Operational Practice Flashcards
1
Q
Which agency regulates helicopter operations in Europe?
A
European Aviation Safety Agency (EASA)
2
Q
What does the EASA define as a HEMS flight? (4)
A
A flight:
1. by helicopter
2. operating under a HEMS approval
3. to facilitate emergency medical assistance
4. where immediate and rapid transportation is essential
3
Q
To be a HEMS flights the EASA states you need to be carrying one of what 3 things?
A
- Medical personnel
- Medical supplies
- Ill/injured persons or other persons directly involved
4
Q
If not meeting HEMS criteria what is a AA flight called?
A
Air ambulance mission
5
Q
How large should a landing zone be for a helicopter?
A
Over twice size of discs
6
Q
What regulates PPE in the UK?
A
Health and Safety Executive in the PPE at Work Regulations
7
Q
Describe the JESIP hierarchy of control measures?
A
ERICPD
Eliminate
Reduce
Isolate
Control
PPE
Discipline
8
Q
What should be the standard of helmet?
A
Fire fighting standard
= EN443
9
Q
What is the European standard for High vis?
A
EN471
10
Q
What is the minimum class of garment for working on motorways/dual carriageways?
A
Class 3
11
Q
What specifications make a ‘class 3’ garment? (2)
A
- Mimimum 0.8m2 flourescent background
- Minimum 0.2m2 retro-reflective materials
12
Q
What 3 things should appropriate boots have?
A
- Toe cap to withstand > 200J
- Minimum height 4 inches
- Chemical resistance
13
Q
What should flight suits be made of and what type of fire do they protect from?
A
- Nomex or Kermel
- Flash fire (4-5 secs flame)
14
Q
What proportion of major trauma have SCI and of these how many have severe, time critical injuies?
A
- 0.7%
- 50%
15
Q
What is the benefit of self extrication?
A
Shown to reduce movement of cervical and lumbar spine, improved further with a collar
16
Q
Describe a ‘rapid extrication?’
A
Lateral extrication via closest apperture (usually door). Rescue board slid into car seat and patient rotated then laid down and pulled up board, MILS ideally
17
Q
Describe a B post rip
A
Rear doors opened and cut lower then upper B-post, then entire side of vehicle can pivot on front hinge of A post
18
Q
What is a ‘roof off extrication’?
A
Historial gold standard
Roof removed, board placed behind patients back and seat lowered (if poss). Patient then pulled up board with MILS
Slow
19
Q
What can FRS do to improve access to a vehicle on its side?
A
Roof fold down:
- upper supporting posts cut
- roof folded down
20
Q
What 2 things can FRS do to improve access to a vehicle on its roof? (2)
A
- B-post rip
- Roll back onto wheels
21
Q
What is a dashboard roll used for?
A
Footwell entrapment
22
Q
Describe chain cabling and what it is used for?
A
Chains to front and rear posts, winch used to apply traction.
Reverses vehicle damage forces associated with frontal collision
23
Q
How long does chain cabling take?
A
12.5 mins
24
Q
Describe the 3 parts to the FPHC extrication decision tool for non-medical personel
A
- Can the casualty self extricate
- Is a snatch rescue indicated?
- Deliver quickest appropriate extrication
25
What is the FPHC recommended first line extrication method?
Self/minimally assisted
26
1. What is the acronym USTEP?
2. What is it used for?
3. Who recommends it?
1.Understanding (get patient understand)
Support (emotionall)
Try moving (if unable then can't self extricate)
Egress (clear route out)
Plan - where will they go next (chair/trolley)
2. Non-clinicans to helpe extricate
3. FPHC
| .
27
Under what circumstances does FPHC state MILS is not needed inside the vehicle?
Fully conscious and no neurology
28
If patients have neurology what extrication measure does FPHC recommend
Rapid extrication with gentle handling
29
When does the FPHC recommend using a hard collar in extrication? (2)
1. Suspected serious neck injury
or
2. GCS <15 + evidence of significant injury to any body compartment
30
When should a binder be placed during extrication according to FPHC?
After extrication
31
What are the components of HAVNOT and what is it used for?
Predicting difficult airway
Hx of difficult airway
Anatomical abnormalities
Visual clues (beard, BMI etc)
Neck immobility
Opening mouth <3cm
Trauma
32
What acronym is used to predict difficult BVM?
Mask seal difficulty
Obesity, Obstructed airway
Age >55yrs
No teeth
Snorer, Stiff lungs
33
What acronym is used to predict difficult SAD insertion?
RODS
Restricted mouth opening < 3 fingers
Obstruction at larynyx or below
Distorted airway
Stiff cervical collar, Stiff lungs
34
What is the acronym SHORT?
Predicting difficult cricothyroidotomy
Surgery, Scars, Short neck
Haematoma
Obesity, Oedema
Radiotx
Trauma, Tumour
35
What are the sizes of OP airway and who are they used for? (7)
000 - neonate
00 - infant
0 - small child
1 - child
2 - small adult
3 - medium adult
4 - large adult
36
How are OPAs measured?
Incisors to angle of jaw
37
What size NPA is used usually for:
1. Men
2. Women
1. 7.0
2. 6.0
38
How should NPAs be measured?
Nostril to tragus of ear
39
Describe the IGel sizes
40
What is the mechanism of action of ketamine?
NMDA receptor antagonist
41
What type of drug is ketamine?
Procyclidine derivative
42
What causes the bronchodilation/sympathomimetic actions of ketamine?
It is a partial antagonist of muscarinic receptors
43
What is the onset time of ketamine:
IV
IM
30 secs
6 mins
44
What is propofol?
2-6 di-isopropyl phenol
45
What is the mechanism of action of propofol?
Potentiates action of GABA at GABA receptor?
46
Which paralytic is:
1. depolarising
2. Non-depolarising
1. Suxamethonium
2. Rocuronium
47
What are the potential side effects of suxamethonium? (4)
Bradycardia
Hyperkalaemia
Raises ICP/ intra-ocular pressure
Malignant hyperthermia
48
Why do paediatric patients become bradycardic when SATs drop?
Dominant parasympathetic system
49
When does DAS recommend using needle cricothyroidotomy?
< 8 years old unless previous ENT experience
50
How should a needle cricothyroidotomy be performed?
-14 to 16G cannula inserted angled 45 degrees caudally
- syringe attached and when loss of resistance flatten angle of cannula and advance further 2-3mm
- remove needle and attach pre-prepped 3 way tap with all ports open with 02 tubing
- set oxygen to rate L/min (patients age)
- occlude 3 way tap for 1 sec, open for 4 secs, 1:4 (if not completely obstructed should be some passive exhalation via airway)
51
What blades should be used for:
- pre-term
- term
- 1 year (infant)
- 2 year
- > 2 years
- pre-term = Miller 0
- term = Miller 1
- 1 year (infant) = MAC 1
- 2 year = MAC 2
- > 2 years = MAC2 or 3
52
How much oxygen Fi02 is delivered via NC?
4% per 1L/min (up to 4L)
53
When should a NRB be used?
If need Fi02 >50%
54
How much oxygen does each venturi allow?
Blue = 24 %
White = 28%
Yellow = 35%
Red = 40%
Green = 60%
55
What are the different oxygen cylinders capacities?
56
What are the 3 receptor types involved in shock physiology?
1. Arterial baroreceptors
2. Cardiac C-fibres
3. Arterial chemorecptors
57
Which receptor triggers the baroreceptor reflex?
Arterial baroreceptors
58
Describe the baroreceptor reflex in shock
- Pressure receptors within aortic arch and carotid sinus that respond to stretch
- decreased volume activates these leading to an increased HR and peripheral vasoconstriction
59
Where are cardiac c-fibres located and what reflex do they initiate?
- Left ventricle
- Depressor reflex
60
Describe the Depressor Reflex in shock?
- cardiac c-fibres are mechanorecptors in the LV that respond to excessive cardiac activity in context of hypovolaemia
- leads to bradycardia and peripheral vasodilation
61
Where are arterial chemoreceptors located?
Carotid and aortic body
62
Describe arterial chemoreceptors role in shock?
- in carotid and aortic body that responds to acidosis and hypoxia
- increased minute volume and surpresses cardiac c-fibre mediated reflex
- leads to 'air hunger' and acts to augment venous return via thoracic pump
63
Describe the physiology involved in shock associated with blunt trauma
- Baroreceptor and arterial chemoreceptor predominate. Therefore tachycardia and peripheral vasonstriction and increased minute volume
- Tissue injury and pain suppress c-fibres therefore depressor reflex less common
64
Describe the physiology involved in shock and penetrating trauma
- Major vascular and haemorrhage can occur without significant tissue injury/pain
- At a critical right atrial pressure cardiac c-fibre medicated depressor reflex causes vagal mediated bradycardia and decreased peripheral vasoconstriction.
- Results in drop in cardiac output and worsened shock
- biphasic response
65
Describe the physiology of shock in arterial injury shock
- Sudden loss of elastic arterial diastolic recoil due to major arterial vascular injury
- decreased arterial diastolic pressure leads to impaired LV coronary pressure and immediate/profound shock
- more common in penetrating trauma
66
Desrcibe TBI related shock
- Catecholamine surge and sympathetically mediated local noradreanline affects myocardium
- Concurrently increased ventricular afterload, hypoxia, hypercapnia and other shocked sates leads to myocyte injury and acute onset cardiomyopathy
67
What is in the 'hateful 8' signs/symps shock?
1. Diaphoresis
2. Pallor
3. Venous collapse
4. Abnormal HR
5. Hypotension
6. Air hunger
7. Decreased ETC02
8. Altered mental status
68
Describe te pre-hospital haemostatic ladder (5 parts)
1. Wound dressing
2. Direct pressure and elevation
3. Indirect pressure
4. Haemostatics
5. Tourniquets
69
What are the 2 types of haemostatic gauze and give an example of both?
1.Factor concentrators - Quickclot
2. Mucoadhesive agents - Celox
70
How to factor concentrator haemostatic gauze work?
Granules absorb water, concentrate coag factors, promotes clotting
71
How do mucoadhesive haemostatic gauze work?
Chitosan based
Anionic attraction of red cells, increases adherences to wound surface
72
Where does a proximal tibial IO go in an:
1. adult
2. child
1. 1 finger medial to tibial tuberosity
2. 1 finger below and 1 finger medial to tibial tuberosity
73
Where does a distal tibial IO go in an:
1. adult
2. child
1. 3 fingers above tip of medial malleolus
2. 2 fingers above tip of medical malleolus
74
Where is a femoral IO placed?
2 fingers above patella just off midline (medially)
75
When is a femoral IO useful?
Infants
76
How is resp rate measured using monitoring
Small AC current via ECG lead 1 (adult) or II (paeds) measures change in thoracic impedance
77
What are the flow rates through each cannula size?
78
How does a pulse oximeter work?
- measures absorption of red (660nm) and infrared light (940nm)
- oxy and deoxy haemoglobin have differing absorptions and the proportion is measured around 50 x / sec
79
What is the issue with CO poisoning and oximetry?
Most oximeters unable to differentiate between carboxyhaemoglobin and oxyghaemoglobin therefore will interpret patients saturation as incorrectly high
80
Why do patients with methaemoglobinaemia have low saturations?
Pulse oximeter doesn't measure methaemoglobin and therefore will show low SATs for given Pa02
81
What is a normal range for ETC02
4.0-5.7 kPA
82
Describe the sections of a normal capnography waveform
83
What values of causes the colormetric capnography to be:
- yellow
- purple
Yellow = ETCO2 >15mmHg
Purple = ETC02 <4mmHg
84
What size should the optic sheath measure on US?
<5mm when measured 3mm away from optic disc
85
What does an optic sheath size >6mm suggest?
ICP >20cm H20
86
What is the oxygen calculation for transfer?
(MV x transfer time + ventilator consumption) x 2
87
Where are the 3 areas of increased risk with HEMS flights and why?
1. Enroute (decreased height and visibility restrictions)
2. Landing (decreased site and performance restrictions)
3. Elevated hospital landing (deck edge strike)
88
In terms of aviation, which aircraft has right of way?
Aircraft on the right
89
What should aircrafts do if facing head on head collision?
Avoid collision to right
90
Under what circumstances to HEMS flights not have priority? (2)
1. Aircrafts declaring emergency
2. Non powered aircraft
91
What size landing site are needed:
1. in daylight
2. at night
D = max length of aircraft with rotors running
1. 2D x 2D
2. 2D x 4D
92
What 4 criteria should be looked for in a landed site?
1. Flat
2. Clear of debris
3. No wires
4. < 10 degree slope
93
What requirements are there of a HEMS TCM? (3)
1. Specifically trained
2. Must be front left seat facing forward
3. Complete EASA regulation compliance very 12 months
94
What is required for medical passengers to fly? (2)
1. Pre flight briefing
2. Accompanied by HEMS TCM
95
What is the responsibility of medical passengers? (4)
1. Primary = patient care
2. Medical equipment - present and stored correctly
3. Gain approval for certain medical equipment from pilot
4. Assist with look out
96
Who decides whether a flight is a HEMS mission? (potentially life/limb threatening)
Medical team, not pilot
97
What is the cloud base height limit during:
1. Day
2. Night
1. 500m
2. 1200m
98
What is the visibility limit to fly:
1. day
2. night
1. 1500m
2. >3000m
99
Aside from the size requirement, what else is needed to allow a HEMS landing at night?
Landing zone must be lid from ground or helicopter
100
What is rule 5?
Have to be at least 500m above person/vehicle or structure (can be lower to the ground)
101
What is the minimum level above person/vehicle/structure HEMS flights need to be at night?1
1000m (this is normal aviation rules)
102
If visibility is <5000m what should we ensure forward visibility is greater than?
Distance travelled in 30 secs
103
What should be in the medical passenger brief? (8)
1. Familiarisation of helicopter type
2. Entry/exit under normal and emergency conditions
3. Use of specialist medical equipment
4. Need for commanders approval prior to use of specialist equipment
5. Method of supervision of other medical staff
6. Use of intercomm
7. Location of fire extinguishers
8. CRM
104
What are the wind limits for HEMS flights? (2)
1. 40 knots on rotor starts
2. 70 knots in flight
105
When can HEMS fly in icy conditions?
Can't fly if ice
106
What is the TAF?
Terminal Aerodrome Forecast
107
What is the METAR?
Meteorological Aerodrome Report
108
For landing sites at night what are the 2 conditions that will allow a landing?
1. Pre-surveyed and lit landing sites (either from ground or aircraft)
2. Full briefing and identification of site prior to life with 500m recce above scene with NVG
109
What is performance class 1?
- Able to land or fly away safely in even of engine failure at all stages of flight.
- must be able to clear obstacles safely by 35ft during take/off or landing if engines fail
110
What is performance class 2?
- Have a limited period of exposure in which safe recovery not assured in event of engine failure.
- aircraft may be damaged but crew uninjured
111
When is performance class 1 and 2 required respectively?
1. Hospitals, pre-surveyed night sites
2. HEMs mission landing sites and base
112
What 3 things are in place to mitigate increased risk of HEMS flying?
1. Pilot experience - only HEMS requires experience minimum
2. Instrument ratings for all pilot
3. Need for TCM/second pilot
113
What is the law that governs blue light driving?
No specific rule but multiple exemptions in other laws - driver must justify the need for exemption
114
What Act governs the need for training specifically to use speed exemptions?
2006 Road Safety Act
115
What are the blue light exemptions? (7)
1. Speed limit (police/fire/ambulance only)
2. Red lights - treat as give way
3. Keep left/rigtht bollards
4. Motorway regulations - can use hard shoulder even against direction of traffic
5. Stopping in clearway (no stopping zone), entering bus lane or pedestrian zone
6. Parking on crossings, double white/yellow lines, parking offside at night, parking footway/central reservation
7. Keeping engine running whilst parked
116
What is not exempt in terms of blue light driving (6)?
1. Careless/dangerous driving
2. Not stopping if involved in RTC
3. No seatbelt
4. Ignoring no entry/stop or give way signs
5. Ignoring flashing sights at level crossing/bridge/fire station
6. Crossing solid lines to overtake
117
Who can use:
1. blue lights
2. red front light
3. constant blue light
4. green light
5. amber lights
1. Emergency vehicles only
2. FRS
3. Police
4. Doctors
5. Indicators/reflectors/road clearance/dangerous goods vehicles
118
119
How often should warning lights flash on emergency vehicles?
1-4 x / second and spend equal time on/off
120
What are the EU standards for ambulances?
CEN 1789 EU Standards
121
What are the different class of ambulances?
A1 + A2 = patient transport
B = normal ambulance
C = mobilie intensive care unit
122
What are the regulations set out by CEN 1789? (7)
1. Needs stretcher
2. Green/yellow Battenburg markings (Scotland are white not yello do have the markings)
3. Star of life on roof/sides + rear - must be >500mm diameter
4. Ambulance written on side + rear >100mm height + in capital letters
5. 2000L stationary oxygen and 400L portable oxygen
6. 4 x 12V connectors
7. Needs brake assist (not predictive breaking)
123
Where is the CLEAR acronym used and what does it stand for?
NARU traffic guidelines:
Collision - closed carriage
Lead - establish effective leadership to co-ordinate
Evaluate to ensure proportionate response
Act in partnership, recognising differing priorities
Re-open ASAP
124
What do the following stand for?
1. DHS
2. VMS
3. ALR
4. LBS 1
1. Dynamic hard shoulder (can open to ease congestion)
2. Variable message sign (can change as needed)
3. All lanes running (no hard shoulder)
4. Lane below sign 1 (smart motorway)
125
Who is responsible to requesting changes to smart motorway signs (VMS)?
First police officer on scene, then incident commander
126
If unable to access accident via normal flow, what needs to happen to allow reverse access?
1. Police/fire or Highways England operational commander has control of head of scene
2. Confirmed no vehicles downstream of incident
3. RVP will be chosen (usually 1 junction down) where wait until confirmation lane closure +/- escort
127
At an RTC on motorway who is responsible for safety?
Police/highway England
If not present then fire
128
At an incident on the motorway where should the following park:
1. Police/HE
2. FRS
3. Ambulance
1. 50m behind incident
2. 25m behind incident + fend off
3. Beyond incident to allow safe loading and protection
129
What needs to happen for HEMS to land on motorway?
Lanes closed both directions therefore only land when ready to load
130
How often should distance marker posts be placed and what are they for?
1. Every 100m
2. For maintenance/emergency purposes and to show nearest phone
131
Describe a distance marker post
Number with no units = distance from reference datum (e.g city centre)
On motorway has arrow pointing to direction of nearest phone
132
Describe a driver location sign
133
What do the following represent in terms of carriageway identifiers?
1. A
2. B
3. C + D
4. J
5. K
6. L
7. M
A - 'away from London' (usually, not always
B - 'back to London'
C + D - service road adjacent to A +B
J - slip road off A
K - slip road onto A
L - slip road off B
M - slip road onto B
134
What is the global emergency number?
112
135
What are the initial 3 stages of a 999 call?1.
1. Emergency caller
2. Phone provider (determines which service)
3. Operator Assistance Centre (OAC)
136
Describe how a call ends up generating a CAD (3)
1. Information passed electronically in form of Caller Line Identification (CLI)
2. Via system called Enhanced Information Service for Emergency Calls (EISEC)
3. Data then automatically appears as incident on dispatchers Computer Aided Dispatch (CAD)
137
What do the following stand for?
1. CLI
2. EISEC
3. CAD
1. Caller Line Identification
2. Enhanced Information Service for Emergency Calls
3. Computer Aided Dispatch
138
What is the most common prioritisation systems used in UK?
Advanced Medical Priority Dispatch System (AMPDS)
139
Describe what AMPDS is and how it works
Advanced Medical Priority Dispatch System
- Structured question/answer logic tree to allocate dispatch priority
- 'systemised caller interrogation'
140
What are the 2 advantages and one disadvantage of AMPDS?
1. Incorporates pre-arrival first aid instructions
2. Each illness/injury given unique code for audit
3. Not sensitive for HEMS dispatch which therefore requires additional tier of interrogation
141
Describe the 4 categories of dispatch and the time target
Cat 1 = life threatening - 7mins avg
Cat 2 = emergency calls - 18mins avg
Cat 3 = urgent calls = <120 mins at least 90% time
Cat 4 = less urgent <180mins at least 90% of time
142
Describe the 'fend off' position?
Safe distance from incident with an angle of 40 degrees into the safest direction for the vehicle to go, wheels can be angled in same direction.
143
When arriving first on scene in a vehicle, what should be done? (6)
1. Park safe distance away
2. Leave visible warning lights on
3. Leave engine running to prevent flat battery
4. Secure responders vehicle
5. PPE
6. Update control
144
With respects to HAZCHEM codes (1 number followed by 2 letters) , what does the number mean?
1.
2.
3.
4.
1. Coarse water spray
2. Fine water spray
3. Normal foam (protein based foam that is not alcohol resistant)
4. Dry agents, water should not be used/come in contact with substance
145
If the second character (first letter) of the EAC is:
1. S,T,Y or Z
2. P,R,W, or X
what does it mean?
1. normal fire fighting equipment fine
2. Needs liquid tight chemical protective clothing (CPC), with breathing apparatus
146
What does the 3rd character of the EAC code being an 'E' mean?
May be a public safety hazard outside the immediate area. People should stay indoors and close windows, ignition sources eliminated and ventilation stopped.
147
What does ATMISTER mean?
Handover tool:
Age
Time of injury
Mechanism of injury
Injuries
Signs inc. vitals
Treatment given and neede
ETA
Requests
148
When can a paramedic ROLE? (8)
1. Decapitation
2. Massive IC/cerebral destruction
3. Hemicorporectomy
4. Decomposition/putrification
5. Incinerations (>95% full thickness)
6. Hypostasis
7. Rigor mortis
8. Foetal maceration in newborn
149
What is the SCREAMER mnemonic?
For scene assessment
Safety
Communicate
Read the wreckage
Everyone accounted for?
Assess casualties
Method of extrication
Evacuation route
Right facility
150
What colour is the collar of entonox cylinders?
Blue and white
151
What can cause entonox to seperate into its constituent parts (nitrous oxide and oxygen) and what can be done to reverse it?
1. Temp < 6 degrees
2. Repeated invert to mix
152
How much of the arm should a BP cuff be?
40% of mid arm circumference (usually 12.5cm)
153
Where should a BP cuff be placed?
Level of heart
