EMT Patient Care Protocols
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Questions and Answers

What is the primary concern when a patent airway cannot be established in a patient?

  • Transport the patient to the closest hospital immediately
  • Provide oxygen using a bag-valve-mask (BVM) device
  • Call for ALS rendezvous
  • Transport the patient to the closest appropriate hospital-based emergency department or designated freestanding emergency medical facility (correct)

    • What is the indication of upper airway foreign body or partial airway obstruction in infants and young children?

  • Wheezing
  • Expiratory stridor
  • Coughing
  • Inspiratory stridor (correct)

    • How often should breaths be delivered to a patient 13 years or older who is not breathing adequately?

  • 1 breath every 3 seconds
  • 1 breath every 6 seconds (correct)
  • 1 breath every 10 seconds
  • 1 breath every 12 seconds

    • What is the oxygen saturation level below which supplemental oxygen is administered?

    <p>94%</p> Signup and view all the answers

    In which patients should high-flow oxygen be avoided unless in respiratory distress?

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

    What is the recommended ETCO2 range for patients with significant head injury?

    <p>35-40 mmHg</p> Signup and view all the answers

    When should hyperventilation be initiated in a head-injured patient?

    <p>Only if signs of herniation are present</p> Signup and view all the answers

    What is the recommended breath rate for an infant (less than 1 year of age) who is not breathing adequately?

    <p>35 breaths per minute</p> Signup and view all the answers

    What is the primary consideration when assessing a patient's circulation?

    <p>Pulse rate</p> Signup and view all the answers

    To which protocol should you refer for patients within the first hour after delivery?

    <p>Newly Born protocol</p> Signup and view all the answers

    What is the primary consideration during scene arrival and size-up?

    <p>Scene safety</p> Signup and view all the answers

    What is the first step in the patient approach?

    <p>Determine the Mechanism of Injury (MOI)/Nature of Illness (NOI)</p> Signup and view all the answers

    What is the indication for stopping all movement of a patient?

    <p>Identifying a critically unstable patient</p> Signup and view all the answers

    What is the first step in the initial assessment of a patient?

    <p>Rapidly develop a general impression of the patient</p> Signup and view all the answers

    What is the indication for using the Pediatric Assessment Triangle?

    <p>For pediatric patients only</p> Signup and view all the answers

    What is the purpose of stabilizing the cervical spine?

    <p>To prevent further injury</p> Signup and view all the answers

    What is the next step after identifying a critically unstable patient?

    <p>Stop all movement of the patient</p> Signup and view all the answers

    What is the purpose of suctioning the airway?

    <p>To suction tracheostomy tubes</p> Signup and view all the answers

    What is the recommended compression rate for adults and adolescents during CPR?

    <p>100-120/min</p> Signup and view all the answers

    In what scenario would you use a mechanical CPR device?

    <p>For patients 13 years of age and older only</p> Signup and view all the answers

    What is the recommended compression depth for infants during CPR?

    <p>1½ inches (3.8 cm)</p> Signup and view all the answers

    What is the recommended method for assessing skin color, temperature, and capillary refill?

    <p>Visually assessing the patient</p> Signup and view all the answers

    When should you initiate cardiac monitoring?

    <p>As appropriate</p> Signup and view all the answers

    What is a contraindication for using a spinal immobilization device for a pediatric patient?

    <p>Infant or child car seats</p> Signup and view all the answers

    What is the priority level for a critically ill or injured person requiring immediate attention?

    <p>Priority 1</p> Signup and view all the answers

    What is the recommended method for managing profuse bleeding?

    <p>Using a method appropriate for the patient's injuries</p> Signup and view all the answers

    What is the purpose of assessing the patient's disability?

    <p>To assess the patient's pulse, motor, and sensory function</p> Signup and view all the answers

    What is the recommended method for assessing the patient's exposure?

    <p>By removing clothing as necessary, considering the condition and environment</p> Signup and view all the answers

    During an MCI, who should establish appropriate communications?

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

    What is the recommended reassessment frequency for unstable patients?

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

    Where should Priority 1 patients be triaged according to Maryland Medical Protocols?

    <p>Closest hospital-based emergency department</p> Signup and view all the answers

    What is the consideration for transporting a patient with unresolved symptoms that cannot be managed outside the hospital?

    <p>Transport to the closest Frontline Hospital</p> Signup and view all the answers

    When should a patient be transported to an Assessment Hospital?

    <p>When the patient is a PUI for an EID</p> Signup and view all the answers

    What is the priority category for a non-emergent condition that requires medical attention but not on an emergency basis?

    <p>Priority 3 - Non-emergent condition, requiring medical attention but not on an emergency basis</p> Signup and view all the answers

    What is the consideration for using a helicopter for transport?

    <p>Use of a helicopter would result in a clinically significant reduction in time</p> Signup and view all the answers

    What is the estimated weight of a 6-year-old patient according to the normal vital signs chart?

    <p>15 kg</p> Signup and view all the answers

    When should a patient be repatriated to their original hospital?

    <p>When the patient has a hospital admission within the last 30 days</p> Signup and view all the answers

    What is the heart rate of a newborn patient according to the normal vital signs chart?

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

    What is the primary goal of the Simple Triage and Rapid Treatment (START and/or JumpSTART) technique?

    <p>To rapidly tag and sort patients into priority categories for both treatment and transport</p> Signup and view all the answers

    What is the exception for diverting a critically unstable patient to a freestanding emergency medical facility?

    <p>With the approval of EMS system medical consultation</p> Signup and view all the answers

    When should a patient be transported to a specialty referral center?

    <p>When the patient has indications for specialty referral center</p> Signup and view all the answers

    What is the obligation of healthcare clinicians when reporting suspected child or vulnerable adult abuse and/or neglect?

    <p>To report the case to the local police or adult/child protective service agencies</p> Signup and view all the answers

    What is the consideration for notifying the receiving hospital of a suspected PUI patient?

    <p>To allow for hospital staff to prepare</p> Signup and view all the answers

    What should be done with an impaled conducted electrical weapon dart?

    <p>Stabilize the dart in place and evaluate by a physician</p> Signup and view all the answers

    What type of medication can BLS clinicians assist with administering?

    <p>Fast-acting bronchodilator MDI and sublingual nitroglycerin</p> Signup and view all the answers

    What is the temperature threshold for treating patients with acetaminophen?

    <p>100.4 F (38 C)</p> Signup and view all the answers

    What should be done with oral medications when treating patients with an altered mental status?

    <p>Do not administer oral medications (except oral glucose)</p> Signup and view all the answers

    What documentation should be collected and transported with the patient?

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

    Which option should be selected in the PCR if a BLS unit renders care and then termination of resuscitation and pronouncement of death occurs?

    <p>Dead at Scene with BLS Intervention</p> Signup and view all the answers

    What is the primary consideration for patient care?

    <p>Treating patients with dignity and respect</p> Signup and view all the answers

    Which patients are considered critically unstable?

    <p>Patients with new onset altered mental status</p> Signup and view all the answers

    What should be considered when managing a patient's airway and ventilation?

    <p>Managing the patient's airway and ventilation as indicated and tolerated</p> Signup and view all the answers

    What should be initiated in a critically unstable patient?

    <p>All interventions including ETCO2 monitoring and 12-lead EKG</p> Signup and view all the answers

    What should be controlled in a critically unstable patient?

    <p>Both hypoxia and life-threatening external hemorrhage</p> Signup and view all the answers

    What should be considered when addressing other life threats in a critically unstable patient?

    <p>Addressing any other life threats noted on physical exam</p> Signup and view all the answers

    What should be initiated during the transport of a critically unstable patient?

    <p>Continuing General Patient Care, including transport</p> Signup and view all the answers

    What should be considered when selecting the appropriate triage algorithm?

    <p>Using the appropriate triage algorithm based on patient age and condition</p> Signup and view all the answers

    What should be obtained in a critically unstable patient?

    <p>Both a complete patient assessment and vascular access</p> Signup and view all the answers

    When is receiving trauma center medical consultation required when considering helicopter transport?

    <p>For Trauma Decision Tree categories Charlie and Delta</p> Signup and view all the answers

    What is the maximum age for which the pediatric section of the treatment protocol is used for medical cases?

    <p>18 years</p> Signup and view all the answers

    What is the general guideline for using helicopter transport if the time of arrival at the trauma or specialty referral center via ground unit is less than?

    <p>30 minutes</p> Signup and view all the answers

    When should online medical direction be obtained from the local trauma center and the specialty referral center?

    <p>When transport to the specialty center would require more than 10-15 minutes additional transport time</p> Signup and view all the answers

    For pediatric patients equal to or greater than 50 kg, which dosing method is used?

    <p>Adult dosing</p> Signup and view all the answers

    What is the special note for isolated burn patients without airway injury or other associated trauma?

    <p>They should be flown to a burn center regardless of the location of the closest trauma center</p> Signup and view all the answers

    When should a parent/guardian/caregiver be allowed to remain with a pediatric patient during transport?

    <p>At all times, but secured in a separate vehicle restraint system</p> Signup and view all the answers

    What is the ALS clinician-patient relationship established when?

    <p>The ALS clinician initiates patient assessment and/or administers ALS medication and/or performs ALS procedure</p> Signup and view all the answers

    What is the primary purpose of medical consultation via EMRC?

    <p>To incorporate a physician's knowledge and experience into ongoing patient care</p> Signup and view all the answers

    What is the minimum temperature required for clinicians to treat pediatric patients with acetaminophen?

    <p>100.4°F (38°C)</p> Signup and view all the answers

    When can ALS clinicians terminate their EMS clinician-patient relationship?

    <p>When they are assured that the patient will continue to receive care at the same or greater levels</p> Signup and view all the answers

    When is hospital notification required via EMRC?

    <p>For all Priority 1, Priority 2, and Specialty Alert patients</p> Signup and view all the answers

    What should be relayed to the individual(s) assuming responsibility for the patient?

    <p>The patient's assessment findings and treatment provided</p> Signup and view all the answers

    What should be sent with the BLS unit to the receiving facility?

    <p>A copy of the patient's EKG</p> Signup and view all the answers

    What should be included in the communication for a Stroke patient?

    <p>Last known well time and specific neurological findings</p> Signup and view all the answers

    When should an 'Exceptional Call' be indicated on the Patient Care Report (PCR)?

    <p>When medical consultation is unavailable</p> Signup and view all the answers

    When should the Patient Care Report (PCR) be completed and delivered to the receiving facility?

    <p>As soon as possible, ideally upon transfer of care</p> Signup and view all the answers

    What is the compliance requirement for delivering the completed PCR to the receiving facility?

    <p>COMAR 30.03.04.04</p> Signup and view all the answers

    What is the primary consideration during a Mass Casualty Incident (MCI)?

    <p>Maximizing patient care resources and reserving EMS communications</p> Signup and view all the answers

    What should be included in the suggested elements for notifications and medical consults?

    <p>All of the above, plus pertinent signs and symptoms</p> Signup and view all the answers

    What is the primary concern during scene arrival and size-up?

    <p>Considering Body Substance Isolation (BSI) and Personal Protective Equipment (PPE)</p> Signup and view all the answers

    What is the indication for using the Pediatric Assessment Triangle?

    <p>Rapidly developing a general impression of a pediatric patient on first contact</p> Signup and view all the answers

    What should you do if you have identified a critically unstable patient?

    <p>Stop all movement of the patient and proceed to the Critically Unstable Patient Protocol</p> Signup and view all the answers

    What is the purpose of suctioning the airway?

    <p>To suction tracheostomy tubes</p> Signup and view all the answers

    What is the primary consideration during the patient approach?

    <p>Determining the Mechanism of Injury (MOI) or Nature of Illness (NOI)</p> Signup and view all the answers

    What is the purpose of assessing mental status?

    <p>To identify potential neurological deficits</p> Signup and view all the answers

    What should you do if the patient is judged to be in extremis or at risk for deterioration to cardiac arrest?

    <p>Stop all movement of the patient and proceed to the Critically Unstable Patient Protocol</p> Signup and view all the answers

    What is the purpose of considering the need for additional resources?

    <p>To identify potential logistical needs for the patient</p> Signup and view all the answers

    What is the priority category for a patient with a potentially life-threatening injury or illness, requiring emergency medical attention but not immediately endangering the patient's life?

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

    What is the estimated weight of a 12-year-old patient according to the normal vital signs chart?

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

    What should be done with an impaled conducted electrical weapon dart to the head, neck, hands, feet, or genitalia?

    <p>Stabilize the dart in place and evaluate by a physician</p> Signup and view all the answers

    What is the obligation of healthcare clinicians when reporting suspected child or vulnerable adult abuse and/or neglect?

    <p>Report in good faith to the local police or adult/child protective service agencies</p> Signup and view all the answers

    What is the primary goal of the Simple Triage and Rapid Treatment (START and/or JumpSTART) technique?

    <p>To prioritize patients based on the severity of their injuries</p> Signup and view all the answers

    What type of medication can ALS clinicians administer for seizures?

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

    What is the recommended treatment for patients with fever documented by EMS as greater than 100.4 F (38 C)?

    <p>Administration of acetaminophen</p> Signup and view all the answers

    What documentation should be collected and transported with the patient?

    <p>All relevant medical documentation, including the Emergency Information Form and Medic Alert</p> Signup and view all the answers

    What is the primary consideration for patient care during an MCI?

    <p>To establish appropriate communications</p> Signup and view all the answers

    What is the recommended reassessment frequency for unstable patients?

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

    What is the recommended compression rate for patients 13 years of age and older during CPR?

    <p>100-120/min</p> Signup and view all the answers

    When should a mechanical CPR device be used for patients?

    <p>For patients 13 years of age and older only</p> Signup and view all the answers

    What is the recommended compression depth for adults and adolescents during CPR?

    <p>At least 2 inches (5 cm)</p> Signup and view all the answers

    What is the recommended method for assessing skin color, temperature, and capillary refill?

    <p>Visually assessing skin color and temperature and checking capillary refill</p> Signup and view all the answers

    When should Spinal Motion Restriction protocol be applied to pediatric patients?

    <p>For pediatric patients who are unable to communicate or respond appropriately</p> Signup and view all the answers

    What is the recommended method for managing profuse bleeding in patients?

    <p>Applying direct pressure and using wound packing as needed</p> Signup and view all the answers

    What is the primary consideration when assessing a patient's disability?

    <p>Assessing the patient's motor and sensory function in all extremities</p> Signup and view all the answers

    What is the recommended method for assessing a patient's exposure?

    <p>Removing clothing as necessary and considering the environment</p> Signup and view all the answers

    What is the priority level for a critically ill or injured person requiring immediate attention?

    <p>Priority 1</p> Signup and view all the answers

    When should cardiac monitoring be initiated in patients?

    <p>For patients with signs of cardiac distress or instability</p> Signup and view all the answers

    What is the primary concern when a patient's ventilations are not adequate?

    <p>Providing 100% oxygen using BVM</p> Signup and view all the answers

    What is the indication for administering supplemental oxygen to a patient?

    <p>SpO2 less than 94%</p> Signup and view all the answers

    What is the recommended rate for delivering breaths to a neonate who is not breathing adequately?

    <p>1 breath every 3 seconds</p> Signup and view all the answers

    What is the recommended ETCO2 range for patients with significant head injury and signs of herniation?

    <p>30-35 mmHg</p> Signup and view all the answers

    What is the primary consideration when assessing a patient's pulse?

    <p>The patient's age</p> Signup and view all the answers

    What is the recommended method for managing CO exposure?

    <p>Applying 100% oxygen via NRB mask</p> Signup and view all the answers

    What is the recommended rate for hyperventilating an adult patient with significant head injury?

    <p>20 breaths per minute</p> Signup and view all the answers

    What is the recommended method for assessing oxygen saturation in patients with hemoglobin abnormality?

    <p>Measuring carbon monoxide level with a co-oximeter</p> Signup and view all the answers

    What is the primary consideration when deciding whether to administer high-flow oxygen to a patient?

    <p>The patient's respiratory distress level</p> Signup and view all the answers

    What is the recommended method for assisting ventilations in patients with suspected CO poisoning?

    <p>Applying 100% oxygen via NRB mask</p> Signup and view all the answers

    During a declared Multiple Casualty Incident (MCI), which of the following must be checked on the PCR?

    <p>The 'Exceptional Call' box</p> Signup and view all the answers

    What is the recommended reassessment frequency for stable patients?

    <p>Every 15 minutes</p> Signup and view all the answers

    Which patients should be transported directly to an Assessment Hospital?

    <p>Patients Under Investigation (PUI) for an Emerging Infectious Disease (EID) at a residence</p> Signup and view all the answers

    When should a patient be transported to a Frontline Hospital?

    <p>When the patient has unresolved symptoms that cannot be managed outside the hospital</p> Signup and view all the answers

    What is the consideration for transporting a patient with a specialty center destination care protocol?

    <p>The patient's condition warrants transport to a trauma or specialty referral center</p> Signup and view all the answers

    During an MCI, who should designate an EMS Communicator?

    <p>The EMS Officer-in-Charge (OIC)</p> Signup and view all the answers

    What is the recommended mode of transport for Medevac patients with indications for a specialty referral center?

    <p>Air ambulance</p> Signup and view all the answers

    When should a patient be repatriated to their original hospital?

    <p>When the patient has a hospital admission within the last 30 days</p> Signup and view all the answers

    What is the exception for diverting a critically unstable patient to a freestanding emergency medical facility?

    <p>The patient requires immediate life-saving interventions</p> Signup and view all the answers

    What is the consideration for notifying the receiving hospital of a suspected PUI patient?

    <p>To allow for hospital staff to prepare</p> Signup and view all the answers

    For pediatric patients weighing less than 50 kg, what should be used for medication dosing?

    <p>Pediatric doses</p> Signup and view all the answers

    When is medical consultation necessary for pediatric patients?

    <p>When required by a specific protocol</p> Signup and view all the answers

    What is the primary consideration for transporting a patient who is 18 years or older and receives specialized care at a pediatric facility?

    <p>Medical consultation with a Pediatric Base Station</p> Signup and view all the answers

    What is the purpose of hospital notification for Priority 1, Priority 2, and Specialty Alert patients?

    <p>To notify the receiving hospital of the patient's condition</p> Signup and view all the answers

    What information should be included in hospital notifications for trauma patients?

    <p>Number of victims, GCS, and patient Trauma Decision Tree Category</p> Signup and view all the answers

    What is the purpose of medical consultation for prehospital EMS clinicians?

    <p>To obtain medical direction for patient care</p> Signup and view all the answers

    When should a clinician proceed with additional protocol-directed care without medical consultation?

    <p>When medical consultation is genuinely unavailable</p> Signup and view all the answers

    What is the primary consideration during a Mass Casualty Incident (MCI)?

    <p>Maximizing patient care resources</p> Signup and view all the answers

    What should be included in notifications for patients with fever documented by EMS as greater than 100.4 F (38 C)?

    <p>Pertinent patient signs and symptoms</p> Signup and view all the answers

    What should be done with a parent/guardian/caregiver during transport of a pediatric patient?

    <p>They should be secured in a separate vehicle restraint system</p> Signup and view all the answers

    When is it generally not beneficial to use a helicopter for transport?

    <p>When the time of arrival at the trauma or specialty referral center via ground unit is less than 30 minutes</p> Signup and view all the answers

    What is required when considering whether helicopter transport is of clinical benefit for trauma decision tree category Charlie or Delta?

    <p>Receiving trauma center medical consultation</p> Signup and view all the answers

    What should be obtained when transport to the specialty center would require more than 10-15 minutes additional transport time?

    <p>On-line medical direction from the local trauma center and the specialty referral center</p> Signup and view all the answers

    What should be done with isolated burn patients without airway injury or other associated trauma?

    <p>They should be flown to a burn center, regardless of the location of the closest trauma center</p> Signup and view all the answers

    What should be done with hand injury patients who require Medevac transport?

    <p>They should be flown to the hand center, regardless of the location of the closest trauma center</p> Signup and view all the answers

    When should the ALS clinician-patient relationship be established?

    <p>When the ALS clinician initiates patient assessment</p> Signup and view all the answers

    What should be done when consensus between the ALS and BLS clinicians cannot be gained regarding the transfer of patient care?

    <p>The ALS clinician should get on-line medical direction</p> Signup and view all the answers

    What should be done with an EKG performed by the ALS clinician?

    <p>It should be imported into the patient care report and a copy sent with the BLS unit to the receiving facility</p> Signup and view all the answers

    What should be done with the patient care report (PCR) after transfer of care?

    <p>It should be completed and delivered to the receiving facility as soon as possible</p> Signup and view all the answers

    What is the deadline for delivering the completed PCR after dispatch?

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

    Which of the following patients should be considered critically unstable and require immediate attention?

    <p>Adult patients with new onset altered mental status (AVPU – not alert)</p> Signup and view all the answers

    What should be done with a patient who is identified as critically unstable?

    <p>Cease all efforts at patient movement until ALS treatments are complete.</p> Signup and view all the answers

    Which of the following is a consideration for managing a patient's airway?

    <p>Managing the patient's airway with BVM with or without OPA/NPA</p> Signup and view all the answers

    What should be done with a patient who is pronounced dead at the scene?

    <p>Select the 'Dead on Scene' option in the PCR and document accordingly</p> Signup and view all the answers

    Which of the following is a consideration for maintaining patient confidentiality?

    <p>Maintaining patient confidentiality at all times</p> Signup and view all the answers

    What should be done with a patient who requires ongoing assessments?

    <p>Perform a detailed patient assessment and reassess regularly</p> Signup and view all the answers

    Which of the following is a consideration for patient care?

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

    What should be done with a patient who requires termination of resuscitation and pronouncement of death?

    <p>Select the 'Dead at Scene with BLS Intervention' option in the PCR and document accordingly</p> Signup and view all the answers

    Which of the following is a consideration for managing a patient's circulation?

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

    What should be done with a patient who is critically unstable and requires additional resources?

    <p>Request additional ALS clinicians to assist with patient care</p> Signup and view all the answers

    Which triage category is assigned to patients with severe bleeding or breathing difficulties?

    <p>Immediate (Red)</p> Signup and view all the answers

    What is the purpose of secondary triage?

    <p>To re-prioritize and allocate resources after initial treatment</p> Signup and view all the answers

    Which step in emergency response involves safely removing patients from the scene and transporting them to a medical facility?

    <p>Patient extraction</p> Signup and view all the answers

    What is the purpose of the primary survey in patient assessment?

    <p>To assess patient's airway, breathing, circulation, disability, and exposure</p> Signup and view all the answers

    What is dynamic resource allocation in the context of emergency response?

    <p>Continuously reassessing and adjusting resource allocation to respond to changing patient needs and priorities</p> Signup and view all the answers

    What is the purpose of resource matching in emergency response?

    <p>To allocate available resources to meet the needs of prioritized patients</p> Signup and view all the answers

    Which triage category is assigned to patients with severe head trauma or catastrophic injuries?

    <p>Expectant (Black)</p> Signup and view all the answers

    What is the primary goal of patient assessment in emergency response?

    <p>To prioritize patients based on the severity of their injuries or conditions</p> Signup and view all the answers

    Study Notes

    General Patient Care

    • The General Patient Care section applies to all patient encounters unless otherwise noted in a specific treatment protocol.
    • Response:
      • Review dispatch information and select an appropriate response.
      • Consider Body Substance Isolation (BSI) and Personal Protective Equipment (PPE).
      • Evaluate scene safety and determine the number of patients.
      • Consider the need for additional resources.
    • Scene Arrival and Size-up:
      • Determine the Mechanism of Injury (MOI) or Nature of Illness (NOI).
      • Begin triage and initiate Mass Casualty Incident (MCI) procedures if appropriate.

    Initial Assessment

    • Rapidly develop a general impression of the patient on first contact.
    • Identify critically unstable patients (e.g., those with altered mental status, airway compromise, acute respiratory distress, signs of poor perfusion, or any patient judged to be in extremis or at risk for deterioration to cardiac arrest).
    • If a critically unstable patient is identified:
      • Stop all movement of the patient.
      • Do not initiate transport.
      • Proceed to the Critically Unstable Patient Protocol immediately.

    Patient Assessment

    • Assess mental status:
      • Alert.
      • Responds to verbal stimuli.
      • Responds to painful stimuli.
      • Unresponsive.
    • Assess airway:
      • Stabilize cervical spine when appropriate.
      • Open and establish airway using appropriate adjunct.
      • Place patient in an appropriate position.
      • Suction airway as needed.
      • If a patent airway cannot be established, transport the patient to the closest appropriate hospital-based emergency department or designated freestanding emergency medical facility.
    • Assess breathing:
      • Determine if breathing is adequate and assess oxygen saturation (SpO2) with a pulse oximeter.
      • Provide assistance with 100% oxygen using a Bag-Valve-Mask (BVM) if needed.
      • Titrate oxygen to maintain an SpO2 level of 94% or higher.
    • Assess circulation:
      • Assess pulse.
      • Manage profuse bleeding using appropriate methods (e.g., direct pressure, wound packing, hemostatic gauze, tourniquet, or junctional tourniquet).
      • Assess skin color, temperature, and capillary refill.
    • Assess disability:
      • Assess pulse, motor, and sensory function in all extremities.
      • Assess Glasgow Coma Scale (GCS) for trauma patients.
      • Determine the need for Spinal Motion Restriction.
    • Assess exposure:
      • Remove clothing as necessary to assess patient's injuries, considering the patient's condition and environment.

    Clinical Priority

    • Assign a clinical priority:
      • Priority 1: Critically ill or injured patients requiring immediate attention.
      • Priority 2: Less serious conditions yet potentially life-threatening, requiring emergency medical attention.
      • Priority 3: Non-emergent conditions requiring medical attention but not on an emergency basis.
      • Priority 4: Does not require medical attention.

    Treatment Protocols

    • Refer to all appropriate protocols.
    • Patients who have had an impaled conducted electrical weapon used on them will be transported to the nearest appropriate facility without dart removal.
    • Clinicians may assist the patient or primary caregiver in administering prescribed rescue medication.
    • For patients with fever documented by EMS as greater than 100.4°F (38°C), clinicians may treat with acetaminophen.

    History and Physical Examination/Assessment

    • Conduct a focused examination/detailed examination/ongoing assessment.
    • Collect and transport documentation related to the patient's history.
    • Obtain a contact telephone number for one or more individuals who have details about the patient's medical history.

    Communications

    • Hospital notification:
      • A brief communication to the ED for notification of an inbound patient.
      • All Priority 1, Priority 2, and Specialty Alert patients require hospital notification via EMRC.
    • Medical consultation:
      • A bi-directional communication via EMRC between an authorized hospital-based physician and prehospital EMS clinician.
      • Obtain medical consultation when required by a specific protocol or when a clinician has reached the end of their therapeutic or diagnostic capabilities.

    Destination

    • Priority 1 patients shall be triaged to the closest appropriate hospital-based emergency department, designated trauma, or designated specialty referral center.

    • Priority 2 patients shall be triaged to the closest appropriate hospital-based emergency department, designated trauma, or designated specialty referral center unless otherwise directed by EMS system medical consultation.

    • Stable Priority 3 or 4 patients who do not need a time-critical intervention may be transported to the local emergency department or freestanding emergency medical facility.### General Patient Care

    • Receiving hospital notification of suspected PUI patients should be done as early as possible to allow hospital staff to prepare.

    Transport Priorities

    • For Priority 2 and Priority 3 patients not meeting specialty center destination care protocol, EMS clinicians should ask if the patient has had a hospital admission within the last 30 days.
    • If the patient has had a hospital admission within the last 30 days, transport them to that hospital as long as it's not more than 15 minutes further than the nearest hospital.

    Mode of Transport

    • Medevac patients with indications for specialty referral center should be flown to the appropriate type of specialty center if not more than 10-15 minutes further than the closest trauma center.
    • Consider using a helicopter when the patient's condition warrants transport to a trauma or specialty referral center and would result in a clinically significant reduction in time compared with driving.
    • All requests for scene helicopter transports should be made through SYSCOM.

    Helicopter Transport

    • If the time of arrival at the trauma or specialty referral center via ground unit is less than 30 minutes, there is generally no benefit in using a helicopter.
    • Refer to the Trauma Decision Tree when considering use of aeromedical transport.
    • Provide SYSCOM with the patient's category (Alpha, Bravo, Charlie, or Delta).

    Patient Categories

    • Pediatric Trauma Patients: Indications as per the pediatric section of the Trauma protocols.
    • Spinal Trauma Patients: Indications as per Spinal Motion Restriction protocol.
    • Burn Patients: Indications as per Burn protocol.
    • Hand Injury Patients: Indications as per Hand Trauma protocol.

    Status Evaluation

    • Evaluate the need for emergent versus non-emergent transportation.
    • Do not wait on-scene for advanced life support.
    • Attempt to rendezvous en route to the hospital.

    Transfer of Care/Rendezvous

    • The ALS clinician-patient relationship is established when the ALS clinician initiates patient assessment, administers ALS medication, or performs an ALS procedure.
    • ALS clinicians may only terminate their EMS clinician-patient relationship when they are assured that the patient will continue to receive care at the same or greater level.

    Documentation

    • A Patient Care Report (PCR) will be completed and delivered to the receiving facility as soon as possible.
    • If this is not immediately possible, clinicians must provide documentation of the patient's prehospital care on a template and in a format provided or approved by MIEMSS.

    Confidentiality

    • Patient confidentiality must be maintained at all times.

    Professional Conduct

    • All patients should be treated with dignity and respect in a calm and reassuring manner.

    History and Physical Examination

    • Detailed and ongoing assessments are necessary for general patient care.

    Triage Algorithm

    • START triage algorithm is used to assess patients.
    • JumpSTART triage algorithm is used for pediatric patients.

    Critically Unstable Patients

    • Indications for critically unstable patients include:
    • New onset altered mental status
    • Airway compromise
    • Acute respiratory distress
    • Signs of poor perfusion
    • Any other patient judged by the clinician to be in extremis or at risk for deterioration to cardiac arrest
    • BLS treatments for critically unstable patients include:
    • Ceasing all efforts at patient movement
    • Obtaining a complete patient assessment
    • Controlling life-threatening external hemorrhage
    • Managing the patient's airway and ventilation
    • ALS treatments for critically unstable patients include:
    • Initiating ETCO2 monitoring
    • Obtaining 12-lead EKG
    • Obtaining vascular access and supporting perfusion with IV fluids and vasopressors as indicated.

    General Patient Care

    • The General Patient Care section applies to all patient encounters unless otherwise noted in a specific treatment protocol.
    • Response to patient encounters involves:
      • Reviewing dispatch information and selecting an appropriate response
      • Considering Body Substance Isolation (BSI) and Personal Protective Equipment (PPE) at the scene
      • Evaluating scene safety and determining the number of patients
      • Considering the need for additional resources

    Patient Approach

    • Determine the Mechanism of Injury (MOI) or Nature of Illness (NOI)
    • Initiate triage and Mass Casualty Incident (MCI) procedures if necessary

    Initial Assessment

    • Rapidly develop a general impression of the patient on first contact
    • Identify critically unstable patients:
      • New onset of altered mental status
      • Airway compromise
      • Acute respiratory distress
      • Signs of poor perfusion
      • Other patients judged to be in extremis or at risk for deterioration to cardiac arrest
    • Stop all movement and do not initiate transport if a critically unstable patient is identified
    • Proceed to the Critically Unstable Patient Protocol immediately

    Assessment

    • Assess mental status:
      • Alert
      • Responds to verbal stimuli
      • Responds to painful stimuli
      • Unresponsive
    • Assess airway:
      • Stabilize cervical spine when appropriate
      • Open and establish airway using appropriate adjunct
      • Place patient in appropriate position
      • Suction airway as needed
    • Assess breathing:
      • Determine if breathing is adequate
      • Assess oxygen saturation (SpO2) with pulse oximeter
      • Provide assistance with 100% oxygen using Bag-Valve-Mask (BVM) if necessary
    • Assess circulation:
      • Assess pulse
      • Assess for and manage profuse bleeding
      • Assess skin color, temperature, and capillary refill
      • Initiate cardiac monitoring as appropriate
    • Assess disability:
      • Assess pulse, motor, and sensory function in all extremities
      • Assess GCS for trauma patients
      • Determine the need for Spinal Motion Restriction

    Exposure

    • Assess patient's injuries and remove clothing as necessary

    Clinical Priority

    • Assign clinical priority based on the patient's condition:
      • Priority 1: Critically ill or injured patients requiring immediate attention
      • Priority 2: Less serious conditions yet potentially life-threatening
      • Priority 3: Non-emergent conditions
      • Priority 4: Does not require medical attention

    Treatment Protocols

    • Refer to all appropriate protocols
    • Patients with impaled conducted electrical weapon darts will be transported to the nearest appropriate facility without dart removal
    • Clinicians may assist patients or primary caregivers in administering prescribed rescue medications
    • For patients with fever, clinicians may treat with acetaminophen

    History and Physical Examination/Assessment

    • Conduct a focused examination/detailed examination/ongoing assessment
    • Collect and transport documentation related to patient history
    • Obtain and document a contact telephone number for individuals with details about the patient's medical history

    Communications

    • Hospital notification: A brief communication to the ED for notification of an inbound patient
    • Medical consultation: A bi-directional communication via EMRC between an authorized hospital-based physician and prehospital EMS clinician
    • If medical consultation is unavailable, clinicians shall proceed with additional protocol-directed care

    Reassessment

    • Reassess unstable patients frequently (recommended every 5 minutes)
    • Reassess stable patients at a minimum of every 15 minutes

    Disposition

    • Priority 1 patients shall be triaged to the closest appropriate hospital-based emergency department or designated trauma or specialty referral center

    • Priority 2 patients shall be triaged to the closest appropriate hospital-based emergency department or designated trauma or specialty referral center

    • Stable Priority 3 or 4 patients may be transported to the local emergency department or freestanding emergency medical facility### General Patient Care

    • Receiving hospital notification of suspected PUI patients should be done as early as possible to allow for hospital staff to prepare.

    Priority 2 and 3 Patients

    • For patients not meeting a specialty center destination care protocol, EMS clinicians should ask if the patient has had a hospital admission within the last 30 days.
    • If the answer is yes, the EMS clinician should transport the patient to that hospital as long as it's not more than 15 additional minutes further than the nearest hospital.

    Mode of Transport

    • Medevac patients with indications for specialty referral center should be flown to the appropriate type of specialty center if not more than 10-15 minutes further than the closest trauma center.
    • Consider utilizing a helicopter when the patient's condition warrants transport to a trauma or specialty referral center and would result in a clinically significant reduction in time compared to driving.
    • All requests for scene helicopter transports should be made through SYSCOM.
    • For Trauma Decision Tree category Charlie or Delta, receiving trauma center medical consultation is required when considering whether helicopter transport is of clinical benefit.

    Time of Arrival

    • If the time of arrival at the trauma or specialty referral center via ground unit is less than 30 minutes, there is generally no benefit in using a helicopter.

    Special Patient Considerations

    • Pediatric Trauma Patients: Indications as per the pediatric section of the Trauma protocols.
    • Spinal Trauma Patients: Indications as per Spinal Motion Restriction protocol.
    • Burn Patients: Indications as per Burn protocol.
    • Isolated burn patients without airway injury or other associated trauma should normally be flown to a burn center, regardless of the location of the closest trauma center.
    • Hand Injury Patients: Indications as per Hand Trauma protocol.
    • Medevac patients with appropriate indications for hand center referral should normally be flown to the hand center, regardless of the location of the closest trauma center.

    Status Evaluation

    • Evaluate the need for emergent versus non-emergent transportation.
    • Do not wait on-scene for Advanced Life Support; attempt to rendezvous en route to the hospital.

    Transfer of Care/Rendezvous and Transition of Patient Care

    • ALS clinicians may only terminate their EMS clinician-patient relationship when they are assured that the patient will continue to receive care at the same or greater level, or when they have documented with on-line medical direction that the patient's condition has improved.
    • BLS clinicians have the right to decline the transition of patient care.

    Documentation

    • A Patient Care Report (PCR) will be completed and delivered to the receiving facility as soon as possible, ideally upon transfer of care.
    • If this is not immediately possible, clinicians must provide documentation of the patient's prehospital care on a template and in a format provided or approved by MIEMSS for inclusion in the patient care record before leaving the receiving facility, then deliver the completed PCR within 24 hours after dispatch.

    Confidentiality

    • Patient confidentiality must be maintained at all times.

    Professional Conduct

    • All patients should be treated with dignity and respect in a calm and reassuring manner.

    History and Physical Examination

    • General Patient Care involves taking a detailed history and performing a thorough physical examination.

    Detailed and Ongoing Assessments

    • Perform detailed and ongoing assessments of the patient's condition.

    START Triage Algorithm

    • Use the START Triage Algorithm to assess the patient's condition and prioritize care.

    JumpSTART Triage Algorithm

    • Use the JumpSTART Triage Algorithm for pediatric patients.

    Critically Unstable Patients

    • Identify patients who are in extremis or at risk for deterioration to cardiac arrest.
    • Indications for critically unstable patients include:
      • New onset altered mental status (AVPU – not alert)
      • Airway compromise
      • Acute respiratory distress
      • Signs of poor perfusion
      • Any other patient judged by the clinician to be in extremis or at risk for deterioration to cardiac arrest

    Triage Algorithm

    Triage Categories

    • Immediate (Red): Life-threatening injuries/conditions requiring immediate attention, e.g. severe bleeding, breathing difficulties, cardiac arrest
    • Delayed (Yellow): Serious injuries/conditions requiring prompt attention, but not life-threatening, e.g. broken bones, severe lacerations
    • Minor (Green): Non-life-threatening injuries/conditions treated on a non-urgent basis, e.g. minor lacerations, sprains
    • Expectant (Black): Injuries/conditions unlikely to survive even with immediate medical attention, e.g. severe head trauma, catastrophic injuries

    Triage Process

    Prioritization

    • Primary triage: Initial assessment and categorization of patients based on severity of injuries/conditions
    • Secondary triage: Re-assessment of patients after initial treatment to re-prioritize and allocate resources
    • Re-triage: Ongoing reassessment of patients to adjust priorities and resource allocation as needed

    Emergency Response

    Scene Management

    • Scene safety: Ensuring safety of responders and patients at the scene of the emergency
    • Patient extraction: Safely removing patients from the scene and transporting them to a medical facility
    • Communication: Coordinating with emergency services, hospitals, and other responders for effective response and resource allocation

    Patient Assessment

    Initial Assessment

    • Primary survey: Initial assessment of patient's airway, breathing, circulation, disability, and exposure (ABCDE)
    • Secondary survey: Detailed physical examination and medical history to identify all injuries or conditions
    • Vital signs: Monitoring patient's vital signs (e.g. pulse, blood pressure, respiratory rate) to track changes and prioritize care

    Resource Allocation

    Resource Management

    • Resource matching: Allocating available resources (e.g. personnel, equipment, transportation) to meet needs of prioritized patients
    • Resource optimization: Managing resources for efficient use of available assets
    • Dynamic resource allocation: Continuously reassessing and adjusting resource allocation to respond to changing patient needs and priorities

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    Description

    This quiz covers the general patient care protocols for emergency medical technicians, including response, scene arrival, and patient approach.

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