EMT Operations

While en route back to your station from the emergency department, you discover that you forgot to include vital patient information on the front of your patient care report (PCR). Having left a copy of your PCR with the emergency department staff, you should: A: include the information on an addendum and furnish it to the hospital. B: do nothing, since you already left a copy of the PCR at the hospital. C: document the information on the front of your original PCR. D: notify the emergency department staff and advise them of your error.

A: include the information on an addendum and furnish it to the hospital. Reason: Once you leave a copy of your patient care report (PCR) with the hospital staff, you should not add information to the front of the report. If you discover that you forgot to include vital patient information, you should document the information on a separate addendum and furnish it to the emergency department, which can be sent by fax. The copy of your PCR you leave at the hospital and the original PCR should contain the same information; adding information to the front of the PCR after leaving a copy at the hospital makes the copy and original two separate documents.

While triaging patients at a mass-casualty incident, you encounter a responsive middle-aged female with a respiratory rate of 26 breaths/min. What should you do next? A: Administer high-flow oxygen at once B: Triage her as immediate (red tag) C: Assess her ability to follow commands D: Assess for bilateral radial pulses

D: Assess for bilateral radial pulses Reason: According to the Simple Triage And Rapid Treatment (START) method, if you encounter an adult patient with a respiratory rate that is less than 10 breaths/min or greater than 29 breaths/min, you should triage him or her as immediate (red tag) and move to the next patient. However, if the patient's respiratory rate is between 10 and 29 breaths/min, you should assess his or her hemodynamic status by checking for bilateral radial pulses. If the patient's radial pulses are absent, triage him or her as immediate and move to the next patient. If the patient's radial pulses are present, assess his or her ability to follow simple commands. If the patient is able to follow simple commands, triage him or her as delayed (yellow tag) and move to the next patient. If the patient is unable to follow simple commands, triage him or her as immediate and move to the next patient. Treatment does not occur during the initial triage process.

Which of the following situations would necessitate treatment using implied consent? A: A 65-year-old man who is confused and suspected of having a severe stroke B: A 25-year-old man who is restless and has severe chest pain and diaphoresis C: A 17-year-old pregnant woman with an isolated extremity injury D: An 18-year-old man who is now fully alert after receiving oral glucose

A: A 65-year-old man who is confused and suspected of having a severe stroke Reason: A patient may be treated under the law of implied consent, also called the emergency doctrine, any time he or she is unresponsive or otherwise lacks decision-making capacity (ie, confused, under the influence of drugs or alcohol). In cases such as these, the EMT should assume that the patient would consent to treatment and transport if he or she were able to make an informed decision. Examples of such patients include those who are intoxicated or who otherwise have an altered mental status (ie, stroke, hypoglycemia). Patients younger than 18 years of age may also be treated under the law of implied consent, unless the patient is female and is emancipated or pregnant.

In most states, the EMT is required to report which of the following occurrences? A: Animal bite B: Drug overdose C: Motor vehicle crash D: Injury to a minor

A: Animal bite Reason: Although each state may have slightly differing reporting laws, most require the EMT to report cases such as child or elderly abuse, sexual assault, animal bites, and injury that occurs during the commission of a crime. Injury to a minor is typically not a reportable case unless abuse is suspected. Motor vehicle crashes and drug overdoses are not reportable cases either, unless they occur during the commission of a crime.

When is it MOST appropriate to complete your patient care report for a critically ill or injured patient? A: As soon as all patient care activities are completed B: After the ambulance has been restocked at the station C: Promptly after the primary assessment D: Any time before you arrive at the hospital

A: As soon as all patient care activities are completed Reason: Patient care activities, especially when the patient's condition is critical, take priority over the completion of your patient care report (PCR). Once all patient care activities have been completed, you can complete the PCR. This is usually accomplished at the hospital or immediately upon returning to quarters.

Who has ultimate authority for all issues regarding patient care at the scene of a mass-casualty incident? A: EMS medical director B: Most experienced EMT C: Treatment officer D: Incident commander

A: EMS medical director Reason: The incident commander (IC) is responsible for all logistical and operational aspects of a mass-casualty incident (MCI), such as designating section officers and working in conjunction with other agencies (eg, police, fire, EMS). For all issues regarding patient care, the EMS medical director has ultimate authority. Although the treatment officer is responsible for overseeing all emergency care provided at the scene, and EMTs working in the treatment area are providing direct patient care, these personnel are still functioning under the physician's license. During an MCI, the IC (or his or her designee) is typically in contact with the medical director, who is located at the base station hospital, via mobile phone or two-way radio. In some cases, the medical director may be physically present at the incident.

In which of the following situations is an emergency move of a patient from his or her wrecked vehicle clearly indicated? A: Gas is leaking from the vehicle and there is a small fire in the engine compartment. B: The patient has an altered mental status; diaphoresis; and rapid, shallow breathing. C: Your primary assessment reveals that the patient has signs and symptoms of shock. D: The patient appears unresponsive and a high-power line is lying across the hood.

A: Gas is leaking from the vehicle and there is a small fire in the engine compartment. Reason: An emergency move is indicated if you or the patient's life is in immediate danger. Gas leaking from the vehicle and a fire in the engine compartment are clear indicators that you and the patient's lives are in imminent danger. An emergency move involves grabbing the patient by the clothing, protecting his or her spine as much as possible, and dragging him or her from the vehicle to a safe place. The rapid extrication technique, which involves manually stabilizing the patient's head, applying a cervical collar, and removing the patient from the vehicle onto a long backboard, is indicated if the patient's condition is unstable and/or he or she is in need of treatment that requires a supine position. Never approach or touch a vehicle that is in contact with a high-power line; have the power company cut the power to the line first and then remove the patient from the vehicle.

Which of the following vaccinations is NOT currently recommended by the Centers for Disease Control and Prevention (CDC)? A: Smallpox B: Tetanus, diphtheria, and pertussis C: Hepatitis B D: Measles, mumps, rubella

A: Smallpox Reason: Immunization requirements are usually set by the state department of health, but generally follow recommendations made by the Centers for Disease Control and Prevention (CDC). Recommended immunizations for health care providers include tetanus, diphtheria, and pertussis (Tdap, DTaP) boosters (every 10 years); measles, mumps, rubella (MMR) booster; influenza vaccine (yearly); and hepatitis B vaccine (single or three-shot series). Smallpox vaccinations ceased in 1972 after the World Health Organization (WHO) officially declared the disease eradicated.

You are called to treat a 55-year-old man who is experiencing difficulty breathing. After making contact with your patient, he extends his arm out to allow you to take his blood pressure. This is an example of: A: actual consent. B: formal consent. C: implied consent. D: informed consent.

A: actual consent. Reason: Actual consent, also referred to as expressed consent, is when the patient asks for your help outright. This may also include nonverbal gestures, such as extending the arm to you to allow you to take the blood pressure. Informed consent involves explaining your proposed treatment to the patient, including the potential benefits and risks of the treatment. Implied consent involves treating an unresponsive patient or minor child (when the parents are not present) based on the assumption that the patient (or the parents of a minor) would consent to emergency treatment.

You arrive at the scene of an 80-year-old woman who is weak and lightheaded. Her son, who called 911, is present and asks you to transport his mother to the hospital. You should: A: assess the woman and determine if she wishes to be treated and transported. B: comply with the son's request and transport the woman to the hospital. C: advise the son that he can probably drive his mother to the hospital. D: take the woman's vital signs and apply supplemental oxygen if necessary.

A: assess the woman and determine if she wishes to be treated and transported. Reason: You must obtain consent from any mentally competent adult patient prior to initiating treatment. Just because the patient is 80 years old does not mean that she does not have decision-making capacity. And just because her son wants her to be transported does not mean that she does. Ask her if she wishes to be treated and transported to the hospital. If she does, then you have obtained consent and should proceed accordingly. If she does not, you should determine if she has decision-making capacity; that is, whether or not she is mentally competent. If she is determined to have decision-making capacity, then you cannot legally treat or transport her. If she does not have decision-making capacity (eg, she is confused, under the influence of drugs or alcohol), then you may treat and transport under the law of implied consent. It is not the EMT's decision to determine, let alone recommend, that a patient be taken to the hospital via privately owned vehicle (POV). If the patient requests EMS treatment and transport, you are legally obligated to do so.

While you are inside a crashed vehicle assessing a patient who is entrapped, the rescue team should be: A: assessing exactly how the patient is trapped and determining the safest way to extricate. B: awaiting specific instructions from you as to how to proceed with the extrication process. C: actively extricating the patient using whichever extrication method they deem necessary. D: preparing for a simple extrication process since you were obviously able to access the patient.

A: assessing exactly how the patient is trapped and determining the safest way to extricate. Reason: Your ability to access the patient, with or without difficulty, does not indicate the extent of entrapment or method of extrication. The EMT's job is to assess and treat the patient; the rescue team's job is to determine the degree of entrapment and decide how to extricate. As you are assessing the patient, providing any care that you can within the confines of the vehicle, the rescue team should be assessing the vehicle and the degree of patient entrapment; this will enable them to determine the safest, most effective extrication approach. It is critical for the EMT in the vehicle and the rescue team outside the vehicle to constantly communicate. Once the patient has been assessed and provided any immediate life-saving care, and the rescue team has determined the best extrication approach, extrication can begin.

Upon arriving at the scene of a crash involving a large truck, you immediately note the presence of an orange placard on the side of the tank that the truck is pulling. This indicates that the vehicle is carrying a/an ______________ agent. A: explosive B: corrosive C: radioactive D: flammable

A: explosive Reason: The color of a warning placard indicates the general classification of agent being carried, while the United Nations (UN) number in the center of the placard indicates the exact agent being carried. For example, a red placard bearing the UN number 1203 indicates gasoline; red indicates the classification (flammable), and 1203 indicates the exact agent (gasoline). Orange placards indicate explosive or blasting agents, placards that are half yellow and half white indicate radioactive agents, and black placards indicate corrosive agents. Use your emergency response guidebook (and binoculars, if appropriate) to identify both the classification and exact agent involved. Black corrodes think sin, red is burning hot like fire, orange is what you see at demo places, half yellow and half white stay away. That's radio active

While caring for a trauma patient, blood splashes into an EMT's eyes. This is an example of: A: exposure. B: indirect contact. C: transmission. D: infection.

A: exposure. Reason: Exposure occurs when an individual comes in direct contact with blood or other bodily fluids. Examples of direct exposure include blood splashing into the eyes or mouth and an accidental stick with a contaminated needle or other sharp object. Exposure does not always result in disease transmission and subsequent infection; that depends on whether the patient has an infectious disease. Routine use of standard precautions will afford the EMT the best protection from exposure to an infectious disease.

The information that would be of LEAST pertinence when educating the public on injury prevention is: A: how to provide rescue breathing. B: teaching children to wear bicycle helmets. C: building a childproof fence around a pool. D: the proper usage of child safety seats.

A: how to provide rescue breathing. Reason: The goal of an injury prevention program is just that, prevention. If rescue breathing is needed in a situation, the injury has already occurred. As EMS providers, we are consequence managers. Additionally, we have a responsibility to educate the public on how to avoid injuries in the first place.

As an EMT, your primary responsibility is to: A: keep yourself as safe as possible. B: provide competent patient care. C: transport all patients to the hospital. D: ensure the safety of your partner

A: keep yourself as safe as possible. Reason: As an EMT, your primary responsibility is to yourself. An injured or dead EMT is of no use to a patient. After ensuring the safety of yourself, your crew, and any bystanders, patient care should be initiated.

While caring for an emotionally disturbed 30-year-old male, he suddenly becomes violent and needs to be physically restrained. During the restraint procedure, you should: A: maintain communication with him and closely monitor his airway. B: approach the patient from the front and converge on him quickly. C: place him in a prone position and secure straps across his back. D: ensure that at least three people are available to safely restrain him.

A: maintain communication with him and closely monitor his airway. Reason: Physical restraint may be necessary if a patient is a threat to him- or herself or others. If it becomes necessary to physically restrain a violent patient, there are certain, specific guidelines that must be followed. Use a minimum of four people to restrain the patient, one assigned to each extremity. Approach the patient from the front and the sides; this will prevent him or her from getting away from you. Somebody, preferably you or your partner, should talk to the patient throughout the restraint process, even if the patient is not listening to you. Never restrain a patient facedown (prone); it is impossible to adequately monitor the patient and this position may inhibit the breathing of an impaired or exhausted patient (positional asphyxia). Use just enough force to effectively restrain the patient; the patient's gender, body size, strength, and mental status can be used to determine the appropriate amount of force. Reassess airway and breathing continuously, regardless of the patient's position, and continue to talk to him or her during transport.

You arrive at the scene where a man fell approximately 40 feet and landed on his head. He is unresponsive, has agonal gasps, and a weak carotid pulse. Further assessment reveals an open head injury with exposed brain matter. Upon identifying this patient as an organ donor, you should: A: manage the patient aggressively and provide rapid transport. B: recognize that the patient's injuries disqualify him as an organ donor. C: request authorization from medical control not to initiate care. D: provide rapid transport only because the patient likely will not survive.

A: manage the patient aggressively and provide rapid transport. Reason: It is unlikely that the patient will survive his injury; however, he is still breathing, albeit very poorly, and has a weak carotid pulse. Therefore, you should begin immediate and aggressive treatment and transport him promptly, just as you would for any other critically injured patient. It would clearly be inappropriate to request authorization to provide no care at all. If it is determined by a physician that he will not survive his injury, his organs can potentially be harvested and save several lives.

The role of triage officer at a mass-casualty incident should be assumed by the: A: most knowledgeable EMS provider. B: first EMS provider who is willing to perform the task. C: EMS medical director via telephone communication. D: EMS provider with the most years in EMS.

A: most knowledgeable EMS provider. Reason: The role of triage officer should be assumed by the most knowledgeable EMS provider at the scene. Knowledge and experience will enable this person to most effectively manage the triage process. Just because a person has been in the EMS profession for a long period of time does not mean that he or she has been active or has maintained clinical competence.

While caring for an injured patient, you remove blood-soaked clothing in order to treat his injuries. You should dispose of the clothing by: A: placing it in a biohazard bag. B: leaving it at the scene. C: leaving it at the hospital. D: placing it in a regular trash can.

A: placing it in a biohazard bag. Reason: The appropriate method for disposing of soiled clothing or any other "nonsharp" contaminated item is to place it in a red biohazard bag. The biohazard insignia as well as the red color alerts others that the items within the bag are contaminated.

Upon arriving at the scene of an overturned tanker truck, you see a clear liquid leaking from the rear of the tank. The driver is still in the vehicle and you can see that his face is covered with blood. You should: A: request fire department assistance if they are not already en route. B: ensure that the ambulance is downwind and downhill from the tanker. C: approach the rear of the tanker to identify the type of fluid leaking. D: put on gloves, a gown, and a mask and quickly remove the driver.

A: request fire department assistance if they are not already en route. Reason: Upon determining that you are dealing with a potential hazardous materials incident, you should immediately request specially trained personnel (eg, fire department, Haz-Mat team) if they are not already en route to the scene. Do not approach a vehicle that may be leaking a hazardous material, even if the patient is still in the vehicle, or you may become a casualty as well. Most ambulances are not equipped with the personal protective equipment required for hazardous materials. Park your ambulance in a location that is both upwind and uphill from the incident. Until additional personnel arrive, try to identify the material being carried by reading the United Nations (UN) number on the safety placard affixed to the tanker; however, this should be done from a safe distance and with the use of binoculars.

You receive a call at 3:00 a.m. for a patient who is slumped over the steering wheel of his car, which is parked on the shoulder of the road. Your unit and a police officer arrive at the scene at the same time. You should: A: stay in your unit until the police officer checks the patient. B: park the ambulance 25 feet in front of the patient's vehicle. C: approach the vehicle from the front to ensure maximum visibility. D: shine a spotlight in the side view mirror of the patient's vehicle.

A: stay in your unit until the police officer checks the patient. Reason: Unfortunately, it is not uncommon for people to fake illness or injury with the intent of harming responding personnel. In this situation, you should utilize the safety resource at the scene: the police officer. You and your partner should stay in the unit until the police officer checks the patient to ensure it is safe for you to approach. Remember, the safety of you and your partner comes first!

As you step out of the ambulance at the scene of a nighttime motor vehicle crash on the highway, your MOST immediate concern should be: A: the presence of oncoming traffic. B: rapid assessment of all injured patients. C: whether the car will catch on fire. D: placing safety flares by the ambulance.

A: the presence of oncoming traffic. Reason: Nighttime traffic crashes, especially those that occur on a highway, pose a significant risk to the safety of the EMT. Therefore, immediately upon exiting the ambulance, the concern for oncoming traffic should be at the front of the EMT's mind. Drivers can be blinded by all of the emergency lighting and ¬ inadvertently veer off of the road and strike the rescuer. Safety flares are used less commonly than in the past; they have been known to blow off the road and start grass fires or ignite gasoline leaking from a vehicle. Reflective cones or triangles are safer and are used more often than flares. After ensuring your own safety, which includes notifying the fire department if the vehicle is leaking gas, you should then proceed to the patients.

Which of the following situations is an example of abandonment? A: An EMT transfers care of a patient to a paramedic. B: A paramedic transfers care to an advanced EMT. C: An EMT departs the scene after a paramedic arrives. D: An EMT gives a verbal report to an emergency nurse.

B: A paramedic transfers care to an advanced EMT. Reason: Abandonment occurs any time you disengage from a patient while he or she still requires care or you relinquish your responsibility of patient care to a provider of lesser training. If a paramedic transfers patient care to an advanced EMT (AEMT)—clearly a provider with a lower level of training—then the paramedic has abandoned his or her patient. When delivering a patient to the emergency department, you must give your verbal report to a registered nurse or a physician.

Following a call in which a 6-week-old infant in cardiac arrest did not survive, your partner is exhibiting significant anxiety and irritability. How can you MOST effectively help him? A: Report his behavior to the medical director. B: Allow him to voice his feelings to you. C: Recommend at least 12 hours of sleep. D: Tell him that he needs psychiatric help.

B: Allow him to voice his feelings to you. Reason: Your partner is clearly having difficulty coming to terms with this call's bad outcome. As his partner, you can be most effective during this time by simply listening and allowing him to voice his feelings. Bad feelings should never be kept bottled up. If your partner is still having difficulties, a formal critical incident stress debriefing (CISD) may be needed. Some EMS providers may require psychiatric or psychologic assistance; however, this is not a determination that you can make. At least 8 hours of sleep is healthy; however, in the face of a crisis, sleep does not make the problem go away.

Which of the following statements regarding the use of an escort vehicle when en route to an emergency call is correct? A: An escort vehicle will allow you to arrive at the scene quicker. B: An escort vehicle should be used only if you are unfamiliar with the patient's location. C: With an escort vehicle, the risk of an accident at an intersection is reduced significantly. D: To avoid getting separated from the escort vehicle, you should closely follow it.

B: An escort vehicle should be used only if you are unfamiliar with the patient's location. Reason: Generally, escort vehicles should not be used when responding to an emergency scene. The biggest danger of using an escort occurs at intersections, which is where most ambulance crashes occur. Drivers may yield to the escort vehicle, but may not be prepared for a second vehicle following the escort (wake effect collision). The only time that an escort may be required is when you are unfamiliar with the location of the patient and need assistance getting there. If an escort must be used, you must follow at a safe distance of at least 500 feet.

Which of the following creates a secure loop at the working end of a rope, which can be used to attach the end of the rope to a fixed object or a piece of equipment? A: Figure eight knot B: Figure eight on a bite C: Half hitch D: Clove hitch

B: Figure eight on a bite Reason: Although EMTs infrequently perform special rescue operations (ie, urban search and rescue [USAR]), they should have a basic working knowledge of the different ropes and knots used for rescue purposes. The figure eight on a bite knot creates a secure loop at the working end of the rope, the part of the rope used for forming the knot. This loop can be used to attach the end of the rope to a fixed object or a piece of equipment, or to tie a life safety rope around a person. The loop may be of any size, from an inch to several feet in diameter. The figure eight is a basic knot used to produce a family of other knots, including the figure eight on a bite and the figure eight with a follow-through. A simple figure eight knot is seldom used. The half hitch is not a secure knot by itself, which is why it is used in conjunction with other knots. The clove hitch is used to attach a rope firmly to a round object, such as a tree or fencepost.

You are dispatched to a call for an unresponsive patient. Which of the following is the MOST important information that you should initially obtain from the dispatcher? A: Whether or not the patient is breathing B: The exact location of the patient C: The call back number of the caller D: The patient's sex and approximate age

B: The exact location of the patient Reason: You should attempt to obtain as much patient information from the dispatcher as you can. However, in order to help the patient, you must know his or her location; therefore, this is the most important initial question to ask. Once you determine where the patient is, you should then try to ascertain the sex and approximate age of the patient, whether or not he or she is breathing, and any other information that can help you prepare to provide care. The caller's phone number is generally not disclosed to the responding EMTs, although this is important information for the dispatcher to obtain. In many dispatch systems, the caller's phone number (and location in some cases) automatically appears on the computer screen when the 911 call is answered.

Which of the following practices will provide you with the highest degree of safety when responding to an emergency call? A: Routinely using the lights and siren B: Wearing your seatbelt and shoulder harness C: Asking the police to escort you to the scene D: Always requesting fire department assistance

B: Wearing your seatbelt and shoulder harness Reason: Consistent safety practices, such as wearing your seatbelt and shoulder harness, driving with due regard for others, and avoiding excessive speed, will afford you the highest degree of safety when responding to an emergency call. Unless used to guide you to an area you are unfamiliar with, escort vehicles should be avoided. Escort vehicles are especially dangerous at intersections; as the escort vehicle proceeds through the intersection, other motorists often do not expect a second emergency vehicle to follow. As a result, they may pull out into the intersection, thinking it is clear, and collide with your ambulance (wake effect collision). The use of lights and siren increases the danger factor, especially if used in conjunction with excessive speed. Lights and siren ask for, not demand, the courtesy of the right of way.

While treating a patient in cardiac arrest, you turn the AED on and attach the pads to the patient. However, when the AED begins to analyze the patient's cardiac rhythm, it signals "low battery" and then shuts off. The patient subsequently died. Which of the following statements regarding this scenario is MOST correct? A: The manufacturer of the AED will be held liable for negligence. B: You and your partner may be held liable for negligence. C: The crew that preceded you may be held liable for negligence. D: Most errors associated with the AED involve equipment failure.

B: You and your partner may be held liable for negligence. Reason: The most common errors that occur with the AED are the result of operator error (not equipment failure), usually because no one made sure that the batteries were fully charged when checking the ambulance at the start of the shift. Because the patient died, you and your partner could be held liable for negligence. Remember, the entire ambulance must be checked by the oncoming shift to ensure that all equipment is functional and that all supplies are present. Even though the preceding crew is morally responsible for not replacing the batteries, the legal ramifications will rest on you and your partner's shoulders.

At the scene of a mass-casualty incident, you notice a bystander who is emotionally upset. An appropriate action to take would be to: A: tell the bystander to leave the scene at once. B: assign the bystander a simple, non-patient-care task. C: notify the police and have the bystander removed. D: have the bystander assist you with patient care.

B: assign the bystander a simple, non-patient-care task. Reason: One of the most effective ways to reduce stress in a bystander at the scene of a mass-casualty incident is to assign the bystander a task that is not related to patient care. This may involve assisting other bystanders who are having difficulties as well or providing water to the rescuers. An obviously distressed bystander should not simply be sent away from the scene, but should be looked at as a patient as well. Clearly, if the bystander becomes aggressive or violent, law enforcement personnel should get involved.

Failure of the EMT to obtain consent from a responsive patient before taking his or her blood pressure may constitute: A: abandonment. B: battery. C: negligence. D: assault.

B: battery. Reason: Battery is defined as unlawfully touching another person without his or her consent. Obtaining consent from every responsive patient prior to rendering care is of paramount importance. Assault is defined as instilling fear into another person, but does not involve actually touching him or her. Negligence occurs when the EMT fails to act as another prudent EMT would have acted in the same or similar situation. Abandonment occurs when the EMT terminates patient care without the patient's consent or transfers care of a patient to a provider of lesser training.

Your partner, a veteran EMT of 20 years, has been showing up late to work with increasing frequency over the last several shifts. When he arrives, he is in a bad mood and is clearly not interested in being at work. His behavior is MOST consistent with: A: acute stress. B: burnout. C: drug use. D: delirium.

B: burnout. Reason: Your partner's behavior is consistent with burnout. Burnout is a condition of chronic fatigue, irritability, and frustration that results from mounting stress over time. Although burnout typically manifests after years of service in EMS, some EMTs begin to experience it in a very short period of time, especially if they work in EMS systems with a high call volume and low morale. Some people with burnout abuse drugs or alcohol; if you suspect this, you should report it to your supervisor immediately. The best way to prevent burnout is to recognize the signs of stress and take action to reduce it. An acute stress reaction occurs in response to a sudden, unexpected event; it is clear that your partner has had many stressful events over his career. Delirium is an acute change in cognitive ability; it commonly results from conditions such as hypoxia, hypoglycemia, and drug toxicity.

A 70-year-old man with a history of emphysema and congestive heart failure is in cardiac arrest. His wife tells you that he collapsed about 5 minutes before your arrival. Your partner begins one-rescuer CPR as you prepare the AED. As you are applying the AED pads, the man's wife tells you that she wants you to let him die in peace. You should: A: cease resuscitation only if the AED does not indicate a shock. B: continue performing CPR and ask her if he has a living will. C: perform rescue breathing only and contact medical control. D: comply with her request and cease all resuscitative efforts.

B: continue performing CPR and ask her if he has a living will. Reason: When faced with a situation in which a family member does not wish for you to attempt resuscitation of a loved one, you should inquire about the presence of a living will or out-of-hospital do not attempt resuscitation (OOH-DNAR) order. If a valid living will or OOH-DNAR order is produced, it is generally acceptable to cease resuscitative efforts; consult medical control as needed. If a valid living will or OOH-DNAR order is not available, the most prudent action would be to continue CPR and contact medical control. Even in the absence of such documentation, medical control may advise you to cease resuscitation based on the wishes of the family and the patient's medical history. When in doubt, err on the side of the patient and attempt resuscitation. Few would argue that it is preferable to defend why resuscitation was attempted as opposed to why it was not.

The ultimate goal of any EMS quality improvement program is to: A: provide protocols to all EMTs and hold them accountable if protocols are not followed. B: deliver a consistently high standard of care to all patients who are encountered. C: recognize all EMTs who demonstrate consistency in providing competent patient care. D: ensure that all personnel receive an adequate number of continuing education hours.

B: deliver a consistently high standard of care to all patients who are encountered. Reason: Providing continuing education to all personnel, recognizing those who consistently provide competent patient care, and holding all personnel accountable for adhering to the EMS protocols are all components of any EMS quality improvement program. The ultimate goal, however, is to provide, as a system, a consistently high standard of care to all patients who are encountered.

You and your partner have secured a trauma patient to a long backboard and are preparing to lift the backboard onto the stretcher. When doing so, you should: A: recall that most of the patient's weight is at the foot end of the backboard. B: ensure that the strongest EMT is positioned at the head of the backboard. C: lift the backboard from the sides instead of from the ends. D: be sure to lift the backboard with the powerful muscles of your back.

B: ensure that the strongest EMT is positioned at the head of the backboard. Reason: Since more than half of the patient's weight is distributed to the head end of a backboard, you should always ensure that the strongest EMT is at that position. This will reduce the risk of injury to less strong personnel as well as the risk of dropping the patient. The backboard should be lifted from the ends, not the sides; you have less control over the board if it is lifted from the sides. When lifting any patient, you should use the powerful muscles of your thighs, not your back, to lift. Keep your back straight and in a locked-in position.

When sizing up a motor-vehicle crash in which a small passenger car struck a bridge pillar and sustained severe damage, you should: A: immediately approach the vehicle and determine if it is stable. B: ensure that there are no hazards and then try to open one of the doors. C: disconnect the battery cables and then request heavy extrication tools. D: break the driver's side window and gain rapid access to the patient.

B: ensure that there are no hazards and then try to open one of the doors. Reason: After ensuring your own safety, you should attempt simple access to the patient, trying to get to him or her as simply and quickly as possible without using any tools or breaking any glass. It may be necessary to use tools or other forcible entry methods, some of which may require specialized extrication equipment (eg, Jaws of Life). Many times, however, the patient can be accessed simply by opening a door, even if the door is badly damaged. If the door is locked and the patient is responsive, ask him or her to unlock the door. Stabilizing the vehicle (eg, placing shoring blocks under the car) and disconnecting the car's battery cables are typical functions of the fire department.

When using the power lift to lift a stretcher, you should: A: place your hands palms down on the stretcher. B: ensure that you lift with your palms facing up. C: maintain a slight inward curve to your back. D: bend at the waist and keep your back straight.

B: ensure that you lift with your palms facing up. Reason: In order to achieve the best grip and to avoid injury to your wrists, you should lift a stretcher, backboard, or other carrying device with your palms facing up. Do not bend at the waist; bend at the knees and keep your back in a straight, locked-in position.

The immobilization device MOST appropriate to use for a patient with multiple injuries and unstable vital signs is the: A: short spine board immobilization device. B: long spine board immobilization device. C: vest-style immobilization device. D: scoop immobilization device.

B: long spine board immobilization device. Reason: When caring for a critically injured patient with multiple injuries, the patient's entire body should be immobilized. This is most quickly and effectively accomplished using a long spine board. Vest-style devices or short spine boards take too long to apply and will not provide full body immobilization. The scoop (orthopaedic) stretcher is effective for maneuvering patients in narrow spaces but will not allow for full spinal immobilization because of the vertical opening down the center of the device.

You arrive at the scene of a young male who was stabbed when a burglar broke into his house. Law enforcement officers are present. The patient, who is unresponsive with several stab wounds to the chest, is lying in a narrow space between a couch and coffee table. You should: A: move the coffee table, document what you did, and begin treatment. B: move the coffee table, begin patient care, and notify a police officer. C: obtain permission from law enforcement before moving any furniture. D: treat the patient where he is, without moving the coffee table.

B: move the coffee table, begin patient care, and notify a police officer. Reason: After ensuring your own safety, your primary responsibility when functioning at a crime scene is to provide patient care. Optimally, you should help preserve the scene at the same time. In this situation, however, the patient requires immediate treatment; he is unresponsive and has life-threatening injuries. It would be difficult to provide effective care in his present position, and notifying law enforcement before you move any furniture would unnecessarily delay care. Therefore, you should move the coffee table out of the way and begin treatment. When possible, notify a law enforcement officer of what you moved, where you moved it to, and why you moved it. You should also document this on the patient care report, AFTER you have cared for the patient.

A 52-year-old woman crashed her minivan into a tree. She is pinned at the legs by the steering wheel and is semiconscious. After gaining access to the patient, you should: A: have the fire department disentangle the patient and quickly remove her from the car. B: perform a primary assessment and provide any life-saving care before extrication. C: immediately apply high-flow oxygen to the patient and allow extrication to begin. D: rapidly assess her from head to toe, obtain vital signs, and apply a cervical collar.

B: perform a primary assessment and provide any life-saving care before extrication. Reason: Unless there is an immediate threat of fire, explosion, or other danger, you should perform a primary assessment and begin any live-saving care as soon as you have gained access to the patient. If you wait to do this until after the patient has been disentangled, it may be too late; the patient may already be dead. After you have assessed the patient and treated any immediate threats to life, allow extrication to commence. Once the patient has been freed from the vehicle, continue any life-saving care and perform a rapid head-to-toe assessment to identify and treat other life-threatening injuries. Another EMT can obtain vital signs as you rapidly assess the patient. Prepare for immediate transport after the rapid head-to-toe assessment has been performed and the appropriate spinal precautions have been taken.

You are called to transport a patient with terminal lung cancer from a skilled nursing facility to the emergency department for evaluation of possible pneumonia. As you are reviewing the transfer paperwork, you see that the patient has a valid "do not attempt resuscitation" order. During transport, you should: A: perform CPR for only 2 minutes if the patient develops cardiac arrest. B: provide supportive care, such as oxygen, and keep the patient comfortable. C: monitor the patient because a DNAR order prohibits you from providing care. D: disregard the DNAR order because it is only valid in the hospital setting.

B: provide supportive care, such as oxygen, and keep the patient comfortable. Reason: A valid do not attempt resuscitation (DNAR) order gives you the legal authority not to initiate resuscitative efforts if the patient develops cardiac arrest. Because laws vary from state to state, you must be familiar with the DNAR laws inherent to the state in which you work as an EMT. Many states have adopted out-of-hospital DNAR orders; these are legal documents and should be adhered to if they are valid. Generally speaking, a valid DNAR order must clearly state the patient's medical problem(s), be signed by the patient or legal guardian, and be signed by one or more physicians. In some states, DNAR orders have an expiration date, while in others, no expiration date is included. Contact medical control for guidance if the validity of a DNAR order is questionable. Even in the presence of a valid DNAR order, you are still obligated to provide supportive measures, such as oxygen, pain relief, and comfort. DNAR does not mean do not treat.

Proper guidelines for safe reaching include all of the following, EXCEPT: A: keeping your back in a locked-in position. B: reaching no more than 30" in front of your body. C: avoiding hyperextension of your back. D: avoiding twisting of your back.

B: reaching no more than 30" in front of your body. Reason: Safe reaching practices are critical to the prevention of a back injury. When reaching, you should keep your back in a locked-in position. You should avoid twisting or hyperextending your back, and should reach no more than 15 to 20 inches in front of your body.

Medical control has ordered you to administer one tube of oral glucose to a hypoglycemic patient. Immediately after receiving this order, you should: A: ask medical control to repeat the order word for word. B: repeat the order back to medical control word for word. C: document the order on the prehospital care report. D: administer the medication and reassess the patient.

B: repeat the order back to medical control word for word. Reason: Immediately after receiving an order from medical control, you should repeat the order back to medical control word for word. This will ensure that you heard correctly and understand the order to be carried out. If you receive an order that seems inappropriate, you should ask the physician to repeat the order back to you for clarification. Reassess the patient after administering the medication and document the time and patient's response (good or bad) on your patient care report.

When the incident command system is activated at the scene, you should expect to: A: be assigned one responsibility for the duration of the incident. B: report back to your section officer in between assignments. C: receive instructions and then function independently. D: be immediately directed to the established treatment area.

B: report back to your section officer in between assignments. Reason: The incident command system (ICS) was established in order to maximize effective operations at the scene and maximize the number of lives saved. Deviation from the ICS jeopardizes lives and increases the risk of losing control over the situation. When you arrive at the scene in which the ICS has been activated, you should report to the staging area, where you will be directed to the area in which you are needed. Report to the section officer of that area, receive your instructions, and carry them out. When you have completed your assignment, you must return to the section officer for further instructions. Depending on the situation, you may be sent to another section. The sections that you work in and the responsibilities that you are given may change during the incident. At no time should you attempt to function independently (freelancing); this defeats the purpose of the ICS and puts lives in jeopardy.

You are the first ambulance to arrive at the scene of a motor-vehicle crash. As you approach the scene, you see three patients, two who have been ejected from their vehicles and the other who is still in his vehicle. You should: A: call medical control and apprise him or her of the situation. B: request additional ambulances to respond to the scene. C: begin triaging and treating the most critically injured. D: notify the local trauma center so they can prepare for the patients.

B: request additional ambulances to respond to the scene. Reason: One of the most important aspects of the scene size-up is to determine the need for additional resources. A single EMS unit and two EMTs cannot effectively manage three patients, especially if they are critically injured. Therefore, you must first request additional ambulances at the scene. After requesting additional resources, begin the processes of triage and treatment. Notify the local trauma center early, if possible, so they can prepare to take care of the patients; however, your first priority is to maximize patient care at the scene by requesting additional ambulances.

You arrive at the scene of a traffic accident in which multiple vehicles are involved. You see at least two patients who are lying on the road and are not moving. You should: A: begin triaging the patients. B: request additional ambulances. C: notify medical control for advice. D: begin immediate patient care.

B: request additional ambulances. Reason: As soon as you determine that there are more patients than you and your partner can effectively manage, you should immediately request additional help. Waiting until you are overwhelmed with critically injured patients is not the time to call for help. When in doubt, it is best to call for help. You can always cancel any incoming ambulances if you later determine that they are not needed. After you have called for assistance, you should begin triaging and caring for the patients to the best of your ability.

Upon arriving at the scene of a multiple vehicle crash, you can see that at least two patients have been ejected from their vehicles. You should: A: immediately triage the two patients. B: request at least one more ambulance. C: gather all of the patients together. D: treat the most critical patient first.

B: request at least one more ambulance. Reason: One ambulance and two EMTs can effectively care for only one critical patient or two non-critical patients. As soon as you determine that the patient count exceeds your capabilities, you should immediately call for additional help. After doing this, you should begin the processes of triage and treatment.

When providing care to multiple patients at the scene of a mass-casualty incident, your goal should remain focused on: A: initiating CPR for those in cardiac arrest. B: transporting patients to the hospital. C: keeping all bystanders at a safe distance. D: immobilizing all patients at the scene.

B: transporting patients to the hospital. Reason: At the scene a mass-casualty incident, you will be faced with many challenges, including ensuring your safety, extrication, triage, and patient care. In the midst of all of these activities, however, you must never lose sight of your ultimate goal, which is to transport all patients to the hospital as soon as possible.

When requesting medical direction for a patient who was involved in a major motor-vehicle accident, you should do all of the following, EXCEPT: A: describe the severity of damage to the patient's vehicle. B: use radio codes to describe the situation. C: use proper medical terminology when speaking. D: question an order if it seems to be inappropriate.

B: use radio codes to describe the situation. Reason: When giving a report to medical control or requesting medical direction, you should avoid the use of radio codes, such as "10-50." The physician may not be familiar with such codes. There is clearly less risk of confusion if you use plain English. At the same time, you should use proper medical terminology, especially when describing the patient's injuries. Information regarding the severity of damage to the patient's vehicle is critical information and should be relayed to the physician; this can help him or her appreciate the significance of the situation. Do not be afraid to question an order that is contrary to your training or protocols; the physician may have simply made an error. Repeating an order back to the physician, word for word, will minimize the risk of this occurring.

While functioning at a large-scale terrorist incident, it is important for the EMT to: A: avoid placing any casualty in a "delayed" treatment status. B: use triage and base patient care on available resources. C: begin immediate treatment of the most critically injured. D: identify the person or persons responsible for the event.

B: use triage and base patient care on available resources. Reason: During a terrorist incident, the basic foundations of triage and patient care remain the same; however, the treatment can and will vary. Terrorist incidents can produce a single casualty, hundreds of casualties, or thousands of casualties. When presented with wide-spread mass casualties, you must remember situational awareness. What you do in one situation may not be appropriate for another situation. In large-scale terrorist incidents, it is important to use triage and base patient care on available resources. When triaging casualties, use the same triage process that you would for any other mass-casualty incident. Remain focused on providing the greatest good for the greatest number of people, not the person or persons responsible for the incident.

During the triage process, which of the following injuries or conditions would classify a patient as a high priority? A: Partial-thickness burns with no respiratory difficulty B: Unilateral femur fracture and tachycardia C: A large avulsion to the arm and an altered mental status D: Pulselessness and apnea

C: A large avulsion to the arm and an altered mental status Reason: During triage, patients with an altered mental status, who are in shock, or who have problems with airway, breathing, or circulation, are potentially salvageable and are given immediate priority. Patients who are pulseless and apneic have low priority in a mass-casualty situation. If you focus your efforts on cardiac arrest patients, who will most likely not survive anyway, patients who could have potentially been saved will die as well. Remember, the goal of triage is to provide the greatest good for the greatest number of patients.

Which of the following scene size-up findings is LEAST suggestive of an unsafe environment? A: The sound of breaking glass as you approach a residence B: Screaming and yelling coming from inside a residence C: A large man standing in his yard awaiting your arrival D: Liquid draining from a car that struck a telephone pole

C: A large man standing in his yard awaiting your arrival Reason: When approaching a residence, findings that would suggest an unsafe scene include, among other things, the sound of breaking glass, screaming and yelling, and an unusual silence. Liquid leaking from a wrecked automobile should be assumed to be gasoline and, therefore, dangerous. Although intimidating in appearance, there is no correlation between a person's physical size and his or her potential for violence.

Which of the following situations presents the greatest risk for suicide? A: An EMT who saved a drowning child and receives no media attention B: A woman who quit her job for one that pays a lot more C: A man who was recently diagnosed with stage 4 lung cancer D: A woman who is planning a family trip, but gets called away to work

C: A man who was recently diagnosed with stage 4 lung cancer Reason: Any patient with a significant, most often negative, life change is at risk for suicide. Common catalysts to suicide include chronic depression, the loss of a loved one or a job, relationship problems, financial difficulties, and the diagnosis of a serious or terminal illness. There have been a number of cases in which EMS personnel who performed a heroic act have committed suicide after receiving excessive media attention.

Which of the following actions demonstrates an EMT's knowledge of crime scene preservation? A: Requesting approval from law enforcement before controlling severe bleeding from a patient's arm B: Carefully cutting through the hole in a patient's clothing that was made by a large caliber firearm C: Advising a law enforcement officer after moving a coffee table to access a critically injured patient D: Placing a knife in a plastic zip-lock bag and giving it to a law enforcement officer for safe-keeping

C: Advising a law enforcement officer after moving a coffee table to access a critically injured patient Reason: After ensuring your own safety, your priority when caring for a patient at a crime scene is to do just that, care for the patient. If you need to move a piece of furniture to gain access to a critically injured patient, move the furniture, treat the patient, and then advise a law enforcement officer of what you moved and where you moved it to. In this way, you are providing immediate care to the patient, but are remaining aware that the location of any obstacles between you and the patient may serve as evidence. Clearly, you are not going to request approval from a law enforcement officer before treating a critically injured patient. Items that may have fingerprints on them, such as knives or guns, should be placed in a paper bag; condensation can accumulate in plastic bags, potentially destroying any evidence. When removing clothing from a gunshot victim, you should make an effort to cut around (not through) the hole in the clothing that was made by the bullet. The hole in a patient's clothing may contain gunshot residue and can provide valuable information regarding the type of weapon used and the distance between the assailant and the victim.

You are giving a presentation to a group of laypeople on the importance of calling EMS immediately for cardiac arrest patients. What point should you emphasize the MOST? A: Rapid transport significantly reduces patient mortality. B: Laypeople are incapable of providing adequate CPR. C: CPR and defibrillation are key factors in patient survival. D: Cardiac drug therapy is the most important EMS treatment.

C: CPR and defibrillation are key factors in patient survival. Reason: Early high-quality CPR & defibrillation are the most crucial initial treatments to provide to a patient in cardiac arrest. Adequately performed CPR can keep the heart & brain oxygenated, thus increasing the chance of defibrillation success. Ventricular fibrillation (V-Fib) is the most common initial dysrhythmia seen in adult patients with sudden cardiac arrest & requires prompt defibrillation. Untreated V-Fib will rapidly deteriorate to asystole, the mortality rate from which is very high. You should also advise the audience that compression-only CPR has been linked to patient survival.

You are cleaning the back of the ambulance after transporting a patient with major trauma. Which of the following contaminated items should NOT be placed in a plastic biohazard bag? A: Blood-soaked gauze pads B: Suction canister C: Plastic IV catheter D: Rigid suction catheter

C: Plastic IV catheter Reason: Contrary to popular belief, the end of a Teflon IV catheter (the plastic catheter without the needle) can cut you; it is sharp! Therefore, it should be placed in a puncture-proof sharps container, not a plastic biohazard bag. Items that are blood-soaked or are otherwise contaminated, but cannot puncture, can safely be placed in a plastic biohazard bag.

A patient presents with severe bradycardia, hypersalivation, vomiting, and excessive tearing. Which of the following agents would MOST likely cause his signs and symptoms? A: Anthrax B: Phosgene C: Soman D: Chlorine

C: Soman Reason: Nerve agents (eg, V agent [VX], sarin [GB], soman [GD], tabun [GA]) are among the most deadly chemicals developed. Designed to kill large numbers of people with small quantities, nerve agents can cause cardiac arrest within seconds to minutes of exposure. Nerve agents, discovered while in search of a superior pesticide, are in a class of chemical called organophosphates, which are found in household bug sprays, agricultural pesticides, and some industrial chemicals. Organophosphates block an essential enzyme in the nervous system, which cause the body's organs to become overstimulated. The mnemonic "DUMBELS" can help you recall the signs and symptoms of nerve agent exposure; it stands for Diarrhea; Urination; Miosis (constricted pupils); Bradycardia; Emesis (vomiting), Lacrimation (excessive tearing); and Seizures, Salivation, and Sweating. You can also use the mnemonic "SLUDGEM," which stands for Salivation, Lacrimation, Urination, Defecation, GI distress, Emesis, and Miosis.

Which of the following components is NOT part of an injury or illness prevention program? A: Teaching new parents how to properly install a child safety seat B: Inspecting the home of young parents for child safety locks C: Training a group of daycare employees on infant and child CPR D: Educating teenage students on the dangers of drinking and driving

C: Training a group of daycare employees on infant and child CPR Reason: The operative word in injury and illness prevention is "prevention." An injury or illness prevention program should focus on actions that prevent illness or injury. These include, but are not limited to, teaching new parents how to properly install a child safety seat, educating teenage students on the dangers of drinking and driving, and conducting a courtesy inspection of the home of young parents for the presence of child safety locks. Training laypeople on CPR, although a valuable service, is not part of a prevention program; CPR is not needed until an injury or illness has already occurred.

As soon as you begin transport of a patient to the hospital, you should: A: conduct a detailed examination. B: contact medical control. C: advise dispatch of your status. D: notify the receiving facility

C: advise dispatch of your status. Reason: Immediately upon departing the scene with a patient, you should first inform the dispatcher that you are en route to the hospital. Never leave the dispatcher in the dark, for it is the dispatcher's job to know what units are available to answer emergency calls. Notifying the receiving facility, contacting medical control, and performing a detailed assessment of your patient all can occur while you are en route to the hospital.

A 30-year-old woman crashed her car into a tree at a high rate of speed. She is conscious and alert and has stable vital signs. She has some small lacerations and abrasions to her arms and face, but no obviously life-threatening injuries. As you are loading her into the ambulance, she tells you that she does not want to go to the hospital. You should: A: advise her that she is probably too emotionally upset to be able to refuse EMS treatment and transport. B: obtain a signed refusal from the patient and ask a law enforcement officer to transport her to the hospital. C: advise the patient that she should be transported to the hospital because of the seriousness of the crash. D: ask a law enforcement officer to administer a breathalyzer test to determine if she has been drinking alcohol.

C: advise the patient that she should be transported to the hospital because of the seriousness of the crash. Reason: The consequences of refusal should be explained to any patient who refuses EMS treatment and/or transport. After establishing that the patient can legally refuse treatment and transport (eg, he or she is of legal age AND has decision-making capacity), you must advise her that because of the significant mechanism of injury, the potential for critical injury or death exists, even though she may feel fine now. Once this is explained, and the patient understands and is willing to accept the possible consequences, obtain a signed refusal and ask an impartial person (eg, police officer) to witness the signed refusal.

A conscious and alert 92-year-old woman with chest pain is refusing EMS treatment and transport to the hospital. Her family insists that you transport her. This situation is MOST appropriately managed by: A: transporting the patient as the family wishes. B: obtaining a signed refusal from a family member. C: advising the patient of the risks of refusing care. D: transporting the patient as you explain your actions.

C: advising the patient of the risks of refusing care. Reason: Just because the patient is 92 years old does not mean that she does not have decision-making capacity and cannot make an informed decision. In cases where any patient refuses care, after determining that the patient has decision-making capacity (ie, is of legal age, is not impaired by drugs or alcohol), you must inform the patient of the potential risks of refusing care, namely death. If the patient is aware of and willing to accept the potential consequences of his or her refusal, a refusal of treatment and/or transport form should be signed by the patient. A non-biased witness (ie, law enforcement officer, emergency medical responder [EMR]) should also sign the refusal form.

All of the following are considered key components at the scene of a mass-casualty incident, EXCEPT: A: an adequately staffed treatment area. B: a supply area near the treatment area. C: an on-scene emergency physician. D: an on-site communication system.

C: an on-scene emergency physician. Reason: On-site communications, an adequately staffed treatment area, and a supply area near the treatment area are some of the key components at a mass-casualty incident. Although the physician medical director is ultimately responsible for all patient care activities at the scene, he or she typically communicates with the incident commander via mobile phone or two-way radio from the base hospital. Physical presence of the physician at the scene, although optimal, is often not possible.

Most crashes involving ambulances occur: A: at stop signs. B: on the highway. C: at intersections. D: at stop lights.

C: at intersections. Reason: Intersection crashes are the most common and usually the most serious type of collision in which ambulances are involved. When approaching an intersection, you should come to a complete stop, look in both directions for pedestrians and other motorists, and then proceed with caution. Remember, your lights and siren do NOT give you the right of way; they ask other motorists for the courtesy of the right of way. If you proceed through an intersection without stopping and strike another vehicle that had the right of way, you will be held liable. Whether or not your lights and siren were in use at the time of the incident is irrelevant.

You have completed your patient care report and left a copy at the hospital when you realize that you forgot to document a pertinent finding on the front of the report. You should: A: complete a new run report and add the information. B: take no action and report the event to your supervisor. C: attach an addendum to the original run report. D: write the information on the original run report.

C: attach an addendum to the original run report. Reason: If you discover that you forgot to include pertinent information on your patient care report (PCR) after leaving a copy at the hospital, you should write the information on a separate addendum and attach it to the original PCR. A copy of the addendum also should be sent to the receiving facility. Once you leave a copy of your PCR at the hospital, you should not add anything to the original. Legally, this would result in two different records for the same patient. Many EMS systems use electronic PCR (E-PCR) software, in which case the PCR is electronically submitted to the receiving facility upon completion. As with the hand-written PCR, you should add an addendum to the E-PCR if you forget to include pertinent information on the original.

You are called to a residence for a woman in cardiac arrest. Shortly after starting CPR, the patient's husband presents you with an unsigned document that states "do not attempt resuscitation." You should: A: stop all resuscitative efforts in accordance with the document. B: contact medical control prior to continuing any resuscitative efforts. C: continue CPR until you have contacted medical control for guidance. D: stop CPR until the document can be validated by a physician.

C: continue CPR until you have contacted medical control for guidance. Reason: Do not attempt resuscitate (DNAR) orders are particularly challenging for EMS providers. When presented with documentation, especially if it does not appear to be valid (in this case, an unsigned document), you should err on the side of patient care and continue resuscitative efforts until medical control orders you to stop.

The MOST effective means of preventing the spread of disease is: A: wearing gloves with all patients. B: wearing a mask with all patients. C: effective handwashing. D: up-to-date immunizations.

C: effective handwashing. Reason: According to the Centers for Disease Control and Prevention (CDC), the most effective way of preventing the spread of disease is to frequently and effectively wash your hands, especially in between patients. The regular use of gloves with all patients and wearing a mask when managing a patient with a communicable disease (ie, tuberculosis) will decrease your chance of disease exposure. Remaining up-to-date with your immunizations will reduce your risk of contracting certain diseases if you are exposed.

When driving in emergency mode on a multilane highway, the emergency vehicle operator should keep to the: A: center lane so the traffic can flow around the ambulance. B: right shoulder so that traffic flow is not disrupted. C: extreme left lane so motorists can yield to the right. D: extreme right lane so motorists can yield to the left.

C: extreme left lane so motorists can yield to the right. Reason: When traveling on a highway with more than one lane, the emergency vehicle operator should remain in the extreme left-hand (fast) lane. This allows other motorists to yield to the right as they see you approach. A motorist's typical initial reaction is to slam on their brakes and then look for the best direction to yield; this may be to the left or right, depending on the traffic. Do not attempt to pass a motorist until he or she is clearly aware of your presence and has yielded accordingly. Passing other motorists on the right is unsafe and should be avoided.

The EMT should avoid focusing all of his or her attention on a single critical patient during the triage process because: A: all of his or her supplies will likely be depleted on that one patient. B: three EMTs are required to effectively manage a critical patient. C: other patients may die of problems that may have been corrected. D: the patient will most likely die before he or she can be transported.

C: other patients may die of problems that may have been corrected. Reason: Triage is the process of rapidly assessing patients in order to determine their treatment priority. Focusing your attention on one patient during the triage process not only defeats the purpose of triage (to do the greatest good for the greatest number of people), but it neglects other patients who may die from injuries or conditions that may have been corrected if detected earlier.

Upon arriving at a scene in which a tanker truck overturned and is spilling an unknown liquid on the ground, you should: A: quickly identify the material. B: stay downhill from the scene. C: park upwind from the scene. D: turn off your warning lights.

C: park upwind from the scene. Reason: At the scene of a potential or actual hazardous materials incident, you should park the ambulance in an area that is both upwind and uphill from the incident. However, you must be prepared to quickly relocate if the wind direction changes. Staying uphill is important because many hazardous materials collect in low-lying areas, such as valleys. After ensuring that you are in a safe place, attempt to identify the chemical involved by reading the placard on the tanker (with binoculars) and referencing the placard number in the emergency response guidebook (ERG).

A set of regulations and ethical considerations that define the extent or limits of an EMT's job is called: A: the Medical Practices Act. B: a duty to act. C: scope of practice. D: confidentiality.

C: scope of practice. Reason: The set of legal regulations and ethical considerations that define the job of the EMT is called the scope of practice. The scope of practice provides a clear delineation of the EMT's roles and responsibilities. Duty to act is defined as a legal obligation to respond to every call for help while on duty and in your jurisdiction, whether you are paid for your services or not. Confidentiality entails not releasing any patient information to those not directly involved in the care of the patient. The Medical Practices Act describes the minimum qualifications of those who may engage in emergency medical care and establishes a means of certification.

While en route to the scene of an injured person, dispatch advises you that law enforcement personnel are at the scene. This indicates that: A: the patient is critically injured. B: a crime has been committed. C: the scene is potentially unsafe. D: the scene is safe for you to enter.

C: the scene is potentially unsafe. Reason: The presence of law enforcement at the scene indicates, at a minimum, that the scene is potentially unsafe, otherwise they would not be there. While you are en route, you should make radio contact with the police officers at the scene to determine if it is safe for you to enter; you should also inquire about the severity of the patient's injuries. The more information you obtain before you arrive, the better. For all you know, you could arrive and find yourself in the middle of a fire fight! The mere presence of law enforcement at the scene does NOT ensure a safe environment.

Which of the following patients has the highest priority at the scene of a mass-casualty incident? A: 44-year-old unresponsive man with an open head injury and agonal gasps B: 38-year-old woman who remains apneic after you manually open her airway C: 29-year-old man who is pulseless and apneic with an abdominal evisceration D: 35-year-old unresponsive woman with snoring respirations and severe burns

D: 35-year-old unresponsive woman with snoring respirations and severe burns Reason: The goal of triage is to provide the greatest good for the greatest number of people. Relative to the other patients, who are either in respiratory or cardiac arrest or have injuries incompatible with life, the woman with snoring respirations and severe burns has the best chance for survival. Therefore, she has the highest treatment priority.

Which of the following is the MOST practical method of standard precautions when treating multiple patients during a mass-casualty incident (MCI)? A: Asking each patient you treat if he or she has a communicable disease B: Thoroughly washing your hands in between patient contacts C: Placing clean gloves over soiled gloves in between patient contacts D: Changing your gloves in between contact with different patients

D: Changing your gloves in between contact with different patients Reason: Although the most effective means of preventing the spread of disease involves thorough hand-washing, this is not practical at the scene of a MCI; you usually do not have the time or facilities to do this. In a situation where you are treating multiple patients, you should change your gloves in between patients; this will help prevent cross-contamination. The concept of standard precautions is based on the assumption that ALL bodily fluids are potentially infectious; thus, there is no need to ask a patient if he or she has a communicable disease. Furthermore, to make such an inquiry is unethical.

Following an apparent terrorist attack, numerous patients present with shortness of breath and persistent coughing. A green haze is noted in the area in which the patients are located. Which of the following agents should you suspect they were exposed to? A: Tabun (GA) B: Phosgene oxime C: V agent (VX) D: Chlorine (CL)

D: Chlorine (CL) Reason: The patient's signs and symptoms are indicative of a pulmonary (choking) agent, specifically chlorine (CL). Chlorine (CL) was the first chemical agent ever used in warfare. It has a distinct odor of bleach and creates a green haze when released as a gas. Initially, it produces upper airway irritation and a choking sensation. Later signs and symptoms include shortness of breath, chest tightness, hoarseness and stridor as the result of upper airway swelling, and gasping or persistent coughing. Phosgene, not to be confused with phosgene oxime (a blistering [vesicant] agent), is also a pulmonary (choking) agent. Tabun (GA) and V agent (VX) are examples of chemical nerve agents. Nerve agents are among the most deadly chemicals developed. Designed to kill large numbers of people with small quantities, nerve agents can cause cardiac arrest within seconds to minutes of exposure.

Which of the following is considered minimum personal protective equipment (PPE) when suctioning an unresponsive patient's airway? A: Gloves, gown, and eye protection B: Gloves and a mask C: Gloves, head cover, and eye protection D: Gloves and full facial protection

D: Gloves and full facial protection Reason: You should wear gloves when assessing or treating any patient. The level of personal protective equipment (PPE) used beyond gloves is dictated by the risk and type of exposure. When managing a patient's airway (eg, suctioning, ventilating with a bag-mask device), you should use, at a minimum, gloves and full facial protection. This will protect you from oral and eye exposure if the patient coughs or vomits. A gown should be worn, in addition to gloves and full facial protection, any time there is a risk of blood splatter. Examples of when this may occur include delivering a baby or caring for a combative patient with severe external bleeding. The level of PPE you use in a given situation should be guided by reasonable judgment and common sense.

How does a unified incident command system differ from a single incident command system? A: In a unified incident command system, one agency with several incident commanders has the majority of responsibility for incident management B: In a unified incident command system, a single person is in charge of the entire incident, even if multiple agencies respond to the scene C: In a unified incident command system, a single incident commander is identified and will function as such, regardless of the type of incident D: In a unified incident command system, plans are made in advance by all agencies that assume a shared responsibility for decision making

D: In a unified incident command system, plans are made in advance by all agencies that assume a shared responsibility for decision making Reason: Regardless of the type of incident command system (ICS) used, a single incident commander (IC) must be in charge. In a unified incident command system, plans are drawn up in advance by all cooperating agencies that assume a shared responsibility for decision making. The response plan should designate the lead and support agencies for several types of mass-casualty incidents (MCIs). For example, the Haz-Mat team will take the lead in a chemical leak and the medical team will take the lead in a multi-vehicle car crash. Large MCIs often require a unified incident command system. A single incident command system is one in which one person is in charge, even if multiple agencies respond to the scene. It is generally used with incidents in which one agency has the majority of responsibility for incident management. Ideally, it is used for short-duration, limited incidents that require the services of a single agency.

Which of the following statements regarding the high-efficiency particulate air (HEPA) respirator is correct? A: A HEPA respirator is necessary only if the patient with suspected tuberculosis is coughing. B: A HEPA respirator should be placed on any patient with tuberculosis. C: A surgical mask provides better protection against tuberculosis than a HEPA respirator. D: Long sideburns or a beard will prevent the proper fit of a HEPA respirator.

D: Long sideburns or a beard will prevent the proper fit of a HEPA respirator. Reason: If you are caring for a patient with known or suspected tuberculosis (TB), regardless of whether the patient is coughing, you should place a surgical mask (or high-flow oxygen, if indicated) on the patient and a high-efficiency particulate air (HEPA) respirator (N-95 or higher) on yourself. Unlike a surgical mask, the HEPA respirator is specifically designed to prevent exposure to the bacterium that causes TB. A surgical mask, however, will reduce the transmission of germs from the patient into the air. Do not place a HEPA respirator on the patient; it is unnecessary and uncomfortable. Use of a HEPA respirator should comply with OSHA standards, which state that facial hair, such as long sideburns or beards, will prevent a proper fit.

Which of the following is an example of the EMT providing care based on standing orders? A: Following assessment of a patient with a terminal illness, the EMT notifies the patient's personal physician to determine whether he or she requires any special care. B: After confirming that a patient's blood pressure is adequate, the EMT contacts medical control and requests permission to assist the patient with his prescribed nitroglycerin. C: Prior to administering oral glucose to a patient with hypoglycemia, the EMT confirms the proper dosage and requests authorization from the base station physician. D: The EMT defibrillates a patient with the automated external defibrillator, directs immediate resumption of CPR, and then contacts medical control for further guidance.

D: The EMT defibrillates a patient with the automated external defibrillator, directs immediate resumption of CPR, and then contacts medical control for further guidance. Reason:Standing orders define certain treatment interventions that the EMT is authorized to perform prior to contacting medical control. For example, the EMT knows that a cardiac arrest patient requires CPR, cardiac rhythm analysis with the AED, and defibrillation (if indicated); contacting medical control before performing these crucial interventions would only waste time and increase the chance of a negative patient outcome. Standing orders generally apply to interventions that the patient requires in order to prevent immediate death. Follow your local protocols regarding which interventions you are authorized to perform prior to contacting medical control.

Which of the following statements BEST describes a mass-casualty incident? A: More than three vehicles are involved in the incident. B: More than five patients are involved. C: At least half of the patients are critically injured. D: The number of patients overwhelms your resources.

D: The number of patients overwhelms your resources. Reason: A mass-casualty incident (MCI) occurs any time the number of injured patients overwhelms your available resources. It is not necessarily defined by the number of patients, but rather your ability to effectively manage them. For example, if you and your partner arrive at a scene and find two critically injured patients, you have an MCI (albeit a small-scale MCI) because two EMTs and one ambulance can only care for one critically ill or injured patient effectively.

According to the United States Department of Transportation (USDOT), minimum staffing for a basic life support ambulance includes: A: an EMT who functions as the driver. B: a minimum of two EMTs in the ambulance. C: at least two EMTs in the patient compartment. D: at least one EMT in the patient compartment.

D: at least one EMT in the patient compartment. Reason: The United States Department of Transportation (USDOT) requires at least one EMT in the patient compartment of a basic life support (BLS) ambulance. Although the driver does not have to be an EMT, it is preferable. Regardless, the person operating the ambulance must be able to safely and effectively operate an emergency vehicle. Regulations regarding minimum staffing of an ambulance vary from state to state.

When calling your radio report to the receiving hospital, you should: A: include the patient's name. B: break your report into 60-second increments. C: only give your report to a physician. D: be brief, concise, and factual.

D: be brief, concise, and factual. Reason: A radio report should be brief, concise, and factual. It should include the patient's age and sex, his or her chief complaint, associated assessment findings, vital signs, treatment that you provided, and the patient's response to your treatment. Avoid speculative statements regarding the patient's condition; report only what you know to be fact. Longer radio reports should be broken into 30-second increments; after 30 seconds, pause and ensure the listener heard your previous traffic. The patient's name is not vital to your report; thus, there is generally no need to disclose it. Unless you are requesting medical direction, it is acceptable, and routine practice, to give your report to a registered nurse.

The scene size-up includes all of the following components, EXCEPT: A: assessing the need for assistance. B: determining if the scene is safe. C: evaluating the mechanism of injury. D: donning personal protective gear.

D: donning personal protective gear. Reason: The components of the scene size-up include determining scene safety, assessing the mechanism of injury (MOI) or nature of illness (NOI), determining the number of patients, and requesting additional help if needed. Personal protective equipment (PPE) should be donned prior to beginning the scene size-up.

The safest emergency vehicle operator is one who: A: is physically fit. B: drives with lights and siren. C: has a positive attitude. D: drives with due regard.

D: drives with due regard. Reason: One of the most important attributes of a safe emergency vehicle operator is the ability to drive with due regard for others. This means that the operator must be aware of others around him or her and to keep their safety in mind. The EMT should never assume that all drivers will see or hear the ambulance. A positive attitude about one's ability to safely operate an emergency vehicle is also an important attribute. Although sometimes indicated for the patient's condition, the use of lights and siren increase the risk of an ambulance crash.

When called to the scene of a structural fire to stand by in case any injuries occur at the scene, you should: A: enter the structure with the firefighters so you can provide immediate care to any victims. B: park the ambulance close to the fire so you can rapidly access any patients. C: depart the scene and return to service after the fire has been completely extinguished. D: ensure that your ambulance does not block or hinder other arriving fire apparatus.

D: ensure that your ambulance does not block or hinder other arriving fire apparatus. Reason: When standing by at the scene of a structural fire, you must ensure that the ambulance is parked at a safe distance; this will not only keep you safe from the fire itself, but also minimize your risk of injury if the structure collapses. You must also ensure that the ambulance does not block or hinder access to the fire by fire apparatus that arrives after you. You should receive instructions from the fire officer in charge regarding the appropriate location to park the ambulance. It is not the EMT's job, nor is it safe, to enter a structure fire; if victims are located by firefighters, they will be brought to you. Do not depart the scene and return to service until the fire officer in charge releases you; many dangers still exist after the fire has been extinguished.

A man armed with a shotgun has taken two people hostage and has shot one of them. Upon arriving at the scene, you should: A: inform the incident commander that you will assume responsibility for the entire incident since there is a confirmed patient. B: leave your lights and siren on because this will let the injured person know that you have arrived and are there to help. C: be sure and turn up your portable radio loud enough so that you can remain aware of the entire situation. D: have the incident commander guide you to a shielded staging area and wait for the tactical team to bring the patient to you.

D: have the incident commander guide you to a shielded staging area and wait for the tactical team to bring the patient to you. Reason: Upon arriving at the scene of a tactical situation, such as a hostage situation, the presence of a sniper, or any exchange of gunfire, you should report to the incident commander, who will take you to a shielded, safe staging area that has been selected for the ambulance and for treatment of casualties. Remain there until the tactical team brings the patient or patients to you. As an EMT, you are responsible for patient care once the patient has been brought to you; you are not in charge of the entire incident. When you arrive at the scene, turn your lights and siren off to avoid agitating the gunman. You should also keep your portable radio turned down and minimize radio traffic. If possible, use an ear speaker.

Proper body mechanics when lifting and moving a patient include: A: using the muscles of your lower back to lift. B: maintaining a slight curvature of your back. C: twisting at the waist when moving around a corner. D: keeping the weight as close to you as possible.

D: keeping the weight as close to you as possible. Reason: General guidelines for safe lifting and moving include keeping the weight as close to your body as possible; keeping your back in a straight, locked-in position; using the muscles of your thighs to lift; and avoiding twisting when moving a patient around a corner. Back injuries are the most common injury sustained by the EMT and can be easily avoided if proper lifting and moving techniques are observed.

You are caring for a 6-year-old child with a swollen, painful deformity to the left forearm. As you communicate with the parents of this child, you should: A: use appropriate medical terminology at all times. B: tell them that the child will be transported to the hospital. C: ask them repeatedly how the child was injured. D: make sure that they remain aware of what you are doing.

D: make sure that they remain aware of what you are doing. Reason: When caring for any patient, it is important to keep both the patient and family aware of what you are doing. You should avoid medical terminology whenever possible because most laypeople will not understand what you are saying. The plain English approach is much more effective. When caring for children specifically, you should inform the parents of the need for ambulance transportation and why; doing so will provide them with the information necessary to make an informed decision. Asking the parents repeatedly how the child was injured may be construed by some as implying that the child was abused.

The technique of rapid extrication from a vehicle involves: A: applying a cervical collar, grasping the patient by the clothing, and quickly removing him or her onto the stretcher. B: applying a vest-style extrication device, sliding a long backboard under the patient's buttocks, and removing him or her from the vehicle. C: grabbing the patient by his or her clothing, protecting his or her spine as much as possible, and dragging him or her from the vehicle. D: manually stabilizing the head, applying a cervical collar, and removing the patient from the vehicle onto a long backboard.

D: manually stabilizing the head, applying a cervical collar, and removing the patient from the vehicle onto a long backboard. Reason: The rapid extrication technique is indicated if the patient has life-threatening injuries and/or is in need of treatment that requires a supine position. It is performed by manually stabilizing the patient's head (an EMT in the backseat typically does this), applying a cervical collar, sliding a backboard under the patient's buttocks, and removing him or her from the vehicle and onto the backboard. The vest-style extrication device is not appropriate to use when performing the rapid extrication technique; it takes too long to correctly apply. Do not confuse the rapid extrication technique with an emergency move. An emergency move, which is indicated if you or the patient's safety is in imminent danger, involves grabbing the patient by the clothing, protecting his or her spine as much as possible, and dragging him or her from the vehicle to a safe place.

After assisting a patient with her epinephrine auto-injector, you should: A: replace the cover and place it in the trash can. B: give it to the patient to have it refilled. C: place the device in a red biohazard bag. D: place the device in a puncture-proof container.

D: place the device in a puncture-proof container. Reason: After any device is used that has the potential for causing an accidental needle stick or is otherwise contaminated, it should be placed in a puncture-proof container, which usually is red and has a biohazard logo on it. The cover of the auto-injector should never be replaced, nor should a needle be recapped. Epinephrine auto-injectors are not refillable.

You are called to a local state park where a hiker fell from a cliff into a thick, wooded area with rough terrain. It is cold and foggy and a thunderstorm is approaching. You will MOST likely move the patient to the ambulance by: A: assisting the patient in walking from the wooded area to the ambulance if his injuries are not life-threatening. B: bringing the ambulance stretcher to the patient, loading him onto it, and removing him from the wooded area. C: requesting a helicopter to hoist the patient out of the wooded area and carry him to a site near the ambulance. D: placing the patient in a basket stretcher and using at least four people to carry him to the ambulance.

D: placing the patient in a basket stretcher and using at least four people to carry him to the ambulance. Reason: The basket stretcher, also called a Stokes basket, is ideal for moving patients across rough terrain. Because the patient fell from a cliff, he will require spinal motion restriction precautions. Secure him to a long backboard and place the backboard in the basket stretcher. When carrying a patient across rough terrain, you should utilize at least four people to ensure a safe patient move. Clearly, the patient should not walk; he should be suspected of having a spinal injury due to the fall. A wheeled ambulance stretcher is impractical in situations were the patient must be moved over rough terrain. In many cases, a helicopter can be used to move patients from remote areas to a landing site near the ambulance or directly to the hospital. However, in this case, the weather (eg, fog, approaching thunderstorm) will likely prohibit a helicopter from being able to safely fly.

After arriving at a mass-casualty incident where other ambulances are already present, you should notify the dispatcher and then: A: initiate care for the most critically injured patients. B: repeat the triage process. C: obtain information from the fire service commander. D: report to the staging area.

D: report to the staging area. Reason: Once you arrive at the scene of a mass-casualty incident where an incident command system has already been established, you should report to the staging area, the area designated for all incoming ambulances and resources. The staging officer will know where help is needed the most and will be able to direct your actions accordingly.

While assisting a paramedic in starting an IV on a patient, you are inadvertently stuck by the contaminated needle while attempting to place it in the sharps container. You should: A: hold the paramedic liable for the needle stick. B: cease patient care immediately. C: notify your supervisor and request an HIV test. D: seek medical care as soon as possible.

D: seek medical care as soon as possible. Reason: If you receive an exposure while providing patient care, you should notify your supervisor or designated infection control officer and seek medical care as soon as possible. However, this should be done after you have completed patient care. You will be tested for bloodborne pathogens such as HIV and hepatitis B, and based on the degree of exposure, the physician may suggest immediate treatment. The paramedic did not intentionally stick you with the needle; therefore, you cannot hold him or her liable. Careful and appropriate handling of needles and other sharps will reduce your risk of an accidental stick.

The primary clinical feature associated with exposure to a vesicant agent is: A: tachycardia. B: muscle twitching. C: vomiting blood. D: skin blistering.

D: skin blistering. Reason: The primary route of exposure of blister agents, or vesicants, is the skin. If vesicants are left on the skin or clothing long enough, they produce vapors that can enter the respiratory tract. Vesicants cause burn-like blisters to form on the victim's skin as well as in the respiratory tract (if inhaled). Vesicant agents include sulfur mustard (H), Lewisite (L), and phosgene oxime (CX). The symbols H, L, and CX are military designations. Vesicants usually cause the most damage to damp or moist areas of the body, such as the armpits, groin, and respiratory tract.

Your actions at the scene of a critically injured patient who was shot during a robbery should include: A: caring for the patient while manipulating the scene minimally. B: providing care when the police authorize you to. C: performing a primary assessment only. D: starting immediate care as you would with any other patient.

A: caring for the patient while manipulating the scene minimally. Reason: After ensuring your own safety, your priority while functioning at a crime scene is to provide care to the patient. However, you should make a reasonable effort to avoid manipulating the scene in order to preserve potential evidence. If furniture or other objects do not need to be moved to gain access to the patient and provide adequate working space, they should be left in place. Conversely, if any obstacles impede your care of the patient, they must be moved as needed. Seeking law enforcement approval before treating a critically injured patient would clearly waste valuable time.