EMT Practice: Systems, Safety and Care Part 13

At a scene with downed electrical lines, the EMT should _________.

- stabilize the patient in the danger (hot) zone

- enter the danger (hot) zone for patient removal only

- relocate the danger (hot) zone away from the patient

- remain outside the danger (hot) zone

The use of special tools to remove an entrapped patient from a vehicle is known as _________.

- vehicle stabilization

- complex access

- simple access

- incident management

You are attempting to gain access to a patient who was injured when his truck struck another vehicle from behind. The patient is conscious and alert, but is screaming in pain. You try to open the door, but it is locked. You should:

- break the window and unlock the door.

- use a pry bar to attempt to open the door.

- ask the patient if he can unlock the door.

- request the rescue team to extricate him.

A 19-year-old female has just been extricated from her severely damaged car. She is on a long backboard and has been moved to a place of safety. As your partner maintains manual stabilization of her head, you perform a rapid assessment. The patient is unresponsive, has slow and shallow respirations, and has bilaterally closed femur deformities. You should:

- obtain baseline vital signs and transport at once.

- stabilize her legs with long board splints.

- direct your partner to begin ventilatory assistance.

- apply oxygen via a nonrebreathing mask.

You arrive at an accident scene to find an alternative-fuel vehicle leaking an unknown substance. You should immediately _________.

- disconnect the car battery

- search the vehicle for occupants

- apply retardant to the leaking fuel

- call for additional resources and keep bystanders away from the vehicle

Trench collapses usually involve large areas of falling dirt that weigh approximately _______ per cubic foot.

- 200 lb

- 100 lb

- 150 lb

- 50 lb

Upon arrival at a trench rescue operation, you should _________.

- park as close to the incident as possible

- assist with the rescue operation

- determine if rescuers are operating safely

- park at least 500 feet from the incident

While staged at the scene of a structure fire, the EMT should _________.

- stay with the incident commander

- remain with the ambulance

- locate the safety officer

- assess firefighters for signs of fatigue

Returning the emergency unit to service is part of the _________.

- termination phase

- hazard-control phase

- support phase

- transfer phase

The EMT's responsibility during search-and-rescue operations is to _________.

- assist in the search on foot

- assume medical command

- wait at the staging area until the patient is located

- direct other incoming EMS units

When removing a critically injured patient from his or her vehicle, you should:

- remove him or her using a short backboard.

- move him or her in one fast, continuous step.

- release c-spine control to facilitate rapid removal.

- protect the cervical spine during the entire process.

You are standing by at the scene of a hostage situation when the incident commander advises you that one of his personnel has been shot. The patient is lying supine in an open area and is not moving. As the SWAT team escorts you to the patient, you should:

- perform a rapid assessment and move him to a place of safety.

- treat only critical injuries before moving him to a safe place.

- grab him by the clothes and immediately move him to safety.

- limit your primary assessment to airway and breathing only.

A 33-year-old restrained driver of a motor vehicle crash is awake and alert, complaining only of neck pain and left leg pain. The vehicle is stable and no hazards are present. When removing this patient from his vehicle, you should:

- apply a full leg splint prior to extrication.

- use the rapid extrication technique.

- maintain slight traction to his neck area.

- immobilize him with a vest-style device.

Extrication is defined as:

- dismantling an automobile to remove a victim.

- using heavy equipment to access a patient.

- removal from a dangerous situation or position.

- immobilizing a patient before moving him or her.

Which type of drum is used for the storage of corrosives such as acids, bases, or oxidizers?

- Cardboard

- Polyethylene

- Steel

- Nickel

Which of the following is a requirement when labeling pesticide bags?

- The EPA establishment number

- Routes of entry

- Permissible exposure limits

- Contact information for the responsible party

In which control zone would you find the decontamination area?

- Hot zone

- Warm zone

- Cold zone

- Outer perimeter

Which toxicity level includes materials that are extremely hazardous to health?

- Level 2

- Level 3

- Level 1

- Level 4

The two important underlying principles of the NIMS are standardization and what?

- Maintenance

- Resource allocation

- Flexibility

- Chain of command

Which of the following is a member of the command staff?

- Logistics officer

- Planning officer

- Public information officer

- Operations chief

You are triaging victims of a train derailment. Patient A has significant bleeding from an abdominal injury. Patient B has several simple fractures of the femur and ulna. Patient C is conscious and complaining of head and neck pain. Patient D is in cardiac arrest. How would you prioritize these patients?

- A-yellow; B-yellow; C-green; D-red

- A. A-red; B-yellow; C-green; D-red

- A-red; B-green; C-yellow; D-black

- A-yellow; B-green; C-green; D-yellow

Which level of PPE do you need to wear when dealing with a Level 1 or 2 toxicity level?

- C

- A

- B

- D

What is the primary difference between a disaster and an MCI?

- MCIs are usually short term and disasters are long term.

- EMTs can declare a disaster but not an MCI.

- The number of casualties is higher with an MCI.

- Casualty collection areas are only erected in MCIs.

During triage, how should you tag a child who is breathing fewer than 15 breaths/min?

- Black

- Yellow

- Red

- Green

Placards and labels on a storage container are intended to:

- broadly classify chemicals as being explosive or nonexplosive.

- provide specific information about the chemical being carried.

- advise responders of the appropriate neutralizing measures.

- give a general idea of the hazard inside that particular container.

Which of the following is probably NOT a multiple-casualty incident?

- A rollover crash of a school bus with eight children who have injuries of varying severity

- An apartment fire with one patient and the possibility of others trapped in the building

- A motor vehicle crash with two critically injured patients and two ambulances

- A loss of power to a hospital or nursing home with ventilator-dependent patients

Upon arriving at the scene of a possible hazardous materials (HazMat) incident involving several patients, you should:

- rope off the entire perimeter.

- retrieve all critical patients.

- divert traffic away from the scene.

- carefully assess the situation.

The term used when individual units or different organizations make independent, and often inefficient, decisions regarding an incident is called:

-single command.

- undermining.

- logistical chaos.

- freelancing.

Which of the following duties or responsibilities does NOT fall within the realm of the medical branch of the incident command system?

- Transport

- Triage

- Treatment

- Extrication

A supervisor who has more than seven people reporting to him or her:

- is more beneficial to the overall effort than a supervisor with fewer personnel because his or her team can accomplish more tasks.

- has exceeded an effective span of control and should divide tasks and delegate the supervision of some tasks to another person.

- should assign a specific task to each person reporting to him or her and regularly follow up to ensure that the tasks were carried out.

- should regularly report to the incident commander (IC) to inform him or her of the functions that his or her team is performing.

After primary triage, the triage supervisor should communicate all of the following information to the medical branch officer, EXCEPT:

- recommendations for movement to the treatment area.

- the total number of patients that have been triaged.

- the number of patients in each triage category.

- the recommended transport destination for each patient.

In preparing for a disaster, EMS systems should have enough supplies for at least a ______ period of self-sufficiency.

- 48-hour

- 24-hour

- 96-hour

- 72-hour

The JumpSTART triage system is intended to be used for children younger than _____ years or who appear to weigh less than _____.

- 6; 70 lb

- 8; 100 lb

- 5; 50 lb

- 7; 90 lb

Which of your senses can be safely used to identify a HazMat incident?

- Sound and smell

- Smell and sight

- Sight and sound

- Sight and touch

You are triaging four patients who were involved in a head-on motor vehicle crash. Which of the following patients should be assigned the highest (red) triage category?

- A 50-year-old male with an open head injury and no pulse

- A 49-year-old female with diabetes and difficulty breathing

- A 36-year-old female with back pain and numb extremities

- A 29-year-old male with bilaterally closed femur deformities

According to the START triage system, what should you do if a patient is found to have a respiratory rate of 24 breaths/min?

- Triage the patient as delayed.

- Administer high-flow oxygen.

- Assess his or her neurologic status.

- Assess for bilateral radial pulses.

The development of an incident action plan is the responsibility of the:

-finance section.

- logistics section.

- operations section.

- planning section.

You are approaching an overturned tanker truck to assess the driver, who appears to be unresponsive. As you get closer to the vehicle, you note the smell of noxious fumes and find that you are in the midst of a vapor cloud. What should you do?

- Realize that you are in the danger zone and prevent others from entering.

- Exit the area immediately and gather information for the HazMat team.

- Cover your face with your shirt and quickly extricate the injured driver.

- Remain where you are and perform a visual assessment of the patient.

Following proper decontamination, a 30-year-old male is brought to you. He is semiconscious and has rapid, shallow respirations. A quick visual assessment reveals no obvious bleeding. You should:

- perform a rapid assessment to locate critical injuries.

- ask a firefighter what the patient was exposed to.

- begin some form of positive-pressure ventilation.

- administer high-flow oxygen via a nonrebreathing mask.

Unlike a multiple-casualty incident, a natural disaster:

- usually does not require the incident command system process.

- is typically short-lived and does not require as much manpower.

- often requires personnel to remain on scene for several days.

- exists when there are more than 100 critically injured patients.

The function of the National Incident Management System (NIMS) is to:

- educate city and county governments regarding foreign terrorist attacks.

- prepare for, prevent, respond to, and recover from domestic incidents.

- prepare for the potential of a nuclear attack against the United States.

- facilitate a standard method of incident command for natural disasters.

As a triage supervisor, you:

- must not begin treatment until all patients have been triaged.

- should communicate with area hospitals regarding their capabilities.

- must prepare patients for transport before they leave the triage area.

- are responsible for providing initial treatment to all patients.

While triaging patients at the scene of a building collapse, you encounter a young child who is conscious, alert, and breathing; has bilateral radial pulses; and has a severely angulated leg, which is not bleeding. According to the JumpSTART triage system, you should:

- evacuate him to a designated area and assign him a minimal (green) category.

- apply high-flow oxygen, obtain baseline vital signs, and continue triaging.

- assign him a delayed (yellow) category and continue triaging the other patients.

- quickly bind his legs together to stabilize the fracture, and continue triaging.

What is mustard gas considered to be?

- G-agent

- Mutagen

- Metabolic agent

- Neurotoxin

In which group of agents is miosis a sign of exposure?

- Respiratory agents

- Nerve agents

- Metabolic agents

- Vesicants

Which of the following requires a host to survive?

- Plague

- Botulinum

- Anthrax

- Smallpox

Which is the most deadly route of entry for anthrax?

- Injection

- Absorption

- Inhalation

- Ingestion

Which of the following is the means by which an agent is spread?

- Dissemination

- Volatility

- Incubation

- Contamination

Which of the following is true regarding a dirty bomb?

- It is a highly effective WMD.

- The destructive capability is limited to the explosives that are attached to it.

- The most significant cause of injury is a result of the radioactive material dispersed.

- It is difficult to make because the procurement of radioactive material is tightly regulated.

Which type of blast injury is most likely to produce penetrating trauma?

- Primary

- Tertiary

- Secondary

- Quaternary

Why is it important to follow the requests of the incident commander?

- The incident commander leads the fire department, not EMS.

- It is federal law to follow the ICS structure for patient care.

- The incident commander best understands incident needs.

- The incident commander represents a higher level of care.

You are on scene at a suspected terror attack in which a RDD has detonated. A 67-year-old patient reports tightness in his chest. The patient is coughing up blood and is in respiratory distress. During the physical assessment, you notice subcutaneous emphysema. What is the condition most likely to be?

- Pulmonary embolism

- Exacerbation of asthma

- Myocardial infarction

- Pulmonary blast injury

Petechiae are the result of what?

- Neurologic injury

- Psychologic injury

- Solid organ injury

- Hollow organ injury

The EMT should expect that a patient who was exposed to cyanide will have:

- an abnormally slow pulse rate.

- a normal pulse oximetry reading.

- an abnormally slow respiratory rate.

- skin that is cherry red and hot.

To date, the preferred weapons of mass destruction for terrorists have been:

- chemical weapons.

- nuclear weapons.

- explosive weapons.

- biologic weapons.

All of the following are vesicant agents, EXCEPT:

- phosgene oxime.

- sarin.

- lewisite.

- sulfur mustard.

In determining the potential for a terrorist attack, you should routinely observe all of the following on every call, EXCEPT:

- victim's statements.

- the type of call.

- weather conditions.

- the location type.

Most cases of anthrax begin with:

- signs of shock.

- pulmonary edema.

- respiratory distress.

- flulike symptoms.

The Centennial Park bombing during the 1996 Summer Olympics is an example of:

- domestic terrorism.

- an ecoterrorist attack.

- apocalyptic violence.

- state-sponsored terrorism.

Unlike viral agents, bacterial agents:

- do not replicate in the body.

- respond to antibiotics.

- are far less infectious.

- are usually not treatable.

You and your partner arrive at the scene of a fire at a large office complex. Witnesses tell you that they heard a loud explosion shortly before the building caught fire. You should:

- tell the witnesses that you suspect that the explosion was the work of a terrorist.

- carefully document the witnesses' statements and report them immediately.

- take standard precautions and begin searching for critically injured patients.

- ensure that your ambulance is parked upwind and uphill from the building.

Continual reassessment of the scene at a suspected terrorist or weapon of mass destruction incident is MOST important because:

- a secondary explosive device may detonate.

- bystanders may destroy the evidence.

- weather conditions may change quickly.

- terrorists are often at the scene after an attack.

Points of distribution (PODs) are strategically placed facilities where:

- chemical weapons are manufactured and distributed.

- chemical and biologic weapons are stockpiled.

- antidotes, antibiotics, and vaccines are distributed.

- weapons of mass destruction are distributed.

At present, the likelihood of a nuclear attack against the United States is very low because:

- the United States has an effective early warning system to detect an incoming nuclear missile.

- terrorist nations do not have the ability to deliver a nuclear weapon via missile or bomb.

- other than the United States, no other countries are currently in possession of nuclear weapons.

- all nuclear devices or weapons that different countries are in possession of are currently accounted for.

As you and your partner report for duty, you check your ambulance and begin talking about the possibility of a terrorist attack. The MOST effective and appropriate way to determine the likelihood of this happening is to:

- check with local businesses to see if they have received any terrorist threats.

- ask your immediate supervisor if he or she has been watching the local news.

- know the current threat level issued by the Department of Homeland Security.

- ascertain the current situation overseas with regard to the number of casualties.

After eating at a local restaurant, a 20-year-old male complains of blurred vision, difficulty speaking, and difficulty breathing. He is conscious; however, his respirations are profoundly labored and producing minimal tidal volume. You should:

- assist his ventilations with high-flow oxygen.

- apply oxygen via a nonrebreathing mask.

- position him supine and elevate his legs.

- request a paramedic to administer atropine.

The incubation period for Ebola can be up to:

- 21 days.

- 6 months.

- 72 hours.

- 1 week.

An attack on an abortion clinic would MOST likely be carried out by a(n):

- violent religious group.

- extremist political group.

- single-issue group.

- doomsday cult.

The type and severity of wounds sustained from incendiary and explosive devices primarily depend on the:

- type of material used to manufacture the device.

- size of the structure that was involved in the explosion.

- patient's distance from the epicenter of the explosion.

- pressure that is generated from the explosion itself.

__________ rays easily penetrate through the human body and require lead or several inches of concrete to prevent penetration.

- Beta

- Neutron

- Gamma

- Alpha

The means by which a terrorist will spread a particular agent is called:

- weaponization.

- aerosolization.

- incubation.

- dissemination.

Which of the following statements regarding blast injuries is correct?

- Solid organs such as the middle ear, lungs, and gastrointestinal tract are the most susceptible to pressure changes.

- Solid organs are relatively protected from shock wave injury but may be injured during the secondary or tertiary blast phase.

- Tertiary blast injuries are penetrating or nonpenetrating injuries that result from flying debris, such as ordnance projectiles.

- The gastrointestinal tract is the organ system most sensitive to blast injuries and is the leading cause of death following an explosion.

Multiple people in a small town began experiencing abdominal cramps, excessive salivation and urination, and muscle twitching shortly after a small crop duster plane made several passes over the community. As you are assessing the patients, you further determine that most of them are bradycardic and have miosis. In addition to high-flow oxygen, the MOST appropriate treatment for these patients includes:

- atropine and pralidoxime chloride.

- epinephrine and hyperbaric oxygen.

- activated charcoal and glucose.

- amyl nitrate and naloxone.

What is the best group dynamic for an EMS situation?

- Dependent

- Independent

- Interdependent

- Co-dependent

Which of the following is an example of closed loop communication?

- Speaking concisely

- Telling a team member when he/she is doing something wrong

- Asking "yes" or "no" questions

- Repeating a message back to the speaker

What is the purpose of crew resource management (CRM)?

- It provides clear guidelines for providing support to ALS providers in the field.

- It empowers team members to speak up when they detect a potential problem.

- It clearly defines the roles and responsibilities of each team member prior to engaging in a potentially hazardous event.

- It ensures that the team leader has the ultimate decision-making power in an emergency situation.

What is the best way to ensure the effectiveness of a team?

- Carefully select team members who can collaborate well with others.

- Ensure that the team leader can deliver direct and timely feedback to team members.

- Make sure each team member is knowledgeable about how to do critical procedures.

- Train and practice together.

What is the first step in performing an endotracheal intubation?

- Determine if trauma is present.

- Position the patient.

- Preoxygenate with a BVM.

- Evaluate the airway.

What is the best position for a patient who needs endotracheal intubation?

- Prone

- Sniffing

- Semi-Fowler

- Supine

Which technique should you use when helping ALS spike an IV bag?

- Pure

- Clean

- Aseptic

- Sterile

Which mnemonic is used in CRM?

- PACE (Probe, Alert, Challenge, Emergency)

- PUSH (Placate, Urge, Suggest, Help)

- PRONE (Problem, Report, Object, Negotiate, Evaluate)

- PIE (Plan, Interventions, Evaluation)

You are dispatched to a private residence where the patient is unresponsive, not breathing, and has a weak pulse. You secure her airway with an oral airway and ventilate her with a BVM at a rate of one breath every 5 seconds. An ALS transport ambulance arrives. The paramedic and her AEMT partner enter the house and approach you and the patient. Now that the ambulance has arrived, who will be the team leader?

- The AEMT, because the paramedic will be too busy intubating the patient

- The hospital physician, because he provides medical control

- The paramedic, because she is the highest-level provider on the scene

- You, because you were the first provider on the scene

You are assisting with an endotracheal intubation. After the tube is placed, you notice increased resistance as you ventilate with a BVM. What does this indicate?

- Vascular collapse

- Esophageal intubation

- The ET tube is not secured at the proper depth marking.

- Apneic oxygenation

Hyperventilation during the preoxygenation phase of endotracheal intubation:

- is acceptable if done for fewer than 2 minutes.

- can cause gastric distention and hypotension.

- will decrease the likelihood of aspiration.

- provides a better oxygen reserve for the patient.

You are attending to a 46-year-old male patient complaining of chest pain. Shortly after you begin to render care, an ALS unit arrives and the transfer of care is made. The decision is made to start an intravenous line and administer medication. You should:

- acknowledge that it is no longer your patient and stand back, allowing the ALS provider to work.

- move out of the ALS provider's way and clear the scene.

- clear space and, if necessary, explain the procedure to the patient.

- ensure that enough assessments have been done to justify the decision.

A team of EMTs is caring for a critically injured patient. The team leader advises the EMT that transport will not begin until the patient's closed forearm fracture is splinted. Utilizing the crew resource management model, the EMT should:

- repeat the request back to the team leader and then splint the patient's arm.

- advise the team leader that immediate transport is more important than splinting.

- ensure that the entire team is aware that transport will be delayed for splinting.

- disregard the team leader's request and contact medical control for guidance.

When the EMT assists a paramedic with an advanced intervention, he or she should recall that the focus of the intervention is on:

- solving a clinical problem.

- completing the procedure.

- following local protocol.

- learning to perform the skill.

When working as an independent health care group member, the EMT should expect that he or she:

- will receive no support or guidance from an EMS supervisor.

- will be specifically instructed on how to perform a specific task.

- does not have to wait for an assignment before performing a task.

- will rely on the group leader for making virtually all decisions.

You are attending to a 68-year-old female patient in cardiac arrest. An ALS provider arrives shortly after you do and the transfer of care is made. The ALS provider asks that you assist in the endotracheal intubation. As part of this process, you may be required to:

- visualize the airway and look for any potential complications in advance of the intubation.

- perform the intubation with assistance.

- help position the patient for a better view of the airway during the procedure.

- ventilate and preoxygenate the patient but not handle any of the equipment required for the intubation.

You are organizing a group of EMTs to provide triage in a mass-casualty exercise. In order for the group to be successful, it is essential that:

- individuals understand that their roles will all be accomplished the same way.

- individuals have an understanding of how the group will accomplish its goals.

- individual goals are accomplished.

- individuals understand that this is a one-time exercise and that things will change in the field.

The effectiveness of pit crew CPR is dependent on:

- a team leader who is capable of performing all of the patient care tasks.

- defining clear roles and responsibilities before the call is received.

- rapidly assessing the patient before assigning roles and responsibilities.

- protocols that allow the EMT to function without medical control.

After spiking a bag of IV fluid for the paramedic, the EMT notices that the drip chamber is too full. The EMT should:

- invert the IV bag and squeeze the drip chamber.

- replace the administration set with a new one.

- squeeze the IV bag to force fluid into the tubing.

- let the IV flow rapidly for 20 to 30 seconds.

You are at a mass-casualty scene and in the process of organizing a group to be responsible for ongoing patient care. In order for the group to be successful:

- individuals see this as a one-time exercise and that the group may change.

- individuals have an understanding of how the group will accomplish its goals.

- individual goals are accomplished.

- all individuals have the same roles.

You are attending to a patient who was experiencing abdominal pain at a local shopping mall. The patient sitting on a bench and appears in moderate distress. You are met by a first responder at the scene who wishes to provide you with a patient care report. Your best course of action is to:

- listen to the report while you perform a primary survey and render care to the patient.

- listen to the responder while your partner performs a primary survey.

- move the responder out of the way and begin patient care.

- ask the responder to wait and take their report after you have completed a primary survey.

Which of the following would indicate that the endotracheal tube is NOT in the trachea?

- Absence of sounds over the epigastrium

- Decreased resistance when ventilating

- Steady increase in the oxygen saturation

- Absence of an end-tidal CO2 waveform

The Microdrip administration delivers 1 mL of fluid for every ____ drops.

- 45

- 60

- 10

- 15

If a problem with a team member is not directly or immediately impacting patient care, the team leader should:

- ignore the problem to avoid conflict.

- engage the team member at once.

- discuss the problem after the call.

- contact the medical director at once.

You are called to the scene of a 56-year-old female patient who was the driver of a car that struck a telephone pole. The patient is sitting in her vehicle with her seat belt on and the air bag has deployed. A bystander approaches as you arrive and informs you that he is an off-duty firefighter and was first on the scene. The bystander wishes to provide you with a patient care report. You should:

- ask the bystander for any formal identification and listen to the report once it is verified.

- ask your partner to perform the primary survey while you listen to the report.

- ask the bystander to wait and you will take their report after you have finished your assessment.

- listen to the report while you perform a primary survey and render care to the patient.

You are attending to a 66-year-old male patient in cardiac arrest. As you gather history and begin the resuscitation, an Advanced Life Support (ALS) provider arrives on scene. You should:

- stay focused on the resuscitation and allow the ALS provider to make his or her own assessment.

- continue the resuscitation and provide a patient care report while you work.

- pause the resuscitation and provide a patient care report as quickly as possible.

- ensure that CPR is ongoing by the other providers present and then provide a patient care report off to the side.

The concept of consistent care across the entire health care team from first patient contact to patient discharge is called:

- the continuum of care.

- patient care advocacy.

- the standard of care.

- the scope of practice.

Health care teams that infrequently train and work together:

- can create delays in patient care.

- are unable to accomplish their tasks.

- often work better under pressure.

- need less-explicit verbal direction.

EMTs arrive at the scene of an ill person. The EMR, who arrived before the EMTs, advises that the patient had a syncopal episode. The patient is conscious and alert and remains so throughout transport. When transferring patient care to the emergency department nurse, the EMT should advise the nurse that:

- she should contact the EMR about the incident.

- the patient had a reported syncopal episode.

- the EMR was probably mistaken about the episode.

- there is no evidence to support the syncopal episode.

Which of the following would the EMT MOST likely be asked to do when assisting a paramedic with endotracheal intubation?

- Visualization of the vocal cords

- Placement of the endotracheal tube

- Preoxygenation with a BVM

- Suction under direct laryngoscopy