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EMT-B > Region 11 Policies and Procedures > Flashcards

Region 11 Policies and Procedures Flashcards

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1
Q

What is the definition of an MVI?

A

MVI (Multiple Victim incidents) is defined as three or more patients in the absence of an EMS plan.

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2
Q

What are the two types of radio reports?

A

Routine and Detailed

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3
Q

How many parts does the routine radio report have? What are they?

A

Five. unit & number; age & sex; chief complaint; “routine SMO’s followed”; destination & ETA

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4
Q

When should a detailed radio report be given?

A

Under the following circumstances: abnormal vital signs per policy; deviations from SMO’s; upgrades/escalations; all transports to specialty centers; unusual circumstances

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5
Q

What is the content outline for the detailed radio report?

A

routine report information; vital signs; history; allergies; pertinent physical findings; treatment initiated; patient response to treatment/reassessment; destination & ETA

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6
Q

EMSMD?

A

Emergency Medical Service Medical Director

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7
Q

What equipment is necessary when making initial contact with the pt?

A

quick response bag, stairchair, AED, Oxygen

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8
Q

ALS care should be initiated according to what vital signs and circumstances?

A

Signs: irregular pulse or a pulse rate under 60 or over 110; irregular respiration or a respiration rate under 10 or over 24; systolic BP less than 100 or over 180; diastolic BP over 110; and Pulse Ox under 95%

Circumstances: AMS/unresponsive; cardiac emergencies; seizures/postictal state; suspected stroke or TIA; syncope; SOB/difficulty breathing; pregnancy complications or childbirth; GI bleeding; multiple system trauma; penetrating trauma; overdose/poisoning; burns >10%

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9
Q

Never discontinue care once it has been initiated unless…

A

Resource/Associate Hospital grants approval or if care is transfer is transferred to higher level personnel

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10
Q

Nine circumstances when resuscitation should be withheld.

A

decapitation, rigor mortis w/o hypothermia, lividity, tissue decomposition/putrefaction, mummification, frozen state, incineration, pt declared dead by physician, adult trauma where there is a trauma-related lethal mechanism of injury and the pt is asystolic

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11
Q

Resuscitation should be withheld when there is adult trauma, where there is a trauma-related MOI and the pt is asystolic except in the following five scenarios…

A

drowning/strangulation; lightening strike or electrocution; situations involving hypothermia; pts with visible pregnancy; medical conditions as the likely cause of cardiac arrest

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12
Q

If patient’s status is unclear and the appropriateness of CPR is questionable, what should be done?

A

initiate CPR and contact the base station for further directions

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13
Q

Who should be notified when resuscitation is withheld?

A

base station and CPD

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14
Q

Is resuscitation is withheld, what should the pt disposition be?

A

Transfer to CPD

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15
Q

What are the four circumstances when resuscitation should be terminated?

A

effective spontaneous circulation and ventilation is restored; resuscitation efforts have been transferred to other of equal or greater training; exhaustion and physically unable; direct order from a base station physician

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16
Q

What is the procedure for CPR termination?

A

A) confirm that victim is an adult, normothermic, and in nontraumatic cardiac arrest
B) confirm the initial presenting cardiac rhythm is asystole or pulseless electrical activity (PEA)
C) confirm adequate ventilation
D) notify base station
E) request termination of CPR order from Medical Control
F) Transport to appropriate receiving hospital

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17
Q

In what cases does the agent, having a “power of attorney for health care”, not have authority?

A

If the patient is alert and able to communicate before treatment is initiated and such treatment continues even if patient becomes unable to communicate with you.

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18
Q

Procedure for an agent with the power of attorney to make medical decisions for the patient:

A

1) begin treatment
2) notify medical control and keep medical control advised, and follow orders from medical control physician
3) ask for power of attorney form and examine it, and review to see what medical authority has been given to the agent, listen to agent unless medical control says otherwise
4) if there is any doubt or communication with medical control cannot be established, continue treatment

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19
Q

How should one respond to living wills and patient surrogates?

A

Do not follow the instructions from the living will or from the surrogate unless instructed otherwise by medical control.

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20
Q

What information should the DNR contain?

A

pt name, name and signature of attending physician, effective date, “Do Not Resuscitatie” or DNR, either signature of pt/legal guardian/power of attorney/surrogate decision maker

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21
Q

What is the DNR procedure?

A

verify the order, verify identity of the pt, contact medical control (follow medical control orders ALWAYS), if order is valid and medical control does not say otherwise then follow the DNR terms and record as much info from the DNR, treat the pt and transport if the validity of the DNR is dubious

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22
Q

What can conscious, competent pts consent to/refuse?

A

They can consent to: no, some, or all care, and consent to/refuse transport.

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23
Q

Besides encouraging the pt to receive medical attention, what else should one do when handling a refusal?

A

Inform the pt of the risks involved and document the attempts. Pt must also sign the refusal and two witnesses should also sign the refusal. One witness may be the EMT or Paramedic. Refusals must be called in and documented with the resource/associate hospital.

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24
Q

What should be done in the event that the pt refuses to sign?

A

Find a family member or bystander to witness and sign.

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25
What is the procedure for caring for an incompetent patient?
Identify yourself, and attempt to gain pt's confidence and initiate care. Consider and evaluate the pt's decision-making capability, and the causes of the pt's incompetence. Attempt to initiate Tx and transport (avoid danger and obtain cooperation through conventional means). If pt resists: call police or fire department as backup, contact the resource/associate hospital as needed, use reasonable force, and consider waiving initiating assessment and pt care if it is much more favorable to transport.
26
What are some causes of incompetence?
hypoglycemia, hypoxia, hypotension, stroke/CVA, head trauma, drugs & alcohol, postictal states/seizures, electrolyte imbalance, infections, dementia, psychiatric/behavorial emergencies.
27
In Illinois, a minor can be considered as an adult in what situations?
If the minor is emancipated, married, pregnant, a parent, or a member of the U.S. armed services.
28
Parental or guardian consent is not required for pts over 12 with what issues?
mental health, sexually transmitted diseases, sexual abuse/assault, alcohol or drug abuse.
29
Whose consent is needed for a refusal of service for minors?
Parental or guardian consent.
30
If parent or guardian is not present to consent or refuse, what should be done?
Advise the pt of the illness/injury and explain the need for further evaluation by a physician. Contact the Resource/Associate hospital and inform them of the situation. Administer appropriate care and request police assistance if necessary.
31
In the case that three or more pts refuse care, what should be done?
complete the Chicago EMS Multiple Victim Release Form I
32
In the case that three or more pts refuse to sign a refusal, what should be done?
complete the Chicago EMS Multiple Victim Release Form II
33
What other form should be complete with Multiple Victim Release Forms?
One pt care report/ MICU form per incident
34
What are the three categories for situations of a report of suspicious illnesses at a school facility?
1) Victims with actual exposure and one or more children having complaints of illness and/or illness 2) Victims with potential exposure/actual exposure and no complaints 3) Victims with no direct exposure and/or complaints
35
When dealing with victims with actual exposure and children with complaints, what should be the procedure?
Category I. 1) Assess and treat according to SMOs and complete PCRs 2) When victims have no complaints, contact medical oversight at the resource hospital and school reps will assume custody of the children
36
When dealing with victims with potential exposure/actual exposure and no complaints, what should be the procedure?
Category II. 1) Contact medical oversight at the resource hospital 2) school reps will gain custody of the children
37
When dealing with victims with no exposure and/or complaints, what should be the procedure?
Category III. 1) Contact medical oversight at the resource hospital 2) school reps will gain custody of the children
38
What are the three categories for a motor vehicle crash involving a school bus?
Category I: significant MOI where children have injuries Category II: no MOI causing significant injuries. Victims may have minor injuries Category III: no MOI causing injuries and victims have no complaints
39
If there is a significant MOI and the children report injuries, what should be the procedure?
Category I. 1) Treat injured victims according to the SMOs and complete PCRs. 2) if there are victims with no injuries, contact medical control to get approval to release children to school reps or bus driver.
40
If there is no MOI causing significant injuries and victims have minor injuries, what is the appropriate procedure?
Category II. 1) Treat injured victims according to the SMOs and complete PCRs. 2) if there are victims with no injuries, contact medical control to get approval to release children to school reps or bus driver.
41
If there is no MOI causing injuries and victims have no complaints, what should the procedure be?
Category III. 1) if there are victims with no injuries, contact medical control to get approval to release children to school reps or bus driver.
42
What is the procedure for applying restraints?
1) call for assistance if necessary 2) initiate application when appropriate 3) document the reason for restraints 4) apply restraints 5) restrained pt must be constantly watched by someone 6) document neurovascular status of the extremities of the pt after application and every 15 minutes 7) handcuffs can only be applied by police officers and handcuffed pts must be accompanied by the officer
43
What injuries may be physical signs and should raise suspicion of child abuse?
Perioral and perinasal injuries, fractures of long bones in children under three, multiple soft tissue injuries, frequent injuries, bites, cigarette burns, rope marks, trauma to genital or perianal areas, demarcated burns,
44
What are some situations where child abuse and neglect should be suspected?
Discrepancies between hx of injury and physical exam, prolonged time between injury and the seeking of medical help, parents or guardians respond inappropriately or do not comply with or refuse evaluation, treatment, or transport of the child, the child is apathetic, poor nutritional status, the environment puts the child in potential risk.
45
What's the procedure for treating a child who is suspected of experiencing child abuse and neglect?
1) treat obvious injuries 2) contact associate/resource hospital and request police assistance if parent refuses to consent to treatment and transport of the child. Remain at the scene. 3) police officer, physician, or designated DCFS may take temporary protective custody 4) immunity from liability shall be granted for any person acting in good faith in the removal of a child
46
How long should the ambulance be aired out for when the vehicle has been used to transport a pt with a contagious disease?
5 to 10 minutes while performing a thorough cleaning and disinfection
47
Two things to keep in mind when cleaning and disinfecting a vehicle?
Use a neutral pH detergent and Hydrogen Peroxide will loosen dried blood but can corrode copper, zinc, and brass
48
What's a proper disinfection procedure?
First clean with detergent, then soak with 2% glutaraldehyde product, and then rinse with water.
49
When there's a physician on scene whose orders you disagree, who's directives should be respected?
The directives of the base station ECP.
50
In a scene where a crime, suicide, attempted suicide, accidental death, or suspicious fatality, what's the procedure?
1) request police via radio if they aren't already present 2) make sure the scene is safe 3) initiate pt assessment and provide treatment according to the SMOs. notify Resource/Associate hospital if access to pt is prohibited 4) avoid contaminating the crime scene or damaging evidence
51
Who will be responsible for restocking the ambulance if the receiving hospital is unable to?
The resource hospital
52
Pt should not be transported if:
the pt requires advanced life support, has an actual or potential significant acute of conditions or any minor conditions in which ambulation might result in further deterioration or injury, be intoxicated, with severe abdominal pain, uncontrolled or controlled serious bleeding, complications of pregnancy, signs of labor or delivery, vaginal bleeding, extremely high or low temperatures, who are injured and require immobilization or for whom ambulation will aggravate existing injury or risk new injury
53
If a BLS unit responds to a pt who is in need of ALS care then what will be done if the BLS can prepare and transport the pt in under five minutes?
The BLS vehicle will transport the pt to the nearest appropriate facility and will notify the receiving facility via telemetry or MERCI radio.
54
If a BLS unit responds to a pt who is in need of aLS care then what will be done if the BLS cannot prepare and transport the pt in under five minutes?
1) resource/associate hospital will be notified immediately 2) that hospital will require ALS backup 3) if ALS back up is not available then CFD will be called 4) if CFD cannot respond quick enough for the pt's health then the BLS vehicle will provide rapid transport to the closest appropriate facility
55
Pt can be transported to a distant appropriate facility of the pt's choice only if one of two conditions are met?
After consultation with the resource/associated hospital and: 1) the pt is alert, oriented, and judged by EMT's to be competent to refuse recommended care and understands the risks associated with requested transport 2) orders from a durable power of attorney
56
What is the scale range for trauma pt scoring?
00-113
57
For an adult, what score does a trauma pt need to be transported to the closest trauma center?
00-30
58
For an adult, what score does a trauma pt need to be transported to a regional trauma center?
40-76
59
For an adult, what score does a trauma pt need to be transported to a comprehensive ER?
81-113
60
For an pediatric pt, what score range does the pt need to be transported to a pediatric trauma center?
00-76. If the ETA exceeds 25 minutes, the pt should be transported to the closest TC.
61
Trauma scoring criteria: loss of vital organic function, traumatic arrests
00, closest TC
62
Trauma scoring criteria: evidence of shock, systolic B/P less than or equal to 100
11, closest TC
63
Trauma scoring criteria: evidence of shock, systolic B/P less than or equal to 80 +2x age
11 (mandatory field activation of trauma surgeon), closest TC
64
Trauma scoring criteria: evidence of shock, pulse greater than or equal to 130
12, closest TC
65
Trauma scoring criteria: evidence of shock, peds with a pulse greater than or equal to 140
12, pediatric TC or closest
66
Trauma scoring criteria: evidence of shock, cool/clammy/pale/agitated with delayed cap refill (greater than 2 seconds)
13, closest TC
67
Trauma scoring criteria: Evidence of shock, weak, thready pulse
14, closest TC
68
Trauma scoring criteria: evidence of resp compromise, resp rate greater than or equal to 29, adult
21, closest TC
69
Trauma scoring criteria: evidence of resp compromise, resp rate less than or equal to 10
22, closest TC
70
Trauma scoring criteria: evidence of resp compromise, labored respiration
23, closest TC
71
Trauma scoring criteria: evidence of resp compromise, facial/neck injury with airway compromise
24, closest TC
72
Trauma scoring criteria: evidence of significant head trauma, GCS less than or equal to 10
30, closest TC
73
Trauma scoring criteria: major injury, penetrating injury to the head, neck, torso, groin
40, mandatory field activation of trauma surgeon, regional TC
74
Trauma scoring criteria: major injury, burns 20% TBSA associate with a traumatic injury
41, regional TC
75
Trauma scoring criteria: major injury, flail chest
42, regional TC
76
Trauma scoring criteria: major injury, injury to 2 or more body regions with potential life or limb threat
42, regional TC
77
Trauma scoring criteria: major injury, 2 or more long bone fxs
43, regional TC
78
Trauma scoring criteria: ped with two or more long bone fxs and/or evidence of pelvic fx
43, pediatric TC or closest
79
Trauma scoring criteria: pregnancy of 24 weeks with relative criteria
45, regional TC
80
Trauma scoring criteria: evidence of spinal cord injury, motor or sensory deficits compatible with cord damage
50, regional TC
81
Trauma scoring criteria: limb threat at or above wrist or ankle, complete amputation
61, regional TC
82
Trauma scoring criteria: limb threat at or above wrist or ankle, partial amputation
62, regional TC
83
Trauma scoring criteria: limb threat at or above wrist or ankle, loss of pulse or poor perfusion
63, regional TC
84
Trauma scoring criteria: limb threat at or above wrist or ankle, loss of neurologic function
64, regional TC
85
Trauma scoring criteria: high energy MOI, fall greater than 20 ft
71, regional TC
86
Trauma scoring criteria: high energy MOI, ped fall greater than or equal to 3x body length
71, regional TC
87
Trauma scoring criteria: high energy MOI, major deformity to the vehicle or intrusion into passenger compartment
72, regional TC
88
Trauma scoring criteria: high energy MOI, bent steering wheel
73, regional TC
89
Trauma scoring criteria: high energy MOI, ejection from vehicle
74, regional TC
90
Trauma scoring criteria: high energy MOI, death of occupant
75, regional TC
91
Trauma scoring criteria: high energy MOI, prolonged extrication
76, regional TC
92
``` Trauma scoring criteria: evidence of significant blunt head trauma, adults with agitation depressed mental status CNS leak of nose or ear LOC in children ```
81 82 83 84
93
Trauma scoring criteria: co-morbid factors ``` age greater than 55 age less than 5 severe cardiac/pulmonary disease bleeding disorder pregnancy at 24 wks ```
``` 91 92 93 94 95 ```
94
Trauma scoring criteria: miscellaneous adult bypass ped bypass occupant in motor vehicle crash > 35 mph pedestrian or bicycle ride struck by motor vehicle
100 111 112 113
95
When should a pt be transported to a PSC?
If the pt has had stroke symptoms for six hours or less and one or more abnormalities of the CSS.
96
When should a pt be transported to a PSC if they are have a negative or unobtainable CSS and six hours or less of symptoms?
If they have sudden or persistent alteration of consciousness, sudden onset of severe headaches (vomiting, and +/- systolic BP > 200, and severe or sudden loss of balance.
97
If the closest PSC is on ALS bypass, what rule should be used and how?
The t+5 min rule. If transport time is greater than five minutes then an ALS bypass should be used.
98
Pregnant pts greater than 20 weeks gestation with obstetrical related emergencies should be transported to to a.....
perinatal facility for obstetrical pts.

EMT-B (6 decks)

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