Protocols Flashcards
Whenever possible, what kind of consent should be received on all patients
verbal consent
Who is given the authority to deviate from ALS protocols as required
2 concurring paramedics
what must be considered when deviating from protocols
good judgement and the patients best interest
when possible, who should be contacted to provide input to this decision to deviate
EMS captain
No recovery shall be allowed in any court in this state against any EMT, medic, physician, ARNP, person acting under direct medical supervision of a physician, in an action brought for examining or treating a patient without his or her informed consent if
Pt is intoxicated, under the influence, would under surrounding circumstances reasonably undergo such examination, treatment or procedure if advised
Examination and treatment under this section is limited to
reasonable examination to determine condition and reasonable treatment necessary to alleviate and stabilize
OPQRSTA
onset
palliative
provoke
previous
quality
radiation
severity of pain
time
associated
What is the subjective of a SOAP
chief complaint, OPQRSTA, SAMPLE
What is included in the objective of a SOAP
Physical exam, vitals
What is included in the A and P of the SOAP
in narrative form summarize diagnosis, treatment and disposition
semi conscious patients with intact gag shall have
NPA inserted unless contraindicated
unresponsive patients without a gag reflex shall have an
OPA inserted unless contraindicated
if ventilation is required for longer than how many minutes an igel or ETT should be inserted
2 minutes
what is the preferred method for ventilating a pediatric patient
BVM in conjunction with an oral or nasal airway
children with an advanced airway placed during CPR should be ventilated at
1 breathe every 6 seconds
What pediatric patient should not have an NPA or OPA inserted
pt in respiratory distress accompanied by fever, drooling or stridor
what patients should be placed in recovery position
spontaneously breathing, ams, postictal, suspected drug overdose, if no suspected spinal cord injury
oxygen only administered to pt with O2 sats at
95 percent
90 percent for COPD and asthma
do not withhold oxygen if pt is
dyspneic, tachypneic, hypoxic
who receives O2 at 15 LMP via NRB
TBI and 3rd trimester trauma
Endotracheal intubation shall be confirmed by
visualization of ETT passing vocal chords, auscultation and continuous ETCO2 monitoring
vent rate of adults
1 every 6
vent rate of adults without a pulse
1 every 10
children vent rate
1 every 3 (20 bpm)
children vent rate without a pulse
1 every 6 (10 bpm)
neonate vent rate
40 bpm
All unconscious patients should have what applied
zoll
in peds after how long of BVM oxygenation and ventilation should chest compressions begin if hr remains below 60
1 minute
what lead should all ALS patients be continuously monitored in
lead II
what is a full set of vitals
bp hr rr skin temp 02 sat
If transporting pt to ed what should be done with the 12 lead cables
leave connected until turned over to ed staff
How frequently should 12 lead ekg be performed
every 5 minutes or upon ROSC
priority 3 patients get vitals every how many minutes
at least 2 sets every 15 minutes
priority 2 patients get vitals every how many minutes
every 5 minutes
adult hypotension is defined as
sbp less than 100
what is puberty defined as
breast development for females and underarm, chest or facial hair on males
medical ED
Pediatric is defined as 17 years old and younger
in peds and neonates after how long of oxygenation and ventilation do you begin chest compressions if hr remains below 60
1 min (peds)
30 seconds (neonates)
trauma alert
pediatric is defined as 15 years old and younger
priority 2 pt
unstable with life threats
priority 1 pt
cardiac and respiratory arrest
priority 3 pt
stable with no life threats
all intubated interfacility transfers must be both
paralyzed and sedated by sending facility
if sending facility physician refuses to paralyze who should be contacted
battalion or ems
what may cause air transport destinations to be altered
weather, wind direction, fuel load
pediatric stroke departments
BHMC JDCH
Stable pt over 40 weeks may go to the hospital (OB) of their choice within how many minutes
40 minutes
if hyperbaric chamber is unavailable what hospital shall decompression sickness and co poisoning be transported to
closest ED with helipad
what is the max height for air transport in decompression illness and co poisoning
500 ft
helicopter may be utilized for ground transport greater than
20 minutes
pre hospital extrication greater than
15 minutes
pre hospital response to scene greater than
10 minutes
DAN
8006623637
florida abuse hotline
1866LEABUSE
Who should you report any suspicion of abuse to whether the pt is transported or not
EMS cap
and receiving facility (if transported)
document the call to the hotline in Epcr including
name of call taker
call takers ID
time call was placed
once completed email should be sent to whom
bureau chief of rescue
domestic violence hotline
8005001119
Chapter 401.45 section 3a statute FS
Denial of emergency treatment civil liability
DNRO is in force only when a pt is
in cardiac arrest (does not include a living will)
what form do we as EMS providers accept
original yellow DNRO DH form 1896 with original signatures
a copy on yellow paper or similar color is acceptable with
original signatures
do LEO have the right to refuse resuscitative actions
no
if any question exists on the validity of a DNRO
resuscitation efforts must commence
if a witness is used to confirm the identity of the pt, what must be documented in the Epcr
full name of witness
address and phone number of witness
relationship of witness to pt
proper receipt of DNRO should be documented by
taking a photo with the toughbook and attaching to Epcr
how can a DNR be revoked
by pt or health care surrogate by physical destruction
failure to present it
orally or in writing or expressing contrary intent
If dnr is from out of state
contact must be made to medical control to withhold efforts
a patient is defined as
individual activates EMS for themselves
person familiar with pt advises of change in behavior or suspected medical issue
actual or suspected illness or injury
medical or traumatic complaint
new ams
emt or medic suspects injury due to mechanism
anytime assessment or procedure is performed
what is an exemption from the above rule
public service programs offering routine vital sign checks
what is decisional capacity
when the pt demonstrates the full ability to understand the benefits, risks and options regarding medical treatment
what must the paramedic determine
that the patient has the capacity to make informed decisions
is competency a legal or medical term
legal
who determines competency
a judge
in implied consent what is assumed
it is reasonably assumed that an unconscious patient would want to receive medical assistance
who is able to refuse care
those who are 18 or older and have decisional capacity, as well as emancipated minors, self sufficient minors or minors in the military
who can not refuse care
minors, altered LOC, suicidal or homicidal. (verbal threat or attempt), cognitive deficiency, medical condition that would cause pt to not have decisional capacity
what is our intent in determination and declination of care
transport all pt with implied or expressed consent, regardless of perceived urgency of the complaint
shall fire rescue encourage a patient to decline care or transport
no
in a pt refusal process paramedics should
express their concerns but respect the pt decision
if a pt is initiating a declination process determine they are an adult that has decisional capacity by assuring they are
AA0x4
not under the influence
not suicidal or homicidal
understands and articulates risk/benefit of the decision
what is the best way to assure that the patient/legal guardian understands what has been explained to them
have them repeat it back to the crew
if a pt/legal guardian refuses to sign the refusal what should you do
clearly document why and if available, have the third party witness sign in witness signature section
if a specific treatment modality is being refused but transport is agreed to what should you do
a refusal should be signed and noted for as being for that specific treatment
patients cannot refuse transport if they have received any medication that would affect
mental status or respiratory drive
do family members have the ability to refuse on behalf of a patient who would reasonably accept medical care if they were able
no, request law enforcement, EMS and online medical control
if declination is obtained over the phone for a minor, the conversation must be documented and who must sign
a witness from law enforcement
When LEO calls fire rescue for medical evaluation of a person in custody what will fire rescue do
transport for medical clearance
does the pt in custody have the right to refuse medical treatment
yes but they do not have the right to refuse transport
att language line
18772876794
does use of this service violate HIPPA
no, as long as it does not occur in public
documentation of refusals should include
subjective and objective info
pt found to have decisional capacity
minor left in care of capable adult/guardian
why the pt declined
info provided from FR to alleviate any concerns
risk and benefits explained and understood
third party witness signature (cannot be fire rescue personnel)
when using physician orders what should you do if you feel the order is harmful
decline and follow up a report to the EMS captain. This report will then be forwarded to the medical director via the battalion chief
EMS or fire rescue services provided by a county, municipality or special district is responsible for the care of what kind of pt when nobody is present to refuse and volunteer services arrive simultaneously
unconscious
OPM
fire rescue personnel may except patient belongings when it has been determined that
it is in the patients best interest
it is not likely to disrupt or compromise normal operations concerning safety
reasonable efforts to secure items were made
patient is not capable of being responsible and no family members or designees are available to take custody
what should be included on the PCR when pt belongings are taken custody of
all items listed and inventoried
clearly state that property has been transferred to “hospitals name” and handed to “name of the person”
careful attention should be placed on generic naming
pepper spray
oleoriesin capsicum OC spray
a lachrymatory agent that stimulates the corneal nerves to cause tears, pain, and temporary blindness
lasts around 30-45 minutes with diminished effects lasting for hours.
closing of the eyes, difficulty breathing, runny nose, coughing
increased risk w asthma, certain prescriptions, or subject to restraining techniques which restrict the breathing passages
Mace
chloracetophenone CN gas
non lethal irritant containing purified tear gas and chemical solvents to temporarily incapacitate by causing eye and skin irritations.
burning sensation on affected area and feeling of suffocation if inhaled
can be minimal on those under influence of drugs and alcohol
30 min up to 2 hours
Tear gas
non specific term for any chemical used to cause temporary incapacitation through irritation of the eyes and/or respiratory system
excited delirium
psychotic and extremely agitated state caused by
OD on stimulant or hallucinogenic
drug withdrawal
non medicated psychiatric patients
head trauma
diabetic emergency
does fire rescue remove probes
no
how should ECD wires be cut
trauma shears
what temp should medications be stored at
55-85 degrees F
what are obvious signs of exposure to temperature extremes
changes in color and clarityw
hen should medication thermometer be checked
twice a day at 0800 and 1600
ho should initial temperature check sheet
crew member
medication that has been exposed to extreme temperatures or shows signs of contamination should be
removed from service and forwarded to the EMS division for disposal and replacement
where should med/iv boxes and bags be housed in
climate controlled portions of EMS vehicles (patient module)
whenever possible units should be
parked in shady areas
temp check sheet are to be completed and sent by
inter office mail monthly to logistics along with controlled substance log sheets
clear decontamination and disinfection in the workplace in accordance with
OSHA health standard 1910.1030
workplace includes any area where employees or substance can
cause risk of contamination
readiness areas, dorms, kitchen, offices, inclusive of vehicles and equipment
Decontamination is the process of cleaning an object, surface or substance to remove
soiled contaminants such as body fluids and biological substances
During decon PPE shall be used at all times, at a minimum
gloves and eye protection
biological materials involved in decon shall be placed in
approved red bags or puncture resistant containers
disinfection is the method used to
destroy and prevent growth of disease carrying microorganisms
PPE chem protection should be used at all times, at aminimum
N95 mask, gloves and eye protection with maximum ventilation to area
exposures during decon and disinfection should follow
OPM 401.01
equipment contaminated by blood or OPIM should be
decon and disinfected or disposed of as contaminated waste
surfaces contaminated by blood or OPIM
decon using one step germicidal detergent
what is the final disinfection step
byoplants
contact who to seek byoplant training
EMS captain
as a general rule the application rate is 1 min of spray per
500 square feet of area
objective is to apply sufficient product to achieve a
wet sheen not a saturation, soaking or running
at a minimum
weekly with the use of byoplanet on supply day or after suspected contamination of blood or OPIM
routine disinfection of stations will occur
quarterly or after suspected contamination of blood or OPIM
Who can provide access to byoplanet
battalion chief or EMS captain
staffing of EMS standby shall be left to the sole discretion of the
fire chief
minimum of how many personnel should utilized at EMS standby
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