Flashcards in EMS (protocols) Deck (83):
Traumatic Emergencies is in what color section?
Cardiac Emergencies is in what color section?
Shock Emergencies is in what color section?
Respiratory Emergencies is in what color section?
Medical Emergencies are in what color section?
Environmental Emergencies are in what color section
Behavioral Emergencies are in what color section.
OB/GYN Emergencies are in what color section.
Appendices are what color section.
All ALS procedures are in?
All treatments needing an order from a
Base Station are?
Pediatric patient care is in?
An EMT in Pierce County may administer what medications without Base station contact?
Oxygen,Oral glucose, and Aspirin.
Which medications require base station contact?
Acetaminophen, Activated Charcoal, Epinephrine 1:1000 or Epi-Auto injectors, Nerve Agent Antidote Kit (DuoDote or MARK 1),
Which medications may EMTS "assist with" with base station contact?
Nitroglycerine, Metered dose inhalers.
A physician on scene with a medical license in hand may?
Participate in patient care management by:
a. Assisting the paramedic in carrying out protocols.
b. Performing additional interventions at the direction of the Base Station.
A physician on scene with a medical license in hand may Give orders IF?
a. The Base Station concurs, and
b. The physician accompanies the patient to the hospital.
A medical patient will be transported with CPR in progress only if one of the
1. Drug overdose.
3. Shockable rhythm.
4. Age ≤ 30 years.
5. Situational circumstances requiring the patient to be transported.
What are the 6 obvious signs of
1. Rigor mortis.
6. Evisceration of the heart or brain without vital signs.
When should you always begin
resuscitation and contact the Base Station.
if near-drowning, hypothermia and/or drug overdose is suspected
If the person that you suspect is being abused or neglected is living in a nursing home, boarding home, or adult family home, contact?
WA State Complaint Resolution Unit toll-free hotline, 24 hour/after hours:
SUIDI is the acronym for?
Sudden Unexplained Infant Death Investigation
On all patients age ≤ 15 years old
before the EMS person in charge of the patient leaves the scene they must always?
Mary Bridge Base contact must be made on all patients age ≤ 15 years old
General Principles/Routine Care is in what color section
Pierce County Competency Checklist:
Yes – Patient meets competency criteria elements (all must be marked).
No – Patient does not meet competency criteria elements (if any are marked
NO, the patient is considered incompetent).
Patient/caregiver is: YES NO
1. 18 years old or emancipated minor.
2. Conscious and alert, communicates their choices.
3. Oriented (GCS 15) – understands situation and
consequences; and able to weigh risk/benefit
options; and rationally processes information before making a decision.
4. Not physically or cognitively impaired by the use of alcohol/drug(s).
5. Not suspected of brain trauma or hypoxia (pulse oximetry >85%).
6. No dementia, mental illness, or other medical disease that affects the patient’s ability to make a decision.
What are the Base Stations for Adult Medical & Trauma Patients?
Adult Patients (i.e. age greater than or equal to 16 years old)
Madigan AMC: Assigned agencies
Good Samaritan: Assigned agencies
St. Anthony: Assigned agencies
What is considered a nonviable Neonate?
What are the Neonatal Intensive Care Unit (NICU) capability numbers?
a. 1 = 36 weeks and up.
b. 2 = 32 weeks and up.
c. 3 = 23 weeks and up.
A medical patient with an unstable airway or ongoing CPR will be transported to?
The nearest Receiving Facility’s emergency room regardless of the emergency
department’s designated capabilities.
A trauma patient with an unstable airway will be transported to?
The nearest Receiving Facility’s emergency room regardless of the emergency department’s designated capabilities.
Critical pts. Repeat vitals every?
For non critical pts. Repeat vitals every?
Administer low flow O2
with nasal cannula at?
2 to 6 LPM.
Administer high flow O2
with NRB mask at?
10 - 15 LPM.
For adults assist ventilation with bvm if respiration so are?
30 and/or shallow/labored.
For adult. What is the rate for assisting ventilations with BVM?
12 times/minute/1 every 5 seconds
Pediatric: manage airway and ventilate with BVM and high flow O2 at a rate of?
20 times/minute/1 every 3 seconds if respirations are labored or shallow.
What is the criteria for using CPAP on pts. associated with CHF, pulmonary edema, asthma, or COPD?
1. Awake and able to follow directions.
2. Over 12 years old and able to fit in a CPAP mask.
3. Has the ability to maintain an open airway without assistance.
4. Exhibits two or more of the following:
a. Respiratory rate > 25 per minute.
b. SPO2 50.
c. Using accessory muscles during respirations.
d. Unable to speak in full sentences.
Contraindications for CPAP include?
a. Apnea or respirations
Administrative Policy,Communication Policy,and Transport Policy are in what color section?
What do you do for patients with helmets but no shoulder pads?
For Patients with sports helmets and shoulder pads what do you do?
Players should be stabilized for transport with helmet and shoulder
pads in place.
What are 2 domestic violence resources we can give pts.?
1. Pierce County YWCA, 24 hour: 253-383-2593 or
2. Crystal Judson Family Justice Center, 8:30 a.m. - 4:30 p.m. M – F:
If tourniquet is applied, what must you do?
Mark time applied on the tourniquet.
For CNS and facial trauma pts. That are breathing adequately on own provide oxygen @?
O2 @ 15 l/NRB
If patient is not breathing adequately and has a Traumatic Brain Injury (TBI),
ventilate @ 10 breaths/min. for adults,
20 breaths/min. for children
and 25 breaths/min. for infants.
If increased intracranial pressure (IICP) (widening pulse pressure, decreased HR and increased BP, posturing, blown pupil, change in respiratory pattern) is associated with the TBI. Ventilate @?
ventilate @ 20 breaths/min. for adults,
25 breaths/min. for children
and 30 breaths/min. for infants
How do you transport Amputated parts?
Wrap in sterile saline moistened gauze, place in plastic bag, protect with towel,
place on ice.
Do not remove Impaled objects unless?
The object is impaled in the cheek.
Taser darts should only be removed in the field only if they do not involve?
eye, face, neck, breast, or groin. Patients with retained darts in these areas
should be transported to a hospital
What do you do with taser darts after removal?
The darts should be placed in a biohazard sharps container and turned over
to Law Enforcement.
For pts. With thermal burns
1. Assess airway, O2, and intubate PRN.
2. Stop the burning process, irrigate with room-temperature water if
3. Remove constricting jewelry, and annotate on PCR to whom the jewelry
4. Apply dry, sterile non-adherent dressings and/or clean sheets.
5. Keep patient warm.
For Crush Injury Syndrome (CIS) pts. What must be done before removal?
Patients with CIS may not survive if treatment is not initiated before removal from the situation. It is imperative that patients be pretreated before extrication or
What do you never use on Crush Injury pts.
DO NOT use PASG.
What should the scene time be for cardiac emergencies.
Less than 15 min
What do you administer 02at for cardiac emergencies?
Administer oxygen if oxygen saturation is
When assisting patient in taking patient’s own nitroglycerin be cautious of?
1. Use with caution or seek expert consultation if HR >100. Limit systolic
BP drop of 10% of baseline or 30% if hypertensive. Avoid use of NTG if erectile dysfunction drugs used within 24 – 48 hours, as per AHA.
2. May repeat every 5 minutes x 2 if systolic BP remains >100.
Acute Coronary Syndrome
automatic implantable cardioverter defibrillator
How much aspirin should you give for chest pain?
Give non-enteric coated aspirin for chewing and swallowing; 162mg total if
already taking aspirin, 325mg total if not.
What is required for treatment for pediatrics (less than or equal to 15 years old)
contact with Mary Bridge Children’s Hospital.
rescue breathing ratio?
– Victims 1 to 8 years: 1 breath every 3 seconds
– Victims over 8 years: 1 breath every 5-6 seconds
– Victims 1 to 8 years:
1 Rescuer: 30 compressions to 2 breaths
2 Rescuers: 15 compressions to 2 breaths
– Victims over 8 years: 30 compressions to 2 breaths
What are the Epinephrine administration guidelines?
0.3mg IM for adults and
pediatric patients >66 pounds;
and 0.15mg IM for pediatric
EMT may assist with patient’s own metered dose inhaler, as indicated to a total
5 doses then call Base Station for medical direction.
For Altered level of consciousness/unconsciousness. If increased intracranial pressure suspected?
1. Ventilate @ 20/min. for adults. Keep pulse oximeter ≥ 95%. Keep ETCOl evel between 30 – 35 mmHg if able to monitor.
2. Lay patient flat unless signs of airway compromise, in which case elevate
head of bed no higher than 20 degrees.
What are the activated charcoal dosages?
a. Adult: 1gm/kg orally.
b. Pediatric: 1gm/kg orally.
What does F.A.S.T. stand for?
F.A.S.T. Assessment (Face/Arm/Speech/Time last normal)
What is the patient treatment if readings
1. Remove patient from CO environment.
2. Assure O2 delivery is high flow at 100% for CO readings >5% in a non-smoker and >10% in a smoker.
3. Consider CPAP for CO readings in adults >12%.
4. Contact Base Station for possible transport for hyperbaric therapy with CO
readings >25% in adults and >15% in children and pregnant women.
What are appropriate devices to perform restraint.
soft restraints, gauze roll, triangular bandages, commercial type restraint.
Excited Delirium syndrome.
Procedure for Childbirth – Breech Deliveries.
1. All efforts should be made to rapidly transport the mother to the closest,
most appropriate facility. Place the mother in a gravity dependant, knee chest position and coach her not to push.
2. If delivery cannot be delayed, assess for type of breech delivery: Frank
(bottom first) or Footling (feet first).
a. If Frank: perform delivery, coaching the mother to prevent an explosive delivery.
b. If Footling: place a gloved hand into the vagina along the newborn baby’s chest and face, keeping the cervix open while maintain an air
passage through the birth canal. Deliver the baby.
Procedures for Childbirth – Prolapsed cord.
1. Place mother on back and elevate the hips, or consider knee-chest position.
2. Place sterile gloved index and middle fingers into the vagina, pushing the infant up to relieve pressure on the cord.
3. Check cord for pulse and assure pulse is maintained.
4. Transport immediately.
Procedure for Childbirth – Meconium Present.
1. Assess the mother’s garments and the surrounding area while getting a good
history of when her membrane ruptured and assess for the presence of meconium. Continue to deliver as above.
2. Once delivered, assess the baby for vigorous activity.
Neonatal Resuscitation procedures?
SIGNAL I Death by fire
SIGNAL II Death by natural causes
SIGNAL III Suspicious death
BLS TRANSPORT GUIDELINES
Warm, dry, pink skin.
HR 60 - 120 regular, good peripheral pulses.
RR 10 - 30 deep and easy.
BP >100 systolic.
ALS TRANSPORT GUIDELINES
Cool, clammy skin.
RR 30 shallow, labored.
BP 180 systolic.
BP >120 diastolic.
Altered LOC or loss of consciousness now or prior to arrival.
Indications for PNEUMATIC ANTI-SHOCK GARMENT are?
A. Hypovolemic Shock:
1. Hypotension associated with suspected intraabdominal hemorrhage.
2. Hypotension associated with suspected retroperitoneal hemorrhage.
3. Burns-use clean sheets under PASG.
B. Vasogenic Shock:
1. Use as a splint for pelvic fractures associated with hypotension.
Procedure for PNEUMATIC ANTI-SHOCK GARMENT are?
A. Inflate all compartments if all the following are present:
1. Clear lungs.
2. HR > 100.
3. Systolic BP