10 Tips for Performing EMT Procedures

By Arthur Hsieh

As much as the EMT exam is focused on your knowledge base and decision-making ability, much of the practice of the EMT is a hands-on experience. You touch patients, either with your hands or with a piece of equipment.

Practice, practice, practice

There’s a short saying that reflects the importance of practicing your skills: “Train as you work; work as you trained.”

In other words, how you perform a skill in the field is based on how you learned it in school. Skills like taking a blood pressure, applying a splint, and palpating a broken bone take practice to perfect.

Closely evaluate breathing

A patient’s breathing takes priority over everything else. As the patient talks, listen for unusually short sentences or sentences that break prematurely.

Normal breathing is hard to see; abnormal breathing may appear as being faster, shallower, or even deeper. If you see faster breathing, look for accessory muscle use in the abdomen and neck. If you see these in action, assume that this patient is in serious trouble until proven otherwise.

Palpate firmly and steadily

Hands-on assessments range from taking a patient’s radial pulse to palpating the abdominal region for tenderness and masses. Many EMTs are afraid to hurt a patient during palpation and press too lightly as a result.

Palpation has to be firm enough to depress the tissue underneath the flats of your fingers. Press at a steady rate and watch the person’s face for any signs of discomfort. Stop if you cause pain.

You can quickly check a patient’s extremities during a rapid trauma assessment by putting your hands on the opposite sides of the extremity and pushing them toward each other slightly. If there is an injury, this maneuver will cause pain.

Improve the volume of lung sounds

You can improve the volume by doing two things:

  • Make sure the stethoscope is planted firmly in your ears. The tips of the stethoscope should be pointing slightly forward, in the same direction as your nose. Then place the bell of the stethoscope in between two ribs, not on top of one.

  • Ask the patient to take a deep breath and exhale normally. This causes air to rush in more quickly and increases turbulence in the bronchioles, making lung sounds louder and easier to hear.

Immobilize the patient’s spine at the correct time

In addition to the MOI, a patient should have signs of a possible spinal cord injury, such as pain to the spine, tingling (parathesia), and/or weakness in the extremities (paraplegia). In these cases, immobilize the patient.

Evaluate whether any of the following conditions exist:

  • Another injury is causing so much pain that it may be distracting the patient from spine pain.

  • The patient is intoxicated by alcohol or drugs.

  • The patient is unable to communicate with you because of altered mental status, a language barrier, or other medical conditions.

Control bleeding immediately

In serious trauma, the patient needs every red blood cell he has to carry oxygen throughout the body. This means that you must control bleeding as soon as you detect it. If there is active external bleeding, place a gloved hand on the site and apply direct pressure while you evaluate the patient’s airway and breathing.

Keep in mind that direct pressure controls nearly all forms of external bleeding. If bleeding doesn’t stop within a few seconds, you may need to apply a tourniquet.

Splint an angulated fracture the way you found it (if possible)

Unless otherwise directed, an angulated fracture of a long bone should be splinted in the position in which you found it if a pulse can be detected distal to the fracture. If no pulse is detected, you can apply mild traction to the extremity and attempt once to align the bone’s ends back to their normal position. If the pulse returns, continue to splint the injury.

If you can’t find a pulse after straightening the extremity, continue to splint the injury. Be sure to let the emergency department know you had to straighten the fracture because of what you found.

Perform a focused physical exam

You can’t complete your assessment of the patient with a medical complaint without performing some type of focused physical assessment. For example, if the patient is complaining of chest pain, you should palpate the chest wall and auscultate lung sounds. Each medical condition has a set of physical findings that can help you refine your suspicion of the underlying condition.

Make an abdominal exam more accurate

For the patient with abdominal discomfort or some type of gastrointestinal complaint, you need to palpate the abdomen as part of the physical exam. To perform this exam accurately, have the patient lay supine on his back, with his knees bent.

This relaxes the abdominal muscles, making palpation easier, and puts the organs in the right positions. The organs shift when the patient sits or stands. Use the flats of your fingers to press firmly into each quadrant and watch for any sign of discomfort.

Provide consistent medical documentation

There are a few methods to record your findings, such as the CHART or SOAP method.

CHART stands for:

  • C – Complaint: The patient’s chief complaint

  • H – History: What happened

  • A – Assessment: What you found during your assessment, including a SAMPLE history (signs/symptoms, allergies, medications, past medical history, last oral intake, events leading up to the complaint)

  • R – Rx or Treatment: What care you provided during your assessment

  • T – Transport: What happened during your care; where you transported the patient

SOAP stands for:

  • S – Subjective findings: These include the patient’s chief complaint, the history of the present illness, and the patient’s past medical history including medications and allergies.

  • O – Objective findings: These include vital signs and physical exam findings.

  • A – Assessment: What you think is happening to the patient.

  • P – Plan: This is your treatment plan, indicating what actions you performed.