AMLS 2nd Edition

AMLS 2e Agenda
History of AMLS
Overview of whats new and improved
The course
Instructor resources
Support
 History of AMLS
AMLS has been taught throughout the world since
1999.
AMLS was the first EMS education program that fully
addressed how to best manage patients in medical
crises.
In 2011, NAEMT produced an all-new textbook and
instructor materials for the course.
AMLS continues to be endorsed by the National
Association of EMS Physicians (NAEMSP) and is
accredited by the Continuing Education Coordinating
Board for Emergency Medical Services (CECBEMS) and
recognized by the National Registry of EMTs (NREMT).
 AMLS 2e Committee Members
Jeff Messerole, Chair
Les Becker, Vice Chair
Angus Jameson, MD, Medical Director
Vince Mosesso, MD, Medical Director
Anne Bellows
Leslie Hernandez
 What is AMLS?
AMLS is a sixteen-hour, two-day course
For BLS and ALS practitioners
Consists of interactive/case-based lectures and
patient simulations
Emphasis on the AMLS Assessment Pathway
AMLS Pathway
 AMLS 2e Instructor Resources
Lecture presentations
Patient simulation scenarios
New assessment videos
Instructors manual
Equipment list
Course agenda
BLS and ALS pre- and posttests
 AMLS 2e Course Day 1
AMLS Video 1 Introduction video and Assessment video
Respiratory
Respiratory Disorders Lecture
Cardiovascular Disorders Lecture
Respiratory Disorders Stations (2 simulations)
Cardiovascular Disorders Stations (2 simulations)
Shock Lecture
Shock Stations (4 simulations)
Altered Mental Status and Neurologic Disorders Lecture
Endocrine /Metabolic Disorders Lecture
AMS/Neurologic Disorders Practical Stations (2 simulations)
Endocrine /Metabolic Disorders Stations (2 simulations)
Environmental Emergencies Lecture
 AMLS 2e Course Day 2
AMLS Video 2 Introduction video and Assessment
videoAltered Mental Status
Infectious Diseases Lecture
Abdominal Disorders Lecture
Environmental Emergencies, Infectious Diseases,
Abdominal Discomfort Stations
Toxicologic Emergencies, Hazardous Materials Lecture
Toxicologic Emergencies, Hazardous Materials Station (2
simulations)
Written Evaluation Station
Final Practical Evaluation Stations
 Videos
New AMLS assessment videos
Respiratory emergency
Altered mental status
Sample Assessment Videos
 Lecture Presentation
Case based
Robust instructor notes
Consistent lecture structure
Showcases the use of the AMLS assessment
pathway
 Sample Lecture Presentation
The lecture for the Cardiovascular Disorders
chapter follows, which includes Case 1.
 Chapter 3
Cardiovascular Disorders
 Introduction
Objectives
Apply knowledge of anatomy, physiology, and
pathophysiology to patients presenting with chest
discomfort.
Describe the general assessment process for a
patient presenting with chest discomfort using the
AMLS Assessment Pathway.
Describe the ongoing assessment of the patient
presenting with chest discomfort utilized to rule out
or confirm potential diagnoses and adapt treatment
and management based on patient response and
findings.
 Anatomy
Anatomy
The major organs, spaces and pleurae, the
esophagus, and other structures of the
mediastinum and the musculoskeletal system.
Chest discomfort is typically the direct result of
stimulation of nerve fibers from damaged or
compromised organs.
Although the boundaries of the chest are well-
defined, organs or structures lying close to those
boundaries may be served by similar nerve roots.
 From PHTLS: Prehospital trauma life support, ed 6, St. Louis, MO, 2007, Mosby
The major organs and spaces
Anatomy
 Pathophysiology
Damage or compromise may be due to mechanical
obstruction, inflammation, infection, or ischemia.
An understanding of somatic vs. visceral pain is
important in generating differential diagnoses of
chest discomfort.
 Case 1

Dispatch
You respond to a nursing home for a report of a
person with chest pain who is having trouble
breathing.

What are your concerns as you respond to this call?

AMLS Assessment Pathway
 Initial Observations
Scene safety considerations
Is the scene safe?
Observe the front entrance of the facility.
 Initial Observations
You have responded to this facility in the past.
You are directed to the day room.

Jennifer A. Walz/Shutterstock.
 Initial Observations
Primary survey
Level of consciousness (LOC)Awake, opens
his eyes to the sound of your voice and makes
eye contact.
AirwayOpen and patent.
BreathingRespirations rapid, shallow, and
regular; breath sounds diminished on the left
apex.
Circulation/perfusionRapid radial weak
pulse; skin is cool and moist.
 First Impression
Do you identify any life threats?

Mark Bowden/iStock/Getty.
Is the patient sick/not sick?
 First Impression
What are your initial differential diagnoses?
Which do you think are most likely?
More Likely

Less Likely
First Impression

AMI/unstable Pneumothorax Pneumonia

angina Congestive Musculoskeletal
Thoracic aortic heart failure injury
dissection COPD
Pulmonary exacerbation
embolus a Esophageal
rupture
 Detailed Assessment
History taking
OEarlier today after a vacuum cleaner that was smoking
triggered a coughing spell.
PWorsens with deep breath, otherwise constant.
QSharp.
RLeft side of chest; does not radiate.
SPain is rated as a 6 on a scale of 1 to 10.
TAbout 45 minutes.
 Detailed Assessment
History taking, continued
SLeft-sided chest pain and shortness of breath
ANo known drug allergies
MAlbuterol, prednisone, budesonide inhaled,
roflumilast, aspirin, home oxygen 2 L/min
PCOPD
L2 hours ago
EFire alarm sounded due to smoking vacuum cleaner;
triggered coughing
RTwo packs/day x 40 years; quit 5 years ago
 Detailed Assessment
Secondary survey
Vital signs

110

90%

56 mm
Hg

28 142/90 98.6F (37C)

 Detailed Assessment

Pursed lip
breathing, Abdomen soft, nontender
circumoral cyanosis

Scattered wheezes, coarse

crackles; breath sounds
Clubbing of the fingers
diminished; absent at left
noted
apex; intercostal retractions;
barrel chested

Circulation, motor, and

sensory (CMS) intact Unremarkable
 Detailed Assessment
Diagnostics
BLS ALS Critical Care
Blood glucose level Cardiac monitoring N/A
87 mg/dL (4.8 mmol/L) Sinus tachycardia at
110
12-lead ECG is
unremarkable
ETCO2 = 56 mm Hg,
Intermittent sharkfin
waveform
Detailed Assessment
Capnograph
Refine the Differential Diagnosis

AMI/unstable Pneumothorax Pneumonia

angina Congestive Musculoskeletal
Thoracic aortic heart failure injury
dissection COPD
Pulmonary exacerbation
embolus Esophageal
rupture
 Treatment
Basic life support (BLS)
Monitor vital signs.
Continue O2 2 L/min via nasal cannula; titrate O2 to SPO2.
Advanced life support (ALS)
Administer nebulized albuterol and ipratropium.
Consider corticosteroid administration (e.g., dexamethasone
IV) if respiratory distress worsens.
Consider CPAP for severe cases with caution if pneumothorax is
suspected.
Consider intubation for respiratory failure.
Critical care
Consider needle decompression if signs of shock evolve
(tension pneumothorax).
 Ongoing Management
Reassess the patient.
Further refine the diagnosis.
Modify treatment as necessary.
Transport decision.
 Case Wrap-Up
Diagnosis: spontaneous

Courtesy of Stuart Mirvis, MD.

pneumothorax
Case closure: ED
physician inserted
thoracostomy tube;
removed after several
days in intermediate
care unit.
Further Discussion
Using the AMLS assessment pathway should enable you to quickly identify
life threats that should be managed when found.
Spontaneous pneumothorax (SP) is more common in men than women.
Smoking is an important risk factor, increasing the incidence by 120% as
compared to nonsmokers.
COPD is the most common underlying cause.
Status asthmaticus, tuberculosis, and immunodeficiency are also associated
with SP.
Needle aspiration and pigtail catheters (small SPs) or tube thoracostomy
(large SPs) are common treatment approaches.
Oxygen administration hastens absorption of pleural air.
The patients clinical status determines the urgency and type of treatment.
Monitor for transition to tension pneumothorax.
 Patient Simulations
All scenarios reviewed, revised, and reformatted
More than 100 scenarios to choose from
25 completely new scenarios for various medical
conditions
All scenarios fit two-sided, single-page format
Revised AMLS assessment flow chart included
Sample Patient Simulation
Sample Patient Simulation
AMLS 2e Student Resources
AMLS 2e Student Resources
AMLS 2e Student Resources
 AMLS Committee Activities
Develops course materials using best available
evidence
Determines instructor requirements
Provides advice and guidance to instructors
 AMLS Course Delivery
16-hour, 2-day program
Interactive lectures
Teaching and evaluation stations
16-hour hybrid course coming soon
8-hour online
8-hour classroom
 In Development
2e Hybrid course
2e BLS course
2e Refresher course
8-hour course
All presentations reviewed, revised, and updated
 New AMLS Instructor
Requirements
Be a certified/licensed EMS practitioner
Successful completion of the AMLS course
Successful completion of the NAEMT Instructor
Online course
Needs to be taken one time only
Initial teaching of the course monitored by an
AMLS affiliate faculty*

*New Policy for CoAEMSP accredited sites

 NAEMT Course Administration
NAEMT courses are offered by NAEMT course sites.
Online course site registration process
Courses are administered with oversight by a
course site coordinator.
Online process for course registration
 NAEMT Education Support
Please contact Corine Curd at NAEMT
Headquarters:
To become an AMLS instructor
To become an NAEMT course site
National Association of Emergency Medical
Technicians
Phone: 601-924-7744
education@NAEMT.org
 NAEMT Education Support
Staff
Sylvia McGowan
Service Center Representative
Jody Phillips
Service Center Representative
Stacey Jackson
Service Center Representative
Keshia Robinson
Service Center Manager
Corine Curd
Course Site Development Manager
Tracy Foss
Education Director
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