1. 1: Introduction to Emergency Medical Care

2. 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.

3. 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.

4. 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.

5. History of Emergency Medical Services (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.

6. History of Emergency Medical Services (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

7. History of Emergency Medical Services (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

8. Levels of Training Lay Rescuer First Responder EMT-Basic
EMT-Intermediate
EMT-Paramedic

9. Components of the EMS System (1 of 5)
Access
Easy access in an emergency is essential.
Administration and Policy
Policies and procedures are essential.

10. Components of the EMS System (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.

11. Components of the EMS System (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.

12. Components of the EMS System (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

13. Components of the EMS System (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.

14. 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

15. Roles and Responsibilities of the EMT-B (1 of 2)
Personal safety
Safety of crew, patient, and bystanders
Patient assessment
Patient care based on assessment findings

16. Roles and Responsibilities of the EMT-B (2 of 2)
Lifting and moving patients safely
Transport and transfer of care
Record keeping/data collection
Patient advocacy/confidentiality

17. Professional Attributes of 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

18. Professional Appearance
The EMT-B should maintain
a professional appearance and manner.

19. 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

20. Review
Which of the following is an example of care that is provided using standard orders?
Medical control is contacted by the EMT-B after a patient with chest pain refuses EMS care
The EMT-B defibrillates a cardiac arrest patient, begins CPR, and then contacts medical control
A physician gives the EMT-B an order via radio to administer oral glucose to a diabetic patient
Following an overdose, the EMT-B contacts the medical director for permission to give activated charcoal

21. 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.

22. Review (1 of 2)
Which of the following is an example of care that is provided using standard orders?
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

23. Review (1 of 2)
Which of the following is an example of care that is provided using standard orders?
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

24. 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.

25. 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.

26. Review
2. Quality control in an EMS system is the ultimate responsibility of the:
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 answer
D. EMS administrator.
Rationale: The EMS administrator sees to the daily operations and overall direction of the service or company.

27. 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.

28. 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.

29. 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:
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.
C. retreat to a safe place until law enforcement arrives.
Rationale: Correct answer
D. tell the patient to exit the residence so you can provide care.

30. Review
4. Which of the following is NOT a component of continuous quality improvement (CQI)?
A. Periodic review of run reports
B. Discussion of needs for improvement
C. Negative feedback to those who make mistakes while on a call
D. Remedial training as deemed necessary by the medical director

31. 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.

32. Review
4. Which of the following is NOT a component of continuous quality improvement (CQI)?
Periodic review of run reports
Rationale: This is a part of CQI.
B. Discussion of needs for improvement
C. Negative feedback to those who make mistakes while on a call
Rationale: Correct answer
D. Remedial training as deemed necessary by the medical director

33. 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.

34. 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.

35. Review
5. All of the following are responsibilities of the EMS medical director, EXCEPT:
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.
D. ensuring appropriate EMT education and continuing training.

36. Review
6. Which of the following situations would MOST likely disqualify a person for EMS certification?
A. A misdemeanor at the age of 17
B. Driving under the influence of alcohol
C. Possessing a valid driver's license from another state
D. A mild hearing impairment that is corrected with hearing aids

37. Review
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.

38. Review
6. Which of the following situations would MOST likely disqualify a person for EMS certification?
A misdemeanor at the age of 17
Rationale: Most states seal misdemeanor juvenile records, so it would not likely disqualify a person.
B. Driving under the influence of alcohol
Rationale: Correct answer
C. Possessing a valid driver's license from another state
Rationale: Most states require providers to have a valid in-state driver’s license.
D. A mild hearing impairment that is corrected with hearing aids
Rationale: If the performance of tasks are not impaired, it would not disqualify a person.

39. Review
7. Which of the following should be the EMT-B’s highest priority?
A. Controlling severe bleeding
B. Maintaining a patient's airway
C. Ensuring the safety of his or her partner
D. Sizing up every scene prior to entering

40. 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.

41. Review
7. Which of the following should be the EMT-B’s highest priority?
Controlling severe bleeding
Rationale: This is the priority once the patient’s airway and breathing have been addressed.
B. Maintaining a patient's airway
Rationale: This is most the important priority once patient contact is made.
C. Ensuring the safety of his or her partner
Rationale: Safety is first determined during scene size-up. You do not enter an unsafe scene.
D. Sizing up every scene prior to entering
Rationale: Correct answer

42. Review
8. A patient who requires cardiac monitoring in the field would require, at a minimum, which level of EMS provider?
A. First responder
B. EMT-Basic
C. EMT-Paramedic
D. EMT-Intermediate

43. Review
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.

44. Review
8. A patient who requires cardiac monitoring in the field would require, at a minimum, which level of EMS provider?
First responder
Rationale: This level is trained to initiate BLS before an ambulance arrives.
B. EMT-Basic
Rationale: This level has the knowledge and skills to provide basic emergency care.
C. EMT-Paramedic
Rationale: Correct answer
D. EMT-Intermediate
Rationale: This level can interpret cardiac rhythms, but cannot perform cardiac monitoring.

45. Review
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.

46. Review
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.

47. Review
9. Which of the following is a professional responsibility of the EMT-B?
Telling the family of a dying patient that everything will be OK
Rationale: Discussions about dying patients are handled by providers of a higher level.
B. Maintaining only the skills that he or she feels uncomfortable with
Rationale: 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 situations
Rationale: 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.

48. Review
10. Emergency patient care occurs in four progressive phases. What occurs in the second phase?
A. Activation of EMS
B. Initial prehospital care
C. The patient receives definitive care
D. Continued assessment and stabilization

49. Review
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.

50. Review
10. Emergency patient care occurs in four progressive phases. What occurs in the second phase?
Activation of EMS
Rationale: This is part of the first (initial) phase.
B. Initial prehospital care
Rationale: Correct answer
C. The patient receives definitive care
Rationale: This is part of the fourth (final) phase.
D. Continued assessment and stabilization
Rationale: This is part of the third phase.