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
