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Pinellas County Protocol 2023 > Ops > Flashcards

Ops Flashcards

(94 cards)

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1
Q

Define a patient

A

Anyone requesting medical help from county

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2
Q

What defines a ped in terms of general treatment, hospital destination, and trauma/psych?

A

General < 37kg or handtevy measurable

Hospital destination/psych <18

Trauma<16

Psych < 18

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3
Q

Define crew resource mgmt

A

Lead must hear out input from all members

All members must give input

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4
Q

8 rights of med admin

A

PMDDTRRR

patient, med, dose, document, time, route, reason, response

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5
Q

What must you do before EVERY procedure/med admin

A

I MACC

intervention and med admin cross check

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6
Q

What to do if you make a treatment or medication error?

A

OLMC ASAP.

Inform all team, ED, and document

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7
Q

What are the 4 pt status categories

A

Red = critical/unstable

Yellow = serious/urgent

Green = non-urgent

Black = obvious dead

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8
Q

Red vs black pt

A

Red = stemi, sepsis, trauma alerts. Intervention ASAP

Black = obvious dead or incompatible life injuries

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9
Q

Define yellow pts

A

Potential loss of life/limb if no timely treatment

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10
Q

Where to check hospital status

A

Hs.sunstarems.com

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11
Q

Hospital vs specialty divert? How long does it last?

A

Hospital = min 1 hr no 911 EMS

Specialty = open but minus a specialty service (ex no stroke)

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12
Q

What’s EMS bypass?

A

EMS closes hospital from 911 as punishment

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13
Q

Hospital status is closed. What does this mean

A

Internal disaster or unable to provide care for incoming EMS

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14
Q

Where do red patients go? Who transports?

A

To closest appropriate OPEN hospital with fire medic.

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15
Q

Where do yellow patients go

A

They can choose any appropriate hospital within 30 min

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16
Q

Where do green patients go

A

Can choose Any appropriate <60min away

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17
Q

Where to take preggos? (What Hosp and dept?)

A

Any OB Hosp, Must be assessed by Staff in ED prior to L&D

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18
Q

Where to take veterans

A

VA if their condition is appropriate

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19
Q

Pt is refusing your hospital choice. What do you do?

A

Determine decisional capacity, confirm pt is not RED, get a refusal

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20
Q

Who can go to a free standing ED?

A

Green patients who DONT..

Need specialty service
>20 wks preggo
Have physical/chemical restraints

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21
Q

What’s EMS bypass (general idea)

A

If pt transfer of care too long, Sunstar punishes the ED

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22
Q

What are the time minimums in EMS bypass

A

> 5 min - call dispatch
15 = dispatch calls charge RN
20 = bypass until all current pts transferred

> 30 = EMS bypass x2hr

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23
Q

What’s systems status mgmt?

A

Too many hospitals on divert = OLMC decides transport destination and spreads the load evenly

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24
Q

When can a NON sunstar unit perform. Pt transport?

A

Extreme RED pt
Dangerous scene/environment
Condition 5 (all hands on deck)
EMS emergency or official disaster

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25
Can fire swap cots with you during an emergency
Yes if safe and practical
26
What to do if it’s not in protocol and fire wants to transport
OLMC
27
When to do air transport
RED pts When air faster > ground (ex. Burn center, traffic, extrication)
28
Minimum equipment for an IFT… sunstar only/immediate Unscheduled non emergency Scheduled non emergency
SS only / immediate = full ALS UNscheduled = full ALS/BLS Scheduled = airway bag
29
You’re doing an IFT you feel is higher than your scope. What to do?
You can refuse or hospital must provide a specialist to go with
30
What to obtain prior to ALS IFT
Written physician orders
31
Hospital provide you an ALS med for an IFT transport but you don’t use it. What to do
Give to recording hospital and get receipt signature
32
IFT goes sideways during transport
Call comms for divert option and OLMC
33
When do you NOT have to do a PCR?
Cancelled for “closer unit” Cancelled for “higher priority call”
34
When must you complete your report? What is the last step?
Before leaving hospital. Print paper copy and leave with charge RN
35
When must you report to protective services?
Suspected Child/adult abuse Weird burns
36
What type of burns must be reported to local sheriffs?
2nd or 3rd > 10% BSA Caused by flammable substance And if by suspected violence/illegal activity
37
What documentation used by County?
Modified SOAP s - what you were told O - what you saw A - what you thought P - what you did/who you told
38
When to call OLMC
Advice Disagreement Protocol (and deviations)
39
A pt with a special condition hands you a special card. What is it?
OLMC approved protocols for pts condition
40
What is decisional capacity
Understands their condition, the risk/benefit/alternatives of treatment plan, and has legal ability to consent
41
Implied vs expressed vs third party consent
Implied = can’t express and no 3rd party Expressed = yeah 3rd party = someone else
42
How to determine if pt has decisional capacity
EMS cognitive evaluation
43
What to do if a 3rd party is refusing on pt’s behalf?
Determine party has decisional capacity Document relationship Confirm it’s pts best interest (call cops if not)
44
Minimum documentation in your narrative for refusal
Benefits of care Risks of refusing (severe complication or death) Alternatives explained and offered
45
What QA for a refusal
2 sets vitals (GCS = 15) “Decisional capacity” Narrative > 300 words Witness signature Full Sample
46
All involuntary transport require who to be dispatched
Law enforcement
47
Baker vs marchman act
“Drunk people can’t march” Baker = psych Marchman = drugs/alcohol
48
Who can issue a baker act
Cops, doctors, psychologist/mental health professional, court order
49
Who can issue a marchman act? Under what conditions?
Cops when it shows reasonable evidence substance abuse and incapacitation.
50
What are requirements of the Marchman act
- pt fucked up - did or wants to hurt someone (self) - needs substance help
51
What cardiac arrests (not traumatic) patients don’t need CPR
1. No pulse / breath 2. Obvious death/decomp or 3. Scene safety risk or 4. Valid florida DNR 5. Health care surrogate says no
52
What cardiac arrest patients (traumatic) don’t need CPR
1. No pulse / breath 2. Decomp / noncomp injuries or 3. Massive trauma w/ initial PEA <40 bpm or asystole or 4. Down time > 10min or long ETA
53
Does exposed brain matter constitute obvious death?
No
54
What can’t you do with a Florida DNRO
cardiac or resp arrest = no CPR, ETT / advanced airway mgmt, ventilations, defib Can = pain mgmt and comfort care
55
What’s a living will?
pt becomes brain dead = comfort measures only, no more vents
56
What’s a MOLST vs POLST
Medical orders for life sustaining treatment or Physician orders for life sustaining treatment Instructions for critical pts near death (<1 year)
57
How to validate Florida state DNRO
1. Florida DNRO (1896) = must be original or copy on yellow paper, sigs from dr and pt or proxy/surrogate, not verbally withdrawn, pt identity verified via legal photo.
58
How to honor / validate an out of state DNR or DNR from hospice / health facility
1. Document states DNRO 2. Valid date 3. Signatures and dates (from pt/surrogate, x2 from witnesses)
59
You’re about to transport a pt and senders don’t have a DNR but say pt shouldn’t get CPR.
Call OLMC
60
When transporting a pt, make every effort to get the copy or original DNR? what happens if you cant?
Try for the copy. IF you must take the OG, document where it’s left
61
Can a BLS unit honor a DNR?
Yes, but a medic must arrive onscene to finish it out
62
What’s a patient identification device?
Mini version of DNR
63
Why would cops ask you to draw blood?
To test for drugs and alcohol - accident scene w/ fatal injury/death - DUI - Crime scenes
64
Blood samples for cops should never take priority over…
Emergency medical care
65
Can cop request a blood draw from you for DNA testing?
No
66
Steps to draw a blood sample for cops? How many samples to obtain per person?
1. Make a PCR (even if refusal) 2. Check supplemental form box > indicate blood sample 3. Document 4. Check and use Kit 5. Give to cops *2 samples per person per draw
67
How to handle the Pinellas county blood specimen kit
1. Confirm date & seal integrity 2. Show cop 3. Open in front of cop 4. Only use contents of kit (2 samples per person per draw) 5. Follow instructions for labeling / handoff 6. Document
68
Which pts can refuse a blood draw from cops? Which cant?
Refuse = Crime cases, lesser accidents, or suspected DUI without accident Cant refuse = fatality / fatal injury accidents
69
In terms of getting a blood sample for cops, what is defined as a fatal/ serious bodily injury?
Big death rush, disfigurement, loss of function of any body member or organ
70
What if you refuse to help a cop get a blood sample?
If cop as legal valid reason to obtain, you will get a misdemeanor
71
Which triage type does pinellas use?
START / JumpSTART triage
72
What are the treatment areas for MCIs
Red, yellow, green, black
73
How often to do re triage on pts in an MCI
in > 30min in treatment sector
74
How long does it take to do a triage
< 60s
75
What are the only treatments permitted in START / Jump START triage
Adults = One manual airway opening Peds = airway open & 5 rescue breaths * all pressure on major bleeding source
76
In an active shooter... hot vs warm vs cold zone
hot = direct danger warm = potential danger Cold = no immediate danger
77
how does treatment change in shooter hot zone
extraction to cover, bleed control (tourniquet and combat gauze), chest seal.
78
how does treatment change in a shooter warm zone
normal START triage interventions = combat gauze, tourniquet, chest seal
79
does EMS treatment care change in active shooter cold zones?
no
80
between hot warm cold zones of an active shooter... which one is the transport sector located? the casualty collection point? treatment center?
transport sector = cold zone treatment center = cold zone casualty collection = warm zone
81
What info must be on an ecg prior to transmitting it?
Pt’s full name and bday
82
you need to respond emergent to a staging scene unless…
< 5 min ETA
83
Regarding controlled substances, what’s a blind count?
Manually counting the drugs without looking at electronic inventory
84
Regarding controlled substances, what’s a broken chain of custody?
Period when CS drug or key is no under direct custody of it’s documented handler
85
Guiding principles CRM?
Advocacy Situational awareness Closed loop communication Clear respectful communication
86
There is a broke chain of custody of the CS drugs (ex. Stolen drugs). What do you do?
Contact sup and law enforcement. Remain onscene Limit contact with CS box/drugs
87
What’s a Chapter 401?
Involuntary transport of pt who doesn’t have decisional capacity to make healthcare decisions
88
How long to wash your hands
20 seconds
89
What to use to clean monitor and cables?
Alcohol 80%
90
What to use to clean bags and glucometer
Hydrogen peroxide
91
Per covid rules, who gets a mask?
Everyone > 2 years
92
When drawing up narcs from multiple vials, how many cards do you need?
1 card per vial used
93
When you use a narc, what must you keep? Why?
The vial and the card in the bag. Card = document & turn in Vial = prove to partner it’s wasted
94
How do you document a narc used?
PSTrax Narrative Intervention - ex “fentanyl” Waste intervention Controlled substance signature

Pinellas County Protocol 2023 (9 decks)

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