Protocol 1-33 Flashcards
What types of Hemorrhage should be handled on Protocol 21?
17 Falls - (Neck/Armpit/Groin)
27 Stab/Gunshot (Peripheral punctures) & Thoracic Eviscerations
24 Post Partum Hemorrhage (Fundal Massage)
30 Traumatic Injuries (Neck/Armpit/Groin)
What 3 protocols captures the “Just resuscitated, defibrillated” status?
14 Drowning/Near Drowning/Diving/SCUBA
19 Heart Problems/AICD
33 Transfer/Interfacility/Palliative Care
Protocol 1 - Epigastric pain in cardiac arrest patients (Men >35, Women >45) is:
Considered a heart attack until proven otherwise.
Protocol 1 - Symptoms of a heart attack include:
Aching, chest pain, constricting band, crushing discomfort, heaviness, numbness, pressure, tightness
Protocol 1 - Abdominal pain in females (12-50) who have nearly fainted:
are considered to have an ectopic pregnancy until proven otherwise.
Axiom: Ectopic pregnancies are present before the patient knows she is pregnant.
Protocol 1: Alert patients with pain, and ashen/gray skin:
in patients over 50, may indicate a bleeding aortic aneurysm
Protocol 2: Rules to determine presence of allergy:
difficulty breathing/swallowing
anaphylaxis
swelling
itching
rashes/hives
abdominal pain
Protocol 2: What if Epipen is not prescribed by the patients doctor? (not theirs to begin with)
Have the caller or secondary responder bring the epipen on scene regardless, it may need to be used if symptoms worsen.
Protocol 3: Snake, spider, insect bites should be handled on Protocol:
Protocol 2. Treat as an allergy.
Protocol 3: What does non-recent mean? What is a dangerous body area? What are possible dangerous areas?
Non recent is less than 6 hours, with no priority systems (Breathing, consciousness, bleeding, chest pain)
Dangerous: Armpit/Groin
Possibly Dangerous:
Abdomen
Amputation (not fingers/toes)
Back
Chest
Genitals
Head
Neck
Leg, upper
Protocol 4: The SEND protocol (Medical Miranda Card):
Secondary Emergency Notification Dispatch card, police provides and includes: Chief complaint, Age, Consciousness level, Breathing status, Chest pains and any Bleeding.
Protocol 4: SA preservation
Preservation of evidence in SA situations is very important to patient than initial response/treatment to injuries.
Protocol 4: Sexual assault patients often require:
A very high level of compassionate care.
Protocol 4: Head tilt - when patient has a traumatic injury, ineffective breathing and not alert, Dispatcher shall:
Protect life over limb, and instruct to open the airway.
Protocol 4: If spinal injury is suspected in a Breathing Patient:
PDI encourages patient not to move, and to have the caller stabilize patient’s head and neck.
Protocol 4: If there’s a visible fracture, or foreign objects in the wound:
Do not apply direct pressure.
Protocol 4: Assault complaint Axioms:
Are generally 3rd party, and received by police first.
Protocol 4: An arrest may have been caused by Serious Hemorrhage (priority symptom). Which other protocols does this apply to?
1 Abdominal Pain/Problems
3 Animal Bites
7 Burns/Explosions
17 Falls
27 Stab/Gunshot/Penetrating Trauma
29 Traffic Incidents
30 Traumatic Injuries
Protocol 4: When an incident is Non-recent (over 6 hours ago):
The current priority symptoms take precedence, not the injuries sustained from the incident hours ago.
Protocol 5: Back pain protocol is used when:
Back pain is non-traumatic, or non-recent
Protocol 5: Non Traumatic Back Pain Causes:
Aortic Aneurysm, Kidney stone, Low back syndrome, Kidney infection, Vertebral disc disease
Protocol 5: Non-Recent Traumatic Back Pain Causes:
Bruised spine, fractured ribs, fractured spine, injured nerve, sprained back
Protocol 5: Symptoms of spinal cord injury -
Abnormal breathing, no pain/no movement below injury, tingling sensation or numbness in extremities
Protocol 6: COPD is:
A progressive disease that decreases lung function overtime. Emphysema and Bronchitis are two types. Patients often have both.
Protocol 6: Colors of clinical significance:
Ashen/Gray - Blue/Cyanotic/Purple - Mottled
Protocol 6: Breathing problems:
- Breathing may worsen at any time; potentially life-threatening until proven otherwise
- Asthma patients are usually very experienced, if they mention they cant breathe, consider this as ineffective breathing, ECHO response.
- Rule 9: if patient has non-traumatic chest pain, heart attack symptoms and breathing problems, choose foremost symptom with ECHO response.
Which Protocols have an ECHO response?
2 Allergies
6 Breathing Problems
7 Burns/Explosions
9 Cardiac or Respiratory Arrest/Death
11 Choking
14 Drowning / Diving / SCUBA
15 Electrocution / Lightning
31 Unconscious/ Fainting
Protocol 6: Which problems are Not In the lungs/airway?
Cardiac arrest
Substance abuse / Overdose
Heart attack
Seizures
Stroke
Hyperventilation
Protocol 7: Burns - All electrical burns:
Are considered to be worse than they look externally.
Protocol 7: Burns - Location
Consider the type of location; it may be indicate a deliberate terrorist attack.
Protocol 7: Burns - Axioms
- Pediatric patients with large burns may develop hypothermia
- Use caution when cooling burns in cold climates or exposed to prolonged cooling with water
- Scene care is supportive and compassionate
- Explosions occur as result of a bomb, or because of non-intentional event such as a gas leak or ignition source.
Protocol 8: Carbon Monoxide Suffixes CBRNG MSTU
Chemical
Biological
Radiological
Nuclear
Smell of Gas/Fumess
Carbon Monoxide
Suicide Attempt (Carbon Monoxide)
Suicide Attempt (other toxic substances)
Unknown
Protocol 8: When patients tape windows and door seams shut, posting warning notes “Danger, Call 911”:
This means a chemical suicide is taking place (detergent suicide or other). Mark suffixes S or T
Protocol 8: All hazard exposures/inhalations are considered:
High level emergencies until proven otherwise. Caller should not re-enter this environment as they could potentially harm themselves.
EMD’s first and second law: Don’t create more victims on scene, don’t get it on you or touch it.
Protocol 8: Recreational inhalations of harmful substances should be handled on:
Protocol 23 - Overdose and Poisoning
What is considered difficulty speaking between breaths?
Unable to complete a full sentence without taking a breath.
Only able to speak a few words between breaths.
In infants/children, breathing problems severely hinder crying.
Protocol 8: Carbon monoxide binds tightly to hemogoblin, preventing oxygen delivery throughout the body. If the patient goes unconsciousness from carbon monoxide:
A hyperbaric chamber may be necessary to prevent death or brain damage.
Protocol 9: What is considered Obvious Death?
- Cold/stiff in warm environment
- Decapitation
- Decomposition
- Incineration
- Non-recent death (over 6 hours)
- Severe Injuries incompatible to life
Protocol 9: What is expected death?
Omega Level, or Delta level:
X - terminal illness
Y - DNR order
Z - other
Protocol 9: AGONAL Breathing can still be:
Confused as “still breathing” in an unconscious patient, before the breathing deteriorates during cardiac arrest.
Protocol 9: A healthy child in cardiac arrest:
Should be considered to have foreign body airway obstruction until proven otherwise
Protocol 9: If a caller insists that a DNR should be ignored, or cant verify if it’s in place:
Appropriate response to resuscitate client should be made.
Protocol 9: If a 2nd party caller cannot confirm breathing:
Consider it as cardiac arrest until proven otherwise.
Protocol 9: If caller notes a seizure in the patient:
Shunt to protocol 12 regardless of unconsciousness and breathing status. (Rule 6)
What is Brock’s Law? Protocol 9
The presence of an AED does not ensure it’s use, the EMD does.
(an AED is to be instructed by an EMD in order to curate PDI)
Protocol 10: What is considered a history of heart attack or angina in dispatch? AXIOM: they dont necessary have to have had a heart attack
Patients who have had:
- Angioplasty
- Coronary Artery Stents
- Bypass Surgery
Protocol 10: A patient over 35:
Is considered to have a heart attack until proven otherwise.
Axiom: true heart attacks are uncommon in Females under 45, Males under 35.
Protocol 10: Traumatic chest pain (Rule 2):
Should be handled on Protocol 30 traumatic injuries
Protocol 10: if the description involves Chest pain & STROKE symptoms:
Do not use ASA diagnostic, and utilize protocol 10.
ASA - Which medications?
Alka Seltzer, Anacin, Acriptin, Asperbuf, Aspergum, Bayer, BC Powder, Bufferin, Doan’s, Easprin, Ecotrin, Empirin, Entrophen, Excedrin (only aspirin based), Goody’s, Halfprin, meausrin, St Joseph, Vanquish
ASA Diagostic - ASA and AMI
Acetylsalicylic Acid, Acute Myocardial Infarction
ASA should not be administered
To those under 16
To those having stroke symptoms
ASA past its expiration date / drinking water.
Is safe and advisable to use. Available as 325mg or baby 81mg.
Advise them only a mouthful of water to wash down aspirin.
When 1st party calling, patient should not:
Locate aspirin outside of their own home.
If it’s a 2nd party caller, have them ask neighbours or someone else check if there is aspirin near by.
Protocol 11: Choking (what is not recommended)?
Back blows, due to risk of injury for overly forceful blows.
Protocol 11: The best approach for patients with partial obstruction is ___________________. If patient begins to faint with partial obstruction _________________;
Encourage the patient to continue coughing up the obstruction and to continue to breathe ; EMD should instruct caller for airway maneuver
Protocol 12 - Seizures (Rule 9) caller dispatch instructions
Do not do CPR, do not hold them down, remove objects away from the patient.
Stay on the line, check breathing often.
Protocol 12 - types of Seizure
Continuous, Multiple, Focal, Absence, Atypical, Recurrent, Febrile
Protocol 12 - Rules 1/2 Once a generalized seizure stops:
Assess for AGONAL breathing (mandatory), ineffective/agonal/uncertain breathing is considered cardiac arrest until proven otherwise.
Seizures - If effective breathing cannot be verified, a seizure for patients over 35
Is coded Delta response, due to increased probability of cardiac arrest.
Seizures - symptoms of an aura, strange sights, sounds, smells:
Indicate a premonition or sensation prior to a seizure
Atypical Seizures:
different than a patient’s previous seizure.
May indicate serious underlying conditions unrelated to a seizure disorder
Protocol 13 - Diabetic Problems
Diabetes can be accepted as an accurate diagnosis at face value.
Early sign of low blood sugar is decreased consciousness, agitation, aggression, impaired judgment, confusion and combativeness.
Level of consciousness is key. Airway monitoring is crucial.
Do not advise oral sugar administration, there is no clinical evidence of improved outcome.
Protocol 13 - hypoglycemia:
When too much insulin depletes the body of sugar. Brain is mostly at risk as sugar is their fuel.
Diabetic Ketoacidosis:
Pre-coma state where there is not enough insulin to turn sugar into fuel. Body begins burning fat/muscle to fuel body.
Protocol 14: Drowning / Diving / SCUBA (Rule 1 scene safety, Rule 2 trauma, Rule 11 send then question, Rule 12 ECHO, case entry completed after PDI’s)
Domestic Resuce: pool, hot tub, bathtub
Specialized Rescue: lake, river, sea, canal, water tank
Protocol 14 - determining location of drowning patient:
Allows EMD to properly send echo alert (fasttrack) and continue case entry
Protocol 14 - A submerged patient, less than 6 hours:
Can still be resuscitated by definition, especially in cold-water situations.
Protocol 14 - Head Tilt is only recognized form of airway control:
When presented with trauma, patient not alert, not breathing effectively, EMD should protect life over limb and open airway.
If patient conscious, spinal injury suspected, instruct caller not to move patient, and use hands to stabilize head/neck.
Protocol 15 -All electrocution/lightning strike patients:
Are considered in cardiac arrest until proven otherwise. If patient is unconscious, and lightning strike is confirmed, begin CPR right away.
Protocol 15 - before providing CPR to electrified client:
Advise caller of electrical risks, electrified water.
Axiom: callers attempting to help end up being injured, ensure caller makes sure it is safe to rescue.
EMD’s 2nd law: Dont get it on you or touch it.
Protocol 15 - Hidden exit wounds:
Internal injuries may complicate patient’s status.
Protocol 15 - Lightning Strike Arrest Theory
Lightning is a cosmic countershock, sending heart into asystole (stopping contractions). Because heart is automatic, it will resume, but the accompanying respiratory arrest is more lasting, and can lead to cardiac arrest due to hypoxia.
Protocol 15 - All electrical burns (Protocol 7)
Are considered worse than they look externally.
Protocol 16 - Eye Injuries Rules
for Severe eye injuries, no treatment should be given until emergency units arrive.
Thermal Burns to the eye should affect the face/head, and to be handled on Protocol 7 Burns
Sudden vision problems should be handled on Protocol 28 Stroke.
Protocol 17 - Falls (heights)
Long Fall - 10-29ft (3-9m) in Adults, 6-29ft (2-9m) in infants
Extreme Fall - 30ft/10m (3 stories) or higher.
Protocol 17 - Rule 2 or 6 application:
Always consider that the patient’s fall may be a result of a medical problem. Choose according to the foremost symptom.
Falls are often a secondary injury after being electrocuted.
Distance of fall is key to determining response.
Uncontrolled hemorrhage (neck/armpit/groin) should be handled on Protocol 21 if it is Ground-Level
Ground-level falls caused by fainting/dizziness should be answered on Protocol 31 unconscious/near fainting
Protocol 18 - headache objective Axiom:
Most important objective is to determine if underlying cause of headache is life-threatening (Stroke, Meningitis) or low-acuity.
Protocol 18 - Patients who call an ambulance for a headache:
Are usually more serious than those who arrive to emergency on their own.
Protocol 19 - Heart Problems, an A.I.C.D. :
is used to send an electric shock to control tachyarrhythmias (rapid heart rate) and restore normal heartbeat.
Protocol 19 - AICD’s are becoming more common, but if there are multiple firings:
This indicates a prehospital emergency.
A pulse lower than 50 bpm, and higher than 130bpm at rest, paramedics should be sent.
Protocol 19 - Heart attack symptoms
Aching, chest pain, constricting band, crushing discomfort, heaviness, numbness, pressure, tightness.
Present in arm, jaw, neck or upper back. These can be considered chest pain.
Protocol 20 - heat cold exposure
Life-threatening exposure situations are associated with priority symptoms (Decreased level of consciousness, difficulty breathing)
Protocol 20 - Hypothermic patients:
Can appear dead, but cannot be confirmed dead until they have been warmed up, and dead.
Gradual rewarming is the best method.
Protocol 20 - skin colour changes (red, pale, cyanosis, blue, gray) :
Indicate significant exposure.
Protocol 20 - Just because a patient has a problem in hot/cold environment doesnt mean it was caused by the heat/cold:
It could trigger pre-existing medical problems.
