EMR Chapters 6-8

Question 1

Direct Ground Lift

Answer 1

The direct ground lift is a standard move that can be used to move a patient from the ground or floor to a bed or stretcher. This move is not recommended for use on patients with possible neck or spinal injuries. Depending on the size of the patient, Two or three rescuers can accomplish this move. To accomplish a direct ground lift, the patient should be lying face up or supine, and the patient arms should be placed over their chest. You and your helpers should line up on one side of the patient. One rescuer should be at the patient’s head, another at his or her hips and thighs. Each rescuer should drop one to the ground and keep the other foot planted on the floor. The rescuer at the patient’s head should place one arm under the patient’s neck, and the grasp the far shoulder to cradle the head the other arm should be placed under the patient’s back, just above the waist. The second rescuer should place one arm above, and one arm below the patient’s thighs. On the signal of the rescuer at the head, both rescuer should lift the patient up to the level of their knees. then, on signal, the rescuers should roll the patient towards their chests. finally, on signal, everyone should stand while holding the patient. The patient cannot be moved, reversing the process, when it is time to place him or her in a supine position.

Question 2

Extremity lift

Answer 2

An extremity lift requires two people. This lift is ideal for moving a patient from the ground to a chair or a stretcher. It also can be used to move a patient from a chair to a stretcher. It should not be performed, however, if there is a possibility of head, neck, spine, shoulder, hip, or knee injury, or any suspected fractures to the extremities that have not been immobilized.
The patient should be placed face up with knees flexed. You should kneel at the head of the patient, placing your hands under his or her shoulders. Have your helper stand at the patient’s feet and grasp his or her wrist. Direct your helper to pull the patient into a sitting position while you push the patient from the shoulder. do not have your helper pull the patient by the arms if there are any signs of suspected fractures. Slippery arms under the patient’s armpits and grasp the wrist. Once the patient is in a semi-sitting position, have your helper crouch down and grasp the patient’s legs behind the knees. Direct your helper, so you both stand at the same time. Then move as a unit to one carrying the patient. Try to walk out of step with your patient to avoid swinging the patient. The rescuer at the head should direct the rescuer at the feet when to stop the carry in one to place the patient down in a supine or seated position.

Question 3

Direct carry method

Answer 3

The direct carry is performed to move a patient with no suspected spine injury from a bed, or from a bed level position to a stretcher. First, position the stretcher perpendicular to the bed, with the head end of the stretcher at the foot of the bed. Prepare the stretcher by unbuckling the straps and removing other items. Then, two rescuers should stand between the bed and the stretcher, facing the patient. The first rescuer should slide an arm under the patient’s neck and cup the shoulder, while the second rescuer slides a hand under the patient’s hip and lifts slightly. The first rescuer, then slides his or her other arm under the patient’s back, while the second rescuer, place his or her arms around the patient’s hips and calves. Finally, both rescuers should slide the patient to the edge of the bed, lift/curl him, or her toward their chests, and rotate and place the patient gently onto the stretcher.

Question 4

Draw sheet method

Answer 4

The draw sheet method is an additional way of moving a patient with no suspected spine injury from a bed to a stretcher. This move may be performed from the side of the bed, or from either the head, or the foot of the bed, which ever gives you best access to the patient. To perform the draw sheet method from the side of the bed, begin by loosening the bottom sheet under the patient and positioning the stretcher next to the bed. Be sure to secure the stretcher, so it does not move while transferring the patient from the bed to the stretcher. next, adjust the height of the stretcher, to match the level of the bed, lower the rails, and unbuckle the straps. Both rescuers should reach across the stretcher and rule the sheet against the patient. Grasp the sheet firmly at the patient’s head, chest, hips, and knees. Finally, draw the patient onto the stretcher, sliding him or her in one smooth motion.
several devices have been developed in recent years to make the task of moving patients from stretcher to bed easier and safer. Devices such as slider boards, and slide bags are in the use of many hospitals and nursing care homes.

Question 5

Single-operator stretcher

Answer 5

A type of wheeled stretcher, which is the typical equipment used for packaging and loading a patient and is the most appropriate device for moving a patient over smooth, terrain. This type of stretcher allows a single operator to load the stretcher into the ambulance, without the assistance of a second individual. The undercarriage is designed to collapse and fold up as the stretcher is pushed into the ambulance.

Question 6

Dual-operator stretcher

Answer 6

Another type of wheeled stretcher that requires a second individual to lift the undercarriage prior to pushing it into the ambulance.

Question 7

Electric/pneumatic stretcher

Answer 7

Another type of wheel stretcher that is equipped with an electric or pneumatic mechanism that will lift and lower it at the touch of a button. It minimizes the need for rescuers to lift a stretcher with a patient on it, thereby significantly reducing the risk of back injury.

Question 8

Bariatric stretcher

Answer 8

Another type of wheel stretcher that is designed to accommodate oversized patients up to a maximum of 1600 pounds. It is wider and stronger and can be loaded into the ambulance with a specialized winch system.

Question 9

Other types of equipment for transportation: portable stretcher

Answer 9

This type of stretcher is also known as a folding stretcher or flat stretcher. It is much lighter than a standard wheel stretcher, and it makes the task of moving a patient downstairs or out of tight spaces much easier. Portable stretchers are typically a combination of canvas and aluminum, and they usually fold or collapse for easy storage.

Question 10

Flexible stretcher

Answer 10

This stretcher is made of rubberized canvas or other flexible material, such as heavy plastic, often with a wooden slats sewn into pockets. The flexible stretcher usually has three carrying handles on each side. Because of its flexibility, it can be useful in restricted areas or narrow hallways .

Question 11

Stair chair

Answer 11

The stair chair helps rescuers move seated medical patients down stairways, and through tight spaces where I traditional stretcher will not fit. Most stair chairs are made of sturdy folding frames with either canvas or hard, plastic seeds, and are easy to store. They have a wheels that allow rescuers to roll them over flat surfaces. Some models have a tractor tread mechanism that allows them to easily slide down stairways just by tilting them.

Question 12

Basket stretcher

Answer 12

This device is sometimes referred to as a Stokes basket. It is most commonly used for wilderness or cliff rescue situations. Used in rescue situations and to transport over rough terrain.

Question 13

Scoop stretcher

Answer 13

This device is typically made of hard plastic or aluminum. It is called a scoop stretcher, because it splits vertically into two pieces, which can be used to “scoop”the patient up. these stretches are ideal for moving patients in the position in which they are found.

Question 14

Long spine board

Answer 14

Spine boards are also known as backboards. The long spine board is used for patients who are suspected of having a significant spinal injury. Backboards have been proven to cause pain, agitation, and respiratory compromise in some patients. Current research suggests more discretion with the use of long back boards, with their use reserved for patients with the following:
- Blunt trauma and altered level of consciousness
- Spinal pain or tenderness
- Neurologic complaint, such as numbness or motor weakness
- Anatomic deformity of the spine
- High energy mechanism of injury, and any of the following: Drug or alcohol, intoxication, inability to communicate, or a distracting injury. A distracting injury is the one that prevents the patient from realizing pain in the neck or spine, such as a significant injury to the forearm or chest.

Question 15

Vest-type extrication device

Answer 15

The extrication vest is used to help immobilize and remove patients found in a seated position in a vehicle. It wraps around the patient’s torso, stabilize the spine and has an extended section above the vest with side flaps for stabilizing, the patients head and neck. Rescuers, secure the patient’s head, neck, and torso with straps and padding. The vest has handles that aid in lifting the patient out of the vehicle and onto a long spine board.

Question 16

Full-body immobilization device

Answer 16

The most common type is the full body vacuum splint. It consists of a large airtight bag filled with tiny beads. As the patient is placed on the device, it can be molded to fit the shape and contours of the patient’s body. Once it is in place, a portable vacuum is activated to remove the air from the bag. This result is a hard, cast like splint that immobilizes the patient.

Question 17

Pedi-board

Answer 17

Special, spinal immobilization boards are made to fit infants and children. The back of a child’s head is a larger proportionately than an adults, so boards have a depression in the head and to fit. However, it is still necessary to pad, the child body from the shoulders to the heels to ensure the airway is in a neutral position, while the child is secured on the board.

Question 18

Log roll

Answer 18

To move a prone patient to a supine position and ensures stability of the head and spine, where in injury is suspected, perform a log roll. A log roll can also be used for transferring a supine patient onto a long backboard when there is a likelihood of neck or back injury. However, the lift and slide technique has been shown to cause the less movement of the neck and spine during transferred to a long backboard. A log rule can be accomplished with as few as two rescuers, but three is ideal to minimize twisting of the patient’s spine during the procedure.

Question 19

Lift-and-slide technique

Answer 19

The lift and slide technique was shown to result in less movement of the head and spine during transfer onto a long backboard. Performing this maneuver requires a minimum of five and often six rescuers. One rescuer maintains manual stabilization of the head, while a cervical collar is placed. the other four rescuers position themselves on either side of the patient and, on the count of the rescuer at the head, lift the patient a few inches off the ground. An additional rescuer or bystander may be necessary to carefully position the backboard or stretcher beneath the patient. On the counter, the rescuer at the head, everyone carefully lowers the patient down onto the backboard. The patient is then secured to the backboard.

Question 20

Patient Restraint

Answer 20

Attempting to restrain a patient is dangerous and can place you, your fellow, rescuer, and the patient at risk for injury. Consider all your options such as verbal de-escalation, or waiting for law-enforcement to arrive before attempting restraint, and always follow local protocols. Follow these guidelines when attempting to restrain a patient:
- Ensure that you have adequate assistance of at least four people, including yourself
- clearly planned the action so all participants are clear about their responsibilities
- stay outside of the patient’s range of motion until ready to act
- Once the plan is clear, act immediately
- Approach the patient all at once, with each assistant assigned to control a particular limb.
- Talk to the patient calmly during the restraining process
- Secure all limbs with the appropriate restraining equipment
- Do not secure the patient face down
- Following restraint, check the patient’s airway, breathing, and circulation often.
- Clearly document the reason for restraining the patient as well as the procedure and equipment used.
- Ensure that the group uses only the force required to effectively restrain the patient.

Question 21

Communication

Answer 21

The sharing, or exchanging of information or news. It is extremely important that you understand the characteristics of good communication and what to do when it goes bad. The following is a list of some of the individuals you are likely to communicate with on a regular basis:
- patients
- your partner
- other EMS personnel
- fire personnel
- law enforcement personnel
- hospital personnel
- bystanders
- family members
- friends of patients

Question 22

Types of communication

Answer 22

• verbal. Words and sounds that make up the language we speak.
• nonverbal. Body language, eye contact, and gestures.
  -written. The use of letters and words to express the language we speak.
• visual. Signs, symbols, and designs.

Question 23

The communication process

Answer 23

For any communication activity to be effective, it must have the following components: there must be a sender or one who introduces a new thought or concept, or initiates the communication process. There is the message, which is the thought, concept, or idea being transmitted. There is the receiver or the one for whom the message is intended.

Question 24

Transmitting the message

Answer 24

Research suggests that 55% of communication is delivered by way of body language, which includes gestures, expressions, posture, and many other physical manifestations. About 38% of the message is transmitted by way of the voice or its quality, tone, and inflections, which all express important pieces of the message. Only 7% of any given message is transmitted by this specific words used (verbal).

Question 25

Barriers to communication

Answer 25

Physical (doors, walls, distance, etc); perceptual; emotional; cultural; language; gender; interpersonal

Question 26

Strategies for effective communication

Answer 26

• speak clearly and use the words and terminology that the receiver will understand.
• Keep an open mind, and resist the urge to be defensive or accusatory.
• become an active listener which means putting your biases aside and making every effort to understand what the other individual is saying. Active listening includes using eye contact when appropriate and asking clarifying questions to further define the message.
• Be assertive when appropriate, especially when safety is at stake.
• Remain aware of the influence that body language plays in effective communication.
• Except the reality of miscommunications.

Question 27

Interpersonal communication

Answer 27

A form of communication that most often occurs between three or fewer participants who are in close proximity to one another

Question 28

Therapeutic communication

Answer 28

The face-to-face communication process that focuses on advancing the physical and emotional well-being of a patient. There are three objectives of therapeutic communication that you must be aware of to maximize the results for both you and the patient:
- Collecting information.
- Assessing behavior.
- Educating.

Question 29

Strategies for successful interviewing

Answer 29

• immediately introduced yourself and your level of training
• Obtain the patient’s preferred to name early, and use it frequently during your interview
• Position yourself at or below the patient’s eye level whenever possible
• Ask one question at a time, and allow the patient ample time to respond
• Listen carefully to everything the patient tells you
• Restate the patient’s answers when necessary for clarification

Question 30

Transfer of care

Answer 30

The physical and verbal, handing off of care from one healthcare provider to another. A good transfer of care should contain all of the following elements, regardless of whether the transfer happens at the scene or at the hospital:
- Patient’s name and age
- Chief complaint or the primary patient complaint
- Brief account of the patient’s current condition
- Past pertinent medical history
- Vital signs
- Pertinent findings from the physical exam
- Overview of care provided and the patient response to that care

Question 31

Radio communications

Answer 31

All EMS systems are connected by a very sophisticated arrangement of hardware and software designed to allow all of the resources in the structure to communicate with one another. At the heart of the systems are the radios, pagers, antennae, repeaters (a fixed antennae that is used to boost a radio signal), and specific frequencies that connect each and every vehicle and individual in the system. EMS is set in motion when someone initiates an emergency response by calling 911.
A typical radio system is made up of a combination of transmitters, receivers, repeaters, and antennae. Dispatch centers use powerful base station radios (a high-powered, two-way radio located at a dispatch center or a hospital) that can transmit over a wide area. When terrain is a factor and hills and mountains obstruct radio signals, specialized mountain top, repeaters, are used to capture the signal and redirected to the appropriate receiver.
EMS personnel often carry both pagers and handheld or portable radios that allow them to communicate with the dispatch center and each other. Pagers are used to notify response personnel of an emergency call, and portable radios are used to communicate directly with the dispatch center before, during, and after a call.
You should listen first and begin your transmission when there is a break in the radio traffic on your frequency.

Question 32

Patient care reports

Answer 32

A patient care report is a document that provides details about a patient’s condition, history, and care, as well as information about the event that caused the illness or injury. Some PCR’s are done by hand, but more and more emergency care services are adopting computerized, or electronic documentation. Regardless of how the reports are completed, there are many reasons for accurate and complete documentation. These include:
- continuity of care which refers to how each provider who is assuming care for a patient is properly informed of the patient’s progression, so he, or she can watch for trends and continue effective treatments.
- education. You’re written report may be used as an example for others of proper or not so proper documentation.
- Administration. The report will be used for the compiling of statistical analysis on issues that affect your agency or community.
- Quality assurance. Reports created by you and others in your agency or organization may be reviewed as part of a structured process to improve the overall quality of the care. Your agency provides as well as that of the EMS system as a whole.
- Legal. The report you created is a legal document. It may be used in a civil or - criminal court for any number of reasons.
You need to be aware that all patient information must be considered private and confidential, and you may not share it with anyone outside the chain of direct patient care. One exception to this is when a patient information is requested by a law enforcement officer.

Question 33

Elements of the PCR

Answer 33

Standard PCRs used throughout the EMS profession all share several specific sections. These sections are:

• run data. This section includes information about the call itself, such as the names of the emergency medical responders, taking action, the agency they work for, the date and time of the incident, and Eavan certification levels of those providing patient care. This section may also include the final outcome of the call, such as a patient refusal to be treated, or the name of the person who assumed patient care from you. Remember, all names, times, and locations recorded on your PCR‘s Must be accurate because continued care, billing, and statistical information will all depend on the information you provide.
• Patient data. This section includes all the information about the patient, such as:
• Name, address, date of birth, gender
• Nature of the call
• Detailed notes on the patient’s complaint
• Mechanism of injury
• Assessment findings
• Care administered prior to arrival of EMR
• Vital signs
• Past medical history
• Changes in the patient’s condition
• Treatment provided in the patient’s response to that treatment

The information in each of the sections of the report can be entered in various ways:
- Fill-in
- Check boxes
- Narrative. Space is provided for you to write the “story” documenting the patient’s history, assessment, or care information that does not otherwise fit in checkboxes, or that requires expansion on the details. Often the narrative will contain a blend of both objective and subjective information.

Question 34

Minimum data set

Answer 34

The minimum information required by the US department of transportation (DOT) standards for each patient; applies to only 911 calls. The minimum data set includes:
- Time the incident was reported to 911
- Time of dispatch
- Time of arrival at the patient’s location
- Time the patient was transported from the incident location
- Time the patient arrived at the destination, such as the hospital, aid, station, etc.
- Time the patient care was transferred to more advanced providers
- Patient’s chief complaint
- Patient’s vital signs
- patient’s demographics (age, gender, race, weight)

Question 35

The narrative

Answer 35

A complete, thorough, and well balanced PCR should contain a narrative that tells a brief story about the patient and his or her chief complaint. This is often the most difficult part of the PCR for providers. The story you tell through the narrative should be clear, concise, and as objective as possible.

Objective information: some of the information you gather will be objective in nature. Objective information is impartial and unbiased. The easiest way to think about objective information is that it is most often related to something you can see, here, feel or measure. Much of the objective information about a patient is documented in other areas of the PCR, but some key objective information should be included in the narrative. For example, the following is a list of signs that you might observe during your care of a patient:
- Pulse rate
- Skin color
- breathing rate
- Blood pressure
- Swelling
- Bruising
- The fact that the patient vomited

Subjective information: some of the information you will gather during your assessment will be subjective in nature. Subjective information is often the opinion of the EMR, and is influenced by perception, personal feelings, and prior experience. Symptoms - things that a patient describes such as pain, discomfort, feeling nauseated, or feeling lightheaded - are all subjective findings. subjective information, comprises, personal opinions, judgments, points of view, and other details that are not easily measured. It is up for interpretation, and may even include descriptions of how people feel about something.

Question 36

Correcting errors

Answer 36

At times, you may document something incorrectly while completing a PCR. In this case, if you are using a paper form, you would cross out the incorrect item with a single line, initial it, and write the correct number beside or above it. Never completely cover the incorrect information because it may appear that you were attempting to hide something. Errors made while using an electronic PCR program typically require that you submit an electronic addendum to the original report.

Question 37

Methods of documentation

Answer 37

• Paper forms
• Computer-scan forms
• Laptop/tablet computers
• Smart phone applications