AMLS
nd
2
Edition
AMLS 2e Agenda
• History of AMLS
• Overview of what’s 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
• Instructor’s 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
video–Altered 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 welldefined, organs or structures lying close to those
boundaries may be served by similar nerve roots.
Anatomy
• The major organs and spaces
From PHTLS: Prehospital trauma life support, ed 6, St. Louis, MO, 2007, Mosby
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.
 Airway—Open and patent.
 Breathing—Respirations rapid, shallow, and
regular; breath sounds diminished on the left
apex.
 Circulation/perfusion—Rapid radial weak
pulse; skin is cool and moist.

First Impression
© Mark Bowden/iStock/Getty.
• Do you identify any life threats?
• 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
angina
Thoracic aortic
dissection
Pulmonary
embolus a
Pneumothorax
Congestive
heart failure
COPD
exacerbation
Esophageal
rupture
Pneumonia
Musculoskeletal
injury
Detailed Assessment
• History taking






O—Earlier today after a vacuum cleaner that was smoking
triggered a coughing spell.
P—Worsens with deep breath, otherwise constant.
Q—Sharp.
R—Left side of chest; does not radiate.
S—Pain is rated as a 6 on a scale of 1 to 10.
T—About 45 minutes.
Detailed Assessment
• History taking, continued
• S—Left-sided chest pain and shortness of breath
• A—No known drug allergies
• M—Albuterol, prednisone, budesonide inhaled,
roflumilast, aspirin, home oxygen 2 L/min
• P—COPD
• L—2 hours ago
• E—Fire alarm sounded due to smoking vacuum cleaner;
triggered coughing
• R—Two packs/day x 40 years; quit 5 years ago
Detailed Assessment
• Secondary survey

Vital signs
110
90%
56 mm
Hg
28
142/90
98.6°F (37°C)
Detailed Assessment
Pursed lip
breathing,
circumoral cyanosis
Scattered wheezes, coarse
crackles; breath sounds
diminished; absent at left
apex; intercostal retractions;
barrel chested
Circulation, motor, and
sensory (CMS) intact
Abdomen soft, nontender
Clubbing of the fingers
noted
Unremarkable
Detailed Assessment—
Diagnostics
BLS
ALS
Blood glucose level
Cardiac monitoring
• 87 mg/dL (4.8 mmol/L) • Sinus tachycardia at
110
• 12-lead ECG is
unremarkable
• ETCO2 = 56 mm Hg,
Intermittent sharkfin
waveform
Critical Care
N/A
Detailed Assessment—
Capnograph
Refine the Differential Diagnosis
AMI/unstable
angina
Thoracic aortic
dissection
Pulmonary
embolus
Pneumothorax
Congestive
heart failure
COPD
exacerbation
Esophageal
rupture
Pneumonia
Musculoskeletal
injury
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
Courtesy of Stuart Mirvis, MD.
• Diagnosis: spontaneous
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 patient’s 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
[email protected]
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
Customer Service and
Technical Support
• To place orders or check product availability:
• Contact Jones & Bartlett Customer Service
• http://www.jblearning.com/aboutus/contactus/
• 1-978-443-5000
• [email protected]
• For example, login problems, or error messages
• Contact Jones & Bartlett Technical Support
• http://www.jblearning.com/techsupport/
• 1-978-443-5000
U.S. Sales Team
• Jean Auman
• Moria D’Ambro
• Lori DeGeorge
SD, WV
• Patty Einstein
• Korie Gospodarski
MD, MN
• Hope Gottlieb
NC, OH, SC
ME, UT, VA, VT, WI
AL, AZ, ND, NE, OK,
Sales Director
AK, AR, DE, GA, KY,
CA, WA
U.S. Sales Team
• Jason Hanson
NH, NV, RI
• Joy Knobbe
WY
• Matt Maniscalco
NY, PA
• Jane McCluskey
• Kathy Roethig
CT, IA, KS, LA, MS,
ID, IN, MI, MT, OR,
VP of Sales; FL, NJ,
IL, MA
CO, HI, MO, NM, TX
Thank you for participating!