EMS

Question 1

Indications for helicopter transport

Answer 1

Benefit outweighs risk
15-100 miles
4 S’s:
- Speed, special skills, smoothness + access

Question 2

EMS medical director role

Answer 2

Direct medical control and evaluation
- infield or real-time online discussion
Indirect Medical control and evaluation
- Prospective: standing orders, protocols etc,
- Retrospective: review of EMS patient care and QA

Question 3

Mass gathering definition

Answer 3

> 1000 people

Question 4

4 Phases of Disaster Preparedness

Answer 4

1) Mitigation
2) Preparedness
3) Response: Activation and Implementation
4) Recovery

Question 5

START triage system

Answer 5

RED: Immediate. ie. tension pneumo, hypovolemic shock
YELLOW: Delayed. Serious but not immediately life threatening illness (i.e. long bone fracture)
GREEN: Walking wounded
BLACK: Dead or expectant / unsurvivable

Question 6

Anthrax

Answer 6

Inhalation: 90% fatal
Cutaneous: Most common 20% mortality without treatment, 1% with treatment
Oropharyngeal/GI: Less common, 50% mortality

Pathophys: Spores - bacilli - lymphnodes - toxin

Symptoms: Flu-like illness, hemorrhagic mediastinitis, sepsis / shock
- Cutaneous: painless papules, itchy and vesciular, edema and lymphadentiis. Progress to ulverated black eschar.

Treatment: Supportive care, Ciprofloxacin, doxy or amox
If inhaled: cipro or doxy + rifampin, clindamycin, aminoglycoside, imipenem)
- Vaccine is available
- PEP with cipro or doxy x 60 days

Question 7

Plague (Yersinia Pestis)

Answer 7

Gram -ve bacilli
Fleas from infected rodents to human

Bubonic: skin. Lymph nodes - bubo
Pneumoinc: Highly fatal (near 100%) - person to person
Septicemic: Dissemination

Symptoms: Regional painful lymph nodes and necrosis, flu-like symptoms
- Fulminant pneumoina within 24 hrs, cardio-resp collapse. Meningitis, liver injury, coagulopathy and acral gangrene (black death)

Tx: ISOLATION
- Can aspirate lymphnodes
- Abx: gentamycin, doxycycline, cipro
- Prophylaxis x 7 days.

Question 8

Smallpox (Variola)

Answer 8

4 Types:
- major
- minor
- hemorrhagic
- malignant

Rash spreads from face distally and includes palms and soles

Tx:
- ISOLATION
- Vaccinate within 3 days
- IgG
- +/- antivirals

Question 9

Tularemia

Answer 9

Gram -ve coccobacillus

Symptoms: Slow-healing shallow ulcers, associated lymphadenopathy, conjunctivits, or pharyngitis

Tx: Streptomycin or gentamycin
- Prophylaxis doxycycline x 14 days

Question 10

Viral Hemorrhagic Fever (Ebola and Marburg) and Lassa Fever

Answer 10

Fevers + mylagias, prostration diffuse coagulopathy and DIC / hemorrhage

Tx: Supportive care
- Maybe antivirals or IgG.
-Ribavarin for Lassa fever

Question 11

Nerve Agents

Answer 11

Organophosphates

Symptoms: cholinergic toxidrome
- VX, sarin
- Killer B’s: bradycardia (atypical), bronchorrhea, bronchospasm, vomiting, miosis, defecation

Tx: Supportive + Atropine.
- Pralidoxime
- Benzos for seizure

Question 12

Vesicants (blistering)

Answer 12

Mustard gas
- Pulmonary: pharyngeal edema and pulmonary necrosis

Tx: Supportive care as per burns.

Question 13

Blood agents

Answer 13

Cyanide:
Symptoms: tachypnea, headache, dizziness, vomiting and anxiety, seizures, respiratory arrest and asystole.

• Tx: cyanokist - hydroxycobalamin 5 g.

Question 14

Radiation exposure

Answer 14

Decontamination is key
- Remove clothing (fast)
- Gastric lavage
- Iodine as a blocking agent
- Chealting agents: penicillamine

• LD50 - 4.5 Gray units