Emergency Medical Services
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Questions and Answers

What is regulated under the Controlled Substances Act?

  • Medication delivery and administration records
  • Departmental policies regarding medication storage
  • A drug or chemical substance (correct)
  • Emergency Medical Services (EMS) protocols

    • Who should be contacted for questions or concerns regarding controlled substances?

  • The Controlled Substance Manager (correct)
  • The Hanover County RSI Protocol
  • The Old Dominion EMS Alliance
  • The United States Department of Justice

    • How often are medications stored in the storage area inventoried?

  • Weekly
  • Daily
  • Monthly (correct)
  • Quarterly

    • Where are records pertaining to medication delivery, dispensing, and administration maintained?

    <p>In the storage area</p> Signup and view all the answers

    What is the purpose of updating the box?

    <p>To include filled date, initials of person filling the box, and seal numbers</p> Signup and view all the answers

    What is required for all staff members that have access to the storage area?

    <p>Training on proper record keeping</p> Signup and view all the answers

    What is the name of the protocol that regulates controlled substances?

    <p>Controlled Substances Act</p> Signup and view all the answers

    Who is responsible for maintaining up-to-date records?

    <p>The Controlled Substance Manager</p> Signup and view all the answers

    What is the recommended dose of Fentanyl for RSI?

    <p>1-3mcg/kg IV</p> Signup and view all the answers

    Which of the following is a contraindication for Succinylcholine?

    <p>Pseudocholinesterase deficiencies</p> Signup and view all the answers

    What is the recommended dose of Etomidate for RSI?

    <p>0.3mg/kg</p> Signup and view all the answers

    Why is Atropine used in RSI?

    <p>To manage symptomatic bradycardia</p> Signup and view all the answers

    What is the recommended dose of Rocuronium for RSI in Tier 2 adults?

    <p>1.0mg/kg</p> Signup and view all the answers

    What is the purpose of evaluating eyelash response and mandible tension?

    <p>To await flaccid paralysis or adequate relaxation</p> Signup and view all the answers

    What should be done if oxygen saturation drops below 92% during RSI?

    <p>Stop the procedure and provide oxygenation and ventilation support</p> Signup and view all the answers

    Who should perform the intubation if the first attempt by the second ALS provider is not successful?

    <p>The RSI paramedic</p> Signup and view all the answers

    What is included in the narrative by the intubating medic during Endotracheal Intubation?

    <p>Landmarks visualized, use of bougie introducer, and verification</p> Signup and view all the answers

    What is the purpose of transferring interventions and vital signs from the cardiac monitor/defibrillator?

    <p>To import them into the patient care report</p> Signup and view all the answers

    What is included in the narrative by the RSI medic during Rapid Sequence Intubation?

    <p>Clinical course, procedure, and report to receiving physician</p> Signup and view all the answers

    What is the purpose of the patient care report?

    <p>To reflect transfer of patient care to receiving personnel</p> Signup and view all the answers

    What is included in the essential benchmark interventions?

    <p>12 Lead ECG, Waveform capnography, and Cardiac electrical therapies</p> Signup and view all the answers

    What is the purpose of verifying placement and patency during Intraosseous vascular access?

    <p>To ensure safe and effective vascular access</p> Signup and view all the answers

    What is included in the narrative by the provider during Cricothyroidotomy?

    <p>Clinical course, landmark identification, verification and report to physician</p> Signup and view all the answers

    What is transferred from the first response units to transport units during patient care?

    <p>Patient status and transfer of care</p> Signup and view all the answers

    What is a sign of inadequate sedation and/or pain control?

    <p>Tearing at eyes</p> Signup and view all the answers

    What medication should be considered for extended transport or hypotensive patients?

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

    What is the recommended dose of Vecuronium for long-term paralysis?

    <p>0.1mg/kg IV</p> Signup and view all the answers

    Why should the dose of Midazolam be reduced or avoided?

    <p>If systolic BP is less than 100mmHg</p> Signup and view all the answers

    What should be recorded every five minutes during transport?

    <p>Vital signs and endotracheal tube placement</p> Signup and view all the answers

    What should be considered if intubation is unsuccessful after 2-3 attempts?

    <p>Maintaining a BLS airway for the duration of the transport</p> Signup and view all the answers

    Why is Ketamine used?

    <p>For rapid sedation if patient suddenly wakes and jeopardizes airway</p> Signup and view all the answers

    What medication should be considered for hypotensive patients, asthmatics, and trauma?

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

    What is the primary role of a Free-Standing Emergency Department?

    <p>To provide initial clinical evaluation and medical stabilization</p> Signup and view all the answers

    What happens to patients who require hospital admission after being treated at a Free-Standing Emergency Department?

    <p>They are transferred to an appropriate full-service hospital</p> Signup and view all the answers

    Which of the following patients should NOT be transported to a Free-Standing Emergency Department?

    <p>Patient with a suspected acute MI/STEMI</p> Signup and view all the answers

    What is the primary reason why pediatric patients with complicated medical conditions should not be transported to a Free-Standing Emergency Department?

    <p>They require more advanced care than what a Free-Standing Emergency Department can provide</p> Signup and view all the answers

    Which of the following patients can be transported to a Free-Standing Emergency Department?

    <p>Patient requiring a PEG tube replacement</p> Signup and view all the answers

    Why are patients transported from a medical facility or nursing home usually not transported to a Free-Standing Emergency Department?

    <p>Because they are not seeking a specific service available at the Free-Standing Emergency Department</p> Signup and view all the answers

    What is the typical mode of transportation for patients who require hospital admission after being treated at a Free-Standing Emergency Department?

    <p>EMS unit</p> Signup and view all the answers

    What is the primary goal of a Free-Standing Emergency Department in relation to EMTALA guidelines?

    <p>To provide initial clinical evaluation and medical stabilization</p> Signup and view all the answers

    What is the primary purpose of the EMS Report Quality Review and Quality Improvement process?

    <p>To assess patient care and documentation for compliance within standards</p> Signup and view all the answers

    What is the responsibility of the reviewer and all involved personnel during the quality review process?

    <p>To maintain the security of patient protected health information and confidentiality</p> Signup and view all the answers

    What should be done with any identified potential disciplinary or human resources issues during the quality review process?

    <p>They should be managed in accordance with Hanover County Human Resources Policy</p> Signup and view all the answers

    What should the designated reviewer provide to the involved personnel at the conclusion of each quality review?

    <p>A summary of findings and recommendations</p> Signup and view all the answers

    What should be documented and data collected for during the quality review process?

    <p>Each quality review</p> Signup and view all the answers

    What is the purpose of submitting patient care and medical case reviews to the Operational Medical Director?

    <p>To identify areas of improvement and provide feedback to providers</p> Signup and view all the answers

    What is the definition of a Quality Review?

    <p>The process of assessing patient care and documentation for compliance within standards</p> Signup and view all the answers

    What is the primary goal of the quality review process?

    <p>To identify areas of improvement and provide feedback to providers</p> Signup and view all the answers

    What triggers a general incident review?

    <p>High Risk/Significant Incident</p> Signup and view all the answers

    Who is responsible for overseeing the department's EMS quality review and improvement?

    <p>Quality Improvement Officer</p> Signup and view all the answers

    What is the role of the Operational Medical Director?

    <p>Reviews incidents and provides recommendations for improvement</p> Signup and view all the answers

    Who forwards identified operational concerns to the appropriate officer?

    <p>Quality Improvement Officer</p> Signup and view all the answers

    What is the purpose of the Assistant Chief of Operations?

    <p>Manages operations battalions and department response</p> Signup and view all the answers

    Who is the highest level reviewer of clinical incidents?

    <p>Operational Medical Director</p> Signup and view all the answers

    How can department personnel request incident review or post-incident analysis?

    <p>Through supervising officer or by making the appropriate selection within the EMS report</p> Signup and view all the answers

    Who designates quality reviewers?

    <p>Quality Improvement Officer</p> Signup and view all the answers

    What is the primary purpose of maintaining accurate records in the storage area?

    <p>To track medication usage and inventory</p> Signup and view all the answers

    Where should patients with an uncontrolled airway or unstable vital signs be transported to?

    <p>A full-service hospital</p> Signup and view all the answers

    Which of the following organizations regulates the possession and use of controlled substances?

    <p>United States Department of Justice, Drug Enforcement Administration</p> Signup and view all the answers

    Who is responsible for updating the box and maintaining accurate records?

    <p>The Controlled Substance Manager</p> Signup and view all the answers

    What is the primary function of Incident Quality Review and Quality Improvement?

    <p>To conduct quality improvement through continuous assessment and constructive feedback</p> Signup and view all the answers

    What is the purpose of the Deployment Log?

    <p>To record deployment of personnel and equipment</p> Signup and view all the answers

    What should be done if there is a question about the capabilities of the facility?

    <p>Contact the facility and speak to the ED Attending Physician</p> Signup and view all the answers

    What is the purpose of the accountability logs?

    <p>To track personnel accountability and equipment usage</p> Signup and view all the answers

    Why can patients with uncontrolled airways or unstable vital signs be transported to a full-service hospital near the free-standing Hanover Emergency Center?

    <p>Because the full-service hospital is close to the free-standing Hanover Emergency Center</p> Signup and view all the answers

    What is the purpose of the Hanover Fire EMS Procedures-Guidelines Manual?

    <p>To establish hospital destination policies</p> Signup and view all the answers

    What is the purpose of the narcotics count?

    <p>To ensure accurate counting and tracking of controlled substances</p> Signup and view all the answers

    What is the role of the Controlled Substance Manager?

    <p>To ensure accurate recordkeeping and updating the box</p> Signup and view all the answers

    What should be considered when deciding whether to transport a patient to a full-service hospital or a free-standing emergency department?

    <p>The patient's vital signs and medical condition</p> Signup and view all the answers

    What is the benefit of having a full-service hospital near the free-standing Hanover Emergency Center?

    <p>It allows for the transport of unstable patients to the full-service hospital</p> Signup and view all the answers

    What is the purpose of monthly inventory of medications in the storage area?

    <p>To detect and prevent diversion of controlled substances</p> Signup and view all the answers

    What is the primary goal of the Incident Quality Review and Quality Improvement process?

    <p>To provide quality improvement through continuous assessment and constructive feedback</p> Signup and view all the answers

    How do you remove the stylet from the needle?

    <p>Rotate the stylet counterclockwise and pull it out</p> Signup and view all the answers

    What is the recommended amount of blood to aspirate to confirm placement?

    <p>2 cc of blood</p> Signup and view all the answers

    How much sterile saline should be used to flush the needle?

    <p>10 cc of sterile saline</p> Signup and view all the answers

    What should be attached to the needle after flushing with sterile saline?

    <p>I.V. tubing</p> Signup and view all the answers

    Why should Lidocaine be considered for awake patients?

    <p>To reduce pain during the flush</p> Signup and view all the answers

    What should be applied to the patient after the procedure is complete?

    <p>A yellow instructional wrist band</p> Signup and view all the answers

    How long should the EZ-IO be left in place?

    <p>Up to 24 hours</p> Signup and view all the answers

    How should the EZ-IO be removed?

    <p>By pulling the hub while rotating gently in a clockwise fashion</p> Signup and view all the answers

    What is the primary method for documenting patient contacts?

    <p>Direct entry into the electronic reporting platform</p> Signup and view all the answers

    What should be done with a paper patient care report after transferring data to the electronic report?

    <p>Destroy the paper patient care report</p> Signup and view all the answers

    Why is it important to restrict access to paper patient care reports?

    <p>To prevent patient confidentiality breaches</p> Signup and view all the answers

    What is the primary purpose of documenting patient refusals?

    <p>To fully document the decision not to treat or transport a patient</p> Signup and view all the answers

    When is refusal documentation not indicated?

    <p>Stand-bys for fires, or hazardous materials incidents where no one is injured or exposed to hazardous material</p> Signup and view all the answers

    What is included in the process of properly documenting a patient contact?

    <p>Both direct entry and using a paper patient care report</p> Signup and view all the answers

    What is a prerequisite for a patient's decision to refuse care?

    <p>The patient must understand the consequences of the refusal</p> Signup and view all the answers

    Why is it important to scan all parts of the paper patient care report?

    <p>To capture all information, including patient refusal signatures</p> Signup and view all the answers

    Who has the right to refuse treatment and/or transportation?

    <p>Only competent adults</p> Signup and view all the answers

    What is the purpose of documenting patient contacts?

    <p>To provide proper emergency medical care</p> Signup and view all the answers

    What is the responsibility of Hanover Fire-EMS personnel?

    <p>Both to provide proper emergency medical care and to document patient contacts</p> Signup and view all the answers

    What is the responsibility of the EMS provider when obtaining a patient's refusal?

    <p>To properly assess the patient for any possible illness or injuries and inform the patient of the findings</p> Signup and view all the answers

    What is critical in handling patient documentation?

    <p>Proper handling</p> Signup and view all the answers

    What is an example of an event that may indicate refusal documentation?

    <p>A medical call initiated by the patient or family member</p> Signup and view all the answers

    Why is it important to document patient refusals?

    <p>To protect the EMS agency from liability</p> Signup and view all the answers

    What is the purpose of assessing the patient for any possible illness or injuries?

    <p>To ensure that the patient is properly evaluated for any potential medical conditions</p> Signup and view all the answers

    What is the purpose of updating the deployment log?

    <p>To ensure accountability of controlled substances</p> Signup and view all the answers

    Which agency regulates the possession and use of controlled substances?

    <p>Drug Enforcement Administration</p> Signup and view all the answers

    Who is responsible for maintaining accurate records of controlled substances?

    <p>Controlled Substance Manager</p> Signup and view all the answers

    What is included in the inventory of medications stored in the storage area?

    <p>All medications, including narcotics</p> Signup and view all the answers

    What is the purpose of training staff members on proper record keeping?

    <p>To ensure accurate maintenance of records</p> Signup and view all the answers

    What is the frequency of inventorying medications stored in the storage area?

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

    What is the purpose of having a Controlled Substance Manager?

    <p>To manage the storage of controlled substances</p> Signup and view all the answers

    What is the reference for the protocols used in Hanover Fire EMS?

    <p>Hanover County RSI Protocol</p> Signup and view all the answers

    When must personnel obtain a receiving physician's signature?

    <p>For specific medications and procedures, including Field Cease Resuscitation and on-line medical control</p> Signup and view all the answers

    What is required for a patient who is unable to sign due to incapacity or medical condition?

    <p>Two signatures, with the patient's family or legal power of attorney as the first choice</p> Signup and view all the answers

    Who should sign for a minor patient?

    <p>The patient's parent or legal guardian and the receiving hospital medical staff</p> Signup and view all the answers

    What is the purpose of obtaining patient authorization signatures for billing and HIPPA purposes?

    <p>To comply with billing and HIPPA regulations</p> Signup and view all the answers

    When is a patient's original signature the only signature required?

    <p>When the patient is awake, alert, and oriented</p> Signup and view all the answers

    What is the purpose of obtaining a receiving physician's signature for Field Cease Resuscitation?

    <p>To confirm that the patient's resuscitation efforts have been ceased</p> Signup and view all the answers

    What is the purpose of obtaining a receiving physician's signature for Rapid-Sequence Intubation?

    <p>To confirm that the patient's intubation has been successfully performed</p> Signup and view all the answers

    What is the purpose of obtaining a receiving physician's signature for on-line medical control?

    <p>To confirm that the patient's medical control has been performed under online medical direction</p> Signup and view all the answers

    What is the primary role of a Free-Standing Emergency Department?

    <p>To provide initial clinical evaluation and medical stabilization</p> Signup and view all the answers

    What happens to patients who require hospital admission after being treated at a Free-Standing Emergency Department?

    <p>They are transferred to an appropriate full-service hospital</p> Signup and view all the answers

    Which of the following patients SHOULD be transported to a Free-Standing Emergency Department?

    <p>Patients with minor injuries</p> Signup and view all the answers

    Why are patients transported from a medical facility or nursing home usually not transported to a Free-Standing Emergency Department?

    <p>Unless transported for a specific service available at the free standing ED</p> Signup and view all the answers

    What is the typical mode of transportation for patients who require hospital admission after being treated at a Free-Standing Emergency Department?

    <p>EMS unit</p> Signup and view all the answers

    What is the primary goal of a Free-Standing Emergency Department in relation to EMTALA guidelines?

    <p>To provide initial clinical evaluation and medical stabilization</p> Signup and view all the answers

    Which of the following patients should NOT be transported to a Free-Standing Emergency Department?

    <p>Acute MI/STEMI suspected or identified by 12 lead ECG</p> Signup and view all the answers

    What is the primary reason why pediatric patients with complicated medical conditions should not be transported to a Free-Standing Emergency Department?

    <p>Because the Free-Standing Emergency Department is not equipped to handle their conditions</p> Signup and view all the answers

    What is the purpose of the SOG for patient refusals?

    <p>To define the process and expectations for obtaining and documenting patient refusals</p> Signup and view all the answers

    Who has the right to refuse treatment and/or transportation?

    <p>Any competent adult</p> Signup and view all the answers

    What is necessary for a patient's decision to refuse care to be considered informed?

    <p>The patient must understand the consequences of the refusal</p> Signup and view all the answers

    What is an example of an event that may not indicate refusal documentation?

    <p>A patient who is an occupant of a minor crash or accident</p> Signup and view all the answers

    What is the responsibility of the EMS provider in obtaining an informed decision from a patient?

    <p>To properly assess the patient for any possible illness or injuries</p> Signup and view all the answers

    What is documented on the pre-hospital patient care report in the event of a patient refusal?

    <p>The refusal of care decision fully documented</p> Signup and view all the answers

    What is an event that generally indicates refusal documentation?

    <p>A medical call initiated by the patient or family member</p> Signup and view all the answers

    Why must a patient's decision to refuse care be an informed one?

    <p>So the patient understands the consequences of the refusal</p> Signup and view all the answers

    What should be considered if intubation attempts are unsuccessful and BVM ventilation is ineffective in adults?

    <p>Consider surgical cricothyroidotomy</p> Signup and view all the answers

    What is an important consideration when performing RSI on pediatric patients?

    <p>Ensuring the most experienced provider performs the intubation</p> Signup and view all the answers

    Why may lower dosages of paralytics be appropriate for geriatric patients?

    <p>Due to decreased renal or hepatic function</p> Signup and view all the answers

    What is a second-tier medication option for sedation per protocol in Tactical EMS Providers?

    <p>Approved through ODEMSA regional medication list</p> Signup and view all the answers

    What is a consideration when performing RSI on pediatric patients?

    <p>Obtaining online medical control from an appropriate facility</p> Signup and view all the answers

    What should be considered in geriatric patients regarding Succinylcholine?

    <p>Potential electrolyte imbalances</p> Signup and view all the answers

    What is a consideration for Tactical EMS Providers when performing RSI?

    <p>Sedation per protocol</p> Signup and view all the answers

    Why may Vecuronium metabolize faster in pediatric patients?

    <p>Due to faster pharmacokinetics in pediatric patients</p> Signup and view all the answers

    Which of the following patients may be transported to a free-standing emergency department?

    <p>Patient with general illness/complaint without comorbid or complicating factors</p> Signup and view all the answers

    What type of trauma is appropriate for transport to a free-standing emergency department?

    <p>MVC with minor or minimal complaints</p> Signup and view all the answers

    Which of the following conditions is not suitable for transport to a free-standing emergency department?

    <p>Patient with airway involvement</p> Signup and view all the answers

    What type of patient is suitable for transport to a free-standing emergency department for medical clearance?

    <p>Stable psychiatric patients in need of medical clearance</p> Signup and view all the answers

    Which of the following patients may be transported to a free-standing emergency department for observation?

    <p>Patient with resolved chief complaint requiring observation</p> Signup and view all the answers

    What type of complaint is suitable for transport to a free-standing emergency department?

    <p>General illness/complaint without comorbid or complicating factors</p> Signup and view all the answers

    Which of the following patients may be transported to a free-standing emergency department for minor trauma?

    <p>Patient with minor trauma, such as laceration repair</p> Signup and view all the answers

    What type of patient is suitable for transport to a free-standing emergency department for resolved hypoglycemia?

    <p>Patient with resolved hypoglycemia</p> Signup and view all the answers

    What is the primary goal of the Quality Improvement process?

    <p>To achieve measurable improvement in documentation and patient care</p> Signup and view all the answers

    What is the purpose of the Medication Storage and Recordkeeping procedure?

    <p>To ensure patient safety and health promotion</p> Signup and view all the answers

    What is the scope of the Medication Storage and Recordkeeping procedure?

    <p>All Hanover Fire-EMS Personnel</p> Signup and view all the answers

    What is the purpose of the Quality Review and Quality Improvement process?

    <p>To identify areas for improvement in patient care and documentation</p> Signup and view all the answers

    What may occur based on the recommendations of the Quality Improvement Officer?

    <p>Remedial training or disciplinary action</p> Signup and view all the answers

    What is the responsibility of all personnel in maintaining security of narcotics?

    <p>All personnel share the responsibility</p> Signup and view all the answers

    What is the primary goal of the Quality Improvement process in relation to High Risk/Significant Incidents?

    <p>To minimize the risk of serious harm to patients and department personnel</p> Signup and view all the answers

    What is the purpose of the EMS Report Quality Review and Quality Improvement process?

    <p>To identify areas for improvement in patient care and documentation</p> Signup and view all the answers

    What should be done to patients who are hemodynamically unstable when administering sedation/induction medications?

    <p>Half dose them</p> Signup and view all the answers

    What should be done to the RSI patient during transportation?

    <p>They should remain on the EMS cardiac monitor until physically transferred to the hospital stretcher</p> Signup and view all the answers

    What should the RSI Paramedic do after RSI?

    <p>Present the case and circumstance to the attending emergency physician</p> Signup and view all the answers

    Who should be notified if a conflict or complication develops during RSI?

    <p>The RSI Coordinator and OMD</p> Signup and view all the answers

    Why should the Microstream EtCO2 adapter be transferred to the hospital?

    <p>It is compatible with most receiving hospital Capnography monitors</p> Signup and view all the answers

    What should be verified before and after movement during RSI?

    <p>ET placement via waveform capnography</p> Signup and view all the answers

    What should be included in the documentation of RSI in the electronic Patient Care Report?

    <p>RSI procedure details and medications used</p> Signup and view all the answers

    What is the purpose of notification and documentation after RSI?

    <p>To create a recorded benchmark and CAD note</p> Signup and view all the answers

    Who can refuse treatment and transport after appropriate assessment, treatment, and informed consent?

    <p>Patients with demonstrated mental capacity</p> Signup and view all the answers

    What is required for patients under the age of 14 who refuse treatment?

    <p>Direct consent from the parent or legal guardian</p> Signup and view all the answers

    What is the primary consideration when dealing with a patient who refuses care?

    <p>Respecting the patient's autonomy</p> Signup and view all the answers

    What is the responsibility of every individual EMS provider?

    <p>To accurately assess patients and gather adequate information</p> Signup and view all the answers

    What should EMS personnel do if a patient refuses care?

    <p>Respect the patient's decision and not attempt to treat or transport</p> Signup and view all the answers

    What is required for patients with impaired mental capacity?

    <p>Appropriate medical power of attorney</p> Signup and view all the answers

    What should be documented in accordance with ODEMSA Patient Care Protocol 12.6?

    <p>All patient refusals</p> Signup and view all the answers

    What is the primary consideration for EMS personnel when dealing with a patient who refuses care?

    <p>Protecting themselves from potential harm</p> Signup and view all the answers

    What should be done with patients who have an uncontrolled airway or unstable vital signs unless extenuating circumstances exist?

    <p>Transport them to a full service hospital</p> Signup and view all the answers

    What is the location of the Hanover Emergency Center in relation to the Memorial Regional Medical Center?

    <p>In close proximity</p> Signup and view all the answers

    Who should be contacted if there is a question about the capabilities of a facility?

    <p>The ED Attending Physician as Medical Control</p> Signup and view all the answers

    What is the primary function of the Incident Quality Review and Quality Improvement process?

    <p>Conducting incident reviews and providing constructive feedback</p> Signup and view all the answers

    What is the goal of the Incident Review and Quality Improvement process?

    <p>To identify opportunities for improved processes</p> Signup and view all the answers

    What is the purpose of the EMS Report Quality Review and Quality Improvement process?

    <p>To identify opportunities for improved processes</p> Signup and view all the answers

    What should be done with any identified potential disciplinary or human resources issues during the quality review process?

    <p>Document and refer them to the appropriate authority</p> Signup and view all the answers

    What should be documented and data collected for during the quality review process?

    <p>Identified areas for improvement and corrective actions</p> Signup and view all the answers

    What is the primary sedation agent in the Hanover Fire EMS RSI kit?

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

    What is the initial paralytic medication in the Hanover Fire EMS RSI kit?

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

    What is the long-term paralytic medication in the Hanover Fire EMS RSI kit?

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

    What is the purpose of Atropine in the Hanover Fire EMS RSI kit?

    <p>Rescue of vagal response</p> Signup and view all the answers

    What type of airway device is included in the Hanover Fire EMS RSI kit?

    <p>Supraglottic device</p> Signup and view all the answers

    What is the recommended dose of Etomidate in the Hanover Fire EMS RSI kit?

    <p>40mg</p> Signup and view all the answers

    What is the purpose of the Hanover Fire EMS RSI kit?

    <p>To facilitate rapid sequence intubation</p> Signup and view all the answers

    What is included in the Hanover Fire EMS RSI kit for syringes and needles?

    <p>10ml, 20cc, 5cc, and 18 gauge needles</p> Signup and view all the answers

    What direction should the stylet be rotated to remove it?

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

    How much blood should be aspirated to confirm placement?

    <p>2 cc</p> Signup and view all the answers

    What should be used to flush the needle?

    <p>Sterile saline</p> Signup and view all the answers

    What should be attached to the needle after flushing?

    <p>I.V. tubing</p> Signup and view all the answers

    How long can the EZ-IO be left in place?

    <p>24 hours</p> Signup and view all the answers

    How should the EZ-IO be removed?

    <p>By pulling the hub while rotating clockwise</p> Signup and view all the answers

    What should be considered for awake patients prior to flushing the needle?

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

    What should be applied to the patient after attaching I.V. tubing?

    <p>Yellow instructional wrist band</p> Signup and view all the answers

    What is the primary purpose of performing a detailed neurological exam before administration of neuromuscular blockade in RSI?

    <p>To document the patient's pre-intubation neurological status</p> Signup and view all the answers

    What is the goal of pre-oxygenation in RSI?

    <p>To wash out nitrogen during the procedure</p> Signup and view all the answers

    Which of the following is an indication for RSI?

    <p>All of the above</p> Signup and view all the answers

    What should be done if oxygen saturation drops below 92% during RSI?

    <p>Abort the intubation procedure and call for assistance</p> Signup and view all the answers

    What is an essential component of the patient assessment prior to RSI?

    <p>All of the above</p> Signup and view all the answers

    Why is a thorough and detailed patient assessment essential prior to RSI?

    <p>To determine the need for RSI</p> Signup and view all the answers

    What should be included in the patient assessment prior to RSI?

    <p>All of the above</p> Signup and view all the answers

    What is the purpose of documenting assessment and impression prior to RSI?

    <p>To support medical decision-making and patient care</p> Signup and view all the answers

    Study Notes

    Endotracheal Intubation and Rapid Sequence Intubation

    • Endotracheal Intubation requires a narrative by the intubating medic, describing landmarks visualized, use of bougie introducer, and verification.
    • Rapid Sequence Intubation (RSI) requires a narrative by the RSI medic, outlining clinical course, procedure, and report to the receiving physician.

    Interventions and Vital Signs

    • Essential benchmark interventions include:
    • 12 Lead ECG
    • Waveform capnography
    • RSI medications
    • Cardiac medications
    • Cardiac electrical therapies
    • Interventions and vital signs shall be transferred from the cardiac monitor/defibrillator and imported into the patient care report prior to providing the report to the receiving facility.

    Patient Care Report

    • The PCR shall reflect the transfer of patient care to receiving personnel with a patient status.
    • This includes transfer of care from first response units to transport units, as well as from transport units to hospital staff.

    Free-Standing Emergency Departments

    • Free-Standing Emergency Departments provide initial clinical evaluation and medical stabilization in accordance with Federal EMTALA guidelines.
    • However, they do not provide admission on site.
    • Patients requiring hospital admission will be transferred from the free-standing emergency department to an appropriate full-service hospital, most often by an EMS unit.

    Patient Clinical Conditions

    • The following patient clinical conditions should not be transported to a free-standing emergency department:
    • Acute MI/STEMI suspected or identified by 12 lead ECG
    • Patients in Cardiac Arrest
    • Multiple System Trauma patients or patients who meet Trauma Triage criteria
    • Open fractures/surgical orthopedic patients, long bone fractures
    • Acute or suspected stroke patients/neurological deficits
    • Intubated patients
    • Pediatric patients with complicated medical conditions
    • Patients transported from a medical facility or nursing home, unless transported for a specific service available at the free-standing ED
    • Voluntary psychiatric patients seeking inpatient care

    Medication Storage and Recordkeeping

    • The box should be updated, including filled, dated, initials of the person filling the box, seal numbers, etc.
    • All other records should be updated, including the Deployment Log, accountability logs, and a narcotics count if applicable.

    Controlled Substances

    • Controlled Substance: A drug or chemical substance whose possession and use are regulated under the Controlled Substances Act.

    RSI Procedure

    • Select and administer an induction agent before paralysis.
    • Use of Fentanyl, Atropine, Etomidate, Rocuronium, Midazolam, Ketamine, and Vecuronium in RSI procedure.
    • Evaluate eyelash response and mandible tension after administration.
    • Intubate and place endotracheal tube per standard of practice, and confirm visually.
    • Limit intubation attempts to avoid hypoxia.
    • If first attempt by the second ALS provider is not successful, the RSI paramedic shall perform all subsequent attempts.
    • Sedation and analgesia medications will be determined by the provider based on patient presentation and clinical course.

    Long-Term Paralytics

    • Consider only if succinylcholine is used as the initial paralytic and the patient is sedated.
    • Clear communication of the time of the last paralytic to the receiving facility.

    Record Keeping

    • Record vital signs every five minutes and re-verify endotracheal tube placement with each movement.

    Patient Destination

    • Patients with uncontrolled airway or unstable vital signs should be transported to a full-service hospital unless extenuating circumstances exist.
    • The Hanover Emergency Center is in close proximity to the full-service Memorial Regional Medical Center, making transport to the full ED a viable option for unstable patients.

    EMS Report Quality Review and Quality Improvement

    • The primary function of Incident Quality Review and Quality Improvement is to provide quality improvement through continuous assessment and constructive feedback.
    • The goal of Incident Review and Quality Improvement is to understand how the department performs and identify opportunities for improved processes.
    • General Incident Review Criteria include:
      • Provider request for review
      • Officer request for review
      • High Risk/Significant Incident
      • Deviation from protocol during patient care
      • Delayed report completion
      • Bi-annual provider review
      • External or Internal complaint concerning patient care
    • The Quality Improvement Officer is responsible for overseeing the department's EMS quality review and improvement.
    • Designated Quality Reviewers assist with review and improvement of EMS reporting and care.

    EMS Report Quality Review and Quality Improvement Process

    • Statement of Facts and collected data
    • Incident as applied to referenced standards
    • Identify variance from standards
    • Recommendations for process improvement and training
    • Requests for improvement/completion of incident documentation
    • Patient care and medical case reviews are submitted to the Operational Medical Director for review.

    Medication Storage and Recordkeeping

    • Medication storage boxes should be updated, including filled date, initials of person filling the box, seal numbers, etc.
    • All other records should be updated, including the Deployment Log, accountability logs, and a narcotics count if applicable.

    Definitions

    • Quality Review: The process by which patient care and documentation are assessed for compliance within standards to identify areas of improvement and provide feedback to providers.
    • Controlled Substance: A drug or chemical substance whose possession and use are regulated under the Controlled Substances Act.

    Adults and Pediatrics EZ IO

    • Rotate the stylet counterclockwise to remove it.
    • Confirm placement by aspirating 2 cc of blood.
    • Flush the needle with 10 cc of sterile saline.
    • Attach I.V. tubing and cover with sterile dressing.
    • Apply a yellow instructional wrist band to the patient.
    • The EZ-IO should not be left in place for more than 24 hours.

    Patient Care Documentation (SOG)

    • Personnel must obtain receiving physician signature for specific medications and procedures, including Field Cease Resuscitation, Rapid-Sequence Intubation, administration of controlled substances, and on-line medical control for specific medications or procedures.
    • Deviation from ODEMSA or Department Patient Care Guidelines also requires receiving physician signature.
    • Patient authorization signatures for billing and HIPAA purposes are required for all transported patients.

    Patient Refusals (SOG)

    • Refusal of care decision must be fully documented on the pre-hospital patient care report.
    • Events indicating refusal documentation include medical calls initiated by the patient or family member, and obvious injuries or medical conditions.
    • Events that may not indicate refusal documentation include stand-bys for fires or hazardous materials incidents, routine blood pressure checks, and minor crashes or accidents.

    Documentation Procedure

    • All patient contacts should be properly documented, with direct entry into the electronic reporting platform as the primary method.
    • In situations where a paper patient care report is used, it should be properly documented, restricted to ensure patient confidentiality, and then transferred to the electronic report.

    Free-Standing Emergency Departments

    • These departments provide initial clinical evaluation and medical stabilization in accordance with Federal EMTALA guidelines.
    • Patients requiring hospital admission will be transferred to an appropriate full-service hospital, often by an EMS unit.
    • Certain patient clinical conditions, such as acute MI/STEMI, cardiac arrest, multiple system trauma, and acute stroke patients, should not be transported to a free-standing emergency department.

    Medication Storage and Recordkeeping (SOP)

    • The medication storage box should be updated regularly, including the fill date, initials of the person filling the box, seal numbers, etc.
    • All other records, including the Deployment Log, accountability logs, and narcotics count, should also be updated.
    • The Controlled Substance Manager is responsible for addressing questions or concerns regarding medication storage and recordkeeping.

    Patient Refusals (SOG)

    • The purpose of this SOG is to define the process and expectations for obtaining and documenting patient refusals for any and all incidents.
    • Refusal of care must be fully documented on the pre-hospital patient care report as required by 12VAC5-31-1090.
    • Events that indicate refusal documentation include:
    • Any medical call initiated by the patient or family member
    • Reason to believe that the person has a medical condition that requires further treatment or transportation
    • Obvious injury
    • Events that may not indicate refusal documentation include:
    • Stand-bys for fires or hazardous materials incidents with no injuries or exposure
    • Routine blood pressure checks with normal findings and no other complaint
    • Ambulatory person with minor crash or accident who does not wish to be evaluated

    Patient Refusal Prerequisites

    • Any competent adult has the right to refuse treatment and/or transportation offered by an EMS agency
    • The decision to refuse care must be an informed one
    • The patient must understand the consequences of the refusal
    • The EMS provider is responsible for properly assessing the patient and informing them of the findings

    Patient Destination (SOG)

    • Patient clinical conditions that may be appropriate for transport to a free-standing emergency department include:
    • General illness/complaint without comorbid or complicating factors
    • Musculoskeletal pain
    • Eyes, ears, nose, throat complaints without airway involvement
    • Minor trauma
    • Resolved hypoglycemia
    • Improving, uncomplicated allergic reaction
    • Stable psychiatric patients in need of medical clearance

    Quality Improvement

    • Consists of systematic and continuous actions that lead to measurable improvement in documentation and patient care
    • May result in remedial training, disciplinary action, or revoked privileges

    Medication Storage and Recordkeeping (SOP)

    • The purpose of this policy is to train members of the department on the procedure for accurate record keeping and accountability for narcotics stored by Hanover Fire-EMS
    • Applies to all Hanover Fire-EMS Personnel
    • Ensures patient safety and health promotion related to impairment among healthcare providers

    Rapid Sequence Intubation (RSI) (SOG)

    • Considerations for RSI include:
    • Pediatric patients: consider only if skill set of RSI Paramedic and crew matches the situation
    • Geriatric patients: consider potential electrolyte imbalances and lower dosages of paralytics
    • Tactical EMS Providers: consider sedation and pain management per protocol
    • Transportation considerations:
    • Patients should be transported to the most appropriate facility for the clinical problem
    • Notify receiving facility of the need for ventilator and additional sedation
    • RSI patients should remain on the EMS cardiac monitor until physically transferred to the hospital stretcher
    • Verification of ET placement should occur before and after movement via waveform capnography

    Patient Refusals

    • Adults, emancipated minors (between 14 to 18 years old), and patients with demonstrated "mental capacity" can refuse treatment and transport after appropriate assessment, treatment, and informed consent.
    • Patients with mental capacity are defined as being alert, oriented, and able to understand the circumstances surrounding their illness or impairment, and the risks associated with refusal.
    • Patients under 14 years old cannot refuse treatment without direct consent from their parent or legal guardian.
    • Patients with impaired mental capacity, such as those under the influence of mental illness, drugs, or physical/mental impairment, may have limited ability to refuse treatment and transport.
    • EMS personnel should not put themselves in danger by attempting to treat and/or transport a patient who refuses care.

    Procedures

    • Patients with an uncontrolled airway or unstable vital signs should be transported to a full-service hospital unless extenuating circumstances exist.
    • The location of the free-standing Hanover Emergency Center is in close proximity to the full-service Memorial Regional Medical Center, making transport to the full ED a viable option.
    • Contact the facility and speak to the ED Attending Physician as Medical Control if there is a question about the capabilities of the facility.

    Rapid Sequence Intubation (RSI)

    • RSI is indicated for patients who have failed airway maintenance or protection, failed ventilation or oxygenation, or have an anticipated clinical course that will lead to deterioration.
    • Contraindications for RSI include individual medication contraindications, such as those for succinylcholine.
    • The procedure for RSI includes:
      • Performing a thorough patient assessment and determining the need for RSI based on clinical findings and anticipated clinical course.
      • Documenting assessment and impression.
      • Initiating pre-oxygenation with 100% oxygen by NRB mask.
      • Administering medications, such as sedation agents, paralytics, and ancillary agents.
      • Using rescue airway devices, such as a supraglottic device or surgical airway equipment.

    EZ IO

    • The EZ IO is used for intraosseous infusion in adults and pediatrics.
    • The procedure for EZ IO includes:
      • Performing a thorough patient assessment and determining the need for EZ IO.
      • Identifying the correct insertion site and preparing the equipment.
      • Inserting the needle at a 90-degree angle and confirming placement by aspirating 2 cc of blood.
      • Flushing the needle with 10 cc of sterile saline and attaching IV tubing and covering with a sterile dressing.
      • Applying a yellow instructional wrist band to the patient.

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    Related Documents

    Hanover Fire EMS Procedures-Guidelines Manual PDF

    Description

    This quiz covers various medical procedures performed in emergency situations, including endotracheal intubation and rapid sequence intubation.

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