- Adult CPR rate
- 100–120 compressions per minute.
- Adult CPR depth
- At least 2 inches (5 cm); allow full chest recoil.
- EMT scope of practice
- Basic life support: full assessment, OPA/NPA & BVM, oxygen, CPR/AED, bleeding control & splinting, and a limited drug set — NO IV access, advanced airways, or IV drugs.
- EMT vs AEMT vs Paramedic
- EMT = BLS (no IV, no advanced airway); AEMT adds IV/IO, fluids, supraglottic airways & more meds; Paramedic adds intubation, cardiac monitoring/manual defib & most IV drugs.
- Can an EMT start an IV?
- No. IV/IO access begins at the AEMT level. EMTs provide basic life support only.
- Can an EMT use a supraglottic airway?
- No — supraglottic (blind-insertion) airways are AEMT-level. EMTs use OPA/NPA and a bag-valve-mask.
- Four national EMS levels
- EMR → EMT → AEMT → Paramedic (National EMS Scope of Practice Model).
- What does BLS stand for?
- Basic Life Support — non-invasive emergency care: airway, oxygen, CPR/AED, bleeding control, splinting, and assisting select medications.
- Medications an EMT GIVES
- Oxygen, oral glucose, aspirin, naloxone, and activated charcoal (per protocol).
- Medications an EMT ASSISTS
- The patient's own prescribed nitroglycerin, metered-dose inhaler, and epinephrine auto-injector.
- NREMT exam format (EMT)
- Computer-adaptive test (CAT), 70–120 items, up to 2 hours, pass/fail (no numeric score).
- NREMT EMT passing score
- There is no numeric passing score; the CAT decides pass/fail at ~95% confidence vs an entry-level competency standard.
- NREMT EMT exam fee
- About $104 per attempt (verify current pricing at nremt.org).
- NREMT EMT certification length
- 2 years; recertify via the National Continued Competency Program (NCCP) CE model + a state license, or retake the exam.
- Largest NREMT EMT domain
- Primary Assessment (39–43% of the exam).
- Smallest NREMT EMT domain
- Secondary Assessment (5–9% of the exam).
- Medical direction (online vs offline)
- Offline = written protocols/standing orders; online = real-time orders from a physician by radio or phone.
- Quality improvement vs medical direction
- Medical direction authorizes/oversees care; QI/CQA reviews care after the fact to improve the system.
- First priority on any scene
- Scene safety / your own safety — you can't help if you become a patient.
- What is the scene size-up?
- Before reaching the patient: standard precautions (BSI), scene safety, MOI or nature of illness, number of patients, and call for resources.
- What is BSI / standard precautions?
- Body Substance Isolation — gloves on every patient, plus eye protection, gown, and mask for splash, suctioning, or airborne risk.
- Mechanism of injury (MOI)
- The forces that caused a trauma patient's injuries (fall height, vehicle speed/damage, penetrating object).
- Nature of illness (NOI)
- The general type of a medical patient's problem (e.g., chest pain, dyspnea, altered mental status).
- Signs of a significant MOI
- Fall over 20 ft (or 3 times the patient's height), ejection, death of another occupant, high-speed crash, rollover, penetrating trauma to head/chest/abdomen.
- What to do at an unsafe scene
- Do not enter. Stage at a safe distance and request the appropriate resources (law enforcement, fire, utilities) to make it safe.
- When to call for more resources
- EARLY — during the size-up, before committing to one patient (extra units, ALS, fire/rescue, air medical).
- How to recognize an MCI
- When the number of patients exceeds the resources on scene; declare it, start ICS, and begin START triage.
- Standard precautions — when to apply
- Before patient contact, as part of the scene size-up.
- Personal protective equipment for airborne illness
- Add a mask (and consider eye protection); follow local infection-control protocol.
- Index of suspicion
- The anticipation of possible injuries based on the mechanism — drives a rapid trauma assessment even without obvious findings.
- What is the primary assessment?
- The rapid first check that finds and treats immediate life threats: general impression + AVPU, then XABC (massive bleeding, Airway, Breathing, Circulation).
- What does AVPU stand for?
- Alert, responds to Verbal stimulus, responds to Painful stimulus, Unresponsive.
- What does XABC stand for?
- eXsanguinating (massive) hemorrhage, Airway, Breathing, Circulation — the order of the primary assessment for a bleeding patient.
- General impression
- The immediate sick-vs-not-sick judgment from appearance, work of breathing, and skin color, formed as you approach.
- Signs of inadequate breathing
- Rate <8 or >24, shallow/irregular effort, poor chest rise, accessory-muscle use, tripod position, cyanosis, 1–2 word sentences, altered mentation.
- Treatment for inadequate breathing
- Assist ventilation with a bag-valve-mask (BVM) and oxygen — not just a mask.
- Adult BVM ventilation rate
- About once every 5–6 seconds (~10–12/min); do not over-ventilate.
- Opening the airway (medical patient)
- Head-tilt/chin-lift.
- Opening the airway (suspected spinal injury)
- Jaw-thrust maneuver.
- Maximum suction time per attempt
- About 15 seconds (less in infants/children).
- When to use an OPA
- Unresponsive patient with NO gag reflex.
- When to use an NPA
- Decreased LOC with an intact gag reflex; avoid with a suspected basilar skull fracture.
- How to size an OPA
- From the corner of the mouth to the earlobe (or angle of the jaw).
- How to size an NPA
- From the nostril to the earlobe.
- Bleeding control order
- Direct pressure → tourniquet (extremity, high & tight, note the time) → wound packing/hemostatic gauze (junctional).
- Do you loosen a tourniquet in the field?
- No. Once applied for hemorrhage control, leave it on and transport.
- Earliest sign of compensated shock
- Tachycardia with anxiety/restlessness and pale, cool, clammy skin — before the blood pressure falls.
- Narrowing pulse pressure
- The systolic and diastolic values move closer together — an early warning sign of compensated shock.
- Late (decompensated) shock signs
- Falling blood pressure and altered mental status — ominous, late findings.
- Shock treatment (BLS)
- Control bleeding, high-flow oxygen, keep warm and supine, and transport rapidly.
- First step for adult cardiac arrest
- High-quality CPR + apply the AED as soon as it arrives.
- Adult CPR compression-to-ventilation ratio (1 rescuer)
- 30:2.
- How often to switch CPR compressors
- About every 2 minutes (or every 5 cycles) to prevent fatigue.
- AED on a shockable rhythm
- Clear the patient, deliver the shock, then resume compressions immediately.
- Normal capillary refill time
- Under 2 seconds.
- High-priority (load-and-go) findings
- Poor general impression, unmanageable airway, inadequate breathing, uncontrolled bleeding/shock, altered mental status, severe pain.
- Why treat life threats during the primary assessment?
- Because an airway, breathing, or circulation problem can kill the patient before you ever reach the secondary exam — treat it the moment you find it.
- What does SAMPLE stand for?
- Signs/Symptoms, Allergies, Medications, Pertinent past history, Last oral intake, Events leading up.
- What does OPQRST stand for?
- Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, Time — used to investigate pain.
- What does DCAP-BTLS stand for?
- Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Lacerations, Swelling — what to look/feel for in a physical exam.
- Normal adult heart rate
- 60–100 beats per minute at rest.
- Normal adult respiratory rate
- 12–20 breaths per minute at rest.
- Normal adult oxygen saturation
- 94–100% on room air.
- Normal adult systolic BP
- Roughly 90–140 mmHg.
- Normal infant heart rate
- About 100–160 beats per minute.
- Normal infant respiratory rate
- About 30–60 breaths per minute.
- Reassessment interval — unstable patient
- Every 5 minutes.
- Reassessment interval — stable patient
- Every 15 minutes.
- Focused vs rapid physical exam
- Focused = the area of an isolated complaint (stable patient); rapid head-to-toe = significant mechanism, altered mentation, or critical illness.
- What is more important — one vital set or the trend?
- The TREND across repeated sets — it reveals a patient improving or deteriorating before any single number looks alarming.
- Distal CMS check
- Circulation, Motor, and Sensation distal to an injury — checked before AND after splinting.
- Getting a history from an unresponsive patient
- From family, bystanders, the medications on scene, and medical-alert jewelry.
- Components of a full vital set
- Pulse, respirations, blood pressure, skin signs, pupils, and oxygen saturation.
- Pupil assessment (PERRL)
- Pupils Equal, Round, Reactive to Light — unequal/fixed pupils can indicate a serious brain problem.
- Nasal cannula flow & oxygen %
- 1–6 L/min, about 24–44% oxygen — for mild hypoxia in a talking patient.
- Non-rebreather mask flow & oxygen %
- 10–15 L/min, up to about 90% oxygen — for significant hypoxia, patient still breathing adequately.
- Bag-valve-mask oxygen %
- Up to ~100% with a reservoir at 15 L/min — for inadequate or absent breathing.
- Oxygen target SpO₂
- At least 94%; titrate the device to the need.
- Suspected heart attack (ACS) — EMT care
- Rest, oxygen only if hypoxic, aspirin 162–324 mg chewed (no allergy/bleed), and assist the patient's own nitroglycerin.
- Aspirin dose for ACS
- 162–324 mg chewed, if no allergy and no active bleeding.
- When to hold nitroglycerin
- Low systolic BP, a recent PDE-5 inhibitor (e.g., sildenafil), or per local protocol.
- Hypoglycemia signs
- Rapid-onset altered mental status, diaphoresis, tachycardia, tremor, slurred speech, sometimes seizures.
- EMT treatment for conscious hypoglycemia
- Oral glucose between the cheek and gum — only if the patient is awake and can swallow.
- Can an EMT give IV dextrose?
- No — IV dextrose is AEMT-level. EMTs give oral glucose only.
- Stroke screen (3 signs)
- Cincinnati Prehospital Stroke Scale: facial droop, arm drift, abnormal speech.
- Most important info to relay for a stroke
- The last-known-well time — it determines hospital treatment options.
- Anaphylaxis first-line treatment
- Intramuscular epinephrine into the lateral thigh (EMT assists the patient's auto-injector / per protocol).
- Opioid overdose — EMT priority
- Support ventilation FIRST (BVM + oxygen), then give naloxone and titrate to adequate breathing.
- Asthma/COPD wheezing — EMT action
- Coach and assist the patient's own metered-dose inhaler (albuterol); give oxygen.
- Seizure care
- Protect from injury, do not restrain or put anything in the mouth, then protect the airway afterward.
- Conscious choking adult
- Abdominal thrusts until relieved or the patient becomes unresponsive (then begin CPR).
- Rule of nines (adult)
- Head 9%, each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, genitals 1%.
- Burn care (EMT)
- Stop the burning, remove jewelry/non-adhered clothing, cover with a dry sterile dressing, keep warm — never ice, ointments, or pop blisters.
- Airway burn warning signs
- Singed nasal hair, soot in the mouth, hoarseness, or stridor — anticipate airway swelling.
- Open (sucking) chest wound
- Seal with an occlusive (vented) dressing; burp it if a tension pneumothorax develops.
- Tension pneumothorax signs
- Severe dyspnea, absent breath sounds on one side, distended neck veins, hypotension, late tracheal deviation.
- Impaled object
- Stabilize it in place — do NOT remove it (unless it blocks the airway or chest compressions).
- Evisceration (exposed organs)
- Cover with a moist sterile dressing; never push organs back in.
- Splinting principle
- Immobilize the joint above and below the injury; check distal CMS before and after.
- Spinal motion restriction
- Applied selectively by criteria (e.g., NEXUS), not automatically on every trauma patient.
- Late-pregnancy transport position
- Tilted onto the LEFT side to avoid supine hypotensive syndrome.
- Painless bright-red 3rd-trimester bleeding
- Suspect placenta previa — no vaginal exam, treat for shock, position left side, transport.
- Newborn care order
- Warm, dry, position, stimulate — then assess the heart rate.
- Newborn HR below 100
- Begin positive-pressure ventilation (BVM) — heart rate is the key newborn sign.
- Pediatric bradycardia usually means…
- Hypoxia — open the airway and oxygenate/ventilate.
- Heat stroke (vs heat exhaustion)
- Hot skin and altered mental status — a true emergency needing rapid active cooling and transport.
- Hypothermia handling
- Handle gently (rough movement can trigger V-fib), remove wet clothing, rewarm, and give warm oxygen.
- Activated charcoal
- Given only per medical direction for certain ingested poisons; not for caustics, hydrocarbons, or an unprotected airway.
- Carbon monoxide and SpO₂
- CO falsely reads a normal SpO₂ — give high-flow oxygen and remove the patient from the source.
- Behavioral emergency restraints
- Use only when necessary, monitored, and per protocol — never prone (positional asphyxia risk).
- What is START triage?
- Simple Triage And Rapid Treatment — sorts MCI patients by respirations, perfusion, and mental status.
- First step of START triage
- Ask everyone who can walk to move to one area — they are Green (Minor).
- START categories
- Black (deceased/expectant), Red (immediate), Yellow (delayed), Green (minor).
- START 'Immediate' (Red) criteria
- Breathing >30/min, no radial pulse (or cap refill >2 s), OR cannot follow commands.
- Pediatric triage method
- JumpSTART.
- What is an MCI?
- A mass-casualty incident — one whose needs exceed the resources on scene.
- What is ICS?
- The Incident Command System — the standardized NIMS structure for organizing personnel and resources at an incident.
- Hazmat zones
- Hot (contamination), Warm (decontamination corridor), Cold (safe staging/command).
- Which hazmat zone do EMTs work in?
- The cold zone — never enter the hot zone without proper training and PPE.
- Driving 'due regard'
- Operating the ambulance safely for others even with lights/sirens; slow at intersections (most crashes) and wear seatbelts.
- Expressed consent
- Permission to treat given by an informed, competent adult.
- Implied consent
- The legal assumption that an unconscious/incapacitated patient would consent to life-saving care.
- Consent for a minor
- From a parent or legal guardian; implied consent covers a true emergency when none is reachable.
- Refusal of care
- A competent adult may refuse, even life-saving care — ensure it is informed and document thoroughly.
- What is abandonment?
- Ending care without transferring the patient to a provider of equal or higher training.
- What is duty to act?
- An on-duty provider's legal obligation to respond and provide care within their scope.
- Negligence (4 elements)
- Duty, breach of duty, damages, and causation (the breach caused the harm).
- Purpose of the patient care report (PCR)
- A legal record that supports continuity of care; must be accurate, objective, and complete.
- HIPAA
- Protects patient health-information privacy — share only with those involved in care or as the law requires.
- Honoring a DNR
- Follow a valid Do Not Resuscitate order/advance directive; when in doubt or invalid, begin resuscitation.
- Mandatory reporting
- Report suspected child/elder abuse and other conditions specified by state law.
- Air-medical transport
- Consider for critical, time-sensitive patients with a prolonged ground transport.
- Closed-loop communication
- Repeating back an order or hand-off to confirm it was heard correctly.
- Stages of the grief response
- Denial, anger, bargaining, depression, acceptance (Kübler-Ross) — may appear in patients and families.
- EMR scope
- Emergency Medical Responder — CPR, AED, bleeding control, manual airway, and oxygen; the level below EMT.
- Paramedic-only skills
- Endotracheal intubation, cardiac monitoring/12-lead, manual defibrillation/cardioversion, and most IV medications.
- Can an EMT interpret a cardiac rhythm?
- No — cardiac rhythm interpretation is a Paramedic skill. EMTs apply the AED, which interprets the rhythm for them.
- Can an EMT manually defibrillate?
- No — manual defibrillation is Paramedic-level. EMTs use an automated external defibrillator (AED).
- NREMT retake wait
- At least 15 days between attempts; 3 attempts per authorization, then a 24-hour remedial refresher is required.
- Who administers the NREMT exam?
- Pearson VUE, at test centers (and online proctoring).
- What is the NCCP?
- National Continued Competency Program — the CE model for recertifying (national, local, and individual components).
- Standing orders
- Written protocols that let you perform certain interventions without contacting a physician first (offline medical direction).
- Therapeutic communication
- Building trust and gathering information through active listening, eye contact, honesty, and a calm, respectful approach.
- Critical incident stress
- The emotional toll of disturbing calls; managed with peer support, EAPs, and healthy coping — a wellness topic on the exam.
- Cold zone (scene)
- The safe area where EMS stages, treats, and command operates.
- Danger zone at a vehicle crash
- Stay clear of traffic, fuel/fire, electrical hazards, and unstable vehicles; use a safe approach and PPE.
- Violent/crime scene rule
- Stage until law enforcement secures the scene; preserve evidence when you can without compromising care.
- Number of patients exceeds resources
- Recognize an MCI — request more units, start ICS, and begin triage.
- PPE for arterial bleeding
- Gloves plus eye protection and a gown — splash is likely.
- Hand hygiene
- Wash or use sanitizer after every patient contact, even when gloves were worn.
- Trauma vs medical call
- Use the MOI for trauma, the nature of illness for medical — it shapes your assessment approach.
- Agonal breathing
- Slow, gasping, ineffective breaths in/around cardiac arrest — treat as NOT breathing; begin CPR.
- Tripod position
- Sitting upright, leaning forward on the arms to ease breathing — a sign of respiratory distress.
- Accessory muscle use
- Using neck/chest/abdominal muscles to breathe — a sign of increased work of breathing.
- Cyanosis
- A bluish skin/mucous-membrane color from poor oxygenation — a late, serious sign.
- Stridor
- A high-pitched sound on inhalation signaling upper-airway obstruction (croup, epiglottitis, anaphylaxis, foreign body).
- Wheezing
- A whistling sound from narrowed lower airways (asthma, COPD).
- Pulse check location (adult)
- Carotid (or femoral) — take 10 seconds or less to check for a pulse in a possibly pulseless patient.
- Pulse check location (infant)
- Brachial artery.
- Skin signs to assess
- Color, temperature, moisture (and capillary refill in children).
- Over-ventilation danger
- Raises intrathoracic pressure, lowers cardiac output, and causes gastric distension and aspiration.
- Recovery position
- Lateral recumbent position for an unresponsive, breathing patient with no trauma — helps keep the airway clear.
- Child/infant CPR ratio (2 rescuers)
- 15:2.
- AED pad placement
- Upper-right chest and lower-left side; use pediatric pads/dose attenuator for young children if available.
- Do not delay CPR for…
- Pulse-checks, AED set-up beyond pad placement, or moving the patient — push hard and fast, minimize pauses.
- Return of spontaneous circulation (ROSC)
- A palpable pulse returns after arrest; support breathing and perfusion and transport.
- Onset (OPQRST)
- What the patient was doing when the symptom started, and whether it began suddenly or gradually.
- Provocation/Palliation (OPQRST)
- What makes the symptom better or worse.
- Quality (OPQRST)
- How the patient describes the symptom (e.g., crushing, sharp, dull, tearing).
- Radiation (OPQRST)
- Whether and where the pain travels (e.g., chest pain to the arm or jaw).
- Severity (OPQRST)
- The patient's rating of the symptom, often on a 0–10 scale.
- Baseline vital signs
- The first set of vitals — the reference point you compare every later set against.
- Orthostatic (postural) vitals
- Checking for a BP drop / HR rise from lying to standing — a clue to hypovolemia.
- Capnography (EtCO₂) normal range
- About 35–45 mmHg; used in some systems to confirm ventilation.
- AEIOU-TIPS
- A differential for altered mental status: Alcohol, Epilepsy, Insulin, Overdose, Uremia, Trauma, Infection, Psychiatric, Stroke.
- Glasgow Coma Scale (GCS)
- Scores Eye (4), Verbal (5), and Motor (6) responses, 3 to 15; a score of 8 or less indicates a severe brain injury.
- Simple face mask oxygen
- 6–10 L/min, about 40–60% oxygen — moderate hypoxia.
- Venturi mask
- Delivers a precise oxygen concentration — useful for COPD patients.
- Flail chest
- Two or more adjacent ribs broken in two or more places, causing paradoxical chest-wall motion — support ventilation.
- Cushing's triad
- Hypertension with a widening pulse pressure, bradycardia, and irregular respirations — a late sign of rising intracranial pressure.
- Traction splint use
- For an isolated mid-shaft femur fracture (not for joint, lower-leg, or open pelvic injuries).
- Pelvic fracture care
- Major hemorrhage risk — use a pelvic binder, handle gently, and treat for shock.
- Compartment syndrome
- Pain out of proportion, pallor, and paresthesia in a limb — do not elevate or ice; transport.
- Eye injury with impaled object
- Stabilize the object, cover both eyes (to limit movement), and transport.
- Chemical burn to the eye
- Irrigate continuously with water/saline from the inner to outer eye, and transport.
- Nosebleed (epistaxis) care
- Have the patient sit, lean forward, and pinch the soft part of the nose.
- Dehydration/heat exhaustion
- Move to a cool place, rest, give fluids if alert and able to swallow, and monitor — can progress to heat stroke.
- Frostbite handling
- Do not rub the area or let it refreeze; protect and transport for controlled rewarming.
- Sepsis recognition
- Suspected infection plus poor perfusion (fever or low temp, fast HR, fast RR, altered mentation) — oxygen, fluids per ALS, rapid transport.
- Preeclampsia/eclampsia
- New high BP after 20 weeks with headache/visual changes; eclampsia adds seizures — calm, left-side, transport.
- Prolapsed umbilical cord
- Place mother knee-chest (or hips-up), relieve cord pressure with a gloved hand, give oxygen, and transport rapidly.
- APGAR score
- Newborn assessment at 1 and 5 minutes: Appearance, Pulse, Grimace, Activity, Respiration — each 0–2 (max 10).
- Opioid toxidrome
- Pinpoint pupils, respiratory depression, and a decreased level of consciousness.
- Excited delirium
- Severe agitation with hyperthermia — high risk of sudden death; minimize struggle, monitor, and get ALS.
- Spinal immobilization criteria (NEXUS)
- No midline tenderness, no focal deficit, normal alertness, no intoxication, no distracting injury → SMR not required.
- Emergency move
- Used only for immediate danger, to reach a critical patient, or to access another patient — otherwise use proper body mechanics.
- Phases of extrication
- Gain access, assess/stabilize, disentangle, and remove — patient care drives the process.
- Triage tag purpose
- Quickly communicates a patient's priority category to other responders at an MCI.
- Re-triage
- Patients are reassessed as conditions change — a Yellow can become a Red.
- Greatest good for the greatest number
- The guiding principle of MCI triage — resources go where they save the most lives.
- Decontamination before transport
- Hazmat patients are decontaminated in the warm zone before they are loaded for transport.
- Battery vs assault
- Battery = unlawful touching (treating without consent); assault = creating fear of harmful contact.
- False imprisonment
- Unlawfully restraining or transporting a competent patient against their will.
- Good Samaritan laws
- May protect off-duty providers acting in good faith within their training — they don't cover gross negligence.
- Scope vs standard of care
- Scope = what your level/state allows; standard of care = what a similarly trained provider would do in the same situation.
- Hand-off report (SBAR)
- Situation, Background, Assessment, Recommendation — a structured patient hand-off to the receiving staff.
- Warm zone (hazmat)
- The decontamination corridor between the hot and cold zones — limited operations with PPE.
- Hot zone (hazmat)
- The contaminated area of immediate danger — entry only with proper training and PPE; EMTs do not enter.
- Resource: rehab sector
- Where responders rest, rehydrate, and are medically monitored at a prolonged or hazardous incident.
- Scene size-up — order
- Standard precautions → scene safety → MOI/NOI → number of patients → call for resources.
- Distracting injury
- A painful injury that can mask another (e.g., spinal) injury — a reason to maintain spinal precautions.
- Pertinent negative
- A relevant symptom the patient denies (e.g., 'no chest pain') — documented because it helps rule things out.
- Chief complaint
- The main reason, in the patient's own words, that EMS was called.
- Lung sounds — where to listen
- Compare both sides (apices, mid, and bases) for equal, clear breath sounds.
- Detailed physical exam
- A more thorough head-to-toe exam done en route on a stable patient after the secondary assessment.
- Continuity of care
- Passing complete, accurate information to the next provider so care isn't interrupted — the goal of a hand-off and PCR.
- EMS quality improvement
- Reviewing run reports and outcomes to find and fix gaps — improves the whole system over time.
- Mutual aid
- Help requested from neighboring agencies when an incident exceeds local resources.
- Staging area
- A safe location where incoming units wait for assignment at a large incident.
- Span of control (ICS)
- One supervisor manages about 3–7 people (ideally 5) to keep an incident manageable.
- Defensive driving — intersections
- Most ambulance crashes happen at intersections — slow, clear each lane, and proceed only when safe.
- Documentation errors
- Correct an error with a single line through it, initial it, and write the correction — never erase or obscure.
