Chapter 2 Unit Procedures-Operational guidlines

Question 1

Reports of vehicular accidents with persons trapped will require the dispatch of what companies?

Answer 1

1.3.1

The nearest available Engine, Ladder or Rescue Company.

Question 2

Ay a vehicular accident with persons trapped additional Companies, including additional CFR-D Companies, may be requested by whom?

Answer 2

1.3.2

An Incident Commander at the scene following a size-up.

Question 3

Who may temporarily suspend CFR-D responses when unusual fire or emergency conditions exist?

Answer 3

1.4
In accordance with established guidelines, the Chief of Operations or designee may
temporarily suspend CFR-D responses when unusual fire or emergency conditions exist.

Question 4

Company Commanders shall assign CFR-D certified members to groups that ensure the
greatest likelihood that at least ______ CFR-D qualified Firefighters will report for duty
on any given tour.
Fill in the blank

Answer 4

1.6
Two (2)
1.7
Company Officers of CFR-D Units shall ensure that two (2) CFR-D Firefighters will be working each tour. Officers shall notify their respective Battalion for needed details prior to the start of the tour.

Question 5

In order to be in service as a CFR-D Unit, there shall be a minimum of how many trained members?

Answer 5

1.8
Two (2) trained members (Firefighters or Officer) with current CFR-D Certification.
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.

Question 6

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 take what actions in regards to CFR-D responses?

Answer 6

1.8.1 A, B
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.
Notify the dispatcher and Battalion and enter the event in the Company Journal. Upon notification that a Company will not be able to respond to
any CFR-D incidents, the fire dispatcher shall change or remove that Company’s status in the STARFIRE system.
NOTE: At each change of tours, 0900 and 1800 hours, Unit status defaults to their normal CFR-D status.

Question 7

Assignments for scene survey and patient assessment begin at the start of each tour when
the Officer in Charge assigns CFR-D responsibilities. Companies shall use the following
guide for the distribution of work for CFR-D, based upon the availability of CFR-D personnel.
ABCDE

Answer 7

2.1
-“A” Airway – Firefighter responsible for manually stabilizing the patient’s spine (if trauma is suspected) while opening the airway, maintaining the airway, and administering oxygen if needed. In a response to a cardiac arrest, begins ventilation. This firefighter should carry the oxygen bag.
- “B” Boss – The Officer in Charge. The officer should carry a portable radio and a handlight.
-“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.
-“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.
-“E” Equipment – If a CFR-D Unit is riding with five firefighters, the fifth firefighter should initially remain with the apparatus and help carry any additional
equipment needed.
-The chauffeur or a non-CFR-D trained member remains with the apparatus.

Question 8

If, at any time, CFR-D availability falls below the established threshold levels, CFR-D responses for Companies within a particular area will be discontinued until availability is returned above the threshold level except for what type of responses?

Answer 8

3.3.1

Segment ONE responses.

Question 9

To ensure that remaining available companies are deployed to provide appropriate coverage during periods of high fire and/or CFR-D activity, Companies are instructed to use the signal 10-99 when they expect they will be operating for
more than ___ minutes.
Fill in the Blank

Answer 9

3.3.3

30

Question 10

When approaching the scene the Officer in Charge shall perform the following:
BANS

Answer 10

3. 6.1
   - Ensure BSI (Body Substance Isolation) procedures are used and personal protective gear is on.
   - Determine the need for additional resources.
   - Identify the number of patients involved.
   - Observe the scene for safety of the crew, patient and bystanders.

Question 11

Individuals may identify themselves as patients or may be identified to the Company as such by family, friends or bystanders. Once an individual has been identified as a patient, the Company has the duty to evaluate, render appropriate treatment and generate

Answer 11

3.9.1

A PCR.

Question 12

A PCR is not required when a CFR-D Company is on-scene (10-84) at any CFR-D assignment unless

Answer 12

3.10.1

Patient care is provided.

Question 13

When requesting an ambulance, Companies must provide the following information to the dispatcher for relay to EMD:
PAR 3 C’s

Answer 13

3. 11
   - Pulse
   - Age
   - Respiratory rate
   - Chief complaint
   - CPR initiated
   - CUPS Status

Question 14

If the incident involves attempted resuscitation of a non-breathing/cardiac arrest patient, all efforts shall be exhausted until released by EMS. Fire Department personnel will begin resuscitation efforts unless the following conditions exist:
LORD

Answer 14

4.4
Obvious death
Dependent lividity
Rigor mortis
Decomposition
Valid Do Not Resuscitate Order 
NOTE: 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.

Question 15

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:
-The Officer in Charge shall review the response printout for additional information as to incident location, cross street, dwelling or unit number, and any other pertinent information provided by the EMD or 911 comment section of the printout.
-If after rechecking the information provided no patient is found the Officer in Charge shall verify the information with the dispatcher.
-After re-verification of the dispatch information, the responding Company shall attempt to contact neighbors, building superintendent and/or security personnel.
-If no patient is found after the above efforts have been exhausted, the Officer in Charge shall enter a 10-92 via MDT (therefore canceling the EMS response) and return to service.
What shall the Officer do when returning to quarters?

Answer 15

4.7

The Officer in Charge shall make a notation in the Company journal upon return to Quarters.

Question 16

When a patient refuses medical aid, what must be completed?

Answer 16

4.9.1
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.

Question 17

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 what?

Answer 17

4.12
The physician’s six-digit New York State license number and include the number on the PCR. Members must continue to perform within their scope of practice and not do anything they are not
trained to do.

Question 18

If ESU arrives on the scene of a medical emergency after the CFR-D Unit has initiated patient care; the CFR-Ds should retain responsibility for patient care until a transporting agency assumes responsibility of the patient. 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. When will the CFR-D Unit retain patient care?

Answer 18

4.13.1
However, if ESU is not equipped with what with a SAED, the CFR-D Unit shall retain patient care responsibilities as per the Regional Coordination of Pre-hospital Resources Protocol.

Question 19

What vehicles can be used to transport patients?

Answer 19

4.17
As advised by the New York State Department of Health, under no circumstances shall fire apparatus or vehicles other than NYS-certified ambulances be used to transport patients.

Question 20

In the event that a CFR-D Unit needs medical advice during a CFR-D response, the Unit may telephone the FDNY/EMS telemetry physician at 800-281-8356, if a telephone is available. The telemetry phone number shall be kept posted where?

Answer 20

5.3
On the chart holding the Unit’s PCR forms. Before calling telemetry the Unit shall have completed the primary survey and C.U.P.S. status determination, and should identify themselves as a CFR-D Unit and be prepared to give a concise report to the physician. CFR-D Units shall follow the advice given by the telemetry physician, noting all instructions on the PCR. Telemetry may be utilized for medical consultation and as access to the International Language Bank.

Question 21

Some FDNY members may have previously been trained as EMTs, paramedics or nurses, how shall they operate in regards to patient care?

Answer 21

5.2 & 5.4
Regardless of this level of personal certification, members shall operate as CFR-D providers based solely upon their Department Certification level, and shall immediately relinquish care of the patient to EMS on their arrival.
-All CFR-D trained members shall render emergency care only within the scope of their
training and Regional protocols.

Question 22

Where a minor is found to be suffering from a life-threatening illness or injury, immediate medical intervention must be provided. Regardless of what?

Answer 22

6.1.1 A
Regardless of whether the parent/guardian is available, or refuses to give consent, treatment for a life threatening illness or injury requires immediate
medical intervention.

Question 23

In the event a parent or legal guardian refuses permission for medical treatment for their minors, treatment should nonetheless be provided
whenever the minor is:

Answer 23

6. 1.1 B
7. suffering from a life-threatening illness or injury and
8. it is apparent that a delay in treatment, even if minimal, would jeopardize the minor’s life

Question 24

If the illness or injury is non-urgent in nature, treatment should still be provided unless the parent or guardian refuses to allow this treatment. If
the parent or guardian will not allow treatment to be rendered the following steps should be taken:

Answer 24

6. 1.1 C
   - Carefully explain the reason(s) for the treatment, what intervention is necessary to correct the problem and the consequences if the injury/illness is not treated.
   - Notify the dispatcher of the events unfolding and have them notify EMS. Contact FDNY/EMS Telemetry, if phone is available. Implement their recommendations (if any) while awaiting EMS arrival. Do not leave the scene before EMS arrives.
   - Return the Unit to service after EMS arrives.

Question 25

When the CFR-D Unit suspects child abuse, the circumstances of the suspected abuse shall be reported to EMS personnel at the scene. The
Officer in Charge shall do what upon returning to quarters?

Answer 25

6.1.1 D
Make an entry in the Company journal upon return to quarters including the names of those notified and their Unit designation.

Question 26

If a CFR-D Unit is presented with a NYS DOH Out of Hospital DNR Order, the Officer in Charge shall notify the dispatcher of the above and ask them to
advise EMS. A DNR Order is only an order not to perform what?

Answer 26

6.2.1 A
Cardio-pulmonary resuscitation (e.g., chest compressions and artificial ventilation for a patient in cardiac arrest). It is not a reason to withhold other treatments, such as supplemental oxygen.

Question 27

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 what info?

Answer 27

6.2.1 B

The patient’s name, date of birth, the MD’s signature and license number, and the date issued.

Question 28

If a signed order is presented, the CFR-D Unit should follow it unless it has been revoked in what way?
(2 answers)

Answer 28

6.2.1 C
If a signed order is presented, the CFR-D Unit should follow it unless it has been revoked verbally or in writing.
Obtain the original DNR order and give it to EMS upon their arrival.

Question 29

A DNR Bracelet shall consist of a piece of metal no less than 1.5 inches in length and no less than ½ inch in width with the symbol commonly referred to as the caduceus on the obverse and the words “Do Not Resuscitate” in letters of no less than 16 point size on the reverse. The ends of the piece of metal shall be linked to one another with material of sufficient strength as to be serviceable for ordinary use. A caduceus is a representation of a staff with one entwined snake and one wing at the top.
DNR Bracelets may be sold for use only by persons who have been issued a what?

Answer 29

6.2.2 A

A valid Non-Hospital Order Not to Resuscitate.

Question 30

NYS law classifies nursing homes as a hospital with no distinctions to advanced directives (e.g. DNRs). ). Do Not Resuscitate Orders issued by nursing homes do not have to be on a specific form and each facility may have their own variation.
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 what?

Answer 30

6.2.3
A physician’s signature. The DNR order remains in effect until it is specifically revoked. If presented with a nursing home DNR order follow the guidelines in Section 6.2.1.

Question 31

Is a Living Will valid in a pre-hospital setting?

Answer 31

6.3.2
A Living Will is not valid in the pre-hospital setting for pre-hospital emergency care. If presented with a living will, CFR-D members are to continue to provide care within the scope of training and give the living will to EMS personnel on their arrival.

Question 32

A Health Care Proxy gives a third party the authority to make medical decisions on the patient’s behalf. If a CFR-D Unit encounters a patient with a Health Care Proxy the Officer in Charge shall notify the responding EMS Unit and give the proxy to the EMS crew to take to the hospital with the patient. Is a Health Care Proxy valid in a pre-hospital setting?

Answer 32

6.4.2
A Health Care Proxy is not valid in the pre-hospital setting for pre-hospital emergency care. If presented with a Health Care Proxy, CFR-D members are to continue to provide care within the scope of training.

Question 33

The Quality Assessment/Quality Improvement (QA/QI) Unit reviews CFR-D PCRs for accuracy and protocol compliance.In cases where the written reports indicate that the care provided by CFRD Units appears to deviate from the procedures taught (which are considered the recognized “standard of care”) copies of the call reports are reviewed by a quality assurance review team. Following the QA Committee’s review, the Committee may recommend that a Medical Case Review take place. In cases of potentially serious
deviations, the Medical Director has the right to order what?

Answer 33

7.2.1 A & B
A temporary “suspension of patient care privileges” of the individuals involved in the case until such a time as the case review is completed (in such cases, those members with suspended patient care privileges shall not be counted toward the minimum number of certified members required for a Unit to
be in service as a CFR-D Unit).

Question 34

Once a CFR-D response has been designated for a Medical Case Review, the QA/QI Unit shall schedule a critique/review session for when?

Answer 34

7.4.1
A 9x6 tour when the responding officer (if the officer is certified) and the CFR-D member involved are scheduled to work.

Question 35

Who is the Incident commander at a CFR-D run when FDNY line units and EMS units are on scene?

Answer 35

8.3
The Incident Commander shall be responsible for all decisions at the scene with the exception of patient care matters. CFR-D certified members, EMTs, and Paramedics (including EMS Lieutenants, Captains and Chiefs) shall maintain responsibility for patient care. It is the responsibility of the Incident Commander to evaluate the scene and to provide for the safety of all patients and operating personnel.
Whenever Units of the Bureau of Operations and the Emergency Medical Service are operating at an incident, the ranking Fire Officer on the scene is the Incident Commander.

Question 36

Members shall comply with all orders and directions of the Incident Commander
concerning the safety of operating personnel. However, a pre-hospital care provider receiving an order believed to be detrimental to the patient’s condition, contrary to good patient care, or in violation of medical protocols or agency policy shall inform the Incident Commander of such and continue providing appropriate patient care. If the
Incident Commander persists in giving such an order(s), the pre-hospital care provider is
required to prepare what?

Answer 36

8.7 & 8.8
Prepare and forward, through appropriate channels, a written statement to OMA.
Any failure to perform duties which impact on patient care and/or any failure to adhere to
orders and directions of the Incident Commander in all matters other than those directly related to patient care shall be subject to appropriate corrective or disciplinary action.