Deck 15: Rural Ems

Question 1

Approximately ________ Americans live in rural areas.

A) 50 million
B) 10 million
C) 25 million
D) 75 million

Answer 1

50 million

Question 2

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

A) Helicopters should be used only when a short extrication time is anticipated.
B) In some instances, it may be more efficient to transport patients by ground.
C) Helicopter transport is contraindicated for the patient suffering from altitude sickness.
D) The best use of helicopter transport is for the patient in traumatic cardiac arrest.

Answer 2

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

Question 3

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?

A) Delays in family or bystanders discovering the ill or injured patient
B) The time it takes providers to reach the squad building
C) Lengthy transport times
D) All of the above

Answer 3

All of the above

Question 4

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?

A) Degloving
B) Crush
C) Shearing
D) Rapid deceleration

Question 5

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?

A) Allow paramedics with the rescue squad to perform 12-lead ECGs and carry bedside cardiac marker assays, heparin, and fibrinolytics.
B) Suggest fund-raising activities to build a cardiac catheterization lab at the community hospital.
C) 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.
D) 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.

Question 6

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?

A) cribbing
B) shear trauma
C) orthopedic trauma
D) compartment syndrome

Question 7

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.

A) mobile health screening vans
B) prompt care facilities
C) private practice physician offices
D) extended care facilities

Question 8

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

A) Auger-off
B) Cribbing
C) Lock-out/tag-out
D) PTO

Question 9

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?

A) Transport both patients in one unit to the community hospital.
B) 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.
C) Transport both patients in one unit to the regional trauma center.
D) Transport the first patient to the community hospital while one EMT and one first responder wait on the scene for the BLS transport unit.

Question 10

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

A) Inadequate medical direction
B) Reliance on volunteers
C) Lack of opportunity for providers to use their skills
D) Low-income patient population

Question 11

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

A) People living in rural areas are less likely to have chronic health conditions.
B) People living in rural areas have a much lower risk of serious injuries.
C) There are fewer doctors per capita than in urban settings.
D) All of the above are characteristics.

Question 12

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?

A) Air transport should be requested, as this is a critical patient.
B) This patient should be transported by ground, as ALS level care will likely improve all of his symptoms.
C) This patient should be treated on scene with nitroglycerine and CPAP, and released once his symptoms have resolved.
D) Medical direction is required in this situation, as the patient is likely to present with multiple complications during treatment.

Question 13

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

A) Middle-aged adults
B) Children aged 5 and under
C) Elderly adults
D) Young adults

Question 14

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

A) Volunteers may lack experience, even after several years of volunteering.
B) Because of low operating costs, volunteer agencies are frequently able to send volunteers for specialized training and continuing education.
C) Volunteer turnover is low because of family support for volunteer efforts.
D) Volunteer turnover is low because the volunteers tend to have families in the area and close community ties.

Question 15

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:

A) transport to the community ER so he can receive a blood transfusion.
B) transport by ground to the level III facility, as they have the resources to stabilize the patient.
C) call for air transport to the higher-level trauma center.
D) call for air transport, but tell them to fly to the level III trauma center, as it is closer.

Question 16

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?

A) Wrap
B) Crush
C) Shearing
D) Rapid deceleration

Question 17

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

A) Seeking grant funding for radio equipment upgrades
B) Using landlines instead of radios
C) Using EMS access numbers other than 911
D) Using text-message-based dispatch systems