EMT WAPS study material

EMT 12th Edition – Chapter 8

Lifting and Moving Patients
(Emergency Care and Transportation of the Sick and Injured, 12th Edition)

I. Introduction to Lifting and Moving Patients

  • Lifting and moving patients is one of the most physically demanding tasks for EMTs.

  • Improper lifting is a leading cause of career-ending back and musculoskeletal injuries.

  • The goal is to move patients safely, efficiently, and with minimal risk.

  • EMTs must balance scene safety, patient condition, and urgency before moving a patient.

  • Not every patient needs to be moved immediately—movement should be clinically justified.

II. Principles of Lifting and Moving

  • Always perform a scene size-up before moving a patient.

  • Determine why the patient needs to be moved:

    • To remove from danger

    • To provide care

    • To transport

  • Plan the move before touching the patient.

  • Assign roles and designate one EMT to give commands.

  • Use enough personnel and request additional help early.

  • Never rush unless the situation requires an emergency move.

III. Body Mechanics

  • Body mechanics refers to using your body in the safest, most efficient way.

  • Proper body mechanics reduce fatigue and prevent injury.

Key Principles:

  • Keep your back straight and aligned.

  • Bend at the hips and knees, not the waist.

  • Lift using the large muscle groups of the legs.

  • Keep the patient or load close to your body.

  • Avoid twisting while lifting or carrying.

  • Maintain a wide base of support with your feet.

  • Face the direction of movement.

IV. General Lifting Guidelines

  • Know your physical limitations.

  • Estimate patient weight realistically.

  • Use mechanical aids whenever possible.

  • Lift and lower smoothly—avoid jerking motions.

  • Communicate clearly before, during, and after the lift.

  • If something feels unsafe, stop and reassess.

V. Types of Patient MovesA. Emergency Moves

  • Used when the patient or EMT is in immediate danger.

  • Patient injuries are secondary to life-threatening hazards.

  • Limited or no spinal protection is possible.

Examples of Emergency Moves:

  • Clothes drag

  • Blanket drag

  • Ankle drag

B. Urgent Moves

  • Used when patient condition is life-threatening and requires rapid intervention.

  • Some spinal protection may be used, but speed is critical.

  • Common example: rapid extrication from a vehicle.

C. Non-Urgent Moves

  • Used when the patient is stable and the scene is safe.

  • Allows for full assessment and spinal precautions if indicated.

  • Most common type of patient movement in EMS.

VI. Lifting and Carrying TechniquesPower Grip

  • Palms up with hands at least 10 inches apart.

  • Provides maximum grip strength and control.

Power Lift

  • Back straight, knees bent, lift with legs.

  • Most commonly taught and safest lift.

Direct Ground Lift

  • Used for supine patients on the ground.

  • Requires two or more EMTs.

  • Not used if spinal injury is suspected.

Extremity Lift

  • Used for seated patients with no trauma.

  • One EMT at head/torso, one at legs.

Diamond Carry

  • Four EMTs positioned at head, foot, and sides.

  • Useful in tight spaces.

VII. Equipment for Lifting and Moving PatientsStretchers

  • Wheeled ambulance stretcher (primary transport device)

  • Portable/folding stretcher

  • Scoop stretcher

  • Basket stretcher (rough terrain, water rescue)

Backboards

  • Long backboard for spinal immobilization and extrication

  • Short backboard for seated patients (less commonly used today)

  • Used selectively based on spinal injury risk

Stair Chairs

  • Used for patients who cannot walk but do not require a stretcher

  • Requires coordination and communication

  • Head-end EMT typically controls movement

VIII. Moving Patients in Special Situations

  • Stairs: use stair chairs or coordinated carries

  • Confined spaces: diamond carry or scoop stretcher

  • Vehicle extrication: evaluate need for rapid extrication vs. controlled removal

  • Uneven terrain: basket stretcher and extra personnel

IX. Special Patient ConsiderationsGeriatric Patients

  • Increased risk of fractures and skin injury

  • Move slowly and gently

  • Extra padding may be required

Bariatric Patients

  • Require additional EMTs and specialized equipment

  • Increased risk of EMT injury

  • Plan thoroughly before moving

Medical vs. Trauma Patients

  • Trauma patients may require spinal precautions

  • Medical patients may tolerate movement better but still require caution

X. Post-Move Responsibilities

  • Reassess the patient after every move

  • Ensure patient is properly secured for transport

  • Monitor for changes in condition

  • Clean and decontaminate all equipment after use

XI. Chapter Summary

  • Safe lifting and moving is essential for patient safety and EMT longevity.

  • Proper body mechanics, teamwork, and equipment use reduce injuries.

  • Every move should be planned, communicated, and deliberate.

  • Mastery of these skills is critical for clinical practice, NREMT testing, and WAPS exams.

EMT 12th Edition – Chapter 10 Patient Assessment

I. Purpose of Patient Assessment

  • Patient assessment is a structured, systematic process used to:

    • Identify life-threatening conditions

    • Establish patient priority

    • Guide treatment and transport decisions

  • Assessment begins the moment you arrive and continues until patient transfer of care.

  • No single step is skipped—steps may be repeated or adjusted based on patient condition.

II. Scene Size-Up

Performed before touching the patient.

A. Scene Safety

  • Ensure safety for:

    • EMTs

    • Patient

    • Bystanders

  • Identify hazards:

    • Traffic

    • Fire/explosions

    • Downed power lines

    • Violence or weapons

    • Hazardous materials

  • Use PPE appropriately.

  • If the scene is unsafe, do not enter until secured.

B. Mechanism of Injury (MOI) / Nature of Illness (NOI)

  • MOI (Trauma):

    • How energy was transferred to the body

    • Examples: MVCs, falls, assaults, blasts

    • Helps predict hidden injuries

  • NOI (Medical):

    • Patient’s medical complaint

    • Examples: chest pain, shortness of breath, seizure

  • Guides spinal precautions and assessment focus.

C. Number of Patients

  • Determines:

    • Need for triage

    • Additional units

    • Resource allocation

  • Essential in mass-casualty incidents (MCI).

D. Additional Resources

  • Request early if needed:

    • ALS

    • Fire/rescue

    • Law enforcement

    • Air medical

    • Specialized equipment

  • Early requests prevent delays in care.

III. Primary Assessment (Primary Survey)

Focuses on immediate life threats.

A. General Impression

  • Formed in the first 5–10 seconds

  • Includes:

    • Age and sex

    • Position found

    • Work of breathing

    • Skin color

    • Overall distress

  • Helps determine severity and urgency.

B. Level of Consciousness (LOC)

  • Use AVPU scale:

    • Alert – fully responsive

    • Verbal – responds to voice

    • Painful – responds only to pain

    • Unresponsive – no response

  • Altered mental status may indicate:

    • Hypoxia

    • Shock

    • Head injury

    • Stroke

    • Hypoglycemia

    • Toxic exposure

C. Airway

  • Determine if airway is:

    • Open

    • Clear

    • Maintainable

  • Look/listen for:

    • Snoring

    • Gurgling

    • Stridor

  • Interventions:

    • Manual maneuvers

    • Suction

    • Airway adjuncts

  • Airway always takes priority.

D. Breathing

  • Assess:

    • Rate

    • Depth

    • Effort

    • Symmetry

  • Look for:

    • Accessory muscle use

    • Cyanosis

    • Chest wall movement

  • Interventions:

    • Oxygen therapy

    • Ventilations with BVM

  • Treat life-threatening breathing issues immediately.

E. Circulation

  • Check:

    • Pulse (rate, rhythm, quality)

    • Skin color, temperature, moisture

  • Control life-threatening bleeding immediately.

  • Assess for signs of shock:

    • Pale, cool, clammy skin

    • Weak or rapid pulse

    • Altered LOC

F. Transport Decision

  • Decide early if patient is:

    • High priority

    • Low priority

  • Determine:

    • Rapid transport vs. on-scene care

    • ALS intercept

  • Reassess this decision throughout care.

IV. History Taking

Provides context for assessment findings.

A. Chief Complaint

  • Primary reason for calling EMS

  • Document in patient’s own words when possible.

B. History of Present Illness

  • Use OPQRST for pain or symptoms:

    • Onset

    • Provocation/Palliation

    • Quality

    • Region/Radiation

    • Severity (0–10 scale)

    • Time

C. Past Medical History

  • Use SAMPLE:

    • Signs/Symptoms

    • Allergies

    • Medications

    • Past medical history

    • Last oral intake

    • Events leading up

V. Secondary Assessment

Performed after immediate life threats are addressed.

A. Full Head-to-Toe Exam

Used when:

  • Significant MOI

  • Altered mental status

  • Unresponsive patient

Includes systematic evaluation of:

  • Head and face

  • Neck

  • Chest

  • Abdomen

  • Pelvis

  • Extremities

  • Posterior body

B. Focused Physical Exam

Used when:

  • Patient is stable

  • Complaint is isolated

  • Minimal MOI

  • Exam focuses on affected system or area.

VI. Vital Signs

Establish baseline and trends.

Includes:

  • Pulse

  • Respiratory rate

  • Blood pressure

  • Skin signs

  • Oxygen saturation (SpO₂)

  • Pupils (size, equality, reactivity)

Abnormal vitals often indicate deterioration before symptoms worsen.

VII. Reassessment

Continuous and critical.

A. Frequency

  • Unstable patients: every 5 minutes

  • Stable patients: every 15 minutes

B. Components

  • Repeat primary assessment

  • Recheck vital signs

  • Reevaluate chief complaint

  • Assess response to treatment

  • Identify new problems

VIII. Special Patient Considerations

  • Geriatric patients:

    • Subtle symptoms

    • Multiple comorbidities

    • Higher risk of rapid deterioration

  • Pediatric patients:

    • Age-appropriate communication

    • Early respiratory compromise

  • Communication barriers:

    • Language

    • Hearing impairment

    • Altered mental status

    • Use family or interpreters when appropriate

IX. Documentation

  • Accurate documentation is a legal and medical requirement.

  • Should include:

    • Assessment findings

    • Treatments provided

    • Patient response

    • Changes over time

  • Must be:

    • Objective

    • Clear

    • Complete

    • Timely

X. Chapter Key Takeaways

  • Patient assessment is structured, repeatable, and dynamic.

  • Life threats are addressed immediately and continuously.

  • Good assessment leads to:

    • Better clinical decisions

    • Improved patient outcomes

    • Strong performance on NREMT and WAPS exams

EMT 12th Edition – Chapter 13 SHOCK

I. Definition and Overview of Shock

  • Shock is systemic hypoperfusion resulting in inadequate oxygen delivery to tissues.

  • Shock is a medical emergency and can occur with or without hypotension.

  • Blood pressure is a late indicator of shock.

  • Untreated shock leads to:

    • Cellular hypoxia

    • Metabolic acidosis

    • Organ failure

    • Death

  • EMT goal: early recognition, immediate treatment, rapid transport.

II. Cellular Pathophysiology of Shock

  • Decreased oxygen delivery forces cells into anaerobic metabolism.

  • Anaerobic metabolism produces lactic acid, causing metabolic acidosis.

  • Increased capillary permeability causes:

    • Fluid leakage

    • Decreased circulating volume

  • Failure of cellular membranes leads to:

    • Sodium and water shifts

    • Cellular swelling

    • Tissue death

  • Shock is progressive and time-dependent.

III. Compensatory Mechanisms

The body attempts to maintain perfusion through the sympathetic nervous system:

  • Increased heart rate (tachycardia)

  • Peripheral vasoconstriction

  • Increased respiratory rate

  • Blood shunting to vital organs (brain and heart)

Special Considerations:

  • Pediatric patients compensate well initially but decompensate rapidly.

  • Geriatric patients may show blunted responses due to medications or chronic illness.

IV. Stages of ShockA. Compensated Shock

  • Normal or near-normal blood pressure

  • Tachycardia

  • Tachypnea

  • Pale, cool, clammy skin

  • Anxiety or restlessness

B. Decompensated Shock

  • Falling blood pressure

  • Altered mental status

  • Weak or absent peripheral pulses

  • Cyanosis

  • Decreased urine output

C. Irreversible Shock

  • Severe hypotension

  • Multi-organ failure

  • Minimal response to treatment

  • High mortality

V. Classification of Shock (EXAM CRITICAL)A. Hypovolemic Shock

  • Caused by loss of blood or fluids

  • Hemorrhagic (trauma, GI bleed)

  • Non-hemorrhagic (burns, dehydration)

  • Findings:

    • Narrow pulse pressure early

    • Tachycardia

    • Cool, pale skin

B. Cardiogenic Shock

  • Failure of the heart to pump effectively

  • Causes:

    • Myocardial infarction

    • Dysrhythmias

    • Severe heart failure

  • Findings:

    • Pulmonary edema

    • Weak pulse

    • Hypotension

  • Fluid administration is limited (ALS concern).

C. Distributive Shock

Loss of vascular tone causing widespread vasodilation.

1. Septic Shock

  • Caused by infection

  • Warm skin early, cool skin late

  • Fever or hypothermia

2. Anaphylactic Shock

  • Severe allergic reaction

  • Airway swelling + bronchoconstriction + hypotension

  • Hives, itching, wheezing

3. Neurogenic Shock

  • Spinal cord injury

  • Loss of sympathetic tone

  • Hypotension with bradycardia (key exam clue)

  • Warm, dry skin below injury

D. Obstructive Shock

  • Mechanical obstruction of circulation

  • Causes:

    • Tension pneumothorax

    • Cardiac tamponade

    • Pulmonary embolism

  • Rapid deterioration common

VI. Clinical Presentation and Assessment Findings

  • Altered mental status (earliest indicator)

  • Tachycardia (may be absent in neurogenic shock)

  • Skin signs:

    • Pale, cool, clammy (most types)

    • Warm, flushed (early septic/neurogenic)

  • Weak or thready pulses

  • Delayed capillary refill

  • Hypotension (late sign)

VII. EMT Management of Shock (PRIORITY ORDER)

  1. Airway management with spinal precautions as indicated

  2. High-flow oxygen

  3. Control external bleeding immediately

  4. Position patient supine (unless contraindicated)

  5. Maintain body temperature

  6. Rapid transport

  7. Continuous reassessment

VIII. Transport Considerations

  • Shock patients are high-priority.

  • Minimal scene time.

  • Early ALS request when available.

  • Monitor for deterioration during transport.

IX. Key Exam & Scenario Points

  • Shock can exist before hypotension.

  • Mental status changes are an early warning sign.

  • Children compensate longer but crash faster.

  • Neurogenic shock presents with bradycardia, not tachycardia.

  • Treat shock before identifying the exact type.

X. Chapter 13 High-Yield Summary

Shock is a life-threatening failure of circulation that results in inadequate tissue oxygenation. EMTs must recognize early signs, manage airway and oxygenation, control bleeding, prevent heat loss, and transport rapidly to prevent irreversible organ damage.

CHAPTER 19 – RESPIRATORY EMERGENCIESMaster Combined Outline

I. Overview

  • Respiratory emergencies are time-sensitive and commonly fatal if untreated.

  • EMTs must distinguish between:

    • Oxygenation problems (low O₂)

    • Ventilation problems (poor CO₂ removal)

II. Pathophysiology

  • Airway obstruction, lung disease, or muscle fatigue leads to hypoxia.

  • CO₂ retention causes acidosis → respiratory failure.

  • Pulse oximetry measures oxygenation, not ventilation.

III. Respiratory Distress vs FailureDistress (Compensating)

  • Tachypnea

  • Accessory muscle use

  • Anxiety

  • Speaking in short sentences

Failure (Decompensating)

  • Altered mental status

  • Cyanosis (late sign)

  • Shallow or irregular respirations

  • Fatigue

IV. Common Respiratory Conditions

  • Asthma

  • COPD

  • Pulmonary edema

  • Pneumonia

  • Anaphylaxis

  • Pulmonary embolism

  • Hyperventilation syndrome

V. Assessment Priorities

  • Work of breathing

  • Lung sounds

  • SpO₂ trends

  • Ability to speak

VI. EMT Management

  • Oxygen (appropriate device)

  • BVM ventilation when breathing is inadequate

  • Assist prescribed inhalers/epi (per protocol)

  • Early transport

VII. Summary

Respiratory emergencies require early support of ventilation, not just oxygen, and rapid transport before failure occurs.

CHAPTER 28 – TRAUMA OVERVIEW

I. Trauma as a Disease

  • Leading cause of death ages 1–44.

  • Most trauma deaths are preventable.

II. Kinematics of Trauma

  • Blunt vs penetrating

  • Energy transfer predicts internal injuries.

  • Deceleration causes shearing injuries.

III. Trauma Assessment Sequence

  1. Scene size-up

  2. Primary assessment (ABCs)

  3. Rapid trauma exam

  4. Focused exam (if stable)

IV. High-Risk Indicators

  • AMS

  • Hypotension

  • Severe bleeding

  • Multisystem trauma

  • High-risk MOI

V. EMT Priorities

  • Control catastrophic bleeding

  • Airway and breathing

  • Rapid transport (“load-and-go”)

VI. Summary

Trauma care focuses on what kills first, not visible injuries, with minimal scene time for critical patients.

CHAPTER 29 – BLEEDING & HEMORRHAGE

I. Significance

  • Hemorrhage is the leading preventable cause of trauma death.

  • Patients can bleed out before hypotension occurs.

II. Types of Bleeding

  • External (visible)

  • Internal (hidden)

III. Hemostasis Physiology

  • Vasoconstriction

  • Platelet aggregation

  • Clot stabilization

IV. Bleeding Control Hierarchy

  1. Direct pressure

  2. Pressure dressing

  3. Tourniquet

  4. Hemostatic gauze

V. Internal Bleeding Indicators

  • Shock without visible bleeding

  • Abdominal rigidity

  • Pelvic instability

  • Femur fractures

VI. Summary

Bleeding control is immediate and aggressive, followed by shock prevention and rapid transport.

CHAPTER 31 – SOFT-TISSUE INJURIES

I. Injury Types

  • Abrasions

  • Lacerations

  • Avulsions

  • Amputations

  • Closed soft-tissue injuries

II. Assessment Focus

  • Bleeding severity

  • Contamination

  • Infection risk

III. High-Risk Wounds

  • Neck

  • Chest

  • Groin

  • Large avulsions

IV. Amputation Management

  • Control bleeding

  • Wrap part in sterile dressing

  • Keep cool, NOT frozen

  • Transport with patient

V. Summary

Soft-tissue care centers on bleeding control, wound protection, and infection prevention.

CHAPTER 32 – FACE & NECK INJURIES

I.Why These Injuries Are Critical

  • Airway compromise

  • Major vascular bleeding

  • Aspiration risk

II. Red-Flag Findings

  • Hoarseness

  • Drooling

  • Subcutaneous emphysema

  • Tracheal deviation

III. Management

  • Airway protection

  • Occlusive dressings for neck wounds

  • Do not probe wounds

  • Continuous reassessment

IV. Summary

Face and neck injuries are airway emergencies first, bleeding problems second.

CHAPTER 33 – HEAD & SPINE INJURIES

I. Injury Concepts

  • Primary injury = irreversible

  • Secondary injury = preventable

II. Head Injuries

  • Concussion

  • Skull fractures

  • Epidural (lucid interval)

  • Subdural (slow onset)

III. Spinal Injury Indicators

  • Pain

  • Numbness/tingling

  • Weakness/paralysis

  • Priapism

IV. Spinal Motion Restriction

  • Based on assessment

  • Manual stabilization first

  • Maintain airway priority

V. Summary

Preventing hypoxia and hypotension is the single most important EMT role in head and spine injuries.

CHAPTER 34 – CHEST INJURIES

I. Immediate Life Threats

  • Tension pneumothorax

  • Open pneumothorax

  • Flail chest

  • Cardiac tamponade

II. Assessment Findings

  • Unequal breath sounds

  • Paradoxical movement

  • JVD

  • Respiratory distress

III. Management

  • Oxygen

  • Seal open chest wounds

  • Position for breathing

  • Rapid transport

IV. Summary

Chest injuries can rapidly impair ventilation and circulation—recognition and transport are critical.

CHAPTER 38 – MUSCULOSKELETAL INJURIES

I. Injury Types

  • Fractures (open/closed)

  • Dislocations

  • Sprains

  • Strains

II. Assessment

  • DCAP-BTLS

  • PMS before and after splinting

III. Management

  • Immobilize above and below injury

  • Reduce pain

  • Prevent further damage

IV. Summary

Musculoskeletal injuries are rarely life-threatening but can cause significant bleeding and disability.

CHAPTER 40 – SPECIAL POPULATIONS

I.Geriatric Patients

  • Normal vitals may hide shock

  • Falls = high mortality

  • Polypharmacy complications

II. Pediatric Patients

  • Airway compromise first

  • Respiratory failure precedes arrest

  • Rapid deterioration

III. Pregnant Patients

  • Treat mother first

  • Left lateral tilt

  • Increased oxygen demand

IV. Patients with Disabilities

  • Baseline function matters

  • Adapt assessment and communication

V. Summary

Special populations require modified approaches, but priorities remain airway, breathing, circulation, and transport.