Protocol (sec. 1) Flashcards
Who can choose to modify certain treatment recommendations?
Medical director
When is it recommended that a paramedic make contact with the physician for consultation?
On complicated patients
If the paramedic is unable to make contact with a physician for medical direction, the paramedic may administer:
a. BLS treatment according to his judgment or
b. ALS treatment only as authorized in protocols
Transport decisions should be made using what form?
Hospital Capability form
What is considered a new born?
just delivered
What is considered a neonate?
Younger than 6 weeks
What is considered an infant?
Under 1
What is considered a child?
1 to puberty
What is considered puberty?
pubic hair, facial hair, breast development
What is considered an adolescent?
a. reached puberty
b. treated as adult
Transport decisions definitions for Pediatric (2)
a. Trauma
b. Medical
a. Trauma = 15 yrs
b. Medical = 17 yrs
The treatment protocols are divided into ___ and ___ sections.
Adult and pediatric
How many parts does each section have?
Three
a. Supportive care
b. ALS Level 1
c. ALS Level 2
Define supportive care:
Actions authorized for EMT (BLS) or Paramedic (BLS & ALS) that are supportive in nature
Define ALS level 1:
Actions authorized prior to physician contact
Define ALS level 2:
Actions authorized only for the paramedic that require a physician consult
What is relied upon to determine which of the authorized treatment procedures are appropriate for a given situation?
Paramedic’s judgment
The treatment guidelines are given in:
Bulleted list form as a general order of steps
What is the intension of listing ALS 2 orders?
To allow for appropriate preparation and guide the paramedic
What must be documented in the PCR when a physician gives an ALS level 2 order?
Physicians name
Physicians authorized to approve ALS Level 2 orders include the following: (7)
a. EMS providers medical director
b. Hospital ER physician
c. Physician in his own office
d. Online medical control physician
e. Bystander physician personally known to medic
f. Bystander physician who presents MD or DO
g. Poison Information Center
If medical director, ER physician or online medical control physician give Level 2 orders, they should be requested in the following order:
a. Medcom
b. Telephone
c. Relay via dispatch
If a physician in his own office gives Level 2 orders to the paramedic, the order must: (3)
a. Be verbal or written
b. Signed by physician
c. Given directly to the paramedic
If the bystander physician that is personally known to the medic gives Level 2 orders to the paramedic, the physician must:
a. Accept full responsibility for patient
b. Accompany patient in the ambulance to the hospital
The poison information center is authorized to direct all medical care for what type of patient?
Toxicology and hazardous materials exposures
What is the telephone number for poison control?
800-222-1222
What does PCR stand for?
Patient care report
When is direct contact with the physician in the ER required?
Only when seeking consultation or authorization for ALS 2 orders
The treatment protocols have been designed to what?
Clinical guides, not educational documents
What are some organic causes of behavioral disturbances?
a. hypoglycemia
b. hypoxia
c. poisoning
If the patient is a threat to himself or others what type of force should be used?
reasonable physical force via law enforcement
If physical or chemical restraints are used, what should be placed on the patient?
ECG monitor and pulse ox
What is the state statute for a Baker act?
394.463
Is a baker act an absolute condition for transport?
No
What is the transportation procedure on transporting a baker act? (3)
a. Transported with an accompanying police officer
b. Paramedic-in-charge determines if officer follows or rides in the back
c. Document mileage via dispatch
Who is authorized to dictate certain medical care for persons who pose a threat to themselves or others (Baker Act)?
Police
Courts
Physicians
Which state statute allows for examination and treatment of incapacitated persons?
401.445
What does ICISF stand for?
International Critical Incident Stress Foundation
What is CISM?
Comprehensive, integrated, multicomponent, systematic program of crisis intervention
What is the purpose of CISM?
a. Education
b. Support
c. Assessment
d. Intervention
Who formulated and standardized CISM?
ICISF
What is the goal when applying any of the CISM components?
a. Assess
b. Education
c. Intervene
The Broward County CISM team is also known as:
Broward Region X CISM
The Broward CISM team is made up of: (5)
a. Law enforcement
b. Fire/rescue
c. Corrections
d. Communications
e. Licensed mental health professionals
To join the Broward CISM team, what needs to be completed?
At least 3 core ICISF courses
How long does the Broward CISM team have to respond to a critical incident?
Maximum of 2 hours
How often does the CISM team meet?
a. On a periodic basis
b. for training and information
Define defusing:
a. within first 12 hours
b. Homogeneous groups
Define debriefing:
a. 12-72 hours
b. prior to demobilization
c. significant personal loss
When is the expanded-phase defusing started?
within first 12 hours
Define crisis management briefing: (3)
a. Large incident with high media coverage
b. Large or mixed groups
c. Focus on assessment and information
What is considered a critical incident?
Any situation that is out of the norm or challenges a person’s normal coping
What is the benefit to group intervention?
Stronger group cohesion
Who is contacted when requesting a CISM team?
Communications Captain at Broward Regional Communications Center
What is the communications centers number?
954-765-5100
The agency requesting CISM team should provide the following information: (4)
a. agency name
b. type of incident
c. number of members involved
d. call back information
How are the CISM members contacted?
a. Communication Captain pages out the on-call CISM team leader
b. At the same time, sends out text messages to all CISM members
Who contacts the site contact person?
CISM Clinical director
All personnel are assembled according to:
Type
In a defusing or debriefing, personnel are assembled according to: (3)
a. Rank
b. Involvement to the incident
c. Proximity to the incident
Who determines the assembly of personnel during the defusing or debriefing?
Responding team leader
How is the CISM recorded?
It is not
No written, audio, or video
All patients found in cardiac arrest will receive CPR unless an exception is met: (4)
a. Advanced directive/DNRO
b. Determination of death
c. Discontinuance of CPR
d. Documentation
Which DNRO form is approved in the State of Florida?
Florida DNRO
If a DNRO from another state is presented what is the procedure?
Contact medical control
What is considered a valid DNRO?
a. Original yellow DNRO (DOH form 1896)
b. A copy on yellow paper
c. Patient identification device
What is a patient identification device?
Miniature version of the DOH Form 1896
What must be present to honor a DNRO? (3)
a. States its a DNRO
b. Signed by physician
c. Signed by patient or guardian
How is the identity of a DNRO confirmed? (3)
a. Driver’s license
b. Photo ID or
c. Witness known by patient
If a witness is used to identify the patient of a DNRO, what information must be documented? (3)
a. name of witness
b. address and phone of witness
c. relationship to patient
During transport of a live patient with a DNRO, EMS can provide:
a. pain relief or medically indicated care
b. no respiratory or cardiac resuscitation
Who can revoke the DNRO?
a. Patient
b. Guardian or surrogate
How do you have to express the revoking of the DNRO? (4)
a. Writing
b. Physical destruction
c. Failure to present
d. Orally
What is POLST?
Physician Orders for Life Sustaining Treatment Paradigm
What does POLST emphasize?
End of life planning:
a. Advanced care
b. Shared decision making
c. Ensuring patient’s wishes are honored
Which type of patients should have a POLST form?
Serious illness or frailty
For serious illness or frailty patients, what is the current form to have?
Standing medical orders
For healthy patients, what is a tool for making future end-of-life decisions?
Advanced directives
What are the other programs besides POLST?
a. MOLST
b. MOST
c. POST
What does MOLST stand for?
Medical Orders for Life Sustaining Treatment
What does MOST stand for?
Medical Orders for Scope of Treatment
What does POST stand for?
Physician Orders for Scope of Treatment
How many presumptive and conclusive signs must be present to determine someone dead?
4 presumptive
1 conclusive
What are the presumptive signs?
Unresponsive
Apnea
Pulseless
Fixed dilated pupils
What are the conclusive signs?
Injuries incompatible with life
Tissue decomposition
Rigor mortis
Lividity
What patients require full ALS resuscitation?
a. Hypothermia
b. Barbiturate overdose
c. Electrocution
A trauma victim who does not meet the “determination of death” criteria listed above may be determined to be dead based on the following criteria:
Pulseless and apnea associated with asystole and:
a. Blunt trauma arrest
b. Prolonged extrication
c. Arrest from brain injury
Who is responsible for the body once death has occurred?
Local law enforcement
If CPR is started in the field by EMS personnel, who can stop the resuscitation efforts?
Order from medical direction
What needs to be in place prior to terminating resuscitation efforts? (4)
a. All ALS and BLS
b. Advanced airway successfully accomplished
c. IV with shocks
d. Asystole
How many paramedics should verify ET tube placement?
two paramedics
What do you do with the body if the scene is a suspected homicide?
Do not cover the body with a sheet
A rehab area will be set up at the discretion of:
The incident commander
Who is responsible for the management and coordination of the rehab area?
The first available EMS unit
Who selects the Rehab area?
IC
If the IC does not determine the Rehab Officer decides
What does the Rehab Officer gather for the rehab area? (4)
a. Fluids
b. Food
c. Medical equipment
d. Other (fans, awning, chairs, etc.)
When is food provided in a rehab area?
operations 3 hours or longer
What is the minimum manning for rehab?
2 rescue personnel
Firefighters will be evaluated following: (4)
a. 2 scba bottles or 30 minutes
b. SCBA failure
c. CP, SOB, N&V, W&D, AMS, Cramps
d. At discretion of IC, Rehab officer, Safety officer, CISM coordinator, company officer
When is a medical evaluation form completed?
all personnel entering rehab and before they exit rehab
All personnel receiving ALS treatment and transport will have what completed?
PCR
How often does an examination take place in rehab?
10 minute intervals
If a firefighter is not routinely returned to emergency operations, what is written?
EMS run report and casualty report
If normal presentations are present in rehab, what is the procedure?
Rehydrate and rest for not less than 15 minutes
What are abnormal presentations? BP:
Higher or lower than normal
What are abnormal presentations? SaO2:
Less than 94%
What are abnormal presentations? Pulse:
a. at rest: should be less than 100 bpm
b. at work: should be less than 120 bpm (>120 for >15 min = transport)
c. never to exceed 180 bpm
What are abnormal presentations? Body Temp:
Greater than 100.6F
longer than 15 mins and after O2 = transport
CO values:
5% = normal for non-smoker
8% = normal for smoker
More than 12% = moderate
More than 25% = severe
Normal presentations should return within:
15 minutes
If a team member’s heart rate exceeds 110 bpm, what is performed next?
An oral temperature is taken
If the team member’s heart rate exceeds 110 bpm and the oral temperature is over 100.6F, what is the next step?
Member not permitted to wear PPE and should be treated for heat stress
When will a responder receive ALS treatment and transport?
If presentations are abnormal for more than 15 mins
If an emergency worker has a CO of more than 8% but less than 15% what is done?
Given the opportunity to breath ambient air for 5 mins
If the CO reading is still higher than 8% after breathing ambient air, what is done?
Given oxygen until it drops below 5%
Any member with a CO reading of _____ must be transported to the hospital.
25%
Which hospital should the CO patient be transported to?
One with a hyperbaric chamber
No worker will leave the rehab area until the CO reading is below what?
8%
Any emergency responder with ___, ___, and ___, will receive immediate ALS and transport.
CP, SOB, and AMS
What is done prior to taking anything orally?
Clean hands and face
What is the standard for oral hydration?
a. 1 to 2 quarts of fluid over 15 mins
b. At least 1 quart per hour
c. At least 8 ounces while scba fills
Who authorizes members to leave rehab?
rehab officer
Members can return to manpower or incident commander when the following criteria have been met: (4)
a. Vital signs are WNL
b. Absence of abnormal signs and symptoms
c. Minimum of 15 mins of rest
d. Released by rehab officer
Where is the Rehab Medical Evaluation Form forwarded to?
Rescue (EMS) Division
What is the standard dispatch for an Air Rescue assignment?
1 engine and 1 rescue
Who can modify the air rescue assignment?
uniformed fire department officer
What are fire department personnel used for at a heli-spot?
Safety
Security
Patient Loading
Who is legally and operationally responsible for the helicopter?
PIC
Takeoffs and landings should be in what wind direction?
Into the wind
The heli-spot should be cleared of any obstacles which is considered:
objects more than 40 feet tall that is within 100 feet of the heli-spot
What is the minimum number of rotor guards?
Minimum of one, two if available
Can the marshaller become a rotor guard?
No
Who has the general responsibility & definite responsibility to keep unauthorized personnel away from the helicopter?
a. General = Fire department personnel
b. Most definite responsibility = of the PIC and heli-spot group officer in charge
Is it necessary to have a hose line pulled and/or charged?
No, up to the incident commander
Where will the marshaller stand?
outer edge on the windward side (wind to back)
Who has the primary marshaling duties?
Apparatus Lieutenant or Captain
Who maintains contact with the helicopter?
an additional firefighter assigned to the marshaller
Who has primary responsibility of patient care?
Rescue unit OIC
Air rescue is dispatched by who?
IC
Who contacts the receiving hospital, helicopter or rescue?
Rescue
The only patient information that the IC needs from the rescue unit when requesting air rescue is:
a. number of patients
b. designated receiving facility
Does Air rescue need/require a completed run sheet?
no, whatever information you have should be provided to flight medic
When moving the patient to the helicopter, the patient will be secured to:
a backboard with minimum of 3 straps
If the patient becomes unruly, where is the 4th strap placed?
above the knees
How many members will carry the stretcher to the helicopter?
minimum of 4, one being air rescue crew member
What is the size of the heli-spot?
100’ x 100’
What is Medcom priority I?
a. Critical
b. Immediately life-threatening
What is Medcom priority II?
a. Serious
b. Immediate intervention, potential to become life threatening
What is Medcom priority III?
a. Stable
b. Not requiring immediate medical intervention
What is Medcom priority IV?
Administrative traffic
What are the Medcom classifications?
a. Adult and pediatric
b. Cardiac, Medical, OB, Trauma
How are pre-alerts communicated?
a. Via the dispatcher
b. Second contact via medcom enroute to hospital
When is the refusal of care policy utilized?
Patient refuses evaluation, treatment, and/or transport
Who can refused care?
Competent
Adult (emancipated or legal representative)
Who is classified as an emancipated minor? (3)
a. self-sufficient minor
b. married minor
c. minor in military
An individual may not refuse medical care based on the following: (6)
a. Altered LOC
b. Suicide (attempt or verbal)
c. Severely altered vital signs
d. Mental retardation
e. Not acting as a “reasonable person would”
f. Younger than 18
What information must be provided when a patient signs a refusal of care? (3)
a. release is against medical advice
b. release applies to this instance only
c. EMS should be requested if necessary
After the refusal of care is signed, it must be witnessed. Which includes: (3)
a. Name
b. Contact information
c. Signature (if signature is refused, document in report)
For refusal of care, medical direction should be contact for consultation under the following circumstances: (4)
a. low severity patient who is 18 yrs old
b. refusal presents significant risk to the patient or EMS
c. Patient who is not their own legal guardian
d. Patient who refuses after any IV medication (consider PD)
If a patient refuses transport to the nearest location, it is considered what?
refusal of transport
Who should be contacted when a patient refuses transport to nearest location?
Local department’s supervisor
If a patient refuses to be transported to any facility, who should be contacted?
Medical direction
What is a rescue task force?
team of law enforcement providing forced protection of rescue personnel
What does the rescue task force do?
triage and immediate life saving treatment
What is the procedure for the first arriving officer of an MCI? (5)
a. Size up, estimate number of victims
b. Request a Level # MCI
c. Identify a staging area
d. Direct crews to triage
e. Move walking wounded and assign someone to watch
What should the IC be on the look out for at Active shooter incidents? (4)
a. suspicious individuals
b. suspicious packages
c. suspicious vehicles
d. potential IED
What is the acronym for an active shooter incident?
THREAT
What does THREAT stand for?
Threat suppression Hemorrhage control Rapid Extrication to safety Assessment by medical Transport
What does a red ribbon mean?
immediate care
What does a yellow ribbon mean?
delayed care
What does a green ribbon mean?
Ambulatory (minor)
What does a black ribbon mean?
Deceased (non-salvageable)
What are the first four functions on a MCI?
Triage
Treatment
Transport
Staging
What are other sections/officers of an MCI? (8)
a. Medical
b. Landing zone/Heli-spot
c. Extrication
d. Hazmat
e. Rehab
f. Safety
g. PIO
h. Medical intelligence
What is medical intelligence for?
a. assist with suspected or known WMD events
b. decon, antidotes, and treatment
Are the responding units included in the MCI response?
a. On-scene units are not included
b. Responding units are included in assignment
When is trauma transport criteria determined?
During secondary triage
Upon notification of an MCI, medical control will: (2)
a. gather information from each hospital
b. relays to transport officer or medical communications officer
On large-scale incidents, IC should consider:
sending a hospital coordinator to each hospital
Define active shooter:
a. Individual engaged in killing or attempting to kill in confined, populated area
b. most cases use firearms
Define active shooter incident:
unpredictable and evolve quickly, over within 10-15 mins
Define casualty collection point:
a. safe location to receive victims
b. inside or outside
Define concealment:
provided protection from observation
Define cover:
Provides protection from direct fire
Define contact team:
Officers only going to neutralize the perpetrator
What is strike team?
a. same kind and type of resources with common communication
b. ALS transport strike team would consist of 5 ALS transports
What is a task force?
a. group of resources with common communication
b. MCI task force would be 2 ALS, 2 BLS transport and 1 Suppression
Active shooter Zone - Hot:
a. Direct threat care/Care under fire
b. Not been cleared by law enforcement
Active shooter zone - Warm:
a. Indirect threat care/Tactical field care
b. Entry of Fire/EMS with armed law enforcement
Active shooter zone - Cold:
a. Evacuation care/Tactical evacuation care
b. Not reachable by the perpetrator
Number of victims for MCI level 1:
5-10
Number of victims for MCI level 2:
11-20
Number of victims for MCI level 3:
21-100
Number of victims for MCI level 4:
101-1000
Number of victims for MCI level 5:
1001+
How many units responding during a MCI level 1?
a. 4 ALS transports
b. 2 Suppression units
c. 1 shift commander
d. 1 EMS supervisor
How many units responding during a MCI level 2?
a. 6 ALS transports
b. 3 Suppression units
c. 2 shift commanders
d. 2 EMS supervisors
How many units responding during a MCI level 3?
a. 8 ALS transports
b. 4 Suppression units
c. 3 shift commanders
d. 3 EMS supervisors
e. 1 Command vehicle
f. 1 MCI trailer
g. 1 Operations Chief
What size task force is responding for MCI level 4?
5 MCI Task Forces:
a. 2 ALS transport strike teams (10)
b. 2 BLS transport strike teams (10)
c. 1 Suppression strike team (5)
What size task force is responding for MCI level 5?
10 MCI Task Forces:
a. 4 ALS transport strike teams (20)
b. 4 BLS transport strike teams (20)
c. 2 Suppression strike teams (10)
Who is notified on a MCI level 1?
a. 2 hospitals
b. 1 trauma center
Who is notified on a MCI level 2?
a. 3 hospitals
b. 2 trauma centers
Who is notified on a MCI level 3?
a. 4 hospitals
b. 3 trauma centers
c. Warning Point
Who is notified on a MCI level 4?
a. 10 hospitals
b. 5 trauma centers
c. Warning Point
d. MMRS
e. SMRT
f. FAST
g. DMAT
h. MRC
Who is notified on a MCI level 5?
a. 20 hospitals
b. 10 trauma centers
c. Warning Point
d. MMRS
e. SMRT
f. FAST
g. DMAT
h. MRC
I. IMSURT
What are some considerations for a treatment area? (4)
a. Capable of accommodating the number of victims
b. Consider weather, safety, hazmat
c. Designate entry and exit
d. Divide into Red, Yellow, Green
Who is responsible for re-triaging of victims?
Red, Yellow, Green treatment managers
All MCI victims that are air-transported should be assigned to which hospitals?
Distant unless victim’s needs dictate
The Medical Communications Coordinator will advise medical control with the following information when a unit transports: (4)
a. Unit
b. Number of victims
c. Priority (R,Y,G)
d. Special needs (cardiac, burn)
Ground transported victims should be assigned to hospitals on a:
Rotating basis
What is MRCC?
Medical Resource Coordination Center
What is the MRCC’s prime function?
Maintain status information
How many MCI supply trailers are there in Broward County?
4
How many MCI trailers are there in Region 7?
3 large MCI supply trailers
The staging officer should maintain a reserve of _____ transport vehicles.
two
What is packaged in the MCI bags? (5)
a. 2 triage packs
b. 50 triage DMS tags
c. Grease pencils/pens/pencils
d. MCI FOG 1 - 8
e. Additional tourniquets, dressings, seals, and decompression needles (10)
What color vest for command?
White
What color vest for medical supply officer?
Blue
What color vest for triage officer?
Yellow
What color vest for treatment officer?
Red
What color vest for transport officer?
Green
What color vest for medical supply officer?
Blue
What color vest for Medical Communications Coordinator?
Green
What color vest for staging officer?
Orange
What does START stand for?
Simple triage and rapid treatment
Where are the triage ribbons tied on a patient?
upper extremity in a visible location
Where is secondary triage performed?
Treatment phase
What are the only corrections of lift-threatening problems in triage?
a. Airway obstruction
b. Severe hemorrhage
Adult - Move the walking wounded:
Green
Adult - No respirations after head tilt:
Black
Adult - Respirations over 30/min:
Red
Adult - Perfusion (no radial pulse/cap refill over 2 sec):
Red
Adult - Mental Status (unable to follow commands):
Red
Adult - Stable RPM/Walking:
Green
Adult - Stable RPM/Non ambulatory:
Yellow
What age is JumpSTART performed?
8 or less
Ped - Move the walking wounded:
Green
Ped - No respirations after head tilt and no peripheral pulse:
Black
Ped - Respirations over 45/under 15:
Red
Ped - No respirations with a pulse:
Give 5 ventilations
Ped - If respirations resume after giving 5 ventilations:
Red
Ped - Perfusion (no radial pulse/cap refill over 2 secs):
Red
Ped - Mental Status (Alert/Verbal)
Yellow
Ped - Mental Status (Pain/Unresponsive)
Red
Ped - Stable RPM/walking:
Green
Ped - Stable RPM/Non ambulatory:
Yellow
The START triage system was developed by:
New Port Beach FR
Hoag Hospital
The JumpSTART triage system was developed by:
Dr. Lou Romig
If law enforcement refuses access into the scene:
Notify EMS supervisor and complete incident report
At a crime scene, do not attempt resuscitation if the patient:
Has no pulse, no spontaneous respirations, and meets “death in the field”
What is the website for the protocols?
GBEMDA.org
What is the Broward EMS council’s web site?
Broward.org/BrowardEMS
How often do medical directors meet?
Yearly (or sooner if more emergent)
