EMS Protocols Flashcards
02 should be administered to achieve the following saturation levels:
Normal: >94%
COPD: 88-92%
02 should be administered regardless 02 level when:
- Evidence of increased WOB
- Illness or injury characterized by impaired mechanics of respiration, impaired 02 carrying capacity
- TBI with altered mental status
- Unconsciousness
What are the 5 Ps of the EMS domain?
- patients
- providers
- provisions
- place
- protocol
VOEMS defines a patient as:
a person who needs immediate medical attention or transport, or both, whose physical or mental condition is such that he or she is in danger of loss or life or health impairment or a person that requires medical attention during transport from one medical care facility to another
When is the patient-provider relationship established?
the moment the EMS provider has determined that an assessment of the individual is necessary
-Be aware that a person may ask for assessment and thereby initiate a patient-provider relationship at any time
Who should be requested to assist if the EMS provider has reason to believe that a pt has an illness or injury and the pt’s decision-making capacity is impaired by psychiatric illness?
EMS supervisor
If an ECO is given and PD transport the pt what documentation must be completed?
Refusal
A Durable Power of Attorney only comes into play when?
The pt is impaired.
If a concern arises regarding the decision-making capacity of a pt who should conduct a capacity evaluation?
EMS supervisor
For minors and adults with impaired decision making capacity can informed consent be obtained via telephone?
yes
Who can give consent on behalf of a minor when the legally authorized representative is not readily available?
- Grandparent of a minor
- Adult sibling (over 18)
- Adult aunt or uncle of a minor
- Education institution in which the minor is enrolled that has received written authorization to consent from a person having the right to consent
- An adult who has actual care, control, and possession of a child under the jurisdiction of a juvenile court
- a law enforcement officer who has lawfully taken custody of a minor, if the law enforcement officer has reason to believe the minor may have a life-threatening illness or injury
Persons between the age of what to what may be declared emancipated minor?
14-18
If a minor is pregnant can she give medical consent for herself and her baby solely relating to the delivery of the child?
She can and she can give medical consent for her child
Who should be dispatched if a minor makes a claim to emancipated status that cannot be verified?
EMS supervisor
Minors with intact decision-making capacity, who are ___ or older and whose parent or guardian are unable to be contacted, may refuse assessment, treatment and/or transportation.
14
If police request documentation of service what shall be given to the officer?
FRD 432-Record of Refusal of Transport for Patient in Police Custody
If given what medicines given at the school clinic require the student to leave the school?
- Epi
- Glucagon
- Diastat
- Solu-Cortef
As an EMS provider in VA you are legally required to report your suspicion of abuse, neglect, and or exploitation of members of the following pt populations:
- Children (under 18)
- The elderly (all pt 60 years or older)
- The physically or mentally disabled
An original DNR form is what color?
yellow
When do VA DNR orders expire?
They have no time limit, that are valid until revoked
Can legible photocopies of VADNR or other authorized DNR form be honored?
Yes
What are the five key parts of the DNR form?
- The pt’s full legal name
- A DNR determination
- Signature of Physician (MD) or Nurse Practitioner (NP)
- Date of issue
- The pt’s signature or, if applicable, that of the person authorized to consent on the pt’s behalf
Alternative Forms of DNR Identification must contain the following information:
- pt’s full legal name
- the words- Do Not Resuscitate
- The VDDNR Form issuance date
- Name of Physician (MD) or Nurse Practitioner (NP)
- Phone number of Physician (MD) or Nurse Practitioner (NP)
DNR order may be written on site for patients who are admitted to a hospital or other skilled nursing facility, they may not be a standard DNR form but they can be honored and must contain:
- The pt’s full legal name
- A do not resuscitate determination
- Signature of MD or NP
- Date of issue
- The pt’s signature or, if applicable, that of the person authorized to consent on the pt’s behalf
What color is a POST form?
distinctive bright lime colored form
A DNR order can be revoked at any time by:
- the pt, if the pt executed the order
- the person authorized to consent on behalf of the pt, it that person executed the order
- the MD/NP who issued the order
What resuscitative measures should be avoided or withdrawn if there is a DNR?
- CPR
- Endotracheal intubation or other advanced airway management
- Artificial Ventilation
- Defibrillation
- Cardiac resuscitation medications
If extraordinary care is performed who must be notified immediately following transfer of care?
OMD
If a physician without a pre-existing pt relationship is on scene and wants to handle pt care who must yield care, and will the physician need to accompany the pt to the hopsital?
OLMD will need to yield pt care authority and yes the physician will have to accompany pt to the hospital
When performing START/Jump START how long should your pt contact time be?
30-45 seconds or less
If a dog is preventing access to a pt what resources are immediately available?
- structural ensemble (which provides considerable protection)
- CO2 extinguisher
If full restraints are desired while transported an inmate how should it be performed?
handcuffs attached to the backboard, which can then be blethed normally to the cot
Can a subject in custody be secured and if so how?
Yes but not to cot or unit
During special events minor medical assistance is tracked on what?
FRD 204, a Citizen Contact Log
What form is the Citizen Contact Log and what must be done with it at the conclusion of an event?
FRD 204, and faxed to the EMS Records Fax
MEDEVAC?
refers to evacuation or transport of patients using a medical transport platform where ongoing assessment and interventions can be delivered
TACEVAC
refers to evacuation or transport using non-traditional platforms or vehicles where ongoing monitoring and care cannot be delivered
What is the most effective and expedient method of achieving control of life-threatening extremity bleeding?
tourniquet
Tourniquets are reasonable safe for how long?
less than 2-4 hrs
What type of hemorrhage are tourniquets not beneficial for?
junctional hemorrhage
When is it acceptable to place a tourniquet over clothes?
When placed in the “hot zone”
If the first tourniquet is not effective where shall the second one be placed?
proximal to the first
Are pressure dressings appropriate to be used in the hot zone?
no
When wound packing or using hemostatic agents how long must direct pressure be applied?
3-5 minutes
Wound packing and hemostatic agents in the hot zone?
No
Junctional hemorrhage devices in the hot zone?
no
Under TECC what airway management is emphasized?
positioning and nasopharyngeal airways
In what zones is it acceptable to administer IV fluid?
cold only
With TBI what should 02 levels be maintained at and BP?
o2 above 94% and Systolic BP maintained > or = 110mm Hg
What are the recommended on scene times for trauma, ACS and Stroke?
Trauma: <10 min
ACS and Stroke: < 15 min
How often to you reassess a pt?
5 minutes unstable, 15 minutes stable
