NREMT EMT - Emergency Medical Technicians (EMT002) Exam

Standing orders and protocols are what EMTs follow without having to contact a physician each time , which means they fall under indirect (off-line) medical direction .

In NREMT-based EMS systems, indirect medical oversight is provided through written protocols, policies, and standing orders developed by the medical director. These allow EMTs to deliver timely care in the field without delays, while still operating under physician authority.

A simple way to remember:

Indirect = written beforehand (protocols/standing orders)

Direct (on-line) = real-time orders via radio/phone

The correct answers are A. Provide left uterine displacement and E. Perform compressions at a depth of at least two inches.

Key Concept: Cardiac Arrest in Late Pregnancy

At ≥20 weeks gestation (30 weeks in this case):

The enlarged uterus compresses the inferior vena cava (IVC) when the patient is supine

This reduces venous return and cardiac output, worsening resuscitation effectiveness

Why A is correct (Left uterine displacement):

The uterus should be manually displaced to the left side

This relieves pressure on the IVC and improves circulation during CPR

NREMT/AHA-aligned guidance states:

“Manual left uterine displacement should be performed in pregnant patients during resuscitation.”

Why E is correct (Compression depth):

CPR in pregnant patients follows standard adult CPR guidelines

Compression depth should be at least 2 inches (5 cm)

“Perform high-quality chest compressions at a depth of at least 2 inches.”

Why the other options are incorrect:

B. Avoid using AED❌ Incorrect — AED is safe and indicated in pregnancy

“Defibrillation should not be withheld in pregnant patients.”

C. Request a helicopter❌ Not a priority during active cardiac arrest — resuscitation comes first

D. Upper half of sternum❌ Incorrect — compressions are performed on the center of the chest (lower half of sternum)

Exact Extracts (NREMT/AHA-aligned references):

“Perform manual uterine displacement in late pregnancy during CPR.”

“Use standard CPR compression depth and rate.”

“Defibrillation is safe in pregnancy and should not be delayed.”

Clinical Priority Summary:

In a pregnant cardiac arrest patient, the EMT should perform standard high-quality CPR while relieving uterine pressure on major vessels, making A and E the correct answers.

NREMT distinguishes respiratory distress from respiratory failure. Respiratory distress includes compensatory signs such as tachypnea, accessory muscle use, and diaphoresis. Respiratory failure occurs when those compensatory mechanisms fail and the body can no longer maintain adequate oxygenation or ventilation.

Option D (Altered mental status) is the most reliable indicator of respiratory failure. According to NREMT, hypoxia and hypercapnia directly affect brain function, leading to confusion, agitation, lethargy, or unresponsiveness. This indicates that oxygen delivery to the brain is no longer adequate.

Option A is common in early respiratory distress.

Option B indicates increased work of breathing but not failure.

Option C reflects sympathetic activation, not failure.

NREMT teaches that mental status changes are late and ominous signs, requiring immediate airway and ventilatory support.

Sickle cell crisis (vaso-occlusive crisis) occurs when abnormally shaped red blood cells obstruct blood flow, leading to:

Severe localized or generalized pain (most common symptom)

Often in the back, chest, abdomen, or long bones

Hypoxia may be a contributing factor, but pain is the most reported reason for EMS activation. Cardiac arrhythmias and hypertension are not primary symptoms of sickle cell crisis.