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EMS Protocols 2015 > General Information > Flashcards

General Information Flashcards

1
Q

Who’s responsibility is it to maintain a thorough and ongoing run review process?

A

Each Department

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2
Q

How frequent are medical director audits?

A

Random

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3
Q

The random audit is a part of each departments what?

A

Risk Management and Quality Assurance obligations

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4
Q

Random Audit is used for what 3 reasons?

A
  1. Assure standards of pt care are being met as are generally outlined in the protocols.
  2. To assure that refusal and trip destination policies are being adhered to.
  3. To identify areas in which continuing education is necessary.
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5
Q

Who’s responsibility is it to maintain the overall skills and competencies of EMS personnel?

A

Each Department

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6
Q

Frequency of Skills check offs?

A

Annual

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7
Q

Who’s responsibility is continuing education?

A

EMS personnel and their department

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8
Q

To what 3 persons shall medical control be extended to?

A
  1. Any EMS entity functioning in the EMS system.
  2. Any EMT-P student directly involved with department through an approved training program.
  3. Any EMS entity of your department functioning in a stand-by capacity at a special event as part of the EMS system.
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9
Q

When shall Medical control be utilized? 4

A
  1. Whenever the EMS entity wishes to utilize Medical Control.
  2. When the protocol indicates Medical Control orders only.
  3. When the patient’s complaint does not match a protocol.
  4. When the paramedic wishes to deviate from a protocol.
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10
Q

When shall standing orders be utilized?

A

After assessment performed and clinical indications are present to initiate the orders.

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11
Q

Required each time standing orders are utilized?

A

Contact with the receiving hospital with a verbal report prior to arrival

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12
Q

Who can create Medical Control orders?

A

Only a State of Texas licensed physician

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13
Q

When an order is given who is applicable to?

A

ALL EMS entities involved in the care of the patient

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14
Q

When a physician directed order is made what shall be done before closing the call?

A

Documentation in the PCR

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15
Q

For Medical Control who should the agency contact?

A

Their Medical Director or the hospital which provides Medical Control as described in the contract.

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16
Q

For out of city response what protocols shall an EMS entity provide care under as a part of their normal course of duty and equipped to their scope of practice?

A

These Protocols

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17
Q

When transferring care to another EMS entity what is required?

A

The receiving EMS entity is equal or higher in their scope of practice

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18
Q

When a bystander at scene identifies as a healthcare professional how may they assist? 3

A
  1. Within their scope of practice
  2. Under their professional license
  3. Under their own liability
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19
Q

In the event of a conflict between Medical Control orders an an on-scene healthcare professional what shall occur?

A

Medical Control orders shall be followed

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20
Q

Under these protocols what medications can an EMT-B administer?

A

Epinephrine (auto-injector)
Oral Glucose
Aspirin
Albuterol/Atrovent

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21
Q

Under these protocols what medications can an EMT-B assist with?

A

Assist pt with own bronchodilator administration (metered dose inhaler-MDI)
Assist pt with own nitroglycerin

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22
Q

What advanced access may an EMT-B make?

A

Intraosseous

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23
Q

What airway adjuncts may an EMT-B use?

A

OPA
NPA
King Airway

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24
Q

In addition to what an EMT-B can administer what medications may an EMT-I administer?

A

Narcan

Dextrose (non-oral)

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25
Q

In addition the the advanced access and EMT-B can make how can an EMT-I make advanced access?

A

Peripheral intravenous access (including external jugular)

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26
Q

In addition to the airway adjuncts an EMT-B may use what airway adjuncts can an EMT-I use?

A

Endotracheal Intubation (nasal and oral)

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27
Q

What 4 skills can an EMT-P not perform but a Critical Care paramedic can perform?

A
  1. Intravenous Pump Management
  2. Ventilator Management
  3. Continuation of advanced IV drips
  4. Continuation of advanced lines/chest tubes.
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28
Q

What is meant by “Appropriate Facility?”

A

A hospital that will best address the pt’s medical needs.

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29
Q

Adult trauma pt’s should be transported to what appropriate facility?

A

Level 1, 2, or 3 trauma center either by ground transportation or aero-medical transport.

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30
Q

If an adult trauma pt is unstable what appropriate facility should they be transported to? Why?

A

Nearest Emergency Department

For Stabilization

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31
Q

2 Criteria requiring a pt to be transported to the nearest appropriate Level 1 or Level 2 Trauma Center

A
  1. Significant facial trauma (displaced mandible, orbital or mid-face fractures (excluding nasal fractures))
  2. Amputations proximal to the wrist or ankle
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32
Q

Burn Center Transport Criteria

A

Partial/Full thickness burns (>20% Adult BSA, >10% Peds BSA, facial, inhalation, genitalia)

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33
Q

17 Level 1,2, or 3 Trauma transport criteria

A
  1. Intubated/respiratory distress
  2. SBP<90 (if age >65 SBP <110) or pediatric age appropriate hypotension
  3. Adult GCS <12, Peds GCS<13
  4. Penetrating injury to head, neck, chest, abdomen and/or pelvis
  5. Fracture with pulseless extremity
  6. Ejection from vehicle, rollover or major vehicle deformity
  7. Auto-ped or Auto-bicycle with impact >5mph
  8. Motorcycle crash >20mph or with separation from bike
  9. Femur fx or two long bone fxs (not tibia/fibula or radius/ulna)
  10. Falls >10 ft (peds 2x height)
  11. MVC w/ collision speed >40 mph
  12. Extrication time >20 minutes
  13. Burns (thermal or electrical) not meeting Level 1 or 2 transport criteria
  14. Head trauma w/ persistent GCS <14 or spinal trauma with neuro deficit
  15. Hanging
  16. Paralysis or other sign of spinal cord injury
  17. Death in the same vehicle
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34
Q

Unstable Pedi pt meeting trauma transport requirements shall be transported where? Why?

A

Nearest Emergency Department

For Stabilization

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35
Q

Stable Pedi pt >14 years old meeting trauma transport requirements shall be transported where?

A

Appropriate Trauma Center

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36
Q

Stable Pedi pt <14 years old meeting trauma transport requirements shall be transported where?

A

Cook Childrens Medical Center- Fort Worth

Childrens Medical Center- Dallas

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37
Q

Pedi Trauma pt not meeting trauma transport requirements shall be transported where?

A

Facility of choice (in compliance with policy) as determined by family member giving consent or to the nearest ED if a preference is not expressed.

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38
Q

6 unstable trauma pts requiring transport to the nearest ED for stabilization

A
  1. Tension Pneumothorax
  2. Obstructive airway
  3. Massive facial and neck injury compromising airway
  4. Traumatic arrest with ongoing CPR
  5. Burn pt with potential airway compromise
  6. Patients necessitating emergent blood transfusion
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39
Q

Pt not meeting trauma criteria should be transported to the hospital of choice with due consideration of what 3 things?

A
  1. ED’s status (open or closed)
  2. EMS system operational status
  3. Facility where the pt routinely obtains medical care for continuity of care
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40
Q

Pt with an unstable hemodynamic status should be transported where?

A

Nearest appropriate ED

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41
Q

7 presentations with which a pt is considered unstable

A
  1. Altered Mental Status (unless normal for pt)
  2. Symptomatic bradycardia or tachycardia
  3. Severe difficulty breathing
  4. Airway obstruction that cannot be relieved
  5. Symptomatic hypotension
  6. Suspected high-risk OB pt
  7. Pt w/ existing condition which may deteriorate or not tolerate extended transport time which may result in an unfavorable outcome.
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42
Q

Who should the primary paramedic consult with if the pt stability is in question?

A

Medical Control

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43
Q

Stable medical pt should be transported where?

A

Local destination of their choice and if no preference then to the nearest ED.

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44
Q

Stroke pt should be transported where?

A

Nearest stroke approved facility

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45
Q

If strong suspicion of non-traumatic intracranial hemorrhage what should be considered when choosing a facility for transport?

A

Neurosurgery coverage

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46
Q

STEMI pt should be transported where?

A

Closest facility with 24/7 Interventional Cardiology available.

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47
Q

CPR w/ ROSC pt should be transported where?

A

Nearest hypothermia capable facility with 24/7 Interventional Cardiology available

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48
Q

Premature delivery of a fetus <37 weeks gestation with a mother who is stable should be transported where?

A

Facility with a Neonatal Intensive Care Unit

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49
Q

Premature delivery of a fetus <37 weeks gestation with a mother who is unstable should be transported where?

A

Nearest ED for stabilization

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50
Q

Stable OB pt <20 weeks should be taken where?

A

Patient Preferred facility

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51
Q

Unstable OB pt <20 weeks gestation should be taken where?

A

Closest facility

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52
Q

OB pt >20 weeks gestation should be taken where?

A

Closest facility w/ a Labor and Delivery Unit

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53
Q

True or False
Depending on the case and complaint an OB pt may either go directly to L&D or be seen in the ED to rule out non-OB emergent issues.

A

True

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54
Q

Once Aero-medical is en route to the scene who may cancel the request?

A

The Pilot or medical personnel in attendance with the pt at the scene.

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55
Q

Who reviews aero-medical scene response requests?

A

Medical Director as a part of the EMS QA program

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56
Q

6 criteria for Aero-medical transport

A
  1. Pt located in remote or off-road area not readily accessible to ground ambulance
  2. Ground resources exhausted or exceeded
  3. Special environmental conditions which affect potential pt outcome or prohibit ground access to hospital
  4. Pt w/ >20 minute extrication time
  5. When ground transport times exceed 45 minutes to appropriate facility
  6. Scene commander feels the benefits outweigh the risks
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57
Q

Define Person

A

Any individual that EMS encounters who does NOT demonstrate any known/suspected illness/injury AFTER and evaluation may be released.

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58
Q

6 Circumstances which may make an individual a pt

A
  1. Any individual who activates EMS for themselves
  2. Any individual for whom 911 is activated on their behalf AND has a chief complaint or injury
  3. Any individual with an injury or illness
  4. Any individual with a medical or traumatic complaint
  5. Any individual with a NEW altered level of consciousness
  6. Any individual where EMT/Paramedic suspects injury due to mechanism
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59
Q

Define Incapacitated

A

Lacking the ability, determined by reasonable medical judgement, to understand and appreciate the nature and consequences of a treatment decision, including the significant benefits and harms of, and reasonable alternatives to, any proposed treatment decision.

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60
Q

What kind of needs does the medical community believe EMS entities are required by the public for?

A

Anticipated or Actual medical needs

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61
Q

Though suffering from an illness or injury members of the public may decline all or part of treatment or transport if what 2 factors are NOT present?

A
  1. Impaired capacity to understand the emergent nature of their medical condition due to, but not limited to alcohol, drugs, medications, mental illness, traumatic injury, or grave disability
  2. Legal Minority
62
Q

4 conditions when it is the responsibility of the EMS entity to render the indicated emergency treatment and transport

A
  1. When medically indicated
  2. When requested to render treatment and/or transportation
  3. When evidence for impaired capacity exists
  4. When not of legal majority
63
Q

When is EMS required to complete a PCR?

A

For every pt contact with a chief complaint or injury

64
Q

What shall the PCR contain?

A

Supporting documentation on treatment and/or transportation refused

65
Q

For a refusal that provider believes should be transported what 4 steps may be taken?

A
  1. Have partner offer treatment and/or transport
  2. Consider law enforcement early if there is a threat to self, others, or grave disability
  3. Have supervisor assist in offering transport
  4. Contact medical control in close proximity to pt to assist in offering treatment and/or transport so that direct communication between physician and pt may occur
66
Q

Who may consent to or refuse treatment?

A

Pt
Responsible Adult Relative
Legal Guardian

67
Q

Age requirements for a pt to refuse or consent to treatment

A

18 years of age or older

Between 16 and 18 years and “emancipated”

68
Q

Definition of “emancipated” in regards a pt between 16 and 18 years of age

A

Living apart from his/her parents, WITH OR WITHOUT written evidence of emancipation.
Female w/ baby/child
Married person of either sex

69
Q

9 people who may consent to medical, dental, psychological, and surgical treatment of a child when the person having the right to consent cannot be contacted and has not given actual notice to the contrary

A
  1. Grandparent of the child
  2. Adult brother or sister of the child
  3. Adult aunt or uncle of the child
  4. Educational institution in which the child is enrolled w/ written authorization to consent from the person having the right to consent
  5. Adult w/ actual care, control, and possession of child w/ written consent from the person having the right to consent
  6. Court having jurisdiction over a suit affecting the parent-child relationship of which the child is the subject
  7. Adult responsible for the actual care, control, and possession of a child under the jurisdiction of a juvenile court or committed by a juvenile court to the care of an agency of the state or county
  8. A peace officer who has lawfully taken custody of a minor if the peace officer has reasonable grounds to believe the minor is in need of immediate medical treatment
  9. Texas Youth Commission when the child has been committed to it under Title 3 and when the person having the right to consent has been contacted and has not given notice to the contrary
70
Q

5 situations in which a child may consent to medical treatment

A
  1. On active duty with the armed services of the United States of America
  2. 16 years of age or older and resides separate and apart from the child’s parents, managing conservator, or guardian WITH OR WITHOUT the consent and regardless of the duration of the residence and is managing the child’s own financial affairs regardless of the source of income
  3. consents to the diagnosis and treatment of an infectious, contagious, or communicable disease require by law or rule to be reported including all diseases with the scope of section 81.041
  4. unmarried and pregnant and consents to hospital, medical, or treatment other than abortion and related to the pregnancy
  5. Consents to examination and treatment for drug or chemical addiction, dependency, or any other condition directly related to drug or chemical use.
71
Q

4 conditions which must all be met for a pt to be considered mentally competent.

A
  1. Capable of Understanding the nature and consequences of the proposed treatment and implications of refusal of that treatment
  2. Awake, alert and fully oriented to time, person, place, and situation
  3. No signs of injury or illness which may impair the ability to make an informed decision
  4. Not Suicidal and or homicidal
72
Q

In the order of priority who has the decision making capacity to consent to treatment for an adult pt who is comatose, incapacitated, or otherwise physically or mentally incapable of communication?

A
  1. Pt spouse
  2. Adult child of the pt who has the waiver and consent of all other qualified adult children of the pt to act as the sole decision-maker
  3. Majority of the pt’s reasonably available adult children
  4. Patients parents
  5. Individual clearly identified to act for the pt by the patient before the pt became incapacitated, the pt’s nearest living relative or a member of the clergy
73
Q

If pt not mentally competent and no adult surrogate capable of consenting for pt is available what should occur?

A

Treatment and Transport to the appropriate ED.

74
Q

Can the consent or refusal of a legally responsible present person who is of age and competent be ignored?

A

No

75
Q

For a refusal by a competent pt what 4 assessment findings should be documented?

A
  1. Pt level of orientation
  2. Pt level of consciousness
  3. Whether there is a head injury
  4. Whether the pt is under the influence of drugs or alcohol.
76
Q

For a refusal by a competent pt what 5 things should be documented on the PCR?

A
  1. All cases in which pt refuse care and has a chief complaint or injury
  2. All cases where there is an assessment of competency
  3. Name and phone number of the pt refusing care
  4. All pertinent information clearly and concisely written in summary report
  5. Authoritative witnesses should be documented
77
Q

When shall a PCR be completed for a call?

A

For every pt contact w/ a chief complaint or injury

78
Q

For inter-hospital transfers can an unstable pt be transferred?

A

No

79
Q

For inter-hospital transfers who is responsible to contact the receiving physician?

A

The transferring physician prior to transfer in order to gain appropriate acceptance.

80
Q

For inter-hospital transfers what should EMS use to guide changing pt condition?

A

Protocol

81
Q

For inter-hospital transfers what is the protocol if the pt becomes unstable during transport?

A

Stop at the nearest ED for stabilization

82
Q

For inter-hospital transfers what does the DOPE acronym for failure stand for

A

Dislodged
Obstructed
Pneumothorax
Equipment

83
Q

4 Requirements to determining death

A
  1. Visual examination of the body/remains with sufficient proximity and lighting to assure existence of the death determining condition
  2. Physical examination of the body/remains (must touch the body and expose the area to sight as necessary to determine the existence of the condition
  3. Must be pulseless and apneic (must check for breathing and central pulse, carotid preferred or femoral if unable for at least 10 seconds
  4. Cardiac Monitoring (must be asystole on the monitor, running at least 6 second strips in 2 different leads) if other than asystole on the monitor contact medical control for guidance.
84
Q

6 Conditions in which minimal confirmation necessary to determine death

A
  1. Decapitation
  2. Incineration
  3. Decomposition
  4. Rigor mortis
  5. Lividity
  6. Submersion greater than one hour
85
Q

Once death has been determined who should EMS move to transfer responsibility or management of the scene/ body to?

A

Law Enforcement Agency and/or Medical Examiner’s Office

86
Q

9 Circumstances that must be present in order to cease resuscitation efforts in the field

A
  1. Pt age >18, not pregnant and not traumatic
  2. Scene safe and situation appropriate
  3. Initial EKG rhythm obtained by EMS was asystole
  4. 15 minutes of ACLS performed with no change in rhythm
  5. Not related to hypothermia
  6. Successful advance airway placed
  7. No return of pulse, no spontaneous respirations, no eye opening, no motor response, no improvement of neurologic activity
  8. Police/ Medical Examiner called
  9. Either police, medical examiner, or ems personnel must stay on scene with the deceased until transported from the scene
87
Q

2 possible proofs of DNR

A
  1. Intact, unaltered, easily identifiable Texas DNR bracelet

2. Intact, unaltered Texas DNR form (a copy is allowed)

88
Q

If provided with proof of a DNR but only after resuscitation efforts have been initiated what must EMS do?

A

Discontinue resuscitation efforts

89
Q

3 ways by which the person who enacted the DNR may revoke it

A
  1. Destroying the DNR document
  2. Removing the identification device
  3. Giving verbal revocation
90
Q

If pt with a DNR expires en route to the hospital what is the protocol?

A

Continue to the destination hospital

91
Q

If a pt with a DNR expires during a transfer from one facility to another what is the protocol?

A

Transport pt to the nearest emergency department for pronouncement

92
Q

Define Out of Hospital DNR

A

Directive to health care professional in the out of hospital setting to withhold or withdraw specific life sustaining treatments in the event of respiratory or cardiac arrest

93
Q

Define Health Care Professional

A

Physicians,
Nurses,
EMS,
Physician’s Assistants

94
Q

What 5 life sustaining treatments are prohibited by a DNR?

A
  1. CPR
  2. Transcutaneous Cardiac Pacing
  3. Defibrillation
  4. Advanced Airway Management
  5. Artificial Ventilation
95
Q

Are comfort (palliative) measures prohibited under a DNR?

A

No. The are specifically allowed.

96
Q

On the OOH DNR Form who may make the declaration?

A
  1. The Adult person
  2. Legal guardian, agent in medical power of attorney, or a proxy
  3. Qualified relative: spouse, adult child, parent, nearest living relative
  4. physician based on directive to physicians by person now incompetent or nonwritten communication to the physician by a competent person
  5. On behalf of a minor by a parent, legal guardian, or managing conservator.
97
Q

How many witnesses are required on the OOH DNR form?

A

2

98
Q

How many physician signatures required on behalf of adult pt who is incompetent or unable to communicate and without guardian, agent, proxy, or relative.

A

2

99
Q

What health and safety code regulates who is considered a qualified adult?

A

166.088

100
Q

Who regulates how controlled substances are to be stored?

A

DEA

101
Q

When should the controlled substances storage container be inspected?

A

At every shift change

102
Q

What should occur if inspection of the controlled substances container reveals a broken lock?

A

The contents will be checked and logged appropriately, both the oncoming and off going paramedics will jointly count, date, time, and sign the Controlled Substances Signature Log. Discrepancies will be reported immediately to the immediate supervisor.

103
Q

What policy regulates how controlled substances shall be re-supplied?

A

The narcotic supply exchange policy

104
Q

5 Personal protection measures available when personnel are treating a pt whom they suspect has a blood borne infections disease

A
  1. Disposable medical gloves
  2. Disposable surgical masks
  3. Plastic goggles
  4. Personal decontamination prophylaxis at the conclusion of pt contact (ie hand washing)
  5. Restraint from non-essential invasive therapy
105
Q

5 Conditions by which an employee is considered exposed

A
  1. Pt secretions in an eye
  2. Needle stick from a contaminated needle
  3. Mouth-to-mouth contact during resuscitation
  4. Prolonged contact with pt blood or other body fluids through field personnel’s abraded or open skin
  5. Respiratory contact with airborne infected individual
106
Q

In the event of an exposure the employee should: (3)

A
  1. Notify ED physician at receiving hospital and request that the pt be evaluated for the presence of a blood-borne infection disease including appropriate corroborative blood tests as deemed necessary by the physician.
  2. Obtain pt information
  3. Contact appropriate EMS supervisor to obtain and complete an incident form
107
Q

6 pieces of pt information that should be obtained when an exposure has taken place

A
  1. Pt name
  2. Date of birth
  3. Address of incident
  4. Time of incident
  5. Receiving hospital
  6. Incident number
108
Q

6 requirements to pt being treated and transported without spinal motion restriction in place

A
  1. Age between 13 and 65
  2. Vitals within normal limits
  3. Reliable historian: A&Ox4, GCS 15
  4. No distracting injuries
  5. Normal neurologic function (able to move all extremities/ no numbness or tingling present)
  6. Absence of any neck or back pain or tenderness on palpation or pain with range of motion
109
Q

3 Other considerations when deciding on spinal motion restriction

A
  1. Consider mechanism and have a low threshold to immobilize with high mechanism
  2. Previous spinal injury or surgery
  3. History of osteoporosis
110
Q

4 Steps for spinal immobilization of the ambulatory pt

A
  1. Maintain manual in line stabilization of the C spine while preparing for C-Collar placement
  2. Perform brief neurologic exam for the presence of movement and sensation to light touch in all extremities
  3. Place appropriately sized C-Collar after evaluating the C spine for point tenderness or step off
  4. If the pt can self extricate bring the cot the the pt and have the pt sit down then lie flat
111
Q

4 Steps for the spinal immobilization of the non-ambulatory pt

A
  1. Maintain manual in line stabilization of the C spine while preparing for C-Collar placement
  2. Perform brief neurologic exam for the presence of movement and sensation to light touch in all extremities
  3. Place appropriately sized C-Collar after evaluating the C spine for point tenderness or step off
  4. A long spine board, scoop stretcher, or vacuum body splint may be used as an extrication tool to transfer the pt to the ambulance cot. Long spine board or scoop is removed prior to transport. Vacuum body splint may be left in place
112
Q

3 Special circumstances to consider with spinal immobilization

A
  1. Obese or pregnant pt who is dyspneic-the head of the cot may be raised to no more than 20 degrees
  2. If vomiting the pt may be placed on his side maintaining neutral spine position
  3. If active CPR taking place, transport on spine board to facilitate the efficacy of the compressions
113
Q

Definition of a Mass Casualty Incident

A

Any incident in which the on-scene providers establish a treatment area to care for multiple victims. MCI may overwhelm response capability and require assistance from outside agencies

114
Q

6 steps in the MCI plan

A
  1. Institute the Incident Command System
  2. Triage utilizing the START method
  3. Establish appropriate zones and sectors
  4. Contact medical control and appropriate facilities, including a request for EMS system notification as appropriate
  5. Transport pts to facilities as directed by the transportation officer
  6. Debriefing and incident critique
115
Q

Step 1 of MCI plan is to institute ICS. What are the initial responding units responsible to do at start?

A

Assure scene safety and summon additional units

116
Q

Step 2 of MCI plan is triage using START. What does START triage do?

A

Allow EMS at any training level is triage victims in 60 seconds or less depending on 3 observations

117
Q

During START triage what treatments may be performed?

A

Minimal intervention to stabilize the airway or control hemorrhage done at the same time as triage.

118
Q

What categories of pt are identified during triage?

A

Dead
Immediate
Delayed
Minor

119
Q

Step 3 of MCI plan is to establish zones and divisions. If the incident is a HAZMAT what 3 zones should initial units consider establishing?

A

Hot
Warm
Cold

120
Q

Step 3 of MCI plan is to establish zones and divisions. Other than incident command what are possible divisions that may be considered?

A 
Treatment
Transportation
Staging
Rehab
Safety Officer
Liaison Officer
121
Q

What system may be used to keep up with responders and their assignments at and MCI?

A

PASS system

122
Q

How should various division commanders of an MCI be easily identified?

A

With vests or another acceptable method

123
Q

How should various sectors of an MCI be easily identified?

A

Flags, cones, tarps, or another acceptable method with apparent entrances and exits

124
Q

How should the incident command post of an MCI be identified?

A

Green emergency light or another easily identified green marker

125
Q

Step 4 of the MCI plan is to notify medical control and the other appropriate facilities. Who is responsible for this?

A

The transportation officer or someone assigned to this duty

126
Q

Step 5 of the MCI plan is to transport the pt. Who decides where the pt will be transported?

A

The transportation officer

127
Q

Step 5 of the MCI plan is to transport the pt. If a deviation from the intended destination is made what should occur?

A

Deviation reported back to that sector commander

128
Q

Step 6 of the MCI plan is to debrief the MCI and critique events. When should this be scheduled?

A

After the entire event has been completed

129
Q

Step 6 of the MCI plan is to debrief the MCI and critique events. What else should be considered during this time?

A

Consideration to a critical stress defusing and/or debriefing including all involved parties

130
Q

If a vehicle has a diamond shaped placard or an orange panel on its side or rear what should be assumed?

A

Cargo to be hazardous

131
Q

Where should you park at a suspected hazardous material incident?

A

Uphill and Upwind unless directed otherwise by a competent authority

132
Q

If EMS is the first arriving agency to a HAZMAT what should they do?

A

Establish hot, warm, and cold zones. Do NOT approach the pt.

133
Q

If another appropriate agency is onscene first where should EMS respond?

A

Staging

134
Q

4 Contamination precautions when at a HAZMAT incident

A
  1. Insure pt has been decontaminated and clothing and belongings removed (clear with HAZMAT team)
  2. Implement department approved isolation techniques for MICU
  3. Treat pts that are symptomatic with appropriate protocols
  4. Contact medical control for further guidance as necessary
135
Q

7 Considerations when transporting a pt from a HAZMAT scene

A
  1. Assure crew safety first
  2. Record all product information and transport with victim
  3. Obtain advice for further decontamination of vehicle or personnel from HAZMAT team
  4. Provide name of chemical/agen to ED staff PRIOR to hospital arrival
  5. Double bag any contaminated clothing, equipment, sheets or blankets
  6. Delay pt unloading until cleared by ED staff
  7. Implement any secondary decontamination procedures for vehicle or personnel if necessary
136
Q

All pts transported by stretcher are require to have what at all times?

A

Lap belt

137
Q

All ambulatory pts transported by ambulance whether in the cab or pt compartment are required to have what at all times?

A

Standard seat belt restraints

138
Q

Describe how the decision to restrain a violent pt should be executed

A

Swiftly and Completely using “reasonable force” if necessary

139
Q

1st of 8 guidelines to physical restraint of a pt

A

Use minimum physical restraint require to accomplish necessary pt care and ensure safe transportation

140
Q

2nd of 8 guidelines to physical restraint of a pt

A

Avoid placing restraints in such a way as to preclude evaluation of pt medical status or in a way which will interfere with necessary pt care activities or possibly cause further harm

141
Q

3rd of 8 guidelines to physical restraint of a pt

A

Ensure sufficient personnel are present to control pt while restraining. Use law enforcement when available

142
Q

4th of 8 guidelines to physical restraint of a pt

A

Make sure the pt is always face up

143
Q

5th of 8 guidelines to physical restraint of a pt

A

Secure ALL extremities in a manner that ensures pt and EMS safety

144
Q

6th of 8 guidelines to physical restraint of a pt

A

If necessary use cervical spine precautions to control violent head or body movements

145
Q

7th of 8 guidelines to physical restraint of a pt

A

Place padding under pt head and wherever else needed to prevent the patient from further harming themselves or restricting circulation

146
Q

8th of 8 guidelines to physical restraint of a pt

A

Law enforcement may place pt in restraints requiring a lock but must ride with EMS and pt and be in possession of the key with capability of immediate release of restraint if necessary

147
Q

4 Patients who may benefit from chemical restraint over physical restraint if necessary

A
  1. Alcohol and/or drug-intoxicated patients
  2. Restless, combative head-injury patients
  3. Mental Illness patients
  4. Physical abuse patients (more humane than physical restraints)
148
Q

During chemical restraint what should you be prepared for from the administration of the sedative?

A

Possible hypotensive side effects

149
Q

When chemical restraint is used when should vitals be assessed?

A

Within the first 5 minutes and thereafter as appropriate

150
Q

Why is chemical restraint beneficial to the violently combative pt?

A

The pt stands a lesser chance of injury when sedated

151
Q

7 Things you should document when chemically restraining a pt

A
  1. In what manner was your pt violent (pt comments verbatim)
  2. Did you feel threatened and why?
  3. Were you concerned about your pts outcome without emergency medical interventions and why?
  4. Could you treat your pt appropriately without the use of restraints?
  5. What law enforcement officer was present?
  6. Who was the medical control physician?
  7. Document the frequency of respiratory and mental status change assessments

EMS Protocols 2015 (8 decks)

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