Emergency Medical Services Overview

Questions and Answers

What does EMS stand for?

Emergency Medical Services

In 1966, the National Highway Safety Act charged which agency with the development of EMS standards?

Department of Transportation (DOP)

What is the chain of resources in the EMS system?

Patient > citizen calls 911 > 911 dispatcher > first responders > EMT > emergency department staff > allied health staff

Which communication system is able to identify the number and location of the phone from which a caller is calling 911?

Enhanced 911 Signup and view all the answers

What is the role of Emergency Medical Dispatchers?

Gather information from person experiencing an emergency and potentially provide assistance and instruction as needed prior to the arrival of EMS on scene Signup and view all the answers

What factors might influence our decision-making skills?

Stress, mental state, personal interests, biases Signup and view all the answers

What is the role of the medical director of an EMS system?

A physician that has ultimate responsibility for patient care aspects of EMS system Signup and view all the answers

On-line medical control is when a medical director is contacted via phone or radio to ask for _____ .

permissions Signup and view all the answers

What is the difference between on-line and off-line medical control?

Offline control are standing orders and protocol which remain constant in each scenario; Online control is when a medical director is contacted via phone or radio to ask for permissions Signup and view all the answers

What role does quality improvement play in EMS?

Process of continuous self-review with the purpose of identifying & correcting aspects of the system Signup and view all the answers

What are standard precautions?

Equipment and procedures that protect against the blood and body fluids of the patient Signup and view all the answers

What are the four routes of infection?

Inhalation, Ingestion, Absorption, Injection Signup and view all the answers

What are the four main infectious diseases of concern to EMTs?

Hepatitis B, Hepatitis C, Tuberculosis (TB), HIV/AIDS Signup and view all the answers

What is the Ryan White CARE Act?

Allows EMS providers the right to determine if they have been exposed to an infectious disease Signup and view all the answers

What are the three stages of stress?

1- Alarm (fight or flight); 2- Resistance (coping); 3- Exhaustion (loss of ability to adapt to stressor) Signup and view all the answers

What are the types of stress reactions?

-acute stress reaction; -delayed stress reaction; -cumulative stress reaction Signup and view all the answers

What is acute stress reaction?

-Often linked to catastrophe; -Occurs in EMTs and patients; -Signs and symptoms develop soon after incident; -Normal reactions to extraordinary situation; -May require professional intervention Signup and view all the answers

What is delayed stress reaction also known as?

PTSD Signup and view all the answers

What is cumulative stress reaction?

This reaction, also known as 'burnout', results from sustained low-level stressors and develop over a period of years. Signup and view all the answers

What does CISM stand for and what is its role in EMS?

Critical Incident Stress Management; a comprehensive system that includes education and resources to both prevent stress and to deal with stress appropriately when it occurs Signup and view all the answers

What are the 5 emotional stages of death and dying?

<ol> <li>denial; 2. anger; 3. bargaining; 4. depression; 5. acceptance</li> </ol> Signup and view all the answers

What is the responsibility of EMTs when using the wheeled ambulance stretcher?

EMTs are responsible for lifting the weight of the patient when lowering/raising the stretcher Signup and view all the answers

What is a power stretcher?

A stretcher equipped with hydraulics that limit the effort needed from EMT to lift and lower the patient Signup and view all the answers

What is a bariatric stretcher used for?

Used for obese patients Signup and view all the answers

What is a stair chair used for?

Used to bring a conscious patient down to the waiting stretcher if the patient's condition allows him or her to be placed in a sitting position; can be used to transfer a conscious patient up or down a flight of stairs Signup and view all the answers

What is a contraindication for use of the stair chair in moving a patient?

Patient must be conscious Signup and view all the answers

What is the purpose of a short spine board?

Primarily for removing patients from vehicles when a neck or spine injury is suspected Signup and view all the answers

What is a scoop stretcher typically used for?

Typically used on patients who have experienced suspected hip injury Signup and view all the answers

What is a flexible stretcher useful for?

Can be useful in restricted areas or narrow hallways Signup and view all the answers

What is a basket stretcher also known as?

A Stokes litter Signup and view all the answers

What is the recovery position?

A side-lying position used to maintain a clear airway in unconscious patients without injuries who are breathing adequately Signup and view all the answers

What does shock position refer to?

Supine patient Signup and view all the answers

What situations require an emergency move?

Hazardous scene; Care of life-threatening conditions that require repositioning; The necessity to reach other patients Signup and view all the answers

What situations require an urgent move?

Required treatment can be performed only if patient is moved; Patient's condition rapidly deteriorating Signup and view all the answers

What defines a non-urgent move?

Patient stable; No immediate life threat; Patient can be assessed, treated, and moved in a normal way Signup and view all the answers

What are the requirements for patient refusal of care?

Patient is: Legally able to consent; Mentally competent and oriented; Fully informed of risks; Sign release form Signup and view all the answers

What is a DNR?

Do Not Resuscitate order (DNR) Signup and view all the answers

What is the difference between expressed consent and implied consent?

Expressed consent: Must be informed; Patient verbally gives consent; Implied consent: Assumed consent Signup and view all the answers

What is the scope of practice?

Regulations and ethical considerations that define extent or limits of job duties (what an EMT can do) Signup and view all the answers

What is standard of care?

Care expected from EMT with similar training for patient in a similar situation (how the EMT should perform their job) Signup and view all the answers

What is the duty to act?

Obligation to provide care; While on duty, EMT obligated to provide care if no threat to safety Signup and view all the answers

What must happen to prove negligence?

EMT had duty to act; Breach of duty—EMT failed to provide standard of care expected or failed to act; Proximate causation—patient suffered harm because of EMT action or inaction Signup and view all the answers

Who can a patient's information be shared with without breaching confidentiality?

Can be shared with other health care personnel as part of patient's continuing care Signup and view all the answers

What are examples of evidence of a crime scene?

-Condition of scene; -Patient; -Fingerprints and footprints; -Microscopic evidence Signup and view all the answers

What is an anatomical position?

To stand erect with arms at the sides and palms of the hands turned forward Signup and view all the answers

What are the anatomical terms for front and back?

Front: anterior; Back: posterior Signup and view all the answers

What are the anatomical terms for above and below?

Above: superior; Below: inferior Signup and view all the answers

Define medial and lateral.

Medial: toward the midline or median plane; Lateral: away from the midline or median plane Signup and view all the answers

What position allows vomitus and secretions to drain from the mouth?

Recovery Position Signup and view all the answers

Where does the upper airway begin and end?

Begins at mouth/nose; Ends at glottic opening Signup and view all the answers

What happens at the alveoli?

Tiny sacs in grape-like bunches at the end of the airway; Surrounded by pulmonary capillaries; Oxygen and carbon dioxide diffuse through pulmonary capillary membranes Signup and view all the answers

What is the most common airway obstruction due to altered mental status?

Poor muscle tone Signup and view all the answers

What are maneuvers to open the airway?

-Head-tilt, chin-lift maneuver; -Jaw-thrust maneuver Signup and view all the answers

What are the differences in pediatric vs. adult airway?

Compared to adults, children have: Smaller mouth and nose; Larger tongue; Narrow, flexible trachea Signup and view all the answers

What findings indicate airway problems?

-Inability to speak; -Unusual raspy quality to voice; -Abnormal breathing sounds; -Absent or minimal chest movements; -No air felt or heard (air exchange below normal); -Foreign bodies in airway Signup and view all the answers

What are the 3 steps in caring for an airway?

<ol> <li>Make it; 2. Check it; 3. Keep it</li> </ol> Signup and view all the answers

What are the 2 types of airway adjuncts?

-Oropharyngeal airway (OPA) - Oral Airway; -Nasopharyngeal airway (NPA) - Nasal Airway Signup and view all the answers

What are the 3 most important rules to suctioning the airway?

-Suction no longer than 10 seconds at a time; -Suction only as far as you can see; -Place tip or catheter where you want to begin suctioning, suction only on the way out Signup and view all the answers

What is the difference between inhalation and exhalation?

Inhalation is an active process; Exhalation is a passive process Signup and view all the answers

What is tidal volume?

Amount of air moved in one breath Signup and view all the answers

What is dead space air?

Air moved in ventilation not reaching alveoli Signup and view all the answers

What is alveolar ventilation?

Air actually reaching alveoli Signup and view all the answers

What is external respiration?

Diffusion of oxygen and carbon dioxide between alveoli and circulating blood Signup and view all the answers

Study Notes

Emergency Medical Services (EMS)

EMS stands for Emergency Medical Services.
The Department of Transportation (DOP) developed the EMS standards under the National Highway Safety Act of 1966.
The chain of resources in the EMS system involves the patient, citizen calls 911, 911 dispatcher, first responders, EMT, emergency department staff, and allied health staff.
Enhanced 911 identifies the caller's number and location when dialing 911.

Emergency Medical Dispatch

Emergency Medical Dispatchers gather information from those in emergencies and provide pre-arrival assistance.
Decision-making can be influenced by stress, mental state, personal interests, and biases.

Medical Oversight and Quality Control

The medical director has ultimate responsibility for patient care in the EMS system.
On-line medical control involves contacting a medical director for permissions; off-line control consists of standing orders and protocols.
Quality improvement is an ongoing self-review process aimed at improving system performance.

Infection Control

Standard precautions involve using equipment and procedures to protect against blood and bodily fluids.
Four routes of infection: inhalation, ingestion, absorption, injection.
Four main infectious diseases of concern for EMTs: Hepatitis B, Hepatitis C, Tuberculosis (TB), HIV/AIDS.
The Ryan White CARE Act allows EMS providers to determine exposures to infectious diseases through an agency control officer.

Stress Management

Three stages of stress: alarm (fight or flight), resistance (coping), exhaustion (inability to adapt).
Types of stress reactions include acute stress reaction, delayed stress reaction (PTSD), and cumulative stress reaction (burnout).
Critical Incident Stress Management (CISM) provides education and resources for preventing and addressing stress.

Patient Handling and Transportation

EMS equipment includes wheeled ambulance stretchers, power stretchers (hydraulics), bariatric stretchers (obese patients), and stair chairs for moving conscious patients.
Non-urgent moves involve stable patients without immediate threats; urgent moves are for patients whose conditions are deteriorating, while emergency moves are necessary to address life-threatening conditions.
Requirements for patient refusal of care include: legal ability to consent, mental competence, full risk disclosure, and signing a release form.

Legal Considerations

A Do Not Resuscitate order (DNR) is a legal document that communicates a patient's wishes in case they cannot speak.
Expressed consent involves the patient's verbal approval; implied consent is assumed when a patient is unable to give consent.
Duty to act requires EMTs to provide care when on duty, ensuring no threat to their safety.

Airway Management

The anatomical position involves standing erect with palms facing forward.
Airway begins at the mouth/nose and ends at the glottic opening, with alveoli facilitating gas exchange through diffusion.
Airway obstructions often stem from poor muscle tone in altered mental states, with opening maneuvers including head-tilt, chin-lift and jaw-thrust.
Pediatric airways differ from adults: children have smaller mouths, larger tongues, and narrower tracheas.

Ventilation

Inhalation is active due to diaphragm contraction; exhalation is passive, using diaphragm relaxation. Ventilation refers to both inhaling and exhaling.
Tidal volume describes the air moved in a single breath, whereas dead space volume pertains to air not reaching the alveoli. Alveolar ventilation refers to air actually reaching the alveoli.
External respiration involves the gas exchange between alveoli and blood, while internal respiration refers to gas exchange at the cellular level.

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Description

This quiz covers the essentials of Emergency Medical Services (EMS), including the chain of resources, roles involved, and the importance of emergency medical dispatch. It also delves into the medical oversight and quality control aspects of EMS operations. Test your knowledge on the standards set by the Department of Transportation and the critical decision-making processes in emergency situations.