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EMS Content Flashcards

Not fail EMS. To hell if I am doing this twice.

1
Q

What are the three main goals of quality assurance program in EMS?

A

The three goals are to measure:

individual performance
System performance AND
Identifying system needs (areas of improvement)

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2
Q

What are four advantages of pre-hospital protocols?

A

Consistency and standardization of therapies
Quicker and immediate management
Evidence base therapy
Reduces the need for physician involvement

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3
Q

What are 5 EMS performance indicators?

A

Unit-hour utilization
Response time, transport time, STEMI time
OHCA success rates
Compliances rate with protocol
Procedural success rates: intubation, IV

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4
Q

In order not to transport a patient, what four things need to happen?

A

Paramedics are able to appropriately relay risks and harms
Patient must have capacity: understand the consequences of actions and appreciates risk
Patient has ability to care for themselves
Patient agrees to sign a form of refusal for medical care

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5
Q

What are the four levels of paramedics?

A

Emergency medical responder
PCP
ACP
Critical Care paramedic

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6
Q

What 5 medications can a PCP give? What other 2 skills do they have?

A

O VEGGANN

Oxygen
Ventolin
Epinephrine
Glucagon, glucose
ASA
Nitroglycerin, Narcan

AED and Lead II rhythm interpretation

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7
Q

What are 6 skills in the scope of practice of an ACP?

A

Expanded medication administration

(Procedures)
Peripheral IV and interosseous
Endotracheal intubation
Needle Thoracotomy

(Electricity)
Manual defib, cardioversion, and
transcutaneous pacing
12 lead ECG interpretation

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8
Q

What are 6 skills in the scope of a critical care paramedic?

A

Expanded medication
Transvenous pacing

Mechanical ventilation
Use of IV infusion

Emergency cric
Management of chest
tubes, Foley, NG

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9
Q

What are the two “tiers” of EMS response?

A

Single tier - every response receives the same type of personal expertise and equipment
Multi-tier - combination of ACP and PCP depending on the call

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10
Q

What is the difference between an on-line and off-line in EMS? What are 5 examples of on-line scenarios?

A

Off-line - Paramedics practice under the indirect authority of the off lined MD via standing orders
Requires: medical director, medical directives, CQI, training
Paramedics are not a regulated health profession and therefore cannot perform any controlled acts unless delegated by a physician
Use protocols: pre-authorized medical directives
Provincial + auxiliary directives that may be instituted in certain areas

On-line - Direct and concurrent medical supervision/orders from a physician
Used in scenarios outside of the scope of standing orders, when variance is required, or for
medico-legal issues - such as:

A high risk low volume procedure ex. Needle thoracostomy
Reaching the end of a cardiac resuscitation protocol to TOR
The patient does not stabilize after protocol treatment and additional treatment is needed
The paramedics wishes to consult the physician for situations and critical patients
outside of the scope of medical proactice
For advice on medico-legal issues

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11
Q

What are three types of EMS transport?

A

Primary transport: transition an unstable and undifferentiated patient from the scene to a higher level of care

Secondary transport: interfacility transport between Eds with a partially diagnosed and stabilized patient

Tertiary transport: interfacility transport of one inpatient that is stable

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12
Q

What are 5 steps in the AHA chain of survival?

A

Public awareness (BLS)
EMS activation
CPR
Rapid Defibrillation
Pre hospital ACLS

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13
Q

What are five broad considerations for land vs flight transport?

A

Location: is there road access? Is there a place for the helicopter to land?
Patient: flight physiology
Resources of the crew, land paramedics ex. Are the land paramedics busy with other
emergencies
Weather conditions, visibility
Time by land and time by air; should be >30 mins or 1 hour round trip to warrant air travel

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14
Q

What are 3 absolute contraindications to flight?

A

Imminent obstetrical delivery
Unlikely to survive
Cardiac arrest in progress

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15
Q

What are 6 relative contraindications to flight transport?

A

Severe hypoxia
Trapped gas that cannot be vented ex. bowel obstruction, pneumothorax
12-24 hours after SCUBA diving or decompression illness
Active labour
Psychosis, violent, or dangerous patient
DNR

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16
Q

What is rotor wing vs fixed wing transport? What are five differences between them?

A

Fixed wing cons - have to land at airports (need runway), might need refuel, need land transport from airport to hospital

Fixed wing pros - longer distances at faster speeds, MD on board, can pressurize cabin, less cramped, less noisy, more stable

Rotor wing cons - not pressurized, loud, bumpy, cramped, weight restricted, weather restricted

Rotor wing pros - flexibility in where they land, service larger area ie wilderness, fly lower to the ground less impact on physiology, no traffic land on roof

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17
Q

What is Henry’s law? Why does it matter in flight transports?

A

Mass of gas absorbed in a liquid is directly proportional to the partial pressure of the gas above the liquid

In diving: rapid ascent (decreased pressure) can cause gas to come out of solutions into the blood stream resulting in decompression sickness. Sudden decompression of aircraft at high altitude may result in DCS

Remember - Henry’s Law = Hyperbarics

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18
Q

What is Charles’ Law? What are the two considerations for flight transport?

A

As temperature increases volume also increases

Temperatures fall with altitude; patients travelling via air may be hypothermic on arrival.
Less moisture in the air and patients can get dehydrated, use humidified oxygen

Remember: Charles law = Celcius

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19
Q

What is Boyle’s law (including the formula)?
List 5 medical conditions and 3 equipment considerations relating to flight transport and Boyle’s law

A

P1V1 = P2V2

Pressure is inversely related to volume. Gas in an enclosed space will expand at altitude as pressure decreases

Issue for trapped gases: bowel obstruction, pneumothorax, air embolism, sinuses, middle ear, ruptured globe
Equipment: foley, ETT balloons, air casts, ruptured globe

Remember: Boyle Law = Barotrauma

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20
Q

What is Dalton’s Law? (Including the formula) What are two considerations for flight transport?Who are 2 at risk groups for these concerns?

A

PT = P1 + P2 + P3

Total pressure of a gas mix is equal to the sum of the partial pressures. Partial pressure of all gases change in proportion with a change of total pressure. Partial pressure of oxygen is lower at high altitudes even if FiO2 remains the same

For the same amount of FiO2 you have lower O2 saturations.
At risk populations: COPD, low HgB, V/Q mismatch w poor diffusion (PE, large
pneumonia), areas sensitive to hypoxia (recent MI, recent stroke, limb ischemia).

Supplemental oxygen for all; you cannot transport someone
who is already at 100% Fio2 at sea level

Remember - Dalton = D’em gases

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21
Q

What are the requirements for a TOR with a PCP crew?

A

Not witnessed by EMS, no shock, no ROSC
’No shock, no ROSC, not seen by team’

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22
Q

What are the criteria for a TOR with an ACP crew?

A

Not witnessed by EMS, no shock, no ROSC, not witness by bystander, no bystander CPR
’No shock, no ROSC, not seen by team. The patient dropped with no CPR to intervene’

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23
Q

What are 2 reasons for a TOR with any paramedic crew?

A

Valid DNR
Obvious incompatibility with life: rigorous mortis, transection

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24
Q

What are 4 requirements for a trauma TOR?

A

Age >16, no pulses, no shock, asystole OR PEA with transport time >30 mins

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25
Q

When can a TOR not be advised?

A

Non-cardiac ethology: hypothermia, toxicologic, electrocution, suspected PE, airway obstruction
Penetrating trauma with signs of life
Unexpected: paediatric or young adult

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26
Q

When should EMS transport directly to a trauma centre?

A

Direct to trauma centre if below and <30 mins to trauma centre

Physiologic: GCS <14 in context of trauma, SBP <90, RR<10 or >30, HR <50, >120
Anatomic: skull #, penetrating trauma, flail chest, pelvic #, 2+long bones fractures, crushed/de-gloved or pulseless extremity, amputation
Mechanism: Fall >6m or x2 height of child, high risk MVC (ejection, death in vehicle, >12 inches of intrusion, longer than 20 minutes to extricate, rollover), car vs pedestrian, motorcycle >30 kph
Population: age >55, anti-coagulant, bleeding disorder, pregnant >20 weeks, burn with trauma, ESRD

27
Q

In the case of a trauma, in what two circumstances should EMS travel to the closest hospital?

A

No airway
Survival to trauma hospital is unlikely

28
Q

In what two other circumstances should EMS travel direct to a trauma centre?

A

Penetrating trauma to torso, VSA (thoracotomy)

29
Q

In the case of a stroke, what 3 criteria should be met to travel direct to a stroke centre?

A

Ongoing stroke symptoms (unilateral weakness, slurred speech, facial
droop)
Arrive at stroke centre <6 hours from symptom onset
No life threatening or reversible causes
Duration of transport >2 hours

30
Q

In the case of a STEMI, what 3 criteria should be met for transport to a PCI centre?

A

CP + ECG findings of STEMI
Transport time <60 mins
No life threatening or STEMI equivalents

31
Q

What 4 cardiac arrest meds can ACPs give?

A

ABLE

Amiodarone
Bolus of fluids
Lidocaine
Epinephrine

32
Q

What are the 6 goals of a triage system?

A

Rapidly identify urgent life threats <3 minutes
Reduce delay in treatment

Initatie treatment
Quickly assess all patients arriving in the ED
Get the patient to the right provider and level of care
Infection control

33
Q

Describe the CTAS levels and time goals

A

CTAS and time goal
1 - Resuscitation - immediate
2 - Emergency - <15 mins
3 - Urgent - <30 mins
4 - Less Urgent - <1 hr
5 - Non Urgent - <2 hrs

34
Q

In what 3 scenarios must an EMS place a patch to an MD?

A

A medical directive or RBH has a mandatory patch point (ex. Needle decompression, TOR)
Situations outside of a medical directive where a paramedic believes there is benefit from online medical direction that falls within a paramedic scope of practice
There is uncertainty about the appropriateness of a medical directive

35
Q

What 8 pieces of equipment are required for an EMS system?

A

Vehicles

(Documentation)
Communication means
EMR

PPE

(Resuscitation)
Defibrilator
Airway equipment
Medications

Spine immobilization
Extremity immobilization

36
Q

List 10 basic, clinically proven interventions EMS can provide?

A

Cardiac - CPR, EKG, Defibrillation ventricular arrhythmia

Airway - Jaw thrust, OPA/NPA

Trauma - stop haemorrhage with direct pressure, dressing, tourniquet

Ortho - pelvic binder, splint

Antidotes - Epi for anaphylaxis, Ventolin for asthma, glucose for hypoglycaemia, Narcan for opioids

37
Q

What are the 7 components of EMS dispatch?

A
  1. 911 activation
  2. Trained dispatch personnel
  3. Determine severity of illness
  4. Defined response time
  5. Pre-arrival instructions
  6. Quality assurance
  7. Medical control/supervision
38
Q

What are 5 qualities of a quality assurance program?

A
  1. Set standards
  2. Monitor compliance
  3. System setup for noncompliance
  4. Educational program for correction
  5. Feedback.
39
Q

What are 6 strategies to optimize rural EMS?

A

Optimize allocation of resources

  1. Call prioritization
  2. Strategic placement of bases
  3. Redeployment of units during peak seasons

Extended skills on scene

  1. ALS car meets BLS transport
  2. Extended skillset of BLS crew
  3. Dispatch offers pre-arrival instructions.
40
Q

What is the role of a medical director?

A

“An EMS medical director is a physician with a specialized interest and knowledge of patient care activities unique to the out-of-hospital environment. Medical oversight must extend from the communications centre through all components of field care.” - CrackCast

Offline

  1. Establish protocols - including specialized protocols ie peds or trauma, medical-legal policies, patient detination policies
  2. Conduct CME/paramedic education - courses, lectures, or direct observation
  3. CQI - prospective or retrospective review

Online

  1. Paramedic patch calls in real time
  2. Rideouts for direct scene observation
41
Q

List 6 physiologic challenges with air transport?

A

Barotrauma/ expansion of air filled cavities (Boyle’s Law), Reduction in PO2 (Daltons law)

Colder, Dryer

Noisey, Vibrations, Limited Space

42
Q

What are 5 body cavities affected by air travel?

A

Bowel

Lungs

Sinus

Inner ear

Teeth

43
Q

What are six criteria for air transport?

A

Distance too great for ground, scene is inaccessible by ground (water), Ground units are unavailable or limited

Clinical condition necessitates urgent transport, special EMT skills, transfer to another facility (ie peds, neonatal)

44
Q

What 7 things should be in place before you fly someone?

A

Decide to transfer by air

(Okay airplane now lets get in formation, prove to me you have) Critical activation coordination

Have a back-up plan on the ground

Stabilize patient, anticipate need for in-flight interventions

Copy of medical record, informed consent from patient/family

45
Q

What are 3 ways EMS can triage a trauma?

A

PAM P

Physiologic, Anatomic, Mechanism, Population

(there is another card on this)

46
Q

List 6 biological weapons

A

(Sing to the tune of the ABCs - the first few kind of work)

  1. Anthrax
  2. Botulism
  3. Small pox (C sound)
  4. Plague
  5. Ebola
  6. Brucellois (think E then B from ebola)
  7. and Tularemiaaaaa
47
Q

5 Indicators of bioterrorism

A
  1. Dead animals
  2. Large numbers of sick people
  3. Large numbers of sick people with a clear syndrome (pulmonary, neuro or GI)
  4. New illness syndromes
  5. Multiple outbreaks
48
Q

Describe the START triage method

A

A way of putting patients into categories (Black - expectant, Red - immediate treatment, Yellow -delayed treatment, Green - walking wounded - send off to await further assessment)

Are they breathing? Yes, move on. No = black

Are they moving and following commands? Yes = green and get em out of here!

the rest we “RPM”

RR <10 or >30 = red, Pulses gone or cap > 2 = red, Mental status is abnormal = red

If not identified as black, green or red the rest are yellow

49
Q

What are the indications for and ED thoracotomy? What are 4 things you can do once you are in there?

A

Indications

  1. Cardiac arrest at any point with initial signs of life in field ie BP/Pulse
  2. SBP <50
  3. Penetrating trauma with signs of life within 10-15 min/refractory shock
  4. Cardiac arrest in ED following blunt trauma

–>left antero–>lateral 4th/5th IC

What you can do

  1. Pericardotomy (evacuate clot, deliver the heart)
  2. Cardiac massage
  3. Cross clamp aorta
  4. Hemorrhage control with finger/foley
50
Q

What are 6 areas to set up at a disaster scene?

A
  1. Command post
  2. Area for incoming supplies
  3. Triage and decontamination
  4. Patient care centre
  5. Area for air medical transport
  6. Morgue
51
Q

List 5 services critical to disaster management

A
  1. EMS (pt triage/stabilization/transfer)
  2. Fire/police (scene command, rescue, hazard control, security)
  3. Emergency Manager (Communications, PPE, Safety)
  4. Public Works (Support equipment, personnel supply, safety)
  5. CEO (overall mgmt, communication with federal/provincial bodies)
52
Q

What are goals of triage?

A
53
Q

What are 4 things to do with a concern for pre-hospital COVID?

A
  • PPE
  • screening tool
  • notify receiving facility
  • infection control protocol
54
Q

What are two goals of decontamination?

A

Prevent secondary exposure

Stop absorption

55
Q

What are the three “zones” of decontamination in EMS?

A

Hot zone: not received decontamination

Warm zone: external decontamination

Cold zone: patient decontaminated and should present minimal risk of secondary exposure to medical staff.

56
Q

What are two biohazards that are concerning for secondary exposure?

A

Organophosphates

Radioactive material

57
Q

What are the implications of respiratory concern for chlorine gas exposure? Methyl chloride?

A

Chlorine gas: Alveolar hemorrhage

Methyl chloride:ARDS

58
Q

What are the components of the IMS (incident management system)?

A

Ontario Incident Management System (IMS) is designed to be a response system, but it can be used to manage all stages of an incident. It is created to give communities and organizations a common framework to communicate, coordinate and collaborate during an incident response. I can manage things like weather, explosions, disease outbreak, code grey, code orange

IFLOP

Incident command (chief)

Finance (payers)

Logistics (getters)

Operations (doers )

Planning (thinkers)

59
Q

What are four different levels of PPE?

A

Level A: self containing breathing apparatus and chemical protective suit (highest level)

Level B: self containing breathing apparatus but lower level of chemical protection

Level C: air purifying respiratory with same skin protection as level B

Level D: standard work clothes (gloves / gown / N95 mask)

60
Q

Outline six safety considerations required for every helicopter transport

A

vVehicles and personnel ≥ 100 ft from landing zone

  • Spectators ≥ 200 ft from landing zone
  • Vehicles and personnel ≥ 100 ft from landing zone
  • No smoking/running within 50 ft of helicopter
  • All items kept below shoulder height
  • Flight crew opens/closes doors, supervises patient loading/unloading
  • Eye /ear protection for all
  • Approach/depart only forward of rear cabin door with head down
  • Never approach or depart from the rear of the helicopter
  • Stay clear of the tail rotor
  • If parked on slope, approach and depart from downhill side
  • Hold down loose articles while in landing zone
  • Follow flight crew instructions at all times
61
Q

True or False: One of the benefits of helicopter air medical transport is the ability to pressurize the cabin

A

False!

62
Q

True or False? When considering the safety for flight regarding the weather conditions, the pilot is first given information regarding the patient clinical situation.

A

False

63
Q

True or False: Pregnancy is a contra-indication to air medical transport

A

False

64
Q

True or false: Regarding severity of traumatized patients (mild, moderate, severe and very severe) the patients that derive the greatest benefit from air medical transport are those who are moderately – severely injured.

A

True

EMS (1 decks)

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