EMS Manual Flashcards
A person becomes a patient the moment the EMS provider has determined __ __________ __ _________ to ensure that no illness or injury is overlooked and to ensure that the individual’s capacity to decline an assessment is not impaired by illness, injury, or intoxication.
an assessment is necessary
Patients demonstrate impaired decision-making capacity __ ____ ___ ______ __ __________ ____ _________ or our recommendations or if they have unreasonable excuses for refusal or transport.
if they are unable to understand their condition
The CURVES Mnemonic may aid the assessment of Decision-Making Capacity
- C ommunicate – Must be able to communicate.
- U nderstand – Must be able to understand the following elements and state them back:
- R eason – Must be able to explain the reasons behind their decision.
- V alues – Their reasons must be based on their values and not clouded by
psychosis or suicidal intent. - E mergent condition – Remember under emergent conditions, consent is implied.
- S urrogate – Remember surrogate decision-makers may make decisions on behalf of the patient such as: descending order spouse, adult child, parents,
adult sibling
If the EMS provider has reason to believe the patient’s decision-making capacity is impaired by psychiatric illness, the ___ __________ should be notified, and ___ ______ should be requested immediately to evaluate the patient.
EMS Supervisor, the police
If the patient is deemed a threat, the officers may take the patient into custody on their own authority for _ _____ (“8-hour rule”) during which providers and officers may coordinate transport to the hospital or other facility.
8 hours
Consent is not required in the presence of life-threatening (or potentially life-threatening) illness or injury, or if the patient is unconscious or unable to communicate due to _______, ______ __ ____________ and may reasonably be presumed to have a life-threatening condition.
illness, injury or intoxication
In Virginia Code §54.1-2969 persons between the ages of __ ___ __ _____ ___may be declared an emancipated minor by court order. Emancipated minors may make medical decisions on their own behalf.
14 and 18 years-old
Minors with intact decision-making capacity, who are __ _____ __ ___ __ _____ and whose parent or legal guardian are unable to be contacted, may refuse assessment, treatment and/or transportation.
14 years of age or older
Preexisting agreements between the schools and parents require students must leave
school any time one of the following medications is given at the clinic:
- Epinephrine autoinjector.
- Glucagon.
- Diastat (Diazepam).
- Solu-Cortef.
– Involves a patient who may need care yet has no primary
physician and/or has limited ability to navigate the health-care system.
Medical isolation
Involves barriers to care due to social circumstances – no phone,
no car, no childcare, etc.
Social isolation
Willful infliction of physical pain, injury, mental anguish, or unreasonable
confinement. Sexual abuse falls into this category as well
Abuse
Nonexistent or insufficient care and support necessary to maintain a
person’s physical and/or mental health to the extent that his/her well-being is
impaired or threatened. Persons who live alone/unaided and are unable to care for themselves can be considered to fall into this category, as can a lack of supervision of young children.
Neglect
The illegal use of an incapacitated adult/child or their resources for
another person’s profit or advantage.
Exploitation
As an EMS provider in Virginia, you are also legally required to
report your suspicions of abuse, neglect, and/or exploitation of members of the following
patient populations:
- Children (all patients under 18 years of age, including physically or mentally
disabled/incapacitated). - The elderly (all patients 60 years of age or greater, including those physically or
mentally disabled/incapacitated). - The physically or mentally disabled/incapacitated from 18-59 years of age.
The CRT focuses on individuals or patients that call 9-1-1 greater ____ _ _____ ______ __ ____ , identified as “Super Utilizers.”
than 6 times within 60 days
Legible copies of the VDDNR or other authorized DNR forms may be honored. There are five key parts of the form:
- The patient’s full legal name.
- A DNR determination.
- Signature of Physician (MD) or Nurse Practitioner (NP).
- Date of issue.
- The patient’s signature or, if applicable, that of the person authorized to consent on the patient’s behalf.
In the rare event providers are unable to contact POLMD, attempts should be made to contact __ ___ through the Department of Public Safety Communications (DPSC) and the ___ __________.
an OMD, EMS Supervisor
FRD providers may be called to assist a patient who is incidentally in possession of a weapon (firearm or edged, concealed or otherwise). Such weapons may present a hazard to providers and in all cases are not permitted in receiving facilities. Upon discovery of such a weapon in the possession of a patient with decision-making capacity, providers should utilize the following strategies:
Preferred: The patient willingly leaves the weapon on scene
Alternative: Request law enforcement to the scene if not already present and ask the patient to turn over the weapon to the officer for safekeeping until it can be retrieved
Contingency: EMS Supervisor keeps weapon and accompanies unit to hospital to determine best course of action at destination
5-5-10-2.
- At patient side to 12 Lead ECG less than 5 minutes.
- STEMI identification to Alert less than 5 minutes.
- STEMI identification to enroute to facility less than 10 minutes.
- Two ALS providers should be at the patient’s side during transport
If the patient is prescribed nitroglycerin and has been instructed to take it for the observed symptoms, assist patient with prescribed Nitroglycerin up to a total of…?
3 doses administered by EMS
- If the patient has a blood glucose level less than __, can protect his or her airway, able to swallow, and can follow commands, assist the patient with self-administration of:
o 1 Instant Glucose tube (15 grams).
▪ Reassess and monitor for signs of clinical improvement. Repeat blood
glucose assessment _ _______ after glucose administration. Instant
Glucose tube can be repeated once, if necessary.
70, 5 minutes
All patients greater than __ ____ pregnant who are having an obstetric (OB)-
related emergency should be transported to an OB-capable facility.
20 weeks
Transport the supine patient in the ____ _______ _________ position if delivery is not imminent.
left lateral recumbent
Symptoms associated with organophosphate poisoning are SLUDGE:
- Salivation.
- Lacrimation.
- Urination.
- Defecation.
- Gastric Hypermotility.
- Emesis.
MARCHE
Massive bleeding, Airway, Respiration, Circulation, Head injury,
Hypothermia, Every other injury
EMS BLOOD PROGRAM
The Incident Commander (IC) or designee anticipates
the patient will be entrapped greater than __ ________ from the time of activation
(Stuck).
30 minutes
The following definitions may be helpful in thinking about pediatric patients:
Newly born (Newborn) –
Neonate –
Infant –
Child –
Adolescent –
Adult –
Newly born (Newborn) – minutes to hours post-birth.
Neonate – First 28 days.
Infant – First year (12 months).
Child – 1 year through 8 years.
Adolescent – 9 years through 16 years.
Adult – age 17 or older
Assess the patient’s level of consciousness – AVPU
- Alert.
- Verbal.
- Painful.
- Unresponsive.
HYPOTHERMIC ARREST
* If patient is greater than ____, follow Cardiac Arrest – Universal Management protocol.
86°F
___________ is the most common complication of prehospital deliveries
Hypothermia
A patient with a core body temperature less than ____ is hypothermic.
Mild hypothermia is a core temperature between ____ _____ Severe hypothermia is a core body temperature less than____.
95°F, 90° - 95°F, 90°F
Shivering stops when the core body temperature falls below ?
90°F
For infants and small children if blood glucose is ____ ____ __, can protect his or her airway, able to swallow, and can follow commands, assist the patient with self-administration of 1 Instant Glucose tube (15 grams).
less than 60
If greater than 1 year of age and there is clinical suspicion for opioid overdose (decreased level of consciousness, decreased respirations, pinpoint pupils), administer Narcan Nasal Spray via the ______ ____, prepackaged, nasal atomization
delivery unit 2-4 mg if available.
single dose
______is a complex and dynamic systemic infection that can potentially become life-threatening. Septic shock is severe sepsis plus ____________
Sepsis,.hypotension.
(PACE) framework is the rationale for the differences in strategy and tactics compared with traditional EMS contexts.
Preferred, Alternative, Contingency, Emergency (PACE)
The burned body surface area of a child can be estimated by
- Using the Rule of Nines see below
- Using the size of the child’s palm (including fingers). It is approximately 1% of the total body surface area.
Mild hypothermia is a core temperature between…..? Severe hypothermia is a core bodytemperature less than ?
90° - 95°F, 90°F
Shivering stops when the core body temperature falls below?.
90°F
Treat Frostbite
- Bandage injured areas lightly to protect from pressure, trauma, or friction.
- Place bandages between fingers and toes for protection.
- Do not rub the skin or break blisters.
- Transport patient with frostbitten areas supported, elevated, and covered.
- Place electrodes – acquire 12 Lead ECG.
When outside temperatures are 86° to 104° F, the temperature inside a vehicle can
reach _____ within 15 minutes
140° F
A rule of thumb for the lower limit of normal pediatric systolic blood pressure is?
70 + (2 x Age in years).
Consult with the following parties to obtain a TDO (temporary detention order) if necessary….
*EMS Supervisor.
○ Law enforcement officer.
○ Merrifield Crisis Response Center (MCRC) or Mobile Crisis Unit (MCU).
○ POLMD.
__ _______ is frequently misdiagnosed as a simple headache or viral syndrome. A high
index of suspicion must be maintained, particularly during the winter months, when
faulty heating systems and enclosed spaces make __ _________ more common than it
is at other times.
CO toxicity, CO poisoning
A ______ is defined as an episode of impaired neurological function caused by an abnormal
electrical discharge of brain neurons.
seizure
Threat is real, directly present and poses greater risk than
benefit of most patient care interventions. Good tactics is good medicine. Tactical
superiority is paramount and patient care is limited.
Hot Zone (direct threat):
Threat is conceivable, but remote. Benefits of time critical, life- saving interventions are justified, followed by removal from the threat
environment as soon as achievable.
Warm Zone (indirect threat)
Threat is mitigated, or the patient has been removed
from the threat environment. Care is centered on injury specific and context specific
stabilization, packaging and preparation and completion of transport to definitive care
Cold Zone (evacuation care)
MARCHE
Massive, bleeding, Airway, Respiration, Circulation, Head injury,
Hypothermia, Every other injury
If the patient’s preference involves a long transport interval (greater than 60
minutes one way), contact the ____ ___ ___ ________ for approval.
UFO and EMS Supervisor
All patients greater than __ _____ _______ who are having an obstetric-related
emergency should be transported to an OB-capable facility.
20 weeks pregnant
All children under the age of _____ should be properly restrained during transport in a
child safety seat (CSS) which meets the standards adopted by the National Highway
Traffic Safety Administration (NHTSA)
eight
If the patient is over 18 years of age, administer Baby Aspirin_ ________ orally (81 mg
per tablet), chew and swallow.
2 tablets
When do employee medical evaluations and monitoring?
Pre and post assessments for hazardous materials personnel and Incident requiring rehab. Pg 14
When does a person become a patient?
When the ems provider determines an assessment is necessary to ensure no illness or injury is overlooked and the patient has no impairment to decline assessment. Pg 14
What are factors when determining if a person is a patient or not?
Mechanism of injury. Origin of call, first party vs third party. Potential for missed illness/injury and consequences. Social variables. If a patient asks for assessment. Pg 14.
Who May patient information be shared with?
Parties involved in patient care. Quality improvement representatives. Cost recovery representatives. Pg 15
What is a patient’s INTACT decision making capacity dependent upon?
There ability to understand their condition. Recommended treatment in benefits of the treatment. The risks of refusing treatment. Alternatives to our recommendations. Page 16
What may make informed consent in assessment decision making capacity difficult?
A language barrier. Pg 16
When does the patient have IMPAIRED decision making capacity?
If they are unable to understand their condition or recommendations or if they have unreasonable excuses for transport refusal. Page 16
What does the acronym CURVES stand for regarding decision making capacity?
Communicate. Understand. Reason. Values. Emergent condition. Surrogate. Page 16
