Date of Issue: 2025-10-03
Last revised date: NIL
Last revised date: NIL
Red County Fire Department (RCFD)
Emergency Medical Technician - B
Emergency Medical Technician - B
Course Goal, Requirements and Purpose:
The goal is for you to obtain an EMT-B certification in order to continue your career with the RCFD. The requirements for achieving the goal is to be able to provide correct and safe treatment in a timely fashion to improve the chances of patient survival.
The purpose of this course in EMS is to provide you with the necessary skills of Basic Life Support (BLS) in both the medical and trauma spectrum to pass the EMT-B examination.
Basic Life Support:
The purpose of Basic Life Support (BLS) protocols provide uniform standards for personnel to render prehospital medical and trauma care when responding to an incident. Consent:
- If the patient is conscious:
Introduce yourself by name and rank and ask for their consent to be treated, for example, “Hi, my name is Jane Doe and I am a certified EMT with the RCFD. May I help you, sir/ma’am?”
- If yes, continue.
- If no, ask them to sign a waiver of care before leaving.
- If refusing to sign the waiver, consider requesting support from law enforcement, for example if the patient is behaving irrationally (i.g. altered mental status), appear intoxicated or otherwise not able to care for themselves - still if the person simply refuses without indicators, then leave. - If the patient is unconscious and needs immediate medical treatment there is implied consent.
Universal Algorithm (UA) - the primary assessment and start of all treatment
The RCFD uses an universal algorithm (UA) for our primary assessment, that should be completed for any and all patients, regardless. Note: deviations are only to be made if significant reasons indicate so, use common sense. Devations without cause will not be tolerated.
The UA follows a mnemonic (also known as a memory trick or learning technique that aids information retention and retrieval, i.g. easy to remember in high-stress situations) in order to ensure that the correct priority in care is followed.
By adhering to the UA mnemonic, you ensure that both correct and safe treatment is rendered in a timely fashion.
The UA mnemonic is LC-ABCDE and stands for:
- L - Location and safety
- C - Catastrophic hemorrhage (also called the big C)
- A - Airway
- B - Breathing
- C - Circulation (also called the small C)
- Disability
- Exposure
Ask yourself, is it safe for me to approach the incident/patient. If there are any active hazards in the area such as:
- A shooter, then stay out of the area until police clears it for you.
- Unsafe traffic condition, park safely and/or try and block off traffic in one lane - request police to assist in redirecting traffic, etc.
Use your personal protection equipment. This includes body substance isolation (BSI) equipment to protect you from body substances like blood, urine, feces, etc. It is your responsibility to use safety precautions when rendering medical care to individuals who might be carrying HIV, hepatitis, etc.
Big C - Catastrophic hemorrhage
Most common with trauma patients, such as traffic collisions (TC), stab wounds, low or high velocity gun-shot-wounds (GSW), explosions, etc.
Treat any obvious massive hemorrhage with limb tourniquets, wound packing, pressure bandages and/or junctional tourniquets, as appropriate.
Massive hemorrhage are all arterial bleedings, meaning that an artery has been ruptured, giving bright red to yellowish in color blood due to the high degree oxygenation. Arterial hemorrhages or bleeds, typically exit the wound in spurts, rather than in a steady flow (venous bleeding).
These hemorrhages lead can lead to copious amount of blood loss and can occur very rapidly.
Any damage to a major artery, such as aorta, femoral or carotid, would most likely result in about 200-500 mL/min blood loss, with consequence loss of consciousness in one (1) to three (3) minutes and three (3) to five (5) minutes to death.
A - Airway
Ensure that the patient has a clear airway. If they're talking - then they have a secure airway.
If unconscious or unresponsive, ensure that the patient is on their back (if a spine or neck injury is suspected do not roll them), if they’re not roll them over carefully. Make sure to roll the entire body to prevent their body to twist.
Open their airway and inspect for obstructions, check the patients mouth for foreign objects and/or body fluids such as blood or vomit and remove as quickly as possible with a finger-sweep until the airway is free, you can also consider putting the patient in a recovery position to drain by gravity liquids from their mouth and/or use a portable pump to clear liquid obstructions.
Note: The human brain can only take three (3) minutes of hypoxia (deprived of adequate oxygen supply) before it sustains permanent damage.
Airway management is done through:
- Head-tilt/chin-lift method. (CAUTION: Do NOT use if a spinal or neck injury is suspected.)
- Jaw-thrust method. (CAUTION: Use this method IF a spinal or neck injury is suspected.)
Check for breathing. While maintaining the open airway, place an ear over the patient’s mouth and nose, looking down toward their chest for movement while feeling and listening for signs for respiration. Ventilate the patient with a bag valve mask (BVM) if their own breathing is inadequate.
The breathing is considered inadequate if:
- The patient is unconscious.
- The respiratory rate (RR) is less than 2 in 15 seconds and/or the patient is making snoring or gurgling sounds.
- If the patient suffers from significant respiratory distress administer oxygen, 15 liters/minute, through a non-rebreather mask. Monitor patient closely for possible vomitting/airway compromise.
- If the patient suffers from mild respiratory distress administer oxygen, 4-6 liters/minute, through a nasal cannula. Consider using cannula for patient with nausea or who will not tolerate a mask.
C - Circulation (small C)
Check for a pulse, either by:
- Placing your finger across their artery and counting for one (1) minute, each beats detected or for thirty (30) seconds and then multiplying beats detected by two, this will give you their heart rate (HR) in beats per minute (BPM).
Note: do not use your thumb, as your own pulse might interfere with counting and or detecting absent pulse altogether. - Applying a pulse oximeter to the patients index finger
Note: pulse oximeter detects the different wavelengths for light to pass between the oximeter clamp, thus giving you both saturated oxygen in % and a heart rate, this only works if the patient does not nail polish or similar!)
Do a color, motor and sensation (CMS) check.
- Color of skin? Do a comparison between both hands, make an estimation of their body temperature (BT), is patient cold, normal or hot?
- Motor skills? Can they squeeze your hands with theirs, can they close their hand hard, can they lift their legs, wiggle their feet?
- Does patient have sensation? Do they feel pain or discomfort when pinching their finger, toe, etc?
Check their level of consciousness (LOC) by following the mnemonic AVPU, see below:
- A - Alert, patient is alert, talking, know where they are, etc.
- V - Verbal, patient is conscious, making inconmprehensible talk, they do not know where they are, etc.
- P - Pain, patient is unconscious, but responds instinctively to painful stimuli, for example pinching their finger, etc.
- U - Unconscious - patient is unconscious and does not respond to any painful stimuli, etc
- Pupils are...
- Equal?
- Round?
- Reactive to
- Light?
- Accomodating back to normal?
Primary assessment is at this point completed.
At this point you should have cleared the highest priority objectives, i.g. airway is clear, patient is breathing, has a pulse and is conscious.
You should also at this point have collected the basic baseline vital signs already, see below with within normal limits (WNL) noted:
- RR: 12-20.
- HR: 60-100.
- CRT: < 2 seconds.
- SpO2: 96-99%
- Skin signs: Clammy/normal/pale
- BT: Cold/normal/warm.
Extra vital signs (beyond scope of BLS) that can be obtained by following LC-ABCDE up until this point are:
- BP: SBP 80-120 mmHg.
- Lung sounds: Absent/diminished/normal.
- 12-lead-ECG: TBA.
Check head to toe for secondary, unidentified injuries, reveal/expose patient from clothing as indicated to identify potential injuries.
Protect the patient from the elements, if too cold, take measures to keep the patient warm, with for example ready-heat-blanket (RHB), wool blankets, etc - tuck them in after resolving any identified secondary injuries.
Prepare for evacuation to nearby hospital.
Fill in MIST report and SAMPLE (most commonly used if patient is a medical case only, i.g. no trauma or mechanism of injury) if indicated for the Patient Care Report (PCR).
Treatment protocols - after completing the UA, you should have identified the root problem and should continue with the appropriate protocol
BLS - Medical protocols:
Cardiac Arrest - Medical
If medical in nature:
Universal Algorith
Do not delay initiation of CPR
Follow current CPR guidelines
30 compressions, 2 full breaths and repeat.
Apply AED if indicated.
Obtain medical history and gather medications if possible
Obtain event history
Down time prior to CPR initiation.
Total down time including CPR.
Special considerations related to Cardiac Arrest - Medical:
Cold water drowning and hypothermia patients should have resuscitation performed even with extended down times.
Only stop CPR if:
The patient is breathing and has a pulse, you are relived by a qualified person, stopped by a supervisor or you are too tired to continue.
Abdominal Pain:
Universal Algorithm
Reassure/calm patient
Give nothing by mouth
Obtain vital signs
Obtain medical history or information on traumatic event
Treat for shock as necessary
Beware of vomitting - be prepared to protect the airway
Patients with abdominal pain should be evaluated at County General Hospital and not on-scene.
Altered Mental Status:
Universal Algorithm
Known diabetic
If patient is able to swallow water and their gag reflex is intact, administer glucose paste, juice, non diet sida, milk, candy, or any other type of glucose.
Trauma related
Place patient in full spinal precautions.
Assess for other injuries.
Consider medical cause for patient’s altered mental state, such as:
- Alcohol.
- Epilepsy.
- Insulin.
- Overdose.
- Uremia.
- Trauma.
- Infection.
- Psychiatric.
- Stroke.
- Toxic exposure.
Ingestion/Poisoning:
Universal Algorithm
Decontaminate
Brush off dry substances.
Remove all contaminated clothing.
Flush with large quantities of water.
Reassure/calm patient
Position of comfort
Obtain vital signs
Obtain medical history
Gather medications or list
Do not delay transport
Shock - Medical:
If medical in nature:
Universal Algorithm
Place patient supine with legs elevated
Keep patient warm
Do not delay transport
Obtain vital signs
Obtain medical history
Gather medications or list
BLS - Trauma trauma protocols:
Cardiac Arrest - Trauma
If trauma in nature:
Universal Algorithm
Do not delay initiation of CPR
Follow current CPR guidelines
30 compressions, 2 full breaths and repeat.
Place patient in full spinal precautions
Avoid hyperextension of the neck
Control obvious hemorrhage
Initiate rapid transport
Special considerations related to Cardiac Arrest - Trauma:
AED is not to be applied unless there are indications that the cardiac arrest preceeded the traumatic event
Only stop CPR if:
The patient is breathing and has a pulse, you are relived by a qualified person, stopped by a supervisor or you are too tired to continue.
Spinal Immobilization:
Universal Algorithm
Indications
Patients with a history of significant trauma or mechanism of injury resulting in:
Blunt trauma
Head trauma
Axial spine trauma
Trauma patients with altered level of consciousness (ALOC.)
Trauma patients with a history of alcohol/drug impairment.
Trauma patients complaining of neck or spine pain.
Spinal immobilization is achieved through:
Cervical collars.
Securing patients to long spine boards.
If in doubt, transport patient with spinal immobilization
Shock - Traumatic:
Universal Algorithm
Control hemorrhaging with:
- Continuous direct pressure
- Elevation
- Pressure point (proximal to injury, if hemorrhaging hand, pressure point the carotid artery for example)
- Tourniquet (CAUTION: This is a LAST resort. Nerve damage to limb is unavoidable when applied over thirty (30) minutes and complications from blood clotting might out-weigh the benefits!)
Consider trendelenburg position
Keep patient warm
Do not delay transport
Obtain vital signs and reassess frequently
Signs of hypovolemic shock pulse is fast but weak.
Monitor for changes in mental status
Assess and treat secondary injuries
Spinal Injuries:
Universal Algorithm
Place patient in full spinal precautions
Establish manual spinal stabilization
Apply properly-sized cervical collar maintaining manual c-spine stabilization.
Secure patient to long spine board:
Ensure adequate strapping to prevent patient movement.
Secure head last. Work from feet and upwards.
Monitor airway closely, be prepared to log roll patient in the event of vomitting
Reassure/calm patient
Assess for secondary injuries
Obtain vital signs
Monitor for altered mental status
Soft Tissue Injuries:
Universal Algorithm
Stop bleeding, control hemorrhaging with:
- Continuous direct pressure
- Elevation
- Pressure point (proximal to injury, if hemorrhaging hand, pressure point the carotid artery for example)
- Tourniquet (CAUTION: This is a LAST resort. Nerve damage to limb is unavoidable when applied over thirty (30) minutes and complications from blood clotting might out-weigh the benefits!)
Check distal (away from injury, if hemorrhaging forearm, then check hand) neurovascular status, a CMS check is adequate.
Orthopedic Injuries:
Universal Algorithm
Closed Fractures
- Confirm and mark distal pulses.
- Immobilize joints above and below fracture with well padded splint.
- Apply traction splint to femur fractures only.
- Apply cooling packs to reduce swelling and relieve pain.
- Open Fractures
- Confirm and mark distal pulses.
- Immobilize joints above and below fracture with well padded splint.
- Apply moist dressings and bandages to stop bleeding and reduce contamination.
Do not attempt to “reduce” an open fracture.
Reassure/calm patient
Position of comfort
Obtain vital signs
Consider spinal precautions
Do not delay transport if neurovascular compromise noted
Head Trauma:
Universal Algorithm
Spinal precautions if indicated
Monitor airway closely
Assess Level of Concsciousness (LOC)
This is done via the AVPU-method. Is the patient alert, verbal, or does the patient respond to painful stimuli or is the patient unconscious?
Assess for secondary injuries
Obtain vital signs
Obtain medical history
Gather medications or list
Monitor patient’s mental status for changes and document their LOC.
Eye Injuries:
Universal Algorithm
Chemical contamination
Avoid contamination of unaffected eye.
Flush continuously with water or normal saline for at least 15 minutes or until patient arrives at hospital.
Trauma/foreign body
Bandage both eyes to prevent eye movement.
Do not remove foreign body or impaled objects, instead stabilize with bulky dressings.
Consider need for spinal precaution.
Reassure/calm patient
Position semi-fowlers if possible
Obtain vital signs
Obtain medical history
Gather medications or list
Chest Trauma:
Universal Algorithm
- Penetrating Trauma
- Penetrating trauma often causes open chest wounds, often called "suck and blow."
- Cover wound with chest seal device (CSD) or if not available, use a suitable object such as plastic cover and tape loosely on three (3) out of four (4) sides. This allows air to escape but not seep back in and thus the patient can breathe on their own.
- Monitor patient closely for development of tension pneumothorax, a progressive build-up of air within the pleural space in the patient’s lung, typically followed by circulatory collapse with hypotension and subsequent traumatic arrest. Unexplained tachycardia and hypotension indicates developing tension. If this occurs, remove dressing to allow the air to escape. (CAUTION: Do not remove the CSD.)
- Impaled objects must be stabilized with bulky dressings and do not attempt to remove objects. - Perforating Trauma
- Perforating trauma compared to penetrating trauma, means that there is an exit wound as well, see above treatment protocols but ascertain that both "holes" are addressed. Rule out all penetrating trauma not to be perforating. - Blunt Trauma
- Blunt trauma often causes flail chest.
- Support flail section with pillow or other supportive device to provide patient comfort.
Reassure/calm patient
Position of comfort if possible
Obtain vital signs
Provide manual respiratory support as indicated with a BVM.
Do not delay transport.
Burns:
Universal Algorithm, with special precautions for A - Airway, if smoke inhalation indicated, the airway might swell and close off. Secure an airway early!
Small burns < 15% total body surface area (TBSA)
Cover with moist sterile dressings using normal saline or a commercial water gel burn dressing.
Large burns > 15% TBSA
Cover with moist sterile dressings using normal saline or a commercial water gel burn dressing and then cover with dry dressings to prevent hypothermia.
Reassure/calm patient
Position of comfort
Obtain vital signs
Assess/treat secondary injuries
Treat for shock
Monitory airway closely for swelling
Special considerations:
Chemical burns
Remove patient’s clothing
Remove contaminants with large quantities of water.
Consider other toxic exposures
Abdominal Trauma:
Universal Algorithm
- Blunt Trauma
- Repeat abdominal exam frequently for changes in color and rigidity.
- Do not delay transport! - Penetrating Trauma
- Stop bleeding/apply dressing.
- Stabilize impaled objects with bulky dressings.
- In case of eviscerations cover the area with large moist dressings. (CAUTION: Do not replace intestines or “push” them in.)
- Check if penetrating trauma is perforating, if so address this as well!
Do not delay transport.
Give nothing by mouth
Obtain vital signs frequently
Obtain medical history or information on traumatic event
Treat for shock as necessary
Spinal precautions as indicated
Monitor for vomitting - be prepared to protect airway
In Summary:
The purpose of this course in EMS was to provide you with the necessary skills of Basic Life Support (BLS) in both the medical and trauma spectrum to pass the EMT-B examination. With the treatment matrices found above you the tools to pass the requirements and achieve the goal.
Do note that this document is subject for revision based on lessons learned and continuous quality improvements.
You're recommended to review this material often.