311 - NREMT MEDICAL STANDARDS (EMT-B)

An Emergency Medical Technician (EMT) is a prehospital care provider trained to deliver basic life support (BLS) and emergency medical care. EMTs can assess patients, manage airways, control bleeding, provide CPR, administer certain medications, and assist in stabilizing patients before and during transport to definitive care. They operate under the direction of medical control and are often the primary medical responders on-scene. 

Responsibilities include:

• Patient assessment and vital signs

• CPR and AED use

• Airway management with OPA/NPA

• Bag-valve mask ventilation

• Oxygen administration

• Airway suctioning

• Bleeding control

• Bandaging and splinting

• Spinal immobilization

• Emergency childbirth assistance

• Triage during mass casualty events

• Transport and monitoring of stable patients
  
  

Medications they can give or assist with:

• Oxygen

• Oral glucose

• Aspirin

• Epinephrine (auto-injector)

• Naloxone (Narcan)

• Albuterol (inhaler or nebulizer with approval)

• Nitroglycerin (assisting with the patient's own supply)

They cannot start IVs, intubate, or give medications outside protocol.

• Naloxone (Narcan)

• Albuterol (via patient’s inhaler or approved EMS supply)
  
  

They can also assist patients with prescribed nitroglycerin or inhalers when permitted.

In exigent circumstances only, an ALS Provider may authorize the performance of any ALS procedures to an experienced BLS provider as LONG as the ALS provider is supervising and holds full responsibility for any malpractice that may come of it. Any BLS provider who feels inexperienced or otherwise uncomfortable performing any ALS procedure shall deny any request from an ALS provider, no matter the circumstance.

Pulse Check
Check the patient’s pulse at common sites such as the wrist, neck, or foot using your fingers (not your thumb). A normal adult pulse ranges from 60 to 100 beats per minute. If no pulse is detected, immediately begin CPR and request Advanced Life Support (ALS) assistance. Continue CPR until advanced providers arrive or the pulse returns. If a pulse is present, continue to monitor regularly.

Breathing Assessment
Assess the patient’s breathing by observing chest movement and listening with a stethoscope if available. Normal adult respiratory rate is 12 to 20 breaths per minute. Use a pulse oximeter to measure oxygen saturation; normal readings are 95% or higher. If the patient is not breathing or breathing inadequately, provide assisted ventilations using a bag-valve mask (BVM) at a rate of one breath every 5 to 6 seconds. Administer oxygen via a non-rebreather mask if oxygen saturation falls below 90%. If there is no improvement, escalate care and request ALS.

Blood Pressure Measurement
Measure blood pressure using a sphygmomanometer. Normal adult blood pressure is approximately 120/80 mmHg. Low blood pressure may indicate shock or significant blood loss—treat accordingly and request ALS. High blood pressure may signal other medical concerns and should be monitored closely.

EQUIPMENT

Kendrick Extrication Device (KED)
Use a Kendrick Extrication Device (KED) to immobilize the spine in seated patients when spinal injury is suspected. If the patient’s condition deteriorates, call for ALS support.

Pulse Oximeter
A pulse oximeter clips onto a finger or earlobe to provide a noninvasive oxygen saturation reading. Low readings require oxygen administration and possibly ALS intervention.

Bag-Valve Mask (BVM)
The bag-valve mask (BVM) is used to manually assist breathing in patients who are not breathing adequately. Ensure a proper mask seal and ventilate at the appropriate rate.

Non-Rebreather Mask (NRB)
A non-rebreather mask delivers high-concentration oxygen to patients who are breathing but require supplemental oxygen.

Nasopharyngeal Airway (NPA)
A nasopharyngeal airway (NPA) is inserted through the nostril to maintain airway patency, especially if the oral airway is obstructed and the patient is semi-conscious.

Oropharyngeal Airway (OPA)
An oropharyngeal airway (OPA) is used in unconscious patients without a gag reflex to prevent tongue obstruction of the airway.

Automated External Defibrillator (AED)
An Automated External Defibrillator (AED) analyzes the heart rhythm and advises a shock if a shockable rhythm is present. Follow device prompts carefully.

Summary
If the patient has no pulse and is not breathing, begin CPR immediately and request ALS. If the pulse is present but breathing is inadequate, assist ventilation and administer oxygen as needed. If oxygen saturation is low, provide supplemental oxygen and escalate care if necessary. Use airway adjuncts appropriately and call ALS when the patient’s condition does not improve or deteriorates. Immediate stabilization and transportation are strongly advised for any case. If there is no available ALS, you may use /gdo or /gme to request county ALS assistance. These are essentially nonexistent resources that come and arrive to assist you in your RP. This, at a minimum, should be avoided at any reasonable cost, but it is understandable if you do not have the available resources.

For additional resources or in-depth guidance, consult the CEMSA EMT-B training module.

INCIDENT RESPONSE

CRITICAL CARE ASSIGNMENTS (REQUEST ALS)

Traumatic Injuries
Ensure scene safety and perform rapid primary assessment. Control active bleeding with direct pressure or tourniquets. Apply spinal precautions as indicated. Conduct a secondary survey for fractures and internal injuries. Administer oxygen and prepare for rapid transport. Request ALS for advanced interventions and monitor continuously. Do NOT remove impaled objects.

Altered Mental Status
Ensure scene safety and assess airway, breathing, and circulation. Check blood glucose. Provide oxygen as needed. Monitor vital signs and mental status closely. Request ALS if the patient deteriorates or the underlying cause is unclear. Transport promptly and document thoroughly.

Seizure
Ensure scene safety and protect the patient from injury. Maintain airway patency and provide oxygen if breathing is inadequate. Do not restrain the patient. After seizure stops, monitor the airway and breathing, and assess vital signs. Request ALS if seizures continue or patient remains altered. Transport and document care.

Stroke (CVA) Suspicion
Ensure scene safety and perform primary assessment. Note the time of symptom onset. Administer oxygen if saturation is below 94%. Keep the patient calm and comfortable, minimizing movement. Prepare for rapid transport to a stroke-capable facility. Request ALS and document findings clearly.

Severe Hypoglycemia
Ensure scene safety and assess airway, breathing, and circulation. Check blood glucose if authorized. If low, assist the patient with oral glucose if conscious and able to swallow. Provide oxygen if needed. Monitor closely and request ALS if the patient does not improve or worsen. Transport and document.

Overdose (Suspected Opioid)
Ensure scene safety and use appropriate PPE. Assess airway, breathing, and circulation. Administer oxygen to maintain saturation above 90%. If authorized and available, assist with naloxone (NARCAN) administration. Monitor breathing and level of consciousness continuously. Request ALS and prepare for rapid transport. Document all interventions.

Severe Anaphylaxis
Ensure scene safety and assess airway, breathing, and circulation. Administer high-flow oxygen. Monitor vital signs and be prepared to manage airway compromise. Assist with prescribed epinephrine auto-injector if the patient possesses one. Request ALS immediately and prepare for urgent transport. Document care thoroughly.

RESCUE ASSIGNMENTS

Motor Vehicle Crash (MVC) Versus Pedestrian
Ensure scene safety and control. Quickly assess airway, breathing, circulation, and level of consciousness. Apply spinal precautions with a cervical collar and immobilization if spinal injury is suspected. Control bleeding and treat for shock as needed. Monitor vital signs closely. Request ALS for advanced care and transport promptly to a trauma center; consider the use of Air Operations or Law Enforcement for Med-flight if conditions warrant.

MVC With Obvious Injuries
Establish scene safety and perform a primary survey focusing on airway, breathing, circulation, and consciousness. Control severe bleeding immediately and apply spinal precautions. Conduct a secondary survey for additional injuries. Administer oxygen as needed and immobilize fractures. Request ALS and transport urgently while continuously monitoring the patient.

MVC Unknown Injuries
Prioritize rapid assessment with focus on ABCs and spinal stabilization. Control any visible bleeding and provide oxygen. Perform a secondary survey to detect hidden injuries. Use spinal immobilization liberally when mechanism suggests risk. Request ALS and transport promptly to a trauma facility, monitoring vitals en route.

Low Acuity Assignments (BLS Appropriate) 

Minor Injury

Assess the patient’s airway, breathing, and circulation. Perform a focused secondary survey to identify all injuries. Provide basic wound care, pain management, and immobilize any minor fractures or sprains as needed. Monitor vital signs and watch for any signs of deterioration. If condition worsens or additional care is needed, request ALS and arrange transport. 

Law Enforcement Request / Use of Force Incident

Ensure scene safety and coordinate closely with law enforcement personnel. Maintain a safe distance until the scene is secured. Assess and prioritize patient care once safe to approach. Evaluate airway, breathing, and circulation, and provide immediate life-saving interventions as needed. Control bleeding and immobilize injuries while respecting law enforcement protocols. Monitor vital signs and mental status continuously. Document all injuries and interventions thoroughly. Be prepared to assist with patient transport once law enforcement clearance is given. 

Chest Pain
Ensure scene safety and assess airway, breathing, and circulation. Obtain patient history including pain characteristics and associated symptoms. Administer oxygen if saturation is below 94%. Assist with nitroglycerin if indicated and provide aspirin unless contraindicated. Monitor vitals closely and prepare for rapid transport to a cardiac-capable facility. Request ALS for advanced cardiac care.

• Nitroglycerin: EMT-B can assist a patient in taking their own prescribed nitroglycerin if the patient is alert, has a prescription, systolic blood pressure is above a safe limit (usually >100 mmHg), and no contraindications like recent use of erectile dysfunction meds.

• Aspirin: EMT-B can administer aspirin for suspected cardiac chest pain following local protocols, usually 160-325 mg orally, unless contraindications like allergy or active bleeding exist.

Gas Inhalation / Carbon Monoxide Poisoning
Remove patient from hazardous environment. Administer high-flow oxygen immediately via a non-rebreather mask. Monitor oxygen saturation, noting that pulse oximetry may not detect CO poisoning accurately. Assess for symptoms like headache, confusion, or unconsciousness. Request ALS if severe symptoms are present and transport promptly.

Psychiatric Problem / Case (Request Law Enforcement)
Ensure scene safety for all. Approach calmly and avoid escalation. Assess for medical causes and immediate danger to the patient or others. Use verbal de-escalation techniques; avoid physical restraint unless necessary with backup. Request law enforcement assistance. Provide supportive care and transport to the appropriate facility. Contact a Mental Evaluation Officer, unit, or state-allocated resources as applicable for the local law enforcement agency. 

NON-URGENT CARE (BLS, IFT CONVALESCENT CARE OR URGENT CARE REFERRAL DEPENDENT)

Minor Cuts and Abrasions
Assess and clean wounds, apply dressings, and monitor for signs of infection. Provide basic first aid and reassure the patient. Transport if necessary.

Mild Allergic Reactions
Evaluate the patient's airway and breathing. Administer oxygen if needed. Monitor for progression. Assist with antihistamines if authorized. Transport if symptoms persist or worsen.

Stable Vital Sign Monitoring
Perform routine vital signs checks for patients with non-urgent complaints. Document and report findings. Provide reassurance and basic care.

Muscle Strains and Sprains
Assess injury, provide immobilization, and apply ice if available. Offer pain management within scope and advise on transport for further evaluation.

Minor Burns
Cool affected area with water, cover with sterile dressing, and monitor for pain and shock. Transport if burns cover a large area or involve critical zones.

Non-severe Headache or Dizziness
Assess neurological status and vital signs. Provide supportive care and monitor for changes. Transport if symptoms escalate or persist.

Nausea or Vomiting Without Dehydration
Monitor airway and vital signs. Provide reassurance and supportive care. Encourage transport if symptoms worsen or dehydration develops.

Chronic Condition Follow-Up (Stable)
Assist patients managing chronic illnesses with stable symptoms. Monitor vital signs and provide standard care. Transport if the condition deteriorates.