Protocol (sec. 1) Flashcards
1
Q
Who can choose to modify certain treatment recommendations?
A
Medical director
2
Q
When is it recommended that a paramedic make contact with the physician for consultation?
A
On complicated patients
3
Q
If the paramedic is unable to make contact with a physician for medical direction, the paramedic may administer:
A
a. BLS treatment according to his judgment or
b. ALS treatment only as authorized in protocols
4
Q
Transport decisions should be made using what form?
A
Hospital Capability form
5
Q
What is considered a new born?
A
just delivered
6
Q
What is considered a neonate?
A
Younger than 6 weeks
7
Q
What is considered an infant?
A
Under 1
8
Q
What is considered a child?
A
1 to puberty
9
Q
What is considered puberty?
A
pubic hair, facial hair, breast development
10
Q
What is considered an adolescent?
A
a. reached puberty
b. treated as adult
11
Q
Transport decisions definitions for Pediatric (2)
a. Trauma
b. Medical
A
a. Trauma = 15 yrs
b. Medical = 17 yrs
12
Q
The treatment protocols are divided into ___ and ___ sections.
A
Adult and pediatric
13
Q
How many parts does each section have?
A
Three
a. Supportive care
b. ALS Level 1
c. ALS Level 2
14
Q
Define supportive care:
A
Actions authorized for EMT (BLS) or Paramedic (BLS & ALS) that are supportive in nature
15
Q
Define ALS level 1:
A
Actions authorized prior to physician contact
16
Q
Define ALS level 2:
A
Actions authorized only for the paramedic that require a physician consult
17
Q
What is relied upon to determine which of the authorized treatment procedures are appropriate for a given situation?
A
Paramedic’s judgment
18
Q
The treatment guidelines are given in:
A
Bulleted list form as a general order of steps
19
Q
What is the intension of listing ALS 2 orders?
A
To allow for appropriate preparation and guide the paramedic
20
Q
What must be documented in the PCR when a physician gives an ALS level 2 order?
A
Physicians name
21
Q
Physicians authorized to approve ALS Level 2 orders include the following: (7)
A
a. EMS providers medical director
b. Hospital ER physician
c. Physician in his own office
d. Online medical control physician
e. Bystander physician personally known to medic
f. Bystander physician who presents MD or DO
g. Poison Information Center
22
Q
If medical director, ER physician or online medical control physician give Level 2 orders, they should be requested in the following order:
A
a. Medcom
b. Telephone
c. Relay via dispatch
23
Q
If a physician in his own office gives Level 2 orders to the paramedic, the order must: (3)
A
a. Be verbal or written
b. Signed by physician
c. Given directly to the paramedic
24
Q
If the bystander physician that is personally known to the medic gives Level 2 orders to the paramedic, the physician must:
A
a. Accept full responsibility for patient
b. Accompany patient in the ambulance to the hospital
25
The poison information center is authorized to direct all medical care for what type of patient?
Toxicology and hazardous materials exposures
26
What is the telephone number for poison control?
800-222-1222
27
What does PCR stand for?
Patient care report
28
When is direct contact with the physician in the ER required?
Only when seeking consultation or authorization for ALS 2 orders
29
The treatment protocols have been designed to what?
Clinical guides, not educational documents
30
What are some organic causes of behavioral disturbances?
a. hypoglycemia
b. hypoxia
c. poisoning
31
If the patient is a threat to himself or others what type of force should be used?
reasonable physical force via law enforcement
32
If physical or chemical restraints are used, what should be placed on the patient?
ECG monitor and pulse ox
33
What is the state statute for a Baker act?
394.463
34
Is a baker act an absolute condition for transport?
No
35
What is the transportation procedure on transporting a baker act? (3)
a. Transported with an accompanying police officer
b. Paramedic-in-charge determines if officer follows or rides in the back
c. Document mileage via dispatch
36
Who is authorized to dictate certain medical care for persons who pose a threat to themselves or others (Baker Act)?
Police
Courts
Physicians
37
Which state statute allows for examination and treatment of incapacitated persons?
401.445
38
What does ICISF stand for?
International Critical Incident Stress Foundation
39
What is CISM?
Comprehensive, integrated, multicomponent, systematic program of crisis intervention
40
What is the purpose of CISM?
a. Education
b. Support
c. Assessment
d. Intervention
41
Who formulated and standardized CISM?
ICISF
42
What is the goal when applying any of the CISM components?
a. Assess
b. Education
c. Intervene
43
The Broward County CISM team is also known as:
Broward Region X CISM
44
The Broward CISM team is made up of: (5)
a. Law enforcement
b. Fire/rescue
c. Corrections
d. Communications
e. Licensed mental health professionals
45
To join the Broward CISM team, what needs to be completed?
At least 3 core ICISF courses
46
How long does the Broward CISM team have to respond to a critical incident?
Maximum of 2 hours
47
How often does the CISM team meet?
a. On a periodic basis
| b. for training and information
48
Define defusing:
a. within first 12 hours
| b. Homogeneous groups
49
Define debriefing:
a. 12-72 hours
b. prior to demobilization
c. significant personal loss
50
When is the expanded-phase defusing started?
within first 12 hours
51
Define crisis management briefing: (3)
a. Large incident with high media coverage
b. Large or mixed groups
c. Focus on assessment and information
52
What is considered a critical incident?
Any situation that is out of the norm or challenges a person's normal coping
53
What is the benefit to group intervention?
Stronger group cohesion
54
Who is contacted when requesting a CISM team?
Communications Captain at Broward Regional Communications Center
55
What is the communications centers number?
954-765-5100
56
The agency requesting CISM team should provide the following information: (4)
a. agency name
b. type of incident
c. number of members involved
d. call back information
57
How are the CISM members contacted?
a. Communication Captain pages out the on-call CISM team leader
b. At the same time, sends out text messages to all CISM members
58
Who contacts the site contact person?
CISM Clinical director
59
All personnel are assembled according to:
Type
60
In a defusing or debriefing, personnel are assembled according to: (3)
a. Rank
b. Involvement to the incident
c. Proximity to the incident
61
Who determines the assembly of personnel during the defusing or debriefing?
Responding team leader
62
How is the CISM recorded?
It is not
| No written, audio, or video
63
All patients found in cardiac arrest will receive CPR unless an exception is met: (4)
a. Advanced directive/DNRO
b. Determination of death
c. Discontinuance of CPR
d. Documentation
64
Which DNRO form is approved in the State of Florida?
Florida DNRO
65
If a DNRO from another state is presented what is the procedure?
Contact medical control
66
What is considered a valid DNRO?
a. Original yellow DNRO (DOH form 1896)
b. A copy on yellow paper
c. Patient identification device
67
What is a patient identification device?
Miniature version of the DOH Form 1896
68
What must be present to honor a DNRO? (3)
a. States its a DNRO
b. Signed by physician
c. Signed by patient or guardian
69
How is the identity of a DNRO confirmed? (3)
a. Driver's license
b. Photo ID or
c. Witness known by patient
70
If a witness is used to identify the patient of a DNRO, what information must be documented? (3)
a. name of witness
b. address and phone of witness
c. relationship to patient
71
During transport of a live patient with a DNRO, EMS can provide:
a. pain relief or medically indicated care
| b. no respiratory or cardiac resuscitation
72
Who can revoke the DNRO?
a. Patient
| b. Guardian or surrogate
73
How do you have to express the revoking of the DNRO? (4)
a. Writing
b. Physical destruction
c. Failure to present
d. Orally
74
What is POLST?
Physician Orders for Life Sustaining Treatment Paradigm
75
What does POLST emphasize?
End of life planning:
a. Advanced care
b. Shared decision making
c. Ensuring patient's wishes are honored
76
Which type of patients should have a POLST form?
Serious illness or frailty
77
For serious illness or frailty patients, what is the current form to have?
Standing medical orders
78
For healthy patients, what is a tool for making future end-of-life decisions?
Advanced directives
79
What are the other programs besides POLST?
a. MOLST
b. MOST
c. POST
80
What does MOLST stand for?
Medical Orders for Life Sustaining Treatment
81
What does MOST stand for?
Medical Orders for Scope of Treatment
82
What does POST stand for?
Physician Orders for Scope of Treatment
83
How many presumptive and conclusive signs must be present to determine someone dead?
4 presumptive
| 1 conclusive
84
What are the presumptive signs?
Unresponsive
Apnea
Pulseless
Fixed dilated pupils
85
What are the conclusive signs?
Injuries incompatible with life
Tissue decomposition
Rigor mortis
Lividity
86
What patients require full ALS resuscitation?
a. Hypothermia
b. Barbiturate overdose
c. Electrocution
87
A trauma victim who does not meet the "determination of death" criteria listed above may be determined to be dead based on the following criteria:
Pulseless and apnea associated with asystole and:
a. Blunt trauma arrest
b. Prolonged extrication
c. Arrest from brain injury
88
Who is responsible for the body once death has occurred?
Local law enforcement
89
If CPR is started in the field by EMS personnel, who can stop the resuscitation efforts?
Order from medical direction
90
What needs to be in place prior to terminating resuscitation efforts? (4)
a. All ALS and BLS
b. Advanced airway successfully accomplished
c. IV with shocks
d. Asystole
91
How many paramedics should verify ET tube placement?
two paramedics
92
What do you do with the body if the scene is a suspected homicide?
Do not cover the body with a sheet
93
A rehab area will be set up at the discretion of:
The incident commander
94
Who is responsible for the management and coordination of the rehab area?
The first available EMS unit
95
Who selects the Rehab area?
IC
| If the IC does not determine the Rehab Officer decides
96
What does the Rehab Officer gather for the rehab area? (4)
a. Fluids
b. Food
c. Medical equipment
d. Other (fans, awning, chairs, etc.)
97
When is food provided in a rehab area?
operations 3 hours or longer
98
What is the minimum manning for rehab?
2 rescue personnel
99
Firefighters will be evaluated following: (4)
a. 2 scba bottles or 30 minutes
b. SCBA failure
c. CP, SOB, N&V, W&D, AMS, Cramps
d. At discretion of IC, Rehab officer, Safety officer, CISM coordinator, company officer
100
When is a medical evaluation form completed?
all personnel entering rehab and before they exit rehab
101
All personnel receiving ALS treatment and transport will have what completed?
PCR
102
How often does an examination take place in rehab?
10 minute intervals
103
If a firefighter is not routinely returned to emergency operations, what is written?
EMS run report and casualty report
104
If normal presentations are present in rehab, what is the procedure?
Rehydrate and rest for not less than 15 minutes
105
What are abnormal presentations? BP:
Higher or lower than normal
106
What are abnormal presentations? SaO2:
Less than 94%
107
What are abnormal presentations? Pulse:
a. at rest: should be less than 100 bpm
b. at work: should be less than 120 bpm (>120 for >15 min = transport)
c. never to exceed 180 bpm
108
What are abnormal presentations? Body Temp:
Greater than 100.6F
| longer than 15 mins and after O2 = transport
109
CO values:
5% = normal for non-smoker
8% = normal for smoker
More than 12% = moderate
More than 25% = severe
110
Normal presentations should return within:
15 minutes
111
If a team member's heart rate exceeds 110 bpm, what is performed next?
An oral temperature is taken
112
If the team member's heart rate exceeds 110 bpm and the oral temperature is over 100.6F, what is the next step?
Member not permitted to wear PPE and should be treated for heat stress
113
When will a responder receive ALS treatment and transport?
If presentations are abnormal for more than 15 mins
114
If an emergency worker has a CO of more than 8% but less than 15% what is done?
Given the opportunity to breath ambient air for 5 mins
115
If the CO reading is still higher than 8% after breathing ambient air, what is done?
Given oxygen until it drops below 5%
116
Any member with a CO reading of _____ must be transported to the hospital.
25%
117
Which hospital should the CO patient be transported to?
One with a hyperbaric chamber
118
No worker will leave the rehab area until the CO reading is below what?
8%
119
Any emergency responder with ___, ___, and ___, will receive immediate ALS and transport.
CP, SOB, and AMS
120
What is done prior to taking anything orally?
Clean hands and face
121
What is the standard for oral hydration?
a. 1 to 2 quarts of fluid over 15 mins
b. At least 1 quart per hour
c. At least 8 ounces while scba fills
122
Who authorizes members to leave rehab?
rehab officer
123
Members can return to manpower or incident commander when the following criteria have been met: (4)
a. Vital signs are WNL
b. Absence of abnormal signs and symptoms
c. Minimum of 15 mins of rest
d. Released by rehab officer
124
Where is the Rehab Medical Evaluation Form forwarded to?
Rescue (EMS) Division
125
What is the standard dispatch for an Air Rescue assignment?
1 engine and 1 rescue
126
Who can modify the air rescue assignment?
uniformed fire department officer
127
What are fire department personnel used for at a heli-spot?
Safety
Security
Patient Loading
128
Who is legally and operationally responsible for the helicopter?
PIC
129
Takeoffs and landings should be in what wind direction?
Into the wind
130
The heli-spot should be cleared of any obstacles which is considered:
objects more than 40 feet tall that is within 100 feet of the heli-spot
131
What is the minimum number of rotor guards?
Minimum of one, two if available
132
Can the marshaller become a rotor guard?
No
133
Who has the general responsibility & definite responsibility to keep unauthorized personnel away from the helicopter?
a. General = Fire department personnel
| b. Most definite responsibility = of the PIC and heli-spot group officer in charge
134
Is it necessary to have a hose line pulled and/or charged?
No, up to the incident commander
135
Where will the marshaller stand?
outer edge on the windward side (wind to back)
136
Who has the primary marshaling duties?
Apparatus Lieutenant or Captain
137
Who maintains contact with the helicopter?
an additional firefighter assigned to the marshaller
138
Who has primary responsibility of patient care?
Rescue unit OIC
139
Air rescue is dispatched by who?
IC
140
Who contacts the receiving hospital, helicopter or rescue?
Rescue
141
The only patient information that the IC needs from the rescue unit when requesting air rescue is:
a. number of patients
| b. designated receiving facility
142
Does Air rescue need/require a completed run sheet?
no, whatever information you have should be provided to flight medic
143
When moving the patient to the helicopter, the patient will be secured to:
a backboard with minimum of 3 straps
144
If the patient becomes unruly, where is the 4th strap placed?
above the knees
145
How many members will carry the stretcher to the helicopter?
minimum of 4, one being air rescue crew member
146
What is the size of the heli-spot?
100' x 100'
147
What is Medcom priority I?
a. Critical
| b. Immediately life-threatening
148
What is Medcom priority II?
a. Serious
| b. Immediate intervention, potential to become life threatening
149
What is Medcom priority III?
a. Stable
| b. Not requiring immediate medical intervention
150
What is Medcom priority IV?
Administrative traffic
151
What are the Medcom classifications?
a. Adult and pediatric
| b. Cardiac, Medical, OB, Trauma
152
How are pre-alerts communicated?
a. Via the dispatcher
| b. Second contact via medcom enroute to hospital
153
When is the refusal of care policy utilized?
Patient refuses evaluation, treatment, and/or transport
154
Who can refused care?
Competent
| Adult (emancipated or legal representative)
155
Who is classified as an emancipated minor? (3)
a. self-sufficient minor
b. married minor
c. minor in military
156
An individual may not refuse medical care based on the following: (6)
a. Altered LOC
b. Suicide (attempt or verbal)
c. Severely altered vital signs
d. Mental retardation
e. Not acting as a "reasonable person would"
f. Younger than 18
157
What information must be provided when a patient signs a refusal of care? (3)
a. release is against medical advice
b. release applies to this instance only
c. EMS should be requested if necessary
158
After the refusal of care is signed, it must be witnessed. Which includes: (3)
a. Name
b. Contact information
c. Signature (if signature is refused, document in report)
159
For refusal of care, medical direction should be contact for consultation under the following circumstances: (4)
a. low severity patient who is 18 yrs old
b. refusal presents significant risk to the patient or EMS
c. Patient who is not their own legal guardian
d. Patient who refuses after any IV medication (consider PD)
160
If a patient refuses transport to the nearest location, it is considered what?
refusal of transport
161
Who should be contacted when a patient refuses transport to nearest location?
Local department's supervisor
162
If a patient refuses to be transported to any facility, who should be contacted?
Medical direction
163
What is a rescue task force?
team of law enforcement providing forced protection of rescue personnel
164
What does the rescue task force do?
triage and immediate life saving treatment
165
What is the procedure for the first arriving officer of an MCI? (5)
a. Size up, estimate number of victims
b. Request a Level # MCI
c. Identify a staging area
d. Direct crews to triage
e. Move walking wounded and assign someone to watch
166
What should the IC be on the look out for at Active shooter incidents? (4)
a. suspicious individuals
b. suspicious packages
c. suspicious vehicles
d. potential IED
167
What is the acronym for an active shooter incident?
THREAT
168
What does THREAT stand for?
```
Threat suppression
Hemorrhage control
Rapid Extrication to safety
Assessment by medical
Transport
```
169
What does a red ribbon mean?
immediate care
170
What does a yellow ribbon mean?
delayed care
171
What does a green ribbon mean?
Ambulatory (minor)
172
What does a black ribbon mean?
Deceased (non-salvageable)
173
What are the first four functions on a MCI?
Triage
Treatment
Transport
Staging
174
What are other sections/officers of an MCI? (8)
a. Medical
b. Landing zone/Heli-spot
c. Extrication
d. Hazmat
e. Rehab
f. Safety
g. PIO
h. Medical intelligence
175
What is medical intelligence for?
a. assist with suspected or known WMD events
| b. decon, antidotes, and treatment
176
Are the responding units included in the MCI response?
a. On-scene units are not included
| b. Responding units are included in assignment
177
When is trauma transport criteria determined?
During secondary triage
178
Upon notification of an MCI, medical control will: (2)
a. gather information from each hospital
| b. relays to transport officer or medical communications officer
179
On large-scale incidents, IC should consider:
sending a hospital coordinator to each hospital
180
Define active shooter:
a. Individual engaged in killing or attempting to kill in confined, populated area
b. most cases use firearms
181
Define active shooter incident:
unpredictable and evolve quickly, over within 10-15 mins
182
Define casualty collection point:
a. safe location to receive victims
| b. inside or outside
183
Define concealment:
provided protection from observation
184
Define cover:
Provides protection from direct fire
185
Define contact team:
Officers only going to neutralize the perpetrator
186
What is strike team?
a. same kind and type of resources with common communication
| b. ALS transport strike team would consist of 5 ALS transports
187
What is a task force?
a. group of resources with common communication
| b. MCI task force would be 2 ALS, 2 BLS transport and 1 Suppression
188
Active shooter Zone - Hot:
a. Direct threat care/Care under fire
| b. Not been cleared by law enforcement
189
Active shooter zone - Warm:
a. Indirect threat care/Tactical field care
| b. Entry of Fire/EMS with armed law enforcement
190
Active shooter zone - Cold:
a. Evacuation care/Tactical evacuation care
| b. Not reachable by the perpetrator
191
Number of victims for MCI level 1:
5-10
192
Number of victims for MCI level 2:
11-20
193
Number of victims for MCI level 3:
21-100
194
Number of victims for MCI level 4:
101-1000
195
Number of victims for MCI level 5:
1001+
196
How many units responding during a MCI level 1?
a. 4 ALS transports
b. 2 Suppression units
c. 1 shift commander
d. 1 EMS supervisor
197
How many units responding during a MCI level 2?
a. 6 ALS transports
b. 3 Suppression units
c. 2 shift commanders
d. 2 EMS supervisors
198
How many units responding during a MCI level 3?
a. 8 ALS transports
b. 4 Suppression units
c. 3 shift commanders
d. 3 EMS supervisors
e. 1 Command vehicle
f. 1 MCI trailer
g. 1 Operations Chief
199
What size task force is responding for MCI level 4?
5 MCI Task Forces:
a. 2 ALS transport strike teams (10)
b. 2 BLS transport strike teams (10)
c. 1 Suppression strike team (5)
200
What size task force is responding for MCI level 5?
10 MCI Task Forces:
a. 4 ALS transport strike teams (20)
b. 4 BLS transport strike teams (20)
c. 2 Suppression strike teams (10)
201
Who is notified on a MCI level 1?
a. 2 hospitals
| b. 1 trauma center
202
Who is notified on a MCI level 2?
a. 3 hospitals
| b. 2 trauma centers
203
Who is notified on a MCI level 3?
a. 4 hospitals
b. 3 trauma centers
c. Warning Point
204
Who is notified on a MCI level 4?
a. 10 hospitals
b. 5 trauma centers
c. Warning Point
d. MMRS
e. SMRT
f. FAST
g. DMAT
h. MRC
205
Who is notified on a MCI level 5?
a. 20 hospitals
b. 10 trauma centers
c. Warning Point
d. MMRS
e. SMRT
f. FAST
g. DMAT
h. MRC
I. IMSURT
206
What are some considerations for a treatment area? (4)
a. Capable of accommodating the number of victims
b. Consider weather, safety, hazmat
c. Designate entry and exit
d. Divide into Red, Yellow, Green
207
Who is responsible for re-triaging of victims?
Red, Yellow, Green treatment managers
208
All MCI victims that are air-transported should be assigned to which hospitals?
Distant unless victim's needs dictate
209
The Medical Communications Coordinator will advise medical control with the following information when a unit transports: (4)
a. Unit
b. Number of victims
c. Priority (R,Y,G)
d. Special needs (cardiac, burn)
210
Ground transported victims should be assigned to hospitals on a:
Rotating basis
211
What is MRCC?
Medical Resource Coordination Center
212
What is the MRCC's prime function?
Maintain status information
213
How many MCI supply trailers are there in Broward County?
4
214
How many MCI trailers are there in Region 7?
3 large MCI supply trailers
215
The staging officer should maintain a reserve of _____ transport vehicles.
two
216
What is packaged in the MCI bags? (5)
a. 2 triage packs
b. 50 triage DMS tags
c. Grease pencils/pens/pencils
d. MCI FOG 1 - 8
e. Additional tourniquets, dressings, seals, and decompression needles (10)
217
What color vest for command?
White
218
What color vest for medical supply officer?
Blue
219
What color vest for triage officer?
Yellow
220
What color vest for treatment officer?
Red
221
What color vest for transport officer?
Green
222
What color vest for medical supply officer?
Blue
223
What color vest for Medical Communications Coordinator?
Green
224
What color vest for staging officer?
Orange
225
What does START stand for?
Simple triage and rapid treatment
226
Where are the triage ribbons tied on a patient?
upper extremity in a visible location
227
Where is secondary triage performed?
Treatment phase
228
What are the only corrections of lift-threatening problems in triage?
a. Airway obstruction
| b. Severe hemorrhage
229
Adult - Move the walking wounded:
Green
230
Adult - No respirations after head tilt:
Black
231
Adult - Respirations over 30/min:
Red
232
Adult - Perfusion (no radial pulse/cap refill over 2 sec):
Red
233
Adult - Mental Status (unable to follow commands):
Red
234
Adult - Stable RPM/Walking:
Green
235
Adult - Stable RPM/Non ambulatory:
Yellow
236
What age is JumpSTART performed?
8 or less
237
Ped - Move the walking wounded:
Green
238
Ped - No respirations after head tilt and no peripheral pulse:
Black
239
Ped - Respirations over 45/under 15:
Red
240
Ped - No respirations with a pulse:
Give 5 ventilations
241
Ped - If respirations resume after giving 5 ventilations:
Red
242
Ped - Perfusion (no radial pulse/cap refill over 2 secs):
Red
243
Ped - Mental Status (Alert/Verbal)
Yellow
244
Ped - Mental Status (Pain/Unresponsive)
Red
245
Ped - Stable RPM/walking:
Green
246
Ped - Stable RPM/Non ambulatory:
Yellow
247
The START triage system was developed by:
New Port Beach FR
| Hoag Hospital
248
The JumpSTART triage system was developed by:
Dr. Lou Romig
249
If law enforcement refuses access into the scene:
Notify EMS supervisor and complete incident report
250
At a crime scene, do not attempt resuscitation if the patient:
Has no pulse, no spontaneous respirations, and meets "death in the field"
251
What is the website for the protocols?
GBEMDA.org
252
What is the Broward EMS council's web site?
Broward.org/BrowardEMS
253
How often do medical directors meet?
Yearly (or sooner if more emergent)
