Skill sets

Question 1

Removing contaminated gloves

Answer 1

Using dominant hand, grasp exterior of the opposite glove at the wrist, ensuring that you do not contaminate your skin. 1 (CPI) Starting at wrist, fold glove over and peel it back, turning it inside out as you remove the glove. 1 Place the removed glove in the palm of your gloved dominant hand. 1 Place ungloved fingers inside the cuff of the gloved hand, making sure you do not touch exterior of gloved hand. 1 (CPI) Peel the glove off of your hand, turning it inside out as you remove it. 1 Gloves should be turned inside out, with the second glove serving as a container for the first glove. 1 Objective: To remove contaminated gloves. Must receive 4 out of 6 points.

Question 2

Bridge/bean lift

Answer 2

Initiates Standard Precautions. 1 (CPI) If pt. has suspected spinal injury, then do not use this lifting technique. 1 Determines the number of lifters available for positioning: • 4 people—position at head, chest, waist, and knees • 5 people—position at head, chest, waist, thighs, and knees 1 Prepares and position all of the equipment needed. 1 Positions the lifters and have them form a bridge over the patient, head-toshoulder or shoulder-to-shoulder. (Note: all lifters must use the same configuration whether it is head-to-shoulder or shoulder-to-shoulder.) 1 Explains the commands, procedures, and hand positions for the lift, including distance patient is to be lifted. 1 Positions hands underneath the patient to lift at points of body mass (shoulders, hips). Rescuer at head directs lift. 1 Executes the lift. Another rescuer slides the device into place starting at the pt.’s feet. Lower the patient as a unit. 1 (CPI) Must receive 6 out of 8 points.

Question 3

Multiple person direct ground lift

Answer 3

a

Question 4

Pt assessment

Answer 4

Scene Size-Up Determines scene is safe. 1 (CPI) Introduces self, obtains permission to examine/treat. 1 Initiates Standard Precautions. 1 (CPI) Determines the MOI (mechanism of injury) and/or NOI (nature of illness)— patient’s chief complaint. 1 (CPI) Identifies the number of patient(s) and the LOR of each. 1 Forms general impression—evaluates any extrication issues for each patient(s); considers c-spine stabilization/immobilization. 1 Objective: To demonstrate the proper assessment of a patient, to determine a baseline, and to select the appropriate transport method. Primary Assessment Assesses airway, breathing, circulation, disability (ABCDs). 1 (CPI) Provides any necessary interventions related to airway/breathing. 1 (CPI) Checks for and controls any major bleeding. 1 (CPI) Confirms and monitors LOR (AVPU or GCS). 1 Calls for transport, equipment, and/or additional assistance. 1 Secondary Assessment Performs detailed head-to-toe body assessment physical exam DCAP-BTLS. 1 (CPI) Obtains SAMPLE history from patient and/or witness (if available). 1 Obtains baseline set of vitals. 1 (CPI) Provides interventions per protocols. 1 Treats for shock. 1 Maintains spinal immobilization if applicable. 1 (CPI) Prepares patient for transport. 1 Reassesses vital signs and primary assessment. 1

Question 5

Pt assessment Trauma

Answer 5

Scene Size-Up
Determines that scene is safe. 1 (CPI)
Introduces self, obtains permission to assist/treat. 1
Initiates Standard Precautions. 1 (CPI)
Determines the MOI (mechanism of injury)—patient’s chief complaint. 1 (CPI)
Identifies the number of patient(s) and the LOR of each. 1
Forms general impression—evaluates any extrication issues for each patient(s);
considers c-spine stabilization/immobilization.
1
Primary Assessment
Assesses airway, breathing, circulation, disability ( ABCDs). 1 (CPI)
Manages/treats life threats. 1
Checks for and controls any major bleeding. 1 (CPI)
Confirms and monitors LOR (AVPU or GCS). 1
Calls for transport, equipment, and/or additional assistance, EMS if needed. 1
Secondary Assessment
Performs head-to-toe detailed body assessment. DCAP-BTLS. 1 (CPI)
Exposes and inspects injury to identify level of emergency and formulate
treatment plan.
1 (CPI)
Obtains SAMPLE history from patient and/or witness (if available). 1
Obtains baseline set of vitals. 1 (CPI)
Provides interventions per local protocols. 1
Treats for shock. 1
Prepares patient for transport. 1
Reassesses vital signs and primary assessment. 1

Maintains spinal immobilization if applicable. 1 (CPI)

Must receive 16 out of 20 points.

Question 6

Pt assessment Medical

Answer 6

Scene Size-Up
Determines that the scene is safe. 1
Introduces self and obtains permission to examine/treat. 1
Initiates Standard Precautions. 1 (CPI)
Determines NOI (nature of illness)—patient’s chief complaint. 1 (CPI)
Identifies the number of patient(s) and the LOR of each. 1
Forms general impression—evaluates any extrication issues and considers spinal
precautions.
1
Primary Assessment
Assesses airway, breathing, circulation, disability (ABCDs). 1 (CPI)
Assists breathing, manages/treats life threats. 1 (CPI)
Confirms and monitors LOR (AVPU or GCS). 1
Calls for transport, equipment, personnel, and EMS if needed. 1
Secondary Assessment
Performs detailed head-to-toe body assessment/physical exam. 1
Obtains SAMPLE history. 1 (CPI)
Based on the chief complaint, gathers information by asking OPQRST questions. 1 (CPI)
Obtains baseline vital signs. 1 (CPI)
Provides interventions per local protocols. 1 (CPI)
Treats for shock. 1
Maintains spinal immobilization if applicable. 1 (CPI)
Prepares patient for transport. 1
Reassesses vital signs and primary assessment. 1
Must receive 17 out of 19 points.

Question 7

Pt assessment pupils

Answer 7

Initiates Standard Precautions. 1 (CPI)
Obtains permission from patient. 1
Notes initial size/shape as patient stares at examiners forehead. 1 (CPI)
Shines a light into one eye, noting reaction of pupil. 1 (CPI)
Shines light again into first eye noting if the reaction/size of other pupil gets
smaller.
1
Shines light into other (2nd) eye, noting if pupil gets smaller.
Shines light again into the second eye noting if the other eye reacts by getting
smaller.
1 (CPI)
Acknowledges if reactions are WNL. 1
Must receive 5 out of 7 points.

Question 8

Pt assess pulse

Answer 8

Initiates Standard Precautions. 1 (CPI)
Obtains permission from patient. 1
Locates radial pulse (for child 7 8 YOA, locate brachial pulse).
Locates carotid pulse for unresponsive patient.
1 (CPI)
Notes quality of pulse (strength/regularity). 1
Notes and verbalizes rate. 1 (CPI)
Acknowledges if rate obtained is WNL. 1
Must receive 4 out of 6 points.

Question 9

Assess Resp rate

Answer 9

Initiates Standard Precautions. 1 (CPI)
Obtains permission to treat patient. 1
Determines if patient can speak in complete sentences. 1
Looks for chest rise and fall (On unresponsive patient, places hand on patient’s
chest or listen at mouth for respirations).
1
Determines if patient has breathing problems. 1
Assesses respirations for the following:
• Rhythm
• Depth
• Effort
• Noise
1
Counts number of breaths for 30 seconds and multiply by tow for respirations per
minute determines if patient is breathing within normal limits (12–20 adult) (14–24
child) (20-30 infant).
1 (CPI)

Must receive 5 out of 7 points.

Question 10

Obtaining BP by auscultation

Answer 10

Initiates Standard Precuations. 1 (CPI)
Obtains permission to treat patient. 1
Applies the cuff snugly to the humerus above the elbow ensuring that arrow on
cuff points to brachial artery. Place the sphygmomanometer in position to easily
read.
1 (CPI)
Palpates the brachial artery. 1
Places the stethescope diaphragm over the brachial artery and grasp the ballpump.
Turn the valve clockwise to close.
1
Pumps a pressure of 160mmHg, if you can hear the pulse sound immediately inflate
to 200mmHg. If you can still hear the heartbeat inflate in 20mm increments until no
sound is heard. Open the valve counterclockwise and let the air escape slowly.
1
Notes the number on the gauge where the first beat is heard (systolic pressure)
as the needle descends.
1 (CPI)
Notes the number on the gauge where the last beat is heard (diastolic pressure). 1 (CPI)
Opens the valve, and quickly release remaining air. 1

Must receive 7 out of 9 points.

Question 11

Suctioning Pt Airway

Answer 11

Initiate Standard Precautions. 1 (CPI)
Make sure the suctioning unit is properly assembled and turn on the unit if using
a power system.
1
Pre-oxygenate patient prior to suctioning. 1
Open the patient’s mouth and insert the catheter only as far as you can see. 1 (CPI)
Apply suction in a side to side or circular motion as you withdraw the catheter. 1
Do not suction an adult for more than 15 seconds. 1 (CPI)

Must receive 4 out of 6 points.

Question 12

Insert NP airway

Answer 12

Initiate Standard Precautions. 1 (CPI)
Size the airway. Place the flange against the nostril, and the end should touch the
patient’s lower earlobe. Coat the tip and the entire length with a water-based
lubricant.
1
Insert the lubricated airway into the larger nostril with the curvature following the
floor of the nose. If you are using the right nare, the bevel should face the
septum. If using the left nare, insert the airway with the tip of the airway pointing
upward, which will allow the bevel to face the septum.
1 (CPI)
Gently advance the airway. If using the left nare, insert the nasopharyngeal airway
until resistance is met. Then rotate the nasopharyngeal airway 180 into position.
This rotation is not required if using the right nostril.
1 (CPI)
Continue until the flange rests against the skin. If you feel any resistance or
obstruction, remove the airway and insert it into the other nostril.
1

Must receive 4 out of 5 points.

Question 13

Insert OPA

Answer 13

Initiate Standard Precautions. 1 (CPI)
Hold the adjunct against the side of the face with the flange adjacent to the
corner of the patient’s mouth. Size the airway by measuring from the
patient’s earlobe to the corner of the mouth or from the corner of the mouth
to the angle of the jaw.
1 (CPI)
Open the patient’s mouth with the cross-finger technique. Hold the airway
upside down with your other hand. Insert the airway with the tip facing the
roof of the mouth and slide it in until it is half way into the mouth.
1 (CPI)
Rotate the airway 180°. Insert the airway until the flange rests on the patient’s
lips.
1 (CPI)

Must receive 4 out of 4 points.

Question 14

Oxygen tank set up and breakdown

Answer 14

Inspect the tank, regulator, and O ring or washer for any visible damage. 1
Using an oxygen wrench or the valve stem on the top of the cylinder turn the
valve counterclockwise to slowly “crack” the cylinder for 1 second.
1 (CPI)
Attach the regulator/flow meter to the valve stem using the two pin-indexing
holes and make sure that the washer is in place over the larger hole. Do not
overtighten.
1
Open the O2 system by turning the valve stem on top of the cylinder or using the
wrench, counterclockwise.
1
Check for/correct any leaks. Check for adequate pressure in tank. 1
Attach the oxygen connective tubing to the flow meter. 1
Set the regulator to the proper flow based on the delivery device. 1 (CPI)
Secure the bottle from falling. 1 (CPI)
Close regulator and release pressure from tank. 1 (CPI)
Remove regulator from tank. 1

Must receive 8 out of 10 points.

Question 15

Shock Management

Answer 15

Determine the scene is safe. 1 (CPI)
Introduce self, obtain permission to treat/help. 1
Initiate Standard Precautions. 1 (CPI)
Assess the ABCDs and treat as needed. 1 (CPI)
Recognize patient is showing signs and symptoms of shock. 1
Apply high-flow oxygen. 1
Initiate steps to prevent heat loss from the patient. 1
Properly position the patient with the head lower than the feet, allowing for
consideration of spinal integrity or any significant lower leg injury.
1
Provide for rapid transport. 1
Monitor vital signs regularly (every 3–5 minutes). 1

Must receive 8 out of 10 points.

a

Question 16

Auscultation of breath sounds

Answer 16

Initiates Standard Precautions. 1 (CPI)
Obtains permission from patient. 1
Warms stethoscope. 1
Upper Right Lobe Anterior: places stethoscope on right side of anterior chest
1–1.5 below the middle of the clavicle (2nd intercostal space).
1
Upper Left Lobe Anterior: places stethoscope on left side of anterior chest 1–1.5
below the middle of the clavicle (2nd intercostal space).
1
Lower Right Lobe Anterior: places stethoscope on the right side of chest 2
below the nipple line.
1
Lower Left Lobe Anterior: places stethoscope on the life side of the chest 2
below the nipple line.
1
Upper Right Lobe Posterior: places stethoscope on right upper back between
top of the scapula and the spine 2 below the neck.
1
Upper Left Lobe Posterior: places stethoscope on left upper back between top
of the scapula and the spine 2 below the neck.
1
Lower Right Lobe Posterior: places stethoscope on the right lower back below
the bottom of the scapula.
1
Lower Left Lobe Posterior: places stethoscope on the left lower back below the
bottom of the scapula.
1
Notes and verbalizes breath sounds—normal or abnormal. 1 (CPI)

Must receive 10 out of 12 points.

Question 17

Assisting with metered does inhaler

Answer 17

Initiate Standard Precautions. 1 (CPI)
Obtain patient’s permission to assist. 1
Verify the correct medicine, the correct patient, the correct dose, and that the
medication is not outdated.
1 (CPI)
Vigorously shake the canister; remove the protective cap and apply spacer if
available.
1
Assist patient by holding the device to the patient’s mouth. 1
Encourage the patient to take a deep breath. Assist the patient by depressing
the top of inhaler once to administer the spray. Instruct the patient to hold breath
for approximately 10 seconds.
1
Repeat the treatment ONCE if no improvement according to the instructions on
the inhaler, or in 30–60 seconds.

Must receive 5 out of 7 points.

Question 18

Admin of auto injector

Answer 18

Determines scene is safe. 1 (CPI)
Initiates Standard Precautions. 1 (CPI)
Obtains patient’s permission to assist. 1
Verifies the correct medicine, the correct patient, the correct route, correct dose,
and verifies medication is current.
1 (CPI)
Ensures that patient meets the medical requirements for administration of auto
injector.
1
Removes the pen from its protective case. Removes the cap with the black tip
pointing to the thigh. Holds the pen in the middle keeping your digits from either
end of the pen.
1
Assists the patient with administrating the pen by holding and firmly striking the
outer thigh muscle between the knee and hip through the patient’s clothing and
holds for 10 seconds. If leg is exposed wipes area first with alcohol wipe. Listens
for audible click to indicate needle was activated. Massages the injection site for
10–20 seconds after pen removal from the patient.
1
Records the event for type, quantity, and time. 1
Reassesses the patient vitals and lung sounds. 1
If applicable, and the patient has a second auto injector, assists with
administration of a second dose. Records the type, quantity, and time.
1
Verbalizes proper disposal of the pens with exposed needle. 1

Must receive 8 out of 11 points.

Question 19

Controlling bleeding

Answer 19

Determines scene is safe. 1 (CPI)
Introduces self, obtains permission to help/treat. 1
Initiates Standard Precautions. 1 (CPI)
Exposes the wound site. 1 (CPI)
Identifies the severity of the bleeding. 1
Applies sterile dressing and direct pressure. 1 (CPI)
Maintains direct pressure; applies additional dressing if needed. 1
If bleeding continues, remove dressing and apply a hemostatic bandage
(if authorized).
1 (CPI)
If bleeding continues despite direct pressure and hemostatic bandage, Verbalizes
application of a tourniquet and mark forehead.
1 (CPI)
Bandages the wound and immobilizes as appropriate. 1 (CPI)
Treats for shock as indicated. 1
Prepares patient for transport. 1

Must receive 10 out of 12 points.

Question 20

Stabilizing impaled object

Answer 20

Determines scene is safe. 1 (CPI)
Introduces self, obtains permission to help/treat. 1
Initiates Standard Precautions. 1 (CPI)
Manually stabilizes object, ensuring that no movement or additional damage
occurs to surrounding/underlying tissue.
1
Exposes the wound site. 1
Applies direct pressure using a dressing to control bleeding. 1 (CPI)
Does not remove the object unless it interferes with airway. Stabilizes the object
and body part using bulky dressings around object. If airway is
blocked/compromised, removes the object.
1 (CPI)
Secures the object with the appropriate materials. Shortens object if it is too long
or unwieldy.
1
Secures the patient to a long board for stabilization. 1
Assures that the object cannot move during transport. 1

Must receive 8 out of 10 points.

Question 21

Figure 8

Answer 21

Determines that scene is safe. 1 (CPI)
Introduces self, obtains permission to treat/help. 1
Initiates Standard Precautions. 1 (CPI)
Exposes/visualizes injured area to determine that a figure eight is appropriate. 1 (CPI)
Places patient in a sitting position. 1
Assesses CMS. 1 (CPI)
Places one cravat around each shoulder (over and under the armpit); ensures that
the cravat is not directly over the fracture site and that front of cravat has wide band.
1
Crosses ends of cravats that are behind patient to make a figure eight. 1
Tightens cravats so that the position of the shoulders is the same as if the patient
were sitting normally (shoulders should not be pulled all the way back).
1
Ties cravats with square knots, ensuring that the shoulders are in normal position. 1
Reassesses CMS. 1 (CPI)
Treats for shock if appropriate. 1
Prepares patient for transport. 1

Must receive 10 out of 13 points.

Question 22

Splint upper extremity

Answer 22

Determines scene is safe. 1 (CPI)
Introduces self, obtain permission to help/treat. 1
Initiates Standard Precautions. 1 (CPI)
Exposes injury to assess and manage the ABCDs. 1 (CPI)
Bandages any wounds as necessary. 1
Directs helper to stabilize abouve and below the injury site. 1 (CPI)
Assesses for CMS. 1 (CPI)
Technician chooses the correct device/material for splinting/stabilization. 1
Sizes splint properly; pading as needed and positions splint. 1
Rotates extremity if necessary and as tolerated by patient. 1
Extremity is splinted and stabilized with minimal movement. 1 (CPI)
Sling and swathe correctly applied and restricts movement of injured extremity. 1
Reassesses CMS. 1 (CPI)
Applies cooling method to help reduce swelling/bruising. 1
Prepares patient for transport. 1
Provides oxygen/treat for shock if appropriate. 1

Must receive 13 out of 16 points.

Question 23

Blanket roll for shoulder

Answer 23

Determines that scene is safe. 1 (CPI)
Introduces self, obtains permission to treat/help. 1
Initiates Standard Precautions. 1 (CPI)
Exposes injury; assesses and manages the ABCDs. 1 (CPI)
Places blanket on flat surface, sizing the roll by folding the blanket to fit the
size needed.
1
Places four cravats crosswise on one end of folded blanket; rolls blanket
firmly, including cravats.
1
Assesses CMS. 1 (CPI)
Positions rolled blanket and cravats snugly in the axilla (armpit) of the
dislocated shoulder.
1
While helper holds blanket roll in place, ties one set of cravats over the
opposite shoulder around the neck.
1
Secures second cravat around the patient’s waist. 1
Stabilizes hand and forearm on the blanket with the remaining two cravats. 1
Reassesses CMS. 1 (CPI)
Applies cooling method to help reduce swelling/bruising. 1
Prepares patient for transport. 1
Provides oxygen/treats for shock, if appropriate. 1

Must receive 12 out of 15 points.

Question 24

Posterior S/C dislocation reduction

Answer 24

Determines that scene is safe. 1 (CPI)
Introduces self, obtains permission to treat/help. 1
Initiates Standard Precautions. 1 (CPI)
Assesses CMS. 1 (CPI)
Ties wide cravat around upper chest, under armpits. 1
Forms a tight blanket roll. 1
Places patient in supine position, with blanket roll under shoulder blades. 1
Rescuer #1 applies traction to the wrist on affected side by pulling arm out and
downward toward ground.
1 (CPI)
Rescuer #2 simultaneously places counter-traction on the other side of body by
pulling on cravat tied around upper chest.
1 (CPI)
Reassesses CMS. 1 (CPI)
Treats for shock. 1
Arranges for transport of patient. 1

Must receive 10 out of 12 points.

Question 25

Splinting lower extremity injury

Answer 25

Determines that scene is safe. 1 (CPI) Introduces self, obtains permission to help/treat. 1 Initiates Standard Precautions. 1 (CPI) Exposes injury to assess and manage the ABCDs. 1 (CPI) Bandages any wounds, as necessary. 1 Directs helper to stabilize above and below the injury site by grasping the boot/shoe with one hand and grasping below the knee with the second hand. 1 (CPI) Assesses for CMS. 1 (CPI) Removes boot/shoe per local protocol. 1 Chooses the correct device/material for splinting/stabilization. 1 Sizes splint properly; uses pads as needed and positions splint. 1 Applies gentle traction/tension as needed, rotating extremity if necessary and if tolerated by patient. 1 Splints and stabilizes extremity with minimal movement. 1 Reassesses CMS. 1 (CPI) Applies cooling method to help reduce swelling/bruising. 1 Prepares patient for transport. 1 Provides oxygen/treats for shock, if appropriate. 1 Must receive 13 out of 16 points.

Question 26

Traction splinting

Answer 26

Determines that scene is safe. 1 (CPI) Introduces self, obtains permission to treat/help. 1 Initiates Standard Precautions. 1 (CPI) Exposes and assesses the injury to determine the location and proximity to hip or knee joint; checks for bleeding and treats bleeding if present. 1 Rescuer #1 manually stabilizes the fracture site above and below the injury. 1 (CPI) Rescuer #2 stabilizes the boot/shoe or the ski/snowboard if the equipment is still in place. 1 Rescuer #3 assesses CMS. 1 (CPI) Rescuer #3 prepares traction splint and adjusts to proper size according to manufacturer’s instructions; rescuer uses uninjured leg to measure splint. 1 Rescuer #2 removes ski or snowboard if present and then applies the ankle hitch. 1 Rescuer #2 firmly grasps ankle hitch with one hand and places other hand under the calf and moves the injured leg in a coordinated fashion with Rescuer #1 to straighten leg into anatomical alignment using manual traction; maintains traction as Rescuer #1 releases manual stabilization. 1 Rescuer #3 positions the splint according to manufacturer’s directions and secures the groin strap around upper thigh. 1 Rescuer #3 connects ankle strap if needed and turns crank/knob, gradually replacing manual traction with mechanical traction. 1 Rescuers secure Velcro support straps or cravats. 1 Secures patient to a backboard. 1 (CPI) Reassesses CMS. 1 (CPI) Treats for shock/provides oxygen. 1 (CPI) Prepares patient for transport, activates EMS. 1 (CPI) Must receive 13 out of 17 points.

Question 27

Boot removal

Answer 27

Determines that scene is safe. 1 (CPI) Introduces self, obtains permission to treat/help. 1 Initiates Standard Precautions. 1 (CPI) Rescuer #1 stabilizes the boot to be removed. 1 Rescuer #2 unbuckles/unlaces the boot completely. 1 Rescuer #2 spreads the boot open. 1 Rescuer #1 stabilizes injured area of leg/ankle by placing one hand on front of ankle and one hand on back of the ankle, holding this position firmly as the boot is removed. 1 (CPI) Rescuer #2 gently removes boot by sliding heel away from foot, followed by the toe portion; monitors patient for indications of excessive pain; stops or modifies procedures as appropriate. 1 Assesses CMS. 1 (CPI) Prepares and applies splint, keeping movement of injured extremity to a minimum. 1 Reassesses CMS after splint is applied. 1 (CPI) Treats for shock, if appropriate. 1 Prepares patient for transport. 1 Must receive 10 out of 13 points.

Question 28

Sizing and applying cervical collar

Answer 28

Determines scene is safe. 1 (CPI) Introduces self, obtains permission to treat/help. 1 Initiates Standard Precautions. 1 (CPI) Establishes or maintains manual stabilization of head and C-spine. 1 Measures patient for C-collar per manufacturer’s recommendations. 1 Opens coat or shirt and removes any bulky clothing around neck/shoulder area. 1 (CPI) Slides posterior neck portion of the collar behind the patient’s neck. 1 Swings the chin portion of the C-collar up the patient’s chest until it cups the chin. 1 Secures the C-collar using Velcro closures, ensuring a proper fit. 1 (CPI) Must receive 7 out of 9 points.

Question 29

Log roll onto long spine board

Answer 29

Determines scene is safe. 1 (CPI) Introduces self, obtains permission to treat/help. 1 Initiates Standard Precautions. 1 (CPI) Rescuer #1 kneels above patient’s head and takes/maintains spinal stabilization. 1 (CPI) Rescuers #2, #3, and #4 kneel along one side of the patient. 1 Rescuer #2 assesses CMS, kneels beside the patient’s shoulder/upper chest, and grasps the patient’s shoulder/hip. 1 (CPI) Rescuer #3 positions backboard beside the patient and kneels at the patient’s hips; grasps the patient’s hips, overlapping hands with Rescuer #2 and above the knee. 1 Rescuer #4 kneels beside the patient’s knee/lower leg; grasps the patient’s upper thigh, overlapping with Rescuer #3. 1 Rescuer #1 directs the roll, ensuring that all rescuers are ready to roll the patient toward them as a unit. 1 Rescuer #2 slides backboard into position, tilting the backboard, and then palpates the patient’s spine for any injuries. 1 Rescuer #1 directs other rescuers in lowering the patient onto the backboard as a unit. 1 (CPI) Rescuer #2 ensures that the patient is centered on the backboard; if needed, the patient is recentered on the board using axial movements. 1 Secures the patient on the backboard in the usual method. 1 Reassesses CMS. 1 (CPI) Must receive 11 out of 14 points.

Question 30

Short board immobilization (KED)

Answer 30

Determines scene is safe. 1 (CPI) Introduces self, obtains permission to treat/help. 1 Initiates Standard Precautions. 1 (CPI) Manually stabilizes the head/cervical spine, kneeling next to the patient; establishes in-line stabilization. 1 (CPI) Assesses CMS in each extremity. 1 (CPI) Correctly sizes and applies cervical collar. 1 Places board behind the patient’s back, aligning the top of the device with the top of the patient’s head. 1 Crosses torso straps over the patient’s shoulders and secures to board; pads behind the patient’s head, filling voids; secures the patient’s head to the board using two cravats (forehead and chin). 1 Moves the patient to a long board by placing the long board next to the patient’s buttocks; lifts the patient onto the long board, maintaining C-spine stabilization. 1 (CPI) Lowers the patient into a supine position on the long board, securing the patient and the short board to the long board in the usual fashion. 1 Reassesses CMS in each extremity. 1 (CPI) Must receive 9 out of 11 points.

Question 31

Helmet removal from lying PT

Answer 31

Determines scene is safe. 1 (CPI) Introduces self, obtains permission to help/treat. 1 Initiates Standard Precautions. 1 (CPI) Stabilizes the cervical region in a neutral, in-line position. (Aligns patient axially.) 1 (CPI) Rescuer #1 manually stabilizes head/C-spine by placing hands on either side of the helmet. 1 Rescuer #2 opens/removes the face shield or goggles. 1 Rescuer #2 removes the chin strap and places one hand at the patient’s occiput (base of helmet) and the other at the patient’s chin to ensure head/C-spine immobilization. 1 (CPI) Rescuer #1 grasps the helmet straps and pulls apart, spreading the helmet. 1 Rescuer #1 pulls the helmet axially from the patient’s head with forward rotation of the helmet. 1 Rescuer #1 continues to gently remove the helmet. 1 Rescuer #2 slides the fingers up to the patient’s occiput, ensuring no loss of stabilization. 1 Rescuers exchange immobilization without loss of stabilization. 1 (CPI) Must receive 9 out of 12 points.

Question 32

Immobilizing a standing Pt

Answer 32

Determines scene is safe. 1 (CPI) Introduces self, obtains permission to treat/help. 1 Initiates Standard Precautions. 1 (CPI) Rescuer #1 stands beside or behind the patient; manually stabilizes the patient’s head/C-spine. 1 Rescuer #2 checks CMS in each extremity; sizes and correctly applies cervical collar. 1 (CPI) Rescuer #3 prepares and positions backboard behind the patient. 1 Rescuers #2 and #3 stand next to the patient, one on either side; Rescuer #2 stands on the right side of the patient, places one hand on the patient’s elbow and the other under the patient’s armpit and grasps the backboard slot above the patient’s shoulder. Rescuer #3 does the same on the other side of the patient. 1 Moving as a unit and maintaining spinal stabilization, the rescuers lower the patient to the ground. 1 (CPI) If necessary, realigns/recenters the patient on the board using axial movements. 1 Secures the patient to the backboard in the usual manner. 1 Reassesses CMS. 1 (CPI) Must receive 9 out of 11 points.

Question 33

Stabilizing an impaled object in the eye

Answer 33

Determines scene is safe. 1 (CPI) Introduces self, obtains permission to help/treat. 1 Initiates Standard Precautions. 1 (CPI) Creates a stabilizing device (use a handmade cravat donut or a paper cup). 1 Covers the injured eye with a moist sterile dressing. 1 Applies the stabilizing device to stabilize the object from movement. 1 (CPI) Secures the object with the appropriate materials covering both eyes. 1 Communicates to the patient the procedure you will perform. 1 Must receive 5 out of 8 points.

Question 34

Pelvic stabilization

Answer 34

Determines that the scene is safe. 1 (CPI) Introduces self, obtains permission to treat/help. 1 Initiates Standard Precautions. 1 (CPI) Maintains spinal alignment. 1 (CPI) Measures and applies a C-collar per local protocol. 1 (CPI) Folds a sheet lengthwise 12–18” wide and places it on a backboard where the pelvis will be positioned. 1 Log rolls patient onto backboard maintaining spinal alignment; positions patient so that the buttocks are positioned on the sheet 1–2” above the top of the iliac crest. 1 (CPI) Draws the two ends together over the symphysis pubis, compressing the greater trochanters of the femur. 1 Gently pulls the ends of the sheet tight. 1 Ties the two ends using an overhand knot, or wraps the two sheet ends around each other before securing the ends with one or two nylon cable ties. 1 Keeps the patient’s knees slightly flexed, and pads under the legs/knees with a rolled-up blanket. 1 Secures the patient’s knees and ankles with cravats, padding any voids. 1 (CPI) Secures the patient to the backboard, ensuring that the backboard straps do not go over or put stress on the injured area. 1 (CPI) Must receive 11 out of 13 points.

Question 35

Managing an open chest wound

Answer 35

Determines the scene is safe. 1 (CPI) Introduces self and obtains permission to help/treat. 1 Initiates Standard Precautions. 1 (CPI) Assesses the ABCDs, controls any bleeding. 1 Stabilizes the cervical spine if injury is trauma induced. 1 Exposes the chest. 1 (CPI) Palpates entire chest checking for tenderness/deformities. 1 Applies an occlusive dressing and tape according to local protocol if sucking chest wound is present. 1 (CPI) Applies high flow oxygen via nonbreather. 1 (CPI) Treats for shock and maintains body temperature. 1 (CPI) Loads patient onto long spine board. 1 Readjusts occlusive dressing tape according to local protocol. 1 Transports patient and transfers to EMS personnel. 1 Must receive 11 out of 13 points.

Question 36

Pt restraint

Answer 36

Determines scene is safe. 1 (CPI) Introduces self, obtains permission to treat/help. 1 Initiates Standard Precautions. 1 (CPI) Secures the scene. 1 Determines if patient can refuse care. 1 Calls for additional help or assistance per local protocol. 1 (CPI) Assembles 5 people for physical restrain, 6 people for mechanical restraint. 1 Uses appropriate language with patient to not escalate situation. 1 (CPI) Places patient on spine board. 1 Secures one of the patient’s arms above the head. 1 Secures patient’s other arm at side. 1 Prepares for patient vomiting (has suction equipment available for use if needed). 1 (CPI) Monitors vital signs every 5–10 minutes. 1 (CPI) Maintains patient restraint until care is transferred. 1 Must receive 11 out of 14 points.

Question 37

Assisting with normal child birth

Answer 37

Determines scene is safe. 1 (CPI) Introduces self, obtains permission to treat/help. 1 Initiates Standard Precautions. 1 (CPI) Obtains disposable sterile OB delivery kit or improvises with towels, sheets, blankets, etc. 1 Assists mother in removing clothing, positioning mother on firm padded surface and provides privacy. 1 (CPI) Positions mother in a semi-Fowler’s position, elevates pelvis 2"–4" keeping knees flexed. 1 Times contractions from start of one contraction to the beginning of the next. Notes duration of contraction by feeling the abdomen. 1 (CPI) When the baby is crowning, encourages mother to push while supporting the head of the baby. Applies gentle pressure with his hand to allow head to come out in a controlled fashion. 1 (CPI) After head has emerged, instructs mother to stop pushing and immediately suction baby’s mouth, nostrils with soft rubber bulb syringe. Notes if fluid is not clear (possible meconium in fluid). 1 (CPI) Checks position of umbilical cord. If around the baby’s neck, gently lifts cord over the baby’s head. If unable to lift over head, places 2 clamps 2” apart and cuts cord. 1 (CPI) Guides baby’s head down to deliver the shoulder as mother pushes. Supports baby’s head with non-dominant hand and slides dominant hand under the baby’s body as it emerges. Suctions nose and mouth again. 1 Records time and location of the birth. 1 (CPI) If transport to hospital is 20 min, cuts umbilical cord. 1 Dries infant, wraps in blanket, assesses APGAR and record. 1 (CPI) Prepares for delivery of placenta approx 20–30 min later. Transports placenta with mother to hospital. 1 Places sanitary napkin between mother’s legs. Massages lower abdomen in a firm circular motion. 1 Places mother in Trendelenburg position, provides O2, monitor vital signs. 1 (CPI) Evaluates infant vital signs/APGAR. Provides interventions as necessary. 1 (CPI) Must receive 14 out of 18 points.

Question 38

Nerve Agent Administration

Answer 38

Determines scene is safe. 1 (CPI) Introduces self, obtains permission to treat/help. 1 Initiates Standard Precautions. 1 (CPI) Minimizes further exposure. 1 (CPI) Identifies substance. 1 If nerve gas is suspected, obtains nerve gas antidote kit. 1 (CPI) Observes patient for excessive salivation (pneumonic SLUDGE-DUMBELS). 1 Evaluates patient mental status. 1 Clears/maintains airway and manages secretions. 1 (CPI) If SEVERE signs/symptoms exists— Administers 3 atropine & 3 2-PAM CL injections in rapid succession. 1 (CPI) Maintains airway, uses BVM or suction if needed. Monitor vitals. 1 (CPI) Re-evaluates patient, monitor vitals. 1 (CPI) Arranges for rapid transport. 1 (CPI) Must receive 11 out of 13 points.

Question 39

Manual Spine Stabilization

Answer 39

Determines scene is safe. 1 (CPI) Introduces self, obtains permission to treat/help. 1 Initiates Standard Precautions. 1 (CPI) Kneels beside or above the patient’s heads. 1 Places hands on either side of the patient’s head with the palms adjacent to the ears, the fingers supporting the jaw and the back of the head. 1 Gently moves the patient’s head so that the eyes are looking forward; the patient’s nose and chin are aligned with the sternum. 1 Continues manual stabilization until the patient is secured to a backboard. 1 (CPI) Must receive 6 out of 7 points.