Operations

Question 1

Once contact is made with a patient, the patient remains the EMS provider’s responsibility until one of the following occurs:

Answer 1

1. Care is transferred to receiving facility staff.
2. Care is transferred to an appropriate level healthcare provider
3. The patient is deemed non-viable
4. A valid SOR is obtained

Question 2

Unless otherwise specified. Adult age. Child. Infant. Newborn. Ages….

Answer 2

Adult: over 15 years
Child: 1-15 years
Infant: 1 month to 1 year
Newborn: birth to 1 month

Question 3

In the event of the death of a child less than 1 year of age…what must be done?

Answer 3

The Sudden Unexpected Infant Death (SUID) form will be filled out and faxed to the coroner’s office

Question 4

If based upon the EMS provider’s training, the orders received are inappropriate and/or dangerous…what do you do?

Answer 4

Question the orders three times then verbally refuse to act. Continue to treat the patient according to these protocols.

Question 5

If an order for therapy is denied and the EMS provider believes it to be life-saving:

Answer 5

verbally request it three times. The EMS provider then may contact their supervising hospital for further instructions.

Question 6

In situations where a BLS crew has requested a paramedic for assistance and the paramedic feels BLS transport is indicated….

Answer 6

the paramedic will continue to assist the BLS crew throughout the transport

Question 7

Patient care may be delegated from the Paramedic to the EMS under the following conditions:

Answer 7

1. The patient is stable and does not meet any of the criteria for ALS transport listed.
2. The Paramedic fully informs the EMS of assessment findings and anticipated patient needs.
3. The EMS is comfortably with accepting responsibility for treatment and transport.
4. The patient has not received any ALS treatment.
5. The Paramedic fully documents assessment findings and treatment up to the point of delegation of patient care to the EMT.

Question 8

ALS Treatment and Transport is indicated if the patient has one or more of the following conditions:

Answer 8

Shortness of breath or acute dyspnea
Chest pain or anginal equivalent
New onset altered LOC
Uncontrollable bleeding
Unconsciousness
Seizures
Patient meets Trauma Alert Criteria
Patient meets Medical Alert Criteria
Shock signs/symptoms

OB at >20 weeks with contractions AND evidence of meconium staining OR vaginal bleeding

Childbirth prior to 38 weeks gestation
Syncope or near-syncope
Symptomatic with abnormal vital signs
Any uncertainty about the patient’s status

Question 9

A patient is anyone who ______

Answer 9

requested an ambulance or has had an ambulance requested for them.

Question 10

Patients will be transported to the patient’s hospital of choice when:

Answer 10

their condition is stable and they do not meet a special needs situation. The EMS provider is responsible for informing the patient that transport to a specific hospital may be better for their specific medical situation.

Question 11

Patients with multisystem trauma –> Trauma Center

Answer 11

Under age of 15 –> Riley
Adults and children from same family –> transport to a facility with trauma capabilities for both age groups

OB in 2nd/3rd trimester –> Hospital with Labor and Delivery

STEMI/CVA –> hospital with resources for that specialty.

ROSC patients should be transported to a PCI capable facility

Question 12

Pediatric MCI

Answer 12

Activate MEDMACC

Riley –> 4 Red, 8 Yellow, 30 Green

Peyton Manning –> 2 reds, 6 yellow, unlimited green

Send sickest and youngest to Riley

Question 13

Medical control must be consulted when a patient is refusing transport and any of the following applied

Answer 13

1. Abnormal mental status indicated by slurred or abnormal speech, disorientation to person, place, or time. Inappropriate or irrational thinking.
2. Patient is less than 1 year old.
3. There are any historical data, symptoms, or signs suggestive of a potentially life threatening illness or injury.
4. Patient does not have access to a phone or significant other to aid in getting further care if needed.

Question 14

In the event the patient is less than 18 years old, these persons may take responsibility for the child:

Answer 14

1. parent or legal guardian
2. Individual in loco parentis if there is no parent or legal guardian present; the parent or legal guardian is not reasonably present or declines to act; or the existence of the parent or legal guardian is unknown to the health care provider.
3. Adult sibling of the minor if (same as reasons in number 2).
4. Minor patient if there is compelling evidence of emancipation as defined under IC 16-36-1-3(a)(2)A)-(E) [At least 14 Y; not dependent on a parent for support; living apart from the minor’s parents or from an individual in loco parentis and managing own affairs, is or has been married, is in the military service, is authorized to consent to healthcare.
5. If the patient is a minor and none of the above can be contacted, the patient should be transported to the closest, most appropriate facility.

Question 15

Child specific safety seats or restraints are required until the child has:

Answer 15

reached adult size by provider judgement (as a general rule, greater than 5 feet tall and 100 lbs)

Question 16

The child’s own safety seat is the preferred device unless:

Answer 16

the device has been involved in a MVC, cannot be safely secured in the vehicle, or the child needs care and monitoring that cannot be delivered the the child in the car seat.

With the exception of a minor vehicle crash, avoid using the child’s own safety seat if the seat was involved in a motor vehicle crash. However, using the child’s own seat can be considered if no other restraint systems are available and the seat shows no visible damage/defect.

Question 17

Transportation of a child in any of the following ways is NEVER appropriate:

Answer 17

Unrestrained

In a lap of a parent.

Using only horizontal stretcher straps.
On the bench seat or any seat perpendicular to the forward motion of the vehicle, even if the child is in a child safety seat

Question 18

Transport of the uninjured/not ill child shall be transported:

Answer 18

In a vehicle other than a ground ambulance using a properly installed, size-appropriate child restraint system (preferred).

Size appropriate child seat properly installed in the front passenger seat of the ambulance with the airbags orr.
In a size-appropriate child seat properly installed on the rear facing EMS provider’s seat.

Consider delaying transport of the child until additional vehicles are available without compromising other patients on the scene.

Question 19

Ill/injured child NOT requiring continuous intensive monitoring/interventions shall be transported:

Answer 19

In a size-appropriate child restraint system secured appropriately to the cot (preferred).

In EMS provider’s seat in a size appropriate restraint system.

On the cot using all five straps.

Question 20

The ill/injured child who’s condition requires spinal immobilization or lying flat:

Answer 20

Secured to a size appropriate LBB, then secured to the cot head first with a tether at the foot if possible to prevent forward movement, and all five straps.

Question 21

Guidelines for termination of resuscitation - adults (over age 15Y)

Answer 21

Medical cardiac arrest who have no ROSC after 30 minutes of ALS. Should include at the minimum, CPR with minimal interruptions, ventilation with O2, IV/IO access, administration of fluids and/or appropriate medications per protocol.

Question 22

Termination of resuscitation for traumatic cardiac arrest:

Answer 22

Meets DOA criteria

Terminate for blunt or penetrating traumatic injury found pulseless and apneic (NO AGONALS)…without organized electrical activity (asystole or PEA less than 40) . IF the traumatic arrest is in VTach, VFib, or PEA>40, work as normal and transport rapidly.

Question 23

Exemptions to termination of resuscitation for Traumatic Cardiac Arrest:

Answer 23

Standing protocols for termination/withholding of resuscitative efforts of a traumatic cardiac arrest do NOT apply to patients under 15 Y, females with known pregnancy greater than 24 weeks or uterine fundus palpable above the umbilicus, victims of lightning strikes, victims of cold water immersion (unless known submersion time greater than 30 minutes), or victims with hypothermia as suspected etiology of cardiac arrest.

Question 24

Medical Alert Criteria:

Answer 24

Suspected Acute MI
Suspected Sepsis
Acute neurological deficits of less than 6 hours duration
Inspiratory stridor

Physiological:
SBP <90 or vital signs outside of physiologic ranges for pediatrics
GCS <13
RR<10 or >30 (adults) or RR <15 or >45 (peds)
Heart rate <40 or >120
Temp <92F or >105
SpO2<88%

Question 25

Major Trauma Criteria - Physiologic Criteria

Answer 25

SBP <90
GCS 29
Patient receiving blood products to maintain vital signs.
Airway or respiratory compromise (BVM, intubation, adjunct airway, cricothyroidotomy), needle decompression

Question 26

Major Trauma Criteria - Anatomic

Answer 26

Penetrating trauma to head, neck, chest, abdomen, or extremities proximal to knees/elbows

Traumatic amputation proximal to the wrist of ankle

Burns >15% OR high voltage (>1000 volts)

Any crushed, degloved, pulseless, or mangled extremity

Pelvic fractures

Two or more long bone fractures

Flail chest

Extremity paralysis suggestive of a spinal cord injury

Open or depressed skull fracture

Victim of hanging who meet above criteria

Question 27

Trauma Alert Criteria

Answer 27

MOI:
Ejection from vehicle
Vehicle roll-over
Prolonged extrication from vehicle
Pedestrian struck by a vehicle at a speed >20 MPH
Falls >20 feet (Adults) or 3x child’s height