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.
Define posterior.
The back or toward the back.
What is the midclavicular line?
An imaginary line that extends downward over the trunk from the midpoint of the clavicle; it divides each half of the anterior chest into two parts.
What is bilaterally?
On both the right and the left sides.
Define dorsal.
Pertaining to the back or posterior.
Define ventral.
Pertaining to the front of anterior.
Define plantar.
Refers to the sole of the foot.
Define palmar.
Refers to the palm of the hand.
Define prone.
Lying on the stomach.
Define supine.
Lying on the back.
What is the Fowler position?
Lying on the back with the upper body elevated 45-60 degrees.
What is the Trendelenberg position?
Lying on the back with the lower body elevated approximately 12 inches; sometimes referred to as the shock position.
What are the three functions of the skeletal system?
Gives the body shape; protects the vital internal organs; provides for body movement.
What is the function of the skull?
Houses and protects the brain.
Name the bones of the face.
Orbit; nasal bone; maxilla; mandible; zygomatic bones.
What is the mandible?
The jawbone.
What are the zygomatic bones?
The cheek bones.
What are the fine sections of the spinal column?
Cervical; thoracic; lumbar; sacrum; coccyx.
How many cervical vertebrae are there?
Seven
How many thoracic vertebrae are there?
Twelve
How many lumbar vertebrae are there?
Five
How many sacral vertebrae are there?
Five (fused in adults)
How many coccygeal vertebrae are there?
Four (fused in adults)
To what does word cervical refer to?
The neck.
To what does the word thorax refer to?
The upper back.
To what does the word lumbar refer to?
The lower back.
To what does the word sacrum refer to?
The back wall of the pelvis.
To what does the word coccyx refer to?
The tailbone.
How many ribs are there?
Twelve
To what are the ribs attached posteriorly?
The thoracic vertebrae.
Which ribs are attached to the sternum?
Pairs 1-10
To what are the ribs 1-10 attached anteriorly?
The sternum
To what does the term “floating ribs” refer?
Rib pairs 11 and 12, which are not attached anteriorly.
What is the sternum?
The breastbone
What is the body of the sternum?
The middle bone of the sternum.
What is the xyphoid process?
The inferior portion of the sternum.
What are the three parts of the pelvic girdle?
The iliac crest; the pubis; the ischium.
What is the iliac crest?
The wings of the pelvis.
What is the ischium?
The inferior portion of the pelvis.
Which two structures articulate at the hip joint?
The greater trochanter and the acetabulum.
What is the acetabulum?
The hip socket.
What is the femur?
The thigh bone.
What is the patella?
The knee cap.
What two bones comprise the lower leg?
The tibia and fibula.
What are the medial and the lateral malleolus?
The surface landmarks of the ankle joint.
What bones make up the foot?
The tarsals and metatarsals.
What is the calcaneus?
The heel bone.
What is the collarbone?
The clavicle.
What is the shoulder blade?
The scapula.
What is the upper arm bone?
The humerus.
What is the bone of the lateral forearm?
The radius.
What is the bone of the medial forearm?
The ulna.
What are the bones of the wrist?
The carpals.
What are the bones of the fingers?
The phalanges.
What types of joints are there?
Ball and socket and hinged.
The pharynx is composed of what two structures?
The oropharynx and the nasopharynx.
What is the function of the epiglottis?
To prevent food and liquid from entering the trachea during swallowing.
What is the windpipe called?
The trachea.
What is the cricoids cartilage and where is it located?
A firm cartilaginous ring; forms the lower portion of the larynx.
What is the voice box called?
The larynx.
What are the bronchi?
The two major branches of the trachea to the lungs; each subdivides into smaller air passages called the bronchioles, which end at the alveoli.
What are the three basic steps of the alveolar/capillary exchange?
Oxygen-rich air enters the alveoli during each inspiration; oxygen-poor blood in the capillaries passes into the walls of the alveoli; oxygen enters the capillaries as carbon dioxide enters the alveoli.
What is the normal breathing rate for an adult?
12-20 breaths per minute
What is the normal breathing rate for a child?
15-30 breaths per minute
What is the normal breathing rate for an infant?
25-30 breaths per minute
Which two words are used to describe basic breathing rhythm?
Regular and irregular
How would you describe normal breath sounds?
Present and equal.
How would you describe increased effort of breathing?
Use of accessory muscles, predominantly in infants and children.
How would you describe normal depth of breathing?
Adequate
You are treating a patient who is tachypnic, with shallow, inadequate respirations. What might you expect to discover when examining his skin?
The skin may be pale or cyanotic and cool and clammy.
You are called to the home of a 3-year-old girl. The parents state it has been increasingly difficult for her to breathe the past few hours, and she has used her inhaler five times. What might you expect to see on inspection of her chest and belly?
There may be retractions above the clavicles, between the ribs and below the rib cage; “seesaw” breathing may be present (the abdomen and chest move in opposite directions).
Why is it easier for a child’s airway to become obstructed than an adult’s?
All structures are smaller and more easily obstructed.
How do the adult and child pharynxes differ?
Infants and children’s tongues take up proportionally more space in the mouth than adults do.
How do the adult and child tracheas differ?
Infants and children have narrower tracheas that are obstructed more easily by swelling; the trachea is softer and more flexible; the cricoids cartilage is less developed and less rigid; it is the narrowest portion of the child’s airway.
What are the four chambers of the heart?
Right atrium; left atrium; right ventricle; left ventricle
What is the function of the heart valves?
To prevent the backflow of blood.
What does the right atrium do?
Receives blood from the veins of the body and the heart; pumps the deoxygenated blood to the right ventricle.
What does the right ventricle do?
Pumps the deoxygenated blood to the lungs.
What does the left atrium do?
Receives oxygenated blood from the lungs via the pulmonary veins; pumps the left ventricle.
What does the left ventricle do?
Receives oxygenated blood from the left atrium; pumps it to the body.
What is unique about cardiac muscle?
It is made up of special contractile and conductive tissue.
What is the function of the arteries?
To carry oxygenated blood from the heart to the rest of the body.
What are the arteries of the heart called?
The coronary arteries.
What is the function of the coronary arteries?
To supply the heart with blood.
What is the major artery originating from the heart?
The aorta
What is the origin and function of the pulmonary artery?
Originates in the right ventricle; carries deoxygenated blood to the lungs.
Upon arrival at a motor vehicle crash, you find a woman in her 20’s supine on the street. How do you initially assess circulation?
Palpate the carotid artery.
What is the function of the carotid arteries?
To carry oxygenated blood to the head.
What is the major artery of the thigh?
The femoral artery.
Which vessel supplies the lower arm?
The radial artery
Where can you palpate the radial artery?
Pulsations can be palpated at the wrist, thumb side.
Which artery supplies the upper arm?
The brachial artery
What is another name for a blood pressure cuff?
Sphygmomanometer
Which vessel is auscultated when taking a blood pressure?
The brachial artery
Where can the posterior tibial artery be palpated?
On the posterior surface of the medial malleolus.
After the application of the traction splint, how do you evaluate distal circulation and where?
Palpate the dorsalis pedis on the anterior surface of the foot; check capillary refill, time, sensation, skin condition, and movement..
What is the smallest branch of an artery?
An arteriole
What structure connects arterioles and venules?
Capillaries
Where are the capillaries found?
In all parts of the body.
What is the function of the capillaries?
They allow for the exchange of nutrients and waste at the cellular level.
What is the smallest branch of the venous system?
The venules
What is the function of the venous system?
To carry deoxygenated blood back to the heart and lungs.
What is the function of the pulmonary vein?
To carry blood from the lungs to the left atrium.
Why may the pulmonary vein be considered an artery?
Because it carries oxygenated rather than deoxygenated blood.
What are the largest vessels in the venous system?
The vena cava
Name the two portions of the vena cava.
The superior and the inferior vena cava
What are the four components of blood?
Red blood cells; white blood cells; plasma; platelets
What are the two primary functions of the red blood cells?
To carry oxygen to the organs; to carry carbon dioxide from the organs.
What is the function of the white blood cells?
They function as part of the body’s defense against infection.
What component of blood is the fluid that carries the blood cells and nutrients?
Plasma
To which mechanism are platelets essential?
Clotting
Which component of the red blood cell is responsible for oxygen and carbon dioxide transport?
Hemoglobin
What causes a pulse?
Contraction of the left ventricle, which sends a wave of blood through the arteries.
Where can a pulse be palpated?
Anywhere an artery simultaneously passes near the skin surface and over a bone.
What are the four primary sites for palpating a peripheral pulse on an adult?
The radial arteries; brachial arteries; posterior tibial arteries; dorsalis pedis arteries.
What are the two primary sites for palpating a central pulse?
The carotid and femoral arteries.
What causes systolic blood pressure?
The pressure exerted against the walls of the artery when the left ventricle contracts.
What causes the diastolic blood pressure?
The pressure exerted against the walls of the artery when the left ventricle is at rest.
What is the definition of perfusion?
The circulation of blood through an organ or a structure.
What is the function of perfusion?
The delivery of oxygen and other nutrients to the cells of all organ systems and the removal of waste products.
What is hypoperfusion?
The inadequate circulation of blood through an organ or a structure.
What are the three types of muscle?
Voluntary (skeletal); involuntary (smooth); cardiac
To what do skeletal muscles attach?
Bones
Which muscles are responsible for carrying out automatic muscular functions?
Smooth
Which muscles are voluntary?
Skeletal
Which muscles are under the control of the brain and nervous system?
Skeletal
Which kind of muscle controls the blood vessels?
Smooth
Which kind of muscle is found in the urinary and intestinal tracts?
Smooth
Which kind of muscle possesses the quality of automaticity?
Cardiac
In what way are the cardiac and smooth muscle similar?
They are both voluntary.
What is the function of the nervous system?
To control the voluntary and involuntary activity of the body.
What are the two components of the nervous system?
The central and peripheral
What are the two components of the central nervous system?
The brain and spinal cord
What are the two functions of the peripheral nervous system?
Sensory and motor
What are the functions of the skin?
Protection, temperature regulation, and sensation.
What are the three main layers of the skin?
The epidermis; dermis; subcutaneous layer
What is the function of the endocrine system?
To secrete chemicals such as insulin and adrenaline, which are responsible for regulating body activities and functions.
What general information do you obtain from a patient?
Chief complaint, age, sex and race
What baseline vital signs should you obtain?
Breathing, pulse, perfusion, pupils, and blood pressure.
When assessing breathing, what two main values are you looking for?
Rate and quality.
What is the recommended method for calculating the rate of breathing?
Count the number of breaths in a 30-second period, then multiply by two; to avoid influencing the rate, care should be taken not to inform the patient.
Quality of breathing can be placed in one of four categories. What are they?
Normal; shallow; labored; noisy.
What are some of the characteristics of labored breathing?
Increased effort of breathing; grunting and stridor; use of accessory muscles; nasal flaring; supraclavicular and intercostal retractions in infants and children; sometimes gasping.
You are called to the home of a 5-year-old with a history of asthma. The patient is tripoding and retracting. What sound do you expect to hear on auscultation?
Wheezing. This child is showing the signs of an acute asthma attack; as the attack progresses and the airways become increasingly constricted and occluded, you may have difficulty auscultating breath sounds at all.
You arrive at a nursing home to transport a 76-year-old overweight man. He is sitting upright, is tachypnic and working hard to breathe, and his ankles are swollen. What do you expect to hear in auscultation?
Gurgling. This patient is showing the signs of congestive heart failure, which causes fluid to back up into the lungs.
