Ch. 1 - Introduction to EMS Systems

Abandonment is defined as leaving a sick or injured patient before equal or more highly trained personnel can assume responsibility for care. Given the following examples, match them with the correct legal term:

(Below)

As discussed in lecture (as it pertains to Santa Clara County), if a patient has a valid Do Not Resuscitate (DNR) Order, determine under which of the following circumstances the order would be strictly honored:

(Below)

Which of the following are examples of the five (5) stages of grief? (Select all that apply)

1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance

All of the following are examples of an Advanced Directive EXCEPT:

1. Designation of an Agent to make decisions on your behalf 2. Do Not Resuscitate (DNR) Order 3. Choice to prolong or not prolong life 4. Pain relief 5. Donation of Organs CORRECT ANSWER: Designation of an Agent to decide which of your organs go where and why.

In order to leave the scene after a patient has refused care, which of the following must be done? (Select all that apply)

1. Determine if the patient is competent to refuse care. 2. Ensure that the patient is aware of the risks of refusing care. 3. Inform the patient of the benefits of accepting care. 4. Carefully document the refusal of care, including the actions you took to try to provide proper care and obtain the patient's signature documenting the refusal.

After ensuring the scene is safe, what should be the emergency responder's next priority?

1. Donning the appropriate personal protective equipment (PPE), such as rescue gloves, a reflective vest, rescue helmet, etc. 2. Ensuring your safety from infectious disease by donning the proper body substance isolation (BSI) equipment, such as medical gloves, eye protection, mask, etc.

Negligence is defined as the failure to provide the expected standard of care. For EMS personnel to be found guilty of negligence, which elements must be present? (Be sure to provide the correct responses in the correct order)

1. Duty to act 2. Breach of duty 3. Damages 4. Causation

Scope of Practice is defined as (Select all that apply):

1. Scope Of Care 2. The care that a nationally recognized EMS provider is legally allowed and supposed to provide according to local, state, or regional regulations or statutes

A patient under the age of eighteen cannot legally consent to medical care, except under which of the following circumstances? (Select all that apply)

1. The minor is legally emancipated by a court of law. 2. The minor is married, a parent and/or pregnant. 3. The patient is in the military.

In order to determine if a patient is competent, an emergency responder will ask the patient which of the following questions? (Select all that apply)

1. What is your name? 2. What time of day is it? 3. Where are you? 4. What happened?

Continuous Quality Improvement (CQI) is best described as (Select all that apply):

1. a continuous improvement in the quality of care or service being delivered 2. a process in which all individuals in the EMS system take part, whether as part of a quality improvement committee, EMS supervisor, Medical Director or EMS field personnel. 3. submitting accurate and complete patient care reports (PCRs) that will be audited by trained individuals.

The medical director (Select all that apply):

1. is a physician who assumes the ultimate responsibility for direction and oversight of all patient care. 2. oversees training and assists in the development of treatment protocols.

An example of standing orders or off-line medical direction is (Select all that apply):

1. splinting the leg of patient with a broken bone 2. providing oxygen to a patient with chest pain 3. controlling the bleeding on a patient with an open wound

Standard of Care is defined as (Select all that apply):

1. the care that should be provided for any level of training based on local laws, administrative orders, guidelines and protocols established by the local EMS system. 2. the appropriate level and manner of care that should be provided given a patient's condition and your level of training.

Finding that you are having difficulty coping after responding to a mass casualty incident (MCI), your partner reminds you of the ______________________ scheduled for the next day, which may help you cope.

Critical Incident Stress Debriefing

What is the single most effective way of preventing the spread of disease?

Effective handwashing

You and your partner respond to a residence for the report of a 42-year-old male in cardiac arrest. Upon entering the residence you are led to the living room by the patient's sister explaining his condition and pleading for you to help him. As you make contact with the patient to begin rendering aid, the patient's brother tells you to stop and hands you, what you discover to be a valid DNR. What further actions do you take?

Immediately begin CPR, call for medical direction.

Which personnel protective equipment (PPE) will offer the best protection for an emergency responder when exposed to Meningitis?

HEPA respirator or N-95 Mask

Which personnel protective equipment (PPE) will offer the best protection for an emergency responder when exposed to Tuberculosis (TB)?

HEPA respirator or N-95 Mask

What disease(s) is an emergency responder most at risk of contracting in the field?

Hepatitis B & C

After applying the dressing to a patient's forehead to control the bleeding, he states that he does not want any help; despite explaining the risks of allowing the wound to bleed. The patient explains he does not want help because he knows you will just try to implant another device in his head. Further stating that it is probably those same mind control devices that caused him to walk to the hospital and explains the constant voices in his head.

Implied consent

Upon arrival at the scene of a vehicle accident you find the driver of one of the vehicles unconscious and bleeding from the head. You immediately begin providing medical care.

Implied consent

The Good Samaritan Law protects private citizens and some emergency responders from successful legal prosecution if they act in good faith and within their scope of practice when rendering aid to another person.

True

After returning from a call with a frequent flyer (patient who repeatedly and commonly calls 911 for help) your co-workers at the firehouse ask about the patient by name and ask what his issue was this time. You respond and discuss the details of the call and talk about how many times you responded to help him. Were the patient's HIPAA rights violated?

Yes

After three (3) weeks of bad call after bad call, you start to notice your short temper with your significant other and one (1) time with a patient. In response you suggest to your partner that you go out for dinner and drinks and in the following weeks start to exercise more and go on hikes. Have you found a proper way to cope with your job?

Yes

After you load a patient into the back of your ambulance a older female contacts you, identifying herself as the patient's neighbor and good friend. When she refers to the patient by her first name and inquires if it is her heart, you respond yes, and tell the neighbor that you will take good care of her and get her the best care possible. Were the patient's HIPAA rights violated?

Yes

off-line medical direction

an EMS system's written standing orders and protocols, which authorize personnel to perform particular skills in certain situations without actually speaking to the medical director or her designated agent. Also called indirect medical direction.

on-line medical direction

orders to perform a skill or administer care from the on-duty physician, given to the rescuer in person by radio or by the phone. Also called direct medical direction.

Disaster Medical Assistance Team (DMAT)

specialized teams designed to provide medical care following a disaster.

Standing orders (off-line medical direction) are defined as:

the Medical Director's specific instructions for EMS personnel to provide care for specific medical conditions or injuries.

scope of practice

the care that an Emergency Medical Responder, an Emergency Medical Technician, or Paramedic is allowed and supposed to provide according to local, state, or regional regulations or statutes. Also called scope of care.

emergency medical services (EMS) system

the chain of human resources and services linked together to provide continuous emergency care at the scene and during transport to a medical facility.

National EMS Education Standards

the education and training standards developed by the National Highway Traffic Safety Administration (NHTSA) for the four nationally recognized levels of EMS training.

standing orders

the medical director's specific instructions for specific medical conditions or injuries.

Assault is the threat of bodily harm combined with the present ability to cause the harm. Battery, as it pertains to medical care, can be described as:

the physical act of touching a patient against their will, including providing unwanted medical care.

emergency care

the prehospital assessment and basic care for the ill or injured patient.

medical oversight

the supervision related to patient care provided for an EMS system or one of its components by a licensed physician.

research

the systematic investigation to establish facts.

Protocols are defined as:

written guideliens that direct the care EMS personnel provide for patients

protocols

written guidelines that direct the care EMS personnel provide for the patients.

Confidentiality refers to the treatment of information that an individual has disclosed in a relationship of trust with the expectation that it will not be divulged to others. In the medical realm, HIPAA (Health Insurance Portability and Accountability Act) is the federal law that sets a national standard to protect medical records and other personal health information. Given the above information and discussion in lecture, decide how the law applies to your role as a mandatory reporter and whether the patient's HIPAA rights were violated:

(Below)

Consent, as it applies to emergency medical care, is defined as providing formal permission allowing medical treatment. In order to provide consent, an individual must be competent or properly and sufficiently qualified or capable of making appropriate decisions about one's own health. Match the following examples with the appropriate form of consent:

(Below)

It takes a unique group of individuals to work in emergency medicine, due to constant exposure to not only communicable diseases, but the daily stress of patients at the worst up to and including death. Given an emergency responders exposure to such stressors, it is important to recognize burnout and the signs and symptoms of stress. In the following question, correctly identify the scenarios as examples of burnout or stress and match with the proper coping mechanism.

(Below)

Using the information discussed in lecture and the chart in the book labeled Diseases of Concern to Emergency Medical Responders, answer the following questions.

(Below)

What are the four (4) levels of National Recognized EMS Training? (List from lowest level of training to highest)

1. Emergency Medical Responder 2. Emergency Medical Technician (EMT-B) 3. Advanced Emergency Medical Technician (AEMT) 4. Paramedic (EMT-P)

Which of the following are examples of personal safety? (Select all that apply)

1. Ensuring there are no hazards such as fire, active gun fire, chemical odors, rabid dogs or zombies. 2. Donning personal protective equipment (PPE), such as gloves, eye protection, a mask, or gown as appropriate. 3. Actively assessing the scene for hazards, even if you or someone else determined the scene was safe upon arrival. 4. Immediately leaving the scene if you or your partner deem the scene unsafe, regardless of the patient's medical needs.

Which of the following are routes of exposure, potential dangerous pathogens can enter the emergency responder's body during contact with a patient? (Select all that apply)

1. Ingestion 2. Injection 3. Inhalation 4. Absorbtion

Ethics or moral philosophy is the branch of philosophy that involves systematizing, defending, and recommending concepts of right and wrong conduct. Based on that definition and the information provided in the text, which of the following best describes the ethical responsibility of EMS personnel? (Select all that apply)

1. Providing medical care to all patients, regardless of their religion, socioeconomic status, ethnicity, gender, sexual orientation or culture. 2. EMS personnel have a responsibility to see that their patient receive the most appropriate medical care possible, even if the patient does not think s/he needs any care. 3. All EMS personnel shall put the patient's needs ahead of their own as long as it is safe to do so. 4. All EMS personnel shall maintain all their skills within their scope of practice, including reviewing changes in patient care based on current research, attending EMS conferences, reading EMS periodicals, and attending continued education and refresher trainer as set by local protocols.

After arriving at the hospital you wheel your stable patient into the hospital on a gurney. The ER is extremely busy, but there is an available bed in the hallway. A charge nurse yells over to you from the nurse's station that is the only empty bed. As you transfer the patient to the hospital bed, the same nurse confirms that the patient is stable and says we'll get to him in a minute. You leave the patient care report with the patient and return to your ambulance to prepare to go back into service. What criminal act have you committed?

Abandonment

Which personnel protective equipment (PPE) will offer the best protection for an emergency responder when exposed to HIV or AIDS?

All appropriate PPEs/BSIs based on patient's injuries.

You are walking out of the ER, back to your ambulance when an individual trips and falls in front of you. When the patient fell, his head impacted the cement, causing a gash on his forehead, which causes blood to gush down his face. You identify yourself as an EMR and offer to help, but the patient states that he is fine and does not want any help. Despite his comment you help him to his feet, direct him to sit down and apply a dry sterile dressing to his forehead.

Battery

An extreme emotional state characterized by emotional exhaustion, a diminished sense of personal accomplishment and cynicism.

Burnout

As you approach a patient you and your partner introduce yourselves as Emergency Medical Responders. As your partner begins to ask the patient questions, you pull your BP Cuff from your hip pack and the patient extends their arm toward you.

Expressed consent

You and your partner are eating lunch at a local restaurant when you hear a woman scream, "Someone help! My husband is choking." You contact the husband, introduce yourself as an EMR, asking if you can help them and if they are choking. The man nods his head in an affirmative motion.

Expressed consent

While you and your partner are eating breakfast after a long shift, before you head home, you notice a commotion and hear a man yell, "Someone, please help my son!" You rush to the table to find a 10-year-old boy turning blue and you hear a whistling sound as he gasps for air. You discover the boy has a severe peanut allergy, causing you to believe he may be going into anaphylactic shock and his throat is closing. After asking the father if he has an EpiPen, he tells you that he used the last EpiPen a few weeks prior. You make the quick decision to use your pin knife and a ball point pen to secure an airway through his throat, saving his life as your partner calls for an ambulance. What criminal act have you committed?

Negligence & Battery

After working in the same area for 10 years you start to become complacent at work and even dismissive with some patients, seeing their issues as minor. Have you found a proper way to cope with your job?

No

Between school and work, you find that you no longer have time for yourself and just need to relax, so you blow off a night of studying for a night of drinking and wake-up half naked in a Denny's parking lot. Have you found a proper way to cope with your job?

No

During lecture, your instructor provides multiple examples of calls s/he has run in the past, providing details about the call and medical aid rendered, but does not provide any further identifying patient information. Were the patient's HIPAA rights violated?

No

You and your partner respond to a residence for the call of a 8-year-old patient with a possible broken arm. After introducing yourself to the patient, you start assessing her arm to discover it is deformed and while she is in pain, she is cooperative and talkative. Just as you are going to explain that you are going to apply a splint to her arm until she goes to the doctor, the girl's mother walks back into the room and states that is ok, she doesn't need that. Looking at the young girl, you notice her demeanor has changed and she stopped responding to your questions until her mother prompted her to tell you her arm feels fine. When the story of how the young girl hurt her arm does not match what her mother tells you, combined with her change in demeanor, you suspect possible child abuse. Based on your suspicion you have your partner go outside and call police. Were the patient's HIPAA rights violated?

No

After arriving on scene you find a 42 year old male patient unconscious and pulseless. You immediately begin CPR. As you begin compressions you hear and feel the patient's ribs break. When the patient is released from the hospital, he sues you for pain and suffering. What criminal act have you committed?

None. If you don't break ribs, your compressions are most likely not adequate.

As you are treating an unconscious patient with a gunshot wound (GSW) to the upper leg, you hear what sounds like gunshots from a block away. In response, you immediately get up, run to your ambulance and drive away, leaving the patient in the street. What criminal act have you committed?

None. Your personal safety supersedes patient care.

What is the name of the governmental organization that sets strict standards to reduce the possibility of infectious exposure in the workplace, as well as setting workplace safety standards?

OSHA

You and your partner respond to a residential care home where you are met by a staff member who leads you to the patient's room. Upon contact with the patient he presents with and weak, thready pulse and is gasping for air. The patient's wife informs you that there is a valid DNR, but adds that they spoke last night and decided they want as much time together as possible. What further actions do you take?

Per the patient's next of kin (his wife), render any and all medical aid under your scope of practice to sustain his life and transport the patient to an appropriate hospital or call for Advanced Life Support (ALS).

You and your partner respond to a Skilled Nursing Facility (SNF) for the report of an 89-year-old female in severe respiratory distress, due to end stage Congested Heart Failure (CHF). When you reach her room, led by SNF staff, you find that she has copies of a DNR on her door and above her bed. Upon inspection you determine that the DNR is valid. What further actions do you take?

Raise the backrest of the bed and ensure the patient is comfortable.

You and your partner respond to the scene of a two (2) vehicle accident. You each contact the drivers (only occupants) of each vehicle and begin to render aid. You discover your patient has a valid DNR, signed with today's date due to end stage cancer. What further actions do you take?

Render any and all medical aid under your scope of practice to sustain his life and transport to the nearest medical facility or call for ALS.

__________ is the emergency responder's first priority upon arriving at the scene of an incident.

Scene Safety

After returning home after a long day, you decide to veg in front of the TV with a beer, but find that you can't keep track of what is going on in the show, because your mind keeps wandering back to a call earlier in the day where a 6-month-old baby died.

Sign of stress

For the past week and a half you notice that your normally talkative and upbeat partner has become withdrawn and distant.

Sign of stress

You respond to a residence for the report of a 18-year-old female with a laceration to her hand. You render aid to control bleeding, but advise the patient that she will need more advanced medical care, due to the depth of the laceration. En route to the hospital, as you are gathering a patient history, you discover the patient has been diagnosed HIV+. As part of your ring down over the phone to the hospital, you include her HIV status in your report. As you later enter the ER with your patient, a nurse sees you come in and announces (in ear shot of a quarter of the ER) to a doctor approaching, that this is the HIV+ patient. Were the patient's HIPAA rights violated?

Yes

continuous quality improvement (CQI)

a continuous improvement in the quality of the product or service being delivered.

public safety answering point (PSAP)

a designated 911 emergency dispatch center.

specialty hospital

a hospital that is capable of providing specialized services such as trauma care, pediatric care, cardiac care, stroke care, or burn care.

While employed and actively working in the capacity of an EMR, you have a duty to act. Duty to act is best described as:

a legal responsibility to provide care.

When calling for medical direction over the radio or on the phone, you speak directly with:

a medical doctor at the base hospital

Emergency Medical Responder (EMR)

a member of the EMS system who has been trained to render first-aid care for a patient and to assist higher-level providers at the emergency scene.

Emergency Medical Dispatcher (EMD)

a member of the EMS system who provides pre-arrival instructions to callers, thereby helping to initiate lifesaving care before EMS personnel arrive.

Emergency Medical Technician (EMT)

a member of the EMS system whose training emphasizes assessment, care, and transportation of the ill or injured patient. Depending on the level of training, emergency care may include starting IV (intravenous) lines, inserting certain advanced airways and administering some medications.

Paramedic

a member of the EMS system whose training includes advanced life support care, such as inserting advanced airways and starting IV lines. Paramedics also administer medications, interpret electrocardiograms, monitor cardiac rhythms, and perform cardiac defibrillation.

Advanced Emergency Medical Technician (AEMT)

a member of the EMS system whose training includes basic-level EMT training plus responsibility for a minimal level of advanced life support. Additional skills include starting IV (intravenous) lines, inserting certain advanced airways, and administering some medications.

Scope of Practice Model

a national model that defines the scope of care for the four nationally recognized levels of EMS provider.

medical director

a physician who assumes the ultimate responsibility for medical oversight of the patient care aspects of the EMS system.

public health system

local resources dedicated to promoting optimal health and quality of life for the people and communities they serve.