Intro

Question 0

Paramedics - Base Hospital contact is required by paramedics in the following situations (except in cases of elopement)

Answer 0

1. Any emergency patient transport by paramedics, including by paramedic ambulance to a BLS destination following downgrade to BLS.
2. And emergency patient treatment involving ALS medications or skills (except EKG monitoring)
3. Any emergency patient assessment involving abnormal vital signs, or an altered level of consciousness.
4. Any suspicion that the emergency patient (or designated decision-maker [DDM]) is impaired by alcohol or drugs.
5. The emergency patient/DDM is unable to comprehend or demonstrate an understanding of his/her illness or injury.
6. The emergency patient meets criteria as a trauma center candidate.
7. The emergency patient is > 65 years of age and has experienced an altered/decreased level of consciousness, significant mechanism of injury, or any fall.
8. An emergency patient who is a minor is ill or injured or is suspected to be ill or injured.
9. Whenever paramedics have a question regarding appropriate treatment or disposition of the patient.

Question 1

Emergency Patient

Answer 1

Any person for whom the 911/EMS system has been activated and who meets the following criteria:

1. Has a chief complaint or suspected illness or injury; or
2. Is not oriented to person, place, time, or event; or
3. Requires or requests field treatment or transport; or
4. Is a minor who is not accompanied by a parent or legal guardian and is ill or injured or appears to be ill or injured,

Question 2

Base Hospital contact is NOT REQUIRED on individuals who meet the following criteria:

Answer 2

1. Obvious death
2. Discontinuation of CPR with a Prehospital DNR order or DPAHC on scene.
3. Release of a minor on scene who is neither ill or injured or suspected to be ill or injured, maybe be permissible without base hospital contact if:
   a. Parent or legal guardian so requests
   OR
   b. A responsible adult other than parent or legal guardian so requests
   c. The field EMT, AEMT or Paramedic shall document the circumstances and identification of the person excepting responsibility for the minor.
4. Patients who wish to be released and do not meet base hospital contact criteria.
5. Dispatched as a BLS call where ALS treatment or intervention is not anticipated nor required.

Question 3

San Diego Trauma Centers

Answer 3

Palomar
Sharp Memorial
Childrens
Mercy
UCSD Hillcrest
Scripps La Jolla

Question 4

San Diego Base Hospitals

Answer 4

Palomar
Scripps La Jolla
Tri-City
Sharp Grossmont
Mercy
Sharp Memorial
UCSD Hillcrest

Question 5

Process of Patient Care

Answer 5

1. Recognition
2. Dispatch
3. Response
4. Assessment
5. Treatment
6. Transport
7. Definitive Care
8. Rehab
9. Release

Question 6

Paramedic Roles

Answer 6

4 T's: triage, treatment, transfer, transport
Respond
Assess
Treat
Transport
Record and Communicate

Question 7

When to Transport to Closest Facility

Answer 7

Non-traumatic CPR
Uncontrollable airway
Uncontrolled non-traumatic hemorrhage
If all other facilities are also on emergency department saturation

Question 8

Paramedics shall contact base hospital as soon as possible to verify destination. Paramedics will first attempt to call their regularly assigned base hospital unless the emergency patient meets the following criteria

Answer 8

1. Adult Trauma: For all adult emergency patient who appear to meet trauma center candidate criteria in T-460, paramedics shall first attempt to call the trauma base in the catchment area of the incident.
2. Pediatric Trauma: Paramedics shall first attempt to contact the designated pediatric trauma base for pediatric trauma center candidates.
3. Burns: Paramedics shall first attempt t contact the UCSD base for all emergency patient that meet burn center disposition criteria.

Question 9

B-R-DEAD

“Obvious Death”

Answer 9

B - blunt traumatic cardiac arrest with:
> no visible signs of life
> asystole
> MOI consistant with injuries
R - rigor mortis
D - decapitation
E - evisceration
A - ashes (incineration)
D - decomposition
*pulseless and apnic*

Question 10

AMA Documentation

Answer 10

Field personnel shall document, if possible, the following for all patients released AMA:

a. Who activated 911 and the reason for the call
b. All circumstances pertaining to consent issues during a patient encounter.
c. The presence or absence of any impairment of the patient/DDM such as by alcohol or drugs.
d. The ability of the patient/DDM to comprehend and demonstrate an understanding of his/her illness or injury.
e. The patient/DDM has had the risks and potential outcome of non-treatment or non-transport explained fully by the EMT, AEMT or Paramedic, such that the patient/DDM can verbalize understanding of this information.
f. The reasons for the AMA, the alternate plan, if any, of the patient/DDM and the presence of any on-scene support system (family, neighbor, or friend)
g. The the patient/DDM on the AMA form, or, if the prehospital personnel are unable to have an AMA form signed, the reason why a signed form was not obtained.
i. Consideration should be given to having patient/family recite information (d - g) to the MICN/BHP over the radio or telephone.

Question 11

Bypass

Answer 11

> 30 min to obtain trauma, neuro or anesthesia doc
1 hour for OR
2 or more patients being resuscitated at one time
hospital on internal disaster
Annex D
1 hour for CT scanner

Question 12

An EMT may withhold or discontinue CPR if presented with one of the following:

Answer 12

1. DNR Medallion
2. A complete DNR Form stating, “Do not resuscitate,” “No code,” or “No CPR”
3. A written signed order in the patient’s medical record including the electronic medical record
4. An Advanced Health Care Directive specifying “do not resuscitate”
5. Upon receipt of a Base Hospital Physician Order
6. DNR request communicated by patients attorney-in-fact or healthcare agent
7. A completed POLST form specifying “Do not attempt resuscitate/DNR” in Section A, Cardiopulmonary Resuscitation