General

Question 0

What info should be obtained on all pt.s?

Answer 0

Past medical history, current medications, and allergies should be obtained on all patients

Question 1

If you pull up to the scene of a cardiac arrest and a pumper or basic ambulance was first on scene what should be already attached to pt?

Answer 1

AED

Question 2

What exactly is TKO?

Answer 2

the term TKO means a rate of 30 ml/hr in adult patients and 20ml/hr in pediatric patients

Question 3

What should the detailed examination of a pt contain?

Answer 3

All patients should have a full examination of the affected organ system and related systems. Questions should be asked about history/function of those systems (i.e. Abdominal pain – vomiting/nausea/diarrhea/blood from either orifice, surgeries, prior occurrences, tumors, etc.). Pertinent positive and negative findings should be documented. (Example: Abdominal complaint exam should include localization of pain, distension, obvious discoloration; Breathing complaints should include chest wall injury, lung sounds – type and location, heart sounds, and ease of air entry

Question 4

When should morphine be used in mi/ cp pt?

Answer 4

Any adult patient with chest pain/MI and pain not relieved with 3 doses of nitroglycerin and oxygen may receive morphine 2 mg IV as a standing order without prior medical control approval. Further morphine needs to be approved by medical control prior to administration. An ALS number should be obtained and documented on the patient care report if more than 2 mg of morphine is administered

Question 5

What’s the standing order for morphine for trauma pt.

Answer 5

Any adult patient with a painful injury such as obvious fracture, dislocation, or burn may receive morphine 4 mg IVP as a standing order without prior medical control approval. Additional morphine needs to be approved by medical control prior to administration. An ALS number should be obtained and documented on the prehospital care report if more than 4 mg of morphine is administered

Question 6

What is the standing order for Valium?

Answer 6

Any adult patient who has been witnessed by the EMS crew or a reliable source to be seizing for more than two minutes may be administered diazepam 5 mg IM/IVP every 2 minutes as a standing order without prior medical control approval

Question 7

What are two situations in which pt. positioning is important?

Answer 7

Always consider proper patient positioning based on patient complaint/distress (i.e. respiratory distress – high Fowlers, low blood pressure – shock position (Trendelenberg

Question 8

When can ports and shunts be accessed?

Answer 8

Patients with indwelling IV access (ports, shunts, etc), should not have those devices accessed unless the patient is critical or in full arrest. In all cases, an attempt should be made to obtain IV/IO access prior to accessing those ports. If the patient is not critical or in full arrest, these ports should not be accessed.

Question 9

What is the procedure if you do not follow protocol?

Answer 9

Document any inability to follow protocols on the prehospital care report and document the reasons behind it on a Form 105 addressed to the Medical Director

Question 10

How must a pregnant pt. be transported and how far along must she be?

Answer 10

Pregnant patients over 20 weeks of gestation should be transported in left-lateral tilt. If this is not practical, manual left uterine displacement may be performed using the 1-handed or 2-handed technique

Question 11

When should communication with the receiving hospital take place?

Answer 11

Communication with the receiving hospital should occur at the earliest possible time for stable patients. For patients suffering from ST-elevation MI, stroke, or major trauma, communication with the receiving hospital should take place prior to leaving the scene

Question 12

What should a hospital radio report contain?

Answer 12

Identify yourself and medic unit to the hospital.
Report in MISTE format (along with age/sex if available): Mechanism of injury/nature of illness
Injuries/Illness Status, physiologic (i.e. rapid respiratory rate, thready pulse and vital signs)
Treatments rendered and response to treatment
Estimated time of arrival to receiving facility

Question 13

What should CVA radio reports contain?

Answer 13

For stroke patients, be sure to include the time of onset of symptoms and blood glucose level.

Question 14

What must a DNR contain?

Answer 14

Date and signature of patient or patient’s legal representative. Date and signature of the patient’s attending physician

Question 15

How do you properly document a DNR?

Answer 15

To properly document a DNR order, obtain a photo copy if possible, or document all of the above required information on the trip sheet

Question 16

What do you do if OHDNR pt codes en route

Answer 16

If the patient has a pulse and/or spontaneous respirations, transport the patient without providing cardiopulmonary resuscitation. If transporting a patient with a valid OHDNR order and the patient becomes pulseless and apneic, contact medical control and document time and monitor rhythm. Continue transport.

Question 17

What do you do with a DNR pt. who needs medical care but not CPR?

Answer 17

Dextrose 50% may be given without interfering with the DNR order. A patient may require only IV fluids, antibiotics or nutrition. A patient such as this should be discussed with medical control.

Question 18

What do you do when a pt. is on hospice and they are in cardiac arrest but do not furnish a valid DNR.

Answer 18

A patients who is in hospice is not necessarily (but usually is) DNR so unless papers are present, the patient should be resuscitated appropriately.

Question 19

What’s the proper course of action for any mix up with proper paper work for a DNR?

Answer 19

If there are any questions about the orders or paperwork, contact the primary physician or medical control.

Question 20

What should you do if you are unsure about hospital selection?

Answer 20

Contact a supervisor.

Question 21

What hospital can members of the STLFD go?

Answer 21

Members of the St. Louis Fire Department who are ill (on or off duty) or injured (off duty) may go to any city or county hospital of their choice.

Question 22

What is the procedure for a pt. that wants to go to a non approved county hospital?

Answer 22

If a patient requests a county hospital, a private ambulance service should be contacted and the medic unit must stay on scene and perform all necessary patient care until transferring the patient to the private ambulance service. Make sure to document on the run report the time of transfer and the unit identification of the ambulance assuming care of the patient.

Question 23

Where are critically injured pt.s to be transported?

Answer 23

Critically injured adult patients or patients weighing 50 kilograms (110 pounds) or more shall be transported to the nearest Level I Trauma Center (Barnes-Jewish Hospital or Saint Louis University Hospital)

Question 24

Where are critically ill pt.s to be taken?

Answer 24

Critically ill patients, including those in cardiac or respiratory arrest, shall be transported to the closest most appropriate hospital.

Question 25

Where are seriously burned pt.s to be transported?

Answer 25

Seriously burned patients may be transported to St. John’s Mercy Medical Center when the Barnes-Jewish Hospital Surgical Intensive Care Unit (SICU) does not have capability.

Question 26

What do you do when a critical pt. wants to go to a further hospital?

Answer 26

Patients who request county hospital and are critical/unstable should be transported to the closest appropriate hospital. Medical control should be contacted if necessary.

Question 27

What hospitals can ob pt.s go to?

Answer 27

Pregnant patients shall be transported, regardless of age, to Barnes-Jewish Hospital, St. Anthony’s Medical Center or St. Mary’s Health Center during normal operational status.

Question 28

What is the current diversion policy?

Answer 28

Current diversion policy states that no hospital shall be on diversion for overcrowding or manpower/technology issues. True diversion will only be in effect if there is a crisis situation at the hospital (power outage, fire, bomb threat, hostage situation, etc) and this information should be available via the EMSystem and announced to the crews.

Question 29

What conditions must be met for a physician to intervene on scene?

Answer 29

The physician must provide evidence of a State of Missouri medical license.
The physician must speak with an on-line Medical control physician.
The physician must agree to assume full responsibility for the patient and the patient’s care, and the on-line Medical control physician must directly advise the crews that they may take medical direction from the intervening physician.
The physician must accompany the patient to the hospital in the medic unit.
The physician must provide guidance for the run documentation, and sign the computer or paper sheet.
If all of the above does not apply, the physician may not provide on-scene medical direction

Question 30

What if the physician is posing a safety issue or Delegating things that are outside your scope?

Answer 30

Neither the EMT nor paramedic is to accept orders that are outside the scope of practice, or beyond the training or capabilities of the EMT or paramedic. If there is any disagreement, crews will request that their supervisor respond to the scene and defer to the on-line medical control physician. If the physician’s actions jeopardize the safety of the patient or any other person, or jeopardize patient care in any way, crews should immediately call for their supervisor and the police

Question 31

What if you know the physician personally?

Answer 31

If the physician is a local Emergency physician who is personally known to the crew, only the stipulations concerning scene safety apply. Otherwise the crews should take direction from the doctor just as they would if they were speaking over the phone or radio

Question 32

What if it is the pt.s physician?

Answer 32

if the patient or family members confirm that the person is the patient’s personal physician, and the physician confirms that there is a pre-existing doctor/patient relationship, the doctor enjoys special privileges by virtue of that relationship. The following procedures apply: EMTs and paramedics should defer to the orders of the patient’s personal physician. This includes, but is not limited to the right of that physician to pronounce death. Neither the EMT nor paramedic should accept orders that are outside the scope of practice or beyond the training or the capability of the EMT/Paramedic.

Question 33

What if the physician is trying to get you out of scope or so,etching that is dangerous?

Answer 33

If the physician’s orders or actions would put the patient at risk or are beyond the capability of the crew, the supervisor should be contacted and the Medical control physician should be contacted. Attempt to have any conflicts resolved via doctor-to-doctor communication, using EMS equipment (radio) if necessary.

Question 34

If the physician decides to accompany the crew to the hospital what responsibilities must he assume?

Answer 34

The physician must agree to assume full responsibility for the patient and the patient’s care, and the on-line Medical control physician must directly advise the crews that they may take medical direction from the intervening physician.
The physician must accompany the patient to the hospital in the medic unit.
The physician must provide guidance for the run documentation, and sign the computer or paper sheet.
If the physician is not willing to comply with all of the above stipulations, the physician may not accompany the patient to the hospital.
Once the physician is no longer in attendance, revert to normal operating procedures and protocols.

Question 35

What if a bystander trained in other medical skill would like to help with pt care?

Answer 35

The EMT or Paramedic may, at his/her discretion, allow such personnel to assist you with patient care. Some of these personnel have special skills such as intubation and IV placement. However, it is generally not appropriate to permit them to perform invasive procedures unless they are riding with the medic or have been otherwise positively identified. In these cases, the medic is still responsible for patient care and for verifying any procedure performed