NREMT

This foundational section covers how the EMS system is organized and directed, how EMTs protect their own safety and wellness, the legal and ethical framework for patient care, documentation, communication, and safe lifting and moving. These topics appear throughout the exam, especially in the Scene Size-Up and Safety and Operations domains.

Emergency Medical Services (EMS) is an organized system of personnel, equipment, and resources that provides emergency care to people with acute illness or injury. The modern EMS system evolved from basic transportation services into a coordinated network of prehospital emergency care.

The system's components work together: public access through 911 and dispatch, first responders, EMTs, Advanced EMTs, Paramedics, emergency departments, and specialty care facilities such as trauma, stroke, and cardiac centers. Each plays a distinct role in the chain of survival.

Type	WhatItIncludes
Online(direct)	Real -time communication with a physician by radio or phone for guidance on specific patient care , ,
	decisions
Offline(indirect)	Standingorders writtenprotocols training andqualityimprovementprogramsestablishedbythe , , ,
	physicianmedicaldirector

Emr

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Emt

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Aemt

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Emergency Medical Responder

Emergency Medical Technician

Advanced EMT

Advanced life support

Each level builds on the previous one, with a broader scope of practice and greater training requirements.

Your safety is the highest priority on every call. Assess scene safety before approaching any patient. Hazards include traffic, violence, hazardous materials, unstable structures, electrical hazards, fire, and infectious disease.

Infection Control

Standard precautions apply to every patient contact regardless of suspected infection status. Select personal protective equipment (PPE) based on the anticipated exposure.

PPE/Measure	KeyPoints
Gloves Eyeprotection	Wornforallpatientcontacts;changebetweenpatientsandwhenevercontaminated Guardsagainstsplashesorspraysofbloodandbodyfluids

PPE/Measure	KeyPoints
N95respirator	Required (or higher-level protection) for airborne diseases such as tuberculosis and measles
Handhygiene	Thesinglemosteffectivewaytopreventdiseasetransmission Washwithsoapandwaterforatleast .
	20 seconds or use an alcohol -based sanitizer with at least 60% alcohol before and after every , ,
	patientcontact afterremovinggloves andaftertouchingcontaminatedsurfaces , ,

Bloodborne pathogens of concern include human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Hepatitis B vaccination is recommended for all EMS personnel. Follow post-exposure protocols immediately after any needlestick injury or mucous membrane exposure.

Stress and Wellness

Condition	SignsandManagement
Acutestressreaction	Followsacriticalincident Signsincludeirritability sleepdisturbance difficultyconcentrating and . , , ,
	emotionalnumbness CriticalIncidentStressManagement(CISM)programsprovidepeersupportand .
	professionalcounselingresources
Cumulativestressand	Resultsfromongoingexposuretotraumaticevents Burnoutappearsasemotionalexhaustion . ,
burnout	depersonalization and a reduced sense of accomplishment Prevent it with work -life balance regular , . ,
	exercise adequatesleep healthynutrition andseekingsupportearly , , ,

Physical wellness directly affects job performance. Proper lifting technique protects against back injury: bend at the knees, keep the back straight, hold objects close to the body, and avoid twisting. Use mechanical devices and team lifts whenever possible.

The scope of practice defines the procedures and actions an EMT is legally permitted to perform, based on state law and local protocols. EMTs must work within this scope and under medical direction; practicing outside it exposes the EMT to legal liability.

Consent

Type	WhenItApplies
Expressedconsent	Acompetentadultagreestotreatment verballyornonverbally ,
Impliedconsent	Thepatientisunresponsiveorotherwiseunabletoconsent andareasonablepersonwouldwant ,
	treatment(theemergencydoctrine)
Informedconsent	Thepatientunderstandsthenatureofthetreatment itsbenefitsandrisks andalternativesincluding , ,
	refusal Thepatientmustbementallycompetent oflegalage andfreefromcoercion . , ,
Minors	Consentgenerallycomesfromaparentorlegalguardian Exceptionsincludeemancipatedminors . ,
	pregnant minors for pregnancy-related care and emergencies in which a parent or guardian cannot be ,
	reached whencareproceedsunderimpliedconsent ,

Refusal of care is the right of any competent adult. The patient must have decision-making capacity, understand the consequences of refusal, and be free from impairment. Document the refusal thoroughly: the patient's mental status, the risks explained, and your efforts to persuade the patient to accept care. Have the patient sign a refusal form whenever possible.

Advance directives are legal documents expressing a patient's wishes about medical care. A Do Not Resuscitate (DNR) order indicates the patient does not want CPR. Verify a DNR order's validity according to local protocol; when in doubt, begin resuscitation.

HIPAA (the Health Insurance Portability and Accountability Act) protects patient health information. Protected health information (PHI) is any individually identifiable health information; release it only to those who need it for patient care or as required by law. Mandatory reporting requirements vary by state but commonly include suspected child abuse, elder abuse, domestic violence, sexual assault, and certain communicable diseases.

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Dispatched to the call or

Care below the standard of a

The breach directly caused the

Measurable harm resulted

providing care

reasonable EMT

harm

Abandonment occurs when care is terminated without transferring the patient to an equal or higher level of care. Once care begins, you are obligated to continue until a proper transfer occurs.

Documentation

The patient care report (PCR) is the legal record of the EMS encounter. Thorough, accurate, objective documentation protects both the patient and the EMT.

Patient demographics, chief complaint, history of present

Record facts, not opinions: what you observed, what was said,

illness, past medical history, medications, allergies, physical

and what you did. Use medical terminology correctly and write

findings, vital signs, treatments, the patient's response, and

legibly on paper forms.

transport information.

Refusals, mass-casualty incidents, and deceased patients require special documentation. Refusal documentation must be exceptionally thorough, including the mental status assessment, the risks explained, and every effort to convince the patient to accept care.