Bellaire EMS Protocols 2025

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Questions and Answers

What is the primary purpose of Bellaire Fire Department EMS Protocols?

  • To outline the minimal level of patient care expected from EMS personnel. (correct)
  • To establish guidelines for the transportation of BFD patients only.
  • To replace clinical judgment and experience in emergency medical care.
  • To provide a comprehensive legal document for all emergency situations.

According to Bellaire Fire Department EMS Protocols, EMS personnel are required to follow physician orders on scene even if they conflict with local protocols.

True (A)

List two scenarios described in the Bellaire Fire Department EMS Protocols under which a physician might be considered 'on the scene'.

Non-Medical Control Physician and Attending Physician

According to Bellaire Fire Department EMS Protocols, for patients with suspected brain injury with increased ICP, the ventilatory rate should be adjusted to maintain an End Tidal CO2 (EtCO2) reading of ______ mmHg.

<p>30-40</p> Signup and view all the answers

Match the following hospital door codes with the corresponding Texas Medical Center Hospital:

<p>0911 = Memorial Hermann TMC 5609* = CHI St. Luke's TMC 911* = Methodist TMC</p> Signup and view all the answers

In Bellaire Fire Department EMS Protocols, what is the recommended initial dose of Epinephrine for Asystole/PEA in adults?

<p>1 mg IV/IO (C)</p> Signup and view all the answers

According to Bellaire Fire Department EMS Protocols, Amiodarone is the first-line medication for V-Fib/Pulseless V-Tach.

<p>False (B)</p> Signup and view all the answers

List two sedation options for a ROSC patient as per Bellaire Fire Department EMS Protocols.

<p>Versed and Fentanyl</p> Signup and view all the answers

In Bellaire Fire Department EMS Protocols for ACS/STEMI, the recommended initial dose of Nitroglycerin is ______ mg SL.

<p>0.4</p> Signup and view all the answers

Match the following classifications with the corresponding age guidelines from Bellaire Fire Department EMS Protocols:

<p>Neonate = Gestational birth date to 28 days Infant = &gt; 1 month to &lt; 1 year Pediatric = 1-13 years Adult = &gt; 13 years</p> Signup and view all the answers

According to Bellaire Fire Department EMS Protocols, which medication is recommended for stable Narrow Complex Tachycardia?

<p>Adenosine (B)</p> Signup and view all the answers

In Bellaire Fire Department EMS Protocols, synchronized cardioversion for unstable A-Fib starts at 100 joules.

<p>False (B)</p> Signup and view all the answers

Name two medication options for unstable Bradycardia according to Bellaire Fire Department EMS Protocols.

<p>Norepinephrine infusion and Epinephrine infusion</p> Signup and view all the answers

In Bellaire Fire Department EMS Protocols for CHF/Pulmonary Edema, the Nitroglycerin infusion should be titrated to maintain a MAP of greater than ______ mmHg.

<p>160</p> Signup and view all the answers

Match the following medication and dose for pediatric allergic reactions from Bellaire Fire Department EMS Protocols:

<p>Benadryl = 25mg IV/IO or 50mg IM Dexamethasone = 10mg IV/IO/IM Epinephrine = 0.5mg IM 1:1000</p> Signup and view all the answers

According to Bellaire Fire Department EMS Protocols, what is the initial fluid bolus amount for pediatric cold exposure/hypothermia?

<p>20 ml/kg Normal Saline (B)</p> Signup and view all the answers

In Bellaire Fire Department EMS Protocols, active rewarming for hypothermia includes placing heat packs directly on the skin.

<p>False (B)</p> Signup and view all the answers

What is the target temperature for heat stroke treatment according to Bellaire Fire Department EMS Protocols?

<p>102°F</p> Signup and view all the answers

According to Bellaire Fire Department EMS Protocols, for pulmonary edema, the CPAP setting recommends a PEEP of ______ cmH2O.

<p>5</p> Signup and view all the answers

Match the following medications with their respective initial doses for pain management in Bellaire Fire Department EMS Protocols:

<p>Ofirmev = 1g IV/IO infused over 15min Toradol = 15mg IV/IO or 30mg IM Fentanyl = 0.5-1mcg/kg IV/IO/IN/IM Ketamine = 0.2mg/kg IV/IO or 0.5-1mg/kg IM/IN</p> Signup and view all the answers

In Bellaire Fire Department EMS Protocols, what is the initial dose of Ondansetron (Zofran) for nausea/vomiting in adults?

<p>4mg to 8mg ODT/IV (A)</p> Signup and view all the answers

According to Bellaire Fire Department EMS Protocols, activated charcoal is a primary treatment for overdose/toxicology.

<p>False (B)</p> Signup and view all the answers

List two medication options for opioid toxicity according to Bellaire Fire Department EMS Protocols.

<p>Naloxone and Glucagon</p> Signup and view all the answers

In Bellaire Fire Department EMS Protocols for seizures/convulsions, the initial dose of Midazolam if IV access is not available is ______ mg IM/IN.

<p>10</p> Signup and view all the answers

Match the following medications with their respective doses for Hyperkalemic Emergencies in Bellaire Fire Department EMS Protocols:

<p>Calcium Chloride = 500mg-2g IV/IO Albuterol = via nebulizer continuous 10-20mg Sodium Bicarbonate = 1mEq/kg IV/IO PRN every 10 minutes</p> Signup and view all the answers

According to Bellaire Fire Department EMS Protocols, what is the initial dose of Aspirin for ACS/STEMI?

<p>324 mg PO (B)</p> Signup and view all the answers

In Bellaire Fire Department EMS Protocols, it is recommended to routinely administer supplemental oxygen if SpO2 is greater than or equal to 94% unless the patient is in respiratory distress.

<p>False (B)</p> Signup and view all the answers

Name two conditions listed in Bellaire Fire Department EMS Protocols where oxygen administration should be titrated to >93% even in the absence of respiratory distress.

<p>STEMI/Angina and Stroke/CVA</p> Signup and view all the answers

According to Bellaire Fire Department EMS Protocols, for patients from one hour after birth up to 8 years old, CPR should be initiated if the pulse is absent or if the pulse is less than ______ bpm and the patient is symptomatic with poor perfusion.

<p>60</p> Signup and view all the answers

Match the following medications with their respective doses for Wide Complex Tachycardia from Bellaire Fire Department EMS Protocols:

<p>Amiodarone = 150mg IV/IO infusion over 10 minutes Lidocaine = 1.5mg/kg IV/IO Magnesium Sulfate = 2g IV/IO</p> Signup and view all the answers

In Bellaire Fire Department EMS Protocols, what is the recommended initial dose of Adenosine for stable Narrow Complex Tachycardia in adults?

<p>12mg rapid IV/IO (B)</p> Signup and view all the answers

According to Bellaire Fire Department EMS Protocols, Calcium Chloride and Sodium Bicarbonate can be administered in the same IV/IO line without flushing in between.

<p>False (B)</p> Signup and view all the answers

Name two induction agents for RSI according to Bellaire Fire Department EMS Protocols.

<p>Ketamine and Etomidate</p> Signup and view all the answers

In Bellaire Fire Department EMS Protocols for pediatric patients with hypoglycemia, the recommended dose of Dextrose is 10% ______ G infusion (250mL) IV/IO.

<p>25</p> Signup and view all the answers

Match the following 'P's from the Resuscitation Sequence Intubation 'The 6 P's' with their descriptions:

<p>Position = RAMP / HOB ≥ 20, Ear to sternal notch Preparation = Suction, Video laryngoscopy, bougie PreOx = Maintain highest SpO2 possible for at least 3 minutes Perfusion = Maintain MAP ≥ 70 mmHg PRN via IV Fluids, Blood Transfusion, and/or Vasopressors</p> Signup and view all the answers

According to Bellaire Fire Department EMS Protocols, which medication is NOT recommended for pediatric patients with Croup/Epiglottitis?

<p>Epinephrine (nebulized) (C)</p> Signup and view all the answers

In Bellaire Fire Department EMS Protocols, pediatric cardiac arrest is commonly caused by cardiovascular disease.

<p>False (B)</p> Signup and view all the answers

List three common signs/symptoms of sepsis as outlined in Bellaire Fire Department EMS Protocols.

<p>Fever and/or Hypothermia, Hypotension, Altered mental status, Tachypnea, Warm extremities, Hyper/Hypoglycemia</p> Signup and view all the answers

According to Bellaire Fire Department EMS Protocols for stroke management, Nicardipine infusion should be titrated to maintain BP < / mmHg.

<p>185/110</p> Signup and view all the answers

Match the following components of the LEMON mnemonic with their corresponding descriptions from Bellaire Fire Department EMS Protocols:

<p>L - Look Externally = Assess external factors indicating difficult intubation E - Evaluate 3-3-2 Rule = Assess thyromental anatomy M - Mallampati = Assess anatomy of the mouth and view of anatomical structures N - Neck Mobility = Assess neck movement</p> Signup and view all the answers

In Bellaire Fire Department EMS Protocols, which of the following is NOT a differential diagnosis for Syncope/Near Syncope?

<p>Hyperglycemia (B)</p> Signup and view all the answers

According to Bellaire Fire Department EMS Protocols, for GYN Emergencies related to pregnancy, consider placing the patient in the right lateral recumbent position.

<p>False (B)</p> Signup and view all the answers

Name two medications recommended for severe (life-threatening) agitation/hyperactive delirium as per Bellaire Fire Department EMS Protocols.

<p>Versed and Ketamine</p> Signup and view all the answers

According to Bellaire Fire Department EMS Protocols, for severe (life-threatening) agitation/hyperactive delirium, the dose of Ketamine IM is ______ mg/kg (Ideal Body Weight).

<p>4</p> Signup and view all the answers

Match the following airway procedures with their descriptions from Bellaire Fire Department EMS Protocols:

<p>Cricothyrotomy = Surgical airway when intubation fails Delayed Sequence Intubation = Sedation before intubation to improve oxygenation Go-PAP = CPAP for respiratory distress in spontaneously breathing patients Bougie Tube Introducer = Facilitates intubation, especially with video laryngoscopy</p> Signup and view all the answers

According to Bellaire Fire Department EMS protocols, EMS personnel are required to contact the Medical Director for all patient care decisions.

<p>False (B)</p> Signup and view all the answers

In Bellaire Fire Department EMS protocols, the resource for consultation, advice, guidance, and authorization for treatment not specifically addressed in standard orders is ___________.

<p>On-Line Medical Control (OLMC)</p> Signup and view all the answers

Match the following EMS credential levels with their description of medical privileges according to Bellaire Fire Department EMS Protocols:

<p>Emergency Medical Technician (EMT) = Administration of BLS medications and procedures, including ECG acquisition and blood glucose analysis. Advanced Emergency Medical Technician (AEMT) = EMT level skills plus endotracheal intubation, venipuncture, and non-narcotic medication administration under paramedic supervision. Paramedic I (Attendant) = EMT and AEMT level skills, plus all paramedic level skills except RSI/DSI patient primary caregiver role, cricothyrotomy, finger thoracostomy and whole blood transfusions. Paramedic II (In Charge) = Full comprehensive and unrestricted off-line medical privileges, including surgical airway if credentialed and ultrasound utilization.</p> Signup and view all the answers

Which of the following is NOT a component of the Primary Assessment in Bellaire Fire Department EMS protocols?

<p>Detailed physical head-to-toe exam. (A)</p> Signup and view all the answers

According to the Bellaire Fire Department EMS protocols, supplemental oxygen is always needed for patients with respiratory distress, regardless of SpO2.

<p>False (B)</p> Signup and view all the answers

List three diagnostic procedures authorized under Bellaire Fire Department EMS Protocols at the clinician's discretion.

<p>Blood Glucose Analysis, Blood Pressure Measurement, Cardiac Monitoring (4-Lead or 12-Lead EKG), End Tidal CO2 monitoring, SpO2 measurement, Temperature measurement.</p> Signup and view all the answers

Which of the following is TRUE regarding physician on-scene protocols for Bellaire Fire Department EMS?

<p>BFD personnel may aid and assist an on-scene physician but should not perform procedures outside their scope of practice. (C)</p> Signup and view all the answers

In Bellaire Fire Department EMS Protocols, patient preference regarding hospital destination is always honored, even in critical medical situations.

<p>False (B)</p> Signup and view all the answers

According to Bellaire Fire Department EMS protocols, Trauma Triage & Bypass Algorithm is defined as transporting the patient to the most appropriate, ________ facility.

<p>closest</p> Signup and view all the answers

Which of the following is the recommended initial medication for Asystole/PEA in adults, according to Bellaire Fire Department EMS protocols?

<p>Epinephrine 1:10,000 (B)</p> Signup and view all the answers

In Bellaire Fire Department EMS protocols, defibrillation is the first and most crucial step in treating Asystole.

<p>False (B)</p> Signup and view all the answers

Name three 'H' or 'T' treatable causes listed in Bellaire Fire Department EMS protocols that should be considered in patients with Asystole/PEA.

<p>Hypovolemia, Hypoxia/Hypoxemia, Hydrogen Ion (acidosis), Hypo/Hyperkalemia, Hypothermia, Tamponade, Toxins, Tension pneumothorax, Thrombosis (coronary or pulmonary).</p> Signup and view all the answers

For a patient in V-Fib/Pulseless V-Tach refractory to initial defibrillation, which antiarrhythmic medication is recommended first in Bellaire Fire Department EMS protocols?

<p>Amiodarone (C)</p> Signup and view all the answers

According to Bellaire Fire Department EMS protocols, it is acceptable to administer Calcium Chloride and Sodium Bicarbonate through the same IV/IO line simultaneously to save time during cardiac arrest.

<p>False (B)</p> Signup and view all the answers

In post-ROSC care, Bellaire Fire Department EMS protocols recommend maintaining a Mean Arterial Pressure (MAP) of at least ______ mmHg, or higher if Traumatic Brain Injury is suspected.

<p>70</p> Signup and view all the answers

Match the conditions with the recommended initial medication for stable patients according to Bellaire Fire Department EMS Protocols:

<p>Narrow Complex Tachycardia = Adenosine A-Fib/A-Flutter = Diltiazem Bradycardia = Atropine CHF/Pulmonary Edema = Nitroglycerin</p> Signup and view all the answers

In Bellaire Fire Department EMS protocols, what is the recommended initial dose of Diltiazem for stable A-Fib/A-Flutter in patients under 65 years old?

<p>0.25mg/kg slow push IV/IO (D)</p> Signup and view all the answers

Cardioversion is the first-line treatment for stable A-Fib/A-Flutter according to Bellaire Fire Department EMS protocols.

<p>False (B)</p> Signup and view all the answers

List two sedation options for patients with bradycardia that may be considered if pacing or epinephrine infusion is necessary, according to Bellaire Fire Department EMS protocols.

<p>Fentanyl, Ketamine, Versed.</p> Signup and view all the answers

Which of the following is NOT a differential diagnosis for CHF/Pulmonary Edema listed in Bellaire Fire Department EMS Protocols?

<p>Hyperkalemia (B)</p> Signup and view all the answers

According to Bellaire Fire Department EMS Protocols, CPAP is contraindicated in the management of CHF/Pulmonary Edema.

<p>False (B)</p> Signup and view all the answers

For patients with CHF/Pulmonary Edema and hypotension, Bellaire Fire Department EMS protocols recommend considering a norepinephrine infusion titrated to maintain a MAP of greater than _______ mmHg.

<p>160</p> Signup and view all the answers

Match the following Narrow Complex Tachycardias with their medication management according to Bellaire Fire Department EMS Protocols:

<p>Stable Narrow Complex Tachycardia = Adenosine or Diltiazem Stable SVT with Pre-Excitation (WPW) = Amiodarone Unstable Narrow Complex Tachycardia = Synchronized Cardioversion</p> Signup and view all the answers

Which medication should be avoided in patients with Narrow Complex Tachycardia and suspected WPW according to Bellaire Fire Department EMS Protocols?

<p>Adenosine (C)</p> Signup and view all the answers

For unstable Wide Complex Tachycardia, Bellaire Fire Department EMS protocols recommend immediate medication administration before considering synchronized cardioversion.

<p>False (B)</p> Signup and view all the answers

Name three medication options for stable Wide Complex Tachycardia according to Bellaire Fire Department EMS Protocols.

<p>Amiodarone, Lidocaine, Magnesium Sulfate.</p> Signup and view all the answers

Which of the following is NOT a differential diagnosis for Wide Complex Tachycardia listed in Bellaire Fire Department EMS Protocols?

<p>Pulmonary Embolism (C)</p> Signup and view all the answers

According to Bellaire Fire Department EMS protocols, PVCs (Premature Ventricular Contractions) should always be treated in the field, especially if the patient is symptomatic.

<p>False (B)</p> Signup and view all the answers

In LVAD (Left Ventricular Assist Device) management, if a patient is breathing normally and there is no 'whirring' sound from the device, Bellaire Fire Department EMS protocols mandate contacting the ___________ Coordinator.

<p>VAD</p> Signup and view all the answers

Match the following medication options for Allergic Reaction/Anaphylaxis with their classification according to Bellaire Fire Department EMS Protocols:

<p>Epinephrine 1:1000 IM = First-line treatment for severe reaction Benadryl = Medication for mild reaction Dexamethasone = Medication for mild reaction Albuterol Nebulized = Medication for severe reaction</p> Signup and view all the answers

In Bellaire Fire Department EMS protocols for Allergic Reaction/Anaphylaxis, what is the recommended initial dose of Epinephrine 1:1000 IM for adults?

<p>0.5mg (A)</p> Signup and view all the answers

According to Bellaire Fire Department EMS protocols, Dexamethasone is the preferred first-line medication for severe anaphylactic reactions due to its rapid onset.

<p>False (B)</p> Signup and view all the answers

For patients with cold exposure/hypothermia, Bellaire Fire Department EMS protocols emphasize active rewarming including blankets, warm environment, and removing wet clothing, but specifically advise against placing hot packs _________ on skin.

<p>directly</p> Signup and view all the answers

Match the severity levels of hypothermia with their corresponding temperature ranges according to Bellaire Fire Department EMS Protocols:

<p>Mild Hypothermia = 35-32.1C (95-89.8F) Moderate Hypothermia = 32-28C (89.7-82.5F) Severe Hypothermia = &lt; 28C (&lt;82.4F)</p> Signup and view all the answers

What is the primary goal of treatment for exertional heat stroke according to Bellaire Fire Department EMS Protocols?

<p>Rapid active cooling to reduce core body temperature (A)</p> Signup and view all the answers

According to Bellaire Fire Department EMS Protocols, administration of high-flow oxygen is always indicated for patients with heat stroke.

<p>False (B)</p> Signup and view all the answers

List two medication options for pain management in adult patients according to Bellaire Fire Department EMS Protocols.

<p>Ofirmev, Toradol, Fentanyl, Ketamine, Droperidol (for migraines).</p> Signup and view all the answers

According to Bellaire Fire Department EMS Protocols, for which type of pain is Droperidol specifically indicated?

<p>Migraines (C)</p> Signup and view all the answers

In cases of abdominal pain, Bellaire Fire Department EMS protocols recommend obtaining a 12-lead ECG only if cardiac etiology is suspected.

<p>False (B)</p> Signup and view all the answers

Bellaire Fire Department EMS protocols state that all healthcare providers are obligated by law to report cases of suspected abuse or neglect to the receiving healthcare facility, law enforcement, and either Adult or Child ___________ Services.

<p>Protective</p> Signup and view all the answers

Match the following potential causes of Altered Mental Status with their corresponding 'AEIOU-TIPS' category according to Bellaire Fire Department EMS Protocols:

<p>Low blood sugar = I - Insulin (Hypoglycemia) Electrolyte imbalance = E - Endocrine, Electrolytes, Environmental Stroke = S - Stroke, Seizures, Syncope Overdose = O - Overdose, Oxygen</p> Signup and view all the answers

Which of the following is NOT a treatable underlying cause of Altered Mental Status listed in Bellaire Fire Department EMS Protocols?

<p>Dementia (D)</p> Signup and view all the answers

According to Bellaire Fire Department EMS protocols, asymptomatic hypertension should always be aggressively treated in the prehospital setting to prevent stroke.

<p>False (B)</p> Signup and view all the answers

What is the recommended goal for MAP (Mean Arterial Pressure) reduction in patients with Hypertensive Emergency, according to Bellaire Fire Department EMS Protocols?

<p>15-20%</p> Signup and view all the answers

Which of the following is NOT a differential diagnosis for Hyperglycemia listed in Bellaire Fire Department EMS Protocols?

<p>Hypothyroidism (D)</p> Signup and view all the answers

According to Bellaire Fire Department EMS Protocols, low ETCO2 readings can be predictive of DKA in hyperglycemic patients.

<p>True (A)</p> Signup and view all the answers

In Bellaire Fire Department EMS protocols, the maximum single dose of Dextrose 10% 25G infusion (250mL) IV/IO for adult hypoglycemia is ______ G.

<p>50</p> Signup and view all the answers

Match the following medication options for Hypoglycemia with their administration route according to Bellaire Fire Department EMS Protocols:

<p>Dextrose 10% 25G infusion (250mL) = IV/IO Glucagon = IM (if unable to obtain vascular access) Oral Glucose = PO (if patient is alert and able to swallow)</p> Signup and view all the answers

According to Bellaire Fire Department EMS Protocols, which of the following is NOT a differential diagnosis of Hypoperfusion?

<p>Cardiogenic Shock (C)</p> Signup and view all the answers

According to Bellaire Fire Department EMS Protocols, hyperventilation therapy is routinely recommended for all patients with suspected brain injury and increased ICP.

<p>False (B)</p> Signup and view all the answers

List three potential causes of distributive shock as listed in Bellaire Fire Department EMS Protocols.

<p>Sepsis, Anaphylaxis, Neurogenic Shock.</p> Signup and view all the answers

Which of the following is NOT a sign or symptom of Nausea/Vomiting listed in Bellaire Fire Department EMS Protocols?

<p>Bradycardia (A)</p> Signup and view all the answers

According to Bellaire Fire Department EMS Protocols, a 12-lead ECG is only necessary for nausea and vomiting if the patient also presents with chest pain.

<p>False (B)</p> Signup and view all the answers

In Overdose/Toxicology management, Bellaire Fire Department EMS protocols emphasize calling ____________ (800-222-1222) as soon as possible for all toxic exposures/ingestions.

<p>Poison Control</p> Signup and view all the answers

Match the following toxicities with their specific antidote/treatment according to Bellaire Fire Department EMS Protocols:

<p>Opioid Toxicity = Naloxone Beta-Blocker Toxicity = Glucagon Calcium-Channel Blocker Toxicity = Calcium Chloride Cyanide Toxicity = Cyanokit (Hydroxycobalamin)</p> Signup and view all the answers

Which of the following is NOT a differential diagnosis for seizures/convulsions listed in Bellaire Fire Department EMS Protocols?

<p>Hyperkalemia (A)</p> Signup and view all the answers

According to Bellaire Fire Department EMS Protocols, benzodiazepines like Midazolam are contraindicated in seizure management due to their potential to cause hypotension.

<p>False (B)</p> Signup and view all the answers

List two non-OB related medication options for seizures/convulsions according to Bellaire Fire Department EMS Protocols.

<p>Midazolam, Ketamine.</p> Signup and view all the answers

What is the primary initial treatment for Sepsis according to Bellaire Fire Department EMS Protocols?

<p>Fluid resuscitation with Normal Saline (C)</p> Signup and view all the answers

According to Bellaire Fire Department EMS Protocols, serial 12-lead ECGs are not necessary for patients with ACS/STEMI if the initial 12-lead ECG is diagnostic.

<p>False (B)</p> Signup and view all the answers

In stroke management according to Bellaire Fire Department EMS Protocols, Nicardipine infusion should be titrated to maintain blood pressure below / mmHg.

<p>185/110</p> Signup and view all the answers

According to Bellaire Fire Department EMS protocols, which of the following is a fundamental component of their standard of care?

<p>Aggressive application of airway establishment and maintenance. (A)</p> Signup and view all the answers

Expired state licensure for prehospital care providers does not require immediate cessation of medical duties if the provider is actively seeking renewal.

<p>False (B)</p> Signup and view all the answers

What is the minimum frequency for obtaining a 12-Lead EKG on patients requiring continuous cardiac monitoring as per Bellaire Fire Department EMS protocols?

<p>Every five (5) minutes</p> Signup and view all the answers

According to Bellaire Fire Department EMS protocols, for patients with suspected brain injury and signs of herniation, the ventilatory rate should be primarily based on maintaining an End Tidal CO2 (EtCO2) reading of ______ mmHg.

<p>30-40</p> Signup and view all the answers

Match the following hospital capabilities with their respective Texas Medical Center Hospitals as listed in the Bellaire Fire Department EMS Protocols:

<p>Level I Trauma Center, Comprehensive Stroke Center = Memorial Hermann TMC Level I Pediatric Trauma Center = Texas Children’s Hospital TMC LVAD Facility = CHI St. Luke’s TMC Primary Stroke Center = VA Medical Center</p> Signup and view all the answers

In Bellaire Fire Department EMS protocols, which of the following is NOT an exclusionary criterion for transporting a patient to a Free Standing Emergency Department?

<p>Patients with minor trauma such as bruises or sprains. (A)</p> Signup and view all the answers

In Bellaire Fire Department EMS protocols, for a patient in cardiac arrest due to drowning in cold water, resuscitation efforts should cease if the patient's core temperature is below 32 degrees Celsius.

<p>False (B)</p> Signup and view all the answers

What is the recommended initial dose of Epinephrine 1:10,000 for an adult patient in Asystole/PEA, according to Bellaire Fire Department EMS protocols?

<p>1mg IV/IO</p> Signup and view all the answers

In Bellaire Fire Department EMS protocols for ACS/STEMI, Aspirin 324mg PO should be administered within the first ______ minutes of patient contact, if not contraindicated.

<p>5</p> Signup and view all the answers

Match the following medications with their initial doses for Adult Bradycardia as per Bellaire Fire Department EMS Protocols:

<p>Atropine = 1.0mg IV/IO Norepinephrine infusion = 2-30mcg/min Epinephrine infusion = 2-10mcg/min Fentanyl (for sedation) = 50-100 mcg IV/IO</p> Signup and view all the answers

According to Bellaire Fire Department EMS protocols, what is the preferred initial medication for stable Narrow Complex Tachycardia?

<p>Adenosine (B)</p> Signup and view all the answers

In Bellaire Fire Department EMS protocols, for Wide Complex Tachycardia, synchronized cardioversion is indicated only if the patient is hypotensive.

<p>False (B)</p> Signup and view all the answers

What is the initial dose of Diltiazem for stable A-Fib/A-Flutter in patients under 65 years old, as per Bellaire Fire Department EMS protocols?

<p>0.25mg/kg slow push IV/IO over 2 minutes</p> Signup and view all the answers

Bellaire Fire Department EMS protocols recommend maintaining a Mean Arterial Pressure (MAP) of greater than or equal to ______ mmHg for fluid resuscitation in hypotensive patients.

<p>70</p> Signup and view all the answers

Match the following formulary medications with their appropriate weight-based pediatric doses as per Bellaire Fire Department EMS protocols:

<p>Epinephrine (for Anaphylaxis) = 0.01mg/kg IM 1:1000 Midazolam (for Seizures) = 0.1mg/kg IV/IO Ketamine (for Pain Management) = 0.2mg/kg IV/IO Amiodarone (for V-Fib/Pulseless V-Tach) = 5mg/kg IV/IO</p> Signup and view all the answers

According to Bellaire Fire Department EMS protocols, which of the following is the preferred initial treatment for symptomatic Bradycardia?

<p>Transcutaneous Pacing (A)</p> Signup and view all the answers

In Bellaire Fire Department EMS protocols, for patients with CHF/Pulmonary Edema, Nitroglycerin infusion should be titrated to maintain a Mean Arterial Pressure (MAP) greater than 100mmHg.

<p>False (B)</p> Signup and view all the answers

List three medications, besides Amiodarone, that are listed as medication options for refractory V-Fib/V-Tach in the Bellaire Fire Department EMS protocols.

<p>Epinephrine, Lidocaine, Magnesium Sulfate, Calcium Chloride, Sodium Bicarbonate</p> Signup and view all the answers

According to Bellaire Fire Department EMS protocols, for Allergic Reaction/Anaphylaxis, the dose of Epinephrine 1:1000 IM (Under Paramedic Supervision) is ______ mg.

<p>0.5</p> Signup and view all the answers

Match the signs/symptoms of Allergic Reaction/Anaphylaxis with their severity level according to Bellaire Fire Department EMS protocols:

<p>Urticaria, Hives, Itching, Erythema (one organ system) = Mild Bronchoconstriction, Dyspnea, Hypoxia (two or more organ systems) = Moderate/Severe Nausea, Vomiting (two or more organ systems) = Moderate/Severe Angioedema (two or more organ systems) = Moderate/Severe</p> Signup and view all the answers

Flashcards

On-Line Medical Control (OLMC)

Following guidelines when deviating outside standard orders.

Paramedic II (In Charge)

Authority for paramedics with complete off-line medical privileges.

NEONATE

From gestational birth date to 28 days

INFANT

Greater than 1 month and less than 1 year old

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PEDIATRIC

Between 1 and 13 years of age

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ADULT

Greater than 13 years of age

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Breathing Assessment

Respiratory rate, rhythm, and quality

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Normoxia

Greater than or equal to 94% oxygen saturation

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Spinal Motion Restriction (SMR)

Spinal stability during movement

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EMS Response

Review dispatch data and select the appropriate response.

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Secondary Assessment

A rapid, semi-structured patient assessment.

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Assessing Breath Sounds

Auscultate 4 points anterior and posterior

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Temperature Assessment

Core body temperature determination

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Advanced Airway

Provide a patent airway.

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Cardiac Monitoring

4 Lead and 12 lead EKGs

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Primary assessment

Airway, breathing, circulation. Correct problems before proceeding.

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On-scene non-BFD Physician

Non-medical-control physician must be documented.

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Trauma Triage

Bypassing smaller facilities for rapid transport

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"Physician on scene"

When a physician is at the emergency scene.

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The EMS response

Review the dispatch, consider more resources.

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Voluntary Transport

The patient's wishes are most important.

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Medical Air transport

All airway rules apply, consider risks.

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The pediatric assessment triangle(PAT)

An easy and quick way to assess a patients health.

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Scene Size-Up

Look outside and check for dangers and extra help needed

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Deacon Titel

The fire chief in charge of EMS

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Dr. Lars Testrup

The primary doctor physician

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apparatus/unit phone

All calls that all must be done

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"On the scene"

Medical legal responsibility for a patient.

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Study Notes

  • Bellaire Fire Department Emergency Medical Services (EMS) Protocols for 2025 aim to guide pre-hospital care.
  • Clinical competence, high standards, education, experience, and judgment are vital components of care
  • All calls made to the Medical Director should be done from the unit/apparatus phone
  • The document acknowledges the importance of early medical interventions

State Licensure and EMS Credentialing

  • Bellaire Fire Department (BFD) recognizes various state licensing levels for prehospital care providers
  • Credentials include Emergency Care Attendant (ECA), EMT-Basic, Advanced EMT, and Paramedic
  • Each licensure level must be in good standing with the Texas Department of State Health Services and not expired
  • BFD utilizes internal credentialing process for Emergency Medical Technicians
  • Apply electrodes, do blood glucose analysis, administer nebulized albuterol sulfate, oral acetaminophen and nitroglycerin, and supraglottic airway placement.
  • Designated EMTs can provide patient care en route without interventions that exceed their skill level.
  • AEMTs can perform endotracheal intubation, initiate venipuncture procedures with non-narcotic authorization from a paramedic
  • Paramedic I (Attendant) performs same skill as EMT's but can initiate medical interventions under higher authority.
  • Paramedic II (In Charge) has full medical privileges, some new individual procedures may be limited over time.
  • FTOs have comprehensive medical privileges

General Patient Care Basics

  • Review dispatch, ensure enough resources
  • Don appropriate PPE
  • Address MOI/NOI if MCI, begin triage
  • Neonates must be cared for via gestational birthdates to 28 days
  • Infants should be >1Mo <1 year of age
  • Pediatrics should be in the year range of 1-13 and age
  • Adults > 13 Years of age
  • Stabilize the cervical spine, when appropriate.
  • Rapidly assess Level of Consicousness (LOC) alert, Verbal, Pain, Unresponsive
  • Suction airway, if needed, as needed, consider a tracheostomy and more

General Therapies Overview

  • Measuring core body temperature is necessary to understand the effect of environmental conditions on the body.
  • Measuring body temperature is sublingual and more accurate with rectal readouts
  • Airway-management that has had specialized training for airway or the medical director.
  • IO/IV access to start immediate fluids and or medications
  • Mean Arterial Pressure of 70 mmHG for intravenous fluid resuscitations
  • SpO2 < 94% for supplemental O2 therapy to patients
  • Med administration according to professional standing regulations
  • End tidal CO2 monitoring for patients

Physician on Scene Protocols

  • Responsibility for pre-hospital medical direction lies with the most trained personnel
  • Identify chain of command between Physician that's a non-medical control Physician and an attending Physician
  • BFD personnel can accept orders from patient's doctor over the phone
  • Paramedics have the final decision

Transportation

  • Sick or injured should be directed to the local emergency department
  • Non-emergent and emergency transport of certain patients
  • Patients with trauma should be transported using the Trauma Triage & Bypass Algorithm
  • Medics should load as many patients as they are able before directing to other units
  • Transport in other vehicles with direction of power staff only
  • Select transports who may not be a good frequenter of the EMS system with other previous planning
  • These primarily are STEMI, Stroke/CVA, Level 1 Trauma and other
  • Free standing ED transports require medical director approval
  • Patients must be in declared disasters with approval to be transported
  • Low acuity/priority is considered where there is abdominal pain, fever, urinary, respiratory infections etc

Hospital Designations

  • Free Standing is an ambulatory surgical center, full time on staff physician

Standing Orders

  • Standing Orders function as a model
  • Must be certified by the department of health services
  • Voice Communication to receiving center is essential, make prompt contact
  • Basic needs include a open patent airway with spinal control with oxygen

Adult Medical

Asystole/PEA

  • History or Early/Effective CPR, no electrical activity
  • Pulseless and Apneic
  • Treat underlying, hypovolemia and hyperkalemia, hypoxia
  • Begin CPR; give oxygen, follow prompts and assess levels, blood glucose for all the other conditions
  • 1mg IV Epi, Sodium Bicarbonate, Calcium Chorlide as treatments

VFib/Pulse V-Tac

  • Wide arrhythmia, no cardiac output
  • Similar underlying treatment principles with different management
  • Consider advanced airways
  • Amiodarone, Epi given for the cases, shock as the best management

ROSC

  • Palpable Pulse and Spontaneous Respiration Return with proper treatment
  • Oxygen, glucose assessment
  • Transport and management to facility

Acute Coronary System/ ST Elevatred MI (STEMI)

  • chest pain associated with heart damage
  • Primary treatment assessment is to give 324mg Aspirin and nitro to assist oxygenation
  • IO, IV attempts with large bore needles and proximal access to push
  • Fentanyl or comfort, treatment

Pediatric Emergencies

  • Similar treatments for smaller patients
  • Use of appropriate dosing based on the chart of age, weight and size in each scenario
  • High quality CPR and understanding with the PALS courses and knowledge

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