Prehospital Emergency Care, 11th edition

• “Assessment Tips” and “Assessment Summaries” offer clinical insights needed to accurately evaluate medical conditions and link findings to conditions.
• “Pathophysiology Pearls” explain the causes of medical conditions and injuries so EMTs can best assess signs and symptoms and make the right decisions for each patient.
• “Case Study” and “Case Study Follow-Up” emphasize key concepts from the chapter, provide a link between the text and real-life situations, and deliver accompanying pathophysiology notes that explain the “why” of signs, symptoms, and recommended emergency care.
• “Drug Profiles” give specifications for common medications, including medication name, indications, contraindications, medication form, dosage, administration, actions, side effects, and reassessment protocols.
• “EMT Skills” and “Emergency Care Protocols” provide step-by-step procedures to help EMTs deliver safe, effective emergency care based on proven methods.
• “Emergency Care Algorithms” visually depict procedural steps, further illuminating care and assessment processes.
• “Critical Findings” throughout Chapter 13 (“Patient Assessment”) explain conditions, signs, and symptoms to expect at every step of the assessment, what might be causing them, and how to address them.
  

Reflects the latest and best medical knowledge and practices in emergency medical services

• UPDATED! Course of treatment for spinal trauma has been revised to emphasize spine motion restriction rather than immobilization whenever possible spinal (column or cord) injury is suspected.
• UPDATED! Latest American Heart Association (AHA) guidelines inform strategies for providing excellent patient care.
• UPDATED! Vital signs values throughout the text have been revised to reflect guidelines of the AHA and American Academy of Pediatrics.
• UPDATED! Recommendations for oxygen administration in medical patients and trauma patients have been revised to reflect standards of the AHA and the American College of Surgeons.
• NEW! Extensive new section on sepsis and the cause of septic shock now appear in Chapter 15, “Shock & Resuscitation.”
• NEW! Pharmacology coverage has been added. Topics covered include naloxone, manual administration of epinephrine, and cautions regarding the administration of oxygen.
• EXPANDED! “Respiratory Emergencies” chapter has been expanded with information on breathing distress (respiratory distress/failure/arrest), obstructive pulmonary disease (asthma, emphysema, chronic bronchitis), and pulmonary embolism, pulmonary edema, and cystic fibrosis.
• UPDATED! Altered mental status coverage has been greatly expanded to include AHA’s Stroke Chain of Survival, FAST mnemonic, TIA, cryptogenic stroke, and signs and symptoms associated with anterior circulation stroke and posterior circulation stroke.
  

Offers a wealth of study aids to help students master the material and pass exams

• Objectives inform chapter-by-chapter content and meet National EMS Education Standards and instructional guidelines.
• Key terms appear at the start of each chapter (with page references), in bold type within the chapter, and in the end-of-book glossary.
• Multimedia exercises appear in MyLab BRADY, including related web links, animations, and videos.
• NEW! Photos and illustrations have been added throughout the book.
  

• Course of treatment for spinal trauma has been revised to emphasize spine motion restriction rather than immobilization whenever possible spinal (column or cord) injury is suspected.
• Latest American Heart Association (AHA) guidelines inform strategies for providing excellent patient care.
• Vital signs values throughout the text have been revised to reflect guidelines of the AHA and American Academy of Pediatrics.
• Recommendations for oxygen administration in medical patients and trauma patients have been revised to reflect standards of the AHA and the American College of Surgeons.
• Extensive new section on sepsis and the cause of septic shock now appear in Chapter 15, “Shock & Resuscitation.”
• Pharmacology coverage has been added. Topics covered include naloxone, manual administration of epinephrine, and cautions regarding the administration of oxygen.
• “Respiratory Emergencies” chapter has been expanded with information on breathing distress (respiratory distress/failure/arrest), obstructive pulmonary disease (asthma, emphysema, chronic bronchitis), and pulmonary embolism, pulmonary edema, and cystic fibrosis.
• Altered mental status coverage has been greatly enhanced to include AHA’s Stroke Chain of Survival, FAST mnemonic, TIA, cryptogenic stroke, and signs and symptoms associated with anterior circulation stroke and posterior circulation stroke.
  

Offers a wealth of study aids to help students master the material and pass exams

• Photos and illustrations have been added throughout the book.
  

Content Updates by Chapter

• Chapter 1, Emergency Medical Care Systems, Research, and Public Health: Includes new and updated information on types of EMS services, medical oversight of EMS, and EMS research. New sections on evidence-based guidelines (EBG), mobile integrated healthcare (MIH), and community paramedicine (CP) have been added.
• Chapter 2, Workforce Safety and Wellness of the EMT: Includes new information on emergency infectious diseases (EID), including new sections on Ebola virus and Zika virus disease. A new discussion of clandestine drug labs is included.
• Chapter 3, Medical, Legal, and Ethical Issues: Includes a new explanation of the terms competence and capacity—noting that while EMS personnel cannot judge a patient’s competence (a legal judgment that can only be made in a court of law), EMS and other medical personnel can judge a patient’s capacity (a medical assessment) to understand and make rational decisions.
• Chapter 4, Documentation: Has a new list of documentation goals and expanded information on mandatory reporting.
• Chapter 5, Communication: Has new information and new sections on new and advanced communications technology, including FirstNet, a nationwide public safety broadband, and land mobile radio systems (LMRS), as well as telemetry and land mobile satellite communications.
• Chapter 6, Lifting and Moving Patients: Places new emphasis on spine motion restriction and self-restriction to replace former emphasis on immobilization of patients with suspected spinal injury, on the basis that total “immobilization” of the spine is impossible, and that “immobilization” to a hard spine board has been found in many instances to worsen injuries.(The complete explanation of spine motion restriction is in Chapter 32.)
• Chapter 9, Life Span Development: Presents a table of vital signs revised from the prior edition in accordance with the values included in the AHA and American Academy of Pediatrics Pediatric Advanced Life Support 2016. (Vital signs values throughout the text have been revised to be consistent with these.)
• Chapter 10, Airway Management, Artificial Ventilation, and Oxygenation: Includes revised information on cricoid pressure to reflect contraindications and modified recommendations for its use. The CPAP section is revised to explain uses to overcome PEEP and auto-PEEP (exhalation difficulties) and possible uses of CPAP in children. Importantly, there are updated recommendations for oxygen administration in medical patients and trauma patients to reflect current recommendations of the AHA and ACS (and revised throughout the text to be consistent with these).
• Chapter 11, Vital Signs, Monitoring Devices, and History Taking: Has updated vital signs values, as recommended by the AHA and ACS (as noted for Chapter 9). The chapter includes an increased emphasis on early pulse oximeter use.
• Chapter 12, Scene Size-Up: Has a new section, “Violence Toward EMS Personnel” (what to anticipate; how to protect yourself). Also included is new information on the dangers of calls to clandestine drug labs (and how to protect yourself).
• Chapter 13, Patient Assessment: Includes new spine motion restriction recommendations (more fully explained in Chapter 32). There are also updated guidelines for oxygen therapy goals for medical patients (as recommended by AHA) and for trauma patients (as recommended by ACS). A new section has been added on naloxone (Narcan) administration for opioid overdose.
• Chapter 14, General Pharmacology and Medication Administration: Contains several new elements, including distinguishing two ways EMTs may administer medication: EMT medication administration and patient-assisted medication administration. There are new cautions regarding administration of oxygen (which can be harmful in some circumstances). The chapter includes new information on manual administration of epinephrine for anaphylactic reaction (in lieu of expensive auto-injectors). There is also a new section on intranasal administration of naloxone using a mucosal atomizer device (MAD).
• Chapter 15, Shock and Resuscitation: Now identifies just two stages of shock: compensatory and decompensatory (“irreversible shock” is no longer identified as a stage of shock). There is an extensive new section on sepsis and septic shock, a major cause of death in the United States. There is expanded information on multiple organ dysfunction syndrome (MODS), and there are new sections on cardiac arrest in the pregnant patient and on post-resuscitation care after return of spontaneous circulation (ROSC) from cardiac arrest.
• Chapter 16, Respiratory Emergencies: Has been extensively revised and updated. Included are expanded information on respiratory distress, respiratory failure, and respiratory arrest; on forms of obstructive pulmonary disease (asthma, emphysema, and chronic bronchitis); on pulmonary embolism, pulmonary edema, and cystic fibrosis; and on the use of metered-dose inhalers and small-volume nebulizers.
• Chapter 17, Cardiovascular Emergencies: Features expanded information on dangers of administering too much oxygen and expanded information on evaluating hypertension associated with a cardiac emergency.
• Chapter 18, Altered Mental Status, Stroke, and Headache: Has been extensively revised and updated. New or expanded information is included on the AHA Stroke Chain of Survival; the FAST mnemonic (facial droop, arm drift, speech difficulty, time to call 911) for identifying a stroke; and the ischemic penumbra (area of afflicted brain cells that can be restored to full function by prompt emergency care). There is also new information on atrial fibrillation as a cause of stroke and on atriovenous malformation (AVM), a tangle of malformed vessels that can rupture and cause a stroke. There is expanded information on transient ischemic attack (TIA) and a new section on cryptogenic stroke (unidentifiable cause). New sections introduce two newer stroke screening tools: MENDS (Miami Emergency Neurologic Deficit) and RACE (rapid arterial occlusion evaluation) scale and associated information on large vessel occlusion (LVO), in addition to retaining information on the Los Angeles and Cincinnati stroke screening tools.
• Chapter 19, Seizures and Syncope: Includes information on differentiating a primary seizure (unprovoked, as from a condition like epilepsy) from a secondary seizure (provoked; caused by an insult to the body such as infection, drug withdrawal, brain disease, or other). An updated definition of status epilepticus from the American Epilepsy Society is included, and there is an updated classification and discussion of generalized seizures and partial seizures.
• Chapter 20, Acute Diabetic Emergencies: Includes general updates throughout the chapter and a new section on intranasal glucagon.
• Chapter 21, Allergic and Anaphylactic Reactions: Has expanded information on the causes of anaphylactic and anaphylactoid reactions. There is new information on the use of manual epinephrine injection to control an anaphylactic reaction and a new section on biphasic anaphylactic reactions (that seem normalized but then return in life-threatening form).
• Chapter 22, Toxicologic Emergencies: Puts new emphasis on opioid drug abuse and overdose and on administration of naloxone to reverse an opioid overdose. Expanded information is included on suicide bags and suicide by toxic gas inhalation. There are new sections on the substances methylenedioxymethamphetamine (MDMA) and tetrahydrocannabionl (THC). There is also a new section on cannabinoid hyperemesis syndrome.
• Chapter 23, Abdominal, Hematologic, Gynecologic, Genitourinary, and Renal Emergencies: Introduces new sections on considerations regarding abdominal pain in pediatric, geriatric, immunocompromised, and bariatric surgery patients.
• Chapter 24, Environmental Emergencies: Introduces the concept of two systems, behavioral and physiologic, to regulate body temperature. There is new information on immersion hypothermia to include cold shock response, cold incapacitation, and nonfreezing cold injury. A new term, freezing cold injury, replaces the former term local cold injury. There is a new section on exercise-associated hyponatremia (EAH).
• Chapter 25, Submersion Incidents: Drowning and Diving Emergencies: Has general updates throughout.
• Chapter 26, Psychiatric Emergencies: Has been extensively revised to emphasize distinguishing psychiatric from physical causes of behavior changes, including a mental status exam and a new section, “Mini Assessment for Common Psychiatric Emergencies.” There are updated definitions, based on the Diagnostic and Statistical Manual (DSM-5), and detailed discussion of psychiatric problems, including anxiety; bipolar disorder; depression; neurocognitive disorders; schizophrenia spectrum and other psychotic disorders; substance abuse and addictive disorders; trauma/stressor-related disorders; and extrapyramidal symptoms (involving involuntary movement). There is expanded discussion of violence (including suicide and violence to others), and there is an expanded and updated discussion of principles, techniques, and legal considerations in dealing with psychiatric emergencies. The chapters within the “Trauma” standard include a trauma overview and chapters on bleeding and soft tissue trauma; burns; musculoskeletal trauma and nontraumatic fractures; trauma to the head, spinal column and spinal cord, eye, face, neck and chest; abdominal and genitourinary trauma; multisystem trauma; and trauma in special patient populations.
• Chapter 27, Trauma Overview: The Trauma Patient and the Trauma System: In the Vehicle Collisions section, includes added information about vehicle telemetry data predictive of injury.
• Chapter 28, Bleeding and Soft Tissue Trauma: Includes The Prehospital External Hemorrhage Control Protocol from the ACS Committee on Trauma. There is new and expanded information on tourniquet application and hemostatic impregnated gauze dressings. There is a new section on junctional bleeding control (where extremities or the head meet torso or core body) and expanded information on emergency care for nosebleed.
• Chapter 29, Burns: Includes new information on fluid shifts from burns causing edema that occludes the airway. There is a new section, “Toxin-Induced Lung Injury,” and the Lund-Browder burn classification chart is newly included. The chapter includes expanded information on burn dressings, burn center referral criteria, and treatment of chemical burns.
• Chapter 30, Musculoskeletal Trauma and Nontraumatic Fractures: Has expanded information assessment and care of pelvic fracture and new information on use of the full-body vacuum mattress as a full-body splint. Information on the pneumatic antishock garment (PASG) has been deleted from the chapter, as this device is no longer recommended.
• Chapter 31, Head Trauma: Includes a new discussion of the pathophysiology of primary brain injury, secondary brain injury, and brain herniation. There is new emphasis on spine motion restriction (rather than stabilization or immobilization) and expanded information on establishing and maintaining adequate breathing in head trauma.
• Chapter 32, Spinal Trauma and Spine Motion Restriction: Reflects a critical change in care for spinal trauma: spine motion restriction rather than immobilization. (This concept has been discussed in some prior chapters, but the principal discussion is presented in this chapter.) The chapter recognizes that the neck and spine cannot truly be immobilized and that evidence has shown that immobilization can actually worsen an injury. Use of soft or rigid cervical collars (no longer called cervical spine immobilization collars) to remind the patient to restrict head motion, and techniques of spine motion restriction by EMTs as well as self-restriction by the patient are discussed. The emphasis on spine motion restriction rather than immobilization is a major change throughout the text whenever possible spinal (column or cord) injury is suspected or possible.
• Chapter 33, Eye, Face, and Neck Trauma: Now includes emphasis on spine motion restriction and includes a new section on corneal injury.
• Chapter 34, Chest Trauma: Introduces a new concept: the cardiac box—the rectangular area of the anterior chest to which any penetrating or blunt injury increases the likelihood of cardiac or great vessel injury. There is updated information on care of an impaled object, emphasis on spine motion restriction (noting that immobilizing a patient to a hard board can impede chest excursion), and expanded information on use of a commercial vented occlusive dressing such as Asherman, Halo, or Bolin.
• Chapter 35, Abdominal and Genitourinary Trauma: Now emphasizes spine motion restriction in care of the abdominal trauma patient.
• Chapter 36, Multisystem Trauma and Trauma in Special Patient Populations: Includes expanded information on assessment of trauma in a pregnant patient, new information on cervical spine injury in the pediatric patient, and emphasis on spine motion restriction.
• Chapter 37, Obstetrics and Care of the Newborn: Has extensive revisions and updates throughout. There is new and expanded information on the effects of abruptio placentae on mother and fetus; hypertensive emergencies; assessing contractions; assessment for prehospital delivery and delivery at the scene; benefits of delayed cord clamping; abnormal deliveries; types of breech presentation and breech delivery; and shoulder dystocia. Included are the AHA guidelines for newborn care; obtaining the Apgar score; and meconium present at birth. New sections have been added on the predelivery emergency hyperemesis gravidarum (extreme and prolonged morning sickness); estimating gestational age based on fundal height; face, chin, brow, and compound presentations; and a new list of assessment triggers and immediate interventions.
• Chapter 38, Pediatrics: A new section on “Brief Resolved Unexplained Events”—events in an infant or child that, though brief, concerned the parent or caregiver, such as a period of cyanosis or a change in breathing or level of consciousness. There is also a new discussion of spine motion restriction in the pediatric patient.
• Chapter 39, Geriatrics: A new section on “Cognitive Impairment” and a new discussion of spine motion restriction in the geriatric patient.
• Chapter 40, Patients with Special Challenges: Includes an extensive new section, “Autism and EMS,” based on facts for EMS personnel provided by the Autism Spectrum Disorder Foundation. There are extensive new sections on “Human Trafficking” and “Domestic Violence.” The section on ventricular assist devices (VADs) has been extensively revised, and there is a new section, “Vagus Nerve Stimulator,” about an implanted device found in some patients with seizure disorder.
• Chapter 42, Ambulance Operations and Air Medical Response: Includes two new sections: “Culture of Safety in EMS” (based on recommendations of the National Emergency Medical Services Advisory Council) and “Crew Resource Management” (based on recommendations of the International Association of Fire Chiefs).
• Chapter 43, Gaining Access and Patient Extrication: Has many updates and added details throughout the chapter and new information on gaining access to a home through an unlocked upper story window.
• Chapter 44, Hazardous Materials: Has revised sections on safety data sheets (SDS) [no longer called material safety data sheets (MSDS)]; the 2016 Emergency Response Guidebook; and decontamination. There is a new section on the Wireless Information System for Emergency Responders (WISER) app from the National Library of Medicine providing access to extensive medical information. There is also a new section on “Criminal Use of Hazardous Materials” that includes information on clandestine drug labs.
• Chapter 45, Multiple-Casualty Incidents and Incident Management: Provides a reference and URL to training and certification in the incident command system, provided free of charge on the Federal Emergency Management Agency (FEMA) website. A new section is included on the SALT Field Triage System formulated by the ACS Committee on Trauma.
• Chapter 46, EMS Response to Terrorist Incidents: Has new information and/or new sections on improvised explosive devices (IED); radiological exposure devices (RED); improvised nuclear devices (IND); active shooter incidents and the use of tactical EMS; and cyberterrorism.