General Standard of Care Flashcards
GCS (Glasgow Coma Scale)
Eye Opening
What are the possible results?
1 - Does not open eyes in response to anything.
2 - Opens eyes in response to painful stimuli.
3 - Opens eyes in response to voice.
4 - Opens eyes spontaneously.
Goes from 1-4
GCS (Glasgow Coma Scale)
Verbal Response
What are the possible results?
1 - Makes no sounds.
2 - Incomprehensible sounds.
3 - Utters incoherent words.
4 - Confused, disoriented.
5 - Oriented, converses normally.
Goes from 1-5
GCS (Glasgow Coma Scale)
Motor Activity
What are the possible results?
1 - Makes no movements.
2 - Decerebrate (extensor) posture (an abnormal posture that can include arms and legs held straight out, toes pointed downward, head and neck arched backward).
3 - Decorticate (flexor) posture (an abnormal posture that can include clenched fists, legs held straight out - “to the core”).
4 - Withdrawal from painful stimuli.
5- Localizes to painful stimuli.
6 - Obeys commands.
Goes from 1-6
GCS (Glasgow Coma Scale)
8 or lower
What’s the significance?
any patient with an 8 or lower is strongly considered for intubation
GCS (Glasgow Coma Scale)
3
What’s the significance?
The lowest possible GCS; this indicates a patient is wholly unresponsive.
GCS (Glasgow Coma Scale)
15
What’s the significance?
The highest GCS score
Baseline Vital Signs
What are the 8
AND what else might you ask you partner to check or “do”?
1 - HR
2 - RR
3 - BP
4 - SPO2
5 - GCS
6 - Temp
7 - Pupils
8 - Skin
Put the BP on 3-5min repeat
End tital C02
4-lead/12-lead
BGL
Patient Assessment Standard
When would you use a cardiac monitor?
4-lead/12-lead
Any Neuro, Cardio, or Resp Call
Patient Management Standard
What are the 6 reasons for positioning or re-positioning the patient?
1 - C-spine alignment
2 - Airway patency
3 - Breathing
4 - Venous return and perfusion
5 - Extremity Injury
6 - Patient Comfort
Patient Transport Standard
What of the patient’s do you need to take with you?
Relvent Patient Medications
Record of Medications
Relevent identification
Patient Refusal/Emergency Treatment Standard
What are the 5 things you NEED to do before leaving scene?
Patient with capacity refusal
Inform the patient that treatment/transport are recommended
Explain the consequences of the refusal
Confirm the patient has capacity
Advise patient to call 911 if further concerns arise
Obtain needed signatures for your ACR
Patient Refusal/Emergency Treatment Standard
When do you emergency transport regardless?
Incapable patient without consent
Patient doesn’nt have capacity
Patient is experiencing severe suffering/at risk of sustaining harm (wihtout treatment)
The delay (amount of time) it takes to obtain consent/refusal is prolonging the suffering or putting them at risk
Document everything on ACR
Patient Refusal/Emergency Treatment Standard
When do you emergency transport regardless?
Capable patient without consent
Patient is experiencing severe suffering/at risk of sustaining harm (wihtout treatment)
When a disability or language barrier impeeds the ability to obtain consent/refusal
When efforts have been made to help with the communication issues but nothing’s been found
When the delay (amount of time) it takes to find a practical means to help with communication to obtain consent/refusal is prolonging the suffering or putting them at risk
When there’s no reason to believe the patient does not want the treatment.
Document everything in ACR
Reporting of Patient Care to Receiving Facility Standard
What CTAS would you transmit a report while on route for?
All CTAS 1 and 2
Reporting of Patient Care to Receiving Facility Standard
What do you report to receiving facility for CTAS 1 and 2 patients?
10 things and 2 things to remember to do
Unit #
Patient age
Patient sex
CTAS Level
Cheif Complaint
Pertinent history
Pertinant assessment findings
Pertinent management and response to management
Abnormal vital signs
Estimated time of arrival
Remember to confirm that the facility has ackknowleged the report
provide any changes if the CTAS increases
Patch to Base Hospital Physician Standard
When do you initiate a patch?
When required by the standard or ALS PCS
When there is uncertainty or further direction desired
Patch to Base Hospital Physician Standard
What do you report?
2 things to remember to do
Your level of certification
Provide the pt’s condition, situation, or circumstance
Provided any rquested information
Confirm direction, authorization, and orders given AND document in ACR
Oxygen Therapy Standard
What % do you attempt to maintain oxygen saturation of a patient?
92%-96%
Oxygen Therapy Standard
For what patients do you administer high concentration of oxygen?
6 things
Confirmed/suspected CO, cyanide toxicity, or noxious gas exposure
Upper airway burn
Scuba-diving related disorders
Ongoing cardiopulmonary arrest
Complete airway obstruction
Sickle cell anemia with suspected vaso-occlusive crisis
Oxygen Therapy Standard
What patients do you proceed to give high concentration of oxygen to if SPO2 isn’t working?
5 types + the normal 6
Age-specific hypotension
Respiratory distress
Cyanosis, ashen colour, pallor
Altered level of consciousness
Abnormal pregnancy or labour
Oxygen Therapy Standard (COPD)
What are the indications to begin treatment in a pt with COPD?
Increased Dyspnea
Decreased level of consciousness
An altered mental status
Suffered major traum
Oxygen Therapy Standard (COPD)
What % do you keep the pt’s oxygen concentration at?
What do yu do if SPO2 isn’t working
88%-92%
Administer O2 by nasal cannula with O2 at 2lpm above their home O2
or at 2lpm if they don’t have home O2
Oxygen Therapy Standard (COPD)
What should you be prepared for and checking on after setting up their O2
Re-assess vitals every 10min
Be prepared to ventilate
If status improves then maintain the flow rate
If the status declines (or they feel worse) then increase oxygen every 2-3min by increments of 2lpm
In what order do you Don AND Doff PPE?
DON - - Gown, Mask, Eyewear, and Gloves
DOF - - Gloves, Eyewear, Mask, and Gown
Field Trauma Triage Standard
What are the PHYSIOLOGICAL criteria?
What’s the breaths per minute for infant aged less than a year?
Patient does not follow commands
Systolic BP less than 90mmHg
Respriratory rate less than 10 to greater or equal to 30 breaths per minute or need for ventilitory support
less than 20
Field Trauma Triage Standard
After assessing PHYSIOLOGICAL criteria when can you go to the LTH?
When the the patient meets any of the PHYSIOLOGICAL criteria AND the land transport time is less than 30min
Field Trauma Triage Standard
What are the ANATOMICAL criteria?
8
After assessing ANATOMICAL criteria when can you go to the LTH?
Any penetrating injuries to head, neck, torso and extremities proximal to
elbow or knee
Chest wall instability or deformity (e.g. flail chest),
Two or more proximal long-bone fractures,
Crushed, de-gloved, mangled or pulseless extremity,
Amputation proximal to wrist or ankle,
Pelvic fractures,
Open or depressed skull fracture, or
Paralysis
if the patient meets the anatomical criteria listed
AND the land transport time is less than 30min
Field Trauma Triage
Even if a patient meets either PHYSIOLOGICAL or ANATOMCAL criteria, would you ever transport to the closest emergency department instead of the LTH?
Yes, you would do so if you’re unable to secure the pt’s airway OR survival to the LTH is unlikely
Field Trauma Triage
What criteria does a pt have to meet if a pt has a penetrating chest trauma to the torso or head/neck, for you to transport to LTH not the emerg?
despite it beging dire or terrible airway
Vital signs absent yet not subject to TOR described in the General Directive above
AND
Land transport to the LTH or regionally designated equivalent hospital is
estimated to be <30 minutes
Field Trauma Triage
What are all of the traumatic mechanisms of injury?
8
When would the pt that meets any of the MOI criteria be transported to the LTH?
Falls
i. Adults: falls greater or equal to 6 metres (one story is equal to 3 metres)
ii. Children (age <15): falls ≥3 metres or two to three times the height of the child
High Risk Auto Crash
i. Intrusion ≥0.3 metres occupant site; ≥0.5 metres any site, including the roof
ii. Ejection (partial or complete) from automobile
iii. Death in the same passenger compartment
iv. Vehicle telemetry data consistent with high risk injury
Pedestrian or bicyclist thrown, run over or struck with significant impact (≥30 km/hr) by an automobile
Motorcycle crash ≥30 km/h
When land transport time is less than 30min
Field Trauma Triage
What SPECIALCRITERIA should you consider?
this is in conjuction with the other 3 catagories
When would you transport the pt to the LTH if they did meet any SPECIAL CRITERIA?
Age
i. Risk of injury/death increases after age 55
ii. SBP <110 may represent shock after age 65
Anticoagulation and bleeding disorders
Burns
i. With trauma mechanism: triage to LTH
Pregnancy ≥20 weeks
When the land transport time is less than 30min
Air Ambulance Utilization Standard
What are the indications?
Meeting at least 1 of the bulleted operational criteria AND 1 of the clinical criteria (in FTT)
Air Ambulance Utilization Standard
What are the OPERATIONAL criteria?
4
The land ambulance is estimated to require more than 30 minutes to
reach the scene and the air ambulance can reach the scene quicker.
The land ambulance is estimated to require more than 30 minutes to
travel from the scene to the closest appropriate hospital and the air ambulance helicopter can reach the scene and transport the patient to the
closest appropriate hospital quicker than the land ambulance.
The estimated response for both land and air is estimated to be greater
than 30 minutes, but approximately equal, and the patient needs care
which cannot be provided by the responding land ambulance.
There are multiple patients who meet the clinical criteria and the local
land ambulance resources are already being fully utilized
Air Ambulance Utilization Standard
After assessing the OPERATIONAL criteria what are the CLINICAL criteria you look for?
The medical and obstetircal
keeping in mind that the FTT is inculded as well
Medical:
1. Shock, especially hypotension with altered mentation (e.g.
suspected aortic aneurysm rupture, massive gastrointestinal
bleed, severe sepsis, anaphylaxis, cardiogenic shock
- Acute stroke with a clearly determined time of onset or last
known to be normal <6.0 hours - Altered level of consciousness (GCS <10)
- Acute respiratory failure or distress
- Suspected STEMI or potentially lethal dysrhythmia
- Resuscitation from respiratory or cardiac arrest
- Status epilepticus
- Unstable airway or partial airway obstruction
Obstetrical:
1. Active labour with abnormal presentation (i.e. shoulder,
breech or limb)
- Multiple gestation and active labour
- Umbilical cord prolapse
- Significant vaginal bleeding (suspected placental abruption or placenta previa or ectopic pregnancy)
Air Ambulance Utilization Standard
When Requesting air ambulance, what do you report?
2
You must provide the criteria that the pt meets and all estimated times related to transporting.
stretcher to air-ambulance, air ambulance ride, stretcher to hospital
Air Ambulance Utilization Standard
When do you go to the hospital even though you’ve called the air-ambulance?
If the air ambulance helicopter is en route but not on final approach to the scene, and the land paramedics have the patient in his/her ambulance, then the land ambulance will
proceed to the closest local hospital with an emergency department
Do Not Resuscitate (DNR)
Standard
What Does a Valid MOH DNR Confirmation Form Look Like?
