EMT (Emergency Medical Technician) Crash Course with Online Practice Test, 2nd Edition

1. EMT's First Priority: Scene Safety Always

The EMT’s first priority is always his or her own safety. This will not change.

Personal safety first. An EMT's primary responsibility is to ensure their own safety before attending to others. This principle is paramount and should guide every action at an emergency scene. This includes assessing for hazards, using appropriate personal protective equipment (PPE), and maintaining situational awareness.

Safety for all. After ensuring personal safety, the EMT must prioritize the safety of their partner(s), patients, and bystanders. This involves identifying and mitigating potential risks, such as traffic, hazardous materials, or unstable environments. For example, at a car accident, the EMT should wear a reflective vest, position the ambulance to protect the scene, and be aware of traffic.

Continuous assessment. Scene safety is not a one-time check but an ongoing process. EMTs must continuously reassess the environment for new or changing hazards. This includes being aware of potential threats, such as violence, unstable structures, or environmental dangers. The EMT must be prepared to adapt their approach as the situation evolves.

2. Understanding the EMS System: A Coordinated Effort

EMS is a coordinated network of personnel and resources designed to provide emergency medical care and, when indicated, transport patients to an appropriate higher level of care.

A network of care. The Emergency Medical Services (EMS) system is a complex network of individuals and resources working together to provide emergency medical care. This includes dispatchers, first responders, EMTs, paramedics, hospitals, and medical directors. Each component plays a vital role in ensuring patients receive timely and appropriate care.

Evolution of EMS. The EMS system has evolved significantly over time, from its origins in funeral homes to the modern, highly trained profession it is today. Key milestones include the publication of the "White Paper" in 1966, the development of national training curricula, and the implementation of advanced life support (ALS) services. This evolution reflects a commitment to improving patient outcomes and providing the best possible prehospital care.

Components of EMS. The EMS system encompasses various components, including public access, clinical care, medical direction, integrated health services, information systems, prevention, research, communications, human resources, legislation and regulation, evaluation, finance, public education, and education systems. Each component is essential for the effective functioning of the EMS system and its ability to serve the community.

3. Mastering Airway Management: The Foundation of Care

Most of the manual airway techniques and mechanical airway adjuncts used by the EMT are designed to clear and protect the upper airway.

Airway is paramount. Ensuring a patent airway is the first priority in patient care. This involves recognizing and addressing airway obstructions, using manual techniques like the head-tilt chin-lift or jaw-thrust maneuver, and employing mechanical adjuncts such as oropharyngeal (OPA) and nasopharyngeal (NPA) airways. The tongue is the most common cause of airway obstruction.

Suctioning and positioning. Suctioning is essential for removing secretions and maintaining a clear airway. The recovery position is used for unresponsive patients with adequate breathing to reduce the risk of aspiration. These techniques are critical for preventing hypoxia and ensuring effective ventilation.

Ventilation and oxygenation. When spontaneous breathing is inadequate, artificial ventilation with a bag-valve mask (BVM) or other devices is necessary. Supplemental oxygen is crucial for patients with hypoxia or respiratory distress. The goal is to maintain a pulse oximetry reading of at least 94%.

4. Patient Assessment: A Systematic Approach

The purpose of the primary assessment is to identify and treat immediately life-threatening conditions.

Organized approach. Patient assessment is a systematic process that involves scene size-up, primary assessment, patient history, secondary assessment, and reassessment. This structured approach ensures that critical conditions are identified and addressed promptly. The primary assessment focuses on identifying and treating immediate life threats.

Primary assessment priorities. The primary assessment includes assessing level of consciousness (LOC), airway, breathing, and circulation (ABCs). In unresponsive patients, circulation is assessed first (CAB). Manual cervical spine stabilization is initiated if spinal injury is suspected. The rapid scan is used to identify any remaining life threats.

Secondary assessment and reassessment. The secondary assessment involves a more detailed head-to-toe examination or a focused assessment based on the patient's condition. Reassessment is an ongoing process to monitor for changes in the patient's condition and the effectiveness of interventions. This includes reassessing LOC, airway, breathing, circulation, and vital signs.

5. Shock, Resuscitation, and AED: Time is Critical

The heart and brain become irritable due to lack of oxygen almost immediately.

Understanding shock. Shock, or hypoperfusion, is a life-threatening condition caused by inadequate tissue perfusion. It can result from pump problems (cardiogenic), pipe problems (distributive), or fluid problems (hypovolemic). Early recognition and treatment are crucial to prevent irreversible damage.

CPR and AED. Cardiopulmonary resuscitation (CPR) and automated external defibrillation (AED) are essential interventions for patients in cardiac arrest. The 2010 American Heart Association (AHA) guidelines emphasize high-quality chest compressions, early defibrillation, and minimizing interruptions in chest compressions. The compression-to-ventilation ratio is 30:2 for adults and single-rescuer CPR, and 15:2 for two-rescuer CPR on children and infants.

Time-sensitive interventions. Time is of the essence in managing shock and cardiac arrest. The "Golden Period" and "Platinum 10 Minutes" highlight the importance of rapid assessment, intervention, and transport to an appropriate facility. Early recognition of shock and prompt initiation of CPR and AED use can significantly improve patient outcomes.

6. Medical Emergencies: Recognizing and Responding

Always take seriously any patient complaining of dyspnea, regardless of the level of distress.

Respiratory distress. Respiratory emergencies can be caused by various conditions, including asthma, COPD, anaphylaxis, and pneumonia. Recognizing signs of respiratory distress, such as dyspnea, abnormal breathing patterns, and abnormal lung sounds, is crucial for prompt intervention. Supplemental oxygen and assisted ventilation may be necessary.

Cardiac emergencies. Cardiac emergencies, such as angina and myocardial infarction (MI), require rapid assessment and intervention. Chest pain, dyspnea, and altered LOC are common symptoms. Aspirin and nitroglycerin may be administered per local protocol.

Diabetic emergencies. Diabetic emergencies, such as hypoglycemia and diabetic ketoacidosis (DKA), can lead to altered LOC and other serious complications. Blood glucose monitoring is essential. Oral glucose may be administered for hypoglycemia.

7. Trauma Emergencies: Understanding the Mechanism

Understanding the MOI can help predict injuries, make treatment decisions, and select appropriate hospital destinations.

Mechanism of injury (MOI). Understanding the MOI is crucial for predicting potential injuries in trauma patients. This includes assessing the type of collision, the amount of vehicle damage, the height of a fall, and the type of penetrating trauma. The MOI helps guide the assessment and treatment plan.

Trauma triage. Trauma triage involves determining the severity of injuries and the appropriate destination for the patient. High-priority trauma patients should be transported to a Level 1 trauma center. The Glasgow Coma Scale (GCS) is used to assess the level of consciousness.

Specific trauma injuries. Specific trauma injuries, such as head injuries, spinal injuries, chest injuries, and abdominal injuries, require specialized assessment and management. This includes maintaining manual cervical spine precautions, applying occlusive dressings to sucking chest wounds, and stabilizing fractures.

8. Special Populations: Unique Needs, Unique Care

For sensitive matters, talk with the adolescent without caregivers present when possible.

Pediatric patients. Pediatric patients have unique anatomical and physiological differences from adults. They are more susceptible to airway obstruction, hypothermia, and hypoxia. Bradycardia is a sign of hypoxia in pediatric patients.

Geriatric patients. Geriatric patients often have multiple medical conditions and are on multiple medications. They are at higher risk for falls, heart disease, stroke, and pneumonia. Atypical presentations of MI are common.

Patients with special needs. Patients with hearing impairments, visual impairments, speech impairments, developmental disabilities, or brain injuries require specialized communication and care. It is important to be patient, respectful, and to adapt your approach to meet their individual needs.

9. Legal and Ethical Considerations: Guiding Principles

It is essential for EMTs to know the standing orders, guidelines, and protocols for their state, agency, and medical director.

Scope of practice. EMTs must operate within their scope of practice, which is determined by their licensure or certification level. They must also adhere to the standard of care, which is the level of care a reasonable person with similar training would provide in a similar situation.

Consent and refusals. Informed consent is required from all alert and competent patients. Implied consent can be used for unresponsive or incompetent patients. Competent patients have the right to refuse treatment, but they must be fully informed of the risks of refusal.

Liability and confidentiality. EMTs must be aware of their legal liabilities, including negligence, abandonment, and false imprisonment. They must also protect patient confidentiality and adhere to the Health Insurance Portability and Accountability Act (HIPAA).

10. Effective Communication: The Key to Teamwork

Strong verbal communication skills are needed. Body language won’t help over the phone or radio.

Verbal communication. Effective communication is essential for coordinating care with dispatch, medical direction, and other healthcare providers. This includes using clear text, not radio codes, and relaying patient information from high priority to low priority.

Interpersonal communication. Interpersonal communication involves sending and receiving information between at least two people. Nonverbal cues, such as body language, have a significant impact on communication. Establishing rapport with the patient is crucial for obtaining accurate information and providing compassionate care.

Therapeutic communication. Therapeutic communication involves showing compassion, competence, confidence, conscience, and commitment. This includes active listening, asking open-ended questions, and avoiding judgmental or biased questions.

11. Documentation: The Cornerstone of Accountability

Documentation rule No. 1: If you did it, write it down. If you didn’t do it, don’t write that you did.

Patient care report (PCR). The patient care report (PCR) is a legal document that serves multiple purposes, including continuation of care, billing, research, and quality improvement. It must be factual, accurate, complete, and timely.

Minimum data set. The minimum data set includes essential information such as times, patient information, administrative information, and a narrative. The narrative should paint a clear picture of what happened.

Objective documentation. Documentation should be objective, not subjective. Objective documentation is based on facts, findings, or observations that are difficult to dispute. Subjective documentation is based on opinions or perceptions and can be easily disputed.

12. EMS Operations: Safety and Efficiency

The quality of patient care is far more important than the speed of the response. Do not sacrifice safety for speed.

Ambulance operations. Safe ambulance operations are essential for protecting the crew and the patient. This includes daily inspections, defensive driving techniques, and proper use of emergency equipment.

Phases of an ambulance call. An ambulance call involves several phases, including preparation, dispatch, en route to scene, arrival at scene, patient transfer, transport to receiving facility, arrival at hospital, and post-run phase. Each phase requires careful planning and execution.

Air medical operations. Air medical transport may be necessary for patients with critical injuries or illnesses. EMTs must be aware of safety considerations when working around aircraft, including securing loose equipment, never approaching a rotor wing aircraft from the rear, and never backing up.

Last updated: January 15, 2025