First Responder EMS Curriculum for Training Centers in Eurasia

Voluntary, or skeletal, muscle attaches to bone to provide the body with movement. Thesemuscles are under the direct control of the brain and nervous system. The will of theindividual can cause these muscles to contract and relax. The muscles are under voluntarycontrol.Involuntary, or smooth, muscles contract and relax automatically under the control of theautonomic nervous system. These muscles are found in the walls of tubular structures ofthe gastrointestinal tract and urinary systems. They are also found in the walls of bloodvessels and bronchi (airways).Cardiac muscle is a special muscle that has its own intrinsic electrical activity. It even hasspecialized pacemaker cells. These cardiac muscle fibers are found in no other part of thebody. This muscle can tolerate interruption of blood supply for only very short periods.4. Injuries to Bones and JointsTo care for patients with bone and joint injuries, the First Responder must ascertain themechanism of injury, identify the primary injury along with any other associated injuries,and appropriately treat the injury(ies). As always, the first priority is attention to theairway, breathing, and circulation.The mechanism of injury will often correlate with the nature and extent of the bone or jointinjury. Three primary forces are involved with injuries to the bones and joints. Directforces directly impact the bone or joint injured. Indirect forces occur when a force directlyimpacts another body part that stresses, and injures, a bone or joint in another part of thebody. Twisting forces can also produce significant injury.There are two types of bone and joint injuries: open and closed. In open injuries, thecontinuity of the skin is disrupted, exposing the underlying bone and soft tissues. Theseinjuries are prone to infection. In closed injuries, the skin continuity remains. Both injuriescan result in significant blood loss.a. Signs and SymptomsWhen evaluating a patient for bone or joint injuries, several signs and symptoms willhelp to identify the injury. Pain and tenderness are almost always present. The extremityor body part may be angulated, shortened, or deformed. There is often swelling of thesurrounding soft tissues and bruising (discoloration). When palpating the injured area,the First Responder may feel crepitus or grating of the bones. The joint may bedeformed or locked into position. More dramatically, fractured bone ends may bevisualized in the wound.b. ManagementComplete a scene assessment. Obey body substance isolation guidelines. Assess theairway, breathing, and circulation (ABCs). Protect and maintain the airway andbreathing. After controlling life-threatening injuries, allow the patient to remain in aposition of comfort. After identifying the injured area of the extremity, apply a coldpack to the painful, swollen, or deformed area to reduce swelling and pain. Finally,manually stabilize the injured extremity. Follow these general guidelines wheneverstabilizing an injured extremity:1. Always support the extremity above and below the injured area.2. Cover open wounds with a sterile dressing.First Responder EMS Curriculum/AIHA, July 2002 175