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

Question 1 of 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:

Select one of the following:

  • open wall hospitals.

  • health departments.

  • external emergent care facilities.

  • prompt care facilities.

Explanation

Question 2 of 59

1

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

Select one of the following:

  • silo gas.

  • nitrogen gas.

  • carbon monoxide.

  • silage.

Explanation

Question 3 of 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?

Select one of the following:

  • ​Tag-and-run

  • ​Turn-off/turn-down

  • ​Turn-off/turn-over

  • ​Lock-out/tag-out

Explanation

Question 4 of 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?

Select one of the following:

  • Rope and tackle blocks

  • Compartment expanders

  • Cribbing chambers

  • Air bags

Explanation

Question 5 of 59

1

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

Select one of the following:

  • 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.

Explanation

Question 6 of 59

1

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

Select one of the following:

  • 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.

Explanation

Question 7 of 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?

Select one of the following:

  • 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.

Explanation

Question 8 of 59

1

Transport times in rural areas​ are:

Select one of the following:

  • 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.

Explanation

Question 9 of 59

1

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

Select one of the following:

  • Slightly decrease

  • Increase

  • Sharply decrease

  • Stay the same

Explanation

Question 10 of 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?

Select one of the following:

  • 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.

Explanation

Question 11 of 59

1

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

Select one of the following:

  • EMS dispatchers

  • Emergency 911 access number

  • Radio signal repeater towers

  • ​Ambulance-mounted radio equipment

Explanation

Question 12 of 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?

Select one of the following:

  • 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.

Explanation

Question 13 of 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?

Select one of the following:

  • 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

Explanation

Question 14 of 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?

Select one of the following:

  • 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

Explanation

Question 15 of 59

1

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

Select one of the following:

  • paramedics as​ EMT-Basics or Advanced EMTs.

  • paramedics as physicians.

  • physicians as paramedics.

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

Explanation

Question 16 of 59

1

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

Select one of the following:

  • 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

Explanation

Question 17 of 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?

Select one of the following:

  • 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

Explanation

Question 18 of 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?

Select one of the following:

  • 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.

Explanation

Question 19 of 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?

Select one of the following:

  • 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

Explanation

Question 20 of 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?

Select one of the following:

  • 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.

Explanation

Question 21 of 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?

Select one of the following:

  • Mechanism of injury

  • Emergency medical services​ (EMS) provider safety

  • How many workers are involved

  • ​Turn-off and tag

Explanation

Question 22 of 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?

Select one of the following:

  • 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.

Explanation

Question 23 of 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?

Select one of the following:

  • 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

Explanation

Question 24 of 59

1

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

Select one of the following:

  • 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

Explanation

Question 25 of 59

1

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

Select one of the following:

  • 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.

Explanation

Question 26 of 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?

Select one of the following:

  • 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.

Explanation

Question 27 of 59

1

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

Select one of the following:

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

  • Classes to obtain a boat operating license

  • Water rescue

  • Critical care paramedicine

Explanation

Question 28 of 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?

Select one of the following:

  • 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.

Explanation

Question 29 of 59

1

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

Select one of the following:

  • Auger-off

  • Cribbing

  • Lock-out/tag-out

  • PTO

Explanation

Question 30 of 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.

Select one of the following:

  • mobile health screening vans

  • prompt care facilities

  • private practice physician offices

  • extended care facilities

Explanation

Question 31 of 59

1

Approximately ________ Americans live in rural areas.

Select one of the following:

  • 50 million

  • 10 million

  • 25 million

  • 75 million

Explanation

Question 32 of 59

1

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

Select one of the following:

  • 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

Explanation

Question 33 of 59

1

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

Select one of the following:

  • Middle-aged adults

  • Children aged 5 and under

  • Elderly adults

  • Young adults

Explanation

Question 34 of 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?

Select one of the following:

  • 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

Explanation

Question 35 of 59

1

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

Select one of the following:

  • 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.

Explanation

Question 36 of 59

1

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

Select one of the following:

  • Inadequate medical direction

  • Reliance on volunteers

  • Lack of opportunity for providers to use their skills

  • Low-income patient population

Explanation

Question 37 of 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?

Select one of the following:

  • 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.

Explanation

Question 38 of 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?

Select one of the following:

  • 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.

Explanation

Question 39 of 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:

Select one of the following:

  • 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

Explanation

Question 40 of 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?

Select one of the following:

  • 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.

Explanation

Question 41 of 59

1

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

Select one of the following:

  • 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

Explanation

Question 42 of 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?

Select one of the following:

  • Wrap

  • Crush

  • Shearing

  • Rapid deceleration

Explanation

Question 43 of 59

1

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

Select one of the following:

  • 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.

Explanation

Question 44 of 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?

Select one of the following:

  • Degloving

  • Crush

  • Shearing

  • Rapid deceleration

Explanation

Question 45 of 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?

Select one of the following:

  • cribbing

  • shear trauma

  • orthopedic trauma

  • compartment syndrome

Explanation

Question 46 of 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?

Select one of the following:

  • Crush point

  • Wrap point

  • Shear point

  • Pinch point

Explanation

Question 47 of 59

1

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

Select one of the following:

  • 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.

Explanation

Question 48 of 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?

Select one of the following:

  • 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

Explanation

Question 49 of 59

1

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

Select one of the following:

  • ​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

Explanation

Question 50 of 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?

Select one of the following:

  • 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

Explanation

Question 51 of 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?

Select one of the following:

  • 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.

Explanation

Question 52 of 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?

Select one of the following:

  • In sanitation department positions

  • In community extended care facilities

  • In prompt care facilities

  • In grant fund writing

Explanation

Question 53 of 59

1

Which statement regarding rural populations is​ true?

Select one of the following:

  • 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.

Explanation

Question 54 of 59

1

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

Select one of the following:

  • Sickle bar mower

  • Tractor power turnoff​ (PTO) shaft

  • Tractor rollover

  • Fall into an abandoned well

Explanation

Question 55 of 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?

Select one of the following:

  • 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

Explanation

Question 56 of 59

1

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

Select one of the following:

  • Wrap point

  • Crush point

  • Shear point

  • Pinch point

Explanation

Question 57 of 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?

Select one of the following:

  • Trench rescue

  • Water rescue

  • Fire suppression

  • Wilderness rescue

Explanation

Question 58 of 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?

Select one of the following:

  • 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.

Explanation

Question 59 of 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?

Select one of the following:

  • Ground out

  • Brown out

  • Rust out

  • Flame out

Explanation

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