Extracredit PDF
Extracredit PDF
Extracredit PDF
CHAPTER 1 QUIZ
Write the letter of the best answer in the space provided.
©2010 by Pearson Education, Inc. C H A P T E R 1 Emergency Medical Care Systems, Research, and Public Health
Prehospital Emergency Care, 9th Ed.
M01_MIST7816_09_IRM_CH01.QXD 9/24/09 2:26 AM Page 4
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
You and an EMT partner are assigned to EMS Unit 5 one morning in September. At 1035, the emergency
dispatcher directs you to an accident on Mesa Drive. A woman driving her car along that road called 911
on her cell phone to report that the car ahead of her had swerved to avoid a dog, gone off the road, plunged
into a ditch, and hit a tree.
Your unit pulls up at the scene 6 minutes later. As you don your personal protective equipment, you note
that a county sheriff’s car is already on-scene. A deputy is kneeling beside a male in his early 20s who is
lying on the ground. Even from the top of the ditch, you can see that the young man’s shirt and pants are
blood soaked. The deputy is applying direct pressure to the patient’s right wrist. As you approach, the
deputy tells you that after the crash, the patient, who had been wearing a seat belt, did not believe himself
injured. However, before the deputy arrived, the patient attempted to get out of the car. In doing so, he
sliced his wrist on jagged metal.
Your partner takes over holding direct pressure to the wound. Meanwhile, you introduce yourself to the
patient as you begin your assessment of his condition. The patient seems anxious and restless; as you assess
him, you talk to him, explaining what you are doing, and try to calm him.
Because of the circumstances of the accident, you are especially alert during the assessment to the
possibility that the patient may have received internal and/or spinal injuries. In fact, you determine
that the patient is showing signs and symptoms of internal bleeding and shock (hypoperfusion). Shock
is a life-threatening condition, so you decide that he needs immediate transport to the hospital, some
20 minutes away.
You have provided the patient with high concentration oxygen. Now, as you prepare him for transport,
you ask the police officer to call in a request for a rendezvous with Paramedics of the advanced life support
(ALS) unit. When he has done so, he joins you and your partner in moving the patient, now immobilized
to a long spine board, to the ambulance. You remain with the patient, holding direct pressure on the wrist
wound, while your partner drives. You also monitor the patient’s airway, breathing, and circulation and re-
assess his vital signs.
Seven minutes later, you meet the paramedics of the ALS unit at the parking lot of a farm produce stand.
You provide the paramedics with a concise report of the patient’s condition and your interventions. The
paramedics assume care of the patient. They contact medical direction and report on their findings and
expected time of arrival at the hospital as transport continues.
At 1105, the ambulance reaches County General Hospital. The emergency room staff is briefed on the
patient’s status and vital signs and on the care he has received. The hospital crew takes over, and wheels the
patient off to surgery.
©2010 by Pearson Education, Inc. C H A P T E R 1 Emergency Medical Care Systems, Research, and Public Health
Prehospital Emergency Care, 9th Ed.
M01_MIST7816_09_IRM_CH01.QXD 9/24/09 2:26 AM Page 5
CHAPTER 1 REVIEW
Write the word or words that best complete each sentence in the space provided.
2. The National Highway Safety Act charged the United States ______________________________
______________________________ ______________________________ with developing an EMS system.
3. The emergency medical treatment given by EMTs to patients before they are transported to a
4. The type of facility that provides specialized treatment for injuries that exceed normal hospital
5. The system of answering emergency telephone calls that uses specially trained EMS personnel who
obtain information about emergency situations from callers and also provide instructions for emer-
6. The 911 telephone number used to access emergency services in many parts of the nation is often
who has passed specific additional training programs and is authorized to provide some level of ad-
8. The system of internal and external reviews and audits of all aspects of an emergency medical system
9. Standing orders that allow EMTs to give certain medications or perform certain procedures without
properly completed.
©2010 by Pearson Education, Inc. C H A P T E R 1 Emergency Medical Care Systems, Research, and Public Health
Prehospital Emergency Care, 9th Ed.
M01_MIST7816_09_IRM_CH01.QXD 9/24/09 2:26 AM Page 6
EMT: LISTING
1. List five of the categories in which the National Highway Traffic Safety Administration Technical
Assistance Program sets standards for EMS systems.
(continued)
©2010 by Pearson Education, Inc. C H A P T E R 1 Emergency Medical Care Systems, Research, and Public Health
Prehospital Emergency Care, 9th Ed.
M01_MIST7816_09_IRM_CH01.QXD 9/24/09 2:26 AM Page 7
H a n d o u t 1 - 4 (continued)
©2010 by Pearson Education, Inc. C H A P T E R 1 Emergency Medical Care Systems, Research, and Public Health
Prehospital Emergency Care, 9th Ed.
M01_MIST7816_09_IRM_CH01.QXD 9/24/09 2:26 AM Page 8
__________ 1. As an EMT, your authority to give medications and provide emergency care is an
extension of the medical director’s license to practice medicine.
__________ 2. As an EMT, you will be one of the many persons and professionals that come together to
form an EMS system.
__________ 4. Certification as an EMT requires only that a person successfully complete the DOT
EMT-National Standard Training Program.
__________ 5. Keeping yourself safe is your second priority after patient safety when providing
medical care.
__________ 6. The care an individual patient requires may range from simple emotional support to
life-saving CPR.
__________ 7. You must never abandon care of the patient at the hospital until transfer to hospital
personnel has been properly completed.
__________ 8. Good personality traits are really not very important to the EMT.
__________ 9. Good quality continuing education can often take the place of an original EMT
training course.
__________ 10. Quality improvement is designed and performed to ensure that the public receives the
highest quality prehospital care.
__________ 11. The EMT has no direct role in the quality improvement process.
__________ 12. Striving for quality in the care you personally give to patients and as a collective part of
an ambulance squad is to uphold the highest standards of the EMS system.
©2010 by Pearson Education, Inc. C H A P T E R 1 Emergency Medical Care Systems, Research, and Public Health
Prehospital Emergency Care, 9th Ed.
M01_MIST7816_09_IRM_CH01.QXD 9/24/09 2:26 AM Page 9
©2010 by Pearson Education, Inc. C H A P T E R 1 Emergency Medical Care Systems, Research, and Public Health
Prehospital Emergency Care, 9th Ed.
M02_MIST7816_09_IRM_CH02.QXD 9/24/09 1:01 AM Page 3
CHAPTER 2 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. The stage of the dying process that can be characterized by the words “Why me?” is
A. denial. C. anger.
B. acceptance. D. depression.
__________ 2. A type of emergency call likely to produce extreme levels of stress is one involving
A. a patient with a communicable disease.
B. injury or death of a coworker.
C. a geriatric patient.
D. narcotics.
__________ 3. The goal of the CISD is to
A. assign blame for the incident.
B. assist patients in their recovery.
C. assist emergency care workers in dealing with stress.
D. allocate funds for ambulance services.
__________ 4. A less structured version of the CISD, which may be held from 1 to 4 hours after an
incident and before the formal debriefing, is called a(n)
A. resolution. C. escape mechanism.
B. defusing. D. R&R process.
__________ 5. The stage of grieving in which a patient seeks to postpone death, even for a short time, is
A. anger. C. acceptance.
B. bargaining. D. denial.
__________ 6. Organisms that cause infection, such as viruses and bacteria, are
A. toxins. C. venoms.
B. pathogens. D. poisons.
__________ 7. The standard that assumes all blood and body fluids are infectious and requires
emergency personnel to follow strict procedures to protect themselves from them is
referred to as
A. infective body fluid measures.
B. isolated infection controls.
C. preventive control substance standards.
D. body substance isolation.
__________ 8. Gloves, masks, and gowns are examples of
A. turnout gear.
B. optional field equipment.
C. personal protective equipment.
D. “red bag” gear.
__________ 9. If a patient is suspected of having tuberculosis, an EMT should wear a _____ respirator.
A. PPD C. HEPA
B. CISD D. BSI
(continued)
©2010 by Pearson Education, Inc. C H A P T E R 2 Workforce Safety and Wellness of the EMT
Prehospital Emergency Care, 9th Ed.
M02_MIST7816_09_IRM_CH02.QXD 9/24/09 1:01 AM Page 4
H a n d o u t 2 - 1 (continued)
__________ 10. Lifestyle changes that can help an EMT deal with stress include all of the following
except
A. cut down on sugar, fat, and caffeine.
B. avoid exercise in your daily routine.
C. avoid self-medication.
D. keep balance in your life.
__________ 11. Which of the following materials is not recommended for gloves to be used when there is
the potential for contact with blood and other body fluids?
A. latex C. cotton
B. vinyl D. synthetics
__________ 12. Equipment used as a BSI precaution includes all of the following except
A. a HEPA respirator. C. cotton scrub pants.
B. vinyl gloves. D. goggles.
__________ 13. The process by which an object is subject to a chemical or physical substance that kills all
microorganisms on the surface is
A. sterilization. C. disinfection.
B. OR cleaning. D. scouring.
__________ 14. A situation that would usually call for the use of a gown as protection would be one
involving a
A. drug-overdose patient. C. suspected TB patient.
B. childbirth. D. patient with a fractured leg.
__________ 15. Dispose of all needles immediately after use in a(n)
A. “green bag.” C. “OSHA jar.”
B. “HAZMAT box.” D. “sharps container.”
__________ 16. The single most important way an EMT can prevent the spread of infection is
A. up-to-date immunizations. C. wearing a jumpsuit.
B. hand washing. D. using a mask.
__________ 17. In general, before entering a hazardous materials scene, EMTs should
A. call for an ambulance. C. put on a mask.
B. put on goggles. D. call for a specialized HAZMAT team.
__________ 18. The test that can detect exposure to tuberculosis is the _____ test.
A. PSA C. SAT
B. Mantoux D. Rubella
__________ 19. If you suspect the potential for violence at a scene, before entering it, you should
A. call law enforcement. C. put on body armor.
B. turn on all lights and sirens. D. approach on foot.
__________ 20. Vehicles, structures, and storage containers holding hazardous materials should be
identified by
A. signs or placards. C. reflectors.
B. strobe lights. D. warning flags.
©2010 by Pearson Education, Inc. C H A P T E R 2 Workforce Safety and Wellness of the EMT
Prehospital Emergency Care, 9th Ed.
M02_MIST7816_09_IRM_CH02.QXD 9/24/09 1:01 AM Page 5
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
You and your partner are dispatched to the scene of a motor vehicle collision. As you approach the scene,
you note that a large tanker truck has overturned in the middle of the road. The truck’s driver is trapped
in the cab. You are also informed by dispatch that a bystander has reported that the truck has placards dis-
played on its exterior.
2. If you determine that the truck carries hazardous materials, what should you do next?
©2010 by Pearson Education, Inc. C H A P T E R 2 Workforce Safety and Wellness of the EMT
Prehospital Emergency Care, 9th Ed.
M02_MIST7816_09_IRM_CH02.QXD 9/24/09 1:01 AM Page 6
CHAPTER 2 REVIEW
Write the word or words that best complete each sentence in the space provided.
2. A(n) ______________________________-______________________________
______________________________ is a single incident in which there are multiple patients.
process in which a team of trained peer counselors and mental health professionals meet with
rescuers and health care providers who have been involved in the incident.
6. The state of emotional exhaustion and irritability that can markedly decrease an EMT’s effectiveness
7. According to the U.S. Public Health Service, most contaminants can be removed from the skin with
______________________________ to ______________________________ seconds of vigorous
______________________________ ______________________________.
coughing, or sneezing.
10. In addition to eye protection, gloves, and a mask, another item of personal protective equipment
that should be worn when there may be significant contact with blood or other body fluids is a(n)
______________________________.
(continued)
©2010 by Pearson Education, Inc. C H A P T E R 2 Workforce Safety and Wellness of the EMT
Prehospital Emergency Care, 9th Ed.
M02_MIST7816_09_IRM_CH02.QXD 9/24/09 1:01 AM Page 7
H a n d o u t 2 - 3 (continued)
12. The level of cleaning for items such as backboards and cervical collars, which come in contact with
13. EMS personnel treating a patient suspected of having TB should use a(n)
______________________________ respirator.
14. Before entering scenes involving domestic disputes, gang fights, or bar fights, an EMT should first
______________________________ ______________________________ ______________________________.
15. When approaching a wrecked vehicle that may be carrying hazardous materials, use binoculars to try
material as hazardous.
©2010 by Pearson Education, Inc. C H A P T E R 2 Workforce Safety and Wellness of the EMT
Prehospital Emergency Care, 9th Ed.
M02_MIST7816_09_IRM_CH02.QXD 9/24/09 1:01 AM Page 8
2. List four types of calls that have a higher-than-normal potential for causing stress in EMS personnel.
3. List and define five emotional stages a dying patient may go through.
4. List the basic types of personal protective equipment that EMTs can be expected to use on
a regular basis.
©2010 by Pearson Education, Inc. C H A P T E R 2 Workforce Safety and Wellness of the EMT
Prehospital Emergency Care, 9th Ed.
M02_MIST7816_09_IRM_CH02.QXD 9/24/09 1:01 AM Page 9
__________ 2. All seriously ill patients pass through a five-stage grieving process.
__________ 3. The main purpose of a CISD is to affix responsibility for the events that took place
during an incident.
__________ 5. Keeping yourself safe is your first priority when providing medical care as an EMT.
__________ 6. Diseases are caused by pathogens, which may be spread through the air or by contact
with blood and/or body fluids.
__________ 7. In the practice of prehospital emergency care, all body fluids must be considered
infectious.
__________ 8. It is imperative that the EMT changes gloves between every patient contact.
__________ 9. Because EMTs wear protective gloves while with patients, hand washing is not essential
immediately after each call.
__________ 10. A HEPA or N-95 respirator should be worn after contact with an HIV-positive patient.
__________ 11. In some jurisdictions, when a patient is suspected of having an infection spread by
droplets, a surgical-type mask may be placed on the patient if he or she is alert and
cooperative.
__________ 12. An EMT called to a scene of suspected violence should treat any life-threatening
emergencies before calling law enforcement.
__________ 13. A copy of the Emergency Response Guidebook should be on board every emergency
vehicle.
__________ 14. An EMT exposed to bloodborne pathogens should seek medical attention within
4 weeks after the exposure.
__________ 15. An EMT should make preservation of evidence at a crime scene the highest priority.
©2010 by Pearson Education, Inc. C H A P T E R 2 Workforce Safety and Wellness of the EMT
Prehospital Emergency Care, 9th Ed.
M02_MIST7816_09_IRM_CH02.QXD 9/24/09 1:01 AM Page 10
©2010 by Pearson Education, Inc. C H A P T E R 2 Workforce Safety and Wellness of the EMT
Prehospital Emergency Care, 9th Ed.
M03_MIST7816_09_IRM_CH03.QXD 9/25/09 3:49 AM Page 3
CHAPTER 3 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. Mentally competent adults of legal age who accept care from an EMS crew are said to
give _____ consent.
A. guardian C. partial
B. implied D. expressed
__________ 2. EMS personnel can treat unconscious patients because the law holds that rational
patients would consent to treatment if they were conscious. This principle is known
as _____ consent.
A. expressed C. emergency
B. implied D. actual
__________ 3. Minors who are married or of a certain age and who are legally able to give consent for
medical care are known as
A. emancipated. C. released.
B. practiced. D. responsible.
__________ 4. When a patient refuses care, he or she must sign a(n)
A. codicil. C. DNR order.
B. insurance rider. D. release from liability form.
__________ 5. A legal document, usually signed by the patient and his physician, which states that the
patient has a terminal illness and does not wish to prolong life through resuscitative
efforts, is called a(n)
A. surrogate statement. C. codicil.
B. DNR order. D. unspecified treatment order.
__________ 6. A person whom the signer of a document names to make health care decisions for her in
case the signer is unable to make such decisions for herself is called a(n)
A. proxy. C. designated agent.
B. assistant. D. heir.
__________ 7. Legislative measures intended to provide legal protection for citizens and some health
care personnel who administer emergency care are known as
A. First Responder laws. C. Helping Hands legislation.
B. EMS Acts. D. Good Samaritan laws.
__________ 8. An EMT’s obligation in certain situations to provide care to a patient is referred
to as a(n)
A. agency. C. proxy.
B. surrogate’s role. D. duty to act.
__________ 9. If a jury finds that an EMT had a duty to a patient, that he failed to carry out that duty
properly, and that his action caused harm to the patient, the EMT could be convicted of
A. failure to act. C. fraud.
B. libel. D. negligence.
(continued)
H a n d o u t 3 - 1 (continued)
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
You are dispatched to 44 Crescent Drive for a “difficulty breathing” call. There is something familiar about
the address, which is in a neighborhood of fashionable homes, but you can’t quite place it.
Pulling up at the residence, you quickly make sure the scene is quiet and safe. You and your partner grab
the jump kit and head for the front door. Before you can ring the bell, a man swings the door open and
motions you inside. Now you know why the address is familiar. The man is James Sherman, a prominent
figure in city politics.
He leads you upstairs, explaining as you go that his son has long suffered from cystic fibrosis. Right
now, he’s having extreme difficulty in breathing, and Mr. Sherman would like you to transport him to
Samaritan Hospital.
In the bedroom to which he leads you, you find the son, Jared, lying in bed. He appears to be in his
early 20s and is obviously struggling to breathe. Yet as you approach the bed, he manages to gasp out, “Go
’way . . . no doctors . . . want to die.”
His father turns to you and says, “Don’t pay him any mind. Just get him on oxygen and to the hospital.”
2. Later that day, you return to base. As you’re getting out of your vehicle, a woman walks up.
She identifies herself as a reporter for the local paper and says, “I hear there was a tough call at
Jim Sherman’s house with his son, Jared. You know, you can help protect yourself if you get the
straight facts into the paper. I won’t have to mention your name, and I won’t reveal who my
sources are.” What should you do in this situation?
CHAPTER 3 REVIEW
Write the word or words that best complete each sentence in the space provided.
2. When dealing with children and mentally incompetent adults, the ______________________________
or ______________________________ have the legal authority to give consent.
provide consent.
4. Failure to provide the standard of care is one of the elements that must be proved in a case involving
rejecting treatment.
10. If the EMT is off duty and begins care, then leaves the patient before other trained personnel arrive,
12. The only time that confidential information about a patient may be disclosed is when the patient has
completed a legal document that allows for that patient’s organs and tissues to be used by others
H a n d o u t 3 - 3 (continued)
been committed or any place that evidence relating to a crime may be found.
15. Obvious signs of death, with which resuscitative efforts do not have to be made, include
4. List three types of incidents that most states require health care professionals to report to
authorities.
5. List six presumptive signs of death that should be identified when dealing with a patient who has a
Do Not Resuscitate order.
__________ 1. Consent, or permission from the patient, is required for any treatment or action by
the EMT.
__________ 2. An unconscious patient must regain consciousness before consent can be granted and
treatment can begin.
__________ 3. Expressed consent must be obtained from patients who are able to give it.
__________ 4. It is not legally necessary to explain all procedures and risks of treatment to the rational,
conscious patient.
__________ 5. Emergency care for a patient identified as an organ donor should not differ from the
care provided to any other patient.
__________ 6. Children and mentally incompetent adults are legally allowed to provide consent for
their treatment.
__________ 7. Patients who are mentally competent have the right to refuse medical care.
__________ 8. A release form is designed to protect health care providers from liability arising from the
patient’s informed refusal of treatment and transport.
__________ 9. In all cases of refusal, the EMT should advise the patient to feel free to seek help if
certain symptoms develop.
__________ 11. In most cases, the oral requests of a family member are a sufficient reason to withhold
care from a patient.
__________ 12. An EMT’s duty to act continues throughout the call or until care is transferred to
someone with equal or greater expertise.
__________ 13. Good Samaritan laws do not prevent someone from initiating a lawsuit, nor will they
protect the rescuer from being found liable for acts of gross negligence and other
violations of the law.
__________ 14. Basically, an EMT who places the patient’s welfare above all else when providing medical
care will rarely commit an unethical act on the job.
__________ 15. An EMT is legally responsible for any of the patient’s property he picks up at the
emergency scene.
HANDOUT 3-1: Chapter 3 Quiz HANDOUT 3-4: Medical, Legal, and Ethical
1. D 5. B 9. D 13. B Issues: Listing
2. B 6. A 10. D 14. B 1. Expressed; implied; consent to treat minors or
3. A 7. D 11. C 15. D incompetents.
4. D 8. D 12. B 2. Try again to persuade the patient to accept treatment
or transport; make sure the patient is competent to
HANDOUT 3-2: In the Field make a rational, informed decision; consult medical
direction; have the patient sign a refusal of treatment
1. Jared is an adult and if he is competent, he should form; encourage the patient to seek help if the
make his own health care decisions unless he named problem persists or gets worse.
his father as his health care proxy. Attempt to 3. Findings must be made that (1) the EMT had a duty
determine if Jared is competent. Contact medical to act; (2) the EMT breached that duty; (3) the
direction for guidance. Discuss the consequences of patient suffered a compensable injury; (4) injuries
refusing treatment with Jared. Be sure that he signs a were the result of the EMT’s negligence.
refusal of care if treatment is refused.
4. Any three: abuse (usually child, but sometimes
2. Patient confidentiality is the controlling factor. Say spousal or elderly); injuries that have resulted from a
“No comment” and walk away. crime; drug-related injuries; cases of exposure to
certain infectious diseases; dog bites; cases of
HANDOUT 3-3: Chapter 3 Review transportation against a patient’s will.
1. unconscious 5. Absence of pulse, breathing, and breath sounds;
2. parents, guardians complete unresponsiveness to any stimuli; no eye
3. Emancipated movement or pupil response; absence of blood
pressure; no reflexes; dependent lividity.
4. negligence
5. refusal of treatment
6. competent
HANDOUT 3-5: Medical, Legal, and Ethical
7. DNR order
Issues: True or False
8. duty to act 1. T 5. T 9. T 13. T
9. care 2. F 6. F 10. T 14. T
10. abandoned 3. T 7. T 11. F 15. T
11. Good Samaritan 4. F 8. T 12. T
12. written release
13. organ donor
14. crime scene
15. decapitation, rigor mortis
CHAPTER 4 QUIZ
Write the letter of the best answer in the space provided.
H a n d o u t 4 - 1 (continued)
__________ 12. The EMT may provide confidential information to all of the following except
A. the patient’s family.
B. the emergency department nurse.
C. a court under a subpoena.
D. the police in a criminal investigation.
__________ 13. If a competent patient refuses care or transport, an EMT should
A. immediately leave the scene. C. document the refusal.
B. argue with the patient. D. request police backup.
__________ 14. Incorrect information in a prehospital care report should be
A. erased. C. crossed out with a single line.
B. crossed out completely. D. left unchanged.
__________ 15. During a multiple-casualty incident (MCI), patient information is usually passed
along by
A. triage tags. C. electronic clipboards.
B. face-to-face reports. D. cellular phones.
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
The emergency medical dispatcher sends you to the scene of a motor vehicle collision 3 miles west of the
convenience store on Fonda Road. The emergency involves a single car that has struck a telephone pole.
When you arrive at the scene, you do a quick scene size-up. The vehicle has only minor damage, and no
lines are down. EMRs from the fire department have secured the scene and have initiated CPR on a male
patient. You notice no obvious signs of trauma on the patient, except a 1-inch laceration to the forehead.
One of the EMRs reports: “The patient’s license indicates that he is in his mid-60s. When we arrived,
he was already in cardiac and respiratory arrest. We extricated him from the vehicle and began CPR, while
providing manual cervical-spine stabilization.”
You write down the EMR’s comments in quotes and tell him to continue with CPR. Meanwhile, you
insert an oral airway and apply the automated external defibrillator (AED). Readings on the AED advise
you to stand clear as it begins to charge. The AED shocks the patient a total of three times in this sequence.
Your EMT partner restarts CPR and continues it for 1 minute. Readings on the AED indicate that the
patient has a shockable rhythm. Your partner stands back, and the AED shocks three more times.
The patient now has a weak pulse, but he is still not breathing. You place him on a long spine board and
begin transport to the hospital. En route, the patient becomes pulseless. You use the AED again, regain-
ing the pulse on the seventh shock.
You recheck the patient’s pulse and find it to be strong—62 beats per minute. Other vital signs show a
blood pressure of 112/52 and six spontaneous breaths per minute. You assist his ventilations.
You continue checking vital signs. Upon arrival at the hospital, the patient has a pulse rate of 68, blood
pressure of 124/72, and respirations of 16. He has spontaneous eye opening but is not following
commands.
Because of the patient’s condition, you have been unable to obtain a medical history. You also have no
knowledge of prescribed medications or allergies. You did, however, discover some pertinent personal in-
formation from the patient’s license. Data included: patient name—James Gilligan; date of birth—June 7,
1942; address—73 First Street, Waterford, NY.
You have also recorded these times for your unit, ID# 123 of the emergency team. From the AED:
■ Call received 0934 ■ Power on 0943.22
■ En route 0936 ■ Shock 1 0943.55
■ At scene 0941 ■ Shock 2 0944.12
■ From scene 0955 ■ Shock 3 0944.52
■ At hospital 1013 ■ Shock 4 0946.02
■ In service 1039 ■ Shock 5 0946.51
■ In quarters 1049 ■ Shock 6 0947.31
■ Shock 7 1007.29
1. Using the information in this scenario, fill out as many parts of the following prehospital care report
as possible. You might substitute the prehospital care report used by an EMS agency in your area.
(continued)
H a n d o u t 4 - 2 (continued)
COMMENTS
TREATMENT
Moved to ambulance on stretcher/backboard Medication Administered (Use Continuation Form)
Moved to ambulance on stair chair IV Established Fluid __________________________ Cath. Gauge
Walked to ambulance Mast Inflated @ Time ______________________________________________
Airway Cleared Bleeding/Hemorrhage Controlled (Method Used: ____________________ )
Oral/Nasal Airway Spinal Immobilization Neck and Back
Esophageal Obturator Airway/Esophageal Gastric Tube Airway (EOA/EGTA) Limb Immobilized by Fixation Traction
EndoTracheal Tube (E/T) (Heat) or (Cold) Applied
Oxygen Administered @ L.P.M., Method ______________________________________ Vomiting Induced @ Time _______ Method ___________________________
Suction Used Restraints Applied, Type ____________________________________________
Artificial Ventilation Method ___________________________________________________________ Baby Delivered @ Time ___________ In Country _______________________
C.P.R. in progress on arrival by: Citizen PD/FD/Other First Responder Other Alive Stillborn Male Female
Time from Arrest Transported in Trendelenburg position
C.P.R. Started @ Time Until C.P.R. Minutes Transported in left lateral recumbent position
EKG Monitored (Attach Tracing) [Rhythm(s) _________ ] Transported with head elevated
(continued)
H a n d o u t 4 - 2 (continued)
14 9
Hospital Receiving Agent 1 18
(IF REQUIRED) 14
9
COMPLETE ON WHITE (AGENCY) COPY ONLY
Infant
Adult Child
SIGNATURE
(continued)
H a n d o u t 4 - 2 (continued)
M D Y
DATE RUN NO. AGENCY CODE VEH. ID
Name Agency Enter PCR ID#
Name (Top Center of PCR)
ADDITIONAL HISTORY & Weight in
PHYSICAL EXAM FINDINGS Kilograms
COMMENTS:
AGENCY COPY/WHITE HOSPITAL PATIENT RECORD COPY/PINK RESEARCH COPY/BLUE EXTRA SERVICE COPY/GREEN
PAGE __________ OF __________
CHAPTER 4 REVIEW
Write the word or words that best complete each sentence in the space provided.
1. ______________________________ is an important part of the patient care process and serves a variety
4. To ensure that runs meet current medical and organizational standards, most EMS agencies have
a(n) ______________________________ improvement system in place.
5. The U.S. Department of Transportation calls the information it wants on all PCRs the
______________________________ ______________________________ ______________________________.
7. The ______________________________ data includes the patient’s name and address, sex, age, and any
9. Because the precise times of events during a call can be both medically and legally important, all
10. When bystander observations and the patient’s chief complaint are recorded, they should be placed
in ______________________________ ______________________________.
professionals know that an EMT examined certain areas without making any significant findings.
12. At least ______________________________ complete sets of vital signs should be taken and recorded.
13. If a patient declines emergency treatment or transport, he should be asked to sign a(n)
______________________________-______________________________-______________________________
form.
(continued)
H a n d o u t 4 - 3 (continued)
14. The PCR is considered ______________________________ and must be handled with care and
discretion.
15. In a multiple-casualty incident (MCI), patient information is often passed through the system in the
DOCUMENTATION: LISTING
1. List four basic uses of the prehospital care report (PCR).
3. List three legal issues that pertain to PCRs and other documents that an EMT may complete.
4. List three things to do to correct an error made while filling out a PCR.
MEDICAL ABBREVIATIONS
Below is a list of symbols and codes that you might encounter when reading a prehospital care report
(PCR).
AMT Amount
Approx. Approximately
BP Blood pressure
BS Breath sounds
BILAT Bilateral
CA Cancer
CVA Stroke
(continued)
H a n d o u t 4 - 5 (continued)
CC Chief complaint
cc Cubic centimeter
C/O Complaining of
DT Delirium tremens
DX Diagnosis
ET Endotracheal tube
EKG Electrocardiogram
FX Fracture
FB Foreign body
GYN Gynecology
HX History
IV Intravenous
(continued)
H a n d o u t 4 - 5 (continued)
LAT Lateral
NC Nasal cannula
PT Patient
PE Pulmonary edema
PALP Palpation
RX Medicine
H a n d o u t 4 - 5 (continued)
RXN Reaction
SX Symptom
SZ Seizure
T Temperature
TX Treatment
VS Vital signs
YO Years old
CHAPTER 5 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. The initial communication with EMTs about an emergency call is the
A. hospital radio report. C. dispatch report.
B. verbal report. D. consult with medical direction.
__________ 2. The two-way radio located at a hospital or dispatch center is a
A. mobile radio. C. digital radio.
B. repeater. D. base station.
__________ 3. All of the following patient data should be included in a radio medical report except
A. name and address. C. mental status.
B. age and sex. D. chief complaint.
__________ 4. The federal agency that assigns and licenses radio frequencies used by EMS units is the
A. FDA. C. FCC.
B. HUD. D. DOT.
__________ 5. If an order from medical direction appears to be inappropriate, the EMT should
A. ignore it.
B. follow it exactly.
C. alter the part that appears inappropriate.
D. question it.
__________ 6. The principles of radio communication encourage transmissions that make use of
A. codes or slang. C. plain English.
B. courtesies such as “thank you.” D. phrases such as “be advised.”
__________ 7. To keep emergency frequencies open, an EMT should pause for several seconds if a
transmission takes longer than
A. 1 minute. C. 2 minutes.
B. 30 seconds. D. 15 seconds.
__________ 8. To help calm a patient, an EMT should
A. speak in medical terms. C. use a patient’s first name.
B. explain all procedures. D. downplay expected pain.
__________ 9. In assessing a child, an EMT should
A. keep the truth from the child. C. ask the parents to leave.
B. crouch at the child’s level. D. stand above the child.
__________ 10. If an on-line physician orders medication, an EMT should
A. administer it immediately.
B. repeat back the order word for word.
C. accept the order without question.
D. respond “order received.”
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
The emergency medical dispatcher sends you and your EMT partner to 37 Anne Drive, where a 49-year-old
male is complaining of a crushing pain in his chest.
Upon arrival at the house, you and your partner do a quick scene size-up. The man’s daughter introduces
herself and leads you into the garage. Here you see her father sitting on the floor with his fist clutched to
his chest.
Taking BSI precautions, you and your partner put on gloves. After introducing yourself, you crouch
down to eye level with the man and ask him his name and age.
“I’m Anthony Cohen,” he replies. “I’m 49, but feel like 100. Am I having a heart attack?”
You tell Mr. Cohen that you cannot make a diagnosis but will relay a description of his condition to
medical personnel at the hospital. You listen carefully as Mr. Cohen describes his chief complaint, writing
down notes as he speaks.
You now begin the initial assessment. You observe that Mr. Cohen is awake and alert and that his airway
is open. However, he appears to be splinting his chest wall. His breathing is rapid and shallow. Your partner
immediately administers oxygen while you continue the assessment.
As you start to collect vital signs, your partner obtains a history of the present illness as well as a SAMPLE
history. She tells Mr. Cohen the purpose of her questions. She also says, “While we talk, my partner will be
checking your vital signs—things like your pulse rate.”
You record the following vital signs: blood pressure at 160/100, regular and bounding pulse, a pulse rate
of 120 beats per minute, breathing at 28 breaths per minute, skin pale and moist, pulse ox of 98 percent.
With Mr. Cohen reporting no prior history of heart problems, you and your partner elect to package
him for immediate transport. You request a paramedic intercept en route to the hospital.
2. What information would you include in a 30-second report to the receiving facility?
CHAPTER 5 REVIEW
Write the word or words that best complete each sentence in the space provided.
2. A(n) ______________________________ breaks down sound into digital codes while a(n)
______________________________ responds only to those codes.
touch with the members of the EMS while they are away from the ambulance.
4. In the event of power failure or malfunction, EMS systems should have ______________________________
______________________________ available.
radio communications.
6. After receiving an order from medical direction to administer medication, the EMT should
______________________________ ______________________________ ______________________________
7. The EMT must communicate with partners and patients plus EMS ______________________________,
______________________________ ______________________________, and medical personnel at the
receiving facility.
8. At the conclusion of a call, the EMTs should notify ______________________________ of their return
to the station.
9. When caring for a patient with a hearing loss, be sure that your ______________________________ are
10. The EMT should never use the patient’s ______________________________ in radio transmissions.
COMMUNICATION: MATCHING
Write the letter of the term in the space provided next to the appropriate description.
__________ 2. Federal agency that assigns and licenses radio frequencies B. cellular phone
__________ 7. A member of the EMS system who receives the initial call for help G. oral report
__________ 9. A device that picks up radio signals from lower-power units I. FCC
__________ 3. The Department of Transportation (DOT) licenses radio frequencies used by EMS
agencies.
__________ 5. The opening statement of every radio report transmits the unit identification.
__________ 6. Requests for further orders usually come at the end of the radio report.
__________ 7. An EMT should never question the medications prescribed by an on-line physician.
__________ 8. Patients from some cultures may consider it impolite to make direct eye contact.
__________ 9. Standing over a patient enhances the EMT’s ability to gather patient information.
__________ 10. Use of a patient’s first name will usually put him or her at ease.
__________ K. “The crash was a car versus a pole; estimated speed 45 miles per hour.”
CHAPTER 6 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. When you are lifting a heavy object, avoid using the muscles of your
A. back. C. shoulders.
B. arms. D. legs.
__________ 2. One technique that can greatly reduce the risk of back injuries when lifting and moving
patients is
A. not allowing the weight to get close to your body.
B. keeping the lifted weight in close to your body.
C. keeping your feet together.
D. locking out your knees.
__________ 3. When reaching for a patient or a piece of equipment, an EMT should reach in front of
his body no more than _____ inches.
A. 8 to 12 C. 15 to 20
B. 20 to 24 D. 30 to 36
__________ 4. The lifting technique that should be used by an EMT with one weak leg or one weak
ankle is the
A. power lift. C. power grip.
B. back lift. D. squat lift.
__________ 5. When performing a log roll, an EMT should
A. bend over the patient. C. twist and pull simultaneously.
B. lean from the hips. D. lean from the waist.
__________ 6. The preferred device for carrying a conscious medical patient down a flight of stairs is the
A. stair chair. C. ambulance stretcher.
B. Reeves device. D. backboard.
__________ 7. Which one of the conditions below is not one that permits the use of an emergency
move?
A. The scene is hazardous.
B. Care of life-threatening injuries requires repositioning.
C. The patient’s position is hampering a police investigation.
D. You must reach other patients.
__________ 8. When your assessment of a patient trapped in wreckage reveals that the patient is
suffering from an immediate threat to life, you would order a(n) _____ move.
A. emergency C. immediate
B. urgent D. rapid
__________ 9. The technique used when quickly removing a patient from a vehicle is called
A. log rolling. C. rapid extrication.
B. the long axis drag. D. the Stokes move.
__________ 10. Unresponsive patients with no suspected spinal injuries should be placed in the
A. position of comfort. C. left lateral recumbent position.
B. Fowler position. D. Trendelenburg position.
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
Bob said, “Clay overreacted,” and Andy replied, “Yeah, he endangered the patient. Suppose the guy had
a broken neck or something! He’s just lucky the guy was all right.” Overhearing this conversation, you are
naturally curious and ask, “What happened?”
The two other EMTs tell you that there was a motor vehicle collision, a high-speed crash, where the cars
were found T-boned and the passengers seriously injured. When Clay’s ambulance arrived, it was assigned
by EMS command to the patients in car B.
After approaching the cars, Clay did a quick scene size-up, including assessing for scene safety. The
position in which the cars came to rest after impact made access on the driver’s side impossible, so Clay
looked into the passenger-side window of car B. He could see that the driver, who appeared unresponsive,
had a large cut over his left eyebrow that was bleeding profusely. An initial assessment of the passenger
revealed no obvious injuries.
It was at this point that Clay called EMS command and asked for more manpower as well as the heavy
rescue team. He then immediately extricated the passenger in order to gain access to the driver. Despite
the fact that Clay now had access to the driver and could start patient care, he was unable to extricate the
driver without the assistance of heavy rescue. Eventually, the heavy rescue team disentangled the driver
from the dash. He was then transported to the trauma center.
1. What did Clay decide to do that Andy and Bob had such a problem with? Did he do the right thing?
3. If the driver had not appeared to be seriously injured, what should have happened differently?
CHAPTER 6 REVIEW
Write the word or words that best complete each sentence in the space provided.
1. The proper use of your body to facilitate lifting and moving a patient is called
______________________________ ______________________________.
3. When lifting a patient carrying device, it is best to use a(n) ______________________________ number
of people.
4. Never reach more than ______________________________ inches away from your body for equipment.
5. To get the best hold possible on a piece of equipment, use the ______________________________
______________________________.
6. When faced with a choice of pushing or pulling an object, whenever possible, try to
______________________________.
body as possible.
9. When moving patients up or down stairs, always try to use a(n) ______________________________
______________________________.
10. To help prevent injury when lifting or moving patients or objects, maintain a normal
______________________________ curve of the ______________________________
______________________________.
11. A(n) ______________________________ move is used when no immediate threat to life exists and the
12. The greatest danger to the patient in any emergency move is the possibility of aggravating a(n)
______________________________ ______________________________.
supine patient from a bed to a wheeled stretcher or from any patient carrying device to another.
(continued)
H a n d o u t 6 - 3 (continued)
15. ______________________________ is a term that means readying the patient for transport.
16. A patient with chest pain or difficulty breathing should be placed in a(n)
______________________________ ______________________________ ______________________________.
stabilized manually before being removed from a vehicle onto a long spine board.
19. To slide a patient from an ambulance stretcher to a hospital bed, the EMT would use the
______________________________ ______________________________ method.
2. List three basic techniques used in lifting and moving patients and equipment.
3. List at least three ways of ensuring good teamwork and performance when teams of rescuers are
carrying out lifts and moves.
__________ 1. A conscious patient is found seated in the front seat of a A. Long backboard
car after a collision.
B. Scoop stretcher
__________ 2. An elderly woman has fallen between the toilet and the
bathtub. C. Basket stretcher
__________ 3. A hunter has twisted her knee in the woods. D. Stair chair
Part II. Write the letter of the type of move in the space provided beside the patient move it describes.
CHAPTER 7 QUIZ
Write the letter of the best answer in the space provided.
(continued)
H a n d o u t 7 - 1 (continued)
(continued)
H a n d o u t 7 - 1 (continued)
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
You and your crew are dispatched for a call about a fall at a home. As the ambulance pulls up to a single-
family house, you survey the scene. A truck for AAA Roofers is parked in the driveway. There is scaffolding
at the east end of the house. At its base, two men are kneeling over a third that is lying supine on the ground.
The scene appears to be safe, so you grab your jump kit and approach. As you do, one of the men runs over to
you and tells you that the crew had been removing old shingles from the roof when David lost his footing
and fell about 18 feet to the ground.
Your patient is not conscious when you begin your initial assessment. After determining that he is breath-
ing adequately, you note a large laceration on the left side of the patient’s lower jaw. You also note that an
area on the outside of the patient’s left arm, just above the elbow, is swollen and deformed. There is a large
laceration on the front of the patient’s upper left thigh just above the kneecap, which is bleeding profusely.
1. Which of the body’s major systems do you suspect may have been injured as a result of this
accident?
CHAPTER 7 REVIEW
Write the word or words that best complete each sentence in the space provided.
health care providers will employ the same point of reference when terms of direction and location
are used.
3. The ______________________________ line is one that is drawn vertically from the middle of the
6. When a patient is lying on his back with legs elevated higher than the head and body on an inclined
bones by ______________________________.
8. The top, back, and sides of the skull plus the forehead make up the ______________________________.
9. The spinal column is made up of blocks of bone called ______________________________.
10. The ______________________________ is composed of the ribs, the sternum, and a portion of the
spine.
13. The property that allows the heart to generate and conduct electrical impulses on its own is
______________________________.
14. During respiration, gas exchange with the bloodstream takes place in the small sacs called
______________________________.
15. The section of the respiratory cycle in which the intercostal muscles and diaphragm relax is known
as ______________________________.
(continued)
H a n d o u t 7 - 3 (continued)
16. The respiratory anatomy of infants and children differs from that of adults in that the
______________________________ is narrower, softer, and more flexible.
17. Because the chest walls of infants and children are softer, they rely more on the
______________________________ for breathing.
18. The upper chambers of the heart are the ______________________________, while the lower chambers
20. The elements of the blood that are essential to the formation of blood clots are
______________________________.
21. When the left ventricle of the heart is relaxing and refilling, the pressure remaining in the arteries is
the ______________________________ blood pressure.
condition that results when adequate supplies of oxygen are not delivered to and waste products
23. The peripheral nervous system is made up of nerves located outside of the
______________________________ and the ______________________________
______________________________.
24. The layers of the skin are the ______________________________, the ______________________________,
__________ 2. The directions “left” and “right” always refer to the EMT’s left and right.
__________ 3. The imaginary midline divides the body into upper and lower halves.
__________ 4. The term “lateral” refers to a position farther away from the midline.
__________ 6. There is one midclavicular line centered between the two clavicles.
__________ 7. In the Fowler position, a patient is lying with the upper body elevated.
__________ 9. The ulna is the inner and larger bone of the lower leg.
__________ 10. The heart muscle receives its blood supply through the coronary artery system.
__________ 11. The cricoid cartilage forms the lower portion of the trachea.
__________ 13. The cardiac conduction system delivers waste gases to the lungs where they can be
expelled from the body.
__________ 14. The femoral artery is the main source of blood supply to the upper arm.
__________ 15. The primary function of the red blood cells is to carry oxygen to the body cells and
carbon dioxide away from the cells.
__________ 16. In a blood pressure reading of 120/80, the 120 refers to the diastolic pressure while the
80 refers to the systolic pressure.
__________ 17. A pulse can be felt at the point where a vein passes over a bone near the skin surface.
__________ 18. The skin plays an important part in regulating the body’s temperature.
__________ 19. The epidermis contains the hair follicles and sweat glands.
__________ 20. The thyroid gland makes insulin for the metabolism of calcium.
1. 1.
2.
2.
3.
3.
4.
Major Arteries
5. 1. ______________________________
2. ______________________________
6.
3. ______________________________
4. ______________________________
5. ______________________________
6. ______________________________
7. ______________________________
7. 8. ______________________________
Major Veins
1. ______________________________
8. 2. ______________________________
3. ______________________________
CHAPTER 8 QUIZ
Write the letter of the best answer in the space provided.
H a n d o u t 8 - 1 (continued)
CHAPTER 8 REVIEW
Write the word or words that best complete each sentence in the space provided.
capillary bed generated by the concentration of the heart and blood pressure.
7. The average adult has ______________________________ milliliters of blood for every kilogram
of mass.
10. If the pressure in the alveolus exceeds the blood pressure in the capillary bed, blood flow through
PATHOPHYSIOLOGY: MATCHING
Write the letter of the term in the space provided next to the appropriate description.
__________ 1. Energy source required for cells to carry out their functions A. larynx
__________ 10. The flow of blood through the smallest blood vessels J. dead space
__________ 9. Oncotic pressure is responsible for keeping fluid outside the vessels.
__________ 10. The sinoatrial node is the primary pacemaker of the heart.
CHAPTER 9 QUIZ
Write the letter of the best answer in the space provided.
IN THE FIELD
Review the following real-life situations. Then answer the questions that follow.
(A) You are treating an 8-year-old male patient who is complaining of trouble breathing. The patient’s
mother tells you the patient has a history of asthma and has taken his medicine without relief. While you
are assessing your patient, you note he has inspiratory and expiratory wheezing to both lungs. You place
the patient on oxygen and continue with the rest of your assessment.
1. How does your patient view EMTs and what are his expectations?
(B) You are called to the scene of a bicycle accident. Upon your arrival you find a 22-year-old male lying
on the ground complaining of head pain. Bystanders tell you the patient was riding his bicycle without a
helmet when he tried to jump over a curb. During your assessment you find the patient has a large lacera-
tion to the back of his head. You and your partner bandage the wound, fully immobilize the patient to a
long backboard, and transport the patient to the hospital without any incident.
1. Why are patients in this age group more likely to be injured or killed in an accident?
2. What are the normal vital signs for patients in this age group?
(continued)
H a n d o u t 9 - 2 (continued)
(C) While taking care of an 85-year-old male patient who is complaining of chest pain, you notice the
patient is reluctant to tell you that he has been noncompliant with his medications for the last month.
1. What changes occur in the body that would cause patients of this age to be noncompliant with their
medications?
CHAPTER 9 REVIEW
Write the word or words that best complete each sentence in the space provided.
1. While assessing the skull of an infant, the posterior ______________________________ will fuse at
______________________________ ______________________________ of age.
2. An infant’s head accounts for ______________________________ percent of his total body weight.
6. By preschool age the child’s ______________________________ has reached 90 percent of its adult
weight.
10. Depression and suicide are ______________________________ common among adolescents than any
11. Patients in early adulthood will experience the highest levels of ______________________________
stress.
13. Normally, women in their late 40s and 50s will go through ______________________________.
2. List three anatomical parts of the respiratory system that will change during late adulthood.
__________ 8. The normal heart rate for an adolescent is between 55 to 95 beats per minute.
__________ 12. The maximum life span for a human being is 120 years.
CHAPTER 10 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. The first step of emergency care in the patient with inadequate breathing is
A. checking for the patient’s pulse.
B. manually stabilizing the cervical spine.
C. opening and maintaining the patient’s airway.
D. looking for and controlling severe bleeding.
__________ 2. Inadequate breathing or inadequate blood circulation can cause
A. kyphosis. C. lordosis.
B. hyperglycemia. D. hypoxia.
__________ 3. Signs of inadequate breathing include all of the following except
A. retractions above the clavicles, between ribs, and below the rib cage.
B. cyanosis of the lips, ear lobes, or nail beds.
C. bradypnea.
D. pink skin and respiratory rate between 10 and 24 per minute.
__________ 4. Stimulation of the back of a patient’s throat when suctioning may cause
A. convulsions. C. unequal pupils.
B. a slowed heart rate. D. cyanosis.
__________ 5. A 24-year-old female patient has fallen from the roof of her house and is unconscious.
The best method of opening her airway is the _____ maneuver.
A. head-tilt, chin-lift C. head-tilt, neck-lift
B. jaw-thrust D. tongue-jaw lift
__________ 6. Methods of artificial ventilation, in order of preference, are
1. one-person bag-valve mask.
2. mouth-to-mask.
3. flow-restricted, oxygen-powered ventilation device.
4. two-person bag-valve mask.
A. 2, 4, 3, and 1 C. 1, 4, 3, and 2
B. 2, 4, 1, and 3 D. 4, 3, 1, and 2
__________ 7. Signs of inadequate artificial ventilation of an adult patient include
A. a heart rate that returns to normal.
B. failure of the patient’s skin color to improve.
C. the patient’s chest rising and falling with each ventilation.
D. a ventilation rate of 10–12 per minute.
__________ 8. When high-flow, high-concentration oxygen is attached to a bag-valve mask, the concen-
tration of oxygen delivered to the patient is approximately
A. 16 percent. C. 100 percent.
B. 24 percent. D. 90 percent.
(continued)
©2010 by Pearson Education, Inc. C H A P T E R 1 0 Airway Management, Artificial Ventilation, and Oxygenation
Prehospital Emergency Care, 9th Ed.
M10_MIST7816_09_IRM_CH10.QXD 9/24/09 1:30 AM Page 5
H a n d o u t 1 0 - 1 (continued)
__________ 9. All of the following are important features of bag-valve-mask systems except a
A. non-jam valve system. C. nonrebreathing valve.
B. 15/22 mm respiratory fitting. D. pop-off valve.
__________ 10. The most difficult part of delivering BVM artificial ventilations for a single rescuer is
A. obtaining an adequate mask seal.
B. squeezing the bag completely.
C. maintaining an open airway.
D. preventing the patient from vomiting.
__________ 11. Oropharyngeal airways can be used on unconscious patients, except those who
A. are in cardiac arrest.
B. have a gag reflex.
C. are younger than 8 years.
D. have a contagious respiratory disease.
__________ 12. Because the oropharyngeal airway is likely to stimulate the patient’s gag reflex, the res-
cuer should
A. use only nasal airways. C. be prepared to suction.
B. use the next smaller size. D. not use one.
__________ 13. The nasopharyngeal airway is often utilized because it
A. comes in more sizes than the oropharyngeal airway.
B. often does not stimulate the patient’s gag reflex.
C. can be used even if clear (CSF) fluid is seen in the nose or ears.
D. is made of rigid, clear plastic, which is less likely to cause bleeding.
__________ 14. Which of the following is true regarding suctioning a patient’s airway?
A. Never suction the airway for longer than 15 seconds.
B. Suction only as you insert the catheter into the mouth.
C. BSI precautions are not important if there is no visible blood.
D. You may hyperventilate a patient before and after suctioning.
__________ 15. One advantage of a “tonsil tip” catheter over a “French” catheter is that it
A. is flexible and can be inserted deeper into the pharynx.
B. is more effective for particulate matter.
C. can suction the nose.
D. can be inserted well beyond the base of the tongue.
__________ 16. Before suctioning, a patient who is artificially ventilated should be
A. placed in a position of comfort. C. hyperventilated.
B. hypoventilated. D. fully immobilized.
__________ 17. A nasal cannula should be used to deliver oxygen to a patient who
A. has a chronic lung disease.
B. requires a high flow and high concentration of oxygen.
C. will not tolerate a nonrebreather mask.
D. uses a cannula with a home oxygen system.
(continued)
©2010 by Pearson Education, Inc. C H A P T E R 1 0 Airway Management, Artificial Ventilation, and Oxygenation
Prehospital Emergency Care, 9th Ed.
M10_MIST7816_09_IRM_CH10.QXD 9/24/09 1:30 AM Page 6
H a n d o u t 1 0 - 1 (continued)
__________ 18. Administer oxygen to any patient who needs supplemental oxygen unless
A. the patient is an infant.
B. the patient has COPD.
C. medical direction instructs otherwise.
D. the patient has TB.
__________ 19. Oxygen cylinder sizes vary, but all are considered “full” when pressure
is equal to _____ psi.
A. 1,000 C. 2,000
B. 1,500 D. 2,500
__________ 20. An insufficiency in the supply of oxygen to the body’s tissues is called
A. hypoxia. C. respiratory compromise.
B. hyperventilation. D. bronchoconstriction.
__________ 21. The use of which of the following methods is contraindicated with children?
A. mouth-to-mask
B. flow-restricted, oxygen-powered ventilation device
C. two-person bag-valve mask
D. one-person bag-valve mask
__________ 22. To ease insertion, nasopharyngeal airways must be lubricated with
A. lubricant with petroleum jelly.
B. any petroleum-based lubricant, such as WD-40.
C. any silicone-based lubricant.
D. any water-soluble lubricant.
__________ 23. When a patient who has a full set of dentures needs ventilations
A. leave the dentures in place if they are secure and then ventilate.
B. remove the dentures in all circumstances before ventilating.
C. an endotracheal intubation must be performed.
D. an ATV should be used.
__________ 24. A suction device, whether portable or mounted, must generate a vacuum
of _____ mmHg.
A. 100 C. 300
B. 200 D. 400
__________ 25. When a nasal cannula is used, the flow rate should be no more than _____ liters
per minute.
A. 1 to 6 C. 10 to 12
B. 6 to 10 D. 12 to 14
©2010 by Pearson Education, Inc. C H A P T E R 1 0 Airway Management, Artificial Ventilation, and Oxygenation
Prehospital Emergency Care, 9th Ed.
M10_MIST7816_09_IRM_CH10.QXD 9/24/09 1:30 AM Page 7
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
You and your EMT partner, Cindy, are assigned to a suburban station on a cold February morning. At
0613, you are dispatched to an apartment building for a breathing problem. You arrive at the building
about 7 minutes later and are met by the patient’s wife, who is quite anxious. You put on your personal
protective equipment, get the ambulance cot and your equipment, and follow the woman to the sixth floor
of the building. On the way up in the elevator, the patient’s wife tells you her husband, Mike, is having a
very hard time breathing, and he looks a little blue.
You arrive at the apartment and find your patient, a 23-year-old male, seated in a chair, leaning forward
on his legs. His skin is pale, his lips are cyanotic, and you hear wheezing as he breathes. You introduce your-
self and Cindy to the patient as you begin assessing his condition. It is obvious he is quite anxious, so you
attempt to calm him as you explain what you are doing. Mike cannot speak in full sentences but tells you
that he has had asthma for about 15 years. He usually uses an inhaler but ran out of the medicine about
5 days ago. His breathing got worse 2 days ago, when the elevator was not working and he had to climb
up the five flights to his apartment. You obtain a pulse ox reading and place the patient on oxygen, using
a nonrebreather mask at 15 liters per minute. Cindy begins taking Mike’s vital signs. His blood pressure is
96/74; his pulse is 110; and his respirations are 28 per minute. You decide that Mike needs immediate
transport to the hospital, about 25 minutes away. As you get Mike placed on your cot, sitting up for
comfort, you use your portable radio to request an ALS rendezvous.
1. As you begin patient contact, describe your initial impression, and explain why you feel this way.
2. Is this patient considered a high priority for immediate transport? Explain your rationale.
3. What signs and symptoms indicated to you that the patient was having severe respiratory difficulty?
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CHAPTER 10 REVIEW
Write the word or words that best complete each sentence in the space provided.
1. The most basic components of emergency medical care are to establish and maintain a(n)
______________________________, ensure effective ventilation, and provide oxygen to the patient.
2. The EMT’s chief responsibilities are finding and correcting immediately all
______________________________ - ______________________________ problems.
insufficient.
5. Minimal or uneven chest movements, diminished breath sounds, and noisy breathing are signs of
______________________________ ______________________________.
6. A blue or gray color to the patient’s skin or nail beds is called ______________________________,
7. The procedure commonly used for opening the airway of a patient when no trauma is suspected is
8. The two passageways found at the lower end of the pharynx are the ______________________________
and ______________________________.
10. When one rescuer is using a bag-valve-mask device, the most difficult part of delivering artificial
11. When delivering artificial ventilations to a nonbreathing patient, give one ventilation every
______________________________ seconds to an adult and one every ______________________________
seconds to a child.
12. ______________________________ is the process by which the blood and cells become saturated with
oxygen.
13. The most common cause of an obstructed airway in the unresponsive patient is the
______________________________.
(continued)
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H a n d o u t 1 0 - 3 (continued)
14. Use an oropharyngeal airway for all unresponsive patients who do not exhibit a(n)
______________________________ ______________________________.
15. A properly sized oropharyngeal airway should extend the distance from the level of the patient’s
______________________________ ______________________________ to the angle of the patient’s
______________________________.
soluble lubricant.
17. ______________________________ is an excessive rapid breathing rate and may indicate inadequate
regulator.
19. A nonrebreather mask is the EMT’s best way to deliver high flows and high concentrations of
oxygen to a breathing patient because it can provide concentrations of oxygen ranging from
______________________________ to ______________________________ percent.
20. A surgical opening into the neck and trachea, also known as a tracheostomy, is a(n)
______________________________.
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AIRWAY: LISTING
1. List four factors of breathing that must be assessed when determining whether a patient’s breathing
is adequate.
2. List and describe four sounds that may indicate airway obstruction.
4. List, in order of preference, four methods of providing positive pressure ventilations to patients.
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__________ 1. The trachea is the passageway through which food travels into the stomach.
__________ 2. The nose, mouth, pharynx, and trachea are all parts of the respiratory system.
__________ 3. During mouth-to-mask ventilations of infant and child patients, each breath should be
delivered over 2 to 2.5 seconds.
__________ 5. Excessive use of neck and intercostal muscles is a sign of inadequate breathing
in an adult.
__________ 7. A nonrebreather mask is the preferred method for delivering supplemental oxygen to
patients in the prehospital setting.
__________ 8. Head, neck, or spinal injury should be suspected in any unconscious trauma patient.
__________ 9. The head-tilt, chin-lift maneuver should be used to open the airway of a patient with a
suspected neck injury.
__________ 10. When using the head-tilt, chin-lift maneuver to open a patient’s airway, place your
fingertips on the bony part of the chin, not the soft tissues under the lower jaw.
__________ 11. When opening an unconscious patient’s airway, you may need to insert your thumb into
the patient’s mouth.
__________ 12. When using the jaw-thrust maneuver to open a patient’s airway, stabilize the patient’s
head with your knees.
__________ 13. Use of a pocket mask with supplemental oxygen to ventilate a patient can deliver a
higher tidal volume of air than use of a bag-valve-mask device.
__________ 14. A pop-off valve is an undesirable feature of some older bag-valve-mask devices.
__________ 15. BVMs should have a standard 15/22 mm connection to properly fit face masks and
endotracheal tubes.
__________ 16. If a nasopharyngeal airway is too long, it can enter the esophagus and cause massive
gastric distension.
__________ 17. With a BVM device, a mask seal can more easily be maintained when ventilations are
performed by two rescuers.
__________ 18. Nonbreathing adult patients should be ventilated at a rate of 10–12 times per minute.
(continued)
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H a n d o u t 1 0 - 5 (continued)
__________ 19. If the chest does not rise and fall during BVM ventilation, you should reposition the
head to ensure an open airway.
__________ 20. Using a nasal cannula with supplemental oxygen will deliver nearly 100 percent oxygen
concentration to your patient.
__________ 21. A pediatric-sized BVM mask can be used to establish a seal around a stoma.
__________ 22. Flow-restricted, oxygen-powered ventilation devices may have an audible alarm when the
relief valve is activated.
__________ 23. If a patient rejects an oropharyngeal airway at your first attempt, reopen the airway and
insert it more aggressively.
__________ 25. The EMT should never suction a patient for more than 5 seconds at a time.
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AIRWAY: MATCHING
Write the letter of the term in the space next to the appropriate description below.
__________ 1. The active process of breathing air into the lungs A. ATV
__________ 2. A small flap of tissue that closes over the trachea during B. bilaterally
swallowing
C. bradypnea
__________ 3. The portion of the pharynx that extends from the nostrils
to the soft palate D. cyanosis
__________ 6. A bluish color of the skin and mucous membranes that G. exhalation
indicates poor oxygenation of tissue
H. gastric distension
__________ 7. Innermost covering of the lungs
I. hypoxia
__________ 8. A reduction of oxygen delivery to the tissues
J. inhalation
__________ 9. A breathing rate that is faster than the normal rate
K. intercostal
__________ 10. A breathing rate that is slower than the normal rate
L. nasopharynx
__________ 11. A positive-pressure ventilation device that delivers
ventilations automatically M. tachypnea
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CHAPTER 11 QUIZ
Write the letter of the best answer in the space provided.
(continued)
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M11_MIST7816_09_IRM_CH11.QXD 9/24/09 10:34 AM Page 4
H a n d o u t 1 1 - 1 (continued)
__________ 13. When checking pupils, an EMT should look for all of the following except
A. size. C. reactivity.
B. equality. D. color.
__________ 14. In cases of stroke or head injury, the pupils are likely to be
A. dilated. C. unequal.
B. constricted. D. equal.
__________ 15. A normal systolic blood pressure for a 40-year-old female would be
A. 90. C. 130.
B. 100. D. 150.
__________ 16. When deflating the cuff of a sphygmomanometer, the systolic blood pressure is the
A. first beats. C. dullest sound.
B. last sound. D. loudest beats.
__________ 17. What is the difference between the systolic and diastolic blood pressure readings called?
A. tachycardia C. pressure point
B. bradycardia D. pulse pressure
__________ 18. For unstable patients, an EMT should take vital signs every _____ minutes.
A. 20 C. 10
B. 15 D. 5
__________ 19. In distinguishing signs from symptoms, an example of a symptom would be
A. chest pain. C. retractions.
B. slow pulse. D. cyanosis.
__________ 20. The “L” in SAMPLE stands for
A. length of illness. C. length of chief complaint.
B. last doctor’s visit. D. last oral intake.
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IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
You’re looking out the window of the fire station watching the snow fall. The blare of the speaker breaks
the peace: “Engine 3 respond to an elderly woman complaining of shortness of breath, 18 Warren Street.
Time out 0600.”
“Just around the corner,” you say to your partner. As expected, you arrive on the scene in just a few min-
utes. You survey a quiet neighborhood, known for housing many retirees. Nothing in the immediate en-
vironment of the house indicates possible danger. The crew dons gloves as it walks up to the door. After
you knock at the door, a woman’s voice invites you to enter.
Upon entering, you find an elderly woman sitting upright on an overstuffed chair in the living room.
She is awake and responsive to your questions. Her chief complaint is that she “can’t breathe.” Your gen-
eral impression is that she is in some degree of breathing distress. The woman has an open airway, but her
breathing is labored and noisy. One crew member starts to administer high-flow, high-concentration
oxygen by nonrebreather mask.
While oxygen is administered, you continue with patient assessment. The woman’s pulse is rapid, faster
than 100 beats per minute. You advise the lieutenant that the patient is “high priority.” The lieutenant, in
turn, advises the incoming ambulance of the patient’s condition and priority. The ambulance reports that
weather conditions will delay their arrival by several minutes.
One crew member proceeds to obtain vital signs as you begin the patient interview. You ask the patient
to describe her symptoms. You ask, “Have you had any coughing or bloody sputum?” She responds to your
questions with choppy answers, a sign of difficulty breathing. You ask if the patient has any allergies. You
also find out if she is taking any medications. Finally, you inquire whether she has had similar episodes like
this one.
The crew member taking the vital signs interrupts briefly to relate his findings. He reports that the
patient’s heart rate is 110 beats per minute, strong and slightly irregular. He also indicates a blood
pressure of 160/110 and a respiratory rate of 28, with labored breathing and a pulse ox of 82 percent on
high-flow, high-concentration O2.
The woman offers, “Had a nagging cough for several days. Last night I had so much trouble breathing
that I got up to sit in the easy chair. I’ve been sleeping on and off all night.” She denies any allergies but
did suffer a heart attack several years ago and a subsequent “heart failure.” She is on Digoxin, Lasix, and
potassium supplements.
You ask the patient when she last had anything to eat or drink. Her answer completes your history.
As you write down the information, the ambulance pulls up.
2. How long should the crew member spend in taking the patient’s pulse? Why?
(continued)
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H a n d o u t 1 1 - 2 (continued)
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CHAPTER 11 REVIEW
Write the word or words that best complete each sentence in the space provided.
1. The outward signs of what is going on inside a patient’s body are the
______________________________ ______________________________.
2. The first set of vital signs an EMT obtains is called ______________________________ vital signs.
3. The rhythmic beat generated by the contraction of the left ventricle is called the
______________________________.
4. In patients younger than 1 year, an EMT should first attempt to assess a(n)
______________________________ pulse.
6. If the pulse rate, rhythm, or character is not normal, an EMT should continue taking the count for
______________________________ seconds.
7. For determination of vital signs, an EMT is concerned with two respiratory factors:
______________________________ and ______________________________.
8. An adult patient is breathing outside of normal rates when respirations are above
______________________________ breaths per minute or below ______________________________
10. The harsh, high-pitched sound that indicates labored breathing is ______________________________.
11. In addition to checking nail beds, oral mucosa, and conjunctiva, assess the skin color of infants,
14. The force of blood against the walls of the blood vessels is known as the
______________________________ ______________________________.
15. The bladder of a blood pressure cuff should be centered over the ______________________________
artery.
(continued)
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H a n d o u t 1 1 - 3 (continued)
17. A patient’s ______________________________ are conditions that an EMT cannot observe but can only
18. One way to get an accurate patient ______________________________ is to use the acronym SAMPLE.
20. When gathering information from your patient, try as much as possible to ask
______________________________-______________________________ questions.
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Write the letter of the term in the space provided next to the appropriate description.
__________ 2. Pulse felt in the major artery in the neck B. blood pressure
__________ 6. Pulse felt in the major artery of the upper arm F. dilate
__________ 14. To get larger, as in the pupils of the eyes O. vital signs
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M12_MIST7816_09_IRM_CH12.QXD 9/24/09 10:41 AM Page 2
CHAPTER 12 QUIZ
Write the letter of the best answer in the space provided.
(continued)
H a n d o u t 1 2 - 1 (continued)
__________ 9. During scene size-up at a multiple-vehicle crash, it is important to determine the number
of patients because
A. on-scene resources may be inadequate for them all.
B. run reports are required for each patient.
C. ALS must be called if there are more than two patients.
D. the media must be given accurate information.
__________ 10. Which of the following may be useful in determining the nature of illness/mechanism of
injury?
A. the patient C. family members
B. bystanders D. all of the above
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
Your unit is dispatched to a motor vehicle collision on a well-traveled road. You are the EMT in charge.
The dispatch time is 0130 hours. It is raining with a wind out of the north at 5 miles per hour, and a
temperature of 32°F (0°C). The caller has stated that there is only a single car involved.
1. What scene size-up considerations should you have in mind as you approach the scene?
You are the first emergency unit to reach the scene. You observe that a mid-size passenger car has struck
a power pole head on. You see a victim in the car moving around. Power lines are down, and there is a
strong smell of gasoline in the air.
3. List any additional resources that you would call for this scene.
CHAPTER 12 REVIEW
Write the word or words that best complete each sentence in the space provided.
1. Determining scene safety means looking for possible threats to the safety of
______________________________, ______________________________, and
______________________________.
2. Before approaching patients at a crash scene, EMTs must assess the ______________________________,
______________________________.
3. The forces that may have caused injury to a patient are called the ______________________________,
______________________________, ______________________________.
gear on-scene.
______________________________, ______________________________.
7. With a medical patient, finding out what is or may be wrong with the patient is called identifying
8. Important sources of information for determining what is wrong with a medical patient include the
9. At crime scenes in which guns might be involved, EMTs should position the emergency vehicle out-
10. If your scene size-up indicates that you do not have sufficient resources to handle the call, you
2. List three categories of people with which the EMT must be concerned in ensuring scene safety.
3. List four significant external signs of vehicle impact to look for and document during the scene size-up.
4. List three potential sources of information about the nature of a patient’s illness.
5. List seven ways you can reduce a patient’s anxiety at the emergency scene.
CHAPTER 13 QUIZ
Write the letter of the best answer in the space provided.
(continued)
H a n d o u t 1 3 - 1 (continued)
__________ 11. The rapid trauma assessment should take about _____ minute(s).
A. 1⁄2 C. 5
B. 2–21⁄2 D. 5–7
__________ 12. The respiratory rate, the systolic blood pressure, and the GCS are the major components
of the
A. revised trauma score. C. radio report.
B. patient narrative. D. dispatch information.
__________ 13. When assessing a responsive medical patient’s chief complaint, the “T” of OPQRST
stands for
A. tenderness. C. termination.
B. tension. D. time.
__________ 14. An assessment finding jugular vein distension may indicate
A. hypotension. C. heart failure.
B. hypoglycemia. D. kidney failure.
__________ 15. A detailed secondary exam should be performed
A. before vital signs.
B. before the SAMPLE history.
C. only after all life-threatening injuries and conditions have been managed.
D. only after approval from medical direction has been received.
__________ 16. All of the following are forms of blunt trauma except
A. motor vehicle crashes. C. falls.
B. shootings. D. fights.
__________ 17. Which of the following is a form of peripheral painful stimulus?
A. supraorbital pressure C. armpit pinch
B. sternal rub D. nail bed pressure
__________ 18. When assessing the patient’s skin, you note the color of the skin to be yellow. This is
known as
A. cyanosis. C. urticaria.
B. flushed. D. jaundiced.
__________ 19. Rales are described as
A. high-pitched whistling sounds heard on inhalation.
B. crackling sounds heard on inspiration.
C. coarse sounds heard on inspiration and exhalation.
D. crackling sounds heard on exhalation.
__________ 20. For noncritical patients vital signs should be reassessed every
A. 5 minutes. C. 15 minutes.
B. 10 minutes. D. 20 minutes.
IN THE FIELD
Review the following real-life situations. Then answer the questions that follow.
The patient appears sick from the moment you and your partner arrive at his apartment. He just has that
“sick look.” He is awake and responsive, but he is breathing kind of hard, and his skin is pale and pasty
looking. After letting you in, he goes back and sits in his living room chair. You and your partner introduce
yourselves and tell him you are EMTs with the fire department as you start him on oxygen. He tells you
how his chest pain had started about an hour earlier. He was working on his income taxes when the pain
started, and since he lived alone he didn’t know who else to call. He describes the pain as kind of crush-
ing, kind of like when he had his heart attack. Those comments prompt you to call for a paramedic unit.
The patient tells you that the pain is pretty bad, around an 8 on a scale of 0 to 10, with 0 as no pain and
10 as the worst pain imaginable. The oxygen appears to make him feel better, and he confirms that as well.
It had been 5 minutes since you and your partner had arrived, and nearly 20 minutes since the pain started.
While waiting for the paramedics, you continue with your SAMPLE history while your partner starts
recording a baseline set of vital signs.
1. Based on the patient’s presentation, what other questions could you have asked about the present
chief complaint?
2. What would you proceed to do next if the ambulance was not yet on-scene?
3. If this patient had been unconscious when you arrived, where might you have possibly found more
information?
(continued)
H a n d o u t 1 3 - 2 (continued)
You and your partner are dispatched at 01:30 and arrive on the scene of a motor vehicle rollover a few
minutes later. The firefighters have put up scene lights. To the right of the road, you spot a set of tire tracks.
An automobile rests on all four wheels in a ditch. State police are managing traffic.
After the fire department stabilizes the vehicle and you have taken BSI precautions, you approach. Inside
the vehicle, you notice a young woman who appears to be sleeping, judging by her snoring. She seems
oblivious to all the commotion. You immediately stabilize her head and then try to awaken her. The patient
awakens quickly, but she seems confused and her speech is slightly slurred. Her airway is patent, and her
breathing is relaxed and displays no apparent difficulty. Her radial pulse is strong and regular at roughly
100 beats per minute. As you work, you notice a strong smell of beer in the car and on the patient.
Your partner points out the damage on both sides of the car and on the roof. You decide to continue
manual stabilization of her cervical spine and extricate her from the vehicle onto a long backboard. You
also request a paramedic intercept through the EMS coordinator.
At this point, you begin to perform a rapid secondary assessment. The assessment reveals no significant in-
juries to the patient. The vital signs are also within normal limits. In light of her mental status, you choose to
move the patient rapidly out of the ditch via a Stokes basket, up a ladder, and into the waiting ambulance.
7. Would a detailed exam be appropriate for this patient? If so, when would it be performed?
CHAPTER 13 REVIEW
Write the word or words that best complete each sentence in the space provided.
1. ______________________________ ______________________________-______________________________ is
2. During the primary assessment, any life-threatening condition that is identified must be
______________________________ ______________________________.
3. A patient’s age, sex, appearance, and chief complaint are all elements of the
______________________________ ______________________________.
4. The patient’s answer to the question “Why did you call EMS?” is called the
______________________________ ______________________________.
6. Once the patient’s level of consciousness has been determined during the primary assessment, move
7. Assessment of circulation includes checking capillary refill, pulse, skin color, temperature, and
______________________________.
11. When assessing the responsive medical patient’s condition, use the ______________________________
and ______________________________questions.
12. Reassess vital signs during transport every ______________________________ minutes for critical
(continued)
H a n d o u t 1 3 - 3 (continued)
specific.
14. The secondary exam for the trauma patient should be conducted systematically, starting at the
______________________________.
16. Any findings during your secondary exam should be ______________________________ and reported
18. The purposes of the secondary assessment are to determine any ______________________________ in
19. For both the EMT and the hospital staff, it is not only the patient’s condition, but also the
______________________________ in the patient’s condition that are important.
__________ 1. Sometimes you may skip the secondary assessment because you are too busy taking care
of life-threatening problems.
__________ 2. In assessing the trauma patient with a significant mechanism of injury, you should obtain
a history before completing your exam.
__________ 3. The recording of vital signs should be deferred to the end of the call so that you can
focus better on the patient’s needs.
__________ 5. The initial assessment is performed only once during patient contact.
__________ 6. The memory aid, DCAP-BTLS, is used to obtain a patient’s past medical history.
__________ 7. Documenting changes in a patient’s condition over time, such as slowing respirations or
a rising pulse rate, which may show improvement or deterioration, is known as trending.
__________ 8. Once a patient’s ABCs have been assessed during initial assessment, the EMT can
determine the patient’s priority for treatment and transport.
__________ 9. Immediately treat life-threatening problems with circulation, breathing, and airway in
that order before continuing with the initial assessment.
__________ 10. The patient’s race is a key factor in forming a general impression.
__________ 11. If you suspect spinal injury, ask the patient to nod her head slightly and report if she feels
any pain when doing so.
__________ 12. During the primary assessment, the AVPU scale is used to help determine a patient’s
mental status.
__________ 13. If a responsive patient cannot speak or cry, assume that his airway is not open.
__________ 14. At room temperature, a capillary refill time of up to 4 seconds in an infant indicates
normal perfusion.
__________ 15. A responsive patient who is not obeying commands should be considered a priority for
rapid transport.
OPQRST
A. Onset
B. Provocation
C. Quality
D. Radiation
E. Severity
F. Time
SAMPLE
G. Signs, symptoms
H. Allergies
I. Medications
__________ 5. Do you think this has something to do with my high blood pressure?
(continued)
H a n d o u t 1 3 - 6 (continued)
CHAPTER 14 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. An EMT is permitted, with medical direction, to administer, or assist the patient in
administering, all of the following medications except
A. nitroglycerin. C. penicillin.
B. oxygen. D. oral glucose.
__________ 2. A drug or other substance that is used as a remedy for illness is called a(n)
A. elixir. C. medication.
B. treatment. D. prescription.
__________ 3. A chemical substance that is used to treat or prevent a disease or condition is called a
A. treatment. C. drug.
B. prescription. D. preparation.
__________ 4. The study of drugs is referred to as
A. pharmacology. C. pharmacodynamics.
B. pharmacokinetics. D. pharmacytology.
__________ 5. Epinephrine is an example of a drug’s _____ name.
A. chemical C. generic
B. trade D. brand
__________ 6. The most common uses of a drug in treating a specific condition are known as
A. indications. C. protocols.
B. side effects. D. contraindications.
__________ 7. A thick slurry of activated charcoal is an example of a
A. gel. C. compressed powder.
B. suspension. D. sublingual spray.
__________ 8. Drugs meeting the requirements of the U.S. Pharmacopoeia or National Formulary are
given a(n) _____ name.
A. generic C. official
B. trade D. chemical
__________ 9. Medications administered sublingually are
A. swallowed. C. dissolved under the tongue.
B. inhaled. D. injected under the skin.
__________ 10. Drug actions that are not desired and that occur in addition to the desired therapeutic
effects are referred to as
A. reactions. C. indications.
B. contraindications. D. side effects.
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
You receive a call from a 6-year-old girl who states that her “grandma can hardly breathe.” When you arrive
at the scene, you find a 68-year-old female with labored breathing. She can barely talk as she gasps for air.
But after several attempts, the woman indicates that she has just finished mowing the lawn. She thinks the
exertion has triggered her respiratory condition.
You place the patient in a comfortable sitting position and administer high-flow, high-concentration oxygen.
You ask your partner to take vital signs while you obtain a medical history. The patient indicates that her
physician has prescribed an inhaler for her respiratory condition, but that she has not used it today. The
woman tells her granddaughter to bring the medication to you.
2. What are some brand names of the prescribed inhalers that you might expect to see?
3. After examining the patient’s medication, you call medical direction for permission to assist the pa-
tient in self-administration. In assisting the patient with her medication, what are the key steps that
must be followed?
CHAPTER 14 REVIEW
Write the word or words that best complete each sentence in the space provided.
systems.
swallow.
5. The ______________________________ of a drug are the therapeutic effects that a drug will have.
6. The ______________________________ of a drug is simply how much of the drug should be given to
the patient.
a patient.
reactions.
10. Each drug also has ______________________________, or situations in which the drug should not be
administered because of the potential harm that could be caused to the patient.
3. List the four routes by which the EMT may administer or help a patient to self-administer
medications.
(continued)
H a n d o u t 1 4 - 4 (continued)
5. List two common sources from which to gather information about specific medications.
CHAPTER 15 QUIZ
Write the letter of the best answer in the space provided.
CHAPTER 15 REVIEW
Write the word or words that best complete each sentence in the space provided.
7. The three phases that the body goes through following cardiac arrest are the electrical phase,
10. The lower energy level delivered by the biphasic defibrillator is thought to cause less
______________________________ ______________________________ damage.
__________ 1. Asystole is the absence of electrical activity and pumping action in the heart.
__________ 3. Downtime is the time from when the patient goes into cardiac arrest until
CPR is started.
CHAPTER 16 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. The condition causing breathing difficulty in which the bronchioles of the lower airway
are significantly narrowed from constriction of the muscle layer is known as
A. hypoxia. C. bronchoconstriction.
B. apnea. D. bronchodilation.
__________ 2. The normal range of breaths per minute for most adults is
A. 25–50. C. 15–30.
B. 20–40. D. 12–20.
__________ 3. All of the following are signs of inadequate breathing except
A. present and equal breath sounds. C. cyanotic skin color.
B. restlessness. D. retractions.
__________ 4. A condition in which the cells in the body are not getting an adequate supply of oxygen
is known as
A. hypoxia. C. hypervolemia.
B. hypovolemia. D. hypoergia.
__________ 5. A musical whistling sound that is heard in all lung fields upon auscultation of the chest is
A. rales. C. wheezing.
B. crackles. D. rhonchi.
__________ 6. In an infant or a child, bradycardia is a sign of
A. circulatory collapse. C. respiratory failure.
B. cardiac arrest. D. fatigue.
__________ 7. If a patient is experiencing breathing difficulty but is breathing adequately, he or she
should be placed in a
A. sniffing position. C. prone position.
B. Trendelenburg position. D. position of comfort.
__________ 8. Which of the following is an example of a commonly encountered obstructive lung
disease?
A. emphysema C. pneumonia
B. pulmonary edema D. pneumothorax
__________ 9. A medication commonly prescribed for the patient with a history of breathing
problems is a(n)
A. beta blocker. C. bronchodilator.
B. antiarrhythmic. D. antihistamine.
__________ 10. A condition indicating extreme inspiratory effort in infants and small children in which
the chest is drawn inward while the abdomen moves outward is called
A. nasal flaring. C. retractions.
B. see-saw breathing. D. grunting.
(continued)
H a n d o u t 1 6 - 1 (continued)
__________ 11. All of the following are early signs of breathing difficulty in infants and children except
A. retractions. C. bradycardia.
B. nasal flaring. D. anxiety.
__________ 12. All of the following are examples of medications delivered via prescribed metered-dose
inhalers except
A. albuterol. C. isoetharine.
B. epinephrine. D. metaproterenol.
__________ 13. All of the following are medications commonly used for respiratory problems except
A. Tornalate®. C. Alupent®.
B. Serevent®. D. Prozac®.
__________ 14. A possible side effect from a prescribed inhaler is
A. tachycardia. C. cyanosis.
B. hypotension. D. altered mental status.
__________ 15. The total number of MDI doses that an EMT can deliver to a patient with breathing
difficulty is
A. one. C. three.
B. two. D. determined by medical direction.
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
Your unit has just received a call from the emergency medical dispatcher. A 68-year-old woman at 181
Shadow Lane reports difficulty breathing. You and your partner head to the scene, arriving 12 minutes after
the call.
Upon entry into the house, you find the patient sitting in a chair, leaning forward with her hands on her
knees. She appears anxious and has difficulty speaking in full sentences without gasping for breath. She tells
you, “I can’t seem to get enough air.” As she struggles to catch her breath, the patient adds, “My chest is
so tight.”
You position yourself at eye level with the patient and try to calm her fears. You introduce yourself and
explain that you will need to ask several questions before beginning treatment. From your questions, you
learn that the patient has a history of emphysema and that she takes Lasix®, theophylline, and Ventolin®.
However, she has not taken these medications for several days in an effort to prolong the prescriptions.
“Refills are so expensive,” she explains.
Upon physical examination, you find the patient alert, but restless. Her pulse rate is 120 beats per
minute; her blood pressure is 110/68 mmHg; her respiratory rate is 20 per minute; pulse ox is 88 percent.
Breaths are labored and noisy. Her skin is warm and pale.
2. When you elicited a focused history of the condition, what questions should you have asked the
patient?
(continued)
H a n d o u t 1 6 - 2 (continued)
CHAPTER 16 REVIEW
Write the word or words that best complete each sentence in the space provided.
patient’s skin.
6. Most bronchodilators begin to work almost immediately, and their effects may last up to
______________________________ hours or more.
7. Whenever you have administered a bronchodilator to a patient, you must perform a(n)
______________________________ ______________________________.
8. The term ______________________________ refers to a condition in which the cells of the body are not
9. A patient with breathing difficulty who is sitting upright and leaning slightly forward and support-
ing herself with her arms by holding onto the seat is in the ______________________________ position.
11. A device attached to an MDI that holds medication until it is inhaled is a(n)
______________________________.
12. Metered-dose inhalers can only be administered by the EMT with the approval of
______________________________ ______________________________ through on-line or off-line orders.
(continued)
H a n d o u t 1 6 - 3 (continued)
13. A pulse oximeter reading of less than ______________________________ in a patient with any breathing
14. If upon assessment you find your patient’s breathing rate or tidal volume inadequate, begin
______________________________ ______________________________ ______________________________.
15. The patient with breathing difficulty is a(n) ______________________________ patient, so consider
PRESCRIBED INHALER
Write in the missing information on the medication flash card below, and save the completed card for
future reference.
Prescribed Inhaler
Medication Names:
1. Generic: ______________________________________________________________________________________
2. Trade: ________________________________________________________________________________________
Indications:
1. ______________________________________________________________________________________________
2. ______________________________________________________________________________________________
3. ______________________________________________________________________________________________
Contraindications:
1. ______________________________________________________________________________________________
2. ______________________________________________________________________________________________
3. ______________________________________________________________________________________________
4. ______________________________________________________________________________________________
Medication Form: ________________________________________________________________________________
Dosage: ___________________________________________________________________________________________
Action: ____________________________________________________________________________________________
Side Effects:
1. ______________________________________________________________________________________________
2. ______________________________________________________________________________________________
3. ______________________________________________________________________________________________
4. ______________________________________________________________________________________________
5. ______________________________________________________________________________________________
CHAPTER 17 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. The valve located between the right atrium and the right ventricle that prevents blood
from returning to the right atrium is the _____ valve.
A. mitral C. tricuspid
B. aortic D. bicuspid
__________ 2. The right atrium receives deoxygenated blood from the inferior and superior _____, the
largest veins in the body.
A. aorta C. pulmonary arteries
B. vena cava D. pulmonary veins
__________ 3. The electrical impulse that causes the heart to contract is generated in the right atrium
at the
A. bundle of His. C. sinoatrial node.
B. Purkinje fibers. D. atrioventricular node.
__________ 4. The arteries that branch off the base of the aorta and supply the heart with oxygen-rich
blood are called _____ arteries.
A. pulmonary C. carotid
B. posterior tibial D. coronary
__________ 5. Blood components respond to injury by forming a clot, or _____, in order to stop
bleeding.
A. plasma C. platelet
B. thrombus D. plaque
__________ 6. The delivery of oxygen and nutrients from the blood, through the thin capillary walls
into the cells, and the removal of carbon dioxide and other waste products, is known as
A. hypoperfusion. C. metabolism.
B. shock. D. perfusion.
__________ 7. In cases involving a patient complaining of chest pain and/or difficulty breathing, the
EMT should suspect
A. cardiac problems. C. tracheal deviation.
B. trauma. D. hypovolemia.
__________ 8. While patients with known cardiac problems may take a variety of medications, the most
commonly prescribed medication is
A. nitroglycerin. C. epinephrine.
B. Lasix. D. Digoxin.
__________ 9. If a patient experiences no relief after one dose of nitroglycerin, another dose may be
administered after 3 to 5 minutes if authorized by medical direction, to a maximum of
_____ doses.
A. three C. two
B. five D. six
(continued)
H a n d o u t 1 7 - 1 (continued)
__________ 10. Because nitroglycerin lowers blood pressure, it must not be given to a patient whose sys-
tolic blood pressure is lower than _____ mmHg.
A. 130 C. 100
B. 120 D. 90
__________ 11. One contraindication to the administration of nitroglycerin is the patient’s
A. recent ingestion of Viagra®. C. excessive respiratory efforts.
B. use of aspirin. D. extremity injury.
__________ 12. The condition known as _____ occurs when a portion of the heart muscle dies because
of the lack of an adequate supply of oxygenated blood.
A. angina pectoris C. acute myocardial infarction
B. hypertension D. pulmonary edema
__________ 13. The tiny blood vessels that connect arterioles to venules are
A. valves. C. capillaries.
B. arteries. D. veins.
__________ 14. The measured force exerted during the contraction of the heart is the _____ blood
pressure.
A. systolic C. diastolic
B. systemic D. myocardial
__________ 15. A common side effect of the administration of nitroglycerin is
A. headache. C. altered mental status.
B. hypovolemia. D. diaphoresis.
__________ 16. During cardiac arrest, instead of smooth contractions, the heart shows a different type of
electrical activity, most commonly the uncoordinated twitchings known as
A. asystole. C. ventricular fibrillation.
B. ventricular tachycardia. D. atrial fibrillation.
__________ 17. Cardiac arrest in children is most often the result of
A. hypoxia. C. trauma.
B. bradycardia. D. ventricular fibrillation.
__________ 18. In cases of _____, the heart has a rhythm, but is so weakened that it fails to pump, or it
does not respond to the electrical activity, or there is so much blood loss that there is
nothing to pump.
A. asystole C. pulseless electrical activity
B. ventricular fibrillation D. ventricular tachycardia
__________ 19. The absence of electrical activity and pumping action in the heart is called
A. pulseless electrical activity. C. ventricular fibrillation.
B. ventricular tachycardia. D. asystole.
__________ 20. When both atria contract, it is a process known as atrial
A. systole. C. diastole.
B. work. D. arrest.
__________ 21. Electrical impulses travel from the sinoatrial node to the atrioventricular node by way of
the
A. Purkinjie fibers. C. bundle of His.
B. intranodal tract. D. the right and left bundle
branches.
(continued)
H a n d o u t 1 7 - 1 (continued)
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
You and your EMT partner respond to a call at the Wilson Corporation. The dispatcher reports a conscious
male about 50 years of age complaining of chest pain. When you arrive at the scene, the patient’s secretary
leads you into an office. There you see a man sitting on the sofa next to his desk. He is alert with labored
respirations. He is pale and diaphoretic. Your pulse check reveals a weak and rapid radial pulse, and you
note his skin to be cool and moist to the touch. He is complaining of a squeezing tightness in the center
of his chest.
2. During the focused history and physical exam, you determine that the patient has a history of heart
disease and has physician-prescribed nitroglycerin. What actions must you take prior to assisting the
patient with his prescribed medication?
CHAPTER 17 REVIEW
Write the word or words that best complete each sentence in the space provided.
2. The ______________________________ are the top two chambers on each side of the heart.
3. The blood in the left atrium is ejected through the ______________________________ valve and into
5. As an EMT, you should not take the time to try to ______________________________ the type or
spray.
7. The three drugs that an EMT may administer to a cardiac patient, with the approval of medical
heart.
9. If the responsive patient with chest pain is breathing adequately, administer oxygen at
______________________________ liters per minute via a(n) ______________________________ mask.
10. In general, the EMT’s emergency treatment of patients with heart failure or an acute myocardial
11. Several components of blood are involved in clot formation. They are:
______________________________, ______________________________, and
______________________________.
12. The ______________________________ pressure represents the pressure exerted against the arterial
(continued)
H a n d o u t 1 7 - 3 (continued)
13. If a patient experiences no relief after one dose of nitroglycerin, another dose may be administered
14. The heart contains specialized contractile tissue as well as conductive tissue, known as the
______________________________ ______________________________ ______________________________,
15. The circulatory, or cardiovascular, system has three major components: the
______________________________, the ______________________________
variety of reasons, is not pumping effectively or at all, and no pulses can be felt.
18. The electrical impulse generated by the sinoatrial node travels through the right and left atria by the
19. Each mechanical contraction of the heart has two distinct components of electrical activity:
______________________________ and ______________________________.
21. The delivery of oxygen and nutrients to the cells and the removal of carbon dioxide and wastes is
known as ______________________________.
22. Atherosclerosis is an ______________________________ disease that starts with the intimal lining of the
blood vessel.
2. List six emergency care steps for patients experiencing cardiac compromise.
3. List the three conditions that must be met before assisting a patient with the administration
of nitroglycerin.
__________ 4. The force exerted during circulation of the blood against D. atrium
the arterial walls
E. blood pressure
__________ 5. Smallest artery, leading to a capillary
F. brachial artery
__________ 6. Smallest vein, leading from a capillary
G. capillary
__________ 7. Breastbone, located in the center of the chest
H. cardiac conduction
__________ 8. The two major veins that carry oxygen-depleted blood back system
to the heart
I. carotid artery
__________ 9. Depressed delivery of oxygen and nutrients to the cells
resulting from inadequate circulation of blood through the J. coronary arteries
capillaries
K. diastolic pressure
__________ 10. A fatty deposit within an artery
L. femoral artery
__________ 11. Force exerted against the arterial walls during relaxation of
the left ventricle of the heart M. hypoperfusion
__________ 12. The specialized contractile and conductive tissue of the heart N. nitroglycerin
that generates electrical impulses and causes the heart to beat
O. plaque
__________ 13. Major artery that starts at the left ventricle and carries
oxygen-rich blood to the body P. platelets
__________ 14. Network of arteries supplying the heart with blood Q. sternum
__________ 15. Medication often prescribed for patients with a history R. venae cavae
of heart problems for the relief of chest pain
S. ventricle
__________ 16. One of the two lower chambers of the heart
T. venule
__________ 17. Type of blood vessel that carries blood away from the heart
NITROGLYCERIN
Write in the missing information on the medication flash card below, and save the completed card for
future reference.
Nitroglycerin
Medication Names:
1. Generic: _______________________________________________________________________________________
2. Trade: _________________________________________________________________________________________
Indications:
1. _______________________________________________________________________________________________
2. _______________________________________________________________________________________________
3. _______________________________________________________________________________________________
Contraindications:
1. _______________________________________________________________________________________________
2. _______________________________________________________________________________________________
3. _______________________________________________________________________________________________
4. _______________________________________________________________________________________________
5. _______________________________________________________________________________________________
2. _______________________________________________________________________________________________
3. _______________________________________________________________________________________________
ASPIRIN
Write in the missing information on the medication flash card below, and save the completed card for fu-
ture reference.
Aspirin
Medication Names:
1. Generic: _______________________________________________________________________________________
2. Trade: _________________________________________________________________________________________
Indications:
1. _______________________________________________________________________________________________
2. _______________________________________________________________________________________________
Contraindication: ________________________________________________________________________________
Medication Form: ____________________________________________________________________________
Dosage: __________________________________________________________________________________________
Action: ____________________________________________________________________________________________
Side Effects:
1. _______________________________________________________________________________________________
2. _______________________________________________________________________________________________
3. _______________________________________________________________________________________________
CHAPTER 18 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. All of the following are structural causes of altered mental status except
A. brain tumor. C. trauma to the brain.
B. bleeding in the brain tissue. D. hypoxia.
__________ 2. Assessment of patients with altered mental status must include all of the following except
A. head. C. tympanic membrane.
B. pupils. D. chest.
__________ 3. Altered mental status and the inability to speak or feel sensation or move are all signs or
symptoms of
A. trauma. C. embolism.
B. neurological deficit. D. acute myocardial infarction.
__________ 4. The process of clot formation is referred to as
A. lordosis. C. embolism.
B. thrombosis. D. hemorrhagia.
__________ 5. The most common nontraumatic brain injury is
A. seizure. C. stroke.
B. hypoxia. D. hypothermia.
__________ 6. Paralysis that affects both lower extremities is called
A. paraplegia. C. monoplegia.
B. quadriplegia. D. hemiplegia.
__________ 7. All of the following are signs and symptoms of a neurological deficit resulting from non-
traumatic brain injury except
A. severe headache. C. unequal pupils.
B. paralysis. D. fever.
__________ 8. Transient ischemic attack will always resolve within _____ hours.
A. 1 C. 10
B. 3 D. 24
__________ 9. All of the following are types of headaches except
A. mastoid headache. C. cluster headache.
B. vascular headache. D. tension headache.
__________ 10. All of the following are assessed for in the Cincinnati Prehospital Stroke Scale except
A. facial droop by having patient smile or show his teeth.
B. abnormal speech by having the patient repeat “You cant’t teach an old dog
new tricks.”
C. testing hand strength by grasping your fingers.
D. arm drift by having the patient close his eyes and hold both arms out straight
for 10 seconds.
©2010 by Pearson Education, Inc. C H A P T E R 1 8 Altered Mental Status, Stroke, and Headache
Prehospital Emergency Care, 9th Ed.
M18_MIST7816_09_IRM_CH18.QXD 9/24/09 1:18 AM Page 3
CHAPTER 18 REVIEW
Write the word or words that best complete each sentence in the space provided.
2. Because the ______________________________ controls breathing rate and depth, it is very possible
to find inadequate breathing or unusual breathing patterns in a patient who presents with
signs of stroke.
3. The two structures that must be intact in order for patients to remain in a conscious state are the
4. Though the EMT may rule out trauma at the scene, it is important to note if the patient has suffered
5. When collecting a SAMPLE history, it is especially important to note if the possible stroke patient
6. An unconscious state where the patient does not respond to painful stimuli is referred to as a
______________________________.
7. If a stroke occurs on the left side of the brain, the damage is noticeable on the
______________________________ side of the body.
vessels, followed by vasodilation, and a change in the chemicals that transmit nerve impulses
in the brain.
10. Drugs that can reverse the consequences of stroke must be administered to certain stroke patients
©2010 by Pearson Education, Inc. C H A P T E R 1 8 Altered Mental Status, Stroke, and Headache
Prehospital Emergency Care, 9th Ed.
M18_MIST7816_09_IRM_CH18.QXD 9/24/09 1:18 AM Page 4
2. List seven signs or symptoms of altered mental status commonly associated with nontraumatic or
medical conditions.
3. List five steps in the emergency treatment of patients with altered mental status.
(continued)
©2010 by Pearson Education, Inc. C H A P T E R 1 8 Altered Mental Status, Stroke, and Headache
Prehospital Emergency Care, 9th Ed.
M18_MIST7816_09_IRM_CH18.QXD 9/24/09 1:18 AM Page 5
H a n d o u t 1 8 - 3 (continued)
©2010 by Pearson Education, Inc. C H A P T E R 1 8 Altered Mental Status, Stroke, and Headache
Prehospital Emergency Care, 9th Ed.
M18_MIST7816_09_IRM_CH18.QXD 9/24/09 1:18 AM Page 6
©2010 by Pearson Education, Inc. C H A P T E R 1 8 Altered Mental Status, Stroke, and Headache
Prehospital Emergency Care, 9th Ed.
M19_MIST7816_09_IRM_CH19.QXD 9/24/09 1:24 AM Page 2
CHAPTER 19 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. A sudden and temporary alteration in brain function caused by massive electrical
discharge in a group of nerve cells in the brain is called
A. a convulsion. C. postictal activity.
B. a seizure. D. dysrhythmias.
__________ 2. The chronic brain disorder that is characterized by recurrent seizures is called
A. the aura. C. epilepsy.
B. CVA. D. postictal activity.
__________ 3. All of the following are common causes of seizures except
A. shock. C. infection.
B. hypoxia. D. hypoglycemia.
__________ 4. The period following a seizure in which the patient may be unresponsive, extremely
sleepy, weak, and disoriented is called the
A. grand mal state. C. tonic phase.
B. postictal state. D. clonic phase.
__________ 5. Many patients will tell the EMT that they knew they were going to seize because of the
A. tonic phase. C. clonic phase.
B. postictal state. D. aura.
__________ 6. The period of a seizure when the patient’s muscles become contracted and tense with
arching of the back is called the
A. tonic phase. C. clonic phase.
B. postictal state. D. aura.
__________ 7. The period of a seizure when muscles spasm and then relax, producing violent and jerky
activity, is called the
A. clonic phase. C. aura.
B. tonic phase. D. postictal state.
__________ 8. A life-threatening condition characterized by a patient’s seizing for over 10 minutes or
consecutive seizures without an intermittent period of consciousness is called
A. a grand mal seizure. C. status epilepticus.
B. a convulsion. D. epilepsy.
__________ 9. A sudden and temporary loss of consciousness is called
A. epilepsy. C. syncope.
B. a convulsion. D. seizure.
__________ 10. The type of seizure most common in children between 6 months and 6 years old that is
caused by high fever is called a(n) _____ seizure.
A. absence (petit mal) C. grand mal
B. febrile D. complex partial
(continued)
H a n d o u t 1 9 - 1 (continued)
__________ 11. A type of seizure most common in children, which is characterized by a blank stare,
lasting only a few seconds, and beginning and ending abruptly, is called a(n) _____
seizure.
A. complex partial C. Jacksonian
B. focal sensory D. absence (petit mal)
__________ 12. If a patient’s seizures last longer than 10 minutes, the EMT should begin
A. endotracheal intubation. C. positive-pressure ventilations.
B. CPR. D. AED use.
__________ 13. All of the following are common medications used in the treatment of epilepsy except
A. Dilantin®. C. insulin.
B. Mysoline®. D. phenobarbital.
__________ 14. The term for weakness on one side of the body is
A. aphasia. C. hemiparalysis.
B. dysphasia. D. hemiparesis.
__________ 15. Usually, a postictal patient should be placed in the _____ position.
A. Trendelenburg C. lateral recumbent
B. Fowler D. prone
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
You and your partner are dispatched to the local mall for a man having a seizure. Upon your arrival, you
are greeted by a mall security guard who reports that your patient was noted walking alone through the
mall when he suddenly fell to the ground and began having a “convulsion.” The guard tells you that the
episode must have lasted about 6 or 7 minutes. Your patient is a male, approximately 30 years old, who is
in a semi-sitting position next to a water fountain. He appears to be breathing adequately and is conscious,
although a bit dazed.
2. In what stage of the seizure is the patient upon your arrival? How long should this stage last?
3. What emergency care measures should you take with this patient?
4. What should you do if the patient states that this is normal for him and he doesn’t want to go to the
hospital?
CHAPTER 19 REVIEW
Write the word or words that best complete each sentence in the space provided.
3. The ______________________________ state follows the seizure and is the recovery period
4. Seizure activity that is related to an injury or a medical condition may be an ominous sign of
______________________________ ______________________________ or even permanent brain damage.
5. You cannot force a patient to accept transport or treatment, but you do need to
______________________________ the call.
7. A patient who suffers seizures that last more than 10 minutes or seizures that occur consecutively
postictal and still has an altered mental status or if she does not have a past medical history of
epilepsy or seizures.
9. The ______________________________ serves as a warning that a seizure is going to begin and involves
11. The EMT should place the syncopal patient in the ______________________________ position to allow
12. ______________________________ seizures, caused by high fever, are most common in young children.
13. The EMT needs to be aware that medical conditions such as ______________________________
______________________________ and ______________________________ may be confused with a seizure
H a n d o u t 1 9 - 3 (continued)
15. The EMT should gather a(n) ______________________________ history from the responsive seizure
2. List seven steps in the emergency medical care for a seizing patient.
CHAPTER 20 QUIZ
Write the letter of the best answer in the space provided.
(continued)
H a n d o u t 2 0 - 1 (continued)
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
You and your partner are dispatched at 1015 to the Riverside Apartments on Montgomery Drive, Apart-
ment 323, for an unconscious male. Upon your arrival, the patient’s excited wife meets you at the door. As
she leads you to the kitchen, she explains that her husband, who is diabetic, has not been feeling well and
stayed home from work today due to nausea and vomiting. While they were sitting at the kitchen table, he
suddenly passed out and she immediately called 911. As you enter the kitchen, you see a male patient in
his late 50s slumped in a kitchen chair. Your initial assessment reveals that the patient is unresponsive,
bradypneic (10 breaths per minute), with a weak and rapid radial pulse and pale, cool, and clammy skin.
2. In addition to a SAMPLE history, what additional questions would you ask the patient’s wife?
4. What additional emergency medical care would you provide to this patient?
CHAPTER 20 REVIEW
Write the word or words that best complete each sentence in the space provided.
2. The hormone secreted by the pancreas that is needed to promote the movement of glucose from
3. When there is a(n) ______________________________ of insulin, glucose cannot enter the cells;
instead, it remains in the bloodstream, causing a high level of glucose in the blood, a condition
known as ______________________________.
4. When a diabetic’s insulin level is too high, too much sugar enters the cells and not enough sugar
remains in the blood, a condition called ______________________________.
emergency medical care of the diabetic patient with an altered mental status.
6. Assess and document the mental status of a diabetic patient using the
______________________________ scale.
7. As an alternative to squeezing small portions of the tube of oral glucose into the patient’s mouth,
10. If no mechanism of injury is apparent, you would suspect that a patient’s altered mental status is a
11. Never administer oral glucose to a patient who cannot swallow or who is
______________________________.
12. For a patient with an altered mental status, repeat the ongoing assessment every
______________________________ ______________________________.
(continued)
H a n d o u t 2 0 - 3 (continued)
14. An altered mental status from hypoglycemia will typically have a(n) ______________________________
onset.
15. A patient may take as long as ______________________________ minutes before showing improvement
ORAL GLUCOSE
Write in the missing information on the medication flash card below and save the completed card for
future reference.
Oral Glucose
Medication Names:
1. Generic: ______________________________________________________________________________________
2. Trade: ________________________________________________________________________________________
Indications:
1. ______________________________________________________________________________________________
2. ______________________________________________________________________________________________
3. ______________________________________________________________________________________________
Contraindications:
1. ______________________________________________________________________________________________
2. ______________________________________________________________________________________________
Medication Form: ________________________________________________________________________________
Dosage: ___________________________________________________________________________________________
Actions:
1. ______________________________________________________________________________________________
2. ______________________________________________________________________________________________
CHAPTER 21 QUIZ
Write the letter of the best answer in the space provided.
IN THE FIELD
Review the following real-life situations. Then answer the questions that follow.
The patient is an 8-year-old boy with a known history of allergies and asthma. His mother tells you that
she administered his EpiPen® 5 minutes before your arrival. However, you believe that she gave it incor-
rectly. “He pulled away when I tried to give the shot,” explains the mother. “I saw some of the medicine
form a mist in the air.”
You examine the arm where the mother says that she gave the injection, but find no puncture mark. The
child’s distress has worsened since your arrival, and he now seems barely conscious.
“I have three more EpiPens®,” offers the mother.
Your next patient is an unconscious construction worker named Fred. “He had barely started to work
with some fiberglass insulation when he fainted,” explains one of his coworkers.
You ask the coworkers more questions and find out that Fred was sneezing and coughing just before he
fainted. They also noticed that he was using a handkerchief to wipe his watery eyes and runny nose. “He
usually wears a respiratory mask on the job site,” adds one of the coworkers, “but he forgot to bring it
today.”
Upon conducting a physical examination of the patient, you find a Medic Alert tag indicating that Fred
has a number of allergies. His vital signs include a blood pressure of 70/42 and a weak pulse of 136. During
your initial assessment, the foreman hands you an EpiPen® kit. “I found this in Fred’s lunch box,” he says.
“Will it help?”
CHAPTER 21 REVIEW
Write the word or words that best complete each sentence in the space provided.
1. An abnormal or excessive response of the body’s immune system to a foreign material is called a(n)
______________________________ ______________________________.
2. Foreign substances recognized by the cells of the immune system and eventually destroyed by the
4. Antibodies are proteins that search for the antigen, combine with it, and then help to destroy it in a
jackets, and fire ants, may cause an allergic reaction and anaphylaxis.
6. Red, itchy, possibly raised blotches on the skin are known as ______________________________.
7. Management of the airway during anaphylaxis may require ______________________________
______________________________, the placement of a tube in the trachea to facilitate breathing.
9. A spring-loaded needle and syringe with a single dose of epinephrine is known as a(n)
______________________________-______________________________.
10. The correct dose of epinephrine for an adult is ______________________________ mg; for a child, it is
______________________________ mg.
__________ 1. Generally, an individual must come into contact with an allergen more than once for an
anaphylactic reaction to occur.
__________ 2. Antibodies are proteins that search for an antigen, combine with it, and destroy it.
__________ 3. After 15 to 20 minutes, a patient suffering an allergic reaction has little risk of slipping
into anaphylactic shock.
__________ 4. During an allergic reaction, you can expect to discover a higher-than-average blood
pressure.
__________ 8. Some anaphylactic reactions require repeated doses of epinephrine before the allergic
reaction stops.
__________ 9. The two key categories of signs and symptoms that specifically indicate anaphylaxis are
respiratory compromise and shock.
__________ 10. A patient experiencing an allergic reaction with no signs of respiratory distress or shock
should receive epinephrine.
EPINEPHRINE AUTO-INJECTOR
Write in the missing information on the medication flash card below, and save the completed card for
future reference.
Epinephrine Auto-Injector
Medication Names:
1. Generic: _____________________________________________________________________________________
2. Trade: ________________________________________________________________________________________
Indications:
1. ______________________________________________________________________________________________
2. ______________________________________________________________________________________________
3. ______________________________________________________________________________________________
Contraindications: _______________________________________________________________________________
Medication Form: ________________________________________________________________________________
Dosage: ___________________________________________________________________________________________
Actions:
1. ______________________________________________________________________________________________
2. ______________________________________________________________________________________________
3. ______________________________________________________________________________________________
4. ______________________________________________________________________________________________
Side Effects:
1. ______________________________________________________________________________________________
2. ______________________________________________________________________________________________
3. ______________________________________________________________________________________________
4. ______________________________________________________________________________________________
5. ______________________________________________________________________________________________
6. ______________________________________________________________________________________________
7. ______________________________________________________________________________________________
CHAPTER 22 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. Any substance—liquid, solid, or gas—that impairs health or causes death by its chemical
action when it enters the body or comes into contact with the skin is called a(n)
A. allergen. C. antigen.
B. poison. D. caustic.
__________ 2. The most common poisons ingested by children include all of the following except
A. fertilizers. C. cleaning products.
B. plants. D. toiletries.
__________ 3. Carbon monoxide is an example of an _____ poison.
A. ingested C. absorbed
B. inhaled D. injected
__________ 4. When treating an absorbed poisoning patient, if the poison is a liquid, you should irri-
gate all parts of the patient’s body for at least _____ minutes.
A. 5 C. 20
B. 10 D. 45
__________ 5. Use of activated charcoal is indicated in some cases of _____ poisoning.
A. injected C. absorbed
B. inhaled D. ingested
__________ 6. Activated charcoal is administered in the form of a(n)
A. tablet. C. gel.
B. suspension. D. inhaler.
__________ 7. All of the following are trade names for activated charcoal except
A. SuperChar. C. Liqui-Char.
B. CharCoal. D. Actidose.
__________ 8. The usual dose of activated charcoal for an adult is
A. 12.5–25 grams. C. 30–100 grams.
B. 3 grams/kg of body weight. D. 10 grams/kg of body weight.
__________ 9. In treating cases of inhaled poisons, the drug of first choice is
A. activated charcoal. C. glucose.
B. syrup of ipecac. D. oxygen.
__________ 10. The most common sources of injected poisons are
A. drugs. C. plants.
B. bites and stings. D. over-the-counter medications.
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
The emergency medical dispatcher sends you to a residence at 7290 Riverside. The young woman who
placed the 911 call is waiting for you on the doorstep, even though the day is chilly.
The woman reports that she dropped by the house to visit her friend Randy Johnson and saw through
the window that he was passed out on the couch. The door was unlocked, so she went in to try to wake
him but couldn’t. She tells you, “I wanted to stay and help him, but I just started feeling so bad. I felt sick
to my stomach and my head hurt, almost like there was a band around it. Then I remembered that Randy
had been having trouble with his furnace and was using a kerosene heater until he could get the furnace
fixed. So I was afraid maybe something was wrong with the heater and came outside and called 911 from
my cell phone. What’s going on?”
1. Based on your scene size-up, what answer would you give the woman?
CHAPTER 22 REVIEW
Write the word or words that best complete each sentence in the space provided.
2. Protect the ingested poison patient from aspiration by placing him or her, if possible, in the
______________________________ ______________________________ position.
4. Unless directed otherwise by medical direction, give both adults and children
______________________________ ______________________________ of activated charcoal per
7. Any treatment recommended by the poison control center should be discussed with
______________________________ ______________________________ before it is administered to the
patient.
8. If poison has been splashed into the eye, ______________________________ the affected eye with clean
POISONING: LISTING
1. List the four ways that poisons can enter the body.
2. List nine questions that should be asked during assessment of a patient with ingested poisoning.
4. List the emergency care steps for treating patients with inhaled poisoning.
POISONING: MATCHING
Write the letter of the type of poisoning next to the appropriate scenario below.
__________ 1. You are called to a suburban home to assist an 18-year-old A. ingested poisoning
male who has been found on the floor of his bathroom.
He has a reduced pulse rate and reduced rate of breathing. B. inhaled poisoning
His pupils are constricted to pinpoint size. He seems very
sleepy and unresponsive. There is a constricting band tied C. absorbed poisoning
around his upper arm. You find a hypodermic needle
behind a clothes hamper. D. injected poisoning
ACTIVATED CHARCOAL
Write in the missing information on the medication flash card below, and save the completed card for
future reference.
Activated Charcoal
Medication Names:
1. Generic: _______________________________________________________________________________________
2. Trade: __________________________________________________________________________________________
Indications:
1. ________________________________________________________________________________________________
2. _______________________________________________________________________________________________
3. _______________________________________________________________________________________________
Contraindications:
1. ________________________________________________________________________________________________
2. _______________________________________________________________________________________________
3. ________________________________________________________________________________________________
4. _______________________________________________________________________________________________
2. _______________________________________________________________________________________________
1. children Contraindications:
2. lateral recumbent 1. Patient has altered mental status.
3. activated charcoal 2. Patient has swallowed acids or alkalies.
4. 1 gram, kilogram 3. Patient is unable to swallow.
5. absorption 4. Patient has cyanide overdose.
6. Carbon monoxide Medication Form:
7. medical direction (1) Premixed powder in water, shaken into a suspension.
8. irrigate, 20 minutes (2) Powder—to be avoided in field.
9. airway, breathing
Dosage:
Usually 1 gram per kilogram of body weight for both
HANDOUT 22-4: Poisoning: Listing adults and children.
1. Ingestion, inhalation, absorption, injection.
Actions:
2. Was any substance ingested? Was alcohol ingested Absorbs poisons in the stomach; prevents absorption of
with the substance? When did the patient ingest the poisons by the body; enhances elimination of poisons
poison? Over what time period was the substance from the body.
ingested? How much of the substance was taken?
Has anyone attempted to treat the poisoning? Does Side Effects:
the patient have a psychiatric history that may 1. Blackening of stools.
suggest a possible suicide attempt? Does the patient 2. Vomiting.
have an underlying medical illness, allergy, chronic
drug use, or addiction? How much does the
patient weigh?
CHAPTER 23 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. All of the following vital organs are located in the abdominal cavity except the
A. stomach. C. lungs.
B. gallbladder. D. liver.
__________ 2. Pain that is felt in a body part removed from its point of origin is called _____ pain.
A. referred C. radiating
B. ghost D. provoked
__________ 3. Irritation and inflammation of the peritoneum is called
A. costalcongitis. C. appendicitis.
B. diverticulitis. D. peritonitis.
__________ 4. An abdominal wall muscle contraction that the patient cannot control, resulting from
inflammation of the peritoneum, is called
A. rigidity. C. protecting.
B. guarding. D. posturing.
__________ 5. All of the following are common signs and symptoms of a spontaneous abortion except
A. lower abdominal pain. C. rapid pulse.
B. vaginal bleeding. D. increased blood pressure.
__________ 6. Abdominopelvic pain in the middle of a patient’s menstrual cycle is known as
A. mittelschmerz. C. endometrial.
B. dysmennorhea. D. referred.
__________ 7. Endometriosis is most commonly diagnosed in patients between the ages of
A. 35–45. C. 15–25.
B. 25–35. D. 45–55.
__________ 8. All of the following are part of the urinary system except the
A. kidneys. C. bladder.
B. liver. D. urethra.
__________ 9. Risk factors associated with renal calculi include all of the following except
A. hyperthyroidism. C. obesity.
B. dehydration. D. increased dairy intake.
__________ 10. The abdomen is divided into _____ regions.
A. four C. nine
B. six D. eight
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Prehospital Emergency Care, 9th Ed.
M23_MIST7816_09_IRM_CH23.QXD 9/24/09 2:41 AM Page 4
CHAPTER 23 REVIEW
Write the word or words that best complete each sentence in the space provided.
1. The left lower quadrant of the abdomen contains part of the ______________________________
______________________________ and the female reproductive organs.
4. While assessing your patient you note hematochezia. This means that the patient had a
______________________________ onset of gastrointestinal bleeding.
5. The ovaries are the primary sex glands and are located on either side of the
______________________________.
6. When treating the victim of a sexual assault it is extremely important to not let the patient
______________________________ ______________________________, bathe, comb, or clean any part of
her body.
10. ______________________________ is an artificial process used to remove water and waste substances
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Prehospital Emergency Care, 9th Ed.
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2. List the seven emergency care steps for a patient with acute abdominal pain.
©2010 by Pearson Education, Inc. C H A P T E R 2 3 Abdominal, Gynecologic, Genitourinary, and Renal Emergencies
Prehospital Emergency Care, 9th Ed.
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Prehospital Emergency Care, 9th Ed.
M24_MIST7816_09_IRM_CH24.QXD 9/24/09 1:53 AM Page 3
CHAPTER 24 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. Water chill, which occurs when clothing or the body gets wet, is an example of
A. conduction. C. radiation.
B. convection. D. evaporation.
__________ 2. Wind chill, which occurs when currents of air pass over the body, is an example of
A. conduction. C. radiation.
B. convection. D. evaporation.
__________ 3. All of the following are signs and symptoms of hypothermia except
A. agitation and hyperactivity. C. loss of motor coordination.
B. shivering in early stages. D. cool abdominal skin temperature.
__________ 4. In providing emergency care steps for the hypothermic patient who is alert and respon-
sive, an EMT should
A. passively rewarm the extremities. C. get the patient to walk around.
B. provide the patient with stimulants. D. actively rewarm the patient.
__________ 5. Rough handling of a patient with hypothermia may result in
A. apnea. C. blood clots.
B. ventricular fibrillation. D. seizures.
__________ 6. Superficial local cold injuries are sometimes referred to as
A. “white nose.” C. hyperthermia.
B. frost touch. D. frostbite.
__________ 7. All of the following are signs and symptoms you might expect to find in a heat emer-
gency patient with hot, dry skin except
A. rapid, shallow breathing. C. dilated pupils.
B. generalized weakness. D. heavy perspiration.
__________ 8. To rapidly cool a patient with a hyperthermic emergency, apply ice packs to the neck,
groin, and
A. wrists. C. knees.
B. armpits. D. ankles.
__________ 9. The mildest form of hyperthermia is called
A. heat exhaustion. C. heat stroke.
B. heat cramps. D. fever.
__________ 10. All of the following are factors that put a patient at risk for generalized hyperthermia
except
A. environment. C. age.
B. diet. D. drugs and poisons.
__________ 11. Hot skin that is either dry or moist represents
A. a dire emergency. C. heat cramps.
B. heat exhaustion. D. a stable patient.
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
It is an overcast March afternoon when you are dispatched to a call for a woman who has fallen at 45 Stan-
dish Street. The temperature is in the 30s, with gusty winds. Banks of dirty snow from last week’s storm
still line the streets and sidewalks.
1. What might the information from dispatch plus the weather conditions lead you to expect
at this call?
2. A police car is on the scene when you arrive. The officers assure you that the scene is safe. One
officer says he’ll lead you to the patient, who has fallen in a snowdrift near the garbage can next to
the garage. Given what you know of the situation to this point and given that the police are on the
scene, what step might you take to prepare for this patient before leaving the ambulance?
3. Behind the house, you see a woman apparently in her 60s, lying just off an icy set of steps in a snow
bank. She is wearing only a housecoat and slippers. What injury possibilities do these circumstances
suggest? What actions should you take before proceeding further in your assessment?
4. As you proceed, you discover that the woman is not alert, but does respond inappropriately to
loudly spoken questions. She is not shivering, and the skin on her abdomen is cool to the touch.
She has a blood pressure of 102/60, a heart rate of 60, and a respiration rate of 14. Her skin is
pale, cool, and firm to the touch. What do these findings indicate? How should you proceed?
CHAPTER 24 REVIEW
Write the word or words that best complete each sentence in the space provided.
contact.
2. The process of ______________________________ causes cold air molecules that are in immediate
3. The most significant mechanism of heat loss is ______________________________, which involves the
transfer of heat from the surface of one object to the surface of another without physical contact.
further heat loss and giving the patient’s body the optimum chance to rewarm itself.
11. Another name for late or deep local cold injuries is ______________________________.
14. Always transport a hyperthermic patient with hot skin that is ______________________________ or
______________________________.
(continued)
H a n d o u t 2 4 - 3 (continued)
18. The ______________________________ ______________________________ gets its name from the intense,
19. The two classes of poisonous snakes in the United States are ______________________________
______________________________ and ______________________________
______________________________.
20. Soaking the affected area in ______________________________ water for 30 minutes or throughout
transport will help break down venom from a marine bite or sting.
__________ 2. Water chill, which happens when the body or clothes get wet, is an example of
convectional cooling.
__________ 3. Administering a drink of alcohol is an effective way to reduce the effects of hypothermia.
__________ 4. In all cases of hypothermia, an EMT should begin active rewarming with the extremities.
__________ 6. All heat emergency patients should be allowed to drink cool water.
__________ 7. A patient with hot skin that is either moist or dry represents a dire medical emergency.
__________ 8. Snakebites are relatively uncommon, and the number of people who die from them each
year is extremely small.
__________ 9. Black widow spider bites are the leading cause of death from spider bites in the
United States.
__________ 10. The bite of the brown recluse spider is a serious medical condition that usually does not
heal and may require surgical repair.
CHAPTER 25 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. The term _____ describes a drowning event where a patient is pronounced dead within
24 hours of the event.
A. drowning C. water rescue
B. submersion D. drowning-related death
__________ 2. Death that occurs 24 hours after a drowning is called a
A. drowning. C. water rescue.
B. submersion. D. drowning-related death.
__________ 3. If a swimmer may have been involved in a diving accident or may have been struck by a
boat, water skier, surfboard, or another object, the EMT should suspect
A. spinal injury. C. ARDS.
B. air embolism. D. hypothermia.
__________ 4. A condition in which the stomach fills with water, enlarging the abdomen to the point
that it interferes with the ability to inflate the lungs, is called
A. hydrothorax. C. distended pleura.
B. water in the lungs. D. gastric distension.
__________ 5. As a guideline, the EMT should attempt resuscitation on any pulseless, nonbreathing
patient who has been submerged in _____ water, even if the drowning has been longer
than 30 minutes.
A. warm C. fresh
B. cold D. salt
__________ 6. All of the following are signs and symptoms of arterial gas embolism except
A. dizziness. C. chest pain.
B. delayed onset. D. difficulty breathing.
__________ 7. If you suspect that a patient has a spine injury, maintain in-line stabilization and then
secure the patient to a backboard before
A. evaluating breathing. C. starting rescue breathing.
B. starting CPR. D. removing from water.
__________ 8. Signs and symptoms of barotrauma include all of the following except
A. extreme dizziness. C. nausea.
B. palpitations. D. disorientation.
__________ 9. Decompression sickness may occur up to _____ following a dive.
A. 2 days C. 1 week
B. 72 hours D. 2 weeks
__________ 10. The most important factor in determining whether EMTs enter the water to rescue a
patient is
A. the quality of their equipment. C. the depth of the water.
B. their training. D. their ability to use a rowboat.
©2010 by Pearson Education, Inc. C H A P T E R 2 5 Submersion Incidents: Drowning and Diving Emergencies
Prehospital Emergency Care, 9th Ed.
M25_MIST7816_09_IRM_CH25.QXD 9/24/09 1:54 AM Page 3
IN THE FIELD
Review the following real-life situation. Then answer the question that follows.
It is 1400 in the afternoon and you and your partner are dispatched to a local neighborhood for a possible
drowned child. As you arrive, you note that the police are already on the scene. One officer leads you to
the backyard where another officer is performing CPR on a small child. A young woman is standing nearby.
The officer explains that the 2-year-old had apparently snuck out of the house and had fallen in the pool.
It is estimated that the child had been in the water for about 20 minutes before being discovered by the
babysitter. Your partner instructs the officer to stop CPR, verifies that the child is apneic and pulseless, and
then resumes CPR.
©2010 by Pearson Education, Inc. C H A P T E R 2 5 Submersion Incidents: Drowning and Diving Emergencies
Prehospital Emergency Care, 9th Ed.
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CHAPTER 25 REVIEW
Write the word or words that best complete each sentence in the space provided.
3. The EMT should always assume that a diver has sustained ______________________________ injuries.
______________________________ strategy.
5. In the case of a drowning involving a possible spine injury, the goal is to support the back and
provided.
6. When a person dives into cold water, the ______________________________ diving reflex can prevent
drowning patient, regardless of water temperature, even those who have been in the water for a
prolonged period.
bubbles.
9. The signs and symptoms of an arterial gas embolism have a(n) ______________________________
______________________________.
10. ______________________________ sickness usually occurs when a diver ascends too quickly from a
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Prehospital Emergency Care, 9th Ed.
M25_MIST7816_09_IRM_CH25.QXD 9/24/09 1:54 AM Page 5
Indicate if the following statements are true or false by writing T or F in the space provided.
__________ 1. Drowning is the leading cause of accidental death in children under age 5.
__________ 3. The best prognosis for drowning patients occurs among those who are submerged in
warm, dirty, or brackish (salty) water.
__________ 5. Drowning patients may be unresponsive, not breathing, or pulseless, or they may be
responsive and possibly gasping or coughing up water.
__________ 6. In a water-related emergency, the EMT must reach the patient as soon as possible
without regard for personal safety to initiate lifesaving measures.
__________ 7. Injuries to the cervical spine are seen with many water-related accidents.
__________ 8. The onset of decompression sickness may occur up to 72 hours after a dive.
__________ 9. Divers with upper respiratory infections or allergies are at increased risk of barotrauma.
__________ 10. Provision of oxygen is critical in cases of decompression sickness because it reduces the
size of nitrogen bubbles and improves circulation.
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Prehospital Emergency Care, 9th Ed.
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Prehospital Emergency Care, 9th Ed.
M26_MIST7816_09_IRM_CH26.QXD 9/24/09 1:56 AM Page 2
CHAPTER 26 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. A situation in which a person exhibits actions that are unacceptable to the patient, family,
or community is known as
A. a panic attack. C. a behavioral emergency.
B. depression. D. psychosis.
__________ 2. Which one of the following is not a factor in determining whether the use of force with
an emotionally disturbed patient is reasonable or not?
A. size and strength of patient C. mental state of patient
B. dispatch information D. method of restraint
__________ 3. The medical condition most likely to cause restlessness and confusion, cyanosis, and
altered mental status is
A. excessive heat. C. excessive cold.
B. inadequate blood to the brain. D. lack of oxygen.
__________ 4. One method of protecting against false accusations by a behavioral emergency patient is
A. using medical responders of a different gender than the patient.
B. involving third-party witnesses.
C. limiting the involvement of other medical responders.
D. sharply limiting documentation.
__________ 5. The first step that an EMT takes in a behavioral emergency is to
A. gather a thorough patient history. C. identify him- or herself.
B. complete an initial assessment. D. perform a careful scene size-up.
__________ 6. A state of painful uneasiness about impending problems is called
A. anxiety. C. psychosis.
B. depression. D. mania.
__________ 7. In talking with a behavioral patient, an EMT should take all of the following actions
except
A. identifying him- or herself.
B. avoiding direct eye contact.
C. being as honest as possible.
D. standing at least 3 feet from the patient.
__________ 8. Of the groups listed, the highest suicide rates have been found in which age group?
A. women under age 25 C. men ages 15 to 25
B. men over age 40 D. women over age 50
__________ 9. A patient who has attempted suicide in the past is
A. looking for attention.
B. less likely to commit suicide than one who has not.
C. a candidate for forceful restraint.
D. more likely to commit suicide than one who has not.
__________ 10. In most localities, an EMT cannot legally restrain a patient without orders from
A. dispatch. C. the police.
B. the patient’s physician. D. the patient’s family.
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
The emergency medical dispatcher reports a 14-year-old girl who is “acting in a bizarre manner.” Her
father is currently trying to keep her from leaving the house.
Upon the EMS unit’s arrival at the scene, the father guides the team into the house. He states that his
daughter has been depressed for the past few weeks. Today the daughter’s behavior changed dramatically.
Instead of appearing to be lethargic, the daughter has become hyperactive. The father indicates that the
family has a history of manic depression. “The doctor has a new word for it,” laughs the father nervously.
“They call it bipolar disorder.” The father indicates that his daughter is on medication for the condition,
but feels that she has stopped using it. The girl’s psychiatrist recommended that the father call 911.
The father takes you to meet his daughter, Stephanie. You see a clean, well-dressed young woman who
appears to be happy. She speaks very fast and occasionally exhibits muscle twitches of the face and hands.
Although Stephanie indicates no physical complaints, her vital signs are on the high side of normal. She
doesn’t want to talk about her medical condition. She also doesn’t want to be transported to the hospital.
With her eyes averted, Stephanie says a little too lightly, “My father worries much too much. I’m just fine.”
2. What information might you use to persuade the patient to accompany you to the hospital?
CHAPTER 26 REVIEW
Write the word or words that best complete each sentence in the space provided.
abnormal behavior.
worthlessness, and discouragement—feelings that often do not seem connected to the actual
circumstances of the patient’s life.
5. In providing patient care during a behavioral emergency, an EMT should treat any life-threatening
______________________________.
7. Whenever you are called to care for a patient who has attempted suicide, your first concern must be
9. Before you restrain any patient for any reason, contact ______________________________
______________________________.
10. The best way to protect yourself against false accusations by a patient is to carefully and completely
______________________________ everything that happens during the encounter, including detailed
2. List seven basic principles to keep in mind whenever you encounter a behavioral emergency.
__________ 1. During a behavioral emergency, an EMT should only call the police as a last resort.
__________ 2. When dealing with a patient with a behavior problem, always consider that the problem
may be caused by a physical condition.
__________ 3. Whenever an EMT is called to the scene of a suicide attempt, his or her first concern
should be for the patient’s safety.
__________ 4. Every suicidal act or gesture should be taken seriously, and the patient should be
transported for evaluation.
__________ 5. If a patient’s fear or aggression increases, an EMT should not push the issue of transport.
__________ 6. In treating a behavioral emergency, an EMT should not leave the patient alone.
__________ 7. Once a patient is acting rationally, an EMT may remove soft restraints.
__________ 8. Under most state laws, any adult of sound mind has the right to determine whether he
or she will be treated or, more specifically, touched by another person in the course of
treatment.
__________ 9. The patient who has become calm following a period of combativeness will most likely
not revert to the earlier behavior.
__________ 10. Depending on state and local law, a patient who is disoriented, in shock, mentally ill, or
under the influence of drugs or alcohol may not be considered competent to refuse care.
CHAPTER 27 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. Newton’s first law of motion states that a body at rest will remain at rest and a body in
motion will remain in motion unless acted upon by
A. inertia. C. an outside force.
B. condensation. D. convection.
__________ 2. The term for the energy that is contained in a moving body is
A. kinetic. C. potential.
B. thermal. D. chemical.
__________ 3. An increase in which one of the following causes the greatest increase in kinetic energy?
A. mass C. size
B. velocity D. width
__________ 4. Shearing or tearing forces are placed on the organs and their supportive tissues in the
mechanism of injury called
A. acceleration/deceleration. C. rollover collisions.
B. machine/body collision. D. penetrating injuries.
__________ 5. A bullet traveling through a body part produces a temporary indentation around the
bullet’s actual path. This process is known as
A. penetration. C. cavitation.
B. compression. D. levitation.
__________ 6. The chance of sustaining a fatal injury in a vehicle collision is increased by 300 percent
when the occupant is
A. unrestrained. C. an infant or a child.
B. ejected. D. improperly restrained.
__________ 7. In every motor vehicle collision there are at least how many impacts?
A. two C. four
B. three D. five
__________ 8. A fall should be considered severe any time an adult patient has fallen _____ feet.
A. 2 C. 10
B. 5 D. 15
__________ 9. On what does the extent of injury depend when a vehicle hits a pedestrian?
A. how fast the vehicle was going
B. what part of the pedestrian’s body was hit
C. how far the pedestrian was thrown
D. all of the above
__________ 10. Which one of the following may be useful in determining the nature of
illness/mechanism of injury?
A. the patient C. family members
B. bystanders D. all of the above
©2010 by Pearson Education, Inc. C H A P T E R 2 7 Trauma Overview: The Trauma Patient and the Trauma System
Prehospital Emergency Care, 9th Ed.
M27_MIST7816_09_IRM_CH27.QXD 9/24/09 1:57 AM Page 3
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
Your EMS unit is dispatched to a one-vehicle automobile collision. You arrive and find a 22-year-old female
who reportedly dodged an animal that was in the roadway. She ran off the road and hit a large cedar tree.
After repeated questioning, she admits that she had just taken her seat belt off. You assess the car to find
that the steering column is bent and that there is a starburst pattern on the windshield in front of the
driver’s seat. The driver, meanwhile, is very anxious and restless. You note a large bruise over her sternum.
1. What injuries would you expect to find, considering the mechanism of injury?
2. How would you expect the injuries to be different if the patient had been wearing a seat belt? If the
air bag had deployed?
©2010 by Pearson Education, Inc. C H A P T E R 2 7 Trauma Overview: The Trauma Patient and the Trauma System
Prehospital Emergency Care, 9th Ed.
M27_MIST7816_09_IRM_CH27.QXD 9/24/09 1:57 AM Page 4
CHAPTER 27 REVIEW
Write the word or words that best complete each sentence in the space provided.
1. Since the early 1970s, ______________________________ has been recognized as the leading cause of
3. The factors and forces that may have caused injury to a patient are the
______________________________ ______________________________ ______________________________.
4. The amount of kinetic energy an object contains depends on two factors: the body’s
______________________________ and the body’s ______________________________.
5. During the assessment of a patient who was involved in an MVC, the EMT must maintain a high
______________________________ ______________________________ ______________________________
type of interference.
8. The rate at which a body in motion increases its speed is known as ______________________________.
______________________________.
©2010 by Pearson Education, Inc. C H A P T E R 2 7 Trauma Overview: The Trauma Patient and the Trauma System
Prehospital Emergency Care, 9th Ed.
M27_MIST7816_09_IRM_CH27.QXD 9/24/09 1:57 AM Page 5
2. In the typical vehicular collision, there are actually three impacts. List these.
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Prehospital Emergency Care, 9th Ed.
M27_MIST7816_09_IRM_CH27.QXD 9/24/09 1:57 AM Page 6
Type of injuries:
2. ______________________________ collision
Type of injuries:
3. ______________________________ collision
Type of injuries:
(continued)
©2010 by Pearson Education, Inc. C H A P T E R 2 7 Trauma Overview: The Trauma Patient and the Trauma System
Prehospital Emergency Care, 9th Ed.
M27_MIST7816_09_IRM_CH27.QXD 9/24/09 1:57 AM Page 7
H A N D O U T 2 7 - 5 (continued)
3. ___________________________________ collision
Type of injuries:
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Prehospital Emergency Care, 9th Ed.
M27_MIST7816_09_IRM_CH27.QXD 9/24/09 1:57 AM Page 8
Indicate if the following statements are true or false by writing T or F in the space provided.
__________ 1. Children are initially struck higher in the body in pedestrian collisions than adults.
__________ 2. Air bags are extremely effective in multiple collision incidents but are not effective
in initial impact head-on collisions.
__________ 3. Spinal fractures are more common with rear collisions than with lateral collisions.
__________ 4. The EMT must not only recognize obvious injuries but must also maintain a high index
of suspicion for hidden injuries.
__________ 5. The concept of cavitation deals primarily with blunt trauma injuries.
__________ 6. Trauma is nearly always the result of two or more bodies colliding with each other.
__________ 9. The “paper bag syndrome” results from compression of the chest against the steering
column.
__________ 10. Injuries from rotational crashes or rollover crashes are not as easy to predict as injuries
from other crashes.
©2010 by Pearson Education, Inc. C H A P T E R 2 7 Trauma Overview: The Trauma Patient and the Trauma System
Prehospital Emergency Care, 9th Ed.
M27_MIST7816_09_IRM_CH27.QXD 9/24/09 1:57 AM Page 9
HANDOUT 27-1: Chapter 27 Quiz HANDOUT 27-4: Trauma Overview: The Trauma
1. C 4. A 7. B 9. D Patient and the Trauma System: Listing
2. A 5. C 8. D 10. D 1. Mass, velocity, acceleration, deceleration.
3. B 6. B 2. Vehicle, body, organs.
3. Falls, vehicular collisions, penetrating gunshots or
HANDOUT 27-2: In the Field stabbings, explosions, blast injuries.
4. Head-on, rear-end, side impact, rollover, rotational.
1. Closed and/or open head injuries, soft tissue and
blunt force injuries to the chest, abdominal injuries.
2. Seat belt: Head and neck injuries are still likely, as the HANDOUT 27-5: Recognizing Injury Patterns
seat belt does not hold them immobile. Deceleration 1. Head-on collision. Types of injuries: up-and-over head,
injuries may be present without any outward signs of neck, chest, abdominal injuries; down-and-under knee,
trauma. Air bag: Deceleration injuries are still likely. hip, and leg injuries.
The air bag immediately deflates, allowing secondary 2. Rear-end collision. Types of injuries: neck (most
impact with the steering wheel and/or windshield. common), head, chest.
Abrasions are likely on the arms and face from 3. Lateral-impact collision. Types of injuries: head and
contact with the rapidly deploying air bag. neck, chest abdomen, pelvis, thighs.
©2010 by Pearson Education, Inc. C H A P T E R 2 7 Trauma Overview: The Trauma Patient and the Trauma System
Prehospital Emergency Care, 9th Ed.
M28_MIST7816_09_IRM_CH28.QXD 9/24/09 2:00 AM Page 2
CHAPTER 28 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. The first step an EMT should take when encountering a patient with severe bleeding
is to
A. apply pressure to the wound. C. check the patient’s blood pressure.
B. utilize appropriate BSI. D. apply a tourniquet.
__________ 2. Open wounds in which flaps of skin and tissue are torn loose or pulled off completely
are called
A. avulsions. C. amputations.
B. lacerations. D. punctures.
__________ 3. An average adult weighing 154 pounds will have _____ liters of total blood volume.
A. 8–10 C. 6.8
B. 4.9 D. 12–14
__________ 4. The type of shock most commonly caused by profound blood or fluid loss is _____
shock.
A. hypovolemic C. vasogenic
B. cardiogenic D. irreversible
__________ 5. In the average adult patient who weighs 154 pounds, a blood volume loss of _____
percent or more is considered significant and can lead to shock.
A. 5 C. 1
B. 15 D. 7.5
__________ 6. The next step in bleeding control after direct pressure is
A. tourniquet. C. splinting.
B. elevation. D. rapid transport.
__________ 7. Epistaxis is another way of saying the patient has
A. high blood pressure. C. nose bleed.
B. increased plaque in his arteries. D. abdominal bleeding.
__________ 8. All of the following medications will affect clotting except
A. Coumadin. C. Lasix.
B. aspirin. D. ibuprofen.
__________ 9. Of the following, which is a contraindication to the use of PASG?
A. suspected pelvic fracture with systolic BP less than 90 mmHg
B. profound hypotension with systolic blood pressure less than 50 mmHg
C. penetrating trauma to the chest with systolic blood pressure less than 80 mmHg
D. none of the above
__________ 10. An injury caused by scraping, rubbing, or shearing away is an
A. abrasion. C. laceration.
B. contusion. D. avulsion.
(continued)
H A N D O U T 2 8 - 1 (continued)
CHAPTER 28 REVIEW
Write the word or words that best complete each sentence in the space provided.
and ______________________________ .
2. A wound in which there is no open pathway from the outside to the injured site is called a
______________________________ ______________________________.
3. Simple scrapes or scratches in the outer layer of the skin are known as ____________________________.
the field, unless it is in the cheek or neck and obstructing airflow through the trachea.
7. The final stage of shock, or ______________________________ shock, exists when the body has lost
8. The second step in bleeding control when direct pressure has failed is the use of a
______________________________.
10. A blood loss of ______________________________ percent will affect the patient’s vital signs.
3. List the six emergency care treatments for open neck wounds.
__________ 2. Signs and symptoms of a closed soft tissue injury include swelling, pain, and
discoloration at the injury site.
__________ 3. An open injury may be the indicator of a deeper, more serious injury.
__________ 4. With gunshot wounds, the entry wound usually appears larger than the exit wound.
__________ 10. The use of a tourniquet is the last resort for bleeding control.
HANDOUT 28-1: Chapter 28 Quiz 2. Any of the following: movement, low body
temperature, medications, intravenous fluids,
1. B 5. B 9. C 13. C removing of bandages and dressings.
2. A 6. A 10. A 14. D 3. Place gloved hand over wound to control bleeding,
3. B 7. C 11. D 15. A apply occlusive dressing, cover the occlusive dressing
4. A 8. C 12. B with a regular bandage, apply only enough coverage
to control bleeding, once bleeding is controlled,
HANDOUT 28-2: Chapter 28 Review apply a pressure dressing, if there is suspected spinal
injury, provide appropriate spinal immobilization.
1. epidermis, dermis, subcutaneous layer
4. Self-adhering bandage, gauze roll, triangular
2. closed wound
bandage, or splint.
3. abrasions
4. impaled object
HANDOUT 28-4: Bleeding and Soft-Tissue
5. arteries, capillaries, veins
Trauma: True or False
6. body substance isolation
7. irreversible 1. T 4. F 7. T 9. T
8. tourniquet 2. T 5. T 8. F 10. F
9. low body 3. T 6. F
10. 15
CHAPTER 29 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. In estimating BSA of a burn, each upper extremity in an adult represents what
percentage of the total body area?
A. 7 percent C. 18 percent
B. 27 percent D. 9 percent
__________ 2. The three layers of the skin are the
A. outer dermis, dermis, and subcutaneous tissue.
B. endodermis, dermis, and muscle tissue.
C. mid-dermis, dermis, and subcutaneous tissue.
D. epidermis, dermis, and subcutaneous tissue.
__________ 3. The innermost layer of the skin is the
A. endodermis. C. epidermis.
B. subcutaneous layer. D. dermis.
__________ 4. An example of a superficial burn would be a(n)
A. severe scalding. C. thermal flame burn.
B. eschar. D. sunburn.
__________ 5. One method that the EMT can use to estimate the body surface area damaged by
a burn is the
A. rule of nines. C. rule of sixes.
B. BSC rule. D. plantar system.
__________ 6. In a child under age 5, any partial-thickness burn involving between 10 and 20 percent
of BSA should be considered
A. minor. C. critical.
B. moderate. D. superficial.
__________ 7. All of the following are important factors to consider in determining burn severity except
A. percentage of body surface area involved.
B. location of the burn.
C. patient age and preexisting medical conditions.
D. ambient environmental temperature.
__________ 8. A burn that encircles a body area such as the chest, an arm, or a leg is called
A. full thickness. C. immersional.
B. circumferential. D. severe.
__________ 9. When determining the BSA involved in a burn, the EMT should remember that the
palm of the patient’s hand is equal to about what percentage of total body area?
A. 2 percent C. 1 percent
B. 3 percent D. 1⁄2 percent
__________ 10. Burns are classified according to
A. location of the injury. C. type of heat involved.
B. depth of the injury. D. amount of heat involved.
(continued)
H A N D O U T 2 9 - 1 (continued)
__________ 11. The most important treatment for a patient who has sustained a chemical burn to the
eyes is
A. rapid application of dry, sterile dressings to both eyes.
B. application of gauze pads soaked with saline.
C. copious irrigation with water.
D. provision of oxygen via nonrebreather mask.
__________ 12. A burn in which the epidermis is burned through and the dermis is damaged is known
as a _____ burn.
A. superficial C. full-thickness
B. partial-thickness D. third-degree
__________ 13. Absence of pain in a patient with a severe burn is most commonly associated with a
_____ burn.
A. first-degree C. third-degree
B. second-degree D. superficial
__________ 14. In managing a burn correctly, an EMT may take all of the following steps except
A. apply dry, sterile dressings. C. keep the patient warm.
B. apply ointments or sprays. D. keep the burn site clean.
__________ 15. A partial-thickness (second-degree) burn will appear
A. white to cherry red. C. charred.
B. dark brown or black. D. pink.
__________ 16. When the EMT is dealing with the victim of an electrical burn, the primary concern
should be
A. patient care. C. rapid AED use.
B. personal safety. D. bystander history.
__________ 17. When administering emergency medical care to a burn patient, clothing that has adhered
to a burned area should be
A. covered with an antiseptic ointment.
B. covered with a dry, sterile dressing.
C. carefully removed from the burned skin.
D. left in place after cutting around the adhered area.
__________ 18. When dealing with chemical burns, the EMT should remember that dry chemicals
should be
A. brushed away before irrigating.
B. irrigated without delay.
C. removed with a damp sterile gauze pad.
D. irrigated with neutralizing vinegar.
__________ 19. In cases of chemical burns to the eyes, the EMT should flood the eyes with
A. vinegar. C. water.
B. baking soda and water. D. hydrogen peroxide solution.
__________ 20. The most serious problem usually associated with electrical shocks is
A. internal bleeding. C. hypothermia.
B. hypertension. D. respiratory and/or cardiac arrest.
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
You receive a call to the side of a county highway where it is reported that a utility worker is “on fire and
still up in his bucket.” While responding, you ask your dispatcher to arrange for aerial rescue apparatus to
assist you.
Upon arrival at the scene, you notice a charred utility bucket still in the air near several electrical lines.
The utility worker, while still on fire, has jumped from the bucket and landed on the roadside.
2. Utility officials are on the scene and assure you that the power is off. The fire has been extinguished,
and you approach the patient. He is a male in his early 30s, conscious, and oriented to person, place,
and time. He is complaining of severe pain all over his body. His facial hair has been singed off and
his face is cherry red. He is able to control his own airway. You apply high-flow, high-concentration
oxygen via nonrebreather mask. What types of injuries do you suspect that the patient has suffered?
What was the mechanism of injury?
3. What other emergency care steps would you provide for this patient?
CHAPTER 29 REVIEW
Write the word or words that best complete each sentence in the space provided.
3. Most burn patients who die in the prehospital setting will die from a(n) ______________________________
______________________________, ______________________________ ______________________________, or
other ______________________________.
5. The tough and leathery dead soft tissue formed in a full-thickness burn injury is called
______________________________.
8. When calculating BSA, the EMT should remember that the genital region represents
______________________________ percent of the total BSA.
11. ______________________________ burns can cause severe damage not only to soft tissues, but to the
body as a whole.
13. An alternative to the rule of nines for estimating the BSA of a burn involves using a comparison of
15. If dry lime is the burn agent, do not irrigate the burn with ______________________________ until it
BURNS: LISTING
1. List the signs and symptoms of partial-thickness burns.
CHAPTER 30 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. All of the following are part of the musculoskeletal system except
A. bones. C. cartilage.
B. joints. D. skin.
__________ 2. The sound or feel of broken bone fragments grinding together is referred to as
A. crepitus. C. assonance.
B. stridor. D. dissonance.
__________ 3. There are three kinds of muscle: voluntary, involuntary, and
A. periosteum. C. cardiac.
B. flexible. D. skeletal.
__________ 4. The bones of the upper extremities include all of the following except the
A. radius. C. femur.
B. humerus. D. carpal.
__________ 5. Tissues or fibers that cause movement of the body parts or organs are called
A. periosteum. C. cartilage.
B. muscles. D. tendons.
__________ 6. The mechanism that causes the crushed tissues and fractures found in a patient struck by
an auto is _____ force.
A. direct C. twisting
B. indirect D. rotational
__________ 7. An injury in which the skin over a fracture site is broken may be described as a(n)
A. closed fracture. C. vertical injury.
B. open injury. D. compromised injury.
__________ 8. An injury to a joint in which the bone ends become separated from each other is called
a(n)
A. dislocation. C. sprain.
B. angulation. D. fracture.
__________ 9. The soft pliable splints that are easily shaped for use with deformed extremities are called
_____ splints.
A. box C. vacuum
B. long bone D. traction
__________ 10. After taking BSI precautions, exposing the area, and controlling any external bleeding,
the next step in immobilizing a long bone fracture is
A. replacing protruding bones. C. measuring the splint.
B. assessing distal PMS. D. applying the splint.
__________ 11. If a patient’s injured leg appears either internally or externally rotated, an EMT should
suspect
A. patella injury. C. fibula injury.
B. ankle dislocation. D. hip dislocation.
(continued)
H A N D O U T 3 0 - 1 (continued)
__________ 12. The term for a prickling or tingling feeling that indicates some loss of sensation is
A. paresthesia. C. paraplegia.
B. anesthesia. D. quadriplegia.
__________ 13. The splint best suited for stabilization of a dislocated shoulder or a foot/ankle injury is
a(n) _____ splint.
A. air-inflatable C. formable
B. soft or pillow D. rigid
__________ 14. The splint best suited for easing pain of muscle spasm associated with fractures of the
femur is a(n) _____ splint.
A. air-inflatable C. vacuum
B. traction D. PASG
__________ 15. Muscle injuries resulting from overstretching or overexertion of the muscle are called
A. sprains. C. dislocations.
B. strains. D. sublocations.
__________ 16. The mechanism that operates when one part of an extremity is held stationary while the
rest rotates is _____ force.
A. direct C. twisting
B. indirect D. torsional
__________ 17. Another term for the collar bone is the
A. clavicle. C. scapula.
B. humerus. D. patella.
__________ 18. The displacement of a bone from its normal position in a joint is a
A. fracture. C. dislocation.
B. sprain. D. strain.
__________ 19. The bones of the lower extremities include all of the following except the
A. pelvis. C. femur.
B. patella. D. scapula.
__________ 20. Use of a traction splint is indicated for a painful, swollen, deformed
A. ankle. C. elbow.
B. hip. D. femur.
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
Your unit responds to a 911 call from a mother who reports that her 7-year-old son “has fallen from his
tree house.” When you arrive on the scene, the mother leads you into the backyard, where you see the boy
grimacing in pain. He is holding his right leg. As you approach, he tells you that “it hurts all the way down
to my toes.”
You introduce yourself and learn that the patient’s name is Roger. Roger tells you that he was climbing
into the tree house and fell off of the ladder. You ask Roger if he remembers how he landed. “I think I
landed on my feet first,” he says. “It hurt so much that I couldn’t stand up.”
4. What are four basic questions that should be asked of this patient?
CHAPTER 30 REVIEW
Write the word or words that best complete each sentence in the space provided.
1. The ______________________________ system is composed of all the bones, joints, and muscles
of the body.
3. ______________________________ are the places where bones meet and are a critical element in the
of the limb causing injury some distance away from the point of impact.
6. ______________________________ are bands of connective tissue that bind the muscles to the bones.
______________________________ force.
8. The ______________________________ splint applies constant pull along the length of the femur to
10. Proper ______________________________ and prehospital care of musculoskeletal injuries help prevent
11. If the patient’s thigh is painful, swollen, or deformed, the EMT should treat the patient as if the
______________________________ is fractured.
13. Dramatic-looking or painful extremity injuries can sometimes distract an untrained person from
14. For any splint to be effective, it must immobilize the extremity or joint
______________________________ and ______________________________ the injury.
H a n d o u t 3 0 - 3 (continued)
18. Any device used to immobilize a body part is referred to as a(n) ______________________________.
of ligaments.
20. A triangular bandage used to support the shoulder and arm is called a(n)
______________________________.
Carpals
Clavicle
Femur
Fibula
Humerus
Metacarpals
Metatarsals
Patella
Phalanges
Radius
Scapula
Sternum
Tarsals
Tibia
Ulna
Vertebrae
Xiphoid process
__________ 1. Proper splinting may serve to decrease the incidence of permanent injury.
__________ 2. The three kinds of muscles are voluntary, skeletal, and cardiac.
__________ 3. Voluntary muscles are those that are under the control of a person’s will.
__________ 4. Pulselessness and cyanosis distal to an injured extremity are signs of a very
serious condition.
__________ 5. Both before and after applying a splint, assess pulses, movement, and sensation distal to
the injury.
__________ 6. The most appropriate splint for a shoulder dislocation is the traction splint.
__________ 7. The EMT should align an extremity with gentle traction if there is severe deformity or
absence of distal pulses.
__________ 8. Some types of rigid splints are often pliable enough to be molded to fit any appendage.
__________ 10. Improvised splints can be made from a cardboard box, an ironing board, a rolled-up
magazine, a broom handle, or any similar object.
3. Joints Metatarsals
4. fracture
5. indirect force
6. Tendons
7. direct, indirect, twisting HANDOUT 30-6: Musculoskeletal Trauma: True
8. traction or False
9. distal pulses
1. T 6. F
10. splinting, open
2. F 7. T
11. femur
3. T 8. T
12. pulse, motor function, sensation
4. T 9. F
13. life-threatening
5. T 10. T
14. above, below
15. circulation
16. femur
17. shock
18. splint
19. sprain
20. sling
CHAPTER 31 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. The major components of the central nervous system include the brain and the
A. cranium. C. spinal cord.
B. spinous process. D. dura mater.
__________ 2. If a patient tries to move away from or remove a painful stimulus, this response is termed
_____ movement.
A. purposeful C. catatonic
B. nonpurposeful D. decorticate
__________ 3. The helmet-like structure that protects the brain is called the
A. basilar skull. C. dura mater.
B. cranial skull. D. meninges.
__________ 4. The weakest portion of the skull is made up of many separate bones. It is called the
_____ skull.
A. basilar C. parietal
B. temporal D. occipital
__________ 5. Because of the scalp’s rich blood supply, one likely result of a scalp injury is
A. Battle’s sign. C. cerebrospinal fluid from the nose.
B. bleeding from the ears. D. profuse bleeding.
__________ 6. After taking BSI precautions, the first step in providing emergency care to a patient with
skull fractures and brain injuries is to
A. apply a cervical collar. C. provide manual stabilization of the head.
B. control bleeding. D. transport the patient immediately.
__________ 7. A collection of blood within the skull or brain tissue is called a
A. hematoma. C. concussion.
B. contusion. D. laceration.
__________ 8. Within the skull, the brain is cushioned in a dense serous substance called _____ fluid.
A. cerebrospinal C. pericardial
B. meningeal D. peritoneal
__________ 9. All of the following structures are part of the brain stem except the
A. pons. C. medulla.
B. midbrain. D. arachnoid.
__________ 10. All of the following are highly vascular membranes separating the cranium and the brain
except the
A. subarachnoid space. C. dura mater.
B. pia mater. D. arachnoid.
__________ 11. All of the following are signs of Cushing’s reflex except a(n)
A. increase in blood pressure. C. increase in heart rate.
B. decrease in heart rate. D. change in respiratory status.
(continued)
H a n d o u t 3 1 - 1 (continued)
__________ 12. The bruising and swelling of brain tissue that may accompany concussion is called a(n)
A. contusion. C. epidural rupture.
B. stroke. D. subdural avulsion.
__________ 13. The extreme emergency following a skull fracture in which arterial bleeding pools
between the skull and the protective covering of the brain is called a(n)
A. subdural hematoma. C. contusion.
B. laceration. D. epidural hematoma.
__________ 14. In documenting a possible head or spine injury, it is critical to note whether the patient,
even briefly, lost
A. his breath. C. his balance.
B. consciousness. D. capillary refill.
__________ 15. A head injury in which the scalp is lacerated but there is no opening in the skull is a(n)
A. open head injury. C. epidural hematoma.
B. closed head injury. D. subdural hematoma.
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
At 1800 hours on a hot summer afternoon, you and your crew are called to a domestic dispute. Dispatch
informs you that guns were involved. When you arrive, the police have secured the scene and it is safe.
As you approach the scene, you find a 32-year-old male patient who is combative and responds only to
painful stimuli. You note an entrance wound on the left parietal area. In addition, you note the presence
of Battle’s sign. Initial assessment reveals an increasing blood pressure, decreasing heart rate, and altered
respirations.
3. What five interventions should be carried out while en route to the definitive care facility?
CHAPTER 31 REVIEW
Write the word or words that best complete each sentence in the space provided.
3. Because head injuries can be so serious, the EMT must always be alert for signs of the
4. The ______________________________ skull is made up of plates of large, flat bones that are fused to-
gether to form a helmet-like covering.
5. Inside the skull, the brain is protected from injury by three ______________________________.
8. Bruising and swelling of the brain tissue, or a(n) ______________________________, occurs when the
of responsiveness.
10. A late finding in a patient with isolated head trauma is that blood pressure
______________________________ and heart rate ______________________________.
11. Two nonpurposeful responses that a patient with a head injury might make include
______________________________ and ______________________________.
12. In a rapid trauma exam of a patient with a head injury, examine the head for
______________________________, ______________________________, ______________________________,
(continued)
H a n d o u t 3 1 - 3 (continued)
14. A purplish discoloration of the soft tissues around one or both eyes is called
______________________________ ______________________________ and may be an indication of
intracranial injury.
15. In documenting injuries to the head and spine, carefully note any changes in the patient’s
______________________________ ______________________________ throughout assessment, treatment,
and transport.
3. List the three anatomical components of the brain and give one function or characteristic of each.
Arachnoid
Cerebellum
Cerebral cortex
Cranium
Dura mater
Medulla oblongata
Pia mater
Spinal cord
CHAPTER 32 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. All of the following are signs and symptoms in patients with spinal injuries except
A. paralysis. C. hyperglycemia.
B. priapism. D. incontinence.
__________ 2. The part of the nervous system located outside of the brain and spinal cord that detects
sensations such as pain is the _____ nervous system.
A. peripheral C. central
B. autonomic D. involuntary
__________ 3. The part of the nervous system that controls involuntary functions such as heartbeat and
breathing is the _____ nervous system.
A. peripheral C. central
B. autonomic D. involuntary
__________ 4. Sports helmets most typically open in the
A. front. C. left side.
B. back. D. right side.
__________ 5. In the prehospital environment, the two most likely types of helmets to be encountered
are the sports helmet and the _____ helmet.
A. flight C. football
B. military D. motorcycle
__________ 6. The mechanism of injury in which the vertebrae and spinal cord are stretched and pulled
apart is called
A. rotation. C. distraction.
B. flexion. D. extension.
__________ 7. The appropriate time to initiate in-line stabilization of the cervical spine is
A. prior to opening the airway.
B. after opening the airway.
C. during transport.
D. after insertion of an oropharyngeal airway.
__________ 8. In spinal shock, a patient’s skin is
A. cool and dry. C. flushed and damp.
B. warm and dry. D. cool and sweaty.
__________ 9. Probably the most common and reliable sign of spinal-cord injury in conscious
patients is
A. Battle’s sign. C. raccoon’s sign.
B. pupil dilation. D. paralysis of the extremities.
__________ 10. In the normal extrication of a patient with suspected spinal injury, the device that an
EMT would apply first is the
A. cervical collar. C. Kendrick Extrication Device.
B. short spine board. D. long spine board.
(continued)
©2010 by Pearson Education, Inc. C H A P T E R 3 2 Spinal Column and Spinal Cord Trauma
Prehospital Emergency Care, 9th Ed.
M32_MIST7816_09_IRM_CH32.QXD 9/24/09 1:00 AM Page 4
H a n d o u t 3 2 - 1 (continued)
__________ 11. The mechanism of injury in which there is severe forward movement of the head or the
torso is curved excessively forward is called
A. rotation. C. distraction.
B. flexion. D. extension.
__________ 12. When applying a short spine board or flexible extrication device, you should first
secure the
A. torso. C. shoulders.
B. chest. D. head.
__________ 13. The move used to shift a supine patient onto a long backboard for immobilization is the
A. blanket drag. C. firefighter’s lift.
B. armpit–forearm drag. D. log roll.
__________ 14. The spinal column is composed of 33 bones called
A. meninges. C. phalanges.
B. vertebrae. D. carpals.
__________ 15. Which one of the following is not an indication for removing a helmet in a case of
suspected head or spine injury?
A. Helmet interferes with assessment of the ABCs.
B. Helmet fits snugly.
C. Patient goes into cardiac arrest.
D. Helmet fits loosely.
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Prehospital Emergency Care, 9th Ed.
M32_MIST7816_09_IRM_CH32.QXD 9/24/09 1:00 AM Page 5
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
You and your partner are called to the football stadium at the local high school. You arrive to find the quar-
terback lying in the center of the field at the 30-yard line in a supine position. Coaches are gathered around
him, and one of them meets you as you exit the ambulance. This coach tells you that the quarterback has
not moved since he was tackled. As you approach, you notice that none of the quarterback’s protective gear
has been removed.
4. What continuing emergency care steps would you provide for this patient?
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Prehospital Emergency Care, 9th Ed.
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CHAPTER 32 REVIEW
Write the word or words that best complete each sentence in the space provided.
2. The structural divisions of the nervous system are the ______________________________ nervous
3. The functional divisions of the nervous system are the ______________________________ nervous
of the body.
shock.
11. ______________________________ is a persistent erection of the penis resulting from damage to the
12. Damage to the spinal cord and neck can produce complete paralysis of the entire body, a condition
called ______________________________.
13. Paralysis to only one side of the body is more common in head injuries and stroke, and it is called
______________________________.
(continued)
©2010 by Pearson Education, Inc. C H A P T E R 3 2 Spinal Column and Spinal Cord Trauma
Prehospital Emergency Care, 9th Ed.
M32_MIST7816_09_IRM_CH32.QXD 9/24/09 1:00 AM Page 7
H a n d o u t 3 2 - 3 (continued)
15. Whenever an EMT sees a spider-web-cracked windshield, he or she knows that the driver needs full
______________________________ ______________________________.
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Prehospital Emergency Care, 9th Ed.
M32_MIST7816_09_IRM_CH32.QXD 9/24/09 1:00 AM Page 8
3. List the five divisions of the spinal or vertebral column and the number of vertebra in each.
(continued)
©2010 by Pearson Education, Inc. C H A P T E R 3 2 Spinal Column and Spinal Cord Trauma
Prehospital Emergency Care, 9th Ed.
M32_MIST7816_09_IRM_CH32.QXD 9/24/09 1:00 AM Page 9
H a n d o u t 3 2 - 4 (continued)
5. List questions that should be asked during assessment of a patient with suspected spine injury.
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Prehospital Emergency Care, 9th Ed.
M32_MIST7816_09_IRM_CH32.QXD 9/24/09 1:00 AM Page 10
__________ 1. If the EMT suspects that the patient has a spinal injury, he or she should initiate spinal
precautions.
__________ 2. Your suspicion regarding the presence of a spinal injury should not be altered by the
patient’s ability to walk.
__________ 3. Until the EMT has completely immobilized the patient, manual stabilization of the head
and neck should be maintained.
__________ 4. Because an improperly fitting immobilization device will do more harm than good,
proper sizing is of utmost importance.
__________ 5. The larger head of the infant or young child will cause the head to flex when the patient
is supine.
__________ 6. If a sports helmet is left in place on the patient, the spine is considered to be properly
immobilized.
__________ 8. Spinal shock results specifically from injury to the spinal cord, usually high in the
cervical spine.
__________ 9. A single spinal-cord injury can affect several body organ systems.
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Prehospital Emergency Care, 9th Ed.
M32_MIST7816_09_IRM_CH32.QXD 9/24/09 1:00 AM Page 11
IMMOBILIZATION
Review your knowledge of immobilization techniques by putting the steps of the procedures below in proper
order. With each procedure, write “1” in the space provided next to the step you would perform first, “2”
next to the step you would perform next, and so on.
©2010 by Pearson Education, Inc. C H A P T E R 3 2 Spinal Column and Spinal Cord Trauma
Prehospital Emergency Care, 9th Ed.
M32_MIST7816_09_IRM_CH32.QXD 9/24/09 1:00 AM Page 12
HANDOUT 32-3: Chapter 32 Review HANDOUT 32-5: Spinal Column and Spinal
1. communication, control Cord Trauma: True or False
2. central, peripheral 1. T 4. T 7. F 9. T
3. voluntary, autonomic 2. T 5. T 8. T 10. F
4. skeletal system 3. T 6. F
5. spinal column
6. vertebrae
7. cervical spine HANDOUT 32-6: Immobilization
8. Manual stabilization
The order of steps reading down in each column
9. neurogenic
should be:
10. spinal
A. 5, 4, 2, 6, 7, 1, 3
11. Priapism
B. 9, 2, 8, 6, 1, 3, 5, 7, 4
12. quadriplegia
13. hemiplegia
14. log roll
15. spinal immobilization
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Prehospital Emergency Care, 9th Ed.
M33_MIST7816_09_IRM_CH33.QXD 9/24/09 3:30 PM Page 2
CHAPTER 33 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. The part of the eye that contains the aqueous humor is the
A. lens. C. anterior chamber.
B. cornea. D. vitreous body.
__________ 2. An eye injury that involves an eye being pulled out of its socket is called a(n)
A. extrusion. C. orbital fracture.
B. evisceration. D. periorbital ecchymosis.
__________ 3. The neck contains all of the following structures except the
A. carotid arteries. C. jugular veins.
B. mandible. D. trachea.
__________ 4. The facial bone that is not fused into immovable joints is the
A. mandible. C. temporal bone.
B. malar. D. maxillae.
__________ 5. An EMT should only attempt to remove a foreign object from the
A. retina. C. globe.
B. cornea. D. conjunctiva.
__________ 6. The globe of the eye, or eyeball, is a sphere approximately 1 inch in diameter that is
covered with a tough outer coat called the
A. cornea. C. sclera.
B. pupil. D. iris.
__________ 7. A primary treatment for a patient with chemical burns to the eye is
A. plentiful irrigation.
B. bandaging only the injured eye.
C. covering both eyes with dry dressings.
D. covering both eyes with soaked gauze pads.
__________ 8. The signs and symptoms of orbital fracture include all of the following except
A. vision improvement. C. nasal discharge.
B. double vision. D. tenderness to palpation.
__________ 9. The portion of the eye that focuses light to the retina is the
A. cornea. C. iris.
B. pupil. D. lens.
__________ 10. If a patient has sustained a chemical burn to the eye, the EMT should irrigate the eye for
at least 20 minutes or, if the injury involves an alkali, for at least
A. 11⁄2 hours. C. 45 minutes.
B. 1 hour. D. 30 minutes.
__________ 11. An appropriate irrigant for an EMT to use for a chemical burn is
A. diluted vinegar. C. saline.
B. alcohol. D. sodium bicarbonate.
(continued)
H a n d o u t 3 3 - 1 (continued)
__________ 12. The thin covering of the inner eyelids is called the
A. conjunctiva. C. retina.
B. sclera. D. orbit.
__________ 13. The correct emergency treatment for profuse bleeding with facial injuries includes
A. application of cold packs. C. application of alum.
B. application of heat packs. D. application of direct pressure.
__________ 14. Clear or bloody fluid draining from the ear can indicate a
A. dangerously high fever. C. foreign body.
B. skull fracture. D. flexion injury.
__________ 15. If a nose fracture is suspected, the EMT should
A. apply direct pressure. C. apply warm compresses.
B. apply cold compresses. D. pack the nose with saline gauze.
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
Today is a particularly warm day in July. You and your partner respond to a call to a residence not far from
your station. A woman is standing in the front yard flagging you down and appears to be quite upset. As
you follow her to the back of the house, she explains to you, between sobs, that her 8-year-old son was
hosting a pool party for his baseball team. Two of the young boys were scuffling, and her son was inad-
vertently pushed into a plate glass window into the house.
You enter the house and you note a very upset and crying child lying just inside the den. You note mod-
erate bleeding from the patient’s face and neck. In addition, the boy is holding his hand over his left eye.
He complains of pain in that eye. After you convince him to remove his hand and allow you to inspect the
injury, you note a 1-inch vertical laceration on the left lower eyelid. There is also a laceration on the left
side of the neck.
1. List the basic steps you would take in treating this patient.
3. Name at least four considerations for the assessment and treatment of these face and neck injuries.
CHAPTER 33 REVIEW
Write the word or words that best complete each sentence in the space provided.
1. The bony structures of the skull that surround the eyes are called the ______________________________.
3. The proper medical term for the cheekbones is the ______________________________ bones.
4. When considering an injury to the eye, the EMT must be aware that
______________________________ is a critical consideration in the treatment.
5. If a foreign object becomes lodged in the ______________________________, the EMT should not
7. Injuries serious enough to cause orbital fractures may also cause trauma to the
______________________________ ______________________________.
11. If an eyeball injury is not suspected, the EMT should cover an injured eyelid with
______________________________ ______________________________ to help reduce swelling.
12. In all calls involving chemical burns to the eye, the EMT should begin
______________________________ with ______________________________ or
14. With chemical burns to the eye, the EMT should irrigate the eye for at least
______________________________ minutes or until arrival at the hospital.
__________ 1. When treating bleeding wounds to the neck, the EMT should use circumferential
bandages.
__________ 2. When treating an injury to the nose, the EMT should not probe for a foreign body.
__________ 4. When dressing an injured ear, place part of the dressing between the ear and side
of the head.
__________ 5. If the patient has a foreign object impaled in the cheek of the face, the EMT should
immediately remove it and transport the patient.
__________ 6. When assessing and treating a facial fracture, your first priorities should be to establish
and maintain a patent airway, support breathing, and control bleeding.
__________ 7. If a tooth has been lost, the tooth should be wrapped in dry gauze.
__________ 8. The specialized structures of the face are prone to injury because of their location, but
injuries to them are rare.
__________ 9. Only attempt removal of objects in the conjunctiva; do not attempt removal of objects
on or lodged in the cornea.
__________ 10. Even though they are designed for extended wear, soft contact lenses can cause damage
if left in for a long time.
__________ 11. Generally, you should not remove contact lenses if there has been a chemical burn
to the eye.
__________ 12. The EMT should always attempt to replace an extruded eyeball back into the socket.
__________ 13. If fracture of the orbits is suspected, you should establish and maintain spinal
immobilization.
__________ 14. In any case of severe facial trauma, suspect cervical-spine injury.
1. Take BSI precautions; ensure stabilization of the HANDOUT 33-4: Eye, Face, and Neck
cervical spine; assess and control of airway,
Trauma: Listing
breathing, and circulation.
2. Control bleeding with light pressure; cover lid with 1. Any five: sclera, cornea, pupil, lens, retina,
sterile gauze soaked in saline (if lid skin is avulsed, conjunctiva, aqueous humor, vitreous humor, orbit.
preserve and transport with the patient); cover lid 2. Any four: carotid arteries, jugular arteries, trachea,
with cold compresses; patch both eyes. larynx, cervical spine.
3. Assess the bleeding wounds and the amount of 3. Any four: maxilla fracture, mandible fracture, nasal-
blood lost. Apply a sterile dressing with direct orbital fracture, malar (cheek) fracture,
pressure to the open wounds. Use an occlusive maxilla–nasal–orbital fracture.
dressing on the neck wound to prevent air from 4. Any four: double vision; marked decrease in vision;
entering. Provide stabilization and later loss of sensation above the eyebrow, over the cheek,
immobilization of the spine in a neutral, in-line or in the upper lip; nasal discharge; tenderness upon
position. palpation; bony “step-off”; paralysis of an upward
gaze in the involved eye.
HANDOUT 33-3: Chapter 33 Review
1. orbits
HANDOUT 33-5: Eye, Face, and Neck Trauma:
2. 14
True or False
3. zygomatic 1. F 5. F 9. T 13. T
4. time 2. T 6. T 10. T 14. T
5. eyeball (or globe) 3. T 7. F 11. F
6. blood vessels 4. T 8. F 12. F
7. cervical spine
CHAPTER 34 QUIZ
Write the letter of the best answer in the space provided.
(continued)
H a n d o u t 3 4 - 1 (continued)
IN THE FIELD
Read the following real-life situation. Then answer the questions that follow.
You are dispatched to a tavern where a fight has just taken place. The caller had stated that one man was
injured and needed an ambulance because he couldn’t breathe.
1. Given the reported circumstances, what causes might you expect for this problem?
3. After you are able to enter the scene, you find a 24-year-old male lying on the floor, splinting his
right rib area and having some difficulty breathing. Blood is noted on the floor, and a raspy noise is
heard each time he takes a breath. What would you do next?
5. During transport, the young man complains of greater difficulty breathing. He is cool, tachypneic,
and his neck veins are distended. Examination reveals no breath sounds on the right side. What is
likely to be the cause of the problem?
CHAPTER 34 REVIEW
Write the word or words that best complete each sentence in the space provided.
1. The ______________________________ is the tube-like structure that connects the stomach with
the mouth.
3. The aorta, vena cava, esophagus, and trachea are located in the ______________________________, a
5. Inhalation occurs when the ______________________________ contracts and drops downward and the
______________________________ ______________________________ pull the ribs outward.
wound.
12. An open chest wound can pull air into the thoracic cavity, sometimes with a noticeable sound. This
14. An impaled object in the chest must be ______________________________ before moving the patient.
__________ 3. A pneumothorax occurs only if there is a break in the skin over the chest cavity.
__________ 4. An occlusive dressing must be taped on all four sides to protect the chest wound.
__________ 7. Gloves and eye protection are considered minimal body substance isolation precautions
for an open chest injury.
__________ 9. Crepitation with rib fractures is generally felt over the abdomen.
__________ 10. When a sucking chest wound is detected, immediate care is to dress and bandage it.
__________ 12. A blow to the chest may cause ineffective heart pumping.
__________ 9. An open chest wound that permits air entry I. sucking chest wound
__________ 12. Condition created by the fracture of two or more L. thoracic cavity
ribs in two or more places
M. tracheal deviation
__________ 13. Grating sensation
N. traumatic asphyxia
__________ 14. Movement of the primary breathing tube from
its usual position
CHAPTER 35 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. The damage that results from ruptured hollow abdominal organs is
A. treatable in the field. C. caused by acids and bacteria.
B. caused by profuse bleeding. D. non-life-threatening.
__________ 2. Your patient is the driver of a car that was hit head on. You find her lying on the sidewalk
with her knees drawn toward her chest. She has no specific complaints. You suspect
A. little or no injury because she has gotten out of the car.
B. abdominal trauma due to mechanism of injury and positioning.
C. cavitational injuries due to mechanism of injury.
D. paradoxical motion due to patient positioning.
__________ 3. Your patient with evisceration becomes tachycardic, cool, and hypotensive during
transport; your next action should be to
A. replace the dressing.
B. support the injury with the patient’s arm.
C. reevaluate priority status and expedite transport.
D. loosen one corner of the dressing.
__________ 4. Management of an injury caused by blunt trauma to the scrotum may include
A. direct pressure. C. oxygen.
B. cold compresses. D. all of the above.
__________ 5. Management of a female patient who has suffered a laceration to the genital area will
include all of the following except
A. direct pressure. C. vaginal packing.
B. use of a moistened sanitary pad. D. assessment for hypoperfusion.
__________ 6. The abdominal cavity is separated from the chest cavity by the
A. diaphragm. C. lower ribs.
B. stomach. D. pelvis.
__________ 7. All of the following are hollow organs except the
A. stomach. C. urinary bladder.
B. gallbladder. D. liver.
__________ 8. Shoulder pain caused by blood irritating the diaphragm is caused by
A. Kehr sign. C. Starling’s law.
B. Babinsky sign. D. none of the above.
__________ 9. Abdominal aortic aneurysm may cause the pulses of the lower extremity to
A. be weaker than the upper extremities. C. be absent.
B. be different on either side. D. all of the above.
__________ 10. Which is the most common cause of blunt abdominal trauma?
A. gunshot wounds C. motor vehicle crashes
B. assaults D. falls
CHAPTER 35 REVIEW
Write the word or words that best complete each sentence in the space provided.
abdominal cavity.
1 inch.
(continued)
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Prehospital Emergency Care, 9th Ed.
M36_MIST7816_09_IRM_CH36.QXD 9/24/09 1:05 AM Page 3
H a n d o u t 3 6 - 1 (continued)
__________ 9. Patients are considered to have multisystem trauma when more than _____ major
system(s) are involved.
A. three C. one
B. two D. four
__________ 10. All of the following are signs of child abuse except
A. bruises or burns in unusual shapes and locations.
B. more injuries than usual for a child that same age.
C. children with scrapes to the elbows and knees.
D. an injury that does not correlate with the cause provided.
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Prehospital Emergency Care, 9th Ed.
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CHAPTER 36 REVIEW
Write the word or words that best complete each sentence in the space provided.
essential.
3. Trauma is the leading cause of death for pregnant women. They are especially susceptible to abuse
and ______________________________.
4. When immobilizing a patient in her third trimester the EMT must tilt the backboard to the left in
order to prevent ______________________________ ______________________________
______________________________.
5. Half of all deaths in children ages 1–14 are the result of ______________________________.
6. During spinal immobilization the EMT must pad from the shoulders to the hip in patients less than
______________________________ years old.
7. ______________________________ are considered the most common cause of injury in the elderly.
8. When performing the primary assessment on a trauma patient, the EMT should always suspect
______________________________ ______________________________ injury.
10. When establishing an airway in the trauma patient, the EMT must use the
______________________________ - ______________________________ ______________________________
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Prehospital Emergency Care, 9th Ed.
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CHAPTER 37 QUIZ
Write the letter of the best answer in the space provided.
(continued)
H a n d o u t 3 7 - 1 (continued)
__________ 12. All of the following are signs of imminent delivery except
A. crowning.
B. the patient’s abdomen is extremely hard.
C. contractions are 2 minutes apart or closer and last at least 60 seconds.
D. the patient’s water broke.
__________ 13. When cutting the umbilical cord, it should be cut _____ inches from the infant.
A. 2 C. 10
B. 6 D. 4
__________ 14. In a breech birth, the presenting part of the baby is the
A. feet/buttocks. C. arm.
B. head. D. umbilical cord.
__________ 15. When faced with a limb presentation the EMT should
A. try to reinsert the limb.
B. remain on-scene and complete delivery.
C. place patient on oxygen and transport immediately.
D. begin transport and try to turn the infant.
__________ 16. Infants born before _____ weeks are considered premature.
A. 28 C. 40
B. 38 D. 20
__________ 17. Post-term pregnancy is when gestation of the fetus extends past _____ weeks.
A. 32 C. 50
B. 42 D. 60
__________ 18. Postpartum hemorrhage is the loss of _____ milliliters of blood following delivery.
A. 100 C. 500
B. 1,000 D. 250
__________ 19. The initial APGAR score should be completed at _____ seconds after birth.
A. 60 C. 20
B. 30 D. 10
__________ 20. Which of the following are signs of severely depressed newborns?
A. respiratory rate greater than 60 bpm C. pulse rate greater than 180
B. diminished breath sounds D. all of the above
CHAPTER 37 REVIEW
Write the word or words that best complete each sentence in the space provided.
2. The first 14 days after conception are called the ______________________________ stage.
7. A(n) ______________________________ emergency is one that occurs during the period from the onset
8. When dealing with a prolapsed cord, you should position the patient in the
______________________________-______________________________ position.
9. A ______________________________ birth is one in which the buttocks or lower extremities are the
10. ______________________________ is the area of skin between the vagina and the anus.
3. List 16 of the emergency medical care treatments for patients in active labor.
__________ 4. An umbilical cord that is wrapped around the infant’s neck D. neonate
__________ 9. The child in the uterus from third month of pregnancy J. antepartum
to birth
__________ 10. The mucus and blood that are expelled from the vagina
as labor begins
CHAPTER 38 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. The leading medical cause of cardiac arrest in infants and children is
A. seizure. C. anaphylactic shock.
B. respiratory failure. D. fever.
__________ 2. In caring for a sick child, the EMT should have the parent or caregiver
A. step out of the room.
B. assist in the care of the child when appropriate.
C. follow the ambulance to the hospital.
D. speak only with the doctor about the child.
__________ 3. Artificial ventilations should be performed on an infant or a child at a minimal rate of
_____ breaths per minute.
A. 10 C. 20
B. 15 D. 30
__________ 4. The EMT recognizes that a normal developmental characteristic of toddlers is that they
A. do not like to be touched.
B. are very accepting of an oxygen mask.
C. are eager to show independence from caregivers.
D. need detailed explanations.
__________ 5. The first step in emergency care for a pediatric patient in shock is
A. providing oxygen. C. keeping the patient warm.
B. managing bleeding. D. ensuring an open airway.
__________ 6. Children develop hypothermia more easily than adults because of their
A. lower metabolisms.
B. slower heart rates.
C. smaller lung capacity.
D. larger surface area in proportion to body mass.
__________ 7. In assessing a toddler, the EMT knows that the rib cage is
A. more susceptible to fracture than in adults.
B. much more pliable than in adults.
C. a likely spot for fractures.
D. composed of incomplete skeletal plates.
__________ 8. Signs of early respiratory distress in an infant include all of the following except
A. retractions. C. fontanelles.
B. “seesaw” respirations. D. nostril flaring.
__________ 9. Approximately 5 percent of children have seizures caused by
A. fever. C. head injuries.
B. epilepsy. D. shock.
(continued)
H a n d o u t 3 8 - 1 (continued)
__________ 10. After a pediatric submersion patient has been removed from the water, you should
provide _____ while establishing an airway.
A. suctioning C. back blows
B. chest thrusts D. immobilization
__________ 11. The leading cause of death in children ages 1–14 is
A. fever. C. trauma.
B. drowning. D. respiratory arrest.
__________ 12. The most common injuries sustained by children who are struck by a car while riding
a bike are to the
A. leg, hand, and back.
B. head, spine, and abdomen.
C. head, spine, and lower extremity.
D. upper extremity, lower extremity, and abdomen.
__________ 13. The most common cause of hypoxia in the unconscious pediatric patient with a head
injury is
A. the tongue. C. intercranial pressure.
B. intracranial pressure. D. Kussmaul’s respirations.
__________ 14. One complication that pediatric burn patients are especially susceptible to is
A. hyperthermia. C. hypothermia.
B. febrile seizure. D. hypoxia.
__________ 15. The only major cause of infant and child death to have increased in the last 30 years is
A. vehicular trauma. C. child abuse.
B. poisoning. D. burns.
__________ 16. When a child who an EMT has cared for dies, it can be a good idea for the EMT to turn
for assistance to the
A. ALS crew. C. QI manual.
B. CISD team. D. ICS plan.
IN THE FIELD
Review the following real-life situations. Then answer the questions that follow.
You are dispatched to a home where you find an 8-month-old child in her mother’s arms. The mother says
the child is lethargic. She is breathing at a rate of 46 times a minute, and her pulse rate is 190. Her skin is
cool to the touch, and she is pale. The mother states that the child has been sick for 2 days. This afternoon
she became worse. The mother adds that the child has been vomiting and has had diarrhea.
You are called to the home of a frantic mother of a 4-year-old girl. Her daughter is normally active, and
this morning was no exception. After putting her daughter to bed for a morning nap, the mother went
downstairs and returned a little later to find the child in the bathroom, lethargic and unresponsive, with
several empty prescription pill bottles nearby. The mother immediately called for the ambulance.
(continued)
H a n d o u t 3 8 - 2 (continued)
You are at the home of a family with a 10-month-old child. The father explains he called because the child
had a seizure that lasted about a minute. The child appears flushed. You touch her skin, which is extremely
hot to the touch. The father says the child has been running a fever all day. He put her to bed about an
hour ago. About 10 or 15 minutes ago he heard a crash in the infant’s room and went to investigate. When
he entered, the child was convulsing in the crib. That’s when he called 911.
CHAPTER 38 REVIEW
Write the word or words that best complete each sentence in the space provided.
1. During the assessment and treatment of a young child, you will, if possible, want the child to sit in
child’s neck.
5. For infants and young children who are frightened by the oxygen mask, provide oxygen using the
______________________________ technique.
7. Diarrhea and/or vomiting, dehydration, infection, abdominal injuries, and blood loss are common
8. Because children have a large surface area in proportion to their body mass, they are especially
prone to ______________________________.
9. Fever, epilepsy, meningitis, drug overdose, hypoglycemia, head trauma, and decreased levels of
10. If a pediatric patient has a seizure and there is no possibility of spinal injury, position the patient
______________________________ ______________________________ ______________________________.
(continued)
H a n d o u t 3 8 - 3 (continued)
15. When dealing with suspected foreign body airway obstruction in an infant or a child, never perform
______________________________ ______________________________ ______________________________.
16. If you suspect abuse as the cause of injury with a child trauma patient, do not
______________________________ the caregivers about abuse or ______________________________ them.
17. If there is bleeding in a pediatric patient with a central intravenous line, your emergency care will
18. Pediatric calls are among the most ______________________________ for EMTs.
19. For children with special airway needs, the most common problems that EMS will encounter are
20. ______________________________ tubes are placed into the stomach to assist with feeding.
__________ 1. The term “toddler” refers to a child between 2 and 4 years old.
__________ 2. Modesty and body image are very important issues for school-age children.
__________ 3. With children, padding under the shoulders is often necessary to maintain an open
airway during immobilization to a spine board.
__________ 4. Because children have a smaller blood volume than adults, issues of blood loss are less
serious in those patients.
__________ 5. Determining the cause of respiratory distress in a pediatric patient is an important part of
an EMT’s assessment.
__________ 6. Provide an initial series of six back blows to any infant or child patient suffering a partial
airway obstruction.
__________ 7. Capillary refill can be a useful tool in assessing circulation in pediatric patients.
__________ 8. Infants and children need a respiratory tidal volume of approximately 10 mL/kg.
__________ 9. In a pediatric patient with a foreign body airway obstruction, perform a “blind” finger
sweep of the oral cavity if back blows do not dislodge the obstruction.
__________ 10. Seizures that last longer than 10 minutes or recur without interruption represent a true
medical emergency.
__________ 11. To assess an unresponsive child, give him or her a gentle shake.
__________ 12. With any infant or child poisoning patient, administer activated charcoal once you
determine that the airway is open.
__________ 15. With submersion patients in whom normal breathing is restored, deterioration can still
take place from minutes to hours after the event.
__________ 16. Explaining to parents that SIDS is a relatively common occurrence is one way the EMT
can help them cope with the loss of a child.
__________ 17. With child patients, slow delivery of ventilations and cricoid pressure can help reduce
gastric distension.
(continued)
H a n d o u t 3 8 - 4 (continued)
__________ 18. Use a single leg of the PASG to control serious bleeding in an infant.
__________ 19. Never ask a suspected victim of child abuse to explain the circumstances of an incident
while the possible abuser is present.
__________ 20. CISD is one way EMTs can defuse the stress created by dealing with pediatric
emergencies.
PEDIATRICS: LISTING
1. List at least five signs of respiratory distress in pediatric patients.
2. List the emergency care steps for a child with fever and seizures.
3. List the basic emergency care steps for the pediatric trauma patient.
CHAPTER 39 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. The best place to check for signs of dehydration in the elderly patient is/are the
A. scalp.
B. skin of the forearms.
C. palms of the hands or soles of the feet.
D. mucous membranes of the eyes and mouth.
__________ 2. If an elderly patient has altered mental status and is unable to swallow, position him
A. on a backboard, using pillows to support the head.
B. in the left lateral recumbent position.
C. in a Fowler position.
D. supine.
__________ 3. When assessing an elderly patient in a nursing home or extended-care facility who shows
signs and symptoms of a respiratory disorder, the EMT should
A. put a surgical mask on the patient.
B. make the patient a high priority for transport.
C. immediately begin positive-pressure ventilations.
D. put on a HEPA or N-95 respirator.
__________ 4. Which one of the following should be performed for an elderly trauma patient regardless
of mechanism of injury or level of responsiveness?
A. focused medical exam C. focused trauma exam
B. rapid trauma assessment D. historical exam
__________ 5. Ongoing assessment of an elderly patient who is alert but has an injured arm should take
place every _____ minutes.
A. 5 C. 15
B. 10 D. 20
__________ 6. When obtaining a history from an elderly patient, the EMT should
A. shout loudly, as the patient is probably deaf.
B. use terms of endearment like “honey” to break the ice.
C. address the patient as “Mr.” or “Mrs.” unless asked to do otherwise.
D. speak first to family members, as they are most likely to have accurate information.
__________ 7. With an elderly patient who has aching in her shoulders, fatigue, and trouble breathing,
an EMT should suspect
A. kyphosis. C. arteriosclerosis.
B. a heart attack. D. degenerative spinal changes.
__________ 8. Efforts to save money by elderly people living on fixed incomes may lead to cases of
A. lordosis. C. hypothermia.
B. pulmonary embolus. D. stroke.
(continued)
H a n d o u t 3 9 - 1 (continued)
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
You and your partner are dispatched to a senior citizen’s apartment complex in the center of town. The
caller stated that her husband is “talking gibberish” and not acting right. Your partner, a new EMT, says,
“What does she expect? He’s old!” Since the complex was now less than a minute away, you decide to
explore that comment later.
Upon arrival, you are met by Mrs. Heisler, a spry 80-year-old, who tells you that about 20 minutes
ago her husband began speaking in a slurred voice and not making sense. She didn’t know how to help
him, and so she called 911. “I’m really sorry. I hope I’m not bothering you people.” After looking for
hazards, putting on BSI, and reassuring Mrs. Heisler that she had done the right thing, you approach the
patient. He is an elderly man, sitting slouched in a chair and drooling. You introduce yourself and ask his
name. The reply is garbled.
1. During the scene size-up and initial assessment, what special considerations must be kept in mind?
2. How should the EMTs address the patient? How can they obtain a chief complaint and a history?
3. After performing the initial assessment and rapid medical assessment, the EMTs note the following
results:
• Unequal pupils
• Weakness on the right side of the body
• Slurred speech
• Alterations in respiratory patterns and pulse
What is the likely cause of these signs and symptoms? How should the EMTs manage them?
CHAPTER 39 REVIEW
Write the word or words that best complete each sentence in the space provided.
1. With age, degenerative changes decrease the ability of the heart to ______________________________
______________________________.
2. The net effect of changes in the respiratory systems of elderly people is that
______________________________ air enters the system, ______________________________ gas exchange
4. A decrease in the size of the liver with aging means that many elderly patients who take prescription
6. The geriatric patient’s mental status may be influenced by chronic illness, the present illness
surroundings.
mechanism of injury.
9. Due to changes in pain perception, the elderly may experience a(n) ______________________________
heart attack.
11. Fluid that has leaked into the space between the capillaries and alveoli causes
______________________________ ______________________________.
(continued)
H a n d o u t 3 9 - 3 (continued)
13. If a patient with COPD becomes fatigued from the effort of breathing, be prepared to provide
______________________________ - ______________________________ ______________________________.
15. In the case of suspected geriatric abuse, your first priority is to provide
______________________________ ______________________________ for the injuries.
GERIATRICS: LISTING
1. List six factors that make a geriatric patient especially at risk for a medical/trauma emergency.
2. List at least five conditions commonly responsible for an assessment finding of altered mental status
in geriatric patients.
CHAPTER 40 QUIZ
Write the letter of the best answer in the space provided.
CHAPTER 40 REVIEW
Write the word or words that best complete each sentence in the space provided.
2. Nasogastric tubes are used by advanced life support units in the prehospital setting to
______________________________ the ______________________________.
kidneys.
4. Vascular access devices are typically embedded in the ______________________________ right side of
the ______________________________.
9. Statistics show that over ______________________________ percent of Americans will live below the
10. Patients who cannot pronounce words correctly are said to have ______________________________.
__________ 1. A condition in which the lens of the eye becomes cloudy A. abuse
__________ 2. A condition that interferes with how a body part or system B. pallative care
operates
C. developmental
__________ 3. A patient who is paralyzed to all four extremities
D. hydrocephalus
__________ 4. The branch of medicine that deals with the management of
obese patients E. quadriplegic
__________ 5. Any action or failure to act that results in unreasonable suffering, F. terminal illness
harm, or misery to a person, whether physical or mental
G. Texas catheter
__________ 6. Excess cerebrospinal fluid
H. bariatrics
__________ 7. Progressive deterioration causing death
I. OG tube
__________ 8. Medical interventions centered on reducing the severity
of disease symptoms J. cataracts
__________ 9. Least invasive device used to divert urine out of the bladder
__________ 10. A tube inserted through the mouth that ends up in the stomach
CHAPTER 41 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. The EMT’s first duty to the patient is to arrive at the scene
A. quickly. C. safely.
B. by the most direct route. D. with red lights, horn, and siren.
__________ 2. The EMT should not exceed the posted speed limit unless
A. traffic is light. C. the situation is critical.
B. traveling on holidays. D. using a police escort.
__________ 3. Using a police or other emergency vehicle escort en route to the collision or the hospital
should be
A. a last resort. C. used with all critical patients.
B. standard procedure. D. only used at night.
__________ 4. The standard color for ambulances is
A. orange. C. yellow.
B. red. D. white.
__________ 5. The most common collisions in which ambulances are involved are those at
A. intersections. C. interstate off-ramps.
B. railroad crossings. D. pedestrian crosswalks.
__________ 6. Most states allow an emergency vehicle operator to do all of the following except
A. pass a school bus whose lights are flashing.
B. pass other vehicles in a no-passing zone.
C. proceed past red lights.
D. exceed the speed limits.
__________ 7. A reason for using the siren sparingly is that it signals “emergency,” and it can create
emotional and physical stress for
A. bystanders. C. the patient.
B. EMTs. D. dispatchers.
__________ 8. The daily inspection of the ambulance should include all of the following except
A. checking emergency lights. C. inspecting tie rods.
B. checking power systems. D. testing the horn.
__________ 9. En route to an emergency call, EMTs should do all of the following except
A. think about what equipment will be carried to the scene.
B. determine crew responsibilities.
C. call for ALS support.
D. decontaminate essential equipment.
__________ 10. A common danger when an ambulance follows an escort vehicle is
A. losing contact with the escort.
B. creating additional stress for the patient.
C. confusion for the emergency dispatchers.
D. following the escort too closely.
(continued)
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Prehospital Emergency Care, 9th Ed.
M41_MIST7816_09_IRM_CH41.QXD 9/24/09 1:15 AM Page 3
H a n d o u t 4 1 - 1 (continued)
__________ 11. The minimum distance an ambulance should be parked from wreckage or a burning
vehicle is _____ feet.
A. 100 C. 300
B. 200 D. 400
__________ 12. At the receiving facility, the complete oral report to appropriate emergency department
personnel should include all of the following except
A. the patient’s chief complaint. C. diagnosis of patient’s illness.
B. any history not given previously. D. vital signs taken en route.
__________ 13. Once a helicopter has set down and the pilot has indicated it is safe, you should approach
a helicopter that has landed on an incline from the
A. front. C. rear.
B. uphill side. D. downhill side.
__________ 14. If tires are worn, hydroplaning on a wet road can begin at speeds as low as _____ mph.
A. 30 C. 20
B. 15 D. 35
__________ 15. The level of disinfection required for reusable instruments that have come into contact
with mucous membranes is
A. low level. C. high level.
B. intermediate level. D. sterilization.
__________ 16. When the ambulance is ready to return to quarters, one of the first steps should be to
A. inform the dispatcher. C. refuel the vehicle.
B. complete the log entry. D. check the lights and siren.
__________ 17. When cleaning ambulance surfaces where there is no visible blood or body fluid
contamination, the EMT should use
A. a high-pressure hose. C. soap and water.
B. an infrared lamp. D. an EPA-approved germicide.
__________ 18. Equipment that will be used invasively should be treated with
A. a 1:100 bleach-to-water mixture.
B. sterilization techniques.
C. Lysol.
D. a 1:10 bleach-to-water mixture.
__________ 19. An operational reason to request air rescue is
A. a Glasgow Coma Scale score of less than 13.
B. prolonged extrication.
C. head injury with altered mental status.
D. penetrating injury to the body cavity.
__________ 20. If you have to set up a helicopter landing zone at night, its minimum size should be
_____ feet.
A. 50 ⫻ 50 C. 100 ⫻ 100
B. 75 ⫻ 75 D. 200 ⫻ 200
©2010 by Pearson Education, Inc. C H A P T E R 4 1 Ambulance Operations and Air Medical Response
Prehospital Emergency Care, 9th Ed.
M41_MIST7816_09_IRM_CH41.QXD 9/24/09 1:15 AM Page 4
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
“I am an experienced emergency vehicle operator. I took the defensive driving courses, the emergency
vehicle operator’s course, and everything else I could get my hands on. And my supervisor still put me
through an extensive driver’s training program. So I was proud to be a driver, and I took my job seriously.
At least I thought I did. But here I am, in court, getting ready to tell a grand jury what happened. Let me
tell you, first.
“It was a sunny day. Business was brisk, but not too busy. We’d had a couple of runs, and we thought
we’d take a break. My partner, Jan, and I liked to go to the coffee shop on the other end of town. It was
a little out of the way, but we liked the company there.
“Wouldn’t you know it! As soon as we sat down, the tones go out. ‘Ambulance 60: respond Code 3 to
a person down, unconscious, possible cardiac arrest. Citizen CPR in progress. Address: Oak Crest Apart-
ments, Apartment 222. Time out is 1245 hours.’
“We grabbed our coffees and hauled out fast. Traffic was heavy, and I had to make time being on the
other side of the district and all. So I didn’t ‘spare the horses’ as they say.
“Then up ahead I saw a police car. The police in our town first respond to medical emergencies when
they can. To tell the truth, they’ve pulled us out of jams more than once, so I’m usually glad to see them.
Anyway, I got right in behind him, following him carefully. I’d changed my siren to yelp so that other
drivers could hear the difference as we came up to the intersection.
“I couldn’t have been doing more than 30 when we went through the intersection. She must have run
the light or something. I had the red, but it should have changed by the time I was in the intersection. And
I thought it was OK because the police car got through.
“Next thing, there’s a crash and Jan’s on top of me and the rig’s rolling on its side. My arm was busted
and a few of Jan’s ribs. We were lucky, though, luckier than the lady who hit us. The ED did what they
could, but she was too far gone.
“Anyway, a couple of days later, I’m back at the station. That police officer I followed comes in. He
arrests me for reckless endangerment. Now, I’m waiting to talk to the grand jury.”
2. Did the driver make a mistake in following the police car into the intersection? Why or why not?
(continued)
©2010 by Pearson Education, Inc. C H A P T E R 4 1 Ambulance Operations and Air Medical Response
Prehospital Emergency Care, 9th Ed.
M41_MIST7816_09_IRM_CH41.QXD 9/24/09 1:15 AM Page 5
H a n d o u t 4 1 - 2 (continued)
3. Did the ambulance driver show “due regard for the safety of others”?
4. If you were on the grand jury, would you find sufficient cause to indict the driver on the charges of
reckless endangerment?
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Prehospital Emergency Care, 9th Ed.
M41_MIST7816_09_IRM_CH41.QXD 9/24/09 1:15 AM Page 6
CHAPTER 41 REVIEW
Write the word or words that best complete the following sentences in the space provided.
or riding in an ambulance.
______________________________.
______________________________.
you move the patient, unless he or she is a high priority for immediate transport.
your hands at the end of the run and after all cleaning procedures have been completed.
©2010 by Pearson Education, Inc. C H A P T E R 4 1 Ambulance Operations and Air Medical Response
Prehospital Emergency Care, 9th Ed.
M41_MIST7816_09_IRM_CH41.QXD 9/24/09 1:15 AM Page 7
4. List five medical conditions that would justify a request for air medical transport.
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Prehospital Emergency Care, 9th Ed.
M41_MIST7816_09_IRM_CH41.QXD 9/24/09 1:15 AM Page 8
__________ 1. As an ambulance operator, you should be familiar only with the laws and regulations
that apply on the local level.
__________ 2. During transport, select the shortest route—this is not necessarily the least congested
route.
__________ 3. The most common collisions in which ambulances are involved are head-ons.
__________ 4. The General Services Administration and the DOT developed and published federal
specifications for ambulances.
__________ 5. Most states allow ambulances to be parked anywhere if they do not damage personal
property or endanger lives.
__________ 6. If an ambulance operator acts without due regard for the safety of others, he or she is
still protected by Good Samaritan laws.
__________ 7. The insulation in a newer automobile can reduce the interior decibel level of an
approaching siren by 35–40 percent when the car is parked.
__________ 8. Upon arrival at a vehicle collision, the EMT should park the ambulance in front of or
behind the collision, but never alongside it.
__________ 9. At a car wreck, the ambulance should be parked as close to the wreckage as possible to
speed the loading of patients.
__________ 10. If, en route to the hospital, you are the EMT with the patient, you should keep the
driver informed of the patient’s condition.
__________ 11. If the patient vomits en route, clean up the vomitus with paper towels and dispose of
them as soon as you arrive at the receiving facility.
__________ 12. As a rule, the dispatcher should know the amount of time it takes to travel to a medical
facility so there is no need to notify dispatch when you arrive there.
__________ 14. Stopping an ambulance on wet pavement takes approximately twice the distance as
stopping on dry pavement.
__________ 15. When choosing a landing site for a helicopter, the site should not be more than 40 yards
from the vehicles involved in a collision in order to facilitate patient loading.
©2010 by Pearson Education, Inc. C H A P T E R 4 1 Ambulance Operations and Air Medical Response
Prehospital Emergency Care, 9th Ed.
M41_MIST7816_09_IRM_CH41.QXD 9/24/09 1:15 AM Page 9
©2010 by Pearson Education, Inc. C H A P T E R 4 1 Ambulance Operations and Air Medical Response
Prehospital Emergency Care, 9th Ed.
M42_MIST7816_09_IRM_CH42.QXD 9/24/09 1:17 AM Page 2
CHAPTER 42 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. The majority of electric current and associated hazards in vehicle collisions can be
eliminated most easily by
A. grounding the vehicles.
B. disconnecting the battery.
C. flooding the engine compartment with CO2.
D. turning off the engine.
__________ 2. Upon arrival at the scene of a collision, the EMT’s first task is to
A. stabilize the vehicle.
B. gain access to the patient.
C. perform a scene size-up.
D. provide manual in-line stabilization for the patient.
__________ 3. Which article of protective equipment provides an acceptable level of head protection?
A. bump cap C. uniform cap
B. firefighter’s helmet D. bicyclist’s helmet
__________ 4. The role of the EMT in vehicle stabilization and patient extrication is that of
A. a public information officer. C. a rescuer.
B. traffic control. D. patient care provider.
__________ 5. The safest shoes to wear when involved in the patient extrication process of a vehicle
collision are
A. rubber boots. C. deck shoes.
B. high-top cross-training shoes. D. steel-toed boots.
__________ 6. In general, approach a vehicle that has been involved in a collision and contains a patient
from the
A. front. C. passenger side.
B. driver’s side. D. rear.
__________ 7. Traffic at the scene of a motor vehicle collision should be routed away a minimum
distance of _____ feet.
A. 50 C. 150
B. 100 D. 200
__________ 8. Before entering a vehicle that was involved in a collision, it must be
A. removed. C. ticketed.
B. stabilized. D. marked.
__________ 9. The least costly method of forceful entry into a residence is
A. calling a locksmith. C. breaking a window.
B. using the jaws of life. D. breaking a door.
__________ 10. By far, the most common access problems encountered by the EMT involve
A. crime scenes. C. pets.
B. children. D. motor vehicle collisions.
(continued)
H a n d o u t 4 2 - 1 (continued)
__________ 11. The easiest method of properly stabilizing a vehicle that is upright and on its wheels is to
A. use parallel step chocks.
B. use jacks at the front and rear bumpers.
C. place two wheel chocks.
D. put the car in park.
__________ 12. The most common tool used in vehicle extrication and patient disentanglement is the
A. air bag. C. power hydraulic rescue tool.
B. come-along. D. axe.
__________ 13. Complex access requires the use of
A. specialized tools. C. no special tools or equipment.
B. protective equipment. D. heavy gloves.
__________ 14. All windows in modern automobiles are made of tempered safety glass that will break
into rounded pieces rather than sharp shards except the
A. windshield. C. driver’s window.
B. rear windows. D. sunroof.
__________ 15. Excluding motor vehicle collisions, most injuries are the result of
A. hunting. C. electricity.
B. gravity. D. weather.
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
Dispatch: Medic Three, Ambulance 1701, respond Code 3 to a car off the road. Time is now 0315 hours.
“We roll out of our bunks and grab our boots. In minutes, we are on the road, running lights and sirens
into the dark night. Trying to shake the sleep from my head, I’m wondering what happened. As we pull
up to the scene, we see the State Trooper’s patrol car with its lights on up ahead. His spotlight is slowly
panning the scene, but we can’t see a car.
“Getting out of the ambulance, making sure that there are no downed wires nearby, I walk toward the
trooper. He points down a steep embankment and there is the vehicle, resting on its roof. Looking around,
I see no other access but down the 65-foot embankment.”
3. Suppose that once you got down to the patients, they tell you the driver ran off and that they think
he was hurt and probably intoxicated. What would you do then?
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Prehospital Emergency Care, 9th Ed.
M42_MIST7816_09_IRM_CH42.QXD 9/24/09 1:17 AM Page 5
CHAPTER 42 REVIEW
Write the word or words that best complete each sentence in the space provided.
3. Once the scene is secure and it is safe to approach the vehicle, walk around it once to identify
from the vehicle unless delay would endanger the life of the patient, EMS personnel, or other
rescuers.
before you remove the patient from the vehicle by normal or rapid extrication procedures.
______________________________.
8. The ______________________________ posts are the front posts supporting a vehicle’s roof.
9. When the patient is pinned between the dash, steering wheel, and seat, the technique known as a(n)
easiest disentanglement.
______________________________.
11. The ______________________________ is always the access of choice because it is the largest
12. Getting into a vehicle by opening a door or rolling down a window is called
______________________________ ______________________________.
13. If the ______________________________ cable on a battery is removed first, a spark may occur that
(continued)
H a n d o u t 4 2 - 3 (continued)
14. All ambulances should be equipped with ______________________________ so that scenes can be
15. When called to a motor vehicle collision, look for ______________________________ both at the
17. There are two types of window glass in modern vehicles: laminated and
______________________________.
18. When using chocks to stabilize an upright vehicle, they should be pushed in until they touch the
______________________________.
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Prehospital Emergency Care, 9th Ed.
M42_MIST7816_09_IRM_CH42.QXD 9/24/09 1:17 AM Page 7
2. List the personal protective equipment required for personnel involved in the patient extrication
process.
5. List the two types of access to a patient involved in a motor vehicle collision.
HANDOUT 42-1: Chapter 42 Quiz HANDOUT 42-4: Gaining Access and Patient
1. D 5. D 9. C 13. A Extrication: Listing
2. C 6. A 10. D 14. A 1. Any five of the following: Is the patient ill or injured?
3. B 7. A 11. A 15. B What is the mechanism of injury? What is the
4. D 8. B 12. C location of the incident? What time of day is it? What
is the weather? Is there a report of entrapment? Is
HANDOUT 42-2: In the Field there a report of a leak or spill?
2. Full turnout gear: bunker coat, bunker pants,
1. That you established EMS Command and that you steel-toed boots, head protection (i.e., standard fire
are requesting lights, heavy rescue, and high-angle helmet), eye protection (goggles or safety glasses),
rescue personnel and equipment. and heavy leather gloves; in addition, appropriate
2. Ropes, possibly heavy hydraulic tools, even air BSI gear would be needed for patient contact.
medical rescue. 3. Electrical lines, traffic.
3. Inform the trooper and have him form a search party 4. Step chocks, box crib with wedges, cutting valve
and proceed with a lost person wilderness search stems/tires.
while you continue to triage and care for the patients 5. Complex access, simple access.
on-scene.
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Prehospital Emergency Care, 9th Ed.
M43_MIST7816_09_IRM_CH43.QXD 9/24/09 2:58 PM Page 2
CHAPTER 43 QUIZ
Write the letter of the best answer in the space provided.
H a n d o u t 4 3 - 1 (continued)
__________ 10. A U.S. DOT publication that lists more than a thousand hazardous materials, each with
an identification number cross-referenced to complete emergency instructions, is
A. OSHA Emergency Response Standards. C. Material Safety Data Sheets.
B. NFPA Standard #473. D. Emergency Response Guidebook.
__________ 11. The first course of action that should be taken by the EMT at a hazardous materials
incident is
A. securing the scene. C. beginning rescue of victims.
B. limiting exposure of rescuers. D. contacting an ALS team.
__________ 12. The most essential part of hazardous materials rescue operations is
A. the training of EMTs. C. effective preincident planning.
B. use of SCBA. D. use of specialized HAZMAT suits.
__________ 13. Receiving facilities handling patients from hazardous materials incidents should be
A. the closest to the scene. C. OSHA approved.
B. designated in the incident plan. D. specialized chemical centers.
__________ 14. Lifesaving emergency care, such as airway management and immobilization, should be
performed in the _____ zone.
A. hot C. warm
B. containment D. cold
__________ 15. Radiation contamination occurs when the patient comes into direct contact with
radioactive
A. gases. C. liquids.
B. particles. D. all of these.
IN THE FIELD
Review the following real-life situation. Then consult the Material Safety Data Sheet on page 6 to help you
answer the following questions.
Returning to the station after several back-to-back calls, you and your partner, Juan, start to clean up. You
begin on the inside of the ambulance, while Juan agrees to wash down the backboards. The backboards are
particularly dirty after a couple of tough extrication calls. There is dried blood as well as grease and
antifreeze on the boards.
Juan takes the backboards into the dirty utility room off the main bays. It has a deep sink, as well as
brushes and cleaners to clean equipment. He reviews the cleaning procedures for washing down a dirty
backboard. He then dons a pair of heavy gloves, a plastic gown, and a pair of goggles.
Juan is having a tough time cleaning off the grease from the board, so he decides to mix a little bleach
into the ammonia and soapy water mixture he was using. Smelling the mixture, he thinks to himself, “Boy
is that strong!” He then continues to scrub the boards.
Soon he realizes that his eyes are watering and burning. But he wants to get the job done, so he keeps
on working. Pretty soon he is breathing heavily, more heavily than he should be considering how much
work he is doing. He feels a funny tightness in his chest and gets a little apprehensive.
Having completed washing down the inside of the rig, you go see if you can help Juan out. One look
tells you that something is wrong with Juan. Juan tells you he is having trouble breathing. You call out for
the supervisor and go to work helping your partner.
(continued)
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M43_MIST7816_09_IRM_CH43.QXD 9/24/09 2:58 PM Page 5
H a n d o u t 4 3 - 2 (continued)
(continued)
H a n d o u t 4 3 - 2 (continued)
I – CHEMICAL IDENTIFICATION
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M43_MIST7816_09_IRM_CH43.QXD 9/24/09 2:58 PM Page 7
CHAPTER 43 REVIEW
Write the word or words that best complete each sentence in the space provided.
1. Any substance that in any quantity poses a threat or an unreasonable risk to health, safety, and
2. The EMT should never attempt a hazardous materials rescue unless he or she has had the necessary
______________________________ ______________________________.
4. All emergency responders likely to witness or discover a hazardous materials emergency must be
5. Generally, in the preplanning of incident management, you should prepare for the
______________________________ ______________________________ scenario.
6. There should be a clear chain of command from each rescuer to the ______________________________
______________________________.
rescue, initial decontamination, and treatment for life-threatening conditions by specially trained
zone, rescuers should shed all contaminated protective gear and patients should be as fully decon-
taminated as possible.
9. The area immediately adjacent to the contamination zone is called the ______________________________
______________________________.
10. The 24-hour emergency chemical information and assistance center reachable at 800-424-9300 is
______________________________.
11. The NFPA 704 Hazard Identification System identifies potential danger with the use of numbers
(continued)
H a n d o u t 4 3 - 3 (continued)
12. ______________________________ occurs when the patient is in the presence of radioactive material
without any of the radioactive material actually touching his or her clothing or body.
13. ______________________________ occurs when the patient has come into direct contact with the
accidents.
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Prehospital Emergency Care, 9th Ed.
M43_MIST7816_09_IRM_CH43.QXD 9/24/09 2:58 PM Page 9
2. This is a potentially large spill of material that is a highlighted substance. How large an isolation
zone should be set up at first? How should that zone be changed later?
4. Will evacuation be necessary? What are areas of major concern in this incident?
(continued)
1035 115 Ethane 1050 125 Hydrogen chloride, anhydrous 1063 115 Refrigerant gas R-40
1015 126 Carbon dioxide and nitrous
oxide mixture 1035 115 Ethane, compressed 1051 117 Hydrocyanic acid, aqueous 1064 117 Methyl mercaptan
solutions, with more than
1015 126 Nitrous oxide and carbon 1036 118 Ethylamine 1065 121 Neon
20% hydrogen cyanide
dioxide mixture
1037 115 Ethyl chloride 1065 121 Neon, compressed
• TOXIC; may be fatal if inhaled or absorbed through skin. Small Fires: Water only; no dry chemical, CO2 or Halon®.
• Fire will produce irritating, corrosive, and/or toxic gases. • Contain fire and let burn. If fire must be fought, water spray or fog is recommended.
• Contact with gas or liquefied gas may cause burns, severe injury, and/or frostbite. • Do not get water inside containers.
• Runoff from fire control may cause pollution. • Move containers from fire area if you can do it without risk.
9/24/09
• These are strong oxidizers and will react vigorously or explosively with many • Do not direct water at source of leak or safety devices; icing may occur.
2:58 PM
materials including fuels. • Withdraw immediately in case of rising sound from ventilating safety devices or
• May ignite combustibles (wood, paper, oil, clothing, etc.). discoloration of tank.
• Some will react violently with air, moist air, and/or water. • ALWAYS stay away from the ends of tanks.
• Containers may explode when heated. • For massive fire, use unmanned hose holders or monitor nozzles; if this is impossible,
• Ruptured cylinders may rocket.
Page 11
C H A P T E R 4 3 Hazardous Materials
(continued)
M43_MIST7816_09_IRM_CH43.QXD 9/24/09 2:58 PM Page 12
H a n d o u t 4 3 - 4 (continued)
(continued)
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Prehospital Emergency Care, 9th Ed.
M43_MIST7816_09_IRM_CH43.QXD 9/24/09 2:58 PM Page 13
H a n d o u t 4 3 - 4 (continued)
(continued)
2. List the colors included in the NFPA 704 system and identify the hazard each identifies.
3. List the levels of training identified by the EPA and OSHA in “29 CFR 1910.120—Hazardous
Waste Operations and Emergency Response Standards.”
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Prehospital Emergency Care, 9th Ed.
M43_MIST7816_09_IRM_CH43.QXD 9/24/09 2:58 PM Page 15
CHAPTER 44 QUIZ
Write the letter of the best answer in the space provided.
__________ 1. Any event that places excessive demands on emergency response personnel and
equipment is called a
A. catastrophe. C. multiple-casualty incident.
B. disaster. D. tragedy.
__________ 2. The senior EMT who arrives at the scene of an MCI or disaster assumes responsibility as
the _____ commander.
A. unified C. incident mobile
B. sole D. EMS incident
__________ 3. The unit responsible for distributing the medical materials and equipment necessary to
render care is called the _____ unit.
A. staging C. supply
B. extrication D. triage
__________ 4. A system used for sorting patients to determine the order in which they will receive
medical care or transportation to definitive care is called
A. staging. C. triage.
B. assessment. D. treatment.
__________ 5. In the four-priority triage system, patients who are dead receive what priority level?
A. Priority 3 C. Priority 1
B. Priority 4 D. Priority 2
__________ 6. The unit responsible for the monitoring, overseeing of inventories, and direction of
available ambulances to the treatment unit is called the _____ unit.
A. incident command C. staging
B. transportation D. communication
__________ 7. As an EMT at an MCI, do not let communication difficulties distract you from
A. patient care.
B. contacting the incident commander.
C. using radio codes.
D. direct communication with the receiving hospital.
__________ 8. A sudden catastrophic event that overwhelms natural order and causes great loss of
property and/or life is called a
A. disaster. C. calamity.
B. Force 10 event MCI. D. tragedy.
__________ 9. Critical to any successful rescue effort is an efficient communications system that
includes
A. multiple frequencies. C. E911 capabilities.
B. EMT dispatchers. D. a backup system.
__________ 10. A typical color-coding system for triage tags assigns high-priority patients the color:
A. yellow. C. red.
B. green. D. black.
(continued)
H a n d o u t 4 4 - 1 (continued)
__________ 11. A key to dealing with non-life-threatening injuries in the treatment unit is
A. detailed tagging.
B. taking treatment shortcuts.
C. frequent consultation with medical direction.
D. performing detailed assessments.
__________ 12. After an incident commander is determined, he or she should begin to establish all of the
following EMS units except
A. triage. C. finance.
B. transportation. D. supply.
__________ 13. EMTs arriving at an MCI should first report to the _____ unit.
A. mobile command C. staging
B. supply D. transportation
__________ 14. Patients should be moved from the triage unit to the treatment unit in order of their
A. age. C. seniority.
B. priority. D. complaints.
__________ 15. During an MCI, radio communications from the scene of the incident to the receiving
hospitals should be handled by the
A. incident commander. C. transportation officer.
B. individual EMTs. D. EMD.
IN THE FIELD
Review the following real-life situation. Then answer the following questions.
Our fire department does not make that many EMS calls; however, we are all EMTs. I still remember the
day that we were toned out to a two-car collision with multiple patients. This wasn’t your regular car crash,
at least not in our town. Upon our arrival, Captain Schultz noted one car with severe front-end damage
sitting upright in the intersection with two patients still in the car. The other vehicle was on its side with
the driver still in his seat belt. There was a little girl in the back seat and another child sitting up crying on
the ground.
Captain Schultz immediately requested three more ambulances and another engine company for assis-
tance and then took charge of the triage. He took two firefighters with him to assist. In accordance with
our SOP for multiple-casualty incidents, the lieutenant took control of getting the responding units and
personnel to the patients that Captain Schultz identified as priority.
When the ambulances started to arrive, Captain Schultz directed firefighters to load the priority patients
and waited for additional ambulances for the stable patients. All in all, we transported six patients in five
ambulances.
CHAPTER 44 REVIEW
Write the word or words that best complete each sentence in the space provided.
receiving facilities.
responded to in a controlled and orderly way and that all responsibilities are carried out.
5. A(n) ______________________________ ______________________________ system works best when the
mand center located in a safe area near or at the area where patients will be loaded for transport.
8. EMTs responding to the scene of an MCI should first report to the ______________________________
______________________________ ______________________________ for instructions.
10. ______________________________ is a system used for sorting patients to determine the order in which
they will receive medical care or transportation to definitive care; it is performed in the
______________________________ ______________________________.
11. In triage, the ______________________________ priority involves patients with severe injuries but who
(continued)
H a n d o u t 4 4 - 3 (continued)
ambulances are accessible and that transportation does not occur without the direction of the EMS
incident commander.
14. Effective ______________________________ among emergency responders is one of the most difficult
15. A(n) ______________________________ is a sudden catastrophic event that overwhelms natural order
16. Faced with the grim physical injuries that can accompany a disaster, it is difficult to remember that
18. Arrange for all those involved in a disaster—including ______________________________—to get good
ANALYZING AN MCI
Attached you will find an example of a typical incident tactical worksheet. Given the following scene size-
up information plus reports from the unit officers, answer the questions and complete as much of the sheet
as you are able to.
The Southcross apartment complex is on fire. Starting as a small kitchen fire, the fire has spread to five other
units and displaced at least 30 people. At least five volunteer fire companies are on the scene, each with at
least five firefighters.
Reports of victims are streaming in. As EMS command on-scene, you have coordinated with fire and
police command to establish a perimeter. You have also instructed the next senior EMT on the scene to
establish a forward triage point near the front door of the building. His first report reveals the following:
■ 1 patient that firefighters have started CPR on—Priority 0
■ 2 seriously burned adult patients—Priority 1
■ 2 elderly people, a married couple, both with extensive medical histories, both complaining of
shortness of breath—Priority 1
■ 1 person with bilateral broken ankles from jumping from the third story—Priority 2
■ 3 persons with burns to the hands from helping victims escape—Priority 3
Police also report about 15 residents who are out of the building and exposed to the elements.
A roll call of available receiving facilities shows the following:
1. There are two major missions that EMS command must cope with at this scene. What are they?
3. Assume you are the staging officer. How many ambulances will be needed?
4. Assume you are the transportation officer. Based on the initial triage report, which patients would
you send to which hospital?
(continued)
Level 1 3– 6 Patients Level 2 7–15 Patients Level 3 16+ Patients Rehab & Rescues Signal 30 (Major Fires)
_____ Declare MCI _____ Declare MCI _____ Declare MCI _____ Assess # and Types of _____ Establish Perimeter
_____ EMS All Call _____ EMS All Call _____ EMS All Call Units Needed. (With _____ Designate Triage Area
_____ Cover Town ALS _____ Cover Town ALS _____ Cover Town ALS _____ Establish Perimeter _____ Call in EMS Coordinator
_____ Cover Town BLS _____ Cover Town BLS _____ Cover Town BLS _____ Designate Triage Area _____ Call in Medical Director
_____ Roll Call Hospitals _____ Roll Call Hospitals _____ Roll Call Hospitals _____ Designate Rehab Area _____ Second BLS Unit ?
12:12 AM
_____ Call in EMS Coordinator _____ Call in EMS Coordinator _____ Second BLS Unit ? _____ Second ALS Unit ?
_____ Call in Medical Director _____ Call in Medical Director _____ Second ALS Unit ? _____ Medical Supply ?
_____ Medical Supply _____ Medical Supply _____ Medical Supply ? _____ Transport Officer ?
_____ Transport Officer _____ Transport Officer _____ Treatment Officer ?
Page 8
Hospital AMCH ST. PETERS MEMORIAL VA ELLIS ST. CLARES ST. MARYS SAMARITAIN
Roll Call
CAN TAKE
# PT. SENT
NUMBER OF PATIENTS BY PRIORITY
1 (RED) 2 (YELLOW) 3 (GREEN) 0 (BLACK) TOTAL
RESPONDING UNITS
GUILDERLAND M15 _____ M18 _____ M19 _____ M30 _____ R1 _____ R5 _____ R40 _____ R50 _____ BETHLEHAM 5181 _____ 5182 _____
R60 _____ MED. SUPPLY _____ EMS20 _____ EMS5 _____ EMS10 _____ ONESQUETHAW 2585 _____
COLONIE 621 _____ 622 _____ 631 _____ 632 _____ 641 _____ 642 _____ 651 _____ 652 _____ RAVENA 2687_____ 2689 _____
653 _____ ROTTERDAM A10 _____ A30 _____
ALBANY COUNTY M1 _____ M2 _____ M3 _____ A40 _____
VOORHEESVILLE 5680 _____ 5685 _____ DUANSBURG A32 _____
HELDERBURG 5384 _____ 5386 _____ 5388 _____ MOHAWK _______________________
DELMAR 0981 _____ CAPITAL DISTRICT _______________________
CHAPTER 45 QUIZ
Write the letter of the best answer in the space provided.
(continued)
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H a n d o u t 4 5 - 1 (continued)
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Prehospital Emergency Care, 9th Ed.
M45_MIST7816_09_IRM_CH45.QXD 9/25/09 1:31 AM Page 5
IN THE FIELD
Review the following real-life situation. Then answer the questions that follow.
You are dispatched to an incoming aircraft at the airport that has been diverted to your community after
declaring an in-flight emergency. The only information from the flight crew is “there are many people
having difficulty breathing and vomiting.” Upon arrival you determine there are 123 passengers and
6 flight crew.
1. Your first actions (after protecting yourself) should include establishing a scene management
system. How would you accomplish this?
2. You suspect a biological agent of some type. What public agencies could help you identify the
causative agent?
3. This is an international flight and you gain information on a pandemic flu virus raging in the
country where the flight originated. What action might you consider in isolating the plane and
passengers?
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CHAPTER 45 REVIEW
Write the word or words that best complete each sentence in the space provided.
system will assist a responder with organizing the scene of a WMD event.
3. The effects from an explosion include primary, ______________________________, and tertiary injuries.
4. Agents such as sulfur and nitrogen mustards, lewisite, and phosgene oxime are examples of
______________________________.
5. Pulmonary agents act primarily to cause ______________________________ injury and are commonly
8. The three primary mechanisms of death associated with nuclear detonation are
______________________________, ______________________________, and
______________________________.
9. Alpha radiation can be stopped by ______________________________ and the outer layer of skin.
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Prehospital Emergency Care, 9th Ed.