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NREMT COGNITIVE EXAM PREP MUST
KNOW CONCEPTS
Where does the modern EMS system have its origin? - Correct answer
The modern EMS system has its origins in funeral homes, which often operated ambulances. However, funeral home operators were often serving competing business interests and patients received little trained care until the hospital.
What is considered the "birth" of EMS? - Correct answer In 1966, a
paper titled "Accidental Death and Disability: The Neglected Disease of Modern Society" is published by the National Academy of Sciences. This paper is widely known in the EMS profession as the White Paper. The White Paper is widely considered the birth of modern EMS. It spotlighted inadequacies of prehospital care in the United States, particularly related to trauma.
Who developed the first EMT National Standard Curriculum? - Correct
answer Early in the 1970s, the US Department of Transportation
developed the first EMT National Standard Curriculum.
What are the levels of EMS training? - Correct answer Emergency
Medical Responder (EMR): provides basic, immediate care including bleeding control, CPR, AED and emergency childbirth. Emergency Medical Technician (EMT): includes all EMR skills, advanced oxygen and ventilation skills, pulse oximetry, noninvasive blood pressure monitoring, and administration of certain medications. Advanced Emergency Medical Technician (AEMT): includes all EMT skills, advanced airway devices, intravenous and intraosseous access, blood glucose monitoring, and administration of additional medications. Paramedic: includes all preceding training levels, advanced assessment and management skills, various invasive skills, and extensive pharmacology interventions. This is the highest level of prehospital care outlined in the National EMS Education Standards.
What are EMT roles and responsibilities? - Correct answer Equipment
preparedness Emergency vehicle operations Establish, maintain scene safety Patient assessment and treatment Lifting and moving Strong verbal and written communication skills Patient advocacy Professional development Quality improvement Illness and injury prevention Maintain certification/licensure
What is the role of the medical director? - Correct answer The medical
director is a physician responsible for providing medical oversight. The medical director oversees quality improvement.
What are the two types of medical direction? - Correct answer Online
medical direction: direct contact between the physician and EMT via or radio. Offline medical direction: written guidelines and protocols.
What is an EMT's first priority? - Correct answer The EMT's first priority
is always his or her own safety. Scene safety is always the top priority! The EMT's safety priorities after personal safety are for his/her partner(s), patients and bystanders.
What are the types of stress? - Correct answer Acute stress: an
immediate physiological and psychological reaction to a specific event. Delayed stress: a stress reaction that develops after the stressful event. It does not interfere with the EMT's ability to perform during the stressful event. PTSD is an example of delayed stress. Cumulative stress: the result of exposure to stressful situations over a prolonged period of time.
What are the stages of grief? - Correct answer Denial
What is the log roll technique? - Correct answer Commonly used to
place a patient on a backboard or assess the posterior. Can be done while maintaining manual cervical spine precautions. Should have at least three trained personnel. The person controlling manual cervical spine protection should direct the log roll.
What are special considerations for bariatric patients? - Correct answer
Obese patients pose additional challenges and risks to providers during lifting and movement. Some EMS systems have special bariatric ambulances with specialized equipment, automated lifting systems, and wider stretchers capable of a greater weight capacity.
What is supine hypotensive syndrome? - Correct answer Patients in the
later stages of pregnancy should not be placed supine due to the risk of supine hypotensive syndrome. Place the pregnant patient on her left side. If patient has potential cervical spine trauma, tilt backboard to the left about 20 degrees.
When can patients be restrained? - Correct answer In general, patients
may be forcibly restrained if they pose a significant, immediate threat to you, your partner, or others. Restraining a patient against his will is a last resort. Anticipate and plan. Request law enforcement assistance. Contact medical direction when possible. Guidelines for restraining a patient: -Get additional help whenever possible; at least 4 people is recommended. -Use the minimum amount of force necessary to protect yourself, the patient and others. -Secure patient supine, with backboard if available. DO NOT secure the patient in a prone position. -Use soft, padded restraints. -Monitor the patient's level of consciousness, airway, and distal circulation continuously. -Thoroughly document the reason for restraining the patient, the method of restraint, the duration of restraint, and frequent reassessment of the patient while restrained.
What is the use of force doctrine? - Correct answer The EMT must act
reasonably to prevent harm to a patient being forcibly restrained. The use of force must be protective, not punitive.
What is scope of practice? - Correct answer Scope of practice outlines
the actions a provider is legally allowed to perform based on his or her license or certification level. Scope of practice is tied to the licensure or certification, not the individual's knowledge or experience. Each state determines the scope of practice for its EMS providers.
What is standard of care? - Correct answer Standard of care is the
degree of care a reasonable person with similar training would provide in a similar situation. Standard of care requires EMTs to competently perform the indicated assessment and treatment within their scope of practice.
What are sources that help establish standard of care? - Correct
answer National EMS Education Standards
State protocols and guidelines Medical direction EMS agency's policies and procedures Reputable textbooks Care considered acceptable by similarly trained providers in the same community.
What is informed consent? - Correct answer Informed consent is
required from all patients who are alert and competent. -Patient must be informed of your carer plan and associated risks of accepting or refusing care and transport. -Patient must be informed of, and understand, all information that would impact a reasonable person's decision to accept or refuse care and transport.
What is expressed consent? - Correct answer Expressed consent also
requires that the patient be alert and competent to give expressed consent. Expressed consent can be given verbally or nonverbally. -Expressed consent is similar to informed consent, but not usually as in- depth as informed consent.
as he or she is not being compensated and gross negligence is not committed. -Each state has some form of Good Samaritan laws. Some protect health care providers, but some do not. -Some states extend their Good Samaritan law to publicly employed EMS providers but not to those in the private sector.
What is assault? - Correct answer A person can be guilty of assault
even if another person only perceived that they intended to inflict harm. Physical contact is not required to be guilty of assault.
What is battery? - Correct answer Battery is physically touching another
person without their consent.
What is negligence? - Correct answer Negligence is the most common
reason EMS providers are sued civilly. -The plaintiff has the burden of proof, not the EMT. -With negligence, the EMS provider is accused of unintentional harm to the plaintiff.
What are the four components of negligence? - Correct answer The
plaintiff must prove all four of the following:
- Duty to act: the EMT had an obligation to respond and provide care.
- Breach of duty: the EMT failed to assess, treat, or transport patient according to the standard of care.
- Damage: the plaintiff experienced damage or injury recognized by the legal system as worthy of compensation.
- Causation: the injury to the plaintiff was, at least in part, directly due to the EMT's breech of duty.
What is gross negligence? - Correct answer Gross negligence exceeds
simple negligence. Gross negligence involves an indfference to, and violation of, a legal responsibility. Reckless patient care that is clearly dangerous to the patient is grossly negligent. Gross negligence can result in civil and/or criminal charges.
What is abandonment? - Correct answer Once care is initiated, EMS
providers cannot terminate care without the patient's consent. Some patient
encounters may also require direct contact with medical direction prior to terminating care. Most EMS agencies have written protocols for terminating care without transporting the patient to a higher level of care. Abandonment is the termination of care without transferring the patient to an equal or higher medical authority. Transfer of care must include a verbal report to an equal or higher medical authority. Most EMS systems allow EMTs to accept care from a paramedic or advanced EMT for transport if an advanced-level assessment or advanced care is not needed.
What is false imprisonment? - Correct answer You may be guilty of
false imprisonment if you transport a competent patient without consent.
What factors influence hospital determination? - Correct answer
Destination factors include: -The patient's request or medical direction -The closest appropriate facility or specialty facility -Written protocols or triage guidelines -Hospital diversion or bypass A patient's ability to pay should NOT factor into where a patient is transported. When in doubt, consult medical direction. Thoroughly document why the destination was chosen. This is especially true if you bypass a closer hospital capable of managing your patient.
What are patient refusals? - Correct answer Competent patients may
refuse treatment regardless of the severity of their condition. -Refusals present high liability risk for EMS providers. -Negligence or abandonment can be much easier to provide if the patient is not transport. -Consider requesting advanced life support personnel or contacting medical direction per local protocols. -During a refusal, the patient must be fully informed of the treatment recommended and the possible consequences of refusing treatment. -The patient is rarely, if ever, fully informed the first time he or she conveys the intent to refuse treatment. Documentation should reflect both the initial refusal and the second refusal after being fully informed.
-COBRA and EMTALA include federal regulations guaranteeing public access to emergency care. -COBRA and EMTALA are also intended to stop the inappropriate transfe of patients, known as a patient "dump."
What are considered obvious signs of death? - Correct answer The
following are typically considered obvious signs of death indicating that resuscitation should not be initiated: -Decomposition -Rigor mortis -Dependent lividity -Decapitation
On what kind of scenes must law enforcement be notified? - Correct
answer 1. Any scene where the patient is dead on arival
- Suicide attempts
- Assault or sexual assault
- Child abuse or elder abuse
- Suspected crime scene
- Childbirth
How should EMT's operate in crime scenes? - Correct answer 1.
Ensure scene safety
- Provide patient care as needed
- Avoid any unnecessary disturbance of scene
- Remember and note the position of patient(s)
- Remember and report everything you touched at the scene
- Cut around (not through) holes in clothing when exposing the patient
- Note anything or anyone suspicious on or near the scene
- Discourage sexual assault patients from changing clothes or showering
- Try to get a same-sex provider to assist with sexual assault patients
- Leave once you are no longer needed at the scene
What are therapeutic communications? - Correct answer Therapeutic
communications typically refers to your interaction with the patient and ability to obtain clinical information.
What are portable and mobile radios? - Correct answer Portable radios:
hand-held transmitter/receiver with a very limited range, unless used with a repeater. Mobile radios: vehicle-mounted transmitters and receivers. These have a greater range than portable radios, but distance is still limited unless used with a repeater.
What is a repeater? - Correct answer A type of base station that
receives low-power transmissions from portable or mobile radios and rebroadcasts at higher power to improve range.
What is a base station? - Correct answer A transmitter/receiver in a
fixed location that is in contact with all other components in the radio system.
Who regulates all radio operations in the US? - Correct answer The
Federal Communications Commission (FCC) regulates all radio operations in the US and has allocated specific frequencies for EMS use only.
How should you communicate with dispatch? - Correct answer 1.
Confirm receipt of dispatch.
- Notify dispatch when en route to the call,on scene, en route to the hospital, and at the hospital. A. Identify who you are talking to first, then who you are. B. Use "affirmative" or "negative," not "yes" or "no." C. Use "copy" to confirm receipt of a transmission. D. Always "echo" orders from medical direction to confirm accuracy. E. DO NOT use unnecessary verbiage such as "please" or "thank you."
How should you communicate with medical direction? - Correct answer
Sample format: -Unit designation, certification level, destination and estimate time of arival -Patient's age, sex, and chief complaint -Patient's level of consciousness -History of present illness or mechanism of injury -Any associated symptoms or pertinent negatives -Patient's vitals
-The name or identifying number and certification level of all EMS providers on the call Narrative
How many bones are there in the human body? - Correct answer There
are 206 bones in the human body.
How many vertebrae are in the spinal column? - Correct answer 33
vertebrae -7 cervical -12 thoracic -5 lumbar -5 sacral -4 coccygeal
What are the components of the upper airway? - Correct answer
Components of the upper airway include: -Nose and mouth -Nasopharynx -Oropharynx -Larynx -Epiglottis
What is the most common cause of upper airway obstruction? - Correct
answer The tongue.
What are the components of the lower airway? - Correct answer
Components of the lower airway include: -Trachea -Carina -Left and right mainstem bronchi -Broncioles -Alveoli
How is lung expansion achieved? - Correct answer During inhalation,
as the chest expands, the parietal pleura pull the visceral pleura, which pull the lungs.
What is the diaphragm? - Correct answer The diaphragm is the primary
muscle of respiration. It separates the thoracic cavity from the abdominal cavity. It is usually under involuntary control but can be controlled voluntarily. The esophagus and the great vessels pass through the diaphragm. The diaphragm is dome shaped until it contracts during inhalation. During inhalation, it moves down and expands the size of the thoracic cavity.
What is inhalation through negative pressure breathing? - Correct
answer The diaphragm and intercostal muscles contract, the thoracic
cage expands, pressure in the chest cavity decreases, and air rushes in. Inhalation is an active process and requires energy. Atmospheric (inhaled) oxygen contains 21% oxygen.
What is exhalation? - Correct answer The diaphragm and intercostal
muscles relax, the thoracic cage contracts, pressure in the chest cavity rises and air is expelled. Exhalation is normally passive and does not require energy. Exhaled air contains 16% oxygen.
What are the different types of respiration? - Correct answer External
respiration: the exchange of oxygen and carbon dioxide between the alveoli and pulmonary capillaries. Internal respiration: gas exchanged between the body's cells and the systemic capillaries. Cellular respiration: also known as aerobic metabolism, uses oxygen to break down glucose to create energy.
What is the primary mechanism of breathing control? - Correct answer
Carbon dioxide drive is the primary mechanism of breathing control for most people. The brain stem monitors carbon dioxide levels in the blood and CSF. High carbon dioxide levels will stimulate an increase in respiratory rate and tidal volume.
What is hypoxic drive? - Correct answer Hypoxic drive is a backup
system to the carbon dioxide drive.
What is afterload? - Correct answer Afterload is the resistance the
heartm ust overcome during ventricular contraction. Increased afterload leads to decreased cardiac output.
What are the components of blood? - Correct answer Plasma: the liquid
component of blood, made mostly of water Red blood cells: the oxygen-carrying component of blood White blood cells: fight infection by defending against invading organisms Platelets: essential for clot formation to stop bleeding
What is perfusion? - Correct answer Perfusion is the flow of blood
throughout the body.
What is the central nervous system? - Correct answer The central
nervous system consists of the brain and spinal cord.
What are the parts of the brain? - Correct answer Cerebrum: largest
part of the brain; controls thoughts, memory and senses Cerebellum: coordinates voluntary movement, fine motor function and balance Brain stem: includes midbrain, pons and medulla; controls essential body functions such as breathing and consciousness
What are the two epidermal layers? - Correct answer The germinal
layer produces new cells and pushes them to the surface. the cells die en route to the surface. The stratum corneal layer is the top epidermal layer and consists of dead skin cells.
What are normal vital signs for infants? - Correct answer Respirations:
normal respiratory rate is about 30-60 breaths per minute for newborns and about 25-50 breaths per minute for infants.
Pulse: normal pulse rate is about 140-160 beats per minute for newborns and about 100-140 beats per minute for infants. Blood pressure: a newborn's blood pressure is about 70 systolic and will increase to about 90 systolic by one year of age.
What is the physiology of newborns and infants? - Correct answer The
typical newborn weighs about 6-8 pounds. The newborn's weight will typically double by 6 months and triple by one year. The newborn's head makes up about 25% o f the body and is a significant source of heat loss. During the first couple weeks, neonates often lose weight, and then begin to gain it back. The newborn's fontanelles (soft spots on the skull) will be fully fused by about 18 months. Depressed fontanelles may indicate hypovolemia. Infants are often nose breathers and can develop respiratory distress easily. Rapid breathing can lead to fluid loss and loss of body heat. Hyperventilation of infants presents significant risk of barotrauma.
What are the reflexes that infants have? - Correct answer Startle reflex,
grip reflex, rooting reflex, sucking reflex
What are the age ranges of toddlers and preschoolers? - Correct
answer Toddlers: 1 to 3 years old
Preschoolers: 3 to 6 years old
What are normal vital signs of toddlers and preschoolers? - Correct
answer Toddlers:
-Respirations: about 20-30 breaths per minute -Heart rate: 90-140 bpm -Blood pressure: 80-90 systolic
-Blood pressure: ~100-120 systolic Physiology -Significant growth occurs over about a 3-year period -Eating disorders are more common in this age group -Puberty Adolescents often: -Exhibit argumentative behavior, and are hypercritical and egocentric -Do not anticipate the consequences of their actions -Are subject to a great deal of peer pressure, and are at higher risk for depression and suicide -Are preoccupied with body image and physical appearance -Become sexually active
What are the stages of adulthood? - Correct answer Early adulthood:
20-40 years of age Middle adulthood: 40-60 years of age Late adulthood: over 60 years of age
What are developments you should know about adulthood? - Correct
answer Vitals:
-Respirations: 12-20 breaths/minute -Heart rate: 60-100 beats/minute -Blood pressurer: about 110/70 to 130/ Characteristics: -Accidental trauma is a leading cause of death in the young adult age group -Mild physical decline typically develops in the middle adult age group -Women typically experience menopause during middle adulthood -Continued physical and mental decline is common in late adulthood -Older adults frequently have extensive medical histories and are on multiple medications
What is ventilation? - Correct answer Ventilation is the moving of air in
and out of the lungs.
What is hypoxia? - Correct answer Inadequate delivery of oxygen to the
cells. Early indications of hypoxia: restlessness, anxiety, irritability, dyspnea, tachycardia. Late indications of hypoxia: altered or decreased level of consciousness.
How long quickly does hypoxia damage the heart and brain? - Correct
answer The heart and brain become irritable due to lack of oxygen almost
immediately. Brain damage begins within about 4 minutes. Permanent brain damage is likely within 6 minutes. Irrecoverable injury is likely within 10 minutes.
What is notable about suction units? - Correct answer Portable and
fixed suction units should be able to generate a vacuum of 300 mmHg when tubing is clamped.
What is proper suctioning technique? - Correct answer Suction time
cannot exceed: -15 seconds for adults -10 seconds for children -5 seconds for infants The recovery position reduces risk of aspiration. Unresponsive patients with adequate breathing and no c-spine injury should be placed in the recovery position.
When is supplemental oxygen needed? - Correct answer The goal of
supplemental oxygen is to maintain a pulse oximetry reading of at least 94%. -Supplemental oxygen is not needed if there are no signs of symptoms of respiratory distress and the pulse oximetry is at least 94%. -When oxygen is administered, it should be titrated to maintain a pulse oximeter reading of at least 94%. Indications: -Any patient in cardiac arrest -Any patient receiving artificial ventilation -Any patient with suspected hypoxia
