Section 1: Introduction to Emergency Medical Care; Well-Being of the EMT; Medical, Legal, and Ethical Issues; The Human Body; Baseline Vital Signs and SAMPLE History; Lifting and Moving Patients Flashcards
Does state, federal, or local government, primarily regulate EMS?
State
Which federal agency is responsible for recommending national standards?
The National Highway Traffic Safety Administration
What are the two main benefits of a universal access number to EMS?
Provides trained staff to answer calls and minimizes delays.
What are the four levels of emergency medical technician training?
Emergency Medical Responder, EMT, Advanced EMT, Paramedic
What is the function of the initial assessment?
To identify and treat life-threatening problems
Why do you perform a focused history and physical exam?
To identify and treat non-life-threatening problems
What is the most important way you can prevent injury when lifting a patient?
Use proper body mechanics
What is your first responsibility when arriving on a scene?
Scene safety
You arrive on a scene of a motor vehicle crash. Utility wires are down around the vehicle. What do you do first?
Call for trained personnel to clear the scene of hazards before proceeding.
Who is responsible for determining to which facility your patient is transported?
The on-scene EMT, following off-line or online medical control procedures.
Under what circumstances might you bypass the nearest medical facility?
Trauma; burns; victim is a child; facility on bypass; specialized care.
In what two ways should you give your patient report upon arrival at the receiving facility?
Provide both an oral report and a written report.
What are the six aspects of EMS quality improvement?
Documentation; run reviews and audits; gathering feedback from patients and hospital staff; continuing education; continuing preventative maintenance; skill maintenance.
As an EMT you serve as the designated agent for whom?
The physician medical director of your EMS system.
What constitutes online medical control?
Physician medical direction by phone or radio.
What constitutes off-line medical control?
Protocols and standing orders.
What does the dying patient need emotionally from the EMT?
Dignity, respect, sharing, communication, privacy and control.
What lifestyle changes can the EMT institute to reduce stress?
Diet, exercise, and relaxation techniques.
What is a critical incident stress debriefing (CISD) team?
A team of peer counselors and mental health professionals who help emergency care workers deal with stress from difficult or unusual incidents.
What does comprehensive critical incident stress management include?
Pre-incident stress education; on-scene peer support; one-on-one support; disaster support services; defusings; CISD; follow-up services; spouse/family support; community outreach programs; other health and welfare programs such as wellness programs.
What types of protective masks are available to the EMT?
Surgical type for possible blood splatter and high-efficiency particulate air (HEPA) respirator if patient is suspected of or diagnosed with tubercuolosis.
What is the most effective method of preventing the spread of infection from individual to individual?
Hand washing.
When are vinyl or latex gloves needed?
When there is the possibility of contact with blood or other body fluids, and they should be changed between contacts with different patients.
What can help you identify possible hazardous materials spills on highways?
Binoculars; placards; Hazardous Materials, The Emergency Response Handbook, published by the U.S. Department of Transportation.
Fire department personnel bring you a patient from the hot zone. What is your first priority?
To determine whether the patient has been properly decontaminated.
What potential life threats are present at an accident scene?
Electricity, fire, explosion, and hazardous materials.
What articles of protective clothing should the EMT wear at a crash scene?
Turnout gear, puncture-proof gloves, helmet, and eye wear.
At a potential crime scene, the EMT must be wary that violence can be committed not only by the perpetrator, but also by the following people as well:
Family members and bystanders.
Prior to entering a potentially violent scene, what should the EMT do?
Wait for the scene to be secured by law enforcement personnel.
What are the five stages that dying patients and those close to them, often experience?
Denial, anger, bargaining, depression, acceptance.
What are the top sources of stress for the EMT?
Long hours; boredom on calls; working too much and too hard; having to respond instantly; responsibility for patients’ lives; making life-and-death decisions; fearing errors; dealing with the death and the grieving; receiving little recognition.
Name some high-stress situations for the EMT?
Multiple-casualty incidents; trauma to children; child, elder or spousal abuse; death or injury to a coworker or other public safety worker.
What is burnout?
A state of exhaustion and irritability that can markedly decrease effectiveness.
What are the warning signs of stress?
Irritability; inability to concentrate; anxiety; difficulty sleeping; nightmare; indecisiveness; guilt; loss of appetite; loss of sexual desire; loss of interest in work; feeling of isolation.
What two things can you do to reduce stress in the work environment?
Request work shifts allowing for more time to relax with family and friends; request a rotation of duty assignment to a less busy area.
Within what timeframe should a CISD meeting be held?
Within 24 to 72 hours of a major incident.
What is discussed in a CISD meeting?
Feelings, fears and reactions.
What is the CISD meeting designed to accomplish?
To accelerate the normal recovery process after experiencing a critical incident.
True or false; Goggles are required for body substance isolation?
False. Goggles are NOT required.
When do you need to wear a protective gown?
In large-splash situations such as a field delivery or major trauma.
Is wearing a gown the best way to guard against body substance contamination?
No. A change of uniform is preferred.
When should a patient wear a mask? What type?
A patient should wear a surgical mask when there is the possibility of airborne disease.
Which organizations govern the regulation of body substance isolation, notification, and testing in an exposure incident?
Occupational Safety & Health Administration (OSHA) and state agencies.
What can you do to preserve a crime scene?
Do not disturb the scene unless required for medical care; help maintain the chain of evidence.
Is the EMT’s scope of practice defined by the federal, state or local legislation?
State
In what ways is the EMT’s scope of practice enhanced by the medical director?
Through the use of protocols and standing orders.
To whom does the EMT have legal duties?
To the patient, medical director and public
What is the primary reference used by states in developing scope-of-practice legislation for the EMT?
The National EMS Education Standards.
Upon what three factors is the EMT’s legal right-to-function contingent?
Telephone and radio communication; approved standing orders and protocols; responsibility to medical direction.
What are five basic ethical responsibilities of the EMT?
Make the physical and emotional needs of the patient a priority; practice and maintain skills to the point of master; attend continuing education and refresher programs; critically review performance, seeking ways to improve response time; honesty in reporting.
Give an example of an advance directive.
Do Not Resuscitate (DNR) orders.
True or false: DNR orders require a written order from a physician?
True. In most jurisdictions, DNR orders require a written order from a physician.
You arrive at the home of a 68-year-old man who presents with a weak, thread pulse and respirations of eight breaths/min. The wife states she has DNR orders but she can’t find them. What do you do?
Begin resuscitative efforts.
In order to obtain expressed consent from a patient, that patient must:
Be of legal age, be able to make rational decisions, and be informed of the steps of the procedures and all related risks.
What is implied consent?
Consent assumed from the unconscious patient requiring emergency intervention.
Upon what assumption is implied consent based?
That the unconscious patient would consent to lifesaving interventions were he or she conscious.
When does the principle of implied consent apply to children?
When life-threatening situations exist and the parent or legal guardian is not available to give consent.
When does the principle of implied consent apply to mentally incompetent adults?
When life-threatening situations exist and the legal guardian is not available to give consent.
What local issues may affect consent for treating children and mentally incompetent adults?
Emancipation issues and state regulations regarding the age of minors.
What is the legal term for unlawfully touching a patient without his or her consent?
Battery
What is the legal term for providing emergency care when the patient does not consent to the treatment?
Assault
You arrive at the home of a 46-year-old diabetic who is semiconscious. You administer a tube of glucose. The patient regains full consciousness and does not want to go to the hospital. What do you do?
Be sure that the patient has been informed of and fully understands all the risks and consequences associated with refusal of treatment and/or transport; have the patient sign a release-from-liability form.
Who can refuse treatment or transport?
Any mentally competent adult; in the case of a child or mentally incompetent adult, the parent or legal guardian.
If you have any doubt as to whether you should or should not provide care to a patient, what should you do?
Err in favor of providing care.
How can you protect yourself from the legal consequences of patient refusal?
Ensure that you document fully and accurately.
You suspect that your patient is drunk, but he signs the release form and tells you to leave. Are you legally liable if something happens to this patient? Why?
Yes. A patient under the influence of alcohol is not considered competent to refuse treatment.
If you are in doubt regarding how to proceed with a patient who is refusing treatment, how should you proceed?
Contact medical control and law enforcement personnel.
True or false: The EMT should never make an independent decision not to transport.
True
Define abandonment.
The termination of care of a patient without assuring the continuation of care at the same level or higher.
You bring a patient into the emergency room, place him on a stretcher in the hallway, inform the unit clerk, and then leave to respond to an urgent call. The patient is later found dead where you left him. For what will you be sued?
Abandonment
Define negligence.
The deviation from the accepted standard of care resulting in further injury to the patient.
What are the four components of negligence?
Duty to act; breach of that duty; injury or damage was inflicted, either physical or psychological; the actions of the EMT caused the injury or damage.
True or false: In order for there to be a duty to act, a contractual or legal obligation must exist.
True
EMTs begin treatment of a patient. Is continuing treatment an implied or formal duty to act?
Implied
Other than the legal duty to act, what other obligations does the EMT have to provide care?
Ethical and moral considerations.
When driving the ambulance not in the company’s service area, an EMT observes an accident. What should he or she consider before acting?
The moral and ethical duty to act; risk management considerations; proper documentations; specific state regulations regarding duty to act; Good Samaritan regulations.
What information is considered confidential in the EMT-patient relationship?
Patient history gained through interview, assessment findings, and treatment rendered.
What must be established before you can accept a release form not from the patient?
Legal guardianship.
Under what four circumstances is a release form not required before releasing confidential patient information?
Other healthcare providers need to know information to continue care; state law requires reporting such as rape, abuse, or gunshot wounds; third-party billing forms; legal subpoena.
True or false: You should treat a potential organ donor differently from any other patient requesting treatment.
False
In what three forms are medical identification insignia most commonly found?
Bracelets, necklaces and cards.
What medical conditions are indicated on medical identification insignia?
Allergies, diabetes, epilepsy and others.
What things may the EMT do to help preserve evidence?
Do not disturb any item at the scene unless emergency care requires it; observe and document anything unusual; if possible, do not cut through holes in clothing from gunshot wounds or stabbings.
How are special legal reporting situations established?
Established by state legislation; may vary from state to state.
What are some commonly required legal reporting situations?
Child, elder or spousal abuse; wounds obtained by violent crime; sexual assault; infectious disease exposure; patient restraint; mental incompetence.
What is normal anatomic position?
A person standing, facing forward, with the palms facing forward.
What is the midline plane?
An imaginary line drawn vertically through the middle of the body from the nose to the umbilicus; it divides the body into right and left halves.
What is the midaxillary line?
A line drawn vertically from the middle of the axilla to the ankle; it divides the body into anterior and posterior halves.
What is the torso?
The trunk of the body from the base of the neck to the top of the legs.
Define medial.
Toward the midline.
Define lateral.
Away from the midline.
Define proximal.
Nearer to a point of a reference or attachment, usually the trunk of the body, than to other parts of the body.
Define distal.
Away from or the farthest from a point of reference or attachment.
Define superior.
Above or higher.
Define inferior.
Below or lower.
Define anterior.
The front or toward the front.
