EMS Manual Flashcards
Medical communications with Medical Control or a receiving facility should be conducted for every ______ patient.
Priority 1
Once a patient has received medications administered by any level of DCFEMS
provider, the patient is categorically considered an ____ patient.
ALS level
No patient will be turned over to BLS care once ALS interventions (Medications,
Airway) have been initiated. An exception to this rule can be made in a ____________
Mass Casualty or disaster scenario.
Hospitals will designate personnel to assess patients brought by EMS transport units with the goal of transferring care and releasing the unit within ______________ to the Emergency Department (ED).
10 minutes of the patient’s arrival
In the event that transfer of care is delayed for longer than __ minutes, the EMS provider will contact the _____
20, ELO
_______ Consent – when a competent patient or guardian is informed of the
potential benefits and risks of a process or procedure, alternatives to that
procedure, and the possible consequences related to each.
Informed
________ Consent – written or verbal request to be evaluated and treated.
Expressed
______ Consent – when a patient is unable to express consent because of
altered mental status or severe distress.
Implied
Conduct Three Assessments: Providers should attempt to assess the following
three major areas prior to permitting a patient to refuse care and/or
transportation:
- Legal Capacity to Refuse Care
- Mental Capacity to Refuse Care
- Medical or situational capacity
Who May Refuse Care (4 persons)
- The Patient
- Parent (For pt under 18)(18 =minor)
- Guardian
- Health Care Agent (“Attorney-in-fact”) obtain a copy of the durable power of attorney document to attach to the patient care report (PCR).
Criteria for determining a patient should be pronounced PDOA shall include ALL of the following Primary Criteria and AT LEAST one of the following Secondary Criteria:
Primary Criteria (ALL must be met)
o Pulseless
o Apneic
o No signs of life (such as spontaneous movement or pupillary response)
FEMS personnel may withhold resuscitation from a patient in cardiac arrest under “compelling reasons” when two criteria are BOTH present:
- End stage of a terminal condition (e.g., cancer, heart failure, dementia etc.)
- Written or verbal information from family, caregivers or patient stating that the
patient did not want aggressive resuscitation efforts such as CPR or intubation.
Pronouncement of Death for PDOA:
current DC Fire and EMS Medical Director shall be listed on the EPCR as the
pronouncing physician.
“The patient was pronounced dead on date at time by Dr.
first and last name of DC Fire and EMS Medical Director by standing order.”
Immediately notify law enforcement and remain on scene until they arrive to take
custody of the body. Document the badge number of the responsible law enforcement
officer.
Regarding DNR what is the “MOST Form”
“Medical Orders for Scope of Treatment Form”
What does “ROSC” stand for? (EMS)
Return of Spontaneous Circulation
the United States Park Police (USPP) Aviation Unit “______” is the primary scene
response air medical resource within the District of Columbia.
Eagle One
Patient assessment and the decision to fly should take less than ___ seconds
60
What does “OCME” stand for? (EMS) also what hospital number ?
Office of the Chief Medical Examiner ( Hospital 30)
In cases of a _________ a reverse triage process should be utilized and
patients in cardiac arrest should be treated first.
lightning strike
What does AVPU stand for?
➢ A —Alert
➢ V —Responsive to verbal stimulus
➢ P— Responsive to painful stimulus
➢ U —Unresponsive
If the patient is very cold due to hypothermia, assess the pulse for ________ before determining that a pulse
is absent.
45 seconds
Utilize an Impedance Threshold Device (ResQPODTM) for patients_____ of age or older in a non-traumatic cardiac arrest (If available).
8 Years
What does DCAP-BTLSIC stand for?
➢ D – Deformities ➢ T – Tenderness
➢ C – Contusions ➢ L – Lacerations
➢ A – Abrasions ➢ S – Swelling/edema
➢ P – Penetrations/punctures ➢ I - Instability
➢ B – Burns ➢ C – Crepitus
What does “OPQRST-I” stand for?
➢ Onset
➢ Provocation/Palliative
➢ Quality
➢ Region/Radiation/Referral
➢ Severity
➢ Timing
➢ Interventions
What does “ SAMPLE” stand for?
➢ Signs/Symptoms
➢ Allergies
➢ Medication
➢ Past medical history
➢ Last oral intake
➢ Events leading up to illness or injury
Vital signs should be monitored at a minimum of every __ minutes for all critical patients and every __ minutes for all other patients.
5, 15
Major trauma and burn patients less than __ years of age should be transported to
Children’s National Medical Center (H02).
15
Major trauma and burn patients __ years of age or greater (adult sized) should be
transported to a trauma or burn facility capable of handling adult patients.
15
Medical or minor trauma patients less than __ years of age should be transported to a medical facility capable of handling pediatric patients.
18
Sexual assault patients less than __ years of age should be transported to Children’s National Medical Center (H02)
18
Pediatric doses apply to pediatric patients weighing less than __ kg (100 lbs.).
45
For pediatric patients equal to or greater than __ kg (100 lbs.), utilize adult dosing.
45
Suctioning Time Limits
Adult
__seconds
Child
__ seconds
Infant
__seconds
Adult 15
Child 10
Infant 5
Nebulized medications shall be driven by a flow rate of __ liters per minute (lpm) or _____________
10, as prescribed by the manufacturer’s recommendations.
_________ is one who presents in extremis and or is at risk of rapidly
deteriorating to the point of cardiac arrest shortly after the arrival of EMS. Often referred to as a “pre-code” or “peri-arrest” patient.
“Crashing Patient”
______________ is a cardiac arrest that occurs after the arrival of EMS. Often referred to as an “EMS-witnessed” cardiac arrest.
Post-Arrival Respiratory/Cardiac Arrest (PARCA)
Two person BVM is more effective than one person BVM. The __ ___ ___ technique
is more effective than the traditional C-E technique and thus is the preferred method.
2 thumbs down
Minimize interruptions in chest compressions. All interruptions in CPR shall be as short as possible and no greater than __ seconds.
10
Switch chest compressors every __ ____ (or after 5 cycles of compressions and
ventilations at a ratio of 30:2) to prevent a decrease in the quality of compressions.
2 minutes
The ____ shall NOT be placed until all Pit Crew positions are in place, first
rhythm analysis has occurred, and at least two cycles of manual CPR have been
performed.
LUCAS
If ROSC has not been achieved after__ ____ of resuscitation in a medical cardiac arrest, consider termination of resuscitative efforts as detailed in the Termination of Resuscitation Medical Cardiac Arrest Protocol.
30 minutes
_____ is a main cause of PEA. Pulseless Electrical Activity (PEA)
Hypoxia
Pulse should only be checked for a maximum of __ ____s, if no definite pulse is felt, assume the patient is in cardiac arrest and start CPR)
10 second
_______ __ __ ____: the failure to achieve sustained return of spontaneous
circulation (ROSC) after treatment with 3 defibrillations and administration of an
antiarrhythmic medication IV/IO. (e.g., amiodarone).
Refractory VF or pVT (ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT).
All adult patients that are successfully resuscitated from a medical cardiac
arrest, regardless of initial cardiac arrest rhythm and 12-lead EKG findings, MUST be transported directly to a__________ receiving facility.
STEMI/ROSC
For ROSC Goal is to maintain an ETCO2 of __ __ mmHg.
35-45
(ROSC) Titrate PEEP as necessary to maintain target O2 saturation of __ __.
94-98%
(ROSC) Keep the head of stretcher elevated __ __ degrees during transport to improve pulmonary function
and decrease risk of micro aspiration.
35-45
(ROSC) Repeat your primary survey and obtain serial vital signs every __ __ minutes.
3-5
