EMT Exam 4 Flashcards
EMS Systems Function
- Emergency
- Non-emergency (planned out appointments, like dialysis)
- Wilderness
- Special Event (football games, concerts)
- Tactical
EMS Systems Organization
- Private
- Public
- Authority
- Municipal (city employees)
- Fire based
- Tiered
What to do at the start of a shift
- Check truck/equipment
- Other PM and checklists
- Check in with dispatch, crew chief
- Get radio
Which ambulance type is biggest
Type 3
Emergency Medical Dispatcher (EMD)
- Interrogate caller and assign priority to call
- Provide pre-arrival medical instructions to callers and information to crews
- Dispatch and coordinate EMS resources
- Coordinate with other public safety agencies
What does it mean to package the patient
Readying the patient to be moved and combining patient and patient carrying device as unit ready for transfer; sick or injured patient must be packaged so that condition is not aggravated
What to do before placing patient on carrying device
- Complete necessary care for wounds, other injuries
- Stabilize impaled objects
- Check dressings and splints
- Cover patient and secure to patient-carrying device
What is the minimum number of straps to secure the patient on the patient-carrying device
Minimum of three straps to secure; chest level, waist level, lower extremities
What to do during transport to hospital
- Continue assessment
- Secure stretcher in place in ambulance
- Position and secure patient
- Adjust security straps
What to do during transport to hospital
- Prepare for resp and cardiac complications
- Loosen constricting clothing
- Load personal effects
- Talk to patient
- Notify hospital
- Compile additional patient info
Who must you transfer patient to
Must transfer to same or higher level of care
What to do after you are free from patient care
- As soon as free from patient care, prepare prehospital care report
- Transfer patient’s personal effects
- Obtain your release from hospital
Terminating the call: at the hospital
- Clean patient compartment
- Prepare equipment for service
- Replace expendable items
- Exchange equipment according to local policy
- Make up ambulance cot
Terminating the call: en route to quarters
- Radio dispatch with your status
- Air out ambulance if necessary for odor control
- Refuel ambulance
Terminating the call: in quarters
- Place badly contaminated linens in biohazard containers
- Clean equipment
- Disinfect non-disposable equipment
Operational reason for air rescue
Speeding transpot to distant trauma center
Medical reasons for air rescue
High priority patients requiring advanced care or procedures not available at local hospital; they don’t fly dead people
In PA who must set up landing zone
Fire department
Command of NIMS
- Operations
- Planning
- Logistics
- Finance
EMS Branch Functions Under Command Structure
- Mobile command center
- Extrication
- Staging area
- Triage area
- Treatment area
- Transportation area
- Rehabilitation area
What is the goal of triage
Afford greatest number of people greatest chance of survival
Prioritizing patients in MCI
- Priority 1: Treatable life-threatening illness or injury
- Priority 2: Serious but not life-threatening illness or injury
- Priority 3: Walking wounded
- Priority 4 (aka priority 0): Dead of fatally injured
Color code for priority 1 patient
Red
Color code for priority 2 patient
Yellow
Color code for priority 3 patient
Green
Color code for priority 4 patient
Black
START Triage
Simple triage and rapid treatment; used to figure out patient priority during MCI
What is START triage patient evaluation based on
RPM: Respiration, pulse, mental status
Evaluation for START triage
- Minor (green): can walk; walking wounded
- Deceased (black): No resp after head tilt
- Immediate (red): Breathing but conscious, perfusion; cap refill > 2 sec/no radial pulse, mental status; can’t follow simple commands
- Delayed (yellow): R- 30, P- 2, M- Can do
Domestic terrorism
Groups of individuals whose terrorist activities are directed at a government or population without foreign direction
International terrorism
Groups or individuals whose terrorist activities are foreign-based and/or directed by countries or groups outside the targeted country or whose activities cross national borders
Types of weapons of mass destruction (CBRNE)
- Chemical
- Biological
- Radiological
- Nuclear
- Explosive
OTTO signs
- May help protect against secondary terrorist attack
- Occupancy (location)
- Type of event
- Timing of event
- On-scene warning signs
First O of OTTO
- Occupancy or location
- Public buildings or assembly areas
- Controversial businesses
- Infastructure systems
First T of OTTO
- Type of event with high suspicion of terrorist involvement
- Explosions
- Incidents involving firearms
- Nontrauma mass casualty incidents
Second T of OTTO
- Timing of event
- National holidays
- Anniversary dates of previous attacks
- Incidents occurring in major public areas at busy points of business day
Second O of OTTO
- On-scene warning signs
- Unexplained patterns of illness or death
- Unexplained signs and symptoms or skin, eye, or airway irritation
- Containers that appear out of place
TRACEM-P
- Recognize harms posed by threat
- Thermal
- Radiological
- Asphyxiation
- Chemical
- Etiological
- Mechanical
- Psychological
What can biological incidents present as
Focused or public health emergency
Focused emergency
- Type of biological incident
- Potential or actual point of origin located; attempts made to prevent or minimize damage and spread
Public health emergency
- Type of biological incident
- Sudden demand upon public health infastructure with no apparent explanation
What are causative agents of biological incidents
- Bacteria
- Viruses
- Toxins
What are the four major routes of entry to the body in a biological incident
- Absorption
- Ingestion
- Injection
- Inhalation
Exposure vs contamination
- Exposure: Substance taken into body through route of exposure
- Contamination: Substance clings to surface areas of body or clothing
Harms of Biological Incident
- Chemical (secondary): Scene of lab
- Etiological (primary); Poisons
- Mechanical (secondary): Explosives used to disperse agents
- Psychological (secondary)
Why is radiological dispersion difficult to detect
Radiation symptoms are delayed for hours or days
Harms of radiological/nuclear incident
- Thermal (primary): Nuclear explosion
- Radiological (primary) Radiological materials
- Chemical (secondary): Radiological substances are also chemical hazards
- Mechanical (primary): Explosion
- Psychological (secondary)
Self-protection measures for radiological/nuclear incident
Time, distance, shielding
Harms of explosive incident
- Thermal (primary): Heat of detonation
- Asphyxiation (secondary): possibility of extremely dusty conditions
- Chemical (secondary): Result of explosive reaction from chemicals present at detonation site
- Mechanical (primary): Typically seen at bombing incidents
- Psychological (secondary)
Self protection measures for explosive incidents
- Preblast protection: Operations occurring after written or verbal warning received but before explosion takes place
- Postblast: Operations occurring after at least one detonation
Dissemination of CBRNE Materials
- Respiratory (most effective/common)
- Ingestion route
- Dermal route
- Human-to-human contact
Weaponization of CBRNE Materials
- Most effective when targeted through inhalation route
- Particles in 3-5 micron size
- Such airborne dissemination can be created by applying energy to material
- Heat, explosives, sprayers can aerosolize materials
Classes of chemical agents
- Choking agents
- Vesicating (blister) agents
- Cyanides
- Nerve agents
- Riot Control agents
Classes of chemical agents: Choking agents
Predominately respiratory
Vesicating (blistering) agents
Cause chemical changes in cells of exposed tissue
Classes of chemical agents: Cyanides
Prevent use of oxygen within cells
Classes of chemical agents: Nerve Agents
Inhibit enzyme critical to proper nerve transmission, causing out of control parasympathetic nervous system
Classes of chemical agents: riot control agents
Irritating materials and lacrimators (tear-flow increasers)
Nerve agents
- SLUDGEM
- Salivation
- Lacrimation
- Urination
- Defecation
- GI Upset
- Emesis
- Miosis
Effects of radiation
Radiologic exposure affects bone marrow, GI system, central nervous system
Blast injury patterns
- Lung injury: Bradycardia, apnea, hypotension
- Ear injury: Rupture of tympanic membrane
- Brain injury: Concussion or mild traumatic brain injury (MTBI) from blast wave
What is the most common type of rescue across the US
A vehicle collision where extrication of the patient is required
What should first-arriving units do in a highway accident
- Establish command and confirm exact location of incident with dispatch center
- Use apparatus to institute upstream blocking to protect work area
- Rescue trucks arriving to perform extrication should be positioned downstream of initial blocking vehicle
