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Operational Practice Flashcards

1
Q

Which agency regulates helicopter operations in Europe?

A

European Aviation Safety Agency (EASA)

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2
Q

What does the EASA define as a HEMS flight? (4)

A

A flight:
1. by helicopter
2. operating under a HEMS approval
3. to facilitate emergency medical assistance
4. where immediate and rapid transportation is essential

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3
Q

To be a HEMS flights the EASA states you need to be carrying one of what 3 things?

A
  1. Medical personnel
  2. Medical supplies
  3. Ill/injured persons or other persons directly involved
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4
Q

If not meeting HEMS criteria what is a AA flight called?

A

Air ambulance mission

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5
Q

How large should a landing zone be for a helicopter?

A

Over twice size of discs

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6
Q

What regulates PPE in the UK?

A

Health and Safety Executive in the PPE at Work Regulations

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7
Q

Describe the JESIP hierarchy of control measures?

A

ERICPD

Eliminate
Reduce
Isolate
Control
PPE
Discipline

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8
Q

What should be the standard of helmet?

A

Fire fighting standard
= EN443

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9
Q

What is the European standard for High vis?

A

EN471

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10
Q

What is the minimum class of garment for working on motorways/dual carriageways?

A

Class 3

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11
Q

What specifications make a ‘class 3’ garment? (2)

A
  1. Mimimum 0.8m2 flourescent background
  2. Minimum 0.2m2 retro-reflective materials
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12
Q

What 3 things should appropriate boots have?

A
  1. Toe cap to withstand > 200J
  2. Minimum height 4 inches
  3. Chemical resistance
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13
Q

What should flight suits be made of and what type of fire do they protect from?

A
  1. Nomex or Kermel
  2. Flash fire (4-5 secs flame)
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14
Q

What proportion of major trauma have SCI and of these how many have severe, time critical injuies?

A
  1. 0.7%
  2. 50%
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15
Q

What is the benefit of self extrication?

A

Shown to reduce movement of cervical and lumbar spine, improved further with a collar

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16
Q

Describe a ‘rapid extrication?’

A

Lateral extrication via closest apperture (usually door). Rescue board slid into car seat and patient rotated then laid down and pulled up board, MILS ideally

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17
Q

Describe a B post rip

A

Rear doors opened and cut lower then upper B-post, then entire side of vehicle can pivot on front hinge of A post

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18
Q

What is a ‘roof off extrication’?

A

Historial gold standard
Roof removed, board placed behind patients back and seat lowered (if poss). Patient then pulled up board with MILS
Slow

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19
Q

What can FRS do to improve access to a vehicle on its side?

A

Roof fold down:

  • upper supporting posts cut
  • roof folded down
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20
Q

What 2 things can FRS do to improve access to a vehicle on its roof? (2)

A
  1. B-post rip
  2. Roll back onto wheels
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21
Q

What is a dashboard roll used for?

A

Footwell entrapment

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22
Q

Describe chain cabling and what it is used for?

A

Chains to front and rear posts, winch used to apply traction.

Reverses vehicle damage forces associated with frontal collision

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23
Q

How long does chain cabling take?

A

12.5 mins

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24
Q

Describe the 3 parts to the FPHC extrication decision tool for non-medical personel

A
  1. Can the casualty self extricate
  2. Is a snatch rescue indicated?
  3. Deliver quickest appropriate extrication
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25
Q

What is the FPHC recommended first line extrication method?

A

Self/minimally assisted

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26
Q
  1. What is the acronym USTEP?
  2. What is it used for?
  3. Who recommends it?
A

1.Understanding (get patient understand)
Support (emotionall)
Try moving (if unable then can’t self extricate)
Egress (clear route out)
Plan - where will they go next (chair/trolley)

  1. Non-clinicans to helpe extricate
  2. FPHC

.

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27
Q

Under what circumstances does FPHC state MILS is not needed inside the vehicle?

A

Fully conscious and no neurology

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28
Q

If patients have neurology what extrication measure does FPHC recommend

A

Rapid extrication with gentle handling

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29
Q

When does the FPHC recommend using a hard collar in extrication? (2)

A
  1. Suspected serious neck injury

or

  1. GCS <15 + evidence of significant injury to any body compartment
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30
Q

When should a binder be placed during extrication according to FPHC?

A

After extrication

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31
Q

What are the components of HAVNOT and what is it used for?

A

Predicting difficult airway

Hx of difficult airway
Anatomical abnormalities
Visual clues (beard, BMI etc)
Neck immobility
Opening mouth <3cm
Trauma

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32
Q

What acronym is used to predict difficult BVM?

A

Mask seal difficulty
Obesity, Obstructed airway
Age >55yrs
No teeth
Snorer, Stiff lungs

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33
Q

What acronym is used to predict difficult SAD insertion?

A

RODS

Restricted mouth opening < 3 fingers
Obstruction at larynyx or below
Distorted airway
Stiff cervical collar, Stiff lungs

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34
Q

What is the acronym SHORT?

A

Predicting difficult cricothyroidotomy

Surgery, Scars, Short neck
Haematoma
Obesity, Oedema
Radiotx
Trauma, Tumour

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35
Q

What are the sizes of OP airway and who are they used for? (7)

A

000 - neonate
00 - infant
0 - small child
1 - child
2 - small adult
3 - medium adult
4 - large adult

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36
Q

How are OPAs measured?

A

Incisors to angle of jaw

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37
Q

What size NPA is used usually for:
1. Men
2. Women

A
  1. 7.0
  2. 6.0
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38
Q

How should NPAs be measured?

A

Nostril to tragus of ear

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39
Q

Describe the IGel sizes

A
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40
Q

What is the mechanism of action of ketamine?

A

NMDA receptor antagonist

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41
Q

What type of drug is ketamine?

A

Procyclidine derivative

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42
Q

What causes the bronchodilation/sympathomimetic actions of ketamine?

A

It is a partial antagonist of muscarinic receptors

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43
Q

What is the onset time of ketamine:
IV
IM

A

30 secs

6 mins

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44
Q

What is propofol?

A

2-6 di-isopropyl phenol

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45
Q

What is the mechanism of action of propofol?

A

Potentiates action of GABA at GABA receptor?

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46
Q

Which paralytic is:
1. depolarising
2. Non-depolarising

A
  1. Suxamethonium
  2. Rocuronium
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47
Q

What are the potential side effects of suxamethonium? (4)

A

Bradycardia
Hyperkalaemia
Raises ICP/ intra-ocular pressure
Malignant hyperthermia

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48
Q

Why do paediatric patients become bradycardic when SATs drop?

A

Dominant parasympathetic system

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49
Q

When does DAS recommend using needle cricothyroidotomy?

A

< 8 years old unless previous ENT experience

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50
Q

How should a needle cricothyroidotomy be performed?

A

-14 to 16G cannula inserted angled 45 degrees caudally
- syringe attached and when loss of resistance flatten angle of cannula and advance further 2-3mm
- remove needle and attach pre-prepped 3 way tap with all ports open with 02 tubing
- set oxygen to rate L/min (patients age)
- occlude 3 way tap for 1 sec, open for 4 secs, 1:4 (if not completely obstructed should be some passive exhalation via airway)

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51
Q

What blades should be used for:
- pre-term
- term
- 1 year (infant)
- 2 year
- > 2 years

A
  • pre-term = Miller 0
  • term = Miller 1
  • 1 year (infant) = MAC 1
  • 2 year = MAC 2
  • > 2 years = MAC2 or 3
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52
Q

How much oxygen Fi02 is delivered via NC?

A

4% per 1L/min (up to 4L)

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53
Q

When should a NRB be used?

A

If need Fi02 >50%

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54
Q

How much oxygen does each venturi allow?

A

Blue = 24 %
White = 28%
Yellow = 35%
Red = 40%
Green = 60%

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55
Q

What are the different oxygen cylinders capacities?

A
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56
Q

What are the 3 receptor types involved in shock physiology?

A
  1. Arterial baroreceptors
  2. Cardiac C-fibres
  3. Arterial chemorecptors
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57
Q

Which receptor triggers the baroreceptor reflex?

A

Arterial baroreceptors

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58
Q

Describe the baroreceptor reflex in shock

A
  • Pressure receptors within aortic arch and carotid sinus that respond to stretch
  • decreased volume activates these leading to an increased HR and peripheral vasoconstriction
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59
Q

Where are cardiac c-fibres located and what reflex do they initiate?

A
  • Left ventricle
  • Depressor reflex
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60
Q

Describe the Depressor Reflex in shock?

A
  • cardiac c-fibres are mechanorecptors in the LV that respond to excessive cardiac activity in context of hypovolaemia
  • leads to bradycardia and peripheral vasodilation
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61
Q

Where are arterial chemoreceptors located?

A

Carotid and aortic body

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62
Q

Describe arterial chemoreceptors role in shock?

A
  • in carotid and aortic body that responds to acidosis and hypoxia
  • increased minute volume and surpresses cardiac c-fibre mediated reflex
  • leads to ‘air hunger’ and acts to augment venous return via thoracic pump
63
Q

Describe the physiology involved in shock associated with blunt trauma

A
  • Baroreceptor and arterial chemoreceptor predominate. Therefore tachycardia and peripheral vasonstriction and increased minute volume
  • Tissue injury and pain suppress c-fibres therefore depressor reflex less common
64
Q

Describe the physiology involved in shock and penetrating trauma

A
  • Major vascular and haemorrhage can occur without significant tissue injury/pain
  • At a critical right atrial pressure cardiac c-fibre medicated depressor reflex causes vagal mediated bradycardia and decreased peripheral vasoconstriction.
  • Results in drop in cardiac output and worsened shock
  • biphasic response
65
Q

Describe the physiology of shock in arterial injury shock

A
  • Sudden loss of elastic arterial diastolic recoil due to major arterial vascular injury
  • decreased arterial diastolic pressure leads to impaired LV coronary pressure and immediate/profound shock
  • more common in penetrating trauma
66
Q

Desrcibe TBI related shock

A
  • Catecholamine surge and sympathetically mediated local noradreanline affects myocardium
  • Concurrently increased ventricular afterload, hypoxia, hypercapnia and other shocked sates leads to myocyte injury and acute onset cardiomyopathy
67
Q

What is in the ‘hateful 8’ signs/symps shock?

A
  1. Diaphoresis
  2. Pallor
  3. Venous collapse
  4. Abnormal HR
  5. Hypotension
  6. Air hunger
  7. Decreased ETC02
  8. Altered mental status
68
Q

Describe te pre-hospital haemostatic ladder (5 parts)

A
  1. Wound dressing
  2. Direct pressure and elevation
  3. Indirect pressure
  4. Haemostatics
  5. Tourniquets
69
Q

What are the 2 types of haemostatic gauze and give an example of both?

A

1.Factor concentrators - Quickclot
2. Mucoadhesive agents - Celox

70
Q

How to factor concentrator haemostatic gauze work?

A

Granules absorb water, concentrate coag factors, promotes clotting

71
Q

How do mucoadhesive haemostatic gauze work?

A

Chitosan based
Anionic attraction of red cells, increases adherences to wound surface

72
Q

Where does a proximal tibial IO go in an:
1. adult
2. child

A
  1. 1 finger medial to tibial tuberosity
  2. 1 finger below and 1 finger medial to tibial tuberosity
73
Q

Where does a distal tibial IO go in an:
1. adult
2. child

A
  1. 3 fingers above tip of medial malleolus
  2. 2 fingers above tip of medical malleolus
74
Q

Where is a femoral IO placed?

A

2 fingers above patella just off midline (medially)

75
Q

When is a femoral IO useful?

76
Q

How is resp rate measured using monitoring

A

Small AC current via ECG lead 1 (adult) or II (paeds) measures change in thoracic impedance

77
Q

What are the flow rates through each cannula size?

78
Q

How does a pulse oximeter work?

A
  • measures absorption of red (660nm) and infrared light (940nm)
  • oxy and deoxy haemoglobin have differing absorptions and the proportion is measured around 50 x / sec
79
Q

What is the issue with CO poisoning and oximetry?

A

Most oximeters unable to differentiate between carboxyhaemoglobin and oxyghaemoglobin therefore will interpret patients saturation as incorrectly high

80
Q

Why do patients with methaemoglobinaemia have low saturations?

A

Pulse oximeter doesn’t measure methaemoglobin and therefore will show low SATs for given Pa02

81
Q

What is a normal range for ETC02

A

4.0-5.7 kPA

82
Q

Describe the sections of a normal capnography waveform

83
Q

What values of causes the colormetric capnography to be:
- yellow
- purple

A

Yellow = ETCO2 >15mmHg
Purple = ETC02 <4mmHg

84
Q

What size should the optic sheath measure on US?

A

<5mm when measured 3mm away from optic disc

85
Q

What does an optic sheath size >6mm suggest?

A

ICP >20cm H20

86
Q

What is the oxygen calculation for transfer?

A

(MV x transfer time + ventilator consumption) x 2

87
Q

Where are the 3 areas of increased risk with HEMS flights and why?

A
  1. Enroute (decreased height and visibility restrictions)
  2. Landing (decreased site and performance restrictions)
  3. Elevated hospital landing (deck edge strike)
88
Q

In terms of aviation, which aircraft has right of way?

A

Aircraft on the right

89
Q

What should aircrafts do if facing head on head collision?

A

Avoid collision to right

90
Q

Under what circumstances to HEMS flights not have priority? (2)

A
  1. Aircrafts declaring emergency
  2. Non powered aircraft
91
Q

What size landing site are needed:
1. in daylight
2. at night

A

D = max length of aircraft with rotors running

  1. 2D x 2D
  2. 2D x 4D
92
Q

What 4 criteria should be looked for in a landed site?

A
  1. Flat
  2. Clear of debris
  3. No wires
  4. < 10 degree slope
93
Q

What requirements are there of a HEMS TCM? (3)

A
  1. Specifically trained
  2. Must be front left seat facing forward
  3. Complete EASA regulation compliance very 12 months
94
Q

What is required for medical passengers to fly? (2)

A
  1. Pre flight briefing
  2. Accompanied by HEMS TCM
95
Q

What is the responsibility of medical passengers? (4)

A
  1. Primary = patient care
  2. Medical equipment - present and stored correctly
  3. Gain approval for certain medical equipment from pilot
  4. Assist with look out
96
Q

Who decides whether a flight is a HEMS mission? (potentially life/limb threatening)

A

Medical team, not pilot

97
Q

What is the cloud base height limit during:
1. Day
2. Night

A
  1. 500m
  2. 1200m
98
Q

What is the visibility limit to fly:
1. day
2. night

A
  1. 1500m
  2. > 3000m
99
Q

Aside from the size requirement, what else is needed to allow a HEMS landing at night?

A

Landing zone must be lid from ground or helicopter

100
Q

What is rule 5?

A

Have to be at least 500m above person/vehicle or structure (can be lower to the ground)

101
Q

What is the minimum level above person/vehicle/structure HEMS flights need to be at night?1

A

1000m (this is normal aviation rules)

102
Q

If visibility is <5000m what should we ensure forward visibility is greater than?

A

Distance travelled in 30 secs

103
Q

What should be in the medical passenger brief? (8)

A
  1. Familiarisation of helicopter type
  2. Entry/exit under normal and emergency conditions
  3. Use of specialist medical equipment
  4. Need for commanders approval prior to use of specialist equipment
  5. Method of supervision of other medical staff
  6. Use of intercomm
  7. Location of fire extinguishers
  8. CRM
104
Q

What are the wind limits for HEMS flights? (2)

A
  1. 40 knots on rotor starts
  2. 70 knots in flight
105
Q

When can HEMS fly in icy conditions?

A

Can’t fly if ice

106
Q

What is the TAF?

A

Terminal Aerodrome Forecast

107
Q

What is the METAR?

A

Meteorological Aerodrome Report

108
Q

For landing sites at night what are the 2 conditions that will allow a landing?

A
  1. Pre-surveyed and lit landing sites (either from ground or aircraft)
  2. Full briefing and identification of site prior to life with 500m recce above scene with NVG
109
Q

What is performance class 1?

A
  • Able to land or fly away safely in even of engine failure at all stages of flight.
  • must be able to clear obstacles safely by 35ft during take/off or landing if engines fail
110
Q

What is performance class 2?

A
  • Have a limited period of exposure in which safe recovery not assured in event of engine failure.
  • aircraft may be damaged but crew uninjured
111
Q

When is performance class 1 and 2 required respectively?

A
  1. Hospitals, pre-surveyed night sites
  2. HEMs mission landing sites and base
112
Q

What 3 things are in place to mitigate increased risk of HEMS flying?

A
  1. Pilot experience - only HEMS requires experience minimum
  2. Instrument ratings for all pilot
  3. Need for TCM/second pilot
113
Q

What is the law that governs blue light driving?

A

No specific rule but multiple exemptions in other laws - driver must justify the need for exemption

114
Q

What Act governs the need for training specifically to use speed exemptions?

A

2006 Road Safety Act

115
Q

What are the blue light exemptions? (7)

A
  1. Speed limit (police/fire/ambulance only)
  2. Red lights - treat as give way
  3. Keep left/rigtht bollards
  4. Motorway regulations - can use hard shoulder even against direction of traffic
  5. Stopping in clearway (no stopping zone), entering bus lane or pedestrian zone
  6. Parking on crossings, double white/yellow lines, parking offside at night, parking footway/central reservation
  7. Keeping engine running whilst parked
116
Q

What is not exempt in terms of blue light driving (6)?

A
  1. Careless/dangerous driving
  2. Not stopping if involved in RTC
  3. No seatbelt
  4. Ignoring no entry/stop or give way signs
  5. Ignoring flashing sights at level crossing/bridge/fire station
  6. Crossing solid lines to overtake
117
Q

Who can use:
1. blue lights
2. red front light
3. constant blue light
4. green light
5. amber lights

A
  1. Emergency vehicles only
  2. FRS
  3. Police
  4. Doctors
  5. Indicators/reflectors/road clearance/dangerous goods vehicles
119
Q

How often should warning lights flash on emergency vehicles?

A

1-4 x / second and spend equal time on/off

120
Q

What are the EU standards for ambulances?

A

CEN 1789 EU Standards

121
Q

What are the different class of ambulances?

A

A1 + A2 = patient transport
B = normal ambulance
C = mobilie intensive care unit

122
Q

What are the regulations set out by CEN 1789? (7)

A
  1. Needs stretcher
  2. Green/yellow Battenburg markings (Scotland are white not yello do have the markings)
  3. Star of life on roof/sides + rear - must be >500mm diameter
  4. Ambulance written on side + rear >100mm height + in capital letters
  5. 2000L stationary oxygen and 400L portable oxygen
  6. 4 x 12V connectors
  7. Needs brake assist (not predictive breaking)
123
Q

Where is the CLEAR acronym used and what does it stand for?

A

NARU traffic guidelines:

Collision - closed carriage
Lead - establish effective leadership to co-ordinate
Evaluate to ensure proportionate response
Act in partnership, recognising differing priorities
Re-open ASAP

124
Q

What do the following stand for?
1. DHS
2. VMS
3. ALR
4. LBS 1

A
  1. Dynamic hard shoulder (can open to ease congestion)
  2. Variable message sign (can change as needed)
  3. All lanes running (no hard shoulder)
  4. Lane below sign 1 (smart motorway)
125
Q

Who is responsible to requesting changes to smart motorway signs (VMS)?

A

First police officer on scene, then incident commander

126
Q

If unable to access accident via normal flow, what needs to happen to allow reverse access?

A
  1. Police/fire or Highways England operational commander has control of head of scene
  2. Confirmed no vehicles downstream of incident
  3. RVP will be chosen (usually 1 junction down) where wait until confirmation lane closure +/- escort
127
Q

At an RTC on motorway who is responsible for safety?

A

Police/highway England

If not present then fire

128
Q

At an incident on the motorway where should the following park:
1. Police/HE
2. FRS
3. Ambulance

A
  1. 50m behind incident
  2. 25m behind incident + fend off
  3. Beyond incident to allow safe loading and protection
129
Q

What needs to happen for HEMS to land on motorway?

A

Lanes closed both directions therefore only land when ready to load

130
Q

How often should distance marker posts be placed and what are they for?

A
  1. Every 100m
  2. For maintenance/emergency purposes and to show nearest phone
131
Q

Describe a distance marker post

A

Number with no units = distance from reference datum (e.g city centre)

On motorway has arrow pointing to direction of nearest phone

132
Q

Describe a driver location sign

133
Q

What do the following represent in terms of carriageway identifiers?
1. A
2. B
3. C + D
4. J
5. K
6. L
7. M

A

A - ‘away from London’ (usually, not always
B - ‘back to London’
C + D - service road adjacent to A +B
J - slip road off A
K - slip road onto A
L - slip road off B
M - slip road onto B

134
Q

What is the global emergency number?

135
Q

What are the initial 3 stages of a 999 call?1.

A
  1. Emergency caller
  2. Phone provider (determines which service)
  3. Operator Assistance Centre (OAC)
136
Q

Describe how a call ends up generating a CAD (3)

A
  1. Information passed electronically in form of Caller Line Identification (CLI)
  2. Via system called Enhanced Information Service for Emergency Calls (EISEC)
  3. Data then automatically appears as incident on dispatchers Computer Aided Dispatch (CAD)
137
Q

What do the following stand for?
1. CLI
2. EISEC
3. CAD

A
  1. Caller Line Identification
  2. Enhanced Information Service for Emergency Calls
  3. Computer Aided Dispatch
138
Q

What is the most common prioritisation systems used in UK?

A

Advanced Medical Priority Dispatch System (AMPDS)

139
Q

Describe what AMPDS is and how it works

A

Advanced Medical Priority Dispatch System

  • Structured question/answer logic tree to allocate dispatch priority
  • ‘systemised caller interrogation’
140
Q

What are the 2 advantages and one disadvantage of AMPDS?

A
  1. Incorporates pre-arrival first aid instructions
  2. Each illness/injury given unique code for audit
  3. Not sensitive for HEMS dispatch which therefore requires additional tier of interrogation
141
Q

Describe the 4 categories of dispatch and the time target

A

Cat 1 = life threatening - 7mins avg
Cat 2 = emergency calls - 18mins avg
Cat 3 = urgent calls = <120 mins at least 90% time
Cat 4 = less urgent <180mins at least 90% of time

142
Q

Describe the ‘fend off’ position?

A

Safe distance from incident with an angle of 40 degrees into the safest direction for the vehicle to go, wheels can be angled in same direction.

143
Q

When arriving first on scene in a vehicle, what should be done? (6)

A
  1. Park safe distance away
  2. Leave visible warning lights on
  3. Leave engine running to prevent flat battery
  4. Secure responders vehicle
  5. PPE
  6. Update control
144
Q

With respects to HAZCHEM codes (1 number followed by 2 letters) , what does the number mean?
1.
2.
3.
4.

A
  1. Coarse water spray
  2. Fine water spray
  3. Normal foam (protein based foam that is not alcohol resistant)
  4. Dry agents, water should not be used/come in contact with substance
145
Q

If the second character (first letter) of the EAC is:
1. S,T,Y or Z
2. P,R,W, or X

what does it mean?

A
  1. normal fire fighting equipment fine
  2. Needs liquid tight chemical protective clothing (CPC), with breathing apparatus
146
Q

What does the 3rd character of the EAC code being an ‘E’ mean?

A

May be a public safety hazard outside the immediate area. People should stay indoors and close windows, ignition sources eliminated and ventilation stopped.

147
Q

What does ATMISTER mean?

A

Handover tool:

Age
Time of injury
Mechanism of injury
Injuries
Signs inc. vitals
Treatment given and neede
ETA
Requests

148
Q

When can a paramedic ROLE? (8)

A
  1. Decapitation
  2. Massive IC/cerebral destruction
  3. Hemicorporectomy
  4. Decomposition/putrification
  5. Incinerations (>95% full thickness)
  6. Hypostasis
  7. Rigor mortis
  8. Foetal maceration in newborn
149
Q

What is the SCREAMER mnemonic?

A

For scene assessment

Safety
Communicate
Read the wreckage
Everyone accounted for?
Assess casualties
Method of extrication
Evacuation route
Right facility

150
Q

What colour is the collar of entonox cylinders?

A

Blue and white

151
Q

What can cause entonox to seperate into its constituent parts (nitrous oxide and oxygen) and what can be done to reverse it?

A
  1. Temp < 6 degrees
  2. Repeated invert to mix
152
Q

How much of the arm should a BP cuff be?

A

40% of mid arm circumference (usually 12.5cm)

153
Q

Where should a BP cuff be placed?

A

Level of heart

DipIMC (14 decks)

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