System design, delivery systems, SOP, Education, Occ health

Question 1

Pro all ALS

Answer 1

All response types covered
Response time may improve
Incremental cost for established ALS agency is minimal

Question 2

Pro BLS with some ALS

Answer 2

Concentrates procedures for ALS (less skill dilution)
ALS may not have major benefit over ALS most of the time

Question 3

Public utility model features

Answer 3

1. Single ambulance service designated
2. Governmental unit does billing
3. Government unit owns capital equipment
   Medical director preferable to be appointed by third party

Question 4

What is queuing analysis

Answer 4

How many units are required for a given hour

Question 5

Medical director voice regarding performance standards

Answer 5

Voice of the likely effect of response of interval performance
Medical equipment
Certification levels on clinical outcomes

Question 6

Largest cost to EMS systems

Answer 6

75 % Labor
25% infrastructure

Question 7

3 axis of essential system measures

Answer 7

1. Clinical sophistication
2. Response time reliability
3. Economic efficiency

Question 8

4 feature of effective medical oversight

Answer 8

1. External (vs internal)
2. Authoritative (vs advisory)
3. Broad scope of authority (vs narrow)
4. Funded (vs volunteer)

Question 9

Features of high performance systems

Answer 9

1. Sole provider
2. Controls center operations
3. Accountability
4. Maximizes revenue
5. Flexible production strategy
6. Systems status management

Question 10

What is system status management

Answer 10

Ambulance deployment model based on anticipation of need

Question 11

EMS assessment system

Answer 11

Bladrige healthcare criteria for performance excellence

Question 12

EMS at crossroads 2007 said what about Air EMS

Answer 12

Growth primarily money driven
Needs to be actually clinical beneficial
Needs to be safe

Question 13

First HEMS program

Answer 13

Dr Crowly and Shock Trauma with Maryland state police
1970

Question 14

First hospital based HEMS

Answer 14

1972 - St Anthonys in Denver CO

Question 15

% of population that needs HEMS to get to trauma center

Answer 15

27%

Question 16

What act increased CMS reimbursement for HEMS transport

Answer 16

1997: Balanced budget act

Question 17

Airline deregulation act

Answer 17

States have no jurisdiction over aviation aspects of air EMS programs (stays with FAA) or economics of providing services

Question 18

Title 14 of federal code

Answer 18

FAA responsible for all aviation specific issues: safety inspections, helicopter licensure, air traffic control

Question 19

Miles for HEMS

Answer 19

50-175 miles

Question 20

Fixed wing miles for benefit

Answer 20

> 150 miles

Question 21

Visual flight rule standard

Answer 21

1 mile visibility
500 ft ceiling

Question 22

Federal tort claims act associated with

Answer 22

Sovereign immunity

Question 23

4 things needed for EMS clinician to practice

Answer 23

Educate or trained
Certified as competent
Licensed to perform
Credentialed by medical director

Question 24

EMR airway interventions

Answer 24

Air adjuncts
Positive pressure (not CPAP)
Suction upper airway
Supplemental O2

Question 25

EMR meds

Answer 25

Autoinjectors, intranasal atomizers (naloxone)

Question 26

EMT meds

Answer 26

Epi autoinjector Nebs SL nitro (patients own) OTC meds for pain and fever Oral glucose ASA

Question 27

AEMT different stuff

Answer 27

Waveform capo IV and IO access IV meds: parenteral analgesia for pain, nausea, dextrose, epi, glucagon, naloxone Supraglottic aria but not ETT

Question 28

5 things from EMS education agenda for the future

Answer 28

1. National EMS core content 2. National EMS scope of practice model 3. National EMS education standards 4. National EMS certification 5. National EMS education program accreditation

Question 29

3 big things in medical directors role in EMS education

Answer 29

1. Approve curriculum 2. Review student performance and progress/attest to competence 3. Faculty selection/Curriculum development

Question 30

Education vs training

Answer 30

education: more theory based training: more skill based

Question 31

Conn Ed vs Maintaince of cerficaiton/reeducation

Answer 31

Con ed: provision of new information Maintenance: covering material students have been exposed to in past (required for national registry recertification)

Question 32

Remediation of EMS providers must be

Answer 32

Educational and constructive

Question 33

Work force entry should evaluate what for EMS

Answer 33

Knowledge and skills

Question 34

What does OSHA part 1904 state

Answer 34

Requires employers to keep records and report on work related injuries and keep records for 5 years

Question 35

NFPA 1582

Answer 35

Requires fire departs have physician to provide medical oversight Requires fire departments to establish a comprehensive medical program to address safety

Question 36

Hep C transmission risk

Answer 36

0.2% percutaneous 0% risk for mucocutaneous

Question 37

HIV transmission risk

Answer 37

0.3% risk for percutaneous (higher for deeper injuries, larger needles) 0.09% for mucutaneous

Question 38

What guides vaccination recs

Answer 38

NFPA 1582

Question 39

HAZWOPER governs what

Answer 39

Any incident requiring PPE to work in an immediately dangerous to life and health environment

Question 40

Two things that require a transport capable EMS unit at all fireground and hazmat incidents

Answer 40

NFPA 1500 and HAZWOPER

Question 41

Structure rest after how many minutes of firefighting

Answer 41

20 minutes

Question 42

NFPA 1584 states

Answer 42

Rehab for FF 5-10 minute rest after consuming one 30 min SCBA cylinder or 20 minutes of heavy exertion 20 minutes of rehab after two SCBs or 45 minutes heavy exertion

Question 43

Sleep Scales

Answer 43

Pittsburg sleep quality index Epworth Sleepiness Scale *not fatigue scales*

Question 44

Greatest source of tort claims for EMS

Answer 44

Ambulance crashes

Question 45

Step based approach after traumatic event

Answer 45

1. Does individual feel event was significant? 2. If so - supervisor led hot wash 3. If not resolved - 10 question trauma screening questionnaire 4. If 6 or more positive, referral for a more complete assessment