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Flashcards in CFR-D 2 ++NOT FINISHED++ Deck (80):
0

HOW MANY CFR-D FF'S SHALL COMPANY OFFICERS ENSURE THAT A CFR-D UNIT STARTS THE TOUR WITH?

2

++Company Officers of CFR-D Units shall ensure that two (2) CFR-D Firefighters will be working each tour. Officers shall notify their respective Battalion for needed details prior to the start of the tour.++

1

WHO SHALL COMPANY OFFICERS NOTIFY PRIOR TO THE START OF A TOUR IF THERE ARE NOT 2 CFR-D FF'S SCHEDULED TO WORK A PARTICULAR TOUR?

BATTALION

++Company Officers of CFR-D Units shall ensure that two (2) CFR-D Firefighters will be working each tour. Officers shall notify their respective Battalion for needed details prior to the start of the tour.+*

3

DURING THE TOUR 2 MEMBERS OF A CFR-D UNIT TAP OUT. THIS LEAVES JUST THE BOSS, ECC & NOZZLEMAN LEFT ON DUTY. THE NOZZLEMAN IS THE ONLY CFR-D CERTIFIED MEMBER STILL WORKING. CAN THIS COMPANY STILL BE DISPATCHED TO EMS RESPONSES?

NO BUT THEY CAN RESPOND TO CALL RECEIVED DIRECTLY FROM CIVILIANS

++During roll call the Officer in Charge shall determine the number of CFR-D certified personnel on duty. If that number has fallen below the minimum, the Officer in Charge should follow these procedures:
-Without two CFR-D certified members, the Company shall not respond to any CFR-D calls. The Company may still be dispatched for calls received directly from the public to assist civilians.
-Notify the dispatcher and Battalion and enter the event in the Company Journal.++

5

TRUE/FALSE

IF FOR SOME REASON YOUR COMPANY HAS BEEN PLACED OOS FOR CFR-D RESPONSES, AT THE CHANGE OF THE TOUR WHEN YOU HAVE ENOUGH MEMBERS CFR-D CERTIFIED TO RESPOND TO CFR-D EMERGENCIES, THE OFFICER ON DUTY MUST NOTIFY THE DISPATCHER TO CHANGE THE UNIT'S CFR-D STATUS.

FALSE

++At each change of tours, 0900 and 1800 hours, Unit status defaults to their normal CFR-D status.++

6

WHAT ARE THE "A" AIRWAY FIREFIGHTER'S DUTIES?

-CARRIES O2 BAG
-MANUALLY STABILIZES SPINE, MAINTAINS AIRWAY & ADMINISTERS O2 (TRAUMA)
-BEGINS VENTILATIONS IN CARDIAC ARRESTS

8

WHAT ARE THE "C" CHECKER FIREFIGHTER'S DUTIES?

-CARRIES TRAUMA BAG
-PATIENT ASSESSMENT & HANDS ON CARE (TRAUMA)
-CHECKS PULSE & BEGINS COMPRESSIONS (CARDIAC)

9

WHAT ARE THE "D" DEFIB/DOCUMENTER FIREFIGHTER'S DUTIES?

-RESPONSIBLE FOR PCR
-HOOKS UP & OPERATES DEFIB (CARDIAC)

11

WHAT ARE THE THREE SEGMENT 1 RESPONSES?

CARDIAC ARREST

RESPIRATORY ARREST

CHOKING

14

WHILE DRIVING DOWN QUEENS BLVD. E287 IS FLAGGED DOWN BY A GROUP OF PEOPLE STATING THAT SOMEONE IS IN CARDIAC ARREST IN A NEARBY STORE. NO AMBULANCE IS ON SCENE, YOUR MEN JUMP OUT, MAKE PATIENT CONTACT & BEGIN TO ADMINISTER CARE. AS THE OFFICER YOU CONTACT DISPATCH AND REQUEST THE RESPONSE OF AN AMBULANCE, WHAT INFORMATION MUST YOU PROVIDE DISPATCH WITH?

"CHRIS AND CHARLIE CAN PLAY RUGBY"

C - CUPS STATUS
A - AGE
C - CHIEF COMPLAINT
C - CPR INITIATED
P - PULSE RATE
R - RESPIRATORY RATE

17

ENGINE 305 RECEIVES A TICKET FOR A CARDIAC ARREST AT 120 FOREST HILLS LANE, NO AMBULANCE IS ON SCENE. UPON THE BUILDING THEY FIND A 60 MALE UNRESPONSIVE AND NOT BREATHING. THE FF'S IMMEDIATELY BEGIN CPR - COMPRESSIONS AND VENTILATIONS (PATIENT IS IN CRITICAL STATUS) AS THE OFFICER IN CHARGE YOU SHOULD?

-CONTACT DISPATCH REQUEST ETA OF RESPONDING AMBULANCE

-ADVISE DISPATCH TO RELAY PATIENTS CONDITION TO RESPONDING EMS AMBULANCE

18

FOR CUPS CRITERIA WHAT WOULD "CRITICAL" BE?

CRITICAL

-PATIENT RECEIVING CPR
-PATIENT IN RESPIRATORY ARREST
-PATIENT RECEIVING LIFE SUSTAINING VENTILATORY/CIRCULATORY SUPPORT

19

YOUR NOZZLEMAN INFORMS YOU THAT YOUR CFR-D UNIT IS OUT OF BAG VALVE MASKS. ARE YOU IN SERVICE OR OUT OF SERVICE?

IN SERVICE FOR FIRE DUTY, OOS FOR EMS

++If equipment has been left with the patient or supplies have been expended and the Company does not have the minimum amount specified in Chapter 4 section 2.1, the Company is to go back in service for fire duty but advise the borough fire dispatcher and the Battalion that it is not available for CFR-D responses.++

20

IF YOUR COMPANY IS OOS FOR CFR-D RESPONSE BECAUSE IT NEEDS TO RESTOCK, WHO MUST THE OFFICER NOTIFY?

BATTALION

DISPATCHER

++If equipment has been left with the patient or supplies have been expended and the Company does not have the minimum amount specified in Chapter 4 section 2.1, the Company is to go back in service for fire duty but advise the borough fire dispatcher and the Battalion that it is not available for CFR-D responses.++

21

FOR CUPS CRITERIA WHAT WOULD "STABLE" BE?

-MINOR ILLNESS
-MINOR ISOLATED INJURY
-ANY PAIN NOT CATEGORIZED AS CRITICAL, UNSTABLE OR POTENTIALLY UNSTABLE

22

AT A CARDIAC ARREST RESPONSE THIS FF CHECKS PULSE AND BEGINS COMPRESSIONS?

CHECKER FF - "C" FF

2.1.3 “C” Checker – Firefighter responsible for conducting the patient assessment and
performing any hands-on care. In response to a cardiac arrest, this Firefighter checks pulse and begins compressions and shall carry the Trauma Bag.

23

THIS FF CARRIES THE TRAUMA BAG, IS RESPONSIBLE FOR PATIENT ASSESMENT AND HANDS-ON CARE & AT A CARDIAC ARREST RESPONSE THIS FF WILL BEGIN COMPRESSIONS AND CHECKS PULSE?

CHECKER FF - "C" FF

2.1.3 “C” Checker – Firefighter responsible for conducting the patient assessment and
performing any hands-on care. In response to a cardiac arrest, this Firefighter checks pulse and begins compressions and shall carry the Trauma Bag.

24

AT A CARDIAC ARREST RESPONSE THIS FF BEGINS VENTILATIONS?

AIRWAY FF - "A" FF

2.1.1 “A” Airway – Firefighter responsible for manually stabilizing the patient’s spine
(if trauma is suspected) while opening the airway, maintaining the airway, and administering oxygen if needed. In a response to a cardiac arrest, begins
ventilation. This firefighter should carry the oxygen bag.

25

AT A CARDIAC ARREST RESPONSE THIS FF HOOKS UP AND OPERATES THE DEFIBRILLATOR?

DEFIB/DOCUMENTER FF - "D" FF

2.1.4 “D” Defib/Documenter – Firefighter responsible for completing the Pre-Hospital
Care Report (PCR). In a response to a cardiac arrest, hooks up and operates the defibrillator.

26

WHICH FF IS RESPONSIBLE FOR COMPLETING THE PRE-HOSPITAL CARE REPORT (PCR)?

DEFIB/DOCUMENTER FF - "D" FF

2.1.4 “D” Defib/Documenter – Firefighter responsible for completing the Pre-Hospital
Care Report (PCR). In a response to a cardiac arrest, hooks up and operates the defibrillator.

27

TRUE/FALSE

AT ALL EMS RESPONSES THAT REQUIRE A PCR TO BE FILLED OUT, IT IS THE OFFICER'S RESPONSIBILITY TO COMPLETE.

FALSE

2.1.4 “D” Defib/Documenter – Firefighter responsible for completing the Pre-Hospital
Care Report (PCR). In a response to a cardiac arrest, hooks up and operates the defibrillator.

28

IF A CFR-D UNIT IS RIDING WITH 5 FF'S WHERE SHOULD THE "E" EQUIPMENT FF INITIALLY OPERATE?

INITIALLY REMAIN WITH THE APPARATUS AND HELP CARRY ANY ADDITIONAL EQUIPMENT NEEDED

2.1.5 “E” Equipment – If a CFR-D Unit is riding with five firefighters, the fifth firefighter should initially remain with the apparatus and help carry any additional equipment needed.

29

TRUE/FALSE

A PCR IS NOT NEEDED FOR A DOA.

FALSE

++The CFR-D Unit must complete a Pre-Hospital Care Report even if the patient is DOA, to document that the Company properly examined the patient to confirm that the patient exhibited the criteria for obvious death.++

30

WHO CAN SUSPEND CFR-D RESPONSES WHEN UNUSUAL FIRE OR EMERGENCY CONDITIONS EXIST?

CHIEF OF OPERATIONS OR DESIGNEE

31

THIS FF WILL CARRY THE OXYGEN BAG, IS RESPONSIBLE FOR MANUALLY STABILIZING THE PATIENTS SPINE (IF TRAUMA SUSPECTED) WHILE OPENING THE AIRWAY, MAINTAINING THE AIRWAY AND DELIVERING OXYGEN IF NEEDED. IN A CARDIAC ARREST RESPONSE THIS FF BEGINS VENTILATIONS?

AIRWAY FF - "A" FF

2.1.1 “A” Airway – Firefighter responsible for manually stabilizing the patient’s spine
(if trauma is suspected) while opening the airway, maintaining the airway, and
administering oxygen if needed. In a response to a cardiac arrest, begins
ventilation. This firefighter should carry the oxygen bag.

32

WHAT TOOLS DOES THE "B" BOSS CARRY AT AN EMS RESPONSE?

PORTABLE RADIO AND A HANDLIGHT

33

TRUE/FALSE

ON EMS RUNS THE ECC SHOULD REMAIN WITH THE RIG.

TRUE

2.1.6 The chauffeur or a non-CFR-D trained member remains with the apparatus.

34

E319 RESPONDS TO AN EMS EMERGENCY: BOX 4356
JUNIPER VALLEY PARK
ADULT MINOR INJURY
FELL OF SWING IN PARK

UPON ARRIVAL THE OFFICER OBSERVES AN EMS AMBULANCE NEAR THE ENTRANCE TO THE PARK, HE TURN TO HIS ECC AND INSTRUCTS HIM TO RETURN TO QUARTERS, DID THE OFFICER OPERATE CORRECTLY?

NO

3.8.1 When an EMS Unit or a certified ambulance agency is on-scene and a CFR-D
Unit arrives, the Fire Officer will confer with the EMS Unit or certified ambulance agency to ensure both Units have responded to the same incident. The CFR-D Unit will remain on-scene and assist until it is determined that their assistance is no longer needed. After conferring with the EMS Unit or certified ambulance agency, the Fire Officer will determine what signal to transmit to the fire dispatcher.

35

E319 RESPONDS TO AN EMS EMERGENCY: BOX 4356
JUNIPER VALLEY PARK
ADULT MINOR INJURY
FELL OF SWING IN PARK

UPON ARRIVAL THE OFFICER OBSERVES AN EMS AMBULANCE NEAR THE ENTRANCE TO THE PARK, HE TURN TO HIS ECC AND INSTRUCTS HIM TO RETURN TO QUARTERS, DID THE OFFICER OPERATE CORRECTLY?

NO

3.8.1 When an EMS Unit or a certified ambulance agency is on-scene and a CFR-D
Unit arrives, the Fire Officer will confer with the EMS Unit or certified
ambulance agency to ensure both Units have responded to the same incident. The
CFR-D Unit will remain on-scene and assist until it is determined that their
assistance is no longer needed. After conferring with the EMS Unit or
certified ambulance agency, the Fire Officer will determine what signal to
transmit to the fire dispatcher.

36

LIST THE SEGMENT 2 RESPONSES:

-ANAPHYLACTIC SHOCK
-DIFFICULTY BREATHING
-ASTHMA
-REPORTED DROWNING
-REPORTED JUMPER
-MULTIPLE TRAUMA
-UNCONSCIOUS
-REPORTED SNAKE BITE
-PREGNANCY WITH COMPLICATIONS
-MULTIPLE SEIZURES

37

LIST THE SEGMENT 3 RESPONSES:

-REPORTED AMPUTATION
-MAJOR BURNS
-CARDIAC
-ELECTROCUTION
-MAJOR INJURY
-IMMINENT BIRTH
-PEDESTRIAN STRUCK
-OB-GYM EMERGENCIES
-INTERNAL BLEEDING
-GUN SHOT WOUNDS
-STABBING

38

WHAT ARE THE 3 INSTANCES IN WHICH A CFRD ENGINE WOULD TRANSMIT A 10-99?

-CPR IN PROGRESS
-OFFICER FEELS THAT EMERGENCY WILL HAVE UNIT OPERATING FOR OVER 30 MINS
-COMPANY REQUEST ETA FROM AMBULANCE AND DISPATCH STATES NO AMBULANCE AVAILABLE

39

AFTER CONFERRING WITH THE EMS UNIT ON SCENE IF A CFRD COMPANY IS NOT REQUIRED WHAT TEN CODE SHALL AN OFFICER TRANSMIT?

10-91 AND GO 10-8


3.8.2 If the Company is not required, they shall clear the scene (using signal 10-91) and
go 10-8 via MDT. EMS may special-call a Company to a scene if they need assistance. Companies should be aware that they may, on occasion, be reassigned
back to a canceled run.

40

HOW IS AN INDIVIDUAL CONSIDERED A PATIENT ON AN EMS RUN?

-INDIVIDUAL IS SICK OR INJURED
-INDIVIDUAL EXPOSED TO A SITUATION OR CONDITION THAT COULD HAVE CAUSED INJURY

3.9.1
An individual is considered a patient if:
A. the individual is sick or injured, or
B. the individual was exposed to a situation or condition that could have the
potential to cause injury: e.g., smoke condition, CO poisoning, MVA.

41

E287 RESPONDS ON SCENE WITH A MAN IN ELMHURST PARK IN CARDIAC ARREST, NO EMS UNIT IS ON SCENE. E287 HAS A STELLAR EMS CREW ON DUTY TODAY AND THEY KNOW THAT A CRITICAL OR UNSTABLE PATIENT REQUIRES PACKAGING IMMEDIATELY. THE OFFICER IS ALSO A STELLAR EMS BUFF & HE KNOWS THAT HE MUST CONTACT DISPATCH FOR TWO ITEMS OF INFORMATION, WHAT ARE THE 2 ITEMS?

-ETA OF RESPONDING AMBULANCE (PROVIDE CUPS STATUS, AGE, CHIEF COMPLAINT, IF CPR INITIATED, PULSE & RESPIRATORY RATE)

-ADVISE DISPATCH TO RELAY THE SERIOUSNESS OF THE PATIENTS CONDITION TO RESPONDING EMS UNITS

3.9.3 If it is determined that the patients condition is either CRITICAL or UNSTABLE,
(utilizing the CUPS status) the Officer in Charge shall:
A. Ask the dispatcher for an ETA of the responding ambulance.
B. Advise the dispatcher to relay the seriousness of the patient’s condition to
the responding EMS Unit(s).

42

TRUE/FALSE

Following the arrival of an EMS Unit on the scene, the CFR-D Company
operating at a Segment ONE (Arrest:Cardiac/Respiratory, Choking) incident will remain on the scene and assist the EMS
Unit until it is determined that their assistance is no longer needed.

TRUE

43

TRUE/FALSE

A CFRD UNIT THAT IS ON-SCENE (10-84) AT ANY CFRD ASSIGNMENT MUST GENERATE A PCR.

FALSE

3.10.1 A PCR is not required when a CFR-D Company is on-scene (10-84) at any CFR-D assignment unless patient care is provided.

44

E307 WAS RETURNING TO QUARTERS FROM GETTING THE MEAL AND CAME UPON A CIVILIAN STRUCK BY A CAR ON THE CORNER OF NORTHERN AND 80TH STREET. THE OFFICER HAS REQUESTED AN AMBULANCE. WHAT INFORMATION DOES HE NEED TO PROVIDE THE DISPATCHER WITH?

"CHRIS AND CHARLIE CAN PLAY RUGBY"

C-CUPS STATUS
A-AGE
C-CPR INITIATED?
C-CHIEF COMPLAINT
P-PULSE RATE
R-RESPIRATORY RATE

3.11 When requesting an ambulance,
Companies must provide the following information to the dispatcher for relay to EMD:
3.11.1 CUPS Status
3.11.2 Age
3.11.4 Chief complaint
3.11.5 If CPR initiated
3.11.6 Pulse and respiratory rate

45

E289 ARRIVES ON SCENE TO A EMS RUN WHERE THE FEMALE PATIENT IS RESPONSIVE BUT UNABLE TO FOLLOW COMMANDS. SHOULD THEY BEGIN PACKAGING?

YES

3.12 If the patient is CRITICAL or UNSTABLE, packaging efforts must begin immediately
while treating life threats. Immobilize to a spineboard if indicated.

CRITICAL: PATIENTS EITHER RECEIVING CPR, IN RESPIRATORY ARREST OR RECEIVING LIFE-SUSTAINING VENTILATORY/CIRCULATORY SUPPORT

UNSTABLE: (UNCLE PETE DRINKS RUM) UNRESPONSIVE WITH NO GAG OR COUGH REFLEX, POOR GENERAL IMPRESSION, DIFFICULTY BREATHING, OR RESPONSIVE BUT UNABLE TO FOLLOW COMMANDS.

46

IN WHAT INSTANCES SHOULD PACKAGING BEGIN IMMEDIATELY ON EMS RUNS?

3.12 If the patient is CRITICAL or UNSTABLE, packaging efforts must begin immediately
while treating life threats. Immobilize to a spineboard if indicated.

CRITICAL: PATIENTS EITHER RECEIVING CPR, IN RESPIRATORY ARREST OR RECEIVING LIFE-SUSTAINING VENTILATORY/CIRCULATORY SUPPORT

UNSTABLE: (UNCLE PETE DRINKS RUM) UNRESPONSIVE WITH NO GAG OR COUGH REFLEX, POOR GENERAL IMPRESSION, DIFFICULTY BREATHING, OR RESPONSIVE BUT UNABLE TO FOLLOW COMMANDS.

47

ON AN EMS RUN YOU HAVE DEEMED YOUR PATIENT TO BE POTENTIALLY UNSTABLE OR STABLE, WHAT SHOULD BE PERFORMED ON THE PATIENT?

APPROPRIATE PHYSICAL EXAM

3.13 If the patient is POTENTIALLY UNSTABLE or STABLE, perform the appropriate
focused physical exam for the patient.

48

LIST THE CRITERIA FOR A CRITICAL PATIENT:

-RECEIVING CPR
-IN RESPIRATORY ARREST
-REQUIRING/RECEIVING LIFE SUSTAINING VENTILATORY/CIRCULATORY SUPPORT

49

LIST THE CRITERIA FOR AN UNSTABLE PATIENT:

"UNCLE PETE DRINKS RUM"

-UNRESPONSIVE W/ NO GAG OR COUGH REFLEX
-POOR GENERAL IMPRESSION
-DIFFICULTY BREATHING
-RESPONSIVE BUT UNABLE TO FOLLOW COMMANDS

50

LIST THE CRITERIA FOR A POTENTIALLY UNSTABLE PATIENT:

-PALE SKIN OR POOR PERFUSION (SHOCK)
-COMPLICATED CHILDBIRTH
-UNCONTROLLED BLEEDING
-SEVERE PAIN IN BODY
-SEVERE CHEST PAIN, SYSTOLIC BP OF LESS THAN 100mmHG
-INABILITY TO MOVE ANY PART OF BODY

51

LIST THE CRITERIA FOR A STABLE PATIENT:

-MINOR ILLNESS
-MINOR ISOLATED INJURY
-UNCOMPLICATED EXTREMITY INJURY

52

E54 HAS JUST RESPONDED TO A MVA ON THE FDR. THE NOZZLEMAN & BACK-UP HAVE BECOME HEAVILY SOILED IN BLOOD. IS THE UNIT IN SERVICE?

NO

3.16.1 If decontamination of a member, personal protective equipment, and/or the
equipment used is required, the Company will not be available until the situation
has been rectified. Upon completion of the decontamination process, the
Company shall transmit the appropriate signal.

53

E34 HAS USED MULTIPLE TRAUMA BANDAGES AND ICE PACKS AT AN MVA ON THE HENRY HUDSON, THE NOZZLEMAN INFORMS THE OFFICER THAT E34 NEEDS TO RESTOCK EMS SUPPLIES. IS E34 IN SERVICE FOR EMS OR FIRE DUTY?

OOS-FOR EMS
IN SERVICE-FOR FIRE DUTY

3.16.2 If equipment has been left with the patient or supplies have been expended and
the Company does not have the minimum amount specified in Chapter 4 section
2.1, the Company is to go back in service for fire duty but advise the borough fire
dispatcher and the Battalion that it is not available for CFR-D responses. If this
occurs, the Company is to immediately return to quarters to replace equipment
and supplies, and notify the borough dispatcher when it is available for CFR-D
response.

54

AN CFRD ENGINE HAS JUST GONE OOS FOR CFRD RESPONSES FOR RESTOCK ISSUES. WHO DOES THE OFFICER NEED TO NOTIFY THAT THE COMPANY IS OOS FOR CFRD AND WHO WILL HE NOTIFY WHEN BACK IN SERVICE?

NOTIFIES BATTALION & DISPATCH WHEN OOS FOR CFRD ( TO RESTOCK)

NOTIFIES DISPATCH WHEN BACK IN SERVICE FOR CFRD

3.16.2 If equipment has been left with the patient or supplies have been expended and
the Company does not have the minimum amount specified in Chapter 4 section
2.1, the Company is to go back in service for fire duty but advise the borough fire
dispatcher and the Battalion that it is not available for CFR-D responses. If this
occurs, the Company is to immediately return to quarters to replace equipment
and supplies, and notify the borough dispatcher when it is available for CFR-D
response.

55

3 REASONS TO TRANSMIT A 10-99

-CPR
-OFFICER DETERMINES THAT COMPANY WILL LIKELY REMAIN ON SCENE FOR 30 MINS OR MORE
-ANY CFRD RESPONSE IN WHICH UNIT REQUEST AN ETA FOR EMS AND EMS REPORTS NO UNIT AVAILABLE


3.19 Once on the scene, a CFR-D Unit must transmit a signal 10-99 (Company will be
operating for at least 30 minutes) in the following instances:

3.19.1 Confirmed cardiac/respiratory arrest (Company performing CPR/defibrillation).

3.19.2 Any situation where the Company officer determines that the Company will likely
remain on the scene for 30 minutes or more (e.g., vehicle extrication, multiple
patients).

3.19.3 Any CFR-D response where, in response to a request for an ETA for EMS from
the Company at the scene, EMS reports no Unit available.

56

FOR EMS RESPONSES, WHEN WOULD FIRE DEPARTMENT PERSONNEL NOT BEGIN RESUSCITATIVE EFFORTS (5 INSTANCES)?

-OBVIOUS DEATH
-DEPENDENT LIVIDITY
-RIGOR MORTIS
-DECOMPOSITION
-VALID DNR

++DOA - PCR MUST STILL BE COMPLETED++

57

E312 ARRIVES ON SCENE TO AN EMS RUN IN WHICH THEY ARE MET AT A LOCKED APT DOOR BY AN ELDERLY WOMEN STATING TO BE THE MOTHER OF THE MAN INSIDE FROM WHICH SHE HAS NOT HEARD FROM IN A WEEK. E312 FORCES ENTRY AND FINDS THE MAN DOA & LOOKS LIKE HE HAS BEEN FOR SOME TIME. DOES E312 NEED TO COMPLETE A PCR?

YES

Fire Department personnel will
begin resuscitation efforts unless the following conditions exist:
4.4.1 Obvious death
4.4.2 Dependent lividity
4.4.3 Rigor mortis
4.4.4 Decomposition
4.4.5 Valid Do Not Resuscitate Order (see Section 6.2)

NOTE: The CFR-D Unit must complete a Pre-Hospital Care Report even if the patient is
DOA, to document that the Company properly examined the patient to confirm that
the patient exhibited the criteria for obvious death.

58

YOU'RE THE LT OF ENGINE 1 FOR THE DAY TOUR AND ARE CALLED ON AN EMS RUN (MALE - DIFF BREATHING) IN PENN STATION. WHEN YOU ARRIVE THE PATIENTS WHEREABOUTS ARE NOT KNOWN, SO YOU INSTRUCT YOUR MEMBERS TO TRY TO LOCATE SAID INDIVIDUAL. IF AFTER A COMPLETE SEARCH OF THE AREA IN QUESTION IS PERFORMED AND NO PATIENT IS FOUND, IN ORDER - WHAT 3 STEPS MUST YOU AS THE OFFICER PERFORM?

-OFFICER REVIEWS RESPONSE TICKET
-OFFICER CONTACTS DISPATCHER
-COMPANY ATTEMPTS TO CONTACT NEIGHBORS, BLDG. SUPERINTENDENT, SECURITY, ETC..

++NO PATIENT FOUND OFFICER TRANSMITS A 10-92 AND TAKES A MARK IN THE COMPANY JOURNAL++

59

YOUR COMPANY IS CALLED ON AN EMS RUN, NO PATIENT CAN BE FOUND - YOUR OFFICER HAS REVIEWED THE RESPONSE TICKET, CONTACTED DISPATCHER & DISPATCHED THE COMPANY TO CONTACT NEIGHBORS, SUPERINTENDENT, SECURITY, ETC... AND STILL NO PATIENT IS FOUND. WHAT SHOULD YOUR OFFICER TRANSMIT?

10-92
-TAKES A MARK IN THE COMPANY JOURNAL

4.7 If a patient’s whereabouts are not known, the responding Company will make every
effort to ascertain the location of said individual. If, after a complete search of the area in question, no patient is found, the following procedure shall be used:

4.7.1 The Officer in Charge shall review the response printout for additional information as to incident location, cross street, dwelling or unit number, and any other pertinent information provided by the EMD or 911 comment section of the printout.

4.7.2 If after rechecking the information provided no patient is found the Officer in
Charge shall verify the information with the dispatcher.

4.7.3 After re-verification of the dispatch information, the responding Company shall
attempt to contact neighbors, building superintendent and/or security personnel.
If no patient is found after the above efforts have been exhausted, the Officer in
Charge shall enter a 10-92 via MDT (therefore canceling the EMS response) and
return to service. The Officer in Charge shall make a notation in the Company
journal upon return to Quarters.

60

E218 HAS FORCED ENTRY INTO APT 4D ON OCEAN AVE AND AVEN R. THE OFFICER IN COMMAND OF E218 KNOWS THAT THERE ARE PARAMETERS IN WHICH WHO HE CAN LEAVE IN CHARGE OF SAFEGUARDING THE PREMISES. WHO CAN E218 OFFICER LEAVE TO WATCH APT 4D?

-OWNER
-POLICE DEPARTMENT
-RESPONSIBLE PERSON


4.8 If, after a search, the patient is located but the company cannot gain access to the patient, the CFR-D Unit shall use any and all resources necessary to gain access and render aid. If forced entry is the only option, the officer in command should request police response for security/safety and have the fire dispatcher advise the responding EMS Units of the situation. If others within the premises deny access to the patient, the Officer in Charge shall immediately request Police Department assistance. The Police Department will then determine the appropriate action to be taken. If forcible entry is required to gain access, the officer in command must have the premises safeguarded by members until custodianship is turned over to the owner, occupant, Police Department, or a responsible person. When selecting a responsible person, the officer in command must evaluate the ability of that person to provide adequate security.
Note: The responsibility of safeguarding premises shall not be delegated to EMS
personnel. This includes awaiting the arrival of PD.

61

TRUE/FALSE

EMS CAN BE LEFT TO SAFEGUARD A PREMISES THAT HAS BEEN FORCED ENTRY BY A FD UNIT.

FALSE

The responsibility of safeguarding premises shall not be delegated to EMS personnel. This includes awaiting the arrival of PD.

62

E287 ARRIVES ON SCENE AND FINDS A MAN WHO HAS JUST BEEN STRUCK BY A CAR. HE STATES THAT HE IS FINE AND REFUSES MEDICAL ATTENTION (RMA). DOES E287 NEED TO GENERATE A PCR FOR THIS MEDICAL RESPONSE?

YES


4.9 If the patient refuses medical aid (RMA), the CFR-D Unit shall ensure that the patient is alert and oriented, and understands that refusal may cause him or her further injury. The Unit shall encourage the patient to remain on the scene until the arrival of the more highly trained EMS crew. The Unit shall notify the fire dispatcher for documentation
purposes and remain with the patient until the arrival of an EMS crew.

4.9.1 When a patient refuses medical aid, a Pre-Hospital Care Report (PCR) must be
completed. If the patient insists on leaving the scene, the Officer in Charge
should notify the dispatcher and the Unit shall go back in service after the patient
has left.

63

IF YOU ARE DISPATCHED TO AN EMS RUN AND THE PERSON REFUSES MEDICAL ATTENTION (RMA), WHAT PROCEDURES SHOULD YOU IMPLEMENT?

-CFRD UNIT SHALL ENSURE THE PATIENT IS ALERT AND ORIENTED & UNDERSTANDS REFUSAL OF TREATMENT MAY CAUSE FURTHER INJURY/HARM
-ENCOURAGE THE PATIENT TO REMAIN ON SCENE UNTIL THE ARRIVAL OF EMS
-NOTIFY DISPATCH FOR DOCUMENTATION PURPOSES
-REMAIN WITH PATIENT UNTIL ARRIVAL OF EMS
-COMPLETE A PCR
-IF PATIENT INSISTS ON LEAVING SCENE, OFFICER NOTIFY DISPATCH AND UNIT SHALL GO BACK IN SERVICE AFTER THE PATIENT HAS LEFT

64

YOUR UNIT ARRIVES ON-SCENE OF AN EMS EMERGENCY AND FINDS AN ADULT MALE EXHIBITING ALERTED MENTAL STATUS BEHAVIOR, HE HAS A DEEP HEAD WOUND. THE MAN IS REFUSING MEDICAL ATTENTION. AS THE OFFICER YOU SHOULD?

-REQUEST POLICE ASSISTANCE AND REMAIN ON SCENE UNTIL THE ARRIVE OF EMS

4.10 If a patient exhibiting altered mental status or appearing to be an emotionally disturbed person (EDP) declines to accept treatment, the Officer in Charge should request police assistance and remain on the scene until the arrival of EMS.

4.10.1 The Officer in Charge shall:
A. Brief EMS of the situation found, the patient’s condition and the actions taken by the Unit;
B. Complete the Pre-Hospital Care Report;
C. Take steps to place the Unit back in service.

65

YOUR UNIT IS CALLED TO AN EMS RUN OF IMMINENT CHILD BIRTH IN THE QUEENS CENTER MALL. WHEN YOU ARRIVE ON SCENE, NO EMS UNIT IS THERE BUT A MAN IS CROUCHED OVER THE WOMAN, HE IDENTIFIES HIMSELF AS A PHYSICIAN. AS THE OFFICER WHAT MUST YOU REQUEST FROM THIS MAN?

-PROPER IDENTIFICATION
-PHYSICIAN'S SIX DIGIT NYS LICENSE NUMBER (INCLUDE ON PCR)

++NOTIFY DISPATCH THAT PHYSICIAN IS ON SCENE AND REQUEST THAT EMS IS NOTIFIED++

4.12 If a physician is on the scene of a CFR-D response when EMS is not yet on the scene and offers his/her assistance, he/she should be asked to produce proper identification. The Unit may accept such assistance and notify the fire dispatcher that a physician is on the scene and request that EMS is notified. The Unit shall ask for the physician’s six-digit
New York State license number and include the number on the PCR. Members must
continue to perform within their scope of practice and not do anything they are not
trained to do.

66

E287 IS DISPATCHED TO A MAJOR INJURY OF A MINOR IN ELMHURST PARK. WHEN THEY ARRIVE ON SCENE THE OFFICER NOTES THAT NYPD ESU HAS ALREADY INITIATED MEDICAL CARE OF A YOUNG BOY WHO LOOKS TO HAVE A BROKEN LEG. AS THE OFFICER OF 287 YOU ASCERTAIN IF ANY ASSISTANCE IS REQUIRED, ESU STATES THAT THEY HAVE EVERYTHING UNDER CONTROL. WHAT SIGNAL DO YOU TRANSMIT?

10-91 AND GO 10-8

4.13 If a CFR-D Unit arrives on the scene of a medical emergency and NYPD Emergency
Service Unit (ESU) has already initiated patient care, the ESU EMTs retain responsibility for patient care. The Office in Charge of the CFR-D Unit shall ascertain from ESU if any further assistance is required from the CFR-D Unit. If no assistance is required, the Officer in Charge shall transmit signal 10-91 and go 10-8. If assistance is required, the
ESU EMTs shall have medical authority at the scene until the arrival of an ambulance.

67

E287 IS DISPATCHED TO A MAJOR INJURY OF A MINOR IN ELMHURST PARK. THEY ARRIVE ON SCENE AND BEGIN MEDICAL CARE OF A YOUNG BOY WHO LOOKS TO HAVE A BROKEN LEG. NYPD ESU EMTS ARRIVE ON SCENE, IF E287 WERE TO RELEASE THE PATIENT TO ESU, WHAT MUST THE NYPD ESU BE EQUIPPED WITH?

SAED

4.13.1 If ESU arrives on the scene of a medical emergency after the CFR-D Unit has initiated patient care; the CFR-Ds should retain responsibility for patient care until a transporting agency assumes responsibility of the patient. If the ESU EMTs assumes the role of higher level pre-hospital care provider and assumes responsibility for patient care, the Company shall release the patient to ESU. However, if ESU is not equipped with a SAED, the CFR-D Unit shall retain patient care responsibilities as per the Regional Coordination of Pre-hospital Resources Protocol.
Note: A PCR is not required when a CFR-D Company is on-scene (10-84) at any
CFR-D assignment unless patient care is provided.

68

AFTER COMPLETION OF A PATIENTS INITAL ASSESSMENT, IF EMS IS STILL NOT ON SCENE, WHAT MUST THE OFFICER IN CHARGE RELAY TO DISPATCH?

-CUPS STATUS
-AGE
-CHIEF COMPLAINT
-CPR INITIATED?
-PULSE RATE
-RESPIRATORY RATE

69

WHERE IS THE TELEMETRY PHONE NUMBER POSTED FOR CFR-D ENGINES?

TELEMETRY NUMBER POSTED ON THE CHART HOLDING THE UNITS PCR FOMS


5.3 In the event that a CFR-D Unit needs medical advice during a CFR-D response, the Unit may telephone the FDNY/EMS telemetry physician at 800-281-8356, if a telephone is
available. The telemetry phone number shall be kept posted on the chart holding the
Unit’s PCR forms. Before calling telemetry the Unit shall have completed the primary
survey and C.U.P.S. status determination, and should identify themselves as a CFR-D Unit and be prepared to give a concise report to the physician. CFR-D Units shall follow the advice given by the telemetry physician, noting all instructions on the PCR. Telemetry may be utilized for medical consultation and as access to the International Language Bank.

70

BEFORE A UNIT CALLS TELEMETRY FOR MEDICAL ADVICE DURING A CFR-D RESPONSE, WHAT MUST THE UNIT HAVE COMPLETED?

-PRIMARY SURVEY
-CUPS DETERMINATION


5.3 In the event that a CFR-D Unit needs medical advice during a CFR-D response, the Unit may telephone the FDNY/EMS telemetry physician at 800-281-8356, if a telephone is
available. The telemetry phone number shall be kept posted on the chart holding the Unit’s PCR forms. Before calling telemetry the Unit shall have completed the primary survey and C.U.P.S. status determination, and should identify themselves as a CFR-D Unit and be prepared to give a concise report to the physician. CFR-D Units shall follow the advice given by the telemetry physician, noting all instructions on the PCR. Telemetry may be utilized for medical consultation and as access to the International Language Bank.

71

TRUE/FALSE

FF EGAN IS A TRAUMA DOCTOR ON THE SIDE. A JOB THAT REGULARLY HAS HIM PERFORMING MAJOR MEDICAL LIFE SAVING PRACTICES. ON A EMS TRAUMA RUN FF EGAN CAN EMPLOY THESE PRACTICES & ASSUME FULL PATIENT CARE WHILE WORKING IN HIS CFRD E274.

FALSE

5.4 Some FDNY members may have previously been trained as EMTs, paramedics or nurses but regardless of this level of personal certification, members shall operate as CFR-D providers based solely upon their Department Certification level, and shall immediately relinquish care of the patient to EMS on their arrival.

72

IF YOU ARRIVE ON SCENE TO AN EMS RUN WHERE A MINOR IS FOUND TO BE SUFFERING FROM A LIFE THREATENING ILLNESS OR INJURY AND IMMEDIATE MEDICAL INTERVENTION IS REQUIRED BUT A PARENT/GUARDIAN IS REFUSING MEDICAL CARE AND REFUSES TO GIVE CONSENT, SHOULD YOU INSTRUCT YOUR UNIT TO PROVIDE MEDICAL CARE?

YES

6.1.1 Aid to Minors:
A. Where a minor is found to be suffering from a life-threatening illness or injury, immediate medical intervention must be provided. Regardless of whether the parent/guardian is available, or refuses to give consent, treatment for a life threatening illness or injury requires immediate
medical intervention.

B. In the event a parent or legal guardian refuses permission for medical treatment for their minors, treatment should nonetheless be provided whenever the minor is:
1. suffering from a life-threatening illness or injury and
2. it is apparent that a delay in treatment, even if minimal, would jeopardize the minor’s life.

C. If the illness or injury is non-urgent in nature, treatment should still be provided unless the parent or guardian refuses to allow this treatment. If the parent or guardian will not allow treatment to be rendered the
following steps should be taken:
1. Carefully explain the reason(s) for the treatment, what intervention is necessary to correct the problem and the consequences if the injury/illness is not treated.

2. Notify the dispatcher of the events unfolding and have them notify EMS. Contact FDNY/EMS Telemetry directly at 800-281-8356, if a phone is available. Implement their recommendations (if any)
while awaiting EMS arrival. Do not leave the scene before EMS arrives.

3. Return the Unit to service after EMS arrives.

73

IF A CFRD UNIT SUSPECTS CHILD ABUSE, WHO IS NOTIFIED?

-EMS PERSONNEL ON SCENE
-ENTRY IN COMPANY JOURNAL (INCLUDE NAMES AND UNIT DESIGNATION OF THOSE NOTIFIED)

When the CFR-D Unit suspects child abuse, the circumstances of the suspected abuse shall be reported to EMS personnel at the scene. The Officer in Charge shall make an entry in the Company journal upon return
to quarters including the names of those notified and their Unit designation.

74

THE OFFICER OF E319 SUSPECTS CHILD ABUSE WHEN THEIR UNIT IS DISPATCHED TO A MINOR INJURY AND FINDS A 11 YEAR OLD BOY WITH A BLACK EYE. THE FATHER IS INSISTING THAT HIS SON FELL, BUT THE BOY IS ACTING VERY DISTANT TO THE FATHER. THE OFFICER HAS RELAYED HIS SUSPICION TO THE EMT UNIT THAT HAS ARRIVED ON SCENE. HE ALSO KNOWS THAT HE MUST MAKE A ENTRY INTO THE COMPANY JOURNAL UPON RETURN TO QUARTERS. WHAT MUST BE INCLUDED IN THE JOURNAL ENTRY?

-NAME OF EMS PERSONNEL NOTIFIED
-UNIT DESIGNATION OF EMS PERSONNEL NOTIFIED

When the CFR-D Unit suspects child abuse, the circumstances of the suspected abuse shall be reported to EMS personnel at the scene. The Officer in Charge shall make an entry in the Company journal upon return to quarters including the names of those notified and their Unit designation.

75

TRUE/FALSE

A DNR ORDER IS AN ORDER TO WITHHOLD ALL MEDICAL TREATMENT.

FALSE

If a CFR-D Unit is presented with a NYS DOH Out of Hospital DNR Order, the Officer in Charge shall notify the dispatcher of the above and ask them to advise EMS. A DNR Order is only an order not to perform cardio-pulmonary resuscitation (e.g., chest compressions and artificial ventilation for a patient in cardiac arrest). It is not a reason to withhold other treatments, such as supplemental oxygen.

76

WHAT MUS BE INCLUDED ON A NYS OUT OF HOSPITAL DNR FORM?

-COPY OF NYS OUT OF HOSPITAL DNR FORM
-ATTENDING PHYSICIAN MUST SIGN AND DATE THE FORM
-MUST CONTAIN PATIENTS NAME, DATE OF BIRTH, MD'S SIGNATURE AND LICENSE NUMBER & DATE ISSUED.

77

WHAT ARE THE TWO WAYS A DNR MAY BE REVOKED?

VERBALLY AND IN WRITING

78

YOU ARRIVE ON SCENE TO A PERSON IN CARDIAC ARREST. WHEN YOU BEGIN TO START CPR YOUR NOZZLE MAN INFORMS YOU THAT THE PATIENT IS WEARING A DNR BRACELET. DO YOU PERFOM CPR OR TAKE THIS AS AN OUT OF HOSPITAL DNR?

DO NOT PERFORM CPR

6.2.2 NYS law permits a patient with a legal DNR order to wear a bracelet to express his or her wishes not to be resuscitated in the event of cardio-pulmonary arrest.

79

WHAT IS THE MINIMUM REQUIREMENT OF A DNR IN THE NURSING HOME SETTING?

PHYSICIANS SIGNATURE

6.2.3 NYS law classifies nursing homes as a hospital with no distinctions to advanced
directives (e.g. DNRs). ). Do Not Resuscitate Orders issued by nursing homes do not have to be on a specific form and each facility may have their own variation. A nursing home does not have to utilize the New York State Out of Hospital DNR form. The minimum requirement for a valid DNR is that the facility form contains a physician’s signature.

80

TRUE/FALSE

A DNR ORDER NEED NOT HAVE A CURRENT DATE.

TRUE

6.2.4 NYS law provides immunity from liability for “good faith actions” if the CFR-D
provider believes the DNR order has expired or is invalid and basic life support, including defibrillation, measures are carried out. A DNR order need not have a current date.

81

TRUE/FASLE

IF A UNIT IS PRESENTED WITH A LIVING WILL OR HEALTH CARE PROXY, CPR AND LIFE SAVING MEASURES SHOULD BE WITHHELD.

FALSE

6.3.2 A Living Will is not valid in the pre-hospital setting for pre-hospital emergency
care. If presented with a living will, CFR-D members are to continue to provide care within the scope of training and give the living will to EMS personnel on their arrival.

6.4.2 A Health Care Proxy is not valid in the pre-hospital setting for pre-hospital emergency care. If presented with a Health Care Proxy, CFR-D members are to continue to provide care within the scope of training.

82

BOY EMPALED ON FENCE
UNITS ON SCENE:
E319
EMT UNIT 46
EMS CAPT 17

AT THIS INCIDENT, WHO WOULD BE CONSIDERED THE INCIDENT COMMANDER?

OFFICER OF E 319


NOTE: Whenever Units of the Bureau of Operations and the Emergency Medical Service are operating at an incident, the ranking Fire Officer on the scene is the Incident Commander.

8.3 The Incident Commander shall be responsible for all decisions at the scene with the exception of patient care matters. CFR-D certified members, EMTs, and Paramedics
(including EMS Lieutenants, Captains and Chiefs) shall maintain responsibility for
patient care. It is the responsibility of the Incident Commander to evaluate the scene and to provide for the safety of all patients and operating personnel.

83

BOY EMPALED ON FENCE
UNITS ON SCENE:
E287
EMS UNIT 56 X-RAY (1ST ON SCENE)
FOREST HILLS VOLUNTEER EMT UNIT 16

WHO IS RESPONSIBLE FOR ALL PATIENT CARE DECISIONS?

FOREST HILLS VOLUNTEER EMT UNIT 16


8.4 The ranking Fire Suppression officer shall consult with and be guided by the highest
level pre-hospital emergency medical provider at the scene for patient care decisions. Regardless of which EMS agency first establishes patient contact, FDNY EMS shall be responsible for coordination of pre-hospital resources in situations involving:

8.4.1 Multiple Casualty Incidents (MCIs);

8.4.2 Unscheduled MEDEVAC transports;

8.4.3 Hazardous materials situations requiring decontamination;

8.4.4 Fires/crimes in progress; or

8.4.5 Unusual public health or safety emergencies.

84

FF LEE IS INSTRUCTED BY HIS OFFICER TO BEGIN CHEST COMPRESSIONS ON A YOUNG BOY HE HAS DETERMINED TO BE BREATHING ADEQUATELY. HE INFORMED HIS OFFICER OF HIS EVALUATION AND CONTINUES TO PROVIDE THE CARE HE DEEMS NECESSARY. IF HIS OFFICER PERSISTS IN GIVING SUCH ORDERS, WHO SHOULD FF LEE PREPARE A WRITTEN STATEMENT TO?

OMA

8.7 Members shall comply with all orders and directions of the Incident Commander
concerning the safety of operating personnel. However, a pre-hospital care provider receiving an order believed to be detrimental to the patient’s condition, contrary to good patient care, or in violation of medical protocols or agency policy shall inform the Incident Commander of such and continue providing appropriate patient care. If the Incident Commander persists in giving such an order(s), the pre-hospital care provider is required to prepare and forward, through appropriate channels, a written statement to OMA.

85

FOR CUPS CRITERIA WHAT WOULD "POTENTIALLY UNSTABLE" BE?

-PALE SKIN
-COMPLICATED CHILDBIRTH
-UNCONTROLLED BLEEDING
-SEVERE PAIN IN ANY AREA OF BODY
-SEVERE CHEST PAIN, BP OF LESS THAN 100 mmHg
-INABILITY TO MOVE ANY BODY PART

86

FOR CUPS CRITERIA WHAT WOULD "UNSTABLE" BE?

-POOR GENERAL IMPRESSION
-UNRESPONSIVE W/NO GAG REFLEX
-RESPONSIVE BUT UNABLE TO FOLLOW COMMANDS
-DIFFICULTY BREATHING

87

TRUE/FALSE

YOUR UNIT TAKES UP FROM A CFR-D RUN AND YOUR NOZZLE MAN INFORMS YOU THAT HE NEEDS TO DECON SOME EQUIPMENT AND HIS BUNKER GEAR. YOU ARE OUT OF SERVICE FOR CFR-D RUNS, BUT IN SERVICE FORE FIRE DUTY.

FALSE

++If decontamination of a member, personal protective equipment, and/or the equipment used is required, the Company will not be available until the situation has been rectified. Upon completion of the decontamination process, the Company shall transmit the appropriate signal.++

Decks in Undeleted Class (130):