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PHTLS_ Prehospital Trauma Life Support 8TH

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Published by patrasyounas_younasbarkat, 2022-07-12 06:31:55

PHTLS_ Prehospital Trauma Life Support 8TH

PHTLS_ Prehospital Trauma Life Support 8TH


Ruggedized Intravenous Line ccontinued>

The TEMS operator inserts a second IV catheter The TEMS operator secures the second catheter
• and att aches t he IV line to the arm with
• (18 gauge) directly through the dressing film and
rubber stopper of the saline lock and administers circumferential application of a Velcro securing
device or tape.
fluids and medications through this catheter.

• If and when the trauma patient must be moved,
the securing device or tape, IV line, and second
catheter are removed. The primary catheter
and saline lock remain in place, thus ensuring
rapid IV access once the patient move has been


ABO An abbreviation for "army battle makers in the event that the patient is anhidrosis The absence of sweating.
dressing." unable to make a medical decision for
himself or herself. The two types of anisocoria Inequality of pupil size.
abuse The willful infliction of written advance directives most often
iajwy, unreasonable confinement, encountered are a living will and a antecedent Something that occurred
intimidation, or cruel punishment medical power of attorney. earlier in time.
resulting in physical or psychological
harm or pain, or the withholding of aerobic metabolism Oxygen-based anterior cord syndrome Damage to the
seIVices that would prevent these metabolism; the body's principal anterior portion of the spinal cord,
events. combustion process; the most efficient usually as a result of bony fragments or
process for the production ofcellular pressure on spinal arteries.
acetylcholine A chemical that functions energy.
as a neurotransmitter, released at the aortography An x-ray study of the aorta
end of nerve cells to transmit a nervous aerosol Solid particles and liquid in which a radio-opaque contrast
system impulse. particles that are suspended in air. material is iajected into the circulatory
system to show the aorta.
acid A chemical substance that has a pH afterload The pressure against which
less than 7 and that will neutralize an the left ventricle must pump out (eject) apnea The absence of breathing.
alkali. blood with each beat.
apoptosis A process of cell death in
acidosis Accumulation of acids and air density As used in this text, which a progranuned series of events
decreased pH of the blood. the property of organs having leads to the death of a cell without
approximately the same weight and causing inflanunation.
active strategy When referring to iajwy density as air---e.g., lung tissue.
prevention, prevention steps that appendicular skeleton That portion
require the active participation ofthe air-purifying respirator (APR) A device of the skeleton that includes the
individual---e.g., wearing a helmet. that uses a filter, canister, or cartridge shoulders and arms as well as the
to remove contaminants from ambient pelvis and legs.
acute mountain sickness A constellation air that passes through the air-purifying
of symptoms that result from travel to component and makes the air safe to aqueous A system that is water-based or
high altitude (usually above 8,000 feet breathe. in which water is the solvent.
[2,400 meters]).
alpha particle A particle emitted during arachnoid mater (arachnoid
acute respiratory distress syndrome the decay of a radioactive material; membrane) Spiderweb-like
(ARDS) Respiratory insufficiency as consists of two protons and two transparent membrane between
a result of damage to the lining of neutrons, thus giving the particle a the dura mater and the pia mater;
the capillaries and alveoli in the lung, positive charge. the middle of the three meningeal
leading to the leakage offluid into the membranes surrounding the brain.
interstitial spaces and alveoli. alveoli The terminal air sacs of the
respiratory tract where the respiratory aspiration pneumonitis Inflanunation
acute radiation syndrome (ARS) The system meets the circulatory system and pneumonia caused by inhaling
physiologic consequences of whole- and gas exchange occurs. gastric contents or vomitus.
body radiation; characterized initially
by acute nausea and vomiting, anaerobic metabolism Metabolism not assist control (A/ C) ventilation A form
followed by damage to the bone using oxygen; an inefficient process for of mechanical ventilation; breaths
marrow (hematologic syndrome), the production of cellular energy. may be assisted by the ventilator if
the gastrointestinal tract, and the the patient triggers the device by
cardiovascular/central nervous system. anaphylactic shock A life-threatening adequately attempting to breathe in or
allergic reaction, usually characterized will automatically occur ifthe patient
acute tubular necrosis (ATN) Acute by hives (urticaria), shortness does not breathe.
damage to the renal tubules, usually of breath and wheezing, and
due to ischemia associated with shock. cardiovascular collapse. atelectasis Collapse of alveoli or part of
the lung.
advance directive A written declaration anastomosis A connection between two
that describes end-of-life treatment structures such as two blood vessels or atherosclerosis A narrowing of the blood
wishes and appoints medical decision adjacent bowel. vessels; a condition in which the inner
layer of the artery wall thickens while
fatty deposits build up within the artery.


atlas The first cervical vertebra (Cl); the imaginary line that passes through the blast lung injury (BU) Results from
skull perches upon it center of the body. exposure to high-order explosive blast
overpressure wave; lung damage varies
atropine A chemical that competitively bag-mask device A mechanical from scattered petechiae to contusions
inhibits the effect ofacetylcholine ventilation device consisting of a and pulmonary hemorrhage.
at parasympathetic nerve endings; self-inflating bag made ofplastic or
anticholinergic medication; used to rubber and several one-way valves; blast overpressure Pressure exceeding
treat victims of nerve agent poisoning. squeezing the bag results in positive- normal atmospheric pressure that
pressure ventilation through a mask or results from a high-order explosive
austere environment A setting in endotracheal tube. May be used with detonation.
which resources, supplies, equipment, or without supplementary oxygen.
personnel, transportation, and other blast wave A sharply defined wave front
aspects ofthe physical, political, baroreceptor A sensory nerve ending ofincreased pressure that propagates
social, and economic environments are that is stimulated by changes in blood outward from the center ofan
extremely limited. pressure. Baroreceptors are found in explosion.
the walls of the atria of the heart, vena
autonomic nervous system The part of cava, aortic arch, and carotid sinus. blast wind The result ofthe sudden
the central nervous system that directs displacement of air from an explosion.
and controls the involuntary functions barotrauma Injury to air-containing
ofthe body. organs that results from a change in air blind nasotracheal intubation
pressure. A technique of inserting an
autonomy A competent adult patient's endotracheal tube through the nares
right to direct his or her own health basal level Baseline or minimal level. into the trachea without visualizing the
care free from interference or undue larynx and vocal cords.
influence. basal metabolic rate The number of
calories the body burns while at rest, blister agent A chemical that creates
autoregulation The biologic process of resulting in heat production as a burnlike injuries; used as a weapon of
detecting change within the system by-product of metabolism. mass destruction.
and adjusting for that change; in the
circulatory system, the process of base A chemical with a pH greater than blunt trauma Nonpenetrating trauma
maintaining a constant blood flow as 7; dissolves in water and releases caused by a rapidly moving object that
blood pressure changes. hydroxide ions or accepts hydrogen impacts the body.
ions; causes liquefaction necrosis of
awareness level In hazardous materials tissue. bradypnea Abnormally slow breathing
training, the basic level of lmowledge rate; usually less than 12 breaths
a responder should have, involved basilar skull fracture A fracture of the per minute.
recognition of an incident, isolation floor of the cranium.
and protection from exposure, and brain stem The stemlike part of the brain
notification that the incident is behavioral regulation (and physiologic that connects the cerebral hemispheres
happening. thermoregulation) An individual's with the spinal cord.
conscious response to environmental
axial loading The force acting on or thermal change and the physical bronchioles The small divisions of the
applied to the long axis of an object; actions taken to keep warm or cool. bronchial tubes through which air
typically refers to force applied to the passes to the alveoli.
spine from the head downward; may beneficence An ethical term that means
also result from the weight ofthe body "to do good"; requires prehospital Brown-Sequard syndrome A condition
being applied to the lower part of the care providers to act in a manner that caused by penetrating injury that
spine, as would occur in a fall from a maximizes the benefits and minimizes involves hemitransection ofthe spinal
height landing on the feet. the risks to the patient. cord; only one side of the cord is
axis The second cervical vertebra (C2); beta particle A high-speed or high-
its shape allows for the wide possible energy electron emitted from capillary The smallest type of blood
range of rotation of the head. Also, an radioactive decay. vessel. These minute blood vessels
are only one cell wide, allowing for
biologic agent A bacterium, virus, or diffusion and osmosis of oxygen and
toxin that can be used as a weapon of nutrients through the capillary walls.
mass destruction.


capnography (end-tidal carbon caudad Toward the tail (coccyx). intellectual, sensory, and motor
dioxide) The method ofmeasuring functions.
and monitoring the partial pressure cavitation The act of forcing tissues of
ofcarbon dioxide in a sample of gas. the body out of their normal position; chemical energy The energy, usually in
It can correlate to the arterial partial to cause a temporary or permanent the form of heat, that results from the
pressure of carbon dioxide (PaC02). cavity (e.g., when the body is struck by interaction of a chemical with other
a bullet, the acceleration ofparticles of chemicals or human tissue.
cardiac output The volume of blood tissue away from the missile produces
pumped by the heart (reported in liters an area of injury in which a large chemoreceptor A sensory nerve ending
per minute). temporary cavity occurs). that is stimulated by and reacts to
certain chemical stimuli; located
cardiac tamponade Compression of the cellular respiration The use of oxygen outside of the central nervous system.
heart from an accumulation offluid by the cells to produce energy. Chemoreceptors are found in the large
in the pericardium surrounding the arteries of the thorax and neck, the
heart; in the case of trauma, the fluid central cord syndrome Damage to the taste buds, and the olfactory cells of
is usually blood; the accumulation of central portion ofthe spinal cord that the nose.
fluid prevents normal blood return to usually occurs with hyperextension
the heart by compressing the heart, of the cervical area; characterized chemosis A watery swelling of the
thus impairing circulation. by weakness or paralysis ofthe covering (conjunctiva) of the eye.
upper extremities but not the lower
cardiogenic shock Shock that results extremities. chilblains Red or purple skin lesions
from failure of the heart's pumping on the skin that are itchy and painful
activity; causes can be categorized central neurogenic hyperventilation and appear after cold exposure,
as either intrinsic, a result of direct Pathologic rapid and shallow particularly in patients with poor
damage to the heart itself, or extrinsic, ventilatory pattern associated with underlying circulation.
related to a problem outside the heart. head injury and increased intracranial
pressure. choke A constriction in the barrel of a
Care Under Fire A phase of care in shotgun to decrease the amount of
tactical casualty care; refers to the cerebellum A portion of the brain pellet spread after firing.
limited medical care that can be that lies beneath the cerebrum and
provided to a trauma victim while in behind the medulla oblongata and chokes ("the chokes") A form of
a hostile situation such as an active is concerned with coordination of decompression sickness characterized
shooter incident; also referred to as movement. by cough, substemal chest pain,
Direct Threat Care. cyanosis,dyspnea, shock,and
cerebral perfusion pressure The cardiopulmonary arrest.
casualty collection point A location amount of pressure needed to maintain
used for the collection, triage, cerebral blood flow; calculated as the cilia Hairlike processes of cells that
treatment, and evacuation of casualties difference between the mean arterial propel foreign particles and mucus
from a multiple-casualty incident. pressure (MAP) and the intracranial from the bronchi.
pressure (ICP).
cataract A condition of the eye in which cingulate herniation A condition
the lens becomes progressively more cerebral vascular resistance The in which the cingulate gyms along
opaque and blocks and distorts light resistance to blood flow that must the medial surface ofthe cerebral
entering the eye and blurs vision. be overcome in order to push blood hemispheres is forced under the falx,
through the blood vessels in and usually as a result ofhemorrhage or
catecholamines A group of chemicals around the brain. edema, causing injury to the medial
produced by the body that work as cerebral hemispheres and the midbrain.
important nerve transmitters. The main cerebrospinal fluid (CSF) A fluid found
catecholamines made by the body are in the subarachnoid space and dural circumferential burn A bum that
dopamine, epinephrine (also called sheath; acts as a shock absorber, encompasses an entire body part such
adrenalin), and norepinephrine. They protecting the brain and spinal cord as the arm, leg, or chest.
are part of the body's sympathetic from jarring impact.
defense mechanism used in preparing classic heatstroke A disorder that
the body to act. cerebrum The largest part of the brain; results from exposure to high humidity
responsible for the control of specific and high temperature, characterized
by elevated body temperature

Glossary 671

above 104°F (40°C) and neurologic competence (1) A legal term referring gun touches the patient at the time
abnormalities (altered mental status). to a person's general ability to make of discharge, resulting in a circular
good decisions for himself or herself; entrance wound, often associated with
closed fracture A fracture of a bone (2) the ability, skill, knowledge, visible burns, soot, or the imprint of
in which the overlying skin is not and qualification to do something the muzzle.
interrupted. su c c e s sfully.
contrecoup injury An ir\jury to parts of
coagulative necrosis The type of complete cord transection Complete the brain located on the side opposite
tissue damage that results from damage and severing of the spinal that of the primary ir\jury.
acid exposure; the damaged tissue cord; all spinal tracts are interrupted,
forms a barrier that prevents deeper and all normal neurologic functions convection The transfer of heat from
penetration ofthe acid. distal to the site are lost. the movement or circulation of a gas
or liquid, such as the heating of water
coagulopathy Impairment in the normal comprehensive emergency or air in contact with a body, removing
blood-dotting capabilities. management The steps needed to that air (such as by wind) or water,
manage an incident, consisting offour and then having to heat the new air or
cold zone A geographic area that is free components: mitigation, preparation, water that replaces what left.
from contamination from a hazardous response, and recovery.
material. cord compression Pressure on the
compressibility The ability to be spinal cord caused by swelling, bone
cold-induced diuresis Increased urine deformed by the transfer of energy. fragments, or hematoma, which may
production as a result of peripheral result in tissue ischemia and, in some
vasoconstriction from exposure to cold. compression The type of force involved cases, may require decompression to
in impacts resulting in a tissue, organ, prevent a permanent loss of function.
cold-induced vasodilation or other body part being squeezed
(CIVD) Physiologic response that between two or more objects or body cord concussion The temporary
occurs once an extremity has been parts. disruption of the spinal cord
cooled to 50°F (10°C) in an effort to functions distal to the site ofa spinal
provide some protection from the cold. compression injury An ir\jury caused by cord ir\jury.
severe crushing and squeezing forces;
command The first component of may occur to the external structure of cord contusion Bruising or bleeding into
the incident command system, the body or to the internal organs. the tissue of the spinal cord, which
responsible for all incident oversight may also result in a temporary loss of
and management. It is the only position conduction The transfer of heat between cord functions distal to the ir\jury.
in the incident command system that two objects in direct contact with each
must always be staffed. other. cord laceration An ir\jury that occurs
when spinal cord tissue is tom or cut.
command staff The public information confidentiality The obligation of
officer, safety officer, and liaison health care providers to not share core temperature (1) The temperature
officer; they r eport directly to the patient information that is disclosed at which vital organs are maintained
incident commander. to them within the patient-provider and function best; (2) the measured
relationship to anyone other than temperature of the deep structures and
commission A purposeful act. those the patient has authorized, other organs of the body.
medical professionals involved in the
commotio cordis Sudden cardiac patient's care, and agencies responsible cornea The dome-shaped transparent
dysrhythmia, often fatal, that results for processing state and/or federally outer portion of the eye that covers the
from a blow to the anterior chest or mandated reporting. pupil and colored iris.
conjunctiva The clear (usually) mucous coup injury An ir\jury to the brain
compartment syndrome The clinical membrane that covers the sclera located on the same side as the point
findings noted from ischemia and (white part of the eye) and lines the of impact.
compromised circulation that can eyelids.
occur from vascular ir\jury causing cranial vault The space within the skull
hypoxia of muscles in an extremity contact wound The type of wound or cranium.
compartment. The cellular edema that occurs when the muzzle of a
produces increased pressure in a crepitus A crackling sound made by bone
closed fascial or bony compartment. ends grating together.


Critical Incident Stress Management delayed primary closure Delayed without a proportional increase in fluid
(CISM) A group of intervention suturing of a wound for 48 to 72 hours volume.
strategies used to help prevent and to allow any swelling to go down and
manage stress after an incident. to ensure that there are no signs of diverter A device on a shotgun to spread
infection. the pellets into a wider, horizontal path
Cushing's phenomenon The when fired.
combination ofincreased arterial denuded Having the covering or surface
blood pressure and the resultant layer removed. Don Juan syndrome The pattern of
bradycardia that can occur with injury that often occurs when victims
increased intracranial pressure. dependent lividity The settling or fall or jump from a height and land on
pooling of blood in the lowest lying their feet. Bilateral calcaneus (heel
cyanosis Blue coloring of skin, mucous portions of a deceased body. bone) fractures are often associated
membranes, or nail beds indicating with this syndrome. After the feet land
unoxygenated hemoglobin and a dermatome The sensory area on and stop moving, the body is forced
lack of adequate oxygen levels in the the body for which a nerve root is into flexion as the weight of the still-
blood; usually secondary to inadequate responsible. Collectively, they allow moving head, torso, and pelvis come
ventilation or decreased perfusion. the body areas to be mapped out for to bear. This can cause compression
each spinal level and to help locate a fractures of the spinal column in the
dead space The amount of space that spinal cord injury. thoracic and lumbar areas.
contains air that never reaches the
alveoli to participate in the critical gas dermis The layer of skin just under the dorsal root The spinal nerve root
exchange process. epidermis made up of a framework of responsible for sensory impulses.
connective tissues containing blood
debridement The removal, usually vessels, nerve endings, sebaceous drowning The process of experiencing
surgically, of dead or damaged tissue. glands, and sweat glands. respiratory impairment from
submersion/immersion in liquid; may
decerebrate posturing Characteristic designated incident facility An or may not result in death.
posture that occurs when a painful assigned location where specific
stimulus is introduced; the extremities incident command system functions DUMBELS A mnemonic that represents
are stiffand extended and the head are performed; for example, incident the constellation of symptoms
is retracted. One of the forms of command is located at the incident associated with the muscarinic effects
pathologic posturing (response) command post. of nerve agent toxicity (diarrhea,
commonly associated with increased urination, miosis, bradycardia,
intracranial pressure. devitalized Lifeless or dead. bronchorrhea, bronchospasm, emesis,
lacrimation, salivation, sweating).
decomposition A state of decay or rotting. diaphragm The dome-shaped muscle
that divides the chest and abdomen dura mater The outer tough membrane
decompression sickness A group of and that functions as part of the covering the spinal cord and brain; the
disorders that result from the effects of breathing process. outer ofthe three meningeal layers.
increased pressure on gases in a diver's Literally means "tough mother."
body. diastole Ventricular relaxation
(ventricular filling). dynamic pressure The component of an
decontamination Reduction or removal explosion that is directional and felt as
of hazardous chemical, biologic, or digital (tactile) intubation A technique a blast wind.
radiologic agents. for nonvisualized endotracheal
intubation that involves the provider dysarthria Difficulty speaking.
decorticate posturing A characteristic placing his or her fingers into the
pathologic posture of a patient with patient's mouth and throat to guide the dysbarism The changes that result
increased intracranial pressure; when placement of the endotracheal tube. physiologically as a result of changes
a painful stimulus is introduced, the in ambient environmental pressure.
patient is rigidly still with the back and distraction The pulling apart oftwo
lower extremities extended while the structures--e.g., pulling apart the ecchymosis A bluish or purple irregularly
arms are flexed and fists clenched. fractured components of a bone or part formed spot or area resulting from a
ofthe spine. hemorrhagic area below the skin.
deep frostbite Freezing oftissue that
affects skin, muscle, and bone. distributive shock Shock that occurs eclampsia A syndrome in pregnant
when the vascular container enlarges women that includes hypertension,

Glossary 673

peripheral edema, and seizures; also esophagus The muscular tube that extramural (extraluminal)
called toxemia of pregnancy. connects the mouth to the stomach. pressure Pressure in the tissue
surrounding the vessel.
edema A local or generalized condition in eucapnic state A condition in which the
which some ofthe body tissues contain blood carbon dioxide level is within a extreme altitude An elevation higher
an excessive amount of fluid; generally normal range. than 18,045 feet (5,500 meters).
includes swelling ofthe tissue.
eupnea Normal, unlabored, quiet face-to-face intubation A technique
edentulism The absence of teeth. breathing or respiration. for endotracheal intubation in which
the endotracheal tube is inserted
elasticity The ability to stretch. evaporation Change from liquid to orally while the intubator is facing the
vapor. patient instead of being located at the
electrical energy The result of movement usual location above the head of the
of electrons between two points. event phase The moment of the actual patient.
endotracheal tube A plastic tube that falx A vertical fold of the thick dura
is inserted into the trachea to ensure evisceration A condition in which that separates the two halves of the
an open airway and used to assist a a portion ofthe intestine or other cerebrum of the brain.
patient to breathe. abdominal organ is displaced
through an open wound and fascia A band of tissue that separates
environmental temperature The protrudes externally outside the different layers; a fibrous band of
thermal temperature ofthe air abdominal cavity. tissue that encloses muscle.
surrounding an individual.
exercise-associated hyponatremia field exercise A training event that
epidermis The outermost layer of the (EAH) A life-threatening condition involves the actual execution and
skin, which is made up entirely ofdead associated with excessive performance of the community
epithelial cells with no blood vessels. consumption of water (1.5 quarts (1.4 disaster-response plan.
liters] or greater per hour) during
epidural hematoma Arterial bleeding prolonged activities leading to marked finance/administration section The
that collects between the skull and lowering of the sodium concentration section responsible for all costs and
duramater. in blood. financial actions of the incident.

epidural space Potential space between exercise-associated hyponatremic first death peak The first of three peaks
the dura mater surrounding the encephalopathy (EAHE) A life- that occur with death from trauma;
brain and the cranium. Contains the threatening condition of cerebral results from massive iJ'\iury or rapid
meningeal arteries. edema resulting from lowered exsanguination; can be minimized by
sodium concentration in blood from preventive measures.
epiglottis A leaf-shaped structure that excessive consumption of water
acts as a gate or flapper valve and (1.5 quarts [1.4 liters] or greater per first-degree frostbite Epidermal iJ'\iury
directs air into the trachea and solids hour) during prolonged activities. limited to skin that had brief contact
and liquids into the esophagus. with cold air or metal; involved skin
exertional heatstroke (EHS) A condition appears white or as yellowish plaque;
epinephrine A chemical released from of elevated body temperature usually there is no blister or tissue loss; skin
the adrenal glands that stimulates the in males working or exercising in thaws quickly, feels numb, and appears
heart to increase cardiac output by the heat and humidity, characterized red with surrounding edema; healing
increasing the strength and rate of by pale, sweaty skin, elevated body occurs in 7 to 10 days.
contractions. temperature, and altered mentation.
flail chest A chest with an unstable
epithelial Any tissue that covers a exsanguination Total loss of blood segment produced by multiple ribs
surface or lines a cavity. volume, producing death. fractured in two or more places or
including a fractured sternum.
eschar Thick scab of dead tissue, often external respiration The transfer
resulting from a burn. of oxygen molecules from the flail sternum A variation of fl.ail chest
atmosphere to the blood. that involves fracture of the ribs on
escharotomy An incision made into an both sides of the sternum, allowing the
eschar to allow the tissues underlying extracellular fluid All body fluid that is sternum to fl.oat freely.
the tough, leathery damaged skin not contained within cells.
created by severe burns to expand as
they swell.


flat bone A thin, fiat, and compact heat acclimatization A process of homeostasis A constant, stable internal
bone, such as the sternum, ribs, and increasing tolerance to exposure to environment; the balance necessary to
scapulae. heat. maintain healthy life processes.

fontanelle The soft, membranous space heat stress index The combination homeotherm A warm-blooded animal.
between the unfused bones ofan of ambient temperature and relative
infant's skull; often referred to as the humidity. hot zone The geographic area of highest
"soft spot." contamination from a hazardous
heatstroke An acute and dangerous material; only specially trained and
foramen A small opening; plural is reaction to heat exposure characterized equipped workers may enter this
foramina. by high body temperature and altered area.
mental status.
foramen magnum The opening at the hydrofluoric acid A type of acid;
base of the skull through which the heat syncope Fainting or exposure to even small amounts can
medulla oblongata passes. lightheadedness after standing lead to life-threatening lowering of
for prolonged periods in a hot the serum calcium levels and cardiac
fourth-degree burn A burn iajury that environment; results from vasodilation dysrhythmias.
involves all layers of the skin, as well and venous blood pooling in the legs,
as the underlying fat, muscles, bone, or causing low blood pressure. hypercarbia An increased level of
internal organs. carbon dioxide in the body.
heat tetany A rare and self-limited
fourth-degree frostbite A freezing condition that results from hyperchloremic acidosis A type
iajury that involves the skin, hyperventilation due to acute exposure of metabolic acidosis (decrease
underlying tissue, muscle, and bone. to short, intense heat conditions. in blood pH) associated with an
increase in the amount of chloride
fragmentation The breaking up of an hemiparesis Weakness limited to one ion in the blood; may result from the
object to produce multiple parts or side of the body. administration of large amounts of
shrapnel. normal saline.
hemiplegia Paralysis on one side ofthe
frostbite The freezing of body tissue as a body. hyperextension Extreme or abnormal
result of exposure to freezing or below- extension of a joint; a position of
freezing temperatures. hemorrhagic shock Hypovolemic shock maximum extension. Hyperextension
resulting from blood loss. of the neck is produced when the
full-thickness (third-degree) burn head is extended posterior to a neutral
A burn to the epidermis, dermis, and hemothorax Blood in the pleural space. position and can result in a fracture
subcutaneous tissue (possibly deeper). or dislocation of the vertebrae or in
Skin may look charred or leathery. high altitude An elevation above 5,000 spinal cord damage in a patient with an
to 11,480 feet (1,500 to 3,500 meters). unstable spine.
galea aponeurotica A tough, thick layer
oftissue underneath the scalp that high-altitude cerebral edema (HACE) hyperflexion Extreme or abnormal
covers the cranium. A life-threatening complication of brain ftexion of a joint. A position of
swelling that results from travel to maximum ftexion. Increased ftexion
gamma ray A ray of high-energy high altitude (usually above 8,000 feet of the neck can result in a fracture
electromagnetic radiation released as a (2,400 meters)). or dislocation ofthe vertebrae or in
result of radioactive material decay. spinal cord damage in a patient with an
high-altitude pulmonary edema unstable spine.
grand mal seizure A generalized seizure (HAPE) A life-threatening complication
that involves loss of consciousness and offtuid accumulating in the lungs that hyperkalemia Increased blood
muscle contractions; also known as results from travel to high altitude potassium.
tonic-clonic seizure. (usually above 8,000 feet (2,400
meters)). hyper-rotation Excessive rotation.
group training Disaster response
training directed at specific response high explosive A type of explosive hypertension A blood pressure greater
groups. designed to detonate and release than the upper limits of the normal
its energy very quickly; capable range; generally considered to exist
Haddon Matrix A table that shows of producing a shock wave, or ifthe patient's systolic pressure is
the interaction of host, agent, and overpressure phenomenon, which can greater than 140 mm Hg.
environmental factors in an incident. result in primary blast iajury.

Glossary 675

hypertonic saline Any solution of ICS general staff The chiefs of each of which some tracts and motor/sensory
sodium chloride in water with a the four major sections of the incident functions remain intact.
concentration of sodium chloride command system (ICS): operations,
greater than physiologic saline, which planning, logistics, and finance/ independent learning Studying on one's
is 0.9% sodium chloride, the same as administration. own.
body fluid.
immersion A condition occurring when inferior vena cava A major vein that
hyphema A collection ofblood in the water has splashed or washed over the carries deoxygenated blood from the
anterior chamber of the eye, between face and airway, allowing for drowning lower half of the body back to the
the clear cornea and the colored iris. to occur by aspiration. heart.

hypobaric hypoxia Hypoxia caused by immersion foot A nonfreezing cold inhalation The process of drawing air
the decrease in atmospheric pressure exposure iajury caused by prolonged into the lungs.
and the partial pressure of oxygen at immersion of extremities in wet and
increasingly higher altitudes. moisture that is cool to cold; also injury A harmful event that arises
referred to as trench foot. from the release of specific forms of
hypochlorite solution A solution used in physical energy or barriers to normal
the production of household bleaches impact phase The phase of the disaster flow of energy.
and industrial cleaners. cycle that involves the actual incident
or disaster. injury process Similar to disease, a
hypoperfusion Inadequate blood flow to process involving a host, an agent (in
cells with properly oxygenated blood. incident action plan (IAP) A the case of iajury the agent is energy),
continuously updated outline of the and an environment or situation
hypopharynx The lower portion of overall strategy, tactics, and risk that allows the host and agent to
the pharynx that opens into the management plans developed by the interact.
larynx anteriorly and the esophagus incident commander or the incident
posteriorly. command system staff. inner perimeter A geographic boundary
at a hazardous incident surrounding
hypothalamus The area of the brain incident command post (ICP) The the area of highest danger and
that functions as the thermoregulatory location at which incident command potential lethality.
center and the body's thermostat to functions are performed.
control neurologic and hormonal insensible loss The unmeasured loss of
regulation of body temperature. incident command system (ICS) water and heat from exhaled air, skin,
A system that defines the chain of and mucous membranes.
hypothermia A condition characterized command and organization of the
by core body temperature below various resources that respond during integrated communications
normal range, usually between 78°F a disaster. A communications system that
and 90°F (26--32°C). allows all responders at an incident
incident commander (IC) The individual to communicate with supervisors and
hypoventilation Inadequate ventilation responsible for all aspects of a subordinates.
when minute volume falls below response to an incident, including
normal. developing incident objectives, intentional injury IItjury associated with
managing all incident operations, an act of interpersonal or self-directed
hypovolemic shock Shock caused by setting priorities, and defining the violence.
loss of blood or fluid. incident command system organization
for the particular response; the IC intercostal muscles The muscles located
hypoxia (hypoxemia) Deficiency of position will always be filled. between the ribs that connect the ribs to
oxygen; inadequate available oxygen. one another and assist with breathing.
Lack ofadequate oxygenation of incisura (tentorial incisura) Opening
the lungs due to inadequate minute in the tentorium cerebelli at the intermediate-range wound
volume (air exchange in the lungs) junction of the midbrain and the A penetrating gunshot wound that
or a decreased concentration of cerebrum. The brain stem is inferior to occurs at a distance of approximately
oxygen in the inspired air. Cellular the incisura. 6 to 18 feet (1.8 to 5.5 m).
hypoxia is inadequate oxygen available
to the cells. incomplete cord transection Partial intermittent mandatory ventilation
transection of the spinal cord in (IMV) A form of mechanical ventilation
iatrogenic Caused by the treatment. that delivers a set rate and tidal volume
to patients.


internal (cellular) respiration The to have resulted from the forces ligament A band oftough, fibrous tissue
movement or diffusion of oxygen and motion and changes in motion connecting bone to bone.
molecules from the red blood cells into involved; the science of motion.
the tissue cells. liquefaction necrosis The type of tissue
kinetic energy (KE) Energy available irtjury that occurs when an alkali
interstitial fluid The extracellular fluid from movement. Function ofthe weight damages human tissue; the base
located between the cell wall and the of an item and its speed: KE = 1;2 of the liquefies the tissue, which allows for
capillary wall. mass x the velocity squared. deeper penetration ofthe chemical.

intervertebral foramen A notch through kyphosis A forward, humplike curvature living will A form of advance directive
which nerves pass in the inferior ofthe spine commonly associated that expresses a patient's end-of
lateral side of the vertebra. with the aging process. Kyphosis life treatment wishes, such as
may be caused by aging, rickets, or whether mechanical ventilation,
intracellular fluid F1uid within the cells. tuberculosis of the spine. CPR, dialysis, or other types of
life-prolonging or life-sustaining
intracranial pressure The pressure lactated Ringer's (LR) An intravenous treatments are desired; generally does
exerted against the inside ofthe crystalloid solution that is isotonic not go into effect until the patient
skull by brain tissue, blood, and with blood and used to replenish lacks decision-making capacity and
cerebrospinal fluid; usually less than circulating volume and electrolytes; has been certified by a health care
15 mm Hg in adults and 3 to 7 mm Hg contains water, sodium, chloride, professional, usually a doctor, to be
in children. calcium, potassium, and lactate. either terminally ill or permanently
intramural (intraluminal) pressure The laryngeal mask airway (LMA) An
pressure exerted against the inside airway management device; the distal logistics section The section responsible
of the walls of blood vessels by the end that is inserted into the patient's for providing all services, equipment,
intravascular fluids and blood pressure mouth is shaped like an oval mask to and facilities for the incident.
cycle. cover the supraglottic structures and
isolate the trachea to allow for air logistics section chief The position
involuntary guarding Rigidity or spasm passage. responsible for directing the logistics
of the abdominal wall muscles in function for the incident commander.
response to peritonitis. larynx The structure located just above
the trachea that contains the vocal long bones Femur, humerus, ulna,
ionization The process by which a cords and the muscles that make them radius, tibia, and fibula
molecule becomes charged by gaining work.
or losing an electron. long-range wound A penetrating
law of conservation of energy A law of gunshot wound that occurs at a
ipsilateral On the same side. physics stating that energy cannot be distance greater than 18 feet (5.5 m).
created or destroyed but only changed
iris The colored portion of the eye that inform. low explosive A type of explosive that
contains the adjustable opening of the changes relatively slowly from a solid
pupil. Lewisite An oily liquid used as a or liquid to a gaseous state (in an
chemical weapon to produce burnlike action more characteristic of burning
ischemic sensitivity The sensitivity blisters; it is a blister agent (vesicant). than of detonation); because they
of the cells of a tissue to the lack of release their energy much more slowly,
oxygen before cell death occurs. liaison officer A command staff low explosives do not produce blast
member who assists or coordinates overpressure.
justice That which is fair or just; in with multiple agencies; serves as an
medicine, usually refers to how intermediary between the incident maceration Softening of the skin as
medical resources are distributed with commander and outside agencies. a result ofexposure to constant
regard to health care. moisture; the skin turns white and
Lichtenberg's figure A branching or breaks down, and can easily become
kill zone The area of greatest risk in a fernlike reddish skin marking that is infected.
hazardous incident; the area within the painless and results from being struck
inner perimeter. by lightning. maculopapular rash A skin rash
characterized by areas of reddish
kinematics The process of looking at
the mechanism of irtjury ofan incident
to determine what irtjuries are likely

Glossary 677

discoloration (macules) in association Unlike living wills, MPOAs go into myocardial hypertrophy An increase in
with small, raised bumps (papules). effect immediately anytime a patient the heart's muscle mass and size.
is incapable of making his or her own
magnesium A highly flammable decision, regardless of pre-existing myoglobin A protein found in muscle
chemical element used to make condition, and become inactive again that is responsible for giving muscle its
incendiary weapons; also an essential when/if the patient regains decision- characteristic red color.
electrolyte in human physiology. making capacity.
myoglobinuria The release ofmyoglobin
mammalian diving reflex A reflex medulla (medulla oblongata) Part of into the bloodstream in considerable
that occurs with submersion in the brain stem. The medulla is the amounts, causing a reddish or tea-
cold water (less than 70°F [21°C]) primary regulatory center of autonomic colored urine, toxicity to the kidneys,
resulting in rapid slowing ofthe body's control of the cardiovascular system. and kidney failure.
metabolism, spasm of the larynx,
shunting of blood from the periphery meninges Three membranes that cover nasopharyngeal airway An airway that
to the heart and brain, and a marked the brain tissue and the spinal cord; the is placed in the nostril and follows
decrease in heart and respiratory rate. dura mater, arachnoid, and pia mater. the floor of the nasal cavity directly
posterior to the nasopharynx in order
manually triggered (oxygen-powered) midbrain The portion of the brain stem to lift the tongue off of the back of
device An oxygen-powered ventilation located above the pons; contains the pharynx and open the airway.
device powered by pressurized oxygen, nerve pathways that go between the This airway is commonly tolerated by
triggered manually to deliver a breath; cerebrum and the medulla oblongata patients with a gag reflex.
may cause gastric distension and and contains centers for visual and
pulmonary barotrauma auditory reflexes. nasopharynx The upper portion of the
airway, situated above the soft palate.
mass-casualty incident (MCI) An minute ventilation See minute volume.
incident (such as a plane crash, neural arches 'IWo curved sides of the
building collapse, or fire) that produces minute volume The amount of air vertebrae.
a large number of victims from one exchanged each minute; calculated
by multiplying the volume of each neurogenic "shock" Shock that occurs
mechanism, at one place, and at the breath (tidal volume) by the number of when a cervical spine iajury damages
same time; also referred to as multiple- breaths per minute (rate). the spinal cord above where the
casualty incident. nerves of the sympathetic nervous
mitigation In emergency medicine, a system exit, thus interfering with the
mass-casualty incident (MCI) reduction in the Joss of life and property normal vasoconstriction and leading
response The postevent actions taken by lessening the impact ofdisasters. to vasodilitation and decreased blood
to minimize damage, morbidity, and pressure.
mortality resulting from the incident. MTWHF A mnemonic that represents the
constellation of symptoms associated neutral position The position of a joint
mean arterial pressure (MAP) The with stimulation of nicotinic receptors, that allows for maximal movement;
average pressure in the vascular system, usually after nerve agent exposure; neither flexed nor extended.
estimated by adding one-third of the MTWHF stands for mydriasis (rarely
pulse pressure to the diastolic pressure. seen), tachycardia, weakness, Newton's first law of motion
hypertension, hyperglycemia, A fundamental law ofphysics stating that
mechanical energy The energy that an fasciculations. a body at rest will remain at rest, and a
object contains when it is in motion. body in motion will remain in motion
mucocutaneous Made up of or unless acted on by an outside force.
mediastinum The middle of the thoracic pertaining to both skin and mucous
cavity containing the heart, great membranes. Newton's second law of motion
vessels, trachea, main bronchi, and A fundamental law of physics stating
esophagus. multisystem trauma patient A patient that the acceleration of an object is
with iajury to more than one body directly proportional to the magnitude
medical power of attorney (MPOA) An system. of the force applied, in the same
advance directive document used by direction as the force applied, and
competent adults to appoint someone muscarinic site An acetylcholine inversely proportional to the mass of
to make medical decisions for them receptor found primarily in smooth the object.
in the event that they are unable to muscle and glands.
make such decisions for themselves.


Newton's third law of motion A oncotic pressure Pressure that osteophytosis The development of
fundamental law of physics stating that determines the amount offluid within bony outgrowths, usually along joints,
for every action, there is an equal and the vascular space. particularly of the spine; also referred
opposite reaction. to as bone spurs.
open fracture A fracture of a bone in
nicotinic site An acetylcholine receptor which the skin is broken. osteoporosis A loss of normal bone
found primarily in skeletal muscle. density with thinning of bone tissue
open globe A penetrating irtjury to the and the growth of small holes in the
nitrogen mustard An oily chemical eye; irtjury that involves the full bone. The disorder may cause pain
used as a chemical weapon to produce thickness of the cornea or the sclera of (especially in the lower back), frequent
burnlike blisters; can also damage the eye. broken bones, loss of body height,
the respiratory tract, gastrointestinal and various poorly formed parts ofthe
tract, and bone marrow; blister agent; open pneumothorax (sucking chest body. Commonly a part ofthe normal
vesicant; also used as an anticancer wound) A penetrating wound to the aging process.
medication. chest that causes the chest wall to
be opened, producing a preferential out-of-hospital do not resuscitate
nonfreezing cold injury (NFCI) pathway for air moving from the
A syndrome resulting from damage outside environment into the thorax. (ON R) An order given by a physician to
to peripheral tissues, caused by ensure that prehospital care providers
prolonged (hours to days) exposure to operations level In hazardous materials do not perform CPR on a terminally
wet/cold; also called immersion foot training, the level of knowledge and ill patient at home, or in some other
and trench foot. training that a responder should have community or nonclinical setting,
when involved in the response to against the patient's wishes.
nonmaleficence An ethical principle that and control of an incident involving
obligates the medical provider to not chemical spills or release. outer perimeter The geographic
take actions that may harm the patient boundary that defines the "safe zone"
or place the patient in harm's way. operations section The section where no threat should exist at a
responsible for all tactical operations hazardous incident.
norepinephrine A chemical released at the incident.
by the sympathetic nervous system overpressure phenomenon The sudden
that triggers constriction of the operations section chief The position increase in atmospheric pressure or
blood vessels to reduce the size of responsible for managing all shock wave that occurs in proximity to
the vascular container and bring it operations activities in the incident the detonation of a high explosive.
more closely into proportion with the command system.
volume of the remaining fluid. oxygen delivery The process of oxygen
oropharyngeal airway An airway transfer from the atmosphere to
normal saline An intravenous crystalloid that, when placed in the oropharynx the red blood cells (RBCs) during
solution comprised of water and superior to the tongue, holds the ventilation and the transportation
sodium and chloride in a concentration tongue forward to assist in maintaining of these RBCs to the tissues via the
of o.goA>. an open airway; used only in patients cardiovascular system.
with no gag reflex.
obtunded A condition in which the oxygenation The process of providing,
patient's mental capacity is dulled oropharynx The central portion of the treating, or enriching with oxygen.
or diminished; mild to moderate pharynx lying between the soft palate
decreased level of consciousness with and the upper portion of the epiglottis. paradoxical pulse A condition in which
impaired sensory perception. the patient's systolic blood pressure
orotracheal intubation A method of drops more than 10 to 15 mm Hg
oculomotor nerve The third cranial securing an open and patent airway during each inspiration, usually due to
nerve; controls pupillary constriction that involves insertion of a plastic the effect of increased intrathoracic
and certain eye movements. tube through the mouth into the pressure such as would occur with
trachea. tension pneumothorax or from
omentum A fold of peritoneum that pericardia! tamponade.
covers and connects the stomach to osmosis The movement of water (or
other intra-abdominal organs. other solvent) across a membrane parasympathetic nervous system The
from an area that is hypotonic to an division of the nervous system that
omission The failure to act. area that is hypertonic. maintains normal body functions.

Glossary 679

parenchyma The essential or functional Generally produces both permanent end-of-life wishes of the terminally ill
cells or elements of an organ. and temporary cavities. and frail elderly.

paresthesia Abnormal skin sensations percutaneous Occurring through the physiologic reserve The excess
that include tingling, "pins and skin-e.g., a needlestick. functional capacity of an organ or
needles," burning, prickling, and organ system.
crawling. percutaneous transtracheal ventilation
(PTV) A procedure in which a 16-gauge physiologic thermoregulation The
parietal pleura A thin membrane that or larger needle through which the process by which the body's
lines the inner side ofthe thoracic patient is ventilated is inserted directly temperature is controlled; involves
cavity. into the lumen of the trachea through dilation and constriction of blood
the cricothyroid membrane, or directly vessels to help remove or conserve
partial-thickness (second-degree) through the tracheal wall. body heat.
burn A burn that involves both
the epidermis and the dermis. Skin pericardiocentesis A procedure that pia mater A thin vascular membrane
presents with reddened areas, blisters, involves insertion ofa needle into closely adhering to the brain and
or open, weeping wounds. the pericardia! space to remove spinal cord and proximal portions of
accumulated blood or fluid. the nerves; the innermost of the three
passive strategy In irtjury prevention, meningeal membranes that cover the
a prevention method that requires no periorbital ecchymosis See raccoon brain.
action on the part ofthe individual-
e.g., vehicle air bags. eyes. planning section The ICS section
responsible for the collection and
patent airway An open, unobstructed periosteum The thick layer of evaluation of information related to the
airway of sufficient size to allow for connective tissue that covers the incident .
normal volumes of air exchange. surface of bones, except for the joint
surfaces. planning section chief The ICS
patient care report (PCR) The position responsible for collecting
written report documenting the peritoneal space The space in the and evaluating information and
prehospital care provided to a patient; anterior abdominal cavity that cont.a.ins assisting in planning with the incident
includes the history, assessment, the bowel, spleen, liver, stomach, commander.
prehospital interventions, and gallbladder. The peritoneal space
reassessment, and patient response is covered by the peritoneum. Also pneumothorax An irtjury that
to treatment. referred to as the peritoneal cavity. results in air in the pleural space;
commonly producing a collapsed
peak overpressure The maximum value peritoneum The lining of the abdominal lung. A pneumothorax can be open
of pressure experienced at a given cavity. with an opening through the chest
location at the moment a blast wave wall to the outside or closed resulting
from a high explosive reaches the peritonitis Inflammation of the from blunt trauma or a spontaneous
location. peritoneum. collapse.

pediatric trauma score (PTS) A clinical pharynx The throat; a tubelike structure positive end-expiratory pressure
scoring system based on clinical that is a passage for both the breathing (PEEP) The pressure in the lungs above
information that is predictive of and digestive tracts. Oropharynx-area atmospheric pressure at the end of
severity of injury and can be used for of the pharynx posterior to the mouth; expiration; also refers to a ventilatory
triage decision making. nasopharynx-area ofthe pharynx
beyond the posterior nares of the nose. technique to assist breathing in which
pelvic ring The round shape that an increased amount of pressure is
comprises the pelvis; made up ofthe physician orders for life-sustaining applied to the lungs at the end of
ilium, ischium, pubis, sacrum, and treatment (POLST) An advance expiration to increase the amount of
coccyx; also referred to as the pelvic directive that allows for the air remaining in the lungs and enhance
girdle. acceptance or refusal of a wide variety gas exchange.
of life-sustaining treatments, such as
penetrating trauma Trauma that results CPR, medical nutrition and hydration, postevent phase The phase
when an object penetrates the skin and ventilator support, and allows beginning as soon as the energy
and irtjures underlying structures. prehospital care providers to access from the crash is absorbed and the
an active physician order regarding the


patient is traumatized; the phase of primary blast injury (PBI) An injury public health impact of injury The
prehospital care that includes response that is caused by exposure to the blast totality of the impact ofinjury on
time, Golden Period, and transport overpressure wave from the detonation the health of the public; includes
time. of a high explosive (e.g., pulmonary deaths, injury, disability, and financial
bleeding, pneumothorax, perforation considerations.
posttraumatic endophthalmitis of the gastrointestinal tract).
Infection of the intraocular contents, public information officer (PIO) The
usually as a result ofpenetrating primary contamination Exposure to ICS command staff officer responsible
trauma to the eye. a hazardous substance at its point of for interacting with the public and
release. media and distributing information.
posttraumatic stress disorder (PTSD) A
mental health condition that results primary hypothermia A decrease in pulmonary contusion A bruising of the
from exposure to a horrific or body temperature that occurs when lungs; can be secondary to blunt or
terrifying event and leads to flashbacks healthy individuals are unprepared for penetrating trauma.
to the incident, nightmares, anxiety, overwhelming acute or chronic cold
and uncontrollable thoughts about the exposure. pulse oximeter A device that measures
incident. arterial oxyhemoglobin saturation. The
principle An element that must be value is determined by measuring the
powered air-purifying respirator present, accomplished, or ensured absorption ratio of red and infrared
(PAPR) A protective respiratory device by the health care provider in order light passed through the tissue.
that draws ambient air through a filter to optimize patient survival and
canister and delivers it under positive outcome; also refers to the four pulse pressure (1) The increase in
pressure to a facemask or hood. ethical concepts of autonomy, pressure (surge) that is created as
nonmaleficence, beneficence, and each new bolus of blood leaves the
pre-event phase/precrash phase The justice. left ventricle with each contraction;
phase that includes all ofthe events (2) the difference between the systolic
that precede an incident (e.g., ingestion principlism The use of the four and diastolic blood pressures (systolic
of drugs and alcohol) and conditions ethical principles of autonomy, pressure minus diastolic pressure
that predate the incident (e.g., acute or nonmaleficence, beneficence, and equals pulse pressure).
pre-existing medical conditions). This justice, which provide a framework for
phase includes injury prevention and one to weigh and balance the benefits pulseless electrical activity A condition
preparedness. and burdens of treating a specific characterized by organized electrical
patient in order to do what is in the activity on cardiac monitoring without
preference The manner in which the patient's best interest. an associated palpable pulse.
principle of care is achieved in the
time given and by the prehospital care privacy The right of patients to control quaternary blast injury An injury
provider available. who has access to their personal health from a blast or explosion that
information. includes burns and toxicities
preload The volume and pressure ofthe from fuel, metals, trauma from
blood coming into the heart from the prodrome (predisaster) phase structural collapse, septic syndromes
systemic circulatory system (venous (warning phase) The phase in the from soil, and environmental
return). disaster cycle in which a specific event contamination.
has been identified as inevitably going
preparedness A step of comprehensive to occur and in which specific steps quaternary effect See quaternary bl,ast
emergency management that involves can be taken to mitigate the effects of injury.
identifying, in advance of an incident, the ensuing events.
the specific supplies, equipment, and quiescence (interdisaster period) The
personnel that would be needed to profile A penetrating object's initial size time in between disasters or mass-
manage an incident, as well as the and the degree of change in size that casualty incidents during which
specific action plan that would be occurs at the time of impact. risk assessment and mitigation
taken ifan incident were to occur. activities are undertaken and when
psychogenic "shock" A temporary plans for the response to likely
presbycusis A condition characterized neurogenic shock as a result of events are developed, tested, and
by a gradual decline in hearing. psychological stress (fainting). implemented.

Glossary 681

quinary blast injury A red blood cell (RBC) A disc-shaped cell rifling Grooves on the inside of the barrel
hyperinfiamrnatory state in blast that contains hemoglobin to carry that spin a single missile (bullet) in a
victims thought to result from oxygen to the organs and cells ofthe stable flight pattern toward the target.
bacteria, chemicals, or radioactive body.
materials added to the explosive device rigor mortis The temporary stiffening
and released upon detonation. remote assessment A process by which and rigidity of muscles and joints that
tactical operators and providers occurs after death; typically begins
raccoon eyes (periorbital gather information without revealing within 2 to 4 hours of death and lasts
ecchymosis) Contusion or ecchymotic their position or intent to the hostile approximately 36 to 48 hours.
area around each eye, limited by force; includes remote observation
the orbital margins; may result from with binoculars, remote acoustic riot control agent A chemical agent
direct trauma to the orbit or from surveillance, and thermal imaging. used to rapidly and briefly disable
basilar skull fracture. those exposed to it by causing
rescue (emergency or relief) phase The irritation to the skin, mucous
radiation The direct transfer of energy period during the disaster cycle membranes, lungs, and eyes.
from a warm object to a cooler one immediately following the impact,
by infrared radiation. during which response occurs sacral spine (sacrum) Part of the spinal
and appropriate management and column below the lumbar spine
radiation dispersion device (ROD) intervention can save lives. containing the five sacral vertebrae
A conventional explosive with a (Sl-85), which are connected by
radionuclide (radioactive material) resource management Agreements and immovable joints to form the sacrum.
attached that is detonated to disperse procedures that enable local, state, The sacrum is the weight-bearing base
the radioactive material. and federal agencies to work together ofthe spinal column and is also a part
under one command during a large- ofthe pelvic girdle.
radiation energy Any electromagnetic scale incident.
wave that travels in rays and has no safety officer The res command
physical mass to it. respiration The total ventilatory and
circulatory processes involved in the staff officer who is responsible for
rapid sequence intubation (RSI) exchange of oxygen and carbon dioxide monitoring, assessing, and ensuring the
A method ofpatient intubation that between the outside atmosphere and safety of emergency personnel.
includes pharmacologic adjuncts the cells of the body. Sometimes in
for sedation and muscle relaxation. medicine limited to meaning breathing SAMPLE history A mnemonic to
and the steps in ventilation. remember the components of the
rebound tenderness A physical history; stands for symptoms, allergies,
examination :finding that occurs by reticular activating system (RAS) The medication, past medical and surgical
pressing deeply on the abdomen central nervous system control center history, last meal, and events leading
and then quickly releasing the responsible for maintaining the level of up to the iajury.
pressure, causing more severe pain consciousness and alertness.
when the abdominal pressure is sclera The dense, fibrous, white outer
suddenly released. retroperitoneal space The space in layer of the eyeball.
the posterior abdominal cavity that
recovery (reconstruction) phase The contains the kidneys, ureters, bladder, second death peak The second of three
period during the disaster cycle that reproductive organs, inferior vena cava, peaks that occur with death from
addresses the community's resources abdominal aorta, pancreas, a portion of trauma; occurs within minutes to a few
to endure, emerge, and rebuild the duodenum, colon, and rectum. hours after iajury; can be minimized
from the effects ofthe disaster by rapid prehospital assessment,
through the coordinated efforts retroperitoneum See retroperitoneal treatment, and transport.
of the medical, public health, and space.
community infrastructure (physical second-degree frostbite A freezing
and political); this period is usually the rhabdomyolysis The breakdown of iajury due to cold exposure that
longest, lasting months, and perhaps muscle tissue with the release of involves the epidermis and superficial
years, before a community fully intracellular muscle components into dermis; initially appears similar to
recovers. the circulation. first-degree iajury, but frozen tissues
are deeper; after thawing, results in
superficial skin blisters surrounded
by erythema and edema; there is


no permanent loss oftissue; healing sequela An aftereffect or complication of solar keratitis Burns to the cornea of
occurs in 3 to 4 weeks. a disease or iajury; plural is sequelae. the eye that result from exposure to
ultraviolet light, commonly as a result
secondary blast injury Injury that sesamoid bone A bone, usually small of reflection off of snow; also referred
results from shrapnel, flying debris, and round, located within tendons. to as snow blindness.
and bomb fragments; typically causes
penetrating ballistic iajury. shear Change-of-speed force resulting in solid density Tissue density consistent
a cutting or tearing ofbody parts. with bone.
secondary contamination Exposure to
a hazardous substance after it has been shear force Energy applied to the body span of control In an incident command
carried away from the point of origin that tends to move an organ or part system, the number of subordinates
by a victim, a responder, or a piece of of the body in one direction while who report to one supervisor at any
equipment. the adjacent part moves in a different level within the response organization;
direction or remains fixed in place. in most situations, one person can
secondary hypothermia A decrease in effectively supervise only three to
body temperature as a consequence ofa shock A widespread lack of tissue seven people or resources.
patient's systemic disorder, including perfusion with oxygenated red
hypothyroidism, hypoadrenalism, blood cells that leads to anaerobic specialist level In hazardous materials
trauma, carcinoma, and sepsis. metabolism and decreased energy incidents, an individual who is trained
production. to provide command and support skills.
secondary impact syndrome The
sudden deterioration in neurologic shock front The boundary between the spinal shock An iajury to the spinal
status in patients who have sustained a blast overpressure wave created by a cord that results in a temporary loss of
concussion and then have a second high explosive detonation and normal sensory and motor function.
concussion before the symptoms from atmospheric pressure.
the first one have fully resolved. spinal stenosis Narrowing of the spinal
shock wave See slwckfront. canal.
self-aid The provision ofmedical care to
one's selfafter sustaining an iajury. short bones Metacarpals, metatarsals, spinous process The tail-like structure on
phalanges. the posterior region of the vertebrae.
self-contained breathing apparatus
(SCBA) A personal protective device simple pneumothorax The presence of sprain An iajury in which ligaments are
consisting of a mask and portable air within the pleural space. stretched or even partially tom.
supply ofair, used in environments
that are oxygen-deficient or pose a risk simulation A form oftraining that spray The dispersal pattern of pellets
oftoxic inhalation. involves the imitation, enactment, fired from a shotgun.
or representation, verbally or with
self-contained underwater breathing models, of the management of an spread See spray.
apparatus (SCUBA) A portable incident or patient.
breathing device for underwater use, staging area A predetermined area
consisting of a mask with connecting single command A command structure where resources, equipment, and
tubes to a tank of compressed air. in which a single individual is personnel can be located safely and at
responsible for all of the strategic the ready for assignment.
senescence The process of aging. objectives of the incident. Typically
used when an incident is within a START triage algorithm A method of
sepsis Infection that has spread to single jurisdiction and is managed by evaluating patients and assigning
involve the entire body. a single discipline. priorityfor treatment and transport
during a mass-casualty incident;
septic shock Shock resulting from locally single-system trauma patient A involves evaluating the respiratory
active hormones due to widespread patient who has experienced trauma status, perfusion status, and mental
systemic infection, causing damage that involves iajury to only one status of the patient.
to the walls ofblood vessels, producing body system.
both peripheral vasodilation and status epilepticus A life-threatening
leakage offluid from the capillaries sniffing position A slightly superior condition in which a seizure persists
into the interstitial space. anterior position of the head and for greater than 5 minutes or in which
neck to optimize ventilation as well two or more seizures occur without a
as the view during endotracheal period of wakening in between.

Glossary 683

steady-state metabolism A condition submersion A situation where the entire that produces the fight-or-flight
of stable cellular, organ, and body body goes completely under water. response.
sulfur mustard An oily, clear to yellow- systemic vascular resistance The
stellate wound A star-shaped wound. brown liquid that can be aerosolized by amount of resistance to the flow of
a bomb blast or a sprayer; a vesicant or blood through the vessels. It increases
stipple Multiple small dots resulting from blister agent used as a weapon of mass as the vessel constricts. Any change in
gun powder from point-blank gunshot destruction. lumen diameter or vessel elasticity
wounds. can influence the amount of resistance.
superficial (first-degree) burn A burn to
stopping distance The distance over the epidermis only; red, inflamed, and systolic blood pressure Peak blood
which a moving object comes to a stop; painful skin. pressure produced by the force of
a measure of how quickly energy is the contraction (systole) of the
dissipated or transferred. superficial frostbite A freezing irtjury ventricles of the heart.
due to cold exposure that affects
stress wave A supersonic, longitudinal the skin and subcutaneous tissues, tachypnea An increased breathing
pressure wave that (1) creates resulting in clear blisters when rate.
high local forces with small, rapid rewarmed.
distortions; (2) produces microvascular Tactical Casualty Care (TCC) The
irtjury; and (3) is reinforced and superior vena cava A major vein that emergency medical care provided in a
reflected at tissue interfaces, thereby carries deoxygenated blood from the hazardous or tactical situation.
enhancing irtjury potential, especially upper portion ofthe body back to the
in gas-filled organs such as the lungs, heart. Tactical Emergency Medical Support
ears, and intestines. (TEMS) An out-of-hospital system
supplied air respirator (SAR) A personal of care dedicated to enhancing the
stroke volume The volume of blood protective device consisting of a mask probability of special operations law
pumped out by each contraction and source ofair that is not carried by enforcement mission success,
(stroke) of the left ventricle. the responder; used in environments reducing mission medical liability and
that are oxygen-deficient or pose a risk risk, and promoting public safety.
subarachnoid hemorrhage of toxic inhalation.
(SAH) Bleeding into the cerebrospinal Tactical Evacuation Care The phase
fluid-filled space beneath the supraglottic airway An airway device of care in Tactical Casualty Care
arachnoid membrane. inserted blindly into the mouth and in which medical care is provided
pharynx; designed to isolate the once the threat or hazard has been
subconjunctival hemorrhage trachea from the esophagus; none of completely addressed, similar to a
Bleeding found between the clear these devices provide a complete seal conventional EMS situation; also
conjunctiva covering the eye and the of the trachea, so the risk of aspiration referred to as Evacuation Care.
white sclera. is lowered but not completely
prevented. Tactical Field Care The phase of care
subcutaneous emphysema in Tactical Casualty Care in which
Accumulation of air in the soft tissues surgical cricothyrotomy A procedure medical care is provided when the
of the body. to open a patient's airway that is threat or hazard has been contained
accomplished by making an incision but could resume; also referred to as
subcutaneous (or hypodermis) into the cricothyroid membrane in Indirect Threat Care.
layer The layer of skin just under the neck to open the airway into the
the dermis that is a combination of trachea. tamponade The closure or blockage
elastic and fibrous tissue as well as of a wound or blood vessel; also
fat deposits. surveillance The process of collecting the compression of the heart by the
data within a community, usually for accumulation of blood or fluid in
subdural hematoma A collection of infectious diseases. the pericardium.
blood between the dura mater and
the arachnoid membrane. sutural bones The flat bones that make technician level In hazardous materials
up the skull. incidents, an individual trained to
sublimation A process in which work within the hazardous area
solids emit vapors, bypassing the liquid sympathetic nervous system The and stop the release of hazardous
state. division of the nervous system materials.

subluxation A partial or incomplete


tendon A band oftough, inelastic, third death peak The third of three transmural pressure Difference between
fibrous tissue that connects a muscle peaks that occur with death from the pressure inside a blood vessel and
to bone. trauma; occurs several days or weeks the pressure outside the vessel.
after the initial injury, usually caused
tension pneumothorax A condition in by sepsis and organ failure. transverse process A protuberance at
which the air pressure in the pleural each side ofa vertebra near the lateral
space exceeds the outside atmospheric third-degree frostbite A freezing injury margins.
pressure and cannot escape, the due to cold exposure that involves the
affected side becomes hyperinfl.ated, epidermis and dermis layers; skin is trauma chin lift A maneuver used
compressing the lung on the involved frozen with restricted mobility; after to relieve a variety of anatomic
side and shifting the mediastinum to the tissue thaws, skin swells and develops airway obstructions in patients
opposite side to partially collapse the blood-filled blister (hemorrhagic bulla), who are breathing spontaneously;
other lung; usually progressive and is an indicating vascular trauma to deep accomplished by grasping the chin and
imminently life-threatening condition. tissues; skin loss occurs slowly, leading lower incisors and then lifting to pull
to mummification and sloughing; the mandible forward.
tentorial incisura See incisura. healing is slow.
trauma jaw thrust A maneuver that
tentorium cerebelli (tentorium) An tidal volume The normal volume of allows opening of the airway with
infolding ofthe dura that forms a air exchanged with each ventilation. little or no movement of the head and
covering over the cerebellum. The About 500 ml of air is exchanged cervical spine; the mandible is thrust
tentorium is a part ofthe floor of between the lungs and the atmosphere forward by placing the thumbs on each
the upper skulljust below the brain with each breath in a healthy adult at zygomatic arch and placing the index
(cerebrum). rest. and long fingers under the mandible
and at the same angle, thrusting the
tertiary blast injury An injury that tonsillar herniation The process by mandible forward.
occurs from an explosion when the which the brain is pushed down
victim becomes a missile and is thrown toward the foramen magnum and traumatic asphyxia Blunt and crushing
against some object; injuries, usually pushes the cerebellum and medulla injuries to the chest and abdomen
blunt, are similar to those sustained in ahead of it, causing damage and, with marked increase ofintravascular
ejections from vehicles, in falls from ultimately, death. pressure, producing rupture ofthe
significant heights, or when the victim capillaries; characterized by a purplish
is thrown against an object by the total lung capacity The total volume discoloration ofthe skin ofthe upper
force wave resulting from an explosion. of air in the lungs after a forced torso and face along with petecchiae of
inhalation. the skin.
thermal energy Energy associated with
increased temperature and heat. toxidrome A collection of clinical traumatic rhabdomyolysis See
signs and symptoms that suggest rhabdomyolysis.
thermal equilibrium The transfer of exposure to a certain class of chemical
heat from a warmer object to a colder or toxin. trench foot A nonfreezing cold exposure
object in an effort to create the same injury caused by prolonged immersion
temperature between them. tracheal shift Movement or of extremities in wet and moisture
displacement of the trachea away that is cool to cold; also referred to as
thermal gradient The difference in from the midline ofthe neck. immersion foot.
temperature (high vs. low temperature)
between two objects. transesophageal echocardiography triage French word meaning "to
A technique ofperforming ultrasound sort"; a process in which a group of
thermite An incendiary compound that ofthe heart using an ultrasound probe patients is sorted according to their
consists ofpowdered aluminum and inserted into the esophagus. priority of need for care. When only
iron oxide that burns furiously at 3,600°F several patients are involved, triage
(l,982°C) and scatters molten iron. transmission-based PPE The personal involves assessing each patient,
protective equipment used, in addition meeting all of the patients' highest
thermoregulatory center The area of to standard precautions, to prevent priority needs first, and then moving
the brain (hypothalamus) that controls transmission of disease; includes to lower priority items. In a mass-
body temperature. aerosol, contact, and droplet casualty incident with a large number

Glossary 685

of patients involved, triage is done who are apneic or who cannot water density Organs that have a tissue
by determining both urgency and provide adequate ventilation for density similar to that of water-
potential for survival. themselves. e.g., liver, spleen, muscle.

triage officer A trained individual who vertebral foramen Hole or opening in weapon of mass destruction A
oversees the process of assigning iI\iury the bony structure ofthe vertebrae chemical, biologic, radiologic,
severity categories and prioritization of through which blood vessels or explosive agent designed to
treatment and transport. and nerves pass. create significant damage and large
numbers of casualties.
tumble An end-over-end motion. Bullets very high altitude Elevation levels
commonly tumble when resistance is between 11,480 to 18,045 feet white blood cell A nearly colorless
met by the leading edge of the missile. (3,500 to 5,500 meters). blood cell in the circulation
responsible for responding to
uncal herniation The process by vesicant A chemical agent such as sulfur invading microorganisms.
which an expanding mass (usually mustard and lewisite used as a weapon
hemorrhage or swelling) along the of mass destruction; also referred white phosphorus An incendiary agent
convexity of the brain pushes the to as blister agent because these used in the production of munitions.
medial portion of the temporal lobe agents create an iI\iury that is visually
downward through the tentorium similar to a bum. work of breathing The physical
that supports the cerebrum, causing work or effort performed in moving
damage to the brain stem. vestibular folds The false vocal cords the chest wall and diaphragm to
that direct airflow through the vocal breathe.
uncus The medial portion of the cords.
temporal lobe. years of potential life lost (YPLL) An
vestibular nuclei The areas of the brain estimate of the impact of an iI\iury
unified command (UC) An ICS command from which the vestibular nerves calculated by subtracting age at
structure in which the incident responsible for balance arise. death from a fixed age of the group
commanders of all of the various under examination, usually 65 or 70
agencies responding to an event work viscera The internal organs of years or the life expectancy of the
together to manage the incident the body. group.

unintentional injury An iI\iury that was visceral pleura A thin membrane zone of coagulation The region of
unplanned and did not involve intent that covers the outer surface of each greatest tissue destruction in a full-
to harm. lung. thickness bum; the tissue in this zone
is necrotic (dead) and is not capable
unity of command An incident vitreous humor The clear, jelly-like oftissue repair.
command system management concept material that fills the eye behind
in which each responder has only one the lens and maintains the eyeball's zone of hyperemia The outermost zone
direct supervisor. round shape. in a full-thickness bum; has minimal
cellular iI\iury and is characterized
vapor A solid or liquid in a gaseous state, volatility The likelihood that solids by increased blood fiow secondary to
usually visible as a fine cloud or mist. or liquids will vaporize into a an inflammatory reaction initiated by
gaseous form at room temperature. the bum iI\iury.
ventilation Movement of air into and
out of the lungs through the normal voluntary guarding An assessment zone of stasis The region next to the
breathing process; the mechanical finding in which the patient tenses the zone of coagulation; blood fiow to
process by which air moves from the abdominal muscles when the provider this region is stagnant and the cells
atmosphere outside the body through palpates a tender area of the abdomen. in this zone are iI\iured, but not
the mouth, nose, pharynx, trachea, irreversibly. Ifthey are subsequently
bronchi, and bronchioles, and into warm zone A geographic area of deprived of the delivery of oxygen
and out of the alveoli. To ventilate a diminished contamination from or blood flow, these viable cells will
patient is to provide positive-pressure a hazardous material and the die and become necrotic. Timely and
inspirations with a ventilating device, locationforthecontamination appropriate bum care will preserve
such as a bag-mask device, and then reduction corridor where exposed blood flow and oxygen delivery to
alternately allowing time for passive patients are decontaminated by the these iI\iured cells.
exhalation to occur; used in patients hazardous materials team.



Note: Page numbers followed acute mountain siclmess (AMS), 622, 627/ airway and ventilation, 164-192
byf, indicate materials in acute radiation syndrome (ARS), 423, algorithm, 172/
:figures. anatomy, 164
535, 536/ lower, 164-166
A acute renal failure, 66 upper, 164
ABCDE assessment acute respiratory distress syndrome assessment of, 170
chest rise, 171
burns, 411-414 (ARDS), 66 obstructions, 171
primary survey, 139-145 acute tubular necrosis (ATN), 66 position of, 170-171
abdomen, 151,365/ adenosine triphosphate (ATP), 53, upper airway sounds, 171
abdominal evisceration, 373 complex, 177
abdominal trauma, 362-376 218, 476 endotracheal intubation. See
anatomy, 363-364 adequate exposure, 107 endotracheal intubation
assessment, 367-371, 372/ adjunctive device, selection of, supraglottic airways, 177-178
blunt trauma, 367 CQI, 188
children, 447, 447/ 176-177, 176/ evaluation
evisceration, 373 adult airways vs. child airways, 436 capnography, 191
FAST, 370, 371/-372/ adult patients pulse oximetry, 190-191
genitourinary irtjuries, 376 LEMON Assessment, 179/-180/
history, 367-368 causes of spinal irtjury in, 298 management, 171-173, 174f, 175/
impaled objects, 372-373 fluid resuscitation, 417 manual clearing of, 175
kinematics, 367 advance directives, 42 manual maneuvers, 175
management, 372 Advanced Trauma Life Support suctioning, 175-176
obstetrical patient, 373-376 NPA, 177
pathophysiology, 364, 366 (ATLS), 9-10 OPA, 177
penetrating trauma, 367 aerobic metabolism, 55, 218 pathophysiology, 169
primary assessment, 368 aerosol, 522 hyperventilation, 170
secondary assessment, 368-370 neurologic function, decreased,
special examinations/key indicators, precautions, 529 169-170
Afghanistan, 108 physiology, 166-168
370-372 afterload, 58 traumapatient, 168-169
ABGs. See arterial blood gases AGE. See arterial gas embolism prolonged transport, 191- 192
abrasion, 451/ age ventilatory devices, 188-190
abruptio placentae, 374, 374/
abuse, 158 drowning, 600, 602 airway management, 139, 662
heat-related illness, 547-548 airway control, 171
child,449, 450 aging, 458-463. See also geriatric trauma algorithm, 172/
accident, 3-4 air bags, 87-88 essential skills, 171-173, 174f
accidental cold-water immersion, 600 air density, 75 methods of, 175/
ACEP. See American College of air-purifying respirator (APR), 512 spontaneous ventilation rate, 140/
airflow prevention, over patient's technique, 281
Emergency Physicians and ventilation skills, 195-216
acetabular fractures, 389 burn, 416/
acetylcholine, 525 airway alcohol, 600
acidosis, 141, 335 algorithm, 485/
burns, 411, 412/
from anaerobic metabolism, 224 geriatric trauma, 464, 469 for managing shock, 243/
acids, 424 head trauma, 270-271, 280-281 all-hazard system, 494-495
ACS-COT. See American College of pediatric trauma, 435-436, 435!, all-risk and all-hazard system, 494-495
allergic urticaria, 647f
Surgeons Committee on Trauma 436!, 441-442 alpha-particle radiation, 534, 537
acticoat dressing, 416/ primary assessment of shock, 225 alternative tourniquets, 234/
active fragmentation, 99 primary survey, 139-145
active strategies, 23 and respiratory system, 50-54, 51/
acute hemorrhagic mediastinitis, 530 shock management, 232
airway adjuncts and procedures,

categories for
complex, 173, 174f
manual, 171, 173, 173/
simple, 173, 173/


altemobaric vertigo, 611--612 appendicular skeleton, 381 axial unloading, 303
alveolar duct, 165/ APR. See air-purifying respirator axis, 292, 293!
alveolar epithelium, 337/ aqueous humor, 275
alveolar sacs, 165/ arachnoid membrane, 260 B
alveolar-capillary interface, 518 ARDS. See acute respiratory Babinski refiex, 266
alveolus, 166, 337/ Bacillus anthracis, 529
American Association for the Surgery of distress syndrome bag-mask device, 170, 188, 202
arms, immobilization, 309
Trauma(AAST), 240 ARS. See acute radiation syndrome two-provider method, 202-203
American College of Emergency arterial bleeding, 141 bag-mask ventilation, 435
arterial blood gases (ABGs), 281
Physicians (ACEP), 656 arterial gas embolism (AGE), 613 use of correct-sized, 437
American College of Surgeons BAL. See British anti-lewisite
assessment of, 614--615 Banks, Sam, 8
Committee on Trauma arteries, 59/ baroreceptors,339
(ACS-COT), 656 arytenoid cartilage, 166/ barotrauma, 517, 610--613
American National Standards Institute ascending nerve tracts, 293-294
(ANSI), 118 asphyxiant toxidrome, 523 signs, symptoms, and treatment, 617/
ammonia, 526 asphyxiants, 419-420 basal level, 546
amputation, 395-397,395/ aspiration pneumonitis, 460 basal metabolic rate, 545, 563
AMS. See acute mountain siclmess assessment bases, 424
anaerobic metabolism, 55-56 basilar skull fractures, 273
acidosis from, 224 algorithm, 147! Battle of Bull Run, 7
analgesia, 158 pediatric trauma, 434-441 Battle's sign, 273
burns,418 assist control (A/C) ventilation, 189 Beck's triad, 351
anaphylactic shock, 64 asystole, 157 bee sting, 647--648
anastomoses, 568 atelectasis, 341 behavioral regulation, 545
anatomic deformity of spine, 301 atherosclerosis, 460 bellows effect, 97
ancient period, 7 athletic equipment removal, 307! bends,614
anemia, 269 Ativan, 526 beneficence, 40,42-43
angular-impact collision, 89 atlas, 292, 293/ benzodiazepines,283,395
anhidrosis, 553 ATLS. See Advanced Trauma Life Support beta-adrenergic blocking agents, 231
anisocoria, 152, 272 ATN. See acute tubular necrosis beta blockers, 467
ANSI. See American National ATP. See adenosine triphosphate beta bum, 534
Standards Institute atropine, 184!. 525, 526 beta-particle radiation, 534, 537
antecedent trauma, 274 audible noise, 343 bimodal patient transport, 521
anterior cord syndrome, 296, 297! auscultation, 340, 346/ biologic agents, 511, 527- 533
anterior longitudinal ligaments, 292, 293/ abdominal trauma, 370
anterior-medial proximal tibia, 248 austere environment, 492 precautions, 529/
anterior-posterior compression fractures, "auto-PEEP," 232 biologic WMD agents,
389, 389/ automated blood pressure
anthra.x,529-530 classification of, 527!
antibiotics, 645 monitoring, 145 birdshot, 105, 106/
anticoagulants, 467 autonomic nervous system, 61 Black Death, 530
medications, 231 autonomy, 40, 41 blast i.r\juries, 107- 110
anxiolysis, 395
aortic arch, 352 advance directives, 42 blast waves and body, 108
aortic shear i.r\jury, 383 privacy and confidentiality, 41 categories, 109f, 519/
aortic tear, 96 truthtelling,41-42 explosion-related i.r\juries, 108-109
aortography, 352 autoregulation, 263 i.r\jury from fragments, 109-110
apneic, 140 of cerebral blood fl.ow, 263-264 multi-etiology i.r\jury, 110
apoptosis, 265 autoregulatory mechanism, 264 physics of blast, 108
AVPU, 143, 143f, 439 blast lung i.r\jury (BL!), 520/
axial loading, 296 blast overpressure, 108
blast wave, 108,516, 517/


blast wind, 108, 519 brain death and organ donation, 283--285 burns characteristics, 408-411
bleeding, primary survey, 141- 143 brain iltjuries, 27&-280 burst lung, 612
BLI. See blast lung iI\iury brain stem, 261, 262/ Bush, George W., 126
blind nasotracheal intubation (BNTD, breathing
181, 281 burns,412
blister agents, 425 geriatric trauma, 464, 469 C-A-T. See Combat Application
blisters, 409/ head trauma, 271, 281 Tourniquet
blocking therapy, 538 pediatric trauma, 43&-437, 442-443
blood-borne pathogens, 128-130 primary assessment of shock, 225--227 C-TECC. See Committee on Tactical
blood-clotting cascade, 66, 67/ primary survey, 140-141 Emergency Casualty Care
blood-clotting system, 233 shock management, 232
blood-glucose measurement, 270 thoracic trauma, 335--337 calcium channel blockers, 231, 467
blood, hemodynamic response, 59-60 brisance, 517 capillary, 336, 337/
blood pressure British anti-lewisite (BAL), 527
bronchioles, 166 bleeding, 141
aortic disruption, 353/ bronchospasm,526, 527 endothelium, 337/
vital signs of shock, 229-230 Brown-Sequard syndrome, 297, 297/ refilling time, l~ 228
blood substitutes, 240 bubonic plague, 530, 531 capnography, 191, 244, 340
blood vessels, cardiovascular buckshot, 105, 106/ carbon dioxide, 51, 167
buddy aid, 659 and cerebral blood flow, 264
response, 59 bullet vehicle, 83 diffusion of, 167/
blown pupil, 266 bum cooling, 415/ carbon monoxide monitor, 420/
Blue Star of Life, 8 bum depth, 409-410, 410/, 411/ carbon monoxide toxicity, 420
blunt cardiac iltjury, 349-350 bum iI\iuries, 407-426 cardiac contusion, 349-350
blunt cardiac rupture, 350 ABCDE assessment, 411-414 cardiac dysrhythrnia, 65
blunt force iI\iury, 340 analgesia, 418 cardiac output (CO), 58
blunt iI\iury, 276 anatomy of skin, 407-408, 408/ cardiac tamponade, 65, 65!, 223, 22.V,
blunt trauma, 76, 78-98, 261 bum cooling, 415/
bum depth, 409-410, 410/, 411/ 350-351, 350/
abdomen, 97- 98 bum size estimation, 413, 413/ cardiogenic shock, 57, 64, 64!, 219, 219/,
abdominal trauma, 367 chemical burns, 423-426, 423/
defined, 76 children, 413, 421-422 223-224
falls, 92-93 circumferential burns, 419, 419/ extrinsic causes, 65
head, 94 contact bums, 422 intrinsic causes, 64-05
iI\iuries, 366 dressings, 413-414 sources of, 225
mechanical principles, 79 elderly persons, 464 cardiopulmonary, 614
neck, 94-95 electrical bums, 418-419, 418/ cardiopulmonary arrest, 15&-158
spinal trauma, 298-299 fluid resuscitation, 416-417 cardiopulmonary resuscitation (CPR),
sports iI\iuries, 93 initial bum care, 414-416
thorax, 95--97 Lund-Browder chart, 413, 414/ 6,64&-647
BNTI. See blind nasotracheal intubation radiation burns, 422-423 cardiovascular response
board splint, 391/ rule of nines, 413, 413/
bomb threats (safe evacuation rule of palms, 413, 414{ blood vessels, 59
smoke inhalation iI\iuries, 419-421 heart, 57- 59, 57/, 58/
distances), 124{ toxin-induced lung iI\iury, 421
botulinum toxin, 532-533 transportation, 414, 415/ care, phaseso~658-664,658f
botulism, 533 zones of bum iI\iury, 408, 408/
Boyd, David, 8 bum size estimation, 413, 413/ care under fire, 37, 658!, 659-660, 659/
Boyle's law, 610, 610/ bum unit care, iI\iuries requiring, 415/ Caroline, Nancy, 8
bradycardia, 157 carotid artery, 276
bradypnea, 140 casualties
brain, 2621
collection points, 500
meningeal coverings of, 261/ extraction and evacuation of,

cataract, 461
catecholamines, 230, 461
caudad, 195

movement of torso, 304, 305/

Index 689

cavitation, 76-78, 101-102 chest injury. See thoracic traUina phasesofcare, 658-664,658!
CDC. See Centers for Disease Control chesttube,347-348,348! practice components, 657
Cheyne-Stokes breathing, 271 practice guidelines, 657
and Prevention Cheyne-Stokes ventilations, 266 RAM, 660
cefazolin, 400 chickenpox,531,532! zones of operation, 658
cell membrane, 59 Class I hemorrhage, 61-62, 6!lf, 220
cellular mechanisms, 265 from smallpox, differentiating, 532! Class II hemorrhage, 62, 62.f. 220
cellular perfusion and shock, 57 chilblains, 566-567 Class III hemorrhage, 62, 6!lf, 220-221
cellular respiration, 53, 168, 336 child abuse, 421-422, 421.f. 42!lf, 449, 600 Class IV hemorrhage, 62, 62!, 221
cement, 424-425 classic heatstroke, 553, 553!
Centers for Disease Control and and neglect, 450 clavicles, 294
child airways, adult vs., 436 clinical herniation syndromes, 266
Prevention (CDC), 86 child immobilization device, 328-329 close range wounds, 106
central cord syndrome, 297, 297! child safety seats, 5 closed fracture, 387, 388.f. 389-391
central nervous system (CNS), 290, 595 children. See also pediatric traUina Clostridium botuli num, 532
CNS. See central nervous system
injury, 241, 434 abuse,421-422,42lf,422f coagulation cascade, 221, 222f
nerves of, 294, 29'lf altitude illness, 627f coagulative necrosis, 424
central neurogenic hyperventilation, 266 burns,413, 421-422 coagulopathy, 66
cerebellUin,261,262! docUinenting nonaccidental coccygeal vertebrae, 292
cerebral blood flow, 263-264 coccyx, 292
carbon dioxide and, 264 traUina in, 452! cold-induced diuresis, 566
cerebral concussion, 276-277 spinal traUina, 307, 328-329 cold-induced vasodilation (CIVD), 568
cerebral contusions, 279 child's ventilation, effectiveness of, 437 cold-related illness, 566-578
cerebral edema, 267-268 chokes, 105, 614 epidemiology, 544
cerebral glucose metabolism, 270 cholinergic toxidrome, 523 frostbite, 566, 569-570
cerebral hypoxia, 229 chronic obstructive pulmonary disease major disorders, 567-578
cerebral perfusion pressure, 263 minor disorders, 566-567
cerebral vascular resistance, 263 (COPD), 337 prevention,579-582
cerebrospinal fluid (CSF), 261, 293 chronic subdural hematoma, 279 prolonged transport, 483-484
cerebrUin,261,262! cigarette burns, 339.f. 449, 451f cold shock, 570, 574
cervical collars, 280, 303-304 cilia, 421, 460 cold urticaria, 566
improper sizing/improper application cingulate herniation, 265 cold-water submersion, surviving,
of, 309 601-602
sizing and application, 315-316 burns,412 cold zone, 120, 121.f. 123, 425.f. 512!, 514
cervical spine, 63~0 geriatric traUina, 465, 469 colloids, use of crystalloids vs., 240
immobilization, 663 head traUina, 271, 281-282 Combat Application Tourniquet
manual stabilization of, 171! pediatric trauma, 437-439,
stabilization, 139-140,311 (C-A-T), 234
cervical vertebrae, 292 438.f. 443-445 self-application to lower extremity,
cervical vessels, injuries to, 276 primary assessment of shock, 227-228
Champion, Howard, 8 primary survey, 141- 143 252-253
chemical agents, 522-527 thoracic trauma, 338-339 self-application to upper extremity,
classification of, 522! circulatory system, 54
chemical burns, 423-426, 423! circumferential burns, 419, 419! 250-251
chemical energy, 16 CISM. See critical incident stress Combat Gauze, 236
chemical exposures, 424-426 Combat Ready Clamp, 236
chemical-resistant barrier, 512 management combitube, 174.f. 203-205
chemoreceptors, 337 CIVD. See cold-induced vasodilation command, 496
chemosis, 274 civilian tactical emergency medical command staff, 496-497
Chernobyl nuclear disaster, 533 command structure, 125-126
chest, 150-151, 335 support (TEMS) commission, 158
barriers to traditional EMS access,

historical overview, 656-657
MCis, 664
medical intelligence, 664


Committee on Tactical Combat contributory negligence, 84/ crystalloids
Casualty Care (COTCCC), control zones, 514
234,236,656,657 controlled hemorrhage, 241-244 vs. colloids, use of, 240
Committee on Tactical Emergency COPD. See chronic obstructive infusions, 241
Casualty Care (C-TECC), 657 CSF. See cerebrospinal fluid
pulmonary disease CT. See computed tomography
commotio cordis, 351-352 coral snake, 648, 648/ cue ball, 76, 77/
communications, 156 cord compression, 296 Cullen's sign, 369
cord concussion, 296 Curry, George J., 8
barriers, 301 cord contusion, 296 Cushing's phenomenon, 266
disasterresponse,505-506 cord laceration, 296 Cushing's reflex, 271
community-wide interventions, EMS, 28 core temperature, 545 cutaneous and lymphatic
compartment syndrome, 397-398 cornea, 275
"compensated shock," 220 corneal abrasion, 274 (type I DCS), 614
compensatory d efense mechanisms, 220 cosmesis, 645-646 cutaneous anthrax, 530
competence, 41 cost, trauma, 2, 3/ cutaneous skin bends, 614
complete cord transection, 296 COTCCC. See Committee on Tactical cyanide, 524
comprehensive emergency cyanide antidote kit, 420
Combat Casualty Care cyanide poisoning, 420
management, 490 coumadin, 279 Cyanokit, 420
compressibility, 92 Counter Narcotics and Terrorism cyanosis, 340, 346/
compression, 79
Operational Medical Support D
abdomen, 97 (CONTOMS), 656, 660 DCI. See decompression illnesses
head,94 coup,270 DCS. See decompression sickness
ir\juries, 366 Cowley, R. Adams, 5, 137, 476 dead space, 50, 166, 168!, 339, 339/
neck,94-95 CPAP. See continuous positive airway death from iajury, 19, 20f, 21-22, 21!
thorax,95-96 pressure "Death in a Ditch" (Farrington), 8
computed tomography (CT), 265 CPR. See cardiopulmonary resuscitation debridement, fracture, 390
computerized medical literature search, CQI. See continuous quality improvement decerebrate posturing, 144, 266
cranial ir\jury, penetrating, 280 decision-making capacity, 41
44, 4:lf cranial nerve III, 261 decomposition, 646
concentrated biohazard agent vs. cranial nerves, 262/ decompression illnesses (DCI), 613/
cranial vault, 261 decompression sickness (DCS), 613-614
infected patient, 528 cranium, 150!, 260
conduction, 545 crash phase, 72 assessment of, 614-615
confidentiality, 41 crepitus,272,383 factors related to, 614{
confounding factors, shock assessment, cribriforrn plate, fracture of, 275 signs, symptoms, and treatment, 618/
cricothyroid membrane, 187 decontamination, 123,502-503,504{,
230-231 crime scene, 121-122
coning,266 critical incident stress management 514-515
coajunctiva, 274 (CISM), 504 from nerve agents, 525/
contact area, 76 critical-thinking, 34 decorporation therapy, 538
contactburns,422,449 components of, 37/ decorticate posturing, 144, 266
contact freeze ir\jury, 566 to control biases, 39 deep frostbite, 569
contactir\jury,593 in data analysis, 3940 deep second-degree burn, 409
contact precautions, 528 phases ofpatient care, 40 definitive care, 152-154
contact wounds, 106 in rapid decision making, 39 definitive medical care, 493, 500/
continuous positive airway pressure steps in, 38/ dehydration, 548-549, 550!, 566
critical trauma patient, 146, 148/ delayed primary closure, 645
(CPAP), 342 crush syndrome, 398-399 denaturation, 408
continuous quality improvement density, 75-76
denuded burned areas, 409, 409/
(CQI), 188
CONTOMS. See Counter Narcotics and

Terrorism Operational Medical
contrecoup ir\jury, 270

Index 691

dependent lividity, 646 JCS, 493-494 DuoDote, 526, 526/
depressed skull fracture, three- characteristics of, 494-496 dura mater, 260, 273
organization of, 496-497, 496/ dying declaration, 122
dimensional reconstruction of, dynamic pressure, 108
273,274/ initial response, 498 dysarthria,279
dermatome, 294 mass-casualty incident, 492-497 dysbarism, 608
map, 295/ media, 506 dysesthesia, 594
dermis, 408,408!,544 medical assistance teams, 501-502 dysrhythmia, 65
descending aorta, 352, 353/ medical concerns, 493
descending nerve tracts, 294 NIMS, 493 E
designated incident facilities, 495 personal preparedness, 490, 492 EAH. See exercise-associated
devitalized tissue, 410 pitfalls, 505-506
dextran,240 preparedness,490,505 hyponatremia
diabetes guidelines, recreational diving psychological response, 503--504 ecchymosis, 275
with, 620f-62lf scene security, 506 ECG. See electrocardiographic (ECG)
diaphragm, 97, 150, 15lf, 165!, 166, 294, search and rescue, 498 eclampsia, 375
336,366 self-dispatched assistance, 506 edema, 275
diaphragmatic rupture, 355--356 steps in process, 498/ edentulism, 459
diastolic blood pressure, 58 supply and equipment resources, 506 educational strategies, iajury
diastolic pressure, 263 terrorism/WMDs, 502
diazepam, 526 transport, 501 prevention, 25
dicobalt edetate, 420 treatment, 500-501 EHS. See exertional heatstroke
digital intubation, 186 treatment area, 503 elasticity, 76
dilutional hyponatremia, 552, 556 triage, 499-500 elder abuse, 464, 470, 472/
direct pressure, 142 worker stress, 504 electrical burns, 418-419, 418/
direct strike, 591 disaster medical assistance teams electrical energy, 16
direct threat care, 659--660 electrocardiographic (ECG)
dirty bomb, 502 (DMATs), 501
detonation of, 422 disease, iajury as, 16-17 monitoring, 145
disability dislocations, 392-393, 393!, 646 emergency, 489
distended neck veins, 346/ Emergency Care and Transportation of
burns,41~13 distraction, 296
distributive shock, 57, 63, 219, 219!, the Sick and Injured, 8
geriatric trauma, 465 emergency incident rehabilitation, 562,
head trauma, 271-272, 282 221- 223
pediatric trauma, 439, 439/ divers alert network (DAN), 615, 615/ 564, 565/
primarysUIVey, 143--144 diverters, 105 emergency medical services (EMS), 3,
disaster, 488 diving. See scuba-related diving iajuries
disaster cycle, 489-490, 492 DMATs. See disaster medical assistance 15-16,638,639
disaster management, 488-507 access, barriers to traditional, 657-658
communications,505-506 teams community-wide interventions, 28
comprehensive emergency do-not-resuscitate (DNR) order, 42 iajury prevention for, 28-29
Don Juan syndrome, 92 one-on-one interventions, 27-28
management, 490 dorsal root, 294 trauma care in, 7- 9
decontamination,502-503,502/ down-and-under path, 81-83 emergency medical technician (EMT), 8
disaster cycle, 488-490, 492 dramatic bleeding, 282 Emergency Military Tourniquet, 234
education and training, dropletprecautions,529, 531 Emergency Ilesponse Guidebook
504-505 drug storage in thermal extremes, (ERG), 120
emergency supply list,
564-566 emergency supply list, 490/-49lf
490/-491/ drunk driving, 4
failure to notify hospitals, 506 dry drowning, 601 EMS. See emergency medical services
first aid kit, 492/ DUMBELS, 525, 525/ EMS drug storage in thermal extremes,
food kit, 492/
EMS literature, reading, 43
EMS personnel, 40

iajury to, 22


EMT. See emergency medical technician epidermis, 408, 408/, 544 explosion and weapons of mass
end-tidal carbon dioxide (ETC02), 191, epidural hematomas, 260, 277-278, 278f destruction, 502
epidural space, 260
232,281 epiglottis, 164, 165/, 166f biologic agents, 527-533
monitoring, 145, 481 epinephrine,220, 648 chemical agents, 522- 527
endocrine response, nervous system, 61 epithelial covering of cornea, 274 control zones, 514
endothelial toxicity, 661 ERG. See Emergency Response evaluation and management,
endotracheal intubation, 178, 178/, 276,
Guidebook 521,523
435-436,441-442,444{ eschar, full-thiclmess bum, 409 explosions and explosives, 515-521
alternate techniques escharotomies, 419,419! ICS, 511-512
escharotomy, 412 incendiary agents, 522
digital intubation, 186 esophagus, 105, 164, 165f injury pattern, 521, 52lf
LMA, 186-187 ETC02• See end-tidal carbon dioxide mechanisms of injury, 517-520
needle cricothyroidotomy, 187 ethics, prehospital care, 40 PPE, 512-514, 513/, 523, 528/, 537
surgical cricothyrotomy, 187- 188 principles of decontamination,
endotracheal tube placement, autonomy, 41-42
beneficence,42-43 514-515
verification of, 185-186 justice, 43 radiologic disasters, 533-538, 534f
equipment for, 178f nonmaleficence, 42 scene assessment, 511
indications, contraindications, and principles, 40 transport, 521, 523-524, 538
etomidate, 184! triage,514
complications, 181 eucapnic state, 232 explosion-related injuries, 108-109
methods of, 181-184 euhydration, 548 explosions and explosives, 515-521
prediction of, 179- 181 eupnea, 141 explosives, categories of, 516-517
endotracheal (ET) tube, 175, 178f evacuation, 493 explosives safe distance stand-off
securing, 186 evaluation, steps in, 44
energy, 72- 79 determine the impact, 45 chart, 518f
laws ofenergy and motion, 73-75 narrow the selection, 44 expose/environment
solid object and human body, exchange read and assess, 44-45
evaporation, 546 burns, 413
between, 75-79 event phase, 5, 72 geriatric trauma, 465
enforcement strategy, injury evidence, types of, 43-44 head trauma, 272
evisceration, 373 pediatric trauma, 439
prevention, 25-26 excessive extension, 296 primary assessment of shock, 229
engineering strategy, injury excessive flexion, 296 primary survey, 144-145
excessive lateral bending, 296 shock management, 237
prevention, 26 excessive rotation, 296 exposure protocol, 130, 131!
entrance and exit wounds, 102-103 exercise-associated hyponatremia (EAR), exsanguination,273
Environmental Protection Agency external hemorrhage, 141, 232,
550/, 555-556
(EPA), 531 exercise-associated hyponatremic 283,386,445
environmental temperature, 545 external nares, 165f
environmental trauma, 542-584 encephalopathy (EAHE), 555 external respiration, 51, 53, 168
exertion-associated collapse, 551 extracellular fluid, 60
altitude. See high-altitude illness exertional heat exhaustion, 552 extramural/intraluminal pressure, 232
cold-related illness. See cold-related exertional heatstroke (EHS), 553, 553! extreme altitude, 623
exertional hyponatremia, 555 extremities, 152
illness exhalation, 336 extremity trauma, 448
diving. See scuba-related diving injuries exit wound, 102-103 extrinsic causes of cardiogenic
drowning. See submersion incidents expanding bullets, 98f
EMS drug storage in thermal extremes, expiration, 52/, 337 shock, 223-224
exploitation, 472f eye, chemical bums to, 424
564-566 eye injuries, 274
heat-related illness. See heat-related eye protection, 130
eyelidlaceration, 274
lightning. See lightning injuries
prolonged transport, 582-584
EPA. See Environmental Protection

epidemiological triad, 16, l 7f

Index 693

F flail sternum, 350 general impression, 139
face, 150/ flares, 118 general staff, 497
face shields, 130 "flash-to-bang" rule, 596 genitourinary injuries, 376
face-to-face intubation, 181-182 fiashover, 593 geriatric trauma, 45&-473
face-to-face orotracheal intubation, fiat bones, 381
floating ribs, 350 airway,464, 469
212-213 fluid resuscitation, 41&-417 assessment,463-468
facial bruising, 451.f fluid therapy, 146, 444-445 breathing, 464,469
facial injuries, 274-276 focused assessment with sonography for burns, 464
facial trauma, 280 cardiovascular system, 460--461
falling domino effect, 77 trauma (FAST), 370, 371/-372/ chronic medical problems,
falls, 92-93, 463 fontanelles, 259
falx, 265 food and water needs, 642 458-i59
Farrington era, 8 food-borne botulism, 533 circulation, 465, 469
fascia, 397 food kit, 492/ communication challenges,
fascial, 346 foramen magnum, 230, 259
fasciotomy, 398 foramina, 259 465-466
FAST. See focused assessment with forensic evidence, 145/ disability, 465
formable splints, 390/ disposition, 472
sonographyfor trauma fourth-degree burns, 410, 410/, 411/ ears, nose, and throat, 459
FDA. See U.S. Food and Drug fourth-degree frostbite, 569 elder abuse, 464, 470, 47:lf
fractured cervical spine, 2 elder maltreatment, 470--472
Administration fractures, 387 environmental factors, 467
femur fractures, 391 fragmental injury, 109-110 expose/environment, 465
fragmentation, 99, 517 falls, 463
traction splint for, 403-405 File of Life, 467, 468/
fentanyl, 184f. 394 active/passive, 99 immobilization,469
FGC. See Fire Ground Command System blast injuries, 109-110 legal considerations, 470
Fick principle, 5&-57 high-energy weapons, 102 management, 469-470
field amputation set, 397, 397/ freezing cold injury, 567- 570 musculoskeletal system, 462-463
field exercises, 505 frontal bone, 150/ nervous system, 461
field management and care period, 12 frontal-impact collisions, 80 nutrition and immune system, 463
field triage, 514 frontal lobe, 26¥ pain perception, 461-462
frostbite, 566, 569-570, 583 PED, 459/
ofinjured patients, 2011 guidelines frostnip, 566 physiologic changes, 46&-467
for, 226f full-thickness burns, 409, 410, 410/ prolonged transport, 472-473
fund of knowledge, of prehospital care renal system, 462
Field Triage Decision Scheme, respiratory system, 459-460
153-154, 155/ provider, 36 secondary survey, 465-468
File of Life, 467, 468/ G temperature control, 469-470
finance/administration section, 497 gamma radiation, 535, 537 transport, 472-473
fingertip burns, 451.f gamma rays, 534-535 vehicular trauma, 463-464
Fire Ground Command System gas, 522 vision and hearing, 461
gastric catheter, 159 Glasgow Coma Scale (GCS), 8,
(FGC), 125 gastric distension, 437
Firefighting Resources of California gastrointestinal anthrax, 530 143, 144, 144!, 237, 271, 27lf,
gastrointestinal (GI) squeeze, 612 273, 439
Organized for Potential gastrointestinal tract, thorax, 105 pediatric, 271,27¥
Emergencies (FIRESCOPE), 125 GCS. See Glasgow Coma Scale gloves, 129
first aid kit, 492/ gelignite, 516 glycogen, 449
First Battle ofBull Run, 7 gelofusine, 240 Golden Hour, 5, 137, 476
first-degree burns, 409, 409/ Golden Period, 137, 476
first-degree frostbite, 569
First Geneva Convention, 7
first peak of death, 638
fitness, 561
flail chest, 96/, 341-342


golden principles ofprehospital care, head-on collision, 88-89 minor disorders, 549-551
475-485 head-out immersion, 601 prevention, 556-564
head trauma, 258--285 prolonged transport, 582-584
airway management, 480 risk factors, 546-549, 547!
body temperature, 481-482 airway,270-271,280-281 heat stress index, 560
death, why it happens, 476-477 anatomy, 259-262 heatsyncope,551
hemorrhage, 481 assessment,270-273 heat tetany, 549
kinematics,478-479 brain death and organ donation, heatstroke, 550!, 553-554, 582
no harm principle, 484-485 helmet, motorcycle, 4
primary smvey approach, 479 283-285 helmet removal, 330-331
safety, 477-478 brain injuries, 276-280 HELP. See heat escape lessening posture
scene situation, 478 breathing, 271, 281 hematologic failure, 66
shock therapy, 481-482 cervical vessels, injuries to, 276 hematomas, 280
spinal immobilization, 482 circulation, 271, 281-282 hematuria, 376
splinting, 481-482 disability, 271-272, 282 hemidiaphragm, 366
transport, 482-483 expose/environment, 272 hemiparesis, 273
ventilation/oxygen,480-481 facial injuries, 274-276 hemiplegia, 273
gowns, 130 kinematics, 270 hemodynamic response, blood, 59-60
grab and run period, 12 laryngeal injuries, 276 hemoglobin-based oxygen carriers
grand mal seizures, 270 management, 280-283
Grey-Turner's sign, 369 pathophysiology, 264-270 (HBOCs), 240
Gross, Samuel, 218 physiology, 263-264 hemopneumothoraces, 518
ground current, 593 primary assesment, 270-272 hemopneumothorax, 339
group training, 505 primary brain injury, 264 hemorrhage, 227,261, 269, 282
gunpowder, 105 scalp injuries, 273
secondary assessment, 272-273 control of, 141-142
H secondary brain injury, 264-270 external, 141
HAGE. See high-altitude cerebral edema skull fractures, 273, 274f golden principles of prehospital
Haddon Matrix, 17-18, 18f specific head and neck injuries,
Hague Convention of 1899, 102 care, 481
Hampton, Oscar, 8 273-280 musculoskeletal trauma, 386-387
hand washing, 130 transportation, 282-283 pediatric trauma, 433-434
handguns, 105 headrest, 83, 84f TEMS, 661
handheld end-tidal carbon dioxide heart, cardiovascular response, 57-59, hemorrhage control
directpressure, 232-234
detector, 191! 57f, 58f elevation and pressure points, 234
HAPE. See high-altitude pulmonary heart muscle damage, 64-65, 223 hemostatic agents, 236
heat acclimatization, 548, 561, 562!, 563! internal hemorrhage, 236
edema heat cramps, 549, 550!, 551 junctional, 236
hard palate, 165! heat edema, 549 tourniquets, 234-236
Harris, Jeffrey, 9 heat escape lessening posture (HELP), hemorrhagic shock, 61-63, 62f, 220-221
hazardous materials, 119-121, 123 classification of, 220, 220!
hazardous materials scene control 572, 573! hemostasis, 644
heat exhaustion, 550!, 552-556 hemostatic agents, 233, 236, 644
zones, 425! heat rash, 549 hemothorax, 339, 349
hazardous materials training, 119 heat-related illness, 546-564 Henry's law, 610
HBIG. See hepatitis B immune globulin hepatic failure, 67
HBOCs. See hemoglobin-based oxygen dehydration, 548--549 hepatitis, 128, 129!
emergency incident rehabilitation, 562, hepatitis B (HBV), 128, 129!
carriers hepatitis B immune globulin (HBIG), 128
HBsAg. See hepatitis B surface antigen 564, 565! hepatitis B surface antigen (HBsAg), 128
HCV. See hepatitis C epidemiology, 543 hepatitis C (HCV), 128, 128f
head, 149, 150f heat exhaustion, 550!, 552-556
heatstroke, 550!, 553-554, 582
immobilization, 307-308 hyponatremia, 550!, 555-556, 582-583
major disorders, 551-556

Index 695

hepatocellular carcinoma, 129/ human body, muscles of, 382/ hypotonic crystalloid solutions, 434
herniation,265--267 human immunodeficiency virus (HIV), hypoventilation,54, 167, 169
hetastarch, 240 hypovolemia, 63, 222
high-altitude, 622 129, 129/ hypovolemic shock, 57, 61, 64/, 219-221,
high-altitude cerebral edema (RACE), human skeleton, 381/
hunting response, 568 219/, 282
622, 627/ hydration, 558!, 560--561 hypoxemia,54, 169
high-altitude illness, 622--629 hydrofluoric acid, 425 hypoxia, 54, 65, 169, 265, 269, 335,
hydrogen cyanide, 524
altitude acclimatization hydroxocobalamin, 420, 524 342,433
procedures, 628/ hypoxic drive concept, 338
hype~rotation,296 hypoxic encephalopathy, 185
.AM:S,624-625, 627/
assessment, 627 hypercapnia, 270 IAPs. See incident action plans
children, 627! hypercarbia, 335 iatrogenic cerebral edema, 433-434
epidemiology, 622 hyperchloremia, 221, 239 IC. See incident commander
factors to consider, 623-624 hyperchloremic acidosis, 417 ICP. See incident command post;
golden rules of, 628/ hyperextension, 296
HACE, 625--627, 626/, 627/ hyper:flexion, 296 intracranial pressure
HAPE, 626/, 627-628, 627/ hyperglycemia, 270 ICS. See incident command system
hypobaric hypoxia, 622-623 hyperhydration,548 IEDs. See improvised explosive devices
management, 627 hyperkalemia, 399 immersion, 599
pre-existing medical conditions, 624 hypertension, 460 immersion foot, 567
prevention, 626/, 628 hypertonic crystalloid solutions, 239, 434 inunersion hypothermia, 572-574
prophylaxis, medications as, 628-629 hypertonic saline, 239 inunobilization oftorso to board device,
signs, symptoms, treatment, 626/ hyperventilation,54, 170, 232,264,281
high-altitude pulmonary edema (HAPE), hyphema,275,275/ 304-305
hypobaric hypoxia, 622-623 immobilization skills, evaluation of, 310/
622, 627/ hypocapnia, 170, 270 impact phase, 489
high-energy weapons, 100--102 hypochlorite solutions, 425 impaled objects, 372-373
high explosives, 516-517 implementation, public health
high spinal cord iitjuries, 297 hypodermislaye~408, 408f
high-voltage electrical iitjuries, 593 approach, 27
hypoglycemia, 270 improvised explosive devices (IEDs), 236
lightning vs., 593/ hypoglycemic agents, 467 IMS. See National Fire Incident
highway design, 117 hyponatremia, 550/, 555-556, 582-583
historical overview hypoperfusion, 55, 229 Management System
IMV. See Intermittent Mandatory
ancient period, 7 manifest, signs of, 224
Farrington era, 8 hypopharynx, 164, 165/ Ventilation
hospitals, military, and mortuaries, 7 hypotension, 230, 269 in-water patient packing equipment, 603/
Larrey period, 7 hypotensive resuscitation, 241 inadequate immobilization, 309
modern era, 8-9 hypothalamus, 545 incendiary agents, 522
HIV. See human immunodeficiency virus hypothermia, 144, 463, 570--578, 662 incident action plans (IAPs), 126, 494
HIV-1, 129/
HIV-2, 129/ algorithm, 580/ consolidated, 495
hives, 566 assessment, 575-576 incident command post (ICP), 496
Holcomb, John, 9 drowning, 600 incident command system (ICS), 125,
homeostasis, 458, 546 immersion, 572-574
homeotherms, 545 J-wave, 575, 576/ 493-494, 493/, 511-512
hot lightning, 593 management, 578 characteristics of, 494-496
hot zone, 120, 121/, 123, 425/, national guidelines, 578-579 general staff, 497
pathophysiologic effects, 574-575 incident command training
512/, 514, 657/ physiologic characteristic, 577/
Hoyt, Walter, 8 prolonged transport, 583-584 resources, 128/
huddle techniqu e, 573/ ranges of severity, 572f incident commander (IC), 126, 494, 537
incomplete cord iitjuries, types of,



incomplete cord transection, 296 interstitial space, 53, 168 junctional hemorrhage control, 236
independentlearning, 504 intervention evaluation, public health jurisdictional authority, 494
infected patient, concentrated biohazard justice, 40, 43
approach, 27
agent vs., 528 intervertebral disc, 294, 294{ K
intervertebral foramen, 294 Kendrick extrication device (KED), 320
inferior vena cava, 338 intestinal botulism, 533 Kennedy, Robert, 8
informed consent, 41 intracellular :fluid, 60 keraunoparalysis, 595
inhalation, 337 intracerebral hematomas, 268 ketamine, 185!, 394
inhalational anthrax, 530 intracranial hematoma, 277-280 kill zone, 658
inhalational botulism, 533 intracranial hypertension, 268-269 kinematics, 71,270, 382-383
iltjuries intracranial iltjuries, 259 kinematics of trauma, 70-110
intracranial pressure (ICP), 261, 267-268
death from, 19, 20!, 21-22, 21!, 22/ intramural/intraluminal pressure, 232 assessment, 110
to EMS personnel, 22 intraosseous (IO) infusion, 444/ blast iltjuries, 107- 110
pattern of, 521, 521/ intraosseous route, 238 cavitation, 76-78
and treatment, time between, 231 intraosseous vascular access, 248-257 contact area, 76
iltjwy prevention, 15-16 intrapulmonary pressure, 166/ density, 75-76
classification, 19 intravascular :fluid, 60 energy, 72- 79
definition, 16 intravenous (IV) access, 341, 342 general principles, 72
as disease, 16-17 intravenous fluids, 483 kinetic energy, 73
EMS King LT airway, 206-208
warming, 240 Kocher, Emil Theodor, 102
community-wide interventions, 28 intravenous route, 237-238 kyphosis, 460, 462, 462f
one-on-one interventions, 27-28 intravenous solutions, 239-240
providers, 28-29 intrinsic causes of cardiogenic shock, 223 L
goal, 23 intubation, 280 Lactated Ringer's (LR), 146, 239, 443
Haddon Matrix, 17- 18, 18/ involuntary guarding, 369 Larrey, Dominique Jean, 7
intervention, opportunities for, 23 IO infusion. See intraosseous infusion Larrey period, 7
potential strategies, 23, 24/-25/ ionization, 534 laryngeal iltjuries, 276
public health approach, 26-27 ionizing radiation, 534 laryngeal mask airway (LMA),
strategy implementation, 23, 25-26
Swiss cheese model, 18-19, 19/ dose rates of, 537 17.V, 186-187, 186!, 187,
iltjwy process, 16 terrorism with, 535! 208-210, 657
Irtjury Severity Score (ISS), 153 ipsilateral pupil, 266 larynx, 150!, 164, 165!
inner perimeter, 658 Iraq, 108 late age, 457
insensible loss, 546 iris, 275 lateral compression fractures, 389, 389f
inspection, abdominal trauma, 368-369 irradiation, 534 lateral-impact collisions, 83-84
inspiration, 54(, 337/ irritant gas toxidrome, 523 law of conservation of energy, 73
instability, 387-393 ischernia, 266-267 laying the bike down, 90
integrated communications, 495 Le Fort fractures, types of, 275, 276/
integrated TEMS programs, 657 organ tolerance to, 54f Le Fort I fracture, 275, 276!
intelligence, 126 Le Fort II fracture, 275, 276f
intentional iltjury, 4, 19 ischernic sensitivity, 56, 218 Le Fort ill fracture, 275, 276!
intercostal muscles, 335 isotonic crystalloid solutions, 239, 434 left heart, 58
interdisaster period, 489 ISS. See Irtjury Severity Score legs, immobilization, 308
intermediate-range wounds, 106-107 LEMON assessment, for intubation,
Intermittent Mandatory Ventilation J 179f- 180f
J-wave, 575, 576f lethal triad, 572, 573!
(IMV), 189 jaundice, 129f Letterman, Jonathan, 7
internal-ear barotrauma, 611 Jennett, Bryan, 8 leukopenia, 535
internal hemorrhage, 225, 236, 386, 388
internal (cellular) respiration, 53, 168 joint dislocation deformities, 384!
interstitial fluid, 60
journals, for review, 44, 44f
jugular venous distension, 443

Index 697

Level A personal protective equipment, long-acting neuromuscular blocking mass-casualty incidents (MCis), 131,
512,513! agent, 283 492-493,664

Level B personal protective equipment, long bones, 381 res, 493-496
512,513! long-range wounds, 107 organization of, 496-497
lorazepam, 526
level B protection, 123 loss of consciousness (LOC), 439 NIMS, 493
Level C personal protective equipment, low-dose radiation exposure, 536 response, 488
low-energy weapons, 100 mass effect, 263, 265--266
512-514, 513! low explosives, 517 Mattox, Ken, 9
Level D personal protective equipment, lower airway, 164, 166 maxilla, 150!
lower respiratory tract, 165f MCis. See mass-casualty incidents
513!, 514 LR. See Lactated Ringer's Mcswain, N.E., 7
level of consciousness (LOC), 143, 169, LSTAT. See Life Support for Trauma and mean arterial pressure (MAP), 58, 263
mechanical energy, 16
170,227, 270,299 Transport mechanical ventilations, initial settings
Lewis,Frank, 9 lumbar vertebrae, 292
lewisite, 527 Lund-Browder chart, 413, 414{ for, 189-190
liaison officer, 496-497 lung toxicants, 526-527 mechanoreceptors, 337
Lichtenberg's :figures, 595, 596f lyophilized plasma, 63f, 221, 221!, 238 media, 506
lidocaine, for RSI, 183! mediastinal emphysema, 612
Life Support for Trauma and Transport M mediastinal structures, 339
maceration, 567 mediastinum,336, 336!
(LSTAT), 245 maculopapular rash, 531 medical arrest, wilderness, 646-647
life-threatening conditions, 479, 479f MADD. See Mothers Against medical history, 484
life-threatening injuries, 272 medical intelligence, 664
ligaments, 292, 382 Drunk Driving medical power of attorney (MPOA), 42
lightning injuries, 590-591 Madrid terrorist bombing (2004), 502! medications, 231, 467
magnesium, 522 medium-energy weapons, 100, lOlf
vs. high-voltage electrical injuries, 593f main bronchi, 166 medulla, 261
assessment, 595--596 mainstem bronchus, 165! meninges, 260
epidemiology, 591 mainstream technique, 191 meningitis, 273
management, 596 Mallampati classifications, 179f mental status, altered, 301
mechanism ofinjury, 591-593 maltreatment, categories of, 471-472 metabolic heat production, 545
minor injury, 594 mammalian diving reflex, 602 metabolism, 55--56
moderate injury, 594-595 mandible, 150! methemoglobin, 420
myths/misconceptions, 597! mandibular fractures, 275--276 Metropolitan Medical Response System
prevention, 596 mangled extremity, 399, 399!
safety guidelines, 598! mannitol, 283 (MMRS), 501
severe injury, 595 manual in-line stabilization of midazolam, 184!, 526
signs, symptoms, and treatment, 594{ middle-ear squeeze, 611
survivors of, 598! head,303 midface fractures, 275
lightning safety guidelines, 598! manually triggered (oxygen-powered) MIEMS. See Maryland Institute of
Lilly kit, 420
limb pain (type I DCS), 614 devices, 188-189 Emergency Medical Services
limited scene intervention, 146 MAP. See mean arterial pressure mild cyanide poisoning,
liquefaction necrosis, 424 mark-1 kit, 526
liquids, 522 Maryland Institute of Emergency Medical symptoms of, 524
living will, 42 Miles, A.B., 7
LMA. See laryngeal mask airway Services (MIEMS), 5 miliaria rubra, 549
LOC. See level of consciousness; loss of Masimo prehospital carbon monoxide military, PHTLS in, 11
minimal response, initial fluid bolus, 244
consciousness monitor, 420f minor injury, lightning injuries, 594
localized cutaneous cold injury, 567 mask squeeze, 611
logistics section, 497 masks, 130 minute ventilation 01J ,339f
logistics section chief, 497 MASS, 499
logroll, 316-319 minute volume, 167


miosis, 525 muscular system, 336/ National Association of Emergency
mitigation,490 musculoskeletal iltjuries, 230 Medical Technicians (NAEMT),
MMRS. See Metropolitan Medical musculoskeletal trauma, 378--405 9,656

Response System algorithm, 39Qf National Emergency X-radiography
mnemonics,525, 525/ amputation,395-397 Utilization Study (NEXUS), 640
moderate iltjury, lightning iltjuries, anatomy/physiology, 381-382
assessment,382-385 National EMS Advisory Council
594-595 associated iltjuries, 385 (NEMSAC), 22
modern era, of prehospital care, 8-9 compartmentsyndrome,397-398
modular organization, 495 critical multisystem trauma National Fire Incident Management
moist skin, 143 System (IMS), 125
Mongolian blue spots, 45lf patient, 393
monitoring and reassessment, 156 crush syndrome, 398-399 National Fire Protection Association
Monro-Kellie doctrine, 265, 266/ dislocation, 392-393, 393/ (NFPA), 117-118
Morando, Rocco, 8 extremities, 385/
morphine, 394 femur fractures, 391 National Highway Traffic Safety
Mothers Against Drunk Driving fractures,387-393 Administration (NHTSA), 86
(MADD) , 4 kinematics, 382-383 National Incident Management System
motor function, 384 lower extremities, 385/ (NIMS), 126, 128/,493,511
motor vehicle crashes (MVCs), 79-88 mangled extremity, 399
pain management, 393-394 National Registry ofEMTs (NREMT), 8
air bags, 87-88 pelvic fractures, 388-389, 389/ National Tactical Officers Association
frontal impact, 80-83 primary assessment, 383
lateral impact, 83-84 prolonged transport, 400 (NTOA), 656
motorcycle crashes, 88-90 relief of anxiety, 395 near-drowning,598
occupant protective and restraining secondary assessment, 383-384 neck, 149-150, 150/
sprain, 399 needle cricothyrotomy, 214-216
systems, 86-88 transport, 400 needle decompression
pedestrian iltjuries, 90-92 upperextremities,384/
rear impact, 83 myocardial hypertrophy, 460 need for, 66lf
rollover, 85-86 myoglobin, 398 of thoracic cavity, 346-347, 347/
rotational impact, 84-85 needle thoracostomy, 346-347
seat belts, 86-87 N neglect, 472/
three collisions, 79 NAEMSP. See National Association of NEMSAC. See National EMS Advisory
vehicle incompatibility, 86
motor vehicle iltjury prevention, Emergency Medical Service Council
Physicians nerve agents, 524-525
449--450 NAEMT. See National Association of
motorcycle crashes, 88-90 Emergency Medical Technicians decontamination from, 525/
narcotics, 311 nervous system, endocrine response, 61
angular impact, 89 nasal bone, 150/ neural arches, 291
ejection impact, 90 nasal cavity, 165f neurogenic shock, 63, 64{, 222-223,
head-on impact, 88-89 nasal fractures, 275
iltjury prevention, 90 nasopharyngeal airway (NPA), 173/, 177, 282,297
motorcycle deaths, 4 200-201,662 vs. spinal shock, 64/, 223f
MPOA. See medical power of attorney nasopharynx, 164, 165/ neurologic deficits, 290, 291, 299
MTWHF, 525 nasotracheal intubation, 181 neurologic examination, 152, 297
mucocutaneous exposures, 128 National Association of Emergency neurologic function, 384
mucosa! hypertrophy, 611 Medical Service Physicians decreased, 169-170
multisystem trauma patient, 138, 477 (NAEMSP), 656 neurologic stimuli, 294
muscarinic sites, 525 neuromuscular blocking agents, 281
muscle (heat) cramps, 549, 550/, 551 neurons,270
muscle fascia, 397-398 neutral in-line movement, 303
muscles of hwnan body, 382/ neutral in-line position ofhead, 306-307
neutral position, 435
neutralizing agents, for chemical

burns, 424
neutrons, 535
Newton's first law of motion, 73, 74, 98

Index 699

Newton's second law of motion, 73 management, 376 oxygen, 167, 18'lf
Newton's third law of motion, 73 spinal trauma, 309 diffusion of, 167!
NEXUS. See National Emergency obtunded, 662
obtunded children, 441 oxygen consumption, 53, 168
X-radiography Utilization Study occipital bone, 150! oxygen delivery, 53, 168
NFCI. See nonfreezing cold injury occipital lobe, 262f oxygen-powered devices, 188-189
NFPA. See National Fire Protection occlusive dressing, removal of, 346 oxygen saturation (Sp02), 190
Occupational Safety and Health oxygenation,53, 164,336
NFPA Standard 1561, 125 Administration (OSHA), 118 of trauma patient, 51, 53
NFPA Standard 1584, 564 oculomotor nerve, 261 oxygenation process, 168-169
nicotinic sites, 525 older age, 457
NIMS. See National Incident Management omentum, 373 p
omission, 158
System oncotic pressure, 59 packaging, 153
nipple level, 294 one-on-one interventions, EMS, 27-28 PaC02, 191
nitrogen, 613 OPA. See oropharyngeal airway pain management, 158, 393-394
nitrogen mustards, 425 open fracture, 387-391, 388!
no-delay trauma care period, 12 open globe, 275 patient assessment and
no harm principle, 484-485 open pneumothorax, 339, 343-345 management, 158
noisy ventilations, 270 operationssection, 497
nonaccidental trauma operations section chief, 497 pediatric trauma, 445
oral cavity, 165f painful injuries, distracting, 301
in children, documention of, 452! orbit, 150! palpation, 340
indicators of, 451/
nondepressed skull fracture, 273 trauma to, 274 abdominal trauma, 369-370
nonfreezing cold injury (NFCI), 567- 568 organ donation, brain death and, pancuronium, 185!
nonlethal penetrating injuries, 659 paper bag effect, 95, 96f
nonmaleficence, 40, 42 283-285 PAPR. See powered air-purifying
nonstandard tactical evacuation care organ failure, 67
organ tolerance to ischemia, 218, 218f respirator
vehicle, 663f oropharyngeal airway (OPA), 171, paradoxical motion, 342
nonsteroidal anti-infiarnmatory agents, 467 paradoxical pulse, 35lf
nonsteroidal anti-infiarnmatory drugs 173/, 197 paranasal sinuses, 150f
tongue blade insertion method, 199 parasympathetic nervous system, 61
(NSAIDs), 231 tongue jaw lift insertion method, parenchyma, 261
Norcuron, 185f paresthesia, 504
norepinephrine, 220 197- 198 parietal bone, 150f
normal saline (NS), 239, 443 oropharynx, 164, 165f parietal lobe, 262f
normal ventilatory rates, 281 orotracheal intubation, 181 parietal pleura, 336, 336f
nose, 150f orthostatic hypotension, 551 Parkland formula, 417
NPA. See nasopharyngeal airway osborne wave, 575, 576! partial-thickness burns, 409~10, 409f
NREMT. See National Registry of EMTs OSHA. See Occupational Safety and Pasadena kit, 420
NS. See normal saline passive fragmentation, 99
NSAIDs. See nonsteroidal anti- Health Administration passive strategies, 23
osmosis, 60, 60f patent, 139
infiarnmatory drugs osteomyelitis, 387 pathologic mechanisms, 265
NTOA. See National Tactical Officers osteophytosis, 462 patient assessment and management,
osteoporosis, 341, 462, 463
Association out-of-hospital medical order, 42 137-160
nuclear weapon, detonation of, 422 over the counter (OTC) medications, 467 ABCDE approach, 139-145
overdistension, with local injury, 612 abdomen, 151
0 overpressure phenomenon, 516 abuse, 158
obstetrical patient overtriage, 153 adjuncts, 145
overwhelming infection, 67 airway, 139
anatomic and physiologic changes, anatomic regions, assessing, 149-152
373-375 assessment algorithm, 147f

assessment, 375


breathing (ventilation), 140-141 PED. See pre-existing disease Pediatric Trauma Score (PTS), 439-441,
cervical spine stabilization, 139- 140 pedestrian injuries, 90-92 440!
chest, 150-151, 151/ pediatric, 440/
communication, 156 pediatric endotracheal intubation, 442/ pediatric verbal score, 439, 439/
disability, 143-144 Pediatric Glasgow Coma Scale (GCS) PEEP. See positive end-expiratory
expose/environment, 144-145
extremities, ] 52 score, 271, 272/ pressure
Field Triage Decision Scheme, 153-154 pediatric intraosseous infusion, 444f pelvic binders, 392, 394[
fluid therapy, 146 pediatric patients pelvic fractures, 366, 376, 388-389, 389!,
GCS, 143, 144, 144/
general impression, 139 blood pressure, 438/ 391-392
golden period, 137 causes of spinal injury in, 298 pelvic ring fractures, 388, 389, 389/
head, 149-150, 150/ fluid resuscitation, 417 pelvis, 151
hemorrhage control, 141 pulse rate for, 438! penetrating injuries, 299/
limited scene intervention, 146 ventilatory rates for, 436/ penetrating trauma, 76, 100, 103-105, 299
monitoring and reassessment, 156 pediatric trauma, 430-453
neck, 149- 150 abdominal injuries, 447, 447! abdomen, 105
neurologic examination, 152 abuse,421--422,449,450 abdominal trauma, 367
pain management, 158 airway, 435--436, 435!, 436!, 441--442 defined, 76
pelvis, 151 assessment,434--441 entrance and exit wounds, 102-103
perfusion, 142- 143 breathing,436-437,442--443 extremities, 105
primary survey (initial assessment), circulation, 437--439, 438!, 443-445 fragmentation, 102
CNS injury, 434 head, 103-104
138-145 common patterns of injury, 431, high-energy weapons, 100-102
priorities, 138 low-energy weapons, 100
prolonged transport, 158-159 43lf, 432! medium-energy weapons, 100
resuscitation, 145--146 demographics of, 430-431 profile, 98-99
SAMPLE history, 149 disability, 439, 439f shotgun wounds, 105--107
secondary survey, 146-152 expose/environment, 439 spinal trauma, 299
see, hear, feel, 146, 148-149 extremity trauma, 448 thoracic trauma, 339-340
simultaneous evaluation, 145 fluid therapy, 444--445 thorax, 104
terminology, 138/ h e m o r rhage,433--434 tumble, 99
transport, 146, 153 hypoxia, 433 percussion, 340
traumatic cardiopulmonary arrest, kinematics, 431 abdominal trauma, 370
motor vehicle injury prevention, percutaneous exposures, 128
156-158 percutaneous transtracheal ventilation
vital signs, 149 449--450
patient care, phases of, 40 pain management, 445 (PTV), 187,214-216
patient care report (PCR), 156, 484 pathophysiology, 432--434
patient, condition of, 36 Pediatric Trauma Score, 439-441, 440! perfluorocarbons (PFCs), 240
patient tracking, 493 prolonged transport, 450, 452 perfusion, 142-143,383-384
patient transport, shock psychosocialissues,431--432 pericardiocentesis, 351
recovery and rehabilitation, 432 periorbital bruising, 451!
management,237 secondary assessment, 441 periorbital ecchymosis, 273
patient triage, 514 spinal trauma, 446-447 periosteum, 259
Pavulon, 185! TBI, 445--446 peripheral nerve assessment
PC021 191 tension pneumothorax, 443
PCR. See patient care report thermal homeostasis, 431 of lower extremities, 385/
PEA. See pulseless electrical activity thermal injuries, 448-449 of upper extremities, 384!
peak overpressure value, 108 thoracic injuries, 447 peripheral nervous system (PNS), nerves
PEARRL, 144 transport, 445, 450, 452
pectoral muscles, 335 vascular access, 444 of, 294, 29'if
vital signs and quantitative norms, 440/ peristalsis, 375
peritoneal cavity, 363, 364!
peritonitis, 364
permanent cavity, 76

Index 701

pernio, 566--567 positive end-expiratory pressure (PEEP), prehospital care providers, 310!, 324-328,
personal protective equipment (PPE), 189, 190,281 511, 514

122, 123 positive-pressure ventilators, 189-190 safety, 657f
donning,528, 528f postcrash phase, 72 prehospital environment, 270
levels, 512-514, 513/, 523 posterior longitudinal ligaments, prehospital management, 421
radiologic disaster, 537 prehospital methods of
removal of, 532 292, 293!
removing,528,529! posteventphase, 5-7, 5f, 6f, 72 immobilization, 303
WMD events, 512 posttraumatic endophthalmitis, 275 prehospital pediatric
PFCs. See perfiuorocarbons posttraumatic stress disorder
phantom pain, 395! intubation, 443!
pharmacologically assisted intubation, (PTSD), 503
powered air-purifying respirator Prehospital Trauma Life Support
182-184 (PHTLS), 10-11,240,476
drugs used for, 184f- 185f (PAPR), 514
pharyngeal tonsil, 150! PPE. See personal protective assessment terminology, 138f
pharynx, 150/, 164, 165! ATLS, 9-10
phases, 72 equip men t international, 11
phosgene, 526 pralidoxime, 526 in military, 11
photophobia, 274 pralidoxime chloride, 525 phases of trauma care, 3-7
PHTLS. See Prehospital Trauma Life pre-eclampsia, 375 philosophy, 2-3
pre-event phase, 4-5, 72 trauma care in EMS, 7-9
Support pre-existing disease (PED), 459f vision for future, 11
physical activity guidelines, 560 pre-existing medical conditions, 231 prehospital volume resuscitation, 241
physician's order for life-sustaining precrash phase, 72 preload, 58
predisaster phase, 489 preoxygenation, 175
treatment (POLST), 42 preferences, 34 preparedness,490,505
physiologic reserve, 462 presbycusis, 461
physiologic thermoregulation, 545 principles vs., 34! presbyopia, 461
pia mater, 260 pregnancy, abdominal trauma, pressure immobilization technique,
PIO. See public information officer
pit vipers, 648 373-376 650-651, 650!
prehospital assessment of trauma prickly heat, 548, 549
envenomation, treatment of, 649-650 primary assessment
plague, 530-531 patient, 219
planning section, 497 prehospital care, 33-34, 279, 596 algorithm, 396!
planning section chief, 497 ofhead trauma
plaque, 460 critical thinking, 37-39, 37/, 38f
plasma osmolality, 61 to control biases, 39 airway, 270-271
plasma transfusion, 221 in data analysis, 39-40 breathing, 271
Platinum 10 Minutes, 483, 484 phases ofpatient care, 40 circulation, 271
pleural space, 336/, 339 in rapid decision making, 39 disability, 271-272
pneumonic plague, 530 expose/environment, 272
p ne umothorax, 3 39 , 6 1 3 ethics, 40 pediatric trauma, 434-435, 434!
PNS. See peripheral nervous system autonomy, 41--42 of shock
pocket masks, 188 beneficence,42--43 airway,225
POLST. See physician's order for justice, 43 breathing,225-227
nonmaleficence, 42 circulation, 227-228
life-sustaining treatment principles, 40 disability, 228-229
polytrauma, 477 expose/environment, 229
POPS. See pulmonary overinflation principles and preferences, 34-35 primary blast injuries, 108, 109/,
condition of patient, 36
barotrauma equipment available, 36-37 517-519, 519/, 521
portable pulse carbon monoxide fund of knowledge, 36 primary brain injury, 264
situation, 35-36 primary contamination, 523
monitors, 420 primary hypothermia, 571
r e s e a r ch , 4 3 primary prevention, terminology of, 17
EMS literature, reading, 43
evaluation, steps in, 44-45
evidence, types of, 43--44


primary swvey (initial assessment), pulmonary overpressurization syndrome rapid-sequence intubation (RSI), 182-184,
138-145 (POPS), 612 182f-183f, 443f

principles pulmonary system, thorax, 104 protocol, 281
ofmedical care, 34 pulmonary volumes/relationships, 339! RBCs. See red blood cells
vs.preferences,34f pulse, 227 RDDs. See radiation dispersion devices
and preferences, prehospital care, rear-impact collisions, 83
34-35 circulatory status, 142 rebound tenderness, 369
condition of patient, 36 pulse oximeters, 190-191, 190!, 225 recompression therapy, 616!
equipment available, 36-37 pulse oximetry, 145, 340 reconstruction phase, 489
fund of knowledge, 36 pulse pressure, 58 recovery, 490
situation, 35--36 pulse rate, vital signs of shock, 229 recovery phase, 489
pulseless electrical activity (PEA), red blood cells (RBCs), 50, 476
principlism, 40, 4lf reflective clothing, 117-118
privacy, 41 157,350 reflective cones, 118
prodrome (predisaster) phase, 489 pulseless ventricular tachycardia, 158 relative hypovolemia, 63, 297
profile, 98-99 pulselessness, 398 relief of anxiety, 395
prolonged transport, 158-159 pupil, 152f relief phase, 489
pupil constriction, 152! remote assessment, 660
airway management, 191-192 pupil dilation, 152f rescue, 489
cold-related illness, 583-584 pupillary inequality, 272 rescue throw lines, 603!
crew, 159 pyramidal fracture, 275 research, prehospital care, 43
equipment, 159 Q EMS literature, reading, 43
geriatric trauma, 472-473 quaternary blast injuries, 109!, 519!, 520 evaluation, steps in, 44-45
head trauma, 282- 283 quaternary effects, 520 evidence, types of, 43-44
heat-related illness, 582-584 quiescence or interdisaster period, 489 resource management, 496
high-altitude illness, 629-630 quinary blast injuries, 108, 109! respiration, 336
lightning injury, 629 respiratory rate, 140
musculoskeletal trauma, 400 R respiratory system, 164-166, 165!
patient, 159 Raccoon eyes, 45lf airway and, 50-54, 51f
pediatric trauma, 450, 452 radiation, 545 organs of, 165!
recreational scuba-related diving response, 490
exposure to, 422 response time, 5
injuries, 629 radiation burns, 422-423 resuscitation, 145-146
shock,244-245 radiation catastrophes, medical effects reticular activating system, 261
spinal trauma, 311 retroperitoneal space, 363, 365f
thoracic trauma, 356-357 of, 534-537 retroperitoneum, 271
prone/semi-prone patient, 318-319 radiation dispersion devices (RDDs), 534 reverse squeeze, 611-{)13
psychogenic "shock," 64 radiation energy, 16 Revised Trauma Score (RTS), 439
psychological response, to disasters, radiation exposure, treatment and rhabdomyolysis, 582
rhinorrhea, 525
503-504 decontamination for, 538f rib fractures, 341
PTS. See Pediatric Trauma Score radioiodine, 538 rifles, 105
PTSD. See posttraumatic stress radiologic disasters, 533-538, 534f rifling, 105
radionuclide, 533 right heart, 58
disorder RAM. See Rapid and Remote Assessment rigid cervical collars, 303-304
PTV. See percutaneous transtracheal
Methodology guidelinesfo~304:f
ventilation Rami fractures, 389
public health impact of injury, 21, 26-27 range, 105 rigid splints, 390!
public information officer (PIO), 497 Rapid and Remote Assessment rigor mortis, 646
PubMed, 44f Ringer's solution, 221
pulmonary contusions, 340, 342 Methodology (RAM), 660
pulmonary overinfl.ation barotrauma, rapid extrication, 324-328

612-613 vs. short device for seated patient, 309
rapid response, initial fluid bolus, 244

Index 703

riot control agents, 426 vehicle positioning and warning secondary impact syndrome, 277
risk factor identification, public health devices, 118 secondary prevention, terminology of,

approach, 27 violence, 118-119 17- 18
road traffic injuries, 3, 3f weather/light conditions, 117 secondary survey, 146--152
rocuroniUill, 185f WMD, 123 See, hear, feel, 146, 148-149
rollover, 85--86 scene assessment, 115-116, 511 seizures, 270
rotational-impact collisions, 84-85 scene control zones, 123 self-aid, 659
routine prophylactic hyperventilation, scene security, 506 self-contained breathing apparatus
Schwartz, Lew, 8
281 sclera, 274 (SCBA), 512
RSI. See rapid-sequence intubation scoop stretcher, 301, 302f self-contained underwater breathing
RTS. See Revised TraUilla Score scuba. See self-contained underwater
"ruggedized" IV securing system, 662 apparatus (scuba), 608
rule of nines, 413, 413!, 449 breathing apparatus self-dispatched assistance, 506
rule of palms, 413, 414[ scuba-related diving injuries, 608-621 Sellick maneuver, 183!
rule of ten for burn resuscitation, 417 semtex, 516
rural roads, 117 barotraUilla, 610-613 senescence, 458
Boyle's law, 610, 610! sensory function, 384
s DAN contact information, 615! sepsis, 364
DCS, 613-614 septic shock, 64, 64f
sacral vertebrae, 292 epidemiology, 608-609, 609f sequelae, 503
sacrurn,292,293 fitness to dive, 616, 618, 619f-620f, 620 sesarnoid bones, 381
safe zone, 658 flying after diving, 621 severe acute respiratory syndrome
safety officer, 496 Henry's law, 610
SAH. See subarachnoid hemorrhage management, 615 (SARS), 510-511
SALT, 499 mechanical effects of pressure, severe tachypnea, 141
SAMPLE history, 149, 340 sharps injury, 130, 130!
sandbags,308 609-610 shear, 79
SAR. See search and rescue; supplied air prevention, 615-616
recompression therapy, 616f abdomen, 97-98
respirator units ofpressure, 610f head, 94
sarin, 524 search and rescue (SAR), 493, 498 neck, 95
SARS. See severe acute respiratory team, 639, 641 thorax, 96--97
seat belt sign, 447f shear forces, 366
syndrome seat belts, 86--87 shear injury, 383
SBP. See systolic blood pressure Second Battle of Bull Run, 7 shear wave, 517, 517f
scalp injuries, 273, 273! second death peak, 638 shivering, 545
SCBA. See self-contained breathing second-degree burns, 409-410, 409! shock, 54-55,335, 477!
second-degree frostbite, 569 algorithm for managing, 243!
apparatus secondary assessment anatomy of, 57-61
scene, 114-134 burn injuries, 413-414 assessment, 224-225
of head traUilla, 272-273
blood-borne pathogens, 128-130 pediatric traUilla, 441 confounding factors, 230-231
command structure, 125-126 of shock, 229-230 musculoskeletal injuries, 230
crime, 121- 122 secondary blast injuries, 109!, 519, 519f primary, 225-229
decontamination, 123 secondary bombs, 125 secondary,229-230
hazardous materials, 119-121, 123 secondary brain injury, 264 cellular perfusion and, 57
highway design, 117 extracranial causes of, 269-270 complications, 65-67
IAPs, 126 intracranial causes of, 265-269 definition of, 219
reflective clothing, 117-118 secondary contamination, 523 management, 231
scene control zones, 123 secondary drowning, 598 airway, 232
secondary devices, 123-125 secondary hypothermia, 571 breathing, 232
standard precautions, 129 disability, 237
traffic safety, 116--117 expose/environment, 237
triage, 130-134


hemorrhage control, 232-236 smallpox,531-532,531/ spinal cord anatomy, 293-295
patient transport, 237 differentiating chickenpox from, 532/ spinal cord injuries, 296-297, 434
vascular access, 237-238 spinal cord tracts, 293, 293/
volume resuscitation, 23&-244 smallpox vaccination program, 532 spinal cord transection, 296
pathophysiology of, 57-61 smoke inhalation, fluid management, 417 spinal immobilization, 301
physiology of, 55-57, 21&-219 smoke inhalation injuries, 419-421
prolonged transport, 244-245 snakebite, 648-651 indications for, 298!, 299-301, 300!
traumatic sniffing position, 435, 435/ spinal movement precautions, 311
classification of, 219 snow blindness, 567 spinal pain/tenderness, 299
types of, 219-224 soft-tissue injuries, 383-384 spinal shock, 296
types,61 SOFTI'. See Special Operations Force
cardiogenic shock, 64-65 neurogenic shock vs., 64.f. 223/
distributive (vasogenic) shock, Tactical Tourniquet spinal stenosis, 463
solar keratitis, 567 spinal trauma, 289-312
63-64 solid density, 76
hemorrhagic shock, 61-63, 62f solid organ injuries, nonoperative anatomy and physiology, 291-295
hypovolemic shock, 61 assessment,297-301
shock front, 108 management of, 368/ athletic equipment removal, 307/
shock wave, 108, 516, 517/ span of control, 495 backboard debate, 305-306
short bones, 381 Special Operations Force Tactical blunt trauma, 29&-299
short device for seated patient, rapid cause of, 290
Tourniquet (SOFTI'), 234 cervical collar, 303, 315-316
extrication vs., 309 special weapons and tactics (SWAT) children,307,328-329, 446-447
shotgun wounds common immobilization mistakes, 309
team, 656 completing the immobilization,
assessment of, 107 specific skills (airway and ventilation),
categories of, 105-106 307-309
close-range wounds, 106 195-216 evaluating immobilization skills, 310/
contact wounds, 106 alternate trauma jaw thrust, 196 immobilization of torso to board
intermediate-range wounds, 106-107 bag-mask ventilation, 202-203
long-range wounds, 107 face-to-face orotracheal intubation, device, 304-305
side flash, 591 immobilizing the patient,
simple adjuncts, 177 212-213
simple pneumothorax, 343 laryngeal mask airway, 20&-210 principles, 303
simulations, 505 nasopharyngeal airway, 200-201 indications for spinal immobilization,
simultaneous evaluation, 145 needle cricothyrotomy and
single command, 494 298.f. 299-301, 300/
single-system trauma patient, 138 percutaneous transtracheal management, 301-311
sinus squeeze, 611 ventilation, 214-216 manual in-line stabilization ofhead, 303
sitting immobilization, 320-323 oropharyngeal airway, 197-199 mechanism of injury, 296, 29&-299
situation, prehospital care, 35-36 supraglottic airway, 203-208 neurologic examination, 297
skeletal injuries, 295-296 trauma chin lift, 197 neutral in-line position of head, 306-307
skin, 143, 407-408, 408.f. 463, 544-545 trauma jaw thrust, 195 obese patients, 309
skin bends, 614 visualized orotracheal intubation pathophysiology, 295-297
skin color, 143, 228 of the trauma patient, penetrating trauma, 299
skin quality, 228 210-212 pregnant patients, 310
skintemperature,228 specific skills (spinal trauma), 315-333 prolonged transport, 311
skull, 149, 150/ cervical collar, 315-316 rapid extrication vs. short device for
internal view of, 260! child immobilization device, 32&-329
skull fractures, 273, 274{ helmet removal, 330-331 seated patient, 309
sleep deprivation, 22 logroll, 316-319 rigid cervical collars, 303-304
slugs, 105 rapid extrication, 324-328 scientific concepts, 290
sitting immobilization, 320-323 signs and symptoms of, 301/
vacuumsplintapplication,331-333 skeletal injuries, 295-296
SPF. See sun protection factor spinal cord injuries, 296-297
"spider web" pattern, 270 steroids, 310-311
spinal cord, 614 transport, 311

Index 705

spine board immobilization in submersion incidents, 599-608 tactical casualty care (TCC), 656
water, 601! assessment,604, 607! Tactical Combat Casualty Care
spinous process, 291 epidemiology, 599-600 (TCCC), 656
splash contact, 591 factors to consider, 600 course, 645
splinting, 390-391, 390f-39lf management, 604-606, 605!, 607! guideline,657, 658, 658!
sport drinks, 558! mechanism ofinjury, 601-602 Tactical Combat Casualty Care
sport utility vehicle (SUV), 86 patient resuscitation, 606
sports injuries, 93 predicators ofsurvival, 603 Committee (TCCC), 37
sprain, 399 residential pools, 608 tactical emergency medical support, 657
spray, 105 surviving cold-water submersion, Tactical Emergency Medical Support
spread, 105 601-602
squeeze, 610 water rescue, 602-603,603! (TEMS), 656
St. Petersburg Declaration of tactical evacuation care, 37, 658f
suboptimal restraint, 450 tactical field care, 37, 658!, 660-663, 660!
1868, 102 Succinylcholine, 185f tactile intubation, 186
staging area, 496 sucking chest wound, 343 target vehicle, 83
Standard on Emergency Services suctioning, 175-176 TBis. See traumatic brain injuries
sulfur mustard, 425, 527 TCC. See tactical casualty care
Incident Management, 125 sun protection factor (SPF), 642-644 TCCC. See Tactical Combat
standard precautions, 129 sunburn, 642, 643
standard splash-resistant suit, 537 superficial burns, 409, 409f Casualty Care
Starling's law, 58 superficial frostbite, 569 tear gas, 426
START triage algorithm, 499 superior vena cava, 338 Teasdale, Graham, 8
status epilepticus, 270 supine hypotension, 374-375 temperature balance, 545-546
stay and play period, 12 supine patient, 316-318 temporal bone, 150!
steady-state metabolism, 545 supplied air respirator (SAR), 512 temporal lobe, 262!
stellate (starburst) wound, 103 supportive therapy, 524 temporary cavity, 76
step voltage, 593 supraglottic airways, 177-178, 177!, 203 TEMS. See Tactical Emergency
stepped breaths, 202
sternum, 150, 151f combitube, 203-205 Medical Support
steroids, 310-311 king LT airway, 206-208 tendon, 382
Stewart, Ronald, 476 surgical cricothyrotomy, 187-188 tension pneumothorax, 65, 66!,
stipple, 105 surveillance, public health approach,
stopping distance, 74 223-224, 224!, 339, 343-346,
Storm Data, 591 26-27 344f-346f, 437, 443
stress waves, 517, 517! susceptibility, 17 tension wave, 517f
stress, workers, signs of, 504 sutural bones, 381 tentorial incisura, 230, 261
stride voltage, 593 SUV. See sport utility vehicle tentorium cerebelli, 261
stroke volume, 58 SWAT team. See special weapons and terrorism, 502
subarachnoid bleeding, 279 tertiary blast injuries, 109!, 519-520, 519!
subarachnoid hemorrhage (SAH), tactics team tertiary prevention, terminology of, 18
thermal energy, 16
279-280 Swiss cheese model, 18-19, 19! thermal equilibrium, 545
subconjunctival hemorrhage, 274 thermal gradient, 545
subcutaneous emphysema, 340, 346!, sympathetic nervous system, 61 thermal homeostasis, 431
synthetic colloid solutions, 239-240 thermal injuries, 448-449
612-613 systemic vascular resistance, 58 thermal trauma, 543
systolic blood pressure (SBP), 58, thermite, 522
subcutaneous laye~408,408f thermoregulation, 545-546
263, 439 thermoregulatory center, 545
subdural hematoma, 260, 278-279, 278! third death peak, 638
subjunctival hemorrhage, 274, 274! T third-degree burns, 409, 410, 410!
sublimation, 523 third-degree frostbite, 569
Sublimaze, 184 tabletop exercises, 505 thoracic injuries, children, 447
subluxation, 295 tachycardia, 220
tachypnea, 141,436


thoracic trauma, 334-361 toxemia of pregnancy, 375 trauma patient
anatomy,335-336 toxidrome, 523 oxygenation and ventilation of,
assessment, 340-341 toxin-induced lung injury, 421 51, 53
blunt cardiac injury, 349-350 trachea, 150f, 336, 336! visualized orotracheal intubation of
blunt force injury, 340 tracheal deviation, 346! the,210-212
cardiac tarnponade, 350-351, 350! tracheal or bronchial rupture, 354!
circulation, 338-339 tracheal shift, 339 trauma response algorithm, 485!
cornrnotio cordis, 351-352 tracheobronchial disruption, 354-355 traumatic aortic disruption,
diaphragmatic rupture, 355-356 traction splints, 390f, 391
flail chest, 341-342 352-354
hemothorax, 349 for femur fractures, 403-405 traumatic arrest, wilderness, 646
needle decompression of thoracic traffic delineation devices, 118! traumatic asphyxia, 355, 356/
cavity, 346-347 traffic safety, 116--117 traumatic brain injuries (TBls), 227,
pathophysiology, 339-340 tranexarnic acid (TXA), 244
penetrating injury, 339-340 transesophageal echocardiography, 352 259, 268
physiology, 336-339 transient response, initial fluid bolus, 244 management of suspected, 284/
pneumothorax, 339 transmission-based PPE, 528 pediatric trauma, 445-446
prolonged transport, 356-357 transmural pressure, 232 traumatic cardiopulmonary arrest,
pulmonary contusion, 340 transport, 153
rib fractures, 341 156--158
tracheobronchial disruption, 354-355 burns, 414, 415/ traumatic rhabdomyolysis, 398
transport, 356--357 communication with receiving traumatic shock
traumatic aortic disruption, 352-354
traumatic asphyxia, 355, 356! facility, 484 classification of, 219
tube thoracostomy, 347-348 disaster management, 501 types of, 219-224, 219/
ventilation, 336-338 duration of, 154 traumatic subarachnoid hemorrhage
environmental trauma, 582-584
thoracic vertebrae, 292 geriatric trauma, 472-473 (tSAH), 280
thoracoabdomen,363 golden principles of prehospital care, treatment area, 503
thoracostomy, 335 trench foot, 567
three-dimensional reconstruction 482-483 Trendelenburg position, 237
intravenous fluid, 483 triage, 131
of depressed skull fracture, medical history, 484
273,274! method of, 154 disastermanagement, 499,499!
3-3-2 rule, 179! musculoskeletal trauma, 400 explosions and WMD, 514
thyroid gland, 150! pediatric trauma, 445, 450, 452 field triage scheme, 153-154
tidal volume (VT), 167, 339! primary survey, 145 scene, 130-134
tissue densities, 76 spinal trauma, 311 triage and initial stabilization,
tissue hypoxia, 266 thoracic trauma, 356-357
TLC. See total lung capacity transportation, head trauma, 282-283 493, 499!
tongue, 150f, 165! transverse processes, 291 Triage Decision Scheme, 153-154
tongue blade insertion method, 199 trauma, 2 triage officer, 499
tongue jaw lift insertion method, 197-198 cause of death, 2 triage systems, 514
tonsil, 165! in EMS, 7-9 Trunkey, Donald, 5, 9
tonsillar herniation, 265 event phase, 5 truthtelling,41-42
tooth squeeze, 611 Golden Hour, 5 tSAH. See traumatic subarachnoid
total lung capacity (TLC), 339! postevent phase, 5-7, 5f, 6f
tourniquet, 659 pre-event phase, 4-5 hemorrhage
tourniquet application, protocol for, 236! preparation, 5 tube thoracostomy, 347-348, 348!
tourniquets, 142, 234-236, 644,644/ thermal, 543 tumble, 99
tow device, 603! trauma chin lift, 173, 173f, 175, 197 turbinates, 150f, 165!
trauma jaw thrust, 173, 173f, 195 2-PAM chloride, 525
alternative, 196 two-provider method, 202- 203
2004 Madrid terrorist bombing, 502!
TXA. See tranexarnic acid
tyrnpanic membrane rupture, 108-109
type I DCS, 614, 618f
type II DCS, 614, 618/

Index 707

u ventilation, 164, 167,336-338.Seealso w
airway and ventilation
ultraviolet (UV) rays, 642--643 wadding, 105
umbilicus level, 294 rapid evaluation of, 437 walking wounded, 499
uncal herniation, 265 of trauma patient, 51, 53 warm zone, 120, 12lf, 123, 425!, 512f,
uncontrolled hemorrhage, 241 ventilation skills, airway management
uncus,265 514,658
undertriage, 153 and, 195-216 warning phase, 489
unequal pupils, 152! ventilatory devices, 188-190 Warren, John Collins, 218
unified command, 494 ventilatory rate, 225 water density, 76
unified command system, 125 water intoxication, 550!. 555
Uniform Crime Report of the airway management, 140 water rescue, 602-603, 603!
levels, 140--141 waveform capnography, 340--341
Federal Bureau of Investigation vital signs ofshock, 229 WBCs. See white blood cells
(FBI), 656 ventral root, 294 WBGT index. See wet-bulb globe
unintentional i.r\jury, 4, 4J, 19 ventricular fibrillation, 158
unity of command, 495 Versed, 184, 526 temperature index
unstable spinal column i.r\jury, 296 vertebrae, 291 weapon of mass destruction (WMD),
up-and-over path, 80-81 vertebral anatomy, 291-293
upper airway, 164 vertebral column, 291-293, 292! 122-123, 488,502,510
sounds, 171 vertebral foramen, 291 agents, classification of
upper respiratory tract, 165f vertical shear fractures, 389, 389!
upward streamer, 593 very high altitude, 622 biologic, 527!
urinary catheter, 159 vesicant agents, 527 scene of, 512!
U.S. Food and Drug Administration vesicants, 425 weather/light conditions, 117
(FDA), 236, 524 vestibular folds, 164 wet-bulb globe temperature (WBGT)
uvula, 165! vestibular nuclei, 266
violent scene, 118-119 index, 560
v viral hepatitis, 128 wet drownings, 601
viscera, 373 white blood cells (WBCs), 59
vacuum mattress splint, 301, 302! visceral pleura, 336 white phosphorus (WP), 425, 522
vacuum splint, 391! visualized orotracheal intubation, of WHO. See World Health Organization
vacuum splint application, whole-body exposure, 535
trauma patient, 210--212 wilderness trauma care, 635-651, 637/
331-333 vital signs. See also individual
Valium,526 backboard use, 642
valvular disruption, 65, 223 component parts bee sting, 647-648
valvular rupture, 350 cervical spine, 639--640
vapor, 522 pediatric trauma, 440! CPR, 646
varicella, 531, 532! dislocations, 646
variola major, 531 secondary assessment ofshock, elimination needs, 641
variola minor, 531 229--230 food and water needs, 642
vascular access, 444, 662-663 function and cosmesis, restoration of,
secondary survey, 149
shock management, 237-238 vitreous humor, 275 645-646
vascular system, thorax, 104-105 vocal cords, 164, 166f hemostasis, 644
vasoconstriction,61, 169,220 volatility, 523 improvised evacuations, 640--641
vasogenic shock. See distributive shock volume resuscitation, algorithm for infection, prevention of, 644-645
vasovagal "shock," 64 i.r\jury patterns, 638
vecuronium, 185! managing, 244{ medical arrest, 646-647
vehicle incompatibility, 86 volume resuscitation, shock management safety, 638-639
vehicle positioning and warning snakebite, 648-651
blood, 238 sun protection, 642-644
devices, 118 intravenous solutions, 239--240 traumatic arrest, 646
venous bleeding, 141 managing, 240--244 wound management, 644
tranexamic acid, 244 wind chill index, 581!
voluntary dehydration, 548 WMD. See weapon of mass destruction
voluntary guarding, 369


work of breathing, 339! y zone of hyperemia, 408f, 409
worker stress, 504 zone ofstasis, 408, 408!
World Health Organization (WHO), years of potential life lost (YPLL), 21 zones of fire, 659, 660
Yersinia pestis, 530 zones of operation, 658
datafor road traffic zygomatic bone, 150f
iI\jUiies, 3, 3f z
wound botulism, 533
WP. See white phosphorus Zemuron, 185!
zone of coagulation, 408, 408!

Index 709

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