EMR exam prep: 588 explained questions for the National Registry exam

C is correct.When the number of patients is greater than the responders on scene can manage, the first-arriving EMR should immediately declare a mass-casualty incident (MCI) and request additional resources, such as more ambulances, personnel and supervisors. Help takes time to arrive, so the call must go out before the EMR becomes absorbed in patient care; the same report gives dispatch the location, hazards, best access route and an estimated patient count, and it starts the incident command system. Starting to triage every patient is the right next step after that call, but beginning triage first delays the resources that 14 patients will need. Treating the most injured patient focuses one responder on one person while the rest of the scene goes unmanaged and no extra help has been requested. Beginning CPR on the nearest patient is the wrong priority in a mass-casualty incident, because a single resuscitation would occupy a rescuer for a long time while many patients with survivable injuries wait; in triage, patients who are not breathing after the airway is opened are tagged as deceased or expectant. Once help is requested, the EMR begins triage and directs walking patients to one area.

A is correct.On the AVPU scale, a patient who does not respond to voice is next checked for a response to pain, and the preferred method is a central stimulus such as squeezing the trapezius muscle between the neck and shoulder. A central stimulus tests whether the brain itself perceives the pain, so a moan, grimace or purposeful movement gives a true picture of the level of responsiveness. Pressing a fingernail bed is a peripheral stimulus; a hand may pull away through a spinal reflex even when the brain is not responding, so the finding can overstate the patient's level, and repeated pressure can injure the nail bed. Pricking the sole of a foot has the same weakness, because withdrawal of a limb can be a reflex rather than a sign of brain function, and it also risks breaking the skin. Shouting loudly in the ear simply repeats the verbal test, which the patient has already failed, so it tells the EMR nothing new about the pain level. The EMR should record exactly how the patient responded and recheck the AVPU level often to spot any change.

D is correct.The hot zone, also called the exclusion zone, is the contaminated area immediately around the release of a hazardous material. Entry is limited to hazardous materials technicians wearing specialized protective gear, such as chemical-protective suits and self-contained breathing apparatus, so an EMR without that training and equipment must stay out. The warm zone, or contamination reduction zone, lies just outside the hot zone and is where decontamination takes place; responders there also wear protection, but it is the buffer where contamination is removed, not the area around the release itself. The cold zone, or support zone, is the clean area farther away, positioned upwind and uphill, where command, triage and treatment of decontaminated patients occur; this is where an EMR normally works. The staging area is a location in the cold zone where arriving units and equipment wait until they are assigned, so it is not contaminated at all. During scene size-up, the EMR should view the scene from a safe distance, use binoculars and the Emergency Response Guidebook to identify the material, and wait for the hazmat team to bring decontaminated patients out to the cold zone.

B is correct.An amputated part should be wrapped in dry sterile gauze, sealed in a plastic bag, and kept cool by placing the bag on ice or in a container of ice and water, then sent with the patient. Cooling slows the tissue's metabolism and protects it for possible reattachment, while the gauze and bag keep it clean and stop the tissue from touching the ice. Some local protocols call for gauze lightly moistened with sterile saline, so the EMR follows medical direction. Packing the finger directly in ice is wrong because contact with ice can freeze the tissue and cause frostbite damage that makes reattachment impossible. Submerging the finger in cold saline is also wrong; soaking lets the tissue absorb fluid and become waterlogged, which damages the cells the surgeon needs. Keeping the finger warm in a towel speeds the breakdown of tissue that no longer has a blood supply, shortening the time available for replantation. Remember that the patient comes first: control bleeding at the stump with direct pressure or a tourniquet if needed, treat for shock, and label the bag with the patient's name and the time.

A is correct.When responding with lights and siren, the safest practice at a red light or stop sign is to come to a complete stop, make sure every lane of cross traffic has seen the vehicle and yielded, and then proceed through the intersection with caution. Intersections are where many emergency vehicle crashes happen, and many agency policies require this full stop even where state law permits less. Laws grant emergency vehicles certain privileges, but the driver must always drive with due regard for the safety of others and remains responsible for any crash. Proceeding at speed because the siren clears traffic is wrong, since other drivers may not hear the siren inside closed, noisy cars or may not react in time. Slowing slightly and coasting through the intersection still lets the vehicle enter before the driver knows that all cross traffic has stopped. Waiting in line until the signal turns green is not required and delays care; emergency vehicles may pass a red light once it is safe to do so. Local laws and agency policies vary, so every emergency vehicle operator must know them before driving to a call.