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WHAT ARE THE 4 NATIONALLY RECOGNIZED EMS LICENSURE LEVELS IN ORDER?

EMERGENCY MEDICAL RESPONDER (EMR), EMERGENCY MEDICAL TECHNICIAN (EMT), ADVANCED EMERGENCY MEDICAL TECHNICIAN (AEMT), PARAMEDIC.

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WHAT IS THE PRIMARY ROLE OF THE EMR?

INITIATE IMMEDIATE LIFESAVING CARE (BLEEDING CONTROL, CPR) TO CRITICAL PATIENTS WHILE AWAITING ADDITIONAL EMS RESPONSE.

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WHAT IS THE AEMT FORMERLY KNOWN AS?

EMT-INTERMEDIATE.

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WHAT SKILLS DISTINGUISH THE AEMT FROM THE EMT?

AEMTS ADD ADVANCED AIRWAY ADJUNCTS (SUPRAGLOTTIC AIRWAYS), IV AND IO ACCESS, FLUID THERAPY, AND A LIMITED SET OF MEDICATIONS TO THE EMT SCOPE. RHYTHM INTERPRETATION, MANUAL DEFIBRILLATION, AND SURGICAL AIRWAYS REMAIN EMS PROVIDER SKILLS.

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DEFINE LICENSURE.

A PROCESS BY WHICH A GOVERNMENT ENTITY REGULATES AN OCCUPATION BY GRANTING AUTHORITY (A LICENSE) TO A PERSON TO ENGAGE IN AN ACTIVITY.

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DEFINE CERTIFICATION.

A PROCESS BY WHICH A LEVEL OF STATUS OR ACHIEVEMENT IS RECOGNIZED BY THE GRANTING OF A DOCUMENT ATTESTING TO THAT STATUS.

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DEFINE REGISTRATION.

THE ACT OF ENROLLING ONE'S NAME IN A REGISTER OR BOOK OF RECORD (E.G., NREMT REGISTRATION).

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DEFINE CREDENTIALING.

MEDICAL DIRECTOR AUTHORIZATION FOR AN EMS PROVIDER TO PRACTICE WITHIN A SPECIFIC ROLE AND PERFORM SELECTED SKILLS IN A SPECIFIC EMS AGENCY.

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WHAT IS RECIPROCITY?

THE PRACTICE OF GRANTING LICENSURE OR CERTIFICATION BASED ON LICENSURE/CERTIFICATION FROM ANOTHER STATE, AGENCY, OR ASSOCIATION.

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WHAT IS PROFESSIONALISM?

THE WAY IN WHICH A PERSON FOLLOWS THE STANDARDS OF CONDUCT AND PERFORMANCE ESTABLISHED BY A PROFESSION, INCLUDING ADHERENCE TO A CODE OF ETHICS.

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LIST THE 11 ATTRIBUTES OF THE PROFESSIONAL EMS PROVIDER.

INTEGRITY, EMPATHY, SELF-MOTIVATION, APPEARANCE/PERSONAL HYGIENE, SELF-CONFIDENCE, COMMUNICATIONS, TIME MANAGEMENT, TEAMWORK AND DIPLOMACY, RESPECT, PATIENT ADVOCACY, CAREFUL DELIVERY OF SERVICE.

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DEFINE INTEGRITY IN THE CONTEXT OF EMS PROFESSIONALISM.

BEING HONEST - POSSIBLY THE MOST IMPORTANT BEHAVIOR FOR EMS PROFESSIONALS. INCLUDES BEING TRUTHFUL, DISCIPLINED, AND PROVIDING COMPLETE AND CORRECT DOCUMENTATION.

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DEFINE EMPATHY IN THE CONTEXT OF EMS PROFESSIONALISM.

IDENTIFYING WITH AND UNDERSTANDING THE FEELINGS, SITUATIONS, AND MOTIVES OF OTHERS; INCLUDES CARING, COMPASSION, RESPECT, AND BEING SUPPORTIVE AND REASSURING.

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WHAT ARE THE PRIMARY RESPONSIBILITIES OF THE EMS PROVIDER?

PREPARATION, RESPONSE, SCENE ASSESSMENT, PATIENT ASSESSMENT, RECOGNITION OF INJURY/ILLNESS, PATIENT TREATMENT, APPROPRIATE PATIENT DISPOSITION/REFERRAL, PATIENT TRANSFER, DOCUMENTATION, RETURNING TO SERVICE.

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WHAT ARE THE ADDITIONAL (NON-PRIMARY) RESPONSIBILITIES OF THE EMS PROVIDER?

COMMUNITY INVOLVEMENT, SUPPORT OF PRIMARY CARE/MIH EFFORTS, ADVOCACY FOR PUBLIC EMS INVOLVEMENT, PARTICIPATION IN LEADERSHIP, PERSONAL AND PROFESSIONAL DEVELOPMENT, COMMUNITY INJURY/ILLNESS PREVENTION.

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WHAT IS DIRECT MEDICAL OVERSIGHT?

PHYSICIAN-DIRECTED CARE PROVIDED IN REAL TIME (IN PERSON OR VIA REMOTE MEANS); ALSO KNOWN AS ONLINE MEDICAL CONTROL. ONLINE DIRECTION SUPERSEDES ESTABLISHED PROTOCOLS AS A RULE.

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WHAT IS INDIRECT MEDICAL OVERSIGHT?

THE OVERSIGHT OF ALL MEDICAL COMPONENTS OF AN EMS SYSTEM - PROTOCOL DEVELOPMENT, CREDENTIALING, EDUCATION, STANDING ORDERS, QA/CQI; FORMERLY KNOWN AS OFF-LINE MEDICAL CONTROL.

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WHAT ARE TREATMENT PROTOCOLS?

WRITTEN GUIDELINES THAT DEFINE THE SCOPE OF PREHOSPITAL INTERVENTION PRACTICED BY EMS PERSONNEL; CREATED BY THE MEDICAL DIRECTOR OR REGIONAL ADVISORY GROUP.

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WHAT ARE STANDING ORDERS?

SPECIFIC INTERVENTIONS AN EMS PROVIDER SHOULD TAKE IN SPECIFIC SITUATIONS THAT MAY OR MAY NOT REQUIRE DIRECT MEDICAL OVERSIGHT; OFTEN PART OF TREATMENT PROTOCOLS.

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WHAT SHOULD AN EMS PROVIDER DO WHEN A PHYSICIAN WHO IS NOT THE MEDICAL DIRECTOR OR PATIENT'S PRIVATE PHYSICIAN IS ON SCENE?

FOLLOW ESTABLISHED PROTOCOLS; IF NO PROTOCOL ADDRESSES THE SITUATION, IMMEDIATELY CONTACT ONLINE MEDICAL DIRECTION.

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DEFINE CQI.

CONTINUOUS QUALITY IMPROVEMENT - A FRAMEWORK TO IMPROVE ORGANIZATIONAL PERFORMANCE THAT MEASURES, EVALUATES, IMPROVES, AND CONTROLS PROCESSES; EVALUATES THE ENTIRE EMS SYSTEM.

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WHAT KEY AREAS DOES CQI MONITOR IN EMS?

MEDICAL DIRECTION, FINANCING, TRAINING, COMMUNICATIONS, PREHOSPITAL CARE/TRANSPORT, INTERFACILITY TRANSPORT, RECEIVING FACILITIES, SPECIALTY CARE UNITS, DISPATCH, PUBLIC INFORMATION/EDUCATION, DISASTER PLANNING, AND MUTUAL AID.

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WHAT IS A 'NEAR MISS' IN PATIENT SAFETY?

AN ERROR THAT OCCURRED WITHOUT CAUSING PATIENT HARM - AN OPPORTUNITY TO IMPROVE SYSTEMS BEFORE HARM OCCURS.

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WHAT DOES 'I PASS THE BATON' STAND FOR?

I=INTRODUCTION, P=PATIENT, A=ASSESSMENT, S=SITUATION, S=SAFETY CONCERNS, B=BACKGROUND, A=ACTIONS, T=TIMING, O=OWNERSHIP, N=NEXT. A MEMORY AID FOR SAFE PATIENT HANDOFFS.

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WHAT ARE THE TWO MAIN ASPECTS OF WELLNESS?

PHYSICAL WELL-BEING AND MENTAL/EMOTIONAL HEALTH. BOTH ARE ESSENTIAL FOR SAFE DELIVERY OF EMERGENCY CARE AND MANAGING INHERENT EMS STRESSORS.

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WHAT IS THE HEALTHY BMI RANGE AND THE ENGLISH-SYSTEM FORMULA?

18.5 TO 24.9 KG/M2. FORMULA: WEIGHT (LB) / [HEIGHT (IN)]2 X 703.

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WHAT IS THE NORMAL TARGET BLOOD PRESSURE FOR ADULTS?

SYSTOLIC LESS THAN 120 MM HG AND DIASTOLIC LESS THAN 80 MM HG. FOR DIAGNOSED HYPERTENSION, TARGET IS LESS THAN 130/80 MM HG.

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HOW MUCH WEEKLY PHYSICAL ACTIVITY DO ADULTS NEED?

AT LEAST 150 MINUTES OF MODERATE-INTENSITY ACTIVITY PER WEEK, PLUS STRENGTH TRAINING OF ALL MAJOR MUSCLE GROUPS AT LEAST TWICE PER WEEK.

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HOW MANY HOURS OF SLEEP DOES THE AVERAGE ADULT NEED?

7 TO 8 HOURS PER DAY. EMS ROTATING SHIFTS AND EXTENDED WORK HOURS CAUSE CIRCADIAN DISRUPTION AND SLEEP DEPRIVATION.

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WHEN WERE UNIVERSAL PRECAUTIONS INTRODUCED AND WHEN DID STANDARD PRECAUTIONS REPLACE THEM?

UNIVERSAL PRECAUTIONS: 1987 CDC - FOCUSED ON BLOODBORNE PATHOGENS. STANDARD PRECAUTIONS: 1996 CDC - APPLY TO ALL PATIENTS IN ALL SETTINGS REGARDLESS OF DIAGNOSIS.

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WHAT PPE AND DISEASES ARE ASSOCIATED WITH AIRBORNE PRECAUTIONS?

N95 MASK (CLINICIAN) + SURGICAL MASK (PATIENT). DISEASES: TUBERCULOSIS, MEASLES, COVID-19, CHICKENPOX. DROPLET NUCLEI REMAIN SUSPENDED IN AIR AND TRAVEL GREAT DISTANCES.

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WHAT PPE AND DISEASES ARE ASSOCIATED WITH DROPLET PRECAUTIONS?

SURGICAL MASK + EYE PROTECTION. DISEASES: INFLUENZA, RSV, CROUP, MENINGOCOCCAL MENINGITIS, WHOOPING COUGH (PERTUSSIS), EBOLA. DROPLETS TRAVEL SHORT DISTANCES ONLY.

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WHAT PPE AND DISEASES ARE ASSOCIATED WITH CONTACT PRECAUTIONS?

GOWN + GLOVES. DISEASES: MRSA, C. DIFFICILE (C. DIFF), VANCOMYCIN-RESISTANT ENTEROCOCCUS (VRE).

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WHAT PPE IS REQUIRED FOR AEROSOL-GENERATING PROCEDURES ON PATIENTS WITH A SUSPECTED AIRBORNE-TRANSMISSIBLE INFECTION?

N95 OR HIGHER RESPIRATOR (OR PAPR), PLUS GOWN, GLOVES, AND EYE PROTECTION. AEROSOL-GENERATING PROCEDURES INCLUDE SUCTIONING, NEBULIZER TREATMENT, AND ADVANCED AIRWAY MANAGEMENT.

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WHAT IS THE CORRECT PPE DONNING ORDER?

1. GOWN, 2. MASK/RESPIRATOR, 3. GOGGLES/FACE SHIELD, 4. GLOVES.

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WHAT IS THE CORRECT PPE DOFFING ORDER?

1. GLOVES, 2. GOGGLES/FACE SHIELD, 3. GOWN, 4. MASK/RESPIRATOR. PERFORM HAND HYGIENE AFTER EACH STEP.

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HOW LONG SHOULD HANDS BE WASHED? WHAT ALCOHOL CONCENTRATION IS NEEDED FOR SANITIZER?

SOAP AND WATER: AT LEAST 20 SECONDS. HAND SANITIZER: AT LEAST 60% ALCOHOL. SANITIZER IS NOT EFFECTIVE AGAINST C. DIFF SPORES, NOROVIRUS, OR HEAVILY SOILED HANDS.

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WHAT ARE THE 8 POST-EXPOSURE STEPS AFTER BLOOD/BODY FLUID EXPOSURE?

1) WASH AREA WITH SOAP/WATER (WATER ONLY FOR EYES/MOUTH), 2) DOCUMENT, 3) DESCRIBE ACTIONS TAKEN, 4) REPORT TO HOSPITAL AND AGENCY OFFICER, 5) COOPERATE WITH INVESTIGATION, 6) GET SCREENED, 7) OBTAIN POSTEXPOSURE PROPHYLAXIS, 8) FULL MEDICAL FOLLOW-UP.

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WHAT IS THE #1 REASON EMS WORKERS LEAVE THE PROFESSION?

BACK INJURY. 1 IN 4 EMS WORKERS SUFFERS A CAREER-ENDING BACK INJURY WITHIN THE FIRST 4 YEARS. 47% HAVE SUSTAINED A BACK INJURY ON DUTY.

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WHAT WEIGHT REQUIRES TWO PEOPLE TO LIFT?

MORE THAN 60 POUNDS (27 KG).

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WHAT ANSI VEST CLASS IS REQUIRED FOR ROADWAY WORK?

ANSI HIGH-VISIBILITY VESTS CLASS 2 OR HIGHER, WORN OVER TURNOUT GEAR. MINIMIZE TIME SPENT ON ROADWAYS.

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WHAT ARE THE WARNING SIGNS OF A SUBSTANCE USE DISORDER?

USING SUBSTANCE TO RELIEVE TENSION; USING INCREASING AMOUNTS; LYING ABOUT USE; GUILT ABOUT USE; AVOIDING DISCUSSION OF USE; SUBSTANCE INTERFERING WITH DAILY ACTIVITIES.

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WHAT IS THE DIFFERENCE BETWEEN EUSTRESS AND DISTRESS?

EUSTRESS = POSITIVE, PROTECTIVE, PERFORMANCE-ENHANCING STRESS. DISTRESS = NEGATIVE, DEBILITATING STRESS; SOURCE OF ANXIETY AND STRESS-RELATED DISORDERS.

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WHAT ARE SELYE'S THREE STAGES OF THE GENERAL ADAPTATION SYNDROME?

1. ALARM REACTION (FIGHT-OR-FLIGHT), 2. RESISTANCE (ADAPTATION; INCREASED RESISTANCE), 3. EXHAUSTION (COPING FAILS; VULNERABILITY TO ILLNESS).

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WHAT HAPPENS PHYSIOLOGICALLY DURING THE ALARM REACTION?

HYPOTHALAMUS TRIGGERS PITUITARY TO RELEASE ACTH, WHICH STIMULATES ADRENAL GLANDS TO RELEASE ADRENALINE AND NORADRENALINE, CAUSING: INCREASED HR AND BP, PUPIL DILATION, BRONCHODILATION, INCREASED BLOOD GLUCOSE, SLOWED DIGESTION, BLOOD SUPPLY SHIFT FOR CLOTTING.

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WHAT ARE THE FOUR CATEGORIES OF STRESS WARNING SIGNS?

PHYSICAL (CHEST PAIN, ARRHYTHMIAS, VOMITING), EMOTIONAL (ANGER, FEAR, PANIC), COGNITIVE (CONFUSION, POOR CONCENTRATION, MEMORY PROBLEMS), BEHAVIORAL (CRYING, WITHDRAWAL, INCREASED ALCOHOL USE).

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WHAT ARE THE FOUR PHASES OF THE ADAPTATION PROCESS IN ORDER?

1. DEFENSE MECHANISMS, 2. COPING, 3. PROBLEM SOLVING, 4. MASTERY.

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WHAT IS BURNOUT?

PHYSICAL AND EMOTIONAL EXHAUSTION WITH NEGATIVE ATTITUDES RESULTING FROM CUMULATIVE CHRONIC STRESS THAT CANNOT BE MANAGED WITH USUAL COPING MECHANISMS.

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WHAT ARE THE FOUR STRESS MANAGEMENT TECHNIQUES?

REFRAMING (NEW EMOTIONAL VIEWPOINT), CONTROLLED BREATHING (FOCUS ON DEPTH/RATE TO ACHIEVE CALM), PROGRESSIVE RELAXATION (SYSTEMATICALLY TIGHTEN THEN RELAX MUSCLE GROUPS), GUIDED IMAGERY (VISUALIZING CALMING IMAGES WITH A GUIDE).

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HOW IS TACTICAL (SQUARE) BREATHING PERFORMED?

BREATHE IN 4 COUNTS, HOLD 4 COUNTS, EXHALE 4 COUNTS. REPEAT AT LEAST 3 TIMES. CONTROLS THE SYMPATHETIC FIGHT-OR-FLIGHT ALARM REACTION.

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