EMS Patient Management and Stroke Protocols
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Questions and Answers

What best describes a 4th party caller in an EMS context?

  • Someone who has detailed knowledge about the patient's history.
  • A dispatcher who only relays information from health professionals.
  • A person who is not on scene but is familiar with the patient's condition. (correct)
  • A person who is physically present with the patient.

    • What is one of the primary purposes of the EMS700 system?

  • To provide direct ambulance transportation to all patients.
  • To manage non-emergency calls for service.
  • To enforce law enforcement protocols during EMS events.
  • To assist with clinical decisions and resource matching. (correct)

    • Which of the following represents a potential reason for longer inpatient hospital stays?

  • Increased medical technology.
  • Higher acuity patient cases. (correct)
  • More effective discharge planning.
  • Higher drug costs.

    • What does the term 'Verbal DNR' refer to in an EMS setting?

    <p>A verbal instruction from the patient regarding their medical care.</p> Signup and view all the answers

    Which group primarily acts as 1st party callers in medical emergencies?

    <p>The patients themselves.</p> Signup and view all the answers

    Why is Montgomery Hospice notable in the context of EMS?

    <p>It provides palliative care services for patients in need.</p> Signup and view all the answers

    What is the role of a Stabilization Room in the EMS process?

    <p>To provide immediate care for patients in critical condition.</p> Signup and view all the answers

    Which scenario exemplifies a patient in police custody in the EMS context?

    <p>A prisoner requiring medical evaluation.</p> Signup and view all the answers

    What is a possible transport outcome for a DNR-B Montgomery Hospice patient?

    <p>Transport to the Casey House from anywhere in the county</p> Signup and view all the answers

    What does a LAMS score of 4 or 5 indicate?

    <p>Large Vessel Occlusion (LVO)</p> Signup and view all the answers

    Which facilities are categorized as Thrombectomy Capable Primary Stroke Centers?

    <p>Shady Grove Medical Center and Georgetown University Hospital</p> Signup and view all the answers

    Which statement is true regarding the treatment of patients in police custody?

    <p>Medical assessments must still be performed on these patients.</p> Signup and view all the answers

    Which of the following is NOT an appropriate action regarding law enforcement and patient transport?

    <p>Allow police to dictate transport decisions</p> Signup and view all the answers

    What does the LAMS scale measure?

    <p>Neurological function related to stroke symptoms</p> Signup and view all the answers

    What should you do when identifying a DNR-B patient?

    <p>Call the Montgomery Hospice staff</p> Signup and view all the answers

    What is a common misconception regarding the transport of police custody patients?

    <p>They can be placed in any position during transport.</p> Signup and view all the answers

    What qualifies a patient to receive a telehealth visit with Hospice Staff?

    <p>Patient's DNR-B status</p> Signup and view all the answers

    Which of the following actions can be conducted by Montgomery Hospice staff during a telehealth visit?

    <p>Facilitate scheduling of a hospice visit in the home</p> Signup and view all the answers

    Which condition renders individuals incapable of making medical decisions, according to the Maryland protocol?

    <p>Mental health crisis</p> Signup and view all the answers

    What is the primary goal of repatriating a patient to a previous medical facility?

    <p>To maintain consistency of care</p> Signup and view all the answers

    In what situation should EMS clinicians transport a patient who has had a hospital admission within the last 30 days?

    <p>For Priority 2 or 3 patients</p> Signup and view all the answers

    What should not occur when an individual is Emergency Petitioned?

    <p>They are free to refuse treatment</p> Signup and view all the answers

    Which of the following actions is included in the ROSC Checklist after achieving Return of Spontaneous Circulation?

    <p>Verification of patient’s neurological status</p> Signup and view all the answers

    Which of these factors is aimed at improving patient outcomes during repatriation?

    <p>Treatment Expediency</p> Signup and view all the answers

    What is the purpose of the 5-minute Lineup Drill mentioned in the content?

    <p>To increase the number of patients discharged neurologically intact</p> Signup and view all the answers

    What is emphasized for EMS clinicians regarding patient requests during transport?

    <p>Honor reasonable requests</p> Signup and view all the answers

    What is the primary purpose of the Crisis Center as described?

    <p>To assist medically ill patients</p> Signup and view all the answers

    When considering placing a second Advanced Life Support (ALS) paramedic on a call, what key factor should be prioritized?

    <p>Good medicine</p> Signup and view all the answers

    Which of the following situations would NOT typically require the use of the trauma kit mentioned?

    <p>Cardiac arrest</p> Signup and view all the answers

    What is a key function of the QuikLitter mentioned in the trauma kit?

    <p>To assist in safe patient extrication</p> Signup and view all the answers

    What does the SPASM mnemonic help establish during patient assessment?

    <p>Patient's wishes for care</p> Signup and view all the answers

    In which scenario would extra manpower from an additional paramedic be least beneficial?

    <p>Responding to a high-volume medical call</p> Signup and view all the answers

    What should be done first when responding to a cardiac arrest situation?

    <p>Establish floor of care</p> Signup and view all the answers

    What type of incidents are explicitly included for response using the trauma kit?

    <p>Penetrating and blunt trauma events</p> Signup and view all the answers

    What is the appropriate action if a clinician has a reasonable belief that a patient does not want resuscitation?

    <p>Talk to the family about the situation</p> Signup and view all the answers

    In what scenario can a verbal DNR be obtained according to the guidelines?

    <p>Any time, including after resuscitation has begun</p> Signup and view all the answers

    Which of the following individuals qualifies as a patient under the outlined definitions?

    <p>A person involved in a situation suspected to lead to injury</p> Signup and view all the answers

    What must be kept in mind when identifying a verbal DNR?

    <p>Obtaining it respects patient wishes rather than determining futility</p> Signup and view all the answers

    Which of the following statements is false regarding the definitions of a patient?

    <p>A patient must exhibit clear signs of illness or injury to be considered one</p> Signup and view all the answers

    What are the age criteria for a patient to be eligible for transport to the Crisis Center?

    <p>Patients need to be aged 18 or over</p> Signup and view all the answers

    Which of the following scenarios would exclude a patient from being transported to the Crisis Center?

    <p>Chest pain or shortness of breath</p> Signup and view all the answers

    What is the first step in the process for transporting a patient to the Crisis Center?

    <p>Assess the patient using the criteria</p> Signup and view all the answers

    Which statement accurately reflects the service provided by the Crisis Center?

    <p>It provides medical monitoring and meals</p> Signup and view all the answers

    What should be done if a patient has a history of DTs or seizures upon withdrawal?

    <p>They need immediate hospitalization</p> Signup and view all the answers

    What is a requirement for patients to consent to transportation?

    <p>Be able to communicate and cooperate</p> Signup and view all the answers

    What benefit is highlighted for patients when utilizing the Crisis Center?

    <p>No waiting as recliners are available right away</p> Signup and view all the answers

    What is NOT a criterion for admitting a patient into the Crisis Center?

    <p>Experiencing anxiety attacks</p> Signup and view all the answers

    What is the primary responsibility of EMS when dealing with a patient who may not want resuscitation?

    <p>To respect the patient's wishes regarding resuscitation</p> Signup and view all the answers

    Which of the following statements accurately describes obtaining a verbal DNR?

    <p>It may occur at any point, even after resuscitation starts</p> Signup and view all the answers

    Who qualifies as a patient according to the broader definitions provided?

    <p>Any individual for whom a healthcare professional calls 911</p> Signup and view all the answers

    What is a fundamental consideration when assessing a patient's wishes about resuscitation?

    <p>Assessing the patient’s mental state and expressed desires</p> Signup and view all the answers

    In which scenario would a 2nd party caller be considered valid for identifying a patient?

    <p>When the patient is unconscious and unable to call for help</p> Signup and view all the answers

    Which of the following roles does the EMS700 system NOT fulfill?

    <p>Conducting hospital admissions</p> Signup and view all the answers

    What is one of the responsibilities that encompasses the concept of a 4th party caller?

    <p>Someone who has no knowledge of the patient</p> Signup and view all the answers

    Which aspect does NOT contribute to the challenges faced by the healthcare system as outlined?

    <p>Adequate staffing levels</p> Signup and view all the answers

    What best describes the function of a Stabilization Room in an EMS setting?

    <p>Facilitates the stabilization of patients before transport</p> Signup and view all the answers

    Which statement is true regarding police custody refusals in EMS?

    <p>Patients in police custody have the same rights as others</p> Signup and view all the answers

    What critique commonly arises from the longer inpatient hospital stays?

    <p>Higher costs for the healthcare system</p> Signup and view all the answers

    What is a primary function of the ROSC Checklist after Return of Spontaneous Circulation?

    <p>Assessing the effectiveness of CPR provided</p> Signup and view all the answers

    Which scenario exemplifies the role of interconnected professional entities in EMS?

    <p>A police officer requesting an ambulance for a bystander</p> Signup and view all the answers

    What is a primary use of the trauma kit mentioned?

    <p>Providing a blanket to prevent hypothermia</p> Signup and view all the answers

    What should be prioritized when deciding whether to place a second Advanced Life Support (ALS) paramedic on a call?

    <p>Ensuring good medical practice</p> Signup and view all the answers

    Which scenario would likely require utilizing the trauma kit?

    <p>Response to a building explosion</p> Signup and view all the answers

    What is a critical action to initiate during a cardiac arrest response?

    <p>Establish the floor of care</p> Signup and view all the answers

    Under what condition can the Crisis Center not assist?

    <p>Unconscious patients requiring stabilization</p> Signup and view all the answers

    What does the SPASM mnemonic assist with during patient assessment?

    <p>Establishing a floor of care</p> Signup and view all the answers

    Which of the following represents a situation where extra manpower is least beneficial?

    <p>During a simple transport to the hospital</p> Signup and view all the answers

    What should be done when a patient expresses a desire not to be resuscitated?

    <p>Gather evidence of the patient's wishes</p> Signup and view all the answers

    What potential outcome is least likely for a DNR-B Montgomery Hospice patient?

    <p>Transport to the ED</p> Signup and view all the answers

    What LAMS score indicates a large vessel occlusion?

    <p>4 or 5</p> Signup and view all the answers

    Which statement is true regarding the treatment of patients in police custody?

    <p>They must receive appropriate medical assessments.</p> Signup and view all the answers

    What is NOT a requirement for patients to receive a telehealth visit with hospice staff?

    <p>Having a DNR-B status</p> Signup and view all the answers

    Which facilities are categorized as acute stroke centers?

    <p>Comprehensive Stroke Center or Thrombectomy Capable Center</p> Signup and view all the answers

    What is the purpose of the EMIHS 5-minute Lineup Drill?

    <p>To organize emergency services response</p> Signup and view all the answers

    Which of the following actions is NOT permitted for patients during police custody transport?

    <p>Restraints to prevent medical care</p> Signup and view all the answers

    Which factors are evaluated to determine an individual's medical decision-making capacity?

    <p>Mental state and understanding of information</p> Signup and view all the answers

    What are DNR-B patients allowed to receive when being transported?

    <p>Medical assessments and treatments</p> Signup and view all the answers

    What is a requirement for a patient to be classified as a DNR-B?

    <p>Must have a serious medical condition</p> Signup and view all the answers

    Study Notes

    EMS 700

    • EMS 700 is a system that monitors EMS resources, ED conditions, and hospital statuses
    • Assists with clinical decisions and matching each patient with the best need

    Montgomery Hospice

    • Patients enrolled in Montgomery Hospice have a sticker on their hospital bed
    • When a patient is identified as Montgomery Hospice, call 6001 Muncaster Mill Rd, and collaborate with Hospice Staff
    • Possible Outcomes: transport to Casey House, telehealth visit with Hospice Staff, scheduling of a Hospice visit, or transport to the ED (unlikely).

    Stroke Patients

    • Patients suspected of having a stroke must go to a Thrombectomy capable hospital: Shady Grove Medical Center, Suburban Hospital, Washington Hospital Center, or Georgetown University Hospital
    • LAMS (LOS Angeles Motor Scale) helps determine the severity of a stroke
    • If LAMS score is 4 or 5, it indicates Large Vessel Occlusion (LVO)
    • If LAMS score is 4 or 5, patient can go to any Primary Stroke Center for treatment, any hospital in Montgomery County is a valid option
    • A LAMS score of 0-3 means that the patient should go to a Thrombectomy capable hospital.

    Patients in Police Custody

    • Patients in Police Custody (who are not being Emergency Petitioned) have the right to refuse medical treatment and/or transport
    • Medical decision capacity is determined by: Understanding, Appreciation, Reasoning and Expressing a choice
    • Maryland Protocol lists 5 conditions under which people are incapable of making medical decisions.
    • If a patient is being Emergency Petitioned, they cannot refuse and must remain in police custody.
    • An Emergency Petitioned patient can be transported to a hospital-based emergency department via patrol car or by EMS when accompanied by Police

    Repatriation

    • Repatriation is when a patient is returned to a medical facility that provided previous treatment
    • This is suggested in cases of: Treatment Expediency, Coordination of Care, Consistency of Care, and Improved Patient Outcomes

    ROSC (Return of Spontaneous Circulation)

    • MCFRS achieves a lot of ROSC in patients.
    • The goal is to increase the number of patients who are discharged from the hospital neurologically intact.
    • MCFRS now has a ROSC Checklist placed on each LUCAS device to help make this happen.

    Trauma Care Bag

    • The trauma care bag is used for Burns, Penetrating, and Blunt Trauma
    • Examples of call types that would require use of the Trauma Care Bag: Shootings, Stabbings, Fires, Multi-Patient Dispatches, Building Explosions, Metro Events, Trail Rescues, ALL TRAUMA!!

    Two Medics on One AFRA

    • The decision of whether or not to place a second AFRA in service on an ALS2 call is up to the individual unit officer responding to the call.
    • The decision should be consistent with the Operational Doctrine Statement
    • Decisions should be based on the situation and priority is given to good medicine.

    Verbal DNR

    • When there is a cardiac arrest, the unit officer responding should use the SPASM mnemonic to guide the patient assessment.
    • The unit officer should gather evidence of the patient's wishes. This includes talking to family, checking for a living will, or looking for an incomplete DNR.
    • If the patient does not have an official DNR, the unit officer should attempt to obtain a verbal DNR from the patient's family.
    • The decision to obtain a verbal DNR must be made with consideration of the patient's wishes and duty to act.

    What is a Patient

    • A patient is anyone encountered by EMS who has or may have an actual or potential injury or medical problem
    • A patient exists if a 2nd party caller witnessed signs or symptoms which imply illness or injury, even in the face of denial by the patient
    • A patient exists if a Power of Attorney has called 911
    • A patient exists if a trained provider suspects a situation would lead to illness or injury.

    Calling Party Differentiation

    • A 1st party caller is the patient themselves.
    • A 2nd party caller is someone who knows the patient and is familiar with their situation.
    • A 3rd party caller is someone who is not on the scene, they may not know the patient well, such as a passerby.
    • A 4th party caller is a professional entity who requests EMS services. For example, Police requesting EMS.

    EMS700

    • EMS700 is a program to help EMS professionals with resource management.
    • EMS700 monitors EMS resources, ED conditions, and hospital statuses.
    • EMS700 assists with clinical decisions matching each patient to the appropriate care.
    • Examples of assistance: Alternative Destinations, Hospital Transports, DTT, Refusals.

    MONTGOMERY HOSPICE

    • DNR-B (Do Not Resuscitate) patients are already enrolled in Montgomery Hospice.
    • Look for a sticker on their hospital bed to identify DNR-B Montgomery Hospice patients.
    • Call the Montgomery Hospice number (6001 Muncaster Mill Rd) for assistance with DNR-B patients.
    • Hospice staff will assist with transport options, telehealth visits, and scheduling in-home hospice visits.

    Stroke Patients & Thrombectomy Capable Hospitals

    • Stroke patients with a LAMS score of 4 or 5 are indicative of Large Vessel Occlusion (LVO) and must go to a Thrombectomy capable hospital.
    • Thrombectomy capable hospitals in Montgomery County are:
      • Shady Grove Medical Center
      • Suburban Hospital
      • Washington Hospital Center
      • Georgetown University Hospital

    Patients in Police Custody

    • Patients in police custody who are not emergency petitioned may be considered for the Crisis Center Stabilization Room.
    • The Crisis Center is located at 1301 Piccard Drive.
    • The Crisis Center is not an alternative shelter and cannot stabilize unconscious patients.

    Crisis Center Stabilization Room

    • Criteria for Transport to the Crisis Center Stabilization Room:

      • Age 18 or over
      • Medically stable
      • Able to communicate
      • Cooperative
      • Consents to transport
      • Can walk on their own or with minimal assistance and sit in a recliner.
      • One or more of the following:
        • Requesting mental health support
        • Experiencing acute alcohol intoxication
        • Under the influence of other substances and needs a safe place to sober up.

    • Exclusions from Transport to the Crisis Center Stabilization Room:

      • Evidence of trauma or needs stitches.
      • Chest pain, shortness of breath, unexplained abdominal or back pain.
      • Any plan to harm self or others (suicidal ideation is okay).
      • Combative or violent.
      • History of DTs or seizures upon withdrawal (for intoxication).
      • In police custody.

    Trauma Care Bag

    • The Trauma Care Bag is not your average trauma kit.
    • It contains:
      • Blanket to prevent hypothermia.
      • QuikLitter for extrication.
      • Supplies for burns, penetrating, and blunt trauma.
    • Examples of calls to use the Trauma Care Bag:
      • Shootings/Stabbings
      • Fires
      • Multi-patient Dispatches
      • Building Explosions
      • Metro Events
      • Trail Rescues
      • ALL Trauma!!

    Two Medics on One AFRA

    • Decision to add a second AFRA:
      • The individual unit officer responding to the call has the authority to make this decision based on the situation.
      • Decisions must be consistent with the Operational Doctrine Statement.
      • The extra manpower could be beneficial for carrying a patient up or down stairs or pit crew CPR.

    Verbal DNR

    • When a verbal DNR is considered:
      • Cardiac Arrest
      • Reasonable belief that the patient does not want resuscitation.
      • Paperwork is not an “official DNR” or is missing.
    • Process for obtaining a verbal DNR:
      • Gather evidence of the patient's wishes (talk to family, review living will, incomplete DNR).
      • Obtain a verbal DNR via the normal medical consult process by articulating why you believe the patient did not want resuscitation.
    • Keep in mind: Obtaining a verbal DNR can happen at any point, including after resuscitation has begun.

    What is a Patient?

    • A patient is anyone encountered by EMS with an actual or potential injury or medical problem.
    • Anyone who requests EMS (1st party caller) or anyone who has had EMS requested for them (2nd party caller) is considered a patient.
    • This also includes:
      • Someone a health care professional calls 911 for (2nd party caller).
      • Someone a Power of Attorney calls 911 for (4th party caller).
      • Patients where a 2nd party caller witnessed signs or symptoms of illness or injury, even in the face of denial by the patient.
      • Anyone involved in a situation that a trained provider suspects would lead to illness or injury.

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