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Santa Clara Local systems
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In addition to any specific criteria for withholding or discontinuing resuscitation contained within individual treatment protocols, resusitative efforts may be withheld, discontinued, and/or death determined under the following circumstances (BLS) - .... 🔰 VERIFIED ANSWERS.... ✔✔ 1. Five signs of immediate DOA
- A pulseless and/or apneic patient with a valid DNR
- A pulseless and/or apneic patiend who has exercised his/her right to die under the end of life option. if criteria met EMS will discontinue resuscitate effort, cancel prehospital personnel in route, provide appropriate care to bystanders, and complete PCR documentation about actions taken and reason for pronounced death. valid forms of identification for a physician on scene - .... 🔰 VERIFIED ANSWERS.... ✔✔ valid CA physicians medical license other ID that indicates physician CA medical license # and business address physical involvement of a physician at the scene. - .... 🔰 VERIFIED ANSWERS.... ✔✔ patient must give consent. then care may be
relinqueshed to the physician who will remain responsible for care until another MD takes over. physician may manage care, but ultimately accepts responsibility for patient. must accompany crew and patient in ambulance. documentation when physician at scene (5 things) - .... 🔰 VERIFIED ANSWERS.... ✔✔ 1. physician name
- CA medical license #
- business phone #
- level of patient care involvement
- all procedures and treatments performed at the scene. patient destinations: patient choice - .... 🔰 VERIFIED ANSWERS.... ✔✔ patient may betransported to requested facility as long as facility meets medical requirements, barring any EMS surge and hospital diversion. patient destination: routine patient destination - .... 🔰 VERIFIED ANSWERS.... ✔✔ patients may be transported to routine emergency department UNLESS patient meets criteria that requires specialty care. SCCO Specialties Trauma facilities - .... 🔰 VERIFIED ANSWERS.... ✔✔ Trauma: Regional MC, Stanford, Santa Clara Valley MC SCCO Specialties Psyciatric: - .... 🔰 VERIFIED ANSWERS.... ✔✔ psyciatric: El Camino MV, Santa Clara Valley MC EPS, PA VA hospital, Stanford.
Diversion centers Central - .... 🔰 VERIFIED ANSWERS.... ✔✔ Central: Regional MC SJ, Santa Clara Valley MC, O'Connor Diversion centers Southern - .... 🔰 VERIFIED ANSWERS.... ✔✔ Southern: Good Samaritan Hospital, Kaiser SJ, St. Louise. Acceptable DNR documents - .... 🔰 VERIFIED ANSWERS.... ✔✔ 1. POLST (physician order for life sustaining treatment stating no CPR)
- EMSA and CMA approved EMS, prehospital DNR form
- CA approved DNR medallion
- Durable Power of Attorney for Health Care (DPAHC) What to do if proper DNR document(s) present - .... 🔰 VERIFIED ANSWERS.... ✔✔ If EMS personnel arrive and patient is pulseless and apneic: -Establish DNR/advanced directives/code status -may withhold resuscitative effort if valid DNR form stating DNR.
- if no forms continue resusitative efforts until they are provided if patient (with a valid DNR form) is conscious and states he/she wants resusitative efforts... - .... 🔰 VERIFIED ANSWERS.... ✔✔ ...DNR form is ignored (document request) if unfamiliar DNR form is presented... - .... 🔰 VERIFIED ANSWERS.... ✔✔ ....continue resuscitative efforts until proper form provided.
If no DNR is confirmed an crew believes POLST is not valid b/c lack of signatures.... - .... 🔰 VERIFIED ANSWERS.... ✔✔ ...Patient recieves full resusitative efforts. if patient expires en route 3 options: - .... 🔰 VERIFIED ANSWERS.... ✔✔ 1. return to point of departure.
- continue to destination so nurse can give time of death
- go to nearest ED of an acute care facility. Prehospital transfer of care - .... 🔰 VERIFIED ANSWERS.... ✔✔ a. the scene of an emergency shall be managed by the appropriate public safety agency having primary investigative authority. b. provides full list of information, via report, regarding patient history, medical assessment, critical changes, as well as any treatments provided. Transfer of patient care may be: - .... 🔰 VERIFIED ANSWERS.... ✔✔ 1. Paramedic to paramedic
- Fire medic to county medic
- In "load and go" situations, with no time to transfer care, initial paramedic will maintain medical control.
- Paramedic to ALS flight crew
- Paramedic to BLS
- Prehospital personnel to hospital staff.
consequence management and mitigation of the incident and scene. EMS Duty chief may serve in the following capacities - .... 🔰 VERIFIED ANSWERS.... ✔✔ 1. Liaison between agencies that are requested by incident commander
- may delegate any system roles to the contractors ALS field supervisors.
- Fill in incident command system i.e. medical branch, tranpotation, ambulance staging, medical comm's, treatment of unit leader, etc. Private EMS response to hazardous materials general procedure: initial actions: - .... 🔰 VERIFIED ANSWERS.... ✔✔ a. Safety (of yourself and others around you) b. isolate area and deny entry Private EMS response to hazardous materials general procedure: secondary actions: - .... 🔰 VERIFIED ANSWERS.... ✔✔ a. Establish Command: ( i.e. incident commander) b. Identify hazardous Materials
- ask bystanders what the saw smell tasted, or heard. -refer to DOT guide book Private EMS response to hazardous materials general procedure: supportive actions: - .... 🔰 VERIFIED ANSWERS.... ✔✔ a. only
trained public safety HAZMAT or authorized specialized personnel are allowed to enter the "Hot Zone" of a HAZMAT incident b. EMS providers shall coordinate with on scene HAZMAT specialists to provide recieving hospital's with information (i.e. chemical names, Decon methods, DOT reference #, etc) HAZMAT incident Patient treatment and transport - .... 🔰 VERIFIED ANSWERS.... ✔✔ 1. decontaminated patients will be instructed to move to the "cold zone" by IC and will receive treatment there.
- both IC or designees, AND transporting paramedic must both agree that patient has been appropriately decon'd. then patient may be treated and transported. HAZMAT incident once decision to transport has been made, transporting crew will contact receiving hospital and provide following info: - .... 🔰 VERIFIED ANSWERS.... ✔✔ decon alert chemical name decontamination method DOT reference # any appropriate treatment information/considerations provide routing patient notification report request that ED have appropriate representative meet in docking bay.
Type 2 ambulance strike team: - .... 🔰 VERIFIED ANSWERS.... ✔✔ (5) BLS ambulances, with two EMTs, and one strike unit leader with separate vehicle. types of strike teams/ task forces: ambulance task force: - .... 🔰 VERIFIED ANSWERS.... ✔✔ Five ambulances, two of which must be ALS ambulances, as well as one task force unitl leader with separate vehicle. EMS personnel Markings and protective Gear: Standar ID: - .... 🔰 VERIFIED ANSWERS.... ✔✔ All EMS personnel shall wear uniforms that identify the agencies they work for when attached to EMS calls (i.e. company uniform, ID badge visible at all times) EMS personnel Markings and protective Gear: Protective gear: - .... 🔰 VERIFIED ANSWERS.... ✔✔ protective gear shall be worn when directed by the IC, public safety personnel, county or EMS field supervisor, as well as when OSHA requirements call for such gear.
- high visibility jacket and goggles with three company identifier EMS personnel Markings and protective Gear: Indications: - .... 🔰 VERIFIED ANSWERS.... ✔✔ 1. Federal aviation admin. FAA alerts
- MPMP activations
- actual/suspeded HAZMAT events
- incidents on roadways or freeways
- working with aircraft
- mutual or automatic air responses.
- when the need for clear ID and/or recognition exists due to multi-agency response, environmental conditions, and or general safety. EMS life safety procedures:
- First on scene - .... 🔰 VERIFIED ANSWERS.... ✔✔ if first on scene one crew member assumes IC role other responsible for overall incident safety. IC assumes responsibility for incident management, requeires C.A.N. report Fire dept. or law enforcement can have IC rolde transferred to them once they arrive on scene (county Communications should be notified of this change.) C.A.N. Report - .... 🔰 VERIFIED ANSWERS.... ✔✔ C: conditions: what is observed A: actions: what IC plans to do N: needs: what additional resources are needed. Life Hazard Zones (LHZ) - .... 🔰 VERIFIED ANSWERS.... ✔✔ 1. defined as an area containing a process or condition that would likely cause seriuos injury or death to exposed.
- escape routes shall be identified for every emergency scene to allow for rapid retreat if necessary.
- IC shall designate safety zones that are areas that can be used for staging od an area of safe retreat. Emergency vehicle positioning - .... 🔰 VERIFIED ANSWERS.... ✔✔ 1. positioning emergency vehicles to form a barrier between an emergency scene and flowing traffic or other hazards> (with emergency lights on) -an vehicle used to create this barrier shall be unoccupied. -patients are not to be loaded into these vehicles.
- if a scene has already been protected, ambulances should position themselves beyond the scene to create a safe location for crews and patients to be loaded into ambulance. imminent danger scene staging - .... 🔰 VERIFIED ANSWERS.... ✔✔ a. crews may be advised by dispatch of any imminent danger, and to stage and wait further instructions. b.s when staging for 10+ minutes, contact IC to identify ways to dafely and quickly access the patient. Imminent dange scene safety - .... 🔰 VERIFIED ANSWERS.... ✔✔ a. EMS personnel may not enter any scene where imminent danger exists. b. in the event that EMS responders arrive on scene and are subsequently exposed to imminent danger, the responders may retreat to a safe area to stage until the scene is safe while making a resonable effort to evacuate the patient with them.
c. If crew retreats, crews must advise county communications and the IC to request appropriate resources. d. any retreat shall be documented thoroughly, and a system variance report should be completed. Risk refusal "turn down" - .... 🔰 VERIFIED ANSWERS.... ✔✔ A "turn down" is a situation where an EMS responder has determined that due to safety concerns, they cannot undertake or negotiate a safe alternate solution (based on assessments of risk and the ability of the individual to control the risk. Including, but not limited to: "turn down" situations" - .... 🔰 VERIFIED ANSWERS.... ✔✔ a. Violation of safe work practices b. Environmental conditions make the work unsafe c. Individual lacks necessary qualifications or experience d. Defective equipment is being used e. The assignment violates federal, state, or local law or regulation f. Assignment violate established policies, procedures, or treatment protocols If Assignment is turned down... - .... 🔰 VERIFIED ANSWERS.... ✔✔ inform the EMS field supervisor and complete a System Variance report
- Respiratory Rate
- Pulse Rate (obtained via palpation)
- Pulse Oximetry (if unit is equipped)
- Temperature b. Advanced Vital Signs
- Blood Glucose (via Fingerstick, or IV start)
- Cardiac Monitoring (ECG)
- Capnography (expiratory CO2 levels) Neonate: - .... 🔰 VERIFIED ANSWERS.... ✔✔ Considered between 0-4 months of age Infant: - .... 🔰 VERIFIED ANSWERS.... ✔✔ Considered between 1 month to 1 year of age Child: - .... 🔰 VERIFIED ANSWERS.... ✔✔ Considered older than 1 year of age Pediatric: - .... 🔰 VERIFIED ANSWERS.... ✔✔ Defined as under 15 years of age Routine Medical Care (Pediatric) - .... 🔰 VERIFIED ANSWERS.... ✔✔ Baseline Vital Signs (assessed every 10 minutes for stable, every 5 minutes for unstable patients)
- Glasgow Coma Scale
- Blood Pressure (first should be obtained via manual cuff)
- Respiratory Rate
- Pulse Rate (obtained via palpation)
- Pulse Oximetry (if unit is equipped)
- Temperature b. Advanced Vital Signs
- Blood Glucose (via Fingerstick, or IV start)
- Cardiac Monitoring (ECG)
- Capnography (expiratory CO2 levels) . Infectious Disease Control Measures a. Universal/Standard Precautions (PPE) - .... 🔰 VERIFIED ANSWERS.... ✔✔ 1. Nitrile Gloves
- Eye Protection
- Hand washing after every patient contact
- If hand washing not possible, use waterless hand sanitizer Infectious Disease Control Measures a. Universal/Standard Precautions Contact Transmission - .... 🔰 VERIFIED ANSWERS.... ✔✔ 1. Occurs through contact with pathogens on the patients skin or other surfaces the patient has touched, OR pathogens contained in bodily fluids/substances/secretions a. Vomit, feces, urine b. Draining wounds
- Universal Precautions, with the addition of an N95 respirator or P100 particle respirator, should be used. Face shields and impermeable gowns may be used if indicated Infectious Disease Control Measures Aerosolized Transmission - .... 🔰 VERIFIED ANSWERS.... ✔✔ 1. May occur when bodily fluids/secretions are aerosolized during certain procedures (i.e. nebulizer treatments, suctioning, and intubation)
- Universal precautions, along with N95 or P100. Face shields and impermeable gowns should be used if indicated Ventricular Assist Device (VAD) - .... 🔰 VERIFIED ANSWERS.... ✔✔ A VAD us a device that supplements or replaces the cardiac ventricle in pumping blood to the body Patients with VADs present prehospital providers with unique assessment difficulties - .... 🔰 VERIFIED ANSWERS.... ✔✔ 1. Unable to palpate pulse
- Unable to read blood pressures
- Unable to obtain pulse-oximetry readings
c. EMS providers should rely on patients level of consciousness, skin signs, capillary refill, etc. to make any clinical decisions d. VAD patiens also have implanted cardioverter-defibrillator (ICD) and/or a pacemaker/ICD VAD Special considerations - .... 🔰 VERIFIED ANSWERS.... ✔✔ 1. VADs are currently only done at Stanford and Kaiser Santa Clara
- CHEST COMPRESSIONS ARE CONTRAINDICATED IN PATIENTS WITH VADs Procedures A. Spinal Motion Restriction (SMR) - .... 🔰 VERIFIED ANSWERS.... ✔✔ a. SMR will be applied to all patients that have, or may have sustained a significant mechanism of injury and have an abnormal spinal injury assessment b. Begins with manual stabilization and immobilization of the cervical spine, followed by proper application of the following devices:
- Properly sized cervical collar
- Long plastic spine board
- Web belt or strapping device
- Lateral head support device
