NREMT Cognitive Exam Prep
Where does the modern EMS system have its origin?
- The modern EMS system has its origins in funeral homes, which often operated
ambulances. However, funeral home operators were often serving competing
business interests and patients received little trained care until the hospital.
What is considered the "birth" of EMS?
- In 1966, a paper titled "Accidental Death and Disability: The Neglected Disease of
Modern Society" is published by the National Academy of Sciences. This paper is
widely known in the EMS profession as the White Paper. The White Paper is widely
considered the birth of modern EMS. It spotlighted inadequacies of prehospital care
in the United States, particularly related to trauma.
Who developed the first EMT National Standard Curriculum?
- Early in the 1970s, the US Department of Transportation developed the first EMT
National Standard Curriculum.
What are the levels of EMS training?
- Emergency Medical Responder (EMR): provides basic, immediate care including
bleeding control, CPR, AED and emergency childbirth.
Emergency Medical Technician (EMT): includes all EMR skills, advanced oxygen
and ventilation skills, pulse oximetry, noninvasive blood pressure monitoring, and
administration of certain medications.
Advanced Emergency Medical Technician (AEMT): includes all EMT skills,
advanced airway devices, intravenous and intraosseous access, blood glucose
monitoring, and administration of additional medications.
Paramedic: includes all preceding training levels, advanced assessment and
management skills, various invasive skills, and extensive pharmacology
interventions. This is the highest level of prehospital care outlined in the National
EMS Education Standards.
What are EMT roles and responsibilities? - Equipment preparedness
Emergency vehicle operations
Establish, maintain scene safety
Patient assessment and treatment
Lifting and moving
Strong verbal and written communication skills
,Patient advocacy
Professional development
Quality improvement
Illness and injury prevention
Maintain certification/licensure
What is the role of the medical director? - The medical director is a physician
responsible for providing medical oversight. The medical director oversees quality
improvement.
What are the two types of medical direction? - Online medical direction: direct
contact between the physician and EMT via or radio.
Offline medical direction: written guidelines and protocols.
What is an EMT's first priority? - The EMT's first priority is always his or her own
safety. Scene safety is always the top priority!
The EMT's safety priorities after personal safety are for his/her partner(s), patients
and bystanders.
What are the types of stress? - Acute stress: an immediate physiological and
psychological reaction to a specific event.
Delayed stress: a stress reaction that develops after the stressful event. It does not
interfere with the EMT's ability to perform during the stressful event. PTSD is an
example of delayed stress.
Cumulative stress: the result of exposure to stressful situations over a prolonged
period of time.
What are the stages of grief? - Denial
Anger
Bargaining
Depression
Acceptance
How can you prevent the risk of infection? - Immediately report exposures to the
designated infection control officer.
Handwashing is the single most important way to prevent the spread of infection.
Hand sanitizers can be effective, but soap and water is preferred when available.
,What are the two types of PPE? - Minimum PPE: gloves and eye protection should
be used during any patient contact situation.
Expanded PPE: use disposable gown and mask for significant contact with any body
fluid--for example, during childbirth. Use a high-efficiency particulate air (HEPA)
mask o N-95 respirator for suspected airborne disease exposure, such as tuberculosis.
What are emergency moves? - These are used when the scene is dangerous and the
patient must be moved before providing patient care. Types of emergency moves
include the armpit-forearm drag, shirt drag, and blanket drag.
What is an urgent move? - Used when the patient has potentially life-threatening
injuries or illness and must be moved quickly for evaluation and transport.
Rapid extrication: an urgent move used for patients in a motor vehicle; it requires
multiple rescuers and a long backboard. The patient is rotated onto a backboard with
manual cervical spine precautions and removed from the vehicle.
What are non-urgent moves? - Used when there are no hazards and no life-
threatening conditions are apparent.
Types of non-urgent moves include direct ground lift, extremity lift, direct carry
method, and draw sheet method.
What is the log roll technique? - Commonly used to place a patient on a backboard or
assess the posterior.
Can be done while maintaining manual cervical spine precautions.
Should have at least three trained personnel. The person controlling manual cervical
spine protection should direct the log roll.
What are special considerations for bariatric patients? - Obese patients pose
additional challenges and risks to providers during lifting and movement.
Some EMS systems have special bariatric ambulances with specialized equipment,
automated lifting systems, and wider stretchers capable of a greater weight capacity.
What is supine hypotensive syndrome? - Patients in the later stages of pregnancy
should not be placed supine due to the risk of supine hypotensive syndrome. Place
the pregnant patient on her left side. If patient has potential cervical spine trauma, tilt
backboard to the left about 20 degrees.
When can patients be restrained? - In general, patients may be forcibly restrained if
they pose a significant, immediate threat to you, your partner, or others.
Restraining a patient against his will is a last resort.
, Anticipate and plan. Request law enforcement assistance. Contact medical direction
when possible.
Guidelines for restraining a patient:
-Get additional help whenever possible; at least 4 people is recommended.
-Use the minimum amount of force necessary to protect yourself, the patient and
others.
-Secure patient supine, with backboard if available. DO NOT secure the patient in a
prone position.
-Use soft, padded restraints.
-Monitor the patient's level of consciousness, airway, and distal circulation
continuously.
-Thoroughly document the reason for restraining the patient, the method of restraint,
the duration of restraint, and frequent reassessment of the patient while restrained.
What is the use of force doctrine? - The EMT must act reasonably to prevent harm to
a patient being forcibly restrained. The use of force must be protective, not punitive.
What is scope of practice? - Scope of practice outlines the actions a provider is
legally allowed to perform based on his or her license or certification level.
Scope of practice is tied to the licensure or certification, not the individual's
knowledge or experience.
Each state determines the scope of practice for its EMS providers.
What is standard of care? - Standard of care is the degree of care a reasonable person
with similar training would provide in a similar situation.
Standard of care requires EMTs to competently perform the indicated assessment and
treatment within their scope of practice.
What are sources that help establish standard of care? - National EMS Education
Standards
State protocols and guidelines
Medical direction
EMS agency's policies and procedures
Reputable textbooks
Care considered acceptable by similarly trained providers in the same community.
What is informed consent? - Informed consent is required from all patients who are
alert and competent.
-Patient must be informed of your carer plan and associated risks of accepting or
refusing care and transport.
Where does the modern EMS system have its origin?
- The modern EMS system has its origins in funeral homes, which often operated
ambulances. However, funeral home operators were often serving competing
business interests and patients received little trained care until the hospital.
What is considered the "birth" of EMS?
- In 1966, a paper titled "Accidental Death and Disability: The Neglected Disease of
Modern Society" is published by the National Academy of Sciences. This paper is
widely known in the EMS profession as the White Paper. The White Paper is widely
considered the birth of modern EMS. It spotlighted inadequacies of prehospital care
in the United States, particularly related to trauma.
Who developed the first EMT National Standard Curriculum?
- Early in the 1970s, the US Department of Transportation developed the first EMT
National Standard Curriculum.
What are the levels of EMS training?
- Emergency Medical Responder (EMR): provides basic, immediate care including
bleeding control, CPR, AED and emergency childbirth.
Emergency Medical Technician (EMT): includes all EMR skills, advanced oxygen
and ventilation skills, pulse oximetry, noninvasive blood pressure monitoring, and
administration of certain medications.
Advanced Emergency Medical Technician (AEMT): includes all EMT skills,
advanced airway devices, intravenous and intraosseous access, blood glucose
monitoring, and administration of additional medications.
Paramedic: includes all preceding training levels, advanced assessment and
management skills, various invasive skills, and extensive pharmacology
interventions. This is the highest level of prehospital care outlined in the National
EMS Education Standards.
What are EMT roles and responsibilities? - Equipment preparedness
Emergency vehicle operations
Establish, maintain scene safety
Patient assessment and treatment
Lifting and moving
Strong verbal and written communication skills
,Patient advocacy
Professional development
Quality improvement
Illness and injury prevention
Maintain certification/licensure
What is the role of the medical director? - The medical director is a physician
responsible for providing medical oversight. The medical director oversees quality
improvement.
What are the two types of medical direction? - Online medical direction: direct
contact between the physician and EMT via or radio.
Offline medical direction: written guidelines and protocols.
What is an EMT's first priority? - The EMT's first priority is always his or her own
safety. Scene safety is always the top priority!
The EMT's safety priorities after personal safety are for his/her partner(s), patients
and bystanders.
What are the types of stress? - Acute stress: an immediate physiological and
psychological reaction to a specific event.
Delayed stress: a stress reaction that develops after the stressful event. It does not
interfere with the EMT's ability to perform during the stressful event. PTSD is an
example of delayed stress.
Cumulative stress: the result of exposure to stressful situations over a prolonged
period of time.
What are the stages of grief? - Denial
Anger
Bargaining
Depression
Acceptance
How can you prevent the risk of infection? - Immediately report exposures to the
designated infection control officer.
Handwashing is the single most important way to prevent the spread of infection.
Hand sanitizers can be effective, but soap and water is preferred when available.
,What are the two types of PPE? - Minimum PPE: gloves and eye protection should
be used during any patient contact situation.
Expanded PPE: use disposable gown and mask for significant contact with any body
fluid--for example, during childbirth. Use a high-efficiency particulate air (HEPA)
mask o N-95 respirator for suspected airborne disease exposure, such as tuberculosis.
What are emergency moves? - These are used when the scene is dangerous and the
patient must be moved before providing patient care. Types of emergency moves
include the armpit-forearm drag, shirt drag, and blanket drag.
What is an urgent move? - Used when the patient has potentially life-threatening
injuries or illness and must be moved quickly for evaluation and transport.
Rapid extrication: an urgent move used for patients in a motor vehicle; it requires
multiple rescuers and a long backboard. The patient is rotated onto a backboard with
manual cervical spine precautions and removed from the vehicle.
What are non-urgent moves? - Used when there are no hazards and no life-
threatening conditions are apparent.
Types of non-urgent moves include direct ground lift, extremity lift, direct carry
method, and draw sheet method.
What is the log roll technique? - Commonly used to place a patient on a backboard or
assess the posterior.
Can be done while maintaining manual cervical spine precautions.
Should have at least three trained personnel. The person controlling manual cervical
spine protection should direct the log roll.
What are special considerations for bariatric patients? - Obese patients pose
additional challenges and risks to providers during lifting and movement.
Some EMS systems have special bariatric ambulances with specialized equipment,
automated lifting systems, and wider stretchers capable of a greater weight capacity.
What is supine hypotensive syndrome? - Patients in the later stages of pregnancy
should not be placed supine due to the risk of supine hypotensive syndrome. Place
the pregnant patient on her left side. If patient has potential cervical spine trauma, tilt
backboard to the left about 20 degrees.
When can patients be restrained? - In general, patients may be forcibly restrained if
they pose a significant, immediate threat to you, your partner, or others.
Restraining a patient against his will is a last resort.
, Anticipate and plan. Request law enforcement assistance. Contact medical direction
when possible.
Guidelines for restraining a patient:
-Get additional help whenever possible; at least 4 people is recommended.
-Use the minimum amount of force necessary to protect yourself, the patient and
others.
-Secure patient supine, with backboard if available. DO NOT secure the patient in a
prone position.
-Use soft, padded restraints.
-Monitor the patient's level of consciousness, airway, and distal circulation
continuously.
-Thoroughly document the reason for restraining the patient, the method of restraint,
the duration of restraint, and frequent reassessment of the patient while restrained.
What is the use of force doctrine? - The EMT must act reasonably to prevent harm to
a patient being forcibly restrained. The use of force must be protective, not punitive.
What is scope of practice? - Scope of practice outlines the actions a provider is
legally allowed to perform based on his or her license or certification level.
Scope of practice is tied to the licensure or certification, not the individual's
knowledge or experience.
Each state determines the scope of practice for its EMS providers.
What is standard of care? - Standard of care is the degree of care a reasonable person
with similar training would provide in a similar situation.
Standard of care requires EMTs to competently perform the indicated assessment and
treatment within their scope of practice.
What are sources that help establish standard of care? - National EMS Education
Standards
State protocols and guidelines
Medical direction
EMS agency's policies and procedures
Reputable textbooks
Care considered acceptable by similarly trained providers in the same community.
What is informed consent? - Informed consent is required from all patients who are
alert and competent.
-Patient must be informed of your carer plan and associated risks of accepting or
refusing care and transport.
