Operations Study Guide for the EMT Test

General Information

The EMT exam devotes between 15% and 19% of its questions to scene size-up and safety. This is the beginning stage of all emergency calls and being thorough during this time will pave the way for a smoother, more effective run.

An ambulance call is considered to have nine distinct phases, starting at preparation and ending with post-run cleaning and completion of paperwork. The nine phases involve the ambulance, as a vehicle, and the crew that will be using it, and are:

preparation—During this phase, the EMT will perform a thorough check of the apparatus to ensure that all necessary equipment and supplies are present and functional.
dispatch—Basic information regarding the emergency is obtained and relayed to the responding crew. This information includes the nature of the call, the location, the number of patients, and any other special hazards or considerations.
en route—Safe operation of the ambulance using lights and sirens to get to the emergency quickly and efficiently. Providers may review dispatch information to better prepare for the call.
arrival at scene—Upon arrival, the crew should immediately assess for scene safety. An unexpected hazard or the need for additional resources should be relayed to dispatch at this time. Proper personal protective equipment measures should be taken at this time. Crews should ensure that they park the ambulance strategically and assess for traffic safety.
transfer of patient—Movement of the patient to the stretcher, ensuring they are properly secured, then safely moving them to the ambulance. EMTs should ensure they are using proper lifting and moving techniques during this phase to prevent self-injury or improper patient movement.
transport—Relay the number of patients and the transport destination to dispatch when leaving the scene. During transport, the patient should be continually reassessed (vital signs, condition) every 5 minutes for a critical patient and every 15 minutes for stable patients. Any necessary interventions should be performed at this time.
delivery—Upon arrival at the receiving hospital, notify dispatch. Upon entering the hospital, ensure that the patient is properly triaged. Transfer the patient from the stretcher to the hospital bed. Give a detailed verbal report to the receiving nurse or doctor, including all vital signs, assessment findings, and interventions performed. Complete a written patient care report and obtain any department-required signatures.
en route to station—Notify dispatch of your departure from the hospital, your intended destination, and whether your unit is in or out of service.
postrun—Ensure that all equipment is properly returned, restocked, and disinfected, and that the ambulance is ready to handle another assignment. Ensure that all necessary reports are filed. This time may be used to debrief the previous call.

You will notice these terms being used throughout these EMT test preparation materials.

Scene size-up 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.

Action Plan

It is important to develop a plan of action before you arrive at an emergency scene. This should be done using all of the information available to make your operation safe and effective.

Dispatch

Beginning with the 911 call, dispatch will provide you with basic information regarding the location of the call, the nature of the emergency, and the number of patients. Dispatch may be operated by the local EMS or shared with other agencies. It must be accessible 24 hours a day and staffed with trained personnel who gather and relay all information to responders.

En Route

Information known about the call should be reviewed and clarified with dispatch as necessary. Roles and responsibilities of team members can be clarified prior to scene arrival. During the en route phase, the crew faces the danger of a crash, and seat belts should always be worn.

Scene Investigation

Upon arrival, an initial scene-size up will occur to identify hazards, assess scene safety, and assess the need for more resources. The vehicle needs to be parked in a safe manner while considering patient access and traffic considerations, along with the ability to egress safely for the transport phase.

Parking

Some things to consider when parking an emergency vehicle include ensuring that you have a clear means of entering and exiting the scene. The ambulance should be parked strategically to ensure that EMTs can exit the ambulance safely and that there are no traffic hazards. Ensure that the parking brake is engaged and the emergency warning lights are activated. In the presence of any smoke or hazardous materials, ensure that the ambulance is parked uphill/upwind of the scene.

Hazards

It is important for EMTs to ensure scene safety on any emergency incident, meaning any potential hazards should be identified and reported immediately. Some hazards that may be encountered on scenes include smoke, fire, hazardous materials, downed power lines, broken glass or other sharp materials, uncontrolled animals, violent individuals, and swift water. Anything that poses a potential risk to patient or provider safety should be considered a hazard.

Radio Use

Radio communication is an important aspect of emergency response; it acts as a lifeline for providers to ensure their safety and relay necessary information. The radio should be utilized during all phases of call response to inform dispatch of the ambulance’s location and the safety of the crew. The radio may also be utilized to request additional resources or provide patient updates.

Additional Resource Assessment

During the scene size-up, EMTs should assess the need for any additional resources. These resources may include police, fire department, hazardous materials units, special/technical rescue, additional ambulances, advanced life support units, or anything else that may be required to help mitigate risks and allow for patient safety.

Gather as much information as possible, starting with information from the 911 call. Observation of the environment and information from the patient and/or witnesses regarding the incident are also helpful. Ensure the environment is stable and safe and always use universal precautions.

In the case of a psychiatric emergency, be sure to determine if you need law enforcement backup. Occasionally, an EMT will encounter a violent patient. To assess the risk of danger, try to determine if the patient has a history of violence. Assess his/her body language, looking for signs of physical tension and aggression. Consider the type of speech or language the person is using, such as shouting. Also, be aware of your surroundings and determine if there is anything near the patient that could be used as a weapon. Always use extreme caution if you think there is potential for violence and get law enforcement involved, if needed.
In the case of patients who are experiencing bleeding, take needed safety measures during your scene size-up. Apply proper personal protective equipment.
If the patient has been a victim of a sexual assault, try to have a female EMT provide care and be sure law enforcement is involved.
In the case of a lightning or other environmental emergency, such as heat or cold exposure, the key to medical treatment starts with ensuring the team and patient are in a safe environment and are protected from further injury. Ensure reverse triage for any patient in respiratory or cardiac arrest. Assess them for entrance and exit wounds and any other related injuries.
When approaching any motor vehicle collision scene, ensure it is safe before entering. On arrival, be sure to look for any potential hazards to the crew or the patient; these include traffic, fire, fuel leaks, downed power lines, unstable vehicles, undeployed airbags, etc. If needed, call for additional resources to help mitigate these hazards.

Resources for Large Incident Management

While most of your calls will involve a small number of people in a small area, there is always the possibility that you will encounter a larger-scale incident, and there are numerous types of these. 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.

Here are some concepts to know:

mass-casualty incident (MCI)—An emergency typically involving more than three patients, during which the initial responder may be outnumbered. Additional responders and resources are often required to meet the demands of the situation.
mutual aid response—An agreement made between EMS agencies, whose coverage areas border each other, to respond to each other’s coverage areas during mass-casualty incidents or times of resource depletion.

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.

Here are some concepts to know:

freelancing—units or individuals acting independently on scene, often making inappropriate decisions while unsupervised (considered an unsafe practice)
span of control—supervisor to subordinate ratio, typically 1:5
command—the person or persons in charge of an emergency who make decisions, delegate tasks, and maintain organization
incident commander (IC)—the individual who oversees the entire incident command system, to whom other division leaders directly report
unified command system—a type of command style used during large-scale incidents, during which multiple agencies or municipalities are involved
single command system—a type of command style used during smaller-scale incidents, during which a single individual is put in charge of the operation
command post—a designated area where the incident commander and support staff are stationed
termination of command—the dismantling of the command structure at the conclusion of the incident
demobilization—the act of retiring responders to their homes or a place of rest after their work at an incident has concluded
finance—position in the command structure responsible for all accounting and finances associated with an incident
logistics—position in the command structure responsible for supplies and equipment
operations—the section of ICS responsible for carrying out the commander’s plan of action
planning—responsible for creating and implementing the plan of action, which will resolve the incident
incident action plan—a verbal report or physical document identifying the objectives that must be completed to manage the incident properly
safety officer—the individual on the command staff responsible for monitoring the operation to ensure it is safe and free of hazards; has the ability to cease operations if they become or are deemed unsafe
public information officer (PIO)—member of the command staff who is responsible for keeping the press and public informed about the incident
joint information center (JIC)—a location designated by the IC where PIOs from different agencies can meet to exchange information
liaison officer—member of the command staff responsible for relaying information between different organizations

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.

Here are some concepts to know:

open incident—an active or ongoing situation; one that has not yet been contained
closed incident—an incident that has been fully contained and in which all patients have been treated and accounted for

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.

Here are some concepts to know:

triage supervisor—member of the command staff responsible for the triage of all patients, typically utilized during mass-casualty incidents; ensures all patients are sorted properly into categories determined by their severity
treatment supervisor—member of the command staff responsible for overseeing and directing EMS providers in the treatment area
treatment area—a designated location where patients are brought after they are triaged and where they are reassessed, treated, and monitored while awaiting transport to the hospital
transportation area—designated area where ambulances and crews are stationed, ready to transport patients from the incident to the hospital
transportation supervisor—member of the command staff responsible for facilitating the transfer of patients from the treatment area to an ambulance with a crew for transport
staging supervisor—works at a designated location away from the scene to coordinate the movement of apparatus from multiple organizations into and out of the incident safely
extrication supervisor—the individual responsible for determining the severity of the incident, as well as what equipment and resources will be necessary for extrication
rescue supervisor—the individual responsible for determining the severity of the incident, as well as what equipment and resources will be necessary for rescue
morgue supervisor—the individual responsible for the coordination of the removal of deceased victims, working alongside members of the medical examiners’ office, coroners, and law enforcement