Ops Flashcards
Define a patient
Anyone requesting medical help from county
What defines a ped in terms of general treatment, hospital destination, and trauma/psych?
General < 37kg or handtevy measurable
Hospital destination/psych <18
Trauma<16
Psych < 18
Define crew resource mgmt
Lead must hear out input from all members
All members must give input
8 rights of med admin
PMDDTRRR
patient, med, dose, document, time, route, reason, response
What must you do before EVERY procedure/med admin
I MACC
intervention and med admin cross check
What to do if you make a treatment or medication error?
OLMC ASAP.
Inform all team, ED, and document
What are the 4 pt status categories
Red = critical/unstable
Yellow = serious/urgent
Green = non-urgent
Black = obvious dead
Red vs black pt
Red = stemi, sepsis, trauma alerts. Intervention ASAP
Black = obvious dead or incompatible life injuries
Define yellow pts
Potential loss of life/limb if no timely treatment
Where to check hospital status
Hs.sunstarems.com
Hospital vs specialty divert? How long does it last?
Hospital = min 1 hr no 911 EMS
Specialty = open but minus a specialty service (ex no stroke)
What’s EMS bypass?
EMS closes hospital from 911 as punishment
Hospital status is closed. What does this mean
Internal disaster or unable to provide care for incoming EMS
Where do red patients go? Who transports?
To closest appropriate OPEN hospital with fire medic.
Where do yellow patients go
They can choose any appropriate hospital within 30 min
Where do green patients go
Can choose Any appropriate <60min away
Where to take preggos? (What Hosp and dept?)
Any OB Hosp, Must be assessed by Staff in ED prior to L&D
Where to take veterans
VA if their condition is appropriate
Pt is refusing your hospital choice. What do you do?
Determine decisional capacity, confirm pt is not RED, get a refusal
Who can go to a free standing ED?
Green patients who DONT..
Need specialty service
>20 wks preggo
Have physical/chemical restraints
What’s EMS bypass (general idea)
If pt transfer of care too long, Sunstar punishes the ED
What are the time minimums in EMS bypass
> 5 min - call dispatch
15 = dispatch calls charge RN
20 = bypass until all current pts transferred
> 30 = EMS bypass x2hr
What’s systems status mgmt?
Too many hospitals on divert = OLMC decides transport destination and spreads the load evenly
When can a NON sunstar unit perform. Pt transport?
Extreme RED pt
Dangerous scene/environment
Condition 5 (all hands on deck)
EMS emergency or official disaster
Can fire swap cots with you during an emergency
Yes if safe and practical
What to do if it’s not in protocol and fire wants to transport
OLMC
When to do air transport
RED pts When air faster > ground (ex. Burn center, traffic, extrication)
Minimum equipment for an IFT…
sunstar only/immediate
Unscheduled non emergency
Scheduled non emergency
SS only / immediate = full ALS
UNscheduled = full ALS/BLS
Scheduled = airway bag
You’re doing an IFT you feel is higher than your scope. What to do?
You can refuse or hospital must provide a specialist to go with
What to obtain prior to ALS IFT
Written physician orders
Hospital provide you an ALS med for an IFT transport but you don’t use it. What to do
Give to recording hospital and get receipt signature
IFT goes sideways during transport
Call comms for divert option and OLMC
When do you NOT have to do a PCR?
Cancelled for “closer unit”
Cancelled for “higher priority call”
When must you complete your report? What is the last step?
Before leaving hospital. Print paper copy and leave with charge RN
When must you report to protective services?
Suspected Child/adult abuse
Weird burns
What type of burns must be reported to local sheriffs?
2nd or 3rd > 10% BSA
Caused by flammable substance
And if by suspected violence/illegal activity
What documentation used by County?
Modified SOAP
s - what you were told
O - what you saw
A - what you thought
P - what you did/who you told
When to call OLMC
Advice
Disagreement
Protocol (and deviations)
A pt with a special condition hands you a special card. What is it?
OLMC approved protocols for pts condition
What is decisional capacity
Understands their condition, the risk/benefit/alternatives of treatment plan, and has legal ability to consent
Implied vs expressed vs third party consent
Implied = can’t express and no 3rd party
Expressed = yeah
3rd party = someone else
How to determine if pt has decisional capacity
EMS cognitive evaluation
What to do if a 3rd party is refusing on pt’s behalf?
Determine party has decisional capacity
Document relationship
Confirm it’s pts best interest (call cops if not)
Minimum documentation in your narrative for refusal
Benefits of care
Risks of refusing (severe complication or death)
Alternatives explained and offered
What QA for a refusal
2 sets vitals (GCS = 15)
“Decisional capacity”
Narrative > 300 words
Witness signature
Full Sample
All involuntary transport require who to be dispatched
Law enforcement
Baker vs marchman act
“Drunk people can’t march”
Baker = psych
Marchman = drugs/alcohol
Who can issue a baker act
Cops, doctors, psychologist/mental health professional, court order
Who can issue a marchman act? Under what conditions?
Cops when it shows reasonable evidence substance abuse and incapacitation.
What are requirements of the Marchman act
- pt fucked up
- did or wants to hurt someone (self)
- needs substance help
What cardiac arrests (not traumatic) patients don’t need CPR
- No pulse / breath
- Obvious death/decomp or
- Scene safety risk or
- Valid florida DNR
- Health care surrogate says no
What cardiac arrest patients (traumatic) don’t need CPR
- No pulse / breath
- Decomp / noncomp injuries or
- Massive trauma w/ initial PEA <40 bpm or asystole or
- Down time > 10min or long ETA
Does exposed brain matter constitute obvious death?
No
What can’t you do with a Florida DNRO
cardiac or resp arrest = no CPR, ETT / advanced airway mgmt, ventilations, defib
Can = pain mgmt and comfort care
What’s a living will?
pt becomes brain dead = comfort measures only, no more vents
What’s a MOLST vs POLST
Medical orders for life sustaining treatment or Physician orders for life sustaining treatment
Instructions for critical pts near death (<1 year)
How to validate Florida state DNRO
- Florida DNRO (1896) = must be original or copy on yellow paper, sigs from dr and pt or proxy/surrogate, not verbally withdrawn, pt identity verified via legal photo.
How to honor / validate an out of state DNR or DNR from hospice / health facility
- Document states DNRO
- Valid date
- Signatures and dates (from pt/surrogate, x2 from witnesses)
You’re about to transport a pt and senders don’t have a DNR but say pt shouldn’t get CPR.
Call OLMC
When transporting a pt, make every effort to get the copy or original DNR? what happens if you cant?
Try for the copy. IF you must take the OG, document where it’s left
Can a BLS unit honor a DNR?
Yes, but a medic must arrive onscene to finish it out
What’s a patient identification device?
Mini version of DNR
Why would cops ask you to draw blood?
To test for drugs and alcohol
- accident scene w/ fatal injury/death
- DUI
- Crime scenes
Blood samples for cops should never take priority over…
Emergency medical care
Can cop request a blood draw from you for DNA testing?
No
Steps to draw a blood sample for cops? How many samples to obtain per person?
- Make a PCR (even if refusal)
- Check supplemental form box > indicate blood sample
- Document
- Check and use Kit
- Give to cops
*2 samples per person per draw
How to handle the Pinellas county blood specimen kit
- Confirm date & seal integrity
- Show cop
- Open in front of cop
- Only use contents of kit (2 samples per person per draw)
- Follow instructions for labeling / handoff
- Document
Which pts can refuse a blood draw from cops? Which cant?
Refuse = Crime cases, lesser accidents, or suspected DUI without accident
Cant refuse = fatality / fatal injury accidents
In terms of getting a blood sample for cops, what is defined as a fatal/ serious bodily injury?
Big death rush, disfigurement, loss of function of any body member or organ
What if you refuse to help a cop get a blood sample?
If cop as legal valid reason to obtain, you will get a misdemeanor
Which triage type does pinellas use?
START / JumpSTART triage
What are the treatment areas for MCIs
Red, yellow, green, black
How often to do re triage on pts in an MCI
in > 30min in treatment sector
How long does it take to do a triage
< 60s
What are the only treatments permitted in START / Jump START triage
Adults = One manual airway opening
Peds = airway open & 5 rescue breaths
- all pressure on major bleeding source
In an active shooter… hot vs warm vs cold zone
hot = direct danger
warm = potential danger
Cold = no immediate danger
how does treatment change in shooter hot zone
extraction to cover, bleed control (tourniquet and combat gauze), chest seal.
how does treatment change in a shooter warm zone
normal START triage
interventions = combat gauze, tourniquet, chest seal
does EMS treatment care change in active shooter cold zones?
no
between hot warm cold zones of an active shooter… which one is the transport sector located? the casualty collection point? treatment center?
transport sector = cold zone
treatment center = cold zone
casualty collection = warm zone
What info must be on an ecg prior to transmitting it?
Pt’s full name and bday
you need to respond emergent to a staging scene unless…
< 5 min ETA
Regarding controlled substances, what’s a blind count?
Manually counting the drugs without looking at electronic inventory
Regarding controlled substances, what’s a broken chain of custody?
Period when CS drug or key is no under direct custody of it’s documented handler
Guiding principles CRM?
Advocacy
Situational awareness
Closed loop communication
Clear respectful communication
There is a broke chain of custody of the CS drugs (ex. Stolen drugs). What do you do?
Contact sup and law enforcement.
Remain onscene
Limit contact with CS box/drugs
What’s a Chapter 401?
Involuntary transport of pt who doesn’t have decisional capacity to make healthcare decisions
How long to wash your hands
20 seconds
What to use to clean monitor and cables?
Alcohol 80%
What to use to clean bags and glucometer
Hydrogen peroxide
Per covid rules, who gets a mask?
Everyone > 2 years
When drawing up narcs from multiple vials, how many cards do you need?
1 card per vial used
When you use a narc, what must you keep? Why?
The vial and the card in the bag.
Card = document & turn in
Vial = prove to partner it’s wasted
How do you document a narc used?
PSTrax
Narrative
Intervention - ex “fentanyl”
Waste intervention
Controlled substance signature
