EMS Operations Study Guide for the EMT

Test
General Information
It is the overall operation of the emergency medical services (EMS) system to provide
emergency care and transport to the sick and injured. Within that system are a multitude of
procedural guidelines that contribute to lifesaving efforts, and each one has its role in delivering
exceptional results. Be sure you know all of the guidelines and understand how they function in a
well-run EMS system. You need to consult your textbook for complete details on all of the
following concepts.

EMS Systems
Emergency medical services are a system of response for the care of the sick and injured. An
EMS system includes many components, including personnel, training, and equipment to
report and respond to emergencies. The system includes ambulances, other first responders,
emergency dispatching, and medical oversight. The Americans with Disabilities Act (ADA)
provides provisions for EMTs with disabilities to pursue a career in EMS when possible.

Terms/Concepts to Know: Emergency Medical Services, certification, licensure, Americans with

Disabilities Act of 1990, National EMS Scope of Practice

Four Training and Licensure Levels

Most states typically follow national guidelines developed by the National Highway Traffic
Safety Administration (NHTSA) in the National EMS Scope of Practice Model. The latest model
went into effect in 2005 and made changes to the levels of certification and skills practiced.

Emergency Medical Responder

EMRs have very basic training and provide care prior to the arrival of EMTs. Training includes
familiarity with some EMT procedures and equipment, but not competency in those procedures
or in ambulance operations.

Emergency Medical Technician

EMTs are trained to provide basic life support (BLS) to ill and injured patients. This training
includes the use of airway adjuncts, automated external defibrillation, and assisting patients with
certain medications. EMT training is the foundation for the next levels of certification, and
EMTs are often considered the backbone of EMS systems. Training is typically 150 hours,
depending on the state. This is what you are training for.
Advanced Emergency Medical Technician

AEMT builds on the EMT training to include limited advanced life support (ALS) care such as
IV therapy, use of advanced airway adjuncts, and the administration of certain emergency
medications. Training is typically 200-400 hours.

Paramedic

Paramedic is the highest level of pre-hospital training. It includes comprehensive training in

basic and advanced life support knowledge and skills, including endotracheal intubation,
emergency pharmacology, and cardiac monitoring. Training ranges from 1,000 to 1,300 hours,
and it is becoming common for it to be included as part of a college degree.

Terms/Concepts to Know: Advanced Life Support (ALS), Automated External Defibrillator

(AED), Emergency Medical Responder (EMR), Emergency Medical Technician (EMT),
Advanced EMT (AEMT), Paramedic

History of EMS

In the past, civilian EMS was not organized and varied widely by location. It was commonly
provided by funeral homes, with minimal care beyond the ability to transport someone on a
stretcher. A few urban areas had better equipped ambulance services, but the focus was still on
transport. Modern EMS systems are considered to have had their start with the passage of federal
legislation in the 1960s and 70s that provided guidance and funding for development.

Terms/Concepts to Know: The White Paper, National Highway Transportation Safety

Administration (NHTSA), Highway Safety Act of 1966, EMS Agenda for the Future

Important Components of the EMS System

The EMS Agenda for the Future defines 14 components of EMS systems that interact with each
other. An EMS system cannot function without all of them, and it is important to understand and
know each of them.

Public Access

A system to request help is vital. In most areas, this is provided by dialing 9-1-1 and being
connected to an emergency communication center. Dispatchers can assess information and send
ambulances and other responders, and provide first aid and CPR instructions.

Communication Systems

Radio and other communication links are essential for sending resources. GPS can be used to
track the locations of responders. Wireless communications can be used to transmit important
information such as response maps and updated information to computers in the ambulance.
Clinical Care

EMTs are trained to use a variety of emergency equipment. Clinical care describes the various
pieces of equipment and when the equipment is indicated or contraindicated for use. Also,
familiarity with the primary service area, checking equipment, and being able to operate all the
features in the ambulance are necessary.

Human Resources

How people are recruited, compensated, and retained are important functions of human
resources. The goal is to create systems that attract and retain talented people. Interstate
mobility, career ladders, and protection of employee well-being are vital to achieving these
goals.

Medical Direction

Each EMS system has a set of protocols written by a physician who authorizes the care provided
by EMTs. These protocols constitute the EMT’s scope of practice. Modifications or further
treatments may be directed by online medical control. Training and continuing education
requirements are also determined by the medical director.

Legislation and Regulation

EMS systems are governed by individual state laws and regulations. State EMS offices
administer these laws and provide oversight, often with input from an advisory committee.
Locally, EMS systems have individual policies and procedures regarding daily operations.

Integration of Health Services

EMS care is only the start of the patient’s medical journey. The care started must be integrated
with the receiving hospitals to assure proper coordination. Many EMS systems have developed
special alert procedures for certain time-sensitive conditions, such as stroke and heart attacks.

Evaluation

Continuous quality improvement is a circular process of reviewing and improving the processes
of patient care and reducing error. Errors can be rule, knowledge, or skill-based and are
inevitable in systems run by humans. EMTs have an obligation to recognize and reduce errors.

Information Systems

Computer technology has become an integral part of EMS systems. Data can be used for a wide
variety of purposes, including staffing, equipment justification, and identifying training needs.
Federal data reporting provides a snapshot of EMS that can be used to improve planning.
System Finance

Regardless of the type of EMS system, funding is needed for continued operations. Funding may
come from many sources, including patient fees, taxes, donations, and grants. EMTs play a
critical role by properly documenting care and obtaining patient billing signatures.

Education Systems

Education systems are critical for producing EMS providers and offering continuing education.
Accreditation is common and some states require special certification for EMS educators.
EMTs have a professional duty to maintain knowledge and obtain the required continuing
education hours.

Prevention

EMS can be considered part of the public health system. The goal of public health is to prevent
health problems, which can then reduce the costs of healthcare. EMTs’ knowledge about the
causes of injury and illness in their community can be used for prevention efforts.

Public Education

EMTs can play important roles in educating the public about healthy behaviors and injury
prevention. CPR and first aid education of the public can minimize the effects of events when
they occur. Public education efforts also increase the standing of EMTs in the community.

Research

EMS treatments were often adopted from other healthcare providers. Evidence-based medicine is
now being used to guide EMS treatment. Good documentation may be vital to gathering research
information. Research must be read carefully to understand the results.

Terms/Concepts to Know: EMS Agenda for the Future, public safety access point, emergency
medical dispatch (EMD), primary service area (PSA), medical director, medical control, mobile
integrated healthcare (MIH), continuous quality improvement (CQI), National EMS Information
System (NEMSIS), public health, primary prevention, secondary prevention

Roles of the EMT

EMTs have many roles and responsibilities, from knowing their equipment to protecting patient
privacy under HIPAA. EMTs must also display professional attributes, including appearance,
integrity, empathy, and respect.

Terms/Concepts to Know: Health Insurance and Portability and Accountability Act (HIPAA)
EMS Operations Study Guide for the EMT
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Workforce Safety and Wellness
Health is defined as a complete state of physical, mental, and social well-being. Work as an EMT
presents many threats to the EMT’s health and wellness.

Health and Wellness

Health and wellness issues can be varied for an EMT. Learn positive stress management and
avoid negative management techniques such as substance abuse. Proper nutrition, exercise, and
sleep are also important, along with an appropriate work/family time balance.

Terms/Concepts to Know: stress responses

Infectious and Communicable Diseases

Caring for patients presents risks of contracting infections. Infectious disease is caused by
foreign organisms, such as bacteria and viruses. Communicable diseases are infectious
diseases that can be spread from person to person.

Risk Management

Infectious diseases have different routes of transmission. Risks of contracting infectious diseases
can be reduced or prevented by following standard precaution recommendations from the
CDC. This can include gloves, handwashing, and immunizations to build immunity.

Post-Exposure Management

If an exposure occurs, it is critical to follow timely reporting of the incident. Clean the area of
exposure and activate your department’s exposure control plan. This will include filling out an
exposure control report and screening to determine what actions may be necessary.

Terms/Concepts to Know: infectious disease, communicable disease, pathogen, contamination,

exposure, transmission, direct contact, bloodborne pathogen, human immunodeficiency virus
(HIV), indirect contact, airborne transmission, foodborne transmission, vector-borne
transmission, Occupational Safety and Health Administration (OSHA), Centers for Disease
Control (CDC), infection control, designated infection control officer, immune, hosts
Scene Safety

Scene safety must always be a priority during all phases of a call. Numerous dangers can be
encountered, including hazardous materials, fire, and traffic hazards when operating on a
roadway. Awareness of potential hazards at all times can reduce the risks.

Terms/Concepts to Know: hazardous materials, safety placards, Emergency Response Guidebook

(ERG)

Protective Clothing

Wear protective clothing appropriate for the potential hazard. Possibilities include gloves, cold
weather gear, turnout gear, and helmets. Hearing and eye protection can also be important, as
well as body armor. Be aware of the possibility of long hair and jewelry becoming caught in
machinery.

Terms/Concepts to Know: personal protective equipment (PPE), high visibility vests, turnout
gear

Dealing with the Critically Ill

Critically ill patients are under a high degree of stress and may have many responses, including
anxiety, hostility, or depression. The EMT must anticipate these reactions and deal with all
patients with dignity and honesty. Patients will initially care more about respect than medical
treatment.

Dealing with Death and Dying

Death will be encountered by the EMT. The grieving process can elicit anticipated responses of
denial, anger, bargaining, depression, and acceptance. There is no right response to death, and
the EMT should focus on sincere communication that acknowledges feelings, without
judgement.

Terms/Concepts to Know: grief response

On-the-Job Stress

High stress is a part of the environment of EMS. Recognizing and understanding stress can help
prevent negative influences. The body has responses to stress that can be anticipated. Stressful
situations can lead to post-traumatic stress disorder (PTSD).

Terms/Concepts to Know: general adaptation syndrome, acute stress reaction, delayed stress
reaction, cumulative stress reaction, post-traumatic stress disorder (PTSD), critical incident stress
management (CISM), cover, concealment
Other Issues in the Workplace

Cultural diversity is increasing across society and will be encountered in EMS. Sexual
harassment and substance abuse can also be issues in the workplace. Companies need to have
illness and injury programs in place, and everyone needs to be aware of suicide prevention
practices.

Terms/Concepts to Know: cultural diversity, sexual harassment

Medical, Legal, and Ethical Issues

Providing EMS involves understanding and applying many medical, legal, and ethical issues.
EMTs need to understand consent, patient autonomy, legal obligations, and ethics.

Consent

Consent is required from all patients and competent patients have the right to refuse care.
Expressed consent from the patient is ideal, but special circumstances such as implied consent
when a patient is unconscious or when dealing with minors are common. Involuntary consent
may involve forcible restraint on a person who is mentally incapable of providing expressed
consent.

Terms/Concepts to Know: consent, decision-making capacity, patient autonomy, expressed

consent, informed consent, implied consent, emergency doctrine, medicolegal, emancipated
minors, in loco parentis, forcible restraint

Patient Rights

Patients have a right to confidentiality of medical care. HIPAA protects, by law, a patient’s
protected health information from disclosure. Advanced directives specify a patient’s healthcare
wishes when they are no longer able to do so themselves. These include such documents as a
living will or a DNR order.

Physical Signs of Death

Physical signs of death can be categorized as presumptive and definitive signs. Except in
special circumstances, resuscitation should be withheld from patients with definitive signs of
death. A medical examiner will often become involved in cases of death outside of a hospital.

Terms/Concepts to Know: presumptive signs, definitive signs, dependent lividity, rigor mortis,
putrefaction
Special Situations

Some patients may have consented to organ donation. In some areas, donation of organs or
tissue can still occur after death and EMTs should be familiar with practices in their area.
Patients may have medical ID-type bracelets with important medical information.

Giving Care

EMTs must operate within their scope of practice. Standards of care are determined by laws,
institutional standards, published textbooks, and professional organizations. Duty to act is an
EMT’s obligation to provide patient care and is defined by law and departmental policy.

Terms/Concepts to Know: standard of care, emergency, duty to act

Extreme Situations

Failure to conform to accepted standards of care or outside of the EMT’s scope of practice is
negligence. Patient care must be continued until transferred to another provider and care cannot
be forced on competent patients. Inappropriate or false disclosure can result in defamation.

Terms/Concepts to Know: negligence, proximate causation, res ipsa loquitur, negligence per se,
torts, abandonment, assault, battery, kidnapping, false imprisonment, defamation, libel, slander

Good Samaritan Laws

All states have passed Good Samaritan laws that provide at least some degree of legal
protection to EMS providers who render aid within the scope of their training. Some states also
have expanded EMS laws to provide immunity except in cases of gross negligence or willful
misconduct.

Terms/Concepts to Know: Good Samaritan laws, gross negligence, immunity

Legal Considerations

Accurate written records should be maintained about all patient contacts for possible future court
appearances or legal proceedings. Reporting cases of abuse or neglect is typically required by
EMTs. All patient care should be conducted in an ethical manner.

Terms/Concepts to Know: mandated reporting, ethics, morality, bioethics, applied ethics, statute
of limitations, governmental immunity, discovery, depositions, compensatory damages, punitive
damages
EMS Operations Study Guide for the EMT
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Communications and Documentation
Transferring information about a patient is necessary for care. This takes place both in person or
verbally over a radio or phone, and also in written documentation records.

Therapeutic Communication

Communication with a patient is both verbal and nonverbal. Providers need to establish a
rapport with patients and adjust their communications for cultural, age, and language abilities of
the patient. Oral reports to other healthcare providers are used to transfer responsibility of care.

Terms/Concepts to Know: therapeutic communication, cultural imposition, open-ended

questions, closed-ended questions, rapport

Written Communication

Patient contacts require written documentation, and different forms often exist based on the
outcome of the contact. This can include transports, refusals of care, and special situations, such
as a multi-casualty event. Errors should also be honestly recorded along with corrective actions.

Terms/Concepts to Know: patient care report (PCR), refusal of care

Communications Systems and Equipment

EMS systems rely on radio systems for communicating with dispatch centers and hospitals.
Many types of radio systems exist, and they may also be enhanced with cellular and telemetry
communications for contacting medical control at hospitals. All types of radio systems need to
be maintained.

Terms/Concepts to Know: base station, channels, very high frequency (VHF), ultra high
frequency (UHF), repeater, telemetry, simplex, duplex, multiplex, MED Channels, trunking,
interoperable communications, mobile data terminal (MDT), Federal Communications
Commission (FCC), paging, standing orders

Patient Assessment
Patient assessment is the foundation of all EMT care. It can be divided into five major parts:
scene size-up, primary assessment, history, secondary assessment, and reassessment.

Scene Size-Up

This begins with the information provided by dispatch and continues with initial assessment
upon arrival. Scene safety and identification of additional resources needed are important
components. Situational awareness for changing conditions must be maintained at all times.

Terms/Concepts to Know: scene size-up, situational awareness

Primary Assessment

The primary assessment is the beginning of the patient assessment. It is similar to the scene size-
up, with a goal of gaining an overall impression of how the patient is doing and the severity of
their injuries/illness. The goal is to identify immediate or imminent life threats that require
immediate intervention.

Terms/Concepts to Know: symptom, sign, primary assessment, vital signs, general impression,
perfusion, AVPU scale, responsiveness, orientation, altered mental status, spontaneous
respirations, life threats, shallow respirations, retractions, distracting injuries, accessory muscles,
nasal flaring, dyspnea, tripod position, sniffing position, labored breathing, pulse, palpate,
cyanosis, jaundice, sclera, diaphoretic, capillary refill, hypothermia, frostbite, vasoconstriction,
coagulate, DCAP-BTLS, crepitus, Golden Hour

History Taking

The history of the current event and the patient’s past medical history can be crucial to
determining the proper course of care. The history determines what event triggered the call for
help and is often gathered concurrently with the primary assessment.

Terms/Concepts to Know: OPQRST, pertinent negatives, SAMPLE history, synthesizing, chief

complaint

Secondary Assessment

The secondary assessment is a systematic, detailed examination of the patient. It is often

focused on certain body systems as determined by the chief complaint or injury. In critical
patients, it may be done en route to the hospital and may never be completed if the injury is life-
threatening and requires more immediate attention.

Terms/Concepts to Know: secondary assessment, auscultate, focused assessment, stridor, breath

sounds, tidal volume, wheezing, crackles, rales, rhonchi, tachycardia, bradycardia, blood
pressure, systolic pressure, diastolic pressure, hypotension, hypertension, PEARRL,
subcutaneous emphysema, paradoxical motion, guarding, pulse oximetry, metabolism, carbon
dioxide, capnography

Reassessment

This is performed at regular intervals during patient care and sometimes may even occur before
the secondary assessment is complete, to see if the primary assessment findings have changed.
The main purpose is to check for improvement or deterioration of the patient.

Terms/Concepts to Know: reassessment intervals of a stable patient, reassessment intervals of an

unstable patient

Lifting and Moving Patients

Lifting and moving patients is an integral part of EMS operations. Many different devices exist
for safe patient movement and for lifting and moving in special situations.

Wheeled Ambulance Stretcher

The wheeled stretcher is the most basic piece of ambulance devices and is used for practically
every transport. Most commonly referred to as a gurney, it can typically adjust to different
heights to facilitate movement and has safety belts for securing the patient. It also has other
specific features to ease movement through tight spaces and around corners.

Terms/Concepts to Know: wheeled ambulance stretcher

Backboards

The backboard is a rigid, flat, rectangular device traditionally used to immobilize patients with
potential spinal injuries. It has places for straps to secure the patient and handholds for lifting.
Backboards are commonly used for moving patients out of awkward places.

Terms/Concepts to Know: backboard, spine board, long backboard

Moving and Positioning the Patient

This includes techniques to reduce provider injuries or dropping of the patient. Patient
movement should also be done so that conditions aren’t worsened and the patient is comfortable.

Body Mechanics
Body mechanics pertain to the relationships between lifting forces and the structures of the
body. Lifting techniques should be done in a manner that involves proper mechanics that reduce
the chance of injury.

Terms/Concepts to Know: body mechanics, power lift, power grip

Safe Reaching and Pulling

Reaching and pulling during patient movement is common and an easy source of injuries. Proper
techniques should be practiced to reduce the risk of injury.

Safe Lifting and Carrying

Moving a patient can provide many opportunities for EMT injury. It is important to know and
use the proper techniques. They will not totally prevent all injuries to the EMT, but will greatly
reduce the incidence of such injury.

Terms/Concepts to Know: diamond carry, stair chair

Directions and Commands

It is important that patient movements be coordinated among team members with clear
commands for execution. Complicated moves may require pre-planning prior to execution.

Emergency and Urgent Moves

At times it may be necessary to move patients quickly using rapid extrication techniques. This
can occur due to scene dangers or imminent risk to the patient.

Terms/Concepts to Know: emergency move, rapid extrication technique

Nonurgent Moves

Patients will need to be moved from various positions in order to provide care and transport.
Moves need to be planned among all first responders to assure safety of the team and the patient.

Terms/Concepts to Know: direct ground lift, extremity lift, draw sheet

Geriatrics and Bariatrics

Geriatric patients can present special movement challenges because of their fragility, which
makes them susceptible to further injury. Bariatric, or obese, patients present issues concerning
having enough resources to safely move them.
Terms/Concepts to Know: bariatrics, scoop stretcher

Other Equipment

Ambulances are equipped with many different devices for moving patients in specialized
situations. This can include bariatric cots to accommodate the weight and girth, and basket
stretchers for rescue situations.

Terms/Concepts to Know: portable stretcher, bariatric stretcher, flexible stretcher, short

backboard, Kendrick Extrication Device (KED), vacuum mattress, basket stretcher, neonatal
isolette, powered cot

Medical Restraints

It can be necessary to place a patient in restraints when the patient is in danger of self-harm or
injury to the first responders and is incompetent to refuse care. The safety of the patient and
staff is a priority.

Terms/Concepts to Know: restraints, asphyxia

Personnel Considerations

EMTs always need to be aware of the dangers of lifting. They should ensure that the lift can be
completed safely and ask for help when necessary.

Terms/Concepts to Know: safe lifting capacity

EMS Operations Study Guide for the EMT

Test
Transport Operations
Ambulances have evolved since the first horse-drawn ambulances in the 1800s. There are many
unique aspects of operating an ambulance that need to be understood.

Vehicle Design
Ambulances are vehicles designed for treating and transporting patients. They include a
driver’s compartment, a patient compartment, warning systems, and communication systems.
Increasing the amount of technology for communication and navigation can distract the driver
from safe operations.

Terms/Concepts to Know: ambulance, first-responder vehicles, Star of Life, NFPA 1917

Standard for Automotive Ambulances, Type I, II, III ambulance

Phases of a Call

An ambulance call is considered to have nine distinct phases, starting at preparation and ending
with post-run cleaning and completion of paperwork. The nine phases involve the ambulance, as
a vehicle, and the crew that will be using it.

Preparation

An ambulance is a large piece of equipment, stocked with hundreds of pieces of equipment and
supplies. The vehicle should be inspected daily to assure it is mechanically ready to be operated
and that all supplies are present and equipment is in functioning order prior to a call.

Dispatch

Dispatch may be operated by the local EMS or shared with other agencies. It must be
accessible 24 hours a day and staffed with trained personnel. Basic information regarding
location of the call, the nature of the emergency, and the number of patients needs to be gathered
and relayed to responders.

En Route

During the en route phase, the crew faces the danger of a crash and seat belts should always be
worn. Information known about the call should be reviewed and clarified with dispatch as
necessary. Roles and responsibilities of team members can be clarified prior to scene arrival.

Arrival at Scene

This is when initial scene-size up will occur to identify hazards, assess scene safety, and assess
the need for more resources. The vehicle needs to be parked in a safe manner while considering
patient access and traffic considerations along with the ability to egress safely for the transport
phase.

Transfer of Patient

Transfer of the patient from where they are found to the ambulance can require specialized
equipment. Ultimately, the patient needs to be safely secured to the stretcher in the ambulance.
When to begin transfer can be a dynamic process, requiring interaction between assessment and
treatment.
Transport

Dispatch needs to be informed of the intended destination and what time transport begins. A
patient report needs to be given to the receiving hospital and the patient needs to be reassessed as
needed. Transport needs to be done efficiently, but without undue risk of emergency transport,
unless warranted.

Delivery

Again, dispatch needs to be informed upon arrival at the receiving facility. The patient needs to
be brought inside and physically transferred to the hospital bed. A verbal report and transfer of
care to hospital personnel is necessary. Charting can then be completed, as well as cleaning of
the ambulance.

En Route to Station

Dispatch may be informed of your status upon leaving the hospital and, depending on local
protocol, when arriving at the station or post. Refuel as necessary and obtain food if it is a long
shift.

Postrun

The postrun phase includes completion of anything necessary to return the ambulance to its pre-
run status. Paperwork should be completed and filed. Any equipment or ambulance
maintenance issues should be resolved or reported, as necessary.

Terms/Concepts to Know: decontaminated, CPR board, jump kit, cleaning, disinfection, high-
level disinfection, sterilization

Defensive Driving

Ambulances must be operated following common defensive driving techniques. Exemptions

from normal traffic laws are allowed in emergency mode, but the liability still exists.
Ambulances are large vehicles with their own handling characteristics. Transport with lights and
siren is usually unnecessary.

Terms/Concepts to Know: blind spots, driver characteristics, cushion of safety, excessive speed,
siren syndrome, hydroplaning

Air Operations

Fixed-wing and helicopter aircraft are used as ambulances. Helicopters can be called directly to
scenes; the decision to do so must be based on patient condition and transport considerations.
Once called, a landing zone will need to be secured and safety around the helicopter ensured.

Terms/Concepts to Know: air ambulances, medevac

A Team Approach
Modern healthcare is based on a team approach. Care will be transferred to other members of the
broader healthcare team. Effective communication and collaboration are essential.

Team Types

Different types of teams can exist. They can include regular teams, temporary teams, and
speciality teams, such as for special events. Teams are typically multidisciplinary and need to
focus on a common goal.

Terms/Concepts to Know: continuum of care, community paramedicine, mobile integrated

healthcare (MIH)

Group Versus Team

A group is made up of individual healthcare providers who all are working to take care of a
patient, but typically do so independently. A modern approach to healthcare consists of a team of
healthcare providers who are interdependent on each other and have clear roles.

Terms/Concepts to Know: groups, teams, team leader

Types of Groups

Different types of groups can exist. Common types can include dependent groups which rely on
one leader for direction. In independent groups, each member has an area of responsibility, and
interdependent groups represent true teams. Groups can also be organized according to the
Incident Command System (ICS).

Terms/Concepts to Know: dependent group, independent group, interdependent group

Team Performance

Effective teams have a shared goal, with clear roles and responsibilities. The team leader
monitors and facilitates team performance, and all team members are encouraged to provide
input and speak up if they recognize a problem.

Terms/Concepts to Know: crew resource management

Transferring Patient Care

Transfers of care present a point for critical errors to occur. Transfers should be minimized and
conducted in a standardized format to ensure proper transfer of care. Critical information needs
to be passed on to the next team member and responsibilities clearly transferred.
Terms/Concepts to Know: minimal interference, uninterrupted critical care, common priorities,
common terminology

ALS and BLS Care

Basic Life Support (BLS) and Advanced Life Support (ALS) care exist together, and often BLS
care continues as part of the addition of ALS care. In some states, BLS care may be blended with
some ALS procedures. EMTs may still need to assist with ALS skills, such as vascular access
and advanced airways.

Terms/Concepts to Know: endotracheal intubation, oxygenation, preoxygenation, apneic

oxygenation, direct laryngoscopy, video laryngoscopy, gum elastic bougie, esophageal
intubation, vascular access, saline locks

Team Conflict Troubleshooting

While effective teams have minimized conflicts, conflict will still occur. When conflict occurs,
the patient must always come first. Other troubleshooting techniques can include keeping calm,
waiting until after the incident to address, focusing on the behavior, and choosing your battles.

EMS Operations Study Guide for the EMT

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Incident Management
Large-scale incidents and disasters can be very challenging to manage. They require the use of
Incident Command and the National Incident Management System to resolve effectively.

National Incident Management System (NIMS)

Principles of NIMS include interoperability, flexibility, and standardization. It is a framework for

government, private and nongovernmental organizations to work together. It has five principles:
preparedness, communications, resources, command, and maintenance.

Terms/Concepts to Know: mass-casualty incident (MCI), mutual aid response, National Incident
Management System (NIMS)
Incident Command System (ICS)

The incident command system is a structure for managing actual incidents. It is built around a
modular organization with a manageable span of control and clear lines of authority with
common terminology. It includes logistics, finance, planning, and operations under one
command.

Terms/Concepts to Know: incident command system (ICS), freelancing, span of control,

command, incident commander (IC), unified command system, single command system,
command post, termination of command, demobilization, finance, logistics, operations, planning,
incident action plan, safety officer, public information officer (PIO), joint information center
(JIC), liaison officer

EMS Response within the ICS

Planning is an important component of preparedness. EMS organizations should have disaster

plans based on likely hazards and mutual aid agreements with neighboring organizations. Staff
should have basic incident command training, and interagency training in simulated responses.

Terms/Concepts to Know: open incident, closed incident

The Medical Branch of the ICS

Incident command includes a branch specifically for the medical component. Major areas of
the medical branch include triage, treatment, transportation, and staging. Other special
components may be added such as rescue, special extrication, or morgue.

Terms/Concepts to Know: triage supervisor, treatment supervisor, treatment area, transportation

area, transportation supervisor, staging supervisor, extrication supervisor, rescue supervisor,
morgue supervisor

Mass-Casualty Incidents

Traditionally, a mass-casualty incident (MCI) has been defined as an emergency with three or
more patients, or one that stresses the EMS system’s typical capabilities. An MCI can also
include a situation with the imminent potential to become an MCI. When an MCI occurs, crews
should initiate triage and the command system.

Terms/Concepts to Know: mass-casualty incident (MCI)

Triage

The goal of triage is to sort patients into categories by injury severity and try and do the most
good for the most patients. Triage tags are usually used to quickly sort injured into red, yellow,
green, and black to aid in organizing their movement to the appropriate treatment area.

Terms/Concepts to Know: triage, primary triage, secondary triage, START triage, JumpStart
triage, triage categories, triage tags, disaster, casualty collection point

Hazardous Materials

Hazardous materials incidents can be very unsafe. The EMT needs to recognize the incident and
request additional resources from resource lists. Transport vessels are marked by DOT placards
marking system. Control zones need to be established for incident management.

Terms/Concepts to Know: hazardous material, hazardous material (HazMat) incident, container,

bulk storage container, secondary containment, intermodal tanks, non-bulk storage vessels,
drums, placards, safety data sheet (SDS), bill of lading, Chemical Transportation Emergency
Center (CHEMTREC), hot zone, warm zone, cold zone, decontamination area, toxicity

Vehicle Extrication and Special Rescue

EMTs are not usually responsible for special rescue without extra training. Extrication typically
occurs around the EMT and patient and requires constant communication to be done safely.

Safety

The need to focus on safety during rescues and extrication cannot be overstressed. It requires a
mindset focused on safety and proper protective gear depending on the hazards present. It
could include helmets, high visibility clothing, turnout gear, and protective gloves.

Vehicle Safety Systems

Modern vehicles have a variety of safety systems that can pose hazards to rescuers after a
crash. This includes shock-absorbing bumpers that can suddenly release, hitting rescuers.
Undeployed airbags can spontaneously deploy and require extra caution.

Terms/Concepts to Know: shock-absorbing bumpers, airbags, side-impact airbags

Extrication Fundamentals

Vehicle extrication is complex and dangerous. The EMT’s main role is to operate safely and
stabilize and package the patient. There are 10 phases, including hazard control, access,
removal, and transfer. Good communication and clear roles among all team members is critical.

Terms/Concepts to Know: extrication, entrapment, access, hazard control, simple access,

complex access

Special Situations

Many kinds of special rescue situations exist requiring unique skills. Technical rescue can
include water rescue, building collapses, fires, search and rescue, and SWAT situations. Special
situations can present unique hazards and communication and safety are paramount.

Terms/Concepts to Know: technical rescue situation, specialized weapons and tactics team
(SWAT), tactical situation, structure fire, self-contained breathing apparatus (SCBA)

Terrorism and Disaster Response and Management

Terrorism is an ongoing threat that can happen anywhere. Terrorists have increased their
targeting of civilians, and EMTs need to be prepared for such incidents.

Terrorism Facts

Terrorism refers to a violent act, typically against civilian targets, intended to instill fear.
Terrorists can single out individuals or organized groups and have domestic or international
agendas. Recent terrorism events in the US have included the Boston Marathon bombing and a
number of mass shootings.

Terms/Concepts to Know: international terrorism, domestic terrorism

Weapons of Mass Destruction

Weapons of mass destruction (WMDs) are intended to bring about a large number of
casualties. WMDs can be biological, nuclear, incendiary, chemical, or explosive weapons.
While terrorists have used all of the previous types except nuclear, they have favored explosives.
Terms/Concepts to Know: weapon of mass destruction (WMD), weapon of mass casualty
(WMC), B-NICE, weaponization, state-sponsored terrorism, dirty bomb

The EMT Response

The type and nature of the weapon will affect the appropriate EMT response to a WMD incident.
Be familiar with the various approaches that might be needed in different situations.

Terms/Concepts to Know: covert, secondary device, cross-contamination

Chemical Agents

Chemical agents are gases and liquids that can be dispersed in the air to kill and injure. They
include vesicants, choking agents, nerve agents, and cyanides. Treatment is usually based on
symptoms, though a few, such as cyanide and nerve agents, have antidotes.

Terms/Concepts to Know: persistency, volatility, route of exposure, vapor hazard, contact hazard,
vesicants, sulfur mustard (H), mutagen, lewisite (L), phosgene oxime (CX), chlorine (Cl),
phosgene, nerve agents, LD50, off-gassing, nerve-agent aging, DuoDote auto-injectors,
Cyanides, SLUDGEM, miosis

Biologic Agents

Biologic agents have been used by terrorists, most recently anthrax powder in the US mail.
Biologic agents include bacteria, viruses, and neurotoxins. They can be disseminated via
multiple routes and the incubation period and initial similarity to routine illnesses make them
hard to detect.

Terms/Concepts to Know: dissemination, disease vector, contagious, incubation, virus, bacteria,

smallpox, viral hemorrhagic fevers (VHF), anthrax, bubonic plague, lymphatic system, buboes,
pneumonic plague, neurotoxins, botulinum, ricin, syndromic surveillance, points of distribution
(PODS)

Radiologic/Nuclear Devices

Radiation is energy emitted by radioactive decay. The energy is emitted in the form of alpha,
beta, gamma, and neutron radiation. Each type has a different penetration potential. Shielding,
exposure time, and distance from the source are important protective factors.
Terms/Concepts to Know: radioactive material, ionizing radiation, decay, alpha, beta, gamma (x-
ray), neutron radiation, radiological dispersal device (RDD), Special Atomic Demolition
Munitions (SADM), exposure time, distance, shielding

Incendiary and Explosive Devices

Incendiary devices cause fires and explosive use explosive energy to cause damage and injury.
They have been the most common type of terrorist device, and can come in various sizes, from
small backpack bombs to truck bombs. Secondary devices are always a concern to the EMT.

Terms/Concepts to Know: improvised explosive device (IED), primary, secondary, tertiary, and
quaternary blast injuries, pulmonary blast injury