter. (pp 120–121)

14. Demonstrate rescue breathing on a patient with a stoma. (p 121)

15. Demonstrate airway management on a patient in a vehicle. (p 124)

Chapter 7: Professional Rescuer CPR

National EMS Education Standard Competencies

Shock and Resuscitation

Uses assessment information to recognize shock, respiratory failure orarrest, and cardiac arrest based on assessment findings and manages theemergency while awaiting additional emergency response.

Assessment

Uses scene information and simple patient assessment findings to identifyand manage immediate life threats and injuries within the scope ofpractice of the EMR.

Primary Assessment

Primary assessment for all patient situations (p 133)

Level of consciousness (p 137)

ABCs (p 133)

Identifying life threats (p 133)

Assessment of vital functions (p 133)

Begin interventions needed to preserve life (p 134)

Anatomy and Physiology

Uses simple knowledge of the anatomy and function of the upper airway,heart, vessels, blood, lungs, skin, muscles, and bones as the foundation ofemergency care.

Pathophysiology

Uses simple knowledge of shock and respiratory compromise to respondto life threats.

Knowledge Objectives

1. Describe the anatomy and function of the circulatory system. (p 131)

2. List the reasons for a heart to stop beating. (p 133)

3. Describe the components of CPR. (p 133)

4. Explain the links in the cardiac chain of survival. (p 134)

5. Describe the conditions under which you should start and stopCPR. (pp 134–135)

6. Describe the techniques of external chest compressions on anadult. (pp 135–136)

7. Describe the techniques of external chest compressions on aninfant. (p 137)

8. Describe the techniques of external chest compressions on achild. (p 137)

9. Explain the steps of one-rescuer adult CPR. (p 137)

10. Explain the steps of two-rescuer adult CPR. (p 139)

11. Explain how to switch rescuer positions during two-rescuer adultCPR. (p 142)

12. Explain the steps of one-rescuer infant CPR. (p 143)

13. Explain the steps of two-rescuer infant CPR. (p 145)

14. Explain the steps of child CPR. (pp145–146, 148)

15. Describe the signs of effective CPR. (p 148)

16. State the complications of performing CPR. (pp 148–149)

17. Explain the importance of creating sufficient space for CPR. (p 149)

18. Describe the indications for the use of automated external defibrillation. (p 149)

19. Describe the steps in using automated external defibrillation. (p 150)

20. Explain the importance of CPR training. (p 152)

21. Explain the legal implications of performing CPR. (p 152)

Skills Objectives

1. Demonstrate adult chest compressions. (p 136)

2. Demonstrate infant chest compressions. (p 137)

3. Demonstrate child chest compressions. (pp 145–146)

4. Demonstrate one-rescuer adult CPR. (p 138)

5. Demonstrate two-rescuer adult CPR. (pp 139–142)

6. Demonstrate how to switch rescuer positions during two-rescuer adult CPR. (p 142)

7. Demonstrate one-rescuer infant CPR. (p 143)

8. Demonstrate two-rescuer infant CPR. (p 145)

9. Demonstrate child CPR. (pp 145–146, 148)

10. Demonstrate creating sufficient space to perform CPR. (p 149)

11. Demonstrate automated external defibrillation. (p 150)

Chapter 8: Patient Assessment

National EMS Education Standard Competencies

Assessment

Use scene information and simple patient assessment findings to identifyand manage immediate life threats and injuries within the scope andpractice of the emergency medical responder (EMR).

Scene Size-up

Scene safety (pp 164–165)

Scene management (pp 164–165)

Impact of the environment on patient care (p 164)

Addressing hazards (pp 164, 165)

Violence (p 164)

Need for additional or specialized resources (pp 165–166)

Standard precautions (p 166)

Primary Assessment

Primary assessment for all patient situations (p 168)

Level of consciousness (p 168)

ABCs (pp 169–170)

Identifying life threats (p 169)

Assessment of vital functions (p 169)

Begin interventions needed to preserve life (pp 169–170)

History Taking

Determining the chief complaint (p 172)
Mechanism of injury/nature of illness (p 165)
Associated signs and symptoms (p 172)

Secondary Assessment

Performing a rapid full-body scan (p 175)
Focused assessment of pain (p 175)
Assessment of vital signs (p 180)

Reassessment

How and when to reassess patients (p 186)

Knowledge Objectives

1. Discuss the importance of each of the following steps in the patientassessment sequence:

Scene size-up (p 164)
Primary assessment (p 168)
History taking (p 172)
Secondary assessment (p 175)
Reassessment (p 186)

2. Discuss the components of a scene size-up. (pp 164–166)

3. Explain why it is important to get an idea of the number of patients atan emergency scene as soon as possible. (p 166)

4. List and describe the importance of the following steps of theprimary assessment:

Forming a general impression of the patient (p 168)

Determining the patient’s level of responsiveness (p 168)

Performing a rapid scan, including:

Assessing the patient’s airway (p 169)
Assessing the patient’s breathing (p 169)
Assessing the patient’s circulation (pp 169–170)

Updating responding EMS units (p 170)

5. Describe the differences in checking airway, breathing, and circulationwhen the patient is an adult, a child, or an infant. (pp 170, 180–181)

6. Explain the purpose for obtaining a patient’s medical history. (p 172)

7. Discuss the SAMPLE approach to obtaining a patient’s medicalhistory. (pp 172–173)

8. Explain the difference between a sign and a symptom. (p 175)

9. Describe the sequence used to perform a full-body secondaryassessment. (pp 175–180)

10. List the areas of the body that you should examine during thesecondary assessment. (pp 175–180)

11. Explain the significance of the following signs: respiration, circulation,blood pressure, skin condition, pupil size and reactivity, level ofconsciousness. (pp 180–184)

12. List the information that should be obtained duringreassessment. (p 186)

13. List the information about the patient’s condition that should beaddressed in your hand-off report. (p 186)

14. Explain the differences between performing a patient assessment ona medical patient and performing one on a trauma patient. (p 187)

Skills Objectives

1. Demonstrate the following five steps of the patient assessmentsequence:

Scene size-up (p 164)
Primary assessment, including:

Forming a general impression of the patient (p 168)

Assessing the patient’s responsiveness (p 168)

Assessing the patient’s airway (p 169)

Assessing the patient’s breathing (p 169)

Assessing the patient’s circulation (including severebleeding) (pp 169–170)

Updating responding EMS units (p 170)

Obtaining the patient’s medical history using the SAMPLEformat (pp 172–173)
Performing a secondary assessment, including:

Performing a full-body examination (pp 175–180)

Identifying and measuring a patient’s vital signs (pp 180–184)

Performing an ongoing reassessment (p 186)

Chapter 9: Medical Emergencies