EMS Operations Study Guide for the EMT Test

Workforce Safety and Wellness

Health is defined as a complete state of physical, mental, and social well-being. Work as an EMT presents many threats to the EMT’s health and wellness.

Health and Wellness

Health and wellness issues can be varied for an EMT. Learn positive stress management and avoid negative management techniques such as substance abuse. Proper nutrition, exercise, and sleep are also important, along with an appropriate work/family time balance.

Terms/Concepts to Know: stress responses

Infectious and Communicable Diseases

Caring for patients presents risks of contracting infections. Infectious disease is caused by foreign organisms, such as bacteria and viruses. Communicable diseases are infectious diseases that can be spread from person to person.

Risk Management

Infectious diseases have different routes of transmission. Risks of contracting infectious diseases can be reduced or prevented by following standard precaution recommendations from the CDC. This can include gloves, handwashing, and immunizations to build immunity.

Post-Exposure Management

If an exposure occurs, it is critical to follow timely reporting of the incident. Clean the area of exposure and activate your department’s exposure control plan. This will include filling out an exposure control report and screening to determine what actions may be necessary.

Terms/Concepts to Know: infectious disease, communicable disease, pathogen, contamination, exposure, transmission, direct contact, bloodborne pathogen, human immunodeficiency virus (HIV), indirect contact, airborne transmission, foodborne transmission, vector-borne transmission, Occupational Safety and Health Administration (OSHA), Centers for Disease Control (CDC), infection control, designated infection control officer, immune, hosts

Scene Safety

Scene safety must always be a priority during all phases of a call. Numerous dangers can be encountered, including hazardous materials, fire, and traffic hazards when operating on a roadway. Awareness of potential hazards at all times can reduce the risks.

Terms/Concepts to Know: hazardous materials, safety placards, Emergency Response Guidebook (ERG)

Protective Clothing

Wear protective clothing appropriate for the potential hazard. Possibilities include gloves, cold weather gear, turnout gear, and helmets. Hearing and eye protection can also be important, as well as body armor. Be aware of the possibility of long hair and jewelry becoming caught in machinery.

Terms/Concepts to Know: personal protective equipment (PPE), high visibility vests, turnout gear

Dealing with the Critically Ill

Critically ill patients are under a high degree of stress and may have many responses, including anxiety, hostility, or depression. The EMT must anticipate these reactions and deal with all patients with dignity and honesty. Patients will initially care more about respect than medical treatment.

Dealing with Death and Dying

Death will be encountered by the EMT. The grieving process can elicit anticipated responses of denial, anger, bargaining, depression, and acceptance. There is no right response to death, and the EMT should focus on sincere communication that acknowledges feelings, without judgement.

Terms/Concepts to Know: grief response

On-the-Job Stress

High stress is a part of the environment of EMS. Recognizing and understanding stress can help prevent negative influences. The body has responses to stress that can be anticipated. Stressful situations can lead to post-traumatic stress disorder (PTSD).

Terms/Concepts to Know: general adaptation syndrome, acute stress reaction, delayed stress reaction, cumulative stress reaction, post-traumatic stress disorder (PTSD), critical incident stress management (CISM), cover, concealment

Other Issues in the Workplace

Cultural diversity is increasing across society and will be encountered in EMS. Sexual harassment and substance abuse can also be issues in the workplace. Companies need to have illness and injury programs in place, and everyone needs to be aware of suicide prevention practices.

Terms/Concepts to Know: cultural diversity, sexual harassment

Medical, Legal, and Ethical Issues

Providing EMS involves understanding and applying many medical, legal, and ethical issues. EMTs need to understand consent, patient autonomy, legal obligations, and ethics.

Consent is required from all patients and competent patients have the right to refuse care. Expressed consent from the patient is ideal, but special circumstances such as implied consent when a patient is unconscious or when dealing with minors are common. Involuntary consent may involve forcible restraint on a person who is mentally incapable of providing expressed consent.

Terms/Concepts to Know: consent, decision-making capacity, patient autonomy, expressed consent, informed consent, implied consent, emergency doctrine, medicolegal, emancipated minors, in loco parentis, forcible restraint

Patient Rights

Patients have a right to confidentiality of medical care. HIPAA protects, by law, a patient’s protected health information from disclosure. Advanced directives specify a patient’s healthcare wishes when they are no longer able to do so themselves. These include such documents as a living will or a DNR order.

Physical Signs of Death

Physical signs of death can be categorized as presumptive and definitive signs. Except in special circumstances, resuscitation should be withheld from patients with definitive signs of death. A medical examiner will often become involved in cases of death outside of a hospital.

Terms/Concepts to Know: presumptive signs, definitive signs, dependent lividity, rigor mortis, putrefaction

Special Situations

Some patients may have consented to organ donation. In some areas, donation of organs or tissue can still occur after death and EMTs should be familiar with practices in their area. Patients may have medical ID-type bracelets with important medical information.

Giving Care

EMTs must operate within their scope of practice. Standards of care are determined by laws, institutional standards, published textbooks, and professional organizations. Duty to act is an EMT’s obligation to provide patient care and is defined by law and departmental policy.

Terms/Concepts to Know: standard of care, emergency, duty to act

Extreme Situations

Failure to conform to accepted standards of care or outside of the EMT’s scope of practice is negligence. Patient care must be continued until transferred to another provider and care cannot be forced on competent patients. Inappropriate or false disclosure can result in defamation.

Terms/Concepts to Know: negligence, proximate causation, res ipsa loquitur, negligence per se, torts, abandonment, assault, battery, kidnapping, false imprisonment, defamation, libel, slander

Good Samaritan Laws

All states have passed Good Samaritan laws that provide at least some degree of legal protection to EMS providers who render aid within the scope of their training. Some states also have expanded EMS laws to provide immunity except in cases of gross negligence or willful misconduct.

Terms/Concepts to Know: Good Samaritan laws, gross negligence, immunity

Legal Considerations

Accurate written records should be maintained about all patient contacts for possible future court appearances or legal proceedings. Reporting cases of abuse or neglect is typically required by EMTs. All patient care should be conducted in an ethical manner.

Terms/Concepts to Know: mandated reporting, ethics, morality, bioethics, applied ethics, statute of limitations, governmental immunity, discovery, depositions, compensatory damages, punitive damages