operations exam Flashcards
At the scene of a hazardous materials incident, medical monitoring of patients and emergency personnel should occur:
A) in the hot zone
B) in the warm zone
C) in the cold zone
D) before decontamination
C) in the cold zone
The cold zone is a safe area where personnel do not need to wear any special protective clothing for safe operation. Personnel staging, the command post, EMS providers, and the area for medical monitoring, support, and/or treatment after decontamination are all located in the cold zone. The hot zone is the area immediately surrounding the release and is the most contaminated area; personnel should wear full protective clothing while in the hot zone, and the only operation that should occur is patient rescue. Decontamination of patients and rescue personnel should occur in the warm zone.
A patient is found unresponsive in his small bathroom. He is not breathing and is sitting in the corner. Two EMTs are able to reach him, but they are unable to stand side by side. He appears to weigh about 150 pounds and there is no evidence that he has been injured. Which of the following would be the quickest and MOST practical way of moving him out of the bathroom?
A) Extremity lift
B) Long backboard
C) Direct ground lift
D) Stair chair device
A) Extremity lift
A patient is found unresponsive in his small bathroom. He is not breathing and is sitting in the corner. Two EMTs are able to reach him, but they are unable to stand side by side. He appears to weigh about 150 pounds and there is no evidence that he has been injured. Which of the following would be the quickest and MOST practical way of moving him out of the bathroom?
Which of the following is considered minimum personal protective equipment (PPE) when suctioning an unresponsive patient’s airway?
A) Gloves and a mask
B) Gloves and full facial protection
C) Gloves, grown, and eye protection
D) Gloves, head cover, and eye protection
B) Gloves and full facial protection
You should wear gloves and eye protection when assessing or treating any patient. The level of personal protective equipment (PPE) used beyond this is dictated by the risk and type of exposure. When managing a patient’s airway (eg, suctioning, ventilating with a bag-mask device), you should use, at a minimum, gloves and full facial protection. This will protect you from oral and eye exposure if the patient coughs or vomits. A gown should be worn, in addition to gloves and full facial protection, anytime there is a risk of blood splatter. Examples of when this may occur include delivering a baby or caring for a combative patient with severe external bleeding. The level of PPE you use in a given situation should be guided by reasonable judgment and common sense.
Upon arriving at the scene of an overturned tanker truck, you see a clear liquid leaking from the rear of the tank. The driver is still in the vehicle, and you can see that his face is covered with blood. What should you do?
A) Put on gloves, a gown, and a mask and quickly remove the driver
B) Stage upwind from the incident and what for the fire department
C) Approach the rear of a tanker to identify the type of fluid leaking
D) Ensure that the ambulance is downwind and downhill from the tanker
B) Stage upwind from the incident and wait for the fire department
Upon determining that you are dealing with a potential hazardous materials incident, you should immediately request specially trained personnel (eg, fire department, Haz-Mat team) if they are not already en route to the scene. Do not approach a vehicle that may be leaking a hazardous material, even if the patient is still in the vehicle, or you may become a casualty as well. Most ambulances are not equipped with the personal protective equipment required for potential hazardous materials exposure. Park your ambulance in a location that is both upwind and uphill from the incident. Until additional personnel arrive, try to identify the material being carried by reading the United Nations (UN) number on the safety placard affixed to the tanker; however, this should be done from a safe distance and with the use of binoculars.
Medical control has ordered you to administer one tube of oral glucose to a hypoglycemic patient. Immediately after receiving this order, you should:
A) document the order on the prehospital care report
B) administer the medication and reassess the patient
C) ask medical control to repeat the order word for word
D) repeat the order back to medical control word for word
D) repeat the order back to medical control word for word
Immediately after receiving an order from medical control, you should repeat the order back to medical control word for word. This will ensure that you heard correctly and understand the order to be carried out. If you receive an order that seems inappropriate, you should ask the physician to repeat the order back to you for clarification. Reassess the patient after administering the medication and document the time and patient’s response (good or bad) on your patient care report.
During triage of multiple patients at a bus crash, you encounter a young man who is hysterical because he believes he caused the accident. Other than minor abrasions to his arms and face, he has no other apparent injuries. What should you do?
A) Assign him an immediate priority and remove him from the site
B) Ask another uninjured patient to stay with the patient at all times
C) Direct him to go to the area where the walking wounded patients are
D) Remain with him until he is calm and then assign him a delayed category
A) Assign him an immediate priority and remove him from the site
There are a few special situations in triage. Patients who are hysterical and disruptive to triage and rescue efforts may need to be handled as an immediate priority and transported off the site, even if they are not seriously injured. Panic breeds panic, and this type of behavior could have a negative impact on other patients and on the responders.
While triaging patients at a mass-casualty incident, you encounter a responsive middle-aged woman with a respiratory rate of 26 breaths/min. What should you do next?
A) Triage her as immediate (red tag)
B) Assess for bilateral radial pulses
C) Administer high-flow oxygen at once
D) Assess her ability to follow commands
B) Assess for bilateral radial pulses
According to the Simple Triage and Rapid Treatment (START) method, if you encounter an adult patient with a respiratory rate that is less than 10 breaths/min or greater than 29 breaths/min, you should triage him or her as immediate (red tag) and move to the next patient. However, if the patient’s respiratory rate is between 10 and 29 breaths/min, you should assess his or her hemodynamic status by checking for bilateral radial pulses. If the patient’s radial pulses are absent, triage him or her as immediate and move to the next patient. If the patient’s radial pulses are present, assess his or her ability to follow simple commands. If the patient is able to follow simple commands, triage him or her as delayed (yellow tag) and move to the next patient. If the patient is unable to follow simple commands, triage him or her as immediate and move to the next patient. Treatment does not occur during the initial triage process.
The MOST effective means of preventing the spread of disease is:
A) Effective handwashing
B) up-to-date immunizations
C) Wearing gloves with all patients
D) Wearing a mask with pall patients
A) effective handwashing
According to the Centers for Disease Control and Prevention (CDC), the most effective way of preventing the spread of disease is to frequently and effectively wash your hands, especially in between patients. The regular use of gloves with all patients and wearing a mask when managing a patient with a communicable disease (eg, tuberculosis) will decrease your chance of disease exposure. Keeping up-to-date with your immunizations will reduce your risk of contracting certain diseases if you are exposed to them
Failure of the EMT to obtain consent from a responsive patient before taking his or her blood pressure may constitute:
A) Battery
B) Negligence
C) Abandonment
D) Assault
A) Battery
Battery is defined as unlawfully touching another person without his or her consent. Obtaining consent from every responsive patient prior to rendering care is of paramount importance. Assault is defined as instilling fear into another person, but does not necessarily involve actually touching him or her. Laws can vary from state to state as to these definitions. Negligence occurs when the EMT fails to act as another prudent EMT would have acted in the same or similar situation. Abandonment occurs when the EMT terminates patient care without the patient’s consent or transfers care of a patient to a provider of lesser training.
While transporting a patient with chest pain, the patient asks the EMT if he is going to die. Which of the following would be the EMT’s MOST appropriate response?
A) “I don’t know, but I’m going to take very good care of you.”
B) “Everything will be okay, so please try to remain calm.”
C) “No. Most cases of chest pain are not related to the heart.”
D) “There is nothing to worry about; I will not let that happen.”
A) “I don’t know, but I’m going to take very good care of you.”
When caring for any patient, the EMT should provide emotional reassurance; however, he or she must be honest with the patient. If a patient asks you if he or she is going to die, the honest answer is “I do not know,” because the fact is, you do NOT know. Comfort the patient by reassuring him or her that you are going to provide the best care possible, but do NOT lie. Speak to the patient like a clinician, not a technician with what you feel is an appropriate canned response
Which of the following statements regarding the use of an escort vehicle when en route to an emergency call is correct?
A) An escort vehicle will allow you to arrive at the scene more quickly
B) To avoid getting separated from the escort vehicle you should follow it closely
C) An escort vehicle should be used only if you are unfamiliar with the patient’s location
D) With an escort vehicle, the risk of an accident at an intersection is reduced significantly
C) An escort vehicle should be used only if you are unfamiliar with the patient’s location
Generally, escort vehicles should not be used when responding to an emergency scene. The biggest danger of using an escort occurs at intersections, which is where most ambulance crashes occur. Drivers may yield to the escort vehicle, but may not be prepared for a second vehicle following the escort (a wake effect collision). The only time that an escort may be required is when you are unfamiliar with the location of the patient and need assistance getting there. If an escort must be used, you must follow at a safe distance of at least 500 feet.
The scene size-up includes all of the following components, EXCEPT:
A) Determining if the scene is safe
B) Donning personal protective gear
C) Assessing the need for assistance
D) evaluating the mechanism of injury
B) Donning personal protective gear
The components of the scene size-up include determining scene safety, assessing the mechanism of injury (MOI) or nature of illness (NOI), determining the number of patients, and requesting additional help if needed. Personal protective equipment (PPE) should be donned prior to beginning the scene size-up.
An ambulance and fire apparatus are the first to arrive at a motor vehicle crash on a three-lane highway. There is one vehicle involved and it is located in the far left-hand lane. Where should the ambulance be positioned?
A) In between the fire apparatus and crashed motor vehicle
B) 100 feet past the crashed vehicle, on the same side of the highway
C) Alongside the crashed vehicle in the middle lane of the highway
D) 100 feet past the crashed vehicle on the opposite side of the highway
B) 100 feet past the crashed vehicle, on the same side of the highway
Emergency operations on the highway can be especially dangerous, and it is important to position emergency vehicles in a manner that will ensure responder safety, while at the same time allowing efficient traffic control and flow around the crash scene. Do not park alongside the scene, as you may block the movement of other emergency vehicles. The first emergency vehicle to arrive on scene should park 100 feet before the scene on the same side of the road as the accident. The first vehicle should create a barrier between the scene and oncoming traffic. If other responders have not arrived on scene, the ambulance can be positioned to block the scene and prevent oncoming traffic from getting too close to the scene and emergency personnel. If fire apparatus or law enforcement officers are on scene, they should position their vehicles before the scene, while the ambulance is parked 100 feet beyond the scene. Park the ambulance on the same side of the highway as the crash; this will prevent personnel from crossing the road unnecessarily.
When the incident command system is activated at the scene, you should expect to:
A) Receive instructions and then function independently
B) Be immediately directed to the established treatment area
C) Report back to your section officer in between assignment
D) Be assigned one responsibility for the duration of the incident
C) Report back to your section officer in between assignment
The incident command system (ICS) was established to maximize effective operations at the scene and maximize the number of lives saved. Deviation from the ICS jeopardizes lives and increases the risk of losing control over the situation. When you arrive at a scene where the ICS has been activated, you should report to the staging area; you will then be directed to the area in which you are needed. Report to the section officer of that area, receive your instructions, and carry them out. When you have completed your assignment, you must return to the section officer for further instructions. Depending on the situation, you may be sent to another section. The sections that you work in and the responsibilities that you are given may change during the incident. At no time should you attempt to function independently (freelancing); this defeats the purpose of the ICS and puts lives in jeopardy.
You and your partner have secured a trauma patient to a long backboard and are preparing to lift the backboard onto the stretcher. When doing so, you should:
A) Lift the backboard from the sides instead of the ends
B) Be sure to lift the backboard with the powerful muscles of your back
C) Recall that most of the patient’s weight is at the foot end of the backboard
D) Ensure that the strongest EMT is positioned at the head of the backboard
D) Ensure that the strongest EMT is positioned at the head of the backboard
Since most of the patient’s weight is distributed to the head end of a backboard, you should always ensure that the strongest EMT is at that position. This will reduce the risk of injury to less strong personnel as well as the risk of dropping the patient. The backboard should be lifted from the ends, not the sides; you have less control over the board if it is lifted from the sides. When lifting any patient, you should use the powerful muscles of your thighs, not your back, to lift. Keep your back straight and in a locked-in position.
EMTs are dispatched to a nursing home for a 78-year-old woman who is running a fever. When they arrive, the nurse advises them that the patient’s physician wants her to be taken to the hospital, and that her daughter is en route to the nursing home. The patient is conscious, alert, and oriented, and refuses to go to the hospital. In this case, consent to treat and transport this patient:
A) Has not been obtained because the patient is alert and oriented
B) Is implied because the patient is elderly and lives in a nursing home
C) Can only be obtained once the patient’s daughter
D) Is expressed since her physician, wants her to be taken to the hospital
A) Has not been obtained because the patient is alert and oriented
You must obtain consent to assess and treat any patient who is of legal age and has decision-making capacity. The patient is conscious, alert, and oriented and has decision-making capacity. If she refuses transport, even if her physician requests it, you have NOT obtained consent. Many believe that residents who live in skilled nursing facilities or assisted-living centers relinquish their right to direct their own healthcare; this is NOT true. If a patient is of legal age and has decision-making capacity, consent to treat and transport must be given by them, not a family member. If the patient does not have decision-making capacity, then consent to treat is implied. In this situation, as with any situation in which the patient should be transported to the hospital, you should talk to the patient and explain to her that she could be seriously ill, and that evaluation by a physician would be in her best interest.
You arrive at the scene of an 80-year-old woman who is weak and lightheaded. Her son, who called 911, is present and asks you to transport his mother to the hospital. You should:
A) Advise the son that he can probably drive his mother to the hospital
B) Comply with the son’s request and transport the woman to the hospital
C) Take the woman’s vital signs and apply supplemental oxygen if necessary
D) Assess the woman and determine if she wishes to be treated and transported
D) Assess the woman and determine if she wishes to be treated and transported
You must obtain consent from any mentally competent adult patient prior to initiating treatment. Just because the patient is 80 years old does not mean that she does not have decision-making capacity. Also, just because her son wants her to be transported does not mean that she agrees with this request. Ask her if she wishes to be treated and transported to the hospital. If she does, then you have obtained consent and should proceed accordingly. If she does not, you should determine if she has decision-making capacity–that is, whether she is mentally competent. If she is determined to have decision-making capacity, then you cannot legally treat or transport her. If she does not have decision-making capacity (eg, she is confused, she is under the influence of drugs or alcohol), then you may treat and transport under the law of implied consent. It is not the EMT’s decision to determine, let alone recommend, that a patient be taken to the hospital via privately owned vehicle (POV). If the patient requests EMS treatment and transport, you are legally obligated to do so.
The ultimate goal of any EMS quality improvement program is to:
A) Deliver a consistency high standard of care to all patients who are encountered
B) Ensure that all personnel receive an adequate number of continuing education hours
C) Provide protocol to all EMTs and hold them accountable if protocols are not followed
D) Recognize all EMTs who demonstrate consistency in providing competent patient care
A) Deliver a consistency high standard of care to all patients who are encountered
Providing continuing education to all personnel, recognizing those who consistently provide competent patient care, and holding all personnel accountable for adhering to the EMS protocols are all components of any EMS quality improvement program. The ultimate goal, however, is to provide, as a system, a consistently high standard of care to all patients who are encountered.
At the scene of a mass-casualty incident, you notice a bystander who is emotionally upset. An appropriate action to take would be to:
A) Tell the bystander to leave the scene at once
B) Have the bystander assist you with patient care
C) Notify the police and have the bystander removed
D) Assign the bystander a simple, non-patient-care task
D) Assign the bystander a simple, non-patient-care task
One of the most effective ways to reduce stress in a bystander at the scene of a mass-casualty incident is to assign the bystander a task that is not related to patient care. This may involve assisting other bystanders who are having difficulties as well or providing water to the rescuers. An obviously distressed bystander should not simply be sent away from the scene, but should be looked at as a patient as well. Clearly, if the bystander becomes aggressive or violent, law enforcement personnel should get involved.
Which of the following actions demonstrates the EMT’s knowledge of crime scene preservation?
A) At the scene fo a shooting, the EMT removes the bullets from a handgun and gives them to a police officer
B) The EMT places a shooting victim’s blood-soaked shirt in to a clean plastic bag and then gives it to the police officer
C) While caring for a patient who was stabbed, the EMT moved a coffee table and then informs a police officer afterward
D) After assessing a patient with a single stab wound to the chest, the EMT requests law enforcement permission to treat
C) While caring for a patient who was stabbed, the EMT moved a coffee table and then informs a police officer afterward
After ensuring the safety of you and your crew, your next priority when functioning at a crime scene is to provide emergency patient care. If you need to move a piece of furniture to gain access to a critically injured patient, you should move the furniture, treat the patient, and then advise a law enforcement officer of what you moved and where you moved it to. In this way, you provide immediate care to the patient, but remain aware that the location of any obstacles between you and the patient may serve as evidence. Clearly, you would not request approval from a law enforcement officer before treating a critically injured patient. Items that may have evidence on them, such as article of clothing, should be placed in a paper bag; condensation can accumulate in plastic bags, potentially destroying any evidence. Handling weapons used in the crime can contaminate any fingerprints that may be present and would clearly be inappropriate. Unloading of firearms is a function of law enforcement, not EMS.
An 92-year-old man is unresponsive, pulseless, and apneic. His skin is warm and his face and chest are cyanotic. In this circumstance, you and your partner should:
A) Ask for a do not resuscitate order before starting CPR
B) Contact medical control to determine if CPR is indicated
C) Begin CPR and apply the AED as soon as it is available
D) Recognize that resuscitation is not indicated for him
C) Begin CPR and apply the AED as soon as it is available
Pulselessness, apnea, and cyanosis are presumptive signs of death, not definitive. Therefore, you should begin resuscitative measures, including CPR and defibrillation (if indicated). Resuscitation is not indicated if definitive signs of death are present, such as rigor mortis, livor mortis (pooling), putrefaction, or injuries that are clearly not compatible with life (ie, decapitation). It is acceptable to ask if a do not resuscitate (DNR) order is present; however, this should be done after you have initiated CPR. If a valid out of hospital DNR is presented, then resuscitation is not indicated; follow your local protocols. If there is question regarding the validity of a DNR, begin CPR and contact medical control.
The technique of rapid extrication from a vehicle involves:
A) Applying a cervical collar, grasping the patient by the clothing and quickly removing him or her onto the stretcher
B) Manually stabilizing the head, applying a cervical collar, and removing the patient from the vehicle onto a long backboard
C) Applying a vest-style extrication device, sliding a long backboard under the patient’s buttocks, and removing him or her from the vehicle
D) Grabbing the patient by his or her clothing, protecting his or her spine as much as possible, and dragging him or her from the vehicle
B) Manually stabilizing the head, applying a cervical collar, and removing the patient from the vehicle onto a long backboard
The rapid extrication technique is indicated if the patient has life-threatening injuries and/or is in need of treatment that requires a supine position. It is performed by manually stabilizing the patient’s head (an EMT in the backseat typically does this), applying a cervical collar, sliding a backboard under the patient’s buttocks, and removing the patient from the vehicle and onto the backboard. The vest-style extrication device is not appropriate to use when performing the rapid extrication technique; it takes too long to correctly apply. Do not confuse the rapid extrication technique with an emergency move. An emergency move, which is indicated if your own or the patient’s safety is in imminent danger, involves grabbing the patient by the clothing, protecting his or her spine as much as possible, and dragging him or her from the vehicle to a safe place.
When sizing up a motor vehicle crash in which a small passenger car struck a bridge pillar and sustained severe damage, you should:
A) Immediately approach the vehicle and determine if it is stable
B) Break the driver’s side window and gain rapid access to the patient
C) Disconnect the battery cables and then request heavy extrication tools
D) Ensure that there are no hazards and then try to open one of the doors
D) Ensure that there are no hazards and then try to open one of the doors
After ensuring your own safety, you should attempt simple means to gain access to the patient, trying to reach him or her as simply and quickly as possible without using any tools or breaking any glass. It may be necessary to use tools or other forcible entry methods, some of which may require specialized extrication equipment (eg, Jaws of Life). Many times, however, the patient can be accessed by just opening a door, even if the door is badly damaged. If the door is locked and the patient is responsive, ask him or her to unlock the door. Stabilizing the vehicle (eg, placing shoring blocks under the car) and disconnecting the car’s battery cables are typical functions of the fire department.
As you step out of the ambulance at the scene of a nighttime motor vehicle crash on the highway, your MOST immediate concern should be:
A) The presence of oncoming traffic
B) Whether the car will catch on fire
C) Placing safety flares by the ambulance
D) Rapid assessment of all injured patients
A) The presence of oncoming traffic
Nighttime traffic crashes, especially those that occur on a highway, pose a significant risk to the safety of the EMT. Therefore, immediately upon exiting the ambulance, concerns about oncoming traffic should be at the front of the EMT’s mind. Drivers can be blinded by all of the emergency lighting and inadvertently veer off of the road and strike the rescuer. Safety flares are used less commonly now than in the past; they have been known to blow off the road and start grass fires or ignite gasoline leaking from a vehicle. Reflective cones or triangles are safer and are used more often than flares. After ensuring your own safety, which includes notifying the fire department if the vehicle is leaking gas, you should then proceed to the patients.
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
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.
When arriving at the scene of a motor vehicle crash at night, you determine that the safest place to park the ambulance is in a direction that faces oncoming traffic. What should you do?
A) Position road flares around the front of the ambulance
B) Turn all emergency lighting off to avoid blinding traffic
C) Turn the high-beam headlights own to alert oncoming traffic
D) Turn your headlights off, but keep the emergency lights on
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.
You are called to transport a patient with terminal lung cancer from a skilled nursing facility to the emergency department for evaluation of possible pneumonia. As you are reviewing the transfer paperwork, you see that the patient has a valid do not attempt resuscitation order. During transport, you should:
A) Perform CPR for only 2 minutes if the patient develops cardiac arrest
B) Disregard the DNAR order because it is only valid in the hospital setting
C) Provide supportive care, such as oxygen, and keep the patient comfortable
D) Monitor the patient because a DNAR order prohibits you from providing care
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.
Which of the following is an example of gross negligence?
A) EMTs accidentally drop a patient when they are moving him from his bed to the wheeled ambulance stretcher.
B) The EMT elects not to use spinal precautions on a patient, and the patient is later diagnosed with a spinal fracture.
C) During the ambulance check, the EMT documents that the oxygen cylinder is full, knowing that it is empty.
D) The EMT removes expired aspirin from the ambulance, but forgets to replace it and then has a call for chest pain.
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.
You arrive at the scene of a young man who was stabbed. Law enforcement officers are present. The patient, who is unresponsive with several stab wounds to the chest, is lying in a narrow space between a couch and coffee table. You should:
A) treat the patient where he is, without moving the coffee table.
B) move the coffee table, begin patient care, and notify a police officer.
C) obtain permission from law enforcement before moving any furniture.
D) move the coffee table, document what you did, and begin treatment.
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.
You are the first ambulance to arrive at the scene of a motor vehicle crash. As you approach the scene, you see three patients: two have been ejected from their vehicles and the other is still in his vehicle. You should:
A) begin triaging and treating the most critically injured patients.
B) request additional ambulances to respond to the scene.
C) call medical control and apprise him or her of the situation.
D) notify the local trauma center so personnel there can prepare for the patients.
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.
Which of the following components is NOT part of an injury or illness prevention program?
A) Inspecting the home of young parents for child safety locks
B) Teaching new parents how to properly install a child safety seat
C) Educating teenage students on the dangers of drinking and driving
D) Training a group of daycare employees on infant and child CPR
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.
Which of the following statements would NOT be appropriate to include in your patient care report?
A) “The patient stated that he wanted to kill himself.”
B) “The patient’s breath smelled strongly of alcohol.”
C) “The patient’s wife stated that he is drunk again.”
D) “The patient requires inpatient psychiatric care.”
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.
After arriving at a mass-casualty incident where other ambulances are already present, you should:
A) repeat the triage process.
B) report to the staging area.
C) initiate care for the most critically injured patients.
D) obtain information from the fire service commander.
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.
A man who was recently diagnosed with advanced cancer tells the EMT that he doesn’t think that chemotherapy is necessary because his cancer is “not that bad.” What stage of the grieving process is this consistent with?
A) Anger
B) Denial
C) Bargaining
D) Acceptance
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.
A red placard indicates that the material inside a tanker is:
A) radioactive.
B) explosive.
C) corrosive.
D) flammable.
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.
At the scene of a mass-casualty incident in which the incident command system has been established, an EMT arrives in his personal vehicle and begins treating patients independently. This EMT’s action would MOST likely lead to:
A) reduced efficiency of the operation.
B) faster treatment of critical patients.
C) rapid identification of critical patients.
D) faster transport of the critically injured.
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.
Most crashes involving ambulances occur:
A) at stop signs.
B) on the highway.
C) at stop lights.
D) at intersections.
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.
While en route to the scene of an injured person, dispatch advises you that law enforcement personnel are at the scene. This indicates that:
A) a crime has been committed.
B) the scene is potentially unsafe.
C) the patient is critically injured.
D) the scene is safe for you to enter.
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.
Which of the following patients has the highest priority at the scene of a mass-casualty incident?
A) 29-year-old man who is pulseless and apneic with an abdominal evisceration
B) 35-year-old unresponsive woman with snoring respirations and severe burns
C) 38-year-old woman who remains apneic after you manually open her airway
D) 44-year-old unresponsive man with an open head injury and agonal gasps
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.
You are caring for a man with terminal cancer when his caretaker presents you with a Physician Order for Life-Sustaining Treatment (POLST) form. The purpose of this form is to:
A) advise medical providers that resuscitation is not to be attempted.
B) describe acceptable patient interventions in the form of medical orders.
C) enable the caretaker to make healthcare decisions on the patient’s behalf.
D) limit the treatment provided to the patient to basic life support care.
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.
Your partner, a veteran EMT of 20 years, has been showing up late to work with increasing frequency over the last several shifts. When he arrives, he is in a bad mood and is clearly not interested in being at work. His behavior is MOST consistent with:
A) burnout.
B) delirium.
C) drug use.
D) acute stress.
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.
You arrive at the scene of a traffic accident in which multiple vehicles are involved. You see at least two patients who are lying on the road and are not moving. You should:
A) begin triaging the patients.
B) begin immediate patient care.
C) notify medical control for advice.
D) request additional ambulances.
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.
Which of the following statements BEST describes a mass-casualty incident?
A) More than five patients are involved.
B) At least half of the patients are critically injured.
C) The number of patients overwhelms your resources.
D) More than three vehicles are involved in the incident.
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.
Upon arriving at the scene of a crash involving a large truck, you immediately note the presence of an orange placard on the side of the tank that the truck is pulling. This indicates that the vehicle is carrying which type of agent?
A) Corrosive
B) Flammable
C) Radioactive
D) Explosive
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.
While caring for an injured patient, you remove blood-soaked clothing to treat his injuries. You should dispose of the clothing by:
A) leaving it at the scene.
B) leaving it at the hospital.
C) placing it in a biohazard bag.
D) placing it in a regular trashcan.
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.
When calling in your radio report to the receiving hospital, you should:
A) include the patient’s name.
B) be brief, concise, and factual.
C) give your report only to a physician.
D) break your report into 60-second increments.
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.
