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Flashcards in Protocols Deck (152)

Who may modify certain treatment recommendations?

The medical director of an EMS agency. (3)


The paramedic/EMT must use his judgment in administering treatment in the following manner: (4 choices)

He may determine no treatment is needed, consult medical direction before initiating specific treatment, follow appropriate treatment then consult medical direction, contact medical direction at any time. (3)


When is it recommended to make contact with the physician?

For consultation on complicated patients whenever possible. (3)


What should be used when making transport decisions?

Hospital capability form. (3)


What is a newborn?

Just been delivered. (3)


What is a neonate?

Younger than 6 weeks. (3)


What is an infant?

6 weeks-1 year. (3)


What is a child?

1 year-puberty. (3)


What is puberty?

Facial hair, pubic hair, breast development. (3)


What is an adolescent?

A patient who has already reached puberty. Treat as an adult. (3)


What are the ages for pediatrics for medical and trauma?

Trauma 15 or younger. Medical 17 or younger. (3)


What are the 3 parts each protocol is divided into, and what are they?

Supportive care-actions supportive in nature.
ALS level 1-actions authorized for the medic (or EMT with medical director approval) prior to physician contact.
ALS level 2- actions for the paramedic that require a physician consult. (3)


As the protocols continues, what is assumed?

That the previous steps were ineffective. (4)


What is the intent on listing level 2 orders?

To allow for appropriate preparation and to guide the paramedic. (4)


Which physicians are authorized to approve ALS level 2 orders? (7)

Medical director, receiving hospital ER physician, physician present in his own office, online medical control physician, bystander personally known to the medic, bystander who presents valid MD or Do, poison control. (4)


Contact for ALS level 2 orders should be initiated in the following order:

Medcom, telephone, dispatch. (4)


What were the treatment protocols designed as?

Treatment guides not educational documents. (5)


What are some organic causes of behavioral emergencies?

Hypoglycemia, hypoxia, poising. (6)


What should be used if the patient is a threat to himself or others?

Reasonable physical force via law enforcement. (6)


When can you use chemical restraints?

If physical restraints are unsuccessful in controlling violent behavior. (6)


What must be monitored if the patient is restrained?

ECG and pulse ox. (6)


Who must be accompanied by a police officer and where?

All individuals being Baker Acted. It is up to the paramedic in charge whether the officer will ride in the back or follow behind the rescue unit. (6)


What should be done if the patient is a female and there are no females on the rescue crew?

Attempt to have a female officer accompany the patient. (This is imperative in a rape case) Document the beginning and ending mileage with dispatch via the radio. (6)


Who is authorized to Baker Act?

Police, physicians, and the court. (6)


Who can not refuse medical care?

Patients who are not capable of informed consent. (6)


What is the purpose of the CISM?

To provide education, support, and intervention. (7)


Where was CISM born?

Out of emergency services. (7)


Who formulated and standardized CISM?

ICISF international critical incident stress foundation. (7)


What is the goal when providing CISM?

Have individuals return to work with the tools and support needed to reduce the effects of the critical incident. (7)


What are the benefits of a CISM intervention?

Reduction in PTSD, quicker return to productivity, increase job satisfaction, reduced workers comp, reduced absenteeism, enhanced group cohesion, increased confidence, and extended longevity. (7)


What is the Broward CISM team called?

Broward region X CISM. (7)


Who is the Broward region X made up of?

Law enforcement, fire-rescue, corrections, communications, and others. (7)


What is the required training to be on Broward region X team?

Completion of at least 3 core ICISF courses. (7)


Which organization is the Broward region X part of?

It is independent of any other organization. (7)


When must the CISM be deployed?

A max of 2 hours after the team has been requested. (7)


Are CISM meetings public?

No they are strictly confidential. (7)


What is small group defusing?

Recommended within the first 12 hours after incident, but ASAP. Meet in homogeneous groups. (8)


What is small group debriefing?

12-72 hours after incident. Prior to demob from deployment. On events of significant personal loss. (8)


What is crisis management briefing?

Appropriate for large incidents, or with high media involvement. Best for large groups. Primary focus is assessment and information. (8)


What is a critical incident?

Any incident that is out of the norm or that challenges a persons normal coping mechanism. (8)


Why are all members of the group encouraged to be present in the CISM?

Because of the positive benefits of a group intervention is stronger group cohesion. (8)


Who do you contact for a CISM?

On duty communications captain at the Broward regional communications center. 954-765-5100. (9)


What information is supplied when requesting a CISM?

Agency name, type of incident, number of members involved, call back contact number. (9)


Can department members be part of the CISM team?

No department members will be part of the responding CISM team. (9)


How are personnel grouped in a CISM and what shall their status be?

Personnel are assembled by type according to rank, involvement, and proximity to the incident as determined by the CISM team leader. All personnel will either be off-duty or out of service. (9)


What is the only approved DNR form in the state of FL?

The FL DNRO form. (10


What should you do if presented with a DNR from another state?

Contact medical control as soon as possible. (10)


CPR shall be withheld when? (3)

An original DNR, a copy of a DNR on yellow paper, upon finding a personal identification device or mini DNR on the patient. (10)


Who must sign the DNR?

The patients physician and the patient or their health care proxy. (10)


How shall you identify the patients identity?

Drivers license or other photo ID or a witness in the presence of the patient. (10)


If a witness is used to identify the patient, what must be documented?

The witness name, address, telephone number and relationship. (10)


If the patient has a DNR can you provide treatment?

You can provide comforting, pain-relieving, and any other medically indicated care except CPR. (11)


Can a DNR be revoked?

Yes, at any time. If signed by the patient it must be revoked by the patient otherwise the healthcare proxy. It can be done in writing, by destruction, failure to produce, or oral expression. (11)


How do you determine death in the field?

4 presumptive and 1 conclusive signs of death. (11)


What are the 4 presumptive signs of death?

Unresponsive, apnea, pulseless, fixed dilated pupils. (11)


What are the 4 conclusive signs of death?

Injuries incompatible with life, tissue decomp, rigor mortis, liver mortis. (12)


What patients must always be worked unless they have injuries incompatible with life or tissue decomp?

Hypothermia, barbiturate overdose, or electrocution. (12)


When are children determined dead?

Children are excluded from this protocol except when you make contact with medical control in obvious signs of prolonged death. 912)


When can a trauma patient who would not otherwise meet the signs be considered dead? (4)

Pulseless and apnic with asystole in 2 leads and: blunt trauma arrest, extrication time greater than 15 min with no resuscitation, arrest from brain injury with no brain reflexes. Also blacks at an MCI(12)


What should be done with a body after determined dead?

It should be left at the scene until local law enforcement arrives. It shall be covered with a sheet unless it is a possible crime scene. (12)


When can CPR be discontinued? (3)

When it was started inappropriately by others at the scene, when a DNR is presented, or when contact is made with medical control. (13)


Do you have to do an EMS run report for all death in field patients?

Yes. (13)


Who will have discretion in setting up rehab?

The IC. (14)


At what incidents is it recommended that a rehab area be utilized?

At all working incidents to provide a staging area and an immediate source for rescue and aid. (14)


Where shall the air truck and canteen be staged?

At the rehab area. (14)


What shall be the staffing for the rehab area?

A minimum of 2 rescue personnel. (15)


Who shall oversee the provision of food, fluids, and medical monitoring?

An appointed rehab officer. (15)


When shall workers go to rehab? (4)

After the use of 2 SCBA bottles and/or 30 minutes of strenuous activity, SCBA failure, any stress related symptoms (weak/dizzy, CP, N/V, cramps, SOB), or at the discretion of any company officer. (15)


What shall be completed on all personnel that enter the rehab area, and those who receive treatment?

A medical evaluations for all personnel, a PCR for all patients receiving treatment. (15)


How often shall rehab patients be examined and for what? (8)

Every 10 minutes for GCS, pupils, vitals (BP, HR, resp), ECG, lung sounds, skin, temp, pulse ox. (15)


How long shall rest in rehab be?

Not less than 15 minutes. (16)


What are abnormal vitals after 15 minutes?

BP higher or lower than normal for patient, SpO2 less than 94%, HR greater than 120 at a working incident and never above 180, CO above 5% for a non-smoker or 8% for a smoker, body temp above 100.6. (16)


What % indicates severe inhalation of CO?

25% (16)


After how long in rehab should presentations return to normal?

15 minutes. (16)


When shall someone be treated for heat stress?

If his HR exceeds 110 take temp. If temp higher than 100.6. (16)


What if still abnormal after another 15 min?

Shall be transported. (16)


What defines abnormal after second 15 minutes before transport?

SpO2 less than 94%, HR greater than 120, CO more than 8% must breath ambient air for 5 min, if still above 8%, given O2. (16)


How much oral rehydration is required in rehab?

1-2 quarts over 15 minutes. (17)


For incidents lasting how long shall food be provided?

3 hours or longer. (17)


Crews shall not leave the rehab area until...?

Authorized to do so by the rehab officer. (17)


What is the standard response for an air rescue assignment?

1 engine and 1 rescue. (18)


What shall on scene rescue personnel be concerned with for air operations?

Proper and rapid patient packaging. (18)


Who is legally and operationally responsible for the aircraft?

The PIC-pilot in command. (18)


In which direction should takeoffs and landings be?

Into the wind. (18)


How big shall approach and departures be clear of obstacles?

100x100 and 40 ft tall. (18)


Once the helicopter has landed what shall be posted?

A tail rotor guard. (18)


Who has the primary responsibility for marshaling duties?

The apparatus officer. (19)


What PPE must be worn during air ops?

Helmet, goggles or visor, gloves, full bunker gear, flash light for night ops. (19)


What must ground rescue units do prior to air rescues arrival?

Contact the receiving facility. (20)


What is the only information the recue unit needs to provide when requesting air rescue?

The number of patients and receiving facility. (20)


Does air rescue need a completed report?

No, just a hard copy of whatever information has been obtained. (20)


How shall the air rescue patient be secured?

On a backboard with at least 3 straps. (20)


Who shall carry the stretcher to the helicopter?

A minimum of 4 personnel, at least 1 from the air rescue crew. (20)


What is the key to saving a trauma patient that requires surgery?

Speed. (20)


What will happen if the air rescue crew requires assistance?

The paramedic in charge will accompany the crew and he will bring all necessary equipment. (21)


What are the priorities for medical communications?

1- critical 2-serious 3-stable 4-administrative traffic. (22)


In cases of minors when shall you not accept refusal of care from a guardian?

Attention should be given to signs of child abuse. (23)


What is the requirement to refuse care and who can do so?

emancipated minor,
legal representative for patient. (23)


What is an emancipated minor? (3)

Self sufficient,
in the military. (23)


What is implied consent?

What a reasonable individual would consent to under the same circumstances. (23)


What must the patient GCS be to refuse care?

15 GCS. (24)


What must you advise the patient on all refusals? (3)

It is AMA, applies to this instance only, EMS should be requested again if needed. (24)


What shall be done if the patient will not sign the refusal?

Document their refusal on the PCR and obtain a witness signature if available. (24)


When shall medical control be contacted for refusals? (4)

Low severity patients under 18, when the refusal represents significant risk, they are not their own legal guardian, refusal after administration of IV meds. (25)


How shall you treat patients refusing transport to the closest appropriate medical facility?

They should be considered as refusing transport and refer to local policy. 925)


What shall the first officer on an MCI do? (3,4)

Perform a size up and establish the number of victims, request the level MCI and any special equipment, and identify staging. If an active shooter event establish unified command with PD. (26)


What are the colors for START?

Red-immediate, yellow-delayed, green-ambulatory, black-deceased. (26)


What is THREAT?

Threat suppression, Hemorrhage control, Rapid Extrication, Assessment, Transport. (26)


What does any active shooter scene get until an accurate number of victims can be established?

MCI level 2. (29)


Who can upgrade or downgrade the assignment and when?

Command at any time. (27)


Where do all units respond to an MCI?

Directly to the staging area unless otherwise directed. (27)


In addition to the level, what should be announced when calling the MCI?

The general category. (trauma, haz-mat, smoke inhalation) (27)


Where must trauma victims always go?

State approved trauma centers. (27)


In how long are most active shooter incidents over?

10-15 minute. (28)


What is the CCP?

Casualty collection point, a safe location where fire rescue personnel can receive victims. (28)


What is a liter bearer?

A team of personnel to move victims from the incident site to the treatment area. (28)


What are the MCI levels?

level 1 (5-10)
level 2 (11-20)
level 3 (21-100)
level 4 (101-1,000)
level 5 (above 1,000) victims. (29)


Who reports to the medical branch?

Triage, rescue task force, treatment, and transport. (31)


At an MCI who shall not receive a secondary assessment?

All red tagged victims will be transported immediately. (32)


At an MCI how do transporting units notify the hospital?

Units do not contact the individual hospital unless there is a need for medical control. Medical control will notify the appropriate hospitals. (33)


What is the Medical Resource Coordination Centers primary function?

Maintain the number of victims and hospital readiness status to accept victims. (33)


What MCI trailers are available and from where?

Broward county has 4 and Region 7 has 3 trailers. (34)


How many apparatus must the staging officer maintain?

At least 2 transport vehicles. (34)


What is START and who founded it?

Simple Triage And Rapid Treatment. Newport Beach fire rescue and Hoag hospital. (36)


What age patients is JumpSTART used on and who started it?

Used on patients less than 8. Dr. Lou Romig. (37)


Where should triage ribbons be tied?

The upper extremity in a visible location. (36)


On an MCI when is further assessment stopped?

The first assessment that produces a red. (36)


What findings qualify as a red?

Resp abve 30, no pulse or cap refill over 2 seconds, unable to follow simple commands. (36)


What qualifies as a red in JumpSTART?

Resp above 45 or under 15, no pulse or cap refill over 2 seconds, unresponsive to pain. (37)


In an MCI, if patient is a pediatric with no resp with a pulse, what is treatment?

Give 5 ventilations. If resp resume red, if not black. (37)


What should be done if law enforcement personnel refuse access to a crime scene?

Notify your supervisor and compete an incident report as required. (39)


Who may submit for changes to the protocols and how?

Anyone through the electronic web based version. (40)


How often will medical directors meet?

Yearly or sooner. (40)


What type of care can EMS provide to someone with a valid DNR/DNRO?

Comforting, pain relieving, or any other type of medically indicated care short of respiratory or cardiac resuscitation. (1.4)


In what chapter are additional educational material and medical procedures found?

Chapter 4. (5)


In what chapter are drug summaries found?

Chapter 5. (5)


What is the first guiding principle in behavioral emergencies?

Respect the dignity of the patient. (6)


What protocol references violent and/or impaired patients?

Adult protocol 2.5.2. (6)


Which type of service from the CISM is recommended after extended deployment?

Small group debriefing. (8)


What shall be completed for each FF or emergency worker who is not routinely returned to emergency operations?

An EMS ru report and a casualty report. (15)


In rehab, any emergency responder with chest pain, difficulty breathing, and altered mental status will receive immediate...?

ALS treatment and transport. (16)


When landing a helicopter, where should the marshaller stand?

At the outer edge of the HS perimeter on the windward side, with his back to the wind. (19)


What is the response for a level 1 MCI?

5-10 victims.
4 ALS units
2 suppression units
1 shift supervisor
1 EMS supervisor
(2 hosp and 1 trauma center notified) (1.9)


What is the response for a level 2 MCI?

11-20 victims
6 ALS units
3 suppression units
2 shift supervisors
2 EMS supervisors
(3 hosp and 2 trauma centers notified)(1.9)


What is the response for a level 3 MCI?

21-100 victims
8 ALS units
4 suppression units
3 shift supervisors
3 EMS supervisors
Command vehicle
MCI trailer
Ops chief
(4 hosp and 3 trauma centers and Emergency Management Agency notified)


What is the response for a level 4 MCI?

101-1000 victims
5 MCI task forces (25 units)
2 ALS strike teams (10 units)
1 suppression unit strike team (5 units)
2 BLS strike teams (10 units)
2 mass transit buses
2 MCI trailers
Command vehicle
Communication trailer
5 shift supervisors
3 EMS supervisors, 1 EMS chief
Ops chief
(10 hosp and 5 trauma centers notified EMA notified)(1.9)


What is the response for a level 5 MCI?

More than 1,000 victims
10 MCI task forces (50 units)
4 ALS strike teams (20 units)
2 suppression unit strike teams (10 units)
4 BLS strike teams(20 units)
4 mass transit buses
2 command vehicles
4 supply trailers
Communications trailer
10 shift supervisors
6 EMS supervisors, 2 EMS Chiefs
2 Ops Chiefs
(20 hosp and 10 trauma centers, EMA notified)(1.9)


What may an MCI task force consist of?

2 ALS units, 2 BLS units, 1 suppression unit including common communications and leader. (1.9)


During a MCI what is the minimum number of units that staging must maintain?

A reserve of at least 2 transport vehicles. (34)


According to START, what is the only difference between green and yellow?

Green-stable RPM, walking
Yellow-stable RPM, non walking. (36)


What is the physical restraints protocol?

Protocol 4.23. (6)


Where can you find the emergency worker rehab form?

Section 6 or online forms. (17)