EMS Operations Study Guide for the EMT Test

Incident Management

Large-scale incidents and disasters can be very challenging to manage. They require the use of Incident Command and the National Incident Management System to resolve effectively.

National Incident Management System (NIMS)

Principles of NIMS include interoperability, flexibility, and standardization. It is a framework for government, private and nongovernmental organizations to work together. It has five principles: preparedness, communications, resources, command, and maintenance.

Terms/Concepts to Know: mass-casualty incident (MCI), mutual aid response, National Incident Management System (NIMS)

Incident Command System (ICS)

The incident command system is a structure for managing actual incidents. It is built around a modular organization with a manageable span of control and clear lines of authority with common terminology. It includes logistics, finance, planning, and operations under one command.

Terms/Concepts to Know: incident command system (ICS), freelancing, span of control, command, incident commander (IC), unified command system, single command system, command post, termination of command, demobilization, finance, logistics, operations, planning, incident action plan, safety officer, public information officer (PIO), joint information center (JIC), liaison officer

EMS Response within the ICS

Planning is an important component of preparedness. EMS organizations should have disaster plans based on likely hazards and mutual aid agreements with neighboring organizations. Staff should have basic incident command training, and interagency training in simulated responses.

Terms/Concepts to Know: open incident, closed incident

The Medical Branch of the ICS

Incident command includes a branch specifically for the medical component. Major areas of the medical branch include triage, treatment, transportation, and staging. Other special components may be added such as rescue, special extrication, or morgue.

Terms/Concepts to Know: triage supervisor, treatment supervisor, treatment area, transportation area, transportation supervisor, staging supervisor, extrication supervisor, rescue supervisor, morgue supervisor

Mass-Casualty Incidents

Traditionally, a mass-casualty incident (MCI) has been defined as an emergency with three or more patients, or one that stresses the EMS system’s typical capabilities. An MCI can also include a situation with the imminent potential to become an MCI. When an MCI occurs, crews should initiate triage and the command system.

Terms/Concepts to Know: mass-casualty incident (MCI)

Triage

The goal of triage is to sort patients into categories by injury severity and try and do the most good for the most patients. Triage tags are usually used to quickly sort injured into red, yellow, green, and black to aid in organizing their movement to the appropriate treatment area.

Terms/Concepts to Know: triage, primary triage, secondary triage, START triage, JumpStart triage, triage categories, triage tags, disaster, casualty collection point

Hazardous Materials

Hazardous materials incidents can be very unsafe. The EMT needs to recognize the incident and request additional resources from resource lists. Transport vessels are marked by DOT placards marking system. Control zones need to be established for incident management.

Terms/Concepts to Know: hazardous material, hazardous material (HazMat) incident, container, bulk storage container, secondary containment, intermodal tanks, non-bulk storage vessels, drums, placards, safety data sheet (SDS), bill of lading, Chemical Transportation Emergency Center (CHEMTREC), hot zone, warm zone, cold zone, decontamination area, toxicity

Vehicle Extrication and Special Rescue

EMTs are not usually responsible for special rescue without extra training. Extrication typically occurs around the EMT and patient and requires constant communication to be done safely.

Safety

The need to focus on safety during rescues and extrication cannot be overstressed. It requires a mindset focused on safety and proper protective gear depending on the hazards present. It could include helmets, high visibility clothing, turnout gear, and protective gloves.

Vehicle Safety Systems

Modern vehicles have a variety of safety systems that can pose hazards to rescuers after a crash. This includes shock-absorbing bumpers that can suddenly release, hitting rescuers. Undeployed airbags can spontaneously deploy and require extra caution.

Terms/Concepts to Know: shock-absorbing bumpers, airbags, side-impact airbags

Extrication Fundamentals

Vehicle extrication is complex and dangerous. The EMT’s main role is to operate safely and stabilize and package the patient. There are 10 phases, including hazard control, access, removal, and transfer. Good communication and clear roles among all team members is critical.

Terms/Concepts to Know: extrication, entrapment, access, hazard control, simple access, complex access

Special Situations

Many kinds of special rescue situations exist requiring unique skills. Technical rescue can include water rescue, building collapses, fires, search and rescue, and SWAT situations. Special situations can present unique hazards and communication and safety are paramount.

Terms/Concepts to Know: technical rescue situation, specialized weapons and tactics team (SWAT), tactical situation, structure fire, self-contained breathing apparatus (SCBA)

Terrorism and Disaster Response and Management

Terrorism is an ongoing threat that can happen anywhere. Terrorists have increased their targeting of civilians, and EMTs need to be prepared for such incidents.

Terrorism Facts

Terrorism refers to a violent act, typically against civilian targets, intended to instill fear. Terrorists can single out individuals or organized groups and have domestic or international agendas. Recent terrorism events in the US have included the Boston Marathon bombing and a number of mass shootings.

Terms/Concepts to Know: international terrorism, domestic terrorism

Weapons of Mass Destruction

Weapons of mass destruction (WMDs) are intended to bring about a large number of casualties. WMDs can be biological, nuclear, incendiary, chemical, or explosive weapons. While terrorists have used all of the previous types except nuclear, they have favored explosives.

Terms/Concepts to Know: weapon of mass destruction (WMD), weapon of mass casualty (WMC), B-NICE, weaponization, state-sponsored terrorism, dirty bomb

The EMT Response

The type and nature of the weapon will affect the appropriate EMT response to a WMD incident. Be familiar with the various approaches that might be needed in different situations.

Terms/Concepts to Know: covert, secondary device, cross-contamination

Chemical Agents

Chemical agents are gases and liquids that can be dispersed in the air to kill and injure. They include vesicants, choking agents, nerve agents, and cyanides. Treatment is usually based on symptoms, though a few, such as cyanide and nerve agents, have antidotes.

Terms/Concepts to Know: persistency, volatility, route of exposure, vapor hazard, contact hazard, vesicants, sulfur mustard (H), mutagen, lewisite (L), phosgene oxime (CX), chlorine (Cl), phosgene, nerve agents, LD50, off-gassing, nerve-agent aging, DuoDote auto-injectors, Cyanides, SLUDGEM, miosis

Biologic Agents

Biologic agents have been used by terrorists, most recently anthrax powder in the US mail. Biologic agents include bacteria, viruses, and neurotoxins. They can be disseminated via multiple routes and the incubation period and initial similarity to routine illnesses make them hard to detect.

Terms/Concepts to Know: dissemination, disease vector, contagious, incubation, virus, bacteria, smallpox, viral hemorrhagic fevers (VHF), anthrax, bubonic plague, lymphatic system, buboes, pneumonic plague, neurotoxins, botulinum, ricin, syndromic surveillance, points of distribution (PODS)

Radiologic/Nuclear Devices

Radiation is energy emitted by radioactive decay. The energy is emitted in the form of alpha, beta, gamma, and neutron radiation. Each type has a different penetration potential. Shielding, exposure time, and distance from the source are important protective factors.

Terms/Concepts to Know: radioactive material, ionizing radiation, decay, alpha, beta, gamma (x-ray), neutron radiation, radiological dispersal device (RDD), Special Atomic Demolition Munitions (SADM), exposure time, distance, shielding

Incendiary and Explosive Devices

Incendiary devices cause fires and explosive use explosive energy to cause damage and injury. They have been the most common type of terrorist device, and can come in various sizes, from small backpack bombs to truck bombs. Secondary devices are always a concern to the EMT.

Terms/Concepts to Know: improvised explosive device (IED), primary, secondary, tertiary, and quaternary blast injuries, pulmonary blast injury