3502 - Patient Assessment, Intervention And Transport

Question 1

Who shall be responsible for:

1. Working with the Medical Advisor to ensure that TFD personnel–
   a. Work only within their scope of practice
   b. Comply with the standard of care, including the current edition of the Pierce County Patient Care Protocols
   c. Adhere to TFD policies and procedures regarding patient care
2. Maintaining this document

Answer 1

The Assistant Chief for Emergency Medical Services

Question 2

Who shall be responsible for ensuring that TFD personnel:

1. Work only within their scope of practice
2. Comply with the standard of care, including the current edition of the Pierce County Patient Care Protocols
3. Adhere to TFD policies and procedures regarding patient care

Answer 2

The TFD Medical Advisor

Question 3

Who shall be responsible for:

1. Ensuring that patient assessment and documentation occurs
2. Requesting the appropriate resources in accordance with the guidelines set forth in this document
3. Directing patient care until the first paramedic arrives on the scene and establishes a paramedic/patient relationship
4. Ensuring that TFD personnel observe the guidelines set forth in this document
5. Documenting ALS upgrades by private ambulance paramedics

Answer 3

The Incident Commander (IC)

Question 4

Who shall be responsible for:

1. Working only within his/her scope of practice
2. Complying with the standard of care, including the current edition of the Pierce County Patient Care Protocols
3. Adhering to TFD policies and procedures regarding patient care
4. Performing ALS assessments
5. Determining the need for ALS intervention based on the ALS assessment
6. Ensuring that the ALS assessment and all ALS interventions are properly documented on the patient’s EMIR
7. Contacting the base station in accordance with the guidelines set forth in this document

Answer 4

TFD Paramedics

Question 5

Who shall be responsible for:

1. Working only within his/her scope of practice
2. Complying with the standard of care, including the current edition of the Pierce County Patient Care Protocols
3. Adhering to TFD policies and procedures regarding patient care

Answer 5

TFD EMTs

Question 6

Who shall be responsible for locating and/or dispatching resources in a timely manner at the direction of the IC and in accordance with the guidelines set forth in this document.

Answer 6

FCC personnel

Question 7

TFD personnel shall provide patient assessment, intervention and overall care in accordance with:

Answer 7

the current edition of the Pierce County Patient Care Protocols.

Question 8

Individuals for whom the 9-1-1 system is activated become patients of the Pierce County Medical Program Director (MPD), who delegates medical practice to on-scene EMTs and paramedics through standing orders (protocols) or on-line medical control (base station contact).
4. Normally the first-arriving paramedic will direct patient care.
True or false?

Answer 8

True

Question 9

Should a conflict arise between on-scene paramedics, the IC shall determine which on-scene paramedic shall direct patient care in accordance with the following order:

Answer 9

a. Paramedic Captain or Paramedic Supervisor
b. Lieutenant Paramedic
c. Firefighter/Paramedic beyond initial certification period
d. Firefighter/Paramedic in initial certification period
e. Probationary Firefighter/Paramedic

Question 10

An EMT/patient relationship is established as soon as the on-scene EMT:
2. A paramedic/patient relationship is established as soon as the on-scene paramedic:

Answer 10

sees, hears, smells or touches the patient.

 a. Sees, hears, smells or touches the patient OR 
 b. Provides patient care instructions or assessment guidance to on- scene EMTs

Question 11

On-scene, EMTs may, as necessary and appropriate, transfer patient care to:

Answer 11

a. Another on-scene EMT who has BLS supplies and equipment OR
b. An on-scene paramedic who has ALS supplies and equipment

Question 12

On-scene, paramedics may, as necessary and appropriate, transfer patient care to:

Answer 12

another on-scene paramedic, Registered Nurse, Physician’s Assistant, Nurse Practitioner or Physician who has ALS supplies and equipment.

Question 13

With base station consent, a paramedic may leave a patient who does not require paramedic level care in the care of EMTs if a private ambulance is en route.
True or false?

Answer 13

True

Question 14

After arriving at a receiving center, EMTs and paramedics shall transfer patient care only to a:

Answer 14

a. Registered Nurse OR
b. Emergency Department Paramedic OR
c. Physician’s Assistant OR
d. Nurse Practitioner OR
e. Physician

Question 15

Patients who meet ALS guidelines shall at a minimum receive an ALS assessment.
a. An ALS assessment does not necessarily result in the determination that the patient requires:

Answer 15

ALS intervention or ALS transport

Question 16

An EMT may not order a paramedic to provide ALS intervention; however, an IC may direct a paramedic to perform an ALS assessment.
True or false?

Answer 16

True

Question 17

Contact the base station whenever–

i. A patient meeting ALS guidelines:

Answer 17

will not be transported by a TFD medic company or a private ambulance
A patient s/he has assessed will be left in the care of EMTs while awaiting the arrival of a private ambulance for transport

Question 18

When a paramedic, with base station agreement, determines that a patient who meets ALS guidelines does not require paramedic level care while waiting for a private ambulance, all required TFD reports may be completed by:

Answer 18

an EMT.

Question 19

Before leaving the scene, the paramedic who performed the ALS assessment shall ensure that the reason the patient who meets ALS guidelines but does not require paramedic level care is:

Answer 19

documented on the EMIR.

EXAMPLE: “Patient’s pulse rate is normally less than 60.”

Question 20

If an incident was initially dispatched as BLS and the need for ALS assessment is subsequently identified but not available on-scene, the IC immediately shall:

Answer 20

a. Request a TFD medic company AND
a. Step up the responding private ambulance to priority response AND
b. Provide a short radio report to responding units, if time permits

Question 21

If an incident was initially dispatched as BLS and the need for ALS transport is subsequently identified, the IC immediately shall:

Answer 21

a. Request a TFD medic company AND
b. Cancel, continue or step up the responding private ambulance to priority response depending on the patient’s condition or need for additional paramedics and/or transport AND
c. Provide a short radio report to responding units, if time permits

Question 22

An EMT may not order a paramedic to provide ALS transportation for a BLS patient; however, in certain situations where the timely arrival of a private ambulance is significantly delayed, an IC may direct a paramedic to transport a BLS patient.
True or false?

Answer 22

True

Question 23

PROCEDURE FOR DOCUMENTING AN ALS UPGRADE BY A PRIVATE AMBULANCE PARAMEDIC Incident Commander

1. In the narrative section of the EMIR, write:
2. If the ALS intervention was other than or beyond an IV start, send an email to the Assistant Chief for EMS before going off shift that includes:

Answer 23

1. “ALS upgrade by private ambulance paramedic.”
2. a. Incident Number
   b. TFD ALS personnel who were on-scene
   c. Ambulance that performed the ALS intervention or priority transport
   d. Type of ALS intervention performed, such as medication administration or cardioversion