- What is an EMR?
- Emergency Medical Responder — the entry-level national EMS certification, below the EMT, providing immediate basic life support with minimal equipment until a transporting unit arrives.
- EMR vs EMT vs AEMT vs Paramedic
- EMR = entry-level BLS; EMT = transporting BLS (adds NPA, oral glucose, etc.); AEMT adds IV/IO, fluids & supraglottic airways; Paramedic adds intubation, cardiac monitoring & most IV drugs.
- Who certifies the EMR exam?
- The National Registry of Emergency Medical Technicians (NREMT).
- EMR cognitive exam format
- A computer adaptive test (CAT) of about 90–110 items, up to 1 hour 45 minutes; the test ends once it can decide your competency with confidence.
- How is the EMR exam scored?
- Pass/fail against a criterion-referenced cut score; there is no fixed passing percentage.
- Five EMR exam content areas
- Scene Size-up & Safety, Primary Assessment (heaviest), Secondary Assessment, Patient Treatment & Transport, and Operations.
- Heaviest EMR exam domain
- Primary Assessment — about 37–41% of the exam.
- Smallest EMR exam domain
- Secondary Assessment — about 4–8% of the exam.
- National EMS Scope of Practice Model
- The NHTSA document defining the four EMS levels (EMR, EMT, AEMT, Paramedic) and what each may do — the authoritative baseline for the EMR scope.
- Skills WITHIN the EMR scope
- Scene safety, CPR, AED, bleeding control (pressure, packing, tourniquet), manual airway (head-tilt/jaw-thrust), OPA, suction, BVM, oxygen, naloxone, manual spinal stabilization, cervical collar, splinting, emergency childbirth.
- Skills OUTSIDE the EMR scope (EMT+)
- Nasopharyngeal airway (NPA), pulse oximetry, oral glucose, aspirin, nitroglycerin, inhalers, CPAP, long backboard — these begin at the EMT level.
- Skills that begin at the AEMT level
- IV and IO access, IV fluids, and supraglottic (blind-insertion) airways — NOT in the EMR scope.
- Skills that begin at the Paramedic level
- Endotracheal intubation, cardiac rhythm interpretation, manual defibrillation, and most IV medications.
- EMR airway adjunct
- The oropharyngeal airway (OPA), for an unresponsive patient with no gag reflex. The NPA is an EMT-level adjunct.
- Is naloxone within the EMR scope?
- Yes — an EMR can give naloxone (intranasal or auto-injector) for an opioid overdose. Support ventilation first.
- Does the EMR transport patients?
- Generally no — the EMR provides immediate care and stabilizes, then hands off to a transporting (EMT/ALS) unit.
- BLS
- Basic life support — the non-invasive emergency care an EMR provides: CPR, AED, airway maneuvers, BVM, oxygen, bleeding control, and splinting.
- EMR certification period
- Two years; renew through NCCP continuing education plus a current state EMS credential.
- EMR initial eligibility
- Complete a state-approved EMR course meeting the National EMS Education Standards, meet the state BLS skills requirement, and pass the cognitive exam.
- Medical direction
- Physician oversight of EMS care — offline (protocols/standing orders) or online (real-time orders by radio/phone).
- Do state EMR scopes vary?
- Yes — many states expand the EMR scope beyond the national baseline, so always follow local protocol. The exam is written to the national Model.
- Chain of survival (links EMR controls)
- Early recognition/activation, early CPR, and early defibrillation are the first links — and the ones an EMR, often first on scene, controls.
- First link in the EMS chain
- The EMR — frequently the first trained provider on scene, beginning care before the transporting crew arrives.
- Continuous quality improvement (CQI)
- An ongoing system of reviewing and improving the quality of EMS care delivered.
- Standards of care
- The care expected of an EMR with similar training in a similar situation — the benchmark used to judge negligence.
- Patient care report (PCR)
- The accurate, objective written record of an EMR's assessment and care; a legal document that supports continuity of care.
- Mandatory reporting
- Conditions an EMR must report per state law, such as suspected child, elder, or domestic abuse.
- Stress in EMS
- EMRs face critical-incident stress; recognize warning signs and use healthy coping and peer/professional support.
- Therapeutic communication
- Communicating with the patient and family with empathy, eye contact, and clear language to gain trust and information.
- Lifting & moving — body mechanics
- Use the power lift (legs, not back), keep the load close, and avoid twisting to prevent injury.
- Scene size-up
- The quick pre-patient assessment: standard precautions, scene safety, mechanism of injury or nature of illness, number of patients, and the need for more resources.
- First priority on every call
- Responder safety — you cannot help anyone if you become a patient.
- BSI (body substance isolation)
- Treating all blood and body fluids as infectious and using barriers (gloves, eye protection, mask, gown) matched to the exposure risk.
- Standard precautions
- Infection-control practices applied to every patient — hand hygiene plus barriers — regardless of known infectious status.
- When to wear a gown, mask & eye protection
- When splashing or large fluid volumes are likely — e.g., a childbirth or major bleeding.
- What to do if a glove tears mid-care
- Stop, remove the damaged glove, perform hand hygiene, and apply a fresh glove before continuing.
- Mechanism of injury (MOI)
- The forces/energy that caused a trauma patient's injury (fall height, vehicle speed, blade path) — used to predict likely injuries.
- Nature of illness (NOI)
- The general type of medical problem a non-trauma patient has, gathered from the patient, family, bystanders, and scene.
- MOI vs NOI
- MOI applies to TRAUMA patients (the forces involved); NOI applies to MEDICAL patients (the type of illness).
- Index of suspicion
- Your level of concern for serious, hidden injury based on the mechanism; a significant mechanism (high fall, high-speed crash) raises it.
- Significant mechanism of injury
- Forces likely to cause serious injury — a high fall, ejection, high-speed crash, or rollover — warranting a higher index of suspicion and a rapid exam.
- Rapid deceleration injury
- Injury from energy transferred to the body when motion stops suddenly, as in a head-on crash — even without obvious external wounds.
- What to do at a potentially violent scene
- Stage at a safe distance and wait for law enforcement to secure the scene before approaching.
- Scene hazards to size up
- Traffic, violence, fire, electricity/downed wires, hazardous materials, unstable structures, and environmental dangers.
- Why call for resources early
- Recognizing extra patients or a serious situation up front lets you summon more units before being overwhelmed — it speeds definitive care.
- Counting patients
- Part of the scene size-up — determine the number of patients before committing to one, so you can request the right resources.
- When a call becomes a mass-casualty incident (MCI)
- When the number and severity of patients exceed the resources on scene, triggering a shift to triage.
- Downed power line on a crashed car
- Do not approach — the vehicle and ground may be energized. Stage, keep bystanders back, and call the power company and fire/rescue.
- Approaching a hazmat or fire scene
- Approach from uphill and upwind, identify the hazard from a distance, and stay clear of the danger zone.
- Personal protective equipment (PPE)
- Gear that protects the responder — gloves, eye protection, mask, gown, and, for hazards, turnout gear or specialized PPE as trained.
- Primary assessment
- The rapid search for and treatment of immediate life threats, in the order XABC: control massive bleeding, then Airway, Breathing, Circulation.
- XABC order
- eXsanguinating (massive) bleeding, Airway, Breathing, Circulation — treat each life threat the moment it is found.
- Why bleeding comes before airway (XABC)
- A person can bleed to death faster than an airway problem will kill them, so massive hemorrhage is controlled first.
- General impression
- The immediate sick-versus-not-sick judgment from the patient's appearance, work of breathing, and skin color as you approach.
- AVPU scale
- A rapid level-of-consciousness check: Alert, responds to Verbal, responds to Pain, Unresponsive.
- AVPU — what does A mean?
- Alert — spontaneously alert and aware of surroundings.
- AVPU — patient responds only to pain
- P — responsive to Painful stimulus only.
- AVPU trend A → V → P → U
- Deteriorating level of consciousness — the patient is getting worse.
- Head-tilt chin-lift
- The basic airway maneuver for an unresponsive patient with NO suspected spinal injury — tilts the head back and lifts the chin off the airway.
- Jaw-thrust maneuver
- Opens the airway WITHOUT moving the neck — used when a spinal injury is suspected.
- Oropharyngeal airway (OPA)
- A rigid airway adjunct for an unresponsive patient with NO gag reflex — an EMR-level skill.
- Suctioning limit
- Suction for no more than about 15 seconds per attempt (less in children) to avoid hypoxia.
- Signs of inadequate breathing
- Rate too fast or too slow, shallow/irregular effort, accessory-muscle use, cyanosis, one- to two-word dyspnea, and altered mental status.
- BVM (bag-valve mask)
- The device used to deliver positive-pressure ventilation to a patient breathing inadequately or not at all.
- Adult ventilation rate (no pulse changes aside)
- About once every 5–6 seconds (10–12/min) for a non-breathing adult with a pulse — do not over-ventilate.
- Risk of over-ventilation
- Raises pressure in the chest, lowers cardiac output, and causes gastric distension and aspiration.
- Pulse to check if no radial pulse (unresponsive adult)
- The carotid pulse in the neck — a large central artery that stays palpable when peripheral pulses fade.
- Where to check a pulse in an infant
- The brachial pulse (inside the upper arm).
- Signs of shock (early)
- Fast heart rate, anxiety/restlessness, pale, cool, clammy skin, and delayed capillary refill — with near-normal blood pressure.
- Late (decompensated) shock signs
- Falling blood pressure and a declining mental status — ominous signs that the patient is decompensating.
- High-quality CPR rate
- 100–120 compressions per minute.
- High-quality CPR depth (adult)
- At least 2 inches (5 cm).
- Single-rescuer adult CPR ratio
- 30 compressions to 2 breaths (30:2).
- Two-rescuer CHILD/INFANT CPR ratio
- 15 compressions to 2 breaths (15:2).
- How often to switch compressors
- About every 2 minutes, to limit fatigue and keep compressions high-quality.
- Full chest recoil
- Letting the chest return fully between compressions so the heart refills — essential for effective CPR.
- AED (automated external defibrillator)
- Analyzes the rhythm and delivers a shock to a shockable rhythm; applying an AED is a core EMR skill.
- AED steps
- Power on, attach pads, clear the patient, let it analyze, deliver a shock if advised, then resume CPR immediately.
- Agonal gasps
- Occasional gasping in cardiac arrest — NOT adequate breathing; treat as arrest and begin CPR.
- Transport-priority decision
- The sick-vs-not-sick call ending the primary assessment; a high-priority patient needs a transporting unit summoned early.
- High-priority patient signs
- Poor general impression, airway/breathing trouble, uncontrolled bleeding, signs of shock, or an altered mental status.
- Cyanosis
- Bluish skin or lips signaling inadequate oxygenation.
- Tripod position
- Sitting upright leaning forward on the arms to ease breathing — a sign of respiratory distress.
- Adequate breathing
- Normal rate and depth, regular rhythm, and good, equal chest rise.
- Responsive patient — what does it tell you about the airway?
- A patient who is speaking/crying has an open airway and at least minimally adequate breathing.
- Recovery position purpose
- Lets fluids drain and keeps the tongue clear of the airway in an unresponsive but adequately breathing patient.
- Secondary assessment
- The detailed exam after life threats are addressed — a focused or rapid head-to-toe exam, vital signs, and a history.
- SAMPLE history
- Signs/symptoms, Allergies, Medications, Pertinent past history, Last oral intake, Events leading up.
- OPQRST
- Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, Time — a pain-assessment mnemonic.
- OPQRST — 'What were you doing when it started?'
- Onset.
- OPQRST — 'Describe how it feels'
- Quality (e.g., sharp, dull, crushing).
- OPQRST — 'How long has it lasted?'
- Time.
- SAMPLE — sudden rash after a new food
- A — Allergies.
- SAMPLE — 'What medications do you take?'
- M — Medications.
- SAMPLE — past illnesses and conditions
- P — Pertinent past medical history.
- Vital signs an EMR assesses
- Pulse, breathing (rate & quality), skin (color/temperature/moisture), pupils, and — where trained — a manual blood pressure.
- Capillary refill
- Press a nail bed until it blanches; color should return in under 2 seconds. A delay suggests poor peripheral perfusion.
- Skin signs and perfusion
- Pale, cool, clammy skin points to poor perfusion; assessing skin is a fast window on circulation.
- What pupils tell you
- Pupil findings reflect the brain/head; unequal or non-reactive pupils can indicate a serious head problem.
- PEARRL / pupil check
- Pupils Equal And Round, Reactive to Light — a normal pupil exam.
- DCAP-BTLS
- Deformities, Contusions, Abrasions, Punctures/penetrations, Burns, Tenderness, Lacerations, Swelling — what to look for in the physical exam.
- Focused vs rapid exam
- Responsive medical patient → focused exam of the relevant system; unresponsive or major-trauma patient → rapid head-to-toe exam.
- Jugular vein distension (JVD)
- Distended neck veins felt/seen during the exam — can indicate a chest or cardiac problem.
- Tracheal deviation
- A shift of the trachea away from midline — a late sign of a tension pneumothorax.
- Paradoxical chest movement
- A section of chest wall moving opposite to the rest during breathing — a flail-chest sign found on the exam.
- Weak, thready radial pulse with cool skin
- Suggests developing poor perfusion (early shock).
- Reassessment intervals
- Repeat the primary assessment, vitals, and interventions every 5 minutes for an unstable patient and every 15 minutes for a stable one.
- Baseline vital signs
- The first set of vitals; later sets are compared against them to detect trends.
- Where to get history if the patient can't answer
- From family, bystanders, medical-alert tags, and the scene.
- Chief complaint
- The main problem the patient (or others) report — the reason EMS was called, in the patient's own words when possible.
- Normal adult resting pulse
- About 60–100 beats per minute.
- Normal adult respiratory rate
- About 12–20 breaths per minute.
- EMR bleeding control order
- Direct pressure first; then a tourniquet for limb bleeding it can't control; wound packing for junctional wounds.
- Direct pressure
- Firm, steady pressure directly over a bleeding wound — the first and primary method to control external bleeding.
- Tourniquet placement
- A few inches above the wound on the limb, NOT over a joint; apply high and tight, note the time, and leave it on.
- Who removes a field tourniquet?
- Hospital or higher-level providers — not the EMR in the field.
- Wound packing
- Firmly packing gauze (plain or hemostatic) into a deep junctional wound and holding direct pressure when a tourniquet can't reach.
- Hemostatic gauze
- Gauze treated to speed clotting; packed into a wound and held with firm direct pressure.
- Tourniquet for a partial hand amputation
- Place it on the forearm above the wound (a limb, not over a joint).
- Shock positioning — current guidance
- Keep the patient supine and warm; routine head-down (Trendelenburg) tilt is NO longer recommended for shock.
- EMR shock care
- Control bleeding, maintain airway/breathing, give oxygen, keep warm and supine, and arrange rapid transport.
- Recovery position — when to use
- Unresponsive (or decreased LOC) BUT breathing adequately, has a pulse, and NO suspected spinal injury.
- Recovery position — when NOT to use
- Inadequate breathing (ventilate/CPR instead) or a suspected spinal injury (keep aligned, manage airway in place).
- Burn care (EMR)
- Stop the burning, remove jewelry and non-stuck clothing, cover with a dry sterile dressing, keep warm — do NOT pop blisters or apply ice/ointment.
- Rule of nines (adult)
- Head 9%, each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, genitals 1%.
- Airway-burn warning signs
- Singed nasal hair, soot in the mouth, hoarseness, or stridor — possible airway involvement; manage the airway and transport.
- Open (sucking) chest wound
- Seal with an occlusive (vented) dressing; if signs of a tension pneumothorax develop, burp the dressing.
- Impaled object
- Stabilize it in place — do NOT remove it; control bleeding around it and transport.
- Evisceration
- Cover protruding abdominal organs with a moist, sterile dressing — never push them back in.
- Manual in-line spinal stabilization
- Hold the head neutral with eyes forward (nose in line with the navel) for a suspected spinal injury, before and during a collar.
- Cervical collar
- Supports the neck for a suspected spinal injury but does NOT fully immobilize — continue manual stabilization with it.
- When NOT to force the head to neutral
- If moving the head toward neutral causes severe pain or resistance — hold it where found and stabilize.
- Naloxone (Narcan)
- An opioid antagonist an EMR can give intranasally or by auto-injector to reverse opioid respiratory depression. Support ventilation first.
- Opioid overdose signs
- Pinpoint pupils, slow or absent breathing, and a decreased level of consciousness.
- Goal of naloxone dosing
- Restore adequate breathing, not full alertness; over-aggressive dosing can trigger agitation and withdrawal.
- FAST (stroke screen)
- Face droop, Arm drift, Speech difficulty, Time to call for help and note the last-known-well time.
- EMR stroke care
- Recognize with FAST, note last-known-well, support airway/breathing, check glucose if trained, and transport rapidly to a stroke center.
- Heart-attack signs
- Crushing chest pressure radiating to the arm/jaw, dyspnea, diaphoresis, nausea — subtler in women, the elderly, and diabetics.
- EMR cardiac-chest-pain care
- Keep the patient calm and at rest, give oxygen if hypoxic, monitor, and transport rapidly. (Aspirin/nitro are EMT-level.)
- Conscious choking adult
- Give abdominal thrusts (Heimlich) above the navel until the object clears or the patient becomes unresponsive.
- Choking patient becomes unresponsive
- Lower them to the ground and begin CPR, checking the mouth for the object before giving breaths.
- Infant choking relief
- Alternate 5 back blows and 5 chest thrusts (not abdominal thrusts).
- Emergency childbirth — EMR role
- Support the head as it delivers, suction mouth then nose if needed, keep the newborn warm and dry, and stimulate it.
- Newborn heart rate below 100
- If it stays below 100 despite warming, drying, positioning, and stimulating, begin positive-pressure ventilation with a BVM.
- Late-pregnancy transport position
- Tilt to the LEFT side to avoid supine hypotensive syndrome (the uterus compressing the vena cava).
- Splinting
- Immobilize a suspected fracture to reduce pain and bleeding; check distal circulation, motor, and sensation before and after.
- Oxygen — nasal cannula vs non-rebreather
- Nasal cannula for mild need; non-rebreather (10–15 L/min) for significant hypoxia in a patient breathing adequately.
- Hypothermia handling
- Handle gently (rough movement can trigger fibrillation), remove wet clothing, rewarm passively, and give warm humidified oxygen.
- Heat stroke
- Hot skin with altered mentation — a true emergency needing rapid active cooling and transport.
- Seizure care (EMR)
- Protect the patient from injury, do NOT restrain or put anything in the mouth, and protect the airway afterward.
- Emergency move
- Used only when there is immediate danger, you can't reach a critical patient, or you must access another patient.
- Eye irrigation
- For a chemical eye exposure, flush the eye with copious water/saline, sweeping away from the unaffected eye.
- Mass-casualty incident (MCI)
- An incident whose patient numbers and severity exceed available resources — that mismatch is the defining feature.
- START triage
- Simple Triage And Rapid Treatment — sorts patients by Respirations, Perfusion, and Mental status into four categories.
- START — first step
- Direct everyone who can walk to one area; they are tagged Green (Minor). Then assess the rest where they lie.
- START — Green (Minor)
- The walking wounded — can get up and move on command.
- START — Red (Immediate)
- Breathing over 30/min, no radial pulse or capillary refill over 2 seconds, OR can't follow commands.
- START — Yellow (Delayed)
- Breathing, perfusing, and following commands — but cannot walk.
- START — Black (Deceased/Expectant)
- No breathing even after the airway is repositioned.
- Only treatments during START
- Opening the airway and controlling major bleeding — you keep sorting rather than stopping to treat.
- JumpSTART
- The pediatric version of START triage.
- Incident Command System (ICS)
- The standardized NIMS structure for organizing personnel and resources at an incident.
- Hazmat hot zone
- The contaminated danger area — entered only by trained, properly equipped responders.
- Hazmat warm zone
- The decontamination corridor between the hot and cold zones.
- Hazmat cold zone
- The safe area where EMS stages and command operates — where an untrained EMR works.
- Where an EMR works at a hazmat scene
- The cold zone, unless specifically trained and equipped; patients must be decontaminated before treatment/transport.
- Identifying a hazmat from a distance
- Use binoculars and reference placards/labels; approach from uphill and upwind.
- Expressed consent
- Informed agreement to care from a competent adult told the condition, the proposed care, and its risks.
- Implied consent
- The assumption that an unresponsive patient or an unaccompanied minor in an emergency would consent to lifesaving care.
- Refusal of care
- A competent adult may refuse care after being informed of the risks; ensure an informed refusal and document thoroughly.
- Duty to act
- A legal obligation to respond and provide care — e.g., when an EMR is on duty or dispatched on a call.
- Abandonment
- Leaving a patient you've started caring for without transferring to a provider of equal or higher training.
- Transfer of care
- Handing the patient to a receiving provider of equal/higher training who takes responsibility and receives a report.
- Four elements of negligence
- Duty, breach of duty, causation, and damages — all four must be present.
- Breach of duty
- Failing to provide the standard of care, such as skipping a step local protocol clearly requires.
- Good Samaritan law
- Protects a responder who renders reasonable, good-faith aid within their training from liability.
- Does a Good Samaritan law cover out-of-scope care?
- No — it does not protect care that goes beyond the responder's training and scope.
- HIPAA / patient privacy
- Protect a patient's health information; share it only with those involved in the patient's care.
- Advance directive / DNR
- A valid order (e.g., a DNR) directing the limits of care — honor it when present and valid.
- Due regard (ambulance/emergency driving)
- Operating safely with concern for others — slow at intersections (most crashes) and wear seatbelts.
- Negligence — what 'causation' means
- The breach of duty actually caused harm to the patient.
- Minor at a scene with no parent
- Implied consent allows emergency care, since a reasonable parent would consent to lifesaving treatment.
- EMS levels (lowest to highest)
- EMR → EMT → AEMT → Paramedic. Each level builds on the one below it.
- Is the EMR a transporting provider?
- Typically no — the EMR stabilizes and hands off; the EMT is the first transporting (BLS) provider.
- Where naloxone fits in the EMR scope
- Naloxone (IN or auto-injector) is one of the few medications in the national EMR scope — alongside oxygen.
- Wellness and lifting safety for an EMR
- Maintain fitness, use proper body mechanics, get rest, and manage stress to stay able to respond safely.
- Designated agent / off-duty EMR
- Off-duty good-faith aid is generally covered by Good Samaritan laws; on-duty an EMR has a duty to act.
- Quality vs scope
- Scope = what you're allowed to do; quality (CQI) = how well the system does it. Both shape good EMR care.
- Communicable disease exposure
- Report any blood/body-fluid exposure, follow your agency's exposure-control plan, and seek medical follow-up.
- Why standard precautions on EVERY patient
- A patient's infectious status is usually unknown, so barriers protect the responder regardless.
- Number of patients exceeds resources
- Triggers a mass-casualty response and START triage.
- Sizing up a fall
- A higher fall onto a harder surface raises the index of suspicion for serious injury (greater energy).
- Penetrating-trauma MOI
- Consider the likely path and depth of the object (e.g., a blade through the chest) to anticipate injuries.
- Forming a scene read before exiting the vehicle
- Begin assessing scene safety from the rig as you approach, before you step out.
- Staging area
- A safe location where EMS waits until a hazardous scene (violence, hazmat, fire) is secured.
- Why a fast initial scene size-up
- Hazards and patient needs must be recognized quickly to guide a safe approach and early resource calls.
- Number of patients — why it matters
- Determines whether you have enough resources or must triage and call for help.
- Primary assessment goal
- Find and treat immediate threats to life — nothing else takes priority during it.
- Order of the primary assessment components
- Responsiveness/impression → (massive bleeding) → airway → breathing → circulation.
- Look, listen, feel
- The quick check for adequate breathing — look for chest rise, listen and feel for air movement.
- Stridor
- A high-pitched sound on inspiration signaling upper-airway obstruction (croup, swelling, foreign body, anaphylaxis).
- Suspected epiglottitis in a child
- Keep the child calm, do NOT inspect the throat, give oxygen, and transport — agitation can worsen the airway.
- When to ventilate vs give oxygen
- Ventilate with a BVM for inadequate/absent breathing; give oxygen (cannula/NRB) for hypoxia in a patient breathing adequately.
- Child compression depth
- About one-third the depth of the chest.
- Bradycardia in a child
- Usually means hypoxia — open the airway and oxygenate or ventilate.
- Why minimize CPR interruptions
- Pauses drop blood flow; keep compressions nearly continuous and resume immediately after a shock.
- Hands-only CPR
- Continuous chest compressions without breaths, taught for untrained or unwilling bystanders — EMRs add ventilations.
- Pediatric Assessment Triangle (PAT)
- A from-the-doorway impression of a child: Appearance, Work of Breathing, and Circulation to the skin.
- AVPU vs general impression
- General impression is the overall sick/not-sick sense; AVPU is the specific level-of-consciousness rating.
- Rescue breathing rate (adult, pulse present, not breathing)
- 1 breath every 6 seconds (about 10 per minute).
- Why a focused vs rapid exam choice
- It matches the depth of assessment to the patient's condition and mechanism.
- SAMPLE — Last oral intake importance
- Matters for surgery timing, diabetic emergencies, and possible aspiration.
- OPQRST — Severity
- How bad the symptom is, usually rated 0–10.
- OPQRST — Region/Radiation
- Where the pain is and where it travels (e.g., chest pain radiating to the arm).
- Trending vital signs
- Comparing repeated vitals against the baseline to detect improvement or deterioration.
- Diaphoresis
- Profuse sweating — a sign that can accompany shock, a heart attack, or hypoglycemia.
- Mottled skin
- A blotchy skin pattern reflecting poor perfusion, often seen in shock.
- Why check the neck during a rapid exam
- To find distended neck veins or a deviated trachea, which point to serious chest/cardiac problems.
- Distal CMS check
- Checking distal Circulation, Motor, and Sensory function before and after splinting an injured limb.
- Pertinent negatives
- Important findings the patient does NOT have (e.g., no chest pain), which help rule conditions in or out.
- Hemorrhagic shock
- Shock from blood loss — control the bleeding, give oxygen, keep warm and supine, and transport rapidly.
- Flail chest
- Two or more adjacent ribs broken in two or more places, causing paradoxical movement — support ventilation.
- Tension pneumothorax signs
- Severe dyspnea, absent breath sounds on one side, distended neck veins, hypotension, and late tracheal deviation.
- Sucking chest wound dressing
- An occlusive (vented) dressing; burp it if a tension pneumothorax develops.
- Amputated part care
- Wrap the part in moist sterile gauze, place it in a bag, keep it cool (not directly on ice), and transport it with the patient.
- Nosebleed (epistaxis) control
- Have the patient sit, lean forward, and pinch the soft part of the nose; transport if severe or uncontrolled.
- Hypoglycemia signs
- Rapid-onset altered mental status, sweating, fast heart rate, tremor, and weakness; check glucose where trained.
- EMR and oral glucose
- Oral glucose is an EMT-level skill in the national scope — the EMR provides supportive care and rapid transport.
- Anaphylaxis recognition
- A severe, multi-system allergic reaction with airway swelling, wheezing, hives, and hypotension.
- EMR and the epinephrine auto-injector
- Giving agency epinephrine for anaphylaxis is generally EMT-level; follow local protocol, support the airway, and transport.
- Carbon monoxide and SpO2
- CO can read a falsely normal oxygen saturation — give high-flow oxygen and remove the patient from the source.
- Behavioral emergency safety
- Ensure scene safety, stay calm, set limits, and use restraints only when necessary, monitored, and per protocol — never prone.
- Positional asphyxia
- Suffocation risk from restraining a patient face-down — avoid the prone position during restraint.
- Prolapsed umbilical cord
- Relieve pressure with knee-chest positioning and a gloved hand keeping the presenting part off the cord; transport rapidly.
- Cold-emergency rewarming (EMR)
- Passive rewarming — remove wet clothing, insulate, and move to a warm environment; handle gently.
- Why oxygen is not withheld from a hypoxic COPD patient
- Hypoxia kills; give needed oxygen and monitor — do not withhold it over an unfounded 'hypoxic drive' fear.
- Splint position-of-function
- Splint a limb in a natural, supported position; immobilize the joints above and below the injury.
- Why a tourniquet is left in place
- Loosening it in the field can restart life-threatening bleeding and release harmful byproducts — leave it for the hospital.
- ICS at an MCI
- Provides a clear chain of command and resource tracking so a chaotic scene is managed safely.
- Re-triage
- Reassessing and re-tagging patients as their condition changes during an MCI.
- START decision — no breathing after airway opened
- Tag Black (Deceased/Expectant) and move on.
- START decision — respirations over 30/min
- Tag Red (Immediate).
- Triage priority logic
- Do the greatest good for the greatest number — sort and treat the salvageable critical patients first.
- Decontamination before transport
- Hazmat patients must be decontaminated before EMS treats or transports them, to protect responders and the ambulance.
- Extrication phases
- Gain access, assess/stabilize, disentangle, and remove — patient care drives the process.
- Scene documentation
- Document objectively and accurately on the PCR; it is a legal record supporting continuity of care.
- Competent adult refuses care
- Honor an informed refusal from a competent adult; explain the risks, document thoroughly, and offer to return.
- Why a report is required at transfer of care
- So the receiving provider has the full assessment and treatment picture and care continues seamlessly.
- On-duty EMR delays a response
- Failing to respond promptly while on duty can be a breach of the duty to act.
- Confidentiality exceptions
- Limited sharing is allowed for continuity of care, mandated reporting, and legal requirements.
- What defines an MCI vs a routine multi-patient call
- Patient numbers and severity that overwhelm available resources — not the time of day or distance to a hospital.
- Green-tag patients during START
- Anyone who can walk to a designated area on command — assessed last.
