Mosby's EMT-Basic Textbook - Revised Reprint, 2nd Edition1.1

Mosby's EMT-Basic Textbook - Revised Reprint, 2nd Edition

CHAPTER 1 Introduction to Emergency Medical Care

KEY TERMS

Direct medical direction:

Medical direction in which physician speaks directly with EMTs in the field; also referred to as online

medical direction.

Emergency medical dispatcher:

An EMS dispatcher who has received special education for giving medical care instructions to patients

and others over the phone before EMTs arrive.

Emergency Medical Services (EMS) System:

A system of many agencies, personnel, and institutions involved in planning, providing, and

monitoring emergency care.

Emergency Medical Technician (EMT):

The generic term for a prehospital emergency care provider educated at least to the EMT-Basic level.

EMT-Basic:

A basic prehospital life support provider trained to the NHTSA guidelines for EMT-Basic.

EMT-Intermediate:

An EMT with additional education in one or more advanced techniques such as vascular access and

intubation.

EMT-Paramedic:

An EMT with additional education to the level of full advanced life support.

First Responder:

An individual employed in a position that includes providing initial medical assistance in an

emergency.

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CHAPTER 1 Introduction to Emergency Medical Care of 22


Indirect medical direction:

Any direction provided by physicians that is not direct, including system design, protocol

development, education, and quality improvement; also referred to as offline medical direction.

Medical direction:

The process (usually by a physician) of ensuring that the care EMTs provide is medically appropriate;

also called medical oversight.

National EMS Education and Practice Blueprint:

A consensus document that establishes a core content for the scope of practice for the four levels of

prehospital care providers.

Quality improvement:

A system for continually evaluating and improving the care provided within an EMS system.



IN THE FIELD

Marco and Brittany had just completed the morning truck check. As they were sitting down to a glass of

orange juice and the review of the outgoing shifts calls, the EMS supervisor, Walt, arrived at their station.

Along with him was Juan, a local high-school student. Juan was interested in taking an EMT-Basic course

and working as an EMS provider. Marco explained the training requirements. He told Juan that it was

challenging, but rewarding. He told him without the knowledge and skills he learned in the EMT course, he

could not function as well as he did in this environment. Brittany talked about the personal satisfaction she

gained from helping others. She described the camaraderie of her co-workers and displayed her pride in the

profession. She encouraged Juan to enroll in the course and offered him the opportunity to complete

ride-along shifts with her and Marco while he attended class. As Walt and Juan left the station, Marco and

Brittany returned to their chart review, confident that they had helped guide Juan's career and proud of their

service and the EMS system.

Welcome to the rewarding and exciting field of Emergency Medical Services! This chapter marks the

beginning of your educational process for becoming an Emergency Medical Technician (EMT). EMT–Basics

who care for ill or injured patients before they reach the hospital require a solid foundation—a road map for

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learning. This chapter outlines the job roles and responsibilities to help you learn what you need to know to

become an EMT–Basic.

This chapter also describes the Emergency Medical Services (EMS) system and the role of EMT–Basics

within this system. This is a system of professionals who provide emergency medical care, beginning when

someone initially realizes an injured or ill person requires emergency care, through the patient's admission to

the hospital ( Fig . 1 - 1).

THE EMERGENCY MEDICAL SERVICES SYSTEM

You are about to embark on a great journey that will affect not only your life but also the lives of many

others. You will learn to help patients who are strangers, neighbors, friends, and even loved ones. The

average person requires the assistance of emergency personnel every 7 years. Clearly, this is an important job.

Working or volunteering as an EMT–Basic is both a demanding and rewarding career. Few other professions

have such an impact on people's daily lives.

Everyone has a different reason for becoming involved in the EMS system. Some students have experienced

the loss of a friend or family member following illness or after a medical emergency and want to prevent

others from experiencing the same loss. Others become involved because of television dramas that depict

EMS as an exciting, challenging, and fulfilling profession. Some people take the EMT–Basic program

without planning to work as an EMT–Basic but instead use the education to move toward another health care

position such as a nurse, physician's assistant, or physician. Whatever your reason is, welcome to the ranks of

one of the most rewarding professions in the world.

Every day, people's lives are touched by EMTs. From an elderly patient who must reach the doctor's office

for an appointment, to a child with a life-threatening airway emergency, all of the patients you will encounter

have one thing in common—they need help. They require the assistance of a competent, qualified, and caring

individual. They need you, the EMT–Basic.

The following sections will help you better understand the role of the EMT-Basic in the EMS system,

beginning with the national agency that sets standards for EMS and the education of EMS providers.

THE NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION TECHNICAL

ASSISTANCE PROGRAM

The goal of the Department of Transportation (DOT) and the National Highway Traffic Safety

Administration (NHTSA) is to reduce the death and disability caused by motor vehicle collisions on the

nation's highways. NHTSA has therefore developed a number of programs and initiatives including the

National Standard Curricula and Technical Assistance Programs to guide EMS systems everywhere in the

provision of quality care.4



Fig. 1-1 The EMS system encompasses emergency recognition, system

access, EMS personnel dispatch and response, care provided to the

patient as the scene, medical direction when necessary, and patient

stabilization, transportation, and delivery to the hospital.

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NHTSA has developed standards in 10 areas to assess and benchmark EMS systems ( Fig . 1 - 2).

• Regulation and policy

• Resource management

• Human resources and training

• Transportation

• Facilities

• Communications

• Public information and education

• Medical direction

• Trauma systems

• Evaluation

These aspects of the system are described below to help you better understand the overall system in which

you will be working as an EMT–Basic.

Regulation and policy standards ensure that all states have a lead EMS agency, funding, regulations, and

operational policies and procedures. State legislatures must pass laws that promote quality EMS care and

provide adequate funding. States finance their EMS systems in various ways, but all need to have funds to

provide high-quality, effective EMS care. As you train for your profession and begin working as an EMT–

Basic, you will become familiar with state and local rules and regulations, policies, and procedures.

Fig. 1-2 The National Highway Traffic Safety Administration's 10 standards

for EMS systems.

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Resource management standards coordinate resources throughout the state. These standards allow everyone

access to basic emergency medical care, including treatment by personnel trained primarily at the EMT–

Basic level, and allow all patients to be transported in a well-equipped vehicle to a staffed, equipped, and

prepared receiving facility. Human resources and training standards require all states to have initial

educational programs for EMT–Basics and other higher levels of EMS personnel, as well as continuing

education.

Transportation standards describe safe and effective transportation for all patients. Ambulances and air

medical units must meet minimum criteria and be inspected periodically. All aspects of the state EMS

system must be in a constant mode of readiness.

The facilities standard ensures that patients are transported to the closest appropriate facility. Prehospital

care providers such as EMTs must understand the different hospitals' capabilities and local policies for

specific emergency situations. This includes specialty facilities, such as trauma and burn centers, or

children's hospitals.

Communications standards ensure that patients can call for emergency care and that emergency personnel

communicate effectively with the receiving hospital and other EMS personnel.

Public information and education guidelines promote the public's involvement in the EMS system and

injury prevention programs. EMTs often provide the public with information about system procedures and

injury prevention. This education improves the system and helps patients receive quality care.

In the EMS system, direct patient care is delegated to four levels of providers: First Responders and three

levels of EMTs—EMT–Basics, EMT–Intermediates, and EMT–Paramedics. Medical direction standards

help ensure that physicians stay involved in the patient care system by developing protocols or patient care

guidelines, by providing medical direction and consultation, and by evaluating patient care activities and

quality improvement.

Across the United States, there are many state-wide trauma care systems, including designated trauma

centers, trauma triage guidelines, data collection, trauma registry definitions, system management, and

quality assurance.

Trauma is a severe wound or injury. Trauma patients require specialized care, provided through the state's

trauma system.

The final standard involves evaluation of the effectiveness of patient care, including the care provided by

EMT–Basics. In this way, the EMS system can continue to improve the quality of patient care delivered.

ACCESS TO THE EMERGENCY MEDICAL SERVICES SYSTEM

The manner in which the public contacts the EMS system is extremely important. In most areas of the

United States, “911” is the universal access number to police, fire, and EMS ( Fig . 1 - 3). However, some

areas of the country do not have this capability and must dial a seven- or ten-digit number to access the

EMS system.

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Fig. 1-3 In many areas of the United States, “911” is the universal number

for access to police, fire, and EMS.

Regardless of the phone number used, EMTs should educate the public on proper access to the system.

Public information campaigns, such as “Make the Right Call,” teach the public the proper local access

number and when to call for an ambulance. EMTs at all levels should be active in these and other public

service campaigns.

LEVELS OF EDUCATION

The National EMS Education and Practice Blueprint sets the standards for the education of prehospital

emergency care providers. As mentioned earlier, the four established levels are:

First Responder

EMT–Basic

EMT–Intermediate



EMT–Paramedic

The EMS system currently lists these four levels for certification or licensure, although not all states use

every level. States can also augment the levels with additional care levels. Each recognized level has its

own scope of practice.

The First Responder course is for individuals who are likely to encounter an ill or injured person but are

not trained for ambulance service. The focus at this level is to provide initial stabilization until additional

EMS resources arrive. Many police officers and firefighters are trained at this level.

The EMT–Basic course prepares personnel to provide primary medical care before the patient reaches the

hospital. Most states require the EMT-Basic as the minimum accepted education level for ambulance staff.

The EMT–Intermediate level is an advanced EMT level that includes all skills of an EMT-Basic. In

addition, the EMT-Intermediate is taught advanced skills such as manual defibrillation and administration

of intravenous fluids and some medications.

The EMT–Paramedic, currently the highest skill level, includes all of the skills of an EMT-Basic and

EMT-Intermediate. The training and education also includes more advanced techniques such as tracheal

intubation and administration of additional medications, along with additional knowledge of the human

body.

While requirements and skill levels vary from state to state, a national agency, the National Registry of

EMTs, prepares and conducts examinations designed to test the competency at the First Responder and all

three EMT levels. State regulations and local medical directors determine the specific procedures at all

levels. Check with your instructor regarding the certification process in your state.

THE HEALTHCARE SYSTEM

The EMS system is a part of the overall healthcare system in the United States. This healthcare system has

many components. Most important to EMT–Basics are the prehospital setting and the hospital, although

many other aspects are involved.

First Responders, EMT–Basics, EMT–Intermediates, and EMT–Paramedics are the primary emergency

medical care providers outside of the hospital. The process begins when someone recognizes the patient's

illness or injury and calls the EMS system through the local access number. First Responders such as

firefighters or lifeguards may already be at the scene and provide initial care until more qualified EMTs

arrive. Also involved are professional dispatchers who not only forward the emergency call to the EMS

unit, but who may also give care instructions before the EMS unit arrives. In many systems, emergency

medical dispatchers have received education for providing medical care instructions over the phone before

the EMTs arrive.

The next step in the healthcare system is the hospital. This typically begins with the arrival to the

emergency department, although some states permit EMTs to transport a patient directly to a physician's

office or clinic. Healthcare workers in the emergency department include physicians, nurses, nursing



assistants, nurse practitioners, and physician assistants. Many people perform support services, lab work,

electrocardiograms, x-rays, and other services including clerical, communications, and housekeeping

support. Like you, the EMT-Basic, each person has an important role in providing patient care or

supporting that effort. Without this team of providers and support staff, the system would be ineffective.

Some patients require the attention of a specialty care center. EMTs transport these patients to centers such

as trauma facilities, burn centers, pediatric or children's hospitals. Additionally, with the advances in

healthcare, many areas now have access to chest pain and stroke centers. These specialty centers vary in

different regions. Knowledge of the specialty centers in your area is important, including the local protocol

for transporting patients to one of these facilities. Your service area may have additional specialty centers.

LIAISON WITH OTHER PUBLIC SAFETY WORKERS

Most of the EMT–Basic's responsibilities involve patient care. EMTs also interact with other public safety

workers including local, state, and possibly federal law enforcement. A strong working relationship with

law enforcement personnel ensures the safety of EMTs, patients, and bystanders ( Fig . 1 - 4). Depending on

the system and local policies, some EMTs may interact with law enforcement on every prehospital call,

whereas others work with law enforcement only at automobile crashes, crime scenes, and hazardous

materials scenes. In some systems, law enforcement officers are trained to the First Responder skill level or

higher and routinely arrive on the scene to provide care until other emergency personnel arrive.

EMT–Basics may also work with the local fire department. Many communities organize EMS activities as

a branch of the fire department, using firefighters or EMT–Basics to work on both fire apparatuses and

ambulances. In some areas, EMT–Basics may also interact with the fire department by using their resources

for first response to medical emergencies and traumatic injuries, vehicle rescue, special rescue situations,

and hazardous materials situations. A strong professional relationship between EMTs and other public

safety agencies is important, because this guarantees smooth operation and successful delivery of quality

public safety. As an EMT-Basic, you may interact with other agencies regularly.

Fig. 1-4 EMTs often interact with other public safety workers, including law

enforcement officials.

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REVIEW QUESTIONS


1. What federal agency has developed standards for training and development of the EMS

system?

a. The National Highway Traffic Safety Administration

b. The Department of Homeland Security

c. The Department of Public Health

d. The National Institutes of Health

2. Currently, the National EMS Education and Practice Blueprint and the National Registry of

EMTs recognize how many levels of EMS providers?

3. List the levels of recognition/certification.

THE EMERGENCY MEDICAL TECHNICIAN–BASIC

ROLES AND RESPONSIBILITIES

The roles and responsibilities of EMT–Basics are continually evolving. Job descriptions established by

each service define specific requirements. EMT–Basics must understand these roles and responsibilities to

be competent, professional members of the healthcare team ( Box 1 - 1).

Personal Safety

BOX 1-1 Roles and Responsibilities of the EMT–Basic

Personal safety

Safety of the crew, patient, and bystanders

Patient assessment

Patient care based on assessment findings

Lifting and moving patients safely

Transport and transfer of care

Record keeping and data collection

Patient advocacy (patient rights)



As an EMT–Basic, you have a primary responsibility for your own safety. This role is discussed in depth

in Chapter 2. Ensuring personal safety includes maintaining a healthy body, remaining physically fit, and

using body substance isolation precautions appropriately. Personal safety also includes surveying the

emergency scene for hazards or potential hazards before entering. Chapter 9 describes the appropriate

measures to be taken in this important procedure.

Safety of the Crew, Patient, and Bystanders

EMTs are also responsible for the safety of fellow crew members, patients, and bystanders. Looking out

for the well-being of your partners is extremely important. This includes maintaining scene safety and

coping with stress, as you will learn in the next chapter. You also must ensure the safety of patients. You

are responsible for providing the best possible care for patients, while carrying out safety precautions that

will prevent further injury to them from hazards at the scene. You must also consider the safety of

bystanders. By securing a safe scene and communicating effectively with bystanders, you protect

everyone's safety.

Patient Assessment and Care

Patient assessment is a primary responsibility ( Fig . 1 - 5). EMTs assess the patient's needs and provide

basic medical care established by that assessment. Chapter 10 Chapter 11 Chapter 12 Chapter 13 through

Chapter 14 describe how to assess a patient. As an EMT, you should practice and master these skills.

Without an accurate assessment, you may provide inadequate or inappropriate care to your patient. The

emergency care you provide is based on assessment findings. This approach allows for rapid

management of life-threatening injuries and illnesses and relieves the patient's discomfort quickly.

Lifting and Moving Patients

When the patient has been evaluated and treatment initiated, EMTs then prepare the patient for transport.

Therefore, you must be able to lift and move patients safely. You must be sure the environment is safe for

lifting, for example, by moving debris off of a sidewalk before moving a patient over it. You also must

use safe lifting and moving techniques as described in Chapter 6.

Fig. 1-5 EMTs assess patients to determine the need for care.

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Transport and Transfer of Care

When en route to the receiving facility, or when awaiting a transport unit, EMTs continue to provide care

based on ongoing patient assessment. An orderly transfer of patient care should be maintained, whether

transporting to the receiving facility or another unit. This involves medical/legal issues such as preserving

patient confidentiality and preventing abandonment (see Chapter 3).

Chapter 15 and Chapter 16 describe important issues involved in the transfer of care and information

such as record keeping and data collection. Both are important roles of EMT–Basics ( Fig . 1 - 6).

Patient Advocacy

Another role of EMTs is that of the patient advocate. You must support the patient's legal rights, privacy,

and human dignity as an individual. Chapter 3 describes the patient's legal rights. All patients should be

treated with respect and dignity, regardless of their social and economic backgrounds. Always treat

patients as you wish to be treated yourself.

PROFESSIONAL ATTRIBUTES

Fig. 1-6 One of the many responsibilities of EMTs is record keeping and data

collection.



In addition to these roles and responsibilities, EMTs must behave professionally. Professional attributes

include physical appearance; a positive attitude; up-to-date knowledge and skills; making the patient's

needs a top priority without endangering yourself or others; and expanding current knowledge of local,

state, and national issues affecting EMS and healthcare.

EMTs are healthcare professionals and are an important part of the healthcare team. Therefore, you should

strive to project a professional appearance. Overall grooming, hair, and clothing should be neat and clean at

all times. Shoes or boots should be clean and polished. Many services have a uniform policy for appropriate

attire. Some services may have duty uniforms and dress uniforms to be worn at the appropriate times.

The patient's and family's first impression of healthcare personnel can come from their initial contact with

you. An unkempt EMT may imply sloppy patient care. Dressing in a crisp, clean uniform may reduce the

patient's and family's anxiety.

As you enter this facet of the world of healthcare, you are choosing a profession that demands lifelong

continuing education and skills. Medical care will continue to evolve, and technology will provide EMS

with new options for patient care. Federal, state, and regional laws and regulations will also change the way

in which care is provided. EMTs have an obligation to be knowledgeable and provide technically proficient

care. As a professional, you must keep abreast of changes and advances in medical care.

Continuing education is therefore an important aspect of your career. EMT–Basics should attend

continuing education courses whenever possible and practice skills that are not often used ( Fig . 1 - 7).

Continuing education should not be postponed until you conclude your initial education program. To begin

enhancing your knowledge and reinforcing concepts learned in class, you should begin to attend these

programs immediately. Ask your instructor which programs can be taken before completing your initial

education, and which can be taken afterward. Consider attending courses providing vehicle operation and

rescue education programs. Many states require continuing education as a part of the recertification process

or license renewal.

Fig. 1-7 Continuing education provides opportunities for EMTs to expand

their knowledge and practice skills that are not often used.

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EMS–related journals can keep EMTs informed about trends in prehospital care. Several journals offer

excellent information, such as JEMS (Journal of EMS), Rescue, Prehospital Emergency Care, and

Emergency Medical Services. Check with your instructor or service to see which journal is best suited to

your needs.

Another way to stay informed is to join a professional organization. Several are of benefit to EMTs,

including the National Association of EMTs (NAEMT), the National Assocition of EMS Educators

(NAEMSE), and the National Association of EMS Physicians (NAEMSP). Both organizations keep their

members abreast of changes in EMS through newsletters, journals, and conferences. In addition to these

national organizations, many states and local areas have professional associations for EMS providers. This

is an ideal opportunity to learn more about issues that affect EMS and to participate in decisions affecting

EMT–Basics.

REVIEW QUESTIONS


1. Which of the following is a role or responsibility of the EMT–Basic?

a. Vehicle extrication

b. Fire suppression

c. Patient assessment

d. Crime prevention

2. An EMT's appropriate professional appearance and confidence help to reduce a patient's:

a. Blood pressure

b. Length of stay

c. Level of consciousness

d. Anxiety

3. In order to maintain up-to-date knowledge and skills, the EMT-Basic should:

a. Attend conferences

b. Read professional journals

c. Attend continuing education sessions

d. All of the above

4. Maintaining the patient's dignity, right to privacy, and respecting their wishes is an example of

which role of the EMT-Basic?

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a. Patient confidentiality

b. Patient recognition

c. Patient advocacy

d. Patient assessment

QUALITY CARE

QUALITY IMPROVEMENT

Quality improvement (QI) is a system for continually evaluating and improving the care provided within

an EMS system. You may also hear terms such as quality assurance and quality management, which have

similar goals of evaluating patient care to make improvements to the system. Most EMS systems have a

quality improvement system that identifies a program's strengths and weaknesses and ensures that the

public receives the highest caliber of prehospital care.

The current trend in quality improvement is an approach that gives field providers such as EMT-Basics the

resources, motivation, and education to detect problems, create solutions, and develop methods for

maintaining quality care. The goal is to evaluate the system to determine which methods are successful and

which must be further developed to improve the overall delivery of care.

As healthcare professionals, EMTs must ensure that patients receive the best possible care. This requires an

active role in quality management—participating in patient care reviews and giving constructive criticism

to both co-workers and management for methods of system improvement. Without your input and attention

to quality the system cannot improve.

MEDICAL DIRECTION

Medical direction, sometimes called medical control, is the process by which physicians monitor the care

given by EMT–Basics to ill or injured patients. In the past, some states required medical direction only at

an advanced level and not for EMT–Basics. The nationwide curriculum change in 1994 recommended that

physicians be involved in all levels of prehospital care. Additionally, several skills performed by the

EMT-Basic require medical direction authorization. These skills can be monitored through the two

components of medical direction called direct medical direction and indirect medical direction.

Direct medical direction, also referred to as online medical control, means direct communication between

the physician and the provider in the field ( Fig . 1 - 8). This communication may occur via a cellular

telephone, radio, or telephone (land-line). In some cases, the physician may be present at the scene of the

illness or injury, allowing prehospital providers to speak directly with the physician. The role of a physician

at the emergency scene may vary. Local protocol dictates the proper procedure for following the orders and

advice of a physician at the emergency scene.

Indirect medical direction, or offline medical control, consists of other ways physicians influence care, such

as EMS system design, developing protocols and standing orders, providing initial and continuing



education, and participating in quality improvement. Indirect medical direction encompasses all

components of physician involvement beyond direct medical direction ( Fig . 1 - 9).

Fig. 1-8 A, Direct medical direction allows the EMT on the scene to consult

with physicians or other medical staff at the medical treatment

facility (B) by radio or telephone to determine proper care for the

patient.



The relationship of EMT–Basics and the medical director depends on the specific system. Rural and

frontier providers tend to use the indirect approach because of distance factors. Urban and suburban

providers often interact with medical directors more frequently. Ideally, the relationship begins when the

medical director becomes involved in the education of EMT–Basics. This relationship continues as students

complete their coursework and begin to provide patient care. The medical director participates in quality

improvement of the service and aids in the development of protocols.

Fig. 1-9 Indirect medical direction, such as routine physician review of

prehospital care reports, contributes to quality improvement and

influences care to all patients.

EMT–Basics have a responsibility to interact with the medical director in a professional manner and to

abide by his or her decisions. The medical director is a resource for problem solving before, during, and

after patient interactions. Try to become acquainted with your EMS system of medical direction. A strong

working relationship with the medical director will enhance the quality and appropriateness of the medical

care you provide.

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REVIEW QUESTIONS

QUALITY CARE

1. Indicate whether the following activities are direct or indirect medical direction.

a. The medical director meets with a crew to perform case reviews.

b. The medical director rewrites the “Chest Pain Protocol.”

c. The medical director advises the EMT–Basic over the radio to administer sublingual

nitroglycerin.

d. The medical director advises the EMT–Basic to complete a trauma education program.

e. The medical director orders the patient to be transported to a burn center.

2. Quality improvement is best described as?

a. Sorting out the bad apples

b. System audits

c. A continuous cycle of evaluation

d. Improving the patient care delivery system

CHAPTER SUMMARY


The EMS system is one of many agencies, personnel, and institutions involved in planning, providing, and

monitoring emergency medical care. The National Highway Traffic Safety Administration helps states to

develop EMS systems through established technical standards and assessments of EMS delivery in each

state. These standards include regulation and policy, resource management, human resources and training,

transportation, facilities, communications, public information and education, medical direction, trauma

systems, and evaluation. Each area addresses specific concerns for the quality delivery of EMS.

The four recognized levels of prehospital care providers as defined by the National EMS Education and

Practice Blueprint are First Responder, EMT–Basic, EMT–Intermediate, and EMT–Paramedic. All EMS

personnel interact with other healthcare system professionals. EMT–Basics also interact with law

enforcement officials and firefighters. EMT–Basics should establish a strong working relationship with

these personnel.

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The EMT–Basic has many roles and responsibilities, including personal safety; the safety of crew, patient,

and bystanders; patient assessment; patient care based on assessment findings; lifting and moving patients

safely; transportation of patients and transfer of care; record keeping and data collection; and patient

advocacy. The individual ambulance service provides the EMT–Basic with a job description outlining

specific roles and responsibilities.

The EMT–Basic is a healthcare professional with certain professional attributes: attending continuing

education programs; projecting a professional appearance; maintaining knowledge and skills at a competent

level; participating in issues that affect EMS on a local, state, and national level; and serving as a patient

advocate.

QUALITY CARE

Quality improvement and medical direction go hand in hand. They are important aspects of quality

prehospital care. Quality improvement includes comprehensive planning, reviews of patient care delivery,

and development of methods to improve the delivery system.

Medical direction establishes that all care given to a patient is medically appropriate. Direct medical

direction involves direct contact between the physician and providers in the field. Indirect medical direction

includes other activities such as system planning, protocol development, education, and quality

management.

United Statis Department of Transportation National Highway Traffic Safety

Administration EMT-Basic Objectives

Check your knowledge. The National Registry of EMTs and many state EMS agencies use the

objectives below to develop EMT-Basic certification examinations. Can you meet them?

Cognitive

1. Define Emergency Medical Services (EMS) systems.

2. Differentiate the roles and responsibilities of the EMT-Basic from other prehospital care

providers.

3. Describe the roles and responsibilities related to personal safety.

4. Discuss the roles and responsibilities of the EMT-Basic for the safety of the crew, the patient,

and bystanders.

5. Define quality improvement and discuss the EMT-Basic's role in the process.

6. Define medical direction and discuss the EMT-Basic's role in the process.

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7. State the specific statutes and regulations in your state regarding the EMS system.

Affective

1. Assess areas of personal attitude and conduct of the EMT-Basic.

2. Characterize the various methods used to access the EMS system in your community.

Psychomotor

No psychomotor objectives identified.

Review Questions Answer Key


1. a

2. 4

3. First Responder, EMT-Basic, EMT-Intermediate, EMT-Paramedic


1. c

2. d

3. d

4. c

QUALITY CARE

1.

a. indirect

b. indirect

c. direct

d. indirect

e. direct

2. c

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Mosby's EMT-Basic Textbook - Revised Reprint, 2nd Edition1.1

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