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Various emergency medical procedures and protocols that emts should follow when responding to different types of incidents. It provides guidance on radio communication with hospitals, patient triage and management during mass-casualty events, proper use of medical equipment and medications, and techniques for safe patient extrication and transport. The document emphasizes the importance of following established protocols, maintaining situational awareness, and prioritizing patient care to ensure the best possible outcomes. It also addresses common challenges and potential sources of errors in emergency medical services, underscoring the need for thorough training, effective communication, and sound decision-making skills.
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A patient is found unresponsive in his small bathroom. He is not breathing and is sitting in the corner. Two EMTs are able to reach him, but they are unable to stand side by side. He appears to weigh about 150 pounds and there is no evidence that he has been injured. Which of the following would be the quickest and MOST practical way of moving him out of the bathroom? A) Extremity lift B) Long backboard C) Direct ground lift D) Stair chair device - CORRECT ANS A) Extremity lift When moving any patient, you should do so in the safest, most efficient way possible. If a patient is in a narrow space (ie, small bathroom, narrow hallway) and you and your partner cannot stand side by side to perform a direct ground lift, the extremity lift would be the most practical way of moving him or her. One EMT would lift by the arms and the other by the legs; the patient could then be moved to a larger working area. Two EMTs should be able to safely lift a 150-pound patient. A long backboard would clearly not work in the case of a narrow or small space because there would be little room to the patient's left or right to slide the board underneath him or her. A stair chair would also likely not be possible, or practical, because of such a confined space. A 52-year-old woman crashed her minivan into a tree. She is pinned at the legs by the steering wheel and is semiconscious. After gaining access to the patient, you should: A) perform a primary assessment and provide any life-saving care before extrication. B) immediately apply high-flow oxygen to the patient and allow extrication to begin. C) rapidly assess her from head to toe, obtain vital signs, and apply a cervical collar.
D) have the fire department disentangle the patient and quickly remove her from the car. - CORRECT ANS A) perform a primary assessment and provide any life-saving care before extrication. Unless there is an immediate threat of fire, explosion, or other danger, you should perform a primary assessment and begin any life-saving care as soon as you have gained access to the patient. If you wait to do this until after the patient has been disentangled, it may be too late; the patient may already be dead. After you have assessed the patient and treated any immediate threats to life, allow extrication to commence. Once the patient has been freed from the vehicle, continue any lifesaving care and perform a rapid head-to -toe assessment to identify and treat other life- threatening injuries. Another EMT can obtain vital signs as you rapidly assess the patient. Prepare for immediate transport after the rapid head- to-toe assessment has been performed and spinal precautions have been taken (if indicated). When arriving at the scene of a motor vehicle crash at night, you determine that the safest place to park the ambulance is in a direction that faces oncoming traffic. What should you do? A) Position road flares around the front of the ambulance. B) Turn all emergency lighting off to avoid blinding the traffic. C) Turn the high-beam headlights on to alert oncoming traffic. D) Turn your headlights off, but keep the emergency lights on. - CORRECT ANS D) Turn your headlights off, but keep the emergency lights on. Emergency operations on the highway at night can be especially dangerous for responders; it is important to position emergency vehicles correctly, while at the same time ensuring visibility for oncoming traffic without blinding them. First of all, road flares near an automobile crash are dangerous because leaking fluids , such as gasoline, may not be immediately apparent; safety triangles are safer. If your emergency vehicle is facing oncoming traffic, you should keep
your emergency lights on, but turn your headlights off. Bright lights, such as high-beam headlights, can effectively blind and disorient an oncoming driver, and could cause them to crash into the scene. A 72-year-old woman fell and has a hip injury. She is on the second floor of her home. Which of the following devices should you use to move her down the flight of stairs A) Stair chair B) Long backboard C) Wheeled stretcher D) Scoop stretcher - CORRECT ANS D) Scoop stretcher Of the options listed, the scoop stretcher, also called an orthopaedic stretcher or split litter, would be the most appropriate to use. The scoop stretcher is contoured and allows for the placement of straps to secure the patient; it also allows you to place padding around and under the patient. The long backboard, unlike the scoop stretcher, is flat; therefore, the patient can slide from side to side or top to bottom, even when straps are placed. The wheeled ambulance stretcher is top heavy and is not safe for patient movement down a flight of stairs or across rough terrain. Because the patient has a hip injury, the stair chair would not be appropriate to use. When calling in your radio report to the receiving hospital, you should: A) include the patient's name. B) be brief, concise, and factual. C) give your report only to a physician. D) break your report into 60-second increments. - CORRECT ANS B) be brief, concise, and factual.
A radio report should be brief, concise, and factual. It should include the patient's age and sex, his or her chief complaint, associated assessment findings, vital signs, treatment that you provided, and the patient's response to your treatment. Avoid speculative statements regarding the patient's condition; report only what you know to be fact. Longer radio reports should be broken into 30-second increments; after 30 seconds, pause and ensure the listener heard your previous traffic. The patient's name is not vital to your report; thus, there is no need to disclose it. Unless you are requesting medical direction, it is acceptable, and routine practice, to give your report to a registered nurse. At the scene of a mass-casualty incident, you notice a bystander who is emotionally upset. An appropriate action to take would be to: A) tell the bystander to leave the scene at once. B) have the bystander assist you with patient care. C) notify the police and have the bystander removed. D) assign the bystander a simple, non-patient-care task. - CORRECT ANS D) assign the bystander a simple, non-patient-care task. One of the most effective ways to reduce stress in a bystander at the scene of a mass-casualty incident is to assign the bystander a task that is not related to patient care. This may involve assisting other bystanders who are having difficulties as well or providing water to the rescuers. An obviously distressed bystander should not simply be sent away from the scene, but should be looked at as a patient as well. Clearly, if the bystander becomes aggressive or violent, law enforcement personnel should get involved. Upon arriving at a mass-casualty incident, the EMT is assigned to the treatment area. Upon completion of duties in the treatment area, the EMT should:
A) notify the incident commander and return to service. B) report to the treatment officer for further instructions. C) report to the transportation area to assist with transport. D) report to the triage section to check for remaining patients. - CORRECT ANS B) report to the treatment officer for further instructions. Organized operations at the scene of a mass-casualty incident are crucial in order to achieve the best possible outcome and maximize the number of lives saved. When the EMT is given an assignment, he or she should complete the assignment and then return to the individual who gave the assignment for further instructions. Self-assigning at the scene (freelancing) is dangerous and can compromise the effectiveness of the overall operation. A patient injured his arm and asks to be transported to a specific hospital because he has been there before. The EMT states that he does not feel the doctors there are competent and recommends a different hospital. The EMT's behavior is: A) legal and ethical. B) ethical, but illegal. C) legal, but unethical. D) illegal and unethical. - CORRECT ANS C) legal, but unethical. The EMT's actions in this case are not illegal; he cannot go to jail for making such comments. However, his actions are clearly unethical and unprofessional, and could lead to allegations of slander by the physician; this would be a civil case, not a criminal one. You must not allow your personal feelings to influence a patient's decision as to who treats him or her, or where he or she is treated. You arrive at the scene of an 80-year-old woman who is weak and lightheaded. Her son, who called 911, is present and asks you to transport
his mother to the hospital. You should: A) advise the son that he can probably drive his mother to the hospital. B) comply with the son's request and transport the woman to the hospital. C) take the woman's vital signs and apply supplemental oxygen if necessary. D) assess the woman and determine if she wishes to be treated and transported. - CORRECT ANS D) assess the woman and determine if she wishes to be treated and transported. You must obtain consent from any mentally competent adult patient prior to initiating treatment. Just because the patient is 80 years old does not mean that she does not have decision-making capacity. Also, just because her son wants her to be transported does not mean that she agrees with this request. Ask her if she wishes to be treated and transported to the hospital. If she does, then you have obtained consent and should proceed accordingly. If she does not, you should determine if she has decision-making capacity--that is, whether she is mentally competent. If she is determined to have decision-making capacity, then you cannot legally treat or transport her. If she does not have decision-making capacity (eg, she is confused, she is under the influence of drugs or alcohol), then you may treat and transport under the law of implied consent. It is not the EMT's decision to determine, let alone recommend, that a patient be taken to the hospital via privately owned vehicle (POV}. If the patient requests EMS treatment and transport, you are legally obligated to do so. When using the power lift to lift a stretcher, you should: A) maintain a slight inward curve to your back. B) bend at the waist and keep your back straight C) ensure that you lift with your palms facing up. D) maintain a slight outward curve to your back. - CORRECT ANS C) ensure that you lift with your palms facing up.
To achieve the best grip and to avoid injury to your wrists, you should lift a stretcher, backboard, or other carrying device with your palms facing up. Do not bend at the waist; rather, bend at the knees and keep your back in a straight, locked-in position. You and your partner have secured a trauma patient to a long backboard and are preparing to lift the backboard onto the stretcher. When doing so, you should: A) lift the backboard from the sides instead of from the ends. B) be sure to lift the backboard with the powerful muscles of your back. C) recall that most of the patient's weight is at the foot end of the backboard. D) ensure that the strongest EMT is positioned at the head of the backboard. - CORRECT ANS D) ensure that the strongest EMT is positioned at the head of the backboard. Since most of the patient's weight is distributed to the head end of a backboard, you should always ensure that the strongest EMT is at that position. This will reduce the risk of injury to less strong personnel as well as the risk of dropping the patient. The backboard should be lifted from the ends, not the sides; you have less control over the board if it is lifted from the sides. When lifting any patient, you should use the powerful muscles of your thighs, not your back, to lift. Keep your back straight and in a locked-in position. Which of the following statements regarding the high-efficiency particulate air (HEPA) respirator is correct? A) HEPA respirator should be placed on any patient with tuberculosis. B) Long sideburns or a beard will prevent the proper fit of a HEPA respirator. C) A surgical mask provides better protection against tuberculosis than a HEPA respirator. D) A HEPA respirator is necessary only if the patient with suspected tuberculosis is coughing. - CORRECT ANS B) Long sideburns or a beard will prevent the proper fit of a HEPA respirator.
If you are caring for a patient with known or suspected tuberculosis (TB) or COVID-19, regardless of whether the patient is coughing, you should place a surgical mask (or high-flow oxygen, if indicated) on the patient and a high-efficiency particulate air (HEPA) respirator (N-95 or higher) on yourself. Unlike a surgical mask, the HEPA respirator is specifically designed to prevent exposure to the bacterium that causes TB; it can also filter out particles of the SARSCoV-2 virus, the virus that causes COVID-19. A surgical mask, however, will reduce the transmission of germs from the patient into the air. Do not place a HEPA respirator on the patient; it is unnecessary and uncomfortable. Use of a HEPA respirator should comply with OSHA standards, which state that facial hair, such as long sideburns or beards, will prevent a proper fit. A 30-year-old woman crashed her car into a tree at a high rate of speed. She is conscious and alert and has stable vital signs. She has some small lacerations and abrasions to her arms and face, but no obviously life-threatening injuries. As you are loading her into the ambulance, she tells you that she does not want to go to the hospital. You should: A) advise her that she is probably too emotionally upset to be able to refuse EMS treatment and transport. B) ask a law enforcement officer to administer a breathalyzer test to determine if she has been drinking alcohol. C) advise the patient that she should be transported to the hospital because of the seriousness of the crash. D) obtain a signed refusal from the patient and ask a law enforcement officer to transport her to the hospital. - CORRECT ANS C) advise the patient that she should be transported to the hospital because of the seriousness of the crash. The consequences of refusal should be explained to any patient who refuses EMS treatment and/or transport. After establishing that the patient can legally refuse treatment and transport (eg, he or she is of legal age AND has decision-making capacity), you must advise her that because of the significant
mechanism of injury, the potential for critical injury cannot be ruled out in the field , even though she may feel fine now. It should also be explained, in a manner that the patient can understand, that a hidden significant injury could result in death if untreated. Once this is explained, and the patient understands and is willing to accept the possible consequences, obtain a signed refusal and ask an impartial person (eg, police officer) to witness the signed refusal. The role of triage officer at a mass-casualty incident should be assumed by the: A) most knowledgeable EMS provider. B) EMS provider with the most years in EMS. C) first EMS provider who is willing to perform the task. D) EMS medical director via telephone communication. - CORRECT ANS A) most knowledgeable EMS provider. The role of triage officer should be assumed by the most knowledgeable EMS provider at the scene. Knowledge and experience will enable this person to most effectively manage the triage process. Just because a person has been in the EMS profession for a long period of time does not mean that he or she has been active or has maintained clinical competence. While triaging patients at a mass-casualty incident, you encounter a responsive middle-aged woman with a respiratory rate of 26 breaths/min. What should you do next? A) Triage her as immediate (red tag) B) Assess for bilateral radial pulses C) Administer high-flow oxygen at once D) Assess her ability to follow commands - CORRECT ANS B) Assess for bilateral radial pulses
According to the Simple Triage and Rapid Treatment {START) method, if you encounter an adult patient with a respiratory rate that is less than 10 breaths/min or greater than 29 breaths/min, you should triage him or her as immediate (red tag) and move to the next patient. However, if the patient's respiratory rate is between 10 and 29 breaths/min, you should assess his or her hemodynamic status by checking for bilateral radial pulses. If the patient's radial pulses are absent, triage him or her as immediate and move to the next patient. If the patient's radial pulses are present, assess his or her ability to follow simple commands. If the patient is able to follow simple commands, triage him or her as delayed (yellow tag) and move to the next patient. If the patient is unable to follow simple commands, triage him or her as immediate and move to the next patient. Treatment does not occur during the initial triage process. Which of the following patients has the highest priority at the scene of a mass-casualty incident? A) 29-year-old man who is pulseless and apneic with an abdominal evisceration B) 35-year-old unresponsive woman with snoring respirations and severe burns C) 38-year-old woman who remains apneic after you manually open her airway D) 44-year-old unresponsive man with an open head injury and agonal gasps - CORRECT ANS B) 35- year-old unresponsive woman with snoring respirations and severe burns The goal of triage is to provide the greatest good for the greatest number of people. Relative to the other patients, who are either in respiratory or cardiac arrest or have injuries incompatible with life, the woman with snoring respirations and severe burns has the best chance for survival. Therefore, she is the highest treatment priority. The process of removing or neutralizing and properly disposing of hazardous materials from equipment, patients, and rescue personnel is
called: A) autoclaving. B) sterilization. C) detoxification. D) decontamination. - CORRECT ANS D) decontamination. Decontamination is the process of removing or neutralizing and properly disposing of hazardous materials from equipment, patients, and rescue personnel. Decontamination should occur in the warm zone of a hazardous materials incident. The process of autoclaving involves the use of heat to sterilize instruments; clearly, this is not practical in the prehospital setting. Sterilization involves making an object free from bacteria or other living organisms; sterilization at an emergency incident is generally not possible. Detoxification involves the removal of toxic substances from a living organism; while the process of decontamination may remove or neutralize toxins, it does not kill them. Which of the following statements regarding the use of an escort vehicle when en route to an emergency call is correct? A) An escort vehicle will allow you to arrive at the scene more quickly. B) To avoid getting separated from the escort vehicle, you should follow it closely. C) An escort vehicle should be used only if you are unfamiliar with the patient's location. D) With an escort vehicle, the risk of an accident at an intersection is reduced significantly. - CORRECT ANS C) An escort vehicle should be used only if you are unfamiliar with the patient's location. Generally, escort vehicles should not be used when responding to an emergency scene. The biggest danger of using an escort occurs at intersections, which is where most ambulance crashes occur. Drivers may yield to the escort vehicle, but may not be prepared for a second vehicle following the escort (a wake
effect collision). The only time that an escort may be required is when you are unfamiliar with the location of the patient and need assistance getting there. If an escort must be used, you must follow at a safe distance of at least 500 feet. You are called to transport a patient with terminal lung cancer from a skilled nursing facility to the emergency department for evaluation of possible pneumonia. As you are reviewing the transfer paperwork, you see that the patient has a valid do not attempt resuscitation order. During transport, you should: A) perform CPR for only 2 minutes if the patient develops cardiac arrest. B) disregard the DNAR order because it is only valid in the hospital setting. C) provide supportive care, such as oxygen, and keep the patient comfortable. D) monitor the patient because a DNAR order prohibits you from providing care. - CORRECT ANS C) provide supportive care, such as oxygen, and keep the patient comfortable. A valid do not attempt resuscitation (DNAR) order gives you the legal authority not to initiate resuscitative efforts if the patient develops cardiac arrest. Because laws vary from state to state, you must be familiar with the DNAR laws in the state in which you work as an EMT. Many states have adopted out-of hospital DNAR orders; these are legal documents and should be adhered to if they are valid. Generally speaking, a valid DNAR order must clearly state the patient's medical problem(s), be signed by the patient or legal guardian, and be signed by one or more physicians. In some states, DNAR orders have an expiration date, while in others, no expiration date is included. Contact medical control for guidance if the validity of a DNAR order is questionable. Even in the presence of a valid DNAR order, you are still obligated to provide supportive measures, such as oxygen, pain relief, and comfort. DNAR does NOT mean do not treat. When driving in emergency mode on a multilane highway, the emergency vehicle operator should keep to the: A) right shoulder so that traffic flow is not disrupted.
B) extreme left lane so motorists can yield to the right. C) extreme right lane so motorists can yield to the left. D) center lane so the traffic can flow around the ambulance. - CORRECT ANS B) extreme left lane so motorists can yield to the right. When traveling on a highway with more than one lane, the emergency vehicle operator should remain in the extreme left-hand (fast) lane. This allows other motorists to yield to the right as they see you approach. A motorist's typical initial reaction upon seeing an approaching ambulance is to slam on the brakes and then look for the best direction to yield; this may be to the left or right, depending on the traffic. Do not attempt to pass a motorist until he or she is clearly aware of your presence and has yielded accordingly. Passing other motorists on the right is unsafe and should be avoided. The EMT should avoid focusing all of his or her attention on a single critical patient during the triage process because: A) three EMTs are required to effectively manage a critical patient. B) other patients may die from causes that could have been prevented. C) all of his or her supplies will likely be depleted on that one patient. D) the patient will most likely die before he or she can be transported. - CORRECT ANS B) other patients may die from causes that could have been prevented. Triage is the process of rapidly assessing patients to determine their treatment priority. Focusing your attention on one patient during the triage process not only defeats the purpose of triage (to do the greatest good for the greatest number of people), but also neglects other patients who might die from injuries or conditions that could have been corrected if detected earlier.
You are caring for a 6-year-old child with a swollen, painful deformity to the left forearm. As you communicate with the parents of this child, you should: A) ask them repeatedly how the child was injured. B) use appropriate medical terminology at all times. C) make sure that they remain aware of what you are doing. D) tell them that the child will be transported to the hospital. - CORRECT ANS C) make sure that they remain aware of what you are doing. When caring for any patient, it is important to keep both the patient and the family aware of what you are doing. You should avoid medical terminology whenever possible because most laypeople will not understand what you are saying. The plain English approach is much more effective. When caring for children specifically, you should inform the parents of the need for ambulance transportation and why; doing so will provide them with the information necessary to make an informed decision. Asking the parents repeatedly how the child was injured may be construed by some as implying that the child was abused. You receive a call at 3:00 a.m. for a patient who is slumped over the steering wheel of his car, which is parked on the shoulder of the road. Your unit and a police officer arrive at the scene at the same time. You should: A) stay in your unit until the police officer checks the patient. B) park the ambulance 25 feet in front of the patient's vehicle. C) shine a spotlight in the side view mirror of the patient's vehicle. D) approach the vehicle from the front to ensure maximum visibility. - CORRECT ANS A) stay in your unit until the police officer checks the patient.
Unfortunately, it is not uncommon for people to fake illness or injury with the intent of harming responding personnel. In this situation, you should utilize the safety resource at the scene: the police officer. You and your partner should stay in the unit until the police officer checks the patient to ensure it is safe for you to approach. Remember, the safety of you and your partner comes first! You are called to a residence for a woman in cardiac arrest. Shortly after you start CPR, the patient's husband presents you with an unsigned document that states "do not attempt resuscitation." You should: A) stop all resuscitative efforts in accordance with the document. B) stop CPR until the document can be validated by a physician. C) continue CPR until you have contacted medical control for guidance. D) contact medical control prior to continuing any resuscitative efforts. - CORRECT ANS C) continue CPR until you have contacted medical control for guidance. Do not attempt resuscitation (DNAR} orders can be challenging for EMS providers. When presented with documentation, especially if it does not appear to be valid (in this case, an unsigned document), you should err on the side of patient care and continue resuscitative efforts until medical control orders you to stop. While caring for a trauma patient, blood splashes into an EMT's eyes. This is an example of: A) exposure. B) infection. C) transmission. D) indirect contact. - CORRECT ANS A) exposure.
Exposure occurs when an individual comes in direct contact with blood or other bodily fluids. Examples of direct exposure include blood splashing into the eyes or mouth and an accidental stick with a contaminated needle or other sharp object. Exposure does not always result in disease transmission and subsequent infection; that depends on whether the patient has an infectious disease. Routine use of standard precautions will afford the EMT the best protection from exposure to an infectious disease. Failure of the EMT to obtain consent from a responsive patient before taking his or her blood pressure may constitute: A) battery. B) negligence. C) abandonment. D) assault. - CORRECT ANS A) battery. Battery is defined as unlawfully touching another person without his or her consent. Obtaining consent from every responsive patient prior to rendering care is of paramount importance. Assault is defined as instilling fear into another person, but does not necessarily involve actually touching him or her. Laws can vary from state to state as to these definitions. Negligence occurs when the EMT fa ils to act as another prudent EMT would have acted in the same or similar situation. Abandonment occurs when the EMT terminates patient care without the patient's consent or transfers care of a patient to a provider of lesser training. Which of the fo llowing is an example of informed consent? A) Prior to starting treatment, the EMT asks a patient if he has permission to begin treatment B) The EMT informs a conscious patient of the risk of refusing EMS treatment and transport C) The EMT informs a patient of the potential risks associated with his proposed treatment
D) EMTs treat an unresponsive patient under the assumption that he would consent if he was conscious
then a skills-based failure has occurred. Any error can come from multiple sources. Accidents do not fall into any of the failure categories; however, an investigation should occur to determine, if possible, how and why the accident occurred, as well as how to prevent it from happening again. A 10-year-old child was struck by a car while crossing the street. He has bilateral femur fractures and a head injury. His father has been notified and is 20 minutes away from the scene. The EMT should: A) contact medical control to see if he/she will take custody of the child. B) attempt to contact the child's mother to see if she can be there sooner. C) begin immediate transport and have law enforcement update the father. D) stabilize the child at the scene until the father arrives and gives consent. - CORRECT ANS C) begin immediate transport and have law enforcement update the father. The child in this scenario is critically- injured and needs immediate treatment and transport. In the interest of the child, it should be presumed that the parents would give consent to treat and transport if they were at the scene (implied consent). Begin emergency care, transport without delay, and ask a law enforcement officer to apprise the child's parents of your transport destination. At the scene of a hazardous materials incident, medical monitoring of patients and emergency personnel should occur: A) in the hot zone. B) In the warm zone. C) In the cold zone. D) before decontamination. - CORRECT ANS C) In the cold zone. The cold zone is a safe area where personnel do not need to wear any special protective clothing for safe operation. Personnel staging, the command post,
EMS providers, and the area for medical monitoring, support, and/or treatment after decontamination are all located in the cold zone. The hot zone is the area immediately surrounding the release and is the most contaminated area; personnel should wear full protective clothing while in the hot zone, and the only operation that should occur is patient rescue. Decontamination of patients and rescue personnel should occur in the warm zone. While functioning at a large-scale terrorist incident, it is important for the EMT to: A) use triage and base patient care on available resources. B) identify the person or persons responsible for the event. C) begin immediate treatment of the most critically injured patients. D) avoid placing any casualty in a "delayed" treatment status. - CORRECT ANS A) use triage and base patient care on available resources. During a terrorist incident, the basic foundations of triage and patient care remain the same; however, the treatment can and will vary. Terrorist incidents can produce a single casualty, hundreds of casualties, or thousands of casualties. When presented with mass casualties, you must remember the importance of situational awareness. What you do in one situation may not be appropriate for another situation. In large-scale terrorist incidents, it is important to use triage and base patient care on available resources. When triaging casualties, use the same triage process that you would for any other mass-casualty incident. Remain focused on providing the greatest good for the greatest number of people, not the person or persons responsible for the incident. In which of the following situations is an emergency move of a patient from his or her wrecked vehicle clearly indicated? A) The patient appears unresponsive and a high-power line is lying across the hood. B) Your primary assessment reveals that the patient has signs and symptoms of shock.
C) The patient has an altered mental status; diaphoresis; and rapid, shallow breathing. D) Gas is leaking from the vehicle and there is a small fire in the engine compartment. - CORRECT ANS D) Gas is leaking from the vehicle and there is a small fire in the engine compartment. An emergency move is indicated if your own or the patient's life is in immediate danger. Gas leaking from the vehicle and a fire in the engine compartment are clear indicators that you and the patient are in imminent danger. An emergency move involves grabbing the patient by the clothing, protecting his or her spine as much as possible, and dragging the patient from the vehicle to a safe place. The rapid extrication technique, which involves manually stabilizing the patient's head, applying a cervical collar, and removing the patient from the vehicle onto a long backboard, is indicated if the patient's condition is unstable and/or he or she is in need of treatment that requires a supine position. Never approach or touch a vehicle that is in contact with a high-power line; have the power company cut the power to the line first and then remove the patient from the vehicle. The technique of rapid extrication from a vehicle involves: A) applying a cervical collar, grasping the patient by the clothing, and quickly removing him or her onto the stretcher. B) manually stabilizing the head, applying a cervical collar, and removing the patient from the vehicle onto a long backboard. C) applying a vest-style extrication device, sliding a long backboard under the patient's buttocks, and removing him or her from the vehicle. D) grabbing the patient by his or her clothing, protecting his or her spine as much as possible, and dragging him or her from the vehicle. - CORRECT ANS B) manually stabilizing the head, applying a cervical collar, and removing the patient from the vehicle onto a long backboard. The rapid extrication technique is indicated if the patient has life-threatening injuries and/or is in need of treatment that requires a supine position. It is
performed by manually stabilizing the patient's head (an EMT in the backseat typically does this), applying a cervical collar, sliding a backboard under the patient's buttocks, and removing the patient from the vehicle and onto the backboard. The vest-style extrication device is not appropriate to use when performing the rapid extrication technique; it takes too long to correctly apply. Do not confuse the rapid extrication technique with an emergency move. An emergency move, which is indicated if your own or the patient's safety is in imminent danger, involves grabbing the patient by the clothing, protecting his or her spine as much as possible, and dragging him or her from the vehicle to a safe place. You arrive at the scene where a man fell approximately 40 feet and landed on his head. He is unresponsive, has agonal gasps, and has a weak carotid pulse. Further assessment reveals an open head injury with exposed brain matter. Upon identifying this patient as an organ donor, you should: A) request authorization from medical control not to initiate care. B) manage the patient aggressively and provide rapid transport. C) recognize that the patient's injuries disqualify him as an organ donor. D) provide rapid transport only because the patient likely will not survive. - CORRECT ANS B) manage the patient aggressively and provide rapid transport. It is unlikely that the patient will survive his injury; however, he is still breathing, albeit very poorly, and has a weak carotid pulse. Therefore, you should begin immediate and aggressive treatment and transport him promptly, just as you would with any other critically injured patient. It would clearly be inappropriate to request authorization to provide no care at all. If it is determined by a physician that the patient will not survive his injury, his organs can potentially be harvested and save several Jives.
The set of regulations and ethical considerations that define the extent or limits of an EMT's job is called: A) a duty to act. B) confidentiality. C) the scope of practice. D) the Medical Practices Act. - CORRECT ANS C) the scope of practice. The set of legal regulations and ethical considerations that define the job of the EMT is called the scope of practice. The scope of practice provides a clear delineation of the EMT's roles and responsibilities. Duty to act is defined as a legal obligation to respond to every call for help while on duty and in your jurisdiction, whether you are paid for your services or not. Confidentiality entails not releasing any patient information to those not directly involved in the care of the patient. The Medical Practices Act describes the minimum qualifications of those who may engage in emergency medical care and establishes a means of certification. The safest emergency vehicle operator is one who: A) is physically fit. B) has a positive attitude. C) drives with due regard. D) drives with lights and siren. - CORRECT ANS C) drives with due regard. One of the most important attributes of a safe emergency vehicle operator is the ability to drive with due regard for others. This means that the operator must be aware of others around him or her and to keep their safety in mind. The EMT should never assume that all drivers will see or hear the ambulance. A positive attitude about one's ability to safely operate an emergency vehicle is also an important attribute. Although sometimes indicated because of the
patient's condition, the use of lights and siren increases the risk of an ambulance crash. During the triage process, which of the fo llowing injuries or conditions would classify a patient as a high priority? A) Pulselessness and apnea B) Unilateral femur fracture and tachycardia C) Partial-thickness burns with no respiratory difficulty D) A large avulsion to the arm and an altered mental status - CORRECT ANS D) A large avulsion to the arm and an altered mental status During triage, patients with an altered mental status, who are in shock, or who have problems with their airway, breathing, or circulation are potentially salvageable and are given immediate priority. Patients who are pulseless and apneic have low priority in a mass-casualty situation. If you focus your efforts on cardiac arrest patients, who will most likely not survive anyway, patients who could have potentially been saved will die as well. Remember, the goal of triage is to provide the greatest good for the greatest number of patients. Regardless of their location in the ambulance, portable oxygen cylinders should always: A) have a flowmeter attached to them. B) be scured by fixed clasps or housings. C) contain at least 1,000 psi of pressure. D) be stored together with an oxygen mask. - CORRECT ANS Regardless of where portable oxygen cylinders are stored in the ambulance, they must always be secured by fixed clasps or housings to prevent accidental damage and to prevent them from becoming projectiles. While the oxygen cylinder that you take to the patient's side (for example, the cylinder in your jump kit) should have a flowmeter attached and be stored with a variety of oxygen administration devices (ie, nonrebreathing mask, nasal cannula), spare cylinders
may not necessarily have a flowmeter attached. The safe residual pressure for a portable oxygen cylinder, or the minimum pressure in the cylinder, is 200 psi (many agencies have a safe residual pressure of 500 psi). When the oxygen cylinder falls below the safe residual pressure, it should be removed from service and refilled. A conscious and alert 92-year-old woman with chest pain is refusing EMS treatment and transport to the hospital. Her family insists that you transport her. What should you do? A) Transport the patient as the family wishes. B) Advise the patient of the risks of refusing care. C) Obtain a signed refusal from a family member. D) Transport the patient as you explain your actions. - CORRECT ANS B) Advise the patient of the risks of refusing care. Just because the patient is 92 years old does not mean that she does not have decision-making capacity and cannot make an informed decision. In cases where any patient refuses care, after determining that the patient has decision-making capacity (ie, is of legal age, is not impaired by drugs or alcohol), you must inform the patient of the potential risks of refusing care, including permanent injury, illness, or death. If the patient is aware of and willing to accept the potential consequences of his or her refusal, a refusal of treatment and/or transport form should be signed by the patient. A non biased witness (ie, law enforcement officer, emergency medical responder [EMR]} should also sign the refusal form. Transporting a patient with decision-making capacity against his or her will is kidnapping and false imprisonment. Upon arriving at a scene in which a tanker truck overturned and is spilling an unknown liquid on the ground, you should:
A) quickly identify the material. B) stay downhill from the scene. C) turn off your warning lights. D) park upwind from the scene. - CORRECT ANS D) park upwind from the scene. At the scene of a potential or actual hazardous materials incident, you should park the ambulance in an area that is both upwind and uphill from the incident. However, you must be prepared to quickly relocate if the wind direction changes. Staying uphill is important because many hazardous materials collect in low-lying areas, such as valleys. After ensuring that you are in a safe place, attempt to identify the chemical involved by reading the placard on the tanker (with binoculars) and referencing the placard number in the Emergency Response Guidebook (ERG). When should you complete your patient care report for a critically ill or injured patient? A) Promptly after the primary assessment B) Any time before you arrive at the hospital C) As soon as all patient care activities are completed D) After the ambulance has been restocked at the station - CORRECT ANS C) As soon as all patient care activities are completed Patient care activities, especially when the patient's condition is critical, take priority over the completion of your patient care report (PCR). Once all patient care activities have been completed, you can complete the PCR. This is usually accomplished at the hospital or immediately upon returning to quarters. In most states, the EMT is required to report which of the following occurrences? A) Animal bite B) Drug overdose