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EMT Core Concepts Overview

Jul 8, 2025

Overview

This lecture covered foundational EMT concepts, including PPE, scene safety, vital signs, medication administration, airway management, patient assessment, pediatric/OB emergencies, documentation, and preparation for skills testing and clinicals.

PPE & Scene Safety

  • Begin every scenario by ensuring scene safety and applying appropriate PPE (usually gloves, sometimes gown, mask, or eye protection).
  • Maintain situational awareness; hazards include weapons, animals, unstable terrain, drugs, and bystanders.
  • Request law enforcement if weapons/drugs are present or during crime/domestic scenes; wait for scene to be secured.
  • Always confirm: “Is my scene safe?” and “Do I have proper BSI/PPE?” before patient contact.

Vital Signs & Primary Assessment

  • Follow the ABCs: Airway (open using appropriate technique), Breathing (assess rate, quality, lung sounds), Circulation (pulse, skin condition, capillary refill).
  • Normal adult respiratory rate: 12–20 breaths/min.
  • Assess pulse for rate, rhythm, and quality; check temperature and blood glucose (especially for altered mental status).
  • Perform EKG (4- or 12-lead) and transmit if needed; EMTs may not interpret, but can acquire EKGs.

Respiratory Assessment & Tools

  • Auscultate for abnormal lung sounds: crackles/rales (fluid in lower airway), rhonchi (fluid in upper airway), wheezing (bronchoconstriction), and stridor (upper airway obstruction).
  • Use pulse oximetry (goal: 94% or better; know baseline for COPD patients), capnography (normal EtCO₂: 35–45 mmHg), and temperature measurement.
  • Bag-valve mask (BVM) at 15L/min for apneic patients; nasal cannula (2-6L/min) or non-rebreather mask (10-15L/min) depending on distress.

Medication Administration

  • Six rights: right patient, medication, dose, route, time, documentation.
  • Nitroglycerin: 0.4mg SL, up to 3 doses for chest pain (hold if BP <100 systolic or recent ED meds).
  • Aspirin: 324mg for suspected cardiac chest pain unless bleeding present.
  • Epinephrine: 0.3mg IM for anaphylaxis (must involve ≥2 systems).
  • Albuterol: 2.5mg via nebulizer for wheezing/asthma/COPD; monitor for tachycardia.
  • Oral glucose: 15g (adults), for hypoglycemia if airway protected.
  • Naloxone (Narcan): 2mg IN for opioid overdose with respiratory depression.
  • Activated charcoal: consult poison control, rarely given prehospital.

Advanced Airway & Special Equipment

  • CPAP for CHF, COPD (start at 5cm H₂O; ensure patient is alert with adequate BP).
  • Monitor EtCO₂ for ventilated or altered patients; sudden EtCO₂ rise in arrest indicates return of spontaneous circulation.

Patient Assessment & Transportation

  • Use OPQRST for symptom assessment: Onset, Provocation, Quality, Radiation, Severity, Time.
  • SAMPLE history: Signs/Symptoms, Allergies, Medications, Past history, Last oral intake, Events.
  • Primary assessment: Fix airway, breathing, circulation issues before proceeding.
  • Call for transport early in serious cases (chest pain, stroke, altered mental status, trauma).

Documentation & Legal Considerations

  • Document thoroughly: use CHART or SOAP formats.
  • Good documentation protects you legally; record all findings, interventions, and changes in patient status.
  • Maintain professional demeanor and bedside manner on scene.

Pediatric and OB Emergencies

  • Pediatric assessment triangle: appearance, work of breathing, circulation/skin.
  • Abdominal pain: assess all quadrants, monitor for shock, and consider pregnancy.
  • OB: Imminent delivery, manage cord prolapse, monitor for placenta previa/abruption, perform APGAR scoring at 1 and 5 minutes.

Testing & Clinicals Information

  • Skills days (practice and testing) precede clinical rotations.
  • Complete all virtual preps before on-site skills days.
  • Oral boards occur after final exam and drug screen; clinicals require completion of all prior steps.

Key Terms & Definitions

  • BSI — Body Substance Isolation, PPE protocols for infection control.
  • ABCs — Airway, Breathing, Circulation; initial patient assessment priorities.
  • OPQRST — Mnemonic for pain/symptom assessment questions.
  • SAMPLE — Mnemonic for patient history gathering.
  • Capnography — Measurement of exhaled CO₂ (EtCO₂) as a respiratory assessment tool.
  • CPAP — Continuous Positive Airway Pressure for respiratory distress.
  • APGAR — Newborn assessment scoring system (Appearance, Pulse, Grimace, Activity, Respiration).

Action Items / Next Steps

  • Review medication dosages, indications, and contraindications.
  • Practice OPQRST and SAMPLE assessments.
  • Prepare for upcoming skills days (medical, trauma).
  • Finish all required chapters, virtual preps, and check EMT course checklist.
  • After final exam and drug screen, sign up for oral boards prior to clinical rotations.
  • Ensure documentation skills are up to standard using CHART/SOAP formats.

Full transcript