Patient Treatment and Transport Study Guide for the EMT Test

Patient Transport

Once the decision to transport the patient is made, it’s essential to decide if you should transport the patient with the lights and sirens on or without. Lights and sirens are needed for patients with life-threatening conditions where minutes may affect the outcome. A low-priority transport is one without the lights and sirens and is considered safer.

Vehicle Design

Ambulances have evolved since the first horse-drawn ambulances in the 1800s. There are many unique aspects of operating an ambulance that need to be understood. Ambulances are vehicles designed for treating and transporting patients. They include a driver’s compartment, a patient compartment, warning systems, and communication systems. Increasing the amount of technology for communication and navigation can distract the driver from safe operations.

Here are some concepts to know:

• ambulance—specialized emergency vehicle equipped to provide medical care and transport for sick or injured patients

• first-responder vehicles—rapid response emergency unit (police car, fire apparatus, or specialty SUV) that arrives before an ambulance to begin initial assessment and lifesaving care

• Star of Life—international symbol of emergency medical services; blue, six-pointed star with a rod and Asclepius in the center representing medicine and healing

• NFPA 1917 Standard for Automotive Ambulances—national standard created by the NFPA that outlines the design, construction, performance, and safety requirements for modern ground ambulances in the United States

• Type I, II, III ambulance—There are several types of ambulances currently in use:

  • Type I ambulances are built on truck chassis with a separate, box-style patient compartment mounted on the back.

  • Type II ambulances are built on a van chassis, usually with a raised roof.

  • Type III ambulances are built on a cutaway van chassis with a modular, box-style patient compartment.

Transport and Destination

Selecting the best emergency department (ED) is important and can affect patient outcomes. There may be instances where choosing the closest ED is the best choice. There are other cases when a hospital that specializes in certain conditions, such as strokes, is the best choice.

Here are some concepts to know:

• scene time—This is the total time EMS personnel spend operating at the scene of an emergency, from arrival until departure.

• low-priority transport—This involves the movement of a patient whose condition is stable and not life threatening.

• high-priority transport—This involves the movement of a patient whose condition is unstable and life threatening. Lights and sirens are often utilized in these situations.

It is vital for the EMT to have a working knowledge of the transportation resources and Trauma Center levels when handling injured patients. A major goal of the emergency medical system is to ensure safe, timely, quality, and efficient treatment for an injured patient in the prehospital phase. This includes travel in the most effective, efficient mode of transportation to the most appropriate level trauma center required based on the patient acuity.

Here are some concepts to know:

• classification system of trauma centers—Trauma centers are classified by levels I through V based on the resources, staff, and capabilities available to care for trauma patients:

  • Level I provides comprehensive trauma care for all injuries with 24/7 in-house surgeons.

  • Level II provides initial definitive care for most trauma patients.

  • Level III provides prompt assessment, resuscitation, and stabilization, and transfers patients as needed.

  • Levels IV and V provide basic care and evaluation.

• Glasgow Coma Scale (GCS)—standardized tool used to assess a patient’s level of consciousness;, the scale evaluates three areas:, eye opening (spontaneous, to speech, to pain, or none), verbal response (oriented, confused, inappropriate words, incomprehensible sounds, or none), and motor response (obeys commands, localizes pain, abnormal flexion/extension, or none)

• revised trauma score (RTS)—This is the scoring system used by EMS and trauma teams to quickly assess the severity of a patient’s injuries and help guide triage and transport decisions. The criteria are based on GCS, systolic blood pressure, and respiratory rate.

• trauma score—This is an early trauma scoring system used to assess the severity of a patient’s injuries in the prehospital stage. This score is based on the patient’s respiratory rate, systolic blood pressure, capillary refill, and GCS.

• platinum 10—concept in prehospital trauma care emphasizing that EMS providers should spend no more than 10 minutes on scene for critically injured patients before transport to a trauma center

• types of transportation resources—ground ambulances, first-responder vehicles, air ambulances, non-emergency transport vehicles, specialty vehicles

Preparation for Transport

The following variables should be considered to determine the mode and positioning of the patient for emergency transport: level of consciousness; airway, breathing, and circulation status; geographic location; and type of injuries. A safe position for transport will need to be considered based on patient needs. It may include sitting, supine, standing, or utilizing spinal and/or cervical immobilization. Modes of transport that may be considered include: ambulance, with or without sirens, and air transport.

Here is a concept to know:

• four-person log roll—technique used by EMTs to move a patient safely onto a backboard or stretcher while minimizing spinal movement, especially in suspected spinal injuries

Communication

Remember before you transport: At the beginning of transport, dispatch needs to be informed of the intended destination and what time transport begins. A patient report needs to be given to the receiving hospital and the patient needs to be reassessed as needed. Transport needs to be done efficiently, but without undue risk, unless warranted.

Communications Systems and Equipment

EMS systems rely on radio systems to communicate 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.

Here are some concepts to know:

• base station—a fixed radio communication hub used by EMS and other emergency services to maintain contact with field units

• channels—specific frequencies or pathways used on radios to communicate between EMS units, dispatch, hospitals, and other emergency service units

• very high frequency (VHF)—radio waves in the 30 to 300 MHz range used for EMS and other communications

• ultrahigh frequency (UHF)—radio waves in the 300 MHz to 3 GHz range used for EMS and other communications; used for short-range communication in urban environments where buildings and structures can interfere with signals

• repeater—a radio device that receives a signal and retransmits it at a higher power or different frequency to extend the range of communication

• telemetry—the electronic transmission of patient data from the field to a hospital or medical control in real time

• simplex—a radio communication mode in which all units use the same frequency to both transmit and receive; only one can talk at a time

• duplex—a radio communication mode that allows simultaneous two-way communication, often using two separate frequencies, one for transmitting and one for receiving

• multiplex—a communication technique that allows multiple signals to be transmitted simultaneously over a single channel or medium

• MED Channels—radio frequencies specifically reserved for emergency medical service communications

• trunking—a radio system technology that automatically assigns available frequencies to multiple users, allowing many units to share a limited number of channels efficiently

• interoperable communications—the ability of different agencies, departments, or emergency services to communicate with each other effectively

• mobile data terminal (MDT)—a computerized device installed in an ambulance or emergency vehicle that allows EMS personnel to receive, send, and manage information electronically

• Federal Communications Commission (FCC)—the government agency that regulates interstate and international communications by radio, television, wire, satellite, and cable

• paging—one-way communication system used to alert EMS personnel of an emergency call

• standing orders—preapproved medical protocols that allow EMTs and other EMS personnel to perform specific interventions without contacting medical control

Human Body Vocabulary

Understanding human anatomy is essential in providing accurate information to hospital personnel and securing appropriate treatment. You must be able to use exactly the appropriate term in any report.

Topographical Anatomy

The human body is divided into different planes. Think of the planes of the body as imaginary lines that separate or divide it. The planes are a helpful reference when describing symptoms or injuries. The frontal planes divide the body from front to back. The transverse planes divide the body from top to bottom. The lateral plane divides the body into right and left sides.

Here are some terms to know:

• coronal plane—frontal plane; an anatomical plane that divides the body into front (anterior) and back (posterior) sections

• axial plane—transverse plane; an anatomical plane that divides the body into upper (superior) and lower (inferior) sections

• sagittal plane—anatomical plane that divides the body into left and right portions

• midsagittal plane—specific sagittal plane that divides the body into equal left and right halves

Anatomy and Physiology of the Skeletal System

The skeletal system gives the body its form. The skeletal system includes bones, cartilage, ligaments, and tendons. The skeletal system is divided up into two sections, including appendicular and axial. The appendicular skeletal system includes the pelvis, arms, and legs. The axial skeletal system includes the vertebrae, thoracic cage, skull, and facial bones.

Here are some terms to know:

• ligaments—strong bands of fibrous connective tissue that connect bones to other bones at joints

• tendons—strong, flexible bands of connective tissue that connect muscles to bones

• cartilage—firm, flexible connective tissue that covers the ends of bones at joints and provides structure to other parts of the body

• thorax—chest; the part of the body located between the neck and abdomen containing the heart, lungs, blood vessels, and esophagus

• cranium—bony structure that forms the skull and protects the brain

• vertebrae—individual bones that make up the spinal column

• femur—the thigh bone, which is the longest, strongest bone in the human body

• tibia—shinbone; the larger and stronger of the two bones in the lower leg

• pelvis—bony structure at the base of the spine that connects the trunk to the lower limbs

Anatomy and Physiology of the Musculoskeletal System

The musculoskeletal system not only provides form for the body, but also protects the vital organs. In addition, muscle tissue plays a vital role in movement. The musculoskeletal system includes the voluntary muscle tissue and the bones. The three types of muscle tissue include cardia (which attaches to the heart), smooth muscle (which attaches to the blood vessels and intestines), and skeletal (which attaches to the bones).

Here are some terms to know:

• involuntary muscle—muscles that work automatically without conscious control

• voluntary muscle—muscles that are under conscious control, allowing intentional movement of the body

Respiratory System Anatomy and Physiology

The respiratory system is divided into the upper and lower airways. The upper respiratory system includes the nose, mouth, jaw, pharynx, and larynx. The lower airway consists of the bronchus and the lungs. The upper airway warms and humidifies the air. The lower airway is involved in gas exchange, including taking in oxygen and expelling carbon dioxide from the lungs. The overall function of the respiratory system is to allow for ventilation, which is moving air in and out of the lungs, and respiration, which is gas exchange.

Here are some terms to know:

• nasopharynx—upper part of the pharynx (throat) located behind the nose and above the soft palate

• trachea—windpipe; tube that carries air from the larynx to the lungs

• diaphragm—dome-shaped muscle located at the base of the lungs that plays a primary role in breathing

• epiglottis—flap of cartilage located at the base of the tongue that covers the trachea during swallowing to prevent food and liquid from entering the airway

• thyroid cartilage—large, shield-shaped cartilage in the front of the neck that forms the bulk of the larynx

• alveoli—tiny, balloon-like air sacs at the ends of the bronchioles in the lungs where gas exchange occurs

• pleura—thin, double-layered membranes that surround the lungs and line the chest cavity

Circulatory System Anatomy and Physiology

The circulatory system involves the heart, veins, arteries, and capillaries that carry blood through the body. The circulatory system is also called the cardiovascular system. The two main divisions of the circulatory system include the pulmonary circulation and the systemic circulation. The systemic circulation carries oxygen-rich blood from the heart to the body and back to the heart. The pulmonary circulation transports oxygen-poor blood from the heart to the lungs, where it picks up oxygen to take back to the heart.

Here are some terms to know:

• myocardium—thick, muscular middle layer of the heart wall responsible for contracting and pumping blood throughout the body

• ventricular—two lower chambers of the heart that pump blood out of the heart to the lungs and the rest of the body

• atrium—two upper chambers of the heart that receive blood returning to the heart and move it into the ventricles

• pulmonary veins—blood vessels that carry oxygenated blood from the lungs to the left atrium

• stroke volume—amount of blood ejected by the left ventricle of the heart with each heartbeat

• cardiac output—total volume of blood the heart pumps per minute

• capillaries—tiny, thin-walled blood vessels that connect arteries to veins and facilitate the exchange of oxygen, nutrients, and waste between blood and tissues

• perfusion—process of delivering oxygenated blood to body tissues and organs

Nervous System Anatomy and Physiology

The nervous system includes the spinal cord, the brain, and the nerves. The nervous system plays a role in almost all other body systems. For example, the nervous system controls basic functions such as temperature, breathing, and blood pressure. The nervous system is divided into two sections: the central nervous system (the brain and spinal cord) and the peripheral system (the nerves outside the brain and spine).

Here are some terms to know:

• somatic nervous system—part of the peripheral nervous system that controls voluntary movements of skeletal muscles

• autonomic nervous system—part of the nervous system that controls involuntary body functions, such as heart rate, blood pressure, digestion, and breathing

• brain stem—lower part of the brain that connects the cerebrum to the spinal cord and controls basic life-sustaining functions

• sensory nerves—nerves that carry information from the body’s sensory receptors to the central nervous system

• motor nerves—nerves that carry signals from the central nervous system to muscles and glands to produce movement or action

Digestive System Anatomy and Physiology

The digestive system breaks down food and provides the body with the nutrients and calories it needs. The organs of the gastrointestinal system include hollow organs like the intestines, stomach, and bladder. If these hollow organs become perforated, waste material can spill into the abdominal cavity, causing infection. Solid organs that are part of the system include the liver, kidneys, pancreas, and spleen.

Here are some terms to know:

• retroperitoneal—anatomical space located behind the peritoneum, the lining of the abdominal cavity

• salivary glands—exocrine glands in the mouth that produce saliva to aid in digestion and oral health

• chyme—semi-liquid, partially digested food mixture in the stomach that forms after the stomach breaks down food with acid and digestive enzymes

• bile ducts—tubes that carry bile from the liver and gallbladder to the small intestine to aid in digestion, particularly of fats

Lymphatic System Anatomy and Physiology

The lymphatic system supports the immune and circulatory system. It transports white blood cells, absorbs fatty acids, and helps remove fluid from tissues. It also removes toxins and waste from the body. The lymphatic system includes the thymus glands, lymph vessels and glands, spleen, and lymph nodes.

Here are some terms to know:

• lymph fluid—clear, straw colored fluid that circulates through the lymphatic system

• lymph nodes—small, bean-shaped structures located throughout the lymphatic system; act as filters for lymph fluid as it drains from the body’s tissues

Urinary System Anatomy and Physiology

The urinary system removes waste material from the kidneys. It also controls fluid balance and helps maintain the proper pH of the blood. The urinary system includes the bladder, urethra, ureters, and two kidneys. The kidneys filter waste material out of the blood. The ureters are hollow tube-like structures that carry liquid waste from the kidneys to the bladder, where it is stored until urination takes place. The urethra carries the urine from the bladder to the outside of the body.

Here are some terms to know:

• peristalsis—wave-like, rhythmic muscular contraction of the digestive tract that moves food, liquids, and waste through the gastrointestinal (GI) system

• renal pelvis—funnel-shaped structure inside each kidney where urine collects before it flows down the ureter to the bladder

Genital System Anatomy and Physiology

The genital system involves the reproductive organs that produce life. The reproductive anatomy of the male includes the penis, testicles, and prostate gland. The female genital system includes the ovaries, fallopian tubes, cervix, uterus, and vagina.

Here are some terms to know:

• ovaries—two small, oval-shaped organs located on either side of the uterus in the female reproductive system; exist to produce eggs and release hormones

• fallopian tubes—two narrow, tunnel-like structures that connect each ovary to the uterus

• cervix—lower, narrow portion of the uterus that opens into the vagina

• seminal vesicles—two small glands located behind the bladder in the male reproductive system; main function is to produce thick, nutrient-rich fluid that makes up a large portion of semen

Pathophysiology

Pathophysiology refers to the effect of disease on normal physiological processes. EMTs and paramedics will care for patients with various conditions and diseases that affect different systems. For example, some common diseases that cause respiratory compromise include asthma, pneumonia, and COPD. Other conditions, such as shock, may affect multiple organs.

Here are some terms to know:

• cellular respiration—process by which the body’s cells use oxygen and nutrients to produce energy

• shock—life-threatening condition in which the body’s tissues and organs do not receive enough oxygen and perfusion to function properly

• respiratory compromise—occurs when the lungs cannot provide enough oxygen to the blood or remove carbon dioxide efficiently

Delivery

Dispatch needs to be informed upon arrival at the receiving facility. The patient needs to be brought inside and physically transferred to the hospital bed. A verbal report and transfer of care to hospital personnel is necessary. Charting can then be completed, as well as cleaning of the ambulance.

En Route to Station

Dispatch may be informed of your status upon leaving the hospital and, depending on local protocol, when arriving at the station or post. Refuel as necessary and obtain food if it is a long shift.