TOR, Mass Gathering, ICS, Mass Casualty

Question 1

Universal TOR rule

Answer 1

Arrest not witnessed by EM
No shock delivered
No ROSC prior to transport (any ROSC)

Question 2

EtCO2 with cardiac arrest

Answer 2

Better outcomes with >20
Worse outcomes with < 10
But no definite numbers to go on

Question 3

Exceptions to transport for pediatric cardiac arrest

Answer 3

Obvious death
Crime scenes (or potential for crime scene, think SIDS)

Question 4

Better prognosis in traumatic arrest

Answer 4

1. Isolated stab wound to chest
2. Signs of life when EMS arrives
3. Thoracotomy within 15 minutes

Question 5

Who to withhold in blunt traumatic arrests

Answer 5

Apneic
Pulseless
No organized electrical activity

Question 6

Who to withhold on penetrating cardiac arrests

Answer 6

Apneic
Pulseless
No other signs of live (movement, electrical activity, PUPILLARY response)
penetrating - pupils

Question 7

NAESMP-ASCOT recs in traumatic arrest

Answer 7

Consider if no ROSC after “appropriate filed treatment”
15 minute of CPR
Needs physician oversight

Question 8

Advanced directives

Answer 8

Written document expressive future wishes for care decisions

Question 9

Living will expresses

Answer 9

Wishes of patient in the event of permanent coma or terminal illness

Question 10

POLST delineates

Answer 10

If resuscitation should be initiated
When to transport
Desired intensity of interventions

Question 11

Main goal of mass gathering medicine

Answer 11

To spare existing system

Question 12

Cardiac arrest response time for event

Answer 12

Within 5 minutes

Question 13

Level of care at mass gathering

Answer 13

At least commensurate with level of care at surrounding community

Question 14

Who should pay for medical equipment at a mass gathering

Answer 14

Event provider

Question 15

Who should staff on site treatment facility

Answer 15

At least one medical provider at highest level

Question 16

Facility for large mass gathering

Answer 16

Off site treatment facility - receive patients from prehospital system
Basically free standing hospital

Question 17

Where to place docs at events

Answer 17

Bounded - central medical facility
Unbounded - may need to move with event

Question 18

Most vulnerable part of mass gathering

Answer 18

Communications

Question 19

Where is a 911 call received

Answer 19

Public Safety Answering Points

Question 20

Radio as mass gathering should be what

Answer 20

P25 compliant

Question 21

What implemented NIMS

Answer 21

PPD 5 after 911

Question 22

NIMS does what

Answer 22

Guides all levels of government, NGOs and private sector to prevent, protect against, recover from, and mitigate disasters

Question 23

Unity of command

Answer 23

Each member of team only responds to one person

Question 24

Span of control

Answer 24

No leader is directly responsible for more than 3-7 personnel or functions

Question 25

Unified command

Answer 25

Senior representatives from each agency form the IC and speak as one voice

Question 26

4 Sections of ICS

Answer 26

Operations Planning Logistics Finance

Question 27

Operations in ICS is what

Answer 27

The Doers

Question 28

Planning in ICS

Answer 28

Thinkers

Question 29

Logistics in ICS

Answer 29

Getters (people or stuff)

Question 30

Sections led by who in ICS

Answer 30

Chief

Question 31

Operations responsible for

Answer 31

Tactical decisions and maintain situational awareness Includes staging manager who coordinates available resources waiting on assignment

Question 32

Planning responsible for

Answer 32

Incident action plan Documentation After action report Continual monitoring of situation

Question 33

2 Branches of logistics

Answer 33

Service branch: communications, food and water, medical support Support branch: fuel, maintenance, access to fixed facilities

Question 34

3 positions not in span of control

Answer 34

Safety officer Public information officer Liaison officer *IC role until they delegate*

Question 35

Only role that can violate span of command in ICS

Answer 35

Safety officer

Question 36

What are branches in ICS

Answer 36

Used when number of divisions or groups exceed the recommended span of control *usually in operations*

Question 37

Division vs Group in ICS

Answer 37

Divisions: Geographic Groups: Functional

Question 38

Medical branch vs Unit

Answer 38

Medical branch: Under operations Medical unit: within logistics, supporting responders

Question 39

Units in ICS

Answer 39

Functional responsibility for a specific activity

Question 40

Divisions led by

Answer 40

Supervisors

Question 41

Groups/Units led by

Answer 41

Leader

Question 42

What is the Model Uniform Core criteria

Answer 42

What a MCI triage should contain 24 criteria, 5 triage levels

Question 43

Only MUCC compliant triage tool

Answer 43

SALT

Question 44

5 triage categories

Answer 44

Immediate Delayed Minimal Dead Expectant

Question 45

First step in SALT

Answer 45

Sort - Walk, Wave, Still

Question 46

Start first step

Answer 46

Ambulatory vs Not (ambulatory minor)

Question 47

Second step in Start

Answer 47

Breathing or not If not breathing open airway If still not breathing, dead, otherwise immediate

Question 48

Third step in Start

Answer 48

Respiratory rate - if greater than 30 immediate, if not delayed

Question 49

4th step in Start

Answer 49

Perfusion: if more than 2 seconds immediate, if less delayed

Question 50

5th step in Start

Answer 50

Mental status: responding to commands No: immediate Yes: delayed

Question 51

2 systems for secondary triage

Answer 51

Secondary assessment and victim endpoint (SAVE) and System of risk triage (SORT) Waves intervention of benefit against resources

Question 52

What is tertiary triage

Answer 52

triage of scare resources (as we move down the line after first and 2nd triage)

Question 53

What is population triage

Answer 53

Management of ongoing incidents due to infrastructure loss or disease Balances risk of harm to person vs community (think weather vs disease)

Question 54

Focal point of local disaster

Answer 54

EOC

Question 55

Emergency management assistance compact between what groups

Answer 55

States

Question 56

4 phases of emergency management

Answer 56

1. Mitigation 2. Preparedness 3. Response 4. Recovery