General Standards of Care Flashcards
When is the general standard of care applicable?
- At all things when a paramedic is providing pt care while on duty
- Pt care provided by a paramedic in general
- Pt care pertaining to certain illness/injury
- Under all environmental conditions providing personal safety
General measures: Pre-scene/at scene, paramedic will?
- Use appropriate route and speed (Marvilis), operate lights amd sirens responsibly
- Confirm call info and location
- Upon arrival at scene, assess environment (Routes of entry/exit, safety)
- EMCA
How do you request assistance from allied sources?
• 10-200, 10-2000, red button
Upon approaching pt, paramedic shall?
- Introduce yourself & partner
- Gain consent
- Establish trust
- Protect pt from hazards and exposure to environmental conditions
- Wash hands after each pt contact
Operational procedures directly/indirectly impacting pt care on regular basis
- Personal Cleanliness
- Cleanliness/decontamination, maintenance, safety of the equipment and ambulance itself (vehicle checks)
- Completion of Ambulance Call Reports
- Familiarization or legislation, standards, and procedures Pertaining to health and safety, and communicable diseases
- participation in training and continuing education
Patient assessment
• Regardless of dispatch priority coding, assume existence of serious life-threatening conditions until proven otherwise
Environmental Assessment
- Pt condition
- House condition
- Demeanor of family
- Seek medical information, medical alerts, medications
- collect and transport other relevant identification (health card)
History Assessment: Concurrent with or following the primary survey
- Establish CC, why pt called?
- listen history of present illness or incident:
- question patient directly, question others on scene
- seek medical identification
- observe patient behaviour
- sample history
- determine CTAS level
Physical assessment: performing primary survey
• Look test • C-spine • AVPU • ABC’s (clear ABC’s before moving on) • Look for external hemorrhage • Establish baseline vitals: - HR - RR - BP - SPO2 - GCS - Pupils - Skin • Load & Go decision
- primary survey completed within two minutes unless major problem encountered*
If a patient is uncooperative or combative leading to limitations in your assessment what do you do?
- Do your best to game patient’s consent
* if patient remains uncooperative: document, document, document!
Initiate cardiac monitoring on the following patients:
- VSA
- Moderate/severe shortness of breath
- Unconscious/altered LOC
- collapse, syncope (fainting)
- suspected cardiac ischemia
- CVA (stroke)
- Overdose
- Major/Multi trauma
- Electrocution
- Submersion injury
- hypo/hyperthermia
- abnormal vitals or alteration in cardiac rhythm
Secondary exam/ongoing exam
• Elicit history if not already done
• Vitals:
-RR, skin, pulse, BP, pupils, GCS
• perform complete head to toe
- should be completed in five minutes or less*
How often should you repeat ABC’s?
- Every 10 minutes minimum
* continually monitor and reevaluate
Patient transport: If patient deteriorates in route two originally selected facility you should?
• take patient To the most appropriate hospital in closest proximity
Patient refusal of treatment and or transport: the paramedic will…
- where interventions are deem necessary in the patient refuses treatment or transport, try to explain possible consequences of such a refusal
- confirm patient or SDM has capacity utilizing aid to capacity assessment
- Advise patient to call 911 again if further concerns arise
- obtain appropriate documentation on ACR (signatures from patient, partner, and witnesses)
Carry out emergency transport If:
- patient is at risk if treatment is not administered
- patient is unable to understand information to make a proper decision
- patient is a child and it is not reasonably possible to obtain consent or refusal on persons behalf without putting patient at risk
- The communication required in order for patient to give or refuse consent can’t take place due to language barrier or disability
If the paramedic is unable to perform treatment due to patient violence, hostility, Or they are a danger to themselves, you should?
• advise dispatch
• request police assistance
• use physical restraint only if reasonable verbal efforts fail to calm pt
• remain at scene until police arrive
• maintain communication with dispatch
transport with police accompaniment if police agree to take patient in custody custody
If patient refuses treatment and is capable of understanding risks
- If life-threatening illness or serious condition suspected, attempt to call EMS supervisor for advice
- Call bass hospital physician for advice
• if patient continues to refuse treatment give them, or other responsible adult present instructions regarding observations and other information
Patient care on route
- attend to patient at all times
- Complete history and secondary assessments
- initiate and maintain appropriate management interventions
- continuous monitoring of ABC’s
- if deterioration of ABCs, repeat primary survey
Enroute
- have equipment ready and accessible
- Monitor vitals every 5 to 10 minutes for CTAS 1-2 pts
- maintain patient comfort
- patch for CTAS 1-2 pts
Radio reporting: Information You will provide to receiving hospital?
- Unit number
- # of pts
- Age, gender, level of distress, LOA
- CC, brief history of patient illness/injury
- Vitals, working assessment, treatment, and response
- CTAS & ETA
Transfer of care: upon arriving at facility
- attend to patient while awaiting staff acceptance
- provide a verbal report to medical/nursing staff:
-CTAS, brief history of current illness/injury, relevant past medical history, pertinent physical findings, management at scene and en route, patient response, vitals
Documentation: Went to complete and want to include?
- complete ACR for every call as soon as call is completed
- document concise description of assessment findings and pertinent scene observation
- include both positive and negative findings
- include all management and responses
- if something was not done, document reasons why
