1. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Introduction to Emergency Medical Care 1

2. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson OBJECTIVES 1.1Define key terms introduced in this chapter. Slides 16-18, 26–27, 42–44 16-1826–2742–44 1.2Give an overview of the historical events leading to the development of modern emergency medical services (EMS). Slides 10–13, 1910–1319 1.3Describe the importance of each of the National Highway Traffic Safety Administration standards for assessing EMS systems. Slides 14–1814–18 1.4Describe the components of an EMS system that must be in place for a patient to receive emergency medical care. Slides 21–2721–27 continued

3. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson OBJECTIVES 1.5Compare and contrast the training and responsibilities of EMRs, EMTs, AEMTs, and Paramedics. Slides 28–3328–33 1.6Explain each of the specific areas of responsibility for the EMT. Slides 28–29, 31–3328–2931–33 1.7Give examples of the physical and personality traits that are desirable for EMTs. Slides 34–3934–39 1.8Describe various job settings that may be available to EMTs. Slide 4040 1.9Describe the purpose of the National Registry of Emergency Medical Technicians. Slide 4141 continued

4. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson OBJECTIVES 1.10Explain the purpose of quality improvement programs in EMS programs. Slides 42–4342–43 1.11Explain EMTs’ role in the quality improvement process. Slides 42–4342–43 1.12Explain medical direction as it relates to EMS systems. Slide 4444 1.13List ways in which research may influence EMT practice. Slide 4545 continued

5. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson OBJECTIVES 1.14Give examples of how EMS providers can play a role in public health. Slide 4646 1.15Given scenarios, decide how an EMT may demonstrate professional behavior. Slides 29, 32– 33, 472932– 3347

6. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson MULTIMEDIA Slide 19The Long and Winding Road of Ambulance Service VideoSlide 19The Long and Winding Road of Ambulance Service Video Slide 48Emergency Medical Services for Children VideoSlide 48Emergency Medical Services for Children Video

7. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson The chain of human resources that forms the EMS system How the public activates the EMS system Your roles and responsibilities as an EMT The process of EMS quality improvement (QI) CORE CONCEPTS

8. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Topics The Emergency Medical Services System Components of the EMS System

9. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson The Emergency Medical Services System

10. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson How It Began 1790s—Napoleonic Wars Civil War World War I—Volunteer ambulance corps Korea/Vietnam—MASH-type units and helicopter transport from battlefield continued

11. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson (Bettmann/CORBIS.)

12. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson How It Began Non-military ambulance services began operating in early 1900s in U.S. Often operated by hospitals, fire departments, or funeral homes No requirements or standards for equipment, crew training, or ambulance design “You call, we haul, that’s all!”

13. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Development of Today’s EMS 1966—Department of Transportation charged with developing EMS standards 1970—Founding of National Registry of EMTs (NREMT) 1973—National Emergency Medical Service Systems Act (NEMSSA)

14. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Course Description (1 of 8) EMS system –Team of health care professionals –Provides emergency care and transport –Governed by state laws Source:© Corbis

15. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson NHTSA Standards for EMS Systems 1.Regulation and Policy –Each state establishes laws, policies, and regulations 2.Resource Management –Centralized coordination of emergency treatment and transport resources continued

16. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson NHTSA Standards for EMS Systems 3.Human Resources and Training –Assure EMS personnel are trained and certified to minimum standard by qualified instructors 4.Transportation –Provide safe, reliable transportation—ground, air, or other means continued

17. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson NHTSA Standards for EMS Systems 5.Facilities –Must be transported to closest appropriate facility 6.Communications –Universal access number (911), dispatch to ambulance, ambulance to ambulance, ambulance to hospital, hospital to hospital continued

18. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson NHTSA Standards for EMS Systems 7.Trauma Systems –Develop trauma triage, transport, and treatment protocols 8.Evaluation –Establish program for assessing and improving quality of care provided (QI, QA, TQM) continued

19. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson NHTSA Standards for EMS Systems 9.Public Information and Education –Educate public about role of EMS, increase public awareness, participate in injury prevention programs 10.Medical Direction –Medical director oversees, is accountable for EMS personnel within system

20. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Click here to view a video on the topic of the history of EMS.here Back to Directory The Long and Winding Road of Ambulance Service Video

21. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Overview of the EMS System

22. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Components of the EMS System

23. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Components of the EMS System Emergency Department/Hospital –Doctors, nurses, allied health personnel continued

24. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Components of the EMS System Other specialized care facilities –Trauma centers –Burn centers –Stroke centers –Cardiac centers –Labor and delivery/ pediatrics –Poison control

25. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Think About It What medical services are available in your community? How important is it that EMS personnel know the capabilities of community medical facilities? What are the possible consequences of transporting a patient to a facility not equipped to handle the problem?

26. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Chain of Human Resources in EMS System

27. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Accessing EMS System 911 telephone access –Available in most but not all areas Enhanced 911 –Provides caller number and location for landline phones Cell phones –Newer models may provide location in some areas

28. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Emergency Medical Dispatchers Can provide instructions to callers on how to provide emergency care until EMS personnel arrive EMD certification required in some jurisdictions

29. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson

30. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Critical Decision Making Critical decision making is very important in EMS Information must be gathered, patients assessed, and determination made on treatment and transport options Decisions often time-critical

31. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Examples of Critical Decisions Is it better to take patient to closest hospital or to one farther away but more appropriate for the condition? Is patient stable enough for further evaluation on scene, or should patient be transported immediately? Will this treatment make patient better or worse?

32. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Levels of EMS Training Emergency Medical Responder (formerly First Responder) Emergency Medical Technician (formerly EMT Basic) Advanced EMT (formerly EMT Intermediate) Paramedic (formerly EMT Paramedic)

33. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Advanced Emergency Medical Technicians AEMT course adds knowledge and skills in specific aspects of ALS. –IV therapy –Advanced airway adjuncts –Medication administration

34. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Paramedics Paramedic has extensive ALS training, including: –Endotracheal intubation –Emergency pharmacology –Cardiac monitoring

35. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Roles and Responsibilities of EMTs Personal safety Safety of crew, patient, and bystanders Patient assessment Patient care Lifting and moving Transport Transfer of care Patient advocacy

36. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Course Description EMT has training in basic life support (BLS), including: –Automated external defibrillation –Airway adjuncts –Medication assistance

37. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Think About It How would it impact elderly patient if transported to the hospital without glasses, hearing aid, or dentures? On a routine call, would taking the time to gather these items have a negative effect on the patient’s care? How about assuring the home is secure and locked before leaving? continued

38. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Think About It Could the concept of patient advocacy also extend to the community (fall prevention programs for elderly, poisoning awareness, pool and water safety programs for children)?

39. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Course Description EMT course includes four learning activities: 1.Reading assignments, lectures, and discussions 2.Step-by-step demonstrations 3.Summary skills sheets 4.Case presentations and scenarios

40. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Physical Traits of a Good EMT Ability to lift and carry equipment and patients Good eyesight (distance and reading) and color vision Good communication skills (oral and written)

41. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Personal Traits of a Good EMT Pleasant Sincere Cooperative Resourceful continued

42. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Personal Traits of a Good EMT Self starter Emotionally stable Able to lead Neat and clean continued

43. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Personal Traits of a Good EMT Good moral character Respectful of others Control of personal habits Control of conversation Able to communicate properly Able to listen to others Nonjudgmental and fair

44. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Education Maintain up-to-date knowledge and skills Read EMS magazines; join EMS organizations Refresher courses for recertification Continuing education to supplement original training continued

45. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Education Conferences, seminars, lectures, classes, videos, and demonstrations

46. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Job Opportunities Ambulance services Fire departments Medical facilities Rural/wilderness teams Industrial settings

47. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson National Registry of EMTs (NREMT) Registration for EMRs, EMTs, AEMTs, and paramedics who successfully complete NREMT examinations May help in reciprocity (transferring to another state or region) Considered favorably when applying for employment

48. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Quality Improvement Continuous self-review to identify areas for improvement Develop plans to address areas continued

49. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Quality Improvement Everyone in organization has a role –Prepare careful documentation –Involved in quality process –Get feedback from patients, hospital staff –Maintain equipment –Continuing education

50. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Medical Direction Medical Director: ultimate responsibility for patient care aspects of EMS system All patient care performed under direction of Medical Director Oversees training; develops treatment protocols Off-line medical control (standing orders) On-line medical control

51. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Medical Direction (1 of 2) Physician medical director authorizes EMTs to provide medical care in field. Appropriate care is described in standing orders and protocols.

52. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Medical Direction (2 of 2) 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

53. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Evaluation Medical director maintains quality control. Continuous quality improvement (CQI) reviews and audits EMS system. Refresher training or continuing education are important. Minimizing errors is the goal.

54. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Research Vitally important; more needed in EMS field Care should be based on evidence-based research rather than tradition Goal is improving patient outcomes Form a hypothesis, review literature, evaluate evidence, and adopt practice if evidence supports it

55. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson EMS Role in Public Health Injury prevention for geriatric patients and youth Blood pressure clinics File of life Public vaccination programs Disease surveillance

56. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Think About It How will you refresh your knowledge and stay current once you are out of the classroom? What qualities would you like to see in an EMT who is caring for you? How can you come closer to being this kind of EMT?

57. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Emergency Medical Services for Children Video Click here to view a video on the topic of emergency medical services for children.here Back to Directory

58. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Roles and Responsibilities of the EMT (1 of 5) Keep vehicles and equipment ready for an emergency. Ensure safety of yourself, partner, patient, and bystanders. Operate an emergency vehicle. Be an on-scene leader.

59. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Roles and Responsibilities of the EMT (2 of 5) Perform an evaluation of the scene. Call for additional resources as needed. Gain patient access. Perform a patient assessment.

60. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Roles and Responsibilities of the EMT (3 of 5) Give emergency medical care to patient while awaiting arrival of additional medical resources. Only move patients when absolutely necessary to preserve life. Give emotional support to patient, family, other responders.

61. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Roles and Responsibilities of the EMT (4 of 5) Maintain continuity of care by working with other medical professionals. Resolve emergency incidents. Uphold medical and legal standards. Ensure and protect patient privacy.

62. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Roles and Responsibilities of the EMT (5 of 5) Give administrative support. Constantly continue professional development. Cultivate and sustain community relations. Give back to the profession.

63. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Professional Attributes (1 of 4) Integrity Empathy Self-motivation Appearance and hygiene

64. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Professional Attributes (2 of 4) Self-confidence Time management Communication skills Teamwork and diplomacy Respect

65. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Professional Attributes (3 of 4) Patient advocacy Careful delivery of care Every patient is entitled to compassion, respect, and the best care.

66. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Professional Attributes (4 of 4) As health care professionals, EMTs are bound by patient confidentiality. Be familiar with requirements of the Health Insurance Portability and Accountability Act (HIPAA).

67. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Chapter Review

68. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Source: www.ems.gov

69. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Chapter Review EMS system includes 911 or other emergency access system, dispatchers, EMTs, hospital emergency department, physicians, nurses, physician’s assistants, and other health professionals. EMT’s responsibilities include safety; patient assessment and care; lifting, moving, and transporting patients; transfer of care; and patient advocacy. continued

70. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Chapter Review EMT must have certain personal traits to ensure the ability to do the job. Education, quality improvement procedures, and medical direction are all essential to maintaining high standards of EMS care.

71. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Remember EMS dates back to Napoleonic times. Modern EMS standards come from 1960s–1970s and National Emergency Medical Service Systems Act (NEMSSA). There is a chain of human resources involved in EMS. Critical decisions are made by each member of the chain. continued

72. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Remember There are certain personal and physical traits that help you to be a successful EMS provider. An EMS provider should actively pursue opportunities to improve personal knowledge and abilities as well as the unit’s overall quality.

73. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Questions to Consider What innovation was introduced in the Korean and Vietnam wars that is now common in many EMS systems? What are the four levels of EMS providers? Requesting orders from a physician by radio is an example of what kind of medical control?

74. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Critical Thinking Your patient is hesitant to go to the hospital because she is worried about her dog. What can you do to assist in this situation? What part of your role as an EMT is this an example of?

75. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Please visit Resource Central on www.bradybooks.com to view additional resources for this text. www.bradybooks.com

76. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review 1.Which of the following is an example of care that is provided using standing orders? A.Medical control is contacted by the EMT after a patient with chest pain refuses EMS care. B.The EMT defibrillates a cardiac arrest patient, begins CPR, and then contacts medical control. C.A physician gives the EMT an order via radio to administer oral glucose to a diabetic patient. D.Following an overdose, the EMT contacts the medical director for permission to give activated charcoal.

77. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review Answer: B Rationale: Standing orders—a form of off-line (indirect) medical control— involves performing certain life-saving interventions (ie, CPR, defibrillation, bleeding control) before contacting a physician for further instructions.

78. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (1 of 2) 1.Which of the following is an example of care that is provided using standing orders? A.Medical control is contacted by the EMT after a patient with chest pain refuses EMS care Rationale: This is an example of online medical control given via the phone or radio. B.The EMT defibrillates a cardiac arrest patient, begins CPR, and then contacts medical control Rationale: Correct answer

79. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (2 of 2) 1.Which of the following is an example of care that is provided using standard orders? C.A physician gives the EMT an order via radio to administer oral glucose to a diabetic patient Rationale: This is an example of online medical control given via the phone or radio. D.Following an overdose, the EMT contacts the medical director for permission to give activated charcoal Rationale: This is an example of online medical control given via the phone or radio.

80. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review 2.Quality control in an EMS system is the ultimate responsibility of the: A.paramedic. B.lead EMT. C.medical director. D.EMS administrator.

81. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review Answer: C Rationale: The medical director is responsible for maintaining quality control, which ensures that all staff members who are involved in caring for patients meet the standard of care on every call.

82. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (1 of 2) 2.Quality control in an EMS system is the ultimate responsibility of the: A.paramedic. Rationale: A paramedic has the knowledge and mastery of BLS and ALS skills. B.lead EMT. Rationale: This is the senior EMT with a service or company.

83. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (2 of 2) 2.Quality control in an EMS system is the ultimate responsibility of the: C.medical director. Rationale: Correct answer D.EMS administrator. Rationale: The EMS administrator sees to the daily operations and overall direction of the service or company.

84. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review 3.Upon arriving at the scene of a domestic dispute, you hear yelling and the sound of breaking glass from inside the residence. You should: A.immediately gain access to the patient. B.carefully enter the house and then call the police. C.retreat to a safe place until the police arrive. D.tell the patient to exit the residence so you can provide care.

85. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review Answer: C Rationale: Never enter a scene in which signs of violence are present, including yelling, screaming, or the sound of breaking glass. Law enforcement must secure the scene prior to the EMT’s entry.

86. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (1 of 2) 3.Upon arriving at the scene of a domestic dispute, you hear yelling and the sound of breaking glass from inside the residence. You should: A.immediately gain access to the patient. Rationale: Never enter a scene in which signs of violence are present. Law enforcement must secure the scene. B.carefully enter the house and then call the police. Rationale: Never enter a scene in which signs of violence are present. Law enforcement must secure the scene.

87. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (2 of 2) 3.Upon arriving at the scene of a domestic dispute, you hear yelling and the sound of breaking glass from inside the residence. You should: C.retreat to a safe place until the police arrive. Rationale: Correct answer D.tell the patient to exit the residence so you can provide care. Rationale: Never enter a scene in which signs of violence are present. Law enforcement must secure the scene.

88. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review 4.Which of the following is NOT a component of continuous quality improvement (CQI)? A.Periodic review of run reports B.Discussion of needs for improvement C.Negative feedback to those who make mistakes while on a call D.Remedial training as deemed necessary by the medical director

89. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review Answer: C Rationale: The purpose of CQI is to ensure that the standard of care is provided on all calls. This involves periodic run report reviews, discussing needs for improvement, and providing remedial training as deemed necessary by the medical director. Positive feedback should be provided during this process.

90. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review 4.Which of the following is NOT a component of continuous quality improvement (CQI)? A.Periodic review of run reports Rationale: This is a part of CQI. C.Discussion of needs for improvement Rationale: This is a part of CQI. C.Negative feedback to those who make mistakes while on a call Rationale: Correct answer D.Remedial training as deemed necessary by the medical director Rationale: This is a part of CQI.

91. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review 5.All of the following are responsibilities of the EMS medical director, EXCEPT: A.evaluating patient insurance information. B.serving as liaison with the medical community. C.ensuring that the appropriate standards are met by EMTs. D.ensuring appropriate EMT education and continuing training.

92. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review Answer: A Rationale: Responsibilities of the medical director include serving as liaison with the medical community, ensuring that appropriate standards are met by EMS personnel, and ensuring appropriate EMT education and continuing training. Insurance matters are handled by the EMS billing department.

93. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (1 of 2) 5.All of the following are responsibilities of the EMS medical director, EXCEPT: A.evaluating patient insurance information. Rationale: Correct answer B.serving as liaison with the medical community. Rationale: This is the responsibility of the medical director.

94. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (2 of 2) 5.All of the following are responsibilities of the EMS medical director, EXCEPT: C.ensuring that the appropriate standards are met by EMTs. Rationale: This is the responsibility of the medical director. D.ensuring appropriate EMT education and continuing training. Rationale: This is the responsibility of the medical director.

95. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review 6.Which of the following situations would MOST likely disqualify a person for EMS certification? A.A misdemeanor at the age of 17 B.Driving under the influence of alcohol C.Possessing a valid driver’s license from another state D.A mild hearing impairment that is corrected with hearing aids

96. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review Answer: B Rationale: In most states, a person may be denied EMS certification for being convicted of a felony, such as driving under the influence of alcohol or other drugs.

97. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (1 of 2) 6.Which of the following situations would MOST likely disqualify a person for EMS certification? A.A misdemeanor at the age of 17 Rationale: Most states seal misdemeanor juvenile records, so it would not likely disqualify a person. B.Driving under the influence of alcohol Rationale: Correct answer

98. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (2 of 2) 6.Which of the following situations would MOST likely disqualify a person for EMS certification? C.Possessing a valid driver's license from another state Rationale: Most states require providers to have a valid in-state driver’s license. D.A mild hearing impairment that is corrected with hearing aids Rationale: If the performance of tasks are not impaired, it would not disqualify a person.

99. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review 7.Which of the following should be the EMT’s highest priority? A.Controlling severe bleeding B.Maintaining a patient’s airway C.Ensuring the safety of his or her partner D.Sizing u p every scene prior to entering

100. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review Answer: D Rationale: Personal safety is of utmost concern for the EMT. This involves sizing up a scene to determine whether or not the scene is safe to enter. This will ensure the safety of all personnel.

101. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (2 of 2) 7.Which of the following should be the EMT’s highest priority? A.Controlling severe bleeding Rationale: This is the priority once the patient’s airway and breathing have been addressed. B.Maintaining a patient’s airway Rationale: This is most the important priority once patient contact is made.

102. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (2 of 2) 7.Which of the following should be the EMT’s highest priority? C.Ensuring the safety of his or her partner Rationale: Safety is first determined during scene size-up. You do not enter an unsafe scene. D.Sizing up every scene prior to entering Rationale: Correct answer

103. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review 8.A patient who requires cardiac monitoring in the field would require, at a minimum, which level of EMS provider? A.EMR B.EMT C.Paramedic D.AEMT

104. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review Answer: C Rationale: Of all levels of EMS provider, the paramedic is trained in advanced medical care, including cardiac monitoring, IV therapy, and the administration of a variety of emergency drugs.

105. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (1 of 2) 8.A patient who requires cardiac monitoring in the field would require, at a minimum, which level of EMS provider? A.EMR Rationale: This level is trained to initiate BLS before an ambulance arrives. B.EMT Rationale: This level has the knowledge and skills to provide basic emergency care.

106. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (2 of 2) 8.A patient who requires cardiac monitoring in the field would require, at a minimum, which level of EMS provider? C.Paramedic Rationale: Correct answer D.AEMT Rationale: This level can interpret cardiac rhythms but cannot perform cardiac monitoring.

107. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review 9.Which of the following is a professional responsibility of the EMT? A.Telling the family of a dying patient that everything will be OK B.Maintaining only the skills that he or she feels uncomfortable with C.Maintaining a professional demeanor even under the most stressful situations D.Advising an emergency department nurse that patient reports are only given to a physician

108. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review Answer: C Rationale: Because the public relies upon the EMT to remain calm when others cannot, he or she must project a professional and calm demeanor even when under extreme stress.

109. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (1 of 2) 9.Which of the following is a professional responsibility of the EMT? A.Telling the family of a dying patient that everything will be OK Rationale: Discussions about dying patients are handled by providers of a higher level. B.Maintaining only the skills that he or she feels uncomfortable with Rationale: The quality of care depends upon your ability, so you must maintain all of your skills.

110. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (2 of 2) 9.Which of the following is a professional responsibility of the EMT? C.Maintaining a professional demeanor even under the most stressful situations Rationale: Correct answer D.Advising an emergency department nurse that patient reports are only given to a physician Rationale: You must give your report to the receiving hospital emergency department staff, including a nurse.

111. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review 10.Emergency patient care occurs in progressive phases. What occurs first? A.Activation of EMS B.Initial prehospital care C.The patient receives definitive care D.Incident recognition

112. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review Answer: D Rationale: Someone must recognize an emergency before EMS can be activated.

113. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (1 of 2) 10.Emergency patient care occurs in progressive phases. What occurs first? A.Activation of EMS Rationale: This occurs once an incident is recognized. B.Initial prehospital care Rationale: This occurs when the EMT arrives on scene.

114. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (2 of 2) 10.Emergency patient care occurs in progressive phases. What occurs first? C.The patient receives definitive care Rationale: This occurs when the EMT and patient reach the hospital. D.Incident recognition Rationale: Correct answer