Chapter 48

Which of the following statements regarding vehicle air bags is correct? Vehicles equipped with air bags have a built-in safety sensor that causes all the air bags in the vehicle to deactivate upon impact. Air bags can deploy any time after an accident and must be deactivated even if the vehicle's power supply has been disconnected. Vehicle air bags serve as the primary protective mechanism to protect the front seat passengers of a vehicle involved in a frontal crash. If the air bags on the passenger's and driver's sides have not deployed by the time you arrive at the scene, there is no need to deactivate them.

Air bags can deploy any time after an accident and must be deactivated even if the vehicle's power supply has been disconnected.

Which of the following statements regarding patient transport is correct? Because of the location of most technical rescue scenes, a helicopter should routinely be dispatched to transport the patient. Air transport would be appropriate if the patient is critical or if the scene is far removed from the closest appropriate hospital. In rough-terrain rescues, the use of a long backboard is most practical and appropriate for moving a patient to the awaiting ambulance. Unless an injured patient has fractures to the lower extremities, it is acceptable to allow him or her to walk from the rescue scene to the ambulance.

Air transport would be appropriate if the patient is critical or if the scene is far removed from the closest appropriate hospital.

Which of the following items of personal protective equipment is NOT always required when performing a water rescue? Thermal protection An approved helmet Personal flotation device Contamination protection

Contamination protection

Which of the following statements regarding an EMS provider's role during a trench rescue is correct? It is crucial for the EMS provider to be in the trench to provide emergency care during the rescue attempt. Trench rescue is a part of a paramedic's training, so he or she is properly trained to enter a trench safely. Due to a lack of proper training, EMS providers should remain at least 50 yards away from the trench at all times. EMS providers should attempt to make contact with the patient, but should not enter the trench and attempt rescue

EMS providers should attempt to make contact with the patient, but should not enter the trench and attempt rescue

Which of the following situations does NOT depict a technical rescue? Disentangling a young woman from her badly damaged vehicle Moving a 180-pound man from his living room to the ambulance Gaining access to an unresponsive man who is trapped in a grain silo Retrieving a woman whose car was swept off the road by swift water

Moving a 180-pound man from his living room to the ambulance

Which of the following ECG findings is the MOST significant in a patient who was entrapped for a prolonged period of time? Tachycardia Peaked T-waves Small P-waves First-degree AV block

Peaked T-waves

Without the use of hydraulic tools, which of the following techniques would MOST likely force a jammed door-locking mechanism, even in a door that appears to be badly damaged? Pull on the door handle while applying outward pressure to the upper window frame with a pry bar. Unlock the door and then force the front fender away from the door with a pry bar or similar tool. Place a pry bar between the front and rear doors and bend the front door metal forward. Release the locking mechanism and then pull on the inside and outside door handles at the same time.

Release the locking mechanism and then pull on the inside and outside door handles at the same time.

A frantic woman called 9-1-1 after her father, a 77-year-old man with Alzheimer disease, wandered off into a wooded area near her home. When you arrive at the scene, the woman tells you that she is not sure in which direction her father headed. What should you do? Ask the daughter if her father has any other known medical conditions. Notify the dispatcher and request a helicopter to attempt to find the man. Have your partner stay with the daughter as you attempt to locate the man. Remain with the daughter and immediately request a search and rescue team.

Remain with the daughter and immediately request a search and rescue team.

Which of the following statements regarding the hot zone at a rescue scene is correct? The hot zone should be specifically designated for decontamination of rescue personnel and equipment. The hot zone should be a large perimeter around the entire scene and should be cordoned off with yellow tape. The hot zone immediately surrounds the dangers of the rescue site and is only accessible by entry and rescue teams. The hot zone is designated for the staging of vehicles and equipment and is also where the command post is located

The hot zone immediately surrounds the dangers of the rescue site and is only accessible by entry and rescue teams.

Which of the following statements regarding utility hazards at the scene of a rescue operation is correct? Natural gas displaces carbon dioxide in the air. Live power lines usually arc or produce sparks. Utility hazards can be above or below the ground. You should park at least 10 feet away from downed power lines.

Utility hazards can be above or below the ground.

Which of the following statements regarding cold-water immersion is NOT correct? Water that is colder than 70°F will cause a marked increase in oxygen demand. The cold protective response secondary to hypothermia can protect vital organs. Patients submerged in cold water are often dehydrated secondary to cold diuresis. Bradycardia occurs after falling in cold water and lowers the basal metabolic rate.

Water that is colder than 70°F will cause a marked increase in oxygen demand.

Which of the following statements regarding windshield removal is correct? Removing the windshield is an essential step after the roof of a crashed vehicle has been removed. Never attempt to break the windshield with a center punch, as doing so will cause it to break into large shards of glass. When the windshield is struck with a center punch, a small break occurs but the structure of the glass remains intact. Unlike the tempered glass of side and rear windows, the windshield can be broken with a center punch easily and safely.

When the windshield is struck with a center punch, a small break occurs but the structure of the glass remains intact.

Trench rescues are MOST often required when: an earth excavation collapses and entraps a person. a hiker explores a cave and gets lost or entrapped. a child is entrapped in a septic tank or well casting. an adult or child becomes entrapped in a grain silo.

an earth excavation collapses and entraps a person.

On any call involving a confined space rescue, you should: consider that carbon dioxide levels may be insufficient to support life. assume that the environment is immediately dangerous to life and health. protect yourself with a face mask prior to attempting to rescue the patient. recall that methane gas may be present and may deaden your sense of smell.

assume that the environment is immediately dangerous to life and health.

After a vehicle has been properly stabilized, the simplest way to gain access to a crash victim is to: break the rear passenger-side window. remove the door with the Jaws of Life. attempt to open the least damaged door. enter the vehicle through the rear window.

attempt to open the least damaged door.

When heavy extrication tools are required to force a damaged door open, you should: peel the door down and away from the patient with the spreader. first place 4-inch by 4-inch cribbing underneath the door to hold it in place. avoid trying to force a door open if the patient is leaning against it. gain access to the patient by removing the door that is closest to the patient.

avoid trying to force a door open if the patient is leaning against it.

With regard to rescue, it is MOST important for the paramedic to: have an advanced working knowledge of a wide variety of rescue equipment, such as the Jaws of Life. be trained well enough to be able to coordinate a rescue effort and function as the incident commander. be able to understand and identify potential hazards and determine whether it is safe to gain access to the patient. be able to quickly recognize a rapidly deteriorating situation so that the paramedic can relocate bystanders to a place of safety.

be able to understand and identify potential hazards and determine whether it is safe to gain access to the patient.

If you believe that your assigned task at a rescue incident may be unsafe, it would be MOST appropriate for you to: assign yourself a task that poses less of a safety threat. proceed with the task while exercising extreme caution. reorganize the rescue effort as dictated by the situation. bring your concern to the attention of the safety officer.

bring your concern to the attention of the safety officer.

In rescues that involve lengthy entrapment in a confined space, especially with cave-ins and trench rescues, the paramedic should be especially concerned about the potential for: severe alkalosis. femur fractures. spinal cord injury. crush syndrome.

crush syndrome.

In addition to identifying and evaluating any hazards, scene stabilization typically involves all of the following components, EXCEPT: observing the geographic area. noting the routes of access and exit. observing wind and weather conditions. determining if air transport is available.

determining if air transport is available.

If you must break a window to gain access to a patient trapped in his or her vehicle, you should: break the safety glass of a side window with a center punch. ensure that the patient and all rescuers are protected properly. break the windshield and approach the patient from the front. try to lower the window as far as possible before breaking it.

ensure that the patient and all rescuers are protected properly.

When providing treatment to a patient while he or she is being rescued, it is MOST important to: follow the orders of the person in charge of the rescue. administer high-flow oxygen throughout the entire rescue. advise all personnel that they are to follow your directions. provide reassurance to the patient during the rescue effort.

follow the orders of the person in charge of the rescue.

After the warm zone has been established: law enforcement officials should identify it with red tape. it should be demarcated with orange police or fire line tape. only entry and rescue teams are allowed to function within it. a rescuer should be posted there to prevent unauthorized entry.

it should be demarcated with orange police or fire line tape.

If you are caught in cold water and there are no personnel available to rescue you, you should: swim vigorously to the shore, as this action will increase the metabolic rate and produce heat. keep your face above water, protect your head, and assume a position that minimizes body heat loss. tread water, as this action will decrease heat loss 60% more effectively than any other position or action. allow yourself to become moderately hypothermic, as hypothermia will decrease your body's demand for oxygen

keep your face above water, protect your head, and assume a position that minimizes body heat loss.

The objective of dash displacement is to: pull the dash straight forward. laterally displace the dashboard. lift the dash up and move it forward. remove the entire dash from the vehicle.

lift the dash up and move it forward.

Unique dangers associated with confined spaces include: limited ventilation. carbon dioxide deficiency. sharp metal structures. hyperoxic injury.

limited ventilation.

A 7-year-old child was playing near a large pile of sand when the ground underneath her collapsed. You can hear her crying and asking for her mother. Until the technical rescue team arrives at the scene, you should: get as close to the edge of the trench as possible and attempt to visualize the child. maintain verbal contact with the child, but avoid going near the edge of the trench. throw the child a rope and ask her to tie it around her waist so you can pull her out. use several long backboards as shoring to decrease the risk of a secondary collapse

maintain verbal contact with the child, but avoid going near the edge of the trench.

Immediate implementation of an incident management system is critical because: many technical rescue incidents become complex and require a large number of assisting units and personnel. there must be one person in charge of assigning tasks to incoming ambulances, rescue units, and other emergency resources. each ambulance or rescue unit that responds to the scene must have one person who assumes the role of incident commander. technical rescue incidents tend to attract large crowds and media who must be updated regularly on the status of the rescue situation.

many technical rescue incidents become complex and require a large number of assisting units and personnel.

The MOST common swift water rescue scenario involves: undertow ocean currents that force the victim under water. a canoer who is entrapped in thick brush in fast-moving water. people who attempt to drive their vehicles across a flooded bridge. a swift water rescue technician who does not wear a flotation device.

people who attempt to drive their vehicles across a flooded bridge.

The rescue team has just removed the door from a badly damaged car. The patient, a young woman, is pinned between the steering wheel and driver's seat. You should: limit your primary assessment and treatment to airway management until she has been disentangled from the vehicle. assess the patient's level of consciousness, reassure her that she will be okay, and allow the rescue team to disentangle her. place a heavy glass-proof blanket over the patient, go around to the opposite side of the vehicle, and provide reassurance to the patient. perform a primary assessment, attempt to treat any life-threatening injuries, and remain with the patient as she is being disentangled.

perform a primary assessment, attempt to treat any life-threatening injuries, and remain with the patient as she is being disentangled.

You and your partner are the first to arrive at a rollover vehicle crash. The vehicle apparently rolled several times and ended up on all four wheels on a slight incline. The driver is still in the vehicle, but does not appear to be entrapped. You should: position step blocks at all four corners of the vehicle. place cribbing in the front and back of all four wheels. deflate all tires by removing the valve stems with pliers. stabilize the patient's head in a neutral, inline position.

place cribbing in the front and back of all four wheels.

The size of the rescue area is dependent MOSTLY upon the: potential hazards that exist. number of rescuers present. severity of the patient's injuries. complexity of the rescue effort.

potential hazards that exist.

Packaging a patient is MOST accurately defined as: preparing the patient for movement as a unit. ensuring that full spinal precautions are taken. splinting all fractures before moving a patient. securely fastening a patient to a long backboard.

preparing the patient for movement as a unit.

A 29-year-old man was pulled from icy water after being submerged for approximately 10 minutes. He is unresponsive, apneic, and pulseless. He does not appear to have any injuries. The MOST appropriate treatment for this patient involves: defibrillating up to three times if he is in ventricular fibrillation, removing his wet clothing and applying blankets, and transporting. immobilizing his spine, initiating CPR, removing his wet clothing, and ceasing resuscitative efforts if unsuccessful after 5 minutes. assessing his cardiac rhythm, but attempting resuscitation only if the cardiac monitor reveals ventricular fibrillation or ventricular tachycardia. protecting his spine, initiating resuscitative measures, removing his wet clothing and applying warm blankets, and transporting to the hospital.

protecting his spine, initiating resuscitative measures, removing his wet clothing and applying warm blankets, and transporting to the hospital.

During extrication of a seriously injured patient from his or her crashed vehicle, it is MOST important to: provide emergency care while extrication is in progress if it is safe to do so. place a paramedic in the vehicle with the patient to provide emotional support. apply a vest-style extrication device to facilitate rapid removal after extrication. place a backboard onto a stretcher and have it as close to the vehicle as possible

provide emergency care while extrication is in progress if it is safe to do so.

Your initial attempt to rescue a person from the water should involve: rowing out to the person in a raft or canoe if one is available. removing encumbering clothing and swimming to the victim. reaching out to the victim using any readily available object. throwing the victim a flotation device that is attached to rope.

reaching out to the victim using any readily available object.

A late-model sport utility vehicle struck a tree head on. You are able to gain access to the driver, who was the sole occupant, through the passenger-side door. The patient appears to be unconscious and has blood bubbling from his mouth when he breathes. Upon entering the vehicle, it is MOST important for you to: carefully open the patient's airway with the jaw-thrust maneuver, and ask your partner for a suction unit. ask the rescue team to remove the driver's side door with the hydraulic spreader so your partner can gain access. recall that if the air bags did not deploy during the collision, they could still do so and may severely injure you. conduct a brief head-to-toe exam and then rapidly remove the patient from the vehicle by grabbing him under his arms.

recall that if the air bags did not deploy during the collision, they could still do so and may severely injure you.

Once you have succeeded in establishing verbal contact with a patient who is in the process of being rescued, it is MOST important to: answer all of his or her questions. use the patient's first name. remain in contact with him or her. speak slowly and distinctly.

remain in contact with him or her.

When removing a vehicle's roof, you must FIRST: cut the vehicle posts farthest away from the patient. remove all glass to prevent it from falling on the patient. break the safety glass of the window closest to the patient. remove at least one door so patient assessment can begin.

remove all glass to prevent it from falling on the patient.

After gaining access to a patient with extrication procedures, the next step involves: performing a complete physical assessment of the patient. removing parts of the vehicle that are trapping the patient. pulling the steering column forward with a hydraulic tool. quickly but carefully moving the patient onto a backboard.

removing parts of the vehicle that are trapping the patient.

Once the patient has been disentangled, your primary focus should be to: begin emergency care. protect his or her spine. perform a detailed exam. safely remove the patient.

safely remove the patient.

Access to a patient and the initiation of treatment can begin only after the: triage officer is present. scene has been made safe. patient has been disentangled. fire department is at the scene.

scene has been made safe.

You are assessing an injured hiker and determine that his pelvis is unstable and painful to palpation. The patient is located at the top of a large mountain, and the local rescue helicopter is on another mission and is unable to respond. Assuming you have the appropriate equipment, the MOST effective way of moving this patient is to: apply full spinal motion restriction precautions, establish an IV and administer 15 mg of morphine, and carefully move him in 5-minute increments. place the patient in a Stokes basket, pad around his pelvic area with blankets, and use at least six people to carefully move him down the mountain. secure the patient in a full-body vacuum mattress, place the mattress in a Stokes basket, and utilize at least four people to move him down the mountain. fully immobilize him on a scoop stretcher, apply a commercial pelvic binder to stabilize his pelvis, and then coordinate each move down the mountain.

secure the patient in a full-body vacuum mattress, place the mattress in a Stokes basket, and utilize at least four people to move him down the mountain.

The single MOST important process to ensure ongoing rescuer safety at a technical rescue incident is: the accountability system. assignment of a safety officer. mandated use of reflective vests. the presence of law enforcement.

the accountability system.

The only time a patient should be moved prior to completion of initial care, assessment, stabilization, and treatment is when: more than one noncritical patient is involved. the patient is in severe pain and is extremely anxious. the patient's or responder's life is in immediate danger. your primary assessment reveals no life-threatening injuries.

the patient's or responder's life is in immediate danger.

Prior to displacing a dash, you should anticipate that rescue personnel will FIRST: cut the bottom of the A post where it meets the floor. tie the doors in an open position so they do not move. place a protective barrier between the A post and patient. place a high-lift mechanical jack at the base of the B post.

tie the doors in an open position so they do not move.

The MOST effective way of preparing your department to respond to a technical rescue incident is to: identify hazard areas in the jurisdiction in which you function. train with fire departments and special rescue teams in your area. designate key personnel and equipment to respond to every rescue. attend a technical rescue class that emphasizes responder awareness.

train with fire departments and special rescue teams in your area.

The preferred initial method for disentangling a patient who is trapped between the seat and steering wheel involves: displacing the dashboard forward. using a powered hydraulic spreader. removing the bolts that secure the seat. trying to slide the seat back on its track.

trying to slide the seat back on its track.

As soon as you reach an unresponsive victim who is floating in the water, you should: turn the patient supine without manipulating his or her head or neck. float a buoyant backboard under the patient and initiate ventilations. immediately assess for the presence of breathing and for a central pulse. move the victim's face above water and manually open his or her airway.

turn the patient supine without manipulating his or her head or neck.

A handheld global positioning system is MOST useful in _____________ rescue incidents. nighttime wilderness water-related confined space

wilderness