EMSO - Field Trauma Triage/Air Ambulance/MCI Flashcards

Question

Origin of air ambulance - what was the need for it?

Answer 1

* trauma scene response was the primary resason for implementation of rotary winged aircraft * HEMS response can result in decreased mortality due to a reduction in the time that a patient received definitive care as well as access to advanced clinical interventions * For medical calls, patients with STEMI/CVA have shown to benefit greatly from HEMS response * specialized transport of critically ill patients without depleting local resources

Answer 2

operational (geography) guidelines AND clinical (pt presentation) guidelines

Answer 3

* **Land response to scene \>30 minutes and air can reach scene quicker** * **land response to appropriate hospital \>30 minutes** and air can reach scene and transport the patient to hospital quicker than land ambulance * **Land and air response \>30 minutes, but ALS required and not available on land** * **MCIs - multiple patients who meet clinical criteria and local land ambulance resources are already being fully utilized**

Answer 4

**1) Any patient meeting FTTS** **2) Medical** * Shock - especially hypotension with altered mentation * suspected aortic aneurysm rupture * massive GI bleed * severe sepsis * anaphylaxis * cardiogenic shock, etc. * Acute CVA within 6 hours of Sx onset * Altered LOA (GCS \< 10) * Acute respiratory failure or distress * Suspected AMI (STEMI) or potentially lethal dysrhythmia * Arrest patients - cardiac/respiratory * Status epilepticus * Unstable airway or partial airway obstruction **3) Obstetrical** * Active labour with abnormal presentation (shoulder, breech, limb) * Multiple gestation and active labour * Umbilical cord prolapse * Significant vaginal bleed (suspected abruptio placenta or placenta previa or ectopic)

Answer 5

1) The **_perceived_** severity, without confirmation of reported injuries would meet the clinical guidelines OR 2) the patient cannot reasonably be reached by land (i.e. sites without road access like islands, geographically isolated places, etc.)

Answer 6

Yes, paramedics may choose to cancel the air response based on patient presentation however contact CACC/ACS and advise that an on-scene air ambulance helicopter response is not required and why it is not required

Answer 7

1) applicable operational and clinical guideline 2) ETA to prepare the patient for transport, identify separately any time required for patient extrication 3) ETA for applicable receiving facility - provide estimated land ambulance driving time to the closest appropriate hospital and any additional information as required

Answer 8

* final approach (you can see them and they are lading) * local hospital * LTH

Answer 9

Land ambulance will proceed to the closest local hospital with an emergency department. The air ambulance helicopter will proceed to that local hospital and, if appropriate, assist hospital personnel prepare the patient for rapid evacuation.

Answer 10

1) air amublance helicopter is able to land along the direct route of the land ambulance (towards the hospital) AND 2) it would result in a significant reduction in transport time to the most appropriate hospital

Answer 11

* one rescuer (usually Fire) to assume this role when helicopter is landing * have to wearing protective apparel: * visible vest/coat * helmet with visor * safety goggles or glasses

Answer 12

**1) Site will not affect rescue efforts** **2) Clear area of at least 150' x 150' required** **3) With a safety area, additional 100' for purpose of controlling vehicle & personnel access during landing/takeoff** **4) Away from overhead wires & utility poles** **5) Flat surface** **6) No loose debris within the landing site or safety area** **7) Avoid gravel & sand sites - potential injury** **8) ultimately pilot is responsible for selecting landing site & has final decision whether to land**

Answer 13

* no vehicles or personnel within landing site & safety area during landing or take off * Closer all vehicle doors & access compartments on vehicles close to site * Secure all loose articles & equipment * If requested by flight crew, the Landing Site Coordinator will stand at the upwind edge of safety area, back to the wind & facing the site * Do not have fire lay out hoses, any lines laid should be charged * Site Coordinator will wave off Helicopter if site security is compromised by personnel or vehicles

Answer 14

safety area & landing site

Answer 15

* Only when directed by a member of Air Crew * Never approach from rare by tail rotor-difficult to see * Approach from downhill side if on uneven ground * Carry all equipment horizontally at or below waist level, never over shoulder * Ensure hats, scarves, gloves, glasses and all losse articles are secure

Answer 16

* HEMS will not be permitted to respond to night calls which require landing at a site other than night licensed airports, helipads, or night approved remote landing sites * typically will not land on site ~1 before sunset to 1hr after sunrise * HEMS will NOT conduct "search and rescue" operations

Answer 17

Natural Disaster Terrorism Domestic Terrorism Daily Life Events

Answer 18

Any incident that exhausts the available resources within a 15 minute travel time

Answer 19

* Mandatory training * Specialized training (i.e. CBRN) * Interagency training

Answer 20

an international system that has been adopted by Ontario as the new **GOLD STANDARD** for emergency management and business continuity, replacing the old "Site Command" system * provides a common system for all agencies to coordinate response * used internationally by many agencies (Fire, Police, EMS, and Public Utility) * Flexible and Scalable (used on small incidents and large incidents)

Answer 21

a potential disaster, used in situations (disasters external to the hospital) that could overwhelm hospitals and ambulance resources

Answer 22

to allow dispatchers to go directly to the site to direct where units go, able to act as its own entity

Answer 23

Orange book, reference cards, grease pencils and glow sticks, triage tags, vests

Answer 24

5 distinct jobs, 3 are always performed by paramedics

Answer 25

1) Incident Site Manager (Emergency Site Manager) / Incident Commander (IC) **2) Ambulance Site Coordinator** **3) Triage Officer** **4) Ambulance Traffic Control Officer** 5) Safety Officer **\*bolded: to be done by paramedics**

Answer 26

* designated to oversee entire on-site response * coordinates efforts of all responding agencies * usually the most senior officer of the responding agencies (police, fire, EMS or the most trained in IMS) * has no other function than to coordinate joint response (i.e. **there are not actively participating in pt care!**)

Answer 27

* the senior paramedic of the first responding unit (they also leave their emergency light systems on so others know where to go) * duties may be relinquished to a supervisor/manager incident progresses * CACC must be advised of who this person is and of any changes (identified via truck number)

Answer 28

Last; not transporting

Answer 29

* ensure scene safety * notify CACC of the incident and that you are site coordinator * ensure the Triage Officer has been assigned * utilize MCI bad and any local protocols * establish a command post (lights on truck or if MCI inside, stage a police to stay at command post to coordinate subsequent units, etc.) * liaise with allied agencies on scene and assess for need of others * look for vehicle staging area, access/egress routes, assign Traffic Officer if necessary (i.e. if prolonged event) * coordinate patient transport with CACC and other site officers

Answer 30

* person is usually the site commander's partner * can be assigned to one or more of first responding paramedics (i.e. in situations where triage areas may be more spread out but you would also need a _triage coordinator_ for this)

Answer 31

* identify self as Triage Officer * ensure scene safety, coordinate entry with fire/police * designate a triage area * utilize triage tags and apply to each casualty * assign personnel to deal with casualties - can be paramedics, first aiders, and bystanders * inform Site Coordinator of status, number of patients and priorities

Answer 32

* this officer is needed if multiple units are responding for a prolonged incident * this person usually in the 2nd or 3rd vehicle on scene

Answer 33

* identify self as Traffic Control Officer * assign a designated staging area for vehicles if not already done * liaise with police for assistance with public vehicle control * record crew arrival, remind them to shut off emergency lights, shut off engines, leave repeaters off, leave keys in ignition and vehicle unlocked * brief incoming crews of incident, location of command post and triage area * maintain log of vehicle arrival, departure, destination and number of patients

Answer 34

* assigned if sufficient personnel area available * position will exist if multiple personnel are expected to a prolonged response * typically fire's job

Answer 35

* ensure scene safety by continually monitoring hazards, weather conditions, etc. * remind arriving crews to utilize proper safety equipment i.e. helmet, vest, goggles * if prolonged response, arrange for refreshments and sanitary facilities * rotate crews to reduce physical and mental stress * if prolonged response remember environmental hazards i.e. sun, insects, etc.

Answer 36

the means that we use to quickly and easily identify the most serious victims in every situation originated from French language used by wool traders "to choose or select"

Answer 37

* first medical reference back to Napoleon's surgeon Larrey who used "triaging" to describe process of prioritizing casualties from battle * emphasized the need for such processes and related to specialized field procedures noting that often limited resources were available * this was the first documented cases of realizing the need for "pre-hospital" standards andt raining

Answer 38

* done when the number of patients and/or severity of the their injuries exceed the ability of local resources to provide immediate individual assistance * based on 4 principles

Answer 39

**1) Application of Triage is to do the greatest good, for the largest number of casualties, with the resources available** ## Footnote **2) Triage is absolute not relative** **3) Triage identification is a must** **4) Coordinated transportation to medical facilities**

Answer 40

* the normal standard of care does not apply in these situations * patients that would normally receive full resuscitative efforts may be left without care until sufficient resources are available * initial interventions are limited to opening airway, controlling severe hemorrhages, and categorizing patients your quick ABC check and position them to allow maintenance of their airway and then move on

Answer 41

* patient condition must be judged against ABSOLUTE criteria to determine how critical their injuries are * patient condition SHOULD NOT be judged relative to other patients on scene * criteria is absolute regardless of age of patient

Answer 42

* you should utilize MOH triage tages to help avoid confusion and repeated assessment of patients while others may be missed * tags clearly identify priority of patient * if possible, patients should be groups according to their treatment priorities * tags must be applied to all patients uniformly

Answer 43

* coordinated transportation and distribution of patients is a must for triage to be effective * all patients transported by ambulance or other means must be controlled by triage/site coordinator/traffic officer * distribution of patients must be equal throughout receiving facilities to ensure overloading does not occur

Answer 44

Decreased (Blue/Black) Code 4- Immediate Priority (Red) Code 3- Second priority (Yellow) Code 2 - Delayed Priority (Green)

Answer 45

1) Tagging priorities (blue, red, yellow, green) 2) perforated edges (with 5-digit number to help correspond and organize patients) 3) Anatomical person to circle where patient's injuries are (primary problem)

Answer 46

1) place tags on the same place on each patient (be consistent!) 2) don't leave ripped pieces on ground near patient 3) remember to remove ambulance corner tag when patient is loaded into the truck 4) keep writing on tags to a minimum 5) never attach tag to clothing

Answer 47

* immediate/emergent * life-threatening emergency/illness * high probability of survival if transported and receives definitive care within 30-60 minutes * RR \< 8-10, \>28-30 * ++hemorrhaging * unresponsive * any patient that would be typically transported code 4 (typically your CTAS 1 and 2 patients)

Answer 48

* urgent * patient has potentially life threatening injury * delay of definitive care 2-3 hours is not anticipated to threaten outcome * any patient that has a collar on is at least a yellow * non-life threatening fractures * controlled moderate bleeds * significant amount of pain from injury * any patient that would typically be transported code 3 (typically your CTAS 3 and 4 patients)

Answer 49

* care can be delayed * no potentially life threatening illness/injury * extended delay in receiving definitive care should not threaten outcome * ambulatory patients "the walking wounded" * minor cuts/abrasions * those who need ax but no specific complaints * pts who would normally be transported code 1 (CTAS 5)

Answer 50

* deceases * obviously dead as per code 5 criteria * VSA patients where there is insufficient personnel to perform resuscitation

Answer 51

1) Decapitation 2) Transection 3) Visible decomposition 4) Putrefaction **If VSA:** 1) a grossly charred body 2) an open head/torso wound with gross outpouring of cranial or visceral contents 3) gross rigor mortis (limbs and/or body totally stiff, posturing of limbs and/or body) 4) dependent lividity (fixed, non-blanching purple or black discolouration of skin in dependent area of body)

Answer 52

return to patients and begin secondary assessments and update triage priority if the need arises

Answer 53

categorize patient, position to keep airway open, control any major hemorrhaging, apply triage tage THEN MOVE ON!

Answer 54

any substance which may pose an unreasonable risk to health and safety of operating or emergency personnel, the public, and/or environment if not properly controlled during handling, storage, manufacture, processing, packaging, use, disposal or transportation

Answer 55

* size up incident * establish command * activate IMS * assess toxicological risks * evaluate decontamination methods * treat and transport patients * support HAZMAT team members (medical monitoring, rehab)

Answer 56

1) personal risk of exposure or contamination (consider the location, is it a plant? side effects?) 2) Wind direction 3) Available resources 4) Contingency plans

Answer 57

* occupancy, location * vehicle, container shape * placards, other markings * labels * scene appearance - ?vapour cloud, fire, dead animals * other sensory information - see, hear, smell, eyes watering/burning

Answer 58

a container that is used to transport corrosive or poisonous materials

Answer 59

pressurized contents

Answer 60

pressurized contents

Answer 61

temperature sensitive materials, insulated cars

Answer 62

by using content of the North American Emergency Response Guidebook (NAERG)

Answer 63

* approach upwind - park ~ 800m from scene untl safe to approach * if hazardous/radioactive material suspected - withdraw to be safe * Obtain placard # * Notify CACC of material encountered * Allied agencies * Do not attempt to rescue/recovery patients until safe * initiate care/transport when safe * utilize MCI guidelines as necessary * clean up - as per decontamination procedures

Answer 64

**1) Isolate the area** * do not allow equipment, personnel into the area * do not attempt to rescue pt's from area **2) Identify the material** * done from a safe distance, use CACC information, NAERG, and other agencies **3) Recognize Immediate Dangers & Decontamination Requirements** * Personal Protection - what level is required?? A-D

Answer 65

* respond to the Incident Command Post * Report to Senior Fire or Response Team Officer * Take precautions - PPE * Initiate MCI guidelines if # of casualties exceed resources * patient care & transport - when decontaminated * Follow decontamination procedures of self/equipment/vehicle

Answer 66

True. but specialized duties only if EMS personnel are trained

Answer 67

Part of body/where was the exposure, length of exposure, concentration of material and type

Answer 68

patient is decontaminated and it is safe to proceed

Answer 69

70-80% decontamination, needs to be double bagged, tagged

Answer 70

protect unused equipment and store non-essential equipment

Answer 71

**1) Consider life/limb/function threats, such as** * if chemical in eye, vision loss, * burns * systemic toxicity secondary to chemical absorption through the skin **2) attempt to determine the type and concentration of hazardous material, and duration of exposure;** **3) attempt to remove any contaminated clothing or jewelry;** **4) attempt contamination prior to departing scene;** **5) if chemical injury to the eye** * assess the eye as per *Visual Disturbance Standard*, and * advise patient to remove contact lens if readily removable; **6) if chemical injury to extremity, assess distal neurovascular status in affected extremity;** **7) brush off or manually remove solid, powdered hazardous materials;** **8) attempt to follow first aid and decontamination procedures outlined in the *Transport Canada Emergency Response Guidebook;*** **9) irrigate exposure site using large volumes of cool, not cold water,** **10) notwithstanding 9 above, not irrigate if chemical known to be water-reactive** **11) if irrigating, contain rinse water, if possible;** **12) if an alkali burn is known or suspected, irrigate for a minimum of 20 minutes at scene if patient is stable, and attempt to continue irrigation en route;** **13) for a known acid burn, irrigate for minimum of 10 minutes at scene if patient is stable;** **14) for unknown chemical exposure, irrigate for a minimum of 20 minutes at scene if patient is stable;** **15) with respect to eye irrigation,** * attempt to utilize eye wash station/equipment if available at scene, * advise patient not to rub eye(s), * position the patient with his/her affected side down if one eye is affected or supine if both eyes are affected, * manually open eyelids if required, and * attempt to irrigate away from tear duct(s); **16) provide burn care as per *Burns (Thermal)* *Standard*** **17) If solid particles remain stuck to skin after irrigation is complete, attempt manual removal and then cover affected areas with wet dressing and/or towels;** **18) in conjunction with the *Reporting of Patient Care to Receiving Facility Standard,* notify receiving facility of hazardous material exposure and associated decontamination efforts;** **19) if gross contamination of ambulance or self, decontaminate immediately after call completion**

Answer 72

the ACO will assign a land ambulance and continue the land response until the flight crew requests that the land ambulance be cancelled.

Answer 73

* allied emergency services * bystanders * CANUTEC Resources: * CANUTEC Emergency line * Transport Canada Emergency Response Guidebook * Dangerous goods placard or product code number * MSDS * Poison Control Centre