1: Introduction to Emergency Medical Care

Cognitive Objectives (1 of 2)

1-1.1 Define Emergency Medical Services (EMS) systems.

1-1.2 Differentiate the roles and responsibilities of the EMT-Basic from other prehospital care providers.

1-1.3 Describe the roles and responsibilities related to personal safety.

1-1.4 Discuss the roles and responsibilities of the EMT-Basic towards the safety of the crew, the patient, and bystanders.

Cognitive Objectives (2 of 2)

1-1.5 Define quality improvement and discuss the EMT-Basic's role in the process.

1-1.6 Define medical direction and discuss the EMT-Basic's role in the process.

1-1.7 State the specific statutes and regulations in your state regarding the EMS system.

Affective Objectives

1-1.8 Assess areas of personal attitude and conduct of the EMT-Basic.

1-1.9 Characterize the various methods used to access the EMS system in your community.

• There are no psychomotor objectives for this chapter.

History of Emergency MedicalServices (1 of 3)

• Emergency care developed during warfare at the beginning of the 20th century.

• By the 1960s, domestic emergency care lagged behind.

• Staffed emergency departments were often limited to large urban areas.

History of Emergency MedicalServices (2 of 3)

• Accidental Death and Disability: The Neglected Disease of Modern Society (1966)

• Recommended:– Development of training– Development of federal guidelines and policies– Provide emergency care and transport– Establish staffed emergency departments

History of Emergency MedicalServices (3 of 3)

• Highway Safety Act and the Emergency Medical Act created funding

• DOT developed the first National Standard Curriculum for training EMTs in the early 1970s

• EMS established in most of the United States by 1980

Levels of Training

• Lay Rescuer

• First Responder

• EMT-Basic

• EMT-Intermediate

• EMT-Paramedic

Components of the EMSSystem (1 of 5)

• Access

– Easy access in an emergency is essential.

• Administration and Policy

– Policies and procedures are essential.

Components of the EMSSystem (2 of 5)

• Medical Direction and Control

– Each EMS system must have a medical director.

– Medical control may take place online or

off-line.

• Quality Control and Improvement

– Process used to ensure patient care meets standards.

Components of the EMSSystem (3 of 5)

• Other physician input– Local, state, and national specialists provide

guidance.• State-specific statutes and regulations

– All EMS systems are subject to state regulations.• Equipment

– Properly maintained equipment is essential.

Components of the EMSSystem (4 of 5)

• Ambulance– EMT-Bs must be familiar with the ambulance and

its functions.• Specialty Centers

– Focusing on care for certain types of patients• Interfacility Transports

– Transportation of patients from one care facility to another

Components of the EMSSystem (5 of 5)

• Hospital Staff

– EMS is part of the whole continuum of care.

• Working with Public Safety Agencies

– EMT-Bs should understand the role of each agency.

• Training

– Quality of care depends on training.

Providing a Coordinated Continuum of Care

• 1st Phase—access to EMS system

• 2nd Phase—out of hospital care

• 3rd Phase—emergency department care

• 4th Phase—definitive care

Roles and Responsibilitiesof the EMT-B (1 of 2)

• Personal safety

– Safety of crew, patient, and bystanders

• Patient assessment

– Patient care based on assessment findings

Roles and Responsibilitiesof the EMT-B (2 of 2)

• Lifting and moving patients safely

• Transport and transfer of care

• Record keeping/data collection

• Patient advocacy/confidentiality

Professional Attributesof the EMT-B

• Puts patient’s needs as a priority without endangering self

• Maintains professional appearance and manner• Performs under pressure• Treats patients and families with understanding,

respect, and compassion• Respects patient confidentiality

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Professional Appearance

The EMT-B should maintaina professional appearance and manner.

Continuing Education

• Continuing education required to renew certification• Keep up-to-date on new procedures and issues on

local, state, and national levels• Maintain knowledge and skills

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Review

1. Which of the following is an example of care that is provided using standard orders?

A. Medical control is contacted by the EMT-B after a patient with chest pain refuses EMS care

B. The EMT-B defibrillates a cardiac arrest patient, begins CPR, and then contacts medical control

C. A physician gives the EMT-B an order via radio to administer oral glucose to a diabetic patient

D. Following an overdose, the EMT-B contacts the medical director for permission to give activated charcoal

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Review

Answer: B

Rationale: Standing orders—a form of offline (indirect) medical control—involves performing certain life-saving interventions (ie, CPR, defibrillation, bleeding control) before contacting a physician for further instructions.

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Review (1 of 2)

1. Which of the following is an example of care that is provided using standard orders?

A. Medical control is contacted by the EMT-B after a patient with chest pain refuses EMS care

Rationale: This example is online medical control given via the phone or radio.

B. The EMT-B defibrillates a cardiac arrest patient, begins CPR, and then contacts medical control

Rationale: Correct answer

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Review (1 of 2)

1. Which of the following is an example of care that is provided using standard orders?

C. A physician gives the EMT-B an order via radio to administer oral glucose to a diabetic patient

Rationale: This example is online medical control given via the phone or radio.

D. Following an overdose, the EMT-B contacts the medical director for permission to give activated charcoal

Rationale: This example is online medical control given via the phone or radio.

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Review

2. Quality control in an EMS system is the ultimate responsibility of the:

A. paramedic.B. lead EMT-B.C. medical director.D. EMS administrator.

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Review

Answer: C

Rationale: The medical director is responsible for maintaining quality control, which ensures that all staff members who are involved in caring for patients meet the standard of care on every call.

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Review2. Quality control in an EMS system is the ultimate responsibility of

the:

A. paramedic.Rationale: A paramedic has the knowledge and mastery of basic

and advanced life support skills.B. lead EMT-B.Rationale: This is the senior EMT-B with a service or company.C. medical director.Rationale: Correct answerD. EMS administrator.Rationale: The EMS administrator sees to the daily operations and

overall direction of the service or company.

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Review

3. Upon arriving at the scene of a domestic dispute, you hear yelling and the sound of breaking glass from inside the residence. You should:

A. immediately gain access to the patient.B. carefully enter the house and then call the police.C. retreat to a safe place until law enforcement arrives.D. tell the patient to exit the residence so you can

provide care.

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Review

Answer: C

Rationale: Never enter a scene in which signs of violence are present. These include yelling, screaming, or the sound of breaking glass. Law enforcement must secure the scene prior to the EMT-B's entry.

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Review3. Upon arriving at the scene of a domestic dispute, you hear yelling

and the sound of breaking glass from inside the residence. You should:

A. immediately gain access to the patient.Rationale: Never enter a scene in which signs of violence are

present. Law enforcement must secure the scene. B. carefully enter the house and then call the police.Rationale: Never enter a scene in which signs of violence are

present. Law enforcement must secure the scene.C. retreat to a safe place until law enforcement arrives.Rationale: Correct answerD. tell the patient to exit the residence so you can provide care.Rationale: Never enter a scene in which signs of violence are

present. Law enforcement must secure the scene.

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4. Which of the following is NOT a component of continuous quality improvement (CQI)?

A. Periodic review of run reportsB. Discussion of needs for improvementC. Negative feedback to those who make mistakes while

on a callD. Remedial training as deemed necessary by the

medical director

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Review

Answer: C

Rationale: The purpose of CQI is to ensure that the standard of care is provided on all calls. This involves periodic run report reviews, discussing needs for improvement, and providing remedial training as deemed necessary by the medical director. Positive feedback should be provided during this process.

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Review4. Which of the following is NOT a component of continuous quality

improvement (CQI)?

A. Periodic review of run reportsRationale: This is a part of CQI.B. Discussion of needs for improvementRationale: This is a part of CQI.C. Negative feedback to those who make mistakes while on a callRationale: Correct answerD. Remedial training as deemed necessary by the medical directorRationale: This is a part of CQI.

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Review

5. All of the following are responsibilities of the EMS medical director, EXCEPT:

A. evaluating patient insurance information.B. serving as liaison with the medical community.C. ensuring that the appropriate standards are met by

EMT-Bs.D. ensuring appropriate EMT education and continuing

training.

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Review

Answer: A

Rationale: Responsibilities of the medical director include serving as liaison with the medical community, ensuring that appropriate standards are met by EMS personnel, and ensuring appropriate EMT education and continuing training. Insurance matters are handled by the EMS billing department.

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Review5. All of the following are responsibilities of the EMS medical

director, EXCEPT:

A. evaluating patient insurance information.Rationale: Correct answer B. serving as liaison with the medical community.Rationale: This is the responsibility of the medical director.C. ensuring that the appropriate standards are met by EMT-Bs.Rationale: This is the responsibility of the medical director.D. ensuring appropriate EMT education and continuing training.Rationale: This is the responsibility of the medical director.

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6. Which of the following situations would MOST likely disqualify a person for EMS certification?

A. A misdemeanor at the age of 17B. Driving under the influence of alcoholC. Possessing a valid driver's license from another stateD. A mild hearing impairment that is corrected with

hearing aids

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Answer: B

Rationale: In most states, a person may be denied EMS certification for being convicted of a felony, such as driving under the influence of alcohol or other drugs.

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Review6. Which of the following situations would MOST likely disqualify a

person for EMS certification?

A. A misdemeanor at the age of 17Rationale: Most states seal misdemeanor juvenile records, so it

would not likely disqualify a person.B. Driving under the influence of alcoholRationale: Correct answerC. Possessing a valid driver's license from another stateRationale: Most states require providers to have a valid in-state

driver’s license.D. A mild hearing impairment that is corrected with hearing aidsRationale: If the performance of tasks are not impaired, it would not

disqualify a person.

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7. Which of the following should be the EMT-B’s highest priority?

A. Controlling severe bleedingB. Maintaining a patient's airwayC. Ensuring the safety of his or her partnerD. Sizing up every scene prior to entering

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Review

Answer: D

Rationale: Personal safety is of utmost concern for the EMT-B. This involves sizing up a scene to determine whether or not the scene is safe to enter. This will ensure the safety of all personnel.

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Review7. Which of the following should be the EMT-B’s highest priority?

A. Controlling severe bleedingRationale: This is the priority once the patient’s airway and

breathing have been addressed.B. Maintaining a patient's airwayRationale: This is most the important priority once patient contact is

made.C. Ensuring the safety of his or her partnerRationale: Safety is first determined during scene size-up. You do

not enter an unsafe scene.D. Sizing up every scene prior to enteringRationale: Correct answer

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8. A patient who requires cardiac monitoring in the field would require, at a minimum, which level of EMS provider?

A. First responderB. EMT-BasicC. EMT-ParamedicD. EMT-Intermediate

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Answer: C

Rationale: Of all levels of EMS provider, the EMT-Paramedic is trained in advanced medical care, including cardiac monitoring, intravenous therapy, and the administration of a variety of emergency drugs.

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Review8. A patient who requires cardiac monitoring in the field would

require, at a minimum, which level of EMS provider?

A. First responderRationale: This level is trained to initiate BLS before an ambulance

arrives.B. EMT-BasicRationale: This level has the knowledge and skills to provide basic

emergency care.C. EMT-ParamedicRationale: Correct answer D. EMT-IntermediateRationale: This level can interpret cardiac rhythms, but cannot

perform cardiac monitoring.

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9. Which of the following is a professional responsibility of the EMT-B?

A. Telling the family of a dying patient that everything will be OK

B. Maintaining only the skills that he or she feels uncomfortable with

C. Maintaining a professional demeanor even under the most stressful situations

D. Advising an emergency department nurse that patient reports are only given to a physician.

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Answer: C

Rationale: Since the public relies upon the EMT-B to remain calm when others cannot, he or she must project a professional and calm demeanor even when under extreme stress.

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Review9. Which of the following is a professional responsibility of the EMT-

B?

A. Telling the family of a dying patient that everything will be OKRationale: Discussions about dying patients are handled by

providers of a higher level.B. Maintaining only the skills that he or she feels uncomfortable withRationale: The quality of care depends upon your ability, so you

must maintain all of your skills.C. Maintaining a professional demeanor even under the most

stressful situationsRationale: Correct answer D. Advising an emergency department nurse that patient reports are

only given to a physician.Rationale: You must give your report to the receiving hospital

emergency department staff, including a nurse.

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10. Emergency patient care occurs in four progressive phases. What occurs in the second phase?

A. Activation of EMSB. Initial prehospital careC. The patient receives definitive careD. Continued assessment and stabilization

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Answer: B

Rationale: EMS must be activated before the EMT can arrive, assess the patient, and begin initial care. After initial care and transport have been provided, the third phase is continued assessment and stabilization in the emergency department. The fourth and final phase is definitive specialized care.

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Review10. Emergency patient care occurs in four progressive phases.

What occurs in the second phase?

A. Activation of EMSRationale: This is part of the first (initial) phase.B. Initial prehospital careRationale: Correct answerC. The patient receives definitive careRationale: This is part of the fourth (final) phase.D. Continued assessment and stabilizationRationale: This is part of the third phase.