Operations

Question 1

You are dispatched to the scene of a 9 year old girl who has been struck by a car. Police are unable to reach her parents. What gives you the ability to treat the girl?

Answer 1

Implied Consent

In the absence of a parent or guardian, evaluation, treatment and/or transport of a child should not be delayed pending parental consent. Therefore consent is “implied” assuming the parent would want you to help their child.

Question 2

You are dispatched to 123 Somewhere Rd to a call for an injured woman. As you approach the door of the home, a man opens the door and tells you “this is none of your business” and to “get out of here”. What is the correct course of action in this case?

Answer 2

Return to the ambulance, drive a safe distance away and call for the police

As an EMT you should never place yourself in harm’s way. If you feel a situation may be dangerous you should always wait for assistance from the police.

Question 3

If a patient refuses treatment and an EMT treats the patient anyway, what crime can the EMT be charged with?

Answer 3

Battery

To treat a patient without some form of legal consent could be considered Battery

Question 4

This practice of protecting yourself and your patient from the transfer of bodily fluids is known as what?

Answer 4

Body Substance Isolation

Body substance isolation is a practice of isolating all body substances (blood, urine, feces, tears, etc.) of individuals undergoing medical treatment, particularly emergency medical treatment of those who might be infected with illnesses such as HIV, or hepatitis so as to reduce as much as possible the chances of transmitting these illnesses

Question 5

What law provides protection from legal action to someone who provides help to an injured person?

Answer 5

Good Samaritan Law

Under the common law, Good Samaritan laws provide a defense against torts over the activity of attempted rescue.

Question 6

While responding, ambulances are particularly at risk of collisions in which areas?

Answer 6

Intersections

Cars sitting at intersections may block the view of the ambulance operator and cannot see other cars approaching. Cars approaching the intersection when the light is changing may not want to stop and may accelerate through. Additionally, cars sitting at a stop light might not be paying attention and can accelerate without looking.

Question 7

Headlights are often overlooked as part of the emergency warning lighting system. Headlights should be used while______________?

Answer 7

On the road

Emergency warning lights are often overlooked in busy high traffic areas. Headlights can make a difference when safety counts. Even during daylight hours headlights increase the chances that the ambulance will be seen. Some headlights are wired to flash when the other emergency warning lights are on which enhances the distance downrange the ambulance can be seen.

Question 8

While responding to a Hazardous Materials incident, the EMT should approach the scene from _________?

Answer 8

Up wind, Uphill, Up river

When responding to a known HazMat incident, the Emergency responders need to approach the scene from up wind, uphill and up river. This keeps the materials ahead of the responders and avoids exposure of the emergency workers.

Question 9

EMS should set up in which zone during a HazMat incident?

Answer 9

Cold Zone

The EMS crew is not protected with the appropriate personal protective gear to operate in the hot or warm zones. Patients must be decontaminated thoroughly prior to the EMS sector taking over care of the patient. There are no exceptions here, the potential of exposure to the hazardous material is too great.

Question 10

When is it acceptable to take a patient directly from the hot zone without going through decontamination?

Answer 10

Never

It is never acceptable to skip the decontamination; the risk of exposure of the EMS crew and other health care providers is too great to allow patients to by-pass decon. Most decon teams are capable of handling life threats as the patient is going through the decontamination process.

Question 11

You have called an air medical service to come pick up your accident victim from your scene. The helicopter contacts you when they are 5 minutes out. They ask for landing zone (LZ) information. What information should be included in this safety brief?

Answer 11

Overhead obstructions, type of landing surface, high tension power lines within 1/4 of a mile from LZ.

Any obstructions which would interfere with the approach and departure of the aircraft are very important. Power lines are especially critical as they are impossible to see from the air so the air medical crew will rely on the personnel on the ground to point that information out. Type of surface is important to anticipate dust, grass or other debris which will become airborne during landing. High tension power lines which are in the area are equally important as they may be in the approach or departure pattern.

Question 12

Which of the following patients would be appropriate for air medical transport from your scene?

a) 55 year male with an isolated lower leg fracture secondary to stepping in a hole at a construction site
b) 55 year male with multiple bee stings with no complaints of shortness of breath, difficulty swallowing or hives
c) 55 year male status post fall from standing complaining of ankle swelling and contusion to left elbow.
d) 55 year male high speed motor cycle accident vs. a cement highway barrier

Answer 12

D

The high speed motor cycle mechanism is perhaps the highest degree of concern in this question. The other mechanisms do not have the potential of multiple organ systems being involved. The bee stings, while they are painful, present little risk of being ground transported or even left home to follow their physicians directions if there are no signs of anaphylaxis.

Question 13

When you arrive at the receiving facility you must transfer care to the ED staff. By giving a report to the attending nursing staff about the past medical history, the patient’s complaint assessment, and interventions you have just allowed for what?

Answer 13

Continuity of care

Giving a report to the receiving facility’s staff allows for continuity of care and continued care. This not only allows for a more speedy response by the receiving facility but eliminates unneeded repeated assessments and evaluations.

Question 14

Arriving on scene of a multi-car accident, the in-charge EMT tells dispatch that they have arrived and what they have found. “Squad 3 is on scene. There is a three car accident. All patients are out and walking on the scene.” What is this information called?

Answer 14

Scene size-up

A scene size up allows for several things 1) lets other responding companies know what to expect once they arrive on scene. 2) Allows for an upgrading or downgrading of the assignment. 3) lets dispatch know what to expect in adding extra resources.

Question 15

Upon arriving on any scene, what is the most important action an EMT should do?

Answer 15

Position the ambulance to protect the scene

Scene safety should be the number one concern for any emergency responder to any scene. By positioning the ambulance in a way to block the scene from traffic, which might not be paying attention, then all responders can work within the scene safely. Ease of access to the vehicle is of concern but not at the risk of scene safety.

Question 16

You’ve arrived at the scene of what appears to be a domestic dispute over child molestation. You are asking a 5-year-old child about elimination habits. What word would be best to use when questioning this child?

Answer 16

“Pee-pee”

A 5-year-old will not understand words such as urination or micturition. The best term to use in this instance is “pee-pee.” (This is a good example where the paramedic needs to correlate life span development and effective communication knowledge.)

Question 17

You are in charge of devising an ambulance deployment plan for the EMS system within your community. Your goal is to minimize response times while simultaneously using all of the EMS resources in an efficient and cost effective manner. As such, which of the following information would be most valuable in formulating a plan?

Answer 17

Time and location of calls over last 5 years

Determining the time and location of calls over the past five years is critical, since analysis may reveal patterns to which the appropriate number of EMS resources can be matched. If an increase in the number of motor vehicle collisions is seen during morning rush hour, additional units can be deployed to strategic locations so that they can readily access future incidents.

Question 18

Which of the following statements regarding continuing education is most valued by the public?

Answer 18

It provides the opportunity for the paramedic to learn of new or changing medications and skills.

Since medicine is a constantly evolving profession, the paramedic must stay abreast of current information, techniques, and medications.

Question 19

You are called to a local industrial complex for a potential hazardous materials incident. The dispatcher reports to you that approximately 30 workers have been affected and that several workers have been overcome by fumes. The specialized hazardous materials response team has been dispatched but will arrive approximately 20 minutes after your ambulance. Upon arrival, you are met at the gate by a worker who points to a large white tank next to the building which is the apparent source of the contamination. On the side of the tank you see a multi-colored NFPA 704 symbol with a number four (4) located within the blue diamond, a number one (1) located within the red diamond, a number one (1) located within the yellow diamond, and no indicator located within the white diamond. You are immediately approached by a crowd of approximately fifteen workers who state that they were exposed to fluid which was leaking from the tank. What is your next immediate action?

Answer 19

Have the patients remove their clothing and begin to rinse them with water

Based upon the fact that the substance involved has already been identified as posing a significant health hazard, time cannot be wasted prior to initiation of field expedient gross decontamination. The universal decontaminating solution is water, and no time should be wasted in beginning to rinse any potential contamination away with it.

Question 20

Which of the following patients encountered would the EMT most likely benefit from critical incident stress management?

Answer 20

Death of a 4-year-old male patient from a fall.

Death of a child is often a reason for a paramedic to need CISM. In addition a death of a coworker, an extreme threat to the paramedic, or any other significant incident may also be reasons for CISM. What is most important, however, is that the recognition of stress and poor coping on the part of the provider is more important than assuming the use of CISM’s should be guided by the nature of the call.

Question 21

As an EMT, you release information on a patient to the newspaper. The patient felt he has been slandered. Which specific area of the law may the patient sue under?

Answer 21

Tort

While constitutional and federal law may apply, the best answer is the broad area in all states called “tort law.” These types of laws deal with differences between individuals - such as this example where one person was providing information about another person without previous and appropriate consent.

Question 22

Why is it critical that the paramedic complete an equipment checklist at the beginning of each shift?

Answer 22

Completion reduces the risk of liability associated with providing prehospital medical services.

Completion of an equipment/supply checklist enables the paramedic to determine the overall preparedness of the ambulance for patient care. Checklists allow the paramedic to ascertain whether all necessary supplies and equipment are present and working as well as the expiration dates on medications carried on the ambulance.

Question 23

As the head of the Quality Assurance Committee for your service, you review all patient care reports prior to passing them on to the medical director. On one trip sheet, you note the following narrative: Patient states that he cannot move his bowls and has had abdominal pane for three weeks. Patient also states that he has had a fever and took too Tylenol tablets this morning, but then became nauseated. What advice would you give the EMT regarding this report?

Answer 23

Get a dictionary and look up any questionable words when documenting.

Proper spelling is critical to prehospital documentation. Documentation containing spelling mistakes looks unprofessional and can cast doubt on the quality of care provided. Therefore, it is best to advise the EMT to use a dictionary and look up any and all words that he is unsure of how to spell.

Question 24

What are the rules or standards that govern the conduct of EMS professionals?

Answer 24

Ethics

Ethics are rules or standards that govern professional conduct, whereas morals are the individual’s perceptions of what is right and wrong. Neither standards nor codes are terms applicable to the concept of the question.

Question 25

Upon arrival at a local residence, you hear three possible gunshots in your vicinity. What should be your immediate next action?

Answer 25

Leave the scene until it can be secured by law enforcement.

If you enter a dangerous scene, you should leave the scene in the ambulance and immediately notify law enforcement so that the scene can be secured.

Question 26

You are called to the scene of a car versus tree accident. Upon arrival, you find the car to be engulfed in flames, with fire showing from underneath the hood and inside the passenger compartment. You can see that the operator of this vehicle is unconscious and slumped over the steering wheel. What is your first priority?

Answer 26

Ensuring safety of you and your partner

Your primary responsibility is always to ensure the safety of yourself and your crew. Once this is completed, then the focus can turn to the extrication and management of the patient. Always stay attentive to the scene, however, as things may suddenly change for the worse.

Question 27

After releasing care of a possible child abuse victim over to the emergency department staff, you are having a discussion with another ambulance crew who was not present at the incident. As you are describing your suspicion that the child’s mother is the perpetrator of child abuse, you are overheard by one of the child’s family members. What legal violation have you possibly committed?

Answer 27

Slander

Slander is the act of injuring a person’s character, name, or reputation by making a false or malicious statement with malicious intent or reckless disregard for the falsity of the statement.

Question 28

Of the following, which item is NOT a desired outcome of continued quality improvement (CQI) programs in an EMS system?

a) Provide statistics on call volume, patient profiles, and skills performed.
b) Develop and implement a disciplinary policy for any type of variance in care rendered by the EMS providers.
c) Allow the opportunity to identify potential topics for continuing education for the system’s emergency providers.
d) Provide a system of internal checks and balances that assures quality care is delivered, and system weaknesses are identified.

Answer 28

B - Develop and implement a disciplinary policy for any type of variance in care rendered by the EMS providers.

The benefits of a well-run Continuous Quality Improvement program for an Emergency Medical Service system go well beyond the ability to assess system performance. It allows for the collection of data for statistical analysis, provides a means by which areas of system weakness can be determined and addressed in a checks and balance manner, and also allows the ability to determine what type of continuing education courses may be offered since many times case studies are done on interesting calls.

Question 29

During completion of your patient care report, you write the following statement: The patient was obviously intoxicated and intentionally uncooperative. Subjective statements such as this can open the EMT up to what legal charges?

Answer 29

Libel

Libel is the act of injuring a patient’s character through written statements. Documenting personal opinion and derogatory statements expose the EMT to Libel.

Question 30

Which of the following agencies is responsible for the regulation of EMS radio communications?

Answer 30

Federal Communications Commission (FCC)

The Federal Communications Commission (FCC) is responsible for the control and regulation of all nongovernmental radio communications within the United States.