Santa Clara EMS Test
Personnel Accountability Report (PAR)
-welfare check to verify safety/security of responders -includes all EMS unit including ride alongs
Hazardous Material Procedure
1) Safety + isolate area/deny entry 2) establish command, identify hazardous materials 3)trained HAZMAT personnel allowed to treat area. EMS coordinate effort to provide hospital with pertinent info
Prehospital Task force/ Strike Team type 1
5 ALS ambulanes, EMT/Paramedic, 1 strike team lead with separate vehicle
Strike Team type 2
5 BLS ambulances with 2 EMT's, 1 strike team elader with separate vehicle
Ambulance Task Force
5 ambulances - 2 must be ALS ambulances. 1 task force leader with separate vehicle.
If a pt with a score of 4/5 on the GFAST scale has not shown any normal signs since _____ hours ago you would transport them to a comprehensive stroke center
6 hours
CAN report
Conditions Actions Needs
Risk Refusal - turn down
EMS crew has determined that because of safety concerns they cannot take care of patient. EMS field supervisor completes system variance report
Hazardous Material Accidental Exposure
EMS crew that may be exposed to hazardous material will stop and notify County that they are exposed. Fire will respond. If on scene, notificy IC. Contaminated crew will not transport until decontaminated
patient transport special circumstances
EMS surge, MCI, diversion
Stroke Comprehensive
El camino, Good Sam, Regional, Stanford
Assessing the scene
If first on scene, one crew member becomes IC, other responsible for overall safety Fire/law enforcement takes over IC once on scene
What channel do you speak through to medical?
Medic 92
Physician on scene
Needs valid CA physicians license, other medical license and business address. physician will remain responsible for care until MD takes over. Must accompany crew to hospital
If patient dies en route to hospital
Return to departure point, transport to closest ED, transport to original destination
Emergent Patient Transportation
Transported to nearest ED with red lights/sirens IF time from on scene to ED is < than 10 min. Contact county for event number
EMS personnel badges expire the same day as their EMS license
True
True or False Chest Compressions are contraindicated in patients with VAD
True
Ventricular Assist Device VAD
VAD supplements cardiac ventricle in pumping blood to body
Routine Medical Care Adult
Vitals, Glasgow Coma scale, BP, RR, Pulse, Pulse Ox, Temp, Glucose, ECG, Capnography
EMS standard ID
all EMS personnel will wear uniforms that identify agencies when attached to 911 calls
Imminent Danger is defined as
any threat or hazard that could reasonably be expected to cause immediate death or serious physical harm to a responder.
Emergent Patient Transportation > 10 min
contact 911 for ALS assistance, if no one is available first arriving paramedic will ride to hospital with BLS crew
LHZ indications
fallen power line, energized electrical equipment, collapsed zones, large unprotected holes/pools/sewer access points, damaged vessel containing pressurized gas/ liquid, ammunition/explosives, suspected or present HAZMAT
Prehospital Transfer of Care information will include
full list of information, patient history, medical assessments, critical changes, treatments provided
Pediatric patient definition
neonate: 0-4 months infant: 1 month-1 year child: >1 year pediatric <15 years
Airborne Transmission of Infectious Disease Control
occurs through inhalation or absorption of air that contains TB, measles, chickenpox. Wear N95/N100 respirator/ impermeable gowns
Droplet transmissions Of Infectious disease control
occurs through inhalation or absorption of bodily fluid/substance droplets (influenza, rhinovirus). Wear surgical mask/face shields, impermeable gowns
Contact transmission of Infectious disease control
occurs through pathogens through skin, vomit, draiing wounds, secretions (saliva, sweat). Wear impermeable gown
Routine patient transport
transported to routine emergency department unless EMS system surge, hospital diversion, or patient needs specialty care
VAD assessment difficulties
unable to palpate pulse, read BP, obtain pulse ox. EMS rely on consciousness, skin sign, cap refil
EMS Protective Gear indicated when...
when directed by IC, public safety personnel, county EMS supervisor, OSHA requirements call for gears
Life Hazard Zone
would likely cause death/ seriour injury if exposed
The Operations Director can during MCI
Change emergency procedures to mitigate the potential threat of the MCI
Spinal Injury Assessment
-Determine if language barrier -Assess for distracting injuries/alch/drug -Determine if cooperative, alert, oriented -Palpate/visualize spinal column -remarkable = SMR -unremarkable = -circulation, motor, sensation -flexion/extension elbows/wrist -finger adduction/abduction -plantor flexion/ dorsiflexion -remarkable = SMR -unremarkable = modified SMR
Requests for Medical-Health Mutual Aid into Santa Clara County:
-Incident command officer makes request -Gives information to EMS duty chief -If not resources available then MHOAC coordinates region II resources to help
Determination of Death
-decapitation -decomposition -incineration -obvious destruction of brain, lungs, heart -rigimortis -no pulse + PCR -elected to end life via end of life agreement
If patient is determined to be deceased EMS personnel will
-discontinue resuscitative efforts -cancel prehospital personnel en route -provide appropriate care to bystanders -complete PCR document reason for determination of death
Emergency Vehicle Positioning
-emergency vehicles will be used as a barrier between scene and traffic -If already protected, additional ambulances will be beyond scene to create safety for crews
In extremis means
-protruding limb -uncontrollable airway -unable to stop bleeding after use of tourniquet
Fire can transport when
-pt needs RLS transport and county EMS is not on scene for at least 18 minutes -pt is in cardiac/respiratory arrest -STEMI/Stroke alert -Major Trauma Criteria -Needs rapid transport -uncontrollable airway
Crew Safety
-situational awareness especially when staging -escape routes established -IC designate safety zone for staging
Turn Down occurs because of...
-violation of safe work practices -Environmental conditions -Individuals lacking qualifications or experience -defective equipment being used -assignment violates law or regulation, policies, or procedures
PAR report
-visualize all personnel assigned to unit -determine that they are safe and present -Unit ID, Has par or does not have PAR, # assigned crew present, # non crew present -last assignment -last known location of personnel present
Hazardous Material Hospital Report
Chemical name, decon method, DOT reference #, appropriate treatment info, routing patient notification report, request ED to have personnel outside door to evaluate patient
STEMI
All except PA, El camino, st, louise
Stroke Primary
All except VA
When staging the drivers side should
Be away from traffic, protected. All EMS vehicles that are safety staging should be empty in case their vehicle is hit
BLS Inter facility Transport
Can transport: hospital to SNF/residence, doctors appointment, or dialysis
Protective Gear Indications
FAA Alert, MPMP activation, HAZMAT events, incident on freeway/roadway, working with aircraft, mutual/automatic aid response, need for clear ID due to multi agency response
A 26 year old male with an arrow through his left fore arm proximal to the elbow would be categorized as a major trauma
False
A patient who is a major trauma patient can ask to go to a hospital that is out of county and the EMT will comply
False
A physician on scene give more information than if they are giving online direction?
False
True or false? When arriving at a scene and giving a PAR report, you should count everyone with you except for ride alongs.
False
You can determine an injury as major trauma or minor trauma on scene by viewing the severity of the trauma
False
Infectious Disease Control
Nitrile Gloves Eye protection hand washing after ever patient waterless hand sanitizer
Physician on scene
PCR Physicians Name CA medical License # Business Phone # Level of patient care involvement All procedures and treatments performed at scene
DNR include
POLST for No CPR, DNR, DNR Medallions, Durable Power of Attorney
Updated EMS policy notifications would be distributed as follows except for which medium?
Paper copy sent to every EMS provider
Hazardous Material pre-treatment procedure
Paramedic + IC must agree patient has been decontaminated. Then patient will be cleared for treatment/ transport
Pediatric Trauma Hospitals
Stanford and Valley Med
Adult Trauma Hospitals
Stanford, Valley Med, Regional
You would transport North trauma pt to _______, central trauma pt to _________, and eastern trauma pt to _________
Stanford, Valley Medical, Regional
EMS directors in an MCI can do all of the following except
Take jurisdiction of the local law enforcement
LHZ marked with...
Tape with 3 horizontal strands of red and white barrier tape with DO NOT ENTER printed. If red not available any area barricaded with 3 horizontal strands of barrier tape
Medical Health Operational Area Coordinator
The Medical Health Operational Area Coordinator (MHOAC) for Santa Clara County is the Public Health Officer and EMS Director. -initial point of contact for all mutual aid requests -delegate available resources for mutual aid
When a patient passes away at their home during intervention what agency or person(s) are responsible for the deposition of the descendent?
The fire department or police (if present)
Spinal Motion Restriction SMR
immobilization + cervical collar + backboard + straps + head support device. SMR applied to pt with significant MCI/abnormal spinal injury assessment
Modified Spinal Motion Restriction
immobilization + rigid cervical collar. Used for para-vertebral pain or soft tissue tenderness/ unremarkable spinal injury assessment
EMS duty chief
liaison between agencies that are requested by IC Commander. -delegate roles to ALS contractor supervisors -Fill in IC system -Delegate county health officer
Emergent Definition
life or limp threatening condition that requires immediate care such as: respiratory distress, airway comp, neuro changes, major trauma criteria