EMT exam 5
Discuss situations in which air medical transport should be considered, potential disadvantages of air medical transport, and guidelines for setting up a landing zone
A patient needs to be transported to a trauma center that is distant from the present location. A high priority patient with serious illness or injury is entrapped and a prolonged extrication is expected. Air transport will save time in a time critical patient. Patient is in a remote area that cannot be reached by ground vehicles. The air crew possesses specialty skills, supplies, or equipment not available in a ground ambulance. Patient has an acute stroke, head injury with altered mental status and signs of herniation, chest or abdominal trauma with signs of respiratory distress or shock, serious MOI with unstable assessment findings and vitals, penetrating injury to the body cavity with unstable assessment findings.
Discuss the logistics of staging and transport at an MCI
A staging leader monitors, inventories, and directs available ambulances to the treatment unit at the request of the transport leader. Transport leader makes sure ambulances are accessible and coordinates patient transportation with the triage leader and communicates with hospitals involved. Highest priority patients are stabilized and transported. One or two triage leaders monitors patients for change in mental status. EMT should receive instructions on how to leave and where to go. Leader radios hospital that ambulance is in route. Individual emts should not communicate with the hospital unless an emergency develops during transport. Consider loading ambulatory patients on a bus. Five to ten personnel carrying equipment should board the bus and an ambulance should lead the bus to a hospital.
Explain the general rules of hazardous materials rescue
Avoid contact with any unidentified material. Protect the safety of all rescuers and patients. Provide patient care. Decontaminate clothing, equipment, and the vehicle. Avoid risking your life if the only threat is to the environment. Remember RAIN: Recognize hazardous materials incident, Avoid contact, Isolate the area, Notify the appropriate authorities.
Describe types of inquiries that may occur from conventional explosives and incendiary devices
Blast is the primary affect. Secondary effect results from flying debris. Flames and hot gasses also are 2nd effect. A person can be propelled by the blast or shock wave. Tertiary effects are injuries produced by the propulsion of the person body. Quaternary effects include burn, crush, and inhalation injuries. Quinary effects result from exposure to bacteria, chemicals, radiation, fuels, and metals. Lung injury, abdomen bleeding or lacerated bowel or evisceration. Ear drum can rupture, and bones inside can fracture. Crush injuries. Shrapnel injuries. Primary injury for incendiary devices is a burn.
Discuss situations in which air medical transport should be considered, potential disadvantages of air medical transport, and guidelines for setting up a landing zone part 2
Disadvantages: weather limitations, altitude limitations (some patients with lung trauma or diving injuries are not good candidates), airspeed limitations (wind can slow speed), aircraft cabin size (large, impaled objects or obese patients), terrain, cost (only should be maid when it is to benefit the patient), patient presentation (splinting and proper immobilization and assessment should be complete before loading), noise limited assessment) Setting a landing zone: make sure it is clear of obstructions (60 for small helicopter during day and 100 at night, double the size for medium and large helicopters). Pick loose debris up. Pick a zone 150 feet away from collision vehicles. Alert an approaching aircraft of obstructions such as wires or towers. If the landing site is a divided highway stop traffic on both sides. Consider the wind direction. Mark each corner with a highly visible device such as a flag by day or flashing light by night.
List measures that can be taken to reduce rescuer stress during and after an MCI response
Don't get overwhelmed, deal with patients one by one with priority first. A rescuer should be instructed to rest once every 1 to 2 hours. Make sure that each rescue worker knows his assignment. Workers in staffing area should circulate watching for signs of stress in rescue workers. Make sure each worker is assigned to proper skills. Provide plenty of food and beverages. Encourage workers to talk among themselves. Make sure rescuers can talk with trained councilors.
Differentiate between the levels of hazardous materials training identified by the Occupational Safety and Health Administration.
First responder awareness: trained to recognize a problem but are not expected to take any action other than call for proper resources and prevent others from entering the scene. Required for all operating EMTS. First responder operations: protect people, property, and the environment. Trained in use of specialized personal protective equipment and help stop spreading. Hazardous materials technician: extensive level of training who actually plug, patch, or stop the release of hazardous materials. Hazardless materials specialist: have advanced knowledge and skills, provide command and support activities at the site of a hazardous materials emergency.
Describe the role of the EMT and basic considerations for caring for a patient entrapped in a vehicle
Gaining access to the patient as quickly as can be safely accomplished to perform patient assessment and care. The main priorities are to keep yourself and partner safe and to prevent further harm to the patient. Patient care precedes removal from vehicles unless delaying removal would endanger the life of the patient, Ems personal, or other rescuers. Maintain spine motion restriction at all times. Perform a primary assessment and manage any immediate life threats. Perform a controlled rapid extrication of the patient. Remove the vehicle from around the patient and not the patient from around the vehicle if possible. Use adequate personal. Use the path of least resistance that provides the least chance of further injury to the patient.
Define key terms introduced in this chapter
Multiple casualty incident: any event that places excessive demands on personnel and equipment. National incident management system NIMS: provides a consistent approach to managing disasters by all responders to the incident that might include emergency response personnel and local, state, and federal government agencies and employees. The three main components are flexibility, standardization, and scalability. Incident common system ICS: incident management concept. Focus is the safety of emergency responders and others, achievement of tactical objectives, efficient use of resources. incident commander: responsible for coordinating all aspects of the incident. triage unit: sorts of patients by criticality and assigns priorities for emergency care and transport. Treatment unit: care provided to patients. This is done by the priority assigned to the patient by the triage unit.
Discuss the effects of exposure to and explain the appropriate medical care for each of the following types of chemical agents: a. Nerve agents b. Vesicants c. Cyanide d. Pulmonary agents e. Riot-control agents f. Toxic industrial chemicals
Nerve agents: block the action of an enzyme called ACHE. ACHE is in the plasma of the blood, red blood cells, and nervous tissue. Its function is to stop the action of ACh, a neurotransmitter. ACh accumulates and the skeletal muscles, smooth muscles, glands, and nerves remain in a steady on state with uncontrolled contraction. Death usually results from respiratory muscle failure because the muscles fatigue. Respiratory failure occurs because of the paralysis of respiratory muscles and excessive secretions lead to airway obstruction. Care: Establish airway, PPE at 12 per minute. Suction if needed, position in lateral recumbent. Administration of antidote is the next step. Atropine or pralidoxime. Benzodiazepine for seizures. Wounds should be covered and keep the patient warm.
Give examples of biological agents in each of the following categories and the appropriate medical care for exposure to biological agents: a. Pneumonia-like agents b. Encephalitis-like agents c. Biological toxins d. Other agents
Pneumonia like agents: Anthrax, plague, tularemia. Most present with fever, dyspnea, cyanosis, and headache. Encephalitis like agents: cause symptoms that resemble the flu and include malaise, fever, and headache. Smallpox and Venezuelan equine encephalitis. Biological toxins: Botulinum, ricin, staphylococcus enterotoxin 13 SEB, epsilon toxin, trichothecene mycotoxins T2. Most cause death. Other biological agents: Cholera viral hemorrhagic fevers (Ebola), brucellosis. Care: Primarily supportive, recognition is crucial. Contact the necessary recourses. Isolate Ebola, smallpox, and plague patients. Wear HEPA respirator, head and face protection, and boots, gloves, and body splashing protection. Provide PPV if needed and oxygen regardless at 15 lpm. Antibiotics and anti-toxins are crucial and emt should recognize signs and summon personnel. Prophylaxis is taking antibiotics proper to exposer and should be used in emt response plan.
Describe special considerations in responding to and managing patients exposed to or contaminated with radiation
Protect yourself and others from contamination and no EMT should ever attempt to decontaminate a radiation patient. If suspected wait for a radiation safety officer or transport to the hospital if RSO can't come. Place the patient in a body bag up to the neck, cover the hair completely with a cap or towel, and use disposable wipes to clean the face. Put the disposable wipes in a plastic bag, seal it, and take it to the hospital. Time is critical factor and trained personnel should remove the patient from the source before beginning emergency care. Increase distance from source of radiation. Provide shielding by clothing, aluminum or lead shielding. Determine source of radiation, if trained put on breathing apparatus and don't leave skin or hair exposed. Seal opening with duct tape and wear layers. Wear two pairs of protective gloves under heavy work gloves and shoes covered by two pairs of paper shoe covers under a pair of heavy rubber boots.
Discuss the effects of exposure to and explain the appropriate medical care for each of the following types of chemical agents: a. Nerve agents b. Vesicants c. Cyanide d. Pulmonary agents e. Riot-control agents f. Toxic industrial chemicals part 3
Pulmonary agents: attacks airway and lung tissue. Damaged airways and alveoli leak fluid leading to pulmonary edema and inflammation. Tearing, runny nose, throat irritation, dyspnea are early signs. Care: PPV if needed and high concentration oxygen regardless. Maintain airway possible ALS help with tracheal intubation. If wheezing can administer beta2 agonist. Keep patient calm and do not overexert. Riot control agents: irritation to face and skin and respiratory tract. Eye closing or temporary blindness. Lasts 3o minutes. Care: Supportive, remove patient from area and irrigate eyes. Remove contact lenses. PPV and oxygen if needed. MDI if wheezing and has an MDI. Decontaminate skin with soap and water. Toxic industrial chemicals: can resemble other chemical agents. Discover which one it could be like. Effects are mostly to respiratory tract.
Discuss situations in which air medical transport should be considered, potential disadvantages of air medical transport, and guidelines for setting up a landing zone part 3
Put a fifth warning device upwind side to designate the wind direction. If its dusty or dry enough to create a fire wet the area if possible. Keep patient and crew 100 feet and spectators 200 feet. Assign a person to guide the pilot int wearing eye protection and ear protection and standing near the wind marker with his back to the wind with arms raised overhead to indicate landing direction. Give primary care to a patient and follow instructions from flight crew. Duck when approaching and leaving and only at the pilot's direction. Wait till pilot says its safe. Never walk behind Heli craft. Secure loose items. No smoking 50 feet of craft. If landing on an incline approach from downhill side. Never point spotlights at helicopter.
Explain the principles and assessment categories used in START triage
RPM: Respiratory status, Perfusion status, and mental status. The START is recommended for adults and children over 8 and greater than 100 pounds. It is performed primarily and less than 30 seconds per patient to categorize patients for priority to the triage unit. If respirations are over 30 tag red, if less move to perfusion. If not breathing open airway and assess. If unresponsive and not breathing mark black. For perfusion assess capillary refill of 2 seconds and radial pulse. If no pulse and capillary refill is longer than 2 seconds mark red. If Refill is less but pulse is present move to neurological assessment. Mental status if they listen to commands mark yellow if not mark red.
Given a scenario with multiple patients, categorize patients according to a color-coded triage system.
Red: highest priority: assigned to patients with critical injuries who might not survive the incident with quick treatment and transport. Relate to START category. Yellow: second priority: patients suffering from severe injuries but some delay in treatment should still provide the patient a good chance of survival. Green: lowest priority: patients with injuries in which delay in treatment will not reduce the patient's chance of survival. Black: deceased: patients who are dead or who will not survive even with treatment.
Explain actions that may be required to gain motor vehicle access, including the concepts of simple and complex access.
Simple: access in which tools are not required. See if door will open then see if windows are open. If they are rolled up, ask the patient to unlock without moving their head. Complex: requires the use of tools and specialized equipment. To break a window, tell the patient what you're going to do. Wear heavy gloves and eye protection. Cover the window with contact paper or if possible, have the patient cover himself. Then break the window farthest away from the patient. Use a sharp tool at the lower corner of the window and strike with a hammer. Remove the glass starting at the top until it is removed. If the door must be forced open or removed cover the edges with a blanket or tarp. Walk around vehicle to identify mechanisms of injury and approach facing the patient. Tell the patient not to move his head or neck repeatedly and tell him to focus on an object in front.
Discuss factors that can affect your ability to maintain control while driving an ambulance
Sudden breaking, driver distractions, driving alone, fatigue, railroads, school buses, bridges and tunnels, day of the week, time of day, road surface, backing up the ambulance, higher speeds, aggressive drivers, escorts, intersection collision.
Explain the U.S. Department of Transportation placard system and the National Fire Protection Association symbols for identifying hazardous materials
The NFPA 704 system identifies potential danger with the use of background colors and numbers ranging from 0-4. Blue is a gauge of health hazard, red is fire hazard, and the yellow is reactivity hazard. The white is used for symbols that indicate additional information such as radioactivity, oxidation, need for protective equipment. A placard is a four-sided diamond shape that designates the hazards material. Usually has a 4-digit number identifying the material and a color indicates the class.
Explain the purpose of shipping papers and material safety data sheets.
They have the name of the substance, classification, and the four-digit UN identification number as well as quantity, origin, and destination. Safety data sheets: to communicate the hazards of hazardous chemical products.
Define key terms introduced in this chapter pt2
Transport unit: patients are moved to ambulances or helicopters for transportation and communications are organized to notify the receive facility. Staging unit: ambulances, helicopters, and additional equipment are held in this area until assigned. Morgue unit: deceased casualties are moved to this unit. Triage: system used for sorting patients to determine the order in which they receive medical care or transportation. Triage is one of the first functions performed at the scene. Primary triage: occurs upon arrival of Ems crew. It is done quickly and provides basic categorization of the severity of patients involved in the incident. Secondary triage: after primary they are moved to triage unit where the secondary unit is designed to reevaluate the patient categorization. Disaster: sudden catastrophic event that overwhelms the natural order and causes great loss of property or life.
Identify responsibilities that maybe assigned to EMS (units that might be established) at a multiple-casualty incident.
Triage unit: sort patients by priority Treatment unit responsibilities: Immobilize all patients before moving them. Place in rows of triage category if necessary. Treat only salvageable patients. Provide only necessary care to manage to manage non-life-threatening injuries. Staging and transport unit responsibilities: Emts should receive instructions on how to leave and which hospital to go to.
Describe equipment and methods for stabilizing an upright vehicle, a vehicle on its side, and a vehicle on its roof.
Upright: immobilize the suspension. Position plastic step chocks under each wheel. If not available use box crib with wedges. Air should be removed from the tires by pulling out the tires valve system using a pair of pliers. If air needs to be added use a deflation tool to deflate. Valve stems should be cut, and tires sliced only when it is necessary to release air. Vehicle on its side: attach a stabilizing pole, pulling device, cable or chain from the under carriage of the car to another vehicle or strong immovable object. Rescuers then crib the length of the vehicles side where it has contact with the ground. Every void between the ground and the vehicle should be filled with box cribbing and wedges to minimize movement. As well as the space between the top of the door frame and roof should be filled. Struts can be used to prevent rollover.
Describe the appropriate use of emergency warning devices, such as lights and sirens
Use lights when responding to a call. Turn on headlights during the daytime. Use minimal lighting during heavy fog or when you are parked. Use emergency lights only when a patient's condition requires rapid transport. Never pull directly behind a car and blast your siren. Always let your patient know before you activate the siren. Avoid overuse of airhorn. Do not sound the horn when close to other vehicles.
Describe equipment and methods for stabilizing an upright vehicle, a vehicle on its side, and a vehicle on its roof. part 2
Vehicle on its roof: a box crib built under the hood and trunk and using wedges to remove any remaining space to take the weight of the vehicle of the roof posts. Air bags under the front or rear can stabilize as well. Low pressure bags should be used by themselves because of their greater lift height. If using high pressure bags, a box crib should be built within a couple inches of the surface of the vehicle. Then sliding an airbag into that space.
Discuss the effects of exposure to and explain the appropriate medical care for each of the following types of chemical agents: a. Nerve agents b. Vesicants c. Cyanide d. Pulmonary agents e. Riot-control agents f. Toxic industrial chemicals part 2
Vesicants: blistering, burning, and tissue damage on contact. Stinging and development of ulcers in the eyes, shortness of breath, coughing, pulmonary edema when inhaled, nausea vomiting, and fatigue. Care: immediate irrigation with water or chemical decontamination kit. Apply a dry sterile dressing after. Patch eye after flushing. dimercaprol is an antidote for lewisite. Cyanide: rapid agent that disrupts the capability of the cell to use oxygen. If inhaled patient can lose consciousness and die within 6-8 minutes if a high concentration. Low concentration causes anxiety, weakness, dizziness, nausea, muscular trembling and more. Care: Manage airway and provide PPV if needed, provide oxygen at 15 lpm. Antidote such as cyanokit.
Define key terms introduced in this chapter part 2
Warm zone: contamination reduction zone- immediately adjacent to the hot zone. All personnel must wear appropriate protective gear. All supplies used in the warm zone must remain there until fully decontaminated. Cold zone: support zone: adjacent to the warm zone. Patients should be decontaminated and rescuers should be shed of contaminated gear.
Differentiate between the characteristics of the following types of radiation: a. X-ray and gamma radiation b. Neutron radiation c. Beta radiation d. Alpha radiation
Xray and gamma (same type just created differently): most penetrating type of radiation and can travel long distances. Generated in a nuclear plant, nuclear bomb, and through decay of radioactive particles. Gamma radiation is a major external hazard and a lesser internal hazard. Neutron: powerful and damaging that penetrates several hundred meters of air and easily passes through the body. It occurs outside of the nuclear chain reaction its threat to life occurs near an active nuclear reactor or bomb explosion. Beta: low speed, low energy particle that is easily sopped by 6-10 feet of air, clothing, or a few millimeters of skin. Serious threat from ingestion of contaminated foods and inhalation of particles. Internal hazard. Alpha: heavy and slow-moving particle that travels only inches in air and stopped by clothing or outer layer of the skin. Serious internal contaminant. Ingested or inhaled.
Use scene size-up findings to anticipate and prepare for the following: a. Potential problems in accessing patients b. Need for additional resources c. Appropriate personal protective equipment d. Appropriate measures to improve scene safety e. Location of all patients f. Vehicle safety in a collision situation part 2
appropriate measures to improve scene safety: Always assume downed power lines is electrically alive. If a line is down and broken 75 feet from the pole the area to be secured should be greater 75 feet in all directions from the pole. If the lines are in contact with the vehicle stay away. Request assistance from local electric service company. If a patient is still in the vehicle use the PA system and advise them to stay inside the vehicle because the electricity could pass through them. Discourage patents from touching metal. When moving away from downed power lines shuffle with small steps keeping feet together and on the ground. If police are not on scene designate a person to control traffic. Traffic should be stopped and rerouted. If it has to be channeled, it should be 50 feet from the wrecked cars. If there is a substance leaking park upwind and uphill if liquid is leaking. Disconnect airbags by removing battery cables. Stay clear of front bumper.
Describe the privileges afforded to EMTs operating emergency vehicles and the precautions that must be observed while using these privileges.
exceed the speed limit only if you are not endangering lives or property, drive the wrong way down a one-way street, turn in any direction at any intersection, park anywhere as long as you're not endangering lives or property, leave the ambulance in middle of street or intersection, cautiously proceed through a red light, pass other vehicles in no passing zones. In passing you first must signal, ensure the way is clear, and avoid endangering life and property. It must be a serious emergency. Must use warning devices. You must slow down at intersections so traffic can stop. Cant Park just over the crest of a hill unless theres flares or a police officer to divert.
Define key terms introduced in this chapter
hazardous material: one that in any quantity poses a threat or unreasonable risk to life, health, or property if not properly controlled during manufacture, processing, packaging, handling, storage, transportation, use, and disposal. safety zone: rescue operations and a specific sequence of decontamination procedures take place. hot zone: exclusion zone-where contamination can be present. an area that is immediately adjacent to the accident site and where contamination can still occur. A single enters and exit is established. the hot zone should be restricted. Only work done in the hot zone is hazard assessment, control of the release or hazard, and rescue performed by trained personal.
Explain precautions that should be taken when driving an ambulance in inclement weather
keep mirrors clear, avoid sudden breaking and sudden moves of the steering wheel, if going through large puddle slow down and turn on wipers, as you leave the puddle tap the break lightly to dry it out. If the ambulance pulls to one side pump the break slowly and smoothly to dry the breakout. If you begin to hydroplane hold the steering wheel steady and gently pump the break. Do not turn the wheel from side to side or jam on the break. make sure engine is tuned, heater and defroster are working, and battery is charged. Carry emergency weather equipment. Equip ambulance with studded snow tires. Stay aware of temperature. Avoid sudden movements or breaking. Slow down but avoid decelerating suddenly when visibility is poor. Watch the road and cars behind. Turn on headlights. If traveling 15 mph or more below speed limit use four-way flashers. Use defroster. Tap breaks if need to slow down to warn vehicles behind.
Use scene size-up findings to anticipate and prepare for the following: a. Potential problems in accessing patients b. Need for additional resources c. Appropriate personal protective equipment d. Appropriate measures to improve scene safety e. Location of all patients f. Vehicle safety in a collision situation part 3
location of all patients: always locate patient before attempting to gain access. skid marks, child's scarf, ask bystanders, under seats, trunks, child's car seat. All are indications of location of patient. vehicle safety in a collision situation: if fire is not yet on scene remove fire extinguisher from vehicle and place near collision. Vehicle must be stabilized. Before disconnecting batteries, lower windows and unlock doors and move power seat to good position. Remove negative cable first.
Explain precautions that should be taken when driving an ambulance at night
make sure you have quartz halogen headlights. Keep headlights clean. Replace burned out bulbs. Dim high beams within 500 feet of approaching a vehicle. Never stare into high beams. Do not flick high beams. Never use high beams going into a curve. Keep windshield clean. Keep instrument panels dim. Keep eyes moving. Make sure your rested.
Use scene size-up findings to anticipate and prepare for the following: a. Potential problems in accessing patients b. Need for additional resources c. Appropriate personal protective equipment d. Appropriate measures to improve scene safety e. Location of all patients f. Vehicle safety in a collision situation
potential problems in accessing patients: heavy traffic, emergency on the 16th green of a golf course, stands at a game. utility workers above or below ground, construction workers from ditches to rooftops and around heavy equipment, painters work with ladders and scaffolding, antennas and water towers need maintenance, industrial sites, intersections known for collision. need for additional resources: traffic control and crash investigation, extraction, downed wires or crash involving hazardous cargo or spills. Fast moving water, fire suppression, air evacuation. appropriate PPE: shattered glass, sharp metal, flammable liquids, battery acid, blood. PPE must be used at every incident when such hazards are or may be present. Roadway work you should wear a visibility vest. Full turnout gear is needed for extrication process.
List sensory indications that a hazardous materials situation may exist
smoking or self-igniting materials, extraordinary fire conditions, boiling or spattering of materials that have not been heated, wavy or unusually colored vapors over a container of liquid material, characteristically colored vapor clous, frost near a container leak, unusual odors, unusual condition of containers.
