Objectives for Chapters 1, 2, 4, 8, and 15 (minus Key Terms)

Access the Centers for Disease Control web site to obtain the latest information on diseases of concern to EMS providers. (p. 36)

<<https://www.cdc.gov>>

Given a variety of scenarios, identify circumstances that may allow a claim of negligence to be established. (pp. 90-91)

A finding of negligence, or failure to act properly, requires that all of the following circumstances be proved: The EMT had a duty to the patient (duty to act). The EMT did not provide the standard of care (committed a breach of duty). This may include the failure to act; that is, he did not provide needed care as would be expected of an EMT in your locality. Failure to act is a major cause of legal actions against EMS systems or EMTs. There was proximate causation (the concept that the damages to the patient were the result of action or inaction of the EMT. This means that by not providing the standard of care, the EMT caused harm to the patient. The harm can be physical or psychological. An example of proximate causation would be injuries caused when EMTs dropped the stretcher carrying a patient.

Discuss the EMT's obligations with respect to advance directives, including do not resuscitate orders. (pp. 85-90)

A legal DNR order prevents unwanted resuscitation and awkward situations. In most cases the oral requests of a family member are not reason to withhold care. If the family requests you to not resuscitate the patient, and if there are no legal DNR orders available, it is a legal and ethical dilemma that is usually best resolved by providing care. It is better to be criticized or sued for attempting to save a life than for letting a patient die. At times, a family under duress may ask that a DNR order be ignored and resuscitation be initiated despite the DNR. In such a situation, contact medical direction for advice and, if necessary, ask the medical direction physician to speak to the family.

Identify with the feelings of a patient who has a communicable disease. (pp. 33-36)

A patient with a communicable disease would naturally feel afraid (especially if their disease is consider fatal) and stigmatized.

Describe physical and physiological characteristics, including normal vital signs, for individuals in each of the following age groups: g. Middle adult (pp. 183-184)

A person in middle adulthood may start to have some vision problems, has high cholesterol, could develop cancer, has trouble controlling weight, and for women in the late 40s to early 50s, menopause commences. Heart disease is the major killer after the age of 40 in all age, sex, and racial groups.

Describe physical and physiological characteristics, including normal vital signs, for individuals in each of the following age groups: c. Preschool age (pp. 179-180)

A preschooler has a heart rate of 80-120/minute, a respiratory rate of 20-30/minute, and a systolic blood pressure of 80-110 mmHg. His or her body systems continue to develop and refine their various processes.

Differentiate among acute, delayed, and cumulative stress reactions. (pp. 41-42)

Acute stress reactions are often linked to catastrophes, such as a large-scale natural disaster, a plane crash, or a coworker's line-of-duty death or injury. Signs and symptoms of an acute stress reaction will develop simultaneously or within a very short time following the incident. They may involve any one or a combination of the following areas of function: physical, cognitive (the ability to think, emotional, or behavioral. These are signs that this particular situation is overwhelming your usually ability to cope and to perform effectively. Like an acute stress reaction, a delayed stress reaction, also known as posttraumatic stress disorder (PTSD), can be triggered by a specific incident; however, the signs and symptoms may not become evident until days, months, or even years later. Signs and symptoms may include flashbacks, nightmares, feelings of detachment, irritability, sleep difficulties, or problems with concentration or interpersonal relationships. Cumulative stress reaction, or burnout, is not triggered by a single critical incident, but instead results from sustained, recurring low-level stressors--possibly in more than one aspect of one's life--and develops over a period of years. The earliest signs are subtle. They may present as a vague anxiety, progressing to boredom and apathy, and a feeling of emotional exhaustion. If problems are not identified and managed at this point, the progression will continue. Now the individual will develop physical complaints (such as headaches or stomach ailments), significant sleep disturbances, loss of emotional control, irritability, withdrawal from others, and increasing depression. Without appropriate intervention, the person's physical, emotional, and behavioral condition will continue to deteriorate, with manifestations such as migraines, increased smoking or alcohol intake, loss of sexual drive, poor interpersonal relationships, deterioration in work performance, limited self-control, and significant depression.

Promote the importance of safety on EMS calls. (pp. 27-52)

Always take standard precautions and wear the appropriate personal protective equipment. Do not help patients unless you are specifically trained to do so. Instead, keep your distance and prevent other bystanders from getting hurt. Rather than confronting people in a potentially unsafe scene, retreat, radio, and reevaluate.

Describe the typical psychosocial characteristics and concerns of individuals at each stage during the life span. (pp. 175-185)

An infant's nervous system includes four reflexes that will diminish over time: moro, palmar, rooting, and sucking. He gradually learns to: track objects with eyes, recognize familiar faces, move objects to mouth with hands, express himself with smiles and frowns, drool without swallowing, reach out to people, sleep through the night without waking for feeding, discriminate between family and strangers, sit upright in a high chair, make one-syllable sounds, develop a fear of strangers, shift quickly in moods, respond to the word "no," sit alone, play peek-a-boo, respond to adult anger, stand up, explore objects by mouthing, sucking, chewing, and biting, recognizes his own name, crawls, attempt to walk alone, show frustration about restrictions, walk with help, and know his own name. Within the first six months, an infant starts displaying: bonding, trust versus mistrust, scaffolding, and temperament. A toddler will begin to grasp that words "mean" something, begins to understand cause and effects, develops separation anxiety, engages in play-acting, and masters the basics of language that will continue to be refined throughout childhood. Preschoolers become involved with peer groups, which give them access to other families and the outside world. Interacting with peers gives them opportunities to learn new skills, compare themselves to others, and feel like they're part of a group. During the school age years, self-esteem (influenced by one's peers) and moral reasoning develop, which is important because parents generally spend less time with children at this age and only provide general supervision. Internal self-control, therefore, becomes more crucial. At the adolescent stage, teens want to: achieve more independence, develop their own identity, be treated like an adult, and consider the possibility of losing their virginity soon. Eating disorders, drug abuse, suicide, and depression are quite common in this age group. Teens become more logical, analytical, and engaged in abstract thinking--developing their own personal code of ethics. At early adulthood, the highest levels of job stress occur as one is trying to establish his or her own identity, both romantic and affectionate love develops, childbirth is most common in this age group, as is, unfortunately accidental death. People in middle adulthood often experience empty-nest syndrome, feel the need to become more task-oriented and complete lifetime goals before time runs out, and grow increasingly concerned about their children's wellbeing as they start new lives, and how they will care for their aging parents. People in late adulthood are concerned with: where they can live with a substantially reduced income following retirement, how long they can live there, what they can still do to benefit themselves and others, how they can pay for their basic necessities, and when they will die.

Describe physical and physiological characteristics, including normal vital signs, for individuals in each of the following age groups: a. Infant (pp. 175-178)

An infant's weight will likely double by six months and triple by twelve months. Her head will be equal to 25 percent of her total body weight. An infant's airway is shorter, narrower, less stable, and more easily obstructed than at any other stage in her life. She is primarily a "nose breather" until at least four weeks of age. She is also a diaphragm breather. She will fatigue more easily with breathing difficulty because her accessory muscles are less mature and tire easily. Her chest wall is less rigid and her lung tissue is more prone to trauma from pressure. The vital signs for an infant are 140-160/minute for heart rate, 40-60 breaths per minute, and 70 mmHg to 90 mmHg systolic blood pressure from birth to 1 year respectively. Her extremities grow in length from a combination of growth plates that are located at the ends of the long bones (humerus and femur), and the epiphyseal plates located near the ends of the long bones. Within the first six months, the infant will bond with her caregivers and start displaying the following characteristics: bonding, trust versus mistrust, scaffolding, and temperament.

Outline proper responses to incidents including: b. Terrorist incidents (p. 47)

As part of your initial and subsequent training, you will likely be made aware of any specific threats or targets in your area in addition to any specific protocols relating to potential chemical, biological, nuclear, or explosive incidents.

Describe the role of communication technology in EMS systems. (p. 412)

As the name implies, radio communication is conducted by radio. Technology has allowed the use of cell phones and other equipment to be used in areas where radio transmissions were previously the only choice. The verbal report is your chance to convey information about your patient directly to the hospital personnel who will be taking over his care. Interpersonal communications are important in dealing with other EMTs, the patient, family and bystanders, medical direction, and other members of the EMS system. There are a number of components to any radio or communications system: base stations, mobile radios, portable radios, repeaters, cell phones telemetry, and other devices. Computers and tablets are being used to record information at the patient's side. This information may be wirelessly transmitted to dispatch and to the hospital. These same devices permit transmission of some standard messages, such as ambulance identification or arrival at the scene, by punching a key. The messages are transmitted in a condensed form that helps keep busy frequencies less crowded.

Provide a thorough, organized, concise report of pertinent patient information when giving a radio report or requesting orders. (pp. 416-417)

As you give the twelve parts of the radio medical report, use the following guidelines when communication with medical direction: Give the information to medical direction clearly and accurately. Speak slowly and clearly. The physician's orders will be based on what you report. After receiving an order for a medication or procedure, repeat the order word for word. You may also ask to do a procedure or give a medication and be denied by medical direction. Repeat this also. If an order is unclear, ask the physician to repeat it. After you have a clear understanding of the order, repeat it back to the physician. If an order appears to be inappropriate, question the physician. There may have been a misunderstanding, and your questioning may prevent the inappropriate administration of a medication. If the physician verifies the order, he may explain to you why he has given you that particular order.

Describe varous types of communication devices and equipment used in EMS system communication. (p. 413)

Base stations are two-way radios that are at a fixed site such as a hospital or dispatch center. Mobile radios are two-way radios that are used or affixed in a vehicle. Most are actually mounted inside the vehicle. These devices have lower transmitting power than base stations. The unit used to measure output power of radios is the watt. The output of a mobile radio is generally 20-50 watts with a range of 10-15 miles. Portable radios are handheld two-way radios with an output of 1-5 watts. This type of radio is important because it will allow you to be in touch with the dispatcher, medical direction, and other members of the EMS system while you are away from the ambulance. Repeaters are devices that are used when transmissions must be carried over a long distance. Repeaters may be in ambulances or placed in various areas around an EMS system. The repeater picks up signals from lower-power units, such as mobile and portable radios, and retransmits them at a higher power. The retransmission is done on another frequency. Cell phones are phones that transmit through the air to a cell tower. In many areas where the distances or expense is too great to set up a conventional EMS radio system, cell phones allow EMS communications through an already established commercial system. Telemetry is the process of sending and receiving data wirelessly. In EMS this may be an electrocardiogram (ECG), vital signs, or other patient-related data. Some systems allow EMTs to acquire and transmit ECGs to the hospital. Computers and tablets are being used to record information at the patient's side. This information may be wirelessly transmitted to dispatch and to the hospital. These same devices permit transmission of some standard messages, such as ambulance identification or arrival at the scene, by punching a key. The messages are transmitted in a condensed form that helps keep busy frequencies less crowded.

Give examples of common stressors in EMS work. (pp. 44-45)

Common stressors in EMS work include: multiple-casualty incidents, calls involving infants and children, severe injuries, abuse and neglect, and death of a coworker.

Given a scenario involving an ethical challenge, decide the most appropriate response for an EMT. (pp. 81-97)

Consider the consequences of not acting in the patient's best interest. A patient who legally refuses care could deteriorate after you leave; make sure you have done everything in your power to persuade him to accept transportation and treatment and if he still refuses, ask that a friend or relative stay with him after you depart. Without official DNR orders, resuscitate the patient despite what the patient's family may say about his wishes not to be resuscitated. Respect all patients' privacy and refrain from describing the patient's history, condition, or treatments to anyone except for his nurse or physician.

Recognize situations that may legally require reporting to authorities. (pp. 96-97)

Crimes that may require reports include violence (such as gunshot wounds or stabbings) and sexual assaults. You should also report intoxicated persons found with injuries or mentally incompetent people who have been injured.

Explain the purpose of critical incident stress management (CISM). (p. 44)

Critical incident stress management (CISM) is a comprehensive system that includes education and resources to both prevent stress and to deal with stress appropriately when it does occur. EMS systems and organizations have different systems for dealing with stress prevention, critical incident stress, and chronic stress, including wellness incentives, professional counseling, and peer support.

Outline proper responses to incidents including: c. Rescue operations (pp. 47-48)

Depending on the emergency, you may need the police, fire department, power company, or other specialized personnel. Never perform acts that you are not properly trained to do. Do your best to secure the scene. Then stand by for the specialists. As you work in rescue operations or on patients during a rescue operation, you will need personal protective equipment that includes turnout gear (coat, pants, and boots), protective eyewear, helmet, and puncture-proof gloves.

Describe physical and physiological characteristics, including normal vital signs, for individuals in each of the following age groups: e. Adolescent (pp. 181-182)

During the adolescent stage, teens will usually experience a rapid 2-3 year growth spurt, beginning distally with enlargement of her feet and hands followed by enlargement of the arms and legs. The chest and trunk enlarge in the final stage of growth. Girls are usually finished growing by the age of 16 and boys by the age of 18. In late adolescence, the average male is taller and stronger than the average female. At this age, both males and females reach reproductive maturity. Secondary sexual development occurs, with noticeable development of the external sexual organs. In females, menstruation begins and breasts develop. Typical vital signs for this age group are: 55-105/minute for heart rate, 12-20/minute for respiratory rate, 80-120 mmHg for systolic blood pressure.

Describe the stages of the stress response, including the effects of each stage on the body. (pp. 42-43)

During the first stage (alarm reaction), your sympathetic nervous system increases its activity in what is known as the fight-or-flight syndrome. Your pupils dilate, your heart rate increases, and your bronchial passages dilate. In addition, your blood sugar increases, your digestive system slows, your blood pressure rises, and blood flow to your skeletal muscles increases. At the same time, the endocrine system produces more cortisol, a hormone that influences your metabolism and your immune response. Cortisol is critical to your body's ability to adapt to and cope with stress. In the second stage (stage of resistance), your body systems return to normal functioning. The physiologic effects of sympathetic nervous system stimulation and the excess cortisol are gone. You have adapted to the stimulus, and it no longer produces stress for you. You are coping. Many factors contribute to your ability to cope; these include your physical an mental health, education, experiences, and support systems, such as family, friends, and coworkers. Exhaustion, the third stage of the general adaptation syndrome, occurs when exposure to a stressor is prolonged or the stressor is particularly severe. During this stage, the physiologic effects described by Selye include what he called the stress triad: enlargement (hypertrophy) of the adrenal glands, which produce adrenaline; wasting (atrophy) of lymph nodes; and bleeding gastric ulcers. At this point the individual has lost the ability to resist or adapt to the stressor and may become seriously ill as a consequence. Fortunately most individuals do not reach this stage.

Compare and contrast the training and responsibilities of EMRs, EMTs, AEMTs, and Paramedics. (pp. 7-8)

EMRs: This level of training is designed for the person who is often first at the scene. Many police officers, firefighters, and industrial health personnel function in this capacity. EMTs provide basic-level medical and trauma care and transportation to a medical facility. The AEMT, like the EMT, provides basic-level care and transportation as well as some advanced-level care, including use of advanced airway devices, monitoring of blood glucose levels, and administration of some medications, which may include intravenous and intraosseous administration. The Paramedic performs all of the skills of the EMT and AEMT plus advanced-level skills. The Paramedic provides the most advanced level of prehospital care.

Give examples of how EMS providers can play a role in public health. (pp. 14-15)

EMS has a role in many public safety issues including: injury prevention for geriatric patients, injury prevention for youth, public vaccination programs, and disease surveillance. When on a call to a patient's home, the EMT can identify things that may cause falls such as footwear or rugs. EMS may also run blood pressure clinics and offer methods for the elderly to present medications and medical history to EMTs in the event of an emergency. EMS is frequently involved in car-seat clinics, distribution of bicycle helmets, and other programs for youth. More and more EMS providers are being trained and allowed to provide vaccination clinics for the public. Seasonal flu and variations such as H1N1 are examples of vaccinations that are frequently offered by EMS providers. Some regions are beginning to allow specially trained EMS providers to take routine vaccinations (e.g., routine childhood vaccinations) out to the public--especially in areas where many children do not have routine well care and are at risk. On the front lines, EMS reports may serve as an indication that a trend in injury or disease is beginning. Such trends may range from flu to violence to terrorist attacks.

Describe various job settings that may be available to EMTs. (p. 11)

EMTs are employed in public and private settings, such as fire departments, ambulance services, and urban/industrial or rural/wilderness settings.

Explain EMT's role in the quality improvement process. (p. 13)

EMTs work toward quality care in several ways, such as: preparing carefully written documentation, becoming involved in the quality process, obtaining feedback from patients and the hospital staff, maintaining your equipment, and continuing your education. Call reviews are based on the prehospital care reports that you and other crew members write. If a report is incomplete, it is difficult for a QI team to assess the events of a call. If you are ever involved in a lawsuit, an inaccurate or incomplete report may also be a cause for liability. Be sure the reports you write are neat, complete, and accurate. As you gain experience, you may wish to volunteer for assignment to the QI committee. In addition, quality improvement has a place on every call. An individual ambulance crew can perform a critique after each call to determine things that went well and others that may need improvement. Have another EMT or advanced EMT look over your report before turning it in to ensure it is accurate and complete. Your organization may send a letter to patients that ask for comments on the care they were given while under your care. Hospital staff may be able to provide information that will help strengthen your caregiving skills. It will be difficult to provide quality care with substandard, damaged, or missing equipment. Although the ingenuity of EMTs should never be underestimated, it could be dangerous to administer oxygen or provide cardiac defibrillation without proper, functional equipment. Check and maintain equipment regularly. An EMT who was certified several years ago and has never attended subsequent training will have a problem providing quality care. Seldom-used skills deteriorate without practice. Procedures change. Without some form of regular continuing education, it will be difficult to maintain standards of quality.

Explain medical direction as it relates to EMS systems. (pp. 13-14)

Each EMS service or agency has a Medical Director, a physician who assumes the ultimate responsibility for medical direction, or oversight of the patient-care aspects of the EMS system. The Medical Director also oversees training, develops protocols (lists of steps for assessment and interventions to be performed in different situations), and is a crucial part of the quality improvement process. An EMT at a basic or advanced level is operating as a designated agent of the physician. This means that, as an EMT, your authority to give medications and provide emergency care is actually an extension of the Medical Director's license to practice medicine. The physician obviously cannot physically be at every call. This is why EMS systems develop standing orders. The physician issues a policy or protocol that authorizes EMTs and others to perform particular skills in certain situations. This kind of "behind the scenes" medical direction is called off-line medical direction. Certain other procedures that are not covered by standing orders or protocols require the EMT to contact the on-duty physician by radio or telephone prior to performing a skill or administering a medication. Orders from the on-duty physician given by radio or phone are called on-line medical direction.

Given a variety of ethical dilemmas, discuss the issues that must be considered in each situation. (pp. 82-83)

Even if your patient was legally able to consent, awake and oriented, fully informed, and asked to sign a "release" form, this will not guarantee that you will be free from liability if a patient refuses care or transport. Leaving a patient who will not accept care or transport is a leading cause of lawsuits against EMS agencies and providers, even though it was the patient who refused. Occasionally the patient's condition deteriorates to the point of unconsciousness, which leaves the patient unable to summon help, leading to a severely worsened condition or even death. In addition to the liability factor, there is also an ethical issue. You would undoubtedly feel guilty if a patient were found unconscious or deceased after refusing care and you felt that transportation would have prevented the circumstance. If in doubt, do everything possible to persuade the patient to accept care and transport. If the family requests you to not resuscitate the patient, and if there are no legal DNR orders available, it is a legal and ethical dilemma that is usually best resolved by providing care. It is better to be criticized or sued for attempting to save a life than for letting a patient die.

List items that may be considered evidence at a crime scene. (pp. 95-96)

Fingerprints, fibers, dirt, and traces of blood, the condition of the scene (overturned furniture, broken windows, doors found ajar, and pry marks), the position the patient was found in, the condition of her clothes, injuries, and footprints would all be considered evidence.

Explain legal and ethical considerations in situations where patients refuse care. (pp. 83-85)

For a patient to legally refuse care or transport, he must be: legally able to consent, awake and oriented, fully informed, and asked to sign a "release" form. Take all possible actions to persuade a patient who you feel should go to the hospital but refuses; these actions may include: spending time speaking with the patient, listening carefully to try to determine why the patient is refusing care, informing the patient of the consequences of not going to the hospital, consulting medical direction, asking the patient if it is all right if you call a family member--or advise the patient that you would like to call a family member, and calling law enforcement personnel if necessary. Subjecting the patient to unwanted care and transport has actually been viewed in court as assault (placing a person in fear of bodily harm) or battery (causing said harm or restraining). If all efforts fail and the patient does not accept your care or transportation, it becomes vital to document the attempts you made--to make your efforts a part of the official record--to prevent liability. Write into your records every step you took to persuade the patient to accept care or go to the hospital. Include the names of any witnesses to your attempts and the patient's refusal. In all cases of refusal, you should advise the patient that he should call back at any time if he has a problem or wishes to be cared for or transported. It is advisable to call a relative or neighbor who can stay with the patient in case problems develop.

Describe the components of an EMS system that must be in place for a patient to receive emergency medical care. (pp. 5-6)

For the patient, care begins with the initial phone call to the Emergency Medical Dispatcher (EMD). The EMS system responds to the call for help by sending to the scene available responders, including Emergency Medical Responders, EMTs, and advanced life support providers (Advanced EMTs and Paramedics). From the ambulance, the patient is received by the emergency department. The emergency department serves as the gateway for the rest of the services offered by the hospital. Some hospitals handle all routine and emergency cases but have a specialty that sets them apart from other hospitals. One specialty hospital is the trauma center. In some hospitals a surgery team may not be available at all times. In a trauma center, surgery teams capable of the comprehensive treatment of trauma patients are available twenty-four hours a day. Many others make up the hospital portion of the EMS system. They include physicians, nurses, physician's assistants, respiratory and physical therapists, technicians, aides, and others.

Explain the purpose of Good Samaritan laws. (pp. 91-92)

Good Samaritan laws have been developed in all states to provide immunity to individuals trying to help people in emergencies. Most of these laws will grant immunity from liability if the rescuer acts in good faith to provide care to the level of his training and to the best of his ability. These laws do not prevent someone from initiating a lawsuit, nor will they protect the rescuer from being found liable for acts of gross negligence and other violations of the law.

Discuss the health concerns related to exposure to hepatitis B, hepatitis C, tuberculosis, and AIDS. (pp. 34-36)

Hepatitis, an infection that causes an inflammation of the liver, comes in several forms, including hepatitis A, B, C, and other strains. Hepatitis B has been found to live for many days in dried blood spills, posing a risk of transmission long after many other viruses would have died. For this reason, it is critical for you to assume that any body fluid in any form, dried or otherwise, is infectious until proven otherwise. Hepatitis B can be deadly. Hepatitis C infects many EMS providers in the same way as hepatitis B, yet there is no vaccine against hepatitis C. Tuberculosis (TB) is an infection that sometimes settles in the lungs and that in some cases can be fatal. TB is highly contagious. Unlike many other infectious diseases, it can spread through the air. Health care workers and others can become infected even without any direct contact with a carrier. Because it is impossible for the EMT to determine why a patient has a productive cough, it is safest to assume that it could be the result of TB and that you should take the necessary respiratory precautions. AIDS (acquired immune deficiency syndrome) is a set of conditions that results when the immune system has been attacked by HIV (human immunodeficiency virus) and rendered unable to combat certain infections adequately. The virus does not survive well outside the human body. This limits the routes of exposure to direct contact with blood by way of open wounds, intravenous drug use, unprotected sexual contact, or blood transfusions. Puncture wounds into which HIV is introduced, such as with an accidental needlestick are also potential routes of infection.

Adapt communication principles for effective interaction with patients of various ages and cultures. (pp. 419-422)

If a person has a mental disability or is hard of hearing, speak slowly and clearly. Do not talk down to the patient. If the patient has a hearing disability, he may read lips. In any case seeing your lips may help him understand what you are saying. Therefore, be sure that a deaf or hearing-impaired person can see your mouth when you talk. Remember that a person who is blind or has a visual deficit can usually hear, so do not give in to the temptation to speak to him loudly or unnaturally. For the visually impaired person, you will want to take the extra effort to explain anything that is happening that he cannot see. You may also find people who do not speak the same language as you. In this case, use an interpreter (for example, a family member or friend who speaks both languages) or a manual that provides translations. Family members are not always familiar with medical terminology, so you should be cautious using them. It is sometimes possible to get a professional translating service through the hospital. You may also find that your communications center or medical direction has someone available who speaks the patient's language.

Given scenarios, decide how an EMT may demonstrate professional behavior. (pp. 9-11)

In addition to being in good physical shape and staying current in your education, EMTs should be able to inspire confidence and help to calm the sick and injured, convey an understanding of the situation and the patient's feelings, establish better coordination with other members of the EMS system, bolster the confidence of patients and bystanders, adapt a tool or technique to fit an unusual situation, show initiative and accomplish what must be done without having to depend on someone else to start procedures, overcome the unpleasant aspects of an emergency so needed care may be rendered and any uneasy feelings that exist afterward may be resolved, able to control a scene, organize bystanders, deliver emergency care, take charge when necessary, promote confidence in both patients and bystanders with a neat appearance to reduce the possibility of contamination, allow for trust in situations when the patient cannot protect his own body or valuables and so all information relayed is truthful and reliable, restraint from consuming alcohol within eight hours of duty and smoking when providing care, avoid inappropriate conversation that may upset or anger the patient or bystanders or violate patient confidentiality, be compassionate and empathetic, be accurate with interviews, and treat all patients equally regardless of race, religion, or culture.

Describe the indications for use of an N-95 or HEPA respirator. (p. 32)

In cases where there will be blood or fluid spatter, wear a surgical-type mask. In cases where tuberculosis (a disease that is carried by fine particles in the air) is suspected, an N-95 or a high-efficiency particulate air (HEPA) respirator approved by the National Institute for Occupational Safety and Health (NIOSH) is the standard.

Give an overview of the historical events leading to the development of modern Emergency Medical Services (EMS). (pp. 3-4)

In the 1790s the French began to transport wounded soldiers away from the scene of battle so they could be cared for by physicians. However, no medical care was provided for the wounded on the battlefield. During the American Civil War, Clara Barton began a service for the wounded and later helped establish the American Red Cross. During World War I, many volunteers joined battlefield ambulance corps. And during the Korean Conflict and the Vietnam War, medical teams produced further advances in field care, many of which led to advances in the civilian sector, including specialized emergency medical centers devoted to the treatment of trauma (injuries). Nonmilitary ambulance services began in some major American cities in the early 1900s--again as transport services only, offering little or no emergency care. Smaller communities did not develop ambulance services until the late 1940s, after World War II. The importance of providing hospital-quality care at the emergency scene--that is, beginning care at the scene and continuing it, uninterrupted, during transport to the hospital soon became apparent. The need to organize systems for such emergency prehospital care and to train personnel to provide it also was recognized. During the 1960s, the development of the modern EMS system began. In 1966 the National Highway Safety Act charged the U.S. Department of Transportation (DOT) with developing EMS standards and assisting the states to upgrade the quality of their prehospital emergency care. In 1970 the National Registry of Emergency Medical Technicians was founded to establish professional standards. In 1973 Congress passed the National Emergency Medical Services Systems Act as the cornerstone of a federal effort to implement and improve EMS systems across the United States.

Deliver an organized, complete, concise report of pertinent patient information when giving a verbal report to receiving hospital personnel. (pp. 417-418)

Include the following in your verbal report: chief complaint, history that was not given previously, additional treatment given en route, and additional vital signs taken en route.

Use knowledge of physical, physiological, and psychosocial development to anticipate the needs and concerns of patients of all ages. (pp. 175-185)

Infants have relatively weak immune systems and should receive all of their recommended vaccines. Toddlers should not be rushed into toilet training and can reasonably be expected to learn between 18-30 months of age. Preschoolers are beginning to compare themselves to others and may need to be taught that it's ok to excel in some areas and be more inept in other areas. School age children should be given more emotional support as their self-esteem develops and is heavily affected by their level of popularity with peers at school. Adolescents should be educated on safe sex, drug abuse, and depression; parents should be taught to watch out for warning signs of suicidal behaviors in their kids. Schools should promote healthy diets and positive body image to prevent eating disorders. People in early adulthood should learn how to balance their work and recreational/family time. Those in middle adulthood should watch their cholesterol, eat foods rich in cancer-fighting nutrients, exercise regularly, and monitor their heart health. Individuals in late adulthood should become more involved in their community after retirement so they won't feel lonely after a spouse has died or their children have moved away.

Explain each of the specific areas of responsibilites for the EMT. (pp. 8-9)

It is not possible to help a patient if you are injured before you reach him or while you are providing care, so your first responsibility is to keep yourself safe. Safety concerns include dangers from other human beings, animals, unstable buildings, fires explosions, and more. Though emergency scenes are usually safe, they also can be unpredictable. You must take care at all times to stay safe. The same dangers you face will also be faced by others at the scene. As a professional, you must be concerned with their safety as well as your own. As an EMT, one of your most important functions will be assessment of your patient, or finding out enough about what is wrong with your patient to be able to provide the appropriate emergency care. Assessment always precedes emergency care. The actual care required for an individual patient may range from simple emotional support to lifesaving CPR and defibrillation. Based on your assessment findings, patient care is an action or series of actions that your training will prepare you to take to help the patient deal with and survive his illness or injury. Since EMTs are usually involved in transporting patients to the hospital, lifting and moving patients are important tasks. You must perform them without injury to yourself and without aggravating or adding to the patient's existing injuries. It is a serious responsibility to operate an ambulance at any time, but even more so when there is a patient on board. Safe operation of the ambulance, as well as securing and caring for the patient in the ambulance, will be important parts of your job as an EMT. Upon arrival at the hospital, you will turn the patient over to hospital personnel. You will provide information on the patient's condition, your observations of the scene, and other pertinent data so that there will be continuity in the patient's care. As an EMT, you are there for your patient. You are an advocate, the person who speaks up for your patient and pleads his cause. It is your responsibility to address the patient's needs and to bring any of his concerns to the attention of the hospital staff.

Outline proper responses to incidents including: a. Hazardous material incidents (pp. 46-47)

The primary rule is to maintain a safe distance from the source of the hazardous material. Make sure your ambulance or other emergency vehicle is equipped with binoculars. They will help you identify placards, which are placed on vehicles, structures, and storage containers when they hold hazardous materials. These placards use coded colors and identification numbers that are listed in the Emergency Response Guidebook developed by the U.S. Department of Transportation, Transport Canada, and the Secretariat of Communications and Transportation of Mexico. This reference book should be placed in every vehicle that responds to, or may respond to, a hazardous material incident. It provides important information about the properties of the dangerous substance as well as information on safe distances, emergency care, and suggested procedures in the event of spills or fire. Your most important rules at the scene of a hazardous material incident are recognizing potential problems, taking initial actions for your personal safety and the safety of others, and notifying an appropriately trained hazardous material response team. Do not take any actions other than those aimed at protecting yourself, patients, and bystanders at the scene. As an EMT, you should not be treating patients until after they have undergone decontamination (cleansing of dangerous chemicals and other materials).

Given a scenario of an emergency response involving a safety threat, describe actions you should take to protect yourself and other EMS providers (pp. 46-50)

Keep a safe distance and wait for specialists to treat patients at hazmat incidents before approaching said patients. Pay attention to specific local protocols concerning terrorist incidents in the area. During an incident that involves rescue operations, do not attempt to help unless you have been properly trained to do so. Instead, secure the area. Do everything in your power to protect yourself when encountering scenes that could become or may still be violent. This means wearing safe clothing, carrying only the essentials of your response kit, bringing a portable radio with you at all times, designating specific roles for you and your partner, and watching out for evidence so as not to disturb it, signs of violence (overturned furniture, arguing, threats, broken glass, etc.), alcohol or drug use, the presence of weapons that might be turned on you, and family members, bystanders, perpetrators, and pets--all of whom could behave irrationally towards you. EMTs should react to danger by retreating, radioing for help, and reevaluating. Retreating is as simple as running away, dropping everything that could prevent you from making a quick escape, and hiding. The radio should be used both to warn other responders as well as to request police assistance. Reevaluation involves remaining alert as you maintain a distance from the scene and only reentering after police have secured the area.

Identify situations that would constitute libel or slander. (p. 93)

Libel is when information that is false and injurious to another is spread in written form; this could be done online or passed along on a note. Slander is when information is shared verbally, which could be done over the phone or in person.

List lifestyle changes that can be used to manage stress. (pp. 44-45)

Life style changes that help manage stress are: developing more healthful and positive dietary habits, exercising, and devoting time to relaxing.

Discuss how to communicate effectively by radio with dispatch and hospital personnel. (pp. 414-416)

Make sure that your radio is on and the volume is adjusted properly. Reduce background noise by closing the vehicle window when possible. Listen to the frequency and ensure that it is clear before beginning a transmission. Press the "press to talk" (PTT) button on the radio, then wait one second before speaking. This prevents cutting off the first few words of your transmission. Speak with your lips about two to three inches from the microphone. When calling another unit or base station, use their unit number or name, followed by yours. "Dispatcher, this is Ambulance 2." If the unit you are calling tells you to "Stand by," wait until they tell you they are ready to take your transmission. Speak slowly and clearly. Keep the transmissions brief. If it takes longer than thirty seconds, stop at that point and pause for a few seconds so emergency traffic can use the frequency if necessary. Use plain English. Avoid codes. Do not use phrases such as "be advised." These are implied and serve no purpose. Courtesy is assumed, so there is no need to say "Please," "Thank you," and "You're welcome." When transmitting a number that might be unclear (fifteen may sound like sixteen or fifty), give the number then repeat the individual digits. Say "Fifteen, one-five." Anything said over the radio can be heard by the public on a scanner. Do not use the patient's name over the radio. For the same reason, do not use profanities or statements that tend to slander any person. Use objective, impartial statements. Use "we" instead of "I." As an EMT, you will rarely be acting alone. "Affirmative" and "Negative" are preferred over "Yes" and "No" because the latter are difficult to hear. Give assessment information about your patient, but avoid offering a field diagnosis of the patient's problem. For example, say "Patient complains of abdominal pain" rather than "Patient probably has appendicitis." Avoid slang or abbreviations that are not authorized. Use EMS frequencies for only authorized EMS communication. The twelve parts of a radio medical report are: unit identification and level of provider, estimated time of arrival, patient's age and sex, chief complaint, brief, pertinent history of the present illness, major past illnesses, mental status, baseline vital signs, pertinent findings of the physical exam, emergency medical care given, response to emergency medical care, and contact made with medical direction if required or if you have questions.

Identify situations that would constitute a breach of patient confidentiality. (pp. 92-93)

Patient information should not be disclosed based on verbal permission, nor should information be disclosed over the telephone. To do so would be a breach of confidentiality.

Describe physical and physiological characteristics, including normal vital signs, for individuals in each of the following age groups: f. Early adult (pp. 182-183)

Peak physical condition occurs between 19 and 26 years of age, when all body systems are at optimal performance levels. At the end of this period, the body begins its slowing process. Typical vital signs for early adulthood are: an average of 70/minute for heart rate, 16-20/minute for respiratory rate, and 120/80 mmHg for blood pressure.

Give examples of the physical and personality traits that are desirable for EMTs. (pp. 9-10)

Physically you should be in good health and fit to carry out your duties. You should be able to lift and carry up to 125 pounds. You need coordination and dexterity as well as strength. Your eyesight is very important in performing your EMT duties. Make certain that you can clearly see distant objects as well as those close at hand. Be aware of any problems you may have with color vision. You should be able to give and receive oral and written instructions and communicate with the patient, bystanders, and other members of the EMS system. Eyesight, hearing, and speech are important to the EMT; thus, any significant problems must be corrected if you are going to be an EMT. You should be pleasant, sincere, cooperative, resourceful, a self-starter, emotionally stable, able to lead, neat and clean, of good moral character and respectful of others, in control of personal habits, controlled in conversation and able to communicate properly, able to listen to others, and nonjudgmental and fair.

Complete a prehospital care report in the format or formats required by your service. (pp. 422-429)

Prehospital care reports vary from system to system and state to state. Although the information that is required to complete each is relatively similar, the method used to record the data may be somewhat different. Many prehospital care reports are now done by direct data entry. This can take several forms. Laptops, tablets, and pen-based computers are commonly used. They allow the EMT to enter information about a call directly into the device. Receiving hospitals have data connections that allow for transfer of information. Many of these devices are web based. With this method, the EMT also has the option of signing on to a secure web site, using computers at the hospital and at the station to enter the data. With all of these methods, the EMT uses a printer at a receiving hospital to print out a hard copy of the report for the emergency department staff. Written reports are those that have portions with narrative areas, areas to record vital signs in written number form, and check boxes. These are used in some areas and will also serve as a backup should computer entry be unavailable. The term written is used in this context to describe both computer-based and handwritten reports.

Explain the purpose of quality improvement programs in EMS programs. (pp. 12-13)

Quality improvement, an important concept in EMS, consists of continuous self-review with the purpose of identifying aspects of the system that require improvement. Once a problem is identified, a plan is developed and implemented to prevent further occurrences of the same problem. As implied by the name, quality improvement is designed and performed to ensure that the public receives the highest quality prehospital care.

Describe ways in which you can minimize your impact on evidence while meeting your obligations to care for your patient. (pp. 95-96)

Remember what you touch and inform the police of what you moved in order to access and treat the patient. Minimize your impact on the scene. Do not tread over areas that are not necessary to explore. Avoid using the phone. Do not cut through bullet or knife holes in clothing. Cooperate with the police by giving them your statement and making notes of your observations and actions at the scene after taking care of the patient.

Describe physical and physiological characteristics, including normal vital signs, for individuals in each of the following age groups: h. Late adult (pp. 184-185)

Someone in late adulthood is often tachycardic, more likely to develop respiratory disorders, has decreased metabolism, exhibits disruptive sleep-wake cycles, and all his or her other body systems are deteriorating as time progresses. The individual's vital signs will depend on his or her physical and health condition.

Differentiate between scope of practice and standard of care. (p. 82)

The standard of care is usually defined as the care that would be expected to be provided by an EMT with similar training when caring for a patient in a similar situation; in general, scope of practice refers to what you should be able to do, while standard of care refers to what you should do in a particular situation and how you should do it.

Describe physical and physiological characteristics, including normal vital signs, for individuals in each of the following age groups: b. Toddler (pp. 178-179)

The toddler's body temperature ranges from 96.8 degrees fahrenheit to 99.6 degrees fahrenheit. She will gain approximately 2.0 kg (4.4 lb) per year. Her vital signs are 80-130/minute for heart rate, 20-30 breaths/minute, and 70-100 mmHg systolic blood pressure. Her terminal airways branch and grow, the alveoli increase in number, her brain is now 90% of an adult brain weight, fine-motor skills develop, muscle mass and bone density increase, the body becomes more susceptible to illness, an immunity to pathogens develops as exposure occurs and through vaccination, and by three years of age, all a toddler's primary teeth have come in. An infant is physiologically capable of being toilet trained by 12-15 months of age, but is not psychologically ready until 18-30 months.

Describe your scope of practice as an EMT. (pp. 81-82)

The EMT is governed by many medical, legal, and ethical guidelines. This collective set of regulations and ethical considerations may be referred to as a scope of practice, which defines the scope, or extent and limit, of an EMT's job. The skills and medical interventions the EMT may perform (what you do to help the patient) are defined by legislation, which varies from state to state. Sometimes different regions within the same state may have different rules and guidelines for their EMTs.

Understand legal issues and special situations associated with documentation. (pp. 430-437)

The Health Insurance Portability and Accountability Act (HIPAA) requires ambulance services that are covered by the law to take certain steps to safeguard patient confidentiality. This typically includes placing completed PCRs into a locked box. HIPAA, state, and local regulations will indicate to whom the information may be distributed. Obviously the receiving hospital must receive patient care information so they can treat the patient properly. Most reports have a copy that will be left at the hospital. Document all actions you take to persuade the patient to go to the hospital. In addition, you will have to make notes on the patient's competency, or his ability to make an informed, rational decision on his medical needs. If the patient is not capable of making this determination for any reason--including age, intoxication (alcohol and/or other drugs), mental competency, or as a result of the patient's medical condition--you must document any actions you take to protect the patient. The patient must be informed of the potential results of not going to the hospital or of refusing your care. Most EMS agencies have a refusal-of-care form to use in the event that you have done your best to persuade the patient to accept care or transport and the patient still refuses. This form may be part of either the prehospital care report or a separate document. You should make sure the patient reads and signs this form. If the patient refuses to sign a refusal form, get the witnesses to sign a statement confirming that the patient has refused care or transport. You should also include information about the patient refusal in the narrative section of the prehospital care report. Never be tempted to write down an extra set of vital signs when none were taken. Just don't do it! Document only the vital signs that were taken. If there is a reason you have taken only one set, document the reason. Any time there is incorrect information on the report, it must be corrected. If the paper report is still intact (all copies attached and not yet distributed), or if you are correcting the paper copy of a computer generated form, draw a single horizontal line through the error, initial it, then write the correct information beside it. Do not completely cross out the error or obliterate it. This may appear to be an attempt to cover up a mistake in patient care. If the error is discovered at a later date, after the report has been submitted, draw a single line through the error, mark the area with your initials and the data, and add the correct information to the end of the report or on a separate note. This should be done in a different color ink when possible so the change will be obvious. A patient in a multiple casualty incident (MCI) will probably be moved from one treatment area to another at the scene then receive transport to a hospital. Patients may be transported to several different hospitals. It is very important to keep the information with the patient as he moves through the system. This is often done through the use of a triage tag. Some examples of unusual situations that will require documentation on a form other than a prehospital care report include: exposure to infectious disease, injury to yourself or another EMT, hazardous or unsafe scenes to which other crews should be alerted, referrals to social service agencies for the elderly or other patients in need of home care, and mandatory reports for child or elderly abuse.

Describe the purpose of the National Registry of Emergency Medical Technician. (pp. 11-12)

The National Registry of Emergency Medical Technicians (NREMT), as part of its effort to establish and maintain national standards for EMTs, provides registration to EMRs, EMTs, AEMTs, and paramedics.

Explain the essential provisions of OSHA, the CDC, the Ryan White CARE Act, and the Ryan White HIV/AIDS Treatment Extension Act of 2009 as they relate to infection control in EMS. (pp. 36-39)

The Ryan White CARE Act Regarding Emergency Response Employees is a federal act which applies to all fifty states and mandates a procedure by which emergency response personnel can seek to find out if they have been exposed to potentially life-threatening diseases while providing patient care. The procedures for exposure follow-up by emergency response personnel denoted in the act remain in force under its most recent extension as the Ryan White HIV/AIDS Treatment Extension Act of 2009. Emergency response personnel referred to in this act include firefighters, law enforcement officers, EMTs, and other individuals who provide emergency aid on behalf of a legally recognized volunteer organization. The Ryan White CARE Act requires every state's public health officer to designate an official within every emergency response organization to act as a "designated officer." The designated officer is responsible for gathering facts surrounding possible emergency responder airborne or bloodborne infectious disease exposures. Under CDC guidelines, after contact with the blood or body fluids of a patient you have transported, you may submit a request for a determination to your designated officer. The designated officer must then gather information about the possible exposure. If the information indicates a possible exposure, the officer forwards the information to the medical facility where the patient is being treated. If the patient can be identified, medical records are reviewed to determine if the patient has a life-threatening disease. The medical facility then must notify your designated officer of their findings in writing within forty-eight hours after receiving the officer's request. The designated officer must notify you, and you will be directed by your employer to a health care professional for a postexposure evaluation and follow-up as appropriate.

Describe the importance of each of the National Highway Traffic Safety Administration standards for assessing EMS systems. (pp. 4-5)

The categories and standards set forth by NHTSA are: regulation and policy, resource management, human resources and training, transportation, facilities, communications, public information and education, medical direction, trauma systems, and evaluation. Each state EMS system must have in place enabling legislation (laws that allow the system to exist), a lead EMS agency, a funding mechanism, regulations, policies, and procedures. There must be centralized coordination of resources so that all victims of trauma or medical emergencies have equal access to basic emergency care and transport by certified personnel, in a licensed and equipped ambulance, to an appropriate facility. At a minimum, all those transporting prehospital personnel (those who ride the ambulances) should be trained to the EMT level using National EMS Education Standards that are taught by qualified instructors. Safe, reliable ambulance transportation is a critical component. Most patients can be effectively transported by ground ambulances. Other patients require rapid transportation, or transportation from remote areas, by helicopter or airplane. The seriously ill or injured patient must be delivered in a timely manner to the closest appropriate facility. There must be an effective communications system, beginning with the universal system access number (911), dispatch-to-ambulance, ambulance-to-ambulance, ambulance-to-hospital, and hospital-to-hospital communications. EMS personnel may participate in efforts to educate the public about their role in the system, their ability to access the system, and prevention of injuries. Each EMS system must have a physician as a Medical Director accountable for the activities of EMS personnel within that system. The Medical Director delegates medical practice to nonphysician providers (such as EMTs) and must be involved in all aspects of the patient-care system. In each state, enabling legislation must exist to develop a trauma system including one or more trauma centers, triage and transfer guidelines for trauma patients, rehabilitation programs, data collection, mandatory autopsies (examination of a body to determine cause of death), and means for managing and ensuring the quality of the system. Each state must have a program for evaluating and improving the effectiveness of the EMS system, known as a quality improvement (QI) program, a quality assurance (QA) program, or total quality management (TQM).

Explain the importance of asking for information to be repeated for confirmation and clarification. (p. 417)

The communication between you and medical direction must be clear and concise to avoid misinterpretations that can inadvertently harm the patient.

Define health habits that promote physical and mental well-being. (pp. 27-28)

The concepts of well-being aren't difficult if you start and maintain some healthful habits, such as: maintaining solid personal relationships, exercise, sleep, eating right, limiting alcohol and caffeine intake, and seeing your physician regularly and keeping up to date on vaccines.

Recognize medical identification devices and organ donor status. (pp. 93-95)

The device may be a necklace, bracelet, or card and may indicate a number of conditions including: heart conditions, allergies, diabetes, and epilepsy. An organ donor is a patient who has completed a legal document that allows for donation of organs and tissues in the event of his death.

Given a scenario, recognize a patient's or family member's reaction to death and dying. (pp. 45-46)

The five (sometimes overlapping) stages are: denial, anger, bargaining, depression, and acceptance. First, the patient might deny that he is dying, which puts off dealing with the inevitable end of the process. Then, the patient could become angry at his situation. This anger is commonly vented upon family members and EMS personnel. Afterwards, in the patient's mind, bargaining seems to postpone death, even for a short time. Later, the patient becomes sad, depressed, and despairing, often mourning things not accomplished and dreams that will not come true. He retreats into a world of his own and is unwilling to communicate with others. Finally, the patient may come to accept death, although he does not welcome it. Often the patient may come to accept the situation before family members do. At this stage, the family may need more support than the patient.

List indications of the potential for danger to yourself or others at the scene of an EMS call. (pp. 46-50)

There could be a hazmat incident, terrorist incident, rescue operations, or violence.

Describe the purpose of the tuberculin skin test (TST). (p. 40)

There is no immunization against tuberculosis but the tuberculin skin test (TST) can detect exposure. EMTs are often given this test during routine or employment screening physicals. If the test determines that you have been exposed to tuberculosis, seek treatment and follow-up from a doctor or other health care professional. EMS workers should be checked for exposure to TB on a regular basis (usually yearly).

Explain the role of the Federal Communications Commission as it relates to EMS system communication. (p. 414)

To maintain order on the airwaves, the Federal Communications Commission (FCC) assigns and licenses radio frequencies. This prevents two or more agencies from trying to use the same frequency and interfering with each other's communications. There are also strict rules about interfering with emergency radio traffic and prohibiting profanities and offensive language.

Given a scenario involving death or dying, use effective techniques for interacting with the patient and family members. (pp. 45-46)

Treat the patient with respect and do everything you can to preserve the patient's dignity and sense of control. For example, talk directly to the patient. Avoid talking about the patient to family members in the patient's presence as if the patient were incompetent or no longer living. Be sensitive to how the patient seems to want to handle the situation. For example, allow or encourage the patient to share feelings and needs, rather than cutting off such communications because of your own embarrassment or discomfort. Respect the patient's privacy if he does not want to communicate personal feelings. An EMT should be tolerant of angry reactions from the patient or family members, listen empathetically, restrain from providing false reassurance, and offer as much comfort as you realistically can.

List ways in which research may influence EMT practice. (pp. 15-22)

Two ways research impacts EMS are through a focus on improving patient outcomes and through evidence-based techniques. Although our concern may seem to be whether patients make it to the hospital alive, we must remember that EMS is part of a larger system. What we do also affects the patient's long-term survival. If something appears to help in the short term but has no effect in the long term, it is not useful. This research into long-term results (patient outcomes) allows us to make the best decisions for the patient's overall care. Evidence-based decision making means that the procedures and knowledge we use in determining what care works is based on scientific evidence.

Describe physical and physiological characteristics, including normal vital signs, for individuals in each of the following age groups: d. School age (pp. 180-181)

Typical vital signs for a school age individual are: 70-110/minute for heart rate, 20-30/minute for respiratory rate, and 80-120 mmHg systolic blood pressure. His or her body temperature is approximately 98.6 degrees fahrenheit and will gain 3 kg (6.6 lb) and grow 6 cm (2.4 in) per year. One of the most obvious changes during this time is the loss of primary teeth. Replacement with permanent teeth begins.

Demonstrate principles and techniques of effective verbal and nonverbal interpersonal communication. (pp. 418-419)

Use eye contact. Be aware of your position and body language. Use language the patient can understand. Be honest. Use the patient's proper name and/or title. Listen.

Given an example of a patient-care situation, determine the appropriate personal protective equipment to prevent exposure to infectious disease. (pp. 28-34)

Vinyl or other nonlatex gloves should be used whenever there is the potential for contact with blood and other body fluids. In cases where there will be blood or fluid spatter, wear a surgical-type mask. In cases where tuberculosis (a disease that is carried by fine particles in the air) is suspected, an N-95 or a high-efficiency particulate air (HEPA) respirator approved by the National Institute for Occupational Safety and Health (NIOSH) is the standard. Face shields offer protection of the entire face by use of a mask with an attached see-through shield that covers the eyes. In some jurisdictions, a surgical-type mask may be placed on the patient if he is alert and cooperative and suspected of having an infection spread by droplets (such as flu or measles).

Describe proper procedures for hand washing and using alcohol-based hand cleaners. (p. 31)

When soap and water are available, vigorous hand washing is recommended. Wash your hands after each patient contact (even if you were wearing gloves) and whenever they become visibly soiled. Alcohol-based cleaners are considered effective by the Centers for Disease Control (CDC)--except when hands are visibly soiled or when anthrax is present--and are often available when soap and water are not. The alcohol helps kill microorganisms. Place the amount of hand cleaner recommended by the manufacturer in one palm and rub it so it covers your hands. Rub until dry.

Given a variety of scenarios, determine which type of patient consent applies. (pp. 82-83)

With expressed consent, the consent is given by adults who are of legal age and mentally competent to make a rational decision in regard to their medical well-being and it must be obtained from all patients who are physically and mentally able to give it. Expressed consent must be informed consent. That is, patients must understand the risks associated with the care they will receive. With implied consent, the patient is unconscious but the law allows EMTs and other health care providers to provide treatment, at least until the patient becomes conscious and able to make rational decisions. Children and mentally incompetent adults are not legally allowed to provide consent or refuse medical care and transportation. The parents and guardians of these patients have the legal authority to give consent, so it must be obtained before care can be given. There are times, however, when care may be given without this direct consent from a parent or guardian. One situation where care may be given without direct consent from a parent or guardian is a child care provider of school authority who may act in loco parentis (in place of a parent) when the parents are not physically present. Parents may provide written documentation to these individuals allowing them to act in their absence. In cases of life-threatening illness or injury when a parent or guardian is not present, care may be given based on implied consent.

Outline proper responses to incidents including: d. Violence (pp. 48-50)

Your first priority--even before patient care--is to be certain that the scene is safe. If the dispatcher knows that violence is or potentially may be present, he will advise you not to approach the scene until it is safe. The dispatcher may name a certain location where you should wait, or stage, a location that is far enough from the scene to be safe but near enough that you can respond as soon as the scene has been secured. Wear safe clothing. Prepare your equipment so it is not cumbersome. Carry a portable radio whenever possible. Decide on safety roles. Observe for violence, crime scenes, alcohol or drug use, weapons, family members, bystanders, perpetrators, and pets. Crime scenes should not be disturbed. Alcohol or drug use could cause people to behave unpredictably, and any of the bystanders, perpetrators, pets, or family members at the scene could turn violent towards you. You can react to danger by retreating, radioing for police assistance and to warn others of danger, then reevaluating (you should only reenter the scene after police have secured the area, but until they arrive maintain a level of alert observation). Retreating may involve fleeing, getting rid of any cumbersome equipment, and taking cover and concealing yourself.