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CFR-D > Ch 2 Unit Procedures > Flashcards

Ch 2 Unit Procedures Flashcards

1
Q

In order to be in service as a CFR-D Unit, there shall be a minimum of two (2) trained
members (Firefighters or Officer) with current CFR-D Certification. during the tour a member taps out leaving just 1 firefighter and the officer with cfr-d certificates. Can the unit remain in service as a CFR-D unit ?

A

YES!
NOTE: While CFR-D Units must begin each tour with two (2) certified Firefighters, in the
event that during a tour the minimum CFR-D staffing reduces to 1 Firefighter and 1
Officer, the Company shall remain available for CFR-D response
Sec 1.

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2
Q

During roll call the Officer in Charge shall determine the number of CFR-D
certified personnel on duty. If that number has fallen below the minimum, the
Officer in Charge should follow these procedures

A

A. Without two CFR-D certified members, the Company shall not respond to
any CFR-D calls. The Company may still be dispatched for calls received
directly from the public to assist civilians.
B. Notify the dispatcher and Battalion and enter the event in the Company
Journal.
Sec 1.8.1

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3
Q

Assignments for scene survey and patient assessment begin at the start of each tour when
the Officer in Charge assigns CFR-D responsibilities. With this in mind who begins compressions and who carries the trauma bag ?

A

“C” Checker – Firefighter responsible for conducting the patient assessment and
performing any hands-on care. In response to a cardiac arrest, this Firefighter
checks pulse and begins compressions and shall carry the Trauma Bag.
Sec 2.1.3

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4
Q

Assignments for scene survey and patient assessment begin at the start of each tour when
the Officer in Charge assigns CFR-D responsibilities. With this in mind who fills out the PCR report ?

A

“D” Defib/Documenter – Firefighter responsible for completing the Pre-Hospital
Care Report (PCR). In a response to a cardiac arrest, hooks up and operates the
defibrillator.
Sec 2.1.4

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5
Q

If it is determined that the patients condition is either CRITICAL or UNSTABLE,
(utilizing the CUPS status) the Officer in Charge shall:

A

A. Ask the dispatcher for an ETA of the responding ambulance.
B. Advise the dispatcher to relay the seriousness of the patient’s condition to
the responding EMS Unit(s).
Sec 3.9.3

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6
Q

When requesting an ambulance or after initial care has been completed and EMS not on scene Companies must provide the following information to
the dispatcher for relay to EMD:
CCC RAP

A

CCC RAP

CUPS Status
Age
Chief complaint
If CPR initiated
Pulse and respiratory rate
Sec 3.11.1-6
Sec  4.15
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7
Q

You arrive and see a male with severe chest pain and a systolic bp of less than 100mmhg. according to CUPS this patient is considered Unstable…Agree or Disagree

A

Disagree!!
Patient is Potentially Unstable
Severe chest pain, especially with a systolic BP of less than 100mmHg
Sec 3.14

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8
Q

10-84 at the scene of an elderly male with a cough…As a Lt Awaiting Ems for this call you are in a hurry to get back to fire duty so you request an ETA…in which dispatch responds No Unit Available. The Lt tells the dispatcher that his unit is 10-99. agree or Disagree

A

Any CFR-D response where, in response to a request for an ETA for EMS from
the Company at the scene, EMS reports no Unit available.
Sec 3.19.3

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9
Q

Fire Department personnel will
begin resuscitation efforts unless the following conditions exist:

LORD Vader

A 
Obvious death
Dependent lividity
Rigor mortis
Decomposition
Valid Do Not Resuscitate Order
Sec 4.4.1-5
Lividity usually starts one to two hours after death and is completed after three to four hours and
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10
Q

Upon examination of the patient it is decided that resuscitation efforts are not needed due to obvious death. Does a PCR report need to be filled out ?

A

YES!
The CFR-D Unit must complete a Pre-Hospital Care Report even if the patient is
DOA, to document that the Company properly examined the patient to confirm that
the patient exhibited the criteria for obvious death
Sec 4.4.1 Note

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11
Q

If a patient’s whereabouts are not known, the responding Company will make every
effort to ascertain the location of said individual. If, after a complete search of the area in
question, no patient is found, the following procedure shall be used…. 1-6

A
  1. The Officer in Charge shall review the response printout for additional
    information
  2. Recheck the information provided
  3. Verify the information with the dispatcher
  4. Attempt to contact neighbors, building superintendent and/or security personnel
  5. If no patient is found Officer enter a 10-92 via MDT
  6. The Officer in Charge shall make a notation in the Company
    journal upon return to Quarters.
    Sec 4.7
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12
Q

When a patient refuses medical aid (RMA) does a PCR need to be filled out ?

A

YES!!
When a patient refuses medical aid, a Pre-Hospital Care Report (PCR) must be
completed. If the patient insists on leaving the scene, the Officer in Charge
should notify the dispatcher and the Unit shall go back in service after the patient
has left
Sec 4.9.1

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13
Q

CFR-D assignment at roll call.. ABCD

A 
Airway
Boss
 Checker
 Defib,  Documenter
Equipment
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14
Q

E 321 is 10-84 at a medical response, ESU enters after patient care has been started. ESU wants to assume patient care. As the LT do you hand over control ?

A

If the ESU
EMTs assumes the role of higher level pre-hospital care provider and assumes
responsibility for patient care, the Company shall release the patient to ESU.
However, if ESU is not equipped with a SAED, the CFR-D Unit shall retain
patient care
Sec 4.13.1

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15
Q

When the CFR-D Unit suspects child abuse, the circumstances of the
suspected abuse shall be reported to ??

A

EMS personnel at the scene. The
Officer in Charge shall make an entry in the Company journal upon return
to quarters including the names of those notified and their Unit
designation
Sec 6.1.1

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16
Q

What information must the Out of Hospital DNR form contain ? 1-5

A 
The order must be a copy of the NYS Out of Hospital DNR form. The patient’s attending physician must sign and date the form,
which must contain the 
1. patient’s name
2. date of birth
3. the MD's signature and license number
4. and the date issued.
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17
Q

A nursing home does not have to utilize the New York State Out of Hospital
DNR form. The minimum requirement for a valid DNR is that the facility form
contains a physician’s signature True or False

A

True

Sec 6.2.3

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18
Q

If it is determined that the patients condition is either CRITICAL or UNSTABLE,
(utilizing the CUPS status) the Officer in Charge shall:

A

A. Ask the dispatcher for an ETA of the responding ambulance.
B. Advise the dispatcher to relay the seriousness of the patient’s condition to
the responding EMS Unit(s).
Sec 3.9.3

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19
Q

If forcible entry is required to gain access, the officer in command must have the
premises safeguarded by members until ?

A

custodianship is turned over to the owner,
occupant, Police Department, or a responsible person
Sec 4.8

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20
Q

The responsibility of safeguarding premises shall not be delegated to EMS
personnel. This includes awaiting the arrival of PD.
True or False

A

True

Sec 4.8

21
Q

4.9.1 When a patient refuses medical aid is a Pre-Hospital Care Report (PCR)
completed. ?
If the patient insists on leaving the scene, the Officer in Charge
should notify who ?

A

YES!!

the dispatcher and the Unit shall go back in service after the patient
has left
Sec 4.9.1

22
Q

If a physician is on the scene of a CFR-D response when EMS is not yet on the scene and
offers his/her assistance, he/she should be asked to produce proper identification. The
Unit may accept such assistance and notify the fire dispatcher that a physician is on the
scene and request that EMS is notified. The Unit shall ask for the physician’s ??

A

Six-digit
New York State license number and include the number on the PCR.
Sec 4.12

23
Q

CFR-D curriculum regarding scene control, safety, obtaining patient consent, and
beginning care are to be followed carefully by the Company. If EMS has not arrived by
the completion of the INITIAL ASSESSMENT , the Officer in Charge shall contact the fire
dispatcher to relay to EMS a report on the patient’s

A
  1. CUPS status
  2. age
  3. chief complaint,
  4. pulse, respiratory rate
  5. and if CPR has been initiated
    Sec 4.15
24
Q

What does CUPS stand for ?

A

Critical
Unstable
Potentially unstable
Stable

25
Q

3.12 If the patient is CRITICAL or UNSTABLE
What must be done ?
3.13 If the patient is POTENTIALLY UNSTABLE or STABLE,

A

packaging efforts must begin immediately
while treating life threats. Immobilize to a spineboard if indicated.
Sec 3.12

Perform the appropriate
focused physical exam for the patient
Sec 3.13

26
Q

A patient is considered Unstable when ?

DRUG

A

 Poor general impression
 Unresponsive with no gag or cough reflexes
 Responsive but unable to follow commands
 Difficulty breathing
Sec 3.14

27
Q

A patient is considered critical when ?

A

 Patients either receiving CPR, in respiratory arrest or requiring
and receiving life-sustaining ventilatory/circulatory support
Sec 3.14

28
Q

A patient is considered potential Unstable when ?

A

 Pale skin or other signs of poor perfusion (shock)
 Complicated childbirth
 Uncontrolled bleeding
 Severe pain in any area of the body
 Severe chest pain, especially with a systolic BP of less than 100mmHg
 Inability to move any part of the body
Sec 3.14

29
Q

A patient is considered Stable when ?

A

 Minor illness, minor isolated injury, uncomplicated extremity
injuries, and/or any patient that cannot be categorized as Critical,
Unstable or Potentially unstable
Sec 3.14

30
Q

If during a CFR-D response, a verbal alarm for an additional sick or injured person is
received, what shall be done ?

A

the Company shall make every attempt to make patient contact and notify the
dispatcher. If contact is made with the 2nd patient, the Company shall not leave the scene
until relieved by EMS or the patient leaves the scene
If responding Company initiates patient care for another patient at the verbal
alarm, the Officer will notify the dispatcher and the fire dispatcher will send
appropriate resources to the original location
Sec 3.18.1
Conflict Comm 6.5.2
In the event the unit is responding to another alarm and it is evident human
life is not in jeopardy at the scene of the verbal alarm, the unit shall proceed
to the original alarm after transmitting radio notification of a verbal alarm to
dispatcher and receiving acknowledgement.

31
Q

If equipment has been left with the patient or supplies have been expended and
the Company does not have the minimum amount
the Company is to go back in service for fire duty but advise

A

the borough fire
dispatcher and the Battalion that it is not available for CFR-D responses
3.16.2

32
Q

If forcible entry is required to gain access, the officer in command must have the
premises safeguarded by members until custodianship is turned over to the
POOR

A 
Police Department,
Owner
Occupant
Responsible person
4.8
33
Q

When a patient refuses medical aid, a Pre-Hospital Care Report (PCR) must be
completed. If the patient insists on leaving the scene, the Officer in Charge
should notify the dispatcher and the Unit shall go back in service after the patient
has left.
Agree Disagree

A

Agree

4.10

34
Q

If a physician is on the scene of a CFR-D response when EMS is not yet on the scene and
offers his/her assistance. Do we aceppt ?

A

YES
he/she should be asked to produce proper identification. The Unit may accept such assistance and notify the fire dispatcher that a physician is on the
scene and request that EMS is notified. The Unit shall ask for the physician’s six-digit
New York State license number and include the number on the PCR.

4.12

35
Q

In the event the ambulance assigned by the “911” system (EMS or voluntary hospital) is
not yet on the scene and another NYS certified ambulance service (e.g., hospital,
commercial or volunteer) is on the scene the CFR-D Unit will, turn over responsibility for
the patient to the ambulance crew as long as ?
Who is notified ?

A

the ambulance crew is trained at the SAME or
HIGHER level as a CFR-D Unit. If responsibility for care is turned over in this manner, the
fire dispatcher should be notified, and should advise EMS.

36
Q

Do Not Resuscitate Order (DNR)

A

A legally recognized medical order that authorizes a
health care provider to NOT perform cardiopulmonary resuscitation (CPR); including chest
compressions, bag valve mask ventilations, defibrillation, endotracheal intubation and/or
the administration of medications to a patient in cardiac or respiratory arrest

37
Q

Out of Hospital Do Not Resuscitate (DNR) Order

A

A medical order applicable to a
patient who is not in or originating from a hospital or nursing home, that authorizes a health
care provider to NOT perform CPR
arrest. In New York
State, an Out of Hospital DNR Order is ONLY VALID if recorded on a New York State
Department of Health standard form DOH-3474

An Out-of-Hospital
DNR Order should be updated by the patient’s physician every ninety (90) days
but remains valid even if it has not been updated.

38
Q

DNR Bracelet

A

A standard New York State Department of Health (NYSDOH) metal
bracelet which includes a caduceus and the words “Do Not Resuscitate” (Appendix B).
A DNR bracelet is considered a valid DNR Order

39
Q

Medical Orders for Life-Sustaining Treatment (MOLST)

A

For purposes of this policy,

a MOLST form WITHOUT a DNR Order is not sufficient for the withholding of CPR.

40
Q

Hospital and Nursing Home DNR Forms

A

MAY NOT BE EXPIRED
A DNR Order issued on a hospital or
nursing home form. In order for a Hospital or Nursing Home DNR Order to be honored
by pre-hospital providers, the form must be current - it may NOT be expired. Hospital
and Nursing Home DNR Forms may be honored ONLY if the patient originates from the
nursing home or hospital that issued the Order.

41
Q

Health Care Proxy

A

Health Care Proxies are NOT recognized in the

pre-hospital environment.

42
Q

Living Will

A

Living Wills are NOT recognized in the

pre-hospital environment.

43
Q

Power of Attorney (POW)

A

Not usually an

instrument for medical decisions and NOT recognized in the pre-hospital environment.

44
Q

Pre-hospital health care providers (CFRs, EMTs, and Paramedics), when informed of or
presented with any of the following shall follow the procedure below:

A

 Out-of-Hospital DNR Form
 DNR Bracelet
 Non-expired Hospital or Nursing Home DNR Form
 MOLST Form with a DNR Order

45
Q

With a VALID DNR If the patient is NOT in cardiac or respiratory arrest, full treatment for all injuries, pain, difficult
or insufficient breathing, hemorrhage and/or other medical conditions must be provided.

A

TRUE

46
Q

A DNR Order shall be disregarded and full resuscitative efforts shall be initiated in any
of the following circumstances:

A

 Any case where there is reasonable evidence to suggest that the DNR Order has been
revoked or cancelled.
 If the patient is conscious and states that they wish resuscitative measures.
 If the patient is unable to state his/her desire and a family member is present and
requests resuscitative measures for the patient and a confrontational situation is likely to result if the request is denied.
 A physician directs that the Order be disregarded.

47
Q

Valid DNR
Relief of choking by removing a foreign body is appropriate, but if breathing has
stopped, ventilation shall NOT be assisted.
Agree Disagree

A

Agree

48
Q

If there are any questions about the validity of the DNR Order, unusual circumstances, or
a potential confrontation between pre-hospital providers and persons at the scene appears
likely as a result of the DNR Order, request

A

the response of an EMS Officer and contact

the OLMC Physician

CFR-D (4 decks)

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