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GLOSSARY
Abandonment Situation in which a Paramedic
walks away from or discontinues care for a
patient without turning over care to another
provider who has the same or higher level of
training.
Accessory pathway A congenital abnormal
cardiac electrical pathway that may be
indicated by a short PR interval.
Abnormal automaticity Spontaneous impulses
generated in cardiac muscle that may interfere
with the SA node’s contraction-regulating
impulses.
Abrasions An irritated area on the skin caused
by wearing or rubbing away by friction.
Abscess A localized collection of pus
surrounded by inflamed tissue.
Absolute bradycardia A sinus rhythm with a
rate below 60 bpm.
Acetylcholine The chief neurotransmitter
released into the synapse from the nerve’s
presynaptic membrane during
neurotransmission.
Acetylcholinesterase A chemical that breaks
down acetylcholine.
Acid A substance with a pH value less than 7; a
molecule that has a proton that is not orbited
by a paired electron.
Abstract An abbreviated summary that hits a
research study’s highlights.
Accessory muscles Muscles recruited to assist
with body functions when the normal muscles
used for that task are inadequate. For
example, in respiratory distress, accessory
muscles may be used to help expand the rib
cage, allowing the patient to inhale.
Acid load Excessive amounts of acid in the
tissues to the point that tissues are acidotic.
Acidemia Condition in which the amount of
hydrogen atoms in an arterial blood gas
sample is below 7.35.
Acidosis Excessive acid in a body system that
can have a profound effect upon the body’s
uptake, distribution, and the effectiveness of
medications administered.
Acknowledging Responding to a patient’s
answer to a question with a positive reply,
either verbal or nonverbal, that encourages
further dialogue.
Actionable Determination if a claim can be the
basis for a lawsuit. To be actionable, a claim
must generally have the four elements of a
tort.
1 Action potential A stimulus that raises the
resting membrane potential above a specific
threshold.
Acute myocardial infarction (AMI) Death of
cardiac muscle tissue.
Active transport The movement of a chemical
substance through a gradient of concentration
in the opposite direction to that used for
normal diffusion, which requires an
expenditure of energy.
Activities of daily living (ADL) The everyday
events people perform in the course of their
life, such as eating, dressing, driving,
performing personal hygiene, and generally
caring for themselves.
Act-utilitarianism An approach to ethical
decision making in which the Paramedic
weighs the outcomes or consequences of
performing the act against not performing the
act and then makes a decision that maximizes
the intrinsic good.
Acute coronary syndrome (ACS) A complex
of symptoms associated with the continuum
of cardiovascular disease, emphasizing its
morbidity (and more importantly, its
mutability) and not simply its mortality.
Acute hemolytic reaction A serious bodily
response to a transfusion that most often
occurs as a result of an A-B-O blood type
incompatibility, which leads to agglutination
and hemolysis of the transfused blood.
2 Acute renal failure (ARF) The net effect of
prolonged hypoperfusion, leading to a
reduction in the kidneys’ ability to function.
Acute respiratory distress syndrome (ARDS)
A serious reaction to various injuries that
involve the lungs.
Acute respiratory failure Dysfunction within
the lungs that impairs respiration.
Acute traumatic stress An unexpected and
sudden stressful event which is unlike the
stress of day-to-day EMS and understandably
requires a different approach to relieve.
Adenosine triphosphate (ATP) The chemical
energy source in a cell used to power the rest
of the cell’s functions.
Administrative law judge (ALJ) One who
decides cases involving violations of a
department’s regulations.
Adrenergic transmission The transmission of a
nervous system signal using adrenaline as the
neurotransmitter.
Advanced directives Written declarations of
patient intent during specific circumstances,
which are designed to provide guidance when
a patient is threatened with living in a
persistent vegetative state or being afflicted
with a terminal illness.
Against medical advice (AMA) Situation in
which patients refuse medical care in
opposition to all logic when confronted with a
clear and immediate danger to their health.
Advanced emergency medical technician
(AEMT) An EMS professional trained to
administer a limited number of drugs and
perform skills that have been shown to
positively impact patient survival.
Advanced life support (ALS) Additional skills
and equipment offered by Paramedics over
and above basic life support, such as
intubation and ventilation.
Adverse drug reaction An unwanted or
harmful biological response to a drug that
creates a subsequent negative impact upon the
patient’s health.
Aerobic metabolism The step in the
metabolism process in which the cell uses
oxygen to create ATP from glucose.
Affidavit A sworn written statement which
attests to facts that pertain to a legal case.
Ageism A stereotypical view of the elderly as
frail or feeble.
Age of majority The legal age a person must be
in order to consent to a medical procedure; 18
years of age in most states.
Agglutination Clumping together of red blood
cells.
Agonist A drug or other chemical that can
combine with a receptor on a cell to produce
a physiologic reaction typical of a naturally
occurring substance.
Affinity An attraction to or liking of something.
3 Airlock A technique in which the Paramedic
injects a small bubble of air into the injection,
essentially sealing off the drug below from
leaking out to the subcutaneous tissues above.
Algorithm A logic tree in flowchart format that
simply states: if this, then do that; if not this,
then do this other thing. Algorithms can be
useful during an emergency when time is of
the essence.
Akinetic State of being without motion.
Alarm A signal on an ECG machine that
indicates, via visible and/or audible signal,
that a patient’s heart rate is above or below a
certain rate.
Alarm stage The first stage of the general
adaptation syndrome, during which the body
responds to the stressor via the central
nervous system.
Alert report A notification sent to the receiving
medical facility about an incoming patient
arrival. The information in the alert report is
brief and concise: age, sex, chief complaint,
mental status, vital signs, treatments in
progress, and an estimated time of arrival
(ETA).
Algor mortis The body’s natural cooling. As
the body’s metabolic processes cease, so does
the production of heat.
Alkalemia Condition in which the amount of
hydrogen atoms in an arterial blood gas
sample is above 7.45.
Alkaloids Nitrogenous chemicals which are
alkaline in nature and often chemically
combined with acids to create water-soluble
salts, such as morphine sulfate or atropine
sulfate.
Allergic reactions A bodily response that
occurs when exposed to a certain substance,
ranging from sneezing and rashes to severe
complications.
Alpha-adrenergic blockers Competitive
blockers occupying the adrenergic receptor
and preventing the catecholamine drug from
attaching to the adrenergic receptor. Alphaadrenergic blockers can be divided as either
long-acting and short-acting or competitive
and noncompetitive.
4 Alpha1 adrenergic receptors Sympathetic
neuroreceptors primarily involved with
excitation. They are located in the peripheral
vascular beds, on the arteriole side, and
control the sphincters (round muscles) of the
bladder, intestine, and the iris of the pupil.
Anaerobic metabolism The phase of glucose
metabolism that does not utilize oxygen, in
which the cell changes glucose into pyruvate
acid, which is in turn converted into lactic
acid.
Alpha2 adrenergic receptors Sympathetic
neuroreceptors found in the gastrointestinal
tract where they decrease bowel motility, via
relaxation of the smooth muscles within the
intestinal walls.
Alternative hypothesis A result in a research
study indicating the treatment is a plausible
explanation for a change.
Alternative medicine Techniques other than
traditional western medicine people may
attempt for a more natural treatment, such as
use of megavitamins, therapeutic massages,
chiropractic medicine, and acupuncture.
Alveoli A large collection of small sacs in the
lung that provides a larger surface area for
gas exchange than if the lung were made up
of a single large sac; singular is alveolus.
Analgesia A condition where the patient does
not feel pain yet remains conscious. More
importantly, the patient retains his or her
protective reflexes.
Analgesics Medications that relieve pain by
inhibiting the synthesis or release of
prostaglandins or stimulating opiate receptors
(opiate agonists).
Anaphylactic response An exaggerated
immune response that can lead to severe
airway compromise and/or cardiovascular
collapse secondary to relative hypovolemia.
Anaphylatoxins Substances that increase the
degranulation of mast cells and attract other
white blood cells (leukocytes) to the site.
Anasarca Total body edema.
Ambulatory Able to walk.
Americans with Disabilities Act (ADA) A law
that prohibits discrimination based on
disability in hiring, promoting, training, and
retiring.
AMPLE A mnemonic used to determine a
patient’s past medical history, consisting of
questions about allergies, medications, past
medical problems, last oral intake, and events
preceding the incident.
Amplitude modulation (AM) When
modulating an audio signal, changing the
wave’s height.
Anemia Condition in which the blood is lacking
red blood cells, hemoglobin, or volume.
(How to check)
Anemic hypoxia A low hematocrit, or other red
blood cell abnormality, that can lead to
oxygen deprivation at the cellular level.
5 Anesthesia A lack of sensation, painful or
otherwise. Anesthetic drugs primarily induce
anesthesia by interfering with or blocking
nerve conduction.
Apical pulse The pulse rate at the chest.
Angulated Describes an extremity where the
bone is obviously fractured and displaced at
an abnormal angle.
Anorexia nervosa A psychiatric illness
involving problems with self-image
characterized by self-starvation and bulimia.
Anoxia Hypoxia of such severity that
permanent damage results.
Antagonist A drug or other chemical that
interferes with the physiological action of
another substance, especially by combining
with and blocking its nerve receptor.
Antecubital fossa (AC) A triangular cavity of
the elbow joint that contains a tendon of the
biceps, the median nerve, and the brachial
artery.
Apologize An admission of fault or error
accompanied by a request for acceptance of
that admission.
Apoptosis A normal physiological process in
which old or damaged cells are destroyed so
new ones can take their place.
Appeal A request for an appellate court to
change the decision issued by a trial level
court.
Artifact A disturbance in the isoelectric line of
an ECG as a result of outside interference
with the signal.
Anticholinergics Drugs that block acetylcholine
from binding to either muscarinic or nicotinic
receptors and stop parasympathetic activity.
Antigens Foreign proteins found in bacteria.
Antimetabolites Drugs that prevent enzymes
from stimulating a cell’s metabolism.
Antitussive A cough suppressant.
Anxiolytics CNS depressants that reduce
apprehension, fear, and anxiety.
Arytenoid One of three separate cartilaginous
structures in the aryepiglottic folds that are
attached to each other and other structures by
ligaments as well as the intrinsic and extrinsic
muscles of the larynx.
Aortic stenosis A condition in which the
leaflets of the aortic valve become scarred
over time and the pathway through the valve
narrows.
Ascites Accumulation of fluid in the peritoneal
cavity.
6 Assault An intentional tort involving a threat of
violence, either physical or verbal.
Asthma A chronic lung disorder marked by
recurrent airway obstruction and labored
breathing.
Atrioventricular (AV) node A small mass of
specialized cardiac muscle fibers, located in
the wall of the right atrium of the heart, that
receives heartbeat impulses from the
sinoatrial node and directs them to the walls
of the ventricles.
Ataxia A disequilibrium in one’s walk that
resembles a drunkard’s stagger.
Atherosclerosis The underlying pathology of
coronary artery disease, which starts as a
streak of fat (cholesterol) on the walls of an
artery. The fat infiltrates into the wall of the
artery and forms a fatty lesion.
Atropine A parasympathetic blocker that
decreases vagal response.
Augmented leads A modified unipolar limb
type made from combining the lead type and
the positive electrode location (i.e.,
augmented voltage right or aVR, augmented
voltage left or aVL, and augmented voltage
foot now called aVF).
Atrial diastole State during the cardiac cycle in
which the atria are at rest.
Atrial kick The active contribution of blood to
the ventricle by the atria during the cardiac
cycle.
Auscultation An assessment performed by
listening, typically using a stethoscope.
Atrial systole State in which the atria contract
during the cardiac cycle.
7 Autoimmune response An immune response
triggered by some infections that causes
damage to the host.
Bachmann’s Bundle A special pathway the SA
node uses to communicate with the left
atrium.
Automatic answers Short, single-word
responses such as “yes” or “no” given in
reply to closed-ended questions.
Bacterial contamination Infection of blood
products often due to contamination during
the blood collection process, which can lead
to septic patients following transfusions.
Automaticity A cell’s ability to generate its
own action potential.
Automatic transport ventilators (ATV)
Mechanical devices that deliver a specified
volume of respiratory gas.
Balanced anesthesia Process of using a
combination of anesthetic agents—some
inhaled and some injected intravenously—to
minimize the side effects that occur with
using only one particular anesthetic agent.
Barotrauma Physical damage to tissues, or an
injury caused by an imbalance between
pressures in the environment and those within
the body.
Autonomic nervous system The body system
that maintains the involuntary, yet essential,
life-preserving functions such as digestion.
AV block An interruption of AV conduction
that can be indicative of disease or ischemia
at the level of the AV node.
AVPU A technique used to report the patient’s
general level of consciousness. A stands for
alert, V stands for responsive to voice, P
stands for responsive to pain, and U stands
for unresponsive.
Axis The major direction, or vector, of the
energy of depolarization in the heart.
Barrel The shaft of a syringe.
Base Atoms that lack a proton and therefore
want to accept protons from an acid in order
to become electrically balanced; a substance
with a pH value greater than 7.
Baseline vital signs An initial set of vital signs
taken from the patient against which all
subsequent vital signs are compared to check
for changes.
Basic life support (BLS) The early assistance
given to patients in the field, such as CPR,
oxygen, and suction.
Axis deviation Any situation in which the
heart’s axis is not normal.
8 Battery An intentional tort involving unwanted
touching.
Behavioral emergency Abnormal or bizarre
behavior that may include violence or threats
of violence.
Beneficence A belief that the physician’s
actions are acts of mercy and charity, a good
act performed for people at a time of need.
Benign Something that will not harm or
threaten health.
Benzodiazepines Medicines that help relieve
nervousness, tension, and other symptoms by
slowing the central nervous system. These
drugs are short acting, share the
characteristics of the other benzodiazepines,
and have been studied in the prehospital
environment as a sole agent to facilitate
intubation.
Best practices Those actions which have led to
the most desirable outcomes in the past.
Beta1 adrenergic receptors Sympathetic
neuroreceptors that cause the muscle of the
heart, the myocardium, to beat harder and
stimulate the heart to beat faster. Beta1
adrenergic receptors are also found in the
kidneys where they cause the secretion of
renin.
Beta2 adrenergic receptors Sympathetic
neuroreceptors that act upon the smooth
muscles found in the bronchial walls, the
level of the terminal bronchioles, and cause
bronchodilation.
Bilateral Relating to both the left and right
sides.
Bioavailability The difference between the
amount of a drug administered and the
amount that is bound and unavailable for use.
For example, imagine an aspirin pill with 325
mg of active ingredient is swallowed, and
then after various factors come into play, only
150 mg is free and unbound in the blood
plasma. Thus, less than 50% of the
medication is bioavailable.
Bioethics A form of applied ethics—that is,
ethics applied to the medical situation—
which creates a set of guiding principles for
the medical practitioner.
Biological death Death associated with
irreversibility, meaning that any efforts to
prolong life would be futile.
Biotransformation A detoxification process in
the body that simply transforms a drug—by
oxidation, hydrolysis, or reduction—into a
water-soluble compound which can be
excreted in the urine.
Bipolar leads Use of two electrodes—one
negative and one positive—to measure the
electrical potential between the leads’
electrodes.
Beta-blockers Medicines that block the
sympathetic nervous system action at the Beta
receptors.
Beta-selective Drugs that preferentially targets
either Beta1 or Beta2 receptors.
Bevel An angled surface of a needle point
designed to quickly pierce the skin with a
minimum of pain.
Bigeminy Condition in which an ectopic
complex occurs at every other complex.
Blastocyst A hollow, fluid-filled ball formed by
the zygote. The cells inside of the blastocyst
will form the human, whereas the cells on the
outside will form a protective covering that
eventually develops into the placenta.
9 Bleb(s) A small blister created when injecting
medication, which is about the size of a
mosquito bite; a change in the cell wall
membrane.
Body armor A form of personal protective
equipment used to protect the Paramedic from
thrown objects or projectiles like bullets.
Blind insertion airway device (BIAD) An
airway management tool that is placed blindly
and provides an airway that is superior to
face-mask ventilation, yet is not as protective
as an endotracheal tube.
Blocking behaviors Self-protective behaviors
that inhibit free dialogue with the Paramedic.
Many of these blocking behaviors are
manifestations of psychological defense
mechanisms.
Blood bank Location where donated blood and
blood products are evaluated and stored for
future transfusions.
Blood-brain barrier Tight slit junctions in the
capillaries of the brain which prevent toxins
and chemicals, including drugs, from easily
passing into the brain.
Blood chemistry A study of the blood’s
chemical composition, such as its level of
electrolytes.
Blood pressure A measure of the pressure
within the blood vessels that make up the
circulatory system. The pressure will vary
depending upon the type of vessel and the
phase of heart contraction.
Blood-typing Classifying blood as A, B, AB, or
O based on antibodies.
10 Body habitus One’s physique or body build.
Body language The transmission of a message
by nonverbal visual cues. Experts suggest that
70% of any spoken message is conveyed by
body language.
Body substance isolation Protection worn to
keep a patient’s body fluids from coming in
contact with the Paramedic, such as latex
gloves.
Bronchial sounds Lung sounds auscultated
over the larger airways that are louder and
sound like air rushing through a hollow tube.
Bronchoconstriction Narrowing of the
airway’s lumen.
Bronchodilation Widening of the airway’s
lumen.
Bronchospasm Temporary narrowing of the
smaller air passages of the bronchi due to
violent, involuntary contraction of the smooth
muscle of the bronchi that sometimes
accompanies a respiratory infection.
Bolus A concentrated volume of fluid infused
rapidly over several seconds or minutes.
Bronchus Either of the two primary divisions of
the trachea that lead into the right or left lung;
plural is bronchi.
Borrowed servant doctrine Situation in which
the Paramedic in charge of an emergency is
responsible for the actions of those
Paramedics working in a subordinate role.
Bounce A radio wave phenomenon that occurs
whenever a short wave strikes a reflective
surface and is redirected in another direction.
Bradycardia A heart rate that is under 60 beats
per minute for an adult or below the lower
limit of normal for a child.
Bradykinesia Extremely slow movement.
Brain dead A state in which an
electroencephalogram shows zero brain
activity, indicating brain death.
Breach of duty Situation in which a Paramedic
fails to perform patient care in conformance
with the standard of care.
Buffered Actions taken to render an atom
neutral (not to have an electrical charge).
Bulimia Eating disorder characterized by bingeeating and then purging via laxatives or
vomiting.
Breakthrough seizure An unexpected epileptic
seizure in a person who has had good seizure
control, which occurs when the drug level in
the plasma drops below the therapeutic level.
11 Bundle of His A wide, thick group of cardiac
muscle fibers that conducts an electrical
impulse to the interventricular septum.
Capsule Medicinal powder placed within a
gelatin casing that generally makes it easy to
swallow and keeps it from easily dissolving
in the water-based saliva of the mouth.
Cardiac action potential The electrochemical
activity of the heart’s individual cells.
BURP technique A method to improve
laryngoscopic view through backward,
upward, and rightward pressure.
Butterfly IV catheters A throwback to the days
of steel needles, in which short steel needles
are embedded into a plastic anchor device
that has wings, like a butterfly.
Calibration Process used to assess the accuracy
of the ECG monitor, in which the Paramedic
compares the ECG machine’s operation
against standard settings.
Cardiac cycle A single contraction (one
heartbeat), during which blood flows through
all four chambers of the heart. This
contraction includes an entire sequence of
events from atrial filling through ventricular
filling and ejection.
Cardiac monitor A device that shows the
electrical and pressure waveforms of the
cardiovascular system; the ECG oscilloscope.
Capacity The mental ability to understand what
one is being told.
Capillary refill A measure of the patient’s
ability to perfuse the extremities with
oxygenated blood.
Capnography The process of tracking the
carbon dioxide in a patient’s exhaled breath,
which enables Paramedics to objectively
evaluate a patient’s ventilatory status.
Capnometry The determination of the end-tidal
partial pressure of carbon dioxide.
12 Cardiac output The volume of blood pumped
out of the left ventricle with each contraction.
Cardiac skeleton A fibrous matrix to which the
muscles, valves, and rings of the myocardium
are attached and that separates the atria from
the ventricles.
Cardiogenic shock Problems with the heart that
lead to its failure to pump.
Cardioselective Beta-selective drugs that only
affect the heart.
Carina Level of the 5th thoracic vertebrae; an
anatomical part, ridge, or process.
Case-control study An observational study
method in which the Paramedic compares
cases—those patients with the disease—to
controls—those patients without the
disease—and then examines the procedures
performed on both to see if there was an
association between outcomes.
Catecholamines A classification of very potent
adrenergic agonists that cause a direct
response from the adrenergic receptor.
Carotid bruit A whooshing sound heard in a
carotid artery that has plaque buildup on the
artery walls.
Carotid pulse A measure of the beats produced
by blood flow taken in the anterior neck.
Cell An area that a mobile radio transmission
tower services for cell phone calls.
Cell-mediated immunity Immunity that results
from the activity of T lymphocytes.
Cellular telephones Low-powered wireless
transmitters (radios) that work within close
proximity to a radio tower.
Cellulitis A skin infection.
Cell wall membrane A porous semipermeable
dual layer lipid–protein matrix that makes up
the outside of a cell.
Celsius scale A method of measuring
temperature based on a system of 10 in which
water freezes at 0°C and water boils at 100°C.
Carrier squelch A type of squelch control that
eliminates background static during pauses in
a radio transmission, essentially muting the
radio between transmissions and thereby
improving the message’s overall quality.
Case law Law established by previous judicial
decisions.
Case report An example of a descriptive study
Paramedics use to report interesting or unique
cases, which allow other Paramedics to gain
insight into a problem.
Central nervous system depressants Drugs
that produce a state of reduced central
nervous system activity.
Central venous pressure (CVP) A
measurement used to assess a patient’s
hemodynamic status.
Cerebellum The portion of the brain
responsible for coordination of muscles and
balance.
Channel crowding Situation in which several
agencies share the same radio frequencies.
Chart audit A system of quality review
performed retrospectively in which the
Paramedics reviews the chart against care
standards.
13 CHEATED A mnemonic for an EMS-specific,
user-friendly documentation method
highlighting chief concern/complaint, history,
examination, assessment, treatment,
evaluation, and disposition.
Chemical hiatus Situation in which the drug
level in the body drops below the therapeutic
level before the infusion has assumed
dominance. If left untreated, a potentially lifethreatening return ventricular ectopy could
occur.
Chemical name A description of a drug
according to its elemental chemical makeup
and molecular structure.
Chemotactic factors Chemical messengers
released by mast cells that attract specific
leukocytes (white blood cells) to the injury
site.
Chemotherapy Use of drugs to combat
infections and diseases, most notably cancer.
Chevron Method for securing a catheter hub
that involves slipping the inverted tape, sticky
side up, under the hub until it adheres to the
hub, then crossing it over the hub.
Chief concern or complaint (CC) The main
reason for which the patient is seeking
medical care.
Cholinergic transmission The transmission of
a nervous system signal using acetylcholine
as the neurotransmitter at the motor endplate.
Chordae tendinae Strong cords of connective
tissue that connect the mitral valve to the
papillary muscle of the heart’s left ventricle.
Chest leads Leads in which the exploring
electrode is placed on the chest and the other
is connected to one or more limbs.
Choreography The ability to organize a team’s
efforts in order to deliver appropriate
interventions in a timely manner.
Chromosomes A double helix of DNA that
carries genetic information.
14 Chronotropy To make the heart beat faster.
Circumflex (Cx) A minor branch of the left
coronary artery that bends around to the left
side of the heart and provides blood to the
lateral wall of the left ventricle.
Clock method Procedure used to determine the
infusion rate in which the Paramedic mentally
visualizes a clock with a sweep hand pointing
out the drug infusion rate. When the sweep
hand is at the 15 second point, it represents 1
milligram of drug at 15 drops per minute or
15 milliliters an hour. When the sweep hand
is at the 30 second position, it represents 2
milligrams of the drug infusing at 30 drops
per minute, and so forth.
Civil law The legal system designed to handle
cases not of a criminal nature, often involving
business transactions, such as contracts, torts,
estates, trusts, wills, real estate matters,
commercial matters, and grievances against
the government.
Clarification Communication technique in
which a Paramedic asks the patient to restate
the message in other words.
Climacteric An age-related decrease in sex
hormone production that occurs in both men
and women.
Clinical death The absence of vital signs.
Clinical death is characterized by
unresponsiveness to loud verbal and painful
stimuli, absence of breathing, and an absence
of a central pulse.
Clonic Repetitive muscle contractions during a
convulsion.
Closed-ended questions Questions that
generally start with words like “do,” “is,” or
“are” and require the answer to be a short,
direct reply—usually just “yes” or “no.”
Closed-ended questions are used when
specific information is needed quickly.
Clot tubes A red top blood sample tube that
contains no additives or preservatives to
prevent blood clotting.
Coagulation The thickening process through
which the blood makes clots.
Clinical decision making The process of
systematic analysis and critical thinking the
Paramedic uses to make clinical decisions
that will be incorporated into a patient’s
treatment plan.
Clinical trial Experimental medical research
process in which subjects are assigned at
random to either the treatment group or to the
non-treatment group (i.e., those receiving
standard care [control group]).
15 Coagulation cascade The process the body uses
to manufacture fibrin and fibrinogen.
Colloid Blood substitutes that contain proteins
and are capable of both pulling fluids from
within the interstitial space into the
circulation (to help augment the circulating
volume) and remaining within the
bloodstream for a prolonged period of time
(to help maintain the circulating volume).
Colorimetric device Encapsulated pieces of
litmus paper over which an exhaled breath
flows. When carbon dioxide is in the presence
of water, it forms carbonic acid; the pH
sensitive litmus paper in the colorimetric
device detects this acid and changes color.
Coagulation factors Proteins which act to
attract platelets to each other to build platelet
plugs. Additionally, coagulation factors are
key to the production of fibrin and fibrinogen,
two materials that serve to solidify and
stabilize the platelet plug, making it
impermeable to liquid.
Coagulative necrosis Condition in which
muscle cells die, such as in myocardial
infarction, the skeleton of the cell remains,
and the tissue remains firm.
Coded (or tone) squelch Sometimes called
private line, a type of squelch control that
permits the radio to receive only the intended
signal by eliminating reception of nearby
broadcast messages and only accepting
signals with the correct code.
Cognitive restructuring Action taken to
reframe the brain’s interpretation of a
stimulus so that it is nonthreatening.
Cohort study An observational study method
that examines patients who have been
exposed to a treatment and compares them to
a group that was not exposed to the same
treatment. The patients are followed to
determine outcomes.
Cold maceration Process of letting medicinal
herbs steep in cold water.
16 Combining forms Creating a word by placing
two or more roots together, separated by a
vowel, to explain a complex process. For
example, the term “cardiomyopathy”,
meaning disease of the muscle of the heart, is
made up of “cardia-” (meaning heart), “my”
(meaning muscle), and “patho” (meaning
disease), with the letter “O” separating the
roots “cardia”, “my”, and “patho.”
Command presence The ability to present
oneself as the person of authority.
Commercial ambulance services For-profit
EMS services that provide interfacility
medical transportation as well as emergency
medical services to patients. Many of these
commercial ambulance services originated
from the funeral homes that previously
provided the service.
Communications Act of 1934 A resolution
which states that the President of the United
States has control over all government radios
and that the Federal Communications
Commission (FCC) has control over the
civilian use of radios.
Complete heart block Obstruction of electrical
signals through the AV node or at the bundle
of His, in which case pacemakers lower in the
heart at the level of the bundle of His, bundle
branches, or even the ventricular myocardium
will take over as the pacemaker.
Communications specialists (COMSPEC)
Enhanced 9-1-1 staff that dispatch emergency
responders to people who are unable to speak
or who have lapsed into unconsciousness.
Comprehensive Drug Abuse Prevention and
Control Act of 1970 (Controlled Substance
Act) A law that expanded the Drug
Enforcement Administration’s authority to
include schedules of potentially dangerous
and addictive drugs that had special
restrictions.
Concealment Any object that blocks the
pursuer’s vision of the Paramedic, although it
does not offer physical protection.
Community-based EMS Volunteer (nonprofit)
EMS squads that operate independently of
local fire departments or hospitals.
Competency assurance The necessity of the
Paramedic not only to maintain minimal skills
and an adequate knowledge base, but to
continue to remain current with updates to
EMS.
Concentration gradient The difference in
concentration between two solutions in
different areas (i.e., on two sides of a
membrane). When a concentration gradient
exists, the higher concentration will diffuse
across the membrane to the lower
concentration solution until a balance is
reached.
Concept formation The inductive logic process
of forming ideas about what is causing a
patient’s condition based on the patient’s
history and the Paramedic’s knowledge base.
Complementary medicine See Alternative
medicine.
Complete blood count (CBC) The quantity of
each type of blood cell in a given sample of
blood, often including the amount of
hemoglobin, the hematocrit, and the
proportions of various white cells.
17 Conduction system Specialized cardiac cells
designed to carry on the heart’s electrical
rhythm.
Constitutional signs/symptoms General
nonspecific findings, such as fevers,
unexplained weight loss, night sweats, chills,
headaches, nausea, and vomiting, that are
often common to all sick patients.
Contiguous leads Situation in which two or
more leads look at the same wall of the left
ventricle.
Conductivity The ability of an electrical
stimulus to be transmitted from cell to cell.
Congestive heart failure (CHF) The heart’s
inability to pump strongly enough to
completely meet the body’s needs for oxygen
and nutrients.
Conjunctiva The mucous membrane that lines
the inner surface of the eyelids.
Continuous infusion A volume of fluid evenly
administered over the course of a period of
time (i.e., an hour).
Continuous quality improvement (CQI) An
ongoing process of review and reengineering, in order to refine a process and
improve its delivery.
Contractility The cardiac muscle fibers’ ability
to shorten or contract.
Contributory negligence A legal assertion that
an action, although not directly causing an
injury or problem, nonetheless made it worse.
Conscious sedation The first stage of
anesthesia where the patient does not feel
pain but is awake enough to maintain
protective airway reflexes.
Constitutional examination An evaluation that
assesses the patient’s general appearance.
18 Cormack-Lehane grading system A
quantitative measure system that grades the
view of the glottic opening by how much is
occluded by the tongue— Grade I is a clear
view of the entire glottic opening whereas IV
is visualization of the tongue or soft palate
only. Proper patient position and external
laryngeal manipulation can improve the view
by one to two grades.
Cost–benefit ratio A classic economic analysis
that asks the question of whether it is
advantageous (i.e., cost-effective) to take a
particular action or make a change in a
procedure.
Costal margin The lower edge of the chest
(thorax) formed by the bottom edge of the rib
cage.
Costovertebral angle Area located over the
lower ribs just medial to the posterior axillary
line.
Countermeasures Steps that could be effective
in reducing injury.
Couplets Situation in which two ectopic
complexes occur together.
Coronary artery disease (CAD) The series of
events that leads up to and includes
myocardial infarction.
Cover Any object that cannot be penetrated by a
projectile, from bullets to frying pans.
Examples of cover include telephone poles
and even fire hydrants.
Coronary circulation A special set of arteries
and veins that supplies blood to the muscles
of the heart.
Crenate Dehydration and collapse of a cell.
Crepitus Crackling or popping sounds under
the skin or near joints.
Cortisol A glucocorticoid hormone that
stimulates the production of glucogen from
amino acids and fatty acids contained in
lipids.
19 Cricoid pressure Also called the Sellick’s
maneuver, a procedure that involves
identifying the cricoid ring and gently
applying approximately 10 pounds of
pressure in a posterior direction throughout
airway management; from the onset of
ventilation until completion of intubation.
Crowning Part of the childbirth process in
which the infant’s head begins the passage
into the birth canal, indicating delivery will
occur within several minutes.
Criminal law Laws dealing with violations of a
person’s duties to the community and for
which the written law requires the person to
provide satisfaction.
Critical incident response team (CIRT)
Individuals called in during an acute stress
situation to meet with the affected personnel,
typically front-line responders.
Critical incident stress debriefing (CISD) An
intervention to defuse stressors in an acute
stress situation, such as a line-of-duty death,
serious injury of a coworker while on-the-job,
and post-event suicide of a fellow responder.
Cross-match Comparing a donor’s blood to a
patient’s blood to determine compatibility of
antibodies and type.
Cryoprecipitate The protein portion of plasma
made up of concentrated clotting factors.
Crystalloids Electrolyte-containing fluids
Paramedics use during trauma resuscitation
that, when dehydrated, create crystals.
Cultural competence A Paramedic’s ability to
function effectively within the diverse
populations that she serves.
Culture The culmination of life experiences in
a locality or region that affects the way a
person thinks and behaves.
Cyanosis A bluish hue that develops when the
patient develops a decreased oxygen level in
the blood.
Cross-sectional survey A snapshot of a certain
aspect of a population at a given moment in
time that the researcher is interested in,
obtained by means of observation.
Cytopathic Manifestations of disease at the
cellular level.
Cytoplasm A fluid mixture inside a cell,
primarily made up of water and organelles,
which has a specific cellular function(s).
20 Decoction Process of bringing water to a boil
then steeping medicinal herbs in the water
(like one would steep a teabag), then drinking
the resulting solution.
Dangerous instruments Any object that could
be used, under the right circumstances, to
produce serious injury or even death, such as
a broken bottle or box cutter.
Decode To interpret and understand a message.
Decubitus ulcers Also known as pressure
ulcers, tender or inflamed patches that
develop when skin covering a weight-bearing
part of the body is squeezed between bone
and another body part, or a bed, chair, splint,
or other hard object, creating pressure or
friction.
Data and Safety Monitoring Board (DSMB)
A group of individuals who are not directly
involved in a research study but who can
nonetheless make an objective decision about
the research based on the merits of the data.
Data dredging Sometimes called data mining,
it means conducting research by searching
through a database without a predefined
scientific question in mind (i.e., without a
predefined hypothesis).
Dead airtime A period in which no radio
transmissions are made on a particular
channel.
Deadly weapons Objects that are, by design,
intended to inflict death or disability (e.g., a
gun or a knife).
Deep tendon reflexes (DTRs) Involuntary
muscle contraction in the muscle associated
with a tendon.
Defasciculating dose A small dose of a nondepolarizing paralytic which, when
administered before administering a certain
drug, prevents the fasciculations associated
with that drug.
Defensive medicine The practice of a
Paramedic performing a wide variety of
random tests to limit liability or criticism
from the medical director, rather than
performing just those tests that benefit the
patient.
21 Deontology Duty-based ethics in which the
decision as to whether an action is right or
wrong is based on principles and not upon the
consequences.
Defusing An immediate intervention intended
to avert acute stress reactions among the
emergency responders.
Depolarization A cascade of ionic changes at a
cell wall that occurs as electrolytes transfer
across the cell in an attempt to balance
(neutralize) the charge.
Degranulate The process of breaking down or
losing granules.
Delirium A sudden change in mental function,
usually associated with reversible metabolic
derangements (e.g., hypoxia, or the toxic
effects of medications).
Deltoid An intramuscular injection site in the
muscle that overlays the shoulder and extends
downward toward the elbow, forming an
inverted triangle in the process.
Depolarizing neuromuscular blocker One of
the two major classes of neuromuscular
blockers; binds to the acetylcholine receptor
and causes the muscle to depolarize or
contract.
Deposition Out-of-court testimony made under
oath and recorded by an authorized officer for
later use in court.
Demobilization An opportunity to mitigate the
effects of the acute stressors and to decrease
the incidence of acute traumatic stress
reactions.
Denature To break down a protein’s complex
folded structure.
22 Descriptive analysis Based on the Marriott
method of analysis, a way to gather
information for a thorough ECG
interpretation consisting of review of the
rhythm, rate, width of the QRS complex, and
atrial activity.
Descriptive study Documentation that simply
states that a condition or situation exists
without trying to offer an explanation.
Detailed physical examination A more
thorough evaluation given to low-priority
patients with whom the Paramedic has more
time.
Developmental milestones The skills and
abilities a child achieves at certain ages in his
or her life, measured against the norms of
other children.
Dextrocardia Condition in which the heart and
lungs in a body are opposite their normal
position while the abdominal organs are in
their usual position.
Diagnosis Identification of a disease or disorder
based on available symptoms and testing.
Diagnosis-related groups (DRG) Groups of
patient populations with the same or similar
diagnosis, who may benefit from similar
treatments.
Diaphoretic To be profusely sweaty.
Diaphragm A large, thin, dome-shaped muscle
that divides the abdomen from the thorax.
Diastolic blood pressure The minimum blood
pressure measured during diastole when the
heart relaxes and fills.
Digital intubation An endotracheal intubation
technique that uses the Paramedic’s hand to
identify laryngeal structures and to guide tube
placement.
Diminished autonomy Standard that states any
person who is mentally incapable of making
an informed decision (e.g., by virtue of age or
infirmity) cannot willingly consent to
participate in research.
Diphasic A wave that begins as a positive
deflection then becomes a negative wave or
vice versa; having two phases.
Diplomacy To calmly and thoughtfully resolve
issues without angering the parties in the
dispute.
Direct questioning An interviewing technique
in which a Paramedic asks simple,
unambiguous questions of the affected party
about the situation at hand.
Disclosure An open dialogue between patient
and provider in which the provider tells the
patient about the procedure, including its
attendant risks, and recommends the
procedure.
Disease An abnormal change in the function of
cells, tissues, or organs. An example of each
is cancer in cells, emphysema in tissues, and
acute myocardial infarction in organs.
Disorder A physiological deviation from a
normal homeostasis.
Disseminated intravascular coagulation
(DIC) A condition in which, after initial
blood clotting factors are partially consumed
by massive coagulation throughout the body,
the remaining clotting factors are insufficient
to protect the body.
23 Distention An abnormal expansion, such as in a
vein or the abdomen.
Distracting injury Situation in which a pain
(often dull visceral pain) is overshadowed by
another more intense pain from another
injury; for example, a fractured femur taking
attention away from chest pain.
Distress A negative response to stimuli that
overcomes the body’s innate defenses and
serves as the body’s maladaptive reaction to
stress.
Distributive shock The third category of the
Hinshaw–Cox shock classification, which is
descriptive of the problem of poor blood
distribution. Distributive shock includes
shock caused by the widespread
vasodilatation seen with severe infections and
during anaphylactic reactions, to name a few
causes.
Do-Not-Resuscitate (DNR) order Sometimes
called a Do-Not-Attempt-Resuscitation
(DNAR) order, a directive from the patient
that artificial means of life support should not
be used, generally in cases when a condition
is terminal and artificial life support will just
delay the inevitable.
DOPE A mnemonic Paramedics use to help
remember the causes of problem intubations.
The D in dope stands for displaced
endotracheal tube; the O stands for
obstructions of the endotracheal tube, such as
a mucous plug; the P suggests the possibility
of a pneumothorax; and the last letter, E,
indicates equipment failure.
Dormant A state of biological rest a disease
may stay in until favorable conditions exist
for it to reanimate.
Dorsalis pedis (DP) pulse A measure of the
beat created by blood flow measured over the
dorsum of the foot.
Diuretics Medications that cause the increased
loss of fluid and salts from the body.
Divine command ethics Extrinsic ethics based
upon a higher authority, such as the Bible’s
Ten Commandments or Buddha’s Four Noble
Truths and Eight Paths to Righteousness, in
which that higher authority has predetermined
what qualities a virtuous person would have
and calls upon the person to display those
virtues through correct action.
Dominance A condition of superiority, as in
when the actions of one bodily function are
faster than or overpower the actions of
another.
24 Dorsiflex The ability to raise toes above the
horizontal toward the tibia.
Dorsogluteal (DG) The most common
intramuscular injection site, located in the
gluteus medius.
Dry powder inhalers (DPI) Respiratory device
that uses a solid drug pulverized into microfine particles for inhalation.
Duplex A radio that uses two frequencies—one
to transmit and one to receive—so that an
operator can talk and listen at the same time,
permitting more rapid communications.
Dose The amount of drug needed to produce the
desired effect.
Double-blinded randomized clinical trial
(RCT) A prospective scientific study that
controls known and unknown variables,
leaving only one variable to be manipulated.
Subjects are then chosen at random to be
included in either the experimental treatment
group or in the control group.
Double-blind study A research study in which
both the researcher and the participants are
unaware of which group the subject is in.
Downregulation A decrease in the number of
cell receptors in a cell due to changes in
hormone levels.
Dress-up philosophy Technique in which
Paramedics add barrier devices for protection
as the situation warrants.
Drug Any material which, when injected,
ingested, inhaled, or absorbed into the body,
is used for the diagnosis, treatment, or cure of
a disease or condition.
Drug decline The idea that while a drug moves
through the body various forces and organs
are weakening it, reducing its effectiveness.
Drug reservoir A type of drug depot in the
body, created when drugs bind to certain
substances, that stores the drug until it is
needed. The effect of a drug reservoir is to
prolong the drug’s action within the body.
Duration The length of a QRS complex wave.
Duty to act An element of a tort that implies a
Paramedic must act whenever called upon to
perform patient care (i.e., the Paramedic is
“on duty”).
Dyskinesia Lack of ability to control body
movements.
Dysplasia Situation in which there are too many
new, or immature, cells being produced that
are not functional.
Dysrhythmias An abnormality of the electrical
activity in the heart.
Ecchymosis Blood from ruptured vessels
moving into other tissues; bruising.
ECG interpretation A systematic approach
used to rapidly and accurately analyze an
ECG rhythm strip.
ECG rhythm strip A printed hard copy from
an ECG machine of at least one lead that
shows the ECG complexes over a long period
of time allowing Paramedics to analyze the
rhythm.
Echo technique Communication method in
which the physician gives an order and the
Paramedic, in order to ensure it’s been
interpreted correctly, repeats the order back to
the physician exactly as received.
25 Ecological study Sometimes called a
correlational study, this type of research
design serves to provide information about
trends and rates of disease within a
population, often cited as X number of cases
of Y disease per 1,000 or per 100,000 of Z
population.
Elastic gum bougie A device made entirely of
wound gum rubber, with a hard, smooth, and
round plastic tip, that resembles a very long
stylet. The device is directed through the
vocal cords and into the trachea to serve as a
guide for an endotracheal tube.
Ectopic To occur in an abnormal or atypical
position.
Ectopic beats Aberrant cardiac beats resulting
from abnormal automaticity.
Ectopic focus Any complex that occurs outside
of the sinus of the heart’s cavity.
ED50 The dose of a drug that effectively creates
the therapeutic effect in a majority of patients.
Edema A dramatic fluid buildup in the body’s
tissues.
Edentulous A state of having no teeth.
Efficacy The power to produce an effect; the
ability of a drug to realize its full intended
therapeutic effect.
Ejection fraction The percentage of blood
pushed and squeezed out of the heart,
typically 60% to 75% of the end diastolic
volume.
Electrical alternans Situation in which every
other ECG complex has alternating amplitude
(i.e., the one QRS complex is smaller when
compared to the next).
Electrical storm Multiple recurrent episodes of
ventricular fibrillation.
Electrocardiogram A device used to monitor
cardiac rhythm.
Electromagnetic interference (EMI)
Disruptions of an ECG signal caused by the
flow of electricity through an electric device,
such as a radio, cellular telephone, or
television, which creates an electromagnetic
field.
Electromyographic signal (EMG) An
electrical current recorded by the ECG any
time a muscle contracts, appearing as narrow
rapid spikes on the ECG monitor.
Electroporation The effect of electrical current
passing through the tissue.
Elixir A sweetened tincture used for medicinal
purposes.
26 Emancipated minors A special class of youths
who are below the age of majority but are
permitted to give informed consent, provided
they are capable of understanding the
consequences of their decisions and that they
are not impaired by alcohol or drugs. These
include married persons, single parents, the
military, and youth living on their own.
Embryo An unborn child at any stage of
development between conception and birth.
Emergency doctrine Policy invoked when
family members or guardians are not present
that states if a parent was present the parent
would want the child treated and transported
to the hospital. The emergency doctrine is
usually invoked only in cases of life- or limbthreatening emergencies.
Emergency exception A situation in which a
care provider performs a procedure without
fully explaining it to the patient because the
delay created by a lengthy explanation might
compromise the patient’s health.
Emergency medical dispatch (EMD) A
dispatch algorithm in which the
communications specialist interrogates the
caller, gives prearrival instructions, and uses
preset criteria to make a response
determination before dispatching the
appropriate EMS responder units.
Emergency medical responder (EMR) An
EMS provider who is expected to render lifesaving care with minimal equipment; for
example, a police officer or fire fighter
providing rapid response.
Emergency Medical Services (EMS) The field
of medicine that involves transporting the
sick or wounded to medical care and
providing treatment to patients prior to their
arrival at the hospital.
Emergency Medical Technician-Ambulance
A national standard curriculum established in
1969 for the training of ambulance
drivers/attendants in new skills and lifesaving techniques.
Emergency Medical Technician (EMT)–Basic
Part of a team that responds to the emergency
scene, typically aboard an ambulance, and is
trained to provide initial care on scene as well
as medical care to the patient while in transit
to the hospital.
Emergency vehicle operator (EVO) Any
individual who operates a vehicle en route to
a response call.
Emergent An assessment classification in
which the patient’s condition unexpectedly
developed and is in need of immediate
medical attention.
Empathy An emotional understanding of the
patient’s feelings; to be able to understand
what it is like to walk in the other person’s
shoes.
Empiric therapy Treatment based on initial
observations obtained during the primary
assessment.
EMS Act of 1973 Federal legislation that
delineated the 15 aspects of an EMS system
that needed improvement including education
(both public as well as provider), improved
communications (including public access),
and system evaluation, but offered little
money to help make those improvements.
27 EMS Agenda for the Future Overall
framework which suggests that EMS will be
more intimately intertwined with public
health, as well as public safety, over time and
continue to evolve along with health care.
EMS Education Agenda for the Future The
plans that emerged from the 1996 meeting of
over 30 EMS organizations held with the
intent of implementing the educational
portions of the EMS Agenda for the Future.
Emulsions Finely pulverized particles placed
into oils, such as cod liver oil.
Endotoxins Poisons produced by bacteria
during an infection that stimulate chemical
mediators to affect the hypothalamus.
Endotracheal tube The basic tool of
endotracheal intubation which provides a
conduit for oxygenation and ventilation
between the patient’s lungs and the ventilator
(person or machine).
End-tidal carbon dioxide (ETCO2) A standard
method of measurement and monitoring
carbon dioxide levels used for both
confirming endotracheal tube placement and
monitoring patient status, ventilation, and
continuing tube placement.
Endocardium A single-layer thick sheet of
epithelial cells that act as a lining in the heart;
the heart’s innermost layer.
Enhanced excitability The ability to respond to
a much weaker stimulus.
Endocrine shock A fifth classification of
shock, which recognizes the importance of
hormones in maintaining homeostasis. The
classic endocrine shock is hypoglycemic
shock.
Endogenous Originating within the body.
Endorphins Neuromodulators that reduce the
sensation of pain and affect emotions by
attaching to opiate receptors on the neuron,
which in turn inhibit neural activity.
28 Enteral Administration of drugs through the
gastrointestinal tract, either through pills
taken orally or through suppositories.
Enteric coating A protective coating on a tablet
that permits the tablet to travel, unaltered,
through the stomach and into the intestine for
absorption.
Environmental risk Modifiable risk factors
that are a function of one’s lifestyle or
occupational choice, such as farmers
developing respiratory issues from their
exposure to dust.
Epicardium The heart’s outermost part; a part
of the pericardium that is closely adherent to
the heart.
Equity A concept of fairness or
evenhandedness. To be accepted, any change
must appear to be equitable to all parties
concerned.
Erythema Abnormal redness of the skin caused
by capillary congestion.
Epidemiology The study of the causes,
distribution, and control of disease in
populations.
Epiglottis A “U” shaped structure in the upper
airway attached to the anterior pharynx
between the base of the tongue and the larynx
that protects the lower airway from foreign
body aspiration.
Erythrocytes Red blood cells that transport
oxygen and carbon dioxide through the blood.
Epilepsy A neurological disorder
characterized by recurrent seizures that occur
without known cause.
Epistaxis Nosebleed.
Equianalgesic Drug characteristic in which a
dose of a new medication formulation has the
same ability to produce analgesia as 10
milligrams of morphine.
Escape mechanism A form of backup
pacemaker in the heart that will continue to
prompt contractions (at a slower rate) if the
SA node stops sending impulses.
Equiphasic A flatline pattern on an ECG
machine that occurs if the differences in the
flow of electricity result in a zero net
difference in direction.
29 Esophageal intubation detection devices
(EDD) Devices used to confirm endotracheal
tube placement. Two major styles of these
devices exist: self-inflating bulbs and syringe
style aspirators.
Etomidate A sedative that functions primarily
as a hypnotic, although it also is an excellent
amnestic.
Eustress A positive, manageable form of stress
from daily activities.
Eutectic mixture of local anesthetics (EMLA)
A cream that helps to reduce the pain of
needle insertion, consisting of lidocaine 2.5%
and prilocaine 2.5%.
Esophageal-tracheal Combitube (ETC) A
rescue device placed into the esophagus that
allows tracheal placement. The double-lumen
design allows for endotracheal as well as
esophageal intubation.
Ethical relativism When a majority of
Paramedics agree to a specific conduct or
course of action, determining that it does
more good than harm, which suggests the act
is ethical.
Ethics From the Greek “ethos” meaning
character, a system of guiding principles that
govern a person’s conduct.
Ethics committee A group that can help
individuals, including Paramedics, deal with
common ethical concerns.
Ethnocentrism A view that one’s own cultural
practices and customs are superior.
Etiology The origin of a disease.
30 Evaluation and Management Documentation
Guidelines Standardized histories that permit
the Paramedic to identify diseases, disorders,
and syndromes, vis-á-vis, through symptom
pattern recognition, and document the
medical necessity of the therapeutic services
provided to the patient.
Event monitor A credit-card sized device
patients may use to record abnormal ECG
activity that occurs very irregularly (as in
days or weeks apart). When the patient senses
the abnormal activity, the monitor is placed
on the chest for a preset period of time.
Event report Documentation following a mass
casualty incident that details the situation and
conditions that occurred which led to the
incident. Triage tags are attached to this
report.
Evidence-based practice A research approach
based on observed experimental results, in
hopes of making the results more reliable and
valid than peer reviews.
Exacerbation Periodic episodes in which a
chronic disease returns, or flares up.
Excitability The ability to respond to a
stimulus.
Excited delirium A physical state a restrained
patient may reach if agitated and combative
in which he becomes tachycardic,
hypertensive, and has hyperpyrexia.
Exercise A series of physical activities, both
aerobic (e.g., walking or jogging) and
strength training, which is considered optimal
to perform for maintaining health.
Exhaustion The final, recovery stage of the
general adaptation syndrome, which occurs
when the body’s response is insufficient to
meet the challenge of the stressor.
Exogenous Originating outside of the body.
Exotoxins Proteins produced by bacteria that
are released into the interstitial fluid. They are
then absorbed, because they are highly
soluble, into surrounding cells.
Expanded scope of practice Assigning
additional duties and responsibilities to
Paramedics beyond the scope of practice to
provide health care where scarce healthcare
resources exist.
Extrinsic trigger A stimulus prompting an
airway spasm that originates outside the
body, such as pollen, dust, and mold.
Exudate A collection of white blood cells and
fluids; whitish discharge.
Facilitation Interviewing technique in which
the Paramedic nods his head in
acknowledgement and says “Go on,” as well
as tries to make eye contact, which may
encourage the patient to continue talking
about a subject.
Facsimile machine A device that, using digital
technology, can transmit a high-quality copy
of documentation from one location to
another.
Exposure Situation in which blood or bodily
fluids from a patient are spilled, splashed, or
dripped onto or injected into a Paramedic.
Exposure report A special incident report
completed after an exposure that details the
circumstances that resulted in the Paramedic
being exposed, in hopes that a future
exposure will not occur in the same manner.
Expressed consent During an emergency
situation, an assumption that if a patient does
not object to receiving care, consent for the
procedure has been given.
External laryngeal manipulation A technique
used to improve visualization of the glottic
opening in which the Paramedic performs
direct laryngoscopy with his left hand while
manipulating the larynx with his right hand.
Once he has an improved view of the glottic
opening, the Paramedic has an assistant take
over the external laryngeal manipulation,
holding the larynx absolutely still.
Extracellular water The water that is outside
of cells.
Fading Progressive weakening of a radio wave
as it encounters more and more obstacles.
Fahrenheit scale A standard used to measure
temperature based on freezing and boiling
temperatures of a water and salt solution. In
this scale, water freezes at 32°F, water boils
at 212°F, and a person’s body temperature is
98.6°F.
Failure to thrive Situation in which a child
does not grow as expected, perhaps due to
psychosocial or nutritional imbalances.
Fallout Situation that occurs in the airway
whenever large particles carried in the air
current settle out as airflow velocity is lost.
31 False imprisonment A restriction of movement
or a confinement that abridges the patient’s
right to freedom, such as by the use of
restraints.
Fibrin An elastic, insoluble, whitish protein
produced by the action of thrombin on
fibrinogen and forming an interlacing fibrous
network in the coagulation of blood.
FarMedic© An EMS course specifically
directed to the rural or farm emergency.
Fibrinogen A protein in the blood plasma that
is essential for the coagulation of blood and is
converted to fibrin by the action of thrombin
in the presence of ionized calcium.
Fasciculations Transient fine muscle
contractions, seen after administration of a
depolarizing neuromuscular blocker.
Febrile non-hemolytic reaction An elevation
of the patient’s temperature of 1°C from
baseline within two hours of the start of a
transfusion which begins shortly after the
initiation of the transfusion or a new unit. It is
often secondary to minor antibodies present
in the recipient’s blood that cause a mild
reaction when exposed to the donor’s blood.
Fick principle The process of getting oxygen to
the cells, which can be summed up in five key
concepts: oxygenation, ventilation,
respiration, circulation, and cellular
respiration.
Federal Communications Commission (FCC)
The agency with rule-making and
enforcement responsibility for civilian radio
frequencies.
Feedback The mechanism by which the
Paramedic can ensure the message sent was
the message received and decoded; that is, the
message heard was the message sent.
Fee for service A “pay as you go” approach to
health care, with a certain amount of medical
care provided gratis to the poor or uninsured.
Femoral pulse A count of the beats created by
blood flow in the femoral artery that is
measured at the patient’s groin.
Fetal alcohol syndrome Umbrella term
covering a variety of birth defects caused by a
mother drinking during pregnancy.
Fetal hydantoin syndrome (FHS) Birth defects
such as cleft lip, cleft palate, and congenital
heart anomalies seen in children born to
mothers taking hydantoins during pregnancy.
32 Fidelity The physician’s obligation, and
therefore the Paramedic’s obligation, to keep
any promises made to the patient.
Field A place to enter data on a chart or form.
Field diagnosis See Paramedical diagnosis .
Fight or flight The body’s instinctive response
to a potential life threat, either to resist it or
avoid it. This primitive stress response may
have been critical to the survival of primeval
man, but can be unhealthy today.
Fire-based EMS Using the fire service, with
their combination of trained personnel, lifesaving equipment, emergency vehicles, and
strategically located stations, as the platform
for delivery of EMS; the predominant means
of delivering EMS in the United States.
Flail segment Condition that develops when
two or more adjacent ribs are fractured in two
or more places, which produces an unstable
area of the chest that impedes normal
respiration.
First-due report A brief synopsis of the scene
size-up obtained by the first arriving
responder.
First pass metabolism A chemical degradation
of a drug by the liver that markedly reduces
the drug’s bioavailability.
Fixed-post staffing The method of resource
allocation in which EMS is stationed in
centrally located standing facilities, from
which ambulances respond to emergencies.
Fixed-wing aircraft A traditional airplane,
rather than a helicopter, used by flight
Paramedics to transport patients.
Flashback A return of blood that may be
observed in the tubing when an IV solution
bag is lowered below the level of the patient’s
heart, which indicates that the IV access
remains patent.
Flight Paramedic The most highly trained level
of EMS provider; this individual transports
critically ill patients from emergency scenes
or other facilities to definitive care.
Fluori-methane A topical refrigerant,
sometimes called vapocoolant spray, that
numbs the skin at the injection site in as little
as 15 seconds.
Flush the line A procedure in which the
Paramedic runs fluid through an intravenous
administration set to remove any air bubbles
in order to prevent an air embolism.
Focused/vectored physical examination (PE)
A more detailed evaluation following the
primary assessment in which the Paramedic
looks for observations that the physician will
most likely request.
Followership A willingness to follow a leader’s
direction and to support the mission, putting
aside personal ambitions.
33 Food, Drug, and Cosmetic Act Law that
prohibits the sale of new drugs before they go
through safety testing.
General adaptation syndrome The body’s
predictable pattern of response to stressors.
Foreseeable harm Risks that can reasonably be
expected as a result of a medical procedure.
Frequency modulation (FM) When
modulating an audio signal, changing the
wave’s speed.
Fresh frozen plasma Blood component formed
by removing the red blood cells and platelets
from whole blood. The remaining liquid
component of the blood is still rich in several
of the clotting factors needed as part of the
coagulation system.
Functional job description Tasks described in
a job description that are needed to perform
the functions of the job, excluding rare or
marginal job functions.
Functional syncytium A group of myocardial
cells that act as a unit.
Gain Enlargement in the size of the tracing
shown on the ECG monitor screen.
Gait The way a patient walks.
Gallop The combination of the normal and
extra heart sounds that occur with changes in
ventricular filling. This produces a galloping
rhythm, similar to hearing a horse gallop.
Garbage can diagnosis An imprecise and
overgeneralized field diagnosis the Paramedic
might make that lends little direction to
patient care.
Gene A sequence of nucleotides in DNA on a
chromosome that determines an individual’s
physical characteristics.
General impression A Paramedic’s overall
evaluation of the patient, in which she
assesses the patient’s mental status, airway,
breathing, and circulation, to determine which
patients require immediate transport.
Generation A span of time used to differentiate
advancements (e.g., the next generation of
drugs).
Generic name A simple name given to a drug,
often listed by the manufacturer in the United
States Pharmacopeia (USP).
Genetic make-up Those physical
characteristics that make up a person,
including appearance, disposition, and so on.
Genotype An individual’s genetic make-up.
Gestalt A decision-making process in which the
Paramedic comes to a conclusion not through
a summation of symptoms but rather from
patterns observed in similar situations in past
practice and experience. Also referred to as
the Paramedic’s “gut feel.”
Glottis The space between the vocal cords.
Glucagon An enzyme that breaks down
glycogen into individual glucose molecules.
34 Glycogen A dual molecule in the liver and
muscles that stores any glucose which is not
needed immediately by the body.
Glycolysis An aerobic process during which the
body uses eight different enzymes to divide
glucose and create a chemical called
pyruvate.
Glyconeogenesis The production of glucogen
from amino acids and fatty acids contained in
lipids.
Glycoside Any of a group of organic
compounds, occurring abundantly in plants,
that yield a sugar and one or more nonsugar
substances on hydrolysis.
Good Samaritan statutes Laws that protect
well-meaning people who, although they have
no duty to provide care to an injured person,
do so nonetheless.
Governmental immunity Also called sovereign
immunity, a practice in which the government
is exempt from liability for torts committed
by its employees except to the extent that it
has consented by statute to be sued.
Haddon matrix An easily understood concept
map of injury causation and prevention.
Using a model similar to the one used for
disease, Haddon plotted the factors that cause
injury across a horizontal X-axis and the
stages of an injury process along the Y-axis.
The result was an injury prevention matrix.
Half-life (t1/2) The point when the decline of
the amount of a drug in the bloodstream due
to metabolism reaches 50%.
Hands-off The process in which one mobile
radio tower switches the transmission to
another tower so that there is no interruption
in transmission.
Hanger Hook-like device an IV bag is hung
from.
Hanging the bag Process of suspending an
intravenous solution for delivery to the
patient.
Hard-wire Use of physical transmission lines
for communication rather than radio waves,
i.e., wireless.
Gross negligence Intent to willfully, or with
reckless disregard for a patient, cause harm to
a patient.
Hard wire monitoring Devices that feature
electrodes running from the device to the
patient, causing limited mobility for the
patient.
Ground wave High-frequency (HF) radio
transmissions that are capable of being
transmitted over the land.
Harrison Act A law established in 1914 that
made it illegal to obtain “narcotics” (e.g.,
morphine) without a prescription.
Guidelines General rules that provide the
Paramedic with direction while also
permitting use of her knowledge and
experience to shape clinical decisions.
Whenever guidelines are in use, the
Paramedic must be willing to discuss and
defend the clinical decisions.
Head elevated laryngoscopic position (HELP)
A patient position that places the head in
extension along the atlanto-occipital joints,
bringing the pharyngeal, laryngeal, and oral
axes into alignment using an elevation pillow.
It can also be used in patients who are unable
to lay flat (i.e., CHF patients or morbidly
obese patients) or to help clear secretions.
Gum Sometimes called resin, a complex sugar
in plants, a polysaccharide, that when
moistened becomes a gelatinous material.
35 Healthcare proxy This person has a
responsibility to review the medical record,
consult with healthcare providers, and give
consent to either initiate or to refuse care for
the patient.
Health Insurance Portability and
Accountability Act (HIPAA) Federal
legislation that has placed conditions upon all
healthcare providers that protect patient
privacy during claims processing, data
analysis, utilization review, quality assurance,
and practice management.
Health maintenance organization (HMO) A
managed care system that provides payments
to healthcare providers at a negotiated annual
per capita rate. These rates are based on
practice history of the insured patients and
helps to prevent fluctuations in payments,
thus making expenses, costs, and budgets
more predictable.
Heart failure Situation in which an impaired
heart cannot meet the body’s demands for
perfusion.
Heave To cause to swell or rise. When referring
to the heart, a heave indicates the heart is
beating so forcibly that the chest wall is felt
to move by the Paramedic assessing the
patient.
Heel stick Puncturing an infant’s heel with a
lancet then drawing the blood off with a
capillary tube to acquire a sample.
Hematocrit The volume of red blood cells in
the blood expressed as a percentage.
Hematoma A mass of clotted blood that forms
in a swelling as a result of a broken blood
vessel.
Hematopoiesis The manufacturing process the
body uses to create the three main solid
components of blood: red blood cells, white
blood cells, and platelets.
Hemicorporectomy Amputation at the waist.
36 Hemocytoblast The generic stem cell from
which all other blood cells (red, white, and
platelets) develop.
Hemoglobin The molecule in red blood cells
that accepts oxygen in the lungs and carries it
to the body’s tissues to allow cellular
respiration.
Hemolysis The disintegration of red blood cells,
resulting in a release of hemoglobin.
Hemostasis The stoppage of blood flow through
a blood vessel or body part.
Hemothorax Collection of blood in the pleural
cavity which can cause lung collapse.
Heparin sulfate An anticoagulant released from
the endothelium of the walls of the arteries
that temporarily prevents blood clot
formation in the narrowed coronary arteries.
Heparin well An intermittent infusion device
filled with heparin to prevent clot formation
in the device.
Hepatectomy The surgical removal of a portion
of the liver.
Hepatojugular reflux An elevation of venous
pressure visible in the jugular veins when
firm pressure with the flat hand over the liver.
Hermeneutics The Paramedic’s ability to put
himself in the patient’s situation, with all of
the accompanying physical and cultural
influences, in order to understand the patient
better.
Hernia Openings in the muscle and tissue
layers that allow the an organ to protrude
through the opening into another cavity.
Hertz A unit of frequency measured in cycles
per second.
Hexaxial reference system An artificial
construct created to help conceptualize the
heart’s normal axis and to help determine if
there is any axis deviation.
Histoxic hypoxia The inability of the cells to
accept or use oxygen, such as in cyanide
poisoning.
Holter monitoring A continuous type of ECG
monitor that records the ECG activity while
the patient goes about his routine work and
play activities, which is often used on patients
with sporadic dysrhythmia problems.
Homeostasis The processes a body undertakes
to try to maintain a constant state of balance
or equilibrium.
High-flow nasal cannula (HFNC) An advance
in nasal cannula technology in which, by
humidifying and warming the oxygen and
using membrane technology, up to 40 LPM is
comfortably delivered to the patient through a
nasal cannula.
High priority patients Patients with the most
serious, yet treatable, conditions. They are
generally transported to the hospital
immediately, with further assessment being
performed en route.
History of present illness (HPI) A
chronological description of the development
of the patient’s present illness, including
symptoms the patient is currently displaying,
which may help the Paramedic make a
diagnosis. This can be determined by asking
when, where, why, and how type questions
about the problem.
History taking Medical questioning to
determine the disorder, syndrome, or
condition affecting the patient that resulted in
the call for assistance.
Horizontal equity Injury prevention strategy in
which standards are broadly applied to all
individuals equally, such as the level of a
legal blood alcohol content.
Horizontal leadership A leadership style that
“flattens the pyramid” so Paramedic leaders
work toward linking, or networking, with the
members of a public safety team. Horizontal
leadership emphasizes an “out and back” line
of communication instead of an “up and
down” line of communication and can be
visualized more like a wagon wheel.
Hormones The chemical messengers that
stimulate the body’s organs and help to
maintain the body’s internal environment.
Hospice A concept of care focused on providing
for the physical, emotional, and spiritual
needs of a terminal patient.
Hospital-based EMS An EMS system design
where a hospital provides EMS services in
the form of a flycar or ambulance.
Hotline A telephone number dedicated to
providing the caller with immediate
assistance.
Huber needle A beveled needle intended to
pierce a stopper without coring it, thereby
preventing leakage of the contents within the
catheter from leaking out of the stopper when
the needle is withdrawn.
37 Human dignity The right of every person to be
treated respectfully, regardless of his or her
station in life.
Hypercarbia Condition in which the amount of
bicarbonate ions in an arterial blood gas
sample is greater than 30.
Human rights Rights based on a commonly
desired human condition (i.e., freedom from
want, freedom from pain, and freedom from
suffering). Human rights involve universally
accepted standards of justice.
Hyperlipidemia An abnormally high level of
triglycerides and cholesterol which, when
uncontrolled, can lead to atherosclerosis.
Humoral immunity The component of the
immune system involving antibodies that
circulate as soluble protein in blood plasma.
Hydrostatic pressure Pressure created by the
force behind the volume of water in the body.
Hyoid The only bone in the body that does not
directly articulate with another bone. Instead,
it serves as a common point of attachment for
a number of muscles and ligaments that
function in swallowing and airway
maintenance.
Hyperoxia Condition in which partial pressure
of oxygen dissolved in the arterial blood gas
sample is greater than 100.
Hyperplasia An abnormal increase in the
number of cells due to frequent cell
division/reproduction which causes the tissue
or organ to increase in size.
Hyperpnea Deep breathing.
Hyperreflexive Reflexes that are significantly
more brisk than normal.
Hyperresonant Percussion notes that sound
similar to striking a drum, indicating an
increased amount of air in the chest.
Hypertension A systolic blood pressure that is
above the upper limit of normal.
Hyperthermia A condition that occurs if too
much heat builds up in the body’s core; a
body temperature above 38°C (100.4°F).
Hyperacute T wave An increase in the
amplitude of T waves in the leads facing
cellular damage.
Hypertonic Fluid that has less water and more
salt (electrolytes) than the solution on the
other side of a semipermeable membrane.
Hypertonic fluid on the other side of a
semipermeable membrane will pull fluids into
itself.
Hypercapnia Condition in which the partial
pressure of carbon dioxide dissolved in an
arterial blood gas sample is greater than 45;
increased carbon dioxide levels.
38 Hypertrophy An increase in either the weight
or functional capacity of a tissue or organ
beyond what is normal.
Hyperventilation A deeper than normal
respiration that may be caused by respiratory
distress, a metabolic condition, or drug
overdose.
Hypotonic Fluid that has more water and less
salt (electrolytes) than the solution on the
other side of a semipermeable membrane. In
an effort to balance concentrations, the water
from the hypotonic solution will cross the
membrane until the two solutions are
balanced.
Hypnotic state A sleep-like condition often
induced by a large dose of CNS depressants.
Hypocapnea Condition in which the partial
pressure of carbon dioxide dissolved in an
arterial blood gas sample is less than 35.
Hypocarbia Condition in which the amount of
bicarbonate ions in an arterial blood gas
sample is less than 22.
Hypoglycemia Condition in which blood sugar
(or blood glucose) concentrations fall below a
level necessary to properly support the body’s
need for energy and stability.
Hypoventilation Shallow respirations that can
be caused by drug overdose, head injury, or
another condition.
Hypokalemia The development of low sodium
potassium in the blood serum.
Hypovolemic A state of decreased circulating
blood volume.
Hyporeflexive Reflexes that are significantly
less brisk than normal.
Hypovolemic shock The first category of the
Hinshaw—Cox shock classification, which
includes shock that arises from trauma
(hemorrhagic shock) but also includes other
etiologies where there is a loss of circulating
blood volume.
Hyporesonant Percussion note that is dull in
character and often indicates fluid in the lung.
Hypotension A systolic blood pressure below
the lower limit of normal.
Hypothermia A condition that occurs if there is
too little heat in the body’s core; a body
temperature less than 35°C (95°F).
Hypoxemia A decreased oxygen level in the
blood.
Hypoxia Condition in which partial pressure of
oxygen dissolved in an arterial blood gas
sample is less than 70; low oxygen
concentration that causes cells to redirect
their metabolic processes to anaerobic
respiration in an effort to sustain the cell.
Hypoxic hypoxia Lack of oxygen, due to an
oxygen poor environment, which can lead to
hypoxia.
39 Iatrogenic Adverse effects or complication that
results from a medical intervention.
Idiosyncratic reaction Situation in which a
drug produces an unpredictable reaction that
is not allergic in nature or due to overdose
and resultant toxicity, but often due to the
patient’s genetic make-up.
Immune complex Situation in which an
antibody has attached to an antigen and
stimulates the complement system.
Immunocompetent Capable of providing
immunity.
Immunoglobulins A type of protein globulin.
Five types of immunoglobulins have been
identified: IgA, IgD, IgE, IgG (gamma
globulin), and IgM. Each immunoglobulin
fits into the surface of an antigen in a key and
lock fashion, linking them together.
Implanted vascular access device (IVAD) A
central venous catheter that has the port
buried in a subcutaneous pocket under the
skin’s surface. Implanting the entire device
affords the IVAD the skin’s protection, which
decreases the rate of infection, as well as
protects the port from physical trauma.
Implied consent An assumption that an
unconscious patient in danger would consent
to a life saving procedure if awake and
capable of consenting.
Incidence The number of new cases of a disease
per standardized group per time. An example
would be 1 case per 100,000 per year of x
disease.
40 Incision and drainage (I&D) A minor surgical
procedure used to release pus or pressure
from a site such as an abscess.
Indirect statement A question that asks for an
explanation that is not constrained by the
question. An example of an indirect statement
would be, “Please tell me about your pain.”
In extremis An appearance of grave illness or
mortal injury.
Infarction A large area of necrosis in a tissue or
organ.
Inflammation A protective reaction of tissue to
irritation, injury, or infection, characterized
by localized pain, redness, swelling, and
sometimes loss of function.
Initial assessment See Primary assessment.
Initial impression A global patient assessment
made on initial contact with a patient based
on a myriad of factors such as patient
presentation, environmental factors, gross
observation, and resources on-scene.
Injury Something that damages or harms.
Injury prevention See Prevention; Injury
prevention strategies.
Injury prevention strategies Techniques used
to go about implementing Haddon’s
countermeasures, which include engineering
safety into products or processes, educating
people about the dangers, increasing or
improving enforcement of laws and
regulations which promote safety, and
providing economic incentives for people to
use safer products or processes.
Inotropy To make the heart beat harder.
Insensible loss The volume of fluid that is lost
from the body in the form of perspiration off
the skin (1.1 liters/daily) and the vapor in the
breath.
Insight An understanding of the patient’s
current or chronic medical condition, as well
as the consequences of inappropriate
treatment; the ability to make reasonable
decisions.
Inspection A physical examination technique
that involves looking closely at the patient.
Internal locus of control The idea that one has
the ability to remain in control of a given
situation.
International unit (IU) A standardized
measurement that reveals the quantity of a
biologically active substance, such as a
hormone or vitamin, required to produce a
specific response.
Interpretation An interviewing technique in
which the Paramedic tries to determine the
meaning of a message based on what is said
and the speaker’s nonverbal cues.
Interstitial fluid The fluid between cells.
Interval A segment and an ECG wave together.
Inspiratory capacity The total of the tidal
volume plus the inspiratory reserve volume,
which is a measure of the maximum air that
can be inspired.
Institutional Review Board (IRB) An
independent ethics committee consisting of
experts from the fields of theology, sociology,
psychology, and medicine, which is
responsible for reviewing all aspects of a
proposed research project in terms of the
potential psychosocial impact and to ensure
that all human subject research is ethical.
Integrity A personal commitment to a code of
moral or ethical behavior which serves as a
foundation for the patient–provider
relationship.
Intended biological effect The modification a
drug is designed to have on the function of a
tissue or an organ, such as reduce fever,
eliminate pain, and so on.
Interference Extraneous electromagnetic
energy heard on the radio as crackles and
dead spots.
Intimate space In the theory of proxemics, an
area about the size of a beach blanket where
patients feel most vulnerable. Entry into that
space is only permitted to those people whom
the patient trusts.
Intracellular water The water that is within
cells.
Intradermal Injections that place a small
quantity of medicine just under the epidermis
and in close proximity of the subcutaneous
tissue.
Intramuscular injection Injection deposited
between the layers of muscle, which is a
common method of medication
administration.
41 Intraosseous (IO) An injection into the bone
marrow.
Intravascular fluid A type of extracellular
water found in the blood, which is primarily
made of plasma and constitutes about 4% of
the total body weight (3 or 4 L).
Intrinsic rate The rate at which the pacemaker
cells of the heart depolarize.
Intrinsic trigger A stimulus prompting an
airway spasm that originates within the body,
such as through stress or exercise.
Inverted T waves A negative T wave that’s
normally positive and upright, which may
indicate coronary ischemia.
Isoelectric line A line on the ECG that extends
from the end of the T wave to the start of the
ventricular depolarization represented by the
QRS complex. This line indicates the period
of time when the myocardium, particularly
the ventricular mass, has been repolarized and
awaits depolarization. An isoelectric line on
the monitor and on the rhythm strip should
appear as a fl at line between ECG
complexes.
Isometric Exercise using free weights.
Isotonic In terms of exercise, resistance
exercises. In terms of fluid management, a
balanced solution (equal water and salt on
both sides of a membrane).
Involuntary consent Situation during a life or
limb emergency in which an officer can
provide consent for a person in custody (e.g.,
a prisoner). Involuntary consent is usually
reserved for true emergencies; the police
power to provide consent is not generally
invoked for minor emergencies or elective
procedures.
Ions An atom that has a positive or negative
charge due to a gained or lost electron.
Ischemia A deficient supply of blood going to a
body part due to an obstruction of the inflow
of arterial blood.
Ischemic hypoxia Problems of circulation that
can lead to oxygen deprivation at the cellular
level.
Ischemic patterns Changes in an ECG as the
result of abnormal repolarization.
42 IV bags Soft plastic solution containers that
collapse as the solution is withdrawn,
eliminating the need for venting. These create
a closed system that helps to decrease the risk
of outside contamination.
IV push Procedure in which a Paramedic
administers medication by attaching a syringe
filled with the medication to an infusion
device and rapidly injects the medication.
Jaundice A yellowish hue of the skin, which
can indicate liver failure or obstruction of the
bile duct.
Justice The application of the concept of
fairness, which implies impartiality in the
administration of rewards. In terms of
research, the belief that one group of people
should not bear all the risks of research when
the benefits of said research would benefit all
persons in the larger society.
J-wire A special tightly wound spring wire with
an open hook at the end to prevent it from
puncturing soft tissues, which is inserted into
the hub of a needle during the Seldinger
technique.
Joule heat Heat caused by the buildup of
thermal energy as a result of electricity
overcoming resistance from the tissues.
Kaizen Japanese concept of continual self
improvement that emphasizes process and
system thinking.
J point The start of the ST segment found at the
juncture of the QRS and the ST segment, the
point where the angle from the QRS changes.
Keep the vein open (KVO) A slow infusion of
fluid designed to be just enough to keep the
veins from occluding.
Jugular venous pressure The force at which
blood flows throughout the venous system,
which can help diagnose issues in the lung
and heart.
Kefauver-Harris Act A 1962 amendment to
the Federal Food, Drug and Cosmetic Act that
required all drugs to undergo an extensive
review that not only ensured the public’s
safety, but also reassured the public that a
drug would do what it claimed to do.
Ketamine A dissociative anesthetic that
provides excellent amnesia, analgesia, and
anesthesia during procedures and intubation.
Most notably, however, it has minimal
respiratory depression even at very high
doses.
Kinematics The branch of dynamics that
studies motion apart from mass and force
considerations.
Junctional tissues A long strip of tissue below
the AV node connecting the atria and the
ventricles that is capable of independently
initiating a stimulus if the SA nodal impulse
should fail to depolarize one first.
Kinesics The study of nonverbal behavior in
interpreting communications.
Knowledge base The Paramedic’s previous
experiences, anecdotal information, and
formal medical education.
Jurisdiction The court having authority to
decide a legal case, typically based on
location.
43 Korotkoff sounds Sounds heard during the
inflation and deflation of the cuff that are
caused by the change in the nature of blood
flow through the artery.
Labor Uterus contractions which signify the
start of the childbirth process.
Lacerations A torn or ragged wound.
Landline A hard-wired telephone.
Laryngeal mask airway A blindly inserted
airway device designed to be used in
situations where face-mask ventilation was
inappropriate but the invasiveness of
endotracheal intubation was not necessary.
Lead Any of the conductors connected to the
electrocardiograph, each comprising two or
more electrodes that are attached at specific
body sites and used to examine electrical
activity by monitoring changes in the
electrical potential between them.
Lead I An electrode point that measures the
voltage change between the right arm and the
left arm. The negative electrode is on the
right arm. The positive electrode is on the left
arm.
Lead II An electrode point that notes the
change between the right arm and left leg and
provides a view of the inferior wall of the
heart. The positive electrode is located on the
left leg.
Lead III An electrode point that measures
change between the left arm and left leg. The
positive electrode is on the left leg.
Laryngoscope The primary, compact, and selfcontained device healthcare providers use to
visualize the larynx.
Leading question A question that may direct
the patient toward an answer that might not
necessarily have been given if asked in
another manner; for example, asking “Was
the pain crushing?” rather than “Tell me what
the pain in your chest was like.”
Left anterior descending coronary artery
(LAD) A coronary artery branch that
provides blood to the anterior wall of the left
ventricle.
Larynx Also known as the “voice box,” the
upper group of structures of the lower airway
that contains the vocal cords.
LD50 Shorthand for lethal dose 50%, the drug
dosage where 50% of the test animals given
that dose died.
Left bundle branch A division of the bundle of
His that lies within the septum and serves as a
further passageway for electrical impulses
into the left ventricle.
44 Legitimate interest A determination of which
individuals need access to a patient’s
confidential medical information, and the
extent of the information they are entitled to
view.
Legitimization The process in which a
Paramedic listens and seeks to understand the
patient and the patient’s concern, regardless
of how seemingly insignificant the problem.
This process supports the patient and
demonstrates caring.
LEMON law A rapid mnemonic used to predict
a difficult airway when evaluating a patient.
The elements of the LEMON law are to:
■ L—Look externally for anything that will
hinder ventilation or intubation
■ E—Evaluate the 3-3-2 rule to assess the
airway anatomy
■ M—Mallampati classification
Leukocytes White blood cells, which help the
body fight off disease.
Leukotrienes Slow acting substances of
anaphylaxis that produce chemical effects
similar to histamine and help to prolong the
inflammation.
Libel Situation in which a falsehood damaging
to a person’s reputation is written or printed
and then disseminated to the public.
Lidocaine A common local anesthetic and
antiarrhythmic drug.
Life-long learning The commitment made by
all Paramedics when they attain their first
certification to remain current with the state
of the profession.
Lighted stylettes Malleable stylettes with a
bright light source at the distal end and a
power source at the proximal end. When
placed in the trachea, a bright, wellcircumscribed light is seen in the midline of
the trachea.
■ O—Obstruction, either new or chronic,
should be evaluated
■ N—Neck mobility should be determined if
not contraindicated (contraindicated in
suspected C-spine injury) .
Les ambulance volutes Light two-wheeled
carriages used by the French military in the
early 1800s that carried an attendant as well
as a driver, often viewed as the precursor to
the modern ambulance.
Line of sight (LOS) The path that radio
transmissions take over land, which ideally
are free of obstructions that will impede the
radio waves.
Line-out To place a single diagonal line across
any open areas of a document in order to
prevent the addition of new content to a PCR
by others after the Paramedic has completed
the PCR.
Lipid-soluble A substance that is able to be
dissolved in lipids (fat).
45 Lipophilic Characteristic of being attracted to
lipids.
Liquid oxygen (LOX) Concentrated oxygen in
liquid form.
Liquifactive necrosis Process in which cells
that are largely lipid in content, such as the
neurons of the brain, simply liquefy upon
death and leave a pool in their place.
Literature Published reports of research.
Livor mortis A condition caused by relaxation
of the vascular bed and a pooling of blood in
dependent portions of the body.
Loco parentis Legal doctrine that states if a
child has been left in the custody and care of
another adult (e.g., a schoolteacher) then that
adult has the authority to provide consent for
medical care.
Lotions Topical medications mixed in water.
Lower esophageal sphincter (LES) A
functional portion of the esophagus where its
walls contract inwardly, forming a physical
barrier to the reflux of stomach contents up
the esophagus.
Lymphocytes Almost colorless cells found in
the blood, lymph, and lymphoid tissues,
constituting approximately 25 percent of
white blood cells and including B cells, which
function in humoral immunity, and T cells,
which function in cellular immunity.
Lysosomes Tiny sacs in a cell that contain
enzymes which can break down proteins.
Macintosh blade A curved laryngoscope blade
with common sizes from 1 to 4 with a large
flange and flat surfaces to control the tongue.
Macro-drop Administration set with a short,
straight line that has few obstructions, such as
filters or medication portals. It is used when
volume replacement is needed (e.g., during a
trauma resuscitation).
Low priority patients Patients with relatively
minor conditions who can typically be treated
in a more focused manner on-scene.
Lozenges Medicines intended to dissolve in the
mouth.
Luer lock A needle adaptor that attaches to the
syringe hub by use of a twist connection,
where the adaptor on the syringe is grooved
and will mate with a flange on the needle hub.
Lymphangitis Inflammation of the lymphatic
channels in the skin that occurs when there is
spread of an infection from a site distal to the
channel.
Lymphedema The swelling of tissues on a limb
due to lymphatic obstruction.
46 Macroglossia A state of having an abnormally
large tongue.
Magmas Powdered drugs with particles so large
that they are visible when they are mixed, or
suspended, in water.
Malfeasance Wrongdoing or misconduct; for
example, if the Paramedic performed an
inappropriate procedure (e.g., gave a fluid
bolus to a hypertensive head-injured patient).
Malignant Cancerous; something that will
cause harm or damage health.
Mechanism of action The way a drug
specifically works upon a cell.
Malignant hyperthermia A skeletal muscle
disease that leads to a life-threatening
reaction to succinylcholine and some other
inhaled anesthetics.
Mechanism of injury (MOI) A description of
the forces applied to a patient with the
potential to cause injury, such as a motor
vehicle collision (MVC) or a fall.
Malpractice Failure to exercise an appropriate
degree of professional skill during a service,
resulting in injury, loss, and damage.
Managed health care A financial system where
a large corporation or the government obtains
health insurance for its workers via private
sources, who then gather groups of healthcare
providers and obtains a reduced rate in
exchange for a guaranteed client base. The
managed healthcare insurance plan then
mandates that patients seek treatment from
this preferred medical group, in essence
managing the care that the patient will receive
by providing medical care for the lowest
price.
Mandatory reporting A situation in which one
is required by law to report a crime, such as
child abuse, sexual assaults, gunshot wounds,
certain communicable diseases, and animal
bites.
Mason–Likar modification Adjustment in the
placement of electrodes to help Paramedics
obtain a more accurate 12-lead ECG, which
involves moving the electrodes to the
shoulders and the hip rather than the ankle
and wrist.
Masses A large, firm area of considerable size
in the body.
Master problem list In a POMR recordkeeping
system, a list of the medical conditions for
which a patient had been, or currently was,
receiving treatment.
Medical command An immediate and direct
physician involvement in patient care. The
physician’s authority can be exercised either
on-scene or over-the-air at the time of an
emergency.
Medical ethics The way Paramedics behave in
regard to patients.
Medical intelligence The healthcare provider’s
process of learning from experience and past
medical practice and then coming to a
decision.
Medical lines Sometimes called lifelines, a
means of adding medications directly into the
circulation.
Medical oversight When a physician is
involved in the quality assurance/quality
improvement process and provides direction,
either in the form of protocols or education,
to Paramedics.
Medical Priority Dispatching™ A
classification system designed to ensure the
right response gets to the right person at the
right time.
Mean arterial pressure (MAP) The average
blood pressure in the arterial system over
time, typically about 60 to 80 mmHg.
47 Medical record Documentation about the
patient’s condition that will be used in the
future by other physicians and allied
healthcare professionals for patient care. As a
part of the medical record, the patient care
report often provides vital information to
physicians about the origin of a condition or
disease.
Menopause An age-related cessation of a
woman’s menses for an entire year, generally
indicating the end of the woman’s
reproductive abilities.
Medical restraint Any device used to
immobilize a patient for both the patient’s
and the care provider’s safety; may include
straps, jackets, and so on.
Meta-analysis A technique used when it is
difficult to obtain a large population of study
subjects, or the event being studied is
relatively rare. The results of several similar
small studies are combined and a statistical
hypothesis test is applied, taking into account
differences in subjects and methods used
before a conclusion is made.
Medical self-help Instructions provided to
patients by 9-1-1 on self-rescue actions they
can take during the time before responders
arrive.
Medical utility An assumption that those with
the best medical prognosis should be treated
with the medical provider’s limited resources.
Medication-facilitated intubation The use of
adjunctive medications during intubations,
either to provide sedation or cause muscular
paralysis to protect patients and improve their
quality of care.
Medulla oblongata The part of the brain
responsible for controlling involuntary vital
functions; the brainstem.
Membrane attack complex (MAC) In cases
where the body does not recognize the
bacteria and cannot mount an effective
antigen—antibody defense, a complex
created by the complement system which
attaches itself to the cell’s walls and forms a
tube from the outside to the inside. The tube
allows water to enter the cell, the cell to
swell, and the cell to lysis.
Memory cells Clone cells that have a memory
of the make-up of the original cell.
Meniscus A concave-curved shape liquid
assumes due to tensions within a syringe.
48 Mentors Experienced master Paramedics who
take on graduate Paramedics as their protégés
to teach them paramedicine.
Metabolic acids Acids formed during anaerobic
metabolism and amino acids formed by the
breakdown/oxidation of proteins.
Metabolism Biochemical reactions that need to
occur for life processes to go on.
Metabolite A chemical produced by
degradation of a medication into
subcomponents that may be active or
inactive.
Metaplasia Replacement of one adult cell type
with another type of adult cell.
Metered dose inhaler (MDI) Portable and
simple to operate respiratory device that
delivers a specific amount of aerosolized
medication to the lungs.
Micro-drop Administration set with fine
control of the infusion stream, used when
careful titration of medicated fluid is desired
(e.g., when a medical patient needs a slow
infusion of a drug). Misfeasance To perform a legal action in an
illegal manner; for example, if the Paramedic
performs the correct procedure but does so
incorrectly.
Mitochondria The largest organelle in the cell,
found outside a cell’s nucleus, which
produces energy.
Mitosis The process of cell division.
Micrognathia A state of having a small jaw.
Milieu An environment where an action can
occur.
Military emergency medicine The largest and
oldest EMS service, consisting of those who
provide emergency medical care to members
of the armed forces.
Miller blade A straight laryngoscope blade with
common sizes from 00 to 4 with a small and
curved flange designed to open a conduit to
the larynx on the right side of the mouth and
hold the tongue in the midline to the left side
of the mouth.
Mobile data terminal Laptop or handheld
computers inside a vehicle a Paramedic can
use to create a downloadable document for
transmission over a telephone line, via
modem, over the Internet, or by using
wireless technologies.
Mobile subscriber units (MSU) The various
varieties of cellular phones for use within a
cellular radio system. The three main
varieties are the portable cellular telephone,
the transportable cellular telephone, and the
mobile telephone.
Modified chest Lead 1 (MCL1) An alternative
ECG lead Paramedics may use to monitor
patients instead of/in addition to Lead II.
MCL1 simulates the precordial lead V1, one
of the six precordial leads of a 12-lead.
Minimum data sets Certain fields with
requested information that must be completed
on a PCR or other form.
Morality A personal code of conduct.
Minute ventilation A measure of the total
volume of gas that passes through the lungs in
a minute. It equals the respiratory rate (RR)
times the volume per breath (Tidal Volume,
or TV).
Moral obligations Certain mores that go
beyond the basic human rights which every
patient enjoys; for example, an off-duty
Paramedic’s moral obligation may be to
provide care when coming in contact with an
injured person.
49 Morbidity The incidence of disease.
Morphology The shape of a QRS complex
wave.
Myocardial ischemia A condition that occurs
prior to myocardial cell death in which the
heart tissue is slowly or suddenly deprived of
oxygen and other nutrients.
Mortality The state of death.
Motion A request sent to a judge for some
action (i.e., dismiss the case, order a party to
do something, postponement, cease and desist
orders, etc.). A motion can be verbal, but is
most often a written request that contains
pertinent points for the judge to consider.
Mucolytics Drugs that thin mucous secretions
and physically break down the viscosity of
mucus by breaking apart the mucoprotein
structure.
Multiple organ dysfunction syndrome
(MODS) A failure of two or more organ
systems.
Multiplex Radios that permit the transmission
of audio signals as well as data.
Municipal EMS service A governmentfinanced and administered EMS system that
may exist as an independent entity or crosstrained with the police or fire department.
Murphy’s sign Right upper quadrant tenderness
that worsens when the patient takes a deep
breath while the quadrant is palpated. A
Murphy’s sign indicates gallbladder
inflammation .
Muscarinic receptors Parasympathetic
neuroreceptors that are slower than nicotinic
receptors and indirectly open ion channels
that cause depolarization. Muscarinic
receptors, by definition, are more sensitive to
muscarine, a naturally occurring chemical
found in mushrooms, than to nicotine.
Mutation A change in the DNA sequence of
one gene.
Myocardial infarction The death of myocardial
cells.
50 Myocardium A muscular layer that actually
performs the heart’s work by contracting
forcefully and ejecting blood from within the
heart’s chambers.
Myoglobulinuria A condition in which the
protein products of muscle breakdown clog
the kidneys.
Narcotic The hallucinogenic effects of opiates,
thought to be the result of stimulation of the
sigma receptors located in the limbic system.
Narcotics A class of drugs known for their
ability to induce a profound state of sedation.
Nares The openings to the nose; nostrils.
National EMS Education Program
Accreditation A designation that assures
students their EMS education will meet
national standards and assures the public that
graduates of those educational programs will
be competent providers.
Nasogastric tube A single-lumen tube passed
through the nose into the stomach to evacuate
air from the stomach.
Nasotracheal intubation The process of aiding
respiration by placing an endotracheal tube
through the patient’s nostril and into the
trachea.
National Association of EMTs (NAEMT) A
professional organization, founded in 1975,
whose mission is to represent the views and
opinions of all prehospital care providers.
National Centers for Injury Prevention and
Control A federal agency tasked with injury
surveillance.
National EMS Core Content Created under the
leadership of the National Association of
EMS Physicians (NAEMSP) a curriculum
that defines the entire universe of disorders,
diseases, syndromes, and skills that an EMS
provider might encounter and for which he
would be expected to provide emergency
care.
National EMS Education Standards Created
under the leadership of the National
Association of EMS Educators (NAEMSE),
the basis for EMS instruction that provides
direction for EMS educators regarding both
the core content and the scope of practice.
National EMS Scope of Practice (NEMSSOP)
Created under the leadership of the National
Association of State EMS Officials
(NASEMSO), an organizational plan that
clearly defines four levels of EMS providers
and identifies the knowledge and skills
required for each level.
National Formulary (NF) A drug reference
manual that lists medications which are
approved for prescription. It contains specific
chemical information that is more helpful to
the pharmacist and manufacturer than the
physician.
National Registry of Emergency Medical
Technicians (NREMT) An organization that
provides a process of practical testing and
written examinations for the certification of
Paramedics, providing proof that the
individual being licensed is minimally
competent to provide a specified level of care.
The majority of states currently accept
National Registry certification for state
licensure.
National Standard Curriculum (NSC) A
seminal document that defines the scope of
practice for many EMS providers distributed
by the National Highway Traffic Safety
Administration (NHTSA).
Nature of illness The history of the present
patient’s illness, often reported by the patient
himself or the patient’s family.
51 Necrosis A physiological process in which
living cells die, often due to disease, injury,
or some other pathological state.
Needle cricothyroidotomy A type of surgical
airway performed by piercing the
cricothyroid membrane with a large bore
needle and catheter, allowing rapid access to
an otherwise obstructed airway.
Neuromuscular blocking agents (NMBAs)
Medications that block transmission of nerve
impulses to skeletal muscle at the
neuromuscular junction.
Negative pressure ventilation A mechanical
ventilation technique in which a negative
pressure environment is created around the
patient’s chest, thus sucking air into the
lungs. An iron lung is an example.
Negligence A failure to exercise the degree of
care that a prudent person would exercise.
Negligence per se Situation in which a
Paramedic commits a criminal act, and the
patient is injured as a result of that criminal
act. The assumption is that the Paramedic’s
negligence flows from the criminal act.
Neuroreceptor A chemical receptor that
receives messages from the neurotransmitters.
Neurotransmitter A chemical messenger that
transmits a nervous signal across the synapse.
Neuroleptics Major tranquilizers that prevent
nausea.
Nicotinic receptors Chemical receptors from
the parasympathetic nervous system found in
the central and peripheral nervous system as
well as the neuromuscular junction with
skeletal muscles. Cholinergic stimulation of
nicotinic receptors is quick in onset and short
in duration, causing a sodium influx and local
depolarization.
Neuromodulator Substances that inhibit the
transmission of painful sensations to the brain
and spinal cord by adjusting, or modulating,
the rate of a neuron’s discharge.
Nitric oxide (NO) A colorless, poisonous gas
involved in oxygen transport to the tissues,
the transmission of nerve impulses, and other
physiological activities.
Neostigmine An acetylcholinesterase inhibitor
that can be used to reverse the effects of the
competitive (non-depolarizing) NMBAs.
NKDA Acronym that stands for “no known
drug allergies.”
No apparent distress (NAD) An appearance of
not having difficulty.
Nociceptors Pain receptors in the body that
respond to chemical, mechanical, or thermal
stimulus.
Noisy Characteristic of an ECG signal that is of
poor quality and produces an unreadable
tracing.
52 Non-depolarizing neuromuscular blockers
One of the two major classes of
neuromuscular blockers; competes with
acetylcholine for the receptor but does not
cause the receptor to fire.
Nonfeasance A failure to perform the correct or
required procedure, which would be an error
of omission; for example, if a Paramedic were
to arrive on-scene of a cardiac arrest and the
defibrillator failed because of a dead battery,
which the Paramedic should have checked
during routine maintenance.
Norepinephrine The chief neurotransmitter
used in the sympathetic nervous system.
Normal saline (NS) A solution of 0.9% sodium
chloride in sterile water (0.9% NaCl) that
contains the same amount of salt as does
blood. NSS has become an EMS standard
solution in many systems because it is
compatible with all medications as well as
blood.
Normal sinus rhythm An optimal rhythm to
provide adequate filling of the ventricles and
sufficient ejection of blood for perfusion.
Nonjudgmental Providing services based upon
human need, with respect for human dignity,
unrestricted by consideration of nationality,
race, creed, color or status.
Non-malfeasance A concept suggesting that no
act of harm will be done during a medical
treatment.
Nonrebreather face masks (NRB) Oxygen
masks with an oxygen reservoir that can
deliver up to 80% FiO2; they do not deliver
100% FiO2 because there will always be
some room air mixing through the open side
port.
Normocardiac A heart rate between 50 and
100, which is considered to be normal.
Nosocomial A hospital-acquired infection.
Notary public A public officer recognized by
the court who can verify the Paramedic’s
writings to authenticate them as evidence.
Null hypothesis When considering the results
of a research study, the supposition that the
treatment did not create changes (i.e., any
changes are purely random and coincidental).
The purpose of the study is to determine if the
null hypothesis is true or false.
Nonspecific ST changes Situation in which the
ST segment changes do not fit a pattern of
ischemia, nor are they contributory toward
another diagnosis. Causes of nonspecific ST
changes include improper lead contacts,
electrolyte abnormalities, drug-induced
changes, hyperventilation, and even a drink of
cold water.
Nutritional flow The daily process of excretion
and reabsorption of approximately half the
nutrient-laden fluids in the body that is
essential to the body’s sustenance.
Nystagmus A fine tremble of the eye when
holding a lateral gaze; unequal movement or
oscillating eye movements that are usually
involuntary.
53 Obesity A growing health crisis when an
individual’s body mass index is 30 or greater;
a common layperson definition of morbid
obesity is 100 pounds over ideal weight.
Ointments Topical medications placed in either
lanolin, an oil from sheep’s wool, or
petroleum jelly.
Oliguria An decreased output of urine, below
20 mL per hour.
Omega loop Creation of a stress loop when
securing an intravenous administration set
tubing to the patient. Initially, a strip of tape
is laid across the adaptor and against the skin.
Then a loop of tubing is taped across the first
strip of tape, which will absorb any tension
on the tubing and potentially prevent the IV
catheter from being displaced.
Observational study In contrast to the
descriptive study, a study that asks a question
and poses a simple explanation or hypothesis.
To have a scientifically valid result from an
observational study, one must control
extraneous confounding variables that could
account for the desired change.
Oncotic Caused by swelling (e.g., oncotic
pressure).
Obstructive shock The final category of the
Hinshaw–Cox shock classification, which
deals with the physical impairment of forward
blood flow despite an effective pump, an
adequate blood volume, and a normal
vasculature. Examples of obstructive shock
include massive pulmonary clots, embolism,
and a collapsed lung (pneumothorax), which
proceeds to crush the heart as well.
Open-ended questions Questions that allow the
patient to express himself without restriction,
with answers that can be used as a
springboard to other questions. Open-ended
questions usually begin with words like
“how,” “what,” or “could” and ask for an
explanation.
Ockham’s razor A theory that simply states
that if all things are equal, the simplest
solution tends to be the best one. In other
words, common things occur commonly.
Oils Substances that have been extracted from
plants for centuries for their use as food
additives as well as medications.
54 On-line medical control Medical command
technique in which physicians can give
medical direction and exercise medical
command via the base radio.
Operational competence A Paramedic
knowing how the various team members
interact, knowing an organization’s policies
and procedures, and possessing situational
awareness.
Opsonization A process in which the plasma
proteins mark resistant bacterium by
attaching fragments of themselves to the
bacterial cell wall, thus enhancing the impact
of the leukocytes.
Otitis media A middle ear infection marked by
pain, fever, or hearing loss.
Optic Pertaining to the eyes.
Orientation A person’s awareness of himself in
terms of place and time.
Orogastric tube A single-lumen tube passed
through the mouth into the stomach to
evacuate air from the stomach.
Outcomes evaluation A matter of comparing
the level of injury or illness before and after
an injury prevention program.
Orotracheal intubation The most common
technique used to intubate patients, in which a
laryngoscope is used to visualize the larynx
and the vocal cords, and an endotracheal tube
is observed to pass through the vocal cords.
Over-the-counter (OTC) Nonprescription
medications that can be purchased by the
public without a prescription so patients can
self-treat minor illnesses.
Orphan drugs Drug therapies for rare or
uncommon diseases, which generally are
unprofitable for manufacturers to produce
because the drugs are so rarely used.
Orthostatic hypotension An abnormal decrease
in blood pressure that occurs when someone
stands up.
Orthostatic vital signs Vital signs that change
with position. For example, when an
individual changes position from lying down
to standing, the blood pressure normally has a
tendency to drop due to gravity.
Oscilloscope An electronic instrument that
produces an instantaneous trace on the screen
of a cathode-ray tube corresponding to
oscillations of voltage and current, used in
some cases to measure electrocardiograms.
Osteoporosis A loss of calcium from the bones
secondary to a decrease in hormones.
Ovum A female gamete; the egg in a female
fertilized by a sperm cell to create an embryo.
Oxygenation The ability to move oxygen from
the air in the lungs into the blood.
p value The probability of random chance
causing the changes in a clinical trial, rather
than the treatment. An acceptable p value is
arbitrarily assigned by the researcher prior to
the start of the study and is symbolized as α.
Packed red blood cells (PRBC) Blood
component formed by removing nearly all of
the plasma from a unit of blood and adding a
small volume of preservative to the unit.
Pain threshold The amount of stimulus
required to elicit a pain response in a person.
Palliative care Measures used to increase
comfort and reduce pain, such as medication.
Otic Pertaining to the ear.
55 Palpation Evaluation that involves the provider
placing his hands or fingers on the patient’s
body in an effort to detect any abnormalities.
Palpitations The sensation of one’s heart
having an irregular and/or rapid heartbeat.
Pandemics Outbreaks of diseases that spread
throughout a country or a region, which may
reach disaster proportions if not prevented or
controlled in an appropriate fashion.
Papillary muscle Muscles that stabilize, open,
and close the valve leaflets with each
myocardial contraction.
Paramedic field diagnosis See Paramedical
diagnosis.
Paramedical diagnosis A broad and
comprehensive identification of a syndrome,
a group of signs and symptoms that suggest a
disease, or a primary disorder of homeostasis,
such as hypoxia, in a patient upon assessment
by the Paramedic.
Paramedicine A special subset of medicine that
Paramedics provide in the out-of-hospital
setting.
Parasympathetic nervous system The portion
of the autonomic nervous system responsible
for the body’s involuntary vegetative
functions including digestion, heart rate, and
the like, largely controlled by the vagus
nerve. These functions are summarized as
“feed and breed.”
Paradigm blindness The attitude that “we have
always done it this way.” Paradigms can
sometimes become barriers to innovation and
improvement.
Paradoxical respiration A disruption in normal
respiration in which, during inhalation, the
flail segment is drawn inward by the negative
pressure in the chest rather than expanding
outward with the rest of the chest wall.
During exhalation, the opposite occurs due to
the increased pressure in the thorax during
exhalation.
Paraglossal approach An intubation technique
that involves inserting the entire length of the
laryngoscope blade blindly into the
esophagus and then slowly withdrawing the
blade under direct visualization.
Paramedic The highest level of EMS provider,
whose skill level and education includes
advanced assessment and diagnosis of
syndromes and disorders and the treatment
thereof.
56 Parasympathomimetic A chemical agent that
mimics the action of acetylcholine.
Parenteral A method of drug administration
that bypasses the gastrointestinal system, such
as injection, which is preferred during an
emergency because of the rapidity of onset of
the medication’s action as well as
predictability of the drug levels.
Past medical history (PMH) Significant
historical information necessary to determine
the nature and potential severity of the
patient’s illness or injury. All patients should
be questioned about issues like chronic
illnesses, medications taken, allergies, and
use of tobacco, alcohol, or other drugs.
Pathogen An organism that causes an infectious
disease.
Pathogenesis The sequence of events—at the
molecular and cellular level—that leads to
organ dysfunction.
Pathologic Physical changes as a result of
disease.
Pathophysiology The study of the causes of
suffering in the normal human condition.
Patient advocate An individual who fights for
the rights and wishes of the patient in terms
of health care. Whenever a Paramedic acts to
help a patient obtain needed health care, he is
acting in the advocacy role.
Patient autonomy The patient’s ability to
control her person and her personal destiny
through decision making. Followed to its
logical conclusion, patient autonomy implies
that patients could decide to do nothing about
a fatal illness, a decision that might lead to
their own demise.
Patient care report (PCR) Documentation
completed by the Paramedic indicating the
care provided to a particular patient.
Patient concordance The process of shared
decision making between the healthcare
provider and patient.
Pattern recognition A tendency to quickly
label an ECG rhythm because it looks like
another ECG rhythm seen previously, which
is poor practice because it negates nuances
that differentiate one wave from another.
PCR audits A careful review of the patient care
report documentation for specific data that
allows healthcare managers, EMS
administrators, and EMS physicians to ensure
that acceptable patient care is provided to all
patients equally.
Peak expiratory flow The maximum velocity
of gas movement during exhalation.
Peak-load staffing EMS practice in which,
during predictable hours of high demand,
additional ambulances are placed in-service at
strategic locations.
57 PEARLS A mnemonic (partnership, empathy,
apology, respect, legitimization, and support)
that includes the qualities needed to provide
for a strong Paramedic–patient relationship.
Peer reviewed An article or research study that
was critically appraised by experts in the field
for validity.
Penumbra A predictable pathway of cell
changes leading to cell necrosis and
myocardial infarction.
Percutaneous central venous catheters
(PCVC) A central venous access device
inserted into the deep veins via the subclavian
vein (in the chest), the internal jugular vein
(in the neck), and the femoral vein (in the
groin).
Percutaneous cricothyrotomy A surgical
technique used to gain entry to the trachea
through placement of a needle, then
guidewire, then a small bore tracheostomy
tube in a rapid fashion with less bleeding than
a traditional surgical cricothyrotomy.
Pericarditis An inflammation of the pericardial
sac that surrounds the heart.
Pericardium The membranous sac filled with
serous fluid that encloses the heart as well as
the roots of the aorta and other large blood
vessels.
Percussion The act of lightly but sharply
tapping the body surface to determine the
characteristics of the underlying tissue.
Percussion note The sounds that result from the
act of percussion. Air-filled structures will
produce a hollow, tympanic percussion note
similar to that of a drum. Fluid-filled
structures will produce a dull percussion note.
Solid structures will provide a loud, welldefined percussion note.
58 Peripherally inserted central catheter (PICC)
A very long central venous access catheter
placed within a vein in the antecubital fossa
that is threaded into the vena cava while
under fluoroscopy.
Peritoneum The inner lining of the abdomen.
Persistent vegetative state (PVS) A permanent
state of unconsciousness.
Personal digital assistants (PDA) Personal
palm computers Paramedics can use as they
move about the patient compartment at will,
all the while transmitting and receiving
critical patient information.
Phagocytosis A process in which neutrophils
destroy bacteria by engulfing them.
Personal space In the theory of proxemics, the
area where a patient would engage in a oneon-one conversation. This personal space,
about one and one-half feet to four feet, is the
distance within which most Paramedics
initially interview patients for a history.
Pertinent negatives Those symptoms which, if
present in a patient, could indicate a more
serious underlying problem.
pH scale A measure of the differing degrees of
acidity or alkalinity in a substance. The range
of pH is from 0 to 14, with 7 being neutral.
Values lower than 7 are acids, values higher
than 7 are bases, and pure distilled water is
neutral (pH is an abbreviation for potential
hydrogen).
Pharmacodynamics The study of how drugs
come to create their therapeutic effect.
Pharmacogenomics A combination of
pharmaceutical research with the study of the
human genome.
Pharmacokinetics The study of how drug
absorption, distribution, detoxification, and
elimination affect a drug’s therapeutic value.
Pharmacological effect A new or different
effect a drug generates in the body other than
what was expected.
Pharmacology The study of drugs.
Pharynx The area of the airway composed of
the spaces behind the nose (the nasopharynx)
and the oral cavity (the oropharynx).
Phenotype The visible outward expression of
the chromosome, which is the result of the
genetic influences of both parents.
Phlebotomy The act of drawing or removing
blood from the circulatory system in order to
obtain a sample for analysis and diagnosis.
59 Physical examination Also called an exam, an
assessment of the patient from head to toe in
an effort to detect signs associated with a
disease or condition.
Physiology The study of the body’s functions,
in its normal human condition, which focuses
on the physical, mechanical, and biochemical
processes that go on inside the body every
day (i.e., how the body works).
PIER A model public education system
developed by the National Highway Traffic
Safety Administration (NHSTA) which
stands for public information, education, and
relations.
Piggyback infusion The process of
administering a medication infusion by
attaching the secondary intravenous line
containing the medication to a primary
intravenous line to eliminate the need for a
second intravenous line.
Physician extenders Allied health professionals
who work under the license granted to the
physician.
Physician’s Desk Reference (PDR) A
reputable source of information about
prescription and over-the-counter
medications; a compendium of manufacturer
drug-prescribing information which is usually
found in a package insert required by law to
accompany all medications.
Physician’s Order of Life-Sustaining
Treatment (POLST) A more detailed
description than a DNR order of the patient’s
wishes, placed in the form of a physician’s
order. These forms are generated through a
discussion between patients and their
physician that addresses specific situations
including utilizing artificial hydration,
nutrition, intubation, antibiotics, and other
medical therapies.
Physiologic A physical loss of cells as a result
of the normal changes of aging or simple
disuse; a natural development of cells.
60 Pitting edema The amount of indentation
produced when the edematous limb is pressed
over the tibia by the examiner’s finger.
Placebos Inactive drugs used in research trials
that appear similar to the actual drug in order
to create blinding for the participants.
Placenta The vascular organ that connects the
unborn child to the mother’s uterus, providing
safety and nutrition during its development.
Plain English transmissions The use of
everyday speech to transmit information
rather than using codes or jargon.
Plantarflexion The ability to push the toes
downward and away from the tibia.
Point of care Testing done in the field by the
Paramedic, such as capillary blood draws,
which enhance the Paramedic’s ability to
provide immediate emergency services while
still in the field and to transmit critical
information to the emergency department.
Plaque Fatty lesion formed in the artery as a
result of atherosclerosis.
Plasma cells Cells that generate antibodies.
Point of service (POS) A managed care system
with qualities of both an HMO and a PPO.
The patient is allowed to choose a healthcare
provider from among a list of preferred care
providers (PCP) but may elect to see another
“out of system” provider, without a referral,
at a substantially higher copayment and/or
deductible, similar to a fee-for-service
arrangement.
Polarity The direction of a QRS complex wave.
Platelet See Thrombocytes.
Portable radios Radio devices that can be
carried from place to place.
Platelet plug A concentrated mass of platelets
that serve as a short-term fix to a plaque
rupture.
Pleura The delicate serous membrane that lines
each half of the thorax and is folded back
over the surface of the lung on the same side.
Pleural effusion Excess fluid that builds up in
the fluid-filled space that surrounds the lungs,
which can cause difficulty breathing.
Pneumothorax Condition in which air or
another gas is present in the pleural cavity as
a result of disease or injury.
Point The end of a needle, often cut obliquely in
such a fashion that a sharp leading edge is
created.
Positional asphyxia Situation in which a patient
in excited delirium develops hypoxia and
goes into cardiac arrest when restrained
prone, particularly if hobble restrained.
Positive pressure ventilation A mechanical
ventilation technique in which the pressure in
the patient’s airway is increased, thus forcing
air into the lungs. Intubation or a bag-valve
mask are examples.
61 Postmortem Specific changes within the body
that are associated with death.
Post-traumatic stress disorder (PSTD)
According to the Diagnostic and Statistical
Manual, the development of “characteristic
symptoms following exposure to an extreme
traumatic stress involving direct personal
experience of an event that involves actual or
threatened death or serious injury, or other
threat to one’s physical integrity; or
witnessing an event that involves death,
injury or a threat to the physical integrity of
another person.”
Prefix An affix placed at the beginning of a root
word to modify that root word; for example,
adding the prefix “un-” to the root word “do”
makes “undo,” the opposite of do.
Potable infusions Process of boiling water over
the top of medicinal herbs and immediately
drawing off the solution.
Potent Chemically or medically effective;
strong.
Potentially infectious materials (PIM) Any
substance with the ability to transmit bacteria
to another material.
Potentiation Situation in which one drug
increases the effectiveness of another drug.
Power The ability to attribute the changes in a
research study to the treatment rather than
chance.
Predictable injury pattern Characteristic
injuries associated with a particular
mechanism of injury.
Preferred provider organization (PPO) A
managed care system that serves as a
modified fee-for-service schedule, permitting
patients to choose their healthcare provider
from among a roster of approved physicians.
Pre-induction agents CNS depressants
administered as a premedication before the
introduction of anesthesia to decrease the
incidence of fear or panic (anxiolysis) or
combativeness (sedation) in the patient.
Preload The volume of venous blood entering
the heart during diastole.
Prescription drugs Drugs that cannot be
dispensed by a pharmacist without the written
or verbal order of a physician or a mid-level
healthcare provider, such as a physician’s
assistant.
Pressured speech Condition characterized by a
patient speaking so fast it appears she has an
urgency or pressure to speak quickly.
Preventative maintenance (PM) A program
that forestalls the incidence of failure, thereby
decreasing the incidence of injury and
potential litigation.
62 Prevention The steps taken to avoid illness or
injury.
Primary assessment The Paramedic’s initial
evaluation performed to find and manage any
life threatening injuries or conditions the
patient might have by assessing for (and
correcting, if possible) any threats to airway,
breathing, and circulation.
Primary infusion A continuous intravenous set
to which other medications may be added as
supplements.
Primary rhythm The main heartbeat.
Prime wave The first wave in a QRS complex
in a situation where a wave repeats itself. The
prime wave is represented by a capital letter
and the second wave is represented by a
lowercase letter. For example, a proper
notation of a QRS might read RSr.
Primum non nocere The duty to “first, do no
harm.”
PR interval The distance from the beginning of
the P wave to the start of the QRS complex.
Problem-oriented medical recordkeeping
(POMR) Recordkeeping system in which a
master problem list records the medical
conditions for which that patient had been, or
currently was, receiving treatment. Indexed as
such, new entries in the medical record would
be placed into the patient’s file under the
problem listed. All healthcare professionals,
from physicians to nurses to dieticians, would
place their entries into the patient’s record.
This system provides some order to the
records needed by hospitals, medical
specialties, and allied healthcare providers—
all of whom need the same information.
Process evaluation A measurement of the
means used to carry out a program and how
successful it was.
Process server A person hired by an attorney to
deliver a summons and complaint to the
defendant in a case.
Prodrugs A precursor of a drug that is
converted into its active form in the body by
normal metabolic processes. For example,
heroin is a prodrug that, when acted upon by
the liver, metabolizes into morphine.
Product liability The responsibility a
manufacturer has to ensure a drug (or other
product) is not defective (unfit for its
suggested use or results in harm to the
consumer).
Privacy officer An officer at a healthcare
agency responsible for providing patient
record security and recording security
awareness training of all employees, as well
as implementing a privacy protection plan
within the agency.
Private line (PL) See Coded (or tone) squelch.
Professional development Steps a Paramedic
may take to continue advancement of his or
her EMS skills, which may include
attendance at state and national EMS
conferences or regional workshops,
consultation with medical directors for
guidance and education on new technologies,
and review of EMS trade journals.
Prognosis The expected outcome from a
disease, determined by a culmination of
modifiable risk factors, nonmodifiable risk
factors, and the availability of treatments.
63 Progress notes In a POMR recordkeeping
system, new entries in the medical record.
Pronator drift An indicator of upper motor
neuron weakness that is tested for by asking
the seated patient to hold her arms out with
the palms facing the ceiling and then close
her eyes. The test is positive if one arm drifts
away from the starting position.
Protocols A written set of mandatory
instructions for the Paramedic to use in
specific situations in the absence of the
physician. Protocols, almost by definition,
assume that one patient’s situation is the same
or similar to another patient’s condition in the
same situation.
Proxemics A theory based on the concept that
four spaces surround a person—intimate
space, personal space, social space, and
public space—which provide varying levels
of comfort when people move within them.
Prospective research The most scientifically
valid research, in which an attempt is made to
account for all predictable or known
confounding variables, to control those
variables, and then add a treatment. If change
occurs, then it may be reasonable to conclude
that the treatment may have caused that
change.
Prostaglandin A chemical mediator released
from the mast cell that creates the sensation
of pain, although its primary function is to
increase vascular permeability and smooth
muscle contraction later in the inflammatory
response.
Protected health information (PHI) Facts
from a patient’s medical record that are not to
be dispersed to the public without
authorization.
Protective custody Situation in which a law
enforcement officer assumes temporary
custody of a child in order for the child to
receive medical care after the parent refuses
to give consent.
64 Proximate cause The immediate or direct
reason why something occurred. In legal
terms, the action that created an injury or
reason for a claim.
Prudent layperson standard An approach to
defining an emergency that simply estimates
if another citizen, not a physician, who was in
the same or similar circumstance would think
it appropriate to call EMS.
Public Health Model A framework showing
the connections between host, agent, and
environment in preventing injury.
Public Health Service A federal program
which makes up a key portion of the
Department of Health and Human Services.
With 5,700 commissioned health services
officers and 51,000 civilian employees, all led
by the Surgeon General, the current United
States Public Health Service provides support
to county and state Public Health
Departments as well as health care to
medically underserved areas.
Public information officer (PIO) An EMS
agency employee whose responsibility is to
interface with the news media and provide
public information.
Public safety access point (PSAP) A
centralized communications center which
runs 24 hours a day, seven days a week, and
contains the entire 9-1-1 operation; a place
where a service callback or additional
emergency information would be available.
Public space In the theory of proxemics, the
area one would occupy with a stranger
without fear but with an ability to flee if
danger should arise.
Public trust An understanding between the
patient and the Paramedic that the patient will
be treated with dignity and respect in the
same manner a physician would treat the
patient.
Pulse oximetry A noninvasive measurement of
the percentage of hemoglobin in arterial
blood that is bound to oxygen molecules.
Pulse pressure The difference between the
systolic and diastolic blood pressures. The
pulse pressure can provide the Paramedic
with an indication about the blood volume
status or compensation for illness in a given
patient.
Pulseless electrical activity (PEA) A situation
in which the patient displays electrical
activity in the heart but no signs of
contraction; an electrical rhythm without a
pulse.
Punitive damages Money paid to reimburse an
individual for more than just the actual
damages suffered that prompted a court case;
a monetary fine designed to “punish” the
loser of the case.
Pure Food and Drug Act of 1906 A law that
prohibits the use of false or misleading claims
about medicines. The law further stipulates
that if a medicine contains any of the 11
“dangerous” drugs, then the drug(s) have to
be listed on the label.
65 Purkinje fibers Cardiac muscle fibers that
connect directly with the ventricular
myocardium, allowing the ventricles to
contract nearly simultaneously with the
atrioventricular node, creating a functional
syncytium.
Pyrogen Chemical mediator that produces
fever.
Pyrogenic reaction A devastating systemic
complication of intravenous therapy that
occurs when a contaminated fluid, or fluid
run through a contaminated administration
set, is infused and leads to nearly immediate
sepsis.
QRS complexes A combination of two or more
ECG waves, which combine in predictable
ways to describe other cardiac events and are
the basis for ECG interpretation.
Pursed lip breathing A sign of increased work
of breathing, in which the patient puckers his
or her lips while exhaling, providing some
resistance to exhalation that provides pressure
to keep the alveoli open.
Quadrageminy Situation in which ectopic beats
occur every fourth beat.
Quality assurance (QA) Verifying a program’s
compliance with established standards.
Quarantine The practice of isolating diseased
individuals from the larger community.
Putrefaction A process of decomposition
within the body characterized by greenish
discoloration, secondary to hemolysis of
blood, and slippage of the skin from the
skeleton, due to breakdown of subcutaneous
fat.
Pyelonephritis An infection of the upper
urinary tract and kidney.
Pyrexia A fever that makes the body’s
environment hostile to bacteria.
66 Quickening Fetal movements during the second
trimester that serve as the first signs of life.
Q waves Pathologic waves on an ECG that
indicate electrical silence (i.e., no
depolarization) in a certain portion of the
ventricular wall. Reception The process of interpreting a sent
message, which may be influenced by both
physical and cultural factors.
Receptor The portion of a cell that attracts a
certain molecule.
Reciprocal changes ST-segment depressions
seen on the 12-lead ECG in leads that face the
wall opposite of those with ST-segment
elevations.
Recovery For cells, a return to a former
functional capacity. For a person, a return to
health.
Radial pulse A measure of the beats created by
blood flow taken at the wrist over the radial
artery.
Radio head A small remote radio control panel
placed in the driver’s and/or patient
compartment of an emergency vehicle. The
actual transmitter is usually placed in a
different location in the vehicle.
Range A certain set of acceptable physical
parameters the body uses to try maintaining a
normal equilibrium.
Rate counter A digital readout on some ECG
monitors that measures the number of ECG
complexes that pass in a minute, usually
counting the tallest, or deepest, wave on the
ECG.
Reasonable accommodations Actions taken by
an employer to make a workplace more
accessible for a person with special needs,
such as adding ramps or elevators.
Rebound tenderness Tenderness that becomes
worse when the pressure is suddenly released
during palpation that may indicate irritation
of the peritoneum.
Reentry phenomenon The reexcitation of a
region of the heart by a single electrical
impulse, which may cause ectopic beats,
tachyarrhythmia, or an abnormal conduction
mechanism.
Refereed A review process in which an editor
will typically distribute an article to a panel of
expert Paramedics, who offer input and edit
the article. The article is returned to the
author, who revises the article based on the
edits.
Reference librarian A librarian trained in
research techniques who can help researchers
develop a search strategy to identify which
resources, such as articles, will be most
helpful in a study.
Referred pain Pain from one source transmitted
to other parts of the body, via common nerve
pathways.
Reflected path When using the radio wave
phenomenon of bounce, using enough
reflective surfaces so that the redirected radio
transmission will roughly result in the
intended direction of travel.
Recanalization The process of re-opening an
artery to restore blood flow.
67 Reflection An interviewing technique in which
the Paramedic repeats the patient’s words,
which may encourage additional responses.
Reflection is helpful because it typically
doesn’t interrupt the patient’s train of
thought.
Refractory Unable to respond to a new
stimulus.
Relative bradycardia A sinus rhythm with a
rate that is too slow for the patient’s
metabolic needs.
Release of information A written authorization
allowing documents to be given to an
attorney.
Reliable Giving the same result on multiple
trials.
Refusal of medical assistance (RMA) A
situation in which a patient can consent to a
medical procedure, and yet still refuses care.
Remission Situation in which the body’s
defenses, or medical treatment, may force the
disease into a non-active state. Remission
does not mean the patient has been cured, but
rather means the disease has been stopped.
Remodeling To change the shape of something,
such as the interior chamber of a ventricle.
Repeaters Radios that pick up, amplify, and
then retransmit a radio transmission, which
can extend the range of a VHF almost
indefinitely.
Repolarization The restoration of a polarized
state across a membrane, as in a muscle fiber
following contraction or the recovery of the
myocardial cell.
Regulations Rules established by a government
department to regulate the conduct of
citizens.
Regurgitation A backflow of blood into the
atria.
Rehabilitation Steps such as taking a rest
break, eating some food, drinking fluids, and
using lavatories that help EMS responders
handle stress more effectively while at the
scene of a prolonged incident.
68 Rescue devices Airway management tools used
when intubation is not successful, such as a
blind insertion airway device.
Residual Physical or chemical changes that
remain in a patient after an encounter with a
disease, such as scars or hemiplegia.
Resistance The second stage of the general
adaptation syndrome, during which the body
attempts to reestablish homeostasis, utilizing
the endocrine and/or the immune system.
Rib retractions Situation in which the work of
breathing increases and more effort is needed
to generate the negative pressure in the thorax
required for inspiration. When this happens,
the skin between the ribs is pulled inward
because of this negative pressure in the chest.
Respect High regard based upon a
nonjudgmental attitude toward the patient.
Respiratory acid Acid in the body formed
when excess carbon dioxide reacts with water
to form carbonic acid (H2CO3) before
conversion into bicarbonate, which is the
intermediary step in carbon dioxide transport.
Resting membrane potential A difference in
the electrical potential between the outside of
the cell and the inside of the cell while in a
resting state.
Right Something to which a person is entitled
based on society’s sense of fair play.
Right bundle branch A division of the bundle
of His that lies deep within the myocardium
and serves as a further passageway for
electrical impulses to the right ventricle.
Reticular activating system (RAS) A complex
network of interconnected reflexes in the
brainstem that maintains wakefulness.
Retrospective research Research technique in
which a Paramedic looks at past practice,
typically from patient care reports, to
determine how to resolve a current issue or
question.
Re-uptake The reabsorption of a
neurotransmitter by a neuron following
impulse transmission across a synapse.
Reverse R wave progression The loss of an R
wave progression, which is suggestive of an
anterior wall AMI.
Right chest leads ECG recording technique in
which the V4 to V6 wires from the left chest
electrodes are switched over to the same
relative position on the surface of the right
chest and the ECG is rerecorded as V4R,
V5R, and V6R.
Reverse use- (rate) dependent Drugs that
prolong the repolarization of normal
myocardial tissues, as electrographically
demonstrated by a prolonged QT interval.
Rhabdomyolysis A breakdown of skeletal
muscle releasing cell contents including
myoglobin.
69 Right coronary artery (RCA) Cardiac artery
that provides blood to the right atrium and
ventricle and the inferior portion or wall of
the left ventricle.
Root A word, often supplemented with prefixes
or suffixes, that relates to the main idea and
often describes the organ involved or the key
symptom.
Rigor mortis A stiffening of the muscles, which
often occurs after death.
Risk The likelihood that a situation could lead
to harm.
Risk factors Traits or practices that tend to
make a person more or less vulnerable to a
disease as compared to another person.
Risk management A plan that emphasizes
safety and whose goal is to reduce Paramedic
injury in an effort to promote a culture of
safety in an organization.
Risk manager An individual in an organization
who identifies known hazards and then tries
to mitigate those hazards.
Rovsing’s sign Pain in the right lower quadrant
that occurs when the left lower quadrant is
palpated, which is often associated with
appendicitis.
Rub A low-pitched, soft scratching sound that
occurs at any time during the cardiac cycle.
Rules out A deductive process in which the
Paramedic eliminates all explanations for the
patient’s condition that don’t match the
symptoms, thereby leaving the correct
diagnosis.
Runaway infusions An out-of-control drip
infusion that results in the patient being
overmedicated.
Running the line out The process of clearing
intravenous administration tubing of any air
and running fluid freely from the end.
Run of ventricular tachycardia Nonsustained
bursts of ectopic ventricular beats that occur
three or four at a time.
70 R wave progression A series of changes in the
primary deflection of the QRS from negative
in V1 to positive in V6 in a normal 12-lead
ECG.
SAFE-R A crisis intervention model consisting
of five steps: stimulation reduction,
acknowledgement, facilitation, explanation,
and return or restoration.
Safety officer In a large emergency situation, an
individual assigned to maintain scene safety
for the responders.
Saline locks Process of filling the intermittent
infusion device with saline to seal, or lock,
the device and prevent thrombus formation.
Scientific method The acquisition of
knowledge through objective observation and
considered reasoning.
Sclerosis An inflammation, thickening, or
hardening of a body part.
Scope of practice The duties and
responsibilities that fall under a particular
Paramedic’s experience and skill level.
Scored Adding a depression across the middle
of a tablet that makes dividing the tablet in
half easier.
Script An idea in the Paramedic’s mind about a
set of symptoms that has an associated
symptom complex and an associated field
diagnosis and treatment plan.
Sedative Medications used to decrease a
patient’s level of consciousness, lessen
irritability, decrease excitability, or cause
muscular relaxation.
Salvo see Run of ventricular tachycardia.
Satellite phones Satellites that radio waves are
sent to, in which they literally bounce off the
satellite and return back to Earth, bypassing
obstructions such as mountains.
Scanners Multiband radio receivers that
monitor several radio frequencies, including
those used by cellular telephones.
Scene safety Steps taken to ensure the
Paramedic’s well-being when responding to
an emergency situation, such as rerouting
traffic, assessing for threats, securing unstable
areas, and the like.
Schizokinesis A physiological theory that
suggests past painful experiences,
unconsciously recalled by trigger words, can
elicit an autonomic nervous system response.
In some cases, this response could be harmful
to the patient.
Segment The space between ECG waves.
Seldinger technique A catheter-over-the-wire
technique used to cannulate the femoral vein.
Self-awareness Possessing a conscious
understanding of one’s life influences and
prejudices.
Semantics The meanings of words.
Senescence A breakdown in the body’s ability
to monitor for organ system failure and to
repair those organs, which is inherent in the
concept of being elderly.
Senile dementia Altered mental status caused
by irreversible damage to the brain that
typically is manifest over a long period of
time (e.g., a series of brain attacks, such as
strokes).
Sensitivity A measure of how often a medical
field test gives a correct positive result.
71 Sepsis A toxic condition resulting from the
spread of bacteria or its toxic products from a
focus of infection.
Septal hematoma A form of nasal trauma that
results in a bruise or bleeding.
Shock–liver A form of liver failure.
Shunting A displacement of blood volume to
the core circulation.
Side effects Unintended reactions one may have
to a medication in addition to its therapeutic
effect, such as drowsiness or nausea.
Sign Indication that appears during a physical
examination that suggests the cause of a
disease or injury.
Septic shock Condition in which the patient
develops a potentially serious drop in blood
pressure from a systemic infection in the
blood.
Serial vital signs All vital signs taken after the
baseline vital signs that are useful to illustrate
trends in vital sign changes.
Serotonin A neurotransmitter found primarily
in the gastrointestinal tract that causes arterial
and venous constriction.
Serve In legal terms, to cause to be delivered, as
in a summons or other document.
Settlement A sum of money paid to the plaintiff
in order to conclude a case without going
through a trial.
Shams Ineffective devices used in research
trials that appear similar to the actual device
in order to create blinding for the participants.
Shared decision making Collaborative medical
practice in which the patient is seen as being
interdependent with, rather than dependent
on, the Paramedic. In a shared decisionmaking model, the patient is consulted about
clinical decisions, empowering her with
current information about her state of health.
Shared practice The knowledge that both
physicians and Paramedics are responsible for
the patient’s care.
72 Sign-out An authentication measure in which
the Paramedic writes the time, date, and
initial after the last entry. The sign-out
indicates that the PCR was written and
completed by the person listed “in-charge” at
the time and date listed.
Simplex A radio system that only allows
communication in one direction at a time,
such as a walkie-talkie; the simplest radio
system.
Sim’s position A modified left lateral position
used when administering medication rectally
in which the patient is asked to bring her right
knee to the chest as far as practical. This
position provides optimal access to the anus
while minimally compromising the patient’s
dignity.
Simulcast The ability to interact with several
departments of an organization at once.
Single-blind study A research study in which
the subjects do not know which group they
are in, although the researcher does.
Sinoatrial node (SA) The initial portion of the
conduction system, located just beneath the
epicardium on the posterior wall of the right
atrium near to the end of the vena cava and at
the junction of the sinus of Valsalva and the
atria.
Sinus bradycardia A sinus rhythm with a rate
below 60 bpm, although most patients are not
symptomatic until the heart rate falls below
50 bpm.
Small volume nebulizer (SVN) An alternative
platform for the delivery of inhaled
medications in which the medication is
suspended in a stream of air which is then
smashed against a round surface in the SVN,
creating micro-fine particles that are ideal for
inhalation.
Sinus dysrhythmia An irregular heart rhythm
characterized by alternating increases and
decreases in the heart rate.
Sinus of Valsalva An area adjacent to the aortic
valve that creates a space between the aortic
wall and each semilunar wall.
Sinus tachycardia A sinus rhythm with a rate
greater than 100 bpm.
Situs inversus A condition characterized by
complete reversal of all thoracoabdominal
organs, such that they are positioned the
mirror opposite of normal.
Skip A radio wave transmission technique to
overcome the problem of obstacles to line of
sight, in which the high-frequency radio
antenna is directed toward the sky. The radio
signal then rises until it strikes the
ionosphere, a layer of atmosphere where the
sun’s ultraviolet rays ionize the gasses, and
the signal is reflected back to Earth.
Sky wave A radio wave transmitted into the
atmosphere for a return to Earth rather than
being transmitted across land.
Slander Situation in which defamatory lies
about a person are told to others.
SOAP notes One of the earliest standardized
documentation formats, which contains
subjective (S) information obtained from the
patient or the patient’s family, objective (O)
information obtained during physical
examination, an assessment (A) of the
patient’s problem, and a plan (P) for action.
Social norm A rule of conduct that regulates the
interaction between people but is not specific
to one individual.
Social space In the theory of proxemics, an area
of relative safety where strangers can enter,
with certain expectations of conduct. A
dining room in a restaurant is an example of
the use of social space.
Somatic pain Acute sharp, burning pain that
often arises from the skin, ligaments, muscle,
fascia, bones, or joints. Unlike visceral pain,
somatic pain can be localized to a specific
area.
Slip-tip A syringe adaptor that simply slides
inside the needle hub.
73 Spacer A device attached to a metered dose
inhaler that allows a more controlled
inhalation of smaller, ideal-sized drug
particles suspended in the vapor within the
chamber than are possible with the metered
dose inhaler alone.
Special incident reports (SIR) Documentation
completed by the Paramedic that is not
directly related to patient care but is instead
used for administrative purposes or as a part
of a court proceeding.
Specialty Care Transport (SCT) A growing
subspecialty in EMS, in which Paramedics
perform critical care interfacility
transportation by transporting sick and
injured patients from outlying clinics and
critical access hospitals to tertiary care
centers.
Specificity A measure of how often a patient
with a negative medical field test truly does
not have the condition the test is designed to
detect.
Spike Sometimes called a bayonet, a very sharp
point on an administration set which is used
to pierce the fluid container.
Spirits Liquid medications brewed from various
materials that have a volatile oil that
evaporates at room temperature and leaves a
distinctive odor in the air.
Spontaneous abortion Situation that occurs in
about 30% of pregnancies in which the
zygote fails to implant and the pregnancy
prematurely ends; often referred to as a
miscarriage.
Squelch control A static-reduction technique in
radio transmissions that reduces the amount
of signal received between transmissions,
narrowing the reception of radio waves and
eliminating background interference.
74 Standard leads The 12 leads used in a standard
electrocardiogram, comprising the standard
bipolar limb leads I–III, the augmented
unipolar limb leads, and the standard
precordial leads.
Standard of care Care and treatment that
another Paramedic with the same or similar
training would have rendered in the same or a
similar situation.
Standing orders Preauthorized medical orders
often given to Paramedics by physicians.
Star of life The symbol of EMS as represented
by six points: detection, reporting, response,
on-scene care, care in transit, and transfer to
definitive care.
Starling’s law A cardiac theory that states the
heart’s stroke volume increases in response to
an increase in the volume of blood filling the
heart (the end diastolic volume). The
increased volume of blood stretches the
ventricular wall, causing cardiac muscle to
contract more forcefully.
Static Radio interference caused by unshielded
electrical devices emitting 60 cycle
interference, lightning in the atmosphere,
bursts of radio waves from sunspot activity,
and even the spark plugs in an automobile.
Status asthmaticus Persistent bronchospasm
that is resistant to routine treatments.
Status epilepticus A condition of unremitting
convulsions interspersed with brief instances
of coma.
Statute A law enacted by legislation rather than
previous case decisions.
Statute of limitations The time allowed from
the occurrence of an incident during which a
lawsuit can be filed. The statute of limitations
simply states that a plaintiff (usually the
patient) cannot commence a lawsuit after a
certain amount of time has passed.
Sternal notch An anatomical position near the
base of the neck.
Sternal retractions Situation in which the work
of breathing increases and more effort is
needed to generate the negative pressure in
the thorax required for inspiration. When this
happens, the skin at the top of the sternum is
pulled inward because of this negative
pressure in the chest.
Strain Signs of fatigue often seen when the
body is repeatedly overstimulated, perhaps by
constant bombardment by stress-inducing
stimuli.
Stress The body’s reaction to stimuli; a
disruption in homeostasis.
Stress management A process of coping with
chronic stress in an effort to recover from its
effects.
Stress reduction Actions an individual takes to
eliminate the source of stress.
Stethoscope A medical instrument used to listen
inside the body, consisting of hollow flexible
tubes connected to ear pieces that join to a
piece placed against the area to be evaluated.
Stewardship To uphold the noble traditions of
medicine while caring for patients.
Stigma A negative connotation attached to
participation in a program, such as labeling
and public embarrassment.
Stressors Stimuli that cause stress. Modern
stressors include psychosocial pressures from
family, coworker complaints, and
supervisors’ demands, as well as such things
as unrealistic expectations and noise
pollution.
Strike-out A method of error correction on the
patient care report in which the Paramedic
crosses through the mistake with a single line,
leaving the content below the strike-out
legible. Next to the strike-out, the Paramedic
should place the date and initial the strike-out
to indicate authorship.
ST-segment depression A reduction of the ST
segment, which is a >1 mm depression below
the J point from isoelectric baseline.
ST-segment elevation A rise in the ST
segment, which is a >1 mm depression below
the J point from isoelectric baseline.
Stochastic effects Long-term complications
from ionizing radiation exposure.
Stock solution A standard concentration of a
solution that may be diluted to weaken its
potency for certain patients.
75 Stylet A commonly used adjunct to oral
intubation that provides rigidity to the
endotracheal tube.
Subcutaneous emphysema The presence of air
between the layers of the skin that indicates a
leak in the respiratory system.
Subcutaneous injection Injection in the layer
of skin directly below the dermis and
epidermis, which is the slowest and least
dependable means of obtaining therapeutic
drug levels in the bloodstream.
Subendocardial ischemia Condition that
occurs during myocardial ischemia in which
the deep myocardial tissues becomes
ischemic first, since coronary perfusion
occurs from the surface (or epicardium)
inwardly.
Subpoena A legal command or direction issued
by the court to appear at a certain place, such
as the office of the plaintiff’s attorney or the
courthouse, at a particular time.
Substituted judgment Situation in which a
surrogate decision maker has the
responsibility to know the patient’s
preferences and must place the patients’
wishes before the surrogate’s wishes.
Succinylcholine A depolarizing neuromuscular
blocker composed of two acetylcholine
molecules hooked back to back. It offers a
rapid onset of action (30 to 60 seconds) and
rapid termination of effect (3 to 12 minutes)
with return of sufficient ventilation to sustain
life in 8 to 10 minutes. Succinylcholine
produces muscle fasiculations at onset of
action.
76 Suffix An affix placed at the end of the root
word to modify that root word; for example,
adding the suffix “-less” to the root word
“help” makes “helpless,” meaning something
different than “help.”
Summarization Communication technique in
which the Paramedic takes the patient’s own
words, then paraphrases the patient’s words
to ensure that the message sent was correctly
received.
Summary dismissal A request by the
defendant’s attorney to end a court action
based upon the facts in the case, stating that
the facts of the case are clear and without
dispute.
Summary judgment Determination by a judge
to dismiss or decide a case solely on the
preliminary evidence without conducting a
trial.
Support Assistance that promotes another’s
interests.
Suppositories Medication within a wax carrier
that melts at body temperature and is
typically given internally for a local effect;
often administered in the vagina, urethra, or
rectum.
Supraventricular rhythm A cardiac rhythm
originating above the ventricles, indicated by
a narrow QRS.
Surfactant A fluid that decreases the alveoli’s
surface tension and prevents the alveoli from
collapsing during expiration.
Surgical anesthesia A near-coma state of
sedation in which the patient loses protective
reflexes in a head-to-toe (cephalocaudal)
direction.
Surgical cricothyroidotomy A surgical
procedure to gain entry to the trachea through
the anterior neck by making an incision
through the cricothyroid membrane.
Sympathomimetics Drugs that mimic the
effects of the sympathetic neurotransmitter
norepinephrine.
Symptom Something that indicates the presence
of a physical disorder.
Symptom complex A list of abnormal
conditions found by the Paramedic during the
history of the present illness and the physical
examination.
Suspension Medications that will not dissolve
in a solvent and thus remain as finely
pulverized particles floating in a liquid.
Symptom pattern A series of conditions
associated with a known disease. The
Paramedic compares the symptom complex
against the symptom pattern to arrive at a
diagnosis.
Synapse The point at which an impulse passes
from one neuron to another.
Sweep speed The speed of the rhythm passing
by on the ECG monitor screen. Standard
sweep speed is 25 mm/second, although the
Paramedic may alter this speed to get a closer
look at certain features of an ECG.
Sympathetic nervous system The portion of
the autonomic nervous system responsible for
those emergency responses that are at “standby,” ready to provide the person with the
ability to flee (flight) or fight.
Syncope A transient loss of consciousness that
spontaneously resolves.
Syndrome A collection of symptoms that
characterize a condition or state.
Synergism The interaction between drugs
which can occasionally lead to unexpected or
extra effects.
Syntax The rules of grammar.
Syrups Medicines mixed with sugar and water.
77 System architecture The arrangement of radio
components. Currently, two radio
architectures exist in EMS: traditional land
mobile radio (LMR) architecture and cellular
system architecture.
Systemic Pertaining to more than one internal
organ system.
Systemic inflammatory response syndrome
(SIRS) Localized infection leading to
systemic infection leading to sepsis, then on
to septic shock and multiple organ
dysfunction syndrome.
Systemic pathology Illnesses and ailments of
humans related to specific organs.
Systems review A head-to-toe approach to
history gathering in which the healthcare
provider starts at the head, questioning about
issues/concerns that may be present at the
nervous system level (stroke, seizures), and
moving downward to cover the
cardiovascular system, respiratory system,
abdomen, genitourinary system, extremities,
and behavioral disorders.
System status management (SSM) A dynamic
alternative to fixed-post staffing in which
ambulances are “on the road” and moving to
new locations to improve response times.
Systole Ventricular contraction.
Systolic blood pressure The maximum blood
pressure measured during systole when the
heart contracts.
Tablet A dry medicinal powder that is
compressed into a pill shape.
Tachycardia A heart rate that is over 100 beats
per minute for an adult or above the upper
limit of normal for a child.
Tachypnea Rapid breathing.
78 Tactical EMS (TEMS) EMS providers
working with police SWAT teams trained on
how to provide care to the wounded while in
hostile surroundings as well as maintain the
health of the SWAT team members during
prolonged operations.
Tactile fremitus Vibrations palpated on the
chest wall that occur with speech.
Tamponade Compression performed to control
bleeding.
Tardive dyskinesia A neurological disorder
characterized by involuntary movements of
the extremities often caused by long-term use
of certain drugs (antipsychotic or
neuroleptic).
Teachable moment The time when the patient
has a heightened awareness of a problem and
is receptive to information.
Telemetry The process of transmitting
measurements and recordings to another
location, where they are interpreted; a
monitoring device connected to a patient by
two or three wires that collects data and sends
it via radio waves to an antenna.
Teleological A model of ethics that simply
states the end justifies the means. This
approach implies that, even though some
harm may occur, in the end if the outcome is
good then the behavior is ethical.
10-codes A system from the 1920s in which
police departments that only had one radio
frequency used abbreviated messages
designed to minimize airtime. Plain speech is
preferred over 10-codes to avoid confusion
and improve interoperability.
Tenderness A soft or yielding texture;
physically weak.
Tentative field diagnosis A determination of
what’s causing the patient’s problems
performed upon initial evaluation.
Teratogen Toxic substance or agent such as an
illegal drug or an infection such as rubella
(measles) or toxoplasmosis that could lead to
fetal malformation.
Teratogenic effect Exposure to ionizing
radiation that can cause birth defects and
cancer in subsequent generations as a result
of changes in the structure of DNA.
Tertiary care Highly specialized care provided
in areas such as trauma centers and cardiac
centers.
Thrombin A protease in blood that facilitates
blood clotting by converting fibrinogen to
fibrin.
Thrombocytes Platelets; blood cells that aid in
clotting.
Therapeutic effect See Intended biological
effect.
Thrombophlebitis An inflammation of a vein
that may develop at an IV insertion site.
Therapeutic index The ratio of the difference
between a drug’s median effective dose (the
ED50) and the median lethal dose (the
LD50).
Thrombus A mature clot made of platelets
cross-linked with fibrin and other blood cells
in a firm meshwork; a blood clot.
Therapeutic level (t) The point when the drug
levels attain the targeted value, as manifested
by observation of the therapeutic effect.
Therapeutic touch Intentional touching that
mimics earlier comfort experiences (such as a
mother stroking an infant’s cheek) and
telegraphs reassurance, understanding, and
caring to the patient as a means to heal.
Third spacing A process that occurs when
colloidal osmotic pressure is low, in which
fluid leaks from the intravascular space and
into the interstitial space.
3-3-2 rule A simple method for rapidly
evaluating a patient’s anatomy, in which a
Paramedic should be able to place three
fingers between the tip of the chin and the
hyoid bone, place three fingers between the
upper and lower teeth at the maximal mouth
opening, and place two fingers between the
thyroid notch and the floor of the mouth.
Thrill Vibration of the chest associated with
heart contraction.
Thyroid gland A highly vascular, “H” shaped
structure that lies along the sides of the larynx
and upper trachea.
Tidal volume The volume of a normal breath,
approximately 5 to 7 cc/kg of ideal body
weight.
Tincture Medicinal substance that is dissolved
in alcohol.
Tincture of benzoin Medication often applied
to skin before applying tape or another
adhesive bandage, used to both prevent
allergic reactions on the skin from the
bandage and to help the tape or bandage
adhere longer.
To keep open (TKO) The minimal infusion
rate needed to keep veins from becoming
occluded by a clot.
Tolerance Resistance to a drug over time,
which prompts the patient to take larger doses
of the drug to acquire the same effect.
Tonic A series of whole body contractions that
often precede a seizure.
79 Tonicity A solution’s ability to exert an osmotic
pressure upon the membrane.
Tracheobronchial suctioning Direct suctioning
of the secretions in the bronchial tree.
Topical Medications meant to be applied to the
skin.
Tort A civil or private wrongful act, other than
a breach of contract, resulting in some type of
injury or harm (not necessarily physical
injury).
Total body clearance The sum of all drug
excretion from the kidneys, skin, lungs, and
liver.
Toxicology The study of poisonous substances.
Toxin Any substance capable of causing cell
injury and death, including poisons.
Trace A horizontal left-to-right movement on
an ECG monitor.
Trachea A conduit for respiratory gasses to
pass to and from the lungs.
80 Trade name Drug name manufacturers give a
patented drug to distinguish it from other
similar drugs.
Transdermal Pertaining to topical medication
absorption, in which medicines are applied to
the skin and absorbed into the body.
Transtracheal jet ventilation (TTJV)
Ventilation of the lungs using special highpressure devices through a large bore catheter
placed through the cricothyroid membrane,
which is a commonly taught and performed
emergent oxygenation technique.
Transfusion-associated circulatory overload
(TACO) Situation that occurs when the
patient receives more volume of blood
products than can be handled by the
circulatory system.
Transfusion-related acute lung injury
(TRALI) A new acute lung injury that occurs
within six hours of a transfusion and is
directly related to the transfusion.
Translaryngeal illumination Using a lighted
stylet during endotracheal intubation to take
advantage of the larynx’s proximity to the
anterior surface of the neck.
Trauma Mechanical injury due to abrupt and
sudden physical forces acting upon the body,
such as friction, blunt force, or penetrating
force.
Translocations Gross breaks in some
chromosomes with subsequent rejoinings at
new locations.
Transmission The process of conveying a
message, which can be either a true and
accurate representation of the sender’s
thoughts or may be conveyed in such a way
that the meaning is misconstrued by the
receiver.
Transmural ischemia The stage of myocardial
ischemia when the ischemia affects the entire
thickness of the myocardium, from the
endocardium to the epicardium.
Trauma line Intravenous access inserted into
the vascular space so that intravascular
volume can be replaced quickly.
Treatment pathway The continuum of patient
care which starts with the primary assessment
and is continued in the emergency
department, critical care units, rehabilitation
floors, and homecare services.
Triage tag A form of documentation tag used in
mass casualty incidents to quickly prioritize
patients based on how quickly they need
assistance (i.e., immediate treatment vs minor
injury).
Trigeminy Situation in which ectopic
complexes occur every third complex.
81 Tripod position A position patients may
assume when in respiratory distress to help
with breathing, in which they place their
hands on their knees or legs and lean forward
in a sitting position, creating a tripod. This
position allows the overworked accessory
muscles to work better, although most
patients begin to tire when they are in such
severe respiratory distress.
Type I error A common error made in an
experiment in which the researcher rejects the
null hypothesis and accepts the alternative
hypothesis when in fact it is not supported.
Type II error A common error made in an
experiment in which the researcher
incorrectly fails to reject the null hypothesis;
a failure to observe the change created by the
treatment when one did occur.
Umbilical cord A connection between the
mother’s placenta and unborn child (at the
navel) used to transfer nutrition, respiratory
gasses, and wastes in the months prior to the
child’s birth.
Unilateral Relating to only one side.
Unipolar lead The use of a single positive
electrode, using Wilson’s central terminal, to
record differences in electrical potential.
Troches Lozenges that dissolve and are
absorbed in the mouth through the oral
mucosa.
Trunking A technique whereby, using
computers, multiple users can communicate
over fewer frequencies, with the computer
selecting the frequency to be used based on
availability.
Turgor A distended state of tension in living
cells.
Turned over to A process of transferring a
patient to another care provider with equal or
greater skill.
Tympanic membrane Sometimes called the
eardrum, a thin membrane that separates the
external ear from the middle ear.
Type and crossed Donor blood that is
successfully matched to recipient blood.
Type and cross-matched See Type and
crossed.
82 United States Pharmacopeia (USP) A drug
reference created by an independent
nongovernmental science-based public health
organization called the United States
Pharmacopeia. The United States
Pharmacopeia is made up of over 1,000
scientists, practitioners, and representatives
from various colleges of medicine and
pharmacy who set the standards for
medication manufacturing in the United
States.
Universal donor Name given to Type O blood,
since it can be given to any of the A-B-O
blood types without adverse reactions. Type
O blood does not have surface proteins that
incite the immune response, which ends in
hemolysis.
Universal law A situation that demands action
by any person in that situation, as a matter of
duty.
Universal recipients Name given to individuals
with Type AB blood, since they can receive
blood from any donor. This is because people
with Type AB blood do not have antibodies
against A or B proteins present in the plasma.
Upregulation An increase in the number of cell
receptors in a body cell due to changes in
chemical levels.
Urgent An assessment classification in which
the patient’s condition is not emergent,
suggesting further assessment and evaluation
is needed before treatment is initiated.
Use- (rate) dependent Drugs which act upon
the ionic channels during the open/active state
and preferentially will be attracted to rapidly
depolarizing ectopic pacemakers.
Uvula A fleshy lobe that typically hangs in the
midline of the pharynx.
Vagus nerve The major parasympathetic nerve
which originates in the medulla, exits the
skull at the base of the brain, travels down the
neck (proximal to the larynx), branches into
the heart and lungs, innervates the stomach,
passes through the digestive tract, and ends in
the anus.
Valecula The space formed between the
anteriorsuperior surface of the epiglottis and
the posterior base of the tongue.
Valid Logically correct and accurate.
Value judgment A Paramedic’s decision as to
which course of action is the correct course of
action in terms of right or wrong.
Vapocoolant spray See Fluori-methane.
Vasopressor A chemical that causes
vasoconstriction, particularly on the
arterioles.
Vastus lateralis (VL) An intramuscular
injection site on the anterior thigh. The
Paramedic mentally divides the vastus
lateralis muscle into three equal portions.
Choosing the middle section of the VL, the
Paramedic prepares the intended injection site
with an alcohol-soaked pad.
Vector The sum of electrical events which
makes up the common direction of the
electrical wave front.
Vecuronium A non-depolarizing
neuromuscular blocking agent commonly
used by Paramedics in the prehospital setting.
83 Venous cannulation The process of threading a
catheter into a vein.
Venturi masks Special masks with a restricted
intake that permits an exact percentage of
oxygen. These can be used to deliver oxygen,
although their use in the prehospital
environment is generally limited to specialty
care services.
Veracity An adherence to truthfulness. When a
Paramedic practices being truthful with all of
her patients, then that Paramedic can be said
to have veracity.
Ventilation A measure of how well a patient is
moving air in and out of the lungs during
inhalation and exhalation.
Ventricular diastole Condition after a
contraction when the ventricles of the heart
are in a relaxed state.
Ventricular rhythms A heartbeat originating
from the ventricle, indicated by a wide QRS.
This is usually, but not always, dangerous
because the origin of the beat is in the last
pacemaker in the ventricles.
Ventricular systole Condition in which, with
the pressure elevated in the ventricles, the
ventricular muscle fibers contract forcefully
and generate sufficient pressure to force open
the aortic and pulmonary valves to eject
blood out of the heart.
Verbal consent A spoken request for
permission to perform a procedure,
accompanied by a simple explanation, which
can improve patient compliance and decrease
the risk of misunderstanding.
Vertical equity Injury prevention programs
where the people most affected receive the
major emphasis. For example, if statistics
demonstrate a higher number of accidental
shootings among children in low-income
households, then public health programs
could be justifiably organized to emphasize
prevention within that population.
Vesicular sounds Lung sounds auscultated over
the peripheral, smaller airways that sound like
leaves rustling in the wind.
Vicarious liability Based on the legal principle
respondeat superior (“let the master
answer”), the basis that a person is
accountable for the actions of others.
Ventricular tachycardia A rhythm experienced
when the ectopic focus is ventricular and the
ventricular pacemaker becomes dominant.
With ventricular tachycardia, the rhythm is
regular, the rate is fast, and every beat is
wide.
Virtue ethics A somewhat middle ground
approach to ethics that does not depend on
consequence-driven decisions or duty-driven
decision making, but upon virtues. The virtue
ethics approach suggests that a “rightthinking” person will make the best decision
for the patient based upon a predetermined set
of virtues.
Ventrogluteal (VG) An intramuscular injection
site located on the lateral thigh proximal to
the hip.
Visceral pain Poorly localized pain that arises
from the internal organs and is usually
described as pressure-like, dull, or aching.
84 Vital signs Objectively measured characteristics
of basic body functions, such as temperature,
pulse, respirations, and blood pressure. Vital
signs provide the Paramedic with an
indication as to how well the patient’s body is
functioning or compensating for an injury or
illness.
Volume overload A potentially devastating
complication of intravenous infusions that
occurs when a positional IV access is
inadvertently adjusted and the infusion flow
is unrestricted.
V/Q mismatch A mismatch between the
amount of the lungs that are filled (alveolar
ventilation) and the capillary circulation
(pulmonary perfusion).
Walked on Suppression of a radio signal.
Wellness A state of physiologic equilibrium
free of disease. More than an absence of
illness, it is an active process of becoming
aware of, and making choices toward, a more
successful existence.
Wide open (WO) A rapid infusion of
intravenous fluid.
Wilderness EMT (WEMT) An EMS provider
in rural and woodland areas with special
training that fosters critical thinking as well
as creativity when working in an environment
where supplies may be limited and patient
transport to definitive care prolonged.
Witness A person who can confirm testimony
or evidence presented in a case, or
authenticate information provided.
Working diagnosis A presumptive conclusion
the Paramedic makes based on the available
signs and symptoms.
World Health Organization (WHO) The most
prominent and influential international public
health agency.
Z-track An injection technique in which the
Paramedic holds the drug-filled syringe in the
dominant hand, bevel up, and pulls gentle
traction on the injection site with the nondominant hand as a means to prevent leakage.
Zygote A fertilized ovum.
85