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NREMT Cognitive Exam Prep
Where does the modern EMS system have its origin? - correct answer The modern EMS system has its origins in funeral homes, which often operated ambulances. However, funeral home operators were often serving competing business interests and patients received little trained care until the hospital. What is considered the "birth" of EMS? - correct answer In 1966, a paper titled "Accidental Death and Disability: The Neglected Disease of Modern Society" is published by the National Academy of Sciences. This paper is widely known in the EMS profession as the White Paper. The White Paper is widely considered the birth of modern EMS. It spotlighted inadequacies of prehospital care in the United States, particularly related to trauma. Who developed the first EMT National Standard Curriculum? - correct answer Early in the 1970s, the US Department of Transportation developed the first EMT National Standard Curriculum. What are the levels of EMS training? - correct answer Emergency Medical Responder (EMR): provides basic, immediate care including bleeding control, CPR, AED and emergency childbirth. Emergency Medical Technician (EMT): includes all EMR skills, advanced oxygen and ventilation skills, pulse oximetry, noninvasive blood pressure monitoring, and administration of certain medications. Advanced Emergency Medical Technician (AEMT): includes all EMT skills, advanced airway devices, intravenous and intraosseous access, blood glucose monitoring, and administration of additional medications. Paramedic: includes all preceding training levels, advanced assessment and management skills, various invasive skills, and extensive pharmacology interventions. This is the highest level of prehospital care outlined in the National EMS Education Standards.
What are EMT roles and responsibilities? - correct answer Equipment preparedness Emergency vehicle operations Establish, maintain scene safety Patient assessment and treatment Lifting and moving Strong verbal and written communication skills Patient advocacy Professional development Quality improvement Illness and injury prevention Maintain certification/licensure What is the role of the medical director? - correct answer The medical director is a physician responsible for providing medical oversight. The medical director oversees quality improvement. What are the two types of medical direction? - correct answer Online medical direction: direct contact between the physician and EMT via or radio. Offline medical direction: written guidelines and protocols. What is an EMT's first priority? - correct answer The EMT's first priority is always his or her own safety. Scene safety is always the top priority! The EMT's safety priorities after personal safety are for his/her partner(s), patients and bystanders. What are the types of stress? - correct answer Acute stress: an immediate physiological and psychological reaction to a specific event.
Rapid extrication: an urgent move used for patients in a motor vehicle; it requires multiple rescuers and a long backboard. The patient is rotated onto a backboard with manual cervical spine precautions and removed from the vehicle. What are non-urgent moves? - correct answer Used when there are no hazards and no life-threatening conditions are apparent. Types of non-urgent moves include direct ground lift, extremity lift, direct carry method, and draw sheet method. What is the log roll technique? - correct answer Commonly used to place a patient on a backboard or assess the posterior. Can be done while maintaining manual cervical spine precautions. Should have at least three trained personnel. The person controlling manual cervical spine protection should direct the log roll. What are special considerations for bariatric patients? - correct answer Obese patients pose additional challenges and risks to providers during lifting and movement. Some EMS systems have special bariatric ambulances with specialized equipment, automated lifting systems, and wider stretchers capable of a greater weight capacity. What is supine hypotensive syndrome? - correct answer Patients in the later stages of pregnancy should not be placed supine due to the risk of supine hypotensive syndrome. Place the pregnant patient on her left side. If patient has potential cervical spine trauma, tilt backboard to the left about 20 degrees. When can patients be restrained? - correct answer In general, patients may be forcibly restrained if they pose a significant, immediate threat to you, your partner, or others. Restraining a patient against his will is a last resort. Anticipate and plan. Request law enforcement assistance. Contact medical direction when possible. Guidelines for restraining a patient: -Get additional help whenever possible; at least 4 people is recommended.
-Use the minimum amount of force necessary to protect yourself, the patient and others. -Secure patient supine, with backboard if available. DO NOT secure the patient in a prone position. -Use soft, padded restraints. -Monitor the patient's level of consciousness, airway, and distal circulation continuously. -Thoroughly document the reason for restraining the patient, the method of restraint, the duration of restraint, and frequent reassessment of the patient while restrained. What is the use of force doctrine? - correct answer The EMT must act reasonably to prevent harm to a patient being forcibly restrained. The use of force must be protective, not punitive. What is scope of practice? - correct answer Scope of practice outlines the actions a provider is legally allowed to perform based on his or her license or certification level. Scope of practice is tied to the licensure or certification, not the individual's knowledge or experience. Each state determines the scope of practice for its EMS providers. What is standard of care? - correct answer Standard of care is the degree of care a reasonable person with similar training would provide in a similar situation. Standard of care requires EMTs to competently perform the indicated assessment and treatment within their scope of practice. What are sources that help establish standard of care? - correct answer National EMS Education Standards State protocols and guidelines Medical direction EMS agency's policies and procedures Reputable textbooks Care considered acceptable by similarly trained providers in the same community.
What are advance directives? - correct answer Advance directives are written instructions, signed by the patient, specifying the patient's wishes regarding treatment and resuscitative efforts. There are several types of advance directives. -Do Not Resuscitate (DNR): DNRs are specific to resuscitation efforts and do not affect treatment prior to the patient entering cardiac arrest. -Living will: Living wills are broader than DNRs. They address health care wishes prior to entering cardiac arrest. This may include use of advanced airways, ventilators, feeding tubes, etc. How do Good Samaritan Laws affect EMTs? - correct answer Good Samaritan laws are designed to protect someone who renders care as long as he or she is not being compensated and gross negligence is not committed. -Each state has some form of Good Samaritan laws. Some protect health care providers, but some do not. -Some states extend their Good Samaritan law to publicly employed EMS providers but not to those in the private sector. What is assault? - correct answer A person can be guilty of assault even if another person only perceived that they intended to inflict harm. Physical contact is not required to be guilty of assault. What is battery? - correct answer Battery is physically touching another person without their consent. What is negligence? - correct answer Negligence is the most common reason EMS providers are sued civilly. -The plaintiff has the burden of proof, not the EMT. -With negligence, the EMS provider is accused of unintentional harm to the plaintiff. What are the four components of negligence? - correct answer The plaintiff must prove all four of the following:
- Duty to act: the EMT had an obligation to respond and provide care.
- Breach of duty: the EMT failed to assess, treat, or transport patient according to the standard of care.
- Damage: the plaintiff experienced damage or injury recognized by the legal system as worthy of compensation.
- Causation: the injury to the plaintiff was, at least in part, directly due to the EMT's breech of duty. What is gross negligence? - correct answer Gross negligence exceeds simple negligence. Gross negligence involves an indfference to, and violation of, a legal responsibility. Reckless patient care that is clearly dangerous to the patient is grossly negligent. Gross negligence can result in civil and/or criminal charges. What is abandonment? - correct answer Once care is initiated, EMS providers cannot terminate care without the patient's consent. Some patient encounters may also require direct contact with medical direction prior to terminating care. Most EMS agencies have written protocols for terminating care without transporting the patient to a higher level of care. Abandonment is the termination of care without transferring the patient to an equal or higher medical authority. Transfer of care must include a verbal report to an equal or higher medical authority. Most EMS systems allow EMTs to accept care from a paramedic or advanced EMT for transport if an advanced-level assessment or advanced care is not needed. What is false imprisonment? - correct answer You may be guilty of false imprisonment if you transport a competent patient without consent. What factors influence hospital determination? - correct answer Destination factors include: -The patient's request or medical direction -The closest appropriate facility or specialty facility -Written protocols or triage guidelines -Hospital diversion or bypass A patient's ability to pay should NOT factor into where a patient is transported.
-The information is necessary for continuity of care -The information is necessary to facilitate billing for services -The EMT has received a valid subpoena -Reporting possible crimes, abuse, assault, neglect, certain injuries or communicable diseases What is HIPAA? - correct answer Health Insurance Portability and Accountability Act (HIPAA) -HIPAA is a federal law established in 1996 and has had a huge impact on health care. HIPAA improved privacy protection of patient health care records. -HIPAA gives patients greater control over how health care records are used and transferred. -EMS agencies are mandated to provide HIPAA training to all employees who have any contact with patients or patient records. -EMS providers must provide patients with privacy practices and obtain signature of receipt. What are COBRA and EMTALA? - correct answer Consolidated Omnibus Budget Reconciliation Act (COBRA) and Emergency Medical Treatment and Active Labor Act (EMTALA) -COBRA and EMTALA include federal regulations guaranteeing public access to emergency care. -COBRA and EMTALA are also intended to stop the inappropriate transfe of patients, known as a patient "dump." What are considered obvious signs of death? - correct answer The following are typically considered obvious signs of death indicating that resuscitation should not be initiated: -Decomposition -Rigor mortis -Dependent lividity -Decapitation
On what kind of scenes must law enforcement be notified? - correct answer
- Any scene where the patient is dead on arival
- Suicide attempts
- Assault or sexual assault
- Child abuse or elder abuse
- Suspected crime scene
- Childbirth How should EMT's operate in crime scenes? - correct answer
- Ensure scene safety
- Provide patient care as needed
- Avoid any unnecessary disturbance of scene
- Remember and note the position of patient(s)
- Remember and report everything you touched at the scene
- Cut around (not through) holes in clothing when exposing the patient
- Note anything or anyone suspicious on or near the scene
- Discourage sexual assault patients from changing clothes or showering
- Try to get a same-sex provider to assist with sexual assault patients
- Leave once you are no longer needed at the scene What are therapeutic communications? - correct answer Therapeutic communications typically refers to your interaction with the patient and ability to obtain clinical information. What are portable and mobile radios? - correct answer Portable radios: hand-held transmitter/receiver with a very limited range, unless used with a repeater. Mobile radios: vehicle-mounted transmitters and receivers. These have a greater range than portable radios, but distance is still limited unless used with a repeater.
-Treatment provided and response to treatment -Any requests for additional interventions -Echo any orders provided by medical direction What two components must be present for transfer of care? - correct answer
- Verbal report
- A written copy of the patient care report must also be provided What are the purposes of the patient care report? - correct answer
- Continuation of care
- Legal document
- Billing
- Research and continuous quality improvement What is the minimum data set? - correct answer The minimum data set identifies the information that should be included on every PCR. Times: -Dispatch time -Time en route to call -Time on scene -Patient contact time -Time en route to hospital -Arrival time at hospital -Time transfer of care was completed Patient information: -The patient's age, sex, and chief complaint -The patient's level of consciousness -Minimum of two sets of vital signs -All assessments completed on the patient
-All treatments provided and response to treatment Administrative information: -The address of the call -Date of the call -Your unit designation -The name or identifying number and certification level of all EMS providers on the call Narrative How many bones are there in the human body? - correct answer There are 206 bones in the human body. How many vertebrae are in the spinal column? - correct answer 33 vertebrae -7 cervical -12 thoracic -5 lumbar -5 sacral -4 coccygeal What are the components of the upper airway? - correct answer Components of the upper airway include: -Nose and mouth -Nasopharynx -Oropharynx -Larynx -Epiglottis
Exhaled air contains 16% oxygen. What are the different types of respiration? - correct answer External respiration: the exchange of oxygen and carbon dioxide between the alveoli and pulmonary capillaries. Internal respiration: gas exchanged between the body's cells and the systemic capillaries. Cellular respiration: also known as aerobic metabolism, uses oxygen to break down glucose to create energy. What is the primary mechanism of breathing control? - correct answer Carbon dioxide drive is the primary mechanism of breathing control for most people. The brain stem monitors carbon dioxide levels in the blood and CSF. High carbon dioxide levels will stimulate an increase in respiratory rate and tidal volume. What is hypoxic drive? - correct answer Hypoxic drive is a backup system to the carbon dioxide drive. Specialized sensors in the brain, aorta and carotid arteries monitor oxygen levels. Low oxygen levels will stimulate breathing. The hypoxic drive is less effective than carbon dioxide drive. What is the minute volume? - correct answer Respiratory rate times tidal volume. What are normal breathing rates for adults, children and infants? - correct answer Normal adult rate: 12-20 breaths per minute Normal pediatric rate: 15-30 breaths per minute Normal infant rate: 25 to 50 breaths per minute
Non-labored Regular rhythm Clear and equal breath sounds bilaterally What are the three layers of heart muscle and pericardium? - correct answer Endocardium: smooth, thin lining on the inside of the heart Myocardium: thick muscular wall of the heart Epicardium: outermost layer of the heart and innermost layer of the pericardium Pericardium: fibrous sac surrounding the heart What is the heart's electrical conduction system? - correct answer The primary power plant, the sinoatrial (SA) node, normally generates impulses between 60 and 100 times per minute in the adult. The atrioventricular (AV) junction is the backup pacemaker and generates electrical impulses at about 40 to 60 per minute. The bundle of His is the final pacemaker for the heart. It generates impulses only at about 20 to 40 per minute. What is preload? - correct answer Preload is the precontracting pressure based on the amount of blood coming back to the heart. Increased preload leads to increased stretching of the ventricles and increased myocardial contractility. What is afterload? - correct answer Afterload is the resistance the heartm ust overcome during ventricular contraction. Increased afterload leads to decreased cardiac output. What are the components of blood? - correct answer Plasma: the liquid component of blood, made mostly of water Red blood cells: the oxygen-carrying component of blood
What is the physiology of newborns and infants? - correct answer The typical newborn weighs about 6-8 pounds. The newborn's weight will typically double by 6 months and triple by one year. The newborn's head makes up about 25% o f the body and is a significant source of heat loss. During the first couple weeks, neonates often lose weight, and then begin to gain it back. The newborn's fontanelles (soft spots on the skull) will be fully fused by about 18 months. Depressed fontanelles may indicate hypovolemia. Infants are often nose breathers and can develop respiratory distress easily. Rapid breathing can lead to fluid loss and loss of body heat. Hyperventilation of infants presents significant risk of barotrauma. What are the reflexes that infants have? - correct answer Startle reflex, grip reflex, rooting reflex, sucking reflex What are the age ranges of toddlers and preschoolers? - correct answer Toddlers: 1 to 3 years old Preschoolers: 3 to 6 years old What are normal vital signs of toddlers and preschoolers? - correct answer Toddlers: -Respirations: about 20-30 breaths per minute -Heart rate: 90-140 bpm -Blood pressure: 80-90 systolic
Preschoolers: -Respirations: about 20-25 breaths/minute -Heart rate: 80-130 bpm -Blood pressure: about 90-110 systolic What is the physiology of toddlers and preschoolers? - correct answer As the immune system develops, children at this age typically experience a number of minor colds, viruses, flu-like symptoms, respiratory infections, etc. Fine motor skills improve and the brain grows rapidly in size. Toddlers: typically walk, climb, distinguish basic shapes and colors and are potty trained. Preschoolers: typically are physically coordinated and communicate well verbally, know their name and address and can dress themselves, can count to 10 or beyond. What developments you should know about school-age children? - correct answer Vital signs: -Respirations: about 15 to 20 breaths/minute -Heart rate: 70-110 bpm -Blood pressure: 90-120 systolic Physiology: -Permanent teeth replace baby teeth -The musculoskeletal system is growing rapidly School-age children typically: -Read and write -Develop problem-solving skills -Are establishing their self-image and morals -Have a large social circle due to school -Understand the concept of death
