Lecture 1: EMS Systems, Workforce Safety and Wellness, and Medical, Legal, and Ethical Issues

An EMS system consists of a team of _____ that provide _____ and are governed by _____ laws.

Healthcare professionals; emergency care; state

Laws/bodies that govern EMS systems in California include _____ and _____.

Code of Regulations (CCR) Title 22; County EMS Agencies

California follows the _____ curriculum and uses the _____ as the certifying exam for EMTs.

Department of Transportation (DOT); NREMT

The integration of pre-hospital care with hospital/emergency department care ensures _____.

Continuity of care

To be certified as an EMT in California, you must pass a _____, the _____, and a _____; submit an application and fee to your _____, and renew your certification every _____.

EMT course; NREMT; background check; county; 2 years

To renew your EMT certification on time or within 6 months of your expiration date, you must complete _____ or a _____.

24 hours of CE; refresher course with skills validation exam

To renew your EMT certification within 6 to 12 months of your expiration date, you must complete _____ and a _____.

12 additional hours of CE; skills validation exam

To renew your EMT certification within 12 to 24 months of your expiration date, you must complete _____ with _____ and _____.

24 additional hours of CE; skills validation exam; retake the NREMT

What are the four licensure levels for emergency providers?

EMRs, EMTs, A-EMTs, and paramedics

EMRs, or _____, consist of _____, _____, _____, and similar personnel who can provide _____ and other immediate care before _____.

Emergency medical responders; law enforcement; firefighters; park rangers; BLS; EMT arrival

EMTs, or _____, have the knowledge and skills to provide _____, including using an _____, basic _____ adjuncts, and assisting patients with certain _____.

Emergency medical technicians; basic emergency care; automated external defibrillator (AED); airway; medications

T/F: Upon arrival, EMTs share responsibility for assessment, care, package, and transport of patients with EMRs.

False; EMTs assume full responsibility

AEMTs, or _____, can perform some advanced emergency care, including _____ therapy, advanced _____, and limited _____ administration.

Advanced emergency medical technicians; IV; airways; medication

Paramedics perform extensive emergency care, including _____, emergency _____, _____ monitoring, and other advanced assessments and treatments.

Endotracheal intubation; pharmacology; cardiac

Emergency medical services began in the early 20th century with _____.

Warfare

In the 1960s, domestic emergency care in the U.S. was lagging, with staffed emergency departments limited to _____ and prehospital care largely staffed by _____.

Large urban areas; civilians

In the 1960s, _____ provided the first recommendations for emergency medical training, federal guidelines, emergency care and transport, and staffed emergency departments.

"Accidental Death and Disability: The Neglected Disease of Modern Society"

The Highway Safety Act of 1966 helped create the _____.

National Highway Traffic Safety Administration (NHTSA)

In the 1970s, the DOT created the first _____ for EMTs.

National Standard Curriculum

In the 1970s, the American Academy of Orthopedic Surgeons (AAOS) created the first _____ for EMTs.

Textbook

The Emergency Medical Act of 1973 helped create _____ for EMS systems.

Funding

By the 1980s, EMTs were present in most states, with some _____ in training.

A-EMTs

In the 1990s, NHTSA's _____ helped standardize EMS education and levels of providers.

EMS Agenda for the Future

In the 2010s, NHTSA's _____ established the current national standard curriculum.

EMS Agenda 2050

On the federal level, EMTs are governed by an _____ that is _____ and includes the _____; relevant organizations include the _____and _____.

National EMS Scope of Practice Model; adaptable; National Standard Curriculum/NREMT; NHTSA; DOT

On the state level, _____ regulate EMS operations.

State laws

On the local level, the _____ provides oversight and support for EMTs.

Medical director

Medical directors must be a _____.

Physician

Medical directors are responsible for _____, which involves audits to find areas that need improvement.

Continuous quality improvement (CQI)

_____ control includes radio, telephone, and paramedics (PMs) contacting their base hospital for orders.

Online/direct

_____ controls include protocols and standing orders.

Offline/indirect

Protocols refer to the medical director determining the EMT's _____, while standing orders refer to how EMTs are _____ to render certain care.

Scope of practice; pre-authorized

EMTs in Los Angeles mostly rely on _____ control, meaning they do not need to _____.

Offline; consult medical direction before implementing standing orders

Mobile integrated healthcare refers to healthcare provided in the _____ by _____.

Community; paramedics

The roles and responsibilities of an EMT include _____ safety, evaluating a _____, performing patient _____, driving and maintaining a _____, providing proper _____, protecting patient _____, _____patients to an appropriate facility, and properly _____.

Personal; scene; assessment; vehicle; care; privacy; transporting; transferring care

Professional attributes of an EMT include making patient needs a priority without _____, maintaining a _____ appearance, performing with composure and confidence _____, treating patients and families with _____ and _____, treating patients _____ and without _____, being willing to _____, and respecting patient _____.

Unnecessarily endangering yourself; professional; under pressure; respect; compassion; equally; bias; serve others; confidentiality

Infectious disease refers to _____.

Disease caused by harmful organisms within the body

Communicable disease refers to _____.

Disease that can be spread from one person or species to another

Contagious disease refers to _____ disease that can be _____.

Infectious; spread from one person to another

What are the 5 main routes of disease transmission?

Direct, indirect, airborne, vector-borne, and food-borne

Direct transmission refers to diseases that are spread through _____ or are _____.

Physical contact; bloodborne

Bloodborne pathogens refer to _____.

Pathogenic microorganisms present in the blood that can cause disease

Diseases that are spread through direct transmission include _____ and _____.

Hepatitis B; HIV

Indirect transmission refers to diseases that are spread through _____.

Needle sticks

Airborne transmission refers to diseases that are spread through _____.

Sneezing/coughing

When dealing with diseases that involve airborne transmission, use an _____ and _____ and place a _____ or _____ on your patient.

N95; protective eyewear; surgical mask; non-rebreather

Vector-borne transmission refers to diseases that are spread through _____, _____, or _____.

Fleas; ticks; mosquitos

Food-borne transmission refers to diseases that are spread through _____.

Contaminated food

Standard precautions (SP)/body substance isolation (BSI) refers to the assumption that _____ and so you must _____.

All body substances have the potential to spread disease; keep a barrier between you and all body substances

The best way to reduce infection risk is _____.

Washing your hands

To wash your hands properly, use _____, water, rub your hands together for _____, rinse and dry your hands with a _____, then use it to _____.

Warm, soapy; 10-15 seconds; paper towel; turn off the faucet

T/F: Hand sanitizer is not a good alternative to handwashing.

False; waterless handwashing is OK if water is not available

The minimum PPE you should be wearing when working with patients is _____, which you must also _____.

Gloves; remove correctly

For PPE, use _____, _____, and _____ PRN, and always dispose of _____.

Eye protection; masks; gowns; sharps

Disinfection refers to _____.

Killing pathogenic agents with disinfecting chemicals

_____ are another way to reduce your infection risk.

Immunizations

What are the 4 diseases of special concern for EMTs?

HIV/AIDS, hepatitis, meningitis, and tuberculosis

T/F: There is currently no vaccine available for HIV/AIDS.

True

HIV is transmitted through _____, _____, or _____.

Blood; vaginal secretions; semen

HIV is not easily transmitted at work, but it may be transmitted through _____, with a _____ chance of developing disease after exposure.

Needle sticks; 0.3% to 0.4%

Hepatitis refers to the _____.

Inflammation of the liver

Hepatitis A is spread through _____ contamination.

Fecal-oral

T/F: There is a vaccine available for Hepatitis B.

True

Hepatitis B is spread through _____, _____, or _____, with a _____ chance of developing disease after exposure without vaccination.

Blood; sexual contact; needle sticks; 6% to 13%

The standout symptom for Hepatitis B is _____, with other symptoms including weakness, fatigue, fever, and weight loss.

Jaundice/yellow skin

T/F: Chronic carriers of Hepatitis B are no longer infectious.

False; blood and body fluids are infectious whether or not the patient is symptomatic

Meningitis refers to _____ that surround the _____.

Inflammation of the meninges; brain and spinal cord

Meningitis is caused by a _____ or _____ infection and can be transmitted through _____.

Viral; bacteria; direct contact with respiratory secretions

The symptoms of meningitis are generally very _____, including fever, chills, nausea, vomiting, and rash, as well as nuchal rigidity (_____), photophobia (_____), and phonophobia (_____).

Flu-like; stiff neck; sensitivity to light; sensitivity to sound

The correct PPE when working with a patient with meningitis is a _____, _____, and _____.

Surgical mask; gloves; eye protection

The definitive test for meningitis is a _____, with normal _____ appearing _____.

Lumbar puncture/spinal tap; cerebrospinal fluid; clear and water-like

Tuberculosis is a _____, _____respiratory infection spread through _____ and treated with _____.

Bacterial; lower; airborne droplets; antibiotics

Latent tuberculosis refers to disease that is not _____ nor _____.

Communicable; symptomatic

T/F: Latent tuberculosis generally progresses into active tuberculosis very quickly.

False; tuberculosis can be latent for a long time

It takes about _____ from exposure to symptom onset for tuberculosis.

2 to 12 weeks

_____ of positive skin tests for tuberculosis end up developing the disease.

5%

Symptoms of tuberculosis include _____, _____, and _____.

Respiratory distress; productive cough; bloody sputum

The PPE you must wear when working with a tuberculosis patient are a _____ for yourself and a _____ for your patient.

HEPA/N95 mask; surgical or oxygen mask

Your infection control routine should involve _____, cleaning the _____, disposing of _____, and removing _____.

Standard precaution; ambulance; medical waste; contaminated linen

Ryan White law dictates that you must _____ and _____ post-exposure to a harmful disease.

Notify your supervisor; get screened

If exposed to a patient's blood or bodily fluids, _____, clean the exposed area with _____ (and rinse your eyes for _____ if exposed), and activate _____.

Turn over patient care to another provide; soap and water; 20 minutes; infection control

Taking care of ourselves includes recognizing hazards like _____ neglect, _____ and _____ threats, and _____ and _____ stress.

Personal; environmental; human-made; mental; physical

Wellness has _____, _____, and _____dimensions; at home, wellness involves _____ and _____, while at work, wellness involves _____ and _____.

Mental; physical; social; diet; exercise; standard precautions; scene safety

When working as an EMT, you must maintain a _____ demeanor and manage your _____ in order to _____ patients, family, and bystanders.

Calm; emotions; calm

Even when you are under stress, focus on _____ safety, _____ safety, and patient _____.

Personal; scene; care

On a scene, _____ is your biggest priority.

Personal safety

Personal safety involves using your _____ when driving, using _____/PPE, _____ in a safe place, ensuring the scene is _____, and wearing _____ clothing if necessary.

Seatbelt; standard precautions; parking; well-lit; reflective

Never approach an object with _____ on a scene; try to read it from a distance.

Placards

Examples of scene hazards include _____, _____, _____, and _____.

Hazardous materials; electricity; violence; fire

Toxic gases can be _____ and _____, as is the case with _____.

Odorless; colorless; carbon monoxide

Violence on a scene can include _____, _____, _____, and _____.

Civil disturbances; large gatherings; domestic violence; crime scenes

Determinants of violence include _____, _____, _____, and _____.

Past history; posture; vocal activity; physical activity

When arriving on a crime scene, law enforcement must first _____ and _____.

Secure the scene; preserve evidence

T/F: EMTs are authorized to approach fires on a scene.

False

Death and dying may occur _____ or _____.

Suddenly; after prolonged illness

What are the 5 parts of the grieving process?

Denial, anger, bargaining, depression, and acceptance

Denial in the grieving process refers to _____.

Refusal to accept the death

Anger in the grieving process refers to _____.

Blaming others for the death

Bargaining in the grieving process refers to _____.

Promising to change

Depression in the grieving process refers to _____.

Open expression of grief