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E M E RG E NCY
CARE 14 T H E D I T I O N
This page intentionally left blank

DANIEL LIMMER • M I C H A E L F. O ’ K E E F E
MEDICAL EDITOR: EDWARD T. DICKINSON , MD, NRP, FACEP
E M E RG E NCY
CARE 14 T H E D I T I O N
LEGAC Y AU T HORS
HARVEY D. GRANT
ROBERT H. MURRAY, JR.
J. DAVID BERGERON
Senior Vice President, Product Management: Adam Jaworski Product Marketing Coordinator: Brian Hoehl
Director, Product Management: Katrin Beacom Full-Service Project Management and Composition: SPi Global
Content Manager: Kevin Wilson Inventory Manager: Vatche Demirdjian
Development Editor: Rachel Bedard Manager, Rights & Permissions: Gina Cheselka
Vice President, Content Production and Digital Studio: Caroline Power Interior and Cover Design: Studio Montage
Managing Producer, Health Science: Melissa Bashe Cover Art: Pearson photo by Michal Heron
Content Producer: Faye Gemmellaro Managing Photography Editor: Michal Heron
Operations Specialist: Maura Zaldivar-Garcia Photographers: Michal Heron, Kevin Link, Maria Lyle, Isaac Turner
Director, Digital Production: Amy Peltier Back Cover Photo: © Daniel Limmer
Digital Studio Producer: William Johnson Printer/Binder: LSC Communications, Inc.
Digital Content Team Lead: Brian Prybella Cover Printer: Phoenix Color/Hagerstown
Notice on Care Procedures: It is the intent of the authors and publisher that this text be used as part of a formal Emergency Medical Technician
(EMT) education program taught by qualified instructors and supervised by a licensed physician. The procedures described in this textbook
are based on consultation with EMT and medical authorities. The authors and publisher have taken care to make certain that these procedures
reflect currently accepted clinical practice; however, they cannot be considered absolute recommendations.
The material in this text contains the most current information available at the time of publication. However, federal, state, and local guidelines
concerning clinical practices, including (without limitation) those governing infection control and universal precautions, change rapidly. The
reader should note, therefore, that the new regulations may require changes in some procedures.
It is the reader’s responsibility to familiarize himself or herself with the policies and procedures set by federal, state, and local agencies as well as
the institution or agency where the reader is employed. The authors and the publisher of this text and the supplements written to accompany it
disclaim any liability, loss, or risk resulting directly or indirectly from the suggested procedures and theory, from any undetected errors, or from
the reader’s misunderstanding of the text. It is the reader’s responsibility to stay informed of any new changes or recommendations made by
any federal, state, or local agency as well as by his or her employing institution or agency.
Notice on Gender Usage: The authors in the fourteenth edition have made great efforts to eliminate gender-preferential language in all general
discussions. However, in case studies in which a patient is identified as a man or a woman, the applicable pronoun is used.
Notice Regarding “Street Scenes” and “Scenarios”: The names used and situations depicted in the Street Scenes and Scenarios throughout
this text are fictitious.
Notice on Medications: The authors and the publisher of this text have taken care to make certain that the equipment, doses of drugs, and
schedules of treatment are correct and compatible with the standards generally accepted at the time of publication. Nevertheless, as new
information becomes available, changes in treatment and in the use of equipment and drugs become necessary. The reader is advised to
carefully consult the instruction and information material included in the page insert for each drug or therapeutic agent, piece of equipment,
or device before administration. This advice is especially important when using new or infrequently used drugs. Prehospital care providers are
warned that use of any drugs or techniques must be authorized by their Medical Director, in accordance with local laws and regulations. The
publisher disclaims any liability, loss, injury, or damage incurred as a consequence, directly or indirectly, of the use and application of any of
the contents of this text.
Copyright © 2021, 2016, 2012 by Pearson Education, Inc. 221 River Street, Hoboken, NJ 07030, or its affiliates. All Rights Reserved. Printed in
the United States of America. This publication is protected by copyright, and permission should be obtained from the publisher prior to any
prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying,
recording, or otherwise. For information regarding permissions, request forms, and the appropriate contacts within the Pearson Education Global
Rights & Permissions department, please visit www.pearsoned.com/permissions/.
CIP available at the Library of Congress
ScoutAutomatedPrintCode 2014043533
ISBN-10: 0-13-662126-0
ISBN-13: 978-0-13-662126-3
Dedication
This edition is dedicated to Stephanie, Sarah and Margo. I am fortunate to be

surrounded by your love and support. And to my buddy, Lulu.
— D.L.
To the memory of my parents, Mike and Noreen, and to my family.

— M.O’K.
To my wife Debbie for her endless patience and support for this 14th edition, and
to all the EMS providers of PennStar and the Malvern, Berwyn, and Radnor Fire
Companies who keep me grounded in the prehospital environment.
— E.T.D.
Acknowledgments
This 14th edition of Emergency Care, like others, has left your authors feeling grateful
for the dynamic and talented team we have worked with. It is also a time for change,
so as we give our thanks, we must sadly say goodbye to some people very dear to us.
First on this list is Michal Heron. Since the 6th edition of Emergency Care, Michal
has been our photo editor and photographer extraordinaire. Her talent, vision, and
attention to detail have been a foundation not only for the visuals, but for the book
itself, creating a bright and welcoming appearance with accurate images to learn
from. Michal—there will never be another you and we will miss you acutely.
Sandy Breuer was the editor of Emergency Care, also since the 6th edition. She came
onboard with Michal and changed the way books were done at Brady. Her talent
and sense of humor were limitless. Her dedication is legendary. We didn’t get to
work with Sandy on this edition but her legacy lives on in the book you see before
you today.
Faye Gemmellaro is a gentle giant behind the scenes. If books had air traffic
controllers, Faye would be ours. Guiding this edition to a safe landing with skill and
aplomb, Faye manages multiple tasks effortlessly and coordinates pieces that, while
unseen to many who write and read these books, are so necessary. Faye has moved
to another part of Pearson. It won’t be the same without you, Faye.
Editors come and go over the years. This edition saw several members of the editorial
team leave the fold. Marlene Pratt, Executive Editor, is no longer with the team. Marlene
was the editor for this product for many years, including the Pearson award-winning
10th edition. She later oversaw all of Brady. Derril Trakalo was with us for the kick-off of
this edition and got us started on a solid course before relocating to another corner
of Pearson. Our sincere thanks to both Marlene and Derril for their dedication to this
book and our best wishes to you. Julie Alexander was a Vice President over Brady
for many, many years and also no longer with us. Julie was always personable and
approachable while at the helm. We are sad knowing you aren’t there.
When we say so many goodbyes, there are many people to introduce to you. Katrin
Beacom is the new Director of Product Management. She is a familiar and friendly
face to us as the former marketing manager for Brady years ago. Kat, it is good to
have you back. Kevin Wilson recently replaced Derril Trakalo. We still call him an
editor even though Pearson calls him Content Manager. Kevin comes from the sales
force and has brought much to the table bringing this edition to fruition. We look
forward to working with you.
Our editor this edition is Rachel Bedard. Rachel had tough shoes to fill but did so
admirably. Rachel and her team tracked content and schedules, edited manuscript,
made sure photos were placed and referenced, and perhaps the most difficult task,
dealt with busy authors. Your authors know EMS and EMS education, but putting
together a textbook is something totally different and sometimes foreign. We are
grateful for Rachel and her team for artfully assembling the book you have before
you now.
There are so many people to thank including Pearson’s editorial assistants, the sales
reps who help get the book out to you and your instructors, Beth Muniz who directs
our sales force, magician and problem solver Lenny Losacco, marketing professionals
like our old friends Brian Hoehl, Rachele Strober, and more. We’re sorry we can’t
name you all.
We thank our families who put up with the schedule of writing and publishing a
textbook and support us in this labor of love.
We are grateful for the educators who put their trust in us to provide the book which
serves as a foundation for their course. We salute the current EMRs, EMTs, AEMTs,
and paramedics who make EMS what it is today. Finally, we welcome the students
who enter EMS through their EMT course. You give us hope for the future. We wish
you the joys, successes and lasting friendships we have gained over the years we
have been in EMS.
— D.L.
vi
BRIEF CONTENTS
SEC T ION 1 SEC T ION 3

Foundations 1 Patient Assessment 288
CHAPTER 1 CHAPTER 11
Introduction to Emergency Scene Size-Up 289
Medical Services 2 CHAPTER 12
CHAPTER 2 Primary Assessment 312
Well-Being of the EMT 22 C HAPTER 13
CHAPTER 3 Vital Signs and Monitoring Devices 338
Lifting and Moving Patients 54 CHAPTER 14
C H A P TE R 4 Principles of Assessment 368
Medical, Legal, and Ethical Issues 79 C HAPTER 15
CHAPTER 5 Secondary Assessment 403
Medical Terminology 102
CHAPTER 16
C H A P TE R 6 Reassessment 453
Anatomy and Physiology 115
CHAPTER 17
CHAPTER 7 Communication and Documentation 462
Principles of Pathophysiology 154
CHAPTER 8 SEC T ION 4
Life Span Development 184
Medical Emergencies 493
CHAPTER 18
SEC T ION 2 General Pharmacology 494
Airway Management, Respiration, CHAPTER 19
and Artificial Ventilation 199 Respiratory Emergencies 517
CHAPTER 9 C HAPTER 20
Airway Management 200 Cardiac Emergencies 555
C H A P TE R 1 0 CHAPTER 21
Respiration and Artificial Ventilation 236 Resuscitation 580
vii
C H A P T ER 2 2 SEC T ION 6
Diabetic Emergencies and Altered
Mental Status 619 Special Populations 1050
C H A P T ER 2 3 CHAPTER 36
Allergic Reaction 650 Obstetric and Gynecologic Emergencies 1051
C H A P T ER 2 4 CHAPTER 37
Infectious Diseases and Sepsis 669 Emergencies for Patients with Special
Challenges 1101
C H A P T ER 2 5
Poisoning and Overdose
Emergencies 694 SEC T ION 7
CHAPTER 26 Operations 1140
Abdominal Emergencies 725 CHAPTER 38
C H A P T ER 2 7 EMS Operations 1141
Behavioral and Psychiatric Emergencies CHAPTER 39
and Suicide 745 Hazardous Materials, Multiple-Casualty
C H A P T ER 2 8 Incidents, and Incident Management 1176
Hematologic and Renal Emergencies 763 CHAPTER 40
Highway Safety and Vehicle
SEC T ION 5 Extrication 1213
Trauma 782 C HAPTER 41

EMS Response to Terrorism 1243
C H A P T ER 2 9
Bleeding and Shock 783
A P P E N DI X
C H A P T ER 3 0
Soft-Tissue Trauma 823 APPENDIX A
Basic Cardiac Life Support Review 1283
C H A P T ER 3 1
Chest and Abdominal Trauma 867
R E F E R E NC E S
C H A P T ER 3 2
Musculoskeletal Trauma 892 REF ERENC E
Medical Terms 1297
C H A P T ER 3 3
Trauma to the Head, Neck, REF ERENC E
and Spine 947 Anatomy and Physiology Illustrations 1304
C H A P T ER 3 4
Multisystem Trauma 997
Answer Key 1317
CHAPTER 35
Glossary 1377
Environmental Emergencies 1012 Index 1393
viii
CONTENTS
Emotion and Stress 38
1
• Physiologic Aspects of Stress 39
SECTION • Types of Stress Reactions 40
• Causes of Stress 41
• Signs and Symptoms of Stress 42
Foundations 1 • Dealing with Stress 42
CHAPTER 1 Scene Safety 46
Introduction to Emergency Medical Services 2 • Hazardous Material Incidents 46
The Emergency Medical Services System 3 • Terrorist Incidents 47
• How It Began 3 • Rescue Operations 47
• EMS Today 4 • Violence 48
Components of the EMS System 5 Chapter Review 52

• Accessing the EMS System 7
• Levels of EMS Training 7 CHAPTER 3
Think Like an EMT A Key Concept 8 Lifting and Moving Patients 54
Roles and Responsibilities of the EMT 9 Protecting Yourself: Body Mechanics 56
• Traits of a Good EMT 10 Protecting Your Patient: Emergency, Urgent,
• Where Will You Become a Provider? 12 and Nonurgent Moves 58
• National Registry of Emergency • Emergency Moves 58
Medical Technicians 12 • Urgent Moves 59
• Quality Improvement 13 • Nonurgent Moves 59
• Medical Direction 14 Think Like an EMT Choosing a
The EMS Role in Public Health 16 Patient-Carrying Device 71
Research 17 Chapter Review 77
• The Basics of EMS Research 17
Special Issues 19 CHAPTER 4
Chapter Review 20 Medical, Legal, and Ethical Issues 79
Scope of Practice 81
CHAPTER 2 Patient Consent and Refusal 82
Well-Being of the EMT 22 • Consent 82
Well-Being 24 Think Like an EMT Ethical Dilemmas 82
Personal Protection 25 • When a Patient Refuses Care 83
• Standard Precautions 25 • Do Not Resuscitate Orders and Physician’s
Think Like an EMT Standard Precautions 26 Orders for Life-Sustaining Treatment 87
• Personal Protective Equipment 26 Other Legal Issues 90
Diseases of Concern 31 • Negligence 90
• Specific Diseases of Concern 33 • Duty to Act 92
• Infection Control and the Law 34 • Good Samaritan Laws 92
• Immunizations 38 • Confidentiality 92
ix
• Special Situations 93 The Regulation of Homeostasis 161

• Crime Scenes 95 The Cardiopulmonary System 162
• Special Reporting Requirements 98 • The Airway 163
• Other Ethical Responsibilities 98 • The Lungs 164
Chapter Review 99 • The Blood 168
• The Blood Vessels 169
CHAPTER 5 • The Heart 172
Medical Terminology 102 • The Cardiopulmonary System: Putting It
All Together 174
Medical Terminology 104
• The Components of Medical Terms 104 Shock 174
• Abbreviations and Acronyms 106 Pathophysiology of Other Systems 176
• When and When Not to Use Medical Terms 107 • Fluid Balance 176
The Language of Anatomy and Think Like an EMT Why Is Her Heart
Physiology 107 Beating Rapidly? 178
Anatomic Terms 107 • The Nervous System 179
• Directional Terms 107 • The Endocrine System 180
• Positional Terms 111 • The Digestive System 180
• The Immune System 181
Chapter Review 112
Chapter Review 181
CHAPTER 6
Anatomy and Physiology 115 CHAPTER 8
Locating Body Organs and Structures 118 Life Span Development 184
Body Systems 118 Infancy (Birth to 1 Year) 186
• Musculoskeletal System 118 • Physiologic Changes 186
• Respiratory System 127 • Psychosocial Changes 188
• Cardiovascular System 130 Toddler Phase (12–36 Months) 188
• Life Support Chain 136 • Physiologic Changes 189
• Lymphatic System 139 • Psychosocial Changes 190
• Nervous System 139 Preschool Age (3–5 Years) 190
• Digestive System 142 • Physiologic Changes 191
• Integumentary System 143 • Psychosocial Changes 191
• Endocrine System 144 School Age (6–12 Years) 191
• Renal System 144 • Physiologic Changes 191
• Reproductive System 147 • Psychosocial Changes 192
Think Like an EMT Identifying Possible Adolescence (13–18 Years) 192
Areas of Injury 147 • Physiologic Changes 193
Chapter Review 150 • Psychosocial Changes 193
Early Adulthood (19–40 Years) 193
CHAPTER 7 • Physiologic Changes 193
Principles of Pathophysiology 154 • Psychosocial Changes 193
The Cell 158 Middle Adulthood (41–60 Years) 194
• Water and the Cell 159 • Physiologic Changes 194
• Glucose and the Cell 159 • Psychosocial Changes 195
• Oxygen and the Cell 159 Late Adulthood (61 Years and Older) 195
• The Vulnerability of Cells, Organs, and • Physiologic Changes 195
Organ Systems 161 • Psychosocial Changes 196
x
Think Like an EMT Determining If Vital • Pathophysiology of the Cardiopulmonary

Signs Are Normal 196 System 241
Chapter Review 197 Respiration 243
• Adequate and Inadequate Breathing 243
Positive Pressure Ventilation 251
• Techniques of Artificial Ventilation 251
2
Oxygen Therapy 264
SECTION • Importance of Supplemental Oxygen 264
• Oxygen Therapy Equipment 265
• Hazards of Oxygen Therapy 270
Airway Management, Respiration, • Administering Oxygen 271
and Artificial Ventilation 199 • Supplemental Oxygen for Patients with
CHAPTER 9 Chest Pain? What is the Evidence? 274
Airway Management 200 Special Considerations 279
Airway Physiology 203 Think Like an EMT Oxygen or Ventilation? 279
• Pediatric Airway Physiology 205 Assisting with Advanced Airway Devices 281
Airway Pathophysiology 206 • Preparing the Patient for Intubation 281
• Sounds of a Partially Obstructed Airway 207 • Ventilating the Intubated Patient 283
Think Like an EMT Will the Airway • Assisting with a Trauma Intubation 284
Stay Open? 210 Chapter Review 285
Opening the Airway 210
• Head-Elevated, Sniffing Position 211
• Providing an Airway: Manual Airway
3
Maneuvers 212
Obstructed Airways 214 SECTION
• Conscious Choking Adults and Children 214
• Unconscious Choking 215
Airway Adjuncts 216
Patient Assessment 288
• Rules for Using Airway Adjuncts 217 CHAPTER 11
• Oropharyngeal Airway 217 Scene Size-Up 289
• Nasopharyngeal Airway 220 Scene Size-Up 290
• Supraglottic Airways 222 • Scene Safety 291
Suctioning 227 Think Like an EMT Should I or Shouldn’t I? 298
• Using Gravity to Clear an Airway 227 • Nature of the Call 299
• Suctioning Devices 228 • Number of Patients and Adequacy of Resources 307
• Pediatric Suctioning 230 Think Like an EMT Determining Areas of
• Techniques of Suctioning 230 Concern at the Scene 309
Keeping an Airway Open: Definitive Care 233 Chapter Review 309
Special Considerations 233
Chapter Review 234 CHAPTER 12
Primary Assessment 312
CHAPTER 10 The Primary Assessment 314
Respiration and Artificial Ventilation 236 • Approach to the Primary Assessment 314
Physiology and Pathophysiology 239 • Performing the Primary Assessment 315
• Mechanics of Breathing 239 • Form a General Impression 318
• Physiology of Respiration 240 • Beginning Spinal Motion Restriction 318
xi
• The “Look Test” 319 • How a Clinician Reaches a Diagnosis 392

• The Chief Complaint 321 • How an EMT Can Learn to Think Like an
• Assess Mental Status 321 Experienced Physician 398
• Assess the A-B-Cs 322 Chapter Review 401
• Determine Priority 327
Think Like an EMT Determining Priority 328 CHAPTER 15
Comparing the Primary Assessments 333 Secondary Assessment 403
Chapter Review 335 The Secondary Assessment 405
• Components of the Secondary Assessment 405
CHAPTER 13 Secondary Assessment of the

Vital Signs and Monitoring Devices 338 Medical Patient 407
• Responsive Medical Patient 407
Gathering the Vital Signs 340
• Unresponsive Medical Patient 411
Vital Signs 340
• Pulse 340
Think Like an EMT Challenges in
History Gathering 412
Think Like an EMT Solving Assessment
Problems 344 Mid-Chapter Review 418
• Respiration 345 Secondary Assessment of the Trauma Patient 420
• Skin 347 • Trauma Patient with Minor Injury/Low Priority 420
• Pupils 349 • Spinal Motion Restriction—Applying a
• Blood Pressure 350 Cervical Collar 425
• Temperature 356 • Trauma Patient with Serious Injury or
Monitoring Devices 359 Multisystem Trauma/High Priority 428
• Oxygen Saturation 359 • Some General Principles 443
• Blood Glucose Meters 361 Think Like an EMT Rapid Trauma or
• Capnography 364 Focused Exam? 443
Chapter Review 365 Detailed Physical Exam 447
• Trauma Patient with a Significant Injury 448
CHAPTER 14 • Trauma Patient Who Is Not Seriously Injured 449
Principles of Assessment 368 Chapter Review 450

Principles of Assessment 370
• The Patient History 370 CHAPTER 16
Think Like an EMT Critical Thinking Reassessment 453
and Decision Making 370 Reassessment 454
The Physical Examination 377 • Components of Reassessment 454
• Physical Examination Techniques 377 • Observing Trends 457
• Pediatric Physical Exam 378 • Reassessment for Stable and
Unstable Patients 457
Body System Examinations 378
• Respiratory System 379 Think Like an EMT Trending Vital Signs 458
• Cardiovascular System 382 Chapter Review 459
• Nervous System 384
• Endocrine System 386 CHAPTER 17
• Gastrointestinal System 387 Communication and Documentation 462
• Immune System 388 Communications Systems and Radio
• Musculoskeletal System 389 Communication 464
Critical Thinking and Decision Making 391 • Communications Systems 464
• EMT Diagnosis and Critical Thinking 392 • Radio Communication 466
xii
The Verbal Report 469 Think Like an EMT How or Whether to

Think Like an EMT Communication Assist with Medications 514
Challenges 470 Chapter Review 514
Interpersonal Communication 470
• Team Communication 470 CHAPTER 19
• Therapeutic Communication 471 Respiratory Emergencies 517
Prehospital Care Report 474 Respiration 520
• Functions of the Prehospital Care Report 476 • Respiratory Anatomy and Physiology 520
• Elements of the Prehospital Care Report 478 • Adequate Breathing 522
Special Documentation Issues 482 • Inadequate Breathing 523
• Legal Issues 482 • Adequate and Inadequate Artificial
Think Like an EMT Choosing How and Ventilation 527
What to Document 483 Breathing Difficulty 528
• Special Situations 487 • Pediatric Respiratory Distress 532
Chapter Review 491 • Continuous Positive Airway Pressure (CPAP) 535
Respiratory Conditions 538
• Chronic Obstructive Pulmonary
Disease (COPD) 538
4
• Asthma 540
SECTION • Pulmonary Edema 541

• Pneumonia 542
• Spontaneous Pneumothorax 542
Medical Emergencies 493 • Pulmonary Embolism 543
• Epiglottitis 543
CHAPTER 18
• Croup 544
General Pharmacology 494
• Bronchiolitis 544
Medications EMTs Can Administer 496 • Cystic Fibrosis 544
Think Like an EMT We Are Really Close • Viral Respiratory Infections 545
to the Hospital. Should I Give Aspirin? 498 The Prescribed Inhaler 546
EMTs Assisting with Prescribed Medications 499 The Small-Volume Nebulizer 547
General Information about Medications 503 Think Like an EMT Administering a
• Drug Names 503
Prescribed Inhaler 550
Think Like an EMT ALS Is on the Way.
Chapter Review 552
Should I Assist the Patient with
Her Inhaler? 504
• What You Need to Know When Giving
CHAPTER 20
a Medication 504 Cardiac Emergencies 555
• Medication Safety and Clinical Judgment 504 Cardiac Anatomy and Physiology 557
• Medication Authorization 505 Acute Coronary Syndrome 558
• The Five Rights 505 • Management of Acute Coronary
• Routes of Administration 506 Syndrome 559
• Pharmacodynamic Considerations 507 Think Like an EMT Meeting Sublingual
• Reassessment and Documentation 507 Nitroglycerin Criteria 569
• Medications Patients Often Take 508 Cardiovascular Disorders 570
Assisting with IV Therapy 510 • Coronary Artery Disease 570
• Setting Up an IV Fluid Administration Set 510 • Angina Pectoris 570
• Maintaining an IV 513 • Acute Myocardial Infarction 571
xiii
• Heart Failure and Acute Pulmonary Edema 574 • Stroke 639

• Aneurysm 576 • Dizziness and Syncope 643
Chapter Review 577 Chapter Review 647
CHAPTER 21 CHAPTER 23
Resuscitation 580 Allergic Reaction 650
The Pathophysiology of Cardiac Arrest 583 Allergic Reactions 651
• Mechanical Failure of the Heart 583 • Distinguishing Anaphylaxis from Mild
• Electrical Dysfunction of the Heart 584 Allergic Reaction 655
• Sudden vs. Asphyxial Cardiac Arrest 585 Think Like an EMT Allergic Reaction or
• Agonal Respirations 585 Anaphylaxis? 657
• The Effects of Cardiac Arrest 586 Self-Administered Epinephrine 660
• Pediatric Cardiac Arrest 586 • Additional Doses of Epinephrine 663
Patient Assessment 586 EMT-Administered Epinephrine 663
• Sudden Unexpected Infant Death Chapter Review 667
Syndrome (SUIDS) 588
Think Like an EMT Is My Patient Really in CHAPTER 24
Cardiac Arrest? 589 Infectious Diseases and Sepsis 669
Improving Cardiac Arrest Survival 589 Infectious Diseases 671
• Chain of Survival 589 • How Diseases Spread 671
• Management of Cardiac Arrest 600
Think Like an EMT What’s Going On? 674
• The Steps of Resuscitation 602
Sepsis 674
• Terminating Resuscitation 612
• Pathophysiology 675
• Special Considerations in Resuscitation 612
• Common Causes 675
Chapter Review 616
Selected Common Communicable Diseases 677
• Chickenpox 678
CHAPTER 22 • Measles 679
Diabetic Emergencies and Altered • Mumps 681
Mental Status 619 • Hepatitis 681
Pathophysiology 622 • HIV/AIDS 684
Assessing the Patient with Altered • Influenza 685
Mental Status 622 • Croup 686
• Safety 622 • Pertussis (Whooping Cough) 686
• Primary Assessment 622 • Pneumonia 687
• Secondary Assessment 623 • Tuberculosis 688
Diabetes 624 • Meningitis 688
• Glucose and the Digestive System 624 • Sexually Transmitted Infections (STIs) 690
• Insulin and the Pancreas 624 • Diseases Carried by Ticks 690
• Diabetes Mellitus 624 • Emerging and Newly Recognized
• Diabetic Emergencies 625 Infectious Diseases 691
• Blood Glucose Meters 630 Chapter Review 692
• Hypoglycemia and Hyperglycemia Compared 633
Think Like an EMT The Sweet Taste of CHAPTER 25
Success 633 Poisoning and Overdose Emergencies 694
Other Causes of Altered Mental Status 634 Poisoning 697
• Seizure Disorders 634 • Ingested Poisons 700
xiv
Think Like an EMT Administer Naloxone? 708 Think Like an EMT Psych Condition or
• Inhaled Poisons 708 Hidden Medical Condition? 750
• Absorbed Poisons 712 • Situational Stress Reactions 750
• Injected Poisons 714 • Acute Psychosis 750
• Poison Control Centers 714 Emergency Care for Behavioral and
Think Like an EMT Find the Clues 715 Psychiatric Emergencies 751
Alcohol and Substance Abuse 715 • Assessment and Care for Behavioral and
• Alcohol Abuse 715 Psychiatric Emergencies 751
• Substance Abuse 717 • Suicide 753
Chapter Review 723 • Aggressive or Hostile Patients 755
• Reasonable Force and Restraint 756
• Transport to an Appropriate Facility 759
CHAPTER 26
• Medical/Legal Considerations 759
Abdominal Emergencies 725
Chapter Review 760
Abdominal Anatomy and Physiology 727
Abdominal Pain or Discomfort 730
CHAPTER 28
Abdominal Conditions 730
Hematologic and Renal Emergencies 763
• Appendicitis 731
• Peritonitis 731 The Hematologic System 765
• Cholecystitis/Gallstones 731 • Blood Clotting 766
• Pancreatitis 732 • Coagulopathies 766
• Gastrointestinal (GI) Bleeding 732 • Anemia 768
• Abdominal Aortic Aneurysm 732 • Sickle Cell Disease 768
• Hernia 733 The Renal System 771
• Renal Colic 733 • Diseases of the Renal System 771
• Cardiac Involvement 733 • Urinary Tract Infections 771
• Abdominal Pain Associated with the • Kidney Stones 771
Female Reproductive System 734 • Patients with Urinary Catheters 771
Assessment and Care of Abdominal Pain • Renal Failure 771
or Discomfort 734 • Medical Emergencies with End-Stage
• Scene Size-Up 735 Renal Disease 776
• Primary Assessment 735 • Kidney Transplant Patients 778
• History 735 Think Like an EMT Should You Request

• Physical Examination of the Abdomen 738 Advanced Life Support? 778
• Vital Signs 740 Chapter Review 779
• General Abdominal Distress 740
Think Like an EMT Assessing a Patient
with Abdominal Pain 742
5
Chapter Review 743
SECTION
CHAPTER 27
Behavioral and Psychiatric Emergencies
and Suicide 745 Trauma 782
Behavioral and Psychiatric Emergencies 747 CHAPTER 29
• What Is a Behavioral Emergency? 747 Bleeding and Shock 783
• Psychiatric Conditions 748 The Circulatory System 786
• Physical Causes of Altered Mental Status 748 • Main Components 786
xv
Shock 788 Chest Injuries 873

• The Pathophysiology of Shock 789 • Blunt Chest Injuries 874
Think Like an EMT In Shock or Stable? 797 • Penetrating Chest Injuries 876
• Treating Shock 798 • Occlusive and Flutter-Valve Dressings 879
Bleeding 799 • Injuries within the Chest Cavity 880
• External Bleeding 800 Abdominal Injuries 885
• Internal Bleeding 818 Think Like an EMT What’s the Likely Cause? 886
Chapter Review 820 Chapter Review 890
CHAPTER 32
CHAPTER 30
Musculoskeletal Trauma 892
Soft-Tissue Trauma 823
Musculoskeletal System 894
Soft Tissues 825
• Anatomy of Bone 894
Closed Wounds 827
• Self-Healing Nature of Bone 896
• Types of Closed Wounds 827
• Muscles, Cartilage, Ligaments, and Tendons 899
• Emergency Care for Closed Wounds 829
General Guidelines for Emergency Care 901
Open Wounds 830
• Mechanisms of Musculoskeletal Injury 901
• Types of Open Wounds 830
• Injury to Bones and Connective Tissue 902
• Emergency Care for Open Wounds 835
• Assessment of Musculoskeletal Injuries 904
Treating Specific Types of Open Wounds 836
• Splinting 907
• Treating Abrasions and Lacerations 836
Emergency Care of Specific Injuries 915
• Treating Penetrating Trauma 837
• Upper-Extremity Injuries 916
• Treating Impaled Objects 838
• Lower-Extremity Injuries 916
• Treating Avulsions 842
Think Like an EMT Sticks and Stones
• Treating Amputations 843
May Break My Bones, but Trauma Centers
• Treating Genital Injuries 844
Save Me 944
Burns 845
Chapter Review 944
• Classifying Burns by Agent and Source 845
• Classifying Burns by Depth 846
• Determining the Severity of Burns 847
CHAPTER 33
Trauma to the Head, Neck, and Spine 947
Think Like an EMT Burns—By the
Numbers 850 Nervous and Skeletal Systems 950
• Classifying Burns by Severity 850 • Nervous System 950
• Treating Specific Types of Burns 851 • Anatomy of the Head 950
• Radiation Burns 856 • Anatomy of the Spine 950
Electrical Injuries 856 Injuries to the Skull and Brain 953

• Scalp Injuries 953
Dressing and Bandaging 858
• Skull Injuries 953
Chapter Review 864
• Brain Injuries 953
• Glasgow Coma Scale 961
CHAPTER 31 • Cranial Injuries with Impaled Objects 963
Chest and Abdominal Trauma 867 • Injuries to the Face and Jaw 963
Anatomy and Physiology of the Chest • Nontraumatic Brain Injuries 964
and Abdomen 869 Wounds to the Neck 964
• Anatomy and Physiology of the Chest 869 Injuries to the Spine 966
• Anatomy and Physiology of the Abdomen 870 • Identifying Potential Spine and Spinal
• Pathophysiology of the Chest and Abdomen 873 Cord Injuries 967
xvi
• The Evolution of Spinal Care 977 • Snakebites 1044

• Spinal Motion Restriction Decision Making 979 • Poisoning from Marine Life 1046
Think Like an EMT More than a Pain in Think Like an EMT Safety First 1046
the Neck 990 Chapter Review 1047
Chapter Review 994
CHAPTER 34
6
Multisystem Trauma 997
Multisystem Trauma 998 SECTION
• Determining Patient Severity 999
Managing the Multisystem-Trauma Patient 1003
A Typical Call 1003 Special Populations 1050
• Analysis of the Call 1005 CHAPTER 36
Think Like an EMT Determining Criticality 1005 Obstetric and Gynecologic
• General Principles of Multisystem-Trauma Emergencies 1051
Management 1006 Anatomy and Physiology 1054
• Trauma Scoring 1008 • External Genitalia 1054
Chapter Review 1009 • Internal Genitalia 1055
• The Female Reproductive Cycle 1056
• Fertilization 1056
CHAPTER 35
Physiologic Changes in Pregnancy 1057
Environmental Emergencies 1012
• Changes in the Reproductive System 1057
Exposure to Cold 1015
• Other Physiologic Changes in Pregnancy 1058
• How the Body Loses Heat 1015
Labor and Delivery 1059
• Generalized Hypothermia 1016
• The Stages of Labor 1059
• Extreme Hypothermia 1022
Normal Childbirth 1065
• Local Cold Injuries and Frostbite 1022
• Role of the EMT 1065
Exposure to Heat 1025
Think Like an EMT My Baby
• Effects of Heat on the Body 1025
Won’t Wait! 1065
• Patient with Moist, Pale, and Normal or
Cool Skin (Heat Exhaustion) 1026 The Neonate 1071
• Patient with Hot Skin, Whether Dry or • Assessing the Neonate 1071
Moist (Heat Stroke) 1027 • Caring for the Neonate 1072
• The Dangers of Extreme Body Care after Delivery 1078
Temperatures 1029 • Caring for the Mother 1078
Water-Related Emergencies 1029 • Delivering the Placenta 1078
• Water-Related Accidents 1029 • Controlling Vaginal Bleeding after Birth 1079
• Drowning 1030 • Providing Comfort to the Mother 1080
• Diving Accidents 1034 Childbirth Complications 1080
• Scuba-Diving Accidents 1035 • Complications of Delivery 1080
• Water Rescues 1037 • Emergencies in Pregnancy 1087
• Ice Rescues 1038 Gynecologic Emergencies 1095
High-Altitude Emergencies 1039 • Vaginal Bleeding 1095
• High-Altitude Illness 1039 • Trauma to the External Genitalia 1096
Bites and Stings 1041 • Sexual Assault 1097
• Insect Bites and Stings 1041 Chapter Review 1098
xvii
CHAPTER 37 Receiving and Responding to a Call 1151

Emergencies for Patients with • Role of the Emergency Medical Dispatcher 1151
Special Challenges 1101 • Operating the Ambulance 1153
Patients with Special Challenges 1103 Transferring the Patient to the Ambulance 1159
• Disability 1103 Think Like an EMT Arriving Safely 1161
• Terminal Illness 1106 Transporting the Patient to the Hospital 1161
• Obesity 1106 • Preparing the Patient for Transport 1161
• Homelessness and Poverty 1107 • Caring for the Patient en Route 1163
Approaches to Care of Patients with Transferring the Patient to the Emergency
Special Needs 1108 Department Staff 1164
• Autism 1108 Terminating the Call 1166
• Infants and Children with Medical Challenges 1110 • At the Hospital 1166
General Considerations in Responding • En Route to Quarters 1168
to Patients with Special Challenges 1111 • In Quarters 1168
• Advanced Medical Devices in the Home 1111 Air Rescue 1171
• Variety of Health Care Settings 1112 • When to Call for Air Rescue 1171
• Knowledgeable Caregivers 1113 • How to Call for Air Rescue 1172
• A Knowledgeable Patient 1113 • How to Set up a Landing Zone 1172
• Following Protocols 1114 • How to Approach a Helicopter 1173
• Establishing the Baseline 1114
Chapter Review 1174
• Don’t Forget the Routine Care 1115
Diseases and Conditions 1116
CHAPTER 39
Advanced Medical Devices 1116
Hazardous Materials, Multiple-Casualty
• Respiratory Devices 1116
Incidents, and Incident Management 1176
• Cardiac Devices 1120
Hazardous Materials 1178
• Gastrourinary Devices 1123
• Training Required by Law 1179
Think Like an EMT EMTs Need to Know 1128
• Responsibilities of the EMT 1180
Abuse and Neglect 1128
• Establish a Treatment Area 1186
• Child Abuse and Neglect 1128
Multiple-Casualty Incidents 1192
• Elder Abuse and Neglect 1133
• Multiple-Casualty Incident Operations 1192
• Role of the EMT in Cases of Suspected
• Incident Command System 1194
Abuse or Neglect 1133
Think Like an EMT We Have How Many
• Intimate Partner Violence 1134
Patients? 1196
• Human Trafficking 1135
• Psychological Aspects of MCIs 1199
Chapter Review 1136
• Triage 1201
• Transportation and Staging Logistics 1209
7
Chapter Review 1210
SECTION
CHAPTER 40
Highway Safety and Vehicle Extrication 1213
Operations 1140
Highway Emergency Operations 1214
CHAPTER 38 • Initial Response 1215
EMS Operations 1141 • Positioning Blocking Apparatus 1216
Preparing for the Ambulance Call 1144 • Exiting the Vehicle Safely 1217
• Ambulance Supplies and Equipment 1145 • Being Seen and Warning Oncoming Traffic 1217
• Ensuring Ambulance Readiness for Service 1148 • Night Operations 1217
xviii
Vehicle Extrication 1219 Characteristics of CBRNE Agents 1259

• Preparing for Rescue 1219 • Chemical Agents 1260
• Sizing Up the Situation 1219 • Biologic Agents 1261
• Recognizing and Managing Hazards 1220 • Radioactive/Nuclear Devices 1269
Think Like an EMT When Minutes • Incendiary Devices 1270
Count, Decisions Matter 1221 • Blast Injury Patterns 1271
• Stabilizing a Vehicle 1231 Strategy and Tactics 1272
• Gaining Access 1235 • Isolation 1272
Chapter Review 1241 • Notification 1274
• Identification 1274
• Protection 1275
CHAPTER 41
• Decontamination 1275
EMS Response to Terrorism 1243
Self-Protection at a Terrorist Incident 1275
Defining Terrorism 1246
• Protect Yourself First 1275
• Domestic Terrorism 1246
• How to Protect Yourself 1276
• International Terrorism 1246
• Resources 1277
• Types of Terrorism Incidents 1248
• Future Trends 1277
Terrorism and EMS 1248
Think Like an EMT It Could Happen
• Emergency Medical Responders as Targets 1248
to You . . . 1279
• Identify the Threat Posed by the Event 1249
• Recognize the Harms Posed by the Threat 1251 Chapter Review 1279
Time/Distance/Shielding 1252
Responses to Terrorist Incidents 1253
• Responses to a Chemical Incident 1253 APPENDIX A B
asic Cardiac Life
• Responses to a Biologic Incident 1254 Support Review 1283
• Responses to a Radiologic/ Reference: Medical Terms 1297
Nuclear Incident 1257
Reference: A
natomy and Physiology
• Responses to an Explosive Incident 1258 Illustrations 1304
Dissemination and Weaponization 1258
Answer Key 1317
• The Respiratory Route 1259
• Other Routes 1259 Glossary 1377
• Weaponization 1259 Index 1393
xix
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PHOTO SCANS
2-1 Glove Removal 28 19-3 Prescribed Inhaler 549

3-1 Emergency Moves, One-Rescuer Drags 60 19-4 Small-Volume Nebulizer (SVN)—Patient
3-2 Emergency Moves, One Rescuer 61 Assessment and Management 551
3-3 Emergency Moves, Two Rescuers 62 20-1 Managing Acute Coronary Syndrome 563–565
3-4 Patient-Carrying Devices 63–64 20-2 Aspirin 567–568
3-5 Loading the Stretcher into the Ambulance 64–66 20-3 Nitroglycerin 568–569
3-6 Nonurgent Moves, No Suspected Spine Injury 72–74 21-1 High-Performance CPR 593–594
3-7 Transfer to A Hospital Stretcher 76 21-2 One-Person CPR 603
9-1 Positioning the Patient for Basic 21-3 High-Performance Team CPR 603–604
Life Support 211 21-4 Assessing and Managing a Cardiac
9-2 Inserting an Oropharyngeal Airway 219 Arrest Patient 606–608
9-3 Inserting an Oropharyngeal Airway 22-1 Management of a Diabetic Emergency 629
in a Child 220 22-2 Oral Glucose 632
9-4 Inserting a Nasopharyngeal Airway 221 22-3 Cincinnati Prehospital Stroke Scale 641–642
9-5 Insertion of a King Airway 225–226 23-1 Assessing and Managing an
9-6 Insertion of an i-gel™ Airway 226–227 Allergic Reaction 658–659
9-7 Suctioning Techniques 231 23-2 Epinephrine Auto-Injector 661
10-1 Preparing the Oxygen-Delivery System 271 23-3 Ready-Check-Inject 664–666
10-2 Administering Oxygen 273–274 25-1 Ingested Poisons 701
11-1 Establishing the Danger Zone 295 25-2 Activated Charcoal 702–703
11-2 Mechanism of Injury and Affected Areas 25-3 Naloxone 706
of the Body 300 25-4 Naloxone Antidote for Narcotic Overdose 707
12-1 Primary Assessment—Patient is 25-5 Inhaled Poisons 710
Apparently Lifeless 324 25-6 Absorbed Poisons—Hazmat—Illegal
12-2 Primary Assessment—Patient with A Pulse 325–326 Meth Lab 713
13-1 Taking Vital Signs on a Child 357 26-1 Assessment of the Patient with
13-2 Using a Blood Glucose Meter 363 Abdominal Distress 734–735
15-1 Examination of the Responsive 27-1 Restraining a Patient 758
Medical Patient 409–410 29-1 Sequential Steps in The Control of
15-2 Examination of the Unresponsive External Bleeding 804–805
Medical Patient 413 29-2 Applying Direct Pressure 807
15-3 Applying a Cervical Collar 426–428 29-3 Uncontrolled Extremity Bleeding that
15-4 Physical Examination of the Trauma Requires Immediate Tourniquet
Patient 430–433 Application 812–813
15-5 Assessing Breath Sounds 440 30-1 Dressing and Bandaging 859–860
15-6 Assessing Distal Function 441–442 31-1 Dressing an Open Abdominal Wound 889
15-7 The Pediatric Physical Examination 445–447 32-1 Immobilizing a Long Bone 911–912
16-1 Reassessment 455 32-2 Immobilizing a Joint 913
19-1 CPAP 537–538 32-3 Applying a Vacuum Splint 914
19-2 Prescribed Inhaler—Patient Assessment 32-4 Applying a Sling and Swathe 928–929
and Management 548 32-5 Splinting an Injured Humerus 930
xxi
32-6 Splinting Arm and Elbow Injuries 931–932 33-10 Removing a Helmet from an Injured
32-7 Splinting Forearm, Wrist, and Hand 933 Patient 992–993
32-8 Applying an Air Splint 934 35-1 Water Rescue with Possible Spinal
32-9 Applying a Bipolar Traction Splint 935–936 Injury 1032–1033
32-10 Applying the Sager Traction Splint 937 36-1 Assisting in a Normal Delivery 1069
32-11 Two-Splint Method—Bent Knee 938 38-1 Inspecting the Ambulance 1149
32-12 One-Splint Method—Straight Knee 939–940 38-2 Transferring the Patient 1165
32-13 Two-Splint Method—Straight Knee 941 38-3 Activities at the Hospital 1166
32-14 Two-Splint Method—Leg Injuries 942 38-4 Terminating Activities in Quarters 1169–1170
32-15 One-Splint Method—Leg Injuries 943 38-5 Danger Areas Around Helicopters 1173
33-1 Dressing an Open Neck Wound 965–966 40-1 Positioning Cones or Flares to
33-2 Spinal Trauma Gallery 968–969 Control Traffic 1218–1219
33-3 Selective Spinal Immobilization 40-2 Extinguishing Fires in Collision

Assessment 975–976 Vehicles 1228
33-4 Applying a Vest-Type Extrication 40-3 Stabilizing Vehicles Involved in a

Device 980–981 Collision 1232
33-5 Extrication Procedures 982 40-4 Disposing of the Doors and Roof 1238
33-6 Four-Rescuer Log Roll 985 40-5 Displacing the Front End of A Car 1239
33-7 Spinal Precautions for a Supine Patient A-1 Mouth-To-Mask Ventilation 1287
Utilizing a Scoop Stretcher 986 A-2 Locating the CPR Compression Site 1289
33-8 Rapid Extrication from a Child A-3 CPR Summary—Adult Patient 1290
Safety Seat 988–989 A-4 Infant CPR 1291
33-9 Patient in Standing Position with A-5 Clearing the Airway—Infant 1294
Possible Spine Injury 991
xxii
VISUAL GUIDES
CHAP TER 7
Pulmonary vein The ultimate goal of emergency care
Ventilation Transports oxygenated is to move air into the body and ensure
Moves air in blood to the heart.
and out of the
adequate circulation so that all cells are
body. perfused with oxygen.
T
AR Cells die when they don’t receive
HE
Ventilation, Respiration, and Perfusion oxygen. People die when too many
166–167
E
TH
cells die.
TO
Respiration
Moves oxygen
to cells and
Alveoli removes carbon
dioxide.
Perfusion
O2 Delivers oxygenated
blood to body cells.
Red
blood
TO
TH CO2 cells
EA
LVE OL I
C H A P T E R 11
Systemic
capillary
Heart
Pumps blood
through a network
of vessels to the
body and the lungs.
Scene Size-Up 292

TO
TH
Y
OD
E
U
NG EB
L
S TH
TO
O2
Pulmonary artery
Transports deoxygenated
blood to the lungs.
Body
cells
CO2
C H A P T E R 12 Red blood cells
Primary Assessment 316–317
C H A P T E R 13
Obtaining Vital Signs 342–343
C H A P T E R 14
Medical Body System Exams 380–381
C H A P T E R 15- 01
Medical Patient Assessment 414–415
C H A P T E R 15- 02
Trauma Patient Assessment 422–423
xxiii
Letter to Students
Dear Student:
Welcome to the exciting world of EMS.

We are pleased that your instructor has chosen Emergency Care as your classroom
textbook. We believe our textbook will serve you well in class, on your certification
exam, and long into your experience as an EMT, whether you are seeking your first
job in EMS or looking to serve your community as a volunteer.
We would like to offer some advice to you as you begin your program—advice likely
given to you by your instructor as well. Please be sure to keep up on your reading
and assignments, pay attention in class, and engage fully in your skills during labs.
Teachers will teach, but true learning is driven by you, the student. Take notes and
make flash cards. Pay particular attention to the pathophysiology material in this text.
Understanding pathophysiology is the difference between understanding a disease
process and simply memorizing the signs and symptoms.
This is a very exciting time in EMS. EMTs are using new and exciting technologies. You
may have opportunities to take additional classes such as Advanced EMT (AEMT) and
paramedic in the future. We have seen growth in the critical care and flight paramedic
roles and a relatively new area called community paramedic, which bridges EMS with
primary, in-home medical care.
We hope you share our excitement about the class you are beginning. Our sincerest
best wishes to you for success in your class—and wherever EMS takes you.
Daniel Limmer Michael F. O’Keefe Edward T. Dickinson, MD, NRP,

AS, LP, I/C NRP FACEP
[email protected] [email protected] [email protected]
xxiv
PREFACE
EMERGENCY C ARE has set the standard for EMT training for more
than thirty-five years. We strive to stay current with new research and developments
in EMS, and this new edition is no exception. The text meets the current American
Heart Association guidelines for CPR and ECC to prepare your students for testing and
practice today and beyond.
The foundation of Emergency Care is the National EMS Education Standards. While
using the Standards as our base, Emergency Care, fourteenth edition, has been written
to go beyond the Standards to provide the most current reflection of EMS practice
and show readers what EMS systems and EMTs are actually doing around the country
today. The caveat “follow local protocols,” of course, appears frequently—whenever the
equipment or practice described has been adopted in some but not all systems.
In addition, the text was developed taking into account the years of experience that
the authors have had with EMS curricula and practice, with the input of countless instruc-
tors and students. The result is a proven text with outstanding readability and a level of
detail that instructors have found more appropriate for their classrooms than any other.
The content of the fourteenth edition is summarized in the following text, followed by
brief details on “what’s new” in each section of this edition.
What’s New in the Fourteenth Edition? • This edition has integrated the assessment, care, and treat-
The fourteenth edition has undergone extensive development ment of children into all parts of the text. We take the
and change. approach that children, while having some physiological dif-
This edition boasts more new professional photos than any ferences from adults, do not constitute a distinct and separate
previous edition. The author and photographic team worked population. Their needs and functions are generally like those
together to supply a combination of realistic and real-life emer- of adults. We provide clear information about the differences
gency images that are unrivaled in EMT literature. The resulting while providing the overall continuity of care for patients
artwork in Emergency Care 14e is a powerful teaching tool for from neonates to older adults.
students. • Likewise, the care of older adults is no longer discussed sepa-
The Patient Care feature that appears in clinical chapters has rately. Our text provides chapters with patient scenarios that
been fine-tuned to address Fundamental Principles of Care first, cover a range of ages, so that students have continuous prac-
followed by actions that the EMT may need to employ in car- tice considering age as a factor in their overall information
ing for the patient. In this edition, actions are not numbered, gathering and assessment.
because there is no one correct sequence for patient care. The • The Secondary Assessment chapter was reworked into three
EMT must continually base decisions and priority actions on more focused chapters that address specific aspects of the
the evolving condition of the patient. EMT’s role and care of patients. Details are provided below
All chapters throughout the text have been updated to under Section 3.
conform to the most current American Heart Association Guide-
lines for Cardiopulmonary Resuscitation and Emergency Cardiovas- • Cardiac Emergencies and Resuscitation are two distinct chapters
cular Care. in the fourteenth edition. Infectious Diseases and Sepsis is a new
The Operations section of the book has been updated and chapter in this edition, as you will see under Section 4.
expanded to include new triage procedures and updated guide- • Special Populations, Section 6 of the fourteenth edition, has been
lines for handling incident scenes. changed significantly, with pediatric and geriatric care inte-
There is significant organizational change in this edition. grated throughout the text, and updates to remaining chapters.
xxv
SE C T ION 1 SE C T ION 3
Foundations: Chapters 1–8 Patient Assessment: Chapters 11–17
The first section sets a framework for all the sections that Key elements of the EMT’s job are the ability to perform a thor-
follow by introducing some essential concepts, information, ough and accurate assessment, treat for life-threatening condi-
and skills. The section introduces the EMS system and the tions, and initiate transport to the hospital within optimum time
EMT’s role within the system. The section then covers issues limits. This section explains and illustrates all of the assessment
of EMT safety and well-being, including safe techniques of steps and their application to different types of trauma and med-
lifting and moving patients. Legal and ethical issues are then ical patients. In addition, it focuses on the skills of measuring
discussed. Basic medical terminology, anatomy, physiology, vital signs, using monitoring devices, taking a patient history,
pathophysiology, and lifespan development round out this communicating, and documenting.
first section.
What’s New in the Patient Assessment Section?
What’s New in the Foundations Section? • In Chapter 11, Scene Size-Up, there is a new Think Like an
• In Chapter 2, Well-Being of the EMT, there is new text on EMT section (Should I or Shouldn’t I stay or retreat from a
Invisible Wounds—Preventing Psychological Trauma and scene? ) There is also additional text on airbag deployment.
discussion of eSCAPe, a mnemonic for dealing with posttrau- • Chapter 12, Primary Assessment, includes updated text on
matic stress. There are also updated sections on Realities of spinal motion restriction.
Well-Being and self-protection in a violent event.
• Chapter 13, Vital Signs and Monitoring Devices, has new
• Chapter 3, Lifting and Moving Patients, has new text on text on capnography.
bariatric patients and provides new images of the “no lift-
• Chapter 14, Principles of Assessment, pulls together assess-
at-all” stretcher. It also updates information on the use of long
ment processes for adults and children. It also discusses crit-
spine boards
ical thinking skills that EMTs can develop to improve their
• Chapter 7, Principles of Pathophysiology, has new text on work in the field.
the regulation of homeostasis and the fight-or-flight response,
• Chapter 15, Secondary Assessment, drills down on the
plus new information about pediatric vascular response and
secondary assessment needs of patients with medical emer-
pediatric compensation.
gencies and traumatic emergencies. A section of this chapter
covers important considerations for caring for children who
SE C T ION 2 are experiencing trauma.
Airway Management, Respiration, and Artificial • Chapter 16, Reassessment, focuses on the need for continual
review of patient status until patient care has been transferred
Ventilation: Chapters 9–10
to the Emergency Department or health care facility.
There are only two chapters in Section 2, but it may be the most
• Chapter 17, Communication and Documentation, has
important section in the text, because no patient will survive
updated forms and equipment as well as new text on com-
without an adequate airway, adequate respiration, and adequate
pletion of the Prehospital Care Report.
ventilation.
As mentioned, the chapters in this section and throughout
the text have been updated to conform to the current American
SE C T ION 4
Heart Association Guidelines for Cardiopulmonary Resuscitation and
Emergency Cardiovascular Care. Medical Emergencies: Chapters 18–28
The Medical Emergencies section begins with a chapter on
What’s New in the Airway Management, Respiration,
pharmacology that introduces the medications the EMT can
and Artificial Ventilation Section? administer or assist with under the current curriculum. The
• In Chapter 9, Airway Management has new text on the section continues with chapters on respiratory emergencies,
head-elevated, sniffing position; providing an airway; man- cardiac emergencies, resuscitation, diabetic/altered mental
ual airway maneuvers; obstructed airways; conscious choking status (including seizure and stroke) emergencies, allergic
adults and children; and unconscious choking. It also includes emergencies, infectious diseases and sepsis emergencies,
Scan 9-5 Insertion of a King Airway and Scan 9-6 Insertion poisoning/overdose emergencies, abdominal emergencies,
of an i-gel™ Airway, and covers using gravity to clear an air- behavioral/psychiatric emergencies, and hematologic/renal
way. There are new pediatric text sections on pediatric airway emergencies.
physiology and suctioning in pediatrics.
What’s New in the Medical Emergencies Section?
• Chapter 10, Respiration and Artificial Ventilation, has
added new text: Face Mask Ventilation—Core Principles, and • Chapter 18, General Pharmacology, has updated text on
Ventilation Rates and Volume. There is also new pediatric text naloxone plus new photos of nasal naloxone administration.
in the form of a Pediatric Note about providing supplemental • Chapter 19, Respiratory Emergencies, has new text on
oxygen. the pressures of the respiratory system, a Pediatric Note on
xxvi
bronchiolitis, as well as content on pediatric respiratory dis- • Chapter 35, Environmental Emergencies, has updated infor-
tress and croup. mation on scuba and water accidents and a new section on
• Chapter 20, Cardiac Emergencies, includes more infor- high-altitude emergencies.
mation on 12 lead ECG and special information for helping
pediatric patients. This chapter focuses on the needs of the
incipient medical cardiac patient.
SE C T ION 6
• Chapter 21, Resuscitation, focuses on patients who require Special Populations: Chapters 36–37
life-restoring procedures. In particular, the updated Resus- Special populations discussed in this section include those with
citation chapter provides procedures and requirements for emergencies related to the female reproductive system, preg-
high-performance CPR. nancy, or childbirth; and to patients with certain disabilities or
• Chapter 22, Diabetic Emergencies and Altered Mental those who rely on advanced medical devices at home. As men-
Status, has new content on pediatric patients with seizures. It tioned, pediatric and geriatric information has been integrated
also describes thrombectom, and advances in the treatment into appropriate chapters throughout the book. The chapters
of patients with stroke. in this section emphasize how to serve all of these patients
by applying the basics of patient assessment and care that the
• Chapter 23, Allergic Reactions, includes pediatric as well as
student has already learned.
adult epinephrine devices.
• Chapter 24, Infectious Diseases and Sepsis, is a new chapter What’s New in the Special Populations Section?
in Emergency Care’s fourteenth edition. It provides an over- • Chapter 36, Obstetric and Gynecologic Emergencies, con-
view of common infectious diseases that EMTs may encoun- tains updated text on neonatal resuscitation.
ter. It also describes conditions that lead to sepsis and signs • Chapter 37, “Emergencies for Patients with Special Chal-
that sepsis may be occurring. lenges, has new text addressing an emergency involving
• Chapter 25, Poisoning and Overdose Emergencies, includes a home ventilator and a new section stressing the need for
a new Scan 25-6 Absorbed Poisons—HAZMAT—Illegal awareness of vulnerable populations (including child, elder,
Meth Lab. and domestic abuse and human trafficking).
• Chapter 26, Abdominal Emergencies, now includes text
on abdominal pain associated with the female reproductive
system. SE C T ION 7
Operations: Chapters 38–41
SE C T ION 5 This section deals with nonmedical operations and special sit-
uations, including EMS operations, hazardous materials, mul-
Trauma: Chapters 29–35 tiple-casualty incidents and incident management, highway
The Trauma Emergencies section begins with a chapter on safety, vehicle extrication, and the EMS response to terrorism.
bleeding and shock and continues with chapters on soft-tissue
trauma; chest and abdominal trauma; musculoskeletal trauma; What’s New in the Operations Section?
trauma to the head, neck, and spine; multisystem trauma; and • Chapter 38, EMS Operations, has updated images and pro-
environmental emergencies. cedures required by EMTs.
What’s New in the Trauma Section? • Chapter 39, Hazardous Materials, Multiple-Casualty Inci-
dents, and Incident Management. Includes a new swxtion
• Chapter 29, Bleeding and Shock, has had an extensive
on SALT (Sort, Assess, Lifesaving Interventions, Treatment/
rewrite with information on progression of actions in
Transport), a triage method used at MCIs that is gaining pop-
response to extensive bleeding. New content includes junc-
ularity and acceptance in EMS systems.
tional tourniquets and methods of preventing or coping with
the development of shock. • Chapter 40, Highway Safety and Vehicle Extrication,
includes new text on alternative fuel vehicles.
• Chapter 30, Soft-Tissue Trauma, has numerous new images
to prepare students for events they may encounter in the field. • Chapter 41, EMS Response to Terrorism, has been updated
to address “homegrown” terrorist attacks and strategies for
• Chapter 31, Chest and Abdominal Trauma, includes sections
providing care safely during such events.
on the pathophysiology of the chest and abdomen and on
rib fracture, plus additional material on occlusive and flut-
ter-valve dressings.
A P P E N DI X A N D R E F E R E NC E S
• In Chapter 33, Trauma to the Head, Neck, and Spine, there is The Appendix in this edition provides a basic cardiac life sup-
continued updating on methods of spinal motion restriction port review. References include a listing of medical terms along
and new text on the rigid spine board and scoop stretcher. with root prefixes and suffixes; anatomy and physiology illus-
• Chapter 34, Multisystem Trauma, includes new content on trations; and the answer key, glossary, and index. All have been
multiple trauma in the pediatric patient. reviewed and updated.
xxvii
OU R G OA L You can also reach the authors through the following email addresses:
[email protected]
Improving Future Training and Education
[email protected]
Some of the best ideas for better training and education meth-
ods come from instructors who can tell us what areas of study [email protected]
caused their students the most trouble. Other sound ideas come
from practicing EMTs who let us know what problems they Visit Brady’s web site:
faced in the field. We welcome any of your suggestions. If you http://www.bradybooks.com
are an EMS instructor who has an idea on how to improve this
book or EMT training in general, please write to us at:
Brady/Pearson Health Sciences

c/o EMS Editor Pearson Education
221 River Street
Hoboken, NJ 07030
xxviii
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About the People
C ON T E N T C ON T R I BU T OR S REVIEWERS
Becoming an EMT requires study in a number of content areas We wish to thank the following reviewers for providing invalu-
ranging from airway to medical and trauma emergencies to able feedback and suggestions in preparation of the 14th edition
pediatrics and rescue. To ensure that each area is covered accu- of Emergency Care.
rately and in the most up-to-date manner, we have enlisted the
Andrew Appleby
help of several expert contributors. We are grateful for the time
Instructor of Paramedics and EMS
and energy they have put into their contributions.
Western Wyoming Community College
Rock Springs, WY
14th Edition:
Randall W. Benner
Dan Batsie, BA, NRP Instructor in the Department of Health Professions
Chief of Emergency Medical Services Youngstown State University
Vermont Department of Health Youngstown, OH
Burlington, VT
Sarah Clark
Brooke Beck, OMS III, UNTHSC Program Director
Texas College of Osteopathic Medicine ENTPKY, Inc.
Ft. Worth, TX Lexington, KY
Edward T. Dickinson, MD, NRP, FACEP Robert Cormier
Professor Instructor
Department of Emergency Medicine Centauri High School
University of Pennsylvania School of Medicine La Jara, CO
Philadelphia, PA
Kenneth Crank
Ben Esposito EMT-P Instructor
Lieutenant/Hazardous Materials Specialist Cincinnati State Tech and Community College
Youngstown Fire Department Cincinnati OH
Youngstown, OH James Dinsch
Jake Freudenberger, OMS III, EMT-B, UNTHSC Program Director, Department Chair & EMS Assistant
Texas College of Osteopathic Medicine Professor
Ft. Worth, TX Indian River State College
Fort Pierce, FL
Robert Kronenberger
Robert Farnum
Fire Chief
EMS Instructor
Middletown Fire Department
Department of Public Health and Human Services
Middletown, CT
Big Timber, MO
David Lambert MD FACEP David Fifer M.S., NRP, FAWM
Department of Emergency Medicine Assistant Professor & Program Coordinator
Perelman School of Medicine Eastern Kentucky University
University of Pennsylvania Richmond, KY
Philadelphia, PA
Scott Gano
Steven J. Salengo, MEd, NRP Associate Professor
EMS Faculty Columbus State University
Hillsborough Community College Columbus, OH
Tampa, FL
Jonathan Hockman
Eric Steffel, NRP, BSEMSA EMS Outreach Representative
Northwest EMS Detroit Medical Center
Tomball, TX Detroit, MI
xxix
Mark Hornshuh James Robertson

Program Specialist EMT Instructor
Portland Community College Van Buren Intermediate School District
Portland, OR Lawrence, MI
Michael Hunter
Steven J. Salengo, MEd, NRP
Education Coordinator
EMS Faculty
Harrison County Hospital
Hillsborough Community College
Corydon, IN
Tampa, FL
Jennifer Kline
Program Manager Laurie Sheldon
Gateway Community College EMT Faculty
Phoenix, AZ Union County College
Cranford, NJ
Kurt Larson
EMT Instructor Jennifer Stout
George Stone Technical Center EMS Faculty
Pensacola, FL Howard College
Marisa Laurent San Angelo, TX
Fire Science Assistant Instructor
Joshua Tilton, NR-P, CCEMTP, EMS I, F I
Community College of Rhode Island
EMS Instructor
Warwick, RI
City of Columbus Division of Fire
David Leclair Columbus, OH
EMS Instructor
Otsego County EMS Jeremiah Underwood
Cooperstown, NY Program Director, Emergency Medical Science
Guilford Technical Community College
Mike McDonough
Jamestown, NC
EMT Faculty
Santa Barbara City College Tim Williamson
Santa Barbara, CA Program Director, EMS/Paramedic
Dean C. Meenach, RN, BSN, CEN, CCRN, CPEN, EMT-P Gateway Technical College
Director of EMS Education Burlington, WI
Mineral Area College
Park Hills, MO
ORG A N I Z AT IONS
Margaret Mittelman
EMT Basic and Advanced Program Coordinator We wish to thank the following organizations for their assis-
Utah Valley University tance in creating the photo program for this edition:
Orem, UT
Essex Rescue (Essex Junction, VT)
Jeff Orphal Will Moran, Executive Director, EMT-P
EMS Faculty Colleen Nesto, Deputy Executive Director, EMT-P
Apollo Career Center Sean McCann, A-EMT
Lima, OH
Malvern Fire Company (Malvern, PA)
Robert Preshong Keith Johnson, EMS Chief
United States Army Medical Department Center and Rich Constantine, Deputy EMS Chief
School
San Antonio, TX Sarasota County Fire Department (Sarasota, FL)
Branson K. Ratsep, EMT-P Chief Michael Regnier
Lead EMT Instructor
Suncoast Technical College (Sarasota, FL)
Monterey Peninsula College
Scott Kennedy, ARNP—Health and Public Safety Program
Salinas, CA
Manager
Gates Richards, MEd, WEMT-I, FAWM Brian Kehoe, EMT-P—EMS Program Director
EMT Director Mark Tuttle, EMT-P—Human Simulation Coordinator/Lead
NOLS Wilderness Medicine Institute EMT Instructor
Lander, WY Dustin Martinez, EMT-P—EMT Instructor
xxx
Vermont Hazardous Materials Response Team Models

Dave Patneaude, VHMRT and Derby Line Fire Dept. Thanks to the following people who portrayed patients and
Paul Snider, VHMRT and Derby Line Fire Dept. EMS providers in our photographs:
Harry Fell, VHMRT, Colchester Rescue and Grace Batsie Alex McCarthy
Vergennes Rescue
Margo Batsie McKenna Martin
Kaitlyn Armstrong, VHMRT and VT DMV Detective
William Irwin, VHMRT, Bakersfield Vol. Fire/Rescue and Addyson Brown Mairead McCann
VT Department of Health Aubrey Brown Sean McCann, EMT
Todd Cosgrove, VHMRT and Bakersfield Vol. Fire/Rescue Ava Brown William Mitchell
Jude Brown Colleen Nesto, EMT-P
Seth Bueno Andrew Rychlak
SU B J E C T M AT T E R E X P E RT S / P HO T O
Natalie Corapi Mark Scanlon
C O OR DI NAT OR S
Davian Craddock Makayla Shanahan
Thanks to the following for valuable assistance directing the
Caera Crosby Ashton Stewart
medical accuracy of the shoots and coordinating models, props,
and locations for our photo shoots: Bambi Dame Victoria Stokes
Emily Danis Matthew Thompson
Dan Batsie,
Chief of Emergency Medical Services, Vermont Hillary Danis Lillian Turner
Department of Health (Burlington, VT) Arianna Franzen Michelle Turner
Dustin Martinez, Jennifer Franzen, EMT Jordan Tuttle, EMT/FF
EMT-P, Sarasota County Fire Department (Sarasota, FL) Jackie Goss, EMT-P Mark Tuttle, PMD BS, EMS
Duncan Higgins, AEMT Program Director, EMT-P
Sean McCann,
Advanced EMT, Essex Rescue (Essex Junction, VT) Timothy Kinville Hadley Warner, EMT
Scott Kramer Leo Wermer
Mark Tuttle,
PMD BS, EMS Program Director, EMT-P, Suncoast Amelia Lamberty Deborah Williams
Technical College (Sarasota, FL) Margo Limmer Joshua Williams, EMT
Rodney Van Orsdol, Sarah Limmer Michael Wheeler
EMT-P, Sarasota County Fire Department (Sarasota, FL) Jacy Lunna Peter Withbroe
Tyler Lyke
C R E DI T S Photographers
All photos not credited here, or under the photograph, are Michal Heron
Pearson-owned assignment photos.
Kevin Link
Detail of Section Two photo on Page xi © Daniel Limmer
Section Opener Two: © Daniel Limmer Maria Lyle
Section Opener Three: © Daniel Limmer
Isaac Turner
Chapter Opener for all chapters in Section Three: © Daniel
Limmer
Digital Post-Production
Chapter Opener for all chapters in Section Four © Ed Effron
Chapter Opener for all chapters in Section Seven © Ed Effron Maria Lyle, Maria Lyle Photography
xxxi
About the Authors
AU T HOR
DANIEL LIMMER
• Began EMS in 1978. Became an EMT in 1980 • Works part-time as a freelance photojournal-
and a Paramedic in 1981. ist and is working on a documentary project
• Is a Lecturer at Central Washington University photographing EMS people and agencies
in Ellensburg, Washington, and an Adjunct throughout the United States.
Faculty member at Eastern Maine Community • In addition to his EMS experience, was a dis-
College in Bangor, Maine. patcher and police officer in upstate New York.
• Especially enjoys teaching patient assessment, • Lives in Maine with his wife, Stephanie, and
and believes critical thinking and decision- daughters Sarah and Margo.
making skills are the key to successful clinical • Is a Jimmy Buffett fan (Parrothead) who
practice of EMS. attends at least one concert each year.
AU T HOR
M I C H A E L F. O ’ K E E F E
• EMT Provider Level Leader for National EMS • Has a special interest in EMS research, and got
Education Standards. a master’s degree in biostatistics.
• Expert writer for 1994 revision of EMT-Basic • Past chairperson of the National Council of
curriculum. State EMS Training Coordinators.
• EMS volunteer since college in 1976. • Interests include science fiction, travel, foreign
• Member of development group for the languages, and stained glass.
National EMS Education Agenda for the
Future: A Systems Approach and The National
EMS Scope of Practice Model.
M E DIC A L E DI T OR
E D W A R D T. D I C K I N S O N
• In 1985, was the first volunteer firefighter to • Has a full-time academic emergency medicine
receive the top award from Firehouse Maga- practice at Penn Medicine in Philadelphia,
zine for heroism for the rescue of two elderly where he also serves as the Medical Director
women trapped in a house fire. for PENNStar Flight.
• Is the Medical Director of the Malvern, Berwyn, • Is board-certified in both Emergency Medicine
and Radnor Fire Companies in Pennsylvania. and Emergency Medical Services.
• Has been continuously certified as a National • Has served as medical editor for numerous
Registry Paramedic since 1983. Brady EMT and First Responder texts.
• First certified as an EMT in 1979 in upstate • Lives in Chester County, Pennsylvania, where
New York. he is married to Debbie and has two sons,
Steve and Alex.
xxxii
9 9
AirwayAirway
Management
Management
A Guide to...
K E Y F E AT U R E S
• How to recognize an adequate or an inadequate airway
• How to open an airway
• How to use airway adjuncts
• Principles and techniques of suctioning
Outcomes
After reading this chapter, you should be able to:
9.1 Describe the structure and function of the normal airway.
(pp. 203–206)
• Differentiate the structures of the upper airway from those of the lower
airway.
• Match airway structures to their functions.
9.2 Explain concepts of airway pathophysiology. (pp. 206–210)
Related Chapters • List causes of obstruction of the upper and lower airway.
The following chapters provide additional information related to topics• List the steps to airway assessment in the primary assessment.
discussed in this chapter: • Distinguish between signs that indicate absent breathing, inadequate airway,
3 Lifting and Moving Patients and adequate airway.
6 Anatomy and Physiology • List signs of inadequate airway that are more likely in children than in adults.
• Explain how to determine whether a patient’s airway status may
7 Principles of Pathophysiology
worsen.
10 Respiration and Artificial Ventilation
9.3 Describe the use of manual maneuvers to open the airway.
19 Respiratory Emergencies
(pp. 210–216)
• Given a scenario, provide a rationale for selecting the type of manual maneu-
Standard ver that is best for the patient in the scenario.
Related Chapters
Airway Management, Respiration, and Artificial Ventilation (Airway
9.4 Explain the use of adjunctive equipment to manage a patient’s
Management)
airway. (pp. 216–234)
• State the importance of having a suction device immediately available
Competency
The following chapters provide additional information related to management
during airway topics procedures.
discussed in thisApplies
chapter:
knowledge (fundamental depth, foundational breadth) of general• Given scenarios, identify adherence to general rules for using airway
anatomy and physiology to patient assessment and management to ensure adjuncts.
3 Lifting and aofMoving Patients
patent airway, adequate mechanical ventilation, and respiration for patients• Describe how the features of an oropharyngeal airway allow it to provide an
all ages. air passage in patients who cannot maintain their own airways.
6 Anatomy and Physiology • List the sequence of steps used in the insertion of an oropharyngeal airway.
Core Concepts • Identify instances when a nasopharyngeal airway offers benefits over an oro-
7 Principles of Pathophysiology
• Physiology of the airway pharyngeal airway.
• List the sequence of steps used in the insertion of a nasopharyngeal airway.
• Pathophysiology of the airway
10 Respiration and Artificial Ventilation • Describe the minimum features required of suction units.
• Match the components and attachments of suction devices with their
19 Respiratory Emergencies designed purposes.
• Suggest responses to complications encountered when suctioning a
patient’s airway.
Standard
M09B_LIMM9134_14_SE_C09.indd 200 28/08/2019 18:22
Airway Management, Respiration, and Artificial Ventilation (Airway

Management) 201
CORE CONCEPTS Highlight the key points

Competency
addressed in each chapter. The topics not only
M09B_LIMM9134_14_SE_C09.indd 201 28/08/2019 18:22
Applies knowledge (fundamental depth, foundational breadth) of general

help students anticipate chapter content, but
anatomy and physiology to patient assessment and management to ensure
also guide their studies through the textbook
a patent airway, adequate mechanical ventilation, and respiration for patients OBJECTIVES Objectives form the basis of
and supplements. • How to recognize an adequate or an inadequate airway
of all ages.
• How to open an airway each chapter and were developed around
the Education Standards and Instructional
Core Concepts • How to use airway adjuncts
Guidelines.
• Principles and techniques of suctioning
• Physiology of the airway
• Pathophysiology of the airway
Outcomes
406 SECTION 3
After reading this chapter, you should be able to:
9.1 Describe
When performing a secondary theyou
assessment, structure and function
will generally completeofthree
the basic
normal airway.
com-
CORE CONCEPT ponents: physical examination, patient
(pp. history, and vital signs. Although we will present
203–206)
Components of the them in this order, there is not necessarily a need to maintain a “first, second, third”
• Differentiate the structures of the upper airway from those of the lower
secondary assessment linear approach. In fact, high-performing teams will often combine elements in a single
airway.
coordinated effort.
ndd 200 • Match airway structures 28/08/2019
to their 18:22
functions.
• Physical examination. This part of the secondary assessment, as the name implies,
9.2 your
is where you will use Explain
sensesconcepts
to examineofthe
airway pathophysiology.
patient. (pp. 206–210)
You may feel for injuries,
listen for abnormal breathing
• Listsounds,
causesand look for swelling.
of obstruction of theItupper
is important to useairway.
and lower your
senses to their fullest to get the most relevant information.
• List the steps to airway assessment in the primary assessment.
• Patient history. The history is obtained by asking questions. Most commonly,
• Distinguish between signs that indicate absent breathing, inadequate airway,
questions will be answered by the patient, but answers may also come from family
and adequate airway.
or even bystanders. These answers to your questions will provide you with vital
information about your•patient.
List signs
Youofwill
inadequate airway
use questions to that are more
confirm likely in
suspicions, children than in adults.
seek
additional information, and differentiate
• Explain how topossible problems
determine from aprobable
whether problems.
patient’s airway status may
history of the present illness You will ask about the patient’s
worsen. current condition or complaint—the history of the
or injury (HPI) present illness or injury (HPI)—and you will ask whether the patient has had any
information gathered regarding 9.3 Describe
prior medical problems the usetakes
and if the patient of manual maneuvers topast
any medications—the open the airway.
medical
the symptoms and nature of the
history (PMH). (pp. 210–216) xxxiii
patient’s current concern.
• Given
• Vital signs. You will take a scenario,
vital signs such asprovide a rationale blood
pulse, respirations, for selecting
pressure,the type of manual maneu-
and
past medical history (PMH) ver that is best for the patient in the scenario.
ife/pulse:
siveness VISUAL GUIDES Visually present patient
12
or
thing assessment in a series of flow charts. Primary Assessment
V I S UA L G U I D E
Identify and Treat Life Threats
206 SECTION 2
FIGURE 9-5 A comparison of child and adult respiratory passages. GENERAL IMPRESSION: Chief Complaint and AVPU
way Key Decision:
Child has smaller nose
and mouth.
In child, more space is If the patient is apparently life-
taken up by tongue. less (no breathing or agonal
breathing), go directly to a pulse
check and the C-A-B approach.
Child’s trachea is narrower.
thing Cricoid cartilage is less rigid and

less developed. How does the patient look?
Airway structures are more easily You may perform airway, breathing, and circulation in any order.
obstructed.
“ VOICES Insights or facts This is dependent on the patient’s presentation and emergent needs. Multiple
The most important
parts of the primary assessment can be performed simultaneously when more
things we can do for from EMTs in the field. than one EMT is present.
lation our patients are in the AIRWAY

A-B-Cs.
” Key Decision:
Airway Pathophysiology
Open the airway. Suction if necessary. Place an oral or nasal airway if
CORE CONCEPT indicated.
Pathophysiology of the BREATHING

For air to make the journey from the nose and mouth to the lungs, the pathway must be
airway relatively unobstructed. A variety of obstructions can interfere with airflow. Foreign Key Decision:
bodies
g is inadequate,
such as food and small toys are common obstructions, as are fluids, including blood and
your ventilations
vomit. The airway can even be obstructed by the patient. A patent airway requires control
gainst each other.
of more than 14 different muscle groups that support and keep open the channel of air.
oms suggesting This is referred to as intact muscle tone. Conditions such as altered mental status and neu-
’s need as deter- rologic disorders can result in a loss of this muscle tone and lead to collapse of the airway.
ient’s complaint A common obstruction in a person with a decreased mental status is the tongue—or, more
Is the patient hypoxic?
precisely, the epiglottis connected to the tongue. This obstruction occurs when aIs the patient breathing?
lack of Is the patient breathing adequately?
muscle tone causes the tongue to relax and fall back. When it does, the epiglottis falls Oxygenbacksaturation readings Significant respiratory distress Absent or inadequate
s you may find. below 94% and hypoxia (very low oxygen breathing
and covers the entrance to the trachea. Often people consider this as the tongue obstructing
ificantly impact saturation or cyanosis)
(© Daniel Limmer) the airway but, in reality, the epiglottis actually causes the obstruction. Patient position
is an injury that
is often an associated factor in muscle tone–related airway obstruction. 316 An unconscious
ies by observing
or semiconscious patient lying flat (supine) is often at higher risk for the simple airway
occlusion described above. This doesn’t mean that the supine position is universally bad;
it simply means that anytime a patient has an altered mental status, the airway must be
M12_LIMM9134_14_SE_C12.indd 316 31/10/2019 09:08
carefully and continually monitored.
01/10/2019 11:12
Point of View POINT OF VIEW Tells stories of EMS care

“ It happened so fast. I knew I was allergic to bees, but I never had a reac- from the patient’s perspective and includes
tion that bad. It was like all of a sudden, I just couldn’t breathe. I was fine
just a few moments earlier, then my voice started to get real raspy and I photos that illustrate the patient’s viewpoint.
could barely take a breath. I thought I was going to die. I remember the
EMTs arriving, but not much more. I know they helped me with a dose
of epinephrine, but by the time I regained consciousness, I was at the
hospital. That medicine saved my life. ”
Ch
M09B_LIMM9134_14_SE_C09.indd 206 28/08/2019 18:22
PATIENT CARE SECTIONS Provide descrip- Patient Care

tions of the fundamental principles and Care of the Patient with Severe Choking
critical actions needed for various patient Fundamental Principles of Care
care scenarios. Severe choking implies that the airway is completely blocked by a foreign body. It is indicated
(and differentiated from nonsevere choking) by an inability to move air. Here the patient is not
breathing, coughing, or speaking. This situation requires immediate intervention.
In patients with signs and symptoms indicating severe choking, take the following steps:
• Call for advanced life support assistance.
• Immediately assess for air movement. If no air movement is found, begin
foreign-body airway maneuvers.
• For conscious adults and children (patients over the age of 1 year), initiate
abdominal thrusts.
• For conscious infants (patients 1 year old or younger), initiate back slaps and chest
thrusts.
• For any unconscious choking patient, or a patient who becomes unconscious due
to choking, begin CPR.
For conscious adults and children (older than 1 year), follow these general guidelines for
initiating abdominal thrusts:
xxxiv • Stand or kneel behind the patient.
• Place a fist over the patient’s navel and then grab that fist with your other hand.
• Press your fist into the patient’s abdomen with a quick, forceful upward thrust.
210 SECTION 2
THINK LIKE AN EMT A scenario-based Think Like an EMT

feature that offers practice in making criti- Will the Airway Stay Open?
cal decisions. You have learned about the signs of an unstable airway. Use this information to
consider whether the following patients have airways that will stay open.
1. A 16-year-old asthma patient who tells you he is tired and seems to be nod-
ding off to sleep
2. A 72-year-old female who was recently diagnosed with pneumonia. Today
she has called you because her breathing is much worse. She is breathing
rapidly and has diminished lung sounds on the left side.
3. A 35-year-old male who tells you he is having trouble breathing. You notice he
is drooling and is sitting bolt upright. When you attempt to lean him back on
the stretcher, he coughs, gags, and repositions himself in a sniffing position.
4. A 16-month-old whose mother tells you the child has had a cold for two days
and woke up with a cough tonight. The child is awake and alert but barking
like a seal when coughing.
Opening the Airway

CHAPTER REVIEW
Assessing the airway Includes
is one of the a summary
highest priorities of When signs indicate
of your assessment.
CORE CONCEPT an inadequate airway, a life-threatening condition exists. Prompt action must be taken to
Chapter Review How to open an airway key
openpoints, key
and maintain the terms
airway, asand definitions,
explained next. review
For most patients, the airway can be assessed by simply assessing their speech. In a
questions, and critical-thinking exercises
person with a diminished mental status, the procedures for airway evaluation, opening
Key Facts and Concepts that ask students
the airway, to apply
and artificial ventilation are knowledge,
best carried out with case
the patient lying supine
• The primary assessment is a systematic approach to quickly lifeless and apparently are not breathing or have only (flat on the back). Scan 9-1 illustrates the technique for positioning a patient found lying
finding and treating immediate threats to life. agonal respirations. This begins with a pulse check and chest
compressions if there is no pulse.
studies, and more.
on the floor or ground. Patients who are found in positions other than supine or on the
• The general impression, although somewhat subjective, can
provide extremely useful information regarding the urgency • If your patient shows signs of life (e.g., moving, moaning, ground should be moved to a supine position on the floor or stretcher for evaluation and
of a patient’s condition. talking) and is breathing, you will take a traditional A-B-C
approach.
treatment.
• The determination of mental status follows the AVPU
approach. • Remember that the mnemonic A-B-C is a guide to interven- Any movement of a trauma (injured) patient before immobilization of the head and
• Evaluating airway, breathing, and circulation quickly but
tions that may be taken. You will choose your interventions spine can produce serious injury to the spinal cord. If you suspect an injury that could
based on the patient’s immediate needs. They may be done
thoroughly will reveal immediate threats to life that must be have resulted in spinal trauma, protect the head and neck as you position the patient.
in any order that fits the patient’s needs.
treated before the EMT proceeds further with assessment.
• Your approach to a patient will vary depending on how
• The patient’s priority describes how urgent the patient’s Airway and breathing, however, have priority over protection of the spine and must be
need to be transported is and how to conduct the rest of ensured as quickly as possible. If the trauma patient must be moved to open the airway
the patient presents. The American Heart Association
your assessment.
recommends a C-A-B approach for patients who appear
or to provide ventilations, you will probably not have time to provide complete spinal
precautions but, instead, will provide as much manual stabilization as possible.
Key Decisions
Interpret the following as indications that head, neck, or spinal injury may have
• Is this patient medical or trauma; responsive or unresponsive; • Do I need to stop and suction the airway, insert an artificial
adult, child, or infant? airway, administer oxygen, or ventilate the patient?
occurred, especially when the patient is unconscious and cannot tell you what happened
• Does this patient have any signs of life? • Is the patient’s condition stable enough to allow further or respond to assessment questions:
assessment and treatment at the scene?
• Does this patient require a C-A-B approach (likely in cardiac • Mechanism of injury is one that can cause head, neck, or spine injury. For example,
arrest)? Does the patient therefore require chest compressions
and defibrillation as the first priority? a patient who is found on the ground near a ladder or stairs may have such injuries.
Motor-vehicle collisions are another common cause of head, neck, and spine injuries.
Chapter Glossary • Any injury at or above the level of the shoulders indicates that head, neck, or spine
A-B-Cs airway, breathing, and circulation. mental status level of responsiveness.
injuries may also be present.
AVPU a memory aid for classifying a patient’s level of respon- primary assessment the first element in a patient assessment;
siveness or mental status. The letters stand for alert, verbal steps taken for the purpose of discovering and dealing • Family or bystanders may tell you that an injury to the head, neck, or spine has
response, painful response, unresponsive. with any life-threatening problems. The six parts of primary
chief complaint in emergency medicine, the reason EMS was assessment are: (1) forming a general impression, (2) assessing occurred, or they may give you information that leads you to suspect it.
called, usually in the patient’s own words. mental status, (3) assessing airway, (4) assessing breathing,
(5) assessing circulation, and (6) determining the priority of the
general impression impression of the patient’s condition
patient for treatment and transport to the hospital.
that is formed on first approaching the patient, based on the
patient’s environment, chief complaint, and appearance. priority the decision regarding the need for immediate trans-
port of the patient versus further assessment and care at the
interventions actions taken to correct or manage a patient’s
scene.
problems.
spinal motion restriction a procedure for limiting movement
manual stabilization using one’s hands to prevent movement M09B_LIMM9134_14_SE_C09.indd 210or 11/09/2019 19:41
of the head, neck, and spine when spinal injury is possible
of a patient’s head and neck until a cervical collar can be
likely.
applied.
Preparation for Your Examination and Practice

Short Answer 3. Explain how to assess airway, breathing, and circulation
during the primary assessment. Explain the interventions
1. List factors you will take into account in forming a general
you will take for possible problems with airway, breathing,
impression of a patient.
and circulation.
2. Explain how to assess a patient’s mental status with regard
4. Explain the C-A-B approach to the primary assessment, and
to the AVPU levels of responsiveness.
explain the circumstances in which the C-A-B approach
would be appropriate.
335
M12_LIMM9134_14_SE_C12.indd 335 09/09/2019 08:52
S T U DE N T R E S OU RC E
WORKBOOK FOR EMERGENCY CARE, 14TH EDITION This self-paced workbook contains updated and revised matching
exercises, multiple-choice questions, short-answer questions, labeling exercises, skills checklists, and case studies that
promote critical decision making, and a NEW Grey Zone feature with real-life practice scenarios. This workbook is available
for purchase at www.bradybooks.com.
xxxv
MyLab BRADY
www.mybradylab.com
What Is MyLab Brady?

Part of the world’s leading collection of online homework, tutorial, and assessment products, Pearson MyLab BRADY is
designed with a single purpose in mind: to improve the results of all higher education students, one student at a time.
With input from more than 11 million student users annually, Pearson MyLab creates online learning experiences that are
truly personalized and continuously adaptive. MyLab reacts to how students are actually performing, offering data-driven
guidance that helps them better absorb course material and understand difficult concepts.
Pearson also provides Learning Management System (LMS) integration services so you can easily access MyLab BRADY
from Blackboard Learn, Brightspace by D2L, Canvas, or Moodle. From a single course section to delivery across an entire
institution, we offer the integration, support, and training you need.
Understand How Your Students Make Decisions

Decision-Making Cases take EMT students through typical real-world scenarios. These branching cases give students
practice with critical thinking, gathering patient data, and making decisions for care and treatment. Access all of the
multimedia resources for your text in one place.
Multimedia Library
Each MyLab BRADY course comes with a Multimedia Library full of supporting visual and audio media, and other
resources. Use it to build assignments, supplement your lectures, or give your students access to a wealth of related
material. Support the learning needs of individuals and the entire class.
Results
Instructors can view students’ results by chapter, outcome, homework, and more—to identify where more classroom time
is needed. Digital access anytime, anywhere.
Pearson eText
The Pearson eText gives students access to their textbook anytime, anywhere, on the device of their choice, including PC,
tablet, or smartphone. In addition to note taking, highlighting, and bookmarking, the Pearson eText offers interactive and
sharing features. Rich media options let students watch lecture and example videos as they read or do their homework.
Instructors can share their comments or highlights, and students can add their own, creating a tight community of learners
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Contact us at www.mybradylab.com/contactus for more information.
xxxvi
SECTION
1
Foundations
CHAPTER 1
Introduction to Emergency
Medical Services
CHAPTER 2
Well-Being of the EMT
CHAPTER 3
Lifting and Moving Patients
CHAPTER 4
Medical, Legal, and Ethical Issues
CHAPTER 5
Medical Terminology
T
he “Foundations” section details essential concepts CHAPTER 6
and skills you will need as an Emergency Medical Anatomy and Physiology
Technician.
Chapter 1 gives an overview of the Emergency Medical CHAPTER 7
Services and the health care system. Chapter 2 emphasizes
how to keep yourself safe and well. Chapter 3 explains tech- Principles of Pathophysiology
niques for safe lifting and moving. Chapter 4 discusses legal
and ethical issues you will face as part of your career. CHAPTER 8
Chapter 5 provides basic information about how medical Life Span Development
terms are constructed. Chapter 6 offers an overview of the
structure (anatomy) and function (physiology) of the human
body. Chapter 7 introduces principles of pathophysiology:
how illness and injury affect the body. Finally, Chapter 8
concerns life span development: physical and mental pat-
terns common to the different age groups who will be your
patients.
Another random document with
no related content on Scribd:
XVI
Les Mères doivent voter
«Le vote est le droit à la considération, le

vote est le droit au pain.»
H. A.
La mère doit voter pour préparer un bon avenir à ses enfants. La

femme électeur ne peut pas comme le demandait un candidat, être un
satellite de l’homme. Elle doit déposer elle-même son bulletin dans l’urne,
et non se borner à multiplier la capacité sociale de son mari. Ce candidat
voulait qu’on donnât à la famille la prééminence politique à laquelle elle a
droit. Il préconisait le vote familial au lieu du vote des femmes.
«Ce que la femme doit vouloir, écrit-il, c’est la reconnaissance

légale de son existence sociale au même titre que le mari. La
question de savoir ensuite quelle sera la main qui portera dans
l’urne le morceau de carton représentant le bulletin familial, n’est
qu’accessoire.
«L’essentiel c’est que la femme existe. Et elle comprendra
qu’elle ne pourra conquérir ce droit éminent à l’existence qu’en
s’appuyant sur ses enfants, dont le nombre donnera autant de voix
à la famille. Ce sera là la grande force de la femme, qui ne doit se
considérer que pour ce qu’elle est naturellement: la multiplicatrice
de la capacité sociale de son mari».
Les hommes qui se moquent de Guillaume II parlant de sa royauté de

droit divin, disent aux femmes qu’ils ont sur elles une autorité de droit
divin, et que la politique est incompatible avec les fonctions de mères et
d’épouses. Mais le travail de mercenaire, de blanchissage, de portefaix
n’est pas incompatible avec ces fonctions.
On ne peut opposer la maternité, à l’exercice des droits de cette
quantité innombrable de femmes qui ne sont pas mères, qui ne le seront
jamais, qui ne l’ont jamais été.
On ne peut pas opposer, davantage, la maternité à l’exercice des
droits des femmes qui sont mères, parce qu’en aucun cas, un devoir ne
peut destituer d’un droit.
Quand il survient à l’homme des devoirs, les devoirs de la paternité, le
prive-t-on de ses droits civiques? Non. Alors pourquoi sous le prétexte
qu’elle est mère destituerait-on la femme des siens?
Est-ce que la paternité entraîne moins d’obligations que la maternité?
Est-ce que le soin d’élever l’enfant n’incombe pas solidairement aux deux
auteurs de sa naissance? Dernièrement, un candidat a enlevé un
auditoire d’hommes avec cette phrase: «Si les femmes votaient, vous
seriez obligés de garder les enfants.» Cet argument n’est pas heureux. Il
exprime avec un trop naïf égoïsme que si l’homme détient le droit de la
femme, c’est surtout dans la crainte d’être astreint à faire son devoir. Les
républicains excluent les femmes du droit, de crainte que la femme ne leur
échappe comme servante.
Qu’on n’allègue pas contre les mères l’impossibilité où elles seraient
de quitter leur enfant pour voter. Est-ce que les mères ne pourraient pas
se faire remplacer par le père près du berceau de l’enfant pour aller
préparer, par leur vote, un avenir heureux aux petits êtres qu’elles
adorent?
Est-ce que l’homme serait déshonoré parce qu’à son tour il garderait
l’enfant?
La maternité ne s’oppose pas plus à l’exercice des droits civiques,
qu’elle ne s’oppose à l’exercice d’un commerce, à l’exercice d’une
profession, à l’exercice d’un art.
Les femmes ne manqueraient pas plus à leurs devoirs familiaux en
contribuant par leur part d’intelligence au bien de la société, qu’elles n’y
manquent en allant à l’Eglise, au théâtre, au cinéma, dans les magasins.
Si la maternité absorbait la femme, au point de l’empêcher de
s’occuper de toute vie extérieure, alors il faudrait commencer par faire des
rentes à toutes les mères qui n’en ont pas, car l’obligation de gagner le
pain quotidien, l’obligation d’aller quérir les provisions du ménage,
éloigneront certainement toujours plus les mères de leurs enfants que
celle d’aller déposer dans l’urne un bulletin de vote un jour d’élection.
D’ailleurs, si la maternité n’était une allégation hypocrite pour refuser le
vote aux femmes, celles qui ne sont pas mères devraient pouvoir exercer
leurs droits, tandis qu’elles en sont tout aussi bien destituées que celles
qui sont mères.
Si nous demandons pour toutes les femmes, pour celles qui sont
mères, comme pour celles ne le sont pas, l’intégralité du droit, c’est que
nous savons que le sentiment de la responsabilité, qui résulte de la
possession du droit, éveille à un haut degré l’idée du devoir.
C’est que nous savons que la femme, une fois en possession de ses
droits civiques, marchera avec l’homme dans la voie du progrès, et que
ses enfants, après s’être nourris de son lait, s’assimileront ses idées de
justice et de liberté.
Si nous demandons pour la femme l’intégralité du droit, c’est que nous
savons que l’autorité de la Citoyenne est indispensable à la femme pour
être non seulement une mère selon la nature, une mère qui donne à son
enfant la santé, la force et la beauté du corps, mais encore, mais surtout,
une mère selon l’intelligence, une mère capable de donner à son enfant la
santé, la force et la beauté de l’âme, mens sana in corpore sano.
Quelques personnes nous disent: La famille serait désorganisée si
l’homme cessait de régner partout en roi absolu, si la femme avait sa part
de pouvoir dans la famille et dans l’Etat.
Profonde erreur. Qu’est-ce donc qui peut mieux établir la sympathie
entre les hommes que la solidarité des intérêts qui résulte de la
communauté du pouvoir?
Qu’est-ce donc qui pourrait mieux qu’une communauté de pouvoir
amener entre les époux la concorde, l’union de l’esprit? Union autrement
solide, celle-ci, que l’union du cœur!
Qu’est-ce qui pourrait mieux qu’une communauté de pouvoir, amener
chez les époux une communion de goûts, d’idées, d’aspirations, une
communion de vie intellectuelle?
Aujourd’hui, quand l’union si éphémère du cœur cesse d’exister, un
abîme se creuse entre les époux parce qu’ils n’ont pas un seul point de
ralliement. Aucun but moral, aucun intérêt élevé ne les réunit. Et dans ces
ménages où l’on ne cause, certes, ni de politique ni de sociologie, les
enfants sont le plus souvent abandonnés.
Tandis qu’avec cette chose rationnelle, la vie publique ouverte aux
femmes, la vie publique commune pour les époux, comme est commune
la vie privée, le niveau moral intellectuel s’élèverait bientôt dans chaque
ménage.
L’obligation pour les femmes de s’occuper de choses sérieuses qui
intéressent les hommes, établirait au grand profit de l’harmonie conjugale
entre maris et femmes, une émulation salutaire pour le progrès.
Les intérêts de la société, avant d’être discutés et rendus publics,
seraient d’abord discutés et résolus en famille. L’enfant témoin de ces
saines préoccupations grandirait heureux. Sa précoce initiation à la vie
civique aurait la puissance de l’éloigner des atmosphères vicieuses.
Donc, à ce triple point de vue, le bonheur de l’homme, l’intérêt de
l’enfant, l’harmonie de la famille, il est urgent que la femme, que la mère,
exerce au plus tôt ses droits civiques.
Les Français souverains ne font encore que jouer au progrès. Ils ont
badigeonné une façade de république, mais ils n’ont point la virilité
nécessaire pour accomplir les transformations fondamentales en
changeant la condition de celle qui donne aux mâles et femelles de la
nation les muscles et la moëlle. Cependant, si les milieux influent sur les
individus, combien plus exercent sur eux, d’action, les molécules d’où ils
tirent leur origine.
«Dis-moi d’où tu sors, je te dirai qui tu es!...»
Les Français, qui tous, sortent de serves, ne peuvent pas être
naturellement indépendants. L’absence de caractère, la veulerie ne se
surmonteront que quand les humains naîtront de mères libres.
La mère donne à l’enfant son empreinte. Le sein maternel fait ce qu’ils
sont, les humains.
Les femmes annulées, opprimées font des enfants à la mentalité
tordue. Pour que les enfants soient droits cérébralement il faut appeler
celles qui les créent à la plénitude de l’existence sociale et politique.
Il faut affranchir la dispensatrice de la vie en proclamant l’égalité des
sexes devant la loi.
Les femmes n’ont pas seulement le droit de participer à la politique.
Elles ont besoin d’y participer, afin de trouver là un point d’appui quand,
par le fait de la disparition de leur compagnon, le sol manque sous leurs
pieds.
Les femmes concentreraient sur l’amélioration des conditions
d’existence leurs énergies accumulées qui pourraient aider à résoudre
des problèmes qui aujourd’hui semblent insolubles, parce qu’ils
concernent l’humanité toute entière et que les seuls efforts masculins sont
impuissants à en donner la clef.
Le droit qu’ont les femmes de faire valoir leurs droits civiques, se
double pour elles du devoir de changer pour les générations qu’elles
créent, la vie de privations en vie de satisfaction, de bien-être.
Le droit d’intervenir dans les arrangements sociaux est refusé aux
femmes par les hommes qui leur attribuent le plus grand pouvoir occulte.
C’est une anomalie de garder les femmes qui tiennent une si grande place
dans la position d’inférieures où elles sont.
Si l’instinct de conservation ne contraint les antiféministes à dire à la
femme: Tu n’es plus une poupée avec laquelle on joue et dont on se joue.
Tu es un important acteur social dont on attend l’effort. Si la dispensatrice
de la vie reste annulée, si la femme n’a pas le pouvoir de sauver les
individus en transformant, avec les lois, le milieu social, elle sera la
vengeresse inconsciente qui poussera l’humanité dégénérée à s’abîmer
dans l’anéantissement.
XVII
La fonction maternelle rétribuée
«Parce que la femme est mère, elle ne

peut être ni électeur, ni député, mais elle peut
être blanchisseuse, femme de peine.»
Hubertine Auclert.
Le sexe masculin est incapable de bien légiférer pour les deux sexes.
Parce que les femmes ne sont ni électeurs, ni éligibles, les lois,
mêmes faites pour elles, se tournent contre elles. Ainsi la loi sur la
recherche de la paternité fait condamner à l’amende, à la prison, à
l’interdiction de séjour, la fille mère qui n’a pas de preuves écrites de la
coopération de celui qu’elle poursuit comme cocréateur de son enfant.
Pour assurer aux hommes de n’être pas ennuyés par les femmes qu’ils
rendent mères, cette loi force les femmes à recourir à l’infanticide: la
charge d’un enfant étant au-dessus des ressources d’une fille-mère.
Pendant que des hommes graves clament que le pays se dépeuple,
pendant que des politiciens se liguent pour augmenter la natalité, ce ne
sont pas seulement celles qui n’ont pu devenir mères selon la formule
édictée par le Code, qui risquent la vie pour empêcher un bébé de naître.
Tous les jours, des épouses légitimes disent: «je ne peux pas avoir un
nouvel enfant, je serais délaissée» et elles vont trouver l’opérateur, de
chez lequel elles sortent non point toujours mortes, mais souvent
estropiées.
Pourquoi cette rage de destruction d’embryons humains existe-t-elle
dans un pays dont on prédit l’effacement pour cause de manque
d’habitants?
Parce que les Français, barbares, laissent à la femme qui ne parvient
pas à se suffire à elle-même, la charge d’élever les enfants communs.
Femmes mariées comme femmes célibataires ont la terreur de la
maternité, parce que la maternité leur inflige, en plus de la souffrance, la
gêne, la pauvreté, la noire misère.
Les Françaises n’auraient point cette terreur de la maternité, si elles
pouvaient en participant à la législation, se donner des garanties. Les
hommes législateurs ne proposent point de procurer la sérénité au sein
maternel. On semble n’attacher aucune importance à ce que les Mères de
la nation, détériorées par les souffrances physiques et morales, ne soient
pas en état à donner le jour à des êtres assez forts pour supporter la vie.
Quand on veut fabriquer un objet, on donne au moule qui doit l’exécuter la
forme et la solidité nécessaires. Mais lorsqu’il s’agit de fabriquer des
humains, on se dispense de prendre cette précaution élémentaire. On
aime mieux créer des hôpitaux pour les malades que de donner aux
génératrices la possibilité de mettre au monde des enfants robustes, sur
lesquels n’aurait point de prise la maladie.
La nature qui ne demande pas à la femme son acquiescement à la
maternité, lui impose la charge de l’enfant. La mère n’a qu’une garantie
illusoire d’être aidée à élever l’enfant, puisque cette garantie repose sur le
seul bon plaisir de l’homme. Chacun sait en effet, que l’amant se dérobe
dès qu’apparaît la grossesse de son amie, et que de plus en plus
nombreux sont les époux légitimes qui font la fête et se dispensent de
remplir le devoir paternel. Dans l’intérêt de la nation et de l’espèce
humaine, cet état de choses doit cesser. Il est plus que temps de régler la
question relative aux rapports des sexes.
La mère qui assure la perpétuation de l’espèce doit être traitée comme
le soldat qui assure la sécurité du territoire: c’est-à-dire, être logée, nourrie
durant le temps de son service de mère.
La maternité cessera de terrifier les Françaises quand, au lieu de les
déshonorer et de les réduire au dénûment, elle les fera considérer et
indemniser comme d’indispensables fonctionnaires.
On se procurera l’argent nécessaire pour rétribuer la maternité en
établissant l’impôt paternel que les hommes auront avantage à payer pour
s’épargner des coups de revolver, des brûlures de vitriol et se garantir des
procès en recherche de paternité, suivis souvent de procès en divorce.
Il suffit de mettre dans la loi cet article: «A partir de 16 ans tout
Français paie l’impôt paternel pour indemniser les mères sans ressources
et assurer l’existence des enfants.»
XVIII
L’enfant doit-il porter le nom de la Mère? Matriarcat
Tous ceux qui ont séjourné en Algérie dans les oasis, ont pu voir au
printemps des Arabes grimper au faîte de hauts palmiers femelles, pour
répandre au-dessus de leur tête du pollen de palmiers mâles. Les fruits du
dattier femelle ainsi fécondé, lui appartiennent en propre. Ne devrait-il pas
en être ainsi des fruits humains? Pourquoi la femme qui a modelé dans
ses flancs et moralement formé l’enfant, peut-elle moins bien le classer
socialement que l’homme fécondateur?
Ce ne sera plus en étalant devant les tribunaux une faiblesse, point
générale chez son sexe, en exhalant des plaintes au théâtre contre
l’homme auteur de son déshonneur, que la mère naturelle parviendra à se
faire honorer. C’est en revendiquant virilement la responsabilité de son
acte, c’est en demandant d’être, par une rétribution équitable, mise à
même d’exercer cette fonction sociale: la maternité.
L’élémentaire justice, faisant proposer de donner un père à l’enfant
naturel, qui paraît avantageux pour la femme, règle en réalité à son
détriment une situation, en augmentant l’autorité de l’homme.
La mère élevée par son enfant au rang de chef de famille, a une autre
situation morale que l’esclave qui reconnaît son indignité, en demandant
le patronage de l’homme qui se dérobe.
—Que veut le féminisme?
—Diviser l’autorité familiale et sociale.
Enlever à l’homme la moitié de son pouvoir autocratique pour en doter
sa compagne. Or la recherche de la paternité tend à un but tout opposé,
puisqu’elle concentre dans une seule main l’autorité, en conférant à
l’homme, hors du mariage, comme dans le mariage, la qualité de chef de
famille.
Emile de Girardin, qui demandait que toute distinction établie par les
lois, entre les enfants naturels, adultérins, incestueux, légitimes, fût abolie,
voulait que l’enfant porte le nom de sa mère et soit sous son autorité.
C’était le matriarcat substitué au patriarcat.
En confondant les mères entre elles, en les reconnaissant également
aptes à exercer l’autorité sur leurs enfants et à leur donner leurs noms, le
matriarcat empêcherait de distinguer les mères naturelles des autres, et il
rendrait les enfants égaux devant l’état-civil.
Bien que la couvade n’existe pas matériellement en France, les
Français matricides rendent moralement inexistantes les mères en se
substituant à elles, en s’attribuant le mérite de leurs maternités et en
retirant honneurs et profits.
La créatrice annulée et écrasée chez nous a exercé ailleurs, en une
période de l’évolution humaine, une domination bienfaisante.
Le matriarcat a existé et existe encore dans un certain nombre
d’agglomérations humaines.
Dans la Chine antique, avant l’époque de Fohi, disent les anciens
livres, les hommes connaissaient leur mère, mais ils ignoraient qui était
leur père.
En Asie, les Lyciens prenaient le nom de leur mère et attribuaient
l’héritage aux filles.
Dans l’ancienne Egypte, les enfants portaient le nom de leur mère et
étaient dirigés par elle. Les femmes d’Egypte, dit Hérodote, vont sur la
place publique, se livrent au commerce et à l’industrie pendant que les
hommes demeurent à la maison, et y font le travail intérieur. Les femmes,
aux portes de l’Egypte, considèrent comme un déshonneur de tisser et de
filer.
Les Hurons et les Iroquois prennent le nom de leur mère, et c’est par
elle qu’ils comptent leur généalogie. C’est par les femmes que se consiste
la nation, la noblesse du sang, l’arbre généalogique, l’ordre des
générations et la conservation des familles.
La noblesse utérine exista en France en la période féodale. La mère
noble donnait le jour à un fils noble: le père fut-il roturier.
Les Crétois, d’après Platon, nommaient leur patrie d’origine, matrie:
combien d’autres peuples primitifs préférant la réalité à la fiction se
servaient de ce doux terme, matrie (mère) pour désigner les lieux qu’ils
habitaient. Ne serait-il pas plus naturel de dire: la France est ma matrie,
ma mère, que: la France est ma patrie, mon père?
Les Touaregs qui habitent le centre du Sahara Africain, ainsi que
presque tous les peuples de race berbère, sont régis par le matriarcat. Ils
se dénomment en raison de cela Beni-oummia (fils de la mère).
C’est, dit une formule de leur droit traditionnel, «le ventre qui teint
l’enfant». Aussi, le fils d’une mère noble et d’un père esclave est noble, le
fils d’une mère esclave et d’un père noble, est esclave.
Chez les Beni-oummia la loi salique est renversée. Ce n’est point le fils
du chef qui succède à son père, c’est le fils de la sœur de celui-ci.
Même nomade, la femme Targuie est instruite et a partout la première
place. Elle discute dans les conseils de la Tribu. Elle a l’administration de
l’héritage. Elle seule dispose des tentes, maisons, troupeaux, sources et
jardins. Enfin, elle confère, avec la condition sociale, les droits de
commandement sur les serfs et les redevances payées par les voyageurs.
On voit que les peuples qui se désintéressent de la paternité, au point
de s’appeler «fils de la mère» accordent à la femme, avec l’autorité
morale, bien des privilèges et que les Français civilisés auraient beaucoup
à apprendre au point de vue féministe, des Touaregs qualifiés de
barbares, par ceux qui ne les connaissent pas.
Malgré que les hommes s’efforcent de se le dissimuler, la mère donne
à l’enfant son empreinte en dépit de l’école. Nos belles écoles, qui sont à
juste titre l’orgueil et l’espoir de la nation, ne cultivent que l’intelligence.
Quand on aura affranchi la dispensatrice de la vie en proclamant
l’égalité des sexes devant la loi, les humains ne piétineront plus. Ils
courront dans la voie du progrès.
XIX
Les mères et la dépopulation
En entendant répéter que les femmes ont pour unique rôle de mettre
des enfants au monde, on pouvait penser que le sexe féminin restait dans
la mission qui lui est assignée, en demandant de faire partie de la
commission extra-parlementaire chargée de combattre la dépopulation.
Il nous semblait que les deux sexes réunis, étaient seuls compétents
pour décider d’une affaire où le couple est indispensable. Eh bien, nous
étions dans l’erreur. Les hommes seuls suffisent pour repeupler la France,
puisque pas une femme n’a été nommée membre de la commission de
repeuplement.
Les Français présomptueux croient qu’ils pourront, sans les
Françaises, augmenter la natalité, comme sans elles, ils pensent
continuer à administrer et à gouverner.
Les messieurs réunis pour remédier à la dépopulation, s’imagineront
résoudre la question en récompensant l’homme qui n’a que du plaisir en
devenant père, tandis que la femme ruine sa santé, risque sa vie en
enfantant.
N’étant point traitée comme la cheville ouvrière du repeuplement, la
génératrice continuera, suivant la coutume, à se préserver de la
fécondation, à recourir à l’avortement, de sorte que l’homme déçu de ses
rêves de paternité, ne pourra percevoir le dédommagement du travail
puerpéral qui lui aura été attribué.
Bien que notre orgueil national prenne plaisir à constater que les
peuples les plus civilisés sont les moins prolifiques, la disette d’enfants
met la France en si mauvaise posture dans le monde, que les législateurs
ont songé à proposer de surtaxer les célibataires, les veufs, les divorcés.
Si cet impôt vexatoire ne frappait que les femmes, qui ne votant point,
ne sont point à ménager, il serait sûrement adopté par la commission.
Mais les célibataires mâles étant électeurs, on ne rééditera pas la loi de
1798 qui, durant quelques années, surimposera les célibataires.
D’ailleurs, un impôt ne contraindrait pas au mariage les célibataires.
L’unique moyen d’augmenter la natalité consiste à intéresser les
génératrices à cette augmentation. Pendant que les femmes n’auront
aucun avantage à procréer beaucoup d’enfants, elles se soustrairont aux
nombreuses maternités qui les accablent de souffrances, les surchargent
de travail et les enlaidissent!
Certes, les hommes sont en France bien puissants. Pourtant, quoique
souverains, ils ne peuvent ni changer les lois naturelles, ni augmenter,
sans le concours des femmes, la natalité. Il devient donc, dès lors,
indispensable que les femmes fassent connaître à quelles conditions elles
consentiront à être plus souvent mères. La solution de la question du
dépeuplement est seulement là.
Si les législateurs ne trouvent pas que les procréatrices sont, plus que
quiconque, aptes à donner sur cela leur avis, les efforts en vue du
repeuplement échoueront: les seules personnes capables de les faire
aboutir étant laissées de côté.
On propose de spolier les génératrices, de récompenser les hommes
du travail de gestation et de parturition des femmes. La prime donnée au
père n’allégerait point le fardeau maternel. Ce ne serait pas, parce que les
hommes civilisés empocheraient la récompense de l’enfantement, qu’ils
parviendraient plus que les primitifs—simulant les douleurs quand leur
femme accouche—à faire croire que ce sont eux qui mettent au monde
les enfants.
Pour obtenir de la femme qu’elle dépense ses forces, passe ses nuits
en veilles, ruine sa santé et risque sa vie afin d’augmenter la population,
c’est employer un singulier moyen que de gratifier le père, parce qu’il vote,
du travail accompli par la mère, qui ne vote pas. Est-ce le moyen de
déterminer les femmes à appeler à la vie beaucoup d’enfants? Les
ouvriers seraient-ils excités à travailler en un chantier où le contre-maître
s’attribuerait leur salaire?
Les nombreuses maternités déforment, fatiguent, affaiblissent,
enlaidissent, non le père, mais la mère. Si, au lieu de lui attacher par un
petit intérêt son mari, on spolie la femme souffreteuse de la rente qui lui
est due pour la donner à l’homme gaillard, est-ce que ce ne sera pas
inciter celui-ci à la dépenser, cette rente, avec une accorte voisine, point
productrice d’enfants?
On tourne autour de la question de l’indemnisation maternelle, qu’on
ne veut pas proposer parce que la femme qui est en droit de la toucher,
est une hors la loi.
Il est facile de comprendre que quiconque a la peine doit toucher un
salaire et que les femmes ne se déprimeront ni ne s’useront plus, dans le
seul but de procurer des rentes à leur mari qui, après la douzaine
d’enfants pourrait les planter là.
La femme est la propriété de l’homme (une propriété de rapport)
comme l’arbre à fruit est celle du jardinier, puisqu’on reconnaît seulement
à celui-ci le droit de tirer profit des fruits humains.
Que l’on tourne et retourne, en tous sens, la question du
repeuplement, on ne parviendra à la résoudre que par l’indemnisation
maternelle, qui allégera les charges du père et permettra à la mère de
conserver en se soignant, des forces de réserve pour de nouvelles
maternités.
A la femme aisée ou riche, qui ne serait, ni par une indemnité, ni par
une retraite, encouragée à de successives maternités, on pourrait offrir
l’appât des récompenses honorifiques.
Nous trouvons puériles les décorations, mais puisque les hommes en
raffolent, les femmes peuvent bien, à leur exemple, les convoiter.
Il ne faudrait pas bien entendu, que la décoration attribuée à la
maternité, lui soit spéciale: une croix de la maternité serait de suite
appelée Croix de Gigogne.
Mais admettre la femme, six fois mère, à la Légion d’honneur,
honorerait la croix en lui faisant récompenser ce qui est utile au pays.
XX
La femme en état de légitime défense
Les infanticides sont si fréquents, que chacun est forcé de se

demander s’ils ne sont pas une nécessité sociale, et s’il ne serait pas
temps de mettre, relativement à la génération, les conventions et les lois
en harmonie avec la nature.
Le public qui traque la coupable d’infanticide et dispute à la police le
soin de l’amener devant ses juges, n’est rien moins que disposé à
atténuer son crime.
Cependant, cette meurtrière était en état de légitime défense. C’est
pour se sauver qu’elle a tué. La société tout entière fonçait sur elle,
menaçait de la vomir de son sein, de l’écharper moralement. Affolée par
l’horreur de sa situation, elle est devenue horrible. Elle a mis son enfant
hors la vie, pour ne pas être mise hors de l’humanité.
Il faudrait voir comment se comporteraient ceux qui déclament contre
la fille-mère exterminatrice, s’ils étaient aux prises avec les difficultés
inénarrables de son présent et l’épouvantement de l’avenir qui lui est
réservé. Sa faute va tendre autour d’elle un cordon sanitaire. On
s’éloignera d’elle comme d’une pestiférée, ses amis ne la connaîtront
plus. Toutes les portes, tous les cœurs lui seront fermés. Enfin, alors que
ses besoins s’augmenteront de ceux d’une autre existence, elle ne
trouvera plus d’ouvrage.
La fille-mère a à choisir entre le mépris public, un dénûment sans nom
et... le crime! L’instinct de la conservation, le sentiment faux mais très
violent de l’honneur, en font une criminelle.
Quel est l’individu, homme ou femme, qui sachant qu’il va être à tout
jamais flétri et flétri injustement, est bien certain de ne pas perdre un
instant la raison, et de ne pas commettre un crime pour échapper à
l’opprobre qui l’attend?
A ceux qui soutiennent que la mère infanticide a été impitoyable, on
peut demander si elle a été aussi impitoyable et féroce que la société qui
contraint toutes les pauvres filles, sous peine de déchéance, à se

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CIP available at the Library of Congress

This edition is dedicated to Stephanie, Sarah and Margo. I am fortunate to be

To the memory of my parents, Mike and Noreen, and to my family.

SEC T ION 1 SEC T ION 3

Trauma 782 C HAPTER 41

Components of the EMS System 5 Chapter Review 52

• Special Situations 93 The Regulation of Homeostasis 161

Think Like an EMT Determining If Vital • Pathophysiology of the Cardiopulmonary

• The “Look Test” 319 • How a Clinician Reaches a Diagnosis 392

CHAPTER 13 Secondary Assessment of the

CHAPTER 14 • Trauma Patient Who Is Not Seriously Injured 449

Principles of Assessment 368 Chapter Review 450

The Verbal Report 469 Think Like an EMT How or Whether to

SECTION • Pulmonary Edema 541

• Heart Failure and Acute Pulmonary Edema 574 • Stroke 639

Assessment and Care of Abdominal Pain • Renal Failure 771

or Discomfort 734 • Medical Emergencies with End-Stage

• Scene Size-Up 735 Renal Disease 776

• Primary Assessment 735 • Kidney Transplant Patients 778

• History 735 Think Like an EMT Should You Request

Shock 788 Chest Injuries 873

Electrical Injuries 856 Injuries to the Skull and Brain 953

• The Evolution of Spinal Care 977 • Snakebites 1044

CHAPTER 37 Receiving and Responding to a Call 1151

Vehicle Extrication 1219 Characteristics of CBRNE Agents 1259

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2-1 Glove Removal 28 19-3 Prescribed Inhaler 549

33-3 Selective Spinal Immobilization 40-2 Extinguishing Fires in Collision

33-4 Applying a Vest-Type Extrication 40-3 Stabilizing Vehicles Involved in a

Scene Size-Up 292

C H A P T E R 12 Red blood cells

Primary Assessment 316–317

Welcome to the exciting world of EMS.

Daniel Limmer Michael F. O’Keefe Edward T. Dickinson, MD, NRP,

Brady/Pearson Health Sciences

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About the People

Mark Hornshuh James Robertson

Vermont Hazardous Materials Response Team Models

About the Authors

Airway Management, Respiration, and Artificial Ventilation (Airway

CORE CONCEPTS Highlight the key points

Applies knowledge (fundamental depth, foundational breadth) of general

thing Cricoid cartilage is less rigid and

lation our patients are in the AIRWAY