EMS Operations Study Guide for the EMT Test

Communications and Documentation

Transferring information about a patient is necessary for care. This takes place both in person or verbally over a radio or phone, and also in written documentation records.

Therapeutic Communication

Communication with a patient is both verbal and nonverbal. Providers need to establish a rapport with patients and adjust their communications for cultural, age, and language abilities of the patient. Oral reports to other healthcare providers are used to transfer responsibility of care.

Terms/Concepts to Know: therapeutic communication, cultural imposition, open-ended questions, closed-ended questions, rapport

Written Communication

Patient contacts require written documentation, and different forms often exist based on the outcome of the contact. This can include transports, refusals of care, and special situations, such as a multi-casualty event. Errors should also be honestly recorded along with corrective actions.

Terms/Concepts to Know: patient care report (PCR), refusal of care

Communications Systems and Equipment

EMS systems rely on radio systems for communicating with dispatch centers and hospitals. Many types of radio systems exist, and they may also be enhanced with cellular and telemetry communications for contacting medical control at hospitals. All types of radio systems need to be maintained.

Terms/Concepts to Know: base station, channels, very high frequency (VHF), ultra high frequency (UHF), repeater, telemetry, simplex, duplex, multiplex, MED Channels, trunking, interoperable communications, mobile data terminal (MDT), Federal Communications Commission (FCC), paging, standing orders

Patient Assessment

Patient assessment is the foundation of all EMT care. It can be divided into five major parts: scene size-up, primary assessment, history, secondary assessment, and reassessment.

Scene Size-Up

This begins with the information provided by dispatch and continues with initial assessment upon arrival. Scene safety and identification of additional resources needed are important components. Situational awareness for changing conditions must be maintained at all times.

Terms/Concepts to Know: scene size-up, situational awareness

Primary Assessment

The primary assessment is the beginning of the patient assessment. It is similar to the scene size-up, with a goal of gaining an overall impression of how the patient is doing and the severity of their injuries/illness. The goal is to identify immediate or imminent life threats that require immediate intervention.

Terms/Concepts to Know: symptom, sign, primary assessment, vital signs, general impression, perfusion, AVPU scale, responsiveness, orientation, altered mental status, spontaneous respirations, life threats, shallow respirations, retractions, distracting injuries, accessory muscles, nasal flaring, dyspnea, tripod position, sniffing position, labored breathing, pulse, palpate, cyanosis, jaundice, sclera, diaphoretic, capillary refill, hypothermia, frostbite, vasoconstriction, coagulate, DCAP-BTLS, crepitus, Golden Hour

History Taking

The history of the current event and the patient’s past medical history can be crucial to determining the proper course of care. The history determines what event triggered the call for help and is often gathered concurrently with the primary assessment.

Terms/Concepts to Know: OPQRST, pertinent negatives, SAMPLE history, synthesizing, chief complaint

Secondary Assessment

The secondary assessment is a systematic, detailed examination of the patient. It is often focused on certain body systems as determined by the chief complaint or injury. In critical patients, it may be done en route to the hospital and may never be completed if the injury is life-threatening and requires more immediate attention.

Terms/Concepts to Know: secondary assessment, auscultate, focused assessment, stridor, breath sounds, tidal volume, wheezing, crackles, rales, rhonchi, tachycardia, bradycardia, blood pressure, systolic pressure, diastolic pressure, hypotension, hypertension, PEARRL, subcutaneous emphysema, paradoxical motion, guarding, pulse oximetry, metabolism, carbon dioxide, capnography

Reassessment

This is performed at regular intervals during patient care and sometimes may even occur before the secondary assessment is complete, to see if the primary assessment findings have changed. The main purpose is to check for improvement or deterioration of the patient.

Terms/Concepts to Know: reassessment intervals of a stable patient, reassessment intervals of an unstable patient

Lifting and Moving Patients

Lifting and moving patients is an integral part of EMS operations. Many different devices exist for safe patient movement and for lifting and moving in special situations.

Wheeled Ambulance Stretcher

The wheeled stretcher is the most basic piece of ambulance devices and is used for practically every transport. Most commonly referred to as a gurney, it can typically adjust to different heights to facilitate movement and has safety belts for securing the patient. It also has other specific features to ease movement through tight spaces and around corners.

Terms/Concepts to Know: wheeled ambulance stretcher

Backboards

The backboard is a rigid, flat, rectangular device traditionally used to immobilize patients with potential spinal injuries. It has places for straps to secure the patient and handholds for lifting. Backboards are commonly used for moving patients out of awkward places.

Terms/Concepts to Know: backboard, spine board, long backboard

Moving and Positioning the Patient

This includes techniques to reduce provider injuries or dropping of the patient. Patient movement should also be done so that conditions aren’t worsened and the patient is comfortable.

Body Mechanics

Body mechanics pertain to the relationships between lifting forces and the structures of the body. Lifting techniques should be done in a manner that involves proper mechanics that reduce the chance of injury.

Terms/Concepts to Know: body mechanics, power lift, power grip

Safe Reaching and Pulling

Reaching and pulling during patient movement is common and an easy source of injuries. Proper techniques should be practiced to reduce the risk of injury.

Safe Lifting and Carrying

Moving a patient can provide many opportunities for EMT injury. It is important to know and use the proper techniques. They will not totally prevent all injuries to the EMT, but will greatly reduce the incidence of such injury.

Terms/Concepts to Know: diamond carry, stair chair

Directions and Commands

It is important that patient movements be coordinated among team members with clear commands for execution. Complicated moves may require pre-planning prior to execution.

Emergency and Urgent Moves

At times it may be necessary to move patients quickly using rapid extrication techniques. This can occur due to scene dangers or imminent risk to the patient.

Terms/Concepts to Know: emergency move, rapid extrication technique

Nonurgent Moves

Patients will need to be moved from various positions in order to provide care and transport. Moves need to be planned among all first responders to assure safety of the team and the patient.

Terms/Concepts to Know: direct ground lift, extremity lift, draw sheet

Geriatrics and Bariatrics

Geriatric patients can present special movement challenges because of their fragility, which makes them susceptible to further injury. Bariatric, or obese, patients present issues concerning having enough resources to safely move them.

Terms/Concepts to Know: bariatrics, scoop stretcher

Other Equipment

Ambulances are equipped with many different devices for moving patients in specialized situations. This can include bariatric cots to accommodate the weight and girth, and basket stretchers for rescue situations.

Terms/Concepts to Know: portable stretcher, bariatric stretcher, flexible stretcher, short backboard, Kendrick Extrication Device (KED), vacuum mattress, basket stretcher, neonatal isolette, powered cot

Medical Restraints

It can be necessary to place a patient in restraints when the patient is in danger of self-harm or injury to the first responders and is incompetent to refuse care. The safety of the patient and staff is a priority.

Terms/Concepts to Know: restraints, asphyxia

Personnel Considerations

EMTs always need to be aware of the dangers of lifting. They should ensure that the lift can be completed safely and ask for help when necessary.

Terms/Concepts to Know: safe lifting capacity