Bk 35 - EMS Field Manual

Question 1

Acute Life-Threatening Event (pediatric pts)

An ALTE may occur during sleep, wakefulness, or feeding in the pediatric patient characterized by a COMBINATION of:
-Transient Apnea
-Color Change
-Marked Muscle Tone Changes
-Choking/Gagging

The most important diagnostic step is to __________.

Answer 1

Obtain a history of the current complaint from the person who witnessed the event.

Question 2

Glasgow Coma Scale Chart:

(Required on every Pt over 12 months of age)

Answer 2

Question 3

— Child / Elder / Dependent Adult Abuse or Neglect —

Child: under 18yo
Elder: 65yo or older
Dependent Adult: 18-64 who cannot care for self

Reporting:
1. Request MFC to have law enforcement respond
2. Member in charge of pt care shall forward completed “Dept of Social Services Report” to appropriate EMS Batt Captain within _____ hours.
3. Make Journal (F-2) Entry

Answer 3

36 hours

Question 4

DHS, Reference # 814

A patient may be determined dead if in addition to the absence of respiration, cardiac activity, and neurological reflexes, one or more of the following conditions exists:

Answer 4

+ Decapitation.

+ Massive crush injury.

+ Penetrating or blunt injury with evisceration of the heart, lung, or brain.

+ Decomposition.

+ Incineration.

+ Extrication time GREATER THAN 15 minutes, with no resuscitative measures performed prior to extrication.

+ Pulseless, non-breathing victims of a multiple victim incident where insufficient medical resources precluded initiating resuscitative measures.

+ Drowning victims, when it is reasonably determined that submersion has been GREATER THAN ONE HOUR.

(Rigor Mortis requires assessment)

Question 5

DHS, Reference #814

If the initial assessment reveals RIGOR MORTIS and/or POST-MORTEM LIVIDITY ONLY:

RESPIRATORY
•Assuring that the patient has an open airway

•Look, listen, and feel for respiration

1. Auscultate lungs for a minimum of _____ seconds

CARDIAC
2. Auscultate apical pulse for a minimum of _____ seconds

3. Adults and children: Palpation of the carotid pulse for a minimum of _____ seconds
4. Infants: Palpation of the _______ pulse for a minimum of 60 seconds

NEUROLOGICAL
•Assess pupil response with a penlight or flashlight

•Check for a response to painful stimuli

Answer 5

1. Auscultate lungs for minimum of 30 seconds
2. Auscultate apical pulse for minimum of 60 seconds
3. Adults and children: Palpation of the carotid pulse for a minimum of 60 seconds
4. Palpation of the brachial pulse for a minimum of 60 seconds

Question 6

Responsibility for on scene patient health care management rest with?

Answer 6

The most medically qualified person on scene.

Question 7

Procedures Following Determination of Death:

Answer 7

-All therapeutic modalities initiated during resuscitation must be left in place (ET/ETC tubes, IV catheters, EKG electrodes, OP/NP airways ect.)

-The deceased shall not be moved without the Coroner’s authorization

Question 8

True or False?

In the prehospital setting, a Living Will or Durable Power of Attorney are non-acceptable DNR forms.

Answer 8

True

Question 9

Resuscitation shall begin immediately and paramedics shall contact the base hospital for further direction if there is any objection or disagreement by family members or caretakers about withholding resuscitation; or if prehospital personnel have any reservations about the validity of the ________ order.

Answer 9

DNR order

Question 10

DNR

For patients who are pulseless and apneic with valid DNR orders, EMT-Is and EMT-Ps shall provide for their comfort, safety, and dignity by using the following appropriate supportive measures:

Answer 10

EMT:
-Maintain Airway (OP/NP) and Suctioning
-Administer O2
-Control external hemorrhage
-Apply dressings, bandages, slings
-Immobilize skeletal injuries
-Position of comfort

Medics:
-Visualize airway/remove foreign bodies by means of laryngoscope and Magill forceps
-Contact base hospital if IV access and/or pain meds are necessary

Question 11

Advanced Health Care Directives (AHCD)

The AHCD enables patients (over the age of 18) who are unable to speak for themselves (e.g., coma, Alzheimer’s, etc) to provide their health care instructions

A Valid AHCD must meet the following requirements:

Answer 11

-Patient is unable to make their own life decisions

-Power-of-Attorney Health Care Agent is designated with effective DATE

-End of Life Decision box is designated (checked)

-Two witness signatures and DATED or Notary Public

-Signed by a Patient Advocate or Ombudsman if the patient is in a skilled nursing facility

Question 12

EMS SOGs are intended as guidelines to establish pre-determined tasks for each member of the company.

Company Commanders shall assign tasks/responsibilities based upon the ______ of each team member.

Answer 12

Expertise

Question 13

Suggested personnel for each EMS assignment and equipment to be carried to the patient:

Answer 13

Question 14

Equipment to be carried in per type of call:

Answer 14

Question 15

Size-ups shall be given to additional resources responding with the fire company.

In particular, a size-up for an EMS incident shall be provided under the following conditions:

Answer 15

-Requests for an ALS unit when a BLS unit is dispatched for an “A” or “B” category call.

-Additional resources requested beyond the original dispatch.

Question 16

The “EMS size-up” (given on TAC 10) shall include the following information and be very brief (vital signs normally are not included):

Answer 16

-Address/Approach

-Age

-Chief Complaint

-Level of Distress

-Continue Emergency or Non-Emergency

-Equipment needed

Question 17

Captain Tasks on EMS Incident:

Answer 17

-Supervise team
-determine need for additional resources
-assess scene safety
-assist with AED rapid application
-interact with family bystanders.
-Initiate F-902M
-record patient assessment data, interventions, patient’s medical history and list of medications
-Give a brief size-up to the paramedics.

Question 18

The decision to transport a patient is governed by:

Answer 18

-The patient’s medical condition

-DHS policies and guidelines

-LAFD policies

-Patient’s chosen receiving facility

-Medical judgment of the on scene medical authority

Question 19

EMT Expanded Scope of Practice Chart:

Answer 19

Question 20

City Volunteer Programs

The City’s _______ are trained civilian volunteers who respond, on request, to Fire/Police emergencies to perform immediate and/or short term on-scene intervention to civilian victims, families, witnesses, and survivors of traumatic events such as:

-Grief management
-Shelter
-Food acquisition
-Abused/neglected children
-Death
-Drive-by shootings
-Drownings
-Fires with displaced occupants
-Homicides
-Major traffic accidents
-Suicides

Answer 20

Crisis Response Team (CRT)

(Requested through MFC)

Question 21

In order to effectively supervise EMS incidents, officers are expected to have a clear understanding of and the ability to apply the following Department of Health Services policies and procedures (Prehospital Care Policy Manual, LAFD Book 33):

Answer 21

DHS Ref#

802 - EMT Scope of Practice

806 - Procedures prior to base hospital contact

808 - Base hospital contact and transport criteria

814 - Determination of Death in field

502,508,510,511,512, 515, 518, 519, 520 - Patient destination policies

822, 829 - Suspected abuse policies

Question 22

Patients shall not be transported to a medical facility that has requested diversion due to “______ Disaster.”

Answer 22

Internal Disaster

Question 23

Prehospital personnel shall notify the ________ agency of SEXUAL ASSAULT victims regardless whether the patient complains of physical injuries.

Answer 23

local law enforcement

(EMS personnel, in conjunction with law enforcement, are HIGHLY ENCOURAGED to transport suspected sexual assault patients, who deny physical injuries, to a designated SART Center.)

Question 24

Pediatric patients (14 years of age or younger), who meet Trauma Center Criteria and/or Guidelines, shall be transported to a designated ______ that is within ____ mins.

Answer 24

Pediatric Trauma Center (PTC) within 30 mins

(If outside of 30 mins, transport to adult trauma center)

Question 25

Pediatric Transporting Guidelines:

Answer 25

Question 26

Patients who are at least _____ weeks pregnant and who appear to be in active labor or have perinatal complications, chief complaint is related to the pregnancy, and injured perinatal patients who do not meet trauma criteria or guidelines shall be transported to the most accessible PERINATAL CENTER.

Answer 26

20 weeks.

(Honor pt destination requests if pt is stable and eta to facility does not exceed 20 mins)

Question 27

Firefighters, who sustain burn injuries, that do not meet base station contact criteria, shall be TAKEN DIRECTLY to?

Answer 27

Grossman Burn Center at Sherman Oaks Hospital
or
Torrance Memorial Hospital Burn Center

(Burns secondary to or associated with injuries meeting trauma center criteria shall be transported to a trauma center prior to a burn center.)

Question 28

A cache of spare gurneys is maintained at each _______ office.

Answer 28

EMS Battalion Office

Question 29

Multi-Casualty Medical Supply Cache

Caches are transportable inside Department helicopters, heavy apparatus, plug buggies, and rescue ambulances.

Each cache is designed to provide basic first-aid and EMT-I level treatment for ____ to ____ patients.

Answer 29

15 to 50 pts

Question 30

ALS Personnel on RA shall:

1. Perform a daily inventory check.
2. Document entries of the controlled medications on the F-_____ form and in the Journal (F-2), any time there is a change in personnel or controlled medication.

Answer 30

F-903 Controlled Medication Inventory

Question 31

Individual paramedic units are provided with a minimum inventory list of EMS supplies to be maintained onboard and intended to supply a resource for an average _____-hour shift.

Answer 31

24hr

(However, to meet specific needs, it may be necessary to increase the established minimums of certain medications andlor supplies.)

Question 32

Each fire station shall order EMS supplies and medications (other than controlled medication) on a _____ basis.

Answer 32

Monthly

Question 33

The senior ranking (EMS) member on the rescue ambulance shall make a Cal/OSHA notification of serious industrial injuries, illness, or death (other than a traffic accident). If no Department ambulance has responded, the Incident Commander shall make the notification.

If the patient is a Los Angeles Fire Department member, the _______ is responsible for making the Cal/OSHA notification.

Additionally, contact the District Attorney’s Office ASAP

Answer 33

-Station commander (where the member is regularly assigned)

(Reporting member shall journalize the Cal/OSHA notification including the name of the person notified and the time of notification.)

Question 34

Communicable Disease Exposure Procedures:

Answer 34

Question 35

Department equipment which has been contaminated with blood or other body fluids, shall be decontaminated by members wearing disposable rubber protective gloves as follows:

Answer 35

-Rescue equipment shall be washed with a disinfectant-detergent solution and hot water then air dried.

-Electronic equipment and RA patient area shall be wiped with 1:10 bleach/water solution

Question 36

Suspected Child Abuse / Neglect

It is recommended that a verbal report be made to both the Department of Children and Family Services (DCFS) and local law enforcement. However if the child is in imminent danger, local law enforcement should be notified immediately.

The report should be sent to DCFS within _____ hours.

Answer 36

36 hours

Question 37

Suspected Elder and Dependent Adult Abuse

LAFD members have a LEGAL OBLIGATION to report known or suspected elder and dependent adult abuse.

Reports of physical abuse, sexual abuse, isolation, abandonment, financial abuse, neglect, and self-neglect are to be made IMMEDIATELY or AS SOON AS PRACTICALLY POSSIBLE by TELEPHONE to ________

The follow-up written report shall be immediately forwarded to the EMS Battalion Captain. The EMS Battalion Captain shall review and Fax the report to the appropriate agency. This whole process shall be completed within?

Answer 37

LA County Adult Protective Services

two working days (48 hours)

(When the abuse or neglect is suspected to have occurred in a long-term care facility, report either to the local law enforcement agency or to “Long Term Care Ombudsman”)

Question 38

Assessment Mnemonics:

Answer 38

Question 39

Task Oriented SOG’s for EMS Incidents (Chart):

Answer 39

Question 40

The F-420 shall be carried on all LAFD apparatus and shall be completed BY THE CONCERNED MEMBER who may have been exposed to a “Reportable Communicable Disease” and/or received a contaminated needle wound.

Reportable Communicable Diseases Include:

Answer 40

-AIDS
-Hepatitis
-Meningitis
-Syphilis
-Tuberculosis

Question 41

The F-420, F-225 and DWC Form 1 shall be completed for what level exposures?

Answer 41

All “Level II and III” exposures.

Question 42

Assessment Guidelines:

Answer 42