EMS Operations
Judgment, not trivia
Operations questions test priorities. At every scene the order is personal safety, partner, patient. Park safely, don PPE, size up for traffic, fire, wires, hazmat, and violence, and never enter a hot zone. The first arriving unit establishes incident command, one person is always in charge, and everyone uses common terminology.
Triage and hazmat
START for adults, JumpSTART for children. Red is immediate, yellow delayed, green minor or walking, black deceased or expectant. Spend roughly 30 seconds or less per patient, treat only life threats, and move on. Hazmat scenes have hot (exclusion), warm (decontamination), and cold (safe) zones; only trained, PPE-equipped responders enter the hot zone, and patients are decontaminated before transport.
Transport and communication
Emergency versus non-emergency response, with "due regard" for everyone else's safety while using lights and sirens - an ambulance is not automatically shielded from liability. For a landing zone, a 100 by 100 foot area, clear of wires and debris, no flares, with obstacles reported to the pilot. Use a structured handoff (SBAR or MIST) and document objectively.
Legal and ethical
Informed consent, capacity to refuse (alert, oriented, understands risks, not impaired), DNR and POLST orders, confidential communication, and mandatory reporting obligations.
Traps
Entering an unsafe scene to "help." Triage by appearance rather than respiration, perfusion, and mental status. Accepting a refusal without documenting capacity. Assuming lights and sirens are always appropriate.
Rule of thumb
The fastest way to become a second patient is to skip scene safety - the scene is controlled before the patient is touched.