MOD 1 Study Flashcards
Name of the publication that exposed the serious morbidity and mortality caused to Americans by highway crashes?
Accidental death and disability: the neglected disease of modern society
Parts of the ems system include
Bystanders
Dispatch
First responders
BLS (EMT)
ALS(paramedics)
Transport
Emergency department (ED)
Specialty care
How many hours of EMR training
50-80
How many hours of EMT training
150-200
How many hours of AEMT training
200-400
How many hours of paramedic training
1,000-2,000
Ems curricula is designed by what agency?
National highway traffic safety administration
What does evident based treatment mean
We know that it works because it’s been validated by a research study
List of entity’s that can influence the medical industry to adopt a treatment
Physician opinion
Theories by prominent industry thinkers
Logical course of action
Describe how a control group bs an experimental group study works
The control group are people who are getting treated with “conventional” methods and the experimental group is getting the “new” methods. You want the experimental group to have a good outcome so your treatment gets approved.
Describe how a treatment vs placebo study works
The treatment means whatever you are trying to validate. Placebo is a fake treatment. Has no therapeutic value and is given fake medicine like a sugar pill
Describe how a retrospective study works
To look at previous studies on the topic to see if any previous studies gives you a population of data of information on the topic you are trying to research. Basically to compile other research from other studies
What intervention discussed was a standard of care, then was considered contra-indicated, then became once again a standard of care?
If a tourniquet should be applied to a patient with a severe bleed. It was read posted because military data shows tourniquets can be applied to sever injuries with minimal risks and positive effects on the patient
What intervention was a standard of care but was shown to cause more harm than good
Bite sticks for seizures
What current intervention was adjusted over time to become more effective
How many compressions are performed in one cycle of 2-rescuer adult cpr. Went from 5 compressions, to 30 compressions
1992:5 2000:15 2010:30
What are the expectations of an emt as it relates to research
Should be familiar with current trends. Read ems journals, take continuing education classes, attend industry conferences, and review ems websites. Taking a survey for a researcher , having his care records mined for data
Difference between ethnocentrism and cultural imposition
Ethnocentrism is when someone thinks their cultural values are more important than others and cultural imposition is when you force your values onto others
Describe the difference between simplex and duplex radio transmission
Simplex is one way communication,when one party transmits, the other can only receive. Duplex is two way communication, can simultaneously transmit and receive on one channel
Name a couple of pieces of radio equipment discussed in lecture and which ones are static(can’t be moved)
Base station radio (static)
Mobile and portable radios
Repeater based system (static)
Digital equipment
Explain the difference between online and offline medical direction
Online is when you receive medical directions from a physician in real time
Offline medical direction relies on pre established protocols and guidelines without direct communication
If you needed to talk to a large group of bystanders, what piece of ambulance equipment would you use
External public address system
What is the name and acronym for software that dispatches your ambulance to assignments
CAD ( computer aid dispatch)
A paramedic has extensive ALS training, including
Endotracheal intubation
Emergency pharmacology
Cardiac monitoring
Other advanced assessment and treatment skills
Americans With Disabilities Act (ADA)
Prohibits employers from failing to provide full and equal employment
History of EMS
Origins include:
Volunteer ambulances in World War I
Field care in World War II
Field medic and rapid helicopter evacuation in Korean conflict
Training adds knowledge and skills in specific aspects of ALS, including:
IV therapy
Advanced airway adjuncts
Administration of limited number of medications
Off-line (indirect)
Standing orders, training, supervision
Online (direct)
Physician directions given over the phone or radio
Continuous Quality Improvement (CQI)
Reviews and performs audits of the EMS system to identify areas of improvement and/or assign remedial training
Minimizing errors is the goal.
Uses a plan-do-study-act cycle
Quality control in an EMS system is the ultimate responsibility of the:
medical director
CHART method
Chief complaint or chief concern
History
Assessments
Treatment (Rx)
Transport
SOAP
Subjective
Objective
Assessment
Plan
Expressed consent
The patient acknowledges he or she wants you to provide care or transport.
2. To be valid, the consent that the patient provides must be informed consent, which means that you explained the nature of the treatment being offered, along with the potential risks, benefits, and alternatives to treatment, as well as potential consequences of refusing treatment.
Implied consent
Applies to patients who are:
a. Unconscious
b. Otherwise incapable of making a rational, informed decision about care
2. Implied consent applies only when a serious medical condition exists and should never be used unless there is a threat to life or limb.
3. The principle of implied consent is known as the emergency doctrine.
4. Try to get consent from a spouse or relative before treating based on implied consent.
Involuntary consent
Applies to patients who are:
a. Mentally ill
b. In a behavioral (psychological) crisis
c. Developmentally delayed
2. Obtain consent from the guardian or conservator
a. It is not always possible to obtain such consent.
b. Many states have protective custody statutes that allow these individuals to be taken, under law enforcement authority, to a medical facility.
Minors and consent
- The parent or legal guardian gives consent.
- In some states, a minor can give consent.
a. Emancipated minor: an individual under the legal age who is legally considered an adult
b. Many states consider minors to be emancipated if they are married, if they are members of the armed services, if they are parents, or if living away from home and no longer relying on parents for support. - Teachers and school officials may act in place of parents (in loco parentis) and provide consent for treatment of injuries that occur in a school or camp setting.
- If a true emergency exists and no consent is available, treat the patient under implied consent.
Forcible restraint
Necessary for patients who are in need of medical treatment and transportation but are combative and present a risk of danger to themselves or others
2. Forcible restraint is legally permissible.
a. Consult medical control for authorization and utilize law enforcement on the scene.
b. Restraint without legal authority exposes you to potential civil and criminal penalties.
c. Make sure you know the local laws and protocols regarding forcible restraint.
d. Once applied, do not remove restraints en route unless they pose a risk to the patient.
e. Consider calling ALS backup to provide chemical pharmacologic restraint.
A do not resuscitate (DNR) order gives permission to
withhold resuscitation.
1. “Do not resuscitate” does not mean “do not treat.” Even in the presence of a DNR order, you are still obligated to provide supportive measures (oxygen, pain relief, and comfort) to a patient who is not in cardiac arrest, whenever possible.
2. Each ambulance service should have a protocol to follow in these circumstances.
Advance directives
A written document specifying medical treatment for a competent patient should he or she become unable to make decisions
2. Most commonly used when a patient becomes comatose
3. Often referred to as a living will or health care directive
You may encounter physician orders for life-sustaining treatment (POLST) and medical orders for life-sustaining treatment (MOLST) forms when caring for patients with terminal illnesses.
- These medical orders explicitly describe acceptable interventions for the patient.
- They must be signed by an authorized medical provider to be valid.
- If you encounter these documents, contact medical control for guidance.
Some patients may have named surrogates to make decisions for them when they can no longer make their own.
Durable powers of attorney for health care
2. Also known as health care proxies
Determination of the cause of death is the medical responsibility of a
physician
Presumptive signs of death:
- Unresponsiveness to painful stimuli
- Lack of a carotid pulse or heartbeat
- Absence of chest rise and fall
- No deep tendon or corneal reflexes
- Absence of pupillary reactivity
- No systolic blood pressure
- Profound cyanosis
- Lowered or decreased body temperature
Definitive signs of death:
- Obvious mortal injury such as decapitation
- Dependent lividity
a. Blood settling to the lowest point of the body, causing discoloration of the skin - Rigor mortis
a. Stiffening of body muscles caused by chemical changes within muscle tissue
b. Occurs between 2 and 12 hours after death - Algor mortis
a. Cooling of the body until it matches the ambient environment - Putrefaction (or decomposition) of body tissues
a. Depending on temperature conditions, occurs between 40 and 96 hours after death
In most states, the medical examiner, or the coroner in some states, must be notified in the following cases:
a. The patient is dead on arrival (DOA; sometimes called dead on scene [DOS])
b. Death without previous medical care, or when the physician is unable to state the cause of death
c. Suicide
d. Violent death
e. Known or suspected poisoning
f. Death from accident
g. Suspicion of a criminal act
h. Infant and child deaths
3. Make every attempt to limit your disturbance of a scene involving a death.
4. If emergency medical care has been initiated, be sure to carefully document what was done or found on scene.
Organ donors
- Organ donors have expressed a wish to donate their organs.
- Consent is evidenced by information on a donor card or driver’s license.
- Treat potential organ donors the same as any other patient.
a. Your priority is to save the patient’s life.
b. Remember that organs need oxygen.
Medical identification insignia
- Bracelet, necklace, keychain, or card indicating DNR order, allergies, or other serious medical condition that may be helpful in assessing and treating the patient
- Some patients wear medical bracelets containing a USB flash drive.
a. Often stored as a PDF file that can be read on most computers
Scope of Practice
A. Outlines the care you are able to provide
B. Usually defined by state law
C. The medical director further defines the scope of practice by developing protocols or standing orders.
Standards of Care
A. The manner in which you must act or behave is called a standard of care.
B. It is defined as how a person with similar training would act under similar circumstances.
Duty to Act
Duty to act is an individual’s responsibility to provide patient care.
B. Once your ambulance responds to a call or treatment is begun, you have a legal duty to act.
C. In most cases, if you are off duty and come upon a crash, you are not legally obligated to stop and assist patients. Know your local laws and policies pertaining to your duty to act.
Negligence
Negligence is the failure to provide the same care that a person with similar training would provide in the same or similar situation.
B. All four of the following factors must be present for the legal doctrine of negligence to apply:
1. Duty
a. The obligation to provide care and to do so in a manner that is consistent with the standard of care established by training and local protocols
2. Breach of duty
a. The EMT did not act within an expected and reasonable standard of care.
3. Damages
a. A patient is physically or psychologically harmed in some noticeable way.
4. Causation
a. A cause-and-effect relationship exists between a breach of duty and the damages suffered by the patient.
C. Res ipsa loquitur
1. An EMT can he held liable under this theory if it can be shown that an injury occurred, that the cause of the injury was in the control of the EMT, and that such injuries generally do not occur unless there is negligence.
D. Negligence per se
1. A theory that can be used when the conduct of the person being sued is alleged to have occurred in clear violation of a statute
a. Example: An EMT performs an ALS skill that resulted in injury to the patient
E. Torts
1. Civil wrongs
a. Not within the jurisdiction of US criminal courts
b. Examples include defamation of character and invasion of privacy.
Abandonment
Abandonment is the unilateral termination of care by the EMT without the patient’s consent and without making any provisions for care to be continued by a medical professional who is competent to provide care for the patient.
B. Once care is started, you have assumed a duty to act that must continue until an equally competent medical provider assumes responsibility.
C. Abandonment may take place at the scene or in the emergency department where you are dropping off your patient.
1. Obtain a signature on the patient care record from the person accepting transfer of care at the hospital.
Assault and Battery, and Kidnapping
A. Assault: unlawfully placing a person in fear of immediate bodily harm
1. Includes threatening to restrain a patient who does not want to be transported
B. Battery: unlawfully touching a person
1. Includes providing emergency care without consent
C. Kidnapping: seizing, confining, abducting, or carrying away by force
1. Could include a situation where a patient is transported against his or her will
2. False imprisonment is the unauthorized confinement of a person.
D. Potential legal problems may arise in situations in which a patient has not given or rescinds consent for treatment and/or transport.
Defamation
Defamation is the communication of false information that damages a person’s reputation.
1. Libel: written, such as a false statement on a patient care report
2. Slander: spoken, such as inappropriate comments made during “station house” conversation
B. All statements on your run report should be accurate, relevant, and factual.
Good Samaritan Laws and Immunity
A. Good Samaritan laws are based on the common law principle that when you reasonably help another person, you should not be held liable for errors or omissions that are made in giving good-faith care.
B. To be protected by provisions of Good Samaritan law, several conditions must generally be met:
1. You acted in good faith in rendering care.
2. You rendered care without expectation of compensation.
3. You did not exceed your scope of practice.
4. You did not act in a grossly negligent manner.
C. Gross negligence is defined as conduct that constitutes a willful or reckless disregard for a duty or standard of care.
D. Immunity statutes apply to EMS systems that are considered governmental agencies.
1. Sovereign immunity provides limitations on liability and immunity is not complete.
Records and Reports
Your agency should maintain a complete and accurate record of all incidents involving sick or injured patients.
1. Such records are an important safeguard against legal complications.
B. The courts’ perception of records and reports:
1. If an action or procedure was not recorded on the written report, it was not performed.
2. Incomplete or untidy reports are evidence of incomplete or inexpert emergency medical care.
C. National EMS Information System (NEMSIS)
1. Provides the ability to collect, store, and share standardized EMS data throughout the United States
