2019 Emergency Medical Services Flashcards
When does a person become a patient?
When an assessment is necessary to ensure no illness or injury is overlooked
If a psychiatric patient is deemed a threat to themselves or others __
Police officers may take the patient into custody on their own authority for up to 8 hrs
Your patient with a Richmond Agitation Sedation Scale score of -2 is described as…
Briefly (<10 seconds) awakens with eye contact to voice
A medical ECO is valid for up to how long
4 hrs
P. 33
In regards to pre-hospital patient care if an intervening physician not on scene is attempting to assume patient care responsibility, they must first
They may not assume patient care responsibility or provide POLMD without physical presence on scene
Persons identified as “super utilizers” are perfect candidates for the Community Response Team referal. What are the requirements to be eligiable for a referal?
Greater than 6 calls of service within 60 days
Are we allowed to transport motorized wheelchairs in the back of county ambulances?
No. We are unable to properly secure the equipment in the back of the transport unit.
Per the BLS treatment protocol for acute coranary syndrome, your 17- year old female patient is complaining of crushing chest pain. What is the dose of Aspirin you would give her?
None. She is under 18 years old.
What is a true statement regarding patients with artificial hearts (TAH)?
TAH patients should not have CPR performed and should not have the LUCAS device applied.
in regards to hyperglycemia, what is not part of the five “I’s” that cause diabetic ketoacidosis and hyperosmolar hyperglycemic states:
immunizations
Pregnant patients greater than __ should be transported to an OB capable facility.
20 weeks
Transport the supine patient in the__ position if delivery is not imminent
Left lateral recumbent
In preparation for childbirth, what temperature should the back of the medic be?
90-100F
Upon a successful, uncomplicated delivery of a newborm how long should the cord be delayed in clamping?
30-60 seconds
How far should cord clamps be placed following an uncomplicated delivery of a newborn
Two places. 8-10 inches from the infant
Hemoglobin’s binding affinity for CO is how many times greater than its affinity for oxygen.
250 times
In regards to envenomation, recommendations from poison control…
Are not considered POLMD
For patients less than what age should pediatric orders always apply?
14 years old
What is not a contraindication for air medical transport from emergency scenes
Patients who have a fear of flying
The Pedi-mate can accomidate children up to __
40 lbs
What does the “C” in the CURVES mnemonic stand for?
Communicate
________ is the absence of mechanical or electrical cardiac activity.
Asystole
___________ is three or more ventricular complexes in succession.
Ventricular Tachycardia
Hypothermic Arrest is for patients whose arrest is believed to be due to hypothermia (core temperature below _____°F).
95
The hallmark of A-Fib is a narrow complex tachycardia that is ________ irregular.
Irregularly
When loading, or unloading a loaded cot from the unit, a minimum of __________ must be standing outside at the rear of the vehicle.
Two personnel
QI Committee conclusion findings may include: No variance, Variance and _________
Not a patient care issue
What can be used to frighten an animal out of a work area or into an area that can be secured?
CO2 extinguisher
A less desirable way to secure a weapon that a patient has on their person would be ?
Place it in the locked medication compartment on the transport unit
What is the safest place for an adult accompanying a patient in a transport unit?
Front passenger seat
Resuscitative efforts may not be terminated if the patient is under the age of what ?
18
What mnemonic should be used when calling in a medical radio and face to face report
DeNEST
For cases considered for field termination,contact POLMD after _____minutesof resuscitation for discussion and if approved,may terminate after ______minutesof resuscitation?
20min/30min
Minors with intact decisio-making capacity,who are _____ years old or older and whose parent or legal guardian are unable to be contacted,may refuse all services
14
How many complete sets of vital signs are needed with a refusal?
2
A mnemonic that may aid the assessment of decision-making capacity
CURVES
What does the abbreviation ECO stand for?
Emergency Custody Order
Never restrain a patient in the _______,________or_________position
Prone,Hogtied,hobbled
Restrain patient in a position of comfort and safety where the patients _________,_________and_________are protected and can be continuously monitored .
Airway,Breathing and Circulation
What group does triage in the Hot and Warm zone
Rescue Task Force
Who removes patients from the warm zone ?
Extraction Task Force
Who gets notified of a workplace fatality/injury and how soon do they need to be notified
VOSH/ASAP
If a patients preference of hospital involves a transport greater then 60 minutes one way , who must be contacted for approval?
EMS Supervisor/UFO
How many grams of Glucose does one tube hold?
15 grams
How much baby aspirin can a BLS provider administer to a patient over 18 years old experiencing chest pain ?
162 mg
If a patient is prescribed nitroglycerin and has been instructed to take it for observed symptoms ,how many total nitroglycerin can the BLS provider assist the patient with taking
3
How much Epi can be given with a pre marked syringe
0.3mg
In a hypoglycemic emergency of an adolescent male with a glucose level less than ____, you can administer one instant glucose tube, as long as they meet all criteria.
70
In a moderate to severe adult allergic reaction emergency, the proper drug administered for a BLS provider is _____.
0.3mg epinepherine
When performing chest compressions of an adult patient, what is the depth desired with how many beats per minute?
2 inches/120
If available during a narcotic overdose, what size narcan nasal spray can be administered is ___.
2-4mg
In a hypoglycemic emergency of an pediatric male with a glucose level less than ____, you can administer one instant glucose tube, as long as they meet all criteria.
60
Hemoglobin binging affinity for CO is hwo many times greater than that of air?
250
During a CO emergency you are tasked to check people’s SpCO readings with the RAD-57. What is a normal reading range?
0-4%
In a moderate to severe pediatric 15-30 kg allergic reaction emergency, the proper drug administered for a BLS provider is _____.
0.15 mg epinepherine
For acute coronary syndrome how many baby aspirin can be administered?
2
If a patient is prescribed nitroglycerin and the paitent took 1 tablet prior to calling 911 how many more can you assit with giving?
2
How many prpescribed nitroglycerin can you assist giving?
3
To assist giving nitroglycerin what must the sbp be over?
100
If your patient has a heart rate____ or less than can you not assist giving nitroglycerin?
50
Suction no longer than how many seconds?
15
Do not deploy the LUCAS until after what cycle of CPR?
5th
For a adult/teen what is the approiate depth for compressions during CPR?
2”
What pulse oximeter range indicates COPD?
88% - 92%
What pulse oximeter range indicates nomal?
94% or greater
What may a reading “KETONES” mean on a Gulcometer indicate?
300mg/dL or higher
When is a patient provider relationship established?
The moment the EMS provider has determined an assessment is necessary to ensure that no illness/injury is overlooked and to ensure the individual’s capacity to decline an assessment is not impaired by illness, injury or intoxication
For field EMS operations, minors are patients under the age of what?
18
What age can a patient refuse care if attempts at notifying a parent or legal guardian were unsuccessful?
14
In the mnemonic CURVES used to aid in assessing decision-making capacity, what does the R stand for?
Reason: must be able to explain the reasons behind their decision
What color is POST form?
Bright lime colored
In the time goal for ACS of 5-5-10-2, what does the 10 stand for?
STEMI identification to enroute to facility less than 10 minutes
BLS providers should withhold given the patient’s prescribed nitroglycerin if the patient’s systolic blood pressure is below what?
100
If patient is having a moderate to severe allergic reaction, after contacting POLMD, BLS providers can administered how much Epinephrine?
Epi (1mg/ml) .3mg IM
Liver Mortis onset time postmortem is what?
20 minutes to three hours
The placement of the LUCAS should be deferred until after what cycle of CPR?
5th cycle
What is the temperature of a patient with mild hyperthermia?
90 to 95 degree F
What is a patient’s condition if they have the following signs and symptoms of hyperthermia: Normal mental status; Cool, moist skin; Weak and rapid pulse; Rapid and shallow respirations; Headache, dizziness, nausea/vomiting, and cramping?
Heat Exhaustion
Where do you clamp the cord on newborn umbilical cord?
Two places about 8 – 10 inches from the newborn
What is hemoglobin binding affinity for CO verses O2?
250 times greater affinity for CO than O2
What is the acronym used to remember the symptoms of an organophosphate poisoning?
SLUDGE
What is the minimum MAP necessary for proper blood flow to the organs, like the kidneys and brain?
60 mmHg
What is the most capable type of Stroke Center/Hospital that can handle any type of stroke?
Comprehensive Sroke Center
Death from atrial bleeding an occur in how many minutes?
2-4 minutes
What is the BLS treatment for simple burns less than 10% BSA?
Apply a sterile gauze soaked with cool/tepid water or normal saline to burned area; wrap the patient in a dry sheet
What is the term that describes eye movement together?
Conjugate
What age group(s) are reported to Adult Protected Services (APS) if abuse, neglect or exploitation is suspected?
Mentally or physically disabled between 18 year and 59 years old and elderly greater than 60 years old
What color is the Physician Orders for Scope of Treatment (POST) form?
bright lime
When on scene with a Fairfax County working dog such as, Police drug detection canine or FRD accelerant detection dog, that has had a toxic exposure to a narcotic, what should FD personnel do?
FD personnel can supply the handler the Narcan for them to administer
What hospital(s) have a dedicated bariatric in-patient care unit?
INOVA Fair Oaks Hospital, Reston Hospital Center
What is the recommended maximum on scene time for a trauma once providers have full access to the patient?
10 minutes
When a transport is going to be greater than ________, contact the UFO and EMS supervisor for approval.
60 minutes
When glucometer reads “KETONES?”, the reading would be ______ or higher?
300mg/dL
How long should pressure be held during wound packing?
3 minutes
When loading or unloading a loaded cot from the unit, what is the minimum of personnel must be standing outside at the rear of the vehicle?
2 personnel
When should oxygen be administered to a patient?
When oxygen saturation levels are below 94%
Suctioning for an adult should be no more than ______ and for infants/children should be no more than _______.
15 seconds, 5 seconds
Assessments are repeated every ________ for unstable patients and every _______ for stable patients.
5 minutes, 15 minutes
What is the “E” in the CURVES mnemonic for assessment of Decision-making capacity?
emergent condition
Epinephrine, Glucagon, Diastat and what other medication require a child to leave school?
Solu-cortef
How long is a medical ECO good for?
4 hours
According to START Triage a pediatric patient that is not breathing after opening of their airway should have what performed?
Check for a pulse
When should the FACT*R protocol be considered for any patient?
Entrapment of greater than 30 mins with sustained heart rate of 110 BPM and SBP of 90.
How many attempts are allowed for I-gel placement in patients greater than 12 years old?
2
First degree burns involving more than _____% BSA are transported to a burn center.
50%
What does the “T” in TICLS for the pediatric assessment stands for?
tone
What does the Mnemonic may aid the assessment of Decision-Making Capacity called?
CURVES
What does the “C” in curves mean?
Communicate
In the field of EMS operations, what is considered a minor?
Under the age of 18
What age can minors refuse service with intact decision making capability?
14
What is the Willful infliction of physical pain, injury, mental anguish, or unreasonable confinement called?
Abuse
When should CRT be called on a patient?
Six 911 calls within 60 days
What color is the physicians Order for Scope of Treatment form?
Bright Lime green
What does the acronym START stand for?
Simple triage rapid transport
How many rescue breathes can you give a peds in triage if the have a pulse?
5
What the recommended on scene time for a trauma patient?
10 minutes
What is the recommended on scene time for ACS and stroke?
10 minutes
What does a Cincinnati Prehospital Stroke test include?
Asset speech, facial droop and test arm drift
What alert is 5-5-10-2 used for?
Stemi
What is the goal in time of a medic unit enroute to a hospital with a stemi alert?
10 minutes
Where is position 3 in pit crew cpr?
Head
What temperature should the back of the transport unit be if delivery is imminent?
90-100
Who do you contact if patient request transport to go out of state?
UFO and EMS supervisor
What does CPAP stand for?
CONTINUOUS POSITIVE AIRWAY PRESSURE
What is a general contraindiction for I-gel?
Patients who have ingested caustic substances
What is the absence of mechanical or electrical cardiac activity?
Asystole
When does a person become a patient?
When a provider has determined an assemssment is needed
What is the mnemonic for assessing decision making capacity?
CURVES
If a provider believes that a patient may be affected by psych illnesses who must be notified?
EMS Capt
The Police can take a patient into custody for how long?
8 hours
Who must be present in the transport unit while transporting an ECO?
The Police
Durable power of attorney only comes into play when?
The patient is impaired
When is consent not required?
In life threatinf illness or injury or if impaired
If a minor claims to be emancipated but can not prove it what should be done?
Add an EMS Capt
Patients over what age can refuse care if guardians are unavalibale?
14
If taking a student from a school clinic what must be done?
Have FCPS representative come with
Who are the only people who can recommend TDO?
Community Service Board Member
How many key items are on a DNR?
5
Virgina Board of Health allows what two items to be used in place of a DNR?
Necklace and Bracelet
What color is a POST form
Lime Green
What populations are we mandatory reporters for?
Children, the elderly, and the mentally disabled
What color is a DNR?
Yellow
How many steps can you carry a patient with only 2 providers?
4
What scale is used for determining decision making capability?
RASS
What acronym is used for LOC?
APVU
Capacity of Bariatric Cot
850lbs
Minors with intact decision making capacity who are how many years of anger or older, whose parent or legal guardian are unable to be contacted, may refuse assessment, treatment or transport?
14
Can a refusal for minors be performed without parent or guardian on scene?
Yes
A pregnant minor, regardless of age, can give medical consent for herself and her baby
Solely relating to the Delivery of the child
Documentation of a call where a DNR is followed must include
The name of the issuing MD or NP
With a hospice patient who has documentation not recognized by EMS contact
EMS Supervisor and Hospice Representative
An intervening physician who is not directly on scene may not
assume patient responsibility or POLMD
FRD protocols authorize administration of ALS medications to
Human patients only
In scenarios where a Fairfax county working dog has a toxic exposure to a narcotic who can administer narcan?
The police handler
Citizen contact log for standby at special gatherings
FRD-204
Frequently older than 60 yrs, may have sudden onset of abdominal pain and/or back pain with syncope and hypotension
Abdominal Aortic Aneurysm
Abdominal Pain preceding vomiting is suggestive of a cause that may require
Surgical intervention
In the presence of ACS, blood thinner use is not a contraindication for
Aspirin
Acute onset chest pain and/or back pain accompanied by unexplained extremity pain or neurological symptoms (acute paralysis) is concerning for
thoracic aortic dissection
Silent/painless abdominal or right arm pain, no traumatic jaw, arm or thoracic back pain especially related to exertion, nausea and/or vomiting, shortness of breath, syncope, lightheadedness and weakness, palpitations, GI abdominal upset, pain and cramps.
Atypical presentation of ACS
With chest pain do not give anyone under 18 yrs
Aspirin
In ACS avoid doing what to the right forearm, wrist or hand?
IV access
Decomposition, Decapitation, Incineration, Mortal Wounds
withhold CPR
Withhold CPR with traumatic injuries incompatible with life or valid DNRs. These patients shall not be resuscitated but should be transported to what center?
VAD
When does a person become a patient?
When the EMS provider has determined an assessment is necessary to ensure that no illness or injury is overlooked and to ensure the individual’s capacity to decline an assessment
Who may patient information be shared with?
Parties involved in patient care
The mnemonic CURVES may aid in the assessment of what?
Decision-making capacity
At what age may a minor patient refuse assessment, treatment and/or transport if a parent or guardian cannot be contacted?
14
What defines abuse?
Willful infliction of physical pain, injury, mental anguish, or unreasonable confinement
What are the parameters that define a “Super Utilizer”?
More than 6 calls within 60 days
Which of Fairfax County’s hospitals have dedicated bariatric in-patient care units?
INOVA Fair Oaks and Reston Hospital Center
What is the recommended on scene time for a trauma patient once providers have full access?
10 minutes
The mnemonic SLUDGE is is used to identify symptoms of what?
Organophospahte exposure
In tactical emergency casualty care, what does the first H in MARCHE stand for?
Head Injury
The phrase “sick, stuck, and survivable” is used to identify the need for what?
FACT*R
Which of the following is not an OB/Maternity capable hospital?
INOVA Mt Vernon
What cycle of CPR should the LUCAS device be placed?
Fifth
If a glucometer reads 300mg/dL or higher, it may show what that we disregard, since we currently do not use this function?
KETONES?
Using the EpiRite Syringe, what dose should be administered to a pediatric patient?
0.15ml
How many miligrams of Narcan is in the Adapta Pharma pre-filled intranasal delivery device?
4mg
How many liters per minutes should be used for proper mist generation when administering a nebulizer?
6-8 liters per minutes
