Ems Flashcards
(98 cards)
1
Q
Mutual aid deployment using JFRD protocols will be approved on an as needed basis by who?
A
Medical Director and Division Chief of Rescue
2
Q
What must be on a power of attorney document, when presented to JFRD?
A
Must be notarized, signed by the patient and two witnesses. Specifically state that the agent’s power of attorney
This person can verbally revoke a do not resuscitate order (DRNO) if it is present and valid
3
Q
Any unusual circumstances with the power of attorney document contact who?
A
Rescue District/Battalion Chief
Note: if there is any doubt to the authenticity of power of attorney document, members should provide examination and treatment
4
Q
If medical personnel are concerned for the safety of a minor and the parent or legal guardian refuses treatment and transport contact who?
A
Rescue District/ Battalion Chief and law enforcement for assistance with transport
5
Q
A patient shall be defined as:
A
A person who presents with subjective and/or objective signs and/or symptoms or a complaint which results in evaluation and/or treatment
6
Q
A patient encounter is dependent on neither?
A
Treatment nor transport nor cooperation from the patient. If a technician perceives a medical problem that requires evaluation, a patient encounter has been made and a full patient care report must be completed
7
Q
Completed JFRD Controlled Substance Dailey Checklist will remain with the notebook until collected by?
A
District/Battalion Chiefs and forwarded to the Quality Improvement Officer
8
Q
JFRD Controlled Substance Daily Checklist each time a controlled substance is administered. The Explanation: will read how?
A
CCR number, medication, amount administered, amount wasted
9
Q
If OIC or paramedic of an engine is verifying that the numbered seal is intact and documented accordingly on a spare rescue (able unit) when not staffed and finds the seal is broken, he should?
A
Contact Rescue District/Battalion Chief
10
Q
Who’s signature is verification that all shifts have accurately completed the Dailey Substance log?
A
Company Captain
11
Q
Discrepancies concerning controlled substances will be:
A
- reported to Rescue/District Battalion Chief
- recorded in the company log
- documented in the explanation section
- investigated by____________
12
Q
Discrepancies concerning controlled substances will be investigated by who?
A
The Quality Improvement Officer and Rescue District\Battalion Chief and a discrepancy report will be provided to the Division Chief of Rescue AND the JFRD Medical Director
13
Q
Controlled substances with only the month and year are considered expired when?
A
On the first day of that month listed
Note: medication (except controlled substances) with date of month and year expire at the end of that month
14
Q
What dates of each month do Chiefs Inspections take place for controlled substances?
A
23rd, 24th, 25th
15
Q
Who’s signature is verification that all signatures, inventory, amount used and wasted are correct since last audit?
A
District/Battalion Chief
Note: Captains signature is verification that all shifts have accurately completed the daily controlled substance log
16
Q
ALS Engine Controlled Substance Inventory:
A
Minimum
• Madazolam - 5mg
Maximum
• Madazolam - 10mg
17
Q
Controlled Substance
Rescue Unit maximum and minimum
A
Minimum and maximum •Modazolam- 15mg ~ 25mg •Etomidate- 60mg ~ 100mg •Fentanyl- 200mcg ~ 400mcg •Ketamine- 500mg ~ 1500mg
18
Q
Controlled Substance inventory will be determined and authorized by:
A
Division Chief of Rescue and the Medical Director
19
Q
Restocking of Controlled Substance should occur when:
A
•minimum ALS Engine Inventory reached
•minimum Rescue inventory is reached
•Month prior to expiration date
•prior to holiday or weekend when stock is close to minimum Rescue inventory
Note: not the engine
20
Q
Expired Controlled Substances will remain in the locked safe labeled Do Not Use. A note will be made in the comment section indicating______
Expired or damages CS will be turned into:
A
~Amount and name of the expired medication
~District/Battalion Chief during normal business hours
21
Q
Access to safe at_____ requires concurrent use of a key and pin. A seal is in place on the hinge of the safe and is replaced each time the safe requires access.
Access to the safe at_____ requires using a key that is attained by breaking a seal.
A
~ R103, R104, and R106
~ R105, and R107
22
Q
Discrepancies concerning controlled substances with District/Battalion Chief daily inspections will be:
A
- reported to the Division Chief of Rescue and the Medical Director
- investigated by the Quality improvement Officer with a discrepancy report provided to the Division Chief of Rescue and the JFRD Medical DirectorNote: difference from regular company is who it’s reported to and obviously only investigated by QI Officer
23
Q
IV fluids and medications will be stored at the station in a climate controlled secure location. Access to this area will be limited to:
A
The appropriate JFRD personnel
24
Q
On the first day of each month, all IV fluids and medications will be inventories and inspected for expiration date and damage by:
A
The Officer-in-Charge or designee
25
Additions to the inventory of IV fluids and medications will be procured form______ in amounts authorized by_______.
~ Logistical Support Facility Manager
~ Division Chief of Rescue and JFRD Medical Director
26
Dispersal of IV fluids and medications from the Logistical Support Facility will be documented on_______, signed by________.
~ JFRD Logistical Support Requisition
~ the requesting Company Captain or designee
27
In the event a JFRD Company requires restocking of IV fluids or medications after business hours, they will temporarily restock from:
Inventory of the closest JFRD Company after consulting with the company officer
28
Expired or damages IV fluids or medications will be picked up_____ by_______ and returned to the Logistical support facility for disposal during normal business hours.
~ monthly
~ District/Battalion Chief
29
Law enforcement is responsible for what at the scene of an emergency?
Traffic control and general scene management
30
If Law enforcement refused to remove the handcuffs to allow the patient to sign, document in the Narrative section of the PCR that patient verbalized a refusal of treatment. Who signs where the patient would normally and who signs the witness signature in the PCR?
~ your name where the patient would normally and law enforcement officer signs the witness signature in the PCR
31
Patient in police custody:
| Transport destination for stable and unstable patient?
* Unstable transport to the closest most appropriate hospital
* Stable law enforcement will dictate the hospital destination
32
Blood draw:
~ All items except_______ will be returned to the kit with______ being sealed in the plastic bag provided.
~ Who will seal the blood collection kit, maintain the chain of custody and complete the documentation
~ In your report, record______
* needle; the Betadine prep pad
* investigating officer
* the date printed on the blood draw kit and investigating officers name
33
Blood draw on PT not transported:
~ In your report record______
~ if possible have the patient_____
* date printed on the blood draw kit and the investigating officers name
* sign a refusal and have the investigating officer witness the refusal. If patient refuses to sign then document "Refused to Sign"
Note: same as if you do transport and patient has the right to refuse transport if mentally competent
34
Methods of restraints
| • Law enforcement:
* handcuffs
* plastic ties
* hobble restraints
Note: if used ensure they follow behind the rescue
35
Methods of restraints
| • JFRD personnel:
* soft limb restraints
* stretcher straps
* wide cloth restraints
Note: restrained PT's shall be placed in supine position
36
When restraints are in use, circulation to extremities shall be evaluated_______.
At least every 5 minutes
37
Documentation of the use of restraints on the EMS field copy and PCR shall include:
* patients behavior necessitating placement of restraints
* the type of restraints
* status of circulation distal to restraints
38
Who must review CAD status daily to ensure that all reports have been completed?
chief officers
39
Disposition codes: explanations
~ Stand By
~ Transfer to another EMS agency
~ Unit Assist
~ Treated and Transferred Care Within Agency
* non-transporting rescue/non-primary suppression unit on a cardiac arrest, hostage situation, secondary units to extrication, MCI's or any additional manpower request
* transfer to ATU
* will be used every time a suppression unit arrives on scene at the same time or has the same patient contact time as rescue
* when suppression apparatus arrives on scene first and provides patient care prior to arrival of rescue. Must include all info from patient contact to transfer of care to rescue
40
Assessments for
~ stable patient
~ unstable patient
~ minimum required for all transports
* stable every 15 minutes
* unstable every 5 minutes
* two at Pt contact and arrival at hospital
41
Anytime an ALS procedure is performed, the paramedic that performed the procedure must be listed where?
In the flow sheet
42
Parent information must be added to the billing section under______ for all pediatric patients
NOK
43
Acquire the patients______ from the hospital's facesheet when possible and document in the billing section.
Health insurance information
44
If the laptop is not functioning following a transport, a paper __________ must be completed. This form is located where?
* "Responsibility" signature
| * Target Solutions under JFRD EMS Resources
45
The paper signature form filled out when patient is transported to hospital and computer isn't working must be delivered to who?
This person will then deliver it to who?
* Rescue District/Battalion Chief
| * Quality Improvement Officer during their next visit to headquarters
46
JFRD radio reports should be transmitted within?
One minute
47
If unable to reach hospital via medical radio:
Stable patient?
Unstable patient?
~Stable: proceed to the hospital and give a verbal report upon arrival
~unstable patient: relay brief radio report through FRCC
48
The purpose of Quality Improvement is to_____.
Promote practices that will provide the highest quality prehospital emergency care.
49
The intention of Quality Improvement_____.
Will be to train
50
The Authority for the continuous Quality Improvement program comes from who?
The Director/Fire Chief in addition to the Medical Director
51
The program will review present standards or practice how often?
At least annually
52
Administration of the continuous Quality Improvement program will be the responsibility of who?
* Medical Director
* Division Chief of Rescue
* Assistant Rescue Chief********
* Quality Improvement Officer
53
Who will appoint the Quality Improvement Officer? After receiving recommendations from who?
* Director/Fire Chief
| * Division Chief of Rescue
54
Who will have Quality Improvement meetings and communicate on a weekly basis?
Medical Director and Quality Improvement Officer
55
The Quality Improvement program will be a________ process, changing with the identified needs of the department and consisting of the following aspects:
~Dynamic process
* Proactive
* Concurrent
* Retrospective
56
Proactive Quality Improvement consist of?
Who will apply an Acceptable Standard of Care (ASC) with benchmarks based upon JFRD rules, this Emergency Medical SOG and national standards?
•Evaluation and training or practices that promote high quality patient care, PRIOR to the delivery of patient care
• ~Quality Improvement Officer
~Division Chief of Rescue
~ Medical Director
57
Concurrent Quality Improvement will consist of?
This will be accomplished by who?
•supervision and evaluation of practices for quality DURING the delivery of patient care
• ~ Rescue District/Battalion Chiefs and
Quality Improvement Officer
58
~Retrospective Quality Improvement will consist of?
~Who will appoint select individuals to the Quality Improvement Committee?
~The Committee will meet how often?
~ Practices, which deviate from the SOG or the ASC, will be identified by:
* evaluation of practices for quality AFTER the delivery of patient care.
* Division Chief of Rescue
* as often as needed
• ~ PCR database queries
~ concerns regarding the delivery of PT care
~ patient outcome reports from the hospital
~ patient care complaints
59
Emergency-Pro review process
Who must view all the following
reports monthly:
•Captains
```
• ~ all cardiac & trauma arrest
reports
~ all "ALERTS"
~ all DOA's
~ all controlled substance use
~ all refusals of PT <16 and >64
~ all reports where meds were given without
transport
~ all advanced airways
```
60
Who must review all of the following reports monthly, if not already reviewed by the Captain?
District/Battalion Chief
~ will review the same criteria as the Captain
61
Employ who fails to report or prevents another from reporting abuse or discloses confidential information relating to abuse cases or who makes a false report maybe charged with?
A second degree misdemeanor
62
When JFRD personnel suspect that abuse or neglect to child or vulnerable adult, they shall initiate the following:
•treat related injuries
•transport all suspected cases
~ if transport is refused:
• request law enforcement
• stay with PT until law enforcement arrive
• notify Rescue District/Battalion
* report suspicion to emergency D. Physician
* the officer-in-charge shall make the initial verbal report by calling the statewide toll free number 1-800-962-2873. Obtain name and ID number from the contact person
* notify Rescue dDistrict/Battalion Chief
63
After making the report of abuse to the statewide toll free number notify who via email within 24 hours indicating what?
* Division Chief of Rescue
* that you have reported the case to the Florida Abuse/Neglect Registry, including only the first name and ID number of the contact person. No PT info!
64
Florida/Neglect Registry's toll free number?
1-800-962-2873
65
Unquestionable death criteria:
```
Considered DOS
• unresponsive
•apneic
•pulseless
•in addition to above at least one:
~lividity
~clear signs of decay or decomposition
~rigor mortis
~open cranium with exposed brain matter
~decapitated or severed trunk
```
66
Trauma death criteria:
Blunt chest trauma or multi system trauma PT meeting the following criteria shall be considered DOS:
•apneic
•pulseless
•asystole or wide complex ventricular rhythm
of 30 or less without pulses, document and
call
67
Medical Asystole:
The following apply to PT who are pulseless and asystolic that do not meet unquestionable death criteria. Remember to use situational awareness prior to making this decision, if in doubt follow appropriate arrest protocol and transport. Resuscitation efforts may be terminated only when all of the following criteria exist.
```
•arrest was not witnessed
•no shocks provided
•PT 18 years or older
•rhythm remains asystole after 20 min of full
ACLS
```
68
Acutely hypothermic PT's in cardiac arrest shall be treated and transported if submersion is________.
<60 minutes
69
If a law enforcement officer denies you access to the scene, they are assuming full responsibility and acting within the law to preserve evidence. You must obtain what?
The law enforcement officers name and badge number, explaining to them that you are required to document in the PCR that they assumed the responsibility for the pronouncement of death and they denied you access to the scene.
70
DNRO key points:
* yellow paper, w/ DO NOT RESUSCITATE ORDER in black across the top
* may be duplicated as long as it's not altered and in good quality and on yellow paper, shade doesn't have to be exact
* patient identification device
* devices and forms must be signed by PT physician
* device or form accompanies PT during transport
* provide comforting, pain-relieving and any other medically indicated care, short of respiratory or cardiac resuscitation
* DNRO may be revoked by PT if signed by the PT or the health care surrogate, or proxy or court appointed guardian or person acting pursuant to a durable power of attorney
71
What is the final step in assuring the continuity of patient care?
Transportation to the appropriate facility
72
All patients will be transported based on what?
Patient assessment in the most appropriate manner consistent with their condition.
Note: deviation will be documented on the patient care report
73
In those situations where extraordinary circumstances exist, as in multiple patient incidents, who may elect to deviate from existing guidelines in deterring destination of patients?
The Incident Commander
74
Patients will be transported by rescue with proper consent for the following:
All obvious reason! Here's a few different ones:
•systolic >180 or diastolic >110
•reported LOC
•reported blood in stool or vomit NOT piss
•all near drowning's
•conditions that might be exacerbated by
Improper handling or inappropriate transport
•Peds PT 15 or younger who are symptomatic
~exceptions superficial injuries when
competent parent is on scene
•elderly PT 65 or older
~exceptions non-symptomatic without a
complaint or signed refusal
75
Transport of passengers is at the sole discretion of who?
Exception:
Officer in charge of he Rescue
* Peds PT, parent or guardian
* geriatric PT, guardian or caregiver
* PT with language barriers, translator
* PT with speech disabilities, person proficient in sign language
76
Transportation of unstable patient should begin within______.
10 minutes when possible
77
Patients who are stable will be transported where?
To the hospital where the patient is usually seen and has the PT's medical records
78
Pediatric patient who are unstable or in cardiac arrest should be transported where?
To the closest approved Pediatric Emergency Department
79
Transport of Pediatric PT to alternate hospital should only take place if_______.
Patients immediate condition is such that the PT's life will be endangered if care is delayed by proceeding to an approved Pediatric hospital
80
Stable Pediatric patient with a complex complaint and/or medical history(i.e. Congenital cardiac, neurological, or endocrine abnormalities)transport where?
Baptist downtown or UF health
81
Exception for a patient being transported to the emergency department:
* OB PT may be taken directly to labor and delivery when accompanied by RN,PA, or physician
* OB PT directly to Baptist Pavilion, Baptist Beaches OB, or St. V's Southside Women's Center after consultation with the ED via radio
* STEMI alerts directly to cardiac cath lab when accompanied by RN,PA, or physician
* inter-Facility transfers may be taken directly to the appropriate department. The transferring physician will determine destination
82
What can not go to a stand alone ED?
Chest pain, STEMI's, Stroke Alerts, Peds, Pregnancies, baker acts, post cardiac arrest with ROSC, trauma alerts, trauma reds
Note: if paramedic expects specialized services(i.e. OR,ICU, CATH Lab,GI suite
Should be avoided
Note: very obvious except pregnancies
83
If patient not assessed by medical staff within____, consult with_______for guidance. If there is an issue contact______.
* 15 min
* Charge Nurse or Nurse Manager
* your District/Battalion Chief
84
If the transfer to the hospital stretcher is delayed more than______ notify______.
* 30 min
| * FRCC
85
Approved adult hospitals?
```
All obvious hospitals, a few less obvious:
•BMC Clay county stand alone
•BMC Towncenter stand alone
•BMC Nassau
•Memorial Julington Creek stand alone
•UF North stand alone
•UF Starke
•St. V's Clay
```
86
Approved Pediatric Hospitals
* Wolfsons Children Hospital
* UF Health
* Memorial
* Orange Park Medical Center
87
Air transport Units ATU should be considered for critically ill or injured PT's anytime ground transportation time to the closest appropriate hospital exceeds______.
20 min
88
The definition of service animal does not affect or limit the broader definition of______ under the Fair Housing Act or the broader definition of________ under the Air Carrier Access Act.
* assistance animal
| * service animal
89
Acceptable alternative methods of transporting a service animal to the receiving facility include but are not limited to:
* family member
* friends or neighbor
* animal control
* a District/Battalion Chief
* law enforcement official
90
Personnel should document on the PCR instances where the patient or cardiac accompanying a minor patient utilized a service animal and note______. If the service animal was not transported in the ambulance with the patient, the PCR should_______ and________.
* whether or not the service animal was transported with the patient
* the reasons and the means by which the animal was transported
91
Personnel may only ask two questions about a service animal:
* is the dog a service animal because of a disability
| * what work or task has the dog been trained to perform
92
Miniature horses height and weight?
24 inches to 34 inches measured at the shoulders
Generally weigh between 60 and 100 pounds
93
What are the four assessment factors to assist entities in determining whether miniature horses can be accommodated in their facility:
1. Whether the miniature horse is house broken
2. Whether the miniature horse is under the owners control
3. Whether the facility can accommodate the miniature horse's type, size and weight
4. Whether the miniature horse's presence will not compromise legitimate safety requirements necessary for safe operation of the facility
94
What information will FRCC obtain from he caller?
```
•address or location of incident
•nature of emergency
~ number of patients
~ type and severity of injuries
•type of location
•complaint's name
•complainant's phone number
```
95
State approved Trauma Centers:
| Levels :
UF Health- level 1
Orange P Medical Center- level 2
96
Trauma Alert patient being transported to other facility other than SATC or SAPTC will only happen under the following
* Impractical due to unforeseen events (MCI, natural disaster, or other catastrophic event
* after informing PT of the state guidelines, PT still insist on other hospital
* the PT's immediate condition is such that their life may be endangered if care is delayed by proceeding directly to SATC or SAPTC.
97
If Trauma Alert Patient is transported to hospital other than SATC by there wishes, what must be documented and how?
• In the Emergency Pro in the "Trauma section of Incident Tab"
Under
"Trauma Protocol Exceptions"
Select "Yes"
• In the Narrative section document that the protocol was explained to the patient, the patient verbalized understanding of the protocol and refused transport to the trauma center.
98
Emergency Inter-facility transfer procedures, with the exception of stand alone ERs must be first authorized by who? The transfer destination will be decided by who?
* Rescue Battalion Chief
* transferring physician
Note: the only place it says Rescue Battalion Chief in the whole book. There is no district attached
