Introduction to Emergency Medical Care Part 2

21) Which of the following is a physical trait necessary for performing the duties of an EMT? A) Nonjudgmental and fair B) Ability to lift and carry 200 pounds C) Ability to speak clearly D) Ability to remain calm in stressful situations Answer: C Explanation: A) INCORRECT. Being nonjudgmental and fair are important personal attributes for an EMT to have, but they are not physical traits. B) INCORRECT. An EMT would not be expected to lift or carry over 125 pounds, so it would not be considered a necessary ability to carry 200 pounds. C) CORRECT. An important requirement of an EMT is to have the physical ability to give and receive oral and written instructions. D) INCORRECT. An EMT's ability to remain calm in stressful situations is a critical personal trait. 22) Which of the following is a personality trait required of EMTs? A) Ability to lift and carry 125 pounds B) Awareness of problems with color vision C) Ability to dominate the patient D) Control of personal habits Answer: D Explanation: A) INCORRECT. A physical ability is not a personality trait. B) INCORRECT. Awareness of a physical problem, such as color vision, is not related to the qualities that make up a person's character. C) INCORRECT. Although the ability to dominate others may be considered a personality trait, it is not one required to be an EMT. D) CORRECT. To reduce the chances of providing improper care or causing patient discomfort, EMTs should be able to control their personal habits appropriately. 23) Which of the following best describes training that supplements the EMT's original training and that is usually taken in regular intervals? A) Distance education B) EMT training program C) Recertification D) Continuing education Answer: D Explanation: A) INCORRECT. Distance education refers to the way training or courses are delivered, not specifically to the topic. B) INCORRECT. An EMT training program is the initial certification course, not the supplemental training that follows it. C) INCORRECT. Recertification refers to the renewal of an EMT certificate, not specifically to regular ongoing training. D) CORRECT. Ongoing education that supplements an EMT's original training is called Continuing Education (CE). 24) During the new employee orientation, the training officer meets with the new EMTs and explains to them the monthly training schedule and the classes they must attend for EMT recertification. One of the new EMTs asks the training officer why they have to keep taking EMT courses if they already passed the EMT examination. What is the best answer? A) The state requires the training. B) EMTs forget everything once they pass the EMT exam. C) It looks good to a jury should the service be sued. D) EMS is constantly evolving in response to evidence-based research. Answer: D Explanation: A) INCORRECT. Although continuing education is mandated by most states, it is not the reason continuing education is performed. B) INCORRECT. Continuing education does provide EMTs with a good review of rarely used material; however, it is not accurate that EMTs forget everything once they pass the EMT exam. C) INCORRECT. Although continuing education can demonstrate to a jury that the service is providing adequate training, one of the goals of continuing education is to prevent lawsuits from happening in the first place, rather than to look good once a lawsuit has been filed. D) CORRECT. Evidence-based scientific research is what drives changes in EMS. New and improved treatment techniques are derived from this research and the EMT needs to keep abreast of these dynamic changes to his profession. 25) Which of the following is a personal trait an EMT should demonstrate? A) Self-starter B) Strong student C) Strong communication D) Good eyesight Answer: A Explanation: A) CORRECT. One of the personal traits of an effective EMT is that of being a self-starter. B) INCORRECT. Being a strong student is a good quality, but personal traits relate to the behavior and demeanor of the EMT, not her strength in a particular task. C) INCORRECT. Strong communication is obviously important for an EMT, but it is the result of certain personal traits (respectful, able to listen, controlled in tone, etc.) — not a personal trait itself. D) INCORRECT. Good eyesight is a critical physical trait for an EMT to have. 26) What is NOT one the common settings that an EMT may work in? A) Rural/wilderness settings B) Ambulance services C) Hospitals D) Fire departments Answer: C Explanation: A) INCORRECT. One common setting that EMTs work in is rural/wilderness settings. B) INCORRECT. One common setting that EMTs work in is ambulance services. C) CORRECT. EMTs do not work in a hospital. D) INCORRECT. One common setting that EMTs work in is fire departments. 27) The National Registry of Emergency Medical Technicians (NREMT) was founded to establish which of the following? A) An education curriculum for EMT courses B) Quality oversight of emergency medical services practices C) National standards for emergency medical services personnel D) Quality improvement and quality assurance programs for emergency medical services Answer: C Explanation: A) INCORRECT. Although EMT course curricula are based on the standards provided by the NREMT, the National Registry was not founded to create them. B) INCORRECT. The NREMT created the standards used for modern EMS, but the organization does not oversee or determine the quality of provided services. C) CORRECT. In 1970, the National Registry of Emergency Medical Technicians (NREMT) was founded to establish national standards within the industry. D) INCORRECT. The NREMT developed the professional standards for emergency care personnel, but is not involved in quality improvement or any assurance of the care provided. 28) You have just come on duty. The EMT on the previous shift complains to you that the QI manager was giving him grief because he did not document three sets of vital signs on the patient record. The EMT is angry and does not understand why documenting three sets of vital signs is so important. What is the best answer you could give him? A) Vital signs are something you have to fill out because the state requires it. B) The recording of three sets of vital signs demonstrates that you were trending the patient's condition. C) It is important you show the QI manager that you are a team player. D) The report looks better when all the boxes are filled out. Answer: B Explanation: A) INCORRECT. The local or state governmental authority may or may not require three sets of vital signs; regardless, this should not be the primary reason to document them. B) CORRECT. Recording three sets of vital signs demonstrates that the EMT is reassessing the patient at the appropriate periodic intervals, which is important when providing care for a patient. C) INCORRECT. Teamwork is an important trait in an EMT, but is not the driving factor for recording vital signs. D) INCORRECT. QI is not concerned with how the report looks, but rather that the information in the report is complete and accurate. 29) Why is it important for EMTs to participate in quality improvement programs? A) To ensure that individuals making false calls for EMS are prosecuted B) To identify problem employees and create a corrective action plan C) To identify problems and develop a plan to prevent their recurrence D) To ensure adequate personnel are available for emergencies Answer: C Explanation: A) INCORRECT. The aim of any EMS quality improvement program is to continually improve the care and operations within the system — not to identify challenges with particular individuals in the community. EMTs play a critical part in quality improvement by identifying areas in need of improvement, participating in the improvement process and supporting the changes. B) INCORRECT. EMTs should participate in Quality Improvement (QI) programs to assist in bettering their EMS systems and processes, not to pinpoint and create action plans for specific individuals. C) CORRECT. EMS quality improvement programs consist of continuous self-review with the purpose of identifying aspects of the system that require improvement. Once a problem is identified, a plan is developed and implemented to prevent further occurrences of the same problem. It is critical that EMTs participate in this process because they usually have the best visibility to challenges within the system and can provide valuable insight into how to improve. D) INCORRECT. An EMT's participation in an EMS quality improvement program is not necessarily about adequate staffing. It is about the EMT helping to identify and fix any components in the system that cause inefficiencies and challenges to patient care. 30) After delivering a patient to the emergency department, you discuss with hospital staff the details of your care and ask for suggestions to improve your care. This is an example of your role in which of the following? A) Patient advocacy B) Transfer of care C) Quality improvement D) Continuing education Answer: C Explanation: A) INCORRECT. A patient advocate is the person who speaks up for the patient and pleads her cause. B) INCORRECT. Transfer of care is the process of turning care of a patient over to those with higher levels of training. C) CORRECT. Continuous self-review through numerous means with the purpose of identifying aspects of the system that require improvement is known as quality improvement. D) INCORRECT. Continuing education is ongoing structured training designed to supplement the EMT's original course. 31) The EMT's role in the quality improvement process includes becoming involved in the quality process, keeping carefully written documentation, obtaining feedback from patients and the hospital staff, continuing your education, and which of the following? A) Writing protocols and standing orders B) Maintaining your equipment C) Providing quality care D) Being a member of the QI committee Answer: B Explanation: A) INCORRECT. The Medical Director is responsible for writing protocols and standing orders. B) CORRECT. Maintaining equipment properly is an important role the EMT plays in the quality improvement process. C) INCORRECT. Providing quality care is an expectation of all EMTs, but it not part of the quality improvement process. D) INCORRECT. Although it can be beneficial, being a member of the QI committee is not an expected role for an EMT in the quality improvement process. 32) Which of the following is a role of the EMT in the quality improvement process? A) Taking responsibility for the actions of one's partner B) Writing complete patient care reports C) Critiquing performance of one's partner D) Assuring personal safety Answer: B Explanation: A) INCORRECT. The primary roles of an EMT in quality improvement include; preparing carefully written documentation, involvement in the system's quality improvement process, obtaining feedback from patients and hospital staff, maintaining equipment, and continuing education. Taking responsibility for the actions of others is not a part of the quality improvement process. B) CORRECT. Since much of an EMS system's clinical quality improvement data comes from patient care documentation, ensuring that each report is complete and accurate is a very important part of an EMT's involvement in quality improvement. C) INCORRECT. Critiquing the performance of other emergency responders is not a primary role for EMTs in the quality improvement process. An EMT can best assist the process by preparing carefully written documentation, being involved in the system's quality improvement process, obtaining feedback from patients and hospital staff, maintaining equipment, and continuing his education. D) INCORRECT. Although assuring personal safety is a very important responsibility for EMTs, it is not a role in the quality improvement process. Continuing education, equipment maintenance, gathering feedback from patients and hospital staff, preparing complete and accurate patient documentation, and getting involved in the EMS system's structured quality improvement program are all examples of roles for the EMT in a QI process. 33) Who assumes the ultimate responsibility for patient care rendered by the EMT? A) EMS supervisor B) EMT C) Director of quality assurance D) Medical Director Answer: D Explanation: A) INCORRECT. Although an EMS supervisor can be involved, the EMS service's Medical Director assumes ultimate responsibility for the care provided by an EMT. B) INCORRECT. Since every EMT operates under the license of the EMS service's Medical Director it is the Medical Director, not the EMT, who is ultimately responsible for the patient care. C) INCORRECT. In every EMS service or agency, the Medical Director is ultimately responsible for the patient care provided by the EMTs. D) CORRECT. The Medical Director of an EMS agency or service is ultimately responsible for all patient care because the EMTs work under the Medical Director's license. 34) The application of oxygen for a patient who is short of breath without having to contact the physician in the emergency department is an example of which of the following? A) On-line medical direction B) Standards of care C) Standing orders D) Breach of duty Answer: C Explanation: A) INCORRECT. On-line medical directions are orders from an on-duty physician given by radio or phone. B) INCORRECT. Standards of care refer to the expected actions of an EMT as compared to a reasonable person with the same level of training and in the same situation. It is not related to the authorization of specific skills. C) CORRECT. Standing orders are physician issued policies or protocols that authorize EMTs to perform particular skills in certain situations. D) INCORRECT. A breach of duty occurs when an EMT has a responsibility to care for a patient and does not follow through. 35) Which of the following BEST describes a list of steps the EMT should perform while assessing and managing emergency medical situations? A) Standing orders B) On-line medical direction C) Protocols D) Standard operating procedures Answer: C Explanation: A) INCORRECT. Standing orders, also called off-line medical direction, allow EMTs to give certain medications or perform certain procedures without speaking to the Medical Director or another physician. B) INCORRECT. On-line medical direction consists of orders from the on-duty physician given directly to an EMT in the field by radio or telephone. C) CORRECT. Protocols, which are developed by an agency's Medical Director, are lists of steps for assessment and interventions to be performed in different situations. D) INCORRECT. Standard operating procedures are a collection of policies around EMS agency operations and generally do not apply specifically to medical assessment or management. 36) A written authorization for an EMS provider to perform a particular skill in a specific situation is a(n): A) on-line protocol. B) standard of care. C) direct medical order. D) standing order. Answer: D Explanation: A) INCORRECT. Any "on-line" direction indicates a verbal order from a physician to an EMT, usually by phone or radio. B) INCORRECT. Standard of care refers to the expected actions of an EMT as compared to a reasonable person with the same level of training and in the same situation. It is not related to the authorization of specific skills. C) INCORRECT. A direct medical order would generally come from a physician in a specific situation and is considered "on-line" direction. D) CORRECT. A standing order is a policy or protocol issued by a Medical Director that authorizes EMTs and others to perform particular skills in certain situations. 37) You and another new EMT are studying your local protocols. The other EMT notices that you may give oral glucose without utilizing on-line medical control, but you must get an on-line order from a physician before assisting a patient in taking his nitroglycerin for chest pain. The EMT asks you why some drugs require on-line medical control while others do not. What is the best answer to give him? A) Glucose is only sugar so it cannot hurt the patient. B) The physician does not trust EMTs. C) The patient's nitroglycerin might be expired. D) The physician wants to be sure it is appropriate for the patient. Answer: D Explanation: A) INCORRECT. Although glucose is sugar and relatively safe, it can be harmful if given to an unresponsive patient. But ultimately, this answer does not explain why not to give nitroglycerin without a physician's order. B) INCORRECT. The reason protocols are written is not because physicians do not trust EMTs; they are written because EMTs do not have the advanced training that physicians have. C) INCORRECT. Although medications may be expired, this does not require contacting medical control to confirm. D) CORRECT. Nitroglycerin, although indicated for most chest pain patients, is not appropriate for all cardiac patients. The physician, with his advanced training, is better suited to make that determination. 38) You respond to a 35-year-old male patient who fell 50 feet from a bluff. Your authority to provide emergency care is an extension of the Medical Director's license to practice medicine. You are acting as a(n) ________ of the Medical Director. A) subordinate B) employee C) designated agent D) extension Answer: C Explanation: A) INCORRECT. Being a subordinate of the Medical Director does not provide any authority to provide emergency care. B) INCORRECT. An EMS system's Medical Director does not directly employ EMTs, and simply being an employee does not provide the authority to provide care. C) CORRECT. An EMT at a basic or advanced level is operating as a designated agent of the Medical Director. D) INCORRECT. An EMT does not provide care as an extension of the Medical Director. 39) A fellow EMT is talking with the Medical Director at a staff meeting. The EMT states that the neighboring ambulance service is carrying special clotting bandages for serious bleeding wounds. The special bandages cost five times as much as the regular bandages, but the EMT claims they work ten times better. The EMT wants the Medical Director to approve the bandages for use in their ambulances. The Medical Director responds to the EMT by saying he will not approve the bandages until he can prove they are worth the additional cost. How can the EMT best prove the worth of the special bandages? A) Have a member of the other ambulance service call the Medical Director to provide firsthand information on how the special bandages are much better. B) Call the manufacturer of the special bandage and request literature to give to the Medical Director. C) Perform a literature search to see what studies have been done on the special bandages and report the findings to the Medical Director. D) Order a small number of the special bandages and compare them side-by-side to the regular bandages. Answer: C Explanation: A) INCORRECT. Firsthand accounts or anecdotal information do not provide any actual scientific proof that the special bandages are superior. B) INCORRECT. Literature from the manufacturer is designed to sell the bandages and will only present the positives of the bandages without any negative information. C) CORRECT. Finding objective, unbiased, evidence-based research that validates the claims of the special bandage is the only way to actually prove that the special bandages are superior. D) INCORRECT. Product testing of the bandages is a good idea to determine how the bandages will work for that particular service, but does not provide proof that they are actually better. 40) You and your EMT partner are assigned to spend a day at the senior center where you are to inspect the rooms and common areas for fall hazards. Your partner is upset that he is not in the ambulance where the "action is." He complains that "looking for loose rugs" is a waste of his time. What would be the best response to his complaints? A) It is good practice for the next emergency call. B) It makes the taxpayers happy. C) Injury prevention in the community is an important component of EMS. D) It minimizes the number of 911 calls late at night. Answer: C Explanation: A) INCORRECT. EMTs should already have competency in blood pressure techniques prior to hosting any screening clinics. B) INCORRECT. Although community relations are important, it is not the primary reason for checking blood pressures. C) CORRECT. Illness and injury prevention is an important component of EMS as EMTs are always in the field, and the role of EMS in public health is expected to only increase in the future. D) INCORRECT. Blood pressure screening clinics do not impact the number of late night 911 calls. 41) You and your new EMT partner arrive first on the scene of a single car rollover on the shoulder of a busy highway. You pull off in a safe location and just as you stop the ambulance, your partner throws the passenger door open, steps out of the truck, and begins jogging through the scattered debris toward the overturned car. You shout for him to stop and he looks back at you, but then continues to the vehicle and begins assessing the driver. Later, as you are restocking in the ambulance bay of the local trauma center your partner tells you that he thinks you acted unprofessionally by shouting at him. What is the best way to respond? A) Shouting was an attempt to protect the EMT from a potentially unsafe scene. B) New EMTs should expect partners to yell at them occasionally. C) The On-Duty Supervisor should be called. D) An EMT should never hurry to assist a patient. Answer: A Explanation: A) CORRECT. Quickly entering a dangerous scene without taking proper precautions will create additional risks. A professional EMT should always be concerned about the safety of everyone on scene; not just themselves and the patients, but other responders as well. In this case, shouting at the EMT was an appropriate attempt to prevent him from entering an unsafe situation. B) INCORRECT. Although sometimes the noise level of a situation requires responders to raise their voices to be heard, expecting to be yelled at simply because one is a new EMT is not professional or correct. C) INCORRECT. It is important for EMT partners to be able to communicate effectively and professionally when debriefing calls. Generally, a Supervisor should only become involved if the EMTs cannot resolve a conflict themselves or if they need a specific question answered. D) INCORRECT. Emergency medical care sometimes does require responders to act quickly, but never when it places others on scene in danger.