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Pinellas County Protocol 2023 > Ops > Flashcards

Ops Flashcards

1
Q

Define a patient

A

Anyone requesting medical help from county

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2
Q

What defines a ped in terms of general treatment, hospital destination, and trauma/psych?

A

General < 37kg or handtevy measurable

Hospital destination/psych <18

Trauma<16

Psych < 18

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3
Q

Define crew resource mgmt

A

Lead must hear out input from all members

All members must give input

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4
Q

8 rights of med admin

A

PMDDTRRR

patient, med, dose, document, time, route, reason, response

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5
Q

What must you do before EVERY procedure/med admin

A

I MACC

intervention and med admin cross check

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6
Q

What to do if you make a treatment or medication error?

A

OLMC ASAP.

Inform all team, ED, and document

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7
Q

What are the 4 pt status categories

A

Red = critical/unstable

Yellow = serious/urgent

Green = non-urgent

Black = obvious dead

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8
Q

Red vs black pt

A

Red = stemi, sepsis, trauma alerts. Intervention ASAP

Black = obvious dead or incompatible life injuries

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9
Q

Define yellow pts

A

Potential loss of life/limb if no timely treatment

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10
Q

Where to check hospital status

A

Hs.sunstarems.com

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11
Q

Hospital vs specialty divert? How long does it last?

A

Hospital = min 1 hr no 911 EMS

Specialty = open but minus a specialty service (ex no stroke)

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12
Q

What’s EMS bypass?

A

EMS closes hospital from 911 as punishment

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13
Q

Hospital status is closed. What does this mean

A

Internal disaster or unable to provide care for incoming EMS

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14
Q

Where do red patients go? Who transports?

A

To closest appropriate OPEN hospital with fire medic.

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15
Q

Where do yellow patients go

A

They can choose any appropriate hospital within 30 min

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16
Q

Where do green patients go

A

Can choose Any appropriate <60min away

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17
Q

Where to take preggos? (What Hosp and dept?)

A

Any OB Hosp, Must be assessed by Staff in ED prior to L&D

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18
Q

Where to take veterans

A

VA if their condition is appropriate

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19
Q

Pt is refusing your hospital choice. What do you do?

A

Determine decisional capacity, confirm pt is not RED, get a refusal

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20
Q

Who can go to a free standing ED?

A

Green patients who DONT..

Need specialty service
>20 wks preggo
Have physical/chemical restraints

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21
Q

What’s EMS bypass (general idea)

A

If pt transfer of care too long, Sunstar punishes the ED

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22
Q

What are the time minimums in EMS bypass

A

> 5 min - call dispatch
15 = dispatch calls charge RN
20 = bypass until all current pts transferred

> 30 = EMS bypass x2hr

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23
Q

What’s systems status mgmt?

A

Too many hospitals on divert = OLMC decides transport destination and spreads the load evenly

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24
Q

When can a NON sunstar unit perform. Pt transport?

A

Extreme RED pt
Dangerous scene/environment
Condition 5 (all hands on deck)
EMS emergency or official disaster

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25
Q

Can fire swap cots with you during an emergency

A

Yes if safe and practical

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26
Q

What to do if it’s not in protocol and fire wants to transport

A

OLMC

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27
Q

When to do air transport

A

RED pts When air faster > ground (ex. Burn center, traffic, extrication)

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28
Q

Minimum equipment for an IFT…

sunstar only/immediate
Unscheduled non emergency
Scheduled non emergency

A

SS only / immediate = full ALS
UNscheduled = full ALS/BLS
Scheduled = airway bag

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29
Q

You’re doing an IFT you feel is higher than your scope. What to do?

A

You can refuse or hospital must provide a specialist to go with

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30
Q

What to obtain prior to ALS IFT

A

Written physician orders

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31
Q

Hospital provide you an ALS med for an IFT transport but you don’t use it. What to do

A

Give to recording hospital and get receipt signature

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32
Q

IFT goes sideways during transport

A

Call comms for divert option and OLMC

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33
Q

When do you NOT have to do a PCR?

A

Cancelled for “closer unit”
Cancelled for “higher priority call”

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34
Q

When must you complete your report? What is the last step?

A

Before leaving hospital. Print paper copy and leave with charge RN

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35
Q

When must you report to protective services?

A

Suspected Child/adult abuse
Weird burns

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36
Q

What type of burns must be reported to local sheriffs?

A

2nd or 3rd > 10% BSA
Caused by flammable substance
And if by suspected violence/illegal activity

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37
Q

What documentation used by County?

A

Modified SOAP

s - what you were told
O - what you saw
A - what you thought
P - what you did/who you told

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38
Q

When to call OLMC

A

Advice
Disagreement
Protocol (and deviations)

39
Q

A pt with a special condition hands you a special card. What is it?

A

OLMC approved protocols for pts condition

40
Q

What is decisional capacity

A

Understands their condition, the risk/benefit/alternatives of treatment plan, and has legal ability to consent

41
Q

Implied vs expressed vs third party consent

A

Implied = can’t express and no 3rd party

Expressed = yeah

3rd party = someone else

42
Q

How to determine if pt has decisional capacity

A

EMS cognitive evaluation

43
Q

What to do if a 3rd party is refusing on pt’s behalf?

A

Determine party has decisional capacity

Document relationship

Confirm it’s pts best interest (call cops if not)

44
Q

Minimum documentation in your narrative for refusal

A

Benefits of care
Risks of refusing (severe complication or death)

Alternatives explained and offered

45
Q

What QA for a refusal

A

2 sets vitals (GCS = 15)
“Decisional capacity”
Narrative > 300 words
Witness signature
Full Sample

46
Q

All involuntary transport require who to be dispatched

A

Law enforcement

47
Q

Baker vs marchman act

A

“Drunk people can’t march”

Baker = psych
Marchman = drugs/alcohol

48
Q

Who can issue a baker act

A

Cops, doctors, psychologist/mental health professional, court order

49
Q

Who can issue a marchman act? Under what conditions?

A

Cops when it shows reasonable evidence substance abuse and incapacitation.

50
Q

What are requirements of the Marchman act

A
  • pt fucked up
  • did or wants to hurt someone (self)
  • needs substance help
51
Q

What cardiac arrests (not traumatic) patients don’t need CPR

A
  1. No pulse / breath
  2. Obvious death/decomp or
  3. Scene safety risk or
  4. Valid florida DNR
  5. Health care surrogate says no
52
Q

What cardiac arrest patients (traumatic) don’t need CPR

A
  1. No pulse / breath
  2. Decomp / noncomp injuries or
  3. Massive trauma w/ initial PEA <40 bpm or asystole or
  4. Down time > 10min or long ETA
53
Q

Does exposed brain matter constitute obvious death?

A

No

54
Q

What can’t you do with a Florida DNRO

A

cardiac or resp arrest = no CPR, ETT / advanced airway mgmt, ventilations, defib

Can = pain mgmt and comfort care

55
Q

What’s a living will?

A

pt becomes brain dead = comfort measures only, no more vents

56
Q

What’s a MOLST vs POLST

A

Medical orders for life sustaining treatment or Physician orders for life sustaining treatment

Instructions for critical pts near death (<1 year)

57
Q

How to validate Florida state DNRO

A
  1. 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.
58
Q

How to honor / validate an out of state DNR or DNR from hospice / health facility

A
  1. Document states DNRO
  2. Valid date
  3. Signatures and dates (from pt/surrogate, x2 from witnesses)
59
Q

You’re about to transport a pt and senders don’t have a DNR but say pt shouldn’t get CPR.

A

Call OLMC

60
Q

When transporting a pt, make every effort to get the copy or original DNR? what happens if you cant?

A

Try for the copy. IF you must take the OG, document where it’s left

61
Q

Can a BLS unit honor a DNR?

A

Yes, but a medic must arrive onscene to finish it out

62
Q

What’s a patient identification device?

A

Mini version of DNR

63
Q

Why would cops ask you to draw blood?

A

To test for drugs and alcohol

  • accident scene w/ fatal injury/death
  • DUI
  • Crime scenes
64
Q

Blood samples for cops should never take priority over…

A

Emergency medical care

65
Q

Can cop request a blood draw from you for DNA testing?

A

No

66
Q

Steps to draw a blood sample for cops? How many samples to obtain per person?

A
  1. Make a PCR (even if refusal)
  2. Check supplemental form box > indicate blood sample
  3. Document
  4. Check and use Kit
  5. Give to cops

*2 samples per person per draw

67
Q

How to handle the Pinellas county blood specimen kit

A
  1. Confirm date & seal integrity
  2. Show cop
  3. Open in front of cop
  4. Only use contents of kit (2 samples per person per draw)
  5. Follow instructions for labeling / handoff
  6. Document
68
Q

Which pts can refuse a blood draw from cops? Which cant?

A

Refuse = Crime cases, lesser accidents, or suspected DUI without accident

Cant refuse = fatality / fatal injury accidents

69
Q

In terms of getting a blood sample for cops, what is defined as a fatal/ serious bodily injury?

A

Big death rush, disfigurement, loss of function of any body member or organ

70
Q

What if you refuse to help a cop get a blood sample?

A

If cop as legal valid reason to obtain, you will get a misdemeanor

71
Q

Which triage type does pinellas use?

A

START / JumpSTART triage

72
Q

What are the treatment areas for MCIs

A

Red, yellow, green, black

73
Q

How often to do re triage on pts in an MCI

A

in > 30min in treatment sector

74
Q

How long does it take to do a triage

A

< 60s

75
Q

What are the only treatments permitted in START / Jump START triage

A

Adults = One manual airway opening

Peds = airway open & 5 rescue breaths

  • all pressure on major bleeding source
76
Q

In an active shooter… hot vs warm vs cold zone

A

hot = direct danger

warm = potential danger

Cold = no immediate danger

77
Q

how does treatment change in shooter hot zone

A

extraction to cover, bleed control (tourniquet and combat gauze), chest seal.

78
Q

how does treatment change in a shooter warm zone

A

normal START triage
interventions = combat gauze, tourniquet, chest seal

79
Q

does EMS treatment care change in active shooter cold zones?

A

no

80
Q

between hot warm cold zones of an active shooter… which one is the transport sector located? the casualty collection point? treatment center?

A

transport sector = cold zone

treatment center = cold zone

casualty collection = warm zone

81
Q

What info must be on an ecg prior to transmitting it?

A

Pt’s full name and bday

82
Q

you need to respond emergent to a staging scene unless…

A

< 5 min ETA

83
Q

Regarding controlled substances, what’s a blind count?

A

Manually counting the drugs without looking at electronic inventory

84
Q

Regarding controlled substances, what’s a broken chain of custody?

A

Period when CS drug or key is no under direct custody of it’s documented handler

85
Q

Guiding principles CRM?

A

Advocacy
Situational awareness
Closed loop communication
Clear respectful communication

86
Q

There is a broke chain of custody of the CS drugs (ex. Stolen drugs). What do you do?

A

Contact sup and law enforcement.

Remain onscene

Limit contact with CS box/drugs

87
Q

What’s a Chapter 401?

A

Involuntary transport of pt who doesn’t have decisional capacity to make healthcare decisions

88
Q

How long to wash your hands

A

20 seconds

89
Q

What to use to clean monitor and cables?

A

Alcohol 80%

90
Q

What to use to clean bags and glucometer

A

Hydrogen peroxide

91
Q

Per covid rules, who gets a mask?

A

Everyone > 2 years

92
Q

When drawing up narcs from multiple vials, how many cards do you need?

A

1 card per vial used

93
Q

When you use a narc, what must you keep? Why?

A

The vial and the card in the bag.

Card = document & turn in

Vial = prove to partner it’s wasted

94
Q

How do you document a narc used?

A

PSTrax
Narrative
Intervention - ex “fentanyl”
Waste intervention
Controlled substance signature

Pinellas County Protocol 2023 (9 decks)

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