10 free Paramedic practice questions: Responder Wellness and Resilience

To provide mandatory psychological counseling to any paramedic involved in a traumatic call: Professional counseling is the right next step when peer support is not enough, and CISM makes that referral. Support through CISM is offered rather than compelled. Making debriefing mandatory has not been shown to prevent post-traumatic stress.

To investigate whether the paramedic made errors during the call that contributed to a bad outcome: Looking at what went wrong on a call is the job of quality improvement. Chart and case review looks at protocol adherence and clinical decision-making on one specific run. QI has to be improvement-focused, not disciplinary. CISM is about how the crew is coping after the call, not about what the crew did.

To determine whether the paramedic is fit to safely return to full duty: A fitness-for-duty check decides whether one responder can safely go back to full duty. CISM does not make that decision. CISM gives support and early intervention to responders after the event, and responders choose whether to take part.

Acute stress reaction: An acute stress reaction happens during the stressful call itself. You feel nervous and sharply focused while the call is running. This paramedic handled each call well while the call was happening, so the reaction is not coming during calls.

Delayed stress reaction: Delayed stress shows up after one specific event. You get through the crisis and then feel nervous, excited energy once things calm down. There is no single event in this question. The paramedic's problems built slowly over 4 months instead of following one call.

Posttraumatic stress disorder: There was no single overwhelming call, and the paramedic does not relive or think back on any particular call, so this is not posttraumatic stress disorder. Posttraumatic stress disorder comes from one distressing call that the responder keeps reliving, with overreaction to reminders of that call.

Attending the next critical incident stress management debriefing: A debriefing helps many providers. Critical incident stress management does not work for everyone, and some providers do not want to talk about a traumatic call with peers. This partner has already said peer discussion would not help. The debriefing window of 24 to 72 hours also closed weeks ago.

Talking through the call with the crew at the end of the shift: Talking with the crew is peer support, and peer support is a real option when someone turns down the program. This partner said talking with peers would not help. Talking at the end of a shift is the same peer discussion in a less formal setting.

Taking several shifts off until the feelings pass: Rest and a rotated schedule help with general stress. This partner's behavior is still clearly changed weeks after the call. Time off does nothing about the behavior change while the pattern keeps going.

Explain that the response time met the service's standard: Giving the response time is how you would answer a complaint about the facts. Anger in grief gets thrown in every direction, sometimes almost at random, and sometimes at you. Defending the response time turns a grief reaction into an argument at the worst possible moment.

Ask law enforcement to remove the family member from the room: Law enforcement belongs on scene when a grieving person becomes physically abusive. The question says the scene is safe and no one has been threatened. An angry, grieving family member is not a reason to have someone removed. Stay professional and let the person grieve.

Offer an explanation of why the death could not be prevented: Explaining why the death could not be prevented sounds comforting. Grieving people may be offended by advice or explanations about the death. An explanation can come across as trying to make the person's grief smaller instead of accepting the grief.

Spinal motion restriction and patient refusal: Spinal motion restriction is on the list, so half of this pair is right. Patient refusal is a medical and legal risk, and it is not a named high risk activity. Both items in the pair have to be on the list.

Handoff of care and radio communication: Handoff and communication are both on the list. Neither one depends on how a crew lifts or how a crew drives. A lifting and driving program would not target them.

Medication administration and airway management: Medication and airway are on the list too. Both are clinical steps in patient care, and neither is a movement hazard. A lifting program does not touch them.

Back straight, one foot forward, arms held out away from the body: A staggered stance is stable, and it looks like good technique. Holding the arms out away from the body moves the load away from the spine. The farther out the load drifts, the more strain goes on your back.

Back rounded forward, knees straight, lifting with the arms and shoulders: A rounded back with straight knees is how most people pick things up. That position puts the entire load through the spine. A large share of EMS back injuries come from lifting this way.

Back straight and locked, hips rising before the upper body: Every part of option D comes from the real technique except the order. In the power lift, the upper body rises before the hips. Option D has the hips rising first.

The strain shifts onto the shoulders and leaves the spine alone: Your shoulders do work harder as the load moves out. The strain is added to the spine, not moved off it. Your spine is the pivot point the load is levering against.

The load feels lighter, so the legs stop sharing the work: A load that drifts out can feel different in your hands. The legs do not stop working. The change is that the back now takes torque the legs were carrying.

The grip is what fails first, and the spine is not affected: Grip does fail under a load held far out, and a slipping grip is a real way patients get dropped. The spine is loaded at the same time, not spared. Calling the spine unaffected misses the back injury this rule is meant to prevent.

Back rounded slightly, reaching under 15 to 20 inches in front: A reach under 15 to 20 inches in front of the body is correct. The rounded back is the problem. Rounding the back gives up the locked, neutral position that makes the reach safe.

Back locked, reaching over the bed with the knees straight: Reaching over the bed is often the only way to get to the patient. Reaching with straight knees takes your legs out of the movement, and your back takes the whole load.

Back locked, reaching as far as the arms will comfortably go: A locked back is the right start. The reach also has to stay within 15 to 20 inches. Reaching as far as your arms will go turns even a locked back into a long lever.

Once the descent has started and the load proves too heavy: Crews do reassess all through a move. Once the descent has started, the crew is holding a load it cannot set down. Halfway down the stairs is the worst place to need help.

Only if the crew drops or nearly drops the patient: A near drop is a reason to stop and call for help. Waiting for a near drop means the drop has already happened, or almost did.

After the first landing, if the crew is still in control: Pausing at a landing is a real technique, and planned stops belong in a stair carry. Waiting until the first landing to decide still means the crew carried the first flight while doubting they could.

Each responder lifts when ready, so nobody waits under load: Lifting when ready means nobody has to wait under a partial load. Four people starting at four different moments puts the whole weight on whoever moves first. An uneven load like that is how a back gets hurt.

The strongest responder takes the heavy end and starts the lift: Putting the strongest responder on the heavy end is a sensible way to share the load. Starting the lift without a count leaves the other three reacting to a move that has already begun.

The count is called by whoever is closest to the doorway: Somebody does have to call the count. Standing closest to the doorway has nothing to do with the airway. The count belongs with the paramedic at the head, who owns the airway and cannot let go of the patient.