Emergency Care, 13th edition

Emergency Care’s boxed features and pedagogical tools help students learn to think like EMTs

• Core Concepts list the key points addressed in each chapter to help students anticipate chapter content, and guide their studies. Chapter-opening Objectives are based on the National EMS Education Standards.
• Critical Decision Making exercises appear throughout the text. This scenario-based feature helps students learn how to make patient-care decisions while at the scene.
• Decision Points call out key decisions that made during assessment and care of a patient.
• DOT Objectives are listed and follow the DOT numbering system. Each chapter lists the US DOT objectives along with page references that make it easy to see where the objectives are covered.
• FYI sections broaden students' understanding of individual topics. These sections provide material that goes beyond the DOT objectives.
• Inside/Outside boxes call out relevant pathophysiology for a condition or series of conditions, helping students understand disease prevention and treatment.
• Patient Assessment and Care describes the assessment and treatment for particular types of patients, disorders, or injuries. They include important signs and symptoms, as well as key steps of care.
• Point of View photos and stories capture the patient's perspective and recount experiences of EMS care from the patient's point of view.
• Scans summarize step-by-step procedures using easy-to-reference illustrations. Medication Scans provide information needed to help administer medications. Procedure Scans list and describe how to perform particular procedures.
• Street Scenes place book knowledge within the context of real-life calls. Questions within this feature prompt readers to test their knowledge using realistic situations.
• Voices marginal features offer insights or facts from EMTs in the field.
• Chapter Review sections include a summary of key points; key terms and definitions; review questions; critical-thinking exercises that ask students to apply knowledge; case studies; and more.

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Coverage of the latest standards, procedures, and practices prepares students to become effective Emergency Medical Technicians

The chapters in Section 2, and throughout the text are updated to conform to the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

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Chapter-by-chapter changes include:

Section 1 • FOUNDATIONS: Chapters 1-8

• EXPANDED: Chapter 1, “Introduction to Emergency Medical Care” expands the section on the role of research in EMS (including its influence on the development of evidence-based practices).
• EXPANDED: ¿Chapter 2, “The Well-Being of the EMT,” expands information on safe glove removal, updates the information on the Ryan White HIV/AIDS CARE Act to include the Ryan White Extension Act of 2009, and expands information about PTSD (post-traumatic stress disorder).
• NEW/UPDATED: Chapter 4, “Medical, Legal, and Ethical Issues,” now discusses POLST (physician orders for life-sustaining treatment) in addition to the discussion of DNR orders, and adds information about the HIPAA Privacy Rule.
• UPDATED: Chapter 5, “Medical Terminology,” and Chapter 6 “Anatomy and Physiology” are now separate chapters (they were a single chapter in the prior edition) allowing for greater focus on these concepts.

Section 2 • AIRWAY Management, Respiration, and Artificial Ventilation: Chapters 9-10

• NEW: Chapter 10, “Respiration and Artificial Ventilation,” adds information on the selective use of oxygen for patients with chest pain with inclusion of the American HeartAssociation and International Liaison Committee on Resuscitation recommendations on this topic. There is also a new section on the use of oxygen saturation information in recognizing respiratory distress and failure.

Section 3 • Patient Assessment: Chapters 11—15

• UPDATED: Chapter 11, “Scene Size-Up,” now emphasizes that severe mechanism of injury (MOI) no longer means automatically immobilizing the spine.* There is a new emphasis on the use of ANSI-approved reflective vests at emergency scenes.
• UPDATED: Chapter 12, “The Primary Assessment,” includes updated information on the selective use of oxygenation and on spinal immobilization decisions.*
• NEW/UPDATED: Chapter 13, “Vital Signs and Monitoring Devices,” has new information on implanted ventricular assist devices, andupdated information on spinal immobilization decisions.
• NEW: Chapter 14, “Secondary Assessment,” is an entirely new chapter created primarily by combining, resequencing, and updating the prior edition’s chapters on medical patient assessment, trauma patient assessment, reassessment, and critical thinking/decision making. There are many new photos throughout the chapter. The mnemonic DCAP-BTLS is no longer used, but replaced with a simpler list of what to look for during the physical exam: wounds, tenderness, and deformities. The field triage criteria (for significant mechanisms of injury warranting transport to a trauma center) are updated in accordance with current Centers for Disease Control (CDC) guidelines.
• UPDATED: Chapter 15, “Communication and Documentation,” includes updated photos and text about ambulance-mounted radios, iPads with PCR software, pen-based computers, and electronic PCR formats.

* (The student is referred to Chapter 29, “Trauma to the Head, Neck, and Spine” for detailed discussion of this issue.)

Section 4 • Medical Emergencies: Chapters 16—24

• NEW: Chapter 16, “General Pharmacology,” adds naloxone as a drug for reversing narcotic overdose, the intranasal route of drug administration (for naloxone), and the Auvi-Q talking epinephrine injector.
• NEW: Chapter 18, “Cardiac Emergencies,” includes information on a new approach to oxygen administration for ACS (acute cardiac syndrome), high-performance CPR (including a new photo scan), therapeutic hypothermia, titration of oxygen post arrest, the Lucas automatic CPR device, and ventricular assist devices.
• UPDATED/NEW: Chapter 19, “Diabetic Emergencies and Altered Mental Status,” expands the discussion of primary assessment of a patient with altered mental status and new information on intranasal glucagon, sepsis is a dangerous cause of altered mental status, and cardiovascular causes of dizziness/syncope as well as an expanded discussion of care for stroke.
• NEW: Chapter 20, “Allergic Reaction,” now presents information about the Auvi-Q talking epinephrine injector and emphasizes that while anaphylaxis requires oxygen, mild allergic reactions do not.
• NEW: Chapter 21, “Poisoning and Overdose Emergencies,” now includes a section on naloxone as a drug that EMTs will be able to carry and administer, and introduces new information about “detergent suicides,” “bath salts,” and “designer drugs.”
• NEW: Chapter 22, “Abdominal Emergencies,” now includes the Wong-Baker pain scale.
• UPDATED/NEW: Chapter 23, “Behavioral and Psychiatric Emergencies and Suicide,” offers updated mental illness statistics, a new section on Acute Psychosis, a greater emphasis on scene safety, on face-up restraint, and on the patient who remains agitated although in restraint.
• EXPANDED/NEW: Chapter 24, “Hematologic and Renal Emergencies,” has expanded information throughout, including new information on blood clotting and patients with urinary catheters.

Section 5 • Trauma Emergencies: Chapters 25—31

• NEW: Chapter 25, “Bleeding and Shock,” now includes information on septic shock and “sepsis alerts.” The 2014 American College of Surgeons Evidence-Based Prehospital External Hemorrhage Control Protocol is discussed and illustrated.
• NEW/EXPANDED: Chapter 26, “Soft-Tissue Trauma,” now discusses not immobilizing a patient with penetrating trauma to the torso unless there is a neurologic deficit (may harm ability to breathe). There is expanded information on blast injuries, use of a tourniquet as needed, and burns or potential burns to the airway. There are new sections on bite wounds and radiological burns.
• UPDATED: Chapter 27, “Chest and Abdominal Trauma,” and Chapter 28, “Musculoskeletal Trauma,” the use of PASG is no longer recommended.
• UPDATED/NEW: Chapter 29, “Trauma to the Head, Neck, and Spine,” increases emphasis on traumatic brain injury, expands thediscussion on spinal injury, and introduces the NEXUS algorithm for identifying potential spinal injury. New information is added on methods of spinal motion restriction and a new photo scan on “The ambulatory Self-extricated Patient.”
• UPDATED: Chapter 30, “Multisystem Trauma,” includes updated CDC trauma triage guidelines for physiologic criteria, anatomic criteria, mechanism of injury criteria, and special patient or system considerations.

Section 6 • Special Populations: Chapters 32—35

• NEW: Chapter 32, “Obstetric and Gynecologic Emergencies,” includes new information on when to cut or not to cut the umbilical cord, and a new section on how to conduct CPR on a pregnant patient.
• UPDATED: Chapter 34, “Geriatric Emergencies” includes updated statistics on the number of patients over 65 and the few who live in nursing homes as well as a discussion of how illness or injury in an elderly patient affects relationships.

Section 7 • Operations: Chapters 36—39

• NEW: Chapter 36, “EMS Operations,” adds information on the use of GPS maps for navigating and for locating an air rescue. A new section discusses use and maintenance of an ambulance back-up camera.
• NEW/UPDATED: Chapter 38, “Highway Safety and Vehicle Extrication,” includes a new emphasis on and illustrations of ANSI-approved safety vests and helmets as well as information on understanding that the time it takes for air bags to deactivate differs in different vehicles.
• UPDATED: Chapter 39, “EMS Response to Terrorism,” has been thoroughly updated and revised by the specially qualified contributing writer, Eric Powell, Ph.D., FF/NRP, Visiting Professor, Homeland Defense and Security Issues Group, Center for Strategic Leadership and Development, United States Army War College, Carlisle Barracks, Pennsylvania.

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Also available with MyBRADYLab™

This title is also available with MyBRADYLab–an online homework, tutorial, and assessment program designed to work with this text to engage students and improve results. Within its structured environment, students practice what they learn, test their understanding, and pursue a personalized study plan that helps them better absorb course material and understand difficult concepts.

• Track your students’ progress your way. A robust gradebook allows you to see multiple views of your classes’ progress. Completely customizable and exportable, the gradebook can be adapted to meet your specific needs.
• Access all of the multimedia resources for your textbook in one place. To help you build assignments, or add an extra engaging element to your lectures, each MyBRADYLab course comes with a Multimedia Library. The Multimedia Library allows students and instructors to quickly search through resources and find supporting media.
• Support the learning needs of individuals and the entire class. Instructors can view students’ results by chapter, outcome, homework and more, to help identify where more classroom time is needed!
• Read, highlight, and take notes... all online! The Pearson eText provides students with a fully-integrated ¿electronic experience for their PC or iPad®. Features include the ability to highlight, take notes, bookmark pages, search, and more. As an educator you will have the ability to push notes and highlights directly to your students or customize the order of your book.
• Help your students succeed with self-paced interactive exercises. Finally, there's a better way for your students to learn. The Learning Modules in MyBRADYLab allow students to review topics on their own through a self-paced interactive design. Have students practice at home or use them for review in the classroom. MyBRADYLab Learning Modules simply make it easier for your students to learn–and to succeed.

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Coverage of the latest standards, procedures, and practices prepares students to become effective Emergency Medical Technicians

The chapters in Section 2, and throughout the text are updated to conform to the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Chapter-by-chapter changes include:

Section 1 • FOUNDATIONS: Chapters 1-8

• Chapter 1, “Introduction to Emergency Medical Care” expands the section on the role of research in EMS (including its influence on the development of evidence-based practices).
• Chapter 2, “The Well-Being of the EMT,” expands information on safe glove removal, updates the information on the Ryan White HIV/AIDS CARE Act to include the Ryan White Extension Act of 2009, and expands information about PTSD (post-traumatic stress disorder).
• Chapter 4, “Medical, Legal, and Ethical Issues,” now discusses POLST (physician orders for life-sustaining treatment) in addition to the discussion of DNR orders, and adds information about the HIPAA Privacy Rule.
• Chapter 5, “Medical Terminology,” and Chapter 6 “Anatomy and Physiology” are now separate chapters (they were a single chapter in the prior edition) allowing for greater focus on these concepts.

Section 2 • AIRWAY Management, Respiration, and Artificial Ventilation: Chapters 9-10

• Chapter 10, “Respiration and Artificial Ventilation,” adds information on the selective use of oxygen for patients with chest pain with inclusion of the American HeartAssociation and International Liaison Committee on Resuscitation recommendations on this topic. There is also a new section on the use of oxygen saturation information in recognizing respiratory distress and failure.

Section 3 • Patient Assessment: Chapters 11—15

• Chapter 11, “Scene Size-Up,” now emphasizes that severe mechanism of injury (MOI) no longer means automatically immobilizing the spine.* There is a new emphasis on the use of ANSI-approved reflective vests at emergency scenes.
• Chapter 12, “The Primary Assessment,” includes updated information on the selective use of oxygenation and on spinal immobilization decisions.*
• Chapter 13, “Vital Signs and Monitoring Devices,” has new information on implanted ventricular assist devices, andupdated information on spinal immobilization decisions.
• Chapter 14, “Secondary Assessment,” is an entirely new chapter created primarily by combining, resequencing, and updating the prior edition’s chapters on medical patient assessment, trauma patient assessment, reassessment, and critical thinking/decision making. There are many new photos throughout the chapter. The mnemonic DCAP-BTLS is no longer used, but replaced with a simpler list of what to look for during the physical exam: wounds, tenderness, and deformities. The field triage criteria (for significant mechanisms of injury warranting transport to a trauma center) are updated in accordance with current Centers for Disease Control (CDC) guidelines.
• Chapter 15, “Communication and Documentation,” includes updated photos and text about ambulance-mounted radios, iPads with PCR software, pen-based computers, and electronic PCR formats.

* (The student is referred to Chapter 29, “Trauma to the Head, Neck, and Spine” for detailed discussion of this issue.)

Section 4 • Medical Emergencies: Chapters 16—24

• Chapter 16, “General Pharmacology,” adds naloxone as a drug for reversing narcotic overdose, the intranasal route of drug administration (for naloxone), and the Auvi-Q talking epinephrine injector.
• Chapter 18, “Cardiac Emergencies,” includes information on a new approach to oxygen administration for ACS (acute cardiac syndrome), high-performance CPR (including a new photo scan), therapeutic hypothermia, titration of oxygen post arrest, the Lucas automatic CPR device, and ventricular assist devices.
• Chapter 19, “Diabetic Emergencies and Altered Mental Status,” expands the discussion of primary assessment of a patient with altered mental status and new information on intranasal glucagon, sepsis is a dangerous cause of altered mental status, and cardiovascular causes of dizziness/syncope as well as an expanded discussion of care for stroke.
• Chapter 20, “Allergic Reaction,” now presents information about the Auvi-Q talking epinephrine injector and emphasizes that while anaphylaxis requires oxygen, mild allergic reactions do not.
• Chapter 21, “Poisoning and Overdose Emergencies,” now includes a section on naloxone as a drug that EMTs will be able to carry and administer, and introduces new information about “detergent suicides,” “bath salts,” and “designer drugs.”
• Chapter 22, “Abdominal Emergencies,” now includes the Wong-Baker pain scale.
• Chapter 23, “Behavioral and Psychiatric Emergencies and Suicide,” offers updated mental illness statistics, a new section on Acute Psychosis, a greater emphasis on scene safety, on face-up restraint, and on the patient who remains agitated although in restraint.
• Chapter 24, “Hematologic and Renal Emergencies,” has expanded information throughout, including new information on blood clotting and patients with urinary catheters.

Section 5 • Trauma Emergencies: Chapters 25—31

• Chapter 25, “Bleeding and Shock,” now includes information on septic shock and “sepsis alerts.” The 2014 American College of Surgeons Evidence-Based Prehospital External Hemorrhage Control Protocol is discussed and illustrated.
• Chapter 26, “Soft-Tissue Trauma,” now discusses not immobilizing a patient with penetrating trauma to the torso unless there is a neurologic deficit (may harm ability to breathe). There is expanded information on blast injuries, use of a tourniquet as needed, and burns or potential burns to the airway. There are new sections on bite wounds and radiological burns.
• Chapter 27, “Chest and Abdominal Trauma,” and Chapter 28, “Musculoskeletal Trauma,” the use of PASG is no longer recommended.
• Chapter 29, “Trauma to the Head, Neck, and Spine,” increases emphasis on traumatic brain injury, expands thediscussion on spinal injury, and introduces the NEXUS algorithm for identifying potential spinal injury. New information is added on methods of spinal motion restriction and a new photo scan on “The ambulatory Self-extricated Patient.”
• Chapter 30, “Multisystem Trauma,” includes updated CDC trauma triage guidelines for physiologic criteria, anatomic criteria, mechanism of injury criteria, and special patient or system considerations.

Section 6 • Special Populations: Chapters 32—35

• Chapter 32, “Obstetric and Gynecologic Emergencies,” includes new information on when to cut or not to cut the umbilical cord, and a new section on how to conduct CPR on a pregnant patient.
• Chapter 34, “Geriatric Emergencies” includes updated statistics on the number of patients over 65 and the few who live in nursing homes as well as a discussion of how illness or injury in an elderly patient affects relationships.

Section 7 • Operations: Chapters 36—39

• Chapter 36, “EMS Operations,” adds information on the use of GPS maps for navigating and for locating an air rescue. A new section discusses use and maintenance of an ambulance back-up camera.
• Chapter 38, “Highway Safety and Vehicle Extrication,” includes a new emphasis on and illustrations of ANSI-approved safety vests and helmets as well as information on understanding that the time it takes for air bags to deactivate differs in different vehicles.
• Chapter 39, “EMS Response to Terrorism,” has been thoroughly updated and revised by the specially qualified contributing writer, Eric Powell, Ph.D., FF/NRP, Visiting Professor, Homeland Defense and Security Issues Group, Center for Strategic Leadership and Development, United States Army War College, Carlisle Barracks, Pennsylvania.