General Standard of Care Flashcards

Question

# Field Trauma Triage Standard What are the PHYSIOLOGICAL criteria? | What's the breaths per minute for infant aged less than a year?

Answer 1

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

Answer 2

When the the patient meets any of the PHYSIOLOGICAL criteria AND the land transport time is less than 30min

Answer 3

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 ## Footnote AND the land transport time is less than 30min

Answer 4

Yes, you would do so if you're unable to secure the pt's airway OR survival to the LTH is unlikely

Answer 5

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

Answer 6

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

Answer 7

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

Answer 8

Meeting at least 1 of the bulleted operational criteria AND 1 of the clinical criteria (in FTT)

Answer 9

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

Answer 10

Medical: 1. Shock, especially hypotension with altered mentation (e.g. suspected aortic aneurysm rupture, massive gastrointestinal bleed, severe sepsis, anaphylaxis, cardiogenic shock 2. Acute stroke with a clearly determined time of onset or last known to be normal <6.0 hours 3. Altered level of consciousness (GCS <10) 4. Acute respiratory failure or distress 5. Suspected STEMI or potentially lethal dysrhythmia 6. Resuscitation from respiratory or cardiac arrest 7. Status epilepticus 8. Unstable airway or partial airway obstruction Obstetrical: 1. Active labour with abnormal presentation (i.e. shoulder, breech or limb) 2. Multiple gestation and active labour 3. Umbilical cord prolapse 4. Significant vaginal bleeding (suspected placental abruption or placenta previa or ectopic pregnancy)

Answer 11

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

Answer 12

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

Answer 13

If the air ambulance helicopter is able to land along the direct route of the land ambulance AND It would result in a significant reduction in transport time to the most appropriate hospital. ## Footnote Remember if they don't meet criteria or things change then call CACC/ACS to report it's no longer required

Answer 14

They're not permitted at night They're not permitted to perform search and rescure calls Land Ambulance trumps air-amublance if both are able to make it to the scene If land ambulance reaches the scene before on-scene ai-ambulance does they will inform CACC/ACS

Answer 15

Any trauma associated with complaints of neck or back pain, Sports accidents (impaction, falls) Diving incidents and submersion injuries Explosions, other types of forceful acceleration/deceleration injuries Falls (e.g. stairs) Pedestrians struck Electrocution Lightning strikes OR Penetrating trauma to the head, neck or torso

Answer 16

1 - Neck or back pain 2 - Spine tenderness 3 - neurologic signs or symptoms 4 - altered level of consciousness 5 - suspected drug or alcohol intoxication 6 - a distracting painful injury (any painful injury that may distract the patient from the pain of a spinal injury) 7 - anatomic deformity of the spine 8 - high-energy mechanism of injury, such as: i. fall from elevation greater than 3 feet/5 stairs ii. axial load to the head (e.g. diving accidents), iii. high speed motor vehicle collisions (≥100 km/hr), rollover, ejection, iv. hit by bus or large truck, v. motorized/ATV recreational vehicles collision, or vi. bicyclist struck, collision 15 - Age ≥65 years old including falls from standing height ## Footnote No the pt only needs to meet 1

Answer 17

If the pt meets the MOI criteria but meets none of the RISK criteria OR The pt exhibits ALL of the 6 "NO GO" criteria

Answer 18

No spine tenderness No neurologic signs or symptoms No altered level of consciousness No evidence of drug or alcohol intoxication No distracting painful injury AND No anatomic deformity of the spine | The pt MUST meet all the the previouoslt menttioned criteria

Answer 19

NO ## Footnote It identifies pt's where the MOI in combo with the absence of RISK criteris mean SMR no longer needs to be considered

Answer 20

The pt's neurological status

Answer 21

They should be consiered as extrication devices - the ot should be removed from the device onto the stretcher if safe to do so They can remain in place if you deem if morre comfortable and it's less than 30min of trsnport Pt's with suspected PEVLIC FRACTURES should be secured on a spinal board as per the 'Blunt/Penetrating Injury Standard'

Answer 22

When the pt becomes increasingly confused, agitated, or combative the more you try to apply SMR

Answer 23

semi-sitting or supine position | apply manual c-spineuntil you can apply appropriate SMR ## Footnote Yes, place the colar befoer moving the pt

Answer 24

Pt's that have been in a MVC AND remian with isolated neck/back pain WITH no neurolgoical signs or symptoms | You still do a full SMR assessment ## Footnote Yes they can - could be removal of spinal board

Answer 25

CPR means cardiopulmonary resusitation, it's an immediate appliaction of life-saving measures ## Footnote Chest Compressions Defibrillation Artificial ventilation Insertion of an oropharyngeal, nasopharyngeal or supraglottic airway Endotracheal intubation Transcutaneous pacing Advanced resuscitation drugs such as, but not limited to, vasopressors, antiarrhythmic agents and opioid antagonists

Answer 26

It means Do Not Resuscitate | Valid MOH DNR Confirmation Form

Answer 27

It can be the OG or a copy of the OG

Answer 28

the patient with a Valid MOH DNR Confirmation Form appears to the paramedic to be capable and expresses clearly a wish to be resuscitated in the event that he/she experiences a respiratory or cardiac arrest; or the patient with a Valid MOH DNR Confirmation Form appears to the paramedic to be capable and expresses a wish to be resuscitated in the event that he/she experiences respiratory or cardiorespiratory arrest, but the request is vague, incomplete or ambiguous such that it is no longer clear what the wishes of the patient are ## Footnote Respirations and pulse are absent for at least three minutes from the time you 1st noted.

Answer 29

Patient management necessary to provide comfort or alleviate pain | Adivse the CACC/ACS AND Follow the DeceasedPatient Standard ## Footnote Note the TOD (time of death)

Answer 30

Obviously dead The subject of a medical certificate of death, presented to the paramedic crew, in the form that is prescribed by the Vital Statistics Act (Ontario) and that appears on its face to be completed and signed in accordance with that Act Without vital signs and the subject of an MOH Do Not Resuscitate (DNR) Confirmation Form Without vital signs and the subject of a Termination of Resuscitation (TOR) Order given by a Base Hospital Physician OR Without vital signs and the subject of a Withhold Resuscitation Order given by a Base Hospital Physician. | A death that was imminently anticipated (terminal illness)

Answer 31

Decapitation, transection, visible decomposition, putrefaction OR Absence of vital signs AND A grossly charred body An open head or torso wound with gross outpouring of cranial or visceral contents Gross rigor mortis OR Depdendent lividity (fixed, non-blanching purple or black discolouration of skin in dependent area of body)

Answer 32

A team of health care professionals that provide palliative care to termially ill patients | AN order given by BHP to a parmedic to stop resuscitation measures. ## Footnote An adult (who YOU believe) is able to remain with and assume respoonsiblity for the deceased patient.

Answer 33

A death that was not imminently anticipated (sudden) | An order given by BHP to YOU to not initiate resuscitation measures

Answer 34

Confirm the patient is deceased as per the definitions in the standard Ensure that the Deceased Patient is treated with respect and dignity Consider the needs of family members of the decedent and provide compassion-informed decision-making In cases of suspected foul play, follow the directions set out in the Police Notification Standard If applicable follow all directions issued by a coroner or to whom a coroner has delegated any powers or authority pursuant to the Coroners Act (Ontario) If termination of resuscitation occurs in the ambulance en route to a health care facility, advise CACC/ACS to contact the coroner, and continue to the destination unless otherwise directed by CACC/ACS AND For cases of obvious death, note and document the time at which the paramedic confirms the patient was deceased as per the Standards

Answer 35

In the absence of police or a coroner on-scene, the paramedic shall advise CACC/ACS of the death, in which case CACC/ACS shall notify the police or coroner If a coroner indicates that he/she will attend at the scene, the paramedic shall remain at the scene until the coroner arrives and assumes custody of the Deceased Patient. If the coroner indicates that he/she will not attend at the scene, the paramedic shall remain on the scene until the arrival of a person appointed by a coroner or to whom a coroner has delegated any powers or authority pursuant to the Coroners Act (Ontario) Notwithstanding what I just said, if police are present and have secured the scene, the paramedic may depart as soon as documentation has been completed or he/she is assigned to another call AND Where at any time the paramedic has not received any further direction from CACC/ACS, the paramedic shall request that CACC/ACS seek direction from the coroner concerning his/her responsibilities, including whether he/she may leave the scene. ## Footnote That the death requires investigation by a coroner under the Coroners Act

Answer 36

The paramedic shall advise CACC/ACS of the death The paramedic shall make a request of a "Responsible Person" to notify the primary care practitioner or a member of the Palliative Care Team (if any) of the patient and request his/her attendance at the scene If the Responsible Person is unable to provide the notice above, the paramedic shall advise CACC/ACS of the death, in which case CACC/ACS shall attempt to notify the primary care practitioner or member of the Palliative Care Team (if any) of the Deceased Patient, and request his/her attendance at the scene If the Deceased Patient’s primary care practitioner or Palliative Care Team member is contacted and indicates that he/she will attend at the scene, then the paramedic shall remain at the scene until his/her arrival If there is a Responsible Person present, and the paramedics reasonably believe that the Responsible Person will remain until the primary care practitioner or Palliative Care Team arrives, then the paramedic may depart as soon as all required documentation has been completed or he/she are assigned to another call. The police can take over watch as well If the primary care practitioner or Palliative Care Team member cannot be contacted or if he/she is unable to attend, or there is no Responsible Person on-scene, the paramedic crew shall advise CACC/ACS, in which case CACC/ACS shall notify the police or coroner of the death and that there is no one else at the scene who can take responsibility for the Deceased Patient AND If requested by the coroner, the paramedic will provide the coroner with the circumstances of the death; the paramedic will either be released from the scene or instructed to remain with the Deceased Patient until the coroner or a person appointed by a coroner or to whom a coroner has delegated any powers or authority pursuant to the Coroners Act (Ontario) or a Responsible Person CAN attend the scene and assume responsibility for the Deceased Patient

Answer 37

Be aware of problems due to A+P during the primary survey Be aware the primary cause of cardiac arrest is respiratory arrest Remeber Pediatric Vital Signs Consider Assessments for 8 - change in appetite - - change in behaviour/personality - - excessive drooling - - decrease in # of wet diapers - - inconsolable crying or screaming - - lethargy - - tripoding/odd postioning - - work of breathing Conduct a full secondary survey from 'head-to-toe' Have care giers present if possible AND If they're an infant then asses fontanelles ## Footnote Maintain a high index of suspicion when assessing pediatric patients AND Provide support for the head and neck

Answer 38

The duty to report overrides any other provincial statute, including any provisions that would otherwise prohibit someone from making a disclosure (it's an offence under the Act to fail to report) The duty to report under the Child and Family Services Act extends to any child you meet during professional duties NOT just 911 calls

Answer 39

Submersion injury All burns Accidental ingestions/poisoning Other types of in-home injuries, e.g. falls

Answer 40

Household/siblings dirty, unkempt, and/or in disarray Evidence of violence, e.g. overturned or broken furniture Animal/pet abuse Evidence of substance abuse, e.g. empty liquor bottles, drug paraphernalia

Answer 41

Gross or multiple deformities which are incompatible with the incident history, especially in a child under 2 years of age who is developmentally incapable of sustaining this type of injury Multiple new and/or old bruises which have not been reported, or which have been reported as all being new Distinctive marks or burns, e.g. belt, hand imprint, cigarette burns Bruises in unusual areas: chest, abdomen, genitals, buttocks Burns in unusual areas: buttocks, genitals, soles of feet Signs of long-standing physical neglect, e.g. dirty, malodourous skin, hair and clothing, severe diaper rash, uncut/dirty fingernails Signs of malnutrition - slack skin folds, extreme pallor, dull/thin hair, dehydration Signs of “shaking” syndrome - hemorrhages over the whites of the eyes; hand or fingerprints on the neck, upper arms or shoulders; signs of head injury unrelated to the incident history.

Answer 42

A child who is or who appears to be suffering from abuse and/or neglect. Concerning Circumstances (i.e. physical, sexual, or emotional abuse, neglect, or risk of harm) | The inforamtion that a person needs in order to decide to report ## Footnote The requirement to promptly report that a child is or may be in need of protection directly to a Children's Aid Society (CAS)

Answer 43

1- Ensure the pt is not left alone 2- Request police if you belive the pt is at risk of imminent harm 3- Obtain a clear hx attempting to determine validity of the hx by -if the story changes frequently -the parents are vague or blame each other -the NOI is inconsistent with the explanation provided -the mechanism of injury is obviuosly beyond the developmental capabilities of the child -there is unexplained prolonged delay in seeking treatment -there is a hx of recurrent injuries 3.b) interaction beteen parents-child-cargivers (children may paradoxically protect the abusive party) 3.c) appropriateness of child's behaviour relevant to the situation/injury 3.d) appropriateness of the parental response to the child's injury and/or emotional distress 4 - make no accusations or comments about your thoughts infront of the parents or bystanders 5 - transport the child in all cases AND 6 - report suspicions tothe RH and complete the duty to report to the CAS

Answer 44

Assume that all geriatric pts are capable of normal hearing, sight, speech, mobility, and mental function unless otherwise told Assess living conditions and consider the pts ability to perform ADL (Activities of Daily Living) Be aware of pt presentations associated with elder abuse AND If elder abuse is suspected then offer to contact police if they're not already on scene AND alert receiving facility staff. ## Footnote 1 - Geriatric pts can present atypically and may have no co-morbidities - they mey have diminished responses to pain, infection, heat/cold 2 - consider refering them to local agency resources (living conditions) eg. CACC -ADL include: bathing, dressing, transferring, toileting, and eating - relatives, friends, or neighbors my be able to provide allateral information (normal level of function and available support) 3 - Forms of elder abuse include (5): - Financial abuse - Psychological abuse - Physical abuse - Sexual abuse - Neglect (emotional abuse)

Answer 45

Consider underlying organic disorders Give particular attention to personal safety as per the general measures standard request police assistance on scene wait for police assistance if there is an active shooter OR there is direct evidence of ongoing violence If electing to delay service do immediately notify CACC/ACS If the pt is uncooperative then attempt to determine - if illness an/or alcohol/drug intoxication has triggered the present behaviour AND - whether there is a past hx of violence Be alert for behavioural signs of impending violence If confronted then seek egress and attempt to withdraw safely Attempt to speek and calm the pt if you cannot withdraw safely Consider the need for restraints (see mental health cards)

Answer 46

Remove the ECD probe(s) ## Footnote You might decide to leave the probes in during transport if the ECD is above the clavicle, in th nipple, in the genital area or other un usual circumstances AND Police may require preservation of the probes for evidentiary purposes

Answer 47

Vital signs absent pts in which a TOR is not indicated as per the ALS PCS Pts with conditions which require immediate, life-saving interventions which YOU can perfoms. Obstetrical pts in which delivery appears imminent

Answer 48

For CTAS 1 pts For pts who meet bypass criteria protocols as per the standards For obstetrical pts with - eclampsia/pre-eclampsia - limb presentation - ultiple births expected - premature labour expected - umbilical cord prolapse

Answer 49

Ensure the pt is not left alone If the pt is a child - follow the Child in Need of Protection Standard Offer to contact the police if they're not already on scene UPON police request----bag the stretcher linen, dressings, and other materials in contact with the pt then leave with the attending police officer

Answer 50

1- Determine whether a pt may be treated in accordance with a research trial ONLY if the following conditions have been met - MOH has approved the pt care practices set out in the Standards - The research trial has been approved by a Research Ethics Board (REB) that: Abides by and is consistent with the version of the Tri-council Policy Statement on Ethical Conduct for Research involving Humans current at the time of submission AND Meets the requirements for an REB set out in section 15 of O. Reg, 329/04 made under PHIPA AND The research trial has been reviewed and supported in writing by the Ontario Base Hospital Group Medical Advisory Committee 2 - Obtain the appropriate pt consent for participation in the research trial AND 3 - Provide care in accordance with the approved research trial ## Footnote Section 44 of PHIPA - personal health information and researchers AND Paragraph 11 of General Measures Standard - consent

Answer 51

Consider Underlying Organic Disorders Give particular atttention to personal safety as per the genreal measures standard

Answer 52

Assume hat all attempts are of serious intent AND Ask the pt directly whether they have ideation or intent of suicide/self-harm

Answer 53

Do NOT proceed without appropriate documentation and/or escort ## Footnote If a patient is violent or potentially vioolent - refer to the Violent/Aggressive Patient Standard If a patient is in custudy under -Court -Ontario Review Board Disposition a Justive of Peace or hospital's officer in charge or delegate will designate the escort

Answer 54

- directed by a physician or police officer - an unescorted aptient becomes violent en route - the use of restraints is required to provideemergency treatment as per the Patient/Emergency Treatment Stantdard | Only the reasonable and minimum force will be used to restrain the pt ## Footnote When applied prior to departing the scene, whomever ordered the restraint (police officer or physcician) must accompany the pt in the ambulance If the pt meets the Patient Refusal/Emergency Standard AND a police officer has handcuffed the pt, you can't proceed with transport until the police officer takes the pt into custody and it present in the patient compartment. Do NOT transport the pt in prone position

Answer 55

All restraints must be provided and applied by hospital staff or police prior to transport (when sending facility requests them) ## Footnote When the sending facility or physician has made a decision that the pt can be transferred safely (with or wihtout a hospital escort) When the patient does not appear to be a safety risk or have the potential to become violent en route AND If the paramedic feels comfortable with the decision that the patient does not appear to be a safety risk or potential to become one en route

Answer 56

A person who is recommended by a physician for admission to a psychiatric facility as an informal or voluntary patient. ## Footnote The subject of an application for assessment signed by a physician under subsection 15(1) or 15(1.1) of the Mental Health Act (Ontario) (Form The subject of an order for examination signed by a Justice of the Peace under subsection 16(1) of the Mental Health Act (Form 2) AND A person taken into custody by a police officer under subsection 17 of the Mental Health Act (Ontario) AND A patient detained in a psychiatric facility under a certificate of involuntary admission under subsection 20(4) of the Mental Health Act (Ontario) (Form 3) or a certificate of renewal (Form 4).

Answer 57

A high index of suspicion in terms of rapid deterioration ## Footnote Attempt to organize the team before attempting restraint. Prepare all equipment in advance. Inform the patient of the need to restrain them and explain the procedure. Immobilize the patient’s limbs and head in one coordinated effort. Grasp each limb at the main joint and between the main joint and the distal joint, e.g. one hand on the elbow, the other on the forearm. Place the patient in a supine “spread eagle” position or in the left lateral position. If the patient is spitting consider the use of a surgical mask on the pt. Restrain the extremities as follows: - Secure 1 aarm above the head and the other at waist level (or secure BOTH hands to 1 side of the stretcher) - Elevate the head of the stretcher to protect the airway and allow yourself greater visability - Secure the feet - Esnure all limbs are secured to the MAIN FRAME of the stratcher

Answer 58

That the patient was restrained A description of the patient’s behaviour that required that he/she be restrained or continue to be restrained A description of the means of restraint, including the method of restraint the person ordering restraints The position of the patient during restraint The clinical response to restraint

Answer 59

To maintain IV patency is 15mL/hr | To maintain IV patency is 30-60mL/hr

Answer 60

That it never go over the max flow rate of up to 2mL/kg/hr (200mL/hr) Monitor thiamine, multivitamin preperations Monitor drugs within your level of certification Monitor pts with potassium chloride (KCL) for patients GREATER or EQUAL to 18 years of age to a MAX of 10mEq in a 250mL bag.

Answer 61

When the IV is being used for blood (or blood product) administration When the IV is being used to administer potassium chloride to a patient who is <18 years of age When the IV is being used to administer medication When the IV requires electronic monitoring or uses a pressurized intravenous fluid infuser, pump or central venous line OR For a neonate or pediatric patient <2 years of age.

Answer 62

Confirm physician’s written IV order with sending facility staff Determine IV solution, IV flow rate, catheter gauge, catheter length, and cannulation site Note condition of IV site prior to transport Confirm amount of fluid remaining in bag Determine amount of fluid required for complete transport time and obtain more fluid if applicable AND Document all pre-transport IV information on the Ambulance Call Report. | When there is approx. 150mL of solution remaining ## Footnote Monitor and maintain IV at the prescribed rate, this may include changing the IV bag as required If the IV becomes dislodged or interstitial, discontinue the IV flow and remove the catheter with particular attention to aseptic technique AND Confirm condition of catheter if removed.

Answer 63

Any cases involving unusual or suspicious situations i.e - sudden death - foul play - violence - accidents involving emergency vehicles | Code 10-200, Code 10-2000, and Emergency button on radio ## Footnote Contact his/her CACC/ACS via radio or telephone State the nature of the request Indicate the urgency of response and request the estimated time of arrival Advise of possible hazards Indicate access routes (where applicable) Provide police with an update of the situation when they arrive at the scene

Answer 64

Once a body is moved it can never be put back in its original position Careful attention is required whenever something is moved Whenever possible use the shortest, most direct path to the patient and the same path when leaving the scene Attempt to preserve the chain of evidence; do not discard linen/clothes after call completion without checking with the receiving facility or investigating officer The receiving facility staff should also be cautioned regarding the suspected foul play | The use of a police escort to control traffic as it presents more danger ## Footnote Every effort should be made to leave the scene undisturbed and to preserve as much evidence as possible for the police.

Answer 65

Make careful observation of the position of the rope around the pts neck The rope should only be cut IF it cannot be readily slipped off in a way where the knot stays preserved

General Standard of Care Flashcards

(91 cards)