Combined Protocol, DSI, IMS, Exposure Flashcards
<p>A significant exposure is deveined as :</p>
<p>Needle stick or sharps:<br></br>Blood or fluid containing visible blood<br></br>Semen<br></br>Vaginal fluids<br></br>CSF<br></br>Synovial fluid<br></br>Peritoneal fluid<br></br>Pleural fluid<br></br>Pericardial Fluid<br></br>Amniotic fluid <br></br>Mucous membranes<br></br>Abrased or abraded skin<br></br>Airborne contagions</p>
<p>The exposure control officer works under who?</p>
<p>Chief of training and safety division</p>
<p>Exposure to an Airborne contagion other than TB should be documented on ?</p>
<p>FR exposure form</p>
<p>For percuteanous needle sticks how to care for them?</p>
<p>10 min washing with soap and water or 10% iodine or chlorine compounds until soap and water are available</p>
<p>Washing mucous membranes from significant exposure how?</p>
<p>Irrigate with normal saline or water for 10-15min</p>
<p>"Right to know" is applicable for the source patient if?</p>
<p>Patient was transported to the hospital<br></br><br></br>Blood drawn for routine medical need.</p>
<p>If the hospital or the physician do not comply with state mandates for exposure testing what happens?</p>
<p>Contact the EMS captain who will contact the medical director if necessary.</p>
<p>Ryan White act notification is for what time frame?</p>
<p>Within 48hrs of notification of patient diagnosis</p>
<p>EMS captains responsibilities for exposure?</p>
<p>Make sure that employee is source tested<br></br>Make sure state mandates are followed at the ER<br></br>Notify the Exposure control officer as soon as possible during working hours or if unusual or receives treatment have paged<br></br>Contact facility for F/U instructions<br></br>Contact the OHC to make arrangements for F/U or as soon a possible for testing<br></br>Ensure Exposure form is filled out and turned in by the end of shift <br></br>Forward the exposure to the Exposure control officer</p>
<p>Definition of “Verification” for exposure?</p>
<p>Determining whether a reported exposure is and “Actual” or perceived health threat.</p>
<p>When should post exposure testing occur?</p>
<p>1-2 hours preferably at the OHC or Hospital</p>
<p>When it is deemed necessary to have follow up testing who contacts the employee and when?</p>
<p>EMS captain , Exposure control officer, or OHC within 24 hours</p>
<p>Written documentation of follow up testing for an exposure should follow when ?</p>
<p>Within 48hours</p>
<p>Follow up testing from exposure is done at what intervals?</p>
<p>Initially, 3mo, 6mo, 1 year</p>
<p>Post exposure treatments are for which diseases?</p>
<p>AIDS, HIC, Hep B, Hep C, Menningcoccal meningitis, TB</p>
<p>A post exposure treatment written opinon statement is to be completed by what time frame?</p>
<p>Within 15days</p>
<p>A written exposure treatment opinion includes what ?</p>
<p>Results of the medical evaluation <br></br><br></br>Verification that the employee has been informed about any medical condition resulting from the exposure.</p>
<p>Time frame for post exposure prophylaxis?</p>
<p>Within 1-2 hours</p>
<p>What cases are mandated to be reported to the CDC?</p>
<p>Contagious ds<br></br>AIDS<br></br>HBV<br></br>TB</p>
<p>A report of the department’s exposures are sent to who and how often?</p>
<p>Wellness coordinator- Annually.</p>
<p>Who ensures confidentiality with exposure reports for the employee?</p>
<p>EMS captain <br></br><br></br>Exposure control officer</p>
<p>What are the most likely transmission routes from TB?</p>
<p>Persistent cough >2 weeks with one of the following<br></br>-Anorexia<br></br>-weight loss<br></br>-fever<br></br>-hx of drug use<br></br>-night sweats<br></br>-bloody sputum</p>
<p>When treating a possible TB patient what should happen ?</p>
<p>N95 on employees<br></br>Oxygen to patient or if not needed N95 for patient <br></br>Air vents open -no recirculating</p>
<p>When are risk management reports due?</p>
<p>By the end of shift and forwarded to the appropriate party</p>
When filling out risk management forms supervisors must sign forms using what?
Full first and last names AND employee ID
Employees filling forms for PTSD fill out what forms?
The same as employee injury
Who gets notified for vehicle accidents?
BC
What MUST be obtained on a vehicle accident?
A police report AND obtain insurance from other driver
Who gets notified of exposure to communicable ds.?
EMS captain and notify Medical services division.
The exposure contorl manual provides information on what areas?
Risk
Determination
Prevention
Care and cleaning
bio waste
who designates one or more members as the exposure control officer.
the department
exposures to airborne pathogens are doucumented on ?
exposure form
documentation for exposures protects who?
the employee
department
when does the patient have a right to refuse a blood test that might verify an communicable disease?
if blood was not drawn in the field for routine medical need.
the physican notification form is delivered to who and how?
Emergency room physician
hand delivered
who is responsible for ordering the HIV on the patient?
ER physican
when filling out the exposure form which section should be given special attention?
how the exposure occured
how does the Exposure control officer notify employees of a possible exposure from the hosptial?
verbally
the ryan white care act is what type of law?
florida statue
federal.
What does the ryan white care specify?
any licensed facility receving a patient who os subsequently diagnosed as having certain infectious diseases to notify the health care provider.
prophylaxis treatment post exposure is within what time frame?
1-2 hours
when does the exposure from need to be completed by?
prior to the end of shift
If receiving prophylaxis treatment when can an employee discontinue treatment?
when directed by the OHC
All completed documents with an exposure must be forwarded to who?
Exposure control officer
All exposure forms must include what?
an injury tracking number
The exposure control officer gets notified as soon as possible under what conditions?
unusual
emergency situation
receives post exposure treatment
Who contacts the hospital ICC to verify source patient testing?
Exposure control officer.
who is in charge to investigate an exposure?
Exposure control officer
if a competent patient refuses source testing where is this documented?
medical records of the individual sustaining the significant exposure
how are results of the HIV testing if performed at the hospital given to the employee?
person to person
mail to the OHC
medical treatment for a post exposure shall be conducted where?
OHC
counseling and or treatment is in according to who?
US public health service
what is the primary means of preventing occupationally HIV infections
prevention of blood exposures
What guideline is followed by PBCFRs PEP plan?
Center for disease control
public health service
contagious diseases that limit an employee to work with patient care or at a station are ?
influenza
HBV
exudative lesions
who is consulted on the limitations on an employee to work from an exposure?
employees private physican
OHC
legal counsel
CBA
medical director
how long are employee medical exposure records maintained for?
the duration of the employment plus 30 years
the transmission of what cuases TB?
mycobacterium
what environmental factors increase the transmission of TB?
exposure of person in a small space- like a ambulance
close contact during procedures- ET, deep tracheal suctioning
PBCFRs TB infection program includes?
Annual PPD testing
additional PPD testing is done when ?
after a documented exposure
persons who miss the annual TB screening can make it up where?
OHC
Who is allowed to deviate from the protocols?
Ems captains and Trauma hawk Personnel
In mutual aid circumstances whose protocols should be followed?
The transporting agency.
Oxygen is to be administered only when?
maintain sp02 of 95% all patients
90% for COPD and asthma.
ET tubes shall be confirmed how? 3 methods.
visualization
esophageal intubation detector (if available)
continuous EtCo2
Ventilatory rates are the following?
Adults- Pulse 1 q6
No pulse 1 q10
ICP 30-35mmhg
Pediatrics Pulse 1 q3
No Pulse 1 q6
ICP- 30-35mmHg
EtCO2 monitoring will be performed on which pts?
Respiratory distress
ventilatory support
AMS
Sedated / pain medication
seizure pts
ketamine pts
which pt's are required to have a 12 and 15 lead performed?
chest, Arm, neck, back, jaw, shoulder, epigastric pn or discomfort
palpitations
syncope, lightheadness, general weakness, fatigue
SOB, CHF, or hypotension
unexplained diaphoresis or nausea.
12 lead cables will remain on the pt until when?
turned over the ED staff when transporting.
12 leads will be repeated how often?
q 10min
Which pt's shall have a BGL checked?
Diabetics
AMS
seizure
stroke
syncope,
lightheadedness,
dizziness
poisoning
cardiac arrest
A complete set of v/s consists of what and done how often?
Pulse,- Rate rhythm quality
Respirations-Rate and Quality
Temp
Pulse ox
BP- cap refill
ETC02
BGL
Priority 3 - at least 2 sets
Priority 2- q 5min.
Adult hypotension is defined as?
systolic BP> 90.
When should manual BP's be taken?
Initially and to confirm any abnormal or significant change in an automatic BP.
Pt's that have not reached puberty shall be classified as how?
pediatric pts.
When using the Hand Tevy method, what is used for the PRIMARY reference point?
age
What type of pts' meeting trauma alert criteria transported by AIR to St. mary's?
Pregnant (visibly pregnant or by hx of gestation >20wks)
All intubated interfacility transfers must be ______ and ______ by the sending facility.
paralyzed and sedated.
If the sending facility physician refuses to administer paralytics for a trauma transfer then what?
Crew must contact the EMS Captain and follow the advanced A/W protocol, and accompany pt to the receiving facility.
What type of alerts go by air if ground transport is greater than what time?
40mminutes:
Decompression Sickness
STROKE
STEMI
Stroke pt with transport times greater than 20 min go where?
depends- if all other criteria are met;
1. transport time to comprehensive is > 20 min
2. onset time < 2hr
3. no tpa exclusions
4. no severe headache
Primary center, if not all met, comprehensive center.
Pediatric pts are age what?
less than 18.
Where do decompression CO, H2S and CN poisonings go?
Hyberbaric chamber @ st mary's hospital.
Where are psychiatric pts transported?
stable- closest facility
unstable- closest ED for stabilization.
What are the criteria for someone to request a "Free Standing" ED?
Stable Patients
informed if admitted they will be transferred.
sign "Emergency Transport Disclaimer"
What are the Air Transport time criteria?
STEMI / Stroke >40min
Trauma > 25min
Extrication >15min
Response time >10min
When can air transport NOT be used?
Pt weighing > 500lbs or 227kg
Pt that cannot lay supine
combative and cannot be physically restrained
Hazmat contaminated pts
What does MICCR stand for?
Minimally Interrupted cardio-cerebral resusitation
Cardiac arrest pt's with the use of a "Lucas" device will be placed on what?
Scoop stretcher and elevated 15 degrees.
All IVP medications for an arrest are followed by what?
10ml saline Flush
Termination efforts can be done when?
EMS captain OS
persistent asystole for 15 min
Etco2< 10mmHg
No hypothermia
1 defibrillation @ 360j.
500ml NS
All ALS interventions have been completed and reversible causes
addressed.
Social support group is in place for family if needed.
What is considered a "SECONDARY" arrest?
CHF, drowning, FBAO, OD, Hanging, lightning strike- DC current., Trauma, CN, 3rd Trimester pregnancy
When does a ResQpod get placed?
all cardiac arrest patients that are greater than 1yr old.
What are the contraindications for the "ResQpod"
Pt less than 1 yr old
Pt's with a pulse
Cardiac arrest due to trauma
during passive oxygenation
If a rhythm converts back after electrical therapy was used what setting should be used ?
the setting that was successful in converting the rhythm.
Medications should be delivered when in cardiac arrest ?
ASAP after rhythm check and circulated for 2 min
What is the dose of MGSO4 in Torsades?
adults- 2g in 50 ml 60gtts wide open
pedi- 40mg/kg in 50ml 60gtts wide open
primary and secondary arrest pt's go to which facilites?
primary- STEMI facility
secondary- Closest faclility
Spinal motion restriction for what criteria?
focal neurologic deficit
pain to the neck or back
distracting injury
AMS w/ an MOI
intoxication w/ MOI
Sager splints are used on what type fx?
Closed Mid shaft femur only
What are the oral hypoglycemic medications
Glipizide, Glyburide, Glimepiride
indications for Hyperkalemia for CaCl2?
Peaked T waves
Sine wave
Wide complex QRS
RRWCT
severe bradycardia
high degree blocks
it is more important to maintain what levels for COPD and asthma patients?
SPo2 at 90%
Auto PEEP is what?
When Air goes in before a patient is allowed to exhale.
Differences in Croup and Epiglottitis?
Chonic vs Acute
sick for a few days vs Sudden onset
low grade fever vs high grade fever
not toxic looking vs drooling and tripod
Ketamine for seizures is what and what contraindications?
Adults :100mg- pregnancy
penetrating eye
non traumatic chest pain
Pedi >3yrs: 1mg/kg
Sepsis alert criteria?
Adult not pregnant
suspected or documented infection
Hypotension
AMS
Tachypnea - RR>22 or ETco2 < 25mmHg
Which patients receive fluids despite having rales?
Septic pneumonia patients
What is the tine frame for not considering a stroke not an Alert
Witnessed greater than 24 hours
What are the precautions with Ketamine in seizure patients?
Respiratory distress- need for an advanced airway
HTN
Schiziophrenia
What is the criteria for unstable Afib/ flutter
Hypotension only
Bradycardia is defined as?
< 50 BPM
Unstable bradycardia is defined as?
Adult: >50 BPM w. hypotension
Pedi: >50 w/ AMS and age hypotension
For both adult and peds with pacing, what can be given if normotensive and no IV?
Versed- 5mg IN/IM only
0.2mg/kg IN/IM only
Pacing for a peds starts at what?
80 BPM
What is the initial treatment for bradycardia in peds?
Oxygenation / Ventilation
Neonate: 1 q 3 for 30 sec
Infant: 1 q 3 for 1 min
Which extremity is to be avoided with vascular access in chest pain?
Right hand and wrist.
STEMI alert criteria?
2mm elevation smiley face concave in any leads
2mm elevation frown face convex on V2 and V3
1mm elevation frown face convex in any leads
What are STEMI disqualifiers?
LBBB
LVH
Early Repolarization
Pacemaker with QRS > .12
When does NTG get withheld in CHF patients?
febrile patients or nursing home with pneumonia
Stable SVT treatment is?
Adults 12mg Adenosine
Pedi- 0.2mg Adenosine
Unstable SVT treatment is ?
AMS-
Adult 100, 200, 300, 360J
Pedi: 0.5J/kg and 2J/kg
Vtach is defined as?
No p waves
QRS > .12
Concordance in all leads
Neg QRS V6
Neg in 2, 2, AVF and positive in AVL, and AVR
Vtach stable treatment?
Adult : Amiodarone 150mg in 50 15gtts
Pedi: 5mg/kg in 50 15 gtts
Unstable Vtach
Adult : Cardio version 100, 200, 300. 360J
Pedi : 0.5J/kg and 2j/kg
What makes a Vtach patient unstable?
Contraindications to Amiodarone:
Sinus bradycardia
2/3 degree blocks
cardiogenic shock
hypotension
QTC >500
RRWCT is defined as?
> 0.20 or 5 boxes
Treatment for RRWCT is?
Stable :Adult 1g cacl2
100mg bicarb
Pedi: 20mg/kg cacl2
1meq/kg bicarb
What makes RRWCT unstable ?
hypotension
Torsades de point stable treatment?
2g mgso4 in 50 60gtts
Pedi : 40mg in 50 60gtts
Torsades de point unstable is defined as and treated how?
Hypotension:
defib 200, 300, 360
defib 2J/kg and 4J/kg
AEIOU TIPS ?
Alcohol, Epilepsy, Insulin, OD, underdose
Trauma, infection, pyschosis, stroke
Compressions for an LVAD device are ?
Not using the LUCAS
The Right of the sternum.
LVAD patients go to which facility
JFK
Treatment for an LVAD ?
locate emergency bag
take all equipment to ER
verify device is working by lack of pulse or measurable BP.
LIsten for continuous humming.
Hypotensive Fluids 1L
Compressions if unresponsive and unable to restart device or not working.
which cardiac arrest patients MUST be transported
Witnesed
What are the determination of death criteria
1.Lividity
2.Rigor mortis
3.tissue decomposition
4. Valid DNRO
What if the death criteria are not there what can be used?
Known down time of >30min
Apneic
Without mechanism for Hypothermia
Asystolic
Fixed and dilated pupils
Electrocution and LIghtning strikes are what type of arrests
Primary b/c of A/C current
Secondary due to DC current
When can an arrest be called?
EMS captain on scene
persisent asystole for >15min
ALS interventions
Etco2< 10
H and T's or reversible causes treated
1 defib
500 ml NS
Normothermic
support group
What are four protocols where on 500ml NS are used?
Decompression sickness
Calling an arrest.
2nd > 15% or 3rd > 5% degree burns
Hyperkalemia
What is the o2 setting for initial arrest
8L/min for 6 min on oxygen port
What are the amiodarone contraindications
Qtc >500
Blocks
Bradycardia
Hypotension
cardiogenic shock
What type of arrest is a third trimester female considered?
Secondary - and displace the uterus to the left
All drug overdoses are treated as what type of arrest with the exception of?
All OD's except for Cocaine
What are the indications for Esmolol and doses?
Immediately after Double sequential
40 mg IV/IO initially over 1 min
Then:
60mg on 15gtts over 10min 1,25gtts/sec
What type of arrests are to be transported to a trauma center?
Electrouctions and lighning strikes
Adult Cocaine OD get treated with what?
Versed
Pedi cocaine OD get treated with what?
Versed
What are the criteria to administer narcan?
RR below 10
Etco2 >45
02 sat < 92%
if not meeting above Supplemental 02 or BVM 2 min
Mad as a hatter
Red as a beet
Dry as bone refer to S/S of ?
TCA OD
What must TCA ODs be treated with immediately ?
Sodium Bicarb
What are the special populations for Ketamine and the dose?
Age 65 and older
<50kg
Head trauma
Already took sedatives
200mg
What is the sequence for Combative pts and Ketamina
400mg IM
BVM or supplemental 02 for Laryngospasms
0.5mg Atropine for Salivations x3
Ice packs, 1L cold saline and 100meq Sodium Bicarb
How long does Lidocaine dwell in an IO for an adult?
1min
Pedi Ketamine for pain is indicated for what age and pain scale?
< 3 yrs and 7 or greater pain
Lidocaine in an IO for pedi dwell?
1 min
What is the time frame for decompression sickness?
48 hours
How much NS admin for Decompression sickness?
500ml
When treating Heat stroke?
Cool First, transport second
Heat stroke is classified as ?
Temp > 103 or AMS
CO poisoning is at what level?
35ppm
Who carries a rainbow sensor ?
EMS captains and SPLOPS
If SPCO is above what %?
>20%
The cyano kit uses how much? at what rate?
5g diluted in 200ml and at 5 gtts/sec
What does the MARCH acronym mean?
Massive hemorrage
Airway control
Respiratory
Circulation
Head injury / Hypothermia
FAST ultrsound is done for
Blunt or penetrating trauma the ABD or thorax
Undifferentiated hypotension in trauma
FAST ultrasounds can be performed to identify?
Intrabdominal hemorrage
Intrathoracic hemorrage
pericardial hemorrage
PEA motion
For Trauma patients not to be resuscitated what criteria is needed?
Apneic
Fixed dialted pupils
asystole
NEED ALL 3
or injuries incompatible with life
PEA is defined as?
an organized rhythm > 20 BPM
When does bilateral decompression get performed?
Arrest due to penetrating chest trauma
Ultrasunds in traumatic arrests are done when?
observation of cardiac motion in PEA
Finger Thoracostomy is done when ?
known or suspected injury to the chest and or abd
Contraindications for Finger Thoracostomy?
Unwitnessed arrest with blunt trauma
Devestating head trauma
loss of Cardiac output > 10 min
Jump start triage initial is ?
Breathing NO- open A/W - breathing - IMMEDIATE
Breathing NO- open A/W - NO PULSE - DECEASED
Breathing NO-open A/W- Pulse - 5 breaths-no- DECEASED
Breathing NO- open A/W- Pulse- 5 breaths- Yes- IMMEDIATE
Breathing YES- <15 or >45- IMMEDIATE
The " P" in Jump start triage means what ?
posturing
what is Trauma alert criteria for peds with BP?
< 50
Flail chest sis defined?
2 or more adjacent ribs are fractured
Criteria for chest decompression
Absent or diminshed LS
BP< 90
Respiratory distress or difficulty with BVM
What is the primary site for chest decompression?
5th intercostal space mid axillary
What is the secondary site for chest decompression
2 or 3 rd intercostal space mid clavicular
Intercrainial pressure and herniation signs are?
GCS decline of 2 or more points
sluggish or non reactive pupil
Paralysis or weakness on 1 side of the body
Cushings Triad
Adult BP maintain BP for Head injuries is what?
SBP 110-120
Head injuries ETCO2 is?
30-35mmhg
How many attempts to realign for anatomical position
2
What are the contraindications for Ceftriaxone or rocephin?
Allergy to cephalosporins
Neonates birth to 30 days
Pregnant 3rd trimester trauma alerts get transported how?
Left side, 4-6 inches of padding to Right side
Maintain BP for peripheral pulses
Gravida and Para definitions
Gravida- previous pregnancies
Para- Number of Live births
1st and 2nd trimester complications include?
Ectopic
Spontaneous
bleeding
hypotensive
3rd Trimester complications include
Placenta previa-painless vaginal bleeding bright red
Abrupto PLacenta-severe pain sudden onset
Uterine rupture- - intense abd pain and Vaginal bledding
Preeclampsia is defined as?
SBP >160 DSP > 110 with :
AMS
Headache
Visual disturbances
PE
Eclampsia is defined as ?
S/S of pre + seizures or coma
When can you insert a gloved hand into the vagina for a birth?
Breech birth
Prolapsed cord
Time for Breech birth actions
if not delivered in 3 minutes
Who’s responsibility is it to assign a safety officer?
IC
All safety officers will have the authority to ?
Identify and correct safety and heath hazards
To alter,suspend, or terminate un -safe acts that involve an imminent hazard to personnel
Inform the IC of the 2 items above
A safety office should have a working knowledge of what?
Safety concerns for fire rescue in typical incidents
Fire behavior
Building construction
EMS
Only those person who have completed and approved Incident safety officer course ________ be used as a safety officer.
SHOULD
What type of communication is to be used with a second paramedic to ensure proper drug dose?
closed loop communication
what are the sites for IO insertion for an adult and pediatric?
proximal humorous
Proximal Tibia
distal tibia
PEDI: All of the above and Distal Femur.
what is the preferred access fo r pediatrics in cardiac arrest?
IO
for the hx taking in an assessment what pneumoic is used?
OPPPQRSTA
what is the goal for maninging overdose and poisoning pts?
Support ABCs
Terminate arrhymthmmias
Terminate seizures
reverse effects with antidotes or medication
what classes of medications are responsible for dystonic reactions?
antipsychotics
antiemetics
Antidepressants
What are the APGAR score interpretations?
0-3 severe
4-6- Moderate
7-10- excellent
advanced a/w procedures shall be considered for which patients with respiratory involvement?
hoarse voice,
Singed nose hairs
carbonaceous sputum in nose or mouth
stridor
Facial burns
Infants are evaluated when in JUMP start ?
in secondary triage
what is to be documented in the medical report upon administration of Ketamine per the memo?
Correct dose
high flow 02 15L/min
IV after sedation
Cardiac monitor
12/15 lead
Continous SP02
Continous Etc02
BGL
Respiratory rate
temp
minimum 2 sets V/S
GCS w/ V/S
AVPU w/ GCS
What information should be obtained on a dive hx with decompression sickness ?
Depth of dives
Air mixture
Number of dives
What range can the HR be above in Third Trimester pregnancies?
15-20 BPM
Grey Turners sign is?
ecchymosis of the flanks
when can a patient be assisted with an epi pen ?
a/w swelling
respiratrory distress
bronchospasm
tounge or facail swelling
loss of a radial pulse
pedatric age classifications are?
Neonates: birth to 1month
infancts: 1 month to 1 year
children: 1 year to puberty
SAMPLE stand for:
S/S
Allergies
medications
last oral intake
events preceeding
If a 2nd TQ does not stop the bleeding what is the next step?
Celox rapid for 2 minute.
Marine animal stings gets rinsed with what type of water?
Sea water
snake bites what should be documented?
picture of the head including the eyes
benadryl is to be administered over what period of time for IV/IO use?
2min
All medications are administered with the exception of adenosine over 2 minutes or greater. Which one is adminstered in less time?
Push pressor epi 1 min/ ml
ASA is contraindicated at what age?
< 16 years old
How long should a burn be cooled for and what type of liquid?
2min and NS
1st, 2nd degree burns > 15% TBSA or 3rd < 5% get what type of dressing?
Dry sterile
2nd degree burns > 15% TBSA and 3rd > 5% get what type of dressing?
Burn Sheet
Head injured patients mortality rates increases by what percent with a single instance of hypotension?
150%
What pregnant trauma patients are required to have 02?
All 3rd Trimester
Purpose or Goal or DSI is?
Not to blunt spontaneous ventilation or airway reflexes
Primary goal of any airway or respiratory emergency is maintaining?
Ventilation
Oxygenation
Perfusion
Indications for an advanced airway are:
Airway protection
Respiratory failure
Prolonged respiratory suppport
What equipment MUST be in place fro DSI?
Suction unit
Cardiac monitor, BP, SPO2, ETCO2
Positioning for DSI is?
Ear to the sternal notch
Head parallel with the ceiling
Stretcher elevated 15-30 degrees
The Pre-oxygenation step includes?
Maintaining of SP02 for 3min:
Positioning head
NC @ 15L/min
BVM w/ peep @ 10cm/h20
BVM with face seal
Definition of apenic in DSI?
Respirations < 4/min
The only time to give ventilations in the pre-oxygenate phase is?
Patient becomes apneic.
To fix perfusion in adult and infants for DSI what is used?
Adults:
1L saline
Infants:
20ml/Kg
If neither work - push press epi- 1:100,000 at 1ml/min. Max 30 ml . Concentration is 10mcg/ml
What is the contraindications for push pressor epi?
Hypotension secondary to blood loss.
DSI paralysis indications are?
Apneic Status epilepticus
Trismus
EMS captain or flight crew discretion
Contraindications to DSI paralysis is?
Allergy
Predicted difficult intubation
Inability to ventilate with a BVM
Major facial trauma
What are the doses for rocuronium for adult and pediatrics?
Adults 100mg
Pediatric 1mg/kg
What is the warning for rocuronium with patients?
Asthmatic patients may have a drop in BP that may result in Cardiac arrest.
Post intubation placement is ?
ETCO2 continually- initially, continuously, and upon transfer of care
Wave form with no less than 3 boxes
Auscultation of bi-lateral breath sounds
Placement of a gastric tube
Post intubation medications are MANDATORY for any?
ET tube or Igel
What are the post intubation medications that can be used for DSI?
Ketamine Versed Fentanyl
Adult: 200mg 5mg 100mcg. (Contraindication of pregnancy near term >32 weeks)
Pedi: 2mg/kg 0.1mg/kg 1mcg/kg (Contraindication of <6mo.)
Failed airway in adults or pedi is?
Surgical cric >13 yrs of age
Needle Cric < 12 yrs of age
What is the precursor for the cyano kit?
Hydroxocabalamine
What is the half life of the cyano kit
26-31 hours
what is the onset time for the cyano kit?
2-15min
Classification of esmolol
selective b1 class 2 antiarrhythmic
what is the half life of esmolol?
2-9min
what is the duration of etomidate?
3-5 min.
what medication from the pharmacolgy medications has the longest list of side effects?
Etomidate
What are ketamines mechanism of actions?
antagonist for NMDA and blocks these receptors
works on Na and Ca channels for pain relief
dissociation between the limbic and cortical systems
what is the half life for Ketamine?
1-2 hours
what is the duration of ketamine?
IV -10-15min
IM- 20-30 min
contraindications of ketamine
pregnant females
Penetrating eye injures
Non- traumatic chest pain
significant HTN
indications for Ketamine
Sezures
Violent/ impared
pain 7 or higher
pre sedation
post sedation
CPR induced consciousness
What class of medication is rocuronium?
Non-depolarizing agent
what si the mechanism of action for rocuronium?
binds to the cholinergic receptors in the motor end plate
what is the onset of rocuronium?
30-60 sec
What is the durations and half life of rocuronium?
Duration 30-60min
Half life- 14-18 min
What are the contraidications for rocuronium?
Allergy
predicted difficult intubation
inability to use a BVM
major facial or laryngeal trauma
per CQI, what other recommendation is added for ketamine?
High flow 02 per Scheppke
The IMS manual meets what national requirements?
NFPA 1561
Presidential directive 5
“Base’ is defined as ?
The coordination and administer logistic functions
Only 1 per incident
The staging of resources prior to entering on a high rise fire
‘Branch” is defined as?
Level having Functional, geographical, or jurisdictional responsibilities
Is between Section and division/ group in the operations section
Uses Roman numerals or by functional area
Type III construction is what?
Ordinary construction where the interior structural elements are entirely or partially of wood OF SMALLER DIMENSIONS
Type IV construction is?
Heavy timber- interior structures are made of SOLID or LAMINATED WOOD
Type V construction is?
Wood Frame- structural elements are made of ENTIRELY wood.
The command STAFF positions are?
PIO
Safety officer
Liaison
command staff advisors
“Division” is defined as?
A geographical area
Is between the Branch and unit levels
What is the fire flow formula?
Lx W / 3 x % involved
The GENERAL STAFF is made up of?
Operations Chief
Planning Chief
Logistics Chief
Finance/ Admin Chief
Intelligence/ investigation Chief
“Group “ is defined as?
Functional areas
Is between a branch and unit
An IAP planned operational period is how long?
12-24 hours
The ICS 5 major functional areas are?
Command
Operations
Planning
Logistics
Finance/ Admin
Incident objectives are defined as?
Statements of guidance and direction that are specific , measurable , attainable etc for the selection of appropriate strategies and tactical direction of resources.
NIMS components are?
Command and management
Preparedness
Resource management
Communications and info management
Supporting technologies
Ongoing management and maintenance
“Section” is defined as?
One of the 5 major functional areas under the NIMS system
IS between command and branch areas
STEALH stands for?
Set time
Tone
Execution
Analyze
Transfer lessons learned
Hi note
“Strike team” is defined as ?
Resources of the “SAME” Kind and TYPE
“Task Force” is defined as ?
Resources that are DIFFERENT in kind and type
The cornerstone to managing an emergency incident is?
Pre- incident planning
Command staff advisors are?
Technical specialists
Distinguished from officers because they lack authority to direct incident activities.
Intelligence / Investagtory function purpose is what?
to determine the cause or source of the incident
Duties of the intelligence/ inv branch are?
Collecting and analyzing and sharing information
Informing incident operations to protect live and safety of response personnel
Interfacing with counterparts outside the ICS to improve situational awareness,
Where can the intelligence /inv function fit into the the ICS system ?
Command staff - Staff advisor
Planning section as a unit
Operations section as a branch
General staff as a section
Divisions and group persons who are in charge are termed what?
Supervisors
The person in charge of a “branch “ is termed what?
Director
Span of control is defined as?
Optimal span of control is ?
The number of subordinates for which a supervisor is responsible for
Ratio of supervisors to individuals
Acceptable spread is 3-7
Optimal span is 5
On a situation in which is NOT under control yet the ICS should have no more than how many personnel operating under them ?
5- FIVE
What is the command staff person in charge termed as?
Officer
What is the “Section” person in charge title?
Chief
The person in charge of a “unit” is termed?
Leader
A “Strike team or Task force “ person in charge is termed?
Leader
A single resource unit is termed ?
Boss or Leader
A technical specialist in charge is termed?
Specialist
Rules of engagement for an IC is to conduct a n initial risk assessment and implement what and how?
Safe action plan:
Size up
Rescue profile
Risk assessment
Who can effect a change in incident management in extreme situations - who , why and How?
Anyone
Safety
Notifying the IC
Orders and decision making shall be performed where?
At the lowest level within the organization
Any functions within the ICS that remain un delegated remain with whom?
IC
Command presence is conveyed how?
look
Act
Speak
Carry yourself
The IC role is a position of ?
ROLE
The Command post should be set up so the IC has how many views of the incident?
2- TWO
What are the 5 mandatory functions of incident command?
Assumption , confirmation, and positioning of incident command
Initiate and monitor personnel accountably
Situation Evaluation which means “SIZE UP”
Initiate , maintain band control the communications process
Develop and IAP
Assuming command can happen by what 2 means?
Non collaborative/Face to face
Radio communications of “assuming command”
The transfer of incident command what items?
Mode of operations
Current situation
Current unit locations
Current assignments
What has been done
What is planned
Upon transferring of command the IC notifies who?
Communications center
General staff members
Command staff members
All incident personnel
At what two stages of an incident should transfer of command be utilized?
As the emergency escalates
Demobilization phase
Radio transmissions use what model?
Military order model
What are considered the fire ground simplex channels?
14A/ 15A with a radius of 1mile
During multi-jurisdictional incidents how can communication be accomplished?
Compatible systems
Representative
Dissemination of radios
Merging of companies
Emergency traffic can be used with what 3 situations?
By a company that has an immediate communication
Imminent danger while in the exclusion zone
Changing modes of operation from offensive to defensive or vice versa
Emergency Evacuation is for?
Evacuation of a scene or area in imminent danger
What term is used to declare the scene is clear of all personnel of an area that was in imminent danger?
Emergency evacuation - all clear
The term MAYDAY should be used when a FF is?
Lost
Trapped
Disoriented
Air emergency
Serious injury
In need of immediate help
In order to manage a MAYDAY, the IC has to maintain what?
Strong command presence
Composure
Self control
Self discipline
The only persons to communicate during a mayday emergency are?
IC
RIT/RIG
RIG supervisor
Mayday FF
Reporting fire conditions are what 4 types?
Nothing showing
Smoke showing with - light, moderate, or heavy
Flames showing
Working fire
What are the 5 fire operations benchmarks?
Primary complete - ALL CLEAR
Secondary complete- ALL CLEAR
Water on fire
Fire under control
Fire out- OVERHAUL OPERATIONS ARE COMPLETE
The mode of operations at a fire is defined by _________ and _______ and represents the _________ of the scene.
Strategy and tactics
Tempo
What are the 3 modes of fire operations?
Investigating
Offensive mode
Defensive mode
What is the most dangerous time during a fire incident?
When changing from an offensive to defensive mode.
Offensive mode should be used when ?
Salvageable life
No evidence of structural failure or hostile fire event
10 minute benchmarks are used under what conditions?
MARGINAL
The 10 min benchmark is based on what 3 scientific factors?
Building to stay together
Victim survivability
FF air supply when working
If fire conditions have not improved after the 10min benchmark. What should happen ?
Consider switching to “DEFENSIVE MODE
The 10 min benchmark timeframe include what 3 things?
Notification
Response
deployment
Exterior water application from the exterior during offensive operations should done how?
Directly into the fire compartment
Directed at the ceiling
No more than 15 sec
Used with a solid or straight stream pattern
Strategy is defined as?
General course of action or direction to accomplish incident objectives
Tactics are defined as?
Deploying and directing resources to an incident to accomplish objectives
The “S” in CANS arrival report means?
Statement of command to include command name , location, and mode.
When referring to the structure the Alpha side is considered ?
The front
Or address side
When two or more incidents are on the same street then how are they differentiated?
Using a hundred block number or some other designator
The communications center shall announce benchmarks every?
10 min
“CAN “ Progress reports should briefly detail ?
Actions that are being taken
Actions that. Have been completed.
TO have an effective progress report , the report need to be ?
Timely
Complete
Consise
The command sequence consists of:
Incident priorities
Situation evaluation
IAP
Evaluation of IAP
Demobilization
Termination
What are the incidents priorities?
LIPE
Life safety
Incident stabilization
Property conservation
Evidence preservation
Development of the IAP includes?
Mode of operation
Tactical priorities
Scene control
Tasks
The tactical priorities are:
RECEOVS
Rescue
Exposure
Confinement
Extinguishment
Overhaul
Ventilation
Salvage
What is the other term for “Size up”? It is part of the command sequence
Situation evaluation
What is the other term for Tactical Priorites? Part of the development of the IAP
“Overview”
The IC is responsible for ensuring that assignments during an incident are based on what?
Incident priorities
The Situational Evaluation or “Size Up” is based on what?
Critical incident factors
Critical incident factors include which mnemonics?
BELOW
COAL WAS WEALTH
Which critical incident factor mnemonic is used for the “INITIAL “ Situation evaluation
BELOW
Which critical incident mnemonic is used for the “ONGOING”fire ground operations
COAL WAS WEALTH
What make critical incident factors critical?
Ability to line up incident factors in priority based on consequences
Risk Benefit Analysis is 3 components?
Do not risk FF lives for lives or property that cannot be saved
Extend vigilant and measured risk to protect and rescue lives
Limited risk to protect salvageable property.
The Aldridge-Benge FF safety act in Florida instituted what?
Signage for Roofs and truss floors to indicate construction type that is “LIGHT FRAME TRUSS “
Anything with exposed wood or metal supports in regards to constructions is considered?
LIght weight construction
A lightweight floor construction exposed to fire becomes unstable in how long?
3 minutes
The development of the IAP is based off of what?
Incident priorities which include LIPE
Strategies are _______ and equivalent to _________.
General
Goals
Tactics are __________ and _________.
Specific
Measurable
Who is responsible for a “FORMAL WRITTEN IAP?
Planning section chief
Operational periods should be no longer than ?
24 hours
TASKS are defined as ?
Specific assignments that are typically performed by one company or small group working together.
Examples of “TASKS’ are?
Establishing a water supply
Advancing a hose line into a structure
Primary search
RIC
Vertical ventilation
Medical
The Highest INCIDENT Priority is = ________
The Highest TACTICAL priority is =_________.
LIFE SAFETY
RESCUE
A person known to be in the structure with conditions tenable for a person WITHOUT protective gear is termed what?
Salvageable Life
Primary search should be based on which areas in order?
Location of reported victim
Most severely threatened area
Largest number of victims
Remainder of the fire area
Exposed areas
Examples of “EXPOSURES” are
Near fire building
Attached to fire building
Near but protected
Threatened by flying brands, heat or toxic gases
Factors that influence potential exposures are?
Distance
Radiant head
Wind
What is the distance to be considered an exposure?
30 ft
“INITIAL “ Exposure control requires what hose line and how much GPM?
2 1/2 ” and 200gpm
Exposure protection should be accomplished with ?
Ground monitors
Mounted deck guns
Confinement is defined as?
The stopping of the progression of the fire
Examples of the “CONFINEMENT tactical priority would be?
Preventing fires into un burned areas
Time to conduct a rescue
Protect exit stairways and corridors
What is the fire flow formula?
L x W / 3 x % involved
What is the fire formula for multiple floors?
L x W /3 x % involved = GPM/ min x number of floors
The Tactical priority of EXTINGUISHMENT requires?
1.75” line @ 150gpm for most initial fire or one room fire
2.5” line @ 200gpm for larger fires or have extended outside the room of Origin.
What factor has the most impact on the outcome of a fire incident?
The initial attack hose line
Is the action taken to expose hidden fire and to assure complete extinguishment?
Overhaul
Term of : Designed to remove the products of combustion from a fire area and allow cool fresh air to enter?
Ventilation
What is the TACTICAL priority of protecting property from damage?
Salvage
When will the passport accountability system be utilized?
2 or more units assigned to an IDLH incident
LEVEL 2 staging is defined as:
Formal process directed by the IC or Operations section chief where responding units are assigned a specific location in anticipation of future deployment.
Who can establish a LEVEL 2 staging area?
IC
Operations section chief
Approximately how many parking spaces does it take for each fire apparatus?
8 spots
When should LEVEL 2 staging be established? 4 items.
Multiple alarm incidents
Level 2 or greater MCI
Airport III index or greater
Other incident where multiple resources should be supervised
When 2 or mare staging areas are being used that are identified how?
Function or location
Hi rise operation staging is where?
2 floors below the fire floor
What is the term used for the staging of resources prior to entering the incident scene?
BASE
Definition of Perimeter?
The most distant control point for the incident.
What was the perimeter for the Oklahoma City bombing?
20 square blocks
Responders at an active shooter event should realize?
Secondary devices
Actions against responders
Implement PPE
Caution with tactical actions
Preserve evidence
What resources are used to begin at a CBRNE incident?
ERG
WISER
What is the resource that uses the ERG and NIH combined for CBRNE?
WISER
What are the control zones?
Exclusion Zone- Risk outweighs benefit
Hot Zone- HI risk
Warm zone- Little risk
Cold zone- no risk
Decision making for setting up isolation or control zones is based on :
Potential to harm:
1. Life
2. Critical systems
3. Property
The initial isolation zone becomes the hot zone when?
The product is confirmed and additional references are used to confirm the distances.
According to the ERG for for an “UNKNOWN “ hazard is?
100 meters or 330 ft in all directions
Found on Guide 111.
A protective action Zone is identified for what?
Evacuation
Protected in place
Definition of Protection in place is based upon?
Risk assessment of the incident
Evaluation of the IAP is done how often?
AT LEAST every 10 min
Definition of “DEMOBILIZATION”
Release and Return of resources that are no longer needed.
When should incident command be terminated?
When the incident has de-escalated to a point where all units have returned to service.
Definition of an “After Action review “
An analysis of the events that transpired during an incident and a review of the actions used to mitigate it.
PBCFR used 3 types of After action reviews?
Informal debriefing AAR
Informal Battalion AAR
Formal AAR
An “INFORMAL BEBREIFING AAR?
Tail board or FS
handled at the comany level
moderated by the Company officer/ chief
Simple discussion
Definition of a “INFORMAL BATTALION AAR”
Battalion HQ or FS
Handled at the company or Chief officer level
moderated by the Company officer of chief
IN DEPTH
held within a few shifts of immediately after
Definition of a “FORMAL AAR”
Battalion HQ or HQ
CQI or Chief
Detailed and analysis
Scheduled with 30-90 days post
A STEALTH report is the ________ _________ and stands for?
Final report
Set time
Tone
Execution
Analyze
Lessons learned
Transfer lessons
Hi note.
The county established a framework to ensure PBC is prepared to respond and recover from hazardous incidents?
Comprehensive Emergency Management Plan
Examples of Natural hazards are?
Severe Weather- Hurricane, tropical storm, lightening
Floods
Agricultural pests and ds.
Fire
Communicable ds. - H1N1, Eboli
Examples of Technological Hazards are?
Transportation incidents
Hazardous materials
Nuclear power plant
Dike failure
Human Caused Hazards are:
Domestic security
Workplace/ School violence
Mass migration
An incident Support plan is for what type of incidents?
Mass fatality / MCI
General population shelters
Continuity of operations plan
The definition of an HSP?
Hazard specific plan that outlines a mitigation strategy for 12 hazards
What are the 12 hazards outlined by the HSP?
Severe weather
Floods
Agricultural pests ds.
Fire
Communicable ds
Transportation Incidents
Hazmat
Nuclear power plant
Dike failure
Domestic security
Workplace/ school violence
Mass migration
A special or campaign event is a planned and organized activity or contest with how many people?
10,000 or more in a defined geographical area.
The Emergency Operations Area is divided into how many geographical areas?
6
An area command is established when ?
To oversee management of multiple incidents handled by separate ICSs
Very large incidents that involve multiple ICSs
Same area and same type
For Area command of the same type and same area with 2 or more what are the examples?
HAZMAT
Oil spills
Wildland fires
What is the term used for incidents under the authority of an area commander that are multi- Jurisdictional ?
Unified Area Command
Area command oversees management of ___________while an EOC coordinates__________ ___________ and _______________ _________.
Incidents
Support functions and resource support.
The intinial Critical incident mnumonic is and stands for ?
BELOW
Buidling construction
Extent of fire
life safety
occupancy
water supply
An all hazard level 3 IMT is made up of how many people
10-35
An all hazard level 2 IMT is made up of how many people
20-35
An all hazard level 1 IMT is made up of how many people
35-50
who serves as the primary Multi-agency coordination center (MACS) for palm beach county?
PBC EOC
It is recommended that future revisions be completed how often?
on a biennail basis
when transferring command the prefered method is ?
Face to face
Floridas light-frame truss type law is applicable to who?
commercial
Industrial
multi unit residential with 3 untis or more
the purpose of a back up line is?
to protect FF who are performing fire arttack.
overhaul includes which acions?
total xtinguishment of all smoldering fires
checking for all hidden fire and extention
Extinguishing all hidden and extension
upoin arriving in lelvel 1 stagging what shall units announce?
arrival and stagging location
the IC will base the intial isolation zone based from what resources?
WISER and ERG
what is the only way to detect the presence of radation?
monitoring
the protective action zone determines what to factors?
evacuation or protact in place
the decison to evacuate or protectin place is made upon?
whichever offers the lesser degree of danger to the public
What is an example of the PIO disseminting acurate and timely information?
information on public health
safety
protection
the PIO serves as a link to who?
Joint infoirmation system
what are considered examples of natrual hazards?
Hurricanes
tropical storms
lightening
H1N1
ebola
the Hazard specific plan ubder the CEMP is described as?
Formal and Robust
the incident support plan for the CEMP is described as?
written and short
EOAs are _______ and are under the direction and control of the ______.
Field incident commnad posts
EOC
What is the breakdown for incident mgt Teams?
Type 5 and 4 : 7-10 people 1 operational period
Local and regional
Type 3: 10-35 people multiple operatinal periods
All Hazard
Type 2: 20-35 people multiple operational periods
manages 200-500 persons
All Hazard and Wildland team- self contained
GACC, NIFC, NWCG - operate through US forest service
Type 1: 35-50 people multiple operational periods
manages 500-to over a 1000 perons
GACC, NIFC, NWCG- operate through US forest serivce
18 teams exist.
who makes the decision to establish and area command?
agency administrator
public offical with juristictional responsibilty
Need for Area command examples are :
bio terrorism
flooding
hurricanes
Hazmat
oil spills
wildland fires
incidents that do not have similar resource demands are usually handled by who?
EOC
if multiple units arrive OS at the same time and no chief officer has established command, who does it fall to?
first due operstional captain
the ICS forms should be used for what type of incidents?
Large scale
Long duration
complec incidents
The emergency evacutation tones will be repeated how many times?
2 or Twice
COAL WAS WEALTH
Construction
Occuoamcy
Area of fire
Life Safety
Water supply
Appartus / Personnel
Street conditions
'
Weather
Exposures
auxillary appliances
Location and extent of fire
time
Heights and hazards
What are common operational period lenths?
12 hours
DOCs or Department operations centers forcus on what ?
internal managemnt and response
EOC's represent what ?
physcial location for coordination of information and resources
Regional or local IMT activations include what tyoes of incidents?
Major structure fires
MVCs
Armed robbery operations
HAZMAT
special compaign events
Examples of incdients for an All hazard team response is ?
tornado touchdown
Earthquake
Flood
Multi day hostage standoff
festivals
political rallies
state and national summits and confrences
