EMS Protocol

Question 1

Treatment protocols are orders that guide actions that an emergency medical service provider (EMS) is expected to take, and should be followed unless____.

Answer 1

the protocol requires such contact with a Medical Control physician. It is imperative that providers establish contact with Medical Control for confirmation of medical care and further medical direction in situations that are not covered in treatment protocols.

Question 2

Our commitment is to ___ the citizens, public and private sector employees, and visitors of the Nation’s Capital.

Answer 2

provide the best possible care and service to

Question 3

Providers must contact ___ to administer other prescribed rescue medications not specifically mentioned in the District of Columbia Fire and EMS Medical Protocols or formulary.

Answer 3

Medical Control

Question 4

The EMC Bear symbolizes ____.

Answer 4

when Pediatric Care is warranted, and Medical Control is required.

Question 5

_____ is a vital component of pre-hospital care.

Answer 5

Medical communications

Question 6

Medical communications with Medical Control or a receiving facility should be conducted for every ____ patient.

Answer 6

Priority 1
For seriously injured or critically ill patients notification to the receiving facility is required.

Question 7

When communicating with Medical Control or a receiving facility, a verbal reportshould include these essential elements:

Answer 7

➢ Identify unit, level of provider and name
➢ Destination hospital and ETA
➢ Patient’s age, sex
➢ Mental status
➢ Patient’s chief complaint
➢ Brief pertinent history of the present illness
➢ Baseline vital signs to include EKG, glucose, or other pertinent assessments
➢ Pertinent findings of the physical exam
➢ Past medical history, current meds and allergies
➢ Treatment rendered in the field
➢ Patient response to emergency care given
➢ Orders requested, repeat granted orders back to physician
➢ If Medical Control is obtained, document the physician’s name

Question 8

When transmitting patient information, DO NOT include___.

Answer 8

personal or sensitive information
(e.g. name, social security number, address, race, etc.).

Question 9

Once a patient has received medications administered by any level of DCFEMS provider, the patient is categorically considered an ____ patient

Answer 9

ALS level

Question 10

No patient will be turned over to BLS care once ALS interventions (Medications,Airway) have been initiated. An exception to this rule can be made in____.

Answer 10

mass casualty or disaster scenario.

Question 11

Transfer of care can take place if :

Answer 11

• pt has patent airway , maintained w/o assistance or adjuncts

-is hemodynamically stable, vitals stable & commensurate with pt condition

-pt is at their base line mental status and not impaired from medications or drug ingestion

-no MOI warrants a trauma alert or activation

-no cardiac, respiratory, or neurological complaints warrant ALS intervention exist

-the ALS provider gives the BLS provider a full pt report to include. Vital signs and physical assessment

-the EMT who will be in attendance is comfortable with pt conditions and will assume care .

Question 12

Upon arriving at a receiving facility, EMS providers will not _____.

Answer 12

Initiate new medical care once they cross the threshold of that facility.

(Examples include: new IV bags , start O2, Immobilization & restraint application)

Question 13

Hospitals will designated personnel to assess
patients brought by EMS transport unit with the goal of transferring care and releasing the unit within___ of the pt arrival to the ED.

Answer 13

10 minutes

Question 14

In the event that transfer of care is delayed for longer than ___, EMS provider will contact the ___, who will in turn contact the authorized hospital point of contact and attempt to resolve the delay in pt transfer until release.

Answer 14

20 minutes; contact ELO

Question 15

____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.

Answer 15

Informed consent

Question 16

_____Consent — written or verbal request to be evaluated and treated.

Answer 16

Expressed consent

Question 17

____Consent — when a patient is unable to express consent because of altered mental status or severe distress.

Answer 17

Implied consent

Question 18

Conduct Three Assessments: Providers should attempt to assess the following three major areas prior to permitting a patient to refuse care and/or transportation:

Answer 18

1– Legal Capacity to Refuse Care
2– Mental Capacity to Refuse Care
3– Medical or situational capacity

Question 19

The ______ should be summoned to the scene to assist with patients that you believe may be mentally incompetent and refusing services.

Answer 19

Metropolitan Police Department

Question 20

If the patient does not speak English as a primary language and requests language translation services, the ____ will be used for formal translation services.

Answer 20

language line

Question 21

Obtain signature of a witness; preferably the witness should be someone who ____.

Answer 21

witnessed your explanation of risks and benefits to the patient, & who watched the patient sign the form.

All witnesses should be 18 years old or older if possible.
Witnesses may include law enforcement personnel.

Question 22

In cases where the patient’s status is unclear and the appropriateness of withholding resuscitation efforts is questioned, FEMS personnel should _____.

Answer 22

initiate CPR immediately and then contact an EMS Supervisor or Medical Control Physician for further guidance.

Question 23

Criteria for determining a patient should be pronounced PDOA shall include ALL of the
Primary Criteria; they are____.

Answer 23

• Pulseless
• Apneic.
• No signs of life (such as spontaneous movement or pupillary response)

Question 24

Criteria for determining a patient should be pronounced PDOA shall include ALL of the
Primary Criteria and AT LEAST ONE of the Secondary Criteria! secondary criteria’s are:

Answer 24

Rigor mortis

Dependent lividity

Decomposition or putrefaction

Transection of the torso

Incineration

Massive whole-body crush injury

Obvious displacement of brain matter

Valid MOST Form indicating DNR status,other actionable end-of-life medical order

A valid DC licensed physician on scene, familiar with the patient’s medical
status, orders that resuscitation not be attempted

“Compelling reasons” to withhold resuscitation in cases where efforts would
be inappropriate and or inhumane.

During a mass casualty incident, (MCI) the patient is designated as deceased
(black tag) or expectant (grey tag) in accordance with the MCI Protocol.

Question 25

_____ trauma is NOT considered an injury incompatible with life and should be managed per the Traumatic Cardiac Arrest protocol.

Answer 25

Recent penetrating trauma

Question 26

FEMS personnel may withhold resuscitation from a patient in cardiac arrest under
“compelling reasons” when two criteria are BOTH present:

Answer 26

1–End stage of a terminal condition
(e.g., cancer, heart failure, dementia etc.) AND

2—Written or verbal information from family, caregivers or patient stating that the patient did not want aggressive resuscitation efforts such as CPR or intubation.

** Contact FEMS Medical Director or Medical
Control Physician if the situation is unclear.**

Question 27

Online Medical Control Physicians should NOT be used as the pronouncing physician for PDOA patients. The current DC Fire and EMS Medical Director shall be listed on the EPCR as the pronouncing physician. The time the FEMS provider confirmed that the patient was dead shall be listed as the time of death. Wording in the following format must be entered into the ECPR:

Answer 27

“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.”

Question 28

Rigor mortis
The face and neck begin to stiffen between ___ after death. After _____, affect the arms and chest. By ____ after death, rigor mortis is usually firmly established.

Answer 28

Face & neck —two and five hours

arms & chest—seven to nine hours

usually firmly established—By twelve hours after death

(12 hours or longer; there is degradation of the protein in the muscles, causing the, stiffening of rigor mortis to relax and the body to become limp.)

Question 29

Post-mortem dependent lividity also called livor mortis will begin to occur, unless the victim has suffered a large blood loss, about ___ after death, and peak at about ___.

Answer 29

one to two hours after death, and
peak at about six hours

Question 30

The MOST form is divided into four (4) sections (A-D) simplifying patient preferencesfor
life-sustaining treatments, including:
➢ Cardio-Pulmonary Resuscitation (CPR)
➢ Medical Interventions/Treatment Options
➢ Antibiotics and Medically Assisted Nutrition Any incomplete section of the MOST Form implies ______.

Answer 30

full treatment for that specific section.

Question 31

Online Medical Control Physicians ____ be used as the pronouncing physician for PDOA patients.

Answer 31

should NOT

Question 32

The ______shall be listed on the EPCR as the
pronouncing physician. The time the FEMS provider confirmed that the patient was
dead shall be listed as the time of death.

Answer 32

current DC Fire and EMS Medical Director

Question 33

____ transport may be utilized to reduce transport time for critically injured patients when operational and logistical conditions are favorable.

Answer 33

Air medical

Question 34

Air Medical Transport: the United States Park Police (USPP) Aviation Unit “____” is the primary scene response air medical resource within the District of Columbia.

Answer 34

“Eagle One”

Question 35

High-Risk “____” Zones: areas within the District where depending on the time of day and traffic congestion, ground ambulance transport may exceed ___and the total prehospital event time for a critically injured patient may approach or even exceed ____.

Answer 35

Red zones
15 minutes
60 minutes

Question 36

High-Risk “Red” Zones, areas in general correspond with the first due response
areas of engine _____.

Answer 36

15, 19, 25, 27, 30, 32, and 33.

Question 37

____: > 15-minute transport at an average transport speed of 15 mph

Answer 37

Pink

Question 38

____: > 15- minute transport at an average transport speed of 30 mph

Answer 38

Red

Question 39

Unit officers can make a “____” request to USPP via OUC with call location information if there is credible prearrival information (e.g., multiple-callers or MPD is on scene) that a critical trauma patient meeting flight criterion exists. Patient assessment and the decision to fly should take less than ___.

Answer 39

pre-flight
60 seconds

Question 40

____shall determine if the patient is a candidate for air medical transport and make a request for this resource to the incident commander.

Answer 40

The highest-level on scene care provider treating the patient.

Question 41

The highest-level on scene care provider and incident commander must consider the
following operational and logistical factors when deciding to use air transportation:

Answer 41

➢ Incident location
➢ Weather conditions
➢ Landing zone location in proximity to the scene
➢ Landing zone hazards
➢ Terrain
➢ Additional resources needed for landing zone
➢ Availability and location of ALS ground transport resources (ALS transport unit or
BLS transport unit plus paramedic from another apparatus)
➢ Patient condition (risk of suffering cardiac arrest while in flight)
➢ Weight of the patient

Question 42

If a DC Fire and EMS member is requested to assist with/continue patient care during air
medical transport, the member shall:

Answer 42

➢ Be an independent ALS Provider
➢ Follow DC Fire and EMS Pre-Hospital Treatment Protocols
➢ Operate within the established scope of practice
➢ Wear a helmet and protective eye wear
➢ Follow all instructions provided by the flight crew (e.g., communications, seat belt
use, unloading, etc.)
➢ Document in the ePCR the care provided during air medical transport

Question 43

Clinical Indications for Utilizing Air Medical Transport:Air medical transport may be considered for the following patients or incidents:

Answer 43

1. Penetrating trauma
2. High Speed MVC with entrapment
3. Mass Casualty Incident

Question 44

Contraindications for use of air medical transport. Patients with the following conditions should not be transported by air medical transport:

Answer 44

➢ Cardiac arrest or high likelihood to arrest during transport
➢ Penetrating trauma to the head
➢ Contaminated with hazardous materials
➢ Violent or erratic behavior
➢ If the transport by ground will be faster than by air

Question 45

Either PDOA or terminated after a resuscitation attempt; DC FEMS transporting deceased persons directly to OCME shall ____.
This shall only occur in the rare circumstances.
Deceased persons shall be preferentially _____.

Answer 45

NOT be a routine or regular practice.

preferentially left on scene in police custody.

Question 46

two special scene factors prevent leaving the deceased on scene in police custody:

Answer 46

Imminent danger exists that requires the patient to be rapidly moved to an ambulance and or removed from the scene for safe assessment, treatment, and disposition.
(shooting w aggressive/hostile bystanders)

OR

The deceased is in such a public place that not removing the body from the scene would cause significant public disruption or distress.
(e.g., motorcycle crash in the
middle of the highway with all lanes of traffic blocked)

Question 47

_____ shall confirm patient meets deceased criteria as outlined above; determine that special scene factors prevent safe assessment and disposition of the patient on scene and or leaving the deceased on scene in police custody. And request an EMS Supervisor be dispatched if one is not already on scene or dispatched.

Answer 47

OIC or ACIC

Question 48

Transport to OCME shall occur ____of red lights and siren.

Answer 48

without the use

Question 49

Transport to OCME shall be documented as Hospital ___ in the electronic Patient Care
Record.

Answer 49

Hospital 30

Question 50

Initial Scene Survey and Size Up; Protect ____ first, then _____,from hazards.

Answer 50

Protect yourself first, then victims,

Question 51

Initial Scene Survey and Size Up; In cases of a lightning strike a reverse triage process should be utilized and patients in___Should be treated first.

Answer 51

Cardiac arrest

Question 52

Patients that are identified to be unresponsive and do not have a witness to attest as to the mechanism of the change in mental status shall be treated as if they have a ____ injury.

Answer 52

cervical spinal

(Appropriate spinal immobilization precautions shall be employed while the assessment and care is being performed.

Question 53

Assess mental status is AVPU:

Answer 53

A- alert
V- verbal stimulus
P- painful stimulus
U- unresponsive

Question 54

If the patient is unresponsive and presents with apnea or agonal respirations immediately assess for the presence of a pulse. If a pulse is absent, initiate CPR and proceed with resuscitation. If the patient is very cold due to hypothermia, assess the pulse for ___ before determining that a pulse is absent.

Answer 54

45 seconds

Question 55

Utilize an Impedance Threshold Device (ResQPOD™) for patients ____ years of age or older in a non-traumatic cardiac arrest (If available). Remove the device immediately in the event of a Return of Spontaneous Circulation (ROSC).

Answer 55

eight (8)

Question 56

If the patient’s respiratory rate is unusually rapid or slow for their age, the
quality of respiration is insufficient, or if the patient is not breathing, ventilate
with a bag-valve-mask (BVM) every ___second or___times a minute.

Answer 56

6 seconds or 10 times a minute.

Question 57

Any patient that has been intubated with a King Airway or Endotracheal Tube shall have a ____ applied.

Answer 57

‘cervical collar’
(full spinal immobilization is not required)

Question 58

Central/truncal pulses are___.

Answer 58

Central/truncal pulses (radial, brachial, femoral, carotid) strong, weak or absent.

Question 59

Check perfusion by evaluating____

Answer 59

skin color, temperature, and moisture.

Question 60

Perform a rapid full body scan and identify injuries. Treat life threatening conditions as they are recognized. Inspect and palpate each of the major body systems for the following:
(DCAP BTLS.IC)

Answer 60

➢ D – Deformities
➢ C – Contusions
➢ A – Abrasions
➢ P – Penetrations/punctures
➢ B – Burns
➢ T – Tenderness
➢ L – Lacerations
➢ S – Swelling/edema
➢ I – Instability
➢ C – Crepitus

Question 61

Investigate the chief complaint and history of the present illness or event. You should use the mnemonic, “OPQRST-I” to evaluate any kind of pain.

Answer 61

O- Onset – When did the pain/discomfort begin?

P-Provocation/Palliative – What worsens or lessens the pain/discomfort?

Q- Quality – What does the pain/discomfort feel like?

R- Region/Radiation/Referral – Where is the pain/discomfort? Does it move
anywhere?

S- Severity – How severe is the pain/discomfort?

T- Timing – How long/often has this been occurring?

I- Interventions – Any intervention performed prior to EMS arrival and any
effect they may have had?

Question 62

Inquire about pertinent past medical history. You may use the acronym, “SAMPLE”.

Answer 62

S-Signs/Symptoms
A- Allergies
M- Medication
P- Past medical history
L- Last oral intake
E- Events leading up to illness or injury

Question 63

Vital signs should be monitored at a minimum of every ____ for all critical patients and every _____ for all other patients.

Answer 63

every 5 minutes for all critical patients and every 15 minutes for all other patients.

Question 64

Major trauma and burn patients less than ____of age should be transported to
Children’s National Medical Center (H02).

Answer 64

15 years

Question 65

Major trauma and burn patients ____ (adult sized) should be transported to a trauma or burn facility capable of handling adult patients.

Answer 65

15 years of age or greater

Question 66

Medical or minor trauma patients less than ____ of age should be transported to a medical facility capable of handling pediatric patients.

Answer 66

18 years

Question 67

Patients with isolated eye trauma should be transported to _____If significant trauma is associated the patient should be transported to the closest major trauma facility.

Answer 67

Howard University Hospital.

Question 68

Adult sexual assault patients who have sustained major single or multiple system trauma should be transported to the closest trauma facility. Adult sexual assault patients with no trauma or minor trauma will be transported to____.

Answer 68

Washington Hospital Center (H13).

Question 69

Patients with left ventricular assist devices (LVAD) should be transported to an LVAD
referral facility. Currently the only facility in the District of Columbia is _____.

Answer 69

Washington Hospital Center (H13)

Question 70

If cervical spine trauma is indicated, cervical spine stabilization will be maintained
and the modified ____ will be used to open the airway.

Answer 70

jaw thrust

Question 71

If cervical spine injury is not indicated, either the _____ method may be utilized to open the airway.

Answer 71

head tilt-chin lift method or modified jaw thrust

Question 72

Suctioning Time Limits for Adult__.

Answer 72

15 seconds

Question 73

Suctioning Time Limits child___.

Answer 73

10 seconds

Question 74

Suctioning Time Limits infant___.

Answer 74

5 seconds

Question 75

Use of the nasopharyngeal airway is contraindicated in patients with:

Answer 75

➢ Head trauma with epistaxis
➢ Potential basilar skull fracture
➢ History of fractured nasal bone
➢ Significant head or facial trauma or bleeding

Question 76

Ventilation Rate adult___.

Answer 76

1 breath every 6 – 8 seconds

Question 77

Ventilation Rate child ___.

Answer 77

1 breath every 3-5 seconds

Question 78

Ventilation Rate infant___.

Answer 78

1 breath every 3 – 5 seconds

Question 79

Ventilations should be delivered over ___ in sufficient volume to produce visible chest rise.

Answer 79

1-2 seconds

Question 80

Nebulized medications shall be driven by a flow rate of ____(lpm) or as prescribed by the manufacturer’s recommendations.

Answer 80

10 liters per minute

Question 81

Patients exhibiting signs of moderate to severe respiratory distress due to pulmonary edema or near drowning should be placed on the ____.

Answer 81

Continuous Positive Air Pressure (CPAP)
system.

Question 82

After assessment of a patient, the ALS or BLS provider must assign a treatment priority:

Answer 82

Priority 1: Unstable Patients
Priority 2: Potentially Unstable Patients
Priority 3: Stable Patients

Question 83

Which hospital will serve as Medical Control for patients being transported?

Answer 83

Each hospital will serve as its own Medical Control for patients being transported to them.

Children’s National Medical Center (H02) will be the designated Medical Control for ALL Pediatric patients.

Question 84

A crashing patient is_____.

Answer 84

A crashing patient is one who upon EMS arrival presents in extremis and or is at risk of rapidly deteriorating into cardiac arrest (i.e., peri-arrest).

This deterioration into cardiac arrest often occurs while attempting to move, package, or load the patient into a transport unit

Question 85

unless logistically impossible, every effort shall be made to ensure that crashing patients are cared for by ____ on scene and throughout transport to an emergency department.

Answer 85

two paramedics

Question 86

A full set of vital signs include 6 findings:

Answer 86

➢ Blood pressure
➢ Heart Rate
➢ Respiratory Rate
➢ Pulse Oximetry
➢ Temperature
➢ Blood Glucose.

Question 87

For pediatric patients greater than or equal to ___, the adult medication/resuscitation guidelines should be followed. If the patient meets the criteria for being dead on arrival (PDOA), resuscitative efforts shall not be attempted, and notification of law enforcement shall be made.

Answer 87

14 years old

Question 88

Pulse should only be checked for a maximum of ____, if no definite pulse is felt, assume the patient is in cardiac arrest and start cpr.

Answer 88

10 seconds

Question 89

Once pulselessness is established, chest compressions should be initiated ____.

Answer 89

immediately

Question 90

Chest compressions should be ____ in adults, or greater than ____ chest diameter in pediatrics).

Answer 90

2.0 - 2.4 inches

1/3

Question 91

chest compressions should be ____ compressions per minute

Answer 91

100-120

Question 92

All interruptions in CPR shall be as short as possible and no greater than ___.

Answer 92

10 seconds

Question 93

Switch chest compressors every _____
(or after _____) to prevent a decrease in the quality of compressions.

Answer 93

2 minutes

(5 cycles of compressions and
ventilations at a ratio of 30:2)

Question 94

Ventilate SLOWLY with each breath delivered over ____.

Answer 94

1 second

Question 95

Without an advanced airway in place, BVM ventilations shall be performed as follows: Adult

Answer 95

30:2 compression to ventilation ratio

Question 96

Without an advanced airway in place, BVM ventilations shall be performed as follows: pediatric

Answer 96

15:2 compression to ventilation
ratio when > 1 rescuer

30:2 compression to ventilation
ratio when only 1 rescuer

Question 97

Once an advanced airway is in place, continuous chest compressions shall be provided, and ventilations shall occur at the following rate: adult

Answer 97

10 breaths/minute
(1 breath every 6 seconds)

Question 98

Once an advanced airway is in place, continuous chest compressions shall be provided, and ventilations shall occur at the following rate: pediatric

Answer 98

20-30 breaths/minute
(1 breath every 2-3 seconds)

Question 99

All patients in a refractory shockable rhythm (___ or more defibrillations) shall be transported immediately to an emergency ECMO capable facility.

Answer 99

3

Question 100

If ROSC has not been achieved after ___ minutes of resuscitation in a medical cardiac arrest, consider termination of resuscitative efforts as detailed in the Termination of Resuscitation Medical Cardiac Arrest Protocol.

Answer 100

30

Question 101

All EMT’s and Paramedics are expected to act in accordance with the departments
core values:BASICS

Answer 101

Bravery, Accountability, Safety, Integrity, Compassion, Service.

Question 102

___ is the single-most important intervention for a patient in cardiac arrest

Answer 102

CPR;

CPR is the single-most important intervention for a patient in cardiac arrest. High quality, uninterrupted chest compressions are the most critical component of CPR and should be provided as soon as possible.

Question 103

___% of victims of out of hospital cardiac arrest (OHCA) have agonal breathing on
presentation. Agonal breathing is a common reason to misdiagnose a patient as not being in cardiac arrest.

Answer 103

40-60

Question 104

The five components of high-quality CPR are:

Answer 104

1) Ensuring chest compressions of adequate rate

2) Ensuring chest compression of adequate depth

3) Allowing full chest recoil between compressions

4) Minimizing interruptions in chest compressions

5) Avoiding excessive ventilation.

Question 105

Initiation of chest compressions in patients who are unconscious but not in cardiac arrest is associated with low rates of significant adverse events. This contrasts with the significant risk of withholding CPR when a patient is in cardiac arrest. When in doubt, ____.

Answer 105

start chest compressions.

Question 106

_____ pad placement is preferred for defibrillation as preliminary evidence suggests this configuration is superior to anterior/lateral pad placement in shock resistant cardiac arrests. In addition, the initial pad placement at the start of a cardiac arrest allows for easier deployment of double sequential defibrillation if indicated under the refractory VF/pVT protocol.

Answer 106

Anterior/Posterior

Question 107

Utilize _____ for pediatric medication dosing. Recommend consulting and preparing
the Handtevy application enroute to the incident.

Answer 107

Handtevy

Question 108

When using an AED on infants and children ____old, use of reduced energy pediatric specific pads is recommended. If a manual defibrillator nor an AED equipped with reduced energy pediatric specific pads is available, an AED without the reduced energy pads may be used.

Answer 108

< 8 years

Question 109

Epinephrine is administered every ___minutes.

Answer 109

3-5 minutes

Question 110

Post-_____care is a critical component of the chain of survival.

Answer 110

Post-cardiac arrest

Question 111

Resuscitation efforts in presumed medical cardiac arrests shall occur for at least ___ minutes of ALS care

Answer 111

30

Question 112

ALS care starts when ____.

Answer 112

the monitor/defibrillator is both turned on and attached to the patient in cardiac arrest.

Question 113

The _____must authorize termination before resuscitation efforts are stopped.

Answer 113

Medical Control Physician

Question 114

_____ remove any personal property (e.g., jewelry) or medical devices from the body. This includes any devices from procedures you have performed. (e.g., endotracheal tube, IV/IO)

Answer 114

Do not remove

Question 115

If termination of resuscitation is NOT granted: Obtain any additional patient care orders from the medical control physician. Unless medical control recommends immediate transport, remain on scene to continue high quality CPR and ALS care for an additional ____.

Answer 115

10 minutes.

Question 116

If medical control refuses termination a second time, ____.

Answer 116

transport patient to an appropriate receiving facility while continuing resuscitation efforts.

Question 117

For cardiac arrest pt, Immediate Transport Criteria: initiate immediate transport to nearest trauma center(expedite scene time and provide all treatment enroute) for the following patients:

Answer 117

➢ Traumatic cardiac arrest witnessed by FEMS personnel
➢ Traumatic cardiac arrest in a female patient with known pregnancy > 20 weeks
gestational age or fundal height at or above the level of the belly button

Question 118

If the infant is ventilating adequately, administer free flow (blow-by) 100% oxygen at a minimum of ____lpm close to the face.

Answer 118

6 liters per minute

Question 119

APGAR score should be determined____.

Answer 119

Determine the 1-minute APGAR score.
Repeat at the 5 minute interval.

Question 120

What is APGAR?

Answer 120

A-Activity (Muscle Tone)

P-Pulse (Heart Rate)

G-Grimace (Response Stimulation
or Reflex Irritability)

A- Appearance (Skin Color)

R-Respiration (Breathing)

Question 121

Remember that conditioned athletes may have resting heart rates of ____.

Answer 121

40-60 BPM

Question 122

Support airway and provide supplemental Oxygen if Oxygen Saturation by pulse oximetry is less than __%.

Answer 122

94

Question 123

Withhold Nitroglycerin and consult Medical Control if:

Answer 123

➢ The patient meets pediatric criteria.
➢ The patient has a systolic blood pressure ≤110 mmHg or HR<60.
➢ The patient has taken erectile dysfunction medications within the past 24 hours
(i.e. Viagra, Cialis, or Levitra)

Question 124

Washington Metropolitan VAD Centers:

Answer 124

➢George Washington University Hospital H8
➢ MeStar Washington hospital center H13
➢ Inova Fairfax Hospital H29

Question 125

The two most common causes of VAD pump failure are

Answer 125

disconnection of the powersource &
failure of the driveline.

Question 126

The controller is connected to two rechargeable batteries which can provide anywhere from ____hours of power. The VAD can also receive power from a base unit, typically located at the patient’s home, or via adapters to other power sources such as a grounded electrical outlet or car battery.

Answer 126

8 to 12

Question 127

The most common cause of VAD alarms are ___.

Answer 127

low batteries or battery failures.

Question 128

If the patient presents with respiratory distress with suspected bronchospasm /wheezing,
administer Albuterol:
ADULT____
PEDIATRIC____

Answer 128

Adult- Albuterol 2.5 mg via nebulizer
Pediatric - Albuterol 2.5 mg via nebulizer

Question 129

If the patient continues to exhibit or report respiratory distress with bronchospasm/wheezing after the first dose of Albuterol; administer a ______ only for pre-hospital care.

Answer 129

combination of Albuterol and Ipratropium Bromide (Atrovent) via nebulizer
one time

Question 130

For COPD patients experiencing significant respiratory distress, consider _____and start at a pressure of ___ cmH2O with an in-line nebulizer.

Answer 130

Continuous Positive Airway Pressure Device (CPAP) ; 5

Some COPD patients have lung problems that may be worsened by CPAP. If the
patient worsens on CPAP, remove the device immediately.

Question 131

If the patients that present with a loud cough that mimics the “bark of a seal”, respiratory distress, grunting, wheezing or stridor on inspiration, the patient presents with respiratory distress with clinical evidence of “_____”. Administer ____.

Answer 131

“croup”
Administer ,Normal Saline 3 ml via Nebulizer. Repeat 2 additional times as necessary if the patient improves with the initial administration.

Question 132

If a narcotic (opiate) overdose is suspected, administer _____.

Answer 132

Naloxone (Narcan)

Question 133

Narcan an in adult pts at a BLS provider level can administer 2 mg IN only, may repeat ___ at the same dose.

Answer 133

twice

Question 134

Never let the BVM simply “___” while connected to an endotracheal tube (ETT) as this may
dislodge the tube.

Answer 134

“drop”

Question 135

_____ventilate with the minimum volume necessary to see chest rise. Excessive____ and over-inflation of the lungs can result in lung injury and increase mortality and morbidity in some patient populations.

Answer 135

Tidal volume

Question 136

______: maintain normal ventilation rates based on patient age. Routine and or accidental hyperventilation should be strictly avoided.
Goal is to maintain an ETCO2 of 35-45 mmHg.
- Adult: 10-12 breaths per minute
- Child: 20 breaths per minute
- Infant: 30 breaths per minute

Answer 136

Ventilation Rate

Question 137

VAD is a _____.

Answer 137

Ventricular Assist Device (VAD)

Question 138

The patient’s travel bag with ____.

Answer 138

back-up controller and spare batteries, should always accompany them. If feasible, bring the patient’s power module, cable, and display module to the hospital as well.

Question 139

If the patient continues to exhibit or report respiratory distress with bronchospasm/wheezing administer a combination of ____&___ via nebulizer ____ time only for pre-hospital care.

Answer 139

Albuterol and Ipratropium Bromide (Atrovent); one time

Question 140

If the patient is in extremis or does not clear after ____doses of nebulized Albuterol treatment ALS care shall be immediately initiated.

Answer 140

the first

Question 141

Abdominal pain is perceived in three ways:

Answer 141

Visceral: pain is vague, colicky (intermittent) and poorly localized. It is usually the first type of pain felt. It arises from inside the organs.

Somatic: pain is a more specific, localized, and constant pain that arises from outside
the organs due to inflammation of the peritoneum. (e.g., appendicitis = Right lower
quadrant pain or diverticulitis = left lower quadrant pain)

Referred: pain associated with a structure distant from the actual source. (e.g.,
epigastric pain from an acute MI or abdominal pain from pneumonia)

Question 142

______ is a state where a patient is not alert and oriented to person, place, time, and situation within the context of their expected developmental level.

Answer 142

Altered mental status

Question 143

Treatable Causes of Altered Mental Status
(AEIOU-TIPS) A is____

Answer 143

A
Alcohol (intox or withdrawal)
Acidosis
Arrhythmias

Question 144

Treatable Causes of Altered Mental Status
(AEIOU-TIPS) E is___.

Answer 144

E
Endocrine
Electrolytes
Encephalopathy

Question 145

Treatable Causes of Altered Mental Status
(AEIOU-TIPS) I is____.

Answer 145

Insulin (too much or too little)
Hypoglycemia
Hyperglycemia

Question 146

Treatable Causes of Altered Mental Status
(AEIOU-TIPS) o is ___.

Answer 146

O
O2 (hypoxia)
Opioid overdose

Question 147

Treatable Causes of Altered Mental Status
(AEIOU-TIPS) u is__.

Answer 147

U
Uremia

Question 148

Treatable Causes of Altered Mental Status
(AEIOU-TIPS) T is

Answer 148

T
Trauma (blood loss)
Intracranial Pressure
Temperature (low or high)

Question 149

Treatable Causes of Altered Mental Status
(AEIOU-TIPS) the second I is ____

Answer 149

I
Infection (sepsis)
Ischemia (heart attack)

Question 150

Treatable Causes of Altered Mental Status
(AEIOU-TIPS) p is__.

Answer 150

P
Poisoning
Psychiatric

Question 151

Treatable Causes of Altered Mental Status
(AEIOU-TIPS) s is__.

Answer 151

S
Seizure
Stroke
Shock

Question 152

The postictal state after a seizure does not typically last longer than ____ minutes.
Consider non-convulsive status epilepticus (persistent brain seizure without extremity
movement) in patients with prolonged altered mental status after a seizure.

Answer 152

20-30

Question 153

In assessing a patient with an altered level of consciousness, a thorough history, when
able to be obtained, is the most important step in identifying the cause. The history
should include:

Answer 153

➢ History from bystanders
➢ Age of the patient
➢ Environment where patient was found
➢ Recent complaints (e.g., headache, chest pain vomiting, fever)
➢ Pill bottles/medications (e.g., opioids, diabetes, or seizure medication, etc.)
➢ Medical alert tags and accessory medical devices
➢ Evaluate for potential dehydration as a cause of altered mental status in the
pediatric and geriatric population. Assess for reduced oral intake, vomiting,
diarrhea, etc

Question 154

when the body has a hypersensitivity reaction to a foreign protein or allergen (e.g., food, medicine, pollen, insect sting or any ingested, inhaled, or injected substance). Symptoms involve only one organ system and are typically mild to moderate in severity and may include any of the following: hives, skin itching, scratchy throat, watery or itchy eyes, sneezing, dry cough; this is known as as____.

Answer 154

Allergic Reaction

Question 155

a severe, immediate, systemic hypersensitivity reaction that can lead to cardiopulmonary collapse, shock, or arrest. Is known as___.

Answer 155

Anaphylaxis

Question 156

Anaphylaxis is diagnosed when any one
of the following three presentations occur:

Answer 156

1Acute onset of hives, itching, flushing, swollen lips-tongue-uvula and at least one
of the following:
• Respiratory distress
• Hypotension

2Two or more of the following occur rapidly (within minutes to hours) after
exposure to a known or likely allergen:
• Skin-Mucosal reaction (e.g., hives, swollen lips-tongue-uvula)
• Respiratory distress (shortness of breath, stridor, wheezing, hypoxia)
• Hypotension or associated symptoms (e.g., syncope)
• Persistent GI symptoms (e.g., crampy abdominal pain, nausea/vomiting)

3 Hypotension within minutes to hours after exposure to a known allergen for that
patient.

Question 157

____ is the first-line treatment for anaphylaxis and should be administered as soon as possible.

Answer 157

Epinephrine

Question 158

Adult Epinephrine 1 mg/ml
BLS or ALS: ___ mg IM via adult auto-
injector in the anterolateral thigh

Answer 158

0.3 mg IM

Question 159

Pediatric Epinephrine 1 mg/ml
Age ≤ 9 yo
BLS or ALS: ____ mg IM via pediatric auto-
injector in the anterolateral thigh.

Answer 159

0.15 mg

Question 160

Pediatric Age > 9 yo
BLS or ALS: __ mg IM via adult auto-
injector in the anterolateral thigh

Answer 160

0.3 mg

Question 161

If signs of anaphylaxis persist following the first dose of epinephrine, additional IM epinephrine can be repeated by all providers every ____ min as needed

Answer 161

5-15 minutes

Question 162

Anaphylaxis symptoms usually begin within ___ minutes after exposure to the offending agent. Symptom onset from food allergies can be more prolonged, up to a few hours.

Answer 162

5-20

Question 163

To administer Auto injectors after firmly into the thigh until it “clicks” hold in place for __full seconds.

Answer 163

3

Question 164

Cincinnati Pre-hospital Stroke Screen
(FAST Exam) includes:

Answer 164

Facial droop or weakness on either side.
-Ask patient to smile and show their teeth.

Arm and/or Leg weakness.
-Ask patient to extend arms, palms up, with eyes closed. Watch to see if one
arm drifts down. If only one arm drifts, the test is positive. If both arms drift
down, the results are unclear.

Speech is slurred or impaired.
-Ask patient to say, “You can’t teach an old dog new tricks.”

Time: Determine the “last known well” time and transport immediately to a stroke
center

Question 165

___ is the 5th leading cause of death in the United States and a leading cause of long-
term disability.

Answer 165

Stroke

Question 166

____refers to the time-dependent treatment effect of reperfusion therapies
-(tPA and endovascular therapy) in ischemic strokes and the fact that, with each passing
minute, a stroke progresses from ischemia to infarction, additional neurons are lost, and
functional outcomes worsen.

Answer 166

“Time is brain”

Question 167

Suspected ____ stroke , patient has new, acute neurological deficits such as facial droop, weakness, gait disturbance or imbalance, numberless, slurred speech, altered mentation, or vision changes, started within the last 24hours.

Answer 167

Ischemic stroke

Question 168

Suspected____stroke (intracerebral or subarachnoid hemorrhage) ; patient has sudden onset of severe headache (sometimes described as the worst headache is their life) with associated elevated blood pressure, nausea and or vomiting and or alter mental status within the last 24 hours.

Answer 168

Hemorrhagic stroke

Question 169

In Adults
Normal blood pressure:
systolic pressure < ___ mmHg and
diastolic pressure < ___ mmHg

Answer 169

120

80

Question 170

In adults
Severe hypertension:
systolic pressure ≥ ___ mmHg and/or
diastolic blood pressure≥ ___ mmHg.

Answer 170

180

120

Question 171

____is a life-threatening condition defined by persistent, inadequate delivery of oxygen and nutrients to meet cellular demands

Answer 171

Shock

Question 172

Consider 4 potential causes of shock :

Answer 172

1- Hypovolemia (e.g., bleeding, vomiting, or diarrhea)

2-Cardiogenic (e.g., acute MI or cardiac dysrhythmia)

3-Distributive (i.e., neurogenic, septic, anaphylactic, drug overdose/toxicity)

4-Obstructive (e.g., pulmonary embolism, cardiac tamponade, tension pneumothorax)

Question 173

Mortality rates for patients in shock vary widely based on the cause, but the common causes
of shock, including sepsis, trauma, and cardiac failure, have mortality rates of ____%

Answer 173

20-50%

Question 174

The most common cause of shock of unclear cause is ___ shock.

Answer 174

septic

Question 175

Mild to Moderate pain:
pain rated in the ____ range on a scale of 1-10.

Answer 175

1-5

Question 176

Moderate to Severe pain: pain rated in the ___ range on a scale of 1-10.

Answer 176

5-10

Question 177

Patients who are unable to self-report level of pain or have a difficult time communicating their condition can be asked to rate their pain using the ___ scale.

Answer 177

FACES scale

Question 178

____ is a sudden change in behavior caused by an episode of disordered electrical activity in the brain, can pnesent with a variety of abnormal neurologic findings depending on the part of the brain that is involved.

Answer 178

Seizure

Question 179

____Seizure: a seizure involving a small part of the brain that may or may not affect consciousness/awareness. The symptoms vary depending entirely on the part of the brain that is involved at the start of the seizure.

Answer 179

Focal seizure

Question 180

____Seizure: a seizure involving both halves (hemispheres) of the brain. Loss of consciousness always occurs and may be accompanied by spasms, stiffening, shaking, muscle contractions or loss of muscle tone.

Answer 180

Generalized seizure

Question 181

____ seizure: a seizure occurring between 6 months and 5 years of age, associated with fever but without evidence of intracranial infection (i.e., meningitis) or other defined cause. Febrile seizures are divided into two categories, simple or complex, based on clinical features.

Answer 181

Febrile seizure

Question 182

_____ Febrile Seizure: most common type, characterized by a generalized seizure that lasts less than 5 minutes and does not recur in a 24-hour period.

Answer 182

Simple

Question 183

____ Febrile Seizure: characterized by a seizure that has a focal onset (e.g.,
shaking limited to one limb or one side of the body, last longer than 5 minutes or occurs more than once in 24 hours.

Answer 183

Complex

Question 184

If the child experienced a simple febrile seizure with complete return to normal neurologic baseline at time of EMS assessment, ___ transport may be considered.

Answer 184

BLS

Question 185

If the child experienced a complex febrile seizure or has persistent altered mental
status at time of EMS assessment, __ transport shall occur.

Answer 185

ALS

Question 186

Most seizures are self-limited lasting ___ minutes and will need only supportive care
(e.g., suctioning, oxygen, and attention to airway management). Most seizures will not
need treatment with midazolam.

Answer 186

1-3 minutes

Question 187

Involuntary muscle movements, often referred to as ____, may accompany syncope due to cardiac causes or hypoxia.

Answer 187

myoclonic jerks

Question 188

Febrile seizures occur in 2-4% of children younger than ___ years of age with peak
occurrence between ____ months old. Most children have their febrile seizure on the
first day of illness and, in some cases, it is the first symptom that the child is ill.

Answer 188

5 Years;
12 and 18 months

Question 189

If patient restraint is necessary to prevent harm to the patient and others, provide soft four-
point restraints or handcuffs (law enforcement) and transport the patient in a ____ position. Circulation and motor sensory function shall be checked every ____ minutes while in physical restraints.

Answer 189

supine; 5 minutes

Question 190

Consider use of Comprehensive Psychiatric Emergency Program (CPEP) if:

Answer 190

➢ Age 18 or greater and less than age 65.
➢ Vital signs and blood glucose level within normal ranges.
➢ There is an isolated behavioral problem.
➢ Transport should be completed by law enforcement.
➢ No medical problems or injuries that need to be evaluated at the hospital.

Question 191

BLS and ALS providers may assist an adult patient with inhaling vapor from ______ for treatment of nausea and or vomiting.

Answer 191

an isopropyl alcohol wipe
(i.e., an alcohol prep)

➢open a single isopropyl alcohol wipe and place 1-2 cm from the patient’s nose.
➢ Instruct the patient to inhale deeply through their nose and exhale out their mouth.
➢ Inhale 3 times through the nose every 15 minutes, as tolerated.

Question 192

Studies show that inhaling vapor from an isopropyl alcohol wipe provides significant
reduction in nausea within ____.

Answer 192

10 minutes of initiating aromatherapy.

Question 193

when the glucometer reads “LO” the blood glucose level is < ____ mg/dL.

Answer 193

20

Question 194

Administer oral glucose in the form of glucose gel or other appropriate high glucose content
fluid (such as orange juice) if the patient is:

Answer 194

➢ At least 4 years old AND
➢ Has a blood glucose level of < 70 mg/dL AND
➢ Displays signs and symptoms of hypoglycemia AND
➢ Is conscious enough to adequately swallow secretions, follow commands, and
maintain their own airway

Question 195

Hypoglycemia Requiring Treatment
Adult:
Pediatric > 1month old:
Neonate <1 month old:

Answer 195

Adult:<70
Pediatric > 1month old: <70
Neonate <1 month old: < 45

Question 196

Non-Transport of Hypoglycemic Patients; After successful treatment of a hypoglycemic diabetic emergency, Repeat blood glucose level is > ____ mg/dL.

Answer 196

100

Question 197

_____is defined as a blood glucose level (BGL) ≥ 100 mg/dL, but specific prehospital treatment is reserved for patients who present with extremely elevated glucose and or with severe concomitant symptoms.

Answer 197

Hyperglycemia

Question 198

when the glucometer reads “HI” the blood glucose level is > ____ mg/dL

Answer 198

500

Question 199

Hyperglycemia Requiring ALS Treatment and Transport:
BGL ≥ ___ mg/dL with severe symptoms
or
BGL > 400 mg/dL

Answer 199

250 w symptoms

400

Question 200

Consider NTL if BGL<___ mg|dL and otherwise NTL eligible

Answer 200

300

Question 201

____dialysis: a treatment for kidney failure that removes toxins from the body by directly filtering the patient’s blood using a machine that functions like an electric kidney. Hemodialysis typically occurs at a dialysis center and usually needs to be performed every 2-3 days for a period of 3-5 hours per session.

Answer 201

Hemodialysis

Question 202

____dialysis: a treatment for kidney failure that uses the internal lining of the abdomen (peritoneum) as a filter to remove toxins and waste products from the blood. During dialysis a cleansing solution is infused into the abdominal cavity via a permanent catheter through the abdominal wall. After several hours, the fluid with the filtered waste product is removed from the abdomen. Treatments can be done
anywhere including at home, work, or while traveling. This process must be done
frequently, usually four times per day.

Answer 202

Peritoneal dialysis

Question 203

For Renal Failure and Dialysis Emergencies patients Do NOT take blood pressures on the arm with _____

Answer 203

a dialysis shunt/fistula.

Question 204

Fistula bleeding after dialysis will often be from a small punctate needle access site.
Apply firm, direct pressure to the bleeding site.
Placing pressure with only “gauze and tape” will NOT stop the bleeding. The pressure needs to be applied with____.

Answer 204

gloved fingers directly over the bleeding site for 15-30 minutes using a firm two-hand technique.

Question 205

If patient has significant life-threatening bleeding and direct pressure does not control
the hemorrhage, apply a tourniquet to the affected extremity at least _____ proximal to the bleeding shunt/fistula. Do NOT apply tourniquet directly over the shunt/fistula.

Answer 205

3 inches

Question 206

____is a brief episode of non-traumatic loss of consciousness and postural tone that resolves spontaneously with a return to baseline mental status and neurologic function within seconds to a few minutes. It is typically resolved prior to EMS arrival.

Answer 206

Syncope

Question 207

____ is an early sign/symptom of potential impending syncope. It usually lasts for seconds to minutes and may be described by the patient as dizziness, lightheadedness, “nearly blacking out” or “almost fainting.” It is typically resolved prior to arrival of EMS.

Answer 207

Near- syncope

Question 208

If heat exhaustion or cramps are suspected, move the patient to a ____ and obtain a temperature.

Answer 208

cool environment

Question 209

If heat stroke is suspected, initiate immediate aggressive cooling techniques such as
_____ provide mechanical cooling.

Answer 209

removing as much clothing as possible,

cold packs
at the groin, under the axilla and around
the neck;

covering the patient with a cool wet sheet and

set windows and ventilation system in the EMS unit

Question 210

Hypothermia is defined as a core temperature below ____°F.

Answer 210

95°F

Question 211

Patients in cardiac arrest with suspected severe hypothermia shall not be considered dead until _____.

Answer 211

re-warming has been completed at a medical facility.

Question 212

In the event of cold water drowning, the patient shall not be considered deceased until ____.

Answer 212

re-warming has been completed at a medical facility

Question 213

Administer Naloxone (Narcan) if a narcotic (opiate) overdose is suspected and the patient
has any two of the following:

Answer 213

➢ Pinpoint pupils
➢ GCS ˂13
➢ Respiratory depression

Question 214

Patients receiving Narcan should receive care at the ____ level and should be transported to the hospital for further evaluation and treatment.

Answer 214

ALS

Question 215

Contact Poison Control on channel ___ or call 1-800-222-1222 for assistance in managing
specific overdoses. Any medication interventions recommended by Poison Control must first be approved by Medical Control.

Answer 215

H-11

Question 216

Attempt to identify the insect, reptile or animal that caused the injury, if safe to do so. ____ transport a living snake/animal/spider to the hospital. Determine if the patient has access to anti-venom that can be transported to the hospital with them.

Answer 216

DO NOT

Question 217

General Indicators of Carbon Monoxide Exposure:

Answer 217

1-Victims who have been rescued from or had a prolonged exposure to smoke at a fire ground

2-Victims who have been exposed to caron monoxide due to other sourcesof incomplete combustion

3- Exposure or overdoseto Methylene Chloride (commercial paint remover)

Question 218

The most important decision to make with a patient in labor is whether to ____.

Answer 218

attempt delivery in the field or
transport the patient to the hospital.

Question 219

During delivery Once the head emerges, suction the newborns ____ to clear secretions.

Answer 219

mouth then nose

Question 220

Once delivery is accomplished, clamp the cord at ____ from the navel and cut between
the clamps.

Answer 220

6” and 8”

Question 221

occurs when the umbilical cord presents itself outside of the uterus while the fetus is still inside.

Answer 221

Prolapsed cord

Question 222

During prolapsed cord, Palpate the cord for a pulse. If no pulse is obtained, push the newborn’s head or presenting part back into mother only _______.

Answer 222

far enough to regain a pulse in the umbilical cord

Question 223

If the head is not delivered within 3 minutes, place a gloved hand in the vagina, with your
palm toward the newborn’s face utilizing a ____ technique with your fingers. Push the vaginal
wall away from the newborns face to create a space until delivery of the head.

Answer 223

“V”

Question 224

In the event of active post-partum hemorrhage from the vagina, apply a firm uterine massage
starting from the _____.

Answer 224

pubis toward the umbilicus clockwise.

Question 225

In the event that the patient has experienced a miscarriage and the fetus is > 20 weeks in
gestation:

Answer 225

Provide newborn resuscitative measures and transport to the closest appropriate hospital.

the fetus is ≤20 weeksin gestation:
➢ Ensure that the fetus is pulseless and apneic. If so do not attempt resuscitative measures
➢ If there is any question as to the approximate gestation of the fetus, provide resuscitative measures.
➢ If the fetus presents with spontaneous respirations and/or pulses, provide newborn
resuscitative measures and transport to the closest appropriate hospital. If there is a
question as to whether the fetus is viable or not; contact Medical Control for direction.

Question 226

Forgeneral trauma management . Initiate primary assessment utilizing “MARCH” algorithm; which consist of:

Answer 226

M-Massive Hemorrhage
A-Airway
R-Respiratory / Breathing
C-Circulation
H-Head Injury / Hypothermia Prevention

Question 227

When transferring care to trauma center staff use structured handoff format (“AT-MIST”) to
ensure all critical information is communicated:

Answer 227

➢ A – age
➢ T – time of incident
➢ M – mechanism
➢ I – injuries noted
➢ S – symptoms/signs
➢ T – treatments provided

Question 228

DCAP-BTLS-IC is mnemonic acronym to remember specific soft tissue injuries to look
for during a person’s assessment after traumatic injury. DCAP-BTLS-IC is

Answer 228

D – Deformities
C – Contusions
A – Abrasions
P – Penetrations/punctures
B – Burns
T – Tenderness
L – Lacerations
S – Swelling/edema
I – Instability
C – Crepitus

Question 229

Patients with major hemorrhage, hemodynamic instability, penetrating torso trauma, or
signs of traumatic brain injury often require rapid surgical intervention. Transport should
not be delayed. Scene time should NOT exceed _____.

Answer 229

10 minutes.

Question 230

If the patient has burns (thermal, chemical or airway) transport adult patients to the burn
center at ____. and pediatric patients to ___.

Answer 230

Medstar (Hospital 4)

Children’s National (Hospital 2).

Question 231

There are 4 types of blast injury

Answer 231

1-Primary injury: occurs due to the over pressurized blast wave. Most severe injury
occurs at air-fluid interface in the brain, lungs, eardrums, and bowel.

2-Secondary injury: due to projectiles propelled by the blast. Any body part may be
affected.

3-Tertiary injury: due to person being thrown by the blast wind into a solid object. Can
result in crush injury.

4-Quaternary: all other explosion related injuries, illness or disease not described above
including exacerbation or complications of existing conditions (e.g., COPD
exacerbation)

Question 232

If the burns are ≤____ body surface area, cover with Waterjel Emergency Burn Dressing or
if not available sterile dressings soaked in a saline solution.

Answer 232

10%

Question 233

If the burns are >____% body surface area, cover with Waterjel Emergency Burn Dressing or if not available sterile dry dressings. Ensure that the patient is kept covered and warm to
prevent the loss of body heat with mylar blanket.

Answer 233

10

Question 234

Crush _____: a description of a mechanism of injury. Any body part that suffers any traumatic crushing force has sustained. The injury to the soft tissues, muscles, and nerves can be due to the primary direct effect of the trauma and or ischemia related to prolonged compression.

Answer 234

Crush injury

Question 235

Crush _____: systemic manifestations resulting from crush injury, which can
result in organ dysfunction (predominantly acute kidney injury) and or death. Crush
syndrome is the consequence of muscle injury resulting in the spilling of intracellular
contents into the blood stream. The most concerning is the release of potassium and
myoglobin.

Answer 235

Crush Syndrome

Question 236

In general, the CAT tourniquet is expected to be effective on the thigh of pediatric
patients as young as _____ and
arms beginning around ___ of age.

Answer 236

6 to 12 months tight
5 years arm

Question 237

Extremity Trauma / External Hemorrhage Management, ____ may be more effective for infants and young children.

Answer 237

Direct pressure and wound packing

Question 238

A properly applied tourniquet in a conscious patient is very painful. Treat with ALS pain medication. ____ loosen a tourniquet to relieve pain.

Answer 238

Do NOT

Question 239

Remove _____ from the injured limb.

Answer 239

jewelry and potentially constricting clothing

Question 240

For impaled foreign bodies, ems should ____.

Answer 240

Stabilize impaled object to prevent movement.
Control bleeding around the stabilized impaled object. Do NOT remove impaled foreign bodies.

Question 241

Management of exposure to chemical agents: Irrigate the eye(s) immediately with normal saline for a minimum of ____ minutes utilizing IV tubing, a nasal cannula, or Morgan lens. Eye irrigation should commence on scene as soon as possible and be continued throughout transport.

Answer 241

20 minutes

Question 242

Pregnant patients should be transported in the ____ position if clinically and logistically feasible.

Answer 242

left lateral recumbent

Question 243

Pregnant women in cardiac arrest, with a gestational age ___weeks, may be candidates for a peri-mortem c-section upon arrival at the trauma center. Ideally, this procedure is performed within ____ of maternal cardiac arrest. Notify receiving trauma center for preparation as soon as possible.

Answer 243

> 20 weeks;

5 minutes

Question 244

The primary goal of caring for an injured pregnant patient is to stabilize the ____ first, as fetal outcomes are directly correlated with maternal resuscitation.

Answer 244

mother

Question 245

Traumatic Brain Injury Transport patients < ____ old to Children’s National Hospital (H2).

Answer 245

15 years

Question 246

Early signs of neurologic deterioration after head injury include:

Answer 246

o Confusion
o Agitation
o Drowsiness
o Vomiting
o Severe headache

Question 247

The preferred position for SMR is flat and supine. However, there are three circumstances under which raising the head of the stretcher to 30 degrees should be considered:

Answer 247

i. Respiratory distress
ii. Suspected severe brain injury
iii. Promotion of patient compliance

Question 248

Spinal Motion Restriction required for Falls greater than ____ feet

Answer 248

10 feet

Question 249

Level 1 Trauma Center: provides the highest level of trauma care to injured patients. Has a full range of specialists and equipment available 24 hours per day and thus can provide total care for every aspect of injury. Level 1 trauma centers in the region include:

Answer 249

H2-children’s national
H4- medstar
H5- Howard university
H8- George Washington university
H29- inova Fairfax

Question 250

Level 2 Trauma Center: provides comprehensive trauma care, regardless of the severity of the injury.
Provides 24-hour availability of all essential specialties, personnel, and equipment to care for most trauma patients. Level 2 trauma center in the region includes:

Answer 250

H16– university of MD capital region medical center
H22- suburban hospital
H23- Walter reed national military medical center
H26- Virginia hospital center

Question 251

Level 3 Trauma Center: has the resources and capability to perform emergency resuscitation, surgery, and stabilization for many injured patient. Does not have the full availability of trauma specialists but has transfer agreements with a level 1 or level 2 trauma center that provide back up specialty resources as needed.

Answer 251

Currently there are no level 3 trauma Centers amongst our receiving hospitals.

Question 252

Minimize scene time for all trauma patients to < ____.

Answer 252

10 minutes.

Question 253

If a paramedic engine and BLS ambulance are on scene with a Red Criteria trauma patient, providers shall NOT delay transport by requesting a medic transport unit. The engine company paramedic shall upgrade ____.

Answer 253

the BLS ambulance to minimize scene time
(goal < 10 minutes) in Red Criteria trauma patients

Question 254

BLS ambulances shall NOT wait for a prolonged or delayed ALS resource (i.e., paramedic engine or medic transport unit) when caring for a Red Criteria trauma patient. BLS ambulances shall____

Answer 254

initiate transport to the closest level 1 trauma center and request ALS intercept if logistically and geographically feasible.

Question 255

Technology-assisted children refer to those children who depend on medical devices to support bodily function. In all cases utilize the _____ to assist or perform necessary troubleshooting measures because they are often trained in performing those functions.

Answer 255

caregiver

Question 256

All Fire/EMS personnel are required _____ of suspected child / elder abuse or neglect to the Police agency responsible for the area in which the call occurred or the DC Child and family Services Agency

Answer 256

to report cases.

Do not initiate the report in front of the patient, parent, or caregiver. DO NOT CONFRONT OR
BECOME HOSTILE TO THE PARENT OR CAREGIVER.

Question 257

6 Characteristics of the Abused:

Answer 257

1. If less than 5 years old, is likely to be passive.
2. If over 5 years of age, is likely to be aggressive.
3. Does not look to the abuser for support, comfort, or reassurance.
4. May cry without any expectation of receiving help.
5. May be quiet and withdrawn.
6. May be fearful of the abuser.

Question 258

5 History Suggestive of Abuse:

Answer 258

1. The history does not match with the nature or severity of injury.
2. The parents’ and/or caregivers’ account is vague or changes.
3. The “accident” is beyond the capabilities of the patient (e.g. a 12 month old that
   burns self by turning on the hot water in the bath tub).
4. There is a delay in seeking help.
5. The parent and/or caregiver may be inappropriately unconcerned about the
   patient’s injury.

Question 259

8 Physical Assessment Suggestive of Abuse:

Answer 259

1. Fractures in children under 2 years of age.
2. Repeated fractures not explained well.
3. Injuries in various stages of healing.
4. Frequent injuries.
5. Bruises or burns in patterns (e.g. iron or cigarette burns, cord marks, bite or pinch
   marks, and bruised to head, neck, back or buttocks).
6. Widespread injuries over the body.
7. Obvious physical neglect (malnutrition, lack of cleanliness).
8. Inappropriate dress (e.g. very little clothes in winter).

Question 260

7 Characteristics of the Abuser:

Answer 260

1. Crosses all religious, ethnic, occupational, educational, and socioeconomic
   boundaries.
2. May resent or reject the child.
3. May have feelings of worthlessness about self or about the child.
4. May have unrealistic expectations of what the child is capable of doing.
5. May be very critical of the child.
6. Oftentimes the abuser is repeating what was learned as a child (the abuser was more
   than likely abused as a child).
7. May be overly defensive rather than concerned.

Question 261

Grasp the dart itself firmly with one hand and pull to remove one dart at a time. Place the other hand on the patient’s skin at least ____inches away from the puncture. Do not scrape yourself with the dart’s barb upon removal. Do not remove by pulling on the wire. Carefully observe the end of the dart to confirm that the barb is present. If barb is not visible, the dart
has not been fully removed. (See below.) Return the dart, wires, etc., to the police.

Answer 261

four

Question 262

A multiple or mass casualty incident is an emergency scene that creates a number of patients
sufficient to significantly overwhelm available resources.

Multiple Casualty Incident: ___ patients

Mass Casualty Incident: ______ patients

Answer 262

Multiple Casualty Incident: <9 patients (does not need to be declared)
Mass Casualty Incident: 9 or more patients (needs to be declared)

Question 263

____is an acute infectious disease caused by the spore-forming bacterium Bacillus Anthracis. There are inhalation, cutaneous, and intestinal.
Direct person-to-person spread of anthrax is extremely unlikely, if it occurs at all.

Answer 263

Anthrax

Question 264

____is a very potent protein toxin made from mash left over after processing castor beans for oil. It is considered a threat as a biological weapon primarily because it is widely available; it is a category B agent/disease with a high fatality. It is water-soluble, odorless, tasteless and not inactivated by heat.

Answer 264

Ricin poisoning

Question 265

The Environmental Protection Agency (EPA) recommends that no more than ____ additional decontamination attempts be performed for individuals with significant contamination remaining following the first decontamination attempt.

Answer 265

two

Question 266

All providers should attempt to maintain a distance of ___feet or more from the patient when feasible and when it does not interfere with indicated patient care for Coronavirus disease 2019 (COVID-19).

Answer 266

6 feet

Question 267

IGEL Size 5 (Orange) is for ____.

Answer 267

Large adult
90+ kg

Question 268

IGEL Size 4 (Green) is for ____.

Answer 268

Medium adult
50-90 kg

Question 269

IGEL Size 3 Small (Yellow) is for ____.

Answer 269

adult /
large pediatric
30-60 kg

Question 270

IGEL Size 2 (Gray) is for____ .

Answer 270

Small pediatric
10-25 kg

Question 271

IGEL Size 1.5 (Light blue) is for ____.

Answer 271

Infant 5-12 kg

Question 272

IGEL Size 1 ( Pink) is for___.

Answer 272

Neonate
2-5 kg

Question 273

Most adult patients will be managed with a size___IGel.

Answer 273

4 IGEL

Question 274

When putting in IGEL, if there is early resistance during insertion, a___ is recommended.

Answer 274

“jaw thrust” or
“insertion with deep rotation”

Question 275

-The i-gel® is easy to use, insertion can normally be achieved in less than ___, by a proficient user.

Answer 275

“5 seconds

Question 276

The ___ is a truly anatomical device, achieving a mirrored impression of the pharyngeal, laryngeal and perilaryngeal structures, without causing compression or displacement trauma to the tissues and structures in the vicinity

Answer 276

i-gel

Question 277

The preferred site for needle decompression in adults is the ___ intercostal space
(between ribs ____) at the anterior/mid axillary line.

Answer 277

4th intercostal space
(between ribs 4 and 5)

Question 278

the preferred site for needle decompression in children ____ intercostal space (between ribs ____)
at the mid clavicular line.

Answer 278

2nd intercostal space
(between ribs 2 and 3)

Question 279

for chest decompression: Advance the needle with catheter through the parietal pleura until a “____” is felt and air or blood exits under pressure through the catheter.

Answer 279

Pop

Question 280

When using an AED on infants and children ___ years old or less or weighing less than ___ lbs (25 kg), use of reduced energy pediatric specific pads is recommended.

Answer 280

8 years old; 55lbs

Question 281

Daily Check of Zoll AED 3 BLS; is to ensure the defibrillation pads cables ______.

Answer 281

Is always connected to the defibrillator.

Question 282

The green check located to the right of the on/off button displays when the AED is _____.

Answer 282

AED is ready to use ;

do not use or keep in service the Zoll AED 3 Defibrillator if the green check is not dis played in the AED status indicator window.

Question 283

All interruptions in CPR shall be as short as possible and no greater than ___.

Answer 283

10 seconds.

Question 284

If “Shock Advised” EMS should____.

Answer 284

continue chest compressions while the AED is charging

Question 285

the AED shall be placed in a position where ____.

Answer 285

the provider performing chest compressions can see the CPR feedback prompts.

Question 286

Once the monitor/defibrillator is charged, hold compressions and assertively state “____” and visualize that no one, including yourself, is in contact with the patient.

Answer 286

CLEAR

Question 287

If the defibrillator is not discharged within ___ seconds after reaching the selected energy level, the monitor/defibrillator automatically disarms itself

Answer 287

60 seconds

Question 288

Perform manual chest compression for at least ____, two-minute cycles prior to deploying the
LUCAS chest compression system.

Answer 288

least two, two minute cycles

Question 289

Contraindications of LUCAS – Chest Compression Device Patient is too small or too larger. These signs are identified by ____.

Answer 289

Patient is too small: if LUCAS alerts with 3 fast signals when lowering the Suction cup ,and you cannot enter the PAUSE mode or ACTIVE mode.

Patient is too large: if you cannot lock the upper part of LUCAS to the back plate without compressing the pt chest.

Question 290

Pre-position the LUCAS stabilization strap under the patient’s ___ and around the ____.

Answer 290

under the patient’s neck and around the
shoulders

Question 291

Pad placement: ____ placement should be utilized as the first line approach for synchronized cardioversion

Answer 291

anterior/posterior

Question 292

The CPR Leader/Coach position shall be the responsibility of ____. The CPR Leader/ Coach shall provide leadership to and organization of on-scene personnel to ensure the below positions (runner/compressor, ventilator) are filled and that performance meets the department’s standards of care.

Question 293

Runner/Compressor is usually ______.
Immediately assesses responsiveness and checks for the presence of a carotid or femoral pulse.
Important Note: pulse should only be checked for a maximum of 10 seconds, if no definite pulse is felt, assume the patient is in cardiac arrest and immediately start CPR.

Answer 293

First member to arrive at the patient’s side.

Question 294

“Hovers,” no more than ____ inches over the patient’s chest during any pause in chest compressions, including defibrillation attempts, in order to minimize the interruption in compressions or “hands off” time.

Answer 294

two

Question 295

The helmet removal procedure is a guideline designed in two parts. They are:

Answer 295

Part I is for those patients wearing a motorcycle, bicycle, or other non-football type head protective device.

Part II is designed for those patients wearing a football helmet.

Question 296

A _____ is the preferred tourniquet. If none is available, a blood pressure cuff inflated to a pressure sufficient to stop bleeding can be tried only until a commercially made tourniquet is available.

Answer 296

commercially made tourniquet

Question 297

Do not apply a tourniquet _____.

Answer 297

over a joint

Question 298

Only gauze with an _____ may be packed into a wound cavity.

Answer 298

x-ray detectable strip

Question 299

The term______ is used to describe any pelvic fracture that significantly disrupts the pelvic ring. These injuries combine an anterior pelvic injury causing widening (opening) of the pubic symphysis, and a posterior pelvic fracture or ligamentous injury. Open book pelvic injuries result in a risk of major hemorrhage and result in a high incidence of death or disability.

Answer 299

Open book pelvic fracture

Question 300

_____is a commercially available pelvic stabilization device. The SAM Pelvic Sling™ II is one such device.

Answer 300

Pelvic binder

Question 301

it is strongly recommended that providers avoid “____” the pelvis as this may further displace fracture fragments and dislodge already formed blood clots. Instead, gently palpate the bony structures of the pelvis and lower spine for tenderness.

Answer 301

rocking

Question 302

Pelvic fractures most frequently occur in patients ____ y/o who sustain high-energy, side-impact mechanisms of injury such as high-level falls or MVC’s.

Answer 302

15-28

Question 303

The most feared complication of a pelvic injury is ____.

Answer 303

rapid and uncontrolled hemorrhage into the retroperitoneal space.

Question 304

______: a team of hospital-based clinicians, led by an attending trauma surgeon, that is on-call at a local trauma center to respond to entrapments and entanglements that requsire advanced surgical procedures to extricate or resuscitate a patient.

Answer 304

Surgical strike team

Question 305

ALS:
The SNORES bundle of care should be initiated for all patients undergoing procedural dissociation unless logistically not possible due to confined space/technical rescue operations. SNORES is

Answer 305

S - SpO2 monitoring
N - Nasal ETCO2 monitoring
O - Oxygen at a minimum of 6 L via nasal cannula
R - Reassess airway status and vital signs frequently
E - ECG 3 lead monitoring
S – Sugar/glucose check

Question 306

SAMPLE is_____

Answer 306

signs/symptoms,
allergies,
medications,
past history,
last oral,
events leading to

Question 307

What will be complying with DCFEMS protocols regarding patients exhibiting excited delirium?

Answer 307

A member initiates rapid cooling by applying ice packs to a hyperthermic patient.

Question 308

What about applying spinal motion restriction (SMR) is CORRECT?

Answer 308

SMR, when indicated, should be applied to the entire spine.

Question 309

What is one of the inclusion criteria for the Department’s cardiac arrest protocol?

Answer 309

The patient has abnormal breathing.

Question 310

Adult patients exhibiting signs and symptoms of a cerebral vascular accident (CVA) should be screened using the VAN tool. What does the N in VAN stand for?

Answer 310

Neglect

Question 311

According to the D.C. Fire and EMS Department Emergency Medical Services Manual and Pre-Hospital Treatment Protocols, an adult whose blood glucose level is below _____ mg/dL is considered hypoglycemic and should be treated.

Answer 311

70

Question 312

A prolapsed cord occurs when the umbilical cord presents itself outside of the uterus while the fetus is still inside. When this occurs during an OB-GYN emergency, the provider should place the mother in which of the following
positions?

Answer 312

The knee-chest position.