Intro to EMS
What are the main differences between the EMR and EMT?
EMR: CPR + AED, emergency childbirth, bleeding control, basic first aid, OPA, O2 administration; typically lifeguards, park rangers, forest rangers, some fire fighters, and police
EMT: everything an EMR can do + more medical assessment, trauma assessment, EMT meds (Epi, narcan, aspirin, nitro, albuterol, activated charcoal, oral glucose, o2), transport patients; main personnel on IFT/BLS ambulances
What’s the difference between cumulative stress and ptsd?
PTSD involves flashbacks or memories and can develop after a single traumatic event and has a psychological impact on the patient putting them back physiologically in a stress response even though the stressor is not really there
Cumulative stress is when a person experiences a build up of multiple stressors over time; may not be present initially but can occur later on
If you have a critical patient trapped in a vehicle and you can’t get them out, what should you do?
Call for additional resources (Fire, ALS)
You/partner apply manual stabilization to the cervical spine
Are you able to exceed the speed limit when driving code 3?
Yes, in most states, but you cannot drive with reckless disregard, you need to use due regard
What is the difference between simple and complex access?
No tools (roll down the window or open the door) = simple
Using tools to get to the patient (hydraulic rescue tools, spreaders, power saws) = complex
What level of organization sets guidelines for EMT training and the minimum standards of care
Federal Level: NHTSA (national highway traffic safety administration) and DOT
What are the different stages of grief?
Denial Anger Bargaining Depression and Acceptance
Be aware they can coexist at the same time, a person can progress rapidly through these stages, or take extended periods of time to process through these stages
What should you do if you have a stable patient that is stuck in a narrrow alleyway and you can’t get your gurney backboard or scoop in there to get the patient out?
Use a non-urgent move (extremity lift)
What is Code 3 driving and when does Code 3 driving occur?
On the way to a 911 call, you should drive with lights and sirens on
How far away should you park for a suspected mine collapse?
at minimum 500 feet away
What skills might a layperson be trained in?
CPR/AED, Bleeding control, Basic First aid, sling/splint
How to properly wash your hands? How often should you wash your hands?
Ideally for 20 seconds under warm water
Anytime they are visibly dirty or soiled, after any suspected exposure to blood or bodily fluids, Between every patient, whenever you can
Can substitute alcohol based sanitizer, but ensure you wash your hands with soap and water later
What is the optimal power position for lifting?
Straight back (shoulder girdle over pelvic girdle), knees bent, feet about 15 inches apart, arms near the body (no greater than 15-20in in front), power grip (palms turned up)
When you arrive on scene of a TC, what do you need to do to ensure your ambulance is parked appropriately
Park 100 ft before or after the collision (if normal TC suspected) with your wheels turned away from the scene, Put on emergency break, turn off headlights and primaries so you don’t blind traffic
If you see an overturned tanker or truck with a placard on it and a plume of smoke coming from the vehicle, what should you suspect could potentially be occurring, who would you contact, and where will you park?
Potential HazMat incident
Contact Dispatch let them know you need HazMat, call Chemtrec if directed to
Park Upwind and uphill
What’s the organization that regulates EMT schools?
State EMS office
What PPE should you wear if you suspect blood or bodily fluids could come into contact with you?
Gloves, eye protection (goggles + face shield), mask, gown
What is the rapid extrication technique? How do you do it?
Series of coordinated moves to move a patient in a seated position to a supine position when the scene is unsafe and the patient is unstable
First Maintain manual stabilization, Apply a c-collar, have two partners help carry the patient’s trunk and extremities, put patient onto long backboard and secure it onto the gurney
What is a cushion of safety?
A safe distance or buffer zone between you and the vehicle in front of you and other vehicles near you, so that you can quickly maneuver in case of sudden breaking or other maneuvers
What should you do if a patient is in a vehicle next to a downed power line?
Tell the patient to stay in the car
Do NOT approach the patient until you have been told the power is turned off/not live
What is the role of the medical director in EMS?
Provides written protocols/standing orders for EMS personnel, provides training, ensures competency of skills of EMS personnel, does quality improvement, conducts research, can also provide online medical direction via radio/phone or in person, ensures compliance with EMS regulations
Typically the medical director is county specific in EMS, but private organizations can also have their own medical director
Medical directors are typically an ER physician
Medical director can give you special training to do skills outside your traditional scope if approved by the State EMS office, but needs to be a prehospital skillWhat are the physiological signs of stress?
Sympathetic nervous system activation: Sweating, pupil dilation, increased blood glucose, increased heart rate, increased RR, change in mentation: increased anxiety, agitation, or fear
What should you do if you have a patient over the weight limit that 2 EMTs can safely lift?
Request a lift assist and wait for additional units before moving the patient
If you have a patient in the back of the rig and are transporting them to their destination hospital and you pass a crash scene, what should you do?
Report scene to dispatch and keep going to your destination
Describe the ideal landing zone for a Medevac helicopter? When can you call one?
Flat, 100x100ft, visible/marked clearly, hard surface, free of obstacles like power lines, buildings, or trees, away from people
Remember to wait for the blades to stop rotating (make eye contact with the pilot/wait for flight crew to wave you over)
Typically for severe threats of life or limb, shock, spinal cord injuries, drowning, severe burns, GCS less than 13, need for special facilities, or if you are too far away from the hospital (30 minutes in SD but county specific)…etc