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DOT National Standard EMT-Intermediate/85 Refresher

This refresher course for EMT-Intermediate focuses on critical medical and behavioral emergencies, including allergic reactions, overdoses, near-drowning incidents, altered levels of consciousness (ALOC), diabetes complications, seizures, heat/cold emergencies, and various behavioral crises such as depression, anxiety, and agitation. Trainees will explore pathophysiology, epidemiology, differential diagnoses, and treatment options. Emphasis on safe care and restraint protocols will prepare EMTs for real-world scenarios with patients who exhibit potentially dangerous behaviors.

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DOT National Standard EMT-Intermediate/85 Refresher

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  1. Welcome! DOT National Standard EMT-Intermediate/85 Refresher

  2. MEDICAL EMERGENCIES • Allergic reaction • Possible overdose • Near-drowning • ALOC • Diabetes • Seizures • Heat & cold emergencies • Behavioral emergencies • Suspected communicable disease

  3. BEHAVIORAL EMERGENCIES Perspective Pathophysiology Epidemiology PE & Diagnostic Findings S/S Differential considerations Tx MEDICAL EMERGENCIES

  4. perspective • Depression & suicidal ideation • Anxiety Disorders • panic attacks • Schizophrenia • Bipolar disorder • The agitated or violent pt • Factitious illness • Malingering • Conversion disorder

  5. Differential Dx • The agitated or violent pt • Identify causes • Hypoglycemia • Severe amphetamine or cocaine toxicity • Hypoxia • Hyperthermia • Anticholinergic toxicity • Alcohol intoxication or withdrawal

  6. Differential dx • Finger stick glucose determination • Oxygen saturation • PE • Verbal survey

  7. treatment • Consider verbally controlling the pt • Physical restraint to a back board • Chemical restraint

  8. Treatment • Physical restraints • Use only when necessary and in those situations where the pt is exhibiting behavior deemed to present danger to him/herself or to the field personnel • Minimum restraint necessary to accomplish necessary pt care & safe transport • Circulation to the extremities (distal to the restraints) should be evaluated frequently

  9. Chemical restraint Tx • Indications: to reduce combative behavior that endangers the pt or caregivers • Contraindications: • Absolute • sensitivity to diphenhydramine or midazolam • SBP <90mm Hg (adult) • Relative • N/V • Depressed mentation • Suspected drug/alcohol intoxication • Multiple systems trauma • Head injury • Concomitant narcotic administration • These MAY be the proximate cause for the condition that requires proposed sedation. The best judgment of the medic is necessary to evaluate the need for sedation

  10. Treatment

  11. Treatment

  12. Perspective • Pathophysiology • Epidemiology • PE & Diagnostic Findings • S/S • Differential considerations • Tx

  13. Questions? • References • Marx, John A. ed, Hockberger & Walls, eds et al. Rosen’s Emergency Medicine Concepts and Clinical Practice, 7th edition. Mosby & Elsevier, Philadelphia: PA 2010. • Tintinalli, Judith E., ed, Stapczynski & Cline, et al. Tintinalli’s Emergency Medicine A Comprehensive Study Guide, 7th edition. The McGraw-Hill Companies, Inc. New York 2011. • Wolfson, Allan B. ed. , Hendey, George W.; Ling, Louis J., et al. Clinical Practice of Emergency Medicine, 5th edition. Wolters Kluwer & Lippincott Williams & Wilkings, Philadelphia: PA 2010.

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