EMTS Quiz 10

Explain the principles, assessment categories, and process for triaging patients according to the START triage system.

(Simple Triage and Rapid Transport) takes 30 sec per patient -recommended for adults and can also be used for children who are older than 8 years old and greater than 100 lbs in weight Ability to walk (Ambulatory or "walking wounded") -typically tagged green Respirations -if breathing and RR is greater than 30 per min, tag them "red" -if breathing and RR less than 30, assess perfusion -if no respirations are present upon assessment, open airway. they they start breathing and RR is greater than 30 tag "red" -^ less than 30 with shallow or inadequate tag "red" -they're not breathing/ no breathing effort. tag "black" Perfusion -Cap refill and radial pulse -if cap refill is less than 2 and radial pulse is present, go to neurological assessment -if cap refill is more than 2 or radial pulse is absent tag "red" -2 sec cap refill is subject to age, sex, and environmental considerations -radial pulse is your best indicator Mental Status -if ^all that was good, ask patient to squeeze your fingers. if obeys tag "yellow" -if patient is not alert, does not obey your commands, or is unresponsive, tag "red"

Explain the principles, assessment categories, and process for triaging patients according to the SALT triage system.

(Sort, Assess, Lifesaving Interventions, and Treatment/Triage) Assessment Categories 1. using voice commands to determine the mental status 2. initiating lifesaving interventions that can be quickly performed 3. individual assessment and assignment of a priority category 4. providing treatment/transport SALT system 1. Global Sorting -obvious life threats -purposeful movement -patients that can walk 2.Lifesaving Interventions and 3. Assessment of individual patients -Lifesaving interventions are preformed as indicated by assessments -ongoing assessments and reassessments of individual patients are completed 4.Treatment/ Transport -some patients can be treated on scene -transportation conserved for the more seriously injured

warning devices: colors and markings

-"star of life" -aid to traffic safety and reduce the need for excessive dependence on lights and sirens -designed to provide quick identification that the vehicle is an ambulance

List types of situations or events that might result in multiple-casualty incidents of primarily trauma victims, primarily medical victims, or a mix of both.

-Motor vehicle crashes -gang-related violence -apartment fires -anything with multiple patients -terrorism -food poisoning -toxic gas inhalation -refugee influx

Explain the U.S. DOT placard system

-U.S. Department of Transportation regulations require vehicles containing hazardous materials to be marked with specific hazard labels or placards. -vehicle driver must have shipping papers, which identify the exact substance, quantity, origin, and destination -four sided diamond shaped sign that designates hazardous materials in transit on roadways

warning devices: warning lights and emergency lights

-activate emergency lights when responding to an emergency call -turn on headlights during the day. in some situations, the warning lights at the top are not noticeable because they blend in with traffic lights -white lights can be seen from a longer distance, especially during sunset or sunrise

Discuss situations in which air medical transport should be considered

-acute stroke -head injury with altered mental status and signs of herniation -chest or abdominal trauma with signs of respiratory distress of shock -serious MOI with unstable primary assessment findings or unstable vital signs -penetrating injury to the body cavity with unstable primary assessment findings

chemical agents: Vesicant

-blistering, burning, tissue damage -agents include sulfur and nitrogen mustards, lewisite, and phosgene oxime (can be powder but must be irrigated not brushed) PREHOSPITAL CARE -irrigation -manage chemical burns -apply dry, sterile dressing -lewisite, and arsenic-based agent, has an antidote called dimercaprol

the NFPA symbols for identifying hazardous materials,

-blue: health hazard -red: fire hazard -yellow: reactivity hazard -white: additional info, such as radioactivity, oxidation, need for protective equipment etc.

Chemical agents: Pulmonary agents

-cause lung injury PREHOSPITAL CARE -manage airway and breathing; be prepared to suction and administer O2

Describe safety precautions to be taken while working at scenes on and near roadways, and how to increase your visibility to passing motorists.

-dont trust approaching traffic -don't turn your back to approaching traffic -position the first arriving emergency vehicle to create a block and a physical barrier between upstream traffic and the scene -wear your fooking visibility vest -at night, turn off vision impairing lights, including headlights and spotlights, on emergency vehicles that are positioned to oncoming traffic -use other emergency vehicles to slow down traffic -use advance warning signs and other traffic control measures upstream of the scene to reduce the speed of the oncoming traffic -use the traffic cones for traffic control -assign your least favorite emergency personnel to watch traffic cause they don't know how to do anything else -uphill/upwind

Describe privileges afforded to EMTs operating emergency vehicles and the precautions that must be observed simultaneously.

-exceed the speed limit posted for the area only if you are not endangering lives or property -drive the wrong way down a one way street or drive down the opposite side of the road -turn in any direction at any intersection -park anywhere as long as you do not endanger lives or property -leave the ambulance standing in the middle of a street or intersection -cautiously proceed through a red light or red flashing signal -pass other vehicles in no passing zones

guidelines for setting up a landing zone.

-flat square with 60ft sides for small helicopter -100 ft sides for larger helicopter -must be 150 ft away from collision vehicles -stop traffic on both sides even though aircraft will only land on one side -consider the wind direction -make each corner of landing zone highly visible -day: flag or surveyor's tape -night: rotating lights -flares for both day and night if there's no fire hazard -if conditions are dusty or dry enough to create a fire, wet the area down first -spectators should be 200 ft away from air downwash area -emts should be at least 100 ft from downwash area -assign one person to guide the pilot in.

the purpose of shipping papers and safety data sheets.

-helps identify the substance carried in the transport vehicle -shipping papers include the name of the substance, classification, and the four digit UN identification number. -safety data sheets provide information regarding the hazards of chemicals or chemical compounds. 16 sections are required to be provided under HCS (Hazard Communication Standard)

Explain actions and techniques that may be required to gain access to a residential or commercial location.

-if door is locked, go around to windows or other open doors -attempt tp locate pt by yelling through doors or windows -ask neighbor if he has a key -if dispatch is on the phone with pt, ask dispatch if the pt has a key code to access the residence. tell dispatch to text you the info -wait for fire/PD to arrive for a forceful entry PD/FIRE arrive -check all windows and doors. check for hazards such as pets -cut through window screens -if you have to break a window, do it where there are no pts -inform the pt of what you're doing if theyre responsive -wear eye protection, heavy work gloves, and a coat -stand along side the window -use an object like a flashlight to strike the top corner nearest you. do not reach above your head -clear the broken pieces out of the frame

implementing the plan for hazardous materials

-immediately establish an incident command system -identify the best plan of action -nature of the problem -identification of the hazardous material(s) involved -type and condition of containers -weather conditions -fire? -time that has elapsed -what has already been done by people at scene -number of patients -danger of victimizing more people

Driving in rainy or wet weather

-keep mirrors cleared of water -avoid sudden braking or sudden moves of the steering wheel -slow down at big puddles -careful of hydroplaning

Driving in the winter

-make sure your engine is tuned -carry emergency weather equipment -have snow tires or chains -stay aware of temp. most hazardous road conditions occur between 28F and 40F -avoid sudden movements

pre-incident planning for hazardous materials

-one command officer -clear chain of command -establish system of communication -receiving facilities should be predesignated

chemical agents: Nerve Agents (how we fix)

-overstimulates muscles, smooth muscles, glands, and nerves as result vapor- (small exposure) runny nose, mild dyspnea, pupils constrict. liquid- (small exposure) localized sweating, nausea, vomiting, fatigue BOTH (large exposure) sudden unresponsiveness, seizures, copious secreations PREHOSPITAL -ensure adequate airway and ventilation, prepare to suction -atropine and pralidoxime are antidotes -to combat seizures, benzodiazepine (diazepam, lorazepam, midazolam) are used

warning devices: siren

-people drive dumb and wear headphones and/or take a phone call... so they won't hear your wee woo wagon -never pull up behind a car and blast your siren... I wish -the siren may cause your patient to become stressed. always let them know beforehand -sirens have effect on the driver. we drive faster with them on cause we feel like a badass with them on

Describe how to perform a scene size-up of a crash scene and how to use the findings to anticipate and prepare for the subsequent phases of patient assessment.

-preform a 360 degree assessment -evaluate the need for additional resources -PPE -Scene safety -locate all pts -vehicle safety: fire? stable? look for -electrical lines -traffic flow -hybrid vehicles -undeployed airbags -energy absorbing bumpers

Discuss the general rules and guidelines for hazardous material incident rescues.

-protect the safety of all rescuers and patients -provide patient care -decontaminate clothing, equipment, and the vehicle -avoid risking your life or your health if the only threat is to the environment

Describe the primary role of the EMT while a patient is entrapped within a vehicle and/or during the disentangling and extrication process.

-pt care provider -gaining simple access -communication with other EMS personnel -follow chain of command

Chemical agents: Cyanide

-rapidly disrupts the ability of the cells to use oxygen -may be inhaled and ingested -death may occur in 6-8 minutes with high dose PREHOSPITAL CARE -manage AB and oxygenation antidotes -nitrites and sodium thiosulfate -hydroxocobalamin

establishing safety zones for hazardous materials

-safety ones are established in which rescue operations and a specific sequence of decontamination procedures take place hot zone -contamination is present -personnel must wear PPE -number of rescuers limited -bystanders never allowed warm (control zone) -area surrounding the contamination zone -vital to preventing spread of contamination -PPE -lifesaving emergency care is preformed cold (safe) zone -normal triage -stabilization -treatment preformed -rescuers must shed contaminated gear before entering the cold zone

Describe special considerations in responding to and managing patients exposed to or contaminated with radiation

-scene safety -as soon as you suspect radiation and are trained to an appropriate level, put on a self contained breathing positive pressure apparatus plus protective clothing -PPE -Time: less time there the better -Distance: father the better -Shielding: the denser the material between you and the radiation source, the greater the protection. SCBA -Quantity: decreasing the amount of radioactive material in the area can decrease exposure -patient care -personal decontamination -vehicle/equipment decontamination

Driving in fog, mist, dust storms, and smog

-slow down but avoid deceleration suddenly -watch the road ahead and behind carefully -turn on your lights... the whole day -if traveling 15n mph or more below the speed limit, use four way flashers -use the defroster -if you need to slow down, tap your brakes to warn people behind you -be alert #duh

side impact or head protection air bags

-special consideration must be given when cutting any posts in vehicles that have side-impact or head protection systems -these deployment systems might utilize high pressure stored gas cylinders to deploy the air bags, which can cause serious injuries to rescue personnel or pts if they've been punctured by cutting tools

Chemical agents: Riot control

-tear gas and pepper spray PREHOSPITAL CARE -irrigate eyes

vehicle on its roof

-the door posts cannot hold the car up, it may collapse. -don't enter till it is stable -build a box crib under the hood and trunk and using wedges to remove any remaining space -airbags under either the front or the rear of the vehicle can also stabilize the vehicle

Identify responsibilities that may be assigned to EMS (units that might be established) at a multiple casualty incident.

-triage unit -treatment unit -transport unit -staging unit -morgue unit

door removal

-try opening all doors first -rescuers can force or pop a door with manual pry tools. hydraulic spreaders and air chisels

warning devices: air horn

-use to clear traffic quickly -unfortunately.... going right behind someone and using the airhorn causes the driver in front of you #swerve

Describe post-run actions that should be taken to reduce the spread of infection to you, your coworkers, and patients

-wash your hands -dispose of sharps -clean, disinfect, or sterilize contaminated equipment -tell nick to wash your vomit clothes -dispose of infectious wastes

windshield removal and roof rolling

-windshield is removed before roof -after roof is displaced, the stubs of the posts must be covered with duct tape or pieces of old 2 1/2 fire hose to protect the pt and rescuers from any exposed sharp metal

In order, list the major phases of an ambulance call and the EMT's responsibilities during each phase.

1. Prerun prep: check equipment 2.dispatch: they provide; location, nature, callback # of the caller, location of patient(s), severity of problem, special problems 3. en route: confirm dispatch info, give everyone a job, call ALS if needed 4. at scene: tell dispatch, park, scene saftey, VEST, PPE etc. 5. en route to receiving facility: pt is strapped, make sure all doors are closed, seat belts... i guess, lights and sirens? badass mode? reassessment 6. at receiving facility: tell dispatch you arrived, give hospital a summary, transfer pt with PCR, 7. back to station: clean your ambo, wash them hands, tell dispatch you're returning to station, seat belt?, refuel 8. post run: fill out report, take inventory, change out of your uniform cause nick made the pt puke on you, notify dispatch you're in service for another vomit call with nick

Differentiate among the levels of hazardous materials training identified by the Occupational Safety and Health Administration.

First responder awareness: US!! likely to witness hazardous materials emergencies. not expected to take any action other than call for resources First responder operations: firefighters. help stop the emergency from spreading Hazardous materials technician: plugging, patching or stopping the release of a hazardous material Hazardous material specialist: provide command and support activities at the site of a hazardous material

Differentiate between a nuclear weapon and a radiological dispersal device (RDD), or "dirty bomb.

Nuclear weapon -goes through 3 primary mechanisms (radiation, blast, thermal burns) -neutron radiation -beta radiation -alpha radiation RDD -conventional explosive attached to a radioactive materials -doesn't have power like a nuclear weapon does because it doesn't go through that chain reaction

Biological agents

PREHOSPITAL CARE -recognition and contacting public health officials is crucial -smallpox, plague, and ebola are highly contagious; use appropriate PPE

Discuss the interrelationship of triage and treatment within the treatment sector at an MCI.

Pretty self explanatory -if they're red... they get treated first -then yellow then green -black is last to transport, establish a morgue unit

Explain the important principles of a patient tagging system and discuss how to use this system during triage.

RED -highest priority -critical injuries example: airway/breathing difficulty, uncontrolled bleeding, decreased mental status, severe medical problems (poisonings, diabetic, cardiac emergency) YELLOW -severe injuries but can still wait for care and survive -delayed care example: burns without airway issues, major or multiple bone or joint injuries, back injuries with or without spinal cord damage GREEN -girl they are FINE -lowest priority example: minor burns, minor bone or joint injuries, minor soft tissue injuries BLACK -umm... as the book says "obviously dead" and "will not survive"

Explain the principles, assessment categories, and process for triaging pediatric patients according to the JumpSTART triage system.

Used on any patient who appears to be a child -no more than 15 seconds to preform Respiratory -if breathing is between 15 and 45, assess pulse -if breathing spontaneously and breathing rate is less than 15, greater than 45 or irregular, tag "red" -if there's no breathing, even after you tried to open airway, tag "black" -if there's a pulse but no breathing after opening airway, provide 15 seconds of mouth to mask ventilations (about 5 breaths) -if breathing is restored after JumpSTART tag "red" Perfusion -if no peripheral pulse is present, tag "red" -if pulse is palpable, assess mental status Mental Status -AVPU -if child is alert, responds to voice, or responds to pain by localizing it, withdrawing from it, or trying to push away, tag "yellow" -if child is unresponsive to all stimuli, or responds to pain with incomprehensible sounds or inappropriate movement. tag "red"

Describe the principles of a triage system, contrasting primary triage with secondary triage.

a system used for sorting patients to determine the order in which they receive medical care or transportation to definitive care. Primary Triage -occurs immediately upon arrival of the first EMS crew -conducted at the actual site, provided scene is safe -done quickly and provides a basic categorization of the severity of the patients involved in the incident *tagged* Red: 1st priority- immediate care/transport Yellow: 2nd priority- delayed emergency care and transport Green: 3rd priority- minor injuries and ambulatory patients Black: 4th priority- deceased or fatal injuries Secondary Triage -reevaluate the patient categorization, during which the patient might be upgraded to a higher priority, downgraded to a lower priority, or kept the same

advantages and disadvantages to air medical transport

advantages -save time over ground transport -pt is in a remote area and cannot be reached by ground vehicles -ground ambo transport is blocked -they're smarter disadvantage -weather/ environmental limitations -altitude -airspeed: windy -aircraft cabin size: obese pts or pts with large impalements -terrain: no safe landing zone -cost: expensive -pt prep: complete splinting and assessments -noise-limited assessment: lung sounds and BPs can be hard to listen to

Discuss inherent terms, equipment, and methods used for stabilizing an upright vehicle

equipment: -wood cribbing -wedges -step chocks -airbags -hydraulic tools and rams -comealongs -jacks -chains -winches upright vehicle: used to immobilize the suspension -position plastic step chocks under the vehicle parallel to each wheel -push them in until they touch the undercarriage -if step chocks are unavailable, a box crib with wedges can function in the same way. either way it prevents the vehicle from rocking -remove air from tires

Explain actions that may be required to gain motor vehicle access, including the concepts of simple and complex access

simple access -an open door -reach in any open window and unlock the door -tell the responsive pt "without moving your head, unlock the door or lower the window" complex -breaking things -PPE -break window furthest from the pt -break the window with spring loaded device or anything that can break a window -remove broken glass around the edges -if the door must be removed, cover the edges before crawling in to get your pt

Discuss the purposes, logistics, and processing of patients through the staging and transport sections at an MCI.

staging unit -monitors, inventories, directs available ambulances to the treatment unit at the request of the transport unit leader transport unit -ensures that ambulances are accessible and that transportation does not occur without direction of the incident commander or operations section chief. -communicates with hospitals they consider -distribution of patients to each medical facility -surge capacity of each hospital or medical facility -need for transport to a specialty medical facility such as a burn unit or pediatric emergency dept Effective transport -Highest priority patients are stabilized and transported first -before leaving, EMTs should receive specific instructions from the transport unit leader or staging unit leader on how to leave the area -as each ambo leaves, the transport unit leader should radio the hospital that they are in route and briefly describing the injuries involved and giving an estimated time of arrival -when only GREEN tagged patients are left, consider loading then on a bus. Have 5-10 personnel carrying essential equipment.

"Rip and Blitz" Disentanglement

the vehicle is cut from around the pt, minimizing movement and protecting the pt and rescuers at all times. An EMT is inside the vehicle holding C-Spine while this whole thing is happening

vehicle on its side

very unstable and dangerous to EMS personnel -don't attempt to enter a vehicle til it is stable -attach stabilizing pole, pulling device, cable, or chain from the undercarriage of the car to another vehicle or strong immovable object -every void between the ground and the car should be filled with box cribbing and wedges to minimize movement -the 12-18 inch space between the top of the door frame along the roof line and the ground should also be filled