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.

Physical Wellness

Physical wellness refers to actively caring for your body to maintain health, strength, and the ability to perform daily tasks effectively. It involves making healthy choices such as regular exercise, proper nutrition, adequate sleep, and avoiding harmful behaviors. The purpose of physical wellness is not only to prevent illness and injury, but also to improve energy levels, resilience, and overall quality of life. For healthcare providers, and EMTs in particular, maintaining physical wellness is essential to safely perform job duties, manage stress, and provide the best possible care to patients.

Lifting and Moving Patients

Lifting and moving patients is an integral part of EMS operations. This includes techniques to reduce provider injuries or the 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.

Here are some concepts to know:

• body mechanics—proper use of the body’s muscles and posture to safely perform physical tasks, such as lifting, carrying, or moving patients, to prevent injury to both the caregiver and the patient

• power lift—safe technique in which you keep your back straight, bend at the knees and hips, and use your leg muscles to lift a heavy object or patient, keeping the load close to your body to reduce risk of injury

• power grip—safe lifting and carrying technique used in EMS in which the hands fully wrap around an object with all fingers and the thumb on the same side, forming a strong 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.

Here are some concepts to know:

• diamond carry—two-person carrying technique used in EMS to move equipment, such as a backboard or stretcher, through a narrow or crowded space. The providers position themselves at opposite corners of the object, creating a diamond shape, which allows better balance, control, and maneuverability while reducing the risk of injury

• stair chair—lightweight, portable EMS device designed to safely move patients up or down stairs or through narrow spaces when a stretcher cannot be used

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.

Here are some concepts to know:

• emergency move—a rapid technique used to move a patient immediately when there is a life-threatening danger present, such as fire, explosion, or an unsafe scene

• rapid extrication technique—This is a method used to quickly remove a patient from a vehicle when immediate life-threatening conditions exist or the scene is unsafe. It involves manual cervical spine stabilization, placement of a cervical collar when possible, and coordinated movement of the patient onto a long backboard to allow rapid removal while providing basic spinal protection.

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 ensure the safety of the team and the patient.

Here are some concepts to know:

• direct ground lift—a two- or four-person lifting technique used in EMS to raise a patient from the ground to a stretcher or carrying device

• extremity lift—This is a two-person patient lifting technique used in EMS to move a patient who does not have suspected spinal injuries. One provider supports the patient’s arms while the other supports the legs, allowing the team to lift and carry the patient safely from the ground to a stretcher or other surface using proper body mechanics.

• draw sheet—sheet placed under a patient used to lift, move, or reposition them safely in bed

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.

Here are some concepts to know:

• bariatrics—a branch of medicine in EMS that focuses on the care and management of patients who are significantly overweight or obese

• scoop stretcher—a type of stretcher that can be separated vertically into two or more pieces, allowing EMS providers to “scoop” it under a patient without rolling or lifting them

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.

Here is a concept to know:

• safe lifting capacity—the maximum weight a person or piece of equipment can safely lift or carry without risking injury

Standard Emergency Equipment

Many different devices exist for safe patient movement and for lifting and moving in special situations. It is vital to know the appropriate uses of each of them.

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.

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.

Here are some terms to know:

• spine board—rigid, flat device used in EMS to immobilize and safely transport patients with suspected spinal, neck, or back injuries

• long backboard—rigid, full-length board used in EMS to immobilize and safely transport patients with suspected spinal, neck, or back injuries

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.

Here are some concepts to know:

• portable stretcher—lightweight, foldable stretcher designed for easy transport and maneuverability in EMS

• bariatric stretcher—specifically designed stretcher built to safely transport patients who are overweight or obese

• flexible stretcher—stretcher made of strong, flexible material, often reinforced fabric with handles, that can be folded or rolled around a patient; used to carry patients in confined spaces, uneven terrain, or areas where rigid stretchers cannot fit

• short backboard—a small, rigid board used in EMS to immobilize a patient’s head, neck, and torso, typically in situations involving seated patients, helping to prevent spinal movement during extrication and transport

• Kendrick Extrication Device (KED)—specialized, flexible device used in EMS to immobilize and safely extricate patients with suspected spinal injuries from seated positions, such as vehicles

• vacuum mattress—patient transport device used in EMS that molds around the patient’s body when air is removed, creating a rigid, supportive shape

• basket stretcher—Stokes basket, a rigid, durable stretcher designed for safely transporting patients over rough, uneven, or difficult terrain, such as during water rescues, mountain rescues, or confined spaces

• neonatal isolette—This is a specialized, enclosed incubator used to care for and transport newborns, especially premature or medically fragile infants. It provides a controlled environment with regulated temperatures, humidity, and oxygen, protecting the baby from infection and maintaining body heat during transport or in a hospital setting.

• powered cot—motorized stretcher used in EMS that can be raised, lowered, and adjusted electronically to make lifting, loading, and transporting patients safer and easier

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.

Here are some terms to know:

• restraints—devices or methods used in EMS to safely limit a patient’s movement when they pose a risk to themselves or others. Restraints can be physical (straps, belts, handcuffs) or chemical (medication) and are used to prevent injury during transport while ensuring the patient’s safety and dignity.

• asphyxia—a condition in which the body is deprived of oxygen, leading to difficulty breathing and potential damage to organs or death if not treated promptly

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.

Here are some terms and concepts to know:

• infectious disease—disease caused by harmful microorganisms, such as bacteria, viruses, fungi, or parasites, that can be transmitted from person to person, through animals, or via contaminated surfaces, food, or water

• communicable disease—diseases that can be spread from one person to another, either directly through contact with an infected person or indirectly through contaminated objects, food, water, or vectors like insects

• pathogen—microorganism, such as a bacterium, virus, fungus, or parasite, that can cause disease in humans or other organisms

• contamination—presence of harmful substances, such as pathogens, chemicals, or other dangerous materials, on a surface, object, or person

• exposure—coming into contact with a harmful substance, pathogen, or environmental hazard that could cause injury, illness, or infection

• transmission—process by which a disease or infection is spread from one person, organism, or surface to another

• direct contact—transmission of a disease or infection through physical touch between an infected person and a susceptible person

• bloodborne pathogen—a disease-causing microorganism, such as a virus or bacteria, that is carried in human blood and can be transmitted to others through contact with infected blood or certain body fluids

• human immunodeficiency virus (HIV)—bloodborne virus that attacks the body’s immune system, specifically the T cells, making it harder to fight off infections and disease

• indirect contact, airborne transmission—spread of disease when infectious agents are carried on dust particles or tiny droplets that remain suspended in the air, and a person inhales or touches surfaces where they have settled

• foodborne transmission—It is the spread of disease-causing organisms or toxins to a person through contaminated food or drink. This can result from improper handling, cooking, or storage of food.

• vector-borne transmission—spread of disease through an intermediary organism, called a vector, such as a mosquito, tick, or flea, that carries pathogens from one host to another

• Occupational Safety and Health Administration (OSHA)—federal agency within the US Department of Labor responsible for ensuring safe and healthy working conditions; sets and enforces standards, provides training and education, and requires employees to protect workers from hazards such as bloodborne pathogens, chemical exposures, and workplace injuries through safety programs and proper equipment

• Centers for Disease Control (CDC)—national public health agency of the US Department of Health and Human Services that works to protect public health and safety; conducts research, tracks diseases, provides guidelines for disease prevention and control, and offers recommendations on infection control, immunizations, and public health emergencies

• infection control—These are policies and procedures used to prevent the spread of infectious diseases. In EMS, this includes practices such as proper hand hygiene, use of personal protective equipment, cleaning and disinfecting equipment, safe handling of sharps, and following exposure protocols.

• designated infection control officer**—an individual within an EMS agency or healthcare organization responsible for overseeing infection control practices and managing exposures to infectious diseases

• immune, hosts—an individual whose immune system is capable of resisting infection or disease, either through natural immunity or immunity gained from vaccination or prior exposure

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.

Here are some concepts to know:

• hazardous materials—These are substances that pose a risk to health, safety, or the environment if released or improperly handled. These materials can be chemical, biological, radiological, nuclear, or explosive in nature.

• safety placards—standardized warning signs or labels displayed on vehicles, containers, or buildings to identify hazardous materials and indicate the type of danger present

• Emergency Response Guidebook (ERG)—reference manual developed by the US Department of Transportation and other agencies to help first responders safely manage hazardous materials incidents during the initial phase

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.

Mental Health

Mental and emotional 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. Following are some of the situations that may affect you mentally and/or emotionally.

Here is a term to know:

• stress responses—physical, emotional, and behavioral reactions that occur when an individual faces a demanding or threatening situation

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.

Here is a concept to know:

• grief response—emotional, physical, and behavioral reactions a person experiences after a significant loss, such as the death of a loved one or a traumatic event

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).

Here are some concepts to know:

• general adaptation syndrome—model describing the body’s three-stage response to stress, including the alarm stage, resistance stage, and exhaustion stage; helps providers recognize the effects of stress on themselves and others and take steps to manage it effectively

• acute stress reaction—temporary physical, emotional, and psychological response that occurs immediately after a traumatic or high-stress event

• delayed stress reaction—stress response that occurs days, weeks, or even months after a traumatic event

• cumulative stress reaction—also known as burnout; a physical, emotional, or psychological response that develops over time from repeated exposure to stressful situations, often without sufficient rest or coping

• post-traumatic stress disorder (PTSD)—a mental health condition that can develop after experiencing or witnessing a traumatic event, such as a serious accident, violence, or disaster

• critical incident stress management (CISM)—structured program designed to help emergency responders and healthcare providers cope with the emotional and psychological effects of traumatic events

• cover—protective action taken to shield oneself from immediate danger, such as bullets, debris, or hazardous materials, by using a physical barrier like a wall, vehicle, or building

• concealment—a position or object that hides a person from view but does not provide protection from hazards such as bullets or debris

Social Well-Being

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.

Here are some concepts to know:

• cultural diversity—presence of a variety of cultural or ethnic groups within a community or organization

• sexual harassment—unwelcome behavior of a sexual nature that creates an intimidating, hostile, or offensive work or learning environment