NREMT EMT Course Notes

Scene size-up begins before arrival. Use dispatch information to anticipate the location, call type, possible hazards, number of patients, weather, traffic, violence risk, and resources that may be needed. Prearrival planning does not replace on-scene assessment; it prepares the EMT to slow down, look first, and avoid becoming another patient.

• Do not enter a violent, hazmat, traffic, fire, utility, or unstable scene just because a patient is visible.

• If dispatch mentions traffic, violence, hazmat, fire, utilities, or unknown hazards, choose scene safety and staging before patient contact.

Primary assessment identifies and treats immediate life threats. Start with a general impression, level of consciousness, and obvious distress, then move through airway, breathing, circulation, disability, and exposure as appropriate. Do not delay life-saving actions to complete history questions or a detailed exam.

• Do not ask a long history before correcting airway, breathing, circulation, severe bleeding, or cardiac arrest problems.

• If the patient is unresponsive or has poor breathing, airway and ventilation come before history collection.

Secondary assessment fills in details after immediate life threats are addressed. Use it to understand the complaint, identify trends, and guide ongoing care during transport. It should not delay airway, breathing, circulation, severe bleeding control, or rapid transport for an unstable patient.

• Pulse oximetry supports respiratory assessment but does not override mental status, work of breathing, skin signs, or lung sounds.

• If the life threats are handled and the patient is stable enough, use SAMPLE and OPQRST to clarify the complaint.

Severe bleeding is treated immediately. Use direct pressure first when appropriate, apply a tourniquet for life-threatening extremity bleeding that cannot be controlled quickly, and use wound packing for suitable deep wounds when trained and authorized. Reassess bleeding control often because movement can restart hemorrhage.

• Do not assist with nitroglycerin without checking protocol requirements, blood pressure, prescription status, and contraindications.

• If chest pain sounds cardiac, aspirin is usually considered before nitroglycerin assistance unless protocol says otherwise.

Splinting reduces pain and prevents further injury. Check PMS before and after splinting, expose and assess the injury, stabilize above and below the injury, and avoid unnecessary movement. If distal pulse, motor function, or sensation worsens after splinting, reassess alignment and follow protocol.

• Do not splint and forget distal PMS; Pulse, Motor, Sensation must be compared before and after immobilization.

• If a fracture question mentions distal circulation or neurologic function, the answer often involves PMS before and after splinting.

Operations begin with readiness. Check equipment before it is needed, verify oxygen and airway supplies, confirm the AED and suction work, and restock after calls. Missing equipment becomes a patient care problem only after the crew fails to find it during an emergency.

• HIPAA allows treatment-related sharing; it does not block a proper radio report or handoff to the receiving facility.

• If the question asks about patient handoff, choose concise objective communication with relevant findings, treatment, and response.