NREMT EMT — All Questions

In the START triage system, a patient who is not breathing but begins breathing after you open the airway is tagged:

• a.Immediate (red)✓
• b.Minor/walking wounded (green)
• c.Deceased/expectant (black)
• d.Delayed (yellow)

In START triage, a patient who only breathes after the airway is opened is classified Immediate (red). This indicates a critical patient needing the highest transport priority.

The very first priority when arriving at any emergency scene is:

• a.Obtaining a full SAMPLE history from the patient
• b.Ensuring scene safety for yourself, the crew, and bystanders✓
• c.Reaching the patient's side as quickly as possible
• d.Applying high-concentration oxygen to every patient

Scene safety comes before patient contact because an injured rescuer cannot help and becomes another victim. Assess for hazards such as traffic, violence, fire, unstable structures and toxins before approaching. Taking a history, reaching the patient's side, and giving oxygen all matter, but each of them happens only after the scene has been judged safe to enter.

Which type of consent applies to treating an unresponsive patient who cannot agree to care?

• a.Implied consent✓
• b.Involuntary consent
• c.Informed consent
• d.Expressed consent

Implied consent assumes that a reasonable unresponsive person would want life-saving care. It allows EMTs to treat patients who cannot give expressed consent.

In the START triage system, the first step to sort a large group of patients is to:

• a.Begin CPR on every patient who is found not breathing before moving on
• b.Direct everyone who can walk to a designated area (identifying the walking wounded)✓
• c.Check a radial pulse and capillary refill on each patient in turn
• d.Immobilize every patient on a long backboard before sorting them

START begins by asking everyone who can walk to move to a designated area, which quickly identifies the minor (green) patients and shrinks the number left to assess. The remaining patients are then sorted by respirations, perfusion, and mental status. CPR is not begun during START because it ties up rescuers still needed for sorting, checking every pulse one at a time is far too slow for a large group, and immobilization is treatment rather than sorting.

A competent adult refuses care after being informed of the risks. The EMT should:

• a.Respect the refusal, document it thoroughly, and encourage the patient to call back if needed✓
• b.Treat and transport the patient anyway, because the risk of harm is too high
• c.Leave the scene without documenting the contact or the refusal at all
• d.Have a family member sign the refusal form in place of the patient

A competent, informed adult has the right to refuse care, and the refusal must be clearly documented after the risks have been explained. Encourage the patient to call back if symptoms worsen and involve medical direction as local policy requires. Treating a competent adult over their refusal is battery, leaving no record destroys the evidence that the risks were explained, and a relative's signature does not substitute for the decision of the patient who holds it.

Which patient should be moved with an emergency move (before full assessment)?

• a.A stable patient with an isolated ankle injury who wants to leave
• b.A patient in immediate danger from fire, explosion, or an unsafe scene✓
• c.Any patient, whenever the crew is trying to save time on scene
• d.Every trauma patient, to move them clear of the vehicle quickly

An emergency move is used when there is an immediate threat to life, such as fire, explosion or hazardous materials, and it is accepted precisely because the danger of staying outweighs the reduced spinal protection during the drag. It is not chosen for stable patients, not chosen to save time, and not the routine method for trauma patients, who are better served by a non-urgent move that preserves stabilization.

When lifting a heavy patient or stretcher, proper body mechanics include:

• a.Keeping the back straight, lifting with the legs, and keeping the load close to the body✓
• b.Lifting quickly with the arms fully extended and the load held away from you
• c.Twisting at the waist while lifting so you can move in one motion
• d.Bending at the waist and lifting with the back muscles rather than the legs

Safe lifting uses the leg muscles with a straight back and the load held close to the body, avoiding twisting, which reduces the risk of back injury to the EMT. Holding the load away from the body multiplies the leverage acting on the spine, twisting under load loads the spine in the direction it tolerates worst, and bending at the waist shifts the work onto the back muscles instead of the legs.

The purpose of providing a radio report to the receiving hospital is to:

• a.Serve as the legal record of the call for the run report
• b.Alert staff and allow them to prepare for the incoming patient✓
• c.Give the receiving staff the patient's full medical history
• d.Transfer responsibility for the patient before you arrive

A concise radio (MedComm) report gives the hospital key information so they can prepare appropriate staff and resources. It typically includes age, chief complaint, vital signs, treatment, and ETA. The written patient care report, not the radio call, is the legal record, and a full history belongs in that report and in the bedside handoff rather than on the air. Responsibility for the patient stays with the crew until care is formally transferred to hospital staff.

Standard precautions (body substance isolation) mean an EMT should:

• a.Wear personal protective equipment only during CPR and airway care
• b.Assume all blood and body fluids are potentially infectious and use appropriate PPE✓
• c.Base the level of protection on how sick the patient appears to be
• d.Wear gloves only for patients with a known infectious disease

Standard precautions treat every patient's blood and body fluids as potentially infectious, so appropriate PPE such as gloves and eye protection is used on all patient contacts. Reserving protection for CPR, for patients who look unwell, or for patients with a documented diagnosis all fail for the same reason: an infection is often unknown to the patient and to the crew at the time of contact.

Positioning an ambulance at a highway crash to shield the work area from traffic is an example of:

• a.Ongoing patient reassessment
• b.Patient care documentation
• c.Multiple-casualty incident triage
• d.Scene safety and hazard protection✓

Positioning the apparatus to block the work area protects the crew and the patients from being struck, which is part of scene safety and hazard control. Traffic is a leading hazard at roadway incidents. Reassessment, documentation and triage are all patient-facing tasks that do nothing about oncoming vehicles.

In a mass-casualty incident (MCI), the goal of triage is to:

• a.Do the greatest good for the greatest number of patients✓
• b.Transport patients in the order they are discovered
• c.Treat only the most severely injured, regardless of survivability
• d.Give the most care to the first patient found

MCI triage aims to do the greatest good for the greatest number by prioritizing patients most likely to benefit from limited resources. This differs from routine care that focuses fully on one patient.

Which is an example of expressed consent?

• a.Treating an unconscious adult who cannot answer questions
• b.A conscious, competent adult verbally agreeing to be treated✓
• c.Assuming a young child agrees without a parent present
• d.Starting care without asking during a true emergency

Expressed consent occurs when a competent, informed patient specifically agrees to care, verbally or otherwise. The patient must understand the nature of the treatment and its risks. Treating an unconscious adult, or acting at once in a true emergency, relies on implied consent, where the law presumes a reasonable person would agree. A young child generally cannot give consent at all; consent is sought from a parent or guardian, and care that cannot wait proceeds under implied consent.

Abandonment occurs when an EMT:

• a.Stops care of a patient without ensuring an equal or higher level of care takes over✓
• b.Documents a competent adult's informed refusal and then clears the scene
• c.Transfers care of the patient to a paramedic at the hospital door
• d.Contacts medical control for orders before giving a medication

Abandonment is terminating care without handing the patient to a provider of equal or higher training, or without an appropriate release, so proper transfer of care and documentation prevent abandonment claims. Documenting a competent adult's informed refusal ends the encounter lawfully, handing over to a paramedic or to hospital staff is a transfer to an equal or higher level of care, and contacting medical control is consultation, not termination.

During START triage, a patient with a respiratory rate over 30 per minute is tagged:

• a.Immediate (red)✓
• b.Delayed (yellow)
• c.Minor/green
• d.Deceased (black)

In START, a respiratory rate above 30 indicates a critical patient tagged Immediate (red). Respirations, perfusion, and mental status are the three assessments used to categorize patients.

During a mass-casualty incident run under a typical triage protocol, a patient tagged Immediate at initial triage is reassessed twenty minutes later and is now walking and talking normally. What should happen?

• a.The original tag stands until a physician changes it in hospital
• b.The patient is directed to the minor treatment area with the tag unchanged
• c.The patient is retriaged and the tag changed to the current category✓
• d.The patient is transported immediately in the order the first tag set

Triage is repeated as conditions change, and a patient's category is revised in either direction whenever reassessment shows a different status — that is exactly what secondary triage is for. Moving the patient to the minor treatment area while leaving the old tag in place is the closest wrong answer, because the destination is right, but an Immediate tag on a walking patient misinforms everyone downstream who reads it. A tag records a judgement at one moment rather than a permanent classification, and no physician's authorisation is needed to update it on scene. Transporting on an outdated tag sends scarce resources to the wrong patient, which is what triage exists to prevent.

How does a Good Samaritan law generally differ from an EMT's duty to act while on shift?

• a.It removes all liability from any provider who renders aid, on duty or off duty
• b.It offers limited protection to someone who volunteers aid without a duty to act✓
• c.It applies only to physicians and nurses, not to certified EMTs or paramedics
• d.It requires every certified provider to stop and render aid at any emergency scene

Good Samaritan statutes exist to encourage bystanders, including off-duty providers in many states, to help by limiting liability for care given in good faith and without compensation; they do not create an obligation to stop. The blanket-immunity answer is the tempting one, because these laws really are protective, but the protection is limited and none of them shields gross negligence or wilful misconduct. An on-duty EMT dispatched to a call has a duty to act, which is a separate legal concept, and coverage is not restricted to physicians and nurses. The details vary considerably between states.

A crew is asked to set up a landing zone for a medical helicopter at a rural crash. Which requirement is correct?

• a.An area directly beside the wreckage so that the transfer distance to the aircraft is as short as possible
• b.A paved surface only, because the rotor wash lifts dust and gravel from unpaved ground
• c.An area marked with road flares at each corner so the pilot can identify it from the air
• d.A level, firm area clear of wires, poles, and loose debris, sized as the flight crew specifies✓

The landing zone must be level, firm, and free of overhead wires, poles, trees and anything the rotor wash could pick up, and the flight crew specifies the dimensions they need for the aircraft they are flying. Marking the corners is genuinely part of setting up a zone, which is what makes the flare answer plausible, but open flame can be blown into the aircraft or ignite spilled fuel, so cones or secured lights are used instead. Dust and debris are managed by choosing and wetting the surface rather than by demanding pavement that rural scenes rarely offer, and the zone is kept well away from the wreckage.

Under the National EMS Scope of Practice Model, which capability is generally added at the AEMT level that an EMT does not have?

• a.Administering oral glucose to a conscious patient with suspected low blood sugar
• b.Inserting an oropharyngeal airway in an unresponsive patient with no gag reflex
• c.Establishing peripheral intravenous access and administering IV fluids✓
• d.Interpreting a cardiac rhythm and delivering manual defibrillation

Peripheral intravenous access, together with intravenous fluids and a small formulary of intravenous medications, is the capability the Advanced EMT level adds above the EMT. Oral glucose for a conscious patient and insertion of an oropharyngeal airway are both already inside the EMT scope. Interpreting a cardiac rhythm and defibrillating manually sits at the paramedic level; an EMT's defibrillation is done with an AED, which reads the rhythm itself. The national model is a template rather than a law, so the scope any individual provider actually holds is set by that provider's state and, within it, by the service's medical director.National EMS Scope of Practice Model

An EMT assists a patient with the patient's own prescribed nitroglycerin by following a written protocol, without contacting a physician first. What type of medical direction authorized this action?

• a.Offline medical direction, because the physician's authorization was issued in advance as a protocol✓
• b.Delegated practice, which lets an EMT give any medication a patient already has a prescription for
• c.Implied consent, because carrying the prescription shows the patient agreed to the medication
• d.Online medical direction, because the service's medical director personally signed that protocol document

Authorization granted ahead of time in the form of written protocols and standing orders is offline, or indirect, medical direction. Online direction means reaching a physician in real time by radio or phone for that specific patient; a physician's signature on a protocol is what makes the protocol valid, not what makes the direction online. An EMT does practice under delegated physician authority, but that delegation reaches only the medications and procedures the protocol names — a patient's own prescription does not enlarge it. Consent and medical direction are separate requirements that both have to be met: consent comes from the patient, the authority to act comes from the physician.

An ambulance responding with lights and siren reaches a red traffic light at a busy intersection. Under the standard of 'due regard' that state vehicle codes apply to emergency vehicle operators, what should the driver do?

• a.Cross at any speed while the lights and the siren are operating
• b.Proceed at the posted speed limit, holding the right of way
• c.Stop, then cross one lane at a time as each lane yields✓
• d.Cross without stopping, after slowing enough to react to cross traffic

Due regard means the driver stays personally responsible for the safety of everyone else, whatever exemption the traffic code grants. Lights and siren request the right of way, they do not confer it, and a driver who is not seen or not heard has no protection at all. State codes typically permit an emergency vehicle to pass a red signal only after slowing as necessary for safe operation, which makes 'slow, then cross' the tempting answer; emergency vehicle operator training goes further and teaches a full stop with the intersection cleared lane by lane, because a driver who merely slows cannot confirm that the far lanes have yielded, and the near lane stopping is exactly what hides the vehicle still coming in the far one. Intersection collisions are among the most common ways EMS crews and the patients they carry are injured, and the exemption is no defense once the crash has happened.

A helicopter is inbound to a rural crash scene. Which instruction about approaching the aircraft is correct?

• a.Approach from the rear of the aircraft, where the pilot has the clearest view of the ground crew
• b.Approach from the front, in the pilot's view, and only after the crew signals you in✓
• c.Approach as soon as the skids touch down so the transfer is not delayed by the shutdown sequence
• d.Approach from whichever side is uphill so the rotor disc stays well above head height

Ground crews approach a medical helicopter from the front, inside the pilot's field of view, and only after a crew member waves them in. The tail rotor is the lethal hazard and it is close to invisible when turning, so an approach from the rear is never correct. Waiting for the signal matters whether or not the rotors are still turning, because the crew, not the ground unit, decides when the aircraft is ready. Approaching uphill is exactly backwards: on sloping ground the rotor disc sits closest to the ground on the uphill side, so any approach on a slope is made from the downhill side.

EMS is staged at a hazardous materials incident. Where do EMTs without specialized hazmat training normally work, and what is their role?

• a.In the warm zone, where the decontamination corridor is set up and patients can be reached soonest
• b.In the hot zone with the entry team, so treatment begins at the point of exposure
• c.In the cold zone, receiving and treating patients only once they have been decontaminated✓
• d.In the cold zone, but stepping into the warm zone to help move patients who cannot walk out

EMTs without hazmat training and the matching protective equipment work in the cold zone and take patients only after decontamination, because a contaminated patient contaminates the crew, the ambulance and then the emergency department. The warm zone holds the decontamination corridor and is staffed by trained personnel in protective equipment; moving a non-ambulatory patient through that corridor is that team's job, and a good reason for entering is not a substitute for the training and the equipment, which is what makes stepping in 'just to help carry' the most tempting wrong answer here. The hot zone is limited to the entry team. Zone boundaries and the level of protection each requires are set by the hazmat branch under the incident commander.

An EMT arrives first at a single-vehicle crash and sees a diamond-shaped placard with a number on the trailer. What is the correct next step?

• a.Approach the cab closely enough to read the shipping papers, which name the exact material and quantity
• b.Move in immediately to reach the driver, since a short exposure keeps the risk low
• c.Stay well uphill and upwind, and look the placard number up in the Emergency Response Guidebook✓
• d.Read the placard's color and shape, which classify the hazard closely enough to act on

The placard is read from a distance, from uphill and upwind, and the identification number is looked up in the Emergency Response Guidebook, which gives the initial isolation and protective action distance for that material before anyone moves closer. Shipping papers do name the material more precisely, which is what makes that the strongest distractor, but they are carried in the cab within the driver's reach — inside the very area the guidebook exists to keep responders out of until the distance is known. The placard's color and shape give the hazard class only, not the material and not any distance. And an unknown material offers no safe exposure time, so a short exposure is not a low-risk one.

Under the Incident Command System, what does 'span of control' refer to?

• a.The number of people one supervisor can effectively direct, usually three to seven✓
• b.The list of agencies that have authority to assume command at a multi-jurisdiction incident
• c.The geographic area an incident commander is legally responsible for securing and managing
• d.The chain through which orders pass from the incident commander down to the crews

Span of control is a supervision ratio: one supervisor directs roughly three to seven subordinates, with five as the usual working figure, and once the incident grows past that the organization adds another layer of supervisors rather than stretching the ratio. The route orders travel, with each person reporting to exactly one supervisor, is the chain of command and unity of command — a closely related ICS principle and the reason that option is worth a second look, but it describes the direction of reporting rather than how many people report. The ground an incident covers is its perimeter, and which agency holds command at a multi-agency incident is settled through unified command.

During START triage, a patient who did not get up and walk to the collection area when directed is assessed and found to be breathing 24 times per minute, with a radial pulse present, and able to follow simple commands. How is this patient tagged?

• a.Immediate (red)
• b.Minor (green)
• c.Delayed (yellow)✓
• d.Expectant (black)

After the walking wounded have been directed away, START sorts each remaining patient on three checks: respirations, perfusion and mental status. Respirations of 24 are below the 30 per minute that would make this patient Immediate, a radial pulse is present, and the patient follows commands, so nothing triggers an upgrade and the tag is Delayed. Minor is assigned at the very first step to those who get up and walk to the collection area, which this patient did not do; following commands during an assessment is a mental status finding, not the ambulation test, and confusing the two is the usual error here. A respiratory rate that is merely above the normal adult range is not itself a START criterion. Expectant is used for a patient who is still not breathing after the airway has been opened. The four options are the four tag colors themselves, so they are near-identical in length by nature.

Which set of elements must all be present for a claim of negligence against an EMT to succeed?

• a.Breach of the standard of care, damages, and causation, with no separate duty to act required
• b.An error in care, a poor outcome, and a family willing to bring a lawsuit
• c.Duty to act, breach of that duty, damages, and causation linking the breach to the damages✓
• d.Abandonment of the patient, a documented injury, and no signed refusal form

Negligence requires four elements together: a duty to act, a breach of the standard of care, damages the patient actually suffered, and proximate causation tying the breach to those damages. The three-element version that drops the duty is the distractor worth thinking about, because breach, damages and causation are the elements people remember — but in most states an off-duty EMT who drives past a collision, with no relationship to the patient and no statute creating one, has no duty and therefore cannot be negligent for not stopping. The duty is what makes the remaining three actionable. A poor outcome with no breach is not negligence, and a breach that causes no harm is not either. Abandonment and refusal documentation are separate legal problems, not the elements of negligence.

A 15-year-old is injured at a skate park and no parent or guardian can be reached. Under the doctrine generally applied in this situation, how should the EMT proceed?

• a.Have the minor sign the treatment consent form, which makes the consent legally expressed
• b.Withhold all care until a parent arrives, because a minor cannot lawfully consent to treatment
• c.Treat the minor under implied consent, and document the attempts made to reach the guardian✓
• d.Ask an adult bystander to consent on the minor's behalf and record that person's name

When a minor has an emergency condition and a parent or guardian cannot be reached, the law generally presumes a reasonable parent would consent, so the EMT treats under implied consent and documents the attempts made to reach the guardian. Waiting for a parent while an emergency goes untreated is the outcome that doctrine exists to prevent. A bystander, however responsible, has no authority to consent for someone else's child, and a minor's signature does not create valid expressed consent where the minor cannot legally give it. The age of majority, the rules on emancipated and married minors, and the conditions a minor may consent to alone all vary by state, so the local protocol and state law govern the individual case.

A family presents a valid do-not-resuscitate order for a patient in cardiac arrest. What does a DNR order generally direct an EMT to do?

• a.Withhold resuscitation but continue oxygen, suctioning and comfort care✓
• b.Withhold all care, including oxygen, suctioning and any comfort measures
• c.Begin full resuscitation and leave the hospital to honor the order later
• d.Begin chest compressions but withhold ventilations and airway suctioning

A DNR order directs that resuscitation not be started. It is not an order to withhold care, so oxygen, suctioning, positioning, warmth and any pain relief inside the EMT's scope continue as comfort measures, and reading a DNR as 'do nothing' is the most common and most harmful misreading of it. No DNR form asks a crew to compress the chest while withholding ventilation; that combination is not a level any form offers. Deferring the decision to the hospital defeats the point of a prehospital order, which exists precisely so that resuscitation is not begun in the field. Which document a state recognizes out of hospital, and what a crew does when the form cannot be produced or the family objects at the bedside, is set by state law and local protocol, so the service's own policy governs.

An EMT realizes an hour after arriving at the hospital that a vital sign set was recorded on the wrong line of the patient care report. How should the correction be made?

• a.Erase or white out the incorrect entry and write the correct values over it so the record reads cleanly
• b.Leave the report alone and tell the receiving nurse verbally, because an amended report loses its legal weight
• c.Draw a single line through the error so it remains readable, add the correction, then date and initial it✓
• d.Complete a fresh report from memory and discard the original so only one version exists

The record is corrected by striking the error with a single line so the original entry stays readable, writing the correct information beside it, and dating and initialing the change; information remembered later is added the same way as a dated late entry. Erasing, whiting out or destroying the original all look like concealment and can cost the report its credibility if it is ever read in court, which is the opposite of the tidy record those options promise. Telling the nurse verbally is worth doing for the patient's sake, but it does not correct the permanent record. An amended record does not lose its legal weight; a record that appears altered does.

Which entry in a patient care report narrative is objective rather than subjective?

• a.Patient appeared intoxicated and was uncooperative throughout the assessment
• b.Patient was clearly anxious about the crash and seemed to be exaggerating the pain
• c.Skin cool and moist; radial pulse 118 and regular; respirations 22, unlabored✓
• d.The crash was probably caused by speeding, judging from what bystanders said

Measurements and direct observations are objective: skin that is cool and moist to the touch, a pulse counted at 118 and regular, and a respiratory rate counted at 22 without labored effort are findings any other provider at that bedside would record the same way. Intoxicated, uncooperative, exaggerating and probably speeding are all conclusions, and a reader cannot check any of them; they prejudice the care the patient is given next and they read badly if the report is ever produced in court. Record the findings that sit underneath the conclusion instead — the odor of alcohol on the breath, an unsteady gait, the patient's own words in quotation marks, or a bystander's statement attributed to that bystander.

An EMT lifts the head end of a loaded stretcher. Which technique reflects correct body mechanics?

• a.Bend at the waist and use the strong muscles of the lower back to raise the load smoothly
• b.Lift with the legs while twisting toward the ambulance so the load never has to be set down again
• c.Keep the back straight and locked, feet shoulder width apart, and the weight close to the body✓
• d.Extend the arms fully to lift the load away from the body and keep it clear of the shins

A safe lift keeps the back straight and locked in, the feet about shoulder width apart, and the load held as close to the body as possible, because the leverage on the spine grows with every inch the weight moves away from it. Lifting with the legs is right as far as it goes, but twisting while loaded is one of the most common mechanisms of back injury in EMS, so combining the two does not make the lift safe. Bending at the waist transfers the work from the legs to the lumbar spine, and extending the arms to keep the load off the shins buys clearance at the price of exactly the leverage a straight-back lift is trying to avoid.

A patient is found sitting in a car that is burning. Which category of move does this situation call for?

• a.A non-urgent move, because the patient is seated and can be extricated in a controlled way
• b.An emergency move, because the danger to the patient outweighs the risk of moving them✓
• c.An urgent move, because a seated patient is moved with a rapid extrication technique
• d.No move at all until the fire is knocked down, since moving a patient risks worsening any spinal injury

Fire, the threat of explosion, hazardous materials, and an inability to reach other patients are the classic reasons for an emergency move, in which the patient is dragged clear along the long axis of the body before assessment and spinal precautions are completed. The urgent move is the distractor that deserves real thought, because a seated patient often is moved by rapid extrication — but urgent moves are driven by the patient's own condition, such as altered mental status with inadequate breathing, when no external threat is forcing the timing. Here the hazard is the car. Waiting for the fire to be knocked down is only defensible when the scene itself is not what is about to kill the patient.

A combative patient has been physically restrained under local protocol. Which positioning practice is required to reduce the risk of positional asphyxia?

• a.Restrain the patient face down on the stretcher, which limits the patient's ability to strike out
• b.Sit the patient upright with the chest strapped tightly enough to stop the torso moving
• c.Restrain the patient face down with the wrists secured together behind the back for crew safety
• d.Never restrain the patient face down or hog-tied, and monitor the breathing continuously✓

A restrained patient is never left prone or hog-tied, and the breathing is monitored continuously from the moment the restraints go on. Prone positioning, wrists drawn behind the back, and a chest strapped tight enough to stop the torso moving all restrict the chest wall movement the patient needs to breathe — and a patient who has been fighting has just built an oxygen debt, which is what makes any restriction of chest movement so dangerous in exactly this group. Upright positioning is otherwise reasonable; it is the tightness across the chest that makes that option wrong. Restraint is applied only where local protocol and state law permit it, usually with law enforcement present, and the number of restraints, the position and the monitoring interval are all documented.

Which item normally appears in the verbal hand-off report given at the patient's bedside but is kept out of the shorter radio report given while en route?

• a.The patient's age and sex, which the hospital uses to assign a bed and a team
• b.The chief complaint, which tells the hospital what is being brought in
• c.The estimated time of arrival, which sets when the hospital must be ready
• d.The patient's name, which is not put out over an open radio channel✓

The radio report is kept short and identifies the patient only by age and sex, because radio traffic can be picked up by anyone with a scanner; the name is given face to face at the bedside instead. Age, sex, chief complaint, the significant findings, the treatment given and an estimated time of arrival are what the hospital needs in advance so the right team and the right room are ready, so all of those belong on the radio. The bedside hand-off then adds the name, any history obtained during transport, further vital signs, and the patient's response to what was done.

Which statement about releasing a patient's information under privacy rules is correct for an EMT?

• a.It may be given to any nurse or physician who asks for it, at any facility
• b.It may be shared with those involved in this patient's care and treatment✓
• c.It may be released to the patient's spouse or to a parent whenever they ask
• d.It may be discussed in public once the name and the home address are left out

Disclosure for treatment, payment and health care operations is permitted, which is what lets a crew hand a patient off to the receiving nurse without a separate authorization; disclosure beyond that generally needs the patient's written authorization or a specific legal exception such as a subpoena or a mandatory report. Holding a clinical license somewhere is not the same as being involved in this patient's care, which is why 'any nurse or physician' fails. A spouse or parent has no automatic right of access either — for a competent adult patient it is the patient who decides what family is told. And stripping the name does not make the case public property, because the address, the time and the type of crash can identify the patient to anyone who was there. HIPAA reaches EMS agencies that transmit health information electronically for billing, and state confidentiality law can be stricter still.45 CFR 164.506

EMS is called to a scene that turns out to be a homicide, and the patient is obviously deceased. Which action best preserves the scene?

• a.Cover the body with a sheet from the ambulance and turn off any lights left burning in the room
• b.Move the body to the ambulance so the family is not left looking at the deceased any longer
• c.Search the pockets and wallet for identification and a medical history to complete the report
• d.Use a single path in and out, disturb as little as possible, and document whatever you moved✓

Once a patient is obviously dead and law enforcement holds the scene, the crew limits itself to one route in and out, touches as little as possible, and writes down anything that was moved or changed while the patient was being assessed. Moving the body, searching belongings for identification, laying a sheet over the body and switching lights off all alter evidence, and the sheet in particular can transfer fibers onto the body. Sparing the family the sight of the deceased is a real motive, which is what makes that option tempting, but it is the investigator's decision, not the crew's. Nothing about scene preservation delays care where there is any chance the patient is still viable.

A crew member has been irritable, sleeping badly and withdrawing from colleagues since a pediatric call two weeks ago. What is the most appropriate response?

• a.Encourage the colleague to use the service's peer support or employee assistance program✓
• b.Reassure the colleague that the reaction will pass and that talking about the call would make it worse
• c.Report the colleague to the medical director so that fitness for duty is formally reviewed
• d.Move the colleague permanently onto administrative duties, away from any further pediatric calls

Sleep disturbance, irritability and withdrawal that persist for weeks after a difficult call are recognized stress reactions, and the appropriate step is to encourage the confidential help the service already provides — peer support, an employee assistance program, or a mental health professional. Telling a colleague that talking about it would make things worse discourages exactly the help-seeking that resolves most of these reactions. A fitness-for-duty referral is the strongest competing answer and may well be right later if the colleague's ability to work safely is genuinely in question, but as the opening move it turns a colleague's distress into a formal proceeding and teaches the rest of the crew not to disclose. A permanent reassignment does the same and pre-empts a decision the colleague has not been offered.

Which task is part of the post-run phase of an ambulance call rather than the en-route or at-scene phase?

• a.Cleaning and disinfecting the patient compartment, restocking supplies, and completing the report✓
• b.Fastening seat belts and reviewing which crew member will take the lead on patient care
• c.Confirming the dispatch address and the nature of the call with the communications center
• d.Notifying the receiving facility of the patient's condition and the estimated time of arrival en route

Cleaning and disinfecting the patient compartment, restocking what was used and completing the patient care report are post-run tasks, and the unit is not genuinely available again until they are done. Confirming the address with dispatch, fastening belts and settling who leads patient care all belong to the en-route phase, and notifying the receiving facility happens during transport. The post-run phase is the one crews cut short when calls are stacking up, which is how the next patient meets equipment the last patient used.

During the daily vehicle check an EMT finds the portable suction unit will not hold a vacuum. What is the correct action?

• a.Note the fault on the checklist and stay available, relying on the mounted onboard unit
• b.Retest the unit on the way to the first call, once the pump has warmed up
• c.Carry a spare set of rigid catheters as a workaround until the maintenance shop reopens
• d.Remove the unit from service, replace it, and document the fault before taking a call✓

A portable suction unit that will not hold a vacuum is taken out of service, replaced from stock, and the fault documented before the ambulance goes back on the queue. Leaning on the mounted onboard unit is the answer worth arguing about, and it is wrong for a practical reason: the portable is the one that goes to the patient — down the stairs, into the wreck, out to the curb — and state ambulance equipment lists generally require a working portable unit in addition to the mounted one, so a unit missing it is not properly equipped. Catheters generate no suction on their own. Retesting later means the failure is discovered beside a vomiting patient, and the daily check exists precisely so it is found in the bay instead.

An EMT is preparing to suction an unresponsive patient who is vomiting copiously. Which personal protective equipment is indicated?

• a.Gloves, eye protection, and a mask, because a splash of vomit is likely during suctioning✓
• b.Gloves alone, which are sufficient because vomit is not classed as a bloodborne hazard
• c.Gloves and a gown, with eye protection reserved for calls involving arterial bleeding
• d.A fit-tested respirator and gloves, because the airborne route is the concern when suctioning

Any task likely to generate a splash calls for gloves, eye protection and a mask, and suctioning an actively vomiting patient is the standard example; a gown is added when clothing is likely to be soaked through. It is true that vomit without visible blood falls outside the bloodborne pathogens rule, but standard precautions go further and treat all body fluids as potentially infectious rather than sorting them by type, so that reasoning does not get an EMT down to gloves alone. Eye protection is not reserved for arterial bleeding — the eye is a mucous membrane and any splash reaches it. A fit-tested respirator is selected for suspected airborne disease such as tuberculosis, which is a different route of exposure from a splash.

An EMS system reviews a sample of patient care reports each month against its own protocols and feeds the findings back to crews as training. What is this process called?

• a.Medical direction, the physician authority a service operates under
• b.Continuous quality improvement, often shortened to CQI✓
• c.Peer review privilege, a legal protection for the findings of a review
• d.Mandatory reporting, a statutory duty to notify a state agency

Measuring performance against the service's own standard and feeding the result back as education is continuous quality improvement, and the patient care report is the raw material it runs on. Medical direction is the physician authority the service operates under; the medical director usually sponsors and signs off the improvement program, which is why that answer attracts people, but the authority and the review process are two different things. Mandatory reporting is a narrow statutory duty to notify an agency of specific things such as suspected abuse or certain communicable diseases. Peer review privilege is a legal doctrine that in many states shields the findings of such a review from discovery in litigation — it describes protection given to the output, not the name of the activity.

An EMT arrives at a two-car crash on a divided highway at night. Which element of scene size-up is assessed first?

• a.Scene safety, including oncoming traffic, downed power lines, and the vehicle stability✓
• b.The mechanism of injury, which determines whether spinal motion restriction will be needed
• c.The nature of the illness reported by dispatch, which frames the assessment before arrival
• d.The number of patients, so that additional ambulances can be requested without delay

Standard precautions and scene safety come first in the size-up, because an EMT struck by traffic or contacting an energized conductor becomes a second patient and subtracts a rescuer at the same time. Counting patients and calling for resources is the next step and matters greatly at a two-car crash, but it is done from a position that is already safe. Mechanism of injury and nature of illness shape the assessment that follows once the scene can be entered. On a divided highway at night, scene safety means positioning the apparatus to shield the work area and putting on high-visibility outerwear before anyone steps out of the cab.