Protocols Flashcards
Providers must contact ____ to administer other prescribed rescue medications not mentioned in the Protocols.
What must the rescue medication must be provided by the patient or caregiver and must have what?
The mechanism of delivery must be ____
Section 1.3 EMS Protocol
Medical Control
patients name and amount of medication
Within the provider scope of practice
What information do you need prior to contacting Medical Control or a receiving facility
Section 2.1 EMS Protocol
complete patient assessment and set of vital signs
When Communicating with Medical Control or a receiving facility, what essential elements should be included in the verbal report
Section 2.1 EMS Protocol
- Unit ID, level of provider and name
- ETA to facility
- patient age and sex
- mental status
- chief complaint
- history of present illness
- vitals to include EKG
- findings of the physical exam
- past medical history, current meds and allergy
- Treatment rendered in the field
- Response to emergency care given
- Orders requested, repeat granted order back physician
- document the physician name
If you see EMSC Bear what does it stand for and what actions must be taken?
Section 1.3 EMS Protocol
Emergency Medical Serviced for Children
Pediatric care is warranted and Medical Control is required
Once a patient has received medication administered by any level of DC Fire provider. the patient categorically considered an ___. Who should Transport?
Section 2.2 EMS Protocol
ALS level patient
ALS provider shall assume patient care and accompany patient to hospital. Unless estimated time to hospital is less than the ETA of ALS provider or Mass Casualty or disaster scenario.
ALS provider can transfer care to BLS provider when?
EMS Protocol Section 2.2
- airway is patent without assistance
-hemodynamically stable
-patient is at their baseline mental status and not impaired by medication or drug ingestion.
-No MOI or trauma alert activation
-No cardiac, respiratory or neurological issue warrants ALS intervention
-ALS provider gives full patient report to include vitals and physical assessment
-EMT is comfortable
In reference to the transfer of care at the medical facility, when must providers not initiate new medical care?
When shall they maintain pre hospital care?
EMS Protocols Section 2.2
-Once they cross the threshold
- any prehospital care given before the arrival to the hospital until patient is triage or (O2, IV’s and splints) need to be maintained
What is the goal time for transfer of care and when is it achieved?
EMS Protocols Section 2.2
-10 mins
-movement of patient to hospital owned equipment (bed, stretchers, waiting room and etc)
In the event that transfer of care is delayed longer than ____ the EMS provider will contact _____.
EMS Protocols Section 2.2
20 mins
ELO
The definition of a Patient for the purposes of this policy shall be
EMS Protocols Section 2.3
-obtaining a history or interview of a client
and/or
-physical exam, vital signs, assessment or mental status that leads to clinical decision-making actions such as treatment, transport refusal or referral to another agency/service provider.
What are the types of consent and describe them
EMS Protocols Section 2.3
A. Informed Consent – when a competent patient or guardian is informed of the
potential benefits and risks of a process or procedure, alternatives to that
procedure, and the possible consequences related to each.
B. Expressed Consent – written or verbal request to be evaluated and treated.
C. Implied Consent – when a patient is unable to express consent because of
altered mental status or severe distress.
Providers should attempt to assess the following
three major areas prior to permitting a patient to refuse care?
EMS Protocols Section 2.3
Legal Capacity to Refuse Care
-at least 18 years of age
-emancipated (over age 16) by declaration of the court, or is married.
Mental Capacity to Refuse Care
-oriented to person, place, time and purpose
- not a danger to himself or others
-understanding the risks of refusing care or
transportation and any proposed alternatives
Medical or situational capacity
-patient is not suffering from no acute medical conditions that might impair his or her ability to make an informed decision
-no other signs or symptoms of
potential mental incapacity, including drug or alcohol intoxication, unsteady
gait, slurred speech, post ictal period after seizure, cognitive deficits after
hypoglycemia or drug intoxication
Who may refuse care
EMS Protocols Section 2.3
- The Patient
- The Parent
- The Guardian
-appointed by a court
attempt to obtain documentation of
this fact (court order, etc.). If no such documentation is available, you may obtain
refusal signature from the guardian as long as you do so in good faith - Health Care Agent
-Attempt to obtain a copy of the durable power of attorney document to attach to the patient care report (PCR)
-If no such documentation is available u do so in
good faith and do not have any evidence or knowledge that the person is misrepresenting himself as the health care agent
Who will also be requested to the scene to facilitate the FD 12 process with Law Enforcement?
EMS Protocols Section 2.3
-A Battalion EMS Supervisor
In cases where the patient’s status is unclear and the appropriateness of withholding resuscitation efforts is questioned, FEMS personnel should?
EMS Protocols Section 2.4
-initiate CPR
-immediately and then contact an EMS Supervisor
OR
Medical Control Physician
for further guidance.
Name the 3 primary criteria that must be met to pronounce PDOA
What are the secondary criteria and how many need to be met
EMS Protocols Section 2.4
-Primary
Pulseless, Apneic and no signs of life
Secondary
o Rigor mortis:
o Dependent lividity:
o Decomposition or putrefaction:
indicates death occurred at least 24 hours previously.
o Decapitation:
o Transection of the torso: the body is completely cut across below the shoulders and above the hips through all major organs and vessels. The spinal
column may or may not be severed.
o Incineration
o Massive whole-body crush injury
o brain matter
o Valid MOST Form indicating DNR status in Section A or other actionable end-of-life medical order (e.g., POLST From, DNR order, or Advanced Directive) is present on scene
o A valid DC licensed physician on scene, familiar with the patient’s medical status, orders that resuscitation not be attempted (e.g., nursing home or
palliative care physician)
o “Compelling reasons” to withhold resuscitation in cases where efforts would be inappropriate and or inhumane. See “compelling reasons” below.
o During a mass casualty incident, (MCI) the patient is designated as deceased (black tag) or expectant (grey tag) i
Is an ALS Assessment, EKG/rhythm check necessary to
declare a patient PDOA per this protocol?
EMS Protocols Section 2.4
No
BLS providers do NOT need to request an
ALS resource simply to perform a rhythm check when the PDOA criteria are met
Compelling reasons to withhold resuscitation can be invoked when what two criteria are BOTH present?
EMS Protocols Section 2.4
➢ End stage of a terminal condition (e.g., cancer, heart failure, dementia etc.)
AND
➢ Written or verbal information from family, caregivers or patient stating that the
patient did not want aggressive resuscitation efforts such as CPR or intubation.
-written directive (valid MOST Form or DNR order) is not available on scene
- resuscitation effort will be futile, against the patient’s wishes, and or inhumane
When resuscitation efforts may be terminated immediately
EMS Protocols Section 2.4
-If Both Compelling Reasons are confirmed
-the patient has obvious signs of prolonged death or after obtaining additional information such as a valid MOST
Form
When it is determined that the a patient is PDOA what actions do EMS providers take on the EPCR?
EMS Protocols Section 2.4
-The current DC Fire and EMS Medical Director as the
pronouncing physician.
-The time the FEMS provider confirmed PDOA to be listed as the time of death
-“The patient was pronounced dead on date at time by Dr.
first and last name of DC Fire and EMS Medical Director by standing order.”
