midterm Flashcards
1
Q
levels of paramedics
A
PCP, ACP, CCP
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
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
4
Q
Under what authority do paramedics practice
A
Ontario base hospital group
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
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
6
Q
Can a paramedic do anything a m.d. can
A
PCPs delegated directives are found in ALS patient care standards
7
Q
Delegated acts
A
BLS/ALS PCS dictates what we can/ cant do
8
Q
Parts of ALS medical directive
A
indications, conditions, contraindications, treatment, clinical considerations
9
Q
Indications
A
general complaint/CC to which directive applies
10
Q
Conditions
A
clinical parameters that are present for a procedure to be performed or for a medication to be administered
11
Q
Contraindications
A
clinical parameters that when present preclude the performance of a procedure/ administration of a medication
12
Q
Treatment
A
description of the type of procedure to be performed or dosing of medication
13
Q
Clinical considerations
A
key clinical point providing general guidance to the proper performance of a procedure/ administration of a medication
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
15
Q
Role as a student
A
a function or position where during placement is a learning opportunity of paramedicine
16
Q
Responsibility as a student
A
perform as a team member and observe or assist when expected and possible
17
Q
10-4
A
acknowledge transmission
18
Q
10-7
A
out of service- arrived at scene
19
Q
10-8
A
in service- mobile to a location
20
Q
10-19
A
return to station
21
Q
10-20
A
what is your location
22
Q
10-200
A
need police
23
Q
10-2000
A
need police immediately- urgent request
24
Who governs radio equipment standards for EMS
MOH
25
Main radio
only 1, controls all radio functions and all channel/repeater functions are completed here
26
Pt compartment radio
secured in rear compartment to allow medic to communicate as needed. Usually, the headset used to perform hospital patch
27
Portable radio
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)
28
Acceptable words
acknowledge, affirmative, go ahead, how do you read/copy, negative, over, roger, standby, say again, verify
29
Phonetic alphabet
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
29
ISBAR- Identification
identify receiver, identify yourself and unit number
30
10-2000 panic alarm
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
31
ISBAR- Situation
location, age, sex, wt, cc, calling regarding
32
ISBAR- Background
pertinent information, positive/negative findings, OPQRST, SAMPLE
32
ISBAR- Assessment
pertinent positive/ negative findings, physical exam, vitals, ECG
33
ISBAR- Response
response to treatment, reiterate any orders sought, repeat back orders received
34
Code 1
deferrable- any non-emergent call
35
Code 3
prompt call, non life threatening, lights and sirens optional
35
Code 2
scheduled call
36
Code 4
urgent/ life threatening, warning systems are mandatory
36
Code 5
obviously dead w/o physician present
36
Code 6
legally dead- pronounced by physician
37
Code 7
unstaffed at station
38
Code 8
standby at location
39
Code 9
unit in for servicing
40
Code 19
non-essential call
41
Deceased pt codes
5 and 6, CTAS 0
42
How many CTASs during a call
3 minimum- on pt contact, on departure, arrival at destination and possible change on route
43
CTAS Rule one
a minimum of two scores applied to each pt- arrival CTAS and departure CTAS
44
CTAS Rule 2
the CTAS level reported to the receiving institution is the CTAS at departure or if condition deteriorates after transport is initiated
45
CTAS Rule 3
when the CTAS level changes due to pts reaction to treatment, it cannot be greater than two levels below pre-treatment acuity (arrival CTAS)
46
CTAS Rule 4
a pt VSA on arrival and is resuscitated must stay as a CTAS 1
47
CTAS Rule 5
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
CTAS Rule 6
when pt is obviously dead, on arrival, no CTAS level is assigned and documented as 0
49
CTAS 1
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
CTAS 3
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
CTAS 2
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
CTAS 4
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
CTAS 5
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
Level 1
nearest/ closest most appropriate receiving facility
54
Level 2
nearest/ closest most appropriate receiving facility based on communication b/w medics, dispatch, and receiving facility
55
Level 3,4,5
most available receiving facility based on communication of dispatch and facility, final destination may also take into consideration patient's wishes
56
CEDIS categories
cardiovascular, ENT, environmental, gastrointestinal, genitourinary, mental health, neurologic, obstetrics/gynecology, ophthalmology, orthopedic, pediatric, respiratory, skin, substance misuse, trauma, general and minor
57
First order modifiers
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
Second order modifiers
more complaint specific, applied after CC, not used to downgrade CTAS. Blood glucose level, hypertension, dehydration, obstetrics, mental health
59
Pediatric assessment triangle
Appearance- tone, interactiveness, consolability, look/gaze, speech\
Work of breathing- breath sounds, positioning, retractions, flaring, apnea/gasping
Circulation- pallor, mottling, cyanosis
60
5 most common presenting complaints in pediatric pts
fever, respiratory difficulties, injuries, changes in behaviour, vomiting and/or diarrhea
61
Transport ACR
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
Refusal of transport ACR
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
Sections of an ACR
demographics, clinical information, physical assessment, clinical treatment and procedures, general administration
64
Definition of a patient
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
Where do ACRS go and where are they kept
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
How many pts can an ambulance carry and how to document
can carry two patients and determine who is primary by labelling patient 1/2 and sequence 1/2 based on degree of injuries
67
How are communicable diseases spread
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
Gloves
non latex protection worn on all calls and should be removed after pt contact is complete
69
Gowns
suspected outbreaks and worn over uniform, back/ legs exposed
70
Protective eye wear
worn on all calls involving advanced airway management/ vomiting pts, infectious diseases- airborne or body fluids
71
Isolation suits
worn anytime transporting a pt with a confirmed communicable bloodborne (Ebola) or chemo spill, covers entire uniform head to toe
72
how can PPE change due to situation
dependent on workplace, sector specific regulations under OHSA (occupational health safety act) may set out requirements for PPE
73
Surgical mask
protects nose/ mouth from droplets, splashes, sprays, filters out larger particles, must be worn on all calls
74
N95
worn on all calls involving possible infectious diseases, coughing pts, performing respiratory procedures, CPR/BVM or confirmed condition (eg. COVID-19)
75
Cloth mask
used for the public, protects against droplets, loose fit
76
P100 mask
protects against 99.97% of all particles that are 0.3 microns or larger, worn for chemo spills and Ebola virus calls
77
Donning
hand hygiene, gown, mask, eye protection, gloves
78
Doffing
remove gloves, remove gown, hand hygiene, remove eye protection, remove mask, perform hand hygiene
79
Who is responsible for PPE
Employer- provides equipment and training, MSDS documents
Worker- follows PPE practice
80
Informed consent
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
Implied consent
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
Expressed consent
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
Consent for minors (under 18)
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
Emancipated minors
a person under 18 who is married, pregnant, a parent, member of the armed forces, financially independent living away from home
85
Valid consent
valid informed consent must have 3 components- disclosure: you tell them everything, capacity in your opinion is present, voluntariness: pt is not refusing
86
Involuntary consent
is consent for a treatment granted by a court order
87
Abandonment
termination of the paramedic patient relationship without assurance that an equal/ greater level of care will continue
88
Assault
an act of unlawfully placing a person in apprehension of immediate bodily harm without consent
89
Health care consent act
did he consent to the treatment, was the consent informed, was the consent obtained voluntarily, did you misinterpret the treatment to give consent
90
Power of attorney
authorization of the person(s) to make decisions concerning granters personal care
91
When is a person incapable of personal care
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
What to do if pt refuses treatment
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
When would you contact PD
Abuse and neglect situations, WSIB (workplace injuries)
94
Can paramedics medically clear someone
Paramedics cannot medically clear someone, so we need to properly assess and offer transport to the ED
95
What should you do if not granted access to a crime scene
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
What do you do in the cases of suspicious deaths
Call PD and disturb the scenes as minimally possible
97
What do you do if encounter a hanging
Cut the rope above the knot to not disturb it and do not untie it as it is part of evidence
98
Who can you order to transport a dead body
The police
99
What is legal death and when does it occur to paramedics
Legal death is a death pronouncement from a physician, pronounced by base hospital physician through certified ALS provider
Ex. TOR, Withhold of resuscitation
100
What is the role of a coroner
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
What is the purpose of a coroner's inquest
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
Mandatory coroners' inquests (required by law)
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
Discretionary coroners’ inquests
All other inquests conducted at the discretion of the coroner
104
What power does a coroner have
They can access information at will and investigate areas a death occurred without warrants, and request documentation without subpoena
105
Obviously dead patients
Grossly charred, open head/torso wound with gross outpouring of cranial/visceral contents, gross rigor mortis, and dependent lividity
106
what makes a DNR valid
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
What do you do when given a DNR
Obtain the physical copy, ensure its validity, ensure it's for the right patient
108
Withold of resuscitation
Order given by BHP to a medic to not initiate resuscitation measures
108
TOR
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
Mental health act
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
How do paramedics restrain people
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
Can paramedics use restraints
Only if directed by a physician or police officer or an unescorted patient becomes violent en route
112
Chemical restraints
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
How many people are needed to restrain someone
5- one on each limb and someone controlling the head
114
Form 1
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
Form 2
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
What are the acts used to help children in need
Child in need of protection standard, child, youth and family services act, duty to report, the criminal code
117
What agency/society helps children in need
CAS- children's aid society
PHIPA- protects personal health information
118
What is a child in need of protection- paediatric
Pediatric injuries: submersion injury, burns, accidental ingestion/poisoning, other types of home injuries (falls)
119
what scene observations can be made for a child in need of protection
house/siblings dirty, unkempt, disarray, evidence of violence, animal abuse, evidence of substance abuse
120
what physical injuries indicate a child in need
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.
