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EHAAT sign off > Miscellaneous > Flashcards

Miscellaneous Flashcards

1
Q

What is the aim of the MI SOP?

A

To give an oversight of MI planning, structure and response in the event of a significant multi-casualty event, catastrophic and/or protracted incident

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2
Q

What are the objectives of the MI SOP? (4)

A
  1. Provide guidance on roles and responsibilities of EHAAT HEMS at a scene
  2. Provide commonality of language in line with NARU guidelines
  3. Provide awareness of capability of partner agencies
  4. To support and augment regional NHS ambulance service response
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3
Q

What does NARU stand for?

A

National Ambulance Resilience Unit

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4
Q

What is the definition of a MI?

A

An event or situation with a range of serious consequences, which requires special arrangements to be implemented by one or more emergency responder agencies

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5
Q

What is a critical/significant incident?

A

Response in excess of business as usual but not reaching MI criteria

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6
Q

Which region uses the term ‘significant incident’ and which uses ‘critical incident’

A

LAS = significant
EEAST = Critical

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7
Q

What are the 3 overarching principles in MI planning?

A
  1. Emergency Planning
  2. Response
  3. Recovery
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8
Q

Who is EHAATs NHS statutory provider?

A

EEAST

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9
Q

What does the MI SOP say about EHAATs role in emergency planning?

A

We should support provision and implementation of training initiatives to allow us to work alongside EEAST and other critical care teams

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10
Q

How might EHAAT end up responding to a MI out of the region?

A

Request made to EEAST strategic cell be affected region

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11
Q

What are these of MI code regional code for?
1. “Big Bang”
2. “Rising Tide”
3. “Cloud on the Horizon”
4. Headline News
5. CBRNE Incident
6. HAZMAT
7. Environmental Incidents
8. Pre-planned major events

A
  1. A serious transport incident, explosion or series of smaller incidents.
  2. Developing infectious disease epidemic/pandemic or a capacity/staffing crisis.
  3. Serious threat such as a major chemical or nuclear release. This might be
    developing elsewhere nationally and require preparatory action.
  4. Public or media alarm about a personal threat, internal incidents, fire, break down of
    utilities, major equipment failure or violent crime.
  5. Deliberate/Malicious release of hazardous agents.
  6. Unintentional release of hazardous agents.
  7. Major coastal and/or inland flooding, prolonged adverse weather (heat/cold).
  8. e.g. V Festival, Luton Carnival.7. e.g. V Festival, Luton Carnival.
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12
Q

What type of statutory provider is EEAST and what act must they adhere to?

A
  1. Category one
  2. Civil Contingencies Act (2004)
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13
Q

What are the 3 ‘desks’ that may dispatch EHAAT during a MI?

A
  1. Clinical Coordination Desk (CCD)
  2. Regional Coordination
    Desk (RCD)
  3. In a Major Incident, by the Incident Command Desk (ICD)
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14
Q

What does JESIP stand for?

A

Joint Emergency Service Interoperability Principles

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15
Q

What does JESIP set out to do?

A

Set out a commonality of language to services who may respond to MIs

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16
Q

Where should ‘Gold’ Command be located?

A

Joint Services Operations Centre (JSOC)

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17
Q

Where should ‘Bronze’ command be located?

A

On scene

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18
Q

Where might Silver Command be located at a MI?

A

Could be on scene - given size of region maybe en route/remote

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19
Q

Describe the NARU command structure

A
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20
Q

Where is the MI command desk located in EEAST?

A

Chelmsford

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21
Q

How many helicopters are available to respond to a MI in EEAST?

A

5

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22
Q

What is the role of the first HEMS paramedic arriving on scene at a MI

A

Primary triage officer

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23
Q

What is the role of the first HEMS doctor on scene at MI?

A

Complex - not technically Medical Advisor as this is a strategic role and carries with it legal obligations for which we do not have the training for in EEAST. Therefore EEAST staff do this.

However, seems like that is basically what we do without the title

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24
Q

What are subsequent HEMS teams roles when arriving to a MI?

A

Whatever the established command structure requests

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25
Q

What tabards do we have in our MI pack?

A
  1. Doctor
  2. Forward doctor
  3. Primary triage officer
  4. Secondary triage officer
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26
Q

If given a role outside of our ‘usual’roles at a MI who provides the tabards?

A

EEAST

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27
Q

Who decides if EHAAT teams move ‘forward’ at a MI

A

EEAST command

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28
Q

When will EHAAT teams not ‘commit forward’?

A

Terrorist incident

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29
Q

What is the MI radio channel?

A

1

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30
Q

What radio channel should EHAAT teams be on at a MI by default?

A

200/201 unless specifically told to by EEAST command

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31
Q

If telephone networks are down how can we call telephones?

A

Using Sepura handsets

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32
Q

What does the MI SOP say about the ‘overhead’

A

Request a second circuit to gain as much as possible

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33
Q

What information should we relay to CCD in our ‘cockpit’ report at a MI? (4)

A
  1. Access/egress
  2. Wind direction
  3. Landing sites for other assets
  4. Extent of incident
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34
Q

In the event of multiple air assets at a MI what may the police set up?

A

Combined Tactical Air Cell (helps manage air assets)

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35
Q

When may EHAAT HEMS teams provide a tactical role?

A

Until appropriate EEAST staff arrive

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36
Q

What does the MI SOP say about documentation? (3)

A
  1. All will be collated and called upon at an inquest
  2. MI is a crime scene as a default
  3. All decisions must be logged
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37
Q

What is in the MI pack to help with documentation (2)

A
  1. Audio/visual recording devices
  2. Guide to incident reporting
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38
Q

What does METHANES stand for?

A

MI declared/standby
Exact location
Type of incident
Hazards (present and potential)
Access/egress
Number of casualties
EMS required
Start a log

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39
Q

How should we start each log?

A

Dr. J Navein, HEMS doctor, Helimed 55, 09:34, 1st July 2023

40
Q

What does CSCATTT for and what is it used for?

A

Used to helping with planning structure at MI

Command and control
Safety
Communication
Assessment
Triage
Treatment
Transport

41
Q

Who is responsible for decontamination at a MI?

A

Ambulance service but maybe helped by fire/military

42
Q

What is the police responsibility at a MI?

A

Overall responsibility and command

43
Q

What is fires responsibility at a MI?

A

Safety - will deploy safety officers

44
Q

Under what legislation may the military be mobilised in a MI?

A

Civil Contingencies Act 2004

45
Q

What is a MACA and how is is impletmented?

A

Military Aid to Civil Authorities

Request submitted by the Strategic Command Cell (SGC) and decision made at cabinet level

46
Q

If approached by media at a scene what should EHAAT staff do?

A

Politely refer them to police/ambulance service

47
Q

What does LOM stand for?

A

Leading Operational Manager

48
Q

What does NILO stand for?

A

National Incident Liaison Officer

49
Q

What is SORT (context of MI) and what do they provide?

A

Specialist Operations Response Team
- mass decon
- shelters
etc

50
Q

What is the aim of the Death On Scene SOP?

A

To provide a clear explanation of the expected process for deceased patients

51
Q

What are the objectives of the Death On Scene SOP? (2)

A
  1. Describe situations where resuscitation is inappropriate.
  2. Describe the process of pronouncing life extinct.
52
Q

What does the background section of the Death On Scene SOP say re: coroner?(2)

A
  1. Most cases of EHAATs should be referred coroner
  2. Coroner decides how/when and where someone has died and may make recommendations for crown prosecution service
53
Q

Who can authorise removal of a body in a public space?

A

Coroner

54
Q

Do the ambulance service convey deceased patients?

A

No - not unless specifically instructed by coroner

55
Q

If an unexpected death at home who conveys deceased?

A

Undertakers once police has agreed (as coroners representative)

56
Q

How should PLE be documented? (4)

A
  1. Document PLE time
  2. Record call sign of EEAST crews
  3. Record name and shoulder number of police officer who witnessed process
  4. Give my name and PLE time to officer in charge
57
Q

What should we remember to do with all patients who are PLE’d? (2)

A
  1. Leave lines/tubes in situ
  2. Document all incisions even failed attempts
58
Q

What make PLE’ing/working with coroner a little harder in EEAST?

A

Multiple counties with slightly different rules - defer to ambulance officer if doubt or call EEAST clinical advice line

59
Q

What does the policy section in the Death On Scene state about TCA and resus?

A

Resus should always be attempted unless something grossly incompatible with life

60
Q

In what type of death can we only PLE regardless of siutation?

A

Traumatic

61
Q

When was ROLE established?

A

2007

62
Q

Do we need to PLE if patients have been ‘ROLEd’? What else might we do?

A
  1. No
  2. Examine the body
63
Q

What is the difference between EMTs and paramedics with regards to death on scene?

A

Both can ROLE but only a paramedic can terminate resus

64
Q

What does the Death on Scene say about special circumstances? (3)

A
  1. Paeds usually to hospital
  2. If arrest in ambulance usually continue to hospital
  3. Forensic concerns should not get in the way of resusitation - may need to be supportive/reassuring to inexperienced police officers that you will minimise disruption where possible
65
Q
A
66
Q

What are the aims/obsjectives of the Beriplex SOP? (4)

A
  1. Describe the indications for the use of Beriplex in patients with a traumatic brain injury
  2. Describe the steps to be followed in order to correctly administer Beriplex
  3. State the correct dose of Beriplex to be administered to patients by EHAAT clinical team.
  4. Provide guidance for the use of Beriplex in the management of anticoagulant related bleeding.
67
Q

What does the background section of the Beriplex SOP say about warfarin?

A
  1. Inhibits vit K in the synthesis of clotting factors II,VII,IX and X
  2. These factors once synthesised remain in blood for 72 hours
68
Q

Which DOAC is a direct thrombin (IIa) inhibitor?

A

Dabigatran

69
Q

Which DOACs are direct Xa inhibitors?

A

Rivoroxaban/Apixiban/Edoxaban

70
Q

What can be done to reverse Dabigatran pre-hospital?

A

Nothing - PCC/FFP/vit K are ineffective

N: Needs Idarucizumab so consider MTC

71
Q

Which DOACs have evidence to show that an INR >1.4 means active anticoagulant effect?

A

Rivoroxaban and Edoxaban

72
Q

What INR shows an active anticoagulant effect of Apixiban?

A

None - normal INR can also have anticoagulant effect

73
Q

What does the Beriplex SOP say about HI and coagulopathy?

A

Should be reversed until INR <1.3

74
Q

What is in Beriplex?

A
  1. 4-factor PCC derived from human donor plasma and contains all of the Vitamin K-dependent clotting factors (II, VII, IX, X) and Protein-C, Protein S.
  2. Number of other ingredients including human antithrombin III, heparin, human albumin and sodium citrate.
75
Q

How long does Beriplex take to act?

A

< 30 mins

76
Q

What are the risks of anticoagulation reversal?

A
  1. Removes protective/intended affect
  2. Anaphx
  3. HIT
77
Q

Who should not get Beriplex?

A

Patients with known anaphx or HIT

78
Q

What criteria must head injuries have to be able to give Beriplex without discussion for CIC?

A
  1. TBI with suspicion bleed
  2. Confirmed/strongly suspected warfarin
  3. INR confirmed >2.0
79
Q

If patients on warfarin with TBI and suspected bleed but INR <2.0 what should be done?

A

D/w CIC re: reversal

80
Q

What does the Beriplex SOP say about edoxaban and rivoroxaban and HI?

A

If INR > 1.4 then give Beriplex at a dose of 25 IU/kg

81
Q

In patients with high INR on warfarin with TBI how should we calculate dose Beriplex?

A

The body weight/INR dosing schedule

82
Q

In suspected spontaneous IC bleed on warfarin what should be done re: reversal?

A

D/w CIC re: beriplex

83
Q

What does the Beriplex SOP state about extracranial haemorrhage/ code red on anticoagulation? (2)

A
  1. First manage haoemorrhage as per haemorrhage SOP
  2. D/w CIC re: Beriplex
84
Q

What does the Beriplex SOP say about children/adolescents and reversal?

A

Little to no evidence on safety + efficancy

85
Q

How should Beriplex be given? (3)

A
  1. Slow IV push (manufacturer says 8ml/min) = one 40ml vial/ 5mins
  2. Max dose 200ml = 5000IU
  3. Usually give en route to prevent delays on scene
86
Q

What should be done following administration of Beriplex? (5)

A
  1. Recheck INR after 30 mins if still under our care
  2. Beriplex administration sticker in paper notes (if have then)
  3. Beriplex wrist band placed on patient
  4. Hand over to TTL that been given
  5. LOT number of Beriplex vials administered should be recorded in the ‘Drugs’ section of HEMsbase
87
Q

If giving blood, what else must we ensure to do? (5)

A
  1. Give patient an ID number
  2. Take pre-transfusion sample
  3. Warm blood
  4. Give TXA
  5. Give calcium chloride as per SOP
88
Q

How much calcium chloride should be given when transfusing blood in:
1. Adults
2. Kids

A
  1. 10ml of 10% for every 2 units FFP/RBC or 1 whole blood
  2. 0.1ml/kg 10% for every 20ml/kg
89
Q

How should EHAAT teams ensure blood traceability on scene? (4)

A
  1. Immediately place wrist bands with unique identifying number
  2. Add SWIFT wrist band if applicable
  3. Put the unique identifying number on the traceability labels on the RBC/FFP/Lyoplas/WB and pre-transfusion sample + form
  4. Add batch number and unique identifying number to HEMSbase (photos of labels can help)
90
Q

With regards to the pre-transfusion sample what should we do at hospital? (2)

A
  1. Hand over to TTL
  2. Place patients trauma name on the pre-transfusion form alongside the unique patient number`
91
Q

How much blood such be administered to children?

A

Initial bolus of 10ml/kg followed by further 5ml/kg boluses as needed

92
Q

What is the paediatric dose of TXA?

A

15mg/kg

93
Q

Where should the Lyoplas traceability labels be placed once filled out?

A

Retain by team and place in drop box back at base

94
Q

Where should the RBC/FFP/WB traceability labels be placed once filled out?

A

The credo box

95
Q

How do we request ‘operation vampire’?

A

Via EHAAT manager on call

96
Q

How do you set up the MEQU blood warmer?

A
  1. Blue (cold) side to infusion
  2. Red (warm) side to patient
  3. Prime line and transfuse
97
Q
A

EHAAT sign off (7 decks)

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