the final review Flashcards
whats does DSHS stand for
department of state health services (texas)
what does emt regulation and certification fall under
DOT (department of transportation) and then more specifically the NTHSA national traffic association); NHTSA falls under the DOT
Medical director is also known as
medical control, medical direction, they are the medical oversight; the EMT is under their wing
in essence EMT’s are
physician extenders with a wide scope of care without direct supervision in emergency situtations; the eyes and ears of the physician (on the ground while physician is in the hospital)
dead is
dead
what act allows for a doctor to take an EMT under their wings to work
The Medical Practice ACT
(thus the EMT is actually working under the doctor’s licence)
what does the medical director do
writes a protocol book to be followed; must partciipate in QA/QI; must ensure that the EMT knows what they are doing
What are the two types of direction
on line(direct medical direction)
and off line (indirect medical direction which has a branch that is known as standing orders)
define on line/direct medical direction
it’s talking directly to a medical director or agents authorized to give orders for the medical director; is real-time oversight or medical direction provided by a physician to an EMS provider who is seeking immediate feedback or direction that impacts the patient’s care. Direct medical oversight is either on-line or on-scene.
what you can do on consult with the physician
define off line/ indirect medical direction
using a book of protocols that give permission to do things without calling the doctor; makes up the majority of the medical director’s responsibilities and activities.
can perform without consulting the physician
define standing orders
a branch of off line orders is also known as standing orders which is whenever using a protocol book without calling the doctor
(just remember that standing orders are off line medical control)
MEDICAL DIRECTION RULE- DOCTOR SAYS
-what equipment will be on ambulance
- what communication systems will be available
-establish a direct connection to a doctor or agent
- case review
-education program
-systems review
what is QA
quality assesment; this is the checking; making sure the product is acceptable; making sure the system is working; identifying the broken links
what is QI
quality improvement; this is the fixing; this is the making adjustments when the performance is lacking; making it better or fixing the broken links in the system; Quality improvement (QI), also known as continuous quality improvement (CQI), is a system of internal and external reviews and audits of all aspects of an emergency medical system. To ensure the public receives the highest quality of prehospital care, the goals of QI are to identify those aspects of the system that can be improved and to implement plans and programs that will remedy any shortcomings.
QA/QI generally refers to
a range of activities conduced to assess, analyze, critique, and improve current process of health care deivery in an institutionalized setting
define emergency medical services
EMS; medical care is provided to people who become ill or injured
define definitive care
final medical treatment needed
define first responder
first individual to the scene that is medically certified (RN, DR, EMS, etc)
is a red cross first aid person a first responder
no because that is not a regulated profession by the state
what is a tiered system
sending what is needed and not all resources right away; just like a fire send the closest station and then call for additional if needed
what are the six levels of pre-hospital providers
emergency care attendant (ECA); EMT-B; EMT-I; EMT-P; medical director; Emergency Medical Dispatcher (EMD)
define emergency care attendant
ECA; in texas while other states call this a certified first responder; approximately 80 hour course no rotations; first aide class course; deals with one drug-oxygen); this is more for rural fire departments that are designed to help the people that work on an ambulance;
define emtb
about 140 classroom hours and includes rotations; level above eca; about 130-150 hours of training, and about 100 hours of rotations (minimum 40-60); responsible for six drugs as long as they are listed in the protocol
emt-i
also known as an advanced emt; must be an EMT before becoming this; not in wide use; 300 classroom hours, 80 hours of rotations, about 20 drugs they are allowed to administer; they learn not just using an AED but also a defibrilator; and essentially they know how to work the first ten minutes of a cardiac arrest/ dead person; the bridge between emt and paramedic and is more available to rural areas as opposed to a metroplex
emt-p
the highest level of pre-hospital provider; 400 hours plus (minimum 1000) of classroom instruction; 300-500 hours plus ambulance rotations; and 180 hours plus of hospital rotations; can administer up to 60 drugs
define medical director
any doctor (MD/DO)
define emergency medical dispatcher
EMD; a 40 hour course for dispatchers to give care and ask questions prior to EMS field arrival
1966 Accidental Death and Disability
a study showed that there were large amounts of preventable deaths
1969 initial prehospital course called
EMT ambulance
1973 EMS systems act
standardized training, DOT training
1989 DOT began most comprehensive revision that was published in
1994
in order for states to get federal money for EMS they have to follow about 10 federal goals which are:
regulations and policy (they have to have rules in place); resources (start up funding); HR (to protect employees and laws & they also ensure credibility); Transportation (approved ambulances only used); Facilities to transport patient to; Communications systems (radio and 911); Public education programs (don’t smoke in bed, CPR); Medical direction; trauma system in the area; evaluations (QA/QI program); if all are met then federal money can be granted
what are the three types of ambulances
BLS unit: basicl life support; basic life saving that needs to be done to get to a higher skill level
ALS Unit: 1emt-i or 1 emt-p and an emt-b; advanced life support; can run cardiac arrest calls for airway and drugs
MICU: mobile intensive care unit; ALS but with 2 emt-p’s; emergency advanced care and treatment can be started; NOTE: TxDSHS only requires one medic onboard to be an MICU but standard if 2 medics
the basic details of a call
starts with a patient, then a smart person who recognizes the emergency, EMD is called, dispatches pre-hospital proffesssional (EMT’s), transport to hospital staff (DR, RN,etc), patient is discharged
what is the weakest link in a medical emergency
the smart person because if no one makes the call then the other links that are well trained cannot help
define licensure
governing body has granted permission to perform
certification
agency has granted certification that attests to the accomplishments of a set of requirements
note: texas department of state health services is an agency, how can Texas have licensed paramedics? they are no better than a certified paramedic. who is a better lawyer licensed or board certified? certified is usually more difficult then licensure
what are the three main ways patients call EMS
911- speed dial only with no caller ID
enhanced 911- speed dial and caller ID
7 digit- have to call all 7 numbers to get dispatch center
how to communicate:
keep radio traffic short but clear, know how communication system works. know what is ok to say and how to say it, use eye contact when talking to a patient, use proper patient name and introduction
Safety is number 1
safety to self is the most important , then ensure your crew safety, and then ensure the patient’s safety
are bystanders to the scene the responsibility of an emt
no save them for PD but remeber that they can quickly become engrossed in the scene and therefore become patients
what are the other responsibilities of EMS personnel
- to be a patient advocate (do eveything in the patient’s best interest)
- look good (self-maintenence, have your shirt tucked in, a hair cut/ be well manicured)
- be/ keep as fit as possible
-gaining access to a patient
transporting a patient - care for a patient
- safe driving
- documentation
-eat healthy
-transfer care
define body substance isolation
BSI; all people are diseased meat, including the EMT
define personal protection equipment
PPE; gloves, glasses, goggles, masks, etc
Safety is the number
one role and priority
what do you do if the scene is not safe and cannot be made safe
do not enter
when can you enter an unsafe scene
if you have the right training and right equipment for that specific scene (equipment to safely a shooting may differ from one to enter a collapsed building therefore you may be able to enter one but not the other)
what are the basic rules for entering a hazmat scene
use the emergency response handbook to look up the material, use binoculars to look for placards, stay uphill and up wind
what are the basic rules for entering a violent scene
get cops; get good shoes to run in
what are the basic rules for entering a crime scene
get cops and preserve the chain of evidence if possible (do not move things unless absolutely necessary)
what are the five emotions when someone is dying or a family member watches someone die
1) denial: “not me” “no way”
2) anger: commonly seen in long terms spouses; a lot of times individuals are angry at their religion/ God for allowing the death to occur; “i knew i should not have done that”, “you suck”; most common emotion directed at EMT’s;
3) bargaining: “how can i get out of this?”
4)depression: they are not cutting themselves any slack
5)acceptance: “oh well, don’t let it happen again”; a “deal with it” mentality
family membars can tell an EMT who does not really care and is fake
true
what should the EMT do in situations regarding death and a dying family ember in the presence of the family
say helpful things, keep requests simple, try to involve the family as much as possible and do not push them away, ALWAYS TELL THE TRUTH and DO NOT GIVE FALSE HOPE; treat them with dignity and respect; don’t talk down to the family as they know what they know more about the loved one because they are living this
define CISD (critical intense stress debriefing)
occurs 24-72 hours after an incident; this is for the responders; “it is to prevent the EMS workers that have experienced an incident from blowing their head’s off nine months later”; examples of when one is held are: senseless crimes (rape, spousal abuse),death/abuse to child or elderly, death of a coworker, MCI (oklahoma bombing, world trade center); the meeting is not to place blame on anyone or to make the system better, but to let one’s feeling out/ expressing feelings, and expressing frustrations; the professionals who conduct these meeting are from all arond the county and are other EMT’s, firefighters, Dr’s that have special training; to activate a CISD contact your medical director
How to avoid stress
trade shifts, change up your routine, eat healthy, refrain from using alcohol as it only helps short term, excersise, do not smoke, go on a vacation and do not bring your coworkers as you will all end up talking about work instead of resting, get help early on, get sleep (you do not go to a fire station to get sleep)
what is the difference between calling 911 and enhanced 911
E911 is a service that allows emergency operators to provide better assistance to people calling 911 from their mobile phones. It provides emergency operators with more specific information about your location and displays your mobile phone number to emergency operators.
automaticly ties a location to the call—whether it’s a specific address or coordinates. If we had to explain enhanced 911 (E911) in five words or less, we’d tell you that it’s location services for 911 calls.
7 digit dialing?
7-digit non-emergency telephone number. A non-emergency incident is a property damage accident, break-in to a vehicle when suspect is gone, theft of property (when suspect is gone), vandalism (when suspect is gone), panhandlers, intoxicated persons who are not disorderly, or cars blocking the street or alleys.
MI
myocardial infarction
does ems do SOP (standard operating procedure)
no we use a protocol book
special comters
1)burns
2) trauma
3) pedi
1-cardiac
2- stroke
when coming into contact with a patient and they have a dog assume
that it is dangerous
when taking care of patients with pets assume that
all animals are dangerous
what is an example of a tiered system
if there is a car accident the bls responding to the cal gets the lowest injured person
if you don’t need an iv what type of call is it
a bls call
can a paramedic work any ambulance
yes and they can do so without special training