operations exam Flashcards

Question

As soon as you begin transport of a patient to the hospital, you should: A) Contact medical control B) Notify the receiving facility C) Advise dispatch of your status D) Conduct a detailed examination

Answer 1

C) Advise dispatch of your status Immediately upon departing the scene with a patient, you should first inform the dispatcher that you are en route to the hospital. Never leave the dispatcher in the dark, because it is the dispatcher's job to know which units are available to answer emergency calls. Notifying the receiving facility, contacting medical control, and performing a detailed assessment of your patient all can occur while you are en route to the hospital.

Answer 2

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.

Answer 3

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.

Answer 4

C) During the ambulance check, the EMT documents that the oxygen cylinder is full, knowing that it is empty. In the context of medicine, negligence is defined as the failure to provide the same care that a person with similar training would provide in the same or a similar situation. Negligence can further be classified as ordinary and gross. Ordinary negligence is a mere failure to exercise reasonable care. Gross negligence, however, is a conscious and voluntary disregard of the need to provide reasonable care, which is likely to cause foreseeable grave injury or harm to a patient. Of the options listed, documenting that an oxygen cylinder is full, knowing that it is empty, meets the definition of gross negligence because the EMT knowingly and voluntarily chose to falsify the ambulance check. The EMT who elects not to use spinal precautions on a patient who is later diagnosed with a spinal fracture may constitute ordinary negligence, especially if spinal precautions were clinically indicated. The remaining examples do not depict negligence because they were not done voluntarily and wantonly.

Answer 5

B) move the coffee table, begin patient care, and notify a police officer. After ensuring your own safety, your primary responsibility when functioning at a crime scene is to provide patient care. Optimally, you should help preserve the scene at the same time. In this situation, however, the patient requires immediate treatment; he is unresponsive and has life-threatening injuries. It would be difficult to provide effective care in his present position, and notifying law enforcement before you move any furniture would unnecessarily delay care. Therefore, you should move the coffee table out of the way and begin treatment. When possible, notify a law enforcement officer of what you moved, where you moved it to, and why you moved it. You should also document this action on the patient care report, AFTER you have cared for the patient.

Answer 6

B) request additional ambulances to respond to the scene. One of the most important aspects of the scene size-up is determining the need for additional resources. A single EMS unit and two EMTs cannot effectively manage three patients, especially if those patients are critically injured. Therefore, you must first request additional ambulances at the scene. After requesting additional resources, begin the processes of triage and treatment. Notify the local trauma center early, if possible, so personnel there can prepare to take care of the patients; however, your first priority is to maximize patient care at the scene by requesting additional ambulances.

Answer 7

D) Training a group of daycare employees on infant and child CPR The operative word in injury and illness prevention is prevention. An injury or illness prevention program should focus on actions that prevent illness or injury. These include, but are not limited to, teaching new parents how to properly install a child safety seat, educating teenage students on the dangers of drinking and driving, and conducting a courtesy inspection of the home of young parents for the presence of child safety locks. Training laypeople in CPR, although a critical service, is not part of a prevention program; CPR is not needed until an injury or illness has already occurred.

Answer 8

D) “The patient requires inpatient psychiatric care.” Documentation in the patient care report (PCR) should be factual, objective, and free of personal opinion. Statements made by the patient, family members, or bystanders should be included, but should be placed in quotation marks exactly as they were spoken. Notation of the odor of alcohol on a patient’s breath is an objective assessment finding. On the other hand, stating that a patient is drunk would be subjective because you cannot make that legal determination. Stating that a patient requires inpatient psychiatric care is also a subjective statement that is reflective of one’s personal opinion.

Answer 9

B) report to the staging area. Once you arrive at the scene of a mass-casualty incident where an incident command system has already been established, you should report to the staging area, the area designated for all incoming ambulances and resources. The staging officer will know where help is needed the most and will be able to direct your actions accordingly.

Answer 10

B) Denial This scenario depicts classic denial. Despite the fact that the patient was diagnosed with advanced cancer, he refuses to believe that the situation is very serious. During the anger phase of the grieving process, the patient may make statements such as “why me?” During the bargaining phase, the patient may make promises (for example, being a better person or going to church) in exchange for additional time to live. The acceptance phase, which is usually the most difficult phase for the patient’s family, occurs when the patient fully realizes and accepts the significance of the situation and comes to peace with it. It is important to note that the stages of grieving do not always follow a specific order.

Answer 11

D) flammable. Placards are diamond-shaped indicators that are placed on all four sides of highway transport vehicles, railroad tank cars, and other forms of transportation carrying hazardous materials. They identify the broad hazard class to which the material inside belongs. Red placards indicate that the material is flammable. Orange placards indicate that the material is explosive. White and yellow placards indicate that the material is radioactive. Black and white placards indicate that the material is corrosive. Refer to the Emergency Response Guidebook (ERG) for detailed information regarding placard colors and numbers.

Answer 12

A) reduced efficiency of the operation. When the incident command system (ICS) has been established, incoming personnel report to the staging area, where they are assigned to a specific section to perform specific tasks. When these tasks are completed, the individual should report back to the assigning individual for further assignment. Personnel who take it upon themselves to function independently outside of the ICS structure are called freelancers. Freelancing is NOT beneficial in any way; it reduces the efficiency of the entire operation. Furthermore, freelancing does not allow faster identification and transport of critical patients; in fact, it only creates confusion. The ICS is established to facilitate a smooth, efficient operation and minimize loss of life. Freelancing, on the other hand, is completely counterproductive and could actually result in unnecessary loss of life.

Answer 13

D) at intersections. Intersection crashes are the most common and usually the most serious type of collision in which ambulances are involved. When approaching an intersection, you should come to a complete stop, look in both directions for pedestrians and other motorists, and then proceed with caution. Remember, your lights and siren do NOT give you the right of way; they simply ask other motorists for the courtesy of the right of way. If you proceed through an intersection without stopping and strike another vehicle that had the right of way, you will be held liable. Whether your lights and siren were in use at the time of the incident is irrelevant.

Answer 14

B) the scene is potentially unsafe. The presence of law enforcement at the scene indicates, at a minimum, that the scene is potentially unsafe; otherwise, they would not have been summoned. While you are en route, you should make radio contact with the police officers at the scene to determine if it is safe for you to enter; you should also inquire about the severity of the patient's injuries. The more information you obtain before you arrive, the better. For all you know, you could arrive and find yourself in the middle of a firefight! The mere presence of law enforcement at the scene does NOT ensure a safe environment.

Answer 15

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.

Answer 16

B) describe acceptable patient interventions in the form of medical orders. As an EMT, you may encounter Physician Orders for Life-Sustaining (POLST) or Medical Orders for Life-Sustaining Treatment (MOLST) forms when caring for patients with terminal illnesses. These documents explicitly describe acceptable interventions in the form of medical orders. These forms must be signed by an authorized medical provider in order to be valid; this may be a physician, physician assistant, or nurse practitioner, and varies by state. If you encounter these documents, follow your agency protocols or contact medical control for guidance. A POLST or MOLST form is NOT a do not resuscitate (DNR) order or living will, nor does it limit treatment to basic or advanced life support. The interventions listed on the document vary, depending on the patient’s needs. An out-of-hospital DNR order is a legal document that informs EMS personnel that resuscitation is not indicated. A durable power of attorney for healthcare enables a family member or other designated individual to make healthcare decisions on the patient’s behalf.

Answer 17

A) Burnout Your partner's behavior is consistent with burnout. Burnout is a condition of chronic fatigue, irritability, and frustration that results from mounting stress over time. Although burnout typically manifests after years of service in EMS, some EMTs begin to experience it in a very short period of time, especially if they work in EMS systems with a high call volume and low morale. Some people with burnout abuse drugs or alcohol; if you suspect this behavior, you should report it to your supervisor immediately. The best way to prevent burnout is to recognize the signs of stress and take action to reduce it. An acute stress reaction occurs in response to a sudden, unexpected event; it is clear that your partner has experienced many stressful events over his career. Delirium is an acute change in cognitive ability; it commonly results from conditions such as hypoxia, hypoglycemia, and drug toxicity.

Answer 18

D) request additional ambulances. As soon as you determine that there are more patients than you and your partner can effectively manage, you should immediately request additional help. Waiting until you are overwhelmed with critically injured patients is not the time to call for help. When in doubt, it is best to call for help. You can always cancel any incoming ambulances if you later determine that they are not needed. After you have called for assistance, you should begin triaging and caring for the patients to the best of your ability.

Answer 19

C) The number of patients overwhelms your resources. A mass-casualty incident (MCI) occurs anytime the number of injured patients overwhelms your available resources. It is not necessarily defined by the number of patients, but rather by your ability to effectively manage them. For example, if you and your partner arrive at a scene and find two critically injured patients, you have an MCI (albeit a small-scale MCI) because two EMTs and one ambulance can care for only one critically ill or injured patient effectively.

Answer 20

D) Explosive The color of a warning placard indicates the general classification of agent being carried, while the United Nations (UN) number in the center of the placard indicates the exact agent being carried. For example, a red placard bearing the UN number 1203 indicates gasoline; red indicates the classification (flammable), and 1203 indicates the exact agent (gasoline). Orange placards indicate explosive or blasting agents, placards that are half yellow and half white indicate radioactive agents, and black placards indicate corrosive agents. Use your emergency response guidebook (and binoculars, if appropriate) to identify both the classification and the exact agent involved.

Answer 21

C) placing it in a biohazard bag. The appropriate method for disposing of soiled clothing or any other "nonsharp" contaminated item is to place it in a red biohazard bag. The biohazard insignia as well as the red color alerts others that the items within the bag are contaminated. Blood-soaked items should not be placed in a regular trashcan.

Answer 22

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.

Answer 23

C) The EMT defibrillates a patient with the automated external defibrillator, directs immediate resumption of CPR, and then contacts medical control for further guidance. Standing orders define certain treatment interventions that the EMT is authorized to perform prior to contacting medical control. For example, the EMT knows that a cardiac arrest patient requires CPR, cardiac rhythm analysis with the AED, and defibrillation (if indicated); contacting medical control before performing these crucial interventions would simply waste time and increase the chance of a negative patient outcome. Standing orders generally apply to interventions that the patient requires to prevent immediate death. Follow your local protocols regarding which interventions you are authorized to perform prior to contacting medical control.

Answer 24

A) Animal bite Although each state may have slightly differing reporting laws, most require the EMT to report cases such as child or elderly abuse, sexual assault, animal bites, and injury that occurs during the commission of a crime. Injury to a minor is typically not a reportable case unless abuse is suspected. Motor vehicle crashes and drug overdoses are not reportable cases either, unless they occur during the commission of a crime.

Answer 25

B) material safety data sheet. All facilities that use or store chemicals are required by law to have a material safety data sheet (MSDS) on file for each chemical used or stored in the facility. Many sites, especially those that stock many different chemicals, may keep this information archived on a computer. The MSDS provides basic information about the chemical makeup of a substance, the potential hazards it presents, appropriate first aid in the event of an exposure, and other pertinent data for safe handling of the chemical. Shipping papers, called bills of lading (freight bills), are required whenever chemicals are being transported from one place to another. Drivers transporting chemicals are required by law to have a set of shipping papers on their person or within easy reach inside the cab at all times. The company’s policy handbook is of no real value to the incident commander. The Emergency Response Guidebook (ERG) is a tool for emergency responders; it is typically not present at a chemical plant or similar site.

Answer 26

B) assessing exactly how the patient is trapped and determining the safest way to extricate him or her. Your ability to access the patient, with or without difficulty, does not indicate the extent of entrapment or method of extrication necessary. The EMT's job is to assess and treat the patient; the rescue team's job is to determine the degree of entrapment and decide how to extricate the patient. As you are assessing the patient and providing any care that you can within the confines of the vehicle, the rescue team should be assessing the vehicle and the degree of patient entrapment; this will enable them to determine the safest, most effective extrication approach. It is critical for the EMT in the vehicle and the rescue team outside the vehicle to be in constant communication. Once the patient has been assessed and provided with any immediate life-saving care, and the rescue team has determined the best extrication approach, extrication can begin.

Answer 27

C) an on-scene emergency physician. On-site communications, an adequately staffed treatment area, and a supply area near the treatment area are some of the key components at a mass-casualty incident. Although the physician medical director has ultimate authority for all patient care activities at the scene, he or she typically communicates with the incident commander via mobile phone or two-way radio from the base hospital. Physical presence of the physician at the scene, although optimal, is often not possible.

Answer 28

C) an on-scene emergency physician. On-site communications, an adequately staffed treatment area, and a supply area near the treatment area are some of the key components at a mass-casualty incident. Although the physician medical director has ultimate authority for all patient care activities at the scene, he or she typically communicates with the incident commander via mobile phone or two-way radio from the base hospital. Physical presence of the physician at the scene, although optimal, is often not possible.

Answer 29

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.

Answer 30

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.

Answer 31

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 SARS-CoV-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.

Answer 32

A) Allow him to voice his feelings to you. Your partner is clearly having difficulty coming to terms with this call's bad outcome. As his partner, you can be most effective during this time by simply listening and allowing him to voice his feelings. Bad feelings should never be kept bottled up. If your partner is still having difficulties, a formal critical incident stress debriefing (CISD) may be needed. Some EMS providers may require psychiatric or psychological assistance; however, this is not a determination that you can make. At least 8 hours of sleep is healthy; however, in the face of a crisis, sleep does not make the problem go away.

Answer 33

D) maintain communication with him and closely monitor his airway. Physical restraint may be necessary if a patient is a threat to himself or herself or to others. If it becomes necessary to physically restrain a violent patient, specific guidelines must be followed. Use a minimum of four people to restrain the patient, one assigned to each extremity. Approach the patient from the front and the sides; this will prevent him or her from getting away from you. Someone, preferably you or your partner, should talk to the patient throughout the restraint process, even if the patient is not listening to you. Never restrain a patient face down (prone); it is impossible to adequately monitor the patient and this position may inhibit the breathing of an impaired or exhausted patient (positional asphyxia). Use just enough force to effectively restrain the patient; the patient's gender, body size, strength, and mental status can be used to determine the appropriate amount of force. Reassess airway and breathing continuously, regardless of the patient's position, and continue to talk to him or her during transport.

Answer 34

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.

Answer 35

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).

Answer 36

D) A paramedic transfers care to an advanced EMT. Abandonment occurs anytime you disengage from a patient while he or she still requires care or you relinquish your responsibility of patient care to a provider of lesser training. If a paramedic transfers patient care to an advanced EMT (AEMT)--a provider with a lower level of training--then the paramedic has abandoned his or her patient. When delivering a patient to the emergency department, you must give your verbal report to a registered nurse or a physician.

Answer 37

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!

Answer 38

C) Chlorine (CL) The patients' signs and symptoms are indicative of a pulmonary (choking) agent, specifically chlorine (CL). Chlorine was the first chemical agent ever used in warfare. It has a distinct odor of bleach and creates a green haze when released as a gas. Initially, it produces upper airway irritation and a choking sensation. Later signs and symptoms include shortness of breath, chest tightness, hoarseness and stridor as the result of upper airway swelling, and gasping or persistent coughing. Phosgene, not to be confused with phosgene oxime (a blistering [vesicant] agent), is also a pulmonary (choking) agent. Tabun (GA) and V agent (VX) are examples of chemical nerve agents. Nerve agents are among the most deadly chemicals developed. Designed to kill large numbers of people with small quantities, nerve agents can cause cardiac arrest within seconds to minutes of exposure.

Answer 39

C) Chlorine (CL) The patients' signs and symptoms are indicative of a pulmonary (choking) agent, specifically chlorine (CL). Chlorine was the first chemical agent ever used in warfare. It has a distinct odor of bleach and creates a green haze when released as a gas. Initially, it produces upper airway irritation and a choking sensation. Later signs and symptoms include shortness of breath, chest tightness, hoarseness and stridor as the result of upper airway swelling, and gasping or persistent coughing. Phosgene, not to be confused with phosgene oxime (a blistering [vesicant] agent), is also a pulmonary (choking) agent. Tabun (GA) and V agent (VX) are examples of chemical nerve agents. Nerve agents are among the most deadly chemicals developed. Designed to kill large numbers of people with small quantities, nerve agents can cause cardiac arrest within seconds to minutes of exposure.

Answer 40

C) The EMT informs a patient of the potential risks associated with his proposed treatment EMTs should obtain consent to assess and treat from every patient who is of legal age and has decision-making capacity. In order for consent to be informed, the patient must be informed of the EMT’s proposed treatment plan, as well as the risks and benefits of said treatment. If this information is not disclosed to the patient, then consent is not informed. If a patient refuses EMS treatment, the EMT must inform him or her, in layman’s terms, of the risks of refusing EMS treatment; this is called an informed refusal. Regardless of whether the patient accepts or refuses EMS treatment, he or she must be properly informed of risks and benefits. Treating an unresponsive patient based on the assumption that he or she would otherwise accept treatment is called implied consent.

Answer 41

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.

Answer 42

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.

Answer 43

B) Tag the child as immediate According to the JumpSTART triage process, a child who is breathing fewer than 15 breaths/min or more than 45 breaths/min is tagged as an immediate (red) priority. You should then move to the next patient. If the respirations are within the range of 15 and 45 breaths/min, the child’s hemodynamic status is assessed by checking for distal pulses. If distal pulses are absent, the child is tagged as immediate. If distal pulses are present, assess the child’s neurologic status using an age-appropriate AVPU score. Stopping the triage process to begin treatment will delay triage of other patients.

Answer 44

A) The exact location of the patient You should attempt to obtain as much patient information from the dispatcher as you can. However, to help the patient, you must know his or her location; therefore, this is the most important initial question to ask. Once you determine where the patient is, you should then try to ascertain the sex and approximate age of the patient, whether he or she is breathing, and any other information that can help you prepare to provide care. The caller's phone number is generally not disclosed to the responding EMTs, although it is important information for the dispatcher to obtain. In many dispatch systems, the caller's phone number (and location in some cases) automatically appears on the computer screen when the 911 call is answered.

Answer 45

B) Providing training that focuses on recognition and treatment of critical trauma patients Any EMS quality assurance (QA)/quality improvement (QI) program should focus on taking deliberate actions to enhance the quality and level of care provided by the system. In this case, crews are spending too long at the scene of critically injured patients. In the absence of extenuating circumstances (ie, delayed extrication, safety issues), these lengthy scene times would suggest that systemwide focused training on recognizing and treating critically injured patients is warranted. Taking disciplinary action against the crews would be counterproductive; it should be addressed at the system level. Patient follow-up after the call is an important component of the QA/QI process; however, this occurs after the event. Air medical transport can benefit critically injured patients, especially when ground transport times are lengthy. However, it would not be appropriate to implement a protocol that mandates air transport for all critically injured patients.

Answer 46

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.

Answer 47

A) transporting patients to the hospital. At the scene of a mass-casualty incident (MCI), you will be faced with many challenges, including ensuring your own safety, extrication, triage, and patient care. In the midst of all of these activities, however, you must never lose sight of your ultimate goal, which is to transport all patients to the appropriate hospital as soon as possible. At the scene of an MCI, patients who are pulseless and apneic are not treated.

Answer 48

A) Soman Nerve agents (eg, V agent [VX], sarin [GB], soman [GD], tabun [GA]) are among the most deadly chemicals developed. Designed to kill large numbers of people with small quantities, nerve agents can cause cardiac arrest within seconds to minutes of exposure. Nerve agents, which were discovered by researchers looking for a superior pesticide, are classified as organophosphates; these chemicals are found in household bug sprays, agricultural pesticides, and some industrial chemicals. Organophosphates block an essential enzyme in the nervous system, which causes the body's organs to become overstimulated. The mnemonic DUMBELS can help you recall the signs and symptoms of nerve agent exposure; it stands for Diarrhea; Urination; Miosis (constricted pupils); Bradycardia; Emesis (vomiting), Lacrimation (excessive tearing); and Seizures, Salivation, and Sweating. You can also use the mnemonic SLUDGEM, which stands for Salivation, Lacrimation, Urination, Defecation, Gastrointestinal distress, Emesis, and Miosis.

Answer 49

D) EMS medical director The incident commander (IC) is responsible for all logistical and operational aspects of a mass-casualty incident (MCI), such as designating section officers and working in collaboration with other agencies (eg, police, fire, EMS). For all issues regarding patient care, the EMS medical director has ultimate authority. Although the treatment officer is responsible for overseeing all emergency care provided at the scene, and EMTs working in the treatment area provide direct patient care, these personnel are still functioning under the physician's license. During an MCI, the IC (or his or her designee) is typically in contact with the medical director, who is located at the base station hospital, via mobile phone or two-way radio. In some cases, the medical director may be physically present at the incident.

Answer 50

D) A 65-year-old man who is confused and suspected of having a severe stroke A patient may be treated under the law of implied consent, also called the emergency doctrine, anytime he or she is unresponsive or otherwise lacks decision-making capacity (ie, confused, under the influence of drugs or alcohol). In cases such as these, the EMT should assume that the patient would consent to treatment and transport if he or she were able to make an informed decision. Examples of such patients include those who are intoxicated or who otherwise have an altered mental status (ie, stroke, hypoglycemia). Patients younger than 18 years of age may also be treated under the law of implied consent, unless the patient is female and is emancipated or pregnant.

Answer 51

B) at least one EMT in the patient compartment. The United States Department of Transportation (USDOT) requires at least one EMT in the patient compartment of a basic life support (BLS) ambulance. Although the driver does not have to be an EMT, it is preferable. Regardless, the person operating the ambulance must be able to safely and effectively operate an emergency vehicle. Regulations regarding minimum staffing of an ambulance vary from state to state.

Answer 52

C) In a unified incident command system, plans are made in advance by all agencies that assume a shared responsibility for decision making. Regardless of the type of incident command system (ICS) used, a single incident commander (IC) must be in charge. In a unified incident command system, plans are drawn up in advance by all cooperating agencies that assume a shared responsibility for decision making. The response plan should designate the lead and support agencies for several types of mass-casualty incidents (MCIs). For example, the Haz-Mat team will take the lead in a chemical leak and the medical team will take the lead in a multi-vehicle crash. Large MCIs often require a unified incident command system. A single incident command system is one in which one person is in charge, even if multiple agencies respond to the scene. It is generally used with incidents in which one agency has the majority of responsibility for incident management. Ideally, it is used for short-duration, limited incidents that require the services of a single agency.

Answer 53

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.

Answer 54

C) The EMT administers nitroglycerin to a hypotensive patient and the patient’s BP drops further Errors in patient care can stem from three possible sources. They can occur as a result of a rules-based failure, a knowledge-based failure, or a skills-based failure (or any combination of these). For example, if the EMT administers a medication or performs an intervention that the medical director has not authorized him or her to perform, a rules-based failure has occurred. If the EMT administers an inappropriate drug to a patient, such as giving nitroglycerin to a hypotensive patient, then a knowledge-based failure has occurred. If equipment is not used properly, such as an improperly-sized oropharyngeal airway, 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.

Answer 55

D) Reflective vest From a safety standpoint, when you arrive at a scene that is on a road or highway, your first order of action should be to make yourself visible to oncoming traffic when you exit the ambulance. Therefore, of the items listed, the reflective vest would be the most important to don initially. Gloves and eyewear should be applied at any point before you make patient contact. Depending on your degree of involvement in rescue or extrication, a safety helmet may or may not be required.

Answer 56

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.

Answer 57

A) AED and suction device Determining the equipment that should be taken to the patient's side is often guided by the nature of the call and/or departmental policy. For a cardiac arrest patient, the AED would clearly need to be taken in immediately since defibrillation is a critical intervention and has been directly linked to positive patient outcomes. The suction device, which may be needed to clear secretions from the airway, should also be taken immediately; mortality increases significantly if aspiration occurs. Oxygen and ventilation equipment are important; however, chest compressions and defibrillation have clearly been shown to provide the greatest benefit to cardiac arrest patients.

Answer 58

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.

Answer 59

D) No lights or siren Although the patient is complaining of chest pain, the nature of the pain is not consistent with a cardiac problem. Furthermore, her vital signs are stable and there are no apparent life-threats. She should be evaluated by a physician to rule out an occult condition; however, she does not require emergent transport. When transporting any patient, you should assess the risks and benefits of using lights and sirens. Numerous studies have been conducted to determine whether the use of lights and sirens save time getting the patient to the hospital. The findings of these studies show that while time is saved, the time you do save is minimal. If emergency lights are used, an audible alert system (ie, siren) must also be used. State laws generally prohibit the use of one or the other.

Answer 60

B) be secured by fixed clasps or housings. 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.

Answer 61

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.

Answer 62

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.

Answer 63

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.

Answer 64

B) Changing your gloves in between contact with different patients Although the most effective means of preventing the spread of disease is thorough handwashing, this is not practical at the scene of a mass-casualty incident; you usually do not have the time or facilities to do this. In a situation where you are treating multiple patients, you should change your gloves in between patients; this will help prevent cross-contamination. The concept of standard precautions is based on the assumption that ALL bodily fluids are potentially infectious; thus, there is no need to ask a patient if he or she has a communicable disease. Furthermore, to make such an inquiry is unethical.

Answer 65

C) wait until the nurse is freed up and then provide the verbal report. Proper patient care transfer at the emergency department involves giving a verbal report to the receiving nurse or physician, not a unit secretary or technician. Failure to do so could constitute abandonment. If the nurse or physician is busy and cannot take your verbal report, you must wait until they are freed up. It would not be appropriate to contact medical control and give your report to him or her because medical control is not who is accepting your patient.

Answer 66

A) continue full resuscitation and ask her if he has a living will. When faced with a situation in which a family member does not wish for you to attempt resuscitation of a loved one, you should inquire about the presence of a living will or out-of-hospital do not attempt resuscitation (OOH-DNAR) order. If a valid living will or OOH-DNAR order is produced, it is acceptable to cease resuscitative efforts; consult medical control as needed. If a valid living will or OOH-DNAR order is not available, the most prudent action would be to continue full resuscitative efforts and contact medical control. Even in the absence of such documentation, medical control may advise you to cease resuscitation based on the wishes of the family and the patient's medical history. When in doubt, err on the side of the patient and attempt resuscitation. Few would argue that it is preferable to defend why resuscitation was attempted as opposed to why it was not.

Answer 67

A) Smallpox Immunization requirements are usually set by the state department of health, but generally follow recommendations made by the Centers for Disease Control and Prevention (CDC). Recommended immunizations for health care providers include tetanus, diphtheria, and pertussis (Tdap, DTaP) boosters (every 10 years); measles, mumps, and rubella (MMR) booster; influenza vaccine (yearly); and hepatitis B vaccine (single or three-shot series). Smallpox vaccinations ceased in 1972 after the World Health Organization (WHO) officially declared the disease eradicated.

Answer 68

A) cleaning. The process of removing dirt, dust, blood, or other visible contaminants from a surface or equipment is called cleaning. Disinfection is the killing of pathogenic agents by directly applying a chemical made for that purpose to a surface or equipment. High-level disinfection is the killing of pathogenic agents by the use of potent means of disinfection. Sterilization is a process, such as the use of heat, to remove all microbial contamination.

Answer 69

C) have the incident commander guide you to a shielded staging area and wait for the tactical team to bring the patient to you. Upon arriving at the scene of a tactical situation, such as a hostage situation, the presence of a sniper, or any exchange of gunfire, you should report to the incident commander, who will take you to a shielded, safe staging area that has been selected for the ambulance and for treatment of casualties. Remain there until the tactical team brings the patient or patients to you. As an EMT, you are responsible for patient care once the patient has been brought to you; you are not in charge of the entire incident. When you arrive at the scene, turn your lights and siren off to avoid agitating the gunman. You should also keep your portable radio turned down and minimize radio traffic. If possible, use an ear speaker.

Answer 70

D) A cardiac arrest patient receives CPR in the field, but is not defibrillated for 5 minutes and is pronounced dead at the hospital. Proximate causation, one of the four components needed to prove negligence, is defined as a direct relationship between the provider’s action (or inaction) and the patient’s injury, illness, or death. Had the patient in cardiac arrest been defibrillated, the outcome may have been very different. Therefore, one could conclude that failure to defibrillate directly contributed to the patient’s death. The other examples in this question do not demonstrate proximate causation because the EMT either acted appropriately (for example, administering oxygen to a severely hypoxemic patient or administering oral glucose to a conscious patient), or the patient refused treatment that would have otherwise been indicated for his or her injury.

Answer 71

C) Inform him that the patients were transported to the hospital, but that you cannot disclose the extent of their injuries The BEST practice is to NOT talk to the media. Your department should have a public information officer (PIO), whose job is to do just that. If, for whatever reason, talking to the media is unavoidable, you should give the absolute minimum information. In this case, advise the reporter that the patients were transported to the hospital; however, you are not authorized to disclose any other information, including the extent of their injuries, their names, or their ages.

Answer 72

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).

Answer 73

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.

Answer 74

D) reaching no more than 30 inches in front of your body. Safe reaching practices are critical to the prevention of a back injury. When reaching, you should keep your back in a locked-in position. You should avoid twisting or hyperextending your back, and should reach no more than 15 to 20 inches in front of your body.

Answer 75

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.

Answer 76

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.

Answer 77

B) ensure that your ambulance does not block or hinder other arriving fire apparatus. When standing by at the scene of a structural fire, you must ensure that the ambulance is parked at a safe distance; this will not only keep you safe from the fire itself, but also minimize your risk of injury if the structure collapses. You must also ensure that the ambulance does not block or hinder access to the fire by fire apparatus that arrives after you. You should receive instructions from the fire officer in charge regarding the appropriate location to park the ambulance. It is not the EMT's job, nor is it safe, to enter a structure on fire; if victims are located by firefighters, they will be brought to you. Do not depart the scene and return to service until the fire officer in charge releases you; many dangers still exist after the fire has been extinguished.

Answer 78

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 nonbiased 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.

Answer 79

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.

Answer 80

Actual consent, also referred to as expressed consent, is when the patient asks for your help outright. This may also include nonverbal gestures, such as extending the arm to you to allow you to take the blood pressure. Informed consent involves explaining your proposed treatment to the patient, including the potential benefits and risks of the treatment. Implied consent involves treating an unresponsive patient or minor child (when the parents are not present) based on the assumption that the patient (or the parents of a minor) would consent to emergency treatment.

Answer 81

D) Wearing your seat belt and shoulder harness. Consistent safety practices, such as wearing your seat belt and shoulder harness, driving with due regard for others, and avoiding excessive speed, will afford you the highest degree of safety when responding to an emergency call. Unless used to guide you to an area with which you are unfamiliar, escort vehicles should be avoided. Escort vehicles are especially dangerous at intersections; as the escort vehicle proceeds through the intersection, other motorists often do not expect a second emergency vehicle to follow. As a result, they may pull out into the intersection, thinking it is clear, and collide with your ambulance (a wake effect collision). The use of lights and siren increases the danger factor, especially if used in conjunction with excessive speed. Lights and siren ask for, not demand, the courtesy of the right of way.

Answer 82

A) placing the patient in a basket stretcher and using at least four people to carry him to the ambulance. The basket stretcher, also called a Stokes basket, is ideal for moving patients across rough terrain. Because the patient fell from a cliff, the risk of a spinal injury is high; therefore, he will require spinal motion restriction precautions. Secure him to a long backboard and place the backboard in the basket stretcher. When carrying a patient across rough terrain, you should utilize at least four people to ensure a safe patient move. Clearly, the patient should not walk; he should be suspected of having a spinal injury due to the fall. A wheeled ambulance stretcher is impractical in situations were the patient must be moved over rough terrain. In many cases, a helicopter can be used to move patients from remote areas to a landing site near the ambulance or directly to the hospital. However, in this case, the weather (eg, fog, approaching thunderstorm) will likely prohibit a helicopter from being able to fly safely.

Answer 83

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.

Answer 84

C) Negligence and abandonment While laws may vary from state to state, assault is generally defined as instilling fear in an individual, whereas battery is defined as unlawfully touching a patient. Neither of these has occurred in this scenario. However, because the EMT did not deliver oxygen to a hypoxic patient who subsequently stopped breathing, he did not follow the standard of care as a prudent EMT would have in the same or similar circumstance; therefore, his inaction constitutes negligence. Furthermore, he abandoned the patient because he did not provide a verbal hand-off report to a nurse or physician. One cannot simply deliver a patient to the emergency department and leave without properly notifying someone.

Answer 85

B) slow the speed of the ambulance to encourage the motorist to pass. If a vehicle is tailgating the ambulance, whether you are driving in emergency or non-emergency mode, the safest and most appropriate action would be to slow the speed of the ambulance, pull to another lane, and allow the motorist to safely pass. Tapping on your breaks to encourage the motorist the slow down (break-checking) could cause the motorist to rear-end the ambulance; it could also induce road rage. Do NOT exit the ambulance and verbally engage the motorist; this is dangerous and could turn into a physical confrontation without warning. Increasing the speed of the ambulance will only encourage the motorist to increase his or her speed as well; this too is dangerous as it could cause a crash.

Answer 86

C) 100 feet by 100 feet The helicopter landing zone (LZ) should be a hard or grassy level surface. While various flight services may have slightly different recommended LZ dimensions, 100 feet by 100 feet is recommended by the majority of them. The LZ should be no less than 60 feet by 60 feet.

Answer 87

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.

Answer 88

B) skin blistering. The primary route of exposure to blister agents, or vesicants, is the skin. If vesicants are left on the skin or clothing long enough, they produce vapors that can enter the respiratory tract. Vesicants cause burn-like blisters to form on the victim's skin as well as in the respiratory tract (if inhaled). Vesicant agents include sulfur mustard (H), Lewisite (L), and phosgene oxime (CX). The symbols H, L, and CX are military designations. Vesicants usually cause the most damage to damp or moist areas of the body, such as the armpits, groin, and respiratory tract.

Answer 89

C) keeping the weight as close to you as possible. General guidelines for safe lifting and moving include keeping the weight as close to your body as possible; keeping your back in a straight, locked-in position; using the muscles of your thighs to lift; and avoiding twisting when moving a patient around a corner. Back injuries are the most common injury sustained by the EMT and can be easily avoided if proper lifting and moving techniques are observed.

Answer 90

A) use radio codes to describe the situation. When giving a report to medical control or requesting medical direction, you should avoid the use of radio codes, such as "10-50"; The physician may not be familiar with such codes. There is clearly less risk of confusion if you use plain English. At the same time, you should use proper medical terminology, especially when describing the patient's injuries. Information regarding the severity of damage to the patient's vehicle is important information and should be relayed to the physician; this can help him or her appreciate the significance of the situation. Do not be afraid to question an order that is contrary to your training or protocols; the physician may have simply made an error. Repeating an order back to the physician, word for word, will minimize the risk of this occurring.

Answer 91

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.

Answer 92

B) turn the siren off and wait for the bus driver to close the doors and turn the red flashing lights off. It is NEVER appropriate (or legal) to pass a school bus when its red lights are flashing, regardless of the situation! When, and only when, the bus driver turns off the red flashing lights is it legal to pass; even then, you should pass with great caution. None of the other answer options are correct because they all involve passing the school bus when its red lights are flashing.

Answer 93

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 lives.