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DOCUMENT RESUME
ED 093 889 SP 008 260
AUTHORTITLE
INSTITUTIONSPONS AGENCY
REPORT NOPUB DATENOTE
EDRS PRICEDESCRIPTORS
Byers, Bruce B.; And OthersA Task Analysis of Emergency Prehospital Care. AlliedHealth Professions Project.Educational Projects, Inc., Pittsburgh, Pa.Pennsylvania State Dept. of Public Instruction,Harrisburg. Bureau of Vocational, Technical, andContinuing Education.; Sarah Mellon ScaifeFoundation,. Pittsburgh, Pa.AP-14-1021Dec 73364p.; For related documents, see SP 008 256, 257,259, and 261
MF-$O.75 EC-417.40 PLUS POSTAGECurriculum Development; *Emergency Squad Personnel;Health Occupations; Medical Services; *ProfessionalTraining; Surveys
ABSTRACTA selected sample of ambulance service units in the
commonwealth of Pennsylvania was surveyed during May and June 1973.The purpose of the survey was to determine the performance of workactivities by various levels of workers within each of the ambulanceservices. The results of the survey are analyzed and reported. Thedata obtained are used for the purpose of developing job-relatedcurricula for the training of Emergency Medical Technicians (EMT). Abrief discussion of the method for translating task analysis data toinformation usable for the development of curricula and ccursecontent as well as a training module are presented. (Author)
BEST COPY AVAILABLE
EDUCATIONAL PROJECTS, INC.
Pittsburgh, Pennsylvania
Allied Health Professions Project
A TASK ANALYSIS OF
EMERGENCY PREIIOSPITAL CARE
Bruce B. Byers
David J. Lindstrom
S DEPARTMENTOf HEALTH,EDUCATION a WELFARENATIONAL INSTITUTE Of
EDUCATIONC,C)C,:VE -1,,S BEE-% w .k0
D.,(ED EXACTLY AS PECEH,E,E PE 4',C.% OR CR-C,A4'24-1,C,4 OR,5,%
POOS 0, v E O. OR OP.% CSS,A.ED CO 40! %E CE SS4P teEPQE,,E%-r op -%S,H7.,7t
C. PO5 'HO% 0,,t OD. ,v
December 1973
Frank F. Nowak (Principal Investigator)
Ancillary Project 014-1021
Sarah Mellon Sca;fe Foundationand
Commonwealth of PennsylvaniaDepartment of Public Instruction
Bureau of Vocational, Technical and Continuing Education
REST COPY AVAILABLE
TABLE OF CONTENTS
ABSTRACT
INTRODUCTIO'l
Page
1
The Status of Emergency PrehospitalCare 3
Emergency Prehospital Care WithinPennsylvania 4
CURRENT TR ININS PROG'2,AIIS FOR AMBULANCEATTENDANTS 11
THE EPI ALLIED EEALTIi PROFESSIONS PROJECT 14
THE SURVEY SITES 17
CHARACTERISTICS OF TEE RFSPONDt,NTS 22
RESPONSE TO TASK INVENTORY 29
General Description oy: Inventory 29Discussion of Response to Survey 33Patient Care - The Basic First AidFunction 34
Patient Care - Basic Emergency MedicalTechnician Aid 39
Patient Care - Ad.'anccd EmergencyMedical Technician Aid 45
Transportation 49Extrication 51Administrative, Clerical and
Support 53Some General Di:.:cussion Concerningthe Responses Obtained 60
Attendants - L:111 vs. Non-ENT 61Paid vs. Volunteer 66
TEST FOR CO:.:SISTLi:CY OF I::STRU:,1ENT 70
USING TASK ANAL' IS 10 DEVELOP CURRICULAAND CURRICULAR CONTENT 74
TABLE OF CONTENTS
SOME FINAL COMMENTS
Page
78
Need for a Training System 78Training in Inaccessible Areas of
the State 79Need for Refresher Training 80A Career Ladder for the EMT 81Citizen Training 82
CONCLUSION
References
82
84
APPENDIX A: QUESTIONNAIRE A-1
APPENDIX B: DATA RESPONSE B-1
All Respondents B-1Emergency Medical Technician B-13Attendants B-25Paid Personnel (Full and Part-Time) B-37Volunteer Personnel B-49Attendant-Registered PIT B-61Attendant-Non-Registered EMT B-72
APPENDIX C: SYSTEi1 FLOW C-1
APPENDIX D: TASK. DESCRIPTION D-1
APPENDIX E: A SAMPLE =CHING UNIT E-1
APPENDIX F: NAMrS AND ADDRESSES OF SURVEYSITES F-1
LIST OF EXHIBITS
EXHIBIT 1 JOB DESCRIPTION EMERGENCYMEDICAL TECHNICIAN AMBULANCE 7
EXHIBIT 2 SUMMARY OF ORGANIZATIONAL DATA FORAMBULANCE UNITS SURVEYED 19
EXHIBIT 3 SUMMARY OF RESPONDENT BACKGROUND 23
EXHIBIT 4 ANALYSIS OF EMT TRAINING INTERESTS 27
EXHIBIT 5 COMPARISON OF TASK PERFORMANCEBASIC FIRST AID 35
EXHIBIT 6 COMPARISON OF TASK PERFORMANCEBASIC EMERGENCY MEDICAL TECHNICIAN AID 40
EXHIBIT 7 COMPARISON OF TASK PERFORMANCEADVANCED EMERGENCY MEDICAL TECHNICIAN AID 46
EXHIBIT 8 COMPARISON OF TASK PERFORMANCE, TRANSPORTATION . 49
EXHIBIT 9 COMPARISON OF TASK PERFORMANCE EXTRICATION . . . 52
EXHIBIT 10 COMPARISON OF TASK PERFORMANCEADMINISTRATIVE /CLERICAL SUPPORT 54
EXHIBIT 11 TASK WITH SIGNIFICANT DIFFERENCE BETWEENPERFORMANCE BY REGISTERED EMT ATTENDANTSAND NON-REGISTERED ATTENDANTS
EXHIBIT 12 TASK WITH SIGNIFICANT DIFFERENCE BETWEENPERFORMANCE BY PAID AMBULANCE ATTENDANTSAND VOLUNTEER AMBULANCE ATTENDANTS
63
67
ABSTRACT
A selected sample of ambulance service units in the Commonwealth
of Pennsylvania was surveyed during May and June, 1973. The
purpose of the survey was to determine the performance of work
activities by various levels of workers within each of the
ambulance services. The results of the survey are analyzed and
reported.
The data obtained is used for the purpose of developing job-
related curricula for the training of the Emergency Medical
Technicians (EMT). A brief discussion of the method for trans-
lating task analysis data to information usable for the development
of curricula and course content as well as a training module
are presented.
XNTRODUCTION
Until recently, the emergency medical services system (EMSS) has
not been recognized as an important component within the total
health system of the United States. Prevlously, EMSS has been
relegated to a secondary role both in receipt of funding and in
concern about the improvement of its activities. However, the
situation is changing. Professionals within the health delivery
system, governmental officials and the general public are
recognizing the it of adequate emergency medical services
to the total health delivery system. As a result of this
recognition, much study has been undertaken in the past few years
concerning those components of the emergency medical services
system which must be improved and suggestions have been made as
to how these improvements can be made. However, this is only a
beginning. Much remains to be done.
As clearly stated in 19 71 by Melvin K. Duval, M.D., Assistant
Secretary for Health and Scientific Affairs, Department of Health,
Education and Welfare, the major components of the EMSS are:
A. Prevention;
B. Occurrence;
C. Detection;
D. Notification;
E. Dispatch;
F. Treatment;
G. Transport;
H. Emergency room treatment;
1
I. Intensive care treatment;
J. Recuperation; and,
K. Rehabilitation.
Dr. Duval relates the above as links in a total chain. Each
link is as important as the previous and following link and the
breakdown of one single link in the chain may cause the failure
of the total chain.
The three primary objectives of the EMSS are:
A. Resuscitation and maintenance of life;
B. Transportation of the patient; and,
C. Rapid diagnosis and treatment of the basic
medical problems.
Diagnosis and treatment may be performed at the scene and
continued while the patient is in transit to a definitive care
facility. Two major factors which are important in the
attainment of the three primary objectives are the quality of
medical care available and delivered by medical and allied health
personnel and the time frame within which this medical care is
rendered. (Nahum, 1971)
Within the above system, there exists a subsystem which can be
defined as emergency prehospital care. This subsystem begins
with detection of an incident and ends with the transfer of a
patient to an emergency room. The mechanism by which services of
this subsystem can be delivered include ..he ambulance service,
police department, fire department, family, friends or
2
acquaintances of the patient, or a "Good Samaritan" passing by.
This study, the results of which are presented herein, is
directed towards the delivery of emergency prehospital care by
individuals working with ambulance services, police departments
and fire departments whose primary duty it is to provide
emergency care and transportation for the patient. Exhibit 1
presents a model job description for an ambulance attendant who
has the major responsibility for patient care within the
subsystem. (U. S. Department of Transportation, 1972)
The Status of Emergency Prehospital Care
The National Academy o4 Sciences, National Research Council,
summarizes the deplorable state of the art in emergency care in
its publication, "Roles and Resources of Federal Agencies in
Support of Comprehensive Emergency Medical Services":
Emergency medical service is one of the weakest links inthe delivery of health care in the nation. Thousands oflives are lost through lack of systematic application ofestablished principles of emergency care. Few at thesite of accidental injury or sudden illness are trainedin the fundamentals of restoration of breathing, controlof hemorrhage, or splinting of fractures. The majorityof ambulances in the United States are of the hearse,limousine, or station wagon type which are inadequate inspace and equipment and are manned by individuals withinadequate training to provide essential life support.Pilot studies with better-equipped ambulance servicesindicate that thousands of lives can be saved anddisability reduced.
Many ambulances lack radio communication even with theirown dispatchers. Communication rarely exists betweenambulances and hospitals, so that most patients arriveat emergency departments without prior notification.Most emergency departments of the nation are not onlylacking in facilities and personnel, but are overtaxedby millions of nonemergency cases for whom ancillaryoutpatient facilities should be provided, especiallyduring evening hours and on weekends. In comparisonwith facilities for definitive care of illness, few
3
Centers of excellence for the care of the critically illor injured exist. (N.A.S. N.R.C., 1972)
Although the above conditions exist today, the situation is not
hopeless. Fortunately, many are recognizing that emergency
medical care must take a higher priority within the health care
delivery system. Examples of the recognition (and perhaps causes
of the recognition in the first place) are such things as the
television program "Emergency," local newspaper articles on the
subject (Pittsburgh Press, Pittsburgh Post-Gazette, Indiana
Evening Gazette, Philadelphia Inquirer), the existence of five
federally funded pilot projects for research within the emergency
medical services system and the existence of a national peer
registry for Emergency Medical Technicians (EMT). This
recognition has resulted in a number of actions taking place.
These include the establishment of many emergency medical
councils whose major responsibility is to assure that a
coordinated quality emergency medical services system exists
within a local area. In addition, training of an ambulance
attendant, upgrading of equipment and establishment of a
communications network have begun in some areas. These programs
appear to be harbingers of improvements and innovations to come
within the emergency prehospital care system.
Emergency Prehospital Care Within Pennsylvania
Of the 1,018 ambulance services currently operating within the
Comonwealth of Pennsylvania, G6% are volunteer ambulance groups,
27% are funeral directors and commercial firms, 6% are
municipally operated and 1% operate out of hospitals.
Approximately 20,000 individuals work On either a paid or
4
volunteer basis as ambulance attendants within Pennsylvania.
Moreover, ambulance services within the Commonwealth operate
1,470 ambulances and 396 rescue vehicles, twenty-two percent
(22t) of the ambulances being operated have direct two-way radio
communication between vehicles and hospitals (Pennsylvania
Department of Health, 1973).
Pennsylvania currently has no licensing requirements for either
the ambulance services or the personnel providing patient care
for the ambulance service. Bills are currently pending in the
legislature which will require licensing of ambulance services
and provide for training and certification of ambulance
attendants. However, the passage of these bills could have a
major negative effect on delivery of a emergency prehospital care
within the Commonwealth. Only a small portion of those
individuals serving as ambulance attendants have completed the
emergency medical technician training program and only about
one-fourth have completed the Pennsylvania Department of Health
Ambulance Attendant Training course. Proposed legislation, if
passed, will set a minimum training requirement of 40 hours
effective one year after passage of the legislation. It can be
seen that a large number of ambulance attendants will have to be
trained relatively quickly. However, no training system
currently exists within the Commonwealth of Pennsylvania.
Training programs are now being operated by Emergency Medical
Councils and the Division of the Emergency Medical Health
Serv3.ces of the Pennsylvania Department of Health. These
prog;:ams are not funded at a level which can provide for the
training need which will occur upon passage of the legislation.
Consequently, an alternative mechanism must be developed. One
possible alternative
is the introduction
into the community
systoms.
toward which the present study is directed
of basic training for ambulance attendants
college and vocational technical school
EXHIBIT 1
J013 DESCRIPTION EMERGENCY MEDICAL TECHNICIAN-AMSULANCE
Work Reui.r2ments
Responds to emergency calls to provide efficient and immediatecare to the critically ill and injured, and transports the patientto a medical facility.
After receiving the call from the dispatcher, drives ambulanceto address or location given, using the most expeditious route,depending on traffic and weather conditions. Observes trafficordinances and regulations concerning emergency vehicle operation.
Upon arrival at the scene of accident or illness, parks the ambulancein a safe location to avoid an accident. In the absence of police,enlists the assistance of persons available to create a safetraffic environment, such as the placement of road flares, removalof debris, and redirection of traffic for the potection of theinjured and those assisting in the care of the injured.
Determines the nature and extent of illness or injury and establishespriority for required emergency care. Renders emergency care,such as opening and maintaining an airway, giving positive pressureventilation, cardiac resuscitation, controlling of hemorrhage,Treatment of sheet, immobilization of fractures, bandaging, assist-ing in childbirth, management of mentally disturbed patients,and initial care of poison and burn patients. Administers drugs,including intravenous fluids, as directed by a physician.
Reassures patients and bystanders by working in a confident, efficientmanner. Avoids mishandling and undue haste while working expeditiously.Searches for medical identification emblem as a clue in providingemergency care.
Where patients must be extricated from entrapment, assesses theextent of injury and gives all possible emergency care and pro-tection to the entrapped patient and uses the prescribed tech-niques and appliances for removing the patient safely. Radiosthe dispatcher for additional help or special rescue and/or utilityservices, if needed. Provides light rescue service if the ambulancehas not been accompanied by a specialized unit. After extrication,provides additional care in sorting the injured in accordancewith standard emergency procedures.
Complies with regulations on the handling of the deceased, notifiesauthorities, and arranges for protection of property and evidenceat scene.
Assists in lifting stretcher, placing in ambulance and seeing thatpatient and stretcher are secured and that emergency care, ifnecessary, is continued.
7
EXHIBIT 1 (CONTINUED)
From the knowledge of the condition of the patient and the extentof injuries and the relative locations and staffing of emergencyhospital facilities, determines the most appropriate facility towhich the patient will be transported, unless otherwise directedby the dispatcher or a physician. Reports directly to the emergencydepartment or control center the nature and extent of injuries,the number being transported, and the destination to assure promptmedical care on delivery. For serious cases, may ask for additionaladvice from the hospital physician or emergency department.
Constantly observes patient enroute to emergency facility, admin-isters additional care as indicated or directed by physician.
Identifies diagnostic signs which may require radio communicationswith a medical facility for advice and for notification thatspecial professional services and assistance be immediately avail-able upon arrival at the medical facility.
Assists in lifting and carrying the patient out of the ambulanceand into the emergency department.
Reports verbally and in writing his observation and care of patientat the emergency scone and in transit, to the emergency departmentstaff for record and diagnostic purposes. Upon request, providesassistance to the emergency department staff.
After each trip, replaces used linens, blankets and other supplies,sends supplies for sterilization, makes careful check of all equip-ment so that the ambulance is ready for, the next run. Maintainsambulance in efficient operating condition. Ensures that theambulance is clean and washeu and kept neat and in an orderlycondition. In accordance with local or state regulations, de-contaminates the interior of the vehicle after transport ofvictim with contagious infection or radiation exposure. Determinesthat vehicle is in proper operating condition by checking gas,oil, water in battery and radiator, and tire pressure. Maintainsfamiliarity with specialized equipment items used by the ambulanceservice.
Note
Seniority and responsibility should he determined by the one re-sponsible for employment and surveillance of personnel. Atten-dants and drivers should he equally trained in each other's dutiesand responsibilities so that they may function interchangeablyor independently in caring for multiple casualties.
Education, Training & ExDerience
A high school education or equivalency qualification is consideredminimal. Must be 18 years of age or older.
EXHIBIT 1 (CONTINUED)
Minimum training shall be that prescribed in the basic trainingprogram for emergency medical technicians-ambulance of the Departmentof Transportation and the Public Health Service, or equivalency.
Has practical experience in the care and use of emergency equip-ment commonly accepted and employed, such as suction machines,oxygen delivery systems (installed and portable) , backboards,fracture kits, emergency medical care kits, obstetrical kits,intravenous kits, stretchers of various types, light rescue toolsand basic automobile machines. has a basic understanding ofsanitizing and disinfecting procedures. Has knowledge of safetyand security measures.
Acquires, through critiques and conferences with emergency depart-ment personnel, constructive criticism of care rendered and in-struction in advances in patient care and in new or improved equip-ment.
Acquires a thorough knowledge of the territory within his servicearea, and the traffic ordinances and laws concerning the emergencycare and transportation of the sick and injured. has necessarydriver and professional licenses as required by law.
Special Cheracteristics
Aptitudes
Motor coordination in administering emergency care of the criticallyill and injured, In lifting and carrying patients, and in drivingthe ambulance.
Manual dexterity and physical coordination in carrying, lifting,extricating, climbing, hoisting, and other similar maneuvers ina manner not detri.,ental to the patient, fellow workers, or self.
Facility to give and recieve verbal and written directions andinstructions,
Interosts and Temperaments
- A pleasant personality- Leadership ability; firm, yet courteous- Good judgment under stress- Clean and neat in appearance- Good moral character- Emotional stability and psychological adaptability
Physical Demands
Normal good health.
Ability to lift and carry up to 100 pounds.
9
EXHIBIT 1 (CONTINUED)
Visual color discrimination in examining patients and determiningby appearance diagnostic signs that require immediate detectionand proper action, as well as to distinguish traffic signs andlights.
Both far and near visual acuity necessary for driving and forexamining the patient (correction by lenses permitted).
10
CURRENT TRAINING PROGRAMS FOR AMBULANCE ATTENDANTS
A number of training programs have been developed to train
ambulance attendants, either for specific functions or for the
overall performance of their job. The following is a brief
discussion oil some of those training programs which are presently
being offered to train ambulance attendants.
1. American Red Cross
Perhaps the first training program to which an ambulance
attendant is introduced is one which has been developed
by the American Red Cross. This training program is
divided into two sections: 1) the Standard Red Cross
program and, 2) the Advanced Red Cross program. The
standard section requires 10 classroom hours for
completion while the advanced section requires 16 hours.
Subjects covered in the standard course include
treatment of wounds, treatment of shock, artificial
respiration, treatment of poisoning, treatment of burns
and ill effects of heat and cold, injuries to bones,
joints and muscles. The advance course goes into more
detail about the treatment of injury and illness. The
standard course is designed primarily for the average
citizen, whereas the advance course is geared toward
training special interest groups such as policemen,
firemen, rescue squad and ambulance crews.
2. Pennsylvania Department of Health
11
Pennsylvania's Department of Health conducts a 27-hour
ambulance attendant training program. This program
includes the same basic subjects as those covered by the
American Reu Cross courses with additional attention
being given to the theory behind certain treatments and
emphasis on the operation of an emergency vehicle and
related equipment found in such a vehicle. Special
attention is given to the area of emergency childbirth
procedures and applicable Pennsylvania Motor Vehicle
Code regulations.
3. United States Department of Transportation
The most generally accepted training program nationwide
is the United States Department of Transportation's
(DOT) 81-hour course entitled Basic Training Program for
Emergency Medical Technician-Ambulance. This training
program is the model training program upon which
certification for the emergency medical technician is
based. The program includes a 10-hour in-hospital
training session which provides the EMT with the
opportunity to observe various functions within the
hospital. In addition to those items which are covered
in the above training programs, the 81-hour course
includes a unit on cardiopulmonary resuscitation (CPR).
4. Cariliopulmonary Resus-itation
The American Heart Association has developed a training
program specifically for the purpose of instructing
12
students to perform cardiopulmonary resuscitation (CPR).
This training program requires three class hours. The
training program is directed not only to those who
provide ambulance service but also toward nurses,
physicians and the general population of tho United
States.
5. Grant/urray
Messrs, Harvey Grant and Robert Murray have developed
an alternative training program which is the equivalent
of the U.S. Department of Transportation course. The
same basic subject matter is covered in this program as
in the Department of Transportation program. However,
the emphasis of the training program developed by Grant
and Murray is to provide students with the fundamental
knowledge necessary to perform particular tasks required
by their occupation. The required anatomical and
physiological knowledge is introduced during the
presentation of the specific task or group of tasks, as
opposed to being introduced at the beginning of the
course apart from the related task.
In addition to the above training courses, various other
alternative courses have been developed by state agencies to
serve as alternatives to *-he 81-hour DOT course. Among these
courses are the Ohio Training Program, the South Carolina
Hospital Association Training Program and the New Mexico Regional
Medical Program Arbulance Training Course.
13
THE EPI ALLIED HEALTH PROFESSIONS PROJECT
The purpose of the EPI Allied Health Professions Project is to
develop a job-related curriculum based upon the use of task
analysis as a tool for gathering job-related data. The area of
emergency prehospital care was chosen as one of the occupations
to be studied in the EPI Allied Health Professions Project since
it represented an emerging occupation. The job-related data
which is gathered can be used to verify the curriculum content in
the above training programs. This verification process involves
determining those skills and knowledge which are required of an
incumbent performing as an ambulance attendant and comparing the
skills and knowledge to the subject area which is included in a
given training program. This comparison will indicate whether
the skills and knowledge which are required are being taught
within the training program.
The procedure involved in the project is as follows:
1. A series of sentences were developed which define
tasks/functions, or elements of tasks which an ambulance
attendant must perform. These tasks were developed
using observations of ambulance attendants performing on
the job; opinions of recognized experts in the field;
and existing task inventories for other allied health
professions.
2. Background information questionnaires were developed
to obtain specific characteristics of the ambulance
service where the attendant works and to establish the
14
age, sex, education, training, etc. of the individuals
responding to the survey.
3. The survey sites were chosen throughout the
Commonwealth. The basis for choice in this survey was
willingness to participate, a geographical
representation throughout the state, and representation
of both volunteer and paid ambulance services.
4. Completed responses to the task survey instrument
were gathered, keypunched and tabulated using a series
of computer programs.
J. Response tabulation was analyzed by utilizing
post-hoc blocked groups to determine differences in
performance frequency; performer-perceived difficulty of
the task; the amount of supervision received while
performing the task the amount of co-worker involvement
in performing the task and the location where the
performer feels he was trained to perform the task. The
results of this analysis of respondent data are
presented within this report.
6. Those tasks which, in the opinion of experts, were
thought to be necessary for adequate performance as an
ambulance attendant are being analyzed in detail. This
task analysis involves flow charting of the tasks and
writing a detailed task description. The task
description states each elemental step which is required
to perform the task and also considers such things as
15
critical errors which can occur, tolerance levels for
performance of a task element, and cues (indicators) as
to the skills and knowledge which are required to
perform the element and thus the task. See the report
"Developing Job-Related Curricula Using Task Analysis,"
(EPI, October 1973).
7. The results of this task analysis can then be used
to verify existing curriculum or to develop new
curriculum.
16
'OM SURVEY SITES
A total of twenty-nine (29) ambulance service units in the
Commonwealth of Pennsylvania were surveyed. This survey took
place during May and June of 1973. Appendix F presents the names
and addresses of the units surveyed. A summary of the
organi*zational data for the ambulance units surveyed is presented
in Exhibit 2.
The services varied from urban independent ambulance services to
rural volunteer fire department services. A total of 59% of the
services surveyed were fire department services while 52% of the
total were volunteer services.
Some of the services in the survey provide only emerg,-?.ncy
transportation from the site to the medical facility while others
provide emergency medical care and definitive medical care. Not
all of the services provided non-emergency transportation of
convalescent patients (24%).
The average number of calls per year per unit was 1,470 with a
range from a high of 8,201 to a low of 30. The low figure
represents a service which had just started up at the time of the
survey and thus, is a pro-rated number based upon their current
),,vel of service.
A two-way radio system was used by 48% of the services to advise
the hospital of the pending arrival of a patient. A total of 35%
used the two-way radio to advise hospital personnel of the care
given to the patient at the scene and in transport. No
information was provided to the hospital prior to arrival by 7%
17
of the sites surveyed.
By far, the most popular type of ambulance used by the services
is the van type ambulance (42%). This fact seems to represent a
noticeable change from the situation which existed a few years
ago when most ambulance services used either the straight
limousine or raised roof limousine. It would appear that at
least in terms of vehicular equipment, ambulance services have
become more sophisticated. This is based on the assumption that
the vans represented in the survey are likely to meet the
Department of Transportation standards for design.
A total of 41% of the ambulance services surveyed did not charge
for ambulance service; 75% of the services charged $30 or less as
a base. However, in some cases, services which do not charge
request a donation from those using the service.
18
EXHIBIT 2
SUMMARY Or ORGANIZATIONAL DATAFOR AMBUIANCE UNITS SURVEYED
Number Pct.Units Surveyed 29
Type of OrganizationPolice Department 1 3Fire Department 17 59Other Municipal Services 0 0Independent 8 28Other 3 10
Tax StatusProfit 3 10Non-Profit 26 89
Source of FundsLocal taxes 10 35Private grants 2 7Donation and fundraising 21 72Fee for service 18 62Federal or state funds 7 24Subscription or mernoership 15 52
Base ChargeNone 12 41Less than $5 1 3$ 6 $10 2 7$11 $20 2 7$21 - $30 5 17$31 - $40 2 7$41 - $50 1 3
$51 or more 4 14
Location of ambulanceSame location 25 86Different location 4 14
Attendant Pay StatusVolunteer 15 52Paid 10 34Paid and Volunteer 4 14
ManagerVolunteer 15 52Paid 13 45No manager 1 3
19
EXHIBIT 2 (CONTINUED)
Pct.
1421
241721
NumberApproximate population served
Less than 5 0005,000 9,999
10,000 2,1,99925,000 49,99950,000 99,999100,000 149,999150,000 - 2,19,999
4
6
7
5
6
0
250,000 or more 1 3
Radius of primary emergency response2 miles or less 2 73 - 4 miles 2 75 - 8 miles 11 389 - 15 miles 7 2416 25 miles 6 2126 - 50 miles 1 351 - 100 miles 0 0101 miles or more 0 0
Radius of inter-hospital transfer of critically ill orinjured patients
2 miles or less 03 - 4 miles 5 175 8 miles 2 79 15 miles 3 1016 - 2S miles 4 1925 - 50 miles 5 1751 100 miles 5 17101 miles or more 5 17
Services provided by unitEmergency medical care 26 89Definitive medical care, including defibrillation,
1V and/or drug infusion2 7
Emergency transportation from site to a medical facility 29 100Emergency transportation between medical facilities 24 83Non-emergency transportation of convalescent patients 22 76Light rescue operations, using hand tools (e.g. , jacks,
bolt cutters, bars)25 86
Extrication (e.g., from automobiles) 21 73
Average number of calls/year/unit 1,470Range highest 8,201
lowest 30
20
EXIIIBIT 2 (CONTINUIM)
Recorcikeeping dataDate of call 29 100Place of patient pickup 29 100Disposition of patient: 27 93Type of call 28 97Care given to patient 26 89Name of patient 29 100
Central. dispatch or emergency operation center 13 45
Most frequently used method of advising the hospital ofpending arrival of patient
No information is provided 2 7
"Hot line" telephone 1
Normal telephone line 9 31Twoway voice radio system 14 48One-way voice radio system 1 3
Other 2 7
Most frequently used methods of advising hospital personnelof care given to the patient at the scene and in transport.
No information is provided 1 3
"Hot line" telephone 1 3Normal telephone line 1 3
Two-way voice radio system 10 35One-way voice radio system 0 0Verbal communication at hospital 17 59Medical record with patient 6 21
Average number of attendants /unit 19 25
Type of aii.:Julance usedStraight limousine 1 1
Raised roof limousine 16 22Van 31 42Station wagon 6 8Truck-mounted module 4 5Travel-all true;; 11 15Hearse conversion 2 3
Heavy rescue truck 0 0Other 2 3
21
CHARACTERISTIC OF THE RESPONDENTS
As a part of the survey, certain data were gathered concerning
the characteristics of the respondents. Appendix A includes a
reproduction of the questionnaire used to obtain respondent
background information.
A summary of ba'';kground data for all respondents as well as
break-outs for EMT, attendant, paid, and volunteer categories of
respondents is given in Exhibit 3. The total number of
respondents in the survey was 209. Of these respondent, a great
majority (60%) were in the ambulance attendant category. Another
25% are likely to he involved in patient care (crew chief and
driver category).
The average age and average years of EMS experiences of the
respondents seems to indicate that the survey group although
relatively young (average age 29.8 years) were not new to the
field of EMS (average years experience 4.8 years). Thus, it is
likely that the results obtained in the survey are not affected
by the responses of individuals possessing little experience and
thus, performing few task because of the lack of experience.
The average number of trips per month for all respondents was
29.7, with those in the attendant category indicating a 28.5
trips per month. In the attendant category, this represented a
range of from 200 trips per month to 2 trips per month. A large
difference is found when comparing paid versus volunteer
respondents in this category. The number of trips taken in a
month by paid attendants exceeded the number of trips taken by
22
EXHIBIT 3
SUMMARY' (Dr RESPONDENLBACKGROUND
1. Respondents: NumberPer Cent
2. Sex: Per Cent MalePet Cent l'emale
3. Average Age
4. Average Years'EMS Experience
5. Average YearsCurrent PO S i tion
Attendant_Total EMT Attendant Paid Volunteer EMT
209 57 125 63 143 36 89
100 27 60 30 68 17 43
86 88 82 92 84 83 82
13 12 17 8 15 17 17
29.8 27.6 27.2 31.Z 29.0 26.1 27.7
4.8 4.9 3.8 5.1 5.5 3.8 3.8
3.7 3.2 3.5 3.3 3.8 2.8 3.7
6. Position held((Pet. of ResT:andents)
Manager 7 12 0 13 4 0 0
Shift Supervisor 4 4 0 10 2 0 0
Crew Chief 10 11 0 8 10 0 0
Driver 15 9 0 22 11 0 0
Attendant 60 63 100 43 67 100 100Dispatc:Ier 3 2. 0 2 4 0 0
Clerical 1 0 0 3 0 0 0
7. Average Number Trips/ 23 47 22 55 13 38 39Month
8. Reirnbursetnent (PerCent Respondents)
Volunteer 68 37 77 0 100 47 89
Full-Time 23 44 12 78 25 7
Part-Time 7 18 10 22 25 3
9. Registry Held (Number)EMT 57 57 36 35 22 36 0
RN 1 0 0 0 1 0 1
LPN 2 0 0 2 0 0 1
10. ilighe.st Academic. Level(Per Cent Lospendents)
Less dial). t.; 0 0 0 0 1 0 0
Loss than high school 22 19 24 24 22 20 27
High :-;cho;)' diploma 36 32 37, 30 38 33 38Associate de_cir-ee 5 7 6 5 5 6 6
Solna CC) l 1 erjA: 23 30 22 29 22 33 18
Bachehrs deqree 9 9 6 8 9 6 7
Masters (h:(iree 1 0 1 2 1 0 1
23
11.
EXII IPIT 3 (CONTINUED)
Paid VolunteerAttowlant
EMTTotalOccupational Trc.ining(Per Cent Respondent
EMT Attendant.
None 11 2 8 13 10 3 10Standard Red Cross 77 81 78 78 76 83 75Advanced Red Cross 73 75 78 59 79 61 76Instructor Red Cross 24 33 18 35 20 19 18CPR-Atfier, Heart Assoc.. 66 70 69 54 71 69 69Extrication Training 33 49 30 41 29 44 25pL . Dept. of Health 29 33 28 24 31 33 26D . 0.'I.' . -81 hour 20 65 22 38 13 67 3
Electrocardiography 10 26 6 25 3 17 2
Infusion of IV 8 25 5 21 2 14 1
Infusion of Drugs 7 23 5 19 2 14 1
Advanced-480 hour 3 12 2 10 0 8 0
24
volunteers by a factor of six (6). This difference is probably
explained by two facts; in general volunteers will be on call
fewer hours per month as a result of other full-time
responsibilities which they carry; and in terms of the survey
population at least, volunteers tend to service more rural
locations with smaller populations therein yielding a fewer
number of trips a month.
There appears to be no sufficient difference between the
percentages of volunteer and paid personnel responding to the
survey and that which appears to be characteristic of the
Corar,onwcalth of Pennsylvania. This fact along with the
experience of the respondent helps to allow generalization from
specific survey data obtained.
In terms of training received and registry obtained, it would
appear that thirty-five percent (35%) of those individuals
indicating that they held the EMT registry (27% of the total
respondents) did not take the Department of Transportation
81-hour required course for registry. These individuals in all
likelihood were covered under the "grandfather clause" of the EMT
registry program. This clause allowed individuals with certain
experience and past training to take the MAT registry test
without taking the 81-hour course.
Approximately fifty-six percent (56%) of the paid respondents in
:he sample hold the FrnT registry while fifteen percent (15%) of
the volunteers indicated that they held the EMT registry. This
should he expected given the fact that the EMT registry has been
in existence only about three years and that paid attendants who
25
depend upon the job as a livelihood are more likely to have
obtained the registry.
In terns of training received, eleven'percent (11%) of the total
respondents indicated that they had received no specific training
for their job. Eighty percent (80%) of the respondents were
trained at less than the EMT 81-hour level. If this data is
generalizable to the Commonwealth of Pennsylvania, it points to a
lack of sufficient training in the area of emergency prehospital
care. A difference between the amount of training obtained by
paid versus volunteers does appear to exist. This can probably
be explained by the fact that the volunteer organizations in the
sample, and likely volunteer organizations in general, are from
rural areas which have not been offered the opportunity to take
training programs. This difference in training does not likely
represent a difference between paid and volunteers in their
desire to obtain training. The response to the question
concerning a willingness to enroll in training programs showed no
significant difference between paid and volunteer attendants (Sec
Exhibit 4).
The academic level data indicates that the general education of
the respondents is relatively high (75° have obtained a high
school dipluAa or highoO. If this academic level response is
generalizable to the Commonwealth, it would indicate that any
training effort for ambulance attendants need not be simplified
so as to provide training for less than high school educated
students. The difference between paid and volunteer attendants
in terms of general academic training does not appear to be
26
7X:-
TIB
TT
4
AN
AL
YST
S 07
Tni
rT 7
2".7
.\TIT
`.:0
IN
TE
RE
STS
r.T
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i
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I
i',..\
;:".`
,-;-
AT
'ED
IT
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TN
G C
OT
: 2SE
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ININ
G I
NT
ER
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) St
anda
rd11
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vor.
ce,..
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ruc
tor
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ance
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NT
S1
'72,:o.
0, ,.,
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r-,
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7.-,1
No.
%;
iI
I
,,o,
9032
26)
39...
),1
;1--
2.i.
:`,
i
1i)a
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(7u
ll-ti2
e 1
71cl .2
5I
.-1
c;20
:A.
1.,
i
ti,
-.id
(Pa
:t-tim
e)!
1091
0-
0-
1
;I*
-r.
: -,of
i37
341
4527
39i,;
1
I
27 i 1 !
17)
I
10;
;
39 10
0
I
32i ,;
33i
-; I I
27
-) ., 1
I
221 1
101 i
101 I
11
5
;
241 1
4930
1
31I9
195
54I
7157
AV
G.
NO
. MIL
ES
WIL
L":
"::G
TO
A;v1V1-1.1_,
27
371
1963
27I
SO1
880
25
I I
581
9860
261
*Tot
al n
umbe
r of
re.
spon
dent
s w
as 1
92; 1
0 di
d no
t res
pond
to th
is q
uest
ion
in e
ither
way
; 17
did
not i
ndic
ate
spec
ific
cou
rses
ofC
.ic: r
efle
ct a
will
;-,g
r.e.
ss to
trav
el f
or a
dditi
onal
trai
ning
.
significant.
The following question was proposed to all respondents: If
legislation were proposed that would require at least one EMT
(trained at the 8l-hour level) be on every ambulance call, how
would you probably vote? In response to this question, eighty
percent (8V:1) of all respondents indicated that they would vote
for the legislation while only eighteen percent (18%) indicated
that they would vote against such legislation. This response
seems to indicate a feeling, at least on the part of the survey
respondents, that such legislation is necessary in order to
assure that better trained individuals be used in providing
ambulance service in the Come-:lonwealth of Pennsylvania.
28
RESPONSE TO TASK INVENTORY
General Description of Inventory
The purpose of the survey was to obtain information concerning
the general limits of the duties performed by various types of
personnel in ambulance services throughout the state. As has
been previously mentioned, this data provides general information
from which a complete task analysis can begin. It was with this
purpose in mind that the task statements used on the inventory
were structured. In general, statements were chosen in order
that they might be representative of skills and knowledge which
should be obtained by individuals prior to working in the field.
As a result, certain duties which are performed by individuals in
ail ,:tmbu la ac e service may not be included in the task inventory
since they do not represent skills and knowledge which should he
included in a training program.
Not all of the statements included in the inventory can be
considered as tasks in the strict definition (DPI, June 1973).
any of the statements are much larger and include a number of
tasks while others are, in reality, stages of a larger task.
This was consciously done to gather specific information on the
perfonaance of duties by particular individuals. For example,
the statement -- Sets standard types and quantity of ere rgency
and medical equipment needed for unit operation -- probably
involves more than one task. However, for the purposes of
defining general limits to the job, this statement is
appropriate. Further breakdown of the statement into its
individual tasks can occur during the task description and task
29
analysis phase.
On the other hand, those statements which represent a part of a
task generally indicate specific types of equipment and/or
alternate procedures which may be used to perform the entire
task. ror example, Task 49 and 50 (Appendix 13) indicate a use of
a three-foot spine board or a six-foot spine hoard to immobilize
a patient's spine. These statements are really alternate
procedures using different equipment to perform the same task.
However, the data gathered through the use of two separate
statements indicates something about the type of equipment which
is currently being used in an ambulance service.
However, having stated the above, the term "task" will be used to
describe the statements in the inventory even though in many
cases it is inappropriate. This is done for efficiency and
clarity of the document.
The inventory itself was used to gather data on the frequency of
performance of the "task", the amount of supervision received,
the co-worker involvement in the "task", the difficulty as
perceived by the performer and the location where the performer
felt he was trained to perform the "task" (see Appendix A for a
sample page from the survey form). Performance data, gathered in
terms of frequency of performance of the "task" by the
respondent, provides useful information concerning the relative
iyportance of the "task" in relation to other "tasks" performed
by the respondents. Also, this data gives an insight into the
need for retraining for those critical care "tasks" which are
perforred relatively infrequently by the rc2spondent.
30
In the areas of supervision received and co-worker involvement,
data is gathered which is useful in determining under what
circumstances the respondent must perform the "task" (i.e., does
he perform the "task" alone without supervision or does he
perform the "task" with a co-worker and with close supervision).
This information is particularly useful when one considers
"tasks" such as performing CPR or starting an IV. If these must
be done alone, they require additional skill that performing them
with a co-worker would not require. Also, those "tasks" which
are performed with little or no supervision require a
decision-making skill and an ability to handle unsuspected
conditions which are not required on the part of the performer if
he is closely supervised. Thus, this information can be of value
in designing training programs.
The purpose of gathering data on difficulty of the "task", as
perceived by the respondent, is to obtain information on the
relative level of skill practice required in training. However,
the question, as interpreted by the respondent, in many cases
seemed to mean to them that the "task" was strenuous or required
thought processes beyond a normal automatic reaction to a
situation. Thus, the response to difficulty of the "task" is
subject to different interpretations.
Data was also gathered concerning where the respondents felt they
obtained the training to perform the "task". Although this data
relates only to the respondent's preception, and thus can be
misinterpreted, the purpose of this data was to determine whether
the individual felt his occupational training provided him with
31
the necessary tools to accomplish the required duties of the job.
In all cases above, the data listed are particularly meaningful
for some "tasks" while not as meaningful for other "tasks". This
must be considered when interpreting the response to any
particular statement.
The general functional areas represented in the questionnaire
include basic first aid, basic emergency medical technician aid,
advanced emergency medical technician aid, transportation,
extrication, and administration. The first three functional
areas involved specific patient care activities while the areas
of transportation and extrication are concerned with the more
mechanical aspects of getting to the patient and getting the
patient to a definitive care facility. The functional area of
administration involves administrative, clerical and support
functions necssary for the operation of an ambulance service.
32
Discussion of Response to Survey
A tabulation for all of tl'e respondents in the survey, including
their response to each of the questions related to each "task",
is given in Appendix B. Those individuals who did not respond to
a particular statement were not included in the percentage
responding; thus, the percentage indicated for a "task" statement
is generally less than 100%.
Certain selections for particular types of respondents were made
and the data grouped according to these selections. The results
of these groupings will be presented in the following discussions
in terns of each group's respcnse to the various functional
categories. The basic subgroups for which selections were made
are as follows:
A. All respondents in the survey;
B. Respondents holding emergency medical
technician certificates;
C. Respondents who indicated their position
as an ambulance attendant;
D. Respondents who indicated that they were
paid for their work;
E. Respondents who indicated that they were
volunteers;
F. Ambulance attendants who hold an EMT
certification;
33
G. Ambulance attendants who do not hold an
EMT certification.
The tabulation for each of these groups can be found in Appendix
B.
Patient Care - The Basic First Aid Function
Exhibit 5 presents a summary of the pecentage of respondents of
each subgroup who indicated performing each of the "tasks"
contained in the basic first aid functional area. The data
obtained in response to the "tasks" included in this functional
category generally is as might be expected. Tasks such as
treating snake bites (Tasks 67 and 68) , using an S-tube airway
(Task 73) and administering Holger-Neilson method of
resuscitation (Task 79) are performed by only d small percentage
of the respondents. In most cases, this response pattern can be
explained by the fact that cases encountered requiring the method
indicated in the statement are likely to be few or, as in the
case of the use of a tourniquet (Task 59) much better methods are
usually available.
On the other hand those "tasks" where a large percentage of the
respondents indicated performance include such "tasks" as
applying a dressing to control hemorrhage (Task 60) , elevating
the head and shoulders of a patient who is having difficulty
breathing (Task 69), apply bandage to secure dressing to wound
(Task 61), and applying direct pressure to control a hemorrhage
(bleeding) (Task 57) . These work units are in response to
situations which are likely to arise quite often in the emergency
34
CO
MPA
RIS
ON
OF
TA
SK P
ER
FOR
MA
NC
E
PER
CE
NT
OF
RE
SPO
ND
EN
TS
PER
FOR
MIN
G T
ASK
BA
SIC
FIR
ST A
ID
Em
erge
ncy
Atte
ndan
tA
llM
edic
alT
ask
Res
pond
ents
Tec
hnic
ian
Atte
ndan
tsPa
idV
olun
teer
EM
TN
on-E
MT
47.
Use
san
dbag
s to
imm
obili
ze p
atie
nt's
5657
5463
5356
54C
e..r
ViC
731
spin
e (-
lock
).
53.
Use
a tr
actio
n sp
lint t
o tr
eat a
low
er45
7942
6736
7230
extr
emity
fra
ctur
e.
55.
Use
a p
adde
d bo
ard
splin
t to
iobi
l-45
ize
a fr
actu
re.
56.
Use
a s
ling
to im
mob
ilize
a f
ract
ured
66ar
m o
r cl
avic
le.
57.
App
ly d
irec
t pre
ssur
e to
con
trol
hem
orrh
age
(ble
edin
g).
6143
5143
5040
8158
8160
7252
8086
7890
7681
78
58.
App
ly d
igita
l pre
ssur
e to
con
trol
5672
5175
5164
46he
mor
:-::a
ee.
59.
App
ly to
urni
quet
to c
ontr
ol h
emor
rhag
e.11
117
149
39
50.
App
ly d
ress
ing
to c
ontr
ol h
emor
rhag
e.78
8675
8974
8173
61_
App
ly b
anda
ge to
sec
ure
dres
sing
to85
8985
8685
8684
wou
nd.
52.
App
ly b
anda
ges
to im
mob
ilize
a62
7758
6760
7552
frac
ture
(e.
g., r
ibs)
.
EX
HIB
IT 5
(C
ON
TIN
UE
D)
BA
SIC
FIR
ST A
ID -
- C
ontin
ued
Em
erge
ncy
Atte
ndan
tA
llM
edic
alT
ask
Res
pond
ents
Tec
hnic
ian
Atte
ndan
tsPa
idV
olun
teer
EM
TN
on-E
MT
63.
App
ly a
ste
rile
dre
ssin
g to
trea
t a b
urn.
6475
5975
6072
54
67.
Use
a c
onst
rict
ing
band
to tr
eat a
016
710
914
4
snak
ebite
.
63.
Mak
e an
inci
sion
ove
r fa
ng m
arks
and
611
45
78
2
suck
out
sna
ke v
enom
.
69.
Ele
vate
the
head
and
sho
ulde
rs o
f a
8289
8195
7786
79
patie
nt w
ho is
hav
ing
diff
icul
ty in
:,_-,
reat
hi-r
:.
73.
Use
an
S-tu
be a
irw
ay a
djun
ct to
per
form
2530
2322
2622
24
IPPV.
79.
Adm
inis
ter
Hol
ger-
Nei
lson
(ba
ck7
95
134
36
pres
sure
-arm
lift
) m
etho
d of
res
usci
tatio
nto
ven
tilat
e pa
tient
.
82.
Mai
ntai
n bo
dy te
mpe
ratu
re a
nd e
leva
te79
9180
8677
9275
low
er e
xtre
miti
es to
trea
t pat
ient
for
shoc
k.
83.
Tre
at a
con
scio
us p
atie
nt w
ho h
as40
7038
5136
6727
inge
sted
a p
oiso
n.
89.
Use
war
m w
ater
(10
0-10
5 de
gree
s F.
)to
trea
t fro
stbi
te.
Use
col
d pa
ck to
trea
t inj
ury
to s
oft
tissu
e.
812
86
811
7
4149
4635
4453
44
Tas
z
BA
SIC
FIR
ST A
ID--
Con
tinue
d
Em
erge
ncy
Atte
ndan
tA
nM
edic
alR
espo
nden
tsT
echn
icia
nA
':ten
dant
sPa
idV
olun
teer
EM
TN
on-
...,M
T
98,
Ope
rate
a h
ydra
ulic
lift
(H
oyer
)to
mov
e pa
tient
.5
93
65
62
_n
Perf
orm
mou
thco
-mou
th m
etho
d of
IPP
V.
4353
4046
4356
34
104.
Perf
orm
mou
th-t
o-no
sr, m
etho
d of
IPP
V.
3313
1913
33
treatment of a patient.
It is interesting that only about 50% of the respondents
indicated that they used a traction splint to treat a lower
extremity fracture (Task 53), use a padded board splint to
immobilize a fracture (Task 55) , treat a conscious patient who
has ingested a poison (Task 83) , use cold pack to treat soft
tissue injuries (Task 91) , and perform mouth-to-mouth method of
IPPV (Task 103). It is suprising that this relatively small
percentage of the respondents (particularly those in the
attendant category) have found a need during the last year to
perform these "tasks". Perhaps this is a result of the inclusion
of volunteer ambulance attendants who take few calls and thus
have little opportunity to perform even such basic patient care
procedures. This result is significant and would seem to
indicate that even basic skills need to be refreshed because of a
lack of opportunity for practice in the normal job cycle.
It would appear that the respondents did not find any of the
basic first aid "tasks" particularly difficult to perform. Also
the responses seem to indicate that there is a tendency to
perform these "tasks" alone with little or no supervision. In
terms of training, the larger percentage of respondents indic'
that they received the skills and knowledge necessary to perform
the "task" from "on-the-job" or occupational training. However,
in the basic tasks a significant percentage of the respondents
indicated that they received the training from general education
In looking at the other functional categories, it would appear
that the general education response resulted in some cases from
38
misunderstanding since a certain percentage of respondents in the
EMT basic and EMT advanced categories of "tasks" responded that
they received their training for the "tasks" in their general
education, which is highly unlikely.
Patient Care - Basic Emergency Medical Technician Aid
The statements included in this category are those which would
normally be included in an Emergency Medical Technician training
course (81-hour level) but would not be included in a Basic or
Advanced Red Cross First Aid course. Most of the "tasks" in this
category involve the use of special equipment found in an
ambulance. Exhibit 6 lists the percentage of respondents in the
survey indicating performance of the "tasks" in this category.
The results of the response to this functional category is not
suprising. In coneral the "tasks" in thTh category are performed
by more than 50% of all respondents. For example, more than 50%
of all respondents indicated that they performed CPR without
life-support equipment (Task 99) , performed CPR with the use of
life-support equipment (Task 100) and operated a bag-valve unit
to perform IPPV (Task 101).
It is of interest to note that only 6n of all attendants
responding to the survey indicated using a sphygmomanometer and
stethoscope to obtain patient blood pressure (Tosk 105) . Since
this is a basic piece of information which is gathered prior to
treatment of most patients, the response may indicate that a
significant percentage of the respondents in the attendant
category are not gathering initial patient data. This is
39
EX
HIB
IT 6
CO
MPA
RIS
ON
OF
TA
SK P
ER
FOR
MA
NC
E
PER
CE
NT
OF
RE
SPO
ND
EN
TS
PER
FOR
MIN
G T
ASK
BA
SIC
EM
ER
GE
NC
Y M
ED
ICA
L T
EC
IIN
ICIA
N A
ID
Em
erge
ncy
Atte
ndan
tA
llR
espo
nden
tsT
echn
icia
nA
ttend
ants
Paid
Vol
unte
erE
MT
Non
-EM
T
Use
an
emis
is b
asin
in tr
eatin
g63
8976
6589
66na
usea
ted
patie
nt.
45.
Use
a u
rina
l to
prov
ide
the
patie
nt39
4937
4040
4235
with
an
oppo
rtun
ity to
uri
nate
.
46.
Use
a b
ed,,a
n to
pro
vide
the
patie
ntw
ith a
n op
port
unity
to d
efec
ate.
48.
Use
a c
ervi
cal c
olla
r to
imm
obili
zepa
tient
's n
eck.
2632
2424
2728
22
6786
6579
6281
58
49.
Use
a 3
-foo
t spi
ne b
oard
to ir
nmob
ili?,
e60
patie
nt's
spi
ne to
tran
spor
t.
5C.
Use
a 6
-foo
t spi
ne b
oard
to im
mob
ilize
48pa
.tier
.t's
spin
e to
tran
spor
t.
7759
6359
7254
6543
4849
5339
51.
Use
nas
al c
annu
la to
adm
inis
ter
oxyg
en.
4967
5060
4467
43
52.
Use
mas
k to
adm
inis
ter
oxyg
en.
8895
9089
8892
89
54.
Use
a p
neum
atic
(ai
r) s
plin
t to
7984
7983
7686
76'--
obiii
ze a
clo
sed
frac
ture
.
64.
App
ly c
old
wet
app
licat
ions
to tr
eat
4251
3943
4250
35a
burn
.
65.
App
ly v
asel
inc
gauz
e or
oth
er n
on-
2153
poro
us m
ater
ial t
o se
al a
pne
urno
thor
ax.
1543
1242
5
EX
HIB
IT 6
(C
ON
TIN
UE
D)
BA
SIC
'EM
ER
GE
NC
Y M
ED
ICA
L T
EC
HN
ICIA
N A
ID -
- C
ontin
ued
All
T s
3r-s
Pond
ents
66.
Use
a b
ui: d
ress
into
27cb
ilize
an
impa
led
obje
ct.
70.
use
an o
rop'
7ara
r.c-
jeal
air
way
to62
mai
nt,7
1i._
a p
aten
t (op
en)
airw
ay,
71,
Use
an
oxyc
:en
dem
and
valv
e to
56ad
min
iste
r ox
ygen
.
72.
Use
ar
exyr
jen
dent
anci
val
ve to
47.a
.pe
rfor
m in
term
itten
t pos
itive
pre
ssur
eI-
vent
ilatio
n (I
PPV
).
75.
t'-`,
d;;:i
nist
er o
xyge
n th
rouc
:h a
mas
k.
76.
Adm
inis
ter
02-:
ycT
en th
roug
h a
nasa
lca
rmul
a.
77.
Adm
inis
ter
oxyg
en th
roug
h an
oxy
gen
cath
eter
.
88 41 13
78.
Adm
iris
te: o
xyge
n th
roug
h an
incu
bato
r18
syst
em.
81.
Ope
rate
an
oxyg
en-p
ower
ed, m
anua
lly40
tric
icer
ed, m
echa
nica
l ven
tilat
ion
devi
ce.
84.
Ope
rate
veh
icle
mou
nted
suc
tion
tore
mov
e fl
uids
fro
m p
atie
nt's
air
way
.58
83.
Cpe
ro.te
cor
tabl
o su
ctio
n un
it to
rem
ove
55fl
uids
fro
m p
atie
nt's
air
way
.
Em
erc:
ency
Med
ical
Tec
hnic
ian
Atte
ndan
ts.,
Paid
Vol
unte
er
Atte
ndan
t
EM
TN
on-E
MT
5622
4122
5011
8462
8435
0_54
8162
5978
56
6341
6838
6133
9388
9087
9287
5841
56-)
458
34
2310
1711
177
30I2
3311
257
6735
6031
5826
8255
6755
7846
7049
6252
6742
Tas
k
EX
HIB
IT 6
(C
ON
TIN
UE
D)
BA
SIC
EM
ER
GE
NC
Y M
ED
ICA
LT
EC
HN
ICIA
N A
IDC
ontin
ued
Em
erge
ncy
Atte
ndan
tA
ll7%
/7.e
.dic
alR
espo
nden
tsT
echn
icia
nA
ttend
L,n
tsPa
idV
olun
teer
EM
TN
on-E
MT
87.
Adm
inis
ter
suga
r or
sug
ar p
rodu
ct25
3924
3322
2822
to tr
eat p
atie
nt in
insu
linsh
ock.
88.
Use
col
d ap
plic
atio
ns to
low
erpa
tient
's23
3221
1924
19be
C17
90.
Jsc
a fl
asnl
ic:h
t to
exam
ine
the
pupi
llary
6782
5673
6481
61of
a p
atie
nt.
92.
:\...'
tai n
dra
inag
e tu
bing
with
out
1311
248
227
suct
ion
(e.g
., ur
inar
y ca
thet
er).
93.
IJer
fe-7
m a
nem
erge
ncy
child
birt
h25
4721
4019
4212
GC
; J,.
Use
res
trai
nt s
trap
s to
con
trol
a60
7458
7355
7849
com
ba:-
.ive
patie
nt.
99.
Perf
orm
car
diop
ulm
onar
yre
susc
itatio
n57
7455
6057
7547
(CPR
) w
ithou
t the
use
of li
fe-s
uppo
rtec
lu in
men
': .
100.
Perf
orm
CPR
with
the
use
of li
fe-
5574
5273
supp
ort e
quip
men
t.
101.
Ope
rate
a b
acva
lve
mas
k un
it to
5172
4960
perf
orm
inte
rmitt
ent p
ositi
vepr
essu
reve
ntila
tion
(IPP
V).
102.
Usc
a b
ag-v
alve
mas
k un
itto
per
form
IPPV
.
48 48
69 67
45 42
1918
4010
477
EX
HIB
IT 6
(CO
NT
INU
ED
)
BA
SIC
EM
ER
GE
NC
Y M
ED
ICM
., T
EC
HN
ICIA
N A
IDC
ontin
ued
Tas
k
105.
Use
a s
phyg
mom
anom
eter
and
ste
tho-
scop
e to
obt
ain
a pa
tient
's b
lood
pres
sure
,
106.
Piec
e fi
n's,
-ers
on
patie
nt's
wri
st to
coun
t rad
ial p
ulse
.
115.
Ope
rate
a tw
o-w
ay v
oice
com
mun
ica-
tion
radi
o.
125.
Inst
ruct
pat
ient
's f
amily
how
to c
are
for
pa',:
ient
at h
ome.
All
r,e,
pond
Pnts
Em
erge
ncy
Med
ical
Tec
hnic
ian
Atte
ndan
tsPa
idV
olun
teer
Atte
ndan
t
EM
TN
on-E
MT
5582
6160
55._
,c/. ,
48
7889
3479
7392
81
9496
9494
9497
92
1118
1017
817
8
modified somewhat by the fact that 84% of the respondents
indicated that they had taken a patient's radial pulse (number
106). However, in both cases, a large number of those indicating
performance, indicated a frequency of once a week or less. The
same type of result was obtained in response to the use of a
flashlight to examine pupilary reaction (number. 90) . The above
results may be a result of the fact that many volunteers take few
trips and thus, may only handle one true emergency case per week.
However, the fact that more than 30% of the respondents in the
attendant category indicated never performing any of these
"tasks" is certainly of interest.
It was suprising that more than 25% of all respondents indicated
that they performed the "tasks" related to CPR (numbers 99 and
100) without assistance. This would indicate that a training
program should assure that the individual is trained to perform
CPR alone rather than with one individual doing compressions
while the other provides the resuscitation using either life
support equiment or the mouth-to-mouth method of IPPV.
Those "tasks" which were felt to he difficult by the respondents
included the CPR "tasks' (number 99 and 100) , controlling a
combative patient with restraint straps (number 9G) and
performing eicergency child birth (number 93) . It is likely that
this response to difficulty is riot as a result of a felt need on
the part of the respondents for more training, but is a result of
the physicial exertion and pressure under which the performer
must perform.
44
Patient Care - Advanced Emergency Medical Technician Aid
The statements included in this category represent "tasks" which
normally are expected to be included in an advanced Emergency
Medical Technician training program. They involve such things as
infusion of IV fluids (Tasks 107 and 108), administration of
drugs (Tasks 109, 110 and 111) , defibrillation (Task 112) ,
electrocardiograph (Task 113) and telemetry (Task 114) .
Only a very small percentage of the respondents indicated
performing any of these "tasks". This was expected since the
state of the art of ambulance services, in Pennsylvania is not
such that these "tasks" would normally be performed. The fact
that any of the "tasks" were performed is probably a result of
the response of one ambulance service included in the survey.
This service was one of the few, if not the only ambulance
service in Pennsylvania, providing such patient care services
during the time of the survey.
It worthwhile to note that only one of the tasks was rated
difficult by any of the respondents -- Use an endotracheal tube
to maintain an open airway (Task 74) . This seems to indicate
that those who have been trained at this level do not feel that
the paracular "tasks" involved arc difficult to perform.
CO
MPA
7-11
SON
OF
TA
SK P
ER
FOR
MA
NC
E
PER
CE
NT
OF
RE
SPO
ND
EN
TS
PER
FOR
MIN
G T
ASK
AD
VA
NC
ED
E7,
:i220
3i`,
:CY
TE
C.1
-T.N
ICIA
.T.,:
AID
F.m
erce
ney
Atte
ndan
tA
llM
Pdic
alT
ask
Rec
nPri
iient
sT
echn
icia
nA
ttend
ants
tail
Vol
unte
erE
MT
Non
-EM
T
74.
Use
az
endo
trac
heal
be to
mai
n-11
239
1610
17te
en a
n op
en a
irw
ay.
Adm
inis
ter
patie
nt's
insu
lin to
trea
t4
55
26
64
a pa
tient
in a
dia
betic
com
a.
107.
Ass
embl
e in
trav
enou
s fl
uid
1126
1024
522
6
adm
stra
tion
equi
pmen
t.
103.
Perf
orm
a v
enip
unct
ure
to a
dmin
iste
r4
92
102
32
intr
aven
ous
flui
ds.
109.
Use
a s
yrin
c7e
to a
dmin
iste
r in
trav
enou
s9
26
23
1
=iic
atio
ns in
to th
e I.
V. t
o bi
ns.
110.
Use
a s
yrin
ge to
adm
inis
ter
intr
aven
ous
24
13
10
1
med
icat
ions
.
111.
Use
a s
yrin
ge to
adm
inis
ter
intr
o-2
12
10
mus
cula
r m
edic
atio
ns.
119.
Ope
rate
a d
efib
rilla
tor
to a
dmin
iste
rem
piri
cal d
efib
rilla
tion.
616
516
114
1
113.
Ope
rate
an
elec
troc
ardi
ogra
ph s
cope
and
15re
cord
er to
obs
erve
pat
ient
's c
ardi
acac
tivity
.
3714
337
337
-AI"
'VA
NC
ED
EM
ER
GE
NC
Y M
ED
ICA
L T
EC
HN
ICIA
N A
IDC
ontin
ued
L,r
nerg
ency
Atte
ndan
tA
llM
edic
al'g
as ;
Res
oond
ents
Tec
hnic
ian
Atte
ndan
tsPa
idV
olun
teer
EM
TN
on-E
MT
114.
Ope
rate
one
-way
ele
ctro
card
iogr
aph
1130
1027
328
2
tele
met
ry s
yste
m ;.
.c tr
ansm
it (E
KG
or E
CG
).
Transportation
The "tasks" in this category are concerned with moving a patient
either within an Nnbulance or to and from an ambulance using a
stretcher, wheelchair, etc. Exhibit 8 provides a summary of the
response by subgroups for this category.
In terms of patient movement to and from the ambulance, the largo
percentage of the respondents indicated that a variable position
(Task 130) or orthopedic (Task 129) stretcher w,:c:; used as opposed
to the rubberized canvas stretcher 132). Only
about SO% of the respondents indicat: 1 drive an
emergency medical vehicle (Tasks 136 and individuals
in the survey indicated that they had watercraft to
transport a patient (Task 139) , while three indicated
the use of a fixed - -wing aircraft and four individuals indicated
use of a rotary-wing aircraft (helicopter) to transport a patient
(Tasks 140 and 141).
None of the "tasks" in this grouping were percieved to be
particularly difficult on the part of the respondents. Howcofer,
a larger percentage of the respondents felt driving an emergency
medical vehicle under emergency conditions was more difficult
than under non-emergency conditions. Of those who used the
various types of stretchers, the variable position stretcher
(Task 130) seemed to be rated the easiest to use.
48
EX
HIB
IT 8
CO
MPA
RIS
ON
OF
TA
SK P
ER
FOR
MA
NC
E
PER
CE
NT
OF
RE
SPO
ND
EN
TS
PER
FOR
MIN
G T
ASK
TR
AN
SPO
RT
AT
ION
All
Tas
kR
espo
nden
ts
129.
Use
an
orth
oped
ic s
tret
cher
to73
tran
spor
t a p
atie
nt.
130.
Use
a v
aria
ble
posi
tion
stre
tche
r to
78
tran
spor
t a p
atie
nt.
131.
Use
a s
tret
cher
com
pose
d of
rub
beri
zed
51ca
nvas
on
an a
lum
inum
fra
me
to tr
ans-
.:..
po:-
t a p
atie
nt.
132.
Use
rub
beri
zed
stre
tche
r to
sus
pend
a32
patie
nt f
rom
the
ceili
ng o
f an
ambu
lanc
e.
133.
Use
a c
hair
str
etch
er to
tran
spor
t a67
patie
nt.
134.
Use
a c
hair
to tr
ansp
ort a
pat
ient
.52
135.
Use
a w
heel
chai
r to
tran
spor
t a p
atie
nt.
28
136.
Dri
ve a
n em
erge
ncy
med
ical
veh
icle
to58
tran
spor
t a p
atie
nt u
nder
non
-em
erge
ncy
cond
ition
s.
137.
Dri
ve a
n em
erge
ncy
med
ical
veh
icle
to60
tran
spor
t a p
atie
nt u
sing
em
erge
ncy
war
ning
dev
ices
.
Em
erge
ncy
Med
ical
Tec
hnic
ian
Atte
ndan
tsPa
idV
olun
teer
Atte
ndan
t
EM
TN
on-E
MT
7971
8369
8167
8678
8676
8675
5646
6047
5045
3728
3232
3326
7966
6867
7862
6744
7543
6137
3326
3027
3324
7048
7352
6740
7549
7853
5940
Tas
k
139.
Use
a w
ater
craf
t to
tran
spor
t apa
tient
.
140.
Use
a f
ixed
win
g ai
rcra
ft (
airp
lane
)to
tran
spor
t a p
atie
nt.
141.
Use
a r
otar
y w
inc,
air
craf
t (he
licop
ter)
to tr
ansp
ort a
pat
ient
.
EX
HIB
IT 8
(C
ON
TIN
UE
D)
TR
AN
SPO
RT
AT
ION
--C
ontin
ued
All
Res
pond
ents
Em
erge
ncy
Med
ical
Tec
hnic
ian
Atte
ndan
tsPa
idV
olun
teer
Atte
ndan
t
EM
TN
on-E
MT
45
35
43
15
13
10
25
22
26
0
Extrication
Four of the "tasks" were directly related to the extrication of
an entrapped patient (Tasks 121, 122, 123 and 124) . Only one of
the "tasks" (Task 121) directly involves the actual extrication
while the others are those activities which would go on in
support of the extrication operation at an automobile accident.
Exhibit 9 presents a summary of the response obtained for the
function of extrication.
Less than two-thirds of the individuals in the ambulance
attendant category indicated having extricated an entrapped
patient or providing the support services to accomplish this.
This result seems questionable and cannot be explained. Perhaps,
there was some confusion concerning the meaning of extrication on
the part of the respondents. It would seem that any individual
who has been involved in ambulance service for z long period of
time would have many occasions to be involved in the extrication
of aa individual from an automobile which has been involved in an
accident.
Twenty percent (20%) of all respondents felt extrication was
difficult to perform. This is expected since each extrication
involves different circumstances in terms of the damage to the
automobile, the location of the patient and the injuries to the
patient.
The percentage of response to the extrication "task" is
approximately equal to the response of those using a three-foot
spine board (a typical method used for extricating a patient from
51
EX
HIB
IT 9
CO
MPA
RIS
ON
OF
TA
SK P
ER
FOR
MA
NC
E
PER
CE
NT
OF
RE
SPO
ND
EN
TS
PER
FOR
MIN
G T
ASK
EX
TR
ICA
TIO
N
Tas
k
121.
r'xtr
icat
e an
ent
rapp
ed p
atie
nt.
122.
Dir
ect t
raff
ic a
t sce
ne o
f ac
cide
nt.
123.
Use
hig
hway
fla
res
to c
ontr
ol tr
affi
cat
acc
iden
t sce
ne.
124.
Use
por
tabl
e fl
oodl
ight
s to
illu
rnin
ate
Nw
ork
area
.
All
Res
pond
ents
Em
erge
ncy
Med
ical
Tec
hnic
ian
Atte
ndan
tsPa
idV
olun
teer
Atte
ndan
t
EM
TN
on-E
MT
5577
6275
6278
55
3835
3727
4339
35
4749
4635
5256
43
5250
5243
5564
47
an accident) . It would be interesting to determine if this
similarity in response is a result of causal factors or just a
coincidence.
Administrative, Clerical and Support
A large number of the "tasks" included in the inventory were
directly related to administrative, clerical and support services
necessary to operate an ambulance service. Such things as
determining type and quantity of various required supplies and
equipment (Tasks 1, 4, 7, and 10) and maintaining records (Tasks
18, 19, 20, 21, 23, etc.) are included in this grouping. A
summary of the response of all subgroups to this category is
given in Exhibit 10.
It is interesting to note that a large percentage of respondents
(even in the attendant category) indicated performing "tasks"
within this category. This would seem to point out that all
individuals get involved in the administrative and support
functions necessary for operating an ambulance service and that a
division of labor into operating and support is not prevalent.
Since very little emphasis is ple3ed on the functions within a
basic training program, this information is useful.
A total of 81% of respondents (79% of the attendants) indicated
that a special form to report an ambulance trip was used and
completed (Task 27) . Depending on the representativeness of this
sample and on the amount of information contained in such a form,
this would seem to indicate that the requirements of any
legislation which includes reporting ambulance trips would not
53
EX
HIB
IT 1
0
CO
MPA
RIS
ON
OF
TA
SK P
ER
FOR
MA
NC
E
PER
CE
NT
OF
RE
SPO
ND
EN
TS
PER
FOR
MIN
G T
ASK
AD
MIN
IST
RA
TIV
E /C
LE
RIC
AL
SU
PPO
RT
All
Tas
kR
espo
nden
ts
1.Se
t sta
ndar
d ty
pe a
nd q
uant
ity o
f56
emer
genc
y m
edic
al e
q'lip
men
tne
eded
for
uni
t ope
ratio
n.
2.In
vent
ory
type
and
qua
ntity
of
emer
genc
y m
edic
al e
quip
men
t to
dete
rmin
e ne
ed f
or r
epla
cem
ent,
etc.
66
Plac
e em
erge
ncy
med
ical
equ
ipm
ent
79in
a.s
sign
ed lo
catio
n.
4Se
t sta
ndar
d ty
pe a
nd q
uant
ity o
f45
emer
genc
y m
edic
al s
uppl
ies
need
edfo
r un
it op
erat
ion.
5.In
vent
ory
type
and
qua
ntity
of
erne
r-r- Ji
gens
.y m
edic
al s
uppl
ies
to d
eter
min
ene
ed f
or r
e.su
pply
.
6.Pl
ace
emer
genc
y m
edic
al s
uppl
ies
in77
assi
gned
loca
tion.
7.Se
t sta
ndar
d ty
pe a
nd q
uant
ity o
f9
drug
s an
d in
trav
enou
s (I
.V.)
flu
ids
need
ed f
or u
nit o
pera
tion.
8.In
vent
ory
type
and
qua
ntity
of
drug
s an
d12
I.V
. flu
ids
to d
eter
min
e ne
ed f
or r
e-su
pply
or
new
sup
plie
s.
Em
erge
ncy
Med
ical
Tec
hnic
ian
Atte
ndan
tsPa
idV
olun
teer
Atte
ndan
t
EM
TN
on-E
MT
6754
5657
6449
7261
7662
6161
7782
7183
7884
4741
4148
4240
6358
6859
5857
7982
7180
8381
217
117
116
3210
228
224
Ta 9.
Plac
e dr
ugs
and
I.V
.fl
uids
inas
sign
ee,'
loca
tion.
10.
Set s
tand
ard
type
. and
amou
nt o
fof
fice
supp
lies
need
ed f
orun
itG
^ __
ratio
n
11.
Inve
ntor
yty
pe a
ndam
ount
of
offi
cesu
lppl
ios
to d
eter
min
ene
ed f
orre
supp
lyor
new
supp
lies.
EX
HIB
IT 1
0(C
ON
TIN
UE
D)
AD
MIN
IST
RA
TIV
E/C
LE
RIC
AL
SUPP
OR
T--
Con
tinue
dE
mer
genc
y
Atte
ndan
tA
llM
edic
alR
espo
nden
tsT
echn
icia
nA
ttend
ants
?aid
Vol
unte
erE
MT
Non
-EM
24 24
VI
(11
12.
Plac
e of
fice
supp
lies
inas
sign
ed27
loca
tion.
13.
Des
ign
emer
genc
ym
edic
aleq
uipm
ent
24su
ch a
sa
spec
ial
splin
tor
veh
icle
flou
r pl
an.
4.ph
ysic
alfa
cilit
ies
to d
eter
min
e20
need
for
expa
nsio
nor
con
stru
ctio
n.15
.Pr
r-sp
.-Ir
ebu
dget
for
oper
atio
n of
unit.
1616
.A
ssic
ncr
ew a
ndve
hicl
e to
resp
ond
to45
ambu
lanc
eca
ll ba
sed
upon
the
natu
reof
the
call.
17.
Surv
eyty
pe a
ndqu
antit
y of
emer
genc
y30
equi
pmen
tav
aila
ble
for
purc
hase
.
3714
278
335
2518
2524
1917
2818
3022
2516
3022
3026
2520
3019
2524
2517
2114
1622
1116
1410
1417
61
5131
5143
3928
2622
22?.
417
25
EX
HIB
IT 1
0 (C
ON
TIN
UE
D)
AD
MIN
IST
RA
TIV
E/C
LE
RIC
AL
SU
PPO
RT
--
Con
tinue
d
Tas
kA
llR
es,0
0nde
nts
Em
erge
ncy
Med
ical
Tec
hnic
ian
Atte
ndan
tsPa
idV
olun
teer
Atte
ndan
t
EM
TN
on-E
MT
18.
Mai
ntai
n pe
rson
nel r
ecor
ds22
2515
2122
1913
19.
Prep
are
payr
oll f
or u
nit e
mpl
oyee
s.3
71
81
0
Prep
are
fina
ncia
l rep
ort o
f un
it op
erat
ion.
1112
413
106
3
'xam
ine
reco
rd o
f se
rvic
e to
pat
ient
tobi
ll pa
tient
for
ser
vice
.16
216
2413
84
22.
Mai
ntai
n ac
coun
ting
reco
rds.
811
110
83
0
23.
Mai
ntai
n re
cord
s of
pat
ient
s se
rvic
ed.
3635
2635
3828
26
24.
Ope
rate
a ty
pew
rite
r.28
1822
2131
1922
25.
Mai
:tain
rec
ords
of
mai
nten
ance
per
-fo
rmed
on
emer
genc
y m
edic
al e
quip
men
t.28
3518
3227
2515
26.
Com
plet
e in
form
atio
n re
quir
ed b
y sp
ecia
lfo
rm to
rep
ort a
ccid
ent.
4346
3737
4639
36
27.
Com
plet
e in
form
atio
n re
quir
ed b
y sp
ecia
lfo
rm to
rep
ort a
mbu
lanc
e tr
ip.
8188
7975
8489
75
28.
Com
plet
e in
form
atio
n re
quir
ed b
y sp
ecia
lfo
rms
othe
r th
an th
ose
liste
d ab
ove.
2746
2040
2236
13
29.
Exa
min
e re
cord
of
serv
ice
to p
atie
nt to
dete
rmin
e ch
arge
s to
pat
ient
.13
267
229
173
EX
HIB
IT 1
0 (C
ON
TIN
UE
D)
AD
MIN
IST
RA
TIV
E/C
LE
RIC
AL
SU
PPO
RT
Con
tinue
d
T4.
;
30.
Rec
ord
anal
ysis
of
ambu
lanc
e tr
ips
to d
eter
min
e su
ch th
ings
as
type
of s
ervi
ce p
rovd
ed, e
tc.
31.
Cre
ate
and
mai
ntai
n on
-cal
l ros
ter
of s
ta:f
req
uire
d to
ope
rate
uni
t.
32.
Con
duct
mee
tings
with
hos
pita
lre
pres
enta
tive(
s) to
coo
rdin
ate
emer
henc
y m
edic
al s
ervi
ces.
C.1
1
s4.3
33.
Con
duct
mee
tings
with
uni
t per
sonn
el.
Em
erge
ncy
Atte
ndan
tA
llM
edic
alR
espo
nden
tsT
echn
icia
nA
ttend
ants
?aid
Vol
unte
erE
MT
Non
-EM
T
34.
Dev
elop
pol
icie
s or
pro
cedu
res
topr
ovid
e gu
idel
ines
for
dai
ly o
pera
tion
of th
e un
it.
35.
Dev
elop
an
on-t
he-j
ob tr
aini
ng p
rogr
am.
36.
Con
duct
inte
rvie
w to
det
erm
ine
ifap
plic
ant m
eets
sta
ndar
ds f
or e
mpl
oy-
men
t.
37.
Adm
inis
ter
test
to d
eter
min
e if
app
lican
tm
eets
sta
ndar
ds f
or e
mpl
oym
ent.
38.
Eva
luat
e un
it pe
rson
nel t
o de
term
ine
pro-
cres
s, r
aise
s, d
isci
plin
e an
d pr
omot
ion.
2937
2135
2728
18
2335
1232
2022
8
i 721
1119
1611
11
4142
3444
4033
35
2932
2222
3222
21
2633
2029
2628
17
1118
516
96
4
1012
813
86
9
1525
621
138
6
EX
HIB
IT 1
0 (C
ON
TIN
UE
D)
AD
MT
NIS
TIA
TIV
E/C
LE
RIC
AL
SU
PPO
RT
--C
ontin
ued
Em
erge
ncy
Atte
ndan
tA
llM
edic
alT
ank
Res
pond
ents
Tec
hnic
ian
Atte
ndan
tsPa
idV
olun
teer
EM
TN
on-E
MT
-za
Det
erm
ine
staf
f re
quir
ed to
ope
rate
2126
1024
2011
9un
it ef
fect
ivel
y in
any
spe
cifi
c tim
epe
riod
.
40.
Exp
lain
gen
eral
hos
pita
l pro
cedu
res
3153
3449
2461
22to
pat
ient
or
fam
ily.
4 1
.In
forr
:7 p
atie
nt's
fam
ily o
fpa
tient
's32
3934
3531
3931
gene
ral c
ondi
tion.
vl42
.In
form
pat
ient
's a
ttend
ing
phys
icia
n23
3217
3717
2812
coof
pat
ient
's d
eath
.
43.
Info
rm C
oron
er's
off
ice
of p
atie
nt's
3133
2141
2622
20de
ath.
116.
Ans
wer
tele
phon
e to
rec
eive
requ
ests
7281
7167
7481
67fo
r am
bula
nce
serv
ice.
117.
Perf
orm
min
or m
echa
nica
l mai
nten
ance
4663
4451
4564
36on
em
erge
ncy
med
ical
equ
ipm
ent.
118.
Perf
orm
bui
ldin
g m
aint
enan
ceon
4046
3735
4347
33ph
ysic
al f
acili
ty.
119.
Rep
lace
oxy
gen
tank
in v
ehic
le.
7179
7078
7078
66
120.
Ref
ill o
xyge
n ta
n'zs
with
com
pres
sed
3023
2617
3619
28ox
ycen
.
126.
Eva
luat
e qu
ality
of
trai
ning
prog
ram
.20
2513
2120
1910
Tas
1(
EX
HIB
IT 1
0 (C
ON
TIN
UE
D)
AD
:`,P
,IN
IST
RA
TIV
E/C
LE
RIC
AL
SU
PPO
RT
--
Con
tinue
d
Em
erge
ncy
Atte
ndan
tA
llM
edic
alR
espo
nden
tsT
echn
icia
nA
ttend
ants
Paid
Vol
unte
erE
MT
Non
-EM
T
127.
Con
duct
on-
the-
job
trai
ning
ses
sion
s.
128.
Con
duct
for
mal
cla
sses
to in
stru
ctin
ciiv
ic:u
als
in e
mer
genc
y m
edic
al c
are
tecues.
3340
2632
3339
21
3035
2635
2931
24
necessarily involve additional paperwork for most individuals.
Approximately one-third of the respondents indicated that they
conducted formal classes to instruct individuals in emergency
medical care techniques (Task 128) and conducted on the job
training sessions (Task 127) . Given the "state of the art" in
training programs and the response of the individuals involved in
the survey, it would appear that a large amount of training is
received informally on the job within the ambulance services.
Few of the "tasks" included within this category were rated as
being particularly difficult by those responding. In general,
the tendency was to rate the "tasks" as easy to perform, The
exceptions to this are: design emergency medical equipment (Task
13), examine physicial facilities to determine the need for
expansion or construction (Task 14) , preparing budget (Task 15) ,
assigning crew and vehicle (Task 16) and surveying type and
quantity of emergency medical equipment (Task 17). In general,
the response to difficulty of these was moderate to difficult.
Some General Discussion Concerning the Responses Obtained
Most of the "tasks" showed a response frequency of once per week
or less. A surprising percentage of the respondents particularly
in the patient care area indicated performance of the "tasks"
once per month or less. This data seems to indicate that there
may be a need for refresher training for those individuals who
have not had the opportunity to perform the "tasks" very
frequently.
60
The data obtained in the area of supervision (i.e., the co-worker
involvement and the amount of supervision received) and the data
obtained in the training category does not generally seem to
provide much useful information. The pattern of responses
obtained seem to indicate some confusion concerning the amount of
supervision received and where the training was obtained. Also,
some of the responses to the amount of co-worker involvement seem
to indicate that the respondent was confused. Thus, the data
obtained in these areas is subject to much question. Anyone
considering using such a method to obtain job-related data should
take care in explaining to the respondents exactly what is
desired in terms of supervision and co-worker involvement.
On the other hand, the data obtained concerning the perceived
difficulty does seem to make sense when one considers the
relative complexity and lack of standard situation8 within those
"tasks" which were rated as difficult. The respondents seem to
rank "tasks" as being difficult not because they involve many
procedural steps with intricate procedures, but because either
the situation causes mental or physicial pressure to be exerted
upon the performer or the situation results in the need for
ingenuity because of the various conditions which can exist.
An Analysis of Col)arative Rcporn;e3 by Subgroup)s
Attendants - vs. 1:on-flegiGtered
A test on proportions of two independent populations was
perFord to deteriline if a sicinificant difference in response
existed on each of the "tasks" perfore6 by an Emergency Medical
61
Technician attendant and a non-registexed Emergency Medical
Technician attendant. Those "tasks" whore a statistically
significant difference in performance was found between subgroups
(at the .05 level) are summarized in Exhibit 11.
The great majority of "tasks" listed in Exhibit 13 are those
which would ho found in an EMT training program but not in a
basic first aid training program. This would seem to indicate
the effect of training upon the performance of given "tasks" by
ambulance attendants. In all, cases, registered EMT attendants
were lore likely to perform these "tasks" than non-registered
attendants (all direction indicators are pcsitive).
It should be noted that the results can be interpreted only for
each individual "task" and cannot be statistically grouped
touether to indicate a significant difference between ENT
attendants and non-= attendants. That is to say one can look
at the response of those performing CPR using life-support
equipment (Task 100) and reach the conclusion that ENT attendants
are sore likely, in the population, to perform this "task" than
non-registered attendants. On the other hand, one cannot look at
all of the "tasks" included in Exhibit 11 and say that ENT
attendants and non-registered ENT attendants are different (in a
strict statistical sense) .
The results of this analysis do seem to indicate that training
efforts can provide a positive impact on the delivery of
ambulance services. If one can generalize from the sample, then
one would expect that additional, training would for enample
increase the use of CPR in the emergency treatment of patients.
62
EXIIII1TT 11
'171;-11".1 \At1i'11
AN1
NUMber 1)ireqt ion.....
(tomplete infoisation required by specinl form to reportC1111!)111 riee trip (p.01 condiiion, (tare t( ndered, time),("orilplote inioi mat i..-)11 ..ip(.5cial forms other than tlmve
40 oeip.ral hoEpital pics(tedure5-; to pntiont or family (e. q,eri.elflpp,( lOOm procedui es),
42 inform patieiit'5', attending physician of pationt'5-344 Use itO (minis LI:titi in tro,-Itinci nauscated pnlient.48 1.tse a cerviftni c.:-.11ni to 1P:ir]obili..'5e patient's neck..
Use a 3-foot spino hoard to immobilize patient's spine to transport.91 nnso I (.;j111111:1(1 11) 0(1;ni Eli stt'.!r
IThe n traction splint to trent a lovier e::Irornity fracture,56 Ilse o silty.; ta in obiline a fractured Or (t141,2icle.
Apply diciital prcii,sure to c:,-n.trol 1 10103 rLiic 3-
62 Apply 1)nies to immobilit,,e n fracture. , IihS)63 Apply a sterile dres5.Jin,77 to tront a burn, 4-
65 ti ely von I or '7,-!one or C)thrzt" non-porous materii.11 to sen1 o -4-
pnetimothoinx cent ni)66 Use e dir..;.,5:11u to ittnr:ibili./o ii n op object.70 Un on oroph[n-dr,neal nit,..vay to lion i ritI 'ill potent (open) airway,71 lion on demand valve to administer OXycjell,
hoe at-1, demand valvii: to perlinElo intetirtittent portitivepress tire v it ii ii on (Ippv)
76 Adr[iinistor oxyn en throuqii a nasal cannuln.81 Opernle on 1./..,.tr; en- pot':orod , manual ly I riqqered ncchu oh en1
, 1:18,er
82 cCinintain Li.Hy tor2,pciature niyi elevate levier extrernitios to tientpatient for 5:1-.4)(;'.-,,
83 T1(,,0 t 0 (..J1-,Hci,Jit.,, r;.11 tiNlt V.1,1C) Ur:':I (-(1 a poison.81 Operate 0111010 ii,,ourttied suction to remove fluids from patient's
85 OPor.itr-"i"'',trtaLle sur.t.ion u it P lemr)vo fluids from patient's airway, .4
90 hoc a fl.t5thlirtt ti .>amino pupillnry renctin of n pot .
>111 10 nri omepionc:y ciii I 1 elivery,(ie(neascH pat iont n n
91 Use restraint strnps to c c-,t1..,0 tiv,e pat90 Ty teroiscHiat (('iti.') v:itlic,ut the 4:5p0 .0f
pt.sient
100 .';1 h fe-sut,port eqiiipment.
63
N um! ier Ta
I1X111 )11T 1.1 (C(:111. !WED)
Direct ion
101 Operate o hag--va I s 1. unit to perform intermittent pos livepres ion (IPIA7)
102 U e lia(ii-va lye mit to p cc 1w 11'1A.r,
103 to- mot: th of 11)PV1 0 5 Use a splp/iiimomanomiiiter ( 1 . ) 1 . ) o c i pressure cuff) nd ntol oscoi)o to A-
()lito i n a pa t (int' s 1)10..).1 prcii113 Opera 1 (! (f]1..C1 C111 1,(7(1) scope and rc)corcler
to ()Li-ie.-ye pat iw Ii caH i Tie aet iv it y.Perform ititeriaricA.:3 on emeigency
1 3 1 1 : i - i t r i c a t e ni rintrapped on I i
124 tliic poi table flooillit_iInt.si to illuminite v.iof*, reo127 nti-the--01.) t1jjOLi ions. -I
133 Usct a choir stretcher to tu cspioit a p,,Itient.134 1.J;Tie chni t trnpoit o pat 1136 Drive an ciii,cicietir:v ncH icio 1 veli icle (ambulance) to t I arm port a
lint 1'101-1-(;nleic.;crIcy (:ionil it ions137 Drive an ciiregency nod vehicle to transport o pa tient under
i devices , q.s ir 360 1 ieacien 1
It should be pointed out hero, however, that the basic assumption
is that when CPR is used it is needed and that the increased use
c[ CPR is a result of this need and not a result of the attendant
desiring additional practice.
The differences of in this ealparison arc likely to be
understated. The reason for this is the fact that the comparison
was made betweon registered attendants and non-registered EMT
atte:dants and not between these who had obtained the equivalent
of MT training and those who had not. Thus, in the
non registered category a number of individuals were included who
had taken the RNT course or its equivalent. The decision was
made to make this coparison since those individuals who have
taken the equivalent training but had not passed the registry
have not indicated that they posess the skills and knowledge
necessary to perfori-i the tasks required for MT registry. Thus
to ne 1 udi: trained non-registered attendants in the EMT group
would have ber1 to include with those whose skills and knowledge
have been s tra Loch IT re gi s try test ) , a group of
individuals for whoa the level of skills and knowledge is
unknown. However, it is likely that any of those who have had
the training but have not taken the registry for one reason or
another do perfom,1 the EnT I "tasks" adequately, thus,
overstating the performance of the nonregistered attendants in
tenAs of the effect of training.
It is intertmting to note, when looking at the background data of
the respunc:ent:; in these two categories Wee Rxhihit 3) , that 5O
of the pon(,nts in the 1;:1T at:to:Want catgo:cy arc t)cin(j paid,
65
whil(! only 102, of the rcl:-Tonclonts in the non-registered EMTattendant cotegory are being paid. in addition, as might hoexpected, the pereentaije of the respondents who have had thevarious training programs is higher for the attendants than
for the non-registered 7.':1T attendants with the exception of theI:ed Cross and CPJZ training programs.
Pzlid is V LI 11 t (-! 1:
P.osponse:-; to the survey by those indicating that they were
voluntee.,_%; vs, those indicating that they were paid (both full
Z11: were co::,p,:-..red. This coparison was made over allresp.,ndents regardless of position held and type of registryheld. Those lItC1:01H11 which yielded a significant difference inperForance between the two grou:?s are presented is Exhibit 12
All hut five of the "tasl-ss" presented in Exhibit 12 show apositive s ign fi ont f Terence between the pc r.F. ornance by paid
ara)u,I.anc ttcndants and volunteer ambulance attendants. Again
the soL.,,-..; caution must: he stated -- that the significantdifference presented e:..ists for "tar.;hs" and does not represent a
statistical difference between the two groups over all "tasks".
Many of the "tashs" included in 1,hibit 12 are the are as thosefor which differences were found to exist between attendantsand nonL::':' attendr,nts. This probably explains much of the
diff:orenc in performance between paid and volunteer respondents,
since a much larger pc_reentage of the paid category (56,s,;) hold
E!`2 rc:.(listry thi.n1 of the volunteer catego:::y (15 Thus, the
in IwYfolnc'? of "tosks" is Jilely to lw attributble
66
EXPTPri' 12
1)it 0,1
2 er1113 pv,,:c!Ilt. to 4-
dc4L-1:",i, , It '\', 1.(11ii:)111(1:t.
3
t;)
.+-
2,1 f),-20 Hr::; other t.1111 t11:1;,;(,!.
20 N chiJrcir..::; to
21 H,11 t() 1 DICC ut-rit.4(1
, ,'r..cH, VI V.3 t I'D k fdn',Ily (co cj,
4,? , Of
ii: 1 ' r11.1 .; 1 JC.-C13". 4--
51 .
fr,Jctmc,.... (-)z
57 ,
1)4-1.:.J',1131111 ,-:,
(.13
1)5 ()1' IL)11---1`,.)1;)1.1:; tr.)
GI?
1)(1 ( ri;c:
7071
.1, tjvc!(111-1'1
;
7
, 1,
1 'H :1:.
)1 H.1.!
1;7:11.113.Y.'i 3 2 (C7();I:iit1LIPA))
11.)hcIi,m_ .
92 ,t11. :;:tir..111{11 ((. q I I y 4 oi!1(0(:1).
) 14 :.::'!,,Y(T.t 414 ,(;1:'i
JL /!4 i i i rik,-):7!nr(.16 4-
I 02. 4-
Ii I
10'; 1-10(1
II nH LJ, L f;cc;ru Ar.ci if;c...q(lor
11,1 1A.'1f.;111(.:111., 1.) Ii
1:);1) I I
1./1 .4-
1 ;;-:/. L;;-.
1?.3 11;- 'LH F.(;.(,1).(,,
12.1 ;;;;;c11..
'itr) c:f)' ,
-I.1:),%1!Hr,nt.
.4-
3t'; 1:;i.;: (,...t1)111:1r.:)1.1r
,!;! d 1,111;:;(;!,:
v;11..;;-Hr.r".1 rC11,
o higho i)onc-nUcie of re.; in t.c ro(.1 1:;1`.1." :re spo»,fr.,111.:s
rep re2 n to n o; on , tho ztvcrogn
of .1(Y.t.: ci p..Lt-sonno..1 içui f i.umit1v inl:go thim
the
di, ; Un
°bp°
en(2011n tt"
to
f by volun ti,er personini4 (55 pn r
rt. h) . I s bi Li uric., p v s , s
:1 ;n;n o Or offcct on thoi)rs LU Lc tiU Cf',f1 .1.1!
(h, cn bn n th tvc) in nn o trollyingc.:1; in 1 1
it ..ro3.11ntc,:-.::,7 ',7:',w..nn:1 'Again , this isto ninc thc2 (1 trui ci in
i)n(7 C) ZI \HT:JAI:IL r]r1.; 1' 1 Pair! Of
thc VO1111. L.- ci In ):11r.-).1 al:,
Hi)" 1 t: v; I n, n tl,;J. pcL , c.n if no t;
II: ;i o: con n L(:ncy t:11
.;) Lnc., t..!;
In (11.1p1 ) Ci;1 (` " tia:-;hn" inchiCori inLhc.. " clup -.i ro not..
)
7 1. re ("11.111y tirt. )11
" n1'.01121(1
C.,:).1.-rt'J.,1'..('C1 1) 1' (:)::) 0? ;; V' a
t'lr,..1 I
n LT.;
" an,. 3.n(1-Hatod t:hoy
" ; thn 1111' inc1d..'1..v.i.C1;a1n, vTho
r7S f .3.3:P, L. " ti1.31"." but: (11(1 not:
thr.! " tor-1:" ; f L,. nur,hr,-.Q... of
;;:1() In t-ncl " tank"
ri.c)t thc-r: 1-,orfof t11r2 f r ;L " tank" ; and,
nu:Th.3- Of inC of 'licit:11c, r
" . un1_11(.; tilt_ fo)....
nio
'R., (I.',
t.:; f f a Z \.10.]1_1t"
_
t1h:CL." t lic I"( CO `1a!,;, 76 v:
n a.; OC,;111t;1:1 t:C) oxl,,y,on) anci
I r-
-Lc> 7: .r)1
(80'0 of Lhone individnaln who .1.ndicated performinu 'i'-; 51 also
71Led that they performed Tasl: 76 while ninety-even percent
(5 1.) of t1o5. who indi.catn.:1 they (1.i(1 not p(:rforrA Tun% Si. ti.c
indicatcd thv did not po):fom Tan]: 76. Thu, ...1, even thouuh a
5iciniL1eanL dire,-ice in renpone w.n obtained, it does appear
tht .e;iCy
52 (l2,e L. to e':n(3 75 (Adiniter
a 1:-,) \ ;c ;e J cc "tan)::;". In cepriny
the e:lerIce to thr-;o Ta,;):.:1, no nigni.i;c1n wa:; found
0) On]'' to 1:Lcrmt (2:_) of the respondent who
52 did n,); doin Tank 75 while two
(:),',) of the 1-.'dent... who indicated doin,f T.,:1,;1: 75 dia
not doinr.; 'I'm% 52. Yhun, L1I renL)eno to -thi.3 "tosk"
1.0 be conn-trnt.
T- 101 a bc,.(i-v::ive unit to perform :1nterrlittent
verLilat.i.cn (ITV) ) and Tank 102 (Ue a
to pnrfori1 IPPV) yielded a Z value of 8.14 when
the cc we ):o Thun, the renultn seem to indicate
it (11..r.fc;rence between pu1u :ionc of rrnpondents to
the:;e tYo "tankn". In look it at the r(,)nponne data, however,
theye dean to be a connintency bet:!en those inflividuals who
do' iv; 101 anc- who indicated that: they never did
App:-0HF.etcly thIrthree percent (.33) of the
in diced thc-,r 101 and clic not do Tank
102 whil on]y (1'7) of the renpondntn indicated that
0J.H`1 ;11-1(..
th1n lic]; of
in to iL lu c;;:11)10 that tht 1cL thJIL the Lo
on.2 0L112
to tr...2 connistontly bc:tur,o the
11t tLc ! inoin:Ii.on of tho f;c!ond "tas?;" an
en,--..,r. ;.'( -,,..--,-11,,ii, ..,.. ..-,-,:d ).:(-1,--..01-1 for ill; '..., 1:k.,,(;)11:!-'. on
m..,....n.,;-f.,i' ;.,-:t..;:.nii l'.1,.. u:,. of-. thy \'', )1:C-7 (,.pf,, -t.',-, ti .2 :1(), 1.1: ,t.! 3.11 the t..\:0
) y lici%,.. 1):-!::7;-;:..i.vt.:(1 n (Ii.f:f';.::-.0.110:" intht..;:..! nod L.:11-.3 .f.c.2c ',-. rni.t tly opy,-,A,--:d a ) VThVC tAa.'.-1,
liniL 1-,1,....t ,1:,..Ci.
Li
7:7 ( Li r oT. km. invon ol-
T',Ii!; is d,%.,-.7-lcularly
c-r.,! in -L Nionp (Jr. "t].1!:.::::;" 1 t11 and 1(1 :!). Any
Lh: opeY;-:1-(,
on HY:.ft:. Of anci
the pilipc.` Of11Y. to (aTsectly, hut tn
. H 01 ci (.,..: in w0-.1 to def.inc! thc iinitn of
ti in (..:(r,..,c1c.,;:,1..Lf-.'zi L c:e(7:-.; to 1.-.;.-J:e
of. rflv);,.!.7,o :if-, not particniarly
L1:-Id, if it un CA:f-,i:CC:(14 to 1.u.;(-,, the
rY(..; ).1(...:h to dri.rc:c1:."1.y Cov)op
on 1 tv7.i on , u (.11
of ciz,.t-.0 o pYubic!d.
sycl to il,('!icat(..] b,
i.nr sucl an
11(..)1,; 1,, to
total inventory 1)y the same croup of respondents. In addition,
the results provide a rationale for very careful construction of
tas?: statements so at; to remove any ambicluity.
73
USING T? ;I; TdiATXSE"; TO DEVrI,OP CURRICULA AND CURRICULAR CONTENT
The purpose of thi.:; study is to develop job-related curriculum
and course content for training in the area of emergency
prohospi t al care. The data presented in the preceding section
provides useful information for accomplishing this goal.
However, it does not provide information which can be translated
directly into either curricula or COUnle content. Additional
analysis is required. For a complete discussion o.- how curricula
and course content can be developed using task analysis, the
reader is referred. to the document "The Development of
Job-Related Curricula Using Task Analysis" (EPI, 19 73). The
following discussion will briefly summarize the procedure which
can be used to accomplish the goal.
In order to develop job-related curricula, it is necossary to
determine the requirements of the job which must be met by the
trained performer. These requirelaents can be Stated in terms of
the necessary skills and knowledge which the perfoymer must
to perforci thc individual tasks (;'or): units) required of
the job. Knowlecle i^ defined as the what, where, when, how and
Ally of zi given action required by the performer. Skill is
defined as the application of the knowledge to perform the given
action.
Thc,. data obtainf2d in the survey provides a general description ofthe war:: units which must Lie .tc..:complished in pr;.,vi ding cm-.2rgency
prehospital (';re. tjseful inr:'ormaL7lon which is obtained from this
7'
A. The frequency of performance of given
units of work by incumbents;
D. The perceived difficulty of the work units
by the incumbent;
Cl. The relationship of the performer job
function and the work units which he performs;
D. The level of supervision received while
performing each of the work units; and,
E. The involvement of other performers
(co-workers) in the performance of the given
work units.
Using this data, it is possible to determine those work units
which, based upon the frequency of performance and perceived
difficulty by the performer, should be included and/or criphasized
in a training program.
The first step in detentining the skills and knowledge required
of the job involves the developn-nt of a system flow of the job.
Such a flow puts into perspective the major functions which must
be accomplished in perfoIming a given job. Appendix C provides a
system flow for the emergency prehospital ea: re area. This system
flow provides en initial onjanizatien structure from which a task
analysis can 1e(.7in.
In order to undert,-,k0 a task analysis, it is necessary to
(',e:( ..ri.hu the :;.71cijvi6,Ja1. which, using the
ini t 1,-e) , aro tc; be include0.
in the training program, a descrip'Aon is generated. A strict
definition of a task (EPI, 1973a) i.s used for those work units
identified as being important for the nrriculum. Each of the
work units is either embined with other work units or broken
down into additional work units which define the tasks required
on the job. Each of these tasks is then described. The
description involves an initial flow chart of the major
activities or elements in the tashs. This flow chart is then
translated into a detailed description of each element of the
task. c,:Lvle of task descriptions and a resulting training
module Ev...,71 in Appendix I) and Apporldi;-: E.
The tat--;k (..:::Icitptions are analyzed to determine the skills and
knowlede zl):e required to perform these tasks. This
anal.ys is .:tr.:cemplif;hed by looking for cues (indicators) within
each of . of the
AS:
critical errors;
critical but unsuspected conditions;
critical criteria or performance tolerance
cse cues include such things
,ls;
P. alternate step.;;;
material:!, and /cr
OL. 1'
G. procedural steps which indicate a need for
interpersonal relations.
Using these cues, the required skills and knowledge necessary to
perform each element are noted. Tasks are then compared, using
the noted skills and knowledge, to determine which tasks tend to
group together for instructional purposes. These groupings can
define the curriculum to be taught:.
The task grouping can be further broken down into convenient
instructional units. 1'he5e instructonal units include:
A. A didactic presentation of the required
knowledge;
B. Practical exercises to impart the skills;
C. Presentation of critical errors and
avoidance and recovery procedures;
D. Relevant task descriptions;
E. Behavioral objectives;
V. Belated reading assicinr,lent5;
G. Su-.1geLcd teach ling aids;
H. cird pu:;t-tot
An e.:-:,71p1e of Acci1 teaching unit if; inciud in Appendi% E
of this report.
77
5n,11:
Need for a Training System
As is evident from the results of the responses from the survey,
a substantial percentage of those individuals responsible for
providing ambulance service in the Commonwealth of Pennsylvania
do not have adequate training in emergency patient care
procedures. In addition, that training which has been received
by abulance attnndants, has been on a "hit-and-miss" basis.
Training classes have been started up wherever facilities existed
and funds were present to provide such training. In general, the
funds which have becn available for training have been provided
by the United tates Department of Transportation grants. These
grants have not always been sufficient to provide the necessary
materials and/or instructional quality needed for success.
Instructors have been in short supply since there does not exist
a pnol of individuals who are TAalified arulance attendants
(trained beyond Emergency Eedical Technician Level I) and who
have teaching skills.
This approach cannot: becTin to meet the demand for training which
will eist should statewide legislation be passed concerning the
level of required training for anbulance attendants. Thus, a
norc nysLe;Ai:ttic procedure is needed..
In line wjtk UPI in currently 1)1ToLincj 1]::? 1 training at a
vocational nchol and a coLmnnity college. It is felt 'chat such
inntitutienn )ccatl tln:otnjhout the state ,711-,
Yhnreb; traini:;(7 cwortun:;.ti(Jn can he made
to all ambulance attendants. The established
educational institutions of the Commonwealth of Pennsylvania must
assume the responsibility for this training effort as they have
assumed the responsibility for training in other allied health
professions.
In addition, it is imperative that a pool of instructors he
developed throughout the state in order that: properly qualified
individuals will be available to conduct. the basic Emergency
nodical Technician training. Further research is necessary to
deterine at wh%t level of competence, both in the emergency
medical care field and the field of education, the instructot
should be trained. A model training program should then be
constructed and implemented to meet the epected demand for such
instructors.
Trainin(; 1n in ^c: CC fl 1.b1C Areas of the state
The results of the survey and discussions with individuals
operating in rural areas indicate a need for a concentrated
training effort to occur in the more rural areas of the state,
i C 11 I in those areas where vocational training institutions are
not pmesen. Althouh there does seem to be a Yillingness on the
paYt of both pai(1 and volunteer attendants to travel
largo ditancef7 to rccov.J.! training, it would 1)o more officiont
to tal:o the trinin:_c to tilem. In this way, all attrlndants within
: ;c`rl'.ica can iho train(?c: at the same time ifild a
workin Intwc.,cn the li.lbulance attendut within the
and the local ho de,Ailo2(1.
9
In order to accovplish this, a mobile training lab can be used to
reach the inaccessible areas of the state. Such a mobile
training lab would entail a fully equipped ambulance operated by
a pair of trained insttuct:ors. This training lab could be
scheduled to visit a particular ambulance service once per week
for the time necessary to complete the initial training. This
has an additional advantte Of lowering the total equipment cost
throughout the state since the ambulance could move equipment
from one location to the other and therefore not necessitate the
purchase of equipunt for each individual training class. In
addition, the ambulance used as a mobile training lab would
familiarize those individuals in the rural areas with a properly
ccluipped vehicle.
a part of Phase Two of the current LIIT I training progra,
LPI, in eunjunction with AC1Aral Peary Vocational Technical
School and Wcstnoroland County Corunity College, plan such a
venLure. The robile training lab should be operating throughout
the C=onw(falth of Pennsylvania during fiscal year 1974-75.
Need for 1:efresher Training
The results of the survey indicate that there is a large range in
the numUer of trips per r,onth answered by various categories of
atten:lant:-;. It is also evident from loohing at the "task"
perf or; Ince data that ykany ambulance attendants have little or no
e:)prtunity to peri:orm some of the critical patient care tasks
necessary in provi(Th anbulance service. Thus, if an attendant:
has reccivod .c.he training in these tashs and does not have an
epportunity to maintain the shills and hnowle(:(!r, which he
CC)
originally aeguired, either on his on or through e:Terience, he
is likely to lone these skills and knowledge. This is
particularly the cane in volunteer amhulance services in rural
areas where an attendant may he involved in only ten calln per
month.
In response to thin fact, it hem:A(2s denirahle to provide
refresher training for ambulance attendants on a scheduled hanis
in ordr that they might have practice in maintaining their
shills an,A hnowle3ge. Tests on critical patient care tanhs could
be given to all me:rs of: an a;lbulance service and special
training for those mmbers requiring such training could be
provi(Mdfl such o is probably Lest implemented within the
structure of the ilobile training concept.
Phane II of the .d-ove-entioned project includes the development
of a ref:-eshr trainin(: Todule. This refresher module should he
irple;nted during fiscal year 1974-75.
Al Calori for the--- _ -1.- --
'1'h-re has been luch interest in providing the El.:orgency nedical
Techniel;:n advanced training, perhaps oven to the associate
(3c(2 level. iftyr, the current "ntate of the art" in
Pennsylvnia is such that. arrhulance al:tendants aio volunteer
the C::-nd for a(1')ancT]d training dol:n not involve s:Ilaried
pwlitions. Eowever, there be other occupations which are
related to el:,?rgency prehonpital care which can provide sol7cied
pcsiLi(:ns and act on a career laddc,r. These positions must he
11(? Llic? ntrucla of for the1.1 developed.
EPI is currently working on developing such a demand study within
Allegheny County. This demand study will deterinine where the
advanced MT mj..ht find salaried employment. The study will also
attempt_ to define the areas in terms of the skills and
knowledge which would he necessary for the advanced rnT to obtain
el:ployL.ent.
Citizen Tr,zirine
in iost cases, tho first person to roach the site of an emergency
is not a trained abulance attendant. Even with the fast
response of ambulaneo services in most areas, the time between
the arrival of a eiti2en and that of the ambulance can be
critical. it is desirable that all citizens within the
Coonwealth of Pennsylvania be able to provide basic emergency
medical care treatment foJ.: a patient in the interim between
detection and arrival of the a2:bulance. Such training could be
provided as a nornal part of the high school curriculurA within
the health prograil. Currently, American P.ed Cross First ?id
Training is given. This training prograli is being revised to
prov.i da more up-to-daLc training. It is desirable that an effort
be made to introduce either the revised Aurican lied Cross
training progra ade:;uate) or a similar citizen program
within all secondary schools and comunity colleges in the
Coonwealth of Pennsylvania.
Thc "atat.: 0:7 LhY art" in 11:,:nrjency :,12(]::.cal Technician trainincj
HIV: witilin the Comonwealth of'. Pennsylvania.
What exists today, will not exist in the future. What is
necessary to upgrad the emerciency medical care system within the
state is a systel-latic appI0,:,ch to all levels.
attendants must be trained to act as an arm of the hospital
within the comunity. hospital personnel most be able to
continue the level of service cjiven to the patient upon arrival.
Citiens laist be tr,:,incd to provide the initial cre necessary
before the ambulatIce arrives. If such a total system is
developed, it is that its illpaet will save many lives
which would cede be lo:.;t. us is evident fro the precedinu
discussion, much effort is cucrently under way to approach the
proble7:s in a syste:latic manner. Thes efforts should result in
better trained ambulance personnel which should have a positive
effect on the delivery of er1'njeney prehospital cae within the
ComonwoaJth of venie.
1. Molvin K. , M.D. , Hick? tn Ciipin in 11-.2alt " 1 uti.1--4.:x.li (2(11 Join:It:11Volui:tit. 3, 4t1itit , 1971,. I). 8-9.
2. Nt.thatii, 14. , 1-1.1). ,
1.4 ,in.,L1 ..t..1.tL i, Vc.titt,:k.-: 217,, " or. 1.11r:t------- - -------
ptc.-tii.1\-.,t- 13, 1.971, 1.).
3. i. s ();-, ion, 1:,-11.-ic.,;111. Tr7tf.tic SafetyJ(t)) 21-tu3tc. 1,1itiFtThilicji.on, 1).C.
.
U. :1. o 1-1,17 19/2.
4 c),.1 nc--; 14;A 1.(.2,11
i
Dityi 01 01 t.'ttxl.i (:a 1 Sc:j.encc,:-; ,
vc::. If. : to 1. ir 1 01.
, 1niH, 1.912 , P. 3.
5. 1)
'it-01 Li , 19 / , p. ')
{11,
1)1,1:1, th of P,:ral15ylvani.-1,
6. ,11.11 od.ity , inc. , 199 ; .
7:v. (1nrdctn Ci t y, nr;(.1
7. G(..y.\..i; , H. , .t. not 1. , 1964.
8. co-.1:d1 ;!7;_
_ '11 Chi:-',iD: kicjijj
9 hi (hi r 0- 11. :nn t Hof : I in
( 1: , n. jAc;icyn. Y02-1;.: ctut
11 1
0. (1r, , ;'t1,,n-ray,1971.
. /1(.1t_ctl jT. 13T-ar_1y
1. 'Cr t 11 ion (..)1
fnr 1. :_ .
ittn.1 H. ; r , 1 ; rt,;1',t)
..rHH .-n! 01.
"
i 1;-11;
),
ny-t.- s(.1 m;.-,11 cHn-L-1.r-tt:tt.tt rh-,t.rnutt,(f Proim owA ; 1 -:. ' Cr. 0, t.111)Ti
iir
_ . _
t.tpt_ ;rt.
f:..; 'H., 9 , tyr2), Itth--,,1,11, 1',:nt:yr,.tt P P (1,:t 1:1
4. ; 1ntt--H, 1.t f
, ,,
' 1 i ' ,)
r 11). ,
APPENDIX A
QUESTIONNAIRE
1. Age
Personal Background Information
2. Sex Male 01
Female
3. Total years experience in EMS
4. Position held (primary title only)
Owner 01Manager 02
14. Highest academic level achieved
Less than 8 019 0210 0311 0412 05High School Diploma or equiv. 06Associate Degree 07Some College with no degree 08Bachelors Degree 09
Shift Supervisor 03 Masters DegreeCrew Chief 04 Ph.D.Driver 05Attendant 06 15. Training receivedDispatcher 07Clerical 08 none
Standard Red Cross5. Number of ambulance trips per month Advanced Red Cross
Instructor Red Cross6. Years in this position CPR American Heart Association
Extrication Training7. Type of personal reimbursement Pa. Dept. of health Emergency
Ambulance Attendant Course; 27 Houron paid volunteer 01 40 HourFull paid position 02 81 Hour U.S. Dept. of TransportationPartial paid position 03 course or equivalent (EMT Training)
Electrocardiography Training8. If this is a full paid position, in Infusion of I.V. Fluids Training
what area were you previously employed? Infusion of Drugs TrainingAdvanced Medical Technician; 480 hrs.
Health Services 01 Other Specify:MilitaryNone 03Other 04
9. Number of individuals you supervisedirectly
10. If you are paid, on what basis?
SalaryHourlyPer CallOther
11. If part time or voluntary, in whatarea are you presently employed?
12. Registries held
010203
Health Services 01Manufacturing 02Service Industry 03Education o 4
Military 05Student 06Retired 07None 08Other ----09
EMTCITTRNLPNARITOther
13. If you are not a registered rmT, willyou be taking the registry examinationwithin the next year?
YesNo
0]02
16. If you were offered the following courses,in which would you enroll? How many areavailable in your area?
Would AreEnroll Available
Standard Red CrossAdvanced Red CrossInstructor Red CrossCPR American Heart AssociationPa. Dept. of Health EmeraencyAmbulance Attendant Course;
27 Hour40 Hour
81 Hour U.S. Dept. of Transp.Course or equivalent (EMT)Electrocardiography TrainingInfusion of I.V. FluidsInfusion of DrumsAdvanced Medical Technician;
480 Hours
17. How many miles would you be willingto travel for training?
18. If legislation were proposed thatwould require at least one EMT(trained at the 80 hour level) heon every ambulance call, how wouldyou probably vote?
A-1
For such legislation 01Against such legislation 02
EPIAH-01473
ORGANIZATION
1. Is your ambulance unit
Profit 01Non-profit 02
2. What type of ambulance service isyour organization?
Police Department 01Fire Department 02Funeral Home 03Hospital 04Other municipal service OSIndependent 06Other 07--_
3. From which source (s) does yourambulance unit receive operatingfunds? Check all applicable.
Local tax supportPrivate grantsDonations and fund raisingFee for services renderedFederal or state fundsSubscription or membership feesOther source(s)
4. What is your usual base chargefor ambulance service?
No charge ClLess than $5 02$6 to $10 03$11 to $20 04$21 to $30 05$31 to $40 06$41 to $50 07$51 or more 08
5. Are all of your ambulances in thesame location for dispatching?
YesNo
6. Are your ambulance attendants
0102
Volunteer 01Paid 02Paid and volunteer 03
7. Is the manager or director of theambulance unit
Volunteer 01Paid 02No manager appointed 03
8. What is the approximate popula-tion served by your unit?
Under 5,000 015,000 to 9,999 0210,000 to 24,999
--03
25,000 to 49,999 0450,000 to 99,999 05100,000 to 149,999 06150,000 to 249,999 07250,000 or more 08
9. What is the radius from the locationof your ambulances to which you provideprimary emergency yesponse?
2 miles or less3 miles to 4 miles5 miles to 8 miles9 miles to 15 miles
01020304
16 miles to 25 miles 0526 miles to 50 miles 0651 miles to 100 miles 07101 miles or more 08
10. What is the radius to which youprovide inter-hospital transfer ofcritically ill or injured patients?
2 miles or less3 miles to 4 miles5 miles to 8 miles9 miles to 15 miles
01020304
16 miles to 25 miles 0526 miles to 50 riles 0651 miles to 100 miles 07101 miles or more 08
11. What services are provided by yourambulance unit? Check all applicable.
Emergency medical careDefinitive medical care, includingdefibrillation, IV and/or drug infusion
Emergency transportation from site to amedical facility
Emergency transportation betweenmedical facilitiesNon-emergency transportation of conval-escent patientsLight rescue operations, using handtools (e.g., jacks, bolt cutters, bars) --Extrication (e.g., from automobiles)
12. What are the total number of ambulancecalls made by your unit in 1972?
(List number)
13. Which of the following are included inyour record keeping system?
Date of the callPlace of patient pick-upDisposition of patientType of callCare given to patientName of patient
14. Do you provide ambulance service 24 hoursper day, 7 days per week?
Yes, we provide service to all calls if 01we have equipment availableNo, we refuse certain emergency calls 02__-that we do not wish to take
No, we refer certain calls to other 03units in our area __-
Unknown 04
A-2EPIAE-02473
COMUNICATIONS
15. Is there an emergency operationscenter or central dispatcher foryour area?
YesNoUnknown
If you answered yes, give nameand address of dispatchingorganization.
010203
16. What is your most frequently usedmethod of advisiWg the hospital ofthe pending arrival of a patient?
No information is provided 01'Hot line" telephone 02Normal telephone line 03Two-way voice radio system 04One-way voice radio system 05Combination of telephone lines 06Other 07
17. What are the most frequently usedmethods of advising hospitalpersonnel of care given to thepatient at the scene and intransport? Check all applicable.
No information is provided'Hot line" telephoneNormal telephone lineTwo-way voice radio systemOne-way voice radio system _Verbal communication at hospitalMedical record with patient
TRAINING
18. How many patient care attendantsare there in your unit ororganization?
(list number)
19. What are the minimal trainingstandards in your organizationand which do you sponsor?
No minimal requirements
Minimal Sponsor
Standard Red CrossAdvanced Red CrossInstructor Red CrossCPR American Heart Assn.Pa. Dept. of HealthAmbulance AttendantCourse; 27 Hours
40 Hours81 Hour Dept. of Transp.Course or equivalent (MT)
ElectrocardioaraphyInfusion of IV FluidsInfusion of DrugsAdvanced Nedical Tech.;
480 Hours
20. How many attendants are registered withthe national registry for EMT-A?
(list number)
EOVIPMPNT
21. How many ambulances does your unitoperate? Indicate type of each number.
Straight limousineRaised roof limousine (e.g.,high boy)VanStation wagonTruck mounted moduleTravel-all truckHearse conversion or "combination"Amphibious vehicleWatercraftHelicopterAirplaneOther: Please specify
22. How are calls relayed from the dispatcherto the emergency response vehiclepersonnel?
A-3
Normal telephone lines'Hot line" telephoneOne-way voice radio (home monitor)Two-way voice radio systemVerbal face-to-face communicationOther: Specify
STAFFING
23. How many of the personnel in yourorganization fill each of the jobtitles listed below, specify numberof each type.
Job Full PartTitle Time Time Volunteer
Owner
Manager _Shift Supervisor
Crew Chief
Driver
Attendant
Dispatcher
Clerical
EPIAH-02473
Eow cfc,:n
you pe:!:c,rn
Hr.,I,1,..:dual .if.c2c1-kiln1 d:cult
t..:: :S and
' X
're,:eived":
,Is
:I:is
!I
k7
1.)-._e,_:,c.
-----
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[ISet stJnard type and q,:antity of emergency medical equipment
Ineeded fcr unit operatics
11
F 2 Inventory type and c:..:entity of emergency medical equipment
to detIr..nine need for replacement, resupply, or new eqeipment
?Co
la
e..7.orc3e;..cy Isedical equir,ment in assie3ned location
4 Set standard type and euantity of emergency medical supplies
needed for unit operation.
S Inventory type ane_ cllantity of ezergcncv medical .,app lice to
detere need for 'L'enupply or new supplico
6 Place emergency redical supplies in aosigned location
7 Set stanaar.: type and ql:antity of drugs and intravenous
II-V,) fluids needed for unit operation
:nventory type and quantity of drugs and I.V. fluic2s to
determine need for rcsupp:y or new supplies
J ..ace drugs
I.V. _`:.aids in assigned location
1 I2
1
2
3
li 1
23
4S
311
311
12I3
I
; 3
J:
13
11
' 2
3 H1
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I3
1I
I
31.
13
i4
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,I
11
1
I
I4
5II 3
23
12
II
1"1
1
12
34
5
11I
11,
i
!: 1
2,
12
4I
5
tit
12
31
:;3
4
1
0 Oct standard type and amount of officesupplies needed for
t:::::t °pc:rat:Loa
4
1
34
,5
rf,1
it
APPENDIX .3
DATA RESPONSE
TOTAL RESPONSES
PCT OF NUMBER RESPONDING
ALL RESPONDENTS
TASK rESpoNsEs
PCT OF NumerR REsPoNOiwG
OCcuPAT/ONI
ALL RESPONDENTS
TOTAL RESPONSE 209
PCT OF TOT
lee
730927
GROUP
1I
ALL
TASK
FREQUENCY
Tor
ASSIST
SUPERVISION
orFFfoULTY
TRAM!NC
12
34
5pFm
12
3i
23
12
31
23
4
/Set standard type and quantity
716
18
15
41
36
11
12
28
tO
24
15
29
23
1t7
i9
14
11
of emergency medical equipment
needed for unit operation
2 Inventory type and quantity of
614
25
21
31
66
13
15
30
926
22
40
20
111
28
820
emergency medical equipment to
determine need for replacement,etc
3Place emergency medical equipment 14
21
28
16
18
79
14
17
43
12
27
32
52
22
0ii
34
10
22
in assigned location
4 Set standard type and quantity
510
16
15
48
45
11
10
20
10
17
12
24
15
17
20
913
of emergency medical supplies
needed for unit operation
'Inventory type and quantity of
315
21
22
34
61
13
13
29
925
19
33
21
17
27
918
emergency medical supplies to
determine need for resupply
6 Place emergency medical supplies
11
22
25
18
19
77
16
14
39
928
3e
56
15
013
33
623
in assigned location
7 Set standard type and quantity
11
33
86
91
25
32
22
51
i4
53
of drugs and intravenous (I.V.)
fluids needed for unit operation
8 Invent,Nry type and quantity of
14
43
81
12
i4
64
24
37
0i
54
31rug5 and I.V. fluids to determine
need ror resupply or new supplies
9 Place drugs and I.V. fluids in
12
55
80
14
43
73
55
95
02
64
5
assigned location
10 Set standard type and amount of
33
711
72
24
68
64
710
11
10
I8
73
9office supplies needed for
unit operation
11 Inventory type and amount of
24
711
73
24
77
71
te
814
80
59
39
office supplies to determine
need for resupply or new supplies
12 Place office supplies in
25
811
70
27
76
11
210
11
21
50
78
312
assigned location
OCCUPATIONI
ALL RESPONUENTS
CROU°
11
ALL
TASK
13 Design emergency medical
equipment such as a special
splint
or vehicle floor plan
14 Examine physical facilities to
determine need for expansion
or construction
15 Prepare budget for operation
of unit
16 Assign crew and vehicle to res-
pond to ambulance call based
upon the nature of the call
17 Survey type and quantity of
emergency medical equipment
available for purchase
18 Maintain personnel records
19 Prepare payroll for unit
employees
22 Prepare financial report of
unit operation
21
Examine record of service to
patient to 1)111 patient
for service
22
Maintain accounting records
23
maintain records of patients
serviced
24
Operate a typewriter
TASK RESPONSES
PCT OF NUMBER RESPONDING
TOTAL RESPONSE 209
ACT OF TOT
100
730927
FREQUENCY
TCT
ASSIST
SUPERVISION
DIFFICULTY
TRAINING
12
34
5PFM
12
31
23
12
3i
23
4
00
321
71
24
65
10
79
65
13
46
74
7
11
117
75
20
44
10
i8
64
10
35
42
8
10
213
81
16
45
34
36
25
67
21
6
10
913
13
53
45
12
12
11
614
20
19
20
36
17
616
02
423
66
.30
79
10
69
19
12
36
53
13
33
311
75
22
36
63
58
99
04
63
8
00
21
92
30
10
00
31
10
12
2
00
28
85
11
16
10
45
45
14
22
5
32
55
81
16
34
61
48
86
15
82
3
11
41
87
81
31
01
62
40
43
03
10
10
98
59
36
710
12
410
18
20
12
06
15
79
52
812
68
28
45
70
418
16
80
4W
25
9
OCCUPATI0N1
ALL RESPONIENTS
CROUP
11
ALL
TASK 25 Maintain records of maintenance
performed on emergency medical
equipment
26 Complete information reouired
by special form to report
'accident
27
28
29
30
31
32
33
Complete information required
by special form to report
ambulance trip
Complete information required
by special forms other than
those listed above
Examine record of service to
patient to determine charges
to patient
Record analysis of ambulance
trips to determine such things
as type of service provided, etc.
Create and maintain on-call
roster of staff required to
operate unit
Conduct meetings with hospital
representative(s) to coordinate
emergency medical services
Conduct meetings wi"ch
unit personnel
34 Develop pollees or procedures
to provide guidelines for daily
operation of the unit
35 Develop and on-the-job training
program
36 Conduct interview to determine
if applicant meets standards
for employment
TASK RESPONSES
PST OF NUMeER RESPONDING
TOTAL RESPONSE 209
pot or TOT
FREQUENCY
TOT
ASSIST
12
34
5PFM
12
34
912
68
28
68
100
3 10
1
5
2 11
730927
DIFFICULTY
31
23
712
12
0
1
5
TRAINING
23
11
3
4
6
39
14
16
55
43
811
15
314
20
22
16
05
14
514
21
22
25
13
17
81
13
16
38
927
38
52
23
112
34
11
17
47
88
677
64
11
47
11
12
10
04
12
45
32
52
84
13
32
40
45
64
01
52
5
75
9689
611
91
14
10
11
14
14
13
48
44
97
73
23
48
62
99
11
82
311
38
20
214
80
17
34
62
56
47
34
44
6
12
14
24
56
41
712
14
416
13
15
18
28
11
511
15
617
67
29
810
73
13
87
16
26
97
7
14
912
70
26
811
56
11
65
15
36
85
8
01
28
86
11
26
02
24
45
12
33
4
OCCUPATION,
ALL RESPONDENTS
GROUP
/i
ALL
TASK 37 Administer test to determine
if applicant meets standards
for employment
38 Evaluate unit personnel to
determine progress, raises,
discipline and promotion
39 Determine staff required to
operate unit effectively in any
specific time period
40 Explain general hospital
procedures to patient or family
41 Inform patient's family of
patient's general condition
42 Inform patient's attending
physician of patient's death
43 Inform Coroner's office of
patient's death
44 Use an emisis basin in treating
nauseated patient
45 Use a urinal to provide the
patent with an opportunity to
urinate
46 Use a bedpan to provide the
patient with an opportunity to
defecate
47 Use sandbags to immobilize
patient's
cervical spine (neck)
4e Use a cervical collar to
immobilize patient's neck
TASK RESPONSES
POT OF NUMBER RESPONDING
TOTAL RESPONSE 209
PCT OF TOT
100
730927
FREQUENCY
TCT
ASSIST
SUPERVISION
DIFFICULTY
TRAINING
/2
34
5PFM
12
31
23
12
31
23
4
01
:8
87
10
06
11
33
25
12
14
2
10
310
81
15
25
43
43
35
33
42
4
33
411
76
21
27
54
75
511
12
53
8
66
1.0
'
966
'31
47
14
010
18
16
13
16
75
14
56
615
66
'32
58
13
110
19
11
16
45
96
15
13
414
75
23
35
10
/8
10
511
52
87
8
33
520
67
21
54
15
58
11
14
10
410
810
38
18
40
29
.68
15
14
27
114
46
42
18
411
27
15
17
13
530
59
39
910
14
27
25
22
11
27
15
10
9
03
220
73
26
76
10
06
15
12
73
611
87
22
11
41
43
.56
13
17
22
820
23
19
30
412
16
20
11
24
12
49
32
67
12
25
24
11
22
27
19
37
714
22
25
10
OCCOATION1
ALL RESPONDENTS
GROUP
1i
ALL
TASK 49 Use a 3-foot spine board to
immobilize patient's spine to
transport
50 Use a 6-foot spine board to
immobilize patient's spine to
transport
51 Use nasal cannula to administer
oxygen
52 Use mask to administer
oxygen
53 Use a traction splint to treat
a lower extremity fracture
54 use a pneumatic (air) splint
to immobilize a closed fracture
55 Use a padded board splint to
immobilize a fracture
56 Use a sling to immobilize a
fractured arm or clavicle
57 Apply direct pressure to
control hemorrhage (bleeding)
58 Apply digitalpressure to
control hemorrhage
59 Apply tourniquet to control
hemorrhage
60Apply dressing to control
hemorrhage
TASK RESPONSES
PCT OF NUMBER RESPONDING
TOTAL RESPONSE 209
POT OF TOT
100
FREQUENCY
TCT
A,SSIST
12
34
5PFM
i2
3
730927
SUPERVISION
DIFFICULTY
12
31
23
1
TRAINING
23
4
24
13
41
39
60
10
24
21
13
21
22
11
35
ig
13
21
21
10
13
10
34
50
48
918
17
10
16
19
11
29
610
15
20
8
47
11
27
49
49
10
13
16
514
25
34
13
12
17
20
4
716
35
30
11
88
22
23
30
12
27
42
64
20
g19
33
27
6
13
14
26
51
45
616
20
614
22
.6
26
114
18
20
4
36
29
42
19
79
14
31
30
11
27
36
38
36
120
27
27
7
13
932
53
45
816
18
616
20
18
23
215
15
20
4
21
10
52
33
66
ii
21
29
621
34
28
31
316
24
24
4
46
26
43
19
eo
14
20
35
10
22
42
38
34
3 ,
22
23
27
9
13
10
42
41
56
10
15
23
914
29
22
29
318
14
26
5
00
110
88
11
12
51
15
35
18
412
2
36
26
43
21
78
18
22
29
10
23
39
38
35
120
23
29
10
TASK RESPONSES
PCT OF NUMBER RESPONDING
OCCUPATION'
ALL RESPONCENTS
TOTAL RESPONSE 209
PCT OF TOT
100
730927
GROUP
11ALL
TASK
FREQUENCY
TCT
ASSIST
SUPERVISION
DIFFICULTY
TRAINING
12
34
5PFM
12
31
23
12
31
23
4
61
Apply bandage to secure
610
31
39
14
85
18
23
33
11
31
38
51
32
021
28
27
9
,dressing to wound
62 Apply bandages to immobilize a
14
14
43
36
62
12
19
26
11
19
29
28
30
120
16
27
5fracture (e.g., ribs)
63 Apply a sterile dressing to
22
555
34
64
10
24
22
11
18
31
19
42
121
18
29
treat a burn
64 Apply cold wet applications to
01
436
56
42
913
15
713
17
18
22
014
14
20
3treat a burn
65 Apply vaseline gauze or other
00
219
78
21
45
94
410
711
310
820
3
non-porous material to seal a
pneumothorax
66 Use a bulk dressing to
00
125
71
27
59
94
613
613
611
11
22
immobilize an impaled object
67 Use a constricting band to
00
08
89
91
33
23
34
41
10
416
1treat a snakebite
68 Make an incision over fang
00
05
92
61
31
11
33
20
84
14
0marks and suck out snake
venom
69 Elevate the head and shoulders
613
31
32
16
82
18
22
30
827
39
48
29
019
26
26
10
of a patient who is having
difficulty in breathing
77 Use an oropharangeal airway to
14
19
39
35
63
12
17
23
10
17
31
23
33
317
20
26
6maintain a patent (open) airway
71 Use an oxygen demand valve to
47
23
32
32
66
15
19
22
722
32
38
25
116
22
26
6administer oxygen
72 Use an oxygen demand valve to
25
14
26
50
47
815
16
515
23
20
22
313
13
22
7
perform intermittent positive
pressure ventilation (IPPV)
OCCUPATION/1
ALL RESPONDENTS
GROUP
11ALL
TASK
73 Use an S-tube airway adjunct
to perform IPPV
74 Use an endotracheal tube to
maintain an open airway
73 Administer oxygen through
a mask
76 Administer oxygen through a
nasal cannula
77 Administer oxygen through an
oxygen catheter
78 Administer oxygen through an
incubator system
79 Administer Holger-Neilson (back
pressure-arm lift) method of re-
suscitation to ventilate patient
8? Operate pressure-cycled, oxygen-
powered automatic mechanical
resuscitator to perform IPPV
81 Operate an oxygen-powered,
manually triggered, mechanical
ventilation device
82 Maintain body temperature and
elevate lower extremities to
treat patient for shock
83 Treat a conscious patient who
has ingested a posion
84 Operate vehicle mounted suction
to remove fluids from patient's
airway
TASK RESPONSES
PCT OF NUM8ER RESPONDING
TOTAL RESPONSE 209
PCT OF TOT
100
730927
FREQUENCY
TCT
ASSIST
SUPERVISION
DIFFICULTY
TRAINING
12
34
5PFM
12
31
23
12
31
23
4
11
418
72
25
39
72
711
814
110
615
2
01
19
85
11
14
41
36
27
13
710
2
813
33
33
11
88
21
21
30
10
28
42
54
29
121
30
29
7
37
10
22
56
41
810
13
2IC
23
25
14
010
17
18
2
11
29
84
13
16
41
56
57
05
412
0
01
215
80
18
36
52
58
97
02
810
3
C0
07
91
73
12
22
11
31
66
11
1
12
221
72
26
59
64
8it
813
28
911
4
34
12
20
56
40
613
15
412
20
21
17
07
16
19
3
27
24
46
19
79
13
25
32
12
27
34
44
30
216
28
28
8
01
236
56
40
612
16
611
20
11
24
414
13
22
3
05
14
40
39
58
10
18
21
814
31
17
35
414
22
21
7
OCCUPATION1
ALL RESPONDENTS
CROUP
1i
ALL
TASK
85 Operate portable suction unit
to remove fluids from patient's
airway
86 Administer patient's
insulin
to treat a patient in a
diabetic coma
87 Administer sugar or sugar
product to treat patient in
insulin shock
88 Use cold applications to lower
patient's body temperature
89 Use warm water (10o-i& F) to
treat frostbite
w t co
90 Use a flashlight to examine
the pupillary reaction of a
patient
91
Use cold pack to treat injury
to soft tissue
92 Maintain drainage tubing without
suction (e.g., urinary catheter)
93 Perform an emergency childbirth
elivery
94 Place deceased patient in a
disaster pouch
95 Place deceased patient in
a shroud
96
Use restraint straps to control
a combative patient
TASK RESPONSES
PCT CF NUMBER RESPONOINQ
TOTAL RESPONSE 209
PCT OF TOT
100
730927
FREQUENCY
TCT
ASSIST
SUPERVISION
DIFFICULTY
TRAINING
12
34
5PFM
12
31
23
12
3/
23
4
03
942
43
55
918
20
813
26
15
32
512
22
22
5
00
04
93
41
11
10
10
30
22
60
00
222
71
15
69
8$
910
12
12
07
11
15
00
220
75
23
59
63
710
10
Si
010
917
I.
00
07
90
a3
31
11
43
40
73
13
0
39
17
3$
32
67
11
15
24
716
30
43
21
015
22
26
7
03
830
55
41
811
14
411
23
27
11
013
16
16
3
01
39
84
13
14
20
37
75
03
68
1
00
024
72
25
59
96
511
410
d10
10
13
19
3
01
331
62
35
612
14
213
14
14
12
57
14
11
8
01
318
74
22
37
10
110
10
10
10
25
97
7
00
950
38
60
12
22
21
11
22
22
822
28
11
29
18
10
OCCUPATION*
ALL RESPoN'TNTS
GROUP
1i
ALL
TASK v7 Use a geiger counter to detect
radiation level
98 Operate a hydraulic lift
(Moyer) to move patient
99 Perform cardiopulmonary resus-
citation (CPR) without the use
of life-support equipment
:02 Perform CPR with the use of
life- support equipment
101
Operate a bag-valve mask unit
to perform intermittent positive
pressure ventilation (IPPV)
102 Use a bag-valve mask unit to
perform IPPV
103 Perform mouth-to-mouth method
of IPPV
104 Perform mouth-to-nose method
of IPPV
105 Use a sphygmomanometer and
stethoscope to obtain a patient's
blood pressure
106 Place fingers on patient's
wrist to count radial pulse
107 Assemble intravenous fluid
administration equipment
108 Perform a venipuncture to
administer intravenous fluids
TASK RESPONSES
PCT OF NUMBER RESPONDING
TOTAL RESPONSE 209
PCT OF TOT
100
730927
FREQUENCY
TET
ASSIST
SUPERVISION
DIFFICULTY
TRAINING
12
34
5PFM
12
31
23
12
31
23
4
00
02
94
3.
00
11
21
10
12
26
1
01
13
92
50
12
01
22
21
24
61
01
11
45
40
.57
10
18
27
10
16
27
832
16
14
21
25
5
12
11
41
42
S5
915
28
10
13
28
930
14
13
21
24
4
02
11
38
45
51
713
25
616
27
15
32
3i2
20
23
4
02
511
78
19
23
10
35
85
11
14
10
17
2
00
339
54
43
611
17
611
22
11
24
514
17
22
3
00
014
82
15
12
72
37
38
18
916
1
10
17
24
42
56
614
21
312
37
33
18
212
18
25
4
616
23
33
19
78
820
28
719
44
45
26
219
24
27
7
00
18
86
11
42
22
43
54
02
28
2
01
02
92
41
20
02
12
20
11
51
cccuPAT:CNT
ALL RESP0NCENTS
GRZ:UP
1I
ALL
TASK
leo Use a syringe to administer
intravenous medications into
the I.V. tubing
liz Use a syringe to
administer
intravenous medications
Use a syringe to administer
intramuscular medications
112 Operate a defibrillator to
administer empirical defib-
rillation
113 Operate an electrocardiograph
scope and recorder to observe
patient's cardiac activity
114 Operate one-way electrocar-
diograph telemetry system to
transmit (EKG or ECG)
115 Operate a two -way voice
communication radio
116 Answer telephone to receive
requests for ambulance service
117
Perform minor mechanical
maintenance on emergency
medical equipment
118
Perform building maintenance
on physical facility
119
Replace oxygen tank in vehicle
122
Refill oxygen tanks with
compressed oxygen
TASK RESPONSES
PCT Or NUMBER RESPONDING
TOTAL RESPONSE 209
PCT OF TOT
100
730927
FREQUENCY
IcT
ASSIST
SUPERVISION
DIFFICULTY
TRAINING
12
34
5PFM
12
31
23
12
31
23
4
01
02
93
31
20
11
11
20
11
40
01
01
94
20
1.
00
01
10
01
1.
30
00
01
97
10
00
00
0i
00
10
30
00
14
92
61
22
12
21
40
12
50
12
65
83
15
26
42
57
59
02
410
2
02
45
86
11
24
42
35
28
01
38
1
30
21
25
18
494
10
15
45
618
60
77
10
117
39
12
20
11
14
21
26
25
72
915
28
612
45
51
13
114
28
718
46
14
22
50
46
714
17
513
22
21
21
011
15
612
57
919
56
40
511
16
211
22
24
10
0II
12
3it
27
22
40
27
71
11
16
32
619
41
55
11
013
30
li
18
23
916
67
30
48
12
45
18
22
50
613
57
TASK RESPONSES
PCT OF NUMBER RESPONDING
OCCUPATIONI
ALL RESPON7ENTS
TOTAL RESPONSE 209
PCT of TOT
100
G3CV0
1i
ALL
-AS'
12:1:xtricate an entrapped pent
a
12:Direct traffic at scene
of
0
accident
12; Use highway flares to
control
1traffic at accident scene
124 Use portable floodlights
to
0illuminate work area
125 Instruct patient's family
how
0
to care for patient at home
as
126 Evaluate quality of training
0
program
127 Conduct on-the-job training
2
sessions
128 Conduct formal classes to
in-
0struct individuals in emergency
medical care techniques
129 Use an orthopedic stretcher
2to transport a patient
13Z use a variable position stretcher 12
to transport a patient
131 Use a stretcher composed of
6rubberized canvas on an aluminum
frame to transport a patient
132 Use rubberized stretcher to
1
suspend a patient from
the
ceiling of an ambulance
730927
`.9EQUENCY
TCT
ASSIST
SUPERVISION
DIFFICULTY
TRAINING
34
1.5
PFM
12
31
23
12
3i
23
4
112
51
31
65
12
19
28
12
26
21
536
2ffl
13
26
20
7
37
28
56
38
10
812
117
16
19
15
110
15
5it
312
31
49
47
811
16
218
21
30
11
211
20
613
28
41
44
52
812
20
221
23
34
13
022
21
911
02
885
11
13
20
34
53
03
35
1
22
15
75
20
2li
53
95
213
34
75
5
48
19
63
33
614
86
11
11
920
210
96
6
37
19
65
513
75
912
S18
29
89
3
821
43
24
'73
13
22
33
727
33
32
35
116
28
24
5
13
25
27
18
78
12
23
35
826
37
44
27
116
32
19
10
513
26
45.
.51
816
22
19
25
28
20
010
23
15
7
13
27
65
32
510
11
2it
i4
13
13
16
18
85
OCCUPATIONI
ALL RESPONENTS
GROUP
1;
ALL
TASK
133 Use a chair stretcher to
transport a patient
134 Use a chair to transport
a patient
135 Use a wheelchair to transport
a patient
136 Drive an emergency medical
vehicle to transport a patient
under non-emergency conditions
137 Drive an emergency medical
vehicle to transport a patient
using emergency warning devices
138 Operate a fire control device
(fire extinguisher) to
extinguish a fire
139
use a watercraft to transport
a patient
142
Use a fixed wing aircraft
(airplane) to transport
a patient
141
Use a rotary wing aircraft
(helicopter) to transport
a patient
TASK RESPONSES
PCT OF NUMBER RESPONO:NG
TOTAL RESPONSE 209
PCT OF TOT
100
FREQUENCY
YCT
ASSIST
12
34
5PFM
12
3
730927
SUPERVISION
DIFFICULTY
12
31
23
1
TRAINING
23
4
45
13
44
29
67
13
19
29
624
30
32
30
213
27
17
10
I
13
10
39
44
52
615
24
419
22
24
22
210
22
14
le
11
322
67
28
38
10
18
15
17
80
11
11
94
12
818
21
37
'56
516
19
515
32
36
18
012
22
12
12
11
13
20
17
35
60
516
21
614
35
28
28
212
21
13
12
04
10
38
44
51
712
15
719
20
29
18
015
16
11
13
00
13
92
4o
22
02
23
10
31
51
00
01
9,
10
00
00
i0
001110
00
01
95
20
01
C0
10
101110
TOTAL RESPONSES
PCT OF NUMBER RESPONDING
EMERGENCY MEDICAL TECHNICIAN
TASK RESPONSES
PCT OF NUMBER RESPONDING
occuPATIGNI
ENERGENCY wEOICAL TECHNICIANS
GROUP
1I
12
1 El
'TASK
TOTAL RESPONSE
FREDUENcY
57
TCT
PCT OF TOT
27
ASSIST
730927
SUPERVISION
DIFFICULTY
TRAINING
23
45
PFM
12
31
23
12
3i
23
4
1Set standard type and quantity
of emergency medical equipment
needed for unit operation.
728
18
14
33
67
12
19
30
528
25
39
25
05
19
21
19
2lnventory type and quantity of
emergency medical equipment to
determine need for replacementtetc.19
25
21
18
25
72
18
16
26
11
32
23
40
25
05
30
926
3Plarr emergency medical equipment
in assigned location
23
30
14
11
21
77
16
18
35
12
25
33
49
21
05
37
14
19
4Set standard type and quantity
of emergency medical supplies
needed for unit operation
712
11
18
46
47
14
12
16
918
13
25
18
04
21
12
14
'Inventory type and quantity of
emergency medical supplies to
determine need for resupply
528
12
18
35
63
14
12
25
928
16
40
14
e4
33
11
18
6Place emergency medical supplies
25
33
11
11
19
79
12
19
37
932
28
56
14
09
35
526
:in assigned location
7Set standard type and quantity
of drugs and intravenous (I.V.)
fluids needed for unit operation
52
59
74
21
45
11
75
55
11
40
914
2
8Inventory type and quantity of
drugs and T.V. fluids to determine
need for resupply or new supplies
29
14
761
32
012
16
97
11
11
16
00
14
12
5
9Place drugs and I.V. fluids in
assigned location
34
16
12
58
37
77
21
716
11
23
12
02
16
It
12
10Set standard type and amount of
office supplies needed for
unit operation
47
59
70
23
47
95
77
11
12
07
77
5
IlInventory type and amount of
office supplies to determine
need for resupply or new supplies
57
97
72
28
77
74
59
18
70
412
59
12Place office supplies in
assigned location
47
911
68
30
75
14
27
11
21
50
211
412
OCCUPATION!
EHEPSE%CY ''EDICAL TECHNICIANS
CROUP
1I
12
1 EC
TASK 13 Design emergency medical
equipment such as a special
splint
or vehicle floor plan
14 Examine physical facilities to
determine need for expansion
or construction
15 Prepare budget for operation
of unit
16 Assign crew and vehicle to res-
pond to ambulance call based
upon the nature of the call
17 Survey type and quantity of
emergency medical equipment
available for purchase
atI
I...
X.,
18 maintain personnel records
19 Prepare payroll for unit
employees
22 Prepare financial report of
unit operation
21 Examine record of service to
patient to bill patient
for service
22 Maintain accounting records
23 Maintain records of patients
serviced
24 Operate a typewriter
TASK RESPONSES
PCT OF NUMBER RESPONOING
TOTAL RESPONSE
57
PCT OF TOT
27
FREQUENCY
TCT
ASSIST
730927
SUPERVISION
DIFFICULTY
TRAIN/NC
12
34
5!FM
12
31
23
12
31
23
4
00
228
67
30
95
14
711
711
12
54
14
75
20
019
75
21
45
11
05
11
74
75
52
9
00
212
82
14
74
24
25
24
79
20
5
19
519
749
'51
11
14
12
418
23
21
21
42
16
11
19
27
514
67
26
511
70
712
12
11
04
52
14
54
79
74
25
29
72
49
12
70
47
011
02
50
91
70
30
20
52
22
24
04
02
55
88
12
27
00
25
45
22
42
7
94
27
77
21
45
94
59
16
47
512
24
02
72
88
11
25
00
24
24
25
20
4
12
12
74
61
35
411
12
75
18
21
11
02
16
77
42
211
81
18
20
70
27
11
20
70
07
TASK RESPONSES
PoT OF NUMBER RESPONDING
OCCuPAT:ONI
EmERGEN.CY "EDICAL TECHNICIANS
GRCUP
1t
12
1 CO
TASK 25Maintain records of maintenance
performed on emergency medical
equipment
26Complete information required
by special form to report
accident
27Complete information required
by special form to report
ambulance trip
28Complete .nformation required
by special forms other than
those listed above
29 Examine record
of service to
patient to determine charges
to patient
GC
1.1%
3r Record analysis of ambulance
trips to determine such things
as type of service provided, etc.
31 Create and maintain on-call
roster of staff required to
operate unit
32Conduct meetings with hospital
representative(s) to coordinate
emergency medical services
33 Conduct meetings with
unit personnel
34 Develop policies or procedures
to provide guidelines for daily
operation of the unit
35 Develop and on-the-job training
program
36 Conduct interview to determine
TOTAL RESPONSE
FREQUENCY
23
4
77
714
516
12
12
44
26
16
2
11
16
11
9
94
77
12
75
12
712
12
4
20
514
05
23
14
216
59
25
12
14
02
79
57
5 60
53
12
51
72
61
63
77
5B
68
65
81
TCT
PFM 35
46
AS
46
26
37
'35
21
42
32
33
18
PCT OF TOT
27
ASSIST
I2
3
45
19
712
19
12
14
44
77
23
55
9
416
(2
512
11
24
11
4i8
14
514
11
418
11
211
2
730927
SePERvISIOv
DIFFICULTY
12
31
23
712
11
19
12
2
411
25
i9
19
2
11
32
37
47
33
2
414
21
26
11
2
0/1
9i4
70
018
11
12
19
2
414
12
12
18
5
47
55
92
012
21
21
1C
2
411
12
918
2
79
11
519
5
20
99
52
1
0 2 9 9 4 4 2 9 9 7 4 4
TRAININ:
23
21
2
11
7
40
16
18
5
92
16
2
18
4
70
95
11
9
12
7
72
4
9
21
18
11 7 9
11 7
18 4
12 5
if applicant meets standards
for employment
OCCUPATIONI
EuERGEN.CY vEOTCAL TECMNICIANS
GROUP
11
12
1 EC
TASK 37 Administer test to determine
if applicant meets standards
for employment
38 Evaluate unit personnel to
determine progress, raises,
discipline and promotion
39 Determine staff required to
operate unit effectively in any
specific time period
42 Lxplain general hospital
procedures to patient or family
41 Inform patient's family of
patient's general condition
m 1
1...
cy%
42 Inform patient's attending
physician of patient's death
43 Inform Coroner's office of
patient's death
44 use an emisis basin in treating
nauseated patient
45 Use a urinal to provide the
patient with an opportunity to
urinate
46 Use a bedpan to provide the
patient with an opportunity to
defecate
47 Use sandbags to immobilize
patient's
cervical spine (neck)
48 Use a cervical collar to
immobilize patient's neck
TASK RESPONSES
PCT CF NUMBER RESP0NOING
TOTAL RESPONSE
57
POT OF TOT
FREQUENCY
TCT
ASSIST
12
34
5PFM
Z2
29
86
12
05
27
4
730927
SUPERVISION
12
3
22
5
DIFFICULTY
12
3
54
2
i
4
TRAINING
23
22
4
5
40
714
74
25
014
54
411
511
, 75
75
5
54
99
72
26
012
52
59
514
24
11
45
18
918
946
53
49
28
018
32
28
23
09
16
723
12
14
57
61
39
29
19
012
21
18
14
52
11
719
44
916
68
-32
47
16
011
16
14
14
42
12
911
45
718
67
33
57
19
512
11
23
74
44
11
18
11
16
26
37
11
89
23
16
33
418
61
72
97
937
21
19
29
533
51
49
14
919
25
37
39
52
225
912
29
418
68
32
95
12
05
21
21
52
416
77
24
21
40
33
67
12
14
33
721
32
33
25
55
16
32
12
49
28
46
14
86
16
26
37
16
26
35
30
46
90
25
44
12
OCCUPATION1
CROUP
1
TAS'(
EmERGE'vZY "EDICAL TECHNICIANS
12
1 Ea
49 Use a 3-foot spine board to
immobilize patient's spine to
transport
52 Use a 6-foot spine board to
immobilize patient's spine to
transport
51 Use nasal cannula to adthnister,
oxygen
52 use mask to administer oxygen
53 Use a traction splint to treat
a lower extremity fracture
54 Use a pneumatic (air) splint
to immobilize a closed fracture
55 use a padded board splint to
immobilize a fracture
56 use a sling to immobilize a
fractured arm or clavicle
57 Apply direct pressure to
control hemmorrhage (bleeding)
.
55 Apply digital pressu.L-e to
control hemorrhage
59
Apply tourniquet to control
hemorrhage
6Z
Apply dressing to control
hemorrhage
TASK RESPONSES
PCT OF NUMBER RESPONDING
TOTAL RESPONSE
57
PCT OF TOT
27
FREQUENCY
TCT
ASSIST
730927
SUPERVISION
DIFFICULTY
TRAINING
12
34
5PFm
12
31
23
12
31
23
4
47
23
44
23
77
12
28
30
12
3Z
32
26
40
97
21
35
12
25
23
33
35
65
11
23
26
14
21
26
26
33
47
16
28
12
718
18
25
32
67
16
11
25
416
4Z
51
14
07
26
3I
4
14
28
35
18
595
23
21
35
923
56
68
23
27
39
35
12
49
28
39
21
79
11
19
42
523
44
3e
44
49
26
37
7 -
511
33
35
16
e4
12
23
44
725
49
47
33
77
30
35
i2
27
19
33
39
61
521
30
119
32
28
28
47
14
32
9
24
25
51
19
81
11
16
46
912
54
37
37
77
28
35
11
512
39
30
14
86
12
16
46
916
56
42
40
211
28
35
14
27
14
49
28
72
716
40
512
44
28
40
27
21
33
11
e0
29
89
11
04
70
45
54
2o
416
2
516
32
33
14
e6
12
19
39
519
51
39
42
29
30
35
14
TASK RESPONSES
Poi' or NUMBER RESPONDING
OCCuPATION:
EmERCENCy r,,EOlCAL, TECHNICtANS
cRouo
1;
12
1 EC
TASK
TOTAL RESPONSE
FREQUENCY
57
TCT
pc, or TOT
27
ASSIST
730927
SUPERvISION
OrFFiCULTY
TRA!N!NG
i2
34
5PFM
23
t2
31
23
12
34
61 Apply bandage to secure
dressing to wound
12
19
35
23
11
89
14
16
46
11
18
56
60
26
211
30
37
11
62 Apply bandages to immobilize a
fracture (e.g., ribs)
49
23
42
23
17
919
42
918
46
37
37
29
28
35
9
63 Apply a sterile dressing'to
treat a burn
25
11
58
25
75
521
40
9is
44
25
49
09
25
40
5
64 Apply cold wet applications to
02
11
39
47
11
514
28
512
30
19
30
04
10
26
5.treat a burn
65 Apply vaselinc gauze or other
non- porous material to seal a
20
546
47
.53
512
26
97
32
14
28
95
18
33
9
,pneumothorax
66 Use a bulk dressing to
iLnobilize an impaled object
02
451
44
56
518
28
514
32
12
26
16
519
35
5
67 Use a constricting band to
treat a snakebite
20
2t2
84
16
05
72
49
75
22
714
2
6R Make an incision over fang
marks and suck out snake
venom
20
27
89
11
05
42
27
74
02
512
2
69 Llevate the head and shoulders
of a patient who is having
difficulty in breathing
12
28
28
21
It
89
19
14
40
523
54
60
26
09
32
33
12
7Z Use an oropharangeal airway to
maintain a patent (open) airway
214
32
37
14
84
14
14
42
921
49
37
46
09
30
35
12
71,Use an oxygen demand valve to
719
30
25
19
81
14
21
30
11
23
42
42
35
24
35
35
9:administer oxygen
72Use an oxygen demand valve to
perform intermittent positive
pressure ventilation (IPPV)
014
26
23
35
63
919
21
T23
25
21
33
77
23
25
12
TASK RESPONSES
PCT OF NUMBER RESPONDING
OCCUPATIONt
E'ERcENCy "EDICAL TECHNICIANS
TOTAL RESPONSE
57
PCT OF TOT
27
730927
CROUP
1i
12
1 EC
TASK
1
7REOUE%CT
23
45
TCT
PFM
1
ASSIST
23
SUPERVISION
12
3
DIFFICULTY
12
3i
TRAINING
23
4
73 Use an S-tube airway adjunct
to perform IPPV
05
519
67
30
49
11
27
16
12
16
24
12
23
4
74 Use an endotracheal tube to
maintain an open airway
04
514
75
23
27
12
47
10
79
70
14
95
75 Administer oxygen through
a mask
14
30
30
19
793
16
14
44
925
54
63
26
0ii
35
39
7
76 Administer oxygen through a
nasal cannula
416
18
21
40
58
711
23
018
37
33
23
05
26
32
2
tc;
77 Administer oxygen through an
oxygen catheter
44
412
77
23
29
94
712
912
02
11
18
0
Vr)
78 Administer oxygen through an
incubator system
04
521
70
30
411.
11
511.
11
16
1.:
22
21
14
0
79 Administer Flo/ger-Neilson (back
pressure- arm lift) method of re-
suscitation to ventilate patient
00
09
91
94
22
52
24
42
09
ii
0
80 Operate pressure-cycled, oxygen-
powered automatic mechanical
resuscitator to perform IPPV
44
014
79
21
47
75
57
7:2
02
9il
4
81 Operate an oxygen-powered,
manually triggered, mechanical
ventilation device
511
28
23
32
67
421
30
919
32
37
26
25
26
33
2
82 Maintain body temperature and
elevate lower extremities to
treat patient for shock
214
35
40
991
925
47
730
46
65
19
49
32
39
9
83 Treat a conscious patient who
has ingested a posion
24
560
30
70
716
39
919
35
19
40
97
25
37
5
84 Operate vehicle mounted suction
012
33
37
18
82
921
37
519
51
28
46
75
33
35
9to remove fluids from patient's
airway
TASK RESPONSES'
OCCUPATION(
EmERGE\CY r'EDICAL TECHNICIANS
GROUP
1I
12
1 EC
TASK
POT OF
TOTAL RESPONSE
FREOUENCT
12
34
NUMBER RESPoNOING
57
PCT OF TOT
27
TCT
ASSIST
5PFM
12
3
730927
SUPERVISION
DIFFICULTY
12
31
23
i
TRAINING
23
4
85 Operate portable suction unit
to remove fluids from patient's
airway
25
21
42
30
70
916
35
712
42
21
39
74
30
32
7
86 Administer patient's insulin
to treat a patient in a
diabetic coma
00
24
93
50
42
e2
42
40
05
20
87 Administer sugar or sugar
product to treat patient in
insulin shock
00
533
61
39
A11
21
711
16
18
19
20
19
21
4
88 Use cold applications to lower
patient's body temperature
02
426
68
32
414
11
47
16
12
18
02
14
16
2
w t
89 use warm water (100-105 F) to
treat frostbite
20
211
88
12
47
24
07
49
00
911
0
NI
4D92 Use a flashlight to examine
the pupillary reaction of a
patient
526
25
26
18
02
11
16
37
410
53
56
23
27
26
42
7
91 Use cold pack to treat injury
to soft tissue
29
11
28
46
49
516
19
49
32
30
18
07
21
23
2
92 maintain drainage tubing without
suction (e.g., urinary catheter)
02
912
74
'23
27
40
412
14
70
212
92
93 Perform an emergency childbirth
delivery
00
246
51
47
412
26
412
25
725
14
425
23
6
94 Place deceased patient in a
disaster pouch
02
926
61
37
911
21
09
19
23
74
216
12
9
91 Place deceased patient in
a shroud
02
723
67
32
011
18
05
23
18
11
42
16
12
5
96 Use restraint straps to control
a combative patient
22
16
56
25
74
921
39
11
28
28
11
35
26
435
26
12
OCCURATIGNI
EmERGEN:Cm MEDICAL TECUNICIANS
GROUP
1;
12
1 E0
TASK
TASK RESPONSES
Po, or NUMBER RESPONDING
TOTAL RESPONSE
57
PCT or ToT
27
FR7GUE',,CY
TCT
ASSIST
12
34
5PFM
12
3
7.70927
SUPERVISION
DIFFICULTY
12
31
23
1
TRAINING
23
4
97 Use a geigcr counter to detect
radiation level
00
22
95
40
02
00
20
20
02
50
98 Operate a hydraulic lift
05
40
89
90
25
02
23
40
07
50
(toyer) to move patient
99 Perform cardiopulmonary resus-
citation (CPR) without the use
of life-support equipment
00
25
49
23
74
716
46
719
40
12
40
19
525
37
9-
100.Perform CPR with the use of
04
25
46
23
'74
5'14
49
11
16
39
16
39
18
428
37
97ife-support equipment
t
e..)
I-.
101 Operate a bag-valve mask unit
to perform intermittent positive
pressure ventilation (IPPV)
102 Use a bag-valve mask unit to
perform IPPV
0 2
7 5
23
14
42
30
26
47
72
'51
4 5
18
11
42
25
7 9
18
11
42
25
18
12
49
32
4 5
2 2
23
23
42
30
7 4
103 Perform mouth-to-mouth method
of IPPV
00
944
46
.53
512
23
512
30
12
32
50
23
26
5
104 Perform mouth-to-nose method
of IPPV
00
232
65
33
45
/8
55
19
719
22
16
19
2
105 Use a sphygmomanometer and
stethoscope to obtain a patient's
blood pressure
14
19
32
18
16
82
518
40
416
58
54
25
22
28
47
5
106 Place fingers on patient's
wrist to count radial pulse
16
30
33
11
9e9
418
47
518
56
61
25
24
32
40
9
107 Assemble intravenous fluid
administration equipment
22
518
72
26
77
77
it
511
12
20
719
4
108 Perform a venipuncture to
administer intravenous fluids
04
24
89
92
50
05
22
70
04
11
0
OCCUPATION/
ORCuP
1
TASK
EmERGENCY
TECHNICIANS
12
1 E:
109 Use a syringe toadminister
intravenous medications into
the I.V. tubing
112 Use 1 syringe to
administer
intravenous medications
111 Use a syringe to
administer
intramuscular medications
112 Operate a defibrillator to
administer empirical defib-
rillation
113 Operate an electrocardiograph
scope and recorder to
observe
wpatient's cardiac activity
1
K., N
114 Operate one -way electrocar-
diograph telemetry system to
transmit (EKG or ECG)
115 operate a two-way voice
communication radio
116
!Answer telephone to receive
requests for ambulance
service
117
Perform minor mechanical
maintenance on emergency
medical equipment
118
Perform building maintenance
on physical facility
119 Replace oxygen tank in vehicle
12Z
Refill oxygen tanks with
.compressed oxygen
TASK RESPONSES
PCT OF NUMBER RESPONDING
TOTAL RESPONSE
57
POT OF TOT
FREQUENCY
TCT
ASSIST
12
34
5PFH
12
3
24
24
89
92
50
04
00
95
40
20
02
00
98
20
20
02
39
82
16
54
5
47
14
12
61
37
516
9
27
11
11
65
30
11
it
53
23
18
42
96
912
53
16
26
25
14
18
el
11
14
35
916
18
21
33
63
514
32
12
11
11
12
53
46
211
26
212
28
37
19
79
12
14
44
25
79
74
23
40
14
27
730927
SUPERVISION
DIFFICULTY
12
31
23
24
22
70
00
22
20
02
20
0
47
42
12
2
514
14
12
21
2
99
11
721
2
518
67
79
12
2
416
54
60
16
2
223
28
33
25
0
016
25
35
52
423
47
63
14
0
25
14
19
20
1
0 0 0 0 2 0 7 9
ii
11 4 0
TRAINING
23
411
27
25
514
925
721
42
21
30
16
19
5
14
5
33
14
12
4
4
0 0 0 0 4 4
23
23
23
14
26 7
OCCUPATICNI
GROUP
1
TASK
TASK RESPONSES
PCT CF NUMBER RESPONDING
EmERGE'Cy vEGICAL TECHNICIANS
TOTAL RESPONSE
57
PCT OF TOT
27
730927
12
1Ec.
121 Extricate an entrapped patient
122 Direct traffic at scene of
accident
123 Use highway flares to
control
traffic at accident scene
124
Use portable floodlights to
illuminate work area
125
Instruct pi!,tient's family how
to care for patient at hone
1.)
126
Evaluate quality of training
program
127
Conduct on - -the -job training
sessions
FREOUENCY
TV'
ASSIST
SUPERVISION
DIFFICULTY
TRAINING
12
34
5PVM
12
31
23
12
31
23
4
02
26
49
19
77
523
44
11
26
33
12
40
23
932
26
9
02
925
60
35
57
16
211
19
21
11
25
12
79
05
14
30
47
49
49
23
211
30
32
95
919
414
24
14
40
37
60
512
28
218
33
39
14
211
25
911
0..-,
511
79
18
45
20
49
11
5g
44
11
2
05
416
70
25
914
90
14
74
14
72
95
9
47
19
11
56
40
516
14
512
18
14
19
57
11
912
128
Conduct formal classes to in-
09
14
12
61
35
412
12
47
19
16
16
22
11
18
4struct individuals in emergency
medical care techniques
129
Urc an orthopedic stretcher
516
25
33
18
79
11
16
46
726
39
39
33
24
37
32
5to transport a patient
132
Use a variable position stretcher
18
26
12
11
86
919
49
726
46
51
26
27
37
28
11
to transport a patient
131
Use a stretcher composed of
.1
714
25
40
56
519
26
521
25
33
21
g2
28
23
5rubberized canvas on an aluminum
frame to transport a patient
132, Use rubberized stretcher to
00
730
61
37
211
18
014
18
19
12
44
21
II
5suspend a patient from the
ceiling of an ambulance
CCCUPATICN:
C.Ptn:P
1
TASK
EmE9cENCy -E0ICAL TECHNICIANS
12
1 EC
133
Use a chair stretcher to
transport a patient
134
Use a chair to transport
a patient
135
Use a wheelchair to transport
a patient
135
Drive an emergency medical
vehicle to transport a patient
under non-emergency conditions
137
Drive an emergency medical
vehicle to transport a patient
cf
using emergency warning devices
1
138
Operate a fire control device
(fire extinguisher) to
extinguish a fire
139
Use a watercraft to transport
a patient
142
Use a fixed wing aircraft
(airplane) to transport
a patient
141
Use a rotary wing aircraft
(helicopter) to transport
a patient
TASK RESPONSES
PCT OF NUMBER RESP0NOING
TOTAL RESPONSE
57
PCT OF TOT
27
FREQUENCY
TOT
ASSIST
23
45
PFM
12
3
730927
SUPERVISION
DIFFICULTY
12
31
23
1
TRAINING
23
4
11
528
35
19
79
.9
18
46
525
42
44
32
25
30
25
14
25
21
39
30
67
712
39
523
30
37
25
05
25
23
14
40
723
63
33
27
18
222
18
19
12
n7
11
16
9
20
12
21
11
26
70
714
26
721
35
40
26
09
30
18
14
25
18
26
721
75
912
30
11
19
37
32
37
211
28
19
14
07
11
30
51
47
77
23
714
18
30
14
09
16
12
11
00
24
93
50
42
22
44
28
04
42
00
24
93
50
22
20
42
20
04
00
00
24
93
50
24
02
42
40
03
00
TOTAL RESPONSES
PCT OF NUMBER RESPONDING
ATTENDANTS
TASK RESPONSES
tCCUDATIONI
ATTENDANTS
CRCUP
2t
46
TOTAL
PCT OF NUMaER RESPONDING
RESPONSE 125
PCT OF TOT
60
730927
TASK
FREQUENCY
TCT
ASSIST
SUPERVISION
DIFFICULTY
TRAINING
12
34
5PFM
12
31
23
12
31
23
4
1 Set standard type and quantity
of emergency medical equipment
needed for unit operation.
814
16
14
43
54
14
4Z.1
828
830
22
016
16
15
11
2Inventory type and quantity of
6emergency medical equipment to
14
20
20
35
et
12
10
31
727
18
38
18
013
24
816
determine need for replacement,etc.
3 Place emergency medical equipment
in assigned location
13
24
30
15
15
82
16
14
46
12
33
29
54
23
013
34
10
22
4r. ,,;t standard type and quantity
of emergency medical supplies
needed for unit operation
66
14
14
51
41
13
520
10
18
620
15
16
18
10
11
d 1
5Inventory type and quartity of
emergency medical surY-1.
determine need for ir!:pply
515
17
21
38
58
14
929
926
12
30
20
26
26
10
15
N o6
Place emergency medical supplies
in assigned location
12
25
26
18
14
02
18
10
46
832
27
61
13
015
32
626
7Set standard type and quantity
of drugs and intravenous (I.V.)
fluids needed for unit operation
21
22
88
71
16
32
2I
61
24
44
8Inventory type and quantity of
drugs and I.V. fluids to determine
need for resupply or new supplies
23
41
86
10
12
75
22
26
02
63
3
9Place drugs and I.V. fluids in
assigned location
22
64
82
14
50
93
65
95
02
64
6
17 Set standard type and amount of
office supplies needed for
unit operation
42
56
78
18
63
63
75
88
P.
66
26
11
Inventory type and amount of
office supplies to determine
need for resupply or new supplies
34
47
80
18
92
42
75
10
60
47
25
12
Piece office supplies in
assigned location
24
610
76
22
10
27
29
715
60
59
29
CCSuPATtCN:
Cu
f:RP
21
TASK
ATTENDANTS
4
13 Design emergency
medical
equipment such as a special
splint
or vehicle floor plan
14
Examine physical facilities to
determine need for expansion
or construction
Prepare budget for operation
of unit
16 Assign crew and vehicle to res-
pond to ambulance call based
upon the nature of the call
17 Survey type and quantity of
emergency medical equipment
available for purchase
18 Maintain personnel records
19 Prepare payroll for unit
employees
2? Prepare financial report
of
unit operation
21 Examine record of
service to
patient to bill patient
for service
22 Maintain accounting records
23 Maintain records of patients
serviced
2A Operate a typewrite,'
TASK RESPONSES
PCT OF `UMBER RESPOVING
TOTAL RESPONSE 125
PCT OF ToT
p0
-730927
FREovENCY
TCT
ASSIST
SuPERv:SroN
DIFFICULTY
TRAINING
12
34
5PFM
12
31
23
12
31
23
4
10
216
77
19
62
86
73
311
34
72
6
01
014
81
14
52
72
62
28
24
42
6
10
18
87
10
42
23
22
13
45
31
3
42
12
14
67
21
76
13
212
13
15
10
32
13
612
01
121
73
22
82
76
63
77
24
22
10
21
39
82
13
42
42
43
64
02
62
5
00
10
94
ie
00
02
20
08
71
21
01
12
92
4d
20
i2
22
01
82
-2
3
11
22
91
61
12
22
23
21
05
22
00
10
94
10
00
00
00
00
12
10
66
63
70
26
66
10
59
10
17
60
512
66
41
610
75
22
62
5i
413
15
21
12
25
6
DCCUPAT:CNO
ATTENDANTS
CROUP
2I
TA
SK
46 EC
37 Administer test to determine
if applicant meets standards
for employment
38 Evaluate unit personnel to
determine progress, raises,
discipline and promotion
39 determine staff required to
operate unit effectively in any
specific time period
47 Lxplain general hospital
procedures to patient or family
41 Inform patient's family of
patient's general condition
Inform patient's attending
42 physician of patient's death
Inform Coroner's office of
43 patient's death
Use an emisis basin in treating
44 nauseated patient
Use a urinal to provide the
45 patient with an opportunity to
urinate
Use a bedpan to provide the
46 patient with an opportunity to
defecate
Use sandbags to immobilize
47 patient's
cervical spine (neck)
Use a cervical collar to
45 immobilize patient's neck
TASK RESPONSES
PCT OF NUM8ER RESPONDING
TOTAL RESPONSE :25
PCT OF TOT
FREQUENCY
TCT
ASSIST
12
34
5PFM
12
62
3
730927
SUPERVISION
DIFFICULTY
12
31
23
1
TRAINING
23
4
01
16
89
80
52
22
22
51
21
51
00
25
92
61
12
22
10
22
23
20
11
17
87
10
22
31
42
25
02
32
..
..,
74
13
10
64
34
37
18
114
18
15
17
18
10
414
46
816
64
34
75
16
211
21
11
18
47
10
514
14
210
81
17
32
70
67
38
22
66
5
32
214
78
II
42
10
25
87
72
46
56
36
19
44
25
73
17
12
29
014
53
45
18
6li
32
15
18
13
528
62
37
10
10
12
26
25
21
93
614
98
03
218
75
24
84
91
614
11
63
78
86
21
11
40
45
54
14
16
20
818
23
16
31
415
14
20
9
23
10
49
34
65
11
25
23
922
26
16
38
716
19
27
9
TASK RESPONSES
CCCUPATI!:N:
ATTENDANTS
CFO',;?
21
46 ED
PCT OF
TOTAL RESPONSE
NUMSER RESPONDING
125
PCT OF TOT
62
730927
TAS"(
FREOUENCY
TCT
ASSIST
SUPERVISION
DIFFICULTY
TRAINING
12
34
5PFM
12
31
23
12
3,
12
34
25maintain records of maintenance
performed on emergency medical
equipment
24
66
78
18
.6
27
47
39
60
312
22
25Complete information required
by special form to report
accident
46
15
12
61
37
87
14
30
17
22
90
415
211
27Complete information required
by special form to report
ambulance trip
18
19
26
16
19
79
12
16
35
828
34
54
18
112
33
12
15
28Co1plete information required
by special forms other than
those listed above
24
86
76
20
72
63
85
10
62
49
42
29 Exlmine record of service to
patient to determine charges
to patient
22
32
92
71
12
03
22
22
25
2i
Ts.)
37Record analysis of ambulance
trips to determine such things
as type of service provided, .,!tc.
83
46
76
21
39
61
11
510
80
2li
26
31Create and maintain on-call
roster of staff required to
operate unit
21
64
85
12
22
32
64
47
1i
10
25
32Conduct meetings wit', hospital
representative(s) to coordinate
emergency medical services
01
28
86
11
22
52
52
43
25
42
3
33 Conduct meetings with
unit personnel
12
923
65
14
89
11
414
917
18
16
11
57
34 Develop policies or procedures
to provide guidelines for daily
operation of the unit
23
414
76
22
92
72
11
52
13
22
94
6
35 Develop and on-the-job training
program
13
610
76
'20
75
65
94
311
24
65
6
36Conduct interview to determine
01
13
92
51
21
21
12
22
22
2/
it applicant meets standards
for employment
CCOUPATIONt
ATTENDANTS
GROUP
21
46
U.;
TASK
149
Use a 3-foot spine board to
immobilize patient's spine to
transport
57
Use a 6-foot spine board to
immobilize patient's spine to
transport
51
Use nasal cannula to administer
omy,jen
52
Use mask to administer oxygen
53
Use a traction splint to treat
a lower extremity fracture
co otv
54
Use a pneumatic (air) splint
to immobilize a closed fracture
55
Use a padded board splint to
immobilize a fracture
56
Use a sling to immobilize a
fractured arm or clavicle
57
Apply direct pressure to
control hemorrhage (bleeding)
53
Apply digital pressure to
control hemorrhage
59
Apply tourniquet to control
hemorrhage
62
Apply dressing to control
hemorrhage
TASK RESPO'NEES
PCT OF NUMBER RESPONDING
TOTAL RESPONSE 125
PCT or TOT
60
732927
FREQUENCY
TCT
ASSIST
SUPERVISION
DIFFICULTY
TRAINING
12
34
5PrM
12
31
23
12
31
23
4
22
10
44
40
59
13
22
22
11
22
21
1Z
35
918
16
24
10
12
734
54
43
10
14
14
9i5
16
827
514
11
20
6
56
10
28
48
50
11
10
18
318
24
35
12
113
16
22
4
10
14
32
34
990
22
22
32
10
32
42
63
23
722
31
26
7
22
15
24
52
42
813
18
218
19
13
28
7i6
17
20
4
35
28
43
19
-79
16
26
34
929
37
39
36
222
23
27
7 --
22
930
54
43
12
17
14
321
16
17
22
219
12
20
2
21
12
42
40
-58
11
17
22
322
31
23
26
222
18
22
2
65
23
44
21
78
16
18
34
723
42
34
37
324
20
26
9
22
10
38
45
51
10
14
22
613
29
21
25
321
10
22
5
20
07
90
71
13
01
31
30
it
210
1
55
24
42
24
75
18
18
28
623
40
34
34
123
17
30
10
TASK RESPONSES
PCT OF NUMBER RESPONDING
CCCUFAT:ONI
ATTENDANTS
CROUP
2;
46 E.7
TOTAL RESPONSE
125
PCT OF TOT
60
730927
TASK
FREQUENCY
TOT
ASSIST
SUPERVISION
DIFFICULTY
TRAINING
23
45
PFM
12
31
23
12
31
23
4
61
Apply bandage to secure
dresing to wound
76
31
41
14
85
Is
23
31
733
38
49
33
1.
25
23
26
10
62'Apply bandages to immobilize a
fracture (e.g., ribs)
12
14
42
19
58
14
14
26
718
32
26
29
223
12
26
3
63
Apply a sterile dressing to
treat a burn
21
749
39
59
722
23
718
32
17
39
223
14
26
5
64
Apply cold wet applications to
treat a burn
02
533
59
39
814
14
414
18
17
21
118
11
19
2
65
Apply vasoline gauze or other
non-porous material to seal a
pneumothorax
10
214
82
16
35
62
210
2It
2i3
515
2
LJ
66 Use a bulk dressing to
10
220
76
22
29
82
514
214
4i2
620
1
immobilize an impaled object
67
use a constricting band to
treat a snakebite
10
16
90
71
32
13
22
42
12
313
0
68
::ake an incision over fang
marks and suck out snake
venom
10
12
94
41
21
10
21
310
210
0
69
Elevate the head and shoulders
of a patient who is having
difficulty in breathing
713
27
34
18
11
21
19
27
626
41
46
30
121
25
22
11
72
Use an oropharangcal airway to
maintain a patent (open) airway
12
20
38
35
62
14
18
18
818
31
20
34
522
16
23
9
71
Use an oxygen demand valve to
administer oxygen
05
19
33
35
62
15
17
18
621
31
34
26
218
18
24
6
72
use an oxygen demand valve to
23
12
23
54
41
614
14
313
20
16
20
314
11
16
6
perform intermittent positive
pressure ventilation (IPPV)
OCCUPATICNI
ATTENDANTS
CPCUP
2 ;
46 C!:
TASK 73
Use an S-tube airway adjunct
to perform IPPV
74 :Use an endotracheal tube to
maintain an open airway
75 Administer oxygen through
a mask
76 Administer oxygen through a
nasal cannula
77
Administer oxygen through an
oxygen catheter
wAdminister oxygen through an
incubator system
79 Administer nolger-Neilson (back
pressure-arm lift) method of re-
suscitation to ventilate patient
82
Operate pressure-cycled, oxygen-
powered automatic mechanical
resuscitator to perform IPPV
81
operate an oxygen-powered,
manually triggered, mechanical
ventilation device
82
naintain body temperature and
elevate lower extremities to
treat patient for shock
83
Treat a conscious patient who
has ingested a posion
84
operate vehicle mounted suction
to remove fluids from patient's
airway
TASK RESPONSES
PCT OF NUMBER RESPONDING
TOTAL PESPCNSE 125
PCT OF TOT
62
FREQUENCY
TCT
ASSIST
730927
suPEPvtsroN
DIFFICULTY
TRAINING
12
34
5PFM
12
31
23
12
31
23
4
20
517
74
23
58
52
710
615
013
813
2
00
27
87
92
42
12
62
62
46
50
10
10
30
39
10
88
'24
16
30
930
43
53
33
924
29
27
6
36
10
22
54
41
99
13
211
23
25
15
910
14
20
2
12
26
86
10
16
21
53
36
16
210
0
00
111
85
12
33
42
53
65
11
76
2
20
05
92
52
11
21
10
22
76
91
21
218
74
22
58
44
612
611
29
810
2
52
10
18
62
35
512
13
413
18
18
16
17
13
18
2
43
26
47
19
00
i4
23
33
10
30
37
45
31
2 ,.
18
28
27
8
11 .
433
59
38
610
16
612
19
10
26
216
15
20
2
23
15
37
42
55
11
17
18
714
30
14
:4
5i6
22
22
6
CCCUPATI,';%;
CRCUP
2;
TASK
ATTENDANTS
46
85 Operate portable suction unit
to remove fluids from patient's
airway
" Administer patient's insulin
to treat a patient in a
diabetic coma
87 Ac:minister sugar or sugar
product to treat patient in
insulin shock
85 Use cold applications to lower
patient's body temperature
89 Use warm water (100-105 F) to
treat frostbite
93 Use a flashlight to examine
the pupillary reaction of a
patient
91 Use cold pack to treat injury
to soft tissue
92 Maintain drainage tubing without
suction (e.g., urinary catheter)
93 Perform an emergency childbirth
delivery
94 Place deceased patient in a
disaster pouch
95 Place deceased patient in
a shroud
96 Use restraint straps to control
a combative patient
TOTAL
TASK RESPONSES
PCT OF NUMBER RESRONOINC
RESPONSE 125
PCT CF TOT
60
730927
FREOQENCY
TcT
ASSIST
SUPERVISION
DIFFICULTY
TRAINING
12
34
5PFM
12
31
23
12
31
23
4
12
937
5Z
49
715
19
611
26
12
30
513
19
21
5
00
i4
93
5i
22
01
2o
40
32
31
10
320
74
24
69
73
910
10
13
08
11
12
4
10
218
78
21
49
42
611
910
012
10
14
2
00
17
90
82
31
12
52
50
93
12
0
47
17
38
33
66
14
13
23
616
40
43
20
1i6
22
26
5
12
736
50
46
911
18
312
32.!
31
14
713
18
18
3
01
37
85
11
i4
20
28
65
72
58
2
00
120
76
21
68
66
411
210
17
17
14
16
2
01
227
67
30
68
13
213
13
11
13
37
11
89
01
216
78
18
27
91
99
79
26
77
6
10
750
40
58
12
27
23
11
22
23
626
26
14
27
18
10
ACCUPATIQN1
ATTENDANTS
CROJP
2;
46 r:
TASK 97 Use a geiger counter to detect
radiation level
92 Operate a hydraulic lift
(Uoyer) to move patient
99 Perform cardiopulmonary resus-
citation (CPR) without the use
of life-support equipment
107 Perform CPR with the use of
life - support equipment
101 Operate a bag-valve mask unit
to perform intermittent positive
pressure ventilation (IPPV)
t w w:02 Use a bag-valve mask unit to
perform IPPV
103 Perform mouth-to-mouth method
of IPPV
104 Perform mouth-to-nose method
of IPPV
125 Use a sphygmomanometer and
stethoscope to obtain a patient's
blood pressure
106 Place fingers on patient's
wrist to count radial pulse
107 Assemble intravenous fluid
administration equipment
lee Perform a venipuncturc to
administer intravenous fluids
TASK RESPONSES
PCT OF NUMBER RESPONOING
TOTAL RESPONSE 125
PCT OF TOT
FREQUENCY
TCT
ASSIST
12
34
5PFM
12
67
3
730927
SUPFRvIS/ON
12
3
DIFFICULTY
12
31
TRAINING
23
4
00
12
94
30
11
00
21
11
22
51
20
22
94
30
03
02
10
21
23
51
01
10
44
42
55
918
26
818
28
534
15
14
21
24
3
21
10
39
44
;2
814
27
10
13
28
729
15
13
21
25
4
02
10
37
48
49
613
23
518
25
12
33
313
19
23
2
12
610
78
18
32
10
36
75
12
16
10
13
2
10
534
57
40
417
17
411
23
10
23
516
17
18
2
10
111
83
13
12
82
27
29
g10
811
2
49
22
26
36
di
614
25
214
42
34
22
314
21
26
4
619
24
35
14
84
923
29
621
49
52
27
323
26
27
7
20
29
86
10
51
22
53
65
03
34
2
01
02
94
21
11
01
22
17
21
21
TASK RESPONSES
PCT OF ttiUmBER RESPCNOINC
r:CC;JAII:N!
ATTENDANTS
:',RCU'
2s
46
TASK
TCTAL RESPOSE
PREOJEN:CY
23
4
125
5
PCT
TCT
PFM
CF TOT
ASSIST
12
60
3
732927
SUPERVISION
12
3
DIFFICULTY
12
3
TRAINING
12
34
129 Use a syringe to administer
intravenous medications into
the I.V. tubing
00
02
94
21
10
21.
11
1e
21
2
IV' Use a syringe to administer
intravenous medications
00
01
95
10
10
02
11
02
21
20
111 Use a syringe to administer
intramuscular medications
00
01
97
10
02
P0
02
07
20
20
112 Operate a defibrillator to
administer empirical defib-
rillation
00
14
93
52
02
22
i1
31
21
31
t:C
113 Operate an electrocardiograph
scope and recorder to observe
patient's cardiac activity
03
83
83
14
34
62
66
69
02
47
2
cA)
114 Operate one-way electrocar-
diograph telemetry system to
transmit (EKG or ECG)
01
54
87
10
22
53
33
27
12
26
2
115 Operate a two-way voice
communication radio
24
18
30
21
6;4
10
15
46
419
62
75
12
221
36
12
19
116 Answer telephone to receive
requests for ambulance service
712
22
30
26
71
le
14
30
415
45
52
14
216
26
618
117Perform minor mechanical
maintenance on emergency
medi-_-al equipment
511
23
52
44
912
16
315
21
22
18
212
14
610
lIPPerform building maintenance
on physical facility
56
619
60
37
a10
17
211
19
24
72
17
14
27
119Replace oxygen tank in vehicle
36
17
43
29
70
10
17
32
619
42
54
13
017
28
10
17
'IVrtefill oxygen tanks with
32
614
71
26
46
11
54
16
21
47
614
55
compressed oxygen
TASK RESPONSES
PCT OF NU'd8ER RESPONCING
CCCUPA'ION:
ATTENDANTS
TOTAL RESPONSE 125
PCT OF TOT
62
732927
G9CUP
2:
46
r::
TAsx
FREQUENCY
TCT
ASS/ST
SUPERVISION
D/PFI:ULTY
TRAINING
12
34
5PFM
12
31
23
12
31
23
4
Extricate an entrappea patient
121
01
1'ii
52
34
62
11
15
31
13
25
18
338
18
26
26
16
7
Direct traffic at scene of
122
22
630
58
37
12
613
118
15
16
19
011
14
410
accident
Use highway flares to control
123
11
13
32
50
46
812
1traffic at accident scene
81
18
23
26
14
214
21
310
Use portable floodlights to
124
12
11
38
45
52
917
22
225
22
32
16
117
22
610
illuminate work area
Instruct patient's family how
123
2I
28
86
10
23
22
44
44
32
51
to care for patient a'. hone
ea ,
4.4
Evaluate quality of training
cp
00
210
82
:3
26
42
73
29
26
62
2lycoram
Conduct on-the-job training
127
22
616
70
26
510
65
11
9to
15
112
74
3sessions
Conduct formal classes to in-
129
12
618
72
26
413
62
12
11
716
112
60
0struct individuals in emergency
medical care techniques
129
Use an orthopedic stretcher
26
18
45
26
71
13
19
34
627
34
30
36
218
25
24
3to transport a patient
Use a variable position stretcher 12
11
26
30
18
78
14
22
36
629
38
46
25
220
30
17
9to transport a patient
131
Use
stretcher composed c.J!
62
10
28
50
46
613
23
220
22
24
21
g17
24
14
5rubberized canvas on an aluminur
frame to transport a patient
.32 Use
rubberized stretcher to
1Z
126
69
28
412
10
211
13
10
14
26
18
55
suspend a patient from the
ceiling of an ambulance
:CCUPAT/CN1
ATTENDANTS
t;q(!U
23
46 r;
TASK
CT
%
33 Use a chair stretcher to
transport a patient
134
Use a chair to transport
a patient
135
Use a wheelchair to transport
a patient
136
Drive an emergency medical
vehicle to transport a patient
under non-emergency conditions
137
Drive an emergency medical
vehicle to transport a patient
using emergency warning devices
138
Operate a fire control device
(fire extinguisher) to
e:-:tinguish a fire
30 Use a watercraft to transport
a patient
14Z Use a fix*I.d wing aircraft
(airplane) to transport
a patient
141 Use a rotary wing aircraft
(helicopter) to transport
a patient
TASK RESPONSES
PCT OF Nu4BEP RESPONDING
TOTAL PESPCNSE 125
PCT of TOT
FREQUENCY
Tor
ASSIST
23
45
pFm
12
62
3
730927
SUPERv!SION
12
3
DIFFICULTY
12
31
TRAINING
23
4
45
11
46
31
66
12
18
31
627
30
32
33
216
32
14
7
02
11
31
52
44
410
26
217
19
19
19
210
22
11
8
22
322
70
26
17
11
26
16
15
9g
11
10
84
96
16
17
49
48
312
18
214
29
31
15
fy
12
22
10
10
96
18
16
47
47
49
2V)
214
30
24
21
212
18
10
10
05
935
47
49
714
16
618
21
29
17
a17
14
911
21
21
94
3P.
02
0i
22
11
41
31
00
10
96
12
21
00
12
10
21
00
20
11
96
22
02
01
1c
20
22
00
TOTAL RESPONSES
PCT OF NUMBER RESPONDING
PAID PERSONNEL
(FULL- AND PART-TIME)
TCCUPAT:CN:
PAIT pi-PSO":EL(rULL/PART)
CROJP
11
72
3
TAS
TASK
PCT Or NU
TOTAL RESPONSE
63
FREOJE%0Y
12
34
5
RESPONSES
ER RESPONDING
PCT OF TOT
32
TcT
ASSIST
pcm
12
3
732927
SUPERVISION
OIFrICULTY
12
31
23
1
TRAINING
23
4
.met standard type and quantity
of emergency medical equipment
needed for unit operation.
625
31
43
56
11
14
24
522
21
25
25
15
22
1'
11
?Inventory type and quantity of
emergency medical equipment to
determine need for replaccment,etc.
11
19
24
22
21
7S
17
19
32
825
33
43
29
111
33
11
19
:!Place emergency medical equipment
in assigned location
27
17
13
14
27'
71
11
16
40
11
17
35
48
21
76
37
11
17
.Set standard type and quantity
of emergency medical supplies
needed for unit operation
11
11
511
56
41
617
11
811
16
21
17
V5
14
11
13
Inventory type and quantity of
emergency medical supplies to
detervIne need for resupply
sPlacc emergency medical supplies
in assigned location
29
22
21
14
11
24
11
.72
27
t8
71
16
13
14
16
27
37
6
12
27
24
25
27
44
51
16
16
1 2
6 8
24
32
14 8
17
19
7Set standard type and quantity
of drugs and intravenous (I.V.)
fluids needed for unit operation
52
32
86
11
32
52
33
55
7a
58
2
Inventory type and quantity of
drugs and I.V. fluids to determine
need for retupply or new supplies
29
65
73
22
2B
10
83
68
12
08
83
'?Place drugs and I.V. fluids in
assigned location
53
11
872
27
12
511
612
817
82
210
88
17Set standard type and amount of
office supplies needed for
unit operation
65
510
71
25
58
53
511
14
88
310
11 Inventory type and amount of
office supplies to determine
need for resupply or new supplies
65
11
868
37
89
63
12
12
21
80
611
313
12 Place office supplies in
assigned location
65
12
10
68
30
85
13
38
11
25
30
310
513
CCOUr"C"CNI
PAt'
PEPSO'NEL(FULL/PART)
CR'.JD
11
72 CP
3
TASK
TASK RESPONSES
PCT OF NUMeEC RESPONDING
TOTAL RESPONSE
63
PCT OP TOT
30
FREQUENCY
TCT
ASSIST
12
34
5PFM
12
3
730927
SUPERVISION
DIFFICULTY
12
31
23
1
TRAINING
23
4
13'Design amergency nedical
equipment such as a special
splint
or vehicle floor plan
22
224
71
25
85
86
C5
613
52
11
.3
11
14 Examine physical facilities to
dete=ine need for expansion
or construction
20
014
81
16
35
62
28
55
32
50
10
15 Prepare budget for operation
of unit
22
214
03
14
53
23
35
35
58
20
5
16 An:;ign crew and vehicle to res-
pond to ambulance call based
upon the nature of the call
24
616
548
51
11
13
13
316
22
21
24
03
17
817
17 :survey type and quantity of
emergency medical equipment
available for purchase
03
514
73
22
68
50
88
10
83
26
013
15 M,:!intain personnel records
55
210
75
21
28
53
310
12
10
03
62
10
19 Prepare payroll for unit
employees
22
52
89
82
50
22
83
31
23
03
Prepare financial report of
unit operation
20
312
84
13
25
22
36
36
32
52
6
21 :xdmine record of service to
patient to bill patient
for service
12
36
575
24
55
83
313
14
80
513
23
22 Maintain accounting records
22
62
86
10
33
00
25
25
i3
30
2
23 Maintain records of patients
serviced
17
13
52
59
35
311
13
56
21
22
11
03
16
68
24 Operate a typewriter
10
30
875
21
32
80
313
14
50
10
02
10
DCCAYICA:
PAID Pz:Pso,.%EL(FULL/PART)
CPC:;'
1:
72
C-,
3
TASI
TASK RESPONSES
PCT Or NUYEIER RESPONGING
TD74L RESPONSE
A3
PCT Dr TOT
FR70::ENCT
1-CT
ASSIST
23
45
Pim
12
32
3
732927
SUPERVISION
12
3
DIFFICULTY
12
3i
TRAINING
23
4
z'maintain records of maintenance.
performed on emergency medical
equipment
66
811
63
32
312
13
513
13
13
16
02
17
56
2f" Com:dete information required
bv necial form to report
-
accident
612
6:4
62
37
511
10
314
to
11
22
02
13
li
13
27 Com7:1ete information required
by special form to report
ambulance trip
43
24
10
224
75
11
11
33
829
33
40
32
05
37
16
14
V corTlete information required
13
13
512
52
40
66
17
313
19
22
11
2'
617
66
In, special forms other than
those listed above
17:f
2' 1:Namine record of service to
patient to determine charges
to patient
10
56
276
22
63
52
511
14
30
36
28
,...,
v:,
3" '- record analysis of ambulance
17
63
865
35
616
10
017
11
13
21
03
16
310
trips to determine such things
as ty!,)e of service provided, etc.
31 Create and maintain on-call
ro:7ter of staff required to
operate unit
810
10
565
32
313
62
12
14
13
13
12
14
510-
32 Conduct meetings with hospital
reprezentative(s) to coordinate
emergency medical services
22
216
79
19
32
53
53
310
13
33
5
33 Conduct meetings with
unit personnel
25
24
14
52
44
014
19
316
21
22
17
15
10
817
34 ::evelop policies or procedures
to provide guidelines for daily
operation of the unit
213
35
73
22
211
63
68
813
03
85
5
35 Develop and on-the-job training
program
210
611
72
29
516
55
17
65
14
53
66
12 -
.,. Conduct interview to determine
if applicant meets standards
for employment
02
68
83
16
717
72
25
85
32
30
8
Vs:.%ATICsNT
°Ni; PcPS'NEL(F:2t.L/DART)
;R%'
:7
2J
3
TASK 37Administcr test to determine
if applicant meets standards
for employment
vtvaluate unit personnel to
de!Lermine progress, raises,
discipline and promotion
31, Determine staff required to
operate unit effectively in any
specific time period
4;* Explain general hospital
procedures to patient or family
4: Inform patient's family of
patient's general condition
47 Inform patient's attending
physician of patient's death
43 Inform Coroner's office of
patient's death
44 Use an crisis basin in treating
nauseated patient
45 Use a urinal to provide the
patient with an opportunity to
urinate
46 Use a bedpan to provide the
patient with an opportunity to
defecate
47 Use sandbags to immobilize
patient's
cervical spine (neck)
49 Use a cervical collar to
immobilize patient's neck
TASK PESpONSES
per CF NUMBER RESPONDING
Tc7AL RESPO%SE
63
PCT or TOT
30
rREOUE%CY
TCT
ASSIST
12
34
5Prm
12
3
730927
SUPERVISION
DIrrICULTy
12
31
23
1
TRAINING
23
4
22
212
86
13
.0
62
22
55
31
20
53
32
513
78
21
013
32
38
510
35
33
5
,5
36
675
24
08
32
312
811
03
62
8
17
516
11
49
49
66
19
013
32
32
13
15
88
25
11
11
310
63
35
26
17
08
24
14
16
32
10
614
52
822
62
37
23
24
010
24
13
17
6-c!
17
611
65
12
21
57
41
35
25
610
21
24
13
50
13
10
16
11
14
17
33
21
76
16
10
35
313
56
63
le
28
27
16
24
35
527
59
40
11
516
22
32
29
80
019
810
25
216
75
24
62
12
02
16
16
6P
213
85
53
14
41
35
63
11
11
33
817
32
27
32
35
19
22
14
36
17
52
19
79
13
25
33
13
22
37
22
48
85
24
32
16
TASK RESPONSES
CCCJ'"A'IDN.t
PAID Pr-PSI \EL(rULL/PAP')
5RD P
1i
72 C-
TAS1
Coe a 3-foot spine board to
. immobilize patient's spine to
transport
5!Uln a 6-foot spine board to
.
1=01:1.117Q patient's spine to
tran=ort
51
nasal cannula to administer
o:
ea
52 use mask to administer oxygen
53U se a traction splint to treat
a lower extremity fracture
54 Use a pneumatic (air) splint
to immobilize a closed fracture
5sUse a padded board splint to
immobilize a fracture
Use a sling to immobilize a
fractured arm or clavicle
57Appiv direct pressure to
control hemmorrhage (bleeding)
5A Apply digital pressure to
control hemorrhage
5.pply tourniquet to control
hemorrhage
e); Apply dressing to control
hemorrha(je
°CT OF NtP"RER RESPONDING
TOTAL, RrSPD%SE
63
PCT or TOT
30
FREO!JENCT
TCT
ASSIST
12
34
5PFM
12
3
35
14
41
35
63
824
25
33
13
29
51
48
519
19
817
21
14
37
60
14
11
21
17
17
35
19
10
e9
19
22
30
56
25
30
29
67
1?
16
35
512
25
43
16
83
11
33
33
25
22
22
48
51
317
25
25
22
52
17
el
822
43
813
33
37
890
11
21
43
38
11
48
29
73
819
30
22
213
84
.4
32
8
513
32
40
12
89
11
27
32
732927
SUPERvISION.
DIFFICULTY
12
31
23
17
21
37
19
32
11
11
11
22
16
24
7
311
41
51
lz
0
524
54
71
14
g
321
37
24
38
3
529
46
42
38
1
514
27
22
25
1
621
49
42
37
3
524
57
48
40
1
316
41
24
42
5
03
85
61
324
54
46
38
1
1
3 3 6 8 6 6 5 6 8 6 2 8
TRAINING
23
21
24
13
16
24
25
38
33
25
29
30
37
19
19
32
33
27
40
19
37
510
25
41
4 13
11 5 8
10 12 6 8
14 8 3
13
CCC'JPATICN:
P.-9sC %E.L(FIA.L/PART)
C0%'
1;
72
043
TASK
TASK RESPONSES
PCT OF NUMBER RESPONDING
TOTAL RESPC%SE
63
PCT CF TOT
30
FREOL:E%cy
TOT
ASSIST
12
34
5PFM
12
3
730927
SUFERvISION
DIFFICULTY
12
31
23
1
TRAINING
23
4
6: Apply bandage to secure
dressing to wound
11
16
33
25
14
e6
11
22
37
819
54
67
24
017
25
37
13
6. Apply bandages to immobilize a
frzloture (e.g., ribs)
28
21
37
32
08
24
29
816
38
35
29
16
19
32
10
63 Apply a sterile dressing to
treat a burn
26
562
24
75
829
29
622
47
17
56
06
25
35
10
64 Apply cold wet applications to
treat a burn
03
832
54
43
513
21
513
21
14
27
03
13
22
6
65 Apply vaseline gauze or other
non-porous material to seal a
pneamothorax
05
38
56
43
311
19
610
21
11
25
55
13
25
10
fJ65 Use a bulk dressing to
immobilize an impaled object
C2
238
57
41
213
19
510
21
524
10
513
27
6
67 Use a constricting band to
treat a rnakebite
00
010
89
12
22
30
33
53
73
513
2
::ake an incision over fang
marks and suck out snake
venom
20
05
94
50
22
02
35
01
25
10
2
67 Ilevate the head and shoulders
of a patient who is having
difficulty in breathing
16
24
38
17
395
14
21
41
529
54
65
25
08
33
38
13
77 Use an oropharangcal airway to
maintain a patent (open) airway
314
21
46
14
84
13
14
38
821
48
37
40
16
29
35
14
71 Use an oxygen demand valve to
administer oxygen
613
32
32
16
83
13
25
27
824
44
46
33
12
35
35
10
72 Use an oxygen demand valve to
perform intermittent positive
pressure ventilation (IPPV)
310
17
38
29
68
13
21
24
621
35
27
37
33
22
30
14
TASK PESPo\SES
'Cr%1FAI:CN:
PA:') =:.;SCEL(rt:LL/pART)
;7
2
'AS< 71Use an S-tube airway adjunct
to perform IPPV
74:'ne an endotracheal tube to
maintain an open airway
Administer oxygen through
a
oxygen through a
n;a2 a
cannula
77 Administer oxygen through an
oxygen catheter
dr
u7P Administer oxygen through an
incubator system
7: Administer Holger-Neilson (back
pressure-arm lift) method of re-
suscitation to ventilate patient
Operate pressure-cycled, oxygen-
powered automatic mechanical
resuscitator to perform IPPV
81 Operate an oxygen-powered,
manually triggered, mechanical
ventilation device
82 ::aintain body temperature and
elevate lower extremities to
treat patient for shock
83 Treat a conscious patient who
has ingested a pos'on
8'1 Overate vehicle mounted suction
to remove fluids f.rom patient's
airway
ROT OF NUmeEP
TOTAL PESRON.SE
63
FRE.0:1E%CT
TCT
23
45
PFM
25
313
73
22
23
211
83
16
17
21
33
19
8;2
614
19
16
43
56
213
79
17
23
327
65
33
20
213
86
13
55
216
71
27
38
19
25
37
60
316
21
46
13
86
23
344
46
51
011
19
37
32
67
RESPONDING
PCT OF TOT
32
ASSIST
i2
3
25
8
26
6
13
21
35
511
19
26
8
313
11
63
2
313
6
614
27
11
25
37
314
25
617
24
732927
SURERVISIO%
DIFFICULTY
12
31
23
25
10
17
11
1
26
65
63
629
49
63
24
2
211
38
40
14
2
26
12
610
7
214
13
17
13
1
53
33
61
513
85
16
5
517
30
35
22
1
632
38
59
24
1
611
27
10
32
8
511
41
19
43
3
1
3 2
12 6 7 2 1 2 2 3 2 3
TRAINING
23
814
88
32
43
22
25
813
16
13
11.
1d
11
12
25
29
32
41
17
32
27
27
4
2 3 5 3 2 5 2 6 3 6 3
OC.,;PATIC',1
PtIC RFRSO'%El.0%LL/pA;T)
TASK RESPONSES
PC, OF NVY!ER RESPONDING
TOTAL RESPO%SE
63
PCT OF TOT
32
732927
q:',;=
1t
72
O:,
3
T:SK
rREGUENCT
TCT
ASSIST
SUPERVISION
clrrIcuLTy
TRAINING
12
34
5P.M
12
31
23
12
31
23
4
a5 Operate portable suction unit
e5
14
43
35
62
817
25
514
32
17
37
52
29
29
5to remove fluids from patient's
airway
8x, Administer patient's insulin
20
22
95
22
20
32
22
22
22
20
tc treat a patient in a
diaetic coma
87 Administer sugar or sugar
00
232
63
33
611
13
611
11
16
16
214
19
2pro;:uct to treat patient in
insulin shock
87 Use cold applications to lower
20
17
79
19
66
33
63
611
02
814
0patient's body temperature
89 Use warm water (100-105 F) to
a0
26
92
63
32
32
22
5P
610
0treat frostbite
.&.
97 Use a flashlight to examine
621
17
29
25
73
617
24
313
46
54
17
05
22
35
11
the pupillary reaction of a
patient
9!. Use cold pack to treat injury
28
322
56
35
611
83
617
27
82
616
14
2to soft tissue
97 naintain drainage tubing without
02
814
71
24
26
52
611
13
10
20
12
85
suction (e.g., urinary catheter)
vPerform an emergency childbirth
20
040
56
40
313
19
611
16
616
16
517
21
5delivery
94 Place deceased patient in a
23
635
51
44
519
16
216
19
27
87
219
10
13
disaster pouch
9; Place deceased patient in
23
519
68
27
38
13
08
16
16
11
02
13
58
a shroud
96 Use restraint straps to control
22
11
59
22
73
11
27
29
12
22
32
14
27
30
333
24
13
a combative patient
CO
C.,:
"AT
IC\I
P:PsO \ELCFULL/PAg-,
I:RC
-21
72
C14
TASK RESPONSES
ROT OF NUMErR pEsPcNOING
TOTAL RESPONSE
63
pcy CF TCT
37
732927
%S.<
FREOJEN,CY
TCT
ASSIST
SUPERVISION
DIFFICULTY
TRAINING
23
45
Prm
12
31
23
12
31
23
4
97 Use a geiger counter to detect
42
95
70
02
^2
70
00
22
0
radiation level
95 Operate a hydraulic lift
25
02
69
60
23
07
75
20
03
52
(1:oyer) to move patient
99 Perform cardiopulmonary resus-
22
17
43
33
62
516
35
514
33
11
29
20
217
38
6citation (CPR) without the use
of life-stmport equipment
!;77 Perform CPR with the use of
33
17
49
21
73
616
44
819
38
17
38
15
222
43
8life-support equipment
izt Operate a bag-valve mask unit
06
16
38
37
60
314
32
611
37
16
38
33
17
30
8to perform intermittent positive
pressure ventilation (IPPV)
:22 Use a bag-valve mask unit to
25
11
22
57
dt0
55
21
817
17
12
24
50
16
25
5
perform IPPV
I03 Perform mouth-to-mouth method
20
343
51
46
514
14
510
29
13
22
10
314
30
6
of IPPV
124 Perform mouth-to-nose method
20
219
78
19
33
85
312
311
211
16
2
of IPPV
125 Use a sphygmomanometer and-
13
11
16
21
37
62
612
22
36
44
41
17
03
14
35
8
stethoscope to obtain a patient's
blood pressure
106 Place fingers on patient's
16
21
27
16
17
79
514
33
313
56
56
19
38
22
40
8
wrist to count radial pulse
17.7 Assemble intravenous fluid
22
317
73
24
83
85
10
611
12
10
513
5
administration equipment
Perform a venipuncture to
Z3
06
J7
12
25
20
53
36
27
35
2
administer intravenous fluids
TASK PESpcNsEs
PCT CF NUMBER RESPDNDING
7,:CL,'"AT:7N!
PA:) PF."SD-NEL(FULL/PART)
T1TAL RESPC%SE
63
PCT OF TCT
32
730927
SR%P
17
27.-
3
TASK
1
FREOUU:CY
23
45
TCT
PFM
1
ASSIST
23
SUPERVISION
12
3
DIFFICULTY
12
31
TRAINING
23
4
::: Use a syringe to administer
intravenous medications into
the :.V. tubing
73
23
90
6.
23
00
32
25
07
33
0
11:7 Use a syringe to administer
intravenous medications
23
70
94
37
20
C2
22
20
22
2
11
Use a syringe to administer
intramuscular medications
22
00
97
20
27
77
22
07
72
00
117 operate a defibrillator to
adinister empirical defib-
rillation
22
311
81
16
35
62
66
313
07
510
2
111 Operate an electrocardiograph
scope and recorder to observe
patient's cardiac activity
36
13
11
63
33
513
10
5i7
16
11
21
25
26
19
5
114 Operate one-ay electrocar-
die,-;raph telemetry sy,:tem to
tra:Ismit (2::G or ECG)
26
10
12
67
27
510
10
65
14
819
20
517
5
11t, Operate a two-way voice
communication radio
62
14
10
83
;A
68
51
517
65
81
11
06
46
19
21
116 Answer telephone to receive
requests for ambulance service
14
24
16
13
33
67
10
630
311
48
52
13
06
27
11
21
117 Perform minor mechanical
maintenance on emergency
medical equipment
614
11
19
46
51
811
19
216
24
25
22
011
16
616
118 Perform building maintenance
on physical facility
llq Replace oxygen tank in vehicle
8 3
8
14
8
29
11
32
60
19
35
78
0
11
10
13
17
41
2 3
6
22
19
46
27
62
5
13
7 0
10 2
8
38
5
14
10
22
Refill oxygen tanks with
compressed oxygen
35
63
78
17
62
60
214
14
20
712
53
C:%:'A7:C%1
PA:
Pr.PS7.4VEL(rt:LL/PART)
59%7
1;
72
3
TAK
TASK RESPONSES
PCT CF 'NUMBER RESPONDING
TOTAL RESPONSE
63
Poi cc TOT
37
73C927
Extricate an entra
2121
pped patient
127
Direct traffic at scene of
2
accident
V.
123
Use highway flares to control
_r
is at accident scene
124
Use portable floodlights to
2
illuminate worh area
125
in
rue` patient's family how
to care for patient at home
I2"
:valuate quality of training
2
program
127 Conduct on-the-job
training
3
sessions
123 Conduct formal classes to
0nduo in-
struct individuals in emergency
medical care techniques
6129 Use an orthopedic ntretcher
to transport a patient
=37 Use a variable position stretcher 5Z
to transport a patient
14
131 Use a stretcher composed of
rubberized canvas on an aluminum
frame to transport a patient
132 use rubberized stretcher to
s=pend a patient from the
ceiling of an amlulance
TCT
ASSIST
SUPERVISION
DIFFICULTY
TRAINING
23
45
PF m
12
31
23
12
X1
23
4
217
56
21
75
11
24
33
17
27
1?
38
22
532
27
8
82
17
68
27
56
82
814
19
55
11
38
12
(3
19
62
35
3li
10
2IC
17
32
08
16
210
56
32
52
43
313
16
211
27
37
57
519
11
8
26
10
78
17
32
62
11
11
57
22
10
3
32
16
71
21
211
62
11
53
16
12
63
10
88
13
62
32
314
11
314
12
624
06
65
13
812
17
60
35
514
11
612
14
11
22
25
10
14
5
16
22
.58
13
03
14
19
43
632
37
47
37
15
35
35
5
21
17
17
12
86
12
21
48
623
46
52
29
06
38
29
11
16
22
33
60
524
25
519
30
38
19
029
21
8
03
29
63
32
13
17
217
16
11
13
52
16
56
1:
72
'.;-+
7
3-1
Use a chair stretcher to
transport a patient
134
use a chair to transnort
a patient
135
Use a wheelchair to transport
a patient
13
Drive an emergency medical
vs:nicle to transport a patient
unf.er non-er.crgency conditions
177
Drive an emersency medical
ve;licle to transport a patient
emergency warnins
devices
13g
Operate a fire control
device
(`_re extinguisher) to
extinguish a fire
:39
c e a watercraft to transport
patient
:41
141
1:se a fixed wing aircraft
(airplane) to transport
a patient
Use a rotary
(helicopter)
a patient
wins aircraft
to transport
TASK RESPONSES
PCT
OF NI.JBER
TgiAL RESPO\SE
63
FRrouEN.cv
ICT
23
45
PP0.
RESPONDING
PCT OF TOT
ASSIST
12
37
3
732927
SUPERVISIO%
OIF7IOULTY
12
31
23
1
TRAINING
23
4
11
519
S3
27
68
17
17
35
522
35
41
21
32
24
25
11
26
17
49
19
75
817
41
525
37
41
29
22
32
22
16
32
521
63
30
217
10
28
17
19
87
513
86
72
13
14
16
21
73
519
25
821
38
46
22
08
32
2i
11
27
24
17
12
17
78
519
29
17
17
44
35
38
712
29
24
1i
20
343
49
466
814
311
22
27
14
710
14
11
10
72
392
52
32
22
33
01
72
22
20
03
92
32
20
2P
22
07
72
.0
'0
02
95
20
20
22
00
72
7
TOTAL RESPONSES
PCT OF NUNBER RESPONDING
VOLUNTEER PERSONNEL
TASK RE5pONSES
PCT CF NuYpER 9;-SPcNOING
rcTAL PESPCN;SE 143
730927
,.:7,CwAr:::%1
silc_r%7:E6,
pcT oF ToT
68
%P
2:
71
c::
TASK
FR-7c',;EN.cy
TCT
ASSIST
sUPERviS70%
cIFF:cJLTy
TRAININ:
12
34
5PFm
12
31
23
12
31
23
4
_Set standard type and quantity
811
20
17
41
;7
.li
12
31
12
26
13
37
22
122
17
13
le
of emergency medical equipment
needed for unit operation.
iinventory type and quantity of
313
26
22
36
82
11
13
3?
12
27
18
38
16
112
26
620
emergency medical equipment to
determine need fcr replacement,etc.
Place emergency medical equipment
822
36
17
15
53
15
17
45
13
32
37
55
23
114
32
18
24
in assigned location
4:.;et standard type and quantity
28
21
17
46
48
14
624
11
27
11
26
15
28
23
81:;
of emergency medical supplies
needed for unit operation
5Inventory type and quantity of
1,3
24
22
37
59
12
12
30
12
24
16
29
23
17
29
718
emergency medical supplies to
6/
determine need for resupply
.:, z,
''.lace emergency medical supplies
422
31
22
16
80
17
13
41
932
31
58
15
015
34
524
in assigned location
'et standard type and quantity
21
33
87
71
15
3i
21
42
13
34
of drugs and intravenous (I.V.)
fluids needed for unit operation
7:nventory type and quantity of
12
32
86
81
24
22
21
60
4-3
3
drugs and 1*.V. fluids to determine
need for resupply or nev supplies
°Place drugs and 1.V. fluids in
22
33
86
81
24
13
34
30
34
23
assigned location
_ "Set standard type and amount
of
13
713
73
24
68
64
89
17
13
18
63
8
office supplies needed for
unit operation
11Inventory type and amount of
13
513
77
22
66
71
17
712
80
58
28
office supplies to determine
need for resupply or new supplies
121-;iee office supplies in
68
12
73
26
76
12
117
17
18
60
87
212
az,::,ifinec: location
!7CCUFATI:)N1
G7 C.;°
2;
0
Vr!LUNT7-IER
71 Ec
13Desin emergency medical
er,:iprIent such as a special
splint
or vehicle floor plan
14n.xamine physical facilities to
deter:nine need for expansion
or construction
I''Preare budget for operation
of y:nit
TASK RESPONSES
PCT OF NUMBER RESPONDING
TCTAE RESPONSE 143
PCT OF TOT
68
732927
FREDUE\C'
TcT
ASSIST
SUPERVISION
DIFFICULTY
TRAINING
z3
45
PF-1-1
12
31
23
12
31
23
4
22
522
72
24
66
11
79
65
14
39
64
6
11
118
73
22
43
12
211
64
12
37
33
7
12
313
81
17
46
34
36
26
77
31
6
l'-"Assign crew and vehicle to res-
410
12
17
56
43
13
12
10
813
19
18
18
57
:7
615
p-)ncl to critlance call based
upon the nature of the call
17 f.urvoy typo and c.,:antity of
22
427
64
24
59
13
89
95
15
38
54
13
--
e:1(7::cc,r.cv mcd;_col cqui?rlent
availXzlc for purchase
1' n6intain personnel records
1PPrepare payroll fcr unit
employees
33
413
76
22
46
63
68
88
05
63
7
22
11
94
12
20
1C
11
11
1
VP--c:.:arc financial report of
01
28
86
10
61
04
54
41
61
25
tnit opr.ration
2.- Examine record of service to
02
56
85
13
24
51
56
66
15
62
3
pz,tient to
patient
for service
22 naintain accounting records
23 naintain records of patients
serviced
11
32
89
81
31
01
53
40
43
13
79
12
11
60
38
810
13
411
17
27
13
18
15
710
24 :;7_,,,rate a typewriter
32
11
15
65
31
56
61
421
17
91
17
36
8
oCcc
PAT
ITN
:V
-L.,:
NT
=E
R
TASK RESPONSES
PCT or NUYpER RESPONDING
TOTAL RrSPO\SE 143
PCT CF TOT
68
732927
R%P
2:
71
TASK
cRPOuENcY
TcT
ASSIST
SUPERVISION
DIFFICULTY
TRAINING
12
34
5PrM
12
31
23
12
31
23
4
25 naintain records of maintenance
13
913
71
27
.7
78
611
513
10
07
83
6
performed on emergency medical
equinment
V=Cor-Plete information required
29
17
17
53
AA
912
18
315
22
27
13
07
17
313
by special form to report
acc.-,c:ent
27Cs7
etc information required
12
21
33
18
:5
e4
13
19
41
827
47
57
19
I15
34
919
ccial form to report
balance trip
V,Co:plete information required
14
12
775
22
63
84
58
810
03
10
34
by L;pecial forms other than
thcne li.sted above
"c=
~:4:
record of service to
11 .6
43
es
91
14
e4
33
A0
?4
24
patient to determine charges
to p.--tient
t
3:ecord analysis of
bulanee
57
610
71
27
69
82
13
911
11
15
12
48
mtrip; to determin
_uch thing3
.1n type of service provided, etc.
31Create and maintain on-call
22
88
78
20
47
63
97
11
62
417
37
ro:;ter of staff required to
operate unit
32 Conduct meetings with hospital
Z1
213
81
16
36
72
67
56
45
54
6
representative(s) to coordinate
emergency medical services
37Conduct meetings with
110
29
58
40
10
12
12
616
12
13
19
29
13
49
unit personnel
34nevelop policies or procedures
12
722
65
32
11
98
316
86
18
37
98
8
to provide guidelines for daily
operation of the unit
35:Develop and on-the-job training
12
10
13
71
26
10
95
611
65
15
37
84
7
program
3',Conuct interview to determine
01
18
88
93
51
22
32
51
23
43
if applicant meets standards
for employment
VTLNT=ER
SROU=
27
1
TAS'.
37 Administer test to determine
if applicant meets standards
for employment
3:', Evaluate unit personnel to
determine progress, raises,
di:icipline and promotion
3; Dctenline staff required to
operate. unit effectively in any
specific time period
4C Explain general hospital
procedures to patient or family
41 Inform patient's family of
patient's general condition
n.)
42 Inform patient's attending
physician of patient's death
43 inform Coroner's office of
patient's deth
4use an emisis basin in treating
nauseated patient
45 Use a urinal to provide the
patient with an opportunity to
ur:. nate
46 use a bedpan to provide the
patient with an opportunity to
defecate
47 usc sandbags to immobilize
patient's
cervical spine (neck)
::se a cervical collar to
immobilize patient's neck
TASK RESPONSES
PCT OF NUMBER RESPONDING
TOTAL RESRONSE 143
PCT 0P TOT
FREQUENCY
TcT
ASS:ST
12
34
5Prm
12
68
3
.730927
SUPERVISIO%
DIFFICULTY
12
31
23
1
TRAINING
23
4
C1
17
89
81
61
13
21
61
31
34 4.
21
39
84
13
33
43
41
23
33
42
3
13
313
77
22
36
65
83
310
22
54
8
16
88
73
24
38
12
10
12
913
17
74
9
24
817
66
31
79
11
110
Si
10
16
47
96
15
04
211
81
17
46
4i
84
28
43
47
6
12
320
72
26
63
11
48
812
92
69
78
05
18
43
31
t6
15
16
24
115
43
34
22
613
28
15
14
03
532
59
40
813
13
39
22
20
12
312
13
10
9
03
322
72
27
78
12
18
15
11
84
812
88
01
10
42
46
53
14
22
17
822
22
16
29
515
15
19
12
13
10
48
37
62
13
26
27
11
22
23
17
34
618
22
23
7
v^Lu%TFER
CRCU="
2:
71
743<
7'
40,Use a 3-foot spins board to
mmobilize patient's spine to
transport
5! Use a 6 -foot spine board to
immobilize patient's spine to
transport
51 Use nasal cannula to administer
oxygo:1
52
:Je mask to administer oxygen
53 Use a traction splint to treat
a lower extremity fracture
54 Use a pneumatic (air) splint
to immobilize a closed fracture
55 Use a padded board splint to
immobilize a fracture
5Use a sling to immobilize a
fractured arm or clavicle
57 Apply direct pressure to
control hemmorrhage (bleeding)
Apply digital pressure to
control hemorrhage
5'7 Apply tourniquet to control
hemorrhage
67 ApDly dressing to control
hemorr:lago
TASK RESPONSES
PCT CF NUMBER RESPONDING
TOTAL RESPO%SE 143
PCT or TOT
68
7R7OUE\C'
TOT
ASSIST
12
34
5PFm
12
3
732927
SUPERVISIO%
DIFFICULTY
12
3i
23
1
TRAINING
23
4
13
13
42
41
59
11
24
22
15
22
la
838
918
22
20
8
23
937
49
49
10
18
17
17
19
17
831
613
16
22
7
22
832
55
44
814
14
615
19
28
14
715
14
18
3
315
36
34
11
E8
23
24
31
16
29
38
62
23
224
32
25
6
02
925
60
36
516
14
811
15
13
22
17
15
17
2
24
31
41
20
78
16
29
29
14
27
33
38
36
127
27
22
6
12
336
55
43
12
16
15
617
17
17
22
227
13
22
3
22
553
38
62
12
22
23
621
29
24
29
324
22
20
3
33
24
47
23
76
16
22
33
13
22
36
34
33
428
22
22
7
11
10
40
46
51
11
14
22
/1
13
24
21
25
324
13
22
3
02
18
9Z
91
34
21
42
41
17
314
i
13
24
43
25
74
22
20
28
13
24
34
35
34
126
23
24
8
TASK RESPONSES
PCT OF NUR Ri_SPr_1NOING
V1;,J%TrEP
TOTAL RES00%SE 1'*3
PCT OF TOT
68
732927
S;",9
2t
71
TASK
FREQUENCY
TOT
ASSIST
SUPEPVISION
DIFFICULTY
TRAINING
23
45
PVM
12
31
23
12
31
23
4
61'Apply bandage to secure
37
32
45
14
65
21
24
31
11
36
32
46
35
125
29
24
8dressing to wound
67 Apply bandages to immobilize a
11
11
47
38
60
14
17
25
11
27
26
25
32
/25
15
26
3fracture (e.g., ribs)
61 Ap?ly a sterile dressing to
Id
653
38
60
11
23
23
13
17
27
22
36
127
15
27
2treat a burn
64 Apply cold
et applications to
01
239
57
42
11
14
13
814
15
22
20
119
15
22
1treat a burn
65 Apply vasclinc gauze or other
10
110
87
12
43
43
16
54
211
617
1ncn-porous material to seal a
pne:Imothorax
oOh Use a bulk dressing to
21
20
77
22
68
54
510
78
5i3
12
22
0.:.
immobilize an impaled object
67 Use a constricting band to
21
890
92
43
33
33
41
13
417
1
treat a snakebite
6'3 rake an incision over fang
21
692
72
31
21
33
31
10
317
0
marks and suck out snake
venom
6q Elevate the head and shoulders
19
29
38
22
77
22
21
24
12
27
33
42
3:7
124
24
21
8
of a patient who is having
difficulty in breathing
77' Use an oropharargeal airway to
00
18
36
43
55
12
15
17
12
15
24
22
27
422
16
23
3
maintain a patent (open) airway
71 Usc an oxygen demand valve to
25
22
33
38
59
15
16
20
721
27
35
21
123
17
22
5
administer oxygen
7% Use an oxygen demand valve to
13
13
21
59
38
613
13
413
18
17
17
315
918
3
perform intermittent positive
pressure ventilation (IPPV)
TASK RESPONSES
COCJPA':O\I
GEC
2;
71 !:
TASd
PC" OF NUMBER RESPONDING
TOTAL RESPONSE 143
POT OF TOT
68
FREQUENCY
TOT
ASSIST
12
34
5PFm
12
3
730927
SUPERV!S!ON
DIFFICULTY
12
31
23
1
TRAINING
23
4
7!T.:se an S-tube airway adjunct
to perform IPPV
23
521
72
26
49
62
813
715
113
816
3
74Usc an endotracheal tube to
maintain aaopen airway
22
18
87
10
13
31
26
18
14
610
i
nAdminister oxygen through
a m.:tsk
312
34
39
12
87
24
22
28
11
29
40
52
31
127
29
24
7
71,Administor oxygen through a
na,;a1 cannula
13
624
62
24
99
10
312
17
18
15
011
15
15
2
77Adm'-nister oxygen through an
oxygen catheter
11
27
86
11
16
31
53
56
18
313
1
1 oel
7=1;dnister oxygen through an
in,::ubator system
20
110
87
11
33
22
16
55
02
59
3
7.;Ad.7inister Holger-Neilson (back
pressure-arm lift) method of re-
suscitation to ventilate patient
20
04
94
41
02
11
11
21
84
13
1
87.0perate
pres
sure
-cyc
led,
oxygen-
powered automatic mechanical
resuscitator to perform
IPPV
.
01
223
72
26
68
63
612
912
111
813
3
810parate an oxygen-powered,
manually triggered, mechanical
ventilation device
310
17
65
31
613
12
412
15
15
15
09
13
15
3
92Naintain body temperature and
elevate lower extremities to
treat patient for shock
13
26
47
22
77
14
24
31
15
25
34
39
32
222
27
22
8
8.5
Tre
at.a conscious patient who
has ingested a posion
10
233
62
36
612
12
511
17
11
21
222
12
18
3
84 07,eroto vehicle mounted suction
01
12
42
42
55
12
18
20
816
27
16
31
521
21
19
6to remove fluids from patient's
airway
TASK RESPONSES
PCT CF NUYBER RESPONDING
V%',,\,7ER
TOTAL. RESPC:%Sy 143
PCT OF TOT
68
732927
SRC.:P
2:
71
Er.'
TASK
FREO:;rN:Y
TCT
ASSIST
SUPERVISION
DIFFICULTY
TRAINING
12
34
527M
12
31
23
12
31
23
4
85 Operate portable ..action unit
12
742
46
52
-8
14
17
913
24
15
29
517
2?
27
5to remove fluids from patient's
airway
3, Administer patient's insulin
00
15
92
62
11
11
25
32
81
to treat a patient in a
diabetic coma
37 Administer sugar or sugar
20
319
75
22
58
61
812
lc
10
012
914
3proC.,:ct to treat patient in
insL:lin shock
8a t7r,e, cold applications to lower
00
322
73
24
411
72
813
12
12
214
918
1
patient's body temperature
80 use warm water (100 -105 F)
to
00
18
90
83
31
12
54
3SZ
215
1treat frostbite
=
Use a flashlight to examine
13
17
43
34
64
13
14
24
817
35
38
22
127
22
22
A
the pupillary reaction of a
patent
9'. Use cold pack to treat injury
01
12
34
55
44
812
17
413
26
28
13
116
16
17
3to soft tissue
92 I:aintain drainac.:e tubing without
01
16
90
81
31
12
35
30
45
80
suction (e.g., urinary catheter)
93 Perform an emergency childbirth
00
118
82
19
67
56
210
38
713
11
18
2
delivery
94 Place deceased patient in a
21
130
66
32
69
13
313
12
815
59
12
11
6
disaster pouch
951,1ace deceased patient in
20
217
77
20
37
91
12
87
93
67
87
a slIrcud
95 Use restraint straps to control
02
847
44
55
12
21
18
le
22
18
620
26
15
27
16
8a combative patient
TASK RESPONSES
PCT OF NU:',9ER RZSPoNnING
CCCPA"ION:
V7,L:JNTF:E9
TOTAL RESPONSE 143
PCT Cr TOT
68
732927
SRTL'
2:
71
E":
TAs-<
rRrc.JENcY
TcT
ASSIST
suPERS:oN
DIFFICULTY
TRAINING
23
45
Pp.
12
31
23
12
3i
23
4
97 Use a geiger counter to detect
2Z
13
94
41
i1
i2
21
13
38
1.
radiation level
9'.4 Operate a hydraulic lift
20
13
94
51
12
11
31
21
34
61
(Eoyer) to trove patient
cc :'e_rform cardiopulmonary resus-
21
848
42
57
12
19
24
12
17
24
634
14
22
22
22
4ci:ation (CPR) without the use
of life-support equipment
Perform CPR with the use of
01
838
51
48
10
15
21
le
le
24
527
13
18
21
16
3life-support equipment
17,1 Operate a bag-valve mask unit
21
S38
49
48
813
22
618
23
15
29
316
21
21
3to perform intermittent positive
pressure ventilation (1PPV)
Cs_ a bag-valve mask unit to
perform IPPV
IZI Perform mouth-to-mouth method
of :71W
iv. Perform mouth-to-nose method
of IPPV
In Use a sphygmomanometer and
stethoscope to obtain a patient's
blood pressure
lcA, Place fingers on patient's
wrist to count radial pulse
lz7 Assemble intravenous fluid
administration equipment
12? Perform a venipuncture to
administer intravenous fluids
36
87
12
13
51
34
36
06
714
11
338
55
43
79
19
613
22'
12
26
319
18
20
2
12
112
84
13
12
71
36
36
111
816
1
19
18
27
43
55
616
21
315
34
32
19
316
22
22
2
114
22
41
22
78
823
25
822
39
41
29
123
26
22
6
02
14
92
52
12
12
13
22
31
61
01
11
95
21
1P,
11
11
02
15
1
TASK RESPONSES
PCT CF Nt.P.!FER RESPONDING
:CCJRAT:CN,:
v-LJ%-EER
!;P:..dc'
2t
71
F::
TASK
.
TOTAL PESPC%Se
PRECUENCY
12
34
143
5
rcT
PFM
PCT OF TOT
ASSIST
12
68
3
730927
SUPERVISION
DIFFICULTY
12
31
23
i
TRAINING
23
4
1,!q Use a syrin;e to administer
intravenous medications into
the 1.v. tuDinc
00
11
95
21
10
10
11
12
21
52
11 .-'::se a syringe to administer
intravenous medications
20
21
95
11
10
10
11
00
21
40
......
11:Use a syrince to administer
intramuscular medications
20
01
97
10
01
00
10
02
04
0
117
Ope
r,:,.
toa defibrillator to
administer empirical defib-
rillation
22
11
97
11
10
11
22
11
11
30
Q 1
113Operate an electrocardiograph
sce:)e and recorder to observe
patient's cardiac activity
21
33
92
71
32
13
33
31
23
61
co co
1140p,srate one-ay electrocar-
diograph telemetry system to
transmit (1= or ::CG)
00
13
95
3i
21
23
12
21
13
30
1:507erate a two -way voice
cori-unication radio
15
24
33
22
594
11
18
42
618
59
75
10
222
37
919
11Ans-.ter telephone to receive
reci_lests for ambulance service
912
23
32
24
74
818
27
812
45
52
14
217
29
516
117Perform manor mechanical
maintenance on emergency
nedical equipment
33
15
23
52
45
615
16
612
21
22
20
712
13
610
111"erform building maintenance
on physical facility
36
12
23
55
43
813
16
213
23
23
12
111
15
311
1 ';Replace oxygen tank in vehicle
24
20
44
29
70
12
18
29
717
39
53
10
118
27
916
12:fRefill oxygen tanks with
22
10
22
63
36
311
15
67
22
25
60
915
58
compressed oxygen
TASK RESPONSES
PCT Cr NUMeER RESPONDING
'7CCU,':.AT:7!Nt
V7LuNTrER
TO1AL RESPONSE 143
PCT OF TOT
68
730927
ORTUP
2I
71 E:
TASK
FRrOUE%CY
TCT
ASSIST
SUPERVISION
DIFPICULTV
TRAINING
12
34
5PFM
12
31
23
12
3/
23
4
121
Extricate an entrapped patient
110
52
35
t2
.13
17
26
14
24
19
336
18
17
24
17
7
127
Direct traffic at scene of
21
12
33
51
43
13
914
122
17
19
22
113
17
613
accident
423
Use highway flares to control
12
15
37
43
52
10
12
22
322
23
29
16
313
22
815
traffic at accident scene
124
Use portable floodlights to
41
845
40
56
10
12
22
125
22
34
16
115
22
813
illuminate work area
/25
Instruct patient's family how
e8
89
81
41
13
13
30
33
3to care for patient at home
126
E..aluate quality of training
21
315
76
20
212
44
66
113
46
86
3program
127
Conduct on-the-job training
1ssions
28
22
64
33
715
76
10
13
10
17
312
10
73
se
12P
Conduct formal classes to in -
11
620
67
29
513
55
811
616
310
8/
2struct individuals in emergency
medical care techniques
129
Use an orthopedic stretcher
03
20
45
29
69
12
23
29
725
32
29
34
121
26
20
4to transport a patient
13z
Use a variable position stretcher 5
10
29
31
22
76
14
24
32
827
34
41
27
12i
29
15
9
to transport a patient
'31
Use a stretcher composed of
34
12
28
5e
47
913
20
318
23
24
20
214
22
13
7ruLberized canvas on an aluminum
frame to transport a patient
132
Use rubberized stretcher to
11
327
65
32
79
11
312
14
15
14
28
19
95
uf;pend a patient from the
ceiling of an ambulance
TASK RESPO1SES
1-7%,1"
o
2;
71
E".;
'AS'
133
Use a chair stretcher to
transport a patient
134
Use a chair to transport
a patient
135
Use a weeic.aair to transport
a_lent
I3
Drive an emergency medical
vehicle to transport
a patient
uncler non-emergency conditions
137 Drive
an emergency medical
vehicle to transport a patient
using emergency warning devices
13q 0,2rato
a fire control device
(:__re entingis!;cr) to
extin,Tuis21 a fire
139 Une a watercraft
to transport
a patient
14- Use a fixed wing aircraft
(airplane) to transport
a naticnt
141 Use a rotary wing
aircraft
0o7 OF
TVAL.FES°3NSE
FRECUEN.CY
12
34
16
12
52
11
634
23
23
46
22
22
3a
21
22
26
13
36
01
13
22
10
02
11
N.JkP,ER
143
'CT
5Pr'
32
67
55
a3
69
27
45
52
43
53
42
55
93
4
97
1
96
2
RESPON';;NG
PCT oP 707
ASSIST
I2
15
20
613
37
615
515
815
?1 2
10
68
3 27
17
le
16
18
16 2 1 1
732927
SUPE9V!S:0%
0:Fr!CULTY
12
31
23
726
29
29
34
2
316
17
17
18
3
18
15
17
80
313
32
32
17
2
413
31
25
24
1
822
22
31
22
7
03
13
10
02
12
10
11
12
22
1 19
13
13
1.4
i3
i7 5 2 2
TRAIS.ING
23
29
14
19
10
11
9
19
8
18
9
17
le
16
1 12
4
9 a 3
13
13
15 1 0 2
(`nelicopter) to transport
a p,Itient
TOTAL RESPONSES
PCT OF NUMER RESPONDING
ATTENDANT - REGISTERED EMT
OCCUoAT!ONI
ATTENOENTS-EMT
SROLP
1;
46 Et:
12
1 EC
TASK
TASK RESPONSES
ROT Or NU!.18ER RESPoNO1NC
TOTAL RESoCNSE
36
PCT of TOT
FREQUENCY
TOT
ASSIST
12
34
5PrM
12
17
3
731309
SUPERVISION
OtrrioULTY
12
31
23
i
TRAINING
23
4
ISet standard type and quantity
of e:-ergency medical equipment
needed for unit operation.
11
19
19
,4
36
64
.17
639
636
14
39
25
08
14
19
22
z:nentory type and quantity of
er-ereency medical equipment to
11
22
17
11
33
61
14
11
25
11
33
14
33
25
06
28
822
determine need for replacementpete.
3Place emergency medical ec:uipment17
in assigned location
42
14
619
78
17
11
39
14
33
28
50
22
08
39
14
i7
4Set standard type and quantity
of emergency redical supplies
needed for unit operation
86
11
17
50
42
19
614
11
19
11
17
22
06
22
11
11
Inyentory type and quantity of
emergency medical supplies to
deter :ine need for resupply
828
11
11
39
58
14
11
25
11
31
11
31
22
03
31
it
19
6Place_ emergency medical supplies
in asigned location
19
44
11
814
83
17
17
39
836
28
56
19
0ii
36
631
7Set standard t.:pe and quantity
of drugs and intravenous (I.V.)
fluids needed for unit operation
60
26
81
11
03
86
33
08
30
88
3
8Inventory typo and quantity of
3
drug; and I.V. fluids to determine
need for resupply or y.e,: supplies
5U
369
'22
06
17
11
66
811
00
17
66
9Place drugs and I.V. fluids in
assic7ned location
82
14
11
58
.33
80
25
817
819
14
30
19
814
10
Set standard type and amount of
office supplies needed for
unit operation
36
66
75
19
63
38
83
811
26
86
6
11
Inventory type and amount of
office supplies to determine
need for resupply or new supplies
68
i6
75
25
11
36
66
814
80
68
68
12
7"1_acc office supplies in
assigned location
08
88
72
25
11
38
38
817
80
3it
014
OCCUPATION!
AT7ENOEN:TS,-EMT
GROUP
1;
46 EC
12
1 E.
TASK
TASK RESPONSES
PCT CF NUMBER PESPONOING
TOTAL RESPONSE
36
PCT OF TOT
FRFGUENCT
TOT
ASSIST
12
34
5PFM
12
17
3
731009
SUPERV:StON
12
3
OIFF:CUL7T
12
3i
7RA:N/N5
23
4
.3
Desicn e=ergencv medLeal
ecluip77.ent such as a special
splint
or vehicle floor plan
00
322
69
25
.11
014
11
11
38
11
63
14
66
14
ixan:ine physical facilities to
dete=ine need for e::pansion
or cenf.truction
00
211
83
11
30
80
63
36
03
80
3
18
2rsa2re bud :et for operation
zJf
a0
33
89
66
20
60
20
06
63
03
16
Acsi.:n crew and vehicle to res-
pond to anbulance call based
upon thc nature of the call
63
25
661
39
36
14
317
19
17
17
33
14
814
V c,
NJ
17 Survey type and c-71:antity of
e7:-:oncy medical e:uiprent
avail.?Lle ;:or purc!-:ase
::a
18
intain 1:orsonnel records
0 3
3 ... 0
0 8
14 8
75
81
17
19
8 3
2 3
6 8
0 0
ii 6
3 6
6
11
8 3
0 0
6 2
3 8
0 0
8 8
19 Prepare payroll for unit
pleyees
20
30
94
30
00
02
00
00
03
03
22 prepare financial report of
unit operation
03
30
94
60
32
00
03
02
03
06
21 L:xa7.ine record of service to
patient to bill patient
for service
33
30
89
80
06
33
38
00
21i
03
22 ::aintain accounting records
00
30
94
30
02
00
00
00
33
00
23 ::aintain records of patients
serviced
11
66
669
'28
60
14
88
817
80
00'
36
24 Cperate a tvpeuriter
62
311
78
19
30
80
38
14
00
82
08
CCCuPAT:CNI
ATTENCENTS,EmT
CRCU7
1:
A6 EC
12
i EC
TASK 25 ::,,intain records of maintenance
performed on emergency medical
ec,:ipment
26
Cer:1):_ete information required
12.7 special form to report
accident
27 Co:.pletc information required
special form to report
am:,ulance trip
29 cemilete information required
!serial forms other than
those listed above
29 E=dne record of service to
patient to determine charges
to 7u7:tient
C"N
7:ecord analysis of ambulance
,rips. to determine such things
as type of service provided, etc.
31 Crete and maintain on-call
roster of staff required to
c7erate unit
32 Conduct roctings with hospital
re:resentative(s) to coordinate
cmer-:encv medical services
33 Conduct meetings with
unit personnel
34 Develop policies or procedures
to provide guidelines for daily
operation of the unit
35 Develop and on-the-job training
program
36 Conduct interview to determine
if applicant meets standards
for employment
TASK RESPONSES
PCT CF NUMBER RESPONDING
TOTAL RESPONSE
36
PCT OF TOT
FREQUENCY
TOT
ASSIST
23
45
PFM
12
17
3
731009
SUPERv:S:ON
12
3
DIFFICULTY
12
3
TRAINING
i2
34
38
311
72
25
30
17
68
817
60
019
03
811
14
658
39
86
17
38
19
19
It
00
14
317
39
31
17
311
09
811
47
839
33
47
33
38
440
611
14
661
36
83
17
022
11
22
8z
817
36
60
38
81
17
03
60
83
83
00
80
3
11
33
11
69
18
38
11
0it
38
14
00
14
06
63
11
375
'22
33
83
11
83
19
00
i,0
6
00
66
86
11
30
83
80
63
38
80
0
06
11
17
67
:33
68
17
8i4
14
17
17
08
11
68
08
68
78
22
86
8'3
118
314
33
1i
63
06
14
869
28
68
14
811
86
17
33
14
11
6
00
06
92
63
03
30
33
30
36
00
occurDA7:oN7
oRt%P
11
TAs.,1
A*7'ENOENTS.-EMT
46 EO
12
1 E0
37
Administer test to determine
if a2plicant meets standards
for employment
33
L:vaivatc unit Personnel to
do
_ ^.e progress, raises,
isolpline and promotion
3?
:z-torr.ine staff required to
eiort.e. unit effectively in any
fpecific time period
4;7
general hospital
procodures to patient or family
41
Inform patient's family of
1-,ationt's oeneral condition
42 inform patient's attending
physician of patient's death
43 Inform Coroner's office of
patient's death
44 Use an crisis basin in treating
nauseated patient
43 Use a urinal to provide the
patient with an opportunity to
urinate
46 Use a bedpan to provide the
patient with an opportunity to
do fecate
47 Use sandbags to immobilize
patient's
cervical spine (neck)
48 Us_-- a cervical collar
to
i=.ohilize patient's neck
TASK RESPONSES
PCT CF NUMBER RESPONDING
TOTAL RESPONSE
36
Pc? or TOT
17
FREQUENCY
TCT
ASSIST
12
34
5PFM
12
3
753.309
SUPERV:SION
DIFFICULTY
12
31
23
i
TRAIN:NC
23
4
20
06
92
60
26
33
00
60
33
30
00
36
89
80
36
33
30
63
36
00
00
38
86
11
03
60
63
08
03
60
3
22
11
22
636
61
011
36
025
36
33
28
28
22
628
11
17
66
61
29
08
22
014
22
17
17
63
14
619
06
617
72
28
36
17
2ii
14
11
14
33
11
88
33
314
78
'22
63
14
68
611
83
63
611
814
31
36
11
89
28
11
31
0i9
67
72
611
642
19
22
28
628
58
42
19
317
03
39
33
33
322
614
08
614
72
'28
11
014
03
25
17
63
6i4
68
00
25
31
44
56
Si
11
28
317
33
22
28
36
17
25
11
38
28
42
19
81
17
28
31
1425
36
25
50
66
25
44
11
cCoUPATIO1
ATTENOENTSEmT
CROUP
1:
46 Ea
12
1 E0
TASK
49
Usc a 3-foot spine board to
immobilize patient's spine to
transport
50
u:3c a 6-foot spine board to
im:obilize patient's spine to
transport
51
Usc nasal cannula to administer
w:ygen
52
Use mask to administer oxygen
53
Use a traction splint to treat
a lower extremity fracture
1
54
Use a pneumatic (air) splint
to immobilize a closed fracture
55 Use a padded board splint to
immobilize a fracture
56 Usc a sling to immobilize a
fractured arm or clavicle
57 Apply direct pressure tO
control hemmorrhage (bleeding)
58 Apply digital In 'ssure to
control hemorrhz o
59 Apply tourniquet to control
hemorrhage
60 Apply dressing to control
hemorrhage
TASK RESPONSES
POT OF NUMBER RESPONDING
TOTAL RESPONSE
36
PCT OF TOT
FREQUENCY
tcY
ASSIST
17
731209
SUPERVISION
OiFFICUI.TY
TRAINING
12
34
5PFM
12
31
23
12
31
23
4
36
19
44
28
72
.14
28
25
831
33
19
47
68
19
33
14
03
22
28
47
-53
1i
19
19
11
17
25
19
33
08
;.4
22
11
617
19
25
33
67
17
825
319
42
47
17
28
28
33
3
17
25
33
17
892
22
22
33
828
56
64
28
08
39
31
14
33
31
36
28
'72
11
17
39
328
39
22
50
0ii
25
33
6
68
42
31
14
86
14
19
50
63i
50
50
36
08
31
36
11
.3
619
22
50
.50
623
17
323
22
i9
28
311
828
6
30
33
36
28
'72
14
17
33
814
52
31
39
38
25
33
8
88
33
31
19
81
17
19
33
814
58
33
47
0is
25
31
17
33
11
47
36
64
819
33
68
44
19
44
011
i7
28
11
00
03
97
03
03
00
32
00
11
0
811
28
33
19
81
14
19
31
322
53
31
47
014
22
36
14
TASK RESPONSES
!,:CCUPAT:ONI
AT
TE
ND
EN
TS
rEM
T
CROUP
14
6 EC
12
1 EC
TASK
61 Ap7ly bandage
to secure
dressing to wound
62 Apply bandages to immobilize
afracture (e.g., ribs)
63 A,:
a sterile dressing to
treat a burn
6,-
-,pp_y cold wet applications to
trec:t a burn
65 Apply vaseline
cause or other
non-porous material to seal a
pneumothorax
66
Use a bulk dressing to
immobilize an impaled object
67 Use a constricting band to
treat a snakebite
65 Yakc an incision
over fang
narks and suck out snake
venom
69 Elevate the head and shoulders
of a patient who is having
difficulty in breathing
7° Use
an oropharangeal airway to
maintain a patent (open) airway
71 Usa
an oxygen demand valve to
c..: sister oxygen
72
an o::gen deand valve to
7)erfor7 internittent positive
pressure ventilation (=V)
PCT or NUMBER
TOTAL RESPONSE
36
rREOUENOY
TCT
12
34
5PVM
14
14
36
22
14
86
32
31
42
25
/5
30
17
53
28
72
02
14
36
50
50
32
633
58
42
00
644
50
.50
30
38
86
14
30
33
92
8
11
31
22
22
14
e6
06
36
39
17
81
814
33
22
22
-78
08
25
28
36
61
RESPONDING
PCT OF TOT
17
ASSIST
12
3
17
19
36
822
39
325
36
317
28
611
19
617
25
03
8
03
3
22
14
33
17
17
31
19
19
25
11
19
19
731209
SUPERVISION
DIFFICULTY
12
31
23
822
56
50
33
3
619
50
31
44
2
6i9
47
25
47
0
314
33
19
31
0
83
31
631
6
3it
36
833
9
33
83
83
30
63
60
325
58
56
31
0
628
47
31
50
0
825
44
39
36
3
628
25
17
36
6
i i4
i4
14 6 8 8 3 3 8
ii 6 8
TRAINING
23
28
31
25
33
22
36
i7
25
it
28
14
33
611
38
33
31
28
28
3i
36
22
17
4 14 8 6 6 6 3 0 0
14
17 8
14
CCCUPAT;n1
ATTENDENTS..EMT
tRC1JP
1:
46 EQ
12
1 E0
TASK
73
Use an S-tube airway adjunct
to perform IPPV
74
use an endotracheal tube to
maintain an open airway
75
Administer oxygen through
a m:isk
76 Admin'ster
oxygen through a
1-41sal cannula
77
.,
,,Lminister oxygen through an
oxyeen catheter
(7,
78 Administeroxygen through an
incubator system
79
.1:olger-::eilson (back
pressure-arm lift) method of re-
suscitation to ventilate patient
8?"Operate pressure-cycled, oxygen-
powered automatic mechanical
resuscitator to perform IPPV
84
Operate an o:eigen-powered,
rlanually triggered, mechanical
v,!ntilation device
62
.aintain body temperature and
elevate lower extremities to
treat patient for shock
83'freat a conscious patient who
has ingested a posion
84
Operate vehicle nlounted suction
to reove fluids from patient's
airway
TASK RESPONSES
PCT or NUMBER REsPcN0:NG
TOTAL RESPONSE
36
PCT OF TOT
17
FREQUENCY
Tr!
ASSIST
12
34
SPFM
12
3
731009
SUPERVISION
DIFFICULTY
12
31
23
i
TRAINING
23
4
00
814
75
'22
68
60
614
617
03
14
14
3
00
611
81
17
38
63
311
38
60
ja6
2
14
25
31
22
892
22
14
36
828
56
58
33
0ii
36
39
6
314
19
22
39
58
11
819
019
39
33
25
03
28
36
0
33
66
83
17
38
33
86
611
03
8it
0
00
025
75
25
68
it
6i4
614
83
022
60
00
03
97
33
00
30
00
30
06
80
30
011
86
14
36
63
38
68
00
86
3
63
25
25
42
88
322
22
822
28
31
25
36
23
28
0.
36
44
39
892
11
28
42
633
50
61
22
68
33
39
11
30
856
33
67
814
36
822
36
17
44
68
28
33
3
08
39
31
22
'78
11
22
31
322
53
19
53
63
36
36
6
nCUPA':TA,I
AE\OENTS-5M,
::RC.4°
1:
46 EC
12
1 CO
TASK 81
Operate portable suction unit
to remove fluids from patient's
airway
66
Administer patient's insulin
to treat a patient in a
di...
tic coma
87
Administer suuar or sugar
pr(Jduct to treat patient in
s::ock
88
cold applications to lower
patient's body temperature
89 Use warm Water (100-105 F) to
tr_at frostbite
cy.
co
92 Use a flashlight to examine
the pupillary reaction of a
patient
91 Use cold pack to treat injury
to soft tissue
92 7laintain drainage tubing without
suction (c.u., urinary catheter)
93 Perform an emerr,Tency childbirth
delivery
94 Place deceased patient in a
disaster pouch
91 Place deceased patient in
a shroud
96 Use restraint
straps to control
a combative patient
TASK RESPONSES
PCT OF wq;ER RESPONDING
TOTAL RESPONSE
36
PCT OF TOT
FRECUENCY
To,
ASSIST
12
34
5Firm
12
17
3
731209
SUPERVISION
)IFFICULTY
12
31
23
1
TRAINING
23
4
36
19
37
33
67
11
17
31
614
42
11
47
63
31
31
6
00
33
94
62
33
22
60
60
06
00
08
19
72
28
38
17
3t4
/1
11
i7
20
i7
14
3
00
619
75
25
314
81
617
IA
14
00
14
it
3
00
38
89
11
36
33
08
011
30
611.
0
622
28
25
19
61
17
17
28
3i9
58
53
25
36
3i
42
6
36
11
33
47
53
617
22
38
42
28
22
22
25
3
02
11
11
75
'22
38
30
617
11
11
03
ti
8-
3
00
339
58
42
617
17
3i4
25
323
14
225
19
3
00
628
67
33
011
19
0ii
22
22
66
017
11
11
00
622
72
28
011
14
06
22
14
86
019
11
3
00
19
58
22
78
11
22
42
11
39
28
342
33
044
25
11
TASK RESPONSES
CCCVP4Ti0N1
ATTrNDENTS,EMT
GRO'JP
14
6EC:
12
1 EO
TA
SK 97 Use a geiger
counter to detect
raUi,Ition level
99 Ocrate a !lydraulic lift
(I:cyer) to move patient
99 Perform cardiopulmonary
resus-
citation (CPR) without the use
(J.--life-support equipment
r'erfrm
with the use of
li:y-upport equipment
let
Operate a bag-valve mask unit
to porform intermittent positive
pre:;5u.re ventilation (IPPV)
1 0. kJ
122 Use a
bag-valve mask unit to
perfcr. =V
=03 Perform
out -to-:
method
mh
of .7:,7V
124 Perform mouth-to-nose nethod
oc
105 Use a sphyamomanometer and
stethoscope to obtain a patient's
blood pressure
106 Pia-e fingers
on patient's
wri,-;t to count radial pulse
107 Assemble
intravenous fluid
administration equipment
!XI 7er'orm
a venipuncture to
a,'minister intravenous fluids
PCT OF
ToTAL RESPONSE
FREGUENcI
12
34
22
33
00
60
20
19
56
00
22
47
23
22
42
33
17
25
20
14
42
00
331
11
22
39
19
11
39
33
8
00
617
00
03
NUMBER RESPONDING
36
PCT of TOT
TC7
ASSISI
5Pym
12
94
60
0
94
60
0
22
'75
819
28
69
617
33
67
317
53
47
66
44
56
611
67
.33
33
892
817
812
619
78
22
11
3
97
33
0
17
3
3 6
44
44
39
25
28
22
47
44 6 0
731009
SUPERVISION
12
3
00
3
03
3
825
42
11
19
36
622
39
814
22
333
36
22
322
67
617
61
811
3
03
0
0/FPICU4TY
12
3
23
0
06
0
847
19
11
42
17
11
53
3
11
33
3
14
36
3
822
56
33
3
58
28
3
814
0
03
2
i
Z 0 6 3 0 0 0 0 0 0 0 0
TRAINING
23
33
63
3i
36
31
33
25
44
25
22
28
25
it
19
33
50
36
42
811
4
0 0 8 3 3 6 3 8 8 6
CCCUPATICN1
AF.NCNTS,EmT
OROuP
11
TASK
46 Ec
12
1 EC
tlz
109 USe a syringe to administer
intravenous medications into
the 1.V. tubing
use a syringe to administer
intravenous medications
Ilt
'_;ea syrince to administer
intramuscular medications
112 Operate a defibrillator to
nister empirical defib-
rillation
t13 Operate an electrocardiograph
sco^c and recorder to observe
=p:-.tient's cardiac activity
1
--.1 o
114 Operate one -ray electrocar-
dio,.raph telemetry system to
transmit (=0 or ECG)
115 Onerate a two-way voice
communication radio
116 Answer telephone to receive
reouests for ambulance service
117 7crform minor mechanical
maintenance on emergency
meCical eTuipment
ilte Perform building maintenance
on nllysical facility
119 Re-Place (x.v.igen tan: in vehicle
127 Rofill oxygen tanks with
compressed oxygen
TASK RESPONSES
POT OF NUMEER REsPoNoINC
TOTAL RESPONSE
FRECUENCT
12
34
36
5To,
PFm
PCT OF TOT
ASSIST
12
17
3
731229
SUPERVISION
DIFFICULTY
12
31
23
i
TRAINING
23
4
00
03
97
3.
32
02
32
03
00
06
0
00
00
121
02
00
00
00
00
00
32
00
00
120
00
00
00
00
00
00
30
00
311
86
14
80
66
88
811
30
311
0
28
17
867
33
811
86
14
14
11
22
80
819
6
03
14
11
69
28
86
11
11
88
325
20
617
6
50
22
25
03
97
811
56
319
72
75
17
3ii
44
19
19
14
22
33
11
19
81
11
14
33
317
58
53
22
3ii
33
14-
19
11
819
25
33
64
814
31
025
31
31
28
2ii
1:9
419
14
11
14
853
47
e14
28
017
3i
39
62
0i4
314
38
33
33
22
78
14
17
39
322
53
58
.19
36
33
11
28
33
68
78
19
30
11
30
17
19
00
014
36
OCC:.:PAT:ONI
ATTEN:"ENTS-Em7
t4
6 EO
12
1 EO
TASK RESPOkSES
PCT OF NU:4mER RESPoNOING
TOTAL PESPOtiSE
36
PC, OF TOT
17
731229
TAS.<
1
121 wxt-=cite an entrapped patient
0
122 greet traffic at scene of
0
ascident
123
,:se highway flares to control
0
tr,Iff-i_c at accident scene
124
portable floodlichts to
3
ill .._nape work area
125
, .nstruct patient's family how
to care for patient at home
1
128 1yaluate c:uality of training
pro,:ram
2 2
127
Cond..,:ct on-the-job training
3
sesr;ions
125
Con,
ct formal classes to in-
2lu
5truct individuals in emergency
mec:Ical care techniques
129
se an orthopedic stretcher
6U to transport a patient
137
7..;:;0a variable positionstretcher"
to transport a patient
131
Use a stretcher composed of
3
rubberized canvas on an aluminum
frame to transport a patient
132
err zed stretcher to
0ilne ruhb
pond a patient fror, the
ceiling of an ambulance
FRFOVENCY
TDT
ASSIST
SUPERVISION
DIFFICULTY
TRAINING
23
45
PF
12
31
23
12
31
23
4
031
47
22
78
625
44
836
31
853
17
836
25
8
014
25
58
39
a8
17
017
22
22
17
06
17
88
317
36
44
36
68
25
014
39
33
14
6ii
25
314
319
39
36
64
617
28
021
33
36
19
3i4
25
811
36
883
17
66
00
611
88
73
311
3
26
14
81
19
211
80
19
23
14
32
11
36
617
14
61
.39
617
14
617
17
17
19
36
14
11
8
614
11
69
31
611
11
611
14
14
17
g3
ii
17
0
11
25
39
19
81
11
19
44
631
42
31
42
33
39
36
3
17
31
14
14
86
11
22
44
631
47
44
33
36
39
28
11
614
28
50
50
619
22
322
25
22
28
73
28
19
3
03
31
67
33
011
17
011
22
11
17
63
22
86
TOTAL RESPONSES
PCT OF NUMBER RESPONDING
ATTENDANT - NON-REGISTERED EMT
OCCUPATION,
ATTENCENTs.EmT
ORCuP
14
6 EO
12
1 CO
TASK
133
Use a chair stretcher to
transport a patient
134 Use a chair to transport
a patient
135
Use a wheelchair to transport
a eatient
136
Drive an emergency medical
vehicle to transport a patient
under non-emergency conditions
137
Drive an emergency medical
vehicle to transport a patient.
wusing emerency warning devices
-..,
KJ
138
Operate a fire control device
(fire extinguisher) to
extinguish a fire
139
Use a watercraft to transport
a patient
142
Us; a fixed wing aircraft
(airplane) to transport
a patient
.
141
Use a rotary wing aircraft
(helicopter) to transport
.
a patient
TASK RESPONSES
'CT CF NUMBER RESPONDING
TOTAL RESPONSE
36
PCT OF TOT
FREOuENCY
TcT
ASSIST
12
34
5PPM
12
17
3
731009
SUPERvISION
DIFFICULTY
12
31
23
i
TRAIN:NC
23
4
86
23
36
22
78
.8
17
47
325
47
33
42
06
33
19
14
03
22
36
36
61
68
42
322
33
31
28
06
25
19
14
00
825
67
,33
03
19
06
25
17
14
08
li
14
8
17
17
25
831
67
88
28
3i9
42
36
28
06
33
14
14
19
11
31
828
69
11
331
817
42
25
36
36
si
17
11
011
11
28
50
10
11
628
814
22
31
17
0ii
14
14
11
00
30
97
30
03
00
30
30
03
30
Z0
30
97
30
03
00
30
30
03
00
00
33
94
60
06
03
30
60
06
00
TASK RESPONSES
PCT OP NUMBER RESPONDING
OCCUPATION,
ATTENDENT.NON EMT
TOTAL RESPONSE
89
PCT OF TOT
42
731009
ORCUP
2i
46 ED
12
1 NE
TASK
1
,
Set standard type and quantity
7
of eme7:ency medical equipment
needed for unit operation.
2Inventory type and quantity of
4
er.erency medical equipment to
deterine need for replacementoetc.
3:'_ice
'_ice emergency medical equipment
in assigned location
4Set standard
ypc and quantity
4t
of emergency medical supplies
needed for unit operation
Inventory type and quantity of
3
emergency medical supplies to
determine need for resupply
Pl6ce emergency medical supplies
9
in assigned location
7Set standard type and quantity
0
of drugs and intravenous (I.V.)
fields needed for unit operation
SInventory type and quantity of
1
dru,:js and I.V. fluids to determine
need for resupply or new supplies
9Place drugs and I.V. fluids in
0
assigned location
12
4Set standard type and amount of
office supplies needed for
unit operation
11
2Inventory tyne and amount of
office supplies to determine
need for resupply or new supplies
12
l c
office supplies in
2Pae
aenitITned location
FREQUENCY
TOT
ASS:ST
SUPERVISION
DIFFICULTY
TRAINING
23
45
PFM
12
31
23
12
3i
23
4
11
17
15
46
49
.13
328
925
626
20
0i9
17
13
7
11
21
24
36
,61
.11
934
625
20
40
15
016
22
613
17
37
19
13
84
16
15
48
11
33
29
56
24
0/5
31
82:
716
13
52
40
10
422
04
21
12
116
911
10
19
25
38
;57
15
830
524
12
29
19
2f
24
10
13
17
33
22
15
81
18
748
832
2/
63
10
0if
30
624
13
191
61
04
2i
11
40
22
24
21
092
41
03
21
00
40
2i
22
22
191
63
02
11
34,
10
3i
22
14
780
17
63
61
76
87
0f
16
23
882
16
82
31
83
86
03
/1
3
26
10
78
20
92
71
97
15
40
82
7
OCCUPAT:CNI
t:ROUP
2
TASK
w
ATENEENTNON EMT
46
.12
1 NE
13
Design emergency medical
equipment such as a special
splint
or vehicle floor plan
14
Zxamine physical facilities to
determine need for expansion
or construction
15
l're!,are buduet for operation
of 'nit
16 Assivn crew and vehicle to res-
pon,:, to ambulance call based
upon the nature of the call
17 Survey type and quantity of
cerciency medical equipment
available for purchase
is naintain personnel records
19 Prepare payroll for unit
employees
22 Prepare financial
report of
unit operation
21 r.,xaine record of service to
patient to bill patient
for service
22 naintain accounting records
23 maintain records of
patients
serviced
24 0T)erate a
typewriter
TASK RESPONSES
PCT OF NUMBER RESPONDING
TOTAL RESPONSE
PREOUENct
12
34
89
5tCT
)17!A
PCT OF TOT
ASSIST
12
42
3
731009
SUPERVISION
DIFFICULTY
12
31
23
i
TRAINING
23
4
10
213
80
17
43
64
63
111
24
41
6
0i
015
80
16
62
73
/2
29
24
22
7
10
e10
87
11
82
22
83
14
34
31
3
32
418
70
'28
96
82
i0
10
15
73
212
611
00
124
72
'25
83
88
43
87
23
23
10
21
19
83
13
4S
22
32
34
02
43
3
00
00
94
00
00
00
00
00
00
20
00
03
91
30
20
10
2, ...
01
01.
S2
00
22
92
41
11
2i
i2
18
23
1
00
00
94
00
00
00
00
00
02
10
46
79
70
'26
68
83
910
17 ,
60
2i0
76
31
810
74
'22
73
31
415
16
31
i3
26
OCCVPAT:CN1
GROUP
2;
TAS,
AT
TE
ND
EN
T.N
ON
Em
T
46
12
1
25 nairtain records of maint
-
:-:,'
perored en emergency meaical
equipment
26 Complete information required
by special form to report
acc.:_dent
27 Coplete information required
by :;pecial form to report
amulance trip
28 Complete information required
by special forms other than
those listed above
29 1::xaine record of service
to
patient to determine charges
mto patient
i vi
32 1Zecord analysis of ambulance
trips to determine such things
as type of service provided, etc.
3: Crate and maintain on-call
roster of staff required to
operate unit
32 Conduct meetings with hospital
representative Cs) to coordinate
emergency medical services
33 ConConduct meetings with
unit personnel
34
Oevelop policies or procedures
to provide guidelines for daily
operation of the unit
35
Dcelop and on-the-job training
program
Z6
Conduct interview to determine
if applicant meets standards
for employment
TASK RESPONSES
POT OF NUMBER RESPONDING
TOTAL RESPONSE
89
PCT oF TOT
42
731009
'vISION
DIFFICULTY
23
/2
3
'7RANINC
12
34
2.,,
Z17
,3
':.-
71
67
04
62
2
23
16
15
62
.36
88
13
311
16
24
80
6i6
29
915
30
21
225
13
18
36
824
35
56
12
0i3
28
10
16
16
682
13
71
24
22
64
02
63
1
00
30
93
31
01
0r J.
10
20
03
30
73
43
79
18
39
41
96
10
60
2i0
3.7
00
34
89
62
21
13
24
21
1t
34
01
19
87
11
13
32
33
33
23
23
4
10
826
64
:35
99
96
1 5
78
18
14
ii
47
01
317
75
'21
91
72
ii
32
12
22
83
8
12
211
79
17
Es
32
38
22
92
it
32
6
01
12
92
40
30
11
01
2i
3I.
OCCUPATION'
ATTENOENTwNON EMT
CRCUP
21
46 EC
12
1 NE
TASK
37 Administer test to determine
if applicant meets standards
for employment
33 Evaluate unit personnel to
determine progress, raises,
discipline and promotion
39 Determine staff required to
operate unit effectively in any
specific time period
40 Explain general hospital
procedures to patient or family
41 Inform patient's family of
patient's general condition
42 Inform patient's attending
physician of patient's death
43 Inform Coroner's office of
patient's death
44 Use an emisis basin in treating
nauseated patient
45 Use a urinal to provide the
patient with an opportunity to
urinate
46 Use a bedpan to provide
the
patient with an opportunity to
defecate
47 Use sandbags to immobilize
patient's
cervical spine (neck)
48 Use a cervical collar to
immobilize patient's neck
'ASK REspcNses
for er v,:Y9ER
TOTAL RESON.SE
cF
FRE
C:;E
NC
Y2
34
07.
2
42
3
731009
SUPERVISION
I2
3DIFFICULTY
12
3TRAIN:NC
i2
34
27
21
32
41
20
61
00
7,7.!
17
22
11
22
2
11
07
86
92
21
3i
23
02
23
11
911
75
22
46
10
910
812
18
43
9
11
920
65
31
10
313
0i0
20
918
39
94
12
13
e8
84
12
31
32
34
26
22
34
3
32
113
78
20
31
8i
3'
67
23
84
4
13
15
47
30
66
12
12
28
0ii
47
34
24
313
23
13
16
11
428
645
12
10
28
19
16
11
38
ii
12
6
01
120
76
22
76
7i
7SO
97
36
94
31
644
45
54
15
18
17
12
i9
19
13,
33
419
12
18
a
21
352
408
924
20
72i
22
12
33
620
it
20
8
TASK RESPONSES
PCT Or NUMBER RESPONO:NG
OCCuPAT:CN1
ATTENOENT.NON EMT
TOTAL RESPONSE
89
PCT or ToT
42
131229
GROUP
2:
46 EC
12
i NE
TASK
FREQUENCY
tr7m
ASSIST
TERy2!ST
017F;CUL.T3T
i2
34
TRAINING
49
Use a 3-foot spine board to
immobilize
transport
52
Use a G-foot spine board to
immobilize patient's some to
transport
51 use nasal cannula
to administer
oxygen
52 use mask to administer
oxygen
53 Use a traction
splint to treat
a lower extremity fracture
54 Use a pneumatic
(air) splint
to immobilize a closed fracture
55 Use a
padded board splint to
immobilize a fracture
56 use a
sling to immobilize a
fractured arm or clavicle
57Apply direct pressure to
control hermorrbacTe (bleeding)
58Apply digital pressure to
control hemorrhage
"Apply tourniquet to control
hemorrhage
62Apply dressing to control
hemorrhage
patient's spine to
21
744
45
54
12
17
18
12
18
16
730
921
11
136
56
39
912
12
815
12
325
6i*
42
729
54
43
911
15
317
17
30
12
015
710
31
40
989
22
22
31
12
34
37
63
21
22*
1.
11
919
62
07
11
10
213
1/
919
01R
12
28
31
35
36
2ie
23
22
46
21
76
17
28
27
11
434
56
42
11
13
13
319
13
16
22
122
21
345
45
52
so
17
18
i22
22
22
24
12*
63
19
49
21
78
16
17
34
727
35
34
33
428
21
934
48
46
10
12
17
615
22
2S
1*
425
00
09
88
91
13
00
41
30
15
32
22
45
26
'73
20
18
27
624
35
36
29
12*
15
20
8
10
19
3
1f.
18
4
28
24
4
13
15
3
22
24
6 -
13
17
1
16
18.
0
18
25
6
819
2
210
I
15
27
8
TASK RESPONSES
PCT OF NUMBER RESPONDING
OCCUP4T:CNI
ATTENOEvT +NON EMT
CROUP
21
46 EO
12
1 NE
TASK
TOTAL RESPONSE
FREQUENCY
89
TCT
PCT OF TOT
42
ASS:ST
731209
SUPERvISION
DIFFICULTY
TRAINING
12
34
5DPI
12
31
23
12
3i
23
4
61 Apply bandage to secure
dressing to wound
42
29
48
15
84
18
25
29
737
31
48
33
029
21
24
8
62
Anpl'! bandages to immobilize a
fracture (e.g., ribs)
02
842
45
52
16
12
22
618
2t
24
22
227
724
1
L:-5
Apply a sterile dressing to
treat a burn
21
347
44
54
920
18
817
26
13
36
227
10
22
4
Apply cold wet applications to
treat a burn
02
131
63
35
12
12
84
15
12
16
17
124
917
i
65
Apply vaseline gauze or other
nen-porous material to seal a
pnemetherax
00
06
92
62
20
31
11
30
15
210
1
CO
66 Use a _,u1::
dressing to
imm.obilize an impaled object
10
010
87
11
16
11
24
06
2i3
315
0
67 Usc a
constricting band to
treat a snaebite
00
04
92
41
30
03
01
21
i6
213
0
63 rake an incision
over fang
marks and such out snal:c
venom
00
02
94
21
i0
00
i2
20
13
210
0
69
Elevate the head and shoulders
of a patient who is having
difficulty in breathing
66
29
38
20
79
22
21
25
826
34
42
29
126
2i
19
12
77
Use an oropharangeal airway to
maintain a patent (open) airway
11
13
38
43
,54
12
18
13
9i5
25
16
27
624
11
21
6
71 Use
an oxygen demand valve to
administer oxygen
41
13
37
40
56
13
16
16
4i9
26
31
21
124
12
19
6
72
Use an oxygen demand valve to
31
721
62
33
411
12
2il
18
16
13
2i7
/16
3
perform intermittent positive
pressure ventilation (IPPV)
OCCUPATION,
ATTENOENT;NON EMT
GROUP
2:
46 E0
12
1 NE
TASK
73
Use an S-tube airway adjunct
to perform :PPV
74
Use an endotracheal tube to
maintain an open airway
71
Administer oxygen through
a mask
76 Administer oxygen through a
nasal cannula
77 Administer oxygen through an
,oxygen catheter
75 Administer oxygen through an
incubator system
79 Administer Holger-Neilson (back
pressure-arm lift) method of re-
suscitation to ventilate patient
82 Operate pressure-cycled,
oxygen-
pm;ered automatic nechanical
resuscitator to perform IPPV
ei Operate an oxygen-powered,
manually triggered, mechanical
ventilation device
82 naintain body temperature and
elevate lower extremities to
treat patient for shock
83 Treat a conscious T,atient who
has ingested a posion
84 Operate vehicle mounted suction
to remove fluids from patient's
airway
TASK RESPONSES
PCT CF NU",EIER RESPONDING
TOTA*6 RESPONSE
89
PCT OF TOT
FREQUENCY
tOT
ASSIST
12
34
5prm
12
42
3
7312309
SUPERVISION
12
3DIFFICULTY
12
3
TRAINING
12
34
20
318
74
24
48
42
89
615
00
612
1
00
06
98
61
21
0i
31
40
63
90
83
29
46
11
87
23
19
27
9323
38
51
33
029
26
22
7
33
621
61
34
89
10
28
17
21
11
013
913
2
01
06
88
72
41
03
22
31
82
le
0
00
16
89
72
11
i1
22
30
11
72
02
06
90
62
i1
21
10
210
69
1
11
320
78
26
69
34
710
612
3i2
811
2
41
416
78
26
68
92
913
12
12
g8
815
2
42
18
51
24
75
15
21
29
1/
29
3i
38
35
g3.
26
22
7
21
224
72
27
68
84
812
70
119
12
15
1
0i
639
51
46
ii
15
12
911
21
12
27
421
16
16
6
OCCUPATITN1
ATTENOENT,NON EMT
CROUP
21
46 E0
12
1 NE
TASK 81 Operate portable suction unit
to remove fluids from patient's
air.,-ay
86
Administer patient's insulin
to treat a patient in a
diobetic coma
87
F.dminister sugar or suoar
product to treat patient in
insulin shock
81
1,:: ;c cold applications to lower
patient's body temperature
89
',:se warm water (100-105 F)
to
treat frostbite
092
Use a flashlight to e::amine
the pupillary reaction of a
dent
91
use cold pack to treat injury
to soft tissue
92
:7aintain drainage tubing without
suction (e.g., urinary catheter)
93
Perform an emergency childbirth
delivery
94
Place deceased patient in a
disaster pouch
95
Place deceased patient in
a shroud
96
Use restraint straps to control
a combative patient
TASK PESPONSES
PCT OF NumBER RESPONDING
TOTAL RESPONSE
89
PCT or Tor
42
731729
FREQUENCY
TOT
ASSIST
SUPERVISION
DIFFICULTY
TRAINING
12
34
50FM
12
31
23
12
3i
23
4
01
436
56
42
615
15
717
22
12
22
4jj'
15
17
4
20
04
92
41
1i
01
I.
23
24
17
1
10
120
74
22
79
33
79
911
2ii
911
4
10
i17
79
i9
47
22
69
89
217
815
1
00
07
92
72
20
02
33
20
12
212
0
31
12
44
38
61
12
ii
21
8i5
33
39
18
220
19
20
4
01
637
52
44
10
916
313
25
33
10
016
16
16
3
01
06
89
70
21
04
32
02
28
2
00
012
83
12
64
27
06
13
7i3
915
1
21
027
67
28
87
10
213
97
16
210
97
8
01
013
80
15
26
71
12
34
91
82
67
10
246
47
49
12
19
16
11
15
21
722
22
19
22
16
9
OCCUPATION,
ATTENOENT-NON
CROUP
2;
46 EO
12
1 NE
TASK 97
Use a geiger counter to detect
radiation level
98
Operate a hydraulic lift
(':over) to move patient
TASK RESPONSES
PCT OF NUMBER RESPONDING
TOTAL RESPONSE
89
PCT CF TOT
42
731.229
FFEOUENCT
12
34
7CT
5PFM
ASSIST
SUPEgVIS!ON
DIFFICULTY
TRAIN!NC
12
31
23
i2
3i
23
4
03
02
93
20
10
02
21
03
26
1
00
02
93
20
02
22
00
i1
22
6
99
Perform cardiopulmonary resus-
01
739
49
47
917
19
815
22
329
14
18
17
19
1citation (CPa) without the use
of life-support equipment
1Z
Perform CP:: with the use of
21
636
51
45
913
20
12
10
25
624
15
0 17
21
2
life-support equipment
121
Operate a bag-valve mask unit
C1
635
54
42
71i
17
417
19
i2
25
318
it
15
2
to perform intermittent positive
mpressure ventilation (IPPV)
1 m ),,.,
122
U!;,..!a bag-valve mask unit to
01
23
88
72
03
13
12
3g
84
91
perform IPPV
123
Perform mouth-to-mouth method
of IPPV
iez
Perform
outh-to-nose method
of IPPV
10
131
62
34
310
12
49
19
918
522
12
16
i
10
03
90
40
12
11
23
g13
48
i
105
Use a sphycmomanometer and
13
16
28
47
48
413
16
211
33
26
17
321
16
17
2stethoscope to obtain a patient's
blood pressure
126
Place fingers on patient's
wrist to count radial pulse
IC7
Assemble intravenous fluid
administration equipment
103
Perform a venipuncture to
administer intravenous fluids
311
20
46
16
81
10
25
22
722
44
47
27
333
2i
21
7
00
06
89
62
01
02
34
10
41
1.
01
01
92
20
11
20
22
00
21
1
OCCUPATION,
ATTENCENT-NON EmT
CROUP
2i
46 EC
12
1 NE
TASK
109
Use a syringe to administer
intravenous medications into
the I.V. tubing
110
Use a syringe to administer
intravenous medications
111
Use e syringe to administer
intramuscular medications
112
Operate a defibrillator to
administer empirical defib-
rillation
113
Operate an electrocardiograph
scope and recorder to ohuerve
patient's cardiac activity
N tv
114
Operate one-way electrocar-
diograph telemetry system to
transmit (UUG or UCO)
115
Operate a two-way voice
com:1unication radio
116
Answer telephone to receive
rec:uests for ambulance service
117
Perform minor mechanical
maintenance on emergency
medical equipment
115
Perform building maintenance
on phynical facility
119
:cal ace oxygen tank in vehicle
120
fill oxygen tanks with
compressed oxygen
TASK RESPONSES
PCT OF NUMBER RESPONDING
TOTAL RESPONSE
FREOUENOY
12
34
89
5
TCT
PFM
PCT OF TCT
ASSIST
12
42
3
731009
SUPERVISION
DIFFICULTY
12
31
23
1
TRAINING
23
4
00
01
93
12
10
22
11
00
21
10
00
01
93
10
10
02
11
20
2i
10
00
01
96
12
00
02
20
a0
2a
00
01
96
12
21
22
t1
2212021
01
41
90
7Z
14
12
33
32
32
21
00
11
94
20
02
0i
11
Z1
20
ii
13
17
33
29
792
11
17
43
419
57
75
12
125
33
919
48
18
37
29
67
913
28
439
52
12
118
22
218
23
822
60
36
911
12
411
17
19
15
011
12
66
14
324
63
33
68
12
39
15
18
80
815
24
36
10
47
31
66
917
29
7iS
37
53,
10
021
26
912
32
716
69
28
49
11
66
16
21
60
913
64
TASK RESPONSES
OCCUPATION;
ATTENCENT,NON E!AT
CROUP
2a
46 E0
12
1 NE
TASK
PCT OP NU"IPER
TOTAL RESPONSE
89
FREQUENCY
TCT
RESPONDING
PCT OF TOT
42
ASSIST
73.009
SUPERVISION
OIFF:CULTY
TRION:NG
12
34
5ppm
12
31
23
12
3i
23
4
121
Extricate an entrapped patient
01
252
39
55
13
11
26
15
25
13
133
18
19
21
12
7
122
Direct traffic at scene of
accident
00
533
58
36
13
611
119
12
13
20
RI
13
13
210
123
Use highway flares to control
traffic at accident scene
10
11
30
52
43
910
16
120
17
24
13
115
19
39
124
Use portable floodlights to
illuminate work area
01
838
48
47
10
820
225
15
30
15
018
18
69
125
Instruct patient's family how
to care for patient at home
00
08
87
80
22
03
i2
2g
32
20
...
co
L.,
126
Evaluate quality of training
ro(jram
00
19
82
10
24
22
24
17
18
31
0
127
Conduct on-the-job training
sessions
20
217
74
21
97
34
96
713
015
41
1
128
Conduct formal classes to in-
struct individuals in emerency
medical care techniques
10
220
71
24
313
30
12
10
416
116
34
0
129
,:se an orthopedic stretcher
to transport a patient
14
15
47
29
67
13
19
29
626
31
30
34
125
i9
19
3
132
Use a variable position stretcher
to transport a patient
79
24
36
19
75
15
19
33
728
35
47
21
126
26
12
8
131
Use a stretcher composed of
rubberized canvas on an aluminum
frame to transport a patient
71
928
51
45
710
24
219
21
25,
18
013
22
11
6
132
U::e raL,1)erized stretcher to
10
025
72
26
69
73
11
99
12
18
17
34
per..7.Ct patient from the
ceilin,:j of ca ambulance
CCCUPATICN1
A'TENCENT,NON EMT
GROUP
2t
46 EO
12
1 NE
TASK
133
Use a chair stretcher to
transport a patient
134
',:se a chair to transport
a patient
135
Use a wheelchair to transport
a patient
136
Drive an emergency medical
ve.icle to transport a patient
under non-emergency conditions
13?
Drive an emercency medical
ve!liele to transport a patient
emeraency warning devices
138
Operate a fire control device
(fire extinquisller) to
ex.tinguish a fire
139
Use a watercraft to transport
a patient
142
Use a fixed wing aircraft
(airplane) to transport
a patient
141
t'se a rotary wing aircraft
(helicopter) to transport
a patient
TOTAL
TASK PESPONSES
PCT CF NUMBER RESPONDING
RESPONSE
89
PCT Or TOT
42
731009
FREQUENCY
TCT
ASSIST
SuPERv1S10N
DIFFICULTY
TRAINING
12
34
5PFM
12
31
23
12
31
23
4
24
451
35
62
13
19
25
728
22
28
29
220
29
12
4
01
729
58
37
312
19
215
13
15
16
3it
20
86
02
/20
71
24
19
82
612
15
70
12
12
62
62
12
22
56
40
310
13
211
24
29
12
0ii
15
98
44
12
19
55
40
111
16
012
25
24
15
1i2
12
810
02
838
46
48
617
11
6i9
22
28
17
if
,9
15
711
01
11
92
30
02
0i
22
01
60
31
00
00
96
00
00
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APPENDIX C
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APPENDIX D
TASK DESCRIPTION
IYMPATCI1
EXPLANATI=
1. Ans,....er telephone to receive areciuest for apbulanco serviceand/or e::::rgenc:., care withoutallowing the telephone to ringmore than two times. The firstwords spo } :en by the dispatchershould be clear (e.g., "Ambul-ance Service") .
2. Gather inforpation from callerabout the liationt, the incidntor condit:;.ons resuitintaj in thecallers porception of the needfor an ar])ulo,nce and the loca-tion of the potential patient.Infois3ation yathere6 :lust in-
A. phone nuLber of caller;23. uft,':e O patient (if known) ;C. specific location of the
patient, incluc:i.nca the streetacre s, or in an
auto accident, the nearestintorsectien or other land-F.larh;
D. callers percoption of thenature of the patient'sprolflel;specifics concornini thepatiet's vital si(jns (i.e.,is the vitient 1)rethincj,blee(Unc! :n con :;cious
or in severe pih). If anyof the listed prchle:isLoop 1;
. ha:_e of the patient's Coc'Llor(if knon);
B-1
Assumes that the following items areavailable:
A. a telephone system for receivingrequests for emergency care;
B. a radio systeLl for dispatch controlC. writing implement and paper;D. crew members "on call" to respond
to requests for ambulance service;and,
E. ambulance vehicles to respond.
The telephone should be answered insuch a manner that it is obvious tothe individual requesting service thatthe number he has reached is in factan ambulance service.(See Note 1)
The pethod used to gather the infor-mation is post often a series ofshort questions asl:ed by the dispatcher.As the call for an ambulance is re-ceived, the Ferson calling may vol-unteer Post of the necessary infor-mation and the dispatcher must gatherand record that information as rapidlyas possible. The information gatheredmust be recorded in soe mannei. Iftape recording equipment is available,each call should he taped in ordJr toserve as a bacl:up record if some in-forpation is lost or not gathered atall. The dispatcher should alwaysrecord in writing all vital info-nation relating to the patient's con-dition and location as well as thetire of all activities relating : :odispatching a crew and vehicle.(:The ::ote 2)A special lad of nailer is helpfulin provi(ling (TuiCance to the cli:--patcher in ohtainjng X l l the 11r(,!;-f.;,71ry infor,Jotio.(nee note 3)In all telephone con-:orstjon, itadvisal)ie that the dis,patchor fine Olt
G. tiio that the call wasreceived;
H. t.ie nd Cate for v..hiehanbulance service is re-quested (If app:opriate);
I. tine that the incidentoccured (3.3: appropriateand/or pos3;ible).
3. Deter:line 1711il1: the nature ofthe i,a,y he, 1---;;.:(.1 uponthe infornation cjatheredthe caller. (I f orcblcIn is
Loop 2;If )aLient: 15 dead, Loop 3)
4. 1.3ecide that an anbulance isrecluired to transport: oatient.(If an a.:.:],ulance is not recy,dred,Loop 4 ; f c inpetch inq for 2.,.orethan I service, Loop 5).Infon-q eel jar of the esti:late(.1tine of arrival and eupJain anyanticipatdd(I f call rc.!.quires Coroner, Loop 6)
G. Dete-;:-.ine if this call is enrev a] 1 i
fort atin:: e mien Lhe call.on
fact that Cs..f..! cr: Lori--; foran .(-,:'r,jer.c" i if theconCition a "lie-thrLat-enin" nature.
7.
at
i.f ,,, )
P 7)
the nal...le of the caller and use thecal lu r' s sheuind a nore personal
the caller. All infor-be an accurate an pos-
interest innation L.tintsible.(Soo Note 4)
The dispatcher may have to cc; binnall inforf-lation received fron thecaller in an utcei.tpt to deterninethe true nature of the patient'sp-roble31.(See Note 5)
If there in any indication that: anaylbulance is needed, it is hest todispatch a crel.,: and vehicle.
If an a.:-....huriance in to he 1-a.i.c.::."3.eda.3-3
51tt:TtOe neatto
if La c.):-!s not
(cc-= !:ote 6)
a life-thLe,tenincj P:=.0rnencie::int in :hich the
in iT.JJ:76iet(_: (_:oncir2r
rocei':e
that a li.st in 1,.aintainedhich cont.::,.inn the na:ies and locatic,ns
of al] nhlvnTIain sulject as
,:hat all 0:) W] uscFCc outlin-:(1 in
Pu],1ic
-1.hat all (2)-(.-.%;
ed,nal of and
::ote
ELEMENTS
8. Contact the necessary crewmembers which have been select-ed by using phone, portal?le radiohome monitor system or by speak-ing to the crew directly ifthey are in the same locationas the dispatcher. Informthose crew merbers at that timeof the information necessary forthem to respond:
A. nature of call;B. name of patient (if
available);C. the exact location of the
call;D. any special conditions which
may affect travel to thescene.
9. Monitor communication of themobile unit (ambulance) bylistening to any communicationbetween:
A. the ambulance(s) dispatchedand any other vehicle crewswith whom they may communi-cate;
B. the ambulance(s) dispatchedand any other base station;
C. the ambulance(s) dispatchedand any hospital.
10. Receive, acknowledge and recordcommunication from mobile unitswhen transmissions indicate thatthey have:
A. departed base and are movingto the scene;
B. arrived at the scene;C. departed the scene and are
moving to their destination(e.g., hospital or restnome);
EXPLANATIONS =7
It is important for the EMT to knowthe nature of the call for tworeasons:
A. to know if the response to therequest requires travel underemergency conditions using emer-gency warning devices;
. to be able to anticipate the sit-uation to be encountered at thescene and prepare for tasks to beperformed at the scene whileen route.
It is important for the dispatcherto be aware of what is occurringin the field which may have an affecton the ambulance(s) dispatched. Any-thing which might occur may have anaffect on future decisions to be madeby the dispatcher. The following in-formation is important to the dis-patcher.
A. location of all vehicles;B. location of all crew members;C. status of crew (i.e., do they
have a patient);D. are crew and vehicle ready for
service.
The dispatcher should record time atwhich these transmissions are receivedto provide a permanent record of theseaspects of an ambulance call. Oneof the most common complaints re-ceived by those people providing am-bulance service is based upon "responsetime" or the length of time requiredto get an ambulance to tile patient.By recording the time the call wasreceived and all of the informationin Element #10, it is possible to
D-3
ELMENTS
D. arrived at their destin-ation;
E. departed their destinationand are returning to base;
P. finished call and are readyfor service.
EXPLANATIONS
determine exact response time andsupport or refute any claims ofslow ambulance service.(See Note 8)
D-4
LOOP 1
ELEMENTS
1. Determine what illness orinjury symptoms nay hetreated or alleviated by thecaller when given proper in-struction by the dispatcher.
2. Provide instruction to thecaller in very simple termsconcerning emergency caretechniques (e.g., airwaymaintenance, mouth-to-mouth,resuscitation, control ofhemorrhage),(Go to Element #2,F)
EXPLANATIONS
The dispatcher should usually obtainlocation information before attemptingto instruct the caller in any emer-gency care procedures so that a crewmay be dispatched as soon as possible.In that way the crew may be enroutewhile the dispatcher instructs thecaller.
D-5
LOOP 2
ELEMENTS EXPLANATIONS
1. Ask caller if the patient hasconsented to admission toeither a medical or psychiatrichospital. (If patient has con-sented to admission, go toElement 4)
2. If patient mist be involun-tarily committed, ask callerif the local office of theBureau of Mental Health andMental Retardation has beencontacted in reference to aninvoluntary emergency commit-ment. (If this has been done,go to Element 44)
3. If the proper procedures havenot been followed, inform thecaller of those procedures toprovide assistance as necessary(e.g., provide caller with thenecessary phone number).(Go to End)
D-6
Under the Pennsylvania Mental Healthand Mental Retardation Act of 1966,an involuntary oldergency commitmentcan only occur if a MIHER Form 1405 iscompleted and signed. The only waythat form can be completed is if itcan be certified that:
A. the patient has threatened anotherindividual's life, or;
B. the patient has threatened totake his own life.
LOOP 3
ELEMENTS EXPLANATIONS
1. Determine probable cause orconditions surrounding deathby gathering information suchas:
A. brief medical history;B. caller's perception of
cause of death;C. approximate time of death;D. where patient died.(Go to Element 04)
a
By gathering information concerningthe conditions surrounding thepatient's death, the dispatcher willbe able to determine what auxiliaryservices may ho needed (e.g., coronerpolice or funeral director) and whatother actions should be taken by theambulance service.
D-7
LOOP 4
ELEMENTS EXPLANATIONS
1. Suggest appropriate alternativemethod of transportation tocaller (e.g., taxi, conval-escent coach, relative's car,hearse).
2. Provide caller with assistancenecessary (i.e., appropriatephone numbers) Go to End.
It may be necessary to explain tothe caller, the reasonthat anambulance cannot provide the servicerequested (e.g., an otherwise healthypatient: needs a ride to the hospitalto have a cast removed from his arm).This explanation will be based onlocal policy within an ambulanceservice.
D-8
LOOP 5
ELEMENTS EXPLANATION
1. Determine which ambulanceservice should take the callbased upon:
A. location of patient;B. location of ambulance
services;C. nature of call;D. type of service provided
by various ambulanceservices;
E. availability of crewsand/or vehicles;
F. whose turn it is.(Go to Element #5)
D-9
There may be territorial boundarieswhich must be considered when dis-patching two or more ambulance servicesin the same general area. If theseboundaries exist, it is the obligationof the dispatcher to be aware of thoseboundaries and observe them as muchas possible. The nature of the callmay dictate that a special serviceis required which may only be offeredby only one ambulance service. Inthat case, the dispatcher should callthat special service (e.g., heavyrescue capability, mobile coronarycare capability) .
LOOP 6
ELEMrNTS
1. Determine if patient's deathwill require a coroner's in-vestigation by deciding thatone or more of the followingconditions exist:
A. possible murder;B. possible suicide;C. unexplained death;D. patient has not seen a
physician in the last 48hours;
E. sudden unsuspected death;F. unusual or suspicious cir-
cumstances surroundingpatient's death.
(If none of the above con-ditions exist, go to Element#4)
2. If one or more of the aboveconditions exist, call coroffice (or representative,i.e., deputy coroner) and/orpolice and inform of the cir-cumstances surrounding thepatient's death.
3. Receive any instruction andassist the corner, the coroner'srepresentative or the police asnecessary.(Go to Element #4)
EXPLANATIONS
The coroner's office to be notifiedis the office within the county inwhich the patient has died. If thebody must cross county lines whilebeing transported, the coroner ofall counties involved must be noti-fied and their consent given.Technically, the body cannot hemoved until the coroner is notifiedand then:
A. examines the body before it ismoved or;
B. authorizes movement of the bodyto another location for hisexamination.
D-10
LOOP 7
ELEMENTS VXPLANATIONS
1. Determine which specializedcrews and vehicles areavailable by chocking on-callroster and log book to deter -mine what equipment and crewmembers are already out.
2. Select specialized crew andvehicle based upon the natureof the call and the personneland vehicles available.(Go to Element H)
A specialized crew is defined asany group of EMTs which may havetraining and expertise in an areain which others are not as qualifiedand a specialized vehicle is avehicle which carries equipment,related to the EMT's speciality,which may not be available in othervehicles. An example of a specializedcrew and vehicle would be a crewtrained in emergency coronary caretechniques in a vehicle equippedwith an EKG scope, an EKG recorder,I.V. fluid administration equipment,drugs, defibrillator and telemetry.
D-11
NOTES
1. In all cases, the dispatcher must remain cool and calm sincesomeone requesting ambulance service nay be experiencing oneof the most stressful moments of his or her life. By con-centrating on gathering the necessary information, the dispatcherwill be less likely to become emotionally involved in the pro-blem of the caller. It may he necessary to "calm down" thecaller in order to obtain vital information concerning thelocation and condition of the patient. If the dispatcher hasto perform the function, it is best to inform the caller thatit will not be possible to send help unless certain informationis obtained. The dispatcher should take charge and controlall conversations by being firm and decisive... be courteousbut firm.
2. Tape recordings of dispatching process can be valuable in twoways:
A. tape recordings provide a record of exactly what was saidby the caller, regardless of the speed at which the callerspoke;
B. tapes can be used as a training aid for both EMT studentsand dispatchers, by providing realistic examples of in-coming requests for ambulance service.
However, the dispatcher should never rely entirely upon a taperecording but should attempt to gather all important infor-mation and record that information in writing. Advantages inthis procedure include:
A. a quick, visable reference of the critical informationnecessary for dispatching;
H. a reliable reference in the event of an equipment failure.
By recording dispatching times, it is possible for the dispatcherto make a rapid assessment of how efficiently the dispatchingprocess is progressing at any point.
3. The following is an example of a form which may be used forrecording dispatching information. This form must be modifiedto suit local needs.
D-12
!TIMES] [Fowl
Incident Occurred hrs P071 / /
Call Received hrs ROUND TRIP
Vehicle Enroute hrs hrs
Arrive at Scene hrs hrs
Depart Scene hrs hrs
Arrive Destination hrs hrs
Ready for Service hrs hrs
ariun:MPM:E NUMBER] EXT.
!PATIENT'S N1\ILE1
Ar.
[DESTINATION!
INATUIZE OF CULL
PATIENT s DocToq
WHEN IS AMBULANCE NEEDED?
1CREW DISPATCHA
D-13
rISPATCE'Ert
4. If the dispatcher remains calm and has had some experience,it is possible that the dispatcher may detect those callerswho are, for one reason or another, unreliable. Once the dis-patcher feels that there is the slightest possibility that anyof the information gathered from the caller is inaccurate, itis the dispatcher's obligation to inform the emergency medicaltechnicians dispatched, of any potentially inaccurate infor-mation. The dispatcher must never guess... all informationgiven to the ambulance crew must be accurate.
5. The caller is usually very excited in a true emergency sit-uation and therefore any information which is relayed to thedispatcher may be highly inaccurate. It is usually possible toseparate the accurate from the inaccurate, however, it ispossible that the dispatcher may never have a true picture ofwhat is really wrong with a potential patient. At this point,the dispatcher must make a very important decision based oninaccurate information and it is generally an accepted prac-tice to handle such a call as an emergency situation.
6. One of the most critical decisions to be made by the dispatcherinvolves the determination concerning the difference betweenemergency and non-emergency ambulance calls. This decisionhas to be based upon the information gathered from the personrequesting ambulance service by calling the dispatcher. Afterthe dispatcher has gathered all the information concerning thepatient's name, location and condition, the dispatcher mustcombine all information received and determine if the call-hould be handled as an emergency or a non-emergency call.An emergency situation is described in the Pennsylvania MotorVehicle code as that situation in which the loss of human lifeis imminent. This definition of an emergency is often looselynterpreted in such a manner that any ambulance call is erron-:ously assumed to be an emergency and emergency warning devicese used (e.g., red lights and siren). If details are sketchyIcerning an accident or any possible injury to a patient,
i can only be left to the decision of the ambulance driverto whether a call for assistance should be considered and
Ueated as an emergency. Automobile accidents have a highfrequency of injuries and to avoid indecision it is usually''visable.to handle those calls under emergency conditions
the patient(s) examination(s) reveals a non-emergencyituation. If an ambulance service or fire department ambul-ce routinely responds to fire calls, there is no reason thate response to the fire scene should be handled under emer--ncy conditions unless there is good reason to believe thathere is a patient at the scene who needs emergency medicalare to alleviate a life-threatening situation.
all equipment and training levels are equal within an organ-ization, the one aspect which may vary among individuals is theorlount of experience which they have had and the amount of res-c lnsibility which they are able to assume. The dispatcher maytve orders to guide decisions relating to which individuals
D-14
may respond to which calls or that decision may be left entirelyup to the dispatcher, This process requires that the nature ofthe call be matched with the type of experience the individualsavailable have had in an effort to dispatch the most qualifiedindividuals available.
The dispatcher may also have to decide which vehicle and/orcrew should remain at the base station to be prepared to respondto other calls which may come in during the response to thecurrent request for help.
8. With the increasingly high volume of radio traffic on theemergency frequencies, it has become vital that the ABC's ofcommunication be observed (A - Accuracy, B - Brevity andC Courtesy) , In order to promote brevity (short radio tran-smissions), it is a good practice to code most informationtransmitted over a two-way radio. This is especially true whenthe condition of a patient is involved since the patient'sfamily or the patient himself may overhear the transmission.For any code system to work, it is essential that all individualswithin the radio network are familiar with all code designations.By coding information transmitted to the hospital, the hospitalstaff will be required to spend less time on the radio. Itmust be emphasized that alerting the hospital should he accord-ing to the established local policy. Some hospitals wish tobe notified of all arrivals, others only want notification ofvictims with life-threatening emergencies.
D-15
VOICE RADIO COMMUNICATION
Listen before pressing the button on the microphone to avoid inter-fering with another person's transmission.
Pause for at least one second before speaking once the button isdepressed.
In all radio transmission procedures, messages must be as briefand concise as possible.
Military time should he used in all radio communication and in allwritten reports to avoid the confusion between "am" and "pm"
MILITARY TIME
1:00 am = 0100 hrs2:00 am = 0200 hrs3:00 am = 0300 hrs4:00 am = 0400 hrs5:00 am = 0500 hrs6:00 am = 0600 hrs7:00 art = 0700 hrs8:00 am = 0800 hrs9:00 an = 0900 hrs10:(0 am = 1000 hrs11:00 am = 3100 hrs
12:00 Noon = 1200 hrs1:00 pm = 1300 hrs2:00 pm = 1400 hrs3:00 pm = 1500 hrs4:00 pm = 1600 hrs5:00 pm = 1700 hrs6:00 pm = 1800 hrs7:00 pm = 1900 hrs8:00 pm = 2000 hrs9:00 pm = 2100 hrs10:00 pm = 2200 hrs11:00 pm = 2300 hrs
12:00 Midnight = 2400 hrs
Example: 5:45 pm is 1745 hrs in military time
Difficult words or names may need to be made more clear during atransmission. They may be spelled by using the phonetic alphabetpreceded by the words I SPELL. If the word or name may be pronounced,pronounce it before saying I SPELL and immediately follow with thespelling of the word.
D-16
LETTER
PHONETIC ALPHABET
LETTER SPOKEN ASSPOKI'Aq AS
A AlfaBravo (Brah-Vo)
N0
NovemberOscar
C Charlie P Papa (Pa-Pa')Delta Quebec (K-Beck)Echo R Romeo
F Foxtrot S SierraG Golf Tango11 Hotel U UniformI India V VictorJ Juliett Whiskey
Kilo (Key-Lo) X X-RayL Lima (Lee-Ma) YankeeM Mike Zulu
Example: If the receiving party would have difficulty understandingthe word ambulance the transmitting party would say:
Am....bu....lance - I SPELL
AlfaMikeBravoUniformLimaAlfaNovemberCharlieEcho
D-17
TRAVEL TO SCENE
k,LEMENTS EXPLANATIONS
1. Determine if the nature of thecall requires that emergencywarning devices (e.g., redlights and siren) will be usedwhile driving to the scene.(If emergency, Loop 1)
2. Determine the best route oftravel to the scene by an-alyzing routes of travel,distance to scene, time ofday, weather conditions, pro-bable conjested areas alongproposed routes.
3. Determine if a police escortmay be needed during any por-tion of the ambulance call byassessing:
1. traffic conditions;2. familiarity with the
necessary route and des-tination.
(If escort is needed, Loop 2)
4. Determine what equipment willmost likely be needed at thescene based on the nature ofthe call.
5. Gather the necessary equip-ment and check to be sure
D-10
Assumes that crew has been dis-patched and informed of:
A. patieot's name;B. location of patient(s);C. nature of call;D. destination to which patient(s)
is to be transported (ifappropriate);
E. any special conditions which mayaffect travel to the scene;
F. any other emergency units res-ponding to the scene.
(See Dispatch Note 6)
If traffic conditions indicate thattraffic may be very heavy, it may beadvantageous to obtain a police escortto assist in negotiating through thattraffic. If the crew members are notfamiliar with the route to be traveledand/or the destination, a police escortmay prevent the crew from becominglost.
The nature of the patient's illnessor injury will determine the generaltypes of tasks which will be performedat the scene and will therefore dic-tate the types of equipment +.1lich willbe needed.(See Note 1)
If the equipment is kept in a cabinetor box, hung on the wall or stored in
ELEMENTS
that all of the vital equip-ment is operating properly.(If not operating properly,Loop 3)
6. Discuss crew members' res-ponsibilities while enrouteso that upon arriving at thescene each individual will actpromptly and efficiently.
7. Follow directions given by dis-patcher to locate patient.(If something happens whichcauses excessive delay; e.g.,mechanical failure or flat tire,Loop 4)(If unable to locate patient,Loop 5)
8. Arrive at scene and verify thatthe location reached is, in fact,the location of the patient bychecking:
A. house number;B. name of building;C. name on mail box;D. with bystanders; or,E. some other method which
Will provide verification.
9- Contact dispatcher by radioand inform dispatcher that theambulance and crew have arrivedat the scene.(If no radio, Loop 6)
10. Decide if the number ofpatients at the scene will re-quire additional vehicles byrapidly observing the number ofpatients and determining thatthat number exceeds the number ofpatients which the vehicle(s)at the scene can transport.
EXPLANATIONS
some other organized manner, obtainthat equipment and assemble it foruse.
Depending upon the members of thecrew, it may be possible that aformal assignment of responsibilitieswill not be made due to a close work-ing relationship or similar exper-ience at a previous time.
Assumes there is two-way radiocommunication with dispatcher.
EMT must use proper FCC procedures inall radio communication procedures.
D-19
ELEMENTS EXPLANATIONS
11. Decide if any patient(s) re-quire transportation to adifferent destination from thescene than any other patient(s)and determine if additionalvehicles are needed.(If additional vehicles arcneeded, Loop 7)(Go to Patient Survey,Element #1).
The need for transportation todifferent location may result froman obvious need for different types ofcare (e.g., severe neurological in-jury may be treated more expertlyby one medical facility while severeburns may be handled by a differentfacility) .
D-20
LOOP 1
ELEMENTS
1. Turn on emergency warningdevices and travel to thescene by adhering to applicablesections of the PennsylvaniaVehicle Code.
2. Come to a complete stopbefore proceeding through ared traffic signal or a stopsign to be sure other vehiclesyield right of way. Whileapproaching an intersection,the ambulance should decreasespeed and use the siren toalert other drivers of theapproach of an emergencyvehicle.
3. When overtaking or passing aslow-moving vehicle on twolane roads, use the siren tomove the vehicle to the rightberm of the road so it will notbe necessary to cross the centerline. If it becomes necessaryto cross the centerline of theroad, the emergency vehicleshould have one-half mile ofvisibility to observe theopposite lane of traffic.(Go to Element #2)
EXPLANATIONS
Any motor vehicle accident involvingan ambulance will be judged objec-tively by the courts. If an am-bulance is traveling under emergencyconditions, it is not exempt fromviolation of right-of-way law.
It is not stated in the PennsylvaniaVehicle Code that it is necessaryfor an emergency vehicle (operatingwith red lights and siren) to cometo a complete stop before proceedingthrough a red traffic signal or astop sign. However, it may be bestto come to a complete stop in orderto carefully observe all traffic inand around an intersection.
If an accident occurs, involving anemergency vehicle while passinganother vehicle in a no-passing zone,it is most likely that the emergencyvehicle driver will be at fault andcharged with a violation under theVehicle Code of Pennsylvania.
D- 2 1
LOOP 2
ELEMENTS EXPLANATIONS
1. Contact police by telephoneto inform them of the needfor an escort.(If no escort available, go toElement #4)
2. Determine where ambulance willmeet escort vehicle and atwhat time.
3. Meet escort vehicle and followthat vehicle by one car lengthfor every 10 miles per hourspeed. It may not be necessaryto sound the siren of theambulance in the case of apolice escort, however, it maybe necessary to avoid beingoverlooked by other driversconcentrating on the policevehicle.
D-22
Assumes that there is no directradio contact with the police.
One of the major disadvantages ofan escort situation is that otherdrivers tend to observe the firstpassing (police) and may pull backonto the roadway or into an inter-section before the ambulance hasarrived. Great care must be ex-ercised during an escort to avoidthat situation. Another problemwhich may occur is that the policevehicle nay go too fast for thecondition of the patient if thepoliceman driving is not aware ofthe condition of the patient. Ifthe police vehicle goes too fast,the ambulance driver should go onlyas fast as may be comfortable forand best for the patient's con-dition.
LOOP 3
ELEMENTS
1. Examine equipment to be sureit is properly assembled andif it is not, assemble itproperly.
2. Determine if equipment is nowoperating properly.(If operating properly, go toElement #6)
3. Determine if some minorrepair may be made to theequipment in order that itmay operate properly and re-pair that equipment.(If operating properly, goto Element #6)
4. If nothing may be done torepair or adjust the equip-ment selected so that itworks, select an alternatepiece of equipment and/orset of procedures.(Go to Element #5)
EXPLANATIONS
D-23
If a minor repair is necessary andsome spare parts and tools are carriedin the vehicle, it may be possible toperform some very minor maintenancewhile enroute to the scene.
If another type of equipment and/orset of procedures is selected, anattempt must be made to select analternative which will accomplishthe job as well as the first choiceof equipment and/or procedures.
LOOP 4
ELEMENTS EXPLANATIONS
1. Determine that some set ofevents may cause excessivedelay in responding to thecall within an acceptabletime frame.
2. Contact dispatcher by radioand inform dispatcher ofexpected delay.
3. Dispatcher must determine ifanother vehicle can respondwithin an acceptable timeframe.(If another vehicle cannotrespond within an acceptabletime frame, go to Element #5in Loop 4)(If another vehicle is to bedispatched, follow dispatchprocedures)
4. Determine what can be done toallow the vehicle to returnto complete service.
5. Perform those tasks whichmay be necessary to returnthe vehicle to complete service(e.g., change a flat tire, fillgas tank with gas, drive arounda detour).(Go to Element #8)
Assumes another vehicle can re-spond within an acceptable timeframe.
If the problem is mechanicalditshould be determined if it can berepaired, thus permitting the vehicleto return to complete service. Ifthe problem is other than mechanical/it should be determined if the problemcan be eliminated or circumvented(e.g., out of gas, detour enrouteto patient, landslide).
If the problem cannot be solved bythe crew, it will be necessary toobtain help of an appropriate nature.
D-24
Loor 5
ELEMENTS
1. Call dispatcher on radio andinform dispatcher of ambulancelocation and explain difficultyin locating patient.
2. Request that dispatcher verifydirections to patient.(If error is found in directionoriginally recorded, go toElement #7)
3. If the directions recorded bythe EMT were correct orig-inally, ask dispatcher toobtain a clarification or newset of directions by telephon-ing caller that requested anambulance.
4. Receive clarification ofold directions or new set ofdirections from dispatcher.(Go to Element #7)
EXPLANATIONS
Assumes that there is two-wayradio communication betweenvehicle and dispatcher.
All communication should comply withFCC regulations and any explanationof the situation should be brief.
This usually requires the dispat-cher to read the directions overthe radio while the crew checks thosedirections against the directionsoriginally received.
D-25
LOOP 6
ELEMENTS EXPLANATIONS
1. Contact dispatcher by tele-phone to inform dispatcher thatambulance has arrived at scene.(Go to Element #10)
If a radio is not availe2ile, thedispatcher must be contacted insome manner and a telephone maybe available. If a telephone is notavailable and there is no other rea-sonable method of communication, itwill not be possible to inform thedispatcher of the status andlocation of the crew.
D-26
LOOP 7
ELEMENTS
1. Contact the dispatcher by radioto inform the dispatcher of theneed for additional vehicles atthe scene.
2. Inform dispatcher of whatspecific vehicles are neededand the possible destinationif that information is avail-able.(Go to Patient Survey,Element #1)
EXPLANATIONS
D-27
Assumes that there is two-wayradio communication between thevehicle and the dispatcher.
NOTES
;Ton arriving at the location of the patient, it may he nacos-f;ary to have a variety of equipment at the side of the patient1$ soon as possible. In order to assure that certain basicteems of emergency care equipment are within easy reach andloady for use at all times, it may be helpful to store thoseitems in a portable container which may be taken to a-patient's
The size of the container and the items carried mustpermit the EMT to carry the stretcher and the basic equipment atthe same time. That container may be tie size of a tackle boxor knapsack and may include such items as:
A. bag-valve mask;B. zu;sortment of airways;C. padded tongue blades;D. stethoscope;E. blood pressure cuff;F. assorted elastic bandages;G. assorted gauze dressings;W. assorted trauma dressings;I. assorted gauze bandages;J. triangular bandages;K. assorted adhesive bandages;L. assorted tape rolls;M. scri.ssors;N. portable suction with catheters;0. I.V. fluids administration set (if applicable);P. I.V. fluids (if applicable):Q. eurhythmia control drugs (if applicable).
This kit is usually referred to as a jump kit and has become avital part of the equipment used by many emergency medicaltechnicians.
D-28
PRIMARY CONTACT AND SURVEY OF PATIENTS
ELEMENTS EXPLANATIONS
1. Move to the side of the patientto be surveyed. (If more than onepatient, Loop 1). (If the patientis conscious, Loop 2) .
2. Determine if the patient's lifeis in immediate danger becaseof the lack of sufficientrespirations or the loss of alarge nount of blood by posi-tioning the patient's airway ina hyperextended position andquikly observing for massiveblood loss.(If patient is not breathing,go to task of performing IPPV;If patient is bleeding severely,go to task of controlling massiveexternal hemorrhage).
(If all pAtiehts have not beenexamined, Loop 1)
4. Determine if the patient cancommunicate well enough to assistthe EMT in the assessment of theproblem.(If the patient can not commun-icate, Loop 3)
5. Place one hand on the patient'swrist to feel the radial pulseand monitor that pulse duringthe entire survey.
Assumes the EMT has arrived atthe scene, the ambulance vehicleis parked out-of-the-way (but asclose to the patient(s) as possibleand that the EMT can see thepatient to be surveyed) .
Immediately upon arriving at thepatient's location, the EMT mustmove rapidly to the patient'sside.(See Note 1)
D-29
The hyperextension of the patient'sneck can be accomplished quickly byplacing one hand (palm up) underthe patient's neck, the other hand(palm down) on the forehead andthen applying gentle pressure topoint the chin straight up.(See Note 2)
While this process is being per-formed, the EMT can visually observeany external blood loss which isresulting in a life-threateningcondition.(see Note 3)
The pulse is monitored with lightpressure from the second and thirdfinger tips on the radial pulse.The purpose of this procedure isnot necessarily to count the pulsebut to note its strength, con-sistency and general rate.(See Note 4)This monitoring process shouldoccur during the entire survey ofthe patient i.l possible; thisallows the EMT to monitor anychanges which may occur in the pllse.(See Note 5)
ELEMENTS EXPLANATIONS
6. If the patient can communicateto the EMT or if there is apossibility that the patientcan understand what is being said,the EMT must talk to thepatient to:A. reassure the patient that
he will be cared for;B. gather information about the
patient's physical conditionby inquiring for painfulareas and the patient'sperception of the problem.
7. Chock for horizontal nystagmuson left or right gaze to deter-mine level of consciousness andsimultaneously observe pupilsfor degree of dialation andreaction to light.
8. Whi2e gathering the infor-mation from the patient the EMTshould observe other aspects ofthe patient's physical conditionincluding:A. any blood loss ,ounds;
B. the color and pallor of thepatient's skin;
C. the relative temperatureand moisture of the skin;
D. the degree of skin profusion;and,
E. any deformities, depressionsor protrusions.
(If problem is medical illnessonly, Loop 4)(If problem is psychiatricillness only, go to the taskof treatment of a psychiatricpatient).(If problem is some combinationof trauma, medical illness orpsychatric illness, Loop 5).
If the patient is conscious, theEMT can gather valuable informa-tion about that patient's con-dition since the patient's des-cription of pain, its locationand what caused it are importantpieces of information if the Eliis to accurately determine theexact nature of the problem. TheENT must also talk to thc. patient toreassure the patient and attempt toput the patient more at ease.(See Note 6)
This procedure involves asking thepatient to look rapidly to the left(i.e., at the finger of the EMT) andrapidly to the right while the EMTclosely observes the pupils of theeyes to determine if they "wobble"when trying to focus on the objectat the right or left. If the pupilsdo "wobble" on a left or right gaze,this indicates that the patient isnot at a full level of consciot-sness and may, in fact, tend to be-come less alert as tine grows on.
While talking to the patient, theeyes of the EMT must continue toscan the patient in an effort togather as much information aspossible (using all of the sensesavailable to the EMT) in as shorta period of time as possible. Allof the survey signs listed inElement #8 can be checked in lessthan 15 seconds and no equipmentis required.(See Note 7)
D-30
ELEMENTS
9. If nature of problem is trauma-related, the EMT must deter-mine what actions caused thepatient's injury by:A. observing patient's present
position;B. determining previous
position of the patient(if appropriate);
C. observing items which mayhave come in contact withthe patient or which mayhave caused movement ofa harmful nature.
(If bystanders are present,Loop 6)
10. Place the sphygmonanometer(blood pressure cuff) aroundthe patient's left bicep (ifthat area is injured or in-accessable - use the rightbicep) and connect the clothcuff so that the pressuregauge is visable. Shut thevalve by the inflating bulb(if screw-type, turn screwclockwise; if push -- buttontype, do not push button),and repeatedly squeeze thebulb until the needle ofthe gauge stops moving with thepulse. This usually occursbetween a reading 150 to 200 mmHg. (Millimeters of Mercury) .
11. During the entire process ofobtaining the blood pressure,the patient should be instructedto remain motionless.
12. The diaphragm of the stethescopeshould be placed over the brachialartery just below the bloodpressure cuff and in the bend orfold in the elbow. The otherends of tne stethoscope areplaced in the ears of the EMT.
EXPLANATIONS
The EMT can obtain a great dealof information concerning thepatient's problem by determiningthe mechanism of injury (i.e.,what caused the injury). Thiswill help the EMT in determiningwhat actions caused injury towhat portions of the body, (e.g.,if a driver has his headrest inthe down position and his car ishit from behind, there is a highprobability of a cervical spineinjury) .
Assumes that a sphygmomanometerand stethoscope are available.
In the routine ambulance call,the patient's left arm is the onewhich is most accessable enrouteto the hospital. This is due tothe fact that the patient is usuallylocated on the drivers side of thevehicle, with his head toward thefront of the vehicle and on hisback. Therefore, the patient'sleft arm is toward the center ofthe vehicle and if the sphgmonano-meter ib on that arm, the EMTmay periodocally monitor the bloodpressure on the way to the hospital.
It should be explained to thepatient that movement will make itdifficult to obtain an accuratereading.
It may he helpful to palpate thebrachial artery to assist indetermining exactly where to placethe stethescope. The earpiecesof the stethoscope may transmitbacteria from the ears of one EMTto another. As a precaution, allstethescope earpieces must at leastbe cleansed in an alchol solutionafter use.
D -31
ELEtfl
13. The EMT then opens the valvenear the inflating bulb (inthe screwtype, by turningthe screw very slowly in acounter-clockwise direction;in the push-button type, bydepressing the button veryslowly) to allow air to es-cape and the needle to dropapproximately 5mm 11g. persecond.
14. Two numbers must be recorded:
A the point on the gauge atwhich the pulse is firstheard through the stetho-scope (i.e., the systolicpressure) ;
B. the point on the gauge atwhich the pulse is lastheard through the stetho-scope (i.e., the diastolicpressure) .
15. The EMT must combine allthe diagnostic signs whichhave been observed in thesurvey of the patient andcompare the set of symptomsin this patient with symptomsof a wide variety of problems.The most critical decision tobe made by the EMT at this timeconcerns the possibility of hispatient returning to or enter-ing a life-threatening situation.
16. Once the diagnOstic signs arecombined in the mind of the ENT,the EMT must establish a priorityof problems for the individualpatient.(Co to appropriate task relatingto patients highest priorityproblem)
EXPLANATIONS_
Air must be released slowly enoughto allow an accurate reading ofgauge.
The blood pressure of a given patienttends to vary, based upon age and sex,The normal systolic pressure for anadult male is 100 the man's age(up to 140 or 150 mm Hg.) and thenormal diastolic pressure for anadult male is 65-85 mm Hg. Bothpressures are usually 8-10 mm Hglower in the female. A toleranceof 10 mm Hg. is the generallyaccepted standard, however, in thecase of a low blood pressure (e.g.,90/50 mm Hg), the tolerance becomesmore critical as does the relation-ship between more than one pressurereading.
This is the most critical task whichan EMT will perform since it deter-mines what activities will occurfrom this point on. If the EMTuses poor judgment at this point,a major problem may go untreatedfor a considerable period of time.
Certain injuries and/or illnesseswill result in greater danger anddiscomfort to the patient than otherinjuries and/or illnesses. TheEMT must select those problems whichare most serious and treat thoseproblems first. If the EMT usespoor judgment at this point, aminor illness or injury may betreated while a major illness orinjury may be neglected (e.g., aminor scalp laceration may be
D-32
ELEMENTS
17. As patients aro surveyed andtreatment is begun, the EMTshould be planning and actingupon the preparation andtransportation of patients.
EXPLANATIONS
expertly bandaged while the patientslips into deep shock because theEMT has failed to place the patientin a shock position).(See Note 8)
D-33
LOOP 1
BLEmmTs
1. Observe all patients anddetermii" which patient mayneed emergency medical attentionfirst (second, third, etc.).The priority established maybe based on:
A. visual observation by theBM;
B. information from bystanders;and,
C. information gathered by thedispatcher.
2. Move rapidly to the side of thefirst patient selected and deter-mine if the patient is conscious.(If patient is conscious, Loop 2)(If patient is unconscious, go toElement 42 in primary contact andsurvey of patients).
EXPLANATIONS
Assumes there is only one EMTto survey and treat more than onepatient and the EMT can see allpatients.
By scanning all visable patientsfrom a distance, the EMT mustdetermine which patients may needcare before other patients. By-standers may provide informationwhich will help in the selectionof the most critical patients, however,the information from bystanders maymerely mislead the EMT. All availableinformation must be combined in aneffort to reach the best possibledecision. The patient's surveyedfirst may not actually be treatedfirst since further examinationmay reveal that other patientsare, in fact, more critical.
LOOP 2
ELEMENTS EXPLANATIONS
1. It is not necessary to positionthe airway on this patient butthe patient should be survrryedfor massive blood loss by look-ing for large amounts of bloodand/or a spurting artery.
(If massive bleeding is occurringgo to task of controlling massiveexternal hemorrhaging).
2. If no life-threatening problemsare present and there are otherpatients to be surveyed, informthe patient of where you aregoing and instruct the patientnot to move until you return.(If thea:e are other patients,Loop 1).
(If this is the only patientto be surveyed, go to the taskElement #5 in primary contactand survey of patients).
Assumes that the patient selectedis conscious, breathing and cantalk to the EMT conducting thesurvey.
It is best to leave someone withthis patient to observe any changein condition. This individual neednot necessarily be an EMT and mustbe instructed to contact an EMT ifany change occurs.
D-35
ELEMENTS
LOOP 3
EXPLANATIONS
1. Check the scalp for lacerationsand/or contusions by observing forblood in the hair, placing thehands on either side of the neckand sliding the fingers upwardand toward the top of the head.
2. Check the skull for depressionsand/or any protruding bonefragments by gently feelingthe skull with the finger tips.
3. Check the ears and nose forfluid and/or blood by lookingcarefully in the nostrils andat the opening of the ears.
4. Check the neck for fracturesby looking and feeling for de-formity of bony protrusions inthe cervical spine area. (Ifa cervical spine injury issuspected, go to the task ofimmobilization of a spine injury).
Assumes the patient to be examinedcan not communicate (talk) withthe EMT well enough to assist theEMT in the survey process and thatthe patient has no problem whichis immediately life-threatening.
The EMT must be careful not to movethe head while checking for scalpwounds since it is not clear atthis point if the cervical spineis injured.
Care still must be exercised not tomove the head in case the cervicalspine is injured. The EMT must alsobe careful in this procedure not topress so hard on the skull that anybone fragments are pushed into thebrain.
A clear water-like fluid in eitherthe nose or ears is probably cerebro-spinal fluid (the fluid whichsurrounds and cushions the brainfrom shock) which indicates thepossibility of serious brain injury.Blood in either location may be fromtwo sources:
A. lacerated brain tissue; and /or,B. damage to tissue in the nose or
the ear.
The EMT should determine as closelyas possible, where the source ofblood is orginating. When in doubt,assume that there is the possibilityof brain damage.
If the cervical spine is injured, theneck may be fixed in an abnormal posi-tion. If it is, the patient shouldnot be moved or examined furtheruntil the cervical spine is com-.pletely immobilized.
D-36
LOOP 3 (CONTINUED)
ELEMENTS EXPLANATIONS
5. Observe and check the chest formovement on both sides and forpossible fractures from a positionat the head of the patient. Lookdown the chest to see if the chestis rising and falling in a normalmanner (i.e., together) andgently feel the rib cage forpossible fractures.
6. Check the abdomen for spasmsand tenderness by gently pressingagainst the abdomen.
7. Check the pelvic area for frac-tures by feeling the entire pelvicgirdle for bony protrusions, de-pressions, grating and deformity.Observe legs for outward rotation.
8. Check the upper and lower ex-tremities for fractures bylooking for:
A. swelling and discoloration;B. lumps or bony protrusions;C. bruises and other external
trauma; and,D. deformity.
9. Check lower extremities forparalysis by probing the baresoles of the feet with a sharpinstrument (or the skin of theankles above the shoes) andobserving for the involuntarymuscular reaction to pain(i.e., the patient's leg willflinch) .
If the chest is not rising and fall-ing in a normal manner, rib and/orlung damage may be present. Ifdepressions are detected or agrating sensation is felt, ribfractures may be present. If amale EMT is examining a femalepatient/it may be necessary to offeran explanation to bystanders concerning the purpose of the des-cribed procedures.
If the abdomen is very hard and"rock-like", there is a strongpossibility that there is massiveinternal hemorrhage and/or thecontents of the abdomenal organshave been displaced and spilledinto the abdominal cavity.
Outward rotation of one or both legsis characteristic of a fractured hip.If the EMT is examining a patient ofthe opposite sex, this may also bea difficult procedure and it maybe necessary to offer an explanation.
If there has been spinal cord damagethe involuntary muscular activitywill not occur.
D-37
LOOP 3 (CONTINUED)_
ELEMENTS EXPLANATIONS
10. Check the upper extremities forspinal cord damage by probingthe pelvis of the hand with asharp instrurent and observingfor the involuntary muscularreaction.(If there is any evidence ofspinal cord damage, go to thetask of immobilization of aspine injury).
11. If no spinal cord damage isapparent, roll patient intoa position so that the backbuttocks may be examined forfractures or wounds.(If there are more patients,Loop 1)(If all patients have beensurveyed, determine priorityof injuries among all patientsand go to appropriate taskbased on highest prioritypatient).
D-38
If there is no involuntary muscularactivity, there has been spinalcord damage in the cervical spinearea. If this test produces areaction in the upper extremitiesbut not in the lower extremities,the cord damage has occured belowthe area of the cervical spine. Ifthere is the slightest possibilityof spinal cord damage, the patient'sentire spine should be immobilizedbefore the patient is moved.
The back and buttocks area shouldbe checked with as little bodymotion as possible since thepossibility of a spinal fracture cannot be eliminated even though, atthis point, it does not appear tobe cord damage.
Once all patients have been surveyedand priorities have been establishedbetween patients, the EMT must beginto methodically treat prioritypatients.(See Note 8)
LOOP 4
ELEMENTS EXPLANATIONS
1. Gather patient's medical historyinformation by asking the patientand/or family, if presents suchthings as:
A. if anything like this hasoccurred beforejanddif so,when and how often;
B. if the patient has seen adoctor recently;
C. if the patient is on anymedication; and,
D. how long this currentproblem has been going on.
(If the patient cannot supplyall information and there areno relatives present, look foran emergency medical identifica-tion symbol)(Go to Element #10 in the taskof primary contact and surveyof patients)
All patient history informationmust be objectively assessed afterother diagnostic symptoms are observedby the EMT since the medical problemat the moment may have no relationto any previous problem.
If it becomes necessary to look foran emergency medical identificationsymbol, it is best to inform thosearound the patient (e.g., bystanders,family, other medical or rescuepersonnel) exactly what isoccurring during the search.
D-39
LOOP 5
ELEttENTS EXPLANATIONS
1. Determine what combination ofproblems are affecting thepatient's condition at thistime:
A. trauma-related injury;B. medical illness;C. psychiatric illness.
The EMT must observe the patientand determine which problem iscausing the patient the mostharm.
2. Once the conditions affectingthe pationf have been assessed,the EMT must set a priority amongthose problems.(Based on the priority established,go to the appropriate task)
D-40
LOOP 4
ELEMENTS EXPLANATIONS
1. Question bystanders to deter-mine:
A. time incident occurred;B. specifics concerning impact
or contact which had a directeffect upon patient; and,
C. any other conditions whichmay have caused trauma tothe patient.
2. After combining all availableinformation, the EMT mustdetermine the mechanism ofinjury.(Go to Element #10 in the taskof primary contact and surveyof Patients).
Assumes that the bystanderspresent witnessed the accidentwhich caused the injury to thepatient.
The EMT must not become sidetrackedby the bystanders into discussion,..;of activities not specificallyrelating to the trauma encounteredby the patient (e.g. , who was atfault in an automobile accident):Any information gathered from by-standers must be judged by the EMTfor credibility and accuracy and becombined with other observations ofthe scene.
D-41
NOTES
1. Upon arriving at the scene and selecting a patient to survey,the EMT must not be detoured from moving to that patient forany reason, A. possible. If someone wishes to speak to theEMT at the scene to discuss any matter, the EMT should be sureto not stop, but continue to move toward the patient. Thisrapid movement to the patient is especially important when thepatient or patients may be critically ill or injured. If theEMT can immediately determine that the patient(s) is not ina life-threatening condition, the EMT may be able to gathersome valuable background information before even seeing thepatient. If there is any doubt in the mind of the EMT thatthe patient may possibly be in a serious condition, he shouldmove rapidly to the side of the patient and avoid any delays.
2. While positioning the airway by hyperextendiug the patient'snezk, the EMT should be careful to avoid any twisting motionof the neck which may possibly aggravate any cervical spineinjury which may be present. Hyperextension of the neck isgenerally considered to be a safe movement which will notcause any further spinal cord damage in the event that thereis, in fact, a cervical spine injury. If there is anypossibility of a neck injury, the EMT should even performthe hyperextension movement very slowly and carefully to avoidany possibility of further damage. The movements which aremost likely to cause further damage include:
A. Election of the neck (i.e., tucking the chin towardsthe patient's chest); and,
B. A twisting motion of the head (i.e., turning the headfrom left to right). If at any time during the surveyeither the primary survey or the secoLdary survey, theEMT believes that there is a possibility of a spinalinjury, the cervical spine area should be immediatelyimmobilized in a hyperextended position.
3. If blood loss is to become immediately life-threatening tothe patient, that blood loss must be in very large volumeand this generally occurs only upon the complete severanceof .a major artery (e.g., the brachial or femoral arteries).In an adult male patient, one to two quarts of blood lost ina short period of time will result in a very serious, life-threatening condition. While in a child patient, blood lossof one to two pints is equally as serious. At this point inthe survey, the only blood loss whilh should be considered ortreated is a hemorrhage ofthis magnitude. The EMT should notbe sidetracked into worrying about or treating any blood lossof a lesser nature.
D-42
4. While monitoring the radial pulse during the evaluation ofother symptoms, the EMT need not be precise in counting thepulse itself. The purpose of this activity is to monitorthe pulse to determine if the pulse is strong, regular andclose to an acceptable rate. After practice, the EMT shouldbe able to estimate with a reasonable degree of accuracy, thepulse of any individual without actually having to refer toa watch and constantly count the pulse.
5 By monitoring the pulse and observing for rate changes, theEMI' will be able to have one method of constantly monitoringthe patient's condition during other aspects of the survey.If rate changes do occur, the EMT should note when they occurand should attempt to determine why those rate changes areoccurring ( e.g., the pulse may become more rapid upon askingthe patient a certain question which for some reason stimulatesincreased cardiac output). If, by monitoring the pulse, theEMT can determine that something is aggravating the patient'scondition, that situation should be eliminated.
6. When reassuring a patient, the EMT should never lie or misleadthe patient by saying such things as, "Don't worry; everythingwill be just fine." It is obvious to the patient at thispoint that everything is not going to be all right since thepatient is injured and you have been called to the scene. Ifany individual in the emergency medical services system liesto a patient or misleads a patient, the job of the rest of theEMS team will be that much more difficult since the patient willquestion anything else which is said. If the patient has anyunreasonable fears, the EMT should attempt to alleviate thosefears by explaining the situation and informing the patient ofwhat activities are occurring and why. If there is nothinggood to say, be honest in what is said and remain neutral con-cerning topics of discussion. If the patient dues have sincerefears and anxieties, those fears and anxieties may lead totraumatic shock which can be equally as damaging to the patient'sphysiological well-being as any traumatic injury. During theentire survey process, the EMT should first find out thepatient's name and then continue to use the patient's name ina polite and courteous manner throughout the entire surveyprocedure. This use of the patient's name tends to show apersonal interest in the patient and generally results inalleviating some of the anxiety and discomfort which thepatient may be feeling.
7. Certain tc:-.tative concluf,ions may he drawn from certainindications received from the primary diagnostic signs ob-served.
D-43
Diagnostic Sign--------------------
Respiration
--_-_-_-_-_-_-___Observation Indication
None Respiratory arrest
Deep, gasping, labored Airway obstruction,heart failure
Bright red, frothyblood with each exhalation
Lung damage
Diagnostic Sign IndicationObservation
Absent. Cardiacdeath
arrest,
Pulse Rapid, bounding Fright, hypertension
Rapid, weak Shock
Diagnostic Sign Observation
Skin Temperature
Hot, dry
Indication
Excessive body heat(as in heat stoke),high fever
Cool , clammy
Cold, moist
Cool, dry
D-44
Shock
Body is losing heat
Exposure to cold
F
Diagnostic Sign.-- -- ^ - -- 1 +
Observation Indication^ --High blood pressure,carbon monoxide poi-soning, heart attack
Red skin
Skin Color White skin Shock, heart attack,fright
Blue skin Asphyxia, anoxia,heart attack,poisoning
Diagnostic Sign
Pupils of the Eyes
Diagnostic Sign
State ofConsciousness
Observation Indication
Dilated
Constricted
Unequal
Unconsciousness,cardiac arrest
Disorder affecting thecentral nervoussystem, drug use
Head injury, stroke
Observation
BriefBrief unconsciousness
Confusion
Indication
Stupor
Simple fainting
Alcohol use, mentalcondition, slight blowto the head
Severe blow to thehead
Deep coma Severe brain damage,poisoning
D-45
-","1-1
Diagnostic Sign Observation Indication. . _
Lower extremities Injury to spinalcord in the lowerback
Upper extremities Injury to spinalcord in the neck
Paralysis or Lossof Sensation I Limited use of extremities Pressure on spinal cord
Paralysis limited to onestie
Stroke, head injurywith brain damage
Diagnostic Sign f Observation
General pain present atinjury sites
Reaction to Pain Local pain in theextremities
Indication
Injuries to the body,but probably no damageto the spinal cord
Fracture, occludedartery to extremity
No pain, but obvioussigns of injury
Spinal cord damage,hysteria, violentshock, excessive drugor alcohol use
D-46
8, Patients with certain conditions have priority over others.An outline of these conditions is as follows:
A. Highest priority
1. Airway and breathing difficulties2. Cardiac arrest3. Uncontrolled or suspected severe bleeding4. Severe head injuriesS. Severe medical problems - poisonings, diabetic
complications, cardiac patients6. Open chest or abdominal wounds7. Severe shock
B. Second priority
1 . Burns2. Major multiple fractures3. Back damage with or without spinal cord damage
C. Lowest priority
1. Fractures or other injuries of a minor nature2. Obvious mortal wounds where death appears reasonably
certain3. Obviously dead patients that. are dead upon arrival
at the scene.
There is one problem that frequently occurs when the EMT isrequired to place priorities among his patients. That problemrelates to bystanders and/or family members which may be presentand have what they believe to be a different listing of prioritiesfor one reason or another. The EMT must not be swayed from thedeterminat ion which has been made based upon objective informa-tion and an evaluation of all patients. The EMT may be requiredto confront and deal with the individuals that feel the Ehas made an improper selection of priority patients. If thisdoes in fat occur, the PNIT should not let this bystander orfamily member interfere with treatment of critically ill orinjured patients and if necessary should seek the necessarysupport to remove the individual creating the problem from thescene.
D 4 7
TRIAGE
ELEMENTS EXPLANATIONS
1. Confer with all crew memberswho have surveyed injuredpatients to determine natureof injuries of all patients.
2. Determine the number of patientsin each of the three levels ofpriority and their probabledestination.
3. Determine the typo and numberof vehicles available to trans-port patients.
4. Assign patients to vehiclesbased upon:
A. level of priority inreference to all otherpatients;
D. specific nature ofpatient's problem;
C. vehicles available.
October 31, 1973
Assumes that there are two or morepatients which require emergencymedical care and transportation to amedical facility. Assumes there aretwo or more emergency medical technician:at the scene and all patients have beensurveyed for injury. Assumes thatthe following items are available:
A. writing implement;B. trip report: sheets or;C. other sheets of paper.
1
This is usually not a "formal" meet-ing but may be through a series ofsigns or signals, indicating theseverity of individual patients.
Once all patients have been examinedand sorted according to the severityof their condition, the EMT mustdetermine the number of patients ineach priority level. This number mustbe accurate so the EMT may matchpatients with available transportation.(See Primary Contact & Survey ofPatient's Note 8)
The number of vehicles available isimportant since the EMT must knowhow many patients can be transportedat any given time. It is also im-portant for the ENT to be aware ofthe nature of those vehicles (i.e.,are they specialized vehicles suchas Mobile Intensive Care Units) sothat the individual patient may bematched with the 1)031 vehicle forhis specific needs.
This assignment of patients must beclear to all individuals at thescene. To avoid confusion, allinvolved emergency care personnelmust be informed of the assignmentsmade.(See Triage Note 1)
D-48
TRIAGE
ELEMENTS EXPLANATIONS
5. Determine which patients havesimilar priority problems andwill be transported to thesame location.
6. While patients are being treatedand prepared for transportation(packaged) , the EMT must anti-cipate which patients will beready for transportation firstand this may require that someless critical patients be trans-ported initially.
7. Inform all vehicle crew membersand/or drivers of the destina-tion of their patients and iftheir vehicle should return tothe scene once the patient(s)are delivered.(If the EMT will stay with thesame patient until that patientis examined by a physician,Loop 1)
8. Prepare a written statementconcerning the patient'scondition including:
A. patient's name (if known);B. level of consciousness and
any changes in the originallevel;
C. any vital sign informationgathered at the scene;
D. time of incident;E. time of initial contact
and survey;F. any changes wnich may have
occurred in the patient'scondition; and,
C. the times of those changes.
The written record can either bea special form (e.g., a carboncopy of the ambulance "tripsheet") or simply informationwritten on a plain piece ofpaper.
October 31, 1973
All patients being taken to aspecialized facility should be trans-ported in the same vehicle or groupof vehicles to avoid confusion andunnecessary delay.
If a critical patient has not beenproperly prepared for transportationand stabilized, less critical patientsshould be transported. However, itis essential that sufficient vehiclesremain behind to transport the criticalpatients when they are ready.
In a situation in which it becomesnecessary to triage (i.e., surveyall patients and decide how to handlethem), the EMT in charge of the sceneshould stay at the scene and performthe following activities:
A. work with other EMT personnel whoare providing emergency medicalcare to some degree at the scene;
B. observe the entire situation andsupervise all activities at thescene; and;
C. remain at the scene until allpatients have been transported.(See Note 2)
This written statement is vital toassure a continuum of patient carewhen the patient(s) are deliveredto a medical facility. Without theEMT or a written record of thepatient's condition and treatmentrendered, the hospital staff cannot provide the best care possible.This is due to the fact that thehospital staff is operating on partialinformation, which can only be pro-vided by the EMT who performed thesurvey and provided the emergencycare or a written record accompanyingthe patient.
^-49
TRIAGE
ELEMENTS EXPLANATIONS
9. Attach the patient's recordto his body in such a mannerthat it is easily observable.
10. Inform the crew membersresponsible for transporta-tion that there is a writtenrecord to be transported withthe patient.
11. Determine if all patients haveundergone the triage processand transportation.(If there are patients re-maining, go to Elment #3)(If all patients have under-gone the triage process, gotc an appropriate task basedon need)
October 31, 1972
If there is a predetermined positionin which the record is to be placed(e.g., under the patient's pillow),it should he placed in that location.The predetermined position of theform must he common knowledge amongall individuals responsible forpatient care to avoid any confusionin an urgent situation.
If the crew members participatedin emergency care at the scene, theywill be aware of the fact that awritten record will accompany thepatient.
Once the triage process is completed,the EMT usually accompanies the lastpatient(s) loaded in a vehicle. Itis essential that the EMT in chargeof the triage of a large number ofpatients, remain at the scene untilall patients are evacuated.
D-50
TRIAGE - LOOP 1
ELL'1.1EN'PS EXPLANATIONS
1. Inform the individual examin-ing the patient at the medicalfacility of the informationgathered at the scene. In-cluding the items in TriageElement #8.
2. Determine if it is necessary toreturn to the scene to treatand transport additionalpatients.(If it is necessary to return,go to Triage Element #7)(If it is not necessary toreturn to the scene, go to anappropriate termination orclean-up task)
October 31, 1973
Assumes that the EMT conduct itriage and care of a patient w LIstay with that patient untilshe is examined by a member of themedical staff.
It may not be necessary to have awritten record to provide the et;sen-tial information to the individualconducting the initial examination.However, o assure that an accuraterecord of the patients progress ismaintained every time the pE.tient"switches hands", a written recordof emergency care rendered at thescene is essential.
The exact nature of the clean-up ortermination task will be determinedby equipment and procedures used inthe treatment of the patient.
D-51
TRIAGE - NOTES
1. In certain cases, it may be necessary to transport some patients whoare third priority before higher priority patients due to other con-ditions. This procedure should never be practiced until all life-threatening situations have been eliminated in potentially seriouspatients. The cases in which this procedure should be implemented areaffected by certain patients which are contributing to the trauma,panic and/or confusion at the scene. If there is a patient or if themare a number of patients who are causing some type of problem at thescene, they should be removed from the area as soon as possible.
2. In working with the other emergency medical technicians at the scene,the EMT in charge of the triage should not become so involved thathe looses contact with the overall perspective of other activitiesat the scene. The EMT in charge should be aware of the progress ofindividual patients but must also control the entire rescue andevacuation effort.
October 31, 1973 D-52
APPENDIX E
A SAMPLE TEACHING UNIT
MODULE 2
LESSON PLAN
rOPICS MATERIALS
1 ISPATCI! PROCEDURES EPI TR 1Practical exercise B TR 31-37Stages of an ambulance callDescription of dispatch stagePractical exercise
_CRAVE", TO THE SCENEEmergency or non-emergencyLegal aspects P.D.H. HandoutAmbulance accidents P.D.H. HandoutCommunication during travel
RIMARY CONTACT AND SURVEY OF PATIENT (S) EPI TR 2Mechanisms of injury B TR 4-30Survey of patient(s) ManikinTriage Jump KitsCommunication at the scene Blankets
EQUIPMENT NEEDED
1. Overhead Projector2. Projector Screen3. Four (4) Manikins4. Four (4) Jurp Kits5. Four (4) Blankets
E
MATERIALS NEEDED
1. EPI Transparencies 1-22. Brady Transparencies 4-373. P.D.H. Handouts
a. Applicable Sectionsof PennsylvaniaVehicle Code
b. Statistical Summaryof Accidents InvolvingAmbulances
MODULE 2
INSTRUCTOR'S NOTES
1. During the opening practical exercise, attempt to create arealistic simulation of the information-gathering process and allowthe students to make any errors which may occur. When the studentscritique the activities of the exercise, the instructor should dis-cuss the situation with the students so that they may be able todiscover that information, if any, was omitted durinfi the simulation.In this manner, the students will assist in the teaching process.
2. Once the dispatch instruction is complete, all students shouldhave an opportunity to perform the same practical exercise as dis-cussed above and their participation should be recorded on the classroster. Each student should participate in this final exercise inan area away from the rest of the class in groups of four (4). Eachstudent will list the necessary dispatch information and will act asthe caller for another member of the group. The dispatch member ofthe group will be required to obtain all vital information.
3. The instructor should give the following examples of ambulancecalls and ask the students to
a. Determine if the call should be handled as an emergency;b. Justify their decision.
Examples:a. A call is received to respond to an automobile accident in
which the State Police inform you that there may be someinjuries.
b. You are informed that there is a house fire in your area(with no specific information concerning any patients).
c. A panicstricken mother calls to ask for an ambulance topick up her 5 year old son who has fallen off his swingset and may have broken one leg and one arm.
d. You are called to transfer a patient to a special surgicalhospital in another town, 60 miles away, so that the patientmay receive surgery to repair tendons and ligaments in hishand.
e. A doctor calls from the hospital and requests an ambulanceto transfer a patient to another hospital to receive acardiac pacemaker.
f. One of the members of your own organization calls from thescene of an accident and informs you that there are threepatients to he transported with the following problemsrespectively:1. Severe lasceration of the left leg which is dressed and
bandaged with bleeding controlled;2. A fractured right arm;3. A possible fractured pelvis and hip.
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4. The student's should be presented with the following examples andasked to pick first, second and third priority patients.
The following examples assume that the EMT walks into an area inwhich there are three patients and each one is 25 feet from theEMT.
- Which one is surveyed first?
- Which one is surveyed third?
- Does it make any difference?
- Why?
Example 1
Patient A Lunge pool of blood next to patient, patient is leaningagainst the wall with hips and legs on the floor, patientis pale and is gaging at the opposite wall with a blankexpression.
Patient B Patient is pinned under a pile of debris and is screamingthat his leg is broken.
Patient C Patient is lying on the floor on his back, looks bluishin color and doesn't appear to be moving at all.
Ex=le 2
Patient A Patient is slumped over the steering wheel of a car withher airway in a flexed position.
Patient B Lying on ground with one hip on the ground and one hiphip touching the rocker panel of the care patient isscreaming she is being crushed.
Patient C Middleaged male in back seat, holding his chest andleaning against the back seat.
Exaple 3
Patient A One tire of a car is resting on the patient's chest; thepatient's face is a deep purple, mouth and eyes are open.
Patient B Sitting in the front seat holding ailandkerchief over asoft tissue injury to the scalp with head, face and onesholder covered with dark redish-brown blood.
Patient C Lying in a nearby ditch, face down with no movement.
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MODULE 2
OUTI,INE
I. Dispatch Procedures
A. Introcluc:tion practical exercisc.
1. Simulate dispatch process by:a. Selecting two students as caller and
dispatcher respectively;b. Students will talk as if the dispatcher
is receiving a request for ambulance service;c. Student dispatcher will gather what ho feels
Is essential information.2. Instructor will list information gathered.3. Critique by students including discussion of:
a. Items includedb. Items omitted;c. Method of obtaining information, etc.
13. Description or the stages of an ambulance call
1. The job of providing ambulance service consistsof much more than transporting ill or injuredpatients to a hospital, rest home, or clinic
2. Ambulance calls and all tasks performed havefour basic stages:a. Preparation stage (getting things ready);b. Execution stage (performing the task);c. Evaluation stage (looking at what has been
done and determining if it has been doneproperly);
d. Termination .cf-age (cleaning-up and returningequipment and/or personnel to a ready state).
O. The ambulance call itself may actually be sub-divided into six divisions or stages:1. The pre-dispatch stage;2. The dispatch stage;3. Travel to the scene;4. Actions at the scene;5. Travel to the hospital;6. Actions at the hospital.
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TextReferencesVisual Aids/
Notes
Instructor'sNote 1
The pre-dispatch stage (getting things ready)a. The emergency vehicle must be kept in peak
condition, with the tank full of gas at all times;recommended equipment should always he onboard and kept scrupulously clean and In goodrepair.
b. Fully trained personnel must be available to copewith emergency; an ambulance run shouldnever used as a training exercise for newpersonnel.
'Phe dispatch stagea. The ambulance crew should be provided all
information about the call before they leavequarters; this information should include thefollowing points:1. The name of the patient (if known);2. The exact location of the call, including
the street name and number, or in a highwayaccident, the nearest intersection or otherlandmark;
3. The nature of the call, so that crew membersmay be selected and operations pre-plannedwhile enroute to the scene.
b. If recording equipment is not available, aspecially marked chalkboard or printed form ishelpful to remind the person taking the call ofall riece:,;3ary information.
c. Methods of receiving calls may vary fromorganization to organization:1. .Direct phone call from person requesting help;2. Phone call from policc, or emergency opera-
tions center (Poe) which receives allemergency calls;
3. Radio communication from an POC or othersource.
d. When phone is answered, it should be clear tothe caller the number reached in in fact, anambulance service.
e. Gather the information necessary to provide theEM'!' with all the information he will need torespond to the call:1. Phone number r.)f caller;2. Name of patient (if knoiNn);
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TextReferencesVisual Aids/
Notes
B 37B-TR 32
B 37-38MOS 25913-TR 33
EPI-DispatelELEMENT 1-EPI TIZ-1
TextReferencesVisual Aids,/
Notes
3. Specific location of the patient, includingthe street name and address, or in an autoaccident, the nearest intersection or otherlandmark;
/1. Caller's perception of the nature of thepatient's problem;
5. Specifics, concerning the patient's vital signs(i.e., is the patient breathing, bleedingseverely, conscious or in severe pain)?;
G. Name of the patient's doctor (if known);7. Time that the call was received;8. 'limo and date for which ambulance service
is requested (if appropriate);9. Time that the incident occurred (if appro-
priate and/or possible).I. This information is important to obtain so that the
dispatcher and crew may make the best judgmentspossible, based upon all the informationavailable;I. A phone number will provide a method of
contacting the caller if any unforeseendifficulties occur;
2. The patient's name is necessary so that thepatient many be promptly located andidentified;
3. An accurate set of directions must beobtained so that no confusion or unnecessaryloss of time occurs;
4. The cc liar's perception of the patic.'nt'sproblem is important since the caller mayalready understand the patient's illness orinjury situation very thoroughly. (Thisinformation must be examined very care-fully, since the caller may only beguessing);
5. More spec fie information concerning vitalsigns must be gathered to assist in anevaluation of the accuracy of the caller'sgeneral statement concerning the nature ofthe call;
G. By obtaining the name of the patient'sdoctor (and if in fact he has one), it will bernr;f; hie to determine;
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a. An idea of the patient's clinical history;b. Who may know more about the problems of
this particular patient.7. It is necessary to record the time the call
was received in order to rnea;%ire vehicleresponse time and,if possible,the dispatchershould attempt to determine the time which theincident occurred (the incident which hasresulted in an ill or injured patient):
If possible, the dispatcher should recordall times including, incident occurred,call received , vehicle enroute , arrivedat scene, depart scene for destination,arrived destination and ready for service;
b. Time at which incident occurred in asituation such as a UN case.
g. Determine nature of the problem based upon theinformation gathered and determine if en ambulanceis needed.1. May be very difficult decision,2, If patient is 14 years old, has a cast on his
left arm and is otherwise healthy, he probablydoesn't need en ambulance.
3. If there is the slightest possibility that anambulance is needed, it should be dispatched.
h. Inform caller of the estimated time of arrival andexplain any anticipated delays or why an ambulanceis not being dispatched.1, If an ambulance is not being dispatched,
suggest an alternate method such as arelative, a taxi or other non-emergencysource.
2. If it is necessexy, informs the caller ofwhere to meet the ambulance so the callercan escort the crew to the patient.
i. Review elements 8-10 in the EP1 dispatch taskdescription.
S. Other stagesa. Travel to the scene
1. During travel to the scene, the crewshould "size up" the situation, taking intoaccount all available information.
a.
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TextReferencesVisual Aids/
Notes
Instructor'sNote 2
B 36-39B-TR 34
2. Several important questions should beconsidered:a, Is it a routine run, or an emergency
run requiring the exercise of specialdriving privileges?
b. What is the shortest route? Will thetime of day affect traffic on the shortestroute? Will bridges, railroad tracks ordetours affect the route?
c. Will weather affect driving conditions?d. Will other emergency units be responding?
If so, by what route?e. Is the response to a building? If so,
what sort of building? Will there be anelevator for transporting equipment?
f. What special equipment should be carriedin initially?
g, Will police assistance or additionalequipment be needed?
b. Actions at the scene1. At the scene a good rule of thumb for
developing a course of action is the'ThreeA's": analyze, act, anticipate.
2. To analyze the scene is to continue to size-up operations that started when the call wasfirst received; the EMT must consider fourelements: the scene, the_situation, thetraffic, and the pationt(s)
3. Analysis of the scene helps the ambulancecrew to determine their approach to the accident.a. The ambulance should be parked in a spot
allowing easy access to the patient(s), butwell out of the roadway and clear ofspilled gasoline and other clangorousconditions.
b. If the ambulance must be parked awayfrom the danger area, the driver canpull it into the roadway when it is timeto load the patients.
4. Analyzing the situation means determiningexactly what has happened, who is availableto help, and what additional emergency per-sonnel and equipment will be needed.
S. Analyzing the traffic conditions is alwaysimportant in highway accidents.
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TextReferencesVisual Aids/
Notes
13 39-42AAOS 46-49,
256B-TR 35
TextReferencesVisual Alds/
Notesa. It may be necessary to recruit by-
standers to aid in traffic control untilsufficient police officers arrive, butthey must be carefully instructed,
b. If flares are used in night accidents,they should be set up far enough fromthe scene to serve as warning to on-coming traffic; they should be kept awayfrom flammable materials.
c. If wreckage and dangerous conditions atthe accident scene require that the roadbe closed completely, blockades shouldbe set up at the nearest intersection.
G. Analysis of the patients in a multiple patient BTR 35, CLaccident involves the process of triage, orsorting the patients according to the severityof their injuries; they should be sorted intothree groups.a. High priority injuries include airway and
breathing difficulties; cardiac arrest;uncontrolled bleeding; severe head injuries;open chest or abdominal wounds; severemedical problems, such as poisonings andheart attacks; and severe shock.
b. Second priority injuries include burns; majormultiple fractures; and back injuries withor without spinal damage,
c. Third priority injuries include minorfractures; other minor injuries; obviouslymortal wounds in which death appearsreasonably certain; and the obvious dead.
7. When analysis is completed, the EMT must R -TR 35, OL-2act.a, Initial emergency care measures must be
started, treating first the life-threateningproblems and then less serious injuries.
b. Further accidents at the scene must beprevented and bystanders restrained fromcausing additional injury to patients.
c. Distraught relatives must ba reassured.8. Finally, the EMT must. anticipate, or carry out B -TR 35, 01,2A
a second triage for loading and transportation;this step in-cludes:a. Planning, loadingand transportation-
(e.g. , some critical patients may be-loaded while-others are receiving-care).
b. Obtaining assistance as needed forloading the patients into ambulances.
c. Loading patients carefully to avoidaggravation of injuries.
d. Determining the best route for leavingthe scene.
e. Determining the hospital to which thepatients should be taken, depending onthe particular facilities needed.
c. Travel to the hospital1. During travel to the hospital, the delivery of
the patient in an improved or stabilizedcondition is in the hands of the EMT alone.
2. The EMT must remain at the patient's side,observing diagnostic signs that indicate theneed for further treatment.
3. The driver must provide a safe, smooth tripand notify the hospital of the arrival of thepatient, his condition, and any technicalassistance that may be needed.
d. At the hospital1. While the patient is unloaded at the
hospital, the EMT should continue anyspecific procedure, such as artificial venti-lation, until the hospital staff can take over.
2. The emergency department staff should beinformed of all known facts about the accidentand the patient, such as changes in diagnosticsigns or emergency care measures used.
3. In a multiple patient situation, ambulancepersonnel may assist the hospital staff, butonly if they are asked to do so.
4. The ambulance should be prepared for the nextrun before it leaves the hospital.
TextReferencesVisual Aids,
Notes
B 43-44B-TR 37
TextReferencesVisual Aids/
Notes
II. Travel to the Scone
A. Once the necessary information has been received by the EPIcrew, the crew members may have to determine if the call Travel to Sceneshould be handled as an emergency. Elements 1-11
B 38-391. The dispatcher should provide a strong Indication B-TR 34
of the nature of the call.2. If the dispatcher provides no specific decision, the
crew must decide if the call will be handled as anemergency, based on the information available.
3. Review dispatch task description - Note 46.
B. Discuss hypothetical ambulance call descriptions and Instructorsdetermine if calls should or should not be handled as Note 3emergencies.
C. Once it has been determined how the call will be handled,the driver (with help from other crew members or dispatcher)must select the best route of travel to the scene.
1. If the call is not an emergency, the selection of theroute is not very critical.
2. If the call is an emergency, the selection of theroute may be very critical and is based upon severalfactors including:a. Distance to the scene for each route being
considered;b. Time of day is important since traffic conditions
vary widely on most roads at extreme hours (i.e. ,1730 hours and 0200 hours) and if a localIndustry releases its personnel at 1500 hours, itmay be best to use an alternate route which may bea little longer in mileage;
c. Weather conditions may have an effect on theroutes chosen since a snow storm may require thathills be avoided and travel be only on major roads;
d. Any other activities which may be causing ab-normal conjestion along any portion of the routesuch as a fire or accident scene, must also beconsidered.
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Text
References
Visual Aids/
Notes
3. If the route of travel selected is the best and/or onlyroute, the driver and crew must determine if an escortIs needed.a. Types of escorts may be varied under different
conditions.1. Many ambulance services have obtained a police
escort to maneuver through heavy traffic.2. Some ambulance services have required a snow
plow escort to move through a deep snow fall.b. Regardless of the nature of the escort (and it may be
noted that police escorts occur much more frequentlythan snow plow escorts) , the driver or another crewmember must inform the dispatcher of the1. Nature of the escort needed;2. Route of ambulance travel;3. Point at which the ambulance needs the escort
vehicle;4. Time at which the ambulance will meet the
escort vehicle; and,5. Destination of the ambulance.
c. Review EPI Travel to Scene, Loop 2, Element 43 andexplanation,
Meet escort vehicle and follow that vehicle by onecar length for every 10 miles per hour speed. It maynot be necessary to sound the siren of the ambulancein the case of a police escort, however, it may benecessary to avoid being overlooked by other driversconcentrating on the police vehicle.
One of the major disadvantages of an escort situationis that other drivers tend to observe the first passing ve-hicle (police) and may pull back onto the roadway or intoan intersection before the ambulance has arrived.Great care must be exorcised during an escort to avoidthat situation. Another problem which may occur isthat the police vehicle may go too fast for the con-dition of the patient if the policeman driving is notaware of the condition of the patient. If the policevehicle goes too fast, the ambulance driver shouldgo only as fast as may be comfortable for and bestfor the patient's condition.
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d. Escorts may also be used under non-emergencyconditions to assist the driver in locating either thepatient or the destination of the vehicle.
D. Driving to the scene must be safe under all conditions(emergency and non-emergency) and state laws must beobeyed.
1. Discussion of Pennsylvania Department of Healthhandouts on:a. Pennsylvania statutes;b. Applicable sections of Pennsylvania Vehicle Code;
and,c. Statistical summary of Accidents Involving
Ambulances.2. Legal Responsibilities
a. State laws almost always grant the driver of anemergency vehicle certain privileges; however,these privileges do not relieve him of the conse-quences of reckless disregard for the safety of others.
b. The ambulance driver must recognize certainresponsibilities.1. His primary responsibility is a safe and
comfortable ride for the patient.2. He must realize that there are no guarantees
that other drivers will grant the right- -of -way.3. He ;it maintain a safe following distance.4. He must have his vehicle under control at all
times and drive in a manner appropriate toroad and weather conditions.
3. The use of warning devicesa. Several points should be remembered when the
emergency vehicle siren is to be used.1. Use of the siren should be limited to true
emergencies.2. The pitch should be varied to improve audibility,
since it is difficult for a driver in a closed carto distinguish one continuous tone, especiallyif his air conditioner and radio are on.
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TextReferencesVisual Aids/
Notes
B 11AAOS 253
B 13AAOS 254
TextReferencesVisual Aids/
Notes
3. In many medical problems, the siren itselfmay have an adverse effect on the patientby upsetting him and causing unnecessaryapprehens ion .
b. Rapid alternation of the headlights between highand low beams is quite effective for clearingtraffic, even in the daytime.
4. The reckless use of speed 13 13-14a. Very few njury or illness situations require a AAOS 254-255
high-speed run to the hospital; these runs rarelygain more than a minute or two, and the time con-tributes little to the ultimate recovery of the patient.
b. Wild, high-speed runs may actually aggravate the injuryor illness in cases such as heart attack or spinalinjury.
5. Causes of ambulance accidents 13 14a. A sense of urgency may cause the driver to speed; AAOS 255-256
coupled with the vehicle's weight and road char-acteristics, this speed often causes accidents.
b. Cars that stop suddenly when they hear or see theambulance often present an obstacle that the drivercannot avoid hitting.
c. Intersections cause particular hazards, especiallywhen one ambulance is following another and thedrivers of other vehicles pull out as soon as oneambulance has passed.
E. Once underway, the crew members may begin to prepare forthe tasks they will have to ; .::rforni at the scene.
1. If the dispatch information has been properly relayed, theEMT may be able to anticipate what equipment may beneeded at the scene.
2. That equipment should be gathered in one appropriatelocation within the vehicle.
3. It is most helpful if the equipment which may be usedis stored in a "jump kit" of some type.
4. Upon arriving at the location of the patient, it may benecessary to have a variety of equipment at the side ofthe patient as soon as possible. In order to assure thatcertain basic items of emergency care equipment arewithin easy reach and ready for use at all times, it maybe helpful to store those items in a portable containerwhich may be taken to a patient's side. The size of the
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TextReferencesVisual Aids/
Notes
container and the items carried must permit the EMT tocarry the stretcher and the basic equipment at the same time.That container may be the size of a tackle box or knapsackand may Include such items as:a. Bag-valve mask;b. Assortment of airways;c. Padded tongue blades;d. Stethoscope;e. Blood pressure cuff;1. Assorted elastic bandages;g. Assorted gauze dressings;h. Assorted trauma dressings;i. Assorted gauze bandages;J. Triangular bandages;k. Assorteci adhesive bandages;1. Assorted tape rolls;m. Scissors;n. Portable suction with catheters;o. I.V. fluids administration set (if applicable)p. I.V. fluids (if applicable)q. Eurhythmia control drugs (if applicable)
This kit is usually referred to as a jump kit and has becomea vital part of the equipment used by many emergency medicaltechnicians.
F. Any equipment which is to be used at tho scene should be ''checkedout on the way to the scene, if time permits.
1. If any piece of equipment is not workiny properly, the EMTshould try to perform any minor repairs possible.
2. If any piece of equipment cannot be repaired or is missing(e.g., from the jump kit), the EMT should substitute anothertype of equipment for the original piece selected.
G. During this preparation stage (before actually seeing the patientor patients), the crew members should discuss and/or assigntasks and responsibilities to be acted upon at the scene.
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TextReferences
Visual AidsNotes
III. Primary Contact of Survey of Patients
A. Review description of the actions of the EMT at the scene.
1. Analyze2. Act3. Anticipat'
B. Arriving at the scene
1. The vehicle should be parked as close to the patient(s)as possible without:a. Interfering with traffic flow;b. Endangering patients; or,c. Interfering with rescue operations.
2. Upon arriving at the scene, the EMT should rapidlyconduct a visual survey from his vehicle (if possible)to determine if:a. Additional ambulances may be needed, due to
large numbers of patients;b. Additional support vehicles are needed such as
heavy rescue equipment;c. Traffic control personnel are needed; or,d. Any other support services.
3. If any other services or personnel are needed, it isup to the EMT on the scene to contact the dispatcherto request any assistance necessary.a. The EMT must provide as much specific informa-
tion as possible to the dispatcher so the dis-patcher will have a thorough knowledge of whatis going on at the scene.
b. It is then the dispatcher's responsibility to dispatchthe necessary help to the scene.
C. Primary patient contact
1. If there is more than one patient, the job of deliveringemergency care is much more difficult.
2. The may visually survey all potential patients todetermine a "long distance" priority so the EMT willhave some logic to the method of performing the initialor primary survey.a. It may be possible to determine which patients
may be most critical by just ,glancing at all patients.
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b. This is not an accurate or final determination ofwhich patients are more serious than others.1. The patient which looks the most grotesque
and is making the most noise may not be themost serious patient.
2. The total situation must be analysed rapidlyand the EMT must determine which patientwill be surveyed first (not necessarily treatedfirst).
3. Once the um'r selects the patient or patients to besurveyed (if there is more than one EMT, it will bepossible to survey several patients at the same time),the EMT should quickly move to the side of the patientselected.a. The EMT must determine if the patient is breathing.
1. If the patient is conscious and breathing on hisown, it may nut be necessary to position thepatient's airway.
2. If the patient's level of consciousness is notclearly acceptable, the airway should bepositioned by hyperextending the neck and thelook, listen, feel method should be employedto determine the nature of respiratory activity.
b. The EMT must determine if the patient is bleedingexternally to such a degree that the patient's lifeis threE)tened.1. This determination is made as the EMT quickly
looks at the patient's body for massive bloodloss while checking for breathing.
2. Massive blood loss is equally as critical aslack of oxygen; however, this type of bleedingusually only occurs when a major artery hasbeen severed (e.g., in an amputation or gun-shot wound).
3. The observation for massive blood loss andestablishing an open air,vay must occursimultaneously.a. Without blood - oxygen cannot reach the
brain.b. Without oxygen - the heart will no longer
pump blood to the brain.
TextReferencesVisual Aids/
Notes
Instructor'sNote 4
TextReferencesVisual Aids/
Notes
4. If the patient is not breathing, the ENIT must boginintermittent positive pressure ventilation (II)PV) immediately.a. Establish an open airway by hyporextending the neck
and inserting an oropharangeal airway.b. Ventilate the patient 3 to 5 times, and then check the
carotid pulse to determine if there is any cardiac output.c. If there is no cardiac output (and there usually is
not),the EMT must begin external cardiac compressionsby depressing the sternum with the long axis of theheal of the hand.
d. A rate of 15 compressions to 2 ventilations with oneoperator. The rate to be maintained is 60 com-pressions per minute.
(In order to do this, one rescuer must compressthe sternum at an instantaneous rate of 110 perminute, since no compressions are occurringduring the ';-_,ntilation process.)
o. A rate of 5 compressions to I ventilation occurs withtwo rescuers, with the sternum being compressed atleast once every second. There should be no inter-ruption in compressions for ventilation.
f. All the specifics of cardiopulmonary resuscitation(CPR) will be discussed more completely in module 3.
5. If the patient is bleeding as severely as previouslydescribed, that bleeding must be controlled as quicklyas possible by either:a. Direct pressure;b. Digital pressure and/or;c. Tourniquet.
6. All of these procedures (assessment of life-supportproblems and treatment if necessary) must be performedon all potential patients before moving to a survey ofgreater detail.
D. Once all patients have boon surveyed for critical life-supportproblems, the EMT must select the patient which is to be sur-veyed first (based upon the primary evaluation during the initialsurvey).
(Refer to Emergency_Core Instructor's Guide, Unit One, TheEmerencySituation, pages 16-18)
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APPENDIX I'
NAMES AND ADDRESSES OF SURVEY SITES
EP1 ALUM PROITSSIONS PROJECT
EN11.;1(-; TEC11INT:111N.,_;111WrY,_
Oroani-/ation
Belmont Corners First Aid Squad, Pleasant Mount, Pennsylvania
Chin(ihilla First Aid Squad, Chinchilla, Pennsylvania
Citizens Ambulance Service, Indiana, Pennsylvania
Clark's Summit First Aid Squad, Clark's Summit, Pennsylvania
Cotta(je Hose Company, Carbondale, Pennsylvania
Erie County Volunteer Fire Association, Erie, Pennsylvania
Erie Volunteer Fire Association, Erie, Pennsylvania
I'recdms House Enterprises, Inc. Ambulance Service, Pittsburgh, Pennsylvania
Goodfellow ship Ambulance Club, West Chester, Pennsylvania
Greenville Area Ambulance Service, Greenville, Pennsylvania
Jes sop first Aid Squad, jessop, Pennsylvania
Lima Volunteer Fire Department, Limo, Pennsylvania
Lower Marion Police, Ardmore, Pennsylvania
Meadville Area Ambulance Service, Meadville, Pennsylvania
Milmont Volunteer Fire Department, Milmont, Pennsylvania
Monroeville ;41 Volunteer Fire Department, Monroeville, Pennsylvania
Monroeville #S Volunteer Fire Department, Monroeville, Pennsylvania
Moscow First Aid Squad, Moscow, Pennsylvania
Mutual Aid Ambulance Service, Greensburg, Pennsylvania
Newtown Square Volunteer Fire Department, Newtown Square, Pennsylvania
SURVEY RECAPPucje 2.
Organivotton
Northern Wayne First Aid Sci.iad, 1,107,ewoocl, Pennsylvania
Philadelphia Fire Department, Philadelphia, Pennsylvania (3 locations)
River lw;;cue, Harrisburg, Penni;ylvania
St. Mary's Ambulance Service, St, Mary's, Pennsylvania
Valley Ambulance Authority, Coraopolis, Pennsylvania
INashington Ambulance Chair Service, Washington, Pennsylvania
A'ayinart First Aid Squad, 'Way/nail, Pennsylvania
1,1,2