Module 1 study guide
quality control and who is responsible for maintaining it
"We strive to maintain the highest standards in excellence and quality" the medical director is responsible. CQI- circular system of continuous internal and external reviews and audits of all aspects of the EMS system
assault vs battery; libel vs slander
*assault- unlawfully placing a person in fear of immediate bodily harm ex. threatening to restrain a patient who does not want to be transported *battery- unlawfully touching a person ex. providing emergency care w/o consent *libel-defamation that is in writing *slander-defamation that is spoken
direct vs indirect contact vs vector-borne vs foodborne vs airborne
*direct- when an organism is moved from one person to another through touching without without a contaminated intermediate object or person *indirect- spread of infection from the patient with an infection to another person through an inanimate object *Airborne- spreading an infectious agent through droplets or dust *Foodborne- contamination of food or water with an organism that can cause disease *Vector borne- spread of an infection by animals or insects that carry an organism from one person or place to another
proper disposal of sharps
- Do not recap, break, or bend needles. Even the most careful individuals may expose themselves through a needlestick accidentally. - Dispose of all sharp items that have been in contact with human secretions in approved, closed, rigid containers.
define triage, primary triage, and secondary triage
- sort patients based on the severity of their injuries primary- initial triage done in the field, allowing you to quickly and accurately categorize the patient's condition and transport needs secondary- done as patients are brought to the treatment area
what size should a LZ be and how should it be marked and how should you approach it
-100 X 100 feet -marked with weighted cones, level area -approach away from the tail rotor -go around the front to move from side to side
what are some special mandatory reporting's
-abuse of children -injury during the commission of a felony (gunshot wounds, knife wounds, poisonings) -drug related injuries *drug addiction is an illness not a crime -childbirth -attempted suicide, dog bites, certain communicable diseases, assaults, domestic violence, sexual assault, rape
what are the steps of START
-calling out to patients to see who can (considered "walking wounded" and GREEN) -then check on patients who can not walk -respiratory status -if they're not breathing, open the airway by a manual maneuver -if the patient does not begin to breathe > BLACK -pt breathing faster than 30/min or slower than 10/min >RED -10 to 29/min, move to next step -assess hemodynamic status (bilateral radial pulses) -absence or radial pulse > RED -radial pulse present >move to next step -assess neurologic status > "show me 3 fingers" -unconscious or cannot follow commands > RED -complies with simple command > YELLOW
ethical responsibilities; EMT conduct
-ethical responsibilities are to yourself, your patients, your coworkers, and the public -ethics- philosophy of right and wrong, of moral duties, and of ideal professional behavior -morality is a code of conduct that can be defined by society , religion, or a person, affecting character and conscience -bioethics- field of ethics -EMT conduct is conducting yourself in a manner that is consistent with the standards of your profession and to keep the best interests of your patients at the forefront of your conduct and decision making -applied ethics is the manner in which principles of ethics are incorporated into professional conduct
define negligence and what 4 things are required to prove negligence
-failure to provide the same care that a person with a similar training would provide in the same or similar situation -deviation from the accepted standard of care that may result in further injury to the patient 1. duty-emt has an obligation to provide care following standard of care and protocols 2. breach of duty- when the emt does not act with an expected/reasonable standard of care 3.damages- when a patient is physically or psychologically harmed in some noticeable way 4.causation- reasonable cause-and-effect between the breach of duty and the damages suffered by the patient ex. dropping a patient during lifting causing a fracture of the patient's leg
balancing work, family, and health
-get help from a critical incident stress management team -find a balance -rotate your schedule -take vacations -seek help
roles and responsibilities of the EMT according to EMS scope of practice
-humidifiers, partial rebreathing mask, venturi mask, manually triggered ventilators, automatic transport ventilators, oral/nasal airways -pulse oximetry, manual/atuo BP -assisting a patient in taking their own prescribed meds. including auto injector
what are physiologic manifestations of stress
-increased respirations and heart rate -increased blood pressure -constricted venous vessels near the skin surface (causes cool, clammy skin) -dilated pupils -tensed muscles -increased blood glucose levels -perspiration -decreased blood flow to the G.I. tract
incident command system roles and responsibilities
-medical branch director will supervise triage, treatment and transport -depending on the scale of the event, medical may be a branch, or it may fall under the logistics section as a unit
define non-urgent moves and what are the different types
-obstacles have been identified or removed -proper equipment is available -procedures and path to take have been identified and discussed -Extremity lift. -Direct ground lift. -Draw-sheet method. -Direct carry
size up and 360 degree walk around
-on going process of information gathering and scene evaluation to determine appropriate strategies and tactics to manage an emergency, while paying attention to hazards such as downed power lines, leaking fluids, fire, and broken glass 360- allows you to evaluate the hazards and potential injuries and determine the number of patients -look for the mechanism of injury, smoke, trapped or ejected patients, number of vehicles
what is PPE
-personal protective equipment 1. gloves- blood, bodily fluids, secretions, excretions or contaminated items, mucous membranes/non intact skin 2. gown-when contact of the EMT's clothing/ exposed skin to blood, bodily fluids, secretions, excretions, or contaminated items is anticipated 3. mask/eye protection- during procedures and patient care activities likely to generate splashes or sprays of blood, body fluids, secretions, or excretions ex. suctioning endotracheal intubation
interview techniques to avoid
-provide false hope/reassurance -give unsolicited advice -ask leading/biased questions -use authoritative language -speak in professional jargon -talk too much -interrupt the patient -use "why" patients
what are the steps of jumpSTART
-younger than 8 or who appear to weigh less than 100 pounds -identify the walking wounded -infants or children not developed enough to follow commands, should be taken ASAP -respiratory assessment -not breathing> check pulse >no pule= BLACK -not breathing with pulse> open airway with manual maneuver -if pt does not begin to breathe > give 5 rescue breaths and check respirations again - does not begin to breathe after rescue breaths = BLACK *most common cause of cardiac arrest in children is respiratory arrest -assess approx. rate or respirations -less than 15/min or more than 45/min = RED -within the range of 45 to 15 = assess further -hemodynamic assessment > distal pulse -neurologic status > child who is unresponsive or responds to pain by posturing or with incomprehensible sounds or is unable to localize pain > RED - child who responds to pain by localizing it ow withdrawing from it or is alert > yellow
levels of ems and what are some differences
1. EMR 2. EMT 3. AEMT 4. Paramedic
define the different types of ambulances
1. conventional, truck-cab chassis with a modular ambulance body that can be transferred to a newer chassis as needed 2. standard van, forward-control integral cab-body ambulance 3. specialty van cab with a modular ambulance body that is mounted on a cut away chassis
what are the stages of grief. list examples
1. denial-"they're not really gone" 2.anger/hostility-screaming/yelling 3.bargaining-"I promise to be a perfect patient if only I can live until "x" event 4.depression-withdrawls/giving up 5.acceptance-accepting the death/news
10 golden rules
1. make and keep eye contact to established RAPPORT 2. provide your name and use patient's proper name 3. tell the patient the truth 4. use language that the patient can understand 5. be careful what you say about the patient to others 6. be aware of your body language 7. speak slowly, clearly and distinctly 8. if the patient is hard of hearing, face the person so they can read your lips 9. allow time for the patient to answer or respond to questions 10. act and speak in a calm, confident manner
what are examples of terrorist organizations: domestic vs international
1. religious extremist/ doomsday cults 2. extremist political 3. cyber terrorists 4. single issue domestic- in the US international- outside the US
how far should you park from a trench rescue and why
500 ft. because vibration is a primary cause of a secondary collapse
Jump kit
A bag or box containing equipment used by the emergency medical responder (EMR) when responding to a medical emergency; includes items such as resuscitation masks and airway adjuncts, gloves, blood pressure cuffs and bandages.
single command system
A command system in which one person is in charge, generally used with small incidents that involve only one responding agency or one jurisdiction.
unified command system
A command system used in larger incidents in which there is a multiagency response or multiple jurisdictions are involved.
direct ground lift
A lifting technique that is used for patients who are found lying supine on the ground with no suspected spinal injury.
joint information center
An area designated by the incident commander, or a designee, in which public information officers from multiple agencies disseminate information about the incident.
incident action plan
And oral or written plan stating general objectives reflecting the overall strategy for managing An incident
Vesicants
Blister agents; the primary route of entry for vesicants is through the skin. -if left on the skin/clothing, they can produce vapors that can enter the respiratory tract -consists of sulfur mustard (H), lewisite (L), and phosgene oxime (CX) -usually causes the most damage to damp or moist areas, such as , the groin, armpit, and respiratory tract. s
chart (charte) method of documentation
C- chief complaint H- history and physical examination A- assessment R- Rx (treatments) T- transport to use "charte" add "exceptions" it breaks down care/treatment into smaller bits, makes it easier to locate specific assessments or care w/o reading the whole. difficult to learn though
traffic control
Controlling movement of people and supplies in an area to minimize the potential for contamination. -first responsibility is to care for the patients -if police are slow to arrive, you might need to take action to control the scene -purpose is to ensure orderly traffic flow and to prevent another crash
what do dispatchers do and what is EMD
Dispatchers obtain the necessary info from the caller, following dispatch protocols, dispatch the ambulance crew and other equipment and responders that may be needed EMD- emergency medical dispatch-assists dispatchers in providing callers with vital instructions to help them deal with a medical emergency until EMS arrives
what does each letter of "failure' mean
F- failure to understand the environment or underestimating it A- additional medical problems not considered I- inadequate rescue skills L- lack of teamwork or experience U- underestimating the logistics of the incident R- rescue vs recovery mode not considered E- equipment not mastered
who is first priority and who is last
First: red Last: black
Hazmat control zones and what happens in each zone
Hot - HazMat Warm - Decon corridor Cold - Command post/IC
what are the different triage priorities and examples of each
Red: airway/breathing compromise, uncontrolled or severe bleeding, severe medical problems, signs of shock (hypoperfusion), severe burns, open chest or abdominal injuries Yellow: burns w/o airway compromise, major or multiple bone or joint injuries, back injuries with or w/o spinal cord damage Green: minor fractures, minor soft tissue injuries Black: obvious death, obviously non-survivable injury ex. open brain injury, respiratory arrest (if limited resources), cardiac arrest
termination of command
The end of the incident command structure when an incident draws to a close.
incident commander
The individual who has overall command of the incident in the field.
command post
The location of the incident commander at the scene of an emergency and where command, coordination, control, and communication are centralized.
abandonment
Unilateral termination of care by the EMT without the patient's consent and without making provisions for transferring care to another medical professional with the skills and training necessary to meet the needs of the patient.
what is decision making capactiy
ability of a patient to understand the info you are providing, coupled with the ability to process that info and make an informed choice regarding medical care
differences in acute stress vs delayed stress vs cumulative stress vs PTSD
acute- during a stressful situation, in the moment delayed- manifests after the stressful event cumulative- prolong exposure to excessive stress, harder to recover each time PTSD- develops after a person has experienced a psychologically distressing event. characterized by reexperiencing the event and overresponding to stimuli that recalls the event
what patients have the right to refuse treatment
adults who are conscious, alert, and appear to have decision making capacity have the right to refuse treatment or withdraw from treatment at any time
alternative fuel vehicles vs fuel vehicles
alternative- may be powered by electricity, electricity/gasoline hybrids, or fuels such as propone, natural gas, methanol, or hydrogen -battery needs to be disconnected to prevent further fire or explosion - may be more than 1 battery
mobile and portable radios
ambulance will often have more than one radio 1. to comm. with dispatchers/public safety agencies 2. comm. pt. info to medical control -mobile radios are installed in ambulance and operates at a lower power than a base station -VHF (very high frequency) mobile radios operate between 30 and 300 MHZ -UHF (ultra high frequency) mobile radios operate between 300 and 3,000 MHZ -mobile antennas typically limited to 10-15 miles over avg. terrain -portable radios operate at 1-5 watts of power and is more limited than mobile or base station radios
what is a duty to act
an obligation to provide care to a patient
base station; repeater vs scanner
base station- any radio hardware containing a transmitter and receiver that is located in a fixed place repeater- special base station radio that receives messages and signals on one frequency and then automatically retransmits them on a second frequency scanner- radio receiver that searches or "scans" across several frequencies, stops whenever it receives a radio broadcast on that frequency, and continues once the message is complete
how does carbon dioxide/cyanide effect oxygen transmission
carbon dioxide- exposure causes increased respirations cyanide-inhaling cyanide prevents cells from using oxygen
cleaning vs disinfectant vs high-level disinfectant vs sterilization
cleaning- process of removing dirt, dust, blodd, or other visible contaminations from a surface or equipment disinfection- is the killing of pathogenic agents by directly applying a chemical made for that purpose to a surface or equipment high level disinfection- the killing of pathogenic agents by the use of potent means of disinfection sterilization- process, such as the use of heat, which removes all microbial contamination
what is consent and informed consent vs implied consent vs involuntary consent
consent- permission informed- explained the treatment, risks, benefits, alternatives, and consequences to the patient and the patient gives consent implied- when a person is unconscious/ not able to make a rational decision, the law assumes that the patient would consent to care *principle of implied consent is known as the "emergency doctrine" involuntary- used for patients who are mentally ill, developmentally delayed, or who are in behavioral crisis. consent during involuntary consent should be obtained from someone who is legally responsible for the patient, such as a guardian or conservator
what is diamond carry vs one handed carry
diamond carry- one provider at the head, one on each side, and one at the foot (makes a diamond shape) one handed carry- turned in the direction you'll walk and use one hand to carry
standing/indirect/offline orders vs direct/online orders
direct- permission from medical control offline- indirect online- direct standing- do not have to ask= protocols
define emergency move vs urgent moves and when should they be used
emergency move- used when there's a potential for danger to drag or pull a patient to a safe place before assessment and care are provided *only other time you should use this is if you cannot properly access the patient or provide care because of the patient's position urgent moves- may be used to move a patient w/ an altered level of consciousness, inadequate ventilation, or shock (hypoperfusion). weather can also be a reason
which phase of a call is the most dangerous
en route phase
What is NFPA 1917 standard of automotive ambulances and what does it mean for EMS
establishes standards for certifying ambulance operations
extrication vs entrapment
extrication- the removal from entrapment or from a dangerous situation or position entrapment- a condition in which a person is caught within a closed area with no way out or has a limb or other body part trapped
who should handle the foot end of the backboard vs who should handle the head end of the backboard
foot end- smaller person, weaker head end- stronger, bigger, taller person
cultural imposition
forcing cultural values onto a patient
what is the most effective way to control disease transmission
hand washing
How long should scene size up of a scene last
it never stops; lasts the entire time
What is accidental death and disability: the neglected disease of modern society and what it means to EMS
it's a report that revealed the inadequacy of pre-hospital emergency care/transportation. NHTSA of the DOT created funding sources and programs to develop improved systems of prehospital emergency care. EMS-administered through the federal level
EMS continuing education purpose
maintain, update, and expand your knowledge and skills
who's safety is number 1
my own safety is #1
Who is NHTSA and what is their purpose related to EMS
national highway traffic safety administration -guidelines used in EMS education to keep requirements the same for every one
when should you use a stair chair vs when you should not
only use a stair chair when the patient is conscious
scene of a crime
p. 102 in book
emancipated minors
people who, despite being under the legal age in a given state ( most states 18), can be legally treated as adults based on certain circumstances -married, armed services, minors who are parents
transportation supervisor
person responsible for communicating with sector officers and hospitals to manage transportation of patients to hospitals from a multiple-casualty incident.
what is power lift and power grip
power lift- back straight, upright position w/o twisting -spread your legs about 15 in -bring upper body down by bending the legs -curl your arms up tp waist height (lifting by extending the properly placed, flexed legs is the most powerful way to lift) *useful if you have weak knees/thighs power grip- arms/hands facing palm up -hands should be at least 10 in. apart -hands should be inserted under the handle w/ the palm facing up and the thumb extended upward -advance the hand until the thumb prevents further insertion and the cylindrical handle lies firmly in the crease of your curved palm -curl fingers and thumb over handle -handle should be supported on palm
difference between primary prevention and secondary prevention
primary-focuses on strategies that will prevent the event from ever happening secondary- event has already happened. asks "how can we decrease the effects of the event?" ex. helmets and seatbelts
logistics
responsible for communications equipment, facilities, food and water, fuel, lighting, and medical equipment and supplies for patients and emergency responders
finance
responsible for documenting all expenditures for reimbursement
Operations
responsible for managing the tactical operations usually handled by the IC on routine EMS calls
medical branch of the ICS
responsible for triage, treatment, and transportation
what is scope of practice and standard of care
scope of practice- most commonly defined by state law, outlines the care you are legally able to provide for the patients standard of care- manner in which you must act or behave
scope or practice; medical director offline/online
scope of practice-most commonly defined by state law, outlines the care you are legally able to provide for the patients online-telephone/radio offline-standing orders and protocols
Star of life and what does each point represent
serpent and staff represent the staff of Asclepius (god of medicine). staff- medicine and healing, skin-shedding. serpent-renewal 1.detection 2.reporting 3.response 4.on scene care 5. care in transit 6.transfer to definitive care
simple access vs complex access
simple- getting to the patient w/o using any tools or force complex- requires the use of special tools, such as pneumatic and/or hydraulic devices and special training that includes breaking the windshield or removing the roof
planning
solves problems as the arise during the incident, obtain data about the problem, analyze the previous incident plan, and predict what or who is needed to make the new plan work
what is a critical incident stress management
system used to deal with stress on the job, educates and provides resources
what to do if you commit an error during patient care
talk to your supervisor/partner
triage supervisor
the person responsible for overseeing triage at a multiple-casualty incident.
what are the toxicity levels and what is needed in each level
toxicity levels- measures of the health risk that a substance poses to someone who comes into contact with it Level 0- includes materials that would cause little, if any, health hazard if you came into contact with them Level 1- includes material that would cause irritation on contact but only mild, residual injury, even w/o treatment Level 2- includes materials that would cause temporary damage or residual injury unless prompt medical treatment is provided *level 1 and 2 are considered slightly hazardous but require the use of self contained breathing apparatus (scba) if you are going to come into contact with them Level 3- includes materials that are extremely dangerous to health, contact w/ these materials requires full protective gear so no skin is exposed Level 4- includes material that are so hazardous that minimal contact will cause death. For level 4 substances, you need specialized gear that is designed to protect against that particular *For level 1-4, respiratory and chemical protective gear is required
how do you use a scoop stretcher and when should/shouldn't they be used
used when the patients are found lying on the ground or other flat surface -fitted around the patients -parts are connected (top and bottom) -patient is lifted *pay attention to the closure area, so the patient won't be pinched
how should you lift the stretcher/ patient who weights 250 lb or more
w/ 4 providers *may need to use special bariatric equipment for 350 lb +
warm vs cold zone
warm- where personnel and equipment transition into and out of the hot zone, contains the decontamination area cold- safe area where personnel do not need to wear any special protective clothing for safe operation
what is rapid extraction technique
when the patient can be moved from sitting in the vehicle to supine, on a backboard if required, in 1 minute or less table 8-3 p. 284
what are the phases of an ambulance call
Preparation Phase -Inspect the ambulance everyday and after each shift change Dispatch -Nature of the call, location and number of patients En Route -Notify dispatch you're responding -All emergency vehicle operators must drive with due regard for the safety of others Arrival at Scene/Patient Contact -Notify dispatch you are on scene -Ambulance in a safe position/as a barrier Patient Transfer to Ambulance Transport to Receiving Facility -Notify dispatch where you are taking patient -Notify receiving hospital Arrival at Hospital/Transfer of Care -Notify dispatch you've arrived -Provide verbal report to appropriate personnel -Provide written copy of PCR -Obtain transfer of care signature En route to station Postrun Phase/Return to Service
extrication supervisor
In incident command, the person appointed to determine the type of equipment and resources needed for a situation involving extrication or special rescue; also called the rescue officer.
rehabilitation supervisor
In incident command, the person who establishes an area that provides protection for responders from the elements and the situation.
public information officer
In incident command, the person who keeps the public informed and relates any information to the media.
staging supervisor
In incident command, the person who locates an area to stage equipment and personnel and tracks unit arrival and deployment from the staging area.
safety officer
In incident command, the person who monitors the scene for conditions or operations that may present a hazard to responders and patients; he or she may stop an operation when responder safety is an issue.
liason officer
In incident command, the person who relays information, concerns, and requests among responding agencies.
morgue supervisor
In incident command, the person who works with area medical examiners, coroners, and law enforcement agencies to coordinate the disposition of dead victims.
treatment supervisor
In incident command, the person, usually a physician, who is in charge of and directs EMS providers at the treatment area in a mass-casualty incident.
what are the different levels of ppe
Level A- most hazardous, requires fully encapsulated, chemical resistant protective clothing that provides full body protection, as well as, scba and special sealed equipment Level B- -requires non encapsulated protective clothing or clothing that is designed to protect against a particular hazard -eye protection and breathing devices that contain their own air supply Level C- requires the use of non permeable clothing and eye protection and face masks that filter all inhaled outside air must be used Level D- required a work uniform, such as coveralls, that affords minimal protection **All levels of protection require the use of gloves
