EMTs and Paramedics provide emergency care for a wide range of injuries and illnesses—from minor wounds and fractures, allergies and headaches, to traumatic injuries, cardiac arrest, seizures, and stroke.
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In most cases, EMS providers will have some idea of what conditions they will encounter before they get there, but quite frequently, they do not. Sometimes the caller does not clearly or accurately describe the emergency. Other times the caller reports a general situation, such as a traffic accident, which could include any number of medical problems including severe wounds, broken bones, fractures, burns, intoxication, cardiac arrest, brain damage and more.
This article identifies the most common emergencies that EMTs and Paramedics treat and offers a detailed description of the treatments involved for some of the most common emergency situations.
What Injuries & Illnesses Do EMS Providers Most Commonly Treat?
The National Emergency Medical Services Information System (NEMSIS), a national EMS database, provides us a glimpse into the nature and frequency of most 911 EMS calls. According to NEMSIS the most frequent conditions that EMS providers respond to (as determined by the EMS providers) are as follows:
|Injury / Illness||Frequency|
|1. Traumatic injury||21.4%|
|2. Abdominal pain / problems||12.3%|
|3. Respiratory distress||12.2%|
|4. Chest pain / discomfort||10.1%|
|5. Behavioral / psychiatric disorder||7.8%|
|6. Loss of consciousness / fainting||7.7%|
|7. Altered level of consciousness||6.9%|
|9. Poisoning / drug ingestion||3.5%|
|10. Diabetic symptoms (hypoglycemia)||2.5%|
|11. Stroke / cerebrovascular accident (CVA)||2.0%|
|12. Cardiac rhythm disturbance||1.9%|
|13. Cardiac arrest||1.8%|
If you are a current or aspiring EMT professional, continue reading to learn more about each of these common medical emergencies and how they are often treated by medical first responders.
1. Traumatic Injury (21.4%)
Traumatic injury is a term used to describe physical injuries of sudden onset and severity that require immediate medical attention. Traumatic injury kills more people between the ages of 1 and 44 than any other disease or illness. According to the American Trauma Society, 100,000 Americans of all ages die from trauma each year.
What Is Traumatic Injury?
Traumatic injury is a sudden and severe injury which may require immediate medical attention.
Trauma is defined as an injury caused by a physical force; examples include car accidents, falls, drowning, gunshots, burns, stabbings, or other physical threats. Major trauma is any injury that can cause prolonged disability or death. Blunt trauma occurs when a body part is damaged, either by impact, injury, or physical attack. Penetrating trauma occurs when an object pierces the skin and enters a tissue of the body, creating an open wound. The injury may also cause systemic shock or “shock trauma” which may require immediate resuscitation and intervention.
EMT Treatment for Traumatic Injury
Many traumatic injuries can be treated in hospital emergency departments. More severe traumatic injuries may be triaged by EMS providers (EMTs and paramedics) as a Trauma Alert. A Level One Trauma Alert is based on a rapid physical assessment of the victim’s immediate medical needs. Based on trauma alert criteria, first responders deliver the patient to the most appropriate hospital.
2. Abdominal Pain (12.3%)
Abdominal pain has many potential causes. The most common causes—which include gas pains, indigestion, and pulled muscles—are usually not serious. Other conditions, however, can be painful, debilitating, or even life-threatening, and require urgent medical attention.
What Is Abdominal Pain?
Abdominal pain is a common complaint, accounting for up to 10% of emergency department visits. Abdominal pain can be associated with a variety of symptoms, including nausea, vomiting, fever, diarrhea, dark stools (melena) and urinary symptoms. Abdominal pain could be a symptom of appendicitis, biliary colic, cholecystitis, diverticulitis, intestinal obstruction, pancreatitis, renal colic, or abdominal aortic aneurysm.
EMT Treatment for Abdominal Paid
Assessment of abdominal pain should begin before physical contact is made with the patient.
When EMTs arrive on the scene, they must assess several factors to determine the best course of action. Most importantly, they must consider their patients’ overall appearance. Are they conscious? Are they complaining about abdominal pain or guarding their abdomen? Is the patient in the fetal position? Is the patient’s skin pink, pale, cyanotic (blue or purple), ashen or gray? Are there clues on scene that could explain the condition, such as prescription bottles?
For an EMT, a complete treatment would include assessment, obtaining the patient’s medical history, careful examination, including auscultation (listening for sounds with a stethoscope), palpation, and tapping.
3. Respiratory Distress (12.2%)
Respiratory distress (or shortness of breath) can be a serious condition or symptom. Differentiating between the many causes of respiratory distress is not easy and requires clinical knowledge, diligence, and attention to detail.
What Is Respiratory Distress?
Respiratory distress can be primary or secondary. Primary means there’s something wrong with the lungs. Secondary means there’s a problem somewhere else in the body and the lungs are compensating.
Possible primary problems include anaphylaxis, asthma, COPD, pleural effusion, pneumonia, pneumothorax, and pulmonary edema. Possible secondary problems include diabetic ketoacidosis, head trauma, metabolic acidosis, stroke, sepsis, and toxicological overdose.
EMT Treatment for Respiratory Distress
For respiratory distress, the focus is on the lungs and auscultation (listening for sounds from the lungs, heart, and other organs) is key to the assessment.
For example, coarse, thick crackles in the lungs can indicate mucus or infection. “Gurgling” sounds can indicate edema. Wheezes may suggest bronchoconstriction, possibly from asthma or COPD.
An EMT’s assessment may include a physical exam, incident history, and vital signs before deciding the next step in treatment and transport of their patient.
4. Chest Pain (10.1%)
Chest pain takes on many different forms, depending on the cause. A chest pain can be a sharp stab to a dull ache. Sometimes chest pain feels “crushing,” “burning,” or “aching”. In some cases, the pain travels up the neck, into the jaw, then radiates to the back or down the arms.
What Is Chest Pain?
Many different problems can cause chest pain. The most life-threatening causes involve the heart or lungs. The causes can include heart problems, including heart attack or cardiac arrest. It can also result from lung problems including pleuritis, pneumonia, pulmonary embolism, or lung abscess. Gastrointestinal problems, such as acid reflux or esophageal hypersensitivity can also cause chest pain. Still other causes include pancreatitis, gallbladder problems, muscle strain, shingles, and anxiety.
EMT Treatment for Chest Pain
The first step with chest pain is to rule out a cardiac event.
If it is a serious cardiac event, such as heart attack, an EMT may begin prehospital treatment and transport immediately. If it is not a cardiac event, they may continue their assessment by trying to identify a working diagnosis. The assessment could include a physical exam, incident history, and vital signs. A clear diagnosis is essential when determining the best plan for emergency care and transport to the nearest hospital.
5. Behavioral Disorder (7.8%)
Many behavioral disorders, such as violent patient outbursts, are due to an underlying medical problem. Metabolic derangement, like low or high blood sugar, can lead a patient to lash out or resist EMS treatment. In fact, a frequent challenge for EMS providers is to differentiate between alcohol intoxication and a diabetic emergency.
What Is Behavioral Disorder?
A behavioral (or psychiatric) order is a behavioral or mental pattern that causes significant distress or physical impairment. These patterns may be persistent, relapsing, and remitting, or they may occur as a single episode.
Many behavioral disorders can be identified, with signs and symptoms that vary widely between specific disorders. Common mental disorders include depression, bipolar disorder, dementia, schizophrenia, and other psychoses.
EMT Treatment for Behavioral Disorder
EMS providers are sometimes assaulted, punched, kicked, and spit at by patients with behavioral disorders. This may also often occur when responding to intoxicated patients. For this reason, the use of physical restraints may be necessary.
For patients who are hallucinating, have suicidal tendencies, or who are angry and combative, the recommended steps for treatment include taking precautionary safety measures, searching for underlying medical causes, relaxing the patient’s environment, all while remaining calm and patient. In these situations, EMS providers will try their best to hold an open and honest conversation with their patient to gather as much information as possible to share with the rest of their medical team. With this information, EMTs will have a better chance of accurately diagnosing and treating their patients while transporting them to the closest healthcare facility.
6. Loss of Consciousness (7.7%)
Syncope (pronounced sin ko pea) is the medical term for loss of consciousness (or fainting). Syncope is usually caused by a temporary drop in blood-flow to the brain.
Fainting is common and it is often caused by a benign condition, however, it can also be the sign of a life-threatening condition. For example, adults, over the age 80, who present with syncope are at a greater risk of hospitalization and death.
What Is Loss of Consciousness?
There are several conditions that may cause loss of consciousness or syncope.
- Vasovagal syncope is a sudden drop in blood pressure.
- Situational syncope is caused by certain situations affecting the nervous system, including dehydration, intense emotional stress, anxiety, and the use of alcohol or drugs, among others.
- Postural syncope is caused by a sudden drop in blood pressure due to a quick change in position, such as getting up quickly after laying down.
- Neurologic syncope can be caused by neurological conditions, such as seizure, stroke, or transient ischemic attack (TIA).
- Postural Orthostatic Tachycardia Syndrome (POTS) is caused by a fast heart rate (tachycardia) that happens after a person stands up after sitting or lying down.
EMT Treatment for Loss of Consciousness
Prehospital management of syncope includes a variety of acute treatments and rapid assessment of airway, breathing, circulation, and neurological status.
EMT treatment may require IV access, oxygen administration, advanced airway techniques, glucose administration, pharmacologic circulatory support, and defibrillation, among others.
7. Altered Level of Consciousness (6.9%)
Altered level of consciousness (ALOC) is often a subtle condition that is difficult to recognize. In fact, patients with an altered level of consciousness can be among the toughest to assess since there is no standard presentation of symptoms. Furthermore, the symptoms that are associated with this condition can be tied to a wide range of possible diagnoses.
Despite these challenges, EMS providers who follow a structured approach can often diagnose patients who are suffering from ALOC.
What Is Altered Level of Consciousness (ALOC)?
An altered level of consciousness is any abnormal measure of arousal.
Level of consciousness (LOC) is a measurement of a person’s responsiveness to environmental stimuli.
- A mildly depressed level of consciousness or alertness is considered lethargy; in this state the patient can be aroused with little difficulty.
- Patients who are slightly less alert than normal and cannot be fully aroused, are considered obtunded.
- Those who cannot be aroused from a sleep-like state are said to be stuporous.
- Coma is the inability to make any purposeful response.
Scales such as the Glasgow coma scale are used to measure the level of consciousness.
EMT Treatment for Altered Level of Consciousness
When a patient is not oriented to time, place, or person, they may be suffering an altered level of consciousness.
A successful patient treatment includes first treating any immediate life threats. After ensuring the patient’s immediate safety, EMTs may perform a detailed physical exam, searching for the underlying cause of their patient’s ALOC. They may also interview multiple sources on the scene for information about their patient’s health or medical history. Another important element of the EMT response plan includes may include an assessment of the patient’s environment:
- Where is the patient?
- In what position?
- What are they wearing?
- What objects surround them, such as liquor bottles, medications, or needles?
To the greatest extent possible, EMS providers will treat this condition using all their available tools and resources, while transporting the patient to the nearest hospital for definitive care.
8. Seizure (4.7%)
While seizures may take several forms, EMS providers are most often called when a patient experiences a generalized convulsion or complex partial seizure that produces altered awareness and confused behavior.
Epilepsy is one of the most common causes of seizures, affecting about 3 million Americans.
What Is a Seizure?
A seizure, or epileptic seizure, is a series of symptoms cause by excessive brain activity. These symptoms can include uncontrolled shaking movements involving much of the body with loss of consciousness (tonic-clonic seizure), shaking movements involving only part of the body with variable levels of consciousness (focal seizure), or a subtle momentary loss of awareness (absence seizure). Most of the time, these episode last less than 2 minutes. Loss of bladder control may also occur.
Seizures may be provoked and unprovoked. Provoked seizures are due to a temporary event including low blood sugar, drugs abuse, alcohol withdrawal, low blood sodium, fever, brain infection, or concussion. Unprovoked seizures occur without a known cause, but may be triggered by stress or sleep deprivation.
EMT Treatment for Seizure
Treatment for seizure starts by establishing a safe space and removing objects that could hurt the patient. EMS providers will usually check for obvious seizure triggers, such as downed electrical wires or chemical spills. EMTs will assess the patient to determine their level of consciousness, responses, and also look for a medical ID bracelet or necklace (in case the patient suffers from a chronic medical condition).
EMS providers may also question witnesses and attempt to learn what preceded the seizure and how long the seizure lasted. This is typically followed by a thorough head-to-toe examination, and finally, the EMT will determine if the patient can be safely treated on the scene or require immediate transportation to a hospital emergency room.
9. Poisoning or Drug Ingestion (3.5%)
Poisoning emergencies are a major cause of morbidity and mortality in the US.
More than 80% of all accidental poisonings occur with children ages 1 to 3, usually from swallowing household products. Adult poisonings on the other hand, are usually intentional, although a small percentage are the result of chemical exposures at work. Deliberate poisonings are often the result of attempted suicide. Attempted suicide poisoning occurs ten time more often than attempted homicide poisoning.
What Is Poisoning?
Poison is defined as a substance that can produce harmful physiological or psychological effects when ingested, inhaled, injected, or absorbed through the skin.
Acute poisoning is exposure to a poison on one occasion or for a short period of time. Symptoms of acute poisoning develop in close relation to the degree of exposure.
Systemic poisoning occurs through absorption of a poison into the blood throughout the body.
Chronic poisoning is repeated or continuous exposure to a poison where symptoms do not occur immediately, and the patient gradually becomes ill.
In the medical sense, poisoning can be caused by many substances that are not legally classified as a poison, such as drugs or common household medications.
EMT Treatment for Poisoning
EMS providers must consider the possibility of poisoning anytime a patient’s condition cannot be explained by other causes.
The EMS provider may consider respiratory, cardiovascular, and neurological complications. This would include providing adequate ventilatory support, checking for cardiac dysrhythmias, and a neurological exam.
The EMS provider must obtain a pertinent history of exposure to possible poisons and any relevant medical history. Lastly, gastric decontamination may be attempted, through the use of antidotes or gastric lavage.
10. Diabetic Symptoms (2.5%)
An estimated 463 million people have diabetes worldwide (8.8% of the adult population), with type 2 diabetes making up about 90% of the cases. Trends suggest that rates will continue to rise. Diabetes at least doubles a person’s risk of early death. In 2019, diabetes was the 7th leading cause of death globally, and caused approximately 4.2 million deaths.
What Are Diabetic Symptoms?
Diabetes is a group of metabolic disorders characterized by a high blood sugar level over a prolonged period of time. Symptoms often include frequent urination, increased thirst, and increased appetite. If left untreated, diabetes can cause many complications. Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death. Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, nerve damage, eye damage, and cognitive impairment.
EMT Treatment for Diabetic Symptoms
There are 3 life-threatening diabetic conditions that EMS providers must be prepared to manage.
They are hypoglycemia (low blood sugar), hyperglycemia (high blood sugar), and hyperosmolar hyperglycemic nonketotic (HHNK) coma.
Hypoglycemia or insulin shock is a syndrome of diabetes relating to blood glucose levels below 80 mg/dl.
Hyperglycemia results from an absence of insulin or the body’s failure to use available insulin.
HHNK is a medical emergency that develops from sustained hyperglycemia that produces a hyperosmolar state.
Managing diabetic symptoms will depend on careful patient assessment, including onset of symptoms, recent food intake, insulin and hypoglycemic medication use, and alcohol or drug consumption.
11. Stroke (2.0%)
More than 795,000 Americans suffer a stroke every year. One out of 4 stroke victims will die. Two-thirds of strokes strike people 65 or older. Currently, 3 million people in the US have disabilities from strokes. The chances of survival are much greater when emergency treatment begins quickly.
What Is a Stroke?
A stroke is when there is a lack of blood flow to the brain. There are two types of strokes: ischemic and hemorrhagic.
Ischemic stroke is when there is a blood clot blocking an artery to the brain.
Hemorrhagic stroke is when a blood vessel bursts and there is blood moving around freely in the brain.
A stroke is a serious medical emergency. It can cause permanent damage or lead to death, if not quickly treated.
EMT Treatment for Stroke
The Cincinnati Prehospital Stroke Scale was designed to help EMS providers identify a possible stroke before the patient gets to the hospital. It tests for three basic signs. If any of these signs are present, the patient may be having a stroke and should be transported to a hospital immediately.
- Facial droop – The EMT may ask their patient to smile. If one side of their face does not move as well or if part of the face looks like it is drooping, it may be a stroke.
- Arm drift – An EMT may ask their patient to close their eyes and hold their arms out straight for 10 seconds. If one arm does not move, or one arm drifts down compared to the other side, it may be a stroke.
- Speech – At times, the EMT will ask their patient to say the words “You can’t teach an old dog new tricks,” or some other familiar saying. If the patient is unable to speak, slurs their words, or uses incorrect words, it may be a stroke.
About 72% of patients who show one of these signs are having an ischemic stroke. More than 85% of patients who show all three of these signs are having an acute stroke.
Treatment for stroke involves thrombolytic therapy that can only be properly done in the hospital. There is a narrow timeline for treatment, so EMS providers must respond and act quickly.
12. Cardiac Rhythm Disturbance (1.9%)
Cardiac rhythm disturbance, also known as cardiac arrhythmia, affects millions of people (about 3% of the US population). Atrial fibrillation is the most common cardiac rhythm disturbance and is present in about 9% of people in their 80s. The most significant concern is the risk of a stroke because blood can stagnate and form a clot which could stop blood-flow to parts of the brain.
What Is Cardiac Rhythm Disturbance?
Cardiac rhythm disturbance, also known as cardiac arrhythmia, is a group of conditions that cause the heart to beat irregularly, too fast, or too slow.
- A heart rate that is too fast – above 100 beats per minute in adults – is called tachycardia.
- A heart rate that is too slow – below 60 beats per minute – is called bradycardia.
Some cardiac rhythm disturbances have no symptoms. In other cases, symptoms can include palpitations or feeling a pause between heartbeats. In more serious cases, there may be lightheadedness, passing out, shortness of breath, or chest pain. Most cardiac rhythm disturbances are not serious, though they can predispose a patient to complications such as stroke or heart failure. Some cardiac rhythm disorders can result in sudden death.
EMT Treatment for Cardiac Rhythm Disturbance
Atrial fibrillation is the most common cardiac rhythm disturbance and failing to treat it properly could result in a stroke. Guidelines for treating rapid atrial fibrillation may include routine emergency medical care, oxygen therapy, all while positioning the patient comfortably. If the patient experiences shortness of breath, EMS providers would follow the Congestive Heart Failure Guidelines. If the patient has suffered a stroke, EMS providers would follow the Stroke Guidelines. An ECG monitor or 12-lead acquisition would be indicated, if approved. These temporary measures are some of the best tools at an EMS provider’s disposal while they transport their patient to the nearest hospital.
13. Cardiac Arrest (1.8%)
Despite advances in emergency treatment and public awareness, the survival rate of out-of-hospital cardiac arrest remains low, averaging about 6% worldwide. Better understanding cardiac arrests, newer treatment techniques, and better equipment are enabling EMS providers to improve the survival rate for out-of-hospital cardiac arrest patients. In some studies, the survival rate has reached 18.3% with EMS treatment.
What Is Cardiac Arrest?
Cardiac arrest is a sudden loss of blood-flow resulting from a failure of the heart to pump effectively. Signs include loss of consciousness, abnormal breathing, or if breathing has stopped. Some patients may experience chest pain, shortness of breath, or nausea before cardiac arrest. If not treated within minutes, it usually results in death.
The most common cause of cardiac arrest is coronary artery disease. Other causes include major blood loss, lack of oxygen, extremely low potassium, heart failure, and intense physical exercise. The diagnosis is confirmed by finding no pulse. Cardiac arrest can also be caused by heart attack or heart failure.
EMT Treatment for Cardiac Arrest
Treatment guidelines for cardiac arrest have changed recently, and now include a more in-depth consideration of the phases of cardiac arrest.
Current emergency treatment involves three components: cardiopulmonary resuscitation (CPR), defibrillation, and ventilation.
CPR includes chest compressions and ventilation at a ratio of 30:2.
Defibrillation is the most effective way to stop the electrical chaos occurring in the heart during v-fib. If the cardiac arrest is witnessed by an EMS provider, immediate defibrillation is recommended. If the down time is not known or more than five minutes have passed, two minutes of CPR are recommended before defibrillation.
How Do 911 Caller Complaints Differ from Actual Conditions Encountered by EMS Providers?
Several issues make it difficult for EMS providers to prepare for a call before they arrive on the scene. One issue is that callers are not always able to clearly or accurately define the medical problem. This is understandable given that most 911 callers are not medical professionals, and they are usually calling under urgent and stressful conditions.
The national EMS database (NEMSIS) provides data on the frequency of 911 caller complaints compared to the EMS provider’s impression of the patient’s actual condition and the patient’s primary symptom. This data shows a significant difference between the caller complaints versus the actual conditions treated.
How EMT Training Prepares You For Emergency Diagnosis
By Dave Thomas, NREMT-P (Unitek EMT Lead Instructor)
EMT’s are often dispatched to what is referred to as an “unclear problem,” or “unknown.” Therefore, they are taught at the very beginning that every call is dynamic and ever changing, that they need to be ready to improvise, adapt and overcome in each situation. The call starts from the time of dispatch, so the EMT needs to be prepared for whatever comes their way.
All that being said, “breathing problems” and “chest pain” are some of the most regular calls, as well as some form of musculoskeletal injury, from minor slips, trips, and falls, to multiple system trauma from motor vehicle accidents.
Training begins with EMT school; typically 140 –160 hours of class work, lectures, reading, as well as hands-on skills instruction of patient assessment, medication administration, splinting and bandaging, CPR and AED usage, proper use of airway adjuncts with O2 administration and continuous positive airway pressure (CPAP.)
It is drilled into the EMT student to learn how to recognize hazards at the scene of an emergency as they are often chaotic with many stressors in play, from the patient’s own emergency to the environment around them. Students are further trained toward rapid and early recognition and treatment of any life threats to ensure the health of the patient.
The skill that is paramount for the EMT student to learn, which follows them on into paramedic training, is patient assessment. As a prehospital care provider, it is important to ask appropriate questions regarding the patient’s nature of illness or mechanism of injury to guide the plan of care that the patient needs. It is fairly simple to learn how to wrap up a patient’s injury, stop the bleeding, etc., but what’s more of a challenge is learning how to interact and interview a person in their moment of greatest need.
Being a Good Medical Detective
The “breathing problem” call is often one of most challenging, since there are many pathophysiologies that could lend to shortness of breath. Sometimes, the “breathing problem” call is accompanied by a complaint of “chest pain” as the two body systems work closely together. The EMT needs to do a thorough patient assessment to determine the source of the breathing problem.
Does the patient have a medical problem such as Chronic Obstructive Pulmonary Disease? Congestive Heart Failure? One is pulmonary in origin, while the other is cardiac, so the EMT needs to be a good “medical detective” to figure it out, asking about past medical history, current medications, how the patient has been feeling recently. Lung sounds are listened to, in the attempt to identify what part of the respiratory system is being affected and how.
The patient’s vital signs are taken early on but then constantly monitored to see if there are any changes. Medications may be warranted, but which ones? Is it a breathing problem because of chest pain (cardiac) or is it asthma, an anaphylactic reaction, pneumonia or even environmental in origin? Improper treatment or incorrect medications could lead to poor patient outcomes, including death. Each call provides its own opportunity to be the detective, looking for clues to provide the necessary care for the patient.
There are many other calls that emergency medical providers are called to and each one presents its own challenges. It all begins with proper EMT training. However, the EMT who establishes good patient rapport and has developed good assessment skills will be the better healthcare provider!