EMT-Basic Exam: Preparatory - Basics of Emergency Care

Suppose you respond to the scene of an automobile crash. The two cars involved in the crash appear to have crashed head-on. Several bystanders are on the scene, and shattered glass is on the road. A passenger in one of the vehicles has crawled out of the car and appears to be fine. She tells you that she believes the driver of the car, who is still inside the car, is seriously injured and needs immediate attention. You notice smoke coming from under the hood of the car.
As an EMT, you have many responsibilities—you need to assess the driver of the car as well as others in the vehicles who may be injured. You need to keep the bystanders safe and away from the glass and call for assistance. What do you do first?
As an EMT, your primary responsibility in an emergency is to protect yourself. This is especially difficult to do when others need your help. However, if you don’t take the necessary precautions, you may become injured and unable to help those in need. What should you do first in the scenario above? Call the fire department for assistance. The car with smoke coming from under its hood may be on fire. Next, you should try to move any bystanders away from the scene of the accident.

In some cases, EMT-Basics must have special training to extricate, or remove, a patient who is trapped in a motor vehicle or other dangerous situation. 

If you do not have the proper training to extricate the patient from the vehicle, it is important for you to wait for the fire department to arrive and secure the scene before you attempt to assess the trapped patient. Questions about the EMT-Basic’s primary responsibilities will be part of the EMT-Basic exam.

1. Personal Protection
EMT-Basics can protect themselves in several ways. One way is to avoid coming into contact with hazardous materials. Hazardous materials, such as high levels of carbon monoxide, should be dealt with by a hazmat team. You may remember from your training that a hot zone is an area containing hazardous materials. EMT-Basics should never go into a hot zone even if a patient has been decontaminated.
EMT-Basics should also be on the lookout for other life-threatening situations such as fires, potential explosions, and electricity, such as from downed power lines. They should not enter areas when such dangers are present. EMT-Basics should also be on the lookout for people who are upset or angry. EMT-Basics should not intervene in violent situations. Domestic disturbances are particularly dangerous and often escalate into violence. Police presence is necessary before treating patients in these situations. Some questions on the EMT-Basic exam may ask what an EMT-Basic should do to stay safe in a dangerous situation.

2. Body Substance Isolation (BSI)
Body substance isolation (BSI) precautions are designed to keep you from coming into contact with blood and bodily fluids. Because you can’t always tell if a patient is ill or has a contagious disease, it’s important for EMT-Basics to follow BSI precautions. Because this is so important, expect to answer test questions about BSI.
BSI precautions include washing hands, wearing gloves, and wearing eye protection, masks, and gowns, when appropriate. BSI precautions should be followed whenever an EMT-Basic responds to an incident and before coming into contact with a patient.
Hand washing is important in preventing the spread of infection and disease. Before you treat a patient and whenever you change your gloves, use a liquid disinfecting agent that doesn’t require water. After transporting a patient to a hospital, remove your gloves and wash your hands thoroughly. Also wash your wrists and forearms. Wash your hands for at least 10–15 seconds and then dry them with a disposable towel.
EMT-Basics should make a habit of wearing gloves at all times in the field to protect themselves from blood or bodily fluids. Most gloves are either vinyl or nitrile. EMTs today rarely wear latex gloves. Always remember to change your gloves when moving from one patient to another to prevent cross-contamination.
EMT-Basics should wear eye protection, masks, and gowns whenever there is a possibility that they’ll be splashed with blood or bodily fluids. This includes treating patients who are spurting blood or giving birth. EMT-Basics should also wear a mask when performing endotracheal intubation and when their patient may have an airborne infectious disease, such as tuberculosis.

3. Lifting and Carrying Patients
The job of an EMT-Basic is physically demanding. EMT-Basics routinely transport patients, which requires lifting and carrying them. Some test questions ask how you should move a patient without becoming injured. To avoid a lower-back injury, follow these guidelines when lifting a patient:
- Assess a patient’s weight before lifting and note whether you need assistance.
- Keep your back straight and use your legs and not your back. Don’t twist your torso. Bend slightly at the knees.
- Keep your feet shoulder-length apart and make sure you have traction under your feet. Keep your feet flat on the ground. Straddle the patient and distribute the weight to the balls of your feet.
- Use the power lift (squat lift) when lifting from the ground.
- Use the power grip. With this grip, your palm and fingers are in contact with the person or object being lifted, and your fingers are bent at the same angle.

EMT-Basics frequently carry patients from the scene to an ambulance. 
Follow these guidelines when carrying a patient:
- Use a wheeled stretcher whenever possible.
- When a patient must be carried on a stretcher or backboard, use as many emergency personnel as possible. A one-handed carry using more than two persons is safer than two EMT-Basics using a two-handed carry.
- Use a stair chair to carry a patient down stairs.

Tip: Before you take the EMT-Basic exam, carefully review these techniques: rapid extrication of a patient from a vehicle, direct ground lift, direct carry method, and the draw sheet method. Be sure to know which technique should be used with which type of injury. For example, the direct ground lift should only be used when a spinal injury is not suspected.
 

The following equipment is used to lift and transport patients:
- Wheeled stretcher—Used to transport patients from the scene to an ambulance.
- Portable stretcher—Used in places that are too small for a wheeled stretcher.
- Scoop stretcher—Used to lift a patient into a supine position onto a wheeled stretcher.
- Backboard—Used to immobilize a patient; long backboards immobilize the entire patient while short backboards are used to immobilize the patient’s spine as the patient is being extricated.
- Stair chair—Used to transport a patient down stairs; most have wheels used to roll the patient onto a stretcher once the patient is safely down the stairs.
- Basket stretcher—Used in rescues; ropes and lifting devices are easily attached.
- Flexible stretcher—Used to carry a patient from an upper floor from to a ground floor; should only be used when there is no suspected spinal injury.

4. Patient Positioning
The EMT-Basic exam often includes questions about patient positioning. The way in which a patient is positioned depends on his or her condition:
- Unresponsive patients are usually placed in the recovery position (on left side, left arm under head, bent left knee).
- Pediatric patients may be placed in a safety seat designed for an ambulance.
- Patients with a spinal injury must be immobilized.
- Patients in shock should be placed in Trendelenburg position (supine, legs bent at hip, with feet lifted 8–12 inches).
- Patients with chest pain are usually more comfortable sitting than lying down.

5. Medical Direction Physician
On the EMT-Basic exam, you’ll see references to medical direction, or medical control. This is a process by which physicians monitor and assist EMT-Basics in the field. There are two types of medical direction.
On-line medical direction involves direct communication between the EMT-Basic and the physician. Medical direction can offer advice about specific treatments. In some cases, EMT-Basics must receive authorization from medical direction before performing certain interventions. EMT-Basics will often contact medical direction via cellular phone or radio.
Physicians also assist EMT-Basics through indirect medical direction, or off-line medical control. This involves the ways in which physicians develop protocols for EMS systems and influence the education of EMT-Basics.
As an EMT-Basic, it’s important that you cultivate a good working relationship with medical direction. Medical direction is a valuable resource for EMT-Basics, so it’s important for you to treat the physician on call with respect and to always abide by his or her instructions.

Related Topics You Should Review:
- Reaching, pushing, and pulling
- Emergency moves