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midterm Flashcards

1
Q

levels of paramedics

A

PCP, ACP, CCP

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2
Q

The ambulance act

A

to work as a paramedic you must have AEMCA, a graduate of a PCP program or equivalent w/ 70%, paramedic service operator can employ new PCPs for 210 days while waiting for AEMCA certification, six or more demerit points under highway traffic act, three years before employment date started be prohibited from driving a motor vehicle under the criminal code, free from all communicable diseases, immunization signed by physician, no conviction involving moral turpitude that has not been pardoned

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3
Q

What entities govern paramedic practice

A

MOH- provincial exam with over 70% to pass

BHP- certifies the medic to perform delegated “controlled medical acts”

EHS (employers)- hire medics and apply for certification with regional base hospital and MOH for our emergency health services card

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4
Q

Under what authority do paramedics practice

A

Ontario base hospital group

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5
Q

Medical directive

A

written order approved by a physician pertaining to any patient who meets the criteria. Provides authority to carry out treatments/ procedures/ interventions as specified in the directive if pt has certain conditions/ circumstances present

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5
Q

Direct order

A

instructions to another health care provider or group and the order is for one pt and to initiate a specific intervention/ treatment for a specific time that can be verbal or written

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6
Q

Can a paramedic do anything a m.d. can

A

PCPs delegated directives are found in ALS patient care standards

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7
Q

Delegated acts

A

BLS/ALS PCS dictates what we can/ cant do

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8
Q

Parts of ALS medical directive

A

indications, conditions, contraindications, treatment, clinical considerations

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9
Q

Indications

A

general complaint/CC to which directive applies

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10
Q

Conditions

A

clinical parameters that are present for a procedure to be performed or for a medication to be administered

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11
Q

Contraindications

A

clinical parameters that when present preclude the performance of a procedure/ administration of a medication

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12
Q

Treatment

A

description of the type of procedure to be performed or dosing of medication

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13
Q

Clinical considerations

A

key clinical point providing general guidance to the proper performance of a procedure/ administration of a medication

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14
Q

Auxiliary medical directive

A

additional skills to be delegated through use of the auxiliary medical directives that can be introduces after consultation and mutual agreement between RBH and service

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15
Q

Role as a student

A

a function or position where during placement is a learning opportunity of paramedicine

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16
Q

Responsibility as a student

A

perform as a team member and observe or assist when expected and possible

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17
Q

10-4

A

acknowledge transmission

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18
Q

10-7

A

out of service- arrived at scene

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19
Q

10-8

A

in service- mobile to a location

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20
Q

10-19

A

return to station

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21
Q

10-20

A

what is your location

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22
Q

10-200

A

need police

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23
Q

10-2000

A

need police immediately- urgent request

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24
Q

Who governs radio equipment standards for EMS

A

MOH

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25
Q

Main radio

A

only 1, controls all radio functions and all channel/repeater functions are completed here

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26
Q

Pt compartment radio

A

secured in rear compartment to allow medic to communicate as needed. Usually, the headset used to perform hospital patch

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27
Q

Portable radio

A

each medic gets one, red emergency button on microphone/ main part of portable for medics in case of emergency to call. Repeater channels are assigned on the main radio to match portable. Mode selections: MOB (mobile mode), SYS (system mode), LOC (local mode)

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28
Q

Acceptable words

A

acknowledge, affirmative, go ahead, how do you read/copy, negative, over, roger, standby, say again, verify

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29
Q

Phonetic alphabet

A

Alpha, Bravo, Charlie, Delta, Echo, Foxtrot, Golf, Hotel, India, Juliette, Kilo, Lima, Mike, November, Oscar, Papa, Quebec, Romeo, Sierra, Tango, Uniform, Victor, Whiskey, Xray, Yankee, Zulu

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29
Q

ISBAR- Identification

A

identify receiver, identify yourself and unit number

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30
Q

10-2000 panic alarm

A

SSC receives message and send page and waits 30 seconds for a response, if none given PD/FD is requested and a 2nd ambulance is dispatched to last known location of crew initiating panic alarm. SSC advises operations superintendent and NACS is updated via first arriving crew/allied agency about the situation

If the phrase “unit ___ 10-2000 Alpha Charlie” is not provided word for word the alarm is treated as real with appropriate actions

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31
Q

ISBAR- Situation

A

location, age, sex, wt, cc, calling regarding

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32
Q

ISBAR- Background

A

pertinent information, positive/negative findings, OPQRST, SAMPLE

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32
Q

ISBAR- Assessment

A

pertinent positive/ negative findings, physical exam, vitals, ECG

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33
Q

ISBAR- Response

A

response to treatment, reiterate any orders sought, repeat back orders received

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34
Q

Code 1

A

deferrable- any non-emergent call

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35
Q

Code 3

A

prompt call, non life threatening, lights and sirens optional

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35
Q

Code 2

A

scheduled call

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36
Q

Code 4

A

urgent/ life threatening, warning systems are mandatory

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36
Q

Code 5

A

obviously dead w/o physician present

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36
Q

Code 6

A

legally dead- pronounced by physician

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37
Q

Code 7

A

unstaffed at station

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38
Q

Code 8

A

standby at location

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39
Q

Code 9

A

unit in for servicing

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40
Q

Code 19

A

non-essential call

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41
Q

Deceased pt codes

A

5 and 6, CTAS 0

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42
Q

How many CTASs during a call

A

3 minimum- on pt contact, on departure, arrival at destination and possible change on route

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43
Q

CTAS Rule one

A

a minimum of two scores applied to each pt- arrival CTAS and departure CTAS

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44
Q

CTAS Rule 2

A

the CTAS level reported to the receiving institution is the CTAS at departure or if condition deteriorates after transport is initiated

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45
Q

CTAS Rule 3

A

when the CTAS level changes due to pts reaction to treatment, it cannot be greater than two levels below pre-treatment acuity (arrival CTAS)

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46
Q

CTAS Rule 4

A

a pt VSA on arrival and is resuscitated must stay as a CTAS 1

47
Q

CTAS Rule 5

A

if a TOR is received while managing a pt, the CTAS level documented on ACR is based on status of pt on arrival/ departure

48
Q

CTAS Rule 6

A

when pt is obviously dead, on arrival, no CTAS level is assigned and documented as 0

49
Q

CTAS 1

A

requires resuscitation, conditions threatening life/ limb or imminent risk of deterioration, requiring immediate aggressive interventions, major ABC issues, need to be seen by physician immediately

50
Q

CTAS 3

A

requires urgent care and includes conditions that could potentially progress to a serious problem requiring emergency intervention, pts need to be seen by a physician within 30 min

50
Q

CTAS 2

A

potential threat to life/limb/function, requires rapid medical intervention or controlled acts, may require prompt treatment to stabilize the condition, requires controlled acts (ALS), seen by physician within 15 min

51
Q

CTAS 4

A

less urgent care and includes conditions related to age, distress of potential for deterioration/ complications that benefit from intervention like urinary symptoms, mild abdominal pain or earache

52
Q

CTAS 5

A

non urgent care including conditions where intervention/investigation can be delayed or moved to other hospital areas like a sore throat, conditions due to chromic problems, psychiatric complaints with no suicidal ideation or attempts

53
Q

Level 1

A

nearest/ closest most appropriate receiving facility

54
Q

Level 2

A

nearest/ closest most appropriate receiving facility based on communication b/w medics, dispatch, and receiving facility

55
Q

Level 3,4,5

A

most available receiving facility based on communication of dispatch and facility, final destination may also take into consideration patient’s wishes

56
Q

CEDIS categories

A

cardiovascular, ENT, environmental, gastrointestinal, genitourinary, mental health, neurologic, obstetrics/gynecology, ophthalmology, orthopedic, pediatric, respiratory, skin, substance misuse, trauma, general and minor

57
Q

First order modifiers

A

applied once complaint is determined and applied in two steps. Group 1 is dependent on ABCs and deficits like resp distress, hemodynamic stability, LOC, temp. Group 2 is related to specific conditions like pain, bleeding disorders, MOI

58
Q

Second order modifiers

A

more complaint specific, applied after CC, not used to downgrade CTAS. Blood glucose level, hypertension, dehydration, obstetrics, mental health

59
Q

Pediatric assessment triangle

A

Appearance- tone, interactiveness, consolability, look/gaze, speech\

Work of breathing- breath sounds, positioning, retractions, flaring, apnea/gasping

Circulation- pallor, mottling, cyanosis

60
Q

5 most common presenting complaints in pediatric pts

A

fever, respiratory difficulties, injuries, changes in behaviour, vomiting and/or diarrhea

61
Q

Transport ACR

A

an ACR will be completed for each ambulance service request where a pt was assessed regardless if care was provided or pt was transported by ambulance or emergency response vehicle

62
Q

Refusal of transport ACR

A

crew seeks pt/ substitute decision maker to complete and sign the appropriate areas of the refusal of service portion of call report. The crew requests witnesses to complete appropriate area of the report and document the request on ambulance call report incase witness refuses to sign the report

63
Q

Sections of an ACR

A

demographics, clinical information, physical assessment, clinical treatment and procedures, general administration

64
Q

Definition of a patient

A

A person who requests an ambulance service, someone the medic has made contact with for purpose of care or transport regardless of if an assessment is conducted, pt care provided, or transport occurs.

65
Q

Where do ACRS go and where are they kept

A

Original copy is left at the receiving hospital/ coroner who is taking over responsibility
Billing copy is distributed to the department/ office responsible for billing
Base hospital copy is distributed to base hospital
Ambulance service copy is retained by service operator for records for a minimum of 5 years

66
Q

How many pts can an ambulance carry and how to document

A

can carry two patients and determine who is primary by labelling patient 1/2 and sequence 1/2 based on degree of injuries

67
Q

How are communicable diseases spread

A

blood borne: blood, semen, vaginal secretions, cerebral spinal fluid

Airborne: singing, coughing, sneezing, shouting, talking, aerosols

Infectious droplets: virus on hands and touching your nose, mouth, eyes with unwashed hands, inhaled, poor ventilation locations

Fecal oral, direct contact

68
Q

Gloves

A

non latex protection worn on all calls and should be removed after pt contact is complete

69
Q

Gowns

A

suspected outbreaks and worn over uniform, back/ legs exposed

70
Q

Protective eye wear

A

worn on all calls involving advanced airway management/ vomiting pts, infectious diseases- airborne or body fluids

71
Q

Isolation suits

A

worn anytime transporting a pt with a confirmed communicable bloodborne (Ebola) or chemo spill, covers entire uniform head to toe

72
Q

how can PPE change due to situation

A

dependent on workplace, sector specific regulations under OHSA (occupational health safety act) may set out requirements for PPE

73
Q

Surgical mask

A

protects nose/ mouth from droplets, splashes, sprays, filters out larger particles, must be worn on all calls

74
Q

N95

A

worn on all calls involving possible infectious diseases, coughing pts, performing respiratory procedures, CPR/BVM or confirmed condition (eg. COVID-19)

75
Q

Cloth mask

A

used for the public, protects against droplets, loose fit

76
Q

P100 mask

A

protects against 99.97% of all particles that are 0.3 microns or larger, worn for chemo spills and Ebola virus calls

77
Q

Donning

A

hand hygiene, gown, mask, eye protection, gloves

78
Q

Doffing

A

remove gloves, remove gown, hand hygiene, remove eye protection, remove mask, perform hand hygiene

79
Q

Who is responsible for PPE

A

Employer- provides equipment and training, MSDS documents

Worker- follows PPE practice

80
Q

Informed consent

A

tell pt nature of treatment, expected benefits, material risks, material side effects, alternatives, likely consequences if not done, chances to ask questions and get answers

81
Q

Implied consent

A

consent is presumed for a pt who is mentally, physically, or emotionally unable to give consent. It is assumed the pt would want lifesaving treatment if able to give consent. Also called emergency doctrine

82
Q

Expressed consent

A

verbal/ nonverbal/ written communication by a pt who wants treatment, the act of calling EMS is generally considered an expression of the desire to receive treatment, must obtain consent for each treatment provided

83
Q

Consent for minors (under 18)

A

must be given by parents or guardians but under special circumstances an individual at 16 can have the capacity to make health care decisions- emancipated

84
Q

Emancipated minors

A

a person under 18 who is married, pregnant, a parent, member of the armed forces, financially independent living away from home

85
Q

Valid consent

A

valid informed consent must have 3 components- disclosure: you tell them everything, capacity in your opinion is present, voluntariness: pt is not refusing

86
Q

Involuntary consent

A

is consent for a treatment granted by a court order

87
Q

Abandonment

A

termination of the paramedic patient relationship without assurance that an equal/ greater level of care will continue

88
Q

Assault

A

an act of unlawfully placing a person in apprehension of immediate bodily harm without consent

89
Q

Health care consent act

A

did he consent to the treatment, was the consent informed, was the consent obtained voluntarily, did you misinterpret the treatment to give consent

90
Q

Power of attorney

A

authorization of the person(s) to make decisions concerning granters personal care

91
Q

When is a person incapable of personal care

A

if the person is unable to understand information relevant to decision making concerning health care, nutrition, shelter, clothing, hygiene, or safety or is not able to appreciate the foreseeable consequences of a decision/ lack of.

92
Q

What to do if pt refuses treatment

A

can they refuse care?, make multiple attempts to convince pt to accept care, inform pt about decision, consult with online medical direction, have pt sign, have witness sign, advise pt they can call for help again

93
Q

When would you contact PD

A

Abuse and neglect situations, WSIB (workplace injuries)

94
Q

Can paramedics medically clear someone

A

Paramedics cannot medically clear someone, so we need to properly assess and offer transport to the ED

95
Q

What should you do if not granted access to a crime scene

A

Express the need to medically assess for code 5 status, make all attempts to not disturb the scene, if still not allowed in call dispatch and supervisors

96
Q

What do you do in the cases of suspicious deaths

A

Call PD and disturb the scenes as minimally possible

97
Q

What do you do if encounter a hanging

A

Cut the rope above the knot to not disturb it and do not untie it as it is part of evidence

98
Q

Who can you order to transport a dead body

A

The police

99
Q

What is legal death and when does it occur to paramedics

A

Legal death is a death pronouncement from a physician, pronounced by base hospital physician through certified ALS provider

Ex. TOR, Withhold of resuscitation

100
Q

What is the role of a coroner

A

Responsible for determining the cause/circumstances of death surrounding unexpected, unnatural, unexplained deaths

Responsible for identifying deceased and time of death

Conduct investigations or inquests

101
Q

What is the purpose of a coroner’s inquest

A

To answer the questions of who the deceased was, how the deceased died, when the deceased died, where the deceased died, and by what means the deceased came to die.

102
Q

Mandatory coroners’ inquests (required by law)

A

Jail deaths, death in police custody, death at a construction project, death of a psychiatric patient while being physically restrained and detained in a facility, death of a child because of the criminal act of the person with custody where other circumstances are met

103
Q

Discretionary coroners’ inquests

A

All other inquests conducted at the discretion of the coroner

104
Q

What power does a coroner have

A

They can access information at will and investigate areas a death occurred without warrants, and request documentation without subpoena

105
Q

Obviously dead patients

A

Grossly charred, open head/torso wound with gross outpouring of cranial/visceral contents, gross rigor mortis, and dependent lividity

106
Q

what makes a DNR valid

A

A DNR is valid if it has a pre-printed serial number, first/last name, a check box identifying the professional designation of MD, RPN, RN, or RN (EC), check box stating a current plan of treatment exists saying pts capable/ decision maker when pt is incapable, printed name and signature of MD, RPN, RN, RN (EC), and date that precedes date of request for an ambulance

107
Q

What do you do when given a DNR

A

Obtain the physical copy, ensure its validity, ensure it’s for the right patient

108
Q

Withold of resuscitation

A

Order given by BHP to a medic to not initiate resuscitation measures

108
Q

TOR

A

An order given by BHP to a medic to stop resuscitation measures

Trauma: >16, VSA, no shocks delivered, no heart rate or ER is >30min away

Medical: >18, cardiac arrest not witnessed, no defibrillations delivered, no ROSC, and cardiac arrest has to be medical in nature. Final decision is made after 3rd analysis

109
Q

Mental health act

A

The mental health act is a law that describes what should happen when someone who is living with a mental illness needs treatment and protection for themselves/others

Regulates the assessment, admission, and treatment of a person with a mental disorder in a psychiatric facility and defines the rights of patients in psychiatric facilities

110
Q

How do paramedics restrain people

A

Supine, cloth restraints are preferred, use respect and dignity, restrain with one arm above the head/ one at waist/ and feet in spread eagle position.

111
Q

Can paramedics use restraints

A

Only if directed by a physician or police officer or an unescorted patient becomes violent en route

112
Q

Chemical restraints

A

Ketamine: excited delirium/ severe violent psychosis

Midazolam

Doesn’t always work and can have neg side effects like resp depression, ketamine reemergence syndrome, and cardiac arrest

113
Q

How many people are needed to restrain someone

A

5- one on each limb and someone controlling the head

114
Q

Form 1

A

The subject of an application for assessment signed by a physician. It is used to declare that the individual is at risk of harming themself or others due to a suspected mental disorder.

115
Q

Form 2

A

The subject of an order for examination signed by a justice of peace. It is used to authorize the detention of a person long enough for a doctor to make an initial examination to decide if form 1 is appropriate.

116
Q

What are the acts used to help children in need

A

Child in need of protection standard, child, youth and family services act, duty to report, the criminal code

117
Q

What agency/society helps children in need

A

CAS- children’s aid society

PHIPA- protects personal health information

118
Q

What is a child in need of protection- paediatric

A

Pediatric injuries: submersion injury, burns, accidental ingestion/poisoning, other types of home injuries (falls)

119
Q

what scene observations can be made for a child in need of protection

A

house/siblings dirty, unkempt, disarray, evidence of violence, animal abuse, evidence of substance abuse

120
Q

what physical injuries indicate a child in need

A

gross/multiple deformities that are incompatible with incident history, multiple new/old unreported bruises, distinctive marks or burns, bruises in unusual areas, signs of long-lasting physical neglect, signs of malnutrition, signs of shaking syndrome.

legal (6 decks)

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