Jake Anderson
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Paramedic Care Principles and Practice; 6th edition

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Jake Anderson
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Chapter 17: Rural EMS

Frage 1 von 59

1

In rural areas of the United​ States, the paramedic may find employment at alternative health care facilities that provide limited care and nonemergent medical treatment​ called:

Wähle eine der folgenden:

  • open wall hospitals.

  • health departments.

  • external emergent care facilities.

  • prompt care facilities.

Erklärung

Frage 2 von 59

1

A product created from the fermentation of stored crops that poses a particular inhalation risk to paramedics​ is:

Wähle eine der folgenden:

  • silo gas.

  • nitrogen gas.

  • carbon monoxide.

  • silage.

Erklärung

Frage 3 von 59

1

What principle can emergency medical services​ (EMS)providers employ to help ensure that someone is not injured while working around farm machinery that has been turned​ off?

Wähle eine der folgenden:

  • ​Tag-and-run

  • ​Turn-off/turn-down

  • ​Turn-off/turn-over

  • ​Lock-out/tag-out

Erklärung

Frage 4 von 59

1

What piece of equipment is an inflatable​ high-pressure pillow that can help lift a large piece of machinery that has trapped a​ patient?

Wähle eine der folgenden:

  • Rope and tackle blocks

  • Compartment expanders

  • Cribbing chambers

  • Air bags

Erklärung

Frage 5 von 59

1

Which statement is most accurate about access to emergency health care services for people living in rural​ America?

Wähle eine der folgenden:

  • Access is similar to the inner city.

  • Access is diminished overall.

  • Access is greater than in the inner city because there is lower demand for specialty services.

  • Access is greater because of the greater number of rural helicopter air ambulance​ (HAA) bases.

Erklärung

Frage 6 von 59

1

Which statement about the general health of individuals living in rural locations is most​ correct?

Wähle eine der folgenden:

  • Chronic conditions are often identified earlier by Primary Care Physicians​ (PCPs).

  • A disproportionate number of chronic health conditions are likely to exist.

  • Acute conditions are often managed more efficiently in a rural community owing to a smaller population.

  • Acute conditions rarely happen in rural settings.

Erklärung

Frage 7 von 59

1

Why would survival rates for​ out-of-hospital cardiac arrests be lower for residents of rural America than for residents of larger urban​ cities?

Wähle eine der folgenden:

  • Too many 911 calls tie up the limited resources.

  • EMS personnel in rural America are poorly educated and inexperienced.

  • Hospitals are ill prepared to handle patients in cardiac arrest.

  • Emergency medical services​ (EMS) response is generally longer in rural areas because of physical distances.

Erklärung

Frage 8 von 59

1

Transport times in rural areas​ are:

Wähle eine der folgenden:

  • about the same as for suburban areas.

  • about the same as for urban areas.

  • generally lower than for other areas.

  • generally longer than for other areas.

Erklärung

Frage 9 von 59

1

What is the expected change in the occurrence of transporting trauma victims from a rural area to a larger urban​ facility?

Wähle eine der folgenden:

  • Slightly decrease

  • Increase

  • Sharply decrease

  • Stay the same

Erklärung

Frage 10 von 59

1

What is meant by the​ "distance factor" in regard to decision making by paramedics who work in rural areas of the United​ States?

Wähle eine der folgenden:

  • Every decision made must include consideration of the physical proximity of things.

  • Failure to recognize how long it will take to transport a patient may mean prohibitive fuel costs.

  • Rural emergency medical services​ (EMS) providers must rely heavily on communications with hospitals when deciding the best course of treatment.

  • The paramedic should make critical care decisions only when already en route to the receiving facility.

Erklärung

Frage 11 von 59

1

What aspect of EMS communications may be absent in some rural emergency medical services​ (EMS) systems?

Wähle eine der folgenden:

  • EMS dispatchers

  • Emergency 911 access number

  • Radio signal repeater towers

  • ​Ambulance-mounted radio equipment

Erklärung

Frage 12 von 59

1

What is an accurate characterization of the education needs of emergency medical services​ (EMS) providers who work in a​ low-volume rural EMS​ system?

Wähle eine der folgenden:

  • Education needs are​ low, since the call volume is also low.

  • Continuing education is typically not readily available.

  • There is a lowered rate of rust out in rural EMS providers.

  • Continuing education is paid for by the EMS​ service, which must send employees to larger EMS systems.

Erklärung

Frage 13 von 59

1

What is one way in which rural emergency medical services​ (EMS) systems have been able to implement 911 systems in locations that previously had​ none?

Wähle eine der folgenden:

  • By sharing the cost over multiple EMS jurisdictions

  • Through lowering the wages of rural paramedics or changing EMS from a paid to a volunteer service

  • Through​ door-to-door fund raising campaigns

  • By cutting the cost of new equipment purchases

Erklärung

Frage 14 von 59

1

Which of these is not a common way in which rural emergency medical services​ (EMS) systems attempt to increase their recruitment of EMS​ providers?

Wähle eine der folgenden:

  • Designing flexible training sessions to work around​ providers' other obligations

  • Implementing a​ "ride-along" program for interested individuals

  • Each agency keeping its resources only for its own needs

  • Incorporating Internet education when classroom courses are not available

Erklärung

Frage 15 von 59

1

With the benefit of the​ Internet, agencies or units can utilize​ podcasts, virtural​ conferences, and interactive lectures to help​ educate:

Wähle eine der folgenden:

  • paramedics as​ EMT-Basics or Advanced EMTs.

  • paramedics as physicians.

  • physicians as paramedics.

  • ​EMT-Basics or Advanced emergency medical technicians​ (EMTs) as paramedics.

Erklärung

Frage 16 von 59

1

What have many rural volunteer services done to mitigate the cost of offering​ services?

Wähle eine der folgenden:

  • Offer​ on-scene treatment but not transport to the closest hospital

  • Provide EMS services only during​ 12-hour periods, often​ 9:00 a.m. to​ 9:00 p.m.

  • Provide first response service only until a private EMS provider from a distant urban location can arrive

  • Combine services and share costs with neighboring emergency medical services​ (EMS) systems

Erklärung

Frage 17 von 59

1

You respond to a patient in hypovolemic shock from significant blood loss from a traumatic injury involving a piece of agricultural equipment. The patient is compensating for the time​ being, but you suspect they may become decompensated at any moment. You are in a remote rural area more than an hour away from any medical​ facility, and two hours away from a trauma center. What should you​ expect?

Wähle eine der folgenden:

  • Initial care will occur at a trauma center

  • Definitive care will occur at a rural emergency department​ (ED)

  • Definitive care will occur at a prompt care facility

  • To provide the most definitive care for this patient as possible

Erklärung

Frage 18 von 59

1

You are initiating transport for a patient with multiple fractures and dislocations in addition to other injuries. The facility you are driving toward is still an hour away. What is likely for your care of this​ patient?

Wähle eine der folgenden:

  • You will need to extensively splint this patient even if it delays transport.

  • Transport to the​ patient's Primary Care Physician​ (PCP) office for initial stabilization.

  • Reduction of the​ patient's fractures and dislocations will occur at the receiving facility.

  • You will likely need to reduce certain types of dislocations and fractures en route.

Erklärung

Frage 19 von 59

1

You and your partner are rural paramedics responding to an emergency in an area with one small hospital. What is one challenge that you may face that​ urban-based paramedics rarely have to be concerned​ with?

Wähle eine der folgenden:

  • Higher number of trauma runs versus medical runs

  • Absence of technology to use when communicating with the hospital

  • Lack of​ full-time emergency department​ (ED) staff at the receiving facility

  • Higher rates of survival for trauma patients

Erklärung

Frage 20 von 59

1

You are transporting a patient with chest pain to a local rural hospital. You have found ST elevation on two​ 12-lead ECGs​ (electrocardiogram) that you obtained while en route. On arrival at the emergency department​ (ED), you find out that their only​ 12-lead ECG machine is being repaired. What might you have to do in this​ situation?

Wähle eine der folgenden:

  • Summon a helicopter air ambulance to bring their monitor to the hospital.

  • Remove the monitor and have the ED staff treat the patient for an MI.

  • Treat the patient on the basis of the current symptoms only.

  • Keep the patient on your cardiac monitor for the time being.

Erklärung

Frage 21 von 59

1

You are a paramedic in a rural setting where the main source of income for many families is farming. One particular​ afternoon, you are summoned to a farm for a worker who became entangled in a piece of machinery. Other workers are frantically waving you over to their location as you exit the ambulance. What should you consider​ first?

Wähle eine der folgenden:

  • Mechanism of injury

  • Emergency medical services​ (EMS) provider safety

  • How many workers are involved

  • ​Turn-off and tag

Erklärung

Frage 22 von 59

1

Your patient was injured while working on a farm tractor. You find them sitting beside the rear wheel of the tractor holding their arm. The engine of the tractor is still​ running, but the equipment is not in gear. Their adult son arrives as you approach. What should be your first​ action?

Wähle eine der folgenden:

  • Ascertain whether the son knows how to turn off the tractor.

  • Remain at a safe distance until the fire department​ (FD) arrives to shut down and secure the tractor.

  • Climb into the cab to shut off the motor.

  • Drag the patient by the long axis of the body to safety.

Erklärung

Frage 23 von 59

1

Why is it recommended that​ self-contained breathing apparatus​ (SCBA) equipment be part of the standard equipment found on ambulances that operate in rural​ areas?

Wähle eine der folgenden:

  • Because rural ambulances are often​ larger, with more storage space for specialty equipment

  • So that the paramedic can serve a dual role as a firefighter

  • Because of the possible presence of hazardous gases on farms

  • So that the rural system can bill the emergency medical services​ (EMS) run at a higher rate to increase EMS revenues

Erklärung

Frage 24 von 59

1

Which situation would be particularly problematic during a rescue at a​ farm?

Wähle eine der folgenden:

  • Patient pinned under a large farming tractor

  • Patient with a shard of metal impaled in their arm from a sudden breakage of a piece of farming equipment

  • Patient with a leg trapped between the ground and a fallen tree they were cutting

  • Patient with finger amputations from contact with a power saw

Erklärung

Frage 25 von 59

1

Why are recreational emergencies at a destination lake typically a strain on emergency medical services​ (EMS) systems?

Wähle eine der folgenden:

  • There are rarely any onsite first responders or lifeguards.

  • The EMS system has to transport every one of the patients who calls for help.

  • Rural EMS providers are very naive about water sports or activities.

  • They are often​ seasonal, and sudden population changes can stress the rural department.

Erklärung

Frage 26 von 59

1

You are caring for a person who is on vacation and was seriously injured at night. The closest hospital is 2.5 hours away by​ ground, so you decide to use the local helicopter air ambulance​ (HAA) program for transport. In which situation may this not be the best idea for​ transport?

Wähle eine der folgenden:

  • The patient was injured when they wrecked their car on the freeway while returning to their vacation cabin.

  • The patient was injured while bungee jumping.

  • The patient was injured at a lake.

  • The patient was injured while completing a nighttime hike through the woods.

Erklärung

Frage 27 von 59

1

What type of additional training should be provided to a paramedic who works near a large​ lake?

Wähle eine der folgenden:

  • Advanced cardiac life support​ (ACLS) for the experienced provider

  • Classes to obtain a boat operating license

  • Water rescue

  • Critical care paramedicine

Erklärung

Frage 28 von 59

1

You are summoned to an old stone quarry that flooded years ago and was abandoned. Although it posted no​ trespassing, teenagers often go there to jump off the cliffs into the water. Your patient is a​ 16-year-old male who has sustained a spinal cord injury while engaged in this activity. The closest Llevel III trauma center is 40 miles​ away, and the closest HAA base is 100 miles away. Although there is a suitable landing zone​ nearby, why would you not call a helicopter for this​ patient?

Wähle eine der folgenden:

  • You do not suspect decompression syndrome.

  • The injury is to the​ spine, not to the brain.

  • The patient is not in cardiac arrest.

  • It is still probable that ground transport would be faster to the trauma center than air transport.

Erklärung

Frage 29 von 59

1

Which of the following procedures is used to prevent farm machinery from being accidentally restarted?

Wähle eine der folgenden:

  • Auger-off

  • Cribbing

  • Lock-out/tag-out

  • PTO

Erklärung

Frage 30 von 59

1

Although hospitals are widely scattered in rural areas, you might expect to find ________, which are capable of providing limited, nonemergent medical care to meet some of the urgent health care needs of the community.

Wähle eine der folgenden:

  • mobile health screening vans

  • prompt care facilities

  • private practice physician offices

  • extended care facilities

Erklärung

Frage 31 von 59

1

Approximately ________ Americans live in rural areas.

Wähle eine der folgenden:

  • 50 million

  • 10 million

  • 25 million

  • 75 million

Erklärung

Frage 32 von 59

1

Which of the following may provide a solution to communications issues in rural EMS
systems?

Wähle eine der folgenden:

  • Seeking grant funding for radio equipment upgrades

  • Using landlines instead of radios

  • Using EMS access numbers other than 911

  • Using text-message-based dispatch systems

Erklärung

Frage 33 von 59

1

The population in rural areas consists of a disproportionately high number of people in which age group?

Wähle eine der folgenden:

  • Middle-aged adults

  • Children aged 5 and under

  • Elderly adults

  • Young adults

Erklärung

Frage 34 von 59

1

Which of the following factors can account for a delay in the time it takes a patient in a rural setting to reach definitive care?

Wähle eine der folgenden:

  • Delays in family or bystanders discovering the ill or injured patient

  • The time it takes providers to reach the squad building

  • Lengthy transport times

  • All of the above

Erklärung

Frage 35 von 59

1

Which of the following best describes the EMS staffing situation in rural areas?

Wähle eine der folgenden:

  • Volunteers may lack experience, even after several years of volunteering.

  • Because of low operating costs, volunteer agencies are frequently able to send volunteers for specialized training and continuing education.

  • Volunteer turnover is low because of family support for volunteer efforts.

  • Volunteer turnover is low because the volunteers tend to have families in the area and close community ties.

Erklärung

Frage 36 von 59

1

Which of the following is NOT a factor that adversely affects the delivery of EMS in rural
areas?

Wähle eine der folgenden:

  • Inadequate medical direction

  • Reliance on volunteers

  • Lack of opportunity for providers to use their skills

  • Low-income patient population

Erklärung

Frage 37 von 59

1

You are active in your local rural rescue squad as a paramedic. Your small town of 500 people does not have a hospital. There is a small community hospital 25 miles away and a large urban hospital 70 miles away. Recently, you have had two chest pain patients go into cardiac arrest and die after reaching the local community hospital, which does not have a cardiac catheterization lab or fibrinolytic therapy available. Given your rural setting, which of the following should you suggest to the medical director and rescue squad council as a solution?

Wähle eine der folgenden:

  • Allow paramedics with the rescue squad to perform 12-lead ECGs and carry bedside cardiac marker assays, heparin, and fibrinolytics

  • Suggest fund-raising activities to build a cardiac catheterization lab at the community hospital.

  • Develop a general protocol that states that all patients with chest pain of suspected cardiac origin should be transported directly from the scene to the urban hospital 70 miles away

  • Develop a general protocol that states that all patients with chest pain of suspected cardiac
    origin should be transported to the community hospital for evaluation by the nurse practitioner before transporting to the urban hospital.

Erklärung

Frage 38 von 59

1

You are on the scene of a single-vehicle rollover collision in which the two teenage occupants were ejected. Both patients are conscious but seriously injured. Yours is the only transporting vehicle on the scene and you are the only paramedic, but there are two volunteer EMTs and two first responders on the scene. Helicopter transport is not available. There is a small community hospital 23 miles away but a larger level II regional trauma center 40 miles away. The closest BLS transporting unit is 18 miles away. Which of the following is the best transport decision?

Wähle eine der folgenden:

  • Transport both patients in one unit to the community hospital

  • Transport the first patient to the community hospital while one EMT and one first responder remain with the patient, then immediately return to the scene for the second patient.

  • Transport both patients in one unit to the regional trauma center.

  • Transport the first patient to the community hospital while one EMT and one first responder wait on the scene for the BLS transport unit.

Erklärung

Frage 39 von 59

1

You are caring for a man who had his arm mangled by a piece of farm equipment. Bleeding has been controlled with a tourniquet; however, the patient is hypotensive and tachycardic. He has an extensive cardiac history and takes Pradaxa. There is a community hospital 18 minutes away by ground, a level III trauma center 40 minutes away by ground, and a level I trauma center 30 minutes away by air. You should:

Wähle eine der folgenden:

  • transport to the community ER so he can receive a blood transfusion.

  • transport by ground to the level III facility, as they have the resources to stabilize the patient.

  • call for air transport to the higher-level trauma center.

  • call for air transport, but tell them to fly to the level III trauma center, as it is closer

Erklärung

Frage 40 von 59

1

A 77-year-old man presents as hypertensive with crackles in all lung fields. The patient is tachypneic and has a history of MI, CAD, and CHF. His SpO2 is 78% on room air and he takes an extensive list of medications. He is 60 minutes away by ground from the closest hospital. Which of the following is TRUE regarding this patient?

Wähle eine der folgenden:

  • Air transport should be requested, as this is a critical patient.

  • This patient should be transported by ground, as ALS level care will likely improve all of his symptoms.

  • This patient should be treated on scene with nitroglycerine and CPAP, and released once his symptoms have resolved

  • Medical direction is required in this situation, as the patient is likely to present with multiple complications during treatment.

Erklärung

Frage 41 von 59

1

Which of the following statements concerning the use of helicopters in rural EMS is TRUE?

Wähle eine der folgenden:

  • Helicopters should be used only when a short extrication time is anticipated.

  • In some instances, it may be more efficient to transport patients by ground.

  • Helicopter transport is contraindicated for the patient suffering from altitude sickness.

  • The best use of helicopter transport is for the patient in traumatic cardiac arrest

Erklärung

Frage 42 von 59

1

You have been dispatched to a family farm operation for a report of a tractor rollover with an injured person. Which of the following types of injuries should you anticipate?

Wähle eine der folgenden:

  • Wrap

  • Crush

  • Shearing

  • Rapid deceleration

Erklärung

Frage 43 von 59

1

Which of the following is a characteristic of the rural setting?

Wähle eine der folgenden:

  • People living in rural areas are less likely to have chronic health conditions.

  • People living in rural areas have a much lower risk of serious injuries

  • There are fewer doctors per capita than in urban settings.

  • All of the above are characteristics.

Erklärung

Frage 44 von 59

1

You have been dispatched to a hunting camp for a report of a four-wheel ATV rollover with an injured person. Which of the following types of injuries should you anticipate?

Wähle eine der folgenden:

  • Degloving

  • Crush

  • Shearing

  • Rapid deceleration

Erklärung

Frage 45 von 59

1

Which of these terms refers to the condition in which, after circulation to a portion of the body is cut off, toxins develop in the blood, and the patient goes into shock when circulation is restored?

Wähle eine der folgenden:

  • cribbing

  • shear trauma

  • orthopedic trauma

  • compartment syndrome

Erklärung

Frage 46 von 59

1

What is the term for the mechanism of injury when a farmer loses the fingers of one hand while trying to work on a sickle bar mower while it is still​ running?

Wähle eine der folgenden:

  • Crush point

  • Wrap point

  • Shear point

  • Pinch point

Erklärung

Frage 47 von 59

1

Which statement is true about the typical budget for emergency medical services​ (EMS) services in rural areas of the United​ States?

Wähle eine der folgenden:

  • The budget has no effect on the EMS system as a​ whole, as all rural paramedics equip themselves.

  • The budget is mandated by each state government and therefore is sufficient.

  • The budget typically exceeds the EMS resource needs.

  • The budget is typically too low to meet departmental needs.

Erklärung

Frage 48 von 59

1

In an abandoned strip mine in the corner of a state​ park, an ATV enthusiast has sustained a severe head injury from overturning their​ vehicle, and ground transport lacks protocols for rapid sequence intubation. What is the best option for this​ patient?

Wähle eine der folgenden:

  • Advanced life support​ (ALS) supervisor intercept

  • Helicopter air ambulance​ (HAA) transport

  • Transport to a park ranger station

  • Provide spine motion restriction precautions and and provide rapid transport

Erklärung

Frage 49 von 59

1

Which states in the Northeast United States have large rural​ populations?

Wähle eine der folgenden:

  • ​Alaska, Montana, and the Dakotas

  • ​Arkansas, Kentucky,​ Mississippi, North​ Carolina, South​ Carolina, and West Virginia

  • ​Maine, New​ Hampshire, and Vermont

  • New​ York, Massachusetts, and Rhode Island

Erklärung

Frage 50 von 59

1

You are a paramedic in a rural farming community. One particular​ afternoon, you are summoned to a farm for a worker who is pinned under a piece of heavy machinery they were working on. The local sheriff meets you near the location to guide you in and tells you to​ hurry, as the patient is reportedly unresponsive. What should you consider first when making patient​ contact?

Wähle eine der folgenden:

  • Possible internal injuries the patient may have

  • Onset of compartment syndrome

  • Sizing up the scene to look for potential dangers

  • Putting the local helicopter air ambulance​ (HAA) program on​ stand-by

Erklärung

Frage 51 von 59

1

You respond to an emergency involving a patient injured while servicing a wind turbine on a stretch of farmland 20 miles away from the nearest town. What one element of emergency medical services​ (EMS) should you expect for this call that you​ wouldn't in an urban​ environment?

Wähle eine der folgenden:

  • You must contact air support for any emergency.

  • You will be in contact with this patient for a longer period of time.

  • Other EMS crews are likely to respond to the scene.

  • Any​ close-by town will have emergency department facilities.

Erklärung

Frage 52 von 59

1

In rural areas of the United States where health care access is​ limited, the​ paramedic's skills may be utilized in what capacity to help alleviate gaps in health​ care?

Wähle eine der folgenden:

  • In sanitation department positions

  • In community extended care facilities

  • In prompt care facilities

  • In grant fund writing

Erklärung

Frage 53 von 59

1

Which statement regarding rural populations is​ true?

Wähle eine der folgenden:

  • Rural areas have a higher percentage of people over age 65.

  • The​ physician-to-patient ratios are generally higher.

  • One in five doctors chooses to practice in a rural setting.

  • One in ten people in the United States lives in a rural area.

Erklärung

Frage 54 von 59

1

Which piece of equipment would most likely cause an amputation due to a shearing​ mechanism?

Wähle eine der folgenden:

  • Sickle bar mower

  • Tractor power turnoff​ (PTO) shaft

  • Tractor rollover

  • Fall into an abandoned well

Erklärung

Frage 55 von 59

1

To help improve the quality of medical oversight and support that physicians can provide to urban and rural emergency medical services​ (EMS)systems, what national organization has developed​ physician-level courses specifically designed for​ this?

Wähle eine der folgenden:

  • National Association of EMS Physicians

  • National Association of Emergency Medical Technicians​ (EMTs)

  • American College of Emergency Physicians

  • U.S. Department of Health and Human Services

Erklärung

Frage 56 von 59

1

What is the type of mechanism of injury that may occur if a hand gets entangled within a tractor power takeoff​ (PTO) ?

Wähle eine der folgenden:

  • Wrap point

  • Crush point

  • Shear point

  • Pinch point

Erklärung

Frage 57 von 59

1

What type of additional training should be provided to a rural paramedic who works near the borders of a large mountainous state​ park?

Wähle eine der folgenden:

  • Trench rescue

  • Water rescue

  • Fire suppression

  • Wilderness rescue

Erklärung

Frage 58 von 59

1

​It's 2:00 a.m. and you are transporting a trauma victim with significant injuries from an automobile accident. The local emergency department​ (ED) is closed for the​ night, and it will take approximately 1 hour for the staff to arrive. Which option should you​ consider?

Wähle eine der folgenden:

  • Admit the patient to the critical care floor.

  • Request a surgical team.

  • Continue your care in the ED until arrival of the​ on-call staff.

  • Continue care and transport to a more distant trauma center about 1 hour away.

Erklärung

Frage 59 von 59

1

What is the condition in which emergency medical services​ (EMS) providers are unable to stay abreast of current standards or previously taught​ practices?

Wähle eine der folgenden:

  • Ground out

  • Brown out

  • Rust out

  • Flame out

Erklärung

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