OPERATIONS

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) shine a spotlight in the side view mirror of the patient's vehicle. D) approach the vehicle from the front to ensure maximum visibility.

A 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!

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) The exact location of the patient B) The call-back number of the caller C) The patient's sex and approximate age D) Whether the patient is breathing

A You should attempt to obtain as much patient information from the dispatcher as you can. However, 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 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 it 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.

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

C 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.

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) Allow him to voice his feelings to you. B) Tell him that he needs psychiatric help. C) Recommend at least 12 hours of sleep. D) Report his behavior to the medical director.

A 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.

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

A 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 necessarily involve actually touching him or her. Laws can vary from state to state as to these definitions. 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.

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

A 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. ID#EMT-418 How sure are you?? (1 = Guessing; 5 = Confident; Far Left = Not Applicable) 12345 ← PREVIOUSPAUSE/END TESTNEXT →

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

C 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; rather, bend at the knees and keep your back in a straight, locked-in position.

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

A 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 (eg, tuberculosis) will decrease your chance of disease exposure. Keeping up-to-date with your immunizations will reduce your risk of contracting certain diseases if you are exposed to them.

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) informed consent. C) implied consent. D) formal consent.

A 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.

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

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

A At the scene of a mass-casualty incident, you will be faced with many challenges, including ensuring your own 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.

If the EMT could initially only take two pieces of equipment to the side of a patient in cardiac arrest, which of the following should he or she select? A) AED and suction device B) AED and oxygen cylinder C) Pocket mask and oxygen cylinder D) Bag-valve-mask and suction devices

A Determining the equipment that should be taken to the patient's side is often guided by the nature of the call and/or departmental policy. For a cardiac arrest patient, the AED would clearly need to be taken in immediately since defibrillation is a critical intervention and has been directly linked to positive patient outcomes. The suction device, which may be needed to clear secretions from the airway, should also be taken immediately; mortality increases significantly if aspiration occurs. Oxygen and ventilation equipment are important; however, chest compressions and defibrillation have clearly been shown to provide the greatest benefit to cardiac arrest patients.

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

A 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 widespread mass casualties, you must remember the importance of 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.

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

A 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.

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

A 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, and 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 a residence for a woman in cardiac arrest. Shortly after you start 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) stop CPR until the document can be validated by a physician. C) continue CPR until you have contacted medical control for guidance. D) contact medical control prior to continuing any resuscitative efforts.

C Do not attempt resuscitation (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.

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) Soman B) Anthrax C) Chlorine D) Phosgene

A 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, which were discovered by researchers looking for a superior pesticide, are classified as organophosphates; these chemicals are found in household bug sprays, agricultural pesticides, and some industrial chemicals. Organophosphates block an essential enzyme in the nervous system, which causes 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, Gastrointestinal distress, Emesis, and Miosis.

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) whether the car will catch on fire. C) placing safety flares by the ambulance. D) rapid assessment of all injured patients.

A 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, concerns about 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 now 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.

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

A 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 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) placing the patient in a basket stretcher and using at least four people to carry him to the ambulance. B) bringing the ambulance stretcher to the patient, loading him onto it, and removing him from the wooded area. C) assisting the patient in walking from the wooded area to the ambulance if his injuries are not life threatening. D) requesting a helicopter to hoist the patient out of the wooded area and carry him to a site near the ambulance.

A 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 fly safely.

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 dies. Which of the following statements regarding this scenario is MOST correct? A) You and your partner may be held liable for negligence. B) The crew that preceded you will be held liable for negligence. C) The manufacturer of the AED will be held liable for negligence. D) Most errors associated with the AED involve equipment failure.

A 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 your own and your partner's shoulders.

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) perform a primary assessment and provide any lifesaving care before extrication. B) immediately apply high-flow oxygen to the patient and allow extrication to begin. C) rapidly assess her from head to toe, obtain vital signs, and apply a cervical collar. D) have the fire department disentangle the patient and quickly remove her from the car.

A Unless there is an immediate threat of fire, explosion, or other danger, you should perform a primary assessment and begin any lifesaving 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 lifesaving 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.

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) put on gloves, a gown, and a mask and quickly remove the driver. C) approach the rear of the tanker to identify the type of fluid leaking. D) ensure that the ambulance is downwind and downhill from the tanker.

A 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 potential hazardous materials exposure. 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.

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

A 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.

EMTs arrive at a one-vehicle crash on the left shoulder of a 3-lane highway. The fire department has parked their apparatus on the left shoulder, behind the crashed vehicle. The ambulance should be parked: A) past the crashed vehicle, on the left shoulder. B) behind the fire apparatus, on the left shoulder. C) alongside the crashed vehicle, in the middle lane. D) in between the fire apparatus and crashed vehicle.

A When arriving at the scene of a vehicle crash, the ambulance should be parked at a safe distance past the accident site, on the same side of the road. This placement puts several barriers between you and oncoming traffic: the fire apparatus and the crashed vehicle(s). In addition, it allows the ambulance to leave the scene easily. Every effort should be made to keep the ambulance and crew as far away from moving traffic as possible.

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) continue performing CPR and ask her if he has a living will. B) comply with her request and cease all resuscitative efforts. C) perform rescue breathing only and contact medical control. D) cease resuscitation only if the AED does not indicate a shock.

A 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.

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) use radio codes to describe the situation. B) question an order if it seems to be inappropriate. C) use proper medical terminology when speaking. D) describe the severity of damage to the patient's vehicle.

A 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.

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) burnout. B) delirium. C) drug use. D) acute stress.

A 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 behavior, 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 experienced 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.

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

B 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.

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) Triage her as immediate (red tag) B) Assess for bilateral radial pulses C) Administer high-flow oxygen at once D) Assess her ability to follow commands

B 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.

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) treat the patient where he is, without moving the coffee table. B) move the coffee table, begin patient care, and notify a police officer. C) obtain permission from law enforcement before moving any furniture. D) move the coffee table, document what you did, and begin treatment.

B 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 action on the patient care report, AFTER you have cared for the patient.

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

B 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, you should 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 provide immediate care to the patient, but remain aware that the location of any obstacles between you and the patient may serve as evidence. Clearly, you should not 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.

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

B Although the most effective means of preventing the spread of disease involves thorough handwashing, this is not practical at the scene of a mass-casualty incident; 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.

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

B 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 cases in which EMS personnel who performed a heroic act have committed suicide after receiving excessive media attention.

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

B 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.

You arrive at the scene where a man fell approximately 40 feet and landed on his head. He is unresponsive, has agonal gasps, and has 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) request authorization from medical control not to initiate care. B) manage the patient aggressively and provide rapid transport. C) recognize that the patient's injuries disqualify him as an organ donor. D) provide rapid transport only because the patient likely will not survive.

B 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 with 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 the patient will not survive his injury, his organs can potentially be harvested and save several lives.

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) advising the patient of the risks of refusing care. C) obtaining a signed refusal from a family member. D) transporting the patient as you explain your actions.

B 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.

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

B 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.

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 have been ejected from their vehicles and the other is still in his vehicle. You should: A) begin triaging and treating the most critically injured patients. B) request additional ambulances to respond to the scene. C) call medical control and apprise him or her of the situation. D) notify the local trauma center so personnel there can prepare for the patients.

B One of the most important aspects of the scene size-up is determining the need for additional resources. A single EMS unit and two EMTs cannot effectively manage three patients, especially if those patients 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 personnel there can prepare to take care of the patients; however, your first priority is to maximize patient care at the scene by requesting additional ambulances.

Upon arriving at a mass-casualty incident, the EMT is assigned to the treatment area. Upon completion of duties in the treatment area, the EMT should: A) notify the incident commander and return to service. B) report to the treatment officer for further instructions. C) report to the transportation area to assist with transport. D) report to the triage section to check for remaining patients.

B Organized operations at the scene of a mass-casulaty incident are crucial in order to achieve the best possible outcome. When the EMT is given an assignment, he or she should complete the assignment and then return to the individual who gave the assignment for further instructions. Self-assigning at the scene (freelancing) is dangerous and can compromise the effectiveness of the overall operation.

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) at least one EMT in the patient compartment. C) at least two EMTs in the patient compartment. D) a minimum of two EMTs in the ambulance.

B 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.

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

B 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.

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

B 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 is the highest treatment priority.

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) a crime has been committed. B) the scene is potentially unsafe. C) the patient is critically injured. D) the scene is safe for you to enter.

B 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 firefight! The mere presence of law enforcement at the scene does NOT ensure a safe environment.

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

B The primary route of exposure to 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.

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) manually stabilizing the head, applying a cervical collar, and removing the patient from the vehicle onto a long backboard. C) applying a vest-style extrication device, sliding a long backboard under the patient's buttocks, and removing him or her from the vehicle. D) 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.

B 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 the patient 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 your own 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.

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

B Triage is the process of rapidly assessing patients 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 also neglects other patients who might die from injuries or conditions that could have been corrected if detected earlier.

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

B 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 on 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.

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

B 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 upon seeing an approaching ambulance is to slam on the 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.

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

B 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-valve-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, anytime 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.

While you are inside a crashed vehicle assessing a patient who is entrapped, the rescue team should be: A) awaiting specific instructions from you as to how to proceed with the extrication process. B) assessing exactly how the patient is trapped and determining the safest way to extricate him or her. 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.

B Your ability to access the patient, with or without difficulty, does not indicate the extent of entrapment or method of extrication necessary. 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 the patient. As you are assessing the patient and 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 be in constant communication. Once the patient has been assessed and provided with any immediate lifesaving care, and the rescue team has determined the best extrication approach, extrication can begin.

You are giving a presentation to a group of laypeople on the importance of calling EMS immediately for cardiac arrest patients. Which point should you emphasize the MOST? A) Laypeople are incapable of providing adequate CPR. B) Rapid transport significantly reduces patient mortality. C) CPR and defibrillation are key factors in patient survival.

C Early high-quality CPR and defibrillation are the most crucial initial treatments to provide to a patient in cardiac arrest. Adequately performed CPR can keep the heart and 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 and requires prompt defibrillation. Untreated V-Fib will rapidly deteriorate to asystole, which has a very high mortality rate. You should also advise the audience that compression-only CPR has been linked to patient survival.

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

C A mass-casualty incident (MCI) occurs anytime the number of injured patients overwhelms your available resources. It is not necessarily defined by the number of patients, but rather by 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 care for only one critically ill or injured patient effectively.

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) disregard the DNAR order because it is only valid in the hospital setting. C) provide supportive care, such as oxygen, and keep the patient comfortable. D) monitor the patient because a DNAR order prohibits you from providing care.

C 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 in 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."

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

C 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.

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 more quickly. B) To avoid getting separated from the escort vehicle, you should follow it closely. C) An escort vehicle should be used only if you are unfamiliar with the patient's location. D) With an escort vehicle, the risk of an accident at an intersection is reduced significantly.

C 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 (a 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.

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

C 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, because it is the dispatcher's job to know which 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.

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

C 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.

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) document the information on the front of your original PCR. B) do nothing, since you already left a copy of the PCR at the hospital. C) include the information on an addendum and furnish it to the hospital. D) notify the emergency department staff and advise them of your error.

C 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; this document 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 the original two separate documents.

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

C 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 because of the patient's condition, the use of lights and siren increases the risk of an ambulance crash.

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

C 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.

How does a unified incident command system differ from a single incident command system? A) In a unified incident command system, a single incident commander is identified and will function as such, regardless of the type of incident. 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, plans are made in advance by all agencies that assume a shared responsibility for decision making. D) In a unified incident command system, one agency with several incident commanders has the majority of responsibility for incident management.

C 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 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.

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

D 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 and 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.

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 contacts the patient's personal physician to determine whether he or she requires any special care. B) Prior to administering oral glucose to a patient with hypoglycemia, the EMT confirms the proper dosage and requests authorization from the base station physician. C) The EMT defibrillates a patient with the automated external defibrillator, directs immediate resumption of CPR, and then contacts medical control for further guidance. D) 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 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 simply waste time and increase the chance of a negative patient outcome. Standing orders generally apply to interventions that the patient requires to prevent immediate death. Follow your local protocols regarding which interventions you are authorized to perform prior to contacting medical control.

Upon returning to quarters after working a major car accident involving an entire family, a member of the press calls and requests information regarding the call. Which of the following would be the EMT's MOST appropriate action? A) Disclose the general extent of the patient's injuries, but avoid disclosing which facility they were transported to B) Disclose the ages of the patients and the facility to which they were transported, but avoid discussing their injuries C) Inform him that the patients were transported to the hospital, but that you cannot disclose the extent of their injuries D) Provide information requested on the patients who are not minors, but avoid disclosing your name or badge number

C The BEST practice is to NOT talk to the media. Your department should have a public information officer (PIO), whose job is to do just that. If, for whatever reason, talking to the media is unavoidable, you should give the absolute minimum information. In this case, advise the reporter that the patients were transported to the hospital; however, you are not authorized to disclose any other information, including the extent of their injuries, their names, or their ages.

A patient injured his arm and asks to be transported to a specific hospital because he has been there before. The EMT states that he does not feel the doctors there are competent and recommends a different hospital. The EMT's behavior is: A) legal and ethical. B) ethical, but illegal. C) legal, but unethical. D) illegal and unethical.

C The EMT's actions in this case are not illegal; he cannot go to jail for making such comments. However, his actions are clearly unethical and unprofessional, and could lead to allegations of slander by the physician; this would be a civil case, not a criminal one. You must not allow your personal feelings to influence a patient's decision as to who treats him or her, or where he or she is treated.

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

C 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.

A 10-year-old child was struck by a car while crossing the street. He has bilateral femur fractures and a head injury. His father has been notified and is 20 minutes away from the scene. The EMT should: A) contact medical control to see if he/she will take custody of the child. B) attempt to contact the child's mother to see if she can be there sooner. C) begin immediate transport and have law enforcement update the father. D) stabilize the child at the scene until the father arrives and gives consent.

C The child in this scenario is critically-injured and needs immediate treatment and transport. In the interest of the child, it should be presumed that the parents would give consent to treat and transport if they were at the scene (implied consent). Begin emergency care, transport without delay, and ask a law enforcement officer to apprise the child's parents of your transport destination.

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) 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. D) obtain a signed refusal from the patient and ask a law enforcement officer to transport her to the hospital.

C 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

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) V agent (VX) B) Tabun (GA) C) Chlorine (CL) D) Phosgene oxime

C The patients' signs and symptoms are indicative of a pulmonary (choking) agent, specifically chlorine (CL). Chlorine 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.

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

C 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.

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) be sure and turn up your portable radio loud enough so that you can remain aware of the entire situation. 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) have the incident commander guide you to a shielded staging area and wait for the tactical team to bring the patient to you. D) inform the incident commander that you will assume responsibility for the entire incident since there is a confirmed patient.

C 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

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) ask them repeatedly how the child was injured. B) use appropriate medical terminology at all times. C) make sure that they remain aware of what you are doing. D) tell them that the child will be transported to the hospital.

C When caring for any patient, it is important to keep both the patient and the 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.

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

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

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

D Abandonment occurs anytime 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.

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

D A patient may be treated under the law of implied consent, also called the emergency doctrine, anytime 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.

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) break the driver's-side window and gain rapid access to the patient. C) disconnect the battery cables and then request heavy extrication tools. D) ensure that there are no hazards and then try to open one of the doors.

D After ensuring your own safety, you should attempt simple means to gain access to the patient, trying to reach 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 by just 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.

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

D 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 so as 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.

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

D An emergency move is indicated if your own 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 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 the patient 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.

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) begin immediate patient care. C) notify medical control for advice. D) request additional ambulances.

D 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 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) turn off your warning lights. D) park upwind from the scene.

D 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).

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) Asking the police to escort you to the scene C) Always requesting fire department assistance D) Wearing your seat belt and shoulder harness

D Consistent safety practices, such as wearing your seat belt 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 with which you are unfamiliar, 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 (a 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.

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

D During triage, patients with an altered mental status, who are in shock, or who have problems with their 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.

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

D 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.

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

D 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 simply 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 your lights and siren were in use at the time of the incident is irrelevant.

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) treat the most critical patient first. C) gather all of the patients together. D) request at least one more ambulance.

D One ambulance and two EMTs can effectively care for only one critical patient or two noncritical 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.

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) have the bystander assist you with patient care. C) notify the police and have the bystander removed. D) assign the bystander a simple, non-patient-care task.

D 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.

While you are 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) place him in a prone position and secure straps across his back. B) ensure that at least three people are available to safely restrain him. C) approach the patient from the front and converge on him quickly. D) maintain communication with him and closely monitor his airway.

D Physical restraint may be necessary if a patient is a threat to himself or herself or to others. If it becomes necessary to physically restrain a violent patient, specific guidelines 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. Someone, 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 face down (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.

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

D 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.

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) lift the backboard from the sides instead of from the ends. B) be sure to lift the backboard with the powerful muscles of your back. C) recall that most of the patient's weight is at the foot end of the backboard. D) ensure that the strongest EMT is positioned at the head of the backboard.

D Since most 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.

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) corrosive B) flammable C) radioactive D) explosive

D 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 the exact agent involved.

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

D 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 collaboration 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 provide 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.

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

D 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 in CPR, although a valuable service, is not part of a prevention program; CPR is not needed until an injury or illness has already occurred.

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) advise the son that he can probably drive his mother to the hospital. B) comply with the son's request and transport the woman to the hospital. C) take the woman's vital signs and apply supplemental oxygen if necessary. D) assess the woman and determine if she wishes to be treated and transported.

D 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. Also, just because her son wants her to be transported does not mean that she agrees with this request. 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 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, she is 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.