Combined Protocols, IMS, DSI, infection control Flashcards
In order to manage a MAYDAY, the IC has to maintain what?
Strong command presence
Composure
Self control
Self discipline
All drug overdoses are treated as what type of arrest with the exception of?
All OD’s except for Cocaine
The Paramedic development entrance exam includes?
ON the first day completing a written test at 80% or above
If fire conditions have not improved after the 10min benchmark. What should happen ?
Consider switching to “DEFENSIVE MODE
The Tactical priority of EXTINGUISHMENT requires?
- 75” line @ 150gpm for most initial fire or one room fire
- 5” line @ 200gpm for larger fires or have extended outside the room of Origin.
Command structure assignments for an MCI may include what?
Treatment
Transport
Triage
Staging
Rehab
Hazard mitigation
An example of injury while wearing PPE would be?
Burns to the hands while wearing gloves.
What is the main role in an ASHER/MCI for Fire Rescue?
Fire and medical decisions
What is the Definition of a “Strong Hold” with and ASHER/MCI ?
Defensible area within the warm zone that has no windows and all doorways are covered by LE
Also serves a CCP
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
A DNRO applies to who?
Cardiac or respiratory arrest
Succumbing to a disease process of a terminal illness
What are the criteria to administer narcan?
All OF THE BELOW
RR below 10
Etco2 >45
02 sat < 92%
if not meeting above Supplemental 02 or BVM 2 min
The mode of operations at a fire is defined by _________ and _______ and represents the _________ of the scene.
Strategy and tactics
Tempo
The Fire rescue RTF-PEM TEAM leader reports what to the LE RTF-PEM ?
Total number of victims
Non ambulatory patients
When ready to move
Who may terminate a student or observers ride time?
Operational Captain
EMS captain
BC or DC
What does RTF-PEM stand for?
Rescue task Force- Protective element medical
How are expired controlled substances handled by the unit?
Unit gives the expired medication to the EMS captain and records “Expired” in the logbook for the case #
A STEALTH report is the ________ _________ and stands for?
Final report
Set time
Tone
Execution
Analyze
Lessons learned
Transfer lessons
Hi note.
If a rhythm converts back after electrical therapy was used what setting should be used ?
the setting that was successful in converting the rhythm.
Who may terminate a student or observers ride time?
Operational Captain
EMS captain
BC or DC
Failed airway in adults or pedi is?
Surgical cric >13 yrs of age
Needle Cric < 12 yrs of age
When must controlled substances be inventoried?
Begin and end of shift
Custody change
When locked tag seal is changed
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.
Tactics are defined as?
Deploying and directing resources to an incident to accomplish objectives
How long before the expiration date are crews to notify the EMS captain that the controlled substance is about to expire?
7 days
Students may ride at what times?
School Students: 0700-1600
EMR students only 0900-1600
The command STAFF positions are?
PIO
Safety officer
Liaison
command staff advisors
Who gets notified of an ASHER/MCI incident?
FOO
PIO
Indications for an advanced airway are:
Airway protection
Respiratory failure
Prolonged respiratory suppport
What are the Air Transport time criteria?
STEMI / Stroke >40min
Trauma > 25min
Extrication >15min
Response time >10min
An IRE is defined as:
With regards to any Citizen, patient, fire rescue personnel:
- Harm caused by action or inaction
- Caused by equipment failure
- Immoral, unethical , or illegal action
- Cause for litigation
- Poltically sensitive
- Media scrutinization
Definition of “Cold Zone” for an ASHER/ MCI?
Area of no risk
Cold “O” no “O”
All support operations
Unified command
Final approach position
Staging
Name, DOB, phone number and brief narrative are required for which levels of an MCI?
Levels 1 and 2
‘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
EMS captains responsibilities for exposure?
Make sure that employee is source tested
Make sure state mandates are followed at the ER
Notify the Exposure control officer as soon as possible during working hours or if unusual or receives treatment have paged
Contact facility for F/U instructions
Contact the OHC to make arrangements for F/U or as soon a possible for testing
Ensure Exposure form is filled out and turned in by the end of shift
Forward the exposure to the Exposure control officer
A DNRO applies to who?
Cardiac or respiratory arrest
Succumbing to a disease process of a terminal illness
A “DRE” is defined as:
Events that occur during emergency calls, training, pub ed, emergency or non emergency situations:
Potential to cause harm
Equipment failure that had potential but did not.
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.
When are risk management reports due?
By the end of shift and forwarded to the appropriate party
A DNRO applies to who?
Cardiac or respiratory arrest
Succumbing to a disease process of a terminal illness
The Emergency Operations Area is divided into how many geographical areas?
6
Customer complaints concerning communication center go to who?
Communications center supervisor
At what two stages of an incident should transfer of command be utilized?
As the emergency escalates
Demobilization phase
The Paramedic development entrance exam includes?
ON the first day completing a written test at 80% or above
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
If a patient is too combative for a blood draw and at the discretion of the PM?
Blood draw will not be performed and EMS captain notified.
Purpose or Goal or DSI is?
Not to blunt spontaneous ventilation or airway reflexes
Contraindications to DSI paralysis is?
Allergy
Predicted difficult intubation
Inability to ventilate with a BVM
Major facial trauma
Command staff advisors are?
Technical specialists
Distinguished from officers because they lack authority to direct incident activities.
A “Strike team or Task force “ person in charge is termed?
Leader
Term of : Designed to remove the products of combustion from a fire area and allow cool fresh air to enter?
Ventilation
For which of the following fire investigatory incidents shall a Fire investigator be contacted via radio or cell phone?
Juvenile related incidents.
Limitations of Student riders?
Only perform or assist in activities where proficiency has been verified by training facility.
No riding alone with pt’s in pt compartment
Logged in station log book
Wear uniform that training facility has issued
Not subject to duties outside of agreement
The cornerstone to managing an emergency incident is?
Pre- incident planning
Evidence that a fire is suspicious in nature or crime related means:
Incendiary fires/ explosive devices
Firebombs
Stolen vehicles
Burglaries
What are acceptable forms of ID for DNRO
Drivers license
Other photo identification
Witness in the presence of the patient
Who can enter information on a medical report?
Any crew member as ;long as it’s consistent with the authors level of training and certification.
What equipment MUST be in place fro DSI?
Suction unit
Cardiac monitor, BP, SPO2, ETCO2
TIC operations for the most prominent feature of a FF is ?
SCBA bottle
10 minute benchmarks are used under what conditions?
MARGINAL
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.
What are the oral hypoglycemic medications?
Glipizide
Glyburide
Glimperide
Oxygen is to be administered only when?
maintain sp02 of 95% all patients
90% for COPD and asthma.
When a “MAYDAY” is called what happens to the Tac channels?
The MAYDAY remains on the original channel and other operations will switch .
On a confirmed LPG/NG leak where does the “Hot zone” start
Where the 4 gas monitor has LEL readings above 0
Who’s responsible for restraining an patient for a blood draw?
LE
“Division” is defined as?
A geographical area
Is between the Branch and unit levels
Rehab 24 hours post fire incident refer to as?
Carbon monoxide and cyanide exposures
Guidelines for Operational Capt and Lt with Students/ observers?
Let to obtain proper paperwork for student
Safe place to observe with seat belt
Introduce person to others in the station
Familiarity with apparatus
Log person in station logbook
Log person on ePCR’s for calls and treatments performed
The following SHALL NEVER be performed on patients with a DNRO?
Artificial respiration
BVM
ET tube
Supraglottic A/W
Chest compressions
Defibrillation
What is the secondary site for chest decompression
2 or 3 rd intercostal space mid clavicular
What is the term used for incidents under the authority of an area commander that are multi- Jurisdictional ?
Unified Area Command
The exposure control manual provides information on 5 areas. What are they?
Risk
Prevention
Determination
Care and cleaning
Biomedical waste
Definition of Protection in place is based upon?
Risk assessment of the incident
The 10 min benchmark is based on what 3 scientific factors?
Building to stay together
Victim survivability
FF air supply when working
What is the o2 setting for initial arrest
8L/min for 6 min on oxygen port
Who’s responsible for restraining an patient for a blood draw?
LE
Blood Draws are performed when ?
Request of LE
What is the fire flow formula?
Lx W / 3 x % involved
Notification of a serious injury meeting criteria get reported to who and when?
Bureau of,fire standards and training- FF Safety and health section within 4 hours.
The DNRO identification device must be signed by who if the patient cannot provide consent?
Surrogate
Proxy
court order
Power of attorney
The term MAYDAY should be used when a FF is?
Lost
Trapped
Disoriented
Air emergency
Serious injury
In need of immediate help
The IC or ISO shall determine if it is safe for what to happen when atmospheric monitoring?
- FF remove their respiratory protection
- Occupants to enter the structure
- Fire investigators to enter any structure
Observers paperwork differs from students in one way?
Application signed by FR HIPPA compliance officer
Where are psychiatric pts transported?
stable- closest facility
unstable- closest ED for stabilization.
Extensions for paramedic probation are ?
Done by the EMS captain and documented on a professional development form for 18month.
If the extension period is still less than satisfactory then the EMS captain. Recommends the person be referred to the medical services division and medical director for further evaluation.
All documentation to be sent to the compliance officer
What are acceptable forms of ID for DNRO
Drivers license
Other photo identification
Witness in the presence of the patient
What does ASHER/ MCI stand for?
Active Shooter Hostile Event Response- Mass casualty incident
How must green or restricted items the the EMS captain can order be handled?
Submitted in IBEM
Purpose or Goal or DSI is?
Not to blunt spontaneous ventilation or airway reflexes
“INITIAL “ Exposure control requires what hose line and how much GPM?
1.75” and 200
Documentation of blood draw will include what?
Name and badge number of Officer
Kit sealed Y/ N
PM name
Site
Number of tubes drawn
Date and time
Who sample was turned over to
Atmospheric monitors are carried on which vehicles
Engines
Aerials
Rescues
BC
EMS captain
Special ops
When must controlled substances be inventoried?
Begin and end of shift
Custody change
When locked tag seal is changed
Evaluation material for the paramedic development course include what?
Medical protocols
EMS related SOGs
Exposure control manual
PDC skill sheets
Pharmacology
ECG interpretation
Scenario based assessments on Praxctical application of protocols and or patient assessment
What is the command staff person in charge termed as?
Officer
Where do decompression CO, H2S and CN poisonings go?
Hyberbaric chamber @ st mary’s hospital.
Adult who can refuse treatment criteria?
>18 yrs old
AAOx4
Clinically sober
Hypoxia< 94 on room air
COPD < 90
Syncope
Head injury w/ LOC
>100.5
Sever pain
Hypotension
Stroke
The MCI transport log has what information on it?
Patient METTAG ID
Destination hospital
Transport unit number
What are the common means of reporting CQI events?
Field personnel vis chain of command
Reportable events
Hospitals via complaint as a performance improvement process
Patients vis a complaint to the agency
What type of pts’ meeting trauma alert criteria transported by AIR to St. mary’s?
Pregnant (visibly pregnant or by hx of gestation >20wks)
Security of all medical supplies applies to what type?
All non controlled substances , medications, fluids , and medical equipment.
“Task Force” is defined as ?
Resources that are DIFFERENT in kind and type
primary and secondary arrest pt’s go to which facilites?
primary- STEMI facility
secondary- Closest faclility
Type III construction is what?
Ordinary construction where the interior structural elements are entirely or partially of wood OF SMALLER DIMENSIONS
Span of control is defined as?
The number of subordinates for which a supervisor is responsible for
Ratio of supervisors to individuals
Acceptable spread is 3-7
What are the oral hypoglycemic medications?
Glipizide
Glyburide
Glimperide
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.)
The IC shall be advised immediately during an ASHER/ MCI when ?
Fire rescue personnel are requested to or are found in the “HOT or Exclusion “ zones
Extensions for paramedic probation are ?
Done by the EMS captain and documented on a professional development form for 18month.
If the extension period is still less than satisfactory then the EMS captain. Recommends the person be referred to the medical services division and medical director for further evaluation.
All documentation to be sent to the compliance officer
If a parent or guardian refuses a physical exam what must be documented?
Visual exam
Mental status
General appearance
Work of breathing
Circulation to skin
Pedi Ketamine for pain is indicated for what age and pain scale?
< 3 yrs and 7 or greater pain
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
Per CQI, A near miss is defined as?
Incident that had the potential to harm a patient as a result of care rendered by EMS personnel BUT DID NOT actually harm the patient.
When should incident command be terminated?
When the incident has de-escalated to a point where all units have returned to service.
Tactics are __________ and _________.
Specific
Measurable
The Highest INCIDENT Priority is = ________
The Highest TACTICAL priority is =_________.
LIFE SAFETY
RESCUE
For exterior LPG/NG leaks on above ground containers - they should be cooled with what?
2 1/2” line at 200gpm
What is the time frame employees can be held to complete target solutions and other identified training?
1 week
‘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
Post exposure treatments are for which diseases?
AIDS, HIC, Hep B, Hep C, Menningcoccal meningitis, TB
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 “
The following SHALL NEVER be performed on patients with a DNRO?
Artificial respiration
BVM
ET tube
Supraglottic A/W
Chest compressions
Defibrillation
The following incidents REQUIRE an assistant safety officer?
Hazardous material
Dive team operations
Open water incidents
Rehab when assigned
Which extremity is to be avoided with vascular access in chest pain?
Right hand and wrist.
Students may ride at what times?
School Students: 0700-1600
EMR students only 0900-1600
How are new employees selected for the paramedic development course?
Based on Senority
Who are responsible for checking the TIC?
All company officers and chief officers in custody of the TIC.
The heat stress index Is made up from ?
- Air Temperature
- Air Speed
- Humidity
- Radiation - direct sun light
When can a body be covered with a sheet?
When no suspicion of a crime scene
What is the difference between “Safe Haven” and “Safe Place”
Safe haven is referencing new borns
Safe Place is for teenagers
Which critical incident factor mnemonic is used for the “INITIAL “ Situation evaluation
BELOW
In mutual aid circumstances whose protocols should be followed?
The transporting agency.
If a student or observers ride time is terminated who is then notified?
Deputy chief of operations is notified.
The following SHALL NEVER be performed on patients with a DNRO?
Artificial respiration
BVM
ET tube
Supraglottic A/W
Chest compressions
Defibrillation
The command sequence consists of:
Incident priorities
Situation evaluation
IAP
Evaluation of IAP
Demobilization
Termination
Who and where does PPE go if an injury occurs on an emergency incident?
BC secures PPE and training AMS safety division
If a parent is consenting by phone to not have minor treated or transported and no one can sign the refusal form what happens?
Minor to be transported to the appropriate emergency department
Report writing will be in accordance with which type of code?
“Dispatched code”
METTAG number, basic information and tx information are required for what level MCI?
3 or above
Spinal motion restriction for what criteria?
focal neurologic deficit
pain to the neck or back
distracting injury
AMS w/ an MOI
intoxication w/ MOI
The IC shall be advised immediately during an ASHER/ MCI when ?
Fire rescue personnel are requested to or are found in the “HOT or Exclusion “ zones
Gravida and Para definitions
Gravida- previous pregnancies
Para- Number of Live births
What gas type and pipe size does not contain mercaptan?
Natural gas in sizes 18” or greater
For percuteanous needle sticks how to care for them?
10 min washing with soap and water or 10% iodine or chlorine compounds until soap and water are available
Natural gas lines are what sizes?
Commercial 1-4”
Residential 1/2-3/4”
On a confirmed LPG/NG leak where does the “Hot zone” start
Where the 4 gas monitor has LEL readings above 0
ET tubes shall be confirmed how? 3 methods.
visualization
esophageal intubation detector (if available)
continuous EtCo2
“Group “ is defined as?
Functional areas
Is between a branch and unit
When must controlled substances be inventoried?
Begin and end of shift
Custody change
When locked tag seal is changed
During multi-jurisdictional incidents how can communication be accomplished?
Compatible systems
Representative
Dissemination of radios
Merging of companies
What does MICCR stand for?
Minimally Interrupted cardio-cerebral resusitation
What are the 5 components of REHAB?
- Rest
- Energy nutrition
- Hydration
- Accommodation for weather
- BLS and ALS monitoring
Definition of “Warm Zone” for ASHER/ MCI?
Area with “LITTLE” risk
RTF-PEM teams operate
CCP operates here
When declaring an MCI what 2 things must be included?
LEVEL and TYPE
The definition of “Capacity “ is?
The ability to understand the benefits, risks, and alternatives to a proposed tx or intervention.
Preeclampsia is defined as?
SBP >160 DSP > 110 with :
AMS
Headache
Visual disturbances
PE
Station supply orders may be modified by who?
Medical warehouse personnel or by station medical supply audit.
What shall be documented in the pcr for refusals of treatment?
Refusal can result in death or disability
They were AAOx4- clinically sober w/ no life or potential life threatening conditions
Have the capacity to refuse
The only time to give ventilations in the pre-oxygenate phase is?
Patient becomes apneic.
TICs are used for:
Search and rescue
Fire Attack
Overhaul
HAZMAT
Vehicle accidents
Customer complaints concerning communication center go to who?
Communications center supervisor
The development of the IAP is based off of what?
Incident priorities which include LIPE
What are the oral hypoglycemic medications?
Glipizide
Glyburide
Glimperide
What shall be recorded on the controlled substance inventory log?
Total amount in Mg, MCG, etc
NDC or Lot number
Expiration date
“CAN “ Progress reports should briefly detail ?
Actions that are being taken
Actions that. Have been completed.
Limitations of Student riders?
Only perform or assist in activities where proficiency has been verified by training facility.
No riding alone with pt’s in pt compartment
Logged in station log book
Wear uniform that training facility has issued
Not subject to duties outside of agreement
Definition of apenic in DSI?
Respirations < 4/min
Ryan White act notification is for what time frame?
Within 48hrs of notification of patient diagnosis
The ONLY useful purpose for a TAC stick is:
To identify energy sources that were not previously aware of
Safety officer responsibility for an MCI are to do 3 things:
- Request LE
- Provide physical security
- Exclusion zone
The term “MAYDAY” should be used when ?
Lost
Trapped
Disoriented
Seriously injured
Air emergency
‘In need of immediate help
Expired medications shall not be held in quarantine for more than?
30 days
Examples of Natural hazards are?
Severe Weather- Hurricane, tropical storm, lightening
Floods
Agricultural pests and ds.
Fire
Communicable ds. - H1N1, Eboli
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
The ISO with regards to atomospheric monitoring SHALL ensure:
Levels are safe before allowing personnel to remove SCBA during overhaul
Benefits outweigh risks with OV
Respiratory protection is used accordingly
The Fire rescue RTF-PEM supervisor is established by who and works on which TAC channels
IC and 7a or 8/a and 14a or 15a.
For exterior LPG/NG leaks on above ground containers - they should be cooled with what?
2 1/2” line at 200gpm
Divisions and group persons who are in charge are termed what?
Supervisors
Time frame for post exposure prophylaxis?
Within 2 hours
Where are adulterated or expired medications kept?
In a designated “quarantine “ are within the supply closets.
What MUST be obtained on a vehicle accident?
A police report AND obtain insurance from other driver
What are the 4 zones for ASHER/MCI?
Exclusion
Hot
Warm
Cold
What is a customer inquiry?
Inquiry - Request for information -
Lost item
Securing property
Gratitude
Obtain inform
Battalion level procurement of equipment will go through who?
Medical supplies warehouse.
Power CQI, an ERROR is defined as?
Failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim
If a student or observers ride time is terminated who is then notified?
Deputy chief of operations is notified.
Adult Cocaine OD get treated with what?
Versed
Time for Breech birth actions
if not delivered in 3 minutes
A DNRO applies to who?
Cardiac or respiratory arrest
Succumbing to a disease process of a terminal illness
Which patients receive fluids despite having rales?
Septic pneumonia patients
When using the Hand Tevy method, what is used for the PRIMARY reference point?
age
EMS CQI Reportable events are?
Airway or ventilation issues or errors
Electrical therapy issues or error
Deviation from EMS protocols with out justification
Advanced procedure issues or errors:
Paralytic use, pleural decompression, Cricothyrotomy
Repetitive minor issues that cannot be resolved on a supervisor level
Any other issue or error that causes harm or has significant potential to do so.
Who is responsible completing and submitting the DRE form and where does it go?
First person to report event and uploaded to sharepoint.
Clearance from the OHC prior to returning to work must of,had what types of conditions?
- work related injury that resulted in being off duty from WC or LD
- Out patient surgery or hospitalization
Loss of life/ injury definition for fire investigator call out?
Fire or explosion related deaths
Fire or explosion related injuries which require transport by FR.
Pt’s that have not reached puberty shall be classified as how?
pediatric pts.
A DNRO applies to who?
Cardiac or respiratory arrest
Succumbing to a disease process of a terminal illness
First time students on ride alongs must provide the following items:
Written verification of name, year/ class and status in program.
Background check and criminal hx
Written verification of. Proficiency in BSI
Have stethoscope, eye protection, mask and fit tested.
Written confirmation of vaccinations
Written verification of skill proficiency
What is the FAP definition for ASHER/ MCI?
Final Approach position- is the outside area where the RTF-PEM team enters the warm zone
H2s has an almond like Oder detectable at what levels?
1-5ppm and 60-70% of the population
Per CQI and Adverse event is defines as ?
Incident causing injury or other medical condition to a patient as a result of treatment rendered by EMS personnel.
A valid DNRO shall be:
Signed by the competent patient or patients representative
Signed by the licensed Florida physician
Be on original canary yellow or copied on similar colored paper.
When it is deemed necessary to have follow up testing who contacts the employee and when?
EMS captain , Exposure control officer, or OHC within 24 hours
What cases are mandated to be reported to the CDC?
Contagious ds
AIDS
HBV
TB
Natural gas has an LEL of?
5.3-14%
Who is the clearinghouse for citizens complaints?
Operations and administrative services
PEA is defined as?
an organized rhythm > 20 BPM
Pregnant minors can refuse transport only for?
Only if the condition if the condition is related to the pregnancy. If not, then no refusal. Ie. Broken leg.
The fire rescue RTF- PEM TEAM leader reports what to the Fire rescue RTF-PEM group supervisor
PAR levels
- going in and out of the warm zone
- going in and out of structures in the warm zone
- Changing floors or levels with in the warm zone
Guidelines for Operational Capt and Lt with Students/ observers?
Let to obtain proper paperwork for student
Safe place to observe with seat belt
Introduce person to others in the station
Familiarity with apparatus
Log person in station logbook
Log person on ePCR’s for calls and treatments performed
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
After securing the malfunctioning stretcher- Where does the item get reported to ?
Assetworks as a HIGH priority
If the reporting system is down how shall the incident report be documented?
Should be documented on the a “field report”
Medications should be delivered when in cardiac arrest ?
ASAP after rhythm check and circulated for 2 min
Per CQI and Adverse event is defines as ?
Incident causing injury or other medical condition to a patient as a result of treatment rendered by EMS personnel.
Who may ride as an observer?
Local Dr’s, nurses, PA’s, Nurse practitioners, and other medical students or professionals.
EMT’s or paramedics with other local agencies from their chief on letterhead
Individuals seeking employee or are in training
Others approved by the fire rescue administrator and FR HIPPA compliance officer
EtCO2 monitoring will be performed on which pts?
Respiratory distress
AMS
Sedated / pain medication
seizure pts
ketamine pts
An IRE is reported immediately to whom?
Supervisor
What is the minimum size hose line and nozzle for confirmed LPG/NG leak?
1 3/4” with a fog nozzle
Natural gas lines are what sizes?
Commercial 1-4”
Residential 1/2-3/4”
Where do companies leaving rehab report to?
Staging
If a student or observers ride time is terminated who is then notified?
Deputy chief of operations is notified.
The communications center shall announce benchmarks every?
10 min
Adult BP maintain BP for Head injuries is what?
SBP 110-120
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 are the medical NO-GO criteria?
SBP< 100
Pulse >100 with ANY of the following:
Temp > 101
SBP> 180
DBP>100
SPCO>0
ALS S/S.
What are the amiodarone contraindications
Qtc >500
Blocks
Bradycardia
Hypotension
cardiogenic shock
A “DRE” is defined as:
Events that occur during emergency calls, training, pub ed, emergency or non emergency situations:
Potential to cause harm
Equipment failure that had potential but did not.
Half mask cartridge respirators with organic vapor filters can be used when 2 conditions apply?
OV only and 02 is normal
What shall be documented for refusals of Transport?
Death Disablity, AAOx4, Clinically sober, impaired judgement, capacity, assessment, exam, 2 set v/s.
Not being transported may result in death or disability
AAOx4- clinically sober, with no life or potential life threatening conditions to impair judgment
Capacity
Patient assessment
Physical exam
2 sets of V/S
An IAP planned operational period is how long?
12-24 hours
Definition of a “FORMAL AAR”
Battalion HQ or HQ
CQI or Chief
Detailed and analysis
Scheduled with 30-90 days post
The incident safety officer will have the 1st EMS captain on all __________ __________ and _____________ __________provide what to whom?
Working fires and Hazmat incidents their rainbow sensor to the Rehab unit.
Students will arrive at ride time with what equipment?
Stethoscope
Eye protection
Respiratory protection
Clinical and skills documentation able to perform.
Copy of state EMT and BLS cards.
What are the precautions with Ketamine in seizure patients?
Respiratory distress- need for an advanced airway
HTN
Schiziophrenia
Who has the responsibility to call for a fire investigator?
IC
What pages in the ERG are used for LPG and Natural gas leaks?
20-25 and orange guide sections 115-116.
MCI types are classified as:
CBRNE
Shootings
MVC’s
Plane crashes
Collapse
When filling out risk management forms supervisors must sign forms using what?
Full first and last names AND employee ID
What are Half mask cartridge respirators w/ organic vapors particularly used for?
Wildland fires
D/O operating at the pump panel
ISO
Post fire activities
What is the priority order for REHAB?
RHEBA
- Rest
- Hydration
- Energy nutrition
- BLS and ALS
- Accommodation for weather.
The Paramedic Development course is for?
New employees and
Those needing remediation
Exposure protection should be accomplished with ?
Ground monitors
Mounted deck guns
The rehab unit works under which command branch?
Logistics
What are acceptable forms of ID for DNRO
Drivers license
Other photo identification
Witness in the presence of the patient
A patient exists when ?
medical complaint,
obvious injury,
appears in distress
Suggestive of acute illness or injury
Such as: HX, MOI, appearance
Lack of capacity
An “After Action Review” is required for what level MCI?
Level 3 or higher
The following SHALL NEVER be performed on patients with a DNRO?
Artificial respiration
BVM
ET tube
Supraglottic A/W
Chest compressions
Defibrillation
Unstable Vtach
Adult : Cardio version 100, 200, 300. 360J
Pedi : 0.5J/kg and 2j/kg
The THREAT acronym for an ASHER/ MCI stands for what ?
Threat Supression
Hemorrhage Control
Rapid extrication
Assessment
Transport
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
12 lead cables will remain on the pt until when?
turned over the ED staff when transporting.
Who gets notified of exposure to communicable ds.?
EMS captain and notify Medical services division.
Emergency Evacuation is for?
Evacuation of a scene or area in imminent danger
One a controlled substance is removed from the container how long till it needs to be re-sealed?
Immediately following or as soon as reasonably possible
All IVP medications for an arrest are followed by what?
10ml saline Flush
“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
A significant exposure is deveined as :
Needle stick or sharps:
Blood or fluid containing visible blood
Semen
Vaginal fluids
CSF
Synovial fluid
Peritoneal fluid
Pleural fluid
Pericardial Fluid
Amniotic fluid
Mucous membranes
Abrased or abraded skin
Airborne contagions
Rehab 6 hours post fire incident is in reference to ?
Cardiac arrest and WILL be treated for cyanide exposure
A valid DNRO shall be:
Signed by the competent patient or patients representative
Signed by the licensed Florida physician
Be on original canary yellow or copied on similar colored paper.
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
Who is responsible for securing and maintaining scene integrity for a fire investigation?
Operations personnel. Not LE
What is the “Section” person in charge title?
Chief
Who can place an unit OOS for an IRE?
BC or equivalent supervisor
Definition of Accidential fire with substantial monetary loss or structural damage?
Monetary fire loss of $70,000 or structural damage exceeding 20%
Any suspicious or crime related incident regardless of dollar value.
What has to be “Clearly” written on the tag for a stretcher malfunction?
OUT OF SERVICE- DO NOT USE
A valid DNRO shall be:
Signed by the competent patient or patients representative
Signed by the licensed Florida physician
Be on original canary yellow or copied on similar colored paper.
What information is needed to finalize a medical report?
“Report author”
HIPPA or PPA signed
Signature of patient or witness
“Transfer of care “ by hospital staff
MRN
Any students or observers must be listed.
If SPCO is above what level?
>20%
If theft or loss of a controlled substance from the EMS captains stock- how is it handled?
The same as a unit loss except the EMS captain contacts the division chief of medical services 1st.
TIC operations: our eyes work by seeing contrast by objects that are illuminated by either. _______ or. __________.
Sun or another from of light
Propane has an LEL of?
2.1-9.5%
Refusal breakdown chart?
Refusals:
Adults
Minors
Pregnancy
Diabetics
Treatment refusal:
Death or disability
AAOx4 w/ no life or potential life threatening condition to impair judgment
Have Capacity
Transport refusal:
Death or disability
AAOx4 w/ no life or potential life threatening condition to impair judgment
Have capacity
Patent assessment
Physical exam
2 sets of V/S
Meet all previous criteria for refusal
What information is to be entered on a level 1 or 2 MCI?
Name
DOB
Phone number
Brief narrative
What is the most important V/S to stabilize?
CORE temperature
Who has the responsibility to call for a fire investigator?
IC
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.
A valid DNRO shall be:
Signed by the competent patient or patients representative
Signed by the licensed Florida physician
Be on original canary yellow or copied on similar colored paper.
IF an employee fails the PDC entrance exam what happens?
Returned to shift as soon as possible
Cannot re try until next scheduled PDC
IF the employee fails the 2nd time- must wait 24 month before applying again.
TIC’s are assigned to which apparatus?
Every Engine, rescue, EMS captain , and BC.
Definition of the “exclusion zone”?
Risks outweigh the benefits
No FF operations allowed
What must the employee have in order to go to the OHC?
A completed employee injury /illness report. Form FRH-302
The Situational Evaluation or “Size Up” is based on what?
Critical incident factors
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
Under the safe haven law, Law enforcement should not be contacted unless?
Signs of physical abuse are present at the time of surrender.
What are the contraindications for Ceftriaxone or rocephin?
Allergy to cephalosporins
Neonates birth to 30 days
After securing the malfunctioning stretcher- Where does the item get reported to ?
Assetworks as a HIGH priority
Draw out the command sequence
Storing of medication on the rescue truck need to be kept at what temperature?
65-80 degrees Fahrenheit
Minimum par levels with controlled Substances can be found where?
PBC portal/ PBCFR/medical services under the quick link- Controlled substances minimum quantities.
What are the most likely transmission routes from TB?
Persistent cough >2 weeks with one of the following
- Anorexia
- weight loss
- fever
- hx of drug use
- night sweats
- bloody sputum
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.
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
What is the primary site for chest decompression?
5th intercostal space mid axillary
Finger Thoracostomy is done when ?
known or suspected injury to the chest and or abd
The 10 min benchmark timeframe include what 3 things?
Notification
Response
deployment
Intelligence / Investagtory function purpose is what?
to determine the cause or source of the incident
The preferred location for observers to ride is:
Battalion HQ’s unless otherwise specified in the approval process.
What is the fire flow formula?
L x W / 3 x % involved
The medical warehouse temperature is kept at ?
70-76 degrees Fahrenheit
CO poisoning is at what level?
35ppm
What factor has the most impact on the outcome of a fire incident?
The initial attack hose line
When must an employee be required to complete a medical exam and fitness assessment?
Prior to returning to full duty from any injury or illness or any leave greater than 6 months
1st arriving unit responsibilities on a ASHER/MCI?
Establish command
Set LEVEL 2 staging
Set up command at Staging
Establish a unified command with LE.
DSI paralysis indications are?
Apneic Status epilepticus
Trismus
EMS captain or flight crew discretion
Stable SVT treatment is?
Adults 12mg Adenosine
Pedi- 0.2mg Adenosine
The following incidents REQUIRE an assistant safety officer?
Hazardous material
Dive team operations
Open water incidents
Rehab when assigned
“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
Damage of a controlled substance from a a unit is handled how?
Notification t o the EMS captain
Property loss form and tracking number
“Broken/ damaged” written in the case# spot
The EMS captain notifies the division chief of medical services
Any functions within the ICS that remain un delegated remain with whom?
IC
Adult hypotension is defined as?
systolic BP> 90.
Who do assistant safety officers report to?
Directly to the Incident safety officer
How often is injury tracking analyzed
On a quarterly basis
During an MCI command needs to be updated with what information?
Number of patients
Patient categories
Additional resources needed.
EMS CQI Reportable events are?
Airway or ventilation issues or errors
Electrical therapy issues or error
Deviation from EMS protocols with out justification
Advanced procedure issues or errors:
Paralytic use, pleural decompression, Cricothyrotomy
Repetitive minor issues that cannot be resolved on a supervisor level
Any other issue or error that causes harm or has significant potential to do so.
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.
The definition of an HSP?
Hazard specific plan that outlines a mitigation strategy for 12 hazards
What type of work related injuries must be reported?
All injuries no matter how minor
Sager splints are used on what type fx?
Closed Mid shaft femur only
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
When should manual BP’s be taken?
Initially and to confirm any abnormal or significant change in an automatic BP.
Definition of Perimeter?
The most distant control point for the incident.
Unified command will use which management system?
NIMS- National incident Management system
How much NS admin for Decompression sickness?
500ml
Who gets notified for vehicle accidents?
BC
A post exposure treatment written statement is to be completed by what time frame?
Within 15days
Response code levels to an ASHER/MCI by Fire Rescue are?
Code 3 with lights and sirens until unit crosses the LE perimeter./
Responders at an active shooter event should realize?
Secondary devices
Actions against responders
Implement PPE
Caution with tactical actions
Preserve evidence
The Command post should be set up so the IC has how many views of the incident?
2- TWO
When treating a possible TB patient what should happen ?
N95 on employees
Oxygen to patient or if not needed N95 for patient
Air vents open -no recirculating
How many of hours of work may be sustained if ________, _________, _________ and hours__________.
Rest
Hydration
Energy nutrition
At least 4 hours
“Section” is defined as?
One of the 5 major functional areas under the NIMS system
IS between command and branch areas
A report of the department’s exposures are sent to who and how often?
Wellness coordinator- Annually.
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
For Trauma patients not to be resuscitated what criteria is needed?
Apneic
Fixed dialted pupils
asystole
NEED ALL 3
or injuries incompatible with life
Strategy is defined as?
General course of action or direction to accomplish incident objectives
it is more important to maintain what levels for COPD and asthma patients?
SPo2 at 90%
The IC is responsible for ensuring that assignments during an incident are based on what?
Incident priorities
What are the doses for rocuronium for adult and pediatrics?
Adults 100mg
Pediatric 1mg/kg
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
What is the contraindications for push pressor epi?
Hypotension secondary to blood loss.
Students will arrive at ride time with what equipment?
Stethoscope
Eye protection
Respiratory protection
Clinical and skills documentation able to perform.
Copy of state EMT and BLS cards.
Observer dress code is:
White shirt- SS or LS
Black, dark blue pants
Black closed shoes w/ dark socks
Heat stroke is classified as ?
Temp > 103 or AMS
Special events , dignitary details with regard to controlled substances are handled how?
Receive written authorization from the division chief of medical services or designee.
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
Responsibility for,returning to work is who’s?
The employee to notify the BC/ supervisor
How are explained discrepancies handled with controlled substances?
Report to Lt or operational captain
Single line strike though with initials next to change
Once assigned to Safety officer what are the duties?
Don appropriate vest and PPE
Ensure no entry into the hot zone as a single person
Ensure all control zones are established or adjust as necessary
Ensure exclusion zones are recognized
Rehab
Atmospheric monitoring
Remain on scene until relieved by the IC or designee
Document actions as to the incident reporting guide
any accidents injuries or unsafe acts or safety concerns should follow the CQI
Communicate with EMERGENCY TRAFFIC the exclusion zone
A valid DNRO shall be:
Signed by the competent patient or patients representative
Signed by the licensed Florida physician
Be on original canary yellow or copied on similar colored paper.
Who gets contacted with finding of an investigation with regards to citizens complaints?
DC get contacted for findings of Citizens complaints
The county established a framework to ensure PBC is prepared to respond and recover from hazardous incidents?
Comprehensive Emergency Management Plan
What percent is active cooling better than passive cooling?
50-60% more
When must a fire investigator be called?
- Fire is suspicious or crime related-
- Loss of injury or life
- accidental fire w/ substantial monetary loss or structural damage.
- Juvenile related incidents
- Explosive devices/ explosion
- Undetermined
The 5 gas monitor will be used when ?
Incidents where combustion processes have taken place
In areas with close proximity to any fire- wildland, structure, vehicle, training, or dumpster
The preferred location for observers to ride is:
Battalion HQ’s unless otherwise specified in the approval process.
For which of the following fire investigatory incidents shall a Fire investigator be contacted via radio or cell phone?
Juvenile related incidents.
A safety office should have a working knowledge of what?
Safety concerns for fire rescue in typical incidents
Fire behavior
Building construction
EMS
What medical items are on a 1 for 1 swap through the medical warehouse?
Specialized items that include life pak cables and sensors
Definition of a “PAR” level?
The “ideal quantity of each controlled substance carried by a unit in order to maintain sufficient operations.
Employees filling forms for PTSD fill out what forms?
The same as employee injury
What is the TACTICAL priority of protecting property from damage?
Salvage
Reporting fire conditions are what 4 types?
Nothing showing
Smoke showing with - light, moderate, or heavy
Flames showing
Working fire
Development of the IAP includes?
Mode of operation
Tactical priorities
Scene control
Tasks
Limitations of Student riders?
Only perform or assist in activities where proficiency has been verified by training facility.
No riding alone with pt’s in pt compartment
Logged in station log book
Wear uniform that training facility has issued
Not subject to duties outside of agreement
Radio transmissions use what model?
Military order model
Upon arrival the student or observer MUST report to who?
Operational captain and then paired with the LT.
Unstable bradycardia is defined as?
Adult: >50 BPM w. hypotension
Pedi: >50 w/ AMS and age hypotension
Indications for an advanced airway are:
Airway protection
Respiratory failure
Prolonged respiratory suppport
Operational periods should be no longer than ?
24 hours
Who are responsible for the accurate inventory, distribution, transfer, documentation, and record keeping of all controlled substances on a unit?
All department protocoled Paramedics assigned to a unit.
The Fire rescue RTF-PEM supervisor is established by who and works on which TAC channels
IC and 7a or 8/a and 14a or 15a.
Area command oversees management of ___________while an EOC coordinates__________ ___________ and _______________ _________.
Incidents
Support functions and resource support.
On a confirmed LPG/NG leak where does the “Hot zone” start
Where the 4 gas monitor has LEL readings above 0
The Drager X am 5000 monitors which substances?
O2
Flammability
CO
H2S
OV
When 2 or mare staging areas are being used that are identified how?
Function or location
Measures to be taken immediately after a significant exposure?
Clean the wound
Notify the EMS captain
Accompany the source patient to the hospital
Fill out the hospitals exposure log book using the Case number
Report to the OHC immediately or the next business day
Discontinue and treatment after being notified by the OHC of a negative result.
The definition of a newborn to be left at a fire station is defined as?
7 days old or less left by the parent
TIC limitations:
Cannot see into a windowless building- need temperature differences
Cannot see under water
Cannot see through windows or glass
Cannot see through highly reflective materials - stainless, steel, mirrors, windows
Who is allowed to deviate from the protocols?
Ems captains and Trauma hawk Personnel
Orders and decision making shall be performed where?
At the lowest level within the organization
Definition of Accidential fire with substantial monetary loss or structural damage?
Monetary fire loss of $70,000 or structural damage exceeding 20%
Any suspicious or crime related incident regardless of dollar value.
Upon arrival the student or observer MUST report to who?
Operational captain and then paired with the LT.
Distribution of controlled substances from the EMS captain to a unit are signing in what spaces in the book?
EMS captain signs Given/ Issued by and Unit sign received by section .
How is a fire investigator requested?
The IC requests through the communications center.
If allows to return to work with the BCs permission when must the employee go,to the OHC for clearance?
Before the next work day
After securing the malfunctioning stretcher- Where does the item get reported to ?
Assetworks as a HIGH priority
What is the minimum size hose line and nozzle for confirmed LPG/NG leak?
1 3/4” with a fog nozzle
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
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
Examples of the “CONFINEMENT tactical priority would be?
Preventing fires into un burned areas
Time to conduct a rescue
Protect exit stairways and corridors
Who fills,out report for minor injuries and where does it go?
Immediate supervisor and forwarded to BC
STEALH stands for?
Set time
Tone
Execution
Analyze
Transfer lessons learned
Hi note
The DNRO identification device must be signed by who if the patient cannot provide consent?
Surrogate
Proxy
court order
Power of attorney
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
Common Natural gas lines that are 24” are found where in PBC?
Along the turnpike
Port of palm beach to West county energy center owned by FPL
What make critical incident factors critical?
Ability to line up incident factors in priority based on consequences
Treatment for RRWCT is?
Stable :Adult 1g cacl2
100mg bicarb
Pedi: 20mg/kg cacl2
1meq/kg bicarb
Under the safe place law, when should law enforcement be contacted?
- Child is followed by and angry parent to the fire station
- Abuse is ssuspected
- Suicidal/ homicidal
- Teen is hallucinating and out of control
What information is needed to finalize a medical report?
“Report author”
HIPPA or PPA signed
Signature of patient or witness
“Transfer of care “ by hospital staff
MRN
Any students or observers must be listed.
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 is the minimum size hose line and nozzle for confirmed LPG/NG leak?
1 3/4” with a fog nozzle
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
Reportable events are defined as:
An occurrence during emergency calls, training, pub ed, emergency or non emergency situations
IF trauma hawk is taken out of service where are the controlled substances kept?
In a department issued lockable safe
If a parent or guardian refuses a physical exam what must be documented?
Visual exam
Mental status
General appearance
Work of breathing
Circulation to skin
An example of injury while wearing PPE would be?
Burns to the hands while wearing gloves.
When using the TAC stick the user should start on which sensitivity?
HIGH and move to lower ones later.
The ICS 5 major functional areas are?
Command
Operations
Planning
Logistics
Finance/ Admin
An assistant safety officer may be assigned by the IC for rehab under what incidents?
Physical labor of > 2 hours
Excessive rotation of companies
Incidents that require defined hourly work periods
Hire rise fires not controlled by a single company
Wildland fires
Hazmat incidents
Confined space incidents
A DNRO applies to who?
Cardiac or respiratory arrest
Succumbing to a disease process of a terminal illness
What is the tine frame for not considering a stroke not an Alert
Witnessed greater than 24 hours
How does a reservist get entered in the causality page?
RESERVIST1 is the ID number
PBCFR is the first name
RESERVIST was the last name
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
Examples of “EXPOSURES” are
Near fire building
Attached to fire building
Near but protected
Threatened by flying brands, heat or toxic gases
Students will arrive at ride time with what equipment?
Stethoscope
Eye protection
Respiratory protection
Clinical and skills documentation able to perform.
Copy of state EMT and BLS cards.
Who can establish a LEVEL 2 staging area?
IC
Operations section chief
What is the minimum size hose line and nozzle for confirmed LPG/NG leak?
1 3/4” with a fog nozzle
Who can revoke a DNRO?
Patient
Surrogate
Proxy
Court order
Power of attorney
Type III construction is what?
Ordinary construction where the interior structural elements are entirely or partially of wood OF SMALLER DIMENSIONS
Eclampsia is defined as ?
S/S of pre + seizures or coma
TIC operations with victim or FF in structure fire will appear ?
Dark
Who’s responsibility is it to assign a safety officer?
IC
“Mayday” definition is?
Lost
Trapped
Disoriented
Seriously injured
Experiencing an Air emergency
In need of immediate help
TO have an effective progress report , the report need to be ?
Timely
Complete
Consise
What forms are required by students to ride - legal documents?
Copy of Student/ observer ride time
Release of Liability and covenant not to sue.
Indemnification agreement
HIPPA confidentiality agreement
Insurance coverage
What is the dress code for Student riders?
Designated uniform by training facility
Badge or other identifying means
Assuming command can happen by what 2 means?
Non collaborative/Face to face
Radio communications of “assuming command”
What is the fire formula for multiple floors?
L x W /3 x % involved = GPM/ min x number of floors
TASKS are defined as ?
Specific assignments that are typically performed by one company or small group working together.
If the paramedic who signed the controlled substance log can longer keep possession and no relief is available who do they go to?
Lieutenant or operational captain or designee
Who is responsible for securing and maintaining scene integrity for a fire investigation?
Operations personnel. Not LE
Who may terminate a student or observers ride time?
Operational Captain
EMS captain
BC or DC
Definition of a “INFORMAL BATTALION AAR”
Battalion HQ or FS
Company officer of chief
IN DEPTH
Scheduled ASAP
What must the employee have in order to go to the OHC?
A completed employee injury /illness report. Form FRH-302
What are acceptable forms of ID for DNRO
Drivers license
Other photo identification
Witness in the presence of the patient
Extensions for paramedic probation are ?
Done by the EMS captain and documented on a professional development form for 18month.
If the extension period is still less than satisfactory then the EMS captain. Recommends the person be referred to the medical services division and medical director for further evaluation.
All documentation to be sent to the compliance officer
Vtach stable treatment?
Adult : Amiodarone 150mg in 50 15gtts
Pedi: 5mg/kg in 50 15 gtts
What makes a Vtach patient unstable?
Contraindications to Amiodarone:
Sinus bradycardia
2/3 degree blocks
cardiogenic shock
hypotension
QTC >500
Who get notified when a newborn infant is surrendered at a fire station?
PIO
Who maintains the list of resources that may be beneficial in an MCI?
FOO
Positioning for DSI is?
Ear to the sternal notch
Head parallel with the ceiling
Stretcher elevated 15-30 degrees
The 5 gas monitor will be used when ?
Incidents where combustion processes have taken place
In areas with close proximity to any fire- wildland, structure, vehicle, training, or dumpster
Where is the fire rescue RTF-PEM group supervisor located?
Next to the Tactical LE officer in the “Cold Zone”
When using the TAC stick the user should start on which sensitivity?
HIGH and move to lower ones later.
What is the purpose of paramedic development?
Provide a uniform process for new employees attempting to work as a paramedic
Address development for paramedics requiring remediation
What are the control zones?
Exclusion Zone- Risk outweighs benefit
Hot Zone- HI risk
Warm zone- Little risk
Cold zone- no risk
Who has the responsibility to call for a fire investigator?
IC
If there is no logistics branch who does the rehab unit report to?
IC
Definition of Student in regards to ride times?
Enrolled in an education program at an accredited facility that has an agreement with fire rescue.
To include: EMT and paramedic programs
Emergency medical responder
Training programs at secondary school of palm beach county.
Unstable SVT treatment is ?
AMS-
Adult 100, 200, 300, 360J
Pedi: 0.5J/kg and 2J/kg
Definition of “Verification” for exposure?
Determining whether a reported exposure is and “Actual” or perceived health threat.
Factors that influence potential exposures are?
Distance
Radiant head
Wind
Customer complaints regarding fire safety includes what types?
Codes
Overcrowding
Parking in fire lanes
Definition of an MCI?
One that exceeds the capabilities of the first arriving units?
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.
The first arriving unit responsibilities to an MCI are what ?
Establish Command
360
Establish exclusion zone
Declare LEVEL and TYPE MCI
Initial triage
Assign incoming units based on LIPE
Additional resources
Staging officer
Observers unable to keep ride times:
MUST notify the recruitment and human resource development officer in advance.
If an employee cannot,obtain clearance to return to work because the OHC is closed what happens?
The BC MAY allow the employees to return to work if not I’ll and without limitations but must still receive clearance from the OHC before the next day
How is the 1st notification made in the chain of command for complaints?
Verbally to the DC or supervisor.
If not available then BC.for the complaints battalion.
Which pt’s shall have a BGL checked?
Diabetics
AMS
seizure
stroke
syncope,
lightheadedness,
dizziness
poisoning
cardiac arrest
What are three protocols where on 500ml NS are used?
Decompression sickness
Calling an arrest.
2nd > 15% or 3rd > 5% degree burns
Who is responsible for a “FORMAL WRITTEN IAP?
Planning section chief
Expired medications shall not be held in quarantine for more than?
30 days
What are acceptable forms of ID for DNRO
Drivers license
Other photo identification
Witness in the presence of the patient
MInor CQI errors include?
Spelling or topographical errors
TIme delays without patient harm
Lack of detail
Intracranial- report inconsistencies
Protocol deviation without patient harm or potential.
An IRE is defined as:
With regards to any Citizen, patient, fire rescue personnel:
- Harm caused by action or inaction
- Caused by equipment failure
- Immoral, unethical , or illegal action
- Cause for litigation
- Poltically sensitive
- Media scrutinization
Definition of Juvenile related incidents for fire investigation?
Suspected to be the result of juvenile involvement in the ignition process
A protective action Zone is identified for what?
Evacuation
Protected in place
The FUP in a ASHER/MCI is defined as?
Forming Up Position where FR and LE meet to form a team
Pediatric pts are age what?
less than 18.
During a “MAYDAY” the ISO should request what?
An additional safety officer
How does a reservist get entered in the causality page?
RESERVIST1 is the ID number
PBCFR is the first name
RESERVIST was the last name
What is the primary goal with an active shooter event?
Ensure joint command and communications from FR and LE to minimize the risk and maximize safety for all response personnel.
Type III construction is what?
Ordinary construction where the interior structural elements are entirely or partially of wood OF SMALLER DIMENSIONS
Definition of apenic in DSI?
Respirations < 4/min
When treating Heat stroke?
Cool First, transport second
What is the other term for Tactical Priorites? Part of the development of the IAP
“Overview”
Who sets the running par level at the battalion for controlled substances?
The EMS captain.
Limitations of Student riders?
Only perform or assist in activities where proficiency has been verified by training facility.
No riding alone with pt’s in pt compartment
Logged in station log book
Wear uniform that training facility has issued
Not subject to duties outside of agreement
Natural gas lines are what sizes?
Commercial 1-4”
Residential 1/2-3/4”
What is the purpose of paramedic development?
Provide a uniform process for new employees attempting to work as a paramedic
Address development for paramedics requiring remediation
Significant exposures are defined as and are what type?
Exposure through a needle stick , sharps to the following body fluids:
Blood or and body fluid containing visible blood
Semen
Vaginal secretions
CSF
Synovial fluid
Peritoneal fluid
Plueral fluid
Pericardial fluid
Amniotic fluid.
Body fluids to mucus membranes
Chapped or a braided skin
Exposure to Airborne contagions
Primary goal of any airway or respiratory emergency is maintaining?
Ventilation
Oxygenation
Perfusion
A person known to be in the structure with conditions tenable for a person WITHOUT protective gear is termed what?
Salvageable Life
Special events , dignitary details with regard to controlled substances are handled how?
Receive written authorization from the division chief of medical services or designee.
The Pre-oxygenation step includes?
Maintaining of SP02 for 3min:
Positioning head
NC @ 15L/min
BVM w/ peep @ 10cm/h20
BVM with face seal
The DNRO identification device must be signed by who if the patient cannot provide consent?
Surrogate
Proxy
court order
Power of attorney
What shall be documented in the pcr for refusals of treatment?
Refusal can result in death or disability
They were AAOx4- clinically sober w/ no life or potential life threatening conditions
Have the capacity to refuse
What are the common means of reporting CQI events?
Field personnel vis chain of command
Reportable events
Hospitals via complaint as a performance improvement process
Patients vis a complaint to the agency
What type of arrests are to be transported to a trauma center?
Electrouctions and lighning strikes
Offensive mode should be used when ?
Salvageable life
No evidence of structural failure or hostile fire event
What are STEMI disqualifiers?
LBBB
LVH
Early Repolarization
Pacemaker with QRS > .12
Who can place an unit OOS for an IRE?
BC or equivalent supervisor
Who and where does PPE go if an injury occurs on an emergency incident?
BC secures PPE and training AMS safety division
RRWCT is defined as?
> 0.20 or 5 boxes
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
When must an employee be required to complete a medical exam and fitness assessment?
Prior to returning to full duty from any injury or illness or any leave greater than 6 months
What kind of lock can be used for the EMS captains Storage container of controlled substances?
Key, coded, or biometric lock
For expediency of an IRE notification is made how?
By telephone or face to face to the BC.
When can you insert a gloved hand into the vagina for a birth?
Breech birth
Prolapsed cord
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
Minors refusal criteria?
Parent or legal guardian
<18 yrs old if Married
emancipation
military
Parent or guardian by phone w/ person on scene willing to sign
AEIOU TIPS ?
Alcohol, Epilepsy, Insulin, OD, underdose
Trauma, infection, pyschosis, stroke
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
The 3 sensitivities for the TAC are?
HIGH
LOW
FRONT
Bradycardia is defined as?
< 50 BPM
Who do assistant safety officers report to?
Directly to the Incident safety officer
How are the collected expired controlled substances handled?
Hand delivered to an authorized member of the medical services division for proper disposal.
Command presence is conveyed how?
look
Act
Speak
Carry yourself
Special events , dignitary details with regard to controlled substances are handled how?
Receive written authorization from the division chief of medical services or designee.
What are the time frames for rehab?
20 min X 2 for a total of 40 minutes. After 40 minutes BLS/ALS tx, and transport or referral to OHC
Disposal, Destruction of controlled substances are handled how by a unit?
Draw upon Unused medication and dispose of it “as directed by the medical services division,.
Record disposal in log book using 2 different employees.
Additional backboards can be requested from who?
Support 81
Rescues in staging
Inventory specialist
Who has the ultimate responsibility for an ASHER/MCI (Active shooter hostile event response)?
Law Enforcement
Post intubation medications are MANDATORY for any?
ET tube or Igel
Who is allowed to take or contact the complaint?
Lieutenant or higher officer
What is the warning for rocuronium with patients?
Asthmatic patients may have a drop in BP that may result in Cardiac arrest.
What equipment MUST be in place fro DSI?
Suction unit
Cardiac monitor, BP, SPO2, ETCO2
Storing of medications in the station supply room are to be kept at what temperature?
70-75 degrees
An incident Support plan is for what type of incidents?
Mass fatality / MCI
General population shelters
Continuity of operations plan
How are UNexplained discrepancies handled for the EMS captains stock?
Notification to the division chief of medical services
Auto PEEP is what?
When Air goes in before a patient is allowed to exhale.
The DNRO identification device must be signed by who if the patient cannot provide consent?
Surrogate
Proxy
court order
Power of attorney
Customer complaints with regards to matters of fire safety are ha fled by?
Community risk reduction and notification to DC or BC
All medication errors and immediate and delayed outcomes for errors gets reported to who?
EMS captain
Extensions for paramedic probation are ?
Done by the EMS captain and documented on a professional development form for 18month.
If the extension period is still less than satisfactory then the EMS captain. Recommends the person be referred to the medical services division and medical director for further evaluation.
All documentation to be sent to the compliance officer
Pacing for a peds starts at what?
80 BPM
If allows to return to work with the BCs permission when must the employee go,to the OHC for clearance?
Before the next work day
EMS CQI Reportable events are?
Airway or ventilation issues or errors
Electrical therapy issues or error
Deviation from EMS protocols with out justification
Advanced procedure issues or errors:
Paralytic use, pleural decompression, Cricothyrotomy
Repetitive minor issues that cannot be resolved on a supervisor level
Any other issue or error that causes harm or has significant potential to do so.
Decision making for setting up isolation or control zones is based on :
Potential to harm:
- Life
- Critical systems
- Property
Human Caused Hazards are:
Domestic security
Workplace/ School violence
Mass migration
The IC role is a position of ?
ROLE
Examples of Technological Hazards are?
Transportation incidents
Hazardous materials
Nuclear power plant
Dike failure
The initial isolation zone becomes the hot zone when?
The product is confirmed and additional references are used to confirm the distances.
PBCFR used which Rehab standard for Heat stress index?
WBGT- Wet bulb globe temperature
What are acceptable forms of ID for DNRO
Drivers license
Other photo identification
Witness in the presence of the patient
What are acceptable forms of ID for DNRO
Drivers license
Other photo identification
Witness in the presence of the patient
What are the doses for rocuronium for adult and pediatrics?
Adults 100mg
Pediatric 1mg/kg
What is the term used for the staging of resources prior to entering the incident scene?
BASE
For termination of resuscitation efforts who does the scene get turned over to?
Law enforcement
Or CARES team.
What is the criteria for unstable Afib/ flutter
Hypotension only
Who ensures confidentiality with exposure reports for the employee?
EMS captain
Exposure control officer
How can a DNRO be revoked?
By writing
Physical destruction
Failure to produce
Orally expressing a contrary intent
The Pre-oxygenation step includes?
Maintaining of SP02 for 3min:
Positioning head
NC @ 15L/min
BVM w/ peep @ 10cm/h20
BVM with face seal
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
Incidents identified by the EMS CQI officer level containing an EMS CQI reportable event are handled how?
Emailed to the appropriate EMS captain to be handled.
A DNRO applies to who?
Cardiac or respiratory arrest
Succumbing to a disease process of a terminal illness
12 leads will be repeated how often?
q 10min
When will the passport accountability system be utilized?
2 or more units assigned to an IDLH incident
Strategies are _______ and equivalent to _________.
General
Goals
What is the dress code for Student riders?
Designated uniform by training facility
Badge or other identifying means
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.
Fire rescue has an agreement with who for purchasing all pharmaceutical supplies and medications?
Health care district of Palm beach county.
When does NTG get withheld in CHF patients?
febrile patients or nursing home with pneumonia
When two or more incidents are on the same street then how are they differentiated?
Using a hundred block number or some other designator
Type IV construction is?
Heavy timber- interior structures are made of SOLID or LAMINATED WOOD
Lidocaine in an IO for pedi dwell?
2 min
What is the time frame for decompression sickness?
48 hours
When are statements with regards to citizens complaints necessary?
Statements are needed :
- Damage or loss of property
- Poor treatment
- Patient wishes- ie. Not securing residence or wrong transport location
- When the officer needs statements
Who fills,out report for minor injuries and where does it go?
Immediate supervisor and forwarded to BC
LVAD patients go to which facility
JFK
Active atmospheric monitoring is used when ?
Firefighter is actively monitoring an atmosphere to detect the presence of a leak
Investigating residential or commercial alarm activations to determine hazards
A valid DNRO shall be:
Signed by the competent patient or patients representative
Signed by the licensed Florida physician
Be on original canary yellow or copied on similar colored paper.
Incidents identified by the EMS CQI officer level containing an EMS CQI reportable event are handled how?
Emailed to the appropriate EMS captain to be handled.
Per CQI and Adverse event is defines as ?
Incident causing injury or other medical condition to a patient as a result of treatment rendered by EMS personnel.
The difference between the drager X am 2500 and 5000 is ?
The 500o does OV monitoring for Ethylene oxide
What is the order for clearance by the OHC prior to returning to work?
Obtain the day before returning to work and if unable notify the BC/supervisor they are reporting to,the OHC for clearance .
The IC should request how many TAC channels?
3 TAC channels:
- RTF-PEM
- Medical
- Staging
What type of alerts go by air if ground transport is greater than what time?
40mminutes:
Decompression Sickness
STROKE
STEMI
Who are responsible for the accurate inventory, distribution, transfer, documentation, and record keeping of all controlled substances on a unit?
All department protocoled Paramedics assigned to a unit.
The exposure control officer works under who?
Chief of training and safety division
Pedi cocaine OD get treated with what?
Versed
Evaluation of the IAP is done how often?
AT LEAST every 10 min
Refusal breakdown chart?
Refusals:
Adults
Minors
Pregnancy
Diabetics
Treatment refusal:
Death or disability
AAOx4 w/ no life or potential life threatening condition to impair judgment
Have Capacity
Transport refusal:
Death or disability
AAOx4 w/ no life or potential life threatening condition to impair judgment
Have capacity
Patent assessment
Physical exam
2 sets of V/S
Meet all previous criteria for refusal
Confinement is defined as?
The stopping of the progression of the fire
Contraindications to DSI paralysis is?
Allergy
Predicted difficult intubation
Inability to ventilate with a BVM
Major facial trauma
DSI paralysis indications are?
Apneic Status epilepticus
Trismus
EMS captain or flight crew discretion
Cardiac arrest pt’s with the use of a “Lucas” device will be placed on what?
Scoop stretcher and elevated 15 degrees.
The TAC stick has 4 indicators?
Detects AC current only
Provides warning in audible beeps and flashes
Warning signals increase in strength as amplitude increases
Warning signal s make it possible to locate the signal quickly
When does bilateral decompression get performed?
Arrest due to penetrating chest trauma
Definition of “DEMOBILIZATION”
Release and Return of resources that are no longer needed.
Who can participate in ride alongs ?
Students and observers
Definition of Juvenile related incidents for fire investigation?
Suspected to be the result of juvenile involvement in the ignition process
What are the 6 rights to medications?
Right Patient
Right medication
Right Dose
Right Route
Right time and Frequency
Right indication
What is the warning for rocuronium with patients?
Asthmatic patients may have a drop in BP that may result in Cardiac arrest.
Per CQI, A near miss is defined as?
Incident that had the potential to harm a patient as a result of care rendered by EMS personnel BUT DID NOT actually harm the patient.
A written exposure treatment opinion includes what ?
Results of the medical evaluation
Verification that the employee has been informed about any medical condition resulting from the exposure.
Power CQI, an ERROR is defined as?
Failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim
What is the other term for “Size up”? It is part of the command sequence
Situation evaluation
Who has the ultimate responsibility for an ASHER/MCI (Active shooter hostile event response)?
Law Enforcement
Compressions for an LVAD device are ?
Not using the LUCAS
The Right of the sternum.
Who holds the records for citizens complaints and inquiries?
Fire rescue administrative secretary
What is the primary goal with an active shooter event?
Ensure joint command and communications from FR and LE to minimize the risk and maximize safety for all response personnel.
MInor CQI errors include?
Spelling or topographical errors
TIme delays without patient harm
Lack of detail
Intracranial- report inconsistencies
Protocol deviation without patient harm or potential.
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
During which incidents is the TAC stick particularly useful?
Night operations and post storm area searches.
The TAC stick shall only be used to?
Identify an energized source so an exclusionary zone can be created
MCI levels are what numbers?
1- 1-10
2-11-20
3.21-100
4.101-1000
5.greater than 1000.
Power CQI, an ERROR is defined as?
Failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim
Once assigned to Safety officer what are the duties?
Don appropriate vest and PPE
Ensure no entry into the hot zone as a single person
Ensure all control zones are established or adjust as necessary
Ensure exclusion zones are recognized
Rehab
Atmospheric monitoring
Remain on scene until relieved by the IC or designee
Document actions as to the incident reporting guide
any accidents injuries or unsafe acts or safety concerns should follow the CQI
Communicate with EMERGENCY TRAFFIC the exclusion zone
When an atmospheric monitor alarms who SHALL be informed?
IC
Paramedic probation consists of:
18 month probation period which can me ended at any time with an EMS captains approval.
Memorandum with task book to be sent from the EMS captain to the compliance officer
What type of work related injuries must be reported?
All injuries no matter how minor
Follow up testing from exposure is done at what intervals?
Initially, 3mo, 6mo, 1 year
ASHER/MCI incidents with fire are what mode of operation?
Defensive
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
Incidents identified by the EMS CQI officer level containing an EMS CQI reportable event are handled how?
Emailed to the appropriate EMS captain to be handled.
How many attempts to realign for anatomical position
2
One a controlled substance is removed from the container how long till it needs to be re-sealed?
Immediately following or as soon as reasonably possible
A lightweight floor construction exposed to fire becomes unstable in how long?
3 minutes
Diabetics can refuse transport if ALL the following are met?
Baseline, Levels, Food, Adult, oral
Regained baseline mental status
Blood sugar has returned to normal levels
Immediate access to food
A competent adult is present and willing to assume care
Meets criteria to for a general refusal.
Not taking oral hypoglycemic medications
Exposure to an Airborne contagion other than TB should be documented on ?
FR exposure form
A valid DNRO shall be:
Signed by the competent patient or patients representative
Signed by the licensed Florida physician
Be on original canary yellow or copied on similar colored paper.
Reportable events are defined as:
An occurrence during emergency calls, training, pub ed, emergency or non emergency situations
How are safety officers general y assigned?
To a geographical or functional area.
Guidelines for Operational Capt and Lt with Students/ observers?
Let to obtain proper paperwork for student
Safe place to observe with seat belt
Introduce person to others in the station
Familiarity with apparatus
Log person in station logbook
Log person on ePCR’s for calls and treatments performed
Examples of “TASKS’ are?
Establishing a water supply
Advancing a hose line into a structure
Primary search
RIC
Vertical ventilation
Medical
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 are the determination of death criteria
- Lividity
- Rigor mortis
- tissue decomposition
- Valid DNRO
An “INFORMAL BEBREIFING AAR?
Tail board or FS
Company officer/ chief
Simple discussion
the Definition of the CCP in an ASHER/MCI?
Casualty Collection Point- in the warm zone where patients are triaged and treated.
What is considered a “SECONDARY” arrest?
CHF, drowning, FBAO, OD, Hanging, lightning strike- DC current., Trauma, CN, 3rd Trimester pregnancy
FAST ultrsound is done for
Blunt or penetrating trauma the ABD or thorax
Undifferentiated hypotension in trauma
A DNRO applies to who?
Cardiac or respiratory arrest
Succumbing to a disease process of a terminal illness
Where can the par level for a controlled substance for each unit be found?
Front cover of the units controlled substance logbook
And
EMS captains logbook
Anything with exposed wood or metal supports in regards to constructions is considered?
LIght weight construction
The only time to give ventilations in the pre-oxygenate phase is?
Patient becomes apneic.
The TAC stick has 4 indicators?
Detects AC current only
Provides warning in audible beeps and flashes
Warning signals increase in strength as amplitude increases
Warning signal s make it possible to locate the signal quickly
What is the purpose of paramedic development?
Provide a uniform process for new employees attempting to work as a paramedic
Address development for paramedics requiring remediation
For employees returning to full duty who must clearance be obtained from other than the OHC/?
Compliance officer and training division.
Observers paperwork differs from students in one way?
Application signed by FR HIPPA compliance officer
What are the common gasses between the drager atmospheric monitors
O2
Flammability
CO
For expediency of an IRE notification is made how?
By telephone or face to face to the BC.
What categories do ASHER/ MCI patients get categorized to using TECC? (MCI level)
Immediate and Delayed
Summary of a patient is when the following are met?
Any medical complaint, injury or distress
Suggestive acute injury or illness
Lack of capacity
MVC with more than :
Minor Damage
no restraints
air bags
Steering wheeL
occupant injuries
appearance and behavior not normal
Fall that cannot get up on their own
Public assists with acute ambulatory issues
Definition of HOT zone with ASHER/MCI?
HIgh risk area
No FF operations allowed
The GENERAL STAFF is made up of?
Operations Chief
Planning Chief
Logistics Chief
Finance/ Admin Chief
Intelligence/ investigation Chief
Companies should be placed in rehab when ?
Worked for 45min
Used 2 air bottles consecutively
Rehab chart
Electrocution and LIghtning strikes are what type of arrests
Primary b/c of A/C current
Secondary due to DC current
The transfer of incident command what items?
Mode of operations
Current situation
Current unit locations
Current assignments
What has been done
What is planned
A safety office shall be appointed on the following incidents?
HWH-hazardous, Wildland, high hazard
Incident becomes so large, complex, or dangerous that reasoned safety is potentially threatened.
Hazardous or potentially hazardous environments:
Structure fires
Special operations incidents
Large multi casualty incidents
Wild land fires with 4 or more units or during extreme weather.
Any high Hazard Training:
Live burn evolutions
Smoke drills
Dive rescue
Extrication
Elevated victim rescue
above or Below grade operations
confined space rescue
H ow are lost or stolen controlled substances handled from a unit?
Notification to the EMS captain
Property loss form and tracking number
Law Enforcement report attached
EMS captain then to notify the Division chief of medical services
EMS captain to Ensure all paperwork is completed
Documentation for LPG/NG response on the technician is?
Name
Phone number
ID or employee number
Flail chest sis defined?
2 or more adjacent ribs are fractured
Pregnant 3rd trimester trauma alerts get transported how?
Left side, 4-6 inches of padding to Right side
Maintain BP for peripheral pulses
What is the dress code for Student riders?
Designated uniform by training facility
Badge or other identifying means
Only those person who have completed and approved Incident safety officer course ________ be used as a safety officer.
SHOULD
Who may terminate a student or observers ride time?
Operational Captain
EMS captain
BC or DC
What is the fire flow formula?
Lx W / 3 x % involved
What are the common means of reporting CQI events?
Field personnel vis chain of command
Reportable events
Hospitals via complaint as a performance improvement process
Patients vis a complaint to the agency
How is a fire investigator requested?
The IC requests through the communications center.
How are new employees selected for the paramedic development course?
Based on Senority
What is the contraindications for push pressor epi?
Hypotension secondary to blood loss.
People on the ground are patients when?
Unable to get up without assistance
Gets up but does not have capacity
What are the special populations for Ketamine and the dose?
Age 65 and older
<50kg
Head trauma
Already took sedatives
200mg
What kind of lock can be used for the EMS captains Storage container of controlled substances?
Key, coded, or biometric lock
What resources are used to begin at a CBRNE incident?
ERG
WISER
What was the perimeter for the Oklahoma City bombing?
20 square blocks
What is the resource that uses the ERG and NIH combined for CBRNE?
WISER
1st Arriving EMS captain “SHOULD”?
BE the incident safety officer
Ensure the following items are brought to the FUP - Forming up Position
- Available RTF- PEM kits
- Available SKEDS
-Available TQ’s
-Available Mega movers
-Available Trauma rapid response kits
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
What is the most dangerous time during a fire incident?
When changing from an offensive to defensive mode.
When must a fire investigator be called?
- Fire is suspicious or crime related-
- Loss of injury or life
- accidental fire w/ substantial monetary loss or structural damage.
- Juvenile related incidents
- Explosive devices/ explosion
- Undetermined
Observer dress code is:
White shirt- SS or LS
Black, dark blue pants
Black closed shoes w/ dark socks
Significant exposures are defined as and are what type?
Exposure through a needle stick , sharps to the following body fluids:
Blood or and body fluid containing visible blood
Semen
Vaginal secretions
CSF
Synovial fluid
Peritoneal fluid
Plueral fluid
Pericardial fluid
Amniotic fluid.
Body fluids to mucus membranes
Chapped or a braided skin
Exposure to Airborne contagions
What are the incidents priorities?
LIPE
Life safety
Incident stabilization
Property conservation
Evidence preservation
For Area command of the same type and same area with 2 or more what are the examples?
HAZMAT
Oil spills
Wildland fires
RTF-PEM teams are committed by the IC only when ?
Threat to life
Benefits outweigh risks
First time students on ride alongs must provide the following items:
Written verification of name, year/ class and status in program.
Background check and criminal hx
Written verification of. Proficiency in BSI
Have stethoscope, eye protection, mask and fit tested.
Written confirmation of vaccinations
Written verification of skill proficiency
Reportable adverse, near miss, or errors are sent to who?
EMS CQI officer
How are new employees selected for the paramedic development course?
Based on Senority
How is a fire investigator requested?
The IC requests through the communications center.
Observers unable to keep ride times:
MUST notify the recruitment and human resource development officer in advance.
What are the requirements to get into the Paramedic development course?
Current ACLS card
Current state of Florida or National paramedic certification
Complete sign off skill sheets
Complete IV skill sheet
The person in charge of a “unit” is termed?
Leader
The Paramedic Development course is for?
New employees and
Those needing remediation
Sepsis alert criteria?
Adult not pregnant
suspected or documented infection
Hypotension
AMS
Tachypnea - RR>22 or ETco2 < 25mmHg
1st and 2nd trimester complications include?
Ectopic
Spontaneous
bleeding
hypotensive
Torsades de point stable treatment?
2g mgso4 in 50 60gtts
Pedi : 40mg in 50 60gtts
Per CQI, A near miss is defined as?
Incident that had the potential to harm a patient as a result of care rendered by EMS personnel BUT DID NOT actually harm the patient.
Definition of Student in regards to ride times?
Enrolled in an education program at an accredited facility that has an agreement with fire rescue.
To include: EMT and paramedic programs
Emergency medical responder
Training programs at secondary school of palm beach county.
EMS captains responsibility post significant exposure are?
Make sure exposed employee requests patient source testing at the hospital
Consult with the ER physician
Notify the exposure control officer during normal hours unless employee receives post exposure treatment-
Then have the communications center page the control officer at any time
Upon transferring of command the IC notifies who?
Communications center
General staff members
Command staff members
All incident personnel
Who is responsible completing and submitting the DRE form and where does it go?
First person to report event and uploaded to sharepoint.
The command STAFF positions are?
PIO
Safety officer
Liaison
command staff advisors
How long does Lidocaine dwell in an IO for an adult?
1min
Hi rise operation staging is where?
2 floors below the fire floor
According to the ERG for for an “UNKNOWN “ hazard is?
100 meters or 330 ft in all directions
Found on Guide 111.
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
Who processes Controlled substance orders?
Operations division
The only persons to communicate during a mayday emergency are?
IC
RIT/RIG
RIG supervisor
Mayday FF
Medical supply warehouse record keeping inventory items are stored where?
On the “G:” drive in the support services folder
An example of injury while wearing PPE would be?
Burns to the hands while wearing gloves.
“Division” is defined as?
A geographical area
Is between the Branch and unit levels
For exterior LPG/NG leaks on above ground containers of 1000lb or greater they should be cooled with what?
Ground monitor flowing minimum 500gpm
What shall be documented for refusals of Transport?
Death Disablity, AAOx4, Clinically sober, impaired judgement, capacity, assessment, exam, 2 set v/s.
Not being transported may result in death or disability
AAOx4- clinically sober, with no life or potential life threatening conditions to impair judgment
Capacity
Patient assessment
Physical exam
2 sets of V/S
The DNRO identification device must be signed by who if the patient cannot provide consent?
Surrogate
Proxy
court order
Power of attorney
A single resource unit is termed ?
Boss or Leader
What are the oral hypoglycemic medications
Glipizide, Glyburide, Glimepiride
Under the “Safe Haven “ parents may not be pursued unless?
The parents are seeking to reclaim the new born infant
Observer dress code is:
White shirt- SS or LS
Black, dark blue pants
Black closed shoes w/ dark socks
The rehab tracking worksheet has what recorded on them ?
Pulse
BP
Temp
Respirations
SP02
SPCO
SPMET
“Strike team” is defined as ?
Resources of the “SAME” Kind and TYPE
When must a fire investigator be called?
- Fire is suspicious or crime related-
- Loss of injury or life
- accidental fire w/ substantial monetary loss or structural damage.
- Juvenile related incidents
- Explosive devices/ explosion
- Undetermined
What gas and how much is required for both drager monitors to operate correctly?
02 and 10% above
When should post exposure testing occur?
1-2 hours preferably at the OHC or Hospital
What is the distance to be considered an exposure?
30 ft
Contraindications for Finger Thoracostomy?
Unwitnessed arrest with blunt trauma
Devestating head trauma
loss of Cardiac output > 10 min
Critical incident factors include which mnemonics?
BELOW
COAL WAS WEALTH
Once assigned to Safety officer what are the duties?
Don appropriate vest and PPE
Ensure no entry into the hot zone as a single person
Ensure all control zones are established or adjust as necessary
Ensure exclusion zones are recognized
Rehab
Atmospheric monitoring
Remain on scene until relieved by the IC or designee
Document actions as to the incident reporting guide
any accidents injuries or unsafe acts or safety concerns should follow the CQI
Communicate with EMERGENCY TRAFFIC the exclusion zone
Propane has an LEL of?
2.1-9.5%
What type of arrest is a third trimester female considered?
Secondary - and displace the uterus to the left
When referring to the structure the Alpha side is considered ?
The front
Or address side
Rotations of medications are to happen on what day ? AND who is responsible the inspection ?
On the first day of each month and the operational captain or designee
The TAC stick does not?
Read DC current
Or pick up shielded AC voltage
PBCFR used 3 types of After action reviews?
Informal debriefing AAR
Informal Battalion AAR
Formal AAR
Motor vehicle accident criteria for a patient?
Greater than minor damage
No restraint used
Air bag deployed
Steering wheel damage
Other occupants have injuries
Appearance and behavior not normal
When does a ResQpod get placed?
all cardiac arrest patients that are greater than 1yr old.
Reportable adverse, near miss, or errors are sent to who?
EMS CQI officer
Written documentation of follow up testing for an exposure should follow when ?
Within 48hours
The DNRO identification device must be signed by who if the patient cannot provide consent?
Surrogate
Proxy
court order
Power of attorney
What are the 3 modes of fire operations?
Investigating
Offensive mode
Defensive mode
What is the dose of MGSO4 in Torsades?
adults- 2g in 50 ml 60gtts wide open
pedi- 40mg/kg in 50ml 60gtts wide open
Parents under the “Safe Haven “ law can regain custody as longs as what?
The infant shows no signs of abuse
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
Who is responsible for securing and maintaining scene integrity for a fire investigation?
Operations personnel. Not LE
which cardiac arrest patients MUST be transported
Witnesed
A DNRO applies to who?
Cardiac or respiratory arrest
Succumbing to a disease process of a terminal illness
Torsades de point unstable is defined as and treated how?
Hypotension:
defib 200, 300, 360
defib 2J/kg and 4J/kg
Public assists are patients when?
Inability to ambulate is chronic
Approximately how many parking spaces does it take for each fire apparatus?
8 spots
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
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,
Who may ride as an observer?
Local Dr’s, nurses, PA’s, Nurse practitioners, and other medical students or professionals.
EMT’s or paramedics with other local agencies from their chief on letterhead
Individuals seeking employee or are in training
Others approved by the fire rescue administrator and FR HIPPA compliance officer
Employees with work related injuries must be cleared by the OHC before what?
Traveling out of the area.
How are safety officers general y assigned?
To a geographical or functional area.
Which critical incident mnemonic is used for the “ONGOING”fire ground operations
COAL WAS WEALTH
What must TCA ODs be treated with immediately ?
Sodium Bicarb
The following SHALL NEVER be performed on patients with a DNRO?
Artificial respiration
BVM
ET tube
Supraglottic A/W
Chest compressions
Defibrillation
indications for Hyperkalemia for CaCl2?
Peaked T waves
Sine wave
WCT
RRWCT
severe bradycardia
high degree blocks
Students unable to keep ride times :
MUST notify the clinical coordinator of their facility in advance
And coordinator MUST notify the recruitment and human resource development officer
FAST ultrasounds can be performed to identify?
Intrabdominal hemorrage
Intrathoracic hemorrage
pericardial hemorrage
PEA motion
A DNRO applies to who?
Cardiac or respiratory arrest
Succumbing to a disease process of a terminal illness
Students unable to keep ride times :
MUST notify the clinical coordinator of their facility in advance
And coordinator MUST notify the recruitment and human resource development officer
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
When does notification of an injury need to,be reported to the state?
- one or more FF are hospitalized for,more than 24hrs
- LODD
- serious injury related to an equipment failure.
Damage of a controlled substance from a a unit is handled how?
Notification t o the EMS captain
Property loss form and tracking number
“Broken/ damaged” written in the case# spot
The EMS captain notifies the division chief of medical services
Type V construction is?
Wood Frame- structural elements are made of ENTIRELY wood.
Ultrasunds in traumatic arrests are done when?
observation of cardiac motion in PEA
What are considered the fire ground simplex channels?
14A/ 15A with a radius of 1mile
Ketamine for seizures is what and what contraindications?
Adults :100mg- pregnancy
penetrating eye
non traumatic chest pain
Pedi >3yrs: 1mg/kg
If the hospital or the physician do not comply with state mandates for exposure testing what happens?
Contact the EMS captain who will contact the medical director if necessary.
In order to sign a refusal for transport Fire rescue personnel SHALL?
Exhaust all reasonable efforts have been exhausted
Inform the patient that if at any time they change mind or condition deteriorates/ changes they should call 911
Distribution of controlled substances from the EMS captain to a unit are signing in what spaces in the book?
EMS captain signs Given/ Issued by and Unit sign received by section .
Evidence that a fire is suspicious in nature or crime related means:
Incendiary fires/ explosive devices
Firebombs
Stolen vehicles
Burglaries
Who carries a rainbow sensor ?
EMS captains and SPLOPS
What gas type and pipe size does not contain mercaptan?
Natural gas in sizes 18” or greater
The person in charge of a “branch “ is termed what?
Director
The cyano kit uses how much? at what rate?
5g diluted in 200ml and at 5 gtts/sec
A DNRO applies to who?
Cardiac or respiratory arrest
Succumbing to a disease process of a terminal illness
“Mayday” definition is?
Lost
Trapped
Disoriented
Seriously injured
Experiencing an Air emergency
In need of immediate help
What makes RRWCT unstable ?
hypotension
Head injuries ETCO2 is?
30-35mmhg
Primary goal of any airway or respiratory emergency is maintaining?
Ventilation
Oxygenation
Perfusion
Who does station medical supply ordering?
Support services
How does the newborn infant get entered in the PCR if it is unclear the safe haven law?
“Safe Haven Baby”
What forms are required by students to ride - legal documents?
Copy of Student/ observer ride time
Release of Liability and covenant not to sue.
Indemnification agreement
HIPPA confidentiality agreement
Insurance coverage
Who can effect a change in incident management in extreme situations - who , why and How?
Anyone
Safety
Notifying the IC
With refusals, who may help convince a patient?
Family members
Friends
Physician
EMS captain
Medical director
NIMS components are?
Command and management
Preparedness
Resource management
Communications and info management
Supporting technologies
Ongoing management and maintenance
Mad as a hatter
Red as a beet
Dry as bone refer to S/S of ?
TCA OD
Damage from the EMS captains stock are handled how?
Notification to Chief of medical services
Property loss and tracking number
Documentation for LPG/NG response on the technician is?
Name
Phone number
ID or employee number
The “S” in CANS arrival report means?
Statement of command to include command name , location, and mode.
What is a customer complaint?
Misconduct
Taking of property of value
Dissatisfaction with policy or procedures
Criteria for chest decompression
Absent or diminshed LS
BP< 90
Respiratory distress or difficulty with BVM
The tactical priorities are:
RECEOVS
Rescue
Exposure
Confinement
Extinguishment
Overhaul
Ventilation
Salvage
What patients my be examined, treated, or transported without their consent?
Suspected medical conditions that are likely to be incapacitated from intoxication or other medical conditionsl
Who are responsible for checking the TIC?
All company officers and chief officers in custody of the TIC.
Where should the SCBA refill are be located?
Near the “Drop Zone” in the WARM zone
An IRE is reported immediately to whom?
Supervisor
What level MCI and why should be set for ASHER/MCI ?
Level 2 due to unknown amount of victims
What kind of lock can be used for the EMS captains Storage container of controlled substances?
Key, coded, or biometric lock
Who may terminate a student or observers ride time?
Operational Captain
EMS captain
BC or DC
Right to know is applicable for the source patient if?
Patient was transported to the hospital
Blood drawn for routine medical need.
Extensions for paramedic probation are ?
Done by the EMS captain and documented on a professional development form for 18month.
If the extension period is still less than satisfactory then the EMS captain. Recommends the person be referred to the medical services division and medical director for further evaluation.
All documentation to be sent to the compliance officer
Positioning for DSI is?
Ear to the sternal notch
Head parallel with the ceiling
Stretcher elevated 15-30 degrees
Injury tracking is entered by who ? And then forwarded to who?
Training and safety division
Wellness coordinator
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
Who are responsible for the accurate inventory, distribution, transfer, documentation, and record keeping of all controlled substances on a unit?
All department protocoled Paramedics assigned to a unit.
The following SHALL NEVER be performed on patients with a DNRO?
Artificial respiration
BVM
ET tube
Supraglottic A/W
Chest compressions
Defibrillation
Washing mucous membranes from significant exposure how?
Irrigate with normal saline or water for 10-15min
Reportable adverse, near miss, or errors are sent to who?
EMS CQI officer
Is the action taken to expose hidden fire and to assure complete extinguishment?
Overhaul
Who can participate in ride alongs ?
Students and observers
what is Trauma alert criteria for peds with BP?
< 50
Common Natural gas lines that are 24” are found where in PBC?
Along the turnpike
Port of palm beach to West county energy center owned by FPL
A technical specialist in charge is termed?
Specialist
Where is the fire rescue RTF-PEM group supervisor located?
Next to the Tactical LE officer in the “Cold Zone”
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
What are the options for a minor injury requiring treatment?
- shall report to the OHC for further evaluation
- if OHC is closed then may go to the nearest hospital or wait till OHC opens.
Loss of life/ injury definition for fire investigator call out?
Fire or explosion related deaths
Fire or explosion related injuries which require transport by FR.
Who is equipped with the drager X-am 5000 5 gas monitor
EMS captains
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.
A DNRO applies to who?
Cardiac or respiratory arrest
Succumbing to a disease process of a terminal illness
What other documentation is needed post resuscitation termination of efforts?
EKG strip to PCR
ETCO2 to PCR for advanced airway placement
What does the MARCH acronym mean?
Massive hemorrage
Airway control
Respiratory
Circulation
Head injury / Hypothermia
TIC operations a victim or FF will appear what color?
White
MInor CQI errors include?
Spelling or topographical errors
TIme delays without patient harm
Lack of detail
Intracranial- report inconsistencies
Protocol deviation without patient harm or potential.
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.
The IMS manual meets what national requirements?
NFPA 1561
Presidential directive 5
Natural gas has an LEL of?
5.3-14%
What are normal atmospheric conditions
O2- 21%
LEL -0%
CO- 0 PPM
H2S- 0 PPM
All intubated interfacility transfers must be ______ and ______ by the sending facility.
paralyzed and sedated.
