Bk 35 - EMS Field Manual Flashcards
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 __________.
Obtain a history of the current complaint from the person who witnessed the event.
Glasgow Coma Scale Chart:
(Required on every Pt over 12 months of age)
— 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
36 hours
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:
+ 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)
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
- Auscultate lungs for a minimum of _____ seconds
CARDIAC
2. Auscultate apical pulse for a minimum of _____ seconds
- Adults and children: Palpation of the carotid pulse for a minimum of _____ seconds
- 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
- Auscultate lungs for minimum of 30 seconds
- Auscultate apical pulse for minimum of 60 seconds
- Adults and children: Palpation of the carotid pulse for a minimum of 60 seconds
- Palpation of the brachial pulse for a minimum of 60 seconds
Responsibility for on scene patient health care management rest with?
The most medically qualified person on scene.
Procedures Following Determination of Death:
-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
True or False?
In the prehospital setting, a Living Will or Durable Power of Attorney are non-acceptable DNR forms.
True
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.
DNR order
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:
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
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:
-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
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.
Expertise
Suggested personnel for each EMS assignment and equipment to be carried to the patient:
Equipment to be carried in per type of call:
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:
-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.
The “EMS size-up” (given on TAC 10) shall include the following information and be very brief (vital signs normally are not included):
-Address/Approach
-Age
-Chief Complaint
-Level of Distress
-Continue Emergency or Non-Emergency
-Equipment needed
Captain Tasks on EMS Incident:
-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.
The decision to transport a patient is governed by:
-The patient’s medical condition
-DHS policies and guidelines
-LAFD policies
-Patient’s chosen receiving facility
-Medical judgment of the on scene medical authority
EMT Expanded Scope of Practice Chart:
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
Crisis Response Team (CRT)
(Requested through MFC)
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):
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
Patients shall not be transported to a medical facility that has requested diversion due to “______ Disaster.”
Internal Disaster
Prehospital personnel shall notify the ________ agency of SEXUAL ASSAULT victims regardless whether the patient complains of physical injuries.
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.)
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.
Pediatric Trauma Center (PTC) within 30 mins
(If outside of 30 mins, transport to adult trauma center)
