EMT (Emergency Medical Technician) Crash Course Book + Online

edition.

PART I

INTRODUCTION

Chapter 1

Preparing for Success

on the NREMT Certification Exam

Serving the public as an Emergency Medical Technician (EMT) is among today’s most rewarding careers. The overwhelming majority of states in the U.S. require that you pass the National Registry of Emergency Medical Technicians (NREMT) exam to become certified and work as an EMT. Certification through the NREMT indicates that you have demonstrated entry-level competency as an EMT.

The NREMT certification exam is a pass/fail test. Its purpose is not to identify who is the best, but to identify who is competent. Your future patients don’t care what you scored on your certification exam. They care about receiving competent and compassionate care for themselves and those they care about. This Crash Course gives you the essential information you need to prepare for the NREMT certification exam.

THE EXAM

The NREMT exam is a computer-adaptive test (CAT). The test tailors itself to your individual abilities. The exam delivers questions one at a time and the questions are not randomly chosen. While you are taking the test, the software that drives the test is estimating your ability level. The ability estimate gets more and more precise as the exam progresses. The exam ends when there is a 95% certainty that your demonstrated competency is above or below the passing standard.

TOPICS COVERED ON THE EXAM

Your NREMT exam will have between 70 and 120 questions and you will have two hours to complete the test. All of the questions will be multiple-choice and each question will have 4 answer choices. You need to choose the best answer for the question posed.

The exam will broadly cover the content of the 2009 National EMS Education Standards (NEMSES). Topics will include airway, oxygenation, ventilation, cardiology, resuscitation, stroke, trauma, medical emergencies, obstetrics, gynecology, and EMS operations. Here are the percentages for the topics found on the exam.

Source: Wagoner, R. (May 18, 2010). 2009 Practice Analysis and 2010 Test Plan [Powerpoint presentation].

For all but EMS operations, 85% of the questions relate to adult patients and 15% relate to pediatric patients. Although not separate categories, topics such as patient assessment and safety will be emphasized throughout the test.

SCORING

Typically, you can retrieve your score from the NREMT website 24 hours after you complete the exam. If you fail the exam, the NREMT will provide some detailed information about your performance on each of the exam categories. Candidates must wait at least 14 days before taking the test again.

STANDARDS

Like the NREMT certification exam, the information in this publication is based on the 2009 National EMS Education Standards and the 2010 American Heart Association CPR and Emergency Cardiac Care Guidelines. This Crash Course will help you become familiar with these standards before taking the certification exam. For more information about the 2009 NEMSES, visit www.ems.gov/education/nationalstandardandncs.html.

GENERAL TEST-TAKING TIPS & STRATEGIES

BEFORE THE TEST

• Eat a balanced meal and get plenty of rest.

• Don’t cram. Your preparation should end (not begin) the day before the test.

• Avoid caffeine, energy drinks, excess sugar, etc. These will not improve your performance or steady your nerves.

• Study regularly over an extended period before the test.

• Know exactly where the test center is and plan to arrive a few minutes early. Remember, you must have an appointment to take the test. Bring two forms of photo ID.

• The testing center may be cold. Bring something warm in case you need it.

DURING THE TEST

• You cannot skip a question or come back to it later. You must answer each question before the next one will be provided.

• Read the whole question thoroughly at least a couple of times and formulate the answer in your head before you look at the answer choices. If you see a similar answer choice, that’s probably the correct response.

• There are four answer choices. Two of them can often be eliminated after reading the question thoroughly.

• When you get stuck, look for key words in the question and re-read the answer choices. When in doubt, lean towards the more aggressive treatment. For example, if you are not sure whether you should ventilate the patient or just administer oxygen, choose to ventilate.

• Do not complicate scenario-based questions. Do not bring elements into the questions that are not there.

• Relax! Remember, everyone is going to feel like the test is extremely challenging. Everyone is going to miss a lot of questions. This does NOT mean you are failing.

PART II

PREPARING TO BECOME AN EMT

Chapter 2

The Emergency Medical Services System:

History, Public Health, and the EMT’s Role

THE EMERGENCY MEDICAL SERVICES (EMS) SYSTEM

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

B. EMS is also expected to serve a role in the larger public health system through public education and prevention efforts.

HISTORY OF THE EMS SYSTEM

A. The modern EMS system has its origins in funeral homes, which often operated ambulances. This former practice produced an environment in which funeral home operators were serving competing business interests, and patients received little trained care until they arrived at the hospital.

B. EMS is still an evolving profession, younger than many other health-care professions, such as nursing.

C. The 1960s

1. In 1966, a paper titled Accidental Death and Disability: The Neglected Disease of Modern Society is published by the National Academy of Sciences. This paper is widely known in the EMS profession as the White Paper.

i. The White Paper is widely considered the birth of modern EMS. It spotlighted inadequacies of prehospital care in the United States, particularly related to trauma.

D. The 1970s

1. Early in the decade, the U.S. Department of Transportation (DOT) develops the first EMT National Standard Curriculum (NSC).

2. The first EMT textbook is published.

3. Later in the decade, the DOT also publishes the first paramedic NSC.

E. The 1980s

1. The American Heart Association (AHA) dramatically increases its emphasis on cardiovascular disease prevention, science, and education.

2. Additional levels of training are added to the existing EMT and paramedic curriculum.

3. Despite advances, the scope of practice for various levels of training lacks unity from state to state.

F. The 1990s

1. The National Registry of Emergency Medical Technicians (NREMT) advocates for a national training curriculum.

2. The National Highway Transportation Safety Administration (NHTSA) begins work on the EMS Agenda for the Future document.

3. Public access defibrillation and layperson training on use of automated external defibrillators (AEDs) sweeps across the country. This has a significant impact on survival of out-of-hospital cardiac arrest.

G. The 2000s

1. In line with the EMS Agenda for the Future, the NHTSA identifies universal knowledge and skills for EMS professionals through the new National EMS Education Standards (NEMSES).

i. The new NEMSES replace the previous National Standard Curricula.

ii. Four new levels of EMS licensure/certification are created: Emergency Medical Responder, Emergency Medical Technician, Advanced Emergency Medical Technician, and Paramedic.

Author’s Note: For more on the history of EMS, I recommend watching the DVD Making A Difference: The History of Modern EMS Version 2.0, narrated by Jim Page, founder of Jems Communications.

COMPONENTS OF THE EMS SYSTEM

A. Public access: refers to how the public accesses the EMS system

B. Clinical care: outlines the scope of practice and associated equipment

C. Medical direction: physician oversight of patient care

D. Integrated health services: prehospital service providers work cooperatively with hospital personnel to ensure continuity of care

E. Information systems: the information technology component of the EMS system

F. Prevention: the EMS system’s role in preventing injury and illness

G. Research: the move toward EMS care based on evidence-based medicine

H. Communications: communication systems used to activate EMS system, dispatch responders, and communicate with medical direction

I. Human resources: attempts to professionalize EMS occupations

J. Legislation and regulation: ensures the EMS system conforms to various local, state, and federal requirements

K. Evaluation: the quality improvement component of the EMS system

L. Finance: addresses the funding sources of the EMS system

M. Public education: focuses on the EMS system’s role in larger public health system

N. Education systems: addresses the quality of EMS training

ACCESSING THE EMS SYSTEM

A. 911 and non-911 Access

1. Most 911 systems are enhanced, allowing for automatic number and location identification by the dispatcher.

2. Many EMS systems use specially trained Emergency Medical Dispatchers (EMDs) able to give medical instructions to callers.

3. Cell-phone 911 calls and an increasing number of residences without landlines present new challenges for accessing the EMS system or confirming the location of the incident.

LEVELS OF TRAINING

A. Emergency Medical Responder (EMR): provides basic, immediate care including bleeding control, CPR, AED, and emergency childbirth. (Previously known as First Responder.)

B. Emergency Medical Technician (EMT): includes all EMR skills, advanced oxygen and ventilation skills, pulse oximetry, noninvasive blood pressure (BP) monitoring, and administration of certain medications. (Previously known as EMT-Basic.)

C. Advanced Emergency Medical Technician (AEMT): includes all EMT skills, advanced airway devices, intravenous and intraosseous access, blood glucose monitoring, and administration of additional medications.

D. Paramedic: includes all preceding training levels, advanced assessment and management skills, various invasive skills, and extensive pharmacology interventions. This is the highest level of prehospital care outlined in the National EMS Education Standards.

DESTINATION FACILITIES

A. EMTs routinely transport patients to a local medical emergency department (ED) based on the chief complaint or patient request.

B. In certain situations, patients may be transported to a specialty facility.

1. Stroke center: provides rapid specialized care for stroke patients

2. Cardiac center: equipped to provide rapid intervention for cardiac emergencies

3. Trauma center: capable of providing rapid surgical intervention

4. Behavioral center: specializes in management of behavioral emergencies

5. Pediatric center: provides specialty pediatric care

6. Obstetric center: equipped for high-risk obstetrical patients

7. Poison center: provides specialized care for toxicology patients

EMT ROLES AND RESPONSIBILITIES

A. Equipment preparedness

B. Emergency vehicle operations

C. Establish, maintain scene safety

D. Patient assessment and treatment

E. Lifting and moving

F. Strong verbal and written communication skills

G. Patient advocacy

H. Professional development

I. Quality improvement

J. Illness and injury prevention

K. Maintain certification/licensure

PATIENT SAFETY

A. EMTs routinely participate in activities that are high risk for the patient. These activities require adequate training, focus, and attention to detail.

1. Transfer of patient care. This includes moving the patient from one stretcher to another and providing all necessary information to allow continuity of care.

2. Lifting and moving patients. Patients often incur avoidable injuries while being lifted or moved by EMS providers. This includes moving patients by wheeled stretcher and during loading and unloading of patients.

3. Ambulance-involved motor vehicle collisions. All occupants in the back of an ambulance are at risk of injury during a collision. Safety is the priority during transport, not speed.

4. Spinal precautions. Patients can suffer devastating injuries if spinal precautions are not taken when indicated, or are not performed competently.

5. Medication errors.

B. Errors by EMS providers that result in patient injury are usually due to

1. failure to perform skills adequately.

2. lack of knowledge leading to poor decision making.

3. failure to follow established protocols.

C. Preventing Errors

1. Make sure you understand your protocols and follow them.

2. Provide the best possible environment to assess and manage patients; for example, ensure adequate lighting, minimize distractions, etc.

3. When in doubt, consult your partner, Advanced Life Support (ALS) providers, or medical direction.

PROFESSIONAL ATTRIBUTES

A. Professional appearance

B. Competent knowledge, skills

C. Physical capability

D. Leadership skills

E. High ethical standards

F. Emotional stability

G. Critical/adaptive thinking skills

H. Effective listener

I. Ability to function in team environment

MEDICAL DIRECTION

A. The medical director is a physician responsible for providing medical oversight.

B. Online medical direction: direct contact between the physician and EMT via phone or radio.

C. Offline medical direction: written guidelines and protocols.

D. The medical director oversees quality improvement.

QUALITY IMPROVEMENT (QI)

A. Also called continuous quality improvement (CQI).

B. Continuous audit and review of all aspects of the EMS system to identify areas of improvement.

PUBLIC HEALTH

A. EMS providers are part of the larger public health system.

B. The public health system is responsible for the overall health of the entire population.

C. Examples of the EMS system’s participation in public health efforts may include immunization clinics, prevention education, safety, wellness events, and public CPR training.

Your preparation for the national certification exam should have two distinct components:

1. Assemble the information you plan to learn before taking the exam.

i. Create flashcards after reviewing each chapter in this book—each flashcard should contain a reasonable amount of information.

2. Learn the information you have assembled. Keep a few flashcards with you at all times and review them several times each day.

Chapter 3

EMT Safety and Wellness/Lifting and Moving/Patient Restraint

SCENE SAFETY

A. The EMT’s first priority is always his or her own safety. This will not change. This concept is a high priority on the certification exam. Scene safety is always the top priority!

B. The EMT’s safety priorities after personal safety are for his/her partner(s), patients, and bystanders.

C. Maintaining scene safety includes addressing scene-specific hazards, appropriate infection control precautions, and safe lifting and moving techniques.

EMT WELLNESS

A. Physical Well-Being. Job tasks require that EMTs maintain a certain level of physical conditioning, get adequate sleep, and eat a healthy diet.

B. Mental Well-Being. EMTs must recognize that stress is an inevitable consequence of the profession. EMTs must anticipate stress and develop a healthy plan to help manage it.

1. Types of stress

i. Acute stress: an immediate physiological and psychological reaction to a specific event. The event triggers the body’s fight or flight response.

ii. Delayed stress: a stress reaction that develops after the stressful event. It does not interfere with the EMT’s ability to perform during the stressful event. Posttraumatic stress disorder (PTSD) is an example of delayed stress.

iii. Cumulative stress: the result of exposure to stressful situations over a prolonged period of time. This leads to burnout for many EMTs.

2. Causes of stress

i. Long hours, low pay, lack of sleep

ii. Dangerous situations, exposure to death and dying

iii. Challenging interactions with patients, family members, etc.

iv. Working holidays, birthdays, anniversaries, etc.

v. Nonemergency transports and aggressive system-status management

3. Managing stress

i. Recognize signs of stress or burnout: anxiousness; irritability; headache; poor concentration; loss of appetite; difficulty sleeping; loss of interest in sex, hobbies, work, family, friends; increased use of alcohol or drugs.

ii. Address modifiable risk factors for heart disease and stroke: tobacco use, hypertension, lack of exercise, and poor diet.

iii. Find time for relaxing activities and interests; listen to the observations of family and friends. They know you best.

iv. Balance the demands of your personal and professional life.

v. Consider a change in your work environment, or get professional counseling.

vi. Critical Incident Stress Management (CISM). CISM is a formalized process to help emergency workers deal with stress.

Defusing sessions, when needed, are held within 4 hours of the incident.

Debriefing sessions are held 24 to 72 hours after the incident.

CISM teams consist of trained peer counselors and mental health experts.

Participants can, but are not required to, share their feelings.

CISM is meant to facilitate the process of dealing with critical incident stress. It is not used as a critique of patient care or any other type of performance evaluation.

The information shared during a CISM session is confidential.

C. Emotional Demands of the EMS Profession

1. Routine exposure to death and dying

2. Encounters with patients in the various stages of grief

i. Denial. The patient may experience a not me stage.

ii. Anger. The patient may experience a why me? stage.

iii. Bargaining. The patient may experience a but I still need to … stage.

iv. Depression. The patient may