Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OCHT Term II > EMSO - Field Trauma Triage/Air Ambulance/MCI > Flashcards

EMSO - Field Trauma Triage/Air Ambulance/MCI Flashcards

1
Q

What is Field Trauma Triage Standard (FTTS)?

A
  • Detailed criteria that indicate when patients should be transported to a LTH and/or be transported utilizing a Helicopter Emergency Medical Service (HEMS)
  • meant to reduce delays so that patients receive the focused care they need
  • Delays the process of getting the patient to the nearest hospital in order to go to a trauma center which may be further away
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Newest revisions of the FTTG reflect the latest collaboration of which stakeholders?

A
  • Centre for Disease Control (CDC)
  • MOH LTC EHSB
  • Medical Advisory Committee (MAC)
  • Ontario Base Hospital Group (OBHG)
  • Ornge
  • Ontario Association of Paramedic Chiefs (OAPC)
  • Ontario Trauma Advisory Committee
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Who plays a part in FTTG?

A
  • Caller
  • CACC Dispatcher
  • Ornge Dispatcher
  • Paramedic
  • Flight Paramedic
  • Flight Crew
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

4 steps in decision process

A

Step 1: Physiological

Step 2: Anatomical

Step 3: Mechanism of Injury

Step 4: Special Considerations

If any of the criteria in Step 1 or 2 are met, patient automatically meets the FTTG standard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

If the criteria in a particular step are met, where can the patient be taken?

A

Paramedic may take the patient directly to the LTH if the land ambulance transport time is <30 minutes**

the transport time: from the time we leave scene to the time we get to LTH (consider time of day, road conditions); note that service-specific, some services have this time extended to 60 minutes (but for testing purposes, go with <30 minutes)

**if the paramedic is unable to successfully maintain the airway or the patient is unlikely to survive transport to LTH, patient MUST BE transported to the closest ED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Step 1: Physiological criteria

A

Any patient who suffers from significant traumatic MOI, any one of the following:

LOA: patient does not follow commands (TECHNICALLY it’s basically GCS <14 but use your clinical judgement)

Systolic Blood Pressure: <90 mmHg

Respiratory Rate: <10 or ≥ 30 breaths per minute, or need for ventilatory support

  • <20 breaths per minute in infant <1 y.o.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Step 2: Anatomical Criteria

A

Any one of the following:

  • all penetrating injuries to the head, neck, torso and extremities proximal to elbow or knee
  • Chest wall instability or deformity (eg. flail chest) - not just broken ribs
  • Two or more proximal long bone fractures
  • Crushed, de-gloved, mangled or pulseless extremity
  • Amputation proximal to wrist or ankle (not just fingers/toes)
  • Pelvic fractures
  • Open or depressed skull fractures
  • Paralysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the exception re: transporting patients who are unable to maintain their airway or are unlikely to survive transport to LTH?

A

If patient has a penetrating trauma to the torso or head/neck, and meet ALL of the following:

1) VSA yet not subject to TOR

and

2) Land transport to the LTH estimated to be <30 minutes

transport patient directly to LTH regarding of Step 1 and 2 criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

The criteria used for bypass to a LTH in Steps 3 and 4 are not _____________; rather are indications of what?

A

absolute

Steps 3 and 4 are indications of POTENTIAL for significant injury or indicate the patient may require other support services at the LTH (not all patients in these two categories require transport to LTH; based on paramedic’s judgment coupled with Step 3 and 4 criteria to determine need for transport to LTH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Step 3: Mechanism

A

Any one of the following:

1) Falls:

  • adults ≥ 6 m (one storey = 3m)
  • children (<15 y.o.) ≥ 3m or 2-3x height of the child

2) High Risk Auto Crash

  • Intrusion ≥ 0.3m occupant site, ≥0.5m any site, including the roof
  • Ejection (partial or complete) from automobile
  • Death in the sam passenger compartment
  • Vehicle telemetry data consistent with high risk injury (if available, but this is not available to paramedics

3) Auto vs pedestrian/bicyclist thrown, run over, or struck with significant (≥30 km/hr) impact

4) Motorcycle crash ≥30 km/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Step 4: Special Considerations

A
  • Patients may be transported to LTH if any of the following criteria have been met BUT use paramedic judgement and local PPS bypass agreements to help with determining destination

Any one of the following:

1) Age:

  • Older adults: risk of injury/death ↑ after 55 y.o.; SBP <110 may represent shock after 65 y.o.
  • Children: should be triaged preferentially to a pediatric capable centre

2) Anticoagulant and bleeding disorders

3) Burns (with trauma mechanism)

4) Pregnancy ≥ 20 weeks - may be service specific but likely going to obstetrics-specific facility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Ontario’s air ambulance system is regarded as one of the largest and most complex in North America. True or False

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Ontario’s air ambulance system performs approximately ___________ calls annually and services how many people in what area?

A

20 000 calls

servicing 13 million people covering 1 million km2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

History of Air ambulance (When was it established and how it became ORNGE today)

A
  • Ontario - first province with helicopter air ambulance
  • established in 1977 with 1 aircraft
  • 2002 - Amalgamation of base hospitals in Sioux Lookout, Thunder Bay, Sudbury, Timmins and Toronto
  • Ontario Air Ambulance Base Hospital Program established
  • 2001 Coroners Inquest - Ontairo Air Ambulance Services Co. (OAASC) - lots of scandals and bad stuff
  • 2006- became ORNGE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Air ambulance operates from how many bases across Ontario, and how many of those are dedicated aircraft (aka staffed 24/7)?

A

22 bases; 12 are dedicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Dedicated Aircraft are operated by what levels of paramedics (i.e. PCP, ACP, etc.).

A

Carry CCP/ACP/PCP crews, equipment, and supplies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Rotary wing aircraft are located in what locations?

A

Ottawa (1)

Toronto (Hamilton/Oshawa 2)

Thunder Bay (1)

Moosonee (1)

Kenora (1)

Sudbury (1)

London (1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Fixed wing aircraft are located where

A

Sioux Lookout

Thunder Bay

Timmins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Role of charter aircraft

A

used if air ambulance is too busy; air ambulance has standing agreements with transfer companies (think RnR of the sky) who are on call to response and are made of ACPs and PCPs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Transport Canada

A
  • Regulates the operation of aircraft in Canada (rules in which Ornge has to abide by but there are exceptions such as when Ornge is responding to an emergency)
  • Control departures, landing and flight paths (i.e. over water, duty days, etc.)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Ministry Health and Transport Canada - Role

A
  • Set qualifications for medics and pilots
  • maintain aircraft and equipment standards
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Certification of Pilots

A

Must meet flight time experience criteria

undergo continuous training and evals for competency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Certifications of paramedics working for ORNGE

A
  • trained in emergency procedures
  • must learn survival, underwater escape and handling of dangerous goods
  • flight medic is trained to use onboard equipment to survive emergency landing and spending night in winter wild
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Operations Control Centre (OCC)

A
  • The dispatch centre responsible for daily air ambulance resources
  • handles ~20 000 calls for air ambulance support yearly
  • also organizes Pronvincial Transfer Authorization Centre (PTAC)
  • 400 000 numbers/year
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

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

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

On scene requests for air ambulance should meet at least one of:

A

operational (geography) guidelines

AND

clinical (pt presentation) guidelines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Operational Guidelines

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Clinical Guidelines for requesting air ambulance

A

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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are other considerations in which, in the paramedic’s or ACO’s judgement, an air ambulance may be requested?

A

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.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

If air ambulance has already been initiate but after making patient contact you decide it is not necessary to have them, can you cancel?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

If an air response hasn’t been initiated and a paramedic would like to request air, what shall the paramedic provide the ACO with?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Land crews will not delay transport in order to wait for an air response unless:

A
  • final approach (you can see them and they are lading)
  • local hospital
  • LTH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

If the air ambulance helicopter is en route but not on final approach to the scene, and the land paramedics have the patient in his/her ambulance, what shall the paramedics do? How about air ambulance?

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

A land crew may rendezvous with an air ambulance if:

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Landing site coordinator - who is it usually and what protective apparel do that have to wear?

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Landing site requirements (8)

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Landing site - site safety (What are things to consider re: safety)?

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

During landing and take off, stay out of what areas?

A

safety area & landing site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Rules/Guidelines for approach/departing the helicopter (5)

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Limitations of air ambulance

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the four types of MCI?

A

Natural Disaster

Terrorism

Domestic Terrorism

Daily Life Events

42
Q

What is the definition of MCI?

A

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

43
Q

Trainings put in place as a result of MCIs

A
  • Mandatory training
  • Specialized training (i.e. CBRN)
  • Interagency training
44
Q

Incident Management System (IMS)

What is it and what is its purpose?

A

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)
45
Q

Code Orange

A

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

46
Q

Purpose of Comm unit 1600 (Mobile dispatch units)

A

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

47
Q

Contents of MCI kit

A

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

48
Q

How many distinct jobs are there at MCIs and how many of these jobs are always performed by paramedics?

A

5 distinct jobs, 3 are always performed by paramedics

49
Q

What are the jobs/roles at an MCI? Which are to be performed by paramedics?

A

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

50
Q

Role of Incident Site Manager (Emergency Site Manager)

A
  • 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!)
51
Q

Ambulance Site Coordinator

A
  • 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)
52
Q

General rule: First truck in is the _______truck out and are typically (transporting/not transporting) a patient.

A

Last; not transporting

53
Q

Duties of Site Coordinator

A
  • 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
54
Q

Who is the triage officer?

A
  • 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)
55
Q

Duties of the Triage Officer

A
  • 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
56
Q

Who is the Ambulance Traffic Control Officer?

A
  • this officer is needed if multiple units are responding for a prolonged incident
  • this person usually in the 2nd or 3rd vehicle on scene
57
Q

Duties of the Ambulance Traffic Control Officer

A
  • 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
58
Q

When is the Safety Officer assigned?

A
  • assigned if sufficient personnel area available
  • position will exist if multiple personnel are expected to a prolonged response
  • typically fire’s job
59
Q

Duties of Safety Officer

A
  • 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.
60
Q

What is triaging?

A

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”

61
Q

Hx of Triaging

A
  • 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
62
Q

When is triaging done?

A
  • 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
63
Q

What are the 4 principles that triaging is based on?

A

1) Application of Triage is to do the greatest good, for the largest number of casualties, with the resources available​

2) Triage is absolute not relative

3) Triage identification is a must

4) Coordinated transportation to medical facilities

64
Q

Triage Principle #1: Application of Triage is to do the greatest good, for the largest number of casualties, with the resources available.

What does this mean?

A
  • 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

65
Q

Triage Principle #2: Triage is absolute not relative.

What does this mean?

A
  • 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
66
Q

Triage Principle #3: Triage Identification is a must

What does this mean?

A
  • 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
67
Q

Triage Principle #4: Coordinated transportation to medical facilities

What does this mean?

A
  • 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
68
Q

What are the four priorities on a triage tag?

A

Decreased (Blue/Black)

Code 4- Immediate Priority (Red)

Code 3- Second priority (Yellow)

Code 2 - Delayed Priority (Green)

69
Q

Components of a Triage tag

A

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)

70
Q

General rules for triage tag use (5)

A

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

71
Q

Triage Category: RED

A
  • 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)
72
Q

Triage Category: YELLOW

A
  • 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)
73
Q

Triage Category: GREEN

A
  • 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)
74
Q

Triage Categories: BLUE

A
  • deceases
  • obviously dead as per code 5 criteria
  • VSA patients where there is insufficient personnel to perform resuscitation
75
Q

Obviously dead criteria, as per Deceased Patient Standard

A

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)

76
Q

Once all patients have been triaged, what would be your next step?

A

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

77
Q

What are the steps in triaging?

A

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

78
Q

What is deemed a hazardous material

A

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

79
Q

Paramedic role in hazmat calls

A
  • size up incident
  • establish command
  • activate IMS
  • assess toxicological risks
  • evaluate decontamination methods
  • treat and transport patients
  • support HAZMAT team members (medical monitoring, rehab)
80
Q

When you are sizing up the scene of a hazmat call, what considerations are there?

A

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

81
Q

Informal HAZMAT recognition - What are you looking for?

A
  • 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
82
Q

External rings/stiffeners on a vehicle container indicate

A

a container that is used to transport corrosive or poisonous materials

83
Q

Vehicle containers with rounded ends typically indicate

A

pressurized contents

84
Q

Dome covers on rail cars indicate

A

pressurized contents

85
Q

Cars with flat ends indicate

A

temperature sensitive materials, insulated cars

86
Q

The only recognized “formal” method for HAZMAT recognition is what?

A

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

87
Q

What is you don’t know/cannot recognize hazmat related details?

A
  • 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
88
Q

What are the 3 immediate tasks for EMS at hazmat calls?

A

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
89
Q

Roles of the First Responding Ambulance to a Hazmat call

A
  • 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
90
Q

True or false. Paramedics can transport decontaminated patients

A

True

91
Q

True or False. Paramedics can triage decontaminated patients

A

True

92
Q

True or false. Paramedic’s role at a hazmat incident may include evacuation procedures and specialized duties (hazmat/nuclear team)

A

True. but specialized duties only if EMS personnel are trained

93
Q

Patient Care Considerations: What information would you gather regarding incident history?

A

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

94
Q

Patient care considerations: do not start treatment until what has been done?

A

patient is decontaminated and it is safe to proceed

95
Q

When removing patient’s clothing after hazmat exposure, what do you do with the clothes?

A

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

96
Q

What’s the best way to care for equipment at a hazmat call?

A

protect unused equipment and store non-essential equipment

97
Q

As per Hazardous Materials Injury Standard, in situations involving a patient with exposure to a hazardous material, the paramedic shall:

A

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

98
Q

________ may authorize the transport once notified of the patient’s need for re-direct or transport under the Field Trauma Triage Standard.

A

CACC/ACS

99
Q

In cases where a land ambulance can reach the patient(s) and an on-scene response by air ambulance helicopter is appropriate, what will the ACO do?

A

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

100
Q

As per Hazardous Materials Injury Standard in the BLS, when attempting to determine the type and concentration of the hazardous material, use resources such as:

A
  • 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

OCHT Term II (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions