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Final Exam Review_Melissa Perkowski
1. Review types of consent (implied, expressed, etc)
o Consent is generally required from every conscious adult before care can be started. The foundation of consent is
decision-making capacity.
o Implied consent legal assumption that treatment was desired.
▪ Applies to patients who are unconscious or are otherwise incapable of making a rational, informed decision about
care. It applies only when a serious medical condition exists and should never be used unless there is a threat to
life or limb.
▪ The principle of implied consent is known as the emergency doctrine.
▪ Sometimes what represents a “serious threat” is unclear, and it may become a legal question.
o Expressed consent patient gives express authorization for provision of care or transport. The patient acknowledges
he or she wants you to provide care or transport.
▪ To be valid, the patient must provide informed consent, which means you have explained the treatment being
offered, along with the potential risks, benefits, and alternatives, as well as the potential consequences of refusing
treatment. Informed consent is valid if given orally. Always document when a patient provides informed consent,
or have someone witness the patient’s consent.
o Involuntary consent Applies to patients who are mentally ill, in a behavioral (psychological) crisis, are
developmentally delayed.
▪ You should obtain consent from the guardian or conservator; however, it is not always possible to obtain such
consent, so understand your local provisions (sometimes need a law enforcement authority to be present to take
person to medical facility)
2. Review what your actions should be if you come across an MVC as an EMT on duty and off duty
o If you are off duty and come upon a crash, you are not legally obligated to stop and assist patients.
3. Recall the functions of the National Registry, AHA, DOT, Trauma centers, Local EMS offices, State EMS offices
o National Registry of Emergency Medical Technicians (NREMT) is a nongovernmental agency that provides national
standardized EMS testing and certification in much of the United States. May states use the National Registry
standards in certifying their EMTs and grant licensing reciprocity to NREMT-certified EMTs
▪ EMS is regulated ENTIRELY by the state in which you are licensed
o American Heart Association (AHA) Every 3 to 5 years, the AHA unveils a revised set of guidelines based on large
amounts of evidence and serves as a standard for basic life support (BLS) and cardiopulmonary resuscitation (CPR).
o Department of Transportation (DOT) DOT published the first EMT training curriculum in the early 1970s. In the late
1970s, the DOT developed a recommended National Standard Curriculum.
o Trauma Centers Trauma centers are categorized as either adult trauma centers or pediatric trauma centers, but not
necessarily both. The goal of a trauma system is to get the right patient to the right facility in the right amount of time.
▪ Trauma patients with shock, or a suspicious MOI, generally should go to a trauma center.
▪ Trauma centers are classified from levels I III, with level I being able to handle every trauma.
o Local EMS offices At the local level, each EMS service operates in a designated PSA in which it’s responsible for
the provision of prehospital emergency care and the transportation of the sick and injured to the hospital. The
medical director decides day-to-day limits of EMS personnel. Examples include the medications that will be carried
on an ambulance or where patients are transported.
o State office of EMS is the standards for prehospital emergency care and the individuals who provide it are typically
regulated by the state office of EMS
▪ EMT training in nearly every state meets or exceeds the guidelines recommended by the National Highway Traffic
Safety Administration (NHTSA)
4. Review types of medical direction, and know situations that would dictate the use of each type
o Medical direction a physician medical director authorizes EMTs to provide medical care in the field. Appropriate care
is described in standing orders and protocols.
▪ Medical control can be off-line or online.
➢ Off-line (indirect) - Standing orders, training, supervision
➢ Online (direct) - Physician directions given over the phone or radio
5. Review the components of an EMS system
, o There are 14 components of the EMS system
o The EMS Agenda for the Future outlines 14 components of an EMS system
▪ Public access easy access to help in an emergency is essential. The 9-1-1 system is the public safety access
point. At the communication center, trained dispatchers obtain information and dispatch the ambulance crew and
other equipment and responders. An emergency medical dispatch (EMD) system has been developed to assist
dispatchers in providing callers with vital medical instructions until EMS arrival.
▪ Communication systems From caller information, the dispatcher selects the appropriate parts of the
emergency system to activate. EMS may be: part of the fire department, part of the police department,
Independent (either public or private). New technology helps responders locate their patients for example cellular
telephones linked to global positioning system (GPS) units.
▪ Clinical care Describes the pieces of equipment, scope of practice for using that equipment and familiarizes
EMTs with their primary service area (PSA), or main area in which an agency operates. Overall, it familiarizes
EMTs with ambulance controls.
▪ Human resources Focuses on the people who deliver the care such as their compensation, interaction with
other members of medical community and well-being. Efforts are underway to allow EMS providers to move from
state to state more seamlessly. The EMS Agenda for the Future encourages the creation of systems to help
protect the well-being of EMS providers, including building career ladders.
▪ Medical direction Physician medical director authorizes EMTs to provide medical care in the field. Appropriate
care is described in standing orders and protocols.
▪ Legislation and regulation Although each EMS system, medical direction, and training program has latitude, its
training, protocols, and practice must follow state legislation, rules, regulations, and guidelines. A senior EMS
official is usually in charge of necessary administrative tasks such as scheduling, personnel, budgets, purchasing,
and vehicle maintenance, and the daily operations of ambulances and crews.
▪ Integration of health services Prehospital care by the EMT is coordinated with care administered by the
receiving hospital. Care simply continues in the hospital emergency department. This ensures that the
patient receives comprehensive continuity of care.
▪ Evaluation The medical director maintains quality control. CQI reviews and performs audits of the EMS system
to identify areas of improvement and/or assign remedial training. Information and skills in emergency medical care
change constantly. Refresher training and continuing education are important. Minimizing errors is the goal.
▪ Information systems Systems are used to document the care provided. Once stored electronically, the
information can be used to improve care. For example, stored information can help determine: Average on-scene
time for trauma patients, Need for educational sessions, National trends
▪ System finance Finance systems vary depending on which organization is involved. Personnel may be paid,
volunteer, or a mix. EMTs may be involved in gathering insurance information, attending fund- raisers, or other
activities that will help the department secure its finances.
▪ Education systems EMS instructors are licensed in most states. ALS training is usually provided in college,
adult career center, or hospital settings. Continuing education is needed to update knowledge and refresh skills.
▪ Prevention and public education Prevention and public education are aspects of EMS where the focus is on
public health. Public health examines the health needs of entire populations with the goal of preventing health
problems.
6. Recall the following terms and know the importance in the prehospital setting Negligence, Abandonment, CQI,
PCR, EMS administrator, Medical Director, DNR, living will.
o Negligence Failure to provide standard of care
▪ It’s based on the following four factors: duty, breach of duty, damages, and causation. All four elements must be
present for the legal doctrine of negligence to apply and for a plaintiff to prevail in a lawsuit against an EMS
service or provider.
o Abandonment Unilateral termination of care. It’s termination of care without the patient’s consent and without making
provisions for the transfer of care to a medical professional with skills at the same level or at a higher level than your
own skills. Abandonment is legally and ethically a very serious act.
o Continuous Quality Improvement (CQI) A system of internal reviews and audits of the EMS system to identify areas
of improvement and/or assign remedial training. Positive feedback is also discussed. If a problem appears to be
repeated by a single EMT or crew, the medical director will discuss the details with the individual involved.
, o Patient care report aka Prehospital Care Report (PCR) is a legal document It records all care from dispatch to
hospital arrival. It serves six functions: continuity of care, legal documentation, education, administrative information,
essential research record, evaluation and continuous quality improvement
o EMS Administrator sees to the daily operations and overall direction of the service or company.
o Medical Director sees to the daily operations and overall direction of the service or company. The medical director
maintains quality control at the LOCAL level.
o Do-not-resuscitate (DNR) an order not to administer CPR in the event of cardiac or respiratory arrest. “Do not
resuscitate” does not mean “do not treat.” Even in the presence of a DNR order, you are still obligated to provide
supportive measures (oxygen, pain relief, and comfort) to a patient who is not in cardiac arrest, whenever possible.
o Living will aka Health care directive aka advance directive - a legal document stating a person's wishes regarding life-
prolonging medical treatments. It take effect only when a patient is no longer able to make or communicate healthcare
decisions for him- or her- self.
▪ As long as a patient is still able to make and express decisions, the existence (or lack) of an advance directive is
irrelevant. Regardless of the contents of any existing advance directive, healthcare providers must honor the
direct instructions of a competent patient.
7. “I am a communicable disease.” “How can I get to you today.”
o communicable disease is any disease that can be spread from one person or species to another.
o Infection risk can be minimized by: immunizations, protective techniques, hand washing
▪ When these protective measures are used, the risk of the health care provider contracting a serious disease is
negligible.
o Transmission is the way an infections disease is spread. It may be through:
▪ Direct contact (eg, blood)
▪ Indirect contact (eg, needlesticks)
▪ Airborne transmission (eg, sneezing)
▪ Foodborne transmission (eg, contaminated food)
▪ Vector-borne transmission (eg, fleas)
8. Review base stations, repeaters, multiplex, mobile radios, simplex, duplex
o Base Station - A base station is any radio hardware containing a transmitter and receiver that is located in a fixed
place. It is a two-way radio consists of transmitter and receiver.
o Repeater –is a special base station radio. Receives messages and signals on one frequency. Automatically retransmits
them on a second frequency. Provides outstanding EMS communications
o Multiplex- A system that has the capability of transmitting two signals, usually voice and ECG, on the same frequency.
This allows a paramedic to transmit ECG telemetry to a hospital while continuing to talk with the on-line medical control
physician.
o Mobile Radio – is installed in a vehicle. They are used in the ambulance to communicate with: the dispatcher and
medical control
▪ An ambulance often has more than one mobile radio. Portable radios are hand-held devices.
▪ Portable radios are essential at the scene of an MCI.
▪ When away from the ambulance, a portable radio is helpful to communicate with: Dispatch, Another unit and
Medical control
o Simplex – is a Two-way radio hardware may operate in simplex mode. Simplex is push to talk, release to listen. A
communication system that uses radios that transmits and receives on the same frequency. This means that only one
radio in the system can transmit at a time.
o Duplex – is a Two-way radio hardware may operate in duplex mode. Duplex is simultaneous talk-listen. A
communication system that uses radios that transmits and receives on different frequencies. The paired receive and
transmit frequencies in a system that is referred to as a channel. Radios can transmit and receive simultaneously,
allowing communications to take place as if they were going over a telephone line.
9. Know the functions of the following glands: Thyroid, parathyroid, adrenal, pituitary
o Thyroid Regulates metabolism. Person who has their thyroid removed will have decreased tolerance of hot and cold.
▪ Located in neck (over the larynx).
▪ Hormones Produced: Thyroxine and others.
o Parathyroid Regulates serum calcium.
▪ Located on the neck (behind and besides the thyroid). Has a total of 3-5 glands.
, ▪ Hormones Produced: Parathyroid Hormones.
o Adrenal Gland Regulates stress response, fight-or-flight response.
▪ Located above the kidneys.
▪ Hormones Produced: Epinephrine, norepinephrine, and others
o Pituitary Gland Regulates all other endocrine glands.
▪ located at the base of skull.
▪ Hormones Produced: a few hormones that control other endocrine glands.
10. Review the abdominal quadrants and know the organs that are situated in each.
o The abdomen is divided into quadrants for communication purposes.
o Organs commonly found
▪ Right Upper Qudrant (RUQ): Liver, Gallbladder, duodenum of intestines, smaller portion of pancreas
▪ Left Upper Quadrant (LUQ): Stomach, Spleen
▪ Right Lower Quadrant (RLQ): Large and small intestines, ascending colon and the right half of the transverse
colon, appendix
▪ Left Lower Quadrant (LLQ): descending colon, left half of the transverse colon
11. “Hello my name is skin” “do you know my layers”?
o The skin has two principal layers:
▪ Epidermis tough, external layer that forms a watertight covering for the body. It’s composed of several layers
▪ Dermis the inner layer of the skin. It contains the hair follicles, sweat glands, and sebaceous glands. Blood
vessels in the dermis provide the skin with nutrients and oxygen
12. Know the proper positioning of patients and know the situations that would dictate the use of each. Eg. Fowlers,
semi-fowlers, trendelenburg, shock, supine, prone, recovery
o Fowler’s sitting up with the knees bent greater than 45 degrees, helps them breathe better and control the airway.
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o Semi-Fowler’s sitting up = less than 45 degrees. The position of a patient who is lying in bed in a supine position
with the head of the bed at approximately 45 degrees.
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o Trendelenburg patients are in a supine position on an incline with their feet higher than their head to keep blood in
the core of their body. Their FEET are 6 to 12 inches higher than their HEAD.
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o Shock position (modified Trendelenburg position)- the patients head and torso are supine, and the lower extremities
are elevated 6 to 12 inches higher than the head to help increase blood flow to the brain
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o Supine body is facing up
