BLS General

Question 1

What initial equipment is mandatory upon contact with the PT?

Answer 1

bring to the point of initial patient contact all equipment required to establish baseline
vital signs and perform defibrillation

Question 2

for scene responses involving hazardous materials, what references should you use?

Answer 2

for scene responses involving hazardous materials, reference the Transport Canada
Emergency Response Guidebook;

Question 3

What is the first rule in the PT Assesment Standard?

Answer 3

assume the existence of serious, potentially life-, limb- and/or function-threatening
conditions;

Question 4

What are the 7 baseline vital signs

Answer 4

a. heart rate,
b. respiration rate,
c. blood pressure (BP),
d. Pulse oximetry (SpO2),
e. Glasgow Coma Scale (GCS),
f. pupils, and
g. skin colour and condition

Question 5

What are adventitious sound?

Answer 5

Adventitious sounds refer to sounds that are heard in addition to the expected breath sounds mentioned above. The most commonly heard adventitious sounds include crackles, rhonchi, and wheezes.

Question 6

Name the 3 reasons a paramedic shall carry out emergency treatment and transport of an INCAPABLE patient without consent

Answer 6

The paramedic shall carry out emergency treatment and transport, if:
a. the patient does not have capacity;
b. the patient is apparently experiencing severe suffering or is at risk, if the treatment is
not administered promptly, of sustaining serious bodily harm; and
c. the delay required to obtain a consent or refusal on the patient’s behalf will prolong
the suffering that the patient is apparently experiencing or will put the patient at risk
of sustaining serious bodily harm.

Question 7

Name the 5 reasons why a paramedic shall carry out emergency treatment of a capable patient without consent

Answer 7

a. the patient is apparently experiencing severe suffering or is at risk, if the treatment is
not administered promptly, of sustaining serious bodily harm;
b. the communication required in order for the patient to give or refuse consent cannot
take place because of a language barrier or because the patient has a disability that
prevents the communication from taking place;
c. steps that are reasonable in the circumstances have been taken to find a practical
means of enabling the communication to take place, but no such means has been
found;
d. the delay required to find a practical means of enabling the communication to take
place will prolong the suffering that the patient is apparently experiencing or will put
the person at risk of sustaining serious bodily harm; and
e. there is no reason to believe that the patient does not want the treatment

Question 8

Paramedic shall attempt to maintain what SPO2%

Answer 8

administer oxygen therapy using an oxygen delivery system and flow rate to attempt to
maintain a patient’s oxygen saturation between 92-96%, as measured by SpO2, unless
specified otherwise in the Standards;

Question 9

continuously administer high concentration oxygen for patients who have…

Answer 9

a. confirmed or suspected carbon monoxide or cyanide toxicity or noxious gas
exposure,
b. upper airway burns,
c. scuba-diving related disorders,
d. ongoing cardiopulmonary arrest,
e. complete airway obstruction, and/or
f. sickle cell anemia with suspected vaso-occlusive crisis; and

Question 10

if pulse oximetry equipment is not functioning or not providing an interpretable wave
form, administer high concentration oxygen to all patients specified in paragraph 2 above,
as well as those with critical findings, which include…

Answer 10

a. age-specific hypotension,
b. respiratory distress,
c. cyanosis, ashen colour, pallor,
d. altered level of consciousness, and/or
e. abnormal pregnancy or labour.

Question 11

PT with COPD Should receive SPO2% level between?

Answer 11

titrate oxygen administration to achieve an oxygen saturation between 88-92%

Question 12

With COPD PT If pulse

oximetry equipment is not functionin, administer oxygen how? and at what level?

Answer 12

If pulse
oximetry equipment is not functioning, administer oxygen by nasal cannula with oxygen flow
at two litres per minute above the patient’s home oxygen levels, or two litres per minute if
patient is not on home oxygen;

Question 13

how often should you re-assess a COPD PT vital signs?

Answer 13

re-assess the vital signs approximately every 10 minutes;

Question 14

With COPD PT what should be your increment lvl and time if they feel worse?

Answer 14

increase oxygen by increments of two litres per minute above starting level approximately
every two to three minutes if the patient’s status deteriorates or the patient indicates they feel
worse

Question 15

What criteria are used to determine the use of a air ambulance?

Answer 15

The paramedic shall also use this standard to assess the clinical criteria (i.e. to determine if the
patient meets the clinical criteria) as required by the Air Ambulance Utilization Standard.

Question 16

Name the 3 physiological criteria in Field Trauma Triage Standard

Answer 16

a. Patient does not follow commands,
b. Systolic blood pressure <90mmHg, or
c. Respiratory rate <10 or ≥30 breaths per minute or need for ventilatory support
(<20 in infant aged <1 year);

Question 17

Name the 8 anatomical criteria in Field Trauma Triage Standard

Answer 17

a. Any penetrating injuries to head, neck, torso and extremities proximal to elbow or
knee,
b. Chest wall instability or deformity (e.g. flail chest),
c. Two or more proximal long-bone fractures,
d. Crushed, de-gloved, mangled or pulseless extremity,
e. Amputation proximal to wrist or ankle,
f. Pelvic fractures,
g. Open or depressed skull fracture, or
h. Paralysis;

Question 18

Name the 4 criteria for mechanism of injury in field trauma triage

Answer 18

a. Falls
i. Adults: falls ≥6 metres (one story is equal to 3 metres)
ii. Children (age <15): falls ≥3 metres or two to three times the height of the
child
b. High Risk Auto Crash
i. Intrusion ≥0.3 metres occupant site; ≥0.5 metres any site, including the roof
ii. Ejection (partial or complete) from automobile
iii. Death in the same passenger compartment
iv. Vehicle telemetry data consistent with high risk injury (if available)
c. Pedestrian or bicyclist thrown, run over or struck with significant impact (≥30 km/hr)
by an automobile
d. Motorcycle crash ≥30 km/hr;

Question 19

Name the 4 special criteria for field trauma triage

Answer 19

a. Age
i. Risk of injury/death increases after age 55
ii. SBP <110 may represent shock after age 65
b. Anticoagulation and bleeding disorders
c. Burns
i. With trauma mechanism: triage to LTH
d. Pregnancy ≥20 weeks

Question 20

While en route to the local hospital, paramedics may rendezvous with the air
ambulance helicopter if:

Answer 20

i. the air ambulance helicopter is able to land along the direct route of the land
ambulance; and
ii. it would result in a significant reduction in transport time to the most
appropriate hospital

Question 21

Can a air ambulance perform search and rescue?

Answer 21

Air ambulance helicopters are not permitted to conduct search and rescue calls.

Question 22

consider spinal motion restriction (SMR) for any patient with a potential spine or spinal
cord injury, based on mechanism of injury, such as?

Answer 22

a. any trauma associated with complaints of neck or back pain,
b. sports accidents (impaction, falls),
c. diving incidents and submersion injuries,
d. explosions, other types of forceful acceleration/deceleration injuries,
e. falls (e.g. stairs),
f. pedestrians struck,
g. electrocution,
h. lightning strikes, or
i. penetrating trauma to the head, neck or torso;

Question 23

SMR if the patient meets the criteria base on the mechanism of injury. determine if the patient
exhibits ANY risk criteria, as follows,

Answer 23

a. neck or back pain,
b. spine tenderness,
c. neurologic signs or symptoms,
d. altered level of consciousness,
e. suspected drug or alcohol intoxication,
f. a distracting painful injury (any painful injury that may distract the patient from the
pain of a spinal injury),
g. anatomic deformity of the spine,
h. high-energy mechanism of injury, such as,
i. fall from elevation greater than 3 feet/5 stairs,
ii. axial load to the head (e.g. diving accidents),
iii. high speed motor vehicle collisions (≥100 km/hr), rollover, ejection,
iv. hit by bus or large truck,
v. motorized/ATV recreational vehicles collision, or
vi. bicyclist struck or collision, or
i. age ≥65 years old including falls from standing height;

Question 24

if the patient has penetrating trauma to the head, neck or torso, determine if the patient
exhibits ALL of the following,

Answer 24

a. no spine tenderness,
b. no neurologic signs or symptoms,
c. no altered level of consciousness,
d. no evidence of drug or alcohol intoxication,
e. no distracting painful injury, and
f. no anatomic deformity of the spine; and

Question 25

does applying the SMR standard permits you to clear the spine?

Answer 25

This standard does not allow the paramedic to “clear the spine” for blunt trauma
patients. Rather, it identifies patients where the mechanism of injury in combination
with and the absence of risk criteria mean a spine injury does not have to be
considered.

Question 26

what is the main reason for spinal board?

Answer 26

Spinal boards or adjustable break-away stretchers should be considered primarily as
extrication/patient lifting devices. The goal should be to remove the patient from these
devices as soon as it is safe to do so. If sufficient personnel are present, the patient
should be log rolled from the extrication device to the stretcher during loading of the
patient or shortly after loading into the ambulance.

Question 27

What are the reasons you would keep someone on a spinal board?

Answer 27

Spinal boards or adjustable break-away stretchers may remain in place if the paramedic
deems it safer/more comfortable for the patient in consideration of short transport times
(<30 min).
• Recall that patients with suspected pelvic fractures should be secured on a spinal board
or adjustable break-away stretcher as per the Blunt/Penetrating Injury Standard.

Question 28

An immediate application of life-saving measures to a person who has suffered sudden respiratory or
cardiorespiratory arrest. These measures include but are not limited to basic or advanced cardiac life
support interventions outlined in the ALS PCS such as:

Answer 28

1. Chest compression
2. Defibrillation
3. Artificial ventilation
4. Insertion of an oropharyngeal, nasopharyngeal or supraglottic airway
5. Endotracheal intubation
6. Transcutaneous pacing
7. Advanced resuscitation drugs such as, but not limited to, vasopressors, antiarrhythmic agents
   and opioid antagonists

Question 29

what are the 2 reasons a paramedic would perform CPR on a DNR PT

Answer 29

the patient with a Valid MOH DNR Confirmation Form appears to the paramedic to
be capable and expresses clearly a wish to be resuscitated in the event that he/she
experiences a respiratory or cardiac arrest; or
b. the patient with a Valid MOH DNR Confirmation Form appears to the paramedic to
be capable and expresses a wish to be resuscitated in the event that he/she
experiences respiratory or cardiorespiratory arrest, but the request is vague,
incomplete or ambiguous such that it is no longer clear what the wishes of the patient
are.

Question 30

Obviously Dead

means death has occurred if gross signs of death are obvious, including by reason of:

Answer 30

1. decapitation, transection, visible decomposition, putrefaction; or
2. absence of vital signs and:
   a. a grossly charred body;
   b. an open head or torso wound with gross outpouring of cranial or visceral contents;
   c. gross rigor mortis (i.e. limbs and/or body stiff, posturing of limbs or body); or
   d. dependent lividity (i.e. fixed, non-blanching purple or black discolouration of skin in
   dependent area of body).

Question 31

In all cases of death, the paramedic shall:

Answer 31

1. confirm the patient is deceased as per the Definitions above;
2. ensure that the Deceased Patient is treated with respect and dignity;
3. consider the needs of family members of the decedent and provide compassion-informed
   decision-making;
4. in cases of suspected foul play, follow the directions set out in the Police Notification
   Standard;
5. if applicable, follow all directions issued by a coroner or a person appointed by a coroner
   or to whom a coroner has delegated any powers or authority pursuant to the Coroners Act
   (Ontario);
6. if termination of resuscitation occurs in the ambulance en route to a health care facility,
   advise CACC/ACS to contact the coroner, and continue to the destination unless
   otherwise directed by CACC/ACS; and
7. for cases of obvious death, note and document the time at which the paramedic confirms
   the patient was deceased as per the Standards.

Question 32

What is the primary cause of pediatric cardiac arrest?

Answer 32

respiratory arrest is the primary cause of pediatric cardiac arrest

Question 33

when performing a secondary survey of a pediatric PT how should you proceed

Answer 33

if performing a full secondary survey, conduct from “toe-to-head”;

Question 34

In situations where the paramedic has reasonable grounds to believe that the patient is a child who
is or may be in need of protection, the paramedic shall:

Answer 34

1. ensure the patient is not left alone;
2. request police assistance at the scene when it is believed that the patient is at risk of
   imminent harm;

Question 35

The following types of pediatric problems are noteworthy for specific attention when a
paramedic is determining if the patient may be a child in need of protection:

Answer 35

Submersion injury
• All burns
• Accidental ingestions/poisoning
• Other types of in-home injuries, e.g. falls

Question 36

Scene observations which may prompt consideration that the patient is a child in need of
protection include:

Answer 36

• Household/siblings dirty, unkempt, and/or in disarray
• Evidence of violence, e.g. overturned or broken furniture
• Animal/pet abuse
• Evidence of substance abuse, e.g. empty liquor bottles, drug paraphernalia

Question 37

Physical signs which may prompt consideration that the patient is a child in need of
protection include:

Answer 37

Gross or multiple deformities which are incompatible with the incident history,
especially in a child under two years of age who is developmentally incapable of
sustaining this type of injury
• Multiple new and/or old bruises which have not been reported, or which have been
reported as all being new
• Distinctive marks or burns, e.g. belt, hand imprint, cigarette burns;
• Bruises in unusual areas: chest, abdomen, genitals, buttocks
• Burns in unusual areas: buttocks, genitals, soles of feet
• Signs of long-standing physical neglect, e.g. dirty, malodourous skin, hair and clothing,
severe diaper rash, uncut/dirty fingernails
• Signs of malnutrition - slack skin folds, extreme pallor, dull/thin hair, dehydration
• Signs of “shaking” syndrome - hemorrhages over the whites of the eyes; hand or
fingerprints on the neck, upper arms or shoulders; signs of head injury unrelated to the
incident history.

Question 38

the validity of the history provided. Consider if the patient may be a child in need of
protection if,

Answer 38

the story changes frequently or parents’ stories differ,
ii. the parents are vague about what happened or blame each other,
iii. the nature of the injury appears to be inconsistent or improbable with the
explanation provided,
iv. the mechanism of injury is obviously beyond the developmental capabilities
of the child,
v. there has been prolonged, unexplained delay in seeking treatment, or
vi. there is a history of recurrent injuries;

Question 39

Should you speak louder when encountering a geriatric PT?

Answer 39

assume that all geriatric patients are capable of normal hearing, sight, speech, mobility
and mental function unless information is provided to the contrary;

Question 40

What are the guideline to be careful of when dealing with geriatric PT

Answer 40

Geriatric patients can present with atypical signs and symptoms and may have comorbidities.
• Diminished responses to pain, infection, heat/cold may lead the patient and the
paramedic to underestimate the severity of the illness/injury.
• Geriatric patients are susceptible to skin tearing, abrasions, and bruising; use caution
when handling the patient.
• Geriatric patients are more likely to experience adverse effects from medication use.

Question 41

Forms of elder abuse include:

Answer 41

• Financial abuse
• Psychological abuse
• Physical abuse
• Sexual abuse
• Neglect

Question 42

in cases of patients with known or suspected suicide attempts or self-harm, the paramedic shall:

Answer 42

a. assume that all attempts are of serious intent, and

b. ask the patient directly whether they have ideation or intent of suicide or self-harm;

Question 43

only restrain a patient if,

Answer 43

. directed by a physician or police officer,
ii. an unescorted patient becomes violent en route, or

use of restraints is required to provide emergency treatment as per the Patient
Refusal/Emergency Treatment Standard,

Question 44

. in cases in which the patient is restrained, the paramedic shall not proceed
with the inter-facility transport unless,

Answer 44

1. the sending physician or sending facility has made a decision that the
   patient can be transferred safely, either with or without a hospital
   escort,
2. the patient does not appear to be a safety risk or have the potential to
   become violent en route, and
3. the paramedic feels comfortable with the decision that the patient
   does not appear to be a safety risk or who has the potential to become
   violent en route, and

Question 45

an IV line to keep the vein open, as follows

Answer 45

a. The flow rate to maintain IV patency for a patient <12 years of age is 15mL/hr of any
isotonic crystalloid solution.
b. The flow rate to maintain IV patency for a patient ≥12 years of age is 30-60 mL/hr of

Question 46

Can you transport a PT with a KCL IV under 18?

Answer 46

potassium chloride (KCl) for patients ≥18 years of age, to a maximum of 10mEq in a
250 mL bag.

Question 47

Unless within his/her level of certification, a paramedic shall request a medically
responsible escort in the event a patient requires an intravenous:

Answer 47

a. that is being used for blood (or blood product) administration;
b. that is being used to administer potassium chloride to a patient who is <18 years of
age;
c. that is being used to administer medication (including pre-packaged medications,
except as detailed in paragraph 2 from the General Directive above);
d. that requires electronic monitoring or uses a pressurized intravenous fluid infuser,
pump or central venous line; or
e. for a neonate or pediatric patient <2 years of age.

Question 48

The IV bag should be changed when there is approximately:

Answer 48

150 mLs of solution remaining.

Question 49

, the paramedic shall initiate rapid transport:

Answer 49

a. for CTAS 1 patients as per the Prehospital Paramedic CTAS Guide;
b. for patients who meet bypass protocols as per the Standards (e.g. Field Trauma
Triage, Stroke); or
c. for obstetrical patients, with:
i. eclampsia/pre-eclampsia,
ii. limb presentation,
iii. multiple births expected,
iv. premature labour, or
v. umbilical cord prolapse.

Question 50

, the following types of patients may require

interventions prior to initiation of rapid transport:

Answer 50

a. vital signs absent patients experiencing cardiac arrest in which a TOR is not indicated
as per the ALS PCS;
b. patients with conditions which require immediate, life-saving interventions, which
the paramedic can perform; or
c. obstetrical patients in which delivery appears imminent.

Question 51

In situations involving a patient who is reported to have been sexually assaulted, the paramedic
shall:

Answer 51

1. ensure the patient is not left alone;
2. if the patient is a child, follow the Child in Need of Protection Standard;
3. notwithstanding paragraph 2 above, in situation where police are not on-scene, offer to
   contact police; and

Question 52

If a victime of sexual assault declines to report to police, what should you do ?

Answer 52

If the patient declines to report the incident to the police, it is helpful to discuss options
and be knowledgeable regarding local resources (e.g. sexual assault crisis centre; crime
victim assistance programs), and be able to provide phone numbers for same.